Law & Medicine & Intellectuals (was Re: geels)

Gordon Fitch gcf at panix.com
Sun Sep 17 09:49:20 PDT 2000


Anita wrote:
> >pharmacological intervention, as regards agency, is at least a
> >two-way affair -- in the context of what one as patient/patients
> >is/are willing to do, and what the doctor/s is/are willing to do to
> >patient/s. then moving in/out/up a level from individual or group
> >relations the legal, moral, cultural, political, economic normic
> >constraints/licenses come into play.

Yoshie Furuhashi:
> ***** U.S. Study Finds Uninsured Ignore Signs of Illness
>
> CHICAGO, May 7 (Reuters) - People without health insurance are far
> less likely to seek medical help when confronted with symptoms of
> potentially serious illness, U.S. researchers reported on Sunday.
>
> They said the finding was particularly disturbing since the number of
> people without health insurance in the United States -- now 44
> million -- is likely to grow by another million in the next five
> years.
>
> ``Our findings suggest that lack of health insurance is a major
> barrier to obtaining health care for important symptomatic
> conditions,'' said the report from Case Western Reserve University in
> Cleveland.
> ...

Certain aspects of this important complex of issues are obscured. Usually, articles about health care (so-called; we are actually talking about medical care, the practice of medicine, and so forth, not health, which is as different from medicine as knowledge and understanding are different from education) -- usually, articles about medical care treat it as an unalloyed good which requires only better funding and more replete mechanics of distribution to benefit everyone.

But it may be that many of the un- and semi-insured evaluate the medical care establishment (MCE) differently and make an intelligent guess that it isn't worth the money for them. For any given condition, there's a certain risk that, untreated, it will grow worse, but there is also a substantial risk that, if taken to the MCE, either nothing will be accomplished after the very considerable money, nuisance, lost time, discomfort, pain and embarrassment which the MCE exacts upon its clients, _or_ the situation will actually be made worse. After all, it's typical to make patients wait for hours in a room crowded with other sick people, a good formula for encouraging the spread of contagious disease. And professional incompetence is widespread and protected. In short, unless you're very ill, medical care may well be a bad bet, not worth the costs.

These factors affect political considerations of how medical care is to be paid for. Taxes reach the working and middle classes quite efficiently, so they know that they can expect to pay -- without being able to call the tune, since the MCE is not much subject to public review or restraint other than a refusal to pay. Typical private medical insurance for a family runs, I believe, to around $7000 per year -- a substantial outlay for someone whose net income is, say, $50,000. Many people do not think this amount would be reduced because it was exacted by the government -- correctly, I think. But the ability to refuse it would disappear. Therefore, medical insurance paid for through taxes could be reasonably seen as disadvantageous and undesirable for lower- and middle- income people without some kind of fundamental change in relationship between the MCE and its clients.

The most reasonable alternative to the present MCE, the most _socialist_ alternative, would be not a government medical establishment but cooperative HMOs, in which the patient/ client/consumer would be in a direct, hopefully demystified and non-authoritarian relationship with medical care workers. Myteriously, these do not appear, except in the State of Wisconsin, and instead capitalists charge into the breach.



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