In this week's National Journal poll of political bloggers, all of the Right bloggers and almost all of the Left one agreed that Nancy Pelosi had hurt herself "with her handling of the waterboarding controversy." Most of the Left bloggres thought that she "Hurt herself a little," while the Right overwhelmingly picked "a lot."
I was in the latter group, and wrote: "The idea that the CIA might have lied to Pelosi, or might be lying now, is not implausible. The idea that Pelosi has been forthrightly providing a consistent version of what she knew and when she knew it appears impossible."
Question 2 asked about "including a new public insurance plan in health care reform." On the Left, 72% said that "Excluding it would be a deal-breaker," while the remainder wanted a public plan, but did not consider it essential. On the Right, 83% opposed a government plan, and 58% called it a deal-breaker. That group included me, and I wrote: "The government insurance program would inevitably benefit from taxpayer subsidies, making it less expensive, in the short run, than independent plans. Over time, the independent plans would be driven out of business, and even before then, many employers would force their employees into the government program. As private competition is eliminated, the imposition of Canadian-style rationing becomes feasible."
Bloggers: Pelosi hurt herself. Total split on gov't health insurance:
I believe Pelosi on the narrow factual question of whether the CIA briefed her in 2002 that the first waterboarding had actually occurred. No one -- not Leon Panetta, not Porter Goss, not Pete Hoekstra -- straightforwardly disputes her word on that. The CIA logs of the briefing are obviously not credible, as Bob Graham's own on-the-record account demonstrates. And of the internal CIA records describing what took place in briefing, Hoekstra says having reviewed them, it "won’t be crystal clear" what happened.
The preponderance of public evidence today shows that Pelosi was correct on that point: The CIA apparently did abrogate its duty to disclose the interrogations, and seems to have creatively covered up that failure.
However, on the larger issue of Pelosi's acquiescence to torture, she still does not look good.
The crippling nature of congressional intelligence briefings was a mitigating factor. For example, she and all the congressional leaders briefed had to rely on the conclusion of the Justice Department that everything was lawful, and the OLC opinions were withheld from them. But as a political and moral matter Pelosi and Harman seemed more complicit than not for failing to object more vigorously.
"... not implausible(?)" Weasel words. Do you think they lied or not DK?
DK, what exactly, is "Canadian-style rationing?" and why it is any worse than "US-style rationing we currently have? That is, you get good health care in the US if you have money, not necessarilly so good if you have no money.
All commodities, including health care, are rationed. The issue is not whether to ration but what method of rationing is best.
Huh? The fact some who were briefed cannot or will not state that they are certain a particular topic was discussed does NOT provide much weight to the argument the topic was not discussed. As we all know, memories fade with time. On the other hand, the memo released by the CIA summarizes the meeting notes from the several briefings of members of Congress that were given over several years. The memo was based on the materials that were created at the time the briefings took place. The memo states quite clearly that Pelosi was briefed on the enhanced interrogation techniques that had been approved. It also states Pelosi was briefed on the interrogation that took place the prior month that used those techniques.
While it's true that the memo could misrepresent (intentionally or otherwise) the source document it summarizes, it's hard to see how anyone could place more weight on faded memories of what took place than on a summary of contemporaneous documents.
It is noteworthy, however, when they agree on a particular proposition.
Canadian style rationing is when my great-Aunt Catherine over in Windsor has her knee replaced quite successfully, and then several years later when it's time to replace the other one, the bureaucrats tell her she can't go to the orthopedist who'd successfully done the first one, but rather must go to whichever stiff is next in the cue, which happened to be a hack, and which procedure cursed her to limp around or be immobilized, and suffer terribly for the last years of her life.
That's Canadian style rationing.
I'd replace "feasible" with "inevitable."
The right thing to do IMHO is to push for a government program to compete with private programs and to set it up as a level playing field between the two. In the rest of the OECD, government dominates health insurance, and at a much lower cost per capita than the US. That may work too in the US if set up right and given a chance. Or maybe not. It seems worth trying. If the government plan sucks or is too expensive, people won't use it.
