4) Protecting consumers from faulty products
An area of deep importance to every American is the area of food and drug purity. The dawn of industrialism coupled with increased transportation options meant a great variety of new and helpful products such as packaged foods, canned goods, and medicines. Unfortunately, there was little to no regulation on these products at the local or federal levels. This resulted in adulterated food products, both foods that were diluted or polluted in order for manufacturers to get more money for less product and foods that were adulterated with toxic chemicals or heavy metals. (Notice that this penchant for adulterated foods and drugs occurred during the heydey of unrestrained capitalism. Market forces are not capable of controlling everything.) Of course, in any trade or buying scenario, the principle of caveat emptor, but reason suggests it is supremely unethical for a government to turn a blind eye to intentional food or drug adulteration. Even those skeptical of FG involvement in general understand that ensuring consumer protection from dangerous products is a social good. Particularly in the case of faulty food and drugs, it becomes important to have a strong set of consistent standards along with the means and wherewithal to enforce said standards. State governments do not have the resources, ability, or jurisdiction to accomplish this in a meaningful way. Roosevelt recognized this and passed the Pure Food and Drug Act in response. This became the Food and Drug Administration (FDA), the need for which has only grown as the market for processed foods, pharmaceuticals, and imported food and drugs has grown. A secondary example in this area is the United States Department of Agriculture (USDA). The role of the USDA is limited to agriculture, but it still provides consistent and resource-ready protection from faulty products. This protection, while not directly outlined in the Constitution, is a positive and necessary part of ethical and welfare-promoting government.

Now, having gone through these 5 areas that are not specific, designated roles of the FG and argued that FG involvement is supremely beneficial to American citizens, let me apply the whole kit and caboodle to HCR. It's just what you've been waiting for, I know.

1. Simplicity of Trade
Currently, health coverage is a strange, capitalist wonderland. Don't get me wrong, capitalism isn't a bad thing. When the market for something that should be as ubiquitous as health care becomes a strange, capitalist wonderland, there might need to be some fundamental changes. I use "wonderland" in the hopes of bringing to mind images of Lewis Carroll and his narrative of Alice's unruly adventures. In the realm of health coverage, every state sets its own regulations for who can sell and what can be sold. I am not advocating that get rid of this formula willy-nilly. Neither is the President (WH). Neither do either of the other majority bills (House (HR) bill [also here] and Senate (S) [also here]. The Congressional minority (GOP) have proposed allowing insurers to sell across state lines. I'll get to the pros and cons of that momentarily. This roller coaster of regulations becomes problematic in that there is no standard, foundational set of minimum regulations. Thus both the insured and the insurers have to revamp and retool in each state. Furthermore, each insurer has different combinations of benefits, types of coverage for different premiums, and uses equivocating terminology. This is not the idea situation for a comparison shopper, to say the least. And comparison shopping for health coverage is certainly more vital, with the outcome more essential, than any other shopping we might do. By allowing FG oversight, we are allowing for the creation of a set of minimum coverage standards (that leaves everything else up to the states, notably) and providing an exchange that clarifies comparison shopping for the health coverage consumer.

*As to allowing insurance sales across state lines: as I have thought about this, it seems that the only way this will not turn into a mirror of the credit card "find the state of least regulation and pelt everyone from there" situation is to still have a federally established set of minimum standards and regulations. Thus, you still end up with...federal regulations. Otherwise, allowing interstate health coverage sales is simply an almost total deregulation of the insurance industry that ends up stripping states of their power to set regulations within their borders. This might even have the result of forcing states to refuse to allow health care outlets to accept plans they deem unfit, leading to more state regulations and monies invested in enforcing them. Not really a win for states or consumers.

2. Bolstering private investment
I have previously mentioned that pharmaceutical R&D if often supplemented by FG monies. In the scenario of HCR, this would certainly continue. Another aspect of this bolstering of private investment comes with the mandate attached to the bill. In order to facilitate the removal of denials/exceptions based on pre-existing conditions as well as the ability to drop enrollees, the WH bill, the HR bill, and the S bill call for mandate coverage purchase (with a fine in the form of a tax should one choose not to purchase coverage). This much maligned mandate is actually a bolster to enable insurance companies to function as they're meant to (and, unfortunately don't always). All insurance depends on a risk pool: the bigger the risk pool, the more easily companies will recoup their payouts. Furthermore, the group of Americans who have the highest rate of uninsured (18-34 year olds are by and large going to be far less likely to file claims than the demographics currently most insured. By adding the vast majority of this young demographic into the risk pool, companies will have more liquidity, suffer less risk, and be better able to cover the expenses of the ill (a consideration to be taken seriously as the Baby Boomers have entered the demographic that uses their health coverage the most. Having a larger risk pool is better for coverage providers and more advantageous for those who need coverage payouts.

