Edwards Health Care Plan

This is totalitarian.  There is scarcely any other way to describe it.

Ann Althouse agrees.  (ht: Fred).

Comments

[Bubba]

Not much of a stretch from mandatory physical and mental health care to mandatory behavior standards and mandatory birth control and abortion, is there?

[Joe Guarino]

Maybe a little bit of a stretch, but not as much as one would think. It has already happened in at least one country that has a leftist government with totalitarian tendencies-- China.

[Anthony]

So mandating medical checkups is totalitarian, but cohabitation laws (which you've written in favor of) are *not* totalitarian? How can you justify one and not the other?

[Oak Ridge Runner]

"He said he would not buy another SUV in the future."

John won't buy another SUV, but why doesn't he sell the two that he now owns? His continuing hypocrisy.

[Joe Guarino]

Oak, he initially said that when others own SUV's, it is different than him owning an energy-consuming palatial estate because he "worked hard" for all he had. Presumably SUV owners did not.

Anthony, cohabitation laws largely were not enforced, whereas Edwards promises to enforce the provision he proposes. In addition, we were not even remotely totalitarian when cohabitation laws were in effect in NC. Edwards' plan, however, would move us in that direction.

Family obligation is an intrinsic part of the natural social order. Preventive health care is not.

[Bubba]

Yet another good answer to the "gotcha"/deflection question, Joe.

[Bubba]

Great quote from the WSJ's James Taranto on Edwards' disturbing policy position :

"Aside from its obvious creepiness, there is something dissonant on several levels about a liberal politician in this day and age calling for government to police everyone's medical care.

For one thing, liberals, who these days are more or less uniformly pro-abortion, invariably speak of that practice in terms of "privacy" and "choice." But how in the world can anyone who values privacy and choice more than life itself possibly countenance a policy of forcing women to have mammograms?

For another, we live in a time when liberals often sound like antigovernment kooks, making far-fetched claims that the government is spying on all of us, torturing innocent terrorists, deliberately letting hurricane victims die, etc. Of course the object of this paranoia isn't government per se but the Republican Party and especially the current administration."

[Joe Guarino]

That is a great quote, Bubba. Privacy and choice are very important with respect to medical care, except when they are not.

[Anthony]

Joe,

"cohabitation laws largely were not enforced, whereas Edwards promises to enforce the provision he proposes."

That's irrelevant - a law itself is either "totalitarian" in nature or not, independently of whether it's enforced.

"In addition, we were not even remotely totalitarian when cohabitation laws were in effect in NC. Edwards' plan, however, would move us in that direction."

If it is indeed a sliding scale where laws and policies move us in one direction or another, then you could just as easily say that abolishing cohabitation laws moved us in a direction away from totalitarianism, whether or not we were actually anywhere near totalitarianism in a general sense.

"Family obligation is an intrinsic part of the natural social order. Preventive health care is not."

I don't see how that provides justification for the government to regulate private living arrangements.

If you're arguing that the state has an interest in strengthening that obligation, you could also argue that the state has an interest in keeping its citizens healthy - sickness and death can drain a family's resources, put a strain on their relationships, and keep members of that family out of work, decreasing their economic productivity. And this can happen to families (or even single people!) accross the board - not just those that are adverse to "family obligation".

If a state interest justifies legislation in the area of living arangements, I would think it justifies it at least as much in the area of healthcare.

Sorry, but I really think there's a disconnect if you can call Edwards' plan "totalitarian" but not say the same about cohabitation laws.

[Dr. Mary Johnson]

I am enjoying watching Edwards destroy himself as a serious candidate. Not that he ever was one.

I'd love to see Mr. Fancy-Pants spend just one night in a busy inner-city Emergency Department and try to inflict his "I know what's best for all of you" philosophy on the clientele: "Live the way I tell you to live, and I'll get the government to pay for it."

He would be eaten alive.

Whereas the people who are being eaten alive NOW are those who cope with the fruit of privacy and choice every day (the same people who would be required to provide that "preventative care" - for the peanuts the government would throw) . . . and try to help . . . only to have to look over our shoulders for people like Edwards.

[Joe Guarino]

Thanks for your comments, Mary. It would be good to see him trying to peddle this approach in the ER.

Interestingly, Mary, one of the ways Edwards made his mark initially was to appeal to consumeristic sentiments with respect to health care. The HMO was the bad guy, denying treatment and payment for beneficiaries on a regular basis, and Edwards was to be our savior against them.

Ironically, his autocratic, paternalistic approach-- depriving patients of their autonomy-- is entirely in the tradition of the true HMO's.

[Joe Guarino]

Anthony, I disagree regarding the relevancy of the non-enforcement of the cohabitation laws being "irrelevant". And this phenomenon does not merely reflect "living arrangements"; it reflects much more than that.

This is clearly a clash of values. I think family obligations as a societal institution, ingrained in our laws, is at a much higher level of priority than mandatory health care. And many folks came here from other nations to experience much greater freedom when these laws were in place.

