Author Archive for Christopher Roussel

Consequences at Ground Zero

Written by Christopher Roussel. Published on August 26, 2010 ago in Current Events, Politics and Religion. 1 Comment

This entry is part 3 of 3 in the series Defending Secularisation

While the spectacle that has received the buzzword title ‘Ground Zero mosque’ continues to rage, there seem to be a few points of fact that have been overlooked. It may be known that the address for the site (currently Park51 but previously Cordoba House) is 45-51 Park Ave. What is less known here is that 45 Park Ave is already a mosque — and has been since July 2009. It isn’t a new site ex nihilo but an addition or expansion of an already existing community. Further, the new site is two-fold: first is a community centre created by refurbishing the Burlington Coat Factory already at the site (which has been in disuse since 9/11); second is a separate prayer centre (i.e. ‘mosque’) within the community centre complex. The relationship between the prayer centre and community centre is analogous to the relationship between a department store and a shopping mall: independent while overlapping.

The second issue I wish to look at is the response to those who oppose the site. It has been said that it is being opposed because the site is taken as an offense. My primary concern is that this offense is based on an illusion. The common arguments on the offense is that it is because, ultimately, it is believed that the Muslim community behind Park51 is no different from al Qaida. However, there is little non-circumstantial evidence to this argument. In many cases, it would be a good idea to change location in order to show that the Park51 community is peaceful/non-threatening/sensitive. But the problem with that response isn’t that it’s wrong: changing locations will make the people opposing it feel justified/vindicated for having their perceptions based on illusions. At some point, someone needs to stand up for honesty (and dare I say truth, in a generalised sense). Feeding a bad, false impression is never a good solution, and it seems that no matter what the Park51 group does now, that bad impression will be fed: it’ll either be ‘see, they backed down because we were on to their schemes’ or ‘see, they are so bad that they do not even respect our opinions’.

It’s a lose-lose situation, and the biggest loser isn’t them nor the relatives and victims of 9/11, but the American people who will have let the media (left or right wing, doesn’t matter) think for them, decide for them, and act for them. It is the feeding of false perceptions that is the worst consequence, as it leads us further into our sollipstic relativism and disavowal of the public sphere. The false perceptions being touted as prima facie evidence is a radical form of individualism. It is a condition in which we’re sinking away into ourselves where the only things that matter are what we think and believe for ourselves, divorced from any kind of public sphere that mediates between the many individuals to create a kind of community. In other words, it doesn’t matter what is real and/or true but what “I” (here being used to mean anyone) think is real or true. “I” make my own reality and substitute it for the one in which we used to live. Such relativism, whether it comes from the left or the right, needs to be addressed. This case is all the more why a truly secularised society is necessary, as it creates a neutral public sphere in which false perceptions regarding religions can be righted.

Conserving Tradition

Written by Christopher Roussel. Published on July 19, 2010 ago in Religion. Closed

This entry is part 2 of 3 in the series Defending Secularisation

In later parts, I will look at the present condition from different angles, however for now I wish to discuss the history behind what I will call ‘traditionalism’. Traditionalism takes a stand against secularisation because it wants to prevent corruption of the tradition and loss of the tradition’s stature. In other words, traditionalism does have good intentions; and this needs to be acknowledged upfront. My defense of secularisation rests not on dismantling traditionalism but arguing that secularisation attains the goals of traditionalism as well as does something more: secularisation creates more avenues for tradition to grow beyond its preservation.

The greatest problem with traditionalism is that it cannot achieve its intended goals. In order to protect tradition’s freedom, traditionalism requires its believers to enter the political realm and play the game of political power. This inevitably leads to disastrous outcomes. Two examples are: [1] the corruption of tradition’s goals by enforcing the tradition upon everyone, leaving it open to later overthrowing and [2] the subjugation of tradition to the game of political power. Whenever a religious tradition enters the political realm as a political power, it becomes subject to the political realm. It is important to read the last sentence as a critique of religion as a political force. Secularisation in the strictest sense is the separation of religion from the political realm as a political power. Secularisation is not the absolute separation of religion from the political realm, as two completely unrelated realms of participation. In other words, secularisation is a rejection of all religious traditions as unified political parties, allowing people to be religious and political participants without needing to be a particular kind of one to be another (i.e. without needing one to be of a particular political party in order to participate in a particular religious tradition and vice versa).

