What You Should Think About Health Care

September 21, 2009

“Expensive medicines are always good:  if not for the patient, at least for the druggist.”

–Russian proverb

I recall, as a libertarian-minded youngster, becoming upset that media coverage of reforms advocated by Bill and Hillary Clinton referred to “the American health care system.”  I noted a fact as true today as it was then — this nation does not have a systematic approach to health care provision.  It bothered me to think that the implication of a “system” was misleading people into believing there was some sort of problem in need of a solution.

Today I remain concerned about use of the phrase “health care system.”  As a grown man with knowledge of the world that books alone cannot convey, I understand the grotesque inhumanity of American policy as relates to the provision of medical services.  It is a real and grave problem, a problem every other prosperous civilized nation has already solved within its own borders.  Arguments about the precise number of uninsured citizens only distract from the reality that tens of millions of Americans have no practical alternative to emergency medical services.

For some, this means sicknesses and injuries are only addressed in moments of desperation, with inefficient use of precious resources.  For some, this means sicknesses and injuries are endured despite protracted or even lifelong suffering.  According to [warning: PDF link] a recent Harvard study, for around 45,000 people each year, this leads to death.  Effective universal health care policy could save as many American lives as preventing one 9/11-magnitude attack every forty days!

Perhaps it is unfair to compare Republican party leaders with the leaders of Al Qaeda.  Yet the scope of preventable deaths brought about by human choices begs the question — to whom is that comparison unfair?  Are working class families caught in the gap between Medicaid and affluence somehow less innocent than the final occupants of the World Trade Center?  If expense is the real issue, why does solving the much more deadly problem of health care access warrant so much less support than the problem of terrorist attacks?

At a disturbing nexus of ignorance and irony, proponents of universal health care have been cast as villains who pose a threat to the American way of life.  That ignorance stems from some notion that it is unconstitutional for the federal government to see to the general welfare of the American people.  Never mind that the Article 1, Section 8 explicitly provides Congress with that power.  Never mind that the very first sentence of the Constitution articulates that duty as one fundamental purpose of our government.  As with so many other areas of debate, many critics of reform are unwilling to be swayed by even the most obvious facts.

If there has been any betrayal of the American way of life, it has been the institutionalization of political dogma holding that government action impedes private sector solutions.  While political leaders in the opposition party have either failed inexcusably in their duty to be informed or deliberately shirked their duty to serve the public interest, their followers are typically less villainous.  A month or so ago, one well-meaning and apparently patriotic woman shouted out that “the good hearts of the people” should be given a chance to address this problem.

As long as the problem has existed, public goodwill has had unfettered opportunity to provide relief to the sick and downtrodden.  In the early 1990s, it was already clear that philanthropy was inadequate.  In spite of enormous tax breaks for wealthy Americans in the interim, our nation has only seen more and more of our citizens uninsured or underinsured.  The notion that government cannot play a constructive role is repudiated not only by dozens upon dozens of foreign realities, but also by our own increasingly bleak public health reality.

Yet narrow interests remain zealously defended.  Some say that universal access to health care would somehow inhibit the development of new drugs and other medical technologies.  Does our nation lose nothing greater from tens of thousands of deaths (not to mention uncounted lost hours of productivity) brought about by inadequately treated medical conditions?  If medical innovation really suffers somehow from the provision of universal access, how much blood must be spilled in its name?

Yet even that is a false dichotomy.  Several European nations are each home to large thriving medical research enterprises.  Heck, even Cuba, in spite of scant national resources, manages to develop lifesaving new drugs at an impressive pace.  The idea that America, with so much raw wealth and so much intellectual capital, cannot meet the needs of its own people and still outshine the inventiveness of those other nations is a very strange assertion for a self-identified patriot to voice.

If there is any valid criticism of reformers, it would be about their widespread willingness to compromise with a political movement utterly at odds with facts.  In months of high profile public debate, few voices have been raised to ask just what profit-based health insurance actually accomplishes.  In effect, these institutions serve as private sector death panels. Somehow that term has instead achieved cultural resonance based on the fictitious and absurd rationing no public official has ever proposed to end the lives of Americans no one wishes to see dead.

Certainly there are times and places where compromise is in order.  When good faith efforts to get at the facts yield inconclusive results, bold action may be unwise.  Regarding the state of American health care today, it is only efforts made in bad faith that prevent widespread clarity about a national body count caused by a cutthroat economic paradigm applied to health care policy (not to mention monumental losses to productivity suffered by survivors of that same blight.)

Perversely, even as national media outlets are assault by propagandists, they continue to indulge purveyors of misinformation.  Again and again, transparent lies and the unrepentant dissemblers behind them are put on equal footing with provable facts and earnest informed advocates.  As with the disastrous plunge into Iraq, this critical political decision is being shaped by dialogues that equate major league national scoundrels with genuinely wise national leaders.  Yet whatever wisdom exists to promote reform, it seems unable to bring our nation anywhere near the kind of sweeping overhaul that would bring great benefit to each and every other enterprise by way of marginalizing a single parasitic industry.

Neither conservative nor libertarian thinking is without wisdom of its own.  This wisdom becomes folly when it relies on misinformation and hostile emotion.  Every day, more of our own citizens die because this particular folly continues without remedy.  If a few thousand Americans dying in 2001 justify enormous changes to our way of life, on what basis does anyone reject less dramatic change in to prevent the deaths of so many more innocent citizens?

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What You Should Think About Public Health

December 16, 2007

“To wish to be well is part of becoming well.”

–Seneca

Many political insiders seem to be expecting a 2008 race in which a Republican and a Democrat both run hard on a theme of “I’m not Bush.” Though a real clash of ideas cannot be ruled out before the contenders are selected, a contest of hollow sloganeering and character assassination may be as likely as the framing of substantive differences between the candidates. This makes the impending primary process all the more important — it may be the high point of the process in terms of focus on actual policy positions.

When it comes to health care reform, there is little serious commentary from the Republican side. Most candidates are happy to shrug at public unrest.  The party faithful are thought to be more upset by the emergence of a new government program than news that no action is being taken to address the issue. There is some rhetoric about the importance of allowing market forces to solve the problem, but at this point in history that can only be interpreted as a denial of facts.  If market forces were a remedy for this particular problem, then how did it become so much more severe during decades of acquiescence to those very forces?

On the other hand, the core of support for the Democratic Party is concerned about the problem.  They are also largely unwilling to believe that medical self-sufficiency is a wise policy when it comes to cancer patients, accident victims, etc. Even talk of a true universal health care policy is not a problem on that side of the mainstream aisle. Yet, for better or for worse, there is a wide range of opinions.

Near the start of this blog I wrote that Senator Barack Obama has gone farther in politics without personally disappointing me than any other modern leader. While I would not go so far as to say that my disappointment with him is deep, it was disheartening to see such a principled figure conceding that his approach to health care reform would be influenced by the agendas of insurance providers and pharmaceutical producers. Perhaps he is being honest where others opt for political spin, but it seems to me both Senator Edwards and Representative Kucinich are sincere in their declarations of intent to implement a truly universal system.

Many Americans continue to define right and wrong strictly in terms of legality or illegality. This is not absolute — most people are some combination of stickler, pragmatist, and outlaw. Yet willingness to drive 10mph over the speed limit or retain the proceeds of a bank error is not at all the same as the vision to support significant political change. While there is a (clearly bankrupt) ideological basis for contending that profit should drive health care outcomes, there is also a natural tendency for people to believe that the way things are is right simply because it is the way things are.

The way things are right now involves a form of legalized racketeering. At the level of major enterprise operations, the insurance industry provides a service by pooling resources so that unfortunate outcomes do not have an economic ripple effect by disabling otherwise sound businesses. At the level of household economics, the insurance industry continues to collect profits while doing less and less to minimize the lasting economic drag caused by unfortunate outcomes. A case can be made that life, home, and even automotive policies still do more good than harm. To make the same case for health insurance requires a willful obliviousness to reality.

In the very best cases, health insurance adds little to the cost of receiving health care even as it promotes regular checkups and other preventative activities. Such best cases are endangered, if not already extinct, in the modern business environment. More typically, health insurance adds tremendous overhead to the cost of receiving health care even as it discourages consumers from making optimal health maintenance decisions. For most who are fully insured, fees associated with responsible screenings and checkups may act as a disincentive to making the best personal choices.

