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Bloggingheads 02-26-2009 01:12 PM

Brushes with Greatness
 

Joel_Cairo 02-26-2009 02:35 PM

Re: Brushes with Greatness
 
http://i246.photobucket.com/albums/g...cairo/kaus.jpg
http://bloggingheads.tv/diavlogs/179...1:39&out=01:52

bjkeefe 02-26-2009 03:02 PM

"And What Do You Think Of, Bob?"
 
Fine, but why did your voice go up three octaves?

bjkeefe 02-26-2009 03:06 PM

Another Question
 
Just how old is Mickey, anyway?

claymisher 02-26-2009 03:10 PM

Re: "And What Do You Think Of, Bob?"
 
Quote:

Originally Posted by bjkeefe (Post 104968)

'cos that's what soul singers do.

Rich 02-26-2009 03:26 PM

The Joys of Rationed Healthcare
 
So, Bob admits - rightly - that excellent, expensive, high-tech healthcare is going to have to either be rationed or otherwise severely limited. Why oh why would anyone or any company make some high-tech super-duper cure-all machine when it knows from the outset that it will never recoup its costs? This is the flaw of universal coverage. I applaud Bob's admission of that fact, but it doesn't precisely fill me with confidence in the forthcoming control over my health by HHS.

AemJeff 02-26-2009 03:33 PM

Re: The Joys of Rationed Healthcare
 
Quote:

Originally Posted by Rich (Post 104972)
...Why oh why would anyone or any company make some high-tech super-duper cure-all machine when it knows from the outset that it will never recoup its costs? This is the flaw of universal coverage. ...

This is an assertion begging for support. It's refuted by the facts in plenty of countries with universal health care. Health care is always rationed somehow, btw - regardless of the economic model used to support its funding. Maybe rationing based on accidents of circumstance isn't the best model.

bjkeefe 02-26-2009 03:34 PM

Re: "And What Do You Think Of, Bob?"
 
Quote:

Originally Posted by claymisher (Post 104970)
'cos that's what soul singers do.

Awesome answer.

Rich 02-26-2009 03:38 PM

Re: The Joys of Rationed Healthcare
 
Isn't the least unfair method of rationing the use of the market? In other words, if we rely on government to decide who benefits - i.e. rationing - there's nothing but the potential for abuse. Preventing people who can afford high-end healthcare from getting it in order to be fair to those who cannot doesn't actually help anyone.

Francoamerican 02-26-2009 03:54 PM

Re: The Joys of Rationed Healthcare
 
Every western European country has better health care than the United States. People live longer and they generally enjoy better health throughout their lives in Europe---while paying considerably less for their doctors and medicines. The World Health Organisation rates the health care systems of every country in Western Europe as superior to that of the United States. "Socialized" medicine clearly has its advantages...

"Superduper" treatments and machines are wonderful at prolonging life when life is hardly worth living. Perhaps Americans should think less about having a well-engineered death and more about living well.

claymisher 02-26-2009 04:03 PM

Re: The Joys of Rationed Healthcare
 
Quote:

Originally Posted by Rich (Post 104976)
Isn't the least unfair method of rationing the use of the market? In other words, if we rely on government to decide who benefits - i.e. rationing - there's nothing but the potential for abuse. Preventing people who can afford high-end healthcare from getting it in order to be fair to those who cannot doesn't actually help anyone.

That's not the way it works. Every country except Canada still has private medicine. You can spend as much as you want. No one will stop you.

There's also still a free market for medical technology. If you can deliver a cheaper MRI machine, or a machine better than an MRI, hospitals will buy it. Same with gloves, computers, gurneys, etc.

There are hundreds of reason why the analytic tools you learn in econ 101 don't apply to health care. That's more of a problem for econ 101 than anything else.

Rich 02-26-2009 04:05 PM

Re: The Joys of Rationed Healthcare
 
Quote:

Originally Posted by Francoamerican (Post 104977)
Perhaps Americans should think less about having a well-engineered death and more about living well.

I'm certain that Americans are welcome to start thinking just that way. Ought they be forced to think that way by their government? I'm not sure that's a future that is all that bright, really.

Rich 02-26-2009 04:07 PM

Re: The Joys of Rationed Healthcare
 
Quote:

Originally Posted by claymisher (Post 104978)
Every country except Canada still has private medicine. You can spend as much as you want. No one will stop you.

Well, in that case, why worry? We probably won't end up like Canada.

AemJeff 02-26-2009 04:14 PM

Re: The Joys of Rationed Healthcare
 
Quote:

Originally Posted by Rich (Post 104976)
Isn't the least unfair method of rationing the use of the market? In other words, if we rely on government to decide who benefits - i.e. rationing - there's nothing but the potential for abuse.

