Practice Makes Perfect!

....to say nothing about American dental care.

Barack Obama's amazingly consistent smile from Eric Spiegelman on Vimeo.

Beware the Pig in the Poke

The Baucus health care bill (will this this become the president's ???) is looking more and more like a pig in a poke. When the senator introduced the bill on the Senate floor this morning, he reportedly acknowledged its chief criterion was to be acceptable to any 60 senators who are needed for passage (short of the nuclear option).

Republican Senator Olympia Snowe (ME) announced her own criterion: no money added to the deficit. And there are some 584 amendments already proposed to the legislation.

All this makes me wonder...what happened to "reforming" health care? Why aren't senators concerned with ensuring the quality of our present system while expanding it to include those who are left out for reasons of income or pre-existing condition? Shouldn't the issue be resolving current problems in the most practical way possible rather than creating a grossly patchworked pig?

And to make matters worse, this morning Humana, the insurance company that provides Medicare Advantage plans that increase coverage for elderly purchasers, was told (on penalty of lawsuit) to stop sending letters to its customers informing them of the effect cutting Medicare funding will have on their premiums.

Say what? Is the pig also gobbling free speech rights? No wonder seniors are angry, and anyone with a knowledge of and appreciation for our Constitution should be also. This administration bumbles along with a heavy foot, whether through ignorance or intent.

The New English

It's hard to tell which came first, the chicken or the egg, but Senate Finance Committee Chairman Max Baucus (D. Montana) certainly tried to decipher the president's health care reform criteria: Not a dime added to the deficit....unless "spending cuts" are made if "savings" don't materialize. Of course Baucus could find "savings" only or almost exclusively in added costs and fees for consumers and providers of health care. The result is those with insurance will pay more for less to cover those without. That will save the government money. Meanwhile, those presently without health insurance will be forced to pony up some of their cash (and some of the taxpayers') to receive services many of them would not voluntarily have deemed worth their penny.

And all of us are left wondering what this has to do with health care "reform," although it certainly falls into the definition of "change" for one-fifth of our national economy.

Two areas of traditional savings have been identified by the administration: 1. electronic record keeping and 2. a $500 billion cut in Medicare (at the expense of seniors' popular Medicare Advantage supplement insurance programs). Writing in The American Thinker (http://tinyurl.com/lcb2wh), Dr. Gerald T. Reiss, a neurologist, finds the savings from eliminating paperwork will be negligible, but says electronic health records will save money "by using computer algorithms to override the medical decisions of doctors in favor of less expensive alternatives." And does that also mean "less effective" alternatives? The government will decide. As to Medicare Advantage, sorry, old folks.

Writing in Real Clear Markets (http://tinyurl.com/kkamxn), Diana Furchgott-Roth of the Manhattan Institute said the increase in health insurance premiums under the Baucus plan will be "a major cost...to the American public," and along the way wondered if this is "a major violation of President Obama's promise not to raise taxes on those making under $250,000 annually." Well, hey, is a government mandated "increased cost" synonymous with a tax raise? The administration will decide.

But there are a few pluses: The Baucus plan will cover most of those who don't already have coverage even if it's by threatening to impose fines of from $750 to $3,800 on those who don't comply...and by charging businesses a $400 fee per employee for not providing coverage. The Baucus plan will subsidize, on a sliding scale, insurance for those with incomes up to 300% of the federal poverty level by placing a 35% tax on high end plans (guaranteeing that they will become either more costly or less generous) and charge burdensome additional fees on both insurance providers and providers of medical devices (and that's not just scooter chairs, but knee and hip replacements and stents). Isn't it a bitch, being sick and getting old?

Doctors have been promised more reasonable Medicare reimbursement, but this is not included in the Baucus plan and would, naturally, add to its cost...possibly bumping it over "the not one dime added to the deficit" rule and thus requiring additional cost to consumers or a much to be regretted "sorry, Charley" notice to physicians.

One group that won't be affected by traumatic changes in health care provision are trial lawyers. Oh sure, the president made a curtsey to the concept of "tort reform" in his speech before the joint session of Congress. He'll look into a couple of isolated pilot projects to be conducted under the auspices of Health and Welfare Secretary Kathleen Sebelius, eight years head of the Kansas State Trial Lawyers Association... although The Wall Street Journal's Kimberly Strassel claims the dollar "savings" with tort reform are estimated at from $65 to $200 billion dollars annually (http://tinyurl.com/lhnj7w). Do you wonder how politicians missed that saving? Well, Strassel points as one example to Rhode Island Senator Sheldon Whitehouse, who rhapsodized about the virtues of the tort bar without mentioning the "nearly $900,000" it contributed to his reelection campaigns. But let's not be cynics.

Did we really expect a free lunch? And won't we feel the warm fuzzies of caring for our less fortunate citizens? ...well, perhaps citizens, perhaps residents. We'll see how that shakes out five or six or eight years down the road. We'll be able to decide then when it's change we can hardly believe happened.

More Conversation With a Liberal

(...a conversation begun earlier today and recorded below)

It should be noted that Hussein gassed thousands of his own people with gas that we (America) sold him and with our tacit approval. Secondly, it is against international law to attack a sovereign nation without provocation. Iraq was in no way involved in 911. Most of the terrorists on those flights were Saudis. Why didn’t we attack Saudi Arabia?

You are the umpteenth conservative that has said there are better ways to solve the health care crisis but none have forwarded a proposal that does so.

