Obama!!!

When I see Republicans reacting to Obama's health care reform ideas with civilized debate that does not include heightened, inaccurate rhetoric and disinformation, then I will actually believe people "don't like what they've heard."

Because at this point, I don't trust they've heard the facts and thought through solutions. I do trust they've heard all about "death panels" and how old people are gonna die, etc.

Until then, I think this debate you and I are having is actually moot.

And since Obama was elected with a platform about health care reform, I most certainly believe that if Republicans do not have a solution to the health care problem, then they should just get the heck out of the way. People voted for reform. And if I recall, states all over the union (except the south) voted for Obama.

I am not against Health care reform, I am against "Government run" health Care reform, simple as that. Not sure why speaking out and disagreeing makes me an idiot? I was not at a town hall meeting, but if I had chance to go I probably would have, and I would probably speak out. I do not see anything wrong with either that, nor do I see anything wrong with any type of outspoken person or group speaking out in what they believe in. Now i am not talking about any Nazi crap, so please do not lump me in with any of that stuff.

Yeah, but again, isn't it kind of odd that we always end up talking about how Republicans don't want to discuss this, when you're discussing it with one right now? And I'm hardly the only one. But all you want to talk about are the loudest, most ignorant voices in the debate. This doesn't seem like something people do when they actually want the truth; when people want the truth, they find the best argument against something, not the worst. Taking shots at the worst possible representative for an idea is a form of personal reassurance, not a genuine analysis of its merits.

Anyway, the "misinformation" thing is the logical "out," of course. If Obama goes on a whirlwind PR tour to sell the plan, and Americans in polls all over reject the ideas, it can always be said that it's because someone is distorting things. Nevermind that these polls are consistent with past polls and general opposition to nationalized healthcare over the last couple of decades. Nevermind that his claims about cost are continually contradicted by the Congressional Budget Office (is that "misinformation"?). Nationalized healthcare wasn't a popular idea to begin with, so it shouldn't be hard to believe that it still isn't.

But of course, if you believe that the opposition to these ideas is simply because people haven't thought it through, there's no possible way to prove otherwise. Though I'd certainly point out that many people who support it clearly aren't appreciably different.

Regardless, it's pretty much indisputable that this proposal does not enjoy widespread support. Certainly not to the degree that programs like Social Security and Medicare did when they were passed. This just isn't how huge entitlement programs are passed, and for good reason.

Regarding Obama's election: electing a President on the basis of health care reform is not the same as electing them to enact any type of health care reform under any circumstance. And I think I've pretty accurately explained why the notion that Republicans should "get out of the way" doesn't add up. I'll reproduce the relevant parts of my previous response to that sentiment below:

Even if you think the debate about healthcare is moot, there are larger issues from earlier in the thread, such as why Democrats get a free pass on Social Security despite the striking similarities between the two situations, politically.

I am so sick of these disgruntled Hillary voters, turned ultra-conservative Republicans. During the Primary my mother was an avid Hillary supporter, all on board with the Democratic platforms; healthcare, Iraq, and the economy. Since Obama took the candidacy and been sworn in I have to listen to daily rantings about every internet rumor, which of course is true, and have to listen to Fox news, which elevates Obama to near supernatural, mythical preportions. They talk about supporters putting him on a pedestal, the way conservatives talk he's Cthulu. So now my mother is against the same things that Hillary herself ran on. She's convinced that Obama wants to euthanize old folks, is a secret muslim, a communist, and probably sustains life by consuming the blood of unbaptised infants.

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...uh the post is up there...

Got some healthcare stuff here that might interest y'all...


'Fee for service' payment structure increases costs with no (& sometimes negative) health effects

That's the key conclusion of this excellent bit of journalism. It starts by comparing two regions with nigh-identical demographics, yet one of them spends roughly double on healthcare for no discernible benefit. Anecdotally it seems that the worse-performer has embraced the money-spinning possibilities inherent in the system - the more procedures they perform, the more they get.


Over-medication:

A 2003 study of regions over-spending for no health gain found that for every 10% of 'additional' spending death rates actually rose between 0.3 & 1.2% over five years in the disciplines studied. [1, 2]. That's a small rise, but only goes to highlight how high spending isn't producing higher quality of care in the US at the moment. Beyond every procedure coming with its own minor risk, there's a lot of innovation being embraced that doesn't necessarily out perform tried-&-tested tech (& usually costs more). The outlay on proton accelerators to treat prostate cancer is a recent example, but there are many others. Sometimes the pressure to use this tech comes from the patient of course - such as requests for 3D CT scans (which have no health or diagnostic benefits and carry a minimal cancer risk). But hey, the health practitioner can charge more for using the new tech, so they do. Well, most of them...


Methods of obtaining 'qualitative' over 'quantitative' healthcare:

Healthcare organisations that pay their doctors a flat salary (or average out patient fees regardless of insurance source) measure at the highest end of the quality ratings system and at the lowest end of the cost scale, according to the initial article. Some also share information in the local region to try and eliminate unnecessary practices (something not always desirable or common practice in more 'quantitatively' driven private ventures).

Outfits like the former can: spend the time to explain to someone why a CT scan is a bad idea; confer with colleagues over best diagnosis without incurring a charge; & generally have their focus on health outcomes over procedure-based-incomes. The low cost for the patient is a by-product of these working practices.


Less can be more:

It seems strange, but you should be getting that picture now. Overuse of medication, surgery & diagnostic practices are certainly a huge driver behind the expense of US healthcare and the absence of any correlated health improvement.

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The NHS, the 46 million, & the future

A lot of the above solutions are inherent in the UK's NHS system, but that doesn't mean the US has to go down that path. The examples above were all almost exclusively taken from US for-profit ventures.

The NHS does have some other contingent advantages though (& downsides of course ) - the most relevant being the 'NICE' system of assessing procedural efficiency across the board. Not only can they assess which procedures aren't working and dump them (as they can draw from a far broader data pool than independent operators), they can also fight the consumer's corner. By initially rejecting (pay-per-view) a cancer treatment that cost over £30,000 per year but provided a low influence on life expectancy & quality of life, they forced the drug company to offer a win-win deal instead: the NHS would only have to pay in cases where the drug was effective, thus helping everyone discover who the drug worked best for, and reducing the cost (in principle to the consumer).

"Any plan that relies on the sheep to negotiate with the wolves is doomed to failure", says the original article, concerning suggestions that people put more of their own money on the line with health insurance, inducing them to haggle. But it's pretty hard to haggle with the man holding your health in his hands. I'm not fully versed on the admin's current health plan, but it seems to me the source of the insurance is of far lesser importance than how the medicine it pays for is being applied. The attempt to spread cover nationwide is no doubt stirring up a partisan hell, but there are benefits for all demographics in some of the approaches mentioned above (improved healthcare for those that can afford it & lowered insurance costs for those that struggle to or were previously unable to).

Doubtless an outreach to the poorest will do something to rectify the US's poor infant-death & longevity record, but there are clearly other factors that are making you spend more for less at this time.

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Virtual Reality chatter on a movie site? Got endless amounts of it here. Reviews over here

I'm resigning from the political discourse in this country. I'm too old and too tired to do this anymore. I'm watching, once more, the dismantling of any change and the formulation of an angry minority that will make sure no change is made. Every time I open a political blog to see what is going on, I close the window a little more heartbroken than the last time. These next four years will be torture. So I'm done.

You see, health care town hall meetings have descended into a call to arms. Bring your guns! Make sure that socialist President doesn't take your freedoms away.

Because, you see, somehow, the health care reform debate is now about the second amendment.

I lived through the 60s, the 90s. In the 90s, time was taken up by the conservatives to find something to impeach or ruin the Democratic President. I won't even discuss the 60s.

