ﾠ No wonder you don't comprehend: you're putting words in my mouth, and they don't fit there. I never said anything about "having the entire biomedical sector nationalized by stealth." Anyway, how many countries with UHC have NO private biomedical sector? Unless the answer is "most", you're simply confusing yourself by assuming the absolute worst conclusion, even if no one wants it. ## "False dilemma: the argument is rather that the product of money, fear, curiosity and compassion is greater than the product of fear, curiosity and compassion." I'll buy that. And think that the increased amount of compassion and social safety net will compensate for a little reduction in profit. ## Mike, I feel your argument, and your concern for your family is dead on, honorable, and reasonable. I believe that there will certainly be some situations where a change would reduce the quality in specific cases, I also believe that the overall results would be better. But I honestly empathize with you. ## Frank: that article is only a rebuttal if I remove my contention that lifestyle issues are benefitted by social safety net. I'm willing to consider that in balance with Erich's idea that future research might suffer for a lack of mega-profit today. It was kinda narrowly directed, in that sense. But in general, I'm on the side of the issue that says these behaviors (overeating, under-exercising, smoking, drugs, etc.) are by-products of ignorance, loneliness, fear, and repressed negative emotion. And that the countries strengthening their social structure are directly contributing to their citizens' health and welfare in ways that go beyond allopathic medicine. I understand if you disagree with this, and I admit to waffling here a bit. But my courtesy to Erich doesn't change what I believe, and I can't let that alone with so many lives at stake. So, please forgive me, but I have to say that everything I know about human beings says that community matters. ## Yeah, I think health care might be the most important issue in the U.S.--especially if you don't have it, or have relatives and friends who have died because they didn't. ## ﾠMarty S.--yep, Cancer and Heart disease are major factors. And America does pretty well with those, but STILL loses overall. Which implies to me that there is a gigantic black hole of horror in our health care, one that swallows those statistics, and that you are comfortable enough to be able to ignore. Because everyone is afraid of cancer and heart disease, I seriously doubt that suddenly research into those arenas are gonna be slashed. Rich people don't wanna die, and they'll vote with their dollars. Pharma companies will still make profits--but possibly less. Except that their stockholders' money will go further because of things like...wait for it...UHC. ## Marty, Frank, and Erich--it's o.k., guys. We get that your minds aren't going to change, and that's all right. On this issue, you're on the other side of the line: you don't believe the WHO results. WE GET THAT. Those of us on this side DO believe those results. It's as simple as that. Work it out among yourselves, guys--no one is trying to change your opinion. The rest of the world is wrong, and you are right. Cool. ## Marty--a link between education and life expectancy? Great! Thanks for the suggestion: next up, universal education. And I agree that there are other models beside UHC. I don't think any of them have been as well tested, however. I want a Public Option, designed to be deficit neutral, like letting everyone buy into Medicare for cost plus 10%. THAT would keep the insurance companies honest without a vast and expensive regulatory beaurocracy. The insurance companies would have to police themselves, or become obsolete. I love that idea. ## ﾠ Does anyone think this is unfair of me? I'm not trying to be. In fact, I'm offering an olive branch, suggesting that the disagreements are caused by, in essence, differing views of our spiritual essence, and that when it comes down to it we're just going to have to learn to live together. ## I keep hearing an understandable complaint: "so I can't oppose Obama's policies without being racist?" Yes, unfortunately there are some assholes who take that position. And it can't be comfortable being on the end of that. On the other hand, they wouldn't have as much ammunition if it weren't for denial on the Right that racism plays any significant role at all. So you have people on one side in denial that there are very real policy disagreements, and people on the other side denying that a 400% increase in death threats to our first black President is significant. Only if you yourself are awake do you have the right to complain that others are asleep. ﾠ
Wednesday, September 23, 2009
Reduce Government Beaurocracy!
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I'm sorry, but I really do think that the current Obamacare proposals will be, if implemented, effectively nationalization of health care and the biomedical industry by stealth. Why I think that would be a very long argument which I'm not going to write, but Megan McArdle at the Atlantic's had plenty of long essays about this if you're really interested. I understand that that is not what you yourself want, but it is precisely because actions have consequences regardless of Good Intentions that Obamacare dismays me. Obviously, if I were judging it merely by the best intentions of its most ardent supporters, I'd consider it the road to Utopia.
"... you don't believe the WHO results."