I am one of the millions of people that is essentially without health care and I am anything but indigent. I am self employed and in an industry that has been hammered by the economic mess created by the conservatives. I can’t afford health insurance for my family with a deductable of anything less than $10,000. So, the hernia surgery and the skin cancer surgery that I had in the last three years came out of my pocket. The health care system is designed to do one thing well, make money for insurance companies. I have had better health care in Mexico, New Zealand and Chile while on assignments for National Geographic and Sports Illustrated. I, a tourist, was covered by their national system. I couldn’t have paid if I wanted to, I was seen, the problem taken care of quickly and efficiently and I went on my way. America is the only non-third world country without a universal health care system. The scare tactics used by the insurance companies and their friends in congress are lies. Yes certain coverage is denied some people in some cases in those systems but I have news for you: ALL coverage is DENIED to MILLIONS of Americans due to lack of or insufficient health insurance because the costs have gotten out of hand.

Mark Gamba

www.markgamba.com

Well, Mark, can you please document that Saddam Hussein had "the tacit approval" of the US in gassing thousands of his citizens? Or do you mean, we did nothing to prevent or punish it, which, I'm afraid, fits your definition of deferring to a sovereign state.

As to reforming health care insurance...many sensible proposals to do so have been widely circulated on the internet, even popping into the main stream press occasionally. Here's a few:

1. Allow individuals to receive the same tax credit for the cost of individually purchased health care as businesses receive for employer provided care, thus severing health care insurance from employment and solving the "portability" problem.

2. Allow individuals to purchase the policy they want across state lines (at present individuals are limited to purchasing plans that may be inefficient or not what the individual wants because he must purchase health care in state).

3. Expand the number of plans available so that individuals are not required to purchase services that they do not want (perhaps, for example, IVF treatments or breast implants).

4. Work on the problem of "pre-existing conditions" so that an uninsured individual has options for covering a sudden diagnosis of, say, cancer. I'm not sure if this should be accomplished by requiring everyone to carry at least some health insurance (thus lowering the risk factor for insurance companies) or by creating state pools for such individuals.

5. Provide vouchers to the genuinely indigent to purchase insurance.

6. Initiate tort reform to limit rewards to actual damage in order to reduce the practice of "defensive medicine" and the cost of malpractice insurance that has become prohibitive for many doctors.


Now, I don't know the particulars of your situation, although you do not sound indigent. However, there are many millions of Americans who choose not to purchase health insurance because they are young and healthy; they take their chances. Others, I'm sure, face a definite budget strain when confronting the cost of health care, but their decision nevertheless involves choice. Personally, my husband and I spend almost 10 percent of our income on the cost of our share of the health insurance we carry.

I have no personal experience with health care in other countries. However, my son, who lives in London, has been shocked by brief contacts with the NHS there. His wait time for an antibiotic prescription was 6 weeks. His wife, who is Spanish, purchases private insurance from her employer. Nevertheless, when admitted for day surgery for a cyst, she was sent to a recovery room in which there were at least 40 others lying, separated by curtains. She has also lived in Denmark, where, she reports, satisfaction with public care is higher (but Denmark is a very small country).

I have a brother-in-law who has lived in China on a number of occasions, during one of which he had surgery (I believe for a hernia). He was delighted to be charged only the equivalent of some 90 dollars. However, at the time, 90 dollars was about three months' salary for the average Chinese.

I might point out also that emergency room treatment in the US is available to everyone; I imagine many problems are taken care of there "quickly and efficiently." Overall, satisfaction with the quality of care received in this country is very high. It's that quality which conservatives want to protect, and we believe this is possible while extending private coverage to the most needy.

Terri

Here is my issue with all of this, both your suggestions and the current plans wending their way through congress: Why not create a system by which we all pay one entity (the government for example) exactly what we pay for our health insurance (in your case 10% of your income) and that entity provides health care for everyone - period. No enormous profits for soulless corporations (insurance companies, hospitals etc). The profits made off of health care in this country are massive. That money could easily cover (the now reduced) costs of providing health care to all Americans. Simple, logical and workable.

I can answer that question easily: Because some very rich people want to continue getting richer.

Mark

Hi Mark,

I'm not sure how your system would work. Honestly, were my income to increase, would I want to continue to spend 10% on health care? If I were indigent and receiving care, would I want to contribute anything at all should I acquire assets? I think the fact is that most everyone is interested in becoming richer. We're not frozen in our circumstances.

And then, about that one entity... imagine its power. I realize you believe government is benign, but that's hard to support given any historical knowledge. You, yourself, obviously have greatly mistrusted the administration of George Bush. It's not inappropriate here to recall the words of Lord Acton: "Power tends to corrupt, and absolute power corrupts absolutely." This is a lesson played out again and again throughout history.

The advantage of power in the hands of corporations, soulless or not, is their plurality and consequently the competition between them. I've read that health insurance companies reap an average profit of 3 percent. This hardly seems outrageous even though, considering the sums involved, that must be a very large absolute figure. Were there only one health insurer, I suspect profit would be a great deal higher. And there would be little incentive to improve service beyond the goodness of the corporation's soulless heart. (Please note here that a non-profit is equally soulless except its excess is paid out more exclusively in executive salaries rather than stockholder dividends.)

I don't think there is an easy answer to solving problems in health care, and this is all the more reason to proceed cautiously and responsively (i.e. with fiscal restraint) rather than rush in pell mell with good intentions lacking sound judgment and ladened with hubris. Health care is after all a life and death proposition.

Terri

Profits are easy to disguise, anyone who has ever done their own taxes will attest to that, the facts on the ground are this: the current US Insurance industry estimates that 18% of every dollar paid by the insured is used towards “administration”, In France the health care system there spends about 6%, Germany – even less. So there is another 12% (at least) of the money available towards actual care of our health. 10% does seem high when you say it that way, but I spend more than that for insurance and don’t really get anything for it. At least if I was part of a system where all my health care was covered I would be getting something.

I do not believe that governments are benign but I also believe that most of the evil they do is at the bequest of corporations. Had not the tobacco industry spent millions and millions through their lobbyists for the reelection of certain congressmen I doubt the government would choose to subsidize the tobacco industry.

I know that you conservatives hate and fear Michael Moore and he is (like all good showmen) over the top, but he is none the less relatively accurate and his portrayal of the health care system in foreign countries is very similar to my own experiences. I would suggest that you have a glass of wine and sit down and try to watch Sicko even with a grain of salt, he makes it very clear that we do not have a health care system befitting the status of our country. Indeed most people from even decently developed countries enjoy better health care than most Americans do.

It’s a very broken system now and the rest of the world is aware of that. China is watching how and whether we deal with it and whether they continue to loan us money or call in their loans may well depend on our decision.

Best,

Mark

Hi Mark,

Let's take a look at this piece by piece:

1. "Profits are easy to disguise." I'll agree with you here with the caveat that it may not be all that easy for corporations that face much closer regulatory scrutiny than, say, the average small business. However, what this exposes, I think, is the total chaos, or if you prefer, corruption of our tax system that allows Congress to provide sticks and carrots according to the pleasure and often self-interest of particular members of Congress, their constituents, or whichever lobbyists grab their ears. This is certainly an argument for the reform of the IRS tax code, which the Obama administration has not made. In fact, we have a secretary of the treasury who successfully avoided paying his own tax bill until discovered to have done so in the confirmation process.

2. I'll accept the figure of 18% of health insurance benefits going toward administration. I'd even up your figure and say I suspect that a doctor might say that more than 18% of his staff time goes to complying with various insurance regulations (including federal or state Medicare and Medicaid regulations). I don't find the 18% figure totally outrageous. For example, have you ever investigated a charity to which you consider contributing? There's ratings for these. One group that rates is the American Institute of Philanthropy, and here's what it says on its website about its criteria: the "percent spent on charitable purpose" is "the portion of total expenses that is spent on charitable programs. In AIP's view, 60 % or greater is reasonable for most charities. The remaining percentage is spent on fundraising and general administration. Note: A 60% program percentage typically indicates a 'satisfactory' or 'C range' rating. Most highly efficient charities are able to spend 75% or more on programs."

Now, honestly, I'd rather not contribute to a charity that spends more than 15% on administration, but that's my choice.

As far as the lower administration expenses of government medical service in France and Germany, I think it is worth considering that funding is fungible and health services may benefit from sharing administrative costs with other government agencies... say accounting services. The charge has been made that in this country Medicare benefits in this way to achieve a supposed superior administrative efficiency over private health insurance.

3. I agree: a pox on government subsidy for tobacco, corn, ethanol, organic agriculture, etc.

4. This conservative neither hates nor fears Michael Moore; I look at him as a buffoon. However, I have not watched Sicko, but I am willing to submit myself to this agony... fortified perhaps not by a glass of wine, but a good shot of single malt scotch.

5. As to health care in "decently developed" countries, this concept is hard to categorize. I imagine many countries have adequate health care for the reasonably healthy. The U.S. has far superior healthcare for those who are seriously ill. We have five times the survival rate for cancer, for example, than does the U.K., which is a great deal more than "decently developed." On the other hand, the growing phenomenon of "medical tourism" indicates that very good health care is available more inexpensively than in the U.S. in some surprising places. I'm guessing that many of the techniques used were developed here. And this is a factor to consider when judging our health system: its innovation in creating new treatments... which, of course, is a costly proposition. Factoring it out is not quite cricket.

6. Finally, you betcha China is watching, but China is watching our fiscal integrity which is plummeting. It's no wonder China doesn't want to loan us any more money when we are heading to a 9 trillion dollar deficit (without adding a costly remake of health care). We are hell bent on pairing our first world health care with third world financing.

Best,

Terri

Parsing the NY Times on Health Care

One of my sisters graciously forwarded two articles from Sunday's NY Times, and here's my take on these:

The article entitled "A Basis is Seen for Some Health Plan Fears Among the Elderly" (http://tiny.cc/MlOig) certainly illustrates that fears among the elderly are a great deal more than "not entirely irrational" as the author puts it. Let's begin with "Bills now in Congress would squeeze savings out of Medicare, a lifeline for the elderly, on the assumption that doctors and hospitals can be more efficient"....right on, but begging the question, by the way, of any thought that the government can be more efficient than either.

The article says that "the House version of the legislation [and doesn't having different versions cause questions about trial balloons and the lack of seriousness in drawing up the legislation?] would help older Americans with their drug costs." Now wasn't this done under the Bush administration....to general satisfaction????

One, apparently pro- Obama plan individual is quoted saying the elderly are responding to "fear of the unknown." Of course, such fear on questions of their health care would not seem unfounded, but the article goes on to diss the elderly, "62 percent [of those over 45] said they were confused by the debate in Washington, compared with 43 percent of those under 65." I'd suggest that the 57% of those under 65, or most of them, have not followed the debate and know nothing beyond platitudes of the discussion, in other words they know not enough to be confused.

Finally, what do doctors think: "In effect Mr. Obama says he can cut bloated Medicare payments to inefficient health care providers without adversely affecting any beneficiaries. Many doctors are dubious." And..."Cardiologists will be especially hard hit...'Cuts of this magnitude could cripple cardiology practices and threaten access to services for millions of patients,' said Dr. John C. Lewin, chief executive of the American College of Cardiology."

Please bear in mind that the people who are proposing this massive change in an existing system with which most people are happy (note polls) have never run anything in their lives. How can they, honestly, make the claims they do to produce a successful, if volcanic, change in something as vital as American's health care?

The second article on the San Francisco public health plan ("A Public Option that Works" http://tinyurl.com/nuqvy4) is interesting, and I am not opposed to differing plans being tried locally or within states. However, this article leaves many questions unanswered and fails to mention that the San Francisco plan is being challenged before the U.S. Supreme Court (The court will decide on Oct. 5 whether or not to review the case)...but the suit, which is supported by the U.S. Chamber of Commerce and the National Association of Manufacturers, gives an indication that the response of the business world is not as approving as the opinion piece indicates. According to the San Francisco Chronicle (http://tinyurl.com/njo9v9 July 20), "More than 80 percent of the $200 million annual cost will come from state and local taxes and payment from patients, based on their incomes. The restaurant association's lawsuit challenges the city's authority to require large and midsize companies [over 19 employees] to pay the rest of the bill."

