Surging santorum

It occurs to me that non-US readers may not realise the significance of Rick Santorum’s near-tie with Mitt Romney in the Republican Iowa caucus. Rick Santorum opposes not only abortion but contraception. And when we say “opposes abortion”, we mean even in cases of rape or to save a mother’s life. No exceptions. Well, actually one exception: if the life being saved is his wife’s. Then it’s different. And he’s so homophobic that Dan Savage held a contest to come up with something repulsive that could be named ‘santorum’. Then he and the gay activist troops made sure that made it to number one on google. So go ahead, make your day. Google ‘santorum’.

(Thanks, Jender-Mom. Your rants made me do this post.)

37 thoughts on “Surging santorum

  1. Two problems. First, that was no “abortion”, not even under the strictest Catholic teaching. It was a desperate measure, a risky measure, and clearly it resulted in the death of the fetus. But it’s no more an abortion than rescuing one person from a burning building and leaving the other behind, knowing full well that the one left behind may be extremely difficult or even impossible to rescue, is “murder”. You may as well be ragging on McCain for being so tough on crime, when he committed multiple assaults and even murders in Vietnam.

    As for the definition of Santorum, I think it’s splendid that what that name means will forever be associated with the sex act in question. On the other hand, there were a few other great possible associations: gerbiling, bug catching…

    By the way, I love the sort of subjects one of the most popular blogs for feminist philosophers routinely feature. I mean hell, I post worse, but who the hell am I? But between this and the BDSM monkey ranting about rape jokes, I gotta say – stay classy, kids!

    Here’s to 2012. I expect some fart jokes, maybe a rape joke about Bachmann (Oh, it’s a joke about her politics, not a rape joke, shall be the explanation), and of course, more whining. Until then, remember – your lover is thrilled when you put the tongue to the Santorum. ;)

  2. Well, ‘Crude,’ that’s quite the comment.

    I gather you think the reference to the “something repulsive” selected as a defintion of ‘santorum’ was equivalent to an OP about rape, farting, and whatever you meant by the female lover’s putting her tongue to “The Santorum.”

    Quite apart from your sense of appropriateness, your effort to exempt the Santorums from the ‘abortion’ claim is thin gruel, at best. I realize this might be a bit of Catholic ‘Double Effect’ reasoning, but inducing labor in a 20 week pregnancy because the fetus has an infection is not comparable to removing a cancerous uterus that ‘hapens’ to hold a fetus.

    The Catholic doctrine is not simply a matter of intent; it also turns on means/end relations. If you get rid of the fetus in order to save the mother, that does not pass the Catholic test.

  3. Not to mention Santorum’s comment about not wanting to help black people by giving them money when talking about Medicaid, because I guess only black people use that program? But I’m with Andreas, it was depressing enough to see Bachmann elected to congress again and again. I’m glad she’s dropping out.

  4. The reproaches I’ve seen of Rick Santorum concerning whether his wife’s induced labor “passed the Catholic test” (as Sissystars puts it) strike me as the sort of “lay pharisaism” criticized by Camus in “The Unbeliever and Christians”: “I believe indeed that the Christian has many obligations but that it is not up to the man who rejects them himself to recall their existence to anyone who has already accepted them. If there is anyone who can ask anything of the Christian, it is the Christian himself.”

    Anyway, to sum up the opening post for non-US readers: A person who nearly won the Iowa Republican primary election is an adherent of the Catholic religion. Of the repugnant and anti-Catholic Dan Savage, the less said the better.

  5. The doctrine of double effect is a fairly standard topic in moral philosophy. It doesn’t take a Catholic baptism to understand it. To consider the Santorum’s case, one needs to ask why the birth was initiated. It might be said that they didn’t seek the fetus’s death; rather, they merely sought its separation from the womb in order to preserve the mother’s life. It was an unintended consequence that the fetus died.

