Is this biased reporting?

[Chaerophon]

Who makes that assumption? I find that a hard concept to wrap my head around. My life is worth more than the life of a convicted murderer. My contributions far outweigh his in context of civil society's aims: a social framework wherein we pretty much get along. That matter of worth is subjective, not objective, in any case, and I don't think it sound to presume it to be absolute.

But where does your principle come from?

Is that really the way that we define equality in a constitutional state? Your murderer example is a bit of a red herring - on a personal level, I agree with your point, but I don't think that it ought to stand in the way of protective principle. When handing out donor hearts, does it make sense - is it 'just' - to always give it to the highest bidder? Is the 'worth' of a wealthy entrepreneur really calculable in that sense? Can policy be justified on that basis in a democratic society? Certainly America is a meritocracy of sorts, but its foundations rely on a certain populist egalitarianism. One person, one vote has implications beyond the ballot box.

Right to life is not conditional on one's means. This principle is what separates the liberal democratic state from oligarchy. If we attempt to defend liberal democratic structures on utilitarian grounds we end up with a mess. Simply put, we don't think about our rights, about our constitutional entitlements, in utilitarian terms. My rights do not exist as a means to the betterment of the whole; my rights are mine alone, as a condition of my citizenship. If the general betterment of the whole is some kind of a positive externality, then all the better.

Finally, if not some deontological liberal constitution-based model, then who is the judge? How do we determine 'merit' when it comes to the provision of health care? In capitalist society, the fallback is wealth, and wealth alone cannot be the arbiter of 'deservedness' in protecting the right to life. Sure, I'll accept that the surgeon has greater utility-based importance to society than the professional welder - but on what basis do we make such calculations, and who is the calculator? The deeper implications of such reasoning can become very troubling.

[Taem]

Sorry MEAT, I have to agree with our busy friend here - introducing a dictionary definition of tyranny is a weak attempt at discrediting his claims.
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I realize now that my nit was trivial. I was not trying to discredit the posters comments, but to discern his meaning where he was making comparisons using the term "tyranny" for his examples, which I felt were inappropriately labeled thusly. I wasn’t taking into accord that his words did fit within the context of the discussion at hand. For this pointless outburst, I do apologize, as I did not intend to completely steer the car off the road as I did. I'll make a note to refrain from this behavior in the future.

[Taem]

EDIT - Double-post! Didn't see my post on Outline view so I thought it didn't stick but apparently it did when I checked it in Standard view. Still can't see it in outline view though.

[Occhidiangela]

When handing out donor hearts, does it make sense - is it 'just' - to always give it to the highest bidder? 

I don't think so, I'd like to see the basis be "first come first serve" but I'd like to modify that with age, or other criterion where one can. But it is tricky, and it is very hard to be "fair" from all perspectives.

Should I spend that heart on an 80 year old, or on a 17 year old? Where in that choice, hard as it is, lies the greater good? How about a mother, 32, three kids versus a single man of 40? Who between them is more 'deserving' of that heart? What criterion is used? The "get on the list" approach is probably as fair as it can be made, but the matter of access and "who you know" presents the loophole of a greased palm ensuring that the 50 year old fashion queen gets that heart ahead of a "fair" schedule.

Is the 'worth' of a wealthy entrepreneur really calculable in that sense?  Can policy be justified on that basis in a democratic society? 

No, but people who make decisions can be bought in any society. No matter how many rules we right, people are corruptible.

Certainly America is a meritocracy of sorts, but its foundations rely on a certain populist egalitarianism.  One person, one vote has implications beyond the ballot box.

More importantly is the 14th ammendment, Equal Protection Under The Law, but the Jacksonian version of democratic principles in a republic certainly connotes a trace of egalitarianism.

Right to life is not conditional on one's means.

Agreed.

This principle is what separates the liberal democratic state from oligarchy.  If we attempt to defend liberal democratic structures on utilitarian grounds we end up with a mess.  Simply put, we don't think about our rights, about our constitutional entitlements, in utilitarian terms.  My rights do not exist as a means to the betterment of the whole; my rights are mine alone, as a condition of my citizenship.  If the general betterment of the whole is some kind of a positive externality, then all the better.