The Times' authors offer a 4 percent surcharge instituted at 25 percent of restaurants as a mitigating factor... acknowledging also that costs are passed on to employees in the form of lower or delayed pay raises. This does seem regressive to me, as would the restaurant association's desire to pay for the plan through a quarter percent increase in the sales tax.

Under the San Francisco plan, employers with between 19 and 100 employees must add $1.85 per hour cost per employee for "pay or play" ($1.23 for those with over 100 employees). This is a substantial employment cost, and despite the assurances of the authors (offered without statistical backup) that employment in San Francisco has not suffered, it is a cost that would make most small business owners shudder.

There's nothing in this article that informs on satisfaction with the plan among users. It has the advantage that a national plan would not have of not affecting the health care of those satisfied with their current coverage (about 87% of Americans, I believe). The article mentions that Massachusetts has a public health plan without offering any details, and this is as well since the Massachusetts plan is rapidly heading for insolvency.

A Conversation With a Liberal

I had an interesting exchange of emails with a liberal this morning:

I'm fascinated that a person who loves the english language would prefer Bush to Obama or has my quick read of your site misrepresented you? I was looking for a description of plum duff on a whim and found you. I think that the current administration is at least in touch with reality whereas the previous one was not even on speaking terms. Not to mention the fact that Obama is a damn decent orator in this day and age and bush could barely string a coherent sentence together. And all this is mere superficiality. Bush got us into two wars neither of which was well reasoned and he put the final nail in the coffin of our economy. He also ignored all of science during a critical juncture in history. How can any thinking person still hold their head up and say "I'm a conservative"? The last eight years has caused conservativisim to equal having your head in the sand or worse.

best,

Mark Gamba

www.markgamba.com

Hi Mark,

I'm glad you stumbled upon my site and were fascinated. I must say that having just visited your site, I am astounded by the excitement and beauty of your photography.

However, I must confess to being conservative; therefore, although I am impressed by Obama's rhetorical skills in delivering a speech, I must judge him by his policies with which I largely disagree. Also, when he is speaking without a teleprompter, I find the president's rhetoric merely mediocre. He doesn't measure up at all to JFK or for that matter Ronald Reagan in his performance at press conferences, and he employs the most tone-deaf press secretary that we've seen in ages.

Of course how something is said is important, but nevertheless not the message. And in addition, should you read much of the political commentary of the day, I think you may find that conservative writers have better skills and employ logical thinking much more so than liberal commentators (even allowing for a wide range of exception in both categories).

So we must agree to disagree on politics, but I thank you for responding and giving me an opportunity to enjoy your work.

Terri Choate

Conservative writers may be better writers because spin is their biggest ally. The liberals count on truth and reality, both of those are given short shrift these days. Reagan spoke well, indeed. I would not agree that he speaks any better than Obama. I would also point out that Reagan was often lying or mistaken in order in ramp up his hyperbole. Again, the truth is never as glamourous as fiction.

Mark Gamba

Hi Mark,

I can agree that the truth is never as glamourous as fiction...but here's the rub: how can you assume that the Obama administration is speaking the "Truth"? For example, how can this administration claim it can reduce the cost of a Medicare program that already faces insolvency while adding millions of additional recipients and not reducing services? The president has no practical experience in administration (along with most politicians) and cannot honestly make this claim. I also question your faith that liberals, as opposed to conservatives, count on truth and reality. This is an enormous oversimplification.

I respect your concern about truth but believe you need to investigate further...and rely on individual instances.
Best,
Terri

Weapons of mass destruction for example? If Obama gets us out of Iraq, the money not spent there will easily cover the deficit in health care spending.

Mark Gamba

Hi Mark,

Well, weapons of mass destruction are rather old stuff. Like George Bush, and many others, I did believe Saddam Hussein harbored weapons of mass destruction: He certainly gassed thousands of his own population. I also believe that Hussein's repressive administration equaled genocide, reason enough to remove the bastard. I realize, however, this is a slippery slope and can appreciate that you consider internal abuses less than grounds for war (would you feel the same way about fighting Hitler in WWII?). I must admit I am dismayed that liberals show such little regard for human rights in oppressive Muslim countries...while they push for extreme niceties in Western nations.

And I dispute that ending US spending in Iraq (which is happening) will fund public health care for many months...to say nothing of the question of Afghanistan, where at least for the moment, Obama supports a war. I do agree he should; I suspect you do not.

I cover health care quite a bit on my blog. I believe there are many better solutions to health insurance reform than a monumental, necessarily exploding public option. As far as I am concerned it would be easier, more practical, and more affordable to issue vouchers to the truly indigent to buy health insurance without interfering with the coverage of everyone else.

Terri

Democrats Stoop To Censorship

From Saturday's Washington Post:

GOP: Democrats Censoring Mail on Health Care

House Republicans have been prohibited from mailing out this diagram of Democrats' health-care reform plan.

By Ben Pershing
The partisan debate over health-care reform has trickled down into one of the more arcane corners of the House -- the committee on free mail, otherwise known as the Franking Commission.

One of the perks of being a member of Congress is that each lawmaker is allowed to send "franked" -- or free -- mail, as long as it is related to official business. Members use that ability to send newsletters and legislative updates to their constituents. To ensure that privilege is not used inappropriately, a majority of the bipartisan six-member Franking Commission must approve each piece to ensure it meets some basic guidelines. Mail is blocked only on rare occasions.

But now the commission has gotten involved in the health-care fight, prohibiting several Republican lawmakers from mailing out reproductions of a colorful, labyrinthine chart that purports to diagram Democrats' reform plan. The controversy was first reported by Roll Call.

