Many do not realize that any lack or reduction of self-responsibility inexorably leads eventually to a similar lack or reduction of available choices (freedom) with much of it due to government required actions under threat of penalty. (Actual loss of liberty occurs to an individual when others - typically government enforcement agents - take the action of bodily restraining him/her (hir) and/or confiscating hir assets and/or property for any reason.) The recently passed legislation (Obamacare) requiring all citizens to purchase government approved health "insurance" (actually prepaid health services) is the latest in a very long progression from individual self-responsibility for all aspects of one's personal life to government mandated and/or provided life-long "protection" and "maintenance".
An opinion article on March 23 by Richard Amerling MD, "Opting Out of the Third Party System Will Save the Doctor-Patient Relationship" briefly described the history and relationship of insurance payments in the receipt of physician services (in the US) and addressed the claimed "crisis" if there should be no third party payment, comparing it to the non-crisis of the pre-Medicare/Medicaid era and in the delivery of cosmetic surgery, dental, veterinary, and legal services. He warned that "universal coverage" - as is desired by many who also want "single-payer" (government/taxpayer) and are incensed that this newest law didn't actually mandate the latter - will bring with it centrally controlled health care directed by legislated federal committees. Under the current law (scheduled to take effect in most ways approximately 3 years from now), "[i]ndividualized care and medical confidentiality will slowly disappear. Importantly for the administration and Congress, more citizens will become dependent on government largesse. Doctors and other providers will become government employees, and be subject to its whims." Richard Amerling ended with the call to individuals:
It is now left to individual physicians and patients to act in their own interests, and to defend the medical profession and doctor-patient relationship from government intrusion, and ultimately, destruction.
It is time to opt out.
I found Dr Amerling's argument quite good - except for a logical but essential detail pointed out by Paul Wakfer (the comment to Amerling's message was not accepted at the original publication site, but has been placed at the blog "Thinking in Essentials". However in reading the comments to Dr Amerling's article I noted that the author of the second one did not agree that a "solution" had been presented.
Added: March 23, 2010. 12:30 PM CST
This is a solution only for the very, very rich.
The prices of some health care services are so outrageous that almost no-one, even someone earning a good income, can afford to pay for them directly without a third party involved.
Two examples, just from my own family, where my wife makes a good income and has good insurance.
I got diagnosed with cancer at the age of 27. I was completely healthy beforehand, reasonably fit, a non-smoker, with no family history of cancer, and could not have foreseen my diagnosis, so I would not have put money aside in a health savings account.
Without her insurance, the total cost of care would have been around $400,000, not counting the costs of surveillance now that I am past surgery. What kind of folks have that in the bank?
Then, my wife fell pregnant with twins, who developed a highly dangerous syndrome in the womb (twin-to-twin transfusion syndrome) - again, a circumstance for which we could not have prepared, and which strikes utterly at random.
Fetal surgery saved their lives, and they still required weeks in the neonatal ICU. The total cost, up front, would have been around $1,000,000.
Because we have insurance, we could afford good-quality care. We still paid thousands for it, but I and our beautiful daughters are safe and well.
The principle of third-party payment kept us alive.
I urge people not to follow your advice, and not to opt out. Life is unpredictable. Your life may depend on it.
Zander
My (published) response below was formatted on the strong conviction that "Zander" did not understand self-responsibility.
Added: March 25, 2010. 07:05 PM CST
Be Self-Responsible
@Zander
From the fact that you were diagnosed with cancer at 27 - how much, if anything, you did to prevent such an occurrence is another issue - and that you and your wife had twins (pregnancy has a cause, one does not "fall" into it) who had health complications pre and post birth, it does not follow that others should be compelled to pay for your "misfortunes" (both mostly likely not true unavoidable chance, but rather preventable by prior knowledge and intelligent actions by you and your wife). Still, life brings with it unplanned events for which a wide view, long range thinking person plans. Charity and benevolence are voluntary actions - both lose their meaning when compelled. And where the State tries to compel similar actions, real charity and benevolence always decline.
