Health reform from my side of the surgery table
Forty years as a surgeon in university and community hospitals gives some authenticity for the following reflections regarding the failings of our health care delivery. Partisan rhetoric has led to shouting matches rather than reasoned choices, while the most fundamental issue in health care reform has yet to be stated: should health care be continued as a profit-driven enterprise? If a problem well-stated is a problem half solved, a clear answer will allow for progress. Here are the some of the problems I have observed:
#10, 13 Bobo:
The problem is that you’re using an antiquated definition of both democracy and republic – the ones used in 1776, which are no longer relevant.
It doesn’t matter what kind of representative structures are used – if the popular vote is the foundation for the formation of a government, it’s a democracy. What slides the scale away from democracy is how impeded the people is in expressing that power. Who can vote and who cannot and for what arbitrary reason? Whom can they vote for, and what restrictions are there in that regard? The structures you’re talking about do not appear on this scale, but are rather governance factors – which can end up in a number of funny combinations of parliamentarism, (con)federalism, etc etc. The main argument against the US being a democracy has nothing to do with the multi-tiered system or the electoral college, and more to do with it essentially being a one-and-a-half-party system that offers little to no choice for the voters.
Same goes for the word republic – it only denotes that the government offices are publicly held positions, rather than hereditary ones, and even then, the only position that really matters is the head of state. Ruling the state is a *job*, not a divine duty (although it certainly could be argued that some would treat it as such).
Both words meant something completely different when the constitution was written, but that doesn’t make any difference in how the country is defined today.
I will mention a few things..
the SAME has happened all thru the CORP/COMPANY mentality.
“IF’ I cant get my money from the POOR, I will inflate it for the RICH.”
Those persons that ‘GOTTA HAVE IT NOW’ will spend the most, and wont wait for a GOOD item to drop in price in 6 months to 1 year.
Those with the money, will JUMP into the hospital to get it FIXED, while the rest of us SUFFER, because we know how much it will cost.
IF you are going to regulate the medical profession, then you MIGHT as well do ALL the corps and companies..
#21–gee Tippis==I’d like to agree with you or at least understand what target you are trying to hit, but I can’t.
Main Entry: re·pub·lic
Pronunciation: \ri-ˈpə-blik\
Function: noun
Etymology: French république, from Middle French republique, from Latin respublica, from res thing, wealth + publica, feminine of publicus public — more at real, public
Date: 1604
1 —-(1) : a government in which supreme power resides in a body of citizens entitled to vote and is exercised by elected officers and representatives responsible to them and governing according to law (2) : a political unit (as a nation) having such a form of government
Who can vote is “always” arbitrary depending on how you define it. Age limits? Why 21 or 18? Your complaint is meaningless because of its universality.
You say: “The main argument against the US being a democracy has nothing to do with the multi-tiered system or the electoral college, and more to do with it essentially being a one-and-a-half-party system that offers little to no choice for the voters.” /// While I heartily agree the two party system has great limitations and needs to be changed, THAT has nothing to do with the definition of democracy. THE BEST argument that the USA is not a democracy is the Constitution that formally and expressly set up a Republican form of government split between three branches to act as check and balance against excesses along with the Bill of Rights to mitigate against mob rule.
Its not complicated. In fact, pretty narrowly defined and resolved.
#12 Wow, that was a cool article. Thx
I don’t live under your system so I don’t care about the debate, But I love the picture. Very Norman Rockwell with the colours.
Libertylover,
“Change the Constitution if you want the federal government to care for the people.”
Social Security settled the fact that the status quo is to ignore the constitution and pretend it says whatever you feel like. The facts are completely irrelevant and so is the constitution.
Of course unless that particular party feeeeels.. like enforcing say the part of an amendment sub section A and then ignore sub section B. Both sides do it are liars.
14, Fusion, Under Article 1 Section 3 of the Constitution, Senators used to be selected by the state legislators / governor of the states they came from. This is why Senators today serve a six-year term instead of a two-year term. What LibertyLover is talking about was essentially true up until 1913. In 1913, Senators were no longer appointed by their state legislatures / Governor due to the 17th Amendment.
http://tinyurl.com/67wzpv
17, Fusion, The fore-fathers knew that a true democracy was not a good idea for the very reasons LibertyLover has stated in that the majority would outvote the minority in every case of a true democracy.
