Health Care 2020

A dispatch from the future on the effects of health care reform

March 23, 2020—At the beginning of the last decade, there was great excitement about the future of medicine. Advances in biotechnology, nanotechnology, diagnostics, information technology, stem cell treatments, vaccines, and organ transplants were poised to radically improve the health prospects of Americans. Looking back from 2020, we can see that most of these major biomedical advances failed to materialize. What happened? Three words: health care reform.

Thanks to the health care reform legislation, a higher percentage of Americans are now covered by health insurance than ever before—up from 83 percent in 2010 to nearly 95 percent of the legal population now. About half of the newly insured are covered by Medicaid and Children’s Health Insurance Program. Most of the remainder purchased subsidized coverage through the new state insurance exchanges. There have been some improvements in the overall health of Americans. Cardiovascular disease continued its decline because cholesterol lowering statins, which are no longer under patent protection, are more widely prescribed under new federally set treatment guidelines. Over the past 10 years, cancer mortality rates have also continued to decline, at least in part because people now covered by government programs or subsidized insurance now receive earlier cancer screening. Nevertheless, in 2020, cardiovascular disease and cancer remain the leading causes of death among Americans.

It seems like 2020 is a good time for American health care. But these benefits are what 19th century economist Frederic Bastiat would call the visible, or “seen” effects of health care reform. Bastiat pointed out that the favorable “seen” effects of any policy often produce many disastrous “unseen” later consequences. Bastiat urges us “not to judge things solely by what is seen, but rather by what is not seen.” A bad economist looks only at seen effects, according to Bastiat, while a good economist tries to foresee the unseen effects of a policy. So trying to play the role of a good economist, what were some of the deleterious unseen effects of health care reform enacted back in 2010?

Since 2010, insurance companies had been turned essentially into public utilities with the feds setting strict minimum benefits requirements. The health reform bill also limited the administrative costs of insurers, which has ended up basically guaranteeing their profits. With competition all but outlawed, the increasingly consolidated insurance industry has had very little incentive to pay for new treatment regimens outside those specified by government standard-setting agencies. Federal government health agencies have been reluctant to authorize newer treatments because they often lead to higher insurance premiums that then must be subsidized by higher taxes.

Then there is the doctor dearth. The signs of the impending shortage were already clear back in 2010. For example, as reimbursement rates from government health care schemes tightened, more and more doctors were refusing to accept Medicaid and Medicare patients. After health care reform passed, the physician shortage was exacerbated when many doctors faced with declining incomes simply chose to retire early. Already bad in many areas back in 2010, waiting times for a doctor’s appointment 10 years later have nearly quadrupled, reaching the Canadian and British average of about 110 days.

The hardest unseen effect of health care reform to evaluate is what it did to biomedical innovation. Innovation is a trial-and-error process, and making predictions about what might have been is speculative at best. But let’s take a look back at where budding biomedical technologies to treat cancer, replace damaged organs, and develop new vaccines stood back in 2010.

Big pharmaceutical companies initially did fairly well under health care reform, but as the cost of health care rose partly as a result of covering more Americans, Congress enacted legislation allowing government health care schemes to “negotiate” pharmaceutical prices. The negotiation requirement quickly devolved into price controls that have ultimately turned the big drugmakers into little more than cost-plus government contractors. In addition, the feds have established a comparative effectiveness evaluation commission similar to the British National Institute for Health and Clinical Excellence which limits patient access to treatments based on their overall cost-effectiveness. The result of these restrictions is that investments in pharmaceutical and biotech research and development have fallen off sharply.

In his first address to the nation, President Barack Obama promised to seek “a cure for cancer in our time.” In 2020, the five year survival rate from cancer has marginally improved as standard treatments have been more widely deployed, but there is no “cure.” It didn't have to be this way. For example, back in 2010 the biotech startup InCytu was developing a very promising technology that aimed to educate and harness a person’s immune system to destroy tumors. BIND Biosciences was creating a nanoparticle therapy that targeted and destroyed tumor cells while leaving normal tissue alone. Numerous startups were pursuing cancer immunotherapies using cancer vaccines. A couple of treatments, like Dendreon’s prostate cancer vaccine, made it through government approval process. But as health care budgets tightened, private research and development (R&D) funds for new cancer therapies dried up. Sadly, InCytu went out of business in 2014. In 2020, a “cure” for cancer seems as far away as ever.

Hoping to address the shortage of transplant organs, Congress changed the law in 2015 on organ donation to a system of presumed consent. This change did boost the availability of organs, but eventually donations leveled off and tens of thousands of patients needing organs remained on the waiting lists. Back in 2010, treatments using stem cells to repair damaged organs looked promising, especially induced pluripotent stem cells that matched the immune systems of individual patients. An even more visionary proposal was using three dimensional printers to print organs to order, as explained in this retro YouTube video from the startup Organovo. Of course, these possible therapies might have come to nothing, but we’ll never know since private R&D investment funding became scarce as increasing government price controls made the prospects for profiting from new treatments much riskier.

Finally, there's the flu. The 2010 flu epidemic turned out not to be nearly as severe as many at first feared, which is fortunate since vaccine production fell far short of initial goals. Production relied on an 80-year-old technology using inoculated chicken eggs that didn’t work well with the new virus strain. Ever risk-averse, government agencies rejected newer cell-based technologies that could produce flu vaccine three times faster than old-fashioned egg-based technology. In addition, R&D on a universal flu vaccine was put on the shelf for lack of funding. As we now know, this shortsightedness turned tragic when the long-predicted bird flu pandemic finally broke out in 2018, killing over one million Americans. The foregone development of innovative vaccine production techniques could have greatly speeded up the process of inoculating people against the disease.

The seen aspect of health care reform is that it has had some success in providing more Americans with access to vintage 2010 medical therapies. The unseen aspect is that more people are suffering from and dying of diseases that might well have been cured had the Obama version of health care reform never been enacted. As a result of health care reform, Americans forfeited 2020 medicine in favor of more equal access to 2010 treatments.

Ronald Bailey is Reason's science correspondent. His book Liberation Biology: The Scientific and Moral Case for the Biotech Revolution is available from Prometheus Books.

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  • IceTrey||

    For 65 years under the McCarran-Ferguson Act health insurance was not considered "commerce". That is why it was regulated by the states and the states could impose mandates and limit providers. It also excluded health insurance companies from the anti-trust laws. Now Congress is making the case that they can regulate health insurance under the Commerce Clause. So which is it? Commerce or not commerce? If it is commerce then we should be able to buy insurance across state lines and eliminate state mandates. If it's not commerce then the new bill is unconstitutional and should be thrown out.

  • Johnny Longtorso||

    Hmmmmm.....

  • Typical Democrat||

    I mulled this over for a bit, but I then realized the racist underpinnings of your line of questioning and will now go back to bleating, "HOPE AND CHANGE YES WE CAN!"

  • Brett Knoss||

    This bill hasn't made its way through the courts yet.

  • ||

    If this hasnt this should.. America is definitly running under health crisis.. we need to do something about it..

    BigBootyPorn

  • ||

    The McCarran-Ferguson Act did not say that the business of insurance is not commerce. That's what a court ruling said. The Act was a reaction to the court ruling. The Act IS federal regulation of insurance.

  • IceTrey||

    I don' think so. The court said that health insurance is not commerce under the law and the court would follow the lead of congress if they chose to make it so under the law. The congress instead gave the states the authority to regulate insurance which means they still considered health insurance not to be commerce. The M-F Act reinforces the decision of the court that the federal government can't regulate health insurance under the commerce clause.

  • dennis||

    Will Ray Kurzweill adjust his predictions in light of this development?

  • Jeff||

    My father, a life-long Democrat, told me I should be happy Obamacare passed because it will force me to get Insurance (I'm self-employed and 22 so it is pointless for me). I told him that I expected my life would be harder, poorer, and ultimately more brief because of this abomination.

    He was shocked.

  • oh no not this again||

    Parents always say shit like that. A lot of sad faces around here today.

  • ||

    Sorry, Jeff, but it is not pointless to have insurance at 22, it is just pointless for you to have the levels of insurance mandated by most states (and now the federal government).

    Yes, at 22 it's highly unlikely that you will be diagnosed with cancer but it happens.

    More likely is a serious injury from an accident, most likely auto. If you're self-employed, do you have workers comp to take care of to expense? Do you have fifty large to pay to have a serious leg fracture fixed.

    Of course, none of this justifies Obamacare.

  • Christ on a Cracker||

    ... and that is the point. The Gov't should be (since that are going to "do something" anyway) the "insurer of last resort." I'm thinking of the Guarented Student Loans. If you break a leg, the Government will loan you the money at fixed, slightly below market rates. I'm not even opposed to paying the "negotiated" rates.

    The flipside is that the person, and your heirs, will be on the hook forever.

    Insurance solved. Expensive, but won't break the bank.
    QED.

  • GRRRR||

    I am 23 student, I have no insurance and I don't need it. I have a savings account and CDs and the ability to take out loans if anything terrible happens to me... I don't expect others to pay for my life, I wish they didn't demand that I pay for theirs.

  • ||

    Right, because if you happen to get sick or get hit by a car while walking down the street it's your fault and if you don't have the money to pay for treatment you should die. No hard feelings, it's just the market speaking.

  • ||

    Right, because that's what happens. It's not like you can make payments or anything. Doctors demand all their money up front.

  • ||

    I am a different Jeff, by the way!

  • ||

    Right, so since the doctors don't demand the money up front, and since they are required by law to provide this care, the taxpayers and/or consumers will just eat these charges once you declare bankruptcy after they save your life. No need for insurance, society will pick up the tab!

  • Ryan M||

    Not even the best health insurance can solve your worst problems but we do all deserve to have some sort of health coverage. Unfortunately, with the state of the economy we can't all afford it. Nobody should have to suffer.

  • heffer||

    if you recall his books, he showed that upward trends were independent of government systems, or something like that...

  • ||

    Very good piece. I will take issue with the doctor shortage - that was fixed by immigration and lowering standards to allow more minorities graduate from medical school. So in 2020 we have more doctors than anyone would have guessed 10 years earlier, but the younger ones are not very good.