When someone voluntarily enters into a contract with an insurance company for true insurance (catastrophic amount, with large deductible) or even the currently prepaid health service plans, they are in essence "sponging off" those others in the "pool", who have also entered it voluntarily. However, with the US government's newest legislation (and the laws of most European countries), entry into the "pool" is to be forced - with the threat or actual use of physical force if one decides to "opt out". Under those circumstances, the recipient is then effectively the receiver of *stolen goods* - money compelled by government to be paid to an insurance company. Whether the monetary fines and the opportunities for physical force against those who do not comply comes about remains to be seen, but the law does enables government agents to act in ways no other person can do legally.
Private arrangements with providers of health services can and have been made by many (including myself 7 years ago) for an unexpected health related care need, often with a sizable deduction for cash self-pay. (I have not had health insurance for almost 10 years and, at just 2 weeks shy of 65, have no plans to enroll in Medicare.) Having a sizable amount of savings and assets that can be liquidized fairly easily is a demonstration of self-responsibility, instead of irresponsibly operating with the attitude that government will bail-out, always with money taxed (taken under threat of force) from others.
You wrote:
"The principle of third-party payment kept us alive.
"I urge people not to follow your advice, and not to opt out. Life is unpredictable. Your life may depend on it."
I urge others to be self-responsible and *not* follow your example - unfortunately the thinking of far too many people currently is a major reason why health care costs have risen as much as they have in the past 60 years.
A reply the following day from Zander did not surprise me, nor did the content and tone; it is very similar to what I have read and heard before from those who think that bodily disorder/degeneration are inevitable acts of god/nature or simply bad luck.
Added: March 26, 2010. 03:45 PM CST
@Kitty:
The type of cancer was testicular cancer. If you do any research on it, you will see that there is nothing whatever one can do to "avoid" it. Exceedingly healthy people like cyclist Lance Armstrong have been diagnosed with it. I don't pretend to have been as athletic as he is, but it didn't do him any good. There simply is nothing known to medical science that I could have done to make it one whit less likely that I would be diagnosed with it.
I appreciate that it's necessary for your individualistic fantasy to believe that if I got sick, I must in some way have deserved it; but it's simply not the case.
Again, the complications arising from my wife's pregnancy were entirely unforeseeable. We did have the resources by the time we were 30, if we had been uninsured, to have covered the costs of a normal pregnancy ourselves. However, it turned out, again at random, to be a highly dangerous and expensive identical-twin pregnancy with twin-to-twin transfusion syndrome, and the costs of that would have bankrupted us. This is even despite the fact that we are in the fortunate position of having a higher household income than 95% of the people in our state.
Since you seem to know, what are these "intelligent actions" by myself and my wife that could have avoided either of those costs? Or are you simply making that up because it's necessary to your fantasy that intelligent actions exist that we could have taken?
I am glad that you have been fortunate enough to avoid the catastrophes we have endured, and that you have been cautious enough to put money aside against the day they come. But your good luck does not invalidate the idea of third-party provision. You, in your late fifties, may well have had a level of personal resources to put by for health care emergencies that would enable you to weather most things. Would you have been able to do the same when you were 26, like I was, and making decisions about health insurance?
Zander
My (lengthy) response to the above was created to inform about some health specifics and demonstrate (again) how self-responsibility is key to prevention of disorders as well as regaining good health. As I state below, I do not think that the majority of those crying out for government health programs have learned the importance of being or how to be truly self-responsible in (at least) matters concerning their own health.
Added: March 27, 2010. 06:44 PM CST
Self-Responsibility
@Zander
Serious cancer and general health degeneration prevention starts at early age - by parents in choices for/effecting their children and provision of information and good example. There are numerous measures one should take in just the areas of diet/ingestion, sleep, physical activity - these the most important and the least costly. Supplementary measures to these have been investigatable (magazines/books/TV/radio/etc) and accessible for a great many years to those who have been seriously interested. Before the Internet much information was already available, but it has been enormously more abundant and easily found for well over a decade now.
