Wednesday, July 29, 2009

'Poor People Can't Have Health Care Because I Fear Dumb Shit'

Note: unlike many of the other guest pieces on Et tu, Mr. Destructo? today's editorial response comes from a real, live person: the mysterious Mr. Awesome, a law student who is not a pundit and fears nothing. He last paid us a visit to relate his tale of seeing Barack Obama with The Devil.

Tripping the McArdleverse

Megan McArdle is a libertarian blogger for The Atlantