Shifting the conversation about Health Care Reform

Elizabeth Mazzara

The past year the two things that have been on our minds as Americans has been the economy and health care. And, while BPs fireworks in the Gulf have been a distraction of late, I think a reflection on national health care reform is in order.

But before we get there, I’d like to reflect on how we, as progressives, interacted with that process. I think the health care reform debate is a perfect example of progressive-myopia.

Social change is glacial. It is evolutionary. It moves ahead in fits and starts. It is difficult and uncomfortable. And it is ongoing, constant, and never ending.

Throughout my graduate school career, I studied social change. And I think this is the part that hung me up. I was looking for a discrete moment in time in which 'social change' happened. But, social change is a process. And there are many actors who take the lead during different parts, but it is this process that is the key to real social change.

This is what I think we have been missing in the health care debate.

As I am prone to do, let’s look at an example here… Let's take a minute to review the time line of the Civil Rights Movement. It was ten years between Brown v Board of Education of Topeka (which required schools to desegregate) and the 1964 Civil Rights Act. It wasn't until 1971 that the Supreme Court argued that the Constitution's guarantee of' 'equal protection of the laws' supported the busing plans established across the nation (Swann v Charlotte Mecklenburg Board of Education). So we have 20 years of an ongoing, agitated, and very public social movement seeking long term social change, and I would deign to argue that not one of us believes we live in a post-Civil Rights (or at least a post-racist) society.

Does that mean each of these milestones was a failure? Should the Civil Rights Movement have splintered after Brown II when they saw that schools weren't desegregating as required by the United States Supreme Court? (fill in your own series of examples where CRM stumbled or was blocked, but did not fall to illustrate this point)

So why is it then that have been so unwilling to bend when it comes to health care? Do we REALLY believe that we are going to change the delivery system of American health care in one fell swoop? Are we really willing to call this effort a failure because we didn’t get a single payer system out of the gate? I have been stunned by the number of progressives I have spoken to of late that consider this health care reform effort a failure because we didn’t get a public option this time around. To me that is shocking, disappointing and short-sighted.

This is something we Progressives are far too prone to. We are policy driven – we believe the ‘facts will set you free’ – when really, what we are trying to do is NOT change a policy. We are trying to change the fundamental way we, as a society, value health care. We need to start a discussion about WHY health care matters – not provide a fact sheet describing what the change will look like. This is the real battle.

If you believe, like I do, that health care is a right, then you are a part of this social movement. What we are seeking is not health care POLICY, we are seeking social change (read: value-based politics). The policy (i.e. the legislation) is just one tool we will use to create this social change.

The core of this social movement is changing how we, as Americans, understand our relationship to health care.

Before we have meaningful policy, we have to have meaningful support. Before we have meaningful support, we have to have a social movement. Before we have a social movement, we must recognize what it is we are wanting to change and why we want to change it.

In other words, we need to shift the conversation, not just the health care paradigm.

One thing the Right has right is its focus on value-based politics. They appeal to the heart and then to the head. Now that we have the first step in health care reform at the national level (insurance reform), it is imperative that we begin (or continue) the value based discussions about what it means to provide access to basic health care services and what values that access supports.

Call it a social movement, or value-based politics, or whatever you want to. But it is my belief that this is the discussion we need to be having.

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    Elizabeth, you indicate that you believe 'health care is a right'. This means that you are imposing an obligation on someone else to provide you with health care. Who, exactly, are you forcing to provide you with health care?

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      So Ed do you think your relatives should have to pony up 200k for cancer treatment or 50-100 for a heart attack. The average person doesn't have that kind of cash lying around so society has to find a way to pay for this. Unless we only want the rich to get cancer treatment and treatment for heart attacks.

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      Ever heard of cost-shifting? You are paying for those without insurance coverage already. And paying for the most expensive, least effective delivery of it (an ER visit) I might add.

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      I think Ed is totally right.

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    Carla, ditto. Thanks for that. Well put.

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    And Ed. I think your question goes right to the core of what I was trying to say. I think we need to start adding a value-based discussion into the political and policy dialogue. What are the values that push you to think that we shouldn't provide health and wellness care? And, what are the values that push me to say that we should?

