Archive Listing
August 3, 2012 - July 27, 2012
Friday, August 21, 2009
The Problem Nobody's
Talking About
WE NEED HEART AND BRAINS. Now that everyone's focused on health care, it might finally be time to think about it a little bit. Thinking isn't a usual by-product of political debate, but it could be helpful if somebody actually tried it.
The political question is, Do we want the government to be in charge of health care for everybody? Most of us, as we ponder the government's record, are coming down on the "no" side, because whatever government gets involved in typically becomes more expensive, not less, and poorer in quality than what free markets can manage. Additionally, when it comes to health, issues of personal liberty come into play more than on almost any other issue about which the government might want to legislate.
All the fears of a government-run system are justified. Even the darkest and most apparently unmentionable ones, like the suddenly proscribed term "death panels." If the government is responsible for healthcare, there will be death panels. Maybe not tomorrow or next year, but eventually, and they'll be as bureaucratically ruthless as the craziest protester imagines they will. The U.S. Veterans' Administration already has something pretty darn close in full operation.
BUT. And here's where the thinking comes into play. This worst of all possible outcomes will not be prevented by defeating Obama's drive toward universal health care. There is a unique problem with the topic of health care that makes it unlike most of the free market commodities conservatives keep comparing it with. And it's a problem that will be extremely difficult to solve in the long run, whether the chosen instrument is the government or the market or, as the case presently stands, a combination of both.
For much if not most of the services it entails, health care is a commodity. People will make their decisions at the margin based on a rational tradeoff between cost and benefit, similar to the way they buy a car, a house, a college education for their children, and other significant quality of life investments. But the analogy breaks down completely in matters of life and death. At the limit, health care becomes a "Cost No Object" requirement for individuals if not for institutions. Which is simply not true of other commodities. At the limit, people can pass up their dream house, dream car, and dream university as too expensive. Not so when the dream treatment is necessary to prolong life itself. This is the precise point at which the conservative "personal responsibility" argument breaks down. If your child needed an impossibly expensive operation or drug regimen to live, you would probably say anything, sign anything, promise anything, and tell every conceivable lie to procure it, which makes your word as an economic trading partner worthless. There's no such thing as a valid contract with such a person. Life and death is the choice that trumps all other values and codes. People do not regard death as a legitimate trading chip in free market bargaining.
There are multiple reasons why health care costs are rising faster than the rate of inflation. The government is already involved in subsidizing health care for a huge chunk of the population, and whatever the government subsidizes, it produces more of. I believe the record indicates that Canadians go to the doctor more often than Americans do. Americans on Medicare probably go to the doctor more than they would otherwise. Why wouldn't they? It costs them less cash than if they were paying for it out of their own wallets. Frivolous malpractice suits are another big contributor. Suing the doctor is a viable income alternative in this country. This drives up costs in a host of ways -- doctors pass on their malpractice insurance costs to all their patients, they perform tests and procedures they wouldn't otherwise regard as necessary, and they generate expensive additional paper trails that are purely defensive in nature. (No one, to my knowledge, has quantified the cost in quality of doctors practicing medicine with an eye constantly on the lookout for "cops" in the rearview mirror.)
Yet the biggest, deepest driver of increasing medical costs is the expansion of medical technology. There are more things that can be done to treat, cure, and prolong the lives of patients. Stuff the good old family doctor who once made housecalls could never do. (His pro bono kindliness, even if restored, could never make up the difference.) And all those things, especially the newest and greatest things, add huge increments of cost to the entire system. This phenomenon is entirely consistent with free market principles. The first VCR, the first microwave oven, the first iPhone, the first HD television cost a small fortune. As more competitors enter the market, the price falls. But consumer behavior does not follow the normal pattern in medical situations. No one says, "This new set of innovative cancer drugs is too expensive; I'll wait till the price comes down in a year or two." The definition of rational behavior in this circumstance is different. A rational economic decisionmaker could be dead when the price drops to reasonable levels. They have to have it now or it's no good to them at all.
This is not a political problem. It's a major economic problem, a fundamental disconnect between what represents rational behavior to the providers of medical innovations and rational behavior to the consumers of their products. All the ways of arbitrating that disconnect involve unacceptable costs. If we remove the economic incentive for being first to market with a breakthrough product, we will cease to get breakthrough medical products and our health care system will become essentially static. If we enforce sound economic principles on consumers -- pay the freight or don't get the product -- we will be condemning people to death for economic reasons; i.e., free-market "Death Panels."
What's interesting about the present system, the one that's supposedly so "broken," is that it has naturally evolved to handle the disconnect in a way that's actually pretty efficient given the scale of the problem, though still too expensive when we look at the long term. We treat most of health care as the commodity it mostly is. People pay for health insurance and are indemnified against the expenses they regard as most unacceptable. This part of the system works so well that most people are pretty satisfied with it, apart from all the normal grumping and complaining they also spout (if we're being honest) about the phone company, car dealers, their electrician, and their daughter's wedding consultant.
At the same time, everybody in the whole country is also walking around with a get-out-of-jail free card they can play the moment health care ceases to be a commodity and becomes a Cost-No-Object requirement. People with no insurance can go to the emergency room and receive in life-and-death situations the same care anyone else would receive. People who have insurance that can't cover a truly dire and expensive crisis can, when the bills for which they are personally responsible come due, declare bankruptcy. Of course, these additional, unanticipated costs are subsidized in the insurance premiums paid by the people who carry health insurance and by individual creditors, which means that they are already the "brother's keeper" Obama insists they still have to become. That's how the market is bridging the unique and hugely expensive divide between two vastly different definitions of rational behavior.
Overall, the personal costs entailed by the market's ad hoc approach are both rational and acceptable, however much individuals may complain. It may be rough to have to declare bankruptcy because of a life-threatening illness, but what were the stakes? Life and death. If you escape with your life, or with the knowledge that everything possible was done, it's worth the price, now isn't it? All the rest is kvetching. For those who never thought to invest in insurance, or couldn't afford it, there is still an excellent possibility of escaping with their lives. That's not a bad bargain. Is it?
It's the long-term institutional and economic costs that aren't addressed by the current system and probably can't be by a government system that heaps the additional costs of waste, inefficiency, human casualties and economic disincentives for innovation on top of the structural problem of evolving, increasingly expensive medical technology.
The dilemma is this. Doing nothing right now is clearly superior to what's on the table. But doing nothing will also not solve the real problem, which is that the disconnect between economic rationality and human survival rationality will eventually make medical care as we presently conceive it too expensive for both indviduals and society as a whole. Somewhere out there, something's going to break; either 1) people will be denied available care and trapped into early death choices for economic reasons, or 2) medical technology will adjust by ceasing to innovate.
This is the area in which people who are still capable of thinking should start thinking. Hard.
posted at
12:40 pm
by
InstaPunk
Warnings Ignored
NOT
the Messiah.
INSTAPUNK IS (MOSTLY) ALWAYS RIGHT. Just a reminder that we tried to tell you, long before this crisis descended like a ton of bricks. We were right about everything in the last election except the act of insanity that caused the Republicans to nominate John McCain. (Yes, we endorsed him, but what else could we do? The alternative was incomprehensibly worse.) And we've been right all along about Barack Obama.
We warned the press:
Start nitpicking his cabinet
appointments,
legislative agenda or policy decisions, and you will perish in a
wave of hurt euphemisms which will make it clear to the most extreme
sycophants and true believers that you are, ahem, probably a resentful
racist. Watch as, one by one, the most illustrious and invulnerable of
your number are disgraced into retirement for having dared to use their
verbal talents against the new pharaoh. If it can happen to Geraldine
Ferraro, it can happen to you, too.
Continue being the same adoring cheerleaders you've been so far -- through the inevitable crises and missteps and blunders and failures -- and the already tottering structure of the MSM will collapse in cataclysmic ruin. You will bore your dwindling audience absolutely to death, and they will begin seeking honest news reporting elsewhere. (As they have been, btw, for some time now; how's NYT stock doing these days, kemo sabe?)
The nature of your bet thus far is idiotic -- that Obama really is the absolute answer to everyone's prayers you so want him to be. He isn't. He's a flesh-and-blood man who will stumble and err and make some truly awful decisions. When that happens, your extravagantly uncritical support for his rise to power will make you accountable to many Americans before you cover the first act of his administration. And when he does take office, the fact that you have let him rewrite all the rules of what is and is not fair coverage in political reporting will do you in no matter what course you choose. Criticize him and be branded with some of the worst labels available in these United States... Suck up to him and go rapidly out of business -- not to mention lose all the power you have so jealously acquired and used so self-righteously in the last hundred years.
