Trollish Tirades

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Trolls (Internet):

In Internet slang, a troll is someone who posts inflammatory,[2]extraneous, or off-topic messages in an online community, such as an online discussion forum, chat room, or blog, with the primary intent of provoking readers into an emotional response[3] or of otherwise disrupting normal on-topic discussion.[4] The noun troll may refer to the provocative message itself, as in: “That was an excellent troll you posted”. While the word troll and its associated verb trolling are associated with Internet discourse, media attention in recent years has made such labels subjective, with trolling describing intentionally provocative actions outside of an online context. For example, mass media uses troll to describe “a person who defaces Internet tribute sites with the aim of causing grief to families.”[5][6]  Source: Wikipedia.

Paul Krugman, (New York Times columnist, professor of economics and international affairs at Princeton University, and 2008 Nobel Prize laureate in Economics), on his NYT blog “Conscience of a Liberal” recently posted a short, curt message regarding the constant flow of comments he receives written by “trolls.” See the above definition.  Still thinking about my previous post “Hospital Food for the Mind: Benanke, Jackson Hole, and the Importance of Being Wrong,” I realized that trolls fall into the category of ignoramuses I referred to there.

Krugman’s ongoing problem with the troll attacks is that he writes as a pundit as well as an economist. His often pointed remarks and his notoriety as a Nobel Prize winner make him a high-profile target for those who do not see eye-to-eye with him.  This is not a surprise.  Trolls have often been historically portrayed as quite large.  All of us familiar with the Lord of the Rings movies, along with the Harry Potter series also know the wide range of images in which they are portrayed. The point being that by their very stature rather than character or intellectual capacity, mythological though they may be, trolls can’t see eye-to-eye with anybody.

Battle Troll from Lord of the Rings. (c) New Line Cinema. Photo: allthetests.com

Since trolls were certain to respond to Krugman’s banning them (the fact that doing so would reveal themselves probably never crossed their minds), I, too, decided to write a comment.  I know what you’re thinking, but I’m not a troll. I’ve have had numerous comments published on Krugman’s blog (22 to date) so I’m a known quantity on the positive side of the equation, even when I disagree with him. He decided, however, not to publish any comments.  I don’t blame him, really.  But I’d written what I though was a pretty good comment, so I present it here.

Reply to “Trolls:”

It seems counter-intuitive–or just odd, if you like—to comment on this particular post.

The trolls (although I fancy your use of the term “ignoramuses” in a recent post) seem to have three flaws in their character. First, they have no capacity to understand either irony or sarcasm.  Therefore, they won’t understand this comment.  Second, because they think they are completely right, they also believe they are clever enough to slip one of their tirades past your anti-troll sensors…or perhaps they are just oblivious to the fact you can read and recognize their M.O.  Finally, they think they are right, not because they have ever studied economics or whatever else you happen to be writing about, but because they can point to who is wrong.  That’s very important.  They know they are right because they know you are wrong. That’s their rule: you have to be wrong.  About everything, it would seem.

Troll from Harry Potter (c) Warner Bros. Photo: http://www.flixster.com/

That creates an interesting dilemma for the trolls (along with certain pundits, bloggers, etc.).  The problem, of course, is that here we have two diametrically opposed solutions on how to fix the economy. Everybody can’t be right.  Somebody gets to be wrong.  Somebody has to be wrong.

This probably keeps them up at night agonizing over the prospect that they aren’t the ones who are right, even though they believe they must be right, because if they get to be wrong, then you get to be right.  And based on the negative reaction to your recent comments about Texas (from not just the trolls, but pundits and certain economists clinging to failed models), it looks like that their growing sense of anxiety about getting to be wrong escalated into a full-blown panic attack.  They, of course, won’t get that either.

Afterthought: Trolls looked a lot different when I was a kid…

Troll Toy (c) RUSS

Hospital Food for the Mind

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Bernanke, Jackson Hole and the Importance of Being Wrong

And, lo, from the great wilderness, from the antlered gate of the Hole of Jackson, the voice of the Fed, the high priest of the economy, Ben the Reserved has declared what the fortunes of our land shall be; and verily he has declared that it shall be pathetic and the fault of those who…who…who…well, those whose fault it truly is, but now that we are mired in the trap of non-liquidity and are bound ever lower, his hands are tied. And great will be the suffering of all the people. All the people who don’t have a substantial personal fortune, anyway.

