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Wednesday, August 12, 2009

In which I agree with Barack Obama, sort of 


Drudge is linking to this "flashback," in which Barack Obama questioned the value of hip-replacement surgery in the terminally ill, specifically his grandmother. Presumably Drudge thinks the old story is newly relevant given the "death panel" and related arguments that have been flying around in this summer of love, and so it is. Barack Obama is right. It is profoundly wasteful to perform hip-replacement surgery on somebody who is probably going to die in a matter of weeks or even months, and as a conservative I am against profoundly wasteful things. The question is, what should we do about it?

In theory, we should be able to cover these questions in market negotiations. I should be able to buy a "spare no measure" policy that would pay for any potential treatment in the event that I am at risk of life or limb, or a much cheaper "put me out on the iceberg" policy that sends me to a hospice and gives me as much government morphine as I want when the odds turn against me. Then I will have made my choice, just as I do when I choose to smoke, gain lots of weight, or ride a bike without a helmet. Or not.

The problem, of course, is that most people who face end-of-life treatment decisions are "senior citizens," and the government makes the reimbursement decisions for them. These decisions become political controversies, as opposed to choices freely made, because government employees impose them on the people. Not only do people bridle against the coercion, but the decisions themselves become morality plays carried on in tones that do not improve our civil society.

The solution, the only real way out of the end-of-life cost trap, is to privatize health insurance for senior citizens, give them vouchers that subsidize their health care to some baseline, and let them negotiate the end-of-life deal they prefer (and can afford) when they would have become eligible for Medicare. No coercion, apart from the ordinary "coercion" of capitalism, which most Americans think of as "freedom," and no "death panels," and no morality play.

Unfortunately, most Americans do not want to take responsibility for choosing their own fate at the end of their lives, so we are doomed to the wasteful stupidity of hip replacements in dying people or surrendering our destiny to bureaucrats. It is a tragedy.


39 Comments:

By Anonymous Anonymous, at Wed Aug 12, 07:54:00 PM:

As Steyn noted the other day, freedom is messy. Individuals don't always make what other individuals might consider to be the rational decision. But that's no excuse for taking away individual liberty, obviously.  

By Blogger JPMcT, at Wed Aug 12, 08:08:00 PM:

Just amputate the leg instead! According to Obama, we surgeons get paid $50,000 for a leg amputation...and, of course, we make ALL of our decisions based on monetary interest, don't we?

So everybody wins...we get a lot of money and the REALLY expensive hip replacement is avoided...plus, if the patient complains, just give them a pill or something...

TH...I am growing increasingly convinced that Obama is an idiot. Either that, or he really thinks that the average citizen is an idiot!

Unlike the AMA, the American College of Surgeons tends to be at least a little more
thoughtful
. While they are trying their best to remain politically active, the foolish drivel that emerges from the TOTUS is becoming increasingly difficult to swallow.

I am sure we will see this on the front page of all the big media outlets....sure we will.

As an aside, TH, I would love to see the actual details of the evaluation and treatment of Obama's grandmother. Call me cynical, but I suspect he is throwing her under the bus to make a point.

It's getting pretty crowded under that bus, eh?  

By Anonymous Mr. Ed, at Wed Aug 12, 08:37:00 PM:

My parents, who were conservatives and died without government assistance, were horrified by the cost of care, and they were aware that these costs can go through the roof with the elderly. So while they would have mooned the President on just about every issue, I think they would have given him some credit for broaching the subject of the cost of elderly care, though I'm sure they would have kept an eye on him.

It is an intriguing idea to have a baseline policy and a menu of extended benefits. I just wonder how that would work. Would it be a parallel medical option to Medicare like President Bush was proposing for retirement accounts? Would there be a market for policies which might have unpredictable and extremely high payouts? I wonder what someone who understood the insurance industry would say.

For me at this point there is a fear and a hard choice. My fear is that what is being proposed is a sweeping form of regulation and social engineering that will not work at all. It would only just be the beginning too, the proverbial foot in the door. From the start we will need a whole new set of experts to understand and interpret the regulations. The legislation itself if a thousand unread pages. The regulations will be thousands more and will grow year by year as new laws and regulations are piled on the original ones. We've seen it happen with every thing the government has stepped in to manage, from the income tax code, to laws and regulation governing education, the environment, the workplace, and so on and on.

