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Freddie

Freddie deBoer used to blog at lhote.blogspot.com, and may again someday. Now he blogs here.

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125 Responses

  1. Avatar Scott
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    says:

    Opponents do having something to say. You may not like it but it is a valid argument that it is not the gov’ts job to provide health care. However if you read the article, the problem is not lack of socialized medicine, it is that medicaid reimbursements are too low for a doc to be able to even to break even treating him. And won’t these same reimbursements drop under Obamacare?Report

    • Avatar greginak in reply to Scott
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      says:

      we the people can decide what the goverments job is.Report

      • Avatar Scott in reply to greginak
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        says:

        Gee I thought the Constitution laid out what enumerated powers the gov’t has. I checked my copy and providing health care wasn’t in there.Report

        • Avatar greginak in reply to Scott
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          says:

          there are a lot of things the constitution does not specifically say we can do, that we do. it was not meant to be a complete list of all the things the gov can ever do. so if you want to run on a platform of getting rid of medicare, the air force, national highway system, nsf, national parks and about 549 things people like that the feds do then have fun.

          our democracy was not intended to just be a limited gov, but also a gov that was responsive to the people and worked for us.Report

          • Avatar Nob Akimoto in reply to greginak
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            says:

            I’ve always found it interesting how the “limited government” people very rarely have a problem with a standing army….I thought that was one of the main things the framers were afraid of.Report

            • Avatar Scott in reply to Nob Akimoto
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              says:

              Under Art 1 Sec 8 the congress has the power to raise armies but can’t appropriate money for longer than 2 years. But for the record, the US had a very small standing army for most of its history until WW2 and then kept a larger army raised b/c of the cold war.Report

          • Avatar Scott in reply to greginak
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            says:

            “our democracy was not intended to just be a limited gov…”

            If that is true then why were the framers so specific about the powers they were willing to give the new federal gov’t? Could it be b/c they were afraid of a large central gov’t?Report

    • Avatar Nob Akimoto in reply to Scott
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      says:

      Then whose job is it?

      Fine. Let’s get rid of ALL government intervention in health care. No more medicare, no more medicaid and no more tax exemptions to employers for providing health insurance, because well frankly government has no place subsidizing insurance for only some people.

      No more regulating the insurance industry, let’s just let them set premiums as they see fit, and coverage as much as they want. What do you honestly think would be the consequence of these policy prescriptions? Some sort of magical market utopia where everyone is covered and happy?Report

    • Avatar td in reply to Scott
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      says:

      You may have something to say but the problem is that it isn’t particularly relevant to the issue at hand. Having something to say and having a viable alternative are not the same thing.Report

  2. Avatar john henry
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    says:

    I’m curious about your argument here. I guess there’s nothing unique about believing your opinions are correct. But there’s a type of epistemological humility that people generally pay lip service to allowing for the possibility that others could disagree with them in good faith or (even more generously) could be right to disagree with them in good faith. Since you’ve decided to depart from that convention – a convention that I think is one of the basic requirements of civility – I’m curious about why. Is it just an emotional reaction to the linked piece? Is it an inability to understand or an unwillingness to entertain, counterarguments (for instance, the suggestion that the negative economic consequences of the current health care reform package will bring about more suffering than the expansion of health care will alleviate)?

    I’m basically glad that more people will be covered by the current legislation, but nervous about the long term effects. At the same time, I find your dogmatic certitude that this particular health reform package is the best course of action worrying; do you really not see that there may be steep human costs to passing this legislation? And are people like you playing a substantial role in shaping public policy? Why do you believe that disagreeing with you is a sign of moral decay?Report

    • Avatar Freddie in reply to john henry
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      says:

      Opusculum paedagogum.

      Precisely as I described– who here is actually talking about the moral urgency of what is happening? I challenged this comments section to talk about health care in a way that recognizes and acknowledges these horrible hardships, and was greeted by the utter failure of people to do so. I mean I made it very clear what I was doing, and yet still you can’t bring yourself to confront these people. Zic is exactly right. I was asking if you all could argue about this without recourse to arguing about arguing rather than arguing about the actual flesh and blood consequences of what we’re talking about. And you all failed, including ED.

      Incidentally, you might take John Henry’s comments as the ne plus ultra of how people talk about health care reform and the victims of our current system. I say, “look at this suffering,” and he insists on talking instead about how I am talking. He must; they all must. He cannot actually consider the pain of these people when he responds, because he has no meaningful rebuttal to their pain, so he makes it all about me and what my argument says, rather than ignoring what I am asking him to actually consider. As have almost everyone commenting here.

      Honestly, I cannot imagine a more comprehensive and embarrassing confirmation of everything I here argued than what this comments section just came up with. So, yeah, congrats.Report

      • Avatar john henry in reply to Freddie
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        says:

        Honestly, I cannot imagine a more comprehensive and embarrassing confirmation of everything I here argued than what this comments section just came up with. So, yeah, congrats.

        I don’t think anyone who read the post would have expected you to conclude anything else (no matter what the response were). That’s why I asked you questions about the post, rather than about health care reform. The post and your comments make it clear that you care less about discussing health care reform than patting yourself on the back for you’re own enlightened empathy. Go for it. You earned it. I feel like I’m watching the Glenn Beck.Report

        • Avatar john henry in reply to john henry
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          says:

          By the way, as I mentioned, I favor health care reform. I’m not denigrating empathy; just the separation of empathy from reason in formulating public policy. And there’s little evidence that you’ve given any thought to this issue in the post or your comments.Report

        • Avatar Jaybird in reply to john henry
          Ignored
          says:

          Can you not tell how much Freddie is hurting when he writes posts like this one?

          Can you not tell how much it pains him to read comments like yours in response to his post?

          What kind of worm would take such pleasure in causing Freddie as much pain as you are obviously taking pleasure in causing?Report

          • Avatar john henry in reply to Jaybird
            Ignored
            says:

            There is no adequate answer to someone else’s pain. The assurance that there will be health care coverage for more people in four years is certainly not an answer. And Freddie seems to not understand the idea that most public policy involves trade-offs on causing pain to different people. That’s why we have political disagreements; no one would care otherwise. The fact that Freddie can’t see the pain of those who will be negatively impacted by this legislation in the future – whether from rationing, higher unemployment, shortages of doctors, unsustainable debt, etc., doesn’t mean that future pain is not real. It’s hard to believe that Freddie doesn’t know this….but ignorance is the only charitable way to interpret his screed above.Report

            • Avatar Jaybird in reply to john henry
              Ignored
              says:

              There is no adequate answer to someone else’s pain.

              There is.

              It’s called “reform”.

              Honestly, I cannot imagine a more comprehensive and embarrassing confirmation of everything I here argued than what this comments section just came up with.Report

  3. Avatar E.D. Kain
    Ignored
    says:

    “Opponents of healthcare reform” can just as well be a strawman in and of itself. Does it mean “opponents of this particular bill” or does it mean “opponents of any and all healthcare reform”? I ask only because it seems like a terribly wide brush you’re painting with.Report

  4. Avatar greginak
    Ignored
    says:

    ED, i’ll agree Freddie is using a wide brush. it is possible to have good faith arguments against the current bill. but many of opponents of health reform don’t want to discuss the many problems and causalities of our current system. The death panel bullshit was the worst, but a lot of the other milder stuff just doesn’t seem to address the current problems. ED you are by far an exception to that, but how many of the prominent critics in the R’s (or faux news or the con radio talkers) talk about the pain and suffering that goes on with our system. if you even watch the MSM or papers how often do you hear about the people who are screwed in our system.

    We had all the blather about the tea party people protesting the town halls, but did you see on the news about town halls where they weren’t protests. they happened but didn’t get any coverage. or did you see about free medical clinics that had hundreds and thousands of people show up.Report

  5. Avatar Hudson
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    says:

    I like Nicholas Kristoff, but this is sheer NY Timespeak. There are no significant opponents of health care reform; the question is what reforms and how to pay for them. The obvious first step is to allow the purchase of health insurance across state lines (Americans like to shop), enacting tort reform so as to guarantee sufficient numbers of physicians to take on the increased numbers of patients, and to expand Medicaid–which in this case would give John his operation though not guarantee its success.

    The real issue is how much control the federal government should have. Liberals want more, conservative want less.Report

    • Avatar 62across in reply to Hudson
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      says:

      All three of your suggestions would involve more control by the federal government. Requiring interstate health insurance would supersede state regulatory rules. Tort reform would place federal rules around jury awards. Expansion of Medicaid is, well, expansion of an existing federal program.

      Do you want to have another go at what conservatives want?Report

  6. Avatar greginak
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    says:

    The real issue is how much control the federal government should have. Liberals want more, conservative want less.

    standard boilerplate conservospeak.. there is far more to reform then the issues you mention. tort reform has been calculated to have a smallish effect on costs.

    You want to expand medicare, that is a government program you know, so wouldn’t that bring more gov control?Report

    • Avatar Cascadian in reply to greginak
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      says:

      The problem that conservatives should deal with is that the US system isn’t the most cost effective. When you have companies moving to other countries because its cheaper to take advantage of national health care than to fund private accounts, you know you have a problem. Unfortunately, the US has a phobia of looking at other models and what actually works. Instead, we get talk of death panels.Report

      • Avatar zic in reply to Cascadian
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        says:

        This is a great point; but it’s only one facet of the problem of the employer/health-care link in the US. Many small businesses/start-up businesses can’t afford health care, so can’t compete for the best employees. Many employees are trapped in jobs because of insurance and pre-existing conditions.

        The economic drag of our current system spread far beyond the cost of insurance and the cost of care.Report

  7. Avatar Bob Cheeks
    Ignored
    says:

    One indication that the left is fracturing is Freddie’s resort to the old “conservatives are evil because they want to (kill, starve, torture, hurt, hinder, pillage, plunder; fill in the appropriate adj.) this poor group, individual, race, sex (or any combination thereof), ethnicity, etc.,..”
    Freddie knows very well that the debate is about “reform” and that Obama and his fellow travelers demand gummint control while others,even among the left, are seeking a reform that will actually work. Freddie’s great concern, and he has every right to be upset, is that the radical left and the Obama administration are going to be defeated by sundry “groups” of politically disparate Americans who may continue united just to seek revenge on BO and his party.
    It is absolute madness to destroy the finest health care system in the world just to satisfy some perverse belief in a Marxist utopia.Report

  8. Avatar Mike Farmer
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    says:

    The left has criticized the religious right for years regarding their moral righteousness, yet there is no stronger, more influential religion active in America right now than the left’s religion of the state — they are the saviors and everyone who disagress with their religion is a sinner. We need not discuss different paths, because anything outside the true path is apostasy, blasphemy, a sin against the God of State. They ask us to have faith and follow the One True Way because righteousness is on their side.Report

  9. Avatar zic
    Ignored
    says:

    I have said before and continue to say that opponents of health care reform simply have nothing to say in the face of the real, persistent and growing pain of a vast number of Americans without adequate access to health care. You will find, in fact, that the comment section of this very blog can at times be a kind of microcosm for these non-argument arguments– all the evasions, the feints, the topic changes, the concern trolling, the incrementalism, the calls for “more study,” the disingenuousness, the absolute and unwavering dedication to doing anything except acknowledging and confronting the fact that a country that crows so loudly that it is the greatest on earth has an army of people whose lives are in the process of being raped by this American healthcare system.