    I think that's a discussion that needs to happen.

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    As if on cue... an excellent piece from the NY Times about taking the long perspective on change that matters.

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    Not to worry Elizabeth, democrats and Obama have designed a Rube Goldberg health care delivery system guaranteed to raise costs, lower overall access and have business all over our country begging for intervention within the next decade.

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      "lower overall access" - Heat getting to you, Kurt? 30 million people who haven't had access now will. Is that what you call lowering access?

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        Dan, the changes enacted thus far (adult children stay on daddy's and mommy's plan, no pre-ex exclusion for children and no lifetime caps, lowering availability of FSA's) all add costs to policy holders. The estimates are anywhere from 3% to 5% before even figuring in the mandatory oregon $500 tobacco cessation coverage.

        Many medium sized companies are expected to make a financially rational decision and will pass along the additional costs. Some will also bypass coverage altogether paying the 'fine' and telling employees and families to go to the consortiums.

        That is lower overall access. And yes, it is hot over here.

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          ...all add costs to policy holders.
          Except that it doesn't, since it would be adding the most healthy demographic into the actuarial. The demographic least likely to cost the system I might add, which would lower the overall cost for most policy holders. In fact, we already have data (PDF) that the HCR is extending the life of Medicare by some 10+ years and knocking out $130 billion from the deficit.
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            Now, Mitch, don't you be gettin' us all confused with yer "facts" 'n yer "data"--we KNOW what we KNOW 'n that's THAT!

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            Mitch, if the enabling legislation allowed additional charges for the adult cildren your premise would be correct. Unfortunately, the law specifically prohibits additional charges for the adult children staying on the plan. So, every prescription and check-up means additional unfunded costs and a hit to plan experience. So the cost is bourne by the policy holders who pay more.

            The CBO report dated March 2010 has already been shown to have structural deficiencies in their estimates. even so, the cited Medicare savings were based on the assumption that Congress would finally cut the reimbursements to doctors and hospitals that was enabled, but never enacted years ago. The supposed savings are based on cost shifting more to the private sector; raising costs yet again to policy holders.

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              What nonsense. If you add an adult child to your policy, your insurer has to charge the same amount it would charge for any children covered by the plan, he says

              Your claims that the CBO deficit reductions are based on cutting what Medicare pays doctors and hospitals is bunk. In fact, payments schedules actually go up under the Medicare Physician Payment Reform Act (HR 3961) which was the companion bill to the Affordable Health Care for America Act, both of which were already passed and included in the CBO's March analysis.

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                What nonesense is exactly correct Mitchell. The legislation specifically PRECLUDES the policy holder from being charged "extra" for the adult child remaining on the plan. So Jr. stays on and the plan absorbs their additional costs for a minimum of 3 years. Those additional costs are passed on to all on the plan at plan renewal.

                This is just one of countless little details that the democrats have yet to figure out is actually in the legislation. A friend spent about 60 minutes in a telephone coference with Wyden's Chief of Staff and 3 oter staffers a few days ago. They were repeatedly caught flat footed and found to have the wrong interpretations and understandings of what the democrats have passed under the banner of Health Care Reform.

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                  What nonesense is exactly correct Mitchell. The legislation specifically PRECLUDES the policy holder from being charged "extra" for the adult child remaining on the plan. So Jr. stays on and the plan absorbs their additional costs for a minimum of 3 years.

                  More nonsense. The plan doesn't "absorb" anything since the policy holder is still making premium payments for the adult child. They simply can;t be price gouged for continuing the exact same coverage they had. It does not however negatively impact that actuarial at all.

                  Though it does prevent price gouging by insurance companies, and keeps premiums coming in for adults who otherwise don't buy insurance since they are the most healthy demographic and often don't buy insurance for that reason (and the fact that their premiums would be unnecessarily much higher if they bought a single policy instead of continuing the coverage under the families existing plan).

                  In short, you are talking through your hat (again).

