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David Katz, M.D.

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What Health Care is Like: Seeking Supreme Analogies

Posted: 03/28/2012 12:45 pm

Health care is NOT like cell phones. Hold that thought.

Apparently, during the already infamously harsh second day for health care reform before the Supreme Court, one of the justices posed this question: If the government can force us all to buy health care, what can't the government do?

The justice then went on to suggest that the government could force us all to buy cell phones.

Why? Because health care is something we might all need some day in an emergency. A cell phone is also something we might need some day in an emergency. If the government can force us to buy insurance we might need some day to address an emergency that hasn't happened yet, it stands to reason they could force us to buy the cell phone we will need to call 911 to get the emergency response.

And if that analogy holds up, clearly we are on the slippery slope that leads to the government taking over our lives and telling us when to tie our shoes and wipe our... Well, you get the idea.

But this is about the worst analogy I've ever heard. If it's the best the justices can do, grasping at straws would be trading up.

Health care is something that every last one of us SHOULD get (i.e., in the form of preventive services) and virtually every one of us DOES get at some point, if not many points in our lives. People can make it through their whole life without a cell phone, and many do. Every prior generation did -- although they, too, had health care.

Health care is something you get without asking for it when you happen to be hemorrhaging, seizing, drowning, or unconscious. When you've been chewed on by a shark, hit by a train, or shot. The situations in which someone forces you to use a cell phone you don't want are -- well, few and far between at best. I suppose it might occur during a ransom negotiation if you are the kidnapping victim. But even then, you don't have to buy the cell phone!

If you don't buy a cell phone, the body politic does not automatically absorb the cost of cell phone use you need but for which you didn't pay. That is exactly what happens with health insurance. You will get health care in an emergency whether you can pay or not -- and the costs are passed along to those who can pay, without our will or consent. To my knowledge, I have never borne the costs of anyone else's unpurchased cell phone. But I do have health insurance. If you do, too, we have both borne the disease care costs of those who do not -- and nobody asked our permission.

Routine use of health care as recommended by expert bodies can save lives and money. I am aware of no such evidence regarding cell phones. In fact, if anything, there is some evidence that routine cell phone use may be causing potentially serious health problems -- but that's a topic for another day.

I could go on, but it's pointless -- because the point is self-evident. Health care is nothing like cell phones, or any of the other things that "might" come in handy during some future emergency: a bulletproof vest, a car, a ladder, a fire extinguisher, a helicopter, a Hazmat suit, a gas mask, a tank, etc. Truly, about the worst analogy I've ever heard.

So, what is health care like?

It's a lot like the police. We all pay for police protection which we might need some day.

It's rather like (non-volunteer) fire departments. Ditto.

It's something like the TSA. We all pay the costs of the TSA -- even those who don't fly! Is that fair? The question may be moot, since we're already doing it. But the events of 9/11 suggest it is fair, since victims of lapses in air travel security could be minding their business in an office building.

It's rather like the military, for which we all pay. We share in the costs of defending the body politic. Sharing in the costs of defending our bodies would be much like that.

To my knowledge, there is neither a Democratic nor a Republican uprising to eliminate the nation's police, or the military.

Health insurance is also like Social Security, and... a lot like health insurance, in the form of Medicare. We are all required to support Medicare.

It's true, some on the far right have called to have Medicare dismantled. But the program is so popular among seniors that one of the more effective attacks on health care reform was the suggestion that it would undermine Medicare. The bottom line is, we are all "forced" to pay for health insurance already -- and those of us who don't live past 65 will never benefit from it. But it's a done deal, and not going away.

One of the arguments against my analogies might be that some of the services -- such as police and fire -- are provided by state or local government, not the feds. Much is made of that distinction. Far too much, in my opinion.

For one thing, I am an American. I was born in California, and have lived in Massachusetts, New York, New Hampshire, and Connecticut. I have never lived in another country, and never seriously considered it. I have been an American, and proud of it, every step of the way.

For another, I cross state lines all the time. I was in Maryland and Pennsylvania last week, and will be in North Carolina tomorrow. I don't want to review a tome of fine print to know what fundamental rights and protections are left behind at every border.