    This may well pass the Catholic test, but if it does, so would many other things that are supposedly forbidden. E.g., for a raped 13 year old child, a fetus will be a huge physical( and psychological) burden. It isn’t that one wants the fetus to die; rather, separating it from the girl’s womb will just save her the physical stress of carrying it to term. (A full-term pregnancy at age 13 is really not good.)

    I think that I’m here employing a point made by Philippa Foot, who argued that one can’t really separate wanting to do something one knows will bring death (e.g., getting a 20 week old fetus out of the womb) from wanting the death. I think her example was blowing up someone who is blocking a vital escape route. Tthe idea is that its specious to claim that wanting the person blown up is different from wanting them dead.

    It is at least hard to see what the moral difference is.

  6. To be clear (Nemo and Anne), apparently in Santorum’s case, (they claim) labor was *not* in fact medically induced (Uterine infection itself can itself induce labor from within, even at 20 weeks). The scandal is just that the Santorums equivocally admit that they *would have* induced labor as a very-last resort:
    http://oursilverribbon.org/blog/?p=188
    But the induction of labor prior to viability *is* generally counted as a form of abortion, both medically and informally (and Karen Santorum explicitly said as much at the time in above article):
    http://www.ncbi.nlm.nih.gov/pubmed/21664506
    http://www.awomansright.org/LaborInduction.html
    So, it’s not as though philosophers are making the (counterfactual) induced labor into a (counterfactual) abortion with ad hoc arguments. I suspect there’s some odd mental dance by which someone might deny the general claim by embracing the mere *hope* that a 20-week old (severely ill) fetus might survive the procedure. (Apparently, the Santorum fetus-baby survived for two hours, and they treated the situation as the death of an infant.)

  7. Given that he has frequently used his position of public power to advance the subordination of women, gay people, and black people, I think Santorum deserved the treatment Dan Savage gave him. That said, Bob Kerrey’s old remark about the definition of ‘Santorum’ was also pretty good (google: “Bob Kerrey on Santorum”).

  8. Also, conflating Santorum’s religion with his political views is unacceptable. Plenty of Catholic lawmakers have managed to incorporate their faith and their politics without subordinating women and gay people. The relationship between the Catholic religion and Catholic political action is complex, and Catholics are under no obligation to follow Santorum’s version of that relationship. Suggesting that Santorum’s way is the *Catholic* way is insulting to Catholics who have thought about these things in greater depth than Santorum, a group which probably includes most Catholics.

  9. Anne, I somehow think that Camus’ objection to “lay pharisaism” had nothing to do with the notion that a Catholic baptism (or catechesis, or confirmation, all of which he himself had had) is required in order to intellectually grasp the moral-philosophical-theological aspects of the obligations of a Catholic qua Catholic. He didn’t, for example, say that someone who does not recognize and assume those obligations can’t possibly comprehend them (which would obviously be untrue), but that it’s not such a person’s place to reproach another who *has* assumed them for failing in them.

    I’m inclined to agree with Camus here. Considering intellectually whether a particular case constituted an abortion morally impermissible from the standpoint of Catholicism isn’t lay pharisaism in the Camusian sense; for “l’incroyant” to use that inquiry against the “croyant” is. So I think we ought to consider what is the purpose in this case of trying to establish here whether the Santorums failed some “Catholic test” or not.

  10. Matt, I’m afraid I can’t really address that (#11, which I presume was directed toward me) in the general. I’m not sure what actions of Santorum you have in mind, which other exemplars of the relationship between Catholicism and political action you have in mind, the basis for your familiarity with the relative depth of thought devoted to such matters as between Santorum and most Catholics, or pretty much anything that I can really respond to there. In a general way, the matters mentioned in the OP (e.g. Santorum is opposed to abortion and contraception) seem to me be a reflection of his adherence to the teachings of his religion (which is not to say that they have exclusively a religious basis, of course), and could be inferred (if not deduced) from his adherence to those teachings. That’s all.

  11. Nemo, I should have read the Camus more closely, though I think the idea is actually wrong, particularly when the person wants to turn his principles into national policy.. It is important when someone espousing a moral principle does not follow it himself, because we need to consider whether the supposed moral principle is really connected to living a good human life. Moral principles whose adherents excuse themselves from following have a questionable role as national policy. Avoiding the misery the principle can cause, they can they really force it on others? Hypocrisy is not merely unseemly; it can also put in question the liveability of the proposed legislation.

    So I think the purpose is to scrutinize what is going on when men in power try to legislate what women can and can’t do with their bodies.

  12. I was shocked to hear Rick Santorum thank god for his good result in Iowa.
    – Does he think he is the divine candidate?
    – Will he blame the same god if he ever looses an election?

  13. Anne, I’m not sure what significant light, if any, is shed on whether Catholic moral principles are connected to living a good human life by a determination that Rick Santorum’s reach exceeded (arguendo) his grasp on a given occasion. I’m also not sure by what mechanism the falling short of a principle (anti-abortion, anti-drunk-driving, anti-corruption, anti-fraud, anti-sexism, or what have you) by someone who endorses it calls into question its merits as a policy. Hypocrisy might be unseemly, but if, as La Rochefoucauld said, it is but the tribute that vice pays to virtue, what moral conclusions does its occurrence facilitate?

    Andreas, interesting that you should mention that. Santorum *did* lose an election – a bitterly contested one – in Pennsylvania in 2006, after which he gave a concession speech that inspired even Santorum’s nemesis Dan Savage to write about his astonished admiration for Santorum’s graciousness and apparent sincerity. More to the point of your comment, though, Santorum said in the speech that both of the versions he was prepared to give that night (winning and losing) started out the same way: by thanking God.

    Video of Santorum’s widely noted 2006 concession speech, particularly for curious readers (whether within or outside the US) who have never heard (or heard of) this person, is available on C-SPAN here: http://www.c-spanvideo.org/program/195296-9

  14. Nemo:

    I had never seen Santorum before (nor read a word about him previous to the Iowa primary) and I watched part of the video you linked to.

    He seems a nice person or is an excellent actor (or both), and the child standing behind him, presumibly his son, is the kind of child whom I instantly like (I don’t like all children), which says something about Santorum’s (and his wife’s) parenting.

    Nevertheless, his politics stink.

    I can understand why you might not wish to see Santorum trashed as a human being, but why go out of your way to defend him, when presumibly, what he represents politically is completely opposed to what you represent, if I may judge from your previously stated positions in this blog?

  15. SW, that is a sensitive observation about Santorum’s son. How the son will have to go through life in a more Googlefied world than his dad’s, bearing his dad’s surname possibly forever stained by the sick Googlebomb campaign mounted by the dad’s political enemies, is a sad thought. (By the way, although the speech in question received bipartisan acclaim, afterwards a number of Santorum’s Internet detractors publicly mocked another of his children – a little girl just off-camera in that video – because she was bawling during the speech. Also sad.)

    At any rate, I don’t believe I was exactly defending Santorum, or if I was, it was a procedural rather than a substantive defense, as it were – the sort to which I expect everyone is entitled if the occasion presents itself.

  16. Nemo:

    I just googled Santorum (which I hadn’t done previously).

    The boy seems like a sensitive child, the kind who probably would get bullied, even if he weren’t his father’s son and now it will be worse for him. It must be hard on the boy, although I guess people should think about their childen before going into public life and speaking out about controversial issues.

    Politics is dirty business, hardball, as they say. There are bigots and fanatics on both sides. Wasn’t it Truman who said, “if you can’t stand the heat, get out of the kitchen?”

    Maybe the U.S. should simply divide in two nations, with diplomatic relations, but each with its own constitution, the blue constitution and the red one.

    In any case, the same stuff happens everywhere. The son of the Public Works Minister, a possible future rightwing presidential candidate, got very high scores on his university entrance exam (here in Chile) and immediately, the leftwing Twitter-Facebook set proclaimed that the boy must have received the answers beforehand from the Education Minister.