No, of course not. the least unfair system would be triage, prioritizing by need and then applying applying a cost/benefit analysis. (e.g. If two people need heart surgery, pick the one not in late stage cancer first. [Obviously this is a cartoon just to illustrate the logic; extreme circumstances like this are already decided pretty rationally.]) There would be ugly consequences of such a system, but there are ugly consequences of the present system.

Quote:

Originally Posted by Rich (Post 104976)
Preventing people who can afford high-end healthcare from getting it in order to be fair to those who cannot doesn't actually help anyone.

That's ridiculous on its face, unless somehow you think that curing a poorer person doesn't constitute a benefit to that person. I'm sure you don't believe that.

Happy Hominid 02-26-2009 04:15 PM

Re: Brushes with Greatness
 
Mickey - the reason that Obama, unlike Bernanke, didn't give us some glimmer of hope that the recession could be over by the end of the year - is that the recession won't be over by the end of the year. You want to make money? Go bet on the tip I just gave you.

Seriously - is anyone listening to Bernanke anymore? What's next, some old Greenspan quotes?

Happy Hominid 02-26-2009 04:17 PM

Re: Another Question
 
Hey! I GOT the reference!

AemJeff 02-26-2009 04:18 PM

Re: The Joys of Rationed Healthcare
 
Quote:

Originally Posted by Rich (Post 104979)
I'm certain that Americans are welcome to start thinking just that way. Ought they be forced to think that way by their government? I'm not sure that's a future that is all that bright, really.

Rich, you're making it up as you go along. Nobody's being forced think in any specific way. Democracies decide on big policy ideas and then they implement them. Sometimes it's the right thing, sometimes it's not. there's nothing special, in that sense, about healthcare.

themightypuck 02-26-2009 04:20 PM

Re: Brushes with Greatness
 
Listening to Bob talk about the market reacting to this and that drives me nuts. There is an entire industry devoted to this notion that as far as I can tell fares about as well as astrology in actual predictive capacity. As Bob points out later in the diavlog correlation does not equal causation. Other than that quibble it was nice to see Bob and Mickey and I even watched Bob @ TED and was quite impressed although he's got some tough competition from Pinker whose excellent talk about violence is in the on deck circle.

bjkeefe 02-26-2009 04:20 PM

Re: The Joys of Rationed Healthcare
 
Quote:

Originally Posted by Rich (Post 104976)
Isn't the least unfair method of rationing the use of the market? In other words, if we rely on government to decide who benefits - i.e. rationing - there's nothing but the potential for abuse. Preventing people who can afford high-end healthcare from getting it in order to be fair to those who cannot doesn't actually help anyone.

Not to pile on or anything, but it seems to me that the goal of health care reform is to ensure that everyone has access to a minimum level of care, and to the degree that costs hamper pursuit of this goal, you adjust by pushing down what you mean by "minimum level." For example, you might want everyone to be able to get one free checkup per year, and maybe you have to scale it back to one free one every two years for everyone except kids and new mothers. (NB: there is nothing meaningful about this example -- it's just made up to illustrate.)

As far as I know, no serious wonk wants to set up a system where we'd have no doctors in private practice; i.e., if you want to pay for more than the national plan offers you, you'll be able to, up to your own ability to pay. I suspect, also, that there will not necessarily be no private insurers under any plan that has a chance of passing, so you'll continue to be able to opt to pay for your own additional coverage this way, too.

bjkeefe 02-26-2009 04:21 PM

Re: Another Question
 
Quote:

Originally Posted by Happy Hominid (Post 104983)
Hey! I GOT the reference!

Yeah, but you're smart.

bjkeefe 02-26-2009 04:25 PM

Gibbs/Santelli
 
Bob did a pretty good job of giving context to Robert Gibbs' remarks that made Santelli and Liddy go hysterical, but it's probably worth watching the original video if you haven't seen it already. The non-threat is right at the beginning, and as Bob sort of said, it boils down to this: I don't know what Santelli sees out there, but he's not seeing what we're seeing.

The whole thing is worth watching, especially for the zingers at the end.

Not quite CJ Cregg, but pretty good.

bjkeefe 02-26-2009 04:37 PM

Re: Brushes with Greatness
 
Quote:

Originally Posted by themightypuck (Post 104985)
Listening to Bob talk about the market reacting to this and that drives me nuts. There is an entire industry devoted to this notion that as far as I can tell fares about as well as astrology in actual predictive capacity. As Bob points out later in the diavlog correlation does not equal causation.