Then there are those many Americans who are less than fully insured. Catastrophic health insurance — low cost plans that only activate in cases of serious injury or severe illness — do even more to deemphasize prevention. For the millions who either lack the funds to obtain insurance or the will to dedicate so much money to the cause, the reckless trend is increased further. The most cold-hearted of analysts may argue that there is some sort of justice in the suffering of those who did not act with ideal forethought to provide for themselves. Yet the entire nation suffers not only for this major waste of human capital but also for the increased medical demand generated by underutilization of preventative capabilities.

“Things as they are” in the health care sector are more problematic still due to the role of private insurers. Estimates vary, but there is no credible dispute that hundreds of billions of dollars are spent each year to maintain vast bureaucracies of these corporate middlemen. Not a dime of that money goes to actually preventing or curing ailments. Resources greater than those required to sustain the war effort in Iraq are consumed simply counting the beans involved in medical commerce. This does wonders for the wallets of executives overseeing this parasitic industry, but very little for the well being of sick or injured Americans.

It is fair to argue that a single government bureaucracy would, in efforts to minimize waste and fraud, require its own bean counters. However, the ridiculous bloat of health maintenance organizations and insurers sucking the lifeblood, both literally and economically, from working Americans is clearly an order of magnitude greater than what would be required to oversee the administration of a health care system in which basic preventative and curative services were provided based on human needs rather than opportunities for profit.

Doing so would not eliminate profit where it continues to serve some useful purpose. In fact, profit incentives would be refocused on areas where real good would follow from their pursuit. Big pharmaceutical companies would no longer be rewarded for producing slight variations on old medicines then stimulating demand for a new brand name product. Yet a shift away from that form of profiteering would merely free up their tremendous resources to pursue much more beneficial endeavors.  Truly helpful products would continue to enjoy widespread demand from truly helpful physicians.

Ultimately the national health care debate comes down to recognizing that fundamental truth — it is the purpose of physicians to be helpful. Any reasonable compromise would still allow for elite clinics where the most gifted physicians could charge a premium for their services. Any reasonable compromise would still allow supplemental insurance plans for wealthy citizens unwilling to mix with “common” Americans in terms of medical commerce. Yet any reasonable compromise also would marginalize one huge service industry that adds no real value at all to the economy.  Any reasonable compromise also would drive another huge industry to restore clear focus to producing value while producing pills.

What America lacks in the realm of health care is not the human resources to improve outcomes nor the economic muscle to get the job done. What America lacks is the political will to cut out the cancer of private health insurance and rehabilitate the system of private pharmaceutical manufacturing. Insofar as we do have the national will to stop spending more to get less, there is a strong force driving us toward those very changes. Success will involve overcoming the tremendous influence two key special interests have on the political process, but surely there is plenty of strength to be found in struggling on behalf of the general interest.

As the Democratic primary season unfolds, so too may unfold the future of American medical commerce. With a range of proposals from modest subsidies to outright socialization of the sector, this is an area of great uncertainty. Still, this much is certain — any comparative analysis of public health reveals that this nation has a serious problem. It also reveals that many other nations have thrived through decades of relying on serious solutions to this same problem. Resistance to any effective course of action really overcome the desire to solve that problem here?


What You Should Think About Abundance

November 22, 2007

“Abundance never spreads; famine does.”

–Zulu proverb

To describe economics as “the study of scarcity” is reasonable enough, as far as gross oversimplifications go. On the other hand, to follow such an assertion with arguments about the world itself being nothing but a set of scarcities is just plain wrong. In many instances demand for a good or service does exceed supply. Yet there are also instances where it does not. As most of the nation overeats alongside family and friends on this Thanksgiving Day, it is hard to overlook one form of American abundance.

Agricultural outcomes in the United States have as much to do with market economics as a commercial airline flight’s safe landing is a function of the shifting winds. By that I mean disasters may occur naturally, but on balance it is a planned activity. Agricultural policy does not so much influence as directly shape shape the menus in our restaurants and the inventory on supermarket shelves.

Not only does this engineered abundance have trade advantages — it also addresses vital security and public health concerns. Despite all our science and technology, harvests can still be fickle. If an unexpected blight or a bad turn in the weather devastates output from a particular region or with a particular crop, others will have the strength to pick up the slack. However vulnerable depending on foreign oil may make us, it would be an even greater vulnerability to become dependent on foreign food.

