Sunday, June 14, 2009

Yin vs Yang on Health Care: Conservatives make a few points

=== A contrarian view of health care ===

In case any of you have come to the false conclusion that I am a reflexive liberal democrat -- simply because I oppose the hijacked monstrosity that the Republican Party has become, let me make clear that I retain plenty of ways that I can exercise contrary orneriness toward the American left. There are times when even the Frankenstein, undead monster than conservatism has become can startle you, by uttering cogent and reasonable “Goldwater-style” objections, instead of the shrill mania pouring from the Murdoch-Limbaugh-Fox nexus.  We should be ready, whenever this happens, to heap on positive reinforcement rewards!  The biggest reward of all?  To actually listen.

One example is where decent conservatives point out genuine drawbacks to the state-run, “universal single payer” health care systems so widely touted in liberal circles.  As one who lived for extended periods in both Britain and France, I have to tell you that their systems have much we can learn from.. and also some serious flaws.  Without any doubt, they are vastly more fair than ours, and do a far better job at both preventive care and ensuring healthy lives for all kids -- which (as I said last time) should be the core goal of any system.

If we must make a zero-sum choice between Canadian and US health care, then by all means, let’s dump a horror story, in favor of dull, unimaginative and paternalistically meddlesome decency.  But I am always suspicious of zero-sum games. If we’re to improve, we should recognize what the current U.S. system does well.

Let’s start by giving conservatives their say. Here’s a quote from Dennis Gartman's eponymous newsletter. "Canada is a wonderful place to have a nasty gash on one's forehead stitched, or to break one's nose in a game of pickup baseball; but have cancer, or need eye surgery, or want an MRI, and the business of medicine in Canada and/or the UK breaks down badly in favor of medical care here in the US. For example... and we wish to thank The Investor's Business Daily for the data noted here this morning

           "... here in the US men and women survived cancer at an average of just a bit better than 65%. In England only 46% survive. In the US, 93% of those diagnosed with diabetes receive treatment within six months; in Canada only 43% do, and in the UK only 15% do! For those seniors needing a hip replacement and getting one within six months, 15% get it done in the UK; 43% get it done in Canada ... and in the US 90% do! For those waiting to see a medical specialist, 23% of those in the US (fail to) get in within four weeks, while 57% in Canada have not yet done so, and in the UK 60% are still waiting after four weeks.  ......  When it comes to proper medical equipment, in the US there are 71 MRI or CT scanners available per million people. In Canada there are but 18, and in the UK there are only 14! Ah, but the best figure of all is this: 11.7% of those 'seniors' in the US with 'low incomes' say they are in excellent health, which in and of itself sounds rather low ... rather disconcerting ... and an indictment of the system itself, doesn't it? But in Canada only 5.8% do!

            "Yessiree bob, ya' jus' gotta' luv that collectivized, socialized medical care! Let's all go break a collective arm and enjoy the benefits of socialized medicine in the Commonwealth! (Canada) ... but heaven help you if you've got something really, really wrong. If that's the case, you'll be running south to the border faster than you can reach a specialist anywhere in Canada; of that we are certain."

Oh, sure, you can spot the use of cherry-picked statistics, right away. (See below.).  And you’ll note how Gartman airily dismisses the general preventive care that should be the heart and soul of any national system, especially aimed at kids, waving it away as stitching a “gash in the forehead.”  Also, I’d like to see comparison of his figures broken down by age group!  And, frankly, I’d like to smack his smug, dismissive face.  (He is not one of the of those “reasonable conservatives” I was talking about.)

HEALTH-CARE-REFORMNevertheless, putting aside his reactionary reflex and total lack of humility, after his side allowed the calamity of the Bush years, still, Gartman has a point. Because what people tend to ignore is that all health care systems practice rationing.  There is simply no way to avoid it, as we all would pay any price, for any chance of health.  Thus, there is very little market elasticity.  We’ll take our dying loved one to the best doctor, period, and screw the price and screw second best.  Capitalist principles are very dicey here.  So are paternalistic ones.

The chief difference between the US and the rest of the civilized world is that we let profit-driven insurance companies do the rationing, and they do it based solely on profit considerations and whatever they can get away with.  By exiling people who have health conditions, by eliminating the poor, by refusing service for the passive or meek or less influential or less-litigious.  On the other hand, those who can pay, and fiercely enforce their insurance contracts, can get their companies to cover vast and endless expenses for procedures aimed even at extending, futilely, the very last and most painful phases of life.  The phases that take up to a fourth of all medical expense, in the United States.

Europe etc are different.  There, socialist-oid state committees ration procedures, based on criteria that seem to make sense both to those committees and to generally accepted social consensus.  While it seems both logical and laudable that they prioritize children and young adults and illnesses that can likely be cured -- a proper role for paternalistic single-payer systems -- it still seems heartless and callous that they pay for this by telling old people, or those with chronic or “hopeless” conditions that little will be spent on them.  Indeed, this is why many of the elderly rich, all over the world, fly to America for treatment.

What is seldom mentioned is an added drawback to that system.  All the money that America spends (or grotesquely overspends) on unpleasantly difficult conditions - those with a poor prognosis - often results in improved science, treatment and success! In other words, the American system serves as the world’s medical R&D test bed.  This is why MRI machines were available here - for those who could pay out the nose - long before state commissions would buy them overseas.  (And boy, was I glad to get home and use one, back in 1992, even though it cost me $1,000!  Back in Europe, where I had lived, there simply weren’t any available.  At all.)

Is the rightwing wrong about Health Care?  Sure they are, as they have made a habit of being wrong about just about everything, ever since their movement and party drank Rupert Murdoch’s Koolaid and slid into mania, years ago.  The present US Health Care System is a travesty and outrage, period.  Nevertheless, the insistence of the Left upon simply adopting what they see overseas, without discussing the drawbacks, is both lazy and doctrinaire.  It is not worthy of a nation of innovators.

=== Start Down the Road Incrementally ===

Hence, let me return to something I said  before. We could derive the topmost benefit of European style health care if we start by simply providing health care to all kids!  Now, immediately.  Without any “insurance” rigmarole.   Take care of children.  Period. Right away.  Just do it!

One method that would take a one page piece of legislation?  Simply take Medicare and extend it to the other end of the spectrum, the other demographic group that is both helpless and deserving, by simple definition.  Or else, use the kids to experiment with single-payer.  Either way, the political opposition would be in a tough spot putting up much resistance!  Americans are inherently more socialistic when it comes to children than we feel toward adults (who, we think, almost instinctively, should stand on their own two feet.)  Moreover, it lets us act upon prevention and lifelong health investment in youth, by far the best use of medical care dollars.

Seriously, why isn’t this a no-brainer?  A win-win that would let Obama achieve wonders at a stroke, while keeping both cost and complexity down and achieving the greatest bang for the buck.  Poor parents would be relieved of their greatest fear and then be able to bargain better for their own, narrower coverage.  Can anyone explain why this isn’t even mentioned?

And then, with our future safeguarded and the very worst injustice solved, we can gather the best and most sensible people from all sides to compare apples, oranges, grapes and every possible plan for dealing with adult working Americans.

==A bit on Politics==

Lighting the political lamp...  Let’s start with evidence that something special is going on. Everybody, you must watch this. Get to know the guy.  And make your conservatives watch, too. 

Of course, if there are folks on the right who remain impervious to reality.  (As there are some on the left.)  Indeed, the more sensible and moderate and consually wise Obama seems, the more extreme the fantasies concocted by the crazies.  And the more imperative it becomes, for reasonable conservatives to choose the real world.

Speaking of which...

=== Some Conservatives Really Are Openminded ===

My friend, John Mauldin, the brilliant economic analyst, appears to have joined PIMCO’s Bill Gross and other “conservative realists” in breaking away from the standard right-wing doctrine about taxes.  Not in all ways or on all issues. But enough to declare independence form Rupert Murdoch’s party line.

For example, they are much more concerned about trillion dollar deficits than about the purported investment-stifling effects of somewhat higher taxes on the upper class.  Not only are they resigned (and imply some contentment) at seeing the Bush Era’s biggest set of “largesse” breaks for the wealthy expire, next year, they hint that a modest increase might be the least-bad way to reduce both those deficits and inequities in society.  You haven’t seen the punditocracy comment on this trend very much, on TV.  But it is a sea change among the brightest, reality-oriented conservatives and may represent the front of real change in republican circles, at least among those who see reason and patriotism and pragmatism as higher virtues than dogmatism.

And now... partly in order to honor those rational conservatives, and meet them partway, here’s something sure to rile a number of you.  A remise on last time’s topic of health care.  Only from an alternative perspective.

=== ADDENDA ===

“The Obama administration is warning lawmakers that the trust fund that pays for highway construction will go broke in August unless Congress approves an infusion of as much as $7 billion...  Sen. George Voinovich, R-Ohio, said it's clear that Congress must raise the federal gas tax, which is now 18.4 cents per gallon.”

Naturally, I agree with Voinovich.  Our gas taxes are among the lowest on the planet and have encouraged wastrel attitudes for two generations.  Still, I’d like to add one suggestion.  While the gas tax is being raised, also transform it from a flat rate to a PERCENTAGE of the cost at the pump.   That way, it can automatically be indexed to rise when consumption does, and some of that rise can be dedicated to filling strategic reserves and a rainy day fund, to kick in when hard times next return.

*  One of you said:
     “I sincerely hope that those who would mock Dr. Brin’s "10,000 McVeighs" prediction are paying some attention.The murder of Officer Johns at the Holocaust Museum, the murder of Dr. Tiller, the murder of five chilean students in Miramar Beach Florida by a man obsessed with "Illegals" , and now the murder of a nine year old girl and her father by the Minutemen.”   
 Alas. Folks, you ain’t seen nothing, yet.

And finally, oooog.  See why libertarianism is often its own worst enemy. What a shame.


Peter Norvig said...

As I understand it, cancer survival rates are better in the US because we diagnose cases earlier, and earlier-diagnosed cases are the easiest to treat. In the UK a patient with the same level of disease might go undiagnosed, live a long life, die from something else, and never count as a "survival" statistic. So what you really want to look at are death rates, not survival rates -- and this are similar in US and UK.

Catfish N. Cod said...

[continuing from previous post to ensure this is seen -- if that is not appropriate according to house rules, I'll repost on the old thread]

Dear Dr. Brin: your link was 404 compliant. Here's one that works:

In reality, of course, politics is to some degree n-dimensional. It would be interesting to plot Carl's two environmental axes against the most common two axes -- economic and political freedom. However, humans perceive four-dimensional relationships only dimly. Most can't conceive of five-dimensional relationships at all.

You could do a vector analysis and crush the differences down to the two or three largest eigenvectors, of course; but that's really a reductionist tactic.

Perhaps it is time for a more creative view of politics? You could imagine a "political garden" -- the first two axes forming a plot, the third represented by stem-height, while secondary issues could be represented by the colors and shapes of leaves, stems, and flowers...

Anonymous said...

You are off in your assessment in a small but significant sense. In the US we diagnose a large number of early cancers that probably would have had no serious impact anyway. Those US/UK numbers? There were some stats kicking around a couple of years ago to the effect that if you were diagnosed with prostate cancer in the UK you had a 46% chance of dying of it. Here in the US? Only 19%. Great, yes? Not so much. We adopted mass PSA screening before it was proven to prolong life. And since essentially all men over about 85 likely have microscopic CA you can generate really great survival rates....even if you leave them alone they do not generally die of prostate cancer. Sometimes surgery for same kills 'em!
I do not mean to discourage PSA screening in high risk groups, or generally from about 50 to the point at which it is likely you do not have ten good years in you. But beware of monkey-stats, you will be seeing plenty of them


Anonymous said...

And to run on even further....
What we need and deserve is a health care reform plan that includes:
What it will cover.
What it will not cover.
Who will decide.
What it will cost.
Who will pay it.
Who will be included.
We need to stop thinking of the health care system as a faulty ATM that just keeps churning out money and services.
We need ample funding for research free of industy bias.
We need to really adhere to evidence based medicine.
We need to stop counting on pipe dreams like EHR to save money.

The Clinton plan failed because it defined so little of the above.

And Democrats in general are so very, very bad at saying no to anybody. Or at least anybody who makes under $250K per year.

David Brin said...

Over on Kos someone commented: Oregon just did this. Passed a few laws in the State House and Senate to insure the State's children and start a group that will oversee the health insurance regulation.

It's a start!

Clinton failed in 93 -- and torpedoed her husband's presidency --- because she created a plan that was staggeringly complex and easy to ridicule.

Had she gone for the children, it would have passed, Gingrich would not have become speaker, and by now whatever system we used for kids would have the kinks ironed out. We'd know whether we wanted it for everybody.

Tony Fisk said...

Small beer to the US and European market, I know, but the Australian medical system is worth considering in this.

Other than being treated for chickenpox at Mayo clinic in '93 (which, I gather, could have been a lucky accident), I've no experience with other medical systems. So, I don't really know if our system is better/same/worse than anyone else's. I'll give a quick overview, for comparison purposes.

My layman impressions are:
- it is a blend of public and private health care (Whitlam introduced Medicare, which successive conservative governments have whittled away in favour of private health schemes. The situation now is that everyone gets basic medicare cover, with private health options)
- if you want good quality care, or emergency treatment, the public system will give it to you
- if you want timely treatment for a chronic condition that threatens quality of life as opposed to life itself, then go private. Public waiting lists are an ongoing scandal (and the cause of cover ups)
- Australia does have a fairly solid record in medical and biochemical research. (gene-shears, Relenza...I'm not talking about marketing, I'm talking development)
- the usual economic rationalising goes on (although I find a tale of push back by the resident surgeons of one hospital heartening: the bean counters decreed that 'stents', ie: trusses for blood vessels, were only to be used where absolutely necessary. It was pointed out that the savings were more than offset by the number of re-admissions that would result.)
- aged care facilities have been a hidden problem. There is a current push for accountability which leads to perennial headlines of some such facility or other being forced to close due to mismanagement and not meeting quality audits. Don't know how prevalent this actually is, though.

occam's comic said...

In case you did not notice, your conservative health care commentator is of course, trying to deceive. He compared the US's socialized medical insurance for the elderly (medicare) to Canada's socialized medical issuance. It did not compare our employer based medical insurance system against the Canadian system. He is actually making an argument for socialized medical insurance.

Damon said...

All health care systems will soon need to deal with a very significant problem:

Medical capability inflation is outstripping medical affordability.

If we let it sort itself out, only the rich will be able to afford cutting-edge care, but even they will eventually be bankrupted by advances in research.

We need to find a way to ethically decide when to push ourselves away from the Advanced Medicine Buffet that avoids emotional entanglement while also avoiding callous denial of care.

I don't have a solution and I've been chewing on the problem for several years now.

Tony Fisk said...

I'm not familiar with the nitty-gritty of the US health system, but Obama appears to be advocating a mix of public and private insurance here. (he makes an interesting comparison to the fate of GM and the US as a whole if reforms to not go through)

Ostensibly, this sounds like the way things are in Australia (which may or may not be a good thing!) There is a difference, however: it would be a public system imposed on a private network, rather than vice versa.

David Brin said...

A list of events that shows the "rise of the McVeighs"...

Tony Fisk said...

In which Jamais Cascio shows us How to Make Friends and Influence People!

gurable: anything that can weather the wrath of climate change sceptics

sociotard said...

Check out the Candyfab 6000: a 3D sugar printer.

DoctorB said...

In the health care debate, always watch out when Republicans compare the American system to Great Britain. The UK has the cheapest (in every sense) medical system in Europe.
If you want to compare the US fairly to a single-payer system, look to France where they pay less than us per capita and beat us in nearly every medical category.

Funny how the repubs never mention France, or Italy, or Sweden, or Denmark, or Switzerland... all places with single payer systems(sometimes mixed with private insurance) that outperform ours at lower cost.

(sorry I don't know the tags in this system well enough to embed the URLs. Apologies for the messiness)

Jester said...

Switzerland has Universal Coverage, not Single Payer.

They just make it illegal to make a profit selling Health Insurance - it's all done by strictly regulated NPO's, and Government pays for the poorest and subsidizes others.

Japan allows a profit, but it's strictly regulated with salary caps and maximum overhead, and the Government mandates standardized claim forms ect. It works for Japan, which has (essentially) a Benign form of Fascism as an over-arching economic policy.

Despite their high smoking rates and alchohol consumption, and the oldest median age in the world, they pay only 9% of GDP for health care and still live longer than us.

The Government also pays for a very "basic" level of care for unemployed adults, but it's mostly an employer-based system.

I don't know how well it would work here, where CEO's don't much care about bringing shame on their company.

"Single Payer" isn't the only, or even necessarily the best, way to achieve quality affordable health care for all.

I don't have any pat answers, but we need to design a system that works for us - one that enough people will support that it can last (at least once people have a chance to get used to it).

I do know our current system is broken. My Mother, who had health insurance, spent eight months fighting an insurance company to get a biopsy which was recommended by her Oncologist.

She was experiencing pain in her Ovaries, and her Mother and Sister were both survivors of Ovarian cancer. By the time she got the biopsy, her cancer had metastasized.

I'm inclined to laugh rather bitterly when people raise the specter of "long wait times" under Public Systems.

Marino said...

David Brin wrote:
Europe etc are different. There, socialist-oid state committees ration procedures, based on criteria that seem to make sense both to those committees and to generally accepted social consensus.

I beg to disagree. At least here in Italy it's the government (in the stricter technical meaning, the cabinet. Which in turn is made by elected politicians and needs a parliamentary vote of confidence: not a nameless technocratic committee meeting in some Orwellian Room 101) deciding the amount of money to be spent for healthcare, usually using a historical expenditure criterion ("we spent X money last year so this year we will spend X more or less so and so given the tax yeld, the inflation rate etc. etc.")
Funds are then allotted to the Regions, which in turh fund the local healthcare agencies, that run hospitals and clinics and refund private healthcare firms working for the NHS. Rationing is made mostly on available resources (in any given hospital you cannot have the operating room busy in doing only transplants and multiple bypass, needing up to 12 hours and staff shifts: there are also lesser stuff to be treated), or on medical reasons that advice against supplying some therapies to some categories. Like, my 88-years old mother who has her heart's valves all messed up, but probably wouldn't survive anesthaesia if they try to fix it surgically (and she's got a mild leaukemia and diabetes to sane physician would even try surgery on her. She had those former conditions from over thirty years, I wonder which US insurance would have her covered)

it still seems heartless and callous that they pay for this by telling old people, or those with chronic or “hopeless” conditions that little will be spent on them.

I beg to disagree again: my mother is old and has chronic conditions and still gets everything she needs. In fact, I've got a feeling that our NHS spends more on elders.

TwinBeam said...

David frowns disapprovingly at Gartman and wants to smack him - but nods his head in sad agreement with how on-target Lind is.

But both take an annoyingly supercilious tone. Both make factual errors and gross generalizations that 'just happen' to be biased toward making their case.

Brin says Gartman has a few points of value in the health care debate - but Lind's piece is little more than a trivial, continuous sneer at a few naive libertarians' grandiose fantasies.

Why the disparity of reaction?

Carl M. said...

Here's a wacky idea: instead of debating government vs. private insurance, how about patients actually shopping!

Regarding France and Japan, they both have a much higher omega-3/omega-6 ratio in their diets than the U.S. The Japanese eat a lot of cold water fish (high omega-3). The French eat healthy saturated fat instead of pressed seed oils (low omega-6). See the graph here:

sociotard said...

I am fast losing faith in Obama. He went back on his promise regarding trials for Gitmo detainees. The international situation seems to be growing more chaotic. Now, even the cronyism of the Bush era appears to still be in effect:

Inspector General alleges he was fired for investigating a friend of the POTUS

Now maybe I'm being too quick to judge. Maybe Walpin was disorriented at the meeting. Maybe his telecommuting was too much of a pain. I just know everybody on this board would have a pretty standard reaction to this situation if Bush was in the big chair.

tacitus2 said...


The conservative spectrum of the blogosphere is watching very closely for evidence that Obama is human, and the IG situation you mention does smell pretty fishy.

We have, you may recollect in calmer moments, elected a Chicago politician to the highest office in the land. And in the political system he came out of, you just don't go asking questions about Friends of the Big Guy.

As to the international situation, N.Korea might be a nip worse, and who knows what is going on in Iran. Regards the latter Obama's support for the "reformers" has been criticized as wimpy, but really, anything he says in their favor will not help them. Symbolic gestures are part of the job, and may be Obama's strong suit. Goodness knows that the unsavory of the world need not fear a Desert Storm on his watch.

sociotard said...

Y'know what? I'm feeling frisky. If indeed Chicago politics guides Obama's decisions more than the ideals he painted himself with, I am ready to make an entry for the imaginary predictions registry:

Obama will have a Pardon Tsunami, defined as:
1) He will pardon more people than President Bush (or, if he serves only one term, more people than Bush did in his first term)
2) He will grant at least one pardon stinkier than Bush's stinkiest pardon (which is the Scooter Libby commutation, AFAIK)

David Brin said...

I confess to a major predictive blooper with the Pardon Tsunami. Bush really yanked my chain on that one.

Nevertheless, one fired IG... especially a neocon era holdover -- does not a pattern make. Didn't you expect a housecleaning? I wish the law allowed him to fire MORE guys!

tacitus2 said...

I guess you have to read the Chicago papers to find out this kind of stuff

Sorry I am not techno enough to make the link work, but its about two additional IGs let go while in the process of looking at sensitive topics.

Given the phenomenal energy dissipation qualities of Obama's media deflector shields, I am suprised to see this much this early.

And not to harp on things, but the investigations into Rezko and Blago are not exactly making the headlines either, are they now?

I do not per se object to a bare knuckles politician, but to have one who wears a hypocritical halo...


and I will admit, the conservative blogosphere is working hard to find stuff. It will not all be true. The progressive blogosphere is not looking at all. They will find less.

gmknobl said...

On the US being the medical testbed - this is an oft-quoted rule by those opposing a change to our healthcare system. However, at least as regards drug companies, this looks not to be the case, even though the companies say this too. Drug manus make more money here than elsewhere. They claim this allows them to research new drugs they can't elsewhere but statistics don't bear this out. I would take issue with a blanket implication that the entire healthcare system has more available here since we provide the world with the research for healthcare.

Of course, I am referring here only to drugs and costs of drugs. We pay more, way more for them than anyone else and have for a long time. Since Shrub let pass a law making it illegal for the government to bargain with drug companies over the cost of drugs it's become codified. This is one of the many things that needs to be fixed.

And while your point on availability of medical equipment looks to be true, I'd still point out that when the aged get sick, they frequently have to choose between getting treated and going broke or not getting treated and affording to continue on in on a moderate income. Not a choice to make for anyone. It's the RICH elderly who can pay for things. While this may or may not be true in other countries, choosing NOT to get treated her or elsewhere isn't something that's going to show up on any countries statistics well. You can't measure what's not there.

Someone should do a survey in Europe and here and see what percentages there on on this choice.

In my own life, I can tell you that my mother is pragmatic when it comes to severe illness. She's ready to go and won't fight it if it comes. But for now she's healthy. The first thing that happens though and she'll easily make the choice to not get any treatment, even if it's something that can be fixed or cured. Why? Because she can't afford to and figures there's no reason to spend large sums of money (that she doesn't have anyway) for fix her when she's only going to be here a few years anyway. That isn't a happy thought for me or my children but it is pragmatic. If there was no great cost to her she would get help for some things but not the more severe chronic conditions that are usually fatal. But since there is a cost, and one she can't afford on a fixed income, she'd rather just die.

And all that because of the U.S.'s failed healthcare system.

Fix it. Fix it now. And yes, should should have been covered under a proper system that took care of everyone, not just the wealthy.

sociotard said...

Brin Said: Didn't you expect a housecleaning? I wish the law allowed him to fire MORE guys!

Actually, Walpin claims that he was going to retire anyway as Bush went out of office, but that he was persuaded by new administration to stick around.

Anonymous said...

On a slight tangent, the talking heads make me sick (pardon the pun!). If I hear one more empty-headed moron go on TV to proclaim that the public option (as it's being) called is controversial, I may require health care myself.

Poll after poll shows overwhelming support for public health care.

I had typed up a rant, but Bob Cesca says it better that I do.

Anonymous said...

"than" I do, rather...

Libertarian Girl said...

First of all, it would indeed be great to debate the pros and cons of a single payer system if that's what Obama was proposing for us. He is not proposing anything resembling single payer-- he is proposing what would basically be a requirement that everyone either go on a public plan (maybe subsidized, maybe not) or pay for private insurance or have their private insurance subsidized by the government. This is basically a massive corporate welfare handout to the insurance companies and is nothing like the system in any other country.

So, there can really be no comparisons.

Secondly, your link to that Salon article is unfortunate, because it's one of the worst examples of messy logic I've ever seen. Is he talking about Republicans or libertarians? For that matter, is he talking about secessionists or libertarians, since they're certainly not the same thing, either. Not only are these people Republicans/libertarians/secessionists, add "neo-Confederates" to the list. What a hit piece.

None of these nouns would describe the same person in 99% of cases, but he treats them as interchangeable. He's apparently against research into people living longer, and he's against someone stating a fact-- less women are libertarians than support the Democratic Party. Stating that fact is misogynistic, which I guess makes this girl a misogynist!

I think it's unfortunate that my gender doesn't support the Libertarian Party as much as they should. That doesn't make me sexist.

ERic said...

Off topic, but I'm surprised that you haven't posted anything about what's going on in Iran. Some of the stuff I'm reading about the cyber-war that's being waged is just weird to read. It reads like an SF novel. Hackers putting political anti-Ahmedinejad slogans on the state-run TV website. Government and opposition 'forces' creating and destroying twitter proxies. Watching not just the green 'v' fingers be a symbol, but also the upraised cellphones recording the crowds.

I guess it's all coming to fast and furious, and it's still hard to tell where it will all end.

Nevertheless, watching it unfold reminds me of many comments you've made about people-power.

DoctorB said...

Aside from Republicans pretending that Britain and Canada are the only government-run health systems, the thing that frustrates me most about the health care debate is the word "rationing." This word is used as a scare tactic by conservatives and distracts us from a reasonable debate.

Here is a news flash: EVERY system rations health care. There is no way to do all medical procedures that could be possible for every person who could need them.

Our current system in the US rations health care based on income and leaves roughly 40 million people without coverage (some by choice).

We should be debating HOW we want to ration care. The current system is unsustainable because the financial bar to have medical care is rising inexorably.

David Brin said...

No. Many women are pro-freedom. But they know that every situation OTHER than the one we live in was less free and more oppressive. Hence, sensibly, they are willing to give the mixed-solutions appraoch (a mix of government and private market approaches) the benefit of the doubt.

The perceive that any sudden or radical perturbation from today's consensus equilibrium is very likely to push us into older attractor states -- eg feudalism or at least patriarchy. In other words, they have more at stake and therefore they are less doctrinaire and more sensible.

It is woven into human nature to always consider the possibility of toppling the whole apple cart in revolution. If you feel you ought to be an alpha, with a harem... and you cannot even get a date under the present regime, it makes reproductive sense to at least fantasize about major disruption that would give you a chance to wind up on top.

Yes, Ayn Rand was female and promoted such dreams. But always through the dramatic vigor of male characters. Her female characters agreed with the agenda, but principally in order to have a towering hyper-alpha who would be worthy to surrender-to. The female equivalent of a king/harem fantasy.

Very few of today's "libertarians" truly respect the masses that they propose liberating into a domain of universally-joyous and overwhelmingly productive market competition.

If they truly believed in that dream, they would curb the indignant/immature tendency to call the masses of their fellow citizens utter fools... for example, for repeatedly ratifying and voting for the general arrangement set up by Franklin Roosevelt.

In fact, a VERSION of libertarianism is perfectly consistent and logical. It allows that our fellow citizens WILL be capable of operating in such a wide-open mostly-market world of tomorrow, as formidable and ubiquitously competent bargainers and players.... because we are already halfway there! Because the arrangements that the people have voted for are not "wrong turns" but crude halfway measures, necessary intermediate steps TOWARD that world of true liberty.

The government that most libertarians spend all their time reviling -- while frenetically ignoring the real enemy that destroyed 99% of markets and freedom renaissances -- is the midwife of the new world of free and sovereign adults. That is, it will be if we think of it that way and guide it toward that purpose.

In fact, about 60% of the efforts of the democratic party seem aimed at that goal. Alas, zero percent of libertarian efforts seem to be. And that is today's remarkable intellectual tragedy.

David Brin said...

Egad! See this and comment, please:

David Brin said...

Found that during my trial run of "Bing!", which certainly does give different results than Google.

Jon said...

Okay, I have to ask your opinion on these two:

Though I can probably guess on the second one.

Kelsey Gower said...

@ Libertarian Girl,

I don't know why more women "should be" supporting Libertarianism. I don't see hwy they are in obligation to support anything unless they want to.

If Libertarians want women to support their party, they should be trying to make it more attractive to women. Doesn't it seem obvious that more women would be supportive of the Libertarian Party if leaders of the party tried appealing to them, even a little bit?

I don't see where Michael Lind calls Patri Friedman misogynistic because he says that "less women are libertarians than support the Democratic Party". I do see where Friedman says "the vast increase in welfare beneficiaries and the extension of the franchise to women" are two constituencies that are tough on libertarians. A libertarian considers women getting the vote a problem? Go ahead and say Lind took that out of context (and then show me the context if you do), but that sounds pretty damn misogynistic to me. Not to mention counterproductive if he wants more than 16% of the population to be libertarian.

So go ahead, you have a chance to attract more women to the party if you want. They'll listen to you if you explain why a libertarian system is better and gives more freedom to women. I'm listening. Give me some reasons to support the party.

Rocky Persaud said...

Off topic, but current: I've read that Rafsanjani is apparently the richest man in Iran, and possibly one of the people to take over if somehow the current military dictatorship (since the Islamic Republic ended a week ago) is toppled. If the oligarchy wins in Iran, I hope it doesn't take another 30 years for Iranians to enact change.

Carl M. said...

Back to healthcare. Here's a very short bit on why shopping is important. (Data driven!)

Grossman's Law by Steve Wisdom

I'll quote it since it is short:

---begin quote---

I ran across an instance of Grossman's Law of Parking Spots this morning. The Law (as fleshed out by Dan in a prior post) states that you can tell the real beneficiary of an organization by examining the layout of parking spaces. For instance, a supermarket reserves the best spots for the customers; a hospital, for the doctors and nurses; Congress, for the honorable Congresspersons.

Today I went to get a calcium-heartscan at a radiology clinic. This is generally a non-covered medical expense (bringing to mind another Law, perhaps unnamed, that any medical procedure truly useful for maintaining your health isn't covered by HMOs). On checking in, I not only had to pay cash on the barrelhead, I had to sign a form acknowledging that I needed to pay out of pocket (I asked the clerk why Starbucks doesn't adopt this policy and require me to sign a form agreeing to pay $2 for the cup of coffee). So anyone at the clinic was there by choice, on his own nickel.

Anyway, the parking spots adjacent to the front door of the facility were all labeled "FOR PATIENTS ONLY", and the doctors, nurses and staff parked farther away. I couldn't believe my eyes. I've never beheld such a wonder at any medical facility. Amazing.

---end quote---

somercet said...

I simply adore the worshipful singularity of the comments here; thank God you abjure the Kool-Aid lest your brains collapse into a hive mind.

Health care in the U.S. is a terrible mélange of New Deal dinosaurs that hide-bound Democrats refuse to kill and replace. They are determined to make it worse no matter what.

Being the land of filial piety, Japan has the world's worst social security net. Aflac, the supplemental insurance, is huge in Japan for a reason.

Canada is a nightmare. The UK is even worse. And don't cherry pick stories on how some cousin got a booboo stitched. The waiting lists are statistical evidence of rationing.

George Bush created an entire private, no "public-option" Medicare D. Surprise, surprise: it's more popular than expected and cheaper than anyone thought possible.


1. Outlaw employer-provided health insurance. It is insane. They insure neither my car nor apartment, it is ridiculous. Outlaw it and push the money they spent on health care to the individuals.

2. Create $2000 in matching funds for every person/dependent, and make it tax-deductible for the first $6000 or so.

Insurance pools risks for broken arms, cancer and heart attacks. Paying for runny noses is a check-splitting plan. The popularity of the latter is driving up our costs all across the board. Outlaw employer health care and poof! they disappear.

Now you may return to your regularly scheduled moonbattery. Perhaps some Holy Net Neutrality? "For he that charges by bandwidth, let him be blessed. But for he who charges for latency, let him be taken out and stoned to death." Yeah, it's in the Bible somewhere, Leviticus, I think.

Acacia H. said...

When you consider that private insurers do everything in their power to drop you when you have a significant medical problem and try to weasel their way out of paying for services you are qualified for, I cannot see how you can with a straight face claim public insurance is worse than private insurance.

I mean, quotas? They already exist through insurance companies cutting people loose when they come down with a condition. I witnessed this with my brother, who was forced to drop his insurance when his sight was going, and this was twenty years ago.

So I'm calling bullshit on your statements here. Public healthcare is no worse than private healthcare. Claiming otherwise is a delusion similar to that which led to the banking collapse last year and to multiple bubbles in the stock market.

What's truly tragic is that people are so afraid of the "liberal" Democrats when they're the party of the Center-Right, while the Republicans are the party of the Far-Right. There are very few liberals in politics these days.

Rob H.

Catfish N. Cod said...

1) @ Carl M.:

Well, you sure aren't going to the same health care system *I* work in:

a) There is no visible distinction between employee and patient parking. The only difference is that employees get a discount for buying in bulk.

b) Despite that, we're asked (informally) by the management to park on the more distant levels (upper levels of the parking garage; lower levels of the parking dungeon) to make life easier on outpatients.

I have also seen health care facilities run in the way you describe -- and I would not care to work for them.

@ Dr. Brin:

What do you make of the proposal by Sen. Conrad (D-Godforsaken Wilderness) for medical insurance co-ops as an alternative to a "public plan"?

Analysis I have read has been skeptical based on the assumption that insufficient people would opt-in and therefore their bargaining power would be useless. NPR analysis supports this -- in their testbed of Howard Co., MD, 30% of the county's uninsured were potentially covered under existing public assistance programs... and when the county deliberately set up its own public basic plan and sought out the uninsured, only 5% of the remainder were enrolled within a year of starting. Just like the people cursing that their rabbit-ears suddenly failed despite years of warning efforts, some people just ain't gonna get it.

But there are things that no one but Luddite hermits in Montana cabins can miss. Like the oh-so-dreaded 1040. Or the driver's license renewal. Or the census, or the Social Security check. If the Feds required coverage for speedy processing, or the states mandated health insurance as well as car insurance, or if health coverage were flat mandated (as it is in MA)... and helpful brochures listing the co-op plans available in the state were included with these vital documents... might it work?

There is much devilry potential in the details, but it DOES seem to serve the cause of public health care while preserving competition. In fact, it could conceivably run the greedier/less-efficient for-profits out of business altogether, which would be no bad thing at all.

Anonymous said...

Firstly, regarding the superficial matters. Best clinic administrator I ever worked with parked his car at the farrrrrthest end of the big parking lot. He set a good example for priorities and for staying fit. He was a real SOB, but that's irrelevant.
The calcium heart scan, eh? I am curious as to how you decided that this was something "truly useful". To my knowlege there has not yet been an honest study that finds it cost effective at preventing death, or even "lesser cardiac events". Cool, yes. Anecdotes abound, to be sure. But how good is it?
Realize of course that false positive results get you stress testing/angiography that you did not need. False negatives are fairly rare. As I continue to harp about the health care system not being a large faulty ATM that keeps churning money and services out so long as you kick it, I should point out that your health plan would eat the bill for any and all tests that result from this out of plan test.
I am a big technology fan, but we let far too much of it become "standard of care" based on marketing and patient demand, rather than real science.

Former HMO medical director


sociotard said...

A few notes on Obama and transparency:
As a senator, Barack Obama denounced the Bush administration for holding "secret energy meetings" with oil executives at the White House. But last week public-interest groups were dismayed when his own administration rejected a Freedom of Information Act request for Secret Service logs showing the identities of coal executives who had visited the White House to discuss Obama's "clean coal" policies.
Washington, D.C. - The Obama Administration's decision to support Bush-era concealment policies has forced the Electronic Frontier Foundation (EFF) and Public Knowledge (PK) to drop their lawsuit about the proposed Anti-Counterfeiting Trade Agreement (ACTA). EFF and PK had been seeking important documents about the secret intellectual property enforcement treaty that has broad implications for global privacy and innovation.

That last one is pretty annoying. Once signed, treaties are law. To quote a poster on another forum, "What we're really seeing is American law being debated in secret and decided by foreign representatives, with representatives of corporate interests having a near monopoly on input."

Carl M. said...

@Catfish and Anonymous: I was quoting someone else's blog. That's why I put up a URL and added --begin quote-- and --end quote--.

I have had similar experiences personally. When my employer added a dental plan, I tried switching dentists. The amount of run around that ensure torqued me off to the point where I went back to my old dentist and wrote a check.

I've also had pleasant experience going to an integrative medicine M.D. who did not take Medicare claims. Service was great and the office actually posted prices for basic services on the wall! For other services, pricing was discussed openly before the fact -- none of the mysterious padding nonsense that is the norm.

I realize that this model does not work for emergency procedures -- and this doctor did not handle such. But for management of chronic illnesses it is a much superior model.

Anonymous said...

Ah, I missed that. Looking for quotation marks I guess....
I am pre-digital age in some ways. Almost pre analog!


Fake_William_Shatner said...

I enjoyed Bill Mahr's latest show. It's the best one I've seen in some time. He said; "Democrats are now Republicans and the Republicans are insane" -- nailed it. Mahr is criticizing Obama in a constructive way -- and all of us need to put pressure on Obama to have LESS corporate influence. At least we can force Lobbyists to pay more.

They talked a lot about healthcare. I have to agree, that the ultimate solution is Single Payer or Universal. All the cost savings will come, as soon as we get the useless, fraudulent group that is making the paperwork nightmare out of the equation.

You don't get really thoughtful discussions like this on TV too often. I'm not going to make a thoughtful point -- other than to point this out. I'm more of an intelligence groupie pulling down my shirt for Carl Seagan to throw a neckless of plastic beads from his golden chariot in the sky.

There were brilliant points and then there was Meghan. Who was a courageous volunteer to be the sacrificial Conservative on the panel (expect good crops in the fall).

McCain's daughter really brought home the best that Republicans can say right now; "Let's forget that we made Morals our centerpiece for 30 years and all history before I could vote." We owe Republicans a clean slate, since they haven't admitted, much less identified what they did wrong besides acting too Liberal. Lacking any sense of history before she lived it, she sensibly chastised Paul Begala for picking on her, calling him a "know-it-all" ( wouldn't that be a compliment in a rational society ?) The bully pulpit shouldn't just go to a person who has a track-record of wisdom.

Stampeding a herd of cattle, doesn't take a run-on sentence, after all.

My wife said; "She is like all those annoying ladies at the office, who want to tell you how you should act, and all they can do is be annoying to set the example." I just noted that she had a large chest, which didn't help matters.

I immediately imagined that old ad in the back of comic books that shows a muscle-bound bully, kicking sand in the face of some wimp who is trying to score with a girl on the beach. The wimpy guy gets their important weight training book, and comes back and beats up the former bully. Now, with McCain's daughter in play. We see the bully coming back to the beach, with a black eye and his arm in a cast, and crying in front of the babe. She goes away with the crying bully arm in arm and our weight-training hero loses to a sympathy date. Well played. The bully of course, will learn that he can find other, weaker people to continue to kick sand on. It's a numbers game.

"Paul Begala -- you Know-it-all. I'm stealing your date!" It's hard to call someone a bully and then beat them up -- but it can be done, apparently.

For the Meghan/Palin base. They will remember how cute and home-spun she was. Like Hannity, you don't have to win the debate, just look more forceful and tan than the wimp with all the whiney facts. A perfect antidote to the soul-less corporate machine that will clog our skies with coal dust while it reduces damages we can make against companies that willfully shortened our lives to extend their lines of credit.

The road to hell is now paved with cuteness.

Meghan did mean well, and was honest. But that's the exact same qualifications of anyone I could hit with a rock who yelled; "Ouch!" Conviction and content shouldn't be judged with equal merit.

Kirtai said...

One thing that surprises me is that public vs private health systems are always viewed as an either/or situation.
Private health companies do exist in Europe you know.

Anonymous said...

How far we've come.

In 1927, President Calvin Coolidge’s sixteen-year old son, Calvin Jr. developed a blister playing tennis without socks. It became infected. Five days later, he died. Before the advent of antibiotics, tragedies like this were routine.

sociotard said...

Dr. Brin, could I ask you a favor? Cite something for me. You retell the story of Akademos as follows:
Ancient Greek myths tell of a farmer, Akademos, who did a favor for the sun god. In return, Apollo granted the mortal a garden wherein he could say whatever he liked, even about the mighty Olympians, without retribution. Inspired by this tale -- the earliest allegory about Free Speech -- citizens of Periclean Athens used to gather at the Academy to openly debate issues of the day.

I like your version, I'm just trying to find it somewhere. The only story I've found about Akademos were that he told Castor and Polydeukes where Theseus had hidden Helen of Troy. There was never any mention of Apollo, or of a free speech garden. There was a sacred grove of olive trees associated with him, but those were dedicated to Athena.


sociotard said...

nevermind, I found it

Tim H. said...

A possible way to handle costs in a hypothetical public healthcare system would be to specify mostly (% to be decided by people who have some sort of a clue) off-patent drugs. Private insurance would be given a niche where they could offer more immediate non-critical care and lifestyle related things. Also, one thing I've not seen mentioned here much is the competitive disadvantage our existing "system" has become.

Fake_William_Shatner said...

I've got a Love // Annoyed relationship with Obama.

Case in point is this class act response, and thoughtful answer -- that is exactly what I've been saying, and I'm annoyed he didn't credit me;
During today's presser, President Obama was asked several times about his support for the public option. He rebuffed the health care industry's talking point that a public plan would put them out of business.
Q: Won't that drive private insurers out of business?
THE PRESIDENT: Why would it drive private insurers out of business? If private insurers say that the marketplace provides the best quality healthcare, if they tell us that they're offering a good deal, then why is it that the government -- which they say can't run anything -- suddenly is going to drive them out of business? That's not logical.

LINK -- 'Cause I attribute.

The fundamental problem with Health Insurers, is that they provide about as much of a useful service as the RIAA. We automatically worry about the loss of money some company is due -- without first deciding whether the company provides any utility. I really want people to go back to a mindset, where the privileges to form a corporation were based upon providing something of value.

Yes, other civilized nations have private health insurance -- but it's outlawed in most cases for General care. There is no way these organizations can compete with a private/public system with 35% costs on paperwork and huge executive bonuses. So they have to make the system inefficient. Hospitals enjoy the medicaid patients in the Emergency for the same cash cow reasons.

So the AMA and the Health Insurers, will do anything they can, to stop the Government from getting into health insurance. They might even lie and distort facts.

It's a brilliant play for Obama to act all innocent, like he doesn't know they will collapse with the competition.

>> Obama skillfully backpedaled on the don't-ask-don't-tell controversy, after many on the left felled shirked for Gay issues. Then he thoughtfully talked about what he would do for couples that was within his power with a Presidential mandate.

>> And then I'm annoyed, that he keeps robber baron stooges in charge of the Fed and puts a band-aid policy that makes sure no crooks are harmed in the process of regulating it. We still have more stooges overseeing the military, covering up for the CIA, and playing soft ball with multinationals. I realize though, that it's probably not possible to take them head on.

But to give MORE power to the fed -- when they haven't accounted for the $9 Trillion they lost. I mean, shame on me if I lose a friend over $90 dollars. Shame on me if I trust a friend after losing $9,000. But I think I'm out of budget, or hyperbolic comments to understand why they shouldn't be making a case for letting Paulson and Bernenke out of a deep, dark jail cell.

David Brin said...

I was interviewed on the BBC World Service on the issue of “bombing” a lunar crater to discover whether there is ice on the moon. The interviewers worried deeply about littering... but it turned into a delightful and fairminded treatment of the topic..


followed immediately by
Hurry! it will be taken down soon!

said; "Democrats are now Republicans and the Republicans are insane" --

Okay. So what's important? I maintain that the insanity is a disease reaming out the guts of the nation. It is THE problem and Obama can best deal with it (culture war") by completing the job. By driving the undead were-elephant into extinction and forcing those conservatives with decent instincts to rejoin the commonwealth under a different tent.

To do that, he must appear the Man of Total Reason, and he must appear that way DEEP into republican territory.

Does that mean he shouldn't be more aggressive? Sure, I wish he'd find more ways to accomplish BOTH. I think he should call upon the best conservatives to help him appoint some peerless Special Prosecutors and then unleash them! Set them loose to bay and chase down eight years of monstrous treason... so that Obama can seem the soul of moderation, calling for "truth and reconciliation and offering pardons for The Truth.

Top of the list: Moodys and Standard & Poor's, the rating agencies. Change their business model... now!

Re single payer, I have said my peace. Bringing children into Medicare would overnight give us single payer for half of Americans. No complexity or fancy stuff. And the insurance companies would thereupon be terrified into negotiating a reasonable deal.

Sociotard, this reference mentions Apollo rewarding Akademos.

The art of google. Use: Akademos Academy garden Apollo

Acacia H. said...

I must admit to being a tad unsure as to the situation in Iran right now. According to a lot of reports, the Iranian militias and police are cracking down significantly on the Iranian protests. It has been sounding very pessimistic for the most part, like it's a doomed effort.

But then you hear little things like a large amount of money leaving Iran, reminiscent of the exodus of money in '79 when the Shah was overthrown. This suggests that Khamenei might not be in as strong a position as appears. And if Khamenei is ousted... I wonder if he'll flee to Russia and become an Iranian government in exile.

It's something to think about.


On happier (to me) news, Tesla Motors received a $465 million loan from the Federal Government to help it build a factory for its Model S electric sedan. I've long been a fan of this small start-up company, and hope it succeeds in bringing fully-electric cars to the U.S. market.

Rob H.

TwinBeam said...

"THE PRESIDENT: Why would it drive private insurers out of business? If private insurers say that the marketplace provides the best quality healthcare, if they tell us that they're offering a good deal, then why is it that the government -- which they say can't run anything -- suddenly is going to drive them out of business? That's not logical."

Except that the government doesn't have to worry about getting 'customers' to pay for whatever it provides. Government can easily drive the private sector out of any sphere of activity, because it can resort to the taxman and money printer - until it goes too far and destroys the economy.

Obama either doesn't understand the nature of government, or doesn't understand the nature of market capitalism - or he was being dishonest. Take your pick.

Anonymous said...

If I lived in Canada and got cancer, I might not have the same chance as surviving it as a rich person in the U.S. However, as a poor person living in the U.S., I have absolutely NO chance of surviving a bout with cancer, since there is NO way I can afford any treatment or let alone a doctor visit to catch it early.

Fake_William_Shatner said...

Brin said...
To do that, he must appear the Man of Total Reason, and he must appear that way DEEP into republican territory.

I agree with that. That is why I've got a love/annoy feeling for him now.

But as the voting public -- we need to act on our own self interest. If we don't get upset over what our government isn't doing, then he won't have the support he needs.

To be reasonable with our Media in this country, you cannot say that 70% of the country want's something like a single payer. You can't say; "Why don't we just leave Iraq -- it's not like we can make it better by staying." If he talked about overhauling the fed, or auditing Forte Knox -- well, that would be downright crazy.

The Fed just told us it can't account for $9 Trillion. What reasonable response is their to that admission?

I don't disagree that Obama is doing a great job at sounding reasonable. But in the face of our financial collapse and compromised ecosystem,.. we shall see. Really, the solution cannot come from one man -- and Obama can't really push much harder against the Oligarchy he is in.

It's just hard to tell if that is his thinking, or if he is just another Clinton. Anyway, I'm not saying anything that we all might be thinking.

Does that mean he shouldn't be more aggressive? Sure, I wish he'd find more ways to accomplish BOTH. I think he should call upon the best conservatives to help him appoint some peerless Special Prosecutors and then unleash them!

Never going to happen. It's a club for most of these guys. The only thing Unique about the Governor of Chicago getting caught on tape trying to sell the Obama's vacated senate seat -- is that he got caught on tape. Why was he being recorded when there is no mention of WHY he was being investigated? Probably because he was helping a Union keep a company from busting it; Republic Windows and Doors. But I don't really know. The very few we see standing up like Howard Dean, Feingold and yes, Ron Paul, must have no skeletons in the closet.

It's a reservation and anyone not playing by the rules, is outed. Few get in the gates unless they are "made men." How else can we explain the silence and voting for the Patriot Act? Cowards, weak people, or corrupt. The Republicans would NEVER vote for special prosecutors because almost all of them are guilty.

>> Twinbeams. Most of our current, for-profit system is waste and is burying our country. We could afford it if we got rid of our military. If I saw something that was more heat than light in your comments, I'd address it. Healthcare won't be fixed because there are too many vested interests making a bundle -- not until it's an emergency and they are about to lose money.

Fake_William_Shatner said...

Night Life said...
>> The secrets of a successful blog is to weed out trolls and blog spam.

I'm surprised you didn't know this...

Anyway, if you want to know more, and how to become a successful member, follow this LINK

Unknown said...

Hawaii had universal healthcare for children, but the recently "had to" drop it due to budget shortfalls.

Do you think your idea of universal children's health care could only work on a national level?

Fake_William_Shatner said...

Robert said...
But then you hear little things like a large amount of money leaving Iran, reminiscent of the exodus of money in '79 when the Shah was overthrown.

That's a good point. The best way to KNOW what the power structure thinks is to follow their money.

I've been listening to a few people on this issue. It is very interesting of how the protesters are dealing with the very powerful religious groups behind the government. During the Shah's overthrow, they shouted back and forth from the roof tops: "Got is great." Who can get arrested for that? Numerous creative ways that they are shutting down the country without violence -- most of that seems to be coming from the pro-government paramilitaries.

Another tactic, was huge crowds at funerals for people killed by the government. Every time a new person is killed, the rallies get bigger.

I think we should be taking notes. I'm very proud of the Iranians.

I don't think it is any accident, that so much of this protest is echoing the removal of the Shah. That has got to be making the Theocracy anxious.

>> I'd say that demographically, there is no doubt who won.

Fake_William_Shatner said...

atomicsmith said...
Hawaii had universal healthcare for children, but the recently "had to" drop it due to budget shortfalls.

Do you think your idea of universal children's health care could only work on a national level?

>> I'm not well versed in Hawaii's healthcare.

These budget shortfalls are caused by lower taxes on wealth and losses of income by taxpayers while trying to maintain the same services. The past 8 years, the federal government taxed less at the top, and was a master at putting more costs on states with mandates that were unfunded. Something had to break -- maybe Hawaii is paying more for all the school testing, and higher energy costs?

A lot of attention is paid to the costs of benefits to people -- while ignoring all the waste on corporate welfare and handouts, bidding for business between states, military, prisons, roads. Having a few thousand FBI working for the RIAA rather than going after White Collar criminals on Wall Street.

We have a thousand and one Bernie Maddoff's who did NOT go to prison -- you don't think that cost Hawaii something in the scheme of things? Maybe the money for kids went to Bernie, or maybe it went into 200 Humvies left in the sand because a Contractor got a Cost Plus deal.

When we say that those kids aren't covered, and the parents can't pay -- where do you think we PAY for that expense? Medicare and Medicaide. Those kids are going to cost the Federal taxpayer more because of this expediency of the state.

Arnold Shwarzeneggar is cutting back on all the Social supports in California. Without all those poor people spending money and keeping themselves in homes -- who is going to pay eventually?

We are all in this together or we are going to fail alone. We need some Remedial American Citizen 101 education again.

>> Hawaii is going to have to build bigger prisons and emergency rooms, and pay 10-fold for all those kids not getting health care. I'm sure someone will blame violent video games. Hawaii had plenty money for Healthcare -- they just didn't make it a priority.

TwinBeam said...

WS - Too much heat on Obama for you? OK:

Here's govt figures on quality of health care for kids in the US.

"Cherry picking" a few numbers, for 0-4 year olds, while about 7% were reported uninsured, only 2.7% had no usual place of healthcare - 3.1% if you count those who said they used the emergency room.

And only 1.9% had *any* un-met medical need, while 2.3% delayed *any* medical care due to cost - no distinction made for severity of need, but I think we can guess that they're mostly not talking about anything life-threatening.

Now that's still a lot of kids - but is it really a "national crisis" that requires "reforming" health care for the 98% who had no un-met medical needs, and having government take control of a huge chunk of the economy?

Especially when, if I'm reading it right, about 1/3rd of kids are already covered by some form of public insurance?

TwinBeam said...

Seems to me that all we really need is something fairly modest, that emphasizes personal responsibility instead of "pool everyone so the wealthy pay for the poor", even if the former still end up paying quite a bit for the latter.

Make government the lender of last resort for health care. If you need healthcare but don't think you can afford it, you go ahead and have it done, and the govt sets up a payment plan matched to your situation. Even if you are totally disabled and unable to pay, the debt is yours - but has no impact on your ability to get further healthcare.

If you're living on a fixed income, you might have to pay some of that income toward your debt, and your remaining assets might go to the government when you die - but you wouldn't have to go broke before getting some help.

Yes, there might have to be a bit of rationing of healthcare for those with no ability (or no willingness) to pay - but it wouldn't be denial of necessary treatments, just expense controls for that small minority.

Travc said...

On healthcare, there are a couple of good Frontline episodes people really should watch:

Sick around the world

and (less good, but still good)
Sick around America

I've said it before, but it bears repeating... "Free market" simply does not work efficiently with respect to healthcare. Individuals simply cannot make rational choices. Lack of information is obvious, but more fundamentally, rationality requires answering "how much money is your (or your loved one's) life worth to you?"

Healthcare providers can (and do) price people out of the market in a way very similar to monopolies because people generally pay whatever it takes to stay alive. Actually, it is more like extortion than a monopoly. The only real mitigating factor is the guild system healthcare practitioners traditionally belong to.

A few cycles back the Labour party (UK) had a good phrase along the lines of "providing healthcare regardless of the ability to pay". That is the moral argument, which rings true to me and apparently the overwhelming majority of poeple. Yes, resources must be allocated (rationed), but doing it based on people's ability to pay is simply immoral (general consensus wise). A market based approach also won't work even remotely efficiently even in theory!

Jester said...


Debt Slavery and hand-outs to Corporations are the answer to all healthcare woes.

Which don't really exist anyway.

So much for Conservatives making good points on Health Care.

Well, ok, Tacticus makes some good points.

