Monday, August 31, 2009

The Takeover: What opponents of health care reform don't get

U-S-A, we runnin’ this health shit

Obama, we runnin’ this health shit

Death panels, we runnin’ this health shit

Get zipped up in plastic—when it happens, that’s it.

It’s the takeover, the break’s over. They’re coming for you, so take cover.

The President and his panel of experts think they know better than you and your doctor how to treat what ails you. The government takeover of health care will put a bureaucrat in charge of deciding what health care you get—decisions which are best left between you and your doctor!

More insidiously, the experts think they can pick out which individuals are most valuable to society, and therefore most deserving health care. Fail to make the productivity cut, and that’s it—you get zipped up in plastic, no matter how badly YOU think you deserve to get that expensive lifesaving treatment.

That’s what health insurance companies Republicans want you to believe, and that’s what countless misguided people at town halls across the country are shouting.

The obvious flaw in this line of thinking is that no one is talking about having government decide which treatments would be allowed, but rather which treatments would be paid for by the government under a public option. That’s not a “takeover” of health care. Doctors would not be employed by the government. Private insurance companies would still exist, and you could still buy insurance from them—and if you didn’t like your coverage or couldn’t afford it, you’d now have the option of buying insurance through the government.

Even if the government insurance option did drive private insurers out of business (I’ll post later on this), you’d still have the option of paying out of pocket for treatments the government opted not to cover. Only if you were BANNED outright from buying health care beyond what the government covered could reform be considered a “government takeover.”

And in fact, when people understand that the public option is government insurance, not government health care, they overwhelmingly support the President’s plan. As Nate Silver points out, most people don’t understand what a “public option” is, but when you explain it clearly as this poll does, asking “Do you support or oppose giving people the option of being covered by a government health insurance plan that would compete with private plans,” 62% support the plan, versus 32% opposed. Defeating health care reform thus DEPENDS on people believing LIES.

That’s strike one.

The other absurdity in the “bureaucrats making health care decisions” argument is that, well, that’s what happens in private insurance too. Your insurance company already makes decisions about what treatments it will and won’t pay for, which is why doctors have to spend up to a third of their time filing paperwork, battling to convince the company bureaucracies to cover your treatments. In fact, the insurance company bureaucracies unnecessarily waste $286 billion PER YEAR.

So extreme are insurance company efforts to ration treatment that they’ll even revoke your coverage after you’ve paid years of premiums, a practice called “rescission.” Reposting from an earlier entry:

This has happened 20,000 times over the past 5 years (at least one company evaluates its employees on savings from rescinded policies). Here’s how it works. When you get a diagnosis that will require expensive treatment, it triggers a processso-called “denial engine” software, to see if you forgot to report any illness on your initial health status questionnaire; if there’s been even one mistake, no matter how small, they revoke coverage from you and your entire family (of course, without refunding all those premiums you paid). You can have your coverage rescinded for something as simple as shortness of breath or hay fever. Health care rationing indeed. by which your insurance company scours your medical records, using

Unsurprising considering the insurance company bureaucrat has a profit motive to provide as little care as possible. Rationing care is how insurance companies make money!

Simply put, the idea that health care decisions are solely between you and your doctor assumes that there are no constraints on your ability to pay. Otherwise it’s not a choice made freely by you and your doctor, but one limited to the treatment options you can afford—you’re consulting your doctor, your own preferences… and your budget.

Arguing against universal coverage on the grounds that it leads to “rationing” is like arguing against food for the homeless because they aren't deciding what food or how much of it the charity gives them. Creating a public option can only give people MORE choices, not fewer.

So my question for reform opponents is: why is it worse for a government bureaucrat to make these calls than an insurance company bureaucrat?


There's no money in selling insurance to sick people: more reasons free markets don't work in health care

The catch-22 for opponents of health care reform

WSJ inadvertently supports case for health care reform: do you want to trust your health to profit and loss?

Are Sarah Palin and Martin Feldstein closet universal health care supporters?

Global warming goes on monkey trial!

Now this is just absurd. In a story that’s been making its way around climate blogs over the last week, the US Chamber of Commerce is calling for the EPA to literally put global warming science on trial—specifically, a “Scopes monkey trial of the 21st Century”:

The U.S. Chamber of Commerce, trying to ward off potentially sweeping federal emissions regulations, is pushing the Environmental Protection Agency to hold a rare public hearing on the scientific evidence for man-made climate change.

