“Grant me a premise and I will construct you a world.”
This principal tenet of sophistry lies near the core of the current controversy surrounding the Health Care Reform debate. The converse of the maxim is that a false premise will yield a false construct. If the argument of the debate were based upon a fallacious premise, then the whole of the rationale used would be unfounded. Much of the opposition concerning Health care reform proceeds, intentionally or not, from false premises and assumptions. A more careful examination of the arguments reveals their flaws.
The first obvious flaw lies in the generalized description of “Health Care” as the object of discussion. In the context of delivery of medical services, it is critical to note that the components of medical services and health insurance are very different subjects. To institute real reform in the system, measures must address BOTH aspects. The experience in Massachusetts is a clear object lesson. Hailed as a “breakthrough” in reform, the Commonwealth of Massachusetts enacted legislation and a program to provide universal health insurance. Employers were obliged to cover employees, and those without employment based insurance were required to purchase coverage. However, what the program lacks is a system of limits on health care costs. As a result, the premiums for health care in Massachusetts are about the highest in the United States. The compromise struck with the Industry to obtain universal coverage was to refrain from imposing mandatory controls on health care costs. The compromise now threatens to swallow the program, as the government costs to subsidize the rising insurance premiums could bankrupt the state budget.
A second glaring flaw in the arguments raised in opposition is the presumption or premise that the current system is of sufficient quality that it is inherently worth protecting. The medical care systems that operate in the US are not the worst in the world, but they collectively are far from the best, despite being about the most expensive on a per capita basis. The reference to medical care delivery as a plurality is intentional, because there are different delivery systems for different classes of people in the country. For the wealthy, the best technology and the most skilled health professional specialists are available. They have no significant barriers to access or to the best care that their information and networking sources can identify.
A second tier of health care delivery is available to those with employer sponsored health insurance. These people have access to a broad range of primary and specialized health care services. Their options are limited by the provider networks that are established by the insurers in ways that the customer/patient is not even aware. This group pays the illusory cost of “co-pays” that creates a false impression of the true charges being assessed for their health care services. What most failed to realize, until the recent loss of 7 million jobs in the current recession, is that their protection is transitory and is not really “insurance.” It is subsidized health care coverage that can be taken away at the discretion of others, even when the employee is paying a substantial part of the cost of premiums for his or her family.
The third class of health care is for those who are poor and or unemployed. They have no health insurance to protect them from catastrophic or even moderate health incidents. The full impact of the high medical services costs are evident to this group and most simply avoid or defer medical care until the condition is severe. At this point, their deliver system is the local emergency room of the nearest hospital, if the institution will admit them even for temporary urgent care. Of the approximate US population of 300 million, there are about 50 Million in this third category, approximately 1/6 of the entire population.
Thus, on a macro view, the health care delivery system in the US provides no guaranteed support for about 17% of the population, limited and rationed services to the majority of the population and true health care insurance and coverage to less than 5%. The “outcomes” of this delivery system, the statistical measure used in medical parlance to assess the quality and effectiveness of medical services delivery, place the US in the middle of the pack of “developed” nations in quality of care. The per capita costs of the system, however, are nearly the highest. Consequently, it would be very difficult to sustain an argument that maintenance of the status quo is a critical objective.
The mentality of the US consuming public is easily misled and inclined to self delusion. The adherence to buying habits for automobiles is a prime example. When damage to the environment from excess carbon emissions from cars was evident and the cost of gasoline for energy inefficient vehicles was consuming higher and higher portions of the consumer’s take home pay, the public stubbornly refused to embrace change and resisted a shift to smaller more energy efficient cars. They preferred to stay with a broken model to accepting change and adaptation to a new model that was in their own best interest. This same problem is evident in the Health Care Reform debate, as fear mongering and disinformation seeks to turn consumers away from any reform that would alter the status quo. In their fear and stubborn “conservatism” they seek to retain and protect a seriously dysfunctional system that fails to serve the needs and best interests of the public.
To Be Continued….
Sunday, August 23, 2009
Saturday, August 22, 2009
Americans, What Are Your Values And Standards?
