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  #1  
Old 06-11-2009, 07:58 PM
Bloggingheads Bloggingheads is offline
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Default Health Care Showdown (Mark Schmitt & Megan McArdle)

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  #2  
Old 06-11-2009, 09:05 PM
I'm SO awesome!
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

megan, i think you might be the greatest internet troll that has ever lived because this is gonna get some serious commenting once the video starts to work correctly. you are so lacking in courage, intelligence and common sense i can't even believe it. i've never seen a sadder or more bitter apologist mouthpiece for rich people and the opposite of the public's interest in my life.
the fact the mark has to deal with you or that anyone would ever take a libertarian seriously for any reason just hurts my brain. hey, how's that free market working out for you? thanks a lot for supporting a philosophy that has not only ruined the world's economy but for being so rigid that you continue to do so afterwords. THE ONLY THING STANDING IN OUR WAY FROM REFORM IS PEOPLE LIKE YOU. wow, how does the rest of the world do it? there are so many distractions and lies in this diavlog i can't even believe it.
this one was not only a record for you but i have to believe it's a world record for "largest and most complete" load of right wing/libertarian propaganda ever assembled in one place. gee, THANKS FOR LOOKING OUT FOR US. you are a sell out.

Last edited by I'm SO awesome!; 06-11-2009 at 09:07 PM..
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  #3  
Old 06-11-2009, 09:09 PM
Freddie Freddie is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

I don't, actually, care about efficiency arguments. At all. I care about moral arguments.

Here's the situation for Megan and others who oppose health care reform: there are very many people in this country who are incapable of procuring necessary health care when they desperately need it because of their financial and employment situation. The exact numbers are of great controversy. But the most jaundiced, partisan opponents of health care reform must admit that they number in the millions. People can't get health care when they're sick because they can't afford it, in the country with the most powerful economy in the history of the world.

And this not only leaves them suffering, or leaves them in financial ruin. It does kill people. Yes, everyone has guaranteed access to emergency care. Emergency care does not provide the kind of early screening that can save countless lives with preventative care. People die in this country because they put off going to the doctor because they can't afford it, and they only are diagnosed after it is too late for them to be adequately treated. Happens all the time; happens every day.

So the question that we must insist on asking Megan, et al, is what she and they would have these sick people do. What should they do, if they can't get a job that provides health benefits? What should they do?

Because make no mistake, conservative intransigence on this issue causes enormous suffering, hopelessness, financial disaster and death. Make no mistake.
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  #4  
Old 06-11-2009, 09:11 PM
claymisher claymisher is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

Yeah, France, Canada, Holland, Germany, those places don't really exist. Really. So we can't copy their best ideas. And they're foreign. Or something.

I'd like some large country to fully take on the libertarian economic system so we can see it in practice. Then we can write it off as soundly as communism as been written off. Until then we'll keep hearing bullshit about mythical fantasy systems and how "real" libertarianism has never been tried. I doubt libertarianism would even last as long as communism did.

I can't take it anymore. If everybody is going to pay libertarians so damn much attention I want equal time for communists.
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  #5  
Old 06-11-2009, 09:11 PM
claymisher claymisher is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

(It's cool when Freddie posts here.)
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  #6  
Old 06-11-2009, 09:40 PM
themightypuck themightypuck is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

It is interesting that there are 3 libertarians in a row in the vlog queue.
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  #7  
Old 06-11-2009, 09:42 PM
holyworrier holyworrier is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

Megan says that when the government is the only buyer, there's no market. This is a funny thing for a market fundamentalist to say. It only takes three parties to make a market. Two sellers, one buyer.
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  #8  
Old 06-11-2009, 10:04 PM
uncle ebeneezer uncle ebeneezer is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

Bloggingheads young libertarian rule #1: WW>MM
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  #9  
Old 06-11-2009, 10:07 PM
holyworrier holyworrier is offline
 
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Default Megan's flawed utilitarian analysis

A so-called utilitarian approach to health care, which states that private markets produce the greatest innovation which benefits the most people, is seriously flawed. The poor are not affected either way if innovation slows or doesn't. They can't afford it anyway. They will die significantly sooner than their more affluent counterparts no matter what drugs were available. So you can say 'we're going to take a chance on innovation slowing in favor of providing the basics to the poor, to try to help them live a little longer. The more affluent majority are going to outlive them anyway'. Or you can say 'we want to maintain a system based on the market which provides excellent drugs and more nuanced, subtle choices to the affluent majority, and let the (growing number of) poor continue to die prematurely'. What you are doing by opting for the latter course is to give those with an advantage an even bigger one. This is not true utilitarianism.