  • ||

    Making medicine a less desirable career AND lowering standards for entry! Yippee!

  • fish||

    Yeah I was discussing this very thing with my new physician just this week....Dr. President Dwayne Elizondo Mountain Dew Herbert Camacho!

  • OMG||

    My Doctor is actually named Camcho (he is quite good and is officially closed to any new patients)

  • Dr. Lexus||

    Man, you're a tard, and you talk like a fag.

  • I take issue||

    with your synopsis of foreign education. It is markedly competitive and only the best make it to the US.

  • smartass sob||

    but the younger ones are not very good.

    Neither are the old ones - they're suffering burnout.

  • Prolefeed||

    My wife would disagree. Course, she also doesn't think of herself as "old".

  • OMG||

    Actually, all the smart Indian medical students and doctors left the US around 2015, once they figured out that they could no longer make money at the profession in the US.

    Studies show that most were the innovative leaders who gave birth to India's single largest industry, Medical tourism

  • Jeffersonian||

    Nonsense. They all went to Mexican border clinics.

  • Dr Zaius||

    "Mexico" oh stupid human, you mean the "Forbidden Zone". Mexico was destroyed when the War on Drugs went nuclear in 2012.

  • Sean W. Malone||

    It's more than a little disturbing how likely this possibility really is...

  • Im a Doktor||

    Shut up Scrote! I'm batin'!!

  • your baiting is||

    as weak as your hard-on.

  • Brett Knoss||

    I wish, repalcing licensing of doctrs with licensing facilties as a whole and allowing them to make the best use of division of labour would reduce medical costs. Where I live in Saskatchewan there has been massive recruitment of nurses from the Phillipines, people with medical degrees are driving taxies, and there is a shortage of doctors nurses and technicians. The longest strick in the provinces history was by unionized government healthcare technicians. So there will be a shortage, and the doc fix will be really bad for people who use medicare and medicaid.

  • ||

    But, but, Brett, Tommy Douglas is the Greatest Canadian who ever lived.

    And I'd have to say things must really suck in the Phillipines to be able to get people to move to fucking Regina. I'm still trying to get over living there after having been gone for forty-four years.

  • Brett Knoss||

    Next "Reason Saves Saskatchewan"

  • shit ||

    I just wanted to know if Sugarfree was still alive in 2020.

  • ||

    Oh, piffle, Ron. Everyone knows that the Federal Office of Health Innovation will simply mandate the necessary innovation, under humane regulations that allow researchers one hour of time in the yard every single day.

  • ||

    On that note, it was convincingly argued by teh Chony recently that the State is the fountainhead of all scientific advances, and that all scientific advances blossom forth from the State.

  • virginia||

    and this whole time i thought it was Merck that developed the cervical cancer vaccine! damnit i feel dumb.

  • Brett Knoss||

    Yeah totaly they'll legislate that they work 20 hours a day. Did you know that under the current rules medical reasearchers and drug companiy CEO's don't actully have to work. They only have to put life saving drugs on the market!

  • James C Bennett||

    Is it just me, or is the cavalcade of misery that is reason.com just a little extra miserable today? Why do I come here when asking a random passerby to kick me in the nuts would be so much more efficient?

  • ||

    Okay by me. Left foot or right foot?

  • Snaps McShitDo||

    With HCR, you either Biden or you don't!

  • ||

    In the United States of America, health care Bidens you!

  • ||

    There's no question that running healthcare like a utility will kill innovation.

    And innovation doesn't show up as a line item on any CBO balance sheet.

    It won't hurt the providers too badly if the utilities are any indication--they'll just shed tons of dividends.

    I'd hate to be a biotech company looking to do a secondary offering right about now, but the biggest losers will be us patients.

    The CBO doesn't have a line item anywhere for the innovations that didn't come soon enough for you, but sooner or later, if we avoid an accidental death long enough, that'll be the most important aspect of this to each and every one of us.

    Yeah, I don't think anybody's ever lost an election 'cause of innovations that never happened, and I can't think of a better reason why elected politicians shouldn't be trusted to make decisions about my healthcare.

  • ||

    yeah, how much innovation has occurred on the electrical grid since utilities were regulated?

    Oh wait, Obama claimed it was antiquated and in dire need of replacement to keep up with modern technology. Our government must have forgotten to regulate constant innovation into the system. Hurry, we need another law!!

  • ||

    Smart meters are an innovation.

    ...that could have been implemented decades ago. They weren't put in place sooner because regulators leave utilities with little incentive to innovate.

    I mean, literally, the reason utilities throw off so much cash in dividends is because innovation is of little use to them. ...when rate increases are subject to regulators anyway, and when costs aren't a problem because regulators will always make sure they can cover their costs...

    I mean, there are only two main reasons for any company to innovate--to cut costs and to differentiate your product offerings from the competition.

    That's one of the reasons the Department of Energy is getting involved in trying to make utilities innovate. It takes government action to try to make them innovate, because given their regulatory environment, they have little incentive to innovate otherwise.

    40 years or so. Not much innovation.

    Obamacare is set up on the same principles.

  • ||

    Yes, I agree?

    I guess I fail at snark, :(

  • ||

    I was agreeing with you!

    I fail at...agreeing with people!

    ; )

  • ||

    Ah, the countersnark serious explanation retort, well played sir, well played.

  • ||

    That is what is so annoying though. It isn't just Bastiat, we have to think of Mises as well. Sure we can give the CBO the numbers, but they have to use the models as given to them by law. Even if, the CBO used rock solid numbers with rock solid models it would still be imperfect. Subjective Human Action is impossible to predict. Now consider the subjective Human Action of more than 300m individual actors going forward 10 years. Everything about the CBO analysis is bunk.

  • AJs||

    Thanks for the update from the future - while your note from the future was rather enlightening. However what Americans really want to know who wins in 2012? American Idol that is... who wins Idol in 2012?

  • fuck that||

    I want to know if they have another season of 24.

  • ||

    Fuck that, I want to know who wins the Superbowl for the next ten years so I can make a shit ton of money in Vegas. Or which stocks take off.

  • oh no not this again||

    Then you'd be able to afford insurance.

  • Jeffersonian||

    No, he'd have his gains taxed at bleed-from-the-eyes rates, then have the benevolent Central State generously give him health insurance, provided he can wait the 29 weeks to have that separated shoulder looked at.

  • oh no not this again||

    Melodramatic much? I was just teasing, people need to relax. Everyone is acting like they're in a Balko writeup, and their dog just died.

    It's going to be ok.

  • Sean W. Malone||

    Usually, I hate you... but +1 to not "too soon" jokes about the Feds killing people's beloved pets. Tasteless is funny.

  • Brett Knoss||

    Keifer Sutherland will probably have out a big documentary about how without his grandfather America wouldn't have refomred healthcare, and why America needs to adopt true universal healthcare.

  • ||

    Brett, I maybe the only Hit'n'Runner who gets your reference.

    I'm old enough to remember the old Baptist preacher's hellfire and brimstone sermonspolitical speeches.

    Just think, in America religious fundos stop queers from getting married, in Canada they invent Universal Health Care. See the countries are completely different.

  • Brett Knoss||

    Not entirly,he supported a lot of the neo-conservative crap. His thesis was on "The Problems of the Subnormal Family," and advocated the use of Eugenics, which did come inot use in Alberta. Not only did he advocate eugenics but considered unwed mothers guilty. Gay rights wern't discussed but it is imortant to note that most anti-gay laws were created by progressives. Much of modern neo-conservativism rose out of progressivism.

  • ||

    Right, I actually know most of that. I like to kid Douglas lovers about his religiosity and, shall we say, intolerance.

    I've often wondered how some of the old CCFers and labor I knew would react to the to the kinds of sexual and racial policies of today's NDP.

    Of course I guess that's why there's no one in the NDP today besides sociology professors and United Church clergypersons. :)

    Yes, I'm sure modern NDPers have to soft pedal a lot of old TC's stands when he comes up in their discussions.

    Mind you, I find that I have to point out to Amercans who get dreamy eyed about Canada's "liberalism" on pot and gay rights that most of those attitudes stop at the city limits of Toronto, Montreal and Vancouver. Canada has "flyover country" just like the USofA.

    Out of curiosity, where in HELLSaskatchewan are you?

  • ||

    "CCFers and labor" should read "CCF and labor union members".

    Some of the biggest bigots I've ever met were Canadian union members. Pretty much worse than anyone I've met in the thirty-plus years I've lived in Florida.

  • Brett Knoss||

    Rockglen. We have a liberal view of drugs; and guns!

  • ||

    Ah, had to find it on google maps.

    Damn, you're further away from civilization than East Bumfuck.

  • ||

    Actually, almost everyone I met in Saskatchewan had "family in the States". In fact, a lot of them were only a generation or three from settlers who had first homesteaded from places like Minnesota and the Dakotas.

    Most of them spent a good part of the year helping out on the farms of those relatives in exchange for the same.

    That kind of cross-border travel has been seriously hampered by the new regulations.

    Who would ever have though you needed to get a passport so you could go visit your cousins a hundred miles away?

  • ||

    Ooops, forgot "just kidding" tags.

  • Brett Knoss||

    Before the war on drugs,we used have a tighter community, because it was so much easier to cross the border.

  • ||

    I want to know if the Simpsons will still be making new episodes.

  • Brett Knoss||

    The Simpsons should have stopped making episodes 10 years ago!

  • ||

    +1

    They should have canceled that bitch after the frank grimes episode. Everything after that was down hill. That's what sucks nowadays, a show is good for a while, then people just keep watching, because they are "fans" regardless of the quality.

  • Scooter Bibby||

    In 2020 Obama's jackboot thugs will be forcing people to buy insurance, at gunpoint.

    The new Volunteer Corps will be building FEMA Concentration Camps and digging mass graves to fill with victims of the Great American Purge.

    I fear our future.

  • ||

    Which is only appropriate as in 2020 the official pronunciation of "corps" will have been changed to "corpse" as per our Dear Leader.

  • generic Brand||

    hahaha Why is Obama still President in 2020? Or are we just assuming he becomes the dictator the right currently paints him to be? Overturning an amendment (especially in this bitterly partisan time) seems a bit harder than passing the health care bill, which was already hard enough

  • ||

    They don't need to overturn any amendment; they just ignore the Constitution or reinterpret it.

