Wow, it's been a long time!  I've been tempted to blog a few times since my surgery (7 weeks ago today), but this is the first time I've actually had energy to log on.

(Okay, and maybe I've been hoping that Congress could come up with some kind of health care legislation in the same amount of time it took me to regrow 75% of my liver.  Dreamer!)

At any rate, I've been reading (mostly trashy) books, watching television and movies, and napping.  Today was my first "big" walk with Hal and Charlie and it seems to have done the trick for garnering me some energy.  (It's 5:46 and I haven't had a nap yet...that's some kind of record.)

The main item drawing me back to the blog today is not a general update; however, it's to recommend a film from among the many that I've watched.  Called Sin Nombre,  written and directed by Cary Fukunaga, the film is presented with Spanish subtitles.  Despite the challenges usually entailed by subtitles, this is a highly engaging film--part thriller, part love story, part political statement--that asks important questions while telling a compelling story.

I'd say Fukunaga is a man with a future in film.  He's done just about every behind the camera role in film making.  It's clear from the film he put together in Sin Nombre, that his apprenticeship paid off.

 


Comments

Steve Peden

Tue, 29 Sep 2009 14:45:43

We've been worried about ya, hon. Hope you are going better, daily.

"(Okay, and maybe I've been hoping that Congress could come up with some kind of health care legislation in the same amount of time it took me to regrow 75% of my liver. Dreamer!)"

Why???? Why this all-fired rush to "do something"? (Or, as my Dear Daddy used to say, when I would let my enthusiasm overcome my rationality on some job-to-be-done: "That's right! Don't just stand there, DO SOMETHING - even if it's WRONG!")

And, what should they "do"???

 

Laura

Wed, 30 Sep 2009 09:15:45

Thanks for the good wishes (and the worry...I'll count it as prayer and I'll take as much of that commodity as possible!)

Things are pretty good...it's just hard to recover from having 75% of your liver removed. Phew!

As to healthcare, since we've been working on versions of this for over half a century now, I'd say we're not in any all-fired rush that I can detect.

As to what should be done? I am finding myself more and more in agreement with the "Zieglar Plan," named after a friend, that we sever the relationship between employment and health care...and that we decide that health care is a basic human right. Those two decisions should inform the process.

Just my (paltry) two cents.

 

Steve Peden

Wed, 30 Sep 2009 18:29:03

Laura,

Think there is, just possibly, a REASON why we haven't done this whole "health care 'reform'" thing, given all the times we've tried it? And I find it hard to credit that we aren't in an "all-fired rush" when the President, Pelosi and Reid are jawboning representatives and Senators to vote for a 1,200 page bill THAT THEY HAVEN'T READ - and insisting they had to have SOMETHING by August.

I'll give you the same question/thought experiment that I have given health care "reform" proponents for several years now (still haven't had anyone give me an answer):

We have been told (including by the President) that innovation and higher levels of technology in health care are drivers of cost increases, and that a robust "public option" is necessary to provide competition and control costs (snicker!). There are two areas in American health care that are (i) characterized by ever-increasing levels of innovation and technology (including expensive new equipment which is obsoleted by even more expensive new equipment on what seems to be about a two or three year cycle), and (ii) is not compensated or reimbursed for by ANY government plan, or even most private plans (i.e., it is paid for, from the "first dollar" by the CONSUMER). And, yet, both of these areas are characterized by price wars. LASIK surgery, and elective cosmetic surgery (check your Sunday newspaper for the price ads).

So, 'splain this to me, Lucy - why are the two areas that the government is LEAST involved in the two areas that provide (i) constantly improving technology and quality of care, and (ii) constantly FALLING prices? Other than, of course, the obvious - when people are spending their own dollars, the market works rather well, dunnit?

Peden's simple health care "reform" plan (and, BTW, it ain't health CARE reform that any of us are talking about, it's health INSURANCE reform, but that's another issue):

1. Meaningful tort reform;

2. True, interstate competition in health insurance;

3. Individual, portable health insurance, paid for by the individual, with pre-tax dollars;

4. Permit pre-tax health care savings plans, that can be used for regular health care/preventive care, and, if not used, used for retirement, or willed to your heirs;

5. Encourage TRUE health INSURANCE (i.e., fairly low deductible, very high limit, catastrophic care insurance), for individuals (such plans are actually quite inexpensive); and, finally

6. I would be OK with guaranteed coverage, no "prior conditions" exclusions, IF insurance companies could price by actuarial risk. I'm sorry, but if you are a 275 pound couch potato who smokes 2 packs a day, I should not have to subsidize your health care costs.

Health care is a right. OK. How about home ownership? A "right" is a negative construct - my (true) rights are things which the government (interestingly, our Founding Fathers viewed rights as inherent, and only needing protection from what? The gummint. Curious, that.) cannot prevent me from exercising. When you start talking about affirmative "rights" to benefits, services, etc. (properly, these are not rights, they are entitlements), this is where you go astray. For you to have a "right" to health care, there is a corresponding ability to FORCE someone else to supply it to you (a doctor to provide services for below-market prices, or another taxpayer to subsidize it). Again, such are not "rights," they are entitlements.

