I Guess I'm Not... HUMAN

Normally I don't comment over at Markadelphia's blog. He does enough of that here, but yesterday I couldn't resist. Read his very short post, Yep.

I was the first to comment:

Great! Let him and his organization provide that coverage, and let's see how long he and his organization stay in business.

Health care is not a RIGHT.

There were, of course, responses to that, but here's the one I'm going to respond to with an Überpost:

blk said...

From the preamble to the Constitution:

We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.

A basic education is a right in this country. It wasn't always. Most people would agree that protection by the fire and the police departments is a right. It wasn't always that way.

Why isn't health care a right? What else would promote the general Welfare of our population than ensuring that everyone has a long and healthy life? What could be more Just than making sure that every child, worker and elderly person can see a doctor when they're sick?

National health care would promote domestic Tranquility by giving everyone peace of mind, knowing that if their kid comes down with some awful disease they can get treatment. If you have cancer, the emergency room just ain't gonna cut it.

To enjoy the Blessings of Liberty you have to be alive. Many people die in this country because they don't have health care.

We are a rich country. As we've become wealthier and as technology and science have advanced the notion of what is a right has changed. Now that we can afford them, education, police and fire protection are rights. The way health care costs are exploding, we are going to go bankrupt. We have to change the way the system works to reign in costs. By covering everyone we can make it cheaper for each person. When everyone is covered and everyone is paying, we'll finally have the leverage we need to prevent the explosive rise in costs.

That will mean squeezing out unnecessary middlemen who get between you and your doctor. The most expensive and least useful middlemen are insurance industry execs. By eliminating them we can squeeze literally billions of dollars from health care overhead (health care company execs pull in salaries, bonuses and options in the range of tens of millions, to hundreds of millions to a billion dollars).

Where to begin? Why, at the beginning!

A basic education is a right in this country. It wasn't always.

No, indeed it was not. Back when I started this blog, one of the very first posts I published was an essay entitled What is a "Right"? That essay has, over the years, drawn a lot of commentary and inspired a six-part exchange with a professor of mathematics on just that very topic. (Check the left sidebar if you want to read the whole discussion. I recommend it.) The original essay was written to win me a year's membership at AR15.com, and that contest required that I limit myself to, I think, 800 words, but the core point of the essay was this:

A "right" is what the majority of a society believes it is.

That's the pragmatist in me coming out. What people believe is a "right" they will agitate for and defend against encroachment. Conversely, if they don't believe, they won't defend. Is universal education really a "Right"? Philosophically, no, it's not, but we've had it hammered into us for so long the majority believes it is. They believe that it is the job of the government to educate our children to the point that many parents no longer take any responsibility for that education on themselves, and don't pay any attention to what their children learn (or don't) while those children spend six to eight hours a day under the control (or not) of our public education system.

I'll come back to that.

Most people would agree that protection by the fire and the police departments is a right. It wasn't always that way.

Obviously I'm not "most people." I know better. I've lived where residents had to pay a local private fire company to get them to come to their homes if there was a fire. If they chose not to pay, the firefighters could choose not to come. Or if they did, the homeowner would get a big damned bill for their appearance afterward that would represent a lot more than a few years of subscription to their services. If the homeowner chose not to pay that bill, they'd be taken to court.

Does that sound like a "right"?

I also understand that I have no "right" to police protection. That happens to be just one of many reasons I'm an activist for the right to arms. As I said, I'm a pragmatist. I try to deal with the way the world works rather than how people think it ought to be. And given your assertion that police protection is a "right," you ought to read both pieces of that essay. You might be surprised.

Why isn't health care a right? What else would promote the general Welfare of our population than ensuring that everyone has a long and healthy life? What could be more Just than making sure that every child, worker and elderly person can see a doctor when they're sick?

Let's take these one at a time, because they're not a set. This is a textbook example of argumentum ad consequentiam - the proposition that belief in X will lead to good consequences, therefore X is good.

Why isn't health care a right? For the same reason having a fire engine show up at your door in the event of a fire isn't a right - it demands that someone else do something for you. One thing I try to do with this blog is make sure that if someone can say something better than I can, I let them. Let me quote Dr. Pat Santy, a psychologist and MD on the topic:

Let me be clear. I don't believe that people have a "right" to health care; because, what advocating such a "right" basically means is that you believe you have a "right" to my mind; you have a "right" to my professional competence; i.e., you have a "right" to enslave me.