  • fellcolor||

    And we're all experts in that these days.

  • oh no not this again||

    Scooter bibby @ 656

    When i was younger, i heard Mancow say shit just like that about Bill Clinton. And even worse or equal garbage has been said about Bush. Everyone fails rhetoric class.

  • ||

    Yeah, that's what those jackbooted thugs in Germany do. They force people to buy insurance. I guess that means that the Nazis will return any day now.

  • ||

    I mean, seriously, how can you punitively tax people for buying policies with better coverage and not expect less innovation as a result?

    That means they're doing it on purpose, doesn't it?

    They want the resources that would go to new devices and equipment, etc., and the training required to use it, to just go to standard care...

    Is there any other reasonable way to explain that?

  • ||

    To play devil's advocate a bit, a lot of pro-HCR types would argue what good is innovation, if people can't afford what's already available. Many of them would argue that the benefits of the medical world should be available to all, instead of the best of the best going to a select few. I'm not saying I argue, but that's the logic they're pushing.

  • ||

    I won't argue with the interpretation.

    But I think it's a huge point that we're not just talking about unintended consequences here...

    They're crushing innovation. And they're doing it on purpose.

  • ||

    Believe it or not, I wouldn't say that they realize what they're doing. I think there's so little an understanding of how treatments get developed (the whole "NIH-makes-all-the-drugs" mindset) that it'll take a while until people start baying at the NIH for the lack of innovation.

  • Jeffersonian||

    Ever think about what a Sony Beta cost when it first came out? What would have been the outcome of video recording if the government had mandated it only be introduced if virtually everyone could afford it?

    It's not logic, it's insanity.

  • true enough||

    One more reason to imprison or exile even the low-key socialists before they get entrenched.

  • mr simple||

    Yes, that's what we need: a purging of those who disagree with us. Stalin would be proud.

  • liberty_equality_solidarity||

    Well, he KNOWS that those commie-fascist Democrats are just waiting until ACORN-SEIU finalizes the list. These people did have to spend a lot of mental energy on arguing for torture, pre-preemptive war, etc. Appropriating the worst tactic and attitudes (real or imagined) of the opposition is standard on the right nowadays. The Dems wouldn't have the balls to pull the trigger on something like that, the repubs, I hope not, but maybe (have to stop 'socialism'.

  • Abdul Alhazred||

    In a market system, older innovations would become cheaper and increasingly available as time passed, so the newest treatments would be most viable for the wealthy in the beginning, it would become readily available to the masses later.

    Our twice removed system of paying for medical services through "insurance" and providing insurance through employers does a lot to stifle this process keeping older medical procedures and materials expensive far beyond what's normal for any other sector of the economy.

  • Abdul Alhazred||

    In a market system, older innovations would become cheaper and increasingly available as time passed, so the newest treatments would be most viable for the wealthy in the beginning, it would become readily available to the masses later.

    Our twice removed system of paying for medical services through "insurance" and providing insurance through employers does a lot to stifle this process keeping older medical procedures and materials expensive far beyond what's normal for any other sector of the economy.

  • Sam Grove||

    It's just a devilish way to bail on Medicare.

  • ||

    That's actually one of the good parts of the bill. It stops people from using insurance for every little thing, which is a significant factor in cost inflation and creates all sorts of perverse incentives.

    Not that private individuals aren't buying these plans. Only companies looking for ways to pretend to pay people more.

  • ||

    Yeah, Hazel, somebody's gotta put a stop to the innovation menace...

    ...before it catches up with the Alzheimers that's been stalking my family for generations.

    Seriously. Thanks a bunch!

    A slew of willing investors, researchers and entrepreneurs were hot on its heels, all pooling their resources in the most productive ways possible--as only entrepreneurs can! Working to save me from the disease that ruined my grandfather...

    I guess I really did need the government to make that choice for me--'cause it never would have occurred to me to pull the plug on that myself.

    How can I ever thank Obama enough?!

    Maybe this finger will tie him over.

  • ||

    As you will note below, I argue this bill doesn't stop innovation in medical technology. And won't until we're completely bankrupt and forced to ration health care.

  • Slut Bunwalla||

    But it does impose a huge tax on medical technology. And as we all know, you tax what you want less of...

  • ||

    As we now know, this shortsightedness turned tragic when the long-predicted bird flu pandemic finally broke out in 2018, killing over one million Americans.

    only a million Ron, come on, all good disaster scenarios talk in the percentages (10% atleast)

  • ||

    So let's say it kills 32 million, then? Hey, isn't that the supposed number of uninsured people?

  • ||

    now we're talking. How many come back as zombies?

  • ||

    Remember, it's the Democrats we're talking about here. Every last damn vote one of them!

  • ||

    LIT: I didn't want to be accused of alarmism.

  • ||

    what, and buck the trend? That's it, I'm eating raw sparrows eggs until they finally do me in!

  • Tomcat1066||

    Come on Ron! Alarmism is fun! :D

  • ||

    " (10% atleast)"

    We need to leave plenty for the sequels.

  • IceTrey||

    BTW, guess which other law was enacted on this date. Hitler's, Enabling Act. March 23, 1933. Coincidence?

  • ||

    Which reminds me: the record for the longest un-Godwinned comment thread was set following a post in the International Carnivorous Plant Society's forum. A lively exchange following a simple query regarding the care and feeding of Darlingtonia lasted 17 comments before Hitler was mentioned.

  • ||

    He also said,
    "What good fortune for governments that the people do not think."

    and,
    'Make the lie big, make it simple, keep saying it, and eventually they will believe it.'

    Too many coincidences.

  • ||

    DIS BE RACIS YO

  • ||

    I just want to know when and IF average, working Main Street Americans will ever see any benefit?

    Lou
    www.anon-web.hitart.com

  • Reasonsjester||

    In 2020, many of us need facial reconstructive surgery from jackboots stomping on our face, forever.

  • ||

    "In 2020, many of us need facial reconstructive surgery from jackboots stomping on our face, forever."

    That shouldn't be necessary. The modified mugs will be so ubiquitous that it will become seen as normal.

  • ||

    Well, given the number of doctors likley to transition into elective fields like plastic surgery from general practice, at least the price won't be too high.

  • liberty_equality_solidarity||

    Only stinking Socialist would quote a stinking Socialist.

    You sir are a stinking Socialist.

  • Tomcat1066||

    Someone will think of something. The government will MAKE THEM!

  • ||

    Interesting conjecture; of course without reform of some kind many people wouldn't make it to 2020 for lack of coverage that prevented them from early care for preventable diseases.

  • OMG||

    Agreed. I was just thinking the same thing this morning as I tripped over someone in the street who had just dropped dead from lack of health insurance. Then this afternoon, some worker just fell from the sky, right in front of me: fell of a scaffold, dead from lack of health insurance. I was really afraid that sooner of later this "lack of health insurance" would kill us all - no future for any of us.

    No we're saved. I was going to say "God bless Obama," but I hear it's bad form to ask someone to hope for their own best wishes.

  • Drax the Destroyer||

    So that's what "The Happening" was really about. Finally, it makes sense. Still, a horrible movie though.

  • ||

    DEMAN KURV!

    I don't understand why we shouldn't equate expanding the demand on available resources with shortages.

    Any of you who may have just moved somewhere new with a chronic condition? You should make a point of going to see a specialist for a checkup sooner rather than later...

    ...'cause if they really do add 30 million new patients over the next couple of years? A lot of physicians are going to stop accepting any new patients.

    The resource fairy isn't about to drop that many new specialists under your pillow.

    Seriously. Be smart. If you have a chronic condition, get a check-up. ...or you may have to wait in an emergency*.

    *The legal definition of "emergency" is probably about to change.

  • ||

    Interesting conjecture; of course without reform of some kind many people wouldn't make it to 2020 for lack of coverage that prevented them from early care for preventable diseases.

    So, basically, what I'm trying to say is that I'm not convinced more people will get more care with Obamacare.

    ...nevermind quality.

  • ||

    I think you're right on this. I'm considering hiring a concierge practice as a way of dealing with just such a development.

  • ||

    The pains in my joints that I have been ignoring for months? No more. I'm getting checked out now before I'm SOL and arthritic.

    Obamacare scared me into the doctor's office when my hubby's pleas didn't work. WIN?

  • ||

    I'm going to butt in here and point out that I doubt the immediate effect of the bill will be to reduce innovation.

    On the contrary, what's likely to happen is that costs will continue to spiral ever higher, driving MORE resources, not less, into health care innovation. Mainly, into the development of ever more expensive tests designed for more defensive medicine. But probably also into all sorts of other stuff as well.

    That will continue until we have some kind of fiscal crisis and governments are forced to (a) seize control of the insurance industry entirely and turn it into a branch of HHS, and (b) begin raitoning care, just as insurance companies would have if they were allowed to.

    THEN medical innovation with start suffering. But I don't think we'll see much by 2020.

    The damage will be to *other* parts of the economy that resources are being siphoned away from. Not the health industry.

  • ||

    On the contrary, what's likely to happen is that costs will continue to spiral ever higher, driving MORE resources, not less, into health care innovation.

    profits do not spur innovation, promise of more profits or preventing loss of profits does. when the government ends up paying you the same regardless of quality or uniqueness, why innovate. Take money, engender complacency...PROFIT

  • ||

    *note to self, finish reading posts*

    sorry Hazel, I skipped a step there.

  • ||

    I seem to recall that the bill has in it a provision that some percentage of income an insurer has -- I forget what, 85%, 90% -- must be applied to actual medical care. One of the people blabbing at me that this amounted to a cost control, and whew what a great day this is, etc.

    What people making that point miss is that the old electric utilities used to take state-guaranteed return formulae -- which were based on capital expenditure -- to build the holy hell out of the grid in order to maximize profits. The same perverse incentive exists among insurers under this rule.

  • ||

    This is the real perversity.

    What is the reimbursement for an annual physical? If it's $200, I am now forced to give an insurance company an extra $220 in annual premiums(for their 10% margin), rather than letting me pay the doctor the $200 out of my pocket.

    Bending the curve!

  • ||

    The funny thing is that people think that their congressman will be more accountable to them on the whole rationing front than some insurance company owned by rich people. After all, Congress serves the people, so they'll be duty bound to help, right? ;-)

  • ||

    The rationing will be determined by political expediency. I'm pretty sure that there will be no limits on AIDS drugs or breast exams, for instance.

    The Democrats are too pussy to say no to anything, though, so the rationing will likely start with imposing price controls on prescription drugs. It will expand from there. Shortages will develop, followed by wait lists.

  • Democratic Senator||

    But... we're America. We won't allow ourselves to go down the same high-cost, shortage producing roads that other countries have taken. Maybe we haven't been explaining this plan well enough.

    We're trying to give 32 million people health care. That's a good thing. Are you opponents anti-people?

  • Campus Progressive||

    Plus, think of all the 'health jobs' that will be created!

  • ||

    If YOU want to fine, but not out of my pocket. Healthcare is not a right. Its not protected by the constitution. This 'concrete' document only guarantees the right to pursue, not for congress to mandate. November will be very telling this year, and in 2012.

  • Paul||

    That will continue until we have some kind of fiscal crisis

    Think we'll ever see one of those?

  • Rocky the Flying Squirrel||

    And now, here's something you're really going to like.

  • hurly buehrle||

    3 thoughts:

    1. On the physician shortage, you're spot on. A middle-class salary isn't really an acceptable prospect to people who go into 6-figure debt to be trained to save lives. What you left out is that comparative-effectiveness-based health systems tend to push doctors into lower-paying primary care disciplines, rather than specialty care.

    2. On medical innovation, I disagree. Personalized medicine will become a reality. Just not here. The market of the future is in Asia, and that's where personalized medicine will happen. The entrepreneurship and clinical trials to enable it will happen, but they'll happen in China, India, Japan, and Singapore. They already are.

    3. What evidence-based medicine overwhelmingly indicates is that the greatest determinants of your health and longevity have everything to do with the decisions you make. Specifically, if you can (a) not smoke, (b) eat a balanced, Mediterranean-style diet, (c) exercise 3x/week, (d) drink 1-2 glasses of wine/day, and (e) get your colon and/or breasts imaged for cancer on a regular basis in middle age, you'll have done more for yourself than all of current medical intervention can do for you. The worst thing about the dependent mindset that Obamacare will foster is that a dependent mindset will shorten your life.

  • ||

    I can answer all of your concerns. With the first one, don't be surprised if either the J-1 Visa cap (commonly used for foreign graduated with advances degrees such as doctors) or the medical residency cap to be blown sky high. Here come the foreign doctors! I'm with you with the second one, though the sheer amount of financial dealing that go through the United States means that there'll always be SOMETHING going on in the US. Also, with the relaxed caps, clinical research will get a lot cheaper. On the third one, I think factors such as proper nutrition and vaccination status matter more than people think on that. The better your defenses were in childhood, ceteris parabis, the better your life span. Unfortunately, HCR can only do so much, especially since they can't MAKE people go to the doctor.

  • hurly buehrle||

    On your first point, I'm not convinced. I knew a guy a couple years ago, an MD-PhD student at an elite US university, who lost a year in his program due to visa issues because he was Saudi. I'm not convinced that the xenophobia in Washington will take a holiday. Or that it'll make an appreciable difference in the supply of physicians; that supply takes decades to adjust to policy whims, because the training takes so much time.

    On the second point, I can say, professionally, that this stuff is moving away from the US and western Europe. To my personal detriment. The bottom line is that outsourcing clinical trials is very easy; most of the companies that handle the outsourcing are multinational. As far as entrepreneurship, it goes where the real savings are in the long run. And that's in Asia.

    On the 3rd, I'm sure our new overlords will make all sorts of recommendations as to our proper behavior. Some sensible, some not. And all will ignore the fact that individuals don't fit comfortably into the results of traditional statistical models (ever wonder why those distributions have tails?). Which will make the recommendations a mess. Ultimately people have to do what's best for themselves, as they judge based on their experience. Top-down social engineering is antithetical to that.

  • Michael Ejercito||

    On the physician shortage, you're spot on. A middle-class salary isn't really an acceptable prospect to people who go into 6-figure debt to be trained to save lives. What you left out is that comparative-effectiveness-based health systems tend to push doctors into lower-paying primary care disciplines, rather than specialty care.


    If medical schools are so lucrative, why are not new ones being established or existing ones expanding?

  • hurly buehrle||

    Because the number of residency slots is not changing. The constrained supply of doctors is not a big mystery.

  • Michael Ejercito||

    Because the number of residency slots is not changing. The constrained supply of doctors is not a big mystery.


    Why are the number of residency slots not changing?

  • ||

    Also, you can't just build a medical school whenever and wherever you want to. Rules, man, rules!

  • jacob||

    Who's going to fund them? Most states are broke, the ones that aren't don't have 60 million laying around to build a medical school.

  • Chad||

    . On the physician shortage, you're spot on. A middle-class salary isn't really an acceptable prospect to people who go into 6-figure debt to be trained to save lives. What you left out is that comparative-effectiveness-based health systems tend to push doctors into lower-paying primary care disciplines, rather than specialty care.

    Doctors are now making more than most other comparible professionals, even if you subtract the ~$32000 in extra income they need to pay off their loans (assumptions: $200000 loan, 7% interest, amortized over a 30 year career, 50% marginal tax rate).

    Scientists probably are the best comparison group, as PhD plus postdoc requires similar time and talent to med school plus residency. Scientists start around $80000/year and typically are in the $110,000 mid-career. Scientists work in a highly competitive market, so it is reasonable to asssume their salaries are fair; in contrast to doctors, whose production is gated by a cartel. As noted above, you would have to add another $32000 to get close to the appropriate value for doctors, so something like $110,000 starting salaries and $150,000 mid-career salaries should be typical.

    But oh, wait! You are a specialist. That requires even MORE training and debt, you say? Well, let's play the amortization game. Let's assume the resident gets paid $50000 per year (typical) and needs to borrow $40000 each year to live the professional class lifestyle that his comparison scientist would be living at the time. OK, so let's add $40000 to the debt, and shorten the amortization period by a year. How much additional annual salary does this justify? Seriously, take a guess before looking...

    ......
    .....
    ....
    ...
    ..
    .

    A whopping $7000 per year of additional residency required for the specialization. Considering we pay a wildly higher premium for specialists than this, it should surprise no one that every med school student wants to be a specialist.

  • ||

    Scientists work in a highly competitive market, so it is reasonable to asssume their salaries are fair; in contrast to doctors, whose production is gated by a cartel.

    Obviously, we need a new federal agency to set salaries for doctors.

  • ||

    Chad, OMG!

    A scientist can study rocks and shit and take a paycheck for a pretty low key, but non messy job. Or, they can take a high profile job where they will get lots of glory and fame, also for doing something not that messy (I'm watching Kaku right now, and he's a famous as fuck physicist, and he's not elbow deep in spinal fluid). A doctor will have nothing but a series of messy, disgusting, thankless jobs that often lead to a lawsuit. It takes more than just the cost of education to make up for having to stick your hands into people, who might die on you btw, and then you'll be crying into a bottle of jack every night, until your boss finds out you're an alcoholic and you're banned from the profession. Being a scientist kicks ass by comparison, and it is no wonder that many people would rather be a low paid scientist rather than a high paid surgeon. Fuck you Chad. You never think of these things from the sound of it.

  • ||

    Any doctors or surgeons here to give me a high five? Doesn't it piss you off that chad thinks saving or losing LIVES is the same thing as studying rocks all day, or doing math?

  • ||

    I loath Brainy Smurf and yes I find it offensive that he equates inanimate objects, which do not live or die, to a sentient human being anesthetized on the table who have the remote, but very real possibility, of not surviving a procedure.

  • ||

    "has" subject verb agreement FAIL.

  • ||

    A scientist starts at $80k where the fuck do you work, the NIH? Over here at University of maryland, I'm pulling $30k. THIRTY K.

  • Algor||

    You should be working on proving global warming. That's where the big money is.

  • Drax the Destroyer||

    "Over here at University of maryland..."

    Good old UMD. I think I have found your problem right there.

  • Slut Bunwalla||

    You kind of skirted the issue by making this about scientists instead of practicing medical doctors, but I'm going to throw this out there: they also have to pay a LOT for malpractice insurance. So add that on top of the loan payback.

  • ||

    Idiots like Chad also tend to forget a few other simple facts, like:

    1. Most scientists aren't required to carry malpractice insurance with premiums approaching $100K/annum for some specialties

    2. Most scientists aren't required to own/maintain their own facilities, or to pay staff from their own pockets

    3. Most scientists don't have to deal with self-employment issues like carrying their own medical insurance, accepting "negotiated" reminbursement for their services, dealing with the 2.3 miles of red tape on a daily basis, etc.

    4. Most scientists aren't on 24 hour "call" for their services. Very few 3 am calls to examine a rock, or tweak an equation.

    ad infinitum, ad naseum....

    But, that's what makes idiots like Chad special.

  • Ted Kennedy||

    Hey, don't look at me. I checked out before they passed that turd.

  • Ted Kennedy's weeping son||

    *sniff* It's OK, we *sniff* shoved this piece of *sniff* right down their *sniff* throats.

  • ||

    We don't need any more so-called 'breakthroughs' in medical technology. If it was good enough for me, it's good enough for my neighbors grandchildren.

  • 17th Century Guy||

    Damn straight!

  • ||

    Hell, the cancer that killed my Grandfather in the seventies is treatable today. I'd hate to have greater access to that level of care.

  • ||

    So we have to wait for the Bermudans or Nigerians to invent Larry Niven's Autodoc. Of course the whole of US can only import 5 of them and there is waiting list of 150 million people for them.

  • Mo||

    Ron,

    Didn't you say mandatory health insurance would spur innovation back in 2004?

    http://reason.com/archives/200.....urance-now

  • Mo||

    I'm curious what caused the change of heart over the issue.

  • ||

    Mo: Assuming that our "leaders" were going to do "something" about health care, that was my attempt to offer a less bad alternative while still preserving incentives for medical innovation.

  • Tony||

    You might as well own up to it and take the credit. The bill that's passed is essentially the libertarian/conservative plan from back when you guys didn't see a socialist plot around every corner.

  • $||

    One has to wonder why you so vigorously defend it, then.

    *hack hack*

  • Sean W. Malone||

    That's absurd... Oh... Whoops, it's one of Tony's comments. Of course it's absurd.

  • ||

    Tony: Hmmm. Where's my high deductible insurance purchased entirely in private markets available through nationwide competition using vouchers for the poor and elderly which are paid for by entirely abolishing Medicare, Medicaid and SCHIP?

  • ||

    And of course the abolishment of tax credits for businesses to be transferred to individuals.

  • Outed||

    Burned! Good luck trying to explain this away!

  • ||

    Nice try. The details are important:

    Under a mandatory insurance scheme, all Americans would be required to purchase a basic high-deductible catastrophic health insurance policy from a private insurance company. "Let's say you cap the deductible at $4,000 and set a limit that out-of-pocket health care costs can't exceed 10 percent of an individual's or family's income," suggests Pauly. "That would mean that a family earning $30,000 per year would receive $1,000 in a health voucher." In other words, the family would pay the first $3,000 of medical expenses out of pocket and receive a $1,000 voucher to cover expenses up to the $4,000 deductible.

    High-deductible insurance, though it still has some of the problems of third-party-pays coverage, means that routine care still gets negotiated by individuals, a feature most assuredly missing from the current <gulp> law ...

  • Mo||

    Does high deductible insurance not count as insurance? I haven't seen anything that precludes people from purchasing high deductible insurance.

    Note: I am not claiming it doesn't exist, I'm genuinely curious if the bill excludes high deductible insurance.

  • ||

    My understanding is that it basically forbids it.

  • ||

    Ah, mandatory health insurance is a pretty libertarian idea! As long as there are high deductibles.

  • ||

    Not really, more at Republican (because it fellates their insurer buddies). But at least it would have the signal advantage of not building craters with public money.

  • ||

    Juice: In re mandatory see my reply to Mo above.

  • Abdul Alhazred||

    I have several problems with the legislation they passed (in spite of being uninsured myself) and I have no doubt that this bill will limit future innovation, but I doubt it will kill it altogether.

    I realize this may make me a heretic here, but the government is also capable of producing innovation, DARPA, NASA, The Manhattan Project. Free enterprise is certainly better at producing innovation, but I think the overall effect will be a slowing of new technologies and treatments being produced, not a cessation.

    (please don't hate me)

  • ||

    All we have to do is weaponize medicine and we'll be all set.

  • ||

    Recipes for success in government innovation:

    1) have clear goalposts with
    2) a clear timetable
    3) have a bastard enemy that you need the technology to defeat.
    4) have a legal mandate to conduct the research

    Is it surprising that all the technological innovations that government has made were made by the defense agency? The constitution doesn't provide for research, although the military has some pretty wide leeway to do it.

    And not everything that DARPA does is great. You wouldn't imagine the waste that goes in to it to get one successful and useful thing out. Actually, come to think of it, besides ARPAnet (precursor to the internet) I don't know what DARPA has done that has been any good.

  • ||

    He he, that's classified.

  • Drax the Destroyer||

    Yonemoto has got a point.

    Regarding NASA, their overt innovation in space travel dried up in what... the late 70s? Early 80s? Their most spectacular failures of the last 30 years can be tied to [From Wikipedia] "underlying organizational and cultural issues " (Read: Bureaucracy, Laziness, Complacency, Etc...). NASA arguably had a purpose when it was a public relations stunt to show the public that the U.S. was not going to let those damn commies take over space. Unfortunately, it became the maypole of an industry, orbited by teat-sucking corporations more intent on seeing what they could get, rather than what they could do.

    Where has the most innovation come from in the last 10 years? Greedy bastards vying for the X-prize. NASA can't produce anything anymore without overcoming its own inefficiencies, so it hands out millions (a paltry sum to develop new space technologies) to individuals crazy enough to give it a shot. The unfortunate thing is that there is no demand for any of this. What's the damn point in mapping the solar system, if for the same price we could feed the poor, cure some cancers, give free hookers to everyone, etc? Why should you fly in a space ship if it costs 50x what a plane ticket would cost? What's the point if we will never, ever have disgusting sex with hot blue alien chicks?

    If we need a NASA (and we don’t), then we should end the drug war and dump some of the returns into it. When it comes to government waste though, NASA is not the largest cancerous testicle hanging from Uncle Sam’s dessicated crotch. That award goes to Defense, Social Security, and their new demonic brother Health Care “Reform”. In other words, we have bigger fish to fry.

  • Slut Bunwalla||

    We don't need NASA. Every time I point this out to someone, though, they always trot out the "but NASA invented a lot of the technology we use now like the microwave" canard. Yeah, ONE TIME, like 50 years ago. What have they done for us since? Blown up a few shuttles, killed some astronauts? Whoop dee doo.

  • Mike Laursen||

    I agree. It won't kill it altogether. Will just kill it somewhat.

  • ||

    One thing I haven't read much about is how this is going to affect employment of the young. Since employers of any size (50 or more after 2018 or something like that) will have to pick up their young employees on an insurance plan, that's liable to act as a de facto increase in the minimum wage for employees so affected. The net effect is that some jobs will simply cease to exist.

  • Mo||

    Since kids can stay on their parents' insurance until they're 26, I doubt it will have that much effect on the young.

  • ||

    Maybe. That assumes their parents also have jobs with insurance.

  • alan||

    On that note, it was convincingly argued by teh Chony recently that the State is the fountainhead of all scientific advances, and that all scientific advances blossom forth from the State.

    They are followers of Comte who have yet to make the connection that a society created along the lines of scientism would have little use for their inferior product, and would have to do away with them or use them as slave labor to get any return without resorting to market means (creating an imbalance in their perfect social order). Whereas, in a world of normative economics they, the Chony duo, constitute a mere write off.

  • Len Bias||

    Don't worry, there will still be plenty of innovation in 2020 in the medical fields, in places like China and India. And these new breakthrough, cutting edge treatments will be deemed "experimental," and therefore not be available in the US, just like treatments available in the US aren't given out in places like the UK and Canada now.

    Then, as China and India get wealthy off such breakthroughs, they can continue to fund our increasingly unsustainable welfare state that does a passable job of doling out 2010-era treatments.

    I really hope this article and what I've said are wrong and we don't become a lethargic, European-style welfare state (if we haven't already.)

  • Ebeneezer Scrooge||

    But that was the purpose of Obamacare. Now for carbon taxes or some fucking kind to finish frosting the cake.

  • Tony||

    Looking back from 2020, we can see that most of these major biomedical advances failed to materialize. What happened? Three words: health care reform.

    I'm so tired of this ridiculous rationalization that only America can innovate in medicine because we refuse to have universal healthcare.

    The market can't be both a great innovative force and something whose creativity is completely stifled by a few changes in the regulatory environment.

    Not every entrepreneur is itching to go Galt at the slightest increase in controls. If they do, someone will replace them, make the spiffy new devices, all the while not being a whiny paranoid bitch.

  • you make me smile||

    :-)

  • ||

    I did.

  • To that I can only say||

    http://www.youtube.com/watch?v=cSbS4p6ICns

  • Len Bias||

    In the early 90s, there were nearly 20 manufacturers of the flu vaccine, but they were strong-armed by the Clinton administration into selling the vaccines at cost. The number of manufacturers went down to four by the middle of the last decade, and we had to import most of our flu vaccines. Remember the shortage of winter 2004-5?

    Since Obama has stated he intends to "negotiate" with drug companies, it can only mean they have less and less incentive to innovate. It isn't necessarily "going Galt," it's self-preservation. There isn't much incentive to innovate in a climate where companies are "negotiated" out of their profits.

    Moreover, Obama is setting up "comparative effectiveness panels" which "recommend" (and down the line more likely enforce) cheaper drugs over the more expensive ones. Why spend millions of dollars on R&D on a better version of a drug, if these panels will deem them too costly?

    Then again, I could be wrong, and there won't be more shortages like the flu vaccine shortage I mentioned before, and innovation will continue unabated. I really hope I am wrong and you are right.

  • Tony||

    It's entirely possible that government demanding certain outcomes (such as universal healthcare) dooms the profits of health delivery industries.

    To me, that's more of a reason why health shouldn't be a matter of profit at all.

    What people need is fairly easy to determine. What advances need to be made is also pretty clear. We don't need unfettered darwinian marketplace selection to tell us what innovations will extend and enhance human life. We can figure that out. And it's possible to get some pretty bright people on the case--people, in the environment I am describing, who would be working for increasing people's health, rather than profit.

  • Len Bias||

    What you're describing sounds more like a government bureaucracy meant to develop new medical technologies.

    I tend to look at it more in the vein of Adam Smith. If companies are competing with each other for profit, they will be pushed to get out better treatments more quickly. A government appointed group with no deadline, incentive other than to "help" people will inevitably be slower.

    And, what people "need" is entirely subjective. If a company in the private sector wants to pour millions into a drug that will help 1% of the population, they are free to do so. If it's decided by a centralized committee, they could decide that money could be used for something else, and helping 1% of the populations isn't a "need." Sucks for that 1%, but perhaps is for the "greater good. It's a road I don't want to go down, but perhaps you have more faith that I do that determining "need" won't become an entirely political affair.

  • Tony||

    I just think that the same entity that innovated the atom bomb, spaceflight, and the Internet is capable of innovating in any number of ways--most of all because of the resources at its disposal. Humans are capable of being motivated to innovate by forces other than profit.

    I don't reject market forces entirely, I just think that they don't necessarily solve every problem in society. There's a lot of useless crap in the marketplace too. For the useless crap and for lifestyles beyond having basic needs met, let the market do it's thing. For basic needs, it's clearly a failure at providing them universally, otherwise the US's system, the most free-market in the industrialized world, would be the best rather than the worst.

  • Len Bias||

    Everything I've read has said this bill is barely paid for. Where is the extra billions (trillions?) needed for such innovation going to come from? The private sector still has a lot more money floating around than the government at this point.

