Sunday, September 13, 2009

The politics of misinformation

I read this from The Economist about the health care debate, got real mad, decided to try to deconstruct just what this windbag conservative writer, Robert Guest, was trying to say in his latest Lexington column (my notes in red):

The politics of death

THE first patient Dr Sherwin Nuland ever treated died horribly in front of him. James McCarty, a 52-year-old construction boss, had eaten too much red meat, smoked too many Camels and suffered a heart attack (i.e., a typical spoiled welfare mooch--here is where your tax dollars could go under a "socialistic" health care plan). Dr Nuland, then but a student, was asked to keep an eye on him while he recuperated. Suddenly, McCarty threw his head back, bellowed out a wordless roar and hit his own chest with balled fists. His face turned purple, his eyes bulged out of his head, he took “an immensely long gurgling breath”—and he died. Since this was half a century ago, Dr Nuland did what the textbooks then recommended. He cut open his patient’s chest and tried, unsuccessfully, to massage his heart back to life with his bare hands. It felt like “a wet, jellylike bag of hyperactive worms”. And it did no good. The “dead McCarty… threw back his head once more [and gave] a dreadful rasping whoop that sounded like the hounds of hell were barking.”...

The current debate about health-care reform is in part a debate about death, which is why it evokes such fear. Some of this fear is absurd. Outside a town-hall meeting in Reston, Virginia, last week, a few buffoons likened Barack Obama to Hitler. But most of the protesters are sane. (Compared to what? Obviously Guest is out of touch with the demographics of these protesters). Mr Obama plans to cover millions of uninsured people, says Brittany Tomaino, a young would-be oncologist. He will have to find the money somewhere. That means cuts to Medicare, the government health plan for the elderly, which covers her 95-year-old grandfather, she reckons. “If he needs care, they’re going to give it to someone younger,” she predicts. (Which of course is a false prediction, but let's not get hung up on actual facts here.)

A slim majority of Americans support Obamacare (Since Obama did not author the health care bill being passed around, members of the Senate did, the term "Obamacare" is a misnomer. As such, it could also be seen as synonymous with "Unicorn" since both entities do not exist. Or it could, alternatively, be called "Senatorssleepingwithlobbyistscare. But for the sake of succinctness, I am going to replace all references to "Obamacare" with "Unicorns.") But that majority is declining, and the passion is mostly on the other side. Pro-lifers, for example, worry that reform will mean taxpayer-funded abortions. Half of all Americans believe this will happen. Democrats point out that the bills in question do not mention abortion. Pro-lifers respond that the language is vague enough to allow bureaucrats (who are so much worse than the operatives of the Medical Industrial Complex that always look after their customers' best interests) to add abortion funding after the bill is passed. (Hey, here's a fun game: Let's just keep throwing around unfounded misconceptions about the Senate plan and imply that there's merit to sinister conspiracy theories!) They also fret, like Ms Tomaino, that Mr Obama will deny life-saving treatment to Grandpa to save money. This possibility alarms Grandpa, too. Americans over 65 currently receive, through Medicare, fantastically generous health insurance for which they pay only a small fraction of the cost. Only 23% of them think Unicorns will make them better off, while a growing plurality think it will hurt them.

Health reformers always smash up against two unpalatable truths. We are all going to die. And the demand for interventions that might postpone that day far outstrips the supply. (That's an interesting theory--but what has yet to be measured is the impact of preventative care against current medical practices that are only equipped for expensive, last-minute emergency treatments and how preventative care could drive down the need for "death day interventions"). No politician would be caught dead admitting this, of course: most promise that all will receive whatever is medically necessary. But what does that mean? Should doctors seek to save the largest number of lives, or the largest number of years of life? Even in America, resources are finite. (huh, last time I checked, the health care industry is booming in the midst of the most devastating economic downturn in American history, with executives making salaries that would make Goldman Sachs shysters envious). No one doubts that $1,000 to save the life of a child is money well spent. But what about $1m to prolong a terminally ill patient’s painful life by a week? Also, who should pay? (OMG revelation! I see the Hitler connection! This is just like eugenics all over again! Bureaucrats are gonna decide which categories of patients to save by means of unfair, fascist public policy! Eureka!)...

Mr Obama’s supporters say that objections to his reforms are largely based on misunderstanding, fuelled by Republican scaremongering. They have a point. But the Democrats’ bigger problem is that most Americans have pretty good health insurance and no idea how much it costs. Taxpayers foot the bill for the old. Most workers with employer-provided health insurance imagine that their employer is paying for it, when in fact it comes out of their wages. Soaring medical inflation depresses Americans’ standard of living and threatens to bust the budget. The system is riddled with waste. Yet most Americans feel little urge to make it more efficient. When asked if insurance firms should be obliged to pay for expensive treatments that have not been proved more effective than a cheaper alternative, 56% say yes.

Few Americans have a clear idea how Unicorns will affect them—unsurprisingly, since even quite basic details are undecided. The uninsured have the most to gain, but they are only 15% of the population. Everyone else has something to lose. (Outright L.I.E.) Many Americans do not trust the government to do anything much, let alone make decisions about life and death. Small wonder Mr Obama finds the headwind against health reform so blustery.

Actually, I think that at this point a more accurate statement would be that MANY Americans do not trust insurance companies that cut their benefits and life-saving treatments to make a profit and allow their loved ones to die without dignity. But what do I know, I'll never write for The Economist.

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