Leibowitz interview with Kristol: Health Care

[Eiuol]

Imagine if you lost your finger, or a measly part of the damn thing, on the job; imagine if you lost more than a finger in an explosion or firefight during combat. Any military personnel to be injured in such circumstances is in no way responsible for their own treatment. VA clinics provide necessary care for military personnel.

So do completely private hospitals. The military of course should be obligated to pay medical expenses as a result of combat, because it is responsible for that damage. But it should not run its own hospital / health care plan (beyond a battlefield hospital, that is). I'm not treating it any differently than government employees at a court house. If they get hurt on the job, the government should be obligated to pay the medical expenses, nothing more. Nor should the government even attempt to do anything even slightly different than its branches are expected. To me, it is similar to government owned roads. Roads are useful for the military to maintain, create and own in case of attack, in a similar way that taking care of soldiers back at home is useful. But it is clearly not part of how a military is ran and operated. I'm not "upset" that VA clinics provide care, I just think ending public funding of health care (while not on the battlefield) is one of the most important steps to make to achieve a truly free market in health care.

Edited July 30, 2009 by Eiuol

[Andrew Grathwohl]

"imperialism"? What do you mean by that?

Anyway, without our military there is no doubt we would not be as free as we are.

On the battlefield hospitals would be required. There is nothing wrong with funding this as a government service to soldiers, so long as that service is paid for by private donations to government. However, since we are no where near that point now, I have nothing against public financing of such hospitals as we move toward a completely free system. I mean, hospitals for veterans are way down my list of priorities of things to phase out.

Now, to be sure, I agree that it would probably be better, once a soldier it out of the battle field, that he be admitted to a private hospital, where he can get the best care, and all of this should be paid for by the "government."

Imperialism - we run a militaristic empire. There should be no surprise there.

I never said we couldn't have battlefield hospitals. I think that's an enormously important asset. Besides, what would we do with all the army doctors, nurses, and medical technicians? Hospitals for veterans, on the other hand, is not a legitimate function of government, and you cannot deny this. Ayn Rand made it very clear that government's only purpose is to protect individual rights; hospitals for veterans - something which does not aid in the protection of individual rights whatsoever - does not belong in the government.

The government should provide health insurance for veterans? Okay, that could be fine. I don't know if it would be more effective to simply pay them more and give them their own choice, but I suppose in an Objectivist society that would be something determined by the ones involved in making those kinds of decisions. Of course, this would be okay only if it specifically involves government funding health insurance from the private sector, like a corporation does today. Health insurance run by the government would be an illegitimate use of government.

If our soldiers aren't fighting for your liberty, then who the Hell do you attribute your freedom to say that to? Did you fight for liberty in some battle I never heard of?

Even if we forget the great debt we owe WW2 and Vietnam veterans, current American soldiers are future veterans. Guaranteeing they will be taken care of for the rest of their life, if injured, helps them perform immensely better.

I can't think of a single better investment into a free country than a guarantee that injured soldiers will be cared for. That's a lesson from history, as well as an obviously practical course of action today.

Sorry Thales, I'm gonna have to disagree with you there. I did give a few reasons in my previous post, the main point is that the private hospital that has the government as its major client would not be very private. Look at current colleges and hospitals. A small, government run hospital system could offer high quality care, and leave the rest of the health care market to function free of government interference.

Our soldiers have the potential to fight for our liberty, and a very small number of them still do. However, our armed forces as a whole have made me less safe, not more safe.

What debt do we necessarily owe to veterans? Since when did egoism entail an individual necessarily funding anything in government? I would have gladly donated to the armed forces for their efforts in WWII, but I think Vietnam was a disgraceful, disastrous, altruistic shitstorm of a war. Why should I give my hard-earned money to the soldiers who neither obeyed the law nor fought a noble cause? They didn't fight for our freedoms in Vietnam - they fought for the removal of our freedoms. They fought battles based on lies and a false sense of wanting to help savages - none of which were done in the best interest in the United States. And it cost us all a great amount of taxation to cover this destructive, worthless war, which killed some of our bravest men who were cruelly drafted into it.

