by publius
I'm too busy at the moment with school starting to say what needs to be said about this:
The Senate Finance Committee will drop a controversial provision on
consultations for end-of-life care from its proposed healthcare bill,
its top Republican member said Thursday.
There really aren't words to describe not only how ridiculous this is, but how threatening it is to policymaking. I've mentioned before that that the health coverage reform debate is a test of our institutions — both political and media.
In this instance, it's a complete failure. A demonstrable falsehood was repeated and repeated, and it led the Committee to drop a very valuable provision that would help inform individuals — particularly those with less resources — about critical medical and legal issues. The falsity and fearmongering drove the policy here.
Anyway, I'll have much more to say about all this later. Feel free to vent in the comments. I'll join you soon.
As policy goes, it’s a pretty minor concession compared to the overall reforms.
But as a symbol for how poisoned discourse affects policy, it’s down right depressing.
it’s all the Dem’s fault for not communicating to the other members of the committee the truth of the relevant provision. if only the Dems had tried to explain to the other members that, no, the provision, which was added by Republicans, wa not meant to set up DEATH PANELS.
alas, they failed.
and the GOP remains blameless.
I wouldn’t worry to much about it. It will be in any final bill, because it is the right thing to do from a care and economic viewpoint. Of curse both Point and cleek are right, it is a terrible sign for the future of political debate and the GOP remains blameless.
It’s a concession to minority rule. The Republicans win either way, either they are in the majority and rule like dictators, or they are in the minority and make so much noise that the Dems continue to roll over like beaten dogs rather then do what they were elected to do.
Sadly, I don’t see this dynamic changing since Dems, for the most part, are either soft to the point of meekness, or completely beholden to the same folks that fund the Republicans, but do a better job of hiding it.
Just curious…
I’m assuming most of the folks who post here are young. Why was this “end-of-life” stuff so important to you? It almost seemed like you took it personally that folks opposed these alarming provisions.
And have you read any of the stuff that Zeke Emmanuel has written? Since he’s a close advisor to the POTUS on these matters, how can you howl with such outrage that the “death panels are a LIE!” when this Emmanuel has stated that, basically, anyone with dementia (such as my father-in-law) should NOT receive anything more than basic care since they can never be a contributing member of society? Sounds to me like he has decided that if you have Alzheimer’s then your life is not worth living and the State should not pay for anything other than to put you out of your misery.
Yet you folks are shreiking like someone just made stuff up out of whole cloth.
Are you that naive to not see where “no expensive care for non-contributing members of society” could lead?
Or is your faith in Obama so great that you are willfully blind when it comes to the realities of what he is proposing?
And the political message of dropping it is:
“See, the bill *did* have death panels in it, otherwise why whould they have removed the provision?”
Actually, the more I think about, the more depressed I get.
About a couple of years ago, I went into activism of the mind that the biggest political problem facing the country wasn’t a policy problem (like energy or health care), but in how we, as a country, talked about these things, in how we made the decisions in the first place. (Old story, I know…)
So I started working with a grassroots organization on getting money out of politics at the local level*. Then the focus shifted to health care — and I supported the need for reform, so I stayed.
And I thought less about how to change the way we engage with these issues, and more about just fighting for policies with as much integrity and rationality as I could muster.
But now I’m having doubts. Don’t get me wrong, I’ll feel incredible pride to see health care fixed^ in this country; but I’m feeling slightly guilty at the moment about putting aside what was once at the forefront of my political consciousness.
^or at least improved by historic proportions
Emmanuel has stated that, basically, anyone with dementia (such as my father-in-law) should NOT receive anything more than basic care since they can never be a contributing member of society
This is the kind of claim that really should have a link to some source.
Sadly, I don’t see this dynamic changing since Dems, for the most part, are either soft to the point of meekness, or completely beholden to the same folks that fund the Republicans, but do a better job of hiding it.
I’d go with Option Two, especially i/r/t the three Democrats doing the negotiating in the Finance Committee. I have yet to be convinced that any of the six key Senators of both parties involved in those negotiations are acting in good faith.
“I’m assuming most of the folks who post here are young. Why was this “end-of-life” stuff so important to you? It almost seemed like you took it personally that folks opposed these alarming provisions.”
Because young people get terminal diseases or accidents and die too?
Because our parents might face these decisions soon, and we’re not just about ourselves?
Because the provisions were originally proposed by Republicans in prior bills, with bipartisan support, but now suddenly it’s become a partisan issue?
Just a few ideas off the top of my head
And have you read any of the stuff that Zeke Emmanuel has written?
could you walk us through the steps where an adviser changes legislation to provide voluntary counseling, for those who want to decide for themselves what their own end-of-life directives are, into a panel where people decide who lives and who dies ?
I can’t tell you how much it pisses me off that the same people who have been acting like a bunch of howler monkeys over a provision that needn’t have resulted in anything more than the following:
DOCTOR: “Would you like to discuss a living will or extraordinary care provisions?”
PATIENT: “Nah, bro, it’s all good.”
. . . are the same people who have been pushing for DECADES to FORCE pregnant women seeking abortions to sit through a lecture, read a pamphlet, look at sonograms, etc., designed to dissuade them from seeking the care they want.
Can’t we send these people to Antarctica or something?
@ tomalg:
“…[B]asically, anyone with dementia (such as my father-in-law) should NOT receive anything more than basic care since they can never be a contributing member of society? Sounds to me like he has decided that if you have Alzheimer’s then your life is not worth living and the State should not pay for anything other than to put you out of your misery.”
Conflate much? You falsify your own “point”. Basic health care is quality-of-life stuff FOR EVERYBODY. Extreme measures are bitterly painful and both emotionally and financially exhausting for families – especially in cases like dementia and coma – and is EXACTLY why living wills and end-of-life decisions are so important.
My father died almost 20 years ago. He had a living will, and did his best to make sure his doctors understood what he wanted. A proud man who always took care of himself and others, he did NOT want to be kept alive by machine; he did not want to be a vegetable; he wanted to “go when it’s time”. He was SO concerned about this that he insisted that I swear to him that I would “make sure” his wishes were carried out…no matter what….
This is the burden. If your father is in the shape you suggest, then you know the truth of what I’m saying; so why are you so opposed to the idea that your father should have had the right to choose what happened in such an extremity? Did he make a choice? Was it binding on the doctors? Is his current condition/situation what HE wanted?
Blaming the President for this dilemma is shockingly inappropriate (unless, of course, he barged into your father’s hospital room and overrode the doctors by force of arms), and to my mind underscores the strains that afflict families at times like this.
As far as “shreiking like someone just made stuff up out of whole cloth”, that would be those who oppose giving you and me reimbursement for talking to our doctors. Which, apparently, includes you.
tomaig, you really should read what he has written rather than excerpts taken out of context. Would you consider it fair to say that Republicans want all African American babies to be aborted to reduce crime? After all, a major Republican did say those words.
As to why this is important, I have gone through the death of two parents and one father-in-law. In two of those cases decisions were easy because the decisions had been made in advance through consultations with the doctor. In the other it was excruciating to decide at what point to we give up. Also, without some kind of directive, a doctor is obligated to try all means at his/her disposal to keep the patient alive if there is the slightest chance for survival and recovery (as long as the money holds out).
Your comment speaks volumes about your lack of information on this issue.
@tomaig:
Three points: first, I’d be rather disinclined to presume a youthful-majority demographic for the posters here, though this may hinge on what you call “young”.
Two, I’m puzzled why you feel something shouldn’t be viewed as important unless one has a strongly self-interested relationship to it. Important should not mean “beneficial or detrimental to me personally”.
Three, my understanding of the end-of-life counseling is not that it is the government dictating terms regarding how terminal care can be applied, but rather advising regarding legal options and assisting in specifying them. Three-A, I’d second the call for a citation to back up your paraphrase. Your inclusion of “basically” in it set off alarm bells for me, to say the least.
Tomaig: And have you read any of the stuff that Zeke Emmanuel has written? Since he’s a close advisor to the POTUS on these matters, how can you howl with such outrage that the “death panels are a LIE!” when this Emmanuel has stated that, basically, anyone with dementia (such as my father-in-law) should NOT receive anything more than basic care since they can never be a contributing member of society? Sounds to me like he has decided that if you have Alzheimer’s then your life is not worth living and the State should not pay for anything other than to put you out of your misery.
Yet you folks are shreiking like someone just made stuff up out of whole cloth.
In this Time Magazine piece by Michael Scherer:
http://www.time.com/time/nation/article/0,8599,1915835,00.html
Schrerer writes that “[Betsy Macaughy] quotes [Ezekiel Emanuel] discussing the denial of care for people with dementia without revealing that Emanuel only mentioned dementia in a discussion of theoretical approaches, not an endorsement of a particular policy.”
It would be good if someone (here?) can track down the Emanuel piece that Macaughy was referring to, or find a link to someone who has. If it is the case that Emanuel was writing, “Theoretical ethical approaches that a society could take are a. …. b. …., c….., d…. e…. (etc.)”, and Macaughy just quoted Emanuel describing b. as if Emanuel was simply saying that b. is the necessary answer and the proper approach, then, yes, that would be just making stuff up.
The falsity and fearmongering drove the policy here.
And this is different from, say, war on drugs, war on terror, cold war, vietnam, immigration, taxes, etc. etc. etc., how? Falsity and fearmongering is the business of america.
I’m assuming most of the folks who post here are young. Why was this “end-of-life” stuff so important to you? It almost seemed like you took it personally that folks opposed these alarming provisions.
I can afford to pay an attorney to help me and my wife set up living wills. Lots of people on Medicare can’t. I think everyone should have their preferences written down so that their preferences will be honored. I mean, I’m not a child but I’m also strongly in favor of funding Child Protective Services. I’m not a veteran, but I think we should spend more on veteran’s health care.
And have you read any of the stuff that Zeke Emmanuel has written? Since he’s a close advisor to the POTUS on these matters, how can you howl with such outrage that the “death panels are a LIE!” when this Emmanuel has stated that, basically, anyone with dementia (such as my father-in-law) should NOT receive anything more than basic care since they can never be a contributing member of society? Sounds to me like he has decided that if you have Alzheimer’s then your life is not worth living and the State should not pay for anything other than to put you out of your misery.
I just read Emmanuel’s Atlantic article yesterday. You know, the one where he argued passionately against making physician assisted suicide legal. So I’m really curious: what are you talking about? Can you please link to the writings that you’re referring to?
It would be good if someone (here?) can track down the Emanuel piece that Macaughy was referring to, or find a link to someone who has.
i believe this is the one (via Armbinder.
“It’s a concession to minority rule. The Republicans win either way, either they are in the majority and rule like dictators, or they are in the minority and make so much noise that the Dems continue to roll over like beaten dogs rather then do what they were elected to do.”
I think this is probably too strong an indictment of the Dems. One of the things they promised was unprecedented transparency. This is what that transparency looks like. On both sides many of these things would have been dealt with outside the public view in the past.
With the death panels removed from the legislation, it should be easy to forge a concensus bill, yes?
“It would be good if someone (here?) can track down the Emanuel piece that Macaughy was referring to, or find a link to someone who has. If it is the case that Emanuel was writing, “Theoretical ethical approaches that a society could take are a. …. b. …., c….., d…. e…. (etc.)”, and Macaughy just quoted Emanuel describing b. as if Emanuel was simply saying that b. is the necessary answer and the proper approach, then, yes, that would be just making stuff up”
From cleeks link:
“Conversely, services provided to individuals
who are irreversibly prevented from being
or becoming participating citizens are not basic and
should not be guaranteed. An obvious example is
not guaranteeing health services to patients with dementia.”
This seems reasonably unambiguous.
“I’m assuming most of the folks who post here are young. Why was this ‘end-of-life’ stuff so important to you? It almost seemed like you took it personally that folks opposed these alarming provisions.”
It’s almost as if everyone here thinks it’s barely possible they might die someday.
Or could be hit by a car tomorrow.
Or might have a family member that might, someday, die.
Or has had a family member, or close friend, die, and seen what they went through.
Weird of them, isn’t it?
This seems reasonably unambiguous.
New grammar pet peeve: people who think “you should not be guaranteed X” is the same as “you should be denied X.”
Marty, note that in that article he is not endorsing that position, merely stating that as one of the positions that could be taken as opposed to everybody having access to everything under the sun. It is that typwe of taking out of context that is all too common these days.
And in an area such as this is totally inexcusable.
“Marty, note that in that article he is not endorsing that position”
I’d second the idea, implied by cleek, of reading Ambinder’s summary.
“It is that [type] of taking out of context that is all too common these days.”
Thusly.
Marty:
I direct you in the direction of James Fallows. This particular link itself probably doesn’t have the information you’re looking for, but it’s filled with good links – including Fallow’s long history of calling out McCaughey’s long, long history of falsehoods and distortions.
http://jamesfallows.theatlantic.com/archives/2009/08/i_was_wrong.php
“Marty, note that in that article he is not endorsing that position, merely stating that as one of the positions that could be taken as opposed to everybody having access to everything under the sun. It is that typwe of taking out of context that is all too common these days.”