This is what this country does. One side bullies the other and the other capitulates. Discourse becomes mob rule. I took my son to a country fair the other day and I was surrounded by signs about how Obama is a "socialist" and t-shirts sporting the pride of being an "angry mob." I just can't take it anymore.

What happens is that I come away hating my neighbors. Wondering why such people don't want to work for a compromise between differing political philosophies. One side is "right" no matter what and the other side gives in.

I'm not joking. I'm not trying to make any greater point. I'm merely tired of it all. My "liberal" heart has been broken over and over by both the Republicans and the Democrats. At some point, you either give up or fight harder. I fought harder -- working to get Obama elected, hoping for the changes I feel this country needs -- and now it's time to give up. The Democrats don't have the spine to fight angry mobs nor the wisdom to stop lies from being perpetuated.

I had wished it would be different this time. But it's worse. From the time Obama took office, it has gotten uglier and uglier. The rage from the right is more than I could ever have imagined. But why did I think it would be different? I shouldn't have. Modern history shows that the angry right gets their way each and every time.

He who screams the loudest.

You can criticize me all you want, especially you, Yoda, but I will tell you this: I don't believe I'm exaggerating. Look around you and what do you see?

I can't care anymore. It's too much. Let them bring their guns. Let them create new and inaccurate descriptors such as "death panels." Let them scream "socialism" while collecting their social security checks and their medicare benefits. Up is down, down is up. They often jump the shark and get away with it.

They win every time. Why should I fight it?

I may not even vote again. It's all too depressing. I'm just glad I'm not young anymore. As long as I keep my job, I'll have health insurance. That's all that matters.

And I still won't carry a gun.

I love how in 2003, that anti-war protesters were labeled as un-American, and emboldening our enemies. Now, the town hall demonstrators are practically Patriots. Personally, I don't think either are "Patriots," but they are within their rights. I realize the problem with liberals is they can't appeal to self-interest as well as their conservative counterparts. If healthcare was an impoverished third world country with a bad attitude, and an overabundance of natural resources, then the public would have demanded their tax dollars be poured into it. The fear of a MiddleEastern boogieman was enough to give the Republicans a good free ride for about six years and two Presidential terms. The Economic boogieman was the only thing to play into the Democrat's hands. Anyway, the threats of gay marriage, terrorists and now "socialists" is apparently much greater than the threat of how to pay for cancer treatments or prescription drugs, when unable to work or pay co-pays. Of course that's not as visceral as a decrepit, incoherent, urine-stained geriatric wearing a turbain and mumbling into a 1980's camcorder.

I am certain there can be an acceptable "middle ground", but then again I have always leaned to my optimistic side. The problem is that there seems to be no "give and take". Both sides want all or nothing. I do not speak for everyone of course and I am sure there are plenty of "middle ground" folk out there, just need to speak up more I guess.

I will start:

I will take government run health care if I can carry my gun to the doctor's office - seems fair.

I am kidding of course about that, but the middle ground thing never seems to happen.

Honestly I am for the right to bear arms, the same as I believe that women should have a choice on whether to have an abortion. I know I sound like I'm a peacenick, but the reason I speak out so much on the current war isn't so much that there were mistakes, but that they aren't acknowledged. As far as healthcare I don't see much of a difference, at least in terms of results, than current healthcare, so I'm not screaming about either side really.

Not really "a peacenick" so much as someone who doesn't live in America. That's not to say that there aren't people outside of America who don't think that way, but you're not thought of as some kind of pacificist or liberal if you do.

Not sure what you mean, but I'm an American. I personally see Bush's war strategy as fairly liberal, no exit strategy or clear objective. I mean when conservatives talk about welfare they say it's "enabling" people not to work, okay then by staying in Iraq and Afghanistan without time-tables aren't we "enabling" them to rely on us? I mean what's their incentive, if you could have a full-time body-guard in an ever-hostile environment, would you send them away?

