The Right to Health.

[Rawedge Rim]

I think that people that abuse their bodies and create avoidable problems should find themselves at a very low priority level when it comes to the distribution of healthcare resources.

Someone should really examine that [very common] sentiment.

Basically you are saying that some people do not deserve such a societal benefit. But do you know why you wish this? Possible reasons could be:
- these people are criminals and so should forfeit the benefits of society
- these people are imperfect and so should forfeit the benefits of society
- these people are unwise and so should forfeit the benefits of society
- these people could have saved me money and so should forfeit the benefits of society

I would not be proud to claim any of these reasons as mine. Perhaps this is why people always gloss over this aspect and never put a name to it.

The fact that you're mitigating your position ("a very low priority") rather than taking the harder stance that many people might take (being denied healthcare altogether) sounds like you at least feel the ethical paucity of this position.

How many times have you seen some guy outside puffing away on a cigarette and pulling an O2 bottle? I've seen several.

How often do you go into a supermarket and see someone who weighs in excess of 350 lbs. (159 kilos for those outside the US) riding around on a motorized scooter?

Who should have priority in funding? One of the above, or some kid who drew the short straw and has leukemia?

[aliantha]

I thought conservatives were against death panels.

[Cail]

I thought conservatives were against death panels.

No, just that dipshit Sarah Palin.

[wayfriend]

Actually, WF, as someone espousing common sense healthcare reform on a pragmatic basis, I don't feel the least compunction....

Yes, I get that. But I was wondering why you thought such people deserved such punishment. Or if you would avoid saying why. You avoided saying why; I have my answer.

Rawedge Rim did the same.

If someone is going to penalize someone, they should be able to point to some legal principle for doing so. It's a fair question to ask, and one which applies here.

Lacking that, you can't fault someone for assuming that your reason amounts to something like "those who fall behind should get left behind", some form of social darwinism. Because that is what it looks like. And it makes perfect sense that you would avoid admitting as much.

[SoulBiter]

Actually, WF, as someone espousing common sense healthcare reform on a pragmatic basis, I don't feel the least compunction....

Yes, I get that. But I was wondering why you thought such people deserved such punishment. Or if you would avoid saying why. You avoided saying why; I have my answer.

Rawedge Rim did the same.

If someone is going to penalize someone, they should be able to point to some legal principle for doing so. It's a fair question to ask, and one which applies here.

Lacking that, you can't fault someone for assuming that your reason amounts to something like "those who fall behind should get left behind", some form of social darwinism. Because that is what it looks like. And it makes perfect sense that you would avoid admitting as much.

The legal principle is "consequences for your actions". I know people who throw trash out their car window or clean their car out in a parking lot, and their reasoning is, 'well someone else gets paid to clean this up".

The idea is the same. I can do things for my entire life that are self-destructive to my health and "hey even better", its OK because someone else has to pay for it.

[Obi-Wan Nihilo]

Actually, WF, as someone espousing common sense healthcare reform on a pragmatic basis, I don't feel the least compunction....

Yes, I get that. But I was wondering why you thought such people deserved such punishment. Or if you would avoid saying why. You avoided saying why; I have my answer.

Rawedge Rim did the same.

If someone is going to penalize someone, they should be able to point to some legal principle for doing so. It's a fair question to ask, and one which applies here.

Lacking that, you can't fault someone for assuming that your reason amounts to something like "those who fall behind should get left behind", some form of social darwinism. Because that is what it looks like. And it makes perfect sense that you would avoid admitting as much.

Thanks for the aspersions, WF, it woke me up a bit. I needed to dust off my hypocrisy windshield wipers anyway, they hadn't been used enough lately. I guess I kind of get what you're saying -- in a way. Just look at my signature (hoisted on my own petard, as it were).

