Well, busboy, I think you are right. We are talking past each other. I was not talking from the perspective of a healthcare bill in process. I was merely reacting to the notion that, given the authority, a government would try to preserve life, and, preserve it even to the detriment of the patient. That is all of it in a nutshell. No reading from any pending bill, merely what I read into Michael's statements. As you agreed, such a notion is quite wrong-headed, if that is what Michael was touting. I trust you are right and he is not touting that at all. Good thing!
We do face the possibility of a government-run, single-payer healthcare system in the future, I believe, and any legislative steps that might be perceived to be in that direction must be thoroughly examined for their long-term implications.
I am not at all convinced that, if the government was the sole operator of healthcare, they would keep hands off of all the medical decision processes--including EOL--for their own rationales, motives, and political notions, and with ever less care for the patient. I am not reacting here to any specific legislation purporting to lead in this direction, but to the basic principle of rejecting government intervention ever further into our lives.
What knits those statements together you highlighted is the opportunity that seems to be growing for government to increase its role in every direction, and EOL is a critical one. To dredge up an old saw: he who pays the bills calls the tune. If they can, they will, or at least try. My opinion. A line must be drawn somewhere.
I will leave it at that.Comment Posted By mannning On 8.10.2009 @ 16:05
Up until this point, I have been arguing the end-of-life problem and who I would want, and not want, to be involved in my death, and some of the whys. This was in response to a highly specific proposition that offended me.
I deliberately ignored the intermediate problem of coverage by either the government or by insurance companies and which would be better, because the end of life problem dominated my thoughts and dictated my aversion to having the government in the decision loop.
We currently have both involved: via Medicare and Medicaid, the VA and military medical care on the government side; and private medical insurance on the other side, as supplemental to Medicare, for instance, or as primary medical care via an employer's policy. There are a few golden policies written for the wealthy, I suppose, and for Congress, but they are not dominant in the industry.
From a practical view, I do not see how we should favor one over the other: both have their place in our society. Yet, each has its flaws and needs a tuning to become really effective. I have already shown one flaw in having the government take part in the end of life decision process, which, if taken to the extreme, would overload our systems. There are several flaws in the private insurance approach that need to be addressed also. Here is a quick list of what I see as needing to be solved satisfactorily "real soon now", and by employing conservative principles as appropriate:
1. Ensure financial security for Medicare and Medicaid
2. Ensue financial security of Social Security
3. Reform the tort system to eliminate abuses
4. Reform the administration of Medicare and Medicaid to eliminate fraud and abuse
5. Allow health insurance to be portable across state lines and from company to company, if practicable
6. Eliminate the “doughnut hole” in prescription insurance
7. Require immigrants and visitors to take out adequate health insurance in advance of entry into the US
8. Require employers of aliens to take out health insurance on their employees and families.
9. Require proper ID and medical records for all persons resident in the nation.
10.Allow or demand that insurance companies write policies for people with preconditions whose premiums adequately reflect the insurance risks, and spreads the risks as well over the policy field.
11.Address the problems of long-term care more deeply, perhaps with a joint solution between the government and private industry.
12. Address the problem of upper limits to coverage by insurers, cutoff criteria, and the ensuing problem of probable bankrupcy of the patient.
13. Further address the problem of rapid approval of procedures and medications for use by providers for patients.
14. Retain the essential free market approach, while addressing ballooning medical costs. A big how?
15. Perhaps consider an "insurer of last resort" approach to provide coverage in hard cases by industry, and not necessarily the government in the first instance.
16. Doctor compensation is a significant problem. They spend the better part of a decade in schooling, and can incur personal debts in the hundreds of thousands to pay their way, and have a highly constrained personal life during those years; many take a decade to simply catch up.
I have not seen any detailed healthcare plan that not only addresses these problems but also provides a clear and understandable means for solving them adequately, shows how to pay for them, and at the same time preserves the essential freedoms of the marketplace.Comment Posted By mannning On 8.10.2009 @ 15:08
Well now, my AMD sets forth the conditions under which I would prefer to be allowed to die. But, ole Michael never brought up that argument, which puts a small spike into his diabolical plan for the government to keep us alive regardless.
However, can the government ignore such a directive and keep me alive against my will? If I accept a bit of what busboy alluded to, they certainly can disrupt the game, deep six my AMD, keep me bubbling on the tubes, and in the agony of advanced cancer, especially if they want me to vote! Oh Michael, do you really believe in this?
A vote, you may recall, has to be executed by someone in their right mind, so no morphine or other pain-killing drugs for me either. This gets even more diabolical!
