A Bomb I’m Throwing At My Health Policy Class

 

shutterstock_228600766For our first discussion assignment in my “Nursing 614: Healthcare Leadership, Policy, Politics, and Ethics,” I am making the following statement:

To preserve my own intellectual honesty, I would like to challenge the supposition of this entire field of academic study. Namely that it is somehow the role of central planners, policy makers, or government officials to improve the health of any population or individual. Our modern system of socializing the costs of healthcare creates stakeholders in private personal and economic behaviors that otherwise have no natural interests in these areas. Private behavior should be just that: private. Like all things, healthcare choices of individuals are based on a complex web of tradeoffs and assessments of relative value. There is no fundamental reason any government should be involved in this assessment outside the aforementioned current payment system.

Thoughts?

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  1. Kay of MT Inactive
    Kay of MT
    @KayofMT

    Go for it Super Nurse!

    • #1
  2. Son of Spengler Member
    Son of Spengler
    @SonofSpengler

    What is your view on traditional public health questions, such as quarantine and/or required immunization against communicable diseases?

    • #2
  3. Super Nurse Inactive
    Super Nurse
    @SuperNurse

    Son of Spengler:What is your view on traditional public health questions, such as quarantine and/or required immunization against communicable diseases?

    I think we’re well past this time in our history, and my policy class will focus on government intrusion in things like ensuring you walk or bike to work, purchase health care insurance, or eat enough fruit in a given day. For the record, I believe the only time government intrusion is reasonable is to prevent infectious disease outbreaks. In fact, the laudable purpose of the Centers for Disease Control was originally this type of work. It is now the Centers for Disease Control and Prevention, and focuses on many chronic diseases.

    • #3
  4. captainpower Inactive
    captainpower
    @captainpower

    Sounds very philosophical.

    Reminds me of the fluoride in tap water discussion.

    Challenge time:

    On the other hand, a libertarian principle is that one should be free to exercise one’s own liberty until it infringes on someone else’s. Vaccination requirements sacrifice a few for the sake of the many. Opting out infringes upon others.

    Isn’t central policy a way to achieve the most good for the most people? Why does it matter that people can’t make terrible and wrong decisions for themselves?

    What role would the government retain under such a system – educating the populace so they can make information-based decisions?

    What are the actual differences in outcome we should expect from this change in policy? If people will die because of the change, isn’t that not worth it?

    • #4
  5. PsychLynne Inactive
    PsychLynne
    @PsychLynne

    Did they come back with it’s a public health interest because an individual’s choices impact the population?  that those who take a national overview can see things individual and health systems can’t see?  that this type of policy making assure better care and patient outcomes?  because they care about people who make the wrong choices and don’t know any better?  because they know best?

    oops, they don’t usually say that last question out loud…

    Kudos for the bomb throwing as long as it actually starts a give and take conversation!

    • #5
  6. captainpower Inactive
    captainpower
    @captainpower

    Super Nurse: For the record, I believe the only time government intrusion is reasonable is to prevent infectious disease outbreaks. In fact, the laudable purpose of the Centers for Disease Control was originally this type of work. It is now the Centers for Disease Control and Prevention, and focuses on many chronic diseases.

    So since our standard of living has improved so dramatically, why not repurpose the CDC for the threats we face today (prevention) rather than threats of the past (infectious disease outbreaks)?

    • #6
  7. Super Nurse Inactive
    Super Nurse
    @SuperNurse

    captainpower:

    Super Nurse: For the record, I believe the only time government intrusion is reasonable is to prevent infectious disease outbreaks. In fact, the laudable purpose of the Centers for Disease Control was originally this type of work. It is now the Centers for Disease Control and Prevention, and focuses on many chronic diseases.

    So since our standard of living has improved so dramatically, why not repurpose the CDC for the threats we face today (prevention) rather than threats of the past (infectious disease outbreaks)?

    Because the threats of today are fundamentally different than the threats of yesterday! The difference is in the nature of the threats, rather than degree. To prevent modern illnesses, which are virtually all chronic and lifestyle related, the CDC would (does) have to somehow influence individual behaviors at every level, every day. To prevent infectious illnesses, the CDC needs to locate vectors and sources, isolate and quarantine (almost always very temporarily), and ensure access to treatment for infected individuals. This prevents others from becoming infected.

    Acquiescing to the new focus of the CDC is essentially agreement that the government has every right and even responsibility to control your nutrition, physical activity, alcohol and tobacco use, and sexual risk taking, among virtually every other aspect of your life that has or will ever be linked to health.

    • #7
  8. Super Nurse Inactive
    Super Nurse
    @SuperNurse

    PsychLynne:Did they come back with it’s a public health interest because an individual’s choices impact the population? that those who take a national overview can see things individual and health systems can’t see? that this type of policy making assure better care and patient outcomes? because they care about people who make the wrong choices and don’t know any better? because they know best?

    oops, they don’t usually say that last question out loud…

    Kudos for the bomb throwing as long as it actually starts a give and take conversation!