The greatest benefit of secularisation is that one is free to participate in both the political and religious spheres without one interfering with the other. Closely related to this is that each sphere can influence the other but to the extent that one is free to ‘pick the battles’. In short, one can preserve one’s tradition better if one’s tradition is not tied into the rise and fall of political power. This is strength that secularisation provides over traditionalism. While this post is largely a proof-of-concept demonstration, my following posts will analyse details secularisation entails.

The Marriage of Church and State

Written by Christopher Roussel. Published on July 4, 2010 ago in Essays, Religion and Theology. 4 Comments

This entry is part 1 of 3 in the series Defending Secularisation

For Americans, today is the celebration of the American colonies declaring freedom from their European owners. The problem with this is that it has become a common thing to celebrate within the church. My main concern is that church worship is supposed to be dedicated to the worship of God and Christ, not a government.

Perhaps the most telling reasoning behind this marriage is one that confronted me recently. Recently, I commented that today I get to go to church without needing to worship the State. An old friend replied that one should be thankful to the State for the freedom of worship, even if it cuts into the time one spends worshiping God and Christ.

Yet this is exactly the kind of civil religion that ultimately harms the church. Over the next few posts in this series, I will argue that the separation of church and state that we find in secularisation. Through secularisation, Christians have greater freedom to worship God because there is no pretense to glorifying the State before, with, or after God. In other words, a secularised society is better than one in which State and Church is married.

In this respect, American Christianity is largely backwards in its love of civil religion. I wish to analyse the theological underpinning of this marriage, showing that the marriage of Church and State has developed out of a poor understanding of Christian theology. It is only through a secularised politics that Christian theology will grow.

Opposite Ends of Arizona

Written by Christopher Roussel. Published on June 1, 2010 ago in Essays and Politics. 1 Comment

I’m sure most people who read this blog regularly are aware of Arizona’s new law requiring people to produce identification that they are legally in the US (either as citizens, residents, visitors, etc). The interesting thing to me is the ideology behind this. No, I’m not going to discuss whether or not this leads to racial profiling.

What’s fascinating to me is that this law was passed and is promoted as a ‘right-wing’, conservative law. This is because those same ‘right-wing’ conservatives tend to push for privacy rights, supporting laws designed to protect an individual’s identity (e.g. ‘stop and ID’ laws like this). There is no federal law requiring individuals to identify themselves, which is why these state laws have been enacted. However, these state laws are specific in that the only require people who are legally detained to provide identification. In other words, it is a relatively cut-and-dry situation: either one detained or not and it is either legally or not (yes, the legality of the detainment can be up for interpretation, but it is generally clear-cut). Outside of these situations, nobody is required to provide identification. This kind of ideology is based on a fairly conservative reading of the law (particular those regarding illegal search and seizure, presumption of innocence, etc).

The fascination I have is that Arizona’s new identification law resembles what is seen more often in what would be considered by Americans ‘socialist’ or ‘left-wing’ countries. I’m always fascinated in how the political spectrum is imagined in the public consciousness; this is a perfect example of how that image is faulty. The standard left/right distinction in America usually implies that the ‘left’ is about big government and authoritarianism that borders on fascism (the common example here is the American conception of ‘communism’ by which is meant Stalinism). The American ‘right’, on the other hand, is seen as promoting small and limited government.

Colin has posted previously about the Nolan chart. This is one example of seeing the political spectrum as having more than one dimensions. In allowing multiple axes, we can see that there are ‘right-wing’ groups that do support big government as well as ‘left-wing’ groups that support small, limited government. If anything, Arizona’s new law shows just this: that conservative, ‘right-wing’ groups can and do support laws that go against the small, limited government ideology. So perhaps we can have our cake and eat it too, provided we market it properly.

Third Party’s Future Failure

Written by Christopher Roussel. Published on October 20, 2009 ago in Politics. 7 Comments

There is growing support for a third political party in the US. However, because of ideological reasons, it will never survive. Well, perhaps I shouldn’t say the particular party will not survive but that the concept of three parties will never survive in the US.

Because of the emphasis of the two-party right/left divide, there can be only two parties. A third party may replace an existing party, but the only possibility there is of three political parties in the US political landscape would be if they divided along similar ideological lines (i.e. a ‘left’, ‘centre’, and ‘right’). In the remainder of this article, I will use this spectrum to hash out two generic examples of why a third party will always (ultimately) fail. I will use current popular third parties as exemplars of their position in the spectrum.