It means I think the hardcore of both parties--oh, hell, all of both parties are waaaay over the top. Actually, it don't mean squat--just a joke that some didn't get. Or didn't want to get. But who cares, right?

My daddy gave me some very good advice when I was a little boy. He said, "Son, if you're determed to carry a weapon, get one with a chocolate handle, because sooner or later you're gonna meet a tougher fellow who's going to make you eat it." I've lived 66 years and never even carried a pocket knife. Except for sick call in the Army, I've never had medical treatment from the government,either.

I actually do not carry any weapons with me, other than my witty banter.

and the tougher fellow thing - that is what the gun is for.

But there always is a still tougher fellow. And always a faster gun (as a blind seer pointed out in The Fastest Gun Alive).

What most disturbs me about this thread and US politics in general is the rising decibels of vocal exchanges (I wouldn't dignify it as debate) and an even sharper decline in good manners and fair play as participants plumb the gutters with name-calling and outrageous labels of opponents. As far as I can see, there has been no increase in voter turnout and no higher level of debate and certainly no improvement in political canidates--just more shouting that seems to have ramped up since the start of all this red state-blue state idiocy.

As a student of history, I know there have been more rowdy political periods. None was nastier than the political rivalry between Jefferson and Adams when laws were passed--and used--to jail opponents and critics at large. But I also recognize various sections of the country have not been pitted against each other to this degree since the 1860 election that led to the Civil War.

One would think--even hope--that the attacks in Oklahoma City, New York, and Washington would have united the nation against our common enemies both foreign and domestic. Instead, they've become simply additional issues over which we have divided.

I'm sick to death of hearing politicians and their followers trumpeting their stands on principle, when the one thing that has helped this nation survive, the thing that has sustained our union, is our outstanding ability to compromise on issues. Inflamed passions and arrogance and demonization of opponents undermined the ability to compromise and led to the Civil War. Today it will do even worse--it will trivalize us to the point that the rest of the world passes us by.

Meanwhile, the one true thing George Wallace ever uttered is that there is not a spoonful of difference between the two major parties despite all their chest-beating and posturing and pointing fingers at each other. Never once has either of them ever identified a problem before it became a crisis or a trend before it became a movement. As Will Rogers observed more than 70 years ago, each session of Congress starts with a prayer and ends with an investigation. Politicians on both sides wait until they can see which way the public parade is marching, then scurry to get in front so they will look like they're leading it.

I've never put any candidate's campaign sticker on my car bumper because I don't want to have to appologize for the SOB 6 months later when he screws the pooch. And they all do, sooner or later.

So true.
I wish we didn't have to limit ourselves to one candidate from each party when we vote-it just puts too much responsibility on the delegates and not enough power in the hands of the citizens.
I didn't want to vote for John McCain-I wanted Ron Paul--but to vote for him was to not vote at all in the system we have now.

I can certainly relate. Even when I feel strongly about something, talking about it (and defending a viewpoint) can be quite tiring, and I won't pretend it's always the most practical use of one's time. I think it's valuable and necessary, but it has its cost.

That said, I think you'll have trouble staying away. You care too much.

You've been saying this sort of thing a lot, I think, either implying or outright stating that nationalized healthcare represents some grand will of the people that is always being thwarted by special interests and a minority of activists. It just isn't so. Polls change dramatically based on wording, with even the most favorable phrasing producing pretty tepid numbers. Certainly nothing approaching the bipartisan majorities that passed Social Security and Medicare.

This idea does not command a lot of public support. You can still think it's a good idea, and we can still argue about whether or not this is true, but this isn't an idea the public is really getting behind. There are legitimate questions about this that simply aren't getting answered, and it's not just the fringe that's skeptical of it.

I don't know how many people have brought guns to these things (and I'll point out they're not actually allowed inside with them), but I'm sure they're few and far between. As always, a handful of militants become a reason to ignore all valid criticism and concern.