    Freddie, as you can see, few are still willing to even not their heads at the problem. They tilt at you for being “uncivil,” (John Henry,) focus on the fine distinction between this bill or some other reform (E.D. Kain,) challenge the notion of government involvement in health care (Scott, Greginak, Hudson, Mike Farmer) challenge the legitimacy of our government (Bob Cheeks).

    But only Greginik addresses the morality of living in a nation where people with easily treated disease go untreated, where people live in pain, where families are impoverished by healthcare. And suggests this problem of the people of this land is not the people’s problem to solve through their collective bargaining process — government.

    Other modern nations don’t do this. And yet we think Americans are better. We’re more clever, we’re richer, we’re stronger, we’re smarter. Yet we can’t step far enough back from the brink of our ego to see the pain in our midst.

    It is, as Freddie points out, a cultural illness that challenges our myth of superiority. Because we are not kinder. We are not healthier.

    And now this old lady will stop lecturing you silly boys.Report

    • Avatar john henry in reply to zic
      Ignored
      says:

      As a parent, it ill-suits me to object to lectures. At the same time, my point was that Freddie’s post excludes at the outset the possibility of engagement or discussion. The basic structure is 1) X is right! 2) There are no serious arguments against it, 3) anyone who pretends to make one is an evil human being.

      I suppose somebody could respond with a substantive argument (thereby signaling they are an evil human being in Freddie’s world)…but what would be the point? I thought it was more interesting to ask Freddie why he’d bother writing a post like this, rather than make an obviously futile attempt to discuss the issue when Freddie was obviously uninterested in discussing it.Report

  10. Avatar Mike Farmer
    Ignored
    says:

    zic, those who are truly concerned about the welfare of others will welcome all solutions, including solutions outside government coercion, yet all I see from the progressives is insistence on one solution — a government solution. Spare us the faux-righteousness. To claim that those who reject Freddie’s method of arguing the issue are unconcerned with the welfare of others just proves my point. How many of those who are so concerned about real cases are doing anything to improve the situation? Are they seeking out individuals without coverage and doing what they can to help, or are they waiting on the government to do something about it?Report

    • Avatar zic in reply to Mike Farmer
      Ignored
      says:

      . . . yet all I see from the progressives is insistence on one solution — a government solution.

      That’s all you see? I don’t think you’re looking very hard; perhaps the only place you’re looking for an alternative solution is your own church? Or do you do emergency surgery on the homeless on the street?

      Me, I make ganja cookies for people in pain. I donate to charities. I invest in health-care related businesses, including high-risk investments in start-ups. I write and speak to my representatives and senators, to my insurance commissioners. I reported on health care for many years. I vote, including a vote to expand Maine’s medical-marijuana laws last month. I spend hours negotiating with my insurance company. I shop for some medical services.

      I’m sorry, Wellpoint hasn’t called me about a seat on their board just yet, but President Obama hasn’t appointed me to a death panel, either.

      Did it ever occur to you that many progressive might be working on several fronts to improve health care in this country, including using political will? Careers in the medical field? Journalism to show the problems of the current system (and in the current state of advertising free-fall, for a freelancer that’s truly work of the heart).

      This progressive believes a ‘government solution’ is how people do things together in this country. It’s how we educate our children, how we build roads and subways, how we provide health care for anyone over 65, how we wage war.Report

  11. Avatar Nob Akimoto
    Ignored
    says:

    Two things. First on the moral argument.

    I think it says plenty about our general system of values and the limits of charity when we see stories like this thrown around as commonly as they are. I think Freddie is right in that the parameters of the argument often don’t take into account the question of the very real suffering that exists. There’s also the question of whether or not we’re adequately looking after the weakest members of society, either through the state (as some advocate) or through charitable endeavors. I’ll be the first to acknowledge there’s a lot of good work being done by private foundations, especially in urban health stories via clinics, mobile health services, etc., but the point here is that it’s simply not enough. The scale of the problem is much larger than any number of charities working in concert can provide for.

    From the stand point of arguing about individual consequences, then.
    How about the simple fact that any type of reform itself will also significant consequences, and in a climate where people have very real fears and concerns about their own livelihoods it’s irresponsible to go off on a track without considering what the actual long-term economic, social and yes health impacts will be on the vast majority of American citizens. Plurality of anecdote exist on how the healthcare system is failing ordinary people. Cohn had plenty of that to say in his book, and I’ve read enough stories to make my heart bleed for decades. But what happens when premiums become a significant burden for people who are barely making mortgage payments? What happens to employees who suddenly find themselves dumped onto a public policy because their employer no-longer provides them such benefits and they make too much income to qualify for sufficient subsidies? There will be very real, very concrete consequences for those people, too, and the numbers there are threatening to be big if the Congress does screw up the bill they currently have on the table. Worse given the bureaucratic momentum in this country the likelihood that a flawed bill will go uncorrected for years is a very real possibility that does beg either for more time or at least a smarter debate. Not death panels, not “socialism” but is the current system of government-funding, private insurance and structural payments based on government really really that attractive? Should we, as we’re working now, try to right that ship, or should we just build a new one? There’s costs to both choices and there will inevitably be people who get left behind. The question is who do you privilege? It’s clear you’ve made your choice, Freddie, but I’m not comfortable with that choice just yet. I’ve run the numbers, I’ve looked at some of the sacrifices, and while I lean towards saying yes, the problems are inexcusable, the potential for making things much worse with the present political process exists rather abundantly and I’m afraid of what’ll happen if that comes to pass.

    Second issue. Completely off into the other area.
    I’m going to go out here and ask “what the hell are you guys reading when it comes to health care reform that makes you think it’s even remotely close to ‘Marxism’ or any sort of massively government run system, and why in God’s name do you even think the present system isn’t already government run?”

    In a system where half of the funding is from government, all of the major reimbursement is based on government systems, and where the vast majority of hospitals were funded by regional cartelized local government backed schemes, talk of “socialism’ and “marxism” much less “government run” healthcare when you streamline how insurance is purchased by individual consumers is completely divorced from reality. You want to talk about how “great” the current system is? First start by acknowledging that it exists by the grace of government.

    Then we can discuss how we can let “the market” fix it.Report

  12. Avatar Chuck
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    says:

    As these conversations point out, the arguments of the proponents of the healthcare bills have never been able to frame the basic argument that they have. If they have, I have missed it. The fact is that we are all paying for the current wasteful and harmful system in many ways–higher rates on insurance if we do have it, state and local taxes to cover the uninsured, losing our houses if we do not have the right coverage and the wrong illness, etc. The money is being spent. But the current system makes no sense when uninsured people have to do things like wait until their cancer justifies treatment and hospitalization via an emergency room (no, they won’t be paying but the insurance of others and the governments will be). Until we can put everyone in a system and can get a handle on costs (and reduce the costs of things like the example which I have just given by treating the proper way), we have no idea what we are talking about.Report

  13. Avatar Hudson
    Ignored
    says:

    What Freddie wants is an Oprah moment, where John is rushed into surgery by friends and relatives, receives his operation, is cured, pays no bills, and shows up on Oprah to talk about it.

    62across: What I’m against is a vast new expansion of government into the health sector. So, fine, expand Medicaid and find a way to pay for it. If tort reform is so minor, give it to us. Good luck though. The tort system is run by lawyers not physicians, who pay more in insurance premiums than most people make in a year. In other words, do the simple things first.

    The Liberals don’t want to do those simple things because, at bottom, what they want is more control. When George Will asked on The Roundtable last week on ABC Sunday morning why can’t I shop for health insurance the way I buy car insurance, Donna Bazille said, “because we want you to have the best care possible,” meaning, she, speaking for the Obama administration, can make better choices than he, George Will, can make for himself. Yep, that’s what she said.Report

    • Avatar Nob Akimoto in reply to Hudson
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      says:

      That’s an odd question to be asking in the first place, since the national health exchanges and the related things in the bill are all meant to let people basically shop online and compare premiums and coverage simply compared to the byzantine mess that currently exists. So that’s a strawman based either on a bad question, or Brazille not understanding her own administration’s proposal.Report

    • Avatar td in reply to Hudson
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      says:

      Health insurance isn’t like any other kind of insurance because in this case the market cannot efficiently price the risk of carrying your coverage. Markets do a great job of telling us what the replacement costs are for your car or the roof of your house so the risk is much more manageable. Not so for healthcare.Report

    • Avatar greginak in reply to Hudson
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      says:

      like Nob said, if you believe what you wrote then you don’t understand the current plan which will give more choice. a public option that we could all get into would certainly give more choice but that seems like a massive problem for R’s. and how do insurance reforms and potentialy a public option increase gov control. They don’t, but the standard conservative argument is GOV EVIL, LIBS WANT GOV. my guess it part of what brought on Freddie’s post was the use of generic arguments that don’t address the specific problems with healthcare and don’t deal with the human suffering with our current system.Report

    • Avatar Zeke in reply to Hudson
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      says:

      “If tort reform is so minor, give it to us. ”

      If Tort Reform could buy just one more vote for cloture in the Senate, I’d make that deal in a heartbeat. But it won’t, so how is this a relevant concern? I’ve had enough of Democrats pre-emptively compromising with people that aren’t really interested in give and take. Take the trigger for the public option. By my count, this is a compromise of a compromise of a compromise of a compromise. Liberals want single-payer or something like it, but they’ll accept the hacker model with a strong public option, and I guess that a weaker (medicare + 5%) public option would work, and i suppose that if that won’t happen then maybe the opt-out would be fine…this is ridiculous.

      The Republican Party will not support any bill that achieves uiversal coverage, much less a really good one, and nobody else has any votes to offer. At this point, people need to get real. either they support universal coverage and can get behind this bill, or they oppose doing anything about the kinds of stories Freddie has pointed us to.Report

  14. Avatar Sam M
    Ignored
    says:

    Well, OK. I will address the fact that the current “system” sucks and that people are suffering in many ways. Some by not getting care they should get. Others, by paying family-crushing premiums. People are dying. Others are going broke.

    Is that enough wailing? Have I earned the right to talk about the current legislation as proposed? Perhaps not.