It may be heaven for the governing class, but it will only diminish the rest of us. I would much prefer a targeted reform to this sweeping morass.

The hard choice is that we are all dying and there are various ways, at different price points, to push the date of death into the future. We are all in a sense terminally ill,or maybe terminally healthy. Some of us will just take a little longer to reach the end.

They say hip replacements are good for about 10 years. Either we provide them to all those that need them, or we do not provide it to some. Let's assume we can't afford to provide everything to everyone who wants it. Do we just rank people by life expectancy and go from there? Do we say that if the life expectancy is less than some percentage of the life of the hip, 30% for example, that said person does not get a new hip? Do we consider the importance of the person's work? Would a medical scientist doing critical research that may benefit others, with a short life expectancy get a hip at the expense of an unemployed transient who might live still quite a long time (with the hip)? Do we consider whether the person has dependents or not? Do we consider whether the person is loved or unloved? Do we consider the value of benefits provided by society through a person's life and perhaps favor someone who has not received as much favor over someone who has?

I just can't see having legislators and policy wonks writing the operating manual for a system that resolves these and other similar questions. It's messy enough as is. You can't legislate fairness fairly.

M.E.  

By Anonymous WLindsayWheeler, at Wed Aug 12, 08:40:00 PM:

Very commonsensical approach which I concur with.

Though the problem is that Liberals and leftists are going around telling everybody that health care is a right.

No it isn't. Our Health Care is not the gov responsibility. There is not enough money in the world to hand health care to everybody. Telling people that it is a right--is causing big problems. People are demanding something that they can't have.

Though I do have a simple solution to all this. Treat health care like we do Vetenary Care. It's cheap. Why? There are not tort or malpractice lawsuits. Just write a law that doctors, ambulances and hospitals are free from malpractice or just a $5000 dollar limit. That would cut medical costs 3/4 at least.

There is an old saying from the hippies out in California, it used to be on the bumper stickers: "Ass, grass, gas, no one rides for free". That's truth.  

By Blogger tomcog, at Wed Aug 12, 08:49:00 PM:

Under your plan, I would already be dead, thus saving taxpayers a couple of hundred thou. T  

By Anonymous Anonymous, at Wed Aug 12, 10:34:00 PM:

Someone with only a few months left is likely to have very poor survival chances for hip replacement surgery, and would be unlikely to choose to spend their final months in the severe pain associated with recovery from it, as well as risking infection in the incision.

When the question is posed in term of a few months, or even a single year, any ration person would chose palliative methods over surgical.

If you somehow survived what was supposed to kill you, then indulge in the hip replacement.  

By Anonymous Anonymous, at Wed Aug 12, 11:49:00 PM:

TH, I consider you to be a fairly pensive guy, so I would like to hear thoughts on a case that is seemingly irrelevant that I believe is fundamentally related.

Lawyers may represent both sides in the creation of a joint practice wherein both sides have equal stakes, as in the case of a jointly-owned dentistry office (for example.) However, a lawyer expressly may not represent both sides of a sale; there is a conflict of interest in maximizing good to the buyer (a client) when representing the seller (and vice versa.)

Similarly, certain acts that create perverse incentives are illegal. I cannot take out life insurance policies on you, for example, nor can I engage in bilateral transactions that pay out on your untimely death. Such acts clearly place a profit motive behind illegal activity (hitting you with a bus, for example) and is forbidden to minimize bad acts taken for a profit.

Which is why placing a profit-seeking entity in control of managing personal health care seems so fishy to me. (Yes, I do mean management under a private insurance paradigm, as in an HMO.) It may be true that a governmental bureaucrat has no financial incentive to give me good coverage or care, but said bureaucrat also lacks a direct financial incentive in seeing I get no care at all. Given that we should not rely on the benevolence of market actors for the provision of services, or even the ethicality of actors, I think it strange that such a direct incentive to harm should be tolerated. More examples here.

I respect that markets are good at optimizing within a parameter space, but they can be notoriously bad with moral goods (ex: prostitution) and other situations of perverse incentives (pun intended.) Is this really the best route in your eyes, TH?  

By Blogger Donna B., at Thu Aug 13, 06:43:00 AM:

We are all, in some sense, in the final weeks of our lives. Just how long before she died was this hip replacement?

A diagnosis of cancer is not an automatic death sentence.