Let us not mince words - you are saying that I am required, by law, on threat of violence and imprisonment, to pay for the health care of others. OK, that's your opinion, and you are certainly entitled to it. That high-pitched whining you hear is the sound of Adams, Jefferson, Madison, et al, spinning in their graves.

 

Laura

Sat, 03 Oct 2009 18:03:04

Oy vey...I just accidentally deleted my response to you...I'll work on it tomorrow.

<sigh>

 

Laura

Sun, 04 Oct 2009 14:46:11

Let's try this again!

As to reasons we haven't already "done this whole health care reform thing," I can think of several off the top of my head.

1. Poor timing. The issue of health care reform and some sort of public system butted up against McCarthy-ism, the Cold War and the birth of the "take no prisoners and damn the truth" right wing attacks on the Clintons.

2. Effective counter-marketing by the opposition. I've heard more references to socialism and communism in context of this current debate than I can shake a stick at.

Really? We're all going to become communists? Because that's our only choice in building a reasonable, cost effective, compassionate and responsible program for insuring every citizen?

The only thing worse, in terms of fear-mongering, in this debate is the pull the plug on grandma lie started by little Miss Palin.

3. A misguided, or at least outdated and unproven, faith in the virtue and the unfailing payoff of "self-reliance." It's as if folks on the right believe that only shiftless, lazy, dunces are poor.

There was a great quote in an LA Times article today from a woman who added a surcharge to her menu of $1 per person so that she could afford San Francisco's public option insurance for them. (She's not a supporter, btw. It was mandated.) A woman customer complained that she found it offensive that she had to "pay" for the restaurant employees' health care. The owner responded that she found it offensive that the guest was complaining about a dollar while wearing a 4 carat diamond.

About sums it up for me...but I digress.

4. A misguided belief that markets solve every need (even shared public needs) perfectly.

As to your question about cosmetic surgery and Lasik, are you asserting that costs for these procedures have gone down due to market forces and quality of care has risen? I guess I'd like to see some evidence contrasting those two areas of medical care with the astounding and life-saving advances in cancer care over the past 10 years.

The Peden plan has a lot of things I like.

1, 4, 3 and 5 are areas where I agree...although I suspect we'd differ on what's "meaningful" in terms of tort reform.

2. Since interstate insurance competition is likely to lead to consolidations rather than expanded consumer choice over the long term, I'm not sure it's the boon you think it would be. (Banking makes a nice comparison here.)

6. While I agree with your sentiment in terms of not subsidizing others' lifestyle choices, I think there are two issues here.

First, it would be extremely difficult to control these measures, assuming we set good measurements to begin with. How do we monitor my alcohol intake or your tobacco use? What about measuring the level of exercise someone fits into their schedule...do they need a sign off from their trainer or the gym? Talk about big brother, yikes!

Second, we are complex systems...there are plenty of heavy people who live to be 95. There are alchoholics who die in their 80's. There are smokers who never get cancer and nonsmokers who do...how do we control for systemic risk when we barely understand it.

Phew...gotta hit submit since this is where I lost the whole deal yesterday. Good discussion on the Peden plan. I like it.

 

Steve Peden

Wed, 07 Oct 2009 21:32:26

"The issue of health care reform and some sort of public system butted up against McCarthy-ism, the Cold War and the birth of the "take no prisoners and damn the truth" right wing attacks on the Clintons."

Oh, please. I get mortally tired of this whole "level of discourse/whatever happened to civilty" meme. The "right wing" attacks on Clinton were no worse, in tone, tenor or ferocity, than the attacks on Lincoln in the 1860's, the attacks (by his own party, primarily, BTW) on LBJ, the attacks on Nixon, the attacks on Reagan, the attacks on Bush 1 and 2, the attacks on Carter, or the attacks on Obama. Politics in the U.S. is a blood sport - deal.

Yes, I trash Obama and Carter - hell, they earned it. You trashed Bush and, while I disagree with some of your criticisms of W, HE earned it, too. You put yourself out to get that job, it comes with the territory - but let's not be naifs about this - vituperative diatribes against elected officials predate the Constitution, and, overall, I think they are a GOOD thing. My biggest beef with "The One" is the truly absurd cult of personality surrounding him, and his own NPD (narcissistic personality disorder). Politicians are, by and large, ridiculously egotistical (with damned little justification for same, I might add), and it is not just our right, but our DUTY to (as my Brit friends like to say) "take the piss out of them."

"The only thing worse, in terms of fear-mongering, in this debate is the pull the plug on grandma lie started by little Miss Palin."

