Tuesday, April 12, 2005

Slow Armageddon or Wet Coughs?

I've decied to start -- in between the jokes -- to bring some semblance of monthly focus here. So, quick quiz for the remainder of April. Do we want a bunch o'links to the Peak Oil Problem, or discussing National Health Care?

28 comments:

Pete said...

Peak Oil please! I *heart* the apocalypse.

Justin Cognito said...

Seconded. I'd rather take a wild yet easily controllable apocalypse theory than a deeply depressing and all-too-real look at how our country is going down the crapper.

caseyko74 said...

Maybe we should distract ourselves and make fun of the choices Warren Ellis has in his election?

Outside of that I vote for Slow Armageddon. At least if Armageddon is coming I don't have to worry about the fact I have no health care right now (which is fun when you realize certain things are not working properly in your body, but all you can do is deal with it and live with the loss of hearing in the left ear for some bloody reason).

Heronymus said...

I'm for Peak Oil, myself.

Bill Cunningham said...

I'm for nigerian money scams - which have taken a nasty turn as I'm now getting "US Soldier in Iraq" scams saying they've got Saddam's money stored and need a way to get it into the states...

But health care works too...

Sizemore said...

Oil please. I am suffering the same election as Mr Ellis so as silly as your health care system is I'd prefer something that may kill us all before the 5th of May.

Cheers.

Bug-Eyed Earl said...

Health Care. As a Canadian fiend of mine said:


"But of course, conservatives are not known for telling the truth when it comes to healthcare. When the US spends 14% of its GDP on healthcare compared to 10% for Canada, fails to cover 40 million of its citizens, does not produce a significant different in overall patient outcomes, and still claims to have the "best health-care system in the world", a certain amount of bullfuckery is to be expected from its defenders."

There's a lot to be said about this, not to mention the fact that a very high percentage of bankruptcies in the US come from medical bills, and a lot of these people had insurance at the onset of their illness or injury, only to lose it midway through (yes, there are many companies like Insuricare in "The Incredibles.").

shan/invector said...

Healthcare. It's not as interesting to me, but I already know the apocalypse is coming and that it isn't far off. Unless you have something to really break open the Armageddon armour, let's just talk the talk about being unable to walk the walk.

Laurean said...

Healthcare...let's do what everyone else is doing and 'ignore' the problem.

(I know I know bad joke) Seriously though, Peak Oil please.

Novice said...

I can't figure out which is more depressing...my vote is for Health Care.

That's just me, though.

Scott said...

Cake or death?

Well, I say they you tackle them both!

geoff said...

Please not health care. Those discussions (like abortion debates) are impossible to have over the internet, let alone in real life.

I second the Nigerian money scam talk idea.

Josh said...

Peak Oil!

Rogers said...

Actually, I disagree. The abortion debate is difficult because both positions are defensible from reasonable moral standpoints.

The health care situation, however, is facts and figures, plain and simple. The only hitch is whether one believes that the government should be involved in health care. I even understand if someone says they shouldn't. But those people's arguments tend to dead end, because they never propose a private system that works. And status quo on a system that punishes hard-working people is not acceptable. The "our broken system is better than a single-payer system simply because allowing the market to provide services is always ideologically superior, regardless of results" is, frankly, bullshit. It's no more honest than communism's old "we will stick with collectivism because it's morally superior to capitalism even though the potatoes are rotting in the ground" bullshit.

I think it'll be peak oil, anyway. It'll allow me to sell my "FUCK THE TROOPS, I (heart) my SUV" bumper stickers.

geoff said...

Even though you just said it'll prolly be about peak oil...

...I'll stick my neck out and suggest that the brokenness of our current system can be traced largely to the extent that the government is *already* involved.

It's just one more area (a huge one, considering that it directly involves my health) in which I don't want the gub'mint sticking its big dinosaur nose. I don't want to think about the day when going to the hospital will be exactly like going to the DMV, instead of just *sort of* like it. Likewise, I don't want to think about paying 40% of my income for "free" health care.

