ShrinkWrapped

Saving Money on Health Care

I have to be brief today but wanted to point out a certain fantasy quality to the way the Health Care debate is being promugated.  Today, Peter Orszag notes that the crisis in health care is a crisis of cost of care:

This week confirmed two important facts -- that health-care costs are the key to our fiscal future, and that even doctors and hospitals agree that substantial efficiency improvements are possible in how medicine is practiced.

The numbers speak for themselves. The Medicare and Social Security trustees' reports released this week show that health-care costs drive our long-term entitlement problem. An example illustrates the point: If costs per enrollee in Medicare and Medicaid grow at the same rate over the next four decades as they have over the past four, those two programs will increase from 5% of GDP today to 20% by 2050. Despite the attention often paid to Social Security, spending on that program rises much more modestly -- from 5% to 6% of GDP -- over the same time period. Over the long run, the deficit impact of every other fiscal policy variable is swamped by the impact of health-care costs.

The rest of his article is a pure flight of fancy.  We are expected to believe that there are immense savings lurking in the Medical system that can be addressed even as we increase utilization!

(Just in case Peter Orszag has forgotten one of the fundamentals of the markets, when you increase access to a system and decrease its cost to the consumer [which is what lowering health care insurance premiums and making Medicaid and Medicare mroe available does] you increase the use of those now less expensive resources.)

There is only one way to decrease the cost of health care without overt or covert rationing that distorts the market and artificially creates either scarcity or increased expence, and that is to raise the cost of medical care to the consumer (nee patient.)  If patients are expected to pay a portion of their care and are expected to take greater responsibilty for their care (I have yet to find a single pill or intervention that can make people exercise or diet, two of the most well researched, effective, and proven interventions that can actually increase one's health and decrease one's utilization of health care resources) they will use health care resources more judiciously.  Some will neglect their care, get sick, and die prematurely; others will make their own personal, and often brutal, calculations of how much their future health is worth in comparison to their present comforts (ie, should I pay $40 for my blood pressure pills at the cost of giving up cable TV?) and some will change their lifestyle to be able to afford maximal care.  Of course, such a change in our health care model (from "Cheap Health Care is a Right" to "Health Care is [Mostly] Your Responsibilty") will never happen; it is not "compassionate", would never be accepted by a population that has come to expect that they can have it all, and would never even be offered by politicians who want to be re-elected.  Instead, we will either tinker on the edges, or if the left has their way, make wholesale changes in our Medical system that will, in the long run (and maybe not too long) delay major advances in Medicine and Biotechnology and make all of us more equal in our access to less health care than desired, ideal, or possible.

Remember, when it comes to Health Care:

Universal, High Quality, Affordable: Choose two of the three.

Anyone who tells you we can have all three is either a liar or a fool.

Photographic Negatives

In the distant past, images were captured by cameras on film.  The film was then developed into a negative, in which the information was encoded by its opposite, only finally revealed when the image was then transferred to photographic paper.  (These little known facts are presented as a historical summary for those who only know of images as pixels on a screen.)  Our MSM has now taken this model and apparently adapted it for use in their information dissemination.  However, they truncate the process and only print the negatives, a novel approach to "news."  Here are a few examples of news items you may have missed while reading the "news."

During and after the Israeli incursion into Gaza, the MSM was filled, on a daily basis, with stories of Palestinian civilian casualties.  The MSM would eagerly print numbers supplied by Palestinians (who, of course, would never have any reason to slant the numbers and had layers of ethical and religious injunctions against such behavior) showing that the vast majority of Palestinian casualties were civilians.  Elder of Ziyon and others have done the painstaking work of parsing the Palestinian's own casualty lists to discern the reality behind the negative "news" and the results have been striking, even more so because of the refusal of MSM organs to actually report on the results:

Casualties of Truth

For three weeks in December 2008-January 2009, Israel and Hamas fought a war in the Gaza Strip after Hamas announced it was abandoning the ceasefire and began escalated rocket and mortar attacks on Israel.

There is one fact about that war which people around the world think they know: there were about 1400 Palestinians killed in the war and most or almost all of them were civilians, mainly women an children.

This claim, however, is false and demonstrably so on the basis of careful research using publicly available and reliable materials. Indeed, a group of bloggers, including the author, have shown already that more than 30 percent of the claimed "civilian" casualties were in fact, to use the polite word, armed militants or members of Hamas-led security forces. And the number of such combatants we are discovering is rising every day.

