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by Peter Moskos

December 13, 2010

Politics and the Courts and Health Care

It always bothers me when people bitch about court decisions because they don't agree with the politics. It's one thing to be pro-abortion (as I am) or pro illegal immigration (got me there, too) or anti-2nd Amendment (not too fond of how some people interpret it, personally). It's another to think that every Supreme-Court decision needs to be decided in favor of your particular belief rather than the greater issue on which the courts are supposed to make such decisions.

The Supreme Court doesn't (or shouldn't) decide if a specific law is good or bad; it decides if a given issue is constitutional. I think Roe v. Wade was a pretty weak Supreme Court decision. And yet I believe that every woman should have the right to have an abortion on demand.

Much of the Civil Rights Movement was helped by court cases that relied on greater moral issues more than strict constitutional interpretations. That's fine by me too. I also understand that every decision shouldn't be decided on technical grounds or original intent (see, for instance, the 7th Amendment).

Bush v. Gore? Now that was a terrible decision. But the court has always been political. And to some extent it should be.

Why do I mention this? Because I love Obamacare!

OK, actually, I'm just saying that to be provocative. I think Obamacare is too limited and health care should be single-payer, for everybody, and nationalized! But what do I care? I have health care.

I support health care as both a political and moral issue. The free market does not and cannot provide health care. That said, I could fully support a court decision that says that federal government shouldn't be able to tell citizens they have to buy anything. I'm a states' rights liberal! But not too many of us in this club, I can't help but notice.

I just wish more conservative so-called states' righters were equally supportive of states' rights when it came to issues they don't like, like drug legalization, or highway funds. The power of the federal government should not be a liberal versus conservative issue. But as long as it is, here's to health care surviving court challenges!


Anonymous said...

Peter, great post! Seldom do we see people who have principles instead of politics. The Wire (the best series ever made) was great at showing the bad sides of food stamps and projects, and you wrote about these too. How is socializing health care different from (and similar to) socializing food and housing? And should we do all three?
Thanks, Zoran

PCM said...

At some political level those three might be related, but I don't see any practical reason to equate those three. I don't see any "culture of poverty-like health care developing" like some people associate with public housing and welfare (what little we have of it).

In a rich nation, health care should be a right, not a luxury.

If you want to equate health care with anything, I'd equate it with electricity, clean water, roads, and the post office. It's more like a utility. Something that pretty much everybody needs and almost nobody can provide for themselves.

I think that any argument that starts with the premise that some people can't see a doctor (or have to go to the E.R.) or can't get needed cheap medicine is a non-starter. We spend too much on what for too many is crappy health care.

Why should insurance companies be making money on health care? It's absurd. That money should be spend on health care.

The crazy part to me is people who say we don't need nationalized health care because the poor have access to doctors: they go to the E.R. What type of conservative idiot wants to pay for poor people going to the E.R. every time they need a asthma prescription?

So many other countries get health care right. It's really not a mystery. And yet we refuse to look at or follow their examples.

For food and housing the free market does better. But yes, the government needs to step in when people fail. I don't want Americans starving in the streets (which is a problem we do not have) nor sleeping outside because they have no place to go (which is a problem we do have).

And let's not forget, abuses aside, public housing helps a lot of good people. Food stamp feed a lot of good people (my wife included, when she was growing up). To say we shouldn't have these things because some people abuse them really misses the point.

Personally, I think we should abolish tax breaks for the rich. God knows those are abused!

It seems mean to pick on the poor.

Anonymous said...

Thanks. "Many other countries get health care right." Indeed. My friend in Canada raves about her health care, and I am amazed at what my parents get in Germany (a week of physical therapy in a spa in the mountains!).

I didn't understand some analogies you were making.
1. Electricity and water are sold commercially, not nationalized (though they are regulated).

2. "Why should insurance companies be making money on health care?" Why should hospital administrators be paid? Medicare administrators? Doctor's office receptionists? Truck drivers delivering supplies to hospitals? These are all people indirectly involved in health care.

Insurance companies are paid for handling the risk (like car insurance companies). And their profits are in line with other industries.

3. I support food stamps. The government gives money to the poor, and the poor decide whether to buy $1 Wonder bread or $5 baguette. With nationalized health care, government pays a fixed price per approved procedure. That is equivalent to government paying directly to supermarket $1 for approved Wonder bread, and you lose the baguette choice.

4. "public housing helps a lot of good people." ... I agree. But that does not mean that everyone's house should be nationalized.

5. I haven't heard anyone who claims that the poor going to the E.R. is a good idea.

By the way, I do not pick on the poor. There are many well intentioned programs that did disservice to the poor, like the public housing (projects), war on drugs, inner city schools, etc.

PCM said...

Good points, all.

In response:

1) In many places utilities are still public (I still pay the City of New York for my water. And it's very good water). And heavily regulated private is pretty close to public (except for the guaranteed private profit). These necessities can't be completely private because they need to be provided to people who can't pay.

2) Insurance companies are paid only to handle risk that they themselves make. If everybody had health care, there would be no risk to handle, right?. The "risk" is only related to non-coverage.

In a nationalized system, we'd still need admin and truck drivers and paper shufflers, but I don't see why we would need health insurance companies. And even they are needed they shouldn't control health care policy. It's like having prison-guard unions influence sentencing policy (oh...).

So much of insurance companies' work is coding and creating paperwork for doctors so these companies can figure out how not pay. To maximize their profit. If there was no question of coverage, wouldn't that make insurance companies superfluous?

3. We spend too much on health care as is. I would say the analogy is more like this:

You go to the grocery store and see (a $1 Wonder bread) listed as $10. But because you have insurance, you pay $0.75. The government gives some middle man $5, and they pay $3 to the store. When you get home, you notice a few extra things you didn't need, like PB&J, are in the bad (and on the receipt).

The baguette down the street always costs $5. But they don't take food stamps (just like the best doctors don't take insurance).

Good health care costs less than we're paying. This is a systemic problem.

4) Agreed. But "rent is too damn high!" I'd like more rent control and less public housing. (Generally, I'm pro regulation and anti-nationalization. But I think health care might be an exception.)

5) Conservative do. Or at least they use the E.R. as justification as to why we don't need to provide health care to the poor. "They already have health care," goes the argument.

Last: I think it's a mistake to blame schools (or even, necessarily, projects) for the people that go there or live there.

It's easier and more politically correct to blame a building instead of a person. But if you see the homes and families some kids grow up with, the schools don't stand a chance. But people (especially liberals) prefer to blame everything but the parents. But until we see there's a parenting problem, we'll never be able to figure out how to solve these problems.

[Certainly, though, government has at times made things worse: the war on drugs.]

Anonymous said...

"The free market does not and cannot provide health care. "

Really? Why is it then that I can purchase health care products and services? Why is it that I can also not purchase them if I decide I don't want them?

The free market doesn't provide "free" or more accurately, stolen health care.

PCM said...

Wow. And you really think that you represent the entire market? Amazing. Perhaps I should have been clearer and said, "The free market does not and cannot provide health care for all." Or, "The free market does not and cannot provide health care for those without money." My apologies.

And just so understand my position: I do think people who cannot afford it should "steal" health care. I also think starving people should steal bread.

But stealing is so ugly. Wouldn't it be much better for those of us with plenty to be gracious and "provide" life's necessities for those who cannot provide such things for themselves?