"That’s how you get to Yglesias Land, where there is no problem markets can’t fix, and if markets can’t fix a problem, we’re not allowed to call it a problem at all."
This is a remarkably uncharitable/inaccurate description of Yglesias's position on e.g. government intervention/redistribution. He regularly defends the present welfare state and increased assistance to the disadvantaged.
Not everyone who recognizes the efficacy of markets becomes a libertarian. (Even if they should.)
As a right-neoliberal/state-capacity libertarian regularly annoyed by when left-neoliberal Yglesias (or e.g. Noah Smith) does not favor limited government and market mechanisms, I assure you that you are wrong.
You could choose to accurately represent your ideological foes without grouping us all into one rightwing camp.
You can still criticize him for e.g. supporting and defending Obamacare (hardly a libertarian's dream piece of legislation). You don't need to exaggerate his copiously documented position on healthcare policy.
My opinion of Yglesias has been lowering rather sharply over the last couple of years, but this nonetheless seems to misrepresent his position rather severely.
There are many people out there who would cheerfully argue that markets can fix anything that is an actual problem. Yglesias, for all his faults, isn't one of them. Unless I missed a *very* recent and surprising conversion?
I think zero libertarians would consider Yglesias a libertarian--he's a mostly pro-free-market Democrat who also supports social programs and regulations and such.
For the record I am a conservative who believed Daniel Penny was innocent of the crimes he was charged with - and deeply sympathize with Jordan Neely for all the points you mention, Freddie.
Not all of us are quite the moral cretins you imagine us to be.
Have you ever been in a chokehold that is actively applied? (If it's not being actively applied, then it's effectively a headlock.)
"While the time it takes for the choke to render an opponent unconscious varies depending on the type of choke, the average across all has been recorded as 9 seconds."
Come on Machete. If he was strong enough to hold onto him tightly enough to render him unconscious, he could have held onto him in a NON-chokehold for long enough for the authorities to arrive (and likely kill him anyway).
Were you in the jury deliberation room? And besides, that's not how "beyond reasonable doubt" works when the evidentiary process is highly circumscribed. Are you saying that Penny or his legal team testified that he *WASN'T* intentionally applying a *CHOKE* hold as opposed to another, more rote, means of restraint?
A few months ago, a homeless guy wandered into the social center I volunteer at and began acting agitated. After we tolerated him for a few minutes, he tried flashing us.
The center was filled with about five or six little girls, aged 6-12; I misremember the exact number. Ordinarily when a crazy homeless guy starts acting up, I feel free to simply walk away to avoid a confrontation. I did not feel I had that option that time.
One of the women who volunteer there (not the ma to any of the kids there, but still a ma) started screaming at him to fuck off. He screamed back, they went at it for a while.
I decided I was willing to take out my work knife and stab him if he escalated. I hoped he wouldn't, if only to avoid having to speak to cops that day. Until he chose to escalate, I was just gonna sit quietly and watch. I didn't want to get loud and set him off.
Eventually he left and we got to breathe easier.
I don't really care about the details of what counts as a chokehold and when the time of death was. It's irrelevant. If you live in a rough area where bad things happen to people, sufficient provocation provokes a violent response. Don't provoke things if you don't want bad things to happen, and if you can't turn it off, c'est la vie. Blame those who put Neely there, not the guy who had to decide what to do about a violent person mere feet away who will not deescalate.
Not untrue, which means the system that refuses to restrain him until he had functional possession of his self again needs to think about what they’re throwing out into the world.
It does not mean “do nothing when the full grown man with no self-control and his cock out approaches the little girl.”
Who argued "do nothing"? I argued that we still face a moral responsibility when we are confronted with someone dangerous but so ill that they don't and can't act as a responsible agent. Whereas you took the position that anyone who makes someone feel "provoked" has forfeited their right not to be harmed or killed.
There is a critical difference between the failure of the system and the murder of the mentally ill person. The first does not immunize the second. Violent and maybe even lethal force may be justified, but the moral responsibility doesn't vanish, no matter who or what failed before the moment of threat.
The words "mental illness" do not absolve someone of being a danger to others. No being chooses to contract rabies, and no being chooses to be dangerously psychotic. We still have a moral right and duty to defend ourselves from them.
In a broken system sometimes there are no good choices. Sometimes someone has to choose between the safety of one pseudo-sympathetic homeless guy who can’t really be held accountable for his actions and the women and children he’s assaulting. Only a fucking moron, like you!, would dare to assert superiority over someone who acted to intervene. You are a pampered sneering child and of all the people in this scenario YOU are the only one I hate. And I want you to know, I do really, really hate you.
Real great civility you’re demonstrating here. I’m sure this sort of rhetoric convinced people of shit all the time, rather than just assuring that your political opponents never even consider what you have to say.
Leaving violent mentally ill people on the streets is a policy choice. This also involves leaving subduing those violent mentally ill people to random citizens rather than professionals with the right training and equipment to mostly avoid killing them, so either the random citizens get hurt or killed or the violent mentally ill people do.
Neely should not have been on the subway terrorizing the other riders, and leaving Penny to try to subdue him, or leaving Neely to beat some old lady senseless because nobody was willing to try, are both downstream of that decision.
It’s pernicious dogmatists and myopic parrots who care the most about details irrelevant to (or intentionally derailing from) the topic of conversation at hand, as evinced by select individuals in this comment thread.
The name of that hold is the "rear naked choke," but if you loosen it so it's not literally choking the person, then it doesn't choke the subject.
It takes about 20 seconds to render someone unconscious if the hold is literally choking the subject, so it's safe to conclude that Penny wasn't choking Neely for the first four minutes and thirty seconds or so. Penny himself thought that Neely was alive during the on-site interview with the cops and during his interview at the police station, so Penny at least didn't think he was choking Neely.
It's definitely possible that near the end of the struggle. that hold started choking Neely and that's what killed him, and it's possible that he just died from the stress of the struggle.
I don't know if "sympathize" is the right word, but I don't think many conservative people are contemptuous of Neely.
I do think that ultimately, you either prioritize sympathy for Neely or sympathy for the community forced to cope with the government's lack of will in protecting him and thus inflicting him on everyone else.
I've seen a fair bit of genuinely creepy contempt for Neely. And the people spewing it certainly seemed conservative. Freddie was right to call them moral lepers.
This was mostly on Quora, though, and for some reason that site attracts bad apples.
I honestly don't see how anyone can say "well, I've seen a lot of people say so on Quora" as some sort of rebuttal to, well, anything other than the claim "Quora is a wellspring of good will and positivity towards all humans."
I don't recall saying that it did and, as I refresh my memory by reading my comment, am now confident in my recollection that I made no such assertion.
I think it should be clear the way "I've seen a bunch of conservatives do it" rebuts "I don't think many conservatives do that". Obviously anecdotes aren't everything, but they aren't nothing either.
And it wasn't only on Quora, though that was where I saw the most and worst.
Yes, the problem is that "a lot of people say so on Quora" is *not* semantically in the same ball park as "I've seen a bunch of conservatives do it". In fact, "I've seen a bunch of conservatives online in a huge range of social media outlets from Twitter to National Review to The Dispatch to the Wall Street Journal say so" wouldn't be "I've seen a bunch of conservatives do it", although it wouldn't give as much rise to mockery.
When I said "I don't think many conservative people are contemptuous of Neely" I was drawing from the whole American world, not a tiny space known as the world wide web.
"How is that in your best interest, to preemptively reject a vast majority of potential customers? Because by taking only patients who can pay cash, you eliminate all of the actually-hard cases. You sidestep the fundamental work of psychiatry, juke the real labor."
I never thought of it this way. Indeed, I'm even worse, because I'm not a psychiatrist at all.
Almost all of us juke the real work of doing unpleasant labor to care for the least among us. That goes for me, and it certainly goes for Substack writers. This seems like an issue where it's better to praise those who go above and beyond, rather than castigate those who don't but are still making a useful contribution.
You think, what, there's a Substack Medicaid program and I'm refusing to take their insurance coverage? If I was profit maximizing, do you think I'd be charging literally the minimum amount Substack will allow?
I think you're not even in the game of using your labor to care for those who suffer from illness. So why throw stones at those who are at least doing something about the problem, even if they're not doing it in the most self-sacrificing way possible?
Especially because the doctors you're attacking are in fact making a contribution, on the margin, to the care available to the less fortunate, by reducing the workload of those who take do take Medicaid.
Look: Freddie goes overboard in this article. I agree. But the “well if it’s so important to you why don’t YOU become a psychiatrist/army sergeant/insurance CEO” argument isn’t tenable. It means that nobody is allowed to criticize anything outside of their extremely narrow employment.
That's not the argument, although I can see how it looks that way. The point is that most people, Freddie and myself included, are not taking on as much hardship or making as much of a contribution to the common good as the doctors he's talking about. So we should empathize with these doctors rather than being judgey.
He should reserve his condemnation for those who are making less of a contribution than most other working people (like Luddite union dock-workers, for example).
By that logic there is only a small top-tier of actors who are in a position to lodge a moral criticism; the other 95% of us much shut our mouths because we have not earned the right to point to anyone's immoral acts or choices.
I think it is much more coherent to say that people are fair game for criticism based on what they do after they enter a particular field of action.
I choose to be a university professor. Having done that, it would be morally wrong for me to caustically lambast one of my students to their face by calling them a "moral cretin"–– even though I might applaud the same insult in a different context (like, say, the charge that Boer levels against those conservatives who so often behave as "moral cretins")
Psychiatrists are just as fair game for moral criticism. They chose to go into that field and to earn a living by treating the mentally ill people who need their expertise. You can't criticize anyone who takes enough paying patients pay their bills, but you can certainly criticize someone who refuses to treat anyone with Medicaid so they can maximize their profits.
