Yesterday a diary entitled Blockbuster N.Y.Times Health Care Article by user veratis shot up the Recommended list. I was glad to see it get coverage here at Daily Kos, and surprised that I actually had read the article before it was referred to here. Usually, I come to Daily Kos to get word of the big articles in the papers.
Peter Singer's article can be reached here.
Follow me below the fold.
**Update #1 - my "friend" has responded to my final response. It is posted below
One of my "friends" posted the link to Singer's article on his facebook, which sparked me to read it and respond. I write "friends" in quotation marks because we are mostly professional partners, both serving two years ago as Presidents of our respective school's governing associations at Rutgers University. Our interaction was mostly kept to student governance matters, as the structure of our student government calls for all Presidents to meet bi-weekly in a cabinet called the Council of Presidents. In any event, that's some background with my relationship with this individual, who was a year older than me and graduated as such.
The debate that ensues is quite the treasure, and I feel that I have indeed held my own. My "friend" is a self-described "social liberal, economic conservative", and he being a strong intellectual is a tough debater; he just finished his year at Cambridge University in the U.K. as a Gates Scholar. I'm no intellectual "punch-dummy" by any means, as I posted in the comments in the aforementioned recommended diary.
Here is the text of our debate, and my comments in between. The back-and-forth is a bit long, but I assure you it is a good debate:
mconvente's initial post:
Interesting article. I'm moved to respond to two main quotes in the article, them being:
"It is hard to see how the nation as a whole can remain competitive if in 26 years we are spending nearly a third of what we earn on health care, while other industrialized nations are spending far less but achieving health outcomes as good as, or better than ours."
There is a reason why other nations spend less but provide equal or most often better care - it's because they have single-payer systems implemented.
And tied to that:
Linking the British system with Democratic proposals for reforming health care in the United States, Catron asked whether we really deserve a health care system in which "soulless bureaucrats arbitrarily put a dollar value on our lives."
The US system already puts a dollar value on our lives - it's called the profit margin of insurance companies, tied to our "inability to pay", as stated in the piece. Eliminate private insurance companies, lower costs dramatically.
Overall, I'd rather be given a chance at care and have my QALY so high that I must face the impending reality of my death than be excluded from the system in the first place.
This article is mostly referring to end-of-life care, but what about all the people who are worried if they break a bone they can't pay for care, which almost certainly isn't life threatening.
America is the only industrialized nation that doesn't have some form of "public option" of health care, and it's about time they do.
My "friend's" first response:
As for me, I don't believe it is the job, nor should it be the burden, of democratic government to directly provide for the healthcare of its citizens. The economic arguments abound on both sides of the fence, but philosophically, I don't see it as government's responsibility.
As for who should, the answer is always the free market. If the free market fails to provide a solution, then we're in much bigger trouble than a lowered life expectancy. ... Read More
On that note, since when do we have the right to long or healthy life? The fact that we're living so long is a product of our scientific progress, medical advancement, and financial incentives. The day humans decided to break through that 40 year life expectancy by using disinfectant or that 60 year barrier with the polio/measles vaccinations were tributes to the fact that "longevity and health" are more a product we buy into than a right we fundamentally have.
We should not be living this long.
The free market has enabled us to experience a side of life which is unnatural... and now that we're convinced we're all entitled to 75+ years meandering about this planet we expect the government to nationalize it for us, otherwise scream human rights violations or make emotional anecdotal appeals based in personal experiences or social/racial "injustices"
It's really sad how entitled we've all become now. If we all just resigned ourselves to 50 year lives, we'd probably do a hell of a lot more while we're still functional, and be a hell of a lot less demanding on a government whose resources would be better spent improving access to life-long opportunities than medical plans.
I pretty much figured a defense of the free market system would be coming from him. What I didn't expect, however, was this utilitarian ideal of human rights in respect to life expectancy. It seems very hypocritical of him, being that he is an upper-middle class student and one who will most likely be wealthy in his adult years. It's easy for him to write about 75+ year olds "meandering about this planet" - which I interpret a connotation of in-capable elderly people, again keeping with that utilitarian mindset - when he will have no trouble financing his own healthy life.
mconvente's response:
The free market is always a strong driving force for economic prosperity and advancement, though as shown recently, it needs to be regulated in order to provide a safeguard against financial disaster we have seen the last year. However, I don't think it is appropriate to assign the goals of the free market to every single circumstance, and in fact, I think providing for the health care of citizens the free market is likely the worst mechanism.
The goal of providing health care to individuals should be just that, providing care to individuals. The free market implements a restriction on the care of individuals in the form of profit margin, and to me that is unethical.