In the Centre
My first example is best witnessed in the Libertarian Party. Along the American spectrum, its recent invocations (the past 20 years or so) have fallen around the centre-right area. When they masquerade in the two big parties, they are almost exclusively Republicans who happen to vote against their party at times (e.g. Ron Paul, Newt Gingrich). In fact, because of this positioning, they sometimes have difficulty separating themselves from the GOP. If they were to become a major political party, they would continue to occupy the centre of the spectrum, likely fighting the GOP for votes and members.

As a result of this tension, two scenarios are likely: a simple replacement of the incumbent right-side party (e.g. GOP) with the new (e.g. Libertarians) or a distancing of the two with one (Libertarians here) moving closer to the centre and the other (Republicans here) moving further right. However, a centre-right party will not be able to gain many votes/members from the left side of the spectrum, which means any result would be a weakening of the right-side of the spectrum and more than likely a reconciliation or coalition of the two parties, resulting (ultimately) in a single right-side party that has two manifestations. The same outcome is likely for any centrist party that sufficiently leans one way such that it will not be able to take from both sides simultaneously.

Bookends
The other possibility is that of a bookend party, either far-enough left or far-enough right that it is placed on the outside of its related major party. For this example, I will use a stereotypical far-left party: the Socialist party.

Imagine this party gaining strength. Like the first example, it will do so at the cost of its related major party (i.e. the Democrats). Also like the previous example, it will result in either a replacement of its major party or a distancing of the two. However, where we see the biggest difference is in this distancing because it will be pushing the remaining Democrats right but more than likely not enough to push them straight into the major right-wing party (i.e. the GOP), we will see instead a weakened centrist Democratic party that pushes the major right further right while also taking from its membership a small amount. In other words, it would force three parties split along the left/right spectrum with a centrist middle party.

However, I will be bold here and suggest that the centrist party will exist in name only. In practice, it will stand torn between the two other parties, unable to find an ideological position of its own. This is because American political ideology is so entrenched in a two-party system that the option of a middle-ground third party is unfathomable as an ideological position. This ideology crushes any and all middle third parties by ideological attacks from both sides. Instead of a centrist party, there will instead be many centrist third parties unable to coalesce into a major political party or ideological position, much like there is already today. In other words, much like the previous situation, the displacement needed for a third party will ultimately lead to the downfall of an actual third party and become, yet again, a simple replacement of an existing incumbent party.

Plurality
The only possibility of a sustainable ‘third party’ is really through the formation of, in my own count, 4 major parties that break the left/right spectrum. These 4 parties would be split so that one could see two left parties and two right parties, however there are enough ideological beliefs in the four so that there exists a tangible regular alliance across the left-right distinction (e.g. along the lines of government size which would see both left anarchists and right libertarians side together). However they are created and displaced, there will still be a central region which remains undecided which will still be unable to coalesce into its own ideological position. In other words, neutrality–as an uniting ideological position–remains impossible.

Medicare in HR3200

Written by Christopher Roussel. Published on October 6, 2009 ago in Current Events and Politics. 2 Comments

This is part 2 of the series investigating the proposed healthcare reforms. Part 1 is here.

I will quickly review the improvements to Medicare in HR 3200. For those unfamiliar with the various parts of Medicare, I will section the improvements according to each part and provide a very short summary of that part. Medicare applies to individuals to are over 65, those under 65 with certain disabilities, and individuals with end-stage renal disease (kidney failure that requires transplant or dialysis).

‘Original’ Medicare (§1101-§1112)
Medicare Part A is basic hospital coverage. No premium is paid for this part of Medicare as it is geared towards inpatient care, emergency care, and hospice. People under Part A may optionally enroll in Part B and Part D Medicare. The primary change here is to increase payments to medical facilities that operate with Part A by increasing the annual adjustment percentage retroactively from 2004 to 2009.

