Folding, spindeling, and mutilating lauguage for fun since Aug, 2004
Sunday, 08 July 2007

Little bit of catch-up.

The fourth was fun, for the most part.  We got together with the extended family and did some camping and BBQing and water-skiing and stuff.  There was a parade and fireworks and all that jazz.  Rocky, the kids and the dog all had a fabulous time.

I behaved myself for the most part.  At one point we were in the livingroom watching  the travel channel and there was a show on Niagara Falls.  One of the bits was about the history of the falls as related to the underground railroad.  The show described run-away slaves crossing an ice bridge that formed over the falls, as well as a suspension bridge that went over the river into Canada.  One tour you can take traces the route of escaped slaves over the (now modern) bridge into Canada.

The relative we were visiting was not pleased by the description of people escaping the US to find freedom in Canada.

So he proceeded to tell the children that the slaves brought to America from Africa were better off as slaves in America than they were as free people in Africa.  He asserted that slavery was not as bad as some people claimed, and also, that modern black people should be GRATEFUL that their ancestors were slaves because if they weren’t they’d be over in Africa with all the disease and genocide.

Now, this relative is a Conservative older man, living in a rural area, and is unlikely to change his opinion or outlook in anyway, and is unlikely to actually be able to harm anyone with his opinion either.  So I left and took a little walk and later talked with the kids about the conversation, making sure I let them know where this relative was in error.

Later, back home, we had some other relatives as houseguests, and discussion of the health care system ensued.

Let’s just say that I was called ignorant, and stupid, mocked derided, talked over, interrupted, and my ideas completely re-interpreted and misrepresented and scoffed at.  When I tried to explain how the relative was going off in a completely different direction, he raised his voice and said “Let me finish.”

I got very upset.  I was tired from the first day and night of CONvergence, so I teared up and had trouble speaking.  It is something that sometimes happens when I get really angry and I am exhausted.  I was practically speechless to be treated this way in my own house…and by someone I actually like a lot and respect, but whose personal manner changed dramatically on this particular topic.  It was a bit shocking to me.

What was it that made me stupid and ignorant?  I don’t really know, but the relative in question argued that a basic national health care system that only covered standard treatment for routine medical problems would stifle innovation, because people would not buy catastrophic or “Cadillac” healthcare plans if they had the basic national plan available for free.  I wanted to point out that I never proposed it be automatically free for everyone…but that was one of the times I was waved off as “interrupting” before I could get the clarification out.  I suppose it would be overly snarky of me to point out that the clarification would have been unnecessary if I hadn’t been interrupted.  So the person continued to completely demolish the point he thought I had made rather than the one I was actually trying to make.

 I wanted to point out that the plan I was trying to discuss would actually add consumers to the health care system because people currently going without care would be getting it, whereas people who currently have great coverage would choose to use their great coverage and this would drive innovation just as much as it ever has.  No go.

The person insisted that nobody would spend money for insurance to provide state-of-the-art treatments if they could get the insurance for cheaper less innovative treatments for free.

I said “So you don’t think people can be trusted to understand that they need to pay for better coverage to get better treatment?”

Apparently, this is a terrible thing to say to a Republican with Libertarian leanings.

But it seems to me that the average American understands this.  If you have better coverage…you get better treatment.  If you have crappy coverage, you get crappy treatment.  A minimally adequate coverage will get you treatment that is effective for most of the things that most people encounter in life…and no coverage at all is a recipe for disaster.

I assume that, like now, people will try to get the best coverage they have access to.

All I was trying to say is, wouldn’t it be possible for us to have a program to move the people who have no coverage and crappy, inadequate coverage into the category of having minimally adequate coverage?  While it might not be that great if you get cancer…you’ll love it if you get a broken leg or a sinus infection.

The person responded that it would just cost too much to overhaul a system as big as our health care system for what is essentially an incidental segment of the population.  He asserted that it is really very exceptional cases where people cannot afford insurance and are unable to pay for treatment.

I asserted that the overhaul of the system is coming one way or another.  We can either let it break down its present form and change on its own…hoping the magic of the market fairies will pull a better system from the chaos…or we can plan it and manage it so that hopefully it doesn’t lead to radical disruption of our society.

My discussion partner expressed incredulity at that assertion, and told me that people should just bring down costs by buying generics and such.

