Tuesday, August 23, 2011

Responses

Just as a warning, this is long.

As a caveat, I had been working on some responses to some critiques and objections that my friend, Adam Thompson, had leveled against some of my previous posts. I must give him acknowledgment where it is due because I believe on some points his objections are correct. And to be fair and honest, Adam’s philosophical sophistication and prowess is far superior to my own (ergo, why’s he’s one of the leading and most respected UNL philosophy TA’s). So while I’m sure I sound like a Chihuahua nipping at the heels, I’ll go ahead and nip. So, one of Adam’s critiques:

“First, once again the logic is incorrect. A conditional is false if and only if the consequent of the conditional is false while the antecedent is true.”

This is reference to the conditional:

“If x is compassionate, then x will support the liberal agenda.” (c → a)

I said:

I believe this conditional is false because I believe its consequences to be false and in logic if the consequence is false, then the whole conditional is false.

I’ll take that rebuke, because my above statement is very false. I know what I was meaning to say but I did not spell out the necessary and sufficient conditions for the falsity of a conditional correctly.

So, to be absolutely clear about my position, I hold that one can be compassionate, i.e., the antecedent c is true, even though they don’t support the liberal agenda and that is why I hold the consequent a as false and, therefore, the whole conditional false.

Adam said didn’t know what I meant when I said, “liberal agenda.” Good point; the concept of the “liberal agenda” is rather ambiguous and unclear, and if there’s one thing that we who were trained in the analytic tradition of philosophy require is clarity. What is the liberal agenda? [1] While I can’t give any sort of necessary or sufficient conditions, I’ll just give some examples of positions many liberals hold. (Yes Socrates, I haven’t said what the liberal agenda is.) Phil Valentine (2008) writes:

Steve Kangas, a devoted liberal, was a political journalist for the Internet site Votelink out of Boulder, Colorado. […] Kangas wrote that liberalism believes in collectivism… while conservatives believes in individualism. Liberals are for democracy, while conservatives are for constitutionalism. […] He says liberals believe in pacifism, while conservatives believe in armed deference… Kangas goes on to explain that liberals believe in ‘progressive taxes, anti-poverty spending, and other forms of regulation.’ He says they view ‘the runaway profits of the rich—especially in the later stages of wealth accumulation—as undeserved, so redistributing them among the workers who produced them is necessary to prevent exploitation.’” (214-215)

Let’s not forget global warming or call it climate change, save the polar bears, say have you, I don’t care.

While I don’t want to make a hasty generalization and say that all who call themselves “liberal” believe and/or support all of what Kangas does, but for the most part from what I have observed and heard from friends, acquaintances, media-types, and politicians who call themselves liberal, they have expressed support for some (if not all) views very similar to what Kangas espouses. So, that’s what I’m calling the “liberal agenda,” and one can reject this agenda and still be compassionate. (No doubt I’m going to be criticized for this. Guess I’ll have to write a post on this subject.)

To Adam’s criticism concerning my label of socialized medicine in Europe, there are scholars in the medical community, both in the US and in Europe, that say that England has socialized medicine,[2] as well as in Canada.[3] And, I had a boss who is a neutralized citizen from England and he said that England has socialized medicine. However, after doing some digging, the terms socialized medicine and the more commonly used universal health care are used synonymously, especially here in the US, whereas in Europe, universal health care is commonly used.[4] So, I’ll just use the term “universal health care” since it’s what Europeans commonly use.

Be that as it may, under a universal health care system, the government is a primary administer of medical care. Therefore, to say that England, which has universal health care, has a capitalistic health care system is puzzling to me. In England, the government controls/administers 90% of the health care and the private sector only controls/administers 10%, which is more aligned with universal health care system, not a capitalistic system.

The definition of Capitalism[5], call it (C), is:

: an economic system characterized by private or corporate ownership of capital goods, by investments that are determined by private decision, and by prices, production, and the distribution of goods that are determined mainly by competition in a free market

The health care system in England, the NHS, doesn’t satisfy (C) because under a capitalistic system, the private sector would administer and distribute most (if not all) of the health care.

So, the health care question, “Is health care in the US high?” Yes. “Do I want a health care system like that of Europe or Canada?” No, and here’s why.