I actually don’t note that at all. It is part of a summary at the end preceded directly by:
“This civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources . Procedurally, it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed. Substantively, it suggests services that promote the continuation of the polity-those that ensure healthy future generations,ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations-are to be socially guaranteed as basic.” (bold added)
So far today I have seen:
Can you prove it exists – yes
Was it quoted accurately – as stated yes
It is out of context – no the link was provided
The article is not endorsing that position – I read the whole thing twice, he is for the allocation of resources and this is an obvious example, I guess I just disagree that it doesn’t say he is for it.
should you be reading, Mr Ambinder: apologies for misspelling your last name…
This is about the unwillingness of Democrats to take on the Republican message machine. It is about the fundamental fact that the Democratic party barely stands for anything in particular, and fears a hard fight over any issue no matter how moronic. It is what caused them to lose power in 1994, and is an illness apparently still not cured.
It is worth noting that when the Republicans were in power, this is also how they got what they wanted. They threatened, lied, wnet crazy and required a sustained fight on principle in order to oppose them. That is how we ended up with so much crap, but also how Bush could continue to get his way on certain things even after 2006. How many posts were there from that era about how the Dems ran running scared when the rhetoric got tough?
It is hard to see where Obama stands on any of this, or as the 8-ball says, “Reply hazy, try again” which is better than “Better not tell you now.”
Here’s another link, this time with Emmanuel’s recent commentary on it.
That is, as far as I know, the only time he actually advocated rationing. With respect to dementia itself I agree with Hogan when he points out that the difference between “doesn’t guarantee” and “denies” is big. It should be obvious to anyone approaching the issue honestly. Tomaig was, if not lying, lied to and thoughtlessly repeated it.
I’m assuming most of the folks who post here are young. Why was this “end-of-life” stuff so important to you? ….anyone with dementia (such as my father-in-law)
So, you get to care because of family, but you think- what, that the rest of us (youngsters all) don’t have families, or just that we don’t care about them?
And have you read any of the stuff that Zeke Emmanuel has written? Since he’s a close advisor to the POTUS on these matters, how can you howl with such outrage that the “death panels are a LIE!” when this Emmanuel has stated that, basically, anyone with dementia (such as my father-in-law) should NOT receive anything more than basic care since they can never be a contributing member of society?
Because they are not in any bill. Im not aware that anyone in Congress has proposed an amendment of this nature in good faith. Im not aware of any statements by the administration that this is a goal of theirs, or that they would even tolerate something like this.
So yes, the death panels are a lie. If I were to extrapolate from John Ashcroft and Trent Lott’s footsie with Southern white supremacists into a claim that Bush wanted to reverse the results of the Civil War, it would be a similar falsehood.
Or is your faith in Obama so great that you are willfully blind when it comes to the realities of what he is proposing?
You are a liar- Obama has proposed nothing of the sort.
Marty, what do you understand the phrase “socially guaranteed as basic.” to mean?
” the difference between “doesn’t guarantee” and “denies” is big”
This difference is irrelevant when we are talking about setting the level of basic healthcare that society agrees is guaranteed. The provider(or instrument of requiring delivery) of that healthcare is the government so if they don’t guarantee it, it can be denied.
i’m still waiting for Emmanuel’s attackers to explain how the bill in question sets up any kind of death panel.
Marty? wanna give it a try? you seem to think Emmanuel’s essay is an endorsement of some kind of kill-the-infirm system. care to explain how that paragraph gets us from the bills we have no, to the future you imagine Emmanuel wants ?
I’ve read Emmanuel’s piece a couple of times now.
First, the topic he is addressing isn’t specifically whether Alzheimer’s patients should be denied medical care. The topic he is addressing is the fact that an inability to agree on what medical services ought to be included in any kind of universal coverage program prevents us from establishing such a program.
Further, he states that coming to such an agreement will require us to consider “the good” in a social sense. There isn’t, he claims, a way to get there from here without considering questions of social value.
He suggests (not normatively, more in the sense of a prediction) that a consensual understanding of “the good” would likely, or at least possibly, not guarantee medical services to folks suffering from dementia.
A couple of observations:
First, he’s only discussing what would be made available as part of socially guaranteed universal coverage. As has been pointed out upthread, “not guaranteed” is many miles away from “denied”.
Second, it’s unclear to me what is meant by “medical services”. Does “denial of services” mean the demented would be left to utterly fend for themselves, even if they are incapable of doing so? Would they not be fed, clothed, housed, and given whatever basic palliative care is available?
Net/net, it’s unclear (to me) what exactly what fate Emmanuel is envisioning for the demented, nor is it clear whether that fate is one he endorses or not.
All of that said, to be honest it’s not that hard for me to extrapolate from Emmanuel’s piece to a world in which Alzheimer’s patients were disqualified from publicly guaranteed care. I assume that, frex, Medicare would currently cover basic medical services for senile dementia, so this could actually be a step backward for them.
That would suck.
However: I don’t see anything resembling what Emmanuel describes being proposed by anybody as a matter of public policy. Not only not yet, but not bloody likely, ever.
So, yes, there is (to me at least) some troubling language in Emmanuel’s piece, but in the context of the policies that are actually being proposed and the debate we’re actually happening, the idea of “death panels” is paranoid hogwash.
“I’m assuming most of the folks who post here are young. Why was this “end-of-life” stuff so important to you? It almost seemed like you took it personally that folks opposed these alarming provisions.”
Any number of people have chimed in, but let me speak from my experience. My mom passed away 2 years ago from cancer that we thought was gone. We had about 5 months to come to grips with what needed to be done and it was just my brother and me trying to wrestle with this. By the end of the 5 months, we had cobbled together a network of people who were able to address the myriad problems that we faced, but I’m still not sure if we took the best option and the time that it took was time lost. Some sort of network/system to maintain and pass on the kinds of knowledge that is hard earned in these cases matters a great deal to me, especially since my dad is here for a month for what will probably be his last visit here and we have to consider various things.
I have to admit, if I had gotten to your comment first, I would have broken posting rules pretty badly. But as it was a pro-life Republican senator, Isakson from Georgia, who put the end of life panel support into the bill, so I will assume that the problem is lack of information rather than ill intent.
“[I] was only addressing extreme cases like organ donation, where there is an absolute scarcity of resources…”
??
That sounds even worse…So if a person with dementia has viable organs that can be harvested/transplanted is that when the “no guarantees” part comes in?
Like “Live Organ Donation” from Monty Python’s “The Meaning of Life” only worse because they’ll have to euthanize grandma first…
“Marty? wanna give it a try? you seem to think Emmanuel’s essay is an endorsement of some kind of kill-the-infirm system. care to explain how that paragraph gets us from the bills we have no, to the future you imagine Emmanuel wants ?”
I don’t care about what Emmanuel wants. I just think he said it and everyone trying to say he didn’t, or he didn’t mean it, is intellectually dishonest. Just as I discount anything he said in a 2009 Lancet article as being too close to CYA for me to believe it.
People call others lots of bad names, my least favorite, by far, is liar. When asked to prove a statement and facts are supplied then the answer is you were right. Not all of us are good at that, occasionally me.
The provider(or instrument of requiring delivery) of that healthcare is the government so if they don’t guarantee it, it can be denied.
No!
The government is not the healt care provider!! Not government health care.
This is government provided INSURANCE!
The government can decline to cover certain treatments, procedures and medicine, like private insurers do as a matter of course. But that does not mean that people cannot obtain the applicable treatments, procedures and medicine. They just have to come out of pocket.
That sounds even worse…So if a person with dementia has viable organs that can be harvested/transplanted is that when the “no guarantees” part comes in?
Whaaaaaa? That is beyond ridiculous. Trollville.
The provider(or instrument of requiring delivery) of that healthcare is the government
No. Or, to put it another way, no. Not in any bill currently being considered, or at all likely to be considered in the lifetime of anyone here. The most that’s being proposed by anyone in Congress or the White House is that the government become a larger financer of health care than it is now, and that it guarantee a minimum level of coverage for private and public insurance; they are not making the government the deliverer of health care, and they are not having the government set a maximum on what and how much health care you’re allowed to have.
So, to sum up, no.
Given this: “[I] was only addressing extreme cases like organ donation, where there is an absolute scarcity of resources … My quotes were just being taken out of context.”
and this: With respect to dementia itself I agree with Hogan when he points out that the difference between “doesn’t guarantee” and “denies” is big.
this is truly academic. I find it hard to imaging too many people even seeking organ transplants for those with dementia. And, if they do, I suppose they could have at it (under a proposed government-provided insurance regime). They’ll just have to find a way to pay for it, as they probably would under our current system (if money is even the driver for obtaining replacement organs in such cases today).
I could be wrong about this, but I doubt insurance companies generally pay for such things in such cases currently. And, even if they would in theory, would those organs be made available, anyway? (Sorry for the passive voice. I’m just not sure how organs get to people now. But it seems reasonable to think there would be some non-monetary mechanism that would prioritize recipients not suffering dementia or terminally ill over recipients otherwise.)
In any case, I can’t imagine many people, if any, with dementia have been getting organ transplants over, say, the last 20 years. Does anyone have an idea how to get stats on such a thing? I hate to simply rely on my general sense of things to make this kind of argument.
“No!
The government is not the healt care provider!! Not government health care.
This is government provided INSURANCE!
The government can decline to cover certain treatments, procedures and medicine, like private insurers do as a matter of course. But that does not mean that people cannot obtain the applicable treatments, procedures and medicine. They just have to come out of pocket.”
Sorry Eric, you are correct.
“But as it was a pro-life Republican senator, Isakson from Georgia, who put the end of life panel support into the bill, so I will assume that the problem is lack of information rather than ill intent.”
I think this is not quite correct, Isakson has in the past proposed similar end of life counselling provisions which, ironically would have been mandatory for medicare appllicants- don’t do the counselling ineligible for medicare. This provision simply provided for funding, and prior to being terminally ill, unlike the Bush era provision which only provided for it when you were terminally ill.
Whaaaaaa? That is beyond ridiculous. Trollville.
Probably. It can be hard to tell sometimes.
Whaaaaaa? That is beyond ridiculous. Trollville.
Fifty bucks says “ZOMG OBAMA WANTS TO PUT SICK OLD PEOPLE TO DEATH SO HE CAN HARVEST THEIR ORGANS!!!1!” is next week’s meme.
Another fifty bucks says that by this time next week Marty will have explained to us that the widespread propagation of this meme is Obama’s fault for not getting his message out clearly.
Run, Tomaig! Run and tell the people!
I just think he said it and everyone trying to say he didn’t, or he didn’t mean it, is intellectually dishonest.
the point in question was tomaig’s:
“Emmanuel has stated that, basically, anyone with dementia (such as my father-in-law) should NOT receive anything more than basic care since they can never be a contributing member of society? ”
and Emmanuel absolutely did not say that “anyone with dementia … should NOT receive anything more than basic care since”.
Emmanuel was talking about the kinds of things that could happen if people started thinking about health care in a certain way. his denying care example was just one of the results, in this hypothetical world. and he says he doesn’t “fully defending” the resulting conclusion, but offers it as an illustration of the kinds of decisions people will have to make, if we are to have universal health care.
of course, insurance companies already make these decisions, all the time. the media is full of examples of ICs denying coverage for (from our perspective) trivial or cruel reasons. most people can tell their own stories about how their IC has denied them coverage.
intellectual honesty would demand acknowledging that we already have “death panels”.
“I direct you in the direction of James Fallows.”
I got an email from him yesterday! (Okay, it was just a short “many thanks” for sending him some “great” links, and another sentence or two, but I was inordinately pleased.)
I read Fallows’ blog regularly. He also followed up yesterday’s post today.
“should you be reading, Mr Ambinder: apologies for misspelling your last name…”
But “Armbinder” is so much more fitting when someone writes about health care.
Besides, I bet he gets that a lot. (Oh, yes, pet peeves? “alot.”)
“Three, my understanding of the end-of-life counseling is not that it is the government dictating terms regarding how terminal care can be applied, but rather advising regarding legal options and assisting in specifying them.”
Actually, it’s simply the government providing funds for you to consult with your doctor or lawyer (which otherwise turns out to cost money! Money you maybe can’t afford, especially if you’re old and ill!). How terrible this is!
Marty: “he is for the allocation of resources”
Oh, noes! I think it would be much better if we didn’t allocate resources, and simply produced them infinitely! Who could disagree?
“The provider(or instrument of requiring delivery) of that healthcare is the government so if they don’t guarantee it, it can be denied.”
Unlike insurance companies, and HMOs, which cannot deny services!
And people without health insurance at all definitely can’t be denied services, because they don’t have any to start with!
It certainly would be terrible if people could be denied health services; that would be a huge change in current health care.
Observation: as is so often the case, the underlying arguments here tend to revert to variants of: “government is the [potential] problem!” “No, it isn’t!” “Yes, it is!” “No, it isn’t!” “Yes, it is!”
One oddity is the failure to engage the nutball rhetoric. On some level, the theory seems to be to not legitimize it by meeting it squarely. That is sometimes true and probably the correct response to someone arguing that the Moon landings never happened. Who cares what they think and why argue with such people.
But in the health-care situation, nutball rhetoric can be an opportunity. Use it as the foil for making your own arguments — how often does the other side give you a ready-made strawman? i.e., “this is what we want and this is the crap they say (death panels, etc.)”. You can even be a little nutty yourself, and point out how they favor private death panels called insurance companies. Make the argument a contrast between clear logical specifics and nutball crazy. If you cannot win that argument, you do not deserve political leadership.
Marty: “People call others lots of bad names, my least favorite, by far, is liar.”
Marty, two sentences earlier: “I just think he said it and everyone trying to say he didn’t, or he didn’t mean it, is intellectually dishonest.”
“intellectual honesty would demand acknowledging that we already have “death panels”.”
