Health Care

Case Study in Conservative Cruelty: George Will

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I don’t think George Will meant to be cruel when he wrote his recent article “The Time Bomb in Obamacare?” but he was and it is a recurring conservative mistake. Will focused on the law and the constitution. He found a bomb and he imagines he is a good bomb squad officer by analyzing the bomb and figuring out how it is going to blow up. What he missed, and it is crucial, is the vital step of clearing away the civilians. That is a cruel oversight and hurts the conservative cause. You have to make sure that people understand that there is a bomb and which direction to run so they do not get blown up.

The immediate threat for ordinary people is not Obamacare’s constitutional status, but what it will do to ordinary american’s access to care. Institutions that are caught in the payment squeeze will triage because otherwise they go broke and close, which would maximize suffering. Triage means that the lack of funds will cause them to try to maximize who they can save and cut off who they can’t afford to save. If you are going to be triaged, you need to know and you need to make alternate arrangements to pay cash, figure out how to live without needed care, or get your affairs in order. The later people figure this out, the more pain, suffering, and death Obamacare is going to cause.

Nothing George Will said about the law is wrong. By focusing on the Constitution and the law to the exclusion of the upcoming suffering of the people he ended up reinforcing a pernicious stereotype, one conservatives would do well to lose. Ultimately, the conservative focus on the law and the Constitution has the effect of reducing suffering and increasing the happiness of the people. This approach would be greatly increased in effectiveness if conservatives would directly say so instead of assuming people already knew. A great many people do not know and the conservative brand is suffering for it.

Unacceptable Performance by the Veterans Affairs Department

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Here’s a Rudyard Kipling poem which isn’t as well known as some of his other ones:

There were thirty million English who talked of England’s might,
There were twenty broken troopers who lacked a bed for the night.
They had neither food nor money, they had neither service nor trade;
They were only shiftless soldiers, the last of the Light Brigade.

They felt that life was fleeting; they knew not that art was long,
That though they were dying of famine, they lived in deathless song.
They asked for a little money to keep the wolf from the door;
And the thirty million English sent twenty pounds and four !

They laid their heads together that were scarred and lined and grey;
Keen were the Russian sabres, but want was keener than they;
And an old Troop-Sergeant muttered, “Let us go to the man who writes
The things on Balaclava the kiddies at school recites.”

(read the whole poem here)

What reminded me of this poem?

This story.

Apparently, in 2012 the average time to complete a VA disability or pension claim was 262 days, up from 188 days in the prior year and far above the official target of 125 days. More at Nextgov.

I’m not very impressed with the excuses offered by the VA for this situation:

VA officials attribute the backlog, defined as claims in the system for more than 125 days, in part to higher demand by veterans returning from 10 years of wars in Iraq and Afghanistan with severe and complex injuries.

A Texas Veterans Commission official noted that the agency is caught in a “perfect storm” of claims from veterans of recent wars and those from aging Vietnam and Korea veterans whose disabilities are worsening.

But wasn’t this all predictable? Obviously wars cause injuries, and better battlefield medical attention means that more wounded soldiers will survive and hence need extended care. And wasn’t the higher claims rate “from aging Vietnam and Korea veterans” largely predictable from simple demographic analysis? I’m reminded of the saying about a British railroad from several decades ago:  “Despite its frequency and general regularity, Sunday morning seems to consistently catch this railroad by surprise.”

The above remark about the railroad notwithstanding, private enterprises generally seem to be able to deal with fluctuating demand and other problems quite well. There is almost always food in the supermarkets, despite droughts, crop failures, logistical problems, strikes, etc etc. The electricity is almost always on despite storms and electrical failures. And while businesses generally do a better problem than government at dealing with daunting arrays of problems, some government agencies do manage to deal with demand increases and fluctuations far better than the VA seems able to do with these disability claims. Somehow the FAA manages to conduct air traffic control safely and effectively despite the increased demand that occurs in holiday seasons and the varied and often nefarious effects of the weather. The military itself often manages to quickly deploy forces and equipment to far-distant locations. Why has the VA been unable to modify its processes to provide resolution of disability claims in a timely manner?

