Political Compass #18: Better healthcare for those who can pay for it.

Great Debates
1

Many political debates here have included references to The Political Compass, which uses a set of 61 questions to assess one’s political orientation in terms of economic left/right and social libertarianism/authoritarianism (rather like the “Libertarian diamond” popular in the US).

And so, every so often I will begin a thread in which the premise for debate is one of the 61 questions. I will give which answer I chose and provide my justification and reasoning. Others are, of course, invited to do the same including those who wish to “question the question”, as it were. I will also suggest what I think is the “weighting” given to the various answers in terms of calculating the final orientation.

It would also be useful when posting in these threads to give your own “compass reading” in your first post, by convention giving the Economic value first. My own is
SentientMeat: Economic: -5.12, Social: -7.28, and so by the above convention my co-ordinates are (-5.12, -7.28). Please also indicate which option you ticked.

Now, I appreciate that there is often dissent regarding whether the assessment the test provides is valid, notably by US conservative posters, either because it is “left-biased” (??) or because some propositions are clearly slanted, ambiguous or self-contradictory. The site itself provides answers to these and other Frequently Asked Questions, and there is also a separate thread: Does The Political Compass give an accurate reading? Read these first and then, if you have an objection to the test in general, please post it there. If your objection is solely to the proposition in hand, post here. If your objection is to other propositions, please wait until I open a thread on them.

The above will be pasted in every new thread in order to introduce it properly, and I’ll try to let each one exhaust itself of useful input before starting the next. Without wanting to “hog the idea”, I would be grateful if others could refrain from starting similar threads. To date, the threads are:
Does The Political Compass give an accurate reading?
Political Compass #1: Globalisation, Humanity and OmniCorp.
#2: My country, right or wrong
#3: Pride in one’s country is foolish.
#4: Superior racial qualities.
#5: My enemy’s enemy is my friend.
#6: Justifying illegal military action.
#7: “Info-tainment” is a worrying trend.
#8: Class division vs. international division. (+ SentientMeat’s economic worldview)
#9: Inflation vs. unemployment.
#10: Corporate respect of the environment.
#11: From each according to his ability, to each according to need.
#12: Sad reflections in branded drinking water.
#13: Land should not be bought and sold.
#14: Many personal fortunes contribute nothing to society.
#15: Protectionism is sometimes necessary in trade.
#16: Shareholder profit is a company’s only responsibility.
#17: The rich are too highly taxed.

*Proposition #18: * Those with the ability to pay should have the right to higher standards of medical care.

SentientMeat (-5.12, -7.28) ticks Agree.

Another proposition which I feel has conservative bias - I suspect few people would advocate preventing people buying medical care privately, but the necessary caveat to my Agreement is huge:
So long as they contribute to universal healthcare AS WELL.

The consequences of non-universal healthcare are plain, and perhaps manifest themselves most starkly in the case of cancer patients. I personally know, and have read here on the Straight Dope, of people who have contracted cancer while working in a job which left them either unable to afford insurance or, at least, unable to afford the insurance after the current policy expires when enormous premiums due said pre-existing condition are required. They have to sell their house to afford treatment.

This nightmare is almost unimaginable to me, a beneficiary of universal healthcare: That, in a country of plenty where so much goes to waste, citizens unlucky enough to develop cancer before retirement must have that pain compounded many times over by being forced to cash in everything they have saved and worked for in their entire life, just to stay alive. It is a horror story from history, or from the developing world, not here in the 21st Century.

Imagine if such a condition could be accurately predicted when young - why, it would affect one’s entire life. Would you think twice about marrying somebody if losing your house to cancer care bills was on the line, years hence? Could one ever go on holiday or buy a nice car if, in the back of one’s mind, those luxuries were eating up funds required to save one’s life in decades’ time? Is the predicted cancer sufferer doomed to watch everyone with an all-clear prediction spend their money frivolously throughout their carefree lives?

The science of prediction, screening, is developing apace, and it would be economic suicide for a private health insurance company not to stipulate a test for likely future medical needs of new customers. An absence of universal healthcare leaves vast differences in who pays what simply to an accident of birth: I can think of few things more unjust in a civilised society. Cancer (or of course any number of other tragic medical conditions) is bad enough to have to deal with, but the horror of also having to somehow pay for all of the incredibly costly treatment oneself is, I feel, a bigger burden than a single individual ought to have to bear. It is what happens in the Third World, for pity’s sake!

But I digress. The proposition asked about whether private care (whether or not it is actually of “higher standard”) ought not to be available for people to buy. I believe Canada has such a system in force, but if so it is certainly an atypical welfare state in this respect. Here in the UK, so long as you have made your contribution to the universal healthcare system you may pay again for private care, which I feel is a perfectly reasonable approach.

2

Agree.

Healthcare is no different from any other “necessity”. People with more money have better clothes, better food, better houses, and… better health care. Unless one advocates a completely egalitarian society, I don’t see how one can disagree with this.