In that six-part series on 'What is a "Right"?', I concluded that there is only one fundamental right, and all others are corollaries of it, but one defining factor is that YOUR rights end when they require DEMANDING something of another. That's the idealist in me.

And I'm able to tell the difference between idealism and pragmatism.

What else would promote the general Welfare of our population than ensuring that everyone has a long and healthy life? Excuse me? Everyone? What do you do with the chronically ill? The disabled? The terminally ill? Define "long" and "healthy." Who gets to be the arbiter of what is and what isn't a "long and healthy life"? You? Or some bureaucrat? You're postulating a utopian outcome as achievable fact when it is obviously fantasy.

What you're doing is appealing to emotion: "Wouldn't it be wonderful..." Why yes, it would. But back to reality. Life doesn't work that way, Sparky. Some people get roses, some get fertilizer. Wishing it weren't so won't make it not so. If you are incapable of dealing with what is, you shouldn't be advocating change.

What could be more Just than making sure that every child, worker and elderly person can see a doctor when they're sick? And they can't? This is Argumentum ad Misericordiam - the appeal to pity. Let me quote the author of the blog Bloodletting, an up-and-coming doctor now doing his residency training, from a post he wrote in 2004 back when Bush was pushing for expanded Medicare drug prescription entitlements. Fisking Nancy Pelosi's response to a Bush speech:

HEALTH CARE AND MEDICARE PRESCRIPTION DRUGS

Third, our "opportunity society" is built on the belief that affordable, available health care is not a luxury, but a basic foundation of a truly compassionate society. [OK, now we are going to get into the real nitty-gritty about the difference between "want" and "need." Healthcare is denied to nobody. NOBODY. Nobody is denied a ferrari, either, but most people do not want to spend the money on one.]

This is from a man in the system, providing that care - what Markadelphia calls "a primary source." And let's stop playing semantic games. What you're advocating is universal health care insurance - the method of paying for health care. If health care is a right, why should anyone have to pay? What we're debating about here is the level of that care and its cost. I'll come back to this, too.

Next up, National health care would promote domestic Tranquility by giving everyone peace of mind, knowing that if their kid comes down with some awful disease they can get treatment. If you have cancer, the emergency room just ain't gonna cut it. I'm tempted, but let's wait until I come back to the "level of care" question.

To enjoy the Blessings of Liberty you have to be alive. Many people die in this country because they don't have health care. No, they may die because they don't have sufficient or sometimes competent health care, but health care is available. If you're deathly ill and call 911, an ambulance will come, an EMT will examine you, you will be transported to a hospital, and (assuming you live long enough) you will get looked at by a doctor, and probably admitted somewhere. Might be a crappy hospital, might not be enough to save you, but it's a lot more than our Founders got when they wrote the Constitution you quoted.

Now to the meat of it.

We are a rich country. Well, I'd say we were a rich country, but not any more. You are aware of the thing called "the national debt"? As of Monday the Treasury reports that our national debt was $11,919,879,121,739.54. That's $11.9 trillion dollars. That's the total of what the government has spent in excess of its income and not paid off. Per the CIA World Factbook the 2008 US GDP - defined as "the sum value of all goods and services produced in the country valued at prices prevailing in the United States" - was $14.26 trillion. On Sept. 30, 2008 (end of the 2008 fiscal year) the national debt was $10,024,724,896,912.49. According to this site, the total federal income in 2008 through taxes, fees, etc. was $2.524 trillion, or a mere 17.7% of GDP, and each and every year our federal government spends several hundred billion dollars more than it takes in - thus making the national debt ever larger.

Are we a "wealthy nation" or are we a debtor nation, living on money we don't have? Could you run your household that way? Can you spend, each and every year, more money than you earn, borrowing to make up the difference? EVERY year? Do you owe more than five times your annual income to creditors?

As we've become wealthier and as technology and science have advanced the notion of what is a right has changed. That's the only thing you've said that I agree with without reservation. We certainly have "advanced the notion," but that doesn't change the reality. As we've changed the notion of what is a right, we've spent ourselves into the poor house. "Entitlement" spending - and "health care" is just an expansion of entitlement spending - makes up about 45% of the federal budget now. (PDF)

Now that we can afford them, education, police and fire protection are rights. Really? Police protection isn't a right. The courts say so. Fire protection isn't a right. Education isn't a right either, but I will agree that the majority certainly believes that it is.

But can we still "afford" it? I invite you to read The George Orwell Daycare Center. Pack a lunch.

The way health care costs are exploding, we are going to go bankrupt. Regardless of what health care costs do, we are going bankrupt. All you have to do is look at the numbers to see that.

