Town Hall Blues

Required reading: an outstanding essay on the Obama presidency by Fouad Adjami in today’s WSJ. I’m working today, so can’t comment at length myself just now, but readers are invited to weigh in below.

The gist: Mr. Obama, carried into power on a tide of anxiety and guilt, misjudges the fundamental nature of American politics by expecting that the people, having anointed him as their leader, will now refrain from criticism or dissent as he implements his radically progressive and redistributionist agenda.

The article is here.

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  1. Charles says

    Fascinating read.

    Being outside the U.S. and not too familiar with the political climate, I was dismayed to see that dissenters are still being called “un-American.” There is nothing I hate more than the misuse of the term “un-American.”

    Posted August 26, 2009 at 3:09 am | Permalink
  2. Thank you for that, Malcolm, I have linked to it from my place. What I liked most was that he gave me a little hope that all was not totally lost in my favourite \’other country\’!

    Posted August 26, 2009 at 2:53 pm | Permalink
  3. Malcolm says

    Hi Charles, David,

    Yes, for all that Mr. Obama was escorted to the Oval Office by flights of angels and a heavenly choir, he and his cronies are no different from the rest as far as their enjoyment of power, and the wish to exercise it without all that pesky backchat from the electorate.

    Fortunately, we are a pretty stiff-necked crowd here in America, and there is only so much we will put up with. Some of us, anyway.

    Posted August 26, 2009 at 3:05 pm | Permalink
  4. the one eyed man says

    There are a lot of things wrong with Ajami’s essay, in which he makes up in petulance what he lacks in substance. The biggest problem, of course, is that the central premise of his piece – that the people who show up at town hall meetings to disrupt them and shout down anyone with a contrary opinion are somehow interested in “debate,” and that the Obama administration is looking to squelch them – is nonsense.

    If someone — whether a politician, an analyst, or an ordinary citizen – thinks that ObamaCare is too expensive, or ill-conceived, or unfair, or wrong for any other reason: no problem. Bring it on. If someone goes to a public meeting to shout questions at a Congressman, prevent him from answering, and drown out any contrary voices: big problem. Nancy Pelosi is right: the people who show up at public meetings with the express intent of preventing any dialogue are un-American. Just as un-American as the Harvard students who shouted down Robert McNamara (or, for that matter, the people who showed up at Columbia to shout down Ahmedinejad). They are, by definition, “agitators and rowdies.” This is what agitators and rowdies do.

    Ajami’s further point that somehow Obama or the left is trying to evade “political debate” – or that it is OK to be against the Iraq war, but not OK to oppose ObamaCare – is rubbish. Health care has been debated ad nauseum in newspapers, on television, in the blogosphere, and at your local Starbucks. (Peets where I live). No problem at all with that, and of course Ajami is unable to come up with a single example of anyone squelching true “political debate.” He is unable or unwilling to see the distinction between those who discuss the matter rationally and civilly, and those who show up with Hitler posters and demand that the speakers “get your government hands off Medicare” (as though Medicare were something other than a government program).

    What Ajami will not discuss, of course, is that the gullible and excitable people who exemplify H. L. Mencken’s Boobus Americanus at the town hall meetings are fed a steady diet of lies, half-truths, and misrepresentations by hyperventilating entertainers qua journalists on cable television, talk radio, and in the blogosphere. Death panels, pulling the plug on grandma, providing universal health care to illegal immigrants, diminishing the level of Medicare treatments: these are all falsehoods spread by those whose only interest is bringing down Obama, regardless of the consequences. If Obama gave everyone puppies and free vanilla ice cream, they would howl that ice cream makes you fat and Stalin also liked puppies. You can’t reason with these people, no reason to try.

    Given the fact that the opposition party is bereft of ideas and interested only in attacking everything Obama or the Democrats do – incidentally unlike what the Democrats did during the Bush years, when they gave him lots of votes on legislation ranging from the AUMF to Iraq funding bills to prescription drug bills to his Supreme Court and other nominees – I give Obama a lot of credit for tackling a difficult and intractable problem which has always been a political loser. Health care is a complex and nuanced issue which does not lend itself to sound bites or bumper stickers. Does he have the best possible plan? I don’t think so, but it stands in stark contrast with those who are trying to shout him and others down, who have absolutely nothing to offer.

