Bright Monday Highlights

Good Morning. Christ is Risen!

  1. Some Paschal Links from the East: A Dachau icon, four prison camp liturgies recalled, Liturgy pictures from the seminary, from Esteban, a song, the symbolism at the table (in which I wonder how our annual inclusion of White Castle sliders figures in that idea),
  2. Live and word and a Darwinian fable.
  3. Evolution and snake oil.
  4. Information and habit in Baghdad.
  5. On high speed passenger rail.
  6. Heh.
  7. Mr Wilders.
  8. Universal health care in which “and a pony” is not the best remark … but honestly speaking I’ve yet to hear a reasoned answer to my rejoinder that health care requires rationing … and why is “ability to pay” not the fairest method of doing the rationing?
  9. The left’s Ms Coulter.
  10. Verse.
  11. One big factor “keeping the Black man down” and likely one which will not help the “white man” in the future.
  12. Eight years.
  13. A tale (and an amazing book) from the gulag.
  14. Patristics resources.

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18 comments

  1. Boonton says:

    Universal health care in which “and a pony” is not the best remark … but honestly speaking I’ve yet to hear a reasoned answer to my rejoinder that health care requires rationing … and why is “ability to pay” not the fairest method of doing the rationing?

    I think there’s a good argument for it, but it seems fair to provide some type of universial ability to pay, beyond that individuals can supplement with their own ability to pay as much as they desire (or don’t desire)

  2. Boonton says:

    “One big factor “keeping the Black man down” and likely one which will not help the “white man” in the future. ”

    It certainly helped contribute to keeping Sarah Palin down….

  3. and why is “ability to pay” not the fairest method of doing the rationing?

    Because we’re not monsters. We don’t think the rich girl’s nose job is more important than the poor man’s heart valve replacement. Why should it be?

    The left’s Ms Coulter.

    Coulter is a best-selling author. BEST SELLING. Millions of idiot conservatives rush out to buy all her books. Garafolo, not so much. It’s hardly comparable. Also, what has she said that compares to Coulter?

    “I was going to have a few comments about John Edwards but you have to go into rehab if you use the word faggot.”

    “There are a lot of bad republicans; there are no good democrats.”

    “We need to execute people like (John Walker Lindh) in order to physically intimidate liberals.”

    “My only regret with Timothy McVeigh is he did not go to the New York Times Building.”

    “Press passes can’t be that hard to come by if the White House allows that old Arab Helen Thomas to sit within yards of the President.”

    “Vester: You say you’d rather not talk to liberals at all?
    Coulter: I think a baseball bat is the most effective way these days. ”

    Etc.

  4. Mark says:

    Boonton,

    I think there’s a good argument for it, but it seems fair to provide some type of universial ability to pay, beyond that individuals can supplement with their own ability to pay as much as they desire (or don’t desire

    I think I don’t disagree with that … but perhaps we differ on where that line of necessary vs non-necessary lies.

    JA,
    Apples to apples. Do you think a rich man’s heart valve replacement is equally or more important than a poor mans?

  5. Mark,

    Apples to apples.

    No. We’re talking about what criterion to use for rationing. Your suggestion was ability to pay. I’m countering with urgency of need as the criterion. Can I take it you agree?

    If all we’re debating is whether a rich man’s or poor man’s valve replacement is more important, then ok. I’ll say they’re equally important.

  6. Mark says:

    JA,
    No the problem is rationing. We cannot provide all the health care we wish to everyone. Who gets cut off and who does not and by what criteria.

  7. Right. And I’m proposing those with less important/urgent needs get cut off while you’re proposing those with less ability to pay get cut off. If we don’t have enough money in the system to cover every important/urgent treatment, then the whole system has failed. That’s not “rationing,” that’s “failing.”

  8. Boonton says:

    I think I don’t disagree with that … but perhaps we differ on where that line of necessary vs non-necessary lies.

    I would prefer to see a solution that is essentially a voucher like amount that is provided to everyone that can be applied against either employer based insurance or their own purchase of a health insurance policy. In order to qualify for the voucher the plans would have to provide certain basic provisions but have no limit on the upside (i.e. if it wants to cover nose jobs fine by me but as long as it doesn’t kick cancer victims off its rolls). You have here a ‘universal ability to pay’ but doctors still have to compete for business as do insurance companies. How much the voucher should be is going to clearly be a political question but I would like to see it linked directly to some type of tax the way social security is. Obviously if the voucher is set low people would supplement with private money. If the voucher is set very high people have to be willing to pay the tax for it.

    Rationing

    JA’s point is valid. Right now if you just go by ability to pay the rationing happens based on money, not need. Most people don’t object to allocating Wii’s or Carribian vacations like that but we don’t like that with healthcare.

    Food might be a good analogy here. We have food stamps, food banks and other charitiable methods to make sure everyone can ‘afford to eat’. Yet beyond that ‘ability to pay’ decides how many steaks end up at high end eateries versus cheap hamburger meat at fast food joints.

  9. Mark says:

    JA & Boonton,
    OK, in the vein of the endless campaign I’ll outline some thoughts on healthcare tonight to put up some ideas for y’all to shoot at.

  10. Mark says:

    JA,
    I think you’re being disingenuous in claiming that rationing access to cosmetic surgery will make available more resources for oncology drugs or mitral valve replacement surgeries.

  11. Mark,

    I think you’re being disingenuous in claiming that rationing access to cosmetic surgery will make available more resources for oncology drugs or mitral valve replacement surgeries.

    Huh? How can you disagree with the claim that a dollar not spent on a nose job can be spent on oncology drugs and valve replacements? Isn’t that how existing health insurance plans work?

