The process of getting it shows why it will fail to deliver utopia.

Medpundit offers a concise summary of the fallacy that U.S. universal health care/coverage will mimic other established universal systems. It also explains why I don’t believe that universal health care/insurance will lead to the end of routine infant circumcision in America. (I removed the links from this excerpt because they make it appear too busy, but they’re worth reviewing at the original entry. Emphasis here is in original text.)

The British are often held up as the standard to which we should aspire. But we don’t live under a British style of government. We live under a government that’s truly government of the people, by the people, for the people. And what the people want, the people get. Witness the influence of disease activism even now on disease specific government funding and treatment mandates. In England, the government only pays for colonoscopies to check for colon cancer if there are symptoms suggestive of cancer or a family history of colon cancer. In the United States, the Medicare pays for a colonoscopy every ten years for everyone over 50, regardless of symptoms or risk. So do many insurance companies., sometimes if not by choice, by mandate. In England, mammograms are only covered for women between the ages of 50 and 70, and then only every three years. In the United States, we pay for mammograms beginning at age 40, yearly, and with no upper age limit. We just don’t have the heart for rationing that they have in other countries.

It’s possible, probable even, that universal coverage would reduce the number of unnecessary circumcisions performed as compared to our quasi-private system now. However, I suspect the decrease will be neither significant nor long-lasting. The fundamental flaw in populism is that it can’t say “no” if a majority demand a “yes”. Principles and rules do not matter. The rights of the minority do not matter.

In this particular procedure, the opinion of the patient will continue to not matter. He is treated as a statistic, at best. If the procedure has the potential to prevent a problem later on, regardless of the actual risk faced, the foreskin’s contribution to that risk, or the consequences of that risk, the illogical defense allowing parents to continue cutting the healthy genitals of their sons will continue.

Remember that populism doesn’t care about proper context in cost-benefit, or even the existence of such analysis. As long as the case could be made, every parent is assumed to be making it. And every infant is assumed to be pleased at that assumption, depsite the undeniable evidence that intact adult males almost never choose or need circumcision.

The out-of-context nonsense we use today is illogical to anyone seriously considering all the evidence. The risks are small. There are less-invasive treatments and preventions available. Comparable countries that do not circumcise manage to achieve the same low levels of disease. These facts are ignored because they contradict our mental conditioning. We believe of circumcision what we want to believe, not what is true. That is why we hear that male circumcision reduces the risk of HIV infection by 60% rather than the more honest explanation of how much it reduces the absolute risk. Sixty percent is far more persuasive than two percent.

For the United States we must be honest and ask if a central planner wannabe who is immune to the rights of individuals enough to issue mandates wouldn’t also be immune to fiscal rationing for non-medically-indicated circumcision, as long as it pleases “the people”.

Via Kevin, MD

25 thoughts on “The process of getting it shows why it will fail to deliver utopia.”

  1. The British are often held up as the standard to which we should aspire.
    No, the British are never held up as the “standard to which we should aspire” except rhetorically by opponents of the single-payer system who are looking for a straw man to knock down (and who always ignore or dismiss the Canadian example).
    BTW, here’s what Medpundit has to say about the ethical controversy surrounding infant circumcision: “much ado about nothing”.

  2. Canada is also a parliamentary system of government.
    I know Medpundit’s take on infant circumcision is severely lacking. The “two percent” link in my entry is to that post. I also commented on that original post.

  3. Canada is also a parliamentary system of government.
    Yep. Sure is.
    I know Medpundit’s take on circumcision is severely lacking.
    Yet you linked to her blog anyway because she (like most circumcision-friendly doctors) opposes the single-payer concept. Tsk tsk tsk.
    [Note: The “much ado about nothing” quote didn’t come from the “two percent” post you linked to. It came from another post where Medpundit scolded Andrew Sullivan for being too passionate in his opposition to infant circumcision or, in other words, for refusing to treat the matter as a trivial subject like she does.]

  4. The “much ado about nothing” quote didn’t come from the “two percent” post you linked to.
    My mistake. I read through a lot and they jumbled together.
    My link to her does not endorse her opinion or excuse any irrational defense of infant circumcision. However, I won’t impose an intellectual purity test regarding a medical question onto an economic/political question. I wouldn’t hire a doctor who circumcises without need because I believe that indicates poor medical judgment and a lack of ethics. I do not want such a doctor performing any procedure on me. But it does not automatically discredit statements about other, non-medical subjects.
    Another example… I strongly admire Christopher Hitchens for his vocal opposition to infant circumcision. But I think he’s absolutely insane on Iraq. Bonkers and out-of-touch with reality. Should I pretend like he doesn’t have the right answer on circumcision because I think he’s blind to certain obvious facts on Iraq? I don’t think so.
    The first problem facing infant circumcision opponents is still marketing. Americans have been sold a pile of shit dressed up as a bouquet of flowers and convinced ourselves it smells wonderful. Am I going to run around screaming “you’re holding shit, hahaha” or “you should look a little closer at what you’ve bought”? Sure, the former will feel better in the short-term, but which has the chance to be more effective at opening a conversation?
    The “much ado about nothing” post is far too dismissive, and she ignores multiple issues that have a significant affect on the analysis. This is inexcusable. But she’s presenting that incorrect view in response to opposition that she believes is too passionate. I don’t think Sullivan is “too passionate” about this, but if her argument is for facts over emotion, then that’s the necessary approach, even if it’s just a rebuttal rather than a first attempt at facts, as Sullivan’s response would be.
    As she says in the comments on the “two percent” entry, in response to my comment:

    I was kind of surprised at how low the incidence rate of HIV was in the study.

    That’s an opening (which I missed in February) worth using. Will we succeed at changing her mind to the facts rather than her perception of the facts by pretending she doesn’t exist, or worse? If she’s going to inform patients about circumcision, it makes more sense to engage her how she’s demanding to be engaged rather than expecting her to accept something she doesn’t yet accept.

  5. …I won’t impose an intellectual purity test regarding a medical [sic] question…
    How about an ethical purity test regarding an ethical question?
    Namely, this one: do “you” (the person being asked) accept or reject the universal human right of bodily self-ownership?

  6. In a case of ethics, which infant circumcision is, that would absolutely be a starting point. But this wasn’t an infant circumcision issue. I used a political/economic issue to expand on an ethical issue. Implement universal health care or insurance and people’s answers to the ethical question will not automatically change to the only correct answer.

  7. Shunning websites that promote or espouse unsavory viewpoints by not linking to them (other than for the purpose of criticizing those viewpoints) is a common way of showing one’s disapproval thereof.
    If you feel as strongly as I do about the right of all human beings to bodily self-ownership, then making a habit of not linking to adversarial websites should be a no-brainer.
    I guess you just don’t feel as strongly as I do about this issue.
    I’m very disappointed.

  8. One more thing: If I had a blog of my own, I can assure you there’s no way I’d ever link to a circumcision-friendly website in the unlikely event they published a pro-single-payer essay.
    Ethical concerns must always be one’s first priority, not economic or political ones.

  9. The ethical concern is my first priority. That should be clear from my post. Linking to a site that’s at best indifferent about infant circumcision is not the primary point involved.
    My ethical concern is to stop people from violating the rights of infants. That’s why I wrote the entry. Some are advocating an economic/political solution to health care in hopes that it will stop infant circumcision. I contend that it won’t.
    I am not offering a solution designed to first meet my economic/political beliefs, followed by my ethical stance. What will stop the unnecessary circumcision of infants? Single-payer will not. It’s a distraction. I wish I didn’t have to deal with it, but some are pushing it with this false belief.
    We disagree on that. I can accept that. Even when we disagree, your input helps me refine my thinking. But please do not condescend to me about how strongly I feel about this issue.

  10. Linking to a site that’s at best indifferent about infant circumcision…
    Medpundit is not indifferent about infant circumcision.
    Medpundit believes that parents should have the power to surgically alter their son’s bodies when there’s no medical need to do so and has indicated such on more than one occasion.
    And Medpundit has consistently trumpeted sloppy studies touting circumcision’s so-called “benefits” while ignoring studies that examine the harm it inflicts.
    Some are advocating an economic/political solution to health care in hopes that it will stop infant circumcision.
    I don’t know anyone who advocates a single-payer system as a way to eliminate infant circumcision other than myself.
    If the anti-single-payer rhetoric in your blog entry is aimed at me, you’re wasting your time because I’m not moved by ideology-based arguments (I’m moved by real-world models that can be pointed to as examples).
    I wish this single-payer stuff had never come up because it’s a major distraction and everyone knows there’s no way on Earth the US is ever going to adopt such a system (unless the practice of bribing politicians with campaign cash is outlawed) so it’s all quite academic.
    But please do not condescend to me about how strongly I feel about this issue.
    No condescension was intended (sorry if any was inferred).
    I accept that you feel strongly about this issue, but that just makes your decision to overlook Medpundit’s circumcision-friendly slant all the more puzzling to me.
    As I said, it’s something I’d never ever consider doing.

  11. My argument about single-payer and circumcision is not directed at you. I’ve met many anti-circumcision activists who support single-payer primarily because they believe it will end routine infant circumcision.