(Very briefly in regards to testicular cancer:
The abstract of a review paper from 1975, "Can nutrition explain the pattern of international epidemiology of hormone-dependent cancers?" [oldest on PubMed search using string: testicular cancer risk factors, which resulted in *1445 hits*]:
"International data on the distribution of hormone-dependent cancers suggest that they are cancers of affluence. Their occurrence parallels that of bowel cancer fairly closely in population and less closely with regard to individual patient risk. The most plausible hypothesis, although based on extremely incomplete knowledge, is that some components of the Western high-protein, high-fat diet acting in early life make individuals prone to develop these cancers." PMID: 1104146 - http://www.ncbi.nlm.nih.gov/pubmed/1104146
From the abstract of a 1982 paper, "Endogenous hormones as a major factor in human cancer":
"Hormone-related cancers account for almost 30% of all cancer cases in the United States. Data from animal experiments and from epidemiological and endocrinological studies in humans support the hypothesis that the individual hormones which control normal growth of target organs can also create the proper conditions for neoplastic transformation. ... Although scanty, the available epidemiological evidence also suggests a hormonal role in the pathogenesis of testis cancer, thyroid cancer, and osteosarcoma." PMID: 7046921 - http://www.ncbi.nlm.nih.gov/pubmed/7046921
From the abstract of a paper published in 1991, "Testicular cancer: the role of the primary care physician in prevention and early detection": "Since the incidence of testicular cancer has doubled in the last 20 years, we must give more attention to educating the public by encouraging primary physicians to incorporate instruction on self-examination of the testicles into regular physical exams." PMID 1882360 - http://www.ncbi.nlm.nih.gov/pubmed/1882360
From the abstract of a 1996 Danish paper, "Male reproductive health and environmental xenoestrogens":
"The incidence of testicular cancer has increased during the same time [last few decades] incidences of hypospadias and cryptorchidism also appear to be increasing. Similar reproductive problems occur in many wildlife species. There are marked geographic differences in the prevalence of male reproductive disorders. While the reasons for these differences are currently unknown, both clinical and laboratory research suggest that the adverse changes may be inter-related and have a common origin in fetal life or childhood. Exposure of the male fetus to supranormal levels of estrogens, such as diethlylstilbestrol, can result in the above-mentioned reproductive defects." PMID 8880001 - http://www.ncbi.nlm.nih.gov/pubmed/8880001)
Even with the abundance of science-based health information available at one's fingertips, currently far too many individuals in their teens and 20s think of themselves as invincible, *if* they even think of their health at all.
Ideas of invincibility, coupled with the attitudes that many of their parents developed with the growth of "health insurance" (actually increasingly prepaid health benefits) promoted by government actions (WWII freezes on wages resulted in non-wage benefits and later employer tax breaks for those benefits), means that most in their 20s these past 40 years failed (and continue to fail) to develop a self-responsibility view of life. Far too many people view their own health recovery/improvement as something to be done "by the doctor" - after something has gone wrong. Prevention of disorders/degeneration has been mostly ignored by physicians, largely because they have been ingrained with the idea in their own training that such disorder/degeneration is inevitable or that their patients won't do what is necessary. In the latter case, those physicians don't even bother informing/warning patients/clients; in the former case those physicians dismiss or are ignorant of science-based preventative measures. But these incidences of physician informational "negligence" does not eliminate the proper ultimate responsibility of a person's health on the person him/her (hir)self. Additionally, one properly does not accept without investigation everything that anyone at all, but especially a healthcare provider, states as fact or recommends. The person hirself is obviously the most *interested* party in hir own body! With some pathologies (perhaps true for some testicular cancers), such responsibility lies with the neglect of the parents to optimally prevent such problems for their children.
A truly self-responsible individual, because of hir savings, prudent spending, truthfulness in social interactions and good work ethic, will be viewed by others - especially friends/family - as a good risk for a loan when a truly unexpected untoward event occurs. Very long term loans of this type and an additional mortgage on one's home will be taken by a self-responsible person, along with sale of assets, sizable reduction in other expenses and even additional income generation. To the extent that a health problem is a result of avoidable risk factors incurred by a child's parents, it is reasonable that *they* should help pay for correction measures - and the child is reasonable to demand payment to the extent of the risk factors. Seeking charity from a (voluntary) organization may be considered too, but a self-responsible person does *not* seek government's use or threat of force to be shielded from one's debtors - bankruptcy. A self-responsible person also does not view hir (near and far) neighbor as the source of involuntary payment for hir own misfortune of any type, including health-related. If s/he is truly incapable of obtaining sufficient money by way of a combination of savings, sale of assets, loans and through benevolence/charity to pay for some procedure, then the procedure does not take place (and alternatives are utilized). If that means that s/he or a loved one may die, then that is what happens. Simply because some enormously expensive procedure exists does not mean that others should be required to pay for it. This is the bottom line that many (?most?) do not want to face. Would such an individual take (steal) the money hirself? While that action would actually be more self-responsible (and definitely so if intention of future restitution is made clear), most would not do it, but are *very* willing instead to use government's threat of physical force on others to obtain the financing.
