Sources and Filters

I've just said some uncharitable things about another commentator in an American Scene thread.

Here's the thing though: I see no room for charity. The person offered up this interview with Obama as proof that the "death panel" bullshit is somehow rooted in fact, that Obama's own words show that he is proposing something that will result in euthanasia, or at least the withholding of treatment, as a cost-cutting measure.

Here 's the portion of the interview cited to me as corroborating evidence:

V. Postreform Health care

You have suggested that health care is now the No. 1 legislative priority. It seems to me this is only a small generalization — to say that the way the medical system works now is, people go to the doctor; the doctor tells them what treatments they need; they get those treatments, regardless of cost or, frankly, regardless of whether they’re effective. I wonder if you could talk to people about how going to the doctor will be different in the future; how they will experience medical care differently on the other side of health care reform.

THE PRESIDENT: First of all, I do think consumers have gotten more active in their own treatments in a way that’s very useful. And I think that should continue to be encouraged, to the extent that we can provide consumers with more information about their own well-being — that, I think, can be helpful.

I have always said, though, that we should not overstate the degree to which consumers rather than doctors are going to be driving treatment, because, I just speak from my own experience, I’m a pretty-well-educated layperson when it comes to medical care; I know how to ask good questions of my doctor. But ultimately, he’s the guy with the medical degree. So, if he tells me, You know what, you’ve got such-and-such and you need to take such-and-such, I don’t go around arguing with him or go online to see if I can find a better opinion than his.

And so, in that sense, there’s always going to be an asymmetry of information between patient and provider. And part of what I think government can do effectively is to be an honest broker in assessing and evaluating treatment options. And certainly that’s true when it comes to Medicare and Medicaid, where the taxpayers are footing the bill and we have an obligation to get those costs under control.

And right now we’re footing the bill for a lot of things that don’t make people healthier.

THE PRESIDENT: That don’t make people healthier. So when Peter Orszag and I talk about the importance of using comparative-effectiveness studies (9) as a way of reining in costs, that’s not an attempt to micromanage the doctor-patient relationship. It is an attempt to say to patients, you know what, we’ve looked at some objective studies out here, people who know about this stuff, concluding that the blue pill, which costs half as much as the red pill, is just as effective, and you might want to go ahead and get the blue one. And if a provider is pushing the red one on you, then you should at least ask some important questions.

Won’t that be hard, because of the trust that people put in their doctors, just as you said? Won’t people say, Wait a second, my doctor is telling me to take the red pill, and the government is saving money by saying take the blue —

THE PRESIDENT: Let me put it this way: I actually think that most doctors want to do right by their patients. And if they’ve got good information, I think they will act on that good information.

Now, there are distortions in the system, everything from the drug salesmen and junkets to how reimbursements occur. Some of those things government has control over; some of those things are just more embedded in our medical culture. But the doctors I know — both ones who treat me as well as friends of mine — I think take their job very seriously and are thinking in terms of what’s best for the patient. They operate within particular incentive structures, like anybody else, and particular habits, like anybody else.

And so if it turns out that doctors in Florida are spending 25 percent more on treating their patients as doctors in Minnesota, and the doctors in Minnesota are getting outcomes that are just as good — then us going down to Florida and pointing out that this is how folks in Minnesota are doing it and they seem to be getting pretty good outcomes, and are there particular reasons why you’re doing what you’re doing? — I think that conversation will ultimately yield some significant savings and some significant benefits.

Now, I actually think that the tougher issue around medical care — it’s a related one — is what you do around things like end-of-life care —

Yes, where it’s $20,000 for an extra week of life.

THE PRESIDENT: Exactly. And I just recently went through this. I mean, I’ve told this story, maybe not publicly, but when my grandmother got very ill during the campaign, she got cancer; it was determined to be terminal. And about two or three weeks after her diagnosis she fell, broke her hip. It was determined that she might have had a mild stroke, which is what had precipitated the fall.

So now she’s in the hospital, and the doctor says, Look, you’ve got about — maybe you have three months, maybe you have six months, maybe you have nine months to live. Because of the weakness of your heart, if you have an operation on your hip there are certain risks that — you know, your heart can’t take it. On the other hand, if you just sit there with your hip like this, you’re just going to waste away and your quality of life will be terrible.

