Month: September 2009

Why Do We Tie Employers to Sickbeds?

There’s no easy way to give a sufficient account of this letter to Andrew Sullivan, posted under the theme “The View From Your Sickbed.”  I’ll do what I can, but give it a quick read to understand the details.

Bascially, a 33-year-old woman died after overdosing on Tlyenol, a problem further complicated by lupus. In the rush to give her care, the hospital didn’t get the woman’s new insurance information, so it worked under the assumption that the liver transplant she needed to survive wasn’t covered.  Her insurance from her previous job didn’t cover a tansplant, while her insurance from her current job did. The hospital lost time figuring out solutions to a problem it didn’t really have.

This is all unfortunate, no less so from the apparent inevitability of her death suggested in the reader’s e-mail.  But I wouldn’t get here from the facts provided, as the e-mailer did:

But, if there was a universal healthcare plan in place, all of that would have been unnecessary. This woman’s condition and treatment wouldn’t have been contingent on just what was and was not covered by her particular plan, and the simple fact she had recently changed jobs would not have confused what options were available, and a bureaucracy would not have come between her and her doctor.

This conclusion leaves unquestioned the assumptions upon which our current system is built.  Specifically, if we didn’t tie health insurance to employment, this woman may have had consistent coverage on her own, relevant to her unique health considerations.  This may have avoided the situation she encountered due to the hospital’s out-of-date records.

We need reform, but not the reform currently offered.  Regardless, we will never get the process correct until we break from the narrative that demands we accept that the road to peril started at the point and with the cause(s) most convenient to a preferred explanation.

Post script: For the purpose of this post, I’ve intentionally ignored the privacy and data management issues involved in a universal health care plan capable of solving this problem.

Bill O’Reilly On Health Insurance

Many people seem to be quoting this statement from Bill O’Reilly:

… I want, not for personally for me, but for working Americans, to have a [sic] option, that if they don’t like their health insurance, if it’s too expensive, they can’t afford it, if the government can cobble together a cheaper insurance policy that gives the same benefits, I see that as a plus for the folks.

I’ll argue that O’Reilly hasn’t said anything of substance here.  Not because I think we should abandon the people he speaks of, those who (genuinely) can’t afford it; I don’t.  But he’s wrong in his assumption. How will the government offer the same benefits for less money?

Two ways to pay for this seem apparent: subsidies and hiding costs. The latter is reprehensible but the expected outcome.  Just look at how we currently treat the solvency of Social Security and it’ll be clear that politicians will never admit the truth about costs when they can hide them.  (The last resort option is to blame it on the other party and claim that this proves we need more government to oversee the bad people, a group to which the current politician will never claim membership.)

But if I assume this won’t happen, then that leaves subsidies.  If we’re going to subsidize, why not subsidize the private insurance for those who (genuinely) can’t afford it rather than restructure the entire system?

For what it’s worth, insurance is expensive at least in part because government regulates (i.e. limits) the amount of competition in the insurance market.  If you could buy insurance across state lines, you wouldn’t be captive to the specifics of your state.  And so on.

Via Andrew Sullivan.

Religion By Scalpel Is Not A Parental Right

Andrew Sullivan weighs in on the CDC circumcision mess:

… I guess I was an early obsessive on this. As readers know, my position is simply that no parent has a right to permanently mutilate a child for no good reason. Scar tissue should be a personal choice. Would we approve of parents’ tattooing infants? The entire thing is an outrage and should be banned outright with a religious exception for Muslims and Jews.

Damnit, no.  The entire thing is an outrage and should be banned outright.  If it’s wrong for parents to mutilate a child for no good reason, and it unequivocally is, permitting an exception for parents to mutilate their children because their god says they must mutilate their children only legalizes no good reason.  Scar tissue should be a personal choice, unless your parents believe their god tells them to sacrifice your foreskin?  That’s incoherent.  Favoring one subjective, non-medical reason over another subjective, non-medical reason for surgically altering (i.e. mutilating) a child is indefensible.

It is also objectively flawed on its practical point.  Let’s assume the government finally acknowledges that boys deserve closer-to-equal protection that girls already receive, with closer-to-equal being the only way to admit that federal law currently prohibits genital cutting on healthy female minors for all subjective, non-medical reason, including religious reasons cited by parents.  Either the Congress or the courts must embrace this closer-to-equal protection.  What will stop parents from claiming religious requirements if they want to circumcise their sons?  How will the government verify the real Jews from the temporary Jews or the real Muslims from the temporary Muslims? Will the government intervene on matters of theology when Christian parents continue incorrectly claiming that Christianity endorses (or requires) infant circumcision? The only result will be that this hypothetical prohibition on the non-ritual circumcision of male minors would be struck down.

This all-too-common charade only tricks people into thinking they’re being tolerant of religion. Yet, whatever your overall opinion on religion, here religion deserves explicit condemnation.  I’d rather engage reason where it involves what one person may do to another. Circumcision for non-medical reasons, including religious adherence, is purely subjective.  Scar tissue should be a personal choice.  It must therefore be left only to the individual exercising his religious freedom to circumcise himself. Or not.

Update: Mr. Sullivan responds to a reader’s e-mail (emphasis added):

The reason I don’t follow this to its logical conclusion is that I just cannot imagine trying to enforce a total legal ban on it given the religious outrage among Muslims and Jews it might provoke. And I do make exceptions for religious liberty that I don’t for other issues, because I believe very deeply in the right of people to figure out their ultimate purpose in life without the intervention of the state. So I restrict myself to mere venting about what seems to me to be an irrational and barbaric relic.

On the first sentence, he’s right. Enforcement would be difficult. But enforcement is a separate issue. Its difficulty may make the law largely impotent in the years immediately following its introduction, but that is not a valid reason to avoid enacting the legislation necessary to protect the rights of male minors. When those rights are acknowledged, as we’ve acknowledged for female minors for all unnecessary genital cutting, other methods of enforcement (e.g. lawsuits) become more likely, which will eventually act as a deterrent and shape the culture.

However, the fundamental problem with Sullivan’s approach rests in his notion of religious liberty. Religious liberty involves letting a person “figure out their ultimate purpose” through mutilating their own genitals without state intervention. There is no liberty in letting people mutilate another’s genitals. Circumcising another person is not a right, and protecting individuals from unwanted physical harm is exactly the purpose of the state. This is true even when – perhaps especially when – the harm is carried out by well-intentioned parents searching for their ultimate purpose. What about the child’s ultimate purpose? That may include a preference for normal genitals. It probably will include a preference for normal genitals, if he’s left his choice. Instead, Mr. Sullivan’s defense of parents imposing ritual circumcision respects magical thinking more than reason and objective facts.