Ayn Rand – Page 3 – The Moral Healthcare Blog

Remarks on Medicaid Expansion

I had the privilege of testifying in favor of Medicaid expansion for Pennsylvania at a hearing of the PA House Democratic Policy Committee, chaired by Rep. Dan Frankel of Allegheny County. (Follow the link for the agenda and other speakers.)

Good morning. I am Dr. Chris Hughes, state director for Doctors for America, a nation-wide group of physicians advocating for high quality, affordable health care. I have been an intensive care physician for my entire career, now approaching 25 years, and within the past year I have also begun practicing hospice and palliative medicine. I am a former Trustee of the Pennsylvania Medical Society and Chair of the Patient Safety Committee. I have completed graduate studies in health policy at Thomas Jefferson University, and I am now teaching there as well in the Graduate School of Population Health.

I tell you this to let you know that I can get down in the weeds with you about the nuts and bolts of implementation of the Affordable Care Act, and I know a fair amount about health care financing, access, cost shifting, and all the rest. But you have a fine panel assembled here today who can do that for you, and I know you all know your way around these topics as well.

I am here as a physician and a representative of my profession. Every doctor you know, and every nurse and pharmacist and social worker and everyone in the front lines of health care, for that matter, can tell you stories of how our health care system has failed someone. Our system fails people regularly, and often spectacularly, and often cruelly, day in, day out.

I’ve had patients who work full time in jobs that fall far short of the American dream. They get by, but they can’t afford health insurance.

I’ll give you a few of my patients’ stories here, not just to point out the obvious- that we are mistreating our fellow human beings – but that we are misspending countless dollars on the wrong end of the system.

There’s the cabbie who recognizes his diabetes and determines to work harder and longer so he can buy insurance before he is stricken with the label even worse than diabetes: preexisting condition! He doesn’t make it and ends up in the ICU with diabetic ketoacidosis.

There’s the construction worker who has a controllable seizure disorder that goes uncontrolled because he can’t afford to go to the doctor. He ends up in the ICU multiple times.

There’s the woman who stays home to care for her dying mother and loses her insurance along with her job. When she finally gets to a doctor for herself, her own cancer is far advanced.

The laid-off engineer whose cough turns bloody for months and months before he “accesses” the health care system – through the ED and my ICU with already far advanced cancer.

These are people who are doing the right thing – working, caring for family members – and still have to go begging for health care. How many hours does an American have to work to “deserve” health care? 40? 50? 60? I’ve seen all of these.

Not long ago, expanding access to health care was a nonpartisan goal. As recently as 2007, a bipartisan group of U.S. senators, including Republicans Jim DeMint and Trent Lott, ( let me repeat that, “Jim DeMint and Trent Lott” ) wrote a letter to then-President George W. Bush pointing out that our health care system was in urgent need of repair. "Further delay is unacceptable as costs continue to skyrocket, our population ages and chronic illness increases. In addition, our businesses are at a severe disadvantage when their competitors in the global market get health care for ‘free.’ "

Their No. 1 priority? It was to "Ensure that all Americans would have affordable, quality, private health coverage, while protecting current government programs. We believe the health care system cannot be fixed without providing solutions for everyone. Otherwise, the costs of those without insurance will continue to be shifted to those who do have coverage."

Medicaid expansion and the Affordable Care Act will get us closer to this than at any time in our history.

You will hear some physicians speak out against all of this. But what you generally will not hear is their leadership and organizations speaking out against it, except perhaps in the deep south. There is a reason for this. As leaders of our profession, we have to come to terms that we are not just in it for ourselves. We are in it for our profession as well, and that means we have to put our patients’ interests above our own, and that means we have to do our best to ensure that everyone has access to high quality, affordable health care. Don’t just take my word for it. The American Board of Internal Medicine Foundation and other organizations put together a Charter on Medical Professionalism about ten years ago, specifically making this part of our professional responsibility. If you go to their website, you will find that virtually every physician organization you can think of has endorsed it. That means the anesthesiologists and orthopedic surgeons as well as the pediatricians and the family practitioners.

For Medicaid expansion specifically, we should note here that the major national physician organizations, including the AMA, and the organizations representing internists, family practice, pediatricians, psychiatry and more, all endorse Medicaid expansion. On the state level, all of these organizations state chapters endorse it as well, with the exception of the Pennsylvania Medical Society, who have endorsed general terms of expansion only.

