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A Quick Shot of Healthcare, Part 2 – When Morals Meet Medicine

By Brian | August 10, 2009 | Share on Facebook

I’ve been watching the current healthcare debate with great interest, and have a lot of opinions on various aspects of the matter, but can’t seem to consolidate them all into a single blog post. Instead, I’m queuing up a list of “quick shots” – thoughts on particular aspects of the debate – which I hope will spur some discussion

Remember, back in the early 1980′s, when the HIV/AIDS epidemic burst upon the scene? Without full information about what caused the disease or how it was transmitted, there was quite a bit of misinformation floating around. Specifically, I remember a burst of homophobia spewing forth – terms like “the gay plague,” claims that AIDS was God’s revenge on homosexuals, and so forth.

The whole thing kicked off a more fundamental debate. On one side was the radical, religious right who used the medical crisis to demonize the homosexual community. On the other side was the homosexual community and a host of more liberal social groups who’s message was basically “what two people do together in the privacy of their own home is none of your business.” And while this debate isn’t completely resolved (there will always be bigots in the world), I think that we’ve made tremendous progress in our society in accepting not only homosexuals, but a wide variety of groups who share some characteristic that makes them different from the majority.

Now, imagine the early 1980′s with a federal program of significant size providing healthcare to tens of millions of Americans (single payer or otherwise – doesn’t matter for our purposes here). Suddenly, the “what two people do together in the privacy of their own home is none of your business” argument has a massive hole in it. With one group (homosexuals in this case) consuming a disproportionate amount of health care expense, the live-and-let-live crowd would certainly lose some percentage of its members. After all, if your private activities are costing me some of my hard-earned tax dollars, then it very well might be my business after all. It makes me wonder, had the debate taken that tack, whether we would have made the kind of progress we’ve made today with regard to tolerance and equal rights.

Anyone who thinks I’m being an alarmist about this need only look at the current rumblings about obesity floating around the Internet (and, to some extent, Congress) these days. For now, we’re kicking around taxes on cheeseburgers. Are federal laws denying healthcare to those who’s BMI is over a certain threshold that far behind? How tenuous does the link between an activity and healthcare costs have to be before the government is allowed to legislate against it? Skydiving? Motorcycle riding? Hunting? Belonging to a college fraternity or sorority? Each of these activities presents known risks, and potentially raises the average cost of healthcare above the costs for those who don’t participate. Does that give us, the taxpayers, a vested interest in regulating them? And, more to the point, what of those people who will claim a vested interest, even when none truly exists?

It seems clear that some degree of additional government involvement in healthcare is inevitable at this point, and perhaps even warranted. However, I don’t think the implications of this involvement have been fully considered…

Topics: Political Rantings | 2 Comments »

2 Responses to “A Quick Shot of Healthcare, Part 2 – When Morals Meet Medicine”

  1. Jeff Porten says at August 10th, 2009 at 11:34 pm :
    I disagree with your initial premise: the 1980s backlash against homosexuals would have played out nearly exactly as it did, with or without the backdrop of AIDS. Your thesis is that a somewhat rational argument (them diseased gays are costing us money!) would have somehow swayed more people to the cause; I note that a majority of Californians didn’t require a rational argument in 2008, so I conclude that this argument is being made on an irrational basis.

    Which, unfortunately, pretty much covers most of these arguments. My guess is that most of the people who criticize me for smoking put out more carbon monoxide from their cars in a month than I will exhale in a lifetime, but driving is a sacrosanct activity, and smoking isn’t. If you want to extend that to societal costs, I’d be glad to see a comparison of costs stemming from automotive injuries and deaths, highway construction and maintenance, and the millions of square miles of valuable urban space set aside for temporary automobile storage. That’s before we start discussing the trillions of dollars spent on securing supplies of gasoline….

    But here’s where we agree: I think that one of the most corrosive aspects of American culture over the last 300 years has been our Puritanical streak, and it’s only been getting worse in the last few decades. Make any decision which might not be optimally healthy, and you’re treated as if you’re making a sin against God. (I note that Puritans frequently ignore the choices they make which are unhealthy for other people, as is their God-given right as Americans. /sarcasm)

    Personally, I’d address this in two ways:

    1) First, let’s start paying attention to what we do as a society which promotes negative health consequences. The rise of obesity in the US has been a hockey stick since the early 90s, which was not the previous trend. It seems to me that the role of government is on the Food, Inc. side of the equation — convince people that they have a societal role to play beyond investing billions of dollars developing unhealthy food, and billions more marketing it. Quick: name a famous brand of celery. Now name five famous brands of cheeseburgers.

    2) Second, let’s stop pretending that this is a matter of conscious, individual choice, and that everyone who makes bad choices is morally weak. We eat our weight in bacon because we’ve spent 34,950 years in societies where storing up fat was an excellent survival strategy, and 50 years where bacon goes on sale for $2 a pound. Likewise, our history of getting stoned out of our gourds dates back as least as long, so let’s not act surprised when free markets drench us all in fats, sugars, nicotine, caffeine, alcohol, and prescription and illegal drugs — all of which are arguably ingested because of the pleasant serotonin hit they provide.

    The solutions you propose are all stopgaps, and will have the effect of severely curtailing individual liberties — which is why most of them will fail. (The ones which will pass, of course, are the ones where the majority are culturally allowed to sneer at those who make those choices: right now, that includes smokers and drug addicts, but oddly excludes the red meat and alcohol crowd.) Makes more sense to me to promote cultural changes which makes healthy living the logical choice: food pyramids are always going to fail so long as McDonald’s and “Beef: it’s what’s for dinner” has larger marketing budgets, and few people will make time to exercise when we subsidize their ability to drive within 10 feet of every destination.

  2. Brian says at August 11th, 2009 at 12:24 pm :
    @Jeff – as is often the case, your first two words are “I disagree,” but then the rest of your comment seems to reinforce my point. I’m not talking about rational arguments. I’m talking about people with a moral, religious, or social axe to grind suddenly being able to wield the capitalism card as part of their debate arsenal. The effect will be to stir emotion, not build an air-tight business case (as you do when discussing smoking/driving and celery/cheeseburgers).

    Smoking and obesity are frowned upon in American society. But there’s a big difference between the Surgeon General warning you to stop and the Attorney General warning you to stop (or even the Internal Revenue warning you to stop…) Put another way, I don’t think anyone would argue with the federal government “promoting healthy living.” I think people would have a huge problem with them “mandating healthy living,” especially when they’re the ones who decide what “healthy living” is.

    As to your last paragraph, I haven’t proposed any solutions. The examples I gave at the end were meant to show how far afield the moral argument can get from anything that sounds like “healthcare.”

    Hunting, for instance, has historically been a debate between fourth ammendment advocates and public safety advocates. The gun control crowd talks about how many people are injured or killed by guns each year, and the NRA talks about gun safety training. In the scenario we’re discussing, our healthcare policy would suddenly allow the gun control crowd to claim a drain on our hard-earned tax dollars for all of those gun injuries. And if you think that’s just “one more thing,” witness the furor that erupted over $30K in spa treatments for AIG employees’ spouses, or $40K for an auto CEO to fly to Washington, DC on a private plane.

    There’s a subset of our society that is driven to action when they see a moral injustice (people needlessly injured by hunting rifles). There’s a much, much larger subset of society that are driven to action when they’re told their pocketbooks will be affected. As I said in the post, I don’t think the implications of this have been fully considered…

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