I said good luck with that since you have an entire industry built around “motivating” doctors to prescribe new formulations of existing drugs, presenting the new formulations as “innovations”, and fostering the perception that generics are inferior to brand-name drugs (I personally know a drug rep who flat out told me – on several occasions – that I should, under no circumstances buy generic drugs as there was just too much variance in their manufacture and performance…for instance.  I didn't listen to him.  I buy my meds at Costco and go genaric whenever there is one available.  Ther are usually cheap enough to cost me a fraction of my co-pay.)

He countered snidely that I didn’t trust people to be able to make rational decisions on their own.  My attempts to explain the difference between a general understanding of levels of coverage and people making a choice when there is a multi-billion-dollar industry focused on shaping their perception with the complicity of the people who are supposed to be their health advocates fell on deaf ears as he condescendingly explained to me that I had employed a double-edged sword when I invoked personal choice and responsibility.

I guess I had to be punished for defiling said deities by using them in a "liberal" argument.  The Conservative Libertarians have claimed them as their own and nobody else can use them.

Apparently, the magic of the Wonder-Twin Magic Market Fairies of Personal Choice and Personal Responsibility work the same whether you have access to high-quality information from reliable sources or not.  I guess I know better now.

Needless to say, the rest of the conversation is kind of a blur.  I wish I’d walked away from that conversation as well.

Fortunately, CONvergence was in full swing and things can never go that wrong when CONvergence is going on.   I’ll talk about that more in my next entry.

Sunday, 08 July 2007 23:37:33 (Central Standard Time, UTC-06:00) | Comments [12] |  |  | #
Monday, 09 July 2007 04:52:38 (Central Standard Time, UTC-06:00)
*The person responded that it would just cost too much to overhaul a system as big as our health care system for what is essentially an incidental segment of the population. He asserted that it is really very exceptional cases where people cannot afford insurance and are unable to pay for treatment.*

Wow. Just. Wow.

I remember lots of those cases back when I was in the states. The problem isn't that they don't get the treatment, especially in emergencies, they do. The problem is that they are basically economically destroyed afterwards.

Imagine, say, a well known internationally admired computer consulting company implodes overnight, *cough*; A day later you end up in the hospital after a car crash with tens of thousands of dollars in bills. What happens to the house? How do you cover the gaps.

*Sigh*

And why exactly would your libertarian relative even think people make rational judgements. Science has been proving that wrong for years. (You might recommend some books like Daniel Gilbert's Stumbling on Happiness or Malcolm Gladwell's Blink.) Large groups of people don't act rationally, that's why 'branding' works.

I at least hope you got a hug later.
Monday, 09 July 2007 05:36:13 (Central Standard Time, UTC-06:00)
Trees ---

Wow.

To respond to those individuals:

1. Yes, it should be free to everyone.

2. Innovation means NOTHING in the public service realm. If they don't understand that, explain to them why it's not a good idea why they should be asked to pay ala carte for police, fire, and military action.

Wow.

Tony
Monday, 09 July 2007 07:22:45 (Central Standard Time, UTC-06:00)
Ben and Tony,

We actually had a few good conversations too. Also, this guy spent most of the weekend attending to my dog's needs so that I could spend more uninterrupted time at CON. He also ran at least one errand for me.

Thing is, he had some pretty good points. Unfortunatly, I was not allowed to point out where they either didn't contradict my proposal, or where they actually fit with it rather nicely.

It was frustrating.

This person is an Electrical Engeneer working in the medical device industry, so he seems to feel as though his industry, company and job are being attacked when the problems of the medical industry are brought up.

I actually think that people often make the best choices, despite the fact that they are not made on a 100% rational basis (I believe that's a major point in Gladwell's book. People have to be relied on to make their own decisions, but the actual ability to make a decision you can be responsible for must be supported by society to work. Advertizers spend trillions of dollars figuring out how to influence human psychology to cause people to make irrational decisions. How else do you explain people spending 2-3 TIMEs as much for designer jeans that are not of better quality than their cheaper counter-parts...or people repeatedly replacing common household items with junk that wears out right away because it is cheap and easy to get rather than researching and spending just 10 or 15 or 20 dollars more for something that will last three times as long.

It's no secret that people DON'T make rational decisions. The whole marketing industry RELIES on that fact, and is designed to exploit it.