    I just think the chronically over schooled never hear that perspective, and I kind of enjoy being the introduction to the other side of the coin. Usually the debate is, “should we require everyone to buy insurance OR should the government be the only insurance?” Ricocheti know that this is not a debate. You’ve already conceded the central point: that it’s the government’s business at all.

    You’re right, of course, about the “we know best” assumption. The central premise of all of this is that central planning works. There are too many examples of this flawed logic to list, but unintended consequences are a real [COC]!

    • #8
  9. Tiger Inactive
    Tiger
    @Tiger

    Go for it SuperNurse – just don’t be surprised if you get an F.

    Read Kevin D Williamson’s “The End is Near and it’s going to be Awesome.”  He lays out why government and politics can never achieve the results that can be achieved by individuals with freedom to make their own choices.  He uses Healthcare as a specific example in depth.

    • #9
  10. EThompson Member
    EThompson
    @

    Like all things, healthcare choices of individuals are based on a complex web of tradeoffs and assessments of relative value. There is no fundamental reason any government should be involved in this assessment outside the aforementioned current payment system.

    Sure there is! This is yet another veiled redistribution of wealth scheme.

    • #10
  11. Super Nurse Inactive
    Super Nurse
    @SuperNurse

    captainpower:Sounds very philosophical.

    Reminds me of the fluoride in tap water discussion.

    Challenge time:

    On the other hand, a libertarian principle is that one should be free to exercise one’s own liberty until it infringes on someone else’s. Vaccination requirements sacrifice a few for the sake of the many. Opting out infringes upon others.

    I agree. I am all in on this aspect of public health. You don’t get to make other people’s kids sick because you listen to Jenny McCarthy over your own physician.

    Isn’t central policy a way to achieve the most good for the most people? Why does it matter that people can’t make terrible and wrong decisions for themselves?

    There is no logical end to this argument. If people shouldn’t be free to make terrible decisions for themselves, then why bother letting anyone make any decisions? From your career path to your living arrangement to the number of children you can have, we know better than you what is best.

    What role would the government retain under such a system – educating the populace so they can make information-based decisions?

    I would rather not have my money confiscated for such a purpose. If people desire such information, they will purchase it.

    What are the actual differences in outcome we should expect from this change in policy? If people will die because of the change, isn’t that not worth it?

    People die as the result of policies all the time, and we accept this. For example, we could prevent thousands of deaths every year with a single policy change: outlawing automobiles. Yet we continue to allow this deadly scourge. Why? Because we’ve decided the risk is worth the benefit.

    • #11
  12. Super Nurse Inactive
    Super Nurse
    @SuperNurse

    Tiger:Go for it SuperNurse – just don’t be surprised if you get an F.

    Read Kevin D Williamson’s “The End is Near and it’s going to be Awesome.” He lays out why government and politics can never achieve the results that can be achieved by individuals with freedom to make their own choices. He uses Healthcare as a specific example in depth.

    I have been waiting and waiting for this to come out on Audible!!! I love Kevin Williamson, almost creepily so. :) I just don’t have time for non-required reading. But I have an excessive commute.

    • #12
  13. Super Nurse Inactive
    Super Nurse
    @SuperNurse

    Tiger:Go for it SuperNurse – just don’t be surprised if you get an F.

    I have to say, I have not yet had a professor mark me down for honesty. I am sure that a conservative/ libertarian viewpoint is sufficiently rare in academia that I’m very nearly in a protected minority. :)

    • #13
  14. rnfogoros@fastmail.com Inactive
    rnfogoros@fastmail.com
    @DrRich

    Super Nurse,

    The opposition argument goes like this: Even most conservatives would agree that a person with chronic typhoid should be prevented from assembling hoagies at the Subway.  Therefore, there is a legitimate role for government in public health.

    But under the Progressive program, the necessity for some, occasional government intervention has been slowly, gradually, and unrelentingly expanded, to include lots of things that are far less dire than serving the typhoid bacillus with the mayonnaise.  And the next thing you know healthcare has been declared a “right,” and because it is a right, it has become the solemn duty of the Central Authorities to administer that right, and thus, healthcare.

    Progressives have won this debate, and they know it. There is probably little future in arguing with your Progressive overseers that the genie should be re-bottled.

    What you might consider doing instead is falling back a bit, and mounting a strong defense of the last potentially defensible position, namely, the inherent God-given right of individuals to expend their own resources on their own well being. That is, assert the right of individuals to spend their own money, outside of the official healthcare system, on their own health.