Part B (§1121-§1158)
This is a basic medical insurance that includes a premium for coverage. This is aimed at outpatient care, physician services, and physical or occupational therapy.
Changes here include modifications to the growth rate formula and consolidation of medical service codes (e.g. services often billed many times for a single treatment, multiple services grouped together for a single treatment). Funding for this is $20M from otherwise available funds in the Treasury. During the years 2011-2012, physicians performing Medicare services in efficient areas (top 20% based on ZIP code) get an additional 5% on all payments for services performed from section 1848 of the physician fee schedule. The Medicare Improvement Fund for years between 2011 and 2019 is increased to $8 billion annually.
Hospitals will received reduced payments for patients who are readmitted excessively, with the intent on full recovery before discharge. The aim of this is to eliminate unnecessary readmissions.

Medicare Advantage (§1161-§1177)
Part C Medicare combines Part A and Part B Medicare into a single package with the exception that the care and coverage is provided through approved private insurance companies. Medicare Advantage payments will begin to be based on the fee for actual services. MA plans which are rated as high-quality and those which improve their quality rankings will receive additional money (percentages that increase annually from 2011 to 2013). Cost-sharing techniques for MA plans will be limited to the cost-sharing amount for non-MA plans. MA plans which do not have a medical-loss ratio of at least 0.85 must give rebates of premiums to enrollees until the medical-loss ration is at that level. If a plan does not meet this minimum for 3 consecutive years, it will suspend enrollment for new enrollees to that plan. If a plan does not meet the minimum for 5 consecutive years, that plan’s contract with Medicare will be terminated. In effect, this is limiting a company’s profit from Medicare Advantage plans to 15% of annual premium totals.

Prescriptions (§1181-§1185)
Part D is the stand-alone prescription plan. This has a few plans, each with varying premiums and coverage. The first item on the agenda is phasing out of the gap between the annual out-of-pocket threshold and the initial coverage limit. Secondly, drugs prescribed to ‘dual-eligible’ individuals (i.e. those who qualify for both Medicare and Medicaid) are required to offset the cost of such drugs by a regular rebate (paid to the government) that will be used to fund the gradual elimination of the above coverage gap. A discount of 50% is to be applied to qualifying drugs dispensed to individuals who are in the above coverage gap.

Beneficiary Improvements (§1201-§1236)
The low-income level for Medicare benefits is raised in 2012 to $17,000 per individual, to be adjusted each year according to the consumer price index average. Beginning 1/1/2011, co-insurance (and other cost-sharing methods) are eliminated for institutionalised individuals as well as dual-eligible individuals who receive full-benefits. Additionally, beginning 1/1/2010, Medicare enrollment is modified so that individuals can self-certify income and resources without the need of additional documentation except in ‘extraordinary situations as determined by the HIE Commissioner’. Individuals who become eligible for the low-income subsidy (above) are also eligible for retroactive reimbursement of prescription expenses. The relevant insurance plans have 45 days to reimburse individuals after receiving notification from the government that an individual is eligible for the reimbursement or after receiving a valid claim from an individual. It is unclear how far back this retroactive period runs as the threshold level is not increased retroactively.
There is also to be a study to discover language barriers and difficulties for Medicare recipients, which will ultimate provide guidelines and suggestions for providing necessary language services (e.g. on-site interpreter, off-site interpreter, bi-lingual staff, etc). These will be tested in a trial run in different regions and Medicare service type providers, funded by federal grants (not to exceed more than $500,000 per grantee over the three year trial period). The bill requires at least 24 grantees for the trial in varying socio-geographic locations (e.g. urban/rural, Southeast/Northwest, large metropolitan area, etc).
Finally, this section also provides for advanced care planning by a consultant once every 5 years. This is to explain living wills, power of attorney, the role and responsibility of a healthcare proxy, etc. Furthermore, this section (§1233) requires states to standardise these requirements and forms to reduce confusion by health care staff. States must provide information about these updates to health practitioners who are able to sign orders for life sustaining treatment (e.g. physicians, their assistants, and nurses, depending on state law).

Healthcare-ish

Written by Christopher Roussel. Published on August 20, 2009 ago in Current Events, General and Politics. 10 Comments

This is part 1 of a yet-to-be-determined length in a series on the healthcare reform debate in the USA.

Since healthcare is such a big issue these days and there seems to be a lot of discussion as to what the ‘socialist’ suggestion by the Democrats will and will not do, let’s look at the actual bill in question. Feel free to follow along and/or verify the information I’m reporting here; I have tried to merely summarise the bill without much commentary. It’s really long, so I’ll be highlighting sections rather than try a line-by-line analysis. A few things are clear to me after reading through the sections on the healthcare industry reform (Division ‘A’ of the bill).