I’ve got a question.  How can everybody who declares they have the true answer to our current national economic morass be right? Doesn’t somebody get to be wrong; doesn’t somebody have to be wrong, when opposing theoretical positions and hermeneutical assumptions are irreconcilable? Ben Bernanke, as head of the Federal Reserve doesn’t automatically get to be right about the future of the economy simply by virtue of his office.  Alan Greenspan, his predecessor, is Exhibit #1 for the fallacy of that attribution.

Two Economists Fighting Over Who's Wrong. Photo: Yellowstone National Park

Even a brief foray into the cyberland of pundits, op-ed columnists, and bloggers reveals that every single one of them believes he or she is right about his or her solution to our economic woes.  The reason these folk cite for their veracity is that they can point out who is clearly wrong and therefore is an ignoramus. Only rarely does one find an inspired author who actually is working from a model that has been tested under the withering scrutiny of scholarly review and has been further field tested on the roiling surf of economic reality.

The ultimate test for intellectual honesty would be to have all these very-certain self-proclaimed para-ignoramuses stand under the great antler arch in Jackson Hole, during a wild Wyoming thunderstorm with its hurricane force winds and recite the principles of their economic “truth,” on the superstitious belief that if all they were blowing was just hot air, that would dislodge one of the antlers and…the result wouldn’t be pretty.  That’s certainly much more humane than pseudo-presidential candidate Rick Perry’s lynch mob approach. Of course, he has jumped head-first into the pool of para- ignoramuses who believe they are right because they can point out people who have to be wrong.  Perry evidently has exceptional talent for pointing out who is wrong, along with great hair, but that’s another post.

The World Famous Antler Arch of Jackson Hole, Wyoming. Yes, they are real antlers. I've been there and walked through the arch. Note that I survived. Photo Courtesy: ALifeLessSweet.Blogspot.com

So, who’s going to be wrong? That in my mind is far more important with regard to our pathetic economy than who’s right. To sneakily slip in a biblical allusion, we really need the tares to be winnowed from the wheat.

The facts are that someone is wrong about their economic model/dogma/delusion being the one that will revitalize our economy. They need to either get out of the way or in an act of self-preservation we need nudge them out of the way so the folks with the model that will be guaranteed to work can get their economic engine running in high gear.  That we truly need.

From the pronouncements of Ben the Reserved, it’s increasingly clear that the folks who wrong are getting wronger by the day. After all, the economy stuck in pathetic is just plain wrong.

Detail of Antler Arch, Jackson Hole. Photo Courtesy Jackson Hole Chamber of Commerce

Virtual Deficits in a Virtual Economy

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It seems like a simple enough question: What is money made of?

 

The Spanish "Piece of Eight" 16th-17th Century. World's First Global Currancy. Photo: British Museum, London

The answer, however, is complex, very complex, in fact.  So complex that I am only going to briefly address it.

Money, historically, has been whatever a group of people have decided was an acceptable currency to trade for goods and services.  Here’s the definition from Wikipedia:

Money is any object that is generally accepted as payment for goods and services and repayment of debts in a given country or socio-economic context. The main functions of money are distinguished as: a medium of exchange; a unit of account; a store of value; and, occasionally, a standard of deferred payment.

Money originated as commodity money, but nearly all contemporary money systems are based on fiat money. Fiat money is without intrinsic use value as a physical commodity, and derives its value by being declared by a government to be legal tender; that is, it must be accepted as a form of payment within the boundaries of the country, for “all debts, public and private”.

The money supply of a country consists of currency (banknotes and coins) and demand deposits or ‘bank money’ (the balance held in checking accounts and savings accounts). These demand deposits usually account for a much larger part of the money supply than currency.  Bank money is intangible and exists only in the form of various bank records. Despite being intangible, bank money still performs the basic functions of money, being generally accepted as a form of payment.

500 Mixed Medieval Coins. Offered by Dorchesters.com

So, assuming the definition of money is accurate, that “fiat money” is apparently the “gold standard” (of course, gold is no longer the standard for basing the wealth or value of a country’s economy), is “intangible and exists only in the form of various bank records,” my opening question can again be asked: What is money made of?

The whole question of deficits in the United States budget got me to thinking, money has become virtual.  At least almost virtual, in that now money is dynamic, a form of energy of sorts, that can move as photons through fiber optics or as electrons through a copper line, arranged on silicon microchip, or as a radio wave broadcast to a antenna tower or to a satellite thousands of miles into space and back.  And that leads me to ask another question:

How much is an electron/positron worth?  Or a photon?  Or a radio wave?