We have to change the way the system works to reign in costs. Who's this "we"? You want the government to do it, no? An army of bureaucrats appointed by our elected officials. Lots of GSA employees with great benefit packages, administering health care claims or monitoring those evil health insurance companies to ensure no one (especially Uncle Sugar) gets ripped off?

By covering everyone we can make it cheaper for each person. Really? Show me the data. Then explain, using small words, why a healthy 25 year old should be made to pay for the dialysis of an 86 year old (s)he has never met and will never meet? Explain to me how making that healthy 25 year old pay will make it cheaper for him/her.

When everyone is covered and everyone is paying, we'll finally have the leverage we need to prevent the explosive rise in costs. Again, really? Everyone? So you're going to make the poor pay too? I thought the deal was to cover everybody including those who can't pay. Who picks up their tab? I've heard various numbers bandied about, but we'll use 47 million, since that seems to be a popular number. You honestly are going to tell me that adding 47 million people to the health care system is going to make it work better? That it's going to reduce costs? How long does it take for you to get an appointment with your regular doctor, and when you go, how long do you spend in that doctor's actual presence? You're playing in fantasy-land again. It sounds wonderful, but it doesn't pass the smell test.

That will mean squeezing out unnecessary middlemen who get between you and your doctor. And here we go. Who decides who is "unnecessary"? And won't this add to unemployment? Why do those "unnecessary middlemen" exist in the first place? How about this example: What if lawyers had to bill like doctors do? (Stolen without shame from Dr. Westby G. Fisher, MD.)

Beginning July 1, 2010, under the Legal Billing Obfuscation Act of 2009, lawyers will receive their payments for services rendered after approval by a central US government Payment Distribution Authority (USPDA). To receive payment from the Authority plaintiff and defendant complaints must be coded and filed electronically using the International Classification of Legal Complaints, 10th edition (ICLD-10), copyright © 2009, American Bar Association and Legal Proceeding Terminology (LPT) codes, copyright © 2009 American Bar Association. The full publication of each of these codes will be available in print March 1st 2010 and in electronic form on DVD in July 2011.

To familiarize lawyers with the new coding scheme requested by the USPDA, a small sample for the complaint of “Spilling” is shown below:

• Spilling 200
• Spilling, Water – 210
• Spilling, Water, Hot – 211
• with blisters 211.1
• without blisters 211
• Spilling, Water, Warm – 212
• Spilling, Water, Cold – 213
. . .
• Spilling, Coffee - 240.1
• Spilling, Coffee, Hot - 240.11
Spilling, Coffee, Hot, With Cream only - 240.12
• with blisters - 240.121
• without blisters 240.122
• Spilling, Coffee, Hot, With Regular Milk only – 240.13
• Spilling, Coffee, Hot, With 2% milk only – 240.14
• Spilling, Coffee, Hot, With Skim Milk – 240.15
• Spilling, Coffee, Hot, With Soy milk only 240.16
• Spilling, Coffee, Hot, With Sugar only - 240.17
Spilling, Coffee, Hot, With Artificial Sweetner (of any type, including, but not limited to Nutrasweet, Splenda, Sweet ‘n Low) – 240.18
• Spilling, Coffee, Hot, With Cream and Sugar 240.16
. . .

Pairing of improper complaint codes with legal proceeding codes will result in non-payment. “Up-coding” of legal proceedings shall constitute grounds for prosecution with some additional fines imposed by the IRS, as determined by the Office of Health and Human Services. For instance, pairing a legal complaint of “Spilling, Coffee, Hot, with blisters” to and of those of Divorce, same gender, living apart, male (or female) (shown below) will result in non-payment.

• Divorce: 100-199
• Between husband and wife 100.1
• Between same gender couple, living together, male, 100.011
• Between same gender couple, living together, female, 100.012
• Between same gender couple, living apart, male, 100.021
• Between same gender couple, living apart, female, 100.022
. . .

Valid code pairings for spillage include Accident codes (0010-0059), Assault codes (4400-4499), or Battery codes (5500-5599) provided documentation supports the requests for payment.

You're talking about adding another layer of government oversight to a system already buried under paperwork. You won't be "squeezing out unnecessary middlemen," you'll be replacing them with government drones. Yet you think that will make the system more efficient?

What planet do you live on, because it isn't mine.