Whether Pelosi was told that waterboarding was used, or merely could be used is a distinction without a difference.
> Why is that inevitable?
Because that's how all these things work. (It's not inevitable that the fastest horse will win a race, but odds are that it will.)
> The right thing to do IMHO is to push for a government program to compete with private programs and to set it up as a level playing field between the two.
How about we put all govt employees and folks receiving govt-funded health care into the proposed system before we do anything else? If it works as promised, these folks will be healthier and so on. Then we can look at costs.
She and other Dems would like to forget that there was a time for about a year after September 2001 when no one, and I mean no one, was willing to challenge Bush on anything having to do with national security.
She'd be a lot better off if she just admitted that speaking out at that time would have been political suicide. Denial isn't going to earn her any friends on the left or the right.
Canadian style rationing is where life saving PET scans are withheld from the public in Ontario (the largest province by population), and severely rationed elsewhere in Canada. PET scans are expensive but they save and prolong the lives of tens of thousands of cancer patients in the US.
You can't get them in Ontario because of a bureaucratic decision, and the wait is about 3 months in the rest of Canada. All the PET scan clinics near the border get dozens of Canadian patients every week paying the approximently $7000.00 cost out of pocket, because they can't get a mininum standard (by US standards) of care in Canada.
Make no mistake about it, Government run health care means rationed care, which means longer waits for even critical treatment, and some more expensive treatments unavailable.
It's very simple. The parties who say X are willing to say so unambiguously, on the record. No party disputes their account of that factual recollection of X. So I take them at their word.
The memo states quite clearly that Pelosi was briefed on the enhanced interrogation techniques that had been approved. It also states Pelosi was briefed on the interrogation that took place the prior month that used those techniques.
What memo? You have no "memo" to quote, unless you are writing from inside the CIA and are violating the law. There is a public chart purporting to be a log of the briefings, but it does not "state" anything at all in a clear, declarative sentence. There actually are no complete sentences at all. And several entries in the chart have been demonstrated to be wrong.
While it's true that the memo could misrepresent (intentionally or otherwise) the source document it summarizes, it's hard to see how anyone could place more weight on faded memories of what took place than on a summary of contemporaneous documents.
Once again, no "memo" has been made public, only the chart without a complete sentence. The chart does not state clearly that the briefers did, in fact, disclose that waterboading had, in fact, occurred.
The identical, ambiguous noun phrase is recorded on the chart to describe both the briefing of Pelosi and Goss and the briefing of Graham and Shelby:
That weasley construction could easily mean that waterboarding, a technique "that had been employed," was described at the briefing, but the fact that it actually had been used was not disclosed.
Only two of the four members of Congress will say what they recall about the fact in question. Both Pelosi and Graham -- whose own recollection is bolstered by his own meticulous contemporeaneous notes -- say flatly that the CIA briefers did not disclose that waterboarding had occurred. Notably, Graham says that in his briefing, waterboarding was not even mentioned.
The CIA has a more detailed account of Pelosi's briefing, which is still classified. Presumably we might call that record a "memo." That record, purporting to be a memorialization of what occurred in the briefing, has been inspected and described by Pete Hoekstra, who concedes that it is ambiguous on that central point of fact.
The longer the issue is discussed the better for those who are interested in the merits rather than short-term political points. Whether Pelosi's Gallup numbers decline is not important, as her position seems pretty secure.
You, sir, will be in the first batch of citizens scheduled for relocation, as soon as the reeducation camps complete construction.
Anybody else got any smartass remarks they wanna get off their chest?
"All commodities, including health care, are rationed. The issue is not whether to ration but what method of rationing is best."
According to your definition, we ration gasoline today in the US in that I have to pay for the fuel I get at the petrol station. If so what was that "gas rationing" we had during WWII all about? "Rationing" generally means something outside the normal pricing mechanism. We we tell people that they can't have more of something they want even if they are willing to pay for, that's rationing.
Finally is "health care" a commodity? Go over to Bloomberg News at look at "commodities." Do any of those items even remotely resemble health care? If health care is a commodity then the medical care I get a Kaiser is pretty much the same I get at the Mayo Clinic (Rochester). I don't think so.