Chamber officials say it would be "the Scopes monkey trial of the 21st century" -- complete with witnesses, cross-examinations and a judge who would rule, essentially, on whether humans are warming the planet to dangerous effect.

"It would be evolution versus creationism," said William Kovacs, the chamber's senior vice president for environment, technology and regulatory affairs. "It would be the science of climate change on trial."

The original Scopes monkey trial was, of course, the famous 1925 trial of John Scopes, the Tennessee high school teacher arrested for teaching evolution in his classroom. Scopes’ legal guilt was never in doubt, so the two lawyers were free to duel back and forth over faith and reason—William Jennings Bryan arguing for traditional religion, and Clarence Darrow defending the science of evolution. The media turned the trial into a circus, and the nation tuned in to watch images of pitchfork-waving townspeople burning effigies of poor Scopes. In every sense of the word, it was evolution, not John Scopes, on trial.

Scopes lost his monkey trial, and was ordered to pay a $100 fine (overturned on appeal). But in the court of public opinion, Clarence Darrow’s takedown of Bryan, and Bryan’s utter inability to respond, destroyed the credibility of those who opposed evolution’s teaching.

Now it’s the powerful US Chamber of Commerce’s turn to put science on trial. Do they think this time around the outcome will be different? Why would the Chamber willingly expose its shoddy arguments to the spotlight? Maybe they oppose evolutionary science as well as global warming?

More likely, they understand full well their position’s intellectual bankruptcy, and just aren’t too worried about it. Because their strategy isn’t to convince the public through rational debate, but to sow doubt by generating “global warming goes on trial” headlines and hoping the public won’t read past the headlines. After all, Joe Sixpack’s short attention span and lack of scientific training make it hard for him to sort out scientific fact from fiction, so he’s likely to accept whichever side’s conclusions support his views on the role of government.

And unlike William Jennings Bryan, who framed his arguments in terms of faith versus reason—an untenable strategy today—the Chamber has a better strategy for framing the debate: “pseudoscience.” The strategy is to pack your arguments full of scientific-sounding jargon but little actual meaning, and pay off a cadre of “scientists” to repeatedly regurgitate these talking points, in order to add an appearance of credibility to global warming denial. (In fact, it’s the preferred strategy of today’s creationists—they call it “Creation Science.”) To the layman, it all sounds legit; the jargon gives him a few talking points he can spout off whenever challenged, making him feel more secure about rejecting the scientific consensus without really understanding what he’s saying. And the more times you repeat it, the more ingrained the lie becomes.

It may work, but I don’t see it as a winning strategy. When you hold a lie to a lamp, the truth shines brighter. And the evidence for human-caused global warming is so ironclad, the arguments against it so transparently made-up, that if the two were actually put side by side in public spectacle, I’d expect that none but the most hardcore deniers could continue to believe the drivel. The denier lawyers would go home as thoroughly humiliated as William Jennings Bryan after his shellacking by Darrow.

In fact, Bryan died five days later, a sad end to an otherwise admirable life.

So if that’s what the deniers at the Chamber of Commerce want to put themselves through, I say bring it on! Who wants to be Clarence Darrow?

Ever argued with someone over climate change and been stumped by a pseudoscientific sound bite? Just curious about the topic? I’ll be posting on the basics of climate change arguments across the next several weeks—the three facts that disprove any denier talking point; the smoking gun evidence for global warming; defenses of cap-and-trade that don’t rely on numbers; why opposing global warming legislation makes you a socialist; and others.

  • If you’re really interested in the science, RealClimate has excellent articles, most of which are pretty understandable.
  • And for your daily dose of global warming politics, Joe Romm has you covered at ClimateProgress.

Friday, August 28, 2009

AmeriCorps: the most dangerous army in America

Have you ever worked in AmeriCorps? Do you have friends in Americorps? What about the Peace Corps? Here's what the Republican Party thinks about you:

Yes, because there's nothing more threatening than a bunch of granola-wearing college kids with paint brushes and potting soil. Better grab yer guns!

