Healthcare: A 对 or a privilege?

2014年1月24日发布

通过 汤姆·坎贝尔

作者:NC SPIN执行制作人兼主持人汤姆·坎贝尔(Tom Campbell),2014年1月23日。

Dr. Conrad Flick, noted North Carolina family physician, recently appeared on a panel discussion on 卫生保健 conducted by the North Carolina Academy of Family Physicians. During that forum Dr. Flick raised a nagging question.

Flick said it was time America declared whether 卫生保健 is a 对 or a privilege. This question gets to the essence of today’s 卫生保健 debate because, as the noted theologian C. S. Lewis wrote in an essay on the subject, “You can’t get second things by putting them first; you can only get second things by putting first things first.” America’s 卫生保健 system has been built putting second things first. The first is whether 卫生保健 is a 对 of each citizen or just a privilege for those who can afford it?

We made the decision that a “sound basic education” was the 对 of each child. We even decided it was 对 to provide police, fire, defense and other public services, with taxes paying for them. What about 卫生保健?

We sidestepped the fundamental question in the 1960’s, passing Medicare and Medicaid legislation that declared the government as the payer for 卫生保健 for the poor, disabled and elderly. We compounded the issue by requiring that anyone who shows up at the hospital emergency room will be treated, regardless of insurance coverage or ability to pay. The Affordable Care Act, or Obamacare, was another thinly disguised extension of an answer. 通过 requiring everyone to have health insurance, then expanding the list of those who could receive partial or full subsidies for that insurance the country took another big step toward a declaration.

Step by step we have made a de facto decision that 卫生保健 is a 对. We are so far down that path that we would have anarchy if we attempted to unwind previous decisions and take benefits away from people already receiving them. Whether you think the solution 对 or not the reality is correct. So let’s acknowledge the truth and own it: 卫生保健 is a 对 in America.

Then we can get about the redesign of our 卫生保健 system because nobody would deliberately create our current public-private, cost shifting, finger pointing and unaccountable 卫生保健 system. Panelist Peg O’Connell simplified the mess by explaining that the person getting the service and the person providing the service are disconnected from the person paying for the service. Worse still, the person who is paying the person who is paying for the service, the employer, is even further disconnected, aside from worrying how to afford the insurance.

The next decisions are tougher. How do we guarantee equal access to 卫生保健, how do we ensure adequate resources in all areas and who pays for 卫生保健? If a single payer system is preferred and that payer is the government do we even need health insurance? What levels of professional training are necessary for various levels of care?

Do we provide care to all or just American citizens? Do we provide just primary care or specialty care, organ replacements, cosmetic or elective treatments? What about end-of-life care, when the most difficult and expensive decisions must be faced? And what role does 个人的责任 and accountability play in 卫生保健? Should all pay for the consequences of those who overeat, smoke or indulge in poor choices?

Until we claim the truth that 卫生保健 is a 对 we have not 第一要务.

2014年1月24日上午11:07
范凯莉 说:

汤姆在任职后立即关注这件事。健全的基础教育,消防,警察,甚至在一定程度上的防御,都是在州一级做出的决定。那'这是联邦政府接管健康保险业的最重要要点。这是中央计划者违反法律,超出其范围和超出其管理能力做出的决定。医疗保健和/或健康保险是权利还是特权的决定必须在州一级确定。是的,所有52个州! (根据库还是!)

仅仅因为当前获得福利的人们如果更改/取消福利就会暴动,这并不是做正确事情的正当理由。汤姆提到的好处不能由中央计划者最好地处理。汤姆提到的好处最好在州一级处理。除了消除这些好处之外,将这些程序返回到各州将是合乎逻辑的。它'各州管理这些程序,尝试有效的方法要容易得多& what doesn'然后,针对实际居住在各个州的人们制定计划。计划的成本可以移交给各州(由联邦政府支付),逐步减少联邦政府支付的金额,并由各州支付更多。当然,这也意味着联邦政府将不得不停止从每个州窃取这么多钱。如果美联储不再搞砸那个特定的市场/计划,那么他们就没有必要从各州偷钱。如果联邦政府只是简单地把钱留在各州,那么所有州都将有能力负担这些计划。

