healthcare

Talking Points for One Particular Left-Leaning Liberal

R. Horton

First of all, I guess you could get kind of crazy debating terms like “leftist,” “socialist,” “liberal,” “classical liberal,” and so on. And because of the risk of getting kind of crazy, I have no inclination to debate these terms. Let’s just say I believe in trying to make the world better by supporting things like accessible healthcare, accessible education, public libraries, maintained infrastructure, a habitable planet, and things of that nature. I try not to get freaked out by all the names thrown at people like me, and I try not to waste too much time trying to find the label that best fits.

But anyone would agree that I am not right-wing, conservative, alt-right, or any of that. So I think you’d say I’m on “the left” or “left of center.” What’s more, there are a few things I don’t like about the way other people on the left frame their debates. I wouldn’t dream of telling other people how to describe their own ideas, but I do dream of telling people how I like to describe my ideas, so here you go.

Free stuff—I don’t like all the talk about free stuff, whether it is education, healthcare, fire services, police protection, freeways, libraries, or air. Nothing is free, and we should all be able to agree on that. What I want is an equitable form of cost sharing. We all share the cost so that no one is left out. Why do I want my neighbor’s kids to get a free education, even if I don’t think I benefit directly? Because I want to live in a society where people are educated and empowered to share in the promotion of a functioning society. And I want their education to be useful beyond making them good employees.

Wealth distribution—Let’s face it, wealth is distributed. If wealth is going to exist at all, it will be distributed in some sort of pattern. It is absolutely pointless to say you are opposed to a patterned distribution of wealth. So you’re saying you’re actually just opposed to wealth re-distribution, which you imagine is a very different animal. You just don’t want your hard-earned money taken away through taxes to make someone better off. You can’t imagine that anyone else has done anything to make you better off, because you do not want to imagine that. Unlike some people on the left, I’m not saying rich people shouldn’t exist. I’m only saying that if rich people exist, poor people should not.

Market solutions—Some people anthropomorphize capital markets and claim they can fix all our problems. Sometimes entrepreneurs come up with some pretty good ideas, and that’s fine and dandy, but the people had good ideas, not the markets. Also, no markets are free. All markets are the products of the specific agreements various humans have put in place. Those agreements are constantly in flux and are subject to negotiation. “Free” markets do not exist. You will never find a market running wild in nature. I guess this is as good a place as any to say that I see no reason to completely eliminate private health insurance companies. It is only necessary to ensure that no one needs private health insurance.

Rights—to say everyone has a right to free speech is only to say I think society functions better when the government does not restrict speech in most cases. While some people believe “rights” come from God or nature or someplace else, you don’t have to believe that to use the word. It may annoy philosophers and political scientists, but a right is something someone thinks people should have. A “legal right” or “guaranteed right” is just something that was popular enough with people to be written in to law. Of course, it’s your right to believe whatever you want.

You might be thinking I should have some sort of summary conclusion or something, but I can assure you that I do not, so that’s that.

In US, Illness is Financial Anxiety

R. Horton

In August 2016, I moved from Texas to the northwest of England. Last summer, I while walking in the local park I slipped on a stepping stone and sprained my ankle. As the pain pulsed through my body and my ankle began to swell, I began to wonder whether I needed an ambulance, an x-ray, or possibly even surgery.

I did not think about the cost of an ambulance or whether my insurance might refuse to pay for it, the cost of an x-ray if needed, the price of surgery, or even co-pays for medication or any possible treatments. I was worried only about my condition and getting better.

I enjoy hiking, cycling, dirt bike riding and other sports with risk of injury, so I’m not unaccustomed to dealing with the occasional injury. With similar injuries in the United States, though, I always thought immediately of the cost. Mind you, I was never uninsured, but even with insurance proved by the college where I taught, a shattered tibial plateau in 2001 that required two surgeries and months of physical therapy left me with surmountable but daunting bills long after I had recovered. Since 2001, prices have risen dramatically along with higher deductibles, narrower networks, and higher copays for treatment.

In the United States, illness or injury means an immediate calculation of costs and threats to financial security even for working people securely in the middle class. For others, the situation is much worse. Of course, long-term illness or injury can throw middle-class workers out of work, which means they will lose their insurance, unless they can afford COBRA payments to maintain their insurance for a limited time after employment. In my experience, COBRA payments are much higher than people expect or are able to pay.