The chart was produced by the Republican staff of the Joint Economic Committee and has become a popular visual aide on the minority side of the aisle, as the GOP attempts to convince the public that the majority's plan will be a confusing disaster. But Democrats have argued that the chart is an inaccurate representation of their health-care efforts, and for that reason, the three Democrats on the Franking Commission say the GOP can't use it in official mail. House guidelinessay that in franked mail, "Comments critical of policy or legislation should not be partisan, politicized or personalized." But what about information that's inaccurate, or -- arguably -- just misleading?

"We have never before censored anybody's presentation of facts this way," Rep. Dan Lungren (R-Calif.) complained in an interview Friday.

Lungren, the top Republican on both the Franking Commission and the House Administration Committee, said the commission has never traditionally played a fact-checking role. He pointed out that Democrats this year have sent out numerous pieces of franked mail touting the number of jobs created by the economic stimulus package, and while Republicans might disagree with those numbers, they've never moved to block the mail from being sent out.

"We let those things go by, even though we don't think it's true," Lungren said, adding that he knows of at least 15 Republicans who have asked to mail out copies of the health-care chart in question. (For some context, Rep. Kevin Brady (R-Texas) explains the chart's purpose here. Ezra Klein mocked the chart here, and includes a chart of Republicans' own health-care "plan." )

The controversy extends beyond the colorful chart. Salley Collins, a spokeswoman for House Administration panel Republicans, said GOP members were also being told by the Franking Commission that they could not refer to "government-run health care" in their mailings, and had to dub it "the public option" instead.

Democrats, led by Franking Commission Chairwoman Susan Davis(Calif.), say they are trying in good faith to negotiate a compromise with Republicans on this subject. If the impasse isn't resolved, watch for the GOP to turn up the volume on the controversy next week.

By Ben Pershing | July 24, 2009; 3:06 PM ET
Categories: Ethics and Rules , Health Reform , HouseShare This: E-Mail | Technorati | Del.icio.us | Digg | StumblePrevious: Republican Senators For/Against Sotomayor

Health Care for the Generic Person

Peter Singer, who's famous-or infamous-for most candidly promoting the thought that a rat and a boy and a dog are equals (although the precise quote "A rat is a pig is a dog is a boy" was made by Ingrid Newkirk, a co-founder of PETA), has an essay in today's New York Times explaining "Why We Must Ration Health Care": http://tinyurl.com/nuvjr7.

Well, first let's look at the "we." It's not you nor I with our choices to purchase, or not, health insurance, nor our doctors with their advice on the efficacy of treatments who must ration health care, but rather bureaucrats in a governmental agency such as Britain's NICE (National Institute for Health and Clinical Excellence) who will do the rationing. Singer notes, with jaundice, these are the bureaucrats conservatives label "soulless," but in his exposition they come across merely as bloodless... straightforward actuaries.

Singer, himself, is a straightforward utilitarian philosopher, who is a professor of bioethics at Princeton University and also laureate professor at the University of Melbourne, Australia. He was the subject of a fairly sympathetic review by Mark Oppenheimer in the Christian Century (July 2002) that you can read here: http://tinyurl.com/d87hd8.

As a utilitarian, Oppenheimer says, Singer sees "the moral task is to create utility--to increase the amount of happiness in the world, or at least decrease the amount of pain." Of course, these are excellent goals shared by religious people, but one that runs contrary to "monotheistic traditions" that hold "suffering can be redemptive; that people can be called to unexpected and unusual tasks, that a lone human life can have inviolable worth; and that there is something greater than humankind that deserves to be worshipped"...and perhaps honored by the building of cathedrals, by scriptual study, and by contemplation, items Oppenheimer categorizes as "a part of godliness," a trait Singer denies.

Indeed, Singer is well beyond the religious..and not so religious... mainstream because along with promoting respect and good treatment for animals and generosity in charitable giving, he also believes "it's OK to kill babies," and he does mean babies not fetuses. It's OK because, Oppenheimer points out, Singer is a "preference utilitarian" who believes in "allowing people to satisfy as many of their preferences as possible." Babies are incapable of having preferences beyond basic instincts to feed, sleep, and extricate (one might say to live) and so they are subordinate to their parents' preference to live without them...a condition that may continue up to three years of age: "a grey area," Singer told Oppenheimer.

This is the shocking aspect of Singer's world view. However, Oppenheimer also points out that many of Singer's views are accepted generally: for example, killing one of a set of Siamese twins to insure life for the second. And many would accept keeping brain-damaged infants alive only long enough to harvest their organs to save other lives.

Fewer agree with Singer that an animal may have a greater claim to life than a person..."that an intelligent adult ape has more conscious interests than a newborn" and should, perhaps be rescued from a fire before the infant, especially if the infant is retarded. The existence of preferences is the grounds for not taking a life and does not apply to infants and perhaps not to the severely retarded. The fetus's and infant's dearth of preferences is easily outweighed in Singer's philosophy, Oppenheimer points out, by preferences of the parents to kill. Apparently, the ingrained capacity of the infant to develop preferences in the future is of no account.

Oppenheimer points out that Singer might also argue that parents who thus deny themselves a child could later produce another and that parents who do not want the burden of raising a brain-damaged child might then be able to contribute thousands of dollars to UNICEF to save other children.

So this is the Singer who writes in the Times that "we must ration health care." Singer's tone in the Times' essay denies his more radical views. He sounds less like a college professor and philosopher than a business manager. He can think of no other way to apportion health care except by government rationing or by price as we (mostly) do now--although one might suggest charity, prudence (purchasing insurance), or reforming the insurance marketplace to allow individuals to buy the insurance...and only the insurance...that they need (i.e. eliminating requirements to include procedures such as stomach stapling, breast implantation, and sex changes that most people do not want and that drive up costs unreasonably).

