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September 04, 2007

Edwards The Authoritarian

What the hell is John Edwards talking about here?

Democratic presidential hopeful John Edwards said on Sunday that his universal health care proposal would require that Americans go to the doctor for preventive care.

"It requires that everybody be covered. It requires that everybody get preventive care," he told a crowd sitting in lawn chairs in front of the Cedar County Courthouse. "If you are going to be in the system, you can't choose not to go to the doctor for 20 years. You have to go in and be checked and make sure that you are OK."

Seriously? I've read all the guy's health care plans and never once noticed a provision mandating doctor's visits. I've been a big fan of Edwards' willingness to toe towards the line of socialized medicine, but I wasn't expecting him to hop over into authoritarian medicine, too. So I took a look into the claim, which got Ed Morrissey very excited, as it "reveals the arrogance and the authoritarianism that waits around the corner when government-run healthcare gets imposed on a free society." Yikes! Here's what I think Edwards is referring to:

Edwards will require Health Care Markets and public plans to pro-actively monitor chronically-ill patients' health to reduce complications and hospitalizations, and he will offer private plans incentives to do the same. Vermont is demonstrating that this kind of new approach to managing chronic care can improve patients' health and save money. He will also require preventive care coverage, with public plans offering preventive care without co-payments, and provide incentives for patients to participate.

So the public plans, and those participating in the public insurance markets, will have to include provisions for health maintenance among their chronically sick members. Preventive care will be covered, and in the public plan, it will be free. Patients will have incentives to avail themselves of preventive options. But there won't be any mandate for X doctor's visits every Y years. Insofar as anyone has to do anything, the insurers will have to offer patients the option of preventive care. That's a perfectly defensible, even worthwhile, policy position. Edwards should explain it much better. And Captain Ed should keep his cool.

Update: More here.

September 4, 2007 | Permalink

Comments

This also addresses the preventive care kerfuffle:

http://www.concurringopinions.com/archives/2007/09/the_road_to_fas.html

Posted by: Chris | Sep 4, 2007 1:32:43 PM

And Captain Ed should keep his cool.

But that's not how he or the right wing get their links...

Posted by: anon | Sep 4, 2007 1:36:36 PM

There's a policy design issue lurking here: to what extent should a system be demand-pull?

Many of the most effective interventions, at the margins, are basic public health interventions, which don't require a consumer visiting a service provider on the consumer's initiative.

That relationship -- the doctor to the patient -- is the center of the health care system of the imagination, and most of the scary narratives will focus on that archetypal relationship.

But, a lot of effective health care are public health measures, which tend to be under-funded in our present system, and don't involve a personal relationship between an individual doctor and a patient demanding services.

I don't know if useful narratives can be devised that recognize this reality and exploit it. But, I think it worth noting.

Posted by: Bruce Wilder | Sep 4, 2007 1:44:50 PM

Yes, because when the likely democratic nominee is a complete tool of corporate American who favors censoring video games, music, and movies; the biggest threat to our civil liberties is a guy who wants to make you see a doctor.

Get your fucking priorities strait, and stop looking for reasons to hate Edwards so that you don't have to dislike yourself for the next year and a half of pro-hillary bullshit we're going to hear from our evil blogger overlords.

Posted by: soullite | Sep 4, 2007 2:29:19 PM

Do you actually read my posts, or just absorb the first sentence then choose a reaction?

Posted by: Ezra | Sep 4, 2007 2:38:50 PM

Ezra:

I was at the event in Iowa where he made that statement. It came in the context of him discussing Elizabeth and regular mammograms/cancer screens. I took from what he was saying that his plan would, for the first time, make it easier and cost effective for people to seek preventative medical attention, thus lowering costs.

But... I remember saying to myself, "Gee... taken out of context, that sounds like he's advocating a law demanding people get checkups every year." I was not surprised to see that headline on Drudge that night.

Posted by: Owen | Sep 4, 2007 3:04:47 PM

You are going to give all conservatives migraines by your use of the word "free". Wouldn't universal health care be paid for by general tax revenues?

Posted by: steelhead | Sep 4, 2007 3:17:00 PM

free probably means as in all included rather than a stand alone for which one would have to pay separtely.

Posted by: akaison | Sep 4, 2007 3:26:39 PM

I think Edwards was concerned that the libertarian slippery-slopers lacked an ironclad soundbite that would confirm their fears that government-funded universal healthcare will result in a loss of personal liberties. If he meant what he said, that's awful. If he didn't mean that, it was merely sloppy wording.

Posted by: Jeff in Texas | Sep 4, 2007 3:33:58 PM

Poorly worded but I see what Edwards is getting at. A majority of health care spending is related to behavior. The problem is many people need a gun to their head to change and even that isn't enough for some folks (which makes me think we dramatically undertreat mental disorders). There's an interesting article on this topic:

"Many patients could avoid the return of pain and the need to repeat the surgery -- not to mention arrest the course of their disease before it kills them -- by switching to healthier lifestyles. Yet very few do. "If you look at people after coronary-artery bypass grafting two years later, 90% of them have not changed their lifestyle," Miller said. "And that's been studied over and over and over again. And so we're missing some link in there. Even though they know they have a very bad disease and they know they should change their lifestyle, for whatever reason, they can't."
http://www.fastcompany.com/magazine/94/open_change-or-die.html

Posted by: beowulf | Sep 4, 2007 3:51:37 PM

if all private sector plans universally required that peo obtain a physical before covering them or to get a physical once a year- what would be the reaction?