Take your pick.
Continue being the same adoring cheerleaders you've been so far -- through the inevitable crises and missteps and blunders and failures -- and the already tottering structure of the MSM will collapse in cataclysmic ruin. You will bore your dwindling audience absolutely to death, and they will begin seeking honest news reporting elsewhere. (As they have been, btw, for some time now; how's NYT stock doing these days, kemo sabe?)
The nature of your bet thus far is idiotic -- that Obama really is the absolute answer to everyone's prayers you so want him to be. He isn't. He's a flesh-and-blood man who will stumble and err and make some truly awful decisions. When that happens, your extravagantly uncritical support for his rise to power will make you accountable to many Americans before you cover the first act of his administration. And when he does take office, the fact that you have let him rewrite all the rules of what is and is not fair coverage in political reporting will do you in no matter what course you choose. Criticize him and be branded with some of the worst labels available in these United States... Suck up to him and go rapidly out of business -- not to mention lose all the power you have so jealously acquired and used so self-righteously in the last hundred years.
Take your pick.
We warned the irrationally smitten voters and pundits:
Do
you believe the lie that the government really cares about your
health, your healthcare, and your lifespan? Then you don't understand
the circle of power at all. Have they outlawed tobacco and cigarette
smoking? No. Because then they'd lose the incredibly onerous and
regressive taxes they impose on cigarettes. They care about your
healthcare only if it enables them to make more businesses --
insurance, hospitals, medical practices, pharmaceutical giants --
dependent on them for profit, permission, existence. That's what it
means to be "liberal." Inside the circle, that is.
Your side is dedicated to only one constituency: power. If you don't understand that, you're outside the circle. Any good they do you is the sheerest accident, an unintended consequence of a strategy whose prime purpose is to maintain your pitiful dependence on their breathtakingly humongous lies.
Enjoy the next four years. Obama's inside the circle now. Where the hell are you? And more importantly, what the hell are you? You're the meat that baits the trap.
We even warned
the libs who wanted a black president principally to expiate their own guilty
consciences:Your side is dedicated to only one constituency: power. If you don't understand that, you're outside the circle. Any good they do you is the sheerest accident, an unintended consequence of a strategy whose prime purpose is to maintain your pitiful dependence on their breathtakingly humongous lies.
Enjoy the next four years. Obama's inside the circle now. Where the hell are you? And more importantly, what the hell are you? You're the meat that baits the trap.
[I]t's the absolute worst time
to elect a first black president. Nothing he does, or can do, will be
analyzed in nonracial terms. He will be handcuffed by his race,
criticized for every act of compassion and restraint, and there's
absolutely no chance in the current circumstances that he will be able
to govern as a "trans-racial" pioneer of some new age.
I won't labor the point. If times are going to be genuinely hard, there's no rationale for compelling a black American to be identified with hard times in perpetuity. If Obama really were as talented as a Lincoln, there would be some reason for taking the risk. But he isn't. And there isn't.
The presidency right now is a sour apple. Hand it to McCain. He's used to sour apples. Hold your fire. Elect Obama when the time is propitious for success rather than years of darkness and failure.
I know you won't listen. But there's nothing ironic about the advice offered.
I won't labor the point. If times are going to be genuinely hard, there's no rationale for compelling a black American to be identified with hard times in perpetuity. If Obama really were as talented as a Lincoln, there would be some reason for taking the risk. But he isn't. And there isn't.
The presidency right now is a sour apple. Hand it to McCain. He's used to sour apples. Hold your fire. Elect Obama when the time is propitious for success rather than years of darkness and failure.
I know you won't listen. But there's nothing ironic about the advice offered.
Of course, we didn't specifically predict that he would compound the mess by having his Chicago foot soldiers brand all his opponents as racists. We sorta thought he would, but we were too afraid of being called racists to predict that. But you're all smarter than we are. We know. Live with that.
posted at
2:42 pm
by
LocoPunk
Thursday, August 20, 2009
Rants Are
Cool.