Second that. Anyone purporting to even explain daily fluctuations in the market irritates me. Bob Garfield did an excellent piece about this, a while back. (Audio and transcript at the same link.)

Quote:

... I even watched Bob @ TED and was quite impressed ...
Second that, too. Anyone who hasn't seen it: don't miss it.

I enjoyed the Pinker talk, too. I'd hate to have to pick one over the other, though.

bjkeefe 02-26-2009 04:57 PM

Re: The Joys of Rationed Healthcare
 
Quote:

Originally Posted by Francoamerican (Post 104977)
"Superduper" treatments and machines are wonderful at prolonging life when life is hardly worth living. Perhaps Americans should think less about having a well-engineered death and more about living well.

I agree with this completely. This is going to be a big battle, though. Part of the way to make a national plan affordable, by my guess anyway, will be to set fairly stringent limits on heroic measures aimed at keeping a near-carcass just barely ticking over. One has only to think about the Terri Schiavo fiasco to realize this. I did draw some comfort when I realized the majority view was "just let her go," but it was also clear that there were plenty of people eager to demagogue this (and probably some sincerely believing she should be kept hooked up to the machines, admittedly) and it was painfully clear that the MSM was happy to report this for way too long as a "balanced" story.

Happy Hominid 02-26-2009 05:20 PM

Re: Another Question
 
No... I remember it because of my age. But thanks.

Happy Hominid 02-26-2009 05:21 PM

Goldie Hawn
 
Not "Smother's Brothers", Bob. "Rowan and Martin's Laugh-In". Unless she made some one-time appearance on SB that I don't recall.

Yes, Brendan, I'm showing it again...

PaulL 02-26-2009 05:25 PM

No one talks of Rationing in Universal heathcare?
 
Bob should talk to Ezra Klein who claims there will be no rationing.
Quote:

As far as I know, no serious wonk wants to set up a system where we'd have no doctors in private practice
You forgot the Clinton Administration's first try at Universal Healthcare where it was illegal to obtain private treatment.

Francoamerican 02-26-2009 05:31 PM

Re: The Joys of Rationed Healthcare
 
There have been similar cases in Europe too. In Italy for example, quite recently, there was a woman who had been in a coma for many years and was allowed to die after long legal batttles, to the great indignation of the Pope and many fellow Catholics. Such cases reveal a bizarre alliance between religion and medical science, which are both committed, though for different reasons, to preserving life at any cost.

I once read, but I have never been able to verify this, that approximately 90% of what most people (i.e. those who live a normal life span) spend on medical costs over their entire lives is spent in the last six months of their lives. In other words, dying is an expensive business.

bjkeefe 02-26-2009 06:13 PM

Re: No one talks of Rationing in Universal heathcare?
 
Quote:

Originally Posted by PaulL (Post 104998)
Bob should talk to Ezra Klein who claims there will be no rationing.

You forgot the Clinton Administration's first try at Universal Healthcare where it was illegal to obtain private treatment.

I don't remember. Whether your claim is true or not, however, I think we can all agree that effort crashed and burned, and lessons have been learned from it.

I hope you're not bringing up proposals from close to two decades ago for any other reason than to remind us of such lessons. Ditto swinging around the word rationing as an all-purpose club. That's not going to help move any discussion forward. Clearly, there are limits to what sort of health care can be provided, no matter who is paying the bills. In that sense, there is always "rationing" going on -- we never have a situation where everyone gets as much as he or she wants. We are for damned sure not getting it with our current health care system.

bjkeefe 02-26-2009 06:17 PM

Re: The Joys of Rationed Healthcare
 
Quote:

Originally Posted by Francoamerican (Post 105003)
There have been similar cases in Europe too. In Italy for example, quite recently, there was a woman who had been in a coma for many years and was allowed to die after long legal batttles, to the great indignation of the Pope and many fellow Catholics. Such cases reveal a bizarre alliance between religion and medical science, which are both committed, though for different reasons, to preserving life at any cost.

Yeah. We should probably think about updating medical ethics. (I'm sure many people are engaged in that effort, actually.)

Quote:

I once read, but I have never been able to verify this, that approximately 90% of what most people (i.e. those who live a normal life span) spend on medical costs over their entire lives is spent in the last six months of their lives. In other words, dying is an expensive business.
That sounds very familiar, at least as a ballpark figure. I wonder how true it is; e.g., does it include the entire population, so that all those young people who get killed are counted in figuring the average/median? Even if not, and the count is just restricted to people who die a "natural" death, it's still awfully problematic, if accurate.