With his proposals Singer attempts to set a price on human life--or to outline how to do so. It's important to realize he's speaking of generic people. In these terms, "the death of a teenager is a greater tragedy than the death of an 85-year-old. He asks rhetorically, "What if the teenager is a violent criminal and the 85-year-0ld is still working productively?" Well, no dice, seniors: "Decisions about the allocation of healthcare resources should be kept separate from judgements about the moral character or social value of individuals."

Singer also disses those with disabilities. He hypothesizes that a life as a quadriplegic is half as good as a non-disabled life, so it might be more beneficial to save the lives of two non-disabled than to restore the life of a single quadriplegic. If you don't think so, if you think the life of the quadriplegic is equal to that of the able-bodied, Singer asks why bother treating the quadriplegic at all? It's all in the numbers.

Now, Singer does, at the end of his 10 (printed) pages, qualify his support for government care: either people or physicians should be able to get out of Medicare for All should they choose not to participate. Unfortunately, Democrats in the House disagree with him here. Singer also believes people should be able to buy supplemental care to have an option for unrationed care (one I suspect he would use for his family). Does Obama government care allow this? Perhaps for the moment.

And I can't help but remember (because he frequently reminds us) that Obama is also infamous for regretting that the grandmother who raised him worried about the cost of her healthcare deductibles as she lay dying, despite her well-positioned and well off grandson (which opens up the moral, if not ethical, question of family support and care).

And also, I think, utilitarians may find it easy to be fickle. Singer has admitted to believing one might "need to lie for a good outcome." Utilitarians profess to seek lives that are free and valuable, but they value statistical averages and government edict rather than real people and free choices. And they are single minded in the way that I find many libertarians single minded, allowing them to sound logical when in reality they ignore the greater picture. For example, Singer ignores the destruction of incentive to produce new treatments and new pharmaceuticals that destroying profit from them will cause. He ignores a physician's inherent desire to practice his profession to the best of his (or her) own ability freed from bureaucratic restraint. And he ignores grown ups' desire to be free of government interference in personal life choices. And by ignoring "godliness" and human uniqueness, he removes most of the reasons we would choose to have a long life after all.

Obamacare Flow Chart

Do you really want to navigate this maze???

Let's Ban Smoking in the Military?

Yeah, sure... What's OK for the commander-in-chief (choice) is too good for the grunts who bear the burden of the battle.

HAPPY FOURTH OF JULY!

Today was my best fourth of July ever for three reasons.

1. I took part in the 2,ooo strong tea party (that's Taxed Enough Already) in Reno. I waved a sign for two hours in the pretty hot sunshine, and I'm sure I made Sam Adams and company proud.

And here's some pictures:


These signs were not passed out
by big business...or the GOP,
but handmade, often on site...
and this young patriot's was
among the best:
A government big enough to give you everything is big enough to take everything you have.







2. I contributed to the wounded warriors project, a project that assists today's severely wounded and disabled veterans as they return home. And you can do this also by going to https://www.woundedwarriorproject.org/content/view/446/1076/ and clicking on the Donate button on the upper right.


3. I'm baking Dale an apple pie...what could be more American!


ENJOY YOUR FOURTH AND THE FREEDOM OUR CONSTITUTION, NOT CONGRESS NOR THE PRESIDENT, GIVES US. WE MUST PRESERVE THIS GIFT FOR THOSE WHO FOLLOW US!

GOD BLESS THE USA!

Obama Gyrates!

WHOOPEE!

This bobble man is a must for every dash. I received mine last week, and he's been a shimmying and shaking and entertaining me on every drive since.

(You can get yours at Glenn Beck's website: http://tinyurl.com/24dz8s.)

Laughter rises out of tragedy, when you need it the most... Erma Brombeck

Our Dad

Our dad died in 2003 at age 96, and at that time, I was resigned to let him go: I thought "God must need him more than we do." Honestly, old as I was, that's a judgment I wouldn't have been able to make much earlier...because we always needed Dad, at least I know I did, but I also knew that since my mother's death five years earlier, my dad wanted most of all to rejoin her.

Dad regularly put other's needs and happiness before his own. Selfishly, I wanted to hang onto him forever even as I saw the fatigue in his eyes and his occasional stumbling step. To the end, he was always the helper, the fixer, the calm voice of wisdom and love. I may have seen my dad angry twice in my life; that fact made my own temper hard to understand, for Dad was always in command, all-knowing, sweet tempered, and calm. I asked him about this once. He told me that his two older brothers (he was third of nine children) fought constantly. It was mostly the fault of the second oldest, Dad said, who was hot-tempered. Dad decided not to follow that example.

And I think in any case, anger wasn't in his make up. Dad was interested in what makes things work, and he followed that inclination by commuting by rail to MIT from Fall River, Mass, to earn a degree in engineering in 1930. It wasn't an auspicious time to graduate. His own father had wanted Dad to follow in his monument (gravestone) business, but that wasn't Dad's intent. He left for St. Louis, MO, with my mother to take a job offered by a friend's father. By the time he arrived, the job had disappeared. Times were tough then. Dad worked for a while in an auto parts store, and he told me of waking up one morning with 5 cents and a loaf of bread in the house. If it were not for the generosity of neighbors, particularly one in the military who shared his paycheck, going hungry was a definite option.

After my brother was born in St. Louis, my Dad took my mother and their baby to Maine where he had been offered a job working on a farm for food. It was a long, cold winter trip in an unheated car, and on arrival, farming in Maine proved hard scrabble, and the food was limited to basics for survival. (In fact, the hardships there cemented my mother's later distaste for country living.) Eventually, though, times improved. By the time I was born (4th of six, five of us girls), my Dad was working in Columbia, PA. He'd moved into quality control engineering. When the war broke out, he was exempted from military service, and he moved from the manufacture of Cook washing machines to the manufacture of military aircraft.