What Obama statement actually does is accuse the doctor and hospital who did the hip replacement of unethical behavior, possibly malpractice.

Unless... you know the hip replace was done in the last 112 weeks or so of her life.  

By Anonymous Daran, at Thu Aug 13, 08:17:00 AM:

An elderly acquaintance of my parents recently broke her hip. Due to various other issues her life expectancy was already below 6 months, and an operation would likely shorten that.
Otoh if she wasn't operated she would probably spend the last six months in excruciating pain and under heavy sedation.

Together with the doctor she decided to be operated and her last few months were relatively pleasant.  

By Anonymous WLindsayWheeler, at Thu Aug 13, 08:39:00 AM:

In this article, a Prof. OKIMOTO writes that America's debt is 53 Trillion dollars! 53 Trillion! To wit:

"By the end of 2007, total US debt had risen to $53 trillion, or nearly four times the size of America’s annual economic output."

from: The Financial Crisis and America's Capital Dependence on Japan and China

He writes:

"In the system of mercantilist finance, the US has run amuck, ringing up record levels of national debt."

America is a loose cannon. It's spending is 71% of US GDP. It's financial derivatives market and its financial "wizards" have created 694 TRILLION of CDS, 10 times the total Worlds GDP.

This is disgusting in more ways than one. Americans think they live in Lulu land. Americans think they just have to have health care as a "right". While they are doing innumerable damage to the economy, to the world's economy and to their grandchildren. Their wish to live forever. America is a land of children. And the total lack of responsibility, duty, prudence and consignment to fate shows the infantile character of the American people.

The CBO has announced that Federal Spending is UNSUSTAINABLE! Unsustainable. Yet, we are proceeding full speed ahead. The only logical conclusion is that the American people have lost their minds.  

By Anonymous Anonymous, at Thu Aug 13, 09:48:00 AM:

The premise the Democrats use is that private oligopolies control the insurance market, and that consumers are underserved. I think that basic premise is true. The interesting question is why is that the situation we are in and what should we do about it. In Pennsylvania, Congressman Joe Sestak(D) said today on FOX, there are two insurance companies selling coverage to small and medium sized companies. I don't find that number as surprising as you may find it, since here in Maryland, we have only three possible suppliers. That's all. The coverage they can sell is mandated in detailed form by the state legislature, and the prices they offer are essentially identical. The legislature for whatever reason heavily restricts other companies from selling here or offering varieties of coverage.

Other forms of insurance are readily available in Maryland. I can buy auto insurance from tens or even hundreds of companies, over the internet. Prices are all over the map. Life insurance is available from local agents, from banks, from all over the place.

These are all heavily regulated markets, but they are regulated in such a way as to promote consumer choice, ready access, and a plethora of suppliers. Health insurance has been regulated to produce the opposite result.

In America we have a long tradition of being highly suspicious of monopolies, and oligopolies are right there just below monopolies on the suspicion scale. Maybe readers here are too young to remember, but once upon a time in this country you could only buy telephone service from one supplier (for all intents and purposes). It was miserable, and lefties particularly used to spend their weekends protesting "Ma Bell", it's market reach, the lack of consumer choice, the poor product innovation and the aggressively dismissive attitudes of it's service people. The irony of watching the lefties, having won the argument spectacularly on Ma Bell, arguing for the restriction of a badly run oligopoly into a terrible monopoly is sort of astounding to me. Where are the 60's and 70's protestors who pushed for the breakup of the corporate titans? Why, they've all gone through the looking-glass and become tireless advocates for a monopoly.

What should we do about health reform? We need to adopt national policies that promote the growth of many suppliers to the market, consumer choice, price competition and strong consumer protection against fraud. We need to discourage market concentration in the hands of a political party looking to provide pork to their supporters by every possible means.

The media might wish to convince the public that there are a bunch of loonies out there yelling at Congressmen for no good reason. They might wish to say, it's the August "silly season". "What's the big problem?", you often hear TV commentators say.

Well, the problem is that a political party, the Democrats, are trying to monopolize the market for health insurance. That will benefit them, since everyone will need to beg them for health coverage forever. It turns voters into supplicants. It allows political aristocrats an excuse to steal even more money from hard-working people of every economic strata. The political class and their toadies love this idea. But consumers, voters, know a pig approaching an overflowing trough is a bad model for government. And, that's what we have here.

I won't agree with anything Obama says, if he's going to lead the discussion with a proposal to take a monopoly for himself in health care coverage and delivery.  

By Anonymous feeblemind, at Thu Aug 13, 10:04:00 AM:

A problem I see with private insurance and various levels of coverage for seniors is that there will inevitably be people that opt for the 'economy package' and then whine that they are somehow 'victims' when they need coverage they opted not to pay for. Press will get a hold of it, decry the unfairness of it all, asking pols why this is allowed to happen in America etc etc. Everyone can see where that will lead.  

By Anonymous feeblemind, at Thu Aug 13, 10:12:00 AM:

What about bribing the terminally ill to die? Suppose a senior of modest means is told they are terminally ill. Suppose treatment is estimated to cost $200,000 for 6 mos additional life. So what if the senior was offered 100k to take painkillers and go quietly and the gov't saves the other 100 grand? Patient's choice. Not everyone would do it but a percentage would.  

By Anonymous Anonymous, at Thu Aug 13, 11:35:00 AM:

Thanks for that contribution, Jonathan Swift. :)  

By Anonymous WLindsayWheeler, at Thu Aug 13, 12:35:00 PM:

Here is what Glenn Beck says is the real reason for Health Care reform---Reparations Obama style for his kinfolk:

Obama style Social Justice--Reparations

This is what its all about. Also notice the Diversity requirements of our medical facilities--not staffed by the bestest and the brightest but a diversity crew. Yes, I want low-average IQ doctors and nurses.

All this is about is political correctness run amuck. Just like our finances are "run amuck" or medical services are also to "run amuck".

America is the land of morons.  

By Anonymous Anonymous, at Thu Aug 13, 12:41:00 PM:

Hey, how about a game show. Three Old Codgers. Three prizes: $5,000; $50,000; and, $1,000,000. Contestants compete for money for their survivors. They all agree terminate within 30 days of end of show.  

By Anonymous vicki pasadena ca, at Thu Aug 13, 12:41:00 PM:

Having just lost my mother, within the last year, due to a stroke, subsequent surgery and a 2 week coma, I am totally perplexed by the whole debate. The doctor's knew, within probably 48 hours that she would remain in a permanent vegetative state for the rest of her life, with a trach tube and feeding tubes keepin her alive (if you can call it that) indefinitely. None of the doctors, and there were many, save 1 would even be honest enough to say anything remotely approaching the truth. One doctor, a neurologist, told my dad that she would wake up and be coherent within a few days. Lies, lies lies. When it came down to making a decision, the decision was made by myself and my siblings. If she had a living will and directives, that decision would have been made by her living will. It was costly, unnecessary and ultimately self serving for the hospital and the doctors to keep her alive that extra 10 days. She was gone, almost 1/3 of her brain was removed during surgery. That lovely, vital and dynamic woman would have never wanted to end up like that or live that way. What's the solution? Beats me. I now believe it is imperative, no matter what age, you let people know, in writing, what your end of life strategy is. Nothing wrong with that.


We have the choice these days to prolong life well past what the patient would want to exist.


Government control, getting between you and your doctor? Please, the insurance companies do it now, with a service rep who knows NOTHING making the decisions.


Just a comment.  

By Anonymous vicki pasadena ca, at Thu Aug 13, 12:44:00 PM:

Like I said before, Glenn Beck wouldn't know the truth if it came up and bit him in the butt. He is a comedian (and not a very good one) and doesn't deserve 1 minute of a thinking person's time.  

By Anonymous Anonymous, at Thu Aug 13, 01:28:00 PM:

vicki, just set your Wheeler filter to "on" if you get my drift. There's no ignore button on this site so you have to pretend.  

By Anonymous Anonymous, at Thu Aug 13, 03:37:00 PM:

Why not require a patient's estate to pay up to 10% of the total estate value for their last 6-12 month's of health care. If you have a 1 million dollar estate, your heirs owe up to 100K for your end of life care. A person could easily prepare for this expense by buying life insurance. My guess is the patient and their heirs would make certain unnecessary medical expenses where not expended. Basically a deductible on the back end. This way taxpayers would not be on the hook for 100% of wealthy patients like Teddy Kennedy. I understand medicaid bills patients estates after their death to help offset costs of care. Usually there is little to nothing left, but the states bill for what is left.  

