Monday, September 07, 2009

“A More Perfect Death”?

Mortality has absorbed more of my attention lately…

Richard Ross (one wonders if this was not some kind of Freudian slip) Douthat makes an ingenious argument against assisted suicide in this NYT op-ed. In place of the usual death-panel argument of the slippery slope, “especially under government-managed health care, to some sort of death-by-bureaucrat,” he offers the idea that “in the profligate, Promethean United States, it probably won’t lead to rationing-by-euthanasia. It’s just as likely to become one more ‘intervention’ that we insist every health insurance plan should cover — on our way, perhaps, to a rendezvous with fiscal suicide.” On the way, he argues that American “instincts run so strongly toward unlimited spending that it’s much easier to imagine the government going bankrupt paying for extreme life-saving procedures than it is to imagine a suddenly cost-conscious bureaucracy pressuring doctors to administer lethal overdoses.” In other words, assisted suicide is the cherry on top of the exploding fiscal cake of nationalized medicine—America the profligate, in death as in life.

Douthat’s argument against assisted suicide sets aside the familiar, ethical objections and ventures into the culturalist realm. As such, it immediately sends my skepticometer readings through the roof. Still, it’s more logically consistent than any death-panel argument I’ve heard so far from opponents of universal healthcare with a public option.


Ross said...

First, his name is not Richard.

Second, anything is more logical than the "death panel" argument because there is no logic in the link, only propaganda.

Third, he's projecting. It's Republicans that have a problem with fiscal profligacy, which they cover up with claims that fiscal rectitude is, for them, a baseline principle. It is not, at least since Reagan. He's a Republican.

Fourth, these silly arguments have to devolve into notions of culture because, well, he doesn't actually have an argument. Culture is the repository of our collective ignorance. (Think about how many people have said foolish things about Japan which they then attributed to culture.)

Sorry for venting.

Jun Okumura said...

Ross: A summary of my post would be “< strike >Richard< /strike > Douthat makes an ingenious argument against assisted suicide…that sets aside the familiar, ethical objections and ventures into the culturalist realm. As such, it immediately sends my skepticometer readings through the roof. Still, it’s more logically consistent than any death-panel argument I’ve heard so far”

That being said, not being an American, I don’t have to “vent.” Instead, I appreciate the visceral rejection of universal healthcare as one of the Two Wonders of the New World—the other being the NRA interpretation of the Second Amendment—much in the way that I enjoy the fruits of progress in computer graphics in the form of prehistoric nature programs.

Matt at said...

I haven't studied this issue and so I don't know much about it. However, it's easy to imagine both over extravagance and "death" panels.

What I mean is once you have someone hooked up to extravagant and costly machines and living in a kind of semi-conscious state, how long do you keep them like that?

Sadly the only way to determine this is either via

i. a capitalist system in which cost has to be weighed by each family individually (via insurance policy or lack thereof)


ii. A socialized system with some type of centralized rational planning. Yet even here, there would probably have to be some delegated bureaucratic function in which some person decides when enough is enough and the machines have to be turned off.

Ultimately, as decisions like this are so personal, it does seem to me that having a bureaucrat make it would indeed be problematic.

I guess now the situation is far from clear because the current system is a bit of a hybrid between i and ii.

I guess you've seen this:

Ross said...

OK, so the Douthat argument is essentially that the US gov't will extend unlimited health care funds because we cannot be trusted to stay within budget. And I suppose the evidence is the massive social spending the US engages in relative to, say, the spendthifts in France.

As to Matt's argument, we really don't have much of a hybrid. We aren't new to this. We already socialize medicine for the vast majority of people who find themselves nearing death. If you have a problem with how it is presently handled then explain that.

As for the ultimate decision, there really isn't a "person", bureaucrat or otherwise, making it. Rather, the tradeoffs have been managed through a collective decision making process that includes elected politicians, bureaucrats, the courts and ordinary citizens. It's far from perfect and suggestions for improvement are welcome. But let's not act like this is something new. Indeed, it is already managed.

And the Republican "death panel" talking point is simply propaganda tossed at an idea, helping people manage their own decisions in the process, that had been pushed by Republicans in both legislative chambers.

Jun Okumura said...

Ross, Matt: I’ll add to the list of people making decisions the adjusters in the insurance companies.

Generally speaking, Matt, I do have sympathy with complaints about government inefficiency. But the idea of patients and their families making well-informed decisions is something of a myth, I’m afraid. The informational asymmetry is huge. There’s a reason why taxis prices are regulated; there’s also a good case to be made that government is well-advised to step in where choices regarding medical care should not be left totally to the decision of the individual.

That being said, I also do my best to understand what I can only call the American way. The apocryphal—or not, there is no way of knowing—stories about protesters calling on the government to take their hands off their Medicare aside, and after discounting for enormous hypocrisy and considerable misinformation, there remains a powerful streak of independence and self-reliance that is hard to find elsewhere in the developed world (or anywhere for that matter; the third world appears to be highly reliant on family, clan and tribe) that drive some Americans to reject things that would clearly be to their benefit. But I ask you to note that I used the adjective “enormous.” Medicare, Medicaid; then there’s social security, to name the ones I’m aware of. America, more than Japan, has a patchy, jury-rigged social safety net. Allow people to opt out if you must, but are you willing to make sure that such people suffer the consequences as well?

Matt at said...

"But the idea of patients and their families making well-informed decisions is something of a myth, I’m afraid."

Who determines what a well-informed decisions is? Aren't we talking about moral preferences here?

I was just offering a general free market argument. (Above you begin to offer a kind of culture-ism type argument. I usually reject arguments like this for the same reason I reject orientalism or nihonjinron.)

If I were to look into this, I'd immediately want to start looking at the funding to see how well funded medicare and medicaid is. My initial *guess* would be they were underfunded, but that the government makes up the difference by borrowing. This would then take one back to the question of how America is going to handle its growing debt, and what the implications are for the rest of the economy.

By the way, why is it the price of computers always goes down, but medicine always goes up? Generally speaking isn't it the case the prices should come down as technology improves? Superficially, this at least doesn't seem to be the case when it comes to medical care, does it?

Anonymous said...

Here's an interesting case ( if you can't click, copy, paste, & delete white space):

Alternative case 1:
She has private insurance. What does the company do? Well, if the publicity is bad, it might have to lower the prices of its premiums to continue to attract business. Or it might promise coverage in the future, and therefore it might actually have to raise it's premiums. Either way, people concerned would need to investigate the company before they purchased the policy. The price of the insurance would be to some extent a reflection of the coverage.

Alternative case 2:
She has no insurance. I don't know. Can we presume the baby would have died? This involves a very serious discussion. Things that would need to be investigated would be the history of charity. What has been the effect on charity of national health care plans, regulation, and lawsuits? Under a freer regime would charity become more common? What does history say about this? (Also, would costs come down under a more capitalist system allowing more charity in that sense as well?)

-- matt at anarchyjapan