The problem with this argument is that if I admit we currently have death panels then I have to concede we will have them after the reform bill passes. I would then be playing into the hands of the wingnuts that want me to admit my treachery.
“Marty: “People call others lots of bad names, my least favorite, by far, is liar.”
Marty, two sentences earlier: “I just think he said it and everyone trying to say he didn’t, or he didn’t mean it, is intellectually dishonest.” ”
I recognized this when I wrote it, intellectual dishonesty is typically not being honest with ones self. I suspect no one here of lying to me.
It certainly would be terrible if people could be denied health services; that would be a huge change in current health care.
Precisely.
This is what has me tearing my hair out, and thinking that maybe I just need to avoid any discussion of this topic for the foreseeable future, for the sake of my own sanity. Seeing people criticizing the proposed reforms for the exact same things that are already part of the system right now…it was funny the first couple hundred times, but the utter lack of self-awareness is really starting to give me agita. The dire warnings of “big, confusing bureaucracy,” “some bureaucrat making life-or-death decisions for you,” “resources will have to be allocated”–what country have these people been living in? Is this all some elaborate put-on? Am I on Candid Camera?
Conservative Republican Senator Johnny Isakson of Georgia speaks:
Isakson:
“One oddity is the failure to engage the nutball rhetoric.”
I’m not clear where you see this failure to engage; Obama has been out every day doing events denouncing the nutball stuff, and correcting the record; plenty of Democratic Representatives have been doing the same, in between being shouted at at public meetings.
“I suspect no one here of lying to me.”
But you don’t think you were calling anyone a “bad name” when you said that “everyone [here] trying to say he didn’t, or he didn’t mean it, is intellectually dishonest”?
This is an example of what you believe is intellectual honesty?
The problem with this argument is that if I admit we currently have death panels then I have to concede we will have them after the reform bill passes.
we’ll have fewer of them, since denial of coverage is one of the things HC reform is trying to get rid of.
Gary:
What I mean is go after and use it directly as part of the argument. And use it in such a manner that the sound bites of the counter-argument make the news.
I agree that there is push back, but not directed at the nutball rhetoric nearly as strongly as is probably necessary. I do not pretend to know the details of the overall developments to fight back, but it seems to be more of a matter of fighting back by simply dismissing the nutball rhetoric, as in “we need not go there.”
“The dire warnings of ‘big, confusing bureaucracy,’ ‘some bureaucrat making life-or-death decisions for you,’ ‘resources will have to be allocated”–what country have these people been living in?”
As I said, it just goes to people’s core prejudices as to whether they believe Reagan’s formula from his First Inaugural Address: “In this present crisis, government is not the solution to our problem; government is the problem,” or not.
These people seem be believe, as a corallary, that big corporations, including insurance companies, are not the solution to our problem; the solution is to keep studying the problem.
Curiously, these same people tend to support/follow politicians who have among their primary financial supporters, large insurance companies and health care providers. This is all coincidence, I’m sure.
Americans have been shouting at each other variants of “government is socialism, which is totalitarianism” versus Roosevelt’s — Teddy, that is, for over a century:
I’ve given long quotes here before from this speech.
A much shorter set of quotes from that speech:
But Teddy Roosevelt was doubtless a communist dupe.
But let’s go to the Bull Moose Platform, which is to say, Teddy Roosevelt’s platform, of 1912:
Commie, commie, commie!
We need to study these proposals longer: we can’t rush into such complex issues.
“I do not pretend to know the details of the overall developments to fight back, but it seems to be more of a matter of fighting back by simply dismissing the nutball rhetoric, as in ‘we need not go there.'”
August 11th:
August 9th:
Raleigh, July 29th.
Short quote:
And so on.
Terri Schiavo was let go for lack of a will.
Now end-of-life counseling’s also been killed.
Th’ provision died
By death panel lies
Of Palin, whose brain-deadness Schiavo equaled.
As Gary demonstrates, Obama has, in fact, been doing what he can to swat down the lies.
Unfortunately, that does nothing to keep the lies from being repeated.
So then what?
[Emmanuel is claiming that] an inability to agree on what medical services ought to be included in any kind of universal coverage program prevents us from establishing such a program…[and he states] that coming to such an agreement will require us to consider “the good” in a social sense. There isn’t, he claims, a way to get there from here without considering questions of social value.
This is the nub of the whole argument (thanks russell). Emmanuel is absolute right, as summarized above. The choice is between having the arbitrary, cruel, ungodly expensive ‘system’ we have now, and having a rationalized system in which ethics and humanity play the central role. It is a failure of nerve, a failure of *character* to choose the former. I understand what Marty was saying before about people being scared – that, right or wrong, the fear is real. But self-confident adults understand that eventually difficult decisions have to be made, lest they be made for you – arbitrarily – by events. Self-confident nations understand that, too – great nations do.
Should organ transplants be guaranteed as a basic right for all terminal Alzheimer’s patients? That is a hard question, but I do think it’s at least debatable, and answering ‘no’ doesn’t make you Megele. Until we learn how to grow kidneys in the lab, they will be in short supply, and we’re going to have to decide how to deal with questions like this. I would bet my life that, overall, a government-administered health insurance regime would handle such questions more humanely – erring on the side of generosity – than would a for-profit insurance company.
The question here is: do we trust ourselves (in a democratic republic sense) enough, as humane, ethical, intelligent, competent human beings, to rationalize how we deal with public health, or do we not? If the answer is that we don’t, and instead choose (accede to) chaos and entropy, we’re pretty screwed – and not just vis a vis health care.
well said jonny.
The incredible thing is that we can’t as a nation even get to where Teddy Roosevelt was in 1912 ( or Bismarck was a generation before that). Obama doesn’t dare talk like that today, or he would for sure be labeled a commie, and there would be assassination attempts.
OTOH, maybe if he wanted out and quoted TR’s words at one of these town halls,(and identified it as being from TR) it would get people to understand that advocating for national health insurance is as American as apple pie. I bet we can find some Harry Truman quotes that would be helpful too.
“So then what?”
Death panels for critics! After we have their email addresses! But first, camps to lock them up in!
I believe Michelle Malkin has warned us of this.
Though, of course, she’s also in favor of putting Americans in camps. It’s all so confusing.
Observation: as is so often the case, the underlying arguments here tend to revert to variants of: “government is the [potential] problem!” “No, it isn’t!” “Yes, it is!” “No, it isn’t!” “Yes, it is!”
This is at least in part because most of the progressive organizing on this issue has been trying to get citizens to lobby Congress and the President.
It’s the right that has adopted Saul Alinsky-style tactics…and they’re reaping the rewards.
Proponents of real healthcare reform ought to be taking the fight to offices of major insurance companies and the homes of their CEOs, showing up with real people who’ve already been denied coverage, sitting in, getting arrested and getting on the news.
I’m as mad as anyone at the Democrats in Congress for blowing this issue, but their behavior has been entirely predictable. The lack of creativity in building direct actions for a grassroots pro-reform social movement is more disturbing to me. It’s a sad day when progressive are even more reliant on corporate politics than the right is.
“”I suspect no one here of lying to me.”
But you don’t think you were calling anyone a “bad name” when you said that “everyone [here] trying to say he didn’t, or he didn’t mean it, is intellectually dishonest”?
This is an example of what you believe is intellectual honesty?”
Nope, I see it as an example of how people can be ready to challenge the veracity of a statement and when proven wrong start adding a bunch of unrelated counter arguments so they don’t have to say, oh yeah, you are right. I also included myself in doing that occasionally. If you are offended by th observation I will gladly apologize for the offense.
The lack of creativity in building direct actions for a grassroots pro-reform social movement is more disturbing to me. It’s a sad day when progressive are even more reliant on corporate politics than the right is.
Speaking as a progressive born long after the 60s protest movements, I have trouble seeing how the kind of direct action you advocate would effect change.
I mean, let’s say that a bunch of people go harass some insurance executives. And then get arrested. Why do you think the national press would cover that? I mean, when millions of people turned out to protest the war, coverage was very low. I’ve been trying to understand how the media works for a long time and I don’t have a good enough model that would enable me to predict what sorts of direct action will reliably get the press’ attention and change the dominant narrative in positive ways. Do you?
Moreover, even if direct action did get lots of press, what makes you think it would help reform? Given how many very serious people are obsessed with recasting all political disputes into a “Hippies! Fighting Squares! Free love!” narrative, it seems like direct action would hurt reform as the media used it to portray reform proponents as irrational anti-American hippies.
Part of my skepticism here comes from watching how the media reacted to Michael Moore’s movie Sicko. Now, Michael Moore is fat and has various issues as a documentary maker, but it was still kind of shocking how the central story he portrayed made zero impression in the media. I’m talking about taking Americans injured on 9/11 who couldn’t afford health care in the US to Cuba so they could get their damn treatment. That story shocks me. I’d think it would shock a lot of people, even if they just wanted to debunk it. But there was very little media engagement of that story; it just quietly disappeared. Here you’ve got real American heroes badly injured not getting the health care they need — if the media can’t get interested in a human interest story like that, I have no idea what it would take to get their attention.
Organ transplants are already rationed and available organs are distributed by region, health status, age, and family status. The boards that make these decisions are government-sponsored, and the decisions are outcome-based and rational, except for some of the regional discrepancies.
Organs are first made available to recipients in the same region as the donor, both for medical reasons (organs only last so long; lungs especially are fragile to transport), and ‘fairness’. Organs go to people in regions where people donate organs.
My mother’s transplant was determined by her age (63 at the time of surgery, 65 is the cutoff for lung transplants), family status (she had a husband and family willing to assist her in her recovery and the ongoing management of her condition), health status (she was terminal w/o the transplant), and regional (access to a hospital that performed surgeries, access to organs available in that region only). We considered moving her (you can do that to maximize your chances to get an organ–there are websites, look it up.)
My parents have good insurance that paid for this, over $250,000 for the surgery, who knows how much for the follow-up and frequent tests for rejection and lung function, >$5000/month for anti-rejection drugs alone.
Organ transplants are not the best choice for this mental exercise, as your elderly dementia patient would very likely not qualify now in any case. The fact that there will have to be some triage/rationing in any system (whether you call it ‘comparative effectiveness’ or whatever) is a scary one, but it’s already happening, and frankly, probably should. I’d rather government/medical ethics/doctors make those decisions than insurance companies. Even if it might have denied me my mother for the last seven years, and my six year old the chance to know his Nana.
stonetools, what do you expect in a country where Bismarck can be presented as a socialist/commie without the person claiming that being laughed out of town?
Bismarck was a reactionary monarchist who nearly drove the moderate left into the arms of the (not yet called such) bolsheviks by persecuting them without mercy (and it was Wilhelm II.(!!!) who had to stop him). But I have heard/read leading right-wingers painting horror scenarios of a Bismarckian social contract taken shape in the US. Their Bismarck was somewhere to the far left of Marx.
I think Marty missed a key portion of the quote — he bolded the sentence before it, although this: Procedurally, it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed. puts the rest in context.
Emmanual is talking aboout what one such forum MIGHT decide. He goes further: A less obvious example is guaranteeing neuropsycho-logical services to ensure children with learning disabilities can read and learn to reason.
These “panels” are currently comprised of the heads of the insurance companies, and these are the kinds of decisions that they are making RIGHT NOW. Would a public forum deny more services than those currently being offered? Some how, I think not.
“Should organ transplants be guaranteed as a basic right for all terminal Alzheimer’s patients? That is a hard question, but I do think it’s at least debatable, and answering ‘no’ doesn’t make you Megele.”
A clarification, maybe,I believe that much of what Emmanuel was actually saying had merit. Also’ Alzheimer’s and dementia are two different afflictions.
Nope, I see it as an example of how people can be ready to challenge the veracity of a statement and when proven wrong start adding a bunch of unrelated counter arguments
Tomaig was wrong. Emmanuel does not propose withholding non-basic care from people with dementia (and even if he did, that would have sweet diddly to do with currently proposed legislation). If anyone has been “proven wrong and started adding a bunch of unrelated counter arguments,” it’s him, and you on his behalf.
Organ transplants are not the best choice for this mental exercise, as your elderly dementia patient would very likely not qualify now in any case. The fact that there will have to be some triage/rationing in any system (whether you call it ‘comparative effectiveness’ or whatever) is a scary one, but it’s already happening, and frankly, probably should. I’d rather government/medical ethics/doctors make those decisions than insurance companies.
vjs, I don’t know if your 4:38 PM comment was in response to my 1:32 PM comment, but, either way, thanks.
Don’t get me wrong, I’ll feel incredible pride to see health care fixed^ in this country
I doubt anybody here today will live to see health-care really fixed in this country, where ‘fixed’ means people have free access to the care they need, and the drugs they require, and the treatment necessary to full lives…
We were having just about this exact same debate 40 years ago…
Speaking as a progressive born long after the 60s protest movements, I have trouble seeing how the kind of direct action you advocate would effect change.
It simply cannot be any less effective than repeatedly calling the same three dozen Congresspeople or sitting around repeating facts and hoping that the media comes to give a damn.
If progressives were able to create conflict, they might be able to appeal to the media’s bias in favor of it.
But I suspect you’re right that it might not ultimately work. Direct action tends to work when it has teeth, when social revolution or insurrection seem a real possibility, as it did in the ’30 or ’60s. And that’s simply not the case today.
I’m a kidney transplant recipient, and I had to meet several qualifications to become eligible for the transplant program. Physically I had to demonstrate that I was healthy enough to tolerate the surgery and to sustain a transplant for a long period of time. Many tests were required–lots of blood was drawn, Xrays were taken, cardio stress tests were done, EKGs, etc. I also had a psychological evaluation and was asked questions about my social support system. I was dismayed to be told that I would have to have a diseased kidney removed to be eligible–otherwise the diseased kidney might spread infection to the transplanted organ. It took a while to make up my mind, but I gave in and had the surgery. I’ve known other patients who have had to have their teeth pulled because they were so infected. So you see, the awareness and cooperation of the patient are required to complete the transplant process from the very beginning. It’s not just “open up the body, drop kidney in”. This level of awareness would be not possible with a dementia patient. Some dialysis patients I knew (I was on dialysis for over 3 years before transplant) were denied transplants due to heart, lung, liver,etc. conditions that couldn’t be reversed and would limit the lifespan of the transplanted kidney. In addition, the transplant recipient must accept responsibility for the personal care that’s needed post-transplant–eating a good diet, exercise, meticulously following the prescription directions for anti-rejection drugs and putting up with their often unpleasant side effects, regular doctor visits. A high level of self-monitoring is required–again, something a dementia patient would be incapable of. Organs are not to be picked and discarded frivolously like dandelions, nor should they ever be even if they could ever be grown in a lab.
Organ transplants are already rationed and available organs are distributed by region, health status, age, and family status. The boards that make these decisions are government-sponsored, and the decisions are outcome-based and rational, except for some of the regional discrepancies.
I recall Mickey Mantle got a new liver, and killed it, too, just like the first one, and himself, with whiskey…
And I wondered at the time: “um, why?”
“In any case, I can’t imagine many people, if any, with dementia have been getting organ transplants over, say, the last 20 years.”
“Organ transplants are already rationed and available organs are distributed by region, health status, age, and family status.”
My father is on a waiting list for a liver. Organ transplants, at least liver transplants, also take into account how serious the person is about taking care of themselves and their new organ. If someone refuses to stop smoking or drinking alcohol they won’t get a liver.
Luckily my dad takes his health seriously and stopped drinking (it wasn’t alcohol that messed up is liver – he had always been just a social drinker) as soon as his doctor began suspecting liver issues a couple years ago. But an in-laws mother who was also in need of a liver refused to gain weight (she refused to let he wait get into the triple digits) and was removed from the list.
Livers are a scare thing, and they go to 1st the person most in need, then 2nd the person most likely to live the longest with it.
Rosie,
Thanks for all that information and good luck to you.
tomaig: I bet I’ve read a lot more of Zeke Emanuel’s writings than you have. What’s being said about him is utterly, completely despicable. He’s against legalizing physician-assisted suicide and euthanasia, for starters, so the very idea that he’d be involved in “death panels” is absurd. He’s an oncologist who has actually spent a lot of time working with patients at the end of life, and rumor has it he’s good at it.
Betsy McCaughey’s article is a complete travesty. Taking her cites one by one:
First, she writes:
“Savings, he writes, will require changing how doctors think about their patients: Doctors take the Hippocratic Oath too seriously, “as an imperative to do everything for the patient regardless of the cost or effects on others” (Journal of the American Medical Association, June 18, 2008).
Yes, that’s what patients want their doctors to do. But Emanuel wants doctors to look beyond the needs of their patients and consider social justice, such as whether the money could be better spent on somebody else.”
Here’s the article she’s quoting. In it, Emanuel says that there are a number of reasons why health care costs too much in the US, and focuses on seven factors which, he says, drive high rates of utilization. (Together, he calls them “the perfect stprm”.) Here’s one:
“First, there is the matter of physician culture. Medical school education and postgraduate training emphasize thoroughness. When evaluating a patient, students, interns, and residents are trained to identify and praised for and graded on enumerating all possible diagnoses and tests that would confirm or exclude them. The thought is that the more thorough the evaluation, the more intelligent the student or house officer. Trainees who ignore the improbable “zebra” diagnoses are not deemed insightful. In medical training, meticulousness, not effectiveness, is rewarded.
This mentality carries over into practice. Peer recognition goes to the most thorough and aggressive physicians. The prudent physician is not deemed particularly competent, but rather inadequate. This culture is further reinforced by a unique understanding of professional obligations, specifically, the Hippocratic Oath’s admonition to “use my power to help the sick to the best of my ability and judgment” as an imperative to do everything for the patient regardless of cost or effect on others.”
That’s where her quote comes from. But does he think that all the seven factors he discusses should be changed? No: he writes: “Some elements in the perfect storm are difficult or impossible to change; some, arguably, should not change.” But wait: doesn’t that mean that we can’t infer that “Emanuel wants doctors to look beyond the needs of their patients and consider social justice, such as whether the money could be better spent on somebody else.”? Why, yes: it does.
What Emanuel thinks we should focus on is changing the way insurance pays for services, not changing doctors’ understanding of the Hippocratic Oath. Oops!
Second: “Emanuel, however, believes that “communitarianism” should guide decisions on who gets care. He says medical care should be reserved for the non-disabled, not given to those “who are irreversibly prevented from being or becoming participating citizens . . . An obvious example is not guaranteeing health services to patients with dementia” (Hastings Center Report, Nov.-Dec. ’96).
Translation: Don’t give much care to a grandmother with Parkinson’s or a child with cerebral palsy.”
This one has been discussed above. To my mind, the crucial point is that Emanuel is talking about how one might draw the distinction between (a) “basic” services, which should be guaranteed to everyone, and (b) “discretionary” services, which should not. But no one will be denied these discretionary services; they’ll just have to either get a supplemental insurance policy that covers them or pay for them out of pocket.
Plus, it’s not at all clear that he’s advocating the line of thought he explores. But even if he were, this would not be about preventing anyone from getting care.
Third, McCaughey writes: “He explicitly defends discrimination against older patients: “Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years” (Lancet, Jan. 31).”
Here’s the Lancet piece. Here’s what Emanuel says he’s talking about, near the beginning of the piece:
“Allocation of scarce medical interventions is a perennial challenge. During the 1940s, an expert committee allocated—without public input—then-novel penicillin to American soldiers before civilians, using expected efficacy and speed of return to duty as criteria.7 During the 1960s, committees in Seattle allocated scarce dialysis machines using prognosis, current health, social worth, and dependants as criteria.7 How can scarce medical interventions be allocated justly? This paper identifies and evaluates eight simple principles that have been suggested.8—12 Although some are better than others, no single principle allocates interventions justly. Rather, morally relevant simple principles must be combined into multiprinciple allocation systems. We evaluate three existing systems and then recommend a new one: the complete lives system.”
It’s not — not about allocating health care generally. It’s about allocating scarce resources. Suppose you have only one transplantable heart, and six people who need it, and will die otherwise: who do you give it to? Should you just flip a coin? Would it matter if one of them was Hitler? Or if one was in an irreversible coma? How do you choose? — The relevant feature of cases like this is: there are too few resources to serve everyone who needs them. Someone has to figure out who gets what, even if only by flipping a coin.
Zeke’s view “prioritises younger people who have not yet lived a complete life and will be unlikely to do so without aid.” And in the passage McCaughey quotes, he’s saying: this is unlike discrimination on the basis of race or sex. Since race and sex are, if not impossible to change, then at any rate pretty hard to change, most people retain the race and sex they are born with for life. That means that if, say, men discriminate against women, or whites against blacks, (or vice versa), one group of people gets discriminated against for their whole lives.
Prioritizing those who have not yet lived a complete life over those who have is not like that. Everyone is an infant at some point; if you’re lucky, you get to live through all the stages of a complete life. So there is not one group of people who are, say, permanently children, or permanently elderly, and who get dumped on for life.
Moreover (this is me now, not Zeke) the elderly have been lucky in that way: they have gotten to live through most of the other stages (adolescence, youth, the prime of life, etc.) Zeke’s view would try to ensure that as many people as possible would get that chance.
The point he’s making is conceptual: age discrimination is not like other kinds of discrimination. (Thus, there is no age version of statements like: if men menstruated …) He’s also making what seems to me the perfectly reasonable point that if you have, say, only one kidney, and you have to choose between someone who has already lived a full life and someone else who is seventeen, and if both would have a good prognosis after transplant, etc., you should give it to the seventeen year old.
The important point about this article is that Emanuel is only talking about a very small set of cases, in which you really do have to make tough choices. It is completely dishonest for anyone who has read the article to suggest that this covers all of health care. (People who haven’t read the article and pass on McCaughey’s claims anyways aren’t dishonest, just irresponsible.)
I know Zeke Emanuel. He’s not a friend, just someone I know and like. (He was the head TA in the first course I ever taught — the one in which Andrew Sullivan was one of the other TAs. Small world.) He’s a good guy and a good bioethicist. And he’s about as far from “Dr. Death” as you could imagine. Plucking the odd sentence out of context to insinuate the opposite is despicable.
PS: on reflection, I don’t know whether all my links will work or not — my employer has an institutional subscription to these journals, and I don’t know which are behind sub walls. However, if anyone wants a copy of any of the articles (other than the Atlantic), just email me at hbok at mac dot com, and I’ll send you the pdf.
someone should really put hilzoy’s 6:24 on the front page.
As awful as it is that the Dems are removing something that would be tremendously helpful to most families, what horrifies me is — what will the GOP Senators make a bogus attack on next?
“But I suspect you’re right that it might not ultimately work. Direct action tends to work when it has teeth, when social revolution or insurrection seem a real possibility, as it did in the ’30 or ’60s. And that’s simply not the case today.”
Days like today are ones where I fear social revolution or insurrection are the only remaining alternatives. Everything I’ve seen tells me that Obama (as a politician who is trying to raise the level of debate) is well beyond what we can reasonably expect our political process to produce. If that isn’t enough, I’m terrified of the conclusion I reach: the patient (i.e. the United States of America) is terminal and the only choice left is whether or not to die with dignity. I don’t want to think about that, but it feels like events force me to.
Obama told the bankers: “I’m the only thing standing between you and the pitchforks.” I think that’s right, but I’m also sure that the people who need to understand that message don’t have any conception of how right he is. Or maybe Obama is wrong and the American people no longer have the stomach to take up the pitchforks in a just and noble cause. Maybe that hypothesis is more consistent with how things have played out so far. In that case, horrible as it may seem, I suppose we deserve what we get…
With that last paragraph, Hilzoy performs the blog equivalent of this, albeit without Alvy Singer’s neuroses.
Or maybe Obama is wrong and the American people no longer have the stomach to take up the pitchforks in a just and noble cause.
“The American people” are, to understate the case laughably, not of one mind about which causes might be worthy of pitchforks.
But I’m not sure which is scarier: that “the American people” no longer have the stomach to take up the pitchforks in what *I* would consider to be just and noble causes, or that there are all too many people ready to take up the pitchforks for causes that would (from my perspective) destroy us.
Question: why can’t we go after the lobbyist groups financing the bussed-in rioters for fraud? These guys are trafficking in lies and rumors and no one is calling them on it. This can’t be a free speech issue: they are spending money and making money, there’s nothing free about it.
hilzoy, I love when you are angry.
People are complaining that if everybody gets covered we won’t have enough resources. Then when some actually talks about what that means and what kind of choices and decisions are going to have to be made (you know, speaking like an adult)he’s the one that gets condemned.but having people speak at an adult level is apparently too much too ask.
I don’t think I have ever been as disgusted by the state of discourse in this country as I am right now.
here’s a small but hopeful sign that the media might be catching-on to the GOP’s shenanigans. though it may be too late for this provision…
why can’t we go after the lobbyist groups financing the bussed-in rioters for fraud? These guys are trafficking in lies and rumors and no one is calling them on it.
Well whether or not this is entirely true, lying is not against the law and it certainly doesn’t constitute fraud in a situation like this. Not by any legal theory with which I am familiar anyway.
This new Atlantic article may be of interest.
*grins to see evidence that hilzoy is still alive!*
Hilzoy: Back on the 31st there was a publius post on kidney sales that spawned a 309-comment discussion in which you were very sorely missed. Late nudge?
Obama told the bankers: “I’m the only thing standing between you and the pitchforks.”
He may have said something like that, but I have my doubts; and whether he said it or not, the actual administration policy didn’t really reflect that kind of statement. I think the strategy was to just save the financial industry down-and-dirty (more or less) so as not to burn through time and political capital which would be needed for all the other problems they had to deal with. That sounds reasonable, but I think it was a mistake. A larger, more durable store of political capital could’ve been built up by their being a little bold and administering some serious spankings. The message which was actually sent to the country was ‘Yeah, ‘hope’ and ‘change’ are nice campaign words, but the reality is that quite literally business as usual continues in DC. The Big Boys get what they want.’
Obama’s stuff today, as witnessed by me via PBS Newshour, was very good, I thought.
For that matter, the rest of tonight’s report was very good, as well, as is more often than not the case; this discussion of Afghanistan was informative, and so was the interview with the chair of the U.S. Space Flight Review Committee on their findings.
Not to mention Britons Take Issue With U.S. Criticism of U.K. Health System (video only).
Obama did do quite a good job at that townhall in MT. Despite sounding tired – stumbling over words a LOT – he did as good a job as you could reasonably hope for. The guy is just really, really good.
Seconded.
Through all this nonsense as the debate over health care has been hijacked by unconscionable misrepresentation of a perfectly desirable Medicare reimbursement proposal and despicable traducing of Zeke Emanuel and others, I’ve thought it was a darn shame that Hilzoy, who is an actual working professional bioethicist, is no longer blogging. And it’s great that she’s still commenting occasionally. Still, much as I regret it, I think we have to respect her decision to try to claw some of her time back from blogging, and so I would feel weird pestering her to front-page again, even in jest.
Whom do these people think wants to kill them?
By any possible stretch, denial of extended medical care could only happen under any proposed American medical system if their relatives refused to buy them insurance or pay for necessary treatment. Government rules for reimbursed medical treatment, after all, only to come into play if you rely on government coverage, and no jurisdiction I know of (not even Canada) forbids patients paying or buying insurance for costs the government plan will not cover.
So all these people upset about their care or the care their disabled children will receive must assume their families would simply turn their backs and refuse to help with medical bills, even to save their lives.
Interesting that of all the fears about health care reform, that one should gain traction. It appears, on this evidence, that rather a lot of Americans think their relatives secretly want to pull the plug on them.
And I add my voice to the warm welcomes for Hilzoy.
“Still, much as I regret it, I think we have to respect her decision to try to claw some of her time back from blogging, and so I would feel weird pestering her to front-page again, even in jest.”
Indeed.
So, say, Hilzoy, could I have your permission to post your comment in its entirety at my blog? If you’re not comfortable with my listing it as a “Guest Post,” which I’d be thrilled to do, I’d love to simply, you know, quote the whole thing.
No animals would be harmed in the process. I’m just practicing my combined chutphah and deviousness, and experimenting with a Cunning Plan. What could possibly go wrong?
someone should really put hilzoy’s 6:24 on the front page.
someone should really put hilzoy’s 6:24 in the Congressional Record.
Kick ass and take names, sister.
“Whom do these people think wants to kill them?”
John: I don’t think you can attempt to answer that question rationally. You and I may both recognize that these fears are irrational, but the fear we’ve seen tells me there’s a great deal of desperation out in the country.
Playing on those emotions — fear, desperation, even confusion, which I will confess to feeling — is, to borrow a word from hilzoy, despicable.
I thought Grassley was despicable the other day, putting the ruse of death panels in play instead of knocking it down. (I also think Obama should stop carrying on the charade that Grassley is some sort of ally.)
Also, John, I think you overestimate the ability to rely on family to keep one straight and secure. The sick and elderly must rely on the good graces of “the system” when they have no family, or their family has discarded them.
I’d like to see Obama and the Democrats emphasize the social value of compassion and moral imperative. If ever there was a time for Dems to embrace their liberal side, this is it. (To that end, we are certainly missing Ted Kennedy’s eloquence and stature in this fight.)
You’re welcome, hairshirthedonist (5:05pm). Sorry I didn’t reference who I was responding to; I don’t comment much and sometimes forget.
Rosie at 5:08pm: “Organs are not to be picked and discarded frivolously like dandelions, nor should they ever be even if they could ever be grown in a lab.”
Even the ones we will be able to grow will be rationed; especially the ones that are ‘grown to order’ via stem cells.
The maintenance is daunting, and requires a great deal of attention, but results are often amazing. Best of luck to you.
Woody at 5:09: Mickey Mantle’s transplant was hotly debated at the time. The sad fact is that no one wanted to be the ‘person who killed Mickey Mantle’, so he got one and wasted it.
There is also the issue of rich folk buying organs. I saw this happen once with a medical tourist from a Middle Eastern country. The ‘volunteer donor’ and his family were to be taken care of for the rest of their lives, but it was still chilling to see.
Then you have all the variants of targeted donations; volunteers who give up an organ to a family member, friend, or even a stranger. And the daisy chain donations where the organs are swapped in a network of donors and recipients. And which can fall apart in an instant if one person pulls out.
Halteclere at 5:19:
“Organ transplants, at least liver transplants, also take into account how serious the person is about taking care of themselves and their new organ.”
True. And they have to do this because it’s a solemn responsibility. It’s fascinating how they consider the organ as a vital part, almost another patient, in the equation. That’s because the organ (unless live-donated) is representing someone who died, often tragically, often young.
In the hospital, when my mother was diagnosed, a religious person showed up (priest or preacher, I forget). She asked us to pray for my mother to ‘get well’, knowing full well that would entail a transplant. I was shocked and slightly repelled to realize that I was being asked to pray for someone else’s loved one to die in order for mine to live.
hilzoy at 6:24:
Thanks for the links and explanation. I thought Dr. Emanuel’s position would turn out to be something like that, but haven’t had time to pursue the issue.
Then stop lying.
This entire death panel entire argument is predicated on the idea that a distorted and out-of-context quote from someone who has little or no influence on Congress anyway will turn a Republican-authored provision allowing reimbursement for voluntary doctor-patient conversations to protect the patient’s wishes for end-of-life care into panels deciding who lives or dies based on how useful they are.
That. Is. Insane.
Insane, but at that point you could simply be misinformed in good faith, and not bothering to really think about what you’re alleging. You were provided with exhaustive evidence and solid arguments pointing out how utterly ludicrous this was, and how thoroughly it was based on falsehoods and mendacious distortions from bad actors. Yet you persisted, in the face of all evidence, in pushing these falsehoods.
No. At this point you are lying, and I’m sick of playing nice with liars by giving them the benefit of the doubt long after they’ve pissed it away and been given the facts. You are knowingly trafficking in misinformation that will kill people if it is allowed to block health care reform, and none of us should be under any obligation to treat it as a legitimate argument, whether it comes from indifference to the truth or deliberate dishonesty.
Don’t like being called a liar? Then stop passing along lies. And read Hilzoy’s 6:24 comment before you even think about replying on the matter.
KEEP THE GOVERNMENT OUT OF MY MEDICARE!!!
The bill is 1000 pages, I can’t even count that high, surely they hid the death panels in their somewhere. I am a bad singer, there’s no way I’ll make it past Simon, please, have mercy and guarantee that I will not have to sing in front of a Death Panel.
The bill is 1000 pages, I can’t even count that high, surely they hid the death panels in their somewhere.
Page 782.
I am a bad singer, there’s no way I’ll make it past Simon
Then you’re a dead soldier.
The banjo serenader, the piano-organist, people who eat peppermint and puff it in your face…
All goners.
The idiot who praises with enthusiastic tone all centuries but this and every country but his own…
Done for.
And, of course, bad singers. The first to go, natch.
Bow down, bow down to the Lord High Executioner!
ESC: “The bill is 1000 pages, I can’t even count that high, surely they hid the death panels in their somewhere. I am a bad singer, there’s no way I’ll make it past Simon, please, have mercy and guarantee that I will not have to sing in front of a Death Panel.”
Yesterday I had an e-mail exchange with a friend whom I consider to be rational, though a strong rightward leaner. This e-mail exchange began when my friend sent me an e-mail about one Dr. Dave Janda stating (a synopsis) “The underlying method of cutting costs throughout the plan is based on rationing and denying care. There is no focus on preventing health care need whatever. The plan’s method is the most inhumane and unethical approach to cutting costs I can imagine as a physician.”
This e-mail went on to claim several very outright false points about the bill (i.e. no medical care for anyone over 65, halting of medical research, etc.). This e-mail from the “good” doctor linked to the bill as proof.
To rebut my friend’s e-mail I did phrase searches in the bill to see if the quoted text in the e-mail existed, and, not surprisingly, found that none of the scary quoted text.
Basically this Dr, or someone hijacking his name, sent this e-mail out to scare everyone with false lies in the hopes that no one would actually read the linked bill. And, unfortunately, my friend fell for the trick like I’m sure many, many other people have.
So this afternoon I’m sending the original e-mail and my responses to all my friends and family so that they either can combat this viscous falsehood or hopefully not be suckered into believing what it claims.
Add the White House to that list, Halteclere.
They are interested (which in turn created a new series of lies that Obama wants to build an army of informers, so that any critic of his administrtaion can be thrown into the FEMA concentration camps immediately).
“To that end, we are certainly missing Ted Kennedy’s eloquence and stature in this fight.”
I was pointing out the other day (for the nth time) that Democrats don’t have 60 votes in the Senate (at max), we have 58-59, depending on the health of Robert Byrd, and I said at the time Ted Kennedy, who was unlikely for now to make it to many more votes. One hopes he recovers, but one can’t count on it.
This last came up in context of confirming Sotomayor, when I pointed out that Ted Kennedy couldn’t make it to the vote; someone else suggested that, well, if the vote were really important, he’d make it.
His mother’s funeral was yesterday; he couldn’t make it. Don’t expect him to be showing up for any more votes on anything, unless he, one can only hope for, has a miraculous recovery.
Meanwhile, there are no proxy votes in the Senate.
“Even the ones we will be able to grow will be rationed; especially the ones that are ‘grown to order’ via stem cells.”
Well, until they’re not, which is inevitable in the longer term.
“The maintenance is daunting, and requires a great deal of attention”
Yes, now, but in forty years?
“I was shocked and slightly repelled to realize that I was being asked to pray for someone else’s loved one to die in order for mine to live.”
On a dramatically lesser scale, I’ve always been puzzled by the whole phenomenon of sports players having a group prayer to ask God to see that they win. Why, exactly, should, or would, God favor their team over the other team? Are they supposed to be better in God’s eyes?
Mind, I don’t believe in a God, but if I did, it would seem more than disrespectful to me to be praying to such a being for other people to suffer even small harm, so as to favor me. Not to mention that such a God would seem like an awfully petty Being.
I’ve always had some problems with that, myself. Sometimes, though, you hear prayer for guidance through the contest, presumably so that everyone will put forth their best effort, and will not (for example) succomb to the temptation to kick that pesky opposing player in the testicles.
I can wholly support such a sentiment. So to speak.
Sometimes the testicle-kicking is inadvertent, though. Just the other day I inadvertently kicked a kid in the package, and he (unwisely) was not wearing a cup.
Satan was unavailable for comment, after.
Maybe a little pre-contest prayer could have averted the tragedy, but I’m still averse to bothering Him with the small stuff. It’s less icky than praying for money, but still icky.
I offered to cup-check the guy in question today (imagine me swinging a fist low, and up, for the purposes of verification that protection was in place, in demonstration of the testing procedure) and he hastily declined, so maybe he enjoyed flirting with disaster. And he wouldn’t spar with me, either.
“His mother’s funeral”
Gary, you meant his sister’s funeral
“Gary, you meant his sister’s funeral ”
(Joke not meant in bad taste; please don’t take it that way):
Wait, you mean Eunice wasn’t in Chinatown?
Anyway, yes, Rose moved along in 1995; thanks for correcting my error.
“Sometimes, though, you hear prayer for guidance through the contest, presumably so that everyone will put forth their best effort, and will not (for example) succomb to the temptation to kick that pesky opposing player in the testicles.”
Yeah, I can see that; it’s praying for a win that I don’t get. I mean, it’s obvious why you’d want that outcome, but unobvious why God would pick sides.
To ask God to help everyone, or just yourself, be nice, and the like, seems perfectly reasonable, if you think it’ll help.
“And he wouldn’t spar with me, either.”
I take it this isn’t swimming?
Chess?
I take it this isn’t swimming?
i read somewhere that mixed-martial-arts synchronized swim-boxing is the new rage these days!
That’s underwater synchronized ultimate fighting, thanks.
Free sparring, actually, which means mostly that you can use whatever style you like, but no throws (unless arranged beforehand with both parties and the instructors; grappling is normally done at a different time), no kicks below the waist (which I kind of violated, inadvertently), and no hitting the back or back of the head.
Kicks to the head are permitted, unless the opponent is down. Headgear is highly encouraged, and a mouthgard is required.
Joint locks are also verboten, which rules out a lot of the aikido, judo and quite a few hapkido moves.
And no weapons, normally. So, guns, knives, swords, etc are right out.
It’s good exercise; burns well over 1000 calories an hour, depending on how hard you go.
“And no weapons, normally. So, guns, knives, swords, etc are right out.”
What’s the stand on harsh language?
And not even these?
I take it the Vulcan Death Grip is right out, then.
Personally, I feel all fighting contests should have an absolutely mandatory requirement of this background music.
It’s because of this lack that I don’t watch any sports fighting.
Not to mention Britons Take Issue With U.S. Criticism of U.K. Health System
BBC World News did an item on this subject yesterday as well. Apparently there’s a British activist who has fought for years for better funding for the NHS who is now being presented over here as a symbol of the horrors of socialized medicine. She feels like her tireless efforts are being twisted into something that is exactly contrary to her intentions. She is not a happy camper.
And of course all this is happening despite the fact that no one with any influence whatsoever is actually pushing for anything resembling the NHS.
I don’t think I have ever been as disgusted by the state of discourse in this country as I am right now.
As hard as I try to maintain perspective, I’d have to agree with John Miller. The Clinton years were pretty disgusting, for sure, but it was all ultimately rooted in partisan politics–dirty, nasty, unseemly partisan politics, to be sure, but still.
There’s something far uglier at work here. Ignorance, resentment and mean-spiritedness flaunted with pride and worn as badges of honor.
I don’t think that’s remotely clear. David Brock wrote a book about being on the inside of the anti-Clinton forces, and between my own reading of the press then, and all I’ve seen since, through now, it’s not at all clear to me that anything significant has truly changed save that we get a far more visceral and close look at what the grassroots ugliness and craziness looks like now, via Youtube, and rightwing blogs, and leftwing blogs’ obsessive focus on the most extremedly crazy rightwing blogs, and political statements, than we possibly could in 1992, or even 1999.
Was there really less ignorance, resentment, and meanspiritedness on the right during the Clinton impeachment?
