By Mike Stephens
Retired CEO, Hoag Memorial Hospital Presbyterian
Several weeks ago I tuned into “The News Hour” on my local PBS channel. T.R. Reid, a longtime correspondent for The Washington Post, was discussing his recently published book, “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care.” He recounted the global quest he had undertaken to study healthcare systems in other counties in the hope of identifying what could be learned from these countries to help improve healthcare in the United States.
When Reid was asked what he had observed that would be of greatest value in the current healthcare reform debate, he didn’t point to any particular feature of any country’s healthcare system, but referred to the term solidarity, which characterizes the moral foundation of all the industrialized nations he visited.
He defined solidarity as a universal belief that all of a nation’s people should have equal access to basic rights, including the right to equal access to medical care. Reid went on to explain that by defining this basic right, the citizens of the countries he visited shared a common purpose in working together to make the difficult decisions necessary to make this principle a reality.
Of particular interest is Reid’s discussion of a 1994 national referendum when voters in Switzerland voted to change the entire healthcare system from one resembling that in the United States to one modeled after those in other European countries.
Reid mentions that Switzerland decided that society has an ethical obligation to ensure everybody access to medical care when it’s needed. Switzerland’s national debate was waged largely around ideals including equal treatment for everyone, we’re all in this together, and fundamental rights rather than around commercial implications for the healthcare industry.
Our country has entered into the monumental healthcare reform debate without having attempted to answer a basic ethical and moral question: Is equal access to healthcare a basic human right?
By not having done so, we have pitted those who currently possess health insurance coverage against those who do not. We give those who see the debate as an opportunity to foster political partisanship the chance to undermine the reform effort for political objectives.
If we can learn anything from the experience of other countries, it is that sharing a common set of ideals and beliefs regarding the moral and ethical right to healthcare is necessary to ensure the success of any healthcare reform.
November 16th, 2009 at 10:24 pm
I was in sweden a few years ago and spent a week looking at various aspects of their health system. The term “Solidarity” came up over and over again. As Mike said, it is a commitment to the whole, the well being of the nation. Our culture of individuality is a hugh barrier to this kind of social commitment to the health of all. I believe that a balance of both ideals is possible, but extremists on both ends make it very difficult.
November 17th, 2009 at 9:05 am
I believe the debate goes further than just healthcare. We have two additional complications that we are unwilling to address. The basic welfare system and our lack of willingness to limit or incentivize people to grow beyond their dependence on it. Also we have not been able to address illegal immigrants which have put a hugh load and stress on the delivery of healthcare especially in some parts of our country. I would assume that both of those issues have been addressed in both of those counties thus making it much more manageable to implement healthcare reform.
November 17th, 2009 at 2:04 pm
I completely agree - the conversation must be taken to the moral level.
Indeed, we have wasted a tremendous amount of time debating socialized medicine from the practical context without thoroughly considering the more fundamental moral context. Socializing medicine is wholly impractical precisely because it is fundamentally immoral.
Any immoral action, regardless of motive or intent, will result in inevitably impractical consequences.
Examining the fundamental premise, a supposed right to healthcare, provides an absolutely reliable indicator of what any action based upon it would achieve.
There is no right to healthcare, access to healthcare or any other trendy denoting the practice of forcing one individual to provide any service to another – period. Accordingly, any system built to facilitate such a repulsive notion can only lead to disastrous results.
A right which imposes an active obligation (meaning it requires action, as opposed to requiring abstinence from action) on another individual is a blatant contradiction.
To suggest that an individual has a right to healthcare is to suggest they have a right to a portion of another individual’s life, liberty, or property – commonly referred to as slavery.
The purpose of government is to protect individual rights, not violate them by redistributing income or nationalizing an industry. The sooner our culture recognizes this principle - the founding principle of America - the sooner we can stop bickering about superficial details pertaining to how our particular form of fascist/socialist medicine will work (ignoring history, logic and economics), and start talking about the real solution – establishing a complete separation of state and medicine.
I applaud the author for recognizing the proper focus for this conversation.