Today there are only private insurance plans, albeit heavily subsidized by the Federal government. The government insurance is defunct. (Although, to be exact, Congress has enacted ad hoc disaster programs from time to time over the years.)
Why is it always "Canadian-style rationing?"
Canada has a particularly Draconian form of national health care in that you can't go outside it without leaving the country. The system is different in the UK where you can go to a private doctor and pay out of pocket. I don't know about France.
No. It is a distinction with a significant difference.
1) On the core question of Pelosi's credibility, it matters absolutely. It appears that she is telling the truth about the CIA misleading Congress.
2) The apparent fact that the CIA violated the National Security Act, and that its officials may have committed a crime by misleading Congress, is itself a material matter.
I do agree, as I said in my first comment, that this distinction does not get Pelosi off the hook on the larger question of how she exercised her oversight -- or apparently failed to do so. I agree that polically and morally she shares some complicity for torture because she and Jane Harman could have probed and protested more vigorously.
I believe Sam's Club is selling health care plans of some sort, and you can walk in to Wal Mart for med care I believe. Don't know whether you consider that a "commodity" sale, but if Sam Walton's outfit is involved, it's gotta be in the neighborhood of that.
Health insurance plans could be commodities, but that does not mean health care itself is a commodity.
If that's the definition of rationing that you want to go with, then no one of consequence is even remotely suggesting rationing health care in the US. Under any plan under discussion, people remain free to go outside any insurance plan and get whatever health care they're willing to pay for.
Yes, we do ration gasoline.
All economic systems ration goods and services in one way or another.
In a market system, priority for goods and services are given to the highest bidder.
In a communist system, in theory, goods are rationed to each according to his need.
It is just a question of how you want to do it. Arguably, the market system is the most efficient (and it is a very strong argument). That does not mean it is the fairest system.
With health care, one would think we would want to strive to the fairer system. With gasoline, the more efficient is probably better.
Funny, that is exactly the reason why I support the public option.
I think you are draining the word "rationing" of its common meaning as my WWII gas rationing example shows. Of course you're right that all economic systems allocate the production and distribution of goods and services in some fashion-- that's a consequence of finite resources.
The Communist countries did use a price system to allocate goods. In Russia you were free to buy 2 bottles or 10 bottles of Vodka at some price. But those countries had "state capitalism" and not communism. We don't really know how goods and services would be produced and allocated in theoretical Communism as Marx was silent on these kind of details.
"That does not mean it is the fairest system."
Little kids are always talking about "fair." "That's not fair daddy." In the grown-up world we need to get more specific and practical. Some people want more medical services than others. For example people want a colonoscopy every 3 years. Others are satisfied with every 10 years and some people (including a doctor I know) never want it. It all depends on your degree of risk aversion and how you want to spend your money. What most of us don't want is for the government to tell us how many procedures we need and don't need.
I don't see why we shouldn't have a pricing system for medical services with a few exceptions. Public health for one. We certainly want a public approach to the control of infectious diseases. But for many other services, especially elective surgery allocation by price seems reasonable.
"... no one of consequence is even remotely suggesting rationing health care in the US. Under any plan under discussion, people remain free to go outside any insurance plan and get whatever health care they're willing to pay for."
Of course. The politicians could never sell such a program at the beginning. It would meet fierce opposition from the public. But let's face it, that's what we will get at the end of the slippery slope. How are we going to expand medical services to universality without some form of a command system as to who gets what and for how much? Obama plans to introduce an amnesty bill this year. If it passes, then through chain migration we will have an additional 50 million Mexicans come into the US over the next 20 years. Who is going to pay for their medical care?
Also, I have not heard any serious policymaker, or even many serious left-wing health care activists, suggest that we do as Canada does and utterly forbid those treatments that the public plan declines to cover. Consumers would simply be forced to pay out of pocket for those treatments not deemed cost-effective for the public plan to provide. This is no different than what private insurers do now; they, too, have lists of treatments that they don't cover, but they also don't forbid patients from finding and purchasing noncovered procedures and medicines.