And how much do we get tunnel vision by always focusing on the Malkins, the Pam Gellar’s, the people put on Youtube and sometimes the mainstream news as tthe loudest and stupidest voices of the right showing up at rallies on the right, or engaging in harassment?
I’m keeping in mind how much the more extreme voices on right, in turn, have always portrayed everyone to the left of, say, David Broder, as, unitary versions of a combination of the Weather Underground, former Soviet dupes, Muslim terrorist-appeasers, lovers of A.N.S.W.E.R, apologists for Kim Jong Il, etc., and wondering how easy it might be for those of us on the other side to fall into similar types of over-generalization.
I actually think it’s very easy indeed, to fall into those sort of over-generalizations, and over-generalized assumptions, but the big question is where the actual numbers are, and how do the numbers and attitudes of those who show up at these most extremely crazy right-wing blogs, and rallies, and protests, match up against those merely still carrying on with old-fashioned Republican or conservative values of a basically innocent and well-meaning, if somewhat ignorant, from our POV, sort?
I don’t mean to be overly repetitious with what is a nearly obsessive theme with me, but I really really think people should beware of generalizations, and generalized assumptions, and do their best to focus on specific groups, and specific events, and specific people, rather than tending to generalize from the extremes to everyone who disagrees with us and is viewed as On The Other Side.
And one reason is that, really, I don’t see that those who were crazy to impeach Clinton, and obsessed with all their theories about Hillary’s lesbian-based murder of Vince Foster because of the drug-running they were doing out of that airport in Mena, Arkansas, etc., were less ugly and ignorant than the crazies today, or than the folks who were convinced fluoridation was a communist plot led by communist agent Dwight Eisenhower. I don’t think they were less numerous, either, although I don’t have any numbers at hand to point to.
But the stuff that’s going on now is always freshest in our minds, and apt to seem worse than that which fades into historical memory, or which many folks cease to be so crazy about as the decades pass.
On the sidebar of my blog since I started blogging, one of my many favorite quotes: “There exists in human nature a strong propensity to depreciate the advantages, and to magnify the evils, of the present times.”
— Edward Gibbon
He wrote that sometime around 1780, or so.
Gary,
I know where you are coming from, but I think there is one big difference now. And that is, quite simply, the string undercurrent of violence that is running through everything. In a very real sense, more so than in the 90’s, there is a real danger here.
We know that death threats to Obama have tripled, we know that at some town halls, guns have been found, we know that in at least one case a Congressman was physically threatened if not assaulted.
Even going back to the 60’s, which are very fresh in my mind, I don’t think the actual feeding of the anger that is being done today existed to quite the same level, and that was a very chaotic period at both ends of the political spectrum.
And people like Glen Beck and Sean Hannity and even Coulter and Limbaugh, are actively encouraging this insanity with open talk of perhaps needing to spill the blood of patriots.
We are in very dangerous times.
BTW, although I think he was wrong with his earlier statements and perhaps a little intellectually dishonest himself, I don’t view Marty as belonging to the dangerous end of the spectrum.
bedtimeforbonzo:
Opponents of health care reform made every argument in the book. From the argument that the US health care system does most of the world’s research on down. Only this argument stuck, and I wonder why. Personally, I consider the concern that reform would slow research, and I could get a disease that the doctors don’t have the information to treat, at least somewhat rational. So what fears did the “death panel” meme plug into? Understanding the fear might go some way to answering the meme.
“Even going back to the 60’s, which are very fresh in my mind, I don’t think the actual feeding of the anger that is being done today existed to quite the same level, and that was a very chaotic period at both ends of the political spectrum.”
I’m sorry, John, but I just don’t believe this in the slightest. The Sixties were just endlessly more violent in political violence in America than anything remotely resembling 21st century America (or America in the Nineties, or Eighties, for that matter).
Riots were rampant everywhere. People were plotting armed insurrection. The political leadership in the White House feared armed insurrection. There were tanks on the streets of Washington. Ten thousand people were rounded up and held in RFK stadium, The National Guard was shooting kids on college campuses. Bombs were being set off. Black Panthers were being deliberately killed in fusillages of bullets by cops and FBI. Groups both left and right were busily arming themselves for the coming domestic war. People were beaten and assaulted in zillions of different protests. Cops were “pigs” and kids were commie hippies.
I don’t see that we have a hundredth, even a thousandth, of the political violence in America today that we had between, say, 1962-1975. (Say, they released Squeaky Fromme from prison yesterday, speaking of.) Nothing remotely comparable.
You talk about threats, but we had actual dead Kennedys and shot Wallaces, and shot kids, and Freedom Marchers, and hundreds of thousands of people wounded in urban violence and riots and protests, as well as many hundreds killed in rampant National Guard and police violence both generally in the ghettos, and particularly during riot times, in the Sixties, when authorities (police and National Guard) would literally roam the streets randomly firing machine guns at people, windows, anything that moved, and killing lots of people that way. Hundreds of them.
In comparison, you bring up that “we know that at some town halls, guns have been found, we know that in at least one case a Congressman was physically threatened if not assaulted”?
I’m sorry, but this is, well, nuts. In 1971, the fricking Capitol was bombed. How the heck can you compare any of that to contemporary times? Where are the burning cities? Where are the hundreds of dead Americans killed by the police and National Guard? Where are the bombings in response? Where are the stormed buildings, and assassinations and riots, and massed hardhat beatings of hippies? Where are the shot newspaper columnists? where are the beaten Justice Department aides? Where are all the actual dead people from all this?
You say that “the 60’s, which are very fresh in my mind,” and then say that “I don’t think the actual feeding of the anger that is being done today existed to quite the same level,” and I say wha? and wtf?
Try Nixonland for a reminder of how it all was, if you haven’t read it, I suggest, no matter how fresh memories of the Sixties seem to you. I regard myself as quite expert on the U.S. in the Sixties, fanatic, even (and I don’t make claims of knowledge lightly), but I still regard it as a superb summary, so I’m not attempting to in any way insult your degree of familiarity or memory of the Sixties. I’m just recommending an excellent book.
And that is, quite simply, the string undercurrent of violence that is running through everything. In a very real sense, more so than in the 90’s, there is a real danger here
…
History:
Not a real danger, in some people’s minds.
“We know that death threats to Obama have tripled”
Huh. Like this?
I don’t all that often agree with Gary, (Or rather, probably, we don’t often get into topics where we agree.) but, heck, I was born in 1959, and nobody could convince me we’re a more violent nation today. The freaking Detroit riots stopped two blocks from my home.
“American militia movement sympathizer Timothy McVeigh”
Militia movement wannabe who got rejected when he tried to join Timothy McVeigh…
Huh. Like this?
no, like this:
Since Mr Obama took office, the rate of threats against the president has increased 400 per cent from the 3,000 a year or so under President George W. Bush, according to Ronald Kessler, author of In the President’s Secret Service.
Some threats to Mr Obama, whose Secret Service codename is Renegade, have been publicised, including an alleged plot by white supremacists in Tennessee late last year to rob a gun store, shoot 88 black people, decapitate another 14 and then assassinate the first black president in American history.
Most however, are kept under wraps because the Secret Service fears that revealing details of them would only increase the number of copycat attempts. Although most threats are not credible, each one has to be investigated meticulously.
I realize hindsight is always so perceptive. It also seems that generals always base their strategy on what would win the last war.
Therefore with health (insurance) reform, the lesson from the ’90’s was not to impose a piece of legislation on Congress, but to let Congress fashion the legisation.
I’ve watched most of Obama’s townhall performances, and I’m mightily impressed. He’s not perfect, and occasionally messes up some detail, but overall he is so good at explaining what the problem is, and why he thinks it should be tackled in a particular manner.
He is also so good at recognizing the rationale in opposing arguments.
(Today I thought he was paticularly good at explaining why deficit hawks should be the most ardent backers of reform.)
Imagine if he had presented a series of town halls, each one focusing on one or more of his principles together with his draft legislation designed to implement it.
Just musing about the appropriate strategy for the next reform package.
It’s always hard to gauge the zeitgeist. However, it seems that Obama’s race seems to license a more hyperbolic approach. In the 60’s, it was often the liberals who voiced concern about the left going to far, but there didn’t seem to be those on the right who voiced similar concerns (this on opinion before Nixon’s resignation suggests this, though I’d be interested in counterexamples of conservative pundits of the time saying that they had had enough. There were any number of liberal pundits who were worried how the office of the presidency would be tarnished if things were taken to their logical conclusion). Now, we have various (though far too few, I think) voices on the right expressing concern that things are out of hand. Of course, there is this recycling that goes on in the right, where a pundit completely embarrass themselves by publishing some tissue of lies (Malkin on the internment, Goldberg on liberal fascism are two that come to mind) and, after a period of not getting called on, are reintegrated into the club.
I should add that I’m not really sure it today is worse or better than the 60’s. But I am pretty sure that it is different.
Brett: “but, heck, I was born in 1959”
I knew eventually we’d turn up something we have in common! 😉
You are also both featherless bipeds. (waits for Gary to do his Diogenes of Sinope impression…)
responding to Gary 2:26 pm
“Even the ones we will be able to grow will be rationed; especially the ones that are ‘grown to order’ via stem cells.”
‘Well, until they’re not, which is inevitable in the longer term.’
Inevitable is not a word I like to use in regards to science. Possible, certainly.
And the rationing might well come down to cost and access to technologically advanced labs and hospitals. Much like many procedures today.
“The maintenance is daunting, and requires a great deal of attention”
‘Yes, now, but in forty years?’
Now that is probably true, but I was responding to Rosie’s immediate issues there. There are already some advances, like co-transfer of donor bone marrow along with the organ that are helping reduce the need for anti-rejection drugs.
responding to John Spragge at 8:12 pm
“So what fears did the “death panel” meme plug into? Understanding the fear might go some way to answering the meme.”
That is a very interesting and important point. You can’t allay people’s fears until you understand them. And this is a life and death issue; it’s not really odd that people are terrified of change in this context. Especially ill-defined and not-yet-settled-on and it’ll-get-changed-again-in-committee change.
I think deep down people don’t believe that any change that is instituted will help them. That somehow it will end up hurting them. That if they keep their heads down and their noses clean, then maybe, just maybe, if they get sick they’ll win the health insurance lottery and get the care they need in order to survive.
It’s sad and frustrating and I don’t know how to fight it.
“So what fears did the “death panel” meme plug into?”
There’s this strange idea on the right that the left has a Culture of Death, which awaits only power to send us all off into a Dr. Mengele-style nightmare. Remember, the reason liberals hate Sarah Palin is not that she’s manifestly unqualified for any office above dogcatcher; it’s that she didn’t abort her child. We all supposedly wanted her to, and we can’t stand it that she didn’t.
Likewise, we want to kill all the old people and the disabled, like our role model, Hitler.
The Culture of Death can be usefully combined with our supposed love of Stalinist centralized planning to yield all sorts of Brave New World stuff: people grown from stem cells so that we can harvest their organs, babies manufactured to order (and with liberals in charge, the orders would come from the government), etc., etc.
It’s a very strange thing.
“I think deep down people don’t believe that any change that is instituted will help them. That somehow it will end up hurting them.”
A quite rational fear, on the part of most people, who already have health insurance. If your position is shitty, rolling the dice, taking a leap into the dark, makes sense. If your position is acceptable, you should only change it in incremental, reversible steps, so you can back out if you make things worse.
It’s pretty clear the ‘reform’ advocates don’t want incremental change, (Regarding it almost as a swear word.) and prefer that any changes be irreversible. Hence rational fear on the part of people whose situation could, after all, be changed for the worse, with no going back.
I should add: I think it’s really worthwhile to ponder conservatives’ attempts to psychoanalyze liberals, and think more than twice before attempting to psychoanalyze them.
I mean, sticking with the ‘why did we dislike Sarah Palin?’ theme: it wasn’t just that “because she didn’t abort Trig” idea that was so loony; it was all of them: because she was a pro-life career woman with an allegedly hot husband, and we were jealous; because she flew in the face of our assumptions about what women “would have to” choose once liberated, etc., etc.
They were all not just wrong, but in the wrong universe. From which I draw the moral: one psychoanalyzes one’s political opponents at one’s peril — at least, if one is psychoanalyzing them en masse, as opposed to reflecting on individuals. (But then, psychoanalyzing any group en masse is a pretty iffy idea, if I ask me.)
A quite rational fear, on the part of most people, who already have health insurance.”
should read
“A quite rational fear, on the part of most people, who already have health insurance [and have not had to use it for some major expense].”
Three things.
First I st6and by my earlier comments despite Gary’s over the top rhetoric (which I really don’t usually accuse Gary of). I did not speak of out in the open violence, I spoke of an undercurrent which is wide-spread and actively encouraged, even by some people in Congress.
Finally, Brett. The problem with what you suggest is that the only reason for people to fear change, if you are correct, is if people believe the lies they are being told. The only changes that would impact people who like their insurance is that they can’t be arbitrarily dropped from it, that it is totally portable, that there can’t be lifetime caps… oh wait, having extra benefits to their insurance is definitely something to be afraid of. And, believe it or not, what is being proposed is very incremental reform (no scare quotes needed).
The violence of the 60’s early 70’s was in the open and could e very directly identified. Anti-war far left organizations, blacks dealing with multiple factors and Southern whites. This current situation is far more amorphous and all the scarier ecause of it. And yes, the media’s condoning of it makes it all worse.
Secondly, the thing hilzoy ande Brett have in common is being mere children compared to a couple of us commenters.
I really should have previewed. Secondly obviously come before finally. Sheesh. Too early.
