David Brooks makes a very important point in his
column this morning:
We think the budget mess is a squabble between partisans in Washington. But in large measure it’s about our inability to face death and our willingness as a nation to spend whatever it takes to push it just slightly over the horizon.
Health-care costs are at the very core of our fiscal crisis, and not by coincidence. Indeed, I think the cause runs even deeper than Brooks suggests.
The political philosophy that underlies our liberal democracy, and which we rightly revere, places the struggle against death at the center of politics. In most of its forms, it suggests that government exists first and foremost to protect us from death. That has generally meant protecting us from violence, but from the very beginning it also meant protecting us from nature—modernity, after all, has been a quest for power over nature, and has employed both science and politics in that inherently endless pursuit. In 1637, in his Discourse on Method (a political, or perhaps anti-political, work as much as a scientific one), Rene Descartes put plainly what many of the other early moderns also hinted at: that their new way of thinking would (among other things) serve the cause of “the conservation of health, which is without doubt the primary good and the foundation of all other goods of this life.” Strong words—and it’s especially striking that the notoriously doubtful Descartes would say that health is “without doubt” the primary good.
A glance at today’s federal budget, and at those of most modern democracies, would suggest that this view is now widely shared. In a sense, a regime built upon this view is bound to go broke paying for medicine, which is roughly what we’re doing now. Modern medicine has given us tools that the fathers of liberalism could not have imagined for pursuing the conservation of health, and we’re willing to pay a great deal for them. Case by case, it’s very hard to blame anyone for doing so; and even seen in whole, it’s hard to blame the country for doing so. But is there no way to keep that pursuit from overwhelming every other good?
In search of such a way, Brooks points to a thoughtful recent
essay by bioethicists Daniel Callahan and Sherwin Nuland in the
New Republic. Callahan and Nuland suggest a less ambitious kind of medicine, and a more restrained kind of public attitude about its potential. But because the roots of our attitudes about health run so deep, I think what they’re proposing would require an entirely different civilization than ours. They would be better served by pursuing a different way of thinking about economics instead. The one they seem to cling to, which is a kind of instinctive soft socialism, is pretty much the worst possible way to pursue the ends they’re after. Only markets stand a chance—because they both make expensive things cheaper (by driving efficiency) and allow people to prioritize their wants on their own (rather than through the medium of liberal public institutions, which will always have trouble prioritizing health in relation to other goods). That is basically the combination we need, but it will never be easy to attain—for reasons that run much deeper than today’s partisan politics.
This post took my breath away. It did. When I finished it I gasped for air. It is brilliant. I wish I could form my own thoughts so well.
It made me recall that when I was a teenager I had a summer job writing FORTRAN code at the Mt. Sinai Hospital in New York. There was a research scientist there named ( I think) Len Ornstein. I recall reading a paper he was working on in which he forecast that medical care would consume increasingly greater shares of the national wealth in the future.
This was around 1966. Behold.
Reply to this commentLinkReport AbuseI'd like to throw another log into this fire: the less religious a society, the more afraid of death that society is, and thus the greater the weight of its welfare state.
Most (all?) people everywhere are afraid of death. But people with a strong belief in both an afterlife and divine intervention are perhaps less likely to feel the need to stave off their ultimate demise.
The less people believe in an afterlife, the more value their lives here on Earth assume. The more valuable life here on Earth is judged to be, the more measures are justified in prolonging said life, no matter the cost.
It is, after all, the only life we get. Why *not* demand all the health care we can afford-- or even health care we can NOT afford?
Now, I admit, my theory doesn't quite grapple with the American situation, where we are routinely recorded as a far more religious nation than our other Western counterparts. BUT, anecdotally, all but the most fundamentalist religions in the United States pay mere lip service to an afterlife-- it's a comforting thought, but not a compelling justification for behavior.
Meaning, America is probably just as afflicted in the secular disease as Western Europe is, we just hide it better.
Death sucks. No one wants to confront oblivion. BUT, its one thing to be *personally* in denial of your demise out of your own pocketbook. It's another thing entirely to allow others to be in denial of their demise but on YOUR tax dollars.
Reply to this commentLinkReport AbuseYou guys should invite David Brooks to write for NRO the way you have been all over him the last few days in his push to extend the life of Big Government a conservative position.
There are 2 Big Government parties squabbling over how fast government spending will grow in the next 10 years before raising the bar allowing us to borrow more money from our future selves. One party says it should grow slightly slower than the other party.
Let's celebrate!!!
Reply to this commentLinkReport AbuseAs usual Brooks ignores the role that culture plays in this "inability to face death." Not all of America suffers from this narcissism. Those unrefined morons in the middle of the country who still go to church like a bunch of thoughtless lemmings are generally not so concerned with death. Those brave men and now women who go into the military voluntarily face death. It's the narcissists on the coasts and in the Democrat party that can't face death. Brooks thinks all of thinking America should be like him.