The real battle shouldn't be over the existence or nonexistence of a public plan. It should be over the continuation of the state-by-state monopoly system (i.e., the proscription against purchasing across state lines), as well as (relatedly) the extent of coverage mandates that would apply to either private plans, state-provided plans, or the federal plan. The threat of being compelled to purchase coverage for a massive number of treatments that I have no realistic prospect of needing is what scares me most, financially, when I contemplate where the nation's health care system may be going.
How do you know Sen Bob Graham's notes are meticulous?
I read how he writes down what he eats for breakfast, etc., which borders on mental illness.
Did you ever read his notes? Why are there no entries in Graham's notes about how he is writing notes all the time. Writing notes all day never appears in his notes.
I like the way you put it: allocation of resources.
The issue is how to allocate fairly and efficiently. And, yes, a market system has an aspect of fairness to it. If you have something of value, e.g., money, you can trade it for something of value. IMHO, health care is a necessity, like electricity and water. Perhaps health care plans should be treated as public utilities.
IMHO, the USSR is not a good example. I don't see it as a "communist" state as envisioned by Marx. It was bad. It purported to be communist. But I don't think it was. I believe it was worse than any communist state could ever hope to be.
Poor people (or people who just did not want to devote extra money to extra health insurance) would get a certain level of care. People who paid more for the extra insurance would get more inclusive, or faster, or whatever, health care provided. And some people would opt out completely from the government plan, and would buy competing full-coverage health insurance.
But at least everyone would now have some coverage. (Which, at the least, would result in a huge decrease in trips to the Emergency Rooms, since a lot of health issues would be treated proactively, or before they develop into more serious (ie, more expensive) problems.)
I would think that free-market fans would love this. If the government-run plan is run poorly and/or inefficently, then the market would take care of it, and people would gravitate back to private plans. And it would be the poorly-run private plans that would lose the most business. Which is how it should be. One reason why many people stay with their current insurance is because--if they have been sick--they may not be able to get new insurance at a fair rate, or may have "existing conditions" excluded, which would be of little benefit.
Through my mom's friends, I know many people who qualify for Medicare, and they all universally love it. What are the big insurance companies afraid of? (That was rhetorical; I know full-well what they are afraid of.). But really; for those railing against an inclusive government plan (that people can opt out of). . . I still don't see any convincing arguments for that position. You don't want 'Canadian-style' rationed health care? Then stay in your current plan. Let the rest of us move into Medicare, or something similar, and we can stop being the only First-World country with a health system that fails so dramatically for so many of its population.
But little support from the hardcore Left, which eschews competitive models such as that.
Wal Mart controls their costs because they are responsible to make a profit on the ultimate sale. State run enterprises are not responsible to turn a profit, and in fact will run a deficit as we see, and as we will be seeing more of as the entitlements train wreck hits us.
Issues other than profit matter to state run enterprises. For Obama Motors, UAW contracts are of primacy. Obama Health Enterprises will have other prime interests, and we can only imagine what those will be. Experience with public education indicates that the government healthcare enterprise will be beneficial to those working in the enterprise, as a prime issue, and services provided and costs secondary issues.
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My wife has us involved in a Health Savings Account. She says it's the best thing ever, and she's an expert on manuevering through these things. We use what we want, and carry over what we don't need, and the paperwork and hassle is minimal, remarkably so as compared to all other types we've had. Evil Dick Cheney pushed for those HSA's, didn't he? Pure evil, that man.
Ah, so, I see. The government health insurance plan will insure that everyone has a basic level of health care, and then "...people remain free to go outside any insurance plan and get whatever health care they're willing to pay for."
And then how long before the cacaphony of cries of outrage from the usual quarters against the "unfairness" of a system that allows the "rich" to get MRI's and catscans and other advanced treatment techniques immediately, not after months on the queue. Then in the interests of "equality" the private plans will be banned and everyone will have to wait for treatment.