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                    Here's how this messed up legislation will work in the real world. Let's say that my company premiums rise substantially next year (we have been warned that they will). We will then go out to get new quotes from other providers. Except this time around, due to Obamacare rules, since I am changing my plan I now have to provide a plan that meets federal government requirements for coverage. The "you can keep your plan if you like it" BS was just that. My employees and I have lost even more flexibility in choosing our coverage; we can keep our existing plan and pay much higher premiums, or go to a new plan that must meet federal guidelines. Either way we go will cost us more money.

                    Please tell me where I am wrong.

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                    mitchell, you're wrong. you can't repeat something enough times wishing it were true and making it so. I'm not talking through my hat. I base these comments on 31 years working with mid and large sized employer based plans in several different industries and states. I've worked for fully insured, partially self-funded and self insured employers and negotiated, administered and managed plans.

                    I also have an immediate family member with a costly chronic medical condition. I know and understand employer based health care insude and out. You on the other hand pretend behind the keyboard.

                    Nobody hoped for meaningful reform of healthcare and is more disappointed that what we have is an expensive piece of crap that does not reform healthcare.

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                      Health rates in plans with >100 employees are based on that plans experience, pooling, trend and community usage levels as well as catastrophic claims. Plans <100 employees are community based for the same factors.

                      The premiums are either composite rates where employees all pay the same amount regardless of single/family coverage status or tiered. The most common is Tiered single, plus spouse and family. The only tiered plan that would accurately reflect a 19-26 year old staying on the plan is a tiered rate charging for each dependent. Those are rare. All other rates hide the number of dependents.

                      Pooling and experience expectations are based on actuarial estimates of dependents going off the plan between the ages of 19-23. They do not factor in the new mandated extra 3-7 years of coverage and the parents will not pay anytihng extra.

                      however, the entire plan will pay extra at each renewal (current estimate about 3%) to cover the additional years of coverage. The kids staying on mommy and daddy's plan will dirive experience, trend and pooling upward and the entire plan will have to absorb those costs. Even if they pay 30% of the premium, mom and dad are shielded from juniors additional cost impact.

                      Hey, I've only been doing this for 31 years. I could be wrong. but I'm not. You're wrong, Wyden and his staff are wrong and most democrats who voted for this reform have no idea what they actually put into motion.

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                        There are no additional premiums because there is specific language in the reform bill preventing the employer based plans from changing how they charge or figure tiered rates based on adult children on the plan. It is a cynical way to force coverage onto employer based plans while also gutting them at the same time. If the intent was to "encourage" more employers to dump their plans it was ingenious.

                        Did you read the regulation? I did and also have been to several in depth sessions discovering how/what needs to be done to comply with this reform bill. No, I'm not wrong and I'm not talking through my hat. it is you who are typing without thinking (again).

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    Ed's response characterizes the utter irrationality of the right on health care. There is some crazy notion that an individual can exist in a vacuum and avoid paying for the existence of an entire system of health care delivery. We do pay for everyone who doesn't pay. We do pay for every insurance recision and exclusion. And does Ed really want to live in a world where the ambulance verifies your health coverage before they come? Or a world like the People's Republic of China where you pay with cash at the door of the hospital or they haul you to the curb to die? Instead we live in a world where we all pay for the uninsured after they come to the emergency room with disease progression that has been allowed to escalate, with with the most expensive, least efficient and least preventive form of intervention.

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    Another thing I would note about health care and the civil rights movement, is that like civil rights, health care is going to be changed at the state level before it is changed for the whole nation.

    right now in Oregon there are several major developments in health care reform that Laura Etherton has blogged about over here -

    one good thing - the plan to cut administrative waste is looking pretty good.

    one less than good thing - the draft plan for the insurance exchange is weak. it doesn't allow for the exchange to use negotiating power to get lower rates for participants. that's a major flaw.

    we have until Sept. 17th to comment on these plans, and there is a link for that in the most recent blog post there. If you believe the exchange should have bargaining power, let the Oregon Health Policy Board know ASAP!

    but yeah, states started enacting civil rights reforms before they caught on nationally. and the same is going to happen with health care.

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    Great writing Elizabeth...yes, change is slow..but it does happen. In the early 80's very few people used alternative health care like acupuncture, chiro, supplements, but for those few of us early adopters, we stayed committed despite being the 'outsiders'. By 2000 more than 50% of folks were accessing alternatives and now even the traditional system is beginning to include them.

