Matthew Holt

Rantology: Cannon on Freedom or Power?

Ah-ha. Michael Cannon has now replied to me and it basically comes down in his mind to me being a  crypto-fascist Stalinist wanting to break the will of the American people mediated through its representatives, the health care industry lobbyists. His piece is The Ultimate Question: Freedom or Power?

He closes by saying that I could only fix the health care system by getting rid of constitutional democracy. And Michael’s right.

But I have one small correction, the problem is American constitutional democracy. Plenty of countries have written or unwritten constitutions that enable parliamentary parties to govern and make significant changes to social systems, like health care, for the general good of the population as the electorate sees fit. (The UK, Sweden, Germany, Australia, Taiwan and a few others come to mind). Last I checked they were all Democracies with much much higher voting participation than ours. The US Constitution and its associated “constitutional democracy” doesn’t allow such changes due to many factors all highlighted by the highly undemocratic nature of the Senate.

We are beholden to what was written down over 200 years ago by a bunch of white, male, slave owners living in an agrarian society. So when we have an obvious problem with a relatively obvious set of solutions, we can’t get fix it because of the freedom of special interests to overwhelm both the will of the people and the right answer.

So we keep those “freedoms,” which means that I get the unwanted “freedom” of having to buy insurance for my employees in a corrupt market place, and 50–80 million Americans get the freedom to face financial ruin if they get sick.

Perhaps I can give him my freedom and Michael will come over and help me choose my insurance?

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28 replies »

  1. Most of the other advanced developed countries have universal health care which keeps their population physically and financially healthy. Why do we let the medical industrial complex bleed us financially when we are healthy and leave us to die when we get sick?
    It may take a true revolution to break the power of the corporations. I’m ready for a socialist revolution

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  3. At the West Los Angeles VA Healthcare Center there has also been rather open access for patients for at least a few years, although not as open as described in this Boston project. There have been a few patients who have become upset or who have disputed the veracity of the recorded notes, examination, or medical history. A process allows them to either dispute or enter information into their own charts. This openness dovetails well with the VA’s policy of providing full-time patient advocates to assist our patients if they have concerns or complaints. It has been my impression that more often that patients have found this helpful. There are a number of motivated patients who have been active participants in their own healthcare and who have used their own knowledge of the medical records to assist and guide their physicians. I have had a number of patients come to me with questions or comments about the note I had written about their previous visit with me. This has been an opportunity to make sure the patient understands my clinical concerns. Skeptics about this process should note that I have always been open with my patients about my concerns. For instance, if I ordered a test to rule out neoplasm I would share that concern with my patient, but also put it in realistic perspective. If my note describes a patient’s morbid obesity it would most likely be because I had discussed this medical issue with them.

  4. I would love it if the people in this here united states would just get up off their arses shut up and pay their own medical bills out of their own pockets and stay out of mine period. I truly believe in taking care of myself without someone else trying to tell me where I can spend my money I earned, and on what!

  5. Jeff,
    I have changed my mind. Bring on single payor. Bring on universal coverage. I will make 3 times what I make now, since I won’t be giving away free care anymore. I will have to give up my principle concern that the country will go to Hell and go broke, but in the short run it will be great. That is, afterall, the time frame of this discussion. It will also be fair, since everyone will have to buy coverage, instead of just not paying their bills as is now the case.
    But since we are going to cover everyne, lets not have a huge bureaucracy to needlessly track people. We need to have accountability, both from provider and patient, to assure no fraud or waste or abuse is occurring. But if everyone is just salaried, no matter what, just salary us and forget the paperwork. I eagerly await no more dictations. In fact, just make me a government employee so I cannot be sued. What was I thinking when I thought this was a bad idea? Pass the sugar.

  6. @MD as Hell,
    Yes, this is my real name. What’s yours?
    And yes, I would say the health and well being of the public is key to promoting “the general welfare.” As for it’s cost, the status quo is currently bankrupting us, both in the public and private sector (witness GM and Chrysler’s woes – it’s hard to be cost-competitive when you’re tacking a $1,600 per vehicle surcharge on every vehicle).
    I’m not going to get sucked into your class-warfare bull about “wealth redistribution.” The very definition of “politics” is the “authoritative allocation of value.” Every thing the government does involves the redistribution of wealth, all of which has its source in The Commons.
    Your statement about remembering “the United States” is about as meaningless and off-topic as your assertion that our government isn’t a democracy. If you had bothered to take “Civics 102” you would understand that the relationship between the Federal and state governments on this subject are governed under Article 1, Section 8. Moreover, I have seen nothing in the current debate about forbidding national or state plans from entering or participating in the market. So apart from spewing right-wing talking points, what *is* your point?