汤姆最后也弄对了。我们是否为非公民免费提供医疗服务?显而易见的答案,合乎逻辑的答案和正确的答案是:当然不是!我们如何负担不起的人的医疗费用'有助于系统。同样,这是最好由各州决定的决定。例如,假设所有州都实施了自己的社会化医学版本:NC声明我们的计划仅涵盖NC公民,或者如果您是另一个州的居民,则您居住的州将补偿NC的护理费用。此外,由于加利福尼亚是社会主义国家,因此制定了计划,以便任何出现在医疗机构的人都将得到免费照顾。在加利福尼亚会发生什么?他们的体制崩溃了,但是他们是社会主义者,所以他们不这样做'认不出来。第二,非公民的人离开北卡罗来纳州前往加利福尼亚,以便他们获得免费医疗服务。这意味着NC决定不覆盖非美国人有两个预期的效果:非美国人发现有必要退出NC,加利福尼亚涌入他们想要的非支付者–他们的社会主义状态因其证明能力而得到改善对全国其他地区来说,社会主义确实有效。 NC通过不为非美国人付费来节省资金,并制定其他政策来提高市场效率。 NC可以自行决定是否包括整容手术,自愿性手术等,或以什么比率覆盖。在最本地级别做出的决定对于大多数本地人来说都是最有效的。因此,您可以看到,国家运行计划比中央计划程序运行的壁画更有效率。过去50至60年的历史清楚地向我们表明,社会主义,中央计划在每一次失败'尝试过,即使它'负责/控制的魔鬼党。此外,决策越本地化,个人对是否存在诸如此类的决定的影响就越大。'个人的责任'。这是每个中央计划中的一个主要缺陷-他们拒绝承认有这样的事情'个人的责任'. Take Hillary'的想法是要一个村庄养育一个孩子。她的想法是该村庄仅存在于中央计划者级别。就像大多数欧洲国家已经实施一样。如果需要一个村庄,那么该村庄可能是最本地,最小,社区级别的。中央计划在开始之前就失败了,因为无法考虑不同人群之间的差异或地区差异。中央计划者无法识别任何个人情况。再以希拉里为例。她'通常是一个完美的例子'对政客和政策不好。她对班加西灾难的反应浮现在脑海。她无视增加安全性的要求。她拒绝承认真实情况,并与奥巴马的谎言相提并论,这与录像有关。然后,当在国会面前回答有关她在这场灾难中的角色,她在做出错误决定方面的角色的问题时,她的回应等于'有什么区别?'。由于她的决定,四名美国人死亡。因为这是过去的大事,她问这有什么不同?真是个傲慢的屁股!这很重要,原因有两个。首先是因为她负责但拒绝承认(典型的恶魔/社会主义者的回应)。其次,因为它证明了中央计划者在个人生活即将到来时无法做出正确的决定。小组决策是在中央计划者级别上做出的,但是个人决策不能在如此庞大,相互联系,毫无感情的组织中做出。它准确地描述了中央计划者:庞大,杂乱无章,脱节,无情。我们为什么要他们负责任何事情?

2014年1月24日下午12:12
大卫·科斯特 说:

汤姆一如既往地惹人讨厌!

从我的角度来看有两个想法...首先,"healthcare"是不对的。检查宪法。它是如此简单。第二,"healthcare," is a meaningless and dangerous term. It has come to mean everything(ironically perhaps) from sex-change surgery to abortion, from drug addiction counseling to medical marijuana. Yes, there is a justifiable public purpose in providing access to primary care to all, as well as some sort of catastrophic coverage. But lines must be drawn, skin must be in the game for all and poor lifestyle choices must have consequences...otherwise the 卫生保健 system, while clearly benefitting many, will also be another way we foster dependence rather than encourage independence. Many seem to believe some sort of utopian system can be devised that would provide comprehensive care to all, while being paid for by only some.

总体而言,美国人,特别是保守派人士,不反对为有需要的人提供帮助,但他们反对无条件提供无休止的援助。我们必须将公共政策论点与道德论点区分开来。公共政策必须受到财政审慎性和政府职能能力的限制。道德论点并不能解释这种情况。因此,某些事情可能出现的原因"right"从道德的角度来看,只要超出公共政策的范围即可。

反正我的两分钱!感谢您所做的工作!

2014年1月24日下午3:49
理查德·邦斯 说:

Healthcare cannot be a 对 as it requires someone elses time, talents, capital to provide it to you. Paying your 卫生保健 bill can be a government benefit although as with all government programs it will be inefficient and better provided by the private sector so over time there will be a two tier 卫生保健 finance system and providers will generally gravitate to the private system that better rewards them for their efforts.

2014年1月24日下午7:07
韦恩·里弗斯 说:

The most basic component of 卫生保健 is nutrition. Therefore, let the Feds pay for our groceries first. Then we need shelter; let the Feds provide us shelter. We also need clothing; let the Feds provide us with clothing. Thank goodness for the limitless capability of the government to pay for and compassionately provide for all our needs!

2014年1月28日下午3:07
詹姆斯·巴斯 说:

消防部门是't a 对 either, but when we hear about private fire departments letting folks houses burn because they aren'成员,它肯定会引起l叫。执法部门的保护不是't a 对 either, but we sure howl when our houses get broken into.

In almost every community, we have made the de facto decision that law enforcement and fire protection are equal to 对s, and made the rational decision to "第一要务";每个人都付钱,所有都被覆盖。那是社会主义吗?

为什么谢尔登'是否可以通过相同的分析来决定医疗保健?

2014年1月28日下午4:05
理查德·邦斯 说:

Police and Fire protection are not 对s, they are paid for services whether via government or private. Yes government can provide 卫生保健 as a service, whether it be both the finance and provider side as in the VA for all or just the finance side as in Medicare for all. It is not a 对 however as until the government hires someone to provide police, fire, or health protection or at least pays a private party to provide police, fire, or health protection you will not get these services. I have speech 对s, the government does not have to provide a service for me to speak and cannot infringe upon me doing so.

2014年2月1日,上午11:42
芭芭拉·里诺(Barbara Reno),MSN,RN,CCM 说:

Your questions regarding health care in our great country are 对 on target. I commend you for printing them and wish our law-makers would ignore the lobbyists and show us all the moxy it will take to solidify the 对 of health care.

我们的立法者应该将在第一线工作的临床人员纳入如何前进的讨论中。目前"set up"为真正需要护理的人节省宝贵的资源。

Again, thank you for your article. I hope the 对 people will take it to heart.