This is assuming that innovation would slow or disappear, not if the profit motive disappears, which won't happen, but merely if it is diminished somewhat. This is pure speculation on the libertarians' part.

Last edited by holyworrier; 06-11-2009 at 10:17 PM.. Reason: More appropriate title
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  #10  
Old 06-11-2009, 10:08 PM
AemJeff AemJeff is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

Quote:
Originally Posted by uncle ebeneezer View Post
Bloggingheads young libertarian rule #1: WW>MM
"The Ebeneezer Inequality."
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-A. E. M. Jeff (Eponym)
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  #11  
Old 06-11-2009, 10:51 PM
cognitive madisonian cognitive madisonian is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

Not bad, but anyone calling themselves a libertarian who voted for Obama is seriously deluded or not actually a libertarian.
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  #12  
Old 06-11-2009, 10:53 PM
pampl pampl is offline
 
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Default Re: Megan's flawed utilitarian analysis

Quote:
Originally Posted by holyworrier View Post
A so-called utilitarian approach to health care, which states that private markets produce the greatest innovation which benefits the most people, is seriously flawed. The poor are not affected either way if innovation slows or doesn't. They can't afford it anyway. They will die significantly sooner than their more affluent counterparts no matter what drugs were available. So you can say 'we're going to take a chance on innovation slowing in favor of providing the basics to the poor, to try to help them live a little longer. The more affluent majority are going to outlive them anyway'. Or you can say 'we want to maintain a system based on the market which provides excellent drugs and more nuanced, subtle choices to the affluent majority, and let the (growing number of) poor continue to die prematurely'. What you are doing by opting for the latter course is to give those with an advantage an even bigger one. This is not true utilitarianism.
Your premise - that medical innovation doesn't "trickle down" - is wrong. One obvious example, out of many, is new AIDS drugs. Charitable programs immediately start sending them overseas, and even discounting charity it's only a short period of time before they become available for 1% of the price from local manufacturers. Now, it's true that this wouldn't be as possible if the world were as pharma companies wish it and IP laws were strictly enforced everywhere, but that's not close to the world we live in or even the world being offered by Ms. Jane Galt herself.

The real reason I wanted to respond, though, is that you're wrong about utilitarianism. It's blind to poverty, wealth, and other advantages and disadvantages. A true utilitarian would support the world being crushed under grinding poverty as long as there was someone, somewhere being made really, really happy by it. That's part of why true utilitarianism is so unpopular- even Bentham had to fudge the rules. You could make a very strong case that utilitarianism is wrong here but I don't think you can just reverse what the word means. I don't know why you would want to appropriate the label anyway, it doesn't have much cache. Why not say true ballin' is devoting time to helping the poor? Or that true conservatives are interested in conserving the health of the neediest?
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  #13  
Old 06-11-2009, 11:49 PM
uncle ebeneezer uncle ebeneezer is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

Just one segment of the Ebeneezerian Quality Spectrum: HH>=WW>MM>AA
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  #14  
Old 06-12-2009, 12:14 AM
holyworrier holyworrier is offline
 
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Default Re: Megan's flawed utilitarian analysis

I disagree with your take on utilitarianism. I used the term in the same sense as did Megan, and the sense in which the term is generally understood. The greatest good for the greatest number, or the least harm for the greatest number.

You are right about some select drugs trickling down. If they are sent overseas, that has no bearing on the topic at hand. Completely apart from the debate about health care, the poorer one is, the shorter, statistically, one is likely to live. That is a built-in disadvantage which our market-based system compounds.
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  #15  
Old 06-12-2009, 12:25 AM
JimS JimS is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

Sorry, but if there is something that only affects 1500 people, we shouldn't be spending a nickel on it as long as so many other diseases remain.
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  #16  
Old 06-12-2009, 12:34 AM
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

yes! that's seriously what we should do from now on. every time some "angels on the head of a pin" apologist comes on we should respond with communist rhetoric. or maybe next time i'll just go with extreme libertarianism to try to one up them either way it doesn't matter cuz ideologues never chenge their mind.
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  #17  
Old 06-12-2009, 12:50 AM
in2liberty in2liberty is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

Megan,

England’s UH is based on rationing.
France’s is based on controlling costs.

The VA here in the states does both, and it does it to great effect. Patients fight to get into VA care. The patients are really hurting. But they get both great and inexpensive care.

When you go into the VA, your records are electronic, your doctor may change but he can read all your records, the doctors have a limited budget to work with, so they have no incentive to do needless medical tests.

Whereas, Medicare sucks because while we limit payments (control costs), it works within the current system, so doctors have ever good reason to do unnecessary shit they can bill for.