I'll ask you this, WF: if you accept the assumption that there is a limited amount of potential healthcare floating out there at any one time, both fiscally and absolutely, so that questions of care are actually lifeboat-type scenarios writ large, then doesn't it make sense to prioritize? And if we are prioritizing matters of life and death, sickness and health, all of which have moral implications for the healthcare provider rather than mere questions of utility, then aren't we required to weigh the moral condition of the healthcare consumer as well for merit? And setting aside questions of practicality -- such as whether someone's past bad behavior indicates whether they will take the steps necessary to realize the full benefit of the care being provided -- or questions of moral hazard -- such as whether a system that does not reward good behavior while punishing bad does not in fact worsen the problem and thus lead to additional wasted resources -- doesn't the mere fact of culpability for one's illness diminish the claims a person may have upon society to bail them out of the condition they are in, especially compared with other healthcare consumers who have acted prudently but have become ill anyway? If a person is culpable for harming a person, even if it is themselves and by extension society as a whole due to the encumbrance of their subsequent care, doesn't that reduce their moral priority in the lifeboat when care is being handed out?

[Zarathustra]

Actually, you are rejecting the legitimacy of taxation where it is applied to social programs on the basis of property rights. Namely that your property rights are violated by said taxation. If your compliance is secured only by force it hardly matters, but the notion that your property must be regarded as existing in a vacuum where society is concerned, and that no valid claim can be made upon it that does not fit with your immediate and limited conception of your own self interest, is fallacious. Naturally the disposition of your property would be quite different, or even non-existent if no society existed at all.

I think property rights are violated by wealth redistributive schemes of the government. However, taxes to build roads or armies aren't a violation of property rights, because you're not taking property from one group of people and giving it to others. Instead, you're actually spending money on society, because everyone benefits from national defense, etc. And taxation for collective purposes makes sense based on points like yours regarding our connection/dependency upon society.

None of those points obligate me to take care of people who can afford to take care of themselves and who are the cause of their own problems.

So when you say that your money and your land ought to be yours to do with what you please without the encumbrance of others, perhaps you should glance down at the Federal Reserve Note in your hand and see what is said upon it, or examine the deed to your property and take note of its original signatory and notary. Yes you own those things, and yet they are also a subordinate part of a collective enterprise; and sometimes Caesar comes round to take his due.

I don't believe anything I've said is at odds with this.

All you really have to know is that the US pays more per capita for less coverage than any other industrial nation. There are better approaches out there, if we are only willing to learn.

I agree that there are better approaches, and we do pay more, but it's false to say we are paying for less coverage. We have access to more health care options (drugs, procedures, tests, etc.) than other countries, because they ration by taking cost effectiveness into account, and we do not. For instance, Provenge [for prostate cancer] isn't covered by the UK health system, even though it's proven to add months to the life of someone dying of this cancer. It's very expensive ($90,000), but American insurance and Medicare pays for it. In our system, you get to choose whether or not those extra months of life are worth it. In another country, the government would decide that the cost isn't worth your extra months.

Now, perhaps there are some here who think that 90K is too much to spend to give a few extra months of life, but the point is that you can't say that we're paying for less coverage. We're not. We have more options than everyone else. And it shows in the bill.

...I was curious why these other things are allowed, but healthcare for the fat neighbour is off the table. Was curious about the philosophy there (since this philosophy that a society holds determines whether or not you provide healthcare).

You really need a philosophy to explain the concept of personal responsibility? The idea is that foreign to you? My fat neighbor can have all the health care he wants, just like donuts. But he can't have as much of my money as he wants, to pay for either. This is not complicated.

I don't think my skinny neighbor should have the right to vote himself my money, either. But it's just especially galling for someone who creates their own health problems to demand that others fix it, indeed that this is a "right," for which they have NO corresponding responsibility (apparently). Where did my alleged responsibility to take care of my neighbor's health come from? Where did his actual responsibility to take care of his own health go? I think that's what needs a philosophy to explain. "I want this, but don't want to pay for it" isn't a philosophy. It's usually described as theft in most other contexts.

I also don't understand singling out these fat people, chain smokers, drinkers and so and holding them up as a reason to not provide healthcare because they are 'freeloaders' by existing as they are. So what if some people do stupid things. All people do stupid things. How does it hurt you if some people are fat and get healthcare from a system that you pay into? How would it benefit you from an enlightened self interest point of view?

The reason to single them out is because the idea of health being an alleged right. It makes no sense to obligate society to provide something that people are willfully squandering--showing that they don't value this thing that they claim is a right. It would be like saying everyone has the right to a free home, and then millions of people burning down their homes to get a new one. We can't afford to do this, and it wouldn't be right to force the prosperous to pay for things that others are just burning down.

But if you don't think it's a right, then there's the pragmatic argument. If you make it easier for people to escape the consequences of their actions, then you make it less likely that they'll make good choices. The end goal should be better health, not making it easier to ignore one's responsibility to be healthy. We would merely become enablers of their bad choices.

I think the more you "help" people by doing things for them that they can and should do for themselves, the more you end up hurting them. Dependency destroys people. We are a rich, spoiled, pampered country. Making us even more spoiled will only speed our decline.

[Zarathustra]

I'm close to someone who is obese, who has had multiple health care problems, some of which have required surgery, when every single one of these issues could have been fixed by simply losing weight. This person has had her knees replaced ... a completely unnecessary surgery for a person of normal weight. Losing weight would be free, whereas the surgery was very expensive. But she had Medicare which pays for it, so guess which option she chose? She also had some swelling in the night that made it difficult to see in the morning, because her eye lids would swell. Rather than taking a cheap drug (she doesn't like drugs) to reduce fluids, or check on a new CPAP mask (something else she wouldn't need if she wasn't obese), she decided she wanted another surgery, a blepharoplasty, which is basically cosmetic surgery on your eyelids. It's an expensive and extreme way to treat this condition--again, a condition which should wouldn't have if she were fit--but since Medicare pays for it, who cares? Why not go the extreme route, instead of just losing weight? Losing weight is hard and takes personal responsibility. But using tax payer dollars and the expertise of our health care professionals is easy.

This is the problem with providing "free" health care to people who have developed a life style of ignoring their health. When things like surgery are "free," these options start to make sense to people, even when they already have truly free options that would fix the problem in a much healthier, less extreme manner ... if they would only use willpower and take responsibility.

To her credit, she is now losing weight. Good for her. She could have saved herself decades of poor health, and thousands of tax payer dollars, if she'd just made this simple decision years ago. But if we make it easier for people in general not to make this decision, we'll encourage them to have otherwise unnecessary surgeries and medicines, consuming our precious health care resources simply because they choose not to be responsible. I think that's reprehensible.

Others here are describing this position as "abandoning those who fall behind," but it has nothing to do with being a big Meanie. This caricature is only possible by ignoring the fact that people who create their own problems often have the means to fix them readily available. It's not punishing them (another caricature being tossed around) to point out that they often *can* solve their own problems, and that our system should encourage this, rather than the opposite. Not only would it be cheaper for everyone, but everyone would be healthier. That's not leaving people behind or punishing them.

[wayfriend]

The legal principle is "consequences for your actions".

That's not one. It's begging the question. The question is what did these people do to deserve the negative consequences? Why does being unhealthy merit punishment?

then doesn't it make sense to prioritize?

Putting people at a lower priority than others is punitive. They had best deserve this punitive action. What did they do to deserve punitive action? This is the question I am asking.

then aren't we required to weigh the moral condition of the healthcare consumer as well for merit?

Sure. What is the moral condition that deserves punitive action? That's all I want to know.

doesn't the mere fact of culpability for one's illness diminish the claims a person may have upon society to bail them out of the condition they are in

Does it? That's a very astounding position. Very, very astounding.

Does a person deserve less police protection because they didn't lock their door?

Does a person deserve to have their house burn down because they lit a candle and so the fire department said, screw it?

I could go on, but you get my point I think. Punishing someone in this way is tantamount to looking for excuses to ostracize someone from society. One slip-up, your out of the club. This is not a society of equals. This is a society where your class is determined by your grade -- and where what people are graded on is chosen to suit you.

But there's still the question of why, which seems to avoid focus. WHY do people who are imperfect in their health care deserve punishment?

The last statement you made about 'moral condition' suggests that you find unhealthy people to be morally wrong somehow. But with no explanation as to how they are morally wrong, or why it deserves punishment in this form.

Just say why. Thanks.

[Obi-Wan Nihilo]

The legal principle is "consequences for your actions".

That's not one. It's begging the question. The question is what did these people do to deserve the negative consequences? Why does being unhealthy merit punishment?

They willfully caused their own illnesses.

then doesn't it make sense to prioritize?