    This right is anathema to a Progressive healthcare system. Individuals simply cannot be permitted to go outside the system for their own benefit, because to do so demonstrates to others that there’s more healthcare to be had than the various government-controlled expert panels admit.  Allowing individuals to go outside the system creates expectations that simply cannot be allowed.  Indeed, if it is allowed, it will ultimately doom any Progressive healthcare system. (I could demonstrate any number of ways this kind of restriction on individual autonomy is already happening, but not in 500 words or less).

    At the same time, our Progressive leaders are still in the education mode (and not yet the Gulag mode), so they are extremely reluctant to admit the full extent of their designs on individual liberties.

    So challenge them. Say:

    “Supreme Court Justice Joseph Story, in his Commentaries on the Constitution of the United States (1833), asserted that the individual ‘is the proper guardian of his own health.’ In this light, I’ll admit that you have the power and authority to impose any kind of healthcare system you see fit, if you’ll forthrightly admit and declare that as an American citizen I have, and will forever retain, the inherent right to spend my own money on healthcare products or services of my own choosing.”

    I think you will find  you have placed them in very uncomfortable position – reluctant to say what they know is the truth, but also reluctant to admit even this basic, individual right.

    You won’t win the professors over, but your demonstration might start to wake up a few of your fellow students.  In any case this – asserting the right to use our own resources for our own wellbeing – is the final battle, which neither side can afford to lose.

    • #14
  15. kaekrem@aol.com Thatcher
    kaekrem@aol.com
    @VicrylContessa

    I don’t remember what semester it is that I take this class, but you’ve inspired me to not back down during those types of discussions! In our BSN classes, it was Community Health that put me- and most of my class- in a tail spin. If I hear about refugees and access to care one more time I may scream. Is your school particularly liberal? I have the benefit of doing my program in the South, were most of us are pretty conservative. I was talking to my fellow ACNP/RNFA students during a surgical onsite about being from CA. Several expressed a strong interest in doing a travel contract out there. I told them about the taxes, the smog, the gangs and that you can’t carry concealed. When I mentioned the whole no concealed carry thing, every one of them said, “Well, never mind!” I thought, gosh, it’s nice to be in the South!

    • #15
  16. Zafar Member
    Zafar
    @Zafar

    Until the consequences of health outcomes are completely privatised (ie let them die in a ditch if they can’t afford care) it’s hard to argue why health expenditure should be.  It’s putting the cart before the horse.

    • #16
  17. user_358258 Inactive
    user_358258
    @RandyWebster

    Zafar,

    I think it’s more that the consequences of health care decisions should be privatised.  I wouldn’t be caught dead (pardon the expression) riding my motorcycle without a helmet, but I don’t think it’s the government’s responsibility to require it.  The government says that, since the healthcare costs of the decision not to wear a helmet are borne by the community, the community gets to require that helmets be worn.  I’d rather that the health care costs of the decision not to wear a helmet are borne by the decision-maker.

    I don’t know what it’s position is now, but years ago, Cycle World was opposed to mandatory helmet laws, but recommended that everyone wear a helmet.  Their view?  Anyone who didn’t wear a helmet didn’t have a brain to protect anyway.

    • #17
  18. Kay of MT Inactive
    Kay of MT
    @KayofMT

    DrRich: (I could demonstrate any number of ways this kind of restriction on individual autonomy is already happening, but not in 500 words or less).

    I have a very expensive prescription in the US approx $395 for 90 pills, but can get the same drug in Canada, same company, for $114 for 168 pills.  This year for the first time, Canada was not allowed to accept my VISA card. I had to send a check to an office the pharmacy opened in the States, who in turned sent the money on to Canada. Our government is doing it’s best to prevent us from getting drugs from another country, by the same manufacture, same brand name. I’ve just been pushed into an “advantage” plan that I will ignore, and go to the same doctor I have been going to for the last 12 years. I will pay him cash if need be.

    I read some of your facebook page, very interesting.

    • #18
  19. Zafar Member
    Zafar
    @Zafar

    Randy Webster:I think it’s more that the consequences of health care decisions should be privatised.

    Hypothetical: poor mother of four (we’re meeting her a lot today) foolishly smokes and fails to buy insurance.  She gets cancer.

    I don’t see society not expecting Govt to step in, which necessitates a certain socialisation of expenditure.

    Until society is okay with Govt not stepping in, and leaving it entirely to the maybe yes maybe no efforts of private charity, then it’s hard to see how socialisation of expenditure doesn’t endure in some manner.

    • #19
  20. Zafar Member
    Zafar
    @Zafar

    Kay of MT:

    I have a very expensive prescription in the US approx $395 for 90 pills, but can get the same drug in Canada, same company, for $114 for 168 pills. This year for the first time, Canada was not allowed to accept my VISA card. I had to send a check to an office the pharmacy opened in the States, who in turned sent the money on to Canada. Our government is doing it’s best to prevent us from getting drugs from another country, by the same manufacture, same brand name.