This is not setting up a single-payer system (e.g. the ‘socialised healthcare’ of the UK or Canada), but rather a government-run insurance ‘company’. In other words, it would be better to see this as the government setting up public schools while not removing private schools rather than the government setting up and consolidating militias into government-run militaries.
The second aim of this bill is to introduce minimum standards for healthcare. Keeping with my above example, it is similar to the government requiring particular subjects to be taught in school for a particular amount of time (e.g. 3 years of mathematics). These standards do not appear very strict; in fact healthcare plans that I have had previously already meet these requirements.
In order to carry out the above two aims ‘universally’, there are additional regulations and points of enforcement. Most of these are aimed at health insurance companies and employers. The only line of enforcement aimed at the individual taxpayer is a 2.5% tax based on an individual’s adjusted gross income (§401). This tax applies only to individuals who do not have a healthcare plan that meets the minimum requirements (i.e. the previous point).

Purpose And Overview (§101-§116)
In general, it appears this bill is supposed to establish standards for the health insurance industry. Plans that take effect after the change date (not listed in the bill) must meet the new standards (of this bill). People may choose to remain on their current plan, but insurance companies cannot enrol new people under that plan after the change date. Additionally insurance companies must apply rate increases to entire ‘risk groups’ and cannot change any of its terms or conditions on plans that people choose to keep. These kept-back plans must switch to meet the standards within the 5 year grace period after the change date. There are some exceptions to this, notably flexible spending accounts, onsite employer facilities (e.g. a first-aid station), and coverage that only provides mental health, dental, and/or vision care. Insurance plans cannot use pre-existing condition exclusions. Insurance companies are prohibited from dropping clients except in cases of fraud. Insurance premiums are prohibited from excess variation. Variation is allowed by predefined age groups (as long as the highest premium is no more than double that of the lowest), area, and family/group bundling (as long as the variation is uniform compared to individual premiums). A report on the financial aspect of these changes is due within 18 months of the bill. The report will evaluate and compare group-insured and self-insured plans/markets. Insurance company may use a provider network, as long as it provides transparency in the cost difference between in-network and out-of-network coverage. Additionally, these provider networks must meet standards established by the Commissioner. If a plan does not meet a predetermined medical-loss ratio, it must provide rebates to enrolled participants to meet the ratio. In other words, if a company has a low payout on a plan one year (say 20%), it must (in effect) refund the people on that plan until its payout meets the required magic number.

Health Insurance Exchange (§201-§203)
Sets up the Health Insurance Exchange. This will serve as an insurance gateway in addition to offering a public insurance option. The Commissioner is responsible for overseeing the operations of the HIE (e.g. ensuring plans offered through the HIE are qualified, fair, etc). Insurance companies do not need to offer any insurance plans through the HIE, however they still must meet the minimum standards. Individuals who continue to get health insurance through their employer will have choice of any insurance plan offered through the HIE once the employer begins offering any plan through the HIE. It is also here that insurance companies may offer multiple plans through the HIE but if they do, they must conform to the listed package levels In other words, all plans through the HIE must meet the basic plan requirements but there are optional levels of enhanced, premium, and premium-plus which require at least one plan in a lower package level (e.g. if a company offers a premium plan through the HIE, they must also have a basic and enhanced plan available). Only plans at the premium-plus level may offer benefits beyond the required standards. Plans not offered through the HIE may offer benefits beyond the basic requirements (§121).

Required Services (§122)
Defines which services must be offered by every insurance plan: hospitalisation, emergency services, outpatient services, all healthcare professional services (assumingly, this is so that the insurance company cannot deny payment to a professional along the chain, such as an anesthesiologist), equipment and supplies necessary for a health professional to deliver care (again, probably so that a company cannot deny payment for the bottle of iodine used during that surgery), prescription drugs, rehab services, mental health and substance abuse services, recommended preventive services (e.g. vaccination), maternity care, baby and child care (including dental, vision, and hearing) for children under 21. Companies may offer deductibles, but these are limited annually to $5000 for an individual and $10,000 for a family. That limit can change annually (increments of $100). For plans offered through the HIE that are not premium-plus levels, companies may utilise copayments but not coinsurance (i.e. an individual may still have the $20 copay for office visits but not the 10% payment for surgery). Plan prices should be designed to split healthcare costs at 70/30 (i.e. an individual should pay no more than 30% out-of-pocket).

