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Should Healthcare Be Above Democracy?

 
 
Reply Sat 11 Jan, 2020 10:39 am
A recent Bloomberg ad suggests that Bloomberg actually expanded health coverage in NY while Trump plays with health care based on theory. The implication seems to be that anything besides using government to expand health insurance coverage amounts to jeopardizing the health of those who lack health insurance.

If this is accurate, then should healthcare be above democracy generally?

If so, then health insurance would not be the proper way to fund and manage health care.

Government mandate would then be the correct method, in the same way that obligatory military duty, jury duty, and the like are required of people, who are then compensated according to standards of payment beyond market forces.

Are Bloomberg and others who presume to mix economic markets with public duties doing a disservice to the public by mixing business with necessity? It seems quite similar to a spouse who would mix business with marital duties by, for example, leveraging money or favors in exchange for household duties or breadwinner responsibilities.

Should government simply decide that some things are beyond politics and mandate them by rule of law and threat of punishment/imprisonment? As such, things like basic welfare guarantees and health care would simply be required by law and people could be drafted to public service to perform such duties.

Or do you think it is better to use government spending, which results in inflation and all the wasteful business activities that occur when economic rivalry to capture the circulating stimulus money ensues?
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Real Music
 
  1  
Reply Mon 13 Jan, 2020 04:08 pm
@livinglava,
I found the following article. This is an old article dated October 19, 2004.
This article is essentially pertaining to the drafting of medical professionals into the military.
Although, the following article isn't exactly the topic of this thread, in some ways it is.



U.S. Has Contingency Plans for a Draft of Medical Workers


Published October 19, 2004

Quote:
WASHINGTON, Oct. 18 - The Selective Service has been updating its contingency plans for a draft of doctors, nurses and other health care workers in case of a national emergency that overwhelms the military's medical corps.

In a confidential report this summer, a contractor hired by the agency described how such a draft might work, how to secure compliance and how to mold public opinion and communicate with health care professionals, whose lives could be disrupted.

On the one hand, the report said, the Selective Service System should establish contacts in advance with medical societies, hospitals, schools of medicine and nursing, managed care organizations, rural health care providers and the editors of medical journals and trade publications.

On the other hand, it said, such contacts must be limited, low key and discreet because "overtures from Selective Service to the medical community will be seen as precursors to a draft," and that could alarm the public.

In this election year, the report said, "very few ideas or activities are viewed without some degree of cynicism."

President Bush has flatly declared that there will be no draft, but Senator John Kerry has suggested that this is a possibility if Mr. Bush is re-elected.

Richard S. Flahavan, a spokesman for the Selective Service System, said Monday: "We have been routinely updating the entire plan for a health care draft. The plan is on the shelf and will remain there unless Congress and the president decide that it's needed and direct us to carry it out."

The Selective Service does not decide whether a draft will occur. It would carry out the mechanics only if the president and Congress authorized a draft.

The chief Pentagon spokesman, Lawrence T. Di Rita, said Monday: "It is the policy of this administration to oppose a military draft for any purpose whatsoever. A return to the draft is unthinkable. There will be no draft."

Mr. Di Rita said the armed forces could offer bonus pay and other incentives to attract and retain medical specialists.

In 1987, Congress enacted a law requiring the Selective Service to develop a plan for "registration and classification" of health care professionals essential to the armed forces.

Under the plan, Mr. Flahavan said, about 3.4 million male and female health care workers ages 18 to 44 would be expected to register with the Selective Service. From this pool, he said, the agency could select tens of thousands of health care professionals practicing in 62 health care specialties.

"The Selective Service System plans on delivering about 36,000 health care specialists to the Defense Department if and when a special skills draft were activated," Mr. Flahavan said.

The contractor hired by Selective Service, Widmeyer Communications, said that local government operations would be affected by a call-up of emergency medical technicians, so it advised the Selective Service to contact groups like the United States Conference of Mayors and the National Association of Counties.

Doctors and nurses would be eligible for deferments if they could show that they were providing essential health care services to civilians in their communities.

But the contractor said: "There is no getting around the fact that a medical draft would disrupt lives. Many familial, business and community responsibilities will be impacted."

Moreover, Widmeyer said, "if medical professionals are singled out and other professionals are not called, many will find the process unfair," and health care workers will ask, "Why us?"

In a recent article in The Wisconsin Medical Journal, published by the state medical society, Col. Roger A. Lalich, a senior physician in the Army National Guard, said: "It appears that a general draft is not likely to occur. A physician draft is the most likely conscription into the military in the near future."

Since 2003, the Selective Service has said it is shifting its preparations for a draft in a national crisis toward narrow sectors of specialists, including medical personnel.