    There is plenty else in Ajami’s essay which falls flat. Pushing through a “sweeping program” in “record time” is what Presidents do early in office, when they have political capital to spend. Look at FDR’s New Deal or LBJ’s Great Society. They too were strenuously opposed by contemporary Republicans, who were as wrong then as they are now. Opposed for the same reasons: too radical, puts us on the road to socialism, we can’t afford it. Of course, what was once radical is now mainstream. ObamaCare is no more radical than Medicare, Medicaid, or the VA system. It simply pushes the same thing to a greater part of the population.

    Ajami apparently is unable to conceive that “white professional liberals” might vote for Obama because he was the better candidate, not because of “absolution.” And don’t get me started on Sarah Palin. Nor is American foreign policy under Obama “penitent.” Obama is not a “joyless scold.” Ajami credits Obama’s victory on “national panic” over the economy but conveniently ignores the fact that the panic has lifted as the economy has stabilized because – guess what? – the stimulus plan which Ajami and his ilk so vehemently opposed is working. The Wall Street Journal editorial page and op-ed page have an impressive record about being wrong on just about anything. Ajami’s piece is no exception.

    Posted August 27, 2009 at 12:27 am | Permalink
  5. JK says

    ” Ajami credits Obama’s victory on “national panic” over the economy but conveniently ignores the fact that the panic has lifted as the economy has stabilized because – guess what? – the stimulus plan which Ajami and his ilk so vehemently opposed is working.”

    I’m not convinced of that. We’re barely 8 months in at it took a bit of time for the newest version of the “stimmulus plan” to kick in – overlooking that what, less than a quarter of the funds to provide the stimulative effect have been placed?

    Though roundly criticized by many (including myself) at the time, I think I have to reconsider the effects of the Paulson/Bernanke “Wall Street bailout” and the auxiliary actions. History, it seems to me, has a habit of presenting itself (as well as effects) over a greater length of time than eight months. Not too many months prior to this Malcolm quoted some fellow (whose name escapes me) who offerred a prediction that the Dow would reach the (at the time) astounding level of a number (I also forget).

    But at the time I considered it uhm… improbable.

    I would admit that a changing of the guard coupled with a new sort (any sort) of perceived change in the “kind” of stimulus coming down the pike just might affect “the confidence level.”

    But economincs has never been my strong suit.

    There’s a piece of this puzzle I think should be considered in all this, many of the policies the previous Administration put in place that were considered so onerous that Obama would immediately rescind them upon ascension – remain in effect.

    And then there’s those pesky Clintonistas.

    Posted August 27, 2009 at 2:56 am | Permalink
  6. the one eyed man says

    There’s lots of evidence to support the notion that the stimulus is working – a handy example is but there’s lots more.

    It’s easy to forget how awful things were last winter. Hundred year old companies were crashing and burning. Banks wouldn’t lend. Interest rates for everything but Treasuries shot up (actually the rate for some T-bills became zero: people were so afraid that they would rather hide it under a figurative mattress than invest it in stocks or bonds). The Dow was in the mid-6000’s. The world looked like it was going to end.

    We’ve stepped back considerably from the brink, and the stimulus plan (along with the various bailouts) are the likeliest causes. I don’t pretend to claim that everything is hunky dory, but the massive steamship which is the US economy turned around.

    Posted August 27, 2009 at 9:55 am | Permalink
  7. Malcolm says

    Peter, JK, thanks for joining in. (I was beginning to worry that something might have happened to you, Peter…)

    I am swamped at work, so will try to respond this evening.

    Posted August 27, 2009 at 10:57 am | Permalink
  8. Charles says

    If it is true that the “dissenters” mentioned in the article are simply intending to prevent dialogue, then I stand corrected: that would most certainly be un-American–or at least un-democratic. I did not know anything about these town hall meetings previously (they’re not big news here in Korea, and I’m not up-to-date on American news), and had assumed that the author was presenting the facts more or less impartially. Perhaps I assumed too much.

    (I’ve still never actually seen one of these town meetings.)

    Posted August 27, 2009 at 7:59 pm | Permalink
  9. Malcolm says

    Peter, those who raise dissenting voices at these meetings cover the full spectrum of behavior, from informed and thoughtful critics to obnoxious idiots. (As always.) But a lot of people are angry at what they see here, which is a profound, and disturbingly sudden, shift toward socialism. They feel like they are being hustled, which they arguably are, and they are not going to take it lying down.

    As for rowdy agitators, I don’t recall your being bothered back when George Bush’s obstreperous and loutish critics caricatured him as “Chimpy McHitler” — and if you can with a straight face suggest that the Left was better-behaved during the last administration than conservatives are now, you should probably get yourself a spot on the World Poker Tour. I quite agree that shouting someone down is not “debate”, but that has hardly been the only response from the opposition. And to suggest that loud, even unruly dissent is “evil” or “un-American” is ridiculous; if anything, it is the very hallmark of a free society. It’s un-North-Korean, perhaps, but it is as American as apple pie.

    Your true colors are showing when you dismiss all of those who show up at the town-hall meetings to express their dissent as Boobus Americanus, and blithely dismiss their (entirely valid) concerns as “lies, half-truths, and misrepresentations”.

    Death panels? Yes, a scary term, and emotionally charged. But in the communitarian, progressivist ideology expressed by Mr. Obama’s own chief advider on the matter, Ezekiel Emanuel, a physician’s primary concern ought not to be doing whatever he can for the individual patient under his care, but rather working to keep costs down for the social network as a whole, using a utilitarian calculus that assigns a varying value accorsing to a person’s age and circumstances. And under a government program it will not be the physicians making the decisions.

    You don’t think that such rationing will become necessary? It seems not, from your blithe assertion that “ObamaCare is no more radical than Medicare, Medicaid, or the VA system. It simply pushes the same thing to a greater part of the population.”

    Right now under Medicare, which is already foundering, about 150 million Americans pay about 3% of everything they earn to carry the health care of 40 million or so old folks. Add to that burden the cost of assuming responsibility for another 40+ million uninsured. Then put ten or twenty million illegal aliens on a “path to citizenship”, which of course will include medical-care entitlement. How can that possibly be sustained without enormous restrictions on access to services?

    Yes, this is a “sweeping program” being pushed through in “record time”. Isn’t that reason enough in itself to be leery of it? Oughtn’t we to take a little care with this? (I will leave aside discussing FDR’s radical initiatives, except to point out that the nation was still mired in depression at the beginning of his second term, and was lifted out of it only by the Second World War.) But no, as Rahm Emanuel reminds us, a canny politician never lets a crisis “go to waste” — whether it’s a sub-prime meltdown or a fire at the Reichstag.

    Finally, you write:

    Ajami credits Obama’s victory on “national panic” over the economy but conveniently ignores the fact that the panic has lifted as the economy has stabilized because – guess what? – the stimulus plan which Ajami and his ilk so vehemently opposed is working.

    Not so fast; we are talking here about deficits that beggar the imagination. As mentioned in this article (deep-linked from this post at Mangan’s):

    …if the government were to raise taxes so as to seize 100% of all wages, salaries and corporate profits, it still would be showing an annual deficit using GAAP accounting on a consistent basis. In like manner, given current revenues, if it stopped spending every penny (including defense and homeland security) other than for Social Security and Medicare obligations, the government still would be showing an annual deficit.

    We are far from port, on a stormy sea, and our decks are awash. Some folks think it’s maybe not the best time to try rebuilding the ship.

    Posted August 27, 2009 at 11:12 pm | Permalink
  10. the one eyed man says

    1) As noted above, I have no problem with “informed and thoughtful critics,” but those whose purpose is to disrupt are a big problem, regardless of whether they come from the right or the left. To the extent that those who oppose Obama’s agenda are willing to debate it, I think that’s a great thing. However, serious debate from the opposing side has been mostly lacking (see below), which is regrettable. My issue with Ajami is that he fabricates the notion that somehow Obama is trying to steamroll the country into adopting his agenda by excluding opposing voices. The irony, of course, is that those who are trying to exclude opposing voices are those who show up at town hall meetings to shout them down. There are a number of issues which should be on the table, and they are being ignored by both Obama and the Republicans.

    2) The people who called Bush Chimpy McHitler are idiots. So is the guy who slapped a bumper sticker on a local stop sign which says “9/11 is an inside job.” Idiocy is not the exclusive province of the right. However, as far as I know, none of the Chimpy McHitler crowd ever went to a public meeting with the intent to hijack it. And if they did, they were wrong. If people choose to have bizarre views: fine, whatever. If people choose to have bizarre views and prevent those with more lucid views from expressing them: big problem. So I do think that “the Left was better-behaved during the last administration than conservatives are now:” they didn’t go around disrupting other people’s gatherings. Big difference.

    3) I did not say that “all of those who show up at the town-hall meetings to express their dissent as Boobus Americanus.” Only those who shout down others or tell politicians that the government shouldn’t get involved in Medicare. If you think it’s the wrong plan and can express yourself civilly – and not prevent others from also doing so – then bring it on. There are plenty of valid reasons to oppose the health care plan. There are no valid reasons for preventing others from agreeing or disagreeing.

    4) Nor did I say that the (legitimate) arguments against ObamaCare are based on ““lies, half-truths, and misrepresentations.” However, there are plenty of (llegitimate) arguments which are based on sheer fabrication. Let’s take one example. The House bill included Medicare payment for end of life counseling if the patient requests it. No obligation, strictly voluntary, and covers entirely reasonable things like deciding who has power of attorney if you are incapacitated. This was twisted by into government mandated panels which decide whether or not to pull the plug on Grandma, or Troy Palin, or Stephen Hawking, or whomever. And people believe this stuff. Hence they show up with posters of Obama in a storm trooper outfit, and shout down those who would dare to remind them that they suffer from cranial rectal inversion.

    5) Ezekiel Emanuel is a bioethicist whose writings address the hard questions of health care. If you have a limited number of livers available for transplant, who do you give it to? The 25 year old with a history of drinking or the 75 year old who has no history of drinking but needs the liver? I dunno: that’s why people like Ezekiel Emanuel are around.

    One of the issues which bioethicists content with is the trade-off between health care cost and health care results. We have finite resources. Let’s suppose an 85 year old man with renal failure and heart problems needs an operation which may prolong his life by three months. Let’s suppose that for the same cost, you can provide prenatal care to one thousand kids and prevent nasty childhood diseases, or possibly death. You have three choices: you can pay for the old man, you can immunize the kids, or you can pay for both. Right now, the public pays for the old man, but generally not for the kids, and pays for the procedure with borrowed money. Is that the right choice? What would you do?

    Reasonable people will differ, but Emanuel has an opinion and expresses it. I think it’s a reasonable opinion. However, there is no straight line between his opinions and the health care bill – which has no provisions on rationing – or even the likelihood that reductions in health care for any segment of the population are forthcoming. It’s purely suppository, and we know where suppositories go.

    However, it’s a bogus argument. The fact is that we have health care rationing now. Whenever there is more demand for anything than there is supply, there is necessarily rationing. I think that debating how finite resources should be allocated is a debate worth having. Regrettably, that’s not even part of the discussion, as neither the Democrats nor the Republicans are willing to touch it. I think that Obama’s plan can rightly be faulted for expanding coverage without any explicit discussion of rationing. However, that’s not what the bozo brigade recognizes: they are blaming Obama for making decisions on issues which he has been reluctant to even acknowledge.

    6) The deficit is huge, no doubt about it. It will get larger with ObamaCare. (I would be happy to pay higher taxes for universal health care, but regrettably that’s not part of the discussion either.) However, the relevant question is not how large the deficit is, but whether the policies which led to the deficit provided the best option, or whether something else should have been done.

    Last winter, the economy was going down the tubes with what seemed like unstoppable force. Had nothing been done, things would have gotten much worse, perhaps to the point where we would be in a hole too deep to escape from. It clearly needed a shock to the system. Whether the stimulus plan and the various bailouts were the best choice is open to debate. However, to simply complain that the deficit is huge without explaining what should have been done instead is to provide noise but not light.

    We have a $15 trillion economy. Let’s suppose that nothing was done last winter and we shrank to a $10 trillion economy, along with 20% unemployment. This is not a far-fetched possibility. Which is worse: having the economy shrink by one third, or borrowing huge sums of money? If the patient is on the operating table, you can let him die, or you can give him an operation which will keep him alive but with inevitable problems after he leaves the hospital. The stimulus and the bailouts were, I think, required to keep the economy from irrecoverable ruin, and for that reason were justified. Will they lead to hardship in the future? No doubt.

