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Not Very NICE

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Investor’s Business Daily posted an article relating Obama’s Healthcare Bill to the National Institute for Health and Clinical Excellence (NICE), the technocrats responsible for the U.K.’s health care.  The article states:

This administration, pledging to cut medical costs and for which “cost-effectiveness” is a new mantra, knows that a quarter of Medicare spending is made in a patient’s final year of life. Certainly the British were aware when they nationalized their medical system.

The controlling of medical costs in countries such as Britain through rationing, and the health consequences thereof are legendary. The stories of people dying on a waiting list or being denied altogether read like a horror movie script.

The U.K.’s National Institute for Health and Clinical Excellence (NICE) basically figures out who deserves treatment by using a cost-utility analysis based on the “quality adjusted life year.”

One year in perfect health gets you one point. Deductions are taken for blindness, for being in a wheelchair and so on.

The more points you have, the more your life is considered worth saving, and the likelier you are to get care.

The British are praised for spending half as much per capita on medical care. How they do it is another matter. The NICE people say that Britain cannot afford to spend $20,000 to extend a life by six months. So if care will cost $1 more, you get to curl up in a corner and die.

These NICE people bring to mind another technocratic group I’ve read about called the “National Institute of Coordinated Experiments (NICE)” in C. S. Lewis’s 1945 novel That Hideous Strength: a Modern Fairy-Tale for Grown-Ups.  Those NICE folks in Lewis’s novel were an institution which would decide who lived and who died in accordance to their agenda of control and advancement of the remaining people into a Utopian, omni-competent and global scientific technocracy. That Hideous Strength was the fictional representation of the governmental materialism and scientism philosophy of social control Lewis described in The Abolition of Man, in which Lewis explains:

It is the magician’s bargain: give up our soul, get power in return. But once our souls, that is, ourselves, have been given up, the power thus conferred will not belong to us. We shall in fact be the slaves and puppets of that to which we have given our souls. It is in Man’s power to treat himself as a mere `natural object’ and his own judgements of value as raw material for scientific manipulation to alter at will. The objection to his doing so does not lie in the fact that this point of view (like one’s first day in a dissecting room) is painful and shocking till we grow used to it. The pain and the shock are at most a warning and a symptom. The real objection is that if man chooses to treat himself as raw material, raw material he will be: not raw material to be manipulated, as he fondly imagined, by himself, but by mere appetite, that is, mere Nature, in the person of his de-humanized Conditioners.

The Investor’s Business Daily article continues:

The British [NICE] have succeeded in putting a price tag on human life, as we are about to.

Can’t happen here, you say? “One troubling provision of the House bill,” writes Betsy McCaughey in the New York Post, “compels seniors to submit to a counseling session every five years (and more often if they become sick or go into a nursing home) about alternatives for end-of-life care (House bill, Pages 425-430).”

One of the Obama administration’s top medical care advisers is Oxford- and Harvard-educated bioethicist Ezekiel Emanuel. Yes, he’s the brother of White House Chief of Staff Rahm Emanuel and has the ear of his brother and the president.

“Calls for changing physician training and culture are perennial and usually ignored,” he wrote last June in the Journal of the American Medical Association. “However, the progression in end-of-life care mentality from ‘do everything’ to more palliative care shows that change in physician norms and practices is possible.”

Emanuel sees a problem in the Hippocratic Oath doctors take to first do no harm, compelling them “as an imperative to do everything for the patient regardless of cost or effect on others,” thereby avoiding the inevitable move toward “socially sustainable, cost-effective care.”

C. S. Lewis, in his essay “Is Progress Possible? Willing Slaves of the Welfare State“, articulates the danger of this mentality,

Again, the new oligarchy must more and more base its claim to plan us on its claim to knowledge. If we are to be mothered, mother must know best. This means they must increasingly rely on the advice of scientists, till in the end the politicians proper become merely the scientists’ puppets. Technocracy is the form to which a planned society must tend. Now I dread specialists in power because they are specialists speaking outside their special subjects. Let scientists tell us about sciences. But government involves questions about the good for man, and justice, and what things are worth having at what price; and on these a scientific training gives a man’s opinion no added value. Let the doctor tell me I shall die unless I do so-and-so; but whether life is worth having on those terms is no more a question for him than for any other man…

On just the same ground I dread government in the name of science. That is how tyrannies come in. In every age the men who want us under their thumb, if they have any sense, will put forward the particular pretension which the hopes and fears of that age render most potent. They ‘cash in’. It has been magic, it has been Christianity. Now it will certainly be science…We must give full weight to the claim that nothing but science, and science globally applied, and therefore unprecedented Government controls, can produce full bellies and medical care for the whole human race: nothing, in short, but a world Welfare State. It is a full admission of these truths which impresses upon me the extreme peril of humanity at present.

We have on the one hand a desperate need; hunger, sickness, and the dread of war. We have, on the other, the conception of something that might meet it: omnicompetent global technocracy. Are not these the ideal opportunity for enslavement? This is how it has entered before; a desperate need (real or apparent) in the one party, a power (real or apparent) to relieve it, in the other. In the ancient world individuals have sold themselves as slaves, in order to eat. So in society. Here is a witch-doctor who can save us from the sorcerers — a war-lord who can save us from the barbarians — a Church that can save us from Hell. Give them what they ask, give ourselves to them bound and blindfold, if only they will! Perhaps the terrible bargain will be made again. We cannot blame men for making it. We can hardly wish them not to. Yet we can hardly bear that they should.

The question about progress has become the question whether we can discover any way of submitting to the worldwide paternalism of a technocracy without losing all personal privacy and independence. Is there any possibility of getting the super Welfare State’s honey and avoiding the sting?

58 Replies to “Not Very NICE

  1. 1
    David v. Squatney says:

    Hm, Investor’s Business Daily, isn’t this the same outfit that claimed:

    People such as scientist Stephen Hawking wouldn’t have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless”

    More to the point, isn’t it clear that these same sorts of decisions are made by health insurance companies (provided you are fortunate enough to have health insurance)?

  2. 2
    lamarck says:

    The solution is more taxes and more control. We won’t make it out of this mess otherwise.

  3. 3
    GilDodgen says:

    A couple of years ago my mother, at age 86, was run over by a drunk driver. My mom was walking her dog, whom she rescued from an abusive owner. The dog was killed instantly, and my mother was thrown down the street by the impact.

    She was taken to an intensive-care unit in Spokane, Washington by helicopter. It is a complete and utter miracle that she survived. She was at death’s door and there was no realistic prospect that she would survive, at least without being a hopeless vegetable.

    This cost a lot of money.

    She not only survived, but is now her old self, and our family had a great reunion for Thanksgiving in 2008 and in June of this year.

  4. 4
    Frost122585 says:

    If we had any more money to give to taxes I think you would see people investing it in the stock market. The US people are already tapped.

  5. 5
    lamarck says:

    Obama’s entire cabinet are members of the CFR. Here’s a video explaining what this health care bill is actually about:

    http://www.youtube.com/watch?v=7nD7dbkkBIA

  6. 6
    Frost122585 says:

    The apparently the 2nd law applies to liberty, freedom and quality of government as well.

  7. 7
    johnnyb says:

    I get sick when I think about Obama’s statements about health care. He says things like (paraphrasing) “today is the day we will start healing the sick”. But in fact it is just the opposite. A relatively healthy person simply doesn’t need that much health care. If we limited health insurance to only people that (a) were well, or (b) we could expect to get well, it wouldn’t cost much money at all. The _reason_ health care costs a lot of money (beside the beaurocracy and trial lawyers) are that we want our health to be covered even when we are sick without hope of recovery. THAT IS THE ENTIRE REASON WE HAVE INSURANCE! Without that, the idea of paying for insurance would be laughable.

