[culture] The politics of American healthcare
Having a bit of a discussion on Facebook with my friend Bryan Schmidt. We don’t agree on much politically, but we manage to get along just fine, and remain happily civil when we get into political interchanges. My response to his remarks from overnight was such that I’ve decided to promote it to a blog post.
Jay, I have a friend in England who hs been denied surgery by their public healthcare several times for surgery the govt claims is non-essential but his doctor says is. In fact more than one doctor because he got multiple opinions hoping to influence the govt decision.
Unlimited government healthcare can be great stuff.
As the case may be, though I’d hardly describe the UK system as “unlimited” anything. I’ll point out also that no system is perfect, but the UK has the virtue of nearly universal coverage without significant compromise in social outcomes measured by infant mortality, average life expectancy, etc., where in many cases their system provides superior outcomes to the American system.
Also, though you did not raise this point as such, I’d like to highlight the fact that many Americans don’t understand the difference between “single payer” and “single provider” systems. This is largely because the GOP, the AMA and the insurance industry have spent the years since WWII throwing up a deliberate cloud of confusion about “socialized medicine” in order to short-circuit any reasonable discussion of these concepts.
The UK has a single provider system. Canada has a single payer system. In the US, the VA medical system is an example of single provider. Medicare is an example of single payer. Oddly, most people in both those systems like them quite a bit, and would be appalled to discover they are victims of socialized medicine.
The issue is not privatization, it’s capitalism. HMOs and drug companies and our culture of greed have created a health care environment where the rich get the best and everyone else settles.
I don’t think we disagree much here. Healthcare is a market segment where the profit motive is fundamentally at odds with the nominal mission, which creates a permanent tension.
The government can’t run health care any better than any other of its failed, mismanaged programs, espc. In this culture of greed.
Now you’re falling into empty conservative rhetoric. Ronald Reagan’s greatest, most successful lie was “Government is the problem.” Government is no more automatically prone to failure than the private sector is automatically prone to success. The private sector fails all the time. Look at the statistics on the number of private sector mergers and acquisitions that meet their stated financial and business goals. It’s abysmally low. Likewise, look at the statistics on how many major IT projects are cancelled or truncated. If the market were the magic conservatives like to think it is, companies would never go out of business.
Similarly, plenty of government programs work very well. Emergency services, for example. Virtually every community in the United States has a publicly-operated fire department, which generally enjoy sufficient funding and little political opposition. And fire departments tend to poll very well. How well would private sector fire departments function?
When you make a baseline assumption that everything government does will be a mismanaged failure, you’ll find plenty of evidence for that due to observational bias.
For whatever it’s worth, I don’t presumptively assume that government healthcare is the answer. As it happens, Medicare is by far the most efficient healthcare funder in this country, measuring by overhead. That is to say, Medicare spends a larger percentage of every dollar on healthcare than any private sector insurance provider. It also polls very well in customer satisfaction. Hardly a failed, mismanaged program.
What government’s proper role here is in regulation. That’s how our system is established, right there in the Constitution, Article I, Section 8, Clause 3 — Congress is given the responsibility “To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes”.
The conservative panacea of industry self-regulation is a laughable myth. This has been demonstrated over and over again through our history, from the Gilded Age to Enron to the Wall Street derivatives nonsense of recent years. For-profit companies are by design and law intended to maximize both revenue and profit. Our current system evaluates this on a quarterly basis, with the “long view” being a year or two. There are explicit structural incentives for private health insurance providers to limit payouts, and reduce or eliminate coverage for expensive insureds. Like, say, me.
So whether government enters the coverage business directly (say, by expanding Medicare) or simply regulates the behavior of insurance providers, it must have a role.
Also, for more on my response to Ronald Reagan’s anti-government rhetoric, see this post of mine.
If we want to change health care, we need to redefine it as about “Care” and “Health,” not a family’s egos. When the Schiavos can waste hundreds of thousands of dollars and resources keeping alive their dead daughter, money and resources better spent on someone with the hope of a quality of life, while other people die of diseases and injuries we long ago learned how to easily treat, the system is broken not from conservatism but from its heart. It’s not about what it’s supposed to be about, but the soft, bleeding heart Americans can’t give up, can’t let people go, can’t allow our loved ones to die. Fine if those poor people do, but not our families.
The Schiavo case is a very odd example to cite in making a conservative argument, given the specifics of it. Her life was prolonged (at great expense, as you point out) against the wishes of her husband through the effort of significant conservative legal and political muscle, given that her parents had rallied the Right-to-Life movement. That was pretty much the opposite of bleeding heart liberalism, forcing government intervention into a private family matter and seeking to remove the decision from the hands of her husband, where it legally and morally rested. Conservative action prolonged Terri Schiavo’s life, extended the expense for years, and made a political and media circus out of the tragedy of her death.
Speaking as someone who’s been at death’s door more than once in the past two and a half years (I came within about two minutes of death at the time of my original ER admission that led to the primary cancer diagnosis), I’d strongly prefer my loved ones not let go and allow me to die. I don’t think it’s a simple as people being willing to let go, and I don’t think that’s a “bleeding heart” issue.
It’s a sick, corrupting philosophy which government control doesn’t change. I’ve been around the health industry all my life. My dad’s a doctor, mom’s a nurse, dad trained paramedics and techs, uncle developed ultrasound tech and died of cancer for his effort — it’s a bigger problem than “limited government.” It’s an attitude.
Again, I don’t think the American dysfunction around end-of-life issues is an inherently political issue, though it is certainly subject to politicization. Palin’s mendacious “death panels” meme is a very good example of conservatives explicitly undermining efforts to make end-of-life care reasonable, for example. The dysfunction is much deeper in our national psyche than that.
Tags: Cancer, Culture, health, healthcare, Politics
Posted: 5:28 am Thu July 29 2010 | Comments(9) |
[politics|culture] Opinions and those inconvenient facts
Among other political and cultural hobby horses of mine, I rattle on a lot about evolution denial in education. Likewise the gross historical revisionism of the Texas Textbook Commission. There’s a reason for that, beyond my dedication to intellectual honesty and my aversion to hypocrisy.
Opinions, even those that come in the form of sincerely-held, passionate beliefs, do not substitute for facts. Especially inconvenient facts that contradict those opinions.
Yet when we teach kids in school that the objective evidence of the natural world can be disregarded for a subjective religious belief, we are teaching them exactly that. We are fundamentally undermining critical thinking and replacing it with magical thinking.
Magical thinking is something you see all time in adults. I don’t know a single writer who doesn’t indulge in it as part of preparing their writing mind. (Myself included.) Anyone who has a lucky hat, or cannot write without their tea in a special mug, or any other ritual, is doing this. But most of us understand that. I’m feeding the mythos part of my mind when I say I can only write on the Mac laptop, not the Dell. There’s no objective reason I can’t do it the other way around.
But I know I’m doing this. I don’t confuse my own rituals and magical thinking with the objective reality of the world around me.
One of my big quarrels with the contemporary conservative movement, both in its media form (FOX, etc.) and in its political form (GOP, Tea Party) is the pervasiveness of magical thinking they indulge in, and their overwhelming tendency to confuse opinions with facts. Yes, that’s human nature, and we all do it, but movement conservatism has institutionalized this as policy.
Note this item from a recent New York Times/CBS poll of the Tea Party:
Regardless of your overall opinion, do you think the views of the people in the tea party movement generally reflect the views of most Americans? 84% of the self-identified teabaggers said yes. Only 25% of the general public agreed.
These people honestly believe their view is a majority view. They’re not interested in facts. These people also honestly believe that Obama is a Muslim and was not born in the this country.
And outside of the fringe, you see the same magical thinking. Every time the Republican leadership gets into the media and talks about America being a center-right nation, they’re wrong on the face of both the polling and the electoral results. It’s a narrative they believe in, and need to be true to back their political stance, but it simply isn’t true. Any more than their narrative that a majority of Americans want to repeal HCR is true. Similarly, back in the 2000 election, when the Clinton economy was going strong, Bush advocated tax cuts to stimulate further growth. When the economy began to collapse in the face of an oncoming Republican victory, Bush advocated tax cuts to combat economic contraction. That’s like saying you use the gas pedal in your car both to speed up and slow down.
All this confusing opinions with facts? A lot of it comes down to how you’re educated and socialized in the first place. The conservative attack on education, which in its current form has been in play since at least the Reagan years, is about nothing more or less than raising citizens who don’t know how to question their own position, who will uncritically accept passionate statements as truth, and who, like evolution denialists, eagerly embrace their own opinions as facts, unswayed by the reality of the world around them.
Censoring reality is profoundly unAmerican and unpatriotic, and it’s a core conservative value, starting in the grade schools and going right on to the memory hole of FOX News, the GOP and the Tea Party. Reality is unforgiving, those opinions still aren’t facts; but politics is infinitely malleable, as the activists and leaders of this movement well know.
Tags: Culture, Politics, Process, Writing
Posted: 4:46 am Fri April 16 2010 | Comments(12) |
[culture|writing] Outer Alliance Pride Day
As a member of the Outer Alliance, I advocate for queer speculative fiction and those who create, publish and support it, whatever their sexual orientation and gender identity. I make sure this is reflected in my actions and my work.
Today is the Outer Alliance’s first “event”. The idea is both for members to show their support and post an example of queer speculative fiction. Here’s a brief excerpt from my story, “An Elderly Pirate Recalls the Death of Love”, from Electric Velocipede issue 17/18:
Boys love other boys. It’s the way of things. They’re like dogs playin’ together in the fields of their youth. Then they grows to be a man, each in his one way. This one takes up a plow, that one swears on the queen’s shilling, the other turns his collar around and speaks with a mouth full of lemons all the rest of his days.
Ain’t none of ‘em has the courage to allow to what he whispered ‘neath a lavender moon on a summer night when he was fourteen or fifteen. They stand in their ranks all polished and brave, and remember what it was like to share the hand of another man, to bend down and be schooled hard, to stand up and give their all, then they blush with shame while their peter quivers and weeps.
Don’t you make no mistake, though. It was real love, the true love of the boy in the mirror and the boy in the fist all at once. Some of us had the kidney to remember that as the years went on, and some of us kept looking for it in dockside bars and tiny creaking cabins, or in the alleys behind houses where women opened up their charms.
I took Little Ronnie Alton off the second Kennesaw, on a night when the waves was racing mast-high and whatever dwells down deep had churned up for a cold, curious peep at the sky. It was when I had Agricola, my second command she was, a good ship and false as winter warmth.
What? Oh, that. Think about it for a moment. A pirate’s ship will always be false, for even the timbers must needs be clever. A clever sharp will run an honest man into the ground every time. Why should ships be any different?
Tags: Culture, stories, Writing
Posted: 3:14 am Tue September 01 2009 | Comments(6) |
[personal|culture] On bad news
Today is the twenty-third anniversary of the Challenger disaster. I was walking from one building to the other at my workplace, my senior year in college. A small locksmith was located between the two. Glancing in, I saw several people at the counter staring at a white column of smoke on the television. I’d like to say I understood in an instant (as in fact I did when I first glimpsed the news of Columbia‘s death seventeen years later), but all I knew in that moment was that something unusual had happened.
One way of looking at life is that it is made of disasters. Everyone is born in a rush of light and noise and separation, everyone dies eventually, everyone’s heart breaks along the way, we all pass times alone and in pain. Language Log talks today about giving the bad news, in that case terminal cancer diagnosis. My own cancer experience this past year wasn’t terminal, far from it, but being told I had cancer was one of the most frightening experiences of my life, and I remember vividly the doctors coming, vaguely embarrassed, unhappy, bearing words their lips did not want to pour into my ear.
But my disaster would have been intensely private, confined to me and those who know me and love me. STS-51-L played theirs out on a very public stage. Intensely private for each of the seven crew, as all deaths are — the ultimate intimacy — but exposed to the watching world.
Another way of looking at life is that it is made of miracles. We are born into the waiting world, we pass on after a lifetime of experience, with even a little of luck we live and love and follow our hearts. That’s the way I imagine the Challenger seven would want to be remembered. Not for their last moments, but for their best moments.
And, because it seems fitting this day, here’s my Challenger story, “The Angle of My Dreams.“
Tags: Cancer, Culture, Language, Personal, Science, stories
Posted: 5:42 am Wed January 28 2009 | Comments(0) |
[links] Link salad for a Sunday
Undersea webcams — Some cool stuff. (Thanks to lt260.)
Team records ‘music’ from stars — More on COROT and the observation of stellar interiors, this one with a slightly whimiscal bent.
ACLU: 2/3 of US population lives in “Constitution-free” zone — An article about the Border Patrol and Fourth Amendment rights. (Thanks to chriswjohnson.)
Palin’s ‘going rogue,’ McCain aide says — How about that rigorous vetting process, Mr. Straight Talk? (Special bonus, Language Log comments on the usage of the term “going rogue”.)
Dark Night of the Soul — Barack Obama is noted for his powerful intellect, but I don’t think he gets nearly enough credit for the mental dexterity it takes to be simultaneously an Islamic theocrat, atheistic communist and national socialist while posing as a center left candidate. Hahahahahaha. Being a Republican these days is like being OJ’s defense lawyer back in the day. You throw everything you have against the wall regardless of logic or evidence and hope some of it sticks. Unfortunately for the reality-based community, some of that stuff does stick. OJ was acquitted, after all.
ericjamesstone on Obama, Iraq and Afghanistan — I disagree with his argument on a number of levels, but he’s a thoughtful guy with whom I disagree with on a lot of things. In short, the high level argument about Obama makes some assumptions which strike me as facile, while the subordinate argument on both Iraq and Afghanistan seems to hing on logic which says “we in too deep to stop now.” Even if you take the Bush Administration’s stated war aims at face value, we’ve long since passed the point of removing Saddam from power, destroying Iraqi state sponsorship of terrorism and eliminating the threat of Iraqi WMDs. Under Eric’s argument, there seems to be no point where changing policy conditions and changing goals ever enter into the question. “Never stop fighting until we win” is not a strategy, it’s a hope.
10/26/08
Body movement: 2 hour, 35 minute suburban walk
Last night’s weigh-out: n/a
This morning’s weigh-in: 227.6
Currently reading: The Best of C.M. Kornbluth
Tags: Iraq, Links, Personal, Politics, Science
Posted: 7:49 am Sun October 26 2008 | Comments(0) |
[culture] I can’t sleep, why should you? Miscellanea from 2 am.
Awake in the middle of the night here in Seattle. The Locus Awards were fine and fun. My shirt tied for third in the ritual Hawaiian shirt contest. (I was robbed, I tell you — if we were judging under last year’s rules I’d have swept it.) Various eliminatory issues are keeping me from sleeping, so naturally my thoughts turn to the sort of random crap that enters my head at two in the morning. Such as these potential discussion items:
- I recently observed in someone’s comment thread that a vanished culture seems to be able to leave certain things behind. Specifically, literature (The Odyssey is an example of this), art/architecture (much of ancient Rome), and toponyms (the Native American legacy embedded in many American place names). Thoughts?
- Once our culture vanishes, future historians may well adopt May 31st, 2003 as the date from which the decline of the American Empire became inevitable. That’s when US Highway 666 was renumbered to 491, in order to “get the devil out.” The primacy of superstitious nonsense in the setting of public policy has driven this country to bizarre extremes in research, education, family planning and foreign policy, but even highway numbering fell victim. (And to give shame where shame is due, this moronic alteration occurred under the stewardship of New Mexico governor Bill Richardson, a Democrat.)
- It occurred to me this evening that given roughly my same medical and life history (a gross simplification), under pre-modern conditions i would have died around April 30th of this year at age 43, direct cause of death being uncontrolled internal bleeding. As it happens, I’ve also been in the ER twice for closed head injuries, along with experiencing other miscellaneous potentially fatal complaints such as tuberculosis. Anyone who’s ever had major trauma surgery, lives with severe allergies or an autoimmune disorder, experienced a major bacterial infection, or has simply taken a good, hard fall down the stairs is likely living on borrowed time. When would you have died under pre-modern conditions?
Tags: Conventions, Culture, Personal, Seattle
Posted: 2:34 am Sun June 22 2008 | Comments(3) |
[culture] More on the ethics of contact
An observation, and a meta-observation, on my recent post about the ethics of contact.
Observation: Some very good, thoughtful comments have showed up in the thread at jlake.com, including several from people living in South America who have much closer exposure to the issue than most of us in North America.
Meta-observation: Some reactions to my post, both in my comment threads and elsewhere, have been fairly horrified, along the lines of “how could you consider such a thing?” Actually, my intention in my original post was to be very considered, and I believe I concluded with a very specific point against making contact. At the same time, I also note a tendency to conflate a pre-modern life with wisdom or closeness to the planet. That strikes me as a kind of romanticized prejudgment that’s potentially misplaced.
There’s also an implicit challenge (not in a confrontational sense, but in an evidentiary sense) to my standing in even having an opinion — analogous to one that surfaces when white people talk about minority issues, or men talk about women’s issues, for example. The same tension exists in fiction, balancing between writing what you know (middle aged white men, in my case) and stepping outside yourself and thus being vulnerable to criticism for “not getting it right” — I’ve most run into that when writing about Native American characters. It’s a reasonable challenge for me as a writer, as a blogger-cum-cultural-commentator, and as a human being; one that keeps me mentally and emotionally on my toes.
I will say on the topic of standing that I was born and raised in the Third World. I spent much of my childhood frequently encountering people for whom a dumpster to sleep in would have been a vast improvement. (I was always wrapped in a cloak of Western privilege, with a dry bedroom, air conditioning and good food.) Close observation of destitution has leached the romance out of “being closer to the environment” for me. While I am just as much a product of my culture as an uncontacted tribesperson is of theirs, I am not wrapped so closely in my own cultural assumptions that I can’t see them for what they are.
Tags: Culture, Personal
Posted: 6:24 am Fri June 20 2008 | Comments(0) |
[culture] The ethics of contact
I had the radio on briefly during my lunch break, and learned the startling (to me) information that there may be as many as 60 different “uncontacted tribes” in the upper Amazon Basin. Apparently about 45 are in Brazil, and 15 in Peru. The discussion was that Peru is more interested in opening resource exploitation than in cultural protection, while Brazil has an active, long-term policy to keep their “uncontacted tribes” safely isolated. Many of these tribes are thought to be the descendants of refugees and tribal elements fleeing violent contact in prior centuries, and virtually all of them discourage outsiders by violent and even fatal means. Some of them are referred to as “The People of the Arrow.”
The past 500 years of European history have drawn some stark lessons in the ethics of contact. At least part of the Brazilian policy is based on the abysmal healthcare consequences of contact — past tribal contacts have lead to epidemic deaths within weeks of first encounter not unlike the general decimation of tribes in the Americas in the early 16th century. (See 1491 by Charles C. Mann [ Amazon
] for more on this.)
I began turning over the ethics of contact in my head. European, and specifically Anglophone, history on this topic is staggeringly ugly, more so than most of us are willing to admit. Yet at the same time, I am bothered by the notion of leaving people without the opportunity to choose sanitation, healthcare, reduced infant mortality, education access, increased life expectancy, and the whole array of life choices attendant on modern culture when it is functioning correctly.
It is very hard for me to see what is right here. The question is essentially moot for me personally — I am highly unlikely to ever need to make a choice regarding an uncontacted tribe. At the same time, I can argue a number of sides of this question with equal passion. And I do appreciate the value of an extremely conservative, preservationist approach to the uncontacted tribes. Some mistakes can never be undone.
I believe I shall explore this in fiction. Your thoughts?
Bonus question: Would differing immune system requirements be one of the greatest dangers to a time traveller?
Tags: Culture, Fiction
Posted: 4:09 pm Tue June 17 2008 | Comments(7) |
|