While Hamas and other Palestinian political groups were using alleged civilian casualties to bolster their case with international public opinion, they demonstrably knew otherwise. In fact, they publicly bragged about the military activities of those they labeled innocent civilian bystanders. [Emphasis added-SW]

The basis for many claims about the distribution of casualties was in a March report <http://pchrgaza.org/files/PressR/English/2008/list.pdf> by the Palestinian Center for Human Rights (PCHR). Widely covered‹and credulously accepted‹in the Western media, the report was a seemingly comprehensive, detailed list of every death. The bottom line: : the name, gender, age, location, and job of each person is detailed. Most importantly, the PCHR claimed 1180 of the alleged 1414 victims were civilians.

Our team cross-checked the names listed by PCHR with lists of "resisters" compiled by the Al- Mezan Center for Human Rights http://www.mezan.org/en/index.php> , lists of "martyrs" published by Hamas, the Popular Resistance Committees (PRC), and other militant groups in Gaza, as well as from the Ma'an News Agency, and other Palestinian sources. 

This is the kind of investigative reporting that the MSM claimed only they, with their layers of fact checkers and editors, could do successfully.  Please go to the Elder's site and read the whole thing. 

Meanwhile, Barry Rubin has helpfully prepared a short primer of Political Proverbs for an Age of Unreason, which may be useful for a young administration just finding its way in a difficult part of the world.  As a bonus, via MEMRI, he illuminates Arab thinking in their own words; an example:

Don’t Just Take My Word for It: Arab Moderates Warn About Mistaken Western Policies

What do moderate Arabs think about what Westerners think about the Middle East? Usually, such matters are raised only in private conversation with those of long acquaintance in whom the speaker has personal trust. But now we have several statements by respected Arabs who are relatively liberal but also part of the intellectual establishment.

Thanks to MEMRI for gathering and translating these remarks. They could be just about the most important things you read about the Middle East this year.

As you go along, imagine the reaction of the conventional wisdom types if another American or European had said these things.

First up is Tareq al-Homayed, chief editor of al-Sharq al-Awsat, which might just be the best Arab newspaper in the world today. It combines the unusual characteristics of being both Saudi-owned yet relatively liberal.

Homayed explained that if the West is too lenient to extremists this is a grave mistake. Once you start talking to Hizballah you might as well negotiate with al-Qaida. "Openness for the sake of openness,” he concluded, “makes the situation more complicated and sends the wrong message." 

There more; read it all.

In another arena, consider the uncritical MSM coverage of the so-far ill defined Universal Health Care debate in which we are promised there will be universal care, which will raise the quality of care for all while simultaneously lowering costs.  This is nonsense and must be apparent to the architects of the plan but nonetheless they are trying to sell their snake oil to the public and the MSM is doing what they can to assist.  Unfortunately for the plan's success, on occasion someone slips and reveals the truth; int his case Hugh Hewitt noticed and has been on the issue:

On yesterday's program I played a clip of Professor Stuart Altman's testimony before a Senate committee meeting devoted to the radical restructuring of health care.  Professor Altman got perilously close to candor:

People are using technologies that really don't work at all or keep people alive for very limited or very high costs, hospice is one option, but we do need to take account of the costs, ya know, I hate to say it,  the cost benefits of some of the things we do.

As I told the audience yesterday, this is a message to older Americans that they are the target of health care "reform," and that they are going to find themselves the first to run into rationing.  Mortuaries should be gearing up for the transition to ObamaCare because the life expectancy of the elderly is going to take a sudden turn for the worse under any cost-benefit analysis of treatment of older Americans.

His post includes a discussion of California's upcoming vote on funding their government's out of control spending.  It is a fascinating look at what may be a harbinger of "Tea parties" morphing into votes that could shake the Washington elites. 

In almost every arena, beyond the most easily constructed man bites dog narratives, the MSM is not supplying anything close to actual news but instead spending their time supporting a narrative fiction of the world that they have adopted uncritically.  They are so wedded to their world view that they continue to add fictitious cards to bolster their house of cards; when the whole thing crashes (their business model is unsustainable, even with their new and soon to be extended tax advantages given by grateful governments) they will blame the ignorant masses who refused to continue funding their house of cards (or mirrors) long after any resemblance to reality had faded away.