    OK. So it really, really sucks for the people not getting care and for the people spending huge portions of their income. No, wait. It really, really sucks. It’s the worst thing ever. You can’t see it right now, but I am pulling out my hair and shoving bamboo under my own fingernails. Now I am lighting my leg on fire in protest.

    Is that sufficient? Can we talk about the way this reform is structured now? Or is that callous?

    In turn, I hope that you will return the favor and cry a river over the people who will get screwed over with regard the the legislation as proposed. I hope you understand that gargantuan government programs cost a lot of money, that nobody is proposing ways to raise that money yet, which will almost certainly entail cuts to other programs moving forward, which will almost certainly cause death/dismemberment or some such terrible stuff to somebody.

    Why won’t you ever address these people? Why won’t you talk about that suffering? I challenge you to do so.

    After you are done, I guess we will be even. Perhaps we can mail each other vouchers for some Kleenex with which we can wipe our respective misery from our swollen cheeks.

    And then we can… erm… talk about the legislation again?

    One thing I might like to address is the question of Greginak raised regarding the bullshit death panels. I will agree right off the bat that the claim was bullshit, as structured, and that the messenger was a dolt. But the fact of the matter is, to control costs, we are going to have to learn to tell people no. And when we do, people will die. Some 14 year old girls is going to want a $500,000 transplant that has a 10 percent chance of success. And it will be someone’s job to say “no.” If we don’t, no reform will work. At all. And seeing that someone is going to have to make such decisions… well, let’s not call it a panel. But we will have people deciding who lives and who dies. We have that now. And every system in the world has that. It’s just a different panel making the decisions. I mean… a different commission.

    Is it a legitimate question to ask whether a government agency is going to be better or worse at making these tough choices? I think that’s a legitimate questions.

    Would someone out there who has proven himself to be sufficiently worked up about the horror stories please ask it? I am afraid I am not misery-certified yet.Report

    • Avatar greginak in reply to Sam M
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      says:

      sam, if you haven’t seen that current bill has methods to pay for it built in, and FWIW has been scored to be at worst deficit neutral by the CBO then you havn’t been paying attention. as it is now the bill is payed for.

      there will always be some gatekeeper deciding what procedures will get paid for. the private sector does that now so that argument has never made sense to me. and medicare is popular and not killing grandma , so it seems the the EVIL FED health care system has dealt with this just peachy.Report

  15. Avatar Jaybird
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    says:

    Man, I miss when I used to hold positions that were so completely moral that the only arguments against them were non-arguments given by dishonest people (well, sometimes they were just repeating lies they were told by someone who didn’t deserve their trust). It was completely awesome. “You only think that because you’re deceived!”, I would tell them. When they wouldn’t bow to this argument of mine, I would then know that they weren’t deceived any more (I had told them the truth, after all) but deliberately malicious. If there’s one thing that is harder to fight against than people deceived by the Devil, it’s the evil people who have deliberately chosen to ally themselves with him and fight against good people like me. The best part was that this was true for pretty much anything! From the most important things like whether Jesus turned the water into wine at the wedding at Cana or whether he turned it into non-alcoholic grape juice to medium-sized things like “forgive us our debts” vs. “forgive us our trespasses” to small-sized things like whether Amy Grant was going to hell forever for crossing over without taking the cross over or whether she’d just be rebuked before being allowed into heaven because, of course, once you drink from the water of life and all that. And, hey, if you thought that she was going to heaven, might that be because *YOU* are fooling yourself JUST AS MUCH AS SHE IS??? I’ll pray for you.

    Ah, good times.Report

    • Avatar greginak in reply to Jaybird
      Ignored
      says:

      Jay you do contrariness wonderfully, but sometimes it comes off as just not wanting to enter into debate, but to avoid it.Report

      • Avatar Jaybird in reply to greginak
        Ignored
        says:

        You will find, in fact, that the comment section of this very blog can at times be a kind of microcosm for these non-argument arguments– all the evasions, the feints, the topic changes, the concern trolling, the incrementalism, the calls for “more study,” the disingenuousness, the absolute and unwavering dedication to doing anything except acknowledging and confronting the fact that a country that crows so loudly that it is the greatest on earth has an army of people whose lives are in the process of being raped by this American healthcare system. Why, comments on this post might even show a little more….

        Greg, there ain’t nobody who enjoys debate more than I do.

        I was only responding to the signals in the original post that debate was neither expected nor wanted.

        I would be thrilled to discuss such things as the difference between “care” and “government assurances of care”, the barriers to entry to the health care field, the cost/benefits of R&D and whether government involvement has, in practice, stifled medical advancement…

        Dude, I live for that discussion.

        But read that part of the essay again. *ANYTHING* I say will be categorized as an evasion, a feint, a topic changes, concern trolling, incrementalism, a call for “more study,” disingenuous, or otherwise a failure to acknowledge or confront the fact that a country that crows so loudly that it is the greatest on earth has an army of people whose lives are in the process of being raped by this American healthcare system.

        Shit, look at John Henry. He came at this soberly (and in good faith, it seems to me) and wanting to discuss even the possibility that somebody could hold an opposing opinion in good faith and Freddie instead said that he was doing exactly what he predicted and finished with Honestly, I cannot imagine a more comprehensive and embarrassing confirmation of everything I here argued than what this comments section just came up with. So, yeah, congrats.

        Look at the timestamp. That happened *BEFORE* I wrote my comment.

        Additionally, there is also the issue of “We’ve talked about health care a kabillion times on this website and I’ve provided what I think of as a system that will work and Freddie instead is acting as if one of the following two things are true: 1) he has no memory that this debate has happened a dozen times before on this very website and the people he is predicting will offer nothing of value have, in fact, provided not only counter-argument but solutions of their own *OR* 2) he does not give a shit that this debate has happened a dozen times before on this very website and the people he is predicting will offer nothing of value have, in fact, provided not only counter-argument but solutions of their own.

        Given those two possibilities… I’d say that, indeed, I was not in an “enter into debate” kinda mood when I wrote my comment.

        I was fully informed that this was not an “enter into debate” kinda thread beforehand, however. You were too.

        We all were.Report

        • Avatar greginak in reply to Jaybird
          Ignored
          says:

          “Greg, there ain’t nobody who enjoys debate more than I do.”—and just how do you know nobody likes debate more then you? Can you really be sure some people don’t like it more? No i say, no you cannot be sure of that.

          Well we have been over these issues and yes Feddie seems cranky. i, obviously, can’t say exactly where he is coming from. but what i do feel is some people just throw out a laundry list of often ill thought out or shallow complaints as a retort their ideology has no answer too. an example is the “OMG reform will add a trillion dollars to the debt” or ” dems don’t say how they will pay for reform”, well you can disagree with CBO estimates but these complaints are just fact free for anybody who knows a bit about the proposed plans.

          Then there are the arguments raised by bobby ch and mike f, who just go with the attack lib’s mode. they certainly can’t assume any good faith among lib’s and just go with classic mud slinging.

          but none of those arguments addresses the nasty reality we have in our health care system which is often left out of these debates. Matt Yglesis (sp) wrote a few weeks ago about how in our national debates conservatives speak in moralistic terms and libs in technocratic terms. and when libs try to speak in moralistic terms the chattering classes and MSM get their panties in a bun. well this seems like a small scale example of that. how many times on this very blog do conservatives or libertarians make moralistic statements about how they understand or love the constitution or protecting us from the EVIIIILLL GOV. we generally don’t see the same heat in those conversations even when con’s make truly nasty comments about libs only wanting to control people. Freddie is making a similarly moralistic statement from a lib point of view.Report

  16. Avatar Freddie
    Ignored
    says:

    True story: my spam folder has been eating all of the emails I get telling me I have comments on my posts– but didn’t eat the one from Jaybird. It’s like we have some sort of oppositional link, like in Highlander.Report

  17. Avatar Sam M
    Ignored
    says:

    Greginak,

    Is the bill really paid for? If Congress becomes more fiscally responsible in the future.

    http://www.marginalrevolution.com/marginalrevolution/2009/11/is-the-senate-bill-fiscally-responsible.html

    Perhaps you don’t like Cowen. But it’s hard to accuse him of “not paying attention.”

    This might be a good thing to debate here. But of course, debating such a thing is a complete abdication of responsibility. The responsible thing being to sit around and pat progressives on the back for “caring,” and calling everyone else a callous jerk for questioning anything.

    Of course, what I meant to say is that it really, really sucks for people who don’t have health insurance. I mean… really. Did you hear some people don’t have it? It’s like the holocaust and the black plague dipped in honey, rolled in glass and force-fed to a baby. Followed by hot sauce. And death.

    Because that’s the really useful stuff!Report

    • Avatar historystudent in reply to Sam M
      Ignored
      says:

      I agree that it is really vital to look at the bill as a whole and consider its consequences fiscally, bureaucratically, etc. There are ways to fix our health care system, but the Congressional bills on the table will only make matters worse in my judgment.Report

    • Avatar greginak in reply to Sam M
      Ignored
      says:

      well the CBO says its paid for. of course they could be wrong or people in the future may screw things up. but people in the future could screw anything up, so how does that relate to what we should do now? maybe it will cost more then we think now, but maybe it is worth paying for given the human cost involved in the problems with our health care system.Report

  18. Avatar historystudent
    Ignored
    says:

    Every country in the world, regardless of the type of health care system in place, will have sad stories of individuals who are sick and have in some way been overlooked or abused by said system. It is a sorrowful fact of life that no matter what the system, there will always be some who will suffer. Our system is not perfect, and even those who claim ours is the best system on earth (and I am not among them) will admit that we have problems which we need to address and fix. But the current proposals in the Congress are not the way, I am utterly convinced. And I suggest that Americans not be swayed by emotional anecdotes in the quest to decide about health care reform. Instead, facts, analysis, and perspective regarding the bills’ full consequences ought to be the deciding factors in judging where we should go. Here are some links that I found useful in that process:

    http://www.theweeklystandard.com/Weblogs/TWSFP/TWSFPView.asp

    http://budget.senate.gov/republican/pressarchive/2009-11-19HealthCareFactSheet.pdf

    http://www.freedomworks.org/publications/top-10-1-problems-with-harry-reid%E2%80%99s-healthcare-tak

    http://www.dallasnews.com/sharedcontent/dws/dn/opinion/editorials/stories/DN-health_1124edi.State.Edition1.27172a4.html

    http://www.cnsnews.com/news/article/57392

    http://blog.heritage.org/2009/11/19/the-five-flaws-of-the-reid-health-bill/Report

  19. Avatar steve
    Ignored
    says:

    Freddie is certainly correct in that you cannot find anyone on the right who is a long time advocate for health care reform. There has been no right leaning politician who has been willing to use their political capital to try for reform. If you look at the red states, none of them have tried for any of the market oriented reforms supposedly favored by the right. When you look at actual actions, what you see is the right is opposing health care reform.