  12. Mark says:

    JA,
    You think there is no such thing a specialization? Do you expect that a plastic surgeon (who from my experience with reconstructive surgeries required for my daughter regard themselves as something akin to artists) can “do” heart valve replacements? That is what is disingenuous.

    What you’re wanting to do is to say to person X who is willing to spend his own money for his own purposes cannot but instead that money will be taken from him (by force) and be used on person Y and that furthermore that doing so is more fair.

  13. Mark,

    You think there is no such thing a specialization?

    The resource I was referring to was money. However, if economic incentives shift, perhaps more med students will choose general/cardiac surgery over cosmetic surgery.

    What you’re wanting to do is to say to person X who is willing to spend his own money for his own purposes cannot

    Absolutely false. Of course he could spend his own (post-tax) money for his own purposes.

    but instead that money will be taken from him (by force) and be used on person Y and that furthermore that doing so is more fair.

    Taxation is the price of citizenship. If you’re so selfish that you refuse to pay 39% of your taxes on income over $250,000 (or whatever) so that your countrymen can get lifesaving heart surgery, you don’t belong here. Go move to Dubai.

  14. Boonton says:

    Huh? How can you disagree with the claim that a dollar not spent on a nose job can be spent on oncology drugs and valve replacements? Isn’t that how existing health insurance plans work?

    The answer is who is deciding how that dollar is spent? If the person purchasing the plan is an individual or business it may well be an inability to access nose jobs will just result in money being spent elsewhere. Lower premiums, for example, might end up going towards non-healthcare related consumption. If the answer is the gov’t then the question still remains. If the VA decided that returning troops cannot get nose jobs paid for at taxpayer expense (just pretend right now they can), it doesn’t follow that the savings will automatically flow into better oncology care. Maybe, Maybe not.

    On the flip side, it is possible that nose jobs can end up subsidizing healthcare. A hospital may have a plastic surgery center that is profitable thereby offsetting charity care expenses.

    In reality I’m not sure this is a great example. I’ve never heard of any insurance, gov’t or private paying for nose jobs unless your nose was damaged by an accident. A down to earth example might be the law student whoose letter Andrew Sullivan published recently. He has asthma but no coverage since he is in school. He has to basically get his friends mom to swipe samples of the drug he needs. He was jogging on a treadmill and got a sudden pain in his foot. He stayed off of it for several months. In the meantime someone with good coverage will get regular checkups for a $20 co-pay and maybe spend $100 for an emergancy x-ray if they got that mysterious pain in their foot. This type of ‘rationing’ does not seem very efficient or fair.

  15. The really hard ones are going to be about expensive end-of-life care. Is it worth $500,000 to keep a dying man alive for an extra month? With infinite money, of course. But how will the money work?

    These decisions are going to be made much harder if half the country is arguing in bad faith.

    (E.g. they’re against the whole system but will pretend that it’s about euthanasia or class warfare or abortion or anything but the fact that they don’t want millionaires to have to pay e.g. 39% instead of 36% in taxes.)

  16. Boonton says:

    Question do we really spend $500K for an extra month? People often confuse the difference between spending and being charged. For example, we often hear Catholic schools educate for ‘only’ $5K per year. But when one in my area closed the paper reported that tuition only covered half of the expenses. The true cost was $10K.

    Likewise is the man in intensive care for a month before death really costing us $500K or does the hospital simply charge that? Do they charge that because the cost is only $100K but on average they can only collect 20% after taking into account bad debts, insurance contracts and Medicare mandated write offs?

  17. Boonton says:

    These decisions are going to be made much harder if half the country is arguing in bad faith.

    True but on resolution is to agree upon a set of commonly provided benefits and let the market settle all questions outside of that. I’m not sure the ‘last moments of life’ issue is all that important here. Most people die when they are old which means they die with Medicare or medicaid. While sometimes strained, these programs essentially do not require pulling lifesupport or whatnot. Yes some experimental stuff or stuff with very little evidence to support it may be denied but do you really hear of many euthansia contraversies stemming from either financial cost in general or gov’t provided healthcare specifically? For example, the Terry Schiavo case had nothing to do with money.

    We are seeing medical costs increasing but I think this is due more to the fact that medical care has become much more valuable. Imagine an easy exercise. Take a basket of pills that represented the daily medication of a typical 65 yr old in 1990. That basket today, I gurantee, will cost less today than it did in 1990….probably dramatically less. The difference is that a doctor will say today a different set of pills in 2009 will do a better job. That ‘replacement basket’ will cost more and that will get called ‘inflation’ but it really isn’t.

    Doing this with pills is pretty easy since we can look up what is often prescribed and see when stuff goes off patent. It’s harder with other aspects of medical care. You can’t buy a ‘1990’s doctor’ or visit a ‘1990 hospital’. Such a service has to be a mix of, what I think, cheaper ‘1990 stuff’ with ‘post 1990 advance’

  18. Mark says:

    Boonton,
    Chemo (that pill basket) is more expensive today but actually far far more expensive [corrected] effective. That’s one side of the coin. On the other … I think there is no public need to aid anyone at 70+ to live just one month (or six) longer, so I don’t think that’s necessary.

    Pain therapy is one thing … but then again I come from the “death has no sting” camp.

    JA,
    On the “bad faith”, well I don’t think I’m arguing in bad faith, I think my taxes are to high, not just the guy making 3-4 times I am. But I can’t complain about the rhetoric, after all … in today’s essay, I don’t argue you’re arguing in bad faith, just the old phrase … “stupid or evil” to think single payer is a good idea. Like you however (I think), at least on my part I’m mostly trying to be provocative (not divisive or insulting). So try to take that remark in the spirit I mean it.