That’s what this Colorado doctor is warning.
Free market advocate Paul Hsieh writes that a “nanny state on steroids” is the inevitable result of any government-sponsored universal coverage plan.
“Any government that attempts to guarantee healthcare must also control its costs,” he writes, and says that the “inevitable next step will be to seek to control citizens’ health and their behavior.”
There is a fine balance to how intrusive governments should go in controlling patient’s lifestyles. A federal ban on smoking for instance, would be something I can see supporting. But how much is too much? Would checking waistlines over the age of 40, as Japan does, fly here in the United States? How about banning television advertising for eggs, as Britain is trying to do?
Dr. Hsieh wants to nip nanny statism in the bud, and says that rejecting government-sponsored universal care is the first step to do so.
Related posts:
- Does universal health care favor the irresponsible?
- Is universal health care immoral?
- Will universal health care lead to a physician shortage?
- Health insurance doesn’t automatically lead to health care
- Universal health care oxymoron
- Providing universal care, should patients be held accountable?
- How specialists view universal health care
{ 21 comments }
I can’t imagine anyone in the United States allowing their doctor to measure their waistline at any age.
“There is a fine balance to how intrusive governments should go in controlling patient’s lifestyles”
I don’t think we should permit any such ‘balance’. There are principled answers to what the government should and should not be allowed to do. The government should protect individual rights – that is its mandate.
Banning smoking in a government controlled environment (their building or venue) is reasonable – but banning it in all “public” places, including private bars where the patrons are free to stay or go – that is, on principle, wrong.
Please don’t urge a ‘balance’ between poison and healthy food. It is precisely this unprincipled approach that leads to the slippery slope of government control of more and more. Once the principle is violated, it is only a matter of time before lawyers and regular thinking people expose the contradictions of the status quo and destroy the last vestiges of freedom in this country.
The federal government doesn’t have to ban anything. All they have to do is tell states that they will withold precious Medicaid dollars if they don’t pass their own public smoking ban.
I’m pretty sure every state would have a ban in no time.
Sounds like time to kill Medicaid. Your health handout isn’t worth my freedom.
Can being sick without access to care limit your individual freedom?
A recent nationwide poll revealed that 60% of physicians in our Country support a single payer national health insurance based on Medicare which would uset the $750 Billion dollars which private insurance company adminsitrators siphon away from patients, doctors, hospitals, therapists and pharmaceuticals in order to insure all Americans. In addition, a single payer national health insurance based on Medicare (House Bill HR 676) would for the first time in history allow Medicare to bid on pharmaceuticals. Physicians and hospitals would remain private under this bill and therefore avoid the consequences of socialized medicine. For more information, visit the Physicians for a National Health Plan….
http://www.pnhp.org/news/2008/february/what_government_does.php
David says,
“I don’t think we should permit any such ‘balance’. There are principled answers to what the government should and should not be allowed to do. The government should protect individual rights – that is its mandate.
Banning smoking in a government controlled environment (their building or venue) is reasonable – but banning it in all “public” places, including private bars where the patrons are free to stay or go – that is, on principle, wrong.”
Well, I am not free to smoke pot, take heroin, cocaine, or LSD because of a government ban. Is this also wrong, in principle. Let’s go farther-the government restricts the medicines I take, requiring me to get the permission of a doctor-where’s the freedom in that.
i would suspect that the government will make it the physician’s responsibility to ration the care, arguing with patients why certain tests won’t be ordered, and continuing to shoulder the blame (by which i mean get sued) if the zebra gets missed for not ordering the test.
“Well, I am not free to smoke pot, take heroin, cocaine, or LSD because of a government ban. Is this also wrong, in principle. Let’s go farther-the government restricts the medicines I take, requiring me to get the permission of a doctor-where’s the freedom in that.”
Anonymous,
Your comment is logical and reasonable and I agree with it. I do not think the government (federal, state, local or otherwise) should limit your freedom to take what they regard as illicit drugs. I do not think a physician should interfere in your ability to access a medical drug – if someone else wants to sell it to you. You own you – including what you choose to put into your body. I furthermore do not think the FDA should have the right to restrict what types of drugs are allowed onto the market – this, again, is between the buyer and the seller. Many would want a physician’s advice – but by no means should this be mandatory.
Unfortunately we already have a ‘protect and control’ approach to our citizens – the nanny approach is already controlling a massive portion of our lives – to our detriment.