A couple of highlights:
  • Beck claims President Obama is increasing funding for AmeriCorps to "half a trillion dollars" a year (roughly what we spend on defense each year)--and the guests don't even correct him! You can tell the Heritage foundation guy was a little taken aback by the error from the way he pauses, but he just runs with it.
  • The guy on the left starts his critique by saying, "Now I'm not comparing the President to Saddam Hussein or Hitler"... before he goes on to compare the President to Saddam and Hitler. Classic doublespeak. Beginning with the words "Now I'm not saying..." allows him to place an outlandish claim in the viewer's mind while simultaneously pretending that he never actually meant it that way. Even Glenn Beck gets it.

Humans have evolved a variety of mechanisms for making quick decisions without having to resort to time-consuming rational thought. It makes sense - if a lion jumps out of the bush, you don't want to have to calculate the time it takes him to reach you versus the time it takes you to climb back up the tree, before deciding between fight or flight.

Similarly, in politics, most people evaluate candidates and issues through mental shortcuts. One of these shortcuts is party identification: you attach yourself to one party early in life, and subsequently filter out information that doesn't align to that party's positions.

Another shortcut is what I call the "laugh test." As we go through life, we develop a sense for the range of what is "normal," based on the experiences we collect and the stories we hear from authority figures and peers. When pols make claims about themselves or opponents, this gut feel helps us evaluate those claims as being true, merely possible, or completely outlandish.

So for example, when a TV host asserts that the President of the United States is plotting to turn a community service organization into a 21st century Nazi SS, such a claim falls outside the range of most people's ordinary experience; it does not pass the "laugh test," and we can quickly dismiss it as rubbish and move on with our lives.

Glenn Beck has 3 million viewers and growing. The Republican Party's most prominent leader, Sarah Palin, says he's doing "an extraordinary job." What does it say about people whose "laugh test" is so distorted that they could accept the possibility that the President is building a personal Nazi army? When those mental shortcuts are the same ones being used to inform these people's choices on a whole range of decisions, what does that say about the health of our democracy?

Jack Bauer vs. Chuck Norris – we finally have an answer

It’s the age old question. Since the dawn of time, Man has yearned to know, who would win in a fight—Jack Bauer or Chuck Norris?

But the wait is over. Now we know. Check it out:

That’s right—that’s Chuck Norris shaking in his boots, terrified that a skinny guy with big ears and a funny name is coming to take his guns away. He's so scared, he's helping the NRA recruit new members.

Why does Chuck Norris care? Normal people need guns to defend themselves, but Chuck Norris should be able to kill any man unarmed.

For someone who’s kicked THAT much ass to be THAT scared about losing his guns, there’s only one conclusion: he’s gone soft. No longer confident in his ability to roundhouse kick his way through any opponent’s face, he’s scared that he’s about to lose his last defense. Even more telling is his admission that someone COULD take his gun away. NO ONE could take the old Chuck Norris’s gun without getting killed. AND, he's turning to the NRA to defend him. Old Chuck needed protection from no one.

He’s a sitting duck for Jack Bauer.

Sure, Jack likes his guns too, and has killed plenty of people with them. Sometimes he’s even reloaded. But he can still break your neck with his knees, jab you with a pen, or just use his teeth. For Jack Bauer, guns are a convenience.

Chuck’s had a good run, but, considering that gun control is the LAST thing on President Obama’s mind with everything on his plate, and considering that the President has never proposed a federal ban on guns, I’m starting to think Chuck Norris is afraid of phantoms.

In conclusion, I’ll leave you with this montage:

Thursday, August 27, 2009

Oil turns 150

150 years ago today, the modern oil industry was born when Edwin “Colonel” Drake drilled the world’s first successful oil well in Titusville, Pennsylvania. It’s the classic “people told me I couldn’t do it” story of entrepreneurship. The locals dubbed his well “Drake’s folly,” and gathered around to jeer his persistence. The bank ordered him to stop drilling. But before the bank’s letter reached Drake, on August 27, 1859 his bit struck oil, which began bubbling out of the ground the next day, launching a new hydrocarbon era.

It goes without saying that the industry has come a long way since Drake’s primitive wooden rig, thanks to a steady stream of scientific innovations. Four of the top five biggest companies in the world, and seven of the top ten, are oil companies, bringing in over $2 trillion in revenue each year. Colonel Drake’s drill reached a depth of 70 feet. Today, massive rigs drill thousands of feet beneath the sea floor.