November 17th, 2009 at 5:22 pm
Mr. Harper’s comments are an honest statement of a position that many
American’s take on healthcare. I think, however, we have already passed the moral judgement. If healthcare is not a right we should deny care to those who are uninsured or irresponsible or incompetent in their ability to access care. As a nation we will not tolerate letting people be harmed or die because of their individual situation. I believe that is the higher moral ground. Let’s learn to live with it and structure a system to reflect reality.
November 18th, 2009 at 2:15 pm
Mr. Freeman, while I admire your push for expediency, if it were that simple - if all we had to do was democratically concoct some magical new entitlement right and build a system based on such - then a Socialist medicine utopia would already exist and thrive today. Instead, with every step towards Socialization, we see an increasingly failing market plagued by self-inflicted and debilitating dysfunction.
The reason it’s not that easy is because taking from one individual by force and giving to another is theft, no matter how we sugar-coat it, how good it makes us feel about ourselves, and regardless of the underlying intentions. Neither the fact that it may be fueled by good intentions, nor that the consensus agrees, changes the reality of that premise.
One cannot just gloss over the fact that a supposed “right to care” implies the initiation of force against innocent citizens, and then assume that such an action will be implemented without repercussions because we can somehow rationalize it as moral.
The notion that based merely on the fact that an individual is alive, that he exists within some geographic boundary, and that he is “in need” entitles him to a portion of another individual’s property is ridiculous by any objective evaluation. Need is not a valid claim on the life of another. The absurdity of rationalized theft somehow being a moral premise is self-evident.
“If healthcare is not a right we should deny care to those who are uninsured or irresponsible or incompetent in their ability to access care.”
I absolutely agree. Those in this situation would need to rely on friends, family and private charity.
“As a nation we will not tolerate letting people be harmed or die because of their individual situation.”
The problem is that neither you nor any other individual has the right to make that decision for me. If the care for others is a conviction you hold passionately, you’re free to steward your own resources towards that goal. When you hire Government to enforce that conviction on me, you’ve abandoned the realm of ethics. Not only are you violating my rights to property, but also violating the rights of every citizen involved in the market, not to mention the fact that in the process you’re also destroying the field of medicine.
“I believe that is the higher moral ground.”
Based on what grounds? Again, such a belief is adequate in itself so long as the person holding it is the only one responsible for fulfilling its adherence. Once you oblige others to be financially responsible for your belief, you should be willing to justify it and they should be free to voluntarily support you.
“Let’s learn to live with it and structure a system to reflect reality.”
We learn to live with metaphysical facts, i.e., things we cannot change. Granting one man the privilege to be supported by another is a man-made scenario – one that we certainly can and should avoid. Reality in this context is abundantly clear – freedom is the founding essence of this country, freedom is the aspect that brought American medicine to the forefront, freedom is the source of creativity, innovation and prosperity, freedom is precisely what we stand to lose under socializing this and any market, freedom is the only way to salvage American medicine.
Just for the sake of argument, let’s assume the “right to care” is legitimate and should be the primary axiom on which we’ll implement a market. From an economic perspective, such a market would consist of objective entities (private or semi-private businesses and self-sufficient customers) and non-objective entities (publicly funded organizations and dependent customers) - objective meaning the entity is subject to the laws of economics.
The results will be disastrous for the following reasons:
1) Dependent customers will consume more (and less diligently) than they would if they were self-sufficient. When consumption is decoupled from financial responsibility it will increase. Within only a few years, the cost of Medicare was many times over the estimates. Hospital expenditures grew 23% from 1965-1970*.
2) Artificially increased consumption requires more funding. There is a limit to the amount of income that can be redistributed, so costs will eventually need to be controlled. This is why the DRG system was implemented. When Government, a non-objective entity in the market, controls costs, they do so by force, not by the mechanism inherent to a free-market – voluntary choice. Force means regulations, which inevitably breed more regulations recursively.
3) Artificially increased demand raises costs. This exacerbates reason #2. When costs exceed the amount the non-objective entity will pay, the difference is recouped by objective entities in the market, i.e. self-sufficient consumers. When the DRG system was piloted before implementation, the results were obvious. The only Hospitals that reduced costs were those with the highest percentage of indigent liabilities*. They reduced costs by driving up costs for everyone else – sounds familiar. Today we see those same results with dramatically increased insurance premiums which result from Hospitals recouping their losses from dealing with the non-objective (forceful) entity. The bottom line is the market is systematically structured (by intention) to force one segment of the population (the minority) to cover the costs of another (the majority). As that minority shrinks, and the government continues to enforce more onerous regulations to keep the scheme afloat, the costs to that minority will continue to escalate rapidly. The sad aspect is that those costs are inevitably blamed on the “free” market.