And having this socialized veterans' hospital service would boost morale and performance? Give me a break. So now we need to abandon our morals and rational thinking to boost job performance? I'm sure the captains of industry would love to try that out. That sounds like an argument a lot of people use to defend the minimum wage.

I don't care what historical evidence you do or don't have - the capitalist ethic specifically doesn't allow what you're advocating for. A capitalist government, meant to protect individual rights, cannot remove competition from the free market in areas that it has no responsibility in. It has no responsibility in health insurance - it does not deal with individual rights.

Why does a hospital that services veterans need to have the government as its largest client? And why couldn't it be private? You're making a sweeping assumption that no hospital could rightly survive without succumbing to a "public" transformation. You're assuming that there is nobody wise or skilled enough to run a hospital that cares for both the military and the privately-employed citizens.

Why are you sacrificing your values of laissez-faire government for some unfounded notion of practicality? Laissez-faire is laissez-faire. You're trying to have your cake and eat it too, by trying to preserve the sense of (the false facade of) a capitalist government, but also give some sort of beneficial treatment to certain government employees due to some external moral value you possess. Who cares if the government could even run a good public hospital system for veterans? Why does that mean they should? Better yet, why does that mean we must take away this ability from the private sector, as you blatantly suggest here?

Not that I disagree, but I think you're making it more complicated than it has to be. Regardless of the risks that they take, I have no problem with soldiers having health-care provided by the government, because they are (gasp!) government employees! Health care happens to be part of the compensation they receive for their work...which is fine, especially considering the meager salaries that they receive. It's pretty standard for employers to provide their employees with health care. Why would the government be any different?

The distinction that needs to be drawn here is that the care itself still needs to be provided by a private firm. I have no problem with government financing this as payment for the service the armed forces provide.

Soldiers do deserve it. Their job is to go in harms way, and part of reasonable compensation is to make sure their health is taken care of. They provide a service. This is the difference between them and any other citizen.

Listen, socialized medicine is not the same thing as providing soldiers with health care. Socialized medicine is a claim on the lives of others.

Isn't it up to the employer to determine who deserves what as payment for their employees' services? And you're absolutely wrong; plenty of citizens provide services. Soldiers merely engage in one type of service.

Ayn Rand has said that it isn't about the amount of money one makes, nor the job one takes, but rather what you produce through it, and how you choose to benefit from the fruits of that labor. This is demonstrated well by Hugh Akston's character in Atlas Shrugged. I disagree with this senseless categorization of people just because of their occupation. Indeed, some soldiers are incredibly valiant, noteworthy, and spectacular workers, but there are just as many (if not more) who are miserable scumbags. You'll find a whole lot of scumbags in the custodial industry too, but there are also great men who work in that field.

But this is all tangential, because the fact is that engaging in any sort of government hospital service is a violation of individual rights. If our government is to be laissez-faire, then that means no interference until it is retaliatory in nature. The burden of being a soldier lies upon the individual who chooses this as his/her career path. They are free to choose any career they want, so to treat them any differently from any other career, employed by the government or not, is absolutely against the Objectivist virtue of individual rights. Let the private sector cater to the health services needs of the military, and allow government to do only what is right - to fund it as compensation for the soldiers' services to their country.

Not to be snide or short, but I don't see how anyone who says that military personnel should be responsible for the treatment of their injuries could be thinking critically about the issue. Imagine if you lost your finger, or a measly part of the damn thing, on the job; imagine if you lost more than a finger in an explosion or firefight during combat. Any military personnel to be injured in such circumstances is in no way responsible for their own treatment. VA clinics provide necessary care for military personnel. There's really nothing more to say about it.

It's not up to me to decide who is responsible for injuries. That would need to be drafted in a contract and agreed upon before entering employment in the military. I'm not knowledgeable enough to know what the specifics of that should be - I only know what Ayn Rand has taught us about the proper role of government. VA clinics provide a service funded by government that could be performed by the private sector, and is not in any way defending individual rights. The government, again, has every right to provide funding for private medical care for veterans as an employer's benefit, but the government does not have a legitimate role in physically servicing these medical needs. If it were up to me, I'd make sure every military personnel has health insurance, but I would do so only first by making sure that this medical care is as far away from the government as possible.