But advocating mandatory universal healthcare, as SM has done, harkens back to “from each according to his ability, to each according to his need.” While I might willingly help someone in need (of healthcare), that need does not create an **obligation ** for me to help that person.

3

Ticks agree with no caviots. The question seems simple enough without elaboration. Not going to get into the whole Universal Healthcare thing in this thread. By and large Americans don’t seem all that enthused about it, or we’d have a similar system (and a similar rate of taxation) as seen in Europe.

How often does this really happen in the states? My grandfather was treated for stomach cancer in Tuscon and he was a day laborer (he died anyway unfortunately before I was born). Do you have any kind of cite on the frequency that the poor or even middle classes have to sell their homes to get medical treatment? Its a good anacedote, and I’m sure it happens, but I don’t think it happens all THAT often.

You seem to be assuming here that wealth is by and large inherited. I was born poor, grew up lower middle class and am now pretty well to do. None of it was an ‘accident of birth’. Social ‘classes’ aren’t fixed.

Agree.

4

I’m merely arguing that “willing” contributions would not by any means provide universal care, when taxation could. I am not necessarily arguing mandatory universal care: I wish I could believe that universal care might come about without taxation, but I’m afraid it seems mere wishful thinking.

5

-2, -3.28 Agree

I see the question as worded as a way to catch some people who would infer something the question does NOT imply. The more knee-jerky among us would read the proposition as implying that the poor deserve lower quality of care – which is not what the statement says.

What’s more, the response does not even need the caveat about “also contributing to universal care” or whatever. It’s a question of retaining the ability to choose to obtain more of something that is of value. Whether a baseline common level of that value should be established, is an independent question. Also, this is a case in which making something more available to paying customers need not deprive the non-paying, it may even aid the indigent since demand by paying customers can lead to the creation of some surplus capacity that may be then discounted or subsidized for use by the less wealthy – and let’s face it, “so, die if you can’t afford it” may be an objective expression of cold facts, but it’s contrary to the avowed values of our common civilization.

6

-2, -0.5

Agree, and also agree with universal “health safety net”, but would like something akin to a government ‘mandatory health insurance’, much like mandatory car insurance. Those who can’t afford the insurance get the basic level of government sponsored care, paid for by taxes.

Having the companies determine whether or not you get insurance, is, IMO, heading towards semi-slavery. Such terms should not be left to companies, with the huge imbalance of bargaining power, to decide. People should have the right to life.

7

No, that point about vast differences in health bills being an accident of birth pertained to whether or not you got cancer at the wrong time of life.

My point was that for it to happen at all is quite surprising for Europeans, Japanese, Australasians and Canadians, at least. I cannot provide hard figures, but this article parallels the experiences of those few people I mentioned.

Well, not the ones who vote at any rate.

As for the caveat not being “necessary”, I explained at the start of all of this that I felt some questions required more explanation than others as to why I answered the way I did, and invited everyone to provide caveats to their answers if they did not like the question for one or another reason.

8

As I re-read your OP, I have to come to the conclusion that you actually DISAGREE with #18. There is no caveat offered by the statement, so by introducing one as you have, you have disagreed with it. Maybe you didn’t mean to word your caveat so strongly, but you did.

You are saying that you only have the right to get better healthcare if you have paid into a system that allows everyone to get basic coverage. That is **not ** what #18 is saying. If you are unwilling to let go of that caveat, then you need to disagree.

9

Conclude as you wish: I believe that those with the ability to pay should have the right to higher standards of medical care.

10

I agree with the proposition, with the understanding that it is not incompatible with providing universal basic health care for all. You get hit by a truck, have a baby, get stabbed, etc. and sure, you should be taken care of whether you can afford it or not. I take this as a basic tenet of Christian morality- Jesus said “Whatsoever you do to the least of my people, so you do unto me.”

On the other hand, if you have money to burn and you think you need to have 20 cosmetic surgeries on your nose or get your gut stapled shut or a breast implant, knock yourself out. You’re entitled to determine the level of health care you receive as a benefit of your wealth.

11

What if they don’t “contribut to universal healthcare as well”?

12

Then the rules need to be changed so that they do. I would still not deny residents of so uncivilised a country the right to private care.

13

What most of you could probably agree on is the system we have here in Switzerland. Basic health insurance is mandatory. Those who are below certain income levels (depending on number of children etc), get state subsidies to pay the premiums. The insurance companies are not allowed to make profit on the basic insurance. But they have a range of additional insurances you can buy, ranging from private care in hospital (meaning more amenities like tv, single room etc but no difference in medical care) to policies which include alternative medicine and also insurances for dentistry. They cost more and insurers are making a profit on those.

I do think that this is are very fair system. Everyone has a very good basic care which also includes medication and those who want to spend more can either do so by buying additional insurance or by spending money privately.