But unlike the dauntless Colonel Drake, today’s oil industry is a culture of “can’t,” spending millions of dollars to fight bills that will spur innovation in new energy technologies by fearless 21st century Colonel Drakes. We “can’t” stop global warming. Clean energy is “too hard” to invent, and “a long way off.” We’re “dependent” on coal and oil for our way of life.

Of course, to make any of these statements true, you have to tack the word “today” to the end. Coal and oil provide most of our energy and jobs… today. Clean energy is too expensive… today. But not in the future, if we act now.

Sure, if you raise the price of coal some miners will lose their jobs, but they’ll soon move to new jobs working in a windmill or solar panel factory. And sure, if you require people to buy renewable energy the price will rise today, but as government supports accelerate the industry’s growth, economies of scale will soon bring costs down.

Today’s business and political leaders are suffering from a myopia of the now. “Can’t,” “too hard,” and “dependent” are three words that have no part in any businessman’s or politician’s vocabulary. For that matter, they’re words that shouldn’t belong in the vocabulary of any American. Simply put, skeptics and defenders of the status quo make terrible businessmen. If oil executives continue to ignore the signs of peak oil and avoid investments in new energy, they will doom their businesses in the long run.

Colonel Drake reminds me of another story of farsighted perseverance in the face of skepticism: Noah’s ark in the Bible. Living in the middle of the desert, there seemed to be no reason to fear an impending flood. The locals thought he was crazy for building a boat in the desert. “You’re an alarmist!” they jeered. “Building a boat would be expensive! Goat herders will lose jobs!” But Noah had listened to the warnings and trusted the Expert, and so while he continued to prepare for the far off disaster, the skeptics stood around and mocked him, and went about their business as usual.

And when the floods came, we all know what happened to the skeptics. I can only hope that today’s skeptics and defeatists don’t stop the rest of us, and our own Colonel Drakes, from building our own ark - so when the sea levels rise, it’s only the skeptics who are washed away.

Wednesday, August 26, 2009

If you give a birther a birth certificate…

Yesterday was the 400th anniversary Galileo’s demonstration of his telescope to Venetian merchants. Originally built to help sailors spot distant objects at sea, Galileo soon turned his telescope to the stars, and sent shockwaves through Italy and the Church. His discovery that the sun, moon, and planets operated according to the same natural laws as objects on Earth, upended Church dogma and ushered in the era of modern science. From this point on, Man would no longer rely on gut feeling and superstition to understand the natural world.


400 years after Galileo supposedly swept away unquestioning dogma in favor of science, here are some sobering statistics, estimating various groups’ views on the most important question of our time, “Do you think human activity is a significant contributing factor in changing mean global temperatures?”

82% of all scientists agree.
88% of scientists who actively research and publish scientific articles agree.
97% of climate specialists agree.

But as for the general public, only 58% agrees.

It’s scary enough that ordinary citizens can disregard scientific consensus so blithely, but here’s an even more incredible statistic, courtesy of Joe Romm at ClimateProgress:

In 1997 some 42% [of Republicans] said warming had begun and 48% said most scientists believe warming is occurring — a modest 6 point differential. By 2008, the percentage of Republicans saying the effects of global warming have already begun had dropped to a mere 42% (an amazing stat in its own right given the painfully obvious evidence to the contrary). But the percentage saying most scientists believe global warming is occurring had risen to 54% — a stunning 12 point differential.

What this means, as Joe Romm points out, more and more Republicans are willing to reject truths about the natural world which they nonetheless understand that most scientists believe; they consciously understand what the science says, but choose to disregard it. Sure, it’s a well-known human tendency—whether liberal or conservative—to selectively reject evidence that does not confirm one’s own worldviews, but you would think such confirmation bias would not apply to objectively knowable scientific truths. When you reject the word of scientists in favor of demagogues like Rush Limbaugh and Glenn Beck, that’s a pretty good sign that you’ve given up rational thought altogether in favor of blind allegiance to ideology. Actually, I think delusion is a better word.

The American Right is full of such delusional movements, of which global warming denial is but one. Take the birthers—whose ranks may include over half of all Republicans—who believe President Obama was born outside the US. These folks will cling to their paranoid fantasies no matter how many times you show them undeniable evidence to the contrary. They continue to demand that President Obama show his birth certificate, despite the fact that he has already done so. Repeatedly. If you show a birther a birth certificate, he’s going to ask for another one. And if you give a skeptic the evidence for global warming, he’s going to respond, “there is no evidence!”