  12. An addition:
    I’m curious why you repeatedly use ideology and rhetoric to describe my position. I’m trying to figure out if it’s dismissive or just a semantic oddity. I read it as dismissive, which is strange but irrelevant, so I want to clarify.
    My position is based on principle. Each person has inherent liberty. That’s why proxy consent for routine infant circumcision is wrong. The proxy does not own the child. Absent medical need, his (or her) self-ownership right is supreme. Is that stance an ideological position?
    Liberty applies to efforts to extract the financial property from a person just as it applies to extracting the biological property, to phrase it crudely. Single-payer violates that liberty because I can’t opt-out. I’m definitely in the realm of political theory based on liberty, but I can only accept dismissive claims of ideology if it’s a semantic, interchangeable use of principle and ideology/rhetoric.
    Three questions… Is your word-choice semantic or dismissive? On what principle are you basing your support for single-payer? Is it consistent with prohibiting routine infant circumcision?

  13. Absent medical need, his (or her) self-ownership right is supreme. Is that stance an ideological position?
    No, it’s an ethical one.
    Is your word-choice semantic or dismissive?
    I apply the word “ideological” to any belief or argument that derives from some sort of doctrinaire/dogmatic system of thought.
    I’m a freethinker by nature and I reject all such systems.
    I see the ideological approach to problem-solving as being Procrustean.
    Ideologues always try to make the problem fit the solution, instead of the other way around and usually make things worse.
    On what principle are you basing your support for single-payer?
    My support isn’t based on any “principle”.
    It’s based on the real-world observation that people who live in single-payer countries are generally happier about the care they receive and have fewer complaints.

  14. Ideologues always try to make the problem fit the solution, instead of the other way around and usually make things worse.
    Is that what you think I’m doing?
    I think it’s clear with circumcision that I’m not, since I reject chasing benefits in favor of the child’s rights. But with health care, I’m not doing that, either. I do not have a specific solution for what people should do or how people should live. Come up with your own solutions, form a collective, avoid health care, whatever. Just don’t force me to live by your solution.
    That’s what single-payer does. You’ve observed that people in single-payer countries are generally happier. I don’t know what that’s based on, because every poll in the U.S. depends on the wording. It’s the same as opinions on politicians. “It’s all screwed up and something must be done, but not to mine. I actually like mine and wouldn’t change it. But we need to help the unfortunate who aren’t as lucky as me.” Making change based on that is a path to disaster.
    Ultimately, you’re accepting “generally” as sufficient. You’re doing the exact same thing you accuse of ideologues. You’re fitting your solution. I’ve said that I do not want single-payer. Many other people state the same. Your position is that there should be no opt-out.
    For what it’s worth, I base my ideas on real-world observations, too. Economics, particularly. With single-payer, we will not be able to escape rationing and waste. Avoiding either is not part of any reality in which only benefits appear, with costs hidden from the user.
    Even routine infant circumcision fits this. There are all the potential “benefits”. Those are spoken infinitely. And the costs are always hidden. So parents think it’s just a little snip and he won’t mind. And Americans perceive themselves as “generally happier” with this madness.

  15. I don’t know what that’s based on, because every poll…depends on the wording.
    I’ve never seen a poll that indicated that the majority of people who live in single-payer countries would like to see the system they already have replaced with a privately run system.
    In fact, the mere mention of privatization seems to provoke anger and/or laughter from most of them.
    Ultimately, you’re accepting “generally” as sufficient.
    I’m accepting majority rule within constitutional limits as sufficient, which is what one is supposed to do in a democracy.
    You’re doing the exact same thing you accuse of ideologues.
    Bullshit.
    Your position is that there should be no opt-out.
    I’m just being consistent.
    There’s no “opt-out” for police protection or fire protection or any other government service I know of.
    If there’s no “opt-out” for those other services, then there shouldn’t be one for single-payer health care either.
    With single-payer, we will not be able to escape rationing and waste.
    We already have rationing based on one’s ability to pay right now and truckloads of waste.
    And Americans perceive themselves as “generally happier” with this madness.
    Whether Americans perceive themselves as generally happier or not is irrelevant with regard to infant circumcision because the right to bodily self-ownership is absolute and inalienable.