The break down of the family, of religion, of self sacrifice, of marriage, of self-reliance. We ignore these issues at our peril. The freedom for these institutions and ideas to flourish is what has made this country great. Without them you have a bunch of narcissists who are all self-involved and care only for themselves - which ironically causes them to use the state to get what they want.
Free markets are for sure the best method in which a society can best meet its collective needs (if there is such a thing). That being said, this crisis of narcissism runs to our destruction of our institutions. Rid us of the this "I will do anything to stay alive culture because nothing is more important than the self," and you will fix a lot of problems that have cropped up since the advent of the New Deal and the Great Society.
Reply to this commentLinkReport AbuseIt's an eye-opening argument, but I can think of some pretty good counterexamples. Canada, France and Australia have generally similar post-Christian cultures where death is viewed with alarm, and also have considerably more gov't involvement with health care. But they aren't anywhere near the same precipice of bankruptcy. I don't think health care is the most important variable in the comparison.
More important is an economy that emphasizes production. Canada, France and Australia have not surrendered to banking and investment as we have; instead, they've made constant efforts to encourage manufacturing.
Reply to this commentLinkReport AbuseWe are fast approaching the point where it will be possible to significantly extend the human lifespan. There is a very good chance that this year's high school senior could live hundreds of years. Yet here we have people saying that we should just accept our mortality and go quietly into that good night. Not me. I'm going to demand every step be taken, no matter how expensive. I want my chance at those extra years.
Reply to this commentLinkReport AbuseSo, Brooks has determined that the problem with socialism is the American character. If only we would let the wise men have their death panels, everything would be groovy. The Euros gave into this idea a long time ago and they are a few more swirls closer to the drain than we are right now.
For the life of me I'll never get the David Brooks fetish around here. The guy is a pseudo-intellectual poser.
Reply to this commentLinkReport AbuseDavid Brooks is becoming more of a ghoul each year. Which is why the NYT publishes him.
Not a conservative.
Reply to this commentLinkReport AbuseWhile I do not read anything Brooks writes, since his "crease in pants" infatuation with Obama in campaign days, I did read this.
I am a registered nurse with over thirty years experience. Alzheimer's care is not to trick death, it is to provide quality of care for our loved ones. I guess, instead, we should just let the old people and the disabled fend for themselves as they try to "trick" death.
Quality of life does not mean triathalons or climbing Mt. Everest. Quality of life, for me watching my own Dad's decline with Parkinson's Disease, was his knowledge that his family loved him and we cared enough to provide this World War II veteran with the best health care available. Much of his home care came from his long-term life insurance, which he paid for with his own dime. It did not come from Medicare or Medicaid. Once a month a nurse came to his home to take his blood for a blood-thinner---this was paid by Medicare,as a few weeks of rehab after a broken hip. The rest of his care was out-of-pocket from his own money.
My father died,in his own bed, in his own room, after five years of total helplessness---but still knowing his family and having a sense of humor---without a single bedsore or going thirsty. His caregiver and family were with him. He died with a smile on his face, and I miss him daily. In comparison, see how elderly are treated in England under NHS socialized medicine (what Obamacare will bring to us!).
If you are poor, or if you are severely disabled, then Medicaid comes into the picture for nursing homes.Medicare pays for rehab and hospital stays, with money taken from your paychecks. Medicare D pays for some drugs. Otherwise care is out of pocket. Medicaid and Medicare are both necessary entitlements.
Until you look your own helpless parent in the eye, don't tell me about quality of life and the cause for this budget crisis. Other entitlements should be cut first. Rampant fraud of Medicare and Medicaid should be cut first. Foreign aid should be cut first. Pork spending by Congress and the WH should be cut first.Pet entitlements by the Democrats to prolong welfare should be cut first.
Afraid of death? My father would have laughed at that one. He did not suffer with his illness, his family did watching this great man decline. Once my grieving mother said to him, "Why did this happen to you?" He, without hesitation, said, "Why not me?"
Correct me if I am wrong, but this article has the whiff of death panels.
Reply to this commentLinkReport AbuseYou're exactly right. Whiff of Death Panels it is. It is not the fear of dying, it is called dying with dignity. Not the Kevorkian style either, as suicide is not dignity. Caring for a dying parent or loved one as best as you can is a duty.
David Brooks is wrong on just about everything, but rest assured NRO will find a way to work him and other statist apologists in from time to time.
Reply to this commentLinkReport AbuseRe: a wiff of death panels: I don't think Levin is talking death panels at all. Near the end of his post he writes "Only markets stand a chance—because they both make expensive things cheaper (by driving efficiency) and allow people to prioritize their wants on their own (rather than through the medium of liberal public institutions, which will always have trouble prioritizing health in relation to other goods)." Yes, rationing of healthcare is inevitable, but that is true for any scarce good (which is all of them). The only question is how? Levin points to markets, which are the antithesis of death panels, maximizing individual choice and freedom.
