Edwards Opposes Medical Choice

If John Edwards is elected president, Americans will have no choice but go to the doctor when told.

Democratic presidential hopeful John Edwards said on Sunday that his universal health care proposal would require that Americans go to the doctor for preventive care.

“It requires that everybody be covered. It requires that everybody get preventive care,” he told a crowd sitting in lawn chairs in front of the Cedar County Courthouse. “If you are going to be in the system, you can’t choose not to go to the doctor for 20 years. You have to go in and be checked and make sure that you are OK.”

He noted, for example, that women would be required to have regular mammograms in an effort to find and treat “the first trace of problem.” Edwards and his wife, Elizabeth, announced earlier this year that her breast cancer had returned and spread.

Most of the bloggers covering this one are, understandably, focusing on the tyranny angle:

  • Steven Taylor: “If one doesn’t go to one’s annual whatever, will there be a fine? Will the CDC dispatch agents to your house to force the tests on you?”
  • Jon Henke: “Which one of John Edwards’ two Americas gets a freedom of choice and privacy that extends beyond the uterus?”
  • Darleen Click: “State nannyism doesn’t get much better than this.”
  • Brennan: “You want to get an abortion? That’s up to you. You want to decide not to go to the doctor? He’ll force ya to. Oh the freedom!”
  • Ann Althouse: “He’s so warmed up about the generous benefits he’s promising that he doesn’t even hear the repressiveness in his own statements.”
  • Ron Chusid: “A plan like this makes Edwards even more authoritarian than the current Republican Party.”

It strikes me, though, that Edwards is at least being honest about the trade-offs involved. If the government is going to be responsible for everyone’s health care (and at some point in the not-too-distant future, it will be) then it will naturally set all manner of preconditions for receiving treatment. If you’re morbidly obese, you’ll be denied heroic treatment for heart disease. If you don’t get preventative screenings, you’ll be denied remedial treatment.

From a pure business standpoint, this makes perfect sense. If you tear the back off your electronics equipment in an attempt to do repairs, you void the warranty. If your engine seizes up at 30,000 miles and you have never had the oil changed, the manufacturer won’t repair it on their dime. By the same token, why should the taxpayer be on the hook because you won’t take care of your body?

Those who value freedom would argue that the human body is different from mere property. Then again, they wouldn’t insist on cradle to grave health care on the public dime.

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James Joyner
About James Joyner
James Joyner is Professor and Department Head of Security Studies at Marine Corps University's Command and Staff College and a nonresident senior fellow at the Scowcroft Center for Strategy and Security at the Atlantic Council. He's a former Army officer and Desert Storm vet. Views expressed here are his own. Follow James on Twitter @DrJJoyner.

Comments

  1. Dave Schuler says:

    Don’t worry (at least not about compulsory preventive care). Such a plan would never be enacted into law. Exhibit 1: present Medicare/Medicaid/VA programs make no such requirement. Can you imagine a Congressman going home to face the senior citizens in his district with an explanation of his vote to deny them Medicare on the grounds that they hadn’t sought preventive care? I can’t and I doubt that most of those in Congress can, either.

    Who decides what’s required and what’s not? Screening mammographies have demonstrated significantly reduced morbidity and mortality. Screening electrocardiograms are controversial. They were the prevailing wisdom for a while but the studies that I’ve read recently leave room for doubts.

    If the threshold for requirement is too low, the increased costs will be unbearably high. If the threshold for requirement is too high, it won’t have the desired results.

  2. The Breck Girl’s Latest…

    John Edward’s has now come up with a great anti-choice idea: forced doctor visits. It’s so amazing how the pro-choice crowd never see the irony in their stated policies and ideas. As noted by James Joyner at Outside the Beltway,…

  3. Len says:

    I don’t understand the objections.

    A new law was just enacted in our state, passed by our Republican legislature, that requires that you physically present yourself and have your eyes examined at age 79 in order to renew your drivers license. At age 85, you must do this every two years.

    It’s called preventive action.

    A lot of people voluntarily visit their dentists every six months (my mom does so religiously).

    It’s called preventive action.

    A lot of people change the oil in their cars every 3000 miles.

    It’s called preventive action.