    My preference had ben Wyden-Bennett. At the slightest hint that it might be considered, the Republicans backed off of it. There is no, nada working model of a large scale health system that works and is affordable based on the free market systems the right supposedly supports. It would be a huge gamble to embark on such a plan. It would be much better if some state or states which supposedly believed in them tried it as a model. Will not happen IMHO, as the right is just interested, judging by their actions, in opposing health reform.

    SteveReport

  20. Avatar Hudson
    Ignored
    says:

    td: I object to the notion that medical insurance is exceptional. All insurance is based on shared risk as determined by the behavior of a group over time, with the addition of individual performance. If you are the cause of auto accidents, your car insurance goes up, as it should. If you smoke two packs of cigarettes a day, your health insurance should go up by some generally agreed measure. You can’t measure these risks exactly, but you can measure them fairly.

    The intellectual argument over health insurance should have been solved long ago. What does it cost to insure one American (not illegal immigrant) of a certain age with certain health characteristics and risk factors? What is the cost to society, and how much should the individual pay? But, alas, our melting pot bubbles over with complexities.

    In a relatively simpler population, as in Canada, at least when your national health care system was put in place, single payer might make sense. In the U.S., the only system that will work is giving us ample choices with basic market discipline. Otherwise, the feds will just keep printing dollars as they are doing now and bankrupt the country in short order, a decade or less. High finance is another instance of exceptionalism, with the high rollers tossing around terms like credit default swaps that they themselves admit they didn’t understand.

    History has a way of simplifying irrational complexities. Pay your bills or stop spending, or you will go bankrupt. Raise taxes or cut spending, or you will go bankrupt. Bankruptcy is blunt and impossible to ignore. At first, our weasel politicians might point fingers and spin their tops in denial. But their paychecks too will stop coming or purchase nothing. And with that, the drivel will cease. They will learn the old Russian proverb: Eat bread and salt and speak the truth.

    Washington will pass some health care reform this year or the next. Certainly more “Americans” will officially be covered. Let us hope and pray that the costs will not render our currency worthless.Report

    • Avatar td in reply to Hudson
      Ignored
      says:

      The incidence of medical risk is obviously much broader than he who smokes tow packs a day and I think overall the point still stands. When dealing with health insurance the market cannot possibly price the limits of the risk health insurance companies take on in the same way home or car insurers do, so for George Will or anyone else to suggest that we should purchase health insurance in the same we do auto or home just completely misses the point.Report

  21. Avatar Sam M
    Ignored
    says:

    “well the CBO says its paid for. of course they could be wrong or people in the future may screw things up. but people in the future could screw anything up, so how does that relate to what we should do now? ”

    Well, no.

    The fact of the matter is, the actions that amount to “fiscal responsibility” are all foisted upon future congresses. I think it’s fair to say that congress is serially irresponsible with money, and there is no reason to expect that to change.

    For instance, let’s say I weigh 500 pounds. You tell me I need to go on a diet. I say, “Sure. Here’s how I’ll do it. For right now, I am going to stuff my face with cookies and pie, because I am hungry. But starting January 1, I am going to eat 800 calories a day and run 50 miles a week until I am in good enough shape to run a marathon.”

    Do you see this as a balanced diet? After all, I have spelled out the dietary reposnsibility I plan to follow in the future. Or… do you think it makes sense to take my past excesses into account when gauging this plan?

    Either way, I don’t really see how it’s irresponsible or callous to have this discussion instead of trading anecdotes about terrible things that have happened to people. After all, isn’t that Kristoff column exactly what people have been arguing AGAINST for quite some time? Every time there is a state of the union address and they trot out some put-upon widow or orphan or hero or whatever… that’s the measure of responsible discourse? If so, I guess I could counter Kristoff’s anecdote with one about some terrible case of AMT run amok, or government bureaucrat screwing some citizen in a really terrible way. Is that really the way forward?

    Maybe I could go to England and find some guy who has a condition that the government won’t treat. At which point I can scream DEATH PANEL.

    Presto. Discourse. Huh?

    Besides… isn’t this the way the debate has been raging all along? I can’t turn on the network news without seeing some guy who lost his job and his insurance and his daughter is sick, etc. Sure, this is important stuff. But to say it has not part of the discourse is completely absurd. Don’t you remember that case of the young family from Baltimore a while back? They volunteered to be spokesfolks for health reform? But it turns out they actually had some money. Or something. Was that a useful moment in the discussion? Either way, it was, in fact, a moment. We all heard it. Am I am bad person because I am not insisting on stringing together a constant wave of these moments and piecing together my entire understanding of the debate? Sure that’s a mixed metaphor. But that’s how bad, terrible people talk, I suppose.Report

    • Avatar greginak in reply to Sam M
      Ignored
      says:

      every budget item of every sort is passed onto the future, that is how the psst and future work. you have said nothing but that you don’t trust congress, so what?

      Oh remember the family from baltimore very much. the kid and his family had benefited from the SCHIP program. when they spoke out about it royal douchbags like michelle malkin started peeping into their house noting that had marble countertops so therefore they shouldn’t have gotten help. they were viciously smeared for saying they benefited from a program that was in contention.

      in reading your posts you seem irritated by people discussing the human suffering in our current system.Report

  22. Avatar Mike Farmer
    Ignored
    says:

    Gregniak,

    “Then there are the arguments raised by bobby ch and mike f, who just go with the attack lib’s mode. they certainly can’t assume any good faith among lib’s and just go with classic mud slinging.”

    The left is bent on government solutions for healthcare, and they are no listening to other solutions. You might no accept this, and it might be more convenient to hide your head in the sand and pretend that everyone else is merely blocking reform, but that’s incorrect. The left is not operating in good faith, because they refuse to consider all solutions. The simple free market solutions should be the first things we try, since they can take effect immediately and we don’t have to let people suffer for 4 more years (talk about a cynical and cruel way to create fuzzy math — they say people are dying, yet they want to wait 4 years so the numbers will work out).

    You could get the people’s approval through a special vote in a state like Texas to be an experiment in free market healthcare — allow them to buy insurance anywhere they can buy it, and buy policies designed however the seller and buyer agree to have them set up– give tax breaks for individual policies — challenge the private sector in Texas to create tax-free charity care, and if no charity develops, as part of the agreement, care will be provided for those who can’t afford it if they are citizens of the state when the agreement is passed — create rational tort reform — suspend all federal regulations affecting healthcare — allow healthcare providers to design efficient and innovative care designed to save money. In other words, remove all government involvement and see if it works. Make Texas a free market healthcare zone and see if it lowers cost and increases coverage.

    This just popped into my mind, but it would be interesting to see if the people would approve this experiment, and if they did what the results would be. Even if it’s disastrous, the federal government doesn’t like Texans anyway, so no problem. Medicare recipients could be exempt from the experiment since they have been paying into the system, but you could get agreement from the wealthy excluding themselves from receiving Medicare. What would be most interesting is how they dealt with those in greatest need. I think if the people of the state saw themselves as taking responsibility to make free market healthcare work, they would respond, and this would inspire other states. But, I could be wrong.Report

    • Avatar greginak in reply to Mike Farmer
      Ignored
      says:

      Liberals are bent on government solution to health care because that is what we think will work and works well in a lot of other places. that is what Obama campainged on and a lot of Lib’s have been wanting for years. there is nothing hidden or disengeous about that. I nor pretty much any other lib thinks your simple free market solutions will work nor have they worked. So the left is not operating in good faith because they won’t consider solutions that we don’t think will work, haven’t worked in other places and are completely different from what Obama campaigned on. yeah sure.

      when repub’s win elections , and they certainly will, they get to set the agenda and start the terms of debate. when Dem’s win……..well thenReport

      • Avatar Mike Farmer in reply to greginak
        Ignored
        says:

        I am neither Republican nor Democrat, just a free market, libertarian, individualist — both parties have screwed up healthcare when decades ago they began interfering with the free market. We’ll see who has the final say. You go with the State — I’ll choose the market.Report

  23. Avatar Mike Farmer
    Ignored
    says:

    The fact is that statists know that the free market solutions will work, and if they were tried would destroy state power.Report

  24. Avatar Mike Farmer
    Ignored
    says:

    “So the left is not operating in good faith because they won’t consider solutions that we don’t think will work, haven’t worked in other places and are completely different from what Obama campaigned on.”

    So, when Obama said he was open to all ideas he was lying? I think it’s criminal that Democrats are blocking real change in healthcare by insisting on unworkable solutions which will bankrupt the nation and cause many people to die in the process.Report

    • Avatar greginak in reply to Mike Farmer
      Ignored
      says:

      very impressive mind reading mike, did you peak into other parts of my brain other then my beliefs about the free market and the state. i’m interested since i don’t believe the things you are telling me i do, but apparently you know what i think better than i do.Report

      • Avatar Mike Farmer in reply to greginak
        Ignored
        says:

        Mind reading — where did I read your mind? I was talking about the progressive positions in general from what I can tell reading them. So, you have mysterious positions we don’t know about? You’re merely asking gadfly questions? I get it. You’re a trip. I assumed you believe government solution are the best, but then I might have misread that when I said – “You choose the State” — so, you choose the market, too? Great.Report

        • Avatar greginak in reply to Mike Farmer
          Ignored
          says:

          false dichotomy, both markets and the state have roles, strong points and weak points.

          mind reading- you seem to be saying that i and other libs know you are right but just dont’ care because all we care about is power.Report

          • Avatar Mike Farmer in reply to greginak
            Ignored
            says:

            I don’t know what you care about but politicians have cared about power since they were built from scratch. Anything that threatens that power is the “enemy”. The free market threatens state power. Yes, when it comes to creating the best environment for healthcare to operate most efficiently and cover the most people on one hand, and increasing power on the other, politicians will choose power. Everybody knows this.Report

          • Avatar Mike Farmer in reply to greginak
            Ignored
            says:

            “false dichotomy, both markets and the state have roles, strong points and weak points.”

            the present plan will eventually knock the market out of the picture, so you oppose the present bill? Would you like to see more free market reforms which can be implemented immediately? Who knows, they make some of the further reforms unnecessary, right?Report

  25. Avatar Sam M
    Ignored
    says:

    “every budget item of every sort is passed onto the future, that is how the psst and future work. you have said nothing but that you don’t trust congress, so what?”

    The so what is that the CBO score rests on the notion that congress will raise taxes and do a lot of other stuff that congress hates to do. This congress is refusing to do it. But promising that it will do it later. I don’t think it will do what it says. Therefore, I don’t think the CBO score is valid. That is, I do not think that the reform pays for itself. Which is a big deal.