So if somebody chooses to work for a tobacco company or an online casino, but they do it with as much honor as possible given their choice of occupation, you can't criticize them?
You can criticize people who are making more of a contribution, you just can't criticize them *for not making enough of a contribution* if they're making more of a contribution than most other people who you don't have a problem with. (Also if you think nobody is doing good enough, then criticize away, but I'm sure Freddie wouldn't criticize a dock worker.)
I didn’t interpret the final paragraph as saying “the problem is the moral character of psychiatrists.” People are people. The problem is the system of incentives that leads to this outcome. One issue is the sheer lack of practitioners. It takes over a decade to become a psychiatrist. There are also caps on the number of seats in med school and residency. Right now, I think the hypothetical risk of graduating a mediocre psychiatrist is much lower than the very real problem of having far too few.
I don't know wether you're american or not, but you're missing a key piece of context--psychiatrists caused the lack of psychiatrists. The AMA controls accreditation and admissions standards for medical schools in this country, and they use that power to ensure that there are many, many fewer doctors per capita here than essentially anywhere else in the developed world. You're seeing two separate problems where there is only one.
Yes, the AMA lobbies extremely hard for the artificial shortage. But ultimately, the state makes the rules. And “convince legislators to deregulate” is a more realistic lever to pull on than “convince a labor union to lobby in favor of a paycut for its members.”
"What most people are saying, in the realm of politics, is that a broken and cruel medical system is going to make people do crazy things"
In a scene from the series Lioness (another great Taylor Sheridan production) the husband of the main character that is a surgeon tells the parents of the patient, a 9 year old girl, that her brain tumor is inoperable and that she has six months. The father punches the doctor and has to be pulled off in his rage trying to hit the doctor again.
The point here is that assessment of health care access, quality and effectiveness is fraught with high emotional turmoil that can cause the customers of healthcare to lose objectivity and chase fantasy rainbows of something better that does not exist, or that lacks intellectual honesty about tradeoffs.
The reports of the healthcare CEO murderer are that he had severe back pain problems. Having had similar problems in the past, I know that chronic pain can mess with mental and emotional health.
But the bottom line, it is despicable to leverage this murder in any way to push the fantasy dream of government-run healthcare.
Is it "despicable" to write the sentence you quote at the beginning of the post?
Is your argument that, yes, this is a broken and cruel medical system, but no one should speak about its cruelty and brokenness in the wake of this murder? Why not?
Wanting to have a system where the massive profits now going to individuals actually go to providing care to people––wanting a system that less cruel and lethal––is not a "fantasy" of weak minds. Resources are finite and medical care has limits; there is no utopia where a healthcare system can heal everyone. But it's empirically true that an alternative system could deliver more and better care and save many more lives. The rage that has emerged is not just an irrational outburst by people who can't accept reality.
My second-order anger is that collectively we haven't demanded a better alternative.
If I snap and shoot somebody because lizard people are controlling the government that doesn't actually mean that lizard people exist.
If you say "Mangione is crazy" for pulling out a gun then doesn't the crazy/irrational part also extend to his judgement/perspective about the health care system as well? Irrational in one but not irrational in the other?
But DeBoer (and anyone else, like me) doesn't need to reason backwards from Mangione's crazy action to come to the conclusion that the healthcare system is immoral and effed-up.
If you already independently see/believe that that this is an profoundly immoral system, then you can look at what Mangione did and say "lock him up" while still saying that a crazy murderer also correctly perceived the immorality of our system.
Just as I correctly perceive the problems with a world government run by lizard people?
"This insane person decided to kill somebody. Seems like a good jumping off point to examine whatever obsession he had."
If the health care system has problems then they exist regardless of the actions of crazed assassins. Flogging a narrative that "He was crazy but..." just reeks of opportunism and lazy thinking.
"Just as I correctly perceive the problems with a world government run by lizard people?"
If you perceive that, then you are bad at understanding reality and the rest of us have no obligation to give it credence. This hypothetical is applicable *only* if the reality of lizard people can be derived from actions like Mangione's. But his acts are irrelevant. There is a whole world of rational reflection––facts, logical reasoning, precedents––that can support one's opinion about the US healthcare system.
Reasonable people can come to different conclusions, but the mind of someone like Mangione is not dispositive one way or the other. For those who independently see the system as cruel and immoral, Mangione is going to look like a person who saw that reality but then took an immoral and indefensible action.
"If the health care system has problems then they exist regardless of the actions of crazed assassins."
Uh, exactly right––that's been my point. For everyone who sees those problems are real problems, it is totally coherent to say "he was criminal and irrational when he murdered the CEO but he correctly perceived what I rationally perceive."
I was referring to your comment about lizard people. Your statement basically says nothing about the existence of lizard people, which I assumed was your point.
My point is that there are plenty of people right now that are happy to say that Mangione was crazy when he picked up a gun but not crazy when he acquired his grudge against the health care system.
Does that really make sense? Crazy people are crazy. Consistency would suggest that his mental health affected not only the act but the motivations and reasoning behind the act.
If anything wouldn't it make more that people would conclude "This crazy person has a problem with the system, so that means that only crazy people disagree with the status quo"?
"Is your argument that, yes, this is a broken and cruel medical system, but no one should speak about its cruelty and brokenness in the wake of this murder? Why not?"
Because then it would justify the murder of Nancy Pelosi to bring attention to political graft that is insider trading.
It would justify murder of anyone to get national attention for a favored cause.
Like standing at the podium at the memorial of your cousin that died of complications from obesity and diabetes to rage against fast food.
Timing is everything.
Before Obamacare was passed, 74% of Republicans and 55% of Democrats said that healthcare was excellent or good. Today the polling is 42% Republicans and 50% Democrat. So Obamacare as we expected is a step toward government run healthcare and what did it get us? A crash in general satisfaction including that of Democrats that demanded Obamacare.
So this is another reason to lambast those that fuck with the timing and leverage a terrible act to push their agenda... making policy decisions based on the heat of emotion from a terrible act or even a terrible tragedy is one fraught with the risk of making big ass mistakes.
I don't see DeBoer making any justificatory argument like that in his post. He didn't say that he (or other critics of US healthcare) believes the murder was morally justified. And he expressly said it *wasn't* political effective––so therefore could not even be justified as a means to an end.
As I read it, he just make an observation (what "is" and not what "ought to be): this is an effed-up system that is prompting crazy actions––actions that resonate with (not crazy) feelings in a huge number of people.
To make that observation in no way gives a thumbs up to any violence or criminal actions.
If a terrorist blows up a Jewish school and kills a bunch of Jewish school children to get attention for say the Palestinian cause, anyone writing "terrorism is terrible, but you can understand why those Palestinians are angry since their children are being killed by Israel" is in fact aiding the terrorist.
Now a few months later when the news of the school children slaughter is over, it is fine to bring up the topic again.
I think I see your point. But it doesn't seem feasible to me to make the political meaning of a statement contingent on the timing of when you say it.
If I condemn the murder of Jewish children but still bring up a relevant context (i.e. Palestinian militants have killed Jewish children, but to have grounds to condemn them we must also condemn Israeli soldiers who kill Palestinian children), I don't see any logical reason why doing so "aids" the Palestinian militants.
And even more so, I don't see how stating such facts in one moment stating aids terrorists while stating them in a later moment no longer aids any terrorists.
Terrorists do their terrorism to gain attention to their cause... to get the emotional reaction in the media that otherwise was not paying attention.
If you comply you are aiding and abetting the terrorists.
There were some idiot leftists in academia that wrote sympathetic pieces over the 9-11 terrorists... and they lost their careers. That is an appropriate response. At some time in the future, is is fine to speak freely spewing America-hate points... but NOT when the terrorism is still percolating in the minds and hearts of the nation.
In democracy there is a method to solve problems through the political process. Just because those angry and upset about some situation are too lazy to try and solve the problem through the political process is no excuse for them exploiting the acts of terrorists to jump on their activist bullhorn.
I don’t see how the last paragraph at all follows from the first few. We should do what we need to do to achieve our policy goals. Do you think conservatives pull punches in political fights because they think it would be “despicable”? No. They get out there and they do what needs to be done to win.
That’s why they win elections and we don’t. They don’t care about being morally cure. They care about winning.
Freddie, I agree with you about the American healthcare system. I have privileged healthcare and the inequality between what I have and what most have is barbaric. We know this because every other wealthy country does provide healthcare as a right. I wrote a post about it last week.I will DM it to you in case you want to read it.
For a long time I had a knee jerk negative reaction to healthcare as a right because I thought it would lower the quality of my privileged healthcare. My eyes have been opened. But the same people who make decisions about healthcare in America are also the people who have the privilege and are afraid that healthcare as a right means they will lose out.
You make a great point about mental health professionals.
"Every other wealthy country does provide healthcare as a right"
No they don't; they make soothing mouth-noises about rights, and then when it comes time to actually see a doctor and get care, they shove you in waiting lines months or years long, decline to authorize (that's just a fancy way of saying "deny") expensive or experimental treatments they don't understand or like, and send you home without basic tests because they don't have enough modern equipment.
There is no such thing as a free lunch, and medicine - especially modern medicine with all of its wonders - is frightfully expensive and demanding of specialists, machinery, and effort. There is always going to be a bottleneck somewhere; there will never be enough doctors, pharmacists, nurses, and technicians to provide everyone all possible care.
I'm sorry but this is absolute nonsense. Quibble about the use of the word "right" if you must (personally I prefer the term "public service"), but it's incontrovertible that the US spends way more money per capita than other developed nations to achieve far worse outcomes.
All healthcare systems ration care in one way or another, but the way the US rations care really sucks a lot more than the way France or Germany do.
I live in one of those countries with socialised medicine and...it's a lot better than you seem to imagine.
