So Bill can have a Seizure: Healthcare Bill Summary

[IJ]

I'm psyched that I and Bill's buddy Romney agree about this issue. Each year the interns at Beth Israel Deaconness are given an award from the residents, eg, the black scrubs award, for the intern who gets the most autopsy consents, or the white hat award, for the intern most likely to be found on top of a nurse. I got two, one of which was the Mitt Romney, "for the intern most likey to be a legend in his own time, or perhaps just a legend in his own mind."

Anyway, Bill, the government can tax you road dollars and spend them elsewhere even if you don't drive. It can tax you retirement dollars and use them however it likes. It can offer you stupid tax breaks for all sorts of reasons. So I think it's fair to say that the government can tax us all for healthcare expenditures and give tax breaks to those who bought their own insurance. Maybe that's not the best way, but there's precedent.

As for entitlements, yeah, that's a real danger. If there's no incentive to be productive, productivity will drop. I think people do need to be hungry, basically. The idea that we should all get to have padded benefits and employer paid healthcare (no such thing exists) despite skyrocketing costs then retire at 65 and live 20 years getting social security and medicare and going on road trips does not make sense to me. As a nation, we need to have more pride in our work and productivity and expect that people would earn money themselves. I and my partner HATE dealing with people who are literally "entitled" and come to medical or psychiatric care expecting a hand out because they want one and they're entitled. A common story is that someone's supervisor yelled at them, or that their work is stressful, or there are lots of forms. One asked me for medical disability because he worked the night shift and was sleepy during the day. One just saw my partner because she'd been embroiled in a sexual harrassment suit with the military for 24 (twenty four) years on admin leave with pay and just got a 750k settlement. She wants psych disability because she thinks her coworkers and bosses don't like her anymore. No psych symptoms. Doesn't even pretend, or understand. Just wants a free ride, hates her job, and cried the whole interview about how hard it was. Worse, lots of places give out disability for such reasons for a month before anyone sees the shrink; many shrinks continue it; some write for a year disability with no followup or treatment needed!

I think we need to carefully set up our medical system so that people have incentives to spend wisely, think about the treatments they're on, not overuse, not pursue the next xray that isn't needed, not get on the latest branded drug when the generic has more data. They've got to feel like it's their money going out the door when care is bought. Doctors apparently can't do this right either, so we need to be incented to spend wisely as well.

[Bill Glasheen]

I was commenting on your advocacy for withholding public funding for abortion based on the objections of a segment of the population. My comments are about the logic behind what you are advocating, not about what public funding already pays for. I am not even saying I agree that abortions should be publically funding, I am just saying that your stated reason for objecting to it cannot be the only consideration and runs contrary to how our governmental process really works.

I think Dr. Ian and I are on the same page here. So I know I don't have to do a lot of convincing here.

• I am all for a woman having the power and privacy of a doctor-patient relationship. This extends to reproductive activities - including elective abortions.
• Abortions should NOT be considered a procedure that's no different from removing a mole on your ass. There is nothing "good" about getting an abortion. At best it is a necessary evil. To some it is murder - equivalent to killing your 2-year-old child. I don't fall in that latter category, but I have enough empathy for the opinions of others that I am willing to listen and modify my behavior accordingly.
• The first lines of birth control are abstinence (the best and safest), barrier methods, vasectomies, tubal ligation, and various forms of oral contraception.
• Abortion as birth control should be a LAST RESORT. It should be considered a failure of traditional methods of birth control. The exceptions would be rape, genetic defects, incest, and any pregnancy which may result in harm to the mother.

Because of my beliefs (stated above), I want the pregnant woman (and her partner) to take ownership of an elective abortion. (Rape and danger to mother would be exceptions.) Without this disincentive, we're evolving to situations like Russia where an abortion is just another means of birth control, and China where abortion is a means of population control or a way to kill off female fetuses.

You choose to have sex and you get pregnant? You're healthy? Well... call Loverboy and figure out what to do with your pregnancy. While I won't mind some of my tax dollars helping out for a delivery and maybe even some child services, I don't want my taxpayer dollars paying for your abortion. I can't in good conscience live with myself knowing that I'm part of a world where creation of life is managed so recklessly.

You want that? You pay for it. Is it going to hurt you economically to have an elective abortion? Well GOOD!!!! It's SUPPOSED to. For some with no sense of empathy or respect for life, this kind if pain is the only legal form of behavior modification we have

- Bill

[Bill Glasheen]

Anyway, Bill, the government can tax you road dollars and spend them elsewhere even if you don't drive. It can tax you retirement dollars and use them however it likes. It can offer you stupid tax breaks for all sorts of reasons. So I think it's fair to say that the government can tax us all for healthcare expenditures and give tax breaks to those who bought their own insurance. Maybe that's not the best way, but there's precedent.

That's all good.

Car insurance is a legal requirement - IF I CHOOSE TO DRIVE. If I choose not to drive, I'm not required to have it. That's fair. What ISN'T fair is requiring me to purchase a service (3rd party health insurance) just because I'm alive.