[Jake_Ellison]

Why does a hospital that services veterans need to have the government as its largest client? And why couldn't it be private? You're making a sweeping assumption that no hospital could rightly survive without succumbing to a "public" transformation. You're assuming that there is nobody wise or skilled enough to run a hospital that cares for both the military and the privately-employed citizens.

Why are you sacrificing your values of laissez-faire government for some unfounded notion of practicality? Laissez-faire is laissez-faire. You're trying to have your cake and eat it too, by trying to preserve the sense of (the false facade of) a capitalist government, but also give some sort of beneficial treatment to certain government employees due to some external moral value you possess. Who cares if the government could even run a good public hospital system for veterans? Why does that mean they should? Better yet, why does that mean we must take away this ability from the private sector, as you blatantly suggest here?

I'm not gonna argue with two pages of nonsense. I'm not saying any of the long list of things you claim I'm saying. Read the thread again, if you feel like it, if not, go on writing long winded dissertations about what my opinions are. I don't give a fuck, but trust me, no one's reading them.

[2046]

Andrew, I agree with the substance of your point on governmental health insurance, but isn't it a perfectly legitimate function of the armed services to build, own, and maintain hospitals directly on-base, which serves a host of functions, but one of which should be to provide health care to soldiers, including veterans? (Just as it is, for example, perfectly legitimate to have a mess hall, even though government doesn't get involved in the food industry, or a quarter master, even though the government doesn't get involved in the clothing industry.)

Ellison: Please do respond to Andrew's points on government health care, if you want. You can ignore the libertarian nonsense about militarism, but I am at least interested in further clarifications in your opinion about the topic.

[softwareNerd]

... isn't it a perfectly legitimate function of the armed services to build, own, and maintain hospitals directly on-base, which serves a host of functions, but one of which should be to provide health care to soldiers, including veterans? (Just as it is, for example, perfectly legitimate to have a mess hall, even though government doesn't get involved in the food industry, or a quarter master, even though the government doesn't get involved in the clothing industry.)

It might be, and it is a managerial issue, not a philosophical one. Government-run entities will almost always be less efficient than privately-run ones. However, cost is not the only variable that managers have to use in their decisions.

[Jake_Ellison]

Ellison: Please do respond to Andrew's points on government health care, if you want. You can ignore the libertarian nonsense about militarism, but I am at least interested in further clarifications in your opinion about the topic.

I'm in full agreement with RussK's last post, post #25 in this thread. I don't know what else there is to say, sorry.

[Grames]

I don't care what historical evidence you do or don't have

Rationalist.

[Eiuol]

Andrew, I agree with the substance of your point on governmental health insurance, but isn't it a perfectly legitimate function of the armed services to build, own, and maintain hospitals directly on-base, which serves a host of functions, but one of which should be to provide health care to soldiers, including veterans? (Just as it is, for example, perfectly legitimate to have a mess hall, even though government doesn't get involved in the food industry, or a quarter master, even though the government doesn't get involved in the clothing industry.)

Just as I don't think any company should take care of its retired employees, I don't see a reason the -military- should take care of its veteran soldiers. The private health care industry should be used whenever possible. If it is not on a battlefield, private hospitals are available. All the military has to do is pay for services, if it were necessary to "fix" some soldiers up to be sent to fight again. A mess hall is different. It feeds soldiers on the job. A quartermaster provides clothing for soldiers on the job. It is also a logical function of the military with use limited to on the job or training. Regardless of if the military should or could run hospitals for its soldiers that are not on tour, taking care of veterans is -definitely- not part of the functions of the military.

A small, government run hospital system could offer high quality care, and leave the rest of the health care market to function free of government interference.

You really think so? You could run a government run company alongside private companies in any industry without regulation. Does that mean the government should be allowed to do it, as long as it doesn't interfere? Should the government be allowed run a small electric utility company to maintain its facilities? The answer should be obviously no.