Getting back to the modified golden rule, my absolute freedom/rights are bounded by yours (and all other fellow citizens freedoms/rights. That doesn't answer the mail on "when things are scarce, how do we prioritize?" Given a finite amount of doctor/medical man hours in a week, how indeed does allocation of care get fairly apportioned?

Finally, if not some deontological liberal constitution-based model, then who is the judge?  How do we determine 'merit' when it comes to the provision of health care?

You set up a rule, and after the usual process, via voting or consensus building, abide by that rule. But merit is the wrong word, here, rather necessity or "fair share."

In capitalist society, the fallback is wealth, and wealth alone cannot be the arbiter of 'deservedness' in protecting the right to life.  Sure, I'll accept that the surgeon has greater utility-based importance to society than the professional welder - but on what basis do we make such calculations, and who is the calculator?  The deeper implications of such reasoning can become very troubling.
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Well, without the welder, the hospital never got built, so the trauma patient died for lack of a place for the doctor to treat him. :lol: Kidding aside, if the rules apply about 90% of the time, and are pretty fair, the occasional excess found by the exploitation of loopholes and the bribability of the "custodians of the rules" probably meet, to my sense of fairness, the good enough standard for Imperfectable Man. If I'm the guy waiting for the heart on one of those 10% cases, and it never shows up thanks to the beauty queen posited above, then

It sucks to be me.

Life isn't fair, we can only make it "pretty fair."

PS: Thanks for "deontological" as a fine 64 dollar word for the day. :D

Occhi

[Chaerophon]

The heart example was, of course, a thought experiment by which I was intending to clarify my original point, which was this: the only way to (roughly) ensure equal access to health care is through public funding and administration. Given the 'equal worth' argument that I offered, I intended to defend the notion that the unequal access that is resultant from the privately administered 'fee for service' model in the US is unjust. You seem to be contending that the efficiencies of private administration make up for the lack of equality in access to health care in the long-term. However, if I read your post correctly, you also accept the notion that we ought to try and ensure that access is as equal as possible.

I'm not willing to say that we ought to restrict access for the sake of a few dollars; I stand on principle and say that health care access is a fundamental right in modern society, a right that is tied to an equal right to life. It might cost more, it might be a bit more 'inefficient,' but I see it as a fundamental sign of the real committment of a government and its people to their stated democratic ideals. I believe that anything less can be construed as implying that constitutional/political 'personhood' is a relative phenomenon, dependent on some criteria other than membership in society (namely one's monetary means or status). If I can get into the doctor before you because I have more money than you, I question the veracity of the notion that we are, in fact, each equally entitled to a right to life.

P.S. Deontological. There really does need to be a word for what it expresses! :D

[Occhidiangela]

EFFING Windows Key. I pressed it at the 90% reply point and all went blank. Bill Gates must die. Let's try again, goal is now brevity.

the only way to (roughly) ensure equal access to health care is through public funding and administration

.

It is one way, and in some places it has been shown to work for availability concerns, but I am not prepared to say it is "the only way." The German system apparently works, and works well. (Any Germans still with us, please advise.)

Given the 'equal worth' argument that I offered, I intended to defend the notion that the unequal access that is resultant from the privately administered 'fee for service' model in the US is unjust.

The equal worth point needs further clarity. I do not consider a criminal (such as anyone who has entered my nation illegally) to be deserving of any medical care at the expense of The State, a state, or The System. IF there is a policy provision agreed by the electorate to provide such, then so be it. If there are charitable organization willing to provide that care, so much the better. National health care, as a system, is a matter of opportunity cost if we assume even modestly responsible governance (perhaps a bad assumption) and thus finite resources.

We can restrict the conversation to citizens and legal alien residents in the process of earning citizenship and proceed.

Justness is a rather loose consideration for access to care, since even with generally available care it is not uncommon to require a second and third opinion to get the right care versus incorrect care, which can be lethal. Is sloppy care easily available a just condition? I hope that the percentages favor a "good enough" standard, in that misdiagnosis should be rare, but I can't get equal care if the quality of care givers varies widely . . . which it does.

Here's a wrinkle: why do some Canadians come south for medical treatment if social medicine answers their needs? Is it cost or availability? I have heard both.

I know quite a few elderly Texans who go south for their care, to Mexico, due to both cost, cheaper visits, and availability of certain drugs FDA has not approved yet. They find the drive to Nuevo Laredo and back, and treatment by University of Texas Medical School alums who set up shop in Mexico (malpractice insurance premiums down there are much lower than here for example, as are other costs.)

I'm not willing to say that we ought to restrict access for the sake of a few dollars; I stand on principle and say that health care access is a fundamental right in modern society, a right that is tied to an equal right to life.

While your general theory resonates with me via "how the world should work" in an unconstrained environment, the matter of what "rights" are require societal consensus, and the concerns of a given society are a matter of sovereign exercise.

If via sovereign political processes that right is agreed and becomes policy, then amen, Chaer, is indeed a right. In the American case, you cannot overlook the issue of taxation and taxes, a critical concern of American societal structure since the nation's inception.

Since a public system requires tax revenue to support, one needs to get "buy in" from the electorate if a truly "democratic" or "republican" system is to serve its citizens. If the case can be made to show that the tax burden will be "reasonably fair" and the actual costs reduced over the current system, I think such a system would be approved. That case has yet to be made, or made well enough to satisfy the electorate, and those who shoulder the majority of the tax burden.

The deep distrust of what politicians do with the tax dollars once received, and how the funds are allocated, are a powerful disincentive to increasing the tax flow to pay for a system that, once implemented, won't be replaceable and can be, with even moderate PR campaigns, an excuse for an ever increasing tax bill due to "need to afford the health care" for _X_ reason.

Let's peek at the notion that we are equally entitled to a right to life. The self evident truths of the Declaration of Independence did not all make it into the final draft of our Constitution, the operating document for executing "the pursuit of happiness." (Trying to remember which Scottish philosopher came up with that, think it was Reid.)

Under our constitution, the rules of government, we cannot be deprived of life, liberty or property except under due process of law. That does not equal "an equal entitlement to life" irrespective all other factors, as our lawful exercise of the death penalty demonstrates. As a general rule, I think equal protection under the law generally translates to "an equal right to life" but I suspect one can dismantle that notion with a refined argument. Perhaps not.

Here, however, is the key question of free citizens in a free society: who determines the risk decisions of the citizen? The citizen, or "the government" that allegedly serves the citizen's general interest. If a citizen is willing to forgo complete health care coverage in order to afford other options, let the citizen do so. That of course assumes that all citizens will have enough resources to make that decision, rather than having the decision forced on them through paucity of means.

Part of that solution to the latter case is the general practice of "x" percentage of case load being pro bono, as in the practice of law, but such informal standards can result in overload of health resources in a given locale. It is uneven, since the demands are uneven across society.

The answer?

When a system that is 100% public can be envisioned, transitioned to, and presented to the public, particularly those whose shoulders bear the burden of peying for it, as rationally more cost effective in the long run, consensus will be achieved and such a system transitioned to. I think we will get there. I also think it will demand the implementation of "fenced money" in terms of "certain taxes are color coded to that public fund, and that fund alone. If that can't be done, the corruptibility of government will screw the resourcing of the system.

Why do I think we will get there, in time?

The Achilles Heel in the private based system, as I see it, is that layers of profit required to enable any private enterprise to provide health care is at the long term cost of "can't we squeeze another 1/2 % profit out of this operation?"

To achieve that aim, one either eliminates "waste" (whatever that means in Health Care) or one increases price to satisfy share holders. Since shareholders tend to be a "what have you done for me lately" crowd, the long term prospects are for health care costs to rise for that reason (no value added to the care receiver) as well as other reasons, (general costs of any health care system) or for "waste" to be trimmed at the margins continually with the risk that quality of health care continues the leak out of the system.