We need a free and vigorous press; it is a pillar of democracy and when it fails to do its job we all suffer.  Unfortunately we are in a dangerous period where the replacement for the MSM is not yet mature enough to function without the tradition MSM.  Lots of damage can still be done by those who fancy themselves to be the gatekeepers of our information.

Unilateral Disarmament

Barack Obama has shown himself willing and able to use all the powers of his office to get what he wants for himself and his supporters.  He has exhibited the kind of ruthlessness that is an essential part of the "Chicago Way" and has been loathe to surrender any powers or weapons, inherited from the Bush administration, whose loss might inconvenience him.  His behavior is that of a powerful person who knows he has the biggest guns on his side and acts accordingly, brooking very little opposition.  He is perhaps more covert in his use of power than previous Presidents, typically hiding it under sunny proclamations of his administration being the most open, most honest, etc, but this is mainly a problem because he has a fawning press which enables his obfuscations.  None of that is terribly out of line for Presidents, who always try to put the most rosy spin on their policies while hiding their most amoral machinations; ruthlessness and the ability to use power are part of the character of most Presidents.  That is why a recent decision of the President, little commented upon, raises such concerns.

On August 6, 1945, World War II, for all intents and purposes, ended and future Great Power Wars became unthinkable.  A MAD balance of terror succeeded, though often just barely, to hold the peace for the next 64 years.  The Nuclear Bomb was so devastating, the danger of self-immolation from miscalculation or recklessness so great, that our "largest gun" has been kept holstered ever since.  The Obama administration has just made a decision that risks disarming ourselves:

Obama Breaks With Gates, Cancels Nuke Program

Obama's new budget plan includes a little-noted sea change in U.S. nuclear policy, and a step towards his vision of a denuclearized world. It provides no funding for the Reliable Replacement Warhead program, created to design a new generation of long-lasting nuclear weapons that don't need to be tested. (The military is worried that a nuclear test moratorium in effect since 1992 might endanger the reliability of an aging US arsenal.) But this spring Obama issued a bold call for a world free of nuclear weapons, and part of that vision entails leading by example. That means halting programs that expand the American nuclear stockpile. For the past two budget years the Democratic Congress has refused to fund the Bush-era program. But Obama's budget kills the National Nuclear Security Administration program once and for all.

"My colleagues just stared at that line," says Joe Cirincione, a longtime nonproliferation expert and president of the Ploughshares Fund. "They had never seen anything like that." Killing the program, he said, was "the first programmatic impact of the new [zero nukes] policy. People have said they want to see more than words, this is the very first action."

Zenpundit comments:

The Obama administration is making grandiose gestures with America’s nuclear deterrent based less on a hardheaded and comprehensive strategic analysis than self-serving political showmanship, tailored to mollify a Left-wing base deeply resentful of the COIN strategy the administration is starting to take in Afghanistan. Nuclear weapons affect the strategic calculus across the entire spectrum of potential decisions, they’re not just shiny, anachronistic, bargaining chips but the overwhelming reason that great power war came to an end in 1945. Period.

Human nature has not made much moral progress since the end of the Third Reich but its very worst instinct for total destruction has, so far, been held at bay by the certainty of self-destruction.

We need someone to remind us again of how to think about the unthinkable.

I have tried not to read into Barack Obama's words, preferring to discuss his actions (which have been alarming enough); by this action, he is taking real risks with the planet based on a ludicrous belief (that does not reach the level of a theory.)  Obama's serial apologies to our enemies could have been the result of a calculated strategy that if we changed our tone we could either encourage our enemies to decrease their level of aggression toward us or could finally have them reveal their aggressive nature in an unmistakable manner.  This has always been more of a wish than an expectation, but was defensible as a strategy.  Weakening our Nuclear deterrent is far more dangerous for two reasons:

1) It suggests that Barack Obama truly believes that America is not only the center of the world but that our enemies cannot be considered to have their own agency.  Iran's nuclear ambitions are merely a reaction to American (and Israeli) aggression.  If this is true then decreasing the threat form the United States should lead to a commensurate decrease in aggression from our enemies.

2) Aggressors traditionally respond to attempts to "be nice"  by becoming more convinced that they are winning.  The Iranians, among others, do not see negotiations as win/win but as zero sum; if Obama misunderstands this basic distinction between the West and Honor-Shame societies, he will be consistently outmaneuvered by those who are even more ruthless and amoral than he is. 

