Wednesday, August 04, 2010

The power of incendiary labels...

The term "socialist" is constantly being tossed at the President or pretty much anybody who favors policies to say, mitigate financial ruin from health care or economic immobility. Thanks to my generations upbringing during the Cold War and the abbreviation USSR, the word itself has the power to instill fear, even when inappropriately applied.

David Frum, another noted conservative kicked out of the club, explains this well.
“Socialists” did not make this mess. Every one of these distortions was championed by President George W. Bush and remains the declared policy of congressional Republicans.  Republicans have chosen energy command and control because the market-maximizing alternative is an energy tax – and taxes are ideologically taboo.
When conservatives categorize Barack Obama as a socialist, they often cite as proof his campaign season comment to “Joe the Plumber” about spreading the wealth around.
Is income redistribution “socialism”? If so, the angry retirees who thronged town halls last summer to protest any retrenchment in Medicare represent the most powerful socialist constituency in the country – for what is Medicare but “redistribution”?
And in fact, if you listen to the angry right-leaning independents, you hear a very surprising message about the US economy.
When asked: Has government given the middle class short shrift? 70% of Republican-leaning independents say “yes.” In 1997, when Bill Clinton was president, only 55% of Republican-leaning independents answered that question “yes.”
And you know what? It’s not a crazy answer! At the peak of the Bush economic expansion in 2007, the typical American worker earned less (adjusting for inflation) than the typical American worker earned at the peak of the Clinton expansion.
There is an explanation for this disappointment: the rapid increase in health care costs in the 2000s crowded out wage increases. But it’s not “socialist” to feel the disappointment – or to wish to do something about it.
Likewise, it’s not “socialist” to notice that upward mobility seems to have faltered over the past three decades – or that a child born into poverty in Europe is now more likely to escape than a child born into poverty in the United States.
If conservatives decide that only “socialists” care about such issues, they will be excluding themselves from the most important economic concerns of middle-class America.
In a modern democracy, there are things that voters will demand be done one way or another. They will demand that the state provide an education to all young people for example. They will demand that it provide a safety net for the poor. They will demand that it support the retired. They will demand that it protect the environment. And in every country on earth except the United States, they have demanded that sickness not expose people to economic ruin.
Which means that advocates for private markets had better figure out ways to accomplish these goals that do not invite government to mess with the private economy. Back in the 1970s and 1980s, conservatives devised and deployed many such ideas. We need to rediscover that same spirit of creativity anew. If we do, we will not need the epithets. If not – the epithets will not help us or anyone else. [More]
But the greatest disservice may be creation of the "death panel" label for end-of-life counseling. Atul Gawande, who has written prolifically as a surgeon to explain how our health care system is failing us has an insightful and sobering look at how we currently handle real death and why it is not merely going to bankrupt us, but adding to the sorrow.
Given how prolonged some of these conversations have to be, many people argue that the key problem has been the financial incentives: we pay doctors to give chemotherapy and to do surgery, but not to take the time required to sort out when doing so is unwise. This certainly is a factor. (The new health-reform act was to have added Medicare coverage for these conversations, until it was deemed funding for “death panels” and stripped out of the legislation.) But the issue isn’t merely a matter of financing. It arises from a still unresolved argument about what the function of medicine really is—what, in other words, we should and should not be paying for doctors to do.
The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And, in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knew how to fight for territory when he could and how to surrender when he couldn’t, someone who understood that the damage is greatest if all you do is fight to the bitter end.
More often, these days, medicine seems to supply neither Custers nor Lees. We are increasingly the generals who march the soldiers onward, saying all the while, “You let me know when you want to stop.” All-out treatment, we tell the terminally ill, is a train you can get off at any time—just say when. But for most patients and their families this is asking too much. They remain riven by doubt and fear and desperation; some are deluded by a fantasy of what medical science can achieve. But our responsibility, in medicine, is to deal with human beings as they are. People die only once. They have no experience to draw upon. They need doctors and nurses who are willing to have the hard discussions and say what they have seen, who will help people prepare for what is to come—and to escape a warehoused oblivion that few really want. [More]
The whole article is some of the most helpful medical information I have read in years.  But it will be a long time perhaps before political gamesmanship will entertain a sane discussion about end-of-life and social responsibility.

We have discovered the power of epithets to keep people constantly afraid and politically malleable. In the process we are destroying trust and arguably shortening the resultant isolated lives.


Anonymous said...

Is it the cost associated with prolonging terminal cases with expensive treatment the reason health insurance premiums out paced pay raises the last 10 years or so? From my experience, the medical people seem to do a good job of spelling it out about continuing treatments. I have three sisters that are nurses, so maybe I have an unusual sourse of information.

John Phipps said...


End-of-life expenses are certainly a factor, but THE factor. What troubles me is what we get in return for extra medical expenses: not much more time or peace. The article points that out well.

Anonymous said...

The latest research shows that hospice care and pain management wins on multiple levels over agressive treatment of terminal patients. People have a higher quality end of life, they have less pain and suffering, and they actually live longer. The fearmongers ["death panels"] should be ashamed of themselves. All they have accomplished is to make many suffer needlessly, and at a higher cost.None of us get out this life alive, so maybe if we all thought about what we wanted ahead of time, filled out advanced directives, and talked to our loved ones, we could stop this madness.