But this concept is really not controversial among physicians and health care providers. We see everything from the catastrophes to the small indignities. They are tragic, unnecessary, and we are on the road to ending them.

Some in the provider community have expressed concerns about Medicaid in particular as the way we are providing access, so I would like to take a moment to address the concerns we hear most often.

First, that Medicaid is “bad” insurance. What is bad about Medicaid is largely fixed in the ACA. Namely, it is very poorly reimbursed for providers. You’ve already heard [I assume] from HCWP why hospitals want it, but for providers in primary care, the frontlines of health care, they get a massive boost in reimbursement under the new law. Pennsylvania has historically had awful reimbursement in the Medicaid program, among the worst in the nation. Now, reimbursement will go to par with Medicare reimbursement, a huge incentive for providers to take on Medicaid patients whom they may have been reluctant to see previously. There are other new innovations such as Patient Centered Medical Homes and others, coming down the pike, that should really give people who previously had no chance at excellent care, a chance to avoid complications, avoid the ER and avoid the hospital.

I’ve also heard the strange claim that having Medicaid is worse than having no insurance. I suppose that in a vacuum where there is no good data, and where one sees, like I do, patients with no insurance or Medicaid, who don’t know how or aren’t able to access a doctor – you’d be amazed at how often this happens – you could look at patients who get very sick and attribute that to Medicaid, but we do have data now. In Oregon, due to a fairly bizarre set of circumstances a few years ago, Medicaid eligibility was determined by lottery, creating a natural experiment of haves and have-nots. In the first year, those who were enrolled were 70 percent more likely to have a usual source of care, were 55 percent more likely to see the same doctor over time, received 30 percent more hospital care and received 35 percent more outpatient care, and much more.

People often ask me why I am so passionate about this, and I always tell them, “I blame the nuns.” Growing up Catholic, there was nothing so drilled into me as Matthew 25. We used to sing a hymn based on it, “Whatsoever you do to the least of my brothers,” on a regular basis at Mass. And we went to Mass before school every day!

It turns out this is a pretty universal sentiment. I checked. Go to the websites of every mainstream Christian denomination in America and it will be in there somewhere: The Social Gospel and Social Justice. Dignity of the individual. Our duties to the less fortunate. It is a component of every major religion and philosophy in the world, with one notable exception – Ayn Rand’s. And I mention Ayn Rand and her most famous book, Atlas Shrugged, because it is perennially listed as the second most influential book in America after the Bible. A damning fact for us.

In spite of that, I am glad that social justice and a commitment to the fair distribution of our health care resources is integral to the sense of duty of my profession, the nursing profession and all health professions.

I encourage debate about how we get to universal health care, but I refuse to accept that America, alone among all modern nations, and Pennsylvania in particular, will reject the idea that we need to get there. And right now, Medicaid expansion, the Health Insurance Exchanges and many other components of the Affordable Care Act are our best hope. Let’s not squander it.

Thank You.

I am a job creator: A manifesto for the entitled – The Washington Post

I am the misunderstood superhero of American capitalism, single-handedly creating wealth and prosperity despite all the obstacles put in my way by employees, government and the media.
I am a job creator and I am entitled.
I am entitled to complain about the economy even when my stock price, my portfolio and my profits are at record levels.
I am entitled to a healthy and well-educated workforce, a modern and efficient transportation system and protection for my person and property, just as I am entitled to demonize the government workers who provide them.
I am entitled to complain bitterly about taxes that are always too high, even when they are at record lows.
I am entitled to a judicial system that efficiently enforces contracts and legal obligations on customers, suppliers and employees but does not afford them the same right in return.
I am entitled to complain about the poor quality of service provided by government agencies even as I leave my own customers on hold for 35 minutes while repeatedly telling them how important their call is.
I am entitled to a compensation package that is above average for my company’s size and industry, reflecting the company’s aspirations if not its performance.
I am entitled to have the company pay for breakfasts and lunches, a luxury car and private jet travel, my country club dues and home security systems, box seats to all major sporting events, a pension equal to my current salary and a full package of insurance — life, health, dental, disability and long-term care — through retirement.

There’s lots more and it is all dead on!

