UPDATE: A Toothless Task Force? Hardly.
UPDATE: Since publishing this post about the US Preventive Services Task Force around 2 p.m., I have been told by the White House that my interpretation of the Senate legislative language is off. This was, incidentally, the interpretation of several non-partisan policy experts I spoke to as well, but that doesn't matter. What matters is setting the record straight. The White House says that the section of the Senate health reform bill I quoted...
‘‘SEC. 2713. COVERAGE OF PREVENTIVE HEALTH SERVICES.
‘‘(a) IN GENERAL.—A group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for and shall not impose any cost sharing requirements for— ‘‘(1) evidence-based items or services that have in effect a rating of ‘A' or ‘B' in the current recommendations of the United States Preventive Services Task Force;
...only means that US Preventive Task Force recommendations would determine which preventive services private insurers would be federally required to cover at no cost to patients. Linda Douglass, the communications director for the White House Office of Health Reform, says, "The Secretary [of Health and Human Services] would have the discretion to add other preventive benefits to the essential benefits package." This means, under the Senate bill, the task force would decide which preventive services private insurance beneficiaries would get at no out-of-pocket costs. As for other preventive services - including those requiring co-pays or co-insurance - that would be up to HHS.
It's important to be clear on these provisions in the bill, because the coverage requirements for private insurers would be some of the most consequential effects of health reform. But it's also important to point out that while the Secretary of Health and Human Services may have a different opinion than the HHS-affiliated US Preventive Services Task Force on which preventive services are essential enough that patients should be able to get them without shelling out any cash, the task force's guidelines would not be ignored by federal health officials under reform. By federally requiring certain preventive services be fully paid for by insurers, the government would essentially be saying: These particular services are too important. We can't risk Americans forgoing them because of cost. The government would, by default, not be saying the same thing about other preventive services - like annual breast cancer screening for women 40-49 - that the US Preventive Task Force does not recommend by routine. It's also important to point out that, whether its the US Preventive Services Task Force or the Secretary of Health and Human Services, the federal government would - under health care reform - have a big say in what medical care private insurers would have to cover, a change from the current state of affairs that's great or terrible, depending on your opinion about the role of government in health care.
My full original post follows below:
Ever since the US Preventive Services Task Force said annual breast cancer screening should not be routine for women in their 40s, Democrats have been eager to assert that the panel does not set federal policy. In response to the immediate political and public uproar over the new guidelines, Health and Human Services Secretary Kathleen Sebelius released a statement saying, in part:
"The U.S. Preventive Task Force is an outside independent panel of doctors and scientists who make recommendations. They do not set federal policy and they don't determine what services are covered by the federal government."
Then Senate Majority Leader Harry Reid followed a few days later with a statement including this:
"...let's be clear: the task force's recommendation will have absolutely no impact on the bills we in the Senate write, debate or vote on. Secretary Sebelius has also assured me there that nothing in Medicare or Medicaid will change as a result of the recommendation, and that's the way it should be."
These statements are technically true, but if you read them and were left with the impression that the task force and Democratic health reform legislation are unrelated, you should take a closer look at the Senate bill, currently under debate in the chamber.
From Page 17 of the Senate health reform bill:
‘‘SEC. 2713. COVERAGE OF PREVENTIVE HEALTH SERVICES.
‘‘(a) IN GENERAL.—A group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for and shall not impose any cost sharing requirements for— ‘‘(1) evidence-based items or services that have in effect a rating of ‘A' or ‘B' in the current recommendations of the United States Preventive Services Task Force;
This means if the Senate bill became law, the task force recommendations would accomplish two things: they would set the floor for what preventive services private insurers would be required to cover and they would require private insurers to fully cover those services at no cost to patients. If the Senate bill were law today, the list of preventive services private insurers would be federally required to fully cover would not include routine annual mammograms for women in their 40s. (UPDATE: I rewrote the previous sentence, which in my original version erroneously said that insurers would stop covering routine mammograms for women in their 40s under the Senate bill. As the White House points out, most states - like Rhode Island, which I mention below - currently require insurers to cover screening for these women anyway. Plus, private insurers are free to continue the coverage for any procedure even if not required to by law.) Here's how the task force guidelines work:
The task force grades various preventive medical procedures on an A to D scale. Procedures with an A rating are recommended with "high certainty that the net benefit is substantial"; B ratings are also recommended with "high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial." C ratings are for procedures that the task force says should not be routine and D ratings are for procedures the task force says should not be performed. (The task force also has an I rating for procedures for which there is not enough evidence to make a recommendation for or against.) Put more simply, the task force says medical procedures in categories A and B are recommended. The task force's new guidelines moved annual routine mammograms for women in their 40s moved from category B (the 2002 recommendation) to category C, saying women should consult with their doctors. (The task force recommendations only apply to women who are not "at risk" of getting breast cancer because of genetic mutations or family history.)
Of course, even under the Senate bill, private insurance companies could still choose to cover routine annual mammograms for 40-something women and many experts predict they would. There is lots of debate over whether the task force's new guidelines are in the best interest of patients. The American Cancer Society and National Cancer Institute, for example, still recommend routine screening begin at age 40. Given this - and the political lightening rod that mammograms have always been - private insurers seem unlikely to change their coverage anytime soon.
As for Medicare, under the Senate bill, recommendations from the US Preventive Services Task Force would not determine what preventive services would be covered. But recommendations from the task force would determine what preventive services Medicare must cover at 100%. Currently, most preventive services covered by Medicare require that beneficiaries pay a percentage of the total cost. Under the Senate bill, this cost sharing - for preventive services in the task force's categories A and B - would be eliminated.
In response to questions about the role of the task force, Linda Douglass, the communications director for the White House Office of Health Reform sent me an e-mail agreeing that the panel would play a central role in preventive medicine under health reform:
In the current versions of the health insurance reform legislation, these recommendations could form the basis for coverage of preventive services that should be offered for free---services that are unavailable to millions of Americans today. These recommendations would be the minimum--the floor-- upon which plans should be built. The panel's recommendations will not be used to deny coverage. Nothing about these recommendations will prevent your insurance company from covering mammograms as they do today; and the insurance industry has made clear it will continue to be strongly influenced by what doctors recommend.
Douglass is right that no insurer will be prevented from covering a services - it will up to insurers to decide what preventive services they want to cover beyond what's required. Douglass's contention that "the panel's recommendations will not be used to deny coverage" (emphasis mine) is also correct, although insurers could absolutely use the panel's recommendations to decide in advance which services to cover, which is different than refusing to cover something after the fact.
The bottom line is that there is currently no federal requirement that private insurers cover preventive medicine and covering preventive medicine, in most cases, saves money in the long run and keeps people healthier. (State insurance regulators, however, can require certain services be covered. Shortly after the new task force guidelines were released, for example, the Rhode Island insurance commissioner issued a press release assuring residents that state law will continue to require insurers cover annual routine mammograms for women 40-49.) But if health reform legislation is going to require insurers to start fully covering preventive services on a federal level, some entity has to decide what procedures fit into this category. Under the Senate bill, that entity would be the US Preventive Services Task Force, which is comprised of 16 health professionals, including 14 physicians.
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"As for Medicare, under the Senate bill, recommendations from the US Preventive Services Task Force would not determine what preventive services would be covered. But recommendations from the task force would determine what preventive services Medicare must cover at 100%. Currently, most preventive services covered by Medicare require that beneficiaries pay a percentage of the total cost. Under the Senate bill, this cost sharing - for preventive services in the task force's categories A and B - would be eliminated."
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Now I could be wrong, but if let's say for example I am 85 years old, with a chronic condition like for example Renal Insufficiency, which requires dialysis on a routine basis for survival. I could potentially expect one day that the US Preventative Services Task Force could determine due to age and illness, I am no longer an "A" person, but now a "D" person. They could then STOP FUNDING for my dialysis treatment. Or, the USPSTF could say, "for your life rusty and condition we do not see that any potential for improvement will occur. We will pay 10% of the cost of your $1,000/dialysis/day treatment, but you pay the balance out of pocket at 90% of cost". Hmmmm.
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Would that be a fair assessment of this Karen?
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I guess Sarah Palin was NOT wrong about death panels afterall.
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Amazing. Insane, but none-the-less amazing. And liberals actually want this type of Health Care Reform Legislation passed?
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Who are the wack-jobs and wing-nuts now?-
1.1
The post was written by Kate Pickert but your comment really does get to the exact heart of the matter: as a result of right-wing propaganda and the complete failure of the corporate media to separate sh*t from Shinola, has the country become collectively too stupid to govern from a rational, data-based public policy approach?
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1.2
shepherdwong:
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Dude, don't you remember when Joe screamed "You lie!" at Obama about undocumented people being covered?
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Don't you remember the centrist Dems' response?
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They made a big deal out of putting an anti-undocumented provision in the bill, thus completely legitimizing the screamers.
...as a result of right-wing propaganda and the complete failure of the corporate media to separate sh*t from Shinola, has the country become collectively too stupid to govern from a rational, data-based public policy approach?
And as a result of centrist governance, which isn't rational or reality-based public policy, but building half a bridge --and then defending the half that was built to some angry people, while defending the half that wasn't built to others.
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The question now is "How long are liberals going to put up with being made out to be the reasons why government does things that people are afraid of by centrists who won't stand up to those attacks?" -
1.3
Dude, no one is more disgusted with the cravenness and corporatism of some Democrats but it is you who seems to be suffering from some sort of denial over the who and what is to blame.
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1.4
you who seems to be suffering from some sort of denial over the who and what is to blame.
Let's try not to get too personal about it, but:
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What exactly do you mean?
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Whose job is it to deal with the situation?
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Who is in charge? You don't think that liberals are running this show, do you? -
1.5
"You don't think that liberals are running this show, do you?"
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Only brainwashed wingers are dumb enough to believe the obvious lie that liberals have any political power in this country. The question is, if they have no power how can they be to blame? -
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RR - the task force reviews science and evidence about preventive services only, not routine care for chronic conditions.
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1.7
Apologies to Kate Pickert. I would have sworn I saw Karen Tumulty as the source writer.
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But, major KUDOS, Kate for a fine article pointing out the flaws in the Democrat talking points of the past. A past that was filled with lies and accusations. A past that clearly points to a health care reform package that seems to get worse by the minute as you disclose more and more of the TWO THOUSAND AND SEVENTY-FOUR PAGE PLAN.
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Now on to the lefty loons who are attempting to justify this atroscity with further bull-crap.
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For example:
."as a result of right-wing propaganda and the complete failure of the corporate media to separate sh*t from Shinola, has the country become collectively too stupid to govern from a rational, data-based public policy approach?"
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There is not any "propaganda" what-so-ever. Simply fact based comments that point out that Democrats in their zeal and slight of hand are attempting to rush through this rediculous legislation in attempts to call it "health care reform". Why? While it might seem to be that I am saying "Democrats want to kill off Grandma". No, that is only a part of it.
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Democrats (whether stuart wants to claim them or not) want to destroy this Country, period.
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If it isn't dealth panels, then it most definately is ....here goes....let me spell it out to you.........
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R-A-T-I-O-N-I-N-G!!!!!
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Got it sheppy???
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Great.
Douglass is right that no insurer will be prevented from covering a services - it will up to insurers to decide what preventive services they want to cover beyond what's required. Douglass's contention that "the panel's recommendations will not be used to deny coverage" (emphasis mine) is also correct, although insurers could absolutely use the panel's recommendations to decide in advance which services to cover, which is different than refusing to cover something after the fact.
Double-speak.
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"Nothing works better than Extra Strength Health Care Reform PM! It's recommended by doctors!"
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Wonderful.
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So the panel will "play a central role in preventive medicine under health reform", but "the task force's recommendation will have absolutely no impact", and "They do not set federal policy and they don't determine what services are covered."
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Don't you love technically accurate statements about things you buy that turn out later not to really do what you wanted them to do, or thought they should do?
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[youtube=http://www.youtube.com/watch?v=SWo-vDVajns&hl=en_US&fs=1&]
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Great job, centrist Democrats.
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These are the practical and political results of incrementalism.-
2.1
"Great job, centrist Democrats."
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How timely. I was just wondering who was to blame for the corporate takeover of government policy-making.
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Still wondering how you think that Republican policies and political rhetoric speaks to middle-class issues, other than stoking their fears and resentments through a media-promulgated pack of lies and distortions. -
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Whoah, Slim!
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Who said that Republican policies speak to middle-class issues?
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I'm having a really hard time coming up with any GOP policies that have done anything in ordinary people's interests. I'm trying though, I'm sure I can come up with an exception....
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I said:I think that the Republicans do speak to middle class issues, and very effectively in comparison to most Democrats.
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I believe that there is a large constituency that is sympathetic to populist conservatism, mostly because liberals have yet to effectively address that population. Liberals haven't had the opportunity to speak, have our ideas debated and prove ourselves through successful governance because the Democratic party is controlled by a centrist faction (the DLC and New Democrats) who are largely hostile to liberalism, liberals and popular accountability in general. We can't get a fair hearing. The people who speak "for us" on Meet The Press are centrists --either politicians or journos-- matched up against movement conservatives.
I think that centrists --people who slightly modify the rhetoric of the right, and then try to market images-- are largely incompetent at speaking to real people, because they're elites with no connection to a real political base whatsoever, unlike the Republicans.
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You disagree? -
2.3
No. But then I don't see a whit of difference from the corporatist right and corporatist "centrists" (hence the scare quotes). I also don't put calculated political lies in the same category as basic truth so their relative "effectiveness" seems secondary to the fact that they're lies.
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And to answer your previous question (with another question):
"How long are liberals going to put up with being made out to be the reasons why government does things that people are afraid of by centrists who won't stand up to those attacks?"
Other than what we and others like us are doing right now, what, exactly, can liberals do about it?
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2.4
"Other than what we and others like us are doing right now, what, exactly, can liberals do about it?"
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Stay home next Nov. and/or 11/12? Vote for Nader or Paul or fill in the f'ing blank. If there aren't consequences to their (conserva-dems) actions, how are we advancing the progressive cause? By willingly confining ourselves to the veal pen...
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I do agree with you, Shep a 100% here:
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"I don't see a whit of difference from the corporatist right and corporatist 'centrists'"
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The so called centrists are conservatives. Their centrism is a posture, as is Joe Klein's.
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I'd say the distinction between your positions (SZ & Shep's), and correct me if I'm wrong, is that Shep tends to see Obama as a liberal constrained by forces beyond his control, and SZ sees him as a "centrist" hand-crafted from DLC wool.
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And Shep, since when has anything other than "stoking their fears and resentments through a media-promulgated pack of lies and distortions" been necessary? You don't need to address their concerns or policies that improve their lives, you never had to. You just have to have them fearful enough and you'll own them. Plus, as Digby points out, in terms of populism (real or faux), the demagogues are the only ones talking to them at all. Yes, you and I would call such talk lies and fearmongering, but the democrats ain't clucking at all. Their policies are marginally better, but let's be frank, the current dem leadership from the WH to congress is far more concerned about alienating Wall St/the MIC/the estab. than it is about the condition of the middle class or the growing scores in poverty.
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I was wrong during the campaign in saying that Obama had to show some anger or passion to win, but perhaps things weren't quite bad enough. I'm now convinced, perhaps wrongly again, that he'll either have to dial into that anger and go to bat for the people's concerns, or he'll risk losing the country the neo-fascists. Yes, my lead, staying home during the next few elections might result in that too, but perhaps it'd lead to the purifying our party needs. -
2.5
shep and JC:
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If there's absolutely no significant difference between the right and the Third Way, then why are the Third Way-ers in favor of government acting to introduce "health care reform" legislation? -
2.6
"I'm now convinced, perhaps wrongly again, that he'll either have to dial into that anger and go to bat for the people's concerns, or he'll risk losing the country the neo-fascists. Yes, my lead, staying home during the next few elections might result in that too, but perhaps it'd lead to the purifying our party needs."
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Stuart's and my argument (such as it is) sprang from my suggestion that more and better (more liberal-progressive) Democrats made the party more responsive to average voters (I was talking policy) compared to the "conservative" purge of Republicans, which made them sound even crazier and beholden to corporatist policies. I stand by that, both on policy and rhetoric because I don't believe that lies designed to feed racism, xenophobia, sexism and class-resentment are legitimate or desirable for liberals, even if they may appeal to certain people (who are unlikely to ever follow honest, non-authoritarian leaders anyway). So staying home isn't it. Campaigning against "conservative" Democrats and replacing them or, at least, their "conservative" policies with better ones is the way forward. As policy-making gets better, people will become less confused about the differences between the parties.
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As far as Obama goes, I think he took the right read on the direness of our policy-related situation, the dysfunction of our social dynamics and, in particular, the village mindset and is letting the country, particularly progressives armed with the intertubes and new media and "centrists" who are forced to express modest outrage at the most egregious conduct of corporate elites "make him do it". I have no idea if he's liberal or "centrist" but I know with absolute certainty that he has to play a "centrist" on TV (liberal presidents need not apply) and not get too far out in front of the corporatist-press-led-propaganda-fed American public on taking on the corrupt power centers of the entire human race, assuming that he actually wants to try. -
2.7
shepherdwong:
I don't believe that lies designed to feed racism, xenophobia, sexism and class-resentment are legitimate or desirable for liberals
I'm going to wait to argue with that characterization, because this is a separate question than the one I've posed above, and requires its own thread, most likely.
