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  1. #1
    Saizou is offline Senior Member Always Around
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    Default The Wall Street Journal is now the leading comedy magazine in America

    DEATH BY BUREAUCRATIC FIAT

    Quote Originally Posted by ANDREW KLAVAN
    It is very difficult to imagine the country making those decisions just through the normal political channels. And that's part of why you have to have some independent group that can give you guidance.
    —President Barack Obama in a New York Times interview on how costly medical decisions should be made.

    The people behind the long table do not know what they've become. The drug of power has been sugared over in their mouths with a flavoring of righteousness. Someone has to make these decisions, they tell their friends at dinner parties. It's all very difficult for us. But you can see it in their eyes: It isn't really difficult at all. It feels good to them to be the ones who decide.

    "Well, we have your doctor's recommendation," says the chairwoman in a friendly tone. She peers over the top of her glasses as she pages through your file.

    You have to clear your throat before you can answer. "He says the operation is my only chance."

    "But not really very much of a chance, is it?" she says sympathetically. Over time, she's become expert at sounding sympathetic.

    "Seventy percent!" you object.

    "Seventy percent chance of survival for five years—five years at the outside—and even that only amounts to about 18 months in QALYs: quality-adjusted life years."

    "But without this procedure, I'll be dead before Christmas."

    You try to keep the anger out of your voice. The last thing you want to do is offend them. But the politicians promised you—they promised everyone—there would never be panels like this. They made fun of anyone who said there would. "What do they think we're going to do? Pull the plug on grandma?" they chuckled. The media ran news stories calling all rumors of such things "false" or "misleading." But of course by then the media had become apologists for the state rather than watchdogs for the people.

    In fact, the logic of this moment was inevitable. Once government got its fingers on the health-care system, it was only a matter of time before it took it over completely. Now there's one limited pool of dollars while the costs are endless.

    "You have the luxury of thinking only of yourself, but we have to think about everyone," says the professor of ethics. He's a celebrity and waxes eloquent every Tuesday and Thursday on Bill Maher Tonight. "This isn't the free market, after all. We can't just leave fairness to chance. We have to use reason. Is it better for society as a whole that we allocate limited resources for your operation when we might use the same dollars to bring many more high quality years to someone, say, younger?"

    "I'm only 62."

    He smiles politely.

    "Look, it's not just about me," you argue desperately. "My daughter's engaged to get married next year. She'll be heartbroken if I'm not there for it."

    "Maybe you should have thought of that before you put on so much weight," says the medical officer. "I mean, you people have been told time and again . . ."

    But the chairwoman is uncomfortable with his censorious tone and cuts him off, saying more gently, "Perhaps your daughter could move the wedding up a little."

    The member in charge of "stakeholder" exceptions shakes her head sadly as she studies your file. "If only you could have checked off one of the boxes. It would be awful if you were penalized just because of a clerical oversight."

    It begins to occur to you that this is how you are going to die: by the fiat of fatuous ideologues—that is to say, by the considered judgment of a government committee. They are going to snuff you out and never lose a minute's sleep over it, because it's only fair, after all.

    That logic is implacable too. Free people can treat each other justly, but they can't make life fair. To get rid of the unfairness among individuals, you have to exercise power over them. The more fairness you want, the more power you need. Thus, all dreams of fairness become dreams of tyranny in the end.

    You know you should keep your mouth shut. Be humble—they like that. But you speak before you can stop yourself.

    "What you're doing here is evil," you cry out. "You're trying to take the place of God!"

    "Sir, this is a government building!" says the chairwoman, shocked. "There's no God here."

    Mr. Klavan is a contributing editor to City Journal. His latest novel is "Empire of Lies" (Harcourt, 200.

    Andrew Klavan is clearly the greatest writer in the western hemisphere since James Joyce, and the WSJ should be praised for employing this man.

  2. #2
    Stuyvesant is offline Senior Member Always Around
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    Default

    Well, since Vonnegut at least. So it goes. Cute article.

  3. #3
    mystic_guard_sinoel is offline Senior Member Community Builder
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    Default

    i read wsj as weekly shonen jump

    and I'm one of the smart kids.


  4. #4
    999Ghosts is offline Senior Member Long Time Member
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    Quote Originally Posted by mystic_guard_sinoel View Post
    i read wsj as weekly shonen jump

    and I'm one of the smart kids.
    It's a blessing. You've got more than one way of looking at it.

  5. #5
    Aikido is offline Senior Member Community Builder
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    It seems to me that the substance of the health care debate changes several times a week. So I could be wrong, but my understanding of the proposed program is to have a government-owned alternative to the currently privatized system. It seems, then, that the article mis-states the character of the current proposal.

    In point of fact, US taxpayers already subsidize some part of the uninsured because hospitals are required to treat emergency patients regardless of their ability to pay.

    That said, I'm not sure where I stand on the debate because I find the whole thing convoluted and politicized.

  6. #6
    Saizou is offline Senior Member Always Around
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    Quote Originally Posted by Aikido View Post
    It seems to me that the substance of the health care debate changes several times a week. So I could be wrong, but my understanding of the proposed program is to have a government-owned alternative to the currently privatized system. It seems, then, that the article mis-states the character of the current proposal.