Romney’s theory of the “taker class,” and why it matters

For what it’s worth, this division of “makers” and “takers” isn’t true. Among the Americans who paid no federal income taxes in 2011, 61 percent paid payroll taxes — which means they have jobs and, when you account for both sides of the payroll tax, they paid 15.3 percent of their income in taxes, which is higher than the 13.9 percent that Romney paid. Another 22 percent were elderly.

So 83 percent of those not paying federal income taxes are either working and paying payroll taxes or they’re elderly and Romney is promising to protect their benefits because they’ve earned them. The remainder, by and large, aren’t paying federal income or payroll taxes because they’re unemployed. But that’s a small fraction of the country.

Money or Your Life – NYTimes.com

Critics of the Affordable Care Act argue that many Americans neither want nor need health insurance, and that it forces them to pay for coverage against their will. But just as the government collects taxes to pay police officers and firefighters, the individual mandate compels Americans to pay for a service they may not immediately want but could at any time desperately require.

Much of the debate has focused on the role of government in everyday life. I don’t discount the value of that question, but my focus is on real needs. I treat patients with $20,000 chemotherapy injections or monthly doses of IV immunotherapy that cost $10,000 a bag. If they don’t receive these drugs my patients will die, so to me, the most pressing issue here is compassion. Without change, the patients will resemble the man with leukemia, human beings without insurance terrified that their lives aren’t worth what it will cost to save them, all because of a broken but fixable system.

Crowds at conservative rallies have, astoundingly, cheered the idea that uninsured people should, if they become ill or badly hurt, be left for dead. It’s easy to imagine such a thing in the heat of a rhetorical moment. But the reality is, I hope, harder to embrace. Because reality means a real person — you, me, someone we know — condemned to a possibly preventable death because, for whatever reason, they don’t have insurance.

My patient with leukemia is dead. He got the best care money could buy, but his disease only briefly went into remission and he went home on hospice care. Should he, because he did not buy insurance, have been denied this chance for a cure?

The Affordable Care Act is not the health care solution everyone wants, but when patients wish for death panels as a response to leukemia, something needs to be done, and soon. This plan would help any patient facing a tough diagnosis not view treatment as a choice between his money or his life.

Theresa Brown is an oncology nurse and the author of “Critical Care: A New Nurse Faces Death, Life, and Everything in Between.”

I have had similar discussions with those who are not in healthcare as their profession. They cannot seem to see the distinction between cutting people off who did not buy insurance, for whatever reason, and actually carrying out this virtual death sentence. We, as medical professionals, just cannot do this. Therefore, we need to figure out how to have universal access to care and universal insurance coverage. ObamaCare is a very good start.

Subsidiarity (Catholicism) – Wikipedia, the free encyclopedia

Subsidiarity (Catholicism) – Wikipedia, the free encyclopedia:

Paul Ryan has referred to his philosophical bent as having more to do with subsidiarity than Ayn Rand. I consider myself well read, especially about theology, Catholic or other, but I was not familiar with this term, so here is the Wikipedia section on the Catholic take on it:

The principle of subsidiarity was developed by German theologian Oswald von Nell-Breuning.[2] His work influenced the social teaching of Pope Pius XI in Quadragesimo Anno and holds that government should undertake only those initiatives which exceed the capacity of individuals or private groups acting independently. Functions of government, business, and other secular activities should be as local as possible. If a complex function is carried out at a local level just as effectively as on the national level, the local level should be the one to carry out the specified function. The principle is based upon the autonomy and dignity of the human individual, and holds that all other forms of society, from the family to the state and the international order, should be in the service of the human person. Subsidiarity assumes that these human persons are by their nature social beings, and emphasizes the importance of small and intermediate-sized communities or institutions, like the family, the church, labor unions and other voluntary associations, as mediating structures which empower individual action and link the individual to society as a whole. “Positive subsidiarity”, which is the ethical imperative for communal, institutional or governmental action to create the social conditions necessary to the full development of the individual, such as the right to work, decent housing, health care, etc., is another important aspect of the subsidiarity principle.

