Ka$h for Klunkers
Is anyone else amused and amazed by the Ka$h for Klunkers program? I love the program because of how helpful/unhelpful/brilliant/idiotic it is. There are so many beautiful levels to this thing. On the one hand I think it is great, we are encouraging people towards fuel efficiency in a way that is actually working. On the other hand is $4500 a reasonable way to encourage people to buy less gas? How many years of driving a more fuel efficient car will it take to make up that much money? On the other hand the car dealerships are really thankful for the business and car sales went way up. On the other hand the system set up for them to get paid back for all the rebates people earned has left many dealers millions of dollars in debt. On the other hand what are we going to do with all of those clunkers? Are we going to sell ship them to other countries and resale them? Are they going on ebay? I am just asking. The more I think about 3 billion dollars we are paying to help people buy cars, many of which are foreign (although domestically made such as Toyota and Honda) the more I just laugh at how upside down and backwards everything is right now.
If you want to know if your car qualifies for the program check out the New Yorkers take on the criteria.
Why you should never forward me an email
I have been reading up on the health care package before Congress and I am still left with the same lingering questions, objections, and sense that we desperately need to do something, this just isn’t it. What I am not doing, however, is forwarding emails with half truths, posting ridiculous lies on Facebook (seriously Palin!?!) or waging a personal attack on anybody because of this very imperfect effort at improving our health care system. Why do we buy into these things? Why do we ever put belief into an email with quick phrases, page numbers and partial information from a massive document? Why do we take a complex issue and try to boil it down and slap a label on it? I am so confused by our self imposed idiocy.
Go Joe!
Now that I have all that leadership stuff out of the way I can focus on really important things like GI Joe. While filling my mind with all the glorious ideas of the Leadership Summit, my buddy Dave and I went to a midnight opening night showing of GI Joe. There was a lot of concern about how bad this movie was going to be, especially after the studio didn’t prescreen it for critics. I had mild enthusiasm for it going in, I just knew it wasn’t going to amaze me. But you know what, GI Joe was filled with all the silly funny worthy of a Hasbro toy line. The action was fun, the weaponry was ridiculous, there was corny humor, there were beautiful people who appeared as fake as an action figure, there was a barely coherent story line, and there were all the appropriate lines from the cartoon. It was delightful.
Seriously, it was like going to the circus and getting some cotton candy. (Which I don’t recommend I took my daughter to the circus and promised her cotton candy and they cotton candy cost $12. This was especially painful because I knew she wouldn’t like it anyways. But you better believe I ate ever tiny sticky piece of that cotton gold, but I digress) It was sugary goodness that didn’t offer anything but fun and entertainment. It isn’t a movie I would buy, but four years from now when it is showing on TNT or VS or TBS every night I will stop by every time to watch.
August 11, 2009 at 1:14 pm
My biggest issue with Cash for Clunkers is that it actually is encouraging people to buy a NEW car which will most likely require them to take out a LOAN. Aren’t we already enough in debt as it is? And worse still, the debt is attached to a depreciating asset. At least a house will one day appreciate in value. Cars never will.
But then we wouldn’t be supporting all of the auto labor unions that got some people elected…
August 11, 2009 at 4:42 pm
Auto labor unions are a major issue for the future of the auto industry. Thanks for pointing out the further ridiculousness of the government helping us go into even more debt.
August 13, 2009 at 12:57 pm
Hey Greg,
Auto labor unions are a major reason why the auto industry is in the condition that it is. Unions always eventually price themselves out of a job…ask Pittsburgh. A constant demand for higher wages and benefits, coupled with decreased productivity, is an unsustainable business model.
As the 4 of the top 5 “cash for clunkers” sellers are foregin cars (and then the Ford F-150 pick up truck), the program has been a debacle. What are the real costs? What is the real return on investment? Like Obama said: Fed Ex and UPS are doing relatively well, but the US Postal Service is always a problem (HELLO!). The governement is not, and will not ever be, a profitable entity or an efficient provider of services. Their spending will always exceed their budgets and tax revenues. They can just keep printing more dollars, like they have, but, eventually, market forces will put a stop to that as well (and that is never pretty – If you liked the Carter economy, then you’ll love the coming Obama economy).