And that's just looking at it from a practical point of view. A consistently pro-individual philosophy leaves little room for state-run health care (or, likewise, for outlawing abortion!). There's no such thing as a private citizen's "right" to another private citizen's efforts or skills-- if I have the right to get treated by a doctor, then the doctor's rights in the matter are necessarily limited. My rights trump hers at the barrel of Uncle Sam's big ol' gun.

Anyhow, here we are, sorta discussing it. I don't want to take up a lot of space on your excellent site with my jib-jabbering, so I'll shut myself up now.

SDM said...

Though it does look like peak oil wins out, I'd definately like to see a discussion on universal health care, but that might just be because I've been weaving through the nightmare that is our current privatized system, needing a machete or maybe even a light saber to cut through the red tape. The reason for doing all this? I don't think I should have to pay $200-250 a month just so I can breath. =p

Anonymous said...

Health care is such an enormous mess... but on the other hand, do we really want an organization that can't change its mind after making a terribly poor decision that will endanger the lives of every US citizen with a passport (RFID tags in passports) in charge of our health care?

What is an HMO? A gigantic bureaucracy regulating healthcare. And your alternative to this is... a gigantic bureaucracy that pays out to the lowest bidder and is famous for wasting money on boondoggles while not firing incompetents regulating our health care?

OF course, I am not providing a creative solution here... so how about some kind of small business initiative designed to encourage the creation of new, more efficient HMOs?

Of course, that doesn't address issues like people with chronic conditions being denied coverage and the high cost of uninsured care (recently got fucked by the insurance company myself here), but those are thorny debates in and of themselves. Should someone who's morbidly obese or a chain smoker have a right to the same health care as a marathon-running vegetarian, given that their health states are the result of personal choices? Okay, what if the morbidly obese guy has Cystic Fibrosis and can't exercise, or the vegetarian gets a genetic cancer?

These are tough questions- do we really want the answers decided by politicians and career bureaucrats?

Rogers said...

Do we really want them answered by profit-seeking HMO's? There are two fundamental flaws to this argument:

1.) When given the chance for mulitple competing HMO's, there is a race to insure the most healthy, not more opportunities for the uninsured.

2.) Single-payer health-care, by the numbers, works. As a matter of fact, a recent study (link later) determined that the best care in America, bar none, was the ONLY completely government run system -- the Veteran's Amdinistration hospitals.

Your hypothesis is not borne out by your data. Sorry. But, for a rational argument, that's it. Full stop. On the other hand, your hipness to the RFID thing marks you as the same as me, a libertarian with a fundamental distrust of the government and its foibles. I am completely with you there.

I have a stronger belief in a firm social contract, however -- there's just some shit we need to do to keep society functioning so we can enjoy our freedoms.

Fact: Half of all bankruptcies in this country are from medical bills.

Fact: Most of those people had insurance.

Fact: Our corporations are buckling under the weight of providing this care, making the US less competitive on the global market.

Fact: Under a single-payer plan, your wait for elective surgery is longer. Under the US plan, your wait if you are one of 40 million uninsured is much longer. It is infinity.

And, for extra points, my own personal moral stance: in the richest nation in the world, you shouldn't lose your house because your kid gets sick. That is, unarguably, fucked up.

The government is a tool. Just because some people smash windows with a hammer doesn't mean we stop using them to drive nails.

And saying "I don't have an alternative" is not acceptable. There's a saying in the writer's room -- "Don't pitch the problem." If you can't beat the line, then don't fight the fix.

Rogers said...

That is a valid question, though, perhaps the nut of it -- is health care a right?

Personally, I think if bearing arms is a right, so's health care, in a progressive society. But again, that's my social contract fighting my libertarianism.

On the other hand, I think that's a big problem with libertarianism -- it often so values individualism, it completely ignores how the world actually works.

Anonymous said...

In the richest nation in the world, you shouldn't be shot dead in the street for the change in your pocket. That, too, is inarguably fucked up.

So, what then? You tell me.

Giving the government huge amounts of power over your life based on hypothetical and anecdotal examples = really, really poor idea.

The proper role of government is protecting individual rights. And that's more or less it. You have the right to not have your life forcibly and deliberately taken from you by someone else. But there's no right not to get sick, and no right to not fall off your roof drunk, and no right to step into highway traffic without consequence.

