Wow. Charles Krauthammer has an excellent column today on health care reform, proposing a system which he argues will lead to universal coverage and which can pass Congress. You can and should read it here: (Doctor’s orders!)
http://www.washingtonpost.com/wp-dyn/content/article/2009/08/27/AR2009082703262.html?wpisrc=newsletter
This is amazing since I absolutely never agree with Krauthammer, and I have to wonder if he even agrees with himself in this instance since his proposal, he says, will inevitably lead to health-care rationing and, (shudder), end-of-life counseling, also known as Death Panels.
My question is what’s so bad about rationing? It’s the only way to significantly control costs, something everybody agrees we have to do.
Take a typical case as an example: A 75-year-old man has advanced lung cancer. He has a 95 percent chance of dying within two months. With aggressive and expensive treatment, there’s a good chance he could live for six months, though with serious side effects to the treatments. Or, he could accept palliative treatment for his remaining two months—hospice care which includes pain control, assistance to stay at home, and support for the family—which would cost a fraction of what the aggressive treatment would cost.
Why would anyone suggest the government has a moral obligation to pay for the aggressive and expensive treatment? The free market should be at play here. Anyone who wants additional coverage beyond what the government would offer should buy private policies, exactly like they already do with Medicare supplements. This is also how it works in Canada, our socialist neighbor to the north.
Krauthammer suggests that counseling about options at this point would constitute subtle pressure to check out early, but in my view it would amount to an opportunity to explain clearly what the patient’s options are. These panels are optional in the current proposals, by the way; I think they should be mandatory, even though that makes me not pro-life.
Also by the way, and as another example, Mary and I convened our own Death Panels with a local attorney several years ago. We now have end-of-life directives on file that make clear that if we’re brain dead with no chance of recovery—barring direct intervention by the Baby Jesus, which can always happen but isn’t likely in our case—we don’t want any extraordinary measures to keep us alive. This would include things like tube feeding, breathing machines, or deep tissue foot massage by a sexy nurse of the opposite gender.
On second thought, I’ll take the foot massage.
Of course we put subtle pressure on each other since our pension benefits continue to the survivor, but still, we think we made the right decisions. Of course, we might have chosen the tube feeding on the chance the Baby Jesus would change his mind and not hold a grudge, but I wouldn’t expect the government to keep paying to keep me alive indefinitely.
So I would buy into the Krauthammer policy in a K-Falls minute (roughly twelve minutes, actually), which means there still has to be room for compromise in the Congressionaal negotiations.
Maybe health-care reform isn’t dead after all. It just needs a foot massage.
Friday, August 28, 2009
Thursday, August 27, 2009
For Teddy. . . .
For the last several weeks I’ve been busy not-writing about health care. This explains the relative paucity of my blog entries recently. It’s been painful enough just watching the death spiral of health care reform, and writing about it is harder than trying to ignore it. But writing about anything else is actively not-writing about health care, so, sooner or later, I have to try to come to terms with my feelings about this and put something down in writing and up on the blog.
Welcome to later.
Columnist Michael Gerson today has a somewhat charitable view of why things haven’t gone better, presenting some more-or-less rational reasons why most people have never been on board with reform efforts. In part, the problem lies with the majority of Americans who do have health insurance and are risk-averse to changes which might reduce their coverage. In part, it lies in the general mistrust of big government and its ability to deliver on big programs to solve social problems. And in part, it lies in the almost universal concerns that we’re running massive deficits and are still in the middle of the worst recession since the great depression.
(The projected deficit was just revised upwards yesterday from $7 trillion to $9 trillion. I have no idea how much money a trillion dollars is, but I know it’s enough to buy billions of Happy Meals and have enough left over to buy a few million minivans, so from that perspective you could see how the average family would be concerned.)
And part of the pain that makes it hard to write about this is in watching the rapid decline in the public’s confidence in Obama and the inevitable decline in popularity as confidence goes down. I’m not even sure the average American still thinks his kids are cute anymore.
But despite all the rational reasons Americans might be concerned about health care reform, the biggest obstacle still has to be Republican determination to crush Obama. "If we're able to stop Obama on this, it will be his Waterloo. It will break him," said South Carolina Republican Jim DeMint. And let’s not underestimate the power of The Big Lie, no matter how stupid. The best argument I can imagine for Death Panels is Sarah Palin herself. We could send her down here to Oregon for a nice cup of assisted suicide.