As a student in medical humanities, I read many narratives of illness. They all focused on suffering from the condition, facing mortality, finding or making meaning in the face of prolonged pain, but not so much about what truly horrifies Americans when they fall ill. Illness or injury should be a time to focus on healing, if possible, or confronting or preparing for prolonged pain in the case of a chronic condition, or to prepare for death in the case of terminal illnesses. It should not be a time to worry about financial ruin for oneself and one’s family.

The study of medical ethics offers many opportunities to contemplate challenging philosophical problems with rich and varied intellectual interest. However, access to healthcare is by far the most pressing problem in the United States. Anyone concerned about illness, suffering, and medicine must assume the obligation to relieve the suffering created by unaffordable healthcare.

 

 

Ask an Ethicist: Expanding Fast-Food Outlets

R. Horton

Just to be clear, I wrote both the question and answer for this.

Question: I’m a CEO of a large fast-food chain. Obamacare (or the Affordable Care Act) requires me to provide health insurance to employees working more than 30 hours each week. Providing insurance is expensive and I would rather not have to hire so many part-time workers to avoid providing benefits. If Obamacare is not repealed, I won’t be able to expand and create more jobs. How can I ethically expand my business without incurring more expenses?

Answer: Any law that prevents you from opening more outlets should be expanded, but that’s just my opinion. Limiting the number of restaurants you open will encourage locally-owned businesses and aspiring entrepreneurs to open their own establishments serving their friends and neighbors. Chains such as yours destroy local economies and limit workers to minimum-wage jobs with no benefits.

What happens as a result of your not offering health insurance and other benefits? The most obvious consequence is that your employees are likely to not be able to go to the doctor, so they will be sicker, and they will come to work sick because you also do not offer them sick time. Having employees work while they are sick might help explain why noroviruses spread so quickly, but I don’t guess you are concerned with that.

Keeping employees part-time to avoid giving them benefits also means that they must work more than one job in order to survive. This in turn means they are not available to their families and cannot pursue further education. The system you want to maintain keeps workers sick, uneducated, tired, and disconnected. While having a constant pool of desperate job applicants probably sounds like a business bonanza to you, it has consequences. If you haven’t noticed, societies filled with people unable to develop personally and professionally, care for themselves, or seek leisure activities are unhappy societies, and that affects everyone.

What would happen if you provided health insurance? Your employees could afford to work only one job. You could have a more stable workforce, meaning your employees would be more reliable, better trained, and more prepared for advancement. It would mean your employees could get treatment for illnesses and come to work in better health. If you and other businesses provided health insurance, it would mean workers would have more income. More money for workers means expanding markets. And that means you may be able to open a few more outlets after all.

Stop infantilizing old people, please

R. Horton1 Comment

As I write this, I am 55 years old. Like most people my age, I like to think I am a “young 55” or that I look good “for my age.” As I get older, I think I have become a little more patient, more accepting, less doctrinaire, and, yes, sadder and wiser. However, I have not become more adorable, precious, charming, or sweet.

Although I am not yet extremely old, I’ve already noticed that younger people I hardly know sometimes refer to me as “sweetheart” or “sweetie.” This seems to be a particular problem in healthcare settings. Some call it “elderspeak,” which is characterized by treating older people more as children than as fully functioning adults (I personally feel this demeaning language is often inappropriate for children as well, but I will take one thing at a time). For some reason, when people talk to older patients, they tend to slow their speech, raise the volume, and sing their sentences. In addition, every statement seems to become a question and second person pronouns are replaced with first-person plural pronouns ( e.g., “you” becomes “we”). You can read more about this phenomenon here.  At a time when nursing home workers are sharing explicit photos and videos of older adults on social media, complaining about “sweetheart” seems almost quaint, but both the diminutive terms and the more extreme demeaning media rob patients of their dignity and personhood.

Other people seem to think they are honoring older adults by treating them as mascots. Many videos on social media feature adults who are “adorable” or “precious” dancing, singing, or doing other activities they have no doubt done for their entire lives. The videos are presented with the exact same attitude behind videos of kittens, puppies, and babies. Samuel Johnson once said, “A woman’s preaching is like a dog’s walking on his hind legs. It is not done well; but you are surprised to find it done at all.” Videos of the elderly seem to take the same attitude: it is amazing that older people might still do the things they love. If they make the attempt to engage in the activities that make them happy, the are “so cute.”

