Showing posts with label medicare. Show all posts
Showing posts with label medicare. Show all posts

Thursday, April 14, 2011

In his speech on April 13, 2011 on reducing U.S. Government deficits, President Obama identified two strains that have run through the country’s political history and inform our political culture even today. “More than citizens of any other country, we are rugged individualists, a self-reliant people with a healthy skepticism of too much government. But there has always been another thread running throughout our history – a belief that we are all connected; and that there are some things we can only do together, as a nation.  We believe, in the words of our first Republican president, Abraham Lincoln, that through government, we should do together what we cannot do as well for ourselves.”  These two strains can be identified as individualism and collectivism, respectively.

I contend that collectivism enables both individual and collective security. Individual security is oriented to a person’s survival and collective security is exemplified by national defense. In his speech, the president explicitly placed individual security within the collectivist strain. “Part of this American belief that we are all connected also expresses itself in a conviction that each one of us deserves some basic measure of security.  We recognize that no matter how responsibly we live our lives, hard times or bad luck, a crippling illness or a layoff, may strike any one of us.  ‘There but for the grace of God go I,’ we say to ourselves, and so we contribute to programs like Medicare and Social Security, which guarantee us health care and a measure of basic income after a lifetime of hard work; unemployment insurance, which protects us against unexpected job loss; and Medicaid, which provides care for millions of seniors in nursing homes, poor children, and those with disabilities.”  In other words, the president rests entitlement programs on compassion for others with whom we share a society.

According to Obama, our societal connectedness with others implies a duty to contribute to the survival needs of those who cannot fend for themselves. I contend that most Americans are not likely to relate to this deontological basis that relies on the sentiment of compassion. Bluntly stated, too many of us are too selfish (or self-absorbed) to be motivated by such a normative basis. Fortunately, there is an alternative basis of individual security through collective means. Such a basis more firmly integrates the individualism and collectivism that the President identified as running through American history.

Specifically, as the president pointed out in his speech, hard luck can befall each of us; no one is immune from calamity and ruin. Perhaps the richest Americans feel confident that they will never be without their fortunes even in spite of the crushing experiences of many wealthy investors in the stock market crashes of 1873 and 1929, for instance. Yet for even the rich, and certainly for the rest of us, there is a basic psychological ease of mind in being able to have confidence that even in the worst case scenario concerning oneself, a safety net dependent only on the continued existence of the social contract (i.e., the collective) exists.  Regardless of income, we all tend to ignore the foundational peace of mind that comes with security in
survival.  Hence, each individual tends to understate the interest that he or she has in contributing to a fund even if he or she never has to use it. 

In other words, self-interest and individual security by collective means are not incompatible. Therefore, the duty of compassion need not be relied upon as a motivation. Even if I never need to draw on Social Security (taking this program as insurance to be issued only to those who need it rather than as a combination of retirement savings accounts with the wealthy retirees having a claim on at least the money they paid in), it is in my self-interest that there be such a program available to me should I be impoverished at retirement.  Even if I never need to draw on the program, the psychological security afforded to me by it through my life—and, indeed, to a society made up of people of such a psychology—makes being taxed to support the program quite valuable to me even if the value is subtle in my daily life.  In a basic sense, each of us lives with a quiet anxiety concerning one’s own survival being less than certain. Perhaps the existence-anxiety is not consciously felt by those of us who have means; the poor surely are in touch with it.  Yet we are all affected by it, like radiation, whether we know it or not.

Therefore, it is in an American’s self-interest to be taxed for survival-oriented entitlements even if the need is never actually realized; the psychological benefit begins immediately.  We are “in it together” in that each of us, being a human being, is subject to the basic existence anxiety as well as to the beneficial effects from the reduction of it. Additionally, should a person be in need of an entitlement for survival, there is that more tangible benefit too. In isolating only this benefit and calculating the probability of one’s eventual need for it, the typical American tends to understand the value to himself of individual security by collective means. This understatement of the value may involve a rather narrow selfishness that is not in one’s own self-interest, fundamentally speaking.  Besides being contrary to compassion for others in need, the narrow breed of self-interest (i.e., selfishness) is not even in one’s own interest.

Perhaps it is in each of us enjoying the same feeling that comes with having security in our survival being bolstered by social contract that we can feel community. Perhaps such a shared basis can trump even the different experiences in being rich and poor.  That is to say, community may simply be the recognition of having the same feeling or experience. In the case of individual security by collective means, the basis of community can be located in individualism rather than the less reliable motive of compassionate duty. 

Click to add a question or comment on President Obama on social programs and the deficit.

Source:

Barak Obama, “Text of Obama Speech on Deficit,” The Wall Street Journal, April 13, 2011.

Thursday, February 3, 2011

De-Funding Obama's Health-Care Law

It is odd that even after a bill becomes a law, it can be defunded.  One would think that Congress would be required to pass the funding that is required by the law. The Republican Party is strategizing on how to deconstruct Obama’s health-insurance law through various means.

Republicans could turn to the annual appropriations and budget process or push stand-alone bills to delay or stop funding for provisions of the law they dislike, including the individual mandate, the health insurance exchanges and the Medicaid expansion. They might also work to weaken provisions in the bill that deal with Medicare physician reporting requirements that some physicians find onerous and block the creation of a nonprofit research institute to examine the effectiveness of various medical treatments. Mandatory funding, which comprises much of the health measure beginning in 2014, will continue unless Republicans can change current law, a heavy lift considering such initiatives would have to pass both the House and Senate and win Obama’s signature. Discretionary funding must be approved each year but differences between House and Senate versions of appropriations measures must be ironed out and that generally produces a compromise package. Why all of the law’s funding would not be mandatory—as the law is a law—is beyond me. Also, how the mandatory funding could comprise much of the law when the individual mandate, the exchanges, and the medicaid expansion can be defunded, is also beyond me.

A major problem with the defunding strategy is that since so much of the bill is inter-related, trying to dismantle it piecemeal could lead to unintended consequences. While the individual mandate is unpopular, “you can’t pull it out of the law without all sorts of other elements falling apart,” Reischauer says. And scrapping the mandate, which requires most people to have coverage or pay a penalty, would anger health insurers — a core GOP constituency. Insurers have agreed to abide by new consumer protections, such as not denying coverage based on a pre-existing medical condition, in exchange for 32 million new customers. Hospitals agreed to payment cuts on the premise that more people would have health care and hospitals would have less uncompensated care. In other words, because the health insurance industry got basically what it wanted—the mandate without a public option—it would be highly unlikely that certain parts of the law would be defunded unless it were in the interest of the health insurance companies.  Therefore, the mandate is not apt to be defunded unless the rest of the law is to go down too.

I contend that law should not be allowed to be defunded. That is, upon passage, the law should have its required funding established as a matter of law.  Secondly, I contend that private companies with a vested interest in a law should not be allowed to have such power that they can tailor the law to their liking. Extant industries have too much power in the US Government.  As a reflection of this condition, we over-rely on private companies and the market—ignoring their downsides. Where basic necessities such as access to basic health-care is concerned, our over-reliance can be fatal.

Source: http://www.msnbc.msn.com/id/39295110/ns/health-health_care/

 

blogger templates | Make Money Online