30 December 2010
The Life of Death Panels
The debate about “death panels” rages on because it is being conducted by interested parties, like the government and its “independent commissions” who have or influence the power to tax, the medical profession that serves the wishes of its individual clients, and legal advocates, including David B. Rivkin Jr. and Elizabeth Price Foley in the December 30, 2010 Wall Street Journal. Rivkin and Foley blame the FDA for banning the prescription of an expensive drug, Avastin, for the purpose merely of briefly extending and palliating the final months of a terminal breast cancer victim. This is one of the reasons why the American health care system threatens to bankrupt the country. It should not upset us when the FDA judges that the individual benefit of using a costly drug in place of other palliative procedures to avoid “a swifter and less dignified death” is outweighed by adverse side effects and the likely greater epidemiological result of devoting some of our limited resources to serving the medical welfare of the public at large.
Rivkin and Foley fail to come up with a solution to the conundrum the Obama administration finds itself in with costs skyrocketing and individuals demanding entitlement to everlasting lives. While the FDA’s ruling on Avastin actually constitutes the imposition of beneficiary cost-sharing that they prescribe—100% cost-sharing—it will generate nothing but political resistance until Americans admit that their passage on this earth is only transitory.
Convincing them of that won’t be done by any of the voices that argue for health reform now. It must be done by a truly independent voice, uncompromised by its political or commercial stake in the outcome of the debate. Trial lawyers, elected officials, health care providers, all must motivate and defer to real opinion leaders—philosophers, community organizers, teachers, preachers, writers, entertainers—for modifying people’s expectations about their physical existence. Life will inescapably end and we’d better stop blaming anyone else for it and making them pay for failing to correct it.
The debate about “death panels” rages on because it is being conducted by interested parties, like the government and its “independent commissions” who have or influence the power to tax, the medical profession that serves the wishes of its individual clients, and legal advocates, including David B. Rivkin Jr. and Elizabeth Price Foley in the December 30, 2010 Wall Street Journal. Rivkin and Foley blame the FDA for banning the prescription of an expensive drug, Avastin, for the purpose merely of briefly extending and palliating the final months of a terminal breast cancer victim. This is one of the reasons why the American health care system threatens to bankrupt the country. It should not upset us when the FDA judges that the individual benefit of using a costly drug in place of other palliative procedures to avoid “a swifter and less dignified death” is outweighed by adverse side effects and the likely greater epidemiological result of devoting some of our limited resources to serving the medical welfare of the public at large.
Rivkin and Foley fail to come up with a solution to the conundrum the Obama administration finds itself in with costs skyrocketing and individuals demanding entitlement to everlasting lives. While the FDA’s ruling on Avastin actually constitutes the imposition of beneficiary cost-sharing that they prescribe—100% cost-sharing—it will generate nothing but political resistance until Americans admit that their passage on this earth is only transitory.
Convincing them of that won’t be done by any of the voices that argue for health reform now. It must be done by a truly independent voice, uncompromised by its political or commercial stake in the outcome of the debate. Trial lawyers, elected officials, health care providers, all must motivate and defer to real opinion leaders—philosophers, community organizers, teachers, preachers, writers, entertainers—for modifying people’s expectations about their physical existence. Life will inescapably end and we’d better stop blaming anyone else for it and making them pay for failing to correct it.
29 December 2010
Obama Begins
In the December 28, 2010, Wall Street Journal, Fouad Ajami comes to the sensible realization that after a year of groping in the contentious atmosphere of Washington Barack Obama finally has found his footing to manipulate the framework of the federal government in order to achieve some of what he was elected to do. His assumption of the Presidency inspired a lot of hope around the country as well as around the world. Perhaps he and his aides were dazed by this reception, and fooled into the belief that governing would be easy now that the campaigning was over. However, it turned out to be exactly the opposite.
What a student of domestic and world history like Mr. Ajami should recognize is that even the most effective political leaders often mistake their success in reaching the seat of power for a promise of easy riding from then on. For example, Franklin Roosevelt got his second-year comeuppance from the Supreme Court. Abraham Lincoln took a year and a half to find a general who could convert his vision of Union inexorableness into battlefield dominance.
Obama’s opposition in Congress believed that it could pander to the concerns of America’s middle class about overwhelming government debt by mandating tax reductions. Their strategy apparently was to force the other party to reduce spending on entitlements and avoid having to take that step themselves. Ironically, they won majority control of one house of Congress and will have to whittle the large government health and retirement benefits programs themselves.