    And that will hopefully extend now as we explore Health Care reform. Because we don't have a health care system..we have a Disease care system and that is a 'fix it after its broke system' that will bankrupt us. So this first phase of 'reform' is but a scratch for the changes necessary but it is at least opening discussion and bringing it into view.

    To Ed's comment of "health care is a right"...and if so, who is going to pay for it. Perhaps a better statement we could all adopt is: "Health care is a right and a responsibility for which we all need to participate". Because when its a right without a responsibility, then I can abuse my health care (something our current system enables) and yet, make someone else pay. If we all learned of the 'right and responsibility', that we each have for our health and health care--the entire dynamic changes and we, the consumers, would want far more prevention/true health care and far less of the super-expensive, fix it after its broke disease care.

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      Ann... thank you. Excellent, well thought comments. Change is slow and tedious and rarely pretty or perfect. Your comments on alternative and complimentary care is right on! It's a great example of changing how people THINK ABOUT health care and wellness... I continue to argue that THAT is where we will find success in the long run.

      Slow, deliberative, discursive and VALUE BASED.

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    Elizabeth, I think you're right on here. I'd add that as a matter of optics, I think we err if we frame it as an economic issue. Obama did that to get the bill passed--and wisely, in my mind--but we shouldn't keep repeating Peter Orszag's talking point. The issue is not about money, it's about access to health care. As with almost every other public policy issue, there are cost ramifications, but let's not follow the Kurt Chapmans into the weeds. The first goal should be to cover all Americans. This is a value, like you say, and it's the thing we should be talking about.

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      Jeff... thanks for the addition. And, yes. Why do we progressives get so caught up on the 'facts' of change? Let's learn from the rights playbook here. What is driving our desire for this health care reform? What about it appeals to our core values as Americans. Let's start adding that into the conversation and see if we might end up someplace a little different.

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    The time will come, and I hope soon, where health care will be understood as a public utility, much like police and fire protection, streets, sewers, electrical infrastructure, and so on.. it is an essential service that is available to all and for which we all pay. There may always be some cadillac services that some will pay extra for, but essential health care should be,and will be, considered a public utility.

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    Ed's comment depends on the fallacy that differentials in wealth come from differentials in merit. The very wealthy, the only ones who can reliably expect to pay for all of their own health care contingencies, got so rich because they deserve it. Right. You simply can't make such an argument about health care without also arguing that some lives, actually a lot of lives, just aren't worth saving.

    Elizabeth, good article. There are far too many examples of where holding out for "fundamental restructuring" of some important function has left us with no progress at all.

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    Wow, where do I start?

    Carla, I am not currently under any obligation to pay for other peoples health care. I make a choice to pay for my care. And to a very limited extend in this state I have some choice of coverage. Yes, part of my cost is covering those who don't have the ability to pay for it. I am not here to defend the current system; it has many flaws and is far from perfect. But it is a wild leap to say that since the current system has flaws we should let the government take it over.

    Dan, I don't want to pay 200k for cancer treatment; that is why I buy insurance. If someone (relative or not) chooses not to have insurance, then that is their choice.

    And to Bill, the irrational one: I do not live in a 'vacuum'. I do, however, believe that a government monopoly on health care service is not in anyone's best interest. It will not lead to better or less expensive care.

    Susan basically argues that our current system puts a value on life. Do you honestly believe that a government-controlled system would not establish a value, and determine who should live and who should die? The difference, however, would be that with the latter I have lost the control over the value of my own life; the value is no longer set by me but by the government.

    The right answer is to see the restrictions on health insurers and health care providers removed. Let people choose from a wide variety of insurance and care options; don't limit it by what the state thinks you should have and thinks you should pay. There are millions of people out there that can afford our existing insurance but don't purchase it by choice. I believe many of those people would choose a coverage if more cost-effective options were available to them.

    States like Oregon restrict what kind of insurance I can get, which increases my cost. And the new Obama plan is going to increase it yet again, with no improvement in benefits and less options available. It has not fixed a thing, it has only made it worse. But as someone said above, perhaps that is the plan?

