Month: August 2009

Chuck Lane offers some calm thoughts on Medicare and living wills and the extraordinary costs of end-of-life care. What's new in the current proposals in the Congress is encouraging doctors to talk with elderly patients about drawing up powers of attorney and the like to govern end-of-life medical decisions. As long as there is no coercion involved and this is a totally voluntary process – with time for a patient to decide to forgo such measures if he or she wishes – I find this a sensible measure to tackle the huge percentage of medical costs that occur to extend life for a few days. This isn't a death panel, as Chuck concedes. But I disagree with him on whether this measure goes too far – simply because the fiscal crisis is so grave.

Technology – wonderful, amazing technology that has saved my life – is one root cause of the cost escalation. But it can do things no one would have have dreamed of when Medicare was first set up. We should be very, very, very careful to avoid any infringement on everyone's right to determine their own end-of-life treatment in advance. But a nudge from the government to get you to consider your options seems perfectly responsible to me.

Again: my starting point is that the status quo will bankrupt us all – private industry and public finances. I'd rather not do this at all. But we have to make decisions at some point to live within our high-tech means.

A reader writes:

Your obvious shock and dismay at the sheer angry ignorance of the health care teabaggers reiterates my largest problem with your rosy immigrant’s view of America. You have often underestimated just how poisonously dangerous the American populist right is.

I don’t blame you. You came to America after the rise of Reagan. Most of your life in America, you have lived under different Republican presidents who placated these folks with platitudes and campaign rhetoric. The one period when the populist right didn’t feel they had a fellow traveler in charge was when Bill Clinton was elected (thanks to the reactionaries splitting their votes). You remember, no doubt, the level of crazy Clinton had to defuse and dodge, and this was a man who had the advantage of being a Southern bubba who has dealt which such people all his life.

For most of your time in America, this insanity has been muted by the success of conservative politics. Since you live in Washington, you probably saw daily the face of the successful conservative political establishment that milked the populist right, and by milking them kept their bitterness at a manageable level. That safety valve was stuffed up by George Bush’s failed presidency.

So now, these people are facing their worst fears; actual change.

A political and demographic re-alignment is happening before their eyes, and they are reaching back into their old bag of tricks of intimidation, violence, and apocalyptic fearmongering. You are British, Andrew. You love this country, and we love you for it. But you didn’t grow up around these folks, and you don’t realize what a permanent and potent part of the American political landscape they are.

They have always been with us, the people who believed in manifest destiny, who delighted in the slaughter of this land’s original inhabitants, who cheered a nation into a civil war to support an economic system of slavery that didn’t even benefit them. They are the people who bashed the unions and cheered on the anti-sedition laws, who joined the Pinkertons and the No Nothing Party, who beat up Catholic immigrants and occasionally torched the black part of town. They rode through the Southern pine forests at night, they banned non-European immigration, they burned John Rockefeller Jr. in effigy for proposing the Grand Tetons National Park.

These are the folks who drove Teddy Roosevelt out of the Republican Party and called his cousin Franklin a communist, shut their town’s borders to the Okies and played the protectionist card right up til Pearl Harbor, when they suddenly had a new foreign enemy to hate. They are with us, the John Birchers, the anti-flouride and black helicopter nuts, the squirrly commie-hating hysterics who always loved the loyalty oath, the forced confession, the auto-de-fe. Those who await with baited breath the race war, the nuclear holocaust, the cultural jihad, the second coming, they make up much more of America then you would care to think.

I’m always optimistic about America. We’re a naturally rich and beautiful place. Every generation we renew ourselves with a watering of immigrants committed to the American dream, immigrants like you. But please, Andrew, do not for a second underestimate the price in blood and tears we’ve always paid here for progress.

I voted for Obama with my fingers crossed, because I knew that as the populist right lost power, they would become more extreme, more concentrated, and more violent. As to dismissing them as only a quarter or so of America, please remember that it only took a quarter or so of Americans to actively support the Confederacy.

