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mike shupp

Well... it's, ah, un-nuanced. But I don't think I'd read all that much into Obama's remarks. I think he's met Boehner a couple of times by now, and he's made some remarks to Boehner and Boehner's made some remarks back, and they know by now what arguments they're going to raise. So this is pretty much the equivalent of getting in an argument with your wife for the fifth time about her useless brother Donald and having her shrug you off with "Whatever, Dave." So there's familiarity without a lot of love showing and it's not clear outsiders who haven't watched the marriage for a few years can understand what's going on without a scorecard.

Yeah, arguably Obama and Boehner ought to be on more respectful terms with each other, but in a saner universe Obama and Boehner wouldn't be dickering over the budget deficit every other week. Is Obama actually the person who deserves all the blame?


And personally, it seems a damned silly argument. Boehner ought to be free to pop up once a day and scream "We must reduce the deficit immediately!" on all the major networks and websites. And Obama ought to be free to pop up just as often and say "To reduce the deficit, I've just ordered the Secretary of Defense to close a naval base in Turkey, an Air Force base in Italy, and two small Army bases in Kentucky! We'll get back to you on Monday with more closures!" Somehow, after a couple of weeks of that... well, the deficit would be smaller, and Democrats would be pleased and Republicans would be ... They'd be something, anyhow, I'm not sure what.

mike shupp

Couple of thoughts re healthcare.

(1) Healthcare is a potential counter to the problems of low birth rates. If just about everyone was hale and hearty and capable of serious work to say the age of 80, it's a good bet that our retirement age would be raised to 80, and we'd regard the extra 50 million people in the work force as an important part of our economic strength. (Granted, 80 year olds aren't as open to new ideas and as flexible to job shifts as 20 year olds, but their extra experience ought to have some value too.)

(2) We're in an awkward situation where modern medicine can prolong life but not prevent aging. Which leads to the sort of issues no one really wants to address -- the cost of keeping people alive with Alzheimer's and serious disabililties who simply aren't part of the "living" community. It's unclear to what extent improved care and near term medical advances will change this situation. Should the US as a society try to solve this with better medicines? Or should we follow the Japanese example and be working on robot attendents to provide care for the elderly?

(3) At some point, we might hope to know about drug interactions and human genetics that physicicans can diagnose illnesses and prescribe treatment regimes for the sick on an individual-by-individual basis. We might even have tailor-made medicines, and we might even have this be so routinized as to be "cheap" (well, cheaper than the costs of being sick). Alas, we're probably a century away from that point, although we should see glimmerings of it in 50 years. That's my guess, anyhow.

(4). There's probably a huge stock of cheap game-changing medical innovations that haven't been realized yet, but will slip into place with little notice. The Heimlich manuever for treating people with choking, for example, or training people how to deal with drowing victims, or the emergence of paramedics as a profession, or the provision of electroshock gear for treating heart attack victims in building lobbies, or auto seat belts, or spreading disapproval of smoking and drunk driving and wife-beating... Most of these we don't consider medical costs, but they affect health, and they seem to do so in ways which are acceptable to liberals and conservatives.

Dave Tufte

Two comments from Mike, so two replies:

1) I think all your points are well-taken. But as someone who tries to figure out what makes the Obama administration tick, this was an ah-ha moment for me.

2-1) Agreed. The cut-off ages for Medicare are "attached" to those of social security. When that was instituted, the life expectancy of a 65 year old just starting to collect was 2 years. If we had kept up with that target, the retirement age would be around 80.

2-2) Agreed. We have certainly dug a hole for ourselves. For me, the important recognition is that we need to address this first ... not the melange of issues that was in Obamacare.

2-3) Who cares? That tailoring of medications is a secondary concern to the primary one that they make the financial problem worse.

2-4) Again, who cares? It's all good ... but these are secondary or tertiary issues.

mike shupp

Two responses:

(1) I've never seen Obama and Biden as saints or angels given us by God to lead us into Paradise. My thought back in 2008 was that Obama was an ordinary Chicago Democrat who would give us a wishy-washly Big City sort of liberal administration, and that's basically been borne out. I voted for the guy then and in 2012 because the Republican teams seemed worse -- and because my considered judgement is that the USA actually needs a dose of wishy-washy liberalism-- but I've never burned candles in his honor. So it goes.

(2) My points 3 and 4 on the second post were that personalized medicines and some sorts of health-related social tweaking might actually reduce health care spending or related spending over time. Think for a moment about the various initiatives to get lead out of the environment, whether in automobile exhausts or indoor paint. Or asbestos removal efforts. Are these REALLY insane-liberal vs sensible-conservative issues?

Dave Tufte

1) Agreed. I voted for Obama in 2008, but couldn't bring myself to vote for either of them in 2012.

2) I totally agree with this. But, I still think these are secondary ... at best. And, by the way, personalized medicine is another way of saying less elastic demand, which will make the overpricing issues worse.

See my new post on this.

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