Inconceivable!
Is fertility a health issue or a lifestyle choice?
This month a health care refom advisory panel will meet to consider whether contraception should be offered free of charge as a form of preventative medicine, the AP reports. Healthcare reform of course poses many questions concerning how medical services are paid for and delivered. But, as the AP notes, social mores are at the heart of this latest question.
Contraception is a controversial tool for preventing pregnancy, with many religious movements banning it outright. At the heart of the argument against free contraception is that the use of contraception is a lifestyle choice, not a health issue. As the president of the National Catholic Bioethics Center notes, “there are other ways to avoid having children than by ingesting chemicals.”
All other things equal, should the use of contraception be thought of as a health issue or a lifestyle choice? And should it matter for whether it is provided free as a form of preventative care? Read more
Are firemen like doctors?
How deep does the analogy go? Not deep enough to justify universal health care.
At the Washington Post blog, Ezra Klein discusses the parallel between firefighters letting someone’s house burn because he didn’t pay $75 for fire insurance—which happened a few weeks ago in a rural area of Tennessee that doesn’t guarantee fire protection—and letting a person die because they didn’t purchase health care insurance.
When liberals explain why health care needs an individual mandate, the traditional metaphor is firefighting: Everyone needs to buy insurance for the same reason that everyone needs to buy fire protection. But if you leave the market unregulated, some people won’t buy — or won’t be able to afford — fire protection. And we’re not comfortable letting their houses burn down. Similarly, if you leave health coverage to the market, some people won’t buy it, and others won’t be able to afford it, and then, when they get sick and need it, insurers won’t sell it to them. But we’re not comfortable letting them die in the streets. Hence, the health-care law.
Klein argues that fire protection and health care are both “collective goods” which the government must guarantee.
Sam and I discussed a similar question over a year ago, when I attempted to parallel the government’s obligation to protect its citizens against Swine Flu (remember that?) with its obligation to protect citizens against other serious illnesses like cancer.
The parallel between fires and non-epidemic diseases, generally following Sam’s post, does not work perfectly. Fires spread. Non-epidemic diseases, like cancer, do not. If one person isn’t protected against fires, we are all thereby threatened, because those flames can jump from his house to our houses.
When a person is ill with a non-epidemic disease, we are not thereby threatened ourselves, or at least not enough of us to say that the community is endangered. This is why fire insurance is a real “collective good” and health care is not. Health care may be (and I think to a degree is) an individual right, of course, but that’s a different argument.
Do not pass GO. Do not collect heart transplant.
The complexity of allocating health care morally
ABC News reports that the morbidly obese are unlikely to receive heart transplants because their chances of recovery are so slim. Some transplant centers purportedly have a Body Mass Index cutoff of 35.
Although nobody died in the making of the ABC story, the same cannot be said of this horrific anecdote from Britain, in which a premature baby was unattended to for being born two days too early. Elsewhere in the world, a 69-year old Japanese man who was hurt in a traffic accident was turned away from 14 hospitals before he died. In slightly funnier twist, a Swedish man fed up with waiting sewed up his own leg (successfully) and was charged for the unlicensed use of medical instruments.
Healthcare horror stories seem to crop up everywhere regardless of the kind of system that prevails. The American healthcare system is a mixed-public private system, as are those of Germany, France, Switzerland, and the Netherlands. Sweden, the UK, and Canada are single-payer government-run systems. No examples of a pure free-market healthcare system exist anywhere.
Under a pure free-market healthcare system, care would simply be rationed on the basis of the ability to pay and perhaps the charity of doctors. Supply would meet demand, end of story (nothing like this has ever existed for reasons that are beyond the scope of this post). This strikes most people as at least a little offensive –if a child’s parents cannot afford a life-saving procedure, should that be the end of the story? A pure free-market system would definitely have its share of horror stories too. Read more
Feminist polygamy…and other dangerous thoughts
The website Big Think devoted each day last month to a “dangerous idea” from experts in various fields. A number of them relate to public philosophy.
Among the relevant posts, Richard Pildes, NYU constitutional law professor, argues for the abolition of primary elections. (A topic I discussed here). Peter Singer, Princeton utilitarian philosopher, argues we should allow infant euthanasia. Julian Savulescu, Director of the Uehiro Center for Practical Ethics at Oxford, makes the case for bringing back eugenics, in order to breed a more moral human. Dr. Barry Popkin, Director of University of North Carolina-Chapel Hill’s Interdisciplinary Center for Obesity, calls for a tax on the overweight. And Marina Adshade, economics professor at Dalhousie University, argues that polygamy is feminist, since it benefits women economically.
There’s a lot of provocative stuff on the site worth checking out.
-Jake
Image by Flickr user BrunkFordBruan used under a Creative Commons Attribution License
Just what the doctor ordered?
The White House this month asked states to end criminalization of HIV transmission. Basically, these laws make it a crime for anyone who knows they have HIV to engage in activities that could transmit the disease to others (unless informed consent is given). According to the White House:
In many instances, the continued existence and enforcement of these types of laws run counter to scientific evidence about routes of HIV transmission and may undermine the public health goals of promoting HIV screening and treatment. CDC data and other studies tell us that intentional HIV transmission is atypical and uncommon. A recent research study also found that HIV-specific laws do not influence the behavior of people living with HIV in those states where these laws exist.