Show Me the Money! Graphic Representation of a Photon creating an Electron and a Positron. Image: David Horman

Take a look at what (graphically) is the reality of our money today.  When I get paid, my company transfers my “pay check” to my bank account using electrons, which are stored as organized electrons inside a silicon chip that is connected to other microwires.  When I go to the grocery store or the gas station and enter the code for my debit or credit card organized packets of electrons flow to my account, checks to see that I have sufficient electrons arranged to virtually verify there is enough electronically defined money in my account that it can subtract the correct amount and then add it to the store’s account.

That raises an interesting question.  Is the deficit real or virtual?  Are the words being thrown around that we are trillions of dollars in debt based on reality?  How do we really know what the deficit is, if it exists at all, beyond a vituality that has no tangibility?

As the nation with the largest Gross Domestic Product in the world, what would happen to the country, indeed the world, if we hit the reset button?  And can anyone really prove what would happen?  It’s not like we have to open Fort Knox and hand out gold ingots to all the money we supposedly own ourselves?  Where is it written in stone that we have to pay huge sums in interest on this virtual debt?  And if it is only written by an act of legislation, why can’t it be changed?

Many economists state that we are in a liquidity trap.

In its original conception, a liquidity trap results when demand for money becomes infinitely elastic (i.e. where the demand curve for money is horizontal) so that further injections of money into the economy will not serve to further lower interest rates. Under the narrow version of Keynesian theory in which this arises, it is specified that monetary policy affects the economy only through its effect on interest rates. Thus, if an economy enters a liquidity trap, further increases in the money stock will fail to further lower interest rates and, therefore, fail to stimulate.

Dr. Paul Krugman, Nobel Prize Laureate in Economics, Princeton University professor and New York Times columnist, has stated that inflation targeting as the solution to a liquidity trap, “most nearly approaches the usual goal of modern stabilization policy, which is to provide adequate demand in a clean, unobtrusive way that does not distort the allocation of resources.” (Krugman, 2009).

A second Nobel Laureate in Economics, Joseph Stiglitz (Columbia University), shares Krugman’s perspective :

[G]overnments can improve the outcome by well-chosen interventions. Stiglitz argues that when families and firms seek to buy too little compared to what the economy can produce, governments can fight recessions and depressions by using expansionary monetary and fiscal policies to spur the demand for goods and services. At the microeconomic level, governments can regulate banks and other financial institutions to keep them sound. They can also use tax policy to steer investment into more productive industries and trade policies to allow new industries to mature to the point at which they can survive foreign competition. And governments can use a variety of devices, ranging from job creation to manpower training to welfare assistance, to put unemployed labor back to work and cushion human hardship.

The key issue, in light of our living in an age in which money is virtual, that it is almost a literal description of currency to call it electrons or photons, the rules for how to manage the debt and the interest we pay on it is for all intents and purposes, purely arbitrary.  At the same time, the rules provide a basis for the orderly exchange of goods and services. Despite this need for order, the pressure on the American public continues to grow.

If, for example, Congress decided to decrease the amount of interest we pay on the national deficit by even half a percentage point (it is now approximately 3%) it would pump billions into the economy, freeing up the suppression of demand especially on the middle class.  It would be a de facto tax break that might result in the reduction in the deficit more quickly.

 

Debt as a Percentage of GDP: USA, Japan, Germany. Image Courtesy: Alex1011.

I’m still thinking about this idea and its implications.   It might be unworkable.  It might be conceptually accurate but not possible to implement.  But as you can see from the chart above, the level of public debt as of 2009 stands at about 62-63% of the nation’s GDP.  And though the U.S. has the largest economy in the world with a GDP of $14.26 trillion over three times that of Japan and Germany, that percentage roughly calculates as ≈$8.9 trillion.

CORRECTION to my original conclusion:

As of today, the United States’ national debt is $13,795,134,710,938.49.  The total interest bearing debt for the country in October 2010 is 3.047%.  This interest rate has been falling by a few tenths of a percent year by year.  For instance, the interest in October 2008 was 4.009%, and a year later, 3.362%.  These decreases represent substantial billions of dollars of relief.

Still, the debt itself is a crushing reality.  TreasuryDirect.gov provides an easy to understand explanation of what the debt and deficit are and how they are managed on a year to year basis:

What is the difference between the debt and the deficit?

The deficit is the fiscal year difference between what the United States Government (Government) takes in from taxes and other revenues, called receipts, and the amount of money the Government spends, called outlays. The items included in the deficit are considered either on-budget or off-budget.