    In America we take care of our sick, and our elderly, because, as humans, that’s the right thing to do. One of the greatest organizations in the world is the Little Light House, a private, tuition-free preschool for special needs kids. That’s what we do as God-fearing people – we take care of the least of these.

    Yesterday, we found out what we had already suspected – that our 9-week-old son has Cytochrome-C Oxidase Deficiency – a metabolic condition that our oldest son did not survive (just as a note – we have had three healthy children in the meantime). He’s been in the hospital ICU for over a month, and we’re not seeing the light at the end of the tunnel for coming home, and when we do, it will likely be on a respirator.

    Here’s the deal – at least according to medical science, he will never be able to be a productive member of society. But, as a human, he is made in the image of God. No matter whether or not he is ever able to give anything back, he is worth saving – or at least trying to save – because he bears God’s image.

    And that’s what we bought into when we bought health insurance. We bought the knowledge that, no matter what his prognosis was, we were going to have financial help.

    There are a lot of things wrong with U.S. health care. I’ve seen them all up-close and personal. But the one thing that our health care system actually does, and DOES VERY WELL, is treating you as fully human, even if you’re not likely to survive the week.

  8. 8
    Borne says:

    Great post.
    Mortification and a monster police state is coming to America.

    A “brave new world” order of atrocities preached and practiced by the materialist scientific elite and their cronies. All enforced by Obama’s personal army – its at the doors.

    CS Lewis was prophetic in his insight into the world of scientism and it’s intrinsic dehumanization and consequent horrors.

  9. 9
    IRQ Conflict says:

    Praying for your son johnnyb.

  10. 10
    Sal Gal says:

    Hm, Investor’s Business Daily, isn’t this the same outfit that claimed:

    People such as scientist Stephen Hawking wouldn’t have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless”

    Yes, it is. And when Hawking responded by saying that he had gotten fabulous care, and that he would not be alive today otherwise, Investor’s Business Daily retracted the statement about Hawking without any hint of what he had said.

  11. 11
    jerry says:

    “Yes, it is. And when Hawking responded by saying that he had gotten fabulous care, and that he would not be alive today otherwise”

    Does everyone in the same situation get fabulous care in the UK? People here different things about the UK and Canada.

  12. 12
    JTaylor says:

    JohnnyB: “In America we take care of our sick, and our elderly, because, as humans, that’s the right thing to do.”

    We do? Perhaps the care is good, but the cost can be extreme. There’s data to suggest that about 50% of all personal bankruptcies are due to serious illnesses where people did not have adequate health insurance.

    Is allowing people to go bankrupt ‘taking care of them”?

    JohnnyB’s America sounds great but sadly it is not the one that millions and millions of people are experiencing.

  13. 13
    kairosfocus says:

    “Life unworthy of being lived,” anyone . . .

  14. 14
    Reg says:

    Hm, Investor’s Business Daily, isn’t this the same outfit that claimed: ”People such as scientist Stephen Hawking wouldn’t have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless”

    Yes, and the claim is still there in the audio reading of the article (“Listen to Audio Version” link on the article page, 2:38 in).
    Stephen Hawking was born in, and has lived his entire life in, the U.K.
    Does everybody in the same situation get fabulous care? I don’t know. But what assuredly does not happen is that the NHS decides a person’s “life is essentially worthless” because of their handicaps and sends them “to curl up in a corner and die”.

  15. 15
    IRQ Conflict says:

    “JohnnyB’s America sounds great but sadly it is not the one that millions and millions of people are experiencing”

    One has to wonder how many millions are illegal immigrants.

  16. 16
    Seversky says:

    This Investor’s Business Daily reads more like a pernicious piece of propaganda. As Sal Gal has pointed out, they have already been forced to retract the comments about Stephen Hawking since he is alive today because of the treatment he received under the National Health Service, long before he could afford private care.

    When the NHS was first set up in 1948, although there was some opposition from the private sector of the period, it was generally hailed for providing good, basic healthcare to all that was free at the point of use. By funding the service out of general taxation, it was felt that the financial burden was being spread evenly.

    What was not anticipated was the burgeoning increase in cost that followed new and ever-more-expensive drugs and medical technologies and a population in which a greater proportion lived much longer as a result of better care.

    Yes, there is rationing in the UK, just as there is in every other healthcare system in the world. It is almost axiomatic that even the wealthiest nations could spend their entire gross national product on healthcare and still not be able to provide everything that is needed.

    Where resources are limited there will always be hard choices to be made. Treatment and facilities in the US under the private system are unquestionably amongst the best in the world but anyone who doesn’t think the US has rationing is simply not looking closely enough at what is happening. For example, you have insurance companies fighting tooth-and-nail against providing expensive and/or long-term treatment. And what would you call having 43.7 million of your population priced out of the private system other than brute force rationing by the somewhat ironically-named free market?

    The basic truth for all systems is that providing healthcare is expensive and becoming more so year by year. What both American and British consumers have noted is that, for all its faults, no one – but no one – is bankrupted by being unable to pay huge medical bills under the British system.

  17. 17
    JamesBond says:

    Jerry:

    “Does everyone in the same situation get fabulous care in the UK? People here different things about the UK and Canada.”

    I work in the NHS (in a non-medical job), and unfortunately my father recently had a very serious medical emergency (rushed to A&E, emergency surgery, 50/50 chance or surviving, etc).

    My aunt was also a nurse with the NHS for many years, in Cambridge, at one of the hospitals where they’ve worked with Stephen Hawking a lot.

    My (our) experiences with the NHS have always been positive. Sure, it’s not a perfect system, but it’s a lot better than

    NICE isn’t a death-panel orwellian nightmare. Someone has to decide what treatments are appropriate, and what treatments don’t work well enough to use regularly. With things like cancer drugs, you’re often looking at very expensive and intensive treatments which might have a 12% chance of increasing life expectancy by a few months. That’s fine, but what if those few months have to be spent in hospital? And the drugs slowly destroy your liver as well? It’s this kind of stuff that they look at very carefully.

    And it’s exactly what your medical insurance companies do, in the US. I would imagine they are even more stringent than NICE, because they are all about maximising profits for their shareholders. This is why so many things “aren’t covered” by medical insurance over there. I can’t imagine having to deal with an insurance company when my dad was lying in hospital in intensive care.

    And just like in the US, if you want a treatment that NICE has deemed inappropriate or ineffective, you can still pay for it and get it privately. We have BUPA, a medical insurance company who have their own hospitals and everything.

    And what’s more, remember that NICE Guidelines are just that, guidelines issued to the NHS. If a doctor decides that medically he believes a treatment will work for you against NICE Guidelines, he can give it to you. He may have to present his case to his hospital board or something, and he’ll have to have a good reason, but the NICE Guidelines aren’t laws or commandments.

    The NHS has been going strong for 60 years. It’s not a perfect system, but I personally have only ever had good experiences with it. I would never want to live in a country without an NHS-like system.

  18. 18
    JamesBond says:

    Sorry for double posting, but I just wanted to add that my defense of the NHS doesn’t mean I think it will work in the US.

    I do think you guys could implement a great public healthcare system, but obviously it has to be thought out very carefully. It will have to be different from the NHS because the US is a different country with its own needs (you’ll need a lot more gun-shot treatment experts!)

    But it does anger me greatly when people in the US point to the NHS system as a broken, orwellian, death-squad led, failing, murderfactory. It’s not. It’s bloody fantastic (no pun intended).

  19. 19
    jerry says:

    “This is why so many things “aren’t covered” by medical insurance over there.”

    I believe that most people are quite happy with their medical insurance here. The current attack by Obama is on the insurance companies because he thinks that will resonate. So far it hasn’t. It is a political move only and is meant as a scare tactic since the other tactics have not worked. He is losing his halo with a lot of people. He tried to ram through a major change of the system with no debate and the fine print of the laws are just coming out. The projective start date for the health care changes is January 1st, 2013 yet it had to be passed by August 7th 2009. People are starting to see what a phony Obama is. The so called stimulus bill was not mean to stimulate anything except voters for the Democrat party prior to the next two elections. With the economy bad and the future uncertain, less than 8% of the stimulus bill has been spent six months after it was passed. And that was passed with no debate either because it was said it was necessary to do it immediately. And now he is touting a so called end to the recession due to his stimulus bill.

    Obama ignores a real cost inducer such as the tort system which is the Democrat Party’s number one contributor. Several hundred million dollars in the last election cycle paid for easily with a couple nice law suits. Obama said there will be no reform or restrictions on the lawyers and one of the main Senators supporting Obama, plans to introduce laws to make it possible to sue companies not involved in an incident if they just do business with the sued company. The threat of a law suit more than anything has put our system in a straight jacket. It affects every business decision, not just in medicine.

    I have a close relative who had cancer and saw a doctor admit that she prescribes tests for her patients so that she can avoid a law suit 5 to 10 years down the road. She is not atypical. The rate of cat scans and MRI’s per person here are 4-6 times the average in the UK and other countries. A lot are unnecessary but some will pick up something that wasn’t expected. The system allows this to happen so the doctors prescribe them. A typical post chemo care involves a cat scan every 3 months for the first 6 months and then one every 6 months for the next two years and also a pet scan every two years along with blood test every three months. It is not hard to get a cat scan, MRI or pet scan. If it is prescribed, you can call up and usually get an appointment for the next day or within a week where I live.

    I think you watch too many TV shows to think that gunshot wounds are a major aspect of medical care. That may be true for the military. They do exist in certain urban areas but the major expense is care for the elderly such as cancer, cardio vascular problems and nursing care for dementia. People are living longer and no one wants their mother or father not to receive a test or treatment if it could help.

  20. 20
    bFast says:

    Americans who have health insurance unquestionably have the best healthcare in the world. My father moved from Canada to California after remarrying. He had medical issues that would have been treated very slowly in Canada, but under Medicare were dealt with with haste and competance. He likely would have passed away some years ago without American healthcare.

    On the flip side, I have an American friend who has had a dickens of a time getting private healthcare in the states because of preexisting conditions (type 1 Diabetes). As a result he experienced exhorbitant medical bills.

    15% of Americans, for one reason or other, are uninsured. That 15% would be much better off medically if they lived in Cuba. How the Christian community can say, “hey, my healthcare might be diminished if that 15% gets coverage” is horifically selfish to me. And it seems that the religous right is the biggest single community resisting a universal healthcare solution.

    About the British system, it is famous for its two-tier healthcare. They have a poorly funded government system which provides a heck of a lot better care than the unfortunate 15% of Americans get. They also have a parallel private system that provides world-class care. I believe that nothing said above about the “poor British system” applies to their private care. Nothing in the Obama proposal stops people from keeping their private insurance. As such, the Obama plan, as far as I can see, offers the 15% some reasonable standard of care, but continues to offer you gripers the world-class care that rich Americans can afford.

  21. 21
    vjtorley says:

    I think there are two completely separate issues here: (i) should health care coverage be universal? and (ii) can we trust Obamacare? My answer to the first question would be yes and my answer to the second question would be no.

    My main reasons for answering “yes” to the first question are as follows:

    1. The American health system (which is funded by the private sector) seems to compare very poorly with that of other developed countries, according to this BBC report . Curiously, Singapore seems to come out very well in this comparison. Does anyone know anything about Singapore’s system?

    2. Michael Moore’s Sicko. I realize that the accuracy of the movie has been challenged, and I haven’t seen it myself, but the following extract from the Wikipedia article I linked to sounds pretty damning, in itself:

    According to Sicko, almost fifty million Americans are uninsured and those who are covered are often victims of insurance company fraud and red tape. Interviews are conducted with people who thought they had adequate coverage but were denied care. Former employees of insurance companies describe cost-cutting initiatives that give bonuses to insurance company physicians and others to find reasons for the company to avoid meeting the cost of medically necessary treatments for policy holders, and thus increase company profitability.

    3. See also these two articles which the conservative online Drudge Report linked to recently: The brutal truth about America’s healthcare for horrific first-hand descriptions of the pain and suffering that poor, uninsured people in the U.S. currently have to endure, and this article , which shows the extent of support for universal health coverage in Britain:

    Such is the strength of public support for the NHS in the UK, that the two main political parties have agreed to ring-fence its expenditure in the coming years – in spite of cuts to almost all other departmental budgets.

    Mr Cameron, who leads the Conservative party, once headed by Margaret Thatcher, on Friday described the NHS as one of the UK’s “great national institutions” and said the service was his “number one priority”.

    I wish to state that I am utterly opposed to the Quality of Life Years system used by the UK National Health Service. However, the principle of universal coverage is a separate moral issue, and people in Britain overwhelmingly support it.

    4. If health coverage isn’t universal, poor people will die for want of medical care. See Matthew 25:31-46. Enough said.

    On the second question, “Can we trust Obamacare?” my answer is an emphatic “No.” My reason can be summed up in two words: Ezekiel Emanuel. See Principles for allocation of scarce medical interventions by Govind Persad, Alan Wertheimer and Ezekiel J. Emanuel, in The Lancet, 31 January 2009, vol. 373, pp. 423-431.

    The man’s medical philosophy is positively creepy:

    The death of a 20-year-old young woman is intuitively worse than that of a 2-month-old girl, even though the baby has had less life. The 20-year-old has a much more developed personality than the infant, and has drawn upon the investment of others to begin as-yet-unfulfilled projects.

    Adolescents have received substantial education and parental care, investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments. Similarly, adolescence brings with it a developed personality capable of forming and valuing long-term plans whose fulfilment requires a complete life. As the legal philosopher Ronald Dworkin argues, “It is terrible when an infant dies, but worse, most people think, when a three-year-old child dies and worse still when an adolescent does”; this argument is supported by empirical surveys…

    When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated (figure). (Emphases mine – VJT.)

    In Table 2 of the Lancet article, the authors list as an advantage of their proposed complete lives system of health care, the fact that it “[m]atches [the] intuition that [the] death of adolescents is worse than that of infants or [the] elderly.” (The insertions of “the” are mine – VJT.)

    Evidently, my intuitions and Emanuel’s are poles apart. For me and, I suspect, for most people, the crime of killing a newborn infant is, if anything, more evil than killing an adult. We might pardon a man who murdered another man; but the crime of murdering a child is unpardonable. This tells us that intuitively, people regard babies as being every bit as important as adolescents and adults, if not more so.

    The fact that a man like Ezekiel Emanuel is President Obama’s Health Policy Advisor makes me very worried – not only for America, but also for the rest of the world, which may be influenced by the example America sets.

  22. 22
    JTaylor says:

    Jerry: “I believe that most people are quite happy with their medical insurance here.”