[Jake_Ellison]

You really think so? You could run a government run company alongside private companies in any industry without regulation. Does that mean the government should be allowed to do it, as long as it doesn't interfere? Should the government be allowed run a small electric utility company to maintain its facilities? The answer should be obviously no.

Great. You have an analogy, so I'm obviously wrong. What if I now came up with another analogy, let's see here...vets are like a beautiful, exotic flower, they require constant care. Should the government take out health insurance on a flower? Obviously not. Yey, I'm right again.

[Andrew Grathwohl]

I'm not gonna argue with two pages of nonsense. I'm not saying any of the long list of things you claim I'm saying. Read the thread again, if you feel like it, if not, go on writing long winded dissertations about what my opinions are. I don't give a fuck, but trust me, no one's reading them.

What long list of things?

I said that:

1. You assumed whichever hospital(s) the government used for its soldiers would be catering mostly to the government.

2. Because of the above, we can tell that you don't think it's possible to have a hospital managed in any other manner, or that you think this is the best achievable means to manage such an institution.

3. That you would give up a complete laissez-faire government to have veterans' hospitals for soldiers, and that you think this is the right thing to do.

You can't refute those three simple points? It's not nonsense at all - it's completely legitimate to wonder why you, who have so rudely defended your so-called rational opinions in the past, cannot even bother to back up your very collectivist claim that the government should run a veterans' hospital service - and that, stranger yet, you think this constitutes a proper use of government.

[Eiuol]

Great. You have an analogy, so I'm obviously wrong. What if I now came up with another analogy, let's see here...vets are like a beautiful, exotic flower, they require constant care. Should the government take out health insurance on a flower? Obviously not. Yey, I'm right again.

I do not consider it to be an analogy. To me, a government run hospital would be exactly equivalent to government owned small electric utility company. It is NOT part of courts, police and military. Even if it has the money to run it efficiently and without regulation, that doesn't mean it should be allowed to. You completely missed my point. "Should the government be allowed to run a [secondary, non-regulated, voluntary funded company] in order to maintain its [components that run its main functions]?" I would say no. But the issue might simply be whether or not you call taking care of veterans a proper and main function of the military. I think it as a secondary and entirely separate industry, so therefore the military should have nothing to do with it.

[Grames]

I do not consider it to be an analogy. To me, a government run hospital would be exactly equivalent to government owned small electric utility company. It is NOT part of courts, police and military. Even if it has the money to run it efficiently and without regulation, that doesn't mean it should be allowed to. You completely missed my point. "Should the government be allowed to run a [secondary, non-regulated, voluntary funded company] in order to maintain its [components that run its main functions]?" I would say no. But the issue might simply be whether or not you call taking care of veterans a proper and main function of the military. I think it as a secondary and entirely separate industry, so therefore the military should have nothing to do with it.

I would say yes.

Can the government own property at all? Yes.

Is there any basis to distinguish between types of property the government may or may not own? No.

The idea behind laissez-faire capitalism is to prevent corrupt manipulation of markets (a form of force and fraud) on behalf of special interests, not to prevent government from owning property. The government can and should participate in economic activity incidental to its functions.

A government and employers in general have a moral obligation to provide compensation to people wounded or killed on the job or in the line of duty. As this is a moral argument, it completely trumps any economic theory you may care to advocate.

[Myself]

A government and employers in general have a moral obligation to provide compensation to people wounded or killed on the job or in the line of duty. As this is a moral argument, it completely trumps any economic theory you may care to advocate.

What moral argument?

If it's in a soldier's contract that he should be cared for or compensated when wounded in the line of duty, then it would be a contractual obligation, not a moral one.

In a free society the government would have to offer appealing contracts to lure young recruits, so it's likely they would end up including a clause like this. However, there is nothing inherent to the concept of having armed forces that necessitates compensation.

[Andrew Grathwohl]

What moral argument?