    If this congress won’t do what it needs to do, why will the next congress? Or the one after that? This reminds me very much of the GOP’s highly dubious plan to “starve the beast.” We will cut taxes now, and in the future, congress will be FORCED to cut spending. Well, no congress won’t.

    I think the same is true for this plan, which I guess you can call “make the beast hundgrier.” In which case you make it do a whole lot more work (health care) and assume that some jerkass in the near future will be FORCED to raise taxes on Bill Gates. Or Joe Six Pack. Or… somebody.

    Nonsense.

    It’s not like the plan calls for congress to keep taxes where they are. Or refuse to cut them or something. It basically is tying the hands of future congresses. But they somehow manage to never get tied. Unless you have evidence to the contrary.

    Seriously. Let’s say that the Republicans came up with a proposal to pay for the war in Iraq by taxing country club memberships to the tune of $4 million a pop, and raising the gas tax to $5 a gallon, starting in the year 2018. And the CBO said, well, if you do that, sure. YOu would actually pay for the war in Iraq.

    Would the fact that the Republicans are NEVER going to do that come into play at all? Wouldn’t it be curious that they are refusing to do that right now?

    Or maybe you would just say, “Well, the CBO says it’s square.”

    I am guessing you would not say that. At all. And you would be completely right.

    The CBO counts dollars. Not political probabilities.Report

  26. Avatar Sam M
    Ignored
    says:

    “in reading your posts you seem irritated by people discussing the human suffering in our current system.”

    Horse crap. I see plenty of value in doing that, on this issue and many others. What I do take issue with is the idea that nobody is doing this with regard to health care. I see it all the time. It’s part of the discussion. And to sit here and say, “I decree in this post that it’s time to talk about this again. And anyone who refuses to engage the debate on these terms at this time is obviously a callous jerk.”

    I am a fairly libertarian guy, but I see libertarians do this all the time. On the drug war, for instance. I see great value in what Radley Balko does with regard to abouse of police power. People need to see that stuff. But you always get these tedious guys who ALWAYS talk about it in those terms. People will be sitting around discussing some questions regarding medical marijuana or what impact legalization might have on usage, and you get this guy screaming about people kicking down doors, MAN!

    Well, OK. There is a place for that. But a whole bunch of the debate–almost all of it, actually–goes on in policy circles where people are well aware of that stuff. I really don’t think there are a lot of people who argue FOR swat teams raiding the wrong house. So you can sit around and DEMAND that they address this one guy you heard about who, like, totally got shot by the MAN.

    But really, that guy just comes across as kind of a loudmouthed jerk.

    What I don’t get is, what can someone against drug legalization SAY? Does that end the debate? By being against legalization, are you de facto endorsing police brutality? Or is there some kind of other ground to hold?

    In terms of this Kristoff piece, fine. OK. I read it. I completely understand that the current system really, really sucks. How many times can I say that? I am paying about $16,000 a year for health incurance for my family. In a few months my COBRA runs out and I will pine for the days when at least I could be covered.

    But I suppose that’s not enough. Because I am still against the current proposals. Heartless, heartless me.

    But maybe if I just cry enough I will earn the right to discuss the issue? I wonder when that comes. How do I pass this test?Report

  27. Avatar Mike Farmer
    Ignored
    says:

    The current healthcare reform bill will hurt more people than the current system, but that doesn’t mean the current healthcare system shouldn’t be scrapped for free market consumer/provider choice and charity efforts. The current system was created by government intervention. But healthcare is not a “system” — it’s part of market activity. The real culprits of insensitivity in all this are the promoters of the current healthcare bills — the systems-builders. It will put people out of work, create substandard care and create more rationing than in the present system. The unintended consequences of such a montrous intervention will hurt many, many people, but the progressives don’t care — they just want to pass something to keep their agenda alive. Their accusations of opponents being heartless is a smoke screen to cover up their own heartlessness — they want to screw the rich and if they think they can get something for nothing, they’ll vote for it, not accepting that many poor people will be harmed by their hatred of capitalism. It’s the same game they’ve played for decades — the poor are casualties in their war against the rich — but a few eggs get broken when you’re making an omelette. They mistakenly think they are going to be winners, but their ignorance prevents them from seeing we’ll all be losers except those in the highest positions of power.Report

  28. Avatar Kathy Kattenburg
    Ignored
    says:

    I haven’t read all the comments, but enough to decide I should really post my own comment before I get so discouraged and depressed that I can’t bring my fingers to type.

    So many readers above are saying that it’s not about a lack of empathy, it’s just that the issue is reform, but I really think that’s missing the boat. We’re not talking about train schedules here. We’re talking about the actual physical survival of real people. If you understand that the issue here is human lives, and real families who face financial ruin, and real young women who may be standing in a graveyard weeping while their real 23-year-old husband, dead from a treatable medical condition, is lowered into the ground in his coffin, then you don’t propose “solutions” like tort reform and selling insurance across state lines, because neither of those actions will do one goddamn thing to lower the cost of health care or insure even one uninsured person. You have to understand, on a visceral, elemental level, what the problem actually is or you can’t debate it as an “issue” because you have no clue what the issue even is.

    I, for one, understand completely what Freddie’s frustration is about, and I share it.Report

    • Avatar Jaybird in reply to Kathy Kattenburg
      Ignored
      says:

      Imagine, if you will, a country in the Middle East being run by a vile dictator.

      We have the opportunity to go in there and depose this tyrant. We could kill him, kill his sons, and set up a democracy in place of the wicked government we get rid of and make sure that the government will be representative. Of the people, for the people, by the people.

      I mean, the culture under this dictator is pretty sick. They have rape rooms. Women are being raped under the watchful eye of the government. They have prisons for toddlers. They torture their political prisoners (and there are many, many political prisoners).

      Do you support the very idea of liberty and ending this Middle Eastern tyrant’s reign or are you an objective supporter of rape?

      It’s a simple enough question and I have no idea why a woman would oppose the war in Iraq unless she was somehow a tool of the patriarchy.

      Here’s the question:

      Do you see the above framing of the opposition to the War in Iraq as less fair than the framing of the opposition to whatever bill the government will end up passing?

      Because, from here, it seems to me that the question is *NOT* one of “do you think that the 23-year old dude ought to die? (HE HAS A CHILD!!!!)” but one of “do you really think that whatever bill the congress is going to shit out would make a damn bit of difference when it comes to whether or not that 23-year old dude is going to die?”

      My attitude is that “Health Care Reform” is far, far too much like the War in Iraq for my tastes. People are screaming that those who oppose it are objectively pro-rape while, surely, if we pass this bill, we will be greeted with flowers.

      It seems more likely to me that the costs are being ignored entirely while the benefits are, to put it kindly, pie in the sky.

      It’s not that I oppose people living forever and having free everything they could ever want and shit rainbows. I just am not so enamored with the federal government to pretend for a minute that passing a law would provide a damn thing.

      And my saying so no more makes me insensitive to the plight of orphaned children than one’s opposition to Iraq makes one a supporter of sexual assault.Report

      • Avatar Kathy Kattenburg in reply to Jaybird
        Ignored
        says:

        Do you see the above framing of the opposition to the War in Iraq as less fair than the framing of the opposition to whatever bill the government will end up passing?

        Yeah, I do. I see it as completely inept, as a matter of fact.

        Because, from here, it seems to me that the question is *NOT* one of “do you think that the 23-year old dude ought to die? (HE HAS A CHILD!!!!)” but one of “do you really think that whatever bill the congress is going to shit out would make a damn bit of difference when it comes to whether or not that 23-year old dude is going to die?”

        Well, first, I *do* think what’s in the House and Senate bills at this date will make a difference. Maybe not for this particular man, because of the time it takes to implement the legislation. But certainly for millions of other Americans.

        And second, there is no legitimate comparison to be made between a health care reform bill that doesn’t do as much to help reform health care as it should, and actually causing grave and immeasurable harm to millions of Iraqis in the name of “liberating” them.Report

        • Avatar Jaybird in reply to Kathy Kattenburg
          Ignored
          says:

          “And second, there is no legitimate comparison to be made between a health care reform bill that doesn’t do as much to help reform health care as it should, and actually causing grave and immeasurable harm to millions of Iraqis in the name of “liberating” them.”

          Medicare did not do as much as it should have. Medicaid did not do as much as it should have. This upcoming bill will not do as much as it should do.

          Then we get to discuss the question of “how much are we going to pay for something we *KNOW* beforehand will not do what we want it to do?”

          If we agree that there must be a point at which a reasonable person can say “that’s too much” (and, indeed, there must be a point at which a reasonable person could say that, no?), then we now get to ask questions like “is this bill worth it?” and, if the answer is “no”, we may even get to ask questions like “will doing this be worse than the status quo?”

          If a reasonable person can ask that question, it’s unfair to respond to that question (even if the answer that the reasonable person gives is ‘yes’) with asking if he wants more orphans created.

          In the exact same way that saying “but women are being *RAPED*” was an unfair thing to throw in the face of someone who opposed Operation Iraq Freedom.Report

          • Avatar Kathy Kattenburg in reply to Jaybird
            Ignored
            says:

            Back to the point:

            It is disgraceful, shameful, reprehensible, and totally deplorable that a 23-year-old man with a life-threatening but completely treatable medical condition should have to live daily with unbearable pain and very likely forfeit his life and leave his wife a widow and his children fatherless (not “orphaned”) when this country has the resources to ensure that things like that don’t happen. (Or, at least, that they don’t happen routinely.)

            Every other country in the world has some kind of national policy for the delivery of health care. Some work better than others, and none are perfect, but *all* of them do a better job of delivering health care services than we do, and *all* of them do so for a far lower per-person cost than we do. There is no other industrialized country in the world with tens of millions of uninsured citizens. There is no other industrialized country in the world in which a young man could die of a cerebral hemorrhage because he doesn’t have the money or the insurance to pay for surgery.

            THAT is the issue. Not taxes. Not government takeovers. Not socialized medicine or rationing. The issue is that young man who will likely die because the doctors will not do the surgery that would save his life because he doesn’t have insurance. That’s the issue.Report

            • Avatar Jaybird in reply to Kathy Kattenburg
              Ignored
              says:

              Here is the fundamental issue, however:

              Can a reasonable person look at the suggested plan and say “nope, that won’t result in appreciably fewer fatherless children?”

              If it is *POSSIBLE* that one could, then we are now, tah-dah, haggling.

              I’ve posted my suggested fix for providing more health care (aka “doctors”) to people. It involves creation of more doctors. Not creation of more guarantees, creation of more laws, creation of more pledges in which one affirms exactly how deeply one cares about children with dead fathers… it would result in more doctors.

              As it stands, I see the law being proposed (and, indeed, most of the laws likely to be written by lobbyists) as something likely to result in fewer doctors over the long run.

