Posted by: bkivey | 22 May 2012

Letters to the Editor

A sampling of Letters to the Editor that have appeared over the last couple of months:

Health Care

I would argue that the whole health care debate is obsolete. Health insurance premium payers and taxpayers already subsidize the uninsured for care they are unable or unwilling to pay. I believe that paying for the care of those without insurance is a form of government interference. If the Affordable Care Act is unconstitutional, then so is the current “non-system” mandating that insurance premium payers and providers support the non-payers. Where is the consistency in logic?


This week the Supreme Court heard oral arguments on the constitutionality of the Affordable Care Act, aka Obamacare. Many feel the government cannot force individuals to purchase a private product such as insurance. The discussion sidesteps the parallel question: Can doctors and hospitals be forced to provide uncompensated care to individuals without insurance?

The Emergency Medical Treatment and Active Labor Act of 1986 requires that if I, as an on-call physician, do not provide services regardless of whether a patient can pay, I can be fined as much as $50,000. The same holds true for ER physicians and hospitals.

Where is the outrage at this abridgement of freedom? Perhaps those opposing Obamacare don’t really want to see trauma victims bleed to death at the ER door for lack of insurance, so they push the duty onto the providers — a convenient hypocrisy. Patient mandate, intolerable. Provider mandate, just dandy.


I had insurance before I retired, but the company decided to drop my coverage. I opted to continue my medical insurance on my own, as I felt it was in my best interest. If the Supreme Court declares the mandatory medical insurance unconstitutional, I’ll drop my insurance, and if there’s a need for me to seek medical help, I’ll just go to the emergency room and let someone else pay for me. Or better yet, I’ll tell the doctor to send the bill to the Supreme Court.

Northeast Portland

There are many, many other letters with the same misconception: that uninsured people walk (or are carried) into an ER, receive treatment, and walk out, with nary a financial obligation to trouble their irresponsible little heads. The fact is that the moment you leave the hospital, the letters and phone calls from the various providers start. Medical services are like any other business transaction: the benefiting party has a legal (and moral) obligation to pay the service providers. Medical service providers can, and will, make all legal efforts to recoup their costs. Folks who don’t come to terms with their obligation are going to find their credit scores damaged, which will negatively affect their ability to get a loan, a place to live, and ability to get a job.

I’ve had to receive emergency medical care with and without insurance. The times I haven’t had insurance, I paid what bills I could, and arranged payment plans for the rest. Sometimes it took a few years, but everybody was paid in full. I currently have a primary care physician who doesn’t accept insurance, so his prices are very reasonable. His treatment model is to use the most cost-effective (not necessarily the best) treatments and drugs. It’s sort of like government-run healthcare, except I pay cash for everything, and I don’t have to wait for weeks to see him.

Medical providers are required by law to provide emergency treatment to the uninsured, but there’s no corresponding absolution of obligation on the part of  the patient.

A Plan I Like

In the colonial era, homeowners paid collectively for volunteer firemen and received a “fire mark” that hung outside the house. No marker meant no effort would be made to fight the fire in the uninsured houses.

Unfortunately fire, like disease, spreads. In 1736, after a major Philadelphia fire, Ben Franklin formed the first city fire company to fight all fires. Our system of health insurance does the same thing. Hospitals are mandated to treat everyone, regardless of ability to pay — and that came about because of widespread stories about people dying while waiting for care.

Perhaps we should go back to the early 1900s, when counties provided charity wards and poorhouses, giving minimum care to all. (People paid extra for better treatment and better drugs.) Those who opt out of government insurance would agree to minimum charity care when needed. Fair?

Southwest Portland

Searching for a Point

From someone by the user name patsherman comes this:

Admittedly I don’t know much more about our Constitution than any average citizen, so I have to admit that it’s flattering to learn that somebody who knows something about our Constitution agrees with me. It’s even better when I said it before the smarty-pants did. Anyway…

While the linked article discusses whether the filibuster in the US Senate is constitutional or not, the arguments proposed by Mr. Emmit Bondurant are similar to some ideas that I considered over a year ago. The crux of the matter has to do with the relative power of the majority and minority. And an important part of Bondurant’s argument relates to the change in population between 1790 and now.

First, please read the linked article. Then, consider this data that I calculated based on the census data from 1790 and 2010.

In 1790 the five least populous states included 369,676 people or 9.5% of the population
The least populous state, Delaware, had one senator for every 29,547 people
The most populous state, Virginia, had one senator for every 373,805 people
Ratio of most populous to least populous senatorial representation was 12.65

In 2010 the thirteen least populous states included 13,725,340 people or 4.5% of the population
The least populous state, Wyoming, had one senator for every 281,813 people
The most populous state, California, had one senator for every 18,626,978 people
Ratio of most populous to least populous senatorial representation was 66.09

These are dramatic changes, never anticipated by the Founding Fathers.

Fun with numbers, but I’m not seeing a point here. The people are represented in the lower chamber (House), and the states are represented in the upper chamber (Senate). Each state’s House delegation is based on Census data, so the number of Representatives from each state will likely change every decade. Even in 1787 the states were of disparate size, so the purpose of allowing a fixed number of Senators from each state was that the smaller states would have parity with the larger states. I’d say the Founders did an excellent job of foreseeing changes.

Let’s move on:

And consider this:
Based on the data, in 1790 states representing 9.5% of the population could block any amendment to the Constitution. In 2010 states representing a mere 4.5% of the population have the power to block any amendment to the Constitution.

In my opinion this is definitely not what a democracy, a representative democracy, or a representative republic is supposed to be.

Ms. Sherman is careful to use the number 13 as her basis, because any Constitutional amendment would require the approval of three-fourths (38) of the state legislatures. What she’s overlooking is the fact that before an amendment can go to the states, it has to get out of Congress. Any Constitutional amendment must pass by a two-thirds majority in both chambers of Congress. Here is where the most populous states have a significant advantage in shaping legislation. California alone controls 12% of the votes in the House, while the 13 smallest states combined control just 4% of votes. The fact that hundreds of ill-considered Constitutional amendments have died in Congress shows that the system works.

And honestly, if you’re going to complain about something, at least propose some sort of solution.

At the Movies

I watched Goldeneye last night, and some thoughts occurred. We all know the story, so let’s go right to the notes.

  • In the pre-credit sequence, Bond uses a spike gun equipped with a winch to attach himself to a roof and reel himself in. That’s pretty handy, but in the next scene we see that the gun also packs a laser powerful enough to cut steel. When I saw that, my first thought was ‘What, no eye protection?’
  • At the Goldeneye command bunker in Siberia, why are all the displays in English?
  • Dame Judy Dench. Enough said.
  • When Q is showing Bond his new car, I was wondering why any machine Bond gets his hands on needs a self-destruct device. I don’t think I’ve seen anything last the movie.
  • There’s a scene where one of the villain babes is ordering computer components. One phrase stands out: 14.4 modems.
  • In the public bath scene, where does Bond get the gun? It’s not like he’s wearing anything to conceal it under.
  • Bullets don’t spark.
  • Cars don’t spark, either.

It’s still a fun movie.





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