No, I do not want this scenario at my deathbed!Comment Posted By mannning On 8.10.2009 @ 13:50
That's good! Molt sees only emotionalism where the underlying fact is being illustrated graphically. This diabolical idea, that the government would keep one alive through the intense pain process prior to final death, regardless of the desires of the patient or relatives, simply to vote one more time is beyond the pale
Of course, Molt, you also took me literally about a gift--it was a facitious comment. What a humorless crowd! I'd say, beware the government bearing gifts!Comment Posted By mannning On 8.10.2009 @ 13:14
Now you are doing the usual slide dance. Change the scope of the argument, and introduce invective, if you are pinned down. We were not talking about soldiers, the VA, or Medicare, per se.
We were talking solely about your stupid idea that you would welcome the government into the end of life decision process because they want to keep you alive so you can vote, vice insurance companies that you say will abandon you to your fate!
When I pointed out that you just might want to die, but the government would keep you alive for their reasons, you did the dance. So I assume that you actually do want to stay alive through the most painful cancers there are, because the government wants it that way. Out-of-sight rediculous!
Your evasions are sickening, and it is quite obvious that you do not want to address the end of life argument directly at all. This idea of yours is diabolical, and yet you stick to it. That is why I wished you well in your end game. I hope you do not find yourself being kept alive by the government when by all measures, except this one of yours, you should simply die.
It is in this context, and this context alone, that I do not want the government deciders anywhere near my deathbed. Just stop trying to distort this argument in a flawed attempt to defend your absolutely diabolical idea.Comment Posted By mannning On 8.10.2009 @ 12:56
The only thing health insurance providers are responsible for is to pay for covered items--or not. They are not responsible for life or death decisions, and I never said they did.
My first point, and it is logically clear, is that the life or death decision for a patient currently resides with the patient, or his appointed relatives, with medical aspects of the decision contributed by doctors, and with no input from the government. This is fact which I supported from personal experience.
My second point is that it is diabolical to bring the government into this decision if the only motivation of the government is to prolong the life of the patient so that he can vote,when it is totally against the patient's wishes to continue to live. This is a disgusting idea unworthy of rational people.
You are trying to misinterpret my statements yet again. I am NOT saying a thing about the insurance provider's decision to stop or continue paying, except to point out that when the provider stops paying, it throws open the necessity to make a decision on how to proceed. (The key cost factor is at what point in the progression of the illness does the provider decide to withdraw.) Here, it is the patient or his representative, with doctors help, who decides the further course of action. There is no government involvement in this decision. Fact again.
With the government as provider, and as the determining member of the parties concerned---including the patient, doctors, and relatives--it is the government that has the final say whether to extend the life of the patient or not. Under the diabolical scheme, the government wants to prolong life for as long as possible, whether the patient wants that or not. That was your position, and it is truly disgusting. (It is obvious that if the patient wants to live and the government wants him to live longer, all is well and good, until the patient reverses himself and desperately wants to die as his illness progresses, but the good 'ole government says NO!) FACTS AGAIN.
Of course, the reverse is also true. The patient may want to live, yet the government, in its great wisdom decides that the patient's life is over, so it refuses support. Consistency is hard to ensure in government decisions over time.
To attempt to make my statements entirely emotionally driven is rather shoddy work, and unworthy of a thinking person. I used an emotional circumstance to illustrate one of the horrors of the diabolical government approach.
At a higher level, it is obvious that the government could afford more end care than a private company, up to some cutoff point where the huge number of patients in end care absorbs more money than the government can collect from taxpayers and allocate to end care. What happens in that case is a tough question. It becomes similar to the problem of the private suppliers in cutting off paying for care, although with far larger numbers of patients involved, yet the government would retain its life or death decision powers!
The bottom line for me is I do not want the government anywhere near me when I am approaching death, unless it is to provide me with no-strings cash gifts.I trust my doctors far more than any government weenie.
May your end game be a pleasant one:)Comment Posted By mannning On 8.10.2009 @ 03:41
Both of you--michael and busboy-- seem to have misread what I said. Insurance companies can and do cut off coverage when they can justify it to themselves and any state regulators that look into the case, but they are not totally without heart. That does leave patients, doctors and relatives to decide how far to go at that time of cutoff, however. No government involvement exists in the decision to keep or cut off the tubes.
You both seem to be claiming that the insurance companies would definitely cut off coverage far, far earlier in the stages of the patient's illness. That has not been my experience at all in the six family terminal cases where I have been the "selected decision relative" or whatever that is called. The insurance companies, all different, carried their share of costs all the way until death for all six of my close relations, and they were terminally ill for many months as it was. The insurers subordinated their decisions to the doctors, and the doctors consulted with me to determine the course of action. No government involvement was there.
If you have ever been in the position of listening to a loved one begging to die for weeks and weeks because of the total hopelessness of their situation and the agony they are in, you would not welcome some government type injecting himself into the case and telling you that they will keep your mother or father or wife on machines for some weeks to go, and never mind what you or your relatives think. Voting time is some weeks away! Totally Idiotic!
It is silly, no, diabolical, to put the government into this decision loop if the government's paramount motive is to keep a very sick person, who may be in great agony and hoping to die soon, alive for a time far beyond their personal wishes, or the wishes of the relatives in charge, simply because the government can afford to do so and wants votes!