Posted by: akaison | Sep 4, 2007 3:52:58 PM

O noz! John Edwards wil make me git same hairket as him and mak me eet vegnetarnia so he kin save doctr moneee!!

Posted by: El Cid | Sep 4, 2007 3:53:18 PM

All I thought was, "ooops." I agree, he needs to say what he means better, because we should be encouraging people to get preventive care. That's different from requiring it. It doesn't surprise me that right wingers would leap on tat for their "socialized medicine" argument. Unfortunately, it's also a reminder that with them, there's no there there: insisting people shouldn't get preventive care is surely worse.

Posted by: weboy | Sep 4, 2007 4:48:57 PM

It is already the case in most places that the parents of children enrolling in public schools must present proof that the child has been vaccinated to comply with district or state standards. This is government-mandated preventive healthcare. Most kids get a checkup at the same time. Only a few parents cavil. We all understand that the trifling loss of freedom of conscience is repaid many times over.

Posted by: joel hanes | Sep 4, 2007 4:59:58 PM

akaison :


if all private sector plans universally required that peo obtain a physical before covering them or to get a physical once a year- what would be the reaction?

If people could be certain that the insurance companies would not use the results of those checkups to discriminate against them, I think most would comply without a thought.

As it is, most people are certain that the insurer will use the results to deny coverage or payment.

Posted by: joel hanes | Sep 4, 2007 5:03:55 PM

When someone says something vague, it makes sense to look at what he actually meant.

But when he says something as clear and direct as you won't be allowed to not see a doctor because you don't want to, that's pretty darn clear. And it has nothing to do with what Ezra posted as an explanation.

Edwards gaffed, big time here. He's either going to have to walk this one back or defend it. Either way, he's about to drop further back in the polls.

Posted by: Adam Herman | Sep 4, 2007 5:30:16 PM

Joel,

So, that brings up the question to me: what's the big deal here?

And Adam:

You are clearly full of shit. Does anyone here believe this will affect the poll rating at all beyond the normal over the top rancoting by posters like Adam, whom I suspect is a Clintonite.

Posted by: akaison | Sep 4, 2007 5:51:13 PM

By the way Adam- your post is factually false. You claim he is slipping the polls when in fact he's been rising.

Posted by: akaison | Sep 4, 2007 5:53:49 PM

akaison :
what's the big deal here?
Got me. I think Edwards's remark under discussion was unimportant.

I do thin it interesting that some people are angered by the suggestion that they would be required by law to get an annual physical, and I tried to suggest one mechanism

=> In the current system, a physical exam prior to coverage is a threat, not a boon, from the viewpoint of the insured.

Here's another. The right has spent forty years or more prounouncing, in horrified tones "But that would constitute socialized medicine BOOOGA BOOGA BOOGA" as if the very idea of socialized medicine were unspeakable anathema, like boinking your sister or cooking and eating your Mom. In fact, we already have socialized education, and it works pretty well in some places and not so well in others.

Posted by: joel hanes | Sep 4, 2007 7:09:47 PM

joel,

that's my point exactly. i am glad this is not what edwards meant, but the overreaction to this is fascinating considering the private sector does these sorts of mandates without ever calling them that, and no one seems to blink an eye about it. it really just seems knee jerk reaction. when this first came up over at mydd the best argument was about the right of privacy,b ut even that seemed odd given the right to privacy , at least under the present law, is a balancing act, not an absolute. nevertheless I am glad this isn't what edwards meant, because it saves us from folks like adam

Posted by: akaison | Sep 4, 2007 7:22:23 PM

Yeah, i agree with soullite. Theres no reason people should go 20 years w/o seeing a doctor. 1 hour every year isn't an instrustion on anyone's civil liberties.

Posted by: yoyo | Sep 4, 2007 8:20:37 PM

Finally, the curtain has been torn aside, we have seen into the truth of the 'liberal' medicofascists, and soon we will be forced by our Edwards-blessed UN overlords to wear those jogging suits beloved by Fidel Castro and do our Socialist Efficiency! morning calisthenics routine in our public squares to the music of Pete Seeger, mixed with a steady synth beat.

They scoffed at me when I warned them, but I warned them.

Posted by: El Cid | Sep 4, 2007 8:30:57 PM

El Cid- that's some good shit.

Posted by: akaison | Sep 4, 2007 9:32:12 PM

Can someone explain to me why it wouldn't be a good idea to require people who are covered by a national health insurance plan to go to the doctor at least once a year?

What would be wrong with a plan in which everyone would have to visit the doctor for a yearly physical and that requires at-risk individuals to get screened for ailments such as breast or colon cancer? Under such a plan people would be treated for ailments early (and would therefore be less likely to die) and medical cost would also go down. This seems to be a win-win scenario.

Posted by: Anonymous | Sep 4, 2007 10:14:32 PM

Here's the argument Ive heard advanced. I don't necessarily buy it, but it's the argument that's being made. This is a privacy concern much like say abortion. that a person has a right to have control over his or her body, and shouldn't be required to go through a mamogram or prostate exam if it's mandatory. That this is the govt acting to control the body of another, even if its for that person's benefit. I don't buy it because rights are about trade offs. This analysis makes no attempt at that.

Posted by: akaison | Sep 4, 2007 10:31:39 PM

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