I appreciate your principles based approach, it appeals to my sense of a good place to allocate resources to strengthen the mimimum standard of quality of life in a socitey, but one cannot ignore the utilitarian factor. In a health care system, you get out of it, in the macro sense, what you put into it. It requires health care resources to run a system and provide the care to people, and those resources are finite. They do not arrive "ex nihilo" because someone needs health care.

There is no free lunch, and there is no free health care, aside from charitable trusts set up explicitly for that purpose.

And by the way, those same multi million and multi billion dollar charitable trusts are typcially funded and supported by those "capitalists" who this thread's self designated foolso disdains. Sweet irony.

Occhi

[whyBish]

It's an unstable system.  If OPEC decides to switch to the EURO then the value of the US dollar will drop. If China suddenly stopped exporting resources and goods to America - we're #$%&ed. They hold all the economic cards now. We could have a stock market crash and suffer decades of depression TOMORROW.
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Yes, I too prefer a system without organisational structure, so that we can't undertake endevours bigger than a single person :huh:

We should also allocate resources based on need, not effort. It works really well in NZ. Girls, just spread your legs, and the govt. will keep you in the money for life. :wacko:

We also make sure that criminals wife-beating overstayers get $M dialysis treatment at the expense of law abiding citizens :unsure:

[whyBish]

That's definitely one of the points of contention among Anarchists; whether we need a Revolution or whether we need to reform our way to those goals.
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We have no chance of anarchism becoming a long term phenomena. With no-one to organise it, who would initiate such a change?
And if id did somehow magically appear, how would:
- a ) determine the goals of the system (voting? who would be bound by it?)
- b ) develop inter-anarchist agreements? How would two countries negotiate without a central point of authority, that can give some level of assurance that the things being offered will actually come through?
- c ) encourage infrastructural and reseearch investment
- d ) encourage effort in the face of human nature (laziness/greed)
- e ) resolve resource contention?

If a country is anarchist, how do you get a public health or education system (etc.)? Who will work in it? Who will pay them? How will this money be collected?

[whyBish]

Anarchism as a solution set to the complex problems of modern society, and who now preaches of a solution to war.

In other words, a naive fool. 

Occhi
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I would have thought that anarchy was the perfect solution to reduce (external) war. :P
Who would be funding the army under anarchy? How would an army function without anyone to give it direction, and without any layers of leadership / management? What would stop desertion?

[whyBish]

Spagethii= violence. Because it's pretty damned obvious why.
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That's what I was thinking all through this thread... but some of the hardest things to explain are the 'obvious' things.

What is 'fairness'
What is the 'goal(s) of society"?
What should government funds be spent on?
Where should governent funds come from?

[whyBish]

I don't think so, I'd like to see the basis be "first come first serve" but I'd like to modify that with age, or other criterion where one can.  But it is tricky, and it is very hard to be "fair" from all perspectives. 

Should I spend that heart on an 80 year old, or on a 17 year old?  Where in that choice, hard as it is, lies the greater good?  How about a mother, 32, three kids versus a single man of 40?  Who between them is more 'deserving' of that heart?  What criterion is used?  The "get on the list" approach is probably as fair as it can be made, but the matter of access and "who you know" presents the loophole of  a greased palm ensuring that the 50 year old fashion queen gets that heart ahead of a "fair" schedule. 
No, but people who make decisions can be bought in any society.  No matter how many rules we right, people are corruptible.
Occhi
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Exactly. If you said that your chance of getting a heart decreases with age, then there is potential for a black market to develop, where the 'rich old folk' still end up getting up the heart that 17y.o. would have had, if it weren't for the 'inducement'.
I'm guessing there's no need to point out the organ trade black market in China, sourced from "criminals".