First of all, it's "Mrs." Palin (or, I suppose, "Ms." if you prefer that). Second, she did NOT "start" that meme - although her "death panels" formulation was the one that caught on. Finally, if you contend that this is untrue, please explain to me the triage system under Oregon's state health care plan - and why, when they tell you you AREN'T getting treated, they send you a letter advising you that they WILL cover physician-assisted suicide?

"A misguided, or at least outdated and unproven, faith in the virtue and the unfailing payoff of "self-reliance." It's as if folks on the right believe that only shiftless, lazy, dunces are poor."

No, not all poor people are shiftless, lazy dunces. That is, however, the way the smart money bets. You are aware, I assume, that if you (i) finish high school, (ii) DON'T get pregnant or get someone else pregnant, (iii) and stay out of jail, your chances of living at least a middle class life are at least triple what they are if you don't do one or more of those things? People hit hard times for a variety of reasons - I've done it myself, a time or two - but bad life choices account for the VAST majority of being "disadvantaged." When I went to law school, I had a full ride (academic) scholarship paying for school. I found a DUMP duplex, in a borderline slum, that I could rent for $110 a month, and I lived (food, entertainment, clothes, etc., etc.) on $100 per month. I covered the $210 by working throughout law school. I had a classmate, who drove a Mercedes 350SL, and lived in a two bedroom, high-rise apartment in a nice part of downtown (rent free - it was owned by his father), and got food stamps and welfare (he had no "income"), and told me I was stupid for not getting the same deal. I guess I was stupid - but I don't have any problem looking myself in the mirror when I shave. Self-reliance is NOT outdated, nor can you show me a lick of evidence that it doesn't work.


"As to your question about cosmetic surgery and Lasik, are you asserting that costs for these procedures have gone down due to market forces and quality of care has risen? I guess I'd like to see some evidence contrasting those two areas of medical care with the astounding and life-saving advances in cancer care over the past 10 years."

CLEARLY, the cost of LASIK and cosmetic surgery have gone down, and the quality has improved, due to market forces. You have another explanation? I'd love to hear it. I don't deny, for a moment, that there have been truly remarkable advances in fighting cancer, and many other diseases. Cost decreases? Not so much.

And the advances in treatment for cancer and other diseases is one of the best arguments AGAINST "government" health care. Go Google cancer survival statistics for the U.S. vs. all those "enlightened" countries that have government health care. Check out where all these new treatments originated. Where the huge majority of the new drugs have been developed. Where virtually ALL of the new medical technology and equipment has been developed. Our "broken" health care system continues to produce results which blow away all the "enlightened" democratic socialist states (and, yes, I use the word "socialist" - it has a specific meaning, and the definition FITS what your side wants to do).


"First, it would be extremely

 

Steve Peden

Thu, 08 Oct 2009 11:06:31

Well, apparently Robert Reich, caught in an unguarded moment, agrees with "Miss Palin" regarding letting Grandma die:

http://www.weaselzippers.net/blog/2009/10/flashback-sept-26-2007-obama-advisor-tells-audience-truth-behind-obamacare-.html

Listen to the whole thing. Reich is an Obama advisor. 'Nuf said.


And to continue my post that got truncated:

"First, it would be extremely difficult to control these measures, assuming we set good measurements to begin with. How do we monitor my alcohol intake or your tobacco use? What about measuring the level of exercise someone fits into their schedule...do they need a sign off from their trainer or the gym? Talk about big brother, yikes!"

Who the hell says the government needs to be involved in this? If you want insurance, you already get to take a physical; a normal physical would provide evidence of most, if not all, of these issues, and the insurance company can price accordingly. Also, in filling out your insurance application, you are typically asked about these things; lying on the application is (as it should be) grounds for denial of coverage. Big Brother? Hell, no. Just a voluntary transaction between two parties - you want insurance, you disclose your health risks, and you pay accordingly.

"Second, we are complex systems...there are plenty of heavy people who live to be 95. There are alchoholics who die in their 80's. There are smokers who never get cancer and nonsmokers who do...how do we control for systemic risk when we barely understand it."

And so it's now "unfair" to charge a 300 pound chain smoker more than me for health insurance because he/she MIGHT be that one in 100,000 person who will live 80 years anyway (and won't have ANY related health costs)? Bullshit. I get charged more than Deb does for life insurance because, ACTUARIALLY, I will not live as long. I'm not obligated to pay for insurance, but if I choose to, the company selling me the insurance should have the right to price the insurance based on whatever factors make sense to them.

"Since interstate insurance competition is likely to lead to consolidations rather than expanded consumer choice over the long term, I'm not sure it's the boon you think it would be. (Banking makes a nice comparison here.)"

Not sure I agree with your assumptions, here (for one thing, government regulation has been a major accelerant of bank takeovers). Even if true, most people will STILL have more options than they do now - and if we reduce barriers to entry, we encourage existing insurance companies, who don't currently write health coverage (I wouldn't, in this environment) to get into the game.


 



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