I almost hate to say it, but... I didn't sign any social contract. You can talk about how the world actually works, but ask three other people how they think it works and you'll get at least three different answers.

So who gets to be right?

Bill Cunningham said...

"The proper role of government is protecting individual rights"

IMHO - the proper role of government is to ensure the freedoms we enjoy so we the people may be responsible to ourselves, our family and to our community. Yes, we have individual rights, but we also have communal responsibilities to ensure those rights are upheld across the board. You cannot have one without the other.

In terms of health care, this should mean that nobody, absolutely nobody should be sick or dying because they can't afford the medicine or treatment. That should be the least and last obstacle to someone getting well.

Having once been in the VA Hospital - I don't want to wish that on anyone. My personal experience speaking only. Someone else may have a differing opinion. Apparently, the gov't study already does.

Rogers said...

You're ignooooring meee. Don't do that on my blog. Nothing annoys me more -- and I am so very tired of having these discussions -- than this structure:

Visitor: "I think A."
Me; "Enormous amounts of research contradict A, and actually support B."
Visitor: "I will not reference or acknowledge any of that research, and continue along ideological lines."
Me: "Okay, fine, I get you disagree, but at least toss up a supporting fact. Or acknowledge that there are some numbers over here."
Visitor: "I shall continue as if you didn't even post."

Seriously. You seem nice. Don't be that guy.

Giving the government huge amounts of power over your life based on hypothetical and anecdotal examples = really, really poor idea.

Giving private, barely regulated companies huge amounts of power over your life = much better. Enron or Halliburton would never fuck my health for a profit. Noooo.

A.) I never ever use hypothetical or anecdotal examples to make a point in my blog, OR come to a piece of my own personal rational framework. It is a FACT, you can look it up, that we pay more GDP for less coverage. Fact. Fact-o.

It is a fact that the US, despite spending said amount of GDP, rates lowest or tied for lowest at child mortality, general population health, and life expectancy. And yes, further studies have been done to determine if those results were skewed by demographics. They were not.

It is a FACT that the majority of bankruptcies in this country are from medical bills. It is a fact that most of these people had insurance.

It is a FACT that American companies are creaking under the weight of providing health care. For every GM car you buy, $1500 of that cost is health care overhead.

I have facts and research that the system we have is bad. That alone would still excuse saying " sure, then, but I think a government system would be worse"... except there's just as much research showing, demonstrably, obviously, that position just doesn't hold up.

These are not anecdotes. These are facts. People have, after all, been looking at this for some time.

You may be new here, so you may not be aware, this is the house rule -- I do not bring anecdotes to my arguments. That is missile-defense shield fairy dust bullshit, and it DOES not happen here at Kung Fu Monkey.

B.) Bill is right. You can't have individual rights without a social contract. If society ran ONLY to the parameters of the government's ability to police it, we'd have... well, Liberia, or insert your chaotic hellhole here.

"Ask three people how the world works, and who gets to be right?" The guy with the research. That's who. I can point to a dozen societies where the basic tenets of human interaction -- the social contract, as it were -- have collapsed and chaos and murder have ensued. Please, anyone, feel free to point me to the perfectly functioning laissez-faire, libertarian society.

There's a reason the founders used the phrase "We hold these truths to be self-evident," not "we hold these truths to be enforceable." The entire CONCEPT of Western thought is that's there's more to human society than power exchange and regulation.

......

P.S. Oh, and the robbery thing was a poorly chosen example for your argument.

In the richest nation in the world, you shouldn't be shot dead in the street for the change in your pocket. That, too, is inarguably fucked up.

So, what then? You tell me.


Why, if you're shot dead, then publicly-paid-for-police investigate the crime! If they catch the perpetrator (cause), not only is he dealt with on an individual level by the government, then other crime suppression units are brough to bear in the neighborhood in order to prevent recurrence of this "fucked-up thing." Enormous amounts of resources -- and probably support from your local neighbors and community -- swing into gear on your fucked-up thing of choice.

If you go bankrupt because your HMO fucked you when your kid got leukemia, then ... nothing happens. Maybe your church passes the plate. That's nice. Enjoy talking to the nice lady at Make-A-Wish. Her name's Diane, and she has a group rate at DisneyWorld.

When arguing that fucked-up things happen sometimes, and that's life, I would omit the fucked-up thing which invites a large, well-defined and well-regulated response from society.

SDM said...

Another big part of the equation is, when a corporation is deciding how and when health care benefits are being distributed. For the best plans, there is typically a requirement of a full 40 hour work week. There's also a ninety day period before you can get insurance. If you've got a chronic health condition that forces you to mix work, some companies will basically penalize you for the days you missed due to said health problem, and you are denied insurance benefits. And the debt cycle mounts.

A lot of the "insurance" these companies offer are a joke, too. A $200 cap on monthly medication, which I've seen at a number of places with not-so-great plans? Sure, that works if you're not taking medicine for a chronic condition. This is the stuff that is offered to minimum wage workers, the people who are MOST in need of assistance. It's like a bandaid on an amputation, and the mere fact that plan is OFFERED(regardless of if it's used or not) can disqualify people from certain state programs.

A fair number of medical companies have discount/free medication programs as well, but they're closely linked to tax breaks from the government and profitability. If the company loses money, or the tax laws change, medications can be pulled and a family can be stuck with a $500 or more price tag for something they previously got for free. GlaxoSmithKline recently pulled a decent number of medications from its free Bridges to Access program for these very reasons.

Worst of all, there's not only workable examples from other countries, but state-run programs that are saving people's lives. California's MSI program seems to work remarkably well, and could be a nice model for a federal system. I know you said no anecdotes, but I do think this one is relevant... had it not been for MSI, my $20,000, five day hospital stay several years back would have financially ruined me(on a side note, though, the amounts the hospital charged for things was so remarkably insane, I think that's something ELSE that should be looked at... I don't think a tablet of Ibuprofin should cost $25-30 a pop. =p )

Anonymous said...

I think that this debate is one of those enormously complex things that would inevitably get oversimplified by electioneering. Hospitals charging 25-30 bucks for ibuprofen? Is that a result of procurement process? An attempt to cover paperwork costs? Part of the problem is the amount of time doctors have to spend doing paperwork- how much of that is necessary?

I have a friend who's going through med school and is on rotation- he's working inhuman amounts of hours a week, treating people while sleep-deprived and foggy, and it's ostensibly in the name of "toughening them up". If med students can work three shifts in a row, they can handle the stress of being a *real* doctor... of course, *real* doctors don't work anywhere near as much. Sleep deprivation makes you dumb, so this practice is risking lives by putting them in the hands of groggy med students. Of course, if we stop using these med students as slavebeasts, we have to pay more doctors more money to cover those shifts, and the cost goes up.

The price of prescription drugs is high, yeah, but that's because the drug companies have to make money somehow to pay for research. They get exclusivity on their results for what, 14 years? Maybe less, and then the generics hit the market. How do we make those drugs more accessible earlier without taking away the money needed for further research? We could shorten the exclusivity period, but then the companies would raise their prices even higher to recoup their losses and they'd end up losing money anyways. If we subsidize it, then healthy-eatin' vegetarians are paying for the cholestrol pills of Big Mac-noshin' carnivores.

People going bankrupt because their kids got leukemia sucks, but will a single-payer system help that? Leukemia treatment is bloody expensive. Maybe there should be some kind of extremely low-interest federal loans made available for people in those situations.

I'd be more comfortable with state-level systems than a federal one. California's system may work fine in the fifth largest economy in the world, but how would it would in Alabama, where they've had to put state troopers on half-shifts because the state can't afford to pay them full-time?

Should healthy young professionals be allowed to opt into a health insurance group that excludes the unhealthy? My cholesterol is 210, but I've been exercising more and changing my diet slightly to bring it down; I have coworkers who are fantastic athletes in great shape. There's a guy who works in the school cafeteria whose cholesterol is 500. Where do you think my premium is going?

If half of this country is overweight, why not push for healthier living in the general population? If our 500 cholesterol man is raised to believe in healthy living and eating right, he's not going to be such a burden on the system, which lets the company provide for more leukemia patients, right?

