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Is Healthcare a Privilege?

This is Part 1 of my examination of Whole Foods Chairman and CEO John Mackey’s Wall Street Journal article about healthcare.

John Mackey writes:

Many promoters of health-care reform believe that people have an intrinsic ethical right to health care—to equal access to doctors, medicines and hospitals. While all of us empathize with those who are sick, how can we say that all people have more of an intrinsic right to health care than they have to food or shelter?

A careful reading of both the Declaration of Independence and the Constitution will not reveal any intrinsic right to health care, food or shelter.

Do you really want to go there? Really? Ok, we’ll go there. Let’s review the first line of the declaration of independence:

We hold these Truths to be self-evident, that all [people] are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.

Life, Liberty and the pursuit of Happiness. Mr. Mackey, when was the last time you went without healthcare, without food, or without shelter? I have never gone without them either, but I imagine that any one of those situations would impede my “unalienable Rights”, the first of which is Life. Health is a rather important aspect of life.

The phrase Life, Liberty and the pursuit of Happiness is borrowed from writings by the English philosopher John Locke, whom as I understand it was very influential to the ideas and philosophies that guided the founding of our nation. John Lock writes:

The state of nature has a law of nature to govern it, which obliges every one: and reason, which is that law, teaches all [humankind], who will but consult it, that being all equal and independent, no one ought to harm another in his life, health, liberty, or possessions…

Mackey continues:

Even in countries like Canada and the U.K., there is no intrinsic right to health care…Although Canada has a population smaller than California, 830,000 Canadians are currently waiting to be admitted to a hospital or to get treatment, according to a report last month in Investor’s Business Daily. In England, the waiting list is 1.8 million.

Country Population # without health care Percentage
Canada 33 million 830,000 2.5%
UK 60 million 1.8 million 3%
US 300 million 46 million 15%

According to Mackey’s numbers, 2.5% of Canadians and 3% of UK citizens don’t have immediate access to health care. The US Census Bureau says 46 million Americans don’t have health insurance. Am I to understand that Mackey’s argument is that 2.5%-3% not having immediate access to health care is worse than 15% of Americans having access but being unable to afford it? (Do I see a connection to the food and shelter problem?)

Mr Mackey, you and I have had the privilege of being born into a country that affords us certain unalienable Rights. We have the moral obligation to ensure that everyone is guaranteed the same unalienable Rights as we have.

So when we talk about healthcare reform, I start with this assumption: everyone has the right to a full and healthy life. How we guarantee that is up for discussion. The current pseudo-market-based solution is not working for at least 15% of Americans, and doesn’t work very well for a lot more than that. Mackey argues that increased spending on reform might bankrupt us, but at least we’ll have our health.

Life: healthcare, politics Aug 27, 2009 ● updated Aug 28, 2009 2 comments

Whole Foods Healthcare

After hearing the responses to Whole Foods Chairman and CEO John Mackey’s Wall Street Journal article about healthcare, I assumed that the article was full of fear mongering and tired rhetoric. But when I finally got around to reading it, I was pleasantly surprised. He’s one of the few critics of the current healthcare reform discussion that emphasizes that we do indeed need reform and outlines what he thinks it should look like.

Mackey puts forth many great suggestions on how we could reduce the overhead of our healthcare system. There is very little to disagree with in his suggestions, which include offering the same tax benefits to individual plans, remove state boundaries for provider choices, tort reform to reduce the costs of lawsuits, and increased transparency.

Mackey’s premise is that we need to focus on reducing costs and reforming the policies that are preventing insurance companies from competing, while encouraging people to take responsibility for their own health. Despite using obnoxious cliches, he has legitimate concerns about how we would pay for the proposed reforms.

There are three things in his article that are fundamental to the debate. I will examine each of these in separate posts:

  1. Is healthcare a right or a privilege?
  2. Are most health problems self-inflicted?
  3. Who gets to decide what is covered?
Life: healthcare, politics Aug 27, 2009 ● updated Aug 27, 2009 0 comments

Outsourcing vs. Offshoring

My experience is that most people think of “outsourcing” and “offshoring” as synonyms. We talk about the general category of outsourcing with slight repugnance, acknowledging that it is occasionally useful for more mundane and unskilled tasks, but it simply won’t work for the more creative tasks that require an American to do it well. (Maybe nobody blatantly says it requires an American, but we know what you’re implying.)

I don’t intend to address the “Americans are better at creative work” myth, but I will say this: my hypothesis is that any perceived difference in the quality of outsourced work has more to do with the size of the team, access to the stakeholders and end-user, and the ownership and responsibility felt by the people doing the work than it does their nationality, all factors which can also affect an internal team. But I have no experience with offshoring, so I can’t speak to that.

Instead, I want to clarify that offshoring is but one category of outsourcing.

You may not call it “outsourcing”, but you do it all the time

“Outsourcing” simply means paying someone else do work that you could do, usually because they can do it cheaper, better or faster, or any combination of those. We all outsource all of the time. As cofounder of Keepers Household, Inc., I could have our maintenance staff–a position currently held by yours truely–take the time to figure out why the washing machine sometimes doesn’t spin, but not only do I have no interest in this task, I can pay someone else that can diagnose the problem quicker and probably fix it better than I can. I’m exchanging a little money for a working washing machine and a few hours back to do what I’m good at and enjoy1.

In nearly three years of doing web application development at Collective Idea, I can only think of one or two small projects where we didn’t “outsource” parts of the project. On every other project, we’ve worked in conjunction with one or more companies or individuals on various aspects.

It’s not just about getting it cheaper

Design, for example, is an area that we often outsource. We believe strongly in the importance of good interface design, and doing it as early as possible in the project. We can do design ourselves (or at least pretend to), but it is extremely inefficient for us. It is not a core competency, nor is it an area where we have a real competitive advantage.

So we have two options: hire someone that is good and efficient at design, or outsource it. Most companies choose to hire someone, assuming that they will get a better value and the direct access to the designer will yield quicker and higher quality results.

Instead, we outsource it to one of the designers that we know, and not only is the result much better than we could have managed, it is much cheaper. The result is better because we get to work with better designers—people that we couldn’t afford to employ—and they bring with them the experience of all the other projects that they’ve worked on, successes and failures. While the may bill us at a much higher rate than we could have done it ourselves, in the end, it’s still a better value because they make fewer mistakes and are more efficient.

But ultimately, it’s not about getting design done cheaper, it’s about getting it done better. Cheaper just happens to be a nice side effect. We outsource design because we can’t afford to not do it well, so we want the most creative people we can find.

Not just the mundane

On one end of the spectrum of work is the repetitive, dull tasks that anybody can do. And on the other end is the highly creative or skilled work that only a handful of people can do. I disagree with the notion that only the mundane and uncreative tasks are the candidates for outsourcing. The closer the work is to either edge of that spectrum, the more it could benefit from outsourcing.

spectrum of mundane to creative work

Besides design, we’ve also outsourced things that require very specialized knowledge or skills. Occasionally we have interest and can afford to pursue those areas ourselves, but usually it’s more cost-effective and productive to bring in someone that already has experience, for the same reasons we outsource design.

This post is partly inspired by Outsourcing Killed By Django And Ruby On Rails, which argues that the Django and Rails web frameworks have allowed us to compete with the big guns because the frameworks eliminate the 80% of mundane tasks that would otherwise be offshored, allowing us to focus on the creative aspects.

While I agree with their argument that these frameworks eliminate the mundane tasks and allow us to be more efficient, I would argue that more efficiency comes from other factors which have more to do with the culture around these frameworks, such as smaller team sizes, open communication and releasing early which forces you to focus on core features needed by existing users instead of what potential users might want. But I digress…

More importantly, I disagree with their premise that these frameworks have killed outsourcing. From my perspective, they have done exactly the opposite, and it is the ability of small specialized teams to outsource that gives them an even greater edge on the corporate competition.

If frameworks like Django and Rails are killing anything, I would hope that it is the culture of corporate software manufacturing, or the idea that we can just put more cheap labor on the software assembly line and get better results.

  1. I’m writing this right now when I should be fixing the washing machine, but I’ve promised my cofounder/business partner that I’ll call someone to fix it.
Code Life: offshoring, outsourcing, rails Dec 21, 2008 ● updated Feb 26, 2010

What makes us think Detriot will be profitable again?

My gut told me the $700 billion for the banks was a bad idea. But I listened to the bankers and financial “experts” plead their cases and finally came around to acknowledging that it was “necessary”. I should have gone with my gut.

Now the three Detroit automakers are pleading their case to the public and congress. I can’t help but wonder what makes us think that the big three will ever be profitable again.

Realistically, will the big three be building cars that people want to buy in 3 years? 5 years? I don’t see it coming. So why should we loan money to an industry that isn’t sustainable?

If we let them fail, it will undoubtedly be painful. Not just for Detroit, not just for Michigan, but for every town that has an auto supplier, dealer or mechanic. I don’t think that many people are impervious to the effects.

But in the wake of the collapse of the auto industry will be an abundance of manufacturing facilities, a supply chain, and a skilled workforce with nothing to do. It thrills me to think of what can be accomplished if all of these are put to use building something that’s not just 20th century technology with cup-holders and heated seats.

Life: auto, economy, innovation Dec 03, 2008 ● updated Dec 03, 2008 0 comments

I'm not always proud

There were implications by certain politicians this week that we should always be proud of our country.

I’m not proud that 6 innocent Pakistanis and up to 35 innocent Afghans were killed in US-led attacks this week. I’m not proud that we wage wars claiming to bring democracy and freedom to the world, while holding 270 prisoners and neither prosecuting them for a crime or letting them go free. I’m not proud that I am part of the fattest country in the world while 25,000 people die every day from hunger-related causes.

Pride is not something that should be unconditional. Just like a mother that is not proud of her disobedient child, it is her disappointment that shows just how much she loves her child. Disappointed because she knows that he is capable of doing so much good.

Life: america, politics, pride, war Oct 18, 2008 ● updated Oct 18, 2008 0 comments

It doesn't matter if you win or lose

I’ve been really annoyed at the media’s coverage of the Iowa caucuses and the New Hampshire primary. Not only for the unending coverage of polls and speculation, and complete the absence of investigative journalism and coverage of the issues, which is a completely different issue that requires its own rant, but also at the focus on who was the “winner”.

It shouldn’t matter who wins or loses, but what is (or at least should be) more important is what percentage of the vote each of the candidates get, which is indicative of how many delegates to the national convention that they will get from that state.

This whole process is convoluted, so I’m not going to pretend to fully understand it, but here is my take: during the caucuses and primaries, voters not only cast a ballot for their candidate of choice, but also pick a delegate to represent them at the national convention 1. The delegates are then expected to pledge and eventually cast their votes in line with the electorate, but aren’t required to.

Nothing in this process should be concerned with who is the “winner”. The media should be orgasmic about the fact that the race is so friggin’ close, not that Obama surprised us all and won Iowa or Hillary defied all odds to make an unprecedented comeback 2.

Some argue that wining Iowa and New Hampshire means you’ll win the nomination, but even that is debatable. That has been the tendency in recent history, but we also haven’t had a race this close in 80 years. Or, as Jon Stewart puts it, “cold white people and colder white people” aren’t exactly representative of our entire country. The only “win” that the candidates are getting is the attention of the drooling media, thus sidestepping the democratic process.

  1. Actually, in the Iowa caucuses, the voters select delegates to their respective county conventions, which then select delegates to their congressional district conventions, which finally pick the national delegates at the state convention.
  2. What’s that? oh, she was ahead in the polls until Iowa and the media just blew it out of proportion? Never!
Life: media, politics Jan 13, 2008 ● updated Jan 13, 2008 0 comments

Ignorance

ig•no•rance |ˈignərəns| noun
lack of knowledge or information

After spending 6 weeks in Israel this past summer, one thing was very apparent: we are an ignorant people! We know very little about what is happening in the world and have no interest in understanding the complex and delicate histories of the people who’s lives we interfere with.

In an attempt to overcome ignorance, I believe I have found a cure: Avoid mainstream media. Not because they’re liberal or conservative, but because their primary motive is to make money. They have a legal obligation to their share holders to put the bottom line before the truth and the public’s interest. As long as that is the case, news will not be delivered based on worthiness1 but on its entertainment value.

Instead, here a few of the news sources I have found extremely insightful:

  • Democracy NOW!: though it lacks the luster of the news we’ve become accustomed to, this independent syndicated news program is superior to any I’ve seen. Amy Goodman and crew exercise a kind of journalism that the current generation has not seen.
  • Al Jazeera: despite what US media and politicians would have you believe, Al Jazeera is not a terrorist group (or the journalists for the terrorist groups), but instead rivals BBC in number of viewers. Al Jazeera English provides a world perspective on bigger issues, especially those affecting the Middle East.
  • OpenCongress.org: Understanding others requires knowing yourself. OpenCongress.org provides great resources for keeping up with what’s happening on the hill.

How do you fight off ignorance?

  1. “The truth is never sexy, so it’s not an easy sell” Derek Webb
Life: government, ignorance, media, politics Oct 15, 2007 ● updated Oct 14, 2008 1 comment

Stream of consciousness

A while back I signed up for a Tumblr account—and declared that I probably wouldn’t use it. However, I’ve found it really useful for those bits of information that aren’t bookmarkable and aren’t blog-worthy, like quotes and random observations.

So check out my stream of consciousness.

Code Life: Jul 11, 2007 ● updated Oct 20, 2008 1 comment

Derek Webb releases MP3 downloads before CD

The Ringing Bell, the latest album from Derek Webb, releases May 1. Derek has a reputation for being edgy with his counter-cultural message, but with this album he takes it one step farther. Even though the album doesn’t release until May 1, you purchase the album online and download MP3s of the album immediately.

