Tuesday, November 3, 2009

Health Care Reform: Facebook Friends Respectfully Agree to Disagree

A friend and I have recently had a discussion via Facebook about reforming health care delivery in the United States.  I am sharing here, with her permission, our exchange of ideas.  If anyone would like to add to this discussion or comment on the way the discussion was undertaken, please leave a comment here on the blog.

I will begin by sharing the last few posts of  our exchange that took place over four days on Facebook beginning on October 31, 2009:

Marjorie (pseudonym), would you mind if I share our discussion with some friends who probably think more like you than like me concerning the things we talked about? I can replace your name with a pseudonym if you prefer. I think it would be interesting to get some additional feedback from other folks who have been thinking about these issues.

I suspect that nothing I said was enlightening since I ended up shooting from the hip every time, but if you don't use my name or inform me of the cynical laughter emanating from the readers, you may attempt to find worthwhile feedback using our discussion.

Thank you! I think you are great! Not only were you willing to seriously engage me in an exchange on a topic about which you obviously have strong opinions, you also are willing to let others consider our exchange and potentially ridicule (though I hope not) your ideas or mine.

The exchange on Facebook began when Marjorie posted:

ABC's John Stossel Destroys/Pulverizes/Crushes Obama's anti-American 'Health Care' Plan

(Click on link below to watch Stossel video.  Then to return to blog click on back button of browser.)
Stossel Video

Jim responded:
Marjorie, Are you saying President Obama and the Democrats who are in the majority (having been elected by the American people) are supporting an "anti-American 'health care' plan?" That's what the title of your post suggests to me.

And having watched the video, it makes sense to me that you may fear having to perhaps wait a little longer to have hip replacement surgery or something similar. I'm wondering, though, if you mean that people who don't have a job that provides insurance and can't afford the high cost of a non-group policy should just take their chances as my son has been doing and then go bankrupt (leaving everyone else to pay his expenses) if he is in a serious car crash or comes down with MS or some other terrible condition? And do you mean that health care decisions should be based on who has enough money to pay cash (or the best insurance coverage) rather than on who needs a procedure right away? It seems to me that if health-care costs have to be contained in order that the country not go bankrupt, then the current House proposal will provide a big step in that direction while helping thousands who would have died for lack of coverage a good chance at getting the care they need and would have otherwise had to do without. I am quite confident that rich people will ALWAYS have access to a fast, private option. This true in Austria and France where unlike here everyone regardless of socio-economic status has access to quality care. Here, people who are very poor are covered by Medicaid, and disabled folks are covered by Medicare. It's the people in the middle who are losing their homes when they win the serious injury or illness lottery. As a physician who cares about all my patients, I can hardly wait for The President and Democrats in Congress to succeed in reforming a system I believe is seriously broken. It seems to me that the video is an effort to frighten folks into believing change is anti-American if the currently well-enough off are going to be inconvenienced even a little even if the slight inconvenience helps a lot of people live longer and helps decrease the budget deficit.

Marjorie replied:
I knew I would hear from you; you have a list of questions that I should not respond to with questions, so I will wait until I can give my response more time. I do not like the health plan, though. I do not believe that the current proposed plan answers your emotional questions. My favorite cousin died as a result of not having insurance; that that could happen in this country is appalling. In her situation, though, I believe that under this new plan she would have died, also. One question: Why am I not allowed to disagree with the current majority party? It seems every time I do I am accused of being hard-hearted or against the poor and hungry. Furthermore, if John Stossel was fired for this report, then ABC is definitely NOT an unbiased news source; that point was the purpose of my posting this link. Former Teen Dem president and not a strict "party-man" voter, Marjorie

Jim replied:
Marjorie, It seem to me it's one thing to disagree with aspects of a plan and quite another to post a video entitled, "ABC's John Stossel Destroys/Pulverizes/Crushes Obama's anti-American 'Health Care' Plan." I certainly support you having any opinion whatsoever contrary to the majority, but to label the majority health-care plan "anti-American" sounds to me more like Rush Limbaugh than the expression of a thoughtful, majority-contrary opinion.

Seems to me that if the primary reason for posting the video was to object to the firing of John Stossel or to say that as you see it, ABC is biased in some direction, it would have been helpful to comment to that effect when posting it. Stossel's report seems very biased to me. Makes me wonder if he was fired for double dipping from both ABC and the health insurance lobby?