By weakening our nuclear deterrent, by refusing to modernize our forces, by expressing ideas that are interpreted by our enemies as signs of weakness, and by an apparent unwillingness to use our entire range of resources to respond to enemy actions, we disarm ourselves in the face of those who have much fewer (ie, no) qualms about using every weapon at their disposal to gain what they consider to be their just ends. 

No Blogging Today

    Too much work and too little time.

The Core of Paranoia & its Relationship to Anti-Semitism

At the core of paranoia is often found an internal persecutor.  The dynamics are complicated (note the brief summary below) and lead to a particular problem in dealing with the pathology. 

[In close Psychotherapuetic work with paranoid patients (and with "normal neurotic" patients who share similar dynamics) early experiences with a poorly attuned Mother and/or real deprivation and abuse lead to the development of an ego dystonic internal object.  Under the impact of primitive splitting, the idealized and devalued images of the mother are divided and the devalued, hated object is pressed into the unconscious mind.  Once firmly lodged in the unconscious that negative image can never appropriately be tempered by the loving images and fused into a more complex, three dimensional representation of the mother.  Since the mother is the first object, the template, all other objects tend to be experienced as derivatives of the split maternal object.  The hated image resides in the mind and often leads to hypochondria (the sense that a part of the body is going to attack and betray you) or if projected, overt paranoia.  Since the self-representations are comprised of derivatives of the earliest object representations (identifications) having a hated part of oneself is often intolerable.  The hated split object must be kept unconscious; when the pressure of the unconscious increases, one emergency defensive maneuver is to project the hated part into the external world.  "I am not a hateful person; that person, who I do not hate, hates me! His hatred is so intense as to be frightening and I must protect myself from him and his hate.  I must destroy him before he can destroy me!]

The salient point is that the hated object is first internalized and then projected onto an external object.  When reality testing fails catastrophically, a delusion that the hated other is hostile and dangerous ensues.  There are ways to differentiate the fantasied object of paranoia and the paranoid.  The paranoid object will be imbued with all sorts of power and malevolence, far beyond what can be gleaned from the behavior and utterances of the individual designated for hatred and fear. This is often quite obvious when dealing with the individual suffering from a paranoid disorder.  Few people give credence to complaints that the CIA and the Mafia, using mind control beams, are inserting thoughts into the paranoid's head. 

(Interestingly, with so much of modern technology being indistinguishable from magic for most people, there are many people who are willing to believe the most fantastic nonsense, usually but not always in direct proportion to their ignorance .  For example, millions of Muslims now believe that the Swine Flu is an Israeli/Jewish plot; millions of American blacks believe that HIV was created in American government labs to destroy the black population.)

When it comes to populations, the task of differentiating the paranoid from the fantasy object of his disavowed hate becomes slightly more difficult, however, even here it is not an insurmountable challenge for an honest, dispassionate observer. 

Thinking About Anti-Semitism

Anti-Semitism is one of the most rapidly growing religions in the world fueled by Muslim and leftist rage.  It is based on various paranoid delusions (the Jews control all the banks, the Jews are fascists, the Jews are genocidal oppressors) and impervious to reason.  When an individual is paranoid and delusional, it is possible to treat the illness; when societies become deranged by anti-Semitism, historically there has been no cure; those societies that have been overtaken by anti-Smeitism have all been destroyed. 

Time pressures do not permit a more in depth look at this today but several excellent articles and posts are worht perusing:

Siggy linked to an excellent article from the Australian:

Israel still looks good, warts and all

I HAVE my very own Israel problem and it is this: the Israel I know, which I have visited for weeks at a time, which I experience through its literature and media and the Israeli citizens I have met, bears no relation to the Israel I see in most of the Western media. That Israel seems almost to dominate Western intellectual life. It is commonly held that Israel lies at the heart of the widespread Muslim hostility to the West and much of the ideological conflict in the Middle East. But Israel must surely also lie at the heart of the West itself; it is so often the centrepoint of raging ideological debate, shrill mutual denunciation, ferocious polemic, emotional demonstrations, university activism and academic boycotts.

Read it all and take a look at the comments, which reveal the failed reality testing of some of Israel's critics.