  7. There are those who value democracy as a mechanism for preserving a set of institutional and legal protections for individual liberties, and there are those who value the simple exercise of casting ballots as a means of aggregating the will of the majority and translating it directly into whatever end the majority desires at that particular moment in history. Given the tenor of Holt’s previous comments, all of the signs that his sympathies most closely align with the latter camp – but it’s nice of him to make that explicit. Still better for him to make it the ideological platform that his preferences for healthcare reform are built on.
    Since Mathew’s employees are paying for their own health care via reductions in their cash wages, they should be even more upset than he is. As things stand now a set of tax-incentives that came about as an unintended consequences of WWII era price-fixing schemes, a market balkanized into 50 separate markets, cost-shifting, and other distortions forcing them into a situation where their health benefits are tethered to their job and none other than…Mathew Holt..aggregates them into a single entity and uses his personal values and capacities to determine what health insurance options are best for them.

  8. Margalit asks:
    > Providing health care to all is unconstitutional???
    Of course not: the states can provide health care to all just as they provide public education to all. There may be constitutional issues varying from state to state about the means by which this may be accomplished in each of them, but there would certainly be no federal constitutional issues.
    This is not organized very well — I apologize. But here goes:
    It seems to me the federal constitutional question comes to whether medical insurance is “general welfare” or “particular welfare”. Does the fact that all personally and directly benefit make it “general welfare”? I suspect that Michael Cannon thinks the answer to this question is “no”, and there is a good argument to be made for this at least theoretically. Medicare and Social Security would therefore be found unconstitutional. In practice it seems that the answer is “yes” but one wishes it had been settled rather than left un-asked. Of course, FDR didn’t think he ought to have to ask — he thought the court should fall in line with the legislative and executive branches.
    The federal government can’t order a state to do much of anything — about the best they can do is bribe them, and the way they do that is lay an excise tax on individual incomes (cf Art I S 8), and then either implement a program of their own (Social Security, Medicare) or give it back to the state governments if they implement a program Congress likes (Medicaid). Bracketing the General Welfare question earlier, I don’t see a constitutional issue with this.
    But there is an ideological issue: what exactly is the civil authority for? Libertarians tend to limit the use of the civil authority to the prevention and punishment of force or fraud by one individual against another. Even the strictest construction of the federal constitution and the state constitutions would not suit them. And there is a strong libertarian streak in American culture just as there was among the Founders. Then there is the question of the respective roles of the federal and state governments: what does it mean to be a federal republic? What does it mean to be a citizen of the United States of America and simultaneously a citizen of the State of Missouri?
    Whether or not it is constitutional, I think it is unwise and even contrary to human nature to leave every difficult thing to the feds. This is why we have such long arguments about it.
    t

  9. Matthew Holt, you keep complaining about having to buy your employees’ health benefits. I agree: If you had to choose their housing, automobiles, groceries, and clothing, etc., because of a malformed tax policy, you’d be even more frustrated.
    Logically, you should support reforms that allow each individual to buy a guaranteed renewable, incentive compatible, health-status insurance policy that is portable life-long. Instead, you appear to support government monopoly. It’s as if you were frustrated at having to find long-term housing for your employees and decided everyone should live in public housing as a solution, instead of freeing everyone to choose their own housing.
    On the other hand, “MD as HELL” points out that you did not have to buy health benefits for your group: You did it because you value their contribution to your enterprise. How many hours did you spend choosing your office location, equipment, website design, and all the other elements of your business? Why don’t you ask the government to tax you instead, and relieve you of the responsibility of choice?
    With respect to your revolutionary instincts, I respect your entrepreneurship: At the end of a political bloodbath, it’s not people like you (who have mental skills and want what’s best for people) who stand atop the pile of bones. Witness the goings on in France in 1789, or Iran for the last 30 years.