Putting people at a lower priority than others is punitive. They had best deserve this punitive action. What did they do to deserve punitive action? This is the question I am asking.

They willfully caused their own illness.

then aren't we required to weigh the moral condition of the healthcare consumer as well for merit?

Sure. What is the moral condition that deserves punitive action? That's all I want to know.

The choice to willfully cause one's own illness.

doesn't the mere fact of culpability for one's illness diminish the claims a person may have upon society to bail them out of the condition they are in

Does it? That's a very astounding position. Very, very astounding.

Does a person deserve less police protection because they didn't lock their door?

Does a person deserve to have their house burn down because they lit a candle and so the fire department said, screw it?

I could go on, but you get my point I think. Punishing someone in this way is tantamount to looking for excuses to ostracize someone from society. One slip-up, your out of the club. This is not a society of equals. This is a society where your class is determined by your grade -- and where what people are graded on is chosen to suit you.

But there's still the question of why, which seems to avoid focus. WHY do people who are imperfect in their health care deserve punishment?

The last statement you made about 'moral condition' suggests that you find unhealthy people to be morally wrong somehow. But with no explanation as to how they are morally wrong, or why it deserves punishment in this form.

Just say why. Thanks.

Your analogies are not apt. We are not talking about lighting a candle, we are talking about setting your own house on fire. Is it just for firefighters to put their lives at hazard to pull you safely out of the same house you have doused in gasoline and struck a match to? Or better yet, to miss the opportunity to save the people in the house next door which is on fire because it was struck by lightning, because they are having to waste precious minutes chase you all over your burning house and physically forcing you out of it?

Of course not. If I'm the fire marshal, we're going to prioritize our response to other emergencies. Not so say we won't use the hose to keep the flames down or yell in the door to see if anyone wants to be saved, but we aren't going to waste time and valuable resources saving someone that is hell bent on self destruction.

[Ananda]

Mongo,

If you choose to drive too fast because you are late to work and get into an accident, severely injuring yourself and requiring long amounts of physical work and so, should you not get it because you chose to drive too fast?

I actually live in a society where we provide healthcare for alla. We don't discriminate based on choices. We have no problems from it. Seems really silly to try to decide who does get care based on there personal choices. Also, the examples about choosing a fat, chain smoking drinker or a child for some transplant or whatever is silly since systems already prioritise based on those factors.

[Obi-Wan Nihilo]

Then I agree with those systems. Our current system doesn't make those distinctions, and it is moving us towards national bankruptcy.

[SoulBiter]

We are not talking about lighting a candle, we are talking about setting your own house on fire. Is it just for firefighters to put their lives at hazard to pull you safely out of the same house you have doused in gasoline and struck a match to? Or better yet, to miss the opportunity to save the people in the house next door which is on fire because it was struck by lightning, because they are having to waste precious minutes chase you all over your burning house and physically forcing you out of it?

.

Best analogy yet. Good post Mong!!!

[Obi-Wan Nihilo]

Ananda, there is something else you may not be aware of. In the US, 5% of the patients incur 50% of all healthcare costs. Many of the people, possibly most, are afflicted with avoidable diseases that are a consequence of lifestyle choices: smoking, unhealthy diet, morbidly obese, sedentary, alcoholism, etc.

[Vraith]

Ananda, there is something else you may not be aware of. In the US, 5% of the patients incur 50% of all healthcare costs. Many of the people, possibly most, are afflicted with avoidable diseases that are a consequence of lifestyle choices: smoking, unhealthy diet, morbidly obese, sedentary, alcoholism, etc.

the first number is correct.
the second statement is false. It's complicated issue, and avoiding those things is certainly a good thing for the individual and the system.
But those are just risk factors. And in all those cases the number of people WITH a disease and NONE of those risk factors is greater. [there are specific contraries...like smoking and lung cancer].
The largest, by far, risk factor is living a long time.
The single largest cost factor is technology.
the next largest is the combination of subsidies for hospitals and punishment
of individual practices.
Fat, lazy smokers is much farther down the list.

And three of the things you listed would be easily managed by the thing I said earlier...the boring thing I've said many times...treat sugar and all added sweeteners [except maybe stevia] as if they were tobacco.