Evan,
Being sick without health care limits the options open to you as a FREE INDIVIDUAL (it does not limit your political freedom). Indeed, even in this circumstance, it is the current controls and interference in the market by numerous government entities that degrades such a persons options – by forcing prices too high and often eliminating transparency of pricing.
H Green, MD
If the majority support it, it must be right, eh? That will ensure it will work, right? The leaders of the Soviet Union also had the view that if one efficient organization could control all the resources, THEN we would have progress. And a series of five year plans never seemed to go the way they wanted. By eliminating competition and profit, they eliminated incentive, and the whole system collapsed into a gray, stagnant, deathcamp. Unfortunately for you, markets (numerous individuals making their own profit/loss calculations based on prices and their needs) create efficiency – not some out-of-touch bureaucrat trying to anticipate and predict the various effects of a massive complex system (It can’t be done). There are plenty of examples of command economies to view from history, and plenty of Austrian economists who will show you the lessons to be learned from them. Wishing otherwise won’t make it so.
David:
re:”but banning it in all “public” places, including private bars where the patrons are free to stay or go – that is, on principle, wrong.”
Very simple: Second hand smoke causes cancer let alone people with issues with respiratory disorders. Your wish to smoke in a public place should not put non-smokers at this risk. Have you ever treat lung cancer? If you want to smoke…go outside. Nobody is “banning” your right to smoke. Why should you have a “right” to put a nonsmoker at risk?
Anonymous,
You say “Your wish to smoke in a public place should not put non-smokers at this risk. Have you ever treat lung cancer?”
I am a physician, I know the dangers of smoking (though second hand smoke danger is exaggerated), and my mother died of lung cancer. Nobody would think that lung cancer isn’t a horrible thing but your appeal to emotions is still not logical. By the way, I don’t smoke and I have no desire to smoke.
The issue is one of property rights (the rights of the restaurant owner)and freedom. If a restaurant wants to allow smoking – then you are free to go elsewhere if you don’t like it. You are free to start a non-smoking facility (restaurant or otherwise) if you like. You are free to eat at home if you like. If you start a smoke-free restaurant, and I wanted to smoke, then I am free to go elsewhere, or to smoke at home, etc.. You see? Individual freedom and choices – not government force and subversion of the individual.
David said: ‘The issue is one of property rights (the rights of the restaurant owner)and freedom’
No, it’s also about the rights of employees. If you can indemnify all owners who exposes their workers to smoke then go right ahead.
David:
Federal, state and local governments do set specific limts on your laissez-faire idea of “rights” without violating the constitution. For example, I have the right to own a gun. That stated the feds have determined that I do NOT have the right to own a fully automatic assault rifle. The feds have determined that I do NOT have the right to own a grenade launcher. States vary in our “right” to bear arms. In Arizona you can walk right into a Circle K with your pistol on your hip. Try doing that in a 7/11 in NYC. The last estimates I saw are that 3,000 nonsmokers die every year of lung cancer. Yes there is non-smoking lung cancer. Rare but present. Maybe you think it overblown but I certainly don’t want me or mine to be one of those 3,000. Do you? Don’t forget about passive smoking association with other non-lung cancers. Then there is the effect of second-hand smoke and asthma, childhood ear infections, etc, etc. If a local, regional, or state entity bans smoking in restaurants (often done after a public vote by the way) then good luck with a “property/civil rights” argument. Nobody is banning the right to go to smoke, just where to do it. Following your reasoning we all have a right to an AK-47, law’s rocket, and a battle tank.
Japan started the waistline-measuring program in 2008, FWIW.
I’m all for smoking – as long as nicotine addicts use their cancer sticks in the privacy of their own homes. In public, nicotine addicts can
use patches, lozenges, or gum – or “put a pinch between cheek and gum” – just some of the accommodations made for nicotine addicts. Perhaps nicotine addicts should be thankful they don’t have to go to a clinic every day, get their dose of cigs and smoke them on premises under supervision.
WRT to Dr Hsieh’s “nanny state on steroids” theory – PI lawsuits with ridiculous damage awards and lack of individual responsibility have gone quite a way toward providing us with quite a nanny state as is.
I do believe there is a company in Michigan that disallowed employees smoking, even off premises. And fired those who did not comply, citing health care costs. Why is it okay if companies do it?