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Suffice it to say until the above question is settled that I disagree with both your characterization of ordinary conservatives, and your characterization of the rhetoric of the popular right. I don't think that you're being completely accurate, although this partial accuracy is relatively common, and accounts for some of liberals' political problems, I believe. -
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"I'm going to wait to argue with that characterization, because this is a separate question than the one I've posed above, and requires its own thread, most likely."
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I look forward to hearing your argument. Be forewarned though, I will insist that it account for the racism, xenophobia, sexism and "liberal elite"-resentment characterized by the rhetoric and beliefs of the "popular right." In the meantime, I'm going with denial and false-equivalency - nothing personal. -
2.9
SZ: "If there's absolutely no significant difference between the right and the Third Way, then why are the Third Way-ers in favor of government acting to introduce 'health care reform' legislation?"
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But haven't you concluded that this is a "bad bill," and one (try not to LOL here) that won't "help" Americans until 2014? If that ain't a conservative fix, I don't know what is. Actual conservatives in congress might do absolutely nothing, but would that be more than marginally worse. Actually, I'd say this bill is worse for the liberal cause (as it's perceived by most Americans as a liberal cure).
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And, Shep, I guess I'm the outlier then, in seeing an institution with as many status-quo preserving mechanisms in place as the dem party as being virtually irredeemable. As long as we're all faithful registered dem voters, I doubt they'll be any more responsive to our voices now than they've been since LBJ's great society. It amts. to: 'Be patient, we'll get to your concerns.' Well, I've been voting for the f@ckers since Nov. of 1988 and I'm still waiting.
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And excuse me but what? "I don't believe that lies designed to feed racism, xenophobia, sexism and class-resentment are legitimate or desirable for liberals"
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Who said they would be? Populism doesn't = demagoguery or dishonesty. Policy is grand, but if it ain't coupled with some serious shifts in narrative, stiffening of backbone and hostility to entrenched interests, put out there for people to respond to... Obama continues to appear aloof as unemployment proves long-term (see Krug), and what's going to happen next year?
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And I completely disagree with: "I know with absolute certainty that he has to play a "centrist" on TV (liberal presidents need not apply)..." I think liberals have to espouse their liberal principles with absolute clarity and passion. Anything less is rightly perceived as the unprincipled stand for nothingism. But hey, from abortion to gun rights to perpetual war, our debating with one 1/2 of brain tied behind our back, operating according to Reaganist parameters of discourse, has proven really successful. Let's pander to the Joe Kleins and Dave Freakin' Broders of the world. Let's give away the seminal issue of the day to appease Olympia Snowe.
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Sorry, folks, as you were but I got a rugrat beckoning. Back to rocking and lurking. -
2.10
"I think liberals have to espouse their liberal principles with absolute clarity and passion. Anything less is rightly perceived as the unprincipled stand for nothingism."
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Well sure, as long as he doesn't end up being portrayed in the media as a possible "Socialist" who's "taking on too much" and "exploding the deficit" because he's "too beholden to his liberal base." -
2.11
"I guess I'm the outlier then, in seeing an institution with as many status-quo preserving mechanisms in place as the dem party as being virtually irredeemable."
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Oh, and I see the same dynamic, I just don't see that we have much choice other than to try to keep working to try to fix it. Then, I'm a Democrat, never feeling I had the luxury, apathy or generalizing skills of an Independent. My Passive-aggressive quotient is also pretty low. -
2.12
JFC Shep:
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"Well sure, as long as he doesn't end up being portrayed in the media as a possible 'Socialist' who's 'taking on too much' and 'exploding the deficit' because he's 'too beholden to his liberal base.'"
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Had to pass said nina to moms. Argh, as you're perfectly aware, as if the above isn't happening thus far as his admin proves its moderate Rahm-esque bonafides. If you want to l'arn some Americans that liberalism ain't your f'ing enemy, call me naive, but you have to rule like a liberal, standing up for your principles, illustrating over and above the liars (GOP) and propagandists in the media. Playing the game on their terms, according to their lexicon = fail, period, as it has for 40 years (the duration of progressive's wilderness occupancy). Next year his majorities shrink--do you deny that? Or that any hope of a single progressive achievement over the remaining 3-8 years will be more likely. If not now, then when? -
2.13
”If you want to l'arn some Americans that liberalism ain't your f'ing enemy, call me naive, but you have to rule like a liberal, standing up for your principles, illustrating over and above the liars (GOP) and propagandists in the media.”
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Well, we may to agree to disagree on this but I think Obama has been pretty solid leading on liberal principles. I'd say he campaigned and won the presidency on them – even if he didn't call them by name. You can certainly make the case that his rhetoric hasn't matched the policy – in the case of civil liberties and the abuse of executive power the disconnect has been nothing less than shocking.
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But corporatist, militarist, and authoritarian forces have dominated this culture at least since Dwight Eisenhower was president, we are near the end of our third decade of Reagan corporatist “conservatism” and we are still recovering from the most diabolical attack ever witnessed and eight non-stop years of fear and war-mongering. Barack Obama and the Progressive Caucus aren't going to change that in ten months, even if they dare try. -
2.14
What a fascinating discussion... I simply can't stay lurking on this one.
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I am sceptical that the current rightist movement is monolithic enough to be adequately defined by one characterization. Elements appear to be aimed at preserving older race and gender privileges, among other forms of privilege, while other elements speak to perfectly legitimate and rational “populist” anger with the status quo. In some instances, both coexist in the same figure: Gleen Beck for example. Sarah Palin is another right-wing figure whose popularity is fed by a strange mixture of fear, reasonable distrust of elites, unreasonable distrust of empirical evidence, racism, sexism, and genuine anger about the sexism and classism she (and her supporters) face.
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Rusty here on Swampland is a good example of how complex this movement is (if it can even be called a single movement). We can all see the eruptions of racism and anti-Islam paranoia in his commentary, but he also has some perfectly rational views about health care, corruption, and the incoherence of US (not Democratic or Republican) foreign policy. Any characterization of Rusty (or the right as a whole) that focuses purely on one of these elements is unconvincing. -
2.15
Please, please, please, please watch this video. Please.
[youtube=http://www.youtube.com/watch?v=mKKKgua7wQk&hl=en_US&fs=1&rel=0&color1=0x5d1719&color2=0xcd311b&border=1]
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hotbbq, They seem scared and confused, but they know enough to understand (just like the left) that the people in charge are not on their side. And they trust Palin.For now...
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It would also be interesting to compare that (selected) footage with footage from Obama's rallies in the primaries. I cannot count the number of people who said they supported Obama because he had good judgment, believed in talking to people and would bring in real change. -
2.17
@rose
Perhaps, but at a bare minimum that mythos seems coherent and rational. I may never be able to understand how one could trust someone as uninformed, incompetent, and insincere as Sarah Palin.
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"Democrats have been eager to assert that the panel does not set federal policy"
That was only part of the response to the report release. The thrust of the response was this panel was appointed by Bush.
Since the WH and Congress seems to be run by sniveling little kids, the response to everything is its the Republicans fault or Bush did it.
Man up Sally!
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LOL @ "Man-up Sally". Priceless!!
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Don't even... Historians, social scientists and political scientists will be examining and talking about the tragic lessons to be learned from the clusterf*ck known as the Bush Administration (sorry, George H.W.). So will liberals and Democrats.
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You man up, Mary.
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I could potentially expect one day that the US Preventative Services Task Force could determine due to age and illness, I am no longer an "A" person, but now a "D" person. They could then STOP FUNDING for my dialysis treatment.
No, you epic dunce. For starters, dialysis isn't a preventative measure. Secondly, the current bill would also prevent your insurance company from dumping you once you needed it. Thirdly, the board grades effectiveness of a particular procedure against some desired outcome.
Again, I'm sorry to the rest of Swamplanders, but I can't be civil towards willfully ignorant people anymore. I can appreciate differences in philosophy, but I draw the line at perpetuating a false reality.
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"I'm sorry to the rest of Swamplanders, but I can't be civil towards willfully ignorant people anymore."
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Obviously there's no need to apologize to me ;^) The truly scary thing isn't the ignorance, false belief and delusion of many people, it's their unshakable belief that their ignorance, false belief and delusion is the truth.
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If only our valiant watchdogs in the corporate press shared one tenth of the justifiable moral outrage at what corporatist lies and media-propelled propaganda have wrought on the public mind. Then, we all avoid guilt at almost any psychological cost and, with societal elites anyway, "correct conduct" seems always to come down to the matter of where one's bread is buttered. -
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hotbbq says:
."No, you epic dunce. For starters, dialysis isn't a preventative measure. Secondly, the current bill would also prevent your insurance company from dumping you once you needed it. Thirdly, the board grades effectiveness of a particular procedure against some desired outcome."
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Sorry my little liberal friend, but dialysis is most definately a "preventative measure", simply because it prevents the total shut down of your entire bodily function without it! As in no dialysis, complete renal failure occurs, and ultimately death.
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Health, wellness and preventative medicine is based on both treatments and tests. I merely point out that if they decide a certain test or as you say "procedure" is deemed to fall into a lower category rating, like "D", then due to my age and condition, further treatment is futile, and will not improve my condition. Chances are they will not pay for it, period. If enough money is spent on the Democrat drunken sailor approach to health care reform. There will not be enough funds to continue to support someone with a dibilitating disease like Renal Failure. It all comes down then to who decides who lives and who dies. Period.
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Just based off of this statement from you totally proves my point.
."Thirdly, the board grades effectiveness of a particular procedure"
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If dialysis is not a procedure, then I do not know what else could be called one.
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Face it. Democrats want Grandma to die. Poor Grandma. Why do you hate your Grandmother, hotbbq? -
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Rustydog:
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Come on, be honest:dialysis is most definately a "preventative measure", simply because it prevents the total shut down of your entire bodily function without it!
If you can't construct an argument without altering the common meaning of preventative --
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4.4
--the meaning in question (and most folks' minds) being:
Secondary prevention activities are aimed at early disease detection, thereby increasing opportunities for interventions to prevent progression of the disease[3] and emergence of symptoms., and not
Tertiary prevention reduces the negative impact of an already established disease by restoring function and reducing disease-related complications.[4]
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4.5
Sorry my little liberal friend, but dialysis is most definately a "preventative measure", simply because it prevents the total shut down of your entire bodily function without it! As in no dialysis, complete renal failure occurs, and ultimately death.
lol
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Oh... wait, you're serious? You honestly believe you can parse medical and scientific terms with actual meaning in some bizarre attempt to distort reality?
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You're wrong. And an idiot. Dialysis is not classified as a preventative measure, even if it technically "prevents your death." Words and terms have specific meanings in specific contexts, which is a concept you certainly understand but seem perfectly willing to ignore for the purpose of obfuscating an otherwise straight-forward debate. -
4.6
@rustyreturns
Sorry my little liberal friend, but dialysis is most definately a "preventative measure", simply because it prevents the total shut down of your entire bodily function without it!
I'm your friend to the extent dialysis is preventative. I might actually go to the hospital tomorrow to get it done. That way I won't have to worry about renal failure while I take my fill of goodies this Thursday.
... if they decide a certain test or as you say "procedure" is deemed to fall into a lower category rating, like "D", then due to my age and condition, further treatment is futile, and will not improve my condition.