By Blogger John, at Thu Aug 13, 03:58:00 PM:

I have personal experience that doctors can leap to the end-of-life step too quickly.'

Recently my mom's doctor took me aside and tried to talk me into a do-not-resucitate agreement. He thought my mom was dying and was not cooperating with her physical therapy.

Got another nicer doctor to help out. It turns out that my mom had a broken femur. Once that was fixed mom was fine and has been enjoying the earth for these last few years just fine.  

By Anonymous Anonymous, at Thu Aug 13, 05:51:00 PM:

As Mickey Kaus has covered at Slate, Obama is fixated on the problem of cost control. Perhaps he thinks it is the paramount problem with the U.S. health care system. I agree that it is something to worry about, after you know anything about trends for the federal budget.

But Obama has a bug in his software. The bug is his compulsion to expand government control. A plan for more government control, plus a plan for cost control equals a massive political backlash. I am very surprised he couldn't figure that one out.

If Obama wanted to get cost control into the U.S. health care economy, he could have followed the recommendations of the CBO and many oher competent health care economists: restructure the insurance market into an individual consumer market instead of a corporate/government market. Something like the McCain campaign's proposal. But as a liberal Democrat, that's just not in Obama's software code.

Hopefully the congressional/Obama health care bills will now collapse. But one odd result of this debate is that Republicans have been maneuvered into defending the indefensible, namely the Medicare fee-for-service/third party payer financial catastrophe. With political consensus now in favor of that disaster, it may take another decade of financial bleeding before the country is ready to do something about Medicare.  

By Blogger JPMcT, at Thu Aug 13, 06:43:00 PM:

I've noted the horror stories about poor physician behaviour surrounding terminal illness.

Having been in this position innumerable times, let's just say that there is, under so circumstances, any rational rulebook that would satisfy every patient, every family member and every situation.

You do your damned best to try to predict what will happen in a complex series of events over which you have limited control.

You try to deal with factions within families that want diametrically opposite results.

You try to deal with the guilt of family menbers who have neglected the patient and now "want everything done" and become "advocates" for the purpose of soothing their own consciences.

You look at this...then you look at your wife and your children and your extended family and realize how THEY will all suffer if you don't make the perfect decision and get sued.

...and then you just try to sit down and tell the truth and communicate...and even then you sometimes get it wrong.

One thing is clear...some faceless government drone isn't going to give a good crap what anybody thinks...AND...they will be held harmless under the law...and... they will probably be given a bonus for saving money...and...there won't be anybody to complain to.

Bottom line....for God's sake get a living will and have family discussions BEFORE you get sick about your feelings regarding life support. That's the best way not to become a horror story.  

By Anonymous vicki pasadena ca, at Thu Aug 13, 07:40:00 PM:

JPMcT, my point exactly, the living will solves many, not all problems. It sure makes it clear to all the family what the wishes are of the person receiving the care. It is not just the government who doesn't care, the insurance companies care even less, they are out to make money, and they are. Record profits on the backs of the insured. Less and less services every year with more an more contributions from the insured. They do not run their companies as philanthropists, they run them to MAKE money. The faceless government drone? Please, the insurance companies are just as guilty as any government agency. And, because the misguided masses want tort "reform", they want to take away the only power the insured and the family of the insured have, the power to make the companies do the right thing. Trust me, they will not do it on their own.  

By Anonymous Anonymous, at Thu Aug 13, 08:50:00 PM:

A closer read of the Bloomberg interview would reveal that Obama was not just talking about the terminally ill. He was also talking about the "aged." You have to know where this is going.

My father, a WWII veteran and retiree with Medicare and private supplemental insurance had a bad stroke last year and had the audacity to fail to die immediately. I visited him once or twice per day in the hospital and every visit--no exaggeration--I was greeted by at least two doctors who pressured me to give them DNR permission. I refused because he was alert and seemed happy despite loss of his right side and speech. He laughed at jokes. He watched TV. He occasionally said "no" or nodded "yes."

Every DNR refusal on my part was met by ever greater resentment on the doctors' part. I suspected it had something to do with reimbursement issues. He was hospitalized for six weeks. They made several attempts to move him to a nursing home but each time he had some small setback that forced them to keep him.

He died several hours after I visited one night. He was very alert when I left. I have been suspicious ever since. I imagine Obamacare to be ten times worse than this experience.  