So here’s my point, before we go trying to push all people satisfied with their healthcare into some universal thing…. why not:

1. Turn the Medicare system into a VA-style system.
2. Use the new VA-style system to cover all the uninsured.

This would give us a tremendous first step toward electronic record keeping, we’d have a fixed yearly budget, so the doctors would have stop needless tests / treatments.

It’s a BOLD move, it is single payer – and it will house everybody who doesn’t have insurance.

And importantly it lets those who have the money to spend, buy all the extra crap their doctor can sell them on.
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  #18  
Old 06-12-2009, 01:38 AM
TPGS TPGS is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

Megan McArdle's thoughtful analysis of the Obama health care plan has clearly hit a nerve with those who are so emotionally vested in universal health care (and/or Obama) that they will not tolerate rational challenges to the thin plan that Obama and Orszag have laid out.

As Megan pointed out, once the government starts to lower the prices paid for pharms, the companies will stop investing in R&D (Mark was unable to provide examples of government controlled industries that deliver consistent innovation). And this argument can be extended to other health care sectors. When doctors' pay is controlled (i.e. lowered) by the government, over time the better students will stop going into medicine and we will have poorer quality doctors. When hospital administrators' salaries are capped, it will become a less desirable field, and ultimately the quality of hospital care will go down. Add to this the rationing of medical procedures and equipment, and it is clear that large incremental number of people will die under this plan.

Mark was also not able to give a convincing reason why, if the point of this "reform" is to lower the overall cost of health care, these reforms could not be tested first on Medicare and Medicaid. There are two reasons why we are getting the bum's rush on this plan: 1) A test would show that the Medicare and Medicaid patients would not be happy with the level of care delivered under the "reforms", and 2) The reforms would not deliver the promised savings because the increase in government waste/graft would offset any savings from placing controls on the private players in the system.

Rather than wiping out the highest quality health care system in the world that is well-received by 85%-90% of the population, the 10 - 15% who don't have coverage and who truly can't afford it (working poor) should be offered private policies subsidized by the government.
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  #19  
Old 06-12-2009, 02:06 AM
I'm SO awesome!
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

wow! i guess all of the (made up) "facts" just happen to align with those who are interested is dragging their feet on health care. gee, i guess the rest of the industrialized world must.....not exist? i'm sorry, i'm gonna have to start referring to you guys as "Health Care Truthers."
you should attach this:
http://images.3d4medical.com/_a/stil...M000007589.jpg
to your tin foils hats and it'd be like a cute little antenna or something
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  #20  
Old 06-12-2009, 03:17 AM
claymisher claymisher is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

Quote:
Originally Posted by I'm SO awesome! View Post
yes! that's seriously what we should do from now on. every time some "angels on the head of a pin" apologist comes on we should respond with communist rhetoric. or maybe next time i'll just go with extreme libertarianism to try to one up them either way it doesn't matter cuz ideologues never chenge their mind.
Great idea. We should do both simultaneously to maximize the effect. Let's call it Extreme Ironic Commulibertarianism. Here goes:

The constitution isn't valid because I never signed it and it's an instrument of capitalist oppression. Property is the bulwark of liberty and is also theft.
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  #21  
Old 06-12-2009, 03:20 AM
claymisher claymisher is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

Quote:
Originally Posted by TPGS View Post
Megan McArdle's thoughtful analysis of the Obama health care plan has clearly hit a nerve with those who are so emotionally vested in universal health care (and/or Obama) that they will not tolerate rational challenges to the thin plan that Obama and Orszag have laid out.

As Megan pointed out, once the government starts to lower the prices paid for pharms, the companies will stop investing in R&D (Mark was unable to provide examples of government controlled industries that deliver consistent innovation). And this argument can be extended to other health care sectors. When doctors' pay is controlled (i.e. lowered) by the government, over time the better students will stop going into medicine and we will have poorer quality doctors. When hospital administrators' salaries are capped, it will become a less desirable field, and ultimately the quality of hospital care will go down. Add to this the rationing of medical procedures and equipment, and it is clear that large incremental number of people will die under this plan.

Mark was also not able to give a convincing reason why, if the point of this "reform" is to lower the overall cost of health care, these reforms could not be tested first on Medicare and Medicaid. There are two reasons why we are getting the bum's rush on this plan: 1) A test would show that the Medicare and Medicaid patients would not be happy with the level of care delivered under the "reforms", and 2) The reforms would not deliver the promised savings because the increase in government waste/graft would offset any savings from placing controls on the private players in the system.