You can think of the total debt as accumulated deficits plus accumulated off-budget surpluses. The on-budget deficits require the U.S. Treasury to borrow money to raise cash needed to keep the Government operating. We borrow the money by selling securities like Treasury bills, notes, bonds and savings bonds to the public.

The Treasury securities issued to the public and to the Government Trust Funds (Intragovernmental Holdings) then become part of the total debt. For information about the deficit, visit the Financial Management Service web site to view the Monthly Treasury Statement of Receipts and Outlays of the United States Government (MTS).

The question I ponder is why is the United States budget designed so it is forced to “borrow money to raise cash needed to keep the Government operating”?  In a reality of virtual money, what is the purpose of this system, which from my perspective appears to be at best archaic and at worst  a system of financing to guarantee an eventual national financial implosion?

Is the debt real or virtual?  Is the money we supposedly owe ourselves tangible tender or bank fiat money?  If it is the latter, what is to prevent us from taking a revolutionary step of redesigning what the dollar really is?  As I asked at the beginning, how much is an electron worth?

Watch for more in the coming weeks.

Krugman Verifies the Bungee Cord

I’m sitting in the SFO airport waiting for final leg home from a week in San Diego at the National Disciples Pastors Conference.  Getting caught up on Paul Krugman’s NYT blogs.  Just read this: http://krugman.blogs.nytimes.com/2010/09/22/not-over/.  He uses the same Pollster.com I used in my last post.

Just sayin’.  More when I get home and a good night’s sleep.  Typed this on my Droid, by the way.

Landing the Health Care Reform Bill: It Feels Like Apollo 11 Redux

The voyage of the legislation to create a Health Care Reform Bill has all the

Sen. Harry Reid Launches Health Care Reform in U.S. Senate. Photo credit: C-Span

emotional elements of landing Apollo 11 on the Moon in July 1969.  Health Care reform has been a long, complex mission with an uncertain outcome.  Is it an overstatement to say that landing on the Moon and returning to Earth was an easier and safer endeavor than getting the Health Care Reform Bills passed, conferenced and onto the President’s desk for signature?

At this moment, it seems almost to be the case.

When Neil Armstrong took manual control of the lunar lander to find a safe spot to set down, a thousand different things could have gone wrong.  In fact, alarms were going off in the cockpit.

As the Eagle’s landing radar acquired the surface, several computer error alarms appeared. The first was a code 1202 alarm and even with their extensive training Armstrong or Aldrin were not aware of what this code meant. However, they promptly received word from CAPCOM in Houston that the alarms were not a concern. The 1202 and 1201 alarms were caused by a processing overflow in the lunar module computer. As described by Buzz Aldrin in the documentary In the Shadow of the Moon, the overflow condition was caused by his own counter-checklist choice of leaving the docking radar on during the landing process. Aldrin stated that he did so with the objective of facilitating re-docking with the CM should an abort become necessary, not realizing that it would cause the overflow condition.  Source: Wikipedia

Eagle Lunar Lander just seconds after separation, Apollo 11, July 1969, Photo: NASA

It’s one thing to read about it.  As we close this 40th Anniversary of the Apollo 11 Landing, it really is much more satisfying to watch it.  This video is one continuous shot of approximately the final 10 minutes of the descent and landing, viewed from the right window of the LEM.  The audio is quite good, as well.  Watching it still stirs in me that sense of excitement I felt as a 16 year old kid glued to the TV set with my family.

[For a similar, but NASA produced video, click HERE.  This is the final approach, and included is an inset window that tracks the Lander’s progress crater by crater.  It provides a sense of perspective for the approach.]

Regarding the impending passage of the Senate bill and then the conference process, if you tend more toward the pessimistic side, you probably agree with Jonathan Cohn of The New Republic:

If your standard for comparison is your ideal health care reform, then of course this will be disappointing. Like every bill that’s moved through Congress, this one would leave millions uninsured even after full implementation–and leave millions with coverage facing substantial, although generally not crippling, financial burdens. It would introduce some reforms to the delivery system and, according to the official cost estimates, generate budget surpluses over time. But it’s not going to radically turn American health care into a paragon of cost efficiency.

If you tend more to the optimistic side, you probably agree with Paul Krugman of The New York Times:

Let me say that I get especially, um, annoyed at people who say that the plan isn’t really covering the uninsured, it’s just forcing them to buy insurance. That’s missing not just the community rating aspect, but even more important, it’s missing the subsidies. And we’re talking about big stuff: between Medicaid expansion and further support for families above the poverty line, we’re looking at around $200 billion a year a decade from now. Yes, a fraction of that will go to insurance industry profits. But the great bulk will go to making health care affordable.