    I wonder who lobbied them to do that.

    And why the same drug is cheaper in Canada.

    • #20
  21. kaekrem@aol.com Thatcher
    kaekrem@aol.com
    @VicrylContessa

    Zafar:

    Randy Webster:I think it’s more that the consequences of health care decisions should be privatised.

    Hypothetical: poor mother of four (we’re meeting her a lot today) foolishly smokes and fails to buy insurance. She gets cancer.

    Boy, she sure does have a lot on her to-do list! Haircuts, buying insurance, stopping at the gas station for a pack of smokes…

    • #21
  22. Zafar Member
    Zafar
    @Zafar

    I’m gunna make her a small business owner and gun rights and anti-vaccination activist.

    • #22
  23. kaekrem@aol.com Thatcher
    kaekrem@aol.com
    @VicrylContessa

    Zafar:I’m gunna make her a small business owner and gun rights and anti-vaccination activist.

    I think her name should be Lovetta, and she owns a hair salon.

    Pro-gun rights but anti-vaccination? There must be a story there.

    • #23
  24. Zafar Member
    Zafar
    @Zafar

    When she opens up to you she’ll tell you I’m sure.

    • #24
  25. user_358258 Inactive
    user_358258
    @RandyWebster

    Zafar:

    Kay of MT:

    I have a very expensive prescription in the US approx $395 for 90 pills, but can get the same drug in Canada, same company, for $114 for 168 pills. This year for the first time, Canada was not allowed to accept my VISA card. I had to send a check to an office the pharmacy opened in the States, who in turned sent the money on to Canada. Our government is doing it’s best to prevent us from getting drugs from another country, by the same manufacture, same brand name.

    I wonder who lobbied them to do that.

    And why the same drug is cheaper in Canada.

    I don’t know about the credit card.  The drug is cheaper in Canada because the Canadian government controls the price.  There’s some ill-feeling in the US over this sort of thing:  The drug consumers in the US are subsidizing the consumers in the rest of the world.  The drug companies make their money in the US, and the rest of the world rides on US consumers’ coattails.

    • #25
  26. Zafar Member
    Zafar
    @Zafar

    Randy Webster:

    I don’t know about the credit card. The drug is cheaper in Canada because the Canadian government controls the price. There’s some ill-feeling in the US over this sort of thing: The drug consumers in the US are subsidizing the consumers in the rest of the world. The drug companies make their money in the US, and the rest of the world rides on US consumers’ coattails.

    Or…

    • #26
  27. user_657161 Member
    user_657161
    @

    Zafar:

    Randy Webster:

    I don’t know about the credit card. The drug is cheaper in Canada because the Canadian government controls the price. There’s some ill-feeling in the US over this sort of thing: The drug consumers in the US are subsidizing the consumers in the rest of the world. The drug companies make their money in the US, and the rest of the world rides on US consumers’ coattails.

    Or…

    Or else there will be very few new drugs and a lot less medical technology breakthroughs.  Very few private companies are going to spend millions of dollars in R&D if there is no payoff for the 1 in 10 / 1 in 100 that result in a viable product.  Or we could just rely on the State (instead of the private sector) to do this for us.  Yea – that’s the ticket.

    • #27
  28. Kay of MT Inactive
    Kay of MT
    @KayofMT

    Randy Webster: I don’t know about the credit card. The drug is cheaper in Canada because the Canadian government controls the price. There’s some ill-feeling in the US over this sort of thing: The drug consumers in the US are subsidizing the consumers in the rest of the world. The drug companies make their money in the US, and the rest of the world rides on US consumers’ coattails.

    This is not a new drug, it’s been on the market for at least 45 years and was reasonably priced. Then a generic came out, drug company fought over their patent, and won, now no generic, and cost of drug has quadrupled. The Canadian price is about what I used to pay for it in CA.

    • #28
  29. Boss Mongo Member
    Boss Mongo
    @BossMongo

    No real comment to make, here.  Just like.

    • #29
  30. user_358258 Inactive
    user_358258
    @RandyWebster

    Kay of MT:

    Randy Webster: I don’t know about the credit card. The drug is cheaper in Canada because the Canadian government controls the price. There’s some ill-feeling in the US over this sort of thing: The drug consumers in the US are subsidizing the consumers in the rest of the world. The drug companies make their money in the US, and the rest of the world rides on US consumers’ coattails.

    This is not a new drug, it’s been on the market for at least 45 years and was reasonably priced. Then a generic came out, drug company fought over their patent, and won, now no generic, and cost of drug has quadrupled. The Canadian price is about what I used to pay for it in CA.

    I haven’t the faintest, then.

    • #30
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