The fore fathers decided to have a Democratic Republic instead due to the very shortcomings of a true democracy. This is what you’re referring to as a “Constitutional Democracy”.
The problem is you want to take a literal and modern reinterpretation of the words you’re quoting and then spinning it with polemics.
That’s being just as intellectually dishonest as trying to use the general welfare clause to somehow “prove” the Federal Government is required to provide everyone health care.
Would it be nice if the Federal Government provides everyone “free” health care? Maybe, maybe not. Regardless, the Federal Government is expanding its powers in this particular case by not operating within its enumerated powers. Anything not explicitly granted to the Federal Government by the Constitution is a State Government right.
The problem lies in that Liberals believe the Constitution is a living and breathing document which ultimately means someone can argue that the Constitution is somehow “unconstitutional”.
18, Chris, okay “screeching halt” is a bit of an exaggeration. Crawl would be more appropriate.
What’s the last greatest U.S. Government-funded medical innovation? Better yet, what’s the last greatest non-U.S. Government funded medical innovation?
Watch from 4:25 to 5:40 – http://tinyurl.com/mdax62
#23, Bobo:
You’ll note that the definition you gave *exactly* matches what I said: power is executed by elected officials, not by inherited peers. I’m not complaining about the arbitrariness – I have no idea where you got that. I’m saying that democracy is often limited by arbitrary restrictions, and those are the ones that determine how far away from an ideal democracy a state is. So you *are* agreeing with me – or at least repeating my points as arguments for why you’re right — even if you don’t want to.
The argument that the constitution calls the country a republic is pointless because the wording is archaic and not relevant for how “republic” and “democracy” are defined *today* and how they are used to describe a country. The US is still a republic (but not in the sense used two centuries ago), but is is *also* a democracy (but not in the sense of the 18th century), because there is no conflict – none, zip, zero – between the two terms.
I wonder if and when we go to government-run health care if we’ll ever take the Chinese approach: http://tinyurl.com/ya4oqje
The Liberals here could sell it as an approach to keeping health care costs “affordable” for tax payers as well as reducing our country’s CO2 output.
The Liberals only need a little Hope & Change.
#28 Medical achievements second. I noticed a false choice in your reasoning. Delivery of healthcare is related, but not the same as, health research. Private insurance in this country does a pretty terrible job at delivering care from a *public* cost\benefit perspective. From a profitability prospective they are good businesses, which is how they buy all those politicians.
As to medical advancements I would suggest two biggies. Immediate care of trauma patients and the human genome sequencing project. Neither is owned by, or entirely funded by, government but wouldn’t be the same without government.
The NIH budget is $40 billion, give or take. They take use that money to fund basic research. Pharmaceutical companies do research too, but mostly to develop a product they can quickly bring to market and sell lots of units for.
The reason that the biggie companies don’t do basic research anymore is that they are unlikely to be the beneficiaries of anything they develop. This goes for materials science, aerospace, and communications too.
#30 China has too many people; is it any wonder their health system is non-existent at best? Their demographics are a crucial stumbling block to steady development. I like Brazil or India better long term.
China does illustrate the, uh, clarifying force government can bring to massive investments. Could the private sector allocate investment to Chinese infrastructure neatly enough to prevent the country from imploding? I think not.
I think it’s very telling that 90% of the posts related to this article are not related to the content of the article. The article is about health care, not democracy v. republicanism. This says to me that the good doctor’s statements are true and no one can come up with any arguments to the contrary. It’s a very good article.
#23, bobbo, my dear friend,
THE BEST argument that the USA is not a democracy is the Constitution that formally and expressly set up a Republican form of government split between three branches to act as check and balance against excesses along with the Bill of Rights to mitigate against mob rule.