This is not to say that agricultural imports do not have, legitimately, a vital place in modern agricultural policy. Imported foods contribute to dietary diversity, which tends to be a healthy phenomenon. Given our own surpluses, we retain the option to turn inward in time of emergency. Also, save for art and media, food commerce may be the most culturally influential form of trade. All in all, trading food with our neighbors in the world is good for us, good for them, and good for our relationships as well.

Still, because of the safety provided by ample production, it has long been American policy to support domestic food abundance. Everyone has the potential to benefit. In regions where delicacies are produced, less is consumed locally as staples can be shipped in from afar for less than the value of goods from a fresh harvest. This is a benefit for people rich enough to incorporate delicacies into their daily existence. For everyone else, it means that food prices tend to be low and agricultural price shocks caused by nature can be avoided through reasonable dietary change.

Today there is new thinking on American agricultural abundance. Serious policy analysts do not dignify anarcho-capitalist twaddle about going unplanned and exposing our national stomach to the full force of the elements. However, there is much talk of revising planning guidelines in order to address the obesity epidemic. Policies established in the first half of the 20th century are still shaping the food intake of Americans in the 21st century. In a complex “chicken and egg” relationship, growing consumer interest in a healthy diet is accompanied by growing expert interest in agricultural policy reforms.

These reforms would shift focus away from heavily processed items and promote health by making whole foods more available to consumers. If the alliance of officials and corporations pushing for reform has their way, the national strategy that coordinates planting, harvesting, livestock feed, livestock slaughter, etc. will maintain or even elevate the level of satisfaction provided by supermarkets and fast food chains while inverting a key relationship. Under standards established in the 1950s, raw materials suitable for heavily processed products tend to be highly abundant while raw materials suitable for service after minimal processing remain scarce.

This situation drives corporate activity such that fattening foods are where the easy money is. Turning that trend upside down rewards companies that were innovative in the pursuit of brand identities related to healthier eating while removing the incentive for entrenched entities to maintain a keen focus on stimulating demand for unhealthy food. Getting out of this rut is only possible because a long-standing policy of abundance places government in the proverbial driver’s seat. Just as American nutrition improved with the original wave of coherent national agriculture policy, pending reforms off up the prospect of a new wave of improvements to be followed by gains in childhood development and general national health.

In debates about health care policy, there tends to be an implicit assumption that the United States is incapable of doing what dozens of other civilized nations have already done — pursue systematic abundance to produce consistently superior outcomes than the nation endures at present. It is very much a failure to see the forest for the trees. It may not be possible to engineer a surplus of every possible health care good or service, just as it is not possible to maintain a nationwide surplus of every possible fruit and vegetable. Yet it is possible to undertake sensible coordination of activity and deliver a general abundance to the benefit of all.

Agricultural policy first worked its magic in the United States through an emphasis on cereals and dairy products. Once upon a time, a good bowl of Wheaties swimming in fresh milk was the epitome of health food. By the same token, in a nation where millions have no involvement with physicians and millions more only turn to modern medicine after experiencing a health crisis, just delivering universal preventative care would be an enormous step forward. No doubt there is more to public health than getting virtually everybody to participate in routine checkups, but that measure alone would enable tremendous gains. It would actually conserve medical resources by decreasing the extent of time potentially crippling problems go untreated. If labor productivity gets a boost as well, that is hardly cause for complaint.

Yet too much of today’s thinking is afflicted with misconceptions. It is a misconception to think that sound planning could not generate a useful degree of medical abundance. It is also a misconception to think that providing ever-greater advantages to America’s top income quintile will somehow cause their abundance to become some sort of universal phenomenon. The past three decades of American economic history constitute one monolithic denial of trickle-down theories. On the other hand, it does seem to be the case that hardships are not so clearly self-contained amongst America’s poor.

Infectious microbes are no less at home in the bodies of the rich than they are in any other human beings. Contagion has no respect for net worth. Also, since most of America’s economic dynasties rest on corporate ownership or other forms of working investment, the rich suffer from degraded returns on those investments even as the poor suffer more directly whenever preventable illness leads to lost productivity.

Then there is the question of atmosphere. Wealthy Americans do not take an oath to avoid ever having any empathy with working class citizens. Defense of the “right” of the rich to not support universal health care is also an attack on the “right” of those same people to be better protected from disease, enjoy superior returns on domestic investments, tap into a more fit labor pool when launching new ventures, and live in a generally happier society. There is no choice that is not a choice.