I believe they exist; I just don't believe that they're decisive, for a number of reasons that I've written about before at considerable length.
And, yes, there's some remnant of private-sector pharmaceutical biotechnological research outside the U.S. However, the lion's share of private pharma's been heavily relocated to the U.S. over the past several decades, for a number of reasons which certainly do include the fact that pharma and biotech can make profits here that it can no longer make in most of the world.
As for the idea that soak-the-rich is OK because "the rich can afford it": it's a terribly misleading half-truth. Yes, the Ted Kennedys of the world can afford to have everybody else taxed heavily, because people who've already inherited great wealth, and who (unlike Bill Gates) have no ambitions to themselves create qualitatively greater wealth, are fine with a massive redistribution of wealth from the highly productive to the less productive. What such an approach stifles is the twentysomethings or thirtysomethings who aren't already rich and who are trying to make themselves by innovating. Paul Graham's written about that, from first-hand experience.
If you think that UHC is really more important than our developing large, inexpensive supplies of domestic energy, then you must really think that our failure to do so will have no consequences for the length of the current recession or our future likelihood of having Manhattan atom-bombed. Needless to say, I don't think those things.
If you think that UHC is more important than the impending fiscal collapse of the federal government -- to which poorly budgeted UHC will, the CBO tells us, be a likely contributor -- then wait and see what happens to the poor, the non-white, and the non-male when the federal government of the U.S. abruptly stops being able to enforce any laws.
Finally -- as I've written before, obviously to no avail whatsoever -- considering the current Obamacare proposals a disaster on wheels does not at all mean that I think our current system is perfect or that we should simply let poor people die. I'm very much in favor of compassion, and there are a number of reforms which I think would be worth implementing to make the lives of the poor in America at least somewhat better. What I bitterly oppose is ineffectual compassion that I think will end up harming far more people than it helps. It's not just about a reflexive opposition to "bureaucracy": it's about wanting to avoid How Rich Countries Die or The Road to Serfdom.
--Erich Schwarz
Imprimus: bureaucracy. ;-)
Secundus: "people on the other side denying that a 400% increase in death threats to our first black President is significant. Only if you yourself are awake do you have the right to complain that others are asleep."
The numbers you quoted on death threats to Shrub v. Obama were 4k v. 12k; what kind of sleepwalking is required to get 400% increase instead of 200% increase? Confusing a 200% increase with a 0% increase would be the same magnitude of error, but not, in absolute numbers, worse....
Steve: Its not that I don't believe the WHO report, its that I recognize it as one opinion based upon one set of values. The WHO report rates each country in eight categories which it defines based upon its opinion of what are important measures of a countries health care system. WHO is not god and its opinion of what eight things are important are not necessarily the same as other experts in health care system. Secondly to get a final ranking they combine the scores according to a formula they devise which reflects their opinion of the relative importance of each of category. Let's look at another example of this sort of evaluation, to see why some of us might reasonably disagree with this evaluation. Let's say the question is to rank the all time greatest NBA centers. Ask ten different basketball experts and you will get ten different rankings, depending upon what they include in the rankings and how they weight them. Do they emphasize points scored as compared to shots blocked, shots intimated, extra passes made. Do they they think team titles won is relevant to the center's performance or not.
Finally let me give you this quote from the site presenting the WHO results.
"The World Health Organization's ranking of the world's health systems was last produced in 2000, and the WHO no longer produces such a ranking table, because of the complexity of the task."
That is the WHO itself recognizes that its rankings may not tell the whole picture and that repeating the study is not justified.
I find it fascinating that you guys think the good old USofA is not already a socialistic system. The only true capitalists dies a few generations ago.
I like the President's line on Letterman about racism: "You know, I was black *before* the election ..."
Erich-
I never said "soak the rich".
##
Energy proposals are only of use if they improve human life. (And of course I believe that they will). But the primary measurement of whether they improve our lives will be things like infant mortality, life extension, and perceived joy in living. It SERVES those ends, and is not driven by them. So the base of the pyramid must be consideration of those things. And considering that (to me) stats suggest we are paying hugely for an inefficient system...yes, I think our smartest move is to directly use life stats. What good is wealth if people are dying younger? Or energy, or anything else if we are sick? Would you rather have an energy-rich society filled with sick people, or a "poor" society filled with healthy, happy people? Of course they aren't mutually exclusive...but there is value in prioritization.
