INTELLECTUAL CONSERVATISM ISN’T DEAD: WOULD YOU BUY A USED CAR FROM A LIBERAL? (PART II)
This is the second in a series of 5 articles on the state of intellectual conservatism. Part I can be found here.
Should conservatives pay any attention to liberals who attempt to critique us?
I actually sympathize with those conservatives who reject out of hand any effort by a liberal to tell us what’s wrong with us. Sympathize - but neither do I brush off such criticism without reading and digesting it for myself.
There are a few liberals who actually make a living looking seriously at the intersection of politics, philosophy, and ideology and, through rigorous examination, while using logically sound arguments, have something important to say that I believe conservatives should take very seriously.
I should note that I don’t necessarily believe it when a liberal says they are offering their critiques because they believe it important that their philosophical opponents get back on their feet intellectually or politically so they can “challenge” liberalism. That’s stretching things a bit, boys. Let’s just leave it at acknowledging a sincere attempt by reasonable people to honestly look at history and conservative philosophy, and, in an academic sense, offer reality based criticism from their point of view.
I am in the process of writing a long, hopefully readable review of Sam Tannenhaus’s Death of Conservatism. I wish I could have done it sooner but I am a slave to time, and such an interesting, thoughtful, although ultimately flawed book deserves a serious effort. Besides, I get to crib from best conservative reviews of the book since I am so late to the party, thus making my job a little easier.
But today’s lesson comes to us via Jacob Weisberg, editor in chief of the Slate Group, former editor of Slate Magazine, and author of the book In Defense of Government. His liberal credentials impeccable, Weisberg wrote a piece a few days ago in Slate that mourned the loss of Neocon Irving Kristol and the fact that the intellectual conservatism he represented died off decades ago:
In the heyday of Kristol’s influence in the 1980s, Republicans styled themselves the party of ideas. Whatever you thought of those ideas—challenging Soviet power, cutting taxes, passing power back to the states, ending affirmative action, cutting off welfare benefits to the undeserving poor—they represented a genuine attempt to remodel government around a coherent vision. Today, as during the pre-conservative stage of Kristol’s career in the 1950s, the Republican Party takes itself much more lightly. It has fallen back upon what Lionel Trilling once called “irritable mental gestures”—crankily rejecting liberal attempts to come to grips with the country’s problems without offering any plausible alternatives. Since the last election, it has been the brain-dead home of tea parties, pro-life amendments, and climate-change denial.
Are tea parties any more “brain dead” than anti-war protests? I had my doubts that any kind of mass protest movement at the grass roots could ever arise among the highly individualistic conservatives. At this point, I have been proved wrong although I am waiting for the inevitable absorption of the tea party movement into the Republican party. All that energy has to be channeled somewhere. And since a 3rd party would be futile, there’s really only one place for the movement to go; a de facto alliance with the GOP in 2010.
Already there are signs that tea partiers are endorsing candidates for office, raising money, and will no doubt supply volunteers to some of these candidates.
I doubt there will be many Democrats on the list of tea party endorsed candidates.
I have written often of what I believe the tea party groups are really all about. It’s not really about taxes, or even gargantuan deficit spending. It is something that few liberals can grasp, although I have seen some analysis on the left come close. The kind of “change” that Obama seeks to bring to America may seem overdue to many on the left but is seen by most conservatives as an attempt to replace an America they know with an another America, one that rejects the values of their ancestors and substitutes what appears to them to be an alien vision of what America should be.
I disagree with conservatives who say the president’s race doesn’t play a role with a small, but significant minority. But those who issue blanket condemnations using that meme are clueless about what is driving this protest; it is the abandonment - or seeming abandonment - of what conservatives see as “First Principles” that includes a basic outline of the Constitution.
It can be argued that fear of change is a fact of life for conservatives but I reject that as a primary motivation because what the president has done is, in fact, revolutionary. Perhaps not to the educated and urbane who believe us far behind the social democracies of Europe in creating a welfare state. But to millions of patriotic, god fearing Americans, they feel they are losing their country and will fight to keep it.
Is this brain dead? No more so than anti-war protestors who believed that Bush was in league with big business to bring perpetual war to our shores. Or that Bush went to war in Iraq to enrich his friends and cronies. Or that the Terrorist Surveillance Program was riotously abused and that the government was spying on Bush opponents wholesale. Excessive ideology leads to excessive paranoia on both right and left. That is the lesson of America in the modern age.
In fact, Weisberg acknowledges this - at least on the right:
How did this prudent outlook devolve into the spectacle of ostensibly intelligent people cheering on Sarah Palin? Through the 1980s, the neoconservatives became more focused on political power and less interested in policy. They developed their own corrupting welfare state, doling out sinecures and patronage subsidized by the Olin, Scaife, and Bradley foundations. Alliances with the religious right skewed their perspective on a range of topics. They went a little crazy hating on liberals.
Over time, the two best qualities of the early neocons—their skepticism about government’s ability to transform societies and their rigorous empiricism—fell by the wayside. In later years, you might say Kristol and the neoconservatives got mugged by ideology. Actually, they were the muggers. “It becomes clear that, in our time, a non-ideological politics cannot survive the relentless onslaught of ideological politics,” Kristol wrote in 1980. “For better or for worse, ideology is now the vital element of organized political action.”
Reformists - and I include intellectual conservatives in that mix - have, as neoconservatives have done, accepted the New Deal and many elements of the Great Society. But their overall critique of both lies not in a rejection of the role the state must play in a modern industrialized society as so many movement conservatives do, but in the belief that value based reforms as well as more efficient allocation of resources can be achieved without destroying the “safety net” while promoting virtues such as self reliance and independence. In short, conservative reformists want to alter the liberal culture in the bureaucracy that seeks to expand their clientele rather than reduce it.
Is this a “liberal lite” approach to government? Is there enough contrast with Democrats to parlay these ideas into a successful political platform? Movement conservatives do not think so. But I believe they are viewing those toward the center through a darkened prism where attempting to address the many serious problems in our country by working with the opposition is tantamount to a betrayal. How can the application of conservative principles to the serious business of government be a betrayal - unless you believe either there are no problems to solve or the solution is to be found in dismantling government hell bent for leather.
I have been asked several times if I understand the 10th amendment or whether I believe in federalism. Sure I do - and a realistic application of the 10th as well as a healthy federalism when it comes to dealing with our nation’s problems can go a long way toward easing the crushing presence of the federal government in our lives.
But you’re kidding yourselves if you believe it will result in lower taxes or even less government. The more responsibility you pile on the states, the higher the taxes go. It would not be logical to expect as the federal tax burden is reduced, the state tax burden wouldn’t increase.
We all believe that there are many programs at the federal level that could easily be transferred to our state legislatures. Just don’t expect taxes to go down because most of those programs have constituencies of ordinary Americans that depend on them. Weaning people “for their own good” from government would be received contemptuously - and well it should be - from those who benefit directly from federal programs some would wish to do away with.
Sorry for the digression but I think part of the problem with movement conservatives and their attitude toward reformists is that they misunderstand motives and intent. The widespread belief that reformists have no principles is laughable - and fighting words if you try and accuse me of such a ridiculous notion. Applying conservative principles to the operation of government is a worthy and - dare I say - principled goal. The confusion comes in identifying “issues” as principles - a trap ideologues fall into regularly. Substituting dogma, which by its nature can be transient responses to momentary openings offered by the opposition, for immutable principles which, by definition, are unchanging, is what ideologues in the movement are all about.
In short, it is not I who lack principles, my ideological friends.
