Morning Ethics Warm-Up, 10/29/17: What’s Really Wrong With Single Payer, Incompletely Remembering Charles Kuralt, And Dana Milbank Boards The Ethics Train Wreck

(This is my favorite Arthur Sullivan hymn, even more than “Onward Christian Soldiers”…)

GOOD MORNING!

1 CBS’s “Sunday Morning” had a feature today on the late Charles Kuralt, the original host of the show, famous for his feature “On the Road” in which Kuralt visited “the real America,” meeting locals and revealing regional lore to the rest of the country. At the end of today’s segment, CBS bemoaned the fact that Kuralt, who died 20 years ago, was virtually forgotten, even among journalists if they had no grey in their hair.

This is an example of a larger crisis, cultural illiteracy, that often occupies my thoughts. The blame lies with our inadequate schools and its under-educated teachers, as well as popular culture. Barely knowing anything about George Washington, the root of the previous post, is an existential problem, but only slightly more dangerous are the multiple generations whose member can’t name ten U.S. Presidents, don’t know the dates of the Civil War or who the US defeated in World War II, and who have never heard of Jackie Robinson, Clarence Darrow, Brown v. Board of Education, Eugene McCarthy, Ingrid Bergman, or Lucille Ball.

CBS, however, was indulging its own special breed of disinformation by lionizing Kuralt. Yes, I remember well his plummy voice and avuncular style. I also remember, as CBS would have us forget, the fact that after his death it was revealed that being “on the road” allowed Kuralt to maintain one family in Montana and another, his official one, in New York City. His innovative proposal to CBS to fund his trek back and forth over the contiinent facilitated his betrayal of his family. Kuralt was a sociopath.

2. The most significant ethics story of recent weeks that I have thus far neglected was the announcement that Great Britain’s National Health Service will ban patients from surgery indefinitely if they are obese or smoke. Non life-or death operations, like joint replacements, will be put on hold  until such patients conform to the governement’s life style requirements

Obese patients “will not get non-urgent surgery until they reduce their weight” unless the circumstances are exceptional. Smokers will only be referred for operations if they have stopped smoking for at least eight weeks, with such patients breathalyzed before referral.

When the newly radicalized and Bernie-ized Democratic Prty going all-in for single-payer next year, this cautionary tale needs thorough debate. When the government controls health care, it has the power to constrict personal liberty. The British were horrified by this latest development, which can only be described as the other shoe dropping. What did they expect?

Of course, a party that controls a government that can withhold surgery until citizens conform to mandated life choices would never use that same power to demand other behavior from citizens. Or  assign priorities for surgical procedures to favored groups and constituencies.

Keep telling yourself that. You’ll feel better. Continue reading

California “Ethics”

California is not only rapidly exiting mainstream U.S. culture, it is forging its own distorted and unethical version of right and wrong.

Three alarming examples:

1. Forging ahead with single payer, and reality be damned.

The Sacramento Bee  pointed out that by replacing current state-run health programs with a single-payer system, the state would still need to come up with an additional $200 billion annually.This year’s state budget in California is about $180 billion. Yes, implementing a single-payer health care system would require doubling California’s current tax burden.

Oh, never mind! The state Senate voted 23 to 14 this month in favor of SB 562, a single-payer proposal that would guarantee universal health care to all Californians. “What we did today was really approve the concept of a single-payer system in California,” declared state Senator Ricardo Lara following the vote.

No, what they did was reaffirm the fact that progressive cant refuses to yield in the face of cold, hard facts, math, reason and common sense. The cheerleading from the Left is mind-numbing. Writes the Nation: If health care is a right—and it is—the only honest response to the current crisis is the single-payer “Medicare for All” reform that would bring the United States in line with humane and responsible countries worldwide.”

Well, let’s see: health care is NOT a right except in Left-Wing Fantasyland, and all of those “humane and responsible countries” have crushing tax burdens, reduced liberty, economic instability, crushing debt and completely different values, priorities and responsibilities than those of the United States.

Ethics is only ethical when it is practical and practicable in the real world. The ethical response to the fact that single-payer doubles the state budget is to say, “Oh. Well, obviously we can’t do that, then. On to plan B.”

2. That minimum wage increase that Gov. Brown said was based on principle rather than economics? Yeah, about that…

Continue reading

Comment Of The Day: “Comment Of The Day: ‘No, Insurance Companies Treating People With Pre-Existing Conditions Differently From Other Customers Is Not ‘Discrimination’”, (2)

This, the fourth Comment of the Day generated by the post on pre-existing conditions and health care insurance, is a comment on the original COTD on that post, and not on the more recent Comment of the Day on the Comment of the Day on that Comment of the Day, thus sparing Ethics Alarms the most ridiculous headline in its history.

The topic now holds the blog record for most re-published comments, and it could easily be more, since the number of excellent responses from readers on all sides of the issue is well into double figures.

But now it’s texagg04‘s turn. Here is his Comment of the Day on the post, Comment Of The Day: “No, Insurance Companies Treating People With Pre-Existing Conditions Differently From Other Customers Is Not ‘Discrimination’.”

… The beauty of being a Federalist, especially a Libertarian Federalist, is that with the nuance of the system, I’m quite content with communitarian solutions to problems — when they are applied at the *appropriate* level and the *higher* they go, the more they need to provide a value, which left to it’s own the devices the market cannot produce the value soon enough to avoid a catastrophic harm to the market. The lower they go the more they can fulfill the various market whims of the locals.

My wife and I run our *family* as a fairly communist regime, though a bit more free than say, Soviet Russia. We really enjoy our *city* Library system. But for the most part, we really love our State keeping out of our business. I think its great that in places like Chicago and other snow-clad northern wastelands, some communities have mandated that each individual be compelled to ensure his section of city sidewalk is clear of snow – I think its great that some communities don’t.

When a problem arises which threatens the balance of the market severely enough but the market itself cannot provide a solution quickly enough that it essentially cannot save itself, I would submit that is within the government’s purview. Continue reading

Comment Of The Day: “Comment Of The Day: ‘Comment Of The Day: No, Insurance Companies Treating People With Pre-Existing Conditions Differently From Other Customers Is Not Discrimination.’”

I agree, this is getting ridiculous: our colloquy on the ethical and policy complexities of health care policy has created the first Ethics Alarms Comment of the Day on a Comment of the Day on a Comment of the Day. Nonetheless, John Billingsley’s COTD is deserving, as well as interesting and informative. Here it is, his comment on Comment Of The Day: “Comment Of The Day: ‘No, Insurance Companies Treating People With Pre-Existing Conditions Differently From Other Customers Is Not Discrimination’”—which in this case you really should read Charlie Green’s post that prompted it.

I have a few comments on specific points.

“New diseases like RLS”

RLS was first described in 1685 and the first detailed clinical description was in 1944 and it was shown in test recordings in 1962. Not really a new disease but a newly publicized disease. Once a medication was developed that was effective at relieving the symptoms, it became profitable for a pharmaceutical company to target it and raise awareness. The company was not being altruistic, but is it wrong to make money by informing someone that there is a way to relieve the distress they are experiencing? If you have ever talked to someone who really has this disorder, you know how much it disrupts their lives. Is it over diagnosed? Possibly, but polysomnography to make a firm diagnosis is expensive and it is a condition where the clinical symptoms are pretty reliable. Probably cheaper to just treat it.

“Because who’s still going to argue with your doc? Especially when he or she gets side benefits from giving in to the latest DTC ads on network news programs?”

I hate DTC ads. I would be good with a spot that just said, do you experience these symptoms (of RLS perhaps)? If you do, tell your doctor. I actually spent quite a bit of time telling patients why they did not need the newest, expensive drug they heard about on TV or in a magazine either because they didn’t meet the criteria for it or because I felt that the cheaper alternatives were just as effective and needed to be tried first. It was a hard sell, particularly when the patient would say, “but my insurance will cover it.” I, and I think most doctors, take being a good steward of the healthcare dollar seriously. In the past there were sometimes substantial “side benefits” from drug companies especially if you used really expensive things like artificial joints or pacemakers. The most I ever received was dinner in a restaurant and things like cheap pens and sticky note pads. These days there are no more cheap ballpoint pens and meals typically are take out from Newks or equivalent in the office during a presentation. Not something I am likely to sell my soul for although I understand the implications. Continue reading

Comment Of The Day: “Comment Of The Day: ‘No, Insurance Companies Treating People With Pre-Existing Conditions Differently From Other Customers Is Not Discrimination.’”

The health care/ACA/AHCA commentary from readers continues to be uniformly excellent. (It was originally spurred by the post, No, Insurance Companies Treating People With Pre-Existing Conditions Differently From Other Customers Is Not “Discrimination.”Spartan’s Comment of the Day on the topic has itself sparked its own Comment Of The Day, this one authored by Charles Green.

