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Here’s a hypothetical: Someone close to you has a very serious illness, diagnosed as terminal, say cancer, and the doctors are recommending aggressive treatment with chemo-therapy or radiology, or major surgery, or some combination thereof. What should they do?
On the surface, the answer may seem obvious: get the treatment, of course.
But, what if it produces extremely harsh side effects that are so debilitating the patient is barely able to function for weeks or months. And, although the treatment may buy the patient some time, perhaps a few months or a year, it is clear that the he or she will not live much longer. Add to the equation the fact that the care will cost $200,000 or $300,000, perhaps much more.
Does this patient, or any patient for that matter, have an absolute “right” to treatment (health care) regardless of prognosis or cost? How do we decide? And, who should make the decision? The family members, the doctor or the hospital or the rules of the health care system?
These are never easy decisions, and they are complicated by an overlay of personal factors. I have seen families confronted with such situations reach the point of open conflict over whether or not to “pull the plug.” It can be a gut wrenching decision, often involving deep seated feelings about a parent, a spouse or perhaps a child. In 1998, the highly publicized Terry Schiavo case thrust this issue into the public domain at the time. She was diagnosed as being in a “persistent vegetative state,” and the argument between her former husband and her parents made headlines for weeks.
The issue is further complicated by cost considerations, which is where those societies that have socialized or nationalized health care plans encounter problems: They can’t afford extraordinary health care costs for many elderly or gravely ill patients. As a result, health care is rationed, denying it to certain classes of patients, such as those who may be extremely obese, or smokers, or who may have an incurable disease or condition.
In 1901, average life expectancy in the U.S. was approximately 49 years. Over the last 100 years, it has dramatically increased to 77.9 years. This provides testimony to the advances in health care that have been made, but costs have escalated along with longevity.
If health care is a “right,” should there be a limit? If so, what should it be? Is it possible to provide all the health care that everyone needs or wants on an open-ended basis? With the Medicare and Medicaid programs already operating at a substantial deficit, where will the money come from to further expand the scope of the coverage? The Peter G. Peterson Foundation has reported that if the federal government stopped the Medicare program tomorrow – collecting no more payroll taxes and allowing no further accrual of benefits – it would still owe about $34 trillion to those people who are already entitled to health care benefits.
Furthermore, the highest percentage of health care costs are incurred by the elderly. People in general require more health care services as they age.
A 2005 Denver Post editorial, “Medicare: a real fiscal crisis,” noted: “Last year, Medicare’s Hospital Insurance Trust Fund, which pays hospitalization costs for the elderly, reached a foreboding tipping point, paying out more to recipients than it collects in payroll taxes, comptroller general David Walker told the House Ways and Means Committee earlier this month. By some projections, the trust will be depleted by 2019. The forecast comes as 79 million baby boomers get set to retire in the next two decades. To avoid a fiscal wreck, Congress should act now. Yet, Medicare is not even on the table…Since Medicare was created in 1965 it has grown to a $325 billion program serving 42 million beneficiaries. Medicare costs are projected to increase 9 percent a year through 2015. (Medicaid, the federal-state insurance program for low-income and disabled people, also is under enormous cost pressures.)”
“The potential remedies to keep Medicare solvent are none too popular - raise payroll taxes, increase the age of eligibility, or hike seniors’ premiums, deductibles or co-pays. Controlling costs by reducing the reimbursement rates has occurred regularly and hurts beneficiaries when doctors and hospitals refuse to see Medicare patients.”
So, the question remains, “Is health care a right?” Or, perhaps the question should be “How much health care is a right?” And, how do we decide how much and for whom. How should the equities between individuals be balanced out?
There are no easy answers, but treating health care as an absolute “right” without limit is clearly not the solution, if for no other reason than the fact that it can’t be sustained.
“If you do the crime, you do the time,” is a popular saying. That certainly seems to be the mind-set of the American public, who are deluged with daily crime stories in the media and are clamoring for increasingly tougher punishment of offenders, such as child molesters. Politicians and the courts have taken notice, and an examination of crime research reveals that, in addition to being the “Home of the brave and the land of the free,” America’s jails are overflowing.