Colonel Lalich, citing Selective Service memorandums on the subject, said the Defense Department had indicated that "a conventional draft of untrained manpower is not necessary for the war on terrorism." But, he said, "the Department of Defense has stated that what most likely will be needed is a 'special skills draft,"' including care workers in particular.

That view was echoed in a newsletter circulated recently by the Selective Service System, which said the all-volunteer force had "critical shortages of individuals with special skills" that might be needed in a crisis.

The Selective Service and Widmeyer held focus groups this summer to sample public opinion toward registration and a possible draft including medical personnel. People from a variety of professions, including doctors and nurses, were questioned.

The report summarized the findings this way:

$(6$)"There was substantial resistance to the notion of a call-up of civilian professionals that would send draftees to foreign soil."

$(6$)A draft of civilian professionals was seen as unworkable because "training would be inadequate to transform groups of people who had never worked together into cohesive units."

$(6$)People are apprehensive about the length of service that might be required. The "occupation of Iraq has proved more costly, in terms of dollars and lives, than most Americans expected." Members of the National Guard are "serving tours of duty far longer than many ever anticipated."

$(6$)People believe the government has the ability to "find whomever it needs" in a crisis, by using a "master database" if necessary.

President Bush and Mr. Kerry have said they oppose a draft. "Forget all this talk about a draft," Mr. Bush said at the second presidential debate, on Oct. 8 in St. Louis. "We're not going to have a draft so long as I'm the president."

But Mr. Kerry said, "You've got a backdoor draft right now" because "our military is overextended" as a result of policies adopted by Mr. Bush.

Bryan G. Whitman, a spokesman for the Defense Department, said: "The all-volunteer force has been working very well for 30 years. There is absolutely no reason to go back to a draft."

https://www.nytimes.com/2004/10/19/politics/us-has-contingency-plans-for-a-draft-of-medical-workers.html
0 Replies
 
georgeob1
 
  1  
Reply Mon 13 Jan, 2020 04:20 pm
A "Draft" for health care workers is merely a euphemism for their compulsory labor, managed by government. What about the constitutional guaranteed freedoms of these health care workers?

Will the resulting health care system incorporate all the client service quality, technical expertise, and efficiency for which Army Boot Camp is so well noted?
livinglava
 
  1  
Reply Mon 13 Jan, 2020 06:50 pm
@georgeob1,
georgeob1 wrote:

A "Draft" for health care workers is merely a euphemism for their compulsory labor, managed by government. What about the constitutional guaranteed freedoms of these health care workers?

Will the resulting health care system incorporate all the client service quality, technical expertise, and efficiency for which Army Boot Camp is so well noted?

What is worse,
1) drafting healthcare providers into serving the uninsured?
or
2) using government subsidies and mandates to turn the health-insurance industry into an instrument for stimulus spending and thus inflation?

Either way, the net effect is to draft people into providing the same services, so why do it at the expense of stable currency valuation and thus saved money?

Further, what about drafting medical schools and other institutions into providing free health education to people willing and able to take it?

Surely there must be a lot of people who would be willing to go into healthcare if it wasn't such an expensive investment, which leaves them enslaved to debt once they have a diploma.

Why not just train people to serve in their local communities for relatively low pay as public healthcare providers? Then they neither end up in debt nor do they get paid handsomely for their efforts. They just serve the uninsured.
georgeob1
 
  1  
Reply Mon 13 Jan, 2020 07:44 pm
@livinglava,
Do you propose to use government power to force people to do any of these things? If so you don't understand either our Constitution or the importance of individual freedom.
livinglava
 
  1  
Reply Tue 14 Jan, 2020 06:11 am
@georgeob1,
georgeob1 wrote:

Do you propose to use government power to force people to do any of these things? If so you don't understand either our Constitution or the importance of individual freedom.

I just put forth the question of whether healthcare should be above democracy (and markets).

If you are saying that the constitution prevents anything from being regulated outside of democracy, I don't think you are paying attention to how US government works.

The 13th amendment, for example, was made to prevent state-level democracy from controlling slavery. In short, the constitution put the issue of slavery above democracy.

Now you could argue that constitutional amendments are subject to revision by 2/3 majorities in both houses of congress, but that effectively puts them above the state/local level.

Likewise, states don't control whether or not people can get drafted into government service, as far as I know. I haven't done that much research into drafts, though; so maybe I am wrong and states can just exempt their residents from military drafts or any other selective service that could be implemented.
georgeob1
 
  1  
Reply Wed 15 Jan, 2020 11:35 am
@livinglava,
You are confusing the established democratic process with constitutionally protected individual freedoms. The government can't compel a graduate of medical school to work for the government or a government controlled agency. That would indeed be a form of slavery. This principal was however violated when the constitution was enacted while southern states continued the practice of slavery. Southern states even regulated some aspects of slavery through the constitutionally enacted democratic process. However that all ended with the Civil war and amendments to the constitution forbidding the practice of slavery and restating the applicability of all the freedoms in the Bill of Rights to everyone.