A recently released report from the Inspector General of the CIA reveals what many have already known. We do not know whether life imitates are or the reverse. We do know that film depictions of a rogue agency with operatives who feel respect no constraints of law, morality or human rights are pretty accurate images of the type of agency run under the Bush/Cheney/Rumsfeld regime. It may well be that such practices went on at some level in prior administrations, but the heinous practices described in the report and in prior leaks to the media appear to have become systemic during the George W. Bush Administration. The level of abuse is directly related to the level of permissiveness and tolerance shown at the top.
Practices that have been detailed at Abu Ghraib, at GITMO and other detention facilities cannot be excused as necessary or effective. They simply defy all principles of human rights and violate conventions against torture and cruel and inhuman treatment. Threatening a detainee with execution by putting a gun to his head, water boarding, putting a power drill to his head or other body parts has no place in a civilized society. It is not only unethical and morally corrupt, it is expressly illegal. Urinating on the holy book of a prisoner, or using psychological tactics that are intended not to extract information, but primarily to humiliate and degrade the prisoner or mock his religious and cultural beliefs is morally unjustified.
Right wing devotees who fall into the easy hateful and racist inspired rhetoric argue that “suspected” terrorists or terrorist supporters, in their view, are subhuman and deserve no rights. This way of reasoning, if it can be called such, is fallacious and short-sighted. The adherence to fundamental standards of humanity and the rule of law is primarily an internal value. When a murderer enters a health club and guns down several customers in an exercise class, such action is both illegal and immoral. But the societal response is not to torture and kill the perpetrator without due process. The internal values of the society are upheld and strengthened when a process involving the rule of law and incorporating human rights and civility standards is applied. To argue that the response should drop to the level of the actions of the perpetrator, or lower, only degrades and undermines the society.
President Obama is wrong in his position that we need to look forward instead of prosecuting the perpetrators of these horrible activities in the name of, and with the sanction of, the US government and its people. It will not suffice to try to sweep these activities under the rug. The people of the US are entitled to know the types of activities that have been carried out in their name and the legal and moral standards that govern such officially sanctioned conduct. To fail to expose these behaviors, such as assassination squads, secret prisons, extraordinary rendition for the specific purpose of promoting torture and the official use of unregulated mercenaries like Blackwater, is to advise the perpetrators that their conduct is acceptable and can be renewed at the first wink and nod from higher ups in the Administration.
This is not about one President or Administration trashing a predecessor. It is a concern that goes far beyond political retribution. The US citizens and the world need to know that certain minimum standards of conduct are valued and upheld, regardless of the political stripe of the current Presidential Administration. At present, and until Obama take more assertive steps to change the message and image, the standards to which the US government holds its agents is one that ignores the Geneva Conventions, condones and supports torture and promotes racial and ethnic profiling and bigotry. President Obama needs to make a decision whether he accepts that message and image on behalf of the country. If he does not, then he needs to take more aggressive action to hold accountable those who are responsible for approving and carrying out those practices, including George W. Bush if that is where the evidence leads.
Practices that have been detailed at Abu Ghraib, at GITMO and other detention facilities cannot be excused as necessary or effective. They simply defy all principles of human rights and violate conventions against torture and cruel and inhuman treatment. Threatening a detainee with execution by putting a gun to his head, water boarding, putting a power drill to his head or other body parts has no place in a civilized society. It is not only unethical and morally corrupt, it is expressly illegal. Urinating on the holy book of a prisoner, or using psychological tactics that are intended not to extract information, but primarily to humiliate and degrade the prisoner or mock his religious and cultural beliefs is morally unjustified.
Right wing devotees who fall into the easy hateful and racist inspired rhetoric argue that “suspected” terrorists or terrorist supporters, in their view, are subhuman and deserve no rights. This way of reasoning, if it can be called such, is fallacious and short-sighted. The adherence to fundamental standards of humanity and the rule of law is primarily an internal value. When a murderer enters a health club and guns down several customers in an exercise class, such action is both illegal and immoral. But the societal response is not to torture and kill the perpetrator without due process. The internal values of the society are upheld and strengthened when a process involving the rule of law and incorporating human rights and civility standards is applied. To argue that the response should drop to the level of the actions of the perpetrator, or lower, only degrades and undermines the society.
