Pragmatism vs. Idealism

June 1, 2009 at 8:02 pm (Health Care, Politics) (, , , )

Last night, I amused myself before bed by watching a recent episode of Countdown with Keith Olbermann.  I haven’t watched that particular show in awhile (because we’re no longer in the midst of an election), but it was interesting.

I realize that Keith Olbermann is, in many ways, the liberal answer to Bill O’Reilly.  Except that, for one, Olbermann is a lot nicer to the people on his show, and for another, I think his distillation of various news stories is better.  And I can’t help the fact that I think O’Reilly is morally degenerate, but that’s my biases talking.

Anyway, Olbermann had Rachel Maddow on his show to discuss a revelation about waterboarding, and to talk about torture in general.  One of the people who was very vocal that waterboarding was useful and not torture (I wish I could remember the guy’s name, but I can’t) recently underwent the process himself.  He basically said at the end of it that it is absolutely torture, and he would have told anyone anything they wanted to hear to make it stop.

So Olbermann was saying that the best argument against torture is that it doesn’t even work, aside from being inhumane and cruel.  Maddow disagreed with him, and said that the primary argument against torture should be that we, as a society, don’t do it.  In other words, that torture is immoral and wrong, whether it works or not.

I think it’s an interesting question about how we debate certain topics, especially in politics.  I think it’s very easy to get caught up in pragmatic arguments, like the one Olbermann thinks is the most important, and lose sight of the moral arguments, like those Maddow thinks should have primacy.  I can think of at least two other issues that have similar pragmatic vs. idealistic arguments – the death penalty, and health care.  On the one hand, we could argue that abolishing the death penalty or instituting health care is more cost effective than our current system.  On the other hand, we could argue that it is morally wrong for the state to kill people, or that it is a moral imperative for the government to ensure that everyone has equal access to health care.

I think I personally would side with Maddow in this sort of argument.  Torture is wrong not because it is ineffective, but because we don’t do it.  It goes against our values and our belief system.  It’s not an issue of finding a method of torture that works (which is what the pragmatic argument would lead to); it’s an issue of not even looking for one, because it’s wrong.

Similarly, the death penalty is wrong because the government has no business playing God.  Sure, it’s cheaper to get rid of the death penalty (because you won’t need so many expensive trials), but that argument would lead to an attempt to make the death penalty cheaper to enforce.  Not more just, not more accurate – cheaper.  The point is that no matter how cheap it is, it’s wrong.

And finally, with health care, I think this debate is becoming one about whether or not people have the right to health care.  Is it a right like the freedom of speech, thus deserving of protection by the government, or is it a privilege?  I personally think it should be a right, and that anyone who agrees with me on that is weakening their case by arguing first about cost.  Cost is a consideration (and I really do think it would ultimately be cheaper if everyone had insurance, at least), but the first consideration is that people deserve to have health care simply because it is the right thing to do.


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Socialism (and why I buy into it)

May 19, 2009 at 9:07 am (Economy, Health Care, Politics) (, , , , , )

I’ve been thinking a lot about politics (in a sort of vague and non-specific way) over the past few days.  One conclusion that I’ve come to as a result of all of this is that I unabashedly believe that government involvement is often the best thing for certain types of things in this country – at least as it exists today.  I wouldn’t call myself a statist, because I don’t believe that government should be huge and controlling for any reason at all.  What I am, ultimately, is a socialist.  I really believe that when it comes to protecting and promoting society’s interests, the government is our best bet.

I probably ought to explain this further (since that’s kind of a loaded statement these days), so here goes.  I have no illusions that the government in the United States is perfect – it’s not.  It makes mistakes, and it runs things badly at times.  But I think that someone would be hard pressed to find a large entity of any sort that isn’t like that.  Bureaucracies are run by humans, and humans are fallible – the goal is to make them as good as possible, but it is impossible to make them perfect.