[jimcaserta]

Is the mandatory annual car inspection totalitarian? How about the 1/6 to 1/3 of your time you spend working for the government?

Doesn't almost everyone get some coverage from Medicare? Wouldn't it be possible to require those receiving Medicare benefits to get annual exams. Would that improve the quality-of-care/cost ratio? You could let people opt out of the requirements, but then they opt out of the benefit also.

I think Americans, relative to most other wealthy countries, are very bad at prevention and management of chronic disease. Diabetes in this country is a bomb waiting to go off, but it is a disease that is mostly preventable (90-95% of diabetes cases are type 2) and manageable. It is also a disease that causes major damage when unchecked.

How medical care is delivered is heavily skewed toward critical care and procedures and away from primary care. This can have the effect of decreasing the quality of life and increasing the cost.

[Bubba]

"Is the mandatory annual car inspection totalitarian?"

If I don't get my Edwardsian mandatory annual health checkup, does that affect your health?

On the other hand, if you don't get your car inspected, if your brakes are shot and you hit me, my health will possibly be severely affected.

"How about the 1/6 to 1/3 of your time you spend working for the government?"

One sixth to one third?

You are WAY low on your number.

Total up all the hidden costs and you will find many folks work for the government about 60 percent of the time.

If we institute a Edwardsian health care philosophy, be prepared to work for the government to an even larger extent.

That's just making an already insufferable problem worse, while accomplishing little good.

It's not worth it.

[jimcaserta]

Your checkup will most likely not affect my health, but it will affect my pocketbook as I will probably end up paying a portion of your care - at least through medicare. The 60% number strengthens my point - we already tolerate considerable intrusion by government, and none could truthfully call our system totalitarian. Already I (as everyone in the social security system) work 7.25 days each year solely to provide medicare benefits for others. In the past 6+ years, Medicare has expanded, and government involvement in medicine is poised to increase. Finding ways to improve quality of care, reduce cost or both should be a priority.

[Bubba]

"...we already tolerate considerable intrusion by government, and none could truthfully call our system totalitarian."

You may be right.

The words most often use to describe the intrusion are "intolerable" and "outrageous".

Regarding the other analogy you made, you missed the point.

[Joe Guarino]

Jim, the reason the system is skewed away from preventive care is because insurance reimburses to evaluate and treat pathology more reliably than it does keeping people well. It is a function of the way the insurance system has historically been structured. Some of us would argue that this is an argument for getting insurance out of the picture to a greater degree.

But one of the great traditions of American medicine is patient autonomy and consent. You can't impose treatment or evaluation on patients against their will except under very limited circumstances. It is particularly objectionable when it is mandated by government.

A large group of patients is forced to present who otherwise would be unmotivated to do so. Preventive care in many cases can increase expenses dramatically, and even expose patients to certain risks, if they lead to certain other interventions-- other tests, procedures or medications.

[jimcaserta]

So is there too much or too little preventive care and chronic illness management in this country? I would need some evidence that real sensible preventive care increases expenses. I know, through my wife, that more CT & MRI scans are performed than really needed, but the only thing those are really preventing is a potential lawsuit.

I think of preventive care as diabetics managing their blood sugar and asthmatics using steroid and beta agonist inhalers to maintain a healthy lifestyle. Both of those diseases are much better treated daily than waiting until a crisis hits.

I would imagine that a large portion of the money spent on medical care for a given person is spent during their last 3 months of life - when it really helps the least.

I would also imagine that employer-sponsored insurance and medicare have near 90% support. As much as you might want "insurance out of the picture to a greater degree" no recent events point to that happening.

[Cara Michele]

Question for Joe and Mary: I know that neither of you are fond of John Edwards, but aside from your feelings for him (and Democrats in general, and government intrusion as a concept), are either of you, as physicians, actually against the idea of preventative care? I thought that was a good thing, and something that doctors were all for. I've yet to meet one who wasn't.

(No, Bubba, this isn't a "gotcha" question. I'm really curious. *smile*)

[Bubba]

"(No, Bubba, this isn't a "gotcha" question. I'm really curious. *smile*)"

There are only a few people locally who have the reputation for asking "gotcha" or deflection questions, CM.

You are not one of them.

[Anthony]

Joe:

"I disagree regarding the relevancy of the non-enforcement of the cohabitation laws being "irrelevant"."

We'll have to agree to disagree then, obviously.

"I think family obligations as a societal institution, ingrained in our laws, is at a much higher level of priority than mandatory health care."

If that's true, then the question is more one of "degree". I think my point stands that a strong state interest can be demonstrated for keeping citizens healthy.

" And many folks came here from other nations to experience much greater freedom when these laws were in place."

Just as I'm sure many folks would still come here to experience greater freedom even if Edwards' idea became a reality.

At any rate, I won't sidetrack the thread any more with this line - just trying to see how you reconciled what seems to me to be an inconsistency. Thanks for your responses.

I personally agree that Edwards' idea probably is indeed too intrusive, though I think "totalitarian" is a bit overboard.