President Obama is wrong in his position that we need to look forward instead of prosecuting the perpetrators of these horrible activities in the name of, and with the sanction of, the US government and its people. It will not suffice to try to sweep these activities under the rug. The people of the US are entitled to know the types of activities that have been carried out in their name and the legal and moral standards that govern such officially sanctioned conduct. To fail to expose these behaviors, such as assassination squads, secret prisons, extraordinary rendition for the specific purpose of promoting torture and the official use of unregulated mercenaries like Blackwater, is to advise the perpetrators that their conduct is acceptable and can be renewed at the first wink and nod from higher ups in the Administration.
This is not about one President or Administration trashing a predecessor. It is a concern that goes far beyond political retribution. The US citizens and the world need to know that certain minimum standards of conduct are valued and upheld, regardless of the political stripe of the current Presidential Administration. At present, and until Obama take more assertive steps to change the message and image, the standards to which the US government holds its agents is one that ignores the Geneva Conventions, condones and supports torture and promotes racial and ethnic profiling and bigotry. President Obama needs to make a decision whether he accepts that message and image on behalf of the country. If he does not, then he needs to take more aggressive action to hold accountable those who are responsible for approving and carrying out those practices, including George W. Bush if that is where the evidence leads.
Friday, August 21, 2009
When Greed and Arrogance Equal Economic Opportunity
Recent publication of a nearly 900 page report in China preceded an upcoming debate by Chinese lawmakers on a resolution to cap emissions by 2050 and to accelerate CO2 reduction strategies as soon as possible. If the Chinese, who have shown greater discipline than the US in organizing its financial markets, can organize its industrialization processes this suggests a positive path forward for China as it continues aggressive development. While there has been significant discussion and debate in the US about climate change and global warming, the discipline and commitment to actually do anything concrete and constructive about the problem is at best questionable. President Obama has touted the development of “green industries” as a significant component in his plans to revive the economy. Yet the mobilization of opposition by the GOP and the Right Wing Conservatives to any measures that would change the status quo ante bode ill for effective change. This penchant for individualism, greed and arrogance may well serve as an important resource that China can use to build its competitive future.
In the past, debate about the Kyoto Protocol of 1997 has bogged down over the issue of differentiated responsibilities. The US negotiators, predominantly from the conservative camp, have demanded that lesser developed or industrialized countries like China should match emission reductions called for on the part of the US. In response, the developing countries have argued that the US got rich off of industrialization and pollution that has created the existing crisis and was in no position to deny those countries the right to develop as the US has done. In fact, they argue that the US has greater responsibility for emission reduction because it had a greater role in creating the mess that the world now must collectively address. At this point the discussion has broken down and the US has refused to sign the Kyoto Protocol. With the expiration of the Protocol comes the new conference in Denmark [U.N. Climate Change Conference that will be held in Copenhagen this December]. Subsequent developments in climate change and scientific evidence of accelerating deterioration lend urgency to the debate. In addition, the importance of climate change to sustainable economic growth has also risen.
The opportunity for the Chinese in this situation is to focus on the development of technologies that limit or reduce carbon emissions while providing manufacturing and industrial production capacity that is needed for economic growth. For example, the growth of the auto industry in China is staggering. More Chinese are able to own a car now than ever before. The development and production of alternative energy and low emission vehicles would not only further Chinese goals for CO2 limits, but would provide potential export capacity for those countries seeking to meet emission targets but that lack capacity to produce low emission vehicles. This is the “green industry” model that Obama refers to but which the US public is slow and resistant to embrace.
This arrogance on the part of the US public, including both politicians and consumers, will continue to be a weakness that developing countries can exploit. At present, the bulk of growth in sales for US based car manufacturers comes from overseas markets. Though stepping back from the brink of oblivion through bankruptcy, government bailouts and reorganization, these companies still have not been able to convince the US consumers to purchase energy efficient and low emission vehicles. Their near term future depends upon sales to non-US consumers of products manufactured by US workers. However, if China succeeds in developing a strong production capacity for alternative fuel and low emission vehicles, it can continue on its development path while competing effectively with the US for those foreign markets.