So the question becomes not, do I want bureaucracy?  Rather, it becomes, which bureaucracy do I want to have control over the most important parts of my life?  It’s rather pointless to argue about whether or not we need bureaucracy in today’s world, because the fact that it’s impossible to go through even half a day without coming into contact with one speaks to the fact that it is necessary.  Our society is too large and too complex to survive without the rules and regulations that make up bureaucratic red tape.  It is frequently annoying, and sometimes unfair, but I don’t think any other system would be an improvement.

So what bureaucracy do I want to control things like the military, or health care, or my money?  Corporations of a size large enough to manage any of that have the same flaws as the government.  But on top of that, they also have profit as their primary motivation, and they are accountable to nobody but their shareholders.  The government, on the other hand, takes profit entirely out of the picture, and it is accountable to everyone who actually votes.

There are certainly government employees who are not elected or appointed, but most of those report directly or indirectly to somebody who is.  Again, it’s not a perfect system, but it’s a lot better than a corporation who doesn’t care what the rest of the world thinks as long as its major shareholders are happy and it continues to turn a profit.

One of the most common arguments against a government considered to be socialist is that it redistributes wealth.  Perhaps this may sound a bit flip, but I don’t really see why that’s a bad thing.  Sure, wealthy people earned their money (or someone up the family tree a ways did).  I don’t begrudge them that.  What I begrudge them is the disproportionate amount of power they have in our system.  If they are going to have that much power to influence policy and other things, they really ought to be paying a heck of a lot more into it.  On top of that, they are the ones who benefit most from things like public schools, or the military, or infrastructer.  It is only fair that they should pay a larger share of the cost, since they are getting a larger share of the benefits.

I also think that ultimately, the whole argument boils down to a distinction between what is fair and what is equal.  Those two words don’t mean anywhere close to the same thing.  An equal tax structure would have everyone paying the same percentage of their income; a fair one is graduated so that the people earning the most pay the highest percentage.  The reason why the latter is more fair than the former is that someone who is living paycheck to paycheck spends all or most of their income on necessities; someone who is wealthy doesn’t even spend their entire income.  So taxing everyone at, say, 20% means that the poorest won’t be able to afford all their necessities, and the wealthiest will simply have more money (that they don’t need) to save.

In addition, an equal society wouldn’t be good for other reasons.  In a fair society, everyone would get the same chance at a good education; in an equal society, everyone would need to get exactly the same education.  That basically means that the least capable and the most capable lose out, and everyone gets a sort of middling education.  When it comes to higher education, it is fair to say that everyone who meets certain standards can go if they want (regardless of considerations like class or race); equal would mean they have to accept anyone who applies, even if they fall short of the standards that would allow them to succeed.

Aside from all of that, cutting the poorest (and even the middle class) a break is good for our economy and our society as a whole.  Putting most of the burden of taxation on the non-wealthy means they have less ability to consume (which is necessary for the health of the economy), and it makes it extremely difficult or impossible for anyone to actually have upward mobility.  I don’t think that it fits in very well with our ideology as a country to have solid, stratified classes that have little to no movement between them.  And I also don’t think that even the most opulent spending by the wealthiest Americans could possibly make up for the lack of normal spending by everyone else.

So basically, I am all in favor of a little bit of wealth distribution, and I fully support the idea that the US government should take control of those institutions which are most important to all of us.  I know it may seem easy for me to say I’m in favor of wealth distribution now (when I earn relatively little), but I don’t object to paying taxes.  As long as I have enough money left for me, and the government is being responsible with the money I handed over, I think taxes are a good thing (so phooey on everyone who criticized Joe Biden for saying that paying taxes is patriotic – it is).

And since I can’t figure out how to make this post shorter, congratulations to anyone who actually reads the whole thing!