    There are a lot of disease that are more easily treated if they are caught early.

    I repeat… I don’t understand the objections.

  4. James Joyner says:

    A lot of people change the oil in their cars every 3000 miles.

    It’s called preventive action.

    There are a lot of disease that are more easily treated if they are caught early.

    I repeat… I don’t understand the objections.

    A lot of people choose to bear children and raise them or put them up for adoption rather than having abortions. So I don’t understand the objection to outlawing abortion.

  5. Tlaloc says:

    A lot of people choose to bear children and raise them or put them up for adoption rather than having abortions. So I don’t understand the objection to outlawing abortion.

    That’s disingenuous, Mr. joyner, and beneath you. The two situations are in no way comparable. Outlawing abortion is preventing someone from getting something. Requiring health checkups in order to maintain health coverage is not by any stretch of the imagination the same.

  6. Andy says:

    A lot of people choose to bear children and raise them or put them up for adoption rather than having abortions. So I don’t understand the objection to outlawing abortion.

    Well, that right there is one really horrible analogy that doesn’t make any sense at all.

  7. James Joyner says:

    The two situations are in no way comparable.

    and

    Well, that right there is one really horrible analogy that doesn’t make any sense at all.

    In both cases, individual freedom is being sacrificed in order that one might do what the state feels is good. And, indeed, the case for abridging freedom in the case of abortion is much, much stronger in that another life is bearing the consequences of your choice. In the case of forgoing mammograms, the harm is mainly to one’s self.

    I wasn’t being tongue-in-cheek with regards to Edwards’ honesty, however. If the taxpayer are responsible for paying, then it naturally follows that the state will set preconditions.

  8. Darleen says:

    Len

    Driving is a priviledge, not a right, and the requirements of who qualifies for a license is the proper province of the government who issues the license. Requiring further eye tests (or driving tests) is not a medical decision.

    Edwards sez he would require women to get yearly mammograms …even as recent studies have shown it is not the ‘magic bullet’ Silky Pony is touting. Not to mention that individual risk factors vary so much that one woman, at the advice of her doctor, might be having a mammogram yearly and another once every 3 or 5 years.

    I take it you’d have no problem with the government tracking your medical visits with penalities or sanctions levied on you if you skip? Are you ready to pay a hefty fine for not having a Sigmoidoscopy within 30 days of your 50th birthday? Think of it as just another slip, like a W2 or 1099, that your doctor issues you to file every April 15th.

    And what other “health” matters would the government then take upon itself to require conformance, for our own good of course? Ration white sugar? License and regulate bakeries and ice cream parlors akin to liquor stores? Of course tobacco would be banned. And maybe a new system of rating restaurants … so “unhealthy” ones (too much alfredo and red meat on the menu) wouldn’t be allowed to serve anyone under 18.

  9. Darleen says:

    If the taxpayer are responsible for paying, then it naturally follows that the state will set preconditions.

    Nationalized healthcare will first ban (de facto or de jure) the private sector so any kind of “choice” in the matter will be moot.

  10. Andy says:

    Nationalized healthcare will first ban (de facto or de jure) the private sector so any kind of “choice” in the matter will be moot.

    Why will this happen? There are plenty of countries with dual universal public and private sector healthcare systems, such as Germany and France.

    Sounds like a typical reactionary scare tactic to me.

  11. Darleen says:

    Government will dominate the market, indeed, fairly shut it out as many taxpayers will find they cannot afford private health insurance (see public school system)

    And those that do will find that private health insurance will follow the dictates of the government…. mandated “preventive” care else ‘no care’.

    And how about the conflict of interest within the government between running a substantial part of the economy and trying to rein in the costs of seniors? The push to ration care to the elderly (no hip replacement for you grandpa, you’re 3 days beyond your 75th birthday) to “save” on SocSec and Medicare will be great.

    Remember what loving care France visits upon its elderly when August rolls around.

  12. […] QandO, Hot Air, PoliBlog, Outside The Beltway, Protein […]

  13. Tlaloc says:

    In both cases, individual freedom is being sacrificed in order that one might do what the state feels is good.

    No, that’s ridiculous. Outlawing abortion is in effect violating individual control over your own body. It reduces women to being nothing more than life support systems for fetii.

    Requiring people to get check ups in order to maintain their health insurance sacrifices exactly no individual freedom. None. What. So. Ever.

    It is merely a conditional statement- IF you want the state to pay for your medical care THEN you need to get regular check ups so that issues can be addressed when they are small and much less costly.

    The reason your analogy was bad is that criminalizing something is very different than simply requiring a given action to maintain a privelege.

    Having bad eyes is not illegal but it can disqualify you from holding a drivers license. and it is absolutely false to equate the one with the other.

  14. […] PoliBlog (TM), The Reaction, Neptunus Lex, Central Sanity, Betsy’s Page, Six Meat Buffet, Outside The Beltway, Redstate, protein wisdom, THE ASTUTE BLOGGERS, Liberal Values, The Strata-Sphere, The American […]

  15. RGL says:

    Preventive care is a term that has been overhyped
    by politicians who don’t understand what it means.

    Except for vaccinations, fluoridation of water, and recommended routine tests for certain age groups, which most doctors have been doing anyway, preventive care to obviate obesity and drug addiction, for example, should be an individual responsibility and not that of the doctor. Those forced visits, therefore, are useless.

    Furthermore, contrary to what Edwards believes, preventive care does not save money. Visiting a doctor in hopes of not getting certain ailments like cancer or heart disease is far more complex than what Edwards thinks.

    Well, after all, he has been suing obstetricians on behalf of children born with cerebral palsy despite the docs doing all that monitoring during pregnancy. It has now been proven that fetal monitoring will not prevent cerebral palsy. Which means he won all those millions on the basis of junk science. Strange, isn’t it?

  16. JKB says:

    “Requiring people to get check ups in order to maintain their health insurance sacrifices exactly no individual freedom. None. What. So. Ever.”

    Is anyone really confused enough to think that the choice will be to maintain health insurance or drop it? Since Uncle will pay for your health care regardless, he will send along the health police to bundle you off for that colonoscopy. “Bend over this is for your own good.” Are such actions really not a sacrifice of individual freedom?

    If maintaining the health coverage isn’t mandatory, we will end up right were we are now. The worst cases, don’t maintain the coverage then show up at the ER for a bit of free emergency care.

    Of course the way to maintain individual freedom is to retain individual responsibility.

  17. Tlaloc says:

    Is anyone really confused enough to think that the choice will be to maintain health insurance or drop it?

    maybe not drop it but require you to cover some portion of the costs if you refuse to meet the requirements.

    There’s nothing unlikely about that. It’s the people who imagine that we’ll have medical stormtroopers rousting people from their homes and handcuffing them when they miss a physical that are delusional.

  18. Zelsdorf Ragshaft III says:

    I searched my copy of the U.S. Constitution and I can find no guarantee of the governments obligation to provide health care. One is free, however to migrate to where ever such rights exist. America will no longer be a free country if the government becomes responsible for healthcare, hense the exercise of the rights under the second amendment to insure freedom from repressive government.

  19. Len says:

    A lot of people choose to bear children and raise them or put them up for adoption rather than having abortions. So I don’t understand the objection to outlawing abortion.

    Really? You don’t see a difference?

  20. Len says:

    I take it you’d have no problem with the government tracking your medical visits with penalities or sanctions levied on you if you skip? Are you ready to pay a hefty fine for not having a Sigmoidoscopy within 30 days of your 50th birthday? Think of it as just another slip, like a W2 or 1099, that your doctor issues you to file every April 15th.

    The government will be providing me with health, dental and vision insurance. If, in return, I am required to have a yearly check-up (thereby possibly catching something that could be a lot more costly and a lot more deadly later on), I will gladly do so. I don’t see that as any more of an intrusion than the government requiring me to file a tax return no later than April 15th every year.

  21. […] heal the divisions between the two America’s by creating One American Tyranny. How? Through a universal healthscare nannystate where you are required to, “get preventative […]

  22. floyd says:

    It’s all good. Anyone who values liberty would prefer death to Edwards’ brave new world anyway!

  23. Hellblazer says:

    This Rented Life…

    Finally we see what it takes to get the Right Wing of American Politics fired up: John Edwards proposing mandatory health care checkups! Because if there’s anything that gets freedom loving, apple pie eating conservatives up in arms is the……

  24. Grewgills says:

    Funny how many of those who complain most loudly about what an egregious theft of liberty Edward’s plan is support warrantless wiretaps, secret searches and virtually every patriot act provision.

  25. Steve Verdon says:

    Why will this happen? There are plenty of countries with dual universal public and private sector healthcare systems, such as Germany and France.

    And the U.S. Further, France is a mixed system like ours so such a comparison is not valid. I don’t know as much about Germany, but in general you don’t want to have a private and public option as private insurance companies will “cream skim” the least sickly leaving the State with the high cost/sickly people.

    No, that’s ridiculous. Outlawing abortion is in effect violating individual control over your own body.

    The same can be said about Edward’s plan. He will take away control of a person’s body so that it will be cheaper to provide health care to the entire public. People will essentially be forced into doing things they otherwise wouldn’t do.

    Requiring people to get check ups in order to maintain their health insurance sacrifices exactly no individual freedom. None. What. So. Ever.

    Actually it does. It takes away the decision just as with James’ abortion example.

    It is merely a conditional statement- IF you want the state to pay for your medical care THEN you need to get regular check ups so that issues can be addressed when they are small and much less costly.

    While there is quite a bit that hinges on how much the State takes over, it is quite possible that people wont have any choice in the matter. For example, if Darleen is right then there will be no option other than going to the State sanctioned doctor. Failure to do so will meet with some form of punishment.

    The reason your analogy was bad is that criminalizing something is very different than simply requiring a given action to maintain a privelege.

    Yes criminalizing. I’ve argued that this is probably going to necessary if you are going to have some sort of State sponsored health care, at least if you are serious about reducing the growth rate of health care expenditures.

    maybe not drop it but require you to cover some portion of the costs if you refuse to meet the requirements.

    Or hit you with a penalty fee/fine/imprisonment if you can’t pay. Really, what is the difference between these outcomes? None that I can see.

    There’s nothing unlikely about that. It’s the people who imagine that we’ll have medical stormtroopers rousting people from their homes and handcuffing them when they miss a physical that are delusional.

    No stormtroopers, but bureaucrats. Bureaucrats who merely tell you to fork over a chunk of change and that if you can’t pay they’ll start garnishing your wages, forcing you to do community service, etc. Basically taking little bits of your life.

    Why is this such a problem Tlaloc, you should love this kind of thing. It is has been what you’ve been supporting all along.

  26. Grewgills says:

    This recent comment about requiring preventative care gave only one specific case and no mention of what the consequences would be (probably increased co-pay). Keep in mind this type of requirement could easily be attached to your private health coverage removing any coverage if you don’t follow preventive care rules, unless the government steps in to prevent it. Many of hose screaming about this would support the private company’s right to do the same.

    The same can be said about Edward’s plan. He will take away control of a person’s body so that it will be cheaper to provide health care to the entire public. People will essentially be forced into doing things they otherwise wouldn’t do…
    Actually it does. It takes away the decision just as with James’ abortion example.

    No. It will potentially add a cost to deciding not to do something that some people would otherwise not do. If you chose to forgo preventive care, you will pay a higher cost if you are later diagnosed with a disease that the preventive care would have prevented or mitigated. It is not at all likely that care would be entirely withheld, certainly no more likely than your private carrier finding some excuse to deny all or part of your coverage for expensive treatment.

    While there is quite a bit that hinges on how much the State takes over, it is quite possible that people wont have any choice in the matter. For example, if Darleen is right then there will be no option other than going to the State sanctioned doctor. Failure to do so will meet with some form of punishment.

    And that punishment will almost certainly be higher cost of care for the ailment that you neglected to preventively care for.

    Yes criminalizing. I’ve argued that this is probably going to necessary if you are going to have some sort of State sponsored health care, at least if you are serious about reducing the growth rate of health care expenditures.

    No other nation I am aware of has chosen to do this. Do you really think we will be the first?

    Or hit you with a penalty fee/fine/imprisonment if you can’t pay. Really, what is the difference between these outcomes? None that I can see.