A republican form of government has nothing to do with being a democracy. Many republican governments have been dictatorships*. The polar opposite of a republic is a hereditary monarchy where the sovereign makes the rules and laws. A republic is only one FORM of government. A Parliamentary system is most popular and seems to work the best.
* – I can’t think of any republic other than the U.S.A. that is a still a democratic republic. Every other one I can think of either fell into dictatorships or collapsed into chaos.
No matter what you call it, America is a Republic and a Democracy. And note, the Constitution does elude to “elections”.
#27, Guyver,
14, Fusion, Under Article 1 Section 3 of the Constitution, Senators used to be selected by the state legislators / governor of the states they came from. This is why Senators today serve a six-year term instead of a two-year term.
OK, so what is your point? As far as I know none of the colonies wanted to become a monolithic monarchy dictatorship? All of them had, following the British tradition, bicameral legislatures.
The Senate was originally patterned after the British House of Lords. Because even if there was a radical shift in the Parliament, the House of Lords added some stability and continuity in the government. The same was desired in the new country being created. That is why Senate terms are staggered so only 1/3 are ever up for re-election at any one time.
But those appointing them? They were elected by the People to represent the People. They weren’t the King’s representatives appointing someone to represent the King.
*
17, Fusion, The fore-fathers knew that a true democracy was not a good idea for the very reasons LibertyLover has stated in that the majority would outvote the minority in every case of a true democracy.
No, they didn’t give true democracy of one person one vote for a very simple reason. They didn’t believe in it. Their attitude (with exceptions) was only those who owned property were significantly concerned enough to warrant a vote or say in running the country. Don’t forget, the vast majority of revenue for all levels of government was land taxes.
Even though the new America decried the chains of British rule, it was still a class based society. Blacks were slave material and even free(d) blacks had fewer rights that whites.
Women were not only denied the vote, they were expected, often by law, to be subservient. A woman’s property was almost always controlled outright by the husband.
Tradesmen were beholden to their masters with no or little say. If an apprentice ran away, he could be arrested as if he were a common slave.
Enough history lesson, this isn’t the place to write something so basic it is taught in most every college entry History course.
But don’t start reinterpreting something so basic and adding new meanings that fit your wish list. The Constitution was worded and written the way it was because that is the way they thought 225 years ago. We don’t think like that anymore. We, as a society, have progressed. We removed the chains that late colonial society had and fit it all into the Constitution.
*
The fore fathers decided to have a Democratic Republic instead due to the very shortcomings of a true democracy. This is what you’re referring to as a “Constitutional Democracy”.
You are taking a modern term and using it to reflect what the original framers wrote. They never intended to have a “Democratic Republic” as that very thought was not yet known.
Most of the Congress had come from the colonial legislatures. There they had seen their collective will overturned by the British Governor. Their sole aim was by putting the limits of power in writing, everyone would know up front what could and what could not be done. In short, they did not want the whims of a monarchist to over rule society’s collective desires.
The problem most LIEBERTARIANS have is thinking with a modern mindset about what the original framers meant. Inevitably they are wrong.
the surgeon makes excellent points, but runs smack into a huge problem that I have yet to see a good solution to; personal choice and liberty in lifestyle. Shifting the burden of cost to prevention rather than intervention would do a great deal, but people in the US take piss poor care of themselves (working in cardiology, I see this firsthand a lot). Unless you want to lay down some seriously heavy-handed nanny state totalitarianism there is no actual way to apply effective prevention upon the general public. Because of this, you have (broadly speaking) two choices. You can either accept the system basically as is, in which people are largely responsible for their own poor health and largely responsible for paying to fix their self-inflicted problems, or you can advocate controlling authoritarianism over the way people live. Seriously, given the cost burden of intervention it is not economically feasible to socialize healthcare without taking drastic steps to control the way people live. Self-care deficit is a huge damn problem and not one easily overcome.
#35, The problem most LIEBERTARIANS have is thinking with a modern mindset about what the original framers meant. Inevitably they are wrong.
And if you would respond in kind to your challenge, I would teach you where you are wrong here. Do you like going through life being wrong all the time?
Why would you sacrifice others to save your wife?