    7) If you want to make the argument that maybe we needed the stimulus, but we don’t need expanded health coverage – or at least we don’t need it now – then you’ve taken a cogent and respectable position. While you can find this argument in places like The Economist, you can’t find it in the upper ranks of the Republican party. That is because you must also explain why the status quo is preferable to changing the system, or why some other alternative is preferable to both the status quo and ObamaCare. The Republicans won’t do that, because nobody wants to defend the status quo. They won’t come up with an alternative either, being content to simply attack every attempt Obama makes to fix the problem. Instead, all we get is noise. And people showing up at town hall meetings to hijack them and compare Obama to Hitler. As though that wasn’t one of the tactics which propelled the Brown Shirts to power.

    Posted August 28, 2009 at 12:09 pm | Permalink
  11. Malcolm says

    Peter, I have no doubt whatsoever that Mr. Obama is trying to steamroll the country; he has throughout this initiative put an unseemly emphasis on haste, like a salesman with a pen in his hand and cars to move off the lot. This is understandable, as any politician wants to take advantage of favorable winds before the weather changes, but Mr. Ajami was quite correct in making this assessment, I think:

    It was true to script, and to necessity, that Mr. Obama would try to push through his sweeping program—the change in the health-care system, a huge budget deficit, the stimulus package, the takeover of the automotive industry—in record time. He and his handlers must have feared that the spell would soon be broken, that the coalition that carried Mr. Obama to power was destined to come apart, that a country anxious and frightened in the fall of 2008 could recover its poise and self-confidence. Historically, this republic, unlike the Old World and the command economies of the Third World, had trusted the society rather than the state. In a perilous moment, that balance had shifted, and Mr. Obama was the beneficiary of that shift.

    So our new president wanted a fundamental overhaul of the health-care system—17% of our GDP—without a serious debate, and without “loud voices.” It is akin to government by emergency decrees. How dare those townhallers (the voters) heckle Arlen Specter! Americans eager to rein in this runaway populism were now guilty of lèse-majesté by talking back to the political class.

    This is simply how politics works.

    Forgive me, but you seem, frankly, unmoored from reality when you say:

    However, as far as I know, none of the Chimpy McHitler crowd ever went to a public meeting with the intent to hijack it.


    So I do think that “the Left was better-behaved during the last administration than conservatives are now:” they didn’t go around disrupting other people’s gatherings.

    I seem to recall things rather differently; readers may examine their own recollections of the behavior of the Angry Left during the Bush years for independent confirmation.

    As for the question of “death panels”, the point, as I tried to show above, is not that they are specifically created by the legislation at hand, but rather that they are, in the opinion of many, a natural result of the shift toward communitarian, rather than individual, health-care priorities as the system moves toward socialism, and attempts to provide government-run healthcare for all. (Sure, it was Sarah Palin who pointed this out to the general public, but even a stopped clock is right twice a day.) If you look at the progressive movements of the 20th century, both here and in Europe, they were characterized by a trend toward eugenics and a utilitarian calculus that sought to eliminate inconvenient classes of people (not that I have any systematic objection to eugenics, which, if the government is going to be meddling in in individual liberties at all, is perhaps the most productive place to do so). Currently physicians serve as individual advocates for their patients, but it is going to be difficult for them to serve two masters, and if we reach the point where they must depend on a socialist government for their livelihood, the emphasis will inevitably shift. As Ezekiel Emanuel has said:

    “Covering services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic, and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia.”

    I agree that how to allocate scarce resources is a difficult question, but am in no hurry to have to appeal to a government bureaucracy when I am in need. But however we feel about it, to pretend that to raise these concerns is all just scurrilous disinformation is itself a gross distortion.

    You write:

    I think that Obama’s plan can rightly be faulted for expanding coverage without any explicit discussion of rationing. However, that’s not what the bozo brigade recognizes…

    Au contraire: this is exactly what most of the hue and cry has been about. The whole point about “death panels” is that such government-level triage will become necessary as rationing deepens. Which it will.

    Regarding the deficit, I didn’t say that I thought some sort of government action was unwarranted; I was simply pointing out that we are not out of trouble yet, and the cost has already been enormous. Even leaving aside my inveterate antipathy towards progressivism, taking on another colossal government obligation at this time seems awfully unwise, and to try do so in such frantic haste smacks of ideological zealotry.