One of my earliest realizations about my Dad was the respect with which others treated him. It was respect well deserved. Dad was the problem solver. Dad was the one everyone turned to for help. Around my Dad, I felt completely secure and really very special to be Bill Lord's daughter.

I don't remember my Dad playing games with us. I do remember him taking us swimming on hot summer nights...after he'd worked all day. I remember him showing us how to use tools and allowing us to mess around his basement work bench. I remember him fixing our car...in fact I remember impatiently calling him out from under the car on many occasions because it was time to take the family somewhere or time for dinner. And I remember my Dad tutoring me and my sisters patiently in algebra many many nights throughout high school. I owed my A's in math to him. Realizing this, I took symbolic logic in my freshman year of college to avoid math, and I found myself floundering. After weeks of panic, I decided I needed to follow Dad's example and work my way through problems step-by-step: I earned a B.

But my best memories of my Dad are being around him while he worked. Dad always sang. He didn't have a great singing voice, but that didn't matter because he was making up his songs as he went along. The songs were about whatever he was doing and also running commentary about the kid with him. They were funny, filled with Dad's quirky, good natured humor. They were the one thing that could force me to smile when I was in a perfectly awful pout and determined to stay there. Pouting was impossible around Dad.

I don't remember receiving a great deal of advice from Dad. We all just knew how we should act by watching him. He was the original, "do as I do." He did recommend once that I not drink gin. This is advice I've taken over the years...except once when I had the opportunity to try out some authentic moonshine from West Virginia. It reminded me of a time I asked my Dad if he'd gone to a speakeasy during prohibition. He told me no, but he had gone to the beach at night to meet the rum runners to buy whiskey for his Dad. My grandfather, as a result of his stonecutter's trade, suffered painfully from dust in his lungs, and he drank to kill the pain.

But if Dad missed out on speakeasies, he didn't miss out on fun. After my mother's death, he reminisced about the times they went to Horseneck Beach on Cape Cod to fry eggs and heat beans by fireside as the sun set. His and my mother's happiness was low key. They deeply loved each other and were happy with simple, inexpensive pleasures. My mother said she never wanted to live without my dad, and I can understand why. Dad survived Mom by five years, and he spoke to her every day of those years. Dad loved his kids; we all knew that, but his love for my mom was the deep passion of his life. Still, no one knew my Dad who didn't feel lifted up by his acquaintance. Dad was a common man and an uncommonly wonderful guy. I'll miss him this Father's Day.

Trickle Down Learning

How much does your public school district spend per pupil on education? According to a recent position paper from the Nevada Public Policy Institute (NPRI), it’s most likely more than you think, indeed more than you have been told.

In “Funding Fantasies” (download here: http://www.npri.org/publications/funding-fantasies), the Institute’s education policy analyst Patrick Gibbons finds that “[t]he true cost of educating students is regularly misrepresented behind claims that certain expenditures, such as capital outlays and debt service, should not be counted, because those expenditures are not directly related to student learning. But such thinking merely seeks to illegitimately exploit the arcane distinctions of accountancy. If the expenditure does not contribute to student learning, why is it being made?”

Well, good question.

In Clark County (Las Vegas area), the school district reported per pupil spending for the recent school year would be $7,175, but dividing budgeted spending for the school year by the number of students, actual spending per student is $13,387. In Washoe County (Reno area), actual spending per pupil by weighted enrollment was $11,395. But the basic support claimed by the district is $5,323. Not included there is “additional revenue from...federal funds, local funds, capital project funds, food service funds, special service funds and debt service.”

This problem is not singular to the State of Nevada. Gibbons writes “[u]nderreporting of per-pupil spending is a nationwide practice. In the District of Columbia, Andrew Coulson of the Cato Institute found that D.C. schools spent more than $24,600 per student—despite officially claimed expenditures around $13,500 per student. Meanwhile the average tuition at a D.C. private school that accepted vouchers from the D.C. Opportunity Scholarship Program was just $6,620.”

Well, one way of reading this is to confirm suspicions: a huge portion of the money spent on public schools never makes its way into the classroom. It is in the interest of administrators and educators to cry “not enough money” when the truth is closer to “not enough money well spent.”

Gibbons finds that of the $13,387 to be spent per pupil in Clark County in 2008-2009, only $4,514 (33.7%) was to be spent on “instruction related expenses.” Average salaries within the district range from $55,651 for workers in facilities to $113,189 to those in curriculum and professional development. He asks, “Can CCSD's academic results justify these generous average salaries?”…and notes “[t]he district employs 32,202.39 full time equivalent staff (FTE) on its payroll. That’s roughly one employee per 10 students, and an average salary-and-benefits package of $69,871.”

WestEd, a non-profit research institution based in San Francisco, looked at student graduation and achievement rates in Nevada in 2005. The institute concluded in the executive summary to its report (done in collaboration with the Center for Education Policy Studies, CEPS, at the University of Nevada, Las Vegas):

Our review of the state’s student achievement and graduation rate data leads to several findings:

On achievement. Despite some recent gains among the state’s high school students, achievement remains low, ranking Nevada near the bottom among U.S. states. Moreover, as in other states, a significant racial/ethnic and socioeconomic achievement gap persists.

On the graduation rate. Although wide variations exist across districts, Nevada’s overall graduation rate is one of the nation’s lowest. Here, too, the racial/ethnic and socioeconomic achievement gap is evident.

Well, there are gaps and gaps.

NPRI found a gap in school districts’ knowledge: “whether [districts'] spending patterns have any link at all to the policy priorities they publicly profess”…or is spending “an accidental system in which spending decisions, regulations and other restrictions are made piecemeal and with conflicting intent”...noting that “[s]chool board contracts with teacher unions currently determine how nearly half of all funds available to public education are used.”

Of course, teacher unions have a purpose…to increase teacher pay and benefits, but is that synonymous with increasing student achievement? Looking at results, the answer is “not necessarily.”