The Federal Government and many state governments already regulate use and allowable exposures to many materials that can be inhaled, through OSHA and other occupational health agencies. Some materials are banned outright because of their toxicity or other hazards. Regulating activity that causes exposure to environmental toxins is not and has not been outside normal and accepted government power. You can’t run a smelter, or a plating shop or paint spraying operation, or agricultural fumigation process without meeting special requirements.
What is at issue is that:
1. cigarette smoke is now showing good evidence that it is toxic and carcinogenic, to both the smoker and to others not smoking who breathe the smoke and,
2. banning smoking reduces serious health problems associated with that toxicity and,
3, there is a significant public interest in reducing those serious health problems as the state is bearing a significant portion of the costs of the treatment of those problems, the incidence of which is reduced when smoking is banned. Further, there is no compelling and contrary public interest in permitting smoking to remain unregulated.
If you can see where there is a reason to treat release of cigarette smoke into human-occupied environments any differently than release of DDT or dioxin, I’d like to hear it. From what I can see, the root justification is the same.
The objections seem to be little more than “we’re used to doing this so don’t-tread-on me.”
“Nobody is banning the right to go to smoke, just where to do it. Following your reasoning we all have a right to an AK-47, law’s rocket, and a battle tank.”
…ah….I guess. I’m really not a constitutionalist so I’m not sure how you ‘follow my reasoning’ to this conclusion. I could see limiting these clear threats to your neighbors – haven’t really thought about exactly what principles would be involved with regard to personal safety, but I’m sure I could come up with some if you really want to go in this direction.
But in any case, I think you are getting bogged down in someone else’s constituational concerns. My concern is with identifying and applying clear principles upon which a proper society can base its laws (a la Ayn Rand). You also focus on how politically feasible my proposals are, rather than the rightness of them, which are separate issues, but clearly one is more important than the other.
Anonymous said “I do believe there is a company in Michigan that disallowed employees smoking, even off premises. And fired those who did not comply, citing health care costs. Why is it okay if companies do it?”
That is the whole point. These are private decisions between company owners, employees, and customers. I want to leave it in private hands – others want to force the government into making these decisions. Now a company could readily say they don’t want their employees to smoke – and make that part of their contract – I think that would be fine. If they try to implement it retroactively (contract already signed) then employees could claim violation of their contract, if they had a long-term contract – so there could be a legitimate dispute in these circumstances – one that could be addressed in the courts if need be.
The real long-term answer is to dis-associate employment with health insurance. Tax laws go a long way to linking the two – address that and companies would no longer care about your health insurance because they wouldn’t be paying for it.
“You also focus on how politically feasible my proposals are, rather than the rightness of them”
Incorrect David. You are missing my point. I have given you an example how the goverment interprets our constitution “ie our Bill of Rights”.
The second amendment states “A well regulated militia, being necessary to the security of a free state, the right of the people to keep and bear arms, shall not be infringed.”. The feds have interpreted this via stating that we DO NOT have a right to a fully automatic assault rifle (by the way the NRA disagrees and has lost challanges). Similarly, state/local governments have interpreted that property rights are not violated if the banning of smoking is on private property open to the public. This too has been challanged and always upheld to my knowledge. As far as your statement that ” I could see limiting these clear threats to your neighbors (with respect to owning a machine gun)”. Can you NOT see the threat to your neighbors who happen to be sitting in the next booth when you light up? This isn’t 1964, why do you think the risks are so “overblown”?
“Can you NOT see the threat to your neighbors who happen to be sitting in the next booth when you light up?”
I don’t light up, I don’t smoke, but of course I can see the potential for harm here (even though it is overblown), and, for the purposes of argument, I will grant there that some harm is occurring. But I think you are missing MY point by continually referring to past decisions when it comes to rights and the constitution. This is certainly relevant to any lawyer who wants to challenge the laws but it not as relevant for the philosophical purpose of determining what is right and wrong in the first place. Do you see the difference? I understand that we have to deal with the real world of current laws, but first, we must come to a decision as to what types of laws we should be supporting and why and what is the foundation for laws in the first place.
I support a person’s right to his/her own life – including the right to what is created and acquired by that person’s effort. People should have the right to pursue their own happiness, so long as they don’t, by force or fraud, interfere in someone else’s right to do so. I seek a system that, as much as possible, respects this basic position. This means creating a system that protects individual rights and forbids individuals from physically forcing or defrauding others. Rights, to the degree possible, should be designed with this goal in mind and should, in most cases, make clear who has the right to what. When rights are stated clearly, this reduces the reliance on courts and makes business and life flow much more smoothly. By eliminating contradictions among rights, the same benefits are obtained.