So what I'm left to wonder is: how much support do people need to make responsible individual choices? When you ask that question, there is always one Libertarian in the crowd who jumps up and shouts that social support for good decision making (limiting advertizer claims, forcing accurate labeling, releasing government reports or warning labels on the health impact of certain substances, etc) amount to "making people's decisions for them", or "the nanny state". When, in fact, it is actually supporting freedom of choice.

It's not a law saying "people are not allowed to smoke" it is a warning saying "smoking is unhealthy".

Yet many will rallied (and still do) for the "rights" of people to hear the "science" funded by the tobacco industry to say that tobacco smoke doesn't cause cancer...but then vigerously oppose their right to hear the science that says it is very bad for you.
Teresa
Monday, 09 July 2007 07:37:01 (Central Standard Time, UTC-06:00)
I keep hearing proposals about how we need the government to run our health care system because it is “broken.” Broken? If the government ran the system it would be much worse than broken. Could you imagine trying to get the government to do something for you if your particular health issue fell outside the written procedure? You might as well take arsenic.

The general rule should be that government does things badly. We all know this. They create a war on poverty - poverty rates rise. They create a war on drugs - the problem gets worse. A war on terror - terrorism around the world increases.

We already have a national health care system - Medicare and Medicaid. These programs are run much more inefficiently than any program in the private sector. Oh - and please don't respond with the problems in HMOs. They are a government creation, too.

We should limit the amount of things that government does to only things the government must do. Defense, regulation of money, regulation of commerce with other nations, etc.

You know - do only what is allowed by the Constitution, which - by the way - is supposed to LIMIT what the government can do, not what WE can do.


Side note: don't you love family dicsussions on politics? We have them at our get togethers, too. We always leave on good terms, but sometimes the conversations get heated.
Mark
Monday, 09 July 2007 08:41:10 (Central Standard Time, UTC-06:00)
Mark,

I live in Germany. Here the Government does have a big say in what goes on and there *is* a minimum standard.

If the American system isn't broken, how do you explain the difference in things like infant mortality rates, life expectancy, etc.? Spend some time at Gapminder and get back to me. http://tools.google.com/gapminder. (Hint: The big yellow circle is the US; most of the orange circles that do better - Europe.)

The system *is* broken. There just isn't a good way to fix it in America.

The Germans were lucky enough to get a system set up before all the research when into things like lobbying and think-tanks and opinion modification. Bismarck was one of the early proponents in order to de-fang the socialist lobbies. (It worked fairly well actually.)

But Mark, just think about those numbers the next time you see a baby in a stroller and go into a anti-Medicare fit. More children survive in "socialized medicine run by the g'vmnt" in Europe than where YOU do all the good work.
Monday, 09 July 2007 09:39:37 (Central Standard Time, UTC-06:00)
Mark,

HMOs were "created" to increase competition for what had become a monolithic monolpoly that was underserving people. They worked well for decades.

I laugh at the idea that just because a government solutions do not continue to be effective in an economy, industry, and and world that has chanced as radically as they have in the past three-to-four-decades, it means those plans have "failed". when a CEO changes course to compensate for changes in his market, does that mean the previous plan "failed?" because he no longer gets the desired results he used to get? No.

I think it's rediculous to assert that because people want government solutions to change with changing times, that they just want to do more of the same failed solutions. A program addresses a set of circumstances sucessfully for a period of time. Then, when it is clear that the program must change in order to continue to work due to changes in the environment it is "failed" and a "waste".

I have to admit, I agree with you on the war on drugs, but the war on poverty was abative. Sure, it didn't eliminate poverty, and yes, poverty did increase, but look at what was going on an honestly tell me that you don't think the economy was saved much worse and more long-term problems and fall-out.

That's like a home-owner saying the fire department was ineffective because although they prevented his house burning to the ground, they failed to prevent fire damage, and actually increased water damage.
Teresa
Monday, 09 July 2007 19:31:25 (Central Standard Time, UTC-06:00)
Trees,

I'm not going to jump into the argument with both feet. Let's just say that I'm a big fan of Michael Moore's "Sicko". That states my opinion well enough.

Here's the thing that gets me:

"Let’s just say that I was called ignorant, and stupid, mocked derided, talked over, interrupted, and my ideas completely re-interpreted and misrepresented and scoffed at. When I tried to explain how the relative was going off in a completely different direction, he raised his voice and said “Let me finish.”"