And the Marxist system of spreading the poverty will be properly installed. Only those in the nomenklatura will be able to get the really good health care.
"IMHO, health care is a necessity, like electricity and water."
Unlike medical services, utilities like water and electricty are commodities-- you pretty much compete on price. Utilities are also capital intensive and have tremendous barriers to entry. In medicine there is room for competition. I can go to the Mayo Clinic or the Cleveland Clinic, or even the individual practitioner near me. Medical service providers can also compete on quality of service as well as price. Thus I don't think we can usefully compare utilities and medicine.
As for "necessity," that a pretty elastic concept. Just how much medicine is actually necessary? Devout Christian Scientists have opted out of the medical system altogether, and they haven't gone extinct. I would like to know how their health compares to the general population.
I have not yet seen a compelling a argument as to why the normal pricing mechanism does not apply to medical services with a few exceptions-- public health, emergencies etc. Unfortunately private insurance has distorted the whole system. Insurance has led people to believe that they shouldn't have to pay for medical services. That somehow it's a "right." I have to take an expensive migraine headache medication. My insurance pays for it, but if it didn't I would have to face the question: how much is it worth to me not to have a migraine?
If the government ever gets to the point of being that it is that position of negotiating with suppliers of health care at that level, then you can expect shortages, rationing, and/or waiting lines because there won't be the private system there to take up the slack, as there is now.
You can't realistically expect doctors to work for minimum wage, hospitals to admit patients below their own costs, or drug companies to fund new drug research and development without being able to recoup their costs. The doctors will quit, the hospitals will close their doors, and the drug companies will quit inventing new drugs. All almost inevitable if the government tries to bargain down costs all across the board for all, or even most, consumers.
If it were just a case of allocating a thousand or two dollars per person, then this might not be a problem. But whenever the government screws up a market like this, supply and demand get royally screwed up. In this case, without real control over demand, demand will skyrocket, and supply won't keep up (and esp. with the government trying to control costs).
And, yes, we see excess demand by Medicare patients, since they aren't paying the full price (or anything close to it) of their health care. It is, of course, worse, because of how massively they are being cross-subsidized by the rest of us. So, you have my 90 year old uncle getting a hip replacement. Would he have done so if he had been paying for it, or really even a sizable percentage of it? No. But it was almost free to him, so why not (I should add that he was a triple dipper, with Medicare/social security, military, and federal civil service benefits, which may have made this worse).
So, what is going to keep all those who don't have insurance now because they aren't working out of the doctor's offices and hospitals, since they don't have that much else to do, if society ends up paying for their health insurance? What is there to limit their demand, since price would no longer be an issue?
I think a much better system would be to supply a reasonable lower bound on the medical care provided those who aren't willing or able through fault of their own to pay for their own health care. And, then then let the rest of us buy whatever we, and our employers, want.
A government program that can set prices artificially low due to market leverage and advantages provided by law that are not available to private insurers? Kind of like how private insurance subsidizes Medicare's below-market rates now, only worse?
According to the Medicare method, the ideal system is one where doctors and hospital payments are slashed until they are paid one cent more than would cause them to quit seeing patients entirely. This is not really a recipe for a very happy health care system but because individual providers and hospitals are forbidden by law from negotiating together while the government can negotiate en bloc it is where things will go.
The failed USSR is of course a bad example, unlike Cuba, China, Zimbabwe, and soon to be Venezuala. Somehow they never turn out to be the utopias envisioned by Marx or his acolytes. But since Marxism requires a complete remake of the hyman psyche, it is an impossibility that in practice will always lead to mass murder and totalitarian control, because that will be the only way to get those danged proles to obey.
However, this disparity between the way it always must present in reality and the wonderful vision of paradise the words in Das Kapital predicts allows the continued existence of True Believers. They live mainly in the halls of academia in the only conutries rich enough and tolerant enough to be able to afford such a waste of intellectual resources, the ones with the hated capitalist systems.
If only the USSR had been done the way they would have done it...
Do you really believe that your 90 year old uncle getting a hip replacement is a waste of resources?