Plus, dave is right…consumers need less debt, not more.
I haven’t been a big Palin supporter, but the more that liberals bash her, the more Jim Wallis sends out blast emails defending nationalized health care, the more I start to like her. She has a another related post on her facebook page, which is a point-by-point wonkish rebuttal, including footnotes, to the crticisms of her first, which said this:
The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.
Since you took a swipe at Palin yourself, you should take a look at it. This is also a good article, on the subject of health care reform, from the Idaho Press Tribune:
http://www.idahopress.com/sports/?2009-08-11-Is-this-what-you-had-in-mind-with-health-care-reform
The proposed “health care reform” does indeed include all of the bad stuff that the opponents, including Palin are talking about: rationing; governemnt access to citizen bank accounts; approved list of end of life resources (death panel anyone?); healthcare for illegal aliens; abortion services; and etc., etc., etc.
All for an additional $1 trillion taxpayer dollars, that we don’t have, while increasing our already unbelievable/unsustainable debt load (while tax revenues continue to plummit). And…if anyone believes that the federal government is going to pay for these costs through savings, they are a complete fool with no sense of reality or history.
And…here is another good Canadian Free Press article that hits at the heart of the issue:
http://canadafreepress.com/index.php/article/13647
One more:
http://spectator.org/blog/2009/08/13/palin-is-not-wrong
When even the blue state (bluest of blue states) Marylanders are up in arms over the proposed “health care reform”…you know that it has to be bad, real bad.
And…if the Obama admin., and liberals, don’t want public distrust to cripple their efforts related to “health care reform” (I always think George Orwell when I hear phrases like this, but that aside…), then remove the Kevorkian-like language from the proposal and from the comments of cosultants like Ezekiel Emmanuel. If they don’t, they will continue to hear from the public, including Sarah Palin, on the issue (as she was/is right).
On this issue, we need more Sarah Palin and a lot less Jim Wallis.
Regards,
August 13, 2009 at 1:06 pm
Paul,
Thanks for the articles, I will read them. I am certainly not defending the Health Care bill, I just don’t like it when people accept loosely thrown together information and make huge statements based off of the them. For instance the “end of life” counseling. Everything I have read about that indicates that it is about whether or not to create a living will and making sure you are prepared for what may be down the road not anything to do with actually ending your life. But that is one small tidbit in a ridiculous document.
I will read Palin’s new comments, her last ones were just silly. I haven’t read anything put out by Wallis, but I will check it out. I like Jim Wallis a lot, but we often end up with different conclusions on things.
August 14, 2009 at 8:08 am
Everything I have read about that indicates that it is about whether or not to create a living will and making sure you are prepared for what may be down the road not anything to do with actually ending your life.
Really? What kind of living will is Dr. Ezekiel, Obama’s “health care reform” advisor, proposing here:
“[Health services should not be guaranteed to] individuals who are irreversibly prevented from being or becoming participating citizens. An obvious example is not guaranteeing health services to patients with dementia.”
–EZEKIEL EMANUEL
What kind of living will and preparations are indidcated in Dr. Emanuel’s (Rahm’s brother) Complete Lives System of health care rationing (which he has referred to as “justice”)?
Here is a tidbit:
From The Lancet, Volume 373, Issue 9661, Pages 423 – 431, 31 January 2009, Emanuel writes:
The complete lives system
Because none of the currently used systems satisfy all ethical requirements for just allocation, we propose an alternative: the complete lives system. This system incorporates five principles: youngest-first, prognosis, save the most lives, lottery, and instrumental value. As such, it prioritises younger people who have not yet lived a complete life and will be unlikely to do so without aid. Many thinkers have accepted complete lives as the appropriate focus of distributive justice: “individual human lives, rather than individual experiences, [are] the units over which any distributive principle should operate.” Although there are important differences between these thinkers, they share a core commitment to consider entire lives rather than events or episodes, which is also the defining feature of the complete lives system.