I don't even know where to begin with this crap. So if group of medical professionals is going reclassify a procedure that is already at "should not be routine" to "do not perform" and by your own admission will not improve your condition, you still want to continue doing so? You are truly an epic moron. Let's hope that preventative dialysis you are getting prevents cancer and other maladies.
Face it. Democrats want Grandma to die. Poor Grandma. Why do you hate your Grandmother, hotbbq?
Ah there it is. Your teabag is showing. That, folks, is what Republicans have to offer these days. Epic stupidity.
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5
Correct me if I'm wrong but isn't it "Dr. Epic Dunce"?
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5.1
Doctor, business owner, vet, center fielder for the Yankees, and quarterback for the Cowboys.
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6
"If there's absolutely no significant difference between the right and the Third Way, then why are the Third Way-ers in favor of government acting to introduce "health care reform" legislation?"
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I believe I said "corporatist right" (let's leave the racist/religious crazies out of it for now). Obviously, there are somewhere around 40 million reasons why "third-way" corporatists want the sort of legislation that "centrist" Democrats tried to enact, against the efforts of progressives. Perhaps the corporatist right would be in the mix if not for pure political calculations, staggering health care costs being bad for business and all. If they get the sort of profit-fattening "reform" they want that likely leaves the public unhappy and insecure, delivered by "centrist" Dems, what better political victory could you imagine.-
6.1
No, the corporatist right, whose shills populate the discredited network CNBC, for example, don't believe in government interference in the marketplace at all.
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The Third Way people see the government as a structural partner with industry and finance, whereas the elite right see government as the perpetual enemy.
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There is a special "Third Way" in which the center approaches the management of the tension between corporate and state elites over political and economic power. This "partnership" is evidenced by what you correctly characterize as "profit-fattening 'reform'".
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The rightists have come a long way since the relatively principled days of Reagan, they're absolutely on-board with looting the treasury these days. David Brooks represents that new brand of elite conservative who attempted to persuade the rest of the right that "a post-911 world" meant that the era of conservative antipathy for big government was over, but it's a relatively recent phenomenon, and totally at odds with the market fundamentalism that truly characterizes the right.
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Can you see Ronald Reagan enacting "health care reform", or destroying it?
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7
"..the corporatist right, whose shills populate the discredited network CNBC, for example, don't believe in government interference in the marketplace at all."
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OK, I'm starting to understand some of your confusion. First off, I'd suggest that you stop believing anything they say. They're professional liars. Even Larry Kudlow understands, though may never admit, there is no marketplace at all without "government interference". The corporatist right and "centrist" "Third-Way" Democrats are both only about making sure that "interference" translates to the bottom line. Only their rhetoric, based upon the relative sanity and wisdom of their particular constituents, really sets them apart.
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And yes, I can definitely see Ronald Reagan working with "centrist" Democrats to enact their vision of pro-corporate reform, just as he enacted the largest tax increase in history and set about dismantling the world's nuclear weapons. Then, Reagan/Bush was the last Republican administration that wasn't entirely beholden to the religious right and others who form the Republican base and have finally been indoctrinated into a more pure form of crazy. -
8
Every insurance company already has a panel of unnamed people who are making their own decisions about what preventative medicine and tests they will or won't cover, outside of what state laws require.
So yes, I understand why people are concerned about the government panel and its mammogram recommendation but I don't get why it's implied that in the absence of this government panel that even less accountable decision makers aren't imposing the same limitations on us (and they've been doing it for years).
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9
shepardwong:
First off, I'd suggest that you stop believing anything they say. They're professional liars.
Well, "first off" is definitely first off. Let's get this straight before we deal with anything else.
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Do you really think that nobody on the right actually believes in their f-cked up political philosophy?
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Did you think that Alan Greenspan was a professional liar?
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Are you not allowing for any difference between Betsy Mccaughey (professional liar) and Dinesh D'Souza?
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Is that truly your contention --that nobody on the right actually believes what they say, even if they're not literally professional liars or politicians? Even if they're Ron Paul?
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If this is up for debate, and your honest-to-god premise going into this is that all conservatives are liars, just like all grandfathers are men, then we need to get that sorted before we can talk about the differences between what the right and center believe in their hearts and minds.
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It seems to me that just because a lot of conservatives are f-ing liars, and a lot of high-profile conservatives are professional liars, it doesn't automatically follow that all or even a majority of movement conservatives are liars all the time. For every Tom Delay, there are a dozen Ramesh Ponnurus, John Derbyshires and Jonah Goldbergs, who operate in more or less openly authentic, radical, rightist voice. The entertainers are the entertainers, but the rightists are the rightists. The guys in Michigan with the assault rifles and para-military fatigues are not f-ing around, neither are the guys who went to Eastern colleges who admire the guys in Michigan, and they're certainly not lying about who they are. They may lie, like Maglalang does, but even a liar like her puts out a book called "In Defense of Internment", in which she openly, literally defends US concentration camps for Japanese-Americans during WWII.
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That's part of the middle-class appeal of popular rightism, actually (even though we haven't gotten to that argument yet)...it's that the rightists are generally perceived as resolute in their authentic identities, not lying about who they are.
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...But, lest I digress:
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Please explain to me how, in spite of everything I've mentioned above, enough rightists are lying enough for you to reasonably infer that I should literally "stop believing anything they say."
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Thanks so much for spelling it out for me, shepardwong.-
9.1
”Did you think that Alan Greenspan was a professional liar?”
Absolutely, don't you? He was also possessed of some bad dogma, in which he seemed to believe sincerely but that doesn't mean he didn't get paid to lie to the public. This may come as a shock to you but a terrific number of public officials see it as their professional duty.
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Anywho, I was referring to your "..corporatist right, whose shills populate the discredited network CNBC, for example, don't believe in government interference in the marketplace at all,”and specifically that they didn't believe for a moment that you can have a functioning market of any kind without “government interference” of any kind. Yes, that's a lie and educated people who get paid to go on air and pretend that they believe it to convince the uneducated that government regulation only interferes in the marketplace, rather than being a necessary component of it, are professional liars.
