Sunday, April 12, 2009

So let me get this straight...

The following is a personal perspective paper of The Jacksonian Party.

Make of it what you will.


Interesting reading a response to a Ramesh Ponnuru Op-Ed at the NYT on 09 APR 2009 on The Misguided Quest for Universal Coverage.  That is health care coverage, of course. He gets a response from Terrill Gibson, Ph.D. on this at NRO, and he has some interesting points to make.  He appears to be associated with Pastoral Therapy Associates, in Tacoma Washington as a psychotherapist. From his page there:

Terrill L. Gibson, Ph.D. is a diplomate pastoral psychotherapist, an approved supervisor for the American Association for Marriage and Family Therapy, and a diploma Jungian analyst who practices individual and family therapy with Pastoral Therapy Associates in Tacoma. He lectures and writes widely on the basic theme of the integration of psychotherapy and spirituality. He has been a frequent consultant, faculty, supervisor, and facilitator for a variety of Pacific Northwest universities, social service agencies, corporations, and religious congregations. He has a passion for film, sea kayaks, and the blues.

Now if you aren't familiar with how Jungian psychoanalysts work, the folks at Jungian have a nice overview page, and they will do the italicizing and I will do the bolding:

Psychotherapy and Jungian Analysis:

“Psychotherapy” derives from the Greek words psyche (soul) and therapeuein (to attend to).  It describes an interactive, emotional, intuitive, and imaginative process of sustained attention to the soul’s sufferings and creative manifestations.  Jungian analysis represents an extension of psychotherapy into the individual’s depths, a practical application of the discoveries of Swiss psychiatrist, Carl Gustav Jung (1875-1961).  Our familiar ideas about complexes, symbols, creative regression, rebirth, the inner child, archetypes, the collective unconscious, synchronicity, and the role of dreams in the individuation process – all these stem from Jung’s seminal works.

Individuals enter psychotherapy owing to current crisis, longstanding maladjustment, severe psychopathology, or out of an intense desire for personal growth.  In any case, a fundamental perspective of Jungian work consists in moving beyond mere clinical description and the diagnosis of symptoms to an understanding of those symptoms as statements from the depths of the individual’s psyche.  Here, compulsive behaviors, disruptive emotions, troubling memories, intrusive fantasies and the like figure as raw materials in the therapeutic process.  In the deep reflective working-through of emotional conflicts, such prima materia come to reveal their interior symbolic and transformative contents in images and sequences of images – the very stuff of psychic life. 

A systematic exploration of dreams is an especially useful and fruitful means of gaining insight into the deeper currents of one’s inner life.  Explorations of memory, intuitive visual impressions, active imagination, and creative artistic expression all contribute to the same deepening insight.

The orientation of Jungian work align historically with those of the Pre-Socratic philosophers, with the initiatory practices of the Graeco-Roman Mystery traditions, Gnostic speculations of the first and second Centuries CE, the symbolic approaches of Alchemy, Hermetism, Shamanism, German Naturwissenschaft, as well as the art and science of Johann Wolfgang von Goethe.  Contemporary Jungian analytic work is thus congenial with the Archetypal Psychology of James Hillman, the depth psychological research and therapeutics of Stanislav Grof, with Transpersonal Psychology and related holistic arts and sciences.

Fascinating stuff!  Really!  I do understand where they are coming from on this, I really do.  I've done my looks at Joseph Campbell, cross-cultural mythology analysis, and understanding the basis for common human systems that arise from the human condition.  How else do we create the laws of man to help separate us from the Law of Nature?  You need all of that to be able to form the basis of society and relationships that have cross-personal bonds to form family, extended relations amongst families, create culture and society.  Its viewpoint on things outside of that, however, I am more wary of.

That said I'm a bit skeptical when a psychoanalyst comes up with something like this in response to the best way to examine health care in the US:

In response to your NYT OP Ed, Health care is, firstly, an issue of principle. Firstly, health care is a moral not a financial issue. That is were you on the right miss the soul train every time. A fully (and free of personal cost) healthy populace; a fully (and free of personal cost) education system is the only way to assure the base platform for a vibrant democracy. Then we can talk about limited "free enterprise" options but only then—after all have been assured of health and education access without "previously existing condition" clauses and predatory insurance premium schemes.