By Anonymous Mr. Ed, at Thu Aug 13, 09:39:00 PM:

JPMcT thanks. That view from the trenches had a true ring to me.

Personally, I think the demonization of insurance companies is political theater. I've had two. Both were reasonably good. The current one (Kaiser) in my view is exceptional and the people that work there are truly dedicated to their patients. 4 out of 5 people I speak with say the same thing. Nobody is going to score 100.

I certainly do not see malpractice suits as battles for a common cause. If the government is effectively going to limit the pay of medical professionals, why not legal professionals? Is it possible that limiting the pay would reduce the quality of the service by deterring the most talented from entering that profession, thereby hurting their clients? If it will not limit the quality of medical services why would it limit the quality of legal services?

M.E.  

By Anonymous Anonymous, at Thu Aug 13, 10:19:00 PM:

Vicki ... advance directives would go far, and sure, they don't cover all possibilities. I'd add in some type of durable power of attorney so you, or your Mom's designee could've prevented unnecessary procedures. Clearly there are a great range of doctors out there. Even those who graduated at the bottom of their class and managed to pass the entrance exams are called Doctor. And sure there are abuses and absurd procedures performed on people. Got it. I believe that most doctors really take their jobs to heart, and are not in it purely to line their wallet by performing the mythical 'unnecessary procedure'. It's an urban legend that deserves a Snopes page.

Now, explain to us how putting the government in charge fixes the problems you cite. There has, at yet, been zero public discussion surrounding tort reform, or addressing the insurers, who have been jacking their rates for decades and make tons of profit dollars. We're all consumers of healthcare, and insurance is about managing risk.

Healthcare is not free, not all the responsibility of your doctor or pharma or insurer, and it can't be. It starts with each of us taking care of ourselves. And frankly, 270M of us have insurance, most of us are satisfied with it, and virtually ALL of us PAY FOR IT in whole or part, and work for the rest of it as a benefit of that work. If the majority rule worked for the leftist mantra during so many elections they felt were stolen, then why doesn't it work for healthcare?  

By Anonymous vicki pasadena ca, at Thu Aug 13, 10:36:00 PM:

Durable Power of Attorney, absolutely necessary. I am not saying that the government would be any better than the insurance companies as far as solving the problems. I am on record here saying that having the government interfere gives me the creeps. What I am saying is that, for the most part, the private companies are no better, in some cases far worse than some of the things Obama is suggesting or that is in the bill. Don' demonize one and deify the other. I have insurance. It is OK. No insurance, not OK. It is also the call to get the government out of Medicare and Medicaid. That's a joke, right?  

By Blogger JPMcT, at Thu Aug 13, 11:32:00 PM:

I have the advantage of working with very,very good physicians in our hospital system...but I DO NOT think that we are that far above the mean.

The overwhelming majority of us look at the problem and not the insurer. We simply go ahead and do what's right. If the insurance company denies the day in the hospital...well...CRAP!...let them deny it. We do what is right...period.

If I feel that somebody has a need for an MRI scan or a specific procedure...and some bozo bottom dweller at the insurance company balks, I will call him, enumerate the reasons why I AM GOING TO DO the procedure, explain that it is the standard of care, mention that I will direct the patient and the family to his personal office nimber for issues that arise regarding payment...and, lo and behold, most of the time they agree to cover the patient.

Home care issues are a bit stickier...and, thank God, alternative exist that are usually reasonable.

People, the system works! It is a pain for us sometimes. It is a pain for you sometimes...but it works.

Once there is a big gorilla in the room that controls everything, has their fist around the heart of the hospital administrators, controls the radiologists, employs the hospital doctors and determines the "best practices" that, if ignored, affect your income and legal exposure...then WATCH OUT!

You may bitch about your doctors, but I will tell you that they are the last barrier between you and the bean counters as far as health care goes.

Once that barrier gets busted...then you might as well place you order for whatever flavor of Soylent Green that strikes your fancy...the fight will be over...and YOU will have LOST!  

By Anonymous billy Bob Corncob, at Fri Aug 14, 12:19:00 AM:

False dichotomy.

Obama's hypothetical is not 'real' in the sense that it is an anecdote without many added examples.

True, we spend a lot toward the end of life; and we should. It shows respect for life and our elders and it is a measure of our love. We are not starving.