If you're invoking a social contract obligation to provide for these poor ailing children, then I want other people to pull their weight as well. I'll pay for a poor kid to get chemo, but I don't want to pay for a fast food junkie's quadruple bypass or a chain smoker's tracheotomy. I'd want minimum standards for national health care- if people are choosing behaviors that negatively impact their health, then they can go to the HMOs for care. If parents want their kids to be covered, they have to choose a more healthy lifestyle. Shouldn't some of the responsibility for health care should be on the people who want that care?

"Nobody should be sick or dying because they can't afford the medicine or treatment." But if someone is sick or dying because they chose an unhealthy behavior (be it chain smoking, lots of unprotected sex, needle-sharing, or making a documentary about fast food), should those who have chosen more healthy lifestyles be obligated to cover their treatment costs? Does the social contract compel me to take care of you when you can't take care of yourself, or is there a point where I get to say "fuck it, you're on your own"? Are they violating the contract by engaging in self-destructive behavior and placing a burden on the community?

Sorry for the less than coherent rambling.

~No RFID Man

geoff said...

John,

So we pay more GDP for less coverage. And over half of bankruptcies are caused by medical bills. Fact-o-rama. This is me not ignoring you.

I'm not saying your figures are off, or that the studies you've seen are wrong. I'm saying they're right. I'm not arguing with them. I'm arguing against what causes awful results like that in the world's richest nation.

(Well, I will take issue with the "fact that the US, despite spending said amount of GDP, rates lowest or tied for lowest at child mortality, general population health, and life expectancy." Compared to who? Every other nation on the globe? No. Compared to Europe? European nations (and most other first world nations) spend far less than we do on education, and yet produce comparably much better results in their students. So somehow the solution is to tax our people higher and throw that money at something else that maaaany consider a "basic right?")

Don't you want to know *why* we pay so much for so little, and *why* people go bankrupt trying to treat their kid's illness, before you let the government regulate health care even more? I absolutely acknowledge that our current system is fucked. But why is more government regulation automatically the golden solution that will ensure that not a single citizen suffers or dies for lack of money?

On one hand, I understand where guys like you and Bill are coming from. What rational, reasonable person can sit comfortably in their home and say that it's okay for kids to die because their parents couldn't afford the medical costs? Absurd!

Even on the simplest level, when you make something free (or give people the illusion that it's free, as is the case with nationalized health care), demand for it will go up. Add to that the idea that said service is now a "right." We'd better make sure there's no shortage of health care professionals, what with all this increased demand, right?

Will people be lining up outside medical schools, pleading to be let in and trained as doctors when the government strictly regulates every aspect of their profession, from what they can prescribe to how much money they can make?

When the government makes something free for everyone, everyone's going to want it. The government's got to keep it all under control somehow. So they ration it, allocating set amounts of resources to certain regions. They regulate how many doctors, hospitals, etc. there can be.

How is this good? It's like saying you want to make sure everyone's got adequate health care by letting a massive, lumbering bureaucracy put severe limitations on health care resources and professionals.

Maybe you can help me understand something. It's been my (albeit limited) experience that Canadians are fairly evenly split on their opinions of their health care system. Guy A says it's a blessing, and that any other self-described "progressive" nation should emulate it. Guy B says it's disgustingly mismanaged and that the quality of the ludicrously expensive care is very poor. Is it really as simple as, "Guy A is one smart fella, and Guy B is a stupid liar?"

As far as the "is it a right or not" thing goes, putting it next to something like the 2nd Amendment doesn't work, because like all other principled rights, the 2nd amendment is a right to be free from government intrusion, not a right to the services of someone else. There's a crucial distinction there.

I sincerely hope you understand that even with everything I've just said above, I'm not ignoring the evidence and research you're providing, nor am I saying it's untrue. I'm saying that the cause of such a miserable state of affairs can be traced directly to the amount of influence the government already has in the matter, and asking you, honestly and respectfully, why you suggest that giving the government total control will clear it all up.

geoff said...

(Said suggestion is inferred by your strong opposition to both privatizing it and leaving it the way it is, the two most obvious options other than nationalizing it. I just wanted to be clear, since nowhere have I seen you state explicity, "I hereby express my desire to nationalize health care in the United States" and since I've seen exactly such a distinction hang up a thousand different internet discussions.)

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