Marjorie, I'm not trying to come down on you; and I am concerned about using terms like "anti-American" to describe The President with whom you may, in my opinion, freely disagree but who, as I see it, is certainly not pursuing an anti-American agenda. Using words like "anti-American" and "Destroys/Pulverizes/Crushes" seems to me to be extremely provocative, perhaps even inflammatory, and doesn't, in my opinion, contribute to a thoughtful examination of specific differences in perspectives about the legislation currently being debated.

Marjorie responded:
I did comment by asking if it were true; then I went to snopes and found nothing; then I Googled them both with no definite answer as to whether or not that was why he was fired, so I removed the question. Sorry. I did not entitle the video; it came to me that way; however, I believe Socialism is anti-American. It has been since FDR instituted Social Security, which is being used as a retirement plan when it was never meant to be used that way. Both of my sons and my daughter have gone without health insurance at times themselves, and I agree that that is dangerous. The military families I talk to are not happy about their free medical service; my friends in Denmark are not happy about their almost 40% national sales tax; my friends in Canada are not satisfied with their socialized system; my point is that we should not look at and seriously revise the current insurance system in the US, but there is a lot about it which is better than anywhere else in the world--we don't need to throw out the baby with the bathwater. Rushing into this serious a change when no one has bothered to even read the entire bill and pork has been added to it is a grave error. What I know about it, I do not agree with doing; the main thing that scares me is what everyone else and I don't know about it.

Marjorie said further:
I meant to write that my point is that our system needs some revising but that any revising needs to be done carefully, that other systems in use should be studied from all angles, and that even though you can hardly wait for the revamping, patience is important when you are dealing with so many people's lives and the economy in this great nation.

Jim replied:
Marjorie, I've been at the hospital for awhile, so I'm just now getting back to you again.

I'm reading you as saying that you intended to comment on the video and checked it out via snopes and google but didn't find anything but in any case you do believe that Socialism is anti-American and that it has been since FDR instituted Social Security, which you believe was never meant to be used as a retirement program. You also agree that going without insurance is dangerous and have been told by some military families that they do not like their free medical service and by other friends around the world that they do not like their medical delivery systems nor do they like their high taxes. Sounds like you believe that while the system in the US may need some revision after careful examination, there is a lot about it which is better than anywhere else in the world and that you think we don't need to throw out the baby with the bathwater. I'm hearing you say that you think nobody has read the entire bill and that you believe a lot of pork has been added to it and that what scares you is what everyone else and you don't know about it and think that other systems need to be studied from all angles before revamping something that deals with so many people's lives and the economy of this great nation. Am I hearing you correctly?

If so, it makes sense to me that since you seem to think no one has even read the bill and since you also seem to think that Social Security is a form of anti-American socialism, you would be very concerned that the result of this effort to reform health care delivery will be terrible; that The President and members of Congress don't even know what they are putting together; that it will be filled with pork; and that there is a significant risk of acting so hastily that the result will be another anti-American, socialistic program.

Is there more that you would like to say about this before I respond with a few more thoughts of my own?

Marjorie replied:

I have a migraine and don't dare comment at this point; however, you kind of get what I am saying. I am not saying "filled" with pork; I am not saying it "would" be terrible; not reading the entire bill means that the president and congress are unaware of everything it says; socialism is the mildest thing I could call what proposals I have understood.  I hear you saying that you believe that "fear" is motivating me, and that news stories such as John Stossel's are the source of my "fear." Somehow, I don't think I am as emotional about this decision as you seem to be. So far we have rushed through everything we have done since January, and the results are not good. This bill is way too wide-sweeping to rush through it. Respond away, Jim...

Jim replied:

Sorry about your headache.  Hope our discussion hasn't been a contributing factor and that you are now headache-free.

As I read your last post, seems to me that you think I'm kind of getting what you are saying but that you are not saying that the House health care bill would be terrible.  On the other hand, you do think that The President and members of Congress haven't read the bill and are not aware of everything it says and that "socialism" is the mildest thing you could call the proposals that you understand are included. I'm also reading that you think that everything done since January has been rushed with results that you think are not good. Given that you are concerned that changes are being made that you don't think are good and that it is your perception that everything is being rushed, it makes sense to me that you want this wide-sweeping bill on health care to be carefully deliberated.