If it's in a soldier's contract that he should be cared for or compensated when wounded in the line of duty, then it would be a contractual obligation, not a moral one.

In a free society the government would have to offer appealing contracts to lure young recruits, so it's likely they would end up including a clause like this. However, there is nothing inherent to the concept of having armed forces that necessitates compensation.

I don't think anybody disagrees that it would be necessary to have compensation for armed forces. My issue with what has been said in this thread is that I don't think the government is justified in compensating soldiers by means of establishing a government-run hospital service for veterans nor for soldiers who have been injured in the line of battle. The only medical purpose that the armed forces should logically be involved in are ones on the battlefield, which aid in accomplishing the mission of the soldiers. All other matters of medical care may be paid for by the government through contractual obligation for compensation, but they may not be government-operated or government-owned.

[RussK]

So do completely private hospitals. The military of course should be obligated to pay medical expenses as a result of combat, because it is responsible for that damage. But it should not run its own hospital / health care plan (beyond a battlefield hospital, that is). I'm not treating it any differently than government employees at a court house. If they get hurt on the job, the government should be obligated to pay the medical expenses, nothing more. Nor should the government even attempt to do anything even slightly different than its branches are expected. To me, it is similar to government owned roads. Roads are useful for the military to maintain, create and own in case of attack, in a similar way that taking care of soldiers back at home is useful. But it is clearly not part of how a military is ran and operated. I'm not "upset" that VA clinics provide care, I just think ending public funding of health care (while not on the battlefield) is one of the most important steps to make to achieve a truly free market in health care.

Military men and women don't just spend time on the battlefield. If they are in an active component they are usually garrisoned somewhere while not deployed to combat. While in this garrison situation there is constant training in preparation for the combat environment. I hope you don't think that it's 'battlefield and go home', and think the government is obligated to 'pay'--I myself like to use the word treat-- only for combat injuries because that isn't, nor should it be the case.

You say, "I'm not treating it differently than government employees at a court house." Yeah, why is that? It makes no sense to treat them the same. I see you also treat the maintenance of roads and keeping a healthy fighting force, as being similar.

I'm not "upset" that VA clinics provide care, I just think ending public funding of health care (while not on the battlefield) is one of the most important steps to make to achieve a truly free market in health care.

Yeah me too, but I still think the VA is a good organization and will support its existence. I also think that ending public funding of education is one of the most important steps to make in order to achieve a truly free market in education, etc... But this doesn't mean that I'm against the VA benefits given to military personnel for education purposes. Another thing, you do realize that those injured on the battlefield will, hopefully, be taken off, treated in a military run hospital, and then discharged from the military and afterwords receive treatment from the VA, right? If so, how do you think that treatment, off of the battlefield, is to be paid, if not by public funding?

On a side note, one should know that the VA is not a part of the military, and it doesn't just provide health services--education financing, as already mentioned. The military runs its own hospitals, usually on bigger bases or posts, and personnel are given health insurance called CHAMPUS/TRICARE that is used off post. VA is for people out of the military.

[themadkat]

On a side note, one should know that the VA is not a part of the military, and it doesn't just provide health services--education financing, as already mentioned. The military runs its own hospitals, usually on bigger bases or posts, and personnel are given health insurance called CHAMPUS/TRICARE that is used off post. VA is for people out of the military.

For anyone who was not already aware of this, there are so many horror stories about the mess that is Tricare it would make your head spin. They are far worse about actually covering things than even the slimiest private health insurance company. Worse than Kaiser, even.

[RussK]

For anyone who was not already aware of this, there are so many horror stories about the mess that is Tricare it would make your head spin. They are far worse about actually covering things than even the slimiest private health insurance company. Worse than Kaiser, even.

That's one of the reasons I used in my first post to point out how absurd Stewart and Kristol were in their comments. I know people retired from the military, who get TRICARE, who are having problems getting things like MRI's accepted by TRICARE; they used to get things covered with absolutely no hassle. They know times are changing for sure. People currently in the military just can't go to the hospital with their TRICARE and expect the government to pay for it; it has to be an emergency. If it's not an emergency then one has to call TRICARE for approval, and they will approve the use of a civilian hospital only if travel to a military hospital is out of the question. Likewise, if one is currently being treated in a military clinic or hospital, and that facility cannot perform the required treatment, the member will be sent to the nearest civilian hospital to receive proper treatment, using their TRICARE.