Sad and disturbing.

The Connecticut Massacre

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There is information still coming to light about this awful case. Early reports, such as the name of the shooter and the alleged murder of the father, were predictably wrong. It turns out that the shooter, named Adam Lanza, a 20 year old with a history of odd behavior and some evidence of mental illness, such as autism, was living with his mother who was his first victim. There are a number of suggestive reports, that she decided to “stay home to care for” her 20 year old son.

The treatment of severe mental illness in this country has been altered for the worse by a movement that began in the 1960s when mental illness began to be described as a “civil rights ” issue. Several books and movies described abuse of power in commitment of the mentally ill. The first such movie was “The Snake Pit” in which a young woman is committed for what sounds like schizophrenia. The treatment of the time (1948) can be seen as barbaric but there was nothing else available. She did recover, although we know that without adequate treatment, recovery from schizophrenia is unlikely.

The movie that really devastated the mental hospital system was called “One Flew Over the Cuckoo’s Nest” and starred Jack Nicholson.

The movie was powerful in showing the Nicholson character as a guy who just is “different” and harmless.

Read more

“The taxpayer-funded PR blitz for Obamacare”

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It’s already underway and will only get worse. J.E. Dyer’s analysis is worth reading:

It’s one thing when advertisers seek to drive emotional connections with lite beer, pick-up trucks, and air fresheners. It’s something else when the government hires advertisers to drive emotional connections with government policies and institutions. This goes far beyond the old-fashioned “good government” idea of providing information to citizens. In its essence, it differs not at all from a Stalin-era poster hyping the Soviet government’s policies to a beleaguered Russian people.
 
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Advertising is a dangerous thing in the hands of the armed state. I am no more in favor of Republican administrations spending a lot of money on it than of Democrats doing so. With Obamacare, we have reached the fork in the road. A government with the powers conferred by Obamacare cannot, on principle, be trusted to “advertise” its policies to us. The inevitable descent into untrustworthy propaganda has already begun. Until Obamacare is repealed, it will continue to get worse.

Chance Conversations

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Joel Runyon was working on his Mac at a coffee shop in Portland, when an older man sitting next to him asked him how he liked Apple. Resisting the temptation to politely return to his work, Joel engaged the guy in conversation…it turned out he was Russell Kirsch, who was lead designer of the first American stored-program computer (the SEAC) and was also a pioneer of computer image processing. Read about Joel’s conversation with Mr Kirsch at the link, and then read his followup post 7 things I learned from my encounter with Russell Kirsch.

Conversations with strangers can of course expose you to boringness (yes, it’s a word, I checked) and/or weirdness, but they can also often be interested or at least revealing. I was on an Air France flight back from Paris once…the aircraft had to be changed at the last minute and the new plane was not configured with First Class, so those who had reserved FC seats had to be satisfied with Business Class (which, in my experience at least, is nothing to complain about on Air France.) The guy sitting next to me was very, very upset that he didn’t get the First Class seating he had been counting on. In an attempt to get him to talk about something else, I asked him what he did for a living.

Turned out the guy was a professional Communist, on his way back from some kind of Communist meeting.

Here’s another interesting story about a chance conversation. In 2009, an American neurosurgeon overheard a conversation between two former Israel Air Force officers who were talking about flight simulation. He joined the conversation, and the eventual result was a collaboration that led to the founding of this company, which develops systems for surgery rehearsal.

Another interesting story of a chance conversation: see the second comment on this post at Tom Peters’ blog.

For those interested in the history of technology: Russell Kirsch’s SEAC, completed in early 1950, was built by the National Bureau of Standards for use of researchers and engineers who were chomping at the bit for computer capacity and were tired of waiting for more-ambitious planned machines such as EDVAC and UNIVAC. SEAC’s memory capacity was only 512 words (numbers or instructions), but it was applied to a wide range of problems, including lens design, tables for navigation, and design calculations for the hydrogen bomb. The computer also supported early digital imaging work, with the first digital image being a picture of Kirsch’s son.

More about the SEAC project here.