We also wind up with a potential problem of inequity if health care access changes at state borders. If New York requires coverage and New Jersey does not, what happens if an uncovered person from New Jersey gets into a bad car crash in New York? I don't think anyone -- Supreme Court included -- is suggesting they be left to bleed in the street. But when they do receive emergency care in a New York hospital they can't afford, who pays? Presumably, the citizens of New York -- who now pay a "tax" of sorts on behalf of their neighbors from New Jersey.

Whatever one thinks about state autonomy, we are Americans -- and some benefits and burdens work best when shared. I take comfort in the fact, for instance, that Maryland, Pennsylvania, and North Carolina have police and TSA as we do here in Connecticut -- and that all are under the same protective umbrella of the U.S. Military. Hurrah to that.

And regarding that military, by the way: It is the very epitome of a socialist institution. Socialism has been the rallying cry of opposition to health care reform and almost every other initiative of the current administration. But this and every president is commander-in-chief of a socialist military.

And while we're at it, the Catholic church, and every other major organized religion, is also pretty socialist. What, exactly, did we think organized religion was "organizing"?

So here we have it. Not an attempt at Constitutional scholarship -- I readily acknowledge I'm not qualified. Just an effort to identify some supreme analogies. Or, at least, analogies that make a bit of sense.

Maybe if the heavy hand of a government run to socialism can require us to purchase health insurance, they could ALSO require us to pay for police forces, fire departments, the TSA, Medicare, and our military.

Oh, wait -- they already do. And yet still, I tie my shoes and wipe my... nose when I decide.

That was a close one! But apparently, I won't be forced to buy a cell phone any time soon.

Can somebody lend me one? I'd like to call the Supreme Court to let them know.

-fin

Dr. David L. Katz; www.davidkatzmd.com
www.turnthetidefoundation.org

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HUFFPOST SUPER USER
KDog76A
Radical Centrist
07:37 PM on 04/02/2012
It all sounds great on paper, but the general rule of thumb is that larger the role of the government, the worse the bureaucratic nightmare.

Before Obamacare I paid my co-pays, and my deductable $500, then it was free, now I have a gap coverage provider that I have to file everything with until I reach $1500 (they will pay the $1000 difference but on a more select bill of faire. I go for weekly appointments, so now I get a dozen pieces of mail a month for my treatments. there is mailing this and that and signing this and this is only covered for that, and you have to try this med since the better one isnt covered unless you're on the other for 3 months and it doesnt work.

Wasn't it supposed to get easier? Wasn't it supposed to get cheaper?
iflew
Pro Publiae Bonae
11:42 PM on 03/31/2012
Secret informants who clean out waste baskets in the SCOTUS have spread rumors that health care deliberations are considering expanding the scope of the case so as to enable insurance companies to collect premiums "as whatever they want, and deductibles as whatever they damned well want!". More news to follow next janitorial shift change. News Date 04/01/2012
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HUFFPOST SUPER USER
KDog76A
Radical Centrist
07:39 PM on 04/02/2012
Isnt that already the case?
03:52 PM on 03/29/2012
This article seems to have a point if you pick and choose which analogy the justices used. Cell phones was one of several including brocolli. On its face a cell phone is not comparable to health care. At issue is not whether healthcare for everyone is a noble goal the issue it is at what point is the government limited in compelling an individual to purchase ANYTHING- cell phone, insurance. And as the administrations attorney stated if the bill is upheld there is NO LIMIT. The government can require you to buy anything it can make a case for. And if the bill is upheld BOOYA precedent. should. For now its okay because the issue is at hand. But as the justices noted what about cell phones. If a case can be made, the government can compel you to purchase it. As usual, the entire point of the analogy flew over your head.
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HUFFPOST BLOGGER
David Katz, M.D.
Director, Yale Prevention Research Center; Editor-
09:19 PM on 03/29/2012
The very point of any analogy is to compare things that are ANALOGOUS. If they are not, the comparison is invalid, and pointless. The argument "they can make you buy B if they can make you buy A" is only defensible if A and B are alike in important ways.

Health care is like the military- something we support collectively, because it supports us collectively. Something that can 'cost' any one of us if it isn't there. Something that can't be missing for some of us without potentially hurting all of us. Something for which we share costs and benefits- whether we choose to, or not.