The President will show his mettle by managing the necessary culling of those programs in a way that makes clear to the public that refusing to pay the piper inevitably sends home the band. He has taken the first step by accepting extension of the Bush tax cuts. Now he must help shape the resizing of government so as to fairly distribute the disappearance of some of its largesse.
In the December 28, 2010, Wall Street Journal, Fouad Ajami comes to the sensible realization that after a year of groping in the contentious atmosphere of Washington Barack Obama finally has found his footing to manipulate the framework of the federal government in order to achieve some of what he was elected to do. His assumption of the Presidency inspired a lot of hope around the country as well as around the world. Perhaps he and his aides were dazed by this reception, and fooled into the belief that governing would be easy now that the campaigning was over. However, it turned out to be exactly the opposite.
What a student of domestic and world history like Mr. Ajami should recognize is that even the most effective political leaders often mistake their success in reaching the seat of power for a promise of easy riding from then on. For example, Franklin Roosevelt got his second-year comeuppance from the Supreme Court. Abraham Lincoln took a year and a half to find a general who could convert his vision of Union inexorableness into battlefield dominance.
Obama’s opposition in Congress believed that it could pander to the concerns of America’s middle class about overwhelming government debt by mandating tax reductions. Their strategy apparently was to force the other party to reduce spending on entitlements and avoid having to take that step themselves. Ironically, they won majority control of one house of Congress and will have to whittle the large government health and retirement benefits programs themselves.
The President will show his mettle by managing the necessary culling of those programs in a way that makes clear to the public that refusing to pay the piper inevitably sends home the band. He has taken the first step by accepting extension of the Bush tax cuts. Now he must help shape the resizing of government so as to fairly distribute the disappearance of some of its largesse.
28 December 2010
The End-of-Life Counseling Debate
It is not the role of government to change citizens’ opinions. Nor is it the role of the medical profession to persuade patients to adopt a reasonable attitude towards the extension of life beyond the point at which it is pleasant and affordable. Both of these institutions perform a service to their clients; and the customer is king. The issue of end-of-life care is rightfully the concern of independent opinion leaders who are not compromised by their power to tax or their skill at preserving life.
It is evident that American culture now incorporates the belief that the wonders of science can be mobilized practically to avert at least one of life’s inevitable fates—death. However, Americans are confused when they believe that the point of health care is to prolong life. Its real objective is to allow humans to achieve as fulfilling an existence as they reasonably desire by eliminating as many medical impediments as possible. A balance must be struck between the expense of alleviating sickness, particularly chronic disease, and the chances for attaining a fulfilling life, both on an individual’s cost/benefit scale and on society’s as a whole.
If we are to manage the cost of our health care system, our democratic society must be convinced that wellness and long life are not identical. This can be a difficult distinction to make; but once it is broadly accepted and removed from the political debate, the looming bankruptcy of our health care system could be brought to an end.
It is not the role of government to change citizens’ opinions. Nor is it the role of the medical profession to persuade patients to adopt a reasonable attitude towards the extension of life beyond the point at which it is pleasant and affordable. Both of these institutions perform a service to their clients; and the customer is king. The issue of end-of-life care is rightfully the concern of independent opinion leaders who are not compromised by their power to tax or their skill at preserving life.
It is evident that American culture now incorporates the belief that the wonders of science can be mobilized practically to avert at least one of life’s inevitable fates—death. However, Americans are confused when they believe that the point of health care is to prolong life. Its real objective is to allow humans to achieve as fulfilling an existence as they reasonably desire by eliminating as many medical impediments as possible. A balance must be struck between the expense of alleviating sickness, particularly chronic disease, and the chances for attaining a fulfilling life, both on an individual’s cost/benefit scale and on society’s as a whole.
If we are to manage the cost of our health care system, our democratic society must be convinced that wellness and long life are not identical. This can be a difficult distinction to make; but once it is broadly accepted and removed from the political debate, the looming bankruptcy of our health care system could be brought to an end.
06 December 2010
Representation Distorts Democracy
Elections are a distortion of the ideals of democracy that was once necessary because of the inefficiency of communications technology. Now that it is possible for citizens to be continually updated on political issues through social media on the Internet, our elected leaders and particularly our representatives at the federal and local levels are losing their raison d’etre. This could be an explanation for the policy-making strategy of the Republican Party in the U.S. Congress. They have acquiesced to the selfish demands of the segment of the public that funds their continuous media-centric election campaigns. The message of those campaigns is aimed at the lower and middle class voting public: the nation’s welfare depends on keeping its wealthiest members happy. Instead of representing the public at large, the conservative members of Congress advocate policies that are favored by the special interests whose contributions make it possible for them to stay in office.