    In 7), you wrote:

    If you want to make the argument that maybe we needed the stimulus, but we don’t need expanded health coverage – or at least we don’t need it now – then you’ve taken a cogent and respectable position.

    Glad you think so.

    …Instead, all we get is noise. And people showing up at town hall meetings to hijack them and compare Obama to Hitler. As though that wasn’t one of the tactics which propelled the Brown Shirts to power.

    I would be careful about making comparisons to the rise of Fascism and National Socialism; a careful study will reveal a great many parallels that you might find awkward.

    Posted August 29, 2009 at 2:29 pm | Permalink
  12. the one eyed man says

    1) The health care debate has been going on since at least 1993, when the Clintons tried to change things, so the haste doesn’t seem too unseemly to me. Regardless, Obama knows that he needs to make his biggest moves in his first year in office, when he has political capital and before his second year, when nothing gets done in an election year. The people who are trying to obstruct his agenda would obstruct them regardless of how long they took to enact. Even so, the health care debate has been dragging on for months, and will drag on for more months before anything gets done. No steamrolling here.

    2) The Angry Left and the Angry Right have been saying intemperate, offensive, and calumnious things for years, on cable television, talk radio, and the blogosphere. That’s democracy, and the First Amendment, in action. However, only the Angry Right has disrupted and hijacked town hall meetings. That’s throwing a monkey wrench into democracy and the First Amendment. There are plenty of examples on YouTube. Far from being “unmoored from reality,” these are facts. Your inability to cite a single example of the Angry Left rampaging through town hall meetings underscores the fatuity of the comparison. Cindy Sheehan protested on a rented farm near Crawford. Michael Moore made movies. Ariana Huffington blogged. Nobody went to town hall meetings with written instructions and an express intent to disrupt them.

    3) Any time you see an argument which starts “in the opinion of many,” you know that the author does not have sufficient confidence in it to be accountable. In the opinion of many, the Earth is flat. In the opinion of many, 9/11 was an inside job. Or maybe they’re the same people: the flat Earth guys probably also think that 9/22 was an inside job. I don’t know.

    In any event, the notion that if you increase public coverage of the uninsured, the next step is euthanizing “inconvenient classes of people” is an absurdity too gross to be insisted upon. It’s also contradictory. First you claim that the cost of expanded coverage is so great that it will bankrupt us. Then you claim that because of the cost, we’ll have to get rid of annoying people. Well, which is it? The poor house or the slaughter house?

    This argument fails on two grounds. The first is that it ignores the current reality of health care. While you may object to Emmanuel’s suggestion that it is not necessarily an obligation of the public to provide lifelong care to those with dementia are, the fact is that people with dementia – or anything else – are not given lifelong care anyway. If you are old and sick, you get publicly financed treatment from Medicare. If you’re a veteran, you get VA. If you’re poor, you get Medicaid. However, if you’re under 65 and unemployed, you get nothing. Until you’ve spent all your money and become indigent, when you can get public assistance. That’s nuts. So the argument that somehow our health care system is effective, equitable, and efficient — but Obama wants to deprive those who deserve health care to provide it to those who don’t — is ludicrous. Health care is rationed now, except the rationing factors are whether you are in a favored group (the elderly, veterans), what kind of insurance you have, and ability to pay. I would prefer to have rationing decisions made by the government, which can devise a system which treats all parties equitably, than insurance companies, which are motivated by profit. Hence the suggestion that “currently physicians serve as individual advocates for their patients, but it is going to be difficult for them to serve two masters” is wrong. They serve two masters now, except the second master is the insurance companies, and not the government.

    The second ground is that a system which rations health care does not decline care for people which are “inconvenient,” but rather for cost-benefit considerations such as the patient’s age, cost of the procedure, likelihood of success, etc. The British have a system along these lines. In A Theory of Justice, John Rawls made the (vastly oversimplified) argument that a system is fair if everyone who goes into it accepts the validity of the rules without knowing his or her circumstances within that system. In other words, if you would accept a health care system without knowing if you would be sick or healthy, but think it would be fair to all, then it is a just system. The fact is that we have a finite amount of resources competing for a much greater demand for them, and they are currently allocated now in a haphazard and inefficient way. It makes no sense for the government to prolong the life of an old man for three months with a kidney transplant and decline to provide the same procedure for a man in his forties, who could live for decades. An adult discussion of the issue would start from the acknowledgement that we can’t provide everything to everyone, and a well-run government would determine how the finite resources we have can be distributed in the most humane and equitable manner possible.