4) The non-objective entity drives out objective entities. The former, which benefits from being exempt from economic laws because it’s immune to customer satisfaction, drives out the latter, which most certainly are subject to customer satisfaction, limited funding and supply and demand. Once the objective entities are out of business, the only entity left is the coercive monopoly of Government – which exists not by the natural objective forces of the market, not because of its efficiency and innovation – because it effectively held a gun to everyone’s head to enforce compliance.
5) Increased regulations and diminished incentive for profit stifle competency and competitive innovation. This is the most devastating result of Socialist medicine. When providers are saddled with obligations other than what a free market would demand, i.e., those that pertain to innovation, value and customer service, then each of those things stand to suffer.
Currently, providers have to consider every action not in the proper context of providing valuable and innovative care (including the incentive for profit when those two goals are achieved), but in the distorted context of state boards, politicians, lobbyists, HMO administrators under the influence of politicians and lobbyists, a predatory legal system just itching to launch a malpractice suit, and a host of other stipulations that should never even enter the equation.
Essentially, care and insurance providers are wrangled by an incalculable number of government-based influences – each of which diverts their time, energy, expertise and passion from focusing on the proper priorities. This is exactly why the thought of even more government involvement in healthcare, especially full socialization, is the most intimidating possibility this country has ever faced. These trends don’t merely lower quality and raise costs now; they maim the entire field indefinitely. The most talented experts will shy away from such a system. Not only does every single regulation have economic impact, it also has a psychological impact – great minds don’t work under compulsion, and the type of man who will is not the one I want performing my triple-bypass.
6) The long term economic impact will be tremendous. We’ll never know how much more healthcare costs now after 40+ years of government meddling. How many brilliant doctors, biologists, chemists and entrepreneurs get out of the field of medicine because they don’t want to deal with the bureaucratic overhead, the insane malpractice insurance costs, or the decreasing salaries? How many brilliant kids are now rethinking their lifelong passion to be a doctor because the history of every socialized market speaks so clearly for itself? How many discoveries aren’t made because enormous levels of welfare-state taxes have sucked research funding dry? How many innovative treatments fail to make it through the 7-10 years and 7-10 *BILLION* dollars it takes to make it through the FDA? How many of those treatments fail to make it through the FDA because .05% of the patients in trial suffered complications? Would those odds matter to an individual looking to remedy their symptoms? Shouldn’t an individual be able to decide to take their chances with experimental drugs? How many people die because the FDA takes that decision making power away? By what right should government be able to tell me what I can and cannot put into my own body? All of these questions arise from the seemingly harmless notion that individuals have a right to healthcare.
Until these aspects can be accounted for (which could only be achieved by some tremendous manner of overriding fundamental laws of economics, human nature and justice) a prosperous, long-term implementation of Socialist medicine cannot be achieved.
In fact, the only alternatives are a free market in medicine (prosperity, increased quality/duration of life and most importantly justice) or a completely socialized “market” (stagnation, reduced quality/duration of life, and wholesale violation of the rights of every citizen involved). Any mixture of the two is only a short-term balancing act leaning heavily towards full socialization.
America has to make a decision – are we willing to completely destroy a market (likely including the lives of our loved ones) in the futile attempt to cheat reality based on vague collectivist ideals? It certainly looks like it.
(I’m guessing I’ve just about worn out my welcome here. I’ve addressed just about every aspect of this debate in this and my previous comments, so this will be my last contribution to the blog. I appreciate the opportunity to voice my opinion on your property.)
November 18th, 2009 at 2:18 pm
(sorry, forgot to add my references…)
1. Economic Research on Direct-Purchase Health Insurance: New Models for Real Health Care Reform - http://www.econlib.org/library/Columns/y2009/Gormanhealthinsurance.html
2. Lessons From New Jersey - http://content.healthaffairs.org/cgi/reprint/5/2/32.pdf