If anyone comes into my home and treats me that way -- guest or relative -- they get to find a hotel for night. A discussion with two widely differing points of view is one thing. (My dad has gone borderline right-wing Fundamentalist since moving back to the deep south. I love him, but *yikes*.) Being called stupid and ignorant in one's own home, at least to me, is completely unacceptable.

I'm sorry you had to deal with that, Trees. If I'd have known, I would have bought you a drink Saturday night! :-(

Hugs.
Kristi
Monday, 09 July 2007 22:48:03 (Central Standard Time, UTC-06:00)
You know, my father works in the medical billing industry, primarily as a Medicare/Medicaid specialist, and in fact has his own consulting business regarding it. It is his assessment that there are two separate sets of issues involved: A) Problems with the Medicare/Medicaid system making following the system as intricate and as impossible to understand as the tax system; and B) Problems with the medical industry screwing up their billing -- mostly by billing for things that they have absolutely NO right to bill for.

Every time he comes up against something like this, he basically has to look his client in the eye and say "you have XX amount of time to fix this problem, or report yourselves to the government agencies involved, or I will be forced to do so". So far, he has been lucky that most of his clients have made these errors unknowingly, and are willing to fix them. There has only been ONE client who tried to push it.

And the government KNOWS how screwed up the medical billing industry is -- because they offer people like my father MILLIONS of dollars to report their clients.

So, yes, we need reform.

And as a person who does not have medical insurance because we cannot afford it (because the company my husband worked for wanted 3/4 of his income for a "family" plan; and *I* am a freelancer, meaning I can only get coverage if I'm willing to pay through the nose for it), and we cannot afford care (although we have to have it), so we go into debt (on top of every other debt that we cannot help but get into -- and I'm not talking credit cards or home debt either, because we don't have that. I'm talking things like being seriously past due on basic utilities simply because we have to juggle our income. I end up having to "rob Peter to pay Paul.")

So, tell me, where am I supposed to come up with the money? I am MORE than willing to be a partner in my own health. But I do need some basic medications, and some basic care -- and a universal "basic" care system would cover that not only for me, but for almost over 100 women and children I know. And yes, being able to "add" coverage for some type of payment would be perfectly reasonable.

But there are too many "normal" people in this country living at or below poverty level - and not all of them are the "downtrodden poor" that you see stereotyped. Haven't you seen the news about the "Working Poor"??? It's becoming worse every year, families that are working (some parents working 2-3 jobs, and all kids old enough doing so as well), but they still aren't able to make enough to even afford housing!
Cat
Tuesday, 10 July 2007 06:16:42 (Central Standard Time, UTC-06:00)
Cat,

And there are more every year.

At the foodshelf contributers thank-you event last year, the people told us that the fastest growing demographic for those needing emergency food services are living in the suburbs.

When I told someont that, she replied that it was a shame all those poor people were moving to the suburbs.

I said "These are people who LIVE in the suburbs, and are slipping into poverty."

It really is the "two Americas" syndrome. Most of the people my houseguest knows who have financial problems are probably people with tons of medical coverage, and who spent too much money on toys, and didn't look after their affairs.

I also know people like that, and if I only knew them, I would likely think that everyone who had financial problems were in the same boat...irresponsible, lazy and/or greedy.

I also wonder what would happen if every salaried person in the country said "Yes, I'm willing to put in extra time because I'm a hard worker, but I'm fixing the cap at 50 hours a week. That's all you get. I'll work hard while I'm here, and I'll try to streamline my job so it is wicket efficient, but if you can't figure out how to make my job fit into a 50 hour week, you'll have to hire another person."

Yeah, yeah, I know, they'd move all the jobs to Indonesia. Still, it makes a person fantisize, doesn't it?