I suppose you could raise the issue of military conscription and the draft, arguing that the two are analogous, but I don't believe the USSC would agree.
livinglava
 
  1  
Reply Wed 15 Jan, 2020 05:42 pm
@georgeob1,
georgeob1 wrote:

You are confusing the established democratic process with constitutionally protected individual freedoms. The government can't compel a graduate of medical school to work for the government or a government controlled agency. That would indeed be a form of slavery. This principal was however violated when the constitution was enacted while southern states continued the practice of slavery. Southern states even regulated some aspects of slavery through the constitutionally enacted democratic process. However that all ended with the Civil war and amendments to the constitution forbidding the practice of slavery and restating the applicability of all the freedoms in the Bill of Rights to everyone.

I suppose you could raise the issue of military conscription and the draft, arguing that the two are analogous, but I don't believe the USSC would agree.

Idk. I think they could mandate medical schools allow designated students to attend free of charge.

They could also revoke licenses if medical practitioners/institutions refuse to allow apprentices to observe and ask questions.

In short, they could simply deem teaching and mentoring part of general medical duties.
0 Replies
 
McGentrix
 
  1  
Reply Wed 15 Jan, 2020 08:07 pm
@georgeob1,
What about something like offering to pay for Med School in exchange for service as a Doctor in needy areas? So, like all tuition, room & board plus s stipend for 10 years work as a health professional in a remote part of America?
georgeob1
 
  1  
Reply Wed 15 Jan, 2020 08:16 pm
@McGentrix,
That would involve a contract by a free individual with the government , and no constitutional issue would arise.

It's still a bad idea in my view. The track record for government managed healthcare in this country and others is not very encouraging: bureaucracies are not noted for their creativity, innovation and focus on client satisfaction. Indeed any entity, whether government or private, that operates without client choice and competition generally yields poor quality service and indifferent management. In this country the government operated systems for both veterans and native American populations have yielded consistently poor quality services ad sometimes nearly criminal negligence by government providers.
McGentrix
 
  1  
Reply Wed 15 Jan, 2020 08:30 pm
@georgeob1,
But imagine that Doctor getting paid a salary for 10 years, but his care was free to the people seeing him? Gets like a govt issued nurse, an x-ray machine etc and his/her Rx was mail ordered from the Govt?

Maybe, the Doctor, because he is a doctor, gives excellent care to his patients.
livinglava
 
  1  
Reply Thu 16 Jan, 2020 06:07 am
@McGentrix,
McGentrix wrote:

What about something like offering to pay for Med School in exchange for service as a Doctor in needy areas? So, like all tuition, room & board plus s stipend for 10 years work as a health professional in a remote part of America?

The problem with using government subsidies/stimulus for things is that it injects ever more liquidity into an economy that is already overblown with inflationary activity.

Why do you think so much land gets developed unnecessarily except because there is money burning a hole in investors' pockets and people who are anxious to develop the land in order to get a job on their resume', even if there are other suitable, already-developed properties nearby.

If we want a sustainable economy, we have to achieve things like broader healthcare access without spending ever more money into the economy. That way, more people are getting better, more affordable healthcare while others are conserving and thus not investing/spending money and causing all the inflationary activity, environmental harm, and resource waste that comes with growth.
0 Replies
 
georgeob1
 
  1  
Reply Thu 16 Jan, 2020 09:08 am
@McGentrix,
McGentrix wrote:

But imagine that Doctor getting paid a salary for 10 years, but his care was free to the people seeing him? Gets like a govt issued nurse, an x-ray machine etc and his/her Rx was mail ordered from the Govt?

Maybe, the Doctor, because he is a doctor, gives excellent care to his patients.


I'm sure there are doctors out there just as you describe. However the recent statistics on the extent of Medicare fraud strongly suggests the corrosive and corrupting influence of government involvement in the delivery of medical care.
McGentrix
 
  1  
Reply Thu 16 Jan, 2020 10:30 am
@georgeob1,
That's because Medicare is designed that way. What I suggest there is no medicare. There is no insurance.

Imagine, a small town has 1 or 2 doctors. Usually have to go to a larger town to see specialists. Those small town doctors get paid the same as, lets say an O-5. They then have appointments, they see patients, they do their jobs as doctors because that is what they want to do. They aren't forced to, they choose to. The patient doesn't ever even see a bill. They have a cold, they get a simple test.