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The Real Cost of Health Care

February 10, 2009 at 10:58 am (Health Care, Politics) (, )

One of my major interests, at least for the past few years, has been the health care industry in the United States.  Frankly, I think it’s crap and needs to be seriously overhauled.  I also think that the best way to overhaul it is to nationalize it.  The biggest reasons for this belief of mine are that I think it’s a mistake to classify health care as a commodity (thus, everyone should be entitled to it by law) and that I think the only organization that could possible fix it and keep it not-for-profit is the government.  I am definitely not of the opinion that government is the problem (though I will freely admit that it is not always the solution).

So when I saw a blog post in the New York Times today, I was intrigued.  You can read it in full here.

The basic premise is that the time people spend waiting for health care services is a hidden cost of the health care industry (based on the idea that time = money, which in this case, it often does).  So, from the blog entry:

If you count health care-related activities writ large – including time traveling to a doctor, waiting to see a doctor, being examined and treated, taking medication, obtaining medical care for others, and paying bills – the average American spent 1.1 hours a week obtaining health care in 2007.

If you don’t count quite as many activities as “time spent on getting health care,” the figure is 847 million hours (for all Americans over the age of 15 in 2007).  That is, of course, still quite a lot of time.

But let’s go with the 1.1 hours per week spent obtaining health care.  That means that the average American spends 57.2 hours each year on this activity (and it’s actually quite a bit more than that if you’re over 60 or female).  So how much would that cost, in terms of dollars?

If we value all people’s time at the average hourly wage of production and nonsupervisory workers ($17.43 in 2007), Americans spent the equivalent of $240 billion on health care in 2007.

(Sidenote: I only wish I earned $17.43/hour.  I earn quite a bit less than that right now.)  That’s quite a lot of money.  It’s enough that the official report on health care expenditure for 2007 is 11% smaller than it would have been if that amount of money had been included.

But to put it in more approachable numbers, for the average American earning what’s listed as an average salary, they would have spent nearly $1,000 in wasted time.  Since most doctor’s offices are only open during regular business hours, and most people work between the hours of 8 and 5, I don’t find it hard to believe that it was actually lost income (or used up PTO/sick leave).

Even I, earning substantially less than that and requiring very little health care by comparison, have probably spent over $100 in time over the past year.  Most of that is lost income, because I had to take time off of work and because I don’t have paid sick leave or time off.  And this doesn’t even include the actual cost of going to the doctor, paying for insurance, or buying prescription (and OTC) medication.

This is all interesting mostly because one of the biggest fears Americans seem to have about national health care is an explosion of waits for services.  We’ve all heard horror stories about how long some people in countries with national health care have to wait for non-emergency health care.  Nobody really wants to have to wait years to treat a problem that isn’t life threatening, but does affect quality of life.

But if we include the cost of everyone’s time in our discussions about our current system, and any system we want to implement, we should be able to avoid the worst of the issues that some other countries face.  Talking about time wasted can be somewhat abstract for many people, but talking about money wasted generally is not.

It would probably also serve to highlight the need for more primary care type physicians.  General practice isn’t a terribly popular field of specialization among medical students.  It would probably be well worth creating incentives for people to pursue that if it meant that everybody had more access to GPs or family doctors.  It might keep more people from choosing their medical field based mostly on how much money they can earn performing cosmetic procedures, rather than their interest in that particular type of medicine (dermatology, I’m looking at you).  Even those fields that can most easily turn to cosmetic procedures (like dermatology) are frequently medically necessary.  Dermatologists are needed for treating skin cancer, eczema, acne, psoriasis, and probably a hundred other life-threatening, uncomfortable, or just plain annoying issues.  Even plastic surgery can be considered necessary (or at least, very important) for women who have had mastectomies, or for people who have been disfigured in accidents.  It’s not all about nose jobs and face lifts.

I just hope that, if we ever get to a point where we are discussing national health care seriously, this is a part of the discussion.  Quantifying how much time we all spend sitting around doctors’ offices is a very good indication of the quality of our health care system.  Good health care should be both affordable and easily accessible, and I don’t think that’s an impossible goal.

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