    Do you really think women will be sent to prison for failing to get a mammogram? Seriously, you should keep your arguments nearer to reality.

    No stormtroopers, but bureaucrats. Bureaucrats who merely tell you to fork over a chunk of change and that if you can’t pay they’ll start garnishing your wages, forcing you to do community service, etc. Basically taking little bits of your life.

    and when your private insurer refuses coverage and you are forced to do the same?

    The actual health plan advocated by Edwards is a hybrid system. This type of system has its problems as any and all possible systems will. The sum of these problems, particularly in regards to costs and average quality of coverage for all citizens, are far less than those of our current system.

  27. […] ones unlikely to ever take effect. While I don’t totally agree with James Joyner, he made some good points in regards to former Senator John Edwards’ […]

  28. […] ones unlikely to ever take effect. While I don’t totally agree with James Joyner, he made some good points in regards to former Senator John Edwards’ […]

  29. […] James Joyner’s post yesterday on Democratic presidential nomination aspirant John Edwards’s ideas about introducing incentives for patients to seek preventive care has engendered some little comment. I couldn’t get overly excited by the idea for a very simple reason: I don’t think it will happen. Whatever sense it may make (in the context that James notes), it’s not politically possible. And if it’s not politically possible, it’s not possible period. […]

  30. Steve says:

    The actual health plan advocated by Edwards is a hybrid system. This type of system has its problems as any and all possible systems will. The sum of these problems, particularly in regards to costs and average quality of coverage for all citizens, are far less than those of our current system.

    Your sentence structure states that the quality of my medical coverage under the Edward’s system will be far less than it currently is . I’m not sure I want that. Even if it means others will rise from no coverage to my new mediocre coverage.

    I’m wondering why we even discuss universal health care. It will never happen in America. I see it as a way for the left to get uncovered citizens to vote for them. Even though they know they can’t deliver. Even Bill Clinton putting his wife in charge of adopting legislation to create universal health care could not get it done. (Darn stingy Republicans)

    Tell me the practical reasons for the government to force me to pay my tax dollars to provide others with health care. What are the benefits to our society as a whole. I can understand why they force me to pay for universal education, the higher the average educational level of our populace the better for society as a whole, but where are the correlating reasons for universal health care?

  31. Grewgills says:

    Steve,
    Note the commas in the sentence you quote. They set off the phrase “particularly in regards to costs and average quality of coverage for all citizens.” Ignore what is set off between the commas and you are left with “The sum of these problems are far less than those of our current system.” Clearly what is far less is “the sum of these problems.” (ie problems with costs and problems with average quality of coverage) Was that really so difficult to understand?

    I’m wondering why we even discuss universal health care. It will never happen in America.

    Why do you believe it will never happen in America? Is it because you think the Republicans will be able to successfully filibuster all attempts at universal health care legislation for the duration of the republic?

    What are the benefits to our society as a whole. I can understand why they force me to pay for universal education, the higher the average educational level of our populace the better for society as a whole, but where are the correlating reasons for universal health care?

    You have answered your own question with your public education analogy. The reasons are much the same.

  32. Steve says:

    Clearly what is far less is “the sum of these problems.”

    You’re right, I did miss or ignore the commas and I now see the proper meaning of your statement. It was the flow of the sentence that made me interpret it the way I did. Thanks

    Why do you believe it will never happen in America? Is it because you think the Republicans will be able to successfully filibuster all attempts at universal health care legislation for the duration of the republic?

    No, I just think it can’t be done.
    1. I think there are enough Americans that think it isn’t the government’s job to make sure everyone in America has the same health care.
    2. I feel those who advocate UHC and have the ability to introduce it do not feel it strongly enough to get it done.
    3. I have never seen UHC, either in practice abroad or introduced here, that works well.
    Therefore, I feel the feeble attempts of UHC advocates will never convince enough of us to make it happen.

    You have answered your own question with your public education analogy. The reasons are much the same.

