Sunday, September 6, 2009


I'm violating my Brooklyn resident status by not being at a bbq right now, but *whispers* I think PBR tastes like piss. Don't hurt me.

Embracing Rationing:

Chris Bertram takes the hard stand that I think advocates of any sort of comprehensive single-payer plan, which Chris Bertram definitely is, are going to have to take: that some lives aren't worth saving.
Quote which says absolutely nothing of the sort, instead saying a reappraisal of treatment and research goals would be beneficial although easily misrepresented as rationing. Bertram's concluding lines:
So it turns out that the McMegans of this world are right about one thing: in a just society (not that they'd call it that) there would be less spent on expensive medical/drug research and development than a country like the US spends now. But that's a good thing : against a background of fairness and equality, rational and fully informed people would look at the opportunity cost of such activity and say "no thanks!"
I don't think this really follows. First of all, with the exception of cancer drugs, there aren't many drugs that are developed for people in the last few months of life. In other contexts, people complain about this: instead of developing a cure for cancer, we've got another goddamn antidepressant.
Note, she "doesn't think it follows", meaning she has no actual argument, in no small part because she didn't even read what she quoted, hence ignoring the examples Bertam provided.
Instead she talks about medical equipment which, as she points out, is used by all sorts of people recovering from extreme injuries, which is totally relevant, no, really.
And then there's this crap;
Then there's the time inconsistency problem. How much are we really willing to argue that it's wrong to stop a would-be suicide, wrong to dissuade people from smoking, wrong to refuse to pay for your 19 year old daughter to pursue her dreams of a rock career rather than a degree in accounting? But unless we are, we have to ask how thoroughly we should attend to the desire of the young self to ignore the needs of the old self. Dworkin thinks we should ask people what they would buy for themselves from behind a sort of personal veil of ignorance. But why is the perspective of someone at the beginning of their life the right one? Why not ask people what they would want at the end of their life? There's a problem of specificity, but surely you could develop some kind of average set of services, which would probably be very different from what you would pick in youth.
... what? My grandmother had Alzheimer's, Megan. There's no quality of life to to maintain at the end of that progression, and, notably, Bertram was not discussing withholding treatment but rather not spending millions on developing expensive but for all intents and purposes ineffectual treatments. R&D outlay is already being fucking rationed in favor of profit taking via dividends, but that doesn't count because Megan won't acknowledge it. But not seeing the value in researching new drugs with identical effects to older drugs on which the patent has expired in order to maintain profits means we want to kill Grandma. Especially when the drugs in question have minimal effect to begin with.
And then there's this;
Of course, for me, the core problems are more basic: I don't think that there is "a" regime of social justice to which all right-thinking people subscribe, which me [sic] reluctant to empower technocrats to enforce this mythical consensus.
Because having insurance adjusters decide what is a medically necessary treatment based on their desire to maintain profit margins is working fucking fantastically, at least in Megan's mind where it's still the 70s and they still act like humans.
There's another intuition that at least libertarians have, which is that it is not as bad to have undesirable things result from an impersonal process than from an active decision. It is bad if someone's house burns down and they couldn't afford insurance. It's worse if someone's house burns down, and they were in the class of people deemed unworthy by a bureaucrat of having their house rebuilt.
....... ummmmmmmmm, Megan? How fucking stupid are you?
I think almost all progressives have the opposite intuition. They think it's better to try to produce an optimal result, even if that results in individual injustices (which it will--government rules are very broad brush, and will always involve error at the margins). I'm not sure how to bridge that intuitive gap.
Apparently only governments have bureaucracies, just like only they can ration. If it were otherwise Megan would be horribly, horribly wrong, horribly misinformed, and not a very good person. And she thinks she's nice, so it just can't be.
I know I didn't snark this post very well, but sometimes her stupidity is too offensive to be creative with.


shane said...

There's another intuition that at least libertarians have,

Bring on the stupid!

which is that it is not as bad to have undesirable things result from an impersonal process than from an active decision.

That might be an interesting discussion if we didn't spend twice as much as other industrialized countries and get worse results. Why does anyone waste their time arguing with this idiot?

Mr. Wonderful said...

I love that "impersonal process." That's the market, to her. Actually this feels like a very telling remark. That--a process for which no one is responsible, that unfolds no matter what anyone does, and therefore whose results are nobody's fault--is her idea of what society is or, ideally, should be.

It's an abdication of the very principle of rationality. It's economic pantheism. It's the metaphysical way of saying what we know to be the libertarian's core moral principle: As long as I've got mine, I needn't worry about anyone else. Because it's all "impersonal," you see.