As we settle down to dinner this day, we do well to honor the tradition of expressing thanks for our blessings. Though not perfect, the existing collaboration of farmers, corporations, and bureaucrats has accomplished much in the feeding of our nation. Even with all its flaws, a “do more with less” approach to working the land seems to have succeeded in principle. Given the resources and financial inputs devoured by our existing health care institutions, it would seem American endeavors in that area are presently guided by a “do less with more” paradigm.

In truth, that reality is an unpleasant side effect of being misguided by a popular paradigm that forbids even discussing the pursuit of abundance in our capacity for healing. Yet I believe it is a pursuit well worthy of the effort, including the effort to dispel false narratives about unresolvable scarcity. Should we, as many other nations already have, manage to achieve useful abundance in medicine, then our nation will enjoy a new form of strength. Universal health care would be a particular relief to the poor, but its indirect benefits would substantially improve circumstances for the rich too. Were it part of the American way of life, then on future days of Thanksgiving we might all know one more blessing to be counted . . . or at least one more useful abundance to take for granted.


What You Should Think About Medical News

October 25, 2007

“The only way to keep your health is to eat what you don’t want, drink what you don’t like, and do what you’d rather not.”

–Mark Twain

Rarely a day passes without some new proclamation about the nature of a healthy diet. In some households this can produce grumbling about the overconfidence of doctors. Usually medical researchers are not at fault. It just happens that as the story passes through layers of intermediaries, it becomes distorted. Researchers publish with an eye toward being critiqued by peers. Popular medical journals borrow from this and publish with an eye toward keeping professionals up to speed. By the time someone involved with a general media organization decides to do a story about new findings, the emphasis is much more on storytelling than relating the actual findings.

In fairness, this is not just because original medical papers would be unpopular items in daily papers and television newscasts. Most readers would also find raw research uninformative. Competent dutiful science journalists build a bridge between general audiences and the original research. They assess it with expert eyes, then parse it in such a way that their own work is the most accurate and informative retelling their abilities permit. Generating interest with this model involves having some passion for the subject and being exposed to enough research as to have no shortage of genuinely fascinating topics.

I believe the emphasis on cutting corners does even more damage here than crass commercialism. Like a children’s soccer team, reporters in any given niche seem to act as a mob in pursuit of a single thing. After all, why stick your head in academic papers day after day when it is possible to skim somebody else’s report, perhaps glance at another document or two, put it in your own words, and still look like you’ve done the job of a diligent professional? When someone completely fabricates a report (or in Dan Rather’s case, when someone lets one fabrication slip into a report,) the result is scandal. Yet the “do just enough not to get fired” paradigm generates plenty of work that borders on scandalously poor quality.

On the other hand, commercialization is not blameless in all this either. It probably has much to do with a tendency to decontextualize statistics. For many conditions, risk of mortality is less than 1%. If eating a particular food causes a 0.08% chance of mortality to become a 0.17% chance of dying from that same condition, that food is far from toxic. Yet many editors would be much happier to oversee a report claiming “problem food doubles your chance of dying from <insert cause here>” than something like “this food may increase your risk of <insert condition here>.”

A difference like that may seem subtle. Yet a subtle difference in language combined with a dramatic difference in tone can turn a humdrum observation into an alarming report. I dispute the idea that alarming reports make for more popular news than fascinating observations (especially when the alarm is rooted in trivia.) However, I do understand production of fascinating science journalism is hard work, while making people scared of everything but their own shadows can be an easy day at the office.

Medical journalism in mainstream venues is especially problematic because it easily plays into a common misconception — immortality. Sure, everyone on the tall side of puberty should be well aware that death is a human inevitability. Yet how many people really think about it? How many people have come to accept the weight of such a thing? For many young adults, death is something that happens to other people. Even as the years take loved ones from most and provide personal close calls for some, this profound matter is still often left on the fringes of awareness. No doubt this is sensible and healthy — a constant preoccupation with death is generally regarded as one sign of a troubled mind.

Thus, in between the bombastic music and dramatic graphics, an ominous report about how this habit or that diet might have a 2% chance of causing your death is not typically met with the thought, “well, something’s got to do it.” The lack of context transforms new findings that only deserve a little consideration among those intent on a healthy lifestyle into some sort of dramatic threat to which all decent self-loving Americans must be strongly averse.