Care is rationed fairly aggressively, yeah, but it's done so to ensure that people with life threatening conditions get care quickly, and everyone gets a good basic standard of care.
On the one hand, that means my fiancee (healthy, in her 20s) waited months to get her gall bladder removed because it was judged that, while painful, it wasn't going to kill her. On the other hand, that means my father (many other conditions, in his 70s) only waited a couple of weeks to be treated for cancer. Both operations, needless to say, were free at point of use.
Experimental treatments are not widely available, but by their nature probably shouldn't be. And it's widely noted that one reason the US is so expensive is that it tends to *overtreat* people and prescribe too many tests, so yeah, that's a difference, but not necessarily a drawback.
The biggest thing to note is that the American medical system is horribly expensive for a bunch of reasons that have nothing to do with outcomes. Eg, you can build hospitals with lots of open wards that let a small number of nurses keep an eye on a large number of patients, or you build them with lots of large, comfortable private rooms. Medical salaries are lower (as is med school tuition).
Other countries don't have cheap health care because they have socialised medicine; they have socialised medicine because it's health care is cheap. Someone else in the comments mentioned paying the full price of a ER visit in Costa Rica and it being $75. If an ER visit costs your system $75, it's a HELL of a lot easier to say "screw it, the government will just cover every ER visit" and fire the entire medical billing staff than it is if the visit costs $5k. (But despite what some will claim, just firing the medical billing staff will get your $5k visit down to $4995 or so. It's a happy bonus, not the root cause.)
"Of course, profit maximization results in things like a young woman being denied coverage for $8,000/month life-saving medication by her insurance company, leaving her totally powerless; that’s the sort of thing the insurance companies do every single day. A tenacious Penn State student had ulcerative colitis and, despite the fact that he and the university had paid their fair negotiated share in good faith, UnitedHealthCare denied him access to desperately-needed treatment."
Socialized medicine does not actually solve the problem of scarcity.
Canadian Man Dies of Aneurysm After Giving Up on Hospital Wait
It's easy to criticize the (real) faults of our present, very highly regulated, medical system, but if you're not interested in supply-side reforms then you're not focused on the actual issue that limits care in terms of availability or affordability. (As well as innovation.)
No system is perfect. But I’m living under socialised medicine and we don’t fear illness, fear it ruining us, like Americans do. My father-in-law has cancer and it won’t take everything he has. I went for a health check and an ECG and it cost me nothing. The model is preventative and saves money. I would not exchange it for profit.
At the time of payment, sure. But you and your countrymen certainly pay plenty for it.
I also had a free health check and EKG this year.
The rest of the world benefits from American innovation in medical and pharmaceutical technology because we incentivize it via the profit mechanism. (And we do have a lot of nonprofit hospitals [they aren't really cheaper] and socialized medicine for the elderly and poor.)
I was in Costa Rica last year and a member of our party was badly injured. The ER visit and treatment cost her $75. It would have cost over $5,000 in the US. Lost within those numbers are 1) the amount visit and treatment actually cost the provider given the larger system and 2) whether any one member of Costa Rican society ("countrymen") saw their taxes rise to a degree sufficient to even notice. But of course the Costa Rican government doesn't exist to crush any remotely leftist policy (at home or around the globe) to the vast extent the US business-owned government does and they don't maintain a massive network of government (USAID, NED, DEA, CIA) agencies, quasi-governmental NGOs, and military system of bases, taxpayer funded, in every corner of the earth to do that with. I guess that shit gets 'spensive. No healthcare for you!
Who fucking cares? What's the average lifespan? What's the average happiness level? What's the infant mortality rate? The degree of water pollution? The overall quality of life?
Do YOU know, "Slaw"?
You're nothing but a laptop PMC class online shit talker masquerading as some kind of social critic or offeror of rebuttals to what you see as baseless "leftism." And you subscribe to Bari Weiss' shit rag "The Free Press" like a typical fucking online pussy.
But why don't you tell us? What *IS* the "average salary" in Costa Rica? And how does it compare to the median or mean salary? What's the wealth distribution like among native or long-term national Costa Ricans?
Now - Explain in your own words why you asked the question in the first place and when I can read the first edition of "Slaw's Newsletter"............................
What a fargin' moron. No retort or recognition of the facts I mentioned? Namely, the US's constant and highly-funded involvement in anti-leftist (meaning anti-democracy) activity both at home and in "our backyard"?
You are THE reason I've told Freddie that his commentariat is CIA. Prove me wrong.
Yeah, read horror stories about Canada and NHS health care. We hopefully can be instructed by their errors if we redesign our system. I don't know that a one size fits all approach is best, maybe we can offer a variety of options but still ensure nobody goes untreated. And no, won't be cheap.
I’m genuinely curious: are there numbers out there comparing mortality rates due to denied vs delayed treatment in private vs public systems, respectively? The plural of anecdote is of course not data.
The ironic thing is that “medical care” and “mortality” aren’t actually closely related in wealthy societies.
It’s increasingly obvious that paying for medical care in inefficient ways is failing as populations age in terms of either budget or care. Rationing is going to get worse.
Ok. Well, admittedly without being expert on the subject, your defense of the US system seems pretty empty if you’re going to cite a few anecdotes against the business-as-usual disaster that is rejected American claims and insured patients who go bankrupt in the richest country in the world.
I will say that a system which denies/delays care to those with the least urgent *need*, rather than to the ones with the least ability to pay, would be expected to have significant lower mortality rate, higher life expectancy, etc., for a given $ amount of health care expenditure.
The exact extent to which that happens I couldn't say.
(I will also note that Canada's system appears to be slowly getting worse and worse at prioritising based on need, see, eg, MAID. Just having the system doesn't guarantee it will be used in an optimal manner.)
That is a solution no one has proposed yet: most of medical expenses arise post-80. Quit spending millions to get some old geezer 5 minutes more life in a rest home.
Everybody who is minimally sophisticated recognizes that the supply of doctors has to dramatically increase before the ideal of universal healthcare can be made actual. This is why statists are calling for the AMA to be stripped of its control over accreditation and admissions standards for medical schools so that the government can step in and direct them to begin producing a quantity of physicians that is in line with the country's healthcare needs.
Libertarians, on the other hand, are bawling about what a grave injustice it would be to the homework-doers if supply were to double and they were to be compensated at a rate more similar to that of their counterparts in Europe and East Asia.
Which group seems like the protagonist of this story to you?
My experience is that "abolish the AMA and let anyone who wants to start a med school or become a doctor" would get decent support from libertarian circles, but no support outside of them.
The "statist" solution has historically been more like requiring certificates of need before letting a new clinic open, and has been a major part of the problem.
"The message is as simple as it appears: it is logically and morally bizarre that historical crimes, like some of the conduct in the French Revolution, evoke our continuing indignation, while the horrible conditions that inspired those acts don’t, even though they killed far more people."
If we take it as given that United Health were designed to make it as difficult as possible for its customers to get the services contracted for, Mangione's response is not surprising.
At least he didn't shoot up some bramch office or kill a field sales rep but went to someone with at least some policy making authority.
And to echo FdB's point, if the victim were someone that the humans bewailing Thompson's desth did not approve of, they'd be singing a very different tune.
The mob of ululating sadists celebrating and sexualizing Mangione must just be part of my fever dream, I guess.
The reasons you laid for Neely’s death are the same reasons why Daniel Penny obviously shouldn’t be punished. Why do you want retribution against a normal person who responded to circumstances caused by terrible governance.
Anyway. Private insurers operate at thin margins, compensate for losses to providers caused by Medicare and Medicaid, and are a driving force behind pharmaceutical and medical engineering innovations.
Healthcare is expensive. Morbidity and mortality are part of life. I still have yet to hear a viable economic analysis of why any one component of the system should be demonized.
I saw their comments above re the Penny trial - nothing but speculation and cheap rhetoric. This is just one of those self-righteous blowhards who doesn’t actually read about whatever controversy they’re arguing about.
Yeah, I seriously cannot understand why somebody thinks that responding with an affliction hominem attack to somebody's detailed and substantive point is a good look.
I agree with your first sentence. While it's strange to me personally, I'm not all that surprised by it. America has a mob just like Rome did, ours is just online.
Your second line is a bit odd. Even accounting for the state's responsibility for Neely being out and about, that doesn't completely absolve one of doing what Penny did. We prosecute people all the time for manslaughter and not murder, you don't always have to show malice or intent to be held responsible for one's actions.
Your third and fourth lines...the whole point of what people like Freddie are arguing about is that a) the way it's working now is not working, and b) it doesn't have to be this way. Saying private insurers operate at thin margins doesn't absolve them of a system that profits off of sickness. Neither does blaming it on Medicare/caid, or implying it's better for 'innovation' than without...as if countries with taxed healthcare somehow have no idea how to innovate, or no incentive to, or something. I'm always dumbfounded by people who think the profit motive is the best motive for innovation, as if simply wanting to find a better way to do something, for simple human reasons, can never come close to getting the kinds of results like more money does. Good lord that's not just dark, but not true.
Are you really trying to argue that the way we do healthcare in America is somehow better than the way almost every other 1st-world country does it? I mean, we're not talking about trying to choose the best cell phone here, where a company is trying to convince you that their phone is the best fit for your particular lifestyle. We're talking about your basic health, about being alive and well. And the system we have in place to make sure one is alive and well has, as a primary function of its existence, a profit motive. A motive, to paraphrase Freddie, to extract as much money as practically feasible from a given 'customer' in order to at least stay solvent. And you don't understand why that system should be demonized??
"Healthcare is expensive" you say. That's the whole point, IT DOESN'T HAVE TO BE. It's only as expensive as it is here because it's privatized. I'll say that again in case you missed it: healthcare is only as expensive as it is in America because it's privatized. And no amount of 'market-driven' innovations can balance that scale, especially when the eventual product of those very innovations are too expensive for the average consumer to use.