While I am not going through the section on bureaucratic establishments in its entirety (§205-§208), I did want to mention a few pieces of information here. Children born in the US who are not covered by an acceptable plan get up to 60 days on Medicaid automatically. Additionally, any individual who is eligible for Medicaid and is not enrolled in another plan will be automatically added to Medicaid. Adds a trust fund in the US Treasury for the operation of the HIE. This will be funded by individuals not enrolled in a qualified plan and employers not providing a qualified health plan through taxes. If a state wishes to run its own HIE, it is free to do so, however its offered plans cannot cost more than the federal plans.

The Public Option (§221-§226)
The government will offer a public health option offered solely through the HIE. Its premiums will be geographically-adjusted and comply with the rules form above (§113). This public option will be funded by its own premiums; it makes no mention here of any increase in taxes. As of now, I believe, then, that this public option will be functionally like an independent company and not a government agency. The government is giving the public option a $2B loan, which is to be payed back to the Treasury within 10 years. Initially, payment rates will be similar to those currently under Medicare and extrapolated from there for things not covered by Medicare. As an incentive, these payments will pay an additional 5% for the first 3 years. Current Medicare providers will be considered ‘in-network’ to the new system unless they opt-out. The in-network physicians and other participating providers (e.g. chiropractors) must agree to the payment rates the new system sets. Physicians may choose to participate out-of-network, but they must charge within a certain ratio of the in-network price. Healthcare providers who choose to not participate may do so.

Employer-offered plans (§311-§314)
Employers have three requirements to meet.

They must offer each employee coverage under a qualified plan (see above on §201-§203 and §122) or under a grandfathered plan (which will be phased out at the end of 5 years).
They must contribute to the full-time employee’s plan as already required (which is 72.5% of the premium for the lowest cost plan offered for an individual or 65% for family coverage). They should also contribute to any part-time employee’s plan proportionately (e.g. as a proportion of the average weekly hours the part-time employee works to minimum full-time weekly hours). Also, these contributions must not correspond to a reduction of employee’s compensation (i.e. it can’t come from the employee). Unless an employee opts out of coverage, s/he is automatically enrolled in the plan with the lowest premium.
After the second year of the HIE, if an employee declines an employer-offered plan and takes coverage through an HIE plan (other than as part of a spouse’s or parent’s family plan), the employer must make a contribution (equal to 8% of the employee’s average pay) to the HIE trust fund. Small Businesses that have annual payrolls under $400k will pay a smaller percentage.

Rates for Low-Income Families (§241-§246)
Individuals who are enrolled in a plan through the HIE that has a family income below 400% of the Federal poverty level for his/her family size and is not eligible for Medicaid will be eligible for a reduced rate on the basic (bottom-level) plan offered through the HIE. This reduced rate does not apply to full-time employees whose employers offer coverage under a group plan that meets the above specifications specifications unless (after the first year of the HIE) the premium exceeds 11% of family income (Adjusted Gross Income as reported to the IRS). The reduced rate will be determined as a percentage of the family’s expected annual income (see the table in §243(d).1. For reference, the FPL for a single person in the Lower 48 for 2009 is $10,830. For an example here, let us assume an individual earns $30k a year (AGI). This would mean that the premium for that individual would be between $175 and $225 per month.

Extra Revenue (§441-§442)
Individual taxpayers who earn more than $350k (AGI) must pay an additional surcharge tax (1% for AGI between $350k and $500k, 1.5% up to $1M, and 5.4% for over $1M). This tax will increase for tax year 2013 (to 2%, 3%, 5.4% respectively). If this tax generates more than $150B, the increase for TY2013 will not apply; if more than $175B, the surcharge for AGI below $1M will be removed. This income will be determined by the OMB by 1 Dec 2012.

Thus ends the first section of HR 3200. The remaining two sections to be analysed deal with restructuring Medicare/Medicaid and development of public health and workforce.