Namazu 02-26-2009 06:51 PM

Re: Gibbs/Santelli
 
Bob and Mickey are full of shit on this one. I would love to know the chain of custody of this non-contextual hatchet job--is this standard operating procedure in the left-o-sphere these days? Listening to Liddy (please provide a minute marker next time), Santelli was clearly offering passive, non-specific assent (happens all the time in interviews), and has never (in the numerous times he's on TV every day) expressed any personal animosity towards or fear of Gibbs. Santelli has a viewpoint, to be sure, but is one the smartest and most level-headed of CNBC's talking heads. Unlike Bob, he also understands the bond market. Let's agree: don't call someone a nut until you do your homework, and I won't call you an asshole.

Quote:

Originally Posted by bjkeefe (Post 104988)
Bob did a pretty good job of giving context to Robert Gibbs' remarks that made Santelli and Liddy go hysterical, but it's probably worth watching the original video if you haven't seen it already. The non-threat is right at the beginning, and as Bob sort of said, it boils down to this: I don't know what Santelli sees out there, but he's not seeing what we're seeing.

The whole thing is worth watching, especially for the zingers at the end.

Not quite CJ Cregg, but pretty good.


Gravy 02-26-2009 07:20 PM

Re: Brushes with Greatness
 
Bob, I believe that the markets may have wanted Geithner as he was associated with the so-called "bad bank" solution. This was never all that realistic (of the market, not Geithner particularly), but I think they wanted to believe that bank capital could be made good without bank debtholders making much a contribution. If debt got through untouched, then the equity money being wagered on certain banks would probably yield big, big gains. I think it is less and less likely that equity will come through and even redeeming the debt at 100% seems likely to be too much for even future generations to be asked to lift. I didn't like the choice of Geithner, but his current caution and seemingly restricted view of what Treasury is really capable of doing are a little bit more appealing. Still, he is definitely a tax cheat. It is laughable to describe what he did as an honest mistake.

bjkeefe 02-26-2009 07:22 PM

Re: Gibbs/Santelli
 
Quote:

Originally Posted by Namazu (Post 105019)
Bob and Mickey are full of shit on this one. I would love to know the chain of custody of this non-contextual hatchet job--is this standard operating procedure in the left-o-sphere these days? Listening to Liddy (please provide a minute marker next time), Santelli was clearly offering passive, non-specific assent (happens all the time in interviews), and has never (in the numerous times he's on TV every day) expressed any personal animosity towards or fear of Gibbs. [...]

Shorter audio clip of the Santelli/Liddy interview here. The "threat" is discussed starting right at the beginning.

Also, here's a followup, in which Santelli is asked about the interview by Matt Lauer. Relevant portion begins around 1:30. When Lauer presses him, he babbles and backs off a little, but he still is, more or less, saying that he was threatened.

Clearly, this guy is trying to milk his time in the spotlight.

jr565 02-26-2009 07:36 PM

Re: Brushes with Greatness
 
Bj,
This doesn't sound like like a madman. he's reflecting on being called out by name is out by name by the press secretary. I certainly don't think he was being threatened. Further, it was Liddy that suggested it was threatening. but in any case, in his Lauer interview he doesn't sound like a raving lunatic.He finds it odd to be called out by name by the press secretary. He wasn't adamant about the point, or suggesting that in fact he was threatened and Matt was wrong.

In fact lauer sounds like he's trying to divert the criticism from Santelli about the bailout, onto a tangential issue so as not to confront the actual point.

In other words, Bob, and Matt are engaging in subterfuge and character assassination so as to avoid the real issue.

Rich 02-26-2009 07:52 PM

Re: The Joys of Rationed Healthcare
 
Quote:

Originally Posted by Francoamerican (Post 105003)
Such cases reveal a bizarre alliance between religion and medical science, which are both committed, though for different reasons, to preserving life at any cost.

Yes, what could be worse than prolonging life at any cost? Living wills seem to cover this sort of problem already. The reason it becomes a serious issue in a state where healthcare is a state-sponsored right is because everyone is forced to pay for it. Why not just keep the system we have and avoid the problem? The Schaivo case is another fine example of the way our system seemed to actually function: the courts deciding a legal battle over the custody of an adult, in essence. Had everyone kept out of it it would have worked out just as it did. Why must we give the power to the government in the first place? Let's maintain the system we have.

cragger 02-26-2009 07:55 PM

Re: The Joys of Rationed Healthcare
 
Agreeing that none of us who have posted thus far have hard data to quote, a few impressions here -

The cost/age curve for healthcare is likely "bathtub" in shape since small children are also notable consumers of health care for the first few years. I don't know if you have, or have had, or have been around very young children but they get sick a lot, and the smaller they are the less margin you have or are willing to accept for their health risks, in general. The immune system just isn't up to snuff at birth, and most of us aren't programmed to accept suffering by infants well.