The good news is: the FBI has reported that four major categories of crime in America declined in 2007:
Violent crime was down 1.4%.
Murder declined 2.7%.
Forcible rape declined 4.3%, and
Robbery decreased 1.2%.
The bad news is that America has more people incarcerated than ever, more than any other nation. One of every 100 American adults is now in our jails, an estimated 2,319,258 at the start of this year (2008). In 2006, roughly 14% of the total prison population had been convicted of drug offenses. About 750 per 100,000 Americans are incarcerated in the U.S., while China, with 4.3 times the population of the U.S. has only 1.5 million people in its jails, and 628 per 100,000 Russians are incarcerated. (More than 1 in 100 Americans in jail, By David Crary, The Associated Press, February 29, 2008).
However, locking more people up and keeping them there longer costs big bucks. A report on the cost of prisons in the U.S. by the Pew Center’s Public Safety Performance Project noted (http://www.pewcenteronthestates.org/initiatives_detail.aspx?initiativeID=31336):
The total cost of corrections in the 50 states was more than $49 billion in 2007.
Prison costs in 2007 increased six times faster than increases for education.
Average annual cost per prisoner was $23,876. Rhode Island spent the most, at $44,860, and Louisiana the least, at $13,009.
“…California spent $8.8 billion on corrections last year, while Texas, which has slightly more inmates, was a distant second with spending of $3.3 billion.
“Four states – Vermont, Michigan, Oregon and Connecticut – now spend more on corrections than they do on higher education.”
“…prison growth and higher incarceration rates do not reflect an increase in the nation’s overall population. Instead…more people are behind bars mainly because of tough sentencing measures, such as ‘three strikes’ laws, that result in longer prison stays.”
Joe Arpaio, the Sheriff of Maricopa County, Arizona, has become an American folk hero for his tough policies: pink underwear for prisoners, serving bologna sandwiches, housing about 2,000 low risk inmates in barbed-wire surrounded tents with no air conditioning, and chain gangs of both men and women working on county and city projects. Sheriff Arpaio’s no frills policies also include: No coffee (because it has no nutritional value), limiting cable TV shows to the Disney and weather channels, no smoking, no porno magazines, no weights, only “G-rated” movies.
Many Americans in other states would like to see their own law enforcement officials emulate Sheriff Arpaio, but it’s not easy. Legislators and the courts around the country have adopted policies that prevent similar practices. California, for example, does not permit housing prisoners in tents and requires certain amenities, in spite of the fact that many of the states jails are so crowded that prisoners have to sleep on the floor, in hallways, etc. The courts have responded to the situation by requiring that prisoners be released early to avoid such conditions. In Santa Barbara County, for example, the impact is to automatically reduce most short-term sentences (six months or less) by a third or more.
As is so often the case with complex issues, there are no easy answers, but it is clear that the American public is running out of patience with treating prisoners like hotel guests while they are taxed to pay the bills.
I want all the folks that blamed the oil companies and President Bush (co-conspirators!) for the recent spike in oil prices to retract their statement and admit they don’t understand the basics of supply and demand nor the futures market. Or, alternatively, they could admit they do understand market conditions but were simply exploiting the same for political gain.
I want Al Gore to explain why we are having one of the coldest periods in recent history despite the fact that the computer models he has been relying upon would have us believe the end for our planet is near, due to theoretically unstoppable global warming.
I want the Regional Water Quality Control Board to explain why a farmer, rancher or construction site manager is not allowed to have any dirt leave their premises, even during a storm event, lest the dirt make it to the ocean and foul our waters. Yet this same agency allows government entities to haul thousands of tons of sediment to the beach after a fire or flood in order to dispose of the same!
You would think that politicians who want to grow government would realize they need to grow the economy in order to pay the bills, but such is not the case. Instead, I must add to my Christmas list my desire to see politicians and bureaucrats acknowledge that the private sector pays the bills in this state and they should start advocating for removal of all the artificial constraints and burdens that have been placed upon the business community and the use of private property.