Insurance in its original meaning was pooled risk for quite unlikely, but possible, highly costly events. One did not insure for expected occurrences - typical accidents/illnesses (eg. broken bones and childhood illnesses) and death. One saved for these events by accumulating cash and assets to be used to cover these and also did a lot of self-care (home remedies) in addition to home cooking and just letting the body heal itself (eg. as with "colds" and "the flu"). Marriage was typically delayed until a young man was in "a good position" and had some savings to provide for a family with an initial home. Many (?most?) women went into a marriage with a dowry - money and/or utensils/linens/clothing/etc for a new home. Both such parties viewed the start of their family (beginning with just them) to be their responsibility, even if one of more set of parents/relatives provided them with gifts.
Voluntary, truly catastrophic health insurance with a high deductible of (let's say for example) $25k would be available now, and with low premium cost, *if* insurance companies were not so greatly regulated in regards to coverage type and location. Such insurance would promote self-responsibility by individuals for saving money and practicing measures for good current and longterm health. But it starts with the mindset that one does *not* look at hir (near and far) neighbor as the source of money for any health needs. All of those in such a true health insurance "pool" are self-responsible since they are ready to pay that deductible every year and not draw from the "pool" except for truly catastrophic occurrences. This is a far cry from what happens currently - complaints can be heard by many for having to pay *any* deductible more than $10 or $20.
You wrote:
"I am glad that you have been fortunate enough to avoid the catastrophes we have endured, and that you have been cautious enough to put money aside against the day they come. But your good luck does not invalidate the idea of third-party provision. You, in your late fifties, may well have had a level of personal resources to put by for health care emergencies that would enable you to weather most things."
"Good luck" is mostly a result of one's good practices. In my mid-60s, my personal financial resources are not enormous, but my good health practices are. Even so I did have 2 unexpected incidences in the past 7 years (last one 6 years ago) which required payment by me (and my husband) to health care providers, the recurrence possibility of both greatly reduced by modified measures in practice since.
Zander, while you may not in the past have considered self-responsibility in the manner that I have described above (possibly for the reasons given), I truly hope that you (and your wife) will do so now and provide the information and example to your children.
This has been a lengthy reply but I sincerely (and I am always sincere) hope that you - and others - will give it serious thought.
**Kitty Antonik Wakfer
Increasingly wide and varied choices are what children seek as they mature toward adulthood. It is the rare youngster who does not seek, and even yearn, for the time when s/he will be able to decide for hirself what to eat and wear, where and on what to spend hir time, and how to obtain the resources to do all of these. It is only with repeated thwarting of attempts to be independent by parents and other physically authoritative parties that some children retreat from their early dreams entirely and instead shuffle through life, emotionally and physically dependent on others. More often, however, young people simply follow the roles of their parents and nearby adults, get a "good" job - with or without education beyond that typical in their family - start a family, and begin obtaining the things that everyone else has or seeks (usually, but not necessarily, in this order). The concept of self-responsibility to such young people rarely goes beyond paying for one's own possessions, and not even that when now many parents give teenagers prepaid credit cards and the idea of earning the money first (before spending it) has become "old fashioned". So the fact that spending all of one's (weekly/monthly) income, incurring debts on large purchases (car, house, boat, etc), failure to save and having unplanned (in the long range wide viewed sense) children occurs so frequently is not really surprising. And neither is it surprising that so many people turn to government via bankruptcy and/or welfare programs when their typical practices no longer keep their income at least equal to all their expenditures.