    Would anyone here opt to have the state control the distribution of food? That has been tried before; it doesn't work. We couldn't even effectively ration the distribution of gasoline in the 70's. Why would we do it with something as important as health care?

    Free choice works for most other things in our society; why not try it with health care? That will bring costs down and improve quality. People can have control over their own lives and not be dependent on a government completely beyond their ability to influence. My goal is to have the best possible care available to the widest number of people.

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      Carla, I am not currently under any obligation to pay for other peoples health care.

      So you don't pay your doctor or hospital bills?

      Because if you pay for your visits, you are paying for the uninsured already. It is called-cost shifting.

      Every time an insured person goes to the ER, the cost of that visit is shifted into the rates that are charged everyone else. IN fact, you are indirectly subsidizing the most expensive, least effective treatment for the uninsured I might add.

      So your comment starts form a completely false and flawed premise form the outset, and only goes downhill from there.

      Way to go.

      (golf clap)

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        I understand cost-shifting. You are missing the point.

        In your world, you would impose a legal, binding obligation on individuals to pay for and/or provide health care to others. You would expand the existing great divide between the consumer of health care and the provider. The net result will be increased cost, reduced quality, and generations of continued complaining about a service completely out of a person's individual control.

        In my world, I would let people decide how they will handle their own care. The result will be lower cost, better service, and decisions made in the hands of those that should be making them.

        If a group decides to insure themselves, why not? If someone else decides to pay cash, why not? If others form and fund charities to cover the care for those that can't care for themselves, then why not?

        Our system is not ideal; it has many problems. Single payer is not the fix.

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          You are talking through your hat.

          As already pointed out, you are paying for the uninsured already. That renders the rest of your tripe just that, tripe.

          In "your world" you describe the failing status quo and point to nothing but non-specific wishful thinking vapor.

          And yes, single payer is not only a very viable fix, but the most effective one as well.

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        Oh, and (golf clap). :)

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      Hi Ed, If the goal is "to have the best possible care available to the widest number of people," why would we continue to inflate the cost of health care to float the insurance industry? At the small, part time, private practice where I work, we pay 8% of all income to our billing agency in exchange for not having to try and wade through the insurance nightmare that currently exists. We also spend approximately ten unbillable hours a week filling out or phoning in prior authorizations or consulting with pharmacies who have been instructed by insurance companies not to fill prescriptions without contacting the doctor to see if she is interested in trying a different medicine first. It is always 100% in an insurance company's best interest to deny payment and refuse services for as long as possible- how can that possibly translate into great health care? In my mind there is an arguement against converting to single-payer system, but it isn't a healthy people issue- it's a healthy economy issue. At this point the health insurance industry may be "too big to fail." If we just 86'd those companies, what would happen to all of those people? A single payer system would streamline the billing system so much that however massive one might fear the government becoming, it still could never absorb all of those jobs.

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        I agree with you on many points regarding our existing system. But a single payer, government run system is not the answer! This is the first time I have heard filling out government paperwork 'streamlined'. I've done it, it is far from it!

        There are many other options available to us that would leverage the creativity and ingenuity of free people. Let's try some of them first.

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          Why isn't it the answer?

          It works and works well in numerous countries that have it. Are you suggesting that Canada can mange to have a very good,single-payer system but American creativity and ingenuity are incapable of it?

          BTW, multiple millions of people have no problem at all with Social Security or Medicare systems and are not drown in paperwork.

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      Mitch already addressed the issue of cost-shifting, so no need for me to do it. But yes, you are under an obligation to pay for those who can't, whether you like it or not. It's the system we're in. And it's part of what is driving the climbing costs.

      All ideology aside, the most efficient, lowest cost and easiest access system is single payer. The boogeyman phrase "government takeover" is ideological, not practical. It is a scare tactic, not an answer.

      In terms of "value of life", the current system already places a value on it. You just don't happen to be writing the checks for it, your insurance company is doing it so you don't feel the weight of it coming out of your checking account as you would if you directly paid.

      More health insurance companies and corporate healthcare with no consumer laws isn't the answer either. It's again, ideological. But not practical and horrible for consumers.