Consideration of the importance of complete lives also supports modifying the youngest-first principle by prioritising adolescents and young adults over infants. Adolescents have received substantial education and parental care, investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments. Similarly, adolescence brings with it a developed personality capable of forming and valuing long-term plans whose fulfilment requires a complete life. As the legal philosopher Ronald Dworkin argues, “It is terrible when an infant dies, but worse, most people think, when a three-year-old child dies and worse still when an adolescent does”; this argument is supported by empirical surveys. Importantly, the prioritisation of adolescents and young adults considers the social and personal investment that people are morally entitled to have received at a particular age, rather than accepting the results of an unjust status quo. Consequently, poor adolescents should be treated the same as wealthy ones, even though they may have received less investment owing to social injustice.
The complete lives system also considers prognosis, since its aim is to achieve complete lives. A young person with a poor prognosis has had few life-years but lacks the potential to live a complete life. Considering prognosis forestalls the concern that disproportionately large amounts of resources will be directed to young people with poor prognoses. When the worst-off can benefit only slightly while better-off people could benefit greatly, allocating to the better-off is often justifiable. Some small benefits, such as a few weeks of life, might also be intrinsically insignificant when compared with large benefits.
Saving the most lives is also included in this system because enabling more people to live complete lives is better than enabling fewer. In a public health emergency, instrumental value could also be included to enable more people to live complete lives. Lotteries could be used when making choices between roughly equal recipients, and also potentially to ensure that no individual—irrespective of age or prognosis—is seen as beyond saving. Thus, the complete lives system is complete in another way: it incorporates each morally relevant simple principle.
When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated. It therefore superficially resembles the proposal made by DALY advocates; however, the complete lives system justifies preference to younger people because of priority to the worst-off rather than instrumental value. Additionally, the complete lives system assumes that, although life-years are equally valuable to all, justice requires the fair distribution of them. Conversely, DALY allocation treats life-years given to elderly or disabled people as objectively less valuable.
Finally, the complete lives system is least vulnerable to corruption. Age can be established quickly and accurately from identity documents. Prognosis allocation encourages physicians to improve patients’ health, unlike the perverse incentives to sicken patients or misrepresent health that the sickest-first allocation creates.
Objections
We consider several important objections to the complete lives system.
The complete lives system discriminates against older people. Age-based allocation is ageism. Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years. Treating 65-year-olds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not.
Age, like income, is a “non-medical criterion” inappropriate for allocation of medical resources. In contrast to income, a complete life is a health outcome. Long-term survival and life expectancy at birth are key health-care outcome variables. Delaying the age at onset of a disease is desirable.
The complete lives system is insensitive to international differences in typical lifespan. Although broad consensus favours adolescents over very young infants, and young adults over the very elderly people, implementation can reasonably differ between, even within, nation-states. Some people believe that a complete life is a universal limit founded in natural human capacities, which everyone should accept even without scarcity. By contrast, the complete lives system requires only that citizens see a complete life, however defined, as an important good, and accept that fairness gives those short of a complete life stronger claims to scarce life-saving resources.
Principles must be ordered lexically: less important principles should come into play only when more important ones are fulfilled. Rawls himself agreed that lexical priority was inappropriate when distributing specific resources in society, though appropriate for ordering the principles of basic social justice that shape the distribution of basic rights, opportunities, and income.1 As an alternative, balancing priority to the worst-off against maximising benefits has won wide support in discussions of allocative local justice. As Amartya Sen argues, justice “does not specify how much more is to be given to the deprived person, but merely that he should receive more”.