Cara Michele:

No need to worry - "gotcha" questions can only be asked by liberals and Democrats. If they're asked by Republicans (or if a Republican bases an entire blog around them), they're simply "keeping people honest". It's different. :)

[jimcaserta]

I somewhat understand Joe's point, especially considering his specialty. There are people who are over-medicated and over-doctored, and many who don't get adequate care.

My thought is that the second group will eventually get care, often when problems have progressed to the point where they are disruptive to normal life and expensive to treat.

In my mind, the two groups are separate issues.

Joe, what do you think of Medicare? Is it a program that should be expanded, is good as is, or should be reduced?

[Bubba]

(yawn)

[Joe Guarino]

Have had a really busy day, folks. Sorry that I dropped out of sight.

Jim, there are three different levels of prevention-- changing health behaviors (such as smoking); detecting diseases early (such as mammograms); and treating chronic diseases to prevent flares or complications (like your asthma example.)

Many medicines and tests can lead to serious complications. On a population basis, they may be demonstrably beneficial. However, on an individual basis, they can be a big problem for a small percentage. When government requires it, this represents a potential problem for individuals and families who may not relish experiencing complications.

An example-- a true story. An elderly patient is screened for colon cancer with a hemoccult test for blood in the stool. She has a positive test. An endoscopy procedure is recommended to make sure there is no cancer. The procedure is performed, and the patient's aged colon is so thin and non-elastic that it ruptures due to the procedure. The patient dies.

This type of scenario plays itself out all the time. It is regrettable-- and inevitable-- that more interventions lead to more complications in individuals.

I don't think I want to get into Medicare because I don't want to set off another debate within this post.

[Joe Guarino]

Michele, no, I am not against preventive care. I did a residency in general preventive medicine.

I am in favor of patients making free decisions to pursue, or not to pursue, this type of care. There are other ways to provide incentives-- structuring insurance premiums, for instance, based on health habits, etc. But I am against coercion.

It would be good for patients to pursue the different levels of prevention with some understanding of the risk/benefit ratio.

[Cara Michele]

Thanks, Joe. "An ounce of prevention is worth a pound of cure" is a wonderfully wise statement. And not just about health care!

[Dr. Mary Johnson]

I tried to post this last night. It would not take.

Cara, I too am very busy at work. sorry for not responding sooner.

First, Joe's points . . . about preventative care leading to more preventative care (the ultimate in defensive medicine) . . . which sometimes backfires . . . is well-taken.

I am a Pediatrician. When I work in an office setting, a good portion of my tme is spent providing preventative care - much of it "mandatory" for children via order of the state. Most of the time it's a "good thing". But sometimes some of it feels coercive or ill-advised to some parents - and to the doctors.

Does anyone remember Jim Black's attempt to mandate eye exams for all kindergarteners in the state? It was a bad idea (an "under-the-table" deal not properly vetted by doctors & public health officials), and a bad law. Our government at work.

As my case in Asheboro resoundingly demonstrates, there is little "oversight" of government's good intentions now. I don't think it's going to get any better if more programs are mandated.

When it comes to adults, like Joe, I am in favor of patients being free to choose what type of care they receive . . . and doctors being free to decide what kind of care they provide.

And, as you might understand given what I've been through, I am totally against MORE government intrusion upon the physician-patient relationship and the profession in general.

I think John Edwards is projecting. Elizabeth Edwards chose fertility treatments (we could argue all day about the long-term health risks associated with that). She also chose not to get regular mammograms. In hindsight (always 20/20) was a mistake. But it was her mistake.

If she/her husband want to "help" educate the public, well, then educate the public. But I don't think that mandating more government intrusion into our private lives & personal medical decisions is going to solve any problems . . . merely compound them.

In contrast, I've gotten mammograms nearly every year since I was thirty-five (due to fibrocystic breast disease . . . probably more than I ever wanted to share online). Under a government program, those early exams might not have been approved (because I did not fit some demographic). I could have chosen not to pursue the exams. But I sleep better at night with that small amount of re-assurance once a year. On the other hand, it remains to be seen if I will get breast cancer from the cumulative radiation.

Let's say you mandate "preventative care" for adults. Even if the doctor advocates a healthy lifestyle, there's got to be an incentive to follow that lifestyle. People have to WANT it . . . care is ONLY successful when people comply.

Meanwhile, the government will be paying for all these preventative exams without ANY assurance that anything will change. Rather than decrease costs, I believe medical costs will be driven up even more.

What do you do then? Mandate compliance? Good luck with that.

Where does it stop?

This is America. Freedom of everything. Edwards' plan is simply not realistic or practical.

As I said before, I'd like to see Mr. Edwards walk into an Emergency Department anywhere and start telling people how to live their lives (which is what preventative care really is about) in return for "free care" from the government: No alcohol, No drugs, No sex, No good food, No SUV's, etc. (many of the "pursuit of happiness" personal choices that land people in the ED in the first place)

He'd be lunch.

[Joe Guarino]

Thanks, Mary. I agree entirely.