Monday, November 4, 2013

Obamacare and Star Trek

I am in the midst of a conversation with someone over my last posting.  The issue involves the tradeoffs in Obamacare.  A program such as Obamacare will involve a number of tradeoffs within society.  Some of us will pay more for our health services to enable others who do not have such services to finally access them.  Most of us would go further by supporting some types of tradeoffs in general to achieve the purposes of Obamacare.  Whether we accept the specific tradeoffs in the new law is another question and it is the subject of our current national debate.

Well, I don’t want to go into Obamacare as a whole.   Though I have my own opinions about the program, my concern was for one particular tradeoff that to me was unfair.  To support my side of the argument I call upon the wisdom of Star Trek.

In my last blog I noted the situation where an individual with cancer was loosing her insurance and there was no affordable replacement in the exchange.  Was this a fair tradeoff considering how Obamacare was now providing health insurance for other Americans who could not afford it in the past?   My position is no, but more on this at the end of this post.

Jeremy Bentham was a philosopher and social reformer who lived in England from 1748 to 1832.  He is credited as being the first to articulate the philosophy of utilitarianism.   We know this philosophy because most of us have watched Star Trek.  In the movie “Star Trek II: The Wrath of Kahn” Spock justifies his death to Kirk by saying that the needs of the many outweigh the needs of the one.  The plot continued into “Star Trek III: In Search of Spock” when Kirk found Spock’s body for the purpose of restoring to it Spock’s mind and soul.   Spock’s father pointed out to Kirk at the end of movie that the effort to save Spock cost Kirk his ship and his crew.  To this question Kirk responded that the needs of the one outweighed the needs of the many.  This was a true Jeremy Bentham debate.  (For more contemporary Star Trek fans, the debate is included with some interesting character twists in the most recent Star Trek movie “Star Trek Into Darkness.”)

And so we have the same debate here.  When does the need of the one outweigh the needs of the many?    I would say that no one who has a life threatening disease or condition should be put in a position of risk simply because this nation is changing its health care system.    I don’t think any American would want this. 

My previous post was about how the politics of the last two months are playing out.  It was not on the costs and benefits of Obamacare, or how such tradeoffs can be improved.  But if that is the subject, whatever modifications we make to the system should include carve outs for people who are now caught in terrifying circumstances such as the cancer survivor from my previous post.  Within the overall global tradeoffs of Obamacare there can and should be exceptions for cases like hers.   There should also be set asides and ombudsmen to help people in these situations.   Since the media has not mentioned such mechanisms, I can only conclude that someone forgot to put such protections into the law.   If they are not in the law, at a minimum, they should be in the law.

What I am trying to point out in these two posts on Obamacare is that our political debate both for and against the new law is not consistent with our national character.  Both actions of shutting down the Government, which was discussed in the previous post, and constructing a program that threatens the lives of even a few people run against some of the most fundamental principles of fairness that we were taught as children.

Sunday, November 3, 2013

Obamacare, Politics, and Horace Greeley

The nation has seen some incredibly dysfunctional politics on the left and the right over the last two months.  First there was the Republican shutdown and now we have a mess with the rollout of Obamacare.   Today’s RealClearPolitics website offers articles authored by William Saletan and Todd Purdum that discuss how President Obama can still win the Obamacare debate.  The idea is that because of the Republicans counter intelligent effort to shutdown the Government has put the Democrats in a better position to win the 2014 mid-term elections.  Well, let’s take a look at that.