The entire argument here appeals to “public health goals,” a broadly consequentialist notion about overall health of the community. But perhaps the justification for these laws can be found elsewhere.
After all, the state has a responsibility to protect individuals from the negligence of others, and this law may be an expression of this responsibility. This protection can have societal costs, but non-consequentialists might argue that the rights of the individual trump these concerns – the protection of individuals from others is still the first responsibility of the state, morally prior to protecting citizens from, for example, diseases and poor health.
-Han
Photo by Flickr user Trygve.u used under a Creative Commons Attribution license.
I’m not racist, I have lots of friends who are pale
The Washington Post has a ridiculously amazing article on people who think that the “tan tax”, a provision of the health care reform bill charging a 10 percent surcharge on the use of tanning beds, constitutes racism against — yeah, that’s right — pale-skinned people (or is it pigment-challenged Americans?):
The case can seem deceptively simple: Since patrons of tanning salons are almost exclusively white, the tax will be almost entirely paid by white people and, therefore, violates their constitutional right to equal protection under the law.
But does the argument have any merit? Not remotely said Randall Kennedy, a professor at Harvard Law School specializing in racial conflict and law. “There is no constitutional problem at all, because a plaintiff would have to show that the government intended to disadvantage a particular group, not simply that the group is disadvantaged in effect…. To say that this health rationale was a mere pretext for wanting to stick it to white people is completely implausible.”
-Marc
Photo by Flickr user Whatshername? used under a Creative Commons Attribution license.
Paying people to be healthy
The New York Times’ Room for Debate blog has a fascinating discussion on programs that encourage people to become and stay healthy. A panel that includes policy analysts, a doctor and a professor of bioethics consider whether incentive programs work and whether they raise ethical questions or alter the sacred doctor-patient relationship. Check out the full debate here.
Is there a states’ rights issue in the Affordable Care Act?
Chicago labor lawyer Thomas Geoghegan has a piece in Politico debunking the legal claims made by state attorneys general against the Affordable Care Act. Geoghegan’s most persuasive argument is that the voluntary nature of Medicare puts conservative lawyers in a poor predicament. Geoghegan pounces:
Now, the state attorneys general anticipate this annoying quibble. Their complaint has a paragraph that, in effect, says: “OK, we know it’s voluntary. But we’re invested in the old Medicaid rules, and we can’t just leave the program now.”
In other words, if a state voluntarily participates in a federal program, it has a 10th Amendment right to have the federal government implement the program exactly the way the state wants. Implicit here is the claim that the federal government cannot change any welfare program that goes through a state — unless the state agrees.
The idea of “states’ rights” is thought to be at the core of the conservative argument against ACA. But it seems like states have already quite voluntarily delegated much of their health care responsibility quite happily to the federal government. Geoghegan reminds us that the key reason Texas or any other state would not and cannot actually secede is that they would be cut off from the flood of federal entitlement money that’s critical to keeping their operations afloat. The federalism argument plays well on TV, but ultimately the discussion is just about the level at which a particular federal program should be funded.
-John
The blame game
How to talk about blame with diseases like AIDS?
In Tuesday’s NY Times Infectious-disease physician Abigal Zuger writes that it is time to move beyond “obsolete H.IV. statues” that seek to punish those who transmit the disease. She explains that our fascination with playing the blame game over the spread of AIDS is representative of a larger human desire to hold someone else responsible for our illness:
We blame that coughing woman in the subway for our cold, the giant meat company for our food poisoning, all manner of chemicals and electromagnetic radiation for our cancers, and fast-food outlets for our diabetes and heart disease. We cannot experience illness without casting around for blame.
Zuger is certainly correct that the spread of AIDS cannot be distilled into simple terms like innocent victim and murderous sexual deviant. The disease often “moves among the poorest of the poor, the disenfranchised and socially marginalized, where substandard education means no escape.” Read more
Tea Partyers for Medicare
Inconsistency or philosophical conservatism?
The New York Times had a fascinating look yesterday at the demographic and ideological makeup on the Tea Party movement. Long discussed, but little studied, The New York Times and CBS commissioned a poll this month to get a detailed look at the profile and attitudes of Tea Party supporters.
The poll found that the 18 percent of Americans who associate with the Tea Party movement tend to be white, male, married, over 45 and on the “very conservative” end of the ideological spectrum. Tea Partyers express “fierce animosity toward Washington, and the president in particular, [ ] rooted in deep pessimism about the direction of the country and the conviction that the policies of the Obama administration are disproportionately directed at helping the poor rather than the middle class or the rich.”
But here’s the surprising stuff. While Tea Party supporters believe the goal of their movement is reduce the size of government and favor doing so even if it means cutting domestic programs, most happily partake in the three most expensive domestic programs: public education, medicare and social security. And they assert that these programs are “worth the cost to taxpayers.”
So what gives? Read more
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