This isn’t Derek’s first foray into edgy distribution models. For 3 months, his previous album, Mocking Bird, was downloadable for free at freederekwebb.com.

I have a ton of respect for Derek for his willingness to break the mold. I hope other artists and labels follow in his footsteps.

Life: copyright, drm, music Apr 13, 2007 ● updated Oct 20, 2008 1 comment

Addicted to Democracy

It’s not what you think…

A couple months ago, I stumbled upon Democracy Player, which calls itself “the free and open source internet TV platform”. It’s an unique video player that puts a bit of a spin on the traditional podcast/vlog application.

In addition to being able to subscribe to any podcast feed that includes video, Democracy features a channel guide that is somewhat iTunes-esque, allowing you to browse and search video “channels”.

Democracy can search and download videos from YouTube, Google Video, Yahoo! Video, and more, and allows you to save the search results as a “Channel”. The player will then download any new content that matches your search criteria.

I don’t subscribe to a lot of vlogs, but I religiously watch (ironically) Democracy Now! and The Show with Ze Frank. Check it out!

(John, sorry to steal your phrase)

Life: democracy, google, internet, player, tv, video, youtube Feb 08, 2007 ● updated Oct 20, 2008 0 comments

American Idolatry

Tonight I had the incredible misfortune of watching the American Idol finale. Until tonight, I have been proud to say that I’ve never watched a single minute of the show. (I know, you’re thinking ‘do you live in a hole?’) However, tonight I was hanging out with my niece at my brother’s house, and he and his wife are avid watchers of the show. Not only that, but their 3 year old daughter told me how Chris was her favorite, but he got voted off. So we had to watch it.

I’ve avoided saying much about faith, ethics, or politics on this blog (well, I’ve avoided saying much about anything, for that matter), but I can no longer resist.

I have intentionally avoided watching American Idol for many reasons. Partially because it’s a fad and I usually attempt to avoid those anyway, but also there’s something that just feels inherently wrong about it, starting with the title: AMERICAN + IDOL.

As I watched the first hour or so, I read the feature article from the latest edition of Time magazine. After voicing their opinion about the current president at an anti-war protest in Europe, the Dixie Chicks were boycotted by most country radio stations and ridiculed by their fans. They were criticized as being anti-American or un-patriotic. Calling people that have the courage to voice their opinion “anti-American” is just wrong. (Not only in principle, but technically; I have no complaints about Canada, Mexico or most of South America. So, if anything, call me anti-U.S.) Besides the fact that we mis-use the word “American”, “Freedom of speech” is almost synonymous with “American”. How can someone who exercises their first amendment right be anti-American? It doesn’t matter what my opinion is, voicing it constitutes being an American (so feel free to be American if you disagree). If anyone is anti-American, it is those that sit on their couch and are spoon-fed their faith, ethics and politics through a television screen.

They said on the show tonight that over 64 million people voted for the finale, which is more votes cast than in any presidential election in American history. How sad is that! We don’t exercise our right to voice our opinion in our own government, but we will for a TV show? Maybe someone should tell them that just because it’s called “reality TV”, it isn’t a substitute for reality.

A few months ago my wife and I were listening to cheesy Christian radio while driving to see family. (Northwest Iowa is a radio wasteland, so the choice is either country, Christian, or the current price of porkbellies.) The news segment, which is often enteraining anyway, consited primarily of news about a foundation that was established to give awards and cash prizes to movies that effectively communicate about God and the message of the Gospel. I’m a supporter of art in any form, so I can appreciate encouraging good art. But they then proceeded to give an American Idol update, and encouraged listeners to check their website for American Idol news.

As a Christian, I don’t understand how Christians can embrace this show. The show tells you that it is about idols in the title! At least the Israelites have an excuse; the golden snake didn’t have a sign on it that said “Golden Idol”. I’m not being dogmatic, I just know that idolatry is hard enough to deal with as an afluent American, I don’t need help with that. As I watched the show, I was amazed at the amount of sex and ego that I was being bombarded with. Where is Christ in that? I’m not saying everything we consume needs to be “Jesus Junk” (to borrow a phrase I heard someone say recently), but how are we being image-bearers of an artistic creator?

To sum up this post of random thoughts about ethics, faith and politics (I’ll try to post more often on these topics so they’re not so random), I am grateful for the freedom that this country has afforded me. But I am often times ashamed to be an American, and today was one of those times.

Life: ethics May 24, 2006 ● updated Oct 20, 2008 0 comments

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