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Errantry: Novak's Journal
...Words to cast/My feelings into sculpted thoughts/To make some wisdom last
Personal: Thinking about the Health Care Debate 
16th-Aug-2009 10:08 pm
Lorenzo the Magnificent
Happy New [School] Year!

I have basically been an occasional observer at best about the current health care debates in the U.S., focused more on finishing my dissertation at this point, and more-or-less content to just see whatever Congress comes up with, willing to try it, and then make my judgments. But I have long had reservations about the way that the Republican Party's advertising – going back long before this particular episode of America's ongoing health care debate – has made noise about poor services in more nationally socialized medical programs like those in Canada and the U.K. I note this, specifically, as the advertisements play a report of someone who had an utterly dehumanizing experience in such a health care system, and repeat lines about "faceless bureaucrats" picking our healthcare options for us, as though these faceless government bureaucrats are qualitatively different than the faceless insurance company bureaucrats I now deal with.

Beyond the scare tactics designed to panic the masses (and make no mistake: I know perfectly well that the Democratic Party engages in the same kind of nonsense when they are protecting their own evil plots), I also have to say just how strongly these awful reports clash with every actual human being that I've ever talked with who live in such health care systems. When I was interviewing in Canada this past year, the Americans on the faculty to had been living there for some time positively raved about the quality of the health care, virtually sounding like I should get sick just so I can experience how good the system is. Along those lines, I was quite intrigued (and grateful; Thanks, J!) when nimoloth included this link to an American mother who blogged about the comparative positive and negative experiences she had of both the U.S. and U.K. health care systems. I hadn't read anything that thoughtful and un-alarmist in all of this sound and fury, and it was a welcome change from the soundbites I get from Congressional leaders in the newspapers or elsewhere. The simple declaration of access to medical care being a human right is putting the finger on the actual point, it seems to me, one our nation would do well to endorse.

I was particularly struck by the simple observation of it being comparatively crazy that people in the United State do not seek medical attention for fear of the cost. That's so true of my life that I never really thought about it as anything but a "given" in my life. My friend Amy was after me throughout the later end of the spring to go to the doctor for the persistent lung infection that had been weighing me down from Christmas to the end of April, and very much interfered with my work in that time, but it was a comparative no-brainer for me that it was better for me to try to "sweat it out" than deal with a medical expense that I couldn't afford. It's a brilliant business system: I pay insurance premiums that I cannot afford, which so alarm me in their cost that I then avoid using the insurance because I cannot afford the additional debt, even after the insurance picks up a percentage of the cost. It's utterly insane on my part, and yet a perfectly logical reaction given the insanity of the trap so many of us find ourselves in.
17th-Aug-2009 12:04 pm (UTC)
I note this, specifically, as the advertisements play a report of someone who had an utterly dehumanizing experience in such a health care system

I don't know if it's the same advert, but there are two women in the UK being shown in an American TV advert that bashes the NHS, and they're talking about their bad experiences, but according to them, their views are being taken completely out of context:

One British woman said she felt "duped" after becoming the unwitting star of an anti-Obama health campaign.

Kate Spall, who appeared in a US free market group's TV commercial opposing Mr Obama's health bill, said her views were misrepresented.

She told BBC Radio 4's The World at One: " "Absolutely I was deceived yes because when I then found out the link to the website and it was a huge political machine I was horrified because it was the polar opposite of what I believe in. I absolutely believe in universal health care."

Ms Spall and fellow Briton Katie Brickell's descriptions of poor treatment at the hands of the NHS featured in the Conservatives for Patients' Rights (CPR) advert.

Gordon made the interesting point that those with the most to loose, commercially (namely, the insurance companies and drugs companies) are the ones with the money to fund big, expensive anti-reform campaigns.

The whole concept of advertising prescription drugs is very weird to us. It serves to make people obsess about their health more than they probably should. It should be up to the doctor what prescription drug is appropriate, not the patient.
17th-Aug-2009 05:31 pm (UTC)
Yes, it's long been obvious over here that it is businesses "with the most to lose," as you point out, that are the power behind the resistance, although they will certainly deck themselves out in the trappings of grass-roots campaigns, which makes it harder to actually gauge popular opinion on the matter.