Healthcare does have to be expensive. I don’t intend this as ad hominem, but you don’t understand the economics of healthcare at all. The idea that privatization is solely to blame is so wrong as to be almost unapproachable. I don’t know where to begin, really. The facilities, equipment, administration and compliance, personnel, the laboratories… it’s expensive. And some departments like (emergency med) lose money so hospitals have to compensate in other areas.
It is empirically true that profit incentive is a major driver of innovation. It has to be. A single failed pharmaceutical can cost its company tens of millions. Just look at the productivity of American pharma and biotech compared to other companies. Even foreign owned pharma companies like Novo center their r & d here.
The UK and Canada have major problems too. They also turn patients away. If healthcare is plausibly solvable, we would have done it by now.
As for Penny, it’s amazing to watch leftwing types suddenly ignore systemic issues and demand personal culpability for someone they don’t like. Penny tried to restrain - not kill - a violent schizophrenic who had depressants in his bloodstream. He had no malevolent intention. It is good that he is free.
If it's so expensive then how do other advanced countries do it cheaper? If you can't explain that then you can't say it HAS to be expensive. Since privatization is the major difference, and you claim it's not the sole reason, then what other reasons are there? Crappy diet? Milk hormones? General laziness? I mean, offer something up.
Of course the profit motive CAN be an incentive, I said it doesn't have to be the only one, or even the best one. So no, it doesn't have to be the only one.
"If healthcare is plausibly solvable, we would have done it by now." Is this a joke? Most things don't get done in this country unless there's a profit to be made for it.
You're right Penny didn't have malevolent intention, I agreed with that. But that doesn't mean he, or anyone else in a similar situation, should not be held liable for something. This can range from simple negligence to manslaughter, but just because there isn't harmful intent does not mean someone isn't liable. I can forget to put my car in park and roll it into someone else's car - it was a total accident without harmful intent, but I'm still liable for the damages.
I find that I quite like you because I always believe you are motivated by care rather than vengeance or envy. Even if I disagree, that always comes across. I’m not going to say anything else because it seems lots of folks are already doing that. I just want to say I have actual respect for you for whatever value that has for you today. My guess is not much, but there it is.
I have been struck by how the comments sections in the NYTimes articles about this incident. While every op-ed has been an open castigation to anyone who thinks that this murder is understandable in any way, shape, or form, almost every comment has been an explicit rejection of the exact small terror/large terror paradigm those op-eds try to shove down our throats. I've even seen top comments whose authors argue that because health insurance companies make their profits in the gap between the healthcare that people pay for and the healthcare they get, they are profiteers of sickness and death. And this is in the NYTimes comments section! Not a clip sliced from a Chapo episode!
The powerful are continuing to blast normal people with a basic sense of decency for not thinking the system is morally legitimate, rather than seeing people's rejection of its legitimacy as something that means the SYSTEM is wrong. For Bret Stephens to say that his murder and its celebration is the moral crime of our times, and not the fact that THREE (1, 2, 3) people in this country own as much wealth as the bottom 50%--you know, one out of every two every fucking people--says everything you need to know about how committed the system is to (pardon the pop psychology phrase, but I think it's necessary here), gaslighting us into thinking that the crime is not that wealth inequality kills people, but that people kill CEOs back.
Nobody in the political class, not Sanders, not Trump, nobody knows or wants to know just how seething mad with white hot incandescent rage the public is.
Last week I spoke with a bunch of yuppie attorneys who expressed great shock that such a senseless thing could happen to such a great person as CEO Thompon! And when I tried to explain how pissed off the public is Thompson and those like him, they looked at me like I had asked the person who just farted to please identiy himself and changed the subject. Many of these yupcakes were liberals and democrats, card-carrying, dues-paying members in good standing of the PMC. At least one had run for statewide office as a democrat.
They don't get why the dogs don't want to eat the dog food, while they feast on steak and salmon.
I had the same experience with some upper middle class professionals this week as well — they really don’t understand how a lot of this country is living.
Nor have they any interest in knowing how the deplorables live, any more than they want to delve into the consciousness of nazi skinheads or people who misgender.
Freddie I agree With you that the current system is screwed in many regards. I agree we need some form of involuntary institutionalization for the sake of both people like Jordan Neely and normal subway riders. I agree that insurance companies engage in a lot of morally bankrupt behavior. If I could snap my fingers and make all sickness in the world go away I would. I am murderously angry with elites more often than I would like. All that said I think you are missing a point best summarized by another quote.
"[...] how was a girl from Earth to fully understand? The amount of fuel will not power an EDS with a mass of m plus x safely to its destination. To him and her brother and parents she was a sweet-faced girl in her teens; to the laws of nature she was x, the unwanted factor in a cold equation."
— Tom Godwin, The Cold Equations
There are finite hours in the day. Only so many resources. We can't all make it all the time. Do some people have to much? Yeah probably. Could we redirect spending to save more people in x or y way? definitely. Can we solve all problems? No. How do we do the most good with what we have? That is an intractable problem for witch only god knows the answer.
I believe it's human nature to become desensitized to the widespread suffering we see every day - maybe as a psychological defense mechanism against absorbing the magnitude of horrors. Grassroots fundraising experts tell us to tell a story about one hungry child, not billions of hungry children even though, rationally speaking, donors should want to give more to solve a problem affecting billions. But that's not how most people operate. I think this dynamic is at play here with people acting more upset about Thompson's death than the millions who have suffered or died at the hands of a cruel system.
That doesn't explain why Douthat and Sullivan haven't extended empathy toward Neely -- that's another question. But I do generally give public intellectuals a lot of latitude in terms of what they choose to write about and what they don't w/out necessarily seeing their choices as evidence of moral failure. There are dozens of horrendous things going on that I don't write about, and I wouldn't want anyone judging for me that. Sometimes, I really do care about something a lot but my thinking is so muddled or nuanced that it's difficult to produce a coherent piece of writing.
Not trying to be snarky or whatever, but is there any country in the world where a $2m per year treatment of off-label, unusually high-dose biologics would be easy to get?
I genuinely would like to know if those kinds of services are available and covered with little fuss in e.g. Canada.
I just emailed a doctor friend in New Zealand to ask her if that would be available there. I'm curious too. My bet is that it's not available. But we'll see. It might be, if the government(s) of these different countries has negotiated a better price for the medications.
I'd be interested to know the result. That story sounded to me like a really terrible situation for the guy whose treatment costs $2m per year, but also like a situation where I could also easily imagine pretty much any healthcare bureaucracy just saying "sorry, this treatment plan doesn't meet our clinical and/or cost effectiveness guidelines".
She got back to me and said that the patient would need to go through a bunch of trials of other meds first, but then if it was the only effective treatment, they'd pay full freight. If he wanted to shell out $200-$300 dollars for private care so the trials would be scheduled faster, that's an option, but the Entyvio and Remicade would be still be free to the patient.
And she's not 100% on board with some NZ practices (she's American, and originally practiced here). Lots of recently-developed meds aren't available there at all, so I'm kind of surprised that those two biologics are. But she looked them up and confirmed.
In the story it was pretty clear that the issue was not whether those drugs would be covered but whether they would be covered at much higher dosages than typically prescribed.
As a Canadian it would be really hard just to get to the specialist who would recommend this course of treatment. I don’t think the government would pay for it but I’m not sure.
"That’s how you get to Yglesias Land, where there is no problem markets can’t fix, and if markets can’t fix a problem, we’re not allowed to call it a problem at all."
This is a remarkably uncharitable/inaccurate description of Yglesias's position on e.g. government intervention/redistribution. He regularly defends the present welfare state and increased assistance to the disadvantaged.
Not everyone who recognizes the efficacy of markets becomes a libertarian. (Even if they should.)
He did. And then lefties made fun of him too often and he became a zealot.
He is literally in favor of price controls on drugs.
As a right-neoliberal/state-capacity libertarian regularly annoyed by when left-neoliberal Yglesias (or e.g. Noah Smith) does not favor limited government and market mechanisms, I assure you that you are wrong.
You could choose to accurately represent your ideological foes without grouping us all into one rightwing camp.
You can still criticize him for e.g. supporting and defending Obamacare (hardly a libertarian's dream piece of legislation). You don't need to exaggerate his copiously documented position on healthcare policy.
Agreed. We don't all match the caricature of the rich and selfish Republican.
No this is you just being a jackass and making up a narrative in your head.
My opinion of Yglesias has been lowering rather sharply over the last couple of years, but this nonetheless seems to misrepresent his position rather severely.
There are many people out there who would cheerfully argue that markets can fix anything that is an actual problem. Yglesias, for all his faults, isn't one of them. Unless I missed a *very* recent and surprising conversion?
I think zero libertarians would consider Yglesias a libertarian--he's a mostly pro-free-market Democrat who also supports social programs and regulations and such.
For the record I am a conservative who believed Daniel Penny was innocent of the crimes he was charged with - and deeply sympathize with Jordan Neely for all the points you mention, Freddie.
Not all of us are quite the moral cretins you imagine us to be.
If he had been *trying* to kill him, then a chokehold can work in seconds.
A headlock is not a chokehold, and my understanding is that Neely was still breathing when police arrived.
Penny himself described it as a chokehold and he had no pulse when the police arrived.
Come on Freddie.
https://nypost.com/2024/11/02/us-news/shocking-footage-shown-in-daniel-penny-trial-shows-moment-emts-said-jordan-neely-had-a-pulse/
Have you ever been in a chokehold that is actively applied? (If it's not being actively applied, then it's effectively a headlock.)
"While the time it takes for the choke to render an opponent unconscious varies depending on the type of choke, the average across all has been recorded as 9 seconds."
https://en.wikipedia.org/wiki/Chokehold#:~:text=The%20terminology%20used%20varies;%20in,chokeholds%22%20or%20%22chokes%22.