The waiting for medical care and treatment is a very serious problem in Canada and they have a form of universal health care.[6]

[7]

These figures are not as good as the figures here in America.[8] Furthermore, every time I’ve been to the emergency room for asthma and eczema problems, or my wife, or my son, the care was immediate without a wait.[9] Compare this to Canada’s 4 to 10+ hour wait, depending upon what care you require.[10] Concerning the emergency room, if I had to wait 10+ hours to get into the emergency room to get treated for an asthma attack, I would have likely died from suffocation.[11] But we’re told that here in the US, our care sucks, unequal, unfair, etc. I don’t see how waiting 10+ hours for an asthma attack is ‘equal’ or even ‘fair’ whenever someone’s life in the balance, especially in my case whenever minutes mattered. One could object to say, “Your case is extreme; they wouldn’t let you die.” Maybe, but I’m just going off straight numbers from the Canadian websites that calculate emergency room wait times. I’m playing on going to Canada and have an asthma attack just to find out how long I’ll have to wait in the emergency room.

Concerning long term care, with my Aunt (who unfortunately died from cancer) whenever she was initially diagnosed with cancer, she was in for scans and tests in a matter of days and found out she had stage 3 breast cancer, and treatments began shortly thereafter. They never asked about how she was going to pay or anything like that. If she had been made to wait more than 2 or 3 months as is the case in Canada, she would have been at stage 4 and died shortly thereafter. Now, I don’t see any compassionate in this, nor do I see that as ‘fair.’

Adam argued:

I don't see how anyone could reasonably think that that is too high a price to pay to (a) keep people from dying simply b/c they couldn't afford health care, (b) keep people from going bankrupt attempting to pay for normal health care, etc. No one in those countries faces either of these worries, and the large majority wouldn't change this to keep prices open to the market and let people decide whether to purchase health care.

Let’s address (a) really quick. The last time I checked people aren’t being allowed to die in the US simply because they don’t have the money to pay for care. If someone walks into an emergency room in the US, by law they can’t be turned away. Nor do I hear stories of the elderly being kicked out of hospital beds because they can’t afford it. It’s simply not true that there’s a serious problem of people dying in the US simply because can’t afford health care. I find no empirical evidence to support (a). If there is some, I could not find it.

I’m sure there are people who go untreated or undiagnosed because they believe they can’t afford it in the US. Ok, but I would argue that this sort of thing happens in every health care system in the world, and is not isolated to the US health care system simply because we don’t have universal health care. On the contrary, as I pointed in one of my earlier posts:

If the health care system in the UK, for example, is so great and wonderful, then it is hard to see why residences of the UK are pulling their teeth because they can’t find dentists.[12] Additionally, Canada, which has a similar system to the UK, is looking to private sector solutions to their health care because their current health care system is bankrupting them and the care stinks.[13]

Moving to (b), the bankruptcy worry. In 2001, 28% of bankruptcies were said to be caused by medical bills.[14] In 2005, research came out that two-thirds, or about 67%, of the bankruptcies in the US was due to health related costs.[15] However, the research that produced these figures has been called into question. In 2009, research found that there was a higher percentage of medical-cost related bankruptcy in Canada than in the US.

Unlike the United States, Canada has a universal, single-payer, government-run, socialized health insurance system. Advocates of socialized medicine argue that the mixed public-private health insurance system in the United States causes many Americans to become financially bankrupt, and that this would not occur if the US adopted the Canadian health system. Following this logic, we should expect to observe a lower rate of personal bankruptcy in Canada than in the United States. Yet the most recent data (2006 and 2007) shows that personal bankruptcy rates are actually higher in Canada (.30% for both years) than in the United States (.20% and .27%). Research indicates that medical spending was only one of several contributing factors in 17 percent of US bankruptcies, and that medical debts accounted for only 12 to 13 percent of the total debts among American bankruptcy filers who cited medical debt as one of their reasons for bankruptcy. (Skinner and Rovere 2009, 1)[16]

Skinner (2009) states:

Indeed, if we define medical bankruptcies the way Himmelstein and colleagues did for their study in the United States, we find such bankruptcies also occur in Canada. Survey research[17] commissioned by the Canadian government found that despite having a government-run health system, medical reasons (including uninsured expenses), were cited as the primary cause of bankruptcy by approximately 15 percent of bankrupt Canadian seniors (55 years of age and older).[18]

All I could find were stats on Canada I think because Canada specifically researched this phenomenon, but I think that will do. So, the empirical evidence shows two things:

1. There are far more causes of bankruptcy than medical expenses in both Canada and US.

2. If the stats are correct (which I see no reason to doubt them), bankruptcy is just as a much a problem in universal health care system than it is in the US.

Therefore,

3. Adam’s claim concerning bankruptcy that “….No one in those countries faces either of these worries,” is false.

So, Adam’s premise was that if I were reasonable then I wouldn’t support a system health care with such high costs to the customer and result in bankruptcy.