    Where we differ is our faith that the government can succeed at getting its priorities straight. Two successive administrations of different parties in a row are spending way beyond their means and still can't provide basic services well. At this rate, I'll take the private sector with all its useless crap and useful innovations.

    Time will tell.

  • Tony||

    Where is the extra billions (trillions?) needed for such innovation going to come from?

    If you ask me I say we trim the excess wealth of the top 1% and direct it to such social goods.

    Where we differ is our faith that the government can succeed at getting its priorities straight.

    That is certainly a fair question. I'm not for any government, I'm for good government.

    But it's also clear that the market doesn't always have the same priorities as the people.

    Two successive administrations of different parties in a row are spending way beyond their means and still can't provide basic services well.

    Well, one of them just passed a universal healthcare reform bill. The other one did screw things up royally, but of course they were the laissez-faire people.

  • Len Bias||

    "Well, one of them just passed a universal healthcare reform bill. The other one did screw things up royally, but of course they were the laissez-faire people."

    Bush was anything but laissez-faire. He grew the government and set up more bureaucracies than any president since LBJ. You must not read Reason's articles much if you think he was laissez-faire.

    This bill Obama passed is not paid for as it is set up. Many of the posts on Reason (and elsewhere) spell out how, despite the assurances of our leaders, it will lead to a fiscal black hole. And, it doesn't take 3,000 pages to do what its stated goals are. We will see over time what all is in the bill, but I can guarantee much of it is wasteful and excessive.

    You say the market does not always meet the people's needs. Much of this bill doesn't either. That is, unless the people want things like unions being exempt from taxes on their insurance. In nearly 3,000 pages, I bet there will be a lot along those lines.

  • Tony||

    Bush was anything but laissez-faire

    Yeah, I know. There aren't ever real laissez-faire believers in power. Just people funneling resources to their friends while not wanting government looking over their shoulder. But libertarianism has always been the philosophical lipstick on that corporatist pig.

    it will lead to a fiscal black hole

    Healthcare delivery in this country was already headed to a fiscal black hole. Sure the CBO scores that indicate deficit reduction are probably fantasies, but all evidence in the world indicates that centralized healthcare is much cheaper than what we had. This is what many hope is a first step to a system that actually helps fiscally.

    You say the market does not always meet the people's needs. Much of this bill doesn't either.

    The market gave us coverage denial based on preexisting conditions and rescission. This bill at least fixes those. I agree that it's a far cry from good reform, but the free market system is clearly not a viable alternative.

  • Len Bias||

    I gotta go to bed, but I have enjoyed this exchange free of name calling (most people I know just insult me when I criticize the bill). My final thought is we don't have a free-market system now, since various regulations have already made it harder and more expensive to get insurance than it needed to be. If people didn't have to drop their insurance every time they moved to a new state or got a new job (thanks to various regulations) then people wouldn't be left out in the cold without insurance nearly as much. I have experienced this. If I had been allowed to keep the insurance I already had, I wouldn't have been denied.

    I would move it to a more free-market direction, you'd move it to a more centralized one. We'll see how it works out.

  • Michael Ejercito||

    If you ask me I say we trim the excess wealth of the top 1% and direct it to such social goods.


    Like the way the income tax was first implemented?

    Funny how the income tax expanded to include the not-so-rich...

  • progressive illness||

    "the atom bomb, spaceflight, and the Internet"

    As stated above in other words, all we need to do is find a way to convince the army that a cancer cure could be helpful for murdering the shit out of millions of people, and we're golden.

    Granted, they'd probably test it using unknowing human guinea pigs and wreaking untold human misery. But, hey, cancer cure -and- we didn't even need nasty markets.

  • ||

    "Humans are capable of being motivated to innovate by forces other than profit."

    Yes, I hear that threats to life and limb work wonders...

  • ||

    Actually, Len Bias, what tends to happen is that hospital corporations will keep the technology or treatments to themselves claiming intellectual property. They won't share some lifesaving techniques with other hospitals or corporations.

  • ||

    Another example of GOVERNMENT protecting monopolization. I want all patents, copyrights, and trademarks thrown out.

  • Mike Laursen||

    To me, that's more of a reason why health shouldn't be a matter of profit at all.

    Really? You think that a huge sector of the economy is going to function just fine if nobody's allowed to make a profit by engaging in it?

  • OMG||

    "What people need is fairly easy to determine."

    Spoken like every true believer in Statism - that some technocrat has the brilliance to push the right button or pull the right lever just enough to make everything right.

  • ||

    That explains the 1980's technology and all the "shining happy people" at the DMV. Fucking retard.

  • ||

    Tony, what do you think of Glee? I think it's retarded, but I wanted to get your opinion on it. Also, the lead chick isn't very attractive, and that's just a fail in my book.

  • Tony||

    I'm a gay man, how do you think I feel about Glee?

  • ||

    Good answer, Tony. Good answer.

    But do you like Gossip Girl?

  • can you say closet||

    Epi

  • Sean W. Malone||

    But she's such a good singer Epi! Wait for the new songs, new romances, and new "Sue"!!

  • ||

    "I'm so tired of this ridiculous rationalization . . .
    . . . all the while not being a whiny paranoid bitch."

  • ||

    We're so sorry that reality isn't what you want it to be.

  • Jamie Kelly||

    Tony the Cunt Tiger, where do you think all the innovations are coming from? They are coming from the HC industry you hate so much, and they saved your wife from the dreaded twat-hairball disease. Now go sell some more cereal flakes, you grade-A moron. I hope your tigress dies of the AIDS that American innovators have helped suppressed.

  • you make me frown||

    :-(

  • Len Bias||

    And you're part of the reason this horrible bill passed. It's hard to convince people of its downsides if you just spew ugly (and painfully unfunny) names. Way to give those against the bill a bad name.

  • ||

    Name-calling isn't helpful, but I don't think the people who voted for this bill were as persuadable as you do.

  • Len Bias||

    Yes and no. There is always a group of people who think single payer and anything that brings us closer as the way forward. However, as the numbers supporting this bill fell over the year long debate, it's clear some people were persuaded against it. I know so many people who started out for it but changed their minds the more the debate unfolded and what was in the bill become obvious.

  • Tony||

    Would that be the same AIDS that free market fundies of the Reagan era refused to address because they were also fire-breathing bigots? I digress.

    Most scientific advancement comes from government or government funding. The market IS good at innovating ways to make money, but did it ever cross your mind that ways to make money and social goods aren't always the same thing? What motivation do pharmaceutical companies have to invent cures? Wouldn't it be in their best interest just to invent pills you have to take for the rest of your life? The answer is yes, and the evidence is in what products they spend all their time making and marketing.

  • ||

    Herceptin, for example was discovered by government science. Oh wait, no, sorry, Avon had to pony up for that discovery. Yes. A makeup company kicked the shit out of the federal government.

  • ||

    If not for government science, newton's three laws of mechanics would never have been discovered.

    Most scientific advancement comes from government or government funding.

    I think this is simply evidence that the government has successfully monopolized science. Have you ever tried to do be a professor and refuse federal funding. It's impossible. Tenure boards at the most prestigious universities judge you based on how much federal funding you can accrue.

    It's rediculous. How much does an HPLC cost? $40,000 It's a fucking pump with a photodiode at the end of it! I could almost build one out of lego mindstorms. But they are so expensive because researchers can write off huge quantities on account of having an endless supply of money on one end. The result? Small, upstart researchers, such as you might find at a PUI get shut out of the system.

    What motivation do pharma companies have to invent cures? Easy. If Pharma company A makes a drug that is a maintenance drug, and I'm a CEO of Pharma company B and I can make a cure, I'm going to fucking undercut company A 's market by making a cure and stealing all their clients, and advertising the fact that Pharma company A is doing something ethically sketchy (leasing out lifespan)

  • ||

    In HPLCs the pumps are really high precision and the chromatography media are really expensive.

    But yes, lab equipment in general is really inflated in price simply because the market is relatively small, purchases are few and far between, and the money comes from government grants.

    Look through a Fisher or VWR catalog and you'll see prices for some things that you can find (or the equivalent) in a Home Depot for 1/3 of the price.

  • Tony||

    I think this is simply evidence that the government has successfully monopolized science. Have you ever tried to do be a professor and refuse federal funding. It's impossible. Tenure boards at the most prestigious universities judge you based on how much federal funding you can accrue.

    But government investing in science is one of the (few?) things it does for good reasons. Political interference in science is not very well tolerated (and done mostly by the right), and I can't think of many examples of government funded science being that wasteful or misdirected for nefarious ends.

    And there's plenty of evidence that industry-funded science tends to have clear biases. Say, in the interest of the funding entities' profits. The best research done by the private sector is the stuff it usually keeps secret.

    What motivation do pharma companies have to invent cures? Easy. If Pharma company A makes a drug that is a maintenance drug, and I'm a CEO of Pharma company B and I can make a cure, I'm going to fucking undercut company A 's market by making a cure and stealing all their clients, and advertising the fact that Pharma company A is doing something ethically sketchy (leasing out lifespan)

    If only the real world worked like that. More likely they'd come to some mutually beneficial state wherein they both don't cure things.

  • ||

    All of you lefties like to pretend that only the far right hates science, but right now liberals all over the world want to pull the brakes on nanotech and biotech research that might someday make people "unequal." How's that for being anti science?

  • ||

    "Most scientific advancement comes from government or government funding."

    Right. The government was responible for All of Edison's inventions, the Wright Brothers developing the airplane, Fleming's discovery of penicillin, etc.

  • Crawford Kilian||

    As the author of 9 published SF novels and a 5-year-old blog on flu and other infectious diseases, I suggest you leave this kind of fantasizing to the professionals.

    As a naturalized Canadian who's enjoyed the benefits of universal health care since 1967, I confess I just don't get the visceral resistance to it that some Americans seem to cherish more than life itself.

    While spending far less on health care than you, we live longer. Dozens of other countries do too. It's not by accident.

    Consider too that many other countries with similar universal health insurance programs also support flourishing medical systems with plenty of innovation.