And she elected to get the hip replacement and was fine for about two weeks after the hip replacement, and then suddenly just — you know, things fell apart.

I don’t know how much that hip replacement cost. I would have paid out of pocket for that hip replacement just because she’s my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question. If somebody told me that my grandmother couldn’t have a hip replacement and she had to lie there in misery in the waning days of her life — that would be pretty upsetting.

And it’s going to be hard for people who don’t have the option of paying for it.

THE PRESIDENT: So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right?

I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.

So how do you — how do we deal with it?

THE PRESIDENT: Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.

I was told that Obama's statement "I have always said, though, that we should not overstate the degree to which consumers rather than doctors are going to be driving treatment" actually refers to end-of-life panels, and not the doctor-patient relationship.

I was told that this exchange

Now, I actually think that the tougher issue around medical care — it’s a related one — is what you do around things like end-of-life care —

Yes, where it’s $20,000 for an extra week of life.


refers to government euthanasia as a cost-cutting measure, and not pre-planning for end-of-life situations stemming directly from Obama's well-publicized experience with his grandmother.

And I was told that Obama's statement "So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right?" is actually code for a covert desire to do things most Americans would find morally objectionable.

Yeah, I can't imagine where my charity went when someone tries to pass that off as a mere difference of interpretation.

It really makes me despair, that so much of American public discourse is infested with outright lies. The birther stuff is just a symptom -- the envelope on what constitutes "acceptable" has been pushed so far into the red that outright lunatics like Orly Taitz can creep into the margins of public debate and not be laughed off into oblivion.

An Acceptable Assassination

David Frum tries to walk the tight rope between the right wing nutjobs and sanity, and falls to his doom.

It's not enough for conservatives to repudiate violence, as some are belatedly beginning to do. We have to tone down the militant and accusatory rhetoric. If Barack Obama really were a fascist, really were a Nazi, really did plan death panels to kill the old and infirm, really did contemplate overthrowing the American constitutional republic—if he were those things, somebody should shoot him.

But he is not.
Uhh, no, David. Someone should not shoot him. Impeach? Sure. Vote him out in 2012? Absolutely. But shoot him? I suppose it would be OK too if Malia or Sasha were caught in the crossfire, right? Collateral damage and all that.

You can't have it both ways, David. To paraphrase Claude Rains, if the teabagging loonies are even that much right, then sanity is wrong.


More TIFF announcements of films that I'll probably try to see during the fest:

The adaptation of Cormac McCarthy's The Road, starring The Best Actor in Hollywood Viggo Mortensen, is a Special Presentation. It's also directed by The Proposition director John Hillcoat, which is something of an inspired choice. I have hopes.

Alejandro Amenabar returns after a five year break with Agora, in which Rachel Weisz plays an Egyptian astronomer trying to save the Library at Alexandria from rampaging hordes of Christians, or something like that. I'm sure the metaphoric possibilities will be endless. Again, I have hopes, even if it is a Gala.

And Ewan McGregor and George Clooney make fun of conspiracy theories, and/or theorists, in the Gala The Men Who Stare At Goats.

Also, new Herzog and Tornatore, if you're into that sort of thing.

They Saved Broder's Brain

Broder emerges from his fog and makes an interesting comparison between the health care town hall angry idiocy of today and the angry idiocy LBJ faced over the Civil Rights Act.

The obvious difference, of course, is that none of the people against health care reform have ever thought of Obama as "one of us." LBJ was a good ole boy from Texas who 'turned Judas'. Obama is a ManchurianCandidateKenyanMarxistSocialistFascist who's been up to no good from the day he was born on some distant foreign shore.

Corporatocracy FTW!

Sigh. If only my personal notions of integrity and such weren't so antiquated, I might be able to pull down $70K a year like this guy.

Hell, I don't even like wearing branded items of clothing even when I'm not getting paid for it.