  17. By the way, I didn’t look at it closely before – I should have – but the Salon article Jender linked concerning Rick Santorum’s views on contraception and public policy does not seem to have characterized them very accurately. The Salon writer says: “It’s pretty basic: Rick Santorum is coming for your contraception. Any and all of it.” (Cue scary music.) But it’s probably worth noting, strictly for the sake of accuracy, that Santorum has indicated (including as recently as the Iowa primary; see this interview: http://nation.foxnews.com/rick-santorum/2012/01/04/rick-santorum-enters-no-spin-zone) that although he believes that the hypothetical question of contraceptive bans is constitutionally for state rather than federal governments (remember, he’s running for *federal* office), he would vote *against* a contraception ban if one were proposed and he were in a position to vote on it.

    Wouldn’t want anyone to have the wrong impression based on the Salon piece, particularly non-US readers who are in less of a position to know better.

  18. Santorum update: the former Senator for Pennsylvania has placed third in the South Carolina presidential primary vote, behind former Speaker of the House of Representatives Newt Gingrich and former Governor of Massachusetts Mitt Romney.

    On the disputed matter of Santorum and homosexuality which was evoked in the opening post, there was an interesting exchange the other day on “Hardball with Chris Matthews” (for non-US readers, that’s a political talk show on TV) between host Matthews and his guest Robert Traynham, Santorum’s openly gay longtime former top aide. In this clip, Matthews is doggedly trying to get Traynham to say that Santorum is a homophobe, and Traynham is just as vigorously shooting Matthews down:

  19. Thanks Nemo.

    Where does Santorum stand on healthcare? If there’s one issue that moves me, it’s everyone’s right to decent low-cost or free healthcare.

  20. VivePablo, that’s certainly a good issue to raise. Of course, it seems there’s not much one can accomplish directly by means of legislation to make something that’s costly into something less costly; laws tend only to be able to move the costs around somewhat or to disguise them. (That’s just one of difficulties with rights that are formulated/conceived of as positive entitlements to a finite resource.) At the end of the day, it may be that the only things that truly reduce the cost of a good or service are innovation and increased efficiency (which often overlap, of course):

    Anyhow, since I can’t say I know much about your question on Santorum’s healthcare policy views, here’s what the candidate’s website has to say (what follows are his campaign organization’s words, not mine):

    THE SANTORUM HEALTH CARE SOLUTION

    •Priority number 1 = repeal ObamaCare and its burdensome job-destroying bureaucracy, taxes, mandates, and heavy-handed government decision-making… and replace it with market-driven, patient-centered alternatives to increasing health care access and affordability
    ◦President Obama promised that ObamaCare would decrease health care costs – but in a cruel bait-and-switch, the law significantly increases costs and mandates that working Americans foot the bill through unprecedented mandates, taxes and fees
    ◦Especially cruel are ObamaCare’s multiple incentives for employers to discontinue offering health care coverage to their employees – leaving patients uninsured and required to purchase health insurance the government chooses or pay stiff penalties
    •Strengthen patient-driven health coverage options such as Health Savings Accounts coupled with high deductible insurance plans (and repeal ObamaCare policies that gut such options)
    •Reduce costs through competition, increased transparency, electronic records, and health care literacy – empowering patients and their doctors with information and options
    •Allow patients to purchase health insurance across state lines to gain access to the best insurance coverage to fit their individual needs – patients shouldn’t be required to pay for (and subsidize for others) coverage for services they don’t want or need
    •Allow those who purchase their own health care coverage to do so with pre-tax dollars, including a refundable tax-credit for the purchase of health coverage (so that employees are not tied to jobs solely for health coverage, but have portability of affordable coverage)
    •Enact meaningful medical liability reform – to increase access, and reduce added costs and inefficiencies from defensive medicine for federal programs and incentivize state liability reforms
    •Block-grant Medicaid so that states aren’t burdened by unfunded, crippling, one-size-fits-all federal mandates, so that states can implement solutions to address their unique health care needs

  21. Nemo:

    Sorry, Somehow in my confusion I placed my email address, vivepablo, where I should have put my name.