              And, for the record, even though I see those laws as things that would result in less health care overall, it would never occur to me to accuse people who support the laws as ghouls who don’t care that there will be more fatherless children out there.Report

    • Avatar Jaybird in reply to Kathy Kattenburg
      Ignored
      says:

      Now it does strike me, after that, to propose what my solution would look like. It doesn’t involve selling insurance over state lines or tort reform or anything like that.

      Here’s some of what I posted here:
      http://www.ordinary-gentlemen.com/2009/10/hayek-on-health-insurance/
      and reposted here:
      http://www.ordinary-gentlemen.com/2009/10/another-predictable-liberal-defense-of-rep-grayson/
      (Two of the many times that health care was discussed on this website… links provided so that you can see the full context.)

      My own personal take on health care is that technology costs money but information ought to be free (it *WANTS!* to be free!) and, as such, I believe in two tiers for health care.

      Technology that is X years old (sometimes I say 10, sometimes I say 7) ought to be provided more or less at cost to anyone who needs it (and we can subsidize those without even the means to pay for this old tech). Sure, you wouldn’t get the bleeding edge stuff, but you would be promised not only a basic level of health care but a constantly improving basic level of health care.

      (I’d add an addendum to that to say that this would also allow a doctor at age 55 or whatever to say “I’m dropping out” and stop going to cutting edge seminars where he learns the newest bleeding edge techniques to take on rarer and rarer problems. He can join the 7/10 year old tier of medicine and provide his expertise there for a while.)

      Now the meat: If I may veer off into economics for a moment, it seems to me that if people cannot afford health care, we have a cost issue. Either the supply is too low or the demand is too high. Looking out, I don’t see a single thing that we can really do about demand (bring back “smoking is cool”, maybe?) and so we’re stuck with increasing supply. How can we increase supply?

      Well, we’d need more doctors. What’s the biggest problem there? Medical school, for one. Overhead costs for another. Onerous regulation for another. Cartelization for another. It’s pretty much a pain in the ass to be a doctor. Moreover, I see legislation likely to be written by lobbyists as legislation likely to make it *MORE* of a pain in the ass to be a doctor. This strikes me as something likely to result in *FEWER* doctors which will, tah-dah, result in less health care in the pool to be divvied out like so many widgets.

      So I would want medical school to be easier to go to. Not for dumb people, mind… just for people who want to go. If you can go, and get certified (pass something akin to a bar exam), you will have the option of going to Cicely, Alaska for five seasons and, after those five seasons, you will be off the hook for your med school bills. If you don’t want to go to Cicely, of course, you don’t have to. Perhaps you’ll get an offer from another district that needs a doctor, or maybe you’ll have to pay off the bills yourself. The *OPTION* of going to med school for free, however, will be there.

      Additionally, residency, as it is practiced, is abhorrent. We need to eliminate it for the most part. If people can’t sleep, they can’t provide decent health care. Now, I’m not saying that they need to keep banker’s hours… but 80-hour weeks are a good way to burn out and burn out hard. You’ve got a burned out resident? Congrats, you’ve got another guy/gal who could have been a good doctor who is now doing something other than divvying out medical care to the pool like so many widgets.

      There are also problems with the AMA, the DEA, and the FDA but… well, if you read the above and figure “oh, that guy’s a libertarian”, you can probably guess what my take on those three organizations might be and come to a reasonable approximation of what the mini-essay I’d write about *THAT* would be.

      It’s *NOT* that people on the right or the libertarians do not have plans or that they refuse to put them out there. Well, of course, there are some who do. They’re jerks.

      There are others who have provided their plans, however, and it’s constantly thrown out there that people who oppose legislation that will probably result in it being a bigger pain in the ass to be a doctor are people who want others to die… and any attempt to discuss otherwise will be concern trollery or whatever Freddie said in his original essay. Again, that’s as unfair as saying that people who oppose the Iraq War don’t care about rape rooms.Report

  29. Avatar steve
    Ignored
    says:

    “It’s not that I oppose people living forever and having free everything they could ever want and shit rainbows. I just am not so enamored with the federal government to pretend for a minute that passing a law would provide a damn thing.”

    You would be correct if not for the fact that there are many other countries that have working models where the government is involved in health care. Their care is cheaper, everyone has it and is of essentially the same quality.

    If you are ok with many people dying because they cannot afford care, why not just say so? (Ok, maybe you did and I missed it. If so, I apologize.)

    SteveReport

    • Avatar Jaybird in reply to steve
      Ignored
      says:

      Steve, let me ask you an honest question:

      Would the bill that goes before congress provide a model that matches the model used by those many other countries or would it provide a different one?

      The argument “we need to be different from what we are now” will not lead us to “we will be more like Denmark”.

      This bill? It won’t make us more like Denmark. Even if it is different.

      Feel free to point out how only people who don’t care about dead fathers being bulldozed into mass graves would point out such a thing, however.Report

  30. Avatar Mike Farmer
    Ignored
    says:

    But, Kathy, how can I support a bill I think will make matters worse? Isn’t it just as logical for me to think it’s reprehensible of you to support a bill which will lead to more unnecessary deaths? When we run out of money and can’t get anymore credit, who will pay for all the 23 yr men in the future who need care and can’t get it? Care will be rationed, and the lucky will survive. I want society to take responsibility for helping those who fall through the cracks — government is incompetent to handle these types of responsibilities — healthcare will be politicized, bureaucratized and impersonalized. It will be a nightmare of inefficiencies ans cold-hearted decisions. There are millions of compassionate people just like you who would be willing to help the unfortunate if government wasn’t taking and wasting so much of their money.Report

    • Avatar Travis in reply to Mike Farmer
      Ignored
      says:

      Yes, because those warm, loving and cuddly insurance companies do such a great job handling those types of responsibilities without bureaucracy and waste, right?

      Whole departments in these firms are devoted to finding ways to cut off patients who are costing money. A sick person is an unprofitable customer.

      There is nothing more greedy and heartless than the free market.Report

      • Avatar Mike Farmer in reply to Travis
        Ignored
        says:

        Travis, just because you want to deny that even in this story it’s the failure of medicaid to find enough doctors at what they pay, and Medicaid, as you know, is a government program designed to help the poor, and just because you deny what government regulations have done to insurance companies doesn’t mean that the free market won’t be a lot better than government efforts. You can’t ignore government’s role in healthcare being what it is today without being intellectually dishonest or ignorant. Insurance could be much more menu-drives, much more innovative covering the young, if not for government intervention.

        If government could solve the problem, then medicaid would save this young man. Plus, you have no idea what bureaucracy is until the pass this healthcare bill. I just hope you aren’t one of the future victims.Report

        • Avatar Travis in reply to Mike Farmer
          Ignored
          says:

          I notice you completely ignored my points, so there’s no sense carrying on. You argued that the government would make health care “politicized, bureaucratized and impersonalized” — as if somehow the private, profit-driven insurance industry isn’t. Which, of course, is ridiculous.

          You can’t ignore the role of unmitigated private greed in health care being what it is today without being intellectually dishonest or ignorant.Report

          • Avatar mike farmer in reply to Travis
            Ignored
            says:

            I responded to your claim of bureaucracy — I said that government intervention has caused insurance companies to become bureaucratic.

            This is a little different, but the same principle. I started working in a private treatment hospital in 1980 dealing with alcoholism and drug addiction. We had a good recovery rate and helped many families get back together, and undoubtedly saved many lives — we did a ten year follow up and the success rate was 60%. This was before the state started regulating care like they eventually did. I spent a lot of time interacting with state mental health employees, and they couldn’t stand private treatment — they saw us as vultures. The state started adding requirements to what we had to offer and started telling us how we could deliver treatment — much of this required hiring more people, offering more useless programs and doing much, much more paperwork. Prices started to rise and quality began to suffer and companies we contracted with who had Employment Assistance Programs starting having to go through Managed Care to get anybody in treatment. The EAPs knew that treatment worked, especially before the state involvment and meddling — GM and Dupont had done sophisticated studies showing how they were improving their bottom line by treating troubled employees instead of firing them. but once the prices got out of control, and the state requirements become to burdensome to offer good care, they started denying care and flooding the state facilities at a lower cost, but much lower quality. A few years ago, many state programs went belly up and started contracting with private companies, but the state requirements are so burdensome that no one can stay in business.Report

  31. Avatar steve
    Ignored
    says:

    Jaybird- It is not the bill I would prefer. I would like to decouple insurance from employment, something more like Wyden-Bennett. However, even that will require significant government intervention. Still, it is not a single payer like UK or Canada. In the wider approach, it is more like a French approach or many of the other Europeans, just without universal coverage and not as much cost control.

    So, as a libertarian, are you ok with the idea that people who cannot afford health care will die or be unable to work, develop chronic illnesses, like renal failure, that could have been avoided? Libertarians always tap dance around that one. No need to be emotional about it. Everyone dies from something. That is what is done in most of the world. Why hasn’t the free market solved our current problems? Insurance companies can sell across state lines. Many of our states are bigger than other countries that have universal care. Why do we have so many states with just one or two dominant providers? Aside from all of the rent seeking, what I see is insurance companies doing what makes sense, make money by eliminating risk, ie, get rid of the sick people.

    SteveReport

    • Avatar Jaybird in reply to steve
      Ignored
      says:

      “So, as a libertarian, are you ok with the idea that people who cannot afford health care will die or be unable to work, develop chronic illnesses, like renal failure, that could have been avoided?”

      No, I am not.

      But I then ask “is it possible to have a situation where there won’t ever be a case where people in general will die or be unable to work, develop chronic illnesses, like renal failure, that could have been avoided?”

      It seems to me that the answer to that question, in practice, is “no” as well. I can find you a number of cases of care and/or treatment being denied to people in the UK, for example… and then ask you if you, as a moral human being, are ok with the idea that people in general will die or be unable to work, develop chronic illnesses, like renal failure, that could be avoided?

      No need to be emotional about it. Everyone dies from something. That is what is done in most of the world. Why hasn’t more centralized control solved our current problems?

      In addition, I wonder at the number of medical developments and medical advancements that have come about since, oh, the end of WWII (when socialized medicine was established in England and Canada). Where have the most medical advancements been discovered? Where have the most drugs been developed? Where have the most new therapies shown up? Is the lion’s share of this development done in countries with socialized health care or is it done in countries without.

      If it is the latter, is it a fair assumption to wonder if socialized medicine has an effect on R&D? I think it would be.

      The question then comes: Are you willing to trade the treatments of 30 years from now (imaginary they are) for free “what we have now” for everybody?

      It’s a fair question. My answer is “No”… but I expect to be here in 30 years (who doesn’t?).Report

      • Avatar Jennifer in reply to Jaybird
        Ignored
        says:

        “So, as a libertarian, are you ok with the idea that people who cannot afford health care will die or be unable to work, develop chronic illnesses, like renal failure, that could have been avoided?”