It seems now that all is lost, that once again we’re going to say, “No healthcare for you!” 45 million times. But if we really can’t find a way to extend coverage to these unfortunates, I suggest we at least spread the pain around a little more fairly. We could have an annual lottery in which 45 million people are selected at random to not have health insurance for a year. Maybe Congress could help out by donating their healthcare coverage to the needy. If everybody was at equal risk of medical bankruptcy or death by no coverage, I think we’d find a way to extend coverage to everyone rather quickly.
Other good ideas: Anyone who says, “America has the best health care system in the world” will immediately lose all coverage and have one year to write an essay entitled “America Has the Best Health Care System in the World.” I’ll be grading these essays. You can contact me directly for a handout on this assignment.
Idea two, more seriously: Health cooperatives are a promising idea. They might bring on board the blue-dog Democrats, which is vital to any legislation since no Republican save maybe Olympia Snow will ever vote for a reform bill backed by this President. The trick then will be to find a way to get all uninsured Americans into the new National Health Insurance Cooperative by establishing a sliding scale of enrollment fees. Jim DeMint will say this is just socialized medicine in disguise, and he’ll be right, but he might not be able to do anything about it. He’ll have to stay home in South Carolina and drink a deMint Julep.
Really important: Build in real cost controls. Health care costs have to come down or they will grow from being a drag on the economy to being an anchor that pulls us all down. At the current rate of growth, health care premiums are an economic black hole which somewhere between three and twenty years will consume all of our GNP, at which point everyone will work in the health care industry and everyone’s pay will go entirely for health care, a kind of mobius strip of unnecessary procedures using the best equipment money can buy.
A final good idea: Blue Ribbon Panel. Appoint a Blue Ribbon Panel of experts on heath care and tell them to come back in a year with a report and recommendations. Despite the political near-impossibility of reform right now, it’s actually not that hard to come up with a plan that will meet the goals of preserving quality, controlling costs, and covering everybody. Then forget about bipartisanship and ram the plan through Congress. A generation later, they’ll be asking what took us so long.
So there it is. I broke my blog-writer’s block and wrote something about the health care debacle. Now I can get back to the important things in life, like I have to wash my car.
And how sad it is that Teddy Kennedy didn’t live to see it, but I’ll be even sadder if I don’t live to see it.
Welcome to later.
Columnist Michael Gerson today has a somewhat charitable view of why things haven’t gone better, presenting some more-or-less rational reasons why most people have never been on board with reform efforts. In part, the problem lies with the majority of Americans who do have health insurance and are risk-averse to changes which might reduce their coverage. In part, it lies in the general mistrust of big government and its ability to deliver on big programs to solve social problems. And in part, it lies in the almost universal concerns that we’re running massive deficits and are still in the middle of the worst recession since the great depression.
(The projected deficit was just revised upwards yesterday from $7 trillion to $9 trillion. I have no idea how much money a trillion dollars is, but I know it’s enough to buy billions of Happy Meals and have enough left over to buy a few million minivans, so from that perspective you could see how the average family would be concerned.)
And part of the pain that makes it hard to write about this is in watching the rapid decline in the public’s confidence in Obama and the inevitable decline in popularity as confidence goes down. I’m not even sure the average American still thinks his kids are cute anymore.
But despite all the rational reasons Americans might be concerned about health care reform, the biggest obstacle still has to be Republican determination to crush Obama. "If we're able to stop Obama on this, it will be his Waterloo. It will break him," said South Carolina Republican Jim DeMint. And let’s not underestimate the power of The Big Lie, no matter how stupid. The best argument I can imagine for Death Panels is Sarah Palin herself. We could send her down here to Oregon for a nice cup of assisted suicide.
It seems now that all is lost, that once again we’re going to say, “No healthcare for you!” 45 million times. But if we really can’t find a way to extend coverage to these unfortunates, I suggest we at least spread the pain around a little more fairly. We could have an annual lottery in which 45 million people are selected at random to not have health insurance for a year. Maybe Congress could help out by donating their healthcare coverage to the needy. If everybody was at equal risk of medical bankruptcy or death by no coverage, I think we’d find a way to extend coverage to everyone rather quickly.
Other good ideas: Anyone who says, “America has the best health care system in the world” will immediately lose all coverage and have one year to write an essay entitled “America Has the Best Health Care System in the World.” I’ll be grading these essays. You can contact me directly for a handout on this assignment.
Idea two, more seriously: Health cooperatives are a promising idea. They might bring on board the blue-dog Democrats, which is vital to any legislation since no Republican save maybe Olympia Snow will ever vote for a reform bill backed by this President. The trick then will be to find a way to get all uninsured Americans into the new National Health Insurance Cooperative by establishing a sliding scale of enrollment fees. Jim DeMint will say this is just socialized medicine in disguise, and he’ll be right, but he might not be able to do anything about it. He’ll have to stay home in South Carolina and drink a deMint Julep.
Really important: Build in real cost controls. Health care costs have to come down or they will grow from being a drag on the economy to being an anchor that pulls us all down. At the current rate of growth, health care premiums are an economic black hole which somewhere between three and twenty years will consume all of our GNP, at which point everyone will work in the health care industry and everyone’s pay will go entirely for health care, a kind of mobius strip of unnecessary procedures using the best equipment money can buy.
A final good idea: Blue Ribbon Panel. Appoint a Blue Ribbon Panel of experts on heath care and tell them to come back in a year with a report and recommendations. Despite the political near-impossibility of reform right now, it’s actually not that hard to come up with a plan that will meet the goals of preserving quality, controlling costs, and covering everybody. Then forget about bipartisanship and ram the plan through Congress. A generation later, they’ll be asking what took us so long.
So there it is. I broke my blog-writer’s block and wrote something about the health care debacle. Now I can get back to the important things in life, like I have to wash my car.
And how sad it is that Teddy Kennedy didn’t live to see it, but I’ll be even sadder if I don’t live to see it.
Wednesday, August 19, 2009
Our summer vacation
Mary and I are just back from a month-long vacation in our trailer. We visited family and friends from Yellowstone (Mary’s brother Paul and sister-in-law Karen) to Nordegg, Alberta (old friend Nancy and her family. Nordegg is a small town on the eastern slope of the Canadian Rockies where Nancy and her husband Dennis are finishing their retirement home.) We had great visits with everyone and a chance once again to spend time in some of the most spectacular mountain settings on earth.
Plus, we saw a bear, our first grizzly in the wild. Mary picked it out from our speeding truck, eating berries about 300 meters away and across a river. Perfect circumstances for extended grizzly viewing through binoculars, so we stopped and watched for some time. Surprisingly, only one other car pulled over. I guess grizzlies are about as routine up there as deer are here. No one stops to look at deer in deer country, unless you just hit one in your car. On a motorcycle, you will definitely stop.
Of course, bear photos taken with our pocket digi-cam only show a brown dot in the bushes, so you’ll have to take our word for it. Here’s what the bear looks like in our photos:
.
This trip was something of a trial run for a planned excursion this winter when we hope to head to the southwest for two or three months. Mary’s thinking two, I’m thinking three. I guess this will make us snowbirds, a label I don’t particularly like because it evokes pictures of elderly couples pulling trailers or driving motorhomes the size of an army barracks and staying in “parks” which are actually little parking lots with personal sewer hookups. Said elderly couples rarely leave their trailers since they can now automatically level themselves from inside and deploy their satellite dishes so the TV can go on even before their canopy automatically rolls out.
I think of us as more akin to the Lewis and Clark expedition if Lewis and Clark had a Dodge ¾- ton with a Cummins Diesel to pull their chuck wagon.
But then I don’t really have a better name than "snow birds" to describe us since “explorers” is an obvious stretch. Besides, birds have known for millions of years that when it gets really cold and the nights are long, you can just go south. They deserve respect for that, though I consider myself smarter that the average bird, so we’re going to see if it works for us.
We wanted on this last trip to see how well we could get along in the confined space of our trailer and in a setting where we spend almost all our time together for weeks at a stretch. This has never been the case in our marriage, and I think we discovered that the curmudgeon in me comes out in direct proportion to the time I do not spend alone. I need time alone to think my Deep Thoughts, like how long have birds been flying south for the winter?
Millions of years!
Also, we need to work on team trailer-backing since we still do a crappy job of me backing up the trailer as Mary shouts instructions. “NO! Your other left! Turn the wheel this way.” She yells this while inscribing a large circle in the air with her arm, which of course looks backwards to me in my mirror. Meanwhile, neither of us notices that I’m crushing small trees and driving through log fences with the outside, neglected front tire of the truck.
We’re better at this when we’re less tired from driving all day. Too bad we only have to back up the trailer after we’ve been driving all day. Quoth Mary, delivered in a calm but forceful manner: “You need to know that I will walk every fucking mile home if you don’t stop yelling at me like that.” I think that took care of that one problem of mine, anyway. How was I supposed to know I was yelling?
So for our coming winter hajj, we know that we have to drive less and stay longer in one location, and I have to take frequent walks into the desert to think my Deep Thoughts. Also, we have to remember that Scrabble is just a game.
For now, we’re back home where Mary is enjoying not getting ready to go back to work next Monday. This is the best part of early-stage retirement. It hits you about twelve times a day and by itself is enough to overcome any background existential angst, chronic depression, or even a toothache, which Mary has; thank God she got an emergency appointment to see the dentist today.
I’m watching all the motorcycle races I taped while I was gone and thinking about making a little bike trip sometime in about a month. It’s good to be home, but after two or three days I start to feel a little restless, and fall is the perfect time of year for a motorcycle tour.
Plus, I vant to be alone.
Plus, we saw a bear, our first grizzly in the wild. Mary picked it out from our speeding truck, eating berries about 300 meters away and across a river. Perfect circumstances for extended grizzly viewing through binoculars, so we stopped and watched for some time. Surprisingly, only one other car pulled over. I guess grizzlies are about as routine up there as deer are here. No one stops to look at deer in deer country, unless you just hit one in your car. On a motorcycle, you will definitely stop.
Of course, bear photos taken with our pocket digi-cam only show a brown dot in the bushes, so you’ll have to take our word for it. Here’s what the bear looks like in our photos:
.
This trip was something of a trial run for a planned excursion this winter when we hope to head to the southwest for two or three months. Mary’s thinking two, I’m thinking three. I guess this will make us snowbirds, a label I don’t particularly like because it evokes pictures of elderly couples pulling trailers or driving motorhomes the size of an army barracks and staying in “parks” which are actually little parking lots with personal sewer hookups. Said elderly couples rarely leave their trailers since they can now automatically level themselves from inside and deploy their satellite dishes so the TV can go on even before their canopy automatically rolls out.
I think of us as more akin to the Lewis and Clark expedition if Lewis and Clark had a Dodge ¾- ton with a Cummins Diesel to pull their chuck wagon.
But then I don’t really have a better name than "snow birds" to describe us since “explorers” is an obvious stretch. Besides, birds have known for millions of years that when it gets really cold and the nights are long, you can just go south. They deserve respect for that, though I consider myself smarter that the average bird, so we’re going to see if it works for us.
We wanted on this last trip to see how well we could get along in the confined space of our trailer and in a setting where we spend almost all our time together for weeks at a stretch. This has never been the case in our marriage, and I think we discovered that the curmudgeon in me comes out in direct proportion to the time I do not spend alone. I need time alone to think my Deep Thoughts, like how long have birds been flying south for the winter?
Millions of years!
Also, we need to work on team trailer-backing since we still do a crappy job of me backing up the trailer as Mary shouts instructions. “NO! Your other left! Turn the wheel this way.” She yells this while inscribing a large circle in the air with her arm, which of course looks backwards to me in my mirror. Meanwhile, neither of us notices that I’m crushing small trees and driving through log fences with the outside, neglected front tire of the truck.
We’re better at this when we’re less tired from driving all day. Too bad we only have to back up the trailer after we’ve been driving all day. Quoth Mary, delivered in a calm but forceful manner: “You need to know that I will walk every fucking mile home if you don’t stop yelling at me like that.” I think that took care of that one problem of mine, anyway. How was I supposed to know I was yelling?
So for our coming winter hajj, we know that we have to drive less and stay longer in one location, and I have to take frequent walks into the desert to think my Deep Thoughts. Also, we have to remember that Scrabble is just a game.
For now, we’re back home where Mary is enjoying not getting ready to go back to work next Monday. This is the best part of early-stage retirement. It hits you about twelve times a day and by itself is enough to overcome any background existential angst, chronic depression, or even a toothache, which Mary has; thank God she got an emergency appointment to see the dentist today.
I’m watching all the motorcycle races I taped while I was gone and thinking about making a little bike trip sometime in about a month. It’s good to be home, but after two or three days I start to feel a little restless, and fall is the perfect time of year for a motorcycle tour.
Plus, I vant to be alone.
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