    If people have a right to decent healthcare, as they do to a fair trial, their medical costs should be paid for by tax revenue, if necessary.

    There are ways to control medical costs, as the far from perfect Chilean state medical plan shows: if a high enough percentage of the population opts for state medical coverage, then private-sector doctors, laboratories and hospitals have to accept what the state agrees to pay for medical goods and services.

    There are good arguments in favor of subsidizing the demand in terms of medical services (vouchers) and there are good arguments in favor of subsidizing supply, that is, a national health service. In many cases depending on the culture, a mixed system is best, with a strong national health service, which allows people in certain circumstances to opt for non-public healthcare providers.

    With regards to Santorum, I have to admit that the mere fact that he uses the phrase “Obama-care” leads me to skip whatever else he has to say.

  22. Yes, you and me, s.wallerstein; the phrase “Obama-care” seems rather designed to inspire the cult of personality-hatred than to generate careful thought about a complex topic.

    I must further wince at the phrase, “market-driven, patient-centered.” How has that worked out so far? Seems the former has been quite at the expense of the latter.

    I hope that the desires of those who think health care reform is the source of their problems, and simplistic repeal is the solution, are not satisfied. It would be difficult for me to ever return to my home country if it was repealed in toto, since I doubt that any private industry would hand me health insurance if they didn’t have to, and would happily tell me I have ‘prior existing conditions’ that entail my giving a rich corporation a great deal of money just in case I am ever unfortunate enough to need medical care.

  23. SW, sorry, I didn’t realize that was you!

    Anyhow, I find these issues incredibly complex. I think of it as like a leaky dike where plugging one hole with your finger causes another to spring up elsewhere, or a spiderweb where tugging on one strand produces effects in a different part of the structure.

    For example, it is possible to some extent to control medical costs by means other than competition (such as by direct or indirect controls on price exercised by the government, as you indicate). But the effects this can produce in other parts of the system make one pause.

    Take pharmaceuticals for example, a major element in medical costs. When the government in country X can force producers to accept a certain price, either by legislative fiat or because it usurps the local demand-side market, it can cause cost increases in countries Y and Z. If country Y then does the same thing, country Z ends up bearing the brunt (the US has been on the receiving end of this equation to a huge degree). Meanwhile, as producers cut their expenses as a result, they often devote fewer resources to R&D, which negatively impacts health in all the countries.

    I’m not sure that we can analogize the right to a fair trial to a positive right to certain healthcare resources. The state has a natural monopoly on the criminal justice system; don’t think the same can be said for medical goods and services. The state can factor in costs of public defenders for example (like other trial costs) into decisions of whether, when and how it is going to undertake a trial in certain cases. Generally speaking, the state can control “demand” for fair trials, and where this is less true (such as private civil litigation), the right to a fair trial consumes (or can be made to consume) relatively few public resources compared to private resources.

    Anyhow, I wouldn’t be too off-put by the term “Obamacare”. In the US, it’s an extremely common colloquial reference to a law with a much longer name. It’s used more often by opponents of the legislation, but not only by opponents. And certainly it doesn’t mean that someone who uses it must not have anything of merit to say about healthcare legislation, though I’m not opining on Santorum’s specific statements.

  24. Hello Nemo:

    The fact is that all developed countries and many middle-income countries (such as Chile) ensure free or low cost healthcare for everyone, independent of their ability to pay, except the United States.