Weisberg correctly, I believe, diagnoses the switch from intellectual principles to ideological dogma and gives us a turning point of sorts while incorrectly observing the reason why a principled conservative could never support Obamacare:
There was no clearer sign of that shift than the effort by Kristol’s son, William, to prevent any health care reform legislation from passing in 1993—on the theory that the political benefit would accrue to the Democrats. Today, that sort of Carthaginian politics has infected the entire congressional wing of the GOP, which equates problem-solving with treasonous collaboration. Though the president has tried to compromise with them in crafting the last missing piece of the social insurance puzzle, even allegedly moderate Republicans are not interested in making legislation more effective, less expensive, or in other ways more conservative. They are interested only in handing Obama a political defeat.
That’s a pretty shallow, partisan analysis of why Obamacare is being opposed. I agree there is that partisan element to the opposition, but it is obvious Mr. Weisberg lives a sheltered life. Otherwise, he would have noticed that health care reform town hall meetings held by Congressmen were just chock full of people who could care less about Obama being defeated, and cared a great deal more about liberals fiddling with the most intimate, and personal part of their lives; their own health.
I have argued that there was much fear mongering on the right (and some on the left as we have seen with Mr. Grayson and several liberal ideologues) that contributed to the anger. But Weisberg is only fooling himself if he didn’t recognize the underlying reason why people who had never taken a stand on anything in their lives showed up at these meetings and howled bloody murder. If it comforts Weisberg and other liberals to believe it was all astroturfed mobs of rabid, enraged, fearful conservatives - fine. Fooling oneself is not a fault confined to the right.
But Weisberg has a point about how political opposition has deteriorated into a mindless nihilism that offers little in the way of alternatives (although the GOP health care reform plan was both substantive and ignored by the media and Democrats) on issues that need to be addressed.
For health care, as long as Democrats insist on offering a “solution” that will ultimately result in a single payer system of insurance and decisions made by government that are better left to a patient and his doctor, conservatives will oppose them with every fiber of their being. We do not see national health care as the “the last missing piece of the social insurance puzzle” but rather as an insidious attempt by government to control the personal lives of citizens - as fundamentally against conservative principles and our concept of individual liberty as anything that has ever been proposed by an American congress.
I agree with much of what Weisberg has written about intellectual conservatives and their failure to either fight the ideologues politically or challenge their dogmatism. Richard Posner saw this months ago:
My theme is the intellectual decline of conservatism, and it is notable that the policies of the new conservatism are powered largely by emotion and religion and have for the most part weak intellectual groundings. That the policies are weak in conception, have largely failed in execution, and are political flops is therefore unsurprising. The major blows to conservatism, culminating in the election and programs of Obama, have been fourfold: the failure of military force to achieve U.S. foreign policy objectives; the inanity of trying to substitute will for intellect, as in the denial of global warming, the use of religious criteria in the selection of public officials, the neglect of management and expertise in government; a continued preoccupation with abortion; and fiscal incontinence in the form of massive budget deficits, the Medicare drug plan, excessive foreign borrowing, and asset-price inflation.
By the fall of 2008, the face of the Republican Party had become Sarah Palin and Joe the Plumber. Conservative intellectuals had no party.
Nor, I trust, will they have one anytime soon.
That’s stretching things a bit, boys.
I’m sure in most cases you’re right, but that’s not how I feel. I don’t have an interest in sports and I don’t analogize life to team sports. It’s not a we win, you lose thing to me. I don’t want to shuffle off to my death bed counting victories, I want to understand. I want to understand better at the end of each day than I knew upon waking.
In my lifetime liberals have taught conservatives about Civil Rights and conservatives have taught liberals about economics. That’s a net plus all around. That’s why we need intelligent debate and not political coup counting. That’s why I want a functioning conservative intelligentsia because (shock!) sometimes they’re right and when they’re right I want to know about it.
Comment by michael reynolds — 10/6/2009 @ 11:43 am
Rick,
Thank you very much for taking the time to write from a thoughtful point of view. Yours is the first blog I’ve come across that discusses conservatism in ways that don’t rely mostly on vicious or vapid attacks, and instead had more in common with what I’d find in my old college Critical Thinking textbook.
Thank you also for including and responding to intelligent commentary from other sources. I’ve used your blog as a base for me to find other thoughtful conservative outlets. When I find words or phrases I don’t know (’sinecures’, from your quote of Weisberg) all the better.
I don’t believe I know enough about the subject of intellectual conservatism yet to respond thoughtfully to what you’ve written. I will therefore limit my comments by saying that I’m trying to understand better your position on healthcare reform. Specifically when you write, “We do not see national health care as the “the last missing piece of the social insurance puzzle” but rather as an insidious attempt by government to control the personal lives of citizens - as fundamentally against conservative principles and our concept of individual liberty as anything that has ever been proposed by an American congress.”
I look forward to reading your future blog posts, both to learn more about conservatism and in particular to try to understand your point of view regarding healthcare reform.
Comment by Jeremy G. — 10/6/2009 @ 1:22 pm
From one of the other western democracies (but not a european country) I still struggle to understand the fear of universal healthcare. Does it not seem interesting that it has never been abandoned in any country that has adopted it. Why do conservatives think that universal healthcare means more interfearance in their private lives than private health insurers already have?
It’s a good question and I will answer it this way.
The notion that government should run anything as big and complicated as health care is an anathema to people who view any one entity aggrandizing that much power with suspicion. It has always been so and is one of the pillars of American exceptionalism. People who constantly demand more of government do less for themselves and abandon responsibility for their own lives. This is the essence of personal liberty - another pillar of American exceptionalism.
It is a dying notion - probably be dead when my generation is gone. But the concentration of power and loss of personal freedom associated with a government takeover of health care is why I am opposed - no matter how well intentioned the idea.
One insurance company, no matter how big, is a gnat compared to the gargantuan size of our government. Americans will put up with a lot from a corporation but their backs stiffen when its government telling them what to do. That is our nature and has been since the beginning.
ed.
Comment by yoyo — 10/6/2009 @ 5:00 pm
Good government is government that works as advertised. I fear nationalized healthcare because I don’t trust politicians or bureaucrats to keep promises.
I see what’s happened to our schools. All the tax money spent on eradicating poverty made the problem worse. Social Security was a good idea until politicians started using the interest from Social Security deposits for general purposes. Now the program’s ability to support my generation is in doubt. And given our deep recession, how are we going to pay to a new health care program?
I don’t hate Government per se. It does do a good job in some areas like building roads, sewers, and utilities. I’m grateful for police, fire, military, and the occasional, heroic public school teacher. But by and large, the Americans inspire me the most (people like Martin Luther King and Milton Friedman) never held government office.
I just think the human race is hundreds of years away from solving thorny, societal problems. Our economists and sociologists may be at the same point as William Harvey who discovered blood circulation 400 years ago. Yes, we’ve learned much, but we still have a long, long ways to go.
Thanks Rick, for the great posts. I’ve learned much from you and the comments. I think Michael Reynolds expressed it well that liberals and conservatives are at their best when they are learning from each other.
Comment by Doug King — 10/6/2009 @ 6:37 pm
“The confusion comes in identifying “issues” as principles - a trap ideologues fall into regularly. Substituting dogma, which by its nature can be transient responses to momentary openings offered by the opposition, for immutable principles which, by definition, are unchanging, is what ideologues in the movement are all about.”
Why does the Truth always reverberate like poetry?
Comment by busboy33 — 10/6/2009 @ 9:47 pm
@Doug King:
“I fear nationalized healthcare because I don’t trust politicians or bureaucrats to keep promises.”
This I can agree with completely. My support for healthcare reform is not something I came to regardless of this problem . . . but despite it. I trust the private Insurance industry less than I do the government.
There is no doubt in my mind that government health-care will lead to waste, abuse, the consolidation of political pull, ineffeciency, etc. They are the government, it’s inevitable. But even with all of that, the government isn’t saddled also with greed on a case-by-case basis. Private companies have a real, powerful incentive to deny coverage (profit) affirmatively, and that strikes me as more dangerous than passive incompetence.
It’s not a choice (from my eyes) between a good and bad option, but a choice between which is worse. Does the negative of extra government outweigh the benefit of universal healthcare? I don’t like government . . . but in my heart no. It does not.
Comment by busboy33 — 10/6/2009 @ 9:58 pm
Speaking of the 10th Amendment, isn’t having the individual states deciding upon and managing the majority of citizens concerns the greatest beauty of American federalism? (That is to say, having the federal government in charge of things too big for the states to handle and the states in charge of everything else.) I still don’t see why universal healthcare can’t be decided and solved by each state under a federal mandate and broad rules governing state-to-state health care regulations. Let the market decide; states that manage health care well will prosper and states that bungle the job will see in increase in migration.
Comment by Anonymous — 10/6/2009 @ 10:53 pm
Sorry, that was me up there in comment #7; forgot to re-input my information after I reset my browser.
Comment by Surabaya Stew — 10/6/2009 @ 10:57 pm
“I disagree with conservatives who say the president’s race doesn’t play a role with a small, but significant minority.”
I’m curious. With whom does his race play a roll? Conservatives or Liberals? There are bigots and racists on both sides. BOTH.
But the only peeps playing the race card these days seem to lean a bit to the left.
Comment by Jenn of the Jungle — 10/6/2009 @ 11:18 pm
“I am waiting for the inevitable absorption of the tea party movement into the Republican party. All that energy has to be channeled somewhere.”
And I wonder how the Republican Party will be affected by the absorption of all those populist rent seekers.
Comment by sam — 10/7/2009 @ 4:24 am
“For health care, as long as Democrats insist on offering a “solution” that will ultimately result in a single payer system of insurance and decisions made by government that are better left to a patient and his doctor, conservatives will oppose them with every fiber of their being.”
This is the main flaw in conservative thinking on health care..
They actually believe in the fantasy that “a patient and his doctor” can make decisions without any influence from insurance companies who deny choice motivated solely by profit..
They see the government as a potential “middleman” while denying the obvious fact that “for profit” insurance companies already play that role..
They don’t get the fact that a “not-for-profit” government insurance plans only function and purpose would be to serve their clients, not corporate stockholders. They would not exist to make profit. They would exist to provide the service..
Comment by Moltenorb — 10/7/2009 @ 4:32 am
As far as the public option goes, using the argument that the government would get between the doctor and the patient is just plain wrong.I saw a doctor being interviewed yesterday who said right now the insurance companies are getting between doctors and patients, that insurance companies are “rationing” what a doctor can or cannot do. So lets drop the fear tactic about how the government will decide doctor’s decisions.
If you can’t tell the difference between “the government” and an “insurance company” then there is no use trying to discuss anything rationally with any of you.
ed.
Comment by Joe — 10/7/2009 @ 5:11 am
Rick, well written as usual, and I mostly agree with you that the government can’t be trusted to run a program this large, we already see it struggle with similar programs. Still, can we make steps in a direction to remove the issues that cause people to lose care, become unable to afford care and ultimately bankrupt themselves to keep themselves and their families healthy? At this point I am more for regulation than overhaul, but I haven’t seen anyone trying to make the steps in any direction, it always seems to be an all or nothing.
Like others I see this statement and I have to keep scratching my head, “decisions made by government that are better left to a patient and his doctor”. Not because I think the government will do it better than an insurance company, but because there is a middle man there. If that middle man is such a problem then how do we get rid of it? If its a matter of WHO that middle man is then aren’t we just switching from one to another (which I will agree is bad) and in that case I don’t want that one to be come civil servant. If its a matter of WHO that middle man is, who do Conservatives want that person to be? I haven’t seen their suggestion yet, but I also haven’t read all the alternatives.
All I know is that over the years my health care is taking more and more out of my pocket, procedures are getting more expensive and now that I am in a state that demands I pay my own I see more how outrageous the prices are for what you get. The market doesn’t resolve everything, nor is it the only solution out there.
Comment by boyo111 — 10/7/2009 @ 6:43 am
Rick says:
“If you can’t tell the difference between “the government” and an “insurance company” then there is no use trying to discuss anything rationally with any of you.”
Insurance company: Motivated only by profit, and responsible to stockholders, not the welfare of the public.
Government: Not for profit, and responsible for the welfare of the public.
Can YOU tell the difference Rick?
Comment by Moltenorb — 10/7/2009 @ 8:27 am
Of course there is a literal difference. Of course you can tell where the divide is.
Perhaps you haven’t had the joy of dealing with insurance corporations on the same level that some of us have. You try fighting for a procedure for you child that your insurance corporation says is unnecessary, but your doctor says is. You try dealing with that while your kid is literally laying in a hospital bed and then tell us where the difference would lie.
Eventually you reach the point where you say, how could a government system possibly be worse than this?
Comment by Chuck Tucson — 10/7/2009 @ 9:37 am
[...] ISN’T DEAD: CHANNEL YOUR INNER ELDER THE RICK MORAN SHOW: WHY CHICAGO - AND OBAMA - LOST INTELLECTUAL CONSERVATISM ISN’T DEAD: WOULD YOU BUY A USED CAR FROM A LIBERAL? (PART II) INTELLECTUAL CONSERVATISM ISN’T DEAD: IT’S RESTING NO LETDOWN FOR MY BELOVEDS VS. LIONS [...]
Pingback by Right Wing Nut House » INTELLECTUAL CONSERVATISM ISN’T DEAD: CHANNEL YOUR INNER ELDER — 10/7/2009 @ 10:34 am
Rick,
As usual, a well written, insightful piece. As a former conservative-turned-democrat-turned-politician-hater, I appreciate the angle of the piece, but I believe it is missing something. The ideology of conservatism has mixed with what I’ll call the “faith-following” nature of religion, and has led to a very disturbing confluence in the Republican party. While is has obviously become very ideologically-driven, and openly hostile to ideas that are not its own, it has also become openly hostile towards intellectualism. This is, in my opinion, one of the most disturbing trends. It discourages independent thought and research, relying instead on a truly corrupted media of its own to spread hateful and ignorant ideas (most often predicated on lies). Since the triumph of W over McCain, this has truly turned into a vicious spiral, of which Sarah Palin is merely a symptom (though an excellent example) of an anti-intellectual creed. Regardless of your intelligence or eloquence, the Republican party is truly at a crossroads and appears to unfortunately be diverging from you.
As long as you have a very corrupted right-wing media motivated by greed and ratings rather than constructive dialog aimed at addressing and solving some very fundamental, systematic shortcomings in our political system, you will continue to have the portion of the Republican party that considers themselves very religious (mostly the evangelicals obviously, but not exclusively) led down this road like the sheep they have proven themselves to be. I fail to see how your intellectual conservatism can take root in the modern Republican party any more than intellectual liberalism can. This is the unfortunate state of affairs that drives intellectual conservatives such as myself away from the party.
This of course is not to defend the Democrats in any way. But I believe you do find them embracing intellectualism and problem solving in this environment, although whether that’s because they have the luxury of doing so because they’re in power remains to be seen.
I will bring up my constant rallying call which I posted previously on your blog. A third party is the only viable alternative right now. We have often said it is not a realistic expectation, but I do not buy that. Given enough resources (think: Bloomberg), you could truly capture a very large part of this country that sits squarely in the center - they want practical government that abides by the constitution, provides a certain level of a safety net for those that need it, and regulates business in an independent, non-corrupted, minimally intrusive manner.
Just a humble opinion of course, but one I continue to promote in the hopes that it will catch hold. It has happened many times in the past in our political system, and can certainly happen again.
Comment by Dave — 10/7/2009 @ 10:44 am
Chuck:
I think you point to the essential disconnect: most people don’t deal with insurers, their employer does. Which is why talking to most people about insurance companies is like talking to a virgin about sex. They are utterly clueless. They have literally no idea what they’re talking about.
But the employer-provided model is dying and more and more people will soon enough be dealing with insurers directly, and then they will be very quickly disabused of their little free market fantasies.
I’d love to see someone do a poll on this. Because I suspect the percentage of self-employed people who favor a government plan is far greater than the number of cubicle workers who feel the same.
Here’s the quick test: anyone who rants about government imposing rationing as though this were something new is either clueless or a liar.
To put it in the starkest possible terms: a policy holder who dies at 50 is very profitable for private insurers. That’s a big win for them. One who lives to be 80 is a money-loser. Worshippers at the altar of the free market should think long and hard about that fact.
Comment by michael reynolds — 10/7/2009 @ 11:04 am
So not-for-profit government insurance plans would be superior to private for-profit insurance companies? I would like to see this substantiated, and supported with reasonable evidence, that a government-run anything would be more effective all around, and with every assumption made in the calculation well-justified and not idealized.
From working around the federal government for most of my life, I have witnessed far, far too many deadheads manning the decision and administrative posts, and a ratio of effective employees to such deadheads to be about 1 in 10 at best. With such a ratio, I cannot imagine that any government-run organization would compete well with a private one, but there must be one or two somewhere just to prove the rule.
I have also witnessed the thrust by each organization not only to preserve itself, but to grow with each budget cycle, thus increasing its importance, influence in government, number of employees, opulence of its digs, stature of its executive class, and, even worse, to increase its scope to include more and more of the subject area concerned and its critical decision-making authority. Builders in DC have made enormous fortunes from the creation of ever larger agencies of the federal government.
Almost never, however, do the feds work to streamline operations, raise the quality of employees, or reduce their budget. Droves of marginal employees are shuffled around every year from agency to agency, thereby helping one group while burdening others in their turn. Few are fired for incompetence. Any new organization would fall into the same pattern, I believe, and would initially be the happy repository of all the deadheads that could be scraped up from other agencies. The number of employee hours wasted on long and fruitless meetings while their betters work the problem out in closed session is truly astronomical.
The idea that the government could execute our entire set of health programs with reasonable results sends me into a deep fear state. Those that hold to this idea are utopians and idealists that should never get close to deciding health matters for the public.
Comment by mannning — 10/7/2009 @ 12:08 pm
Mannning:
It’s not solely a question of efficiency. It’s a question of motivation as well.
The core motivator of government is re-election, a continuation in power. I suspect you’ll agree.
The core motivator of business is profit. I suspect you’ll argree with this as well.
Lots of voters without health insurance, or denied care is antithetical to the government’s core motivation. Dead voters don’t vote so much. And the relatives of dead voters have a tendency to vote out anyone they hold responsible.
But dead policyholders are wonderful for business so long as they die early. There is a very clear motive for insurance companies to collect premiums all through a person’s healthy years and then abandon them as soon as they begin to require service. Again, this isn’t controversial, it’s simple logic.
Thus far, unarguable.
So if we grant that private insurers are more efficient, but grant also that their profit is maximized by minimizing our health care, precisely how is their efficiency a good thing?
Comment by michael reynolds — 10/7/2009 @ 12:24 pm
Notes on Posner’s screed:
Failure of Military Power—-This is now the province of a liberal government struggling rather ineffectively so far with Iraq, Afghanistan, North Korea and Iran.
Substituting Will for Intellect?
Denial of Global Warming— This has little to do with conservatism per se; rather, it is concerned with the wholesale tinkering with scientific evidence to reach a political conclusion, and a probable vast increase in government power over businesses and citizens to our financial detriment.
Religious Criteria—is this a complaint that few atheists were given public office? Or, is it that the Bush government still adhered to religious morals, and hence hired officials that understood what such morals are, despite the ravings of secularists and the ACLU? It is very simple: between two equally qualified candidates, the differentiators may well have been their relative moral positions and their belief or non-belief in God.
Neglect of Management and Expertise in Government—now owned by the Obama administration, with seriously negative consequences, such as 30 largely unknown, radical and unvetted Czars in the White House, and the specter of huge new government agencies arising from liberal programs. Perhaps the neglect is also yet another complaint that atheists were not generally sought for high positions.
Abortion—Still an issue? The issue will not go away, much to the chagrin of abortionists and their sympathizers. The toll grows every year, now surpassing 50 million killed. At what point will this statistic bite home? At what point will the immorality of abortion be recognized?
Fiscal Incontinence—Look to this new administration for a super example of incontinence! Obama has perhaps anywhere from 7 to 12 times the debt problems the Bush Administration had, and is blithely going about increasing the debt. It will take fiscal conservatives in power real soon now to rescue us from this mania.
Comment by mannning — 10/7/2009 @ 1:44 pm
Let us approach medical care from a different view. We all need such care from time to time, and the frequency and seriousnes of that need usually increases mightily as we age. Thus, costs for care rise with age. In the extreme, medical science now knows how to maintain life for a long time–long after the spark of consciousness and intelligence is gone. We have a few mechanisms for terminating such patients, centered on the desires of the patient himself in writing (AMD), the advice of doctors, and the decisions of close relatives.
If the government enters into this decision via their healthcare programs, will they support the decisions of the patient, the doctor or the relatives? Suppose the patient wants to remain on the tubes; the doctors agree that they can maintain him on the tubes; and the relatives also agree. Does the government agree also?
Try other mixes of desires: patient–no; doctors–yes, and relatives–no. Government? If their motivation is to keep a voter alive to the last moment that he can vote, what then? Rediculous. Who writes the rules for final death here? The government? Who has the last word in each case? The government? Who pays? The government?
Now change out government for the insurance company.
It turns out that the Insurance co. can only deny financial coverage at some point, so the decision would be left up to the patient, doctors and relatives, and their ability to pay, or their rationalization that the patient should be allowed to die anyway. There would be no government involvement in the decision.
Which do you prefer?
Comment by mannning — 10/7/2009 @ 2:27 pm
Manning:
I prefer government, because your case makes no sense.
If the government enters into this decision via their healthcare programs, will they support the decisions of the patient, the doctor or the relatives? Suppose the patient wants to remain on the tubes; the doctors agree that they can maintain him on the tubes; and the relatives also agree. Does the government agree also?
The government has zero motive for trying to end coverage. As we’ve all observed, the government has little difficulty spending money — even when they don’t have it. The government has no need to make a profit, the insurer does. So it is quite clearly the insurer who has a motive for cutting off or limiting or interfering with your health care decisions: the more they interfere, the more profit they make.
You’ve just successfully proven my point: when I’m 80 the government will still want my vote and the votes of my friends and relations. So they “profit” by acceding to my wishes.
But when I’m 80 I’ll represent nothing but a drain on insurers whose motive is necessarily profit and who would, quite clearly, profit from denying me coverage.
Sorry, but the logic is air tight.
The only mystery is why Republican voters — who despite being slow, must be able to perform this same reasoning — choose to side with insurers. You don’t suppose it has anything to do with insurers spending a lot of money to spread lies, do you?
Comment by michael reynolds — 10/7/2009 @ 2:41 pm
Dear Rick
Once again I seem to be missing the point of your concerns with intellecutal conservatism vs movement conservatism. I guess I am somewhere in the middle since I remember WFB on Firing Line and editing NR and Ronald Reagan being President.
I remember the complaints about Ronald when he was President that he was compromising with the Dems because of whatever reason was in vogue at the time.
However, we must always keep in mind the politicians need to govern and make the trains run on time and deal with the government that exists while in office.
On that note I think you deny credit to practical politicians on the Right like Bill Thomas and for a time Rick Santorum. These two were two of the prime public movers behind Welfare reform the and Medicare Presription Drug Benefit expansion. I think they serve as two examples of conservative governance in action and problem solving at work. Welfare reform actually reduced recipients admittedly the booming economy in the late 90s played a role. Also despite the flaws in the way the legislation was passed the Prescription Drug benefit is one of GWB crowning domestic achievements along with cutting capital gain rates to 15%
BTW I do believe he would have achieved more sucess with No Child Left Behind had he operated in the political environment of 2003 rather than 2001/2002 but that is a debate for another time.
I have no idea why compromise with the Obama admin and the popular left is evern considered. Rick these are not our Father’s Democrats. We can do a deal with John Brezux Bill Nelson Joe Libermann and Diane Feinstein but the Netroot ninnies with Nancy Pelosi etc. I cannot think of a powerful conservative Dem in the House. Perhaps they will emerge if they survive the Republican backlash after 2010. This is all specualtion at this point we will see
Comment by Kevin Brown — 10/7/2009 @ 4:10 pm
@manning:
I’m following and respecting your analysis in #22, but I have to agree with MikeReynolds on this one. Your last paragraph started:
“It turns out that the Insurance co. can only deny financial coverage at some point, so the decision would be left up to the patient, doctors and relatives, and their ability to pay, or their rationalization that the patient should be allowed to die anyway.”
But that is demonstrably not true. The endless examples of Insurance companies denying coverage for profit are legion. Most come from insurance industry insiders. That the insurance industry is objectively paying bills in a disinterested manner is jsut not credible.
Do people have trouble getting coverage at a VA facility? Sometimes, yes. Sure. But does coverage get denied more from the government than from a private insurer? Anecdotal evidence says no. Personal (limited) experience says no. Why are seniors by and large so satisfied with Medicare? Because it pays the bills. Wastefully, ineffeciently . . . but it pays the bills.
With a private insurance claims adjuster, if they can make an argument to deny coverage for a big bill they can get a bonus. They can get promoted. They have a reason to try and deny coverage. A government adjuster? They get paid the same whether you get the treatment or not.
As I said before, I’ll take indifference over active negative intention any day. In a perfect world, I’d take active beneficience . . . but that’s not on the table.
As you have said, the government is known for wasteful spending. Why would they manage a health-care plan with an eye toward maximizing profit? I have semi-public recourse options to fight against the system if there is a problem, something I wouldn’t have against a private insurer.
More expensive? Possibly . . . I’ll go so far as to say probably. But just as there is nothing more expensive than the second best military, there is no benefit to a slightly cheaper health insurance plan that doesn’t pay the bills.
Comment by busboy33 — 10/7/2009 @ 5:01 pm
Both of you–michael and busboy– seem to have misread what I said. Insurance companies can and do cut off coverage when they can justify it to themselves and any state regulators that look into the case, but they are not totally without heart. That does leave patients, doctors and relatives to decide how far to go at that time of cutoff, however. No government involvement exists in the decision to keep or cut off the tubes.
You both seem to be claiming that the insurance companies would definitely cut off coverage far, far earlier in the stages of the patient’s illness. That has not been my experience at all in the six family terminal cases where I have been the “selected decision relative” or whatever that is called. The insurance companies, all different, carried their share of costs all the way until death for all six of my close relations, and they were terminally ill for many months as it was. The insurers subordinated their decisions to the doctors, and the doctors consulted with me to determine the course of action. No government involvement was there.
If you have ever been in the position of listening to a loved one begging to die for weeks and weeks because of the total hopelessness of their situation and the agony they are in, you would not welcome some government type injecting himself into the case and telling you that they will keep your mother or father or wife on machines for some weeks to go, and never mind what you or your relatives think. Voting time is some weeks away! Totally Idiotic!
It is silly, no, diabolical, to put the government into this decision loop if the government’s paramount motive is to keep a very sick person, who may be in great agony and hoping to die soon, alive for a time far beyond their personal wishes, or the wishes of the relatives in charge, simply because the government can afford to do so and wants votes!
This brings up the other point that under such a diabolical scheme, it is probably the case that there are not enough facilities, doctors, or nurses to go around to keep everyone alive as long as medically possible (but humanly cruel), and there IS a limit to the government’s largess and tax base, though I have not known of liberals to recognize that fact lately.
Good luck to you both in your personal end game with the government!
Comment by Mannning — 10/7/2009 @ 9:55 pm
Mannning:
I’ve offered you nothing but logic. You’ve not even directly addressed any of my points. You can’t, of course, because they are simple statements of fact.
You are operating from a visceral dislike and distrust of government. But you offer no support for your emotions. Because you have none to offer. Just pure reaction, emotion, ideology.
Your emotions, however formed, and however justified you may feel they are, are not facts or logic or arguments. They’re just restatements of your mind-set, your particular prejudices.
Your privilege obviously. But be careful about imagining yourself to be a rational actor. And consider that your emotions are not just irrational (by definition they are) but simply wrong.
Comment by michael reynolds — 10/7/2009 @ 10:32 pm
If I’m reading you comment #25 correctly, it seems your focus is on “end of life” issues, and not other treatment. You are taking the position that philosophically such decisions should not be in the sphere of government powers. That such a decision made on the basis of a private companies profits is more palatable than such a decision made by Big Brother.
If I’m reading your focus right (I may not be — tell me if I’m not), I have two comments.
First — they already are the government’s responsibility. The judiciary deals with such issues . . . not health insurance providers. You provider (public or private) does not have the legal authority to kill you. That’s why IMO Republicans made complete asses of themselves with the Schiavo case. The State law was clear. The matter was litigated over and over. The federal government wanted to step in and dictate care for an individual, in clear contravention of Federal and State law. And Conservatives supported it in droves, even going so far as asking the Republican Judge that followed the law not to come back to his church because he wouldn’t be an “activist” judge.
http://www.jesus-is-savior.com/Evils%20in%20America/Euthanasia/Terri_Schiavo/judge_greer_asked_to_leave_church.htm
Don’t want to have the plug pulled on you? Get a Living Will. Any attorney worth their salt should be able to draw one up for 100 bucks. The decision is not between you and your doctor . . . its between you and your God. Whether you have public or private insurance, the issue is legal, not a matter of policy.
Second — think about what you are implying. The insurance provider makes these decisions (they don’t as I discussed above). How could leaving that decision in the hands of a private, for-profit company possibly anything but a recipie for disaster?
“This brings up the other point that under such a diabolical scheme, it is probably the case that there are not enough facilities, doctors, or nurses to go around to keep everyone alive as long as medically possible (but humanly cruel), and there IS a limit to the government’s largess and tax base, though I have not known of liberals to recognize that fact lately.”
Agreed. However, how does this argument impact the relation between coverage from the government and coverage from the private sector? The Government is bigger and richer than private companies — if they can’t pay for everything, then private companies by necessity are going to be able to provide less. Are you advocating for less “end-of-life” care? Are you advocating for pulling the plug, regardless of what the patient wanted?
You threw that out and just left it ominously hanging there. You are implying something — what is it?
Comment by busboy33 — 10/8/2009 @ 1:39 am
The only thing health insurance providers are responsible for is to pay for covered items–or not. They are not responsible for life or death decisions, and I never said they did.
My first point, and it is logically clear, is that the life or death decision for a patient currently resides with the patient, or his appointed relatives, with medical aspects of the decision contributed by doctors, and with no input from the government. This is fact which I supported from personal experience.
My second point is that it is diabolical to bring the government into this decision if the only motivation of the government is to prolong the life of the patient so that he can vote,when it is totally against the patient’s wishes to continue to live. This is a disgusting idea unworthy of rational people.
You are trying to misinterpret my statements yet again. I am NOT saying a thing about the insurance provider’s decision to stop or continue paying, except to point out that when the provider stops paying, it throws open the necessity to make a decision on how to proceed. (The key cost factor is at what point in the progression of the illness does the provider decide to withdraw.) Here, it is the patient or his representative, with doctors help, who decides the further course of action. There is no government involvement in this decision. Fact again.
With the government as provider, and as the determining member of the parties concerned—including the patient, doctors, and relatives–it is the government that has the final say whether to extend the life of the patient or not. Under the diabolical scheme, the government wants to prolong life for as long as possible, whether the patient wants that or not. That was your position, and it is truly disgusting. (It is obvious that if the patient wants to live and the government wants him to live longer, all is well and good, until the patient reverses himself and desperately wants to die as his illness progresses, but the good ‘ole government says NO!) FACTS AGAIN.
Of course, the reverse is also true. The patient may want to live, yet the government, in its great wisdom decides that the patient’s life is over, so it refuses support. Consistency is hard to ensure in government decisions over time.
Fact.
To attempt to make my statements entirely emotionally driven is rather shoddy work, and unworthy of a thinking person. I used an emotional circumstance to illustrate one of the horrors of the diabolical government approach.
At a higher level, it is obvious that the government could afford more end care than a private company, up to some cutoff point where the huge number of patients in end care absorbs more money than the government can collect from taxpayers and allocate to end care. What happens in that case is a tough question. It becomes similar to the problem of the private suppliers in cutting off paying for care, although with far larger numbers of patients involved, yet the government would retain its life or death decision powers!
The bottom line for me is I do not want the government anywhere near me when I am approaching death, unless it is to provide me with no-strings cash gifts.I trust my doctors far more than any government weenie.
May your end game be a pleasant one:)
Comment by mannning — 10/8/2009 @ 3:41 am
Mannning says:
“To attempt to make my statements entirely emotionally driven is rather shoddy work, and unworthy of a thinking person. I used an emotional circumstance to illustrate one of the horrors of the diabolical government approach.”
A thinking person may note that your use of the words “the horrors of the diabolical government approach” is pure emotionalism..
Then Mannning says:
“I do not want the government anywhere near me when I am approaching death, unless it is to provide me with no-strings cash gifts.”
Damn…I thought you were a conservative Mannning…turns out you’re just another one of those “gimme something for nothing” liberals..
Comment by Moltenorb — 10/8/2009 @ 4:28 am
Mannning:
You don’t want the government anywhere near you. So I assume you’ll reject Medicare coverage?
How about our veterans? They get government medical care right to the end. Is it “diabolical” to have the government pay for sick and dying ex-soldiers? My father the career soldier doesn’t seem to think so.
I suspect that you have never objected to government-supplied medical care for veterans. If as you say it is necessarily “diabolical” don’t you think our soldiers deserve better? Isn’t it time to cut these old soldiers off and force them to go shopping for coverage in the free market?
Dude, you are not showing much intellectual consistency or logic on this topic. The sum of all you have to say is this: Government = Bad. A rather extreme statement for which you offer no proof.
Comment by michael reynolds — 10/8/2009 @ 8:04 am
Now you are doing the usual slide dance. Change the scope of the argument, and introduce invective, if you are pinned down. We were not talking about soldiers, the VA, or Medicare, per se.
We were talking solely about your stupid idea that you would welcome the government into the end of life decision process because they want to keep you alive so you can vote, vice insurance companies that you say will abandon you to your fate!
When I pointed out that you just might want to die, but the government would keep you alive for their reasons, you did the dance. So I assume that you actually do want to stay alive through the most painful cancers there are, because the government wants it that way. Out-of-sight rediculous!
Your evasions are sickening, and it is quite obvious that you do not want to address the end of life argument directly at all. This idea of yours is diabolical, and yet you stick to it. That is why I wished you well in your end game. I hope you do not find yourself being kept alive by the government when by all measures, except this one of yours, you should simply die.
It is in this context, and this context alone, that I do not want the government deciders anywhere near my deathbed. Just stop trying to distort this argument in a flawed attempt to defend your absolutely diabolical idea.
Comment by mannning — 10/8/2009 @ 12:56 pm
That’s good! Molt sees only emotionalism where the underlying fact is being illustrated graphically. This diabolical idea, that the government would keep one alive through the intense pain process prior to final death, regardless of the desires of the patient or relatives, simply to vote one more time is beyond the pale
Of course, Molt, you also took me literally about a gift–it was a facitious comment. What a humorless crowd! I’d say, beware the government bearing gifts!
Comment by mannning — 10/8/2009 @ 1:14 pm
Well now, my AMD sets forth the conditions under which I would prefer to be allowed to die. But, ole Michael never brought up that argument, which puts a small spike into his diabolical plan for the government to keep us alive regardless.
However, can the government ignore such a directive and keep me alive against my will? If I accept a bit of what busboy alluded to, they certainly can disrupt the game, deep six my AMD, keep me bubbling on the tubes, and in the agony of advanced cancer, especially if they want me to vote! Oh Michael, do you really believe in this?
A vote, you may recall, has to be executed by someone in their right mind, so no morphine or other pain-killing drugs for me either. This gets even more diabolical!
No, I do not want this scenario at my deathbed!
Comment by mannning — 10/8/2009 @ 1:50 pm
@manning:
I’m confused how you go from:
“The only thing health insurance providers are responsible for is to pay for covered items–or not. They are not responsible for life or death decisions, and I never said they did.”
and this:
“life or death decision for a patient currently resides with the patient, or his appointed relatives, with medical aspects of the decision contributed by doctors, and with no input from the government.”
to this:
“it is diabolical to bring the government into this decision if the only motivation of the government is to prolong the life of the patient so that he can vote,when it is totally against the patient’s wishes to continue to live. This is a disgusting idea unworthy of rational people.”
and this:
“With the government as provider, and as the determining member of the parties concerned—including the patient, doctors, and relatives–it is the government that has the final say whether to extend the life of the patient or not.”
Your first two statements are true. Your last two are absolute nonsense. Out of respect for you I won’t call them lies . . . but they are completely and clearly false in every possible facet.
The government is NOT being brought into the decision. At all. No one has proposed that the government have a voice in this debate. The absolute closest was the proposal that a government plan pay for the doctor if you meet with them to discuss end-of-life care (which you said is who you should be talking to). Pay for . . . not direct. You want to talk to your doctor, they will pay for it. You say that the provider only pays for care, not directs it. Then you say that if the government were to be the provider, they would direct care . . . and in the most cruel manner possible.
So if the provider is private, they don’t dictate care. If the provider is public, they do. Why the fundamental change in control? No reason. Depending on who writes the check, the entire paradigm of laws, rights, and precedent implodes instantly. Why? Because.
Wouldn’t the government just act as the private insurer, and so the “hands off decision-making” approach would apply to them as well? Nonsense, you say. Why nonsense? Because.
You provide the example of the government sadistically prolonging the suffering of a patient who begs and begs for death. You end this utterly disgusting example with the triumphant declaration “FACTS AGAIN”.
THAT IS A PARANOID FANTASY. It is NOT “facts”. Surely, you know that. You have made up a monster, then attacked it. That would be as silly as deciding not to vote Republican because they want to kill left-handed people in concentration camps. Surely you don’t support that? It is diabolical! Only a sick twisted person would support that. Have fun in your right-handed-only utopia!
Let me repeat this again. Nobody is proposing to make the government part of the decision-making process for end-of-life decisions. I agree with you wholeheartedly that would be a bad thing — but it is not a real fear. It does not exist. Nobody is trying to make it exist. You are railing against an evil that is not real.
“The bottom line for me is I do not want the government anywhere near me when I am approaching death, unless it is to provide me with no-strings cash gifts.I trust my doctors far more than any government weenie.”
This is EXACTLY what everybody is agreeing to. The government pays for your care. That’s it. Where did you get the idea that the government will get decision-making power, especially over end-of-life issues? It is NOT TRUE. I’ve cited the actual text in the House Bill before, if you would like I’ll be happy to find it again so you can read the actual source material. Haven’t read the Baccus Bill, but I’m pretty sure it’s not in there either.
No hyperbole, no snark. What you fear is certainly something to be afraid of, but is NOT in danger of being a threat. It is as legitimate a concern as being worried about a zombie invasion. Yes, a zombie invasion would be a bad thing. No, it isn’t happening, about to happen, likely to happen, or being advocated to happen.
I really can’t think of anything else to say about this.
If we remove the issue of end-of-life care from the table, does your opinion of healthcare reform change at all?
Comment by busboy33 — 10/8/2009 @ 2:18 pm
@manning (again):
You’ve mischaracterized MikeReynolds argument.
In Comment #20, he tried to illustrate the danger of private insurance — motivation. He tried to illustrate that private insurance had a motivation for policyholders to die before receiving expensive care. To counterbalance that, he gave the example of the government being motivated to keep people alive, ostensibly to make them happy and so they would vote for the politicians.
The issue was a motivation to provide care. Private insurance companies have an incentive NOT to provide care, whereas public insurance does have a motivation to provide care.
This presupposes something that may have been lost . . . that the patient WANTS the care. A private insurer failing to provide care is only a “negative” if the patient wants the care.
“I don’t want plastic surgery!”
“Well, we wern’t going to pay for it anyway.”
” . . . you bastards!”
What MikeReynolds was talking about is trying to get care from your insurer, and being denied. Something that is more of a threat with private insurers than with public insurers. Trying to GET care, not trying to reject care. You read that as the government forcing care on people . . . and that’s isn’t what anybody meant.
MikeReynolds is NOT advocating or suggesting that the government would tie patients down and force care on them. At all. If the goal was to gain the patient’s vote, how would torturing them get votes? Or the votes of their family and loved ones? Even if the government is evil enough to do that, it would be counterproductive.
“Please, please, let me die! I’m in agony!”
“No!! Will you vote for me?”
” . . . okay.”
???
As far as I can tell, this fundamental misunderstanding has resulted in you, me, and MikeReynolds carrying on different conversations. You are absolutely right that if MikeReynolds was/is advocating that, he’s a sumbitch. That is something we all can rally against. But he’s not advocating that.
Comment by busboy33 — 10/8/2009 @ 2:40 pm
Up until this point, I have been arguing the end-of-life problem and who I would want, and not want, to be involved in my death, and some of the whys. This was in response to a highly specific proposition that offended me.
I deliberately ignored the intermediate problem of coverage by either the government or by insurance companies and which would be better, because the end of life problem dominated my thoughts and dictated my aversion to having the government in the decision loop.
We currently have both involved: via Medicare and Medicaid, the VA and military medical care on the government side; and private medical insurance on the other side, as supplemental to Medicare, for instance, or as primary medical care via an employer’s policy. There are a few golden policies written for the wealthy, I suppose, and for Congress, but they are not dominant in the industry.
From a practical view, I do not see how we should favor one over the other: both have their place in our society. Yet, each has its flaws and needs a tuning to become really effective. I have already shown one flaw in having the government take part in the end of life decision process, which, if taken to the extreme, would overload our systems. There are several flaws in the private insurance approach that need to be addressed also. Here is a quick list of what I see as needing to be solved satisfactorily “real soon now”, and by employing conservative principles as appropriate:
1. Ensure financial security for Medicare and Medicaid
2. Ensue financial security of Social Security
3. Reform the tort system to eliminate abuses
4. Reform the administration of Medicare and Medicaid to eliminate fraud and abuse
5. Allow health insurance to be portable across state lines and from company to company, if practicable
6. Eliminate the “doughnut hole” in prescription insurance
7. Require immigrants and visitors to take out adequate health insurance in advance of entry into the US
8. Require employers of aliens to take out health insurance on their employees and families.
9. Require proper ID and medical records for all persons resident in the nation.
10.Allow or demand that insurance companies write policies for people with preconditions whose premiums adequately reflect the insurance risks, and spreads the risks as well over the policy field.
11.Address the problems of long-term care more deeply, perhaps with a joint solution between the government and private industry.
12. Address the problem of upper limits to coverage by insurers, cutoff criteria, and the ensuing problem of probable bankrupcy of the patient.
13. Further address the problem of rapid approval of procedures and medications for use by providers for patients.
14. Retain the essential free market approach, while addressing ballooning medical costs. A big how?
15. Perhaps consider an “insurer of last resort” approach to provide coverage in hard cases by industry, and not necessarily the government in the first instance.
16. Doctor compensation is a significant problem. They spend the better part of a decade in schooling, and can incur personal debts in the hundreds of thousands to pay their way, and have a highly constrained personal life during those years; many take a decade to simply catch up.
I have not seen any detailed healthcare plan that not only addresses these problems but also provides a clear and understandable means for solving them adequately, shows how to pay for them, and at the same time preserves the essential freedoms of the marketplace.
Comment by mannning — 10/8/2009 @ 3:08 pm
Well, busboy, I think you are right. We are talking past each other. I was not talking from the perspective of a healthcare bill in process. I was merely reacting to the notion that, given the authority, a government would try to preserve life, and, preserve it even to the detriment of the patient. That is all of it in a nutshell. No reading from any pending bill, merely what I read into Michael’s statements. As you agreed, such a notion is quite wrong-headed, if that is what Michael was touting. I trust you are right and he is not touting that at all. Good thing!
We do face the possibility of a government-run, single-payer healthcare system in the future, I believe, and any legislative steps that might be perceived to be in that direction must be thoroughly examined for their long-term implications.
I am not at all convinced that, if the government was the sole operator of healthcare, they would keep hands off of all the medical decision processes–including EOL–for their own rationales, motives, and political notions, and with ever less care for the patient. I am not reacting here to any specific legislation purporting to lead in this direction, but to the basic principle of rejecting government intervention ever further into our lives.
What knits those statements together you highlighted is the opportunity that seems to be growing for government to increase its role in every direction, and EOL is a critical one. To dredge up an old saw: he who pays the bills calls the tune. If they can, they will, or at least try. My opinion. A line must be drawn somewhere.
I will leave it at that.
Comment by mannning — 10/8/2009 @ 4:05 pm
Who in f–k’s name is talking about forcing medical care on people?
Only Republicans do that, and then only if your name is Schiavo.
Jesus H. And we wonder why the conversation goes nowhere.
Yes, Mannning: the federal government is going to force you to stay on life support forever . . . forever . . . forever . . . Because, um. . . Um . . .
It’s like trying to talk to the crazy guy who pushes a shopping cart around muttering about the CIA.
Comment by michael reynolds — 10/8/2009 @ 7:22 pm
@manning:
I just couldn’t figure out how I was 100% agreeing with everything you said but kept getting to the end and going ” . . . yeah, . . . yes . . . ye-what? No. . . . nonono, wait, . . . wait, no, what happened . . .”.
If I thought there was the slightest chance they were trying to seize control of “end-of-life” decisions I’d be screaming bloody murder right next to you. Regardless of our conversations, I hope I’ve at least displayed a consistent “oppressive government sucks” belief system. We may disagree with what “oppressive” and “government” mean precisely . . . but some things aren’t “near the line”. I’d be center-of-the-Sun balistic if a US Administration tried something like that, and I CERTAINLY believe with every fiber of my being that Administrations are capable of doing something so morally obscene. You know I’d be screaming bloody murder if Bush tried anything like that, all I can do is swear I have zero “party loyalty” to Obama. He and his can absolutely go to hell if that happened.
You’ve been through it. I’ve only seen it from the distance of a desk . . . and I don’t ever want to think about how horrible what little I had to see was again. You said that things went “smoother” for you because you were designated, the painful conversations were had with loved ones and doctors. You mentioned your AMD (I’m guessing Advanced Medical Directive?). You wrote down what you wanted to happen.
Please everybody, for God’s sake, whatever State you live in:
GET A LIVING WILL, AMD, DNR, WHATEVER THE PAPERWORK FOR YOUR STATE REQUIRES. You do not (notnotnot) want to see what happens when there isn’t the proper paperwork and discussions. Even with all the proper paperwork . . . it is a very, very painful and not-nice situation. You will not like it. Without covering your ass legally . . . you will really, really not like it. If the government has to deal with it, everybody involved will suffer. Yes, there is an extremely high chance you won’t need it. But you might. And if you don’t have it then you’re going to be very sad. Really, really, God-damned sad.
Seriously people — get the paperwork.
manning — Obama dreams about hoping to attempt to maybe try to mess with EOL for one second . . . you give me the caliber, I’ll bring the cartridges. I don’t see it today, but if you show something to me in the future I’ll even give each round a spit-shine. Just imagining it is getting me pissed off.
You think I had a grudge against Bush? Hell, I always thought he was a jagoff (a nice jagoff . . . but a jagoff regardless). I actually think Obama is Not Utterly Pathetic, which is the highest ranking I’ve given a President since I was 6 (Regan’s hair rocked). If I was betrayed by a jagoff that slipped past my jagoff radar . . . that’s a cold flame of hate right there.
And my sympathy for having to grind through EOL dramas again and again. That must have sucked to a jaw-dropping extent.
Comment by busboy33 — 10/8/2009 @ 11:58 pm
You got it, busboy! 9mm P (Lugar)–that fits most of my weapons, including the carbine. Yes, AMD is Advanced Medical Directive, which our hospital promotes at every turn, and gets you to update at each opportunity.
The difficulty I see in all of this is that people simply do not believe that the US government can grow to be your worst enemy in certain domains. The old “I am from the government, and I am here to help!” says it well.
Things usually begin reasonably well in a new agency or department, with high hopes and a ferver to do something to serve the public. It goes downhill from there, some rapidly, and some more gradually, until you can’t read their “mission statement” without derisive laughter.
This isn’t merely an emotional bias with me, because I have seen this phenomena several times over first hand, and it is my government that is screwing up mightily, which is painful to witness. The more complex the issue, the more likelihood there is for a screwup, and the more layers of bureaucracy that become involved. Once it is bucked high enough it becomes politicized, and all hope is lost. We all have shudders from the Terry Schiavo experience. I could talk about quite a few more flubs in government that are equally appalling.
Don’t get me started on the Engineer Corps and New Orleans, for instance, or on the INS and State, illegals, and visas.
In the medical field, I believe the government is just about far enough into the problem. We need solutions, for sure, but most of them can be accomodated without the government crashing through, taking a heavy managerial role, and creating major opportunities for mission creep, egregious errors, and bumbelitis for the next decades. A few rules and regulation changes might be in order, but I’d keep the government bureaucrats away from the field!
The real brainpower in the field is with the doctors, and I cannot imagine how the government could match their collective talent and knowledge across the full spectrum of medical problems in a timely manner, much less for them to keep up with new developments adequately.
In another vein, I voted for Bush twice, and I believe we ended up with the better choice each time, but from the outset of his second term I was greatly disappointed with his efforts and the efforts of his party in Congress, and in what I believed to be the total mismanagement of the Iraqi situation.
But, then, I am far, far more disappointed with Obama, his czars, and his leftwing ilk, and I think I’d have been disappointed with McCain too. The nation thirsts for a leader that we can have confidence in to get us rolling again and it shore ain’t Obama. He is far too devisive.
Comment by mannning — 10/9/2009 @ 2:09 pm
Fingers did not spell correctly: divisive is right!
Comment by mannning — 10/9/2009 @ 2:12 pm
Don’t know if this thread is being checked anymore . . . but I’ve been thinking about this for a few days and just wanted to add this:
I certainly accept that people with power (government) should always looked at suspiciously if they try to expand/retain their power. “I don’t trust ‘em” is smart thinking in my book. Sometimes though, there is some power that power-obsessed people don’t want, because it’s not worth the cost.
EOL to me is a perfect example of a power the government desperately does NOT want to wield. There has to be a default rule for “pull the plug on an incapacitated person or not” if there isn’t a directive in place. There HAS to be a default rule because its going to come up.
You said the hospital hounds everybody about having AMDs. If there isn’t one, then they have to enforce the government’s rule. They either have to leave the patient plugged in despite the sobbing relatives begging them to end the suffering, or they have to pull the plug despite the sobbing relatives calling them murderers. The hospital is doomed no matter what the rule says.
No matter what the AMD says, the hospital (as the physical manifestation of the government’s “power”) is officially not responsible. Let the sobbing relatives rip each other’s hearts out.
The Judge in case like this . . . I’m willing to bet they would rather be doing ANYTHING ELSE rather than dealing with a case like this.
At least in the current healthcare reform discussions, the closest I’ve heard the government even suggested to exerting power in this field is the proposal that the reform bills mandade getting a directive. Or put another way, forcing citizens to exercise their individual rights to make their own decisions. Demanding that the people take the power from the government. Tell us to plug your ass in, tell us to unplug your ass, we don’t care . . . we don’t want anything to do with this crap. Horrible family anguish is bad PR, amigo.
I agree that governments inherently try to expand their power, and I also agree that if the government tried to exert power in this area it would be extremely bad. I honestly can’t see the government wanting to fight the fight for this minor and unproductive powergrab. There’s money to be appropriated, districts to carve up, hookers to abuse, bribes to take, playoffs to watch in boxseats, new jobs to be patronaged away, new types of favors to do for other politicians to grease deals . . . that $h!t actually benefits me. Wading into hysterical family drama with ABSOLUTELY NO TANGIBLE BENEFIT except the smug knowledge I can piss on someone’s not-yet-corpse and get away with it? If I want to feel that powerful . . . well, that’s why I’m chasing the pages! Its less work, I still feel like I’m above the law, and I still have time to line my pockets afterwards.
Politicans may be turned on by power, but they are usually opportunistic narcissists first and formost. Screwing with EOL just seems like something even they wouldn’t want to do. Not because of any sense of morality, but becasue they are such amoral jackholes that they wouldn’t do something so self-destructive. That’s not just evil — that’s crazy-and-evil.
EOL is certainly something that shouldn’t be screwed with, but I guess I’m trying to say I don’t think its something to lose sleep over without something concrete. I don’t think Obama should mess with the military either, but I’m not worried about the next appropriations bill budgeting for mind control food additives. There are more immediate issues that need dealing with — like universal health care (I’ll just slip that in there at the end . . .).
Comment by busboy33 — 10/10/2009 @ 9:45 pm