Accounting, also, has a purpose, but is it to clarify where the money goes or to obfuscate? In Nevada and in the nation, school districts hide the significant expenditures that create a top-heavy school bureaucracy and then claim to the public that they haven't enough money to educate students to even mediocre standards. Perhaps pundits should pan it as trickle down (maybe) learning.

Here's to Holes in Water

George Will turns to our 29th president to offer our 43rd some perspective:

"Noting that people "criticize me for harping on the obvious," Calvin Coolidge justified that practice by saying, "If all the folks in the United States would do the few simple things they know they ought to do, most of our big problems would take care of themselves." Consider what individual Americans know they ought to do, and what their government should know not to do.

"The nation could subtract from its health care bill a significant portion of the costs caused by violence, vehicular accidents, AIDS, coronary artery disease, lung cancer and Type II diabetes resulting from obesity. All six problems are significantly related to known risky behavior, which can change….."

Will notes the "new sobriety" of Americans ("more saving, less spending") encourages economic recovery, but wonders if it will survive. He sees the administration's huge stimulus spending as a "defibrillator" that quickens the economy's pulse, but reminds "a patient cannot become healthy attached to a defibrillator," and he sees the country being lead toward "[t]rillions of dollars of capital...being allocated sub-optimally, by politically tainted government calculations..."

Continues Will, "The president's astonishing risk-taking satisfies the yearning of a presidency-fixated nation for a great man to solve its problems. But as Coolidge said, "It is a great advantage to a president, and a major source of safety to the country, for him to know that he is not a great man." What the country needs today in order to shrink its problems is not presidential greatness. Rather, it needs individuals to do what they know they ought to do, and government to stop doing what it should know causes or prolongs problems.

(You can read the sad litany of "astonishing risk-taking" in the complete article here: http://tinyurl.com/lvlt3p.)

For the sake of our institutions, we can only wish that Obama's hubris will play out as American psychologist Og Mandino suggested: “The next time you are tempted to boast, just place your fist in a full pail of water, and when you remove it, the hole remaining will give you a correct measure of your importance.”

Times are shaky when we hope for a legacy of holes in water!

TOTUS Guides POTUS Through Press Questions

On Amerian Thinker Cliff Thier speculates on the rescue of the president from his "uh"..."uh"..."uhs": http://tinyurl.com/n4puuz.

And you might want to read more on TOTUS' own blog: http://baracksteleprompter.blogspot.com/.

Go Tell it on the Mountain!

We were six adults, three sisters, a brother-in-law and two nephews, and four kids, three sons (grandnephews) and a daughter (grandniece) whose homes spanned the continent, which meant we didn’t know each other all that well. But the bond of family was taken for granted; we climbed together, intermixing easily.

It was an August day in New Hampshire, and at the base of Mt. Monadnock, the heat, humidity and mosquitoes were discouraging even as we entered the shady forest path. The youngest demanded a ride on his father’s shoulders; I didn’t think he would reach the mountain top.

But before long, he was set down, and all four kids scampered ahead, vying to be first, vying to find the best native blueberry bush to gorge on its fruit. The adults proceeded at different paces, taking pictures, noting the vegetation, conversing. Periodically there were stops as the forest gave way to steeper, rocky terrain for a drink of water and snacks and admonishments to be careful.

Mt. Monadnock is not a difficult climb for kids and able bodied adults (although descending with bad knees is a challenge). The rocks are giant stepping stones, but not hard to maneuver over or around. No special equipment is necessary, and as we ascended, earlier climbers, teenagers, ran and lept down the pathway: oh, to be young again!

The reward of the climb is the mountain top. It’s a relatively flat, ½ acre or so of rock surface with peaks to stand upon to soak in the vista of the green, green lowlands below, the ponds, the stretch to the horizon, which can include a faint glimpse of Boston on a clear day. And there are small planes flying below, white against the landscape.

The summit is windy and chill after the climb, but there are rocks again to shelter beside and eat the peanut butter and jelly sandwiches we’d brought for sustenance. And there’s a bronze plaque that notes the elevation: 3,165 feet. I was thinking about this number as I gazed, feeling very much on top of the world, out into the far distance. I live now in Reno, NV, which has an elevation of 4,505 feet. I was, in reality, some 1,400 feet lower than when in my backyard.

Perhaps this is a lesson in perspective, perhaps in irony. But what I was actually experiencing was the joy of the climb, the camaraderie of joint effort and success, the deliciousness of the moment (and the sandwich). These are the tangible understanding I brought back down the mountain.

And I think that is what is to be learned from a mountain top: how to live when we return. When Moses went, he returned with 10 commandments from God to live our lives. My grandnephews and grandniece that day, returned, I think, with awe at the height they’d achieved and confidence to strive and endure to success. Others may have found a peace that eludes them in the flatland, but a peace to bring home.

My granddaughter is now nine months old. She’s accomplished crawling, and now she has taken to looking up. No longer do the scattering of toys on the floor interest her; she looks up to pull things down (including a chair on her head) and she tries to pull herself up, succeeding, on her knees, in reaching into her brother’s toy bin to rattle the contents and pinching her hand as she descents down. There’s a momentary cry of distress, and then she’s off to other mischief.

When her brother was 18 months old, I watched with curiosity as he climbed a vertical stack of wooden flooring some four feet high, successfully. I probably should have stopped him, but we both wanted to see if he could do it, and he could.

Perhaps that’s another lesson: never be satisfied with the status quo, accept the challenge, strive. Why do we climb mountains? We do because they are there, and we do because they are much more enlarging than molehills. Looking up is our nature and destiny.


This posting is an entry into Robert Hruzek' s "What I learned from a mountaintop..." group writing contest a middlezonemusings.com (http://middlezonemusings.com/wilf-mountaintop-experience/). You have until Sunday, June 7, at midnight to enter, and I encourage you to return to Robert's site to read the many fine entries on Tuesday, June 9.