Thursday, October 9, 2008

Medical Choice initiative panel & abortion

Last Friday the Federalist Society put on a panel discussion of Prop. 101, the Freedom of Choice in Healthcare Act. Dr. Jeffrey Singer and Dr. Eric Novak spoke in favor of the proposition, and Dr. Eve Shapiro and Dr. Jonathan Weisbuch gave the argument against it.

Argument For:
This is a civil rights initiative. Just like they did with illegal immigration, the states are now taking healthcare into their own hands since the federal government isn't stepping up to rectify it. State legislator Phil Lopes recently proposed a bill that would ban private health insurance. Prop. 101 would prohibit legislation like this. We need to do something or the special interests will eat us for lunch, lobbying to get their earmarks in any legislation that is passed.

This bill is not going to prohibit the government from regulating healthcare generally, and government will still be able to provide a safety net healthcare system. However, it would prohibit government from using disincentives to cajole people into using government healthcare, and there won't be any special tax breaks for certain groups. The only option this proposition takes off the table is government coercion.

Argument Against:
The doctors arguing against Prop. 101 said it shouldn't be in the Constitution, since we may not want it later (couldn't you use this argument with almost any proposed law?). This should be resolved through the normal legislative process – vote new legislators into office, not bind them permanently.

They contended it was poorly written & vague – if it’s supposed to prohibit a single-payer plan, why doesn’t the language specifically say that. Single-payer systems that have been enacted are at the national level, never the state level, so there's nothing to be afraid of. Dr. Shapiro claimed that ensuring access to private healthcare isn't a big concern of her patients.

They claimed that Prop. 101 would hurt access to healthcare, and warned of vague unintended consequences. Unbelievably, they accused the initiative of being designed to confuse voters and skew real problems. They basically picked apart the initiative in every hypothetical way they could come up with. Since "entity" wasn't defined, something inappropriate like some bogus cancer treatment could exist without interference from the state trying to shut it down.

The doctors insisted it wouldn't improve anything – access, cost, quality – it would just prevent legislators from improving the system in the future.

Their criticism also consisted of pointing out everything the initiative wouldn't do - as if the initiative is flawed because it doesn't do a zillion things. It doesn’t guarantee a choice of your own doctor, or insurance when you lose your job or a preexisting condition is found, no freedom from medical bankruptcy (those last few things should be handled by the free market anyways).

Finally, they noted that Prop. 101 is opposed by several medical groups, AARP, and other organizations. I bet that AAPS (Arizona Association of Physicians and Surgeons) is supporting the initiative, the free market equivalent to the AMA.

Dr.'s Singer and Novak said that the legal arguments against Prop. 101 consisted of one rambling email, whereas there have been numerous reputable legal arguments in favor of it. They said the only thing they agree with the other two doctors on is that the Proposition wouldn't free you from all those things mentioned. It's not supposed to be healthcare reform, it's about civil rights. We need to have our basic constitutional rights protected. People probably thought the First Amendment was ill-advised at the time it was added to the Constitution but Alexander Hamilton went ahead and did it anyways.

Dr.'s Singer and Novak found it fascinating that AHCCCS has come out against it – because it’s against the law for a state agency to take a position on a proposition (Dr.'s Singer & Novak filed a lawsuit against AHCCCS later that day).

It's not true that single-payer healthcare only happens at the national level. A single-payer bill was introduced in the AZ legislature by Rep. Phil Lopez. A single-payer healthcare bill was passed in CA, but was vetoed by the governor. Single-payer healthcare is the only option the initiative takes off the table.

Dr. Singer got a bit irritated at the argument by Dr. Weisbach that certain kinds of healthcare shouldn't be permitted. Singer thought it was arrogant and paternalistic of Weisbach to decide what kind of healthcare should be permitted. It should be the patient's choice which kind of healthcare they want to receive, should not be only the doctor's opinion. Patients should have the right to make their own healthcare decisions. Some patients choose alternative healthcare.

Dr.'s Shapiro and Weisbuch claimed that government bureaucracy is not the problem, it's the bureaucratic insurance companies. The insurance industry puts retraints on the system, which Prop. 101 would exacerbate. Dr.'s Singer and Novak retorted then why is an out-of-state private healthcare plan is funding the anti-Prop. 101 campaign? In fact that company has had more complaints than any other HMO in California. Dr.'s Shapiro and Weisbuch only defense was that the company must be worried about how the law will effect AHCCCS.
When asked whether they favored making it against the law to allow patients to see private doctors, Dr.'s Shapiro and Weisbuch refused to answer! Claimed that it was not applicable to the topic.

All four doctors were asked whether the Proposition would affect abortion. Dr.'s Singer and Novak said it was carefully drafted not to affect abortion laws in any way. Dr.'s Shapiro and Weisbuch generally agreed, although they speculated that there would be lawsuits filed to litigate that. (this seems a bit overreaching - you could file lawsuits over any law over the interpretation of some aspect of it) The National Organization of Women submitted a ballot argument against Prop. 101, which seems like pretty good evidence that the initiative will not favor abortion. For more information on how Prop. 101 would affect abortion, see Clint Bolick's article here.

1 comment:

Anonymous said...

Another important AZ ballot initiative is Prop 200 – the one that could potentially send the predatory payday lenders in Arizona packing.

Payday lending is a perversion of our free market system. These 400% loans they sell are not market interest rates. Customers get trapped.

People don’t pay these rates by choice - $50 every payday for four months, or about $400 in interest, to borrow $300.

Our economy is in trouble, in large part because of reckless lending. The health of our economy depends on cleaning up the credit market.

Vote no on 200. For more: