Editore"s Note
Tilting at Windmills

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March 22, 2006
By: Kevin Drum

THE APOCALYPSE....I'm feeling left out of the Ben Domenech bashing, so let's take a crack at his latest post, which he mildly calls "one of the ever-growing number of signs of the apocalypse":

In brief: A group of British doctors fought in court for the right to remove a fully-conscious little boy from a ventilator, over the objections of his parents, because they judged his quality of life to not be worth living.

Damn socialists. It's a good thing that a God fearing man like George Bush would never sign legislation allowing doctors to pull the plug over the objections of family members, isn't it?

In any case, I'm glad to see Ben arguing that the state should be obligated to provide medical care for sufficiently sick people. It's a start.

Kevin Drum 2:51 PM Permalink | Trackbacks | Comments (196)

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Comments

I guess we're all liberals when you scratch the surface.

Posted by: Boronx on March 22, 2006 at 2:54 PM | PERMALINK

The kid's a twit, but I'm going to guess he can use his new platform to inveigh against the overreach of the Feds when they lead his daddy off in handcuffs for bribery and criminal malfeasance for his Abramoff dealings at Interior.

Posted by: Derelict on March 22, 2006 at 2:55 PM | PERMALINK

Ya know, take a look at the final graf of Domenech's post, which features this ringer of a sentence: "When a group of people are given the de facto authority to decide that a living human boy is not a person, and therefore has none of the protections due to every person, we have crossed a very dangerous line." Has this sort of thinking been fully vetted by the White House? ... 'cause you don't have to change more than a word or two to see a searing indictment of Bush's policy on Gitmo prisoners....

Posted by: ptb on March 22, 2006 at 2:56 PM | PERMALINK

Given Domenech's prior record, maybe it's worth asking what actually did happen in Britain?

Posted by: Doug Bostrom on March 22, 2006 at 2:58 PM | PERMALINK

It's very difficult to determine whether the decision in the boy's case was the correct one, as neither the WaPo article nor the cited Times article has much in the line of details (not their fault, presumably).

Posted by: Peter on March 22, 2006 at 2:59 PM | PERMALINK

It is so very, very hard to crib from Rush, Hannity, Joe Klein, Max Boot, Fox News, Dobson, etc., and complain how all Bush worshipers are blackballed from the media.

Posted by: Freedom Phukher on March 22, 2006 at 2:59 PM | PERMALINK

What an unselfconscious nutjob. Time to start the Domenech Death Watch, in which we proffer likely dates for his separation from the Post?

Posted by: Anderson on March 22, 2006 at 3:03 PM | PERMALINK

Actually, bush's law only applied to adult patients. His successor signed the sequel which extended it to minors.

Posted by: Atrios on March 22, 2006 at 3:03 PM | PERMALINK

I think as far as the Texas kid goes, it sounds like there aren't any facilities that feel like its worth their expense to keep the kid alive for another 6 months. I think these facilities would take the kid, if the parents wanted to pay full price to keep him alive for another 6 months.

But I get the feeling the mother is asking the state to pay. Obviously, state resources aren't unlimited and I think it is correct that there are other kids that can actually have a life that should get the limited resources first. It is a slippery slope. Unfortunately, most everybody leaves on the side of the mountain versus on the top. Doesn't mean I'm going to jump off the mountain because I slipped a foot down it.

Posted by: Chad on March 22, 2006 at 3:05 PM | PERMALINK

And that's a clear difference. Terry received a judgment specifically to provide her with the resources to live.

Posted by: Chad on March 22, 2006 at 3:06 PM | PERMALINK

It's very difficult to determine whether the decision in the boy's case was the correct one, as neither the WaPo article nor the cited Times article has much in the line of details (not their fault, presumably).

Posted by: Peter on March 22, 2006 at 2:59 PM

I'm forced to agree. Although all the spanking this Domenech guy is getting is sure fun to watch.

Posted by: Brazil Connection on March 22, 2006 at 3:12 PM | PERMALINK

See, I think Kevin's punchlines are wry enough to be considered as within the spectrum of humor.. What do you Cobb Awards people want? Fart jokes?

Posted by: ferd on March 22, 2006 at 3:14 PM | PERMALINK

Domenech describes the case as "one of the ever-growing number of signs of the apocalypse (along with the popularity, of course, of Ryan Seacrest)."

Domenech graciously avoids noting yet another sign of the impending End Time, namely the rise of willfully ignorant, party-hack, intellectual-clown ideologues to positions of nominal journalistic integrity. But I digress.

Anyway, what's wrong with the apocalypse? I thought folks in Domenech's neck of the fever swamp were praying for the Rapture to come and leave all us heathens here to face the consequences of the Gog-Magog war. So is this British case a good thing, Ben, or a bad thing?

Posted by: Alek Hidell on March 22, 2006 at 3:14 PM | PERMALINK

Kevin wrote, "In any case, I'm glad to see Ben arguing that the state should be obligated to provide medical care for sufficiently sick people. "

Who pays? Not "the state". The taxpayer does, so its the taxpayer being obligated. Is it fair, and just? No.
Forcing people to pay for other peoples healthcare leads to disaster. Don't believe me, look at Canada, Britain.
In fact, give an example where socialized health care provides more efficient services than the US?

BTW: Where in the US Constitution does it give the Federal government the power to run health care?
As usual, its fuck the facts, stick my head up my ass, dipshit Kevin lying by omitting facts.

Posted by: Terry on March 22, 2006 at 3:15 PM | PERMALINK

Terry/Chaufist: To put it in terms you'll understand, go fuck yourself, asshole.

Healthcare in every other industrialized nation is better than in the U.S. - including Canada and Britain.

Try the concept of the "commonweal" sometime, dipshit.

Posted by: Alek Hidell on March 22, 2006 at 3:17 PM | PERMALINK

In fact, give an example where socialized health care provides more efficient services than the US? - posted by Terry

I thought Mr. Drum himself posted some examples - I can recall France and Sweden without searching the blog.

Posted by: Brazil Connection on March 22, 2006 at 3:20 PM | PERMALINK

Yeah, I think Terry's new. The French and Swedish have been referenced, among others, numerous times.

But don't let that get in the way of good old fashioned vitriol.

Posted by: bill on March 22, 2006 at 3:22 PM | PERMALINK

Alek: Anyway, what's wrong with the apocalypse? I thought folks in Domenech's neck of the fever swamp were praying for the Rapture to come and leave all us heathens here to face the consequences of the Gog-Magog war.

They are, they are (and nicely crafted sentence, BTW). It's just that some of them were hoping for a little more time to get their affairs in order.

Posted by: shortstop on March 22, 2006 at 3:25 PM | PERMALINK

In fact, give an example where socialized health care provides more efficient services than the US?

Um, France, Germany and Denmark for starters...

Posted by: JAL on March 22, 2006 at 3:26 PM | PERMALINK

What proof do you have France and Sweden are better?
How many new drugs have come from these countries?
Specifics please.
As for "other industrialized nations", what are they?
Are there 17 or 20 or 23? List please.
Thank you.

Posted by: Terry on March 22, 2006 at 3:28 PM | PERMALINK

Ben Domenech joins a long list of utterly unqualified right wing boobs who've been given jobs by big name media corporations: Jonah Goldberg (LA Times), Josh Tiernery (NY Times), Andrew Sullivan (Time), etc. And now this cretin. For some reason, these major firms feel that it makes more sense to employ people who haven't drawn an audience, rather than offer a few slots to those writers who have.

So, you employ the right wing bloggers, but not Duncan Black, Kos, Kevin, or any of those bloggers who actually get 100,000s of readers.

That's not business logic talking, that's something else. And the something else could be:

1) Self-loathing. They've internalized the right wing attack. The major media people think they're actually liberal, so they believe that when they hire a right wing nut, they're providing balance.

2) Pride. They hate bloggers as being competiton. But they hate the bloggers who were actually right about the Iraq War and this administration especially. So if they have to employ one of the "bloggers" they're going to hire one who was as deluded as they were on the war. Never, ever going to hire someone who was right when they were, well, wrong.

3) Corporate control. Most of the major media forces are owned by big wealthy conglomerates. So the last thing they're going to do is to give space to people who question the big conglomerates.

4) More pride. Some of the left wing attacks really sting because they're show how some of these allegedly great journalistic enterprises have just been bad journalists. The right wing attacks are mainly just media bias, media bias, attacks that are not as professionally cutting.

BTW - Let me back up what a few commentators have said. The big media players in the NY Times, Wash Post, Knight Ridder really do despise the major left wing bloggers. They're favorite technique to wipe the criticism away is just to lump all the bloggers together as "partisan crazies". That way you don't have to think about what the criticism was.

The tragedy of course is the old paper-based model of making journalism pay is slowly dying. And they know it. But they aren't doing the hard thinking of how it might survive in the future.

Posted by: Samuel Knight on March 22, 2006 at 3:29 PM | PERMALINK

Who's got the best health system? Must be Japan, judging by the longevity statistics.

Posted by: Hattie on March 22, 2006 at 3:34 PM | PERMALINK

Yeah, I think Terry's new. The French and Swedish have been referenced, among others, numerous times.

He's not new. He's also posted as "Chaufist" and I think he's the same idiot who's posted as Terry with-a-last-name (not Terry Ott) going back maybe as far as the Calpundit days.

He's just one of those I mentioned above: someone who's aggressively, willfully stupid.

To the list of countries with better healthcare, we may also add Germany, Belgium, the Netherlands, Australia, Japan, Switzerland, Austria, and Norway.

Posted by: Alek Hidell on March 22, 2006 at 3:35 PM | PERMALINK

As for "other industrialized nations", what are they?
Are there 17 or 20 or 23? List please.

Go here. Poke around. Last I looked, in terms of quality of health care, the U.S. was number 37. So there's at least that many.

Posted by: R.Porrofatto on March 22, 2006 at 3:37 PM | PERMALINK

I have $50 for "Terry" if he comes back and says "whoa, I guess I was wrong. You guys are right. How do we get this national healthcare thing off the ground?"

Of course, he has to mean it, so my money is safe.

Posted by: craigie on March 22, 2006 at 3:40 PM | PERMALINK

In fact, give an example where socialized health care provides more efficient services than the US?

Oh, just off the top of my head let's say France, Germany, Sweden, Norway, Denmark, Finland, Iceland, Holland, Belgium, Switzerland, Austria, Italy, Spain, Portugal, Canada, Britain, Ireland, Japan, Singapore, Monaco, Australia, New Zealand, etc......

Posted by: Stefan on March 22, 2006 at 3:49 PM | PERMALINK

Evidently the lefties are going mental over the conservative blogger at the Post.

Michelle Malkin has been documenting the profanity and bile coming from the Lefties over Domenech.

Posted by: PaddyWhack on March 22, 2006 at 3:49 PM | PERMALINK

Michelle Malkin has been documenting the profanity and bile coming from the Lefties over Domenech.

Yippee for her. She's his intellectual peer. Profanity and bile is precisely what Domenech (and the Post) deserves: he's an unqualified ideological joke.

Posted by: Alek Hidell on March 22, 2006 at 3:55 PM | PERMALINK

Michelle Malkin has been documenting the profanity and bile coming from the Lefties over Domenech because she's a leading connousieur of profanity and bile.

Posted by: HeavyJ on March 22, 2006 at 3:55 PM | PERMALINK

I look forward to the WaPo's -- hopefully public -- response to this letter and the questions it asks:

http://mediamatters.org/items/200603210015

My question: Does Post Online Executive Editor James M. Brady (NOT to be confused with famous Hinckley-handgun victim James S. Brady, right Ben D.?) think employing the RedState guy will bring unsuspecting right-wing readers to the WaPo site, and that they will fall in love with the rest of the editorial content?

Or is it just a spectacular suicidal stunt, in that it angers their core moderate/liberal readers? I don't get who or what they're "targeting" with this blog.

Posted by: Seth on March 22, 2006 at 4:00 PM | PERMALINK

Terry, why do you hate America? Just because the limp-wristed socialists in Europe and to our north (supposedly) have horrible public healthcare systems doesn't mean that American gung-ho ingenuity can't make it work! Are you saying that we are weaker than the French? I think you are.

But seriously, everyone's listed countries with better healthcare than the US. And add on the fact that there are 40 million or so Americans that are uninsured while these countries all insure everyone.

Actually, the uninsureds in this country can still get health care... when they have a critical problem that requires emergency room care. You'll end up paying for it anyway. If all you care about is money (which seems true from your argument), you should realize that paying for preventative care is cheaper than paying for emergency room care once a condition gets critical.

Posted by: crafty on March 22, 2006 at 4:02 PM | PERMALINK

On the original story, here's the BBC:

http://news.bbc.co.uk/1/hi/magazine/4809908.stm
http://news.bbc.co.uk/1/hi/health/4770154.stm

Just search for "baby MB" on the BBC news site for more.

Essentially, the boy is in constant pain, and is certain to die fairly soon. Doctors were arguing that artificially keeping him alive wasn't in his best interests. In contrast to the (predictably stupid) slant taken by the usual religious nutters, this was actually all about the child's human rights, and those of his parents.

Pesonally I feel sorry for the doctors, who have to watch him suffering the whole time.

Posted by: DireWolf on March 22, 2006 at 4:03 PM | PERMALINK

Hell, with the exception of the VA, Tierra del Fuego has a better health care system than ours. Lots of very healthy Penquins.

Posted by: stupid git on March 22, 2006 at 4:03 PM | PERMALINK

In fact, give an example where socialized health care provides more efficient services than the US?
Terry, meet Homer Simpson:

"America's health care system is second only to Japan, Canada, Sweden, Great Britain, well...all of Europe. But you can thank your lucky stars we don't live in Paraguay!"

Posted by: TK on March 22, 2006 at 4:05 PM | PERMALINK

Kevin Drum is cheering the British doctors who sued to take a fully-conscious boy off life support, over the objections of his parents. The doctors determined the boy's quality of life to be not worth living.

Astonishing.

Posted by: BigRiver on March 22, 2006 at 4:07 PM | PERMALINK

Samuel Knight lists Ben Domenech, Jonah Goldberg, Josh Tierney, and Andrew Sullivan as a long list of utterly unqualified right wing boobs who've been given jobs by big name media corporations

What's the common denominator?

THEY ARE ALL FUCKING JEWS

Posted by: Christine on March 22, 2006 at 4:07 PM | PERMALINK

Michelle Malkin has been documenting the profanity and bile coming from the Lefties over Domenech.

As opposed to this nice, logical, respectful statement from Terry:

"As usual, its fuck the facts, stick my head up my ass, dipshit Kevin lying by omitting facts."

Why can't we liberals be so nice?

Posted by: tomeck on March 22, 2006 at 4:09 PM | PERMALINK

Imagine this group of doctors going to the burn unit at Shriner's Children's hopsital, and marking which children get to live and which have to die.

Posted by: Paddy Whack on March 22, 2006 at 4:10 PM | PERMALINK

Christine, shut the fuck up.

At any rate, they're not all Jews. Andrew Sullivan is a Catholic.

Posted by: Alek Hidell on March 22, 2006 at 4:11 PM | PERMALINK

Jay would have something smart to say about this, but he's tossing my salad something fierce right now.

Posted by: Al on March 22, 2006 at 4:13 PM | PERMALINK

Or maybe, Christine, you were using the term "fucking" as a verb and not an adjective? Well, maybe all those guys are screwing Jews, but how would you know? Anyway, I seriously doubt that Ben Domenech and Jonah Goldberg are fucking anybody. Or ever have.

Posted by: Alek Hidell on March 22, 2006 at 4:13 PM | PERMALINK
Kevin Drum is cheering the British doctors who sued to take a fully-conscious boy off life support, over the objections of his parents. The doctors determined the boy's quality of life to be not worth living.

No, he isn't cheering.

I have a theory, though, that there is a direct relationship between your inability to understand gradations of meaning and your political affiliations.

Posted by: obscure on March 22, 2006 at 4:15 PM | PERMALINK

Domenech on my mind. First, the idiocy of the whole post: THE COURT KEPT THE KID ALIVE.

Thankfully, in this case, the judge sided with the parents. But this raises the question of whether such matters should be the purview of judges at all.

Huh? Why? The case was decided the way you want it decided...and that makes you think perhaps it shouldn't be decidable at all? That no one should have the power to decide? I can't parse this. If "matters" are not "the purview of judges", then who are they the purview of? This is really a new height for conservative hostility to the rule of law. They now get upset not because judges are making rulings they disagree with, but because judges are making rulings at all. They disagree with the very idea of judges, as such.

Does the state have the right and power to deprive an innocent living person of life, having been convicted of no crime, simply because a group of people believe they ought not be allowed to live?

Echoing the thread above, it's hard to reconcile this with the GOP's expressed disregard for the lives of Iraqis deprived of life by our invasion of their country. And the "having been convicted of no crime" point doesn't resonate too well with Guantanamo.

the Netherlands' adoption of the so-called Groningen Protocol, which allows doctors to kill innocent newborns if the doctor thinks the child is terminally ill

This is the usual gross distortion of the Dutch policy. For "the doctor", read "the doctor, reviewed by a panel of doctors and medical ethicists, with the consent of the parents, or, if challenged by the parents..." and so forth. The policy was developed partly in response to an earlier system which led doctors to heroically rescue desperately ill newborns, who wound up miserably handicapped with execrable qualities of life, even when their parents explicitly opposed treatment. Parents stuck with severely handicapped kids living in constant misery protested, and so you ended up with the new system. Maybe Ben Domenech would like to travel to Holland to tell those parents what evil people they are for wanting to end their children's suffering. Or maybe he doesn't have a fucking clue what he's talking about.

When a group of people are given the de facto authority to decide that a living human boy is not a person, and therefore has none of the protections due to every person, we have crossed a very dangerous line.

The British court did not consider the question of whether the boy was "a person". It considered whether in this case the state should follow the doctors' recommendation to allow this terminally ill and severely handicapped person to die in his parents' arms, or the parents' desire to continue heroic medical intervention with no hope of recovery. In the state of Texas, of course, the answer would be clear: if the parents lacked sufficient catastrophic health insurance, the boy would be removed from the machines to die. In Britain, because of universal health coverage, the parents had the dignity of getting their case considered in court.

If Domenech considers this case tantamount to a decision on whether the child was "a person", then clearly he must consider any capital punishment case to be a decision on whether the offender is "a person". And who gives judges, or juries, the authority to decide whether someone is "a person"?

Posted by: brooksfoe on March 22, 2006 at 4:16 PM | PERMALINK

BigRiver has invented a position for Kevin which is not supported by anything that Kevin has written or implied.

Not astonishing at all.

Posted by: PaulB on March 22, 2006 at 4:17 PM | PERMALINK

Kevin Drum is cheering the British doctors who sued to take a fully-conscious boy off life support, over the objections of his parents. The doctors determined the boy's quality of life to be not worth living.

Astonishing.

Posted by: BigRiver on March 22, 2006 at 4:07 PM

Imagine this group of doctors going to the burn unit at Shriner's Children's hopsital, and marking which children get to live and which have to die.

Posted by: Paddy Whack on March 22, 2006 at 4:10 PM

As I said in a previous post, it's hard to opine about this specific case when so few details were provided. Also, I'm no doctor, so I have no way to know if the kid's condition merits the doctor's decision, whatever such condition is.

However, you guys seem to be attacking the concept of having doctors deciding who lives and who dies. Well, have you ever heard of a thing called 'triage'? That's what triage is, and this is, in fact, one of the things a doctor is supposed to do, and not only in the case of accidents or catastrophic situations.

Of course, hearing the opinion of a doctor here would greatly improve matters. I'm certainly not one.

Posted by: Brazil Connection on March 22, 2006 at 4:20 PM | PERMALINK

Christine, your common denominator seems to be Skinhead.

Posted by: fracas_futile on March 22, 2006 at 4:22 PM | PERMALINK

what mental giant decided a 24 year old is capable of writing something worth reading in the Post?

Posted by: renato on March 22, 2006 at 4:24 PM | PERMALINK

Well, if they're going to put a conservative blogger on their site, I much prefer a 24-year-old moron to a 42-year-old who might occasionally make some sense. The moron will be more entertaining.

Posted by: brooksfoe on March 22, 2006 at 4:25 PM | PERMALINK

I appreciate the rich irony of the right wing frothing at the mouth about ensuring every zygote terminates in a live birth, and that every person lives as long as possible - while also ensuring all healthcare costs are borne by the consumer, and, when a [middle class] consumer declares bankruptcy due to health care related debts, the credit card companies get to take their pound of flesh.

What's the word I'm looking for? Oh - yeah: self-righteously, reflexively hypocritical. Whoops. Not a word. Still, accurate.

Posted by: J on March 22, 2006 at 4:26 PM | PERMALINK

brooksfoe: *applause*

Posted by: Alek Hidell on March 22, 2006 at 4:27 PM | PERMALINK

big river shallow mind

Posted by: Neo on March 22, 2006 at 4:30 PM | PERMALINK

Skin head?

Call me names because I point out that Jews are AGAIN overrepresented in all places at all times...

AND

Andrew Sullivan is a stealth jew... just like Hitchens and Moore -- they say they are Catholic, or agnostic, or whatever - but they are JEWS and advocate for hive.

Same tactic - different people.

Posted by: Christine on March 22, 2006 at 4:32 PM | PERMALINK

A really difficult problem is determining where to draw the line on medical intervention. Is it justified treating an 80 year old woman for cancer at a cost of $100,000 when such resources could have been used to save the lives of 2 younger people? How do you determine what the relative benefit of one course of action is over the other?

Once these decisions are removed from the patients and/or their loved ones, the recriminations will fly- it is inevitable.

Posted by: Yancey Ward on March 22, 2006 at 4:32 PM | PERMALINK

Who pays? Not "the state". The taxpayer does, so its the taxpayer being obligated. Is it fair, and just? No.

I am not one to usually feed the trolls but this statement highlights for me the remarkably stupidity of this particular strain of conservative "thinking." The fact is plainly that the "people" will always have to pay for the healthcare of others whether its through rising insurance premiums or through the exorbitant costs of covering the uninsured. This is an unavoidable cost of living in a society with other human beings who get sick and who get hurt. The only real question is what is the best and most efficient way to control those costs. Our current system has proven for decades now to be a sterling example of how not to control healthcare costs. Among many other problems, and compared to just about every other country, it has proved to provide the least benefit to the fewest people at the highest cost. Fucking ridiculous.

Posted by: brent on March 22, 2006 at 4:32 PM | PERMALINK

No, Christine, we're calling you names because you're a deeply disturbed and delusional individual whose rantings are not welcome here.

Posted by: PaulB on March 22, 2006 at 4:33 PM | PERMALINK

Call me names because I point out that Jews are AGAIN overrepresented in all places at all times...

You're goddamn right I'm going to call you names, shithead. You're a reprehensible anti-Semite and you are not welcome here.

Posted by: Alek Hidell on March 22, 2006 at 4:36 PM | PERMALINK
BigRiver has invented a position for Kevin which is not supported by anything that Kevin has written or implied.

Thanks, PaulB, for making the point more forcefully than I did.

Kevin pointed to a number of ironies involved with Domenech's polemic. Big River didn't appear to see them, but responded instead to something that wasn't there at all.

Characteristic.

Posted by: obscure on March 22, 2006 at 4:39 PM | PERMALINK

Jay would have something smart to say about this, but he's tossing my salad something fierce right now. Posted by: Al

Laughing out loud in the office imagery there. Best fake Al in a month.

Posted by: Jeff II on March 22, 2006 at 4:41 PM | PERMALINK

Christine:

"advocate for hive?"

You know, anti-semitism is a great evil.

But *schizophrenic* anti-semitism has its redeeming entertainment value :)

Bob

Posted by: rmck1 on March 22, 2006 at 4:45 PM | PERMALINK

Terry, meet Homer Simpson: "America's health care system is second only to Japan, Canada, Sweden, Great Britain, well...all of Europe. But you can thank your lucky stars we don't live in Paraguay!"

Terry, once again please meet Homer Simpson: "Facts are meaningless. Why, you can use facts to prove anything that's even remotely true. Facts, schmacts."

Posted by: Stefan on March 22, 2006 at 4:45 PM | PERMALINK

Andrew Sullivan is a stealth jew.

Wow! Does that mean he's invisible to gaydar?

Posted by: craigie on March 22, 2006 at 4:45 PM | PERMALINK
Call me names because I point out that Jews are AGAIN overrepresented in all places at all times...

In all places at all times?? Gee, that's a lot of places & times...

Reminds me of them goddamn athletic people. Overrepresented in professional sports.

Posted by: obscure on March 22, 2006 at 4:45 PM | PERMALINK

Two new trolls for the list:

Chaufist/Terry (Obnoxious Troll) and Christine (Miscellaneous Psychotic).

Bob

Posted by: rmck1 on March 22, 2006 at 4:46 PM | PERMALINK
Andrew Sullivan is a stealth jew... just like Hitchens and Moore -- they say they are Catholic, or agnostic, or whatever - but they are JEWS and advocate for hive.

The way you just casually invent new fantasies like this to wave away the facts when they get in the way of your paranoid fantasies about Jews everywhere trying to get you is..., well, it would be both pathetic and oddly amusing, but for all the history showing what that kind of mind-virus leads to once it infects too many people.

Posted by: cmdicely on March 22, 2006 at 4:48 PM | PERMALINK

Once these decisions are removed from the patients and/or their loved ones, the recriminations will fly- it is inevitable.

What do you mean, "once"? Right now these decisions on costs are made by insurance companies, not by the patients/or their loved ones.

Posted by: Stefan on March 22, 2006 at 4:49 PM | PERMALINK

cmdicely:

Nothing quite like lumping Hitchens, Moore and Sullivan together.

Put them in the same room and particle/antiparticle annihilations would power Chicago for 13 years.

I guess that's what it means to "advocate for hive."

What a weird expression. I wouldn't even know how to go about googling it.

Bob

Posted by: rmck1 on March 22, 2006 at 4:53 PM | PERMALINK

Which one of these doctors gets to march over to the wall and actually yank the plug out? Dr. Mengele, I bet.

Posted by: Paddy Whack on March 22, 2006 at 4:54 PM | PERMALINK

You know, what I don't get is why people on the left aren't more outraged that this spin cretin Domenech was given his position at the WaPo.

Essentially, the guy is a professional right wing hack, and nothing else. Well, nothing else other than being a totally untrained and unseasoned, easily manipulable, professional right wing hack.

Why is such a person being hired by the WaPo?

I don't care if the moron is, as some on the left claim, an unintentional "gift that keeps on giving" to liberals. What kind of spineless, mindless editors and managers at the WaPo could possibly have signed off on hiring this twit?

THAT is the real issue, and I gotta say, the whole thing pisses me off no end.

Posted by: frankly0 on March 22, 2006 at 4:55 PM | PERMALINK

Best fake Al in a month.

Ditto.

I've read it four times and I still have no idea what "advocating for hive" means. Does this have anything to do with African killer bees?

Posted by: shortstop on March 22, 2006 at 4:55 PM | PERMALINK

Nothing quite like lumping Hitchens, Moore and Sullivan together.

Now that was an image I didn't need. ;)

Posted by: Gregory on March 22, 2006 at 4:57 PM | PERMALINK

This is quite hilarious.

He slams the Brits for something the his dear leader made legal in Texas as well.

Posted by: lib on March 22, 2006 at 4:57 PM | PERMALINK

What kind of spineless, mindless editors and managers at the WaPo could possibly have signed off on hiring this twit?

The ones who repeated phony GOP talking points on the Abramoff scandal and refused to admit their error when called on it, and who kowtow to right-wingnuts' complaints that Dan Froomkin is "liberal"?

Posted by: Gregory on March 22, 2006 at 4:59 PM | PERMALINK

Christine - stealth Jew. Please, let's not write racist material here. If you didn't mean to write something offensive, please apologize. If you did, please don't post.

What I found particularly scary is the cheap attack - you're attacking these people because they're Jewish!. Similar to the "you don't like neo-cons - because you hate Jews!.

And the not so subtle, gay = Jewish wasn't hard to miss either.

Of course the joke is my other favorite example of the non-published web star is Josh Marshall, who I believe is, well, a member of the tribe, as they used to say in the 50s...

Seriously, why don't the major media groups try to grab some of the web's best talent, rather than settling for the re-treads and right wing second-stringers?

Posted by: Samuel Knight on March 22, 2006 at 4:59 PM | PERMALINK

boy that Terry, sure is a kidder. I assume that means you pay cash for all your medical care? I mean if you have an insurance plan, someone else is subsidizing (paying for) your health care. Glad to know you are rich enough to pay cash for medical care, hope you don't need a real operation sometime soon.

and if you have an HMO, you are, shockingly, a hypocrite!

Posted by: northzax on March 22, 2006 at 5:02 PM | PERMALINK

Domenech is about as qualified for his position as Brownie was for his at FEMA.

Thus does the WaPo editorial board mimic its idol, George W Bush.

Posted by: frankly0 on March 22, 2006 at 5:03 PM | PERMALINK

I suggest that the readers of WaPo campaign for the new spectacled guy on The Daily Show to be hired as a counterpoint to this moron. The TDS guy is quite funny.

Posted by: nut on March 22, 2006 at 5:05 PM | PERMALINK

The thing I love about this whole episode is that a right-wing blogger misrepresents the facts in order to make some kind of self-righteous point that's inconsistent with Bush's actual actions.

And this is news exactly how...?

Posted by: Gregory on March 22, 2006 at 5:09 PM | PERMALINK

Stefan,

Rereading what I wrote, I see I could have been clearer.

Insurance companies can't pull the plug on someone, or even direct it to be done. They can just refuse to pay any of the further costs.

Posted by: Yancey Ward on March 22, 2006 at 5:14 PM | PERMALINK

Christine:

Does this mean that any one of *us* -- you know, unsuspecting, right-thinking liberal Gentiles -- could be stealth Jews (cryptoJewry) -- gahh! ... without us even *knowing it???*

You know, by having had a microJEWchip implanted in our brains at birth (especially if our doctors were one of THE HIVE -- and you know how many of *them* there are)?

And that means that we'd be susceptible to JewRays -- which eminate from most neighborhoods with a Kosher deli -- althougth the delis are only boosting substations, not the source of the signal itself.

The JewRays come from the City of London (not London itself, of course) out of a Rothchild-owned transmitter on top of 10 Downing Street ...

Bob

Posted by: rmck1 on March 22, 2006 at 5:16 PM | PERMALINK

What I found particularly scary is the cheap attack - you're attacking these people because they're Jewish!. Similar to the "you don't like neo-cons - because you hate Jews!. Posted by: Samuel Knight

Samuel, head over to Altercation if you want to get an interesting and related take on all this. AIPAC is bashing the shit out of Walt and Mearsheimer's new Harvard study about the Israel lobby in the U.S. At 89 pages, I haven't had the time to read it yet, but I otherwise have great respect for their work.

http://msnbc.msn.com/id/11926202/#pushback

Posted by: Jeff II on March 22, 2006 at 5:19 PM | PERMALINK

the ever-growing number of signs of the apocalypse...

Man, throwing around that word, "apocalypse," is like honey to Repub bees -- 55 percent of the Republican coalition believe in Armageddon. Add in Domenech's "sackcloth and ashes" reference, I believe we have a-whorin' code word media prostie on our hands. Can you believe it?! Another nail in the coffin of the liberal media meme.

Posted by: Apollo 13 on March 22, 2006 at 5:20 PM | PERMALINK

I believe in Armageddon. Ben Affleck's finest performance.

Posted by: Yancey Ward on March 22, 2006 at 5:24 PM | PERMALINK

Hey, I was serious about not understanding what "advocating for hive" means!

Posted by: shortstop on March 22, 2006 at 5:24 PM | PERMALINK

I think that was a typo. It should have read "advocating for jive".

Posted by: Yancey Ward on March 22, 2006 at 5:26 PM | PERMALINK

Guys, while Christine is a genuine anti-Semitic wacko, for hive" is just a typo - the word was supposed to be hire (move your index finger down instead of up from the home row).

Posted by: mars on March 22, 2006 at 5:27 PM | PERMALINK

mars:

No, I think I've actually seen references to "hive" in other psycho anti-semitic rantings before -- although your theory certainly has plausibility.

Oh hell ... now I'm going to have to google it.

Bob

Posted by: rmck1 on March 22, 2006 at 5:30 PM | PERMALINK

I believe in Armageddon. Ben Affleck's finest performance.

Nonsense. His craptacular performance in Daredevil stands unchallenged. That movie had other things to recommend it, however.

I think that was a typo. It should have read "advocating for jive".

Hee. Who put a quarter in the Yance today?

Posted by: shortstop on March 22, 2006 at 5:30 PM | PERMALINK

Speaking of apocalypse promoters, where's SecularAnimist?

Posted by: Jeff on March 22, 2006 at 5:30 PM | PERMALINK

Call me names because I point out that Jews are AGAIN overrepresented in all places at all times...

In all places at all times?? Gee, that's a lot of places & times...Posted by: obscure

They are especially overrepresented in Saudi Arabia, Iran, Southern Lebanon, the Ozarks, Yukon Territory, Guam (the Palm Beach of Micronesia, ya know), Shinjuku, . . .

Posted by: Jeff II on March 22, 2006 at 5:32 PM | PERMALINK

Thanks Jeff, Alterman's a great source on this subject. Despite the fact that he's Jewish himself, he gets attacked for being anti-Semitic whenever he questions Israel's policies. (Not that a Jewish person can't be anti-Semitic, of course... But I think it's safe to say that Eric is definitely NOT.)

Posted by: Samuel Knight on March 22, 2006 at 5:32 PM | PERMALINK

No, hold on; I'm now thinking Christine's homophobia may mean she wanted to type "advocating for HIV." Whatever that means.

Well, we'll never know. She's buried in a shallow peasants' grave next to Arsenia, Karen and all her other alter-egos.

Posted by: shortstop on March 22, 2006 at 5:34 PM | PERMALINK

Yeppers ...

Googled "Jewish hive," came up with all sorts of conspiracy theory wackiness, including a page from StormWatch.

Jewish hive is apparently a current expression in anti-semitic circles.

Bob

Posted by: rmck1 on March 22, 2006 at 5:34 PM | PERMALINK

Speaking of apocalypse promoters, where's SecularAnimist? Posted by: Jeff

He's on a road trip to Memphis to gets some GD barbecue, motherf*&$#@!

I have no idea where than came from.

Posted by: Jeff II on March 22, 2006 at 5:39 PM | PERMALINK

I'm late to the game, but..

Terry, the Canadian healthcare system saved my uncle's life. He got an operation there that he never could have afforded here in the States.

There's no way in the world you can see the British or Canadian systems as being disasters.

Sure, it's hard for fat Conservatives who have to wait in line to get their gastric-bypass surgeries, but other than that, I'll trade our system for one where everybody's guaranteed care, and yes, I want the taxpayer to pay for it.

I'm certainly more willing to pay for my neighbor's health care than I am this stupid effing failure of a war. We could have bought a lot of care for the non-rich with the money we've blown in Iraq, mostly ending up in Haliburton's pockets.

Posted by: PopeRatzo on March 22, 2006 at 5:41 PM | PERMALINK

Jeff II:

And not braking for no damned fuzzy critter, neither.

Screeeech! WHUMP! Yippie, Maude, got another squairrel today!

Bob

Posted by: rmck1 on March 22, 2006 at 5:41 PM | PERMALINK

stefan said:

What do you mean, "once"? Right now these decisions on costs are made by insurance companies, not by the patients/or their loved ones.

you know stefan, you're one of those thinck-headed liberals who just doesn't get the superiority of free-market ideology, do you? In this country you have the FREEDOM to determine whether or not you go on getting necessary medical treatment! If you don't want it, don't pay for it. If you do want it, pay for it. You have a choice to not buy into an uber-socialist health insurance plan. It's FREEDOM!

If you can't personally afford the treatment you need, well, you should stop being lazy and get a third job.

Posted by: crafty on March 22, 2006 at 5:43 PM | PERMALINK

Jeff II:

That's right ... underneath that Zen monkish vegan engineer's exterior, ol' SA needs to *cut loose* every so often and leave a trail of roadkill and BBQ sauce down the highways ...

YEEEHAW ... now whur's m'other Grace Slick tape ...

Bob

Posted by: rmck1 on March 22, 2006 at 5:45 PM | PERMALINK

Most people here in the States can't afford their operations either. They're paid for by insurance companies or the government.

Posted by: JoeF on March 22, 2006 at 5:48 PM | PERMALINK

He's on a road trip to Memphis to gets some GD barbecue, motherf*&$#@!

Okay, I was on the phone with a client when I read this, and I seriously almost lost it. A real career-enhancing move!

Posted by: shortstop on March 22, 2006 at 5:52 PM | PERMALINK

He's on a road trip to Memphis to gets some GD barbecue, motherf*&$#@!

Okay, I was on the phone with a client when I read this, and I seriously almost lost it. A real career-enhancing move! Posted by: shortstop

I wonder if we'd all enjoy each other if we actually met up someplace? Even liquored up real good, I wonder if we could duplicate the weird energy perhaps unique to chatting via a blog? We could even include T-Bone, FF, BigRiver, et al. We'd rope them off in the corner (beyond the velvet cord, ya know), put our heads together from time-to-time, look over at them and laugh. The rest of the time we'd just throw ice at them.

Posted by: Jeff II on March 22, 2006 at 6:00 PM | PERMALINK

I'm STILL laughing at the barbecue line!

Your plan is sound except for the ice. I think we should spit, not throw, it.

Posted by: shortstop on March 22, 2006 at 6:02 PM | PERMALINK

Most people here in the States can't afford their operations either. They're paid for by insurance companies or the government.
Dang, Joe, where do you suppose insurance companies and the government get money from?

Posted by: conspiracy nut on March 22, 2006 at 6:09 PM | PERMALINK
Dang, Joe, where do you suppose insurance companies and the government get money from?

The latter from the People's Republic of China, in no small part.

Posted by: cmdicely on March 22, 2006 at 6:12 PM | PERMALINK

There's no way in the world you can see the British or Canadian systems as being disasters. Posted by: PopeRatzo

Maybe not a disaster, and maybe Americans are "over-medicated." But there are some glaring deficencies in both systems, as there is in Japan as well. For example, big-ass, hideously expensive electronic diagnostic equipment like MRI and CT machines are, or so I've heard, in short supply in both the U.K. and Canada.

Posted by: Jeff II on March 22, 2006 at 6:13 PM | PERMALINK
Maybe not a disaster, and maybe Americans are "over-medicated." But there are some glaring deficencies in both systems, as there is in Japan as well. For example, big-ass, hideously expensive electronic diagnostic equipment like MRI and CT machines are, or so I've heard, in short supply in both the U.K. and Canada.

OTOH, perhaps the better outcome measures in many countries that supposedly have this problem indicate that a better focus on cost-effective preventative medicine reduces the need for hideously expensive electronic diagnostic equipment.

Posted by: cmdicely on March 22, 2006 at 6:23 PM | PERMALINK

cn,

I was countering PopeRatzo's point, not agreeing with it. The fact that his uncle wouldn't have been able to afford to pay for his operation here doesn't mean much.

Anyone who thinks no one is ever denied life-saving or badly-needed medical treatment in Canada or Britain, because those countries have "universal coverage," doesn't know much about how medicine actually works in those places. There's only so much money in the budget. A heart-disease or cancer patient might well be denied treatment that could save his life because it is deemed to cost too much or because the chances of success are deemed to be too small.

Posted by: JoeF on March 22, 2006 at 6:29 PM | PERMALINK

The latter from the People's Republic of China, in no small part.
Not if we'd follow those enumerated powers.

Posted by: conspiracy nut on March 22, 2006 at 6:31 PM | PERMALINK

"OTOH, perhaps the better outcome measures in many countries that supposedly have this problem..."

They don't have better outcome measures.

Posted by: JoeF on March 22, 2006 at 6:31 PM | PERMALINK

OTOH, perhaps the better outcome measures in many countries that supposedly have this problem indicate that a better focus on cost-effective preventative medicine reduces the need for hideously expensive electronic diagnostic equipment. Posted by: cmdicely

This may be the case. But there are instances where preventive medicine just doesn't apply - sports or non-sport joint injuries, non-alcohol related liver problems (identified by blood scans, but needing to be "photographed."), ditto for non-specific lung problems that could be cancer.

Posted by: Jeff II on March 22, 2006 at 6:31 PM | PERMALINK

JoeF
I'd apologize, but that was simply a crazy statement. Most of the commenters around here think that the government is a producer of wealth, instead of a consumer of wealth; so I see far too many statements like that.

And don't bother pointing out to them that all health care systems ration, they think socialized medicine provides free health care for all and sundry.

Posted by: conspiracy nut on March 22, 2006 at 6:35 PM | PERMALINK

If he were to volunteer in a hospital for a couple of months and Mr. Domenech might feel differently. The child in question is in constant pain and probably always under major pain medication, to the point of semi-conciousness. Calling him concious really misses the point.

As for why The Post hired Ben Domenech, one wonders if it was a clever move to both please the administration and discredit them at the same time. After all, the worst curse I know is, "May all your wishes be granted."

Posted by: Doctor Jay on March 22, 2006 at 6:42 PM | PERMALINK
A heart-disease or cancer patient might well be denied treatment that could save his life because it is deemed to cost too much or because the chances of success are deemed to be too small.

Which, also, happens to even the insured in the US. And the uninsured are even worse off.

Posted by: cmdicely on March 22, 2006 at 7:03 PM | PERMALINK

C Nut>Most of the commenters around here think that the government is a producer of wealth, instead of a consumer of wealth

What an idiotic assertion, and by that I mean the 2nd, not the first.

Government provides roads, security, dispute resolution, and administration, among other things. If those very same services are provided by the private sector, they are clearly wealth. In what way are they not, if they're provided by the public sector?

The difference this bit of propoganda-drivel might be alluding to may, charitably, be that the private sector may be run with better efficiency incentives. And so be producing productivity gains.

Yet, in sectors with natural monopolies such gains vs the public sector are unlikely. And in sectors such as health care, equality may be a higher value than the small gains involved in having the *payee* be subject to competition, as well as the delivery system. Given the (likely steep) diminishing marginal utility of high class vs middle class health care plans, such gains are doubtful indeed, as "socialist" country's population health outcomes demonstrate.

Wingers just keep repeating such patently false crap as "the public sector doesn't create wealth" hoping it will be accepted as common sense by the thoughtless. Despite the fact it's clearly a lie, else winger' governments would not include the public sector in GDP calculations.

With the issue at hand, there is a clear difference between the two systems. The private in Texas approved of by Bush, and backed by the judiciary there, decided a child should die if his parent's insurance ran out.

The 'socialist' system in Britain made the decision based on the child's interests, with the judiciary stepping in to decide the child should live.

Posted by: Bruce the Canuck on March 22, 2006 at 7:07 PM | PERMALINK

Most of the commenters around here think that the government is a producer of wealth

No. Most of the commenters here appreciate the vital role government plays in creating and protecting the conditions for optimal production of wealth and social stability.

You are mindless. Go away.

Posted by: obscure on March 22, 2006 at 7:15 PM | PERMALINK

No. Most of the commenters here appreciate the vital role government plays in creating and protecting the conditions for optimal production of wealth and social stability. Posted by: obscure

Well said.

Posted by: Jeff II on March 22, 2006 at 7:18 PM | PERMALINK

I often wondered if thre was a specialized aquarium market for cases like this, you know, take the little tyke home.

There was a movie, Coma, and I think they hung them from the ceiling like office lights.

I am gonna be the first on the market for the womb aquariums, for real, not the fake people like in the South Park episode, but the same idea, you jack off in the thing and a baby grows. Neat, set the lighting, would look cool.

Posted by: Matt on March 22, 2006 at 7:26 PM | PERMALINK

"Which, also, happens to even the insured in the US. And the uninsured are even worse off."

The uninsured in America may be worse off than the insured, but they may still be better off than people in Canada or Britain, at least in some respects. Or the U.S. population considered as a whole may be better off than the Canadian or British populations as a whole. One way or another, health care is rationed in all countries. It's certainly not clear that the British and Canadian forms of rationing produce a better overall outcome than the American one.

Posted by: JoeF on March 22, 2006 at 7:33 PM | PERMALINK

"He's on a road trip to Memphis to gets some GD barbecue, motherf*&$#@!"

Did someone say barbecue? (munching on babyback ribs)

Actually, SecAn is probably one of those crypto-Jewish types. He'll have to stick to Texas-style beef bbq.

Posted by: MJ Memphis on March 22, 2006 at 7:51 PM | PERMALINK

conspiracy nut: Most of the commenters around here think

That's true. Most of them do think. Unlike you.

Posted by: SecularAnimist on March 22, 2006 at 7:52 PM | PERMALINK
It's certainly not clear that the British and Canadian forms of rationing produce a better overall outcome than the American one.

I think its eminently clear that, while one might pull different focuses to argue back-and-forth about which system provides overall better healthcare, both of those alternatives -- among the worst of universal systems in advanced democracies -- are far better than the US in terms of cost efficiency; they do, of course, have some limitations (particularly of the type Jeff II points out) attributable to limited resources, which, OTOH, could no doubt be mitigated in as systems of the same style (or, even better, modelled on more effective universal systems) simply by providing more resources. Considering the vast gulf between other systems and the enormous (per capita or per GDP) spending in the US on healthcare, that could be done here and still save vast amounts of money.

Unless, of course, Americans are uniquely incompetent when it comes to managing healthcare, which I suppose shouldn't be dismissed out of hand as a possibility.

Posted by: cmdicely on March 22, 2006 at 7:56 PM | PERMALINK

There you are SecularAnimist! How about another post predicting imminent global catastrophe. We haven't had one from you for, what, 5 minutes now? And this thread is the natural place for it.

Posted by: jibjab on March 22, 2006 at 7:57 PM | PERMALINK

That's true. Most of them do think. Unlike you.
Posted by: SecularAnimist

You're back! Did you get me my brisket, boy? (Head up thread from 5:30 on.)

Posted by: Jeff II on March 22, 2006 at 8:01 PM | PERMALINK

rmck1 wrote: That's right ... underneath that Zen monkish vegan engineer's exterior, ol' SA needs to *cut loose* every so often and leave a trail of roadkill and BBQ sauce down the highways now whur's m'other Grace Slick tape

Actually what I do to cut loose is plug my 1967 Guild Starfire hollow-body electric bass into my Eden WT550 with two 15" cabinets, turn it up to eleven and play "Spoonful" until it turns into a wall of roaring howling feedback that shakes the foundation of the house. Very relaxing. And 100% wind-generated electricity, by the way.

Posted by: SecularAnimist on March 22, 2006 at 8:02 PM | PERMALINK

"I think its eminently clear that, while one might pull different focuses to argue back-and-forth about which system provides overall better healthcare, both of those alternatives -- among the worst of universal systems in advanced democracies -- are far better than the US in terms of cost efficiency;"

How is this "clear?" And even if they are more "cost efficient," how does that mean they are necessarily better? A less efficient system with more resources may be preferable to a more efficient one with less resources.

Posted by: JoeF on March 22, 2006 at 8:04 PM | PERMALINK

jibjab: How about another post predicting imminent global catastrophe.

Actually it's not imminent. It's already happening.

Posted by: SecularAnimist on March 22, 2006 at 8:04 PM | PERMALINK
How is this "clear?"

Vastly less expensive + not clearly inferior --> clearly more cost efficient.

And even if they are more "cost efficient," how does that mean they are necessarily better?

As drop in replacements, no. As models, well, its fairly obvious, I think, that more utility for each $ invested is better.

A less efficient system with more resources may be preferable to a more efficient one with less resources.

As the amount of resources to devote to the system is a separate decision from the model of system to adopt, this is an irrelevant point when discussing what kind of model to adopt.

Choosing a system may change the efficiency with which resources devoted to healthcare are used, it won't, generally, constrain the maximum amount of resources that may be applied to healthcare.

Posted by: cmdicely on March 22, 2006 at 8:13 PM | PERMALINK

Joef>A less efficient system with more resources may be preferable to a more efficient one with less resources.

I think that may depend on if you're a middle class person with kids, vs an upper middle class. Or steadily employed vs in a boom/bust industry.

My sense is "even" the Canadian system at current funding levels provides better service for a middle income class on down. Incomes in the upper middle class range rankle a bit. Top-end incomes just pay for private in the states. And knowing that no matter what, you & your dependents will be taken care of fairly well, is no small thing.

Since health care outcomes per $ applied probably drop off steeply with increased cost, the population outcomes wind up being either better, or comparable for 2/3 the cost.

Posted by: Bruce the Canuck on March 22, 2006 at 8:28 PM | PERMALINK

"Vastly less expensive + not clearly inferior --> clearly more cost efficient.

There is no agreement that the British and Canadian systems are "not clearly inferior." In terms of wait times for elective surgery, for example, there is clear evidence that they are clearly inferior.

"As the amount of resources to devote to the system is a separate decision from the model of system to adopt, this is an irrelevant point when discussing what kind of model to adopt."

Sorry, but that doesn't follow at all. You don't know that resource allocation and model type are independent. It seems to me highly plausible, and certainly possible, that health systems primarily funded from taxes (e.g., the British and Canadian systems) tend to receive less resources than health systems primarily funded from private sources. If we tried to switch to public funding or single-payer in the U.S., it might well lead to a large reduction in resources, and the same kind of problems here that plague their systems.

Posted by: JoeF on March 22, 2006 at 8:39 PM | PERMALINK

Bruce,
Health care may indeed be subject to some kind of diminishing returns phenomenon, whereby each increment of improvement in health outcomes costs more than the last. But that tells us nothing about how much we ought to spend. The best bang-for-the-buck in health care probably comes from things like mass immunizations and widespread use of antibiotics to fight infectious diseases. But that doesn't mean we (or Canada) shouldn't provide much more health care, over and above immuzinations and antibiotics, even if the bang-for-the-buck does down the more we spend.

Posted by: JoeF on March 22, 2006 at 8:51 PM | PERMALINK

JoeF> But that doesn't mean we (or Canada) shouldn't provide much more health care...

I agree, and that can be a problem with single-payer systems. There has to be an adequate degree of buy-in on the part of taxpayers, which in Canada at least was originally based on the idea of universality. This in turn was supported by a sense of common community that seems weaker now.

My point re "each increment of improvement in health outcomes costs more than the last" isn't about spending as a whole. It's that a universal care system will be spending dollars otherwise spent at the top end for little gain, at the bottom end for greater gain. This will naturally mean better overall population health.

Ie, everybody gets pretty good cancer treatment, but nobody gets all-holds-barred treatment for 2 more months of life. Vs, some people get shitty cancer treatment, and some get all-holds-barred treatment. In the first system, expect griping from the upper middle class. In the second, expect higher overall mortality.

The best compromise may be universal care, with an escape valve for the rich for elective treatment. The problem there is the possible loss of buy-in, and preferential time scheduling if doctors are allowed to work for both systems at once.

Posted by: Bruce the Canuck on March 22, 2006 at 9:05 PM | PERMALINK

Ben Domenmensch is correct.(/ubercons)

Posted by: Mr.Murder on March 22, 2006 at 9:21 PM | PERMALINK

There is no agreement that the British and Canadian systems are "not clearly inferior." In terms of wait times for elective surgery, for example, there is clear evidence that they are clearly inferior.

No, not really -- you're only getting that result because you're comparing the apple of the British or Canadian systems, which cover 100% of the population, with the orange of the American systems, which seems to deliver faster wait times only because it doesn't offer any coverage at all to 20% of the population. Anytime you cut out the bottom-performing 20% your average will necessarily go up.

In the British and Canadian system you may have a longer wait time, but eventually you will be seen. In the US, on the other hand, if you have no insurance then your wait time for elective surgery is effectively infinity, because you can never afford and so will never get it.

Which would you rather be -- a self-employed carpenter in Canada who has to wait six months for a hip replacement, or an uninsured self-employed carpenter in the US who will never get that hip replacement because he'll never be able to afford it, and will therefore have to suffer with that disability for years and years?

Posted by: Stefan on March 22, 2006 at 9:30 PM | PERMALINK

Bruce,

Even if systems that provide universal coverage reduce inequality in the allocation of health care resources amoung the population, they may also reduce the total resources allocated. And the result may be that the typical consumer is worse off than he would be under a more-unequal but larger non-universal system. A bigger but less-equally-divided pie may be a better deal than a smaller but more-equally-divided pie.

And I don't think it's clear that universal coverage systems have significantly lower inequality than the current U.S. system, anyway. Britain has supplementary private insurance that wealthier people use to "jump the queue" for elective surgeries and other health care resources that are in short supply over there. Rich Canadian flock across the U.S. border to get health services they are denied and have to wait a long time for under the Canadian Medicare system. And uninsured and indigent Americans receive free or heavily-subsidized health care from many government and private sources.

Posted by: JoeF on March 22, 2006 at 9:36 PM | PERMALINK

stefan,

"No, not really -- you're only getting that result because you're comparing the apple of the British or Canadian systems, which cover 100% of the population, with the orange of the American systems,..."

No, I'm not. I'm comparing the same thing (wait times for elective surgery) in different countries.

"... which seems to deliver faster wait times only because it doesn't offer any coverage at all to 20% of the population."

Also false. The uninsured in America comprise less than 20% of the population, receive about half the health care services that the insured receive, and are typically without insurance for only a few months.

Posted by: JoeF on March 22, 2006 at 9:43 PM | PERMALINK

JoeF wrote: "are typically without insurance for only a few months."

Not according to the U.S. Census re[prts/

Posted by: PaulB on March 22, 2006 at 9:49 PM | PERMALINK

The uninsured in America comprise less than 20% of the population, receive about half the health care services that the insured receive, and are typically without insurance for only a few months.

The insured in the rest of the developed world comprise 100% of the population, receive the same health care services that everyone else receives, and are never without insurance.

Posted by: Stefan on March 22, 2006 at 9:51 PM | PERMALINK

PaulB,

According to the Census Bureau, over a 36 month period between 1993 and 1996, only 4% of the population lacked health insurance for the entire 36 month period, and only 6% of the population was without insurance for at least 30 months. During this period, the median length of time without health insurance was 5.3 months.

Posted by: JoeF on March 22, 2006 at 9:56 PM | PERMALINK

Stefan,

"The insured in the rest of the developed world comprise 100% of the population, receive the same health care services that everyone else receives, and are never without insurance."

Also false. That's at least the third false statement in a row from you. Rich people in other countries receive better health care services than poor people, by paying for them out of pocket or by buying private insurance. Every country has a multi-tiered health care system, where the rich get more and better care than the poor.

Posted by: JoeF on March 22, 2006 at 10:03 PM | PERMALINK

Rich people in other countries receive better health care services than poor people, by paying for them out of pocket or by buying private insurance.

Yes, by going out of the system. But within the system itself everyone, regardless of ability to pay, is guaranteed the same basic floor of services.

Posted by: Stefan on March 22, 2006 at 10:25 PM | PERMALINK

JoeF>...over a 36 month period between 1993 and 1996, only 4% of the population lacked health insurance for the entire 36 month period...

TSo what's it like now? You haven't disproven his point with 10-year old statistics.

And at what point in a serious illness would many of those people's health insurance have tapped out? How much anxiety would their families suffer in the mean time?

>Every country has a multi-tiered health care system, where the rich get more and better care than the poor.

A statement so loose it has almost no meaning. Some ensure that 100% of people are covered to a standard high enough that do not suffer anxiety about themselves or their children, and some do not. If I lost my job I would just lose dental coverage, not cancer or accident coverage. With a higher income later on, I'll get a knee replacement a few months faster, that's it.

>And I don't think it's clear that universal coverage systems have significantly lower inequality than the current U.S. system, anyway

This statement is just complete bullshit. The number of people who ever seek care outside the Canadian system for non-cosmetic work is in the range of a few percent.

Posted by: Bruce the Canuck on March 22, 2006 at 10:34 PM | PERMALINK

and are typically without insurance for only a few months.

And what's a few months when you've just been diagnosed with metastasing breast or bone or lung cancer, or are in the grip of a severe suicidal depression? After all, it's not as if most illnesses get worse the longer they're untreated....


Posted by: Stefan on March 22, 2006 at 10:46 PM | PERMALINK

This is ridiculous. As long as Liberals and Conservatives are at each others' throats, we will end up with idiots like Goerge Bush (take your pick which one), Clinton, and worse even, H. Clinton in the White House. As for doctors pulling the plug on anyone, they ought to be severely rebuked...as a fellow doctor, my only real mission is life. Not "quality" of life, which the Nazis in Germany managed to mangle, and which many States in the US managed to bungle as well, in their ill fated attempts to sterilize "idiots" (altho one could make an argument for Bush).
Life is life, and life is all we have. So protect it, damnitall, in whatever fashion you need to. Liberals and Conservatives alike have no clue about life. Pragmatists, centrists, the people who make the really hard choices based on really hard conflicting data, they have the real clue. I wish I were one of them.

Posted by: Chris on March 22, 2006 at 10:49 PM | PERMALINK

JoeF: The uninsured in America comprise less than 20% of the population..

Gee, that makes it better...not. Why is that significant? There are about 47 million Baptist/Pentecostal/evangelicals in America according to the 2001 Census but that hasn't stopped the GOP from pandering to the Religious Right. BTW, there were about 46 million uninsured in America in 2004.

According to the Census Bureau, over a 36 month period between 1993 and 1996...

How come you're not using more current data like the 2004 Census data? Like this:

The number of people with health insurance coverage increased by 2.0 million in 2004, to 245.3 million (84.3 percent of the population).
In 2004, 45.8 million people were without health insurance coverage, up from 45.0 million people in 2003.
There was no change in the percentage of people without health insurance coverage (15.7 percent) between 2003 and 2004.
The historical record is marked by a 12-year period from 1987 to 1998 when the uninsured rate (12.9 percent in 1987) either increased or was unchanged from one year to the next (Figure 5)1. After peaking at 16.3 percent in 1998, the rate fell for two years in a row to 14.2 percent in 2000, and the rate increased for three years before stabilizing at 15.7 percent in 20042.
The percentage and number of people covered by government health insurance programs increased between 2003 and 2004, from 26.6 percent and 76.8 million to 27.2 percent and 79.1 million, driven by increases in the percentage and number of people covered by Medicaid, from 12.4 percent and 35.6 million to 12.9 percent and 37.5 million (Figure 6).
The percentage and number of children (people under 18 years old) without health insurance in 2004 was 11.2 percent and 8.3 million, both unchanged from 2003 (Table 7).
With a 2004 uninsured rate at 18.9 percent, children in poverty were more likely to be uninsured than all children (Figure 7).
The uninsured rate and number of uninsured in 2004 was 11.3 percent and 22.0 million for non-Hispanic Whites, and 19.7 percent and 7.2 million for Blacks. The figures for both groups were unchanged from 2003. The uninsured rate for Asians decreased from 18.8 percent to 16.8 percent (Table 7).
The number of uninsured increased in 2004 for Hispanics (from 13.2 million in 2003 to 13.7 million); their uninsured rate was unchanged at 32.7 percent (Table 7).


Posted by: Apollo 13 on March 22, 2006 at 11:11 PM | PERMALINK

Most conservatives do not object to paying for essential diagnostic and preventative health care for the low-income folks. The problem is defining what is "essential" and at what point you stop an infinitely expensive course of care that is going to fail anyhow because some fatal diseases (like old age) we really don't know how to "cure."

You can spend an infinite amount of money trying to fix some peoples' low back pain and, in the end, the only thing that really makes them happy is to have Fed Ex drive up and deliver a two pound package of oxycontin every week.

The same goes or even worse for mental illnesses.
Then there's the moral issues, like should the insurance system pay for in-vitro fertilization or artificial insemination of pricey sperm bought from a superman donor? Should the fertility insurance just cover married women? Widows who preserved their deceased husband's sperm, just in case? Two women married to each other? Should the insurance system cover expensive sex-change procedures, but cut off the funds to pay for a liver transplant for an 80-year-old alcoholic? Should it cover elective plastic surgery on the grounds of improving the mental health of some poor suffering ugly person?

Posted by: Michael L. Cook on March 22, 2006 at 11:17 PM | PERMALINK

JoeF wrote: "According to the Census Bureau, over a 36 month period between 1993 and 1996"

Try the 2002 Census Report, Joe, the one that points out that 15.6% of the population or 43.6 million people were without health insurance for the entire year.

Or the Congressional Budget Office Report, which found that in 1998, between 21 million and 31 million people were uninsured the entire year.

Sorry, Joe, but your numbers just don't add up.

Posted by: PaulB on March 22, 2006 at 11:39 PM | PERMALINK

Should it cover elective plastic surgery on the grounds of improving the mental health of some poor suffering ugly person?

Boy. You could bring the entire health care debate to a screeching halt with questions like that...

Most conservatives do not object to paying for...

Christ's contemporary followers--those who knew his teaching best--abandoned their earthly possessions and sought a communal life.

Caring for each other's health. Christian values and all. Something you talk about, no?

Posted by: obscure on March 22, 2006 at 11:45 PM | PERMALINK

I believe in Armageddon. Ben Affleck's finest performance.

Perhaps, but I thought the asteroid showed more range.

Posted by: Irony Man on March 23, 2006 at 12:37 AM | PERMALINK

After observing the spectacle of Washingtonpost.com dealing with comments in such a clumsy manner (no response from anyone within WaPO to a barrage of angry posts numbering in the hundreds, sudden disappearance of comments already posted, etc.) I have new respect for the way in which Kevin manages this blog.


Perhaps WaPo should invite Kevin to give them a seminar on the subject.

Posted by: lib on March 23, 2006 at 1:16 AM | PERMALINK

Michael:

I think it should pay for boob jobs, yes. In fact, I want several of them. Not on *me* (eww) just, you know, a pair of boobs. To have. Stand-alone, off-the-shelf, so to speak. I'd have 'em, uhh, rack-mounted.

With a detatchable wire connection to my pleasure centers so I could you know, play with them while I was posting.

Bob

Posted by: rmck1 on March 23, 2006 at 1:29 AM | PERMALINK

So when did all this foofaraw result in blogs.washingtonpost.com exceeding their bandwidth? (509 error as I write)

How does one of the top media corporations in the United States run a site that doesn't have enough bandwidth?

And is all the "Ben Doverman" traffic the reason? And if so, will that prove to WaPo that the investment was worth it, because there's no such thing as too much traffic?

Posted by: Dan Hartung on March 23, 2006 at 3:52 AM | PERMALINK

The Apocalypse has apparently been postponed, since the British high court ruled against the doctors and in favor of the family, at least for the time being. If the boy's condition worsens, a new decision may be forthcoming.

As for the disastrous British health care system...really? I had no idea! Comes as news to the 50 million who use it here, too, although most would agree it's not the best system in the world.

Which leads to the next question: why are only Britain and Canada discussed when the issue of universal health care comes up? Why does no one respond with "But in France/Japan/Spain/the Netherlands/etc.", all of which have better health care systems than Britain. And far better systems than the US.

I suspect if the US put its mind to it, they could have a stellar universal health care system, just like their pension system is currently one of the best out there.

Posted by: KathyF on March 23, 2006 at 3:57 AM | PERMALINK

mike cook ... I can barely get you fuckers to help pay for vaccinations and routine childhood checkups. Once we deal with that, then we can address your sex change operation.

Posted by: Nads on March 23, 2006 at 4:31 AM | PERMALINK

Nads:

I like the idea of state-funded lobotomies for irresponsible Republicans, though.

Problem is, we'd probably need a court order to make 'em mandatory ...

Bob

Posted by: rmck1 on March 23, 2006 at 4:38 AM | PERMALINK

Problem is, we'd probably need a court order to make 'em mandatory ...
Bob
Posted by: rmck1

the fuckers would just end up whining about "judicial activism" ... or whatever else bullshit rightwing catchphrase they're employing that week.

Posted by: Nads on March 23, 2006 at 4:41 AM | PERMALINK

Hehe! The Domenech controversy crashed WaPo's blog!
" The server is temporarily unable to service your request due to the site owner reaching his/her bandwidth limit. Please try again later."

These idiots are not only incompetent regarding their staff decisions (Howell, Domenech), they're not even able to chose a reliable company for hosting their blog. While washingtonpost.com is connected through AT&T Worldnet, blog.washingtonpost.com is at an IP belonging to IHNetworks.net, an obscure Ca company. Now look at their website: http://www.ihnetworks.net/

Really, if you're handling the IT for a leading national media service, would you chose such nonames as partner? Ridiculous! Brady should be fired asap.

Posted by: Gray on March 23, 2006 at 4:59 AM | PERMALINK

There's a big diff between a fully conscious boy and a brain dead woman.
So we gonna open up "Brain dead banks" now? Places the warehouse all the braindead people that we are too "enlightened" to let die with dignity?

Posted by: Lurker42 on March 23, 2006 at 7:45 AM | PERMALINK

Most of the commenters here appreciate the vital role government plays in creating and protecting the conditions for optimal production of wealth and social stability.
Having the government tell companies how much they can pay their workers and what kinds of benefits they must provide?

Your pretty words mean nothing in the face of your actions.

Posted by: conspiracy nut on March 23, 2006 at 9:02 AM | PERMALINK

Nads, that is just complete and utter liberal bullshit. There are health clinics in every city/town or county in this country that offers free vaccinations and checkups to low income children. You are a liar (I know thats a word you liberals love so thought you might understand it). So, anything eles you would like to cry about today?

Hard to believe this problem dates back to pre-1992 when the Messiah took office and had eight years to resolve it. What happened? I just can't believe the Democrats had the WH for eight years and di not get a comprehensive UHC program in place. Incompetent fools.

Posted by: Jay on March 23, 2006 at 9:06 AM | PERMALINK

"There are health clinics in every city/town or county in this country that offers free vaccinations and checkups to low income children."

And where do you think they get the money from paying for these treatments and all other cases where people can'tor won't pay? From a money tree in the backyard? No, they have to overcharge paying customers to make up for that. A national health care system would release clinics from this crooky business and would lead to more accountability and justice.

Posted by: Gray on March 23, 2006 at 9:21 AM | PERMALINK

"I just can't believe the Democrats had the WH for eight years and di not get a comprehensive UHC program in place."

Spinmaster Jay, I guess you know perfectly well which party gained control of the legislative during that period and was actively involved in preventing any UHC program.

Posted by: Gray on March 23, 2006 at 9:24 AM | PERMALINK

Gray, the government funds the public health clinics, so that money comes from our taxes! Isn't that where you want it to come from?

Incidentally, the GOP took over congress in 1994 because why? 40 years of democratic control which amounted to pretty much nothing. 40 years of control and yet there is still poverty, no UHC, and Ted Kennedy is still not in prison for manslaughter.

Posted by: Jay on March 23, 2006 at 9:38 AM | PERMALINK

The uninsured in America comprise less than 20% of the population, receive about half the health care services that the insured receive, and are typically without insurance for only a few months.

The uninsured in the rest of the developed world comprise 0% of the population.

Posted by: Stefan on March 23, 2006 at 9:41 AM | PERMALINK

It seems like doctors are no different than anyone else when it comes to the difference between piece-rate work and being on salary. Also the first thing that happens when you create an official government "doctor" is that the government will pay them the same way it pays an official "teacher" or "police officer"--basically on a seniority scale with vanishingly little incentive for good performance or penalty for mediocre interest in their work.

As a consequence, the productivity in public, single-payer health care delivery systems tends to slack off. My favorite example is the story from Canada (via the Reader's Digest)of the veterinarian who noticed that the expensive government owned MRI machine at the local hospital sat unusued during the nightime hours (this type of machine is very rarely employed for emergency care.)


So the vet requested, and received, permission to use the MRI machine to diagnose sick animals, paying for the technician out of his own pocket.
Things were fine for the animals until someone noticed that animals in a health crisis were getting in immediately, but humans were waiting for up to six months. A complaint was made and the government eliminated the embarassment by forbidding veterinary use of the machine altogether. The machine returned to long hours of disuse.

The government did not elect to force medical staff to work a night shift for the benefit of sick humans. Why not? Because night shifts are very unpopular with employees and create a lot of administrative pressure to move everything along more quickly. A slow system allows the bureaucracy more time to get all the paperwork in order.

Private hospitals have to pay doctors who are not residents or interns a shift differential to get them to regularly stay up all night. This is particularly true for dianosticians.

When Hillary Clinton proposed her health plan, two prominent features of it were to arbitrarily cap the number of new doctors being minted, and to cap the percentage of our gross national product that Americans would be allowed allowed to spend on health care. She and her followers would just pick a number of new doctors that could be educated each year and pick a number, say 10%, that we would all be allowed to spend on our health care, and everything would be prioritized within those constraints by government managers, whom she and her husband would appoint.

But here's the rub--do you prioritize the urban guy who wants the complete sex change operation over the rural, fundamentalist farmer who wants a hip replacement? Do you pay for single women to get fertility services? What if she wants to use her brother's sperm, or Uncle Frank's, or a notorious killer on death row whom she fell in love with through correspondence and is married to by proxy?

Single-payer means single-decider, about a whole lot of issues. Then you get into the whole issue of whether pharmacists and other clinical staff should have a right to refuse duties they feel are morally objectionable. To an extent, private medicine accomodates such wishes.

Lastly, we get into the malpractice debate, because your right to sue when things go wrong in Canada and England is much different than it is here. Frankly, government does not like to ever admit mistakes or liability. Shocking!

Posted by: Michael L. Cook on March 23, 2006 at 9:41 AM | PERMALINK

Actually, SecAn is probably one of those crypto-Jewish types. He'll have to stick to Texas-style beef bbq.
Posted by: MJ Memphis

Honestly, I'm still a bit nostalgic for this little BBQ lunch joint in Dallas owned and operated by...a very nice Jewish couple....from....Memphis!

Among the best pork ribs, I've ever had ('wet' division) outside of a party catered by some wacko friends who do that big May BBQ extravaganza on the Memphis riverside. Kinda guys who spend $3500 for their smoker...

Posted by: CFShep on March 23, 2006 at 9:48 AM | PERMALINK

I believe in Armageddon. Ben Affleck's finest performance.

Perhaps, but I thought the asteroid showed more range.
Posted by: Irony Man

Excellent! Like Dorothy Parker's famous put down of Katherine Hepburn: "full gamit of emotions from A to B".

Pittsburgh Pirates pitcher Vern Law once said, "Experience is a hard teacher because she gives the test first, and the lesson afterward."

Posted by: CFShep on March 23, 2006 at 9:55 AM | PERMALINK

Like the Law quote, Shep.

Ted Kennedy is still not in prison for manslaughter.

That tears it. Jay is conspiracy nut with the mouth of David Mamet.

Posted by: shortstop on March 23, 2006 at 10:00 AM | PERMALINK

Michael, GREAT POST!!!!!!!

Posted by: Jay on March 23, 2006 at 10:01 AM | PERMALINK

That tears it. Jay is conspiracy nut with the mouth of David Mamet.

Posted by: shortstop

Yep, only sock puppet known to possess two right hands which must complicate shopping for gloves.

Posted by: CFShep on March 23, 2006 at 10:28 AM | PERMALINK

Actually, SecAn is probably one of those crypto-Jewish types. He'll have to stick to Texas-style beef bbq.
Posted by: MJ Memphis

If memory serves me right, SecularAnimist is a vegan, and a woman.

Posted by: Gregory on March 23, 2006 at 10:41 AM | PERMALINK

Shortstop: Like the Law quote, Shep.

Thanks. Now it only remains to see how long before Stefan..uh...borrows it.

Laughing.

Bowling for git: Horse racing is animated roulette.
--Roger Kahn

Posted by: CFShep on March 23, 2006 at 11:03 AM | PERMALINK

Thanks. Now it only remains to see how long before Stefan..uh...borrows it.

Hey!

But, as Oscar Wilde (or was it me?) said, "Talent borrow. Genius steals."

Posted by: Stefan on March 23, 2006 at 11:34 AM | PERMALINK
Having the government tell companies how much they can pay their workers and what kinds of benefits they must provide? Your pretty words mean nothing in the face of your actions.

Like I said, you're mindless. And delusional too. And, also, WTF are you talking about?

And, also, specifically, which actions of mine are you referring to, you reeking idiot?

Posted by: obscure on March 23, 2006 at 11:50 AM | PERMALINK

"TSo what's it like now? You haven't disproven his point with 10-year old statistics."

The Census Bureau does not collect detailed data on the uninsured every year. The "number of uninsured" statistics being cited by Stefan and Apollo 13 are extremely misleading, because they represent only the total number of uninsured people on any one day, or the total number of people who were uninsured at any point during the previous year.

The reason these numbers are so misleading is that the uninsured population is highly dynamic. Most of the people who become uninsured in any given year are likely to have insurance 6 months later. (This is one reason why Stefan's claim of "infinite" wait times for the uninsured is such total nonsense.)

Here is a CBO document from March 2004, which includes an analysis of data on the uninsured from 1996 thru 1999. The findings are similar to the data I cited earlier. For people who became uninsured between 1996 and 1997, almost half were uninsured for less than 4 months, and almost three-quarters were uninsured for less than a year.

Posted by: JoeF on March 23, 2006 at 11:56 AM | PERMALINK

I have to buck you on this one, Kevin. Far too much of our national resources are spent keeping the terminally ill alive, despite no significant positive prospects in their futures. From the sounds of it, that child could have been kept alive for several hundred thousand dollars per year. How much good could that amount of funding bring about for your average clinic? Lots.

Posted by: Berkeley Choate on March 23, 2006 at 11:59 AM | PERMALINK

Gregory:

SecAm is definitely vegan (and some sort of engineer, if memory serves), but I think recalling that this person is of the male gender.

Although the image of a woman sitting on top of two 15" bass cabinets and ripping into Spoonful until the foundation of the house rattles has its compelling aspects, to be sure :)

Bob

Posted by: rmck1 on March 23, 2006 at 12:02 PM | PERMALINK

""No, not really -- you're only getting that result because you're comparing the apple of the British or Canadian systems, which cover 100% of the population, with the orange of the American systems,..."

No, I'm not. I'm comparing the same thing (wait times for elective surgery) in different countries."

No, we discussed this on this blog some months ago when tbrosz tried to use wait time statistics. The comparison between the universal coverage and non-universal coverage countries is not valid with the reported statistic.

What is loosly referred to as the "wait time" is more precicely "time to admittance for treatment after diagnosis". So in universal coverage countries everyone can get a diagnosis and be scheduled for treatment then treated. In the US a significant number of people are never professionally diagnosed because they lack health insurance and a significant number of those who are diagnosed are not immediately scheduled for treatment because they cannot pay for it. In the common sense understanding both the undiagnosed person and the person who cannot afford treatment are "waiting" for treatment. They may or may not get treatment eventually (for example an american might seek coverage in various ways before seeking diagnosis or treatment). This waiting time is not captured by the "wait time" statistic. The US has another kind of wait time that universal coverage countries do not so the comparison is invalid. Those wait time statistics are probably very accurate for universal coverage countries, but do not measure waiting time in the US nearly as well.

Posted by: jefff on March 23, 2006 at 12:09 PM | PERMALINK

But, as Oscar Wilde (or was it me?) said...

Bwa!

Posted by: shortstop on March 23, 2006 at 12:11 PM | PERMALINK

"time to admittance for treatment after diagnosis"

heh, i'm being dumb. It was worse than that actually it was "time to treament after being scheduled for treatment". Which is collected basically because it is the easy statistic to collect. Figuring out when people actually started thinking they had a problem, or even first asked a doctor about it is a lot harder.

Posted by: jefff on March 23, 2006 at 12:20 PM | PERMALINK

Stefan,

"And what's a few months when you've just been diagnosed with metastasing breast or bone or lung cancer, or are in the grip of a severe suicidal depression?"

There are many public and private programs and agencies providing health care services for the indigent and uninsured. For example, since you mention breast cancer, an uninsured woman would probably be entitled to treatment under the federal Breast and Cervical Cancer Prevention and Treatment Act.

Repeat after me: "No insurance" does not mean "no health care."

You also seem to be under the false assumption that health care is not rationed in countries with "universal" coverage, that there are unlimited resources to provide everyone with whatever health care services they need, and that no one is ever denied life-saving or badly-needed treatment because it costs too much. It ain't true.

Posted by: JoeF on March 23, 2006 at 12:23 PM | PERMALINK

"No, we discussed this on this blog some months ago when tbrosz tried to use wait time statistics. The comparison between the universal coverage and non-universal coverage countries is not valid with the reported statistic."

Yes, it is valid. In the statistics I am talking about, the comparison was made without regard to the insurance status of the respondent.

"What is loosly referred to as the "wait time" is more precicely "time to admittance for treatment after diagnosis". So in universal coverage countries everyone can get a diagnosis and be scheduled for treatment then treated. In the US a significant number of people are never professionally diagnosed because they lack health insurance and a significant number of those who are diagnosed are not immediately scheduled for treatment because they cannot pay for it."

But serious delays in diagnosis and treatment are common in countries with "universal coverage," and seem to be especially common in single-payer health care systems. As this OECD paper says:

"Waiting for publicly funded, elective surgery is seen as one of the most important health system problems in many OECD countries. Part of the reason for that is that general public opinion surveys (surveys not confined to people with recent experience of using health services) suggest that waiting for elective surgery is very unpopular. In the United Kingdom, a regular public opinion survey has indicated for several years that waiting for specialist assessment and waiting for elective surgery are perceived, respectively, as the first and second most important failings of the health care system"

The paper also reports that lengthy waiting periods in the USA were "negligible."

Posted by: JoeF on March 23, 2006 at 12:40 PM | PERMALINK

"If memory serves me right, SecularAnimist is a vegan, and a woman. "

And I'm facetious, so no harm done. :)

Posted by: MJ Memphis on March 23, 2006 at 12:43 PM | PERMALINK

There are many public and private programs and agencies providing health care services for the indigent and uninsured.

There are some, but they provide neither the breadth nor depth of coverage that universal coverage does. Also, many people without insurance are either poor and/or unemployed, or have other issues, and so do not have the resources to track down these programs and go through the application process and bureacratic hurdles of getting coverage.

Instead of relying on such stopgap, patchwork coverage, it is much easier, then, to simply institute a system of universal coverage so that the woman with the sudden diagnosis of breast cancer, or the man who has fallen into depression, does not have to spend days or weeks locating and begging for coverage from someone willing to provide it for free. The moment when you're facing a traumatic health crisis is the last moment you also want to deal with the hurdles and indignities of finding free coverage.

Also, these "public and private programs and agencies" do not provide coverage for free -- someone still has to pay for it, and if the indigent person is not charged that cost is then put off onto the taxpayer or the insured, so we wind up paying for it everyway. A univeral coverage system would rationalize this disparity.

You also seem to be under the false assumption that health care is not rationed in countries with "universal" coverage, that there are unlimited resources to provide everyone with whatever health care services they need, and that no one is ever denied life-saving or badly-needed treatment because it costs too much. It ain't true.

You seem to be under the false assumption that health care is not rationed in the US, that there are unlimited resources to provide everyone with whatever health care services they need, and that no-one is ever denied life-saving or badly-needed treatment because it costs too much. It ain't true.

In the US we have a system whereby we provide fantastic care for a few, pretty good care for the middle, and none or substandard care for the bottom, all for the highest cost compared to others. In the developed world, they have a system whereby they provide pretty good care for everyone, all for less than it costs here. I prefer the latter system.

Posted by: Stefan on March 23, 2006 at 12:52 PM | PERMALINK
In the statistics I am talking about, the comparison was made without regard to the insurance status of the respondent.

It was made based on being diagnosed and scheduled for a procedure. If a greater percentage of the population has less access to healthcare, and is therefore less likely to be diagnosed and even less likely to be scheduled for treatment, it is of dubious utility to compare the wait times of those scheduled for treatment in that country to those scheduled for treatment under a system without those features and try to ascribe meaning to the result.

So, yeah, for people who have the ability to pay -- directly or through insurance -- which allows them to be scheduled for treatment at all in the US, the wait times for some procedures tend to be shorter than in many universal-service countries.

But more people do without those services entirely in the US.

Posted by: cmdicely on March 23, 2006 at 1:04 PM | PERMALINK
The reason these numbers are so misleading is that the uninsured population is highly dynamic. Most of the people who become uninsured in any given year are likely to have insurance 6 months later. (This is one reason why Stefan's claim of "infinite" wait times for the uninsured is such total nonsense.)

Or, it would be, if insurance didn't routinely have exclusions for pre-existing conditions.

Posted by: cmdicely on March 23, 2006 at 1:05 PM | PERMALINK

Stefan,

"There are some, but they provide neither the breadth nor depth of coverage that universal coverage does."

Nonsense. "Universal coverage" just means that everyone is covered for whatever services the system provides. It doesn't mean those services are "broader" or "deeper" than the services covered by programs for the uninsured in America.

"Also, many people without insurance are either poor and/or unemployed, or have other issues, and so do not have the resources to track down these programs and go through the application process and bureacratic hurdles of getting coverage."

They don't have to "track them down." Hospitals and health care clinics know all about these programs for the uninsured, and will refer the patient to the appropriate contact or agency.

"Instead of relying on such stopgap, patchwork coverage, it is much easier, then, to simply institute a system of universal coverage so that the woman with the sudden diagnosis of breast cancer, or the man who has fallen into depression, does not have to spend days or weeks locating and begging for coverage from someone willing to provide it for free."

More nonsense. They don't have to "spend days or weeks begging for coverage." They just have to go to a hospital or clinic and they will be referred to the organizations that provide the services they need.

"Also, these "public and private programs and agencies" do not provide coverage for free -- "

It's free or subsidized for the patient who needs the care.

"someone still has to pay for it, and if the indigent person is not charged that cost is then put off onto the taxpayer or the insured, so we wind up paying for it everyway. A univeral coverage system would rationalize this disparity."

Huh? What "disparity?" Obviously, in countries with universal health care, it is also true that someone has to pay for the coverage, and that someone is also either the taxpayer, or the insured, or both.


Posted by: JoeF on March 23, 2006 at 7:54 PM | PERMALINK

JoeF: The Census Bureau does not collect detailed data on the uninsured every year. The "number of uninsured" statistics being cited by Stefan and Apollo 13 are extremely misleading, because they represent only the total number of uninsured people on any one day, or the total number of people who were uninsured at any point during the previous year.

The reason these numbers are so misleading is that the uninsured population is highly dynamic. Most of the people who become uninsured in any given year are likely to have insurance 6 months later. (This is one reason why Stefan's claim of "infinite" wait times for the uninsured is such total nonsense.)

And yet Joe posted another report with data from "1996 thru 1999" that doesn't have a dang thing to do with conditions today. Evidently, your CBO source doesn't collect detailed data on the uninsured every year that's current to tell us about 2003, 2004, 2005 or any year following 1999. However, it does say "the percentage of Americans who are uninsured has risen in each of the last two years for which information is available." I would guess that trend has continued.

Furthermore, the CBO source using the 1996-1999 data states for 1998:

Between 21 million and 31 million people [who were nonelderly] were uninsured all year [Cite];
At any point in time during the year, about 40 million people were uninsured; and
Nearly 60 million people were uninsured at some point during the year (see Figure 1).
CBO conducted the analysis for 1998 because that was the most recent year for which suitable data were available to construct all three measures. More recent analyses by researchers at the Agency for Healthcare Research and Quality indicate that those three measures of the uninsured remained fairly stable in the subsequent period from 1998 to 2001.(2)
Nearly 30 percent of Americans under age 65 who become uninsured in a given year remain so for more than 12 months, while 45 percent obtain coverage within four months (see Figure 2).(3) Those estimates were obtained by CBO using data from the Census Bureau's Survey of Income and Program Participation for 1996 through 1999. They are very similar to the findings of previous studies that have examined earlier time periods.

The 2004 Census data shows the uninsured [assuming the stats are for "at any point during the year"] has grown to 45.8 million in 2004, up from 45 million in 2003. That's significantly more than the 40 million uninsured "at any point" during 1998, up 14.5% compared to 2004.

The CBO data showed that 21-31 million nonelderly people were uninsured all year round in 1998. Based on today or 2005, I would speculate that the uninsured "all year round" statistic [raising my hand] has grown significantly as well.

Also, from the CBO source:

Rapidly rising health insurance premiums are a source of concern first because they are likely to reduce the percentage of people who have health insurance [raising my hand again]. They also increase the amount of federal subsidy that must be extended to individuals or firms to achieve a specified reduction in the number of people who are uninsured, and the associated growth in health care spending raises the cost of expanding public programs such as Medicaid and SCHIP.
Just how much of the change in insurance coverage rates that has occurred over the past 15 years results from changes in premiums, changes in unemployment rates, and other factors is unknown. But in the two periods in which employment-based coverage dropped (from 1987 to 1993 and from 2000 to the present), health insurance premiums rose rapidly. Private health insurance premiums grew much more rapidly than wages and the prices of other goods and services from 1987 to 1993 and then grew at a more moderate pace until accelerating again in 1999 (see Figure 4). Thus, employment-based coverage rates fell during periods of rapidly rising premiums and stabilized (and even increased) when the growth of premiums slowed. Those simple correlations suggest that rising premiums contributed to the decline in coverage. Other factors, such as cyclical changes in employment, changes in the characteristics of the health plans offered, expansions in public coverage, and demographic changes probably also contributed. (Emphasis added.]

Regardless, the number of insured and uninsured based on the dated detailed statistics available does not take into account the skyrocketing health care costs of the past few years--including insurance premiums--or the fact that hospitals charge uninsured people much higher rates--two to four times more than the insured. Ridiculous!

For me personally, Mrs. Apollo had a life-threatening illness (21-day hospitalization and multiple surgeries) while uninsured during one of those six month gaps that Joe pointed out. We still struggle to pay off the medical bills that piled up. She's the only insured member in our household in case, God forbid, a reoccurrence of cancer that happened while she was insured, were to appear. We can't afford to insure both of us and fortunately, I'm healthy having been athletic for most of my life. Our story isn't unique especially these days and we have a combined income well above the U.S. median household income. We aren't poor.

So pardon me, Joe, if your rebuttals underwhelm me. They don't complete the health care picture for the uninsured or the insured in America.

Posted by: Apollo 13 on March 23, 2006 at 8:14 PM | PERMALINK

cmdicely,
"It was made based on being diagnosed and scheduled for a procedure."

No, it was made on the basis of patients who had elective surgery in the past two years. Not just insured patients who had surgery, but all patients.

"If a greater percentage of the population has less access to healthcare, and is therefore less likely to be diagnosed and even less likely to be scheduled for treatment, it is of dubious utility to compare the wait times of those scheduled for treatment in that country to those scheduled for treatment under a system without those features and try to ascribe meaning to the result."

Then all comparisons of all health care metrics are "of dubious utility," since in all countries some people have "less access to healthcare" than others. In Britain, for example, many wealthier people buy supplementary insurance that allows them to "jump the queue" for access to specialists and elective surgery, and in general to receive better health care than Britons who rely exclusively on the National Health Service. So if you're claiming we can't draw any reliable conclusions about the merits and deficiencies of different systems from such international comparisons, fine. But you've then destroyed any basis for your claim that the health care systems in other countries are "clearly" superior or "clearly" more cost-efficient than the U.S. system.

Posted by: JoeF on March 23, 2006 at 8:16 PM | PERMALINK

"Or, it would be, if insurance didn't routinely have exclusions for pre-existing conditions."

No, Stefan's "infinite wait time" claim is total nonsense regardless of that.

And by the way, since you apparently are not aware of it, the ability of insurers to exclude people from coverage for pre-existing conditions is severely limited by the Health Insurance Portability and Accountability Act.

Posted by: JoeF on March 23, 2006 at 8:22 PM | PERMALINK

Apollo13:

"And yet Joe posted another report with data from "1996 thru 1999" that doesn't have a dang thing to do with conditions today."

You can't have it both ways, Apollo. You claimed the 1996-1999 data is irrelevant, and then quoted it as if you think it is relevant. Which is it? If it's relevant, then the findings I cited are relevant. If it's irrelevant, your own quotes of it are irrelevant.

But the data is relevant. Unless you can produce evidence that the length of time people spend without insurance has changed significantly since the periods I cited, there's no reason to believe "conditions today" are different in this respect. The fact is, most people who lose their health insurance get it back again within a few months. The number of people who go without insurance for very long periods of time is much, much smaller than the "45 million" number you are throwing around, and the problem of the uninsured in America is therefore much, much less serious than that number alone implies.

"The 2004 Census data shows the uninsured [assuming the stats are for "at any point during the year"] has grown to 45.8 million in 2004, up from 45 million in 2003. That's significantly more than the 40 million uninsured "at any point" during 1998, up 14.5% compared to 2004."

You're comparing apples and oranges. The population obviously has also grown during that period. You can't just compare raw totals.

"Regardless, the number of insured and uninsured based on the dated detailed statistics available does not take into account the skyrocketing health care costs of the past few years"

Health care costs have generally been rising faster in countries with universal coverage than they have been in the U.S.

Posted by: JoeF on March 23, 2006 at 8:46 PM | PERMALINK

JoeF: You claimed the 1996-1999 data is irrelevant,

Wrong, Joe, I didn't say the data was irrelevant but not current, and I wasn't attempting to have it both ways. Just showing the data that you had cited so we all can examine what you referenced. Got a problem with that?

Posted by: Apollo 13 on March 23, 2006 at 8:55 PM | PERMALINK

The number of people who go without insurance for very long periods of time is much, much smaller than the "45 million" number you are throwing around, and the problem of the uninsured in America is therefore much, much less serious than that number alone implies.

I didn't "throw around" that 45 million were uninsured for a long, long time and you can't quote me where I did. Misleading?

Plus, you can't prove what number of Americans who are uninsured for longer than six months, 12 months, or more since we don't have current metrics. Therefore, you can't say with absolute certainty how serious the situation is today. What I have shown is the number of uninsured at any given point in 1998 has grown in 2004 by nearly 6 millon.

Posted by: Apollo 13 on March 23, 2006 at 9:10 PM | PERMALINK

The population obviously has also grown during that period. You can't just compare raw totals.

Just because the population has obviously grown, doesn't dismiss us from ignoring a "growing" problem. You don't advocate that, do you, Joe?

Posted by: Apollo 13 on March 23, 2006 at 9:14 PM | PERMALINK

Health care costs have generally been rising faster in countries with universal coverage than they have been in the U.S.

I made no reference to American health care costs compared to countries with universal coverage. "In America" was the context of my cite. Do you have a cite to offer to support your claim and something that actually compares health care costs in America compared to these countries?

Posted by: Apollo 13 on March 23, 2006 at 9:20 PM | PERMALINK

I posted from Joe's CBO data for 1998: Between 21 million and 31 million people [who were nonelderly] were uninsured all year. I speculate that that stat has grown, since Joe admits and I agree, that the population has grown.

What do you propose, Joe, that we do about those who are uninsured for 12 months? You seem to be anti-universal health care, I dunno for sure, so I want to understand what you think is the solution. Do tell.

Posted by: Apollo 13 on March 23, 2006 at 9:31 PM | PERMALINK

One little thing that drives up America's health care costs rather rapidly is the tendency of ailing people in a variety of lands, once they realize their own society isn't going to do much for them, to travel to America by hook or crook.

Once arrived, they soon appear at emergency care facilities. Because they are indigent, to get advanced treatment for their very real problems all the resources of a caring government have to be called upon. Back in the Ellis Island days we would just heartlessly load the sick on a steamer to go back to Poland to die.

If immigration deporting someone home seems to somehow be getting ahead of the medical delivery, a call to the media will usually generate a sympathetic story. The immigrant lady who is pregnant "with complications" is certainly ahead in this contest to have her child born an American than the one who actually practices good pre-natal care.

Posted by: Michael L. Cook on March 24, 2006 at 9:53 AM | PERMALINK

I recall reading about the Canadian government bitching about cars with American license plates in the parking lots of Canadian hospitals. So do people with tourist visas showing up in our hospitals cost more or less than Americans showing up in Canadian hospitals?
Haven't a clue. Anybody here work for the Canadian health service with actual data instead of vague recollections of tourist visa medical refugees?
California and some other states have serious problems about illegal aliens without health insurance, but since they lower wages and raise rents, the rich people don't mind paying more taxes to take care of them vs. the alternative of sending them back to Mexico.

Posted by: wkwillis on March 24, 2006 at 1:56 PM | PERMALINK




 

 

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