It's
not the stone that makes it
all possible; it's the water.
MAGGIE SOUNDS OFF. The subject of rants came up in our Comments section a few days ago, and we sort of agreed with JS, who said:
Ranting feels good, and also has many
positive physiological benefits...
And we liked Maggie's fiery response to this IP post. But it's not the whole story. Rants are, in reality, like the skipping of the stone across the water, sustained by an enormous body of deeper thought rarely referenced in the performance itself. So, when we saw Maggie's rant, we thought maybe this was a good opportunity to show that 1) Rants aren't purely the emotional pyrotechnics they're usually dismissed as, and 2) This rant's not really telling us anything we didn't know already, in pretty excruciating detail. No offense, Maggie. Honestly. Loved the vibe. But we've been all over this, under it, around it, inside it, and completely on top of it for years. What did we do? We hyperlinked her comment. The first link isn't to InstaPunk. All but one of the rest of them are. We're the ocean of rage under your angry skipping stone. Just so you know.
O.M.G.!!!! That poor eagle is stranded
on that drifting chunk of melting
polar ice shelf! Damn you selfish humans! If only the United
States Congress would take charge of every aspect of our very
personal lives and restrict,
forbid, and regulate our very breaths with a bill
that makes things right ...
Our capitalist system has the natural means to flush and correct itself ... if allowed to. But the government over the last several decades has not permitted the natural course of such things. Worse, said government blob is about to cripple and stifle any proper and just failure, lessons learned, and innovations resulting from the process. They are putting us in straightjackets in securely locked padded cells with themselves and unelected lobbyists and czars as the nasty abusive staff of this putrid asylum. Soon we'll all be mercilessly slapped about, abused in our beds, starved, left in our own excrement, and loudly chided to just hurry-up and fucking die already.
We are experiencing a new generation produced from the previous generation that arrived from their parental generation that watched and lived through horrific economic strife and the threat of world fascism. Our generation and that of our offspring's are lazy from lack of want and the need to be useful beyond the limited materials at hand. We knew when we were leaving high school our next paths were either to continue on to college or trade school, find a nepotism placed position with a standing factory in our area, or look for a job we could climb the proverbial ladder in.
Today's generation expects, for some reason, that if they don't go immediately into either the MTV video line-up (NSFW) of music or an insanely ignorant reality show, the NBA/NFL/MLB, or pointless modeling on billboards while posing scantly clad, androgynous sexual partners ... well, then, there's just nowhere else for them to go so the government must assume the job of parent and provider for them and however many offspring they carelessly plant and bring into this society. They suffer from "Day Care" syndrome. All the country is a day care for them ... and all day day care.
Several years ago I saw an evening network news show (I'm thinking it was Diane Sawyer on 20/20 ABC) and she was sitting at a long table with teen girls who were either pregnant or had given birth out of wedlock. She asked them why they would do such an irresponsible thing so carelessly and willingly, and then expect the taxpayers via the government to provide for them and their babies/children (a girl or two/three had more than one child) ... One of the girls made an indignant snit back at her and frankly stated, "Because it's the government's job to take care of me and my baby ... I'll have as many babies as I want. They have to help me."
You have an inner city 'class' in this country where the parents of, say, a 15 yr old kid is roughly on average no more than twice that kid's age ... meaning THEY were parents at 15 yrs old. In most cases their own home situation was one of a single parent who more than not was the mother who also had more children from other 'encounters' outside that kid's sperm donor. For all Planned Parenthood's intended struggle to eradicate the "undesirable" lower class segment of our society (See; Margaret Sanger) their self-righteous goal not only fell flat on its face, but now exists only to justify itself by providing their butcher services to the middle and upper class wenches who are better educated and should be smart enough to use preventative birth control in their careless sex drives ... but have this 'safety net' of dehumanizing someone else's life in order to use abortion as 'birth control'.