A requirement to purchase health insurance is very much like the obligation the government already imposes on us in the form of taxes to support our military. The entire threat of government abusing a new power depends on the analogy that illustrates the potential abuse. As goes the analogy, so goes the threat. In other words, the latter is as utterly invalid as the former. A point that, if I may, seems to have flown over your head, even as it was flying over the cuckoo's nest.
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HUFFPOST SUPER USER
KDog76A
Radical Centrist
07:20 PM on 04/02/2012
It all sounds well and good, but the basic cost of healthcare goods and services aren't going down, they are going up, and so are premiums.

And as far as taxes to pay for the military, thats a bad analogy for the Healthcare law as it stands. Healthcare requires us to pay a private middleman... the insurance company... there is no military "exchange" and on top of that half the population doesnt pay income tax, so half the population doesnt pay for the military at all. For healthcare to be like a tax levy, we would need it to actually be a tax... and have universal coverage... Technically speaking "medicare for all" would have been the best route...

Not that I necessarily think thats the best idea in a country that spends $2 for every dollar it brings in and is closing the gap on haveing to pay every dollar the government collects to pay off our obligations to other nations.
06:15 PM on 03/28/2012
We can't give in to thinking everyone should have health care because that would be like saying everyone, every life in our country is precious and valuable and worthy of the best care we can offer. That violates GOTP tenets.
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HUFFPOST SUPER USER
KDog76A
Radical Centrist
06:31 PM on 04/02/2012
or you could be like the Irish and freak out ovethe austerity measures to cover their universal heathcare since its bankrupting their country
This user has chosen to opt out of the Badges program
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Fourcents
All for One and One for All
05:23 PM on 03/28/2012
Appears that the root cause of opposition by middle class is suspicion of government. The corporations spent decades and millions to convince some of the middle class government is bad. As soon as they get sick reality arrives.

Conservatives are holding opposing facts in each hand and making them completely compatible like the eldly lady who wanted Government out of here Medicare. How can anyone say their "government of the people" is bad? Because many TV ads have made up "death panel" stories. Fear of conspiracy makes people do things against their own interests then they can't understand why when the truth arrives.

Conservatives often seek profit through graft and corruption and use ignorant people to aid and assist. A conservative friend's mother never applied for Medicare or Social Security because she was convinced it was bad and broke until I explained otherwise. Buth they are still suspicious of me, LOL Could it be a species inpediment? LOL
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dpkjj
Peace on Earth
04:32 PM on 03/28/2012
Ah, Dr. Katz, I am running out of different ways to say "brilliant article."
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thejazz
I'll burn that bridge when I come to it.
03:22 PM on 03/28/2012
Health care is health care. Health insurance is not health care. It is access to health care and access can come in many forms. The individual person is the basic unit of the economy. You would think it would be in the countries best interest to keep that unit maintained and in as productive working order as possible, taking into account human nature and all. And do that in the most efficient, cost effective way possible. But no, this is the United States. And health care is a 20% GDP make work/profit project.

Excellent article!
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HUFFPOST SUPER USER
KDog76A
Radical Centrist
06:44 PM on 04/02/2012
If the individual person is the basic unit of the economy, and half the population of the economy pays no income tax, does that mean the value of our economy is zero?

Oh wait its negative $16 trillion right?

You would think it would be in the countries best interest to keep that unit maintained and in as productive working order as possible...

But over half the population is either too young or too old to work, and 10% in the working age bracket are unemployed and another 10-15% are underemployed.

Thats a lot of mortgaged units
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demisfine
Often correct, NEVER right.
03:22 PM on 03/28/2012
How is it that lesser nations like Canada and Great Britain can manage Healthcare for all their citizens?
Can it be that the US is too busy policing the world, too busy subsidizing Big Oil, too busy padding the portfolios of politicians, to afford Healthcare for all?
08:18 PM on 03/28/2012
LESSER nations? They might take exception to that.
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HUFFPOST SUPER USER
KDog76A
Radical Centrist
07:27 PM on 04/02/2012
Except for the fact that their cheap medication was brokered with pharma companies so that basically the US covers all the R&D costs through higher rates...

If we paid the same for meds as the Canadians, the drug companies wouldnt be able to afford to the drugs to Canadia...

The world is riding our coat-tails... I'm not saying these are lesser nations, we aren't number one anymore, the national debt has ruined that. Thats why the world wants to get off of the dollar as the global currency (even if Iran trades oil with Russia, its in dollars) Before the dollar it was the pound sterling (pre 1944) as Britain printed more and more money during the war, it devalued the pound to the point where it wasnt an effective currency for world trade. Guess what we are doing here in the US.
Zip Zinzel
If a Nation expects to be both Ignorant & Free . .
03:19 PM on 03/28/2012
FINALLY, somebody has addressed this issue of INSANE ANALOGIES
Although this article used way too many words to make way too few intelligent points.