So how anyone can call a plan to spend $200 billion a year on Americans in need a defeat for progressives is a mystery.

I wish there were a public option in there; I wish there were broader access to the exchanges; I wish the subsidies were even bigger. There’s lots of work to be done, work that may eventually culminate in a true, not simulated, single payer system. But even in this form, we’re looking at something that will make America a more just, more secure nation.

If you are a Republican or Tea Party Advocate, you are most likely hoping and praying the Health Care Reform bill will suffer the fate of the Soviet Luna 15 Lunar Lander Probe that was launched three days before Apollo 11:

Luna 15, launched only three days before the historic Apollo 11 mission to the Moon, was the third Soviet attempt to recover and bring lunar soil back to Earth. The spacecraft was capable of studying circumlunar space, the lunar gravitational field, and the chemical composition of lunar rocks… After completing 86 communications sessions and 52 orbits of the Moon at various inclinations and altitudes it began its descent. Astronauts Armstrong and Aldrin had already set foot on the Moon when Luna 15 fired its main retrorocket engine to initiate descent to the surface at 15:47 UT on 21 July 1969. Unfortunately, transmissions ceased only 4 minutes after deorbit at a calculated altitude of 3 kilometers. The spacecraft impacted the lunar surface on July 21, 1969. The spacecraft had probably crashed onto the side of a mountain.   Source: Wikipedia.

Launched 3 days before Apollo 11, the USSR's unmanned Luna 15 crashed onto the Moon's surface just hours after the Eagle had safely landed with Armstrong & Aldrin on board.

I’ll give House Minority Leader, Rep. John Boehner (R-OH) the final word…

Photo courtesy Politico.com & BlueStateDigital.com

No, I think I’ll give this Tea Party protester the final word.  Just like the rest of us loyal and patriotic Amurricans, life without spell-check is worse than…oh, wait, he spelled the word right.  In high school he clearly decided to protest which sections of Mrs. Dewey’s English classes were not patriotic enough, because he was getting this way-too-liberal education paid for through public taxation.  And those unacceptable sections happened to include homonyms and writing complete sentences.  I think his pointy hat needs to be cone not a tri-corner.

A Tea Party Protester: The Epitome of the Well-Educated American. Photo: ImageShack

Granny’s Safe UPDATED: Rebutting the “They’re Killing Granny” Lie by Health Care Reform Opponents

Me, Uncharacteristically Pertrubed

Me, Uncharacteristically Perturbed

Now, they’ve gone and done it.  I’m perturbed!

One of the provisions in the health care reform bills being worked on in both the House and the Senate is an incentive, to be paid by Medicare, for doctors and other providers to have a conversation every five years with aging patients regarding what they want for end of life care.  That’s the true part.  I discuss that below in detail.

UPDATE:  Oregon  congressman Earl Blumenauer (D-Dist 3) is the author of this section of the legislation. He states that he has been so frustrated by the Republicans’ distortions and lies of what he wrote that he has developed a Myth versus Fact Sheet that can be read by clicking hereRep Blumenauer wrote in his blog:

Those with no solutions and no answers for how to reform our health care system are hijacking positive, bipartisan efforts that have contributed to a strong bill passed out of two House committees. Republican leadership has abandoned all efforts at passing needed health care reform — even turning their attacks to legislation that has been actively crafted and supported by both parties.

One of these outrageous examples is my Life Sustaining Treatment Preferences Act.

GOP leadership has been gravely distorting the truth and misrepresenting the facts about this bipartisan effort, and in the process throwing members of their own party under the bus — those who have reached across the aisle to do something that will help Americans across the nation.

The bill simply provides people with better care as they grapple with the hardest health care issue of all — their final chapter of life. See the Myths vs. Facts sheet on this. CNN reporter Elizabeth Landau does a great job highlighting the benefits of “doctors and family members having more conversations about end-of-life issues,” which my bill addresses.

This bill has bipartisan support (the main cosponsor is a Republican doctor) as well as support from a diverse coalition like AARP, the American College of Physicians, and Catholic health systems. It is an area where — no matter from a red or blue state — many have been able to bridge the divide.

The bottom line: this is a smart and just thing to do for families going through a tough time.

Indeed, it is a smart and just thing to do.  Americans are known to be among the greatest death-deniers in the world.  This is very well documented.  Physicians, as  a profession are generally not trained in medical school to talk about dying with their patients, and the cultural norm “I’m going to live forever!” is especially deeply held by our doctors.  This, too is very well documented. (One exception I have knowledge of is at Oregon Health and Science University in Portland, where medical residents are trained how to talk to patients about end of life issues.  I have seen their video and am well acquainted with the faculty of the Center for Ethics in Health Care.)