Of course, basic common sense has some say in the matter too. As legitimate information is transformed into unnecessarily dire warnings, the general public only develops a thicker skin as applied to medical risks. “So what if oil-based paint causes cancer when it seeps into groundwater? Last month ‘they’ said fried chicken could kill you!” goes the final interpretation of a story. The abstract “They” responsible for all expert opinions increasingly fades into background noise.

Commercial media then must strive harder to succeed in efforts to attract audiences through hyperbolic alarmism. The mechanism reinforces itself. This not only wastes people’s time by failing to provide more informative content; it also minimizes the impact of medical expertise when something that truly deserves alarm comes to light. Be it an obesity epidemic, overmedicated children, undermedicated hospice patients, etc. the medical issues of the day that should be a big deal sometimes get lumped in with the noise made about fresh research of trivial consequence.

One way to address this is simply to lose interest in those types of stories. If you go to the media to have an emotional reaction, both broadcasters and publishers offer up no shortage of excellent drama (or reality shows, for the shallow folks.) If you go to the media to become more informed, consider filtering out alarmism even if that means ignoring the majority of “health news” items. Of course, that approach is not for everyone.

In the alternative, get in the habit of digging the facts out of whatever journalistic coverage happens to encase them. Distinguish between research that quantitatively assesses risk and research that manages to establish a mechanism of causation. When practical, try to find out whether reports related to risk factors were normalized or based on raw data.

I would never deny that smoking is an unhealthy habit, but in a broad sample the higher mortality rate of smokers would be significantly attributable to a range of other factors from childhood nutrition history to occupational hazards. Without knowing what efforts have been made to factor out other influences, it is difficult to formulate any context for health risks ranging from the pesticides on apples to the tannins in Zinfandel. If you can get down to the facts without being moved by an emotionally charged presentation, then there is still much that can be learned from medical research . . . even after it percolates through the filters of commercial media.


What You Should Think About Stem Cell Research

October 8, 2007

“The Christian church, in its attitude toward science, shows the mind of a more or less enlightened man of the Thirteenth Century. It no longer believes that the earth is flat, but it is still convinced that prayer can cure after medicine fails.”

–H. L. Mencken

The new morning greets us with news that a Nobel Prize has been awarded to three men involved with breakthroughs in the field of stem cell research. Of course, their work is not truly controversial. The “mice have souls too” lobby has yet to make a big splash in our nation’s capital. Though this work did involve embryonic stem cells, it did not involve human cells at all. So, other than putting “stem cells” on people’s minds around the water cooler, the cultural ripples from this should be minor.

Yet stem cell talk is not at all pointless in a nation that seems to remain divided by the issue. Reaching for the wisdom of King Solomon, our President instead demonstrated the wisdom of Solomon Grundy. His approach to an issue straddling science and theology was, in the end, purely political. Just before a terrorist conspiracy would give George W. Bush years to show the world the extent of his spectacularly poor judgment, he issued an executive order to this effect — the kind of medical waste some people believe to be sacred must remain medical waste and at no time should be used to save terminally ill human beings.

Of course that is not the language Karl Rove would craft to explain this bizarre “worst of both worlds” compromise. Yet that does sum up the order. One might regard my characterization as unfair based on the fact that lifesaving stem cell therapies were largely experimental in 2001. So I suppose I should append “even indirectly” to hit the nail on the head. However passionate your feelings about human blastocysts and spirituality might be, the White House action only insures that the fate of these common byproducts of in vitro fertility (IVF) treatments remains disposal as waste.

Whether or not these microscopic Petri dish inhabitants, with their theoretical potential to grow into human babies, deserve to be treated as waste was never the issue. There is little political upside to crushing thousands of affluent (the process is never cheap) couples’ hopes of parenting their own biological children. IVF can be unreliable. Thus producing surplus embryos reduces not only the cost, but also the health risks of repetitive surgery. To put it crudely, when nature and less invasive methods do not lead to pregnancy, you’ve got to break a few eggs to make a baby.

Yet these broken eggs are not always unfertilized. Sometimes the earliest cell divisions reveal signs indicating a full term pregnancy is unlikely. Sometimes the first implantation effort succeeds, leaving high grade reserve embryos no longer wanted by the relevant sperm and egg donors. There have been symbolic efforts at finding upstanding evangelical Christian women willing to carry other people’s embryos to term in order to avert disposal, but that is hardly a comprehensive (or sensible) response to the realities of IVF.