[Jake_Ellison]

I do not consider it to be an analogy. To me, a government run hospital would be exactly equivalent to government owned small electric utility company. It is NOT part of courts

Well, then you need to look into what an analogy is. You're relying on a logical equivalence between two things, for your argument. That's illogical: your premise is that A ≡ B. If that is true, why would you need to substitute B for A, and then state that your point is obvious. If A ≡ B, then your point should be exactly as obvious using A and never mentioning B, as it supposedly is using B. So why use B at all?

[Eiuol]

So why use B at all?

You're right, using the B (electric utility company) was unnecessary. But I did clarify in the next post, I mean to say both the hospitals in question and other companies are equal in how I classify them. Grames pointed out that the government can and should participate in economic activity incidental to its functions, and this is probably your line of thinking. I somewhat agree with the statement, but I do not think of taking care of veterans is part of those functions. You don't necessarily owe veterans for anything they do, that is something only for an individual to decide.

This point is one reason I brought up the analogy that you contested. I'm not sure if incidental costs is enough to say what the government should be allowed to do. Using electricity is certainly an economic activity incidental to the government's functions (unless I misunderstood what he meant by incidental). The reason I think this is not proper for the government to take care of is because it is not a thing of primary importance in government operations. If a government run hospital for military personnel (outside the battlefield) is entirely different, what exactly is the difference? What makes it one of the government's primary concerns? To me, health care seems like an industry completely apart from the military, enough so that they should simply go to private hospitals for treatment of soldiers according to whatever contractual obligation that exists. Of course, the primary/secondary distinction I make should be addressed first as to whether or not it is a valid consideration.

Edited August 1, 2009 by Eiuol

[Markoso]

Hmm, I feel the need to weigh in on this one. I doubt Kristol's comments really need to be picked apart any further, so I'll begin by saying that themadkat and Russk are right on the money thus far about the role of healthcare within the military. There are a lot of specialized services rendered within military-run hospitals, largely targeted towards ensuring marines, airmen, sailors, and soldiers can go off and fight wars. By and large, they are used to ensure personnel are medically fit to deploy to area x, with dependent care being a secondary (this is based on my own personal observations). Furthermore, running base hospitals provides critical training opportunities for military medical staff, such that when not in a warzone, personnel can remain trained and competent to effectively treat a variety of medical cases, and not just combat injuries.

However, outside of this role, TRICARE is largely substandard imo, with *gasp* waiting lists for highly sought after procedures (namely eye surgeries), and the variety of issues with getting certain things covered (see Russk's post above for more detail). In any case, the key point I want to stress here is that by and large, the function served by military medical facilities is not relevant to the debate regarding socialized medicine, and both Stewart and Krisol err by drawing that comparison.

Edited August 2, 2009 by Markoso

[Jake_Ellison]

Grames pointed out that the government can and should participate in economic activity incidental to its functions, and this is probably your line of thinking.

Never even crossed my mind that there's an issue with providing healthcare for veterans, because it is somehow immoral. So it's a safe bet that's not my line of thinking, I've simply been trying to think of the best way for the government to accomplish a task which is obviously well within its functions.

You don't necessarily owe veterans for anything they do, that is something only for an individual to decide.

I do necessarily owe veterans, for winning several wars in the past, and allowing me to enjoy a great degree of freedom from the people who seek to destroy it for all of us. The fact that they did it for themselves too, so they were self interested in fighting for freedom, does not mean we didn't benefit from their efforts.

If it is your contention that these veterans always chose the most lucrative offer on the market, and going to the Pacific or Vietnam was it, you're very far from the truth. They did what was necessary, when others wouldn't, for everyone's sake, and health care should be part of their compensation, for it.

Edited August 2, 2009 by Jake_Ellison