3. Facilitating consistency of coverage/quality
As in other areas, having minimum set of standards at the federal level is greatly beneficial to society. Requiring all insurance providers to conform to a single set of minimum standards means that no matter which company is providing coverage, the consumer is assured a certain set of coverage and quality standards across the board. This lessens the ability of unscrupulous insurers to game the system by offering sub-standard coverage at ultra-low to those who only discover the coverage and quality gaps when they need coverage the most. Having nationwide minimums means that health care providers are always assured of payment for a given set of circumstances. This reduces the risk for enrollees that claims for treatment they have received will be refused and ensures doctors that basic care costs will always be covered regardless of the insurer with whom they are dealing. A nationwide minimum set of coverage standards sets a consistent foundation of coverage and quality for every insurance purchaser.

4. Protecting consumers from faulty products
The previous point briefly touched on how minimum standards prevent unscrupulous insurers from bilking consumers when their health care is in the balance. When insurance fraud prosecution is limited to each state, fraudulent insurers have the opportunity to move on to another state and perpetrate the same fraud there. Federal oversight makes fraud prosecution simpler and more expansive even when states continue to hold regulating powers. The presence of federal minimum standards places federal resources at the disposability of state needs. The greatest tool offered by the HCR bills is that of the coverage plan exchange. In order to participate in the exchange, insurers must meet minimum standards of coverage as well as provide clearly comparable information on benefits and providers. (For a PDF outline of the plan, including the Exchange, see the address at the bottom of the post. This provides the consumer with clear comparisons and the confidence of all plans being vetted for proper coverage. In other words, faulty insurance products will be significantly avoided through both the inclusion of federal oversight and the creating of insurance exchanges (whether one nationwide exchange or federally-overseen state exchanges).

5. Protecting consumers from unscrupulous behavior
As in the above area, both federal oversight and transparent insurance exchanges will be able to cut down on unscrupulous behavior both by insurers and providers. Of course, these HCR bills don't go as far as they could in eliminating unnecessary charges and fraudulent claims, the simple act of creating more accountability moves farther down that path. Helping the system to move toward less unnecessary testing and away from such a great amount of per-procedure payments will add to progressively eliminating unscrupulous behavior on the part of a percentage of providers (note: I realize that many doctors who do a plethora of procedures don't do so because they are unscrupulous, but the end result is unintentional system-gaming. It is good to move away from a system that encourages this. For an interesting article on how too many procedures is worse for us all not better, read this. It's a little long, but worth it.) Federal involvement also helps states to pursue unscrupulous insurers and the small minority of intentionally unscrupulous health care providers with greater ease (similarly to how it has done so in other areas of fraud, etc.).

All right. I seem to have gotten rather lengthy on this point as well. I hope you can see that merely because something is not a specifically designated area for government involvement (S or FG) does not mean that involvement is not positive and beneficial, even necessary. Further, I feel the need to point out that an application of governmental involvement not being specifically mentioned in the Constitution is no reason to label it "un-Constitutional." A thing is un-Consitutional because it contradicts or breaks the Articles or Amendments of the Constitution, not because it suggest a new application of government roles, in this case, regulating commerce as necessary to improve the system of health coverage in the areas I've outlined above. Each area has historically been deemed a proper one for FG involvement, and each area is a part of the commerce of health care.

Whew. That's certainly quite enough for one post. In our next episode: Are we creating a too narrowly run system with HCR, even....*gasp*...resorting to socialism??? Hm. Perhaps my tone there is a spoiler for my position. haha. Until next time.

PS
Excellent article in the NYT about why something must be done.
Even with a requisite skepticism of the Times, it's quite thought-provoking.
Brief comparo of the three proffered bills
The PDF of the President's plan can be found here: www.barackobama.com/pdf/issues/HealthCareFullPlan.pdf (I couldn't link it the way I wanted, likely because it's the automatic download address. Apologies.

Having thoroughly discussed (to the tune of two lengthy bog posts) my first premise, I am now moving on to the second: it is not the designated role of government to run health care.