Rather than wiping out the highest quality health care system in the world that is well-received by 85%-90% of the population, the 10 - 15% who don't have coverage and who truly can't afford it (working poor) should be offered private policies subsidized by the government.
France, Germany, Denmark, Holland, Canada.
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  #22  
Old 06-12-2009, 03:42 AM
claymisher claymisher is offline
 
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Default Innovation, markets, and health

Everybody agrees that new medical practices, treatments, and technologies are good for society. That requires innovation. So let's try to think clearly about where innovation comes from. Markets don't innovate. Corporations don't innovate. Only people do. Who's the greatest innovator in the history of medicine? I'd say it's Ignaz Semmelweis, the man who figured out that doctors should wash their goddam hands (try commercializing that one). Then there's the guys who developed penicillium. And pretty much every Nobelist. You can play this game all day long and the for-profit capitalists will barely get any points on the board at all. Private sector research is vital and necessary, especially for the grunt work of clinical trials, but on the whole most innovation comes out of the public sector, or at least from guys who will never make on dime on their discoveries.

OK, so what are markets good for? They're good for sorting the good ideas from the bad ideas. You throw a bunch of stuff up and see what sticks. It'd be bad to have any kind of system that took final positions on the right treatment for everything and shut out tinkering, so we should avoid that. But it's also a mistake to think that for-profit markets are the only place selective pressure in favor of good ideas can occur. You see this all the time in the tech world. A lot of the good ideas (maybe most of the big ones) evolved successfully without being wholly commercial: Linux, HTML, CSS, Firefox, apache, mysql, perl, ruby, rails, etc. Wishy-washy mixed private/social systems like this have a terrific track record.

Now consider the market for chemotherapy. Let's say it costs $30,000 for a series of treatments. Who's the customer? Who's the provider? Let's say it's your dad, and he has terminal cancer. The oncologist, who you've never met before, walks in and says chemo will help. The family GP isn't so sure. It turns out that the oncologist collects his cut when he writes the prescription (nurses do all the work), so he has every incentive to sell chemo pretty hard. You never see the oncologist again. It happens that chemo can have much, much worse side-effects than you could think possible. Your dad is much worse off, Medicare wasted a lot of money, and one oncologist got a new set of golf clubs.

This is obviously a bad, bad system. Why is it any different than the market for sandwiches? You buy a sandwich, it stinks, you don't buy it again, the business goes under. Or it's great, you buy lots of them, the business expands. But you only decide whether to get chemo or not once, and even then, you have no idea if it's the right thing or not. (Now, I know market triumphalists will say that consumers need to be empowered to make their own choices. Really? You're dying and you're going to take on the hospital staff? You're going to google it on your netbook while you're sedated?)

How is the market mechanism supposed to work for oncologists? How do they good ones get amplified and the bad ones weeded out? Where does the selective pressure come from? You can commercialize sandwiches. You can commercialize optometry. How do you commercialize cancer care? How do you commercialize long-term wellness? Maybe you sign a 30-year contract with Consolidated Medical Incorporated (somehow I'm pretty sure that business is never going to happen). What you need is somebody with no incentive to bullshit you. You need doctors who are paid a straight up salary. This is part of reason why the VA and Mayo clinic are at the top of the charts.

It's pointless to ask markets to do things that can't do. It just makes markets look bad. If you care about markets you'll want to prevent them from getting a bad reputation.

Anyway, the point is that we're better off without the ritual incantation of "markets" and "innovation" and that we should instead think clearly about the specific contexts and mechanisms that get us good outcomes. It's not at all clear the more capitalism is always going to be the answer. But if we're smart we can create institutional and regulatory frameworks to enable scrappy startups get a crack at making things better. BTW, I have an idea for a MRSA cleaning company. Your hospital hires us and we'll make sure your doctors wash their fucking hands ...
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  #23  
Old 06-12-2009, 03:44 AM
JonIrenicus JonIrenicus is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

Great edition.

Some interesting insights from Megan, whom I know many are irritated by (more on that later).


The part about people living longer is true I think. People died earlier decades ago, and that saves expenses. As treatments get better and people live longer, I do not see how the net cost of health care can go lower all things being equal. Now maybe this can be offset with some hidden efficiency, that is the hope, but living longer, and more advanced treatments must make the cost of surviving more expensive.

Also found the point about the R&D budgets for drug companies interesting and telling. Call me an optimist, but I DO think there can be a better system that preserves the profit motive but dampens cost. I will not let the fact that I am too dull to divine it lessen the possibility of its existence or our resolve to craft it.

But the last comment will be to highlight my take on why so many are irritated by Megan.