While on this subject, I want public employee unions to recognize the threat of their being laid off, having holidays such as Caesar Chavez day eliminated, and having their pay cut because of the recession we are in, is in part their own doing. If it is not too much to ask, I would hope the unions will come to the conclusion that the very same politicians they helped elect based upon the promise that their personal gravy train would never end, in the form of salary and benefit packages, are the very same politicians who have long been strangling the golden goose paying for it all.
I want Arnold, our erstwhile Governator, to admit that he helped sink our state economy into a much bigger hole than what led to the ouster of Gray Davis. Despite promising to cut the state’s credit card, he helped pass several phony budgets that were never balanced to begin with and that were laden with tens of billions in debt.
Arnold is dreaming of getting some sort of a position in the Obama administration once his term as governor is up. I say, why wait? Resign now and save us from two more years of economic and political chicanery. As a favor before you go, Arnold, how about admitting that your landmark legislation, AB32, which deals with greenhouse gases, and your support of the diesel engine rule being put in place this week, is going to decimate the farming, construction and transportation sectors of our economy?
Please forgive me for being facetious. Everything I have mentioned in this column deals with real and severe threats to our quality of life and our standard of living. As Americans, we have been given a great gift and stewardship. We inherited faith and freedom and a standard of living that most of the world can only dream of. This holiday season, my real gift request would be for citizens to no longer take these things for granted.
Andy Caldwell is the executive director of COLAB and a 40-year resident of the Central Coast. For contact information, visit the COLAB Web-site at www.colabsbc.org.
What does it say about our culture when a man is trampled to death in the mad rush of a crowd of shoppers, pushing and shoving to get into a store just to buy something? Did any of them really want or need some item of merchandise badly enough to kill for it? Of course not! But, it almost looks that way.
The day after Thanksgiving, an employee in a Long Island Wal-Mart store was knocked down and literally run over by an estimated 2,000 shoppers as he was opening the door at 5:00am. A co-worker noted, “They took the doors off the hinges. He was trampled and killed in front of me. They took me down too…I literally had to fight people off my back.” A 28-year-old pregnant woman was also knocked to the floor and three other shoppers were injured in the melee.
Another violent incident in Palm Desert, California, highlighted the Wal-Mart tragedy, in which two men shot and killed each other in a Toys R Us store, following what was said to be a dispute between two women shoppers. The specific cause of the shooting has not yet been reported.
Call me naïve or “square,” but for the life of me, I cannot understand what could possibly be so important that people will wait in line for hours, sometimes all night, just to be among the first to get into a store to buy a toy or a game or the latest technological gadget, such as an iPod or a BlackBerry, or whatever else they may fancy at the moment. And, for what? This sort of behavior is not about needs, it’s more about entertainment or bragging rights.
Unfortunately, it’s not limited to buying some trinket or the latest game or toy. It extends to the general mindset of far too many Americans today. “Gimme, Gimme,” they seem to exclaim. “I want what I want, and I want it now. And, if I can’t pay for it, the government will, or should.”
We have been hearing for years how much the rest of the world hates America, that it is our policies toward other nations that motivated the 9/11 attacks, that if we were only more willing to help others, we could win back the respect we used to enjoy on the world stage. But, I submit there are other, more basic, more important reasons why so many people in other societies hate us so much, perhaps the most significant of which is our culture of self-centered values and behavior. The “Ugly American” image is still with us, and I believe the Wal-Mart incident will feed that perception. We are intensely disliked because of our over-the-top commercialism in the face of the terrible conditions in which other people around the world must live.
There have always been and always will be obnoxious displays of wealth by individuals: The oil-rich sheikhs in the Middle East or billionaires in other countries, even in places like China and India, but nowhere that I know of does an entire society display such crass commercialism as we do here in America. Perhaps they would if they could, but because they can’t many of them hate us, notwithstanding the fact that huge numbers of them are willing to risk life and limb to get here.
The War on Terror also factors into this. One of the reasons Islamic fundamentalists are dedicated to destroying our culture is because it is so offensive to them. There is no way to reconcile the goal of our enemies to bring down Western societies and the crass commercialism of our own society, which clearly feeds their perception. We mean them no harm, in the sense that if they would leave us alone, we would probably be happy to reciprocate, or at least I believe most Americans would.