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    Ed:"I do not live in a 'vacuum'. I do, however, believe that a government monopoly on health care service is not in anyone's best interest. It will not lead to better or less expensive care."

    Ed, it certainly is irrational to think that your doctor or hospital fee, whether you pay it directly or through your insurance company does not equally cover all their costs, including the costs that are shifted from all those who defaulted or went into medical bankruptcy.

    Regarding government "monopolies". My sister in Canada with other citizens of her country pays half of what we pay in health care services, in a system where her provincial govt. British Columbia, is the insurance carrier for every provincial citizen. She has the security from cradle to grave that she will have good, comprehensive health care choosing her own doctor. (For which there is consistently high support from Canadian citizens.)

    In contrast my sister-in-law in this country, a good hard working self employed person was diagnosed with uterine cancer, was cut off from coverage (recision) by her corporate junk insurance company, and is now in the process of losing nearly everything she has, besides her health and her life, and faces daily harassment from the collection agencies that her "Good Samaritan" hospital let loose on her. Yeah, that corporate health insurance system is really working for us with their 30% administration and parasite cut, compared to the 2% Medicare takes to administer.

    If it's okay for the government to have a monopoly on police and fire protection, on the basic services of every community that make up civilized life, on the military protection services of our nation, then why is it such a leap to say that basic health coverage is not an essential service for every citizen. Who is expendable? Who should not receive it? It seems that the real death panels are on your side of the argument.

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    Ed, if you think you have "control over the value of" your "own life" now, I've got a great deal for you on a bridge.

    It's amazing how willing people are to cede control over their lives as long as it keeps "the government" out of the picture. Give me Regence or give me death! Or both!

    "Free choice" for a working person with cancer and limited resources (The working middle class has received credit instead of raises for the past 30 years or so) is the same as telling a shoeless person to pull himself or herself up by the bootstraps. If they have assets they may pay for their treatment, but only by liquidating the life they have built.

    Again, that whole argument assumes wealth implies merit and lack of wealth is just one's own fault. We do not have an economy that allows more than a few to amass the kind of wealth required to pay for many treatable diseases and conditions. Ed would have us ration care based on wealth.

    Not even Calvinism, which this view is derived, selected and perverted from, would approve.

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    I guess Gibbs' rant should have let us know that neoliberals were launching a full scale offensive. Elizabeth, you succeeded, literally. What neoliberals simply don't understand (besides the fact that they are the anti-progressives) is that it matters why the pace of change is glacial. It also matters what you lose while you're farting around. Will your next piece be one that explains to us why we should be happy with the pace of climate change legislation?

    HCR progressed slowly because Obama decided that's how it would go down. It's that simple. This is midterm spin to convince us that Democrats have done something useful with their power in the last 2 years. I'm not buying. With apologies to John Lennon, "No short heared yellow bellied son of tricky dicky`s gonna mother hubbard soft soap me with just a pocket full of hope".

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      wow. Couldn't disagree more. I fear the focus here has been about the details of health care reform and many of the commenters have completely missed my point, yourself included.

      I am talking about shifting HOW WE TALK ABOUT THIS ISSUE! And what does everyone do? move right back to a FACT BASED DIALOGUE. Who should have what? How much should we pay? Who pays how? Those are all interesting and important questions but they DON'T get at WHAT ARE OUR CORE VALUES AS PROGRESSIVES THAT DRIVE US TO BELIEVE HEALTH CARE IS A RIGHT?

      THAT'S the conversation we need to have. THAT'S why this and ALL OTHER social change is glacial.

      Step back. See the larger picture. See the possibility of shifting a cultural dialogue.

      or not, I Guess.

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        That's my point. The neoliberal and progressive positions have become polar opposites. At least we agree on that!

        I level all the same criticisms. History will judge who had the "big picture".

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    The myth that only the extremely wealthy can afford proper health care is absurd. It's a matter of priorities!! The people I personally know who "can't afford" (or choose not to have) health care, spend their money on unnecessary frivolities. Are they wrong for doing so?? That's not up to me. My point is that they can afford it, they just choose to spent their money elsewhere. Again, priorities. As of now, in this country we have the freedom to choose what we spend our money on.