If your position is acceptable, you should only change it in incremental, reversible steps, so you can back out if you make things worse.
then you should be greatly pleased to see that only incremental, reversible changes are being proposed !
“The violence of the 60’s early 70’s was in the open and could be very directly identified. … This current situation is far more amorphous and all the scarier because of it.”
Gotcha: What really frightens you about all this violence today is the lack of any evidence of it. A few neighborhoods burned to the ground, and maybe National Guardsmen gunning down protesters, and your nerves would be soothed.
Gotcha: What really frightens you about all this violence today is the lack of any evidence of it. A few neighborhoods burned to the ground, and maybe National Guardsmen gunning down protesters, and your nerves would be soothed.
This may be my favorite Brett Bellmore comment ever.
A quite rational fear, on the part of most people, who already have health insurance [and have not had to use it for some major expense].
LJ FTW.
And Gary’s point upthread is well taken. It is indeed always tempting to fall into thinking that it’s never been quite this bad, and I do plead guilty (consider my handle, fer chrissake).
Maybe what I was driving at is that I feel more personally disgusted by the current craziness because I feel very personally invested in seeing some kind of substantial health reform get passed in my lifetime, even if it will not be the kind of reform that I would advocate. This has the potential to affect my personal circumstances like very few other pieces of legislation. As I mentioned in another thread on the topic, I spent 3 months without insurance last year while changing jobs, because COBRA would have swallowed up fully 50% of my take-home pay. I would really, REALLY prefer not to have to go through that again. No one should ever have to go through that in this country.
And that’s the difference between now and 1998-99. By the time the Clinton-craziness was in full swing, I didn’t feel all that personally invested in the guy’s political survival. Yes, his enemies scared the bejesus out of me (still do!), but by the time Monica L rolled around he had proven himself to be a huge disappointment to me on any number of fronts. I sure as hell wasn’t hoping he could stay in office so he could keep being a force for progressive change, because he never was that force.
That’s what different now.
Gary did a pretty good job detailing the violence of the 1960’s compared to now.
While we underestimate the amount of violence back then, I’d like to add that we tend to overestimate the amount of sex folks were having in, say, 1968.
For me personally, that was my major disappointment with those dreary times. I knew it was going on somewhere, but as conservative Americans like to ask today, “Where was mine?”
As we used to say “make love, not war”. The Sixties were more like “make love if you can find the spare time and a willing partner, hold on, let me finish making war first”.
I find it amusing that Brett Bellmore chimed in with his thoughts on the violence imagined by we liberals today, considering the amount of firepower the NRA and the conservative right imagine they require to protect themselves as they cross state lines, etc.
Wayne LaPierre, the noted twit coward, has a Sam Peckinpaugh movie running in his head at all times.
When the gentleman with the black shirt emblazoned with the NRA logo feces at one of the President’s appearances rose in opposition to the health care plan because his taxes might be raised, I tried to imagine all of the violence implied in everyone’s mind in that room.
You have folks in the third row imagining Granny being dragged off from the death panel chamber in a granny boxcar to some granny deathcamp (yes, little mother, you may finish your knitting before we put you to sleep), you have NRA guy imagining the armed siege as the gummint shows up to coerce his hard-earned tax money from him; you have Barack Obama probably thinking the NRA logo feces means someone in th room is thinking armed resistance to all of the above imagined violence should start right now with a bullet between his eyes … you get the drift.
Meanwhile, you’ve got some guy with a family who just lost his job and insurance fidgiting uncomfortably in the seventh row because he has a kidney stone the size of a small asteroid lodged somewhere and HE’S imagining the very real violence of either the surgery and the stack of medical bills to ensue or the passing of that stone through his too-narrow uretha as he keels over from pain in the bathroom and hits his head on the edge of the sink and there’s more unpaid medical bills and calls from bill collectors …… all he wants to know is when can we stop with the imagined violence and get this healthcare reform passed.
As for me, if sex is not going to fill up my time, then violence might as well, because I think lying Republican scum like Limbaugh, Beck, Savage, Grassley, and the RNC deserve an asteroid field of kidney stones hurtling through their urinary tracts.
“Gotcha: What really frightens you about all this violence today is the lack of any evidence of it.”
This explains Brett’s self proclaimed links to the Michigan Militia.
Kidneys stones for Sarah Palin AND Erick Erickson too.
Hand grenades optional, and it’s unfortunate we didn’t have death panels for their grannies years ago when the latter were of child-bearing age.
“I find it amusing that Brett Bellmore chimed in with his thoughts on the violence imagined by we liberals today, considering the amount of firepower the NRA and the conservative right imagine they require to protect themselves as they cross state lines, etc.”
Jonh, I know you’ll pretend this distinction is over your head, and think you’re being amusing in the way you do it, but it’s not violence until you actually USE that firepower.
So, yeah, at this point it’s in your imagination.
Brett, you havewn’t been paying much attention to the news lately, have you.
Yes, I often imagine that I’m amusing.
I guess a violent imagination is like health insurance — you hope you don’t have to use it — but it’s there if you need it.
But, let me ask you a question Brett. If we meet on the street and I detect the gun in your pocket, is it my imagination that you are glad to see me, or are you actually, sincerely glad to see me?
“Don’t like being called a liar? Then stop passing along lies. And read Hilzoy’s 6:24 comment before you even think about replying on the matter.”
This would be more effective if you could find a comment I made that asserted any of the things you accuse me of, in particular any post where I supported or psoited the existence of death panels.
Someone stated a fact, someone else said it wasn’t true, I said it was. There was absolutely nothing in hilzoys comment that disputed the facts. She elaboarated eloquently, as usual, but she didn’t diapute the fact.
I would love to discuss any other lies you might feel can be attributed to me.
Marty’s just fine.
On the other hand, Democratic Blue Dog Rep from Arkansas Mike Ross said today, among other things, that he will never vote for a bill that “kills old people”, referring to the healthcare reform bill.
Let me be as bipartisan as a body can be: Mike Ross is lying, unAmerican Democratic scum.
The liars have won.
Violence is not far behind, because this system must be fucking destroyed.
“”Even going back to the 60’s, which are very fresh in my mind, I don’t think the actual feeding of the anger that is being done today existed to quite the same level, and that was a very chaotic period at both ends of the political spectrum.”
I’m sorry, John, but I just don’t believe this in the slightest. The Sixties were just endlessly more violent in political violence in America than anything remotely resembling 21st century America (or America in the Nineties, or Eighties, for that matter).”
Gary,
As a teen of the late sixties and early seventies, I recall the violence clearly. As important, I remember the stark fragmentation of society. The “war monger” government, the radical underground, the peaceniks waiting for the age of aquarius, racial violence on all sides.
In moments of where I need solace, I also remember hope, mostly thrrough the music. on 4 Way Street, Stephen Stills singing about change in Americas Children,”we are supposed to be some kind of different…if we can’t do it with a smile on our face and love in our hearts we have no right to do it at all”, the tragic reality of “Find the Cost of Freedom”, the call to action of “Ohio”. But today was wondering if we remembered the message of “Teach Your Children”. Or the the Beatles “Revolution”?
And, since the experiences are indelibly linked in my experience, could we have a moment in the room with Hari Selden to perhaps shorten the time between this general rancor and the birth of a world society, perhaps without an extraterrestrial threat required to recognize our on interdependence.
Just got me to thinking.
“Someone stated a fact, someone else said it wasn’t true, I said it was. There was absolutely nothing in hilzoys comment that disputed the facts. She elaboarated eloquently, as usual, but she didn’t diapute the fact.”
That’s nice, Marty, but let’s back up.
Tomaig asserted, on August 14, 2009 at 11:01 AM, near the start of this thread, that:
So the claim was that it was wrong to say “death panels are a LIE!” This was tomaig’s response to post by publius, the post above we started with, in which publius wrote: “A demonstrable falsehood was repeated and repeated, and it led the Committee to drop a very valuable provision that would help inform individuals — particularly those with less resources — about critical medical and legal issues. The falsity and fearmongering drove the policy here.”
So there we have the falsehood — that there would be “death panels,” and tomaig’s assertion that people can’t object that “the ‘death panels are a LIE!,'” because, after all it’s in “the stuff that Zeke Emmanuel has written.”
Alex Russell than responds at August 14, 2009 at 11:34 AM that:
Thus, we again, get back to the accusation of a falsehood, or a “lie,” aka “just making stuff up.”
That’s where you then came in, at August 14, 2009 at 12:09 PM, to quote from cleek’s cite of Emmanuel’s paper, that:
So you were asserting that this demonstrated that, in fact, Zeke Emmanuael was “reasonably unambiguous” that, in fact, he was calling for “death panels.”
That is the actual record of the actual debate, and what you actually claimed.
You then wrote on August 14, 2009 at 12:51 PM, quoting Emmanuel, and asserting of Zeke Emmanuel’s paper that in it:
I later asked you, sarcastically, what was wrong with “allocation of resources,” and how was it that we don’t have “allocation of resources” today, exactly?
You never responded to that.
Discussion went on, and at August 14, 2009 at 01:24 PM you asserted that:
More discussion went by, none of which is essential to the above. So you’re back, now claiming that you “just disagree that [Emmanuel] doesn’t say he is for [death panel],” which you also seem to believe is synonymous with being for “allocation of resources.”
Your attempt to summarize all this is:
I submit that your summary is inaccurate. I submit that Hilzoy did, indeed, dispute the “fact” that Emmanuel did “reasonably unambiguous[ly]” call for “death panels,” no matter that you “guess I just disagree that it doesn’t say he is for it.”
Summary: Emmanuel didn’t call for death panels, he didn’t do so “reasonably unambiguously,” Hilzoy did thoroughly refute this, and that you “guess I just disagree” doesn’t demonstrate there’s any truth to any claim otherwise.
Showing up now to assert that “There was absolutely nothing in hilzoys comment that disputed the facts. She elaboarated eloquently, as usual, but she didn’t diapute the fact” that Emmanuel called for death panels in his paper won’t fly. That dog doesn’t hunt. You can’t make a cliche out of this that anyone will [verb].
I’m not going to call you a “liar,” but I believe I’ve demonstrated that you’ve made repeated and various false — perhaps simply incorrect, out of lack of understanding — assertions, and that saying you “guess [you] just disagree” doesn’t refute this.
I’m, incidentally, still waiting to hear what’s wrong with “allocating resources.” Do you never do that, and instead have infinite resources? Do you assert that right now, our health care system does not “allocate resources” and that we can somehow make it not have to “allocate resources”? If not, what, precisely, is the nature of your objection to “allocating resources” in our health care system, given that it is impossible to do otherwise?
Oh, and “This would be more effective if you could find a comment I made that asserted any of the things you accuse me of, in particular any post where I supported or psoited the existence of death panels.”
Asked and answered. I’m willing to believe that you’re still writing unclearly enough that you don’t realize or recall what you wrote and what you at least appeared to have meant.
But in case you’re wondering why “stop lying” might be tossed your way, the above is an attempt to explain what you’ve written that would contribute to that impression.
“And, since the experiences are indelibly linked in my experience, could we have a moment in the room with Hari Selden to perhaps shorten the time between this general rancor and the birth of a world society, perhaps without an extraterrestrial threat required to recognize our on interdependence.”
Seldon. I’m afraid we need a Second Foundation, and if you want to believe Asimov’s later (less than stellar) attempts to tie his various stories together, a set of robots working in secret for the betterment of humanity, as well as at least one nearly immortal robot.
So I’m afraid we’ll just have to go with trying to get along on blogs, and walking outside and smelling the flowers, if we can, and other such things, before we get to World Peace And Harmony.
Until, of course, you all accept me as World Emperor.
“submit that your summary is inaccurate. I submit that Hilzoy did, indeed, dispute the “fact” that Emmanuel did “reasonably unambiguous[ly]” call for “death panels,” no matter that you “guess I just disagree that it doesn’t say he is for it.”
I did not ever assert that Emmanuel wanted “death Panels”. I asserted that in his paper he supported the allocation of resourcess and stated that an obvious allocation of resources would be to not gaurantee basic (as defined by the process outlined in the paper) healthcare to people suffering from dementia. He did sya that. All of the rest of the discussion, up until hilzoy, was about whether he meant it or not. I think he meant it, in the context of the process he was describing. Thats a long way from death panels.
As for allocation of resources, I thought we had covered in great detail that under any system resourcess were and are allocated. So whats “wrong with it” seemedd to me a rhetorical question, sorry.
” and if you want to believe Asimov’s later (less than stellar) attempts to tie his various stories together”
I could never decide whether they got less than stellar or I just got older.
“I could never decide whether they got less than stellar or I just got older.”
I can’t discount that I got older, too, but my professional opinion (which would have been to buy them and sell them, of course), is that the original robot stories, and foundation and empire stories, were ground-breaking, and that the later stories were not. And that’s what makes the difference in those stories, because you don’t read Asimov for the amazing prose, or depths of characterization.
You read them for ideas that were neat at the time. When you wind up trying to tie together old ideas in not terribly new ways, your result is less than the sum of your parts, and the appeal disappears for those who aren’t really fanatic about the earlier work.
Sf often is very dependent on being read in the context in which it was new and innovative. Once it isn’t, you can’t read it the same way any more, because the context you’re reading it in has changed.
I asserted that in his paper he supported the allocation of resources […] As for allocation of resources, I thought we had covered in great detail that under any system resourcess were and are allocated.
I’m sorry, this makes no sense. If we acknowledge that “allocation of resources” is something that happens under any system, what could it possibly mean when you say that Emanuel “supported the allocation of resources”?
