Tuesday, December 10, 2013

Medical Care Conversation

A "person of some medical authority" (for those who are not regular readers, I work at a hospital, so fill in the blank of the limited number of positions this could mean) mentioned last week that he was not bothered by the insincerity of the central claims for the ACA being revealed as we went forward.  "Everyone knew that.  But they had to say those things to get it passed. It's one of the finest pieces of legislation in our lifetime.  Not for what it is, but because of what it will lead to." Someone worried that it wouldn't work, and much of the system collapse.  "So much the better," he said.  "It will get us there quicker."  He looked positively giddy saying this.

Of course, he often looks giddy, so perhaps I shouldn't hold it against him.

There were definitely voices in the run-up to the vote on the legislation who were quite upfront and vocal that they preferred single-payer...they thought this a barely-acceptable compromise...didn't see how this was going to accomplish what it promised.  I thought they were at least honest. Perhaps my "authority" was one of those, and I am suspecting him unfairly of hypocrisy.  But I've known him for 3 years or so now, and this was the first I'd heard of it.

I was reminded of the response to the Bill Clinton statements in 1998. He was accused of lying, but his defenders were adamant that it was all partisan attacks, that it couldn't be proven. Then it was allowed that he had lied about sex, but that was irrelevant to anything important. All the other accusations were considered unfounded.

By 2003 people's memories had changed.  "Everyone knew he was lying. But he had to." There was often some laughter associated with this.  Well of course, silly, if your goal is to stay in power then you have to do things like that. So it's okay to lie about...well, anything, so long as it's your liar and not theirs? Is there a Democrat today who doesn't acknowledge, and not even very sheepishly, that Clinton lied about a lot of things?

I wonder if we are going to hear this emerging gradually. Of course they knew you couldn't keep your health plan. We all knew that. (Laughter)

Please note that this discussion is entirely independent of whether the ACA is a good idea or not. It is method and basic honesty I am looking at here. It's troubling. In contrast, many people think Bush lied to get us into Iraq.  But you don't hear any of his then-defenders now saying "Well, but he had to, or he never would have gotten the support he needed."  If they were duped, they were honestly duped.


james said...

Morning's at seven; The hill-side's dew-pearl'd; The lark's on the wing; The snail's on the thorn; My party's in power— All's right with the world!

Sam L. said...

And W didn't lie, All the intel community and Willy's admin had the same info, and believed it.

Unknown said...

My first criteria in voting is whether or not I trust the person. Policy matters, but trust matters much more. As members of the medical community, we knew everything in your first paragraph was true. So did many, many other people, yes, including the politicians. But in a subjective truth world, the ends justifies the means.

Assistant Village Idiot said...

Because so many of the supporters are those who believe - who I think are simply wrong and perhaps overoptimistic - I tend to assume that for everyone. That "well-meaning people" could actually be telling themselves there's a good chance this won't work, but we won't say that still doesn't occur to me. I know that there are some, of course. But I would still rather believe that most of us are just fools who could be shown a better way than that most of us are something darker.

Even with this, I still think most were not deeply dishonest. What I think happened, and is happening, is that people have wanted everyone to have health care for a long time. It has ceased to be a rational decision (not that any of us are fully rational about our politics), but more of a deeply-felt need to feel that Something Is Being Done about sick babies and those kids with weird diseases, and single moms who are worried. Beyond that, I think most people don't want to think much about it. They think critical comments are just a ruse.

No one thinks this fully, of course, but it is part of the mix in many minds. I write this because that's what so many people say, first thing out of their mouths, when talking about the issue. Even people who have thoughtful, even elaborate understanding of the issues, when they think they are among only other true believers (which is less true than they think at a psych hospital these days), what comes out of their mouths, right out of the gate, are emotional arguments.

Texan99 said...

The gulf between me and people who assume Bush lied about WMD is very great. I won't try to claim the man never told a lie, but I would be very deeply shocked indeed to find that he lied about the WMD. That he was in some sense mistaken is inarguable. I can't quite make out whether Iraq originally had the weapons (they clearly killed Kurds with them at one point) but smuggled them to Syria during the excruciatingly six-month-long "rush to war," or originally had them and let them deteriorate or dissipate on the black market, or never had nearly as much of a WMD program as everyone thought it expedient to tell their leader they had. What's more, my military friends tell me lots more WMDs were found and destroyed in place than the media coverage would lead us to believe.

But overall it's so obvious to me that there was good reason to think there were WMDs, even if the scope of the problem turned out to have been fundamentally misunderstood. I remained amazed that so many people believe it was a deliberate lie designed to trick us into a war--and yet they don't identify as lies what seem to me to be the perfectly obvious whoppers coming out of the mouth of President Obama.

Do they really see the situation as the mirror-image of what I see?

bs king said...

Texan99 - I don't believe Bush lied, but I'd be happy to explain why my opinion is fairly different from yours.

Back in the 90s, my father-in-law wrote the first weapons inspection ever done in Iraq. He was the Director of the Department of Nonproliferation for the State Department after a 30 year tenure, and was also the US liaison to the IAEA.

He does not now, nor did he ever believe the claims put forward by the Bush administration matched the evidence. His entire job for 30 years was tracking nuclear capabilities around the world and he has testified before Congress numerous times. He expressed his opinion publicly, and was criticized by the Bush administration for it and suffered professional consequences.