It is the rare young adult who has developed a true sense of self-responsibility - that what s/he does with and in life is hirs to decide and that the consequences are hirs to live with. It is the rare young - and even more so, older - adult who understands that while some events may not be caused by hirself or others, the consequences of events are still hir responsibility, and no one else's, to deal with. Others may offer assistance, but they have no responsibility to do so.
While Zander made a reply to my last message above, it is clear that he did not really think deeply about the ideas of individual self-responsibility that I presented. He continues with his reasons for why his situation was unavoidable and does not even address true catastrophic health insurance rather than pre-paid health programs. But more to the point of his failure to acknowledge a person's responsibility for hirself is his view of "society" as some borg-like entity in which all members are inextricably bound to each other, rather than totally unique separate individuals:
I believe deeply that human beings have intrinsic value. If it is medically possible to treat a condition, and we can afford as a society to enable people to have a certain level of health, I think that we should. I do not see why so many people have to die in pursuit of your individualistic fantasy.
Zander's use of "we" is very telling. In actuality he can only properly speak for himself and those who have given him specific permission to include them in a plural reference. He definitely cannot - and does not - speak for me and the many others who have voiced their opposition to being required under penalty of law to participate in some scheme. Furthermore, only individuals earn/make money and therefore can or cannot "afford" to spend it in some particular manner. Governments take money from those earning it according to the method dictated by the rulers (often with agreement of the majority of voters - the tyranny of democracy) and then spend according to various plans and arrangements, even including placating the citizenry ("bread and circuses"). And lastly, because human beings are totally unique separate individuals, each individual will be of different value to each other individual based on the value priorities of the individual doing the assessing - there is no intrinsic value at some particular level. There is however potential value, but of unknown quantity, only becoming estimable as the person hirself becomes known to the one doing the assessing - and even that reasonably changes with time and circumstances.
It is clear to me that Zander does not understand the implications of what he is promoting - and this is true for the very many who say/write very similarly. To realize the implications - the loss of choices as I described above - requires that one be analytical and think of all possible relationships with other things. This is something not taught or even promoted by current education, and certainly not wanted in the populace at large by promoters, supporters and enforcers of the State. However it is also the type of mental process that is crucial for learning to be fully self-responsible. So the fact that Zander is not (yet) fully self-responsible and does not even recognize the need for such, and the prevalence of so many others like him, is not surprising to me at this point.
The fact that there is the current US "crisis" in healthcare and the vast other economic problems in the US (and most other countries) ought to curl the hair on the back of one's neck as a gut feeling (one's background processors) that something is very wrong with the way human interactions are taking place. I contend that it is a steady decrease of individual self-responsibility in the vast majority of individuals in the US (as well as the rest of the world) that has enabled these "crises" to come about, continuing the transformation from a general environment (in the US before the mid-19th century) of voluntary interaction/cooperation between self-made individuals to one of getting the "other guy" to pay for it via government. (See and also, as examples for history.) Self-responsibility has been given a very minor, if any at all, role in the lives of most individuals today. As such, its lack is not recognized as a major source of the current problems and its presence not seen as a major part of the solution.
It is many more self-responsible individuals who are very much needed for a truly free and orderly society - in which the "crises" of the current society could not exist. Rulers and the ruled have no place in a society of fully self-responsible human beings. Nothing in the nature of human beings automatically leads to the conclusion that individuals must be ruled by others in order that there be orderly interactions between them. Society, just like any other natural system can be self-regulating by means of interactions between its members, if only humans are allowed to develop the methods by which such self-regulation can be effective - become self-responsible in the fullest sense - rather than the social system constantly being held in an unnatural (and very unoptimal) state of balance by the operations of its rulers and other influencers (the rulers' "friends").
The solution to the current crises (healthcare, economic problems in general and more) is evident to any who make a serious reasoned examination of the foundational problem. Self-responsibility is the cure, but it must be enacted by large numbers of individuals who have come to this conclusion rather than submit to a procedure done to them, as by a surgeon. It is akin to a prescription for action ("take this medication", "eat these foods", "refrain from/reduce this activity", etc) from a physician which a client/patient then chooses whether or not to follow. This cure is up to individuals - and as human beings, the type of society is always up to individuals.