The public is similarly confused over biology. More than half of Americans believe in Creationism than evolution, but that’s less disturbing to me than the fact that more than half of Americans also claim to accept the theory of evolution. 53% believe that “human beings developed over millions of years from less advanced forms of life,” but fully 66% believe that “God created human beings pretty much in their present form at one time within the last 10,000 years.” The statements’ wording could not be any more unambiguous wording, yet 21% of Americans believe both!

Neither is the health care debate immune from paranoid delusions. Despite repeated debunkings by the mainstream media, the President, Republicans, and the fact that such claims do not pass the “laugh test,” a majority of Americans still cling to demonstrably false beliefs about health care reform. The conservative Wall Street Journal admits:

A majority of Americans (55%) believe the bill will extend health insurance coverage to illegal immigrants even though no proposals currently under negotiation would do so. An equally high number (54%) believe the overhaul will lead to a “complete” government takeover of the health care system, although there is also no actual proposal for that, either.

And nearly as many Americans falsely believe the health care bill contains “death panels” (45%) as those who know otherwise (50%).

These stats are scary. When a majority of citizens hold objectively false beliefs about major issues, the ability of a democracy to function in the interests of its citizens is seriously undermined, a reality which the Founding Fathers knew only too well. That's why they created a representative democracy, to hopefully (maybe too hopefully) act as guardians of the public trust against the masses' tendency toward base passion and disinformation.

We still have hope in Obama. But Rush Limbaugh and friends are a real threat, not only democracy, but to the entire legacy of reason over ideology left to us by Galileo—and to the very ability of Man to progress as a species.

Friday, August 21, 2009

The Onion Reports the Truth on Health Care

Sometimes The Onion just gets it so right. The banner headline of this week’s print edition reads, “Congress Deadlocked Over How To Not Provide Health Care.” Here are some excerpts (my comments in brackets):

Democrats want to create a government-run system for not providing health care, while Republicans say coverage is best denied by allowing private insurers to make it unaffordable for as many citizens as possible.

“We have over 40 million people without insurance in this country today, and that is unacceptable,” Sen. Orrin Hatch (R-UT) said. “If we would just quit squabbling so much, we could get that number up to 50 or even 100 million. Why, there's no reason we can't work together to deny health care to everyone but the richest 1 percent of the population.”

“That's what America is all about,” he added.

[An unfortunately accurate description of the Republican-supported status quo. Since 2001, premiums have risen roughly four times faster than wages, meaning that as premiums gobble up a rising share of workers’ pay, more Americans who currently have health insurance will lose it. The number of uninsured Americans is expected to rise to 54 million as soon as 2013. Without health care reform NOW, we’ll be well on our way to the Republicans’ (fake) goal of 100 million!]

House Minority Leader John Boehner (R-OH) said on Meet The Press that Republicans would never agree to a plan that doesn't allow citizens the choice to be denied medical care in the private sector.

“Americans don't need some government official telling them they don't have the proper coverage to receive treatment,” Boehner said. “What they need is massive insurance companies to become even more rich and powerful by withholding from average citizens the care they so desperately require.
We're talking about people's health and the obscene profits associated with that, after all.”

[Actually, this is a real, standard industry practice, called “rescission.” You may think your insurance premiums guarantee you’ll be covered if you get catastrophically ill, but insurance companies regularly revoke their customers’ coverage once they get sick and actually need it—this has happened 20,000 times over the past 5 years (at least one company evaluates its employees on savings from rescinded policies). Here’s how it works. When you get a diagnosis that will require expensive treatment, it triggers a process by which your insurance company scours your medical records, using so- called “denial engine” software, to see if you forgot to report any illness on your initial health status questionnaire; if there’s been even one mistake, no matter how small, they revoke coverage from you and your entire family (of course, without refunding all those premiums you paid). You can have your coverage rescinded for something as simple as shortness of breath. Health care rationing indeed.]

Though there remain irreconcilable points, both parties have reached some common ground in recent weeks. Senate leaders Harry Reid (D-NV) and Mitch McConnell
(R-KY) point to Congress' failure to pass legislation before a July 31 deadline as proof of just how serious lawmakers are about stringing along the American people and never actually reforming the health care industry in any meaningful way.

