Because most philosophies that frown on reproduction don't survive.

Thursday, August 20, 2009

Who Says No

People at various points in the ideological spectrum have pointed out it's a little odd to see conservatives objecting to the idea of the government deciding what medical procedures ought not to be covered, when they're apparently okay with insurance companies deciding what procedures ought not be covered, or with people not being able to afford procedures because they lack good insurance. However, it strikes me this difference may actually make a fair amount of sense, both for some pragmatic reasons and some emotional/ideological ones.


There are lots of insurance companies, and when polled people often rate their own pretty high. So many people may not expect to ever have problems with their own insurance companies refusing to cover something vital. However, people (conservatives especially) don't tend to trust the government very much, and there's only one. So people who hear about insurance company problems can tell themselves (rightly or wrong) "It won't happen to me." But if the government decides to block something, everyone knows it will effect him.

With insurance companies paying for care, one can always try to use public shame (driving away customers) or lawsuits, or government regulation to make them provide some service you think they owe you -- however if the government is making those decisions people are probably more skeptical of their ability to appeal to the government to get the government to reverse its decision on something. (Most people have experienced this with disputing a cop's version of a traffic stop, or trying to get an appeal through the IRS. It's not easy.)

It's often slow to get government programs to change rules even when it could save them money -- while private enterprises have more obvious incentive to do this. For example, my mom and her parents recently struggled with a rule in my grandfather's veteran's benefits that they would only cover a stay at a rehabilitation facility after a stroke if he'd been in the hospital for at least three days first. This despite his doctor insisting he didn't need to be in the hospital three days, he was ready to be discharged so long as he could get rehabilitative care.


Conservatives at least (liberals seem to have a greater tendency to be deterministic about these things) tend to figure that since insurance is something you buy that if it doesn't cover what you want you could always buy something else. The government saying "that's not covered" simple feels more final to people.

Upsetting as they may be at times, your insurance company in some sense works for you. American consumers have a strong sense of their rights as consumers. (If you doubt this, try getting service at a business in the UK and note the difference.) Few people manage to feel that the government works for them. It does, after all, have the power to arrest your or fine you if you get out of line. Most people would rather fight a customer service rep than "fight city hall".

People prefer making hard choices themselves -- even if it's not much of a "choice". "There's a very experimental treatment available, but the chances of success are low and I don't want to bankrupt by family" has a certain nobility to it. It sounds like you faced a hard choice and did the stoic thing. "There's an experimental treatment available, but a government panel decided that it didn't provide sufficient increase in life expectancy so it's not available in this country," sounds like the system stuck it to you. (This is probably one of the biggest emotional differences between conservatives and liberals on the issue, since it seems that many liberals feel like it's being stuck to them by the system when a company won't sell them something affordibly, but consider the government to be an "us" with only the common good in mind rather than a "them" mostly interested in itself.)


Anonymous said...

Thank you, darwin, for cogently explaining that death panels a) already exist; and b) are necessary.


Darwin said...

Actually, I think what I just explained ties into a basic fact that the Democrats in congress have not been able to wrap their minds around for the last 16+ years:

Americans will generally rebel against the idea of centralized government health care unless the benefits are so generous that they would quickly bankrupt the system.

They don't seem to get that the reason they can win elections talking about health care reforms is that a plurality of voters want more coverage for less money -- however that's something which they simply cannot have, so attempts to turn those election victories into actions won't work.

Anonymous said...

Um, no, what you explained is why conservatives "[object] to the idea of the government deciding what medical procedures ought not to be covered, when they're apparently okay with insurance companies deciding what procedures ought not be covered".

But in my comment I focussed on a side point, which is that death panels, by the definition you used in the "Freak Show" comment thread, are already here, and have been here for 40+ years, and everybody agrees that they are necessary.

CMinor said...

An English businessman dining in Paris found a fly in his soup. He hailed the waiter and pointed at the offending insect, growling, "Le mouche!"

The waiter, being thoroughly Parisian, looked down his nose at his customer and corrected, "La mouche, Monsieur."

The Englishman eyed his bowl suspiciously, then muttered, "D__n good eyesight!"

And I say to Joel, "D__n good eyesight!" (also, lighten up.)
I sure didn't see those two "mouches" in this particular soup.

Seriously, though, Darwin, I think the point is that the means differ even if the end might be the same. A patient deciding to refuse a treatment on the grounds that in may not help does not a "death panel" make; he's an informed consumer choosing among options. If you assume the government health plan will eventually crowd out private options, then once the government decides it won't cover treatment A good luck making a choice about it.

Joel, I don't agree on "death panels" being necessary, but I understand something very close is arising in states that have legalized assisted suicide.

Glenna said...

I've worked in healthcare in this country for 30 yrs. There is already big $$ being made by physicians, hospitals, insurance co & pharm. People have always been triaged not only medically but financially. On any given day, we're trying to decide which amputee gets to go to a rehab facility, which G tube recipient gets the formula ordered by their physician which costs $500/mo or which patient will get the third line antibiotic when the first line would be best.
That said, there is absolutely NO chance that the feds can fix this. One of the many many reasons we're in the mess we are in now is because there has been no Medicare accountability since its inception. Insurance companies have employed case mgrs for years to call hospitals or stepdown facilities every day or two to simply ask: "What are you doing today, tomorrow etc that couldn't be done at home?". Medicare has only started some accountability (mostly via claims) within the last few yrs.
Darwin, this discussion would be much more worthwhile if, instead of framing it in the context of liberals vs conservatives, you'd look at it thru the lens of B16's last encyclical Love in Truth. By applying the principles of subsidiarity, common good etc, we'd expand our vision beyond the pitiful borders of the USA.

Foxfier said...

On the topic of medicare/medicaid accountability, anyone heard this story?

Planned Parenthood of Spokane found to have over-billed by $700k in just a few years in an audit, including for abortion supplies.

Glenna said...

This PP article is just illustrative of my point (above). I wish I could say that its just PP but basically its human nature. If we're on the honor system, we can bet somebody will try to game it. I've never worked for PP, thank God, but I have worked for depts where I regularly heard "We've got round that up or spend that money or the feds won't match it next fiscal year." Like I said, there is not a snowball's chance that the federal gov't will fix this broken system.