The consequence of assuming adults become children once again in later life can have serious consequences. For instance, healthcare providers often ignore the sexual health of older patients. As this article states, “prevailing misconceptions among healthcare providers regarding a lack of sexual activity in older adults contribute to making elders an extremely vulnerable population.” The result of this ignorance, is that STD rates among the elderly are increasing at an alarming rate. Although about 80 percent of adults aged 50 to 90 years old are sexually active, they are infrequently screened for STDs.

I am more concerned, though, about the basic harm of a society that treats its elders as mascots for amusement. As we age we lose the respect of our fellow beings and we lose our status as persons. For the most part, younger people don’t mean any harm, even if they are doing harm; they are acting out of ignorance. That being the case, I am here to help. The following are things you should know about your elders:

  1. They have and talk about sex. In a movie, it is always easy to get a good laugh by having an old person, especially an old woman, make any kind of statement that indicates she knows what sex is. Apparently, many young people believe that when you hit a certain age you become an innocent and naïve virgin, completely unaware of how people reproduce.
  2. They curse. This is related to the first point, but it slightly different. If you curse now, you will probably curse in 10 or 30 years. At what point do you think it should become funny or cute? Old people have the same right to words that everyone else has. Language is a human right.
  3. They still know how to do things. It isn’t amazing that someone who has danced since he was seven still likes to cut the rug when he is 80. Our abilities may diminish over time (some do and some don’t), but we don’t suddenly forget everything we’ve learned over a lifetime.
  4. They are still rational and intelligent. I realize we all suffer some cognitive decline as we age and some are affected by diseases that accelerate or accentuate that decline, but young people also suffer brain injury, disease, and other limitations on cognitive ability. Age is not a sufficient reason to believe someone is stupid.
  5. They’ve won the battles you are fighting. Somehow, your elders have survived. If you can manage the same, you should be honored, as you should honor them now. Any old person can tell you it isn’t easy growing old. Someone who has survived had the wits and strength to overcome many adversities. They could teach you a thing or two.
  6. They are persons. Here, I am using the word “persons” in a philosophical sense of someone who bears human dignity and value. It does not diminish as you age. If anyone has value, you do.

In case you haven’t seen any of the videos I described above, here is an example:
[youtube https://www.youtube.com/watch?v=R7Br3-5L6hM]

Update on Saylor White

R. Horton

After public pressure and eliminating all excuses for denial, Aetna has finally approved Saylor’s surgery, so he is at last getting treatment. His wife sent the following message to those who were concerned about him:

“Great news! Aetna APPROVED Saylor White‘s surgery with the original surgical team and hospital. They could not provide the services in-network so had to approve it. His doctors office is working to reschedule ASAP. Thank you to everyone who has been comfort and support to us during this trying time. Bless you all!”

While we are all relieved and thrilled he is getting treatment, there is no excuse for subjecting sick people to so much stress and indignity.

Notes on European Socialized Healthcare

R. Horton1 Comment

Yesterday, I posted a blog about three people who must rely on contributions from friends, admirers, and strangers to maintain the healthcare they need, and these three individuals are not unusual cases in the US. It is the argument of conservatives that universal healthcare coverage (or anything socialized) will deprive workers of their dignity. It is the pride of ownership and rewards for hard work that gives people self-respect and a feeling of accomplishment. Providing for yourself makes you a better person.

The majority of Europeans, where it is generally inconceivable that anyone would be forced to hold a fundraiser to pay medical bills, seem to disagree. Just as most Americans do not consider Social Security or public education to be a demeaning form of charity, most Europeans do not consider healthcare to be a demeaning government handout. Rather, healthcare is a burden shared by all to protect their common interests. The costs of advanced medical technologies and surgeries are out of range for all but the richest Americans. Medical emergencies can quickly run to the hundreds of thousands of dollars. A six-figure salary will not offset the costs.

Having to ask friends, family, admirers, and strangers to help pay your bills is demeaning, demoralizing, and degrading. The conservative vision of letting everyone pay their own way or debase themselves in their dying months, weeks, or days is appalling and unconscionable. I have my own objections to the Affordable Care Act, but trying to fix the problem is more honorable than ignoring the problem or, worse, declaring that the current crisis in healthcare is acceptable. We must demand solutions. If you are opposed to the solution on the table, bring your idea to the table.

Ignoring the problem is killing us. Unfortunately, we must also be humiliated before we can die penniless and ashamed.