While the fate of unwanted embryos remains grim, so too does the fate of many Americans with an assortment of degenerative, often terminal, conditions. The nation may be divided on how much God is offended by the handling of artificially cultured human embryos, but I would like to think we are united in wishing there was some hope for people with Parkinson’s Disease or ALS. Then there are people suffering from brain or spinal injuries that leave them severely disabled with little prospect of recovery other than a breakthrough in regenerative medicine. Heck, I even think some consideration should be given to the people who might simply like a new head of hair or replacement teeth.

There may be workarounds to bypass the theocratic roadblock. In some contexts, using even more complex procedures, scientists have been able to cause cells harvested from adults to exhibit some of the crucially useful behaviors of embryonic stem cells. For the hair and teeth crowd, I suppose delays related to popular spiritual beliefs may be reasonable. Is it also be reasonable to wait on opportunities to liberate people from crippling injuries? Should people dying a slow death from terminal conditions go unhealed to respect religious demands regarding the treatment of unwanted IVF embryos?

Fortunately this debate does not require answers to those questions. Because existing federal policy does not actually accomplish a single thing in the field of preserving, never mind gestating, surplus embryos; the President’s policy is much worse than it seems at first glance. It delays or denies possible cures for no higher purpose than to save the man’s own public face. In an impressive display of political scumbaggery, the debate was complicated by nuances like “it’s not really a ban, it’s just a way to insure taxpayer money does not fund this stuff,” and “well, they can still work with a small number of existing lines. That’s still research, right?”

There would be no more American wars if our Presidents respected comparatively sensible pacifists as much as they respect zealots dedicated to injecting hardline religious dogma into public policy discussions. All taxpayers have made a huge contribution to finance an effort that somehow made Iraq a much more deadly and hateful place than it was under the thumb of a tyrant. Why some citizens felt it was much more unbearable to fund research into a possible fix for Michael J. Fox’s tremors is beyond me.

Precisely which therapies will become practical when is still largely speculative. Yet there can be no doubt that this field features a rush of spectacular breakthroughs just waiting to be puzzled out by great thinkers. In most parts of the world this research is allowed to continue. Yet here in the United States (sans California,) this critical realm of biotechnology is practically forbidden territory. Even the most heartless cutthroat capitalist cannot be happy about surrendering a competitive advantage in a growing niche . . . all in the name of making George W. Bush appear smart.

It doesn’t take much thinking about his 2001 stem cell decision to realize it makes the sitting President look like a lot of things . . . and “smart” is not among them. Whatever you think about the potential of adult stem cell research, there is no justification for perpetuating a “trash only” policy in the handling of surplus IVF embryos. Any delay in advancing this frontier can be measured in untold human suffering and large numbers of human deaths. If anything, continuity with this policy only demonstrates to the world just how far one particular politician will go to avoid uttering a significant mea culpa.


What You Should Think About Socialized Medicine

October 4, 2007

“Children are like wet cement. Whatever falls on them makes an impression.”

–Dr. Haim Ginott

Of all the episodes of American history that might be preserved by nostalgia, it is downright tragic that the Red Scare should survive into the 21st century. Not even the actual “Reds” Americans were made to fear lasted as long as the negative emotions inflamed by the likes of Joe McCarthy and Richard Nixon. Yet even now we see the most progressive public figures with a shot at the White House running scared from latter day redbaiters.

The term “socialism” is lobbed about like a grenade. It causes panicked flight with comparable haste too. While the rest of the civilized world becomes healthier, taller, more productive, etc.; my own people expose millions of children to risk of lifelong disadvantage simply to honor the lottery of birth. While the rest of the civilized world takes (mostly) sensible measures to reduce workplace absenteeism, preventable disability, and preventable death; the unthinking hatred of socialism that pervades our political culture generates huge obstacles to similar progress here.

These discussions bring to mind the truism, “there is no choice that is not a choice.” Such a statement goes beyond ironclad fact and into the realm of truth emergent from logic alone. Of course every choice is a choice, but what does that mean? Well, I would be surprised if most Americans in the upper income ranges actually would choose to live in a society with more contagion, more misery, and more death . . . all in the name of reduced taxes.