The argument that the federal government should not involved in any way, shape, or form in the health care market/system is often predicated on the point that providing for or over-seeing health care and health coverage is not one of the 18 Constitutionally designated roles of Congress--which get applied broadly to "federal government." (The fact that this stance ignores the very broad--purposefully so, I would submit--applications of "making all laws..." notwithstanding.) I would agree that health care is not a specifically designated role of Congress or the federal government as a whole (the FG). Like the premise that health care is not an inalienable right, this premise could be hotly debated. Also like the previous premise, whether it is true or not is no reason that Congress or the FG cannot or should not get involved in an area of commerce or industry. There are five main reasons I wish to address in which government (state and federal) involvement is a positive, and largely necessary thing:
1) to facilitate simplicity of trade
2) to bolster private investment in risky/capital heavy endeavors
3) to facilitate consistency of coverage or quality
4) to protect consumers from faulty products
5) to protect consumers from unscrupulous behavior

2) Bolstering private investment in risky or capital heavy endeavors
There are many quite precedent-setting or socially beneficial endeavors that post significant risk or require significant capital investment to begin/complete. In these areas, government involvement can make or break the project. Various industries depend on federal grant monies to fund research and development, particularly into areas where there is a high risk of non-return on investment or into new, untested avenues. As a firm capitalist, please understand I support all private endeavors into development, into invention, into creation; as a pragmatist, I know that private investors cannot always enter new and risk-filled areas without bolstering. A major piece of the westward development and industrialization of America, the Trans-continental Railroad, was established with both FG land grants and subsidies. Governments, both state and federal, have more ability to raise and guarantee capital than most private investors. This makes their involvement in large-scale or risky endeavors positive, and often necessary.

3)Facilitating consistency of coverage and/or quality
There are three main examples that support the idea of government involvement in order to facilitate coverage and quality consistency. The first is one we have visited already: public works. Not only does government involvement simplify trade and implementation of public works, it insures that a minimum standard is adhered to by providers. Providers who fail to comply must fix the problems or they are replaced by another provider. A second example is that of interstate highways. (The interstate system is also an example of area 2, a capital heavy investment, btw.) In order to feasibly develop the most advantageous coverage and guarantee a minimum standard of safety, federal regulation and investment was necessary. This investment has been both long-term (the main impetus behind this came from a 90/10 split fed/state). Without the FG, there would likely be no interstate highway system in this country due to the extremely high overhead and big-picture planning necessary.

Before I move on to point 4 and 5, I'd like to take a moment and re-integrate education into the discussion. In my last posts I discussed the benefits of education as parallel to the benefits of widely affordable health coverage and care. I also pointed out that numerous of the founders and early colonial leaders saw the benefits of a universally accessible education, to the point that publicly funded education was discussed and proposed. Now, I'm sure the point will be raised that both ideologically and constitutionally, education was deemed at the time to be a state-by-state matter. I would agree that in application it was, and is today largely a state-by-state, or even district-by-district matter. The intervention of the federal government in education has been largely two-fold: providing necessary funds to districts and state that are in need of financial assistance, and providing minimum education standards to which state curricula and programs must accede. Of course, logically neither the Founders nor the Constitution could be expected to specifically address the role of the federal government in our current education system: when both were around, the nation was rather small and loosely bound due to the nature of communication at the time. I feel it is quite reasonable, however to infer from the expressed attitudes of the Founders toward education in general, and the necessity of a general education for the preservation of the republic, that they would understand the practical necessity of federal oversight and supplemental funding. It's just realistic. Like other areas, as this country has grown, the necessity of federal oversight and involvement has grown. In oder to simplify trade, bolster funding, and maintain a minimum consistency of coverage and quality, education must have some level of government involvement. I submit that the area of health care and coverage is at the point where a comprehensive involvement of the FG has become both positive and necessary.

And despite my endeavor to keep the discussion of this premise to a single post, this one looks long. Therefore, I will pause here and continue this episode after the break. haha.