        No, I am not.

        But I then ask “is it possible to have a situation where there won’t ever be a case where people in general will die or be unable to work, develop chronic illnesses, like renal failure, that could have been avoided?”

        Hello, all. Long time lurker, first time poster.

        To answer your question, Jaybird, as we live in an imperfect world, we can never eliminate avoidable deaths. But are you actually saying that since we can’t have perfection, we shouldn’t do anything? That because we can’t save every single person that dies when they could have been saved, we shouldn’t save anyone?

        Your post goes on to wonder whether R&D will suffer under a system of socialized medicine. This kind of thinking, IMO, is partly what got so angered Freddie in his post: you’re worrying about theoretical problems that may or may not happen down the road while actual human beings are suffering and dying right now. The guy in the Kristof story is only one such person; there are likely thousands of others.

        Not to mention that nothing currently circulating in Congress would create a system of socialized medcine. But that’s a rant for another day….Report

        • Avatar Jaybird in reply to Jennifer
          Ignored
          says:

          “To answer your question, Jaybird, as we live in an imperfect world, we can never eliminate avoidable deaths. But are you actually saying that since we can’t have perfection, we shouldn’t do anything? That because we can’t save every single person that dies when they could have been saved, we shouldn’t save anyone?”

          I actually proposed my plan a few posts up. It’s the one timestamped November 29th, 2009 at 8:15 pm Tort reform is mentioned only long enough to say that my plan doesn’t mention it as is the case for selling insurance over state lines.

          “This kind of thinking, IMO, is partly what got so angered Freddie in his post: you’re worrying about theoretical problems that may or may not happen down the road while actual human beings are suffering and dying right now.”

          Freddie’s anger is not my responsibility but I will say that the argument is similar to whether we ought to worry about carbon dioxide production. Hey, nothing bad has happened so far, right? Why are you kvetching about theoretical problems that may or may not happen down the road while actual human beings are suffering and dying right now of problems that could be easily fixed by industrialization?

          Most of the people who will be alive in 200 years haven’t even been born yet. Why do you give a crap about their welfare, after all?Report

          • Avatar Jennifer in reply to Jaybird
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            says:

            Jaybird: Freddie’s anger is not my responsibility but I will say that the argument is similar to whether we ought to worry about carbon dioxide production. Hey, nothing bad has happened so far, right? Why are you kvetching about theoretical problems that may or may not happen down the road while actual human beings are suffering and dying right now of problems that could be easily fixed by industrialization?

            Most of the people who will be alive in 200 years haven’t even been born yet. Why do you give a crap about their welfare, after all?

            Me: I don’t think your carbon production analogy works. Bad things have happened because of climate change, first of all, so we have had a glimpse of what will happen if we do nothing. And spending money now to provide health care to more people today can’t possibly pose an existential threat to people down the road, the way ignoring CO2 production will.

            With health care, we have numerous examples of countries who provide for all their citizens right now. The sky hasn’t fallen in any of those places. People live longer and have better outcomes in countries that provide health care for all than Americans do.Report

            • Avatar Jaybird in reply to Jennifer
              Ignored
              says:

              What tradeoffs are you willing to make? What costs are you willing to take upon yourself and what costs are you willing to shift onto future generations?

              If we agree that we have a responsibilities to future generations, you will probably come to one conclusion. If you wonder instead what future generations have ever done for you, you will probably come to another.

              I hope that the medical technology of 2040 is as far away from today’s technology as today’s technology is from 1980… (imagine how many people could be helped by technology that would be *THAT* much better). Would you be willing to trade away 2040’s technology in exchange for affordable healthcare for everybody?

              “Why not?”, I could see someone say. “We have no idea what those benefits would even be!”

              For my part, I am very glad that this decision was not made on my behalf in 1980.Report

              • Avatar Jennifer in reply to Jaybird
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                says:

                I am willing to pay higher taxes and to increase tax rates on the wealthy (I am by no stretch of anyone’s imagination wealthy, btw). I am willing–nay, eager–to signifcantly cut our defense budget, to stop engaging in pointless wars overseas, and to use that money to create better safety nets, infrastructure, health care, and all that other good stuff we bleeding hearts love.

                I agree we have responsibilities to future generations. IMO, one of those responsibilities is making sure they know they can get health care when they need it. Fixing the problem now helps people now and in the future.

                And why is there a tradeoff between health care today and better medical technology tomorrow? What does one have to do with the other?

                I’ll say it again: other countries have provided health care for all or most of their citizens without anything catastrophic happening. There’s no reason that we can’t as well.Report

              • Avatar Scott in reply to Jennifer
                Ignored
                says:

                You are willing to increase taxes on someone else, really? Who isn’t in favor of someone else paying more?Report

              • Avatar Jennifer in reply to Scott
                Ignored
                says:

                I also said I’d be willing to pay more taxes myself.Report

              • Avatar Scott in reply to Jennifer
                Ignored
                says:

                Yes you said that but so what? The really telling statement is that you would happily raise them on someone else just to satisfy liberal feel goodness and without considering any unintended consequences. Besides, who are the nebulous “wealthy” that you speak of and assume can afford your tax increase?Report

              • Avatar Jaybird in reply to Jennifer
                Ignored
                says:

                “And why is there a tradeoff between health care today and better medical technology tomorrow? What does one have to do with the other?”

                Where have most technology advancements come from in the last, oh, 60ish years (since the end of WWII)? If they happen to have come from countries that have not adopted free health care for the poor, is it fair to wonder if one has something to do with the other?

                “I’ll say it again: other countries have provided health care for all or most of their citizens without anything catastrophic happening.”

                I am not worried about something catastrophic happening as much as many somethings ranging from fair to pretty good to great *NOT* happening.

                Where has the new tech been developed? Where have the new pills been formulated?Report

              • Avatar Scott in reply to Jaybird
                Ignored
                says:

                I hear Canada has some of the best pharmaceutical companies in the world.Report

              • Avatar chuck in reply to Scott
                Ignored
                says:

                I agree. There is an assumption that the US pharma industry does nearly all the drug development in the world. Where is that written? Among the things the US industry does not do is find new uses for drugs out of patent when there are other such uses if they are studied as they are in other countries where making a profit on the drugs is not primary. These new uses often become the “latest” treatment for a diseases and this must really make them angry since they cannot make a buck.Report

              • Avatar Jennifer in reply to Jaybird
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                says:

                Jaybird, it’s interesting that you characterize countries with universal or near-universal health care as providing “free health care for the poor.” Countries like Canada, Sweden, England, and others provide universal health care for everyone, not simply free health care for the poor. Some poor Americans have free health care, btw, and that doesn’t appear to have stopped us from developing new drugs, diagnostic tests, etc.

                What’s more, the bills in Congress now don’t make health care free for everyone–some people who pay subsidies will still have to pay something. And people who get insurance from their jobs will still do so, and still pay those costs.

                As for the rest of your point, none of us can know whether medical innovation would stop as a result of passing health care reform in the U.S. I don’t know why other countries haven’t developed the technology that we have, or whether it’s even true that every innovation since WWII has come from America. But I confess I’m at a loss as to how providing subsidies for more people to buy health insurance from insurance companies will keep med tech corporations from building better pacemakers or whatever.

                My bottom line is that we can’t keep letting thousands of people die every year because they don’t have insurance, or are under-insured.Report

              • Avatar Jaybird in reply to Jennifer
                Ignored
                says:

                I characterize it as “free health care for the poor” because “free health care for the children” would be far too over the top, even for me.

                “Some poor Americans have free health care, btw, and that doesn’t appear to have stopped us from developing new drugs, diagnostic tests, etc.”

                Yes, but… why are the new drugs, diagnostic tests, etc, developed *HERE* and not somewhere else? The lion’s share are developed here. This strikes me as somewhat odd. Shouldn’t we be responsible for a mere 40% or so with Canada, the EU, Australia, and other countries picking up the rest? 33%, maybe? What is so special about the US? If, after we adopt free health care for the poor, our R&D slows to the rate of other countries, that will be… well, it won’t be a *BAD* thing. It’ll be good things that we’ll never see.

                Again, I’m glad this decision wasn’t made on my behalf in 1980.

                “My bottom line is that we can’t keep letting thousands of people die every year because they don’t have insurance, or are under-insured.”

                I don’t know that I’ve let anyone die. Have you let anyone die? If you haven’t, and I haven’t, how have “we” let people die? By not forcing someone else to pay more in taxes?Report

              • Avatar Cascadian in reply to Jennifer
                Ignored
                says:

                But Jay, how many of those new innovations “we” make are just incremental changes on existing patents? Don’t the French do their fare share of innovation? We wouldn’t want to assume all national health care systems are the same would we?

                How much do we want to preference health widgets over all else? Isn’t the law of diminishing returns starting to set in? Maybe put our resources, as your own plan emphasises, into primary care and let the more exotic stuff wait until the rest of tech. catches up. As much as I love the AARP, especially now that I’m getting longer in the tooth, I’m not sure how some of this stuff works out on a utilitarian analysis.Report

              • Avatar Jaybird in reply to Jennifer
                Ignored
                says:

                I don’t know *WHAT* the numbers are… but a cursory trip down memory lane going through the winners of the Nobel Prize for Medicine showed me that the winners were disproportionately American (want some numbers or is me just saying “it seemed to be more than 40%” enough?).

                New innovations on existing patents should count only insofar as they improve health care, no? I’m sure I could find an anecdote about someone who found Claritin Xtreme infinitely preferable to Claritin Gold, for example.

                “As much as I love the AARP, especially now that I’m getting longer in the tooth, I’m not sure how some of this stuff works out on a utilitarian analysis.”

                I’m under the impression that the utilitarian analysis needs to be made on a person-by-person basis.Report

              • Avatar Jennifer in reply to Jennifer
                Ignored
                says:

                Jaybird, your characterization is wrong. If you wonder why Freddie thinks health care opponents are arguing in bad faith, your misstatement of fact is one reason. It’s like your trying to demonize the health care bills by calling them welfare.

                The bills in Congress are not “free health care for the poor.” The bills will offer subsidies to people who can’t currently buy health insurance. Plenty of middle class people can’t afford insurance. And again, we already provide free health care to the poor through Medicaid.

                In the rest of your post, you’re pulling numbers out of thin air about how much R&D we should be doing or how much other countries are or aren’t doing and wondering whether health care reforms will slow us down. But you haven’t come up with a single, concrete fact about how much R&D is done here vs. elsewhere, and what relationship a country’s health care systems have on R&D in that country. If you are seriously prepared to say we should keep our health care system exactly as it is, even if people needlessly die because of it, you really should make a coherent, factual argument justifying it. Fretting about nebulous “good things that won’t happen” is not a strong argument for doing nothing, when we know that bad things happen right now because too many people fall through the cracks.