14

Apart from Hilary Clinton, you mean? :wink:

Do you believe the flip side of this - that those who are poor should not receive the same level of health care as the rich?

I would agree with the original proposition, but I think the problem is that whatever level of health care the rich receive will be the default for everyone else as well. I am not talking about cosmetic surgery, either.

What level of health care are we talking about establishing as universal here? And are you prepared for the yelling when somebody who paid taxes towards the system needs an incredibly expensive operation with a 20% success rate because they have cancer and will certainly die without it?

What’s the matter with you? Don’t you CARE? People are DYING, and you want to tell them it costs too much to give them HOPE! It’s less than a dollar a week per taxpayer, you monster!

Etc.

If you are talking about some absolutely minimum standard guaranteed, that would be fine with me. But I have no confidence that this standard won’t inevitably be raised to the ceiling and beyond once it becomes clear that someone is going to be denied care, and that cute little children are going to die as a direct result.

Basic and minimum is basic and minimum. It does not mean everything that might sometimes have some chance to do some good for the moment, or we wind up exactly where we are.

Regards,
Shodan

15

Actually John, I’ll retract that “So long as…” in the addendum and replace it with merely “after…”. I am not making my agreement a condition, merely providing an explanation of why I think my answer might be misleading given the phrasing of the question.

16

Well, sorry I nit-picked so much on this with you. It’s not like your -5/-7 rating would change all that much anyway. There ain’t that much more room over in that bottom left corner. :slight_smile:

17

If the rich are using the universal care they’ve already paid for, the level should be equal. Otherwise, they get what they further pay for.

I’m prepared to leave those decisions in the hands of professionals, as they are now even in private corporations. I would be surprised if these “borderline” cases took up more than a small percentage of health spending.

Basic minimum universal care should include eg. child cancer treatment, agreed? If not, how is it universal?

18

Maybe it’s just me, but the statement:

seems to me to imply that money should determine the quality of health care available. Remember, the statement says “higher standards”, not other options or more choices. In Canada right now, there is huge public debate over this possibility, and statements like this one:

scare me because it implies that something as basic as health should be determined by the ability to pay. Health care is not a necessity comparable to clothing, food or housing. It is at the root of human life. The first and only thing one can lay total claim to is one’s health. It is the most basic of human rights, to have the right to have one’s health protected and treated when necessary. Clothes come in all shapes and sizes, and in all levels of quality, but health care is only the best option available.

That said, one can look at universal health care and argue that systems of privatization can be good things, in the sense that they have a real and definite reason to provide faster, cheaper and more efficient services. Right now in Canada we are having huge problems with waiting list for things like MRIs and CATscans and such. Elective surgeries can be put on long delays because of doctor and/or money shortages. These situations leave everyone out, but in this case the option to pay for a private clinic’s MRI services, for example, could be a good thing. If you can pay for it, great, and you get your MRI and off you go. If not, you can still get it through the public system and unless it’s life-or-death urgent, you can live with the wait. That way everyone is still even in terms of what they can get but some can get things faster. This would also likely lessen the burden on the public system and shorten waiting times considerably.

So that political compass statement, as it’s worded, disagree. I can’t think of any justifiable reason why health care should be separated by wealth. That’s barbaric, backwards and highly divisive. Everyone should have access to the best health care available. Note I am not talking about elective or cosmetic things like nose jobs for purely personal reasons or tummy tucks or whatever. I’m talking about health.

19

Strongly Agree.

The government has a duty to provide a certain minimum amount of care but I’m a strong believer than there should be no limit on the maximal amount of care, after all, its your money.

In the end, it comes down to choice, I think its fairly evident that its impossible to have the very best healthcare for everybody so there needs to be a way to ration it. Of all the ones that are possible rationing by wealth seems the best we can do.

20

I was talking about marginal cases, mostly.

Suppose there is my theoretical operation with a 20% success ratio. Is that included under “basic”, or not?

That’s fair enough. Are you prepared to back them up when they deny treatment to someone, but the rich can buy a kidney transplant?

My impression is that they are a major factor. I don’t have a cite, but I was told once that 30% of Medicare spending was incurred during the last six months of life. This was from the head of medical review at the hospital I used to work at.

For example, my cousin and her husband are both doctors. One runs an NICU in the poorer section of her city, the other specializes in pulmonology.

Most of their patients die, or, if they live, are severely compromised.

Would their services be covered under universal health care, or not? If you do, it won’t do much good. If you don’t, some patients will definitely die that wouldn’t if my cousin or her husband treated them.

“Universal” in the sense of “covering everyone” is one thing. In the sense of “covering everything”, it is quite another.

My theory is that we will never get a handle on spending until we implement some form of rationing, and accept that we are letting people die in order to save money. We can’t sugar-coat it any more than that.

And I think things will have to get much worse before we can accept that.

Regards,
Shodan