REALITY-CHECK= Health Care ISN'T LIKE ANY OTHER THING, Period !
1) Cost Shifting is WIDELY estimated as adding at least $1,000 year to everybody else's insurance bill.
ALMOST AS BAD, is that the way the HealthCare system has evolved in relation to 3rd party payers, Insurance Companies= Only the really rich can afford to pay their own way, for almost any medical care. Back in the old days, people routinely paid 100% of their medical care cost right out of their pockets.
NOWDAZE, even the simpilist 10 minute visit to a doctors office that results in nothing more than blood-pressure reading, and the writing of a prescription costs $100 or more if you pay for it yourself.
Cost of Prescription Drugs often cost five-ten times more if you pay yourself.

2) All the analogies offered by SCOTUS were simply too ridiculous to imagine coming from these supposedly learned, intelligent, and thoughtful MEN. Brocolli ?????? Automobile-Purchases ?? Cell-Phones? These nonsensical questions represented nothing more than SCOTUS pandering to the TEA-Zombies, and SHOULD lead to their removal for obvious evidence of excessively diminished mental capacity.
NONE of these other products, in their absence, requires anyone to provide a good or service ! ! !
Unfunded Funerals are cheap & few; and covered uncontroversially by tax dollars already
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essbird
IOKIYANO
02:40 PM on 03/28/2012
Thank you. Unfortunately reason does not seem to be an effective weapon here.

Insurance is also the epitome of socialism (the way the Right uses the term) in that the collective pays to share a pooled risk. Bigger pool, lower risk. Many kinds of capitalism could not exist without socialized (collectivized) risk.
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HUFFPOST SUPER USER
KDog76A
Radical Centrist
06:59 PM on 04/02/2012
Insurance is also very similar to a Ponzi or Pyramid Scheme.

What kinds of capitalism wouldnt exist without socialized risk?

The Chinese and Babylonians used insurance around 2000 BC, but it sure wasnt socialized.

The root problem with the 2,700-page healthcare law is that it benefits insurance companies and bureaucracy more than people... I mean really, if it were benefitting the population, why are the costs continuing to skyrocket? You might say we have to wait for provisions of the law to kick in, but I'd be willing to guess thats when prices go up even higher.

All things considered, I would support Universal Healthcare over Obamacare if the US had the number one economy, the strongest currency and a balanced budget.

The idea of doubling down to cut losses when we are the most broke in history is like borrowing money from the mob to try to win back your mortgage in a card game.
02:21 PM on 03/28/2012
David, you actually have borne the cost of someone's un-purchased cell phone. All stolen cell phones are paid by consumers who pay for cell phones. It's just the cost of doing business for the phone company.
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HUFFPOST BLOGGER
David Katz, M.D.
Director, Yale Prevention Research Center; Editor-
03:57 PM on 03/28/2012
I am not then paying the costs of someone else's decision not to purchase; I am paying the costs of theft.

I believe 'theft is bad' may be one of the few things on which we can agree across the political spectrum! I sure hope so...
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HUFFPOST SUPER USER
KDog76A
Radical Centrist
07:28 PM on 04/02/2012
How about requiring every non-homeowner living in America rental insurance? Landlords have to absorb the losses of renters who refuse or are late paying their rent. Other renters are required to pay higher rents to cover those who aren't...
HUFFPOST SUPER USER
Carolyn Kostopoulos
02:01 PM on 03/28/2012
but here's the difference- social security, medicare, police, fire depts, education, etc are all non-profit services. where the mandate crosses the line, and the reason the cell phone, television or car analogy works, is that it is the first time the government is requiring it's citizens to buy a for-profit product. by all means, require us to have it and take a deduction out of our pay as for SSI and medicare. but you can't REQUIRE me to purchase a product from a company who's CEO makes $10 million a year, who's shareholders want a return and who's stock is traded on Wall Street.

that's the real problem. health insurance as it is administered in this country is a highly capitalist product and it can't be treated as a public good in it's current state.

other countries have figured it out in various ways. we should too