Your key data assumptions are wrong by the way—universal single payer is demonstrably the cheaper and best option in almost all categories—see Arnold Relman, M.D., A Second Opinion. Get your full data spectrum right before pontificating. I've been in health care service and policy for forty years. How long have you been centrally thinking about and working on it?

Ok, point one: health care is a matter of principle?

Now let me get this straight, as I always thought that health care was a fee-for service concept using one's liberty to get what one can afford for oneself based on your perceived need and then using your liberty to see what you can achieve to meet that need.  That is not always at the lowest cost!  As a matter of principle, health care is an exercise in liberty: if you don't want it, don't think you need it, then you shouldn't have to pay for it.  We do have millions of people in the US who feel just that way.

Keith Hennessey looks into the figures on just who needs help for health insurance.  Of the total of 45.7 million that is so often cited the figures break out as follows (in millions) low to high:

4.3 - Medicaid/SCHIP eligible

5.0 - Childless Adults (Age 18-34)

6.4 - Medicaid Undercount

9.3 - Non- Citizens

10.1 - Over 300% of poverty line

10.6 - Remaining uninsured

On principle of liberty, then, there are 10.6 million who have needs they perceive that they cannot afford.  A total of 15.7 million shouldn't be on any list for this (Medicaid Undercount and Non-Citizens).  There are 4.3 million who are eligible for aid but don't take it for one reason or another.  Childless Adults should be able to make up their minds and get a separate call-out for some reason, perhaps because they don't want medical insurance (being young and childless) and they would fall into the 10.6 if they wanted insurance and couldn't pay for it.  Finally 10.1 million are 300% over the poverty line and should be able to find insurance if they want it but choose not to.

Thus on very first principle, that of liberty, we have a tiny fraction of the 299 million person population that can't get affordable medical insurance, which is about 3.5%.  These are people who want to exercise their liberty but find their means unable to meet their ends.  That is unfortunate.

What I can do is donate to charitable hospitals and other health care organizations set up to help the uninsured and poor.  That is a social obligation that I can put my liberty towards as a personal decision.  That said the health insurance system is rigged to slowly drive those out of the market to subsidized for-profit insurance organizations that overburden the private and charitable organizations with the worst and most costly cases that then require those institutions to seek outside help.  Normally from health insurance organizations that have hospital leagues under their control.  Once bought out that venue is then lost for community health care coverage and often closed.  In fact hospitals are closing down in this health care system because keeping beds ready for the sick is a costly proposition and so communities in the most need usually find themselves on the dirty end of the stick in this trade-off.

Seems to me there is a problem in the health care system that revolves around subsidies and the effects of them on driving up cost, lowering affordability and overburdening charitable institutions.


Now, Mr. Gibson then goes on to say that health care is a moral issue, not a financial one.

And I do agree!

No one should be forced to pay for another person's health care via government as that is immoral, in the extreme, to take away one's liberty in the name of society for something that is not a punishment.  For taxation is a burden to ensure that government can protect society and that we, as individuals, have the freest exercise of liberty possible.  Do you see that 19 million that don't get health insurance who can, are eligible for it and otherwise are free to choose to get it?  They outnumber those who are uninsured and can't get it.  One can argue with their reasons, but those are tailored to each and every individual, and are an exercise of liberty.  To tax them and to INCREASE taxation on those already GETTING health insurance who have made decisions for themselves to pay for the minority that is well under 5% and those are used to put our charitable systems in danger because the health insurance system starts to relegate the highest cost patients to those institutions is difficult to swallow.  We are looking to do away with a positive and personal good (charitable institutions) to burden the entire society with the cost of a minority who have needs they can't get.

Perhaps they need better jobs?

Perhaps they need a non-subsidized health care system that puts the TRUE COST of the system upon EVERYONE involved, so that we can all find out just what the REAL COST in terms of LIBERTY the health care system is giving us.


Now to make matters worse, Mr. Gibson then goes on to try and draw an analogy between health care and education.

A single payer system is most often run by the Nation.

Education used to be local before the Federal government got involved to try and 'help' things.