#36
do you know how many persons in this nation would LOVE to have a full diagnostic and ALL the tests needed to TELL them whats happening to THEMSELVES, every year?
Do you understand how much this costs??
DO you know, that the DOCTOR must justify this, BEFORE it can be done, to ANY person. And the odds are it WONT be accepted.
Let me add, that a FULL diagnostic would probably take 2-3 days PER PERSON to complete..
YOU could actually TELL you if you are being killed by pollutants in the job place BEFORE you were heavily exposed..
YOU could discover if someone was wearing out their KNEE PADS.
YOU COULD CATCH the start of most arthritis, before it becomes worse, and correct the diet to HELP.
SO WHAT it might cost $10,000 and you pay 20% as a deductible..($2,000)(do you have an EXTRA $2,000 per year floating around?).
PLEASE, go work for a low paying job, and tell me how it works out..(<$12 per hour)
Please go work seasonal work, and tell me how it works out..
Please go work at a store that HIRES single income females with CHILDREN..as their FIRST choice.
Please go find a hose that rents for <$600 per month..its the ONLY way you will save money.
PLEASE go and try to live off $5 per day in food.(counting GAS to get to the store 20 miles away)
ANd when you need to use your credit card to make ends meet…TRY to pay that 15% (+) interest…
AND PRAY that your children dont have an accident, and that YOU DONT GET SICK..
#38
I’m sorry, but I’m having a hard time making the connection between what I said and your response.
I was making the point that the doctor is very much correct in his notion that frontloading the costs into screening and prevention is a fantastic idea. In any branch of medical practice it is infinitely preferable to prevent a medical condition rather than to treat it acutely.
However, my dissenting point is that we are facing an issue of extremes here and I don’t see an effective middle ground solution. Either we keep the system as is and let the payers get the treatment, and in the process respect personal liberty in lifestyle and health decisions. Or, we socialize and resort to prevention and screening. The problem is, the greatest threat to American health is our own lifestyle and habits. Fully socializing medicine (without resorting to rationing) absolutely requires that we take a stronger authoritarian stance on how people live and what they eat and put into their bodies. If you attempted to simply absorb the cost of universal healthcare in America without rationing or lifestyle controls it would not be sustainable. Our lifestyle is simply too poor to do so. It truly is a testament to the quality of our care that we have such a high life expectancy, because believe me, when you work in healthcare you can see firsthand that the vast majority of people do NOTHING to maintain their own health.
Economically, we could make it work here in the US, but to do so we would have to resort to much heavier-handed governmental controls into people’s lifestyles. IT CAN WORK, but the means by which it can may leave a bad taste in many mouths.
39,
“I was making the point that the doctor is very much correct in his notion that frontloading the costs into screening and prevention is a fantastic idea.”
and my point is back…The costs of going to a Doctor for full diagnostics Every years are prohibitive, to ANYONE not making good money.
they cant afford time off.
They cant afford the 20% deductible.
The Insurance agency WONT allow it.
“However, my dissenting point is that we are facing an issue of extremes here and I don’t see an effective middle ground solution.”
I can give you a choice.
1. STOP paying for your representatives MEDICAL.
2. FORCE upper management/rich to PAY INTO THE SYSTEM. MOST dont. they pay into private systems. and when they DO pay into the system there is a LIMIT that they pay, Unlike those in the bottom, who pay a Percentage of income.
3. RESTRICT MAX PAYMENTS in Social security.
Pres Ford was making over $300,000 per year after retiring.. after spending most of his life in Public office and the military..
4. did you know that BEING a representative they have a RETIREMENT fund, that gives back EQUAL to your wages?? MEDICAL is free, transportation is a WRITE OFF, ANYONE you hire for assistance, is a write off? Cars, planes all of it can be written off.
AS their EMPLOYER, dont we have a SAY in what they are SUPPOSED to get?
5. MAKE their medical EQUAL TO EVERYONE ELSE’S.. If we are getting decent coverage and protect, ISNT it as good as theirs?? AS you mentioned, PREVENTION is better then dealing with it AFTER the damage.