Healthy Practices

Written by Christopher Roussel. Published on April 30, 2009 ago in Philosophy and Politics. 3 Comments

Now that I’ve outlined three ethical situations that unconsciously affect the discussion of healthcare, I’d like to investigate some of the practical issue. The point here is not to make a judgment as to which system is better, but to compare them in a neutral light. I want to look at some of the common criticisms aimed at particular systems (primarily socialized medicine and private medicine) and examine them across the board. I will follow this part with a third that looks at the implementations of each system (finally).

The Problem of Waiting
In Michael Moore’s Sicko, the picture is painted that people in Canada, France, and the UK get VIP treatment when it comes to medical attention. This is partially true when it comes to seeing a GP/PCP. For instance, I can schedule a foreseeable, regular appointment (e.g. a regular checkup) with my GP and should be able to get an appointment two days out; I can also schedule an emergency, same-day appointment if I am unwell. The wait for appointments is minimal (5-10 minutes). However, this is really no different in the US.

In addition to these two types of appointments, most GPs in the UK offer phone consultations daily where doctors advise patients if there should be some concern or not and a daily open clinic where it is a first-come, first-serve basis (mine happens to be for one hour in the afternoon). Oftentimes, GPs in the UK still offer house calls as well for those who are physically unable to get to the clinic. These three are less common in the US primarily because they have very limited use benefits where access to personal transportation is the norm (e.g. since more people use public transportation, it may be very difficult for an ill elderly person to get to the clinic, so house calls are useful for that).

The situation is largely the same when it comes to emergency care. Ambulance response can be horrific in rural areas in both countries. However, the normative time for an ambulance when one calls 9-1-1 (9-9-9 in the UK) is very similar in both countries. Additionally, the ER (A&E in the UK) is prioritized for extremely urgent care and a non-urgent case can suffer a long wait time; however, this is because there are walk-in clinics for these non-urgent cases, usually right next to an ER. In these cases, the time for waiting isn’t much different in either country.

When it comes to special situations, there is less of a country-wide norm. Seeing a specialist in the UK requires a referral (like most in the US) and can take time if that specialist is overbooked. A six-month wait is not uncommon (but also not the norm!) in the UK, but this is also true in the US. I know of at least three different “specialist” practices in the US (two OB/GYNs and one urologist) had a wait time of 5-6 months because of overbooking. Similarly, I have heard numerous accounts of people in the UK saying that they only waited a week to see a specialist.

So, let’s face it, people will be waiting, regardless of how the system operates because waiting is linked to something other than the healthcare system, be it population size, number of specialists in an area, whatever. Even when it comes to operations, there are wait times. When I had a nasal surgery in Denver, I had to wait 3 months for an opening in the surgery schedule. We must be able to separate the practicality of scheduling a surgery with the ethos of how a problem is handled. In the UK, that ethos is one of “wait and see” and arguments for it stem from verifying that the action in question is the best one for that situation. This is a different ethos than that of the US which prefers (ideally) to prescribe an action right away (e.g. surgery, medication, etc). Taking into account the approval process on both sides of the pond, there really isn’t much difference in waiting for anything.
Continue reading ‘Healthy Practices’

Health for Profit

Written by Christopher Roussel. Published on April 27, 2009 ago in Philosophy and Politics. 3 Comments

Let me begin by being very honest. I’m probably the closest thing to a left-wing socialist this site has. I’ve been thinking about the philosophical underpinnings to this subject for quite a while, first as an American living in the UK and secondly (most recently) as I watched Michael Moore’s film Sicko. Before getting into the “practical” side of this (that’s part 2), I wanted to look at the ethical situations various healthcare systems create. I would like to look at three different situations:

the role of the medical doctor
the role of the patient
the role of whatever controls the healthcare

Corporate Mindsets
The nature of every for-profit corporation is to make a profit, typically by spending the least amount of money possible. This means that a for-profit medical company, whether it is a hospital, insurance provider, or medical expert, aims to make money on the majority of its transactions. An unjust strategy would be to deny as many services as possible by any means necessary (i.e. pocket as much money as possible). An idealist strategy would be to approve all services at whatever cost (i.e. run into bankruptcy). When the goal of healthcare is a profit margin, the system moves towards the “unjust strategy” because the primary objective is money instead of healthcare.

Michael Moore’s film is great at emphasizing this as the common situation in the US healthcare industry . Sicko is also great at empasizing the idealist strategy as the common situation in other countries’ healthcare (e.g. Canada, UK, France, and Cuba). I am not interested right now in debating the extent to which the film is accurate (it definitely isn’t, but when is a documentary entirely so?) but creating two extreme poles of healthcare. The first ethical situation which a good discussion about healthcare needs to resolve is this: where is the acceptable “middle ground” (if any) between the two poles of healthcare-for-profit and healthcare-as-ideal.