Marty--
the WHO is expressing an opinion. Yes, and I agree that life span and infant mortality are valid measurements, and far less manipulable by political inclinations than any others I can think of. If your opinion varies, that's fine. Like I said, I hope the weather is nice on your side of the line.
Scotty boy--
you're right! It is a three fold increase, not a 400% increase, which represents a bit of dozing on my part. How wonderful that you are so sharp in analyzing the most important point in my statement. The world just became a better place.
Steve: If I give a student eight math problems and he gets two right does that mean the student can say well I got problem 1) right and problem 5) right so I must know what I'm doing. So the rest of my test must be right and I deserve an A. That's exactly the logic you are using when you pick out two measures that clearly belong in any health care study like life span and infant mortality to say the WHO study must be accepted without argument and ignore the other factors like fairness of how the cost is distributed which are included in their ranking system and in my mind has nothing do with the general health of the population.
Yeah. So, do you have, in your opinion, the right to complain?
"Only if you yourself are awake do you have the right to complain that others are asleep," right?
I'd say - libertarian robot that I am - that the first steps the government should take to improve public health would be to stop supporting Bad Things like tobacco, alcohol, grains - one interesting suggestion is to cut every food subsidy, in the interest of reducing consumption. Oh, and end the drug war; alcohol was dramatically more poisonous and deadly during the Prohibition than before or after.
I'm a lifetime teetotaler, don't even own a coffee maker; I'm not promulgating recreational drug use, just noting that government interference makes the consequences much worse; the term 'blind drunk' came from fairly widespread wood alcohol consumption during Prohibition, something that just didn't happen before or since.
"I never said 'soak the rich'."
Not that concisely, no. Here is verbatim what you did write, just a day or so ago:
"... the idea that we might lose some high-end research that might benefit the very wealthiest has zero traction with me: the wealthiest, if they are really concerned about those rarefied diseases no one else is afraid of, can fund it themselves. I'll go with the greatest good for the greatest number, thank you...
"But, yeah, there'll be money out of your pocket, no doubt. That's the biz, kids, the cost of living in a society with other human beings who have a vote."
The Congressional Budget Office has repeatedly run the numbers on Obama/Pelosi's current proposals for UHC ("Obamacare"). They're budget-busting, and they'll be paid for either by deficit spending that makes Bush look fiscally prudent, or by higher taxes. Since I assume you are not in favor of ueber-Bush deficits, that means that taxes will go up. Since almost all federal revenues currently come from the upper 50% of income-earners in the U.S. (and some amazing proportion comes from the top 10%), that means that the taxes of the affluent will go up.
In addition, we'll see price controls and rationing meant to "bend the curve" on growing medical expenses -- that's actually the point, the thing that lets Obama claim with any kind of straight face that this'll save money. And, we'll see heavy taxation of the sorts of high-end payoffs for successful biomedical research that make the high-risk, easy-lose environment of pharmaceutical or biotechnological research at all worth doing a startup for or making a capital investment in.
Moreover, when I'm talking about that high-risk research, I'm not just talking about things like drugs to postpone human aging (even though such drugs are being pursued by Elixir and Sirtris, and would represent a vast improvement in the human condition if developed). I'm talking about all serious private pharmaceutical industry in the world today. The failure rates on drug development are appalling, nobody seems to know how to make them better (if they did, they would have an absolutely stupendous selfish interest in implementing better methods!), and to recoup the cost of their 95%+ failure rate, drug companies charge premium profits on every new drug they manage to sell while they keep a (short-lived) patent right to it. Cut back on the ability of those companies to make their profits, and you're not just taxing their CEO: you're removing their economic rationale for devising new drugs in the first place. More broadly, that's the whole economic calculus of innovative technology in the U.S. Tax, flatten, and regulate their profits away, and you get a long-term loss of innovation for a very short-term pleasure of cutting some rich guy's budget.
As I said: the Ted Kennedys of the world can live with that fine. It's the people who want to do more than live off their daddy's inheritance money, who are either trying to invest their capital in something genuinely innovative, or whose "wealth" is human capital (brains and gumption) rather than cash in the bank, who are trying to actually do something innovative in the private sector, who I see taking the primary hit from UHC, with the increased taxation and regulation that I expect it to entail.
--Erich Schwarz
"libertarian robot."
That's redundant, isn't it?
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