You know who you are. I think it is because she is a bubble burster. Sometimes it's pretty hilarious, this liberal or non liberal alike goes on about how they have this grand schema figured out, harmony will ensue, the world will rejoice, and in comes the wrench from Megan that wrinkles the entire idea.

I had that feeling before on the receiving end of a wrench to my grand idea. I was talking to a philosophy TA about my grand theory of how to maintain Objective ethical standards and toss out the relativist morality once and for all! And this guy was relentless in his assault of my idea, pointing out issues here, faulty supports there, and on and on (btw, MY theory is still right, but now refined). He was a Megan.

Bob got the same treatment when he was making his case for his global governance ideas, and Megan was just picking at the edges of why this would not be so easy to achieve or that would not happen.

She often finds the bare thread on that perfectly clean suit and yanks at it, exposing the faults. And some of you cannot stand that! I suspect some do not like the assaults to their views, to see them picked at and viewed through the eyes of a different colored lens, usually a less flattering lens.


There is probably more to the irritation, but I think that is definitely part of it. For my part, I think she's great.
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  #24  
Old 06-12-2009, 03:53 AM
claymisher claymisher is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

Quote:
Originally Posted by JonIrenicus View Post
She often finds the bare thread on that perfectly clean suit and yanks at it, exposing the faults. And some of you cannot stand that! I suspect some do not like the assaults to their views, to see them picked at and viewed through the eyes of a different colored lens, usually a less flattering lens.
I couldn't decide if she sounded more like Eyeore or the comic book guy on The Simpsons.

No, you got it backwards. Megan (at least in this one) is a one-way function. It only takes her a second to spout nonsense, but it takes poor Mark Schmitt minutes to spell out why she's wrong. Hell of a debating tactic.
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  #25  
Old 06-12-2009, 04:19 AM
JonIrenicus JonIrenicus is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

Quote:
Originally Posted by claymisher View Post
I couldn't decide if she sounded more like Eyeore or the comic book guy on The Simpsons.

No, you got it backwards. Megan (at least in this one) is a one-way function. It only takes her a second to spout nonsense, but it takes poor Mark Schmitt minutes to spell out why she's wrong. Hell of a debating tactic.
nonsense, yes, an interesting word

http://www.veoh.com/browse/videos/ca...316436GQ6CawaR
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  #26  
Old 06-12-2009, 04:59 AM
T.G.G.P T.G.G.P is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

I haven't listened to the whole thing, but even though I'm a right-wing extremist who agrees with a lot of what she says Megan is really pissing me off. This is probably the worst I've heard from her. Why is she acting like such a hack and reducing everything to those bad liberals vs righties in need of defense against dishonest attacks? Mark wasn't bringing in an axe to grind, did she need to turn it into a partisan fight?
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  #27  
Old 06-12-2009, 06:02 AM
pampl pampl is offline
 
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Default Re: Megan's flawed utilitarian analysis

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Originally Posted by holyworrier View Post
I disagree with your take on utilitarianism. I used the term in the same sense as did Megan, and the sense in which the term is generally understood. The greatest good for the greatest number, or the least harm for the greatest number.

You are right about some select drugs trickling down. If they are sent overseas, that has no bearing on the topic at hand. Completely apart from the debate about health care, the poorer one is, the shorter, statistically, one is likely to live. That is a built-in disadvantage which our market-based system compounds.
That isn't the sense it's generally understood, though. Wherever that summary came from it's pretty misleading. Utilitarianism is choosing whatever action produces the most utility, meaning (happiness/pleasure per person benefited * number of people benefited) - (harm per person hurt * number of people hurt). That doesn't involve simply maximizing the number of people, as well it shouldn't: that reasoning leads to even worse '51% enslaving 49%' outcomes than utilitarianism normally gets accused of.

I'm not sure I understand your complaint here. If it's a question of the poor getting medicine, then international consequences are much more important than domestic ones. Being poor in America is still a relatively high standard of life. If it's just about being able to compete in the market, then I have to point out that most of those added years of lifespan aren't spent competing, they're spent in retirement
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  #28  
Old 06-12-2009, 06:11 AM
pampl pampl is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

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Originally Posted by JonIrenicus View Post
There is probably more to the irritation, but I think that is definitely part of it. For my part, I think she's great.
I like Mcardle too. I think it's because I like hearing people get worked up and she always sounds a little excited or anxious when she interrupts someone to disagree. She reminds me of the main character of the Phoenix Wright games
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  #29  
Old 06-12-2009, 06:21 AM
Francoamerican
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Default Re: Innovation, markets, and health

Quote:
Originally Posted by claymisher View Post
Anyway, the point is that we're better off without the ritual incantation of "markets" and "innovation" and that we should instead think clearly about the specific contexts and mechanisms that get us good outcomes. It's not at all clear the more capitalism is always going to be the answer. But if we're smart we can create institutional and regulatory frameworks to enable scrappy startups get a crack at making things better. BTW, I have an idea for a MRSA cleaning company.Your hospital hires us and we'll make sure your doctors wash their fucking hands ...
All your points are valid. And your example of the cancer patient illustrates how the meaningless rhetoric of "choice" and "innovation" clouds the whole issue in the US by making people believe that their health care will be inferior if medical providers are subject to cost controls---as in France and the rest of Europe. By the way, European pharmaceutical companies also innovate!

Alas, your common sense and the common sense of health care professionals everywhere but in the US, is subject to a constant barrage of nonsense spread by such ideologues as Megan McCardle, who, as far as I can tell, is simply impervious to reason.
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  #30  
Old 06-12-2009, 07:16 AM
Bloggin' Noggin Bloggin' Noggin is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

Wow -- what made Megan such an asshole? Constant interruptions in a nasty hectoring tone and wild accusations of "sounding like a SOCIALIST!" More Obama derangement syndrome (Brink Lindsey is the other example, but he wasn't rude to Josh.) Take a valium next time Megan -- or maybe read some kind of etiquette manual.
Good thing Mark is able to absorb her nastiness without giving it back.
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  #31  
Old 06-12-2009, 07:33 AM
Bloggin' Noggin Bloggin' Noggin is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

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Originally Posted by Freddie View Post

So the question that we must insist on asking Megan, et al, is what she and they would have these sick people do. What should they do, if they can't get a job that provides health benefits? What should they do?
They should die so that the wealthy here and the poor of other countries that do control drug prices will have more and better drugs -- more people will live longer and have longer sexual lives in the rest of the world as a result of their deaths. Perhaps people in the rest of the world will put up plaques thanking the American poor for their unselfish sacrifice.

Some libertarians are natural rights theorists of a particularly absolutist bent (Ayn Rand, Robert Nozick). Others (like Megan) appear to be people who believe that Economics provides you with a complete moral system: One part crass utilitarianism ("seek the greatest overall good, no matter how that's distributed") and one part modified Alexander Popism ("Whatever is is right" -- so long as the market is doing it, not Government).

Will Wilkinson apparently accepts Rawls's focus on the worst off and has nice things to say about Canada, so I wonder what he would say about health care.

Last edited by Bloggin' Noggin; 06-12-2009 at 07:51 AM..
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Old 06-12-2009, 08:10 AM
Bloggin' Noggin Bloggin' Noggin is offline
 
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Default Re: Megan's flawed utilitarian analysis

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I disagree with your take on utilitarianism. I used the term in the same sense as did Megan, and the sense in which the term is generally understood. The greatest good for the greatest number, or the least harm for the greatest number.
You are quoting the slogan, not the doctrine itself. Classical Utilitarianism tells you to maximize the aggregate happiness, counting every person's happiness equally. Effectively, it comes up with a sum, and sums do not say anything about what they are sums OF. I can get to 50 by adding 5 tens or I can add 1 + 1+1+1+46. pampl's criticism cannot be blocked at the get-go. It is not a knock-down argument as it stands though. The standard utilitarian response is that (because of diminishing marginal utility), it's more likely that a more even distribution of resources will tend to produce the greatest sum of happiness: give a dollar to a millionaire and he won't even notice -- give the same dollar to a poor person and he can get something to stave off starvation.
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You are right about some select drugs trickling down. If they are sent overseas, that has no bearing on the topic at hand.
True -- also, what drugs will trickle down overseas if the American market is the generator of drugs? Cialis and Levitra, Rogaine, the cornucopia of anti-depressants Megan is so relieved about and HIV medicines. But cures for the parasites etc. that afflict the poor in Africa, new vaccines etc.? Either government does these things or they don't get done.
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Old 06-12-2009, 09:00 AM
holyworrier holyworrier is offline
 
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Default Re: Megan's flawed utilitarian analysis

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Originally Posted by pampl View Post
That isn't the sense it's generally understood, though. Wherever that summary came from it's pretty misleading. Utilitarianism is choosing whatever action produces the most utility, meaning (happiness/pleasure per person benefited * number of people benefited) - (harm per person hurt * number of people hurt). That doesn't involve simply maximizing the number of people, as well it shouldn't: that reasoning leads to even worse '51% enslaving 49%' outcomes than utilitarianism normally gets accused of.
The Classical Utilitarians, Jeremy Bentham and John Stuart Mill, identified the good with pleasure, so, like Epicurus, were hedonists about value. They also held that we ought to maximize the good, that is, bring about ‘the greatest amount of good for the greatest number’.

http://plato.stanford.edu/entries/ut...anism-history/

Take a fucking poll.