But those who are opposed to health care reform are using our fears about death and distorting them into a malicious fallacy about the legislation’s impact on our lives.  One provision is for providers to have a discussion about end of life care with her or his patients.  As I explain below, this conversation is taking place every day thousands of times.  But for the opponents, it’s another item on their list to distort and spread fear to preserve the status quo, mainly their profit margain.

As Charles Blow, New York Times columnist, stated in his latest piece, “Health Care Hullabaloo:”

I must say that this says more about them than it does about any forthcoming legislation. Belligerence is the currency of the intellectually bankrupt [emphasis added].

Trapped in their vacuum of ideas, too many Republicans continue to display an astounding ability to believe utter nonsense, even when faced with facts that contradict it.

This scare tactic is becoming ubiquitous, as expressed by a woman at a Raleigh, NC town hall meeting with President Obama, reported by ABC News reporter, Jake Tapper:

At the AARP town hall meeting last week, a woman named Mary told the president that “I have been told there is a clause in there that everyone that’s Medicare age will be visited and told to decide how they wish to die. This bothers me greatly and I’d like for you to promise me that this is not in this bill.”

“You know, I guarantee you, first of all, we just don’t have enough government workers to send to talk to everybody, to find out how they want to die,” the president said. “I think that the only thing that may have been proposed in some of the bills — and I actually think this is a good thing — is that it makes it easier for people to fill out a living will.”

After explaining what a living will is, and that he and his wife each have one, the president said, “I think the idea there is to simply make sure that a living will process is easier for people — it doesn’t require you to hire a lawyer or to take up a lot of time. But everything is going to be up to you. And if you don’t want to fill out a living will, you don’t have to…But, Mary, I just want to be clear: Nobody is going to be knocking on your door; nobody is going to be telling you you’ve got to fill one out. And certainly nobody is going to be forcing you to make a set of decisions on end-of-life care based on some bureaucratic law in Washington.”

Check out the AARP’s Myths vs Facts site here.

Here’s the text (authored by Rep. Blumenauer) of the proposed “Americans Health Care Choices Act of 2009”  (beginning on page 425), the House version, regarding advanced planning:

‘‘(hhh)(1) Subject to paragraphs (3) and (4), the

term ‘advance care planning consultation’ means a consultation

between the individual and a practitioner described

in paragraph (2) regarding advance care planning,

if, subject to paragraph (3), the individual involved has

not had such a consultation within the last 5 years. Such

consultation shall include the following:

‘‘(A) An explanation by the practitioner of advance

care planning, including key questions and

considerations, important steps, and suggested people to talk to.

‘‘(B) An explanation by the practitioner of advance

directives, including living wills and durable

powers of attorney, and their uses.

‘‘(C) An explanation by the practitioner of the

role and responsibilities of a health care proxy.

‘‘(D) The provision by the practitioner of a list

of national and State-specific resources to assist consumers

and their families with advance care planning, including the national

toll-free hotline, the advance

care planning clearinghouses, and State legal

service organizations (including those funded

through the Older Americans Act of 1965).

‘‘(E) An explanation by the practitioner of the

continuum of end-of-life services and supports available,

including palliative care and hospice, and benefits

for such services and supports that are available

under this title.

What got me thinking about this post was this comment by the New York Times columnist, economist Paul Krugman.  In a posting to his blog titled “Even-handedness,” he wrote:

AP: FACT CHECK: Distortions rife in health care debate:

Opponents of proposals by President Barack Obama and congressional Democrats falsely claim that government agents will force elderly people to discuss end-of-life wishes. Obama has played down the possibility that a health care overhaul would cause large numbers of people to change doctors and insurers.

So Republicans are claiming that Obama will kill old people. . .

Having just watched Bill Moyers on his PBS program interview Wendall Potter, former CIGNA executive who just testified before congress on the unconscionable tactics being regularly and deliberately used by insurance companies to deny coverage their insureds have rightfully paid for, but will dent the companies’ profits, and how they are in an all-out campaign to destroy health care reform while duplicitously endorsing it, I wrote a comment on Krugman’s blog.