John Cole has a brilliant idea to counter the "death panel" idiocy:

If Democrats were smart (they’re not) they would point out that this is the fitting tribute to Terry Schiavo and name this the Schiavo amendment, because that is really what this does. It provides patients with the information they need to make living wills, so that should they get into a tragic circumstance such that Terri Schiavo found herself, there would not be any questions about what needs to be done.


So the secret project I've started working on is a GO.

Mark the date on your calendars: September 30th will be the first (and hopefully not last) production of No Mercy Hospital. The show is a kind of comedy triage, in which a diverse group of experts get together and perform a differential diagnosis on the very sick film careers of some famous funny folk. The Comedy Bar (at Bloor and Ossington) will be the venue for this no doubt historic event.

More details later.

JP Gets Wise

Jays GM JP Ricciardi took my sage advice and let the White Sox take on Alex Rios' bloated contract.

I'd like to say there's hope for the kid yet, but let's not go too far. Being willing to cut bait on his mistakes is a good sign though.

Sadly Yes

I missed this reader email to Sully on Saturday, but DougJ at B-J caught it. It deserves reposting in full:

Your obvious shock and dismay at the sheer angry ignorance of the health care teabaggers reiterates my largest problem with your rosy immigrant's view of America. You have often underestimated just how poisonously dangerous the American populist right is.

I don't blame you. You came to America after the rise of Reagan. Most of your life in America, you have lived under different Republican presidents who placated these folks with platitudes and campaign rhetoric. The one period when the populist right didn't feel they had a fellow traveler in charge was when Bill Clinton was elected (thanks to the reactionaries splitting their votes). You remember, no doubt, the level of crazy Clinton had to defuse and dodge, and this was a man who had the advantage of being a Southern bubba who has dealt which such people all his life.

For most of your time in America, this insanity has been muted by the success of conservative politics. Since you live in Washington, you probably saw daily the face of the successful conservative political establishment that milked the populist right, and by milking them kept their bitterness at a manageable level. That safety valve was stuffed up by George Bush's failed presidency.

So now, these people are facing their worst fears; actual change.
A political and demographic re-alignment is happening before their eyes, and they are reaching back into their old bag of tricks of intimidation, violence, and apocalyptic fearmongering. You are British, Andrew. You love this country, and we love you for it. But you didn't grow up around these folks, and you don't realize what a permanent and potent part of the American political landscape they are.

They have always been with us, the people who believed in manifest destiny, who delighted in the slaughter of this land's original inhabitants, who cheered a nation into a civil war to support an economic system of slavery that didn't even benefit them. They are the people who bashed the unions and cheered on the anti-sedition laws, who joined the Pinkertons and the No Nothing Party, who beat up Catholic immigrants and occasionally torched the black part of town. They rode through the Southern pine forests at night, they banned non-European immigration, they burned John Rockefeller Jr. in effigy for proposing the Grand Tetons National Park.

These are the folks who drove Teddy Roosevelt out of the Republican Party and called his cousin Franklin a communist, shut their town's borders to the Okies and played the protectionist card right up til Pearl Harbor, when they suddenly had a new foreign enemy to hate. They are with us, the John Birchers, the anti-flouride and black helicopter nuts, the squirrly commie-hating hysterics who always loved the loyalty oath, the forced confession, the auto-de-fe. Those who await with baited breath the race war, the nuclear holocaust, the cultural jihad, the second coming, they make up much more of America then you would care to think.

I'm always optimistic about America. We're a naturally rich and beautiful place. Every generation we renew ourselves with a watering of immigrants committed to the American dream, immigrants like you. But please, Andrew, do not for a second underestimate the price in blood and tears we've always paid here for progress.

I voted for Obama with my fingers crossed, because I knew that as the populist right lost power, they would become more extreme, more concentrated, and more violent. As to dismissing them as only a quarter or so of America, please remember that it only took a quarter or so of Americans to actively support the Confederacy.

Thor Angry!

Having a 15th floor apartment makes for awesome displays when a lightning storm sweeps over the city (as one is doing right now).

As an added bonus, apparently the storm is/was so bad down at ground level that tonight's Nickelback concert was cancelled. Huzzah!