Come on Machete. If he was strong enough to hold onto him tightly enough to render him unconscious, he could have held onto him in a NON-chokehold for long enough for the authorities to arrive (and likely kill him anyway).
Some would say that’s what he did do.
Notably, the jury.
Were you in the jury deliberation room? And besides, that's not how "beyond reasonable doubt" works when the evidentiary process is highly circumscribed. Are you saying that Penny or his legal team testified that he *WASN'T* intentionally applying a *CHOKE* hold as opposed to another, more rote, means of restraint?
I didn't think so.
Wrong. He did in fact have a pulse when police arrived. https://amp.cnn.com/cnn/2024/11/01/us/daniel-penny-trial-jordan-neely-death
Penny held onto Neely for all that time because he was trying to subdue, not kill. He deliberately applied much less pressure than he could have.
What was his pulse rate?
He had a pulse, meaning that he was still alive.
But obviously for longer than he should have. As noted by one of the guys in the subway car with him at the time.
Yeah, seems like this is the sort of thing we ought not to expect random dudes without relevant training or equipment or backup to handle.
A few months ago, a homeless guy wandered into the social center I volunteer at and began acting agitated. After we tolerated him for a few minutes, he tried flashing us.
The center was filled with about five or six little girls, aged 6-12; I misremember the exact number. Ordinarily when a crazy homeless guy starts acting up, I feel free to simply walk away to avoid a confrontation. I did not feel I had that option that time.
One of the women who volunteer there (not the ma to any of the kids there, but still a ma) started screaming at him to fuck off. He screamed back, they went at it for a while.
I decided I was willing to take out my work knife and stab him if he escalated. I hoped he wouldn't, if only to avoid having to speak to cops that day. Until he chose to escalate, I was just gonna sit quietly and watch. I didn't want to get loud and set him off.
Eventually he left and we got to breathe easier.
I don't really care about the details of what counts as a chokehold and when the time of death was. It's irrelevant. If you live in a rough area where bad things happen to people, sufficient provocation provokes a violent response. Don't provoke things if you don't want bad things to happen, and if you can't turn it off, c'est la vie. Blame those who put Neely there, not the guy who had to decide what to do about a violent person mere feet away who will not deescalate.
"Don't provoke things if you don't want bad things to happen." Makes sense––except for precisely the kind of person Neely was.
I'm afraid your moral rule here is: "don't make the choice to be mentally ill and then we won't kill you."
Not untrue, which means the system that refuses to restrain him until he had functional possession of his self again needs to think about what they’re throwing out into the world.
It does not mean “do nothing when the full grown man with no self-control and his cock out approaches the little girl.”
Who argued "do nothing"? I argued that we still face a moral responsibility when we are confronted with someone dangerous but so ill that they don't and can't act as a responsible agent. Whereas you took the position that anyone who makes someone feel "provoked" has forfeited their right not to be harmed or killed.
There is a critical difference between the failure of the system and the murder of the mentally ill person. The first does not immunize the second. Violent and maybe even lethal force may be justified, but the moral responsibility doesn't vanish, no matter who or what failed before the moment of threat.
There exist more options than “do nothing” and “kill him”.
The words "mental illness" do not absolve someone of being a danger to others. No being chooses to contract rabies, and no being chooses to be dangerously psychotic. We still have a moral right and duty to defend ourselves from them.
In a broken system sometimes there are no good choices. Sometimes someone has to choose between the safety of one pseudo-sympathetic homeless guy who can’t really be held accountable for his actions and the women and children he’s assaulting. Only a fucking moron, like you!, would dare to assert superiority over someone who acted to intervene. You are a pampered sneering child and of all the people in this scenario YOU are the only one I hate. And I want you to know, I do really, really hate you.
Sitting here wondering why it is so important to you that I know you really, really hate me.
Don't know the answer, but I believe you––so if that makes you a little happier, then great.
Real great civility you’re demonstrating here. I’m sure this sort of rhetoric convinced people of shit all the time, rather than just assuring that your political opponents never even consider what you have to say.
Good job. You’ve won.
😂😂😂
Leaving violent mentally ill people on the streets is a policy choice. This also involves leaving subduing those violent mentally ill people to random citizens rather than professionals with the right training and equipment to mostly avoid killing them, so either the random citizens get hurt or killed or the violent mentally ill people do.
Neely should not have been on the subway terrorizing the other riders, and leaving Penny to try to subdue him, or leaving Neely to beat some old lady senseless because nobody was willing to try, are both downstream of that decision.
It’s pernicious dogmatists and myopic parrots who care the most about details irrelevant to (or intentionally derailing from) the topic of conversation at hand, as evinced by select individuals in this comment thread.
This. Most "crazy" people are sane enough to push the boundaries but avoid real trouble.
But not unsympathetic toward Neely, toxic childhood, etc. The system failed him as Freddie notes.
Still, i live in a downtown area and when people are seriously acting out in a threatening way my compassion evaporates.
The name of that hold is the "rear naked choke," but if you loosen it so it's not literally choking the person, then it doesn't choke the subject.
It takes about 20 seconds to render someone unconscious if the hold is literally choking the subject, so it's safe to conclude that Penny wasn't choking Neely for the first four minutes and thirty seconds or so. Penny himself thought that Neely was alive during the on-site interview with the cops and during his interview at the police station, so Penny at least didn't think he was choking Neely.
It's definitely possible that near the end of the struggle. that hold started choking Neely and that's what killed him, and it's possible that he just died from the stress of the struggle.
I don't know if "sympathize" is the right word, but I don't think many conservative people are contemptuous of Neely.
I do think that ultimately, you either prioritize sympathy for Neely or sympathy for the community forced to cope with the government's lack of will in protecting him and thus inflicting him on everyone else.
I've seen a fair bit of genuinely creepy contempt for Neely. And the people spewing it certainly seemed conservative. Freddie was right to call them moral lepers.
This was mostly on Quora, though, and for some reason that site attracts bad apples.
I honestly don't see how anyone can say "well, I've seen a lot of people say so on Quora" as some sort of rebuttal to, well, anything other than the claim "Quora is a wellspring of good will and positivity towards all humans."
I don't see how "I don't think many conservatives feel X" constitutes evidence that conservatives don't feel X.
I don't recall saying that it did and, as I refresh my memory by reading my comment, am now confident in my recollection that I made no such assertion.
I think it should be clear the way "I've seen a bunch of conservatives do it" rebuts "I don't think many conservatives do that". Obviously anecdotes aren't everything, but they aren't nothing either.
And it wasn't only on Quora, though that was where I saw the most and worst.
Yes, the problem is that "a lot of people say so on Quora" is *not* semantically in the same ball park as "I've seen a bunch of conservatives do it". In fact, "I've seen a bunch of conservatives online in a huge range of social media outlets from Twitter to National Review to The Dispatch to the Wall Street Journal say so" wouldn't be "I've seen a bunch of conservatives do it", although it wouldn't give as much rise to mockery.
When I said "I don't think many conservative people are contemptuous of Neely" I was drawing from the whole American world, not a tiny space known as the world wide web.
The web is the biggest slice of the world you have access to, you know.
"How is that in your best interest, to preemptively reject a vast majority of potential customers? Because by taking only patients who can pay cash, you eliminate all of the actually-hard cases. You sidestep the fundamental work of psychiatry, juke the real labor."
I never thought of it this way. Indeed, I'm even worse, because I'm not a psychiatrist at all.
Almost all of us juke the real work of doing unpleasant labor to care for the least among us. That goes for me, and it certainly goes for Substack writers. This seems like an issue where it's better to praise those who go above and beyond, rather than castigate those who don't but are still making a useful contribution.
You think, what, there's a Substack Medicaid program and I'm refusing to take their insurance coverage? If I was profit maximizing, do you think I'd be charging literally the minimum amount Substack will allow?
I think you're not even in the game of using your labor to care for those who suffer from illness. So why throw stones at those who are at least doing something about the problem, even if they're not doing it in the most self-sacrificing way possible?
Especially because the doctors you're attacking are in fact making a contribution, on the margin, to the care available to the less fortunate, by reducing the workload of those who take do take Medicaid.
Look: Freddie goes overboard in this article. I agree. But the “well if it’s so important to you why don’t YOU become a psychiatrist/army sergeant/insurance CEO” argument isn’t tenable. It means that nobody is allowed to criticize anything outside of their extremely narrow employment.
That's not the argument, although I can see how it looks that way. The point is that most people, Freddie and myself included, are not taking on as much hardship or making as much of a contribution to the common good as the doctors he's talking about. So we should empathize with these doctors rather than being judgey.
He should reserve his condemnation for those who are making less of a contribution than most other working people (like Luddite union dock-workers, for example).
By that logic there is only a small top-tier of actors who are in a position to lodge a moral criticism; the other 95% of us much shut our mouths because we have not earned the right to point to anyone's immoral acts or choices.
I think it is much more coherent to say that people are fair game for criticism based on what they do after they enter a particular field of action.
I choose to be a university professor. Having done that, it would be morally wrong for me to caustically lambast one of my students to their face by calling them a "moral cretin"–– even though I might applaud the same insult in a different context (like, say, the charge that Boer levels against those conservatives who so often behave as "moral cretins")
Psychiatrists are just as fair game for moral criticism. They chose to go into that field and to earn a living by treating the mentally ill people who need their expertise. You can't criticize anyone who takes enough paying patients pay their bills, but you can certainly criticize someone who refuses to treat anyone with Medicaid so they can maximize their profits.
So if somebody chooses to work for a tobacco company or an online casino, but they do it with as much honor as possible given their choice of occupation, you can't criticize them?
