Healthcare dysfunction

  1. A social good, not a right
  2. Our incapacity is their livelihood
  3. Our permanent emergency
  4. Preventive medicine through channel-changing

1

Matthew Loftus teaches and practices Family Medicine in Baltimore and East Africa, and also writes a great deal. He recently addressed the Maryland Chapter of the American Solidarity Party (my current declared party allegiance).

Excerpts (emphasis added):

We can’t agree on what healthcare is for, what its goals are, because we don’t think about what health is or what it means. We don’t appreciate our ecosystems of life, the way that we are dependent on one another, the land, and animals—so we abuse the Earth and its creatures in order to eat and move around. We live in a culture where personal autonomy reigns supreme, which means that our highest self-achievement involves fulfilling our own personal whims. We have no sense of obligation to one another, leaving many vulnerable people in the lurch when health crises strike them. We concentrate power in the hands of highly educated and wealthy professionals and then act surprised when patients feel disempowered to take care of their own bodies. We take a very scientifically reductionistic approach to what health is, which means that we reduce indicators of health to things we can measure and then sell a pill for.

I think it’s very confusing to talk about health care as a right, because health care isn’t just one thing that you have that someone can take away from you, it’s a whole panoply of services and goods. Plus, a lot of these people think that providing health care because it’s a right also want the government to give you the freedom to be as free from obligations to others as possible, although other people are obligated to sell you things regardless of how you feel about it.

And so I think a more helpful framework is one which views health care as a social good which is necessary to secure one’s right to life. Rights are things that the government must protect at any cost, but social goods are things that we value and share and use on the basis of obligations beyond what any person is entitled to. And because we understand as citizens that the physical bodies of our fellow citizens are valuable and have God-imbued dignity, we have to care for them by helping to contribute to the cost of sharing this social good.

If we start from the understanding that healthcare is a social good necessary to secure the right to life, it follows that every person should be able to access this social good such that they do not die an otherwise preventable death. Any health system that does not meet this basic test is unjust, and our current system fails miserably. I don’t think it’s utopian to aim for a system in which everyone has access to the care they need in order to avoid an otherwise preventable death.

I want to start with the idea that health is stewardship. We have the resources to take care of ourselves, we just have to distribute them wisely. I would argue that the best way to heal our ailing body politic is to redistribute power so that people can make better choices.

Right now, the power in health care is concentrated in payers like the government and health insurance companies. The decision-making power is concentrated among hospitals and doctors. These big entities then spend a lot of time and money trying to convince patients to behave themselves, eat right, exercise, and take their medications to keep from getting sick.

Doctors are rent seekers. It’s true. We want to secure our own incomes. But I didn’t do seven years of medical training to click boxes and harangue people about how to quit smoking — and yet that’s what a primary care doctor ends up spending a lot of his or her day doing. You can do that with a high-school education or less, and if that’s the level of education you have, you might be even more likely to be trusted by the person you’re talking to! All health professionals should spend their day doing the things other people with less training (and lower salaries) could do, and for primary care doctors that means dealing with the medical problems of the most complex patients.

Hospitals and clinics can (and should) fund these community health workers. There’s a few of them in Maryland—not nearly enough—but one of the most exciting programs I’ve seen is the Healthy Community Partnership’s Lay Health Educator Program out of Johns Hopkins Bayview Hospital in Baltimore. They have medical residents, social workers, chaplains, and nurses from the hospital train people from local churches, trusted community members, in basic preventive health skills. You take the power that was concentrated in the hospital and you spread it around the community, giving these folks skills and knowledge that they can use to help others. I don’t think it goes far enough, but it’s what we need a lot more of.

I’m just enough of an American individualist (I grind my teeth when people prattle about healthcare as a “right”) to choke on some of those words, but I think I’m learning that the best we can expect in this life is amelioration of one injustice (like the reality reflected in the mantra in health that “one’s zip code is more important than one’s genetic code”) aware that we probably are creating another, in game of public policy whack-a-mole.

The healthcare system was broken eight years ago; the ACA broke it a different way. May guys like Loftus, who’ve earned the “right to be heard” (irony intended) move us closer to a better answer, with minimal corollary injustices.

Loftus’ article in Comment is also worth a look.

2

Stop listening to the bombastic loudmouths on the radio, television and Internet. To hell with them. They don’t want anything done for the public good. Our incapacity is their livelihood. Let’s trust each other. Let’s return to regular order. We’ve been spinning our wheels on too many important issues because we keep trying to find a way to win without help from across the aisle.

We tried to do this by coming up with a proposal behind closed doors, in consultation with the Administration, then springing it on skeptical members, trying to convince them that “it’s better than nothing” … asking us to swallow our doubts and force it past a unified opposition.

I don’t think that’s going to work in the end — and probably shouldn’t.

Tha Administration and Congressional Democrats should not have forced through the system, without any opposition support, a social and economic change as massive as Obamacare, and we shouldn’t do the same with ours.

Sen. John McCain (compiled from Washington Post and YouTube)

3

The recently proffered Republican health-care bill instantiates much of what is wrong with our politics: The bill was constructed through an extraordinary process in which there were no hearings, no review from the Congressional Budget Office, and no final text of the legislation until shortly before the vote. The process is erratic and covert rather than regular and transparent. It was put together in a purposeful way to avoid substantive debate and meaningful public discourse, making the most of the majority’s procedural advantages for purely political ends. The Republicans are perfectly within their legal authority to proceed that way. But that’s no way to govern. We all know this. As Rod Dreher recently put it, Republicans will have to choose whether they love the rule of law more than they hate the Left. Democrats faced the same choice, once, and they chose poorly, having set upon a course of political totalism that has seen the weaponization of everything from the IRS to the state attorneys general. Republican populists who argue that the GOP must play by the same rules in the name of “winning” have very little understanding of what already has been lost and of what we as a nation stand to lose. The United States will not thrive, economically or otherwise, in a state of permanent emergency.

What’s truly remarkable about our current constant national state of emergency is that no one can say exactly what the emergency is. But we all seem to be very sure that something has to be done about it right now, that we must rouse ourselves to excitement about it, and that the ordinary rules of lawmaking and governance no longer apply. There is not much political mileage to be had from arguing for regular order, transparency, and procedural predictability — but that’s part of what makes those things so valuable. Order in the little things is a necessary precondition of order in the big things. Orderly government cannot be built on a foundation of procedural chaos.

(Kevin Williamson)

4

I stopped watching the brutal, brain-damaging sport of boxing some time ago (not that there are many free offerings on TV now). I now add football, also brain-damaging (CTE) to that soft boycott. Baseball and basketball seem safe for now.

Yes, I’m aware of the “selection bias” problems in the sample: specimens were submitted by families seeking an explanation of odd behavior.

It helps my soft boycott that I find the obligatory red-white-and-blue military flyovers, the faux controversies (can you say Colin Kaepernick?), wardrobe malfunctions and other hooplah outweighing any pleasure I take in the game anyway.

* * * * *

Fiat justitia ruat caelum

There is no epistemological Switzerland. (Via Mars Hill Audio Journal Volume 134)

Some succinct standing advice on recurring themes.

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