“People should know that every day we are working without their best interests in mind,” Reid said. “But the goal here is not to push through some watered-down bill that only denies health care to a few Americans here and a few Americans there. The goal is to recognize that all Americans have a God-given right to proper medical attention and then make sure there's no chance in hell that ever happens.”

And I thought The Onion only printed fake news!

Thursday, August 20, 2009

Are Sarah Palin and Martin Feldstein closet universal health care supporters?

Why opposing health care "rationing" makes you a socialist

When I took Prof. Marty Feldstein’s intro economics course at Harvard, he was fond of defending inequality with the parable, “If a rich man and a poor man came before me, and I gave one dollar to the rich man but nothing to the poor man, the poor man has nothing to be angry about. He is no worse off for the rich man having the dollar—indeed, he is in the same circumstance as before.” The implication is clear—if one person receives something but another doesn’t, there’s nothing wrong with that, since no one is made worse off.

So Prof. Feldstein’s op-ed in yesterday’s WSJ, in which he ominously warns that “the Obama strategy is to reduce health costs by rationing the services that we and future generations of patients will receive,” is more than a bit disingenuous. Because if he believes that a decision not to fund a treatment constitutes “rationing,” then he’s implicitly acknowledging that health care is a universal, fundamental right that government must provide. In fact, if you think health care “rationing” is a bad thing, you MUST support not only government-funded healthcare, but UNLIMITED government-funded health care—which makes you more of a socialist than President Obama!

I’ll explain.

Start with Prof. Feldstein’s basic argument: if the government funds health care, it will inevitably have to decide which treatments to pay for and which treatments not to, so as not to go bankrupt—thus “rationing” health care. This is no different from the more outlandish assertions by other Republican shysters, who demagogue about bureaucratic “death panels” (Sarah Palin) and “pulling the plug on Grandma” (Sen. Chuck Grassley); it’s just less fiery.

Of course, all these arguments about “rationing” are transparently ridiculous. (And I’m not even talking about the fact that private health insurance companies already make bureaucratic decisions about what to treat and what not to; I’m interested in the logical/philosophical aspects of the debate.) You’d think a Harvard professor would know better.

Think about it this way. If you come to me asking for two dollars and I give you only one, no sensible person would call that “rationing”—I am under no obligation to give you anything, so you should just be happy with the one dollar I did give you. By the same token, if the government decides not to pay for a treatment, that’s not “rationing,” but rather a choice not to provide something it was never obligated to provide; the decision leaves you no worse off than you would have been if no public health care option existed.

Unless, that is, health care is a fundamental right.

The logic is pretty simple. Definitionally, “rationing” is when government PREVENTS you from getting something you could have otherwise obtained, or WITHHOLDS something which it is obligated to provide. Let’s start with the first possibility. If publicly-funded insurance prevented you from obtaining health care, it would mean that all Americans were prohibited both from buying insurance on the private market AND from using their own funds to pay for treatments not covered by the government. Unsurprisingly, Feldstein tries to prove this is President Obama’s goal, claiming:

The White House Council of Economic Advisers issued a report in June explaining the Obama administration's goal of reducing projected health spending by 30% over the next two decades. That reduction would be achieved by eliminating “high cost, low-value treatments,” by “implementing a set of performance measures that all providers would adopt,” and by “directly targeting individual providers . . . (and other) high-end outliers.

Feldstein makes it sound like President Obama would go above and beyond limiting what government pays for, and would actually outlaw the provision of “high cost, low-value treatments.” Sounds pretty scary, right? Except that it’s a complete distortion of the actual report, the result of cobbling together out-of-context quotes from pages 13, 19, and 18 (respectively) to change the meaning of the report.

For example, while the original report’s recommendation is to “facilitate the development of a set of performance measures that all providers would adopt and report,” Prof. Feldstein misquotes the report to say that the state will “implement a set of performance measures.” It’s a subtle change that makes a big difference. The first merely describes a role for government in developing a set of standards for evaluating the quality of treatment patients receive. Sounds reasonable—don’t you wish you had some way of comparing doctors’ quality before choosing one? But Feldstein’s misquote makes it sound a whole lot scarier, like it’s a bureaucratic mandate.