You can criticize people who are making more of a contribution, you just can't criticize them *for not making enough of a contribution* if they're making more of a contribution than most other people who you don't have a problem with. (Also if you think nobody is doing good enough, then criticize away, but I'm sure Freddie wouldn't criticize a dock worker.)
The cretins are the liberal people who created a system where Neely was not forced to be treated.
I didn’t interpret the final paragraph as saying “the problem is the moral character of psychiatrists.” People are people. The problem is the system of incentives that leads to this outcome. One issue is the sheer lack of practitioners. It takes over a decade to become a psychiatrist. There are also caps on the number of seats in med school and residency. Right now, I think the hypothetical risk of graduating a mediocre psychiatrist is much lower than the very real problem of having far too few.
I don't know wether you're american or not, but you're missing a key piece of context--psychiatrists caused the lack of psychiatrists. The AMA controls accreditation and admissions standards for medical schools in this country, and they use that power to ensure that there are many, many fewer doctors per capita here than essentially anywhere else in the developed world. You're seeing two separate problems where there is only one.
Yes, the AMA lobbies extremely hard for the artificial shortage. But ultimately, the state makes the rules. And “convince legislators to deregulate” is a more realistic lever to pull on than “convince a labor union to lobby in favor of a paycut for its members.”
"What most people are saying, in the realm of politics, is that a broken and cruel medical system is going to make people do crazy things"
In a scene from the series Lioness (another great Taylor Sheridan production) the husband of the main character that is a surgeon tells the parents of the patient, a 9 year old girl, that her brain tumor is inoperable and that she has six months. The father punches the doctor and has to be pulled off in his rage trying to hit the doctor again.
The point here is that assessment of health care access, quality and effectiveness is fraught with high emotional turmoil that can cause the customers of healthcare to lose objectivity and chase fantasy rainbows of something better that does not exist, or that lacks intellectual honesty about tradeoffs.
The reports of the healthcare CEO murderer are that he had severe back pain problems. Having had similar problems in the past, I know that chronic pain can mess with mental and emotional health.
But the bottom line, it is despicable to leverage this murder in any way to push the fantasy dream of government-run healthcare.
Is it "despicable" to write the sentence you quote at the beginning of the post?
Is your argument that, yes, this is a broken and cruel medical system, but no one should speak about its cruelty and brokenness in the wake of this murder? Why not?
Wanting to have a system where the massive profits now going to individuals actually go to providing care to people––wanting a system that less cruel and lethal––is not a "fantasy" of weak minds. Resources are finite and medical care has limits; there is no utopia where a healthcare system can heal everyone. But it's empirically true that an alternative system could deliver more and better care and save many more lives. The rage that has emerged is not just an irrational outburst by people who can't accept reality.
My second-order anger is that collectively we haven't demanded a better alternative.
If I snap and shoot somebody because lizard people are controlling the government that doesn't actually mean that lizard people exist.
If you say "Mangione is crazy" for pulling out a gun then doesn't the crazy/irrational part also extend to his judgement/perspective about the health care system as well? Irrational in one but not irrational in the other?
But DeBoer (and anyone else, like me) doesn't need to reason backwards from Mangione's crazy action to come to the conclusion that the healthcare system is immoral and effed-up.
If you already independently see/believe that that this is an profoundly immoral system, then you can look at what Mangione did and say "lock him up" while still saying that a crazy murderer also correctly perceived the immorality of our system.
Just as I correctly perceive the problems with a world government run by lizard people?
"This insane person decided to kill somebody. Seems like a good jumping off point to examine whatever obsession he had."
If the health care system has problems then they exist regardless of the actions of crazed assassins. Flogging a narrative that "He was crazy but..." just reeks of opportunism and lazy thinking.
"Just as I correctly perceive the problems with a world government run by lizard people?"
If you perceive that, then you are bad at understanding reality and the rest of us have no obligation to give it credence. This hypothetical is applicable *only* if the reality of lizard people can be derived from actions like Mangione's. But his acts are irrelevant. There is a whole world of rational reflection––facts, logical reasoning, precedents––that can support one's opinion about the US healthcare system.
Reasonable people can come to different conclusions, but the mind of someone like Mangione is not dispositive one way or the other. For those who independently see the system as cruel and immoral, Mangione is going to look like a person who saw that reality but then took an immoral and indefensible action.
"If the health care system has problems then they exist regardless of the actions of crazed assassins."
Uh, exactly right––that's been my point. For everyone who sees those problems are real problems, it is totally coherent to say "he was criminal and irrational when he murdered the CEO but he correctly perceived what I rationally perceive."
If there is a whole world of rational reflection about the US healthcare system then why bring Mangione up in the first place?
Again, opportunism and lazy thinking.
"he was criminal and irrational when he murdered the CEO but he correctly perceived what I rationally perceive."
In other words, "he was only crazy when it was convenient".
Nor does it mean they don't.
"He was crazy when he pulled a gun out but not crazy when he got mad" is just way too convenient.
I was referring to your comment about lizard people. Your statement basically says nothing about the existence of lizard people, which I assumed was your point.
My point is that there are plenty of people right now that are happy to say that Mangione was crazy when he picked up a gun but not crazy when he acquired his grudge against the health care system.
Does that really make sense? Crazy people are crazy. Consistency would suggest that his mental health affected not only the act but the motivations and reasoning behind the act.
If anything wouldn't it make more that people would conclude "This crazy person has a problem with the system, so that means that only crazy people disagree with the status quo"?
"Is your argument that, yes, this is a broken and cruel medical system, but no one should speak about its cruelty and brokenness in the wake of this murder? Why not?"
Because then it would justify the murder of Nancy Pelosi to bring attention to political graft that is insider trading.
It would justify murder of anyone to get national attention for a favored cause.
Like standing at the podium at the memorial of your cousin that died of complications from obesity and diabetes to rage against fast food.
Timing is everything.
Before Obamacare was passed, 74% of Republicans and 55% of Democrats said that healthcare was excellent or good. Today the polling is 42% Republicans and 50% Democrat. So Obamacare as we expected is a step toward government run healthcare and what did it get us? A crash in general satisfaction including that of Democrats that demanded Obamacare.
So this is another reason to lambast those that fuck with the timing and leverage a terrible act to push their agenda... making policy decisions based on the heat of emotion from a terrible act or even a terrible tragedy is one fraught with the risk of making big ass mistakes.
I don't see DeBoer making any justificatory argument like that in his post. He didn't say that he (or other critics of US healthcare) believes the murder was morally justified. And he expressly said it *wasn't* political effective––so therefore could not even be justified as a means to an end.
As I read it, he just make an observation (what "is" and not what "ought to be): this is an effed-up system that is prompting crazy actions––actions that resonate with (not crazy) feelings in a huge number of people.
To make that observation in no way gives a thumbs up to any violence or criminal actions.
I see it just a bit different.
If a terrorist blows up a Jewish school and kills a bunch of Jewish school children to get attention for say the Palestinian cause, anyone writing "terrorism is terrible, but you can understand why those Palestinians are angry since their children are being killed by Israel" is in fact aiding the terrorist.
Now a few months later when the news of the school children slaughter is over, it is fine to bring up the topic again.
I think I see your point. But it doesn't seem feasible to me to make the political meaning of a statement contingent on the timing of when you say it.
If I condemn the murder of Jewish children but still bring up a relevant context (i.e. Palestinian militants have killed Jewish children, but to have grounds to condemn them we must also condemn Israeli soldiers who kill Palestinian children), I don't see any logical reason why doing so "aids" the Palestinian militants.
And even more so, I don't see how stating such facts in one moment stating aids terrorists while stating them in a later moment no longer aids any terrorists.
Terrorists do their terrorism to gain attention to their cause... to get the emotional reaction in the media that otherwise was not paying attention.
If you comply you are aiding and abetting the terrorists.
There were some idiot leftists in academia that wrote sympathetic pieces over the 9-11 terrorists... and they lost their careers. That is an appropriate response. At some time in the future, is is fine to speak freely spewing America-hate points... but NOT when the terrorism is still percolating in the minds and hearts of the nation.
In democracy there is a method to solve problems through the political process. Just because those angry and upset about some situation are too lazy to try and solve the problem through the political process is no excuse for them exploiting the acts of terrorists to jump on their activist bullhorn.
I am not willing to let terrorist dictate, in terms of months, when I can talk about certain political issues. They are not the boss of me.
Maybe not, but they can be your bitch if not mindful.
I think you are exactly right.
I don’t see how the last paragraph at all follows from the first few. We should do what we need to do to achieve our policy goals. Do you think conservatives pull punches in political fights because they think it would be “despicable”? No. They get out there and they do what needs to be done to win.
That’s why they win elections and we don’t. They don’t care about being morally cure. They care about winning.
Freddie, I agree with you about the American healthcare system. I have privileged healthcare and the inequality between what I have and what most have is barbaric. We know this because every other wealthy country does provide healthcare as a right. I wrote a post about it last week.I will DM it to you in case you want to read it.
For a long time I had a knee jerk negative reaction to healthcare as a right because I thought it would lower the quality of my privileged healthcare. My eyes have been opened. But the same people who make decisions about healthcare in America are also the people who have the privilege and are afraid that healthcare as a right means they will lose out.
You make a great point about mental health professionals.
"Every other wealthy country does provide healthcare as a right"
No they don't; they make soothing mouth-noises about rights, and then when it comes time to actually see a doctor and get care, they shove you in waiting lines months or years long, decline to authorize (that's just a fancy way of saying "deny") expensive or experimental treatments they don't understand or like, and send you home without basic tests because they don't have enough modern equipment.
There is no such thing as a free lunch, and medicine - especially modern medicine with all of its wonders - is frightfully expensive and demanding of specialists, machinery, and effort. There is always going to be a bottleneck somewhere; there will never be enough doctors, pharmacists, nurses, and technicians to provide everyone all possible care.