As you go from the outside rural areas, you get into larger area's. You get actual hospitals ran the same way. Where specialists and surgeons and the like work as salaried professionals for the government who also provides necessary things for the staff to use.

This way, there is no billing, there is no medicare costs, there is no fraud because the Dr are all getting paid.

Where the opportunity for fraud and abuse exists is with the executive staff. Someone would have to be ordering supplies and others would have to be gauging doctor effort and patient load.

After 10 years, Doctors would have the yearly option of staying with the government or going into private practice where they can then charge what they want and see who they want etc. Only problem is only the wealthy would be seeing private doctors as healthcare would be free at the govt healthcare centers.

I know it's a dream and anytime you get people involved there is opportunity for waste and abuse but if done properly, I think it would offer us the best chance at free, public healthcare.
Linkat
 
  1  
Reply Thu 16 Jan, 2020 11:29 am
@McGentrix,
McGentrix wrote:

What about something like offering to pay for Med School in exchange for service as a Doctor in needy areas? So, like all tuition, room & board plus s stipend for 10 years work as a health professional in a remote part of America?


States have done similar things in regard to teaching. For example in MA, if you agree to teach (certain levels and certain subjects) in a lower income town for a certain number of years, they will forgive a certain amount of your government loans. Other states will pay a portion of your tuition - things like that due to the need of certain teachers.

I think it is different if you offer an enticement rather than dictate - that leaves the choice and freedom to the individual.
Linkat
 
  1  
Reply Thu 16 Jan, 2020 11:34 am
@georgeob1,
georgeob1 wrote:

That would involve a contract by a free individual with the government , and no constitutional issue would arise.

It's still a bad idea in my view. The track record for government managed healthcare in this country and others is not very encouraging: bureaucracies are not noted for their creativity, innovation and focus on client satisfaction. Indeed any entity, whether government or private, that operates without client choice and competition generally yields poor quality service and indifferent management. In this country the government operated systems for both veterans and native American populations have yielded consistently poor quality services ad sometimes nearly criminal negligence by government providers.


I would think the student would still need to be accepted into the program and maintain an acceptable GPA. If all they are doing is providing incentive but otherwise not involved I see no issue - I think though the route similar to teaching should be to forgive the loans - that way you know they have successfully completed their academic career and will be on the hook for the loans if they do not completely commit to their side of the bargain.
georgeob1
 
  1  
Reply Thu 16 Jan, 2020 12:14 pm
@Linkat,
Linkat wrote:

I would think the student would still need to be accepted into the program and maintain an acceptable GPA. If all they are doing is providing incentive but otherwise not involved I see no issue - I think though the route similar to teaching should be to forgive the loans - that way you know they have successfully completed their academic career and will be on the hook for the loans if they do not completely commit to their side of the bargain.


Such legislation would likely be quickly thrown out by the Supreme Court as a thinly disguised form of compulsory employment. Moreover the usually unanticipated side effects of such legislation would be very harmful.

Today's Federal student loan program is a good example. Subsidized student loans are hardly necessary with today's low interest rates. However they have needlessly brought about the very rapid increase in University Tuition - most dedicated to added overhead and administrative functions unrelated to their educational mission. In short they have made University education LESS accessible to potential students.

I wonder if most holders of student loans understand that the law enacting Federal subsidies and management of the program also deprives the students of the right to subsequently declare bankruptcy to escape the loss of all their assets if things don't work pout for them.
Linkat
 
  1  
Reply Thu 16 Jan, 2020 12:40 pm
@georgeob1,
Quote:
Such legislation would likely be quickly thrown out by the Supreme Court as a thinly disguised form of compulsory employment. Moreover the usually unanticipated side effects of such legislation would be very harmful.


Then how come they are able to do just this in the teaching profession?
georgeob1
 
  1  
Reply Thu 16 Jan, 2020 01:03 pm
@Linkat,
Linkat wrote:

Then how come they are able to do just this in the teaching profession?


Please explain yourself. In way way does the Federal Government exercise control of who teaches or what is taught in our Public schools. These are by long practice, the domain of local and state governments, and not the Federal government. State governments do increasingly control curricula in their schools, generally with adverse long-term effects. Under President Obama the Federal Education department did indeed try to exercise a degree of control through the award of Federal grants, and did so with generally adverse effects. The whole matter is complicated by the Teacher's unions which exercise undue influence over government at all levels. One result is that our public schools are, by many measures, decidedly inferior to those of most advanced nations.
InfraBlue
 
  1  
Reply Thu 16 Jan, 2020 01:27 pm
@McGentrix,
You godforsaken, hippie socialist.
 

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