By fortune’s smiles, I was able to finally meet Charlie last week face to face, as he kindly alerted me that he would be passing through my neighborhood. Finally having personal contact with an Ethics Alarms reader is always a revealing and enjoyable experience, and this time especially so. I think you would all enjoy Charlie; I certainly did. Maybe I need to hold an Ethics Alarms convention.

Here is his Comment of the Day on the post, Comment Of The Day: “No, Insurance Companies Treating People With Pre-Existing Conditions Differently From Other Customers Is Not ‘Discrimination’.”

…The claim that “a free market system” and “freedom of choice” is the solution to all that ails us is a mindless mantra that is only occasionally true, but not always.

It’s important to be clear about when free market solutions are good, and when they are not. It’s not all that hard to sort out. Basically:

Free market solutions ought to be the presumptive default. Unless there is good reason to the contrary, they ought to be the rule.

1. Exception Number 1: Natural monopolies. It makes no sense to have competition for municipal water supplies; airports; multiple-gauge railroads; fishing grounds; groundwater; or police departments. The basic reason is the putative economic benefit is either simply not there, or is absurdly overwhelmed by the social confusion engendered by multiple suppliers.
In these cases, a form of regulated monopoly is desirable. (By the way, the airline industry at a national level is precisely this kind of market; we do not have too little competition there, but too little regulation).

2. Exception Number 2a: Wallet-driven market power monopolies. It’s strategy 101 in business schools that the way to be successful is to be #1 or #2, and the best way to do that is to get more market share than your competition, so you can drive them out of business. The one guaranteed way to do that is to cut prices so low that no one else can compete. Think Walmart. Think Amazon. Think Japanese in the 60s and 70s in any industry.
The reason we have anti-monopoly laws is to reset the playing field when a competitor dominates the market too strongly.

3. Exception Number 2b: Product-driven market power monopolies. Where the product is so obscure, expensive, infinitely variable, and difficult to understand that the producers are de facto in control, because it is too confusing and too dangerous to challenge them.
Drug prescriptions are an interesting example. The ‘free market solution’ to high drug prices was (partly) to let drug companies advertise, and to loosen up the definition of what constituted a ‘new’ drug. What did we get? New diseases like RLS, new definitions of ‘new’ (moving ‘off label’ to ‘on label’) and even higher drug company profits. Because who’s still going to argue with your doc? Especially when he or she gets side benefits from giving in to the latest DTC ads on network news programs?

Continue reading

Comment Of The Day: “No, Insurance Companies Treating People With Pre-Existing Conditions Differently From Other Customers Is Not ‘Discrimination’.”

There have been a lot of lively and articulate debates on Ethics Alarms since it began in late 2009, but I don’t know if any post has generated more thoughtful, informed and enlightening comments than this one. Many of them, and I mean ten or more, are Comment of the Day worthy. I would post them all, but it’s more efficient to just send you to the post. I’m very proud of Ethics Alarms readers on this one. It’s an honor to have followers so astute and diverse.

I chose Spartan‘s comment over the others in part because it was the most overtly about ethics, balancing and altruism. Plus the fact that she gets a lot of flack here, and yet perseveres with provocative comments that are well-reasoned and expressed. She is an excellent representative of all the commenters that add so much to this blog.

Here is Spartan’s Comment of the Day on the post, No, Insurance Companies Treating People With Pre-Existing Conditions Differently From Other Customers Is Not “Discrimination.”

The biggest problem — single payer is a jobs killer. I’ll admit that. Tens of thousands of people will have to find new jobs. Of course, there’s a flip side to this issue. Is it moral to sustain an industry that only benefits the rich and those who have access to employer-sponsored health care?

If we are going to get anywhere in this political debate, we have to be honest. Single payor is not sunshine and rainbows for all. Many people will have to find new jobs. Not everybody will love the care that they are provided. Medical students might decide to become stockbrokers instead because they will not make as much money. (On the plus side, the risk for med mal will go down so maybe there will not be a mass exodus.)

Another truth: a single payer plan will hurt the upper middle class the most. People like me. Because under single payer, I undoubtedly will have to pay more in taxes (the only way it could work), but I most likely will get a lower standard of care down the road. So, I imagine many people like me will go out and buy private insurance to sit on top of government provided medical care. So now I am even out more money. (Similarly, I don’t like my government provided education, so I pay money out of pocket for my kids’ school.)

While acknowledging all of this, I would still vote for single payer. In my view, it’s not ethical to let people die so other people can have jobs. That’s my position. If it means we can never go on another vacation or eat out again, it is more important to me that everyone have access to basic health care.