If so, I think that your views are naturally going to diverge from the mainstream, because that is a little extreme.
I personally think it is more admirable when someone is aware of and open about the knowledge they actually have rather than being unaware or deceptive in asserting they have knowledge they do not.
If David Kopel doesn't know if the CIA lied, but thinks its plausible, I think that is what he should say. He shouldn't instead say: yes, the CIA lied or no, the CIA didn't lie. Right?
Well, the post says he wouldn't have done it if he were paying for it, IOW the uncle we prefer to spend his resource elsewhere. So it sounds like the 90 year old uncle thinks it was a waste of resource.
Your view would make sense if his uncle was rich. But, since that is unlikely, your point probably doesn't make sense.
Someone who doesn't get a procedure that they would have no way to pay for are not in any meaningful sense asserting that such and such procedure is not worth the resources.
Also, some people are stingy in a manner that isn't particular rational. Just as others are spendthrifts in a manner that isn't particularly rational.
The question is not whether the uncle would pay for the procedure with his own money. The question is whether we as a society believe that a hip replacement is a good use of resources.
I would positively assert that those who think that providing older citizens with hip replacement surgery is a waste of money are extreme and very much outside of the mainstream. That some individuals would make different decisions about their own procedures because they do not have the money or because they are idiosyncratic doesn't really change anything.
Who cares if a flaming Democrat like DK thinks Pelosi was right? More important, "I fear for our bacon" wins.
Maybe your right, but I can't read Kopel's mind and either can you. Maybe you can make the argument that "possible" is better than "not implausible" but I think I myself and most people are guilty of sometimes using the less efficient phrase in all sorts of contexts. So, I don't think you can leap to any psychological conclusions based on that.
Canadian style rationing is where life saving PET scans are withheld from the public in Ontario (the largest province by population), and severely rationed elsewhere in Canada. PET scans are expensive but they save and prolong the lives of tens of thousands of cancer patients in the US.
So just to be clear, there will be overwhelming demand for PET scans and other types of treatment by people ready and willing to pay for them but who just can't find someone to give their money to, but at the same time all those PET clinics will be out of business due to an inability to compete against a government subsidized program.
Got that?
But my point there is that they are having these hip replacements at those ages because it is essentially free to them. Which is what happens when you repeal the price side of the supply/demand curve. And the likely result, in the long term, with socialized medicine is that the price mechanism is replaced by rationing.
Below all the hype, you always come back to that, that whenever price mechanisms are interferred with, and people are not, fairly directly, paying for the services they request, then there will be a lot more demand than can be supplied. Adding a bunch of consumers to the system who aren't going to pay for the health services that they will be consuming is just going to make this worse.
Oh, and that uncle. We can't ask him whether it was worth it, because he never fully recovered from the operation, and died within a year or two of having it. But if he were still here to ask, I doubt if he would say it had been a good choice, since he probably didn't get back to where he was in his walking before the operation.
Add to this that she has effectively squashed the ethics investigation of one of her biggest supporters (Rangel), and as a result, shut down the ethics system in the House. Not good for someone whose people ran on a platform of cleaning up the House and transparency.
You can be sure that she and her counterpart in the Senate (Harry Reid) will be the primary targets in a year and a half by the Republicans. The Republicans are likely not dumb enough to run against President Obama, and Pelosi and Reid are much better targets. The best thing that the Democrats in the House could do for continued control of that chamber in 2011 would be to dump her for Seny Hoyer.
The free market already rations scarce medical care the same way it rations most things, by ability to pay. And that means all the usual benefits to innovation and inequality of access. On the other hand, there are some resources, like police and fire protection, that despite a presumed loss if innovation and efficiency, we take out of the marketplace and ration according to need, because we consider them a right, not a privilege. The question is whether medical care is more like police and fire service or landscaping and limousine service.
The hypostatisation of "society". Perhaps there is something to think upon behind the words "we as a society believe", but I find the words themselves more of a veil than a window. As it is, I do see the expression "we as a society believe that hip replacement is a good use of resources" as having more real content than "we as a society are at war with Oceania" -- but not much more.
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