Interestingly though, if you ask him "did Bush lie?" he says "no, he did not". This is not because he ever agreed with Bush's conclusions, but rather because he believes that Bush listened to the evidence he wanted to, and saw what he wanted to see. He also believed he had an overly optimistic view of what would happen, and listened to people who endorsed this view.

Now this explanation made a certain amount of sense to me. My father in law was towards the end of his career at this point, his thoughts were considered "old school" and there were new faces with new methods saying differently. Through my in laws, I've gotten to talk to a few former CIA folks who said the same thing - old folks with standard intel gathering methods were pushed out, new folks less vetted ushered in.

Now who would you trust? The new faces with new ways of doing things, or the moldy oldies? I think it's easy to phrase this nefariously "Bush discarded all the advice that didn't agree with him", but really, he just had to pick. IMHO, he chose the more aggressive option of the ones offered to him.

I guess what I'm saying is, these things are a sliding scale. With large policy questions, I don't think it's a truth/lie binary. There's people presidents chose to trust, plans they think are best, and evidence they weigh or discard. It's a huge series of choices on a continuum.

I'm always going to hold my opinion that Bush didn't make the right choice, because that's what the member of the intelligence community I actually know and trust tells me. I'd imagine that those who personally know someone who said differently will always disagree with me. That's okay with me. It keeps peace in my family, but it also opened my eyes to how many hundreds of people are weighing in on these things, each with their own strengths, biases and experiences. Additionally, we will never have the benefit of rewinding and redoing. Maybe Bush did make the right call. Maybe my father in laws plan leads us to the apocalypse. AVI, didn't you do a post recently on "what if this is the better world?"

I guess my point is, I think people who see the mirror image from you are those who insist that all issues are either good and just or evil and lies. It's harder to say "my enemy made some good points, perhaps trusted the wrong folks, attempted something that wasn't fully thought out, and gave us some mixed results" than to scream "BUSH LIED PEOPLE DIED".

It's hard to make nuanced statements rhyme.

Texan99 said...

Well, it wouldn't shock me to learn that Bush (and many people around him and many on both sides of the aisle in Congress) either attended selectively to only part of the available evidence, or relied on others who did so. I'd be surprised if many of them did so in a culpable way, but it's definitely a human trait I recognize even in people who are attempting to be honest with themselves and others.

I distinguish it sharply from, say, the behavior of Oliver North, who seems to be quite open about admitting that he lied through his teeth for what he considered to be excellent reasons, and he's not a bit sorry about it. He considered it very much like the lies one tells when working undercover.

Where does Pres. Obama fit in this spectrum? I credit him with neither the clarity of Oliver North, nor with Bush's honest attempt to reach a true conclusion in the face of ambiguous evidence and strong temptations to selective attention. Obama seems to have made a political calculation that the truth wouldn't fly publicly, but he's not willing to own up to it afterward.

bs king said...

My suspicion with Obama is that he thought it would be like promising to take someone out for ice cream when really your were taking them to a surprise party...something no one would mind because you were getting something better.

In that context "if you like your insurance you can keep it" makes more sense...he would have known it was wrong, but believed the person would forget when something better happened.

I'm from Massachusetts, and I can tell you health care reform is a few years of pain followed by some good pluses and some lousy minuses. I think he figured if he got the political momentum to push through those years, he could get to the other side.

Assistant Village Idiot said...

Wonderful points. Two things: Bethany, I like that Obama analogy, and certainly it applies to many of his supporters as well. "Yes, I am tricking you but you will like this so much better you will thank me later." Which is great if it is a party instead of ice cream. If it actually turns out to be "But either way, you're paying," then it's a bit different. Folks might say they'll settle for ice cream even if a party is better.

As to the WMD, I think there is a divide between the nuclear vs the chemical&biological weapons, a distinction I did not make at the time. The former was always a long shot, without much supporting evidence (not none, but not much). There was quite a bit of evidence for the latter two. Did W and his administration use this to fool himself, or to fool us?

Well, it's easy to think "we've promised silver and gold. We were accused of having neither. We know we have silver. Therefore we must have gold as well." That's terrible logic, but exactly the type of terrible logic human beings gravitate to.

Texan99 said...

Yes, very much like a grownup lying to a child, believing he won't get called on it because the child will be distracted by a treat and will forget.

terri said...

Maybe the problem isn't intentional lying or embracing of fairy tales as much as it is the incredible naiveté that many politicians have...about just about everything.

Too simplistic an approach in almost every sector.

"You can keep your insurance" --spoken by someone who doesn't understand the complexities of how insurance companies, hospitals and the medical community operate in an adversarial, escalating way towards one another leading to the current mess we are in. Pie in the sky thinking

And it is no better on the right. Stupid politicians telling people to eat cake.

Anyone who has ever had a serious health crisis, a parent with declining health who is not old enough to qualify for medical care, or a great need for insurance, and a job that doesn't offer it, knows how completely screwed up the health insurance system is.

And most consumers are just as clueless, not realizing how much their employers pay for their health insurance over and above the consumer's ever rising premiums and deductibles.

When you see the system from the inside and many different angles you quickly realize how ridiculous and rube-goldberg-like the whole thing is.

james said...

AVI, what do you think of the scientist quoted at the end of this post saying "I am an ideologue", and that he uses it for self-motivation?