Two points. First, in Canada, which has universal health care, again, has a higher medical-rate bankruptcy rates than the US according to the stats. So, even under universal health care, the bankruptcy problem isn’t solved.

Secondly, I’ll grant Adam’s argument for the sake of argument. If Adam’s premise holds true, I fail to see how one could support ObamaCare since health care costs are forecasted to rise for everyone. ObamaCare is a form of universal health care[19] and according to studies, produced by both conservatives and non-conservatives alike, ObamaCare will raise health care costs[20]. So if supporting our current cost of health care is unreasonable given the prices right now and the possibility of bankruptcy, I see it equally unreasonable to support ObamaCare since health care costs are going to go up thus increasing the possibility of individuals declaring bankruptcy, especially given the bankruptcy stats from Canada.

Now, one response could be, “Even if the costs do go up, the increases won’t be felt by those in the middle and lower classes because under universal health care, the government will pay for their care. But in the current system, middle and lower classes are directly affected by the high costs of health care. Therefore, universal health care is fairer.”

How are these costs going to be covered? Using England as an example, the rich are taxed at a much higher rate in order to pay for the costs. For example, a study in England found the following:

Access to the NHS is universal, free at the point of use (except for some copayments for services such as dentistry), and determined on the basis of medical need. In principle, therefore, the burden of financing the NHS is distributed unequally, with a bias against the rich, whereas the NHS's benefits are distributed equally to those in equal medical need. While the NHS is the main health care provider for the vast majority of the population, there also is a relatively small private health care sector (approximately 10 percent of the market) for which consumption as in any private market is determined on the basis of price and income (Tapay and Colombo 2004). (Faden et al., 2009, 791)[21]

In other words, England progressive taxation, even more so than here in the US. Now I believe we could to brass tacks of this debate, and the word is “distribution.” In order to pay for ObamaCare, Obama, Democrats, and Liberals argued and argue that the rich need to be taxed more.[22] In 2009, concerning taxing the rich, Obama said: “These folks can afford it. They were rich back in the ‘90s,’ he said. ‘It’s not like suddenly they’re going to have to go to the poorhouse. But what that does is it allows us to pay for health care reform for a lot of people.’”[23]

We’ve really come full tilt now, to my post “The Rich and Taxation.” There I presented argument (R):

1. If the rich aren’t struggling to make ends meet, then they can afford to pay more in taxes.

2. If the rich can afford to pay more in taxes, then they should pay more in taxes.

Therefore,

3. If the rich aren’t struggling to make ends meet, then they should pay more in taxes.

Adam argued that this is not an “enlightened” view. I agree that it is not but the argument is what it is, and I’ve heard argued by some of the political left, not in these exact words, but (R) is true to the spirit of the argument.[24] I argued that the argument is not sound due to premise (R2) because there is a false implication that “‘can’ implies ‘should’” which does not follow. I’m glad that Adam and I can agree that “can” does not necessarily imply “should.”[25] So, even if we grant that the rich can pay for higher tax rates, it doesn’t follow that they should.

With all this being said, I’m going to leave this post as is and then return later to addressing issues of taxation and fairness. That subject in of itself is a huge subject and one that I would like to dedicate some significant time and research.

[2] Weiner (1987) http://www.jstor.org/stable/3349946

Gottfried (1989) http://www.jstor.org/stable/4315916

[4] http://www.healthpaconline.net/universal-health-care.htm Now, admittedly, philosophers will say that these terms aren’t synonymous since synonymy requires that the terms be substitutable in a sentence salva veritate, but to everyday common folk, the terms are used synonymously.

[9] Yes I was asked if I had insurance but that is for billing purposes, not for screening out patents, and I have yet to find evidence of people being denied medical treatment simply because they didn’t have insurance.

[11] This is not the only problem that universal health care faces. For more see Ken Boyd (2011): http://www.amazon.com/Socialized-Medicine-Italy-Experience-ebook/dp/B005DVFWYA/ref=sr_1_1?s=digital-text&ie=UTF8&qid=1313964109&sr=1-1

[25] Now, if “ought” and “should” are synonymous in ethical contexts as Adam correctly pointed out, then I believe we can infer that not only does “‘ought’ implies ‘can’” but that “‘should” implies ‘can’” in an ethical context as well. So, if you should tell the truth, then you can (or as the ability) tell the truth. But clearly “can” does not imply “ought.” Therefore, (R2) is false because even if the antecedent is true, its consequent would be false.

Posted by at

No comments:

Post a Comment

Subscribe to: Post Comments (Atom)