Prescriptive Care
Related to the first ethical situation is one revolving around the role of the doctor. In a for-profit industry, a doctor has a second ethical issue to resolve that is his/her own variation of above: profit versus care. Medical doctors take an oath to save and preserve life (or to that effect). However, when they are faced also with the role of a business owner in a for-profit, competitive market, they must find how to resolve the two poles listed above.

When the healthcare industry tends towards the idealist pole (which I will later argue is part of universal healthcare in European countries), doctors need not worry about such things. However, doctors are then given a different ethical situation revolving around fairness and equality. In universal healthcare industries, the limitation of resources is based on need and population size rather than need and finances. A person diagnosed with cancer is ranked against all cancer patients across the healthcare market. In a private, for-profit system, this means within the insurance company and tends to mean a shorter list of people competing for treatments. It is the insurance company that weighs each situation, ranks the priority of the patients, etc. In a universal system, there is only one company handling the entire population. As a result, there is a greater responsibility on the GP/PCP to investigate the need and submit the recommendation to the healthcare system. Additionally, there are fewer specialists because there is no competition for profits, which results in a greater workload for the specialist.

The second ethical situation, then, is how the practitioner resolves the results of the first situation (limitations of resources) with the principles of the oath he takes as a practitioner. These can be situated within the framework of a medical association which can provide ethical guidelines for the practitioner to dance between these two ideals.

Patiently Waiting
The final ethical situation I want to highlight follows from the previous ones as well: what is the role of the individual as patient in all of this? This one was less obvious to me until I began to experience the UK’s healthcare system. What role does the patient take in his/her own well-being? In other words, how should the professionals treat a patient’s opinion?

There are limitations to this (e.g. patient’s understanding), but to what extent should an individual not utilize the doctor’s office? This is the one aspect which Sicko does not discuss about healthcare in the UK. There is a greater emphasis in the UK to try to heal on one’s own without a prescription. This doesn’t mean one is supposed to wait until one is dying of pneumonia but that a normally healthy person should be able to recover from a cold without seeing the doctor in addition to knowing when one should see the doctor. Michael Moore never gets to this situation because his emphasis on healthcare-as-ideal and doctor’s responsibility seeks to largely remove the individual responsibility.

The Fear of Toys

Written by Christopher Roussel. Published on January 7, 2009 ago in Current Events and Politics. 8 Comments

Last year, congress passed a law that requires every product made for children 12 and under must be free of lead and certain chemical compounds. This, in itself is a good idea. However, it completely destroys the economic model the US is trying so desperate to keep in play by bailing out big-name companies: the “free-market.”

Costs
The law requires every product, not just a random sampling but all, to be tested. The price to test a cloth diaper, for instance, runs at $400 each. If the requirement was simply one out of a hundred, it means a differential of only $4 per diaper, something that most companies could afford. For many smaller manufacturers and individual homemade crafters, this could mean the end of their business. This also means that many secondhand stores, such as Goodwill and other thrift shops, will be unable to accept clothing and toys without the new label.

The Freedom-Eating Market
Ironically, this comes at a time when the US government is throwing millions (or is it billions?) of dollars at financial and automotive industries so that they don’t close their doors. The hypocrisy here is that it is fine for small toymakers to close shop and be replaced by larger ones who can absorb the third-party testing of products, but it is not acceptable for large corporations to close shop and be replaced by any other business large or small. Had each of these issues been left to the “free market,” both would have been resolved without the need for regulations.

For the toys and other childrens’ products, how many adults knowingly and willingly let their children play with products that are harmful? Look at the many recalls Thomas the Tank Engine toys had over the last two years and the effect the recalls have had on the business. One article on NPR (link) ends with a marketing researcher implying that companies who try to hide these issues end badly. For the large corporations, a truly free market would have seen some close, some merge, and new ones arise without much problem. Sure, there would have been a major recession (like there isn’t one now?), but it would have costed the government and the people much less. Recessions cannot be stopped when they are already immanent; they possibly could be averted before they are noticed, but that is the kind of far-sightedness governments lack.