    In point of fact, US taxpayers already subsidize some part of the uninsured because hospitals are required to treat emergency patients regardless of their ability to pay.

    That said, I'm not sure where I stand on the debate because I find the whole thing convoluted and politicized.
    The "substance" of the health care "debate" in the USA is basically one side having a hard-on for compromise (or rather a hard-on for healthcare industry money), so they water down their own proposals into basically nothing of substance (even though they have solid majorities in both chambers of congress and the presidency), regardless of whether these watered-down proposals will make things better.

    The other side is arguing one or several of the following points, starting with the allegation that the first side wants to kill everyone over 65 by denying them healthcare, and that the president is a communist nazi stealth-muslim who was born in Kenya and therefore is part of a vast, new world order conspiracy to take over the US presidency 48 years later, therefore anything he proposes must be stopped, or that the US has the best healthcare in the world so nothing really needs to be changed. The fact that none of these arguments have any factual basis, or that several of these accusations directly contradict each other apparently doesn't bother the second side in the least.

    The rest of the civilized world watches this and wonders how America has managed to survive as a political entity until now.

  7. #7
    Aikido is offline Senior Member Community Builder
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    Quote Originally Posted by Saizou View Post
    The "substance" of the health care "debate" in the USA is basically one side having a hard-on for compromise (or rather a hard-on for healthcare industry money), so they water down their own proposals into basically nothing of substance (even though they have solid majorities in both chambers of congress and the presidency), regardless of whether these watered-down proposals will make things better.

    The other side is arguing one or several of the following points, starting with the allegation that the first side wants to kill everyone over 65 by denying them healthcare, and that the president is a communist nazi stealth-muslim who was born in Kenya and therefore is part of a vast, new world order conspiracy to take over the US presidency 48 years later, therefore anything he proposes must be stopped, or that the US has the best healthcare in the world so nothing really needs to be changed. The fact that none of these arguments have any factual basis, or that several of these accusations directly contradict each other apparently doesn't bother the second side in the least.

    The rest of the civilized world watches this and wonders how America has managed to survive as a political entity until now.
    First off, to put "debate" is quotations is unnecessarily disparaging because I think that there genuinely is a serious debate going on across the USA both in the home and in Washington. That there are so many proposals and tempers run hot around this issue is proof enough of that. Though I think we can rightly take umbrage at the watered down substance of the proposals in the House and the Senate.

    This is one of the better articles I've read to date:
    http://www.theatlantic.com/doc/200909/health-care

    I like what the author says about reform being more than just a public option (or, more recently, not even a public option). I highlight this paragraph in particular:
    To achieve maximum coverage at acceptable cost with acceptable quality, health care will need to become subject to the same forces that have boosted efficiency and value throughout the economy. We will need to reduce, rather than expand, the role of insurance; focus the government’s role exclusively on things that only government can do (protect the poor, cover us against true catastrophe, enforce safety standards, and ensure provider competition); overcome our addiction to Ponzi-scheme financing, hidden subsidies, manipulated prices, and undisclosed results; and rely more on ourselves, the consumers, as the ultimate guarantors of good service, reasonable prices, and sensible trade-offs between health-care spending and spending on all the other good things money can buy.
    It's a bit long and I'm not sure I agree with the all of the conclusions he gleans from the information presented, but I think the spirit of the article is spot-on.

    EDIT: Also, great to hear from you again Saizou.

  8. #8
    StealDragon's Avatar
    StealDragon is offline Super Moderator Community Builder
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    Wait. That piece was REALLY published? Wall Street Journal like the weekly supermarket tabloid in Buxton, Maine. Not the Wall Street Journal about the Wall Street in New York. No nationally syndicated news paper would ever seriously print that right? ...right?


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    I raise a toast to the the souls that sang all along. I've been gathering friends to just to make some sounds,
    before the ship goes down, I've been making amends by making the rounds before the whole world ends


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  9. #9
    Saizou is offline Senior Member Always Around
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    Quote Originally Posted by StealDragon View Post
    Wait. That piece was REALLY published? Wall Street Journal like the weekly supermarket tabloid in Buxton, Maine. Not the Wall Street Journal about the Wall Street in New York. No nationally syndicated news paper would ever seriously print that right? ...right?
    Don't know if it was published in print, but it's right there on the WSJ homepage, and yes, this is the big and famous WSJ we're talking about.

    Quote Originally Posted by Aikido
    First off, to put "debate" is quotations is unnecessarily disparaging because I think that there genuinely is a serious debate going on across the USA both in the home and in Washington. That there are so many proposals and tempers run hot around this issue is proof enough of that. Though I think we can rightly take umbrage at the watered down substance of the proposals in the House and the Senate.
    Actually I wish this were the case. But consider the following argument from the senior Republican member of the Senate finace commitee:

    Quote Originally Posted by Sen. Chuck Grassley
    "It's not about getting a lot of Republicans. It's about getting a lot of Democrats and Republicans," Grassley said. "We ought to be focusing on getting 80 votes."
    Source can be found here. Furthermore, even co-ops are apparently regarded as unacceptable to the republicans.

    So basically the republican leadership is indicating that they are unwilling to support any bill that doesn't satisfy them, and the only thing that would satisfy them is clearly impossible to achieve even by the most watered-down version of an democratic healthcare bill, which we, as you say, rightly can take umbrage at. Because as we all know, 20 republicans aren't going to start supporting public healthcare anytime soon (or any republican, for that matter).

    Hell, Chuck Grassley even considers getting republicans on board as more important than passing a good bill.

    Therefore, any "debate" on this issue is a complete and utter sham, because one side isn't interested in any compromise at all. How can you have a productive debate if it is impossible for the side with the better argument to sway the other side even a little?

    Quote Originally Posted by Aikido
    This is one of the better articles I've read to date:
    http://www.theatlantic.com/doc/200909/health-care

    I like what the author says about reform being more than just a public option (or, more recently, not even a public option). I highlight this paragraph in particular:

    To achieve maximum coverage at acceptable cost with acceptable quality, health care will need to become subject to the same forces that have boosted efficiency and value throughout the economy. We will need to reduce, rather than expand, the role of insurance; focus the government’s role exclusively on things that only government can do (protect the poor, cover us against true catastrophe, enforce safety standards, and ensure provider competition); overcome our addiction to Ponzi-scheme financing, hidden subsidies, manipulated prices, and undisclosed results; and rely more on ourselves, the consumers, as the ultimate guarantors of good service, reasonable prices, and sensible trade-offs between health-care spending and spending on all the other good things money can buy.
    It's a bit long and I'm not sure I agree with the all of the conclusions he gleans from the information presented, but I think the spirit of the article is spot-on.
    The reasonable thing to do would be to switch to a single-payer system. As one can see from the studies on the subject, the US health system underperforms despite the fact that the per-capita spending is about twice as large than in other western countries. From this one could conclude that something is rotten indeed, but I'm sure we both know that already.

    The real problem with the US healthcare debate is the no one in the mainstream is actually advocating the reasonable option. Rather, the choice has been framed between watered-down bullshit and nothing at all. Furthermore, the real and underlying thing that nobody is willing to say is that it is the insurance companies by their nature are the root of the problem. There is an enormous conflict of interest between the company's goal to maximise profits and the purpose of any sane healthcare system, i.e. to provide care to those who need it and to promote the public health, because the insurance company has no incentive whatsoever to provide any care that is not profitable to them.

    Quote Originally Posted by Aikido
    EDIT: Also, great to hear from you again Saizou.
    Good to hear from you too.

    EDIT: Fixed the last link
    Last edited by Saizou; 08-26-2009 at 02:22 AM.

  10. #10
    Aikido is offline Senior Member Community Builder
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    First off, Chuck Grasslee can go suck a dick and every reasonable person I know, Democrat or Republican, agrees with that. It's true that one of the horrifying things about this debate at the political level is seeing how many idiots get elected. On the flipside I've been impressed with how articulate Anthony Wiener from New York is on many subjects of interest.

    I was also talking about more than political level discussions. Discussions like we're having here, for example (even though I am by no means an expert on the subject, I'm keeping an open mind).

    Part of my opinion stems from anecdotal experience. My girlfriend is Swedish and her parents moved to Houston when she was fairly young. Her dad is an oncologist and MD Anderson is one of the best hospitals in the world for cancer research. Her mom is a registered nurse. Part of the reason they left was because they were fed up with the healthcare system is Sweden. I've been told that for most common ailments and basic care, the Swedish system works generally well and cost-efficiently. But there are often problems with prescribing too by-the-book as well as problems that arise from the rationing of medical care/pharmaceuticals. I read something recently about someone who went around the world and experienced/researched health care in different parts of the world. He had a lot to say, but one of the things he mentioned was about someone in Canada with a shoulder problem that required a specialist. It took him many weeks to actually even go see the doctor to start his treatment due to some aspects of the Canadian healthcare system.

    I pulled this quote from page three of the article I posted:
    The experience of other rich nations should also make us skeptical. Whatever their histories, nearly all developed countries are now struggling with rapidly rising health-care costs, including those with single-payer systems. From 2000 to 2005, per capita health-care spending in Canada grew by 33 percent, in France by 37 percent, in the U.K. by 47 percent—all comparable to the 40 percent growth experienced by the U.S. in that period. Cost control by way of bureaucratic price controls has its limits.
    Singer payer systems are no panacea.

    I agree that it is important to distinguish between health care and health insurance. I do think there are simple things that can be done to vastly improve health care that have nothing to do with insurance (the article I posted mentioned a simple sanitation checklist that drastically reduced deaths from illnesses acquired in the hospital). The author also talked about how health insurance operates in a way that almost no other service in america does. Since we pay only a certain amount out of pocket (in fact, a similar amount to those uninsured), we are not mindful of the cost. Since most Americans with health insurance get it through their employer, these costs are largely invisible to the typical American. The author states, and I agree, that we should be forced to pay for routine check-ups, etc, and have insurance to cover the unpredictables. I think this would do wonders for reducing the cost of health insurance AND care.

 

 
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