There's definitely misinformation floating around, but that's always the case, and some of it's coming from the White House. Their cost estimates of this program are laughable. As I've mentioned several times, the Congressional Budget Office has contradicted them (multiple times, I believe), and it's pretty clear they're being conservative in their estimates, as well.

In other words, the White House is making unrealistic claims, not addressing serious concerns, and not compromising in any meaningful way, all on a plan that enjoys lukewarm public support at best. That is why the proposal is meeting with such resistance.

Their power is directly related to how much we pay attention to it. If you want to have a substantive discussion about the issues, they can't stop you. If you want to focus in on them, ignore the sane questions, and extrapolate their significance and influence far beyond what they actually possess, I can't stop you. But meanwhile, there are some pretty pertinent questions in this very thread (and others) that are rational, reasonable, and deserve to be addressed. That doesn't change no matter how many paranoid guys with guns in Alabama show up on the news.

I see the exact same kind of fringe anger that I saw when Bush was President. The losing side always gets angry, and some of them go particularly loony. People coming to these things with swastikas on placards are morons, but we don't have to go back very far, historically, to find similar practices on the left.

To answer your question, though: no, you're not exaggerating about all of this. You're just leaving out all the times it happened during the last guy's term.

I think I explained in fairly clear terms why nationalized healthcare will inevitably lead to putting a fixed price on the quality of individual lives. This isn't just reasoned speculation, either: it's already happening in other countries. The phrase "death panels" is a pretty sensationalist way of summing this up, but I'd really like to hear a substantive argument as to why this won't happen. What would you call a panel that has to refuse someone care because their algorithm says their quality of life isn't high enough to merit the cost?

Whether or not you continue is up to you, naturally, but I admit that I'm a little disappointed that some of the questions I asked -- repeatedly, and in a very straightforward manner -- never received an answer. I think the Social Security example in 2005 represents a pretty indisputable example of the double standard being applied, and I still don't know what to make of the claims that Republicans have offered not alternatives, when they clearly have. Nor of the suggestion that they have some kind of ethical obligation to roll over and cave to a plan they universally think is a bad idea.

All I'd say in closing is that I think every generation has a tendency to exaggerate pretty much everything about itself. As rufnek has pointed out -- accurately, I might add -- there have been some very ugly periods in American political history, we just didn't witness them firsthand. Things are loud these days, and the present is certainly unique, but I don't believe it represents some unthinkable state of affairs, or some altogether new level of vitriol. People get fired up about these things, as they should. Lives hang in the balance on even the wonkiest of policy disputes. I think I'm more worried about the people who don't care at all than the ones that sometimes care too much.

The are several disingenuous things about the phrase 'death panel':

• The current system already puts limits on access to care - the algorithms just belong to the insurance companies, not the state. Why aren't these organisations also called 'death panels'? [EDIT - the algorithms are of a different nature of course: setting premium levels based on medical histories etc & raising them further to reflect the cost of apparent profligate profiteering in the medical market. The end result is low-to-no care for sections of society tho]
  
  
• The UK's 'NICE' organisation, which guides the NHS policy on which procedures are cost-effective etc, does turn down treatments which cost over £30,000 a year and are clinically ineffective. The focus, you'll notice though, is on weeding out treatments that have scant effect. In many ways, they're 'life panels', because they focus resources on interventions that work (and by saving money in this way are able to spend £30,000+ a year on effective treatments etc). (See my previous post for an example of how their stance can bring down the cost of drugs & target them to those individuals who actually get a medical benefit from them).

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Put bluntly, the disparity between the US's spending on healthcare & its mortality figures means you guys are really overseeing the bigger 'death panel' at the moment

If we were to be more nuanced tho, we might have a more useful debate (as countries running disparate social experiments). Would the US's mortality figures align with the UK's etc if care was spread to all? Is some of the apparently excessive spending actually going on lifestyle benefits for the suffering that are harder to gauge? (The extensive article in my previous post suggests possibly not, but you never know).

We certainly are one hodgepodge of a country. What a great thing that is.