False, a lot of that end of life care involves truly unnecessary procedures.

Almost all is devoted to low to medium probability attempts to prolong life, or high probability attempts at palliative care. If we focus on the false hypothetical, we will screw up the system.

No doubt.  

By Anonymous WLindsayWheeler, at Fri Aug 14, 11:09:00 AM:

Vicki of Pasadena.

You thought to rebute Glenn Beck with ad-hominem attack with "Glenn Beck wouldn't know the truth if it came up and bit him in the butt. He is a comedian (and not a very good one) and doesn't deserve 1 minute of a thinking person's time."

Ad Hominem does not refute what Glenn Beck said. I thought Glenn Beck did a fine job of presenting his case. He presented a clip with Obama saying that the majority of uninsured is disproportionately African-American and that this massive healthcare is about fixing that. It is about sending largese and welfare to his kinsmen thru Socialist Government.

You Vicki, have not presented ONE FACT of rebuttal. You have not presented anything that counterdicts Glenn Beck.

This is not how Western Culture works--this may work under Cultural Marxism, but not in Western Culture. We, Westerners, demand "Proof", Evidence, and reasoning based on such.

If Vicki you want to disprove Glenn Beck---do the work, research, investigate and present findings of FACT.

Glenn Beck did all that. You need to do the same or you are just blowin' in the wind. And you are to be shrugged off as a gasbag.  

By Anonymous Anonymous, at Fri Aug 14, 11:57:00 AM:

The WSJ does a great job with these issues today.  

By Blogger Elise, at Fri Aug 14, 12:19:00 PM:

give them vouchers that subsidize their health care to some baseline

I think in theory what you're proposing, TH, is a good idea but in practice it just moves the decision point. What "baseline" would we subsidize care to? Would you subsidize for certain procedures and not others? That seems fair if scary but what about QALY considerations: would you consider age (the younger elderly get hip replacements; the older don't)? Overall health (the healthy elderly get hip replacements, the sicker elderly don't) and, if so, how would you quantify when someone is "too sick" to qualify for a procedure (imminently terminal cancer disqualifies but mid-stage Alzheimer's doesn't)?

Equally important, who would make the decision about what level we would subsidize and keep remaking it as technology changes? The government? Diseases with the strongest lobbying groups get coverage. Doctors? Their specialties get coverage. I might go with a nationwide referendum that said "here's what we're thinking about covering, here's how much it will cost you".

And, finally, why not do the same for all age groups? This is the proposal Singer made that was looked upon pretty unfavorably by the Right: Medicare for All with only specified items covered, QALY considerations included, and the option to buy "bonus" coverage privately. Or do it for Medicaid? This is what Oregon does that produced such an outcry at RedState. What the RedState post doesn't tell you but the Fox link does is that the treatment under discussion has a less than 5% chance of keeping the patient alive for at least 5 years. How different is this from replacing a hip in someone who is probably going to die within the year?

Few people want to waste treatment. The problem is everyone's definition of waste is different. I'm alive now because 10 years ago I underwent a treatment that had a 3% 5-year survival rate. That wasn't wasteful to me but it certainly would be to Oregon; probably would be to Obama and his Congressional allies; and might very well be to you.  

By Anonymous Anonymous, at Fri Aug 14, 12:33:00 PM:

From my perspective the basic problem with ObamaCare is the market choking monopolism of a state run system. To whom does an individual turn when one is dissatisfied with some aspect or other of care or reimbursement? Beg your Congressman? Please.

I would much prefer very broad competition to none at all.

Allowing ObamaCare to monopolize medical care will result in state-run, crony capitalism. It will result in backroom deals between politicians and large companies. It will result in patronage jobs, poor care, endless taxes and price fixing. It will result in rationing and unavailable care. The fact that anyone at all is in favor of this is unbelievable.  

By Anonymous WLindsayWheeler, at Fri Aug 14, 01:00:00 PM:

I liked Elise's comment and Anonymous at Fri Aug 14, 12:33:00 PM. I liked the logic and reasoning of Anonymous and I believe he is exactly right.

We need to look at this at the Catholic idea of subsidarity. Subsidarity is that things need to happen at the lowest possible level.

Health care and education ARE NOT Purviews of the Federal Government! The Federal Government should have NO say so over health. Remember our Constitution and the 10th Amendment folks?