The principle of subsidiarity was first formally developed in the encyclical Rerum Novarum of 1891 by Pope Leo XIII, as an attempt to articulate a middle course between laissez-faire capitalism on the one hand and the various forms of communism, which subordinate the individual to the state, on the other. The principle was further developed in Pope Pius XI’s encyclical Quadragesimo Anno of 1931, and Economic Justice for All by the United States Conference of Catholic Bishops.
“ It is a fundamental principle of social philosophy, fixed and unchangeable, that one should not withdraw from individuals and commit to the community what they can accomplish by their own enterprise and industry. (Pope Pius XI, Quadragesimo Anno, 79) ”

Since its founding by Hilaire Belloc and Gilbert Keith Chesterton, Distributism, a third way economic philosophy based on Catholic Social teaching, upholds the importance of subsidiarity.

The Church’s belief in subsidiarity is found in the programs of the Catholic Campaign for Human Development, where grassroots community organizing projects are supported to promote economic justice and end the cycle of poverty. These projects directly involve the people they serve in their leadership and decision-making

So, as Inigo Montoya would say, “You keep using that word. I do not think it means what you think it means.” I think we have centuries worth of ample evidence that charity cannot provide health care to nations, that economic justice and ending poverty are not possible through devolved local or institutional efforts. Some things require government, and Paul Ryan and so many others like to pretend that if we just “get out of the way,” all of this will take care of itself. Never has, never will.
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How Ayn Rand Seduced Generations of Young Men and Helped Make the U.S. Into a Selfish, Greedy Nation | | AlterNet

How Ayn Rand Seduced Generations of Young Men and Helped Make the U.S. Into a Selfish, Greedy Nation | | AlterNet:

Only rarely in U.S. history do writers transform us to become a more caring or less caring nation. In the 1850s, Harriet Beecher Stowe (1811-1896) was a strong force in making the United States a more humane nation, one that would abolish slavery of African Americans. A century later, Ayn Rand (1905-1982) helped make the United States into one of the most uncaring nations in the industrialized world, a neo-Dickensian society where healthcare is only for those who can afford it, and where young people are coerced into huge student-loan debt that cannot be discharged in bankruptcy.

…………………………

Ayn Rand’s personal life was consistent with her philosophy of not giving a shit about anybody but herself. Rand was an ardent two-pack-a-day smoker, and when questioned about the dangers of smoking, she loved to light up with a defiant flourish and then scold her young questioners on the “unscientific and irrational nature of the statistical evidence.” After an x-ray showed that she had lung cancer, Rand quit smoking and had surgery for her cancer. Collective members explained to her that many people still smoked because they respected her and her assessment of the evidence; and that since she no longer smoked, she ought to tell them. They told her that she needn’t mention her lung cancer, that she could simply say she had reconsidered the evidence. Rand refused.

So, I guess that explains why the anti-science crowd is so confident in its ignorance – Ayn Rand has their back!

Rand said, “Capitalism and altruism are incompatible….The choice is clear-cut: either a new morality of rational self-interest, with its consequences of freedom, justice, progress and man’s happiness on earth—or the primordial morality of altruism, with its consequences of slavery, brute force, stagnant terror and sacrificial furnaces.” For many young people, hearing that it is “moral” to care only about oneself can be intoxicating, and some get addicted to this idea for life.

Explains most of the Conservative “thought” on economics, doesn’t it? Rand Paul, Paul Ryan, I’m looking at you.

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Daily Kos: An indecent proposal

Daily Kos: An indecent proposal:

That cut-up Grover Norquist suggest wealthy Americans like Warren Buffet contribute to the Federal government on an optional basis, and Hunter at DailyKos offers to accept the offer…

My proposal is that we make taxes for wealthy Americans and corporations entirely optional. That’s it. If a corporation wants to pay zero percent in taxes, they should be allowed to, and if they want to pay the full tax rate, that is also allowed. The same for wealthy Americans.

The only caveat is that non-contributing corporations and individuals will be barred from taking advantage of any government services. It is the perfect free-market-based opt-out: If you do not want to support the American infrastructure and population to the same extent that your fellow citizens do, you can simply decline to, and live your life as the libertarian god you have always longed to be. You will be free! You will be allowed to go Galt, or not go Galt, to whatever degree you wish; as a special bonus, we shall prevent you from becoming that most dreaded of figures, the parasite, since if you are not contributing to the benefit of society it only stands to reason you should not gain profit from it either.