    I’m sorry, I still do not see it. I know this is a limited forum but can’t you give me just one practical reason for UHC? I can see how having a more educated electorate is better for America and so supposedly society has a vested interest in making education available to all citizens. But how does society have a vested interest in people living 30 years past retirement rather than 20? What vested interest does society have in paying for all children to get needed vaccinations rather than their parents paying?
    Contrary to your initial opinion, I am not stupid or unmovable. I just have certain opinions of government’s role and need sufficient evidence that changing that opinion is the right thing to do.
    BTW, if you use public education as an example of why we need UHC and how government can do a better job than the private sector, I’ll vote against it every time.

  33. Grewgills says:

    1. I think there are enough Americans that think it isn’t the government’s job to make sure everyone in America has the same health care.

    Every recent poll I have seen shows about 2-1 support for universal health care by US citizens.

    2. I feel those who advocate UHC and have the ability to introduce it do not feel it strongly enough to get it done.

    Can’t say for sure but every major Dem supports universal health care and some Repub govs as well.

    3. I have never seen UHC, either in practice abroad or introduced here, that works well.

    I am living in Western Europe now and am part of a hybrid universal health care system here and it works quite well.

    I know this is a limited forum but can’t you give me just one practical reason for UHC?

    A healthier populace.
    Better medical outcomes.
    Lower prices.
    No one being forced to wait until a medical condition becomes an emergency then seeking treatment in an emergency room as an indigent patient because they could not afford a doctors visit and certainly cannot afford the emergency room costs.

    But how does society have a vested interest in people living 30 years past retirement rather than 20?

    Society has a vested interest in a healthier population, just as it has a vested interest in a better educated population.

    What vested interest does society have in paying for all children to get needed vaccinations rather than their parents paying?

    So that ALL children are vaccinated regardless of their parents ability to pay.

    BTW, if you use public education as an example of why we need UHC and how government can do a better job than the private sector, I’ll vote against it every time.

    If private schools operated under the same burdens as public schools, private schools would do no better and in many cases would do worse. (I’ve worked in both)

  34. floyd says:

    “”Funny how………..””
    “”””””””””””””””””””””””””””””””””””””””””””””””””

    Grewgills;
    “Jumping to conclusions”doesn’t qualify as a bonafide exercise program![lol]

    Wouldn’t one have to think of himself as dumber than his government in order to support that government running his life? Just asking.

  35. Grewgills says:

    “Jumping to conclusions”doesn’t qualify as a bonafide exercise program!

    2 of the 4 blogs with a reasonable search function linked to in this post also had post supporting the patriot act. Add to this Fox “News” personalities, the WSJ editorial staff, and the bulk of talk radio and I don’t think I had to jump very far.
    Or did I just wrongly jump to the conclusion that this was the conclusion you accused me of jumping to?

    Wouldn’t one have to think of himself as dumber than his government in order to support that government running his life? Just asking.

    So you believe that universal health care = the government running your life?
    or you think that making benefits contingent on meeting requirements = the government running your life?

  36. floyd says:

    “”So you believe that universal health care = the government running your life?
    or you think that making benefits contingent on meeting requirements = the government running your life?””
    “”””””””””””””””””””””””””””””””””””””””””””””””””

    More the latter than the former.
    Mandatory medical treatment even for prophylactic purposes is abhorrent! The inevitable mandatory drug regimen is downright Machiavellian!

  37. Grewgills says:

    Mandatory medical treatment even for prophylactic purposes is abhorrent!

    Do you think it is abhorrent for your insurer, whether it be the government or a private company, to make full coverage for an ailment contingent on following a preventive care regime for that ailment.
    Ex/ If you want full coverage in the possible future event of breast cancer, you must have regular mammograms so that it can be caught early. You can choose not to have regular mammograms, but in that case you are also choosing to pay more in the event that you get breast cancer.
    I don’t think anyone has seriously suggested that people would be physically forced to submit to care, nor is it at all likely that any consequence other than that which I’ve laid out will be implemented.

    The inevitable mandatory drug regimen is downright Machiavellian!

    What are you talking about here?

  38. […] Edwards Opposes Medical ChoiceOutside Beltway – freedom in the case of abortion is much, much stronger in that another life is shut it out as many taxpayers will find they cannot afford private health insurance Note the commas in the sentence you quote. They set off the phrase “particularly […]