What is unsettling about this development is that the more liberal representatives in Congress, the Democrats, have also fallen into that trap. They have abandoned advocacy of equitably distributing the burdens of government, particularly in the case of income tax rates, out of fear that they will also lose the means to finance their expensive reelection campaigns. This has been done in the name of fostering compromise in government policy-making. But it only proves that everyone on Capitol Hill is more afraid of losing their job than of failing to represent the general interest.
Owing to this result, it is time to take advantage of modern advances in information technology and to reform our governmental system by making it rely on the direct opinions of the public for establishing policy. Our elected officials should be limited to advocating policy options, without the power to adopt any of them. All such decisions should be made by referendum.
Elections are a distortion of the ideals of democracy that was once necessary because of the inefficiency of communications technology. Now that it is possible for citizens to be continually updated on political issues through social media on the Internet, our elected leaders and particularly our representatives at the federal and local levels are losing their raison d’etre. This could be an explanation for the policy-making strategy of the Republican Party in the U.S. Congress. They have acquiesced to the selfish demands of the segment of the public that funds their continuous media-centric election campaigns. The message of those campaigns is aimed at the lower and middle class voting public: the nation’s welfare depends on keeping its wealthiest members happy. Instead of representing the public at large, the conservative members of Congress advocate policies that are favored by the special interests whose contributions make it possible for them to stay in office.
What is unsettling about this development is that the more liberal representatives in Congress, the Democrats, have also fallen into that trap. They have abandoned advocacy of equitably distributing the burdens of government, particularly in the case of income tax rates, out of fear that they will also lose the means to finance their expensive reelection campaigns. This has been done in the name of fostering compromise in government policy-making. But it only proves that everyone on Capitol Hill is more afraid of losing their job than of failing to represent the general interest.
Owing to this result, it is time to take advantage of modern advances in information technology and to reform our governmental system by making it rely on the direct opinions of the public for establishing policy. Our elected officials should be limited to advocating policy options, without the power to adopt any of them. All such decisions should be made by referendum.
05 December 2010
China’s Dangerous Game
China has been buying U.S. Treasury debt in order to enable American consumers to buy its manufactured goods. This is a dangerous game that runs the risk of the collapse that caused the Great Recession of 2008.
During the 1990s and 2000s, corporate America and its toadies in Washington encouraged “cash-out refinancing” of home mortgages under the guise of broadening home ownership, but really as a way to bolster consumer demand. The liquidity it created for middle class Americans allowed expanded spending not only on manufactured goods (both domestic and imported) but also on financial, entertainment and a wide range of other services. When the bubble of real estate values burst, every sector of the U.S. and many other Western economies saw a sudden and lasting decline.
China’s leaders are wise to be transforming the country into a consumer society in order to replace its reliance on U.S. and Western consumption for the demand needed to support economic growth. China’s main attraction for Western investors has long been its dreamy billion-plus consumer market. If that is to be the destination for its own output in the future, its leadership must study hard the lessons of the Great Recession in order to avoid a similar collapse. Its investments in U.S. and other Western government debt can suddenly lose value when the band stops in this game of musical chairs and the only place to find a seat will be at home.
China has been buying U.S. Treasury debt in order to enable American consumers to buy its manufactured goods. This is a dangerous game that runs the risk of the collapse that caused the Great Recession of 2008.
During the 1990s and 2000s, corporate America and its toadies in Washington encouraged “cash-out refinancing” of home mortgages under the guise of broadening home ownership, but really as a way to bolster consumer demand. The liquidity it created for middle class Americans allowed expanded spending not only on manufactured goods (both domestic and imported) but also on financial, entertainment and a wide range of other services. When the bubble of real estate values burst, every sector of the U.S. and many other Western economies saw a sudden and lasting decline.
China’s leaders are wise to be transforming the country into a consumer society in order to replace its reliance on U.S. and Western consumption for the demand needed to support economic growth. China’s main attraction for Western investors has long been its dreamy billion-plus consumer market. If that is to be the destination for its own output in the future, its leadership must study hard the lessons of the Great Recession in order to avoid a similar collapse. Its investments in U.S. and other Western government debt can suddenly lose value when the band stops in this game of musical chairs and the only place to find a seat will be at home.