And, finally: The most expensive and least useful middlemen are insurance industry execs. By eliminating them we can squeeze literally billions of dollars from health care overhead (health care company execs pull in salaries, bonuses and options in the range of tens of millions, to hundreds of millions to a billion dollars). Ah, yes: Argumentum ad Invidiam, the appeal to envy.

Total health care expenditures in fiscal year 2009 are estimated to reach $2.5 trillion, according to the National Coalition on Health Care. (Edit: Did, in fact, reach $2.6 trillion in 2009 according to this site.) According to Crooks and Liars, the compensation of the top 10 highest-paid insurance company CEOs totals out to $85,429,970. Assuming the top 100 insurance company executive's compensation is ten times that amount, you're still looking at less than a billion dollars total. Hell, lets assume that the top 1,000 is 100 times that amount, you're looking at $8,542,997,000 You're talking about cutting - at most - 0.3% of total expenditures, even if you don't include what the government employees that replace them will cost.

Whoopee-fucking-doo.

Halving total health care expenditures would increase that savings to a whopping 0.6%! Be still my beating heart! But by G*d those greedy fucking fat-cat executives won't have three vacation homes!

You believe that everyone should have a right to health care. How noble of you! Another example of self-congratulations as a basis for social policy. You asked, What could be more Just than making sure that every child, worker and elderly person can see a doctor when they're sick? You're concerned about Justice? OK, here are some questions for you: How much health care is "Just"? Who decides, and on what basis? Is it "Just" that someone who can afford to pay gets more care than someone who would be dependent on government provided insurance alone? Or do we "level the playing field" and require everyone to accept the same level of care? Would that be "Just"? Or should everyone get every single bit of care that modern medical science can provide? What would that do to the costs you're so concerned about?

Here's the deal, from my perspective. The government does only two things well: nothing, and overreact. (Thank Congressman Adam Putnam for that pithy observation.) You want the federal government, which took in only $2.54 trillion last year, to expand by another $2.5 trillion, and you expect me to believe that it will do better than what we have now. You honestly expect me to believe that the federal government, currently responsible for the administration of Public Education, Social Security, Medicare and Medicaid, will run America's health insurance system better?

Go ahead, pull my other leg. And read today's Quote of the Day.

Don't deny that what you are advocating is the doubling of the amount of money flowing through Washington D.C. You hold up Education, Policing, and Fire Protection as equivalent "rights" yet all those are all paid for through taxation. You claim that the U.S. is a "rich nation," yet you ignore the fact that at our current level of national debt, every man, woman, and child in the country is on the hook for over $39,000 to pay off that debt - far more, in fact, since we're doing it on time and paying interest.

Do you have a spare $39k laying around? I don't know about you, but my VISA card limit is pretty far below that, and I don't think I could float a loan for it, either. And if 47 million people can't pay for health insurance, how many can pay their portion of the national debt?

You've interpreted the Preamble of the Constitution to require the federal government to do a lot of different things. You're hardly alone. FDR put forth the idea of an Economic Bill of Rights that I'm sure you'd love, but have you read the rest of the original document? It's quite short. As P.J. O'Rourke put it,

The U.S. Constitution is less than a quarter the length of the owner's manual for a 1998 Toyota Camry, and yet it has managed to keep 300 million of the world's most unruly, passionate and energetic people safe, prosperous and free.

That document spells out, with brevity and clarity, how the federal government is arranged, how it is to be staffed, and what the powers of each branch are and are not. As you've noted, the public's perception of what are and aren't "rights" has certainly changed over the years, and I put the blame - yes, blame - on our education system. The founding documents of our nation were based on the idea of limiting how much government could do, both for us and to us, yet we've been taught for decades that it's the job of government to take care of us, that only government is big enough to do certain jobs, that we're not qualified to do things for ourselves. In fact, we should be actively discouraged from doing so.

Alexis de Toqueville wrote long ago, "The American Republic will endure until the day Congress discovers that it can bribe the public with the public's money." Congress discovered that little trick some time back, and the bill is now coming due.

And that's brought us to where we are today, $14-plus trillion in the hole and digging ever faster. Yet you and millions like you want us to redouble our digging in the name of "Social Justice!"

No, health care is not a right. Fire protection is not a right. Police protection is not a right. And pretty damned soon if we don't get our shit in one sock and our heads on straight with the nose in front, just living is going to become damned difficult because Reality won't be ignored forever.

And I guess I'm just not human for realizing and articulating that fact.

(Ah, well, only 3,500 words or so in this one. I may be losing my touch.)

UPDATE: Marko writes on the specifics of why health care is not a right. It is, typical of Marko, crystal clear and precise.