Thanks for your comments.

Ashley– I agree that guaranteeing access to health insurance
does not solve the problem.

We need to make structural changes in how we pay for health care –and how it is delivered.

Specifically, we should reward providers for the quality of care that they provide rather than quantity. And should use financial incentives to encourage collaborative care: doctors and hospitals working together while striving for more efficient care–better outcomes at a lower cost.

Finally, we need to invest in public health. To a very large degree, that means investing in public education k-12. Health, education and welfare are all one ball of wax (which is why we once had a federal Dept. of Health Education and Welfare.)

Why do some people argue that any attempt to guarantee health for all encroaches on their rights?

Often, they are concerned that providing care for all will mean in an increase in their taxes. For some, their right to accumulate and preserve capital is an individual economic “right” which trumps
the social goal of trying to create a society which stresses equality.

On the other side of the debate, health care economist Rashie Fein writes: “We live not just in an economy, but in a society.”

See also Dr. Steve Schroeder’s Shattuck lecture referenced below.

Rick–

I think we do need to agree on some values. One goal of a political movement is to move people’s minds from where they are to where they might be. . .

Understanding the role that “behaviors” play in determining our health– and the degree to which poverty influences behavior– is very
important.

On this issue, I strongly recommend Dr. Steve Schroeder’s Shattuck Lecture herehttp://content.nejm.org/cgi/content/full/357

I wrote about his lecture here
http://www.healthbeatblog.org/2008/05/whatever-happen.html

To me, I think it would be best to concentrate on the cost issue rather than the coverage issue. So we get reduced cost and increased coverage.

Right now, it seems the cost part is way lost in the conversation. No government person seems to even mention it anymore except “bending the curve down” and then they go on to talk about higher costs and virtually nothing about reforming money-driven medicine.

Republocrat or Democlin we can all agree that the high cost side needs to be reformed.

Its like Wall Street, there are lots of good words about reducing the greed->risk->bailout thing but scant actions from DC. Too many monied interests on Wall Street and Healthcare I guess.

I was really hoping it would be different this time, and it wouldnt be all talk and no action. The jury is still out.

A University of Michigan study found that 32 percent of Democrats believe that social factors — such as socioeconomic status, neighborhood safety and availability of healthy food — play an important role in health, compared to just 16 percent of Republicans. (http://www.scienceblog.com/cms/news-red-and-blue-messages-about-social-factors-and-health-can-backfire-26293.html) “If you are more liberally minded the ‘neighborhood explanation’ can be motivating, but for people who are more conservative politically, that message can backfire and make them even less interested,” says Peter A. Ubel, M.D., professor of internal medicine at the University of Michigan and director of the U-M Center for Behavioral and Decision Sciences in Medicine. “The same information can polarize people.”

In her dissertation, Robert Wood Johnson Foundation Health and Society Scholar at the University of Pennsylvania, Sarah E. Gollust, Ph.D., notes that the results challenge conventional wisdom that increasing publicity of the social determinants of health will lead to greater public support for health policies. Rather, advocates who want to mobilize the public might consider disseminating information about both social factors and individual behavioral causes to avoid triggering resistance.

And here we are reminded again that it is context, more than content, that makes healthy conversation possible.

Rick Brush
http://www.communitiesofhealth.org

To me, the fundamental question in health reform is “what ought we do to ensure that all members of our nation experience equal chances for health?” Once again I come back to the distinction between health and health CARE. Government programs aimed at insurance reform should not be confused with real actions aimed at improving health. Our obligation is not to ensure that people can buy insurance– insurance without real reform in health delivery, prevention, and public health is meaningless– but to ensure that people have a chance to experience health equally despite (perhaps in spite of) their individual circumstances.

My frustration in this debate tends to be with folks who confuse ANY government attempt to ensure the health of all citizens with an encroachment on their rights– frankly, I’m still unclear exactly what right ensuring health encroaches on.

I believe in society in much the same way as do sociologists, as an abstraction that enables them to have something with boundaries that they can study. I do not believe in society as a romantic valued-laden concept that can be used to summon the masses behind a common good, the public weal, the national purpose, etc. I find that extremely dangerous and fertile fields for the rise of demagoguery of all types, be it conservative or liberal.

You seem to disparage Margaret Thatcher for her failure to grasp the idea of society. How strange that you do so given your idea that society needs to assume responsibility for correcting a serious problem. I know of no other European leader who more effectively and courageously assumed leadership and brought her nation, via the government into the post cold-war world. Perhaps she makes my case better than you realize. Thatcher was the ultimate realist and her accomplishments speak for themselves.

One final point, you say that the US finally recognized an inalienable right when it abolished slavery. I have problems with the use of recognition here, as in virtually all cases because it conveys to me at least the idea that there are values, principles, Platonic forms, etc., out there waiting for us to recognize them. I am a social constructionist and I simply do not think that such entities exist. As for your example of slavery, I think that Americans opposed it managed to persuade those in control of the government that a war that was originally fought to keep the nation together needed to become a war that abolished slavery. Those in control of the government constructed a new justification for the civil war and developed a number of measures that brought this about. Since the US had the power to do so, it used its might to construct a right, which it never treated as inalienable. This act seems like a recognition only in retrospect. The core question is how this developed? Answering that might help all intent on major reforms.

My take on the cost of health care problem is that ill conceived government policies, especially in the agriculture sector, have contributed greatly to the degradation of the food supply. There is considerable grass roots effort aimed at educating consumers and improving the quality of the food supply. Unfortunately, our government has yet to take much notice notice of our efforts. And the public health sector all too often fights against efforts to promote local food production and distribution, especially where raw dairy is concerned.

As for the poor suffering disproportionately from chronic illness and obesity, a toxic food environment is certainly a large part of the problem. But there are appallingly high rates of chronic disease and obesity in all strata of society due to, as I mentioned earlier, the government’s terrible dietary advice. Nearly every institution in the country that serves up food (schools, prisons, hospitals) utilizes the expertise of registered dietitians to plan menus. Unfortunately, dietitians are trained to recommend reduced fat foods as a means of preventing excessive caloric intake. But low-fat diets tend to derange the appetite regulating mechanisms in many of the insulin resistant portion of the population causing them to overeat. Hate to keep harping on this but improving the quality of the food supply needs far more attention than it currently gets.

Why suspect that they are heartless? Does that help us to think collectively?

In response to your most recent comment–”Please explain how one can hold a society responsible . .”

I have a feeling that you don’t really believe that there is such a thing as society–

This reminds me of Margaret Thatcher who also denied the existance of society saying that there is no such thing “only inidiviudal men and women. . and families.”

I suspect that Thatcher never felt part of society, never felt a communal connection with others by virtue of being in the same boat–all human.

You are right that the Founding Fathers did not, ultimately, reocgnize “inalienable rights”, rights that we deserve simply by being human.

But ultimately this country would recognize those “inalienable right” –when we decided that slavery is unacceptable.

Whatever a person’s race, their origin, or the color of their skin, they have an inalietnable right to “life, liberty and the pursuit of happiness.”

In your comment, you write: “Our best option is to muddle through and to let the interplay of diverse narrow interests in competition, conflict and rare convergence rule the day. Democratically based decisions should not be base upon the mythological common good”

I’m sorry to hear you refer to the “common good” as a myth.

Competition among “narrow interests” has led us to the current situation where, in too many cases, youth is pitted against age (and age against youth) men vs. women, Gays vs. Straights, African Americans, Latinos, recent immigrants and whites all divided against each other . .

Read the history of some other countries. Such divisions usually foreshadow the fall of a nation.