To try to get away from the depressing spectacle of the "health care debate" (including, alas, President Obama's unexpected weakness in attempting to achieve a political compromise by trying to appease people who won't be appeased—like Senator Charles E. Grassley, “who feeds the death panel smear, warning that reform will 'pull the plug on grandma'”1), I'm reading an entertaining book, John Allen Paulos's 2008 Irreligion: A Mathematician Explains Why the Arguments for God Just Don't Add Up, which in passing quotes Ambrose Bierce's Devil's Dictionary (1911):Pray, v. To ask the laws of the universe to be annulled on behalf of a single petitioner confessedly unworthy.Mention of Bierce immediately follows Paulos's own statement:
Subjective arguments for God's existence generally claim to establish even more than a connection between God and a particular religion. They claim to establish the existence of a personal God [emphasis mine] who cares about us individually, listens to our prayers, and occasionally intervenes with a miracle on our behalf. An understandable wish perhaps, but absurd nonetheless. [pp. 80-81]
Absurd as it is, I have once or twice caught myself beginning to pray for health care reform to become a concerted, rational undertaking.
_______________- From Paul Krugman's column, "Obama's Trust Problem," published yesterday on The New York Times website.
I love The Devil's Dictionary.
ReplyDeleteYes, isn't it great! A thundering American classic. Ambrose Bierce was one of the fiercest, clearest intellects we have had. Of course, in terms of what has come to be considered "American," his dictionary is neglected if not simply despised for its "cynicism" and "blasphemy."
ReplyDeleteThanks. Smart people get it about God.
ReplyDeleteWhat's the big deal about God? You believe or you don't. I think the subject isn't worth having a discussion over. Waste of time and breath. What I'm having for dinner or had, holds more interest for me.
ReplyDeleteOn the contrary, it's endlessly entertaining! Surely the biggest joke anyone ever told.
ReplyDeletehttp://online.wsj.com/article/SB10001424052970203706604574374463280098676.html
ReplyDeleteNot that Obama himself wants to pull the plug on Grandma, but Rahm's bro sounds like he would. Dr. Ezekiel Emanuel has been appointed the health-policy adviser of the OMB and is a member of the Federal Council on Comparative Effectiveness Research.
Here is a good quote from Dr. Emanuel himself: "When implemented, the complete lives system produces a priority curve on which individuals aged roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get changes that are attenuated"
So that is not really pulling the plug I guess, but maybe a more drawn out slower type death. Fortunately I am still in Dr. Emanuel's good zone, for another 10 years.
Thanks, Joe! The WSJ article you quote is in the context of allocation of scarce resources, which is unavoidable. Princeton University bioethicist Peter Singer wrote about this on July 19, in "Why We Must Ration Health Care." Excerpt in next comment.
ReplyDeleteSinger excerpt:
ReplyDelete"Governments implicitly place a dollar value on a human life when they decide how much is to be spent on health care programs and how much on other public goods that are not directed toward saving lives. The task of health care bureaucrats is then to get the best value for the resources they have been allocated. It is the familiar comparative exercise of getting the most bang for your buck. Sometimes that can be relatively easy to decide. If two drugs offer the same benefits and have similar risks of side effects, but one is much more expensive than the other, only the cheaper one should be provided by the public health care program. That the benefits and the risks of side effects are similar is a scientific matter for experts to decide after calling for submissions and examining them. That is the bread-and-butter work of units like NICE. But the benefits may vary in ways that defy straightforward comparison. We need a common unit for measuring the goods achieved by health care. Since we are talking about comparing different goods, the choice of unit is not merely a scientific or economic question but an ethical one.
"As a first take, we might say that the good achieved by health care is the number of lives saved. But that is too crude. The death of a teenager is a greater tragedy than the death of an 85-year-old, and this should be reflected in our priorities. We can accommodate that difference by calculating the number of life-years saved, rather than simply the number of lives saved. If a teenager can be expected to live another 70 years, saving her life counts as a gain of 70 life-years, whereas if a person of 85 can be expected to live another 5 years, then saving the 85-year-old will count as a gain of only 5 life-years. That suggests that saving one teenager is equivalent to saving 14 85-year-olds. These are, of course, generic teenagers and generic 85-year-olds. It’s easy to say, 'What if the teenager is a violent criminal and the 85-year-old is still working productively?' But just as emergency rooms should leave criminal justice to the courts and treat assailants and victims alike, so decisions about the allocation of health care resources should be kept separate from judgments about the moral character or social value of individuals.
"Health care does more than save lives: it also reduces pain and suffering. How can we compare saving a person’s life with, say, making it possible for someone who was confined to bed to return to an active life? We can elicit people’s values on that too. One common method is to describe medical conditions to people — let’s say being a quadriplegic — and tell them that they can choose between 10 years in that condition or some smaller number of years without it. If most would prefer, say, 10 years as a quadriplegic to 4 years of nondisabled life, but would choose 6 years of nondisabled life over 10 with quadriplegia, but have difficulty deciding between 5 years of nondisabled life or 10 years with quadriplegia, then they are, in effect, assessing life with quadriplegia as half as good as nondisabled life. (These are hypothetical figures, chosen to keep the math simple, and not based on any actual surveys.) If that judgment represents a rough average across the population, we might conclude that restoring to nondisabled life two people who would otherwise be quadriplegics is equivalent in value to saving the life of one person, provided the life expectancies of all involved are similar.
"This is the basis of the quality-adjusted life-year, or QALY, a unit designed to enable us to compare the benefits achieved by different forms of health care. The QALY has been used by economists working in health care for more than 30 years to compare the cost-effectiveness of a wide variety of medical procedures and, in some countries, as part of the process of deciding which medical treatments will be paid for with public money..."
Let's keep on thinking!
Good on you.