Accepting the complete lives system for health care as a whole would be premature. We must first reduce waste and increase spending. The complete lives system explicitly rejects waste and corruption, such as multiple listing for transplantation. Although it may be applicable more generally, the complete lives system has been developed to justly allocate persistently scarce life-saving interventions. Hearts for transplant and influenza vaccines, unlike money, cannot be replaced or diverted to non-health goals; denying a heart to one person makes it available to another. Ultimately, the complete lives system does not create “classes of Untermenschen whose lives and well being are deemed not worth spending money on”, but rather empowers us to decide fairly whom to save when genuine scarcity makes saving everyone impossible.
Legitimacy
As well as recognising morally relevant values, an allocation system must be legitimate. Legitimacy requires that people see the allocation system as just and accept actual allocations as fair. Consequently, allocation systems must be publicly understandable, accessible, and subject to public discussion and revision. They must also resist corruption, since easy corruptibility undermines the public trust on which legitimacy depends. Some systems, like the UNOS points systems or QALY systems, may fail this test, because they are difficult to understand, easily corrupted, or closed to public revision. Systems that intentionally conceal their allocative principles to avoid public complaints might also fail the test.
Although procedural fairness is necessary for legitimacy, it is unable to ensure the justice of allocation decisions on its own. Although fair procedures are important, substantive, morally relevant values and principles are indispensable for just allocation.
Conclusion
Ultimately, none of the eight simple principles recognise all morally relevant values, and some recognise irrelevant values. QALY and DALY multiprinciple systems neglect the importance of fair distribution. UNOS points systems attempt to address distributive justice, but recognise morally irrelevant values and are vulnerable to corruption. By contrast, the complete lives system combines four morally relevant principles: youngest-first, prognosis, lottery, and saving the most lives. In pandemic situations, it also allocates scarce interventions to people instrumental in realising these four principles. Importantly, it is not an algorithm, but a framework that expresses widely affirmed values: priority to the worst-off, maximising benefits, and treating people equally. To achieve a just allocation of scarce medical interventions, society must embrace the challenge of implementing a coherent multiprinciple framework rather than relying on simple principles or retreating to the status quo.
And…Greg, what exactly would you call a group of government bean-counters that make decisions relative to the fair distribution of health care resources based on age and the assessment of their ability to live a complete life?
Sarah Palin was right.
August 14, 2009 at 11:23 am
Man, got to love Paul…the king of cut & paste.
August 14, 2009 at 3:17 pm
Man, got to love the king of all ignore the big fat elephant in the room.
The Dr., an Obama admin. healthcare advisor, is advocating the rationing of healthcare based on the some very shocking criteria.
August 14, 2009 at 12:07 pm
Good article about some of the misinformation out there from NPR
http://www.npr.org/templates/story/story.php?storyId=111729363&ft=1&f=1027
August 14, 2009 at 3:09 pm
No response in regard to Dr. Emaunuel’s shocking proposal for rationing of healthcare?
That seems awfully strange.
Sorry, NPR (are they being one of the the Joseph Goebbels of our time?)…Dr. Emanuel’s writing on the subject is crystal clear. He would have healthcare rationed by age and the ability to live a “complete life” (as defined by whom? What shall we call that determing government panel? Obviously, you don’t like “death panels”.). It is in black and white for all to see.
My grandma had dementia…I am glad that Dr. Emanuel was not determing the distribution and quality of her care.
By the way, some of this thought and rationing is permeating throughout UK’s socialized healthcare system, right now.
If the Obama admin. and the liberals don’t want people to believe the possibility of the existence of what Obama calls “death panels”, then just remove all doubt by firing Dr. Emanuel, who clearly advocates what the opposition is concerned about, and removing all suspect language from Congress’s bill (or just go with the a more sensible proposal that includes, among other things, tort reform and portability).
Given the existence of both, what Sarah Palin said is not “silly”, by any stretch, as you ascribed.
August 14, 2009 at 5:11 pm
I haven’t had time to dig into Dr. Emanuel, the Dr. Kavorkian of the Obama Administration yet. After I read it I offer thoughts.
August 18, 2009 at 4:19 pm
No digging necesary…
Just comment on the king of all cut and paste from above.