The end of life spike in health care costs in part reflects what is likely to be under-utilization of preventative care and health monitoring during most of life. Lots of folks don't see a doctor for years on end until we break something obvious, or get an infection that we finally give in and admit we can't shake on our own. As the medicos point out, there are various things that can be handled better, and persumably or at least possibly cheaper, if caught earlier by more, rather than less, utilization of health care resources on a more regular basis. Cheaper (and certainly better) that is for those individuals who have problems that would be caught earlier. Somebody somewhere probably has an estimate, or sets of conflicting estimates, as to what the overall dollar cost of regularly checking everyone more frequently and thoroughly would be and how it would change the overall cost picture.

It would be interesting to see the cost/age curves for other industrialized societies that have more universal health care, but I would suspect there is and will always be an increase toward the end of life. Sort of goes with the territory, that is where things start to break down. For a lot of people this involves medication for various things, such as helping regulate blood pressure, which allows them to lead fairly normal lives. Its not just people lying in a hospital bed hooked up to machines that will keep them going for a couple of miserable and desperate last weeks.

Regarding the latter, as in the Shaivo case, and your point about ethics, I think ethics and morality evolve in ways noted in one of the Free Will diavlogs. To spare us all my frequent divergent ramblings I'll just suggest that as such they probably always lag the changing conditions that lead to such evolution.

AemJeff 02-26-2009 08:00 PM

Re: The Joys of Rationed Healthcare
 
Quote:

Originally Posted by Rich (Post 105025)
... Let's maintain the system we have.

You obviously have no chronic illnesses and are currently insured.

cragger 02-26-2009 08:09 PM

Re: The Joys of Rationed Healthcare
 
Quote:

Originally Posted by Rich (Post 105025)
Why must we give the power to the government in the first place? Let's maintain the system we have.

A lot of us find this to be a false choice. I don't want a group I have as much contempt for as I do politicians getting into my healthcare decisions. I do however recognize that a system so inefficient that it costs us far more per capita than in other countries we compete with, to get rather poorer health care (averaged across our citizenry) is not one that begs to be left as is.

bjkeefe 02-26-2009 08:17 PM

Re: The Joys of Rationed Healthcare
 
Quote:

Originally Posted by cragger (Post 105026)
[...]

Good points, especially about the likely high early-in-life costs.

You're probably also right about the likelihood of things being more expensive due to people postponing getting attention (or regular checkups, for that matter). However, I do wonder about this one. When I have worked at places where there was good health coverage, I have always noticed people who go to the doctor for just about everything. I'm talking sniffles and a cough, a twinge in a joint, like that. And why not, from the self-interested perspective?

So while I agree that there are lots of cases where putting things off until they get worse means higher costs, I also think there are lots of cases where once the personal costs are low enough, there can be over-consumption of what is ultimately a shared resource. Worse, when this changes even in the slightest, there tends to be howling, which you know will be a fear card the reactionaries will play in the upcoming war. I remember when one company I worked at tightened up a bit, to try to control costs, and the outcry at the change of five or ten bucks co-pay for a doctor's visit was not to be believed.

I can't believe I'm relating anecdotes in a health care policy discussion. I hate that. Ending now.

But good post by you.

bjkeefe 02-26-2009 08:21 PM

Re: The Joys of Rationed Healthcare
 
Quote:

Originally Posted by Rich (Post 105025)
Let's maintain the system we have.

I vote no, too. Too many people are uninsured or under-insured, too many people get wiped out by one-time medical events, too many people are trapped at jobs they hate because they have "a preexisting condition," and too many companies are getting crushed by rising costs.

I'm sure there are lots of other specific reasons, but the bottom line is that our system could be a lot better, and is completely broken from the perspective of tens of millions of people.

bkjazfan 02-26-2009 08:29 PM

Re: Brushes with Greatness
 
Goldie Hawn spoke at my daughter's college graduation several years ago and it was boring.

Now, I have a DVD of "Slumdog" but feel it needs to be seen on the wide screen instead of my 21" TV. I hope it comes back to a theatre.

Kate Winslet was awesome in both "The Reader" and "Revolutionary Road". I liked "TR" a lot expecially the second half of the movie. However, "RR" was not nearly as good as the book it's from by Richard Yates.

John


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