Well, this time he didn’t publish it (however he had recently published my comments on 1 August 2009: “Health Reform Made Simple.“).  I, however, back up all my comments on various blogs.  Here, then, is what I wrote:

The “They’re Killing Granny” Fallacy:

For over a decade, as a hospital chaplain, I have helped hundreds of Grannies complete their Advance Directives.  Often the doctor requests this conversation take place, because Granny has a medical condition that is approaching end-stage, or is already there.  The ideal is that Granny and her physician have already had a conversation about her declining health. The Advance Directive is one tool for her to use to determine the kind of medical care she wants OR doesn’t want IF she can no longer communicate her wishes about treatment.

The purpose of the provision in the bills is to provide an incentive to medical providers to talk with Granny regarding the choice of care she wants at the end of her life.  Why?  Because Americans are the worst death-deniers in the world.  We’ll do just about anything to avoid talking about dying and death.  And physicians are just as bad as the rest of us.

Let me repeat the purpose of the provision: The Doctor talks to Granny so she has a choice to decide what she wants.  The conversation is a huge benefit not only to Granny, so she can make her wishes known, but also to remove the burden from her loved ones of having to guess about the kind of medical care she wants IF she is dying and cannot communicate by any means.

Generally, the types of extraordinary treatments being considered are:

1. Being placed on a ventilator to support breathing.

2. Being fed through a tube.

3. Being provided medications or procedures that are specifically designed to cure the disease, or to artificially prolong the person’s life.

Here are the facts (and I’m assuming most other states are very similar to mine):

1.  Any person over the age of 18 can complete an Advance Directive.  It does NOT require being notarized, it does NOT require your doctor’s signature, and it does NOT require going to an attorney and paying a fee to fill out the form.  You can download your state’s form online, or pick up a free copy at a local doctor’s office, hospital, or public health office.  Be sure to give a copy to your doctor and to take it with you to the hospital if you have a procedure (my hospital will accept a mailed Advance Directive at no charge, even if the person has never been one of our patients).

2.  The purpose of the Advance Directive is to allow Granny to decide in advance if she wants to have extraordinary medical measures should she be clinically assessed as being in the process of dying AND unable to communicate her wishes by any means.

3. Granny in her Advance Directive can choose to have everything from no extraordinary measures to all extraordinary measures.  If Granny chooses not to have extraordinary measures, she will still receive full palliative care measures to keep her comfortable, clean, and to die as peacefully as possible.  Granny, hopefully, will have access to hospice to provide this care; it is already paid for by Medicare.

4.  Granny has the choice of appointing a Health Care Representative (usually a family member or very close friend) to be her “health care power of attorney” to speak on her behalf if she is too ill to communicate (but perhaps is not in a terminal condition), or to consult with her physician if she is in the process of dying.

5. Here are some of the key rules:

a.  Granny has the  right to decline to talk about her end of life with her provider.

b.  Granny has the right to decline to fill out an Advance Directive.

c. Granny must be mentally clear (alert and oriented to time, place, and self) to fill out the Advance Directive.  If Granny is suffering from dementia, or is confused or delirious due to some medical cause, she is not considered competent (at least in my state) to fill out the Advance Directive at that time.  If she clears mentally later, she may can complete the document.  If Granny’s condition is diagnosed as permanent (such as advanced Alzheimer’s), then the family may need to consider a guardianship, but that is another topic.

d. Granny’s doctor, or if she is in a facility, a facility employee, CANNOT be her Health Care Representative, to prevent any conflict of interest in determining her treatment.

Being at the bedside of a critically ill patient, likely to die, and supporting the family through the decision-making process of what to do, when Granny never talked about it is agonizing for everyone.  One conversation would have spared all concerned the pain of indecision and second-guessing.

The AARP states,

Bottom Line: Health care reform isn’t about putting the government in charge of difficult end of life decisions. It’s about giving individuals and families the option to talk with their doctors in advance about difficult choices every family faces when loved ones near the end of their lives.

That is compassionate health care.  It is no slippery slope toward euthanasia, and it is not killing Granny.  It is, however, a provision (already in place in many places around the country), to ensure that the majority of America’s Grannies, truly die in peace and dignity.

A Caveat: Yes, I live in Oregon, which has the ignominious distinction of being the first state in the country to permit suicide with the assistance of a physician.  I personally oppose the legalization of suicide by this means (or any other, for that matter).  My hospital, being a Catholic institution,  does not encourage or participate in assisting terminal patients to commit suicide.  But that is a topic, perhaps, for another blog in the future.