    It fascinates me that the subject of "the value of life" has come up. I think its safe to say the majority of the people who are advocating the health care reform are in favor of abortion. (This "assumption" is backed up by the fact that they want to cover abortions in the new health care plan). The government have just decided the value of an unborn babies life is...nothing.

    I'm 16, home schooled, and obviously brainwashed by my Right Wing Extremist parents. But please try not to get so caught up in your own deceit that you fail to see things from a logical perspective.

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    The myth that only the extremely wealthy can afford proper health care is absurd. It's a matter of priorities!! The people I personally know who "can't afford" (or choose not to have) health care, spend their money on unnecessary frivolities. Are they wrong for doing so?? That's not up to me. My point is that they can afford it, they just choose to spent their money elsewhere. Again, priorities. As of now, in this country we have the freedom to choose what we spend our money on.

    It fascinates me that the subject of "the value of life" has come up. I think its safe to say the majority of the people who are advocating the health care reform are in favor of abortion. (This "assumption" is backed up by the fact that they want to cover abortions in the new health care plan). The government have just decided the value of an unborn babies life is...nothing.

    I'm 16, home schooled, and obviously brainwashed by my Right Wing Extremist parents. But please try not to get so caught up in your own deceit that you fail to see things from a logical perspective.

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      " The people I personally know who "can't afford" (or choose not to have) health care, spend their money on unnecessary frivolities."

      Not so much brainwashed as extremely sheltered. Same effect, I guess, in this case.

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        Susan, I believe you owe that young girl an apology. She is trying to engage in a conversation on a very important topic, and you ridicule her.

        You would be better off to demonstrate your argument:

        There is no-one who can afford insurance while choosing not to purchase it.

        That is what you are saying, correct?

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          Not at all. I'm saying that the people this person personally knows do not, obviously, represent a statistical sample of any kind. Maybe, if she's lucky, a few more years will provide her with the perspective to understand that.

          The religion, and I choose the word on purpose, of "everything comes from choices and everybody gets what they deserve" is one well suited to those to whom life has been good. It makes them feel even better. Those who have been kicked while they were down a few times see things differently.

          The fact is that many insured people are forced into bankruptcy by medical bills if they get sick. It's hard for somebody who hasn't been there to understand how financially devastating a serious illness is, regardless of insurance status.

          Or maybe they do understand, but they believe that overpopulation is real, and an inefficient health care delivery system is an excellent way to thin the herd.

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      A zygote is nor more a living person than an acorn is an oak tree.

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        Personally, I put more value on human life than oak trees. Where do you draw the line? 3 months? 6 months? 9 months? 1 week after birth?

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          Why is it that this blog labels itself progressive, yet most seem to assume that one is speaking from a neoliberal POV?

          That's what makes a dangerous tumor dangerous. It has more of a right to exist than the other cells that contribute to diversity and functioning of the entire organism. All "man is diffent" or better logic derives from religion. I reject that pseudoscience.

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        of a marijuana seed is a 2.2 pound, fully mature, female plant (which is DEA law and practice).

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    Sorry for the double post, the server didn't like me :P

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    Again... I would love to see all of these commenters take a step back and actually address what I wrote. What are the values that are driving this reform effort? Let's talk about that FIRST... and THEN talk about how that translates into policy.

    THAT'S how social change happens. I posted above, this is (or could) shift our cultural dialogue. We don't have move all the way over the Rights Based talk (ala Dworkin) but how but talking about what drives us to believe health care should not be a commodity.

    Let's start there. Progressives, stop arguing the facts, that's where we lose. Appeal to the heart, the head will follow. (If you don't believe, turn your channel to any neo-con talk show right now... few facts, all heart --and bluster).

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      But therein lies the problem. There are those who think that healthcare is a commodity that you only get by making enough money to purchase it. Others (myself included) believe that healthcare is a right for all members in any civilized society.

      When you begin from two differing fundamental starting points, how can you expect a more meaningful or deeper dialogue will somehow reconcile those views?

      Not castigating you for the effort, but there is a fundamental difference in world-view.