Over time, we will witness the process of fixing blame and assessing damages for the loss of life and injuries that occurred in the Wal-Mart incident, and there is little doubt that the company will pay for not protecting their employees and customers as they should have. Chances are it will lead to revised store policies by Wal-Mart as well as many other retailers for handling crowds. However, as Austin Hill, a radio talk-show host and columnist, noted: “…legal liability and moral culpability, are often not the same thing…But one thing is certain: in America’s “moral economy,” personal responsibility is a commodity that is in short supply.”
How many laws do we pass to fix problems, only to find out that they don’t fix anything and often make things worse? Sometimes laws are passed for political purposes, sometimes to bestow some benefit on a particular group or individual, sometimes simply out of ignorance. Whatever the case, the more they pile up, the worse things get.
Logic and reason often have no effect on those who support many of the actions that are taken by our political leaders, who may have other reasons, albeit often wrong or simply self-serving. But, a bigger problem is the lack of knowledge of the electorate, many of whom are uninformed or tuned out.
Does anyone ever stop to consider the number of laws that are passed?
There are over 3,000 counties in the U.S., ranging in size from 41.6 square miles (Arlington, VA) to 141,398 square miles (North Slope Borough, Alaska), along with almost 19,500 municipalities, in addition to the 50 states. That adds up to some 22,500 entities in addition to the Federal government, all putting laws on the books, presumably to correct problems or to influence or regulate behavior, that is, make people do things the legislators want. In California alone, the legislature adopts upwards of 5,000 laws every year.
Obviously, a certain amount of this is necessary. For example, local ordinances for such purposes as regulating traffic, land use, or taxation. In addition, advances in technology bring new problems and with them the need for new laws. The rapid development of computers and the Internet have brought new opportunities for mischief, such as Internet fraud and identity theft. And bio technology is presenting society with moral and ethical challenges that never would have occurred to earlier generations. Who knew?
People never seem to be able get enough of whatever it is they think will satisfy them. Sometimes it’s strictly for personal advantage, sometimes for the greater good, or so they may believe. Environmental activism or unbridled business practices are good examples. Whatever the reason, legislators respond to special interest groups that want to impose their particular need or desire on the rest of society, which results in thousands of new laws and regulations.
P.J. O’Rourke said, “For the people in government, rather than the people who pester it, Washington is an early-rising, hard-working city. It is a popular delusion that the government wastes vast amounts of money through inefficiency and sloth. Enormous effort and elaborate planning are required to waste this much money.”
Furthermore, we can be prosecuted for breaking laws we don’t even know exist. “Ignorance of the law is no excuse” has been a traditional mantra, but it has been reported that Americans are now subject to over five million laws. How can anyone possibly know and obey them all? And, they keep piling up. Every legislative body, municipal, county, state and federal, is constantly making new laws, and nothing ever seems to be taken off the books.
So, if ignorance of the law is really no excuse, then we are all charged with specific knowledge of the millions of laws that regulate us. That’s impossible and is undoubtedly one of the reasons why many Americans have grown increasingly cynical about the law and justice in this country.
And, if five million laws are not enough, there are also hundreds of thousands, perhaps millions, of rules that are superimposed on top of them – by OSHA, EPA, IRS, HUD, EEOC and a host of other alphabet soup agencies. The Internal Revenue Code is a perfect example. The plethora of tax laws and regulations that have been adopted by Congress and the IRS and interpreted by the courts requires over 66,000 pages to codify and interpret. No one, not even the most brilliant CPA or tax attorney, knows or understands all these laws and rules. They can’t even agree on what various provisions may mean, yet it is possible to be prosecuted for fraud for violating them.
Legal precedent is also adding to the burden of excessive control and regulation that are strangling our society. Hundreds of thousands of court cases are used to interpret the laws and comprise entire libraries of additional rules we are expected to abide by in our daily lives. The sheer weight and complexity of all this breeds contempt for the law, evasion and deliberate lawbreaking.
How much longer can we continue to function under this burden before the system ultimately grinds to a halt? Chances are, it will end only when America finally collapses under the weight of excessive regulation. It may take many more years, but if we don’t come to grips with the problem, it will eventually happen. I’m just glad I’m old enough that I will probably not be around when it does.
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