  10. Just a comment on freedom and health. I believe a free people are generally a healthier people. (They even breathe more freely)
    So as a Doc for years I believed that freedom was actually an understudied/undervalued bone-fida health issue
    But I have come to reject the notion that my love of freedom should sway me from my moral belief that all Americans should have access to quality health care.
    Freedom is wonderful but we must not “trade human flesh and human souls in the marketplace”
    That,I posit,is NOT what America was or should be about.
    Dr. Rick Lippin
    Southampton,Pa
    http://medicalcrises.blogspot.com

  11. Let me understand this. Providing health care to all is unconstitutional???
    Let’s just shut down the public schools while we’re at it. I’m sure the people are entitled to the freedom to be illiterate to complement their freedom to be sick, poor and homeless.

  12. Nate asks:
    > Why should all states and the residents of
    > those states be forced to share one plan.
    I don’t think they should: people in different parts of the country will have different attitudes about what sorts of means are best suited to pursue social ends, and then there’s the pesky Federalism thing we fought a civil war over and we’re still fighting about. But I have a theory about why Federal solutions are pursued: because it is easier all `round.
    What it comes down to is the governors would rather have taxes raised or regulations imposed on their citizens by somebody else rather than by them — that way they don’t have to lead. Activists have only one government to lobby and so they don’t have to organize broadly and grapple with the most important kind of diversity: diversity of opinion. The feds can borrow much more readily than the states can, so “The People” can get something for nothing out of a Federal program.
    I talked at some length about that in this thread.
    https://thehealthcareblog.com/the_health_care_blog/2009/05/workers-ungrateful-for-empowerment-to-pay-more-.html
    t
    PS to Matthew & John: once upon a time I could enter an HTML “a” tag in a comment so I could embed a link and not bother everybody with its details. I could do italics, bold, and even bold italics as well. Then the software was “upgraded” and now any HTML tags I enter are simply discarded. Is there some way to bring back simple HTML capability???

  13. That is a very interesting point tom. The US healthcare system should be compared to Europe or industrialized nations as a whole, they don’t share one common system. Why should all states and the residents of those states be forced to share one plan.

  14. “The founding fathers were not interested in a democracy that can redistribute money from the rich to the poor. They wanted to protect the right of each person to keep what he/she earns, even if it is more than someone else, even if it is partly based on inborn qualities, and even if the majority wants to take it away from them.”
    Then why am I paying agra business all those subsidies?

  15. Matthew, I applaud you for agreeing that universal healthcare cannot be implemented in American constitutional democracy. And I agree that it is important to question the American system. But to do that, we have to think more broadly than just health care. We should look into why the American constitution was created this way (i.e., with a senate, a powerful supreme court, and limitations on government power).
    The founding fathers were not interested in a democracy that can redistribute money from the rich to the poor. They wanted to protect the right of each person to keep what he/she earns, even if it is more than someone else, even if it is partly based on inborn qualities, and even if the majority wants to take it away from them. This is what they meant by the “right to the pursuit of property”. That is very different from the kind of thinking that leads to national health insurance, or that is prevalent in Europe and other countries.
    This is what is different about America, and what bothers a lot of people. You are perfectly within your right to question it, and instead to say that all people deserve the same health insurance. But that is not an obvious point…you have to explain why you believe it.

  16. So, Jeff, if that is your real name, we must secure the blessings of liberty to ourselves and our posterity by giving it up? We can promote the “general welfare” by healthcare spending, incurring debt beyond imagination? “Promote” now means “provide”? Where is the justice in wealth redistribution? Whose justice is that?
    I bet we could find a treatment for your BDS.
    And, Jeff, we have 50 other constitutions that govern the governing bodies in our states. Remember the United STATES, those little things that have all the power not authorized to the federal government by the American Constitution, which was intended to keep the federal government out of our daily lives. Civics 102, I believe.
    In order to pass along the “blessings of liberty” you have to pass along liberty, Jeff, not healthcare debt.