Indigint care should be done at the county poor house. Every county used to have one. The poor of that society should be cared for by (a) the County poor house and (b) Catholic and other christian hospitals as charity. If Christian young people can be again influenced to join medical orders of celibacy and poverty, like there was in the 19th century, the poor would have medical care.

Socialism is about trumping Christianity in charity; it is about usurping the role of Christianity. This is the basic problem. Government replaces the Church. Atheists and Masons want to do this. Government becomes the Church.

In the local community, the community knows who needs medical care. The community supports its own. That is what Health care, the Conservative approach, should be. Done at the local level.  

By Anonymous WLindsayWheeler, at Fri Aug 14, 02:20:00 PM:

Vicki says that Glenn Beck doesn't know the truth.

Lawerence Auster of the "View from the Right" blog has this to say about Glenn Beck and his observations:

"...but the reality is that he is the best thing for conservatism on television and he has to be backed. Even better than his notorious "Obama is a racist" comment was his brilliant follow-up in which he argued that Obama doesn't want reparations, because it wouldn't go far enough. He says that Obama prefers nationalized medicine and a universal guaranteed college education to reparations, because blacks, being behind in health, education, and all other socioeconomic indicators, would benefit in a hugely disproportionate way from such programs, leading to the equalization of the races, whereas reparations would only be a one-time deal and would change nothing essential.
Beck's insight is in line with my analysis of Obama's March 2008 race speech, the anti-white, race-socialist meaning of which most conservatives failed to grasp. To hear such an analysis on national television is stunning
."

The rest of the post is here: VFR Some advertisers withdrawing from Glenn Beck Show

Reality must be faced. What is happening is that Utopians with Egalitarianism sentiments are running who have no care for reality, law, and the law of economics, determining social policy. African Americans are disadvantaged but government programs are not going to fix that problem. And gerrymandering wealth transfers is not going to fix that problem.

This must be fought at all costs. And Glenn Beck needs to be supported.  

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By Anonymous glasnost, at Tue Aug 18, 03:40:00 PM:

The premise the Democrats use is that private oligopolies control the insurance market, and that consumers are underserved.

I want to say for starters, it's nice to see some thoughtful discourse and some conservative POV willing at least to listen to arguments.

If you get this much, there's at least the possibility of debate with you.

Well, the problem is that a political party, the Democrats, are trying to monopolize the market for health insurance. That will benefit them, since everyone will need to beg them for health coverage forever. It turns voters into supplicants

Look, I can't speak for Obama with godlike precision, but I'm a hyper-info-addicted liberal, and I spend hours reading the stuff on "my side".

The vast majority of us don't a government monopoly health insurance. I'm not at all sure, personally, that I'd support something like that. I understand the efficiency of the single-payer argument, and there's a good argument that a monopoly on *insurance* doesn't have the same problems as a typical monopoly, because it's just a payment mechanism at heart, and consumers can always pay for medical care itself out of their own pocket. And if the insurance offered sucks, they will. So insurance competes with paying straight.

However, though I can make the argument, I'm not sure I believe it. Bottom line, I would be quite queasy about a government monopoly on health insurance.

So it's a good thing this bill is not even remotely likely to do that. Frankly, you don't even remotely understand how the bill works, if you think that it does do that. There's not going to be a wave of employer cancellations that force people to cover by default, because the bill contains an employer mandate that forces them to pay towards health care, be it through coverage or through paying into the public plan.

And there's not going to be massive subsidies to the government plan. The reimbursement rates are on the level with things being done right now. The subsidies for poor people are handed out to be used on *either* private *or* public plan.

Heck, it's going to be nearly impossible for private employees with pre-existing coverage to get the public plan at all.

No one, or hardly anyone anyway, on the left believes that this bill will lead to a government monopoly on health care. So either Obama is massively fooling his supporters - and there are plenty of centrists and skeptics who would be sounding the alarm, from jake tapper to TNR to marc ambinder to the freaking health insurance industry itself - or
you're just being fed a line.

By the way, the scenarios where politicians fool their own supporters as I suggest here just doesn't happen. There would be dogwhistles - not obscure passages dug up by Malkin and misapplied from decades ago, but right-now dogwhistles - and the less sauve of us lefties would be rubbing our hands about them. That just isn't happening.  

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