Do note that all the money poured in to 'help' education has not changed the one major problem of why poor Johnny couldn't read.  Everything we have done has not changed in any measurable manner to a significant degree the reading rate or comprehension rate of American children.  That is not a success, that is a failure.  The entire bureaucracy that has grown up trying to justify itself on 'helping' children to change that one very vital part of our civil culture has FAILED.

Why?  Because we started to trust in government to do the things that we, as adults, should be doing ourselves, which is looking after the local community and its schools.

According to Mr. Gibson both health care and education are equivalent in having a 'vibrant democracy'.


So let me get this straight: in the US before 1942 (having health kick-backs via taxation to encourage workers who were retired to take wartime jobs with non-pay incentives which received a tax break) and before 1980 and the start of the Dept. of Education, the US did NOT have a vibrant democracy?


We used to have DUELS on the floor of the House of Representatives, talk about VIBRANT!

I had always thought that 'vibrant democracy' was to have the most representative democracy, which means that there should be lots of Representatives in the House, and not this paltry few hundred we have today.  When the House changed its size to be fixed and NEVER float to increased and changing population by PROPORTION, each Representative, then, gained longer lasting districts and the ability to defend them became easier.  Incumbency was always a problem even with non-fixed size, but in the two decades after 1913 the incumbency rate started to increase drastically as Americans got less and less say in their government as their Representatives came to represent more and more people.

To get 'vibrant democracy' you must have diverse, large and representative organs of government.

See the role health care and education plays in that?

It doesn't.

These are non-overlapping areas and to conflate them is to try and gain advantage for one's argument without addressing the problem of individuals having no real chance to know their representative and those in government using the power and money in government to better defend their seats against opponents.  Of course if you can mollify part of your district with kind platitudes about health care, then increase taxes and then bemoan all those left out... well... gaming the system is an old an dishonorable technique in government, isn't it?

By Mr. Gibson's definition the USSR, Cuba, and North Korea having both education and health care absolutely free, and mandatory, no questions asked or else, should be the freest most vibrant democracies on the planet.  Well, the Soviet Union isn't with us any more because when people got a chance to criticize the system the lid blew off the place as it turns out that 'free' isn't 'free' at all.  A quick look at the demographics of Europe witnesses population implosions between now and 2050 by which point all of the parts of 'Old' Western Europe will no longer have majority representation by their once native populations and those they have invited in haven't seen any reason to assimilate as they figure they can outlast the decadent West by a couple of generations and get the place for 'free' as native Europeans die off.  Russia has this problem as a legacy off all that 'free' stuff, and its half-life is 2030.

So what's up with that?  All that 'free' health care and education causing lack of vigor in society?


You see I'm not making the financial cost argument, although that does have a role to play with the impact our tax-incentivized health care subsidy system works.  By trying to mitigate the true cost of the system, the system becomes inefficient and more costly, thus causing an upward spiral.  What is the type of argument when you say that a cost to individuals is for the good of society and, really, you just need to shut up and pay more so everyone can be better?

'The Ends justify the Means.'

The societal burden in Nations that do this is astounding and horrific in lowered family size below that necessary to sustain a Nation, rationed health care, less efficient health care, disinterested doctors, and such lovely artifacts as places like France where the health care professionals take August off to let the elderly die in their apartments during a heat wave.  Can't interrupt those holidays!

I already see that where one medication I take, that is off-patent and has a relatively large needs base (and should thusly be cheaply made by generic manufacturing at standardized quality) can't get that done due to regulatory overhead.

No, I take that back.

ALL my medications have this problem just in different categories.

Health care insurance, I am coming to suspect, sets a 'floor' price for many medications past which no better manufacturing techniques will ever yield a decrease in price and will see, instead, the savings pocketed by the manufacturer and the price remain constant.  Yes, inflation brings the marginal cost down over time, but manufacturing techniques have yielded astounding mass production savings far beyond the rate of inflation, just take a look a car, which does cost more than its 1920's counterpart, but sits at a constant dollar size just about where it was, back then plus is fully modern and does far more than its 1920's counterpart ever could... medications have a fixed effect and so manufacturing techniques that yield greater quantity at lower cost and constant quality should be far cheaper, and yet aren't.  It isn't that the high end medications are so costly, it is that the mid-range and upper low-range are far more expensive than they should be given improving production capabilities since even the 1970's.  Automation is not only helping in drug discovery, but in manufacturing, and yet the overall cost savings is NOT being passed along as health insurance groups doing mass buys and price fixing set prices at a stable rate for their outgo calculations.  When you get charged more per co-pay or in other parts of health insurance, this low end is not making up for it.