    Britain's Conservatives are presently damning and blasting Labour (with good reason) for chipping away at the National Health Service, and promising to restore its funding.

    So why not simply accept universal health care as a cost of doing business as a modern industrial nation, just like providing drinkable tap water and salmonella-free food?

    That's not a rhetorical question: We all need a strong, intelligent and confident US conservatism--not the anxious, defensive, name-calling collective currently masquerading under that name. The longer you content yourselves with sucking your thumbs and denying political reality, the longer you'll postpone real conservatism.

    Dick Nixon and Ronald Reagan, the most brilliant and perceptive US politicians of the last 60 years, would be ashamed of you

  • ||

    Yay canada! You guys destroyed the one medical isotope factory!

  • ||

    Nixon and Reagan were completely 180 from each other on this issue.

    Nixon wanted universal health care.

    Reagan was dead set against it.

    And they both sucked, btw.

  • ||

    Oh please oh please tell us about your science fiction. PLEASE.

  • ||

    I've never heard of him. Me. Think about that for a moment.

  • Drax the Destroyer||

    You live in Canada, good for you. I went to Toronto once. It smelled like garbage in the dead of winter. But to be fair, so does Baltimore, Pittsburgh, Cleveland, Indianapolis, etc.

    Nixon WAS a crook, and Reagan was a hypocrite in conservative clothing.

    With that out of the way, if you want to know where my visceral resistance comes from, it starts in my wallet. I barely have enough money to cover the debts garnered by my biggest mistake (going to college). I worked it out one time and found that if my tax burden was halved, I could pay off my debt in 5 years. Without such a miracle, it will take me 30 years. Interest is a bitch. So what happens when I will inevitably pay more for less service? I will have less money to pay off that 30 year debt. Those 30 years will creep into 31, then 32. I will have to revert (almost ironically) to my college diet of Ramen, pencil shavings, and the taste of a revolver as I contemplate an escape. Any chance of saving for MY kids will be scattered on the winds of fiscal ruin. All for what? So I can wait even longer at the doctor's office? So my Chronic leg pain can be denied attention simply because it is not important enough to warrant care? Let’s make the majority of people’s lives worse, so some MIGHT have better lives. You’ve got to love the road to hell.

    You Canadians/Europeans/Our Self-Appointed betters also fail to recognize the connection between the implementation of HCR and that Americans are generally dumb shits. We do not have the manageable population coupled with free-market-like Education policies to be competitive on a productive global market. I know if I grew up in Canada, I probably would be objectively smarter. Also, I would probably not question many things I question now, and just accept the gruel that is fed to me but that is beside the point. The United States is NOT the rest of the world. We do not have the capacity, drive, and delusion to implement your glorified Universal Health care without incurring worse debt burdens (it will happen). The only thing that can get our asses to move is more money, because more money equals bigger tvs, better vacations, and less diseased-ridden hookers. When we have less money-- when every "middle class" person must force themselves to live a life of depressing failure and self-loathing like me, I won't be surprised to find that the vacuum cleaner in D.C. took our lives from us, all to supposedly help someone. The success of this help will be difficult to prove objectively. But this is all about emotion and not reality, isn’t it?

    Now think about this:
    -The U.S. could not win Vietnam
    -The U.S. could not convert to metric
    -The U.S. could/will not win in Iraq
    -The U.S. could/will not win in Afghanistan
    -The U.S. cannot find Osama Bin Laden
    -The U.S. cannot fund Social Security, Medicare, Medicaid, etc.
    -The U.S. has terrible, terrible schools
    -The U.S. elected Bush 2 (Electric Boogaloo)….Twice

    6 of those failures can be placed directly at the government’s feet. It is not surprising that 4 of them involved the murder of millions of people as well. What makes you think this government is even capable of your vaulted expectations for what a “Modern Industrialized Nation” should do if it cannot accomplish the one enterprise at which it is supposed to excel?

  • ||

    Get out of the way America! Progress is acomin! Canada is a country with the population of California and more natural mineral resources than the United states. If you didn't have a tiny population sitting on a gold mine, where would you be?

    Not to mention that most European countries are as poor as the poorest American states.

  • ||

    The new Administration removes the roadblock to stem cell research, and then almost simultaneously removes the only reason for investing in it. Is this a great country, or what?

  • ||

    At the beginning of the last decade, there was great excitement about the future of medicine. Advances in biotechnology, nanotechnology, diagnostics, information technology, stem cell treatments, vaccines, and organ transplants were poised to radically improve the health prospects of Americans. Looking back from 2020, we can see that most of these major biomedical advances failed to materialize. What happened? Three words: health care reform.

    Bullshit. The excitement is all hype. You wouldn't believe how much of the stem cell shit is fabricated. Nanotechnology? To fix diseases in ten years? You might as well buy nano-colloidal silver.

    We didn't need health care reform to ruin these promises; they were never going to materialize in the first place. And besides, how are we going to enjoy the fruits of our technological development after we hit peak oil. Keep in mind that almost all chemical transformations (including those used to make your precious pharmaceuticals) require incredible volumes of petrochemical solvents.

  • ||

    peak oil is a myth: http://mises.org/daily/1717

  • Paul||

    Keep in mind that almost all chemical transformations (including those used to make your precious pharmaceuticals) require incredible volumes of petrochemical solvents.

    Al Gore can do it on wind.

  • ||

    yes. his own.

  • $||

    Tony|3.24.10 @ 1:08AM|#
    You might as well own up to it and take the credit. The bill that's passed is essentially the libertarian/conservative plan from back when you guys didn't see a socialist plot around every corner.

    Just for posterity's sake:

    Why do you so vigorously defend this bill, if it is of the nature you say it is?

    *hack hack*

  • Tony||

    Because I know that it's the best we could get with the votes in Congress, and that its defeat would doom healthcare reform forever, and that if, nothing else, it will be interpreted as a win for a more activist federal government and get us out of the gloomy, soul-crushing antigovernment paradigm that has dictated the terms of political debate for 30 years. And it may just save a bunch of lives.

  • ||

    When was the "anti-government paradigm" in place? Damn, I missed that! FUck!

  • $||

    Would that be the same AIDS that free market fundies of the Reagan era refused to address because they were also fire-breathing bigots?

    No, that would be the same AIDS that has become so politicized that you and yours expect government largesse to find a cure for what is largely a "poor choices" disease.

    Ronald Reagan (and his Democratic Congress) refused to fund your personal hobby-horse - so therefore there is a free-market failure? How does that follow?

  • abercrombie london||

    very good

  • abercrombie and fitch clothing||

    thank you

  • ||

    Socialism is a disease for which there is no cure. In the latter stages it morphs into communism. For sure there will be no cure by 2020, but many more people will be afflicted by then. At this time, only the patient's death can relieve the misery for those who must be around one who suffers from it.

  • Publius||

    "I just think that the same entity that innovated the atom bomb, spaceflight, and the Internet is capable of innovating in any number of ways--most of all because of the resources at its disposal."

    Yes, they have been doing a great job at putting people in jail for using drugs and shooting their dogs in the process as well.

    Of course, sometimes they get the wrong people, and shoot a good many dogs for no reason whatever, but that's a small price to pay.

    I realize that this might not seem to have much to do with health care, but thinking about our government in all of it's aspects is just so damn exciting, I couldn't help myself.

  • ||

    Ron,

    Do you really have evidence that Statins increase life span, i.e., that they decrease all cause mortality? The data indicates that they do lower cholesterol and may lower cardiovascular death; however, there is no evidence that they increase life span. The same is true for most cancer screening (outside of cervical cancer). The time from detection to death increases with early detection; but overall life expectancy does not. Whether your lung cancer, to give a concrete example, is detected early or late, you die at about the same age. You may benefit from a reduction in symptoms and a better life style; nevertheless, you will die at about the same age regardless. There are good interventions, high blood pressure screening certainly saves lives, but a blanket statement that earlier screening will save lives is just not supported by the current evidence.

    Early screening would be effective if we had advanced treatments. However, as you predict, the rate of innovation, thus the development of advanced treatments, will diminish under the new system.

  • ryan||

    To say something 'saves lives' does not necessarily mean it will postpone the cessation of that life (disregarding the intended meaning in the text you reference). A life's value is not truly determined, by the individual concerned, with its duration being the sole standard of value. It is more relevant to consider a life saved when it (the organism) has become capable of satisfaction. A person living in chronic pain may choose to live free of such pain for a year, instead of enduring the entirety of the life possible to it. A despondent person may prefer to live in full contentment (assuming it is possible for them to know how full contentment feels) for a relatively shorter time than to be depressed and live longer.

    I am only addressing this idea which may be conveyed by a few words you used: that a life's value is determined by a life's span. To assume this for any means of reasoning is a fallacy.

    I will not attempt to explain the implications one might infer from this, but I want it to be said anyway.

  • "Markets Are Magical!"||

    As we know, Ronald Bailey has a history of making accurate predictions. Right?

    In reality, in 2020 we'll likely get a retraction, similar to the one he gave about Global Warming.

    Again, just like the invisible hand theory, and virtually everything else a Libertarian stands for, this all based on a "just so" story.

    Guys, it's over.

    For real.

  • ||

    Good jobs, guys. The most useless troll ever is back.

  • ||

    What I like is that all the people who denied they were socialists are now gleeful in their socialism.

    This is, by the way, socialism, albeit of a different type than we've seen in the past. So piss off while the rest of us decide exactly how wrathful and complete our revenge will be.

  • ||

    "Markets Are Magical!"|3.24.10 @ 8:49AM|#
    "Again, just like the invisible hand theory, and virtually everything else a Libertarian stands for, this all based on a "just so" story."
    Nice to hear from someone who obviously slept through every history class s/he ever took.

  • ||

    Yesterday, my 20 year old daughter, who is getting straight A's in college, decided not to go to medidcal school. She does not want to be a government employee. My guess is that standards will stay relatively high for awhile as the Doctors trained under the "old" program retire. In 10 years America will have the doctors it deserves.

  • ||

    First of all, loved you on The Six Million Dollar Man.

    Second, good for her. I intend to start paying cash to doctors if and when this or any other idiotic scheme takes effect, so maybe the black market will preserve some of the U.S.'s superb levels of healthcare.