    Posted August 30, 2009 at 10:22 am | Permalink
  13. the one eyed man says

    Nicholas Kristof makes the argument better than I can, coincidentally using dementia as an example:

    Posted August 30, 2009 at 11:29 am | Permalink
  14. Malcolm says

    1) No, Mr. Obama pressed very hard to get this legislation enacted before Congress recessed for the summer. I don’t think “unseemly” haste is an unfair description. Of course, the way that seems depends on which side of the issue one is on; I remember hearing a lot about a “rush to war” a few years back, when we had been seeking diplomatic solutions for more than a decade.

    2) Peter, come on. Shouting people down at public events has been a favorite tactic of the far Left as long as I can remember, and recent examples (such as this, which took me about ten seconds to find) are simple enough to come by. You can pretend that all the staid and dignified Left ever does is make thoughtful films, while the Right is a bunch of ill-mannered hooligans, but it just ain’t so. Again, let’s just let the readers consult their own recollections of the behavior of the Left throughout the Bush years and the Iraq war.

    As for the poorhouse versus the slaughterhouse, you present a false choice. As the cost of government-run health care soars — which it will, as the already-sinking Medicare system is expanded to tens of millions of new beneficiaries — the prospect of financial catastrophe will force quality and service downward, and rationing will deepen (just look at Canada and England). But we can have all that and still end up in desperate financial straits. I haven’t suggested that the US will end up with actual euthanization programs any time soon (though that has happened elsewhere also in recent historical memory, in response to the same pressures on community resources), but withholding care in favor of someone deemed to have a more promising future and fewer sunk costs amounts to the same thing. There will indeed be plugs pulled on Grandmas when Grandma is competing against Junior. Ought that be the way it will work? Maybe. But to pretend it wouldn’t ever happen is disingenuous.

    3) Fair enough – vague ad populum assertions are no argument. But it is nevertheless the case that the obvious fact that as more people compete for finite government largesse, the more such goodies will have to be rationed, has been plain to, and articulated by, a great many people (for example, here).

    You wrote:

    Health care is rationed now, except the rationing factors are whether you are in a favored group (the elderly, veterans), what kind of insurance you have, and ability to pay.

    This is a deep confusion about what “rationing” means. Providing costly resources according to the ability to pay is not “rationing”, it’s called “commerce”. By your argument Maseratis, berths on the Queen Mary, and dinners at Jean-Georges (not to mention mundane necessities as food and clothing) are “rationed” too. Your view assumes a “right” to health-care, an assumption to which you can’t just help yourself. Rationing can only occur when the government alone is the arbiter of how such resources are allocated — and it is not unreasonable to imagine that becoming the case.

    Likewise, no physician currently has an insurance company as his “master”; doctors are free to accept whatever insurance they like, or, as was the case with our GP in Brooklyn while we were rasing our kids, none at all. So the question of whether a government-run plan would result in a state monopoly is an important one, and leads directly to questions about rationing.

    I am well aware of John Rawls’s “veil of ignorance” theory of justice, which in turn owes much to Kant’s categorical imperative. But the dispensation of justice, which is the very raison d’etre of the State (along with defense of the borders, and a short list of other obligations), is a different matter from the provision of costly personal services, and to talk about Rawlsian systems of government health-care allocation is to beg the question of whether it is the proper role of government to provide such costly personal services in the first place.

    Finally, it would be simple enough to match Mr. Kristof’s examples of the horrors of private-sector healthcare with equally chilling stories about socialized-medicine systems from around the world.

    Look, I’m all for re-examining the way health care works in this country. Obviously the system we have leaves a lot to be desired, and there is probably no perfect solution. Ajami’s point was that Mr. Obama was riding a political mood and tide that verged on the messianic, and that he understandably tried to ram through in haste what are, as even you must admit, truly radical changes to a major segment of our economy, at a time when we are already committed to enormously costly, and equally radical measures in response to the recent financial crisis. It is simply too much, too fast. Let’s take our time with this. Let’s work for a real national consensus about what sort of society we want to be, rather than taking hasty advantage of a transient political majority.

    Posted August 30, 2009 at 9:15 pm | Permalink