      What I find most revealing is those who are so bent out of shape in the fear that they might end up paying for someone else to not die are not only already paying for it indirectly, but are spending more money than if we simply had universal coverage in a single-payer system.

      Just on the most base motive calculus, they are arguing against their own wallet, to say nothing of the tertiary benefits we all would gain by having a healthier (literally) society and less bankruptcies, more productive people in the workforce, etc. etc.

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    Elizabeth, thanks for refocusing this conversation. So, I will do my best to argue that health care is not a right.

    To say that health care is a right for you is to say that someone else is obligated to provide it to you. I am not speaking of a moral obligation, but rather a legal obligation which someone else is required to provide under force or imprisonment. I don't see how you can argue that it is a right without also saying that it is such an obligation. It is not possible to separate them.

    Put another way, your right means that some taxpayer is forced to pay for it, some practitioner is forced to provide it, and some pharmaceutical companies are forced to provide you with medication.

    Others have argued that we are already obligated to pay for those that don't have it via cost-shifting. This is not correct. Nobody is obligating anyone to purchase insurance. Yes, part of my insurance dollars do pay for those that are not in a position to pay for their care. But I have the choice to buy insurance or not. I could instead go to a private practitioner and pay them cash. There is a fundamental difference between this obligation and a legal one.

    You could argue that we do indeed have a moral obligation to take care of each other. That is a valid argument, one that many people feel strongly about. That is why voluntary charities work so well. But there is nothing moral about forcibly taking property from one person and giving it to another.

    I want the best possible health care I can get, I just don't expect anybody else to pay for it.

    Also, to argue that health care is a right requires you to define just what you mean by health care. Is it a right to get a cup of noodle soup and a warm blanket? Or is it a right to get a $2M bone marrow transplant that has a 1% chance of success? Does your right mean that you can receive the best currently available care, or does it mean that someone is obligated to spend millions of dollars to determine a cure for your unique medical condition? Where do you draw the line? Whether you want to admit it or not, we do not have an infinite supply of resources which means that we must ration care in some form or fashion.

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      These are very good points Ed. This is the difference between positive and negative rights. We create government to protect negative rights such as safety etc. Positive rights can only be instituted via government coercion so they are in fact not rights at all since they do not exist in nature prior to the creation of a State, they are obligations on another which is coercion. The fact is, freedom is defined by lack of coercion and fraud. So we cannot have progressive socialism and be free because it requires coercion and often fraud to implement. Now Carla is correct we do pay for others already, but this was done so until recently outside the scope of force and coercion. We were never threatened with jail etc. Finally, I would like to point out something. Social health care has a 100 % failure rate if we look at history. No system put in place in 1848 is still in existence today. It will fail. Knowing this we must work together to show what the real problem is with health care in America is. If we look at our own history we will see it. Much of it is related to our food. Watch Food Inc to know more also read the Paleo Diet. Also, much of it is related to legislation that forbids the promotion of natural cures as well. 80 to 90% of conditions are metabolic in nature and avoidable or curable outside the scope of prescription drugs. If we could work on that first, before we go straight to coercion to promote a broken system, that would be progress.

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        Thanks Mark. Yes, positive 'rights' are in direct contradiction with freedom. I am anxious to hear Elizabeth elaborate on her position that health care is a right.

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    Why is it when some take that "big step back" that the facts of the matter become so irritating. Points for being honest, and I agree about attitude and perspective, but you can't simply discard facts.

    This is a fact. Where does it fit into this discussion (not)? I decided to stow the car and use Tri-Met on Saturday (sucked). The conversation went on at volume, next to me.

    "Yeah, I'm going to get knocked up again. I'll bet set, then. Have to watch it though, did you hear about Sandra? Yeah, she lost... one of hers. (Second woman: Oh, that's sad. How?) The state. Drugs. She was clean but had to move in with some friends that weren't and she lost one. But I won't make that mistake. One more and I'm set."

    Anchor babies don't exist either. Frankly, I would give full benefits to everyone that applied. Period. I just don't see how denying facts gets your point across though.

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    Elizabeth, are you going to chime in here?

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