This brings up the other point that under such a diabolical scheme, it is probably the case that there are not enough facilities, doctors, or nurses to go around to keep everyone alive as long as medically possible (but humanly cruel), and there IS a limit to the government's largess and tax base, though I have not known of liberals to recognize that fact lately.
Good luck to you both in your personal end game with the government! :)Comment Posted By Mannning On 7.10.2009 @ 21:55
Let us approach medical care from a different view. We all need such care from time to time, and the frequency and seriousnes of that need usually increases mightily as we age. Thus, costs for care rise with age. In the extreme, medical science now knows how to maintain life for a long time--long after the spark of consciousness and intelligence is gone. We have a few mechanisms for terminating such patients, centered on the desires of the patient himself in writing (AMD), the advice of doctors, and the decisions of close relatives.
If the government enters into this decision via their healthcare programs, will they support the decisions of the patient, the doctor or the relatives? Suppose the patient wants to remain on the tubes; the doctors agree that they can maintain him on the tubes; and the relatives also agree. Does the government agree also?
Try other mixes of desires: patient--no; doctors--yes, and relatives--no. Government? If their motivation is to keep a voter alive to the last moment that he can vote, what then? Rediculous. Who writes the rules for final death here? The government? Who has the last word in each case? The government? Who pays? The government?
Now change out government for the insurance company.
It turns out that the Insurance co. can only deny financial coverage at some point, so the decision would be left up to the patient, doctors and relatives, and their ability to pay, or their rationalization that the patient should be allowed to die anyway. There would be no government involvement in the decision.
Which do you prefer?Comment Posted By mannning On 7.10.2009 @ 14:27
Notes on Posner's screed:
Failure of Military Power----This is now the province of a liberal government struggling rather ineffectively so far with Iraq, Afghanistan, North Korea and Iran.
Substituting Will for Intellect?
Denial of Global Warming--- This has little to do with conservatism per se; rather, it is concerned with the wholesale tinkering with scientific evidence to reach a political conclusion, and a probable vast increase in government power over businesses and citizens to our financial detriment.
Religious Criteria---is this a complaint that few atheists were given public office? Or, is it that the Bush government still adhered to religious morals, and hence hired officials that understood what such morals are, despite the ravings of secularists and the ACLU? It is very simple: between two equally qualified candidates, the differentiators may well have been their relative moral positions and their belief or non-belief in God.
Neglect of Management and Expertise in Government---now owned by the Obama administration, with seriously negative consequences, such as 30 largely unknown, radical and unvetted Czars in the White House, and the specter of huge new government agencies arising from liberal programs. Perhaps the neglect is also yet another complaint that atheists were not generally sought for high positions.
Abortion---Still an issue? The issue will not go away, much to the chagrin of abortionists and their sympathizers. The toll grows every year, now surpassing 50 million killed. At what point will this statistic bite home? At what point will the immorality of abortion be recognized?
Fiscal Incontinence---Look to this new administration for a super example of incontinence! Obama has perhaps anywhere from 7 to 12 times the debt problems the Bush Administration had, and is blithely going about increasing the debt. It will take fiscal conservatives in power real soon now to rescue us from this mania.Comment Posted By mannning On 7.10.2009 @ 13:44
So not-for-profit government insurance plans would be superior to private for-profit insurance companies? I would like to see this substantiated, and supported with reasonable evidence, that a government-run anything would be more effective all around, and with every assumption made in the calculation well-justified and not idealized.
From working around the federal government for most of my life, I have witnessed far, far too many deadheads manning the decision and administrative posts, and a ratio of effective employees to such deadheads to be about 1 in 10 at best. With such a ratio, I cannot imagine that any government-run organization would compete well with a private one, but there must be one or two somewhere just to prove the rule.
I have also witnessed the thrust by each organization not only to preserve itself, but to grow with each budget cycle, thus increasing its importance, influence in government, number of employees, opulence of its digs, stature of its executive class, and, even worse, to increase its scope to include more and more of the subject area concerned and its critical decision-making authority. Builders in DC have made enormous fortunes from the creation of ever larger agencies of the federal government.
Almost never, however, do the feds work to streamline operations, raise the quality of employees, or reduce their budget. Droves of marginal employees are shuffled around every year from agency to agency, thereby helping one group while burdening others in their turn. Few are fired for incompetence. Any new organization would fall into the same pattern, I believe, and would initially be the happy repository of all the deadheads that could be scraped up from other agencies. The number of employee hours wasted on long and fruitless meetings while their betters work the problem out in closed session is truly astronomical.
The idea that the government could execute our entire set of health programs with reasonable results sends me into a deep fear state. Those that hold to this idea are utopians and idealists that should never get close to deciding health matters for the public.Comment Posted By mannning On 7.10.2009 @ 12:08