I'm sorry but this is absolute nonsense. Quibble about the use of the word "right" if you must (personally I prefer the term "public service"), but it's incontrovertible that the US spends way more money per capita than other developed nations to achieve far worse outcomes.
All healthcare systems ration care in one way or another, but the way the US rations care really sucks a lot more than the way France or Germany do.
I live in one of those countries with socialised medicine and...it's a lot better than you seem to imagine.
Care is rationed fairly aggressively, yeah, but it's done so to ensure that people with life threatening conditions get care quickly, and everyone gets a good basic standard of care.
On the one hand, that means my fiancee (healthy, in her 20s) waited months to get her gall bladder removed because it was judged that, while painful, it wasn't going to kill her. On the other hand, that means my father (many other conditions, in his 70s) only waited a couple of weeks to be treated for cancer. Both operations, needless to say, were free at point of use.
Experimental treatments are not widely available, but by their nature probably shouldn't be. And it's widely noted that one reason the US is so expensive is that it tends to *overtreat* people and prescribe too many tests, so yeah, that's a difference, but not necessarily a drawback.
The biggest thing to note is that the American medical system is horribly expensive for a bunch of reasons that have nothing to do with outcomes. Eg, you can build hospitals with lots of open wards that let a small number of nurses keep an eye on a large number of patients, or you build them with lots of large, comfortable private rooms. Medical salaries are lower (as is med school tuition).
Other countries don't have cheap health care because they have socialised medicine; they have socialised medicine because it's health care is cheap. Someone else in the comments mentioned paying the full price of a ER visit in Costa Rica and it being $75. If an ER visit costs your system $75, it's a HELL of a lot easier to say "screw it, the government will just cover every ER visit" and fire the entire medical billing staff than it is if the visit costs $5k. (But despite what some will claim, just firing the medical billing staff will get your $5k visit down to $4995 or so. It's a happy bonus, not the root cause.)
Your DM is turned off. Here is my post. https://robertsdavidn.substack.com/p/a-look-at-privileged-healthcare-within
"Of course, profit maximization results in things like a young woman being denied coverage for $8,000/month life-saving medication by her insurance company, leaving her totally powerless; that’s the sort of thing the insurance companies do every single day. A tenacious Penn State student had ulcerative colitis and, despite the fact that he and the university had paid their fair negotiated share in good faith, UnitedHealthCare denied him access to desperately-needed treatment."
Socialized medicine does not actually solve the problem of scarcity.
Canadian Man Dies of Aneurysm After Giving Up on Hospital Wait
https://www.newsweek.com/adam-burgoyne-death-aneurysm-canada-healthcare-brian-thompson-2000545
NHS 'rationing leaves patients in pain'
https://www.bbc.com/news/health-40485724
It's easy to criticize the (real) faults of our present, very highly regulated, medical system, but if you're not interested in supply-side reforms then you're not focused on the actual issue that limits care in terms of availability or affordability. (As well as innovation.)
No system is perfect. But I’m living under socialised medicine and we don’t fear illness, fear it ruining us, like Americans do. My father-in-law has cancer and it won’t take everything he has. I went for a health check and an ECG and it cost me nothing. The model is preventative and saves money. I would not exchange it for profit.
"it cost me nothing"
At the time of payment, sure. But you and your countrymen certainly pay plenty for it.
I also had a free health check and EKG this year.
The rest of the world benefits from American innovation in medical and pharmaceutical technology because we incentivize it via the profit mechanism. (And we do have a lot of nonprofit hospitals [they aren't really cheaper] and socialized medicine for the elderly and poor.)
Also, check this out:
https://www.commonwealthfund.org/out-pocket-health-care-spending-capita
The US medical system is very unfairly maligned relative to the competition.
I was in Costa Rica last year and a member of our party was badly injured. The ER visit and treatment cost her $75. It would have cost over $5,000 in the US. Lost within those numbers are 1) the amount visit and treatment actually cost the provider given the larger system and 2) whether any one member of Costa Rican society ("countrymen") saw their taxes rise to a degree sufficient to even notice. But of course the Costa Rican government doesn't exist to crush any remotely leftist policy (at home or around the globe) to the vast extent the US business-owned government does and they don't maintain a massive network of government (USAID, NED, DEA, CIA) agencies, quasi-governmental NGOs, and military system of bases, taxpayer funded, in every corner of the earth to do that with. I guess that shit gets 'spensive. No healthcare for you!
What's the average salary in Costa Rica?
Who fucking cares? What's the average lifespan? What's the average happiness level? What's the infant mortality rate? The degree of water pollution? The overall quality of life?
Do YOU know, "Slaw"?
You're nothing but a laptop PMC class online shit talker masquerading as some kind of social critic or offeror of rebuttals to what you see as baseless "leftism." And you subscribe to Bari Weiss' shit rag "The Free Press" like a typical fucking online pussy.
But why don't you tell us? What *IS* the "average salary" in Costa Rica? And how does it compare to the median or mean salary? What's the wealth distribution like among native or long-term national Costa Ricans?
Now - Explain in your own words why you asked the question in the first place and when I can read the first edition of "Slaw's Newsletter"............................
If the average salary somewhere is $50 a month how much do you think it costs to pay rent? Or buy groceries?
Use your brain.
As for my SS, click on the link. I have no idea what you're talking about. It's free.
You are my favorite poster.
This is an incredible bit.
How have I not encountered you before.
Average salary. Ha ha ha ha ha ha ha ha ha ha.
What a fargin' moron. No retort or recognition of the facts I mentioned? Namely, the US's constant and highly-funded involvement in anti-leftist (meaning anti-democracy) activity both at home and in "our backyard"?
You are THE reason I've told Freddie that his commentariat is CIA. Prove me wrong.
I do have a CIA mug given in appreciation.
Wasn’t for being a neoliberal shill though.
How many people went to move to Costs Rica vs. the US?
Feel free to go back!
Yeah, read horror stories about Canada and NHS health care. We hopefully can be instructed by their errors if we redesign our system. I don't know that a one size fits all approach is best, maybe we can offer a variety of options but still ensure nobody goes untreated. And no, won't be cheap.
I’m genuinely curious: are there numbers out there comparing mortality rates due to denied vs delayed treatment in private vs public systems, respectively? The plural of anecdote is of course not data.
It’s very hard to compare apples to apples here.
The ironic thing is that “medical care” and “mortality” aren’t actually closely related in wealthy societies.
It’s increasingly obvious that paying for medical care in inefficient ways is failing as populations age in terms of either budget or care. Rationing is going to get worse.
Ok. Well, admittedly without being expert on the subject, your defense of the US system seems pretty empty if you’re going to cite a few anecdotes against the business-as-usual disaster that is rejected American claims and insured patients who go bankrupt in the richest country in the world.
I'm not aware of any good data here.
I will say that a system which denies/delays care to those with the least urgent *need*, rather than to the ones with the least ability to pay, would be expected to have significant lower mortality rate, higher life expectancy, etc., for a given $ amount of health care expenditure.
The exact extent to which that happens I couldn't say.
(I will also note that Canada's system appears to be slowly getting worse and worse at prioritising based on need, see, eg, MAID. Just having the system doesn't guarantee it will be used in an optimal manner.)
Well, you have to adequately FUND the healthcare.
Money doesn’t grow on trees and society is graying.
That is a solution no one has proposed yet: most of medical expenses arise post-80. Quit spending millions to get some old geezer 5 minutes more life in a rest home.
Everybody who is minimally sophisticated recognizes that the supply of doctors has to dramatically increase before the ideal of universal healthcare can be made actual. This is why statists are calling for the AMA to be stripped of its control over accreditation and admissions standards for medical schools so that the government can step in and direct them to begin producing a quantity of physicians that is in line with the country's healthcare needs.
Libertarians, on the other hand, are bawling about what a grave injustice it would be to the homework-doers if supply were to double and they were to be compensated at a rate more similar to that of their counterparts in Europe and East Asia.
Which group seems like the protagonist of this story to you?
Where are these “libertarians” you speak of that oppose deregulation and combating rent seeking to increase supply?
Actually where are these “statists” too?
My experience is that "abolish the AMA and let anyone who wants to start a med school or become a doctor" would get decent support from libertarian circles, but no support outside of them.
The "statist" solution has historically been more like requiring certificates of need before letting a new clinic open, and has been a major part of the problem.
"The message is as simple as it appears: it is logically and morally bizarre that historical crimes, like some of the conduct in the French Revolution, evoke our continuing indignation, while the horrible conditions that inspired those acts don’t, even though they killed far more people."
If we take it as given that United Health were designed to make it as difficult as possible for its customers to get the services contracted for, Mangione's response is not surprising.
At least he didn't shoot up some bramch office or kill a field sales rep but went to someone with at least some policy making authority.
And to echo FdB's point, if the victim were someone that the humans bewailing Thompson's desth did not approve of, they'd be singing a very different tune.
The mob of ululating sadists celebrating and sexualizing Mangione must just be part of my fever dream, I guess.
The reasons you laid for Neely’s death are the same reasons why Daniel Penny obviously shouldn’t be punished. Why do you want retribution against a normal person who responded to circumstances caused by terrible governance.
Anyway. Private insurers operate at thin margins, compensate for losses to providers caused by Medicare and Medicaid, and are a driving force behind pharmaceutical and medical engineering innovations.
Healthcare is expensive. Morbidity and mortality are part of life. I still have yet to hear a viable economic analysis of why any one component of the system should be demonized.
LOL
Was there an argument in there? Or anything that would contribute to the discussion?
I saw their comments above re the Penny trial - nothing but speculation and cheap rhetoric. This is just one of those self-righteous blowhards who doesn’t actually read about whatever controversy they’re arguing about.
Yeah, I seriously cannot understand why somebody thinks that responding with an affliction hominem attack to somebody's detailed and substantive point is a good look.