First, let’s look at the Shutdown.  If you are a Democrat you should herald this as one of the most, oh, I can’t quite find a good term that captures the essence of that political action.  Words like bonehead, moronic, insane come to mind and they are just inadequate.  The Shutdown was never a good idea for three reasons.  First, it was never possible for the Shutdown to achieve its aims of dismantling Obamacare.  Since the first definition of politics is that it is the art of the possible, why engage in the impossible?  Second, we live in a democracy, and if you are a minority in a democracy, you have to compromise.  To tell your constituents that you don’t have to compromise to achieve your ends is, well, like leading lambs to slaughter.  All during the Shutdown I was reflecting on Alfred Lord Tennyson’s Charge of the Light Brigade, a poem about 600 soldiers who loyally gave up their lives in battle on the orders of misinformed superiors who foolishly did not know the battlefield.  The far right Republican leadership misspent the trust of their constituents and lost political capital in the process.  Finally, the Shutdown violated some of the most basic rules we learned in kindergarten about how to live in a sandbox.  Americans don’t like bullies in their sandbox.  Here was Ted Cruz acting like a bully trying to take over the sandbox, and Harry Reid threw him out: the duly elected bigger bully of the sandbox.  The great American center that believes in fair play doesn't appreciate these types of spectacles.   So, one would think that Democrats would be masters of the universe right about now due to the Republican implosion.  Yet, they are not.

The Obamacare rollout fiasco has hurt Democrats, and it is likely that it will hurt them more and more all the way up to the 2014 elections.  Where the Shutdown was a one-time thing, Obamacare will bring healthcare issue after healthcare issue into our political debate for the next year.   It will be a drip-drip-drip that politicians need to avoid in order to look competent and win re-election.  The real issue will not be the botched programming of a governmental website.  That will get fixed, eventually.  It will get fixed late, but it will get fixed.  Rather, the issue will be how Obamacare violates another basic tenet of American culture.

Within the American psyche is a fundamental belief that we can always have more.  The basic quote attributed to Horace Greely from the 1800’s “go west young man!” signifies that we, both individually and as a people, can go out and make more of ourselves for ourselves.  We can have more land or wealth, or whatever by going out and making more of ourselves to get it.  The idea that any resource is finite is against this cultural experience. 

I am old enough to remember the theme of the Kennedy administration, which charged us to explore “New Frontiers.”  And in accordance with that direction, President Kennedy challenged this nation to expand upward and put a man on the moon, a challenge that was fulfilled after his passing.  That was the last great expansionary effort by an American President.  After that came the Vietnam War, terrorism, and the Great Recession and the pathetic recovery following it.  Nationally, it now seems that we cannot expand and grow our way out of problems.  Rather, we have to settle and cope with them. 

Obamacare is a marker in our cultural experience.  It is a formal program that officially recognizes that a critical resource is finite and that some people have too much of it and others have too little.  Whereas our tax policies reallocate a growing resource, namely our income, Obamacare reallocates a finite resource, which is our healthcare.  As an impact of this reallocation, some people who are very sick will get seriously hurt when they loose their healthcare. 

In the last week there have been many stories about Americans who rely on their current health insurance to stay alive.  They usually have cancer and are affiliated with a PPO or other such health provider association.  Many of these PPO’s are based around a university medical center that is normally too expensive to be sponsored by any insurance plan on the new exchanges.  These PPOs and other similar plans are being cancelled because they do not meet the new criteria laid down by Obamacare.  I saw a story about a 52-year-old cancer survivor who needs maintenance treatments from a university hospital.  Her existing PPO plan is being cancelled and she cannot afford a new plan from the exchange.  Not only is the premium higher, but also the $12,000 deductible makes it impossible for her to afford the new plan.  Providing healthcare for her family and herself is now the major challenge in her life as she tries to figure out how to manage her life into a future that is suddenly very threatening. 

From a social programming standpoint, one can say that the healthcare of the cancer survivor is being reallocated to the poor who are now being admitted into Medicaid under the new law.  From an economic perspective, one can discuss the pools of the young insured healthy people paying for sick older people.  However these analyses breakdown because each of these people who have been critically hurt by the new law now have a face.  Each has a very personal story. 

All the Republicans have to do is put these people on television from time to time and remind us how we “reallocated” their healthcare instead of growing the healthcare resource for more of us to enjoy.  Then they will tie each of these stories to a Democratic Senator or Congressman who voted against the Shutdown and for Obamacare and the play will have come full circle.  The Democrats will say that using these people for political purposes is cynical, and to a degree they will be right.  But it is politics and the stories are personal.  They will sway the American voter.  At this moment, I would bet on the Republicans, but that bet assumes that the Republicans are smart, which, by itself, is a big assumption.