The advertising of drugs is very odd, because it creates hope/demand in the patients, who often have no special competence to know if a drug would be good for them. The doctors aren't a sure firewall against dismissing such demand. The investment that goes into developing new drugs is colossal, of course, and the drug companies naturally want to pull out all stops to recoup that investment. But I do wonder at whether the acceptance of that mercantile drive, and the permission to advertise in these ways, puts drugs out on the market that ought to be more restricted, even if they ought to have been allowed at all by the Food and Drug Administration.

I remember seeing an ad for Remicade on television once, which I could hardly believe, as I had already read something on that drug. The ads show happy, healthy-looking models who I doubt ever heard of Remicade. But as both the literature and TV ad reported, in the reasonable voice that seems to add, "Oh, yes, there are a few itsy-bitsy problems for some people (but probably not for you)," one of the possible side-effects from the drug was death. Death was a side-effect, as some users develop fatal blood disorders. ("Ask your doctor today!")
17th-Aug-2009 05:37 pm (UTC)
It must cause doctors no end of headaches, getting patients in all the time saying, "I need this" and "I need that" and second guessing them all the time because they saw some biased commercial. It seems to me like it disrupts the doctor-patient trust, which is a very bad thing.

Prescription drugs are not advertised here - I don't know about Europe. But it certainly doesn't seem to have done any harm to medical progress and scientific research and development. But then, that might not be a valid observation - I suspect many drug companies are large American or multi-national corporations. I suppose here they get the money as well, but it's from the government, not the insurance companies and public.
17th-Aug-2009 06:40 pm (UTC)
You're right: it really does create a kind of pro-active patient, which isn't bad as such, but this is perhaps a bit too specific. I had to learn not to offer such medical advice to my doctors. What was startling, was the way some doctors seemed to take my medical advice, which in the long run didn't do me much good.
17th-Aug-2009 08:33 pm (UTC)
Huh! That's an even more worrying effect, whether a result of laziness or fear or litigation, or some other reason.
17th-Aug-2009 12:46 pm (UTC)
I know perfectly well that the Democratic Party engages in the same kind of nonsense when they are protecting their own evil plots

I'd just like one recent example of when the Democratic Party has stooped to this level of nonsensical fearmongering bullshittery.

You could point to the ZOMG Iraq War is evil, but if we hadn't invaded Iraq we'd have plenty of money for healthcare and this wouldn't be an issue. And we wouldn't have launched a preemptive war that even the Pope was against.

Other than that, I can't think of an example that is on par with the current Republican Party headuptheirassedness. So please, do tell.
17th-Aug-2009 06:35 pm (UTC)
I think I was thinking in wider terms of just "manipulation" than solely the fearmongering sort, but off the top of my head, I'd say regarding:

1) Abortion. Even in the face of the possibility of reasonable restrictions of abortion-on-demand like a ban on the barbarism of the partial-birth abortions of viable babies, you immediately get the hue-and-cry that this means an immanent restriction on all abortion, a return to back alleys and coat hangers, and all the rest. The slippery-slope argument used here probably falls into that fearmongering category for that Democratic constituency.

2) Embryonic Stem-Cell Research. In the face of all reputable scientific reporting, the Democrats trumpeted miracle cures just around the corner if the conservatives would just stop preventing progress because of their ignorant obstinacy. In a state of fervour curiously like that of street preachers we were told that Michael J. Fox would stop trembling! Christopher Reeve would walk again! and (in the greatest of PR coups) Nancy Reagan might speak with her husband again.

But over the last decade, pluripotent stem cells (the kind of stem cell thought to be of potential therapeutic use in embryonic stem cells) have been produced without the cultivation and destruction of human embryos. This should have been a welcome announcement, as there were no ethical objections to these other sources. But it ties back to the Democratic commitment to abortion on demand, which is what the fight had really always been about.

