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Bush Administration Health Care Policy in Three Rules
Unfortunately, knowing these three rules is merely palliative care. A cure would require rebuilding our health care system to make meeting the needs of all Americans its central purpose.Do you ever experience dizziness or nausea when thinking about the current administration’s health care policy? You are not alone. Millions of your fellow Americans are similarly afflicted. The reason you and they have that sea-sick feeling is that the ground really does shift depending on which part of the health care policy domain one observes. Although it won’t make the administration’s various decisions and pronouncements about health care any more reasonable or consistent, the following treatment may help to reduce the symptoms. All you have to do is remember the following three rules.
Rule 1: If sexual reproduction or pleasure is implicated or if the individuals most affected are relatively few or relatively powerless, then the decision-making mode is moralistic and the value to be maximized is ‘dignity.’ For example, when President Bush proclaimed January 21, 2007 to be National Sanctity of Human Life Day, he stated that the “dignity and humanity of every person should be respected” and that we should “value human life in all forms, not just those considered healthy, wanted, or convenient.” He wasn’t talking about reducing the infant mortality rate in the United States to that of the other OECD countries but was instead rewarding the anti-abortion movement with yet another largely symbolic gesture in return for their tireless mobilization of voters for Republican candidates. Protecting ‘dignity’ was also the rationale offered for Bush’s April 11, 2007 threat to veto the Stem Cell Research Enhancement Act of 2007, which he did on June 20, 2007.
The obvious problem with using ‘dignity’ to justify a health policy decision, or any public policy decision for that matter, is that it is a religious-philosophical abstraction.The obvious problem with using ‘dignity’ to justify a health policy decision, or any public policy decision for that matter, is that it is a religious-philosophical abstraction. The empirical evidence for ‘dignity’ is no better than that for the ‘soul’ or the ‘sacred.’ Conservatives deploy ‘dignity’ when they want to avoid difficult discussions about the assumptions and interests underlying their policy preferences. The less obvious problem with ‘dignity’ is that whatever it means, everyone must deserve it in equal measure. That’s a problem because society values individual human lives unequally. The priorities assigned to waiting transplant recipients or the quality of medical care given the insured and uninsured leave no doubt that some human lives are valued more than others.
Rule 2: If most of the population is involved and the profitability of the medical industry is at stake, then the decision-making mode is economic and the value to be maximized is ‘capitalism.’ Of course that word isn’t used to identify the favored value. Nor is the word ‘socialism’ used much to describe its opposite. Both words carry too much ideological mana* to be used. Instead the administration prefers the safer words ‘private’ and ‘government.’ For example, in his struggle to under-fund the State Children's Health Insurance Program or SCHIP, Bush complained on September 21, 2007 that legislation passed by Democrats would transfer “millions of American children who now have private health insurance into government-run health care; and is an incremental step toward a government-run health care system.”
That is the sort of language the medical insurance companies and private hospital chains, entities that have grown enormously rich parasitizing American health care consumers, love to hear. And it ought to be the sort of language loathed by those same consumers. Although medical care comprises a larger part of the economy of the United States than that of the other advanced industrial societies, our national medical statistics are actually often poorer. According to the OECD, health care provision was 15.3% of total gross domestic product in the United States in 2005, while the average among 26 OECD countries was only 9%. If that extravagance actually bought Americans better health care outcomes then it might be understandable. Unfortunately it does not. Life expectancy is lower and the infant mortality rate higher in the United States than the OECD averages. What explains this economic inefficiency? The ironic answer is that much more of the health care provision in the United States is provided by profit-making firms than in the other OECD countries. Our more capitalist health care system delivers typically mediocre health care less efficiently than the more socialist health care systems of the other OECD countries.
The Department of Health and Human Services issued a document on Oct. 17 that presents the formulae for bureaucratic allocation of vaccine in the event of a serious pandemic. The bottom line is that, in the event of a deadly outbreak, some of us will be valued more than others.Rule 3: If the state itself is threatened then the decision-making mode is bureaucratic and values to be maximized are the continuity of government and the safety of its elites. Rarely invoked, at least so publicly, this rule is evident in the "Draft Guidance on Allocating and Targeting Pandemic Influenza Vaccine" issued on October 17, 2007 by the Department of Health and Human Services. Dispensing with ‘dignity’ or the ‘private’ sector health care, this document presents the formulae for bureaucratic allocation in the event of a serious pandemic. The bottom line is that, in the event of a deadly outbreak, some of us will be valued more than others and their chances of survival enhanced by being treated from available vaccine stocks and the rest will have to take their chances. The document discusses influenza, but it is easy to see this as the basic blueprint for a pathogen much nastier.
In the five-tier "severe pandemic" scenario, government leaders, those serving in deployed units of the military and security services (including its private sector components), police, fire and rescue services, and critical healthcare personnel would be given the highest priority. So too would pregnant women, infants and toddlers. In the second tier would be the rest of the military, the National Guard, intelligence services, and people working to maintain communications and utilities. In the third tier would be people working in critical infrastructure such as the post office and the food, drug, and banking industries. The elderly and those with high-risk health conditions would comprise the fourth tier and the remaining population of healthy people 19 to 64 years of age would be last in line.
Although it makes sense that priority would be given to military, police, fire, rescue and medical personnel who might serve on the front lines of a pandemic that would threaten the social order, the categories appear generously broad when it comes to the personnel of the state and its best friends. Would White House speechwriters, FEMA officials, and Blackwater USA executives have tickets in the first tier? Would Comcast and Eli Lilly executives find themselves in the second tier and Fannie Mae accountants in the third? Picture what would happen if political appointees of the Bush administration were given discretionary authority to interpret membership in the tiers.
Note that these three rules are not like rock, paper and scissors. Should they ever come into conflict, capitalism would trump dignity and the continuity of government and the safety of elites would trump capitalism. But dignity trumps nothing. Unfortunately, knowing these three rules is merely palliative care. A cure would require rebuilding our health care system to make meeting the needs of all Americans its central purpose.
John Hickman is associate professor of comparative politics at Berry College in Rome, Georgia. His published work on electoral politics, media, and international affairs has appeared in Asian Perspective, American Politics Research, Comparative State Politics, Contemporary South Asia, Contemporary Strategy, Current Politics and Economics of Asia, East European Quarterly, Journal of Southern Europe and the Balkans, Jouvert, Legislative Studies Quarterly, Political Science, Review of Religious Research, Women & Politics, and Yamanashigakuin Law Review. He may be reached at firstname.lastname@example.org.
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This story was published on November 5, 2007.