    Here are some figures from Wikipedia:

    infant mortality rate:
    U.S. 7.07 (number 34 in the world)
    Cuba 6.95 (number 33)

    life expectancy
    U.S. 78.3 (36)
    Chile 78.3 (36)
    Cuba 78.6 (34)

    per capital income
    U.S. 47, 390 dollars
    Chile 10, 120
    Cuba 5, 520

    That is, Cuba, with one ninth the per capita income of the U.S., delivers better healthcare and Chile, with less than a quarter of the per capita income of the U.S. and a
    very unequal wealth distribution, delivers better healthcare in some aspects.

  25. Well, SW, this is certainly a huge issue. I think pretty much everyone in the US, including politicians of both major parties in the recent healthcare debate (which will shortly be renewed), is in favor of decent healthcare for all and that healthcare reform is necessary to this end. There are some widely varying ideas over exactly what reforms would be most appropriate and sustainable in terms of reaching that goal, and whether all of the 2010 reforms were the right kind.

    That said – and I’ll be the first to admit that I’m no expert in healthcare policy – it doesn’t seem to me that the life expectancy (LE) and infant mortality rate (IMR) statistics enable us to draw much in the way of conclusions about the comparative merits of healthcare systems. Those conclusions rely on some fairly suspect premises, including that LE and IMR are reliable indicators of heathcare system quality, that factors impacting LE and IMR other than healthcare systems are essentially the same across the countries in question, and (at least in Cuba’s case) that the statistics are even accurate to begin with.

    Looking first at LE: First, it seems to me that even under the best scenario LE does not measure a major part of what healthcare systems deliver – treatments that improve quality of life and well-being, and reduce losses in national productivity due to ailment, without necessarily impacting LE in a statistically significant way. Second, there are significant differences among the countries that have little to do with healthcare systems – what the doctors call “lifestyle differences”, for example – but which have huge impact on LE. Though I can’t back this up with proof, I rather suspect that if the US population had the obesity rate and intentional homicide rate of France’s population, US life expectancy would be the highest in the world. (I wonder if people would then interpret this as evidence that the US system delivered better healthcare than any other country.)

    Looking at IMR, it appears that in developed countries low birth weight is one of the major determinants of IMR. However, this article (http://www.realclearpolitics.com/articles/2009/08/23/health_care_and_infant_mortality_the_real_story_97998.html) suggests that healthcare system related factors (such as prenatal care) do not have a significant impact on low birth weight, and that behavioural factors concerning the parents are the real culprits. Indeed, the article refers to empirical work suggesting that if the US population were subjected to a healthcare system similar to Canada’s, the US IMR would actually be higher than it is now.

    Finally, as I noted in my previous comment – although I’m not quite sure how this could best be addressed – the fact that the single payer or nationalized healthcare systems of other countries rely on hard or soft price controls that increase the cost of US healthcare means that US healthcare consumers are effectively paying (in part) for other countries to enjoy their own healthcare systems. (This is on top of the general way in which the welfare states of US allies and even neutrals are funded to a significant extent through defense cost savings achievable due to US security guarantees, which has been the subject of at least one other thread here.) So even if it could be shown that other countries were delivering better healthcare overall than the US – which for the reasons mentioned above, it’s not at all clear that that’s the case – it doesn’t seem quite just that the US should be browbeaten for it. Anyway, as I said, I surely don’t know the best answers to these incredibly difficult questions, but I can perceive that there are layers within layers of complexity to them.

  26. Nemo:

    First of all, I’m not browbeating the U.S. as a society or its population. I’m criticizing its healthcare system, which is very different.

    Infant mortality rate and life expectancy are fairly standard indicators for evaluating any healthcare system. They are used everywhere, but of course two indicators do not sum up the complexity of any healthcare system.

    What I did not include are statistics on the amount of people without healthcare insurance in the U.S.: 16.3% in 2010 (the last year with complete statistics) and 9.8% of children under age 18.

    (Those figures might have improved in 2011, due to the Patient Protection and Affordable Care Act. I hope so. )

    Those statistics might well account for the fact that the U.S. does not rate well in terms of
    standard healthcare indicators, since those who are not insured have substandard healthcare.