The objection to harvesting human embryos for the gain of other people came far too close to admitting that there was something wrong in treating human embryos this way, which would be far too close to admitting that even developing human men and women were deserving of the legal protection of human rights. And so the ferocious commitment on the Democratic part to insisting on the use of embryonic cells in particular, despite the ethically-preferable alternative. And all this while embracing promises for which there was no evidence in a political abuse of science that was mainstreamed in a way that similar abuses among some Republicans, like so-called "scientific creationism," could only dream of. The history of the politicizing of this science makes for fascinating reading.

3) School choice. In what almost sounds like an ironic invocation of the Dem's party language on abortion as a matter of "freedom of choice" for the chooser, the movement for school vouchers and equal access to diverse educational resources and options sounds like it should be a no-brainer, given the Democratic use of "diversity" as one of their touchstones. But here too there has been an outpouring of Democratic ferocity in shouting down an idea that, at the very least, seems worth a try in the face of obvious local public school deficiencies. But especially when some of the school options fall into the Catholic school system, we make that curious discovery that in the American Left "diversity" tends to mean "believing what we believe," which apparently is the right way to be diverse.

17th-Aug-2009 06:36 pm (UTC)

4. Politics as mental health. Maybe this doesn't pertain quite so formally to the Democratic Party, per se, but it is a trait I see embraced by those in the party. This last is a bit of demagoguery that I haven't really heard anyone point out, but which I'm familiar with because of my studies in Soviet history. The far political Right just seems to justify its acts in the name of preference or power: we don't like you, so off to the concentration camp you go. The far political Left, on the other hand, given that its theoretical justifications are all in the name of "equality," "the people," and so on, have had to be more circumspect in their harshness. And so, if you went too far away from the hard Left position of the Party, you were mentally ill.

I see a similar usage in the hard push in the last twenty years from the gay rights movement with the tactic of proclaiming anyone opposed to or even questioning their agenda as suffering from a hitherto undiagnosed (or medically-recognized) mental illness called homophobia. There are distinct tactical advantages in this language, rather than just simply speaking of people who were bigoted against homosexuals. Argument, as such, is dispensed with: you don't argue with the mentally ill. And people certainly don't want to be labeled as mentally ill or as so ugly an unenlightened sort of individual, and so there is a pressure to conform to the agenda so as to avoid the label. There is no need to actually debate whether this is only a matter of protecting the legal rights of homosexuals (which they already legally possessed outside of their sexual orientation), or whether the state has an interested in giving a preferential option to the fecund, baby-producing heterosexual union. That's all sidestepped by this streamlining of language.

It's quite akin, I might add, to the current tendency one hears of understanding caveats that people who vote for the Republican Party are less educated, less informed, not very worldly. Intentional or not, that's another version of this sort of "passive-aggressive" approach to a political position, where the main motive force in an argument is not what I think true or best for the state, but what kind of public perception, fashionable or unfashionable, I wish to possess. The Republican Party has conducted the same kind of nonsense in their use of the word "Patriotic" in the last Bush Administration, where the "Patriot Act" became unassailable because, hey!, it says right on the cover: this is patriotic. And, of course, when the threat of being labeled "unpatriotic" was played against the Dems by Bush, most of them rolled right over, making them equally guilty for the Iraq War, in my opinion, along with Bush, whatever noises they made later when it was deemed politically safe or useful.

And because I am sensitive to such political threats (not from you, but from any other readers), I will note here for the record that despite my willingness to state matters in the above way, I utterly repudiate any implication that I am homophobic or against homosexual people in any way. I had gay friends, some of my best friends, long years before the contemporary surge in the gay rights movement during the Clinton administration. I respected and befriended such persons long before it was fashionable to do so, and I will continue to do so long after it becomes fashionable to do so, should such winds change.

Oi. You made me write a lot. So much that I had to break the response in two. But, anyway, that's the kind of thing that comes to my mind when I think of the Democratic Party engaged in the kind of nonsense that the Republican Party is currently engaged in or allowing.
17th-Aug-2009 05:28 pm (UTC)
It's a brilliant business system: I pay insurance premiums that I cannot afford, which so alarm me in their cost that I then avoid using the insurance because I cannot afford the additional debt, even after the insurance picks up a percentage of the cost. It's utterly insane on my part, and yet a perfectly logical reaction given the insanity of the trap so many of us find ourselves in.