While the ability to receive health care may not be considered an inalienable right, I submit that it is greatly beneficial to our nation as a whole to insure that every citizen has access to health care. Furthermore, I deem it beneficial to insure that said access is affordable. I have noticed a break down of the debate around this point. I emphasize that access should be affordable for good reason. When it is noted that every American should have access to health care, the discussion becomes disingenuous. Those critical or skeptical of HCR that reply that every American does indeed have access to health care. This is true. Any and every American can find a clinic in their area or a hospital emergency room. A hospital emergency room is required to provide care regardless of ability to pay. Every American does have access to health care. But this response is disingenuous because that is not really the point being raised. True access to health care requires affordability. This is why I emphasized at the beginning the difference between health care and health coverage. When proponents of HCR contend that every American should have affordable access to health care, they are really contending that every American should have affordable health coverage. " Why should they?" you might ask. "If they can't afford insurance, who says they should have affordable access health care? Why is it better?" It is better for several reasons:

Like education, health care may not be considered an inalienable right. It is, however, beneficial to society. Particularly where preventative and basic care are concerned, utilizing our collective wealth to provide affordable coverage to the less fortunate raises the collective health standards of the nation. The mere fact that a thing is not an inalienable right should not preclude our willingness to provide it if it is deemed beneficial to our nation as a whole. I will elaborate on this a little more in my next post when I address the issue of designated responsibilities of government.

***Nota bene: some references to the treatment of the poor in Proverbs.
judging fairly brings an established throne
(and on in Deuteronomy)Isrealites commanded to bless the poor
showing favor to the needy honors God
(oh and one in Job) Job lists neglecting the poor as things offensive to God
don't mock or neglect the the poor.
Wisdom reaches out to the poor
This is just a selection of numerous passages that encourage provision for the poor. And that doesn't even count the words of Jesus regarding the poor.

As I mentioned in my last post, I began with three basic premises about health care that I believed necessitated a certain stance on the issue. Through my journey, I discovered that while my premises weren't necessarily false, I had made them more narrow than necessary. I had determined the end to which I thought they pointed without examining whether that application was indeed the only application.

I was going to attempt to deal with my first two premises at the same time, since they are applicationally related, but the post was long. Really long. Therefore, this post will simply deal with the idea that that receiving health care is not an inalienable right. This premise was my reason for determining that it was needless, and possibly dangerous, to force our current system of paying for/providing health coverage in order to insure that every citizen has health coverage or even health care. Now, many of my readers may agree with this premise, some may disagree. Whether or not you subscribe to this premise, my point is this: it is really a reason to walk away from the proposed models of health care reform (HCR), or even going so far as having a government-run, single-payer system. I will admit that I'm not convinced of the superiority of a single-payer system at this time, but I will note that holding to this premise does not make the a single-payer system illegitimate. At this point, you might be wondering how I justify this position. Well, here goes my explanation:

It has long been recognized that it is of particular interest in this country to ensure a general education for all citizens. It is particular because of the fact that America's government is directly enacted, governed, and guided by the votes of her citizens. An uneducated populace is a disaster for a republic such as ours. Even the Founders recognized the importance of education. Thomas Jefferson was a staunch advocate of Thomas Jefferson public proposals for education in Pennsylvania that would tend greatly toward providing public education for said state's citizens. Even George Washington seemed to feel that education was a non-negotiable for maintaining a strong republic capable of rebuffing tyranny. His Farewell Address touches on the importance of education. (You'll find that five paragraphs from the bottom.) In all, the early Americans and the Founders were quite convinced of the necessity of education to the preservation of our republic, even going to far as to propose different methods of providing said education to all citizens. It is clear (and further examination by my readers would make it even more so), that general education is a desirable thing to insure and provide.

Whew. This is getting long. The point to be made above is this: while something like education may not be considered an inalienable right, it is widely (and early on) acknowledged that an education populace is far more beneficial, and even necessary, than an uneducated one. Thus, it is beneficial, and even right, for the government to provide for a general education. This general education does not supplant, undermine, or eliminate privately offered alternatives; but instead, supplements and challenges it. Merely because something is not an inalienable right does not mean that it is not a good and excellent thing to insure to all citizens, even to the point of the government providing the structure and funding for such a thing. I spent a great part of this post outlining this fact using education. Let me spend a small part (part 1b, in fact) applying it to health care and health coverage.

When I mentioned this topic previously, I connected it in kind to the problem with adult inability to deal with unexpected or out-of-the-ordinary emotion in that it is a problem of rearing and education. In order to become adults who value the opportunity to personalize but do not require it, in fact, sacrifice that desire when it's for the best, children must be taught how. For example, I will give you a scenario: parent takes child into a fast-food restaurant and says, "You can have anything you'd like." This happens over and over until the child expects to get what they would like every time. There is no guidance to the child's decision, no instruction teaching them that their choice is a privilege to enjoy rather than right to demand in every circumstance. Now comes an instance when, for whatever reason, the child is unable to order whatever he wants. We all anticipate the result: an attitude, a tantrum. New scenario: a parent offers guided choices. "You may get a hamburger meal. What side would you like: apples or french fries? What drink would you like: lemon slice or iced tea?" On another day: "Today Mommy needs to choose. Let's get chicken fingers and apples, ok? I'll let you choose next time." On another day: "Today is special, you may order what you'd like from the menu as long as you get a sandwich or chicken with it." And so on, offering the child guided choices when appropriate. Now comes an instance when the child may not choose. I think we will all anticipate a much more pleasant response from this child. Child A has become a creature who expects every desire and whim to be fulfilled. Child B enjoys the personalization of his order, but understands that he can't always have what he wants.