Similarly, “targeting individual providers… and outliers” does not refer to targeting treatments for elimination, as Feldstein implies, but rather targeting exceptionally high-cost geographic regions to reform payment methods, so that providers would be paid for quality of care and not quantity of procedures.

Clearly, fears that President Obama plans to limit what you can freely pay for out of pocket are 100% made up; indeed, no reform proposal on the table would do this. So with the possibility for health care prohibition debunked, accusing President Obama of “rationing” care implies that government is withholding something it has to give you, which would require that you acknowledge health care as an inalienable right.

But wait, it’s not just government’s withholding of treatment that’s bad—it’s the very fact of government (not doctors) making the decision about treatment. Right? Well, that’s not quite accurate. With a public option, the decision is not over which treatments you are legally allowed to receive, but which treatments the government will give you money to pay for. For someone who can’t afford health insurance, “no treatment” is the status quo without the public option. By providing some funding where none would have been otherwise, the public option can only EXPAND choice, and it’s a lie to say otherwise.

To illustrate the point, let’s try to imagine a scenario involving one of Sarah Palin’s “death panels.”

Grandma Betsy is sick. In fact, she’s on her last leg, and is only kept alive by expensive machines—with the government footing the bill. But even the pricey life support can only delay death another two months at most, and after a while, a faceless bureaucrat notices something amiss: a grandma in small-town America is racking up enormous medical bills, despite her no longer being a productive member of Obama’s socialist paradise. A quick calculation that her remaining months’ value to society does not justify the cost of keeping her alive, and the local Death Squad is off to pull the plug on poor Grandma. Payments are ceased, and Grandma can no longer afford treatment, so the treatment stops.

Sounds scary, right? Until you realize, that’s the situation Grandma Betsy would have been in WITHOUT government-supported health care (e.g. Medicare). If she was poor, she wouldn’t have been able to afford expensive end of life treatments in the first place. And if she had private insurance, you better BELIEVE the insurance company would fight tooth and nail to pull the plug (with coma victims, for example, private insurance companies like to get the worst diagnosis—persistent vegetative state—since it allows them to cease paying for care).

So if, as Sarah Palin implies, not paying for Grandma’s treatment makes you a “death panel,” then clearly Palin believes SOMEONE must pay to keep Grandma breathing—and for whatever treatment she wants, regardless of cost. And that someone, it turns out, is the government. Palin’s infamous tirade against universal health care actually begins with the criticism that “government will simply refuse to pay the cost.” In other words, the reason we should not have government pay for health care is… that if we had government pay for health care… government would not pay for health care………. what? We even have Republican leadership accusing President Obama of wanting to reduce Medicare payments. So Republicans now favor greater entitlement spending than Democrats??? What is going on here?

No, seriously. How can government have an obligation to continue funding health care for an old person on death's door, but not for a kid whose parents are too poor to afford doctors visits, or for a construction worker who can’t afford insurance to pay for his heart surgery, or for a 12-year old whose mom couldn’t afford an $80 dental checkup for a tooth abscess and died of a resulting brain infection?

Evidently, influential critics of health care reform aren’t actually concerned over “rationing.” If they were, they would be obliged to support the President in providing choice to those currently rationed out of the health care system by their inability to pay—or to offer a competing plan to provide for the sick. Rather, it’s their ideological opposition to the very idea that there is a right to health care standing in the way. In which case they should just say it—admit that they believe that it’s okay for society to let its sick die in the streets. And eliminate Medicare while they’re at it.

Because while there are better and worse ways to implement universal health care, there is no philosophical middle ground—either you believe that society has an obligation to care for its sick regardless of ability to pay, or you believe that decent society can leave its sick to die in the streets. Take your pick.

There is another possibility. I imagine that few elected officials, Republican or Democrat, actually believe that a decent society can leave its destitute to die in the street. In which case, obstruction by elected officials represents a willingness to sacrifice not only their own moral views, but also the lives of people who will die because they lack health care, for short-term political gain.

I think I know which is more likely the case. I’m just not sure which one is worse.


WSJ inadvertently supports case for health care reform: do you want to trust your health to profit and loss?

There's no money in selling insurance to sick people: more reasons free markets don't work in health care

The Takeover: What opponents of health care reform don't get

The Catch-22 for opponents of health care reform: more health care economics