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Sorry if that offends you. It offends me too. And it stops me from trusting anything else they say.
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10
Okay, probably should have posted my last comment here. Here it is:
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I am sceptical that the current rightist movement is monolithic enough to be adequately defined by one characterization. Elements appear to be aimed at preserving older race and gender privileges, among other forms of privilege, while other elements speak to perfectly legitimate and rational “populist” anger with the status quo. In some instances, both coexist in the same figure: Gleen Beck for example. Sarah Palin is another right-wing figure whose popularity is fed by a strange mixture of fear, reasonable distrust of elites, unreasonable distrust of empirical evidence, racism, sexism, and genuine anger about the sexism and classism she (and her supporters) face.
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Rusty here on Swampland is a good example of how complex this movement is (if it can even be called a single movement). We can all see the eruptions of racism and anti-Islam paranoia in his commentary, but he also has some perfectly rational views about health care, corruption, and the incoherence of US (not Democratic or Republican) foreign policy. Any characterization of Rusty (or the right as a whole) that focuses purely on one of these elements is inadequate.-
10.1
"Rusty here on Swampland is a good example of how complex this movement is (if it can even be called a single movement). We can all see the eruptions of racism and anti-Islam paranoia in his commentary, but he also has some perfectly rational views about health care..."
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And still some that are completely detached from observable reality (which is one characterization I feel comfortable applying to the right in general, except those who are only lying of course):"Sorry my little liberal friend, but dialysis is most definately a "preventative measure", simply because it prevents the total shut down of your entire bodily function without it!
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11
Absolutely, don't you? He was also possessed of some bad dogma, in which he seemed to believe sincerely but that doesn't mean he didn't get paid to lie to the public. This may come as a shock to you but a terrific number of public officials see it as their professional duty.
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Isn't that a meaningless distinction? Everyone knows that anyone with his job lies, but isn't the relevant matter his sincerity with respect to the dogma he advocated? The dogma was rightist, and he seemed to sincerely believe it, thus he was sincerely rightist.
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BTW, I'm not sure if he did believe it. I really have no idea, although I suspect he did. But if he believed it, the other lies he told are of limited relevance to this question about the sincerity of professional rightists.-
11.1
rose83: I think that honest ignorance or misguidedness is distinctly different from taking money to say something you know is false, on moral grounds at least. But it's an otherwise very astute observation. Perhaps we should ask stuartzechman which is bigger threat to the republic: public figures who intentionally lie for strategic political purposes or public figures who are too dumb to know that they're telling lies for strategic political purposes. Either way, no doubt, some number of the latter are being fooled by the former.
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11.2
Sorry, I wasn't clear enough...
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I was actually referring to the relevance of the other lies Greenspan told that do not relate to his ideology; according to your own statments, Greenspan was sincere about his ideology.
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Clearly there is a difference between knowingly saying something false for money and saying something false because you're ignorant. But then you yourself have effectively ruled out the first possibiility with respect to Greenspan's dogma: "he was also possessed of some bad dogma, in which he seemed to be believe sincerely."
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Essentially, I am asking why you're even talking about Greenspan's lies, since you are saying they don't extend to his belief in the dogma he advocated.
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12
Well first I want to say thank you to rose83 for her "kind" words on my behalf, notwithstanding the IQ53 racist slam, but hey we can't be 100% in all things.
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But, I do agree. It is not "one big stupid" movement. Like the Democrat Party, there is much diversity of opinions and specific interests that make up the Republican Party. I know many Republicans who have one set requirement, and that is the protection of the right to bare arms. Gun ownership. Period. Nothing else really matters to them, and they see the Republican Party that has the most credibility over the last 230 years guaranteeing this one specific right.
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But I liked this for a change by sheppy...
."Perhaps we should ask stuartzechman which is bigger threat to the republic: public figures who intentionally lie for strategic political purposes or public figures who are too dumb to know that they're telling lies for strategic political purposes. Either way, no doubt, some number of the latter are being fooled by the former.
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I think that any public figure who lies would always be the more threatening person than the one who simply doesn't understand or comprehend due to the fact they are either ill-informed or un-informed from lack of education. I also wouldn't say that someone is simply dumb, but in the case of the un-informed it could simply mean they do not have access to the truthful information to be informed.
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I have always said that the strongest power is held by the person with the most information. Why else would someone want to be "the most powerful man" (or woman) in the world, the US President?
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None of the Presidents in the past 100 years have attained that position by being stupid or un-informed. Including George Bush II. To me it is litterally impossible to take on this major life acheivement and not have some intelligence.
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The question is then for example, did someone withhold information from him about Iraq's WMD's or did someone simply lie and not tell him the entire truth. I still believe that he believed at the time Sadam did possess weapons of mass destruction. I believe the information was withheld. But, I am sure there are those on the left that believe he lied for "political strategic purposes".
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If it was the 2nd choice, I would be for hanging him in public the same as Sadam was hung in Iraq. -
13
Shep, from upthread: "Oh, and I see the same dynamic, I just don't see that we have much choice other than to try to keep working to try to fix it. Then, I'm a Democrat, never feeling I had the luxury, apathy or generalizing skills of an Independent. My Passive-aggressive quotient is also pretty low."
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Really, b/c I'd say that riff suffers from some serious generalization. Indies have such attributes, as opposed to what Rose says elsewhere above:
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"They seem scared and confused, but they know enough to understand (just like the left) that the people in charge are not on their side."
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I mean it amts. to what you believe/want to believe, and prefacing this w/ the obvious, we can agree to disagree. Some either believe or are invested in thinking that party A is better than party B, and that by supporting party A, sooner or later enough breadcrumbs will create a loaf of bread.