We have insurance through Dan's school. It's very good, for grad student insurance, and we only have to pay the premiums for me and Abby - the school pays for Dan's. But we have a $5000 deductible for most major procedures (excluding birth, thankfully), and so Dan is not getting a surgery he should have to correct a genetic deformity in both his feet. We're pretty sure he can have it done later on without serious consequences. But there's no way we can afford to pay $5000 out of pocket for him to have it done while he's in school. So we'll have to wait until he has a real job, aka better insurance, or at least more money with which to pay insane premiums and deductibles.
17th-Aug-2009 06:37 pm (UTC)
Exactly. On top of the premiums, that deductible kills.
17th-Aug-2009 10:03 pm (UTC)
I concur upon this point as well. Mine is sky-high. I don't understand why the government isn't more concerned about regulating things like ridiculous deductibles and pill costs. It doesn't seem like it would be all that difficult, compared to some solutions, if done well.
17th-Aug-2009 09:55 pm (UTC)
After having lived in Canada for, oh, about six weeks, and being involved in more than a few discussions about health care with the locals, I can say positively that the vast majority of Canadians I've talked to despise the system. Three people on this program had relatives who died because their cancer/disease surgeries were scheduled five or six months after major diagnoses due to the doctor shortage, and they didn't live long enough to get in. Francis was actually just at another funeral for a situation like this on Saturday.

I guess I just generally find that personal experience isn't a terribly helpful meter when it comes to these kinds of topics - or anyway, that's the kindest conclusion I can take from these experiences when it comes to health care reform.
18th-Aug-2009 12:35 am (UTC)
Huh. I'm sorry to hear of that. "Doctor shortage" isn't a phrase I had heard. That kind of frustration makes for an interesting and tragic contrast to what I reported. I wonder if that's a geographical difference in access, whether rural Alberta versus urban Ontario (with a major medical school in the center of town), or even simply Alberta versus Ontario?

No, I'm sure personal experience is a variable meter in that "you can always find someone who feels x," but it certainly is more helpful to me when I don't feel that I'm hearing what "the average personal experience" or consensus is as helpfully transmitted to me by a political party or by a political action group funded by an insurance company or the like.
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19th-Aug-2009 06:41 pm (UTC)
I am really not familiar with other countries' national health care systems - I hear stories, too, but of course don't know all the facts.

I think what I find appealing about the idea of a national health care plan is the notion that to some extent, there would be accountability to the people, as opposed to health care being this private business run by companies that don't really care about us. The government might not, either, I suppose, but if hate the way they're running their health care plan, we can write, lobby, vote them out of office, vote to get rid of it, vote for improvements, whatever. Would it be perfect? No. Would we get everything we wanted or felt we deserved? Probably not. But we might have a voice. Right now, we've got nothing. Insurance companies don't give a frak about any of us and don't have to listen to our concerns; in fact, it's their business to make money at our expense.
18th-Aug-2009 03:55 am (UTC)
I read through every single comment--it took almost 3 hours--and I found the repeated sentiment of "how can Americans live with this, with not having equal rights to insurance" ringing out in so many comments. When Dan lost his job last winter, I IMMEDIATELY started panicking about the insurance. Luckily--very luckily, especially now at a time when jobs are scarce--he found one within a couple of months. What people don't understand is that it can take one serious car accident or emergency surgery or sudden to lead you into bankruptcy, losing your home, etc. Insurance really doesn't mean much if you live in the barely-hanging-on middle class or any of the strata below that. There but for the Grace of God go I.

I also have experienced the attitude of "those who don't make money/can't afford health care don't deserve it". That actually sounds quite "American" to me, and then I realize that I was once one of the undeserving, unwashed multitude who "didn't deserve it."

I well remember being uninsured after college, becoming very ill, and not being able to afford my meds. Luckily I had the safety net of my parents; if I'd been totally on my own, I might today (and for the rest of my life) have very serious health problems. I really hope that we get some kind of public option, because honestly I just want peace of mind. And I realize that I haven't had that since I was 21 and ill. The same fear of getting sick and not being covered has lurked under the surface ever since, as something of which I am always conscious.
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