  17. @ MD as Hell,
    First, depending on what sort of business you’re discussing, providing healthcare benefits to employees may actually be a requirement. Absolutes don’t make arguments, though I’m inclined to believe in this particular instance you may be correct.
    Second, the “we’re not a democracy” is complete B.S., last dredged-up by neocons to justify a bloodless coup de tat after the Supreme Court assigned the presidency to George W. Bush. We are a democratic republic, where in the sovereign People elect representatives to execute their will via the legislative and executive branches of government, mediated by the judiciary.
    Please take Civics 101.
    Third, thank you for your opinion on what does and does not constitutes “fundamental freedoms.”
    Fourth, my, my, my what a Nazi-esque interpretation of the President’s Oath of Office. I’m glad to know one of my fellow citizens is more concerned about “healthcare zealotry” than warrantless wiretapping, the suspension of habeus corpus, indefinite detention at the whim of the executive branch without right to a trial, etc., etc., ad nauseum.
    Since you have such an affinity for the Constitution, consider the preamble and reflect:
    “We the people of the United States, in order to form a more perfect union, ESTABLISH JUSTICE, INSURE DOMESTIC TRANQUILITY, provide for the common defense, PROMOTE THE GENERAL WELFARE, and SECURE THE BLESSINGS OF LIBERTY TO OURSELVES AND OUR POSTERITY, do ordain and establish this Constitution for the United States of America.”
    Goodness, that sounds positively communist, especially the parts in caps! I’m sure the Founders didn’t mean access to basic healthcare when they were talking about “justice,” right? “General welfare” couldn’t possibly mean anything universally provided by the government for its citizens, right? You can pass along “the blessings of liberty” to multiple generations by giving absolutely nothing to anyone, right?
    Please.
    I have to hand it to you, however, for having the brains to withhold your identity; it’s the only intelligent thing in your entire post.

  18. inchoate writes:
    > I thought the reference in the poster’s
    > name was to the “angry” sort of mad.
    MD as Hell is paraphasing a quote from Thomas Jefferson:
    “Those who would give up Essential Liberty to purchase a little Temporary Safety, deserve neither Liberty nor Safety.”
    Now I’m among the first to caution against parsing anything too closely, but it seems to me MD has abused Jefferson. On the other hand, what do we make of an adult who wants a nanny?
    t

  19. Matthew says:
    > We are beholden to what was written down
    > over 200 years ago by a bunch of white,
    > male, slave owners living in an agrarian society.
    Actually we’re not.
    We could have an Article V Constitutional Convention and amend it over any objection by the Senate. We could decide at that time whether we want to be a republic as historically understood. I think it would be a great civics lesson simply to have one, whether an amendment was ratified or not.
    And Matthew, it isn’t quite fair to compare countries that are more like our states to “The United States of America”. Personally I wish we could shift our attention to the states and make the politicians at that level grow spines and lead. Then there’d be less call for a federal level program. There is no reason in the world we can’t have perfectly fine universal medical insurance one state at a time and there are lots of good reasons to pursue this route.
    t

  20. “hird, if we are willing to give away our fundamental freedoms and the freedom of all who follow just for a few extra months of life for some but not most, then we are sorry losers not fit to be called Americans.”
    see, I thought the reference in the poster’s name was to the “angry” sort of mad. This tidbit clears up that misconception…

  21. I don’t want a choice. I want health care. I don’t want to have to gamble with my physical and financial health by trying to pick insurance which won’t bankrupt me when I am not sick (and which won’t bankrupt me when I do get sick).
    Most of the other advanced developed countries have universal health care which keeps their population physically and financially healthy. Why do we let the medical industrial complex bleed us financially when we are healthy and leave us to die when we get sick?
    It may take a true revolution to break the power of the corporations. I’m ready for a socialist revolution.

  22. Paul Taylor is the CEO and general counsel for Ozarks Community Hospital. Ozarks Community Hospital is a small health system headquartered in Springfield, MO. He has written the OCH White Paper on Healthcare Reform which is being distributed nationwide. Copies of his position paper can be downloaded at http://www.ochonline.com/pdf/OCHReformWhitepaper2009.pdf. Discussion of healthcare issues featured in the white paper will follow on http://ochhealthcarereform.blogspot.com.

  23. Matthew,
    First,you do not have to buy your employees insurance, but you are free to do so.
    Second, we are not a democracy; we are a Republic (no Battle Hymn of the Democracy).
    Third, if we are willing to give away our fundamental freedoms and the freedom of all who follow just for a few extra months of life for some but not most, then we are sorry losers not fit to be called Americans.
    Fourth, the president is sworn to protect us from all enemies, foreign and domestic (healthcare zealots), and to preserve, protect and defend the Constitution of the United States, so help him God.
    Now frame your zeal for healthcare, now that you understand what we are.

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