    However, for this debate to progress, I would have to seek figures which break down U.S. healthcare in terms of social class. My pre-statistical intuition is that upper middle class and wealthy Americans receive excellent healthcare (and live much much longer than 78 years on the average) and that low income Americans do not and live shorter lives.

    Yes, lifestyle has something to do with life expectancy, but I suspect that you underestimate what unhealthy lifestyles most people in a country like Chile lead and still live as long as people in the U.S., in a society with a much lower per capita income.

    So if I get a chance, I will investigate U.S. healthcare statistics in terms of social class. (not today)

    By the way, you assume that research into medications will be carried out by
    pharmaceutical labs. Why can’t it be carried out by university scientists?
    At present pharmaceutical laboratories may do most of the research into medications, but that is not an eternal law of history. University scientists would do pharmaceutical research just as you do philosophical investigations, for approximately the same salary, with the same motives, the public good, seeking recognition for your talents,
    etc. If research were to be carried out in a university setting, for the public good, not for profit, then the question of who is subsidizing whom would no longer be relevant, since information is information and can only be considered a commodity within the narrow framework of for-profit corporations.

  27. SW, university scientists do carry out a lot of pharmacological research in the US (including basic research that underlies the development of new drugs). But a lot of it is funded by pharmaceutical companies.

    On the other hand, Nemo, I am very skeptical about your claim that price controls in one country cause price rises in another. Do you have an argument or citation for this claim?

  28. Jamie:

    Thanks.

    The point is that information about new medications should be available to everyone, that said information is a public good.

    Those who discover new medications should receive due credit and recognition, but to me at least it seems weird (I have no other word for it) that they “own” that information, especially since, in this case, that information can save lives or improve lives.

    It always strikes me as funny that philosophers or philosophy graduate students who are willing to work long hours for not impressive money and who have the intelligence and power of concentration to earn much much more money in other areas of the economy
    refuse to recognize or cannot see that many other people in other fields are willing to
    do research or solve problems without priorizing a monetary reward.

    I’ve worked with scientists and doctors for many years as a translator and those whom I have worked with try to publish information about health research for the public good, undoubtedly also seeking to be recognized within their field, with very little interest in making more money.

  29. SW, sure, scientists are willing to work long hours without the promise of some gigantic financial reward. But scientific research is still very expensive. Universities couldn’t possibly afford it without grants and sponsorship.

  30. SW, I apologize. I didn’t mean to suggest that you personally were browbeating anyone, although I think critics (including US critics) advocating certain kinds of US healthcare reforms have used the LE and IRM figures to do so. I think my general point there was that since the healthcare systems of other countries are to some degree sustained in their current form by the fact that the US system operates differently, some of the criticisms of that difference are rendered problematic.

    From the European countries I know best, I have the impression that their healthcare systems are not sustainable at any rate, and I already see some of them making steps back toward a model more similar to the US model (such as toward private alternatives, a bigger role for the insurance industry, etc.) In addition, I anticipate that by virtue of simple economic reality, the farther the US moves toward the healthcare model of other OECD countries, the more the rest of the OECD will be obliged to move toward the US model. Maybe they will all meet somewhere in the middle. But just for example, the levels of price controls that exist to cap healthcare costs outside the US can’t be applied absolutely everywhere at once without severely debilitating the quality of healthcare globally. Medical/pharmaceutical goods producers need at least one wealthy, reasonably free market to remain in order to pick up the slack (which is currently the case), or else everyone has to share the pain and downside.

    I understand that LE and IRM are commonly used to evaluate healthcare systems. However, I find convincing the explanations of critics of that practice that, at least when you are comparing among developed countries, LE and IRM are of very limited use and, even worse, are probably highly misleading absent rigourous controls of a type that I’ve never personally seen applied in multicountry comparisons.