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Originally Posted by pampl View Post
I'm not sure I understand your complaint here. If it's a question of the poor getting medicine, then international consequences are much more important than domestic ones. Being poor in America is still a relatively high standard of life. If it's just about being able to compete in the market, then I have to point out that most of those added years of lifespan aren't spent competing, they're spent in retirement
Whether the poor in foreign countries get cheap medicine or not is not relevant to this discussion of the American health care system. The relative poverty of Americans is not relevant to this discussion of the American health care system. Whether or not a person can compete in the market after retirement not relevant to this discussion of the American health care system. Neither are any of your points relevant to the point I made, which is that maintaining our current profit-oriented system, which produces innovations accessible to only the affluent, compounds the advantages the affluent already have over the poor, which, contrary to Megan's little riff on utilitarianism, does not ensure the greatest good for the greatest number. Rather, it disproportionately increases the good already enjoyed by the greatest number, rather than decrease the disparity, which would be a more utilitarian act.

No one, no libertarian, "would support the world being crushed under grinding poverty as long as there was someone, somewhere being made really, really happy by it."

Last edited by holyworrier; 06-12-2009 at 09:13 AM..
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Old 06-12-2009, 10:19 AM
AemJeff AemJeff is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

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Originally Posted by TPGS View Post
Megan McArdle's thoughtful analysis of the Obama health care plan has clearly hit a nerve with those who are so emotionally vested in universal health care (and/or Obama) that they will not tolerate rational challenges to the thin plan that Obama and Orszag have laid out.

As Megan pointed out, once the government starts to lower the prices paid for pharms, the companies will stop investing in R&D (Mark was unable to provide examples of government controlled industries that deliver consistent innovation). And this argument can be extended to other health care sectors. When doctors' pay is controlled (i.e. lowered) by the government, over time the better students will stop going into medicine and we will have poorer quality doctors. When hospital administrators' salaries are capped, it will become a less desirable field, and ultimately the quality of hospital care will go down. Add to this the rationing of medical procedures and equipment, and it is clear that large incremental number of people will die under this plan.

Mark was also not able to give a convincing reason why, if the point of this "reform" is to lower the overall cost of health care, these reforms could not be tested first on Medicare and Medicaid. There are two reasons why we are getting the bum's rush on this plan: 1) A test would show that the Medicare and Medicaid patients would not be happy with the level of care delivered under the "reforms", and 2) The reforms would not deliver the promised savings because the increase in government waste/graft would offset any savings from placing controls on the private players in the system.

Rather than wiping out the highest quality health care system in the world that is well-received by 85%-90% of the population, the 10 - 15% who don't have coverage and who truly can't afford it (working poor) should be offered private policies subsidized by the government.
The ripe old counterfactual about pharma R&D is no more convincing now than it was any of the last million times it was trotted out by the industry or its apologists. If there's a profit to be made there will be pharma research, (most of which will find its way into the sewer of finding a new blockbuster, a chemical similar enough to somebody else's blockbuster to allow it to marketed as competitor) there will be R&D. The obscenity of the pricing of cancer drugs is no different than simply blackmailing the dying.

Do you really propose a system in which everyone with a chronic disease is lumped into a single gov't run pool? Because that's what would happen, with private insurers dropping all their diabetics, heart patients, cancer patients, MS, ALS, etc... in to the government pool while they, the private insurers hold onto those with little need of coverage.

I think neither you, nor Megan, have a clue.
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Old 06-12-2009, 10:45 AM
TPGS TPGS is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

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If there's a profit to be made there will be pharma research. AemJeff
But there won't be a profit to be made. The big, evil pharma companies shouldn't earn a profit, that will be "cost savings" (or, more likely, spent to buy votes via union concessions, etc...). In your fairytale land, the scientists and researchers will show up everyday and work for free?
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Old 06-12-2009, 10:58 AM
AemJeff AemJeff is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

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Originally Posted by TPGS View Post
But there won't be a profit to be made. The big, evil pharma companies shouldn't earn a profit, that will be "cost savings" (or, more likely, spent to buy votes via union concessions, etc...). In your fairytale land, the scientists and researchers will show up everyday and work for free?
In my fairyland demand still drives research. Hard to imagine such a thing? Yours seems to be a somewhat binary world.
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Old 06-12-2009, 11:05 AM
gwlaw99 gwlaw99 is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

One of Megan's best performances. Usually I find she comments on things she doesn't have much knowlege on.