While certainly an interesting take on the progression of human life expectancy, I find your view on this matter to ignore the realities facing us. We cannot, as you propose, "resign ourselves to 50 year lives", unless we all end our lives at our half-century mark, which ignoring monumental opposition from many religious individuals, spits in the face of our human drive to live.
The fact is that we do have the resources to provide for care of all our people, we just need the political will. The free market fails at providing a solution because it's goal is to provide for profits, and profits are maximized when care is minimized. A better solution exists, we just need the will to enact it.
Additionally Brian, you make some pretty lofty ethical presumptions, most notably the presumption that by being tied to scientific advancement automatically precludes something from being a right, and that we shouldn't be living past 50 years old. I'd like to hear your ethical basis for offering such opinions.
I added the last paragraph of that response at the advice of Stroszek in his/her comment.
My "friend's" second response:
I don't need to provide an ethical basis for the fact that our elongated lifetimes are a product of scientific advancement and parallel commercialization, the facts stand around us everywhere.
The burden of proof lie on the other side. I'm still waiting for somebody to prove to me why a long or healthy life is the right of an individual which needs guarantee by a government. This is the massive assumption which is made, not the fact that, for example, AIDS cocktails (a product) extend the life of patients who just 3-4 decades ago were dying in a matter of years and are now living 15-30 years longer.
This blatant disregard for providing an ethical basis for his presumptions pissed me off, and I rightly called him out on it. Next is my final response; my "friend" hasn't replied yet.
mconvente's final (for now) response:
You absolutely do need to provide an ethical basis for your statement about life expectancy, because without such your opinions hold no weight. You fail to mention an important point, most notably that scientific advancements have allowed humans to reach their inherent genetically programmed life expectancy. We have the genetic potential to live to 70, 80, 90 years old, and that potential was unlocked in the 20th century, and continues to be.
It's easy for you to preach this utilitarianism about inflated life spans when you are 23 years old and healthy; without drastic life circumstances, you will be on the tipped side of the scale.
The overall problem with your argument is that you reject the notion that government should be held responsible for providing for health care of its people, ultimately based on your utilitarian ideal that we have no right to live healthy and long lives. This would be fine if you maintained the direction of your argument not to whether or not the free market solution is working, but rather should there be a solution provided in the first place.
But while simultaneously defending your ideal that government should not be involved in providing health care, based on your elongated life expectancy argument, you allow for a free market solution, even saying it's "always the answer."
If you want to debate on whom should provide health care to individuals and what is the best solution, then I gladly will participate. But if you want to utilize and defend some philosophical thesis about our human rights without providing even a rudimentary ethical basis for such - simply stating "the facts surround us everywhere" without even mentioning one - then I suppose the conversation will go around in circles, as we have different ideals about the world and humanity.
Holding true to the advice of Stroszek, I continue to demand an ethical basis for my "friend's" opinions. I believe I find an effective flaw in his argument, and point such out in the middle of my response. Finally, anticipating a deadlock, I offer a final resolution.
I assume he will respond because he loves to debate, and I am interested in what he has to say.
**Follow from Update #1. Here is the text of my "friend's" final response.
"scientific advancements have allowed humans to reach their inherent genetically programmed life expectancy. We have the genetic potential to live to 70, 80, 90 years old, and that potential was unlocked in the 20th century, and continues to be."
Having read quite a bit on the subject I can tell you right now that is not a fact, and is still heavily debated in medical circles. If you want to view this as medicine unlocking our potential then that's our great philosophical divide.
I personally find that we've simply tinkered with human life and turned the knobs just so that we can continue to live, albeit quite terribly in the last quarter of our life (compared to all other animal life), beyond our "programmed life expectancy".
If you don't believe health and long life is something we've turned into a consumer market then we're obviously not going to reconcile here, and there is no need to attempt to. I do believe, however, you'd have a harder time writing a thesis on how medicine and healthcare are a fundamental right than I would putting together one on how they can be easily modeled through simple consumer behavior and capitalistic markets.
The issue here is that you interpret my beliefs as an ethical affront. I do not. It just further makes me believe in how absolutely afraid we are of grasping the fact that death, at any age, is not a matter of ethics. It's a matter of fact.
On a side note, you'd do well to address only the discussion topic and not personally those involved in the argument.
Per my words in this comment, it's hard not to stray from the topic at hand, because quite honestly I can't stand this person for deep-routed reasons during our interactions at Rutgers.
What are your thoughts? You can read the comments from yesterday's aforementioned recommended diary here.