- Bill

[Valkenar]

Justin: botox is a legal medical procedure. So is lasik. Boobies. Tucks. You want that in insurance you pay for?

I think an elective abortion is pretty significantly different from these things. Generally speaking nobody's life is ruined by failure to get some cosmetic surgery.

As for your suggestion that a fetus is not a human life, WTF are you talking about?

It's a collection of tissues based on a full set of human DNA, that is true. But so is my appendix. Just because something has live human cells doesn't mean it has any moral significance as a human life. A fetus has live human cells with working DNA, but it doesn't constitute an important life. Moreover, it lacks all of the features of humanness that make human life important. A heartbeat and a metabolism are not what make a human life worth preserving.

None of that is intended to imply that I think abortion is a lark or a good thing. I have seen the silent scream and other abortion videos. It is undeniably disturbing, messy and unpleasant. It's something to be taken seriously. And yes, if you're talking about very late term abortions there are some moral considerations. But first or second term? Still serious, still significant, but no more relevant to morality than picking out that bagel. The serious and significant parts have to do with the health and well-being of the mother (and maybe father, situationally) only.

[Glenn]

Such an elaboration of your views on abortion is fine and dandy. Having an undergraduate degree in biology my views of "life" are similar to Ian's, and like you I think there are multiple issues to consider in such an topic.

But my point is not just about abortion, it could be about anything that some segment of the population objects to (as I mentioned with the historically (and to some extent current) controversial topics of segregation and voting rights for women). For example there is a segment of the population that objects to experimenting on animals for medical purposes, so when you say

I just don't want to have public money funding health care that is objectionable to a good portion of the population. That's just plain wrong

you are setting up the argument that public money should not fund such research.

[Bill Glasheen]

I just don't want to have public money funding health care that is objectionable to a good portion of the population. That's just plain wrong

you are setting up the argument that public money should not fund such research.

So are you going to call me a specieist?

"A reasonable person" understands the difference between homo sapiens and others species.

"A reasonable person" understands that carefully-done animal research benefits both animals and humans.

"A reasonable person" understands that there are better alternatives to birth control than elective abortions.

"A reasonable person" understands the value of pain (economic, physical, emotional) in modifying human behavior.

"A reasonable person" understands that when we talk about using public funds to facilitate the ending of an adult life (e.g. planned suicide), we're treading on dangerous territory.

That's my moral ground, Glenn. It's consistent with the language of self-defense in the legal code, etc.

- Bill

[Glenn]

Justin,

If I am reading you correctly, the dichotomy you seem to be setting up based on 'importance of life' seems to me to be effectually similar to a dichotomy others have argued based on a concept of potential individuals vs actual individuals. In such a dichotomy, early fetuses who cannot survive independent of the mother's womb are considered potential individuals, and not on par with later fetuses who are considered actual individuals because they do have a chance at survival outside of the womb. The boundary between these classes has obviously changed due to medical technology, but it is seen by some as a convenient cut-off point. The ultimate dilemma in such a justification is what happens if technology removes that dichotomy altogether?

And should independent survival or a classification of importance of life be the only considerations, or moral activities in and of themselves? After all, extending such considerations to all stages of human life gives us aspects from the history of eugenics, so once again there is a slippery slope to tread.

[Glenn]

So are you going to call me a specieist?

No, I'm sticking with economic determinist

"A reasonable person" understands the difference between homo sapiens and others species.

<etc>

We are talking about lawmakers here, I'm not sure your "a reasonable person" prefixes apply. But I think you are focusing too much on my examples and not enough on the big picture. While these statements make perfect sense to me, what I am trying to get you to see is that these are all value judgements and what is reasonable to you and me can be, and with some of those definitely is, "objectionable to a good portion of the population". Treading on dangerous territory can exist with any of those, which is why basing policy solely on the objections of some may not be the best strategy. I would certainly hate for animal research policy to be based solely on the objections of PETA.

[Bill Glasheen]

"A reasonable person" understands the difference between a minority, a preponderance of the population, and a majority.

"A reasonable person" also understands the concept of tyranny of the masses.

What else do you want to know?

- Bill

[Glenn]

Yes, but "a good portion" is very vague and not specifically indicative of any of those. And tyranny of the masses can go both ways.

[IJ]

"Car insurance is a legal requirement - IF I CHOOSE TO DRIVE. If I choose not to drive, I'm not required to have it. That's fair. What ISN'T fair is requiring me to purchase a service (3rd party health insurance) just because I'm alive."

You may have missed the part where I pointed out that your taxes will go to roads even if you don't drive. MY taxes go to public schools even though evidently me and my guy are infertile / haven't adopted. But school is a public good, you say... well, someone just decided so is healthcare. PLUS, it would be reasonable for the gov't to make you have driving training and licensing with taxes, if there was a fair chance you would pop into a gov't car and drive off at a moment's notice. THAT happens in healthcare--you get sick, you drop into a gov't supported hospital.