  • ||

    Offer them a double eagle or two as payment for a bypass.

  • ||

    Just two little quibbles on your insightful piece: 1) It's unlikely that cancer outcomes will improve under ObamaCare, even with increases in screening, since cancer treatment is often prohibitively expensive (hence the necessity for the so-called "death panels") 2)It's likely that, in addition to the many doctors who choose to retire early, many others will stop accepting insurance altogether, as is already happening in affluent areas of the country.

  • ||

    Would that be the same AIDS that free market fundies of the Reagan era refused to address because they were also fire-breathing bigots? I digress.

    I would like to know about the interdimensional travel device you use, Tony.

    You know, the one you must use to get here from the alternate universe where spending on AIDS research has not been the biggest consumer of federal research dollars since about 1984.

  • ||

    No, no, no, the Republicans deregulated AIDS. Along with everything else. We've been living in a total free market economy, with no government funding of anything since the Democrats lost control of the government.

  • ||

    Just think, if the government in Tony's alternate universe had only put that effort into finding a cure for AIDS, cancer and dandruff instead of an interdimensional travel device, Tony wouldn't be galivanting over here to annoy us.

    Wait, alternate universe Reagan deregulated and privatized everything, eliminated taxation and shut down NPR so Tony must have built the interdimensional travel device with his own money.

    Just goes to show what kind of selfish fuck Tony is. Why didn't he spend that money on curing children, women and minorities of AIDS, cancer and dandruff instead of indulging his own hedonistic pursuits?

  • ||

    NAS not NPR. Wrong part of the alphabet soup bowl.

  • "Markets Are Magical!"||

    It's no secret that Reagan, and his cabinet were unmoved by the AIDS crisis. It was the GOP's long awaited "See, I told you God hates Fags!" moment.

    Reagan even thought that Environmentalism was silly since the world was going to end by 2000 anyway. I experienced a lot of this talk throughout the early 90's, as the preppers readied themselves for the inevitable march towards the Kingdom.

    Look, smear shit on the walls all that you like. It doesn't matter. It's actually entertaining to watch. The bitterness and anger come from the realization that the game is finally over. You lost. Even if Conservatives win some seats, and the Presidency, you still have to deal with your opposition. It doesn't end with elections. Although, I would argue that the battle was lost long ago, if it ever really began.

    We are witnessing a great moment in history, ladies.

    If you think you're miserable now, just wait. This is what happens when you narrow your world view so much, that almost everyone becomes an enemy.

    Sit back and enjoy this Marxist, Stalinist, Progressive, Nazi, Muslim Loving Communist, who may or not be related to the Cookie Monster, summon the ghouls and ghosts of the underworld to destroy us all.

  • louboutin||

    We will bring you more exciting and better service. Our Christian Louboutin Shoes are fashionable and creative. Is even more affordable. we provide high quality Christian Louboutin.Look here, there is a very innovative style models, our Louboutin Shoes for sale We are waiting for you.. Please trust us. Choose us!

  • louboutinvips||

    We will bring you more exciting and better service. Our Christian Louboutin Shoes are fashionable and creative. Is even more affordable. we provide high quality Christian Louboutin.Look here, there is a very innovative style models, our Louboutin Shoes for sale We are waiting for you.. Please trust us. Choose us!
    http://www.christianlouboutinvips.com

  • louboutinvips||

    http://www.christianlouboutinvips.com

  • abercrombie london||

    Many years after receiving my graduate degree, I returned to the State University of New York at Binghamton as a faculty member. One day in a crowded elevator, someone remarked on its inefficiency. I said the elevators had not changed in the 20 years since I began there as a student.
    thomas sabo When the door finally opened, I felt a compassionate pat on my back, and turned to see an elderly nun smiling at me. "You'll get that degree, dear," she whispered. "Perseverance is a virtue."

  • abercrombie london||

    Many years after receiving my graduate degree, I returned to the State University of New York at Binghamton as a faculty member. One day in a crowded elevator, someone remarked on its inefficiency. I said the elevators had not changed in the 20 years since I began there as a student.
    thomas sabo When the door finally opened, I felt a compassionate pat on my back, and turned to see an elderly nun smiling at me. "You'll get that degree, 中国历史dear," she whispered. "Perseverance is a virtue."

  • ||

    Thank you! These are some of the questions that no one seemed to consider during this whole drama. It's nice to know that I'm not alone.

  • ||

    truth,,,,obama people have no idea of the extent to which they have to be gulled in order to be led."
    "The size of the lie is a definite factor in causing it to be believed, for the vast masses of the nation are in the depths of their hearts more easily deceived than they are consciously and intentionally bad. The primitive simplicity of their minds renders them a more easy prey to a big lie than a small one, for they themselves often tell little lies but would be ashamed to tell a big one."
    "All propaganda must be so popular and on such an intellectual level, that even the most stupid of those towards whom it is directed will understand it. Therefore, the intellectual level of the propaganda must be lower the larger the number of people who are to be influenced by it."
    "Through clever and constant application of propaganda, people can be made to see paradise as hell, and also the other way around, to consider the most wretched sort of life as paradise."pelosi don't see much future for the Americans ... it's a decayed country. And they have their racial problem, and the problem of social inequalities ...obama feelings against Americanism are feelings of hatred and deep repugnance ... everything about the behaviour of American society reveals that it's half Judaised, and the other half negrified. How can one expect a State like that to hold TOGTHER.They include the angry left wing bloggers who spread vicious lies and half-truths about their political adversaries... Those lies are then repeated by the duplicitous left wing media outlets who “discuss” the nonsense on air as if it has merit… The media's justification is apparently “because it's out there”, truth be damned. STOP THIS COMMUNIST OBAMA ,GOD HELP US ALL .THE COMMANDER ((GOD OPEN YOUR EYES)) stop the communist obama & pelosi.((open you eyes)) ,the commander

  • Casey Davis||

    Very insightful. I like the future perspective.

  • abercrombie milano||

    My only point is that if you take the Bible straight, as I'm sure many of Reasons readers do, you will see a lot of the Old Testament stuff as absolutely insane. Even some cursory knowledge of Hebrew and doing some mathematics and logic will tell you that you really won't get the full deal by just doing regular skill english reading for those books. In other words, there's more to the books of the Bible than most will ever grasp. I'm not concerned that Mr. Crumb will go to hell or anything crazy like that! It's just that he, like many types of religionists, seems to take it literally, take it straight...the Bible's books were not written by straight laced divinity students in 3 piece suits who white wash religious beliefs as if God made them with clothes on...the Bible's books were written by people with very different mindsets...in order to really get the Books of the Bible, you have to cultivate such a mindset, it's literally a labyrinth, that's no joke.

  • abercrombie milano||

    My only point is that if you take the Bible straight, as I'm sure many of Reasons readers do, you will see a lot of the Old Testament stuff as absolutely insane. Even some cursory knowledge of Hebrew and doing some mathematics and logic will tell you that you really won't get the full deal by just doing regular skill english reading for those books. In other words, there's more to the books of the Bible than most will ever grasp. I'm not concerned that Mr. Crumb will go to hell or anything crazy like that! It's just that he, like many types of religionists, seems to take it literally, take it straight...the Bible's books were not written by straight laced divinity students in 3 piece suits who white wash religious beliefs as if God made them with clothes on...the Bible's books were written by people with very different mindsets...in order to really get the Books of the Bible, you have to cultivate such a mindset, it's literally a labyrinth, that's no joke.

  • abercrombie and fitch uk||

    Even if you go on his website, it's still just a a ten minute discussion. The interview with Jim Cramer simply amounted to Jim sputtering something every couple of minutes while John wagged his finger at him the whole time. I've never seen him have an intelligent discussion with anybody, and he only talks to people that he knows he can bully into a corner. Usually idiots, yes, but it's still dispicable. I don't watch him that often, but it is people like him that make me wretch. The fact that people go around saying "He slammed so and so" in that "debate" pisses me off. John's not directly responsible for that, but he certainly plays his audience to get that effect.

  • abercrombie fitch uk||

    Well said. Tucker is despicable, Crossfire became despicable (despite the presence of supposed "heavyweights" like Novack and Carville), and Jon Stewart is a comedian who has never proclaimed himself to be anything else. Just because certain people here don't understand how satire works doesn't change that fact. The fact that The Daily Show has gained some cultural traction doesn't change that.

  • abercrombie uk||

    "The size of the lie is a definite factor in causing it to be believed, for the vast masses of the nation are in the depths of their hearts more easily deceived than they are consciously and intentionally bad. The primitive simplicity of their minds renders them a more easy prey to a big lie than a small one, for they themselves often tell little lies but would be ashamed to tell a big one."

  • estetik merkezi||

    nice informatin. thanks.

  • ||

    The funny thing is that people think that their congressman will be more accountable to them on the whole rationing front than some insurance company owned by rich people.
    Fat People

  • repair denture||

    can you use denture cleaner on retainers

    instyle smile costafter-dental-extractions-will-i-need-to-start-using-a-dental-adhesive-for-my-immediate-dentures/">how fast can dentures be made

  • Retete Slabit||

    Quite old info, but true indeed.

  • Dale Mcleod||

    Its an excellent article.The future of the healthcare reform is looking just great and hope so will get more good news on the healthcare. Personal checks

  • Pizza in Constatan||

    @zombieee that is so true.

  • Pizza in Constanta||

    @zombieee that is so true.

  • House Construct||

    Great article! Keep up the good work

  • Popular iPhone Cases||

    Where do these statistics come from????

    "Thanks to the health care reform legislation, a higher percentage of Americans are now covered by health insurance than ever before—up from 83 percent in 2010 to nearly 95 percent of the legal population now. About half of the newly insured are covered by Medicaid and Children’s Health Insurance Program. "

GET REASON MAGAZINE

Get Reason's print or digital edition before it’s posted online

  • Progressive Puritans: From e-cigs to sex classifieds, the once transgressive left wants to criminalize fun.
  • Port Authoritarians: Chris Christie’s Bridgegate scandal
  • The Menace of Secret Government: Obama’s proposed intelligence reforms don’t safeguard civil liberties

SUBSCRIBE

advertisement