As an example, from 1984 to 2009 the cost of a vial of insulin has not dropped from $20.  Back in 1984 it was yielded from beef/pork pancreatic material.  Since then genetic engineering has allowed production of insulin on truly industrial scales no longer dependent upon animal cadavers.  The cost of a vial of insulin made from genetically engineered systems?  $20.  When did this fully change over?  In the early 1990's.  Mind you, this is for one of the oldest medications with a wide ranging population that uses it (and variants).  During this same era we have seen new and innovative medications start at sky-high dollar per doses and then move into the mere few miles from ground range... while foreign governments that can't pay for Western based manufacturing that depends on subsidized health payments have absconded with intellectual property and produced various medications for a few bucks a pop.

My most expensive medication has been off-patent for nearly two decades, has a limited production license and otherwise has federal regulations on Schedule IV because a few high fliers like to use it.  It is almost impossible to abuse or overdose on it, and yet, because it has the benefit of being able to allow you to stay awake, it is put under harsh regulatory control.  How costly is it?  Well without health insurance it is $10/pill and I use three a day.  And now, since bureaucrats decide my medical reimbursement, I have to get the manufacturer to talk to the health insurance plan about paying for more than 2 out of 3.  Mind you I have a licensed, accredited and fully federally authorized signature and prescription plan for the medication.  Now you do the $10/day cost and see where that gets you at the end of the year.  All for a medication that has limited 'recreational use' value, is off-patent, well known and should be amenable to generic manufacturing, and a good sized population that needs it for medical reasons.

That is part of the liberty cost no one wants to talk about: losing your ability to get a personalized treatment plan for a disorder that WORKS and then have it denied, in part, by a third party interested in reducing THEIR cost.  All for a drug that shouldn't be on any federal control schedule and should be manufactured by generic makers for a few bucks a pill.

Got that?

While it is fine to talk about the 'moral cost' there is also an immorality that we pay for, too: that of supporting bad business plans that depend on 'incentives' to do things that, if they had the best interest of others in mind, wouldn't need incentivizing at all.  Even more astounding is that your human expected life span (beyond some theoretical maximum your body can live) has continued to increase, steadily, since 1900 with a couple of years time out for the influenza pandemic of 1918-19.  With all the 'advances' in modern medicine, the rising life expectancy that is based, per Nation, on Public Health needs (sewers, clean water, etc.) started a trend that continues to this day.  But we are paying a hell of a lot more for that delta increase than our forefathers did.  Indeed, as a percentage of income, it now makes up over 13% by most statistics I can find an upwards of 16% of a family's budget... while before all of this in the pre-subsidized era it sat around 3%.

That ever increasing portion is letting government get in on the act of subsidizing something that is 'good' at a personal cost and societal cost that have a financial cost, but a much higher cost in ensuring that people take care of themselves and recognize their own cost/benefit needs.  Why should anyone have a bureaucrat tell them how to manage their health?  And why should industries use health insurance plans to help them garner greater profits and not engage in cut-throat competition?  There is an economic loss on both of these, but the greater loss is in giving up personal control and decision making to those that may not have your best health in their interest.

There is nothing 'moral' about that.

And no matter how 'good' the end is, the means are not justified for the effects they have.

As you can see I am slowly moving away from any sort of 'health insurance' being subsidized by tax breaks, and forcing these companies to compete completely up and down the line without any favoritism or kick-backs via Congressional largesse.  The more I experience of modern health care systems, the less I like of them.  Just get a couple of long-term chronic conditions under your belt and see what the system looks like when you really ARE sick.  I am not 'thankful' for the system, I despise it and yet we have so rigged it that sick people can't get out of it without killing themselves.  I am more than willing to live and die with my liberty, but get the government and the role of it out of my health care.  Regulating quality of medications and their safety is one thing.  Paying for others to tell me how to lead my life and supporting a corrupt system where companies don't need to compete stiffly?

How immoral.

How immodest to say it is moral or even 'good'.

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