I guess I'm still not sure about your SPECIFIC concerns. To what proposals specifically in the House bill do you know you have objections? It is hard for me to understand what you think is inappropriate, misguided, or corrupt about what is being proposed without specific examples.  I hear your general concern that the bill will lead to something worse than socialism ("socialism is the mildest thing I could call what proposals I have understood"), but to what specifically are you referring, and what from your point of view would be a less mild but more accurate description of what you think is being proposed?

From my perspective, the current House bill as I understand it is inadequate, because many will still be left uninsured. This concerns me not only because of the personal costs to the individuals involved but also because of the increased costs to the rest of us when the health care of the uninsured is neglected due to not being able to afford it leaving them with treatment in an emergency room as their only option.  The cost of that treatment will be passed on to you and me as it is now.  As I understand it, government is already either directly or indirectly paying for 65% of the cost of all health care provided but with less than optimal results.  I am concerned that despite having the most expensive health-care system in the world, we still have a maternal death rate higher than many other developed nations (41st in the world for maternal mortality rates http://www.reuters.com/article/domesticNews/idUSN1339620220071013). It bothers me that when I do evaluations in the emergency room that many of the people I see can’t afford the medications most likely to help them and will stop taking the medicine I prescribe after the 30-day supply provided by a pharmaceutical company coupon has run out.  Then it is highly likely that they will return to the emergency room and perhaps even have to be admitted to the hospital with no means of paying for those costs.

It seems to me that “socialism” is bandied about as a pejorative term  which may often be meant to frighten people but without being specific about what is considered objectionable about the policy being maligned.  It could also be that “socialism” is a term that can be applied to our collective paying for fire protection, police protection, military expenses, and other government services.  Seems to me that just as for many other words, “socialism” is a word that has different connotations for different people.  I don’t think, however, that it implies something that is inherently unconstitutional or “anti-American.”

Marjorie responded:
Migraine left after a night's sleep and medicine. I'm not sure what sparked this one, but it could have been several things, one of which was working on a a project for my daughter in poor lighting.

"Most socialists share the view that capitalism unfairly concentrates power and wealth among a small segment of society that controls capital and derives its wealth through exploitation, creates an unequal society, does not provide equal opportunities for everyone to maximize their potentialities and does not utilise technology and resources to their maximum potential nor in the interests of the public." Lenin believed that socialism was the middle stage between capitalism and communism. There is a difference in our paying taxes to provide protective services for society and "sharing the wealth." As a republic, even since before colonial times, we have been faced with a tenuous balance which has to be maintained between personal freedom and government protection. Those who had to live within the walls of a fort, for instance, to save their families from Indian attack, chose for a period of time to protect themselves by relinquishing some of their personal freedoms. Those who chose to live in communes in the 1960s chose to share everything on principle; they chose to relinquish their freedoms in order to remove themselves from the materialism and capitalism they disagreed with in the US society. That was their choice. It was not mine. I believe that capitalism is one of the secrets of our government's survival over the two centuries.

From where do you get your facts on the health plan; have you read the 1900 pages? what do you believe is in there that will save our poor and hungry? Do you really believe that independent companies will continue to make a profit in competition with our government run plan? do you really believe that employers will continue to provide the perks of health insurance to employees who can simply accept the government plan? do you really believe that costs for private insurance will drop due to that government competition? do you really believe that the new program will pay for itself in ten years?

Jim replied:
Glad you no longer have a headache.  Buddhist monk Thich Nhat Hahn talks about being grateful for non-toothache.  I think the same goes for non-headache.

In True Success:  Ideas About Living And Loving In An Unbalanced World (1991) I wrote, "Seldom does anything have to be all or nothing.  The best available approximation of a balance between the extremes is usually desirable."

I also wrote in True Success, "The world needs to discover a balanced synthesis of two ideals, one American and the other socialist. In an ideal world there would be a spirit of cooperation which would encourage all of us as members of the world community to consider the priorities of everyone else in the world as we set our own priorities.  The "greatest good for the greatest number" is a principle which is consistent with this spirit as long as the basic needs of all INDIVIDUALS are never forsaken involuntarily for the interests of the majority.

The inalienable individual rights of The First Amendment to The Constitution of The United States of America are considered in the U.S.A. to be "basic needs," while in socialist countries "basic needs" are adequate food, clothing, shelter, and medical care.

Rather than adopt either of these definitions of "basic needs" exclusive of the other, it would be far better to join forces as a world community in which no one person is allowed to have excesses above a certain level until the basics of both The First Amendment AND adequate housing, food, clothing, and medical needs are provided for all inhabitants of the world.  In order for this to be possible, while avoiding irresponsible exploitation of our environmental resources, it might be necessary to encourage vigorously the limitation of the world's human population.  At least limit the population until technological developments make it possible to provide the comprehensive basic needs to all without doing irreparable harm to the environment which belongs to us all and to all future generations.

