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statements of the many problems

Entitlement:  what can be said

Certainly in most cases the sense of entitlement is at odds with the notion of individual responsibility.  This is certainly most evident when citizens consider if healthcare is a right or are they responsible for managing their healthcare and its cost.   Philosophically we love individual initiative and responsibility, as long as some conditions are met.  Individualist place very few conditions on this notion, while liberals place a great deal.   And how does this relate to healthcare and its reform?

If we consider that our current system of healthcare insurance is considered by most to be prepaid healthcare, not health insurance, we see how key the discussion and distinctions on "rights or not" becomes.  If healthcare is in the same category as the air we breathe, then it is considered more a right than a service.   Auto insurance is a better model than the one we have today for healthcare.  The sense of individual responsibility is quite different for most folks. 

Individually responsible folks manage their health by taking steps to understand first of all what makes them healthy.  Obesity is a major cost factor in the overall cost of healthcare, more so in this country than any other.   Life Style related costs are a dominate factor in any discussion on overall costs.  So the responsible thing for individuals to do is to loose weight, and take more responsibility for preventative care.  This alone might solve the cost issue in healthcare, but how to support this idea?

Returning to the issue of a "right", we see it manifested in the two Bills in Congress, for having all pay the same price for insurance, and no one pay a penalty for their life style choices is a disservice to the individuals and to the public, all for the sake of having healthcare be an entitlement.  In addition to make these Bills work, a great deal of freedom has to be lost and taxes raised along the way.

One cannot have healthcare reform and not have an increase in individual responsibility built in, in a manner perhaps as Safeway has done, and found also that it reduces the costs significantly and increased the well-being of its employees.  It is clear that the liberal caucus in Congress does not want that step towards individual responsibility to be taken.

The further irony is that by focusing on healthcare as a right and its entitlement for all, we will likely see a determination of the system and still higher costs in the form of taxes, while we also see rationing occurring as it is today in select States.  Pipes writes (see below) on the cost side of the equation, but what about the lack of compassion to install by force a lack of choice, a crippling set of proposals as we see in Congress today, all for the sake of helping the "poor dying person in the street", the poster child of universal care.  I am concerned about that individual, and want to see the best system possible to make the issue a moog point. 

It would seem to me that the best means to help "this person in the street" is to lower the cost of healthcare, and do some form of the compassionate policies in the Proposal section, and improve the overall system.   Do we really feel that the person in the street is gong to suffer as a result?  They will if they are waiting in line for rationed care.  The increased costs of healthcare threaten this person's option and affect us all.  The mere fact that the major cost driver for these increases, among the many detailed in Trends/Costs, was the growth of the public sector in healthcare. 

I return to the example of the $500 computer that is benefitting all, and that condition of low cost productivity was created not by a government public option but by enterprising, self-reliant individuals working in a competitive industry.  How about trying this in healthcare, and treating it as a service and not a right.  It will serve all very well if we can take this step.


Sally Pipes writes (Jul 29, 2009):  In the end, the only way to control costs inside a bureaucratic structure is to cut doctors' pay, transfer patients into managed care, impose government global budgets and introduce price controls. And that's exactly what Bay State leaders have announced they'll do.

Last week, a state commission recommended that the government stop paying health care providers for each procedure and instead compensate provider networks with a flat fee per patient. Of course, such a system of global payments, or "capitation," encourages provider groups to skimp on care, as they get to keep as profit any money not spent treating patients.

If congressional Democrats get their way, every American can look forward to a similar system of capitation in the future. This would upset the care of 85% of Americans who are currently insured and greatly increase government control. Exactly the results Democratic leaders assure can't possibly happen.