At the same time, China has nowhere near the saturation level that the US market has regarding automobile purchases. A recent study suggested that the US was approaching the point at which there was one vehicle owned for almost every licensed driver. In contrast, China may only have less than 10% saturation in the coming decade. If incomes rise to the level that allows more Chinese to purchase cars, the population provided an almost unlimited market potential. In any event, the demand will almost certainly outstrip supply and manufacturing capacity for quite some time. Think back to the US during the inception of Henry Ford and you can grasp a comparison. Yet the difference will be that the Chinese will start with the production of environmentally sensitive products while the US will still be in the process of retooling to manufacture a different type of vehicle that might satisfy US consumer tastes. At the same time the US manufacturers would be stressed with the duality of manufacturing cars to sell in foreign markets in competition with makers like Toyota, Kia and others who have been focused for years on manufacture of environmentally friendly vehicles.
The questions presented are whether the Chinese can take advantage of the economic opportunity presented by the arrogance of the US consumers, and whether the US public can recognize and overcome its arrogance and convert to a more environmentally conscious attitude before other developing countries like China can effectively take advantage of the weakness that current attitudes creates. Unless and until the US consumers and policy makers can get their collective act together, the greed and arrogance of the US public will serve as an attractive economic resource and competitive advantage for developing nations seeking to increase industrialization and prosperity.
In the past, debate about the Kyoto Protocol of 1997 has bogged down over the issue of differentiated responsibilities. The US negotiators, predominantly from the conservative camp, have demanded that lesser developed or industrialized countries like China should match emission reductions called for on the part of the US. In response, the developing countries have argued that the US got rich off of industrialization and pollution that has created the existing crisis and was in no position to deny those countries the right to develop as the US has done. In fact, they argue that the US has greater responsibility for emission reduction because it had a greater role in creating the mess that the world now must collectively address. At this point the discussion has broken down and the US has refused to sign the Kyoto Protocol. With the expiration of the Protocol comes the new conference in Denmark [U.N. Climate Change Conference that will be held in Copenhagen this December]. Subsequent developments in climate change and scientific evidence of accelerating deterioration lend urgency to the debate. In addition, the importance of climate change to sustainable economic growth has also risen.
The opportunity for the Chinese in this situation is to focus on the development of technologies that limit or reduce carbon emissions while providing manufacturing and industrial production capacity that is needed for economic growth. For example, the growth of the auto industry in China is staggering. More Chinese are able to own a car now than ever before. The development and production of alternative energy and low emission vehicles would not only further Chinese goals for CO2 limits, but would provide potential export capacity for those countries seeking to meet emission targets but that lack capacity to produce low emission vehicles. This is the “green industry” model that Obama refers to but which the US public is slow and resistant to embrace.
This arrogance on the part of the US public, including both politicians and consumers, will continue to be a weakness that developing countries can exploit. At present, the bulk of growth in sales for US based car manufacturers comes from overseas markets. Though stepping back from the brink of oblivion through bankruptcy, government bailouts and reorganization, these companies still have not been able to convince the US consumers to purchase energy efficient and low emission vehicles. Their near term future depends upon sales to non-US consumers of products manufactured by US workers. However, if China succeeds in developing a strong production capacity for alternative fuel and low emission vehicles, it can continue on its development path while competing effectively with the US for those foreign markets.
At the same time, China has nowhere near the saturation level that the US market has regarding automobile purchases. A recent study suggested that the US was approaching the point at which there was one vehicle owned for almost every licensed driver. In contrast, China may only have less than 10% saturation in the coming decade. If incomes rise to the level that allows more Chinese to purchase cars, the population provided an almost unlimited market potential. In any event, the demand will almost certainly outstrip supply and manufacturing capacity for quite some time. Think back to the US during the inception of Henry Ford and you can grasp a comparison. Yet the difference will be that the Chinese will start with the production of environmentally sensitive products while the US will still be in the process of retooling to manufacture a different type of vehicle that might satisfy US consumer tastes. At the same time the US manufacturers would be stressed with the duality of manufacturing cars to sell in foreign markets in competition with makers like Toyota, Kia and others who have been focused for years on manufacture of environmentally friendly vehicles.
The questions presented are whether the Chinese can take advantage of the economic opportunity presented by the arrogance of the US consumers, and whether the US public can recognize and overcome its arrogance and convert to a more environmentally conscious attitude before other developing countries like China can effectively take advantage of the weakness that current attitudes creates. Unless and until the US consumers and policy makers can get their collective act together, the greed and arrogance of the US public will serve as an attractive economic resource and competitive advantage for developing nations seeking to increase industrialization and prosperity.
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