A basic tenet that stems from this approach is the recognition that no right should be created that forces another person to provide the benefit (since this creates an inherent conflict among rights). Thus, you have a right to keep yourself alive, but not the right (in most circumstance) to force someone else to keep you alive. You have the right to acquire healthcare, but not the right to force someone else (i.e – Medicare, Medicaid, EMTALA laws) to provide it. You have the right to pursue a job, but not the right to force someone else to hire you.
Now the case of smoking in a restaurant must be distinguished from general cases of air pollution and from gun ownership. We can easily see that the property owner (owner of the restaurant) has the right to control their own property and decide who comes there and who doesn’t. Those who frequent the restaurant, including the employees, are also free to stay or to go- but have no right to the restaurant – that is – have no right to dictate the terms under which they will be served – including smoke exposure.
This is the non-contradictory state of rights that we are trying to achieve. By attempting to do the opposite, you eliminate the benefit and create unending conflicts and the elimination of property rights. Once you eliminate the principled opposition to this sort of thing, the sky is the limit. I might be a man in a bubble that is 10 feet wide, and I ask, no, I demand that the restaurant owner create a door that is 10 feet wide for my access. All of the restaurant’s food must be processed by microwave to eliminate any germs that might be introduced into my food and a portion of the restaurant will need to be cleared of tables so I will have a place to eat. Ridiculous you say? Witness the demand (not request), now enshrined into law (the American with Disabilities Act), for wheelchair access to any ‘public’ location. Once the principle is violated, you see, it is then only a matter of time and effort for someone to take advantage of it. The contradiction between rights created by these laws is lost on many.
I think industrial pollution, spewed into the air and affecting everyone who breaths, is a different case. It cannot be avoided and it flows onto your own property and most anywhere you care to go. Certainly this needs to be addressed in a different manner – and regulation of the amount of pollution is warranted.
I’m not sure where I come down on battle tanks! I think if someone has a nuclear bomb in the middle of the city – then it is a clear massive threat – and cannot be allowed. This goes for all such massive weapons. Where do I draw the line? I’m not sure – as always, I’m looking for a principled answer and haven’t found one yet in this instance.
>>"Now the case of smoking in a restaurant must be distinguished from general cases of air pollution and from gun ownership. We can easily see that the property owner (owner of the restaurant) has the right to control their own property and decide who comes there and who doesn't. Those who frequent the restaurant, including the employees, are also free to stay or to go- but have no right to the restaurant – that is – have no right to dictate the terms under which they will be served – including smoke exposure."
David:
The restaurant owner has to keep his food stored below a set temperature, he has to keep his premises free of vermin, he has to store his stock in a way that doesn't present a fire hazard, have kitchen smoke hoods and grease traps and sinks in certain places and fire exits marked in certain ways. He has to pay his employees a minimum wage and post his menu where required by laws. If he doesn't do those things–required by laws that enforce standards for health and safety and fair business practices.
What makes you think a ban on smoking is any different? The restaurant owner, to use your example, does not have an unlimited right to treat his property any way he pleases or to leave the conduct of his business there as a matter solely between himself and his customers.
What is it about that you don't understand? Please don't tell me you have abandoned reality for the strange and abstracted universe of Ayn Rand. That stuff is best left where you found it, in junior high school.
Dear Anonymous (if that even is your real name) you said:
“If he doesn’t do those things–required by laws that enforce standards for health and safety and fair business practices. What makes you think a ban on smoking is any different?”
I don’t think I did say there was a fundamental difference. Your beloved laws are indeed examples of the same pathology that I am referring to. I’m not sure how I can be clearer than I have already been. I continually represent how things SHOULD be and you continually use arguments based on how things currently ARE – which is a new type of informal logical fallacy – fallacy of argument from the STATUS QUO. If you think you are somehow answering my arguments – you are mistaken.
As for Ayn Rand, call her what you will, she was a philosophical genius who made important contributions to the field. If you (or any of us) could achieve 1/10 as much, we would be very accomplished indeed. Once you have studied her ideas and understood them deeply, it is difficult not to feel pity or contempt for many people. Pity for those who have never been exposed to her ideas. Contempt for those who clearly see her ideas as a threat to their own way of thinking and viewing the world. You yourself may not be in this last category, but it makes me wonder.
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