(Photo: Sarah Palin supporters at a campaign rally last autumn, by Jewel Samad/AFP/Getty.)

Between yesterday’s two lead stories – the killing of Pakistan’s Taliban leader and the report showing decreased unemployment in July – it was a great day for the administration. But Ackerman dials down the former:

[I]nsurgent groups tend to organize themselves precisely for survivability in the event of decapitation. In Iraq, the U.S. killed and detained a lot of al-Qaeda in Iraq leaders, including Abu Musab al-Zarqawi himself, but only when the Sunni Iraqi population decisively turned against AQI did the terrorist network find itself, for all strategic purposes, defeated. I’m not saying that what happened in Iraq is guaranteed to repeat itself in Pakistan. But the New York Times reports that already Mehsud’s deputies are meeting to see who replaces him and where the movement goes next. This is an opportunity that the Pakistani military and its government can seize or can miss. And like Abu Muqawama, my sense is that the Pakistanis are primed to miss it.

And Daniel Indiviglio dials down the latter:

As a recession drags on for this long, and people are unable to find jobs, they begin leaving the workforce. They become discouraged regarding job prospects. BLS offers an unemployment rate that includes these discouraged workers. In June 2009, that was 10.1%. For July, it was 10.2%. Given this change in unemployment including discouraged workers, I think it’s pretty clear that the 0.1% decrease in the reported unemployment rate can be misleading. In reality, those who would like a job but don’t have one increased by 0.1% up to 10.2%.

That does seem to be the general sentiment among the National Review demographic. A reader reports another irony:

They are trying to save the country from the care they receive, I guess. But isn't Medicare popular?

“I don’t like to hear cut and dried sermons. No—when I hear a man preach, I like to see him act as if he were fighting bees!” – Abraham Lincoln.

If you haven't read Hitch's wonderful review of Michael Burlingame's new biography of Lincoln, do yourself a favor.

Zagreb, Croatia, 4 pm

A reader writes:

Maybe about two years ago, I was visiting my girlfriend in another part of the state. Our time together those days was precious since we lived hours away from each other, so it wasn't uncommon for us to be up late at night into the early morning hours. At about 2 a.m. one particular night, she begun to feel these horrible, stinging pains in her lower abdomen. At first we thought – hoped – it was pronounced indigestion or even food poisoning and nothing serious, like appendicitis. She took some painkillers, but the pain persisted for about an hour, to the point where it was so intense that she was vomiting. I said, "The hell with it, we're going to the emergency room."

It didn't take long for the ER to check her in, which was a relief. Once she was admitted, they ran the usual gamut of tests: blood, pregnancy, etc. A doctor came to see her a couple times before he decided she should get some kind of scan, I believe an MRI, but I can't really remember. Anyway, cutting to the chase, it turned out a cyst on one of her ovaries had burst. It was nothing unusual, and the doctor prescribed some stronger painkillers while referring her to a local gyencologist. We were out of there by 10 a.m. and we were beyond relieved: No surgery, no extended time in the hospital. The real trouble would come a few weeks later, when my girlfriend got her bill: $10,000.

At the time my girlfriend was attending college full time and was working part-time at a retail chain store that didn't offer any health coverage to part-timers. The college offered some coverage, which she had, but it only covered about $800 of the total cost for the visit, tests, etc.. She couldn't afford private insurance, and she was too old to be on her parents' policies. So she had a choice: Borrow the money somehow, probably through a bank since nobody in her family had that kind of money lying around, or apply for charity care through the state of New Jersey, which was a no-brainer. Eventually, she was approved for the charity care, which paid the whole bill. So taxpayers were left shouldering the costs anyway.

If only my girlfriend's employer had to provide coverage. If only that coverage were subsidized and available through an insurance exchange that included a public plan. If only there were better cost controls. If only people in much worse financial and health situations than my girlfriend's had access to these things, too. If only.

Chris Good talks to FreedomWorks about the ominous and violent atmosphere at town hall meetings on health insurance reform.