How could this synthesis between individual rights and collective rights be attained? First, we have to come to understand that we are all in this together--that our world has become so small as the result of technological developments, increases in the global human population, and intertwined national economies that we can no longer pretend that we can sagely isolate ourselves from each other.  We are capable of ruining our entire world environment with all kinds of chemical, biological, and nuclear pollutants even if warfare never becomes a factor. Second, we must preserve the opportunity for individual economic incentives while not allowing any single individual or small group of individuals (in business corporations or governments) to exert so much power that they cannot be prevented from doing irreparable harm to the environmental birthright of us all.  Third, we must spread the news that true success does not come from more and more wealth and power but rather from meeting our basic needs and having a loving attitude toward ourselves and equally toward others.  This loving attitude must be demonstrated by our respect for ourselves and for the rights of others.  After meeting our own basic needs, freely given service to others within our own unique limitations can then replace self-centered and ultimately unsatisfying greed and provide us with genuine mutual satisfaction."

Even though those words were written more than 18 years ago, I continue to think in a way that is consistent with what I wrote then.

My perspective on "sharing the wealth" is that it is already being shared but in the opposite direction from what I think you mean.  As I see it, people who work two jobs and can barely make ends meet are sharing their wealth with the people who do nothing other than invest money and bet on the market. I know some folks who held "short" positions in the market before October of last year about which one of them who was already very, very wealthy said, "This was the biggest transfer of wealth in history."  It was a transfer of wealth from hard working pensioners and people invested in mutual funds to people who bet on the market to crash.  Somehow, that doesn't seem like the best way to encourage ordinary people to work hard and invest their hard-earned capital, though I am certainly one who has worked very hard and invested my capital in various ways consistent with our system.  I'm not in any way suggesting we adopt socialism or communism in place of capitalism, but I do think that given the human propensity for power to corrupt, there have to be checks and balances in place that protect the less powerful from the potential intentional or unintentional exploitation by the very powerful.

My information about the House bill on health care reform comes from David Price, Representative from the 4th Congressional District.  While I have not read the entire House bill myself, I have known David well for many years and trust that he has either read it all or is being advised by members of his staff who have read it all.  My answer to all your questions is basically, "Yes." I think that while there will always be the need to make changes in whatever decisions are made about this issue or any other, the House bill on health care reform should, in my opinion, help move us in a direction which will overall be quite beneficial.

Sorry - you left me completely when you said "it would be far better to join forces as a world community in which no one person is allowed to have excesses above a certain level until the basics of both The First Amendment AND adequate housing, food, clothing, and medical needs are provided for all inhabitants of the world." We just are going to have to agree to disagree.

Marjorie, It also seems to me that we are not likely to agree about the best way to reform health care, though I suspect there are lots of other things about which we have pretty similar perspectives. For instance, I bet we are both fans of Tarheel basketball, both love our work, both want our children, grandchildren, students, and patients to have satisfying lives, and both appreciate having been lucky enough to grow up in Greenville rather than Siberia or some other desolate place. Thanks for an interesting discussion; and may the highest and best for all concerned, whatever form that may require, eventually unfold.


  1. I like the discussion. Wanted to add to this a piece of what I came across this morning. I have been thinking a lot the last weeks about validating the tea-baggers - that wonderful group of strong speaking people. Rarely do I agree with them, but I often attempt to validate them and honor them.

    What occurred to me is that we may all be witnessing the world-wide rise of fundamentalism - people "fearing what they see as the future" and "digging in their heels" to slow things down. I don't think this is particularly American or non-American since I can certainly witness it in the Muslim world, etc. etc.

    My wife reminded me that this may be a dynamic connection between those who know how to set all their digital clocks and those who don't want any digital-thingies. Those who are interested in living in a world of people who see things differently and those who want to live among people who seem to agree. Perhaps those who fear "socialism," and those who are interested in how capitalism can be improved.

    These seem to be awful simple splits but I hope you get the idea.

    I think the "progressives", those who are looking with hope into the future, can learn to be more understanding and less dismissive of those who are uncomfortable and even distressed about change.

    Seems to me the growth of technology doesn't give a damn about those who are fearful of change. So I think we have to support each other.

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