[whyBish]

The heart example was, of course, a thought experiment by which I was intending to clarify my original point, which was this: the only way to (roughly) ensure equal access to health care is through public funding and administration.
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Probably just reading you wrong... but you don't actually seem to mean equal access (I probably just don't understand the U.S. medical system).

I would have thought that all citizens in the U.S. DO have 'equal access' to medical services, but don't have 'equal ability' to pay for them?

[whyBish]

National health care, as a system, is a matter of opportunity cost if we assume even modestly responsible governance (perhaps a bad assumption) and thus finite resources.

In the American case, you cannot overlook the issue of taxation and taxes, a critical concern of American societal structure since the nation's inception. 

Since a public system requires tax revenue to support, one needs to get "buy in" from the electorate if a truly "democratic" or "republican" system is to serve its citizens.  If the case can be made to show that the tax burden will be "reasonably fair" and the actual costs reduced over the current system, I think such a system would be approved.  That case has yet to be made, or made well enough to satisfy the electorate, and those who shoulder the majority of the tax burden. 

increasing the tax flow to pay for a system that, once implemented, won't be replaceable and can be, with even moderate PR campaigns, an excuse for an ever increasing tax bill due to "need to afford the health care" for _X_ reason. 
Occhi
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This country (NZ) has a number of examples of non-privatised public goods. Some have turned out well, some have not.

Accident insurance: A government monopoly, funded via approx 0.9% income tax. Able to achieve economies of scale in:
- promotional advertising of risk reduction (whereas an individual company would not recoup the whole benefit)
- research into risk prevention
- removal of all litigation (you cannot sue for work injury / accident, you get compensation via govt. agency, sometimes 'unfair' amounts)
- smaller claims get paid out (whereas under a legal system the lawyer costs would provide a larger barrier to the majority of claims at the small end).
- reduced court burden.
- Unfortunately rates are based on 'industry' so you can't show that you have a better than industry level of safety to get a discount. (But not sure that you would get that under a privat esystem either...?)

Healthcare (free doctors visits, free medical care (limited only by waiting list length):
- As Occhi noted the funds channelled into it are ever increasing
- Really needs some form of limit to usage.
- Politically difficult to change
- Bulk of populace doesn't understand that the money going into healthcare comes from somewhere (i.e. their own pockets). Joe Bloggs thinks that the govt magically prints their own money. Someone else here seems to think that is a good idea too :P

Unemployment benefit (Enough to live on indefinitely)
- Have third / fourth generate beneficiaries :-(
- Means people getting off the benefit face high marginal tax rate (since they are losing the benefit and the 40 hours a week leisure time in exchange for an amount of money probably slightly above the benefit)
- Altered from original purpose of a tide-over between employment, o a safety net for the 'unemployable'
- places a financial large drag on the business sector, reduces NZ competitiveness

Education (including pre-school to tertiary)
- People end up taking degrees in "surfing" and other things that are not business oriented
- Provides a reliable set of standard that allow assessment of an individual by potential employers.

Superannuation (Yes, over here the govt. pays you when you retire too)
- Too prone to political manipulations. Super was set at 65% of median wage from 60 years of age, is currently at 60% from 65. Talk of it being unsustainable mean that it may be removed altogether eventually (aging population supported by shrinking workforce). Projection of two workers per superannuitant by 2020... (if each worker is paying the current top tax rate of 39%, and superannuitant is getting 60% median wage, then there is 8% remaining :huh: )
- Is essentially just the 'old persons' version of the unemployment benefit.
- Govt. can achieve economies in scale for their investments (particularly compared with a low income worker), and due to the longer timeframes and large number of participants can get higher return by placing funds in higher risk investments than an individual may be willing to.

--Edit My post count is too high in this thread

[Occhidiangela]

I would have thought that anarchy was the perfect solution to reduce (external) war.  :P
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Tee Hee, only if every nation agrees to be anarchist.

As soon as one get organized, given that anarchy will tend to facilitate quite a bit of low scale, internal violence/strife (see the Irish and Scots apparent cultural joy of fighting amongst each other, or the Labanese) the first group/nation that "gets organized" will tend to be able to play divide and conquer if they so desire.

