Blog on the Run: Reloaded

Friday, July 15, 2011 8:44 pm

Quote of the day, debt-ceiling edition

From the best political pundit in America today. No, sit the hell down, Brooks, you ignorant twit. You, too, Friedman, you insufferable solipsist. I’m talking about Digby:

I’m afraid that the one thing everyone seems to agree on is that grandma must pay, come what may.

And the sad thing is that because Democrats have a right wing opposition party that’s [expletive]  insane it means that they can run as Ronald Reagan and people feel they have no choice but to vote for them anyway. It must be so liberating for politicians not to have to worry about the effects of their policies on real people.

And let’s be clear about those effects: They’re going to be awful.

Never mind that in cutting government spending so greatly right now we’re going to make unemployment go higher, not lower. Forget that. No, we have a bigger problem: Because of cuts in health care and other human services provided by government, a nontrivial number of Americans are going to die prematurely as a direct consequence of this grandstanding, by both sides, on the debt ceiling. Both the president and Congress will have blood on their hands, and both have made it clear they couldn’t give less of a damn.



  1. Well it seems you and Brooks may be marching to the same drummer after all. No ?

    Death and Budgets… Facing it

    “A large share of our health care spending is devoted to ill patients in the last phases of life. This sort of spending is growing fast. Americans spent $91 billion caring for
    Alzheimer’s patients in 2005. By 2015, according to Callahan and Nuland, the cost of Alzheimer’s will rise to $189 billion and by 2050 it is projected to rise to $1 trillion annually — double what Medicare costs right now.

    Obviously, we are never going to cut off Alzheimer’s patients and leave them out on a hillside. We are never coercively going to give up on the old and ailing. But it is hard to see us reducing health care inflation seriously unless people and their families are willing to do what Clendinen is doing — confront death and their obligations to the living.

    There are many ways to think about the finitude of life. For years, Callahan has been writing about the social solidarity model — in which death is accepted as a normal part of the human condition and caring is emphasized as much as curing.

    In the online version of this column let me provide links to three other essays, which offer
    other perspectives on why we should accept the finitude of life and the naturalness of death. They are: “Born Toward Dying,” by Richard John Neuhaus, “L’Chaim and Its Limits: Why Not Immortality?” by Leon Kass and “Thinking About Aging,” by Gilbert Meilaender.

    My only point today is that we think the budget mess is a squabble between partisans in Washington. But in large measure it’s about our inability to face death and our willingness as a nation to spend whatever it takes to push it just slightly over the horizon. ”

    Maguire says essentially the same thing:
    “The question is, just how obvious is it that we will never cut off Alzheimer’s patients? And if eighty percent of people are pulling the plug on granny, will they continue to provide Medicare coverage for the twenty percent that hold out? That is money that could be spent on childhood nutrition programs or lifesaving medical research, just for example.”

    Comment by Fred Gregory — Friday, July 15, 2011 9:01 pm @ 9:01 pm

  2. Brooks presents a false choice and also desperately wants us to believe that the budget mess is NOT a squabble between partisans. Not only is it a squabble between partisans, it’s worse: It’s a squabble between the 1% who have 40% of the wealth, and everybody else. And he’s trying desperately to work for the 1% and distract people’s attention.

    Comment by Lex — Sunday, July 17, 2011 1:05 pm @ 1:05 pm

  3. You dodge the question regarding death panels or euphimisticaly, rationing. Brooks is enthusiastic for them . How about you ?
    Brooks says, “Most of us will still suffer from chronic diseases for years near the end of life, and then die slowly.” True, but the alternative is more dead people.

    The scary and sloppy case for rationaing

    “Brooks in the end doesn’t have the nerve to reach the logical conclusion of his arguments. He declares, ‘Obviously, we are never going to cut off Alzheimer’s patients and leave them out on a hillside. We are never coercively going to give up on the old and ailing. ‘ Well, then what is the point of his column? If he can’t stomach these outcomes why shouldn’t we continue to spend substantial sums to improve and elongate life?

    Perhaps the point is to rationalize reductions in health-care dollars spent on the elderly, which by gosh is precisely what the Obama administration is trying to pull off with its Independent Advisory Patient Board. Limiting care, conscience free! After all, do all these old people really enjoy living to 90?