Another thing that would be interesting to know...what would happen to our epidemiology data if we had a higher percentage of the population able to get health care? Most likely, a healthier society with more information on how to become healthier yet.
Teresa
Friday, 13 July 2007 08:08:01 (Central Standard Time, UTC-06:00)
I know I've just arrived at 1 Am to a party that started at 7, but here's a few ideas i'd love some feedback on....
When we say that the government is supposed to be limited to basic functions such as protection of the people why do we assume that only means military protection? Admittidly that is likely the only protection teh founders saw as relevant but they lived in a very different time. If one accepts that the consititution was written to withstand time and the changes that come with scientific and technological advancement (and I believe it was, though I am not giving and argument for that here but know such an argument is needed) shouldn't we accept that the government is able to take on new functions of protection within a certain limit? Instead of arguing about small vs. big government shouldn't we be trtying to figure out what the function of government protection should be so we can discern those limits? Let me try to give an example. government oversight agencies were created because unscrupulous business people realized they could make a fast buck by selling poisonous substances as health remedies. Now we could tell two stories about the old snake oil routine: one is buyer beware. but how is the buyer to beware when there is no information available about the product except for what the seller tells you or there is mislabeling of the product? How were people supposed to know there was diethelyne glycol in the toothpaste? How were they to know it was in their pet food? The manufacturer isn't going to tell the public. Who is?? The other story is that we need government (ie. independent, transparent and responsible to the public because we are a democracy.) to give protection in the form of oversight. If the idea is that people need a certain a level of safety to flourish and develop their human potential (surely this is what the political founders were after) then not only do people need protrection from invading armies but they need protection from other kinds of predators, in particular those who are able to manipulate us. Simply pushing personal responsibility (buyer beware) does not seem to me to be sufficient.

One of the biggest threats to our freedom today is the mental and emotional manipulation that is coming from marketers. It is an extraordinary pressure being placed on our ability to make informed and "free" choices. All parents know this and I think those of us in our late thirties/early forties are especially able to speak of the change in marketing over the years. The marketing climate of our country is now so dense that we are like rats in a cage with electric shocks and push bars gallore between us and the small hole to get out and all the while the scientists/marketer keep musing "why doesn't the rat just leave the cage....hmm. shock it again...see what it does...stupid rat....it deserves what it gets..."

to bring this round to healthcare; we tell people to make informed choices and then be responsible for their choices in a climate that is telling them to think about today don't worry about tomorrow, you deserve a great life, deficits don't matter, there is a new pill that will cure ______, a society that builds housing without sidewalks and with dangerous road intersections so one must drive to safely get across the street, housing and work areas arer separated by freeways so driving is the way to work (read: sit on your fat ass in traffic) but perhaps most importantly, we have sold people on a way of life that isn't good for them. Here's teh good life to an American: a house in the suburbs, a large screen T.V so friends can come over and watch while eating chips, dip, brownies, the latest cake that requires at least a pound a butter and three chocolate bars, drinking soda and/or beer. Going out to eat at least once a week, being able to drive everywhere as opposed to having to walk or ride a bike. Having a computer so I don't have to go to the library...to get all this we work about 50-70 hours a week. This is a recipe for ill health and our remedy is to tell people to stop trying to participate in our society?? Of course, what we are really telling people is to not participate in the marketing/consumerists part of our society, but here's the relevance of my earlier point; what are we but a consumerist society? The personal responsibility position is essentially a contradictory one without government intervention to stop predatory marketing and the promotion of real intellectual freedom (neither of which our current government is doing).
so, to try and wrap this up. It seems reasonable that the health and safety of the people is within the role of the government. The question is ;what should the govenment be doing? Under the guise of freedom we have allowed some people to profit from the ill health of others and this is just wrong. Unfortunaetly, the governement is complict in this because of the close relation of industry to government. A good place to start is to get real reform to get the big money out of elections. As long as we maintain that $$=free speech we have a serious problem. A government that looks out for the welfare of the people would use it's bully pulpit to encourage good health practices and work to counteract the poor lifestyle choices being pushed for profit with appropriate regulation and requirements (such as sidewalks, mandatory gym in schools, public transportation, posting of caloric values on menus, information on portion sizes, connect maintaining good health as part of being a good citizen etc etc.). Basic care seems like a reasonable part of such a program. People are correct when they say it needs to be coupled with personal responsibility but personal responsibility cannot come without a balanced civic environment to make reasonable choices and who is going to be able to to that but the government (which, I remind you, is us!)?.

a small penguin
Friday, 13 July 2007 08:52:40 (Central Standard Time, UTC-06:00)
I might add, that the original push for a rubust and powerful central government was driven by tradesmen, small businessmen, and entreupaneurs who were concerned that they were being low-balled by unscrupulous competitors, regulated out of business by corrupt local governments, and inadvertantly harmed by a chaotic patchwork of conflicting local regulations such that business was only profitable for a few rich and well-connected individuals.