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Others see both parties as protecting the powers that be: this group includes the 'he's a muslim interloper loons' and folks like me who are fairly educated and have voted, without exception, for sh!tty dems for 20 years and counting (and I moaned like a f@cker for the duration of Clinton's DLC presidency too).
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Plus, I'm forced to admit that I'm not a joiner. Any club that'd have me, blah blah blah. And perhaps b/c I'm literally an expat outlier at the moment, maybe I'm searching for a reason to the cut the cord.
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And Rose, good to read ya!-
13.1
I don't know if you saw my congratulations (it was on a dead thread), but if not, congratulations again! I hope parenthood is treating you and your wife well.
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And as someone who has on countless occasions vowed to never repeat my youthful support of Nader, and had absolutely no patience for anyone who wasn't for Obama in the GE, I am surprised by how well I can understand why people would give up on the Democratic party now. Not that I would ever do the same myself, but I get it. What's strange is that I am not even slightly surprised by how inadequately they have governed. Nor am I overlooking the very real (and completely unsatisfactory) improvements the Democrats have made on the Bush-era policies. But the Democratic party is essentially daring people like you to leave. They are insulting their base, and I think at a certain point this becomes more about self-respect than anything else.
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I see this as an internal competition between pride and duty to other more vulnerable people, such as the women in Africa whose lives will be saved by ending Bush Administration restrictions on reproductive health aid funding. -
13.2
Yes, I had missed your earlier congrats Rose--warm thanks for both! All is well (screamed Kevin Bacon in Animal House). She's uber cute, making up for a noisy world of pooh.
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13.3
"Others see both parties as protecting the powers that be..."
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Yes, I think it's called politics. But if you've been alive and semi-conscious for the past eight years (or even eight months) and you still can't discern any substantive difference between what Republicans try to do with political power and what Democrats try to do with political power (however flawed) then I still don't blame liberals or Democrats.
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14
stuart says:
Rustydog, com on be honest
If you can't construct an argument without altering the common meaning of preventative --.
Ok if I have to stuart, Gee.
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Ok, dialysis is not a "preventative" measure.
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But, if we have a "US Preventive Services Task Force" in place now, what is to stop a US Procedure Specialty Task Force from being formed?
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Did you watch the 60 Minutes program this past Sunday?
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If not to make it real short in review, a Physician discussed the use of millions of millons of Medicare dollars being used for folks who have not made the decision to end life supporting measures, when everyone including themselves knew their life was over.
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There will be a finite amount of dollars in a Government backed or run insurance plan. Maybe not in 2 years, but perhaps 5 or 10 or 20 years there will not be enough Federal dollars to continue this practice. There will have to be a "Task Force" which will have to decide that further funding for life sustaining procedures will not continue for this person.
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Today, if I pay enough and decide I want anything and everything done to extend my life, then a Physician will ALWAYS continue those interventions. This happens all the time in hospitals with people who have insurance and those whose insurance refuse to continue paying.
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The fear for the Physician is a lawsuit by the family after the patient dies. The Physician will never give a DNR order if he thinks some family member or the patient wanted all possible interventions done to keep the patient alive, even in cases where the Physician is 100% sure that there was no possible way anything could be done to save their life.
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So my point is, there will be a "dealth panel" established, I am confident of it. And this panel will be given the power to decide when enough is enough. As long as insurance remains private, then I do not think this step will be taken. But when public funds are brought into the picture, especially on this vast scope of public funds proposed, it will have to be changed.
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Why else was end of life dicussions on Living Wills or Advanced Directives debated at the beginning of the health care reform debate?-
14.1
And I can believe the world is going to face a cataclysmic end in December of 2012 and we would both be equally rooted in reality. The rabbit hole gets deeper every time you write something.
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15
I really, really wish I could have participated more in this thread, but I had to finish a mobile application tonight...GAH
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Rose:
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If you've been interested by this thread, maybe you'll be interested in a post I put up at PoliLag (link to my recent post entitled "Can We Stop with All the Self-Congratulatory 'Crazy Right' Crap Now?"), which I find to be related to the discussion here.
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Commenters:
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This is excellent commentary, thanks so much for these exchanges, this user community is somewhat extraordinary, especially for an establishment media blog such as Time.com. It's been great reading and thinking (and defending my ideas) tonight, thank you all. -
16
It's late in the game but I was always struck by the way that ideological (versus practical) conservatives like to use the word "rationing."
To ration means literally to allot a certain amount. For those who are pro-free-market, and I am, to a point, this is a virtual synonym for what the market does: it allots scarce resources.
In other words, if you are a conservative you ought to be for rationing because that's what a free market does, indeed, it's what a free market has to do in a world of scarce resources. If your quibble is that it's government that decides the rationing, you would also have to defend your implicit assumption that supply and demand do not work in a government framework. Which, if you've taken even a basic economics class, you wouldn't argue in good faith because it's impossible.
Logically, a free market would kill grandma a lot more quickly if she could not pay for her expensive procedures. Of course, the correct term is not "kill," but "let die," since one is affirmative (proactive) and the other is positive (descriptive).
If you want to hold an ideological position then at least try to be logically consistent.
Or, you could do the easy thing and throw out loaded abstract words like rationing and be a cliched boilerplate shouter.
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17
And one other thing. It seems that if you want to be intellectually sound, you wouldn't cast conceivable inferences as logical inferences.
To suggest that having a task force of preventive measures that government regulates would lead to a similar task force of remedial measures after a disease or condition was discovered is a false inference.
Preventive measures and checks can be standardized. Remedial ones cannot, as all individual patients respond differently to treatments. To claim that the government would nevertheless 1) invent and 2) enforce such a task force would require a ridiculous logical leap. It borders on the impossible that they could come up with a menu that would have to be longer than the tax code. It would fail outright. Is it conceivable? Sure. Are unicorns conceivable? You bet.
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