This is just a sample of the mentality we are dealing with in this generation after ours, and the one they are currently producing. The 'power' has been lazily given over by the more capable, but distracted and complacent, members of society to the powerless who have no more of an idea of what to do with that power than a 3 yr old does with a space shuttle. The liquor cabinet was left unlocked and the drunkards are driving the damn bus. Unaccountability is an art form and personal responsibility has become obsolete, much like the way our body's appendix has, so it's "all good" we're told. They no longer need to think and discover for themselves. All they need are the golden celebrities to guide their politics through Che T-shirts, Chi-Com red stars, and bullshit blurry-eyed warnings of republicans making rape and slavery legal. They are blind to their own chains of ignorance while being raped by the self-important people who lead their very lives ... and the bigger movement behind those 'useful idiots' who would see our society/nation sacrificed for the cause of the collective hive of totalitarian Marxism. They walk joyfully into the fire ... and drag the rest of us with them.
Ashes leave no legacy behind for archeologists and historians to read, define and emulate ... or avoid.
Well, as I said, we don't always rant. But we are the waterfront.Our capitalist system has the natural means to flush and correct itself ... if allowed to. But the government over the last several decades has not permitted the natural course of such things. Worse, said government blob is about to cripple and stifle any proper and just failure, lessons learned, and innovations resulting from the process. They are putting us in straightjackets in securely locked padded cells with themselves and unelected lobbyists and czars as the nasty abusive staff of this putrid asylum. Soon we'll all be mercilessly slapped about, abused in our beds, starved, left in our own excrement, and loudly chided to just hurry-up and fucking die already.
We are experiencing a new generation produced from the previous generation that arrived from their parental generation that watched and lived through horrific economic strife and the threat of world fascism. Our generation and that of our offspring's are lazy from lack of want and the need to be useful beyond the limited materials at hand. We knew when we were leaving high school our next paths were either to continue on to college or trade school, find a nepotism placed position with a standing factory in our area, or look for a job we could climb the proverbial ladder in.
Today's generation expects, for some reason, that if they don't go immediately into either the MTV video line-up (NSFW) of music or an insanely ignorant reality show, the NBA/NFL/MLB, or pointless modeling on billboards while posing scantly clad, androgynous sexual partners ... well, then, there's just nowhere else for them to go so the government must assume the job of parent and provider for them and however many offspring they carelessly plant and bring into this society. They suffer from "Day Care" syndrome. All the country is a day care for them ... and all day day care.
Several years ago I saw an evening network news show (I'm thinking it was Diane Sawyer on 20/20 ABC) and she was sitting at a long table with teen girls who were either pregnant or had given birth out of wedlock. She asked them why they would do such an irresponsible thing so carelessly and willingly, and then expect the taxpayers via the government to provide for them and their babies/children (a girl or two/three had more than one child) ... One of the girls made an indignant snit back at her and frankly stated, "Because it's the government's job to take care of me and my baby ... I'll have as many babies as I want. They have to help me."
You have an inner city 'class' in this country where the parents of, say, a 15 yr old kid is roughly on average no more than twice that kid's age ... meaning THEY were parents at 15 yrs old. In most cases their own home situation was one of a single parent who more than not was the mother who also had more children from other 'encounters' outside that kid's sperm donor. For all Planned Parenthood's intended struggle to eradicate the "undesirable" lower class segment of our society (See; Margaret Sanger) their self-righteous goal not only fell flat on its face, but now exists only to justify itself by providing their butcher services to the middle and upper class wenches who are better educated and should be smart enough to use preventative birth control in their careless sex drives ... but have this 'safety net' of dehumanizing someone else's life in order to use abortion as 'birth control'.
This is just a sample of the mentality we are dealing with in this generation after ours, and the one they are currently producing. The 'power' has been lazily given over by the more capable, but distracted and complacent, members of society to the powerless who have no more of an idea of what to do with that power than a 3 yr old does with a space shuttle. The liquor cabinet was left unlocked and the drunkards are driving the damn bus. Unaccountability is an art form and personal responsibility has become obsolete, much like the way our body's appendix has, so it's "all good" we're told. They no longer need to think and discover for themselves. All they need are the golden celebrities to guide their politics through Che T-shirts, Chi-Com red stars, and bullshit blurry-eyed warnings of republicans making rape and slavery legal. They are blind to their own chains of ignorance while being raped by the self-important people who lead their very lives ... and the bigger movement behind those 'useful idiots' who would see our society/nation sacrificed for the cause of the collective hive of totalitarian Marxism. They walk joyfully into the fire ... and drag the rest of us with them.
Ashes leave no legacy behind for archeologists and historians to read, define and emulate ... or avoid.
