S.F. OKs Universal Health Plan

San Francisco moved closer Tuesday to becoming the nation's first city to provide health care coverage for all its residents. The city's Board of Supervisors unanimously approved a plan that would give adults access to medical services regardless of immigration or employment status. The plan's estimated cost is $200 million a year.

Financed by local government, mandatory contributions from employers and income-adjusted premiums, the universal care plan would cover the cost of everything from checkups, prescription drugs and X-rays to ambulance rides, blood tests and operations. Unlike health insurance, it would not pay for services obtained outside San Francisco. Participants would have to receive care at existing clinics and public hospitals and from doctors who already participate in an HMO for low- and middle-income clients.

The Board of Supervisors must vote on the plan, which has been strongly opposed by the business community, once more for it to become final. Businesses with more than 50 employees would have to start participating next July, while smaller enterprises would begin in April 2008.

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U.K.: FOOLISH MEDICALIZATION OF FOOLISH BEHAVIOUR

By Theodore Dalrymple

There are many heroin addicts in prison. Most of them, for obvious reasons, say something like: “I would give up the heroin, if only I got the help.” This implies, of course, that there exists a technical means by which the behaviour of addicts can be changed, so that no further effort at abstinence will be necessary on their part. The addict sees himself as a person who is ill, like someone with pneumonia, whom it is the duty of the “system” — the paraphernalia of doctors, nurses, social workers, drug counsellors and so forth — to cure. Until such time as the system fulfils its duty, the addict can continue in his habit, secure in the knowledge that he is not to blame, but the system that has failed to cure him.

This is a point of view that the Government has accepted in its entirety, indeed welcomed with a song in its heart; for does it not represent a job creation opportunity? The Government believes, or affects to believe, that the connection between crime and heroin addiction is a simple one: namely, that addicts rob, steal and burgle in order to pay for the heroin without which they will suffer the most terrible withdrawal symptoms. This is nonsense.

Actually, addiction to opiates is not incompatible with work. The great anti-slavery campaigner William Wilberforce took a tincture of opium every day of his very productive life. In the United States in the 1930s, it was found that the majority of injecting morphine addicts still worked, despite their problems with supply.

The criminal records of most addicts who end up in prison are extensive before they ever took up heroin — indeed, a few of them claim to have first taken heroin in prison. In the 1950s, it was found that at least three quarters of the still very small number of heroin addicts in Britain (the numbers of such addicts having increased by between 2,500 and 6,000 times since then to between 150,000 and 300,000) had criminal records before they ever took heroin. In other words, in so far as there is a causative connection between addiction and criminality, it is that criminality — or whatever predisposes people to it — causes addiction and not addiction that causes criminality.

This is borne out not only by the statistics, but by the biography of one of the most famous addicts of recent times, William Burroughs. Burroughs was born into a well-to-do family in St Louis, and from an early age found criminality alluring, at the age of 12 being much influenced by reading the memoirs of a violent criminal called Jack Black. After Harvard, but before he addicted himself to heroin, Burroughs spent some time robbing down-and-out drunks on the New York subway, which is not a sign of a refined moral sensibility, to say the least. (He later disembarrassed himself of his wife by shooting her dead while they were in Mexico, and though he generally disdained his own bourgeois background, he had no hesitation in using family money to bribe himself free.)

It is true that addicts who are prescribed methadone as replacement for their heroin commit fewer burglaries and other crimes than they did before they were prescribed it, I suspect largely because methadone is more consistently sedating than heroin. But it is not true that they become law-abiding citizens after taking methadone: in one series, addicts given methadone committed (on self-report) three acquisitive crimes a month, not exactly a sign of irreproachable uprightness.

Nor is it true that addicts can give up if, but only if, they receive the “help” they claim they want. Huge numbers of American servicemen addicted themselves to heroin during the Vietnam war. Almost all of them gave up spontaneously soon after their return to the US, and two years later their rate of addiction was no higher than that among drafted conscripts who never made it to Vietnam because the war ended.

Moreover, Mao Zedong managed to “cure” 20 million opium addicts by his usual rather uncompromising methods. It wouldn’t have made sense for Mao to have threatened retribution for people who contracted, say, appendicitis or cancer of the bowel, in the hope of reducing the incidence of those conditions: this suggests that addiction to opiates is a pretend illness and treatment is pretend treatment.

It is not true that heroin addicts take a couple of doses and then find themselves enslaved. On the contrary, addicts usually spend a year or so taking heroin intermittently before they decide to take it regularly. It would be truer to say that they hook heroin, than that (as they usually put it, in order to deny their own responsibility) they are hooked by heroin. It is simply implausible to suggest that addicts become addicted by inadvertence or ignorance: the vast majority of the addicted come from backgrounds in which ignorance of history and arithmetic is perfectly possible, but not ignorance of the heroin way of life.

Is any great harm done by pretending that opiate addiction is a disease like any other? After all, a portion of mankind will always resort to mind- altering drugs to obscure the existential problems that confront us all. Certainly methadone when prescribed carelessly — as it is in Britain — is a dangerous drug, and can cause nearly as many deaths as heroin itself.

There is a more intangible harm, however, to the pretence: the existence of drug clinics sends a message to addicts that they are ill and in need of treatment rather than they have chosen a disastrous path in life. It conceals from people their responsibility for their own lives, a responsibility we all find irksome at times, but acceptance of which is the only basis of a meaningful life.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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