Madison himself (a great idol of Libertarianism, and a favorite of mine) gave voice to these concerns in a letter to Thomas Jefferson while aprising him of the progress of the Consitutional Convention.

A robust federal government that has the power to obligate honest business practices is essential. It is up to the people to keep the government honest, and people have been discouraged from doing that through a combination of efforts from big business, the media and the religious right.

Big business funds an uncountable number of "astroturf" groups masquerading as "grassroots advocacy" groups...fighting the government's attempts to provide people with reliable information for their free choice in the name of "free choice".

The media daily promotes a sense of "the world's gone crazy, all we can do is pray. Look! A pregnant woman has been murdered, sorry, now you feel bad...here's a fuzzy kitten story...commercial break, buy this or you'll smell bad. Now let's do a religion peice on how people find comfort in their faith and then we'll see what Paris Hilton is up to for a little opportunity to feel like the noble salt-of-the-earth by comparison."

If 90% of the population paid attention and voted, I bet they wouldn't be able to get away with anything, and by golly, we'd probably have some really good candidates as well.

The religious right? How about numerous statements from leaders of the religious right just out-and-out saying that voter apathy is the GOAL of their tactics, and the only way to win?
Teresa
Friday, 13 July 2007 13:02:14 (Central Standard Time, UTC-06:00)
Sing it Sister!!

Here is a small article from newsweek on comments from past surgeon generals about the role of ideology in the nations top advocator of health which I think demonstrates how forces are conspiring to keep teh American public ill informed, sadly, they are often the same forces taht want to blame people for making poor choices:
for the whole article go to http://www.msnbc.msn.com/id/19737040/site/newsweek/

Earlier in the week, three former surgeons general—including Dr. Richard Carmona, the most recent occupant of that august office—testified before Congress that he felt intense political pressure. Carmona, who left office in July, said that the Bush administration had delayed his reports and changed his speeches on controversial issues such as smoking and stem cells. "Anything that doesn't fit into the political appointees' ideological, theological or political agenda is ignored, marginalized or simply buried," he testified. That came as no surprise to Joycelyn Elders, who served as surgeon general from 1993 to 1994 under President Bill Clinton; she was asked to step down after her comments about masturbation—she called it “a part of human sexuality, and is part of something that perhaps should be taught”—stirred up a political controversy of their own. She spoke with NEWSWEEK's Mary Carmichael about the new revelations. Excerpts:

NEWSWEEK: What was your reaction to the testimony of the three former surgeons general?
Joycelyn Elders: What they were saying was true. I think each surgeon general has a different set of problems. But when they're suppressed—when they can't put the science out there for people to make good decisions about—then our ideas and our morality and ideologies and mythologies get in the way of good science. When I was the surgeon general, I did not feel that we should let politics invade science and marginalize it. And I think we’ve been seeing some of that. Of course, it didn’t start with [George W.] Bush. Look at Dr. [C. Everett] Koop, who stood up for AIDS when heaven knows the president [Ronald Reagan] didn’t want to even mention the word. And [the surgeon general under George H.W. Bush, Dr. Antonia Novello] was more muzzled than anybody ... When tobacco smoking was an issue, she only spoke about it after the state attorneys general were already suing the tobacco companies. But I do think the suppression has been going on more and more lately. And we just can't let that happen.

What does it mean for the office of the surgeon general when political pressure is brought to bear?
It destroys the office. And I think it's a very important office; it has a very important role. We're setting a dangerous precedent. We need to find a way to make that office more independent. We've got to be able to build a support system around the surgeon general such that he is not being constantly bombarded and afraid of losing his job because he's taken a position that's different from the president's. If all he's going to do is be the president's mouthpiece, what does the country need with a surgeon general?

Surgeons general are political appointees, however.
They're nominated by the president and confirmed by the Senate, but it's a statutory appointment. What that means is that you do not serve at the wishes of the president. You're not a Democratic surgeon general, you're not a Republican surgeon general. You are the surgeon general for all of the people. I think the president always hopes that his surgeon general will have similar ideas to his. And that may or may not be the case. But when it comes down to it, the surgeon general must stick to the science.
a small penguin
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