    By all means we should have the debate over public and private resources. Let’s come up with
    market solutions that increase competition and reduce cost. Let’s minimize out unnecessary, external costs (e.g. malpractice insurance). And for the record, I am in favor of living wills and allowing those with terminal illnesses to refuse care. But let’s not kid ourselves.

    Anyone, for example, who has had an elderly parent, a friend with cancer, or an experience with mental illness knows the difference our health-care system, warts and all, has made in the lives of millions and millions of Americans. Who of us would choose to receive only the medical care available 20 years ago? And, from where I sit, I’m not ready to throw in the towel on my loved ones (or anyone else’s) because they can’t walk the dog.”

    Comment by Fred Gregory — Sunday, July 17, 2011 4:21 pm @ 4:21 pm

  4. I’m not dodging the question, I’m rejecting Brooks’s framing. They’re not the same thing.

    In fact, the U.S. spends more than it needs to keeping SOME people alive when it should be helping them die with dignity. But education, not government mandate, is the way to change that practice, and, as with abortion, the decision needs to be made whenever possible by the patient.

    My father made clear for years that he did not want to be kept alive artificially, and when he was in the hospital with his final illness (lung fibrosis), when he could no longer talk, he scribbled out instructions reminding us of his earlier instructions and adding, underlined, “NOT. LIKE. THIS.” He could, perhaps, have been kept alive for years with a tracheotomy and oxygen. He chose otherwise, and as sad as it made me and my family, we respected that choice.

    Comment by Lex — Sunday, July 17, 2011 9:27 pm @ 9:27 pm

  5. Sorry Lex, but you are still dodging. Your family’s sad experience is not all that diferent with what many sons, daughters, husbands and wives face every day. And education has brought about a significant change in which the crises are dealt with. In fact Rubin says in the article I linked : “And for the record, I am in favor of living wills and allowing those with terminal illnesses to refuse care.”

    There is a moral dimension floating around here somewhere in this discssion whether you choose to accept it or not.

    Well shucks,I don’t want to reincarnted like this that’s for sure, like in this cowboy poetry:
    Well son you ain’t changed all that much

    Comment by Fred Gregory — Sunday, July 17, 2011 10:22 pm @ 10:22 pm

  6. What, exactly, am I dodging here, Fred? I believe we spend too much money keeping some people alive, but money aside, I think it also is important that a lot of people who would prefer to die in comfort and dignity don’t realize all the options they have for doing so. Helping them do what they want to do would be better for them and easier on their families. It would have the coincidental benefit of saving one hell of a lot of money, but that’s not the most important reason to do it.

    Brooks just frames the issue badly, as he so often does. Nuland, to whom he refers, has explored this issue with a great deal more nuance in his books and New Yorker articles.

    Comment by Lex — Monday, July 18, 2011 10:09 am @ 10:09 am

  7. Oh, Fred, one other thing: If you read the Dudley Clendinen essay to which Brooks links, you see that Brooks has completely missed Clendinen’s point — which, coincidentally, is essentially the same as mine

    Comment by Lex — Tuesday, July 19, 2011 3:39 pm @ 3:39 pm

  8. I never voiced agreement with Brooks or you on rationing health care for the purpose of ending life. Or Bill Gates for that matter.

    Lex you should take your idelogical allies where you can find them.

    Brooks may have framed the issue badly but Rubin , if you read her entire piece, thrashes
    him pretty good . I am solidly with her.

    “David Brooks of the New York Times likes to fancy himself as a truth-seeker, bringing social and hard sciences to the masses. But in his Friday column on health care and death, he makes some shocking and inaccurate assertions. Given his coziness with the Obama administration one has to wonder if he is test-driving some Obama administration rationalizations for rationing.