Who would be funding the army under anarchy? 
How would an army function without anyone to give it direction, and without any layers of leadership / management?
What would stop desertion?

The same way they function in the contemporary states of anarchy like Sierre Leon, Serbia/Bosnia, Liberia. One of the better descriptions of that condition is here.

The New Warrior Class written in 1994

A small army/warband coalesces around a strong man, who provides via the charismatic method, or force of will, the organization and leadership to move. Like old Gothic or Germanic war band leaders, success breeds success until the army gets unwieldy. It then either splits, or self immolates, and you end up with

A sort of feudalism, depending on what kind of economic system can be strong armed into supporting those with the weapons and the will to use them.

All it takes is one force of personality to "get organized" . . .

Occhi

[Ashock]

Hi,

1) If he is physically a child, then we do well to emulate Kipling,

"But day by day they kicks 'im, which 'elps 'im on a bit,
Till 'e finds 'isself one mornin' with a full an' proper kit."

for how else is he to be guided to knowledge?  ;)

2) And, if he is only mentally a child, it is a cruel, but long standing tradition, for fools to amuse their betters. :)  (De)baiting an ignoramus has certain charms and helps the time pass.

--Pete
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Hey.

1) Well, you know what they say... "You can lead an ignoramus to a toilet but you can't make him pee in it..... however, you *can* make him drink from it."

2) You got me there ;)


-A

[--Pete]

Hi,

I'm not willing to say that we ought to restrict access for the sake of a few dollars; I stand on principle and say that health care access is a fundamental right in modern society, a right that is tied to an equal right to life.  It might cost more, it might be a bit more 'inefficient,' but I see it as a fundamental sign of the real committment of a government and its people to their stated democratic ideals.[right][snapback]93590[/snapback][/right]

Good, in principle. But health care can be a never ending hole that can, and will, swallow all of a society's assets. And the costs aren't only monetary; for every transplant, there needs to be a donor, there's only one or two 'best' doctors in any given field, etc. If you add the desire of some people to 'preserve' the life of their loved ones well beyond any hope of a cure or recovery, you get a good glimmer of where the problems lay.

It is possible, of course, to 'socialize' health care. The result, so far, has been very mixed. In some cases, the care was so inferior that those who could afford to went elsewhere. In other cases, a 'black-market' health care system grew around the state sanctioned system -- often with the tacit acknowledgment of the state. And then there is the problem epitomized by the joke:

What do you call the person who graduated last of his class in med school?
.
.
.
.
.
.
.
.
.
.
'Doctor', of course.

Two facilities might be the same on paper, but the difference in the respective staffs might represent fifty years of medical progress. And, of course, it is impossible for the best practitioner in any field to see all the patients.

So, no matter how one cuts it, universal, premium, indefinite coverage -- while a great sound bite -- is impossible. The real question then becomes, what standard of care, if any, is everyone entitled to? For the answer to be workable, it must meet realistic limitations, or it will fail for lack of resources. Ideal health care coverage is just that -- an ideal.

However, the situation in the USA is far from ideal. It is a tragedy and a travesty, given our means. 'Fixing' that system will take political courage to alienate the medical special interests including the medical insurance companies, and the willingness to ask the voters for the necessary funds. In our political system, that's a no-win situation.

--Pete

[Occhidiangela]

However, the situation in the USA is far from ideal.  It is a tragedy and a travesty, given our means.  'Fixing' that system will take political courage to alienate the medical special interests including the medical insurance companies, and the willingness to ask the voters for the necessary funds.  In our political system, that's a no-win situation.
--Pete
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In our system, it lacks the clarity of the old Perot "here's how it works" briefings and it has lacked a credible advocate, or if you prefer, a good salesman. The idea of a need for reform is recognized by quite a bit of the population . . . and while the AMA & HMO roadblocks may seem monolithic, there is nothing so dangerous as an idea.

"Would you buy a used forceps from that man?" :lol:

Occhi