It’s like saying he supports breathing, or that he’s in favor of gravity.
“It’s like saying he supports breathing, or that he’s in favor of gravity”
Yea, I was caught off guard by the reaction to it myself.
“Yea, I was caught off guard by the reaction to it myself.”
Marty, you’re the one who went on and on about your reaction to favoring “allocation of resources.”
You insisted that Emmanael’s paper supported Tomaig’s claim that “this Emmanuel has stated that, basically, anyone with dementia (such as my father-in-law) should NOT receive anything more than basic care since they can never be a contributing member of society?” was you wrote that “[an] obvious example is not guaranteeing health services to patients with dementia.”
I just went through all this, summarizing what you said.
Either you can’t keep track of what you’re saying, or, no, you’re not being honest about what you’ve said. I’m not a mind reader, so I don’t know which it is, but these seem to be the only two possible ways to interpret what you’ve written, and the way you make claims, and then back away from them, denying you ever actually meant what you wrote.
So: either stop lying about what you wrote, or stop being confused about what you wrote, and denying that you wrote it, or, failing all that, admit that you can’t keep track from one moment to the next of what people have been saying, including yourself, and that you’ve been unable to carry on a coherent coversation of your opinions. Any one of these things is fairly annoying to interact with.
It seems pointless to keep confronting you with your own words when you come back with responses that don’t make any sense like going on and on defending the claim that Zeke Emmanuel’s paper calls for “death panels,” because he was for “allocation of resources,” and saying that therefore everyone who denied that Emmanuel was for death panels was, in your words, “everyone trying to say he didn’t, or he didn’t mean it, is intellectually dishonest” and now saying that you were “caught off guard by the reaction to it myself.”
Try making sense. And try not denying responsibility for what you’ve said, and try keeping track of what you’ve said.
You don’t have any excuse when other people are, in fact, paying attention to what you’ve said, even if you can’t. But if you can’t, don’t be surprised when people react to what you’ve said, and hold you responsible for your claims. Simple denial doesn’t work. You’ve said it in writing. It’s right there, above us, in this thread. It’s not like you claim you didn’t write these things. This is the difference between an oral conversation, where you can get away with that sort of thing, and a written conversation. We have a record.
And this is an example of not making any sense:
At this point your best response is probably to note that the cumulative total of your responses don’t make any sense when put together, that you lost track yourself, and you apologize for it, and ask us to forget all about it.
Alternatively, you can try to make an attempt to explain how all the things you’ve said hang together coherently, and good luck with that choice.
My reading of ‘supporting the allocation of resources’ is ‘supporting a system where resources are allocated by system that includes human judgement’. It seems very telling that people would accept that the allocation of resources is something like ‘gravity’ (props to Uncle Kvetch), yet we would be arguing about ‘death panels’ and ‘socialism’. If you acknowledge the inevitablity of the first, you can only argue about the implementation of the system, you can’t argue that the whole thing is immoral and therefore shouldn’t be done.
All of the rest of the discussion, up until hilzoy, was about whether he meant it or not.
Ah, no.
“Zach Emmanuel wants to deny non-basic health care to people with dementia!”
“Where does he say that?”
[someone else finds quotes]
Marty: “Aha, so he did say that!”
Hogan: “No, he says he wouldn’t guarantee non-basic health care to people with dementia.”
Marty: “But it’s the same thing if government is the sole provider of health care!”
Hogan: “Maybe, but no one is proposing making government the sole provider of health care.”
Marty: “Well, yeah, OK.”
Hogan: “So they’re not the same thing.”
Marty: “It’s interesting how when people are proved wrong, they refuse to admit it, and instead change the subject and throw up irrelevant counter-arguments. Anyway, he did say it.”
Hogan: “Yes, it is interesting. No, wait, what’s the other thing? Oh yeah–tediously predictable.”
“At this point your best response is probably to note that the cumulative total of your responses don’t make any sense when put together, that you lost track yourself, and you apologize for it, and ask us to forget all about it.
Alternatively, you can try to make an attempt to explain how all the things you’ve said hang together coherently, and good luck with that choice.”
So from the beginning:
“Tomaig: And have you read any of the stuff that Zeke Emmanuel has written? Since he’s a close advisor to the POTUS on these matters, how can you howl with such outrage that the “death panels are a LIE!” when this Emmanuel has stated that, basically, anyone with dementia (such as my father-in-law) should NOT receive anything more than basic care since they can never be a contributing member of society? Sounds to me like he has decided that if you have Alzheimer’s then your life is not worth living and the State should not pay for anything other than to put you out of your misery.
Yet you folks are shreiking like someone just made stuff up out of whole cloth.
In this Time Magazine piece by Michael Scherer:
http://www.time.com/time/nation/article/0,8599,1915835,00.html
Schrerer writes that “[Betsy Macaughy] quotes [Ezekiel Emanuel] discussing the denial of care for people with dementia without revealing that Emanuel only mentioned dementia in a discussion of theoretical approaches, not an endorsement of a particular policy.”
It would be good if someone (here?) can track down the Emanuel piece that Macaughy was referring to, or find a link to someone who has. If it is the case that Emanuel was writing, “Theoretical ethical approaches that a society could take are a. …. b. …., c….., d…. e…. (etc.)”, and Macaughy just quoted Emanuel describing b. as if Emanuel was simply saying that b. is the necessary answer and the proper approach, then, yes, that would be just making stuff up.
Posted by: Alex Russell | August 14, 2009 at 11:34 AM
To which cleek responded:
“It would be good if someone (here?) can track down the Emanuel piece that Macaughy was referring to, or find a link to someone who has.
i believe this is the one (via Armbinder.
Posted by: cleek | August 14, 2009 at 11:43 AM ”
At which point I responded, specifically to Alex Russell’s last paragraph:
“”It would be good if someone (here?) can track down the Emanuel piece that Macaughy was referring to, or find a link to someone who has. If it is the case that Emanuel was writing, “Theoretical ethical approaches that a society could take are a. …. b. …., c….., d…. e…. (etc.)”, and Macaughy just quoted Emanuel describing b. as if Emanuel was simply saying that b. is the necessary answer and the proper approach, then, yes, that would be just making stuff up”
From cleeks link:
“Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and
should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia.”
This seems reasonably unambiguous.
Posted by: Marty | August 14, 2009 at 12:09 PM “
After several comments questioning whether Emmanuel was endorsing that position (which of course was a change from, he never said it) I stated:
“Marty, note that in that article he is not endorsing that position, merely stating that as one of the positions that could be taken as opposed to everybody having access to everything under the sun. It is that typwe of taking out of context that is all too common these days.”
“I actually don’t note that at all. It is part of a summary at the end preceded directly by:
“This civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources . Procedurally, it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed. Substantively, it suggests services that promote the continuation of the polity-those that ensure healthy future generations,ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations-are to be socially guaranteed as basic.” (bold added)
So far today I have seen:
Can you prove it exists – yes
Was it quoted accurately – as stated yes
It is out of context – no the link was provided
The article is not endorsing that position – I read the whole thing twice, he is for the allocation of resources and this is an obvious example, I guess I just disagree that it doesn’t say he is for it.
Posted by: Marty | August 14, 2009 at 12:51 PM
At which point the distinction between guaranteed or denied became the topic: where I replied
“” the difference between “doesn’t guarantee” and “denies” is big”
This difference is irrelevant when we are talking about setting the level of basic healthcare that society agrees is guaranteed. The provider(or instrument of requiring delivery) of that healthcare is the government so if they don’t guarantee it, it can be denied.”
A point where I might have been more clear, since it was pointed out, rightfully, that government wasn’t the deliverer of basic healthcare. I should have spent the time to note that the reference was back to the guarantee discussed in Emmauels article, and denial was not active but passive based on the individuals ability to get it outside required basic coverage.
However, that was addressed (still inadequately) in thread here:
“No!
The government is not the healt care provider!! Not government health care.
This is government provided INSURANCE!
The government can decline to cover certain treatments, procedures and medicine, like private insurers do as a matter of course. But that does not mean that people cannot obtain the applicable treatments, procedures and medicine. They just have to come out of pocket.”
Sorry Eric, you are correct.
Posted by: Marty | August 14, 2009 at 01:35 PM
Ultimately, hilzoy summarized his position here:
“Second: “Emanuel, however, believes that “communitarianism” should guide decisions on who gets care. He says medical care should be reserved for the non-disabled, not given to those “who are irreversibly prevented from being or becoming participating citizens . . . An obvious example is not guaranteeing health services to patients with dementia” (Hastings Center Report, Nov.-Dec. ’96).
Translation: Don’t give much care to a grandmother with Parkinson’s or a child with cerebral palsy.”
This one has been discussed above. To my mind, the crucial point is that Emanuel is talking about how one might draw the distinction between (a) “basic” services, which should be guaranteed to everyone, and (b) “discretionary” services, which should not. But no one will be denied these discretionary services; they’ll just have to either get a supplemental insurance policy that covers them or pay for them out of pocket.
Plus, it’s not at all clear that he’s advocating the line of thought he explores. But even if he were, this would not be about preventing anyone from getting care.”
This doesn’t seem to dispute anything I said above aside from not deciding whether he is advocating or not. Note she doesn’t claim he isn’t, only that she is not sure. I state above that I read it that he is advocating that position. The distinction is ok with me, I still read it that he was advocating it.
I am still looking for the lie.
Ah, allocation of resources. How often have I heard someone say, in all seriousness, “these are all top priority,” ignoring the fact that if there aren’t enough resrouces to do all the “top priority” tasks, something will give? It seems to be a common management theme, like asking for 150% effort or insisting that we “do more with less.”
Sure, sometimes you can get people to put out an extraordinary effort, or find efficiencies that were unexpolited, but the usual result of insisting that everything is vital and nothing can be crossed off the list is a poorly done job on everything. It’s almost always better to admit that resources are limited and make an intelligent choice of the priorities.
Or, as Gilbert and Sullivan put it, “When every one is somebodee, then no one’s anybody!”
Gravity. It’s not just a good idea. It’s the law.
I love the “do more with less” crapola.
That’s usually followed up by we must be “lean and mean”.
Because in order to get more with less, one must be starved and then have mean people, wielding the “carrot and the stick”, stand over one demanding more from less, usually resorting to “sturm and drang” to get their way.
The mean people then apply for better jobs bragging about their experience “hiring and firing” on their resumes.
They also brag about their bonuses, which is where the “more” went that all the lesser people were looking for in the first place.
The lean people, who are fired by the mean people because they just weren’t able to become skinny enough to please the meanies, stand on street corners living off the fat of the land as the same mean people drive by, roll down their windows, and growl,
“Get a job! How dare you not do anything with nothing.”
The Culture of Death can be usefully combined with our supposed love of Stalinist centralized planning to yield all sorts of Brave New World stuff:
You forgot the human/animal hybrids.
“This doesn’t seem to dispute anything I said above aside from not deciding whether he is advocating or not.”
Marty, learn to edit, excerpt, and summarize: cutting and pasting every bit of every single message in a string isn’t a coherent response. Neither is there any point, since we’re all capable of rereading the originals if we wish to. A recap would be a different story.
Also, try learning to blockquote: your comment of 10:57 AM was essentially unreadable. No one is going to read one long string of uncut, unformatted, cut-and-paste.
Not to mention that I just wrote a summary, with relevant excerpts. Excerpts.
By the time you get to “This doesn’t seem to dispute anything I said above aside from not deciding whether he is advocating or not. Note she doesn’t claim he isn’t, only that she is not sure. I state above that I read it that he is advocating that position. The distinction is ok with me, I still read it that he was advocating it,” what you’ve produced is one long unreadable piece of incoherency. You’ve also reverted to a lack of antecedents which make your points indecipherable. You wind up on the road to near-gibberish.
But maybe there’s someone out there who read your 10:57 AM, made sense of it, and was persuaded of your point. Anyone? Bueller? Bueller? Anyone?
“But maybe there’s someone out there who read your 10:57 AM, made sense of it, and was persuaded of your point. Anyone? Bueller? Bueller? Anyone?”
Your excerpts were not accurate. The answer to this question is, I did. Just for the record. If you couldn’t sort through it, ok. I won’t respond to this again anyway. Enough is enough.
John Miller: “First I st6and by my earlier comments despite Gary’s over the top rhetoric (which I really don’t usually accuse Gary of). I did not speak of out in the open violence, I spoke of an undercurrent which is wide-spread and actively encouraged, even by some people in Congress.”
John, with all due respect, you wrote of current “violence that is running through everything.”
Yes, you used the word “undercurrent,” and then you went on to cite:
I don’t understand how you can go “back to the” 60s, which were full of violence, and say that “I don’t think the actual feeding of the anger that is being done today existed to quite the same level” on the grounds that there was, in fact, endlessly more actual violence in the Sixties. I’m sorry, but that doesn’t make any sense. Actual violence is worse than “undercurrents.”
Citing just a tiny bit about that widespread violence is not, I think, “over the top.” It’s writing about how much worse political anger and polarization was then than now. And, I’m sorry, but it just was: endlessly.
But my main point is that Rick Perlstein agrees with me.
🙂
“The answer to this question is, I did.”
What question?
“The answer to this question is, I did.”
What question?”
Anyone? Bueller?
But since you metioned it, I figured out bold and a few things, What is the format for block quotes?
“What is the format for block quotes?”
< blockquote > and < / blockquote >, but putting the angle marks directly next to what’s inside them.
Thanks