[Ananda]

Ananda, there is something else you may not be aware of. In the US, 5% of the patients incur 50% of all healthcare costs. Many of the people, possibly most, are afflicted with avoidable diseases that are a consequence of lifestyle choices: smoking, unhealthy diet, morbidly obese, sedentary, alcoholism, etc.

I guess it is like that everywhere, M. Nihil. People who are sick are sick. People who are not sick are not sick. You didn't answer about how far you want personal choices to factor in. Does the man who chooses to drive too fast because he is late for work after typing a long post on a forum about how fat asses shouldn't get healthcare receive treatment when he is in a wreck? How far do these choices go in affecting? I think it is absurd, but once that box is open, it is open. This is why we cover for all.

You guys are forgetting about enlightened self interest in making a better society, too.

[SoulBiter]

www.aetna.com/health-reform-connection/ ... costs.html

I looked up several site and unhealthy lifestyles and obesity ranked around 3rd on most lists.

Unhealthy lifestyles

The growing burden of chronic diseases adds significantly to escalating health care costs. Researchers predict a 42 percent increase in chronic disease cases by 2023, adding $4.2 trillion in treatment costs and lost economic output.18 Much of this cost is preventable, since many chronic conditions are linked to unhealthy lifestyles. For example, obesity accounts for an estimated 12 percent of the health spending growth in recent years.

[Vraith]

www.aetna.com/health-reform-connection/ ... costs.html

I looked up several site and unhealthy lifestyles and obesity ranked around 3rd on most lists.

Unhealthy lifestyles

The growing burden of chronic diseases adds significantly to escalating health care costs. Researchers predict a 42 percent increase in chronic disease cases by 2023, adding $4.2 trillion in treatment costs and lost economic output.18 Much of this cost is preventable, since many chronic conditions are linked to unhealthy lifestyles. For example, obesity accounts for an estimated 12 percent of the health spending growth in recent years.

ARE LINKED, not caused by. And 12%? That shows exactly what I said.
AND it doesn't address the CAUSE of OBESITY...which is far less choice driven than people will have you believe.

[Ananda]

AND it doesn't address the CAUSE of OBESITY...which is far less choice driven than people will have you believe.

Yes, I was thinking to mention this, but it is sort of a side factor here and no matter the cause, covering all is the way to go in my opinion. It is kind, humane, and makes sense from a selfish 'we want a better society' standpoint. It is a win-win.

But, yes, there are other factors like:
- people do jobbs at desks more now
- a large percentage and climbing don't know how to cook a real meal for themselves that doesn't come out of a box
- the processed food in said boxes is total shit and easily makes you more unhealthy

We talked about it before, but each generation is less able to cook for themselves. Our societies are also restructuring around screens in the last decades. I am amazed by these young people (late teens, early twenties) who sits by a computer on a friday night playing games rather than be out dancing, partying, being crazy. Have we turned to the zen of screen? It is certainly a shift in being that has taken place in the last decades in many societies. Our social structure and interaction models are totally changing.

[SoulBiter]

AND it doesn't address the CAUSE of OBESITY...which is far less choice driven than people will have you believe.

Yes, I was thinking to mention this, but it is sort of a side factor here and no matter the cause, covering all is the way to go in my opinion. It is kind, humane, and makes sense from a selfish 'we want a better society' standpoint. It is a win-win.

But, yes, there are other factors like:
- people do jobbs at desks more now
- a large percentage and climbing don't know how to cook a real meal for themselves that doesn't come out of a box
- the processed food in said boxes is total shit and easily makes you more unhealthy

We talked about it before, but each generation is less able to cook for themselves. Our societies are also restructuring around screens in the last decades. I am amazed by these young people (late teens, early twenties) who sits by a computer on a friday night playing games rather than be out dancing, partying, being crazy. Have we turned to the zen of screen? It is certainly a shift in being that has taken place in the last decades in many societies. Our social structure and interaction models are totally changing.

I agree with the above. Yet most of what you posted above is preventable with education, will power, and the motivation to do something other than sit on the coach or in front of a computer.

And Vraith - 12% preventable and only obesity... how much does smoking add to that list? Then lets add in sedentary lifestyles... now the percentage is going up .....,