    I found a Gallup poll that indicates that about 57% of people are satisfied and about 40% are not satisfied:

    http://www.gallup.com/poll/102.....hcare.aspx

    Of course this excludes the 45 million or so that do not have any health care insurance – which is really one of the major failings of the American system

    I’m an ex-pat Brit now living in the USA, and my own (admittedly anecdotal) experience is that the quality of healthcare I received in the UK was on a par with what I receive in the USA (through a HMO). Most of my family still live in the UK and it appears that their care is still more than adequate. Of course I lived in the London area (which has some excellent hospitals) and I do know that care can be variable depending on where you live.

    I’m also happy with my healthcare here in the USA – but my major concern is that if my life circumstances changed I could very easily lose that care. If I lost my job I would have to pay (at my age) some $600-700 per month for a plan which would have likely much higher deductibles. I could easily foresee that in this circumstance I may have little choice but to return to the UK (because even though I don’t live there anymore because I’m still a British citizen (dual actually) I’m still entitled to healthcare. Of course if that happens I’ll be removing myself from the economy here..and this seems to me a story nobody is talking about. How much of a drain on the economy is it that people who would otherwise put money into the general US economy are being made bankrupt because of unaffordable health care. Is that the American dream so many have worked so hard for?

  23. 23
    David v. Squatney says:

    vjtorley,

    Curiously, Singapore seems to come out very well in this comparison. Does anyone know anything about Singapore’s system?

    I lived there for a year, but can’t say I know much about their system, except that it was very inexpensive. I saw a GP once or twice and paid about S$20 per visit. A dental checkup and cleaning cost on the order of S$40. I had no insurance at all.

    An elderly relative from Malaysia was hospitalized for a couple of weeks, IIRC, and the bill totaled on the order of S$7000, with no insurance. Excellent care all around.

    I agree with you that health care should be universal, by the way. I have a relative who is a young wife and mother (early 20’s) and who is facing serious but treatable illnesses, including cancer. She and her husband didn’t have a lot of money, and certainly no health insurance, and they are now financially ruined. I don’t know precisely how much they owe, but it must be in the hundreds of thousands by now.

    On the other hand, I have another relative who had to be hospitalized while traveling in Europe. They admitted him, no questions asked, and AFAIK he was charged nothing for the care. Quite a contrast.

  24. 24
    David v. Squatney says:

    PS to #23: It’s probably clear from context, but I am a citizen of the US.

  25. 25
    Clive Hayden says:

    vjtorley,

    I followed up on your link “Principles for allocation of scarce medical interventions.” Ezekiel J Emanuel scares me. Right from the start he states:

    “Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off , maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multi-principle allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, quality-adjusted life-years, and disability-adjusted life-years.”

    All of the “individual principles” that he is grouping together into the three multi-principle systems, are attempting to adhere to an even greater system of moral guidance, over and above the three systems, or else there would be no compulsion to use the systems, and no standard of how the individual principles should be organized, or even that they “should” be organized. But, the thing he isn’t seeing, is precisely the larger moral system which compels him to organize the individual principles into the three systems. The three systems isn’t the end-point, it isn’t the last system by which all guidance of the individual principles can be discerned, for the three systems is itself guided by something more fundamental, and that is an even more ultimate standard of moral guidance over and above it. But Emanuel doesn’t get it. He is trying to use certain parts of the over-all moral guidance, but only in so far as they suit his purpose of certain kinds of morality but not others, essentially shirking the rest of the ultimate system of morality. And thus he does what Lewis described in The Abolition of Man:

    “A great many of those who ‘debunk’ traditional or (as they would say) ‘sentimental’ values have in the background values of their own which they believe to be immune from the debunking process. They claim to be cutting away the parasitic growth of emotion, religious sanction, and inherited taboos, in order that ‘real’ or ‘basic’ values may emerge. I will now try to find out what happens if this is seriously attempted.

    First of all, he might say that the real value lay in the utility of such sacrifice to the community. ‘Good’, he might say, ‘means what is useful to the community.’ But of course the death of the community is not useful to the community—only the death of some of its members. What is really meant is that the death of some men is useful to other men. That is very true. But on what ground are some men being asked to die for the benefit of others? Every appeal to pride, honour, shame, or love is excluded by hypothesis. To use these would be to return to sentiment and the Innovator’s task is, having cut all that away, to explain to men, in terms of pure reasoning, why they will be well advised to die that others may live. He may say ‘Unless some of us risk death all of us are certain to die.’ But that will be true only in a limited number of cases; and even when it is true it provokes the very reasonable counter question ‘Why should I be one of those who take the risk?’

    The Innovator attacks traditional values (the Tao) in defence of what he at first supposes to be (in some special sense) ‘rational’ or ‘biological’ values. But as we have seen, all the values which he uses in attacking the Tao, and even claims to be substituting for it, are themselves derived from the Tao. If he had really started from scratch, from right outside the human tradition of value, no jugglery could have advanced him an inch towards the conception that a man should die for the community or work for posterity. If the Tao falls, all his own conceptions of value fall with it. Not one of them can claim any authority other than that of the Tao. Only by such shreds of the Tao as he has inherited is he enabled even to attack it. The question therefore arises what title he has to select bits of it for acceptance and to reject others. For if the bits he rejects have no authority, neither have those he retains: if what he retains is valid, what he rejects is equally valid too.

    This thing which I have called for convenience the Tao, and which others may call Natural Law or Traditional Morality or the First Principles of Practical Reason or the First Platitudes, is not one among a series of possible systems of value. It is the sole source of all value judgements. If it is rejected, all value is rejected. If any value is retained, it is retained. The effort to refute it and raise a new system of value in its place is self-contradictory. There has never been, and never will be, a radically new judgement of value in the history of the world. What purport to be new systems or (as they now call them) ‘ideologies’, all consist of fragments from the Tao itself, arbitrarily wrenched from their context in the whole and then swollen to madness in their isolation, yet still owing to the Tao and to it alone such validity as they possess. If my duty to my parents is a superstition, then so is my duty to posterity. If justice is a superstition, then so is my duty to my country or my race. If the pursuit of scientific knowledge is a real value, then so is conjugal fidelity. The rebellion of new ideologies against the Tao is a rebellion of the branches against the tree: if the rebels could succeed they would find that they had destroyed themselves. The human mind has no more power of inventing a new value than of imagining a new primary colour, or, indeed, of creating a new sun and a new sky for it to move in.”

    Emanuel cannot cut up traditional morality into pieces, discarding some and keeping others, for all parts rely on the same authority and source, and are all equally valid if any is valid. He would have no duty to the 20 year old that he wouldn’t have to the 20 month old or the 120 year old, for the objective duty to life itself cannot become subordinated to any subjective duty to cost effectiveness.

  26. 26
    Reg says:

    @ Clive Hayden:

    Emanuel cannot cut up traditional morality into pieces, discarding some and keeping others, for all parts rely on the same authority and source, and are all equally valid if any is valid. He would have no duty to the 20 year old that he wouldn’t have to the 20 month old or the 120 year old, for the objective duty to life itself cannot become subordinated to any subjective duty to cost effectiveness.

    Which is a very commendable and natural sentiment but in the circumstances which Emanuel is talking about (“very scarce medical interventions such as organs and vaccines”) doesn’t really get us anywhere. In these interventions there can be an absolute physical shortage of resources such as fewer donor organs than recipients or fewer vaccine doses than people at risk of infection. If the 20 year old, 20 month old and 120 year old of your example are all very ill and need a kidney transplant and only one compatible kidney is available, there has to be a decision made somehow about which one of them will receive that kidney. How to make that decision is a necessary and important thing to study and discuss; not an attempt to devalue some people’s lives.

  27. 27
    jerry says:

    The “change in healthcare” movement in the US is not about providing better health care. It is about something completely different. If it was about better health care then there would be a debate. Obama and the Democrat leadership did not want debate. They wanted an imposition of a highly regulated system that would control a large percentage of the population through government action.

    As I said above the effective date was to be January 1st, 2013 and yet they wanted to ram it through with no debate by Aug 7th with no consideration of alternatives. Private insurance was to be abolished not directly but made so onerous that no one would choose it especially businesses. When Obama was asked by left wing bloggers if the bill would not let someone chose another plan once they gave up their current plan but had to choose the government option, he declined to answer. Nor can you go back to private insurance once you are on the government plan. Nor from what I understand can you purchase supplementary insurance to cover additional procedures. So essentially the bill proposed would have killed private insurance and made it illegal to switch to it. There would be no two tiered system as in the UK. Also instead of implementing tort reform, they want to expand the ability to sue.

    This was part of the uproar and whether the final bill will contain these onerous conditions will be interesting. They certainly were trying to hide what was in the bill. One of the leading Congressmen on this mocked those who wanted to read the bill saying essentially vote for what we bring to the floor and don’t try to understand what is in it.

    If anyone trust Obama to do the right thing, then they are essentially naive. He has been a dishonest person for nearly all his career so why expect him to change now. He is an ideologue who tries to appear as a nice person but his history is anything but this. People mistake a nice appearance and friendly smile with an honest, honorable person but he has a shady left wing background in Chicago politics in which he has screwed his poor black constituency.

    The goal is much different than better health care. It is an attempt to implement a political system that was well on its way to acceptance till Ronald Reagan and the Gingrich Congress temporarily changed its direction. But with the complete demonization of George Bush, they are trying to continue on using this disdain for Bush to implement a lot more than health care change. Did you ever think what Obama really meant by Change?

  28. 28
    David v. Squatney says:

    Jerry,

    Do you think health care coverage should be universal? If so, how do you think it should be done?

  29. 29
    lamarck says:

    I’m a little troubled that no one commented on the vid I posted on socialism. Why don’t people listen? Here’s another one. The health care debate is a power grab and a tax and that’s it. The delicacies of “the greatest good” and the minutia of european vs. american medicine aren’t on the REAL ruler’s minds one bit. You’re assuming near utopian results compared to the ACTUAL direction we’re headed?

    “We are grateful to the Washington Post, The New York Times, Time Magazine and other great publications whose directors have attended our meetings and respected their promises of discretion for almost forty years. It would have been impossible for us to develop our plan for the world if we had been subjected to the lights of publicity during those years. But, the world is now more sophisticated and prepared to march towards a world government. The supranational sovereignty of an intellectual elite and world bankers is surely preferable to the national auto-determination practiced in past centuries.””
    David Rockefeller Baden-Baden, Germany 1991

  30. 30
    IRQ Conflict says:

    American Thinker has a great article on the history of the US medical farce:

    “Furthermore, they grossly overstate the problem. We hear constantly about the “47 million uninsured.” These figures include 10 to 25 million illegal immigrants, 14 million people who are already eligible for medical benefits but haven’t availed themselves, and 10 million people earning $75,000 or more who could presumably afford their own insurance if they chose to. Even assuming the lowest estimate for illegal immigrants, the true number of uninsured would be only 13 million. Yet the Democrats want to nationalize the entire industry, currently 17 percent of GDP, to provide benefits to 4 percent of the U.S. population.”

    http://www.americanthinker.com.....risis.html

  31. 31
    IRQ Conflict says:

    lamarck, regarding the video. These are some pretty extreme claims. If true, how can you prove it? Further, what could anyone do about it?

    I’m on the fence with this and still don’t know if my head is stuck in the sand or not on these issues.

    The funny thing is, I can see people like this, having all the power and money playing the ‘game’ of control simply because of their unfulfilled and petty lives “dancing on strings of powers they cannot perceive”.

    I do however think that the woman’s lib thing is entirely plausible. It makes sense.

  32. 32
    IRQ Conflict says:

    Darn, wasn’t finished…

    The amount of information vs. disinformation out there is as extreme as the notions themselves imo.

    I do know that I should oppose what I view as an attack on my conservative Judeo/Christian sensibilities. This, imo is the only way I know to keep a solid foundation under my thinking and reaction to apparent “conspiracies”.

    I don’t know, what do you think of the probability these 9/11 theories are true? Why?

  33. 33
    jerry says:

    “Do you think health care coverage should be universal?”

    I do not have much time and this is a complicated problem. My answer is no. But something must be done for those who cannot pay and to those who opt out of insurance and something should be done to accommodate those with previous conditions. But a public health care system to me is anathema. And I am strongly against a system which legislates that all get identical health care.

    It also depends on what is meant by universal health care? There are lots of parameters. Should everyone has access to the best doctors or just an adequate list of doctors. Suppose you know there is a heart surgeon who is considered better than anyone else, does universal health coverage mean that he gets assigned cases by lottery and gets paid the same as everyone else. I would never want to live in such a system. I prefer the best get paid more and get to choose who they treat. My experience is that there is enough good doctors who would be willing to take some patients on a lottery basis, that is provide care to some unfortunate peoples who cannot afford a better insurance policy or afford to pay for high level treatment. I want them all to try to get a reputation that will bring people to them and pay them more because of their excellent treatment. The worst possible system is one where doctors get paid salaries unless they opt to do so.

    Every year new treatments and new drugs come on the market so does universal health care mean that everyone is eligible for every drug and every treatment. This is one of the two main drivers of cost increases and unless we stop medical and drug research, will continue ad infinitum. Should all have equal access. I don’t believe so and if someone has enough money to pay for it, then so be it. For the rest of us, I don’t have the money to pay for everything out there, if something came up I would have to weigh what resources I had against what it might do for me or a loved one. I have an elderly friend who spent nearly everything he had on making his mother comfortable (literally hundreds of thousands of dollars) and now he has nothing and ekes out a living on social security. So I have seen what it does to someone to spend all their resources on this but that was his choice. I am willing to limit what is available for me but I am not ready to provide those who are piggy and want everything and someone else to pay for it. If they have the money for the best doctors and best treatment, more power to them. Otherwise some form of adequate treatment should be the norm for those who cannot pay.

    I am far from an expert but there was a two tiered system proposed a few years ago which I am for. Everyone gets catastrophic care paid for by taxes and would cover pregnancy and treatment of severe previous conditions and would be run by private or as they are now proposing, non profit organizations. Take health care coverage away from business and let everyone pay for incidental health care out of pocket. People could also have the option to purchase with a tax deduction an insurance policy to cover every day expenses such a routine visit to the doctor or a broken leg etc. And if they are truly indigent, then subsidize them.

    But keep the government out of it except as a means of financing catastrophic care and the truly indigent. But catastrophic care does not mean care for everything.

    Such a debate is what should be going on in Washington, not a fiat fueled by a political ideology which is what was just attempted by Obama and the Democrat leadership in Congress.

    And I think the CBO should do an analysis based on the elimination of pain and suffering awards by the courts and the capping of legal fees for suits. It would be an eye opener.

  34. 34
    DATCG says:

    DavidvS.

    “More to the point, isn’t it clear that these same sorts of decisions are made by health insurance companies (provided you are fortunate enough to have health insurance)?”

    Uh right, so your in favor of being forced into a government run rationed healthcare plan for yourself? You want to share this with the poor? You want your parents to wait for months or not get any healthcare at all?

    Or, would you rather have the opportunity to make decisions for yourself? To decide to not buy that sports car, or new sofa, or even a new house, but to determine to take care of your parents?

    I can see how the government taking over such processes lets many people off the hook. I know many people that could care less.

    Sorry Mom, Dad, can’t do anything about it. You’ll just have to suffer cuz Uncle Sam is a Socialist nation now. Gee, I’d really like to work harder, earn more money to help you get better healthcare, but now that Uncle Sam’s in charge I can’t do nuthin bout it. Hey, did you guys make your wills yet? Yeah.. can I get that old cherry colored mustang when you die(ahmmm), I mean when you have a discussion with your “life consultant” euthanasia doctor Pop?

    No thanks, I’d rather work hard and buy my own healthcare thanks and solve the existing problems 1 by 1 instead of SCRAPPING THE ENTIRE Free Market System! The current system that is the best in the world and that takes care of 90% of the people in America, plus illegals.

    Stupid is as Stupid does and Socialist are Stupid robots. I never thought Americans would become so dumbed down and ignorant to put themselves in chains to the government.

    While the Socialist Bureaucrats – they all get a waiver – and are on a totally different healthcare plan. No waiting periods, not rationed care. And benefits for life.

    So, I guess you want to work for the government? Or be a professor? Or teacher? Or even a union worker? The Unions had an exemption last time I looked. Though I doubt that stays.

    But hey, lets screw over the rest of American white collar workers, business owners, farmer joes and all those evil business people that actually produce goods and services.

    Even more to the real point. “Isn’t it clear” that the Congress, the President, Judges, Federal Employees are exempt from this massive socialist takeover?

    Why? Why shouldn’t they have to be rationed like everyone else? Should we all declared ourselves Socialist political bureaucrats today? Or Union workers?

    Whats the point of working in a private free enterprise if I cannot make my own choices? And am forced to pay for everyone elses insurance? This is not France and our Founding Fathers were much smarter than the humanist revolution there. They set out firm pillars for our nation to never come under the control of the government. By giving healthcare control over to the government, we become more enslaved. It is the stupidest idea ever for this nation, besided Cap and Tax Americans to death.

    There is a reason our nation became exceptional among all nations and why people risk their lives to leave communist nations from the four corners of the world to get to America. They see the shining light. They see the freedoms we enjoy. We do not need to follow the socialist failures around the world. Instead, we need to fix the specific problems of our current system, shut down our borders to illegals and shut down ambulance chasing lawyers from scamming billions off of doctors and hospitals.

    Or, we should all just close up our businesses, take up welfare and live on the dole of the government.

    Are you aware that 85% of people are happy with their healthcare?

    Are you aware that Obama/Dems refused to include Tort reform?

    Are you aware Doctors are paying as much as $200,000/year for malpractice?

    Are you aware as a result many doctors, including OBGYNs are dropping out due to the cost?

    Are you aware that Medicare/Medicaid is bankrupt?

    Are you aware that Obama/Dems want to cut $200 billion from MediCare?

    Are you aware that Medicare/Medicaid started out as a $60million a year budget item? And has ballooned into trillions?

    That the same healthcare plan they want to implement today is estimated 1.3 trillion or more? That no savings will be made in the budget? That our budget will balloon into an unsupportable busted wreck? I realize that Rahm Emanuel and Soros thugs love a crisis to make money and policy.

    But I’m not going to cooperate with a fugitive from france(Soros) or thugs from Chicago.

    I’m going to fight back against the elitist who think they own us. It is the American way, our forefathers and founding fathers all stood against this lunacy and set this nation on a direct opposite course from tyranny of the few over the masses.

    Are you aware our massive debt is hemorraghing so much that we have a Communist nation in China teaching us about finances now?

    Keynesian economics and spend, spend, spend is not the solution, neither is any healthcare system based upon Singer/Emanuel social construct that believes in killing the elderly off softly in favor of the 15-40yr groups.

    It is nothing but the return of Darwinian Eugenics programs, except the bigotry and prejudice this time is against the babies and the elderly.

    Pathetic. And curse all the media zealost who carried these peoples water during the election. This is ruining our nation and it will take decades to recover once these theives are gone from office.

  35. 35
    David v. Squatney says:

    DATCG,

    Nice rant 😀

    The point I was trying to make in my post is that health care is already rationed here in the US, in part by insurance companies. Therefore the argument that we shouldn’t have health care reform because it will lead to rationing is bogus.

    A couple of links for your reading pleasure:

    http://www.businessweek.com/ca.....healt.html

    http://covertrationingblog.com.....oning-blog

  36. 36
    lamarck says:

    Insurance companies aren’t the same as health care by force. You will be fined if you don’t sign up for a plan which will of course eventually include buying into companies that got no bid contracts or something similar.

    Good luck starting a small business if you don’t like their health care company options, which will OF COURSE if not at the outset than later give you less for more money because competition is gone. IT’S PRECEDENT SETTING.

    People don’t get the founding fathers. Once their philosophy is explained to the average american, they want nothing to do with these radicals.

    The government isn’t there to ensure public safety apart from foreign invasion. This wasn’t laziness on Jefferson’s part, this was necessity. Safety and health concerns are ALWAYS ALWAYS the trojan horse. Seatbelts laws too. Think libertarians don’t like seatbelt laws in and of themselves? No, it’s because that puts us on the slippery slope.

    Here’s a blunt reality. People must die because of lack of safety regulation imposed by the government. Kids must be shot with guns they pulled out of the closet. School buses MUST be T-BONED by truckers because truckers weren’t super regulated and hadn’t slept in a day. The founding fathers insisted that these people must die, because otherwise you have cambodia or people butchered enmass in africa with machetes. Equivocation with this hard reality results in soft communism then genocide.

    A system that’s good enough for the whole must be left alone, because man has never conceived of a better system and will only devolve into chaos otherwise. Government isn’t a precise tool to effect social change except where it can be established to keep itself in check with competing equal powers almost completely.

  37. 37
    IRQ Conflict says:

    lamarck, you may want to see this:

    http://www.nytimes.com/2006/07......html?_r=1

  38. 38
    tsmith says:

    oh yes I’m hoping for a wonderful system like they have in Britain, so I can see my new dentist, Dr. PLIARS!!

  39. 39
    tsmith says:

    I’d love to see healthcare reform, where you could buy health insurance like car insurance. health insurance should not be provided by your employer.

    but this ‘healthcare’ reform being pushed by the democrats isn’t about healthcare, its about power people’s lives…and making people utterly and totally dependent upon the government.

  40. 40
    tragic mishap says:

    Daniel Hannan comments on British NHS and NICE:

    http://www.youtube.com/watch?v=c2x1yD8vCmE

    He supports Singapore style system of individual healthcare accounts:

    http://blogs.telegraph.co.uk/n.....n-the-nhs/

  41. 41
    jerry says:

    “The point I was trying to make in my post is that health care is already rationed here in the US, in part by insurance companies.”

    Not true. Name one health care option that is rationed to the public. Name one person who could not get that health care option if they wanted it and had the means to pay for it.

    Do not pounce on the phrase ” the means to pay for it,” because every good in this country is rationed except for air and even in some places there is better air than others or cooler air or warmer air at a price. Even water is rationed by price. Housing, vacations, automobiles, education etc. are all rationed by the ability to pay for it.

    If I have a terminal illness and there is a possibility that a treatment may work and it is not sanctioned by the insurance companies or the government, I have the right to buy that treatment if I can come up with the money. So health care is no different than other economic good. The reason is has become an issue is that so many new options are available to let us live longer and better that people want it. NO! They demand it as a right. They want it all and like every other so called right, they want other people to pay for it.

  42. 42
    David v. Squatney says:

    Not true. Name one health care option that is rationed to the public. Name one person who could not get that health care option if they wanted it and had the means to pay for it.

    Do not pounce on the phrase ” the means to pay for it,” because every good in this country is rationed except for air and even in some places there is better air than others or cooler air or warmer air at a price. Even water is rationed by price. Housing, vacations, automobiles, education etc. are all rationed by the ability to pay for it.

    Jerry, first you challenge me to name a health care option which is rationed, then in the next paragraph you concede that everything is rationed, except perhaps air. This makes no sense.

    Of course if you are willing and able to pay for it yourself, you will be able to buy any sort of health care you want, regardless of whether this reform passes or not.

  43. 43
    David v. Squatney says:

    Jerry,

    One addendum to #42: If you believe that health care is not rationed in the US because you can always get it if you are willing and able to pay, then you must agree that the following sentence from the IBD piece is incorrect:

    The controlling of medical costs in countries such as Britain through rationing, and the health consequences thereof are legendary.

    If you have deep pockets, you get buy whatever health care you want in Britain, ergo no rationing.

  44. 44
    jerry says:

    Yes, rationing is not used correctly in the IBD article because as I understand in the UK one can usually buy any medical treatment if one has the cost. But I believe there are other countries where that is not true and certain medical treatments are indeed rationed. There may be exceptions in the UK and even here in the US and one that comes to mind is transplants. Since they are relatively rare I do not know if even a large amount of money could get you one in certain circumstances.

    For example, I had an elderly friend die recently who because of 3 pack a day smoking had severe COPD (stopped smoking 11 years ago) and was scheduled for a lung transplant but was rejected at the last minute when he came down with prostrate cancer. One has to be cancer free for 5 years to get a transplant so he told me it was a death sentence. He was very depressed because he knew he might have 5-10 years or more to live if he got the transplant. So maybe here is a health item that is really rationed. But maybe if he had a couple million dollars to burn he would still be alive. I don’t know.

    There was a provision in Hillary Care and there was some mention of it being possibly in the new bill that one could not buy additional insurance or even pay a doctor for a service if one was in the public program. In other words you could not pay to go to the head of the line or get the service outside the system. It was to be illegal. If that was true then indeed there would be real rationing as some bureaucrat decides who gets treatments.

    You are quibbling over words to find the supposed contradictions and not dealing with the substance. We can get into a discussion of what the word rationing means and I am sure if someone wanted to investigate all transactions in this country we could find many things that are truly rationed besides the transplants I just mentioned.

    Outside of the medical issues discussed, off the top of my head I can think of appointments to West Point or Annapolis are restricted or you could say rationed. I am sure there are others such as camp sites in the High Sierras during the summer or mineral leases in certain government lands, etc. Right now I am rationing a certain machine that has been discontinued (couple hundred still in inventory). I am restricting it to current customers only as a replacement if case their current machine breaks down. I had one guy who wanted to pay three times the price for one and I refused. So I am rationing.

    Maybe the correct word to use is not “rationing” but “restricting” or maybe some other word. Find what is appropriate. But whatever it is there will be more of it in a public plan than if the whole system remains private.

  45. 45
    Learned Hand says:

    But I believe there are other countries where that is not true and certain medical treatments are indeed rationed.

    Is this the proposed model for the new system? I haven’t been following the debate, but I was not under the impression that private treatment contracts would be barred, any more than they already are.

    There may be exceptions in the UK and even here in the US and one that comes to mind is transplants. Since they are relatively rare I do not know if even a large amount of money could get you one in certain circumstances.

    Not legally. A contract for the purchase or sale of an organ is illegal everywhere in the United States, so far as I know, and precedence on the transplant list is supposed to be an unsalable good. I don’t know about foreign jurisdictions, but I suspect that with enough money, you could get a grey-market transplant.

    So maybe here is a health item that is really rationed.

    As noted, all health items are “really rationed.” All items that can be bought or sold are “really rationed.” Economists use the word “rationing” to refer to the allocation of goods and services; in a free market, they are allocated to the party willing to pay the highest price. “Rationing” in the more colloquial sense is called “non-price rationing.”

    There was a provision in Hillary Care and there was some mention of it being possibly in the new bill that one could not buy additional insurance or even pay a doctor for a service if one was in the public program.

    Citation, please?

    Maybe the correct word to use is not “rationing” but “restricting” or maybe some other word. Find what is appropriate. But whatever it is there will be more of it in a public plan than if the whole system remains private.

    We do already ration healthcare, under all three definitions: it’s price-rationed (anyone can pay for most treatments); it’s partially price-rationed (most people cannot afford the market without risk-pooling, which subjects them to an insurer’s decisions about what treatments are cost-effective, and those decisions are only partially subject to external market forces); and in some sectors it’s fully non-price rationed (transplants). Would rationing under the new system actually be any different from the current system, from the perspective of a consumer who cannot currently afford expensive treatments without risk-pooling? It’s a complicated question, that requires a very complex economic analysis. Such analyses exist, but I haven’t read any. Have you?

  46. 46
    David v. Squatney says:

    Jerry,

    First, I’m sorry to hear about your friend. That would be an awful way to go.

    You are quibbling over words to find the supposed contradictions and not dealing with the substance.

    Well, it is true that my post didn’t get into the substance of the debate. I was merely pointing out IBD’s deceptive use, for rhetorical purposes, of the scary word “rationing”.

  47. 47
    Seversky says:

    vjtorley @ 21

    I wish to state that I am utterly opposed to the Quality of Life Years system used by the UK National Health Service. However, the principle of universal coverage is a separate moral issue, and people in Britain overwhelmingly support it.

    I understand your concern and I agree entirely with you that it is wrong to try and argue that one life is more valuable than another. The presumption should be that all lives are equally valuable.

    Of course, there are occasionally cases where doctors find themselves in the invidious position of being forced to make a choice between two lives, such as when an emergency arises during a pregnancy and either the mother or the child can be saved but not both.

    Something similar is true when hard decisions have to be made about the allocation of limited healthcare resources. Somebody will be landed with the responsibility of making those choices. Do they toss a coin or try to find a more rational system? This is the reason why the UK National Health Service set up the National Institute for Health an Clinical Excellence (NICE) whose function – since UD is big on function – is described as follows in the Wikipedia entry:

    As with any system financing health care, the NHS has a limited budget and a vast number of potential spending options. Choices must be made as to how this limited budget is spent. By comparing the cost effectiveness in terms of health quality gained for the money spent. [6]. By choosing to spend the finite NHS budget upon those treatment options that provide the most efficient results society can ensure it is does not lose out on possible health gains through spending on inefficient treatments and neglecting those which are more efficient.

    NICE attempts to assess the cost-effectiveness of potential expenditures within the NHS to assess whether or not they represent ‘better value’ for money than treatments that would be neglected if the expenditure took place. It assessess the cost effectiveness of new treatments by analysing the cost and benefit of the proposed treatment relative to the next best treatment that is currently in use [7]. NICE determines the most effective parameters for treatment use. [8].

  48. 48
    lamarck says:

    IRQ Conflict,
    Just saw your posts. Regarding the Aaron Russo article, it’s filled with straw men and diversions. Bottom line is apportioned means just that and the 16 amendment was never fully ratified. I’m not a tax dodger myself, you have to choose your battles.

    I’m not christian but it’s my understanding that the keystone of christian values is fighting evil so I’d look into this stuff more. We’re in the information war phase and before it becomes a hot war maximum damage needs to be done informing people.

    “The creature from Jekyll Island” covers what the Fed reserve is well.

    9/11 without question had US involvement.
    Here’s a vid of Alex Jones destroying a kool aid drinker:
    http://www.youtube.com/watch?v=qMjgyzKoXy4

    and yes I stream Alex’s radio show every day and he’s that riveting all the time.

    Regarding the big picture, take it out of the “belief” mode and simply look at what they do and more importantly what they say. There’s more quotes as damming as the one I posted earlier.

    Re: extreme views, if your not “extreme” you simply don’t care. Hope this helps.

  49. 49
    Seversky says:

    jerry @ 41

    If I have a terminal illness and there is a possibility that a treatment may work and it is not sanctioned by the insurance companies or the government, I have the right to buy that treatment if I can come up with the money. So health care is no different than other economic good. The reason is has become an issue is that so many new options are available to let us live longer and better that people want it. NO! They demand it as a right. They want it all and like every other so called right, they want other people to pay for it.

    I seem to remember a famous document which says in part:

    We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness

    I could be wrong but I am pretty sure that by “life” the authors meant more than just existing in something like a persistent vegetative state. They meant the ability to live life to the full which cannot be done unless you have your health. So, yes, I would say the right to health is implied in the right to life.

    Of course, you can have an entirely free market in healthcare where you can buy the best treatment available if you have the money which is apparently the sort of system that right-wing libertarians lean towards. What they tend to be less outspoken about is the downside to such a system, which is that those who cannot afford it, for whatever reason, go without. Going without, of course, means that they can get sick and even die. But then from the libertarian perspective it is probably their own fault they do not have enough money and why should the rest of us bail out those too lazy to work?

    In fact, from that perspective, personal wealth is a measure of the skill, talent and hard work of the individual. They are the richest members of society because they are the fittest and as such their survival benefits society. The rest can be left to be flushed out of the gene pool.

    Of course, there are other names for such a policy – names like “social Darwinism” or “eugenics”.

  50. 50
    David v. Squatney says:

    I just found a very spirited comment on our current health care “debate” over at Orac’s blog Respectful Insolence (he’s a physician and researcher). Here’s a snippet:

    What I’d like to know is what is so civilised about a healthcare system that excludes millions because they don’t have insurance, or that rations healthcare according to the wealth of an individual. And what’s so civilised about about a healthcare system where the main priorities are Insurance company profits, drug company profits, medical professionals’ profits, lawyers’ profits? I suppose as long as it’s not “Socialism” who cares! Americans annually spend twice the percentage of GDP that the Brits spend on healthcare, and it’s still a nation of sick and ailing fatties, addicted to therapy and quackery.

    The commenter is a citizen of the UK living in the US, by the way.

  51. 51
    Oramus says:

    If anyone’s interested Taiwan’s government backed healthcare is a diamond in the ruff.

    Key take-away: UHC works in successful economies. Debtor nations need not apply.

  52. 52
    BillB says:

    I’ve noticed quite a lot of conservative Americans saying quite bizarre things about the British and other European healthcare systems.

    Those of us like me (who’s parents both worked in the NHS) observing from the UK and Europe can only laugh at this behaviour and pity you poor Americans as you get suckered into believing that making insurance company owners into millionaires is the best way to provide healthcare, and that getting the richer to help the poorer is evil – Christian values anyone?

    I see nothing wrong with having private healthcare, we have it in the UK, but health insurance is always a gamble, you pay a company money and they, in the interest of profits, will do their best to avoid paying out. I prefer not to gamble with my life and feel so much safer living in a country where I know that I will receive treatment without question, regardless of my age or ability.

    The question I want to know is will we ever get an apology from these Americans for spreading lies about our countries? Probably not.

  53. 53
    tragic mishap says:

    lol @ lamarck

    Go away, you’re embarrassing yourself.

    BillB, you call it a gamble. At least the insurance companies have the law over them, and you have a signed contract which holds weight in a court of law. The “public option” has neither. The government is the law and has never signed a legally binding contract with its citizens over healthcare. They just take the money and say “trust us”. There is no accountability. Liberals continually try to pedal this strange, unfounded belief that government is somehow innately more virtuous than the private sector. All people are bad. What makes them play nice is accountability and authority. The private sector has both. Government has neither. You choose.

  54. 54
    lamarck says:

    Ok tragic goodbye

  55. 55
    tragic mishap says:

    jerry:

    “Maybe the correct word to use is not “rationing” but “restricting” or maybe some other word. Find what is appropriate. But whatever it is there will be more of it in a public plan than if the whole system remains private.”

    Seversky:

    “Something similar is true when hard decisions have to be made about the allocation of limited healthcare resources. Somebody will be landed with the responsibility of making those choices. Do they toss a coin or try to find a more rational system? This is the reason why the UK National Health Service set up the National Institute for Health an Clinical Excellence (NICE) whose function – since UD is big on function – is described as follows in the Wikipedia entry:

    As with any system financing health care, the NHS has a limited budget and a vast number of potential spending options. Choices must be made as to how this limited budget is spent. By comparing the cost effectiveness in terms of health quality gained for the money spent. [6]. By choosing to spend the finite NHS budget upon those treatment options that provide the most efficient results society can ensure it is does not lose out on possible health gains through spending on inefficient treatments and neglecting those which are more efficient.”

    Glad to see you guys agree on something.

  56. 56
    Learned Hand says:

    BillB, you call it a gamble. At least the insurance companies have the law over them, and you have a signed contract which holds weight in a court of law. The “public option” has neither. The government is the law and has never signed a legally binding contract with its citizens over healthcare. They just take the money and say “trust us”. There is no accountability. Liberals continually try to pedal this strange, unfounded belief that government is somehow innately more virtuous than the private sector. All people are bad. What makes them play nice is accountability and authority. The private sector has both. Government has neither. You choose.

    This is no more rational than lamarck’s tinfoil-hat theories about the 16th amendment. Healthcare reform, if it is passed, will be codified in statutory law and regulations. Those laws are, in fact, binding on the government. If a patient believes the government violated the law with respect to his coverage, he has at least the same remedies as he would against an insurer who reneged on a policy. Citizens sue the government all the time over such breaches. People whose social security benefits are denied, for example, sue the government. It’s quite common. And it’s ridiculous to assert that “there is no accountability.” There is; public finances are public, reviewed both by the government’s own auditors and interested citizen parties. Where there are improper expenditures, corrective action ranges from the aforementioned lawsuits to the ballot box. An aggrieved citizen has more options against the government than against a private insurer, in fact; you can’t vote the AIG CEO out of office.

  57. 57
    Seversky says:

    jerry @ 44

    Maybe the correct word to use is not “rationing” but “restricting” or maybe some other word. Find what is appropriate. But whatever it is there will be more of it in a public plan than if the whole system remains private.

    In any system where demand exceeds supply, there will be rationing one way or another. In most, if not all, countries in the world the demand for healthcare outstrips available resources. And it makes no difference whether the system is public or private, some people are not going to get what they want or need. The only difference between public and private in this respect is that, in a public system, the rationing is more obvious because is is discussed more openly. Private systems try to keep it quiet about their “dirty little secret”.

  58. 58
    jerry says:

    “Private systems try to keep it quiet about their “dirty little secret”.”

    It is a much better system when it is has these dirty little secrets. The public system is an abomination. Most of these public systems are living off the breakthroughs developed using the dirty little secret system. With out the so called dirty little secrets we would have a lot worse health care.

    Truman wanted to institute socialized health care in 1948. Does anyone believe we would have all these miracle treatments, miracle diagnostic techniques and miracle drugs with socialized medicine. The reason we have a problems is that there are so many options.

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