Mark Steyn suggests that the enemy is Israel Today, the West Tomorrow:

The joke about Mandatory Palestine was that it was the twice-promised land. But isn’t that Europe, too? And perhaps Russia and maybe Canada, a little ways down the line? Two cultures jostling within the same piece of real estate. Not long ago, I found myself watching the video of another “pro-Palestinian” protest in central London with the Metropolitan Police retreating up St. James’s Street to Piccadilly in the face of a mob hurling traffic cones and jeering, “Run, run, you cowards!” and “Allahu akbar!” You would think the deluded multi-culti progressives would understand: In the end, this isn’t about Gaza, this isn’t about the Middle East; it’s about them. It may be some consolation to an ever-lonelier Israel that, in one of history’s bleaker jests, in the coming Europe the Europeans will be the new Jews.

Richard Landes discusses Noah Pollack's comments on the vastly different reactions to Palestinian civilian casualties in Gaza and the far higher number of Pakistani civilian casualties of the American drone war, which has continued unabated under President Obama:

Combatant/Civilian Casualties and the Moral Hysteria/Hypocrisy of the West

Noah Pollak nails a particularly egregious element of the West’s inconsistencies in denouncing the inhumanity of war. Here we deal with the astounding difference in civilian to combatant casualty ratios between US forces and Israeli in targeted killings: 50:1 (50 civilians killed for every targeted combatant vs. somewhere between 3:1 (at worst), and less than 1:1 (more combatants than civilians killed) in the latest operation in Gaza. Comments at the end.

Unfortunately, anti-Semitism is making inroads in America, as well, though thus far much less virulent and pervasive than in Europe: [HT: Siggy]

State of the Nation
Anti-Semitism and the economic crisis

In order to assess explicit prejudice toward Jews, we directly asked respondents “How much to blame were the Jews for the financial crisis?” with responses falling under five categories: a great deal, a lot, a moderate amount, a little, not at all. Among non-Jewish respondents, a strikingly high 24.6 percent of Americans blamed “the Jews” a moderate amount or more, and 38.4 percent attributed at least some level of blame to the group.

Interestingly, Democrats were especially prone to blaming Jews: while 32 percent of Democrats accorded at least moderate blame, only 18.4 percent of Republicans did so (a statistically significant difference). This difference is somewhat surprising given the presumed higher degree of racial tolerance among liberals and the fact that Jews are a central part of the Democratic Party’s electoral coalition. Are Democrats simply more likely to “blame everything” thus casting doubt on whether the anti-Jewish attitudes are real? Not at all. We also asked how much “individuals who took out loans and mortgages they could not afford” were to blame on the same five-point scale. In this case, Democrats were less likely than Republicans to assign moderate or greater blame.

Finally, though this remains just the tip of the iceberg, Barry Rubin discusses Khaled Mashal's recent interview in the New York Times:

Hamas Says 'Kill Next Week'; Media Perceives Moderation

Resistance is legitimate, he [Mashal] says, but the leaders have to decide precisely how to do it. In other words, shooting at Israel is not useful for us right now so let's rearm, indoctrinate Gaza's young people into being suicide bombers and terrorists (or militants, if you prefer that word), and we will attack again when the movement's leaders decide that suits our interests.

 Is it really so hard to see this? Mashal isn't trying all that hard to conceal his views, ideology, and strategy. In part, that's because he thinks the people he's trying to fool are really stupid. In part, it's because he will have to defend anything he says to his colleagues. In part, too, it is because he is a real true believer (called fanatics in a less enlightened age).

 Finally, in this interview Mashal made this statement professing his moderation: "I promise the American administration and the international community that we will be part of the solution, period."

 Unfortunately, the solution he was referring to was Hamas's final solution for the Jews and Israel.

The New York Times has a long "progressive" history, which includes whitewashing information about the Holocaust when it was happening, so it should come as no surprise that they are all too ready to offer their support for those whose greatest wish is, as chanted at their rallies, to "kill the  Jews" but the mainstreaming of genocidal anti-Semitism is more than a little troubling. 

The worst realization is the understanding that anti-Semitism is an irrational disorder, supported by a large segment of our most capable rationalizers (Academics, the Media), and not amenable to interpretation.  A delusion that is shared by an entire culture or large sub-sections of the culture cannot be corrected or treated without extraordinary upheaval.  The world appears to be hurtling toward an abyss and there are few Statesmen (or women) on the scene who offer much reason for optimism.

The Price of Mathematical Illiteracy

If you are not a liberal when you are young, you have no heart.

If you are not a conservative when you are old, you have no brain.

We have all heard that old adage at one time or another.  It is a short hand way of saying that as one gets older and gains experience and responsibility, the demands of reality eventually cause us to temper our youthful wishes.  Modern liberalism is based on the wish that no one should have to suffer any disadvantages and that we can have whatever we desire, whether it is universal health care, a pristine environment, cheap gasoline, or expansive home ownership available to almost all.  None of these things are remotely possible in an unforgiving world in which 2 + 2 always equals 4, never 5 or 3.  Today David Ignatius, in the course of explaining the impending financial disaster about to fall upon the baby boomers, explains why so few of us actually understand and appreciate our limitations:

Ultimate Generational Bummer

How bad are baby boomers at financial planning? Extremely bad, according to Annamaria Lusardi and Olivia Mitchell of the National Bureau of Economic Research. They found that more than one-quarter of boomer households thought "hardly at all" about retirement, and that financial literacy among boomers was "alarmingly low." Half could not do a simple math calculation (divide $2 million by 5) and fewer than 20 percent could calculate compound interest. The NBER researchers also found that, as of 2004, the typical boomer household was holding nearly half its wealth in the form of housing equity. Uh-oh.

What happens when all the baby boomers who want to retire at 65 without changing their lifestyle find they are several thousand dollars short each month?  David Ignatius offers a not-very-surprising prediction that should make us all shudder:

What's going to happen? Certainly, people will try to save more. But my guess, knowing my generational cohort, is that we'll want a government bailout to supplement our too-meager retirement savings. Unfortunately, the Treasury won't have enough money to fund our Medicare benefits, let alone a top-up in Social Security.

The Most Selfish generation, composed of a large cohort of Narcissists, who have never had to struggle for anything, will expect our children and grandchildren to pay for their comfortable retirements. 

The New Realpolitik

Proponents of Realpolitik suggest that all that matters, and all that we should concern ourselves with, in international relations, is power.  Accurately assessing and managing our power and leveraging it to negotiate among the other powers in the world is an end in itself from which greater American security will flow.  Wikipedia's definition is cogent:

Realpolitik (German: real “realistic”, “practical” or “actual”; and Politik “politics”) refers to politics or diplomacy based primarily on practical considerations, rather than ideological notions. The term realpolitik is often used pejoratively to imply politics that are coercive, amoral, or Machiavellian. Realpolitik is a theory of politics that focuses on considerations of power, not ideals, morals, or principles.

Realpolitik was introduced during the Nixon administration under the tutelage of Henry Kissinger.  Their approach led to the ending of American attempts to isolate China and the beginning of our diplomatic engagement with Communists of China.

An early read of the Obama administration's approach to the international arena suggests that they are operating under a new, very limited understanding of Realpolitik.  In other words, although the Obama administration clearly has some ideological preferences, their interest is much more directed at managing power relationships, as they perceive and define them, than by ideology.  Whether their perception of power relationships is accurate and their management of those relationships is effective will go a long way toward determining how well the newly developing international rule set evolves.  In important areas, the Obama administration acts as if the Untied States is much weaker than it was perceived to be under the Bush administration.

There are two variants of Realpolitik that are important to understand.  One variant, the Tom Barnett version, suggests that the friction we see in the gap and the gap-core interface is an inevitable outcome of modernization and that as the gap becomes better integrated into the core, such friction will diminish and be replaced by more conventional economic competition.  Our management of the transition will involve minimizing extreme perturbations of the rule set.  In this model, moving toward a more mature relationship with China, in which they become greater stakeholders and enforcers in the international system, is key.  In this conception, Iran and its nuclear ambitions is a sideshow.  In the most hopeful iteration of this approach, the belief is that once Iran achieves a nuclear capacity, it will follow the path of the USSR and China and slowly moderate as the realization of the impossibility of the use of nuclear weapons for offensive war becomes clear.  There are many arguments that can be made about this view but on balance it is a reasonably optimistic point of view and defensible as the basis for a foreign policy.

Rationing Medical Care

Hugh Hewitt has been paying attention to the nascent, and mostly covert, discussion of single payer health care and the certainty of rationing under such a system:

The Approach Of Health Care Rationing: You Don't Get What You Don't Pay For, Like Pandemic Protection

My column in the Washington Examiner looks at the rush to radical restructuring of health care, which will indeed bring about rationing, and just after U.S. medicine takes the lead in containing the H1N1 virus.  Rarely has so effective a system been so thoroughly punished for its success.

His point should be better understood by those who support single payer, ie government run, health care but as with so much in our overly bureaucratized system, opportunity costs are never calculated or even acknowledged by those who job it has traditionally been to be purveyors of information, the MSM.  Their failure is going to have a dramatically deleterious effect on our health care if single payer takes off.

A few vignettes, taken from my experience at the Mental Health unit of a Community Medical Center might help to make the case.  The bulk of the population served by the Clinic are poor and most are on Medicaid which has traditionally been extremely generous in New York.

Mr. M was a 19 year old semi-literate immigrant from Somalia.  He had been in America fo less than a year when he suffered from a psychotic break and was hospitalized.  At discharge he was referred to the clinic for follow-up.  At my initial evaluation he had active auditory hallucinations and paranoid delusions, but was not a danger to his self or others; he had stopped his medicines after he left the hospital and his symtpoms had returned.  Complicating matters, he had no fixed abode, no income, no work skills to speak of, and no family available to support him.  I started him on (expensive) anti-psychotic medications but felt that he needed a more comprehensive program if he was to have any hope of recovery.  I suggested we work to arrange for him to return to his country where he had family and could get more support.  It was explained to me that since his country had more primitive health care than the United States, that would not be acceptable.  I then suggested we refer him to a day hospital for ongoing treatment.  I was informed, sotto voce, that since Mr. M was undocumented, we would not be able to refer him.  (I cannot comment on the legal and/or bureaucratic reasoning behind such a decision.)  Mr. M had a partial response to treatment, was followed in the clinic for several months and then was lost to follow up, ie, he stopped keeping appointments and could not be reached by telephone outreach since, as noted, he had no fixed abode and didn't answer his cell phone.  (Yes, despite his lack of work, family, or other supports, he had a cell phone.)  The total cost of his treatment for several months probably reached several thousand dollars since he took quite a bit of time from a team of professionals, including a Psychiatrist, Social Worker, Psychiatric Nurse Practitioner, and Case Manager.  Unless he chooses to return to Somalia, we can expect him to intermittently continue using services in New York Clinics with an occasional very expensive hospital stay thrown in for good measure, all paid for by Medicaid, with minimal chance that he will ever become a productive member of society.

Solipsism and the Apocalypse II

Consider the greatest threats to life on Earth.  If you were to peruse the newspapers or spend any time listening ot talking heads in the MSM, or bloviating Congressmen, Senators, and ex-Senators, it would be clear: Anthropogenic Global Warming is the greatest single danger to life on Earth that mankind is facing today.  This is utter nonsense, not least because even the most excitable proponents of the AGW thesis do not predict a runaway greenhouse effect to destroy the biosphere.  As far as can be discerned frm their pronouncements, the greatest danger seems to be that the global temperature will rise a few degrees, sea levels will rise, perhaps as much as a meter, the arable belt will shift away from the equator, and climates will change, sometimes in a direction that will increase human discomfort.  The possibility of relatively rapid climate change must be taken seriously but we have time to develop technological responses to climate change and our most important tools that can mitigate the effects of climate change are dependent on increasing global wealth.  In other words, rich people can much more easily adapt to climate change than poor people.  The more rapidly the global economy recovers and accelerates from this recession, the better off we will all be, including the planet.  The AGW advocates reveal their ideology most in their fevered rush to slow the economy through the immense tax scheme known as cap and trade.

If AGW is not the greatest existential risk we face, what is?

There are a number of dangers, some to the biosphere itself, others just to homo sapiens, and others primarily to technological civilization.

Bill Joy discussed the threats to the biosphere and to homo sapiens in his seminal article:  Runaway nanotech (the gray goo threat) could dissolve the biosphere.  Unfriendly AI (Artificial Intelligence) far smarter than mere humans, could decide they don't need us as pets or colleagues and that the resources of the universe could be better used to support computation than organic life.  Novel genetically enhanced or invented life forms could destroy all human life on the planet.  (Think of an Ebola like virus with a ten day incubation period and easy transmissibility.)  These are human derived threats which we should deal with proactively, though if the past is any guide are unlikely to gain much attention until the threats materialize.

A different order of magnitude would be that class of dangers about which we can do nothing.  An errant asteroid could end multi-cellular life on the planet.  A nearby star could go Supernova.  The Yellowstone supervolcano could explode.   Until we have moved off the planet and begun spreading through space, the human race will be at risk of encountering the Great Filter.

With all of that as preamble, the fact remains that there are dangers that could derail and destroy civilization and send us into a new dark ages.  These are dangers that we have the wherewithal to address but choose to minimize or ignore at our own great risk.