(And I do not think this type of scenario is limited to a home experience. I believe there are numerous classrooms and curricular experiences that cater to children's whims and limit their experience to only what they know or want to know.)

The key here is that adults allow children the opportunity to choose while not indulging their selfishness. When we indulge a child's selfishness behind the justification that we want them to be happy, we actually set them up for discontent and unhappiness. A child reared to expect to have things exactly the way he likes every time will end up being a sorely disappointed adult when he discovers that rarely in life do things actually conform to our every personalized whim. Except of course, for my [redacted] sets of icons. :-P (I'll never divulge the information that hints at my selfish weakness for computer individuality. haha) The thing is, individuality can be an incredible strength. Americans revel in the freedom to be individual, to seek their individual well-being and happiness. This isn't a bad thing. We must, however, remember that the primary weakness of individuality is selfishness. Unchecked self-interest is not a good thing for an individual or for society. It is an incredible gift to be able to choose things that fit us, to have the options to listen to the music we like, to have the color car we enjoy, to choose from a plethora of desktop icons and wallpapers. The problem lies when we are unwilling to concede our desires for something better; when we fail to acknowledge that our ability to choose injures someone else; when our determination to have what we want becomes a selfish grasping, when our desires have devolved into petulant whims. Henry Ford is famous for saying, "Any customer can have a car painted any colour that he wants so long as it is black." Amazingly, he sold plenty of just, plain black Model T Fords. His customers knew that if they wanted his affordable, available automobile (alliteration unintentional) they would need to sacrifice their desire for individual color. I am skeptical that his car's colorful limitations would do so well in today's market. The viewpoint has changed. We've allowed our sense of and desire for individuality to become our excuse for self-service and selfishness. It isn't pretty. If we want to restore the nobility of the Individual, Rugged or otherwise, we must purpose to teach children the balance of desiring personalization and deferring to what's best, that using discretion in our choices sometimes means sacrificing our individual desires (particularly those of the whim strain) for what's best, that having a choice placed in boundaries for that best (eg. uniforms in school) is not a removal of some fundamental right to which they are entitled and can therefore express their discontent in any way they choose. When we expect every aspect of our life to fit our personalization plan, we have become petulant creatures of selfish whims. This is not the American spirit of individuality at all; it is something far uglier and even sinister.

This is a long post, and I failed to offer warning. I'm not even sure I managed to say everything I intended. haha. Perhaps that put some readers off. I feel it is important, though. If we wish others, those looking in on us, to see the nobility of the spirit of individuality rather than its pitfall vice, we must, as parents and educators, imbue upon children the understanding of discretion, of care for the best, of sacrificing selfishness for kindness. To me, a significant part of this process is teaching them how to handle their desires for personalization in their lives. The home and the classroom are excellent training grounds for this process. The Individual can be a noble figure when the Individual is taught to look out for his brethren even in the way he views personal choices.

In Flanders Fields the poppies blow
Between the crosses row on row,
That mark our place; and in the sky
The larks, still bravely singing, fly
Scarce hear amid the guns below.

We are the Dead. Short days ago
We lived, felt dawn, saw sunset glow,
Loved and were loved, and now we lie
In Flanders fields.

Take up our quarrel with the foe:
To you from failing hands we throw
The torch be yours to hold it high.
If ye break faith with us who die
We shall not sleep, though poppies grow
In Flanders fields.

Aside from the lack of a comma in her compound sentence, I am bothered by this sentiment. I would brush it off as joking (which the exclamation point would support), but I have read her review-ish statements regarding Twilight, and her joke is only partial. It's why she rather doesn't like the book she is discussing in the review in which this statement appears. I just want to say that I certainly hope at no age to lose my tolerance for romance in its many and varied forms. I don't wish to be so jaded/cynical that I dislike a book or a film or a song or a story because it happens to be a romance. That is all I have to say this barely morning. You may return to your regularly scheduled activities.