    Regarding the uninsured, you mention statistics that appear to be those from the latest Census Bureau report for 2010. However, it’s worth taking those statistics with a grain of salt, or at least digging down to see what they really show. The Census Bureau report explicitly acknowledges that for various reasons the presence of healthcare coverage is believed to be underreported in the dataset (incidentally, so is income among the uninsured), so the real figure is presumably smaller.

    It’s also the case that a non-negligible portion of those reported as uninsured are either from households that could afford insurance or who are technically eligible for federal (Medicaid) or state (SCHIP) health insurance but for whatever reason have neglected (or elected not) to enroll. Moreover, a great deal of coverage lapse is due to temporary gaps in (usually employment-related) coverage, which many people think could be fixed by tweaks to the insurance market rather than by substantial increases in government involvement in healthcare). Data from the 2000 census (I’m still looking for the right data from the 2010 census, if available) showed that only 13% of US households below the poverty line – not 13% of all families, mind you, but 13% of poor families – reported that in the past year they had had been unable to meet medical expenses or had elected to forgo some non-emergency care due to an inability to afford it. And it is widely acknowledged that most of the people in the US who are uninsured become insured before long. The subset of US uninsured who are uninsured for long periods of time because of an inability to obtain either private or public insurance is, to my understanding, quite small. (I’m talking pre-PPACA here.)

    I don’t mean to suggest by this that there is not a pressing need in the US to address the problem of the uninsured (though I think the case is still wide open on whether non-US models are the best and most efficient way to do this). Rather, I mean to point out that there seems to me to be reason to doubt that the US rate of uninsured (whatever it truly is) significantly impacts its LE and IRM. This dovetails with the larger notion, already discussed, that as among developed nations, healthcare systems are not among the biggest determinants of LE and IRM.

    Your points about class are well taken. As we consider in future how class issues affect these matters in the US, though, it’s worth bearing in mind that it is not currently the case in many countries with national programs of universal insurance coverage, or nationalized healthcare systems, that such approaches actually in universal access to good healthcare and equal treatment regardless of class.

    I suspect you are right that lower income Americans live shorter lives (on average) than wealthy Americans, but I also suspect that this is also due chiefly to reasons other than access to healthcare. Unhealthy habits such as smoking, bad diet choices, and physical inactivity are much higher among the less wealthy.

    You’re certainly right that the carrying out of most pharmaceutical research by pharmaceutical companies is not an eternal law, but I am very doubtful that the entire sector could be efficiently be transferred to universities without transforming universities into a radically different kind of institution from the ones we know now. Of course there are motivated university professors, but the the key point here isn’t the motivations of the individuals who carry out the research – it’s the motivations of the people who put up the capital. I really don’t see how great results could be achieved by having universities take over the this role while simultaneously keeping universities non-profit and without diminishing the role of undergraduate teaching.

    Terrific discussion as always!

  31. Jamie,

    You asked about price regulation in one country resulting in price increases in other markets. I recall learning from a conference presentation some years ago (not my primary field by any means, though) that this was the case – though the effect was not directly proportionate and can vary widely depending on the severity of the controls, with the effect, IIRC, being more pronounced if the regulation is moderate. Intuitively I would expect that this would be true where reimportation into the relatively unregulated market is restricted (which happens to be the case with pharmaceuticals). I would also expect it to take a while to manifest due to the particularly long pipeline for drug market entry and the stage at which pricing is factored into production decisions. However, I confess that I don’t have a source at hand and will try to find one if I have time (in fairness, feel free to ignore that particular part of my comment until support is forthcoming – I would be delighted to be wrong about this in fact). I did a very, very quick Google search and judging chiefly from blurbs and abstracts it seems the literature is primarily concerned with the costly effects of drug price regulation on drug innovation rather than on pricing in less-regulated markets. It makes sense to me that reduced innovation is in any event a more important concern there, and that it would be exacerbated if the US adopted the kind of price regulations that I suspect would be needed for it to transition in a sustainable way to the healthcare model of many other developed countries.

Comments are closed.