  16. Majority rule within constitutional limits maintains the idea of life, liberty, and the pursuit of happiness. Just because the majority wants something does not make it acceptable. The Constitution mentions nothing about the public provision/financing of health care.
    There’s no “opt-out” for police protection or fire protection or any other government service I know of.
    There is a legitimate case (protect one from harm by another) for police protection as a public good. Fire protection is a little dicier, since it involves life and property protection. The public good aspect is not that you can lose your life and property to fire, but someone else’s fire could take your life and property.
    Also, there are historical examples of private fire departments, since incentives matter. But it’s easy to fall into a free-rider problem. I don’t need protection because you have it. Except it’s not in the interest of a private firm to protect you if there’s nothing but costs without revenue. Again, incentives matter. You might not protect your risk from harming me.
    No such case exists for health care as a public good for everyone, without stricter criteria.
    Waste is caused by lack of price-consciousness, among many factors. Consumers demand/receive all sorts of low-benefit care because they want it and it’s “free”. Except it’s not free, it’s shared by the insurance pool who cumulatively see the actual non-free affect. Single-payer will make that worse, not better. Want more, subsidize. Want less, tax. That applies to health care, as well as everything else the government involves itself in.
    Rationing based on ability to pay is a fact of life for everything. The relevant question is are people receiving care and facing financial hardship or are they not receiving care? If it’s the former, I’m sympathetic but unpersuaded. Life has risk. Choices need to be made.
    If it’s the latter, which I think it is, there is ample room to debate solutions for those rarer situations.
    As I’ve mentioned, one solution we need to look at it is permitting insurance policies that don’t cover every imaginable scenario and offer every protection. Catastrophic care coverage. Break your leg, you’re going to feel a little financial pain, too. Get cancer, you’re going to feel a little financial pain instead of significant economic disaster.
    We could have that but people are encouraged to demand complete protection from risk. Governments mandate it. Government isn’t going to magically change just because it spends more and has complete control.

  17. Also, I wasn’t clear on my point about polling. I’m sure polls in other countries confirm that people are generally happy with single-payer. I meant to write, but didn’t, that Americans are currently happy with what they have. It’s only when collective arguments are made that people start agreeing with all the shoulds involved in single-payer. If we’re applying a “generally happy” standard, then Americans are currently content. No further action is warranted.

  18. The Constitution mentions nothing about the public provision/financing of health care.
    The Constitution doesn’t mention anything about the public provision/financing of police or fire services either.
    There is a legitimate case…for police protection as a public good.
    There’s a perfectly legitimate case for providing police, fire AND medical services as a “public good” whether you agree with it or not.
    These three services have many things in common, even though the arguments for publically funding each of them are somewhat different.
    The most obvious thing they have in common is that they are regularly involved in helping people whose life or physical safety is in danger (the existence of the 911 police/fire/medical emergency hotline underscores the connection between the three).
    If we’re applying a “generally happy” standard, then Americans are currently content.
    I guess you haven’t been looking at the same polls I have.

  19. There’s something wrong with your comment submission form.
    It’s incredibly slow and buggy, and it nearly rejected my last post.

  20. Article I Section 8 provides Congress with the power to provide for the common defense. Police, military, and so on.
    I’d prefer private fire departments, personally, but again, free riding muddies the topic. And I’d put that into “general welfare from the same Constitutional text. I guess it’s possible to interpret that as including health care, but I think it requires a reading out-of-context from American political thinking and theory from the founding to stretch it that far.
    The most obvious thing they have in common is that they are regularly involved in helping people whose life or physical safety is in danger (the existence of the 911 police/fire/medical emergency hotline underscores the connection between the three).
    There’s danger and there’s risk. The services the government does and should provide for health/medical involves danger, articularly danger that is immediate. And they’re also dealt with at a local rather than national level. 911 services don’t centralize through Washington. Why should health care?
    Long-term risks do not meet this, since people can and should be expected to properly plan for predictable/preventable scenarios and outcomes to a degree sufficient enough to not warrant government intervention. That doesn’t mean a complete abandonment of those who can’t, of course, but an initial assumption that they can’t or shouldn’t do this for themselves is bad policy.

  21. On the website response time, it comes and goes. Unfortunately, it’s mostly to do with my host, although there may be a few tweaks to the software available. My comment just posted didn’t take too long, but I’ll keep an eye on it. It may also have something to do with the size of the database, now that I’ve been at this for more than 4 years.

  22. Article I Section 8 provides Congress with the power to provide for the common defense.
    None of the sources I consulted support the idea that this part of the Constitution empowers Congress (the federal government, in other words) to pay for local services like police or fire protection.
    The consensus seemed to be that the word “common”, as used in this section, refers to the states collectively (not the people) and that the word “defense” refers to our country’s armed forces.
    In any case, the Constitution makes no provision for “opting out” and neither do I.
    The services the government does and should provide for health/medical involves danger, [p]articularly danger that is immediate.
    But police and fire services aren’t limited to emergencies only or “danger that is immediate”, are they?
    911 services don’t centralize through Washington. Why should health care?
    I don’t want the federal octopus to involve itself in this matter.
    Single-payer health services should be handled at the state/local level.
    I thought I made that clear in an earlier comment on one of your other blog entries.

  23. Single-payer health services should be handled at the state/local level.
    I thought I made that clear in an earlier comment on one of your other blog entries.
    It’s probably there and I’ve just forgotten. I don’t think it changes any of the analysis, though.

  24. I’m okay with that. I think yours is faulty. That’s what makes the debate fun.
    It’s also why I didn’t expand on the points. We’re making progress in understanding each other, I think (hope?), with this discussion. But we’re dangerously close to circles on this thread.

Comments are closed.