Reply to this commentLinkReport Abuse"we’re willing to pay a great deal for them"
I believe it would be more accurate to say that we are willing to force someone to pay a great deal for our health.
Reply to this commentLinkReport AbuseProfoundly stupid post. The overwhelming problem is the desire for fairness and the thought that humans can somehow make the universe fair. The meme is that it is unfair for a poor person should get less care than a rich person. And therefore, the government can somehow right this wrong. Well, it can't. What is more with all the government corruptions of the market for health care, it increases the cost of care and makes it worse for everyone. Well, guys, life ain't fair. And if you want cheaper care, then let the market work.
Reply to this commentLinkReport AbuseBrooks may be taking it too far on the quality of life issue, but from a fiscal perspective he is dead on.
I understand the concern about "death panels", but if people didn't have the ability to completely seperate their health care decisions from their finances through insurance, I think (and hope) many people would make different healthcare choices.
I would not want to leave my children penniless because I spent every dime I had trying to eke out another month of life. And I should not be eager to change that decision just because the cost will be born by the community in general, and not my loved ones. Because if everyone in the community is willing to pass the costs on to others, then the community is in trouble.
Reply to this commentLinkReport AbuseIn our case, my father did not leave us "penniless." He bought long-term life insurance, with his own money, and paid the premiums. He was cared for at home, which is far cheaper than being cared for in a nursing home with Medicaid. His long-term life insurance policy paid for healthcare workers for his daily care during the day, which helped my elderly mother. He did not need anyone at night. Again, other than three very brief hospitializations and very brief rehab, nothing was paid by Medicare and he did not qualify for Medicaid. Medicare does not pay for nursing homes.
He had no life-lengthening procedures such as a feeding tube or trach. He had a living will. God had other plans for him, as he had a healthy heart and lungs, so he lived a good life as Parkinson's Disease won the battle.
So, if you are elderly and "viable" (unlike a late term fetus who could be viable but Obama wants to pay Planned Parenthood to abort), in other words, like Dear Leader, this old man golfs. He breaks his hip. Sadly, he is 80 yrs old. Off to the camps! Medicare comes out of paychecks, like Social Security, right? It is money we pay into. But, under the Obama Reign of Terror, it is suddenly his stash??? This same 80 year old man has prostate cancer. Too bad, you are one month past the deadline for treatment.
No one in the "community" paid for my father's care. He did. He certainly did not want a life in a wheelchair, but, as a devout Christian, he also did not want the Kevorkian way.
Perhaps, in this death panel discussion, there should be a question of "volunteers" in nursing homes for those who don't have family to see to their needs.
Why is Obama going after seniors instead of generational welfare? Oh, yeah, votes.
Reply to this commentLinkReport AbuseI'm glad your father's experience was good (at least as good as could be expected under the circumstances).
But technically, a community did pay for his care. Since he was leveraging insurance, the cost of end of life care is baked into the insurance premiums which are paid not only by your father, but also everyone else under the insurance plan.
We can all pay for good insurance, but if we all also insist on high cost end-of-life care, we will soon end up with insurance we can't afford.
Please note I have no idea where to "draw the line", and do believe these decisions should (generally) be made individually. I am not saying your family should have made other decisions.
But on a theoretical basis, we can't all expect several million dollars in near end-of-life care. We will banktupt ourselves if we do.
Reply to this commentLinkReport AbuseMy husband has just been diagnosed with extensive small cell lung cancer, a very deadly disease. Without treatment, he will live 6-12 weeks, with treatment he will live from 6-12 months. In either case, he will die soon.
The question is, is it worth the cost of treatment to keep him alive a few months longer? For us it is, because my husband is an entrepreneur who has many business deals here and yon that he needs the time to unwind. My fear is that the government wants to take that decision away from us.
Reply to this commentLinkReport AbuseI am so sorry you and your family are going through this. My prayers for you, Mabelee.
Reply to this commentLinkReport Abuse>it’s about our inability to face death and our willingness as a nation to spend whatever it takes to push it just slightly over the horizon.
I can do better than that. I can face the death of our nation. It's fiscally irresponsible to deny the inevitable. Let's get on with it. What are you afraid of? Cut the defense budget completely. We'll save lot's of money when we do so. The Chinese leaders are wonderful people. And you-know-who, the great conservative thinker, would back me up: recall D. Brooks comments about how "China will be the United States of Collectivism." Sounds good to me.
So, can I get a high-paying gig now at the NYT with lots of fawning admirers at NR?
Reply to this commentLinkReport AbuseSo now National Review is siging on to Soylent Green?
We try to save peoples' lives. If conservatives are against that, I'll become a liberal.
Maybe 5% of Medicare is spent extending lives a short time.
The "studies" being touted by the deathers (including Brooks) are skewed intentionally.
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