For starters, companies that do not pay the going tax rate will be barred from shipping their products on American roads. They will be prevented from connecting to the American electric grid, or from using municipal water or sewer systems. Instead, they will have to provide these services on-site. The good news: They can feel free to pollute as much as they like, as long as no pollution crosses the boundaries of their property (above, below or horizontally) into the rest of America. That would be considered an act of war.

Wealthy Americans that opted out of paying the going tax rate would also, of course, be prohibited from using American roads. This would not be a problem for them, as they generally can afford airplanes or helicopters, which would be similarly fine so long as they did not use American airspace (sorry, but the FAA costs money too, you know). But they could certainly fly around the property, which might be a pleasant experience.

Then we must consider the issue of security. Fire and police protection would be right out, so there would be no particular incentive for poorer Americans not to loot their properties (wealthy Americans tend to have nicer things than the rest of us). The American elite might consider the approach taken by wealthy Mexican families, which is to install a high perimeter fence around the property with a heavily armed private guard service. This would be expensive and unsightly, but it would be up to each individual to decide, for themselves, what the appropriate free-market level of protection for their own property might be. My one tip would be to spend a good deal of time on that decision.

It goes without saying that non-contributing Americans, corporate or otherwise, would not have access to the courts. This should be fine with them, since we know that meddlesome lawsuits are the biggest non-tax-related threat to America today. There is the minor issue of no recourse, if armed mercenaries do manage to overpower your guards and make off with your antique commodes or whatever it is you rich people hoard these days: Again, though, think of the tax savings.

This is a nice echo of Elizabeth Warren’s comments on the arrogance of the John Galt wannabees.

UPDATE: I posted this to the comments section:

Don’t forget the socialism of WWII

Let me add another item to your great piece, Hunter, and to Elizabeth Warren’s recent speech: Did the fathers of any of these captains of industry go to college on the GI Bill?
See here:

Within the following 7 years, approximately 8 million veterans received educational benefits. Of that number, approximately 2,300,000 attended colleges and universities, 3,500,000 received school training, and 3,400,000 received on-the-job training. By 1951, this act had cost the government a total cost of approximately $14 billion.
The effects of increased enrollment to higher education were significant. Higher educational opportunities opened enrollment to a varied socioeconomic group than in the years past. Engineers and technicians needed for the technological economy were prepared from the ranks of returning veterans. Also, education served as a social safety valve that eased the traumas and tensions of adjustment from wartime to peace. For the American colleges and universities, the effects were transforming. In almost all institutions, classes were overcrowded. Institutions required more classrooms, laboratories, greater numbers of faculties, and more resources. House facilities became inadequate and new building programs were established. New vocational courses were also added. This new student population called for differential courses in advanced training in education, commerce, agriculture, mining, fisheries, and other vocational fields that were previously taught informally. Teaching staffs enlarged and summer and extension courses thrived. Further, the student population was no longer limited to those between 18-23. The veterans were eager to learn and had a greater sense of maturity, in comparison to the usual student stereotype. Finally, the idea that higher education was the privilege of a well-born elite was finally shattered.

And of course, it was continued after WW II: Continuation of the Bill

The original G.I. Bill of 1944 expired in 1956, but the concept of veteran compensation continued, with all subsequent legislation still referred to as G.I. bills. In 1952 Congress passed the Veterans’ Adjustment Act to compensate veterans of the Korean War (1950-1953). There were some minor differences between the World War II and Korean G.I. Bills, but the outcome was broadly similar. More than two million Korean War veterans used the G.I. Bill to go to college, and 1.5 million financed new homes. The G.I. Bill underwent a significant change in 1966, when Congress passed the Veterans Readjustment Benefits Act (VRBA) as part of President Lyndon B. Johnson’s Great Society slate of social programs. The VRBA removed the requirement of serving in combat to receive government benefits, and instead made G.I. Bill benefits available to anyone who served in the military, whether in wartime or peacetime. Since 1966 the G.I. Bill has undergone a series of modifications and adjustments, but the fundamental benefits subsidizing education and home ownership remain the same. The Montgomery G.I. Bill (MGIB), enacted by Congress in 1985, provides educational stipends to former members of the military who contribute a small portion of their pay during their time in the service. The Post 9/11 Veterans Assistance Act of 2008 (effective date August, 2009) substantially increased the amount of tuition and housing assistance, allows veterans to transfer benefits to their spouses and children, and provides tuition benefits for National Guard and Reserve members.