Justin, if a woman is truly having an elective abortion, her life won't be "ruined" by giving birth. She can always give the kid up for adoption. I know some nice doctors who are considering adopting! And further, there are some funny looking people out there who suffer without plastic surgery. A recently decided court case decided that breast agumentation was real care needed by a MTF transexual. Where's the line?

And a fetus is not just "a collection of tissues" like your appendix. We know this because we cry when we miscarry, and not when our appendix is lost. Because a murder of a pregnant woman evokes more horror than a nonpregnant woman, generally speaking. We know this because the fetus can develop into an adult, an appendix cannot. We know this because a fetus can move, has a heartbeat, has fingers, has a developing brain. You know this. Don't drink the koolaid! You know this! You're telling me aborting a second "term" (trimester?) baby is nothing bigger than picking out a bagel? That's absurd! You are aware, or ought to be, anyway, that trimesters are made up and have no ethical or moral meaning whatsoever, right?

Glenn has effectively pointed out that the rule, "I just don't want to have public money funding health care that is objectionable to a good portion of the population. That's just plain wrong," is untenable. Bill has countered that there are reasons for these distinctions. I say this confirms my view that abortion is an unresolvable special case that will always be messy to discuss (and perform) and both are right. And making different points.

Note: Tyranny of the majority is a problem when the other party is in power. Tyranny of the minority is a problem when you're in power. Any questions?

[gmattson]

Interesting thread. Truthfully, I don't think many people really understand this new health insurance and/or how we are going to be affected by the changes.

but, I do understand that Bill feels we shouldn't have to buy insurance and cited auto insurance as an example of a good law. . . "you don't drive - you don't need insurance".

Well - If he got his way, does this mean "you don't plan to get hospital/doctor care, you don't need insurance"?

Hmmm, but it doesn't work that way! Whether you have insurance or not, right now you get medical care. . . and those of us who have insurance end up paying for those who can't or won't buy insurance.

I don't see any big changes in the way the system works. But I bet many of us will be paying a lot more for their coverage and those companies/individuals who don't wish to or can't buy insurance will still get taken care of.

[Valkenar]

In such a dichotomy, early fetuses who cannot survive independent of the mother's womb are considered potential individuals, and not on par with later fetuses who are considered actual individuals because they do have a chance at survival outside of the womb.

Yes, this is similar to but not the same as what I'm saying. Really this is off-topic so I've been trying to keep my clarifications short. Anyhow, yes I tend to think the cutoff point is roughly when you can reasonably expect the fetus to survive outside the womb with only basic care. Really it's more complicated than that but it would take pages and pages to comprehensively describe.

She can always give the kid up for adoption.

Maybe she can, maybe she can't. That's not an easy decision to make either.

And further, there are some funny looking people out there who suffer without plastic surgery. A recently decided court case decided that breast agumentation was real care needed by a MTF transexual. Where's the line?

It's a gray area, admittedly. There's no strict line, and I don't see how there can be. I think that's also true for some traditional medical problems. Once you get beyond life or death and functional treatments, you're always talking about quality of life. While it sort of disgusts me that people are so shallow, if someone's life is measurably improved by having big pouty lips, maybe lip augmentation for them is as real an improvement in their life as say, treatment for athlete's foot would be for me (never had it but by all reports it's pretty unpleasant). I'm sure you can come up with a better example than I can of a chronic, unpleasant, but non-life-threatening condition that we take care of.

That isn't to say that perhaps counseling might be a better alternative to cosmetic surgery. But if we're willing to pay a psychologist to help someone lead a happier life, and we could accomplish the same thing more cheaply (probably not) by giving them some ridiculous elective plastic surgery, well then why not?

And a fetus is not just "a collection of tissues" like your appendix. We know this because we cry when we miscarry, and not when our appendix is lost.

Terrible example. We cry when we lose a hand too. A miscarriage often results represents the loss of something ardently desired. Furthermore, I think there's a cultural element here. If you have the belief that a fetus is a person then of course you will cry if it dies. People are good at forming emotional attachment to all kinds of things. Inanimate objects even.

You're telling me aborting a second "term" (trimester?) baby is nothing bigger than picking out a bagel? That's absurd! You are aware, or ought to be, anyway, that trimesters are made up and have no ethical or moral meaning whatsoever, right?

Okay, trimester was a poor choice of metric. I was basically just going for an easy yardstick of developmental progress. Yes, I realize they're an semi-arbitrary framework. Again, fully describing the exact criteria would take forever and not add much clarity. The point is, yes there are fetuses that are human, but they spend most of their time being not human in the sense of being individuals with moral standing. They are of course human in a certain biological sense. You have a human fetus the same way you have a human hand or a human appendix. But I would not call a human fetus "a human"

[MikeK]

Note: Tyranny of the majority is a problem when the other party is in power. Tyranny of the minority is a problem when you're in power. Any questions?

Tyranny of any kind is a problem. And I'm using tyranny in it's classical form.

[MikeK]

Now that health care is in the can, the White House is once again turning their gaze upon rescuing those who are losing their houses. Thankfully this won't cost the taxpayer a thing.