    Brooks then embarks on a flight of misinformation to suggest we’re wasting much of that money. He finds other useful sources:

    As Daniel Callahan and Sherwin B. Nuland point out in an essay in The New Republic called “The Quagmire,” our health care spending and innovation are not leading us toward a limitless extension of a good life.
    Callahan, a co-founder of the Hastings Center, the bioethics research institution, and Nuland, a retired clinical professor of surgery at Yale, point out that more than a generation after Richard Nixon declared the “War on Cancer” in 1971, we remain far from a cure. Despite recent gains, there is no cure on the horizon for heart disease or stroke. A panel at the National Institutes of Health recently concluded that little progress had been made toward finding ways to delay Alzheimer’s disease.
    Much of this is flat-out wrong or misleading. We may not have “cured” all cancers (Brooks is misinformed if he thinks “cancer” is one disease). But survival rates for many types of cancer have soared, especially for breast, prostate and lung cancer. Five-year survival rates for the range of cancers went from 50.1 percent to 65.9 percent in 2000. Peter Pitts of the Center in the Public Interest told me in a phone interview that for many cancers ”early detection and aggressive treatment” can now extend life or result in effective “cures,” that is long-term remission.

    A recent report from the Center for Disease and Prevention control explained:

    As a result of advances in early detection and treatment, cancer has become a curable disease for some and a chronic illness for others; persons living with a history of cancer are now described as cancer survivors rather than cancer victims . From 1971 to 2001, the number of cancer survivors in the United States increased from 3.0 million to 9.8 million. . . . [T]the number of cancer survivors increased from 9.8 million in 2001 to 11.7 million in 2007. Breast, prostate, and colorectal cancers were the most common types of cancer among survivors, accounting for 51% of diagnoses. As of January 1, 2007, an estimated 64.8% of cancer survivors had lived 5 years after their diagnosis of cancer, and 59.5% of survivors were aged 65 years. Because many cancer survivors live long after diagnosis and the U.S. population is aging, the number of persons living with a history of cancer is expected to continue to increase.

    In other words, in just six years the number of cancer survivors increased nearly 20 percent. Interestingly, women and seniors have benefited the most. “Women are more likely to be survivors because cancers among women (e.g., breast or cervical cancer) usually occur at a younger age and can be detected early and treated successfully; in addition, women have a longer life expectancy than men. Among men, a substantial number of cancer survivors had prostate cancer, which is diagnosed more commonly among older men. The large proportion of cancer survivors aged 65 years reflects the increase in cancer risk with age and the fact that more persons with diagnoses of cancer are surviving 5 years.” Put differently, millions more Americans are alive because of progress in cancer research and treatment. I don’t know how one would put a price on the value of lives saved, the contributions those survivors continued to make to society and the children they gave birth to and raised.

    Brooks likewise bizarrely claims that there is no “cure” for a heart attack. He surely picked the worse example possible. A heart attack used to be a death sentence or a recipe for permanent convalescence. Now with the advent of beta-blockers, new medical technology and surgical innovations survival rates have risen dramatically. (Researchers, for example, found “rates [of in-hospital mortality] decreased among all patients from 1994 to 2006, falling more markedly in women than men. The steepest drop, 52.9%, occurred among women younger than 55. The mortality rate for men in the same age group decreased by 33.3%.)

    Alzheimer’s hasn’t been cured, but drugs to slow the rate of deterioration provide building blocks needed for continued progress. For diabetes the results are stunning. (“People diagnosed with diabetes between 1965 and 1980 lived approximately 15 years longer than those diagnosed between 1950 and 1964 (53.4 years vs. 68.8 years).

    Brooks, Pitts says, makes a fundamental error by setting up “cures” as the metric for assessing medical progress. “It is well-established that innovation in health care comes in incremental steps,” he explains. With increasingly personalized treatment made possible by genetic research the type and timing of drugs can be designed for optimal results. If we don’t spend money to make progress that might, for example, slow the rate of Alzheimer’s we’re not going to invest millions in one fell swoop to locate the “cure.” Pitts says, “If you don’t reward innovation,” by funding the painstaking process of step-by-step research we will cease making progress toward long term survival rates and cures, a result that is not morally or politically acceptable in this country. He observes, “The average American male’s life expectancy has increased by a decade over the last 50 years, largely to due pharmaceuticals. We innovated our way to that.”

    Moreover, Brooks ignores diseases such as AIDS, once a death sentence, that is now, albeit by use of expensive drugs, a manageable, chronic disease. Should we not have spent the money?”

    A good question.

    Comment by Fred Gregory — Tuesday, July 19, 2011 6:47 pm @ 6:47 pm

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