It just makes you look like a moron.
I'm still waiting to read the first installment of "Slaw's Substack."
What's stopping you?
Flesh out your accusations and allegations. That man was BAD! Explain the controversy in your own words.
Do YOU have an argument in support?
If you want to hear one grow up and ask for it like an adult.
"Grooow up!" LOL
Yup. I suggest acting like an adult if you want to be treated like one.
I agree with your first sentence. While it's strange to me personally, I'm not all that surprised by it. America has a mob just like Rome did, ours is just online.
Your second line is a bit odd. Even accounting for the state's responsibility for Neely being out and about, that doesn't completely absolve one of doing what Penny did. We prosecute people all the time for manslaughter and not murder, you don't always have to show malice or intent to be held responsible for one's actions.
Your third and fourth lines...the whole point of what people like Freddie are arguing about is that a) the way it's working now is not working, and b) it doesn't have to be this way. Saying private insurers operate at thin margins doesn't absolve them of a system that profits off of sickness. Neither does blaming it on Medicare/caid, or implying it's better for 'innovation' than without...as if countries with taxed healthcare somehow have no idea how to innovate, or no incentive to, or something. I'm always dumbfounded by people who think the profit motive is the best motive for innovation, as if simply wanting to find a better way to do something, for simple human reasons, can never come close to getting the kinds of results like more money does. Good lord that's not just dark, but not true.
Are you really trying to argue that the way we do healthcare in America is somehow better than the way almost every other 1st-world country does it? I mean, we're not talking about trying to choose the best cell phone here, where a company is trying to convince you that their phone is the best fit for your particular lifestyle. We're talking about your basic health, about being alive and well. And the system we have in place to make sure one is alive and well has, as a primary function of its existence, a profit motive. A motive, to paraphrase Freddie, to extract as much money as practically feasible from a given 'customer' in order to at least stay solvent. And you don't understand why that system should be demonized??
"Healthcare is expensive" you say. That's the whole point, IT DOESN'T HAVE TO BE. It's only as expensive as it is here because it's privatized. I'll say that again in case you missed it: healthcare is only as expensive as it is in America because it's privatized. And no amount of 'market-driven' innovations can balance that scale, especially when the eventual product of those very innovations are too expensive for the average consumer to use.
Healthcare does have to be expensive. I don’t intend this as ad hominem, but you don’t understand the economics of healthcare at all. The idea that privatization is solely to blame is so wrong as to be almost unapproachable. I don’t know where to begin, really. The facilities, equipment, administration and compliance, personnel, the laboratories… it’s expensive. And some departments like (emergency med) lose money so hospitals have to compensate in other areas.
It is empirically true that profit incentive is a major driver of innovation. It has to be. A single failed pharmaceutical can cost its company tens of millions. Just look at the productivity of American pharma and biotech compared to other companies. Even foreign owned pharma companies like Novo center their r & d here.
The UK and Canada have major problems too. They also turn patients away. If healthcare is plausibly solvable, we would have done it by now.
As for Penny, it’s amazing to watch leftwing types suddenly ignore systemic issues and demand personal culpability for someone they don’t like. Penny tried to restrain - not kill - a violent schizophrenic who had depressants in his bloodstream. He had no malevolent intention. It is good that he is free.
If it's so expensive then how do other advanced countries do it cheaper? If you can't explain that then you can't say it HAS to be expensive. Since privatization is the major difference, and you claim it's not the sole reason, then what other reasons are there? Crappy diet? Milk hormones? General laziness? I mean, offer something up.
Of course the profit motive CAN be an incentive, I said it doesn't have to be the only one, or even the best one. So no, it doesn't have to be the only one.
"If healthcare is plausibly solvable, we would have done it by now." Is this a joke? Most things don't get done in this country unless there's a profit to be made for it.
You're right Penny didn't have malevolent intention, I agreed with that. But that doesn't mean he, or anyone else in a similar situation, should not be held liable for something. This can range from simple negligence to manslaughter, but just because there isn't harmful intent does not mean someone isn't liable. I can forget to put my car in park and roll it into someone else's car - it was a total accident without harmful intent, but I'm still liable for the damages.
Exceptionally thoughtful article.
Hey Freddie,
I find that I quite like you because I always believe you are motivated by care rather than vengeance or envy. Even if I disagree, that always comes across. I’m not going to say anything else because it seems lots of folks are already doing that. I just want to say I have actual respect for you for whatever value that has for you today. My guess is not much, but there it is.
I have been struck by how the comments sections in the NYTimes articles about this incident. While every op-ed has been an open castigation to anyone who thinks that this murder is understandable in any way, shape, or form, almost every comment has been an explicit rejection of the exact small terror/large terror paradigm those op-eds try to shove down our throats. I've even seen top comments whose authors argue that because health insurance companies make their profits in the gap between the healthcare that people pay for and the healthcare they get, they are profiteers of sickness and death. And this is in the NYTimes comments section! Not a clip sliced from a Chapo episode!
The powerful are continuing to blast normal people with a basic sense of decency for not thinking the system is morally legitimate, rather than seeing people's rejection of its legitimacy as something that means the SYSTEM is wrong. For Bret Stephens to say that his murder and its celebration is the moral crime of our times, and not the fact that THREE (1, 2, 3) people in this country own as much wealth as the bottom 50%--you know, one out of every two every fucking people--says everything you need to know about how committed the system is to (pardon the pop psychology phrase, but I think it's necessary here), gaslighting us into thinking that the crime is not that wealth inequality kills people, but that people kill CEOs back.
Nobody in the political class, not Sanders, not Trump, nobody knows or wants to know just how seething mad with white hot incandescent rage the public is.
Last week I spoke with a bunch of yuppie attorneys who expressed great shock that such a senseless thing could happen to such a great person as CEO Thompon! And when I tried to explain how pissed off the public is Thompson and those like him, they looked at me like I had asked the person who just farted to please identiy himself and changed the subject. Many of these yupcakes were liberals and democrats, card-carrying, dues-paying members in good standing of the PMC. At least one had run for statewide office as a democrat.
They don't get why the dogs don't want to eat the dog food, while they feast on steak and salmon.
I had the same experience with some upper middle class professionals this week as well — they really don’t understand how a lot of this country is living.
Nor have they any interest in knowing how the deplorables live, any more than they want to delve into the consciousness of nazi skinheads or people who misgender.
Freddie I agree With you that the current system is screwed in many regards. I agree we need some form of involuntary institutionalization for the sake of both people like Jordan Neely and normal subway riders. I agree that insurance companies engage in a lot of morally bankrupt behavior. If I could snap my fingers and make all sickness in the world go away I would. I am murderously angry with elites more often than I would like. All that said I think you are missing a point best summarized by another quote.
"[...] how was a girl from Earth to fully understand? The amount of fuel will not power an EDS with a mass of m plus x safely to its destination. To him and her brother and parents she was a sweet-faced girl in her teens; to the laws of nature she was x, the unwanted factor in a cold equation."
— Tom Godwin, The Cold Equations
There are finite hours in the day. Only so many resources. We can't all make it all the time. Do some people have to much? Yeah probably. Could we redirect spending to save more people in x or y way? definitely. Can we solve all problems? No. How do we do the most good with what we have? That is an intractable problem for witch only god knows the answer.
I believe it's human nature to become desensitized to the widespread suffering we see every day - maybe as a psychological defense mechanism against absorbing the magnitude of horrors. Grassroots fundraising experts tell us to tell a story about one hungry child, not billions of hungry children even though, rationally speaking, donors should want to give more to solve a problem affecting billions. But that's not how most people operate. I think this dynamic is at play here with people acting more upset about Thompson's death than the millions who have suffered or died at the hands of a cruel system.
That doesn't explain why Douthat and Sullivan haven't extended empathy toward Neely -- that's another question. But I do generally give public intellectuals a lot of latitude in terms of what they choose to write about and what they don't w/out necessarily seeing their choices as evidence of moral failure. There are dozens of horrendous things going on that I don't write about, and I wouldn't want anyone judging for me that. Sometimes, I really do care about something a lot but my thinking is so muddled or nuanced that it's difficult to produce a coherent piece of writing.
I don't fully agree with everything in here, but the core of it is solid and the disputes mere quibbling. Thank you for writing this.
Not trying to be snarky or whatever, but is there any country in the world where a $2m per year treatment of off-label, unusually high-dose biologics would be easy to get?
I genuinely would like to know if those kinds of services are available and covered with little fuss in e.g. Canada.
I just emailed a doctor friend in New Zealand to ask her if that would be available there. I'm curious too. My bet is that it's not available. But we'll see. It might be, if the government(s) of these different countries has negotiated a better price for the medications.
I'd be interested to know the result. That story sounded to me like a really terrible situation for the guy whose treatment costs $2m per year, but also like a situation where I could also easily imagine pretty much any healthcare bureaucracy just saying "sorry, this treatment plan doesn't meet our clinical and/or cost effectiveness guidelines".
She got back to me and said that the patient would need to go through a bunch of trials of other meds first, but then if it was the only effective treatment, they'd pay full freight. If he wanted to shell out $200-$300 dollars for private care so the trials would be scheduled faster, that's an option, but the Entyvio and Remicade would be still be free to the patient.
And she's not 100% on board with some NZ practices (she's American, and originally practiced here). Lots of recently-developed meds aren't available there at all, so I'm kind of surprised that those two biologics are. But she looked them up and confirmed.
Even at doses way above normal clinical levels?
In the story it was pretty clear that the issue was not whether those drugs would be covered but whether they would be covered at much higher dosages than typically prescribed.
I pushed her on that -- would it still be covered? And her answer was, "Yes, I think."
That's an interesting data point.
As a Canadian it would be really hard just to get to the specialist who would recommend this course of treatment. I don’t think the government would pay for it but I’m not sure.