A false narrative holding that America’s wealthy are of one mind in opposition to socialized medicine feeds into the popular lie by which such policies are characterized as oppressive. To obstruct these initiatives has every bit as much impact on the freedom of people who want to live in a healthier society as supporting health care reform may impact the freedom of people who desire lower taxes. What I mean by “there is no choice that is not a choice” is that inaction thwarts the will of those who desire action no less than action thwarts the will of those who desire inaction.

All too often, critics of socialized medicine carry on as if secret police and state sponsored torture were at the bottom of some slippery slope that begins with taxpayer funded treatment for pediatric cancer patients. Now that recent history shows us the sort of personalities and policies that actually do nudge free peoples in the direction of fascism, a “tyranny of the majority” critique condemning social justice in medical care becomes all the more bizarre. Yet that criticism remains strong today, with far-reaching implications.

Both Hillary Clinton and Barack Obama have chosen to craft their health care proposals with an eye toward protecting the parasitic profiteers of the insurance industry. Because the existing situation enables many organizations to generate gargantuan piles of revenue without contributing any good or service of identifiable value to society, to challenge the status quo is to guarantee zealous lucrative support for one’s electoral rivals. Bribing a do-nothing industry into going along with overdue social change may not be as costly as maintaining a large scale military presence in Iraq, but it is still much more costly than taking direct action to address the medical needs of American citizens.

You don’t need your own car to be glad we have public highways, and you don’t need to be a plaintiff to be glad we have civil courts. Why then do so many people seem to swallow the argument that society as a whole would not benefit from measures that would much improve our standards of public health? Like so many other problems with a political dimension, a contributing cause is deliberate misinformation. When a patient has a long wait for an American doctor, it is accepted as good the physician was industrious enough to book a tight schedule. When a patient has a long wait for a Canadian doctor, it is regarded as a snafu “proving” the inferiority of government bureaucracy.

Yet American health care is already entangled in layer upon layer of complex bureaucracy. Corporations and governments are both organizations. I so wish the past several years had deprived all Americans of the myth that “government ought to be run more like a business.” The private sector has no monopoly on effective management, and federal programs are only run as badly as the leaders charged with operations or oversight manage to run them. If anything, people still enamored with a warped “corporations always do better than government” philosophy should be kept far from the halls of power, because that belief is a barrier to sound thinking in those jobs.

The purported advantages of the private approach — consumer freedom, self-optimizing efficiency, resources concentrated in the hands of the most effective healers — are largely phantoms of rhetoric. Shopping around is downright stupid in an emergency medical situation, and little enough of it occurs in matters of routine or elective health care. Market oriented thinking fails us in large part because the nature of illness and injury combine with the complexities of modern medicine to squelch the kind of unconstrained behaviors that drive a truly free market. Then there is the old saw about corporate research, as if producing yet another brand name cholesterol reduction pill or heartburn remedy was the alpha and omega of medical innovation.

The recent veto of a federal effort to better unite America’s children with America’s health care resources may be a bold stance based on principle, if one assumes irresponsible ignorance pervades the White House. In the alternative, it was a cruel stance based on the notion that sicklier American children are a small price to pay for perpetuating bogus narratives born out of the Red Scare. In the end, the entire nation pays dearly. Lack of access to preventative care creates additional need for curative care while lack of access to curative care promotes disability and death.

In light of all this, what should you think about socialized medicine? If you are actually thinking, then you will compare what is real over here to what is real abroad and recognize the opportunity for huge gains in public morale and public health. Long term economic growth tends to follow from sustained gains in those areas. The insurance industry funds robust misinformation campaigns that go far beyond financing the political campaigns of today’s redbaiters. If you remain rational and do not succumb to the fear they spread, there is much good to see in this idea.

I personally advocate socialized medicine because I believe a measure of taxation is reasonable for the purpose of alleviating preventable misery amongst America’s working poor, not to mention children of poverty as well as indigent folks. I understand pragmatic questions about the importance of caring for those who are not likely generate much future personal income. I find it distasteful to place such a low value on human life, but I also offer a better response than distaste.

Even someone who was fanatically dedicated to overall growth should align somewhere near my position. Proper treatment for children means a more capable workforce in the next generation. Proper treatment for today’s workers means more productivity in the near future. Even proper treatment for retirees, prisoners, and vagrants will tend to be less costly than cleaning up the public messes unchecked desperation or tragedy tend to produce. Like it or not, the reality is that we are all in this economy together. The sooner we recognize that reality, the sooner we can take action to capitalize on opportunities for a better future.