The moment Sen. McConnell and Rep. Boehner realize the "They're killing Granny" distortion has seriously backfired.  Photo: Life Magazine Archives

The moment Sen. McConnell and Rep. Boehner realize the "They're killing Granny" distortion has seriously backfired. Photo: Life Magazine Archives

They Judge Themselves

This level of greed and deceit is by no means new.  The actions of insurance company executives, strategists, and lobbyists, as well as the politicians who parrot their lies are condemned in this passage from the Book of Proverbs in the Bible:

A scoundrel and a villain, who goes about with a corrupt mouth, who winks with his eye, and signals with his feet and motions with his fingers, who plots evil with deceit in his heart–he always stirs up dissension.

Therefore disaster will overtake him in an instant: he will suddenly be destroyed–without remedy.

There are six things that the LORD hates, seven that are detestable to him:

  1. haughty eyes
  2. a lying tongue
  3. hands that shed innocent blood
  4. a heart that devises wicked schemes
  5. feet that are quick to to rush into evil
  6. a false witness who pours out lies
  7. and a man who stirs up dissension among [others].

Proverbs 6:12-19, NIV

In the article about the Seven Deadly Sins, regarding greed/avarice, Wikipedia writes:

In Dante’s Purgatory, the penitents were bound and laid face down on the ground for having concentrated too much on earthly thoughts.

“Avarice” is more of a blanket term that can describe many other examples of greedy behavior. These include disloyalty, deliberate betrayal, or treason, especially for personal gain, for example through bribery .

Take a look again at the section of the bill I quoted.  Read it over several times if you like.  Do you honestly see anything that even hints that the purpose or outcome of that provision will endanger Granny?

Granny is going to be so much better cared for under the new legislation.  Those who oppose health care reform and are lying to get it defeated are the ones who need to be worried.  Very worried.

Greed & Avarice.  Dante's Fourth Level of Hell.  Wood-cut Print, 1476

Greed & Avarice. The sixth of the Seven Deadly Sins. In this depiction, the damned are being boiled in oil. This image appeared in 1496 in Le grant kalendrier des Bergiers, published by Nicolas le Rouge in Troyes, France

I should say in conclusion that both my wife and I have advance directives.  So does my mom, the best grandma in our arm of the galaxy.

The Myth of the Free Market Health Care Reform

I offer my readers two examples of why the “free market” system alone is systemically incapable of creating or sustaining any semblance of real health care reform:

  1. The free market requires that any product related to health care for real human beings actually is designed to make a profit for the owners/shareholders of that business.
  2. The free market requires that any product related to health care for real human beings actually is designed to make a profit for the owners/shareholders of that business.

That is not a typo.

“Hunter,” one of the contributors to the Daily Kos, wrote a letter to the President making his case for free market health care.  Here are his concluding paragraphs:

So, Mr. President, I write to you with this demand: we are not a socialist country, one which believes the health of its citizens should come without the proper profit-loss determinations. I believe that my healthcare decisions should be between me, my insurance company plan, my insurance company’s list of approved doctors I am allowed to see and treatments I am allowed to get, my insurance company’s claims department, the insurance company doctors who have never met me, spoken to me or even personally looked at my files, my own preexisting conditions, my insurance company’s crack cost-review and retroactive cancellation and denial squads, my insurance company’s executives and board of directors, my insurance company’s profit requirements, the shareholders, my employer, and my doctor.

Anything else would be insulting.

Hunter didn’t make this up.  This is, indeed, the reality of health care in the free market.  I urge you to read the complete letter.  You’ll love the part about the gold-plated utensils and its vital relationship to your health care dollar.

Paul Krugman, Nobel-winning economist and New York Times columnist, however, just puts the nails in the free market myth coffin:

There are, however, no examples of successful health care based on the principles of the free market, for one simple reason: in health care, the free market just doesn’t work. And people who say that the market is the answer are flying in the face of both theory and overwhelming evidence.

I urge you to read the complete post from Dr. Krugman’s blog.

It really comes down to this.  If you are chuckling, you understand that health care reform is about real people needing real medical care when they need it, without the cost or lack of access costing them their lives or livelihoods.

If you are experiencing blustery consternation and wanting to call me a socialist, communist, or worse (none of which apply, because I am a dyed-in-the-wool capitalist), you need to make a decision.  Do you want to live in a country that is healthy and prosperous because health care is delivered through a collaboration of the government, mission-driven non-profit organizations and private enterprise, or…

Well, do you want to or not?  The myth that free market health care reform will be achieved is dead.  As Paul Krugman points out there are many things the free market can do very well.  Health care is not on that list.

I care enough about you as a person and as an American to support a portion of my taxes being spent to ensure you can get the medical care you need when you need it, because I know in the long run we will be better off–you, me, and 300 million of our fellow Americans.