                Lastly, and I don’t know why I’m even responding to this, but obviously I personally haven’t let anybody die. But I live in a society, and it’s of some concern to me when my fellow citizens suffer and die needlessly because we don’t have a reasonable health care system. I don’t know why this is an arguable point, but I guess that’s why I’m not a libertarian.Report

              • Avatar Scott in reply to Jennifer
                Ignored
                says:

                Jennifer:

                How about we call it “health care paid for with other peoples money for the poor”?Report

              • Avatar Mark Thompson in reply to Jennifer
                Ignored
                says:

                The point is that there are tradeoffs in any reform. No system is perfect, obviously, but it is foolhardy to think that there are no tradeoffs involved in reform, and particularly the reforms under discussion. Our system may well fail to provide access to adequate health care for a large number of people, but it also seems to do a pretty good job of providing for increasingly high quality of health care for the overwhelming majority of people. Indeed, one could say that the quality of health care that we deemed “adequate” 30 or 40 years ago would be deemed unacceptably poor today. To the extent that the US provides a majority of the world’s medical innovation, it is also appropriate to ask whether increasing standards of health care in other countries is at least in part dependent on innovation that comes from the US.

                One could even argue that, although it is sad that many people lack access to health insurance, those people still have access to a level of care to which only the wealthiest people in the not-so-distant past had access – if anyone had access to it at all (because that level of care did not exist).

                Personally, I think that the innovation tradeoff under the proposed legislation is relatively small (although I think the overall tradeoffs far exceed what in my opinion will be a very minimal benefit from the proposed legislation), particularly because I think advocates of this position overestimate the extent to which our existing system is subject to market forces, while underestimating the extent to which other systems are subject to market forces (and to be fair, I think both sides of the health care debate do this, because it is consistent with both sides’ ideological biases). However, there are plenty of good-faith reasons to believe that the tradeoff in innovation is quite large if you begin with the assumption that the major difference between the US system and other systems is the degree to which they are subject to market forces.

                Think about it this way: imagine having this debate in 1930. Would we have said that all the people who died of things like polio at that time died needlessly, even if they had access to the best health care available at that time? Presumably, the answer is “no,” we would not have. Yet we say that people who die without health insurance die needlessly today, even though they still have access to a far greater level of health care than was available to even the wealthiest persons in 1930.

                Now, even though I’m opposed to the leading Dem proposals, I’m personally an advocate of some fairly broad reforms (especially something like Wyden-Bennett), and I’ve said in the past that I even think a single-payer system would be at least a modest improvement over the existing system, even after factoring in the tradeoffs. But advocates of reform seem to do a poor job recognizing that the innovation argument against reform is a good-faith argument that involves more than just hypotheticals, but instead relies on the notion that improving quality of health care is a very real benefit of the existing system that has (and continues to) prevented many, many deaths that would have occured otherwise.Report

              • Avatar Jaybird in reply to Jennifer
                Ignored
                says:

                Jennifer, if we are talking about providing benefits to people with money that is not their own, we are talking about providing free health care to the poor.

                You can say that, no, we will also be providing health care to the upper middle class as well, and, indeed, we will… but the upper middle class has health care now (surely that’s one of the things that defines the upper middle class). Indeed, we will be providing health care to the rich! And the ultra-rich! Bill Gates will get free health care under this plan as well!

                And if it turns out that he spends some of his own money and gets better health care than John Brodniak, we can ask how something like this could happen… how we could possibly live in the richest country in the world and not pay to save the life of someone like John Brodniak.Report

              • Avatar Jennifer in reply to Jennifer
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                says:

                Jaybird: Jennifer, if we are talking about providing benefits to people with money that is not their own, we are talking about providing free health care to the poor.

                This is ludicrous. One of the bills provides subsidies for a family of four earning up to $88,000. If family X earns $87,999, are you really suggesting that they’re poor??

                Bill Gates will not receive free health care under any plan being considered. He can buy his own insurance, or pay out-of-pocket entirely if he wishes. I can’t tell if this is just your sense of humor, or what, but really, you can’t possibly think that this is what is going on.

                Oppose the various health care proposals all you want. But please, don’t make things up to support your position.Report

              • Avatar Jennifer in reply to Jennifer
                Ignored
                says:

                Mark Thompson:

                The point is that there are tradeoffs in any reform. No system is perfect, obviously, but it is foolhardy to think that there are no tradeoffs involved in reform, and particularly the reforms under discussion. Our system may well fail to provide access to adequate health care for a large number of people, but it also seems to do a pretty good job of providing for increasingly high quality of health care for the overwhelming majority of people. Indeed, one could say that the quality of health care that we deemed “adequate” 30 or 40 years ago would be deemed unacceptably poor today. To the extent that the US provides a majority of the world’s medical innovation, it is also appropriate to ask whether increasing standards of health care in other countries is at least in part dependent on innovation that comes from the US.

                One could even argue that, although it is sad that many people lack access to health insurance, those people still have access to a level of care to which only the wealthiest people in the not-so-distant past had access – if anyone had access to it at all (because that level of care did not exist).

                Personally, I think that the innovation tradeoff under the proposed legislation is relatively small (although I think the overall tradeoffs far exceed what in my opinion will be a very minimal benefit from the proposed legislation), particularly because I think advocates of this position overestimate the extent to which our existing system is subject to market forces, while underestimating the extent to which other systems are subject to market forces (and to be fair, I think both sides of the health care debate do this, because it is consistent with both sides’ ideological biases). However, there are plenty of good-faith reasons to believe that the tradeoff in innovation is quite large if you begin with the assumption that the major difference between the US system and other systems is the degree to which they are subject to market forces.

                Me:

                Yes, there are definitely tradeoffs to making changes to our current system. No argument there. But Jaybird hasn’t said anything that convinces me that the tradeoff will be a drastic drop off in medical innvoation, and that therefore we should keep the status quo. His arguments are vague, just what ifs and maybes. He hasn’t cited anything but his own suspicions and guesses, and not a single concrete fact.

                I don’t begin with the assumption that the difference between the US and other countries is the degree to which they are subject to market forces. It could be that the U.S. has laws that prevents generics from hitting the market longer than similar laws elsewhere. It could be due to differences in tax policy. I really have no idea.

                Mark:

                Think about it this way: imagine having this debate in 1930. Would we have said that all the people who died of things like polio at that time died needlessly, even if they had access to the best health care available at that time? Presumably, the answer is “no,” we would not have. Yet we say that people who die without health insurance die needlessly today, even though they still have access to a far greater level of health care than was available to even the wealthiest persons in 1930.

                Me:

                People died of polio in 1930 because we didn’t know how to stop people from getting it, not because we knew how to stop it but denied vaccines to people because they had no insurance. Deaths from ailments for which we have treatments but withhold them from people because of money are needless. Death from things we haven’t figured out how to treat are tragic and unfortunate, but ultimately are unavoidable. Maybe I’m missing your point, but this thought experiment doesn’t follow for me.

                Mark:

                Now, even though I’m opposed to the leading Dem proposals, I’m personally an advocate of some fairly broad reforms (especially something like Wyden-Bennett), and I’ve said in the past that I even think a single-payer system would be at least a modest improvement over the existing system, even after factoring in the tradeoffs. But advocates of reform seem to do a poor job recognizing that the innovation argument against reform is a good-faith argument that involves more than just hypotheticals, but instead relies on the notion that improving quality of health care is a very real benefit of the existing system that has (and continues to) prevented many, many deaths that would have occured otherwise.

                Me:

                The argument about innovation relies entirely on hypotheticals! We don’t know what effect reform will have on innovation since we haven’t enacted the reforms yet.

                You’re also assuming that the current health care system is the cause of innovations in drugs, tests, medical devices, etc. But how can that possibly be conclusively true?

                We are not talking about laws changing how drug companies develop medicines or how tech companies build pacemakers. We’re talking about the feds giving subsidies for people to get health insurance. How, specifically, will that stop Pfizer or whoever it is from cranking out a new and better Viagra?

                I can agree with you on one point: I’d be happiest of all with a single-payer system.Report

              • Avatar Jaybird in reply to Jennifer
                Ignored
                says:

                Jennifer, I honestly wonder whether there is a reason that the majority of patents are developed in the US (from which new treatments are discovered after patents expire, of course).

                Surely there is a reason that the patents are developed here and not there, no?

                When here becomes very much like there, why is it not fair to wonder if innovation will follow suit?Report

              • Avatar Mark Thompson in reply to Jennifer
                Ignored
                says:

                “But Jaybird hasn’t said anything that convinces me that the tradeoff will be a drastic drop off in medical innvoation, and that therefore we should keep the status quo.”

                No doubt, but as I see it, this discussion is about whether the argument against the proposed reforms is a bad faith argument or a glib argument, not whether it’s a convincing argument to one who begins with a different set of assumptions.

                The key here is the tradeoff issue, though. If one accepts that there are tradeoffs that go beyond taking money out of the pockets of opponents of reform, then how those tradeoffs get valued turns into a very subjective thing.Report

        • Avatar Jaybird in reply to Jennifer
          Ignored
          says:

          (And welcome, by the way.)Report

  32. Avatar Bruce Smith
    Ignored
    says:

    How about thinking outside the box. Why does the debate on health care always have to be focused around private or public delivery? Why can’t it be both and have an associative, or associational, democracy flavor:-

    http://www.respublica.org.uk/media/healthy-policy-developmentReport

  33. Avatar Art Deco
    Ignored
    says:

    facing actual tragedy because of this grotesque, wasteful, perverse, immoral, evil system that we labor under.

    What is grotesque, wasteful, perverse, immoral, and evil is the tolerance of 1.3 million abortions a year in this country. No, I do not expect you or Henry Waxman to do jack about it.Report

  34. Avatar Matt
    Ignored
    says:

    I must give Freddo credit: this was a fine troll. You got ’em all going.Report

  35. Avatar Jaybird
    Ignored
    says:

    Good news!

    http://kristof.blogs.nytimes.com/2009/11/28/the-human-toll-of-our-health-system/

    Kristof’s column has resulted in John Brodniak actually getting treatment from OHSU! Check out update #3!Report

    • Avatar Jennifer in reply to Jaybird
      Ignored
      says:

      That is fantastic news.

      But look what had to happen for him to get the care he needs. Nick Kristoff had to write a column about it. What happens to all the other people like John Brodniak that don’t get that kind of media attention?Report

      • Avatar Jaybird in reply to Jennifer
        Ignored
        says:

        Well, we have to look at exactly what we need to do to provide more and better and freer health care to the poor, don’t we?

        (I’m in the middle of writing a paper about what that would entail, actually…)Report

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