Skip to main content

EXAMINING HEALTHCARE: SEPTEMBER 2018 RANT (ONE DAY LATE)

In a discussion about healthcare, a friend said that the European system was not socialism. Europe was composed of welfare states, of countries whose people wanted something for nothing. So I decided to look at healthcare in both the USofA and Europe to decide which system worked best, both in terms of cost and in terms of outcomes.

I'm not a socialist or a communist. I'm not even a democratic socialist. I do believe that there are certain aspects of daily life that are rightly the domain of government to undertake or, at least, to heavily regulate. I believe that it is clear that for-profit companies generally care more about profit than about the environment, for instance. When air pollution turned the air of cities like Pittsburgh and Los Angeles noxious shades of brown, it took vigorous enforcement of emission standards, not voluntary action on the part of the emitters, to clear the air.

There can certainly be debates about the limits of regulation. I once spoke with a Libertarian candidate for the Pennsylvania State Legislature who posited that all environmental laws should be scrapped. If a business polluted, those affected by the pollution can and should sue, he asserted. For reasons that should be obvious to any thinking person, that position is absurd. Pollution travels. Individuals lack the resources to map sources. Unless we don't care about the air that we breathe, the water that we drink, the food that we eat, we must collectively take responsibility in seeing to that which the Founders described as the General Welfare. In a modern state with hundreds of millions of lives in the balance, that collective responsibility cannot rely on civil litigation. That responsibility is housed in our government. And it is the responsibility of the electorate to empower the government to be both circumspect and scientific in promulgating rules and regulations.

Here's where it gets tricky. Legal scholars have apparently agreed that "...Life, Liberty and the pursuit of Happiness..." in our Declaration of Independence and "...promote the general Welfare..." in our Constitution are not actionable phrases. Certainly not in The Declaration, since that document has no bearing on modern jurisprudence at all. And also not in the preamble to The Constitution, though perhaps some relevance when the phrase is repeated in the body as regards taxation. Indeed, in modern times the Supreme Court leans toward a doctrine that prohibits the consideration of any words that are not actually written into the body of The Constitution. 

Absurd, I say.

Why absurd, you ask?

Because that same SCOTUS believes that corporations are people and that money is speech. Show me where the Founders promoted those ideas anywhere, much less in the body of The Constitution. And of course, there's that nasty little phrase in the Second Amendment about militias. 

So let's consider the Founders' words as regards the true purpose of government. (Bold lettering is mine.)

The care of human life and happiness, and not their destruction, is the first and only object of good government.” ~Thomas Jefferson

"We ought to consider what is the end of government, before we determine which is the best form. Upon this point all speculative politicians will agree, that the happiness of society is the end of government, as all Divines and moral Philosophers will agree that the happiness of the individual is the end of man. From this principle it will follow, that the form of government which communicates ease, comfort, security, or, in one word, happiness, to the greatest number of persons, and in the greatest degree, is the best." ~John Adams

"The will of the people is the source and the happiness of the people the end of all legitimate government upon earth." ~John Quincy Adams

What can be more important to the happiness of people than their good health? Which form of government best promotes good health? We often hear American elected politicians proclaim that we, that Americans, have the best healthcare in the world. If good health is indeed a prerequisite for happiness, that claim is central to whether or not those same politicians are serving us well. Let's examine that claim.

Americans spend more on healthcare per capita than other developed countries. And the fact that Medicare has been prohibited by Congress from negotiating drug prices adds to the cost. That's right. The largest single purchaser of drugs in the USofA, the federal government, has been prohibited by the government itself from reducing healthcare costs. And so the absurdity begins

And America spends more as a percentage of GDP than other developed countries.


But life expectancy doesn't seem to correlate positively to that spending.

And maternal mortality doesn't seem to correspond positively to that spending.

And infant mortality is, quite frankly, a disgrace.

So is there any metric in which the US shows leadership? Yes. 5-year cancer survival rates.



But then I determined what I believe to be the reason why the US leads in that category. Spending, which of course, in the US relates to profit.

That's one heck of a difference.

There are those who might suggest that the lack of spending in other countries at end of life is due to rationing. But no one that I know in Europe has experienced a denial of service because of age. I have more than one friend older than 70, one older than 80, who received full treatment for cancers on the government dime with no questions asked. My take on it is that the difference is a quality of life issue. Europeans just think differently about how to live their lives than Americans do. It's why they insist on longer vacations and take full advantage of their vacation time. It's why they close businesses to vacation with their families even at the height of tourist season because that's when their kids are out of school. And I suspect it's why they don't demand invasive and costly procedures at the end of life.

So, call the countries of Europe and those with similar healthcare systems Welfare States. They don't care. They pay for that welfare through taxation and, on the whole, they are happy to do so. 

My nurse sister-in-law described a conversation about single-payer healthcare that she had with a colleague, a colleague with a Ph.D. "But I believe in capitalism," said the colleague. What does an economic system have to do with healthcare outcomes? Apparently, the impact is almost entirely negative.

Absurd.






Comments

Popular posts from this blog

CHÉ OLIVE / LE ZINC, CREISSAN: RESTAURANT REVIEW

No, it's not Chez Olive. It is indeed Ché complete with red star and black beret. I have no idea why and I wasn't about to ask. The French are the French and not to be analyzed too closely when it comes to politics, especially these days.

Creissan is the next town over from our village of Quarante. We pass through it often and Ché Olive is right there on the main road at the entrance to town. (One of the signs still says Le Zinc. Olive says he prefers Ché Olive though.) Olive opened it a couple of years ago after leaving the Bar 40, Quarante's basic local watering hole that's undergone a bit of a renaissance lately. We hadn't heard much about Ché Olive from our usual sources for dining recommendations. So we just kept passing by. For reasons not central to this review, we decided to stop in for lunch on a mid-week in late December.

The bar is cozy, the restaurant open and bright and modern. Newly renovated and perhaps a bit sterile. We were the first…

CHRISTMAS WALK TO VIEW OF THE PYRENEES: 2018

Cathey said that it was OK for me to take my usual Tuesday morning walk on Christmas Day. I could help set the table and perform other minor tasks necessary for a satisfactory Christmas dinner with friends after I returned. So off I went. Temperature 40℉ at the start near sunup. 50℉ at the finish a couple of hours later. No wind. Blue skies. This was the winter that I came to France for.

The walk can't really be called scenic. Just through the vines until you get to the headland opposite the village. But the closer that you get to the top, you begin to see the Pyrenees peeking through. And at the top, it's a 360° panorama.







RESTAURANT TEN, UZES: RESTAURANT REVIEW

Ten sits just off the market square in Uzes, one of the prettiest villages in southern France. The newly renovated space is airy and comfortable with tables of sufficient size and sufficiently spaced to provide for a pleasant dining experience. Service was cheerful, fully bilingual, and attentive without being overbearing. The food presented well to both eye and tongue. And the rate of approximately 30€ per person for a party of five included starters, mains, a dessert or two, two bottles of local wine, and coffees at the finish. Reasonable if not cheap eats. 

So why am I hesitant to give an unqualified thumbs up?  It took me a while to figure it out.

Uzes is a quintessentially French village in a quintessentially French region of southern France. There are those who will say that the Languedoc is just as beautiful but less crowded and less expensive than its eastern neighbors. I know. I'm one of those people. But the fact remains that for many people, villages like Uzes are their v…