Carl M. said...

Here is a good quote from Fred on Everything about what is really wrong with American healthcare. From

---begin quote---
OK, a brief excursion into cosmic truth. First, socialism. Hard-line conservatives with little grasp of economics refer to anything they don’t like—Hillary, national health care, regulation of anything if it might cost them money—as “socialist.” It’s a utility pejorative, devoid of meaning, as “racist” and “elitist” are for political south-paws. Socialism is of course a system in which the government owns the means of production. Check your dictionary.

Ah! But in America, the means of production own the government. Inverted socialism it is. Here is a far better thing. If you are a means of production, anyway.

Example: Bausch & Lomb makes ophthalmic salt water, useful in treating corneal edema, under the trade name “Muro.” In the Yankee Capital, it costs $23 for 1.8 ounces; in Wincherster, Va., $19; in Farmacias Guadalajara, about $6. The identical product. The generic here, Hipoton, comes in at about $3.

You could call it price-fixing, but I prefer to think of it as governmental regulation of prices. It is perfectly legal, because Big Pharma owns the government.

I believe that Econ textbooks say that price controls haven’t worked from Diocletian on. Wrong. They work splendidly. Ask Bausch & Lomb. If you could make over twenty-two bucks on a dime’s worth of salt water, wouldn’t you be in favor of governmental interference in the economy?

Let me explain medicine briefly. It’s an unholy scam. Here in Mexico my wife occasionally gets ear infections. At any pharmacy, we pick up Amoxicillin, 250mg three times a day for ten days. Six bucks.

Recently we were staying in Maryland with friends, and she got an ear ache. Amoxicillin is by prescription only in the US, which means that doctors have a monopoly on ear aches. It was Friday evening. It was either agony until Monday or go to one of those mall-based walk-in clinics, which wanted $150 for the appointment and prescribed $78 in medicines.

It’s a scam, pure and simple. Above the level of county government, the US is as corrupt as Mexico could ever be, and it’s mostly legal. Yes, I know all the who-struck-John from doctors about engendering resistant bugs. Funny. Any pharmacist in Thailand will tell you the same thing a US doctor will—Amoxicillin, take all ten days’ worth, etc. Scam.

---end quote---

TwinBeam said...

Travc -
Healthcare is monopolistic, but strong demand is not sufficient to create a monopoly. Government backed restrictions on supply (prescriptions, medical school accreditation, licenses to practice) are.

Carl M -
Fred on Everything, as usual, is on a first name basis with reality. Big Pharma (and big medicine) get Big Government to protect their monopolies, always justifying it with arguments that amount to "people are idiots, let us keep them safe by exploiting them".

Jester, as usual, makes a fool of himself, playing with his strawman dolls.

tacitus2 said...

Thanks, although to be fair, I am not a conservative with respect to health care reform, I am a flaming radical. I just see no evidence that the democrats will do anything but preserve the worst of our current mess and expect us to pay more for it. Anybody notice the trial balloon that said taxes would now go up on those making over 200K? BHO said 250K!
Carl M
You do find some amusing quotes on health care! But suggesting that physicians in SE Asia have wisdom on antibiotic resistance is absolutely Pythonesque!
Some inconvenient facts: dose of Pennicillin to cure gonorrhea in 1943 160k units. Dose of same that failed in Phillipines study in 1977 9.6 mill. plus probenicid to enhance blood levels. The difference? Routine administration of pennicillin to "hospitality girls" in brothels in Phillipines and Thailand. Want more recent data? Rate of quinolone resistant gonorrhea in US in 2006: 6.8% Rates in China, Korea, Vietnam? 94,70,52% respectively. Thailand no doubt suppresses this statistic.

Oh, and the otitis media? If you decided to prescribe antibiotics, which ID specialists are now discouraging, why did they not go to Walmart pharmacy where amoxicillin is 4 bucks?

In Moderate Dudgeon


Fake_William_Shatner said...

David Brin said...
I confess to a major predictive blooper with the Pardon Tsunami. Bush really yanked my chain on that one.

>> David, to be honest, nobody thought that Obama would be actively protecting Bush era crimes.

Cheney dances around and taunts Obama on torture, and Obama actively hinders any push to get the emails they purged, or to release who got passes to meetings in the White House.

Obama is becoming more transparent in his administration than the previous -- but nowhere near what our Democracy is used to. Raising the bar doesn't mean that the lawn gnomes can't jump over it.

>> And let's stop with this notion of "Chicago politics." I'm more worried about the NeoCon financial schools that started there than this "mobbed up" notion. We could just as well say Texas politics, Georgia politics, or heck, Ohio politics -- why is the State any better than the city? Obama can sink or swim on his own merits -- it illuminates nothing to find guilt by association with a city.

I'm from New York and then from Georgia. You might as well use my zodiac sign to predict my thought process.

Fake_William_Shatner said...

Tacitus2/Anonymous said...
There were some stats kicking around a couple of years ago to the effect that if you were diagnosed with prostate cancer in the UK you had a 46% chance of dying of it. Here in the US? Only 19%. Great, yes? Not so much. We adopted mass PSA screening before it was proven to prolong life. And since essentially all men over about 85 likely have microscopic CA you can generate really great survival rates....even if you leave them alone they do not generally die of prostate cancer. Sometimes surgery for same kills 'em!

>> Thanks for that. A lot of people don't have this sort of Wisdom when analyzing stats.

I was watching a lecture from some academy of medicine -- I think 6 years ago. The gentleman was comparing survival rates of ALL cancer. Looking at how we've progressed on some, not so much on others. He factored in the presence of earlier screening and just measured outcome: how OLD does someone live with such and such cancer, rather than how LONG they live after the diagnosis.

He determined that over about ten years, modern medicine had increased the overall survival of cancer about 1.5%.

>> That kind of floored me. All this money, research, chemotherapy's and poo-pooing of alternative medicine. Now maybe we have more things causing cancer in our blood stream now. But really, the greatest advance in medicine has been figuring out that people were sick sooner.

Travc said...


I didn't say healthcare in the US was a monopoly. Though the pricing does tend towards a monopolistic rate. There probably is a word to describe the situation, but I don't know it.

The "government backed restrictions on supply" are better characterized as barriers to entry. Importantly, the vast majority of them originated in the guilds in response to the asymmetric information and general lack of information the consumers posses.

Yeah, supply could be opened up by removing those barriers, but that would have it's own incredibly significant ramifications that must be addressed by any serious argument.

Even with much lower barriers to entry, an efficient market requires shopping and rationally evaluating utility. How much more money are you willing to pay for a needed treatment which has, say, a 95% survival rate compared to one which has a 90% survival rate? What is the market clearing price for a 5% better chance at living?

Of course, this assumes you posses accurate information... which is a big assumption. If you want to make it even more difficult, imagine the same question applied to your child or SO where the info is coming from the people trying to sell you the "products".

Insurance makes this line of reasoning a lot more complicated, but it doesn't eliminate the problem (just makes it indirect). There are places in the healthcare system where market based approaches actually make a lot of sense, but they are behind the scenes deeper in the supply chain.

Of course, this is completely ignoring the moral argument. The Hippocratic Oath and "market based" are just not compatible, and most humans favor the former.

theman said...

Firstly, Obama isn't wise. He's saddled the country with trillions in wasteful "stimulus" giveaway that are fueling deficits and future inflation, and his health care "reforms" are going to increase medical costs by mandating additional coverage of dubious values.

Brin's view of the Republican Party as a "hijacked monstrosity" shows that he is a very partisan liberal Democrat, despite his overemphasizing his few disagreements with the party line.

Finally, I do mock the "10,000 McVeigh's" prediction, which isn't coming true; his view that is so is the result of a slanted microscopic examination of the news. The 2 murders that made the national news coming relatively close are a coincidence that hasn't been followed by more. There are always some murders going on, sometimes involving foreigners especially as the number of foreigners increase. Despite Brin's Minuteman bashing, far more US citizens are murdered by illegal aliens than illegal aliens murdered by US citizens, such as this case - .