"If there's a profit to be made there will be pharma research, (most of which will find its way into the sewer of finding a new blockbuster, a chemical similar enough to somebody else's blockbuster to allow it to marketed as competitor) there will be R&D."

This makes no sense. What is a drug company going to do: spend billions on a new drug that could cure cancer or spend a few million slightly improving their current drugs (ie making a 4 hour drug into a 24 hour drug) and make significantly more profits? It's not a matter of IF they can make a profit. It's a question of how much profit they can make with their limited investment resources.
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Old 06-12-2009, 11:20 AM
pampl pampl is offline
 
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Default Re: Megan's flawed utilitarian analysis

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Originally Posted by holyworrier View Post
The Classical Utilitarians, Jeremy Bentham and John Stuart Mill, identified the good with pleasure, so, like Epicurus, were hedonists about value. They also held that we ought to maximize the good, that is, bring about ‘the greatest amount of good for the greatest number’.

http://plato.stanford.edu/entries/ut...anism-history/

Take a fucking poll.
Try actually reading the article you linked to. You're simply wrong.
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Whether the poor in foreign countries get cheap medicine or not is not relevant to this discussion of the American health care system. The relative poverty of Americans is not relevant to this discussion of the American health care system. Whether or not a person can compete in the market after retirement not relevant to this discussion of the American health care system. Neither are any of your points relevant to the point I made, which is that maintaining our current profit-oriented system, which produces innovations accessible to only the affluent, compounds the advantages the affluent already have over the poor, which, contrary to Megan's little riff on utilitarianism, does not ensure the greatest good for the greatest number. Rather, it disproportionately increases the good already enjoyed by the greatest number, rather than decrease the disparity, which would be a more utilitarian act.

No one, no libertarian, "would support the world being crushed under grinding poverty as long as there was someone, somewhere being made really, really happy by it."
Uh, actually most of those points are relevant to your criticism. First, Mcardle herself brought up the international market here. Unless you're saying foreigners aren't people then you have to count them. The relative poverty matters a great deal, unless you're saying that wealthy countries should just focus on compounding their wealth over poor countries instead of lending a helping hand.

Compounding advantages the affluent have over the poor is in some situations utilitarian, as well as ensuring the greatest good for the greatest number. Acting to decrease disparity is not necessarily utilitarian. You really ought to read that article, what you're talking about has nothing to do with utilitarianism and is closer to Rawls' theory of justice. Mills was a "classic liberal" and believed a free market was the embodiment of utilitarianism and that progressive taxation was robbery. Increasing equality simply has no intrinsic value in utilitarianism.

No shit no one would support that, that's why it's a common criticism of utilitarianism.
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Old 06-12-2009, 11:59 AM
AemJeff AemJeff is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

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Originally Posted by gwlaw99 View Post
One of Megan's best performances. Usually I find she comments on things she doesn't have much knowlege on.

"If there's a profit to be made there will be pharma research, (most of which will find its way into the sewer of finding a new blockbuster, a chemical similar enough to somebody else's blockbuster to allow it to marketed as competitor) there will be R&D."

This makes no sense. What is a drug company going to do: spend billions on a new drug that could cure cancer or spend a few million slightly improving their current drugs (ie making a 4 hour drug into a 24 hour drug) and make significantly more profits? It's not a matter of IF they can make a profit. It's a question of how much profit they can make with their limited investment resources.
I don't think I follow your pont, quite. I think the way the market is currently structured makes for a lot of bad incentives - comapared to the actual needs. Drug companies waste a lot of resources on reinventing Vioxx, or creating a new Statin, or whatever - or worse yet, finding a tiny tweak in a molecule so they can market an extremely similar variant on an older drug under a a new patent, extending their monopoly for another seventeen years. Speaking as somebody who is deeply deeply dependent on pharmaceuticals - of me twelve daily prescriptions, two are not generic, and one of the non-generics is insulin, which isn't available in generic form. Where is all the innovation, when out of all those drugs, only one is actually recent enough to covered by a patent?

I don't believe that the actual needs of the people for whom pharmaceuticals could be helpful are particularly well aligned with the interests of the producers of pharmaceuticals. If the system gets shaken up a bit, if the formula governing where from, and how much, and howe to allocate R&D dollars were changed sugnificantly - I don't believe my interests are likely to be damaged, and I think of myself as a pretty representative member of the the class of people who benefit from the output of the pharma industry.
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Old 06-12-2009, 12:06 PM
I'm SO awesome!
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

nice i'll try to think up so good ones for next time.
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