Seems that economics still has a few bugs in the philosophy department. It does pose interesting questions though.

*Snicker* Weren't liberals the ones who supported pulling the plug of Terri Schiavo because it was costing too much even though people of faith were against it? It's hypocritical of you liberals to be now against pulling the plug of the poor.

Landsburg wrote a book dedicated to the proposition that all moral questions could probably be solved by asking his 9-year-old daughter what she thought. He should check with her on this one. She's 17 by now, though, so she might be less inclined to serve as a prop for her father's positions.

Denny Hastert doesn't seem to mind "pulling the plug" for New Orleans so.....

condescending, juvenile, obtuse, and soul cankered as this one in Slate.

I think the adjective you are going for is "true".

Wow - nice example of free market reasoning driven to its logical conclusions.

The irony is that your comment is right next to an advertisement for the Economist. Despite it's indepth coverage, the Economist's greatest weaknesses is its consistent blind faith in "markets good, governments bad" reasoning.

Look back over their predictions recently. For example, they predicted Putin would bring ruin to Russia with his quashing of Kordovsky and the oligarchs - oops best performing market in the world over the last few years.

Good to have you back though. Slate is really a good source of these achingly dumb articles. Anyone read some of John Dickerson's (sp?) stuff? Reminds one of the Wash Post editorial page. Wonder why?

That guy actually has a job at Slate? Wow. Have we no work houses?

Did any of you guys spend more than a minute pondering the issue before you jumped on Kevin's bandwagon? That can be a dangerous practice, because quite often Kevin's wagon is wandering down Dumbass Boulevard, as it is on this topic.

Medicaid doesn't pay for ventilators?

But I didn't realize that a hospital could EVER withhold lifesaving treatment. Is that just a Texas thing?

Anyway, the Terri Schiavo contrast is dead-on. I gather the lady here had the misfortune to be something other than white.

This is pretty close to the philosophy of Peter Singer, which a colleague of mine once described as "logic without compassion." It's interesting how the ultra-libertarians and the far, far left arrive at a similar position of utter contempt for human life. (Whittaker Chambers described Rand's brand of politics as the kind of anti-statism that says "To the gas chambers - go!")

Economist's greatest weaknesses is its consistent blind faith in "markets good, governments bad" reasoning.

This does not need to be inconsistent with preventing poor people from dying horrible deaths. I tend to share the Economist's philosophy, but I also recognize that there is no free-market solution to that poor woman's case, and I don't mind paying higher taxes to prevent that from happenning. (Or, rather, I don't mind the gov't. spending existing taxes on ventilator insurance instead of wasteful subsidies or pork projects.)

Every column I read by Landsburg furhter convinces me of the fact that he only writes them to get a rise out of the typical Slate reader, because what appears to be serious is so obviously ridiculous upon any examination.

However, this latest missive does go to the heart of the current climate. Of friggen course the avereage poor 21-year old (hell, the average rich 21 year old) will choose $75 in the hand over ventilator insurance.

But that's not the point, is it? Even Landsburg had to acknowledge the issues of the tragedy of the commons when in comes to vaccination, but why not health insurance? Moreover, I'm not even sure the question is a close one. Even I would admit that the poorest of the set of poor 21 year olds has some chance of earning $75 bucks by working for it in some way. By the time you are on a ventilator, you are at the complete mercy of a combination of the government, your family, and the hospital.
Exercise your free choice then!

Essentially, the "ventilator" economic choice is a false one. Landsburg confuses (I'm pretty sure, intentionally) gambling with economics.

When most of these issues are framed as what they in fact are, insurance questions, most people support them. It is the goal of the modern Republican party to somehow paint the issues as anything other that what they actually are.

Yow. I couldn't do more than skim this -- and that was enough to get my blood boiling. Two thoughts:

1) Fifteen minutes is a very long time to spend dying. Perhaps Mr. Landsburg will learn something like that one day.

2) Our society has truly failed if the only thing that determines a person's survival is the amount of money they have. Or more accurately, our society has truly failed if we are willing to so baldly state and blandly accept that this is so.

So where are the right-to-lifers on this one? I would think they should be up in arms about this tragic and unnecessary loss of a human life.

First, Al: the key issue is to respect autonomy by ensuring that the care provided accords with the wishes or values of the patient.

If the patient wants to be kept alive on life support, then she should be. If she doesn't, then she shouldn't be.

If she's not able to express her own wishes at the time, then you go to her substitute decision maker, who's supposed to tell the doctors what that person would have wanted if she were able currently to express her wishes.

This is why it's perfectly consistent to say that Shiavo should have been allowed to die while this woman in Texas should not have been.

al - i really shouldn't need to tell you this, but the difference between the terri schiavo case and this one is that schiavo expressly desired to have her feeding tube removed in that kind of situation, whereas in this girl's case there was no desire to do that at all.

this is a question of individual liberty - should people have the right to die with dignity, or should their lives be left to the whims of large, centralized, beaucratic entities?

also, there can never be a free market for health care. if you're having a heart attack you can't shop around for the best treatment option, and if there's an epidemic having a bunch of unprotected people running around is bad for the country. public health is a public good, like clean air - everybody's got a right to it.

if it ain't social it ain't security, and if it ain't public it ain't a health system. as long as it's in somebody's financial interest to see you coming back to the hospital, your health is not going to be taken care of. the VA is the most efficient medical system in the US because it's socialized. this provides yet another refutation of the capitalist dogma that "free" markets are the be-all-end-all form of human social organization.

Sorry, but Mr. Landsburg has a point. We've reached the point in medical science where we can spend hundreds of thousands to millions of dollars extending the lives of the terminally ill a few more days or a few more months, but that doesn't make it the right thing to do. Is extending the life of a terminal patient a day worth not feeding ten poor children for a day? What if it's a hundred children? Or a thousand? We live in a world of limited resources and, at some point, the (tough) decision has to be made, .

I realize some will object that "the rich" will not have to worry about this problem, but that doesn't change what is right. We can't force people to spend their money the way we might want, but that doesn't mean we should make the same mistakes they do.

And do realize I say all this as a liberal progressive and cancer survivor.

Liberals weren't in favor of pulling the plug on Terry Schiavo because of the cost. They were in favor of pulling the plug on Terry Schiavo because

(a) She was dead. Residual activity in the brainstem doesn't really count as alive.

(b) It was the wish of her husband. As a Catholic Christian, I've learned that the Bible says that once you're married, you belong to your spouse, and no longer to your parents. And most certainly not to the government.

I thought conservatives were supposed to be for keeping government out of people's lives?

Where exactly can one buy ventilator (extreme life-prolonging care) insurance for $75, at any age? When I was 22 I worked for an organization with excellent and proactive benefits, and I am reasonably sure if such a thing had been available they would at least have told us about it (and probably just bought it for us, thus massively reducing their long-term liabilities). I don't recall any such product ever being offered.

Cranky

I've always enjoyed Everyday Economics, but I agree with Kevin that this one was pretty bad. Honestly, I wanted to be convinced that he was right, but he never convinced me.

It's not the worst Slate.com article ever. Here is my pick for worst, not just w/Slate.com but for nearly everything.

http://www.slate.com/id/2112083/

I'm reminded of the Helga Wanglie case in Minnesota. Helga was elderly and could no longer express her wishes on the matter.

The hospital thought her continued life on a ventilator (or some sort of life support) was futile and a waste of their resources.

But Helga's husband (her subst. decision maker) said that they both adhered to a strong sanctity of life ideal, according to which you keep the person alive as long as you can.

The hospital challenged the husband's legal status as subst. decision maker and of course lost. The upshot? The hospital had to keep Helga alive as long as the husband wanted them to.

How can it be okay for another state to say pretty much the opposite of this? I'm Canadian and don't know a lot about how the American system works. Is absolutely everything connected with these cases determined at the state level?

I stopped reading that guy when I realized he was just a right-wing opinion writer who dresses his opinions with a little economics. He gives economics a bad name. He also seems to not be a very good economist. He stuck at that econ 101 level. If all you know is econ 101 of course you're going to be a heartless libertarian. But if you factor in grown-up economic thinking like Thomas H. Frank's stuff, you're back in the real world.

In other words, economic considerations are the basis of true compassion
As a former libertarian, I'm not at all surprised. I have heard the phrase "to really value people, you must value them" bandied about before. To tell people outside the party that people HAVE to be given a dollar-value was the height of both political stupidity and (to me) wanton cruelty, but it is the norm. I'm not surprised when this attitude slips into broader conversations.

My God, what an ass.

Please tell me this was satire. I hate to think there really are people this soul-less walking around.

I can guarantee you if it were he on the ventilator, he wouldn't have to reach for Webster's to know what compassion is. Obtuse indeed.

On the contrary, Alex, the article you pan was one of the better articles Slate published. It's a quite effective spearing of the tendency -- a tendency that should be offensive to religious as well as non-religious people -- for those who have survived disaster to credit God for saving them, implying that the neighbors who were killed were somehow less worthy. If you like, you can read it as a call for a boycott of a primitive concept of God.

I guess what matters in these cases is two things: the prognosis and the wishes of the patient or the patient's legally appointed decision makers.

As for the prognosis, it was apparently terminal cancer, so it's not like she could have recovered. The article doesn't say anything about the patient's wishes. So I suppose this thing could go either way.

The vast majority of our health care spending in this country is spent in the last six months of a person's life. We need to have a serious national discussion about whether this spending is good from a quality of life standpoint. I know that I don't want to spend my last months completely incapacitated, and I would choose to die rather than be on life support if I had the choice.

Good luck selling the idea of compulsory/state aided ventillator insurance to the American people in 2006.

Although the article is certainly condescending and borderline malicious, it does (rather obliquely) raise a good point: how, in a world of finite resources, do we maximize the utility of the funds available for providing relief and assistance to the underprivileged? Although I have no idea what it costs to keep a person on a ventilator for a day, and the article unfortunately (and perhaps irresponsibly) did not mention that amount, it does seem perfectly reasonable to ask whether the money is better spent keeping one terminally ill patient alive for a few more days, versus perhaps providing preventive care to extend the lives of several other people for months or years, despite the apparent callousness of allowing a person to die when that death is, in a literal sense, preventable. (Obviously these calculations are highly abstract in the absence of concrete numbers, but the reasoning process they illustrate seems valid). Underneath the distracting talk of "ventilator insurance," I think the article raises that valid point against the bloggers' reaction.

Al,

I don't recall any "liberals" making the argument that Ms. Schiavo should be allowed to die because keeping her on life support was "costing too much." The argument was that the state should not compel her to remain alive in a persistent vegetative state despite the professed wishes of Ms. Schiavo and her husband. This argument is grounded in a respect for personal autonomy that holds that the individual should be permitted to make the most personal of life's decisions without interference from the state, and has nothing to do with the expense of her care.

There is a reason why we have things called "life insurance" and "health insurance" rather than a blizzard of policies dedicated to arcane specific events. The odds of any one thing causing catastrophic loss are not high, but the cumulative probability that something will be needed is significant.

There are honest arguments to be made about how we treat end-of-life issues, both in terms of societal cost and quality of life. Since none but the super-rich can afford out of pocket costs in the millions, however, singling out the poor for triage is more than a little obtuse. It's a moral abomination.

Huh, I just read that Slate article you point to Alex and have to disagree. Tho I don't agree with all of it, at least, it does provoke people to think about the whole out-moded and always illogical God idea. (At least God, as presented in the Old and New Testaments anyway.)

If the author ruffled your feathers, I guess that was the intent.

There is room for a great deal of disagreement about how much assistance rich people should give to poor people, either voluntarily or through the tax system. Landsburg

Mr. Landsburg does not know it is the extra value poor people add by their work that makes rich people rich. Our political economy does not allow for this transaction to be made voluntarily. What was this capital apologist's opinion of the Terry Schiavo affair?

What's striking to me about the Slate column is exactly the lack of compassion. There is no sign whatsoever of Landberg making any emotional connection with the dying woman, or with her family. His empathy organ is not working. It is appropriately symbolic that he has to look compassion up in the dictionary to be sure he knows what it's supposed to mean - his heart doesn't tell him.

My god, this is evil. Just sick, twisted and evil.

No, it's not moral to offer poor people such a choice. Mayve this is obvious, but I'm drawn to an analogy of Sophy's choice here--the boy or the girl? Um, it's not kindness or a concern for the weak that leads people to pose such choices.

This is a really sick way to make yourself feel better about not taking care of sick poor people. I mean, you gave them a choice! It's really THEIR fault they chose to eat instead of get ventilator insurance! You have no moral responsibility for them whatsoever.

Seriously, this is evil. This is an evil argument.

this should help to alleviate the gloom: Construction spending hit an all-time high in November as government spending to build schools, highways and sewer systems offset a slight dip in home building.
***
The Commerce Department reported that total building activity rose to a record $1.146 trillion at an annual rate in November, up 0.2 percent from the October pace.
***
Through the first 11 months of 2005, construction spending is 9 percent above the pace set in 2004 as a boom in housing helped to push construction activity to record levels. However, home building by the private sector was essentially unchanged in November, which could be a harbinger of the expected slowdown in this sector as rising mortgage rates cool housing activity.
***
In other economic news, a closely watched gauge of manufacturing slowed a bit in December but remained at a level indicating manufacturing will continue to expand in coming months. The Institute for Supply Management's manufacturing index turned in a reading of 54.2 last month, down slightly from the November reading of 58.1.

I see Joe Buck said what I did already only better!

...alleviate the gloom...

"Hey look at this puppy over here!"

thanks contentious

Joe,

Here's my problem with the God article.

One of the oldest questions involving religion is, How can a benevolent God allow awful things to happen? Whether you're religious or not, (and I'm in the not category), it just isn't right to say that religion hasn't been dealing with this question for nearly thousands of years. The author comes off like she's discovered some amazing new insight when she's really just blithely repeating what serious religious scholars have debated.

That, and I read it as making light of a truly devastating event. I don't think anyone would have written a column like that after 9/11.

After thinking about it a bit, I have decided to buy this "ventilator insurance" for my kids. I am willing to pay up to $150 each, double the quoted price. Can anyone point me to an agent who will sell it to me? Tbrosz perhaps?

Cranky

Stuart said: "It is appropriately symbolic that he has to look compassion up in the dictionary to be sure he knows what it's supposed to mean - his heart doesn't tell him."

That is so good, I just had to say it again.

Where are the bleeding heart liberals on this one? Why didn't some compassionate liberal fork over some money to keep her on the ventilator? What was that? Liberals are generous when giving out other people's money?

Actually, while I am a firm believer in "no one should die because they can't afford treatment", Landsburg does invole some good discussion:

- Asking Miss Habtegiris before she got sick is probably a good idea. She might have said "I don't want to be put on a ventilator, never mind the insurance." Poor people should not be kept on ventilators just because they can't afford a lawyer to fight for their Right-To-Die.

- Despite his "unfortunate" headline, the crux of the article is actually about deciding where is the best place to spend the money. Letting the person decide is certainly not the worst suggestion. (It might be close to the best)

At some point the country must decide how to spend money. The woman was critically ill (terminal cancer patient) and likely would have died anyways. As medical technology advances, this issue will ballon. Follow this simple argument:
- What if you could cure cancer but it cost $10 billion per person. Even Bill Gates would die.
- What if you could do it for $10 per person, now no one would die.
- Somewhere in the middle is reality, but where do you draw the line? Using economics, only the rich get cured, (bad) bit this subsidizes and refines the system to make it more affordable (good).

It's a complex argument, with no correct answer.

Dang! For a moment there I thought I was reading a rant by the guy that played a detective on Barney Miller. Not to be. His name is spelled Landesburg.

Obviously Mr. Landsburg has not read TAKING CARE: ETHICAL CAREGIVING In OUR AGING SOCIETY, available here:

http://www.bioethics.gov/reports/taking_care/index.html

The report from The President's Council on Bioethics makes the case that folks who want to leave before they succumb to dementia should be talked out of it.

As the report puts it, "Good long-term care requires willing and able caregivers, community supports, caregiving institutions, and social policies that go beyond advance directives and beyond even responsible advance care planning. Public policy must address these issues directly."

Short version: Don't plan ahead. The medical community will take care of you once you start to slide. As for the cost to the family, that cannot be a consideration. Nor can the cost to the society.

"What's striking to me about the Slate column is exactly the lack of compassion. There is no sign whatsoever of Landberg making any emotional connection with the dying woman, or with her family. His empathy organ is not working. It is appropriately symbolic that he has to look compassion up in the dictionary to be sure he knows what it's supposed to mean - his heart doesn't tell him."

Stuart,

I don't think that's at all true. Lansburg explicitly notes his compassion for the dying woman, but implicit in his discussion is the (I think) valid point that the zero-sum game of resource allocation does not allow us to indulge our compassionate impulses on every occasion. Yes, the life of this dying woman could no doubt have been extended for some time by the allocation of additional funds to her care, but at what cost in terms of lost opportunities to help others in which the relief could do more absolute good? What would be the opportunity cost of a policy of extending the life of every terminal patient to the maximum extent achievable by state of the art medical technology? Is it better to spend millions of dollars extending the lives of comatose or terminal patients for a few months when the same funds could be allocated to improve the quality of life for many others? There may be no clear answer to these questions, but an insistence that society consider these questions and strive for solutions that maximize utility across the board seems to me to indicate both the compassion and level-headedness necessary to allocate the finite resources of society between literally millions of competing claims in an equitable way.

Kurtz,

Setting the law aside and just looking at the ethics, it makes all the difference whether the person is still conscious. Maybe we should say that when someone is in a persistent vegetative state with no prospect of recovery, it's a waste of resources to keep that person going. But I don't see how the treatment could be called a 'waste' if the individual is conscious or could regain consciousness.

This Texas law is just filthy. Some Dutch ethicists say that their system of active euthanasia should not be adopted in the US, since it would lead to people being 'euthanized' for purely economic reasons. Critics replied by saying that Americans wouldn't be that inhumane -- after all (they said), there's the potential for people in the US to be passively euthanized for economic reasons, but that doesn't happen. Guess what, now it does.

In fact, this was involuntary euthanasia. I can't think of any other western nation that even considers allowing that.

I realize that the US (and Canadian) legal system bizzarely regards this as passive euthanasia (merely 'allowing' someone to die), but really it's obviously killing. Withdrawing treatment is an action that causes death, and I don't see how one could deny that that's killing. And the people who withdrew the treatment knew full well what the consequences would be. They should be charged with murder.

They should have kept her alive because Dead men pay no bills.

Oh come on it was funny!! *shrug* well I laughed.

OtherPaul:

How can it be okay for another state to say pretty much the opposite of this?

It's not the opposite. Minnesota was saying that extending the lady's life was pointless. Hence Minnesota lost, because who is the state to say that a life is pointless, when God tells us we have to prolong everyone's life, no matter how vegetative or painful? Why, it's positively un-American!

What Texas was saying, on the other hand, was: we don't care whether your life is pointless or holy or rich and full of glory; you don't got the money, honey, so it ain't our problem. And that attitude is as American as apple pie.

the whole article is worth reading, but the beginning is worth quoting: Tirhas Habtegiris, a 27-year-old terminal cancer patient at Baylor Regional Medical Center in Plano, Texas, was removed from her ventilator last month because she couldn't pay her medical bills.

Wouldn't most people on life support with a terminal illness want to be removed from life support?

"Financial considerations" are a measure of how many other people are required to work, and how hard they are required to work. People might have an obligation to work on my behalf, but not to keep me lingering in death with an uncurable illness. Don't forget, lots of people in the world do not have medical even start due to financial considerations. In Oregon, for example, the state will not pay for (and doctors will not perform) bone marrow transplants, though they pay for lots of other medical treatments.

It's no fun to think about death and dying, but that isn't a good reason to stop thinking. While we are thinking, how many people who find this case unsettling have donated the funds necessary to pay all the bills? Not I, my money has gone to tsunami relief, Katrina relief, and Pakistan earthquake relief. If I feel like donating more, that's where I will donate; or to Southern Poverty Law Center, MSF (who say they have more money than they can spend wisely), or local charities.

I suppose I'm naive, but doesn't it seem fucked up that someone in America just died because they couldn't afford their medical bills? Doesn't that just seem.....creepy? Maybe I'm idealizing our country, but it doesn't seem like the kind of thing that should happen here.

And I know in the larger picture if you're poor you're not going to have good health care in the first place, which is likely to shorten your life, so being poor equals being dead sooner is something I get. But this seems so immediate and personal and inhumane and...yeah, creepy.

I have printed out Abramoff's rap-sheet, and posted it on my wall next to Tom Delay's and Lewis Libby's.

yay.

I couldn't find one for Randy "Jailbird" Cunningham though. :(

By the time this is over, I hope I have enough wall-space for them. Or maybe I hope I don't.

That's right, dammit, the rich should be buying healthcare for the poor until they're no longer rich. We've got to bleed those rich people, make them buy the poor homes and cars, too.

Because that's what the lefties want.

If you moonbats are so up in arms about this, why weren't you paying for her ventilator?

Never take seriously anything written by someone with the same last name as an actor on "Barney Miller."

The economic "analysis" was incorrect. The question is what the patient wanted now, not six years ago. I would wager her utility function has undergone some drastic changes. Landsberg also assumes the "price" for the ventilator had anything to do with "free markets". Truly laughable.

The compassion angle is also wrong, insofar as it conflates individual vs. societal choices.

Overall grade: D-

Whoops, that should be the same NAME -- first AND last name.

Suppose somebody told me, "Hey, libdevil, I'll give you $100,000 to go kill this lady. She's a terminal cancer patient in Texas." They'd be commiting a crime, and a monstrously immoral act. If I took the money and did the deed, I'd also be commiting a crime, and a monstrously immoral act. I'd be a contract murderer, in fact, among the lowest of the low. But when hospital administrators kill the same woman for the same $100,000 (or whatever the number is), they're somehow morally correct? No way.

I am as outraged by this as anyone else, but given that billions of people all over the world do no have access to healthcare services more rudimentary than a ventillator, including a large number from India and China whose labor provides the goods and services that we buy everyday, on reading the posts here I cannot but think of a PETA meeting at McDonalds.

Lansburg explicitly notes his compassion for the dying woman, but implicit in his discussion is the (I think) valid point that the zero-sum game of resource allocation does not allow us to indulge our compassionate impulses on every occasion. Yes, the life of this dying woman could no doubt have been extended for some time by the allocation of additional funds to her care, but at what cost in terms of lost opportunities to help others in which the relief could do more absolute good?

This is pure idiocy, of course. Do we ask, every time we cut a paycheck for a police officer, whether in the zero-sum game of resource allocation we might not better fight crime by establishing a midnight basketball league with the same $50,000 a year? One could make the very same cost-benefit comparison with literally every action undertaken by anyone anywhere in pursuit of any goal. And Landsburg doesn't bother arguing that the money spent on this woman's respirator was worse spent than some other worthy health-care goal. He presents no evidence on this question. I can make the same sort of evidence-free argument to show that the Defense Department does not protect America, that government highway spending does not promote transportation, that education spending, private or public, does not promote learning or intelligence, and that eating does not make us less hungry. After all, who is to say that, in the zero-sum game of resource allocation, other techniques might not be more effective at accomplishing these goals?

For example, to keep from getting hungry, it would be far more efficient to shoot yourself in the head than to spend your entire life fruitlessly trying to eat enough to dispel hunger. Hence, eating does not make us less hungry; by prolonging death, it actually, in the long run, makes us hungrier.

It's an amazing argument, really. Giving life-prolonging care to a woman dying of cancer is not "compassionate", since, twenty years earlier, she did not choose to spend a much smaller amount of money to buy a nonexistent type of insurance against the precise catastrophe which, many years later, would strike her down. In the same sense, when your child falls out of a tree and breaks his leg, it is not "compassionate" to bring him to the hospital for treatment, since, earlier that day, he might more efficiently have chosen to purchase an inexpensive but nonexistent metal anti-fracture leg-brace, but instead chose to use his time and resources differently. It is more compassionate to use your precious time and labor on whatever services the market values most highly at that moment, such as, say, writing some software, or practicing corporate law, while leaving your child screaming on the lawn.

Wouldn't most people on life support with a terminal illness want to be removed from life support?

She didn't.

Even though her body was being ravaged by cancer, this family says Tirhas still responded and was conscious. She was waiting (for) one person. "She wanted to get her mom over here or to get to her mom so she could die in her mom's arms," says her cousin Meri Tesfay.

Kevin's right - it's truly stupid, pea-souled column. The dumbest thing in it is this:

Accounting for "economic considerations" means—by definition—trying to give people what they'll value the most. In other words, economic considerations are the basis of true compassion.

What people value the most (compassion, for example) isn't buyable with dollars.

That's a ridiculous oversimplification conspiracy nut, especially given that the uber rich and corporations are often paying *less* taxes than the poor. If the rich and the corporations would pay their gd taxes, it'd sure help.

If you moonbats are so up in arms about this, why weren't you paying for her ventilator?

Because people like me have most of the money, and have been sponging off the system for decades (Social Security Trust Fund, see).

But shsss. Keep it a secret, OK?

James Dillon wrote: ... an insistence that society consider these questions and strive for solutions that maximize utility across the board seems to me to indicate both the compassion and level-headedness necessary to allocate the finite resources of society between literally millions of competing claims in an equitable way.

As far as I can make out, the article advocates that the "finite resources of society" be allocated between "millions of competing claims" in a very simple way: by the ability to pay.

Those who can afford to pay for medical care can have whatever care science is able to provide, for whatever condition they need or want care for, whether it is trivial or life-threatening; those who cannot afford to pay will not get care. Period.

Is that a "compassionate" and "level-headed" way to "maximize utility across the board ... in an equitable way"?

typical republican compassion.

oh, and fuck al.

Good point Neo-liberal - let me clarify.

My crack about the Economist always believing in free market solutions is connected to this article in this way. Consistently they've supported all the "free-market" fixes to the US health care system, and decried European socialism. All this despite the fact there is little evidence that economics really works in health care.

The US is the only industrialized country without socialized medicine and has the highest costs (by far) and middling results. Over and over, attempts have been made to introduce market based solutions and they backfire. And one reason is exactly connected to this article - because nurses and doctors do the compassionate thing. They cheat to help out patients. We've all seen it - and we (almost) all agree that they are doing the right thing.

In addition, there are lots of theoretical reasons why economics doesn't work in health care: there isn't perfect information. There aren't informed consumers, there is tremendous supplier power, etc. All of these are basic tenets of micro-economics - and they just aren't credible assumptions in health care.

And yes, maybe the writer was trying to make the point of how ridiculous economics is in health care.

But when hospital administrators kill the same woman for the same $100,000
So your position is that someone can run up a $100,000 tab for services rendered with no sign of payment coming, and the service provider should just keep providing service?

Let me guess, you also bitch about the high cost of hospitalization, you're probably wondering why hospitals charge so much. Clueless.

Son where can I get some of that ventilator insurance?

Steven Lanburg is making a very religious argument here in favor of the most optimally compassionate possibility.

Of course, we're talking here about "compassion" within the moral framework of the religion of Mammon. Of which tbrosz is a high acolyte, of course.

especially given that the uber rich and corporations are often paying *less* taxes than the poor
Too bad the facts don't support this bullshit. Over 50% of taxes are paid by the top 10% of earners. And taxing corporations is stupid, its a cost that gets passed back to the consumer; you pay those taxes one way or the other.

Accounting for "economic considerations" means—by definition—trying to give people what they'll value the most. In other words, economic considerations are the basis of true compassion.

Yeah, No Preference, I just can't get past that line. See, the thing is, Rupert Murdoch is willing to pay me $1 million to help him out with this corporate merger, while that homeless guy on the corner isn't willing to pay me a dime to give him a bath and a square meal. So by working on the merger for Murdoch, I'm being much more compassionate than I would be if I were to give the homeless guy a bath and a square meal. Murdoch is simply much more deserving of my compassion - about a million dollars worth more deserving, to be precise.

The man is sick. He has a screw loose.

Happy Ney Year everyone.

conspicy nut wrote: moonbats lefties moonbats lefties moonbats moonbats lefties lefties nyah nyah nyah nyah ...

Some one should disconnect conspiracy nut's life support. He's been brain dead for a long time now.

How much would Steve Landesburg pay to insure that a bunch of bloggers won't burn his house down?

Oops. Wrong choice, Steve. Remember, society can't help everybody who makes bad decisions.

Well, color me a scumbag but nothing in this article seems unreasonable to me. Perhaps if the woman wasn't terminal, if there was some chance a cure could be found if she just held out a little longer (spare me any Schaivo theatrics here), I'd feel differently, but I don't think society has an obligation to keep forking out money so someone can live a little longer, probably in great discomfort or pain. If it were me, the only extra I'd want is death by a massive morphine overdose as opposed to natural causes.

That stats you provide do absolutely nothing to undermine what I said, conspiracy nuts. You give no stats for the percentage of the uber rich and corporations not paying taxes. And the corporations not paying taxes simply earn greater revenue which they seldom pass on to their employees. They could pay taxes and still make a profit. AND, it's COMPANIES which want to be treated like INDIVIDUALS in ever other respect, so they can DAMN well pay taxes, too. If you don't think they should pay taxes, talk to THEM about the fact that they shouldn't be treated like HUMAN BEINGS.

So that's what Bush meant by "compassionate conservatism."

"I have printed out Abramoff's rap-sheet, and posted it on my wall next to Tom Delay's and Lewis Libby's.

yay."

Sounds like you had a good Fitzmas.

"Soul cankered" struck me as a bit of over-the-top hyperbole, but after reading that column, wow. It fits perfectly.

It's not the pig, so much - the idea that poor people should be simply be allowed to die - its Landsburg's fumbling, transparent attempt to put the lipstick of economic theory on it that sticks in the craw.

If he'd said "you know what? People die every second. It's the natural condition. I shouldn't have to pay to help them live a little longer" I could have respected him a little. But to make up numbers and other people's opinions and try to perform an ugly little scarf dance with them...

Yeah. Soul cankered.

On another note, I'm a longtime subscriber to the Economist and while they do put an inordinate emphasis on market-based solutions, they also take absolute moral positions, positions which tend to be liberal. Their support for aid to the underdeveloped world, for instance, is based solely on a sense of moral obligation. As is their support for homosexual marriage.

And taxing corporations is stupid, its a cost that gets passed back to the consumer; you pay those taxes one way or the other.
Posted by: conspiracy nut on January 3, 2006 at 1:58 PM | PERMALINK

Taxing consumers is stupid. That's less money they can afford to pay for goods and services, so it acts as a tax on corporations anyway, but instead depresses the economy. Only investment income and corporate profits should be taxed.

The article is a fascinating testament to the futility of attempting to reduce values such as compassion to logical formulas. Clearly, "compassion" is a result not of economic calculus but deeply-felt moral conviction. The absence of it in the case of this author seems to me to be indicative of a strange absence of moral sensibility.

Its also a rather troubling demonstration of the willingness of arrogant #$@&%s to treat serious human issues as little more than an excuse to devise clever cocktail conversation.

I'm a longtime subscriber to the Economist and while they do put an inordinate emphasis on market-based solutions, they also take absolute moral positions, positions which tend to be liberal.

That's because even tho they're conservative, they're over there in a more enlightened Europed, whereas so many of our conservatives are still neck-deep in superstitious religious muck.

If it were me, the only extra I'd want is death by a massive morphine overdose as opposed to natural causes.

But it wasn't you, was it?

What's impossible to understand in this thread, what gives me the sense that I am living in the haunted house at Disneyworld, is how conservatives who argued that Terry Schiavo should be maintained indefinitely on life support at state expense because she was alive though braindead, can now argue that it was right to take Tirhas Habtegiras off of life support because she didn't have the money to pay for it.

It doesn't make any SENSE!!! It's like the gibberish penned by a seven-year-old on an essay question.

Are you clear that Terry Schiavo didn't have the money to pay for life support, either? How can you argue that brain-deadness is a lesser criterion for terminating life support than poverty? How can you argue that people should be maintained indefinitely on life support at state expense ONLY when their brains are dead?

I suppose I'm naive, but doesn't it seem fucked up that someone in America just died because they couldn't afford their medical bills? Doesn't that just seem.....creepy? Maybe I'm idealizing our country, but it doesn't seem like the kind of thing that should happen here.

There probably isn't enough money, and there certainly isn't a large enough supply of doctors, nurses, technicians and custodial staff, to supply everybody with the kind of medical care that people and their families demand in the aggregate. In the US and in every other nation, people die every day because they can not afford a treatment that might keep them alive. In the US, for example, people are dying of AIDS because they can not afford antiretroviral medicatiion (more opportunities for the compassionate among us to make donations of time and money), or because they have multidrugresistant HIV and society hasn't yet invested the resources to develop and test the next antiretroviral drug.

The villain in this story is Death, not the hospital, not economics, not a lack of compassion. But a lack of thinking makes the problem we face worse, not better, no matter who feels morally superior to whom. The cited article is not the last word on the subject that we shall have to read, but it illustrates why economics is called "the dismal science".

Landsburg is not only a repugnant person, he's a poor excuse for an economist as well. I think Slate keeps him around, as they do Kaus, to give them a "contrarian" edge. It certainly isn't for their great writing.

I love lies.

But the most delicious lies are the lies my worshippers tell themselves to convince them that they're worshipping someone else, when they're really worshipping me.

S Ra wrote: If he'd said "you know what? People die every second. It's the natural condition. I shouldn't have to pay to help them live a little longer" I could have respected him a little.

Well, that wouldn't have been enough to fill up an entire Slate column.

Come to think of it, "People die every second. It's the natural condition. I shouldn't have to pay to help them live a little longer" could completely replace not only a Slate column, but whole shelves full of books on so-called free market libertarian "philosophy".

In the US, for example, people are dying of AIDS because they can not afford antiretroviral medicatiion (more opportunities for the compassionate among us to make donations of time and money)

No. Read a book. Read the legislation. The Ryan White Act is supposed to provide government funding for every single HIV+ person in the country to get care and treatment, including antiretroviral medication when they need it. The fact that it is being underfunded at the moment is a violation of this country's basic social contract; it is a decision by the Congress to put poor people to death.

ARV medication is by now so cheap that BRAZIL can afford to treat every single AIDS patient in the country. If the US decides to let poor HIV+ people die rather than guarantee them treatment, that is a political decision by the American voter to kill poor people, not some kind of economic inevitability.

"it is a decision by the Congress to put poor people to death."

Sounds more like natural selection at work to me.

brooksfoe sums it up so well: some conervatives are really going to find themselves holding mutually exclusive opinions on this one.

I just googled Landsburg, and I gotta say, how much of a proffessional disappointment do you have to be to have a PhD in economics from UChicago minted in 1979, and still only teach in Rochester? That has to be a little embarrassing.

What's impossible to understand in this thread, what gives me the sense that I am living in the haunted house at Disneyworld, is how conservatives who argued that Terry Schiavo should be maintained indefinitely on life support at state expense because she was alive though braindead, can now argue that it was right to take Tirhas Habtegiras off of life support because she didn't have the money to pay for it.

I can't contend against that sentiment. I think that when it comes to death and dying most people just give up thinking and form a strong emotional attachment to some small set of details: Schiavo might recover, the state should pay to support a dying woman's wishes, poverty shouldn't matter, neglect to buy insurance shouldn't matter, people should be more generous. Thinking (even done without great skill) requires setting aside compassion for a time, and the result is always cold, calculating, and like a canker upon the soul in its appearance.

ARV medication is by now so cheap that BRAZIL can afford to treat every single AIDS patient in the country.

So we can add Brazil to the list of countries which have superior health care to ours now, too, huh? (Partly kidding/stirring.)

"Thinking (even done without great skill) requires setting aside compassion for a time."

That's only a certain kind of thinking.

I bothered to actually read up on the case, as Landsburg's stuff sounded pretty heartless. Some questions I have in general...

1. Forget waiting for her mom to come from Africa. Red Herring, or should be. What if she just didn't want to die? Still don't pull the plug? Or wait until she's unconscious? How cognizant was she?

2. Hospital beds can be damn scarce. How many people turned away due to full wards?

3. Was she still cognizant?

4. How many $$$ spent on her? Sounds like she received a hell of a lot of care gratis, and the relatives gave a "f$%^ you" in return.

5. Why wouldn't a nursing home take her? Why weren't they required to? Makes a thousand times more sense to put her in a situation similar to Terri Schiavo then to take up an extremely expensive and rare hospital bed.

contentious, YOU are not thinking straight. You're setting up a completely bogus scenario in which hardheartedness equals intelligence, when in this case it actually stems from confusion and muddleheadedness.

You have no idea how much it was costing the state of Texas to keep Habtegiras alive. None. And you don't know how much longer she was going to survive, with life support. So arguing that it was too expensive and the taxpayer has no obligation to prolong her life only reflects your a priori prejudices. You don't know whether keeping her on life support until cancer finally got her would have been any more expensive than giving someone's grandpa a heart operation which only prolongs his life by 6 months, which happens all the time without anyone raising much of a fuss about it.

It's not a matter of sentiment. There's an absolutely crucial intellectual point to be established here, for future reference: lack of national health insurance means that being poor kills people. That's all. If Habtegiras were rich, she would have been able to afford more expensive catastrophic health insurance, and she would have stayed on life support. She wasn't rich, so she had to die a few weeks, or months, or whatever, earlier than she would have if she were rich.

This, then, is one of the underpinnings of the argument for national health insurance. Without it, rich people live while poor people die. That's all.

For anyone who cares, here's an excellent article on Baylor's approach to medical ethics.

Article

If Habtegiras were rich, she would have been able to afford more expensive catastrophic health insurance, and she would have stayed on life support.

And her care would have subsidized all of the patients without health insurance that Baylor is reuqired to treat. The paying subsidize the non-paying.

She wasn't rich, so she had to die a few weeks, or months, or whatever, earlier than she would have if she were rich.

She died a hell of a lot later than she would have if turned away by the hospital and left to her own resources. In effect, she had a de facto form of insurance.

So we can add Brazil to the list of countries which have superior health care to ours now, too, huh? (Partly kidding/stirring.)

Well, Robert S., Brazil's HIV/AIDS comprehensive national treatment program is indeed a model to be emulated, both in the third world and, I'm afraid, in the US. It's better at reaching poor dark-skinned segments of the population, and it's better at ignoring social taboos and being open and frank enough about sex and drug use to reach the gay, transvestite, IDU and sex-worker populations that are most at risk.

As for the rest of the health care industry in Brazil, I imagine that as the US becomes increasingly polarized by wealth, we'll start to resemble more and more a country of state-of-the-art cosmetic surgery clinics for the rich, and filthy, understaffed, medication-short neighborhood health stations for the poor.

Note that the poor woman was "terminal". IE, there was no chance of recovery. So, it is not a question of whether she gets "treatment". There is not any "treatment". Does she get kept alive? Why? What is the compelling reason to keep people alive, as opposed to helping them get better?

What is the compelling reason to help people get better, if not keeping them alive?

She died a hell of a lot later than she would have if turned away by the hospital and left to her own resources.

Red State Mike, is someone advocating revoking the legal obligation of hospitals to treat seriously ill patients who show up at their doors, which the US shares with every single advanced economy on the planet? Or are you congratulating yourself on living in a country where people are better off than they would be in Sudan? I imagine she died a hell of a lot later than she would have if she had been abandoned in the glaciers of Antarctica, too. So?

That stats you provide do absolutely nothing to undermine what I said, conspiracy nuts
You said that the rich and corporations often don't pay as much in taxes as the rich. I pointed out that most of the taxes are paid by the rich. No taxes are paid by the poor, the bottom 50% of wage earners contribute nothing in taxes.

So tell me, since the rich pay over half the taxes, and the poor pay none of the taxes, how is it that the rich often don't pay as much? Clown.

conspiracy nut, I can neither tolerate this continued idiocy nor be bothered to look up the stats I need to refute you; it's not worth it. Please, just stop.

The article itself is an exercise in straw man logic. The author suggests that a lifetime of ventilator insurance would cost maybe $75, but ventilator insurance is not what is on the table in terms of the health insurance debate. Some of us will need long term rehab for leg fractures, others of us will need long term therapy for emphazema, and the rare individual will spend time on a ventilator before dying young. A more realistic debate would be about charging every single person who files an income tax return some amount to allow for minimal medical insurance. The medical care itself can be fee based or socialized, but the issue involves making the insurance pool open and universal. The problem with this article is that it views the universe of possible health care in the most constricted way possible, in fact in a way that goes beyond even what the right wingers would generally imagine.

Good catch, Kevin. I wrote the following email response to the writer:

Mr. Landsburg,

This is in reference to your essay in Slate - http://www.slate.com/id/2133518/ .

My faith tradition happens to be Christian. I don’t seek to convert others. I don’t even think that being Christian is the only way to get closer to that which we don’t know but binds us all together. I do know that Christ would never have spoken these words:

Accounting for "economic considerations" means—by definition—trying to give people what they'll value the most. In other words, economic considerations are the basis of true compassion.

Nor would He have relied on a dictionary definition to describe what true compassion is.

Human beings are called by God to be co-creators in this world. We human beings have the ability to make this world into whatever we choose to.

The free market is a human-created phenomenon. It certainly isn’t some mysterious force which makes everything right, assuming, that is, ceteris paribus. The “efficiencies” of a pure market society are, in fact, well documented.

There are alternatives to your world view that don’t condemn others to die because they made decisions in life that weren’t necessarily in their best interest. Further, there are plenty of instances in which people, through the tragedy that is circumstance, make all the seemingly correct decisions in their lives and still get whacked.

Our life on this earth is a fragile one. Some of us are blessed with more and some not so much. In both cases, the individual has a journey in this life to discover their God-given gift (vocation – “where your deep gladness meets the world's deepest need” – Buechner). Realizing our fullest human potential and helping others realize theirs too is paramount to anything else. For those of us with more, much truly is required and, importantly, it’s an opportunity for a joyful realization of our life’s gifts.

Life’s meaning is much more than the sad economic calculations that you limit your perspective to.

Regards,

Patrick Briggs,
Pasadena, CA

A few basic points:

This is inherently different than the Schiavo case. In that case, money to pay was not the issue - there was plenty of money floating around to keep her alive. The issue was her wishes, and the wishes of her husband, given the fact that she was effectively brain dead. Tirhas Habtegiris was not brain-dead - she was awake, responsive, and wanted to see her mother one last time before she died. (Landsburg helpfully omits any mention of this.)

The second is the vapidity of the 'analysis' presented. He presents a lifetime of ventilator insurance at $75 as his 'back of the envelope' calculation. First off, given the depth of the rest of his writings, I'm fairly certain that he ignored time value of money. Given that most of the need for ventilation insurance is later in life, this is a major consideration. Second, insurance isn't purchased as a lifetime lump sum - he's comparing the cost of lifetime insurance versus the immediate need for food and milk. If you asked most 21 year olds if they would pay for a lifetime supply of milk (with no time-value adjustment, no less) or give it up, most would have to go off the moo-juice entirely. (And, btw, computing the cost of 'ventilator insurance' is problematic, given the huge inefficiences in our health care system.)

Finally, consider: I conclude that YucatanMan either doesn't understand what an economic consideration is or doesn't understand what compassion is, because in fact the two are not in conflict.

Of course the two are in conflict. That conflict is part of life. He later states: I conclude that YucatanMan either doesn't understand what an economic consideration is or doesn't understand what compassion is, because in fact the two are not in conflict; this is the real conflict, the one he avoids with all his talk of milk and CDs. He wants to take this off the 'table' because it's really the only discussion to have.

His version of a social contract would involve the rich giving fixed amounts to the poor, and the poor having decision making around every penny - and if they make the wrong choices or are unlucky, they can pay for it with their lives.

So tell me, since the rich pay over half the taxes, and the poor pay none of the taxes, how is it that the rich often don't pay as much? Clown.
Posted by: conspiracy nut on January 3, 2006 at 2:40 PM | PERMALINK

The Rich are my blessed minions, the corporations my demonic servants, so it would be immoral to tax them.

But fear not, my faithful one, by my own hand, this evil taxation system shall be crushed, and re-built in my image, so that the poor will be paying their fair share once again soon.

conspiracy nut: No taxes are paid by the poor, the bottom 50% of wage earners contribute nothing in taxes.

Bullshit. If they work, then they pay social security taxes, even if they don't pay any federal or state income tax. If they buy anything at all, then they pay sales taxes.

Stupidity, ignorance, hatefulness, greed and dishonesty: that's what passes for "conservatism" in America today. conspiracy nut is a shining example.

So tell me, since the rich pay over half the taxes, and the poor pay none of the taxes, how is it that the rich often don't pay as much? Clown.

In Texas, where this person found no compassion or mercy, there is no personal income tax. There are consumption taxes or sales taxes, which are paid by everyone, and there are property taxes paid by everyone who owns, well, property. Then there are fees for all manner of licenses and permits.

A better way to frame the tax issue is to distinguish between state and local taxes and federal taxes.

Oh, and we might also want to remember that how a government treats people is a moral issue and a values issue. If a rich white guy had been allowed to die like this, there'd be lawsuits galore.

And what is it with Republicans like Trent Lott and Tom Delya who decry lawsuits but file them and make money off of them?

Was she still cognizant?

Yes, she was. See my post above.

Some people miss the main point here. Of course, as a society we have to make tradeoffs on the cost of life support vis a vis other needs. The big problem was the way Landsburg framed the story, and in particular his tone. I couldn't agree more.

Aidan described this article as "rather troubling demonstration of the willingness of arrogant #$@&%s to treat serious human issues as little more than an excuse to devise clever cocktail conversation" (see above).

>No taxes are paid by the poor, the bottom 50% of wage earners contribute nothing in taxes.

This is only true in a hypothetical world where payroll taxes don't exist. My employer has a whole lot of people in the bottom 50-percentile, and I can assure you they pay taxes.

federal or state income tax. If they buy anything at all, then they pay sales taxes.
Point taken, my number is for Federal Income Tax. I should have been more clear, as is the 50% by 10% number.

But, do you want to claim that poor people pay more in sales tax than rich people? Do you want to claim poor people pay more to SS than rich people? If not, the assinine argument that the rich often pay less tax than the poor is just that, assinine.

Oops - I meant I couldn't agree more with Aidan.

This stuff goes on at Baylor every year. From Baylor's ethics report...

Of the 36 explicit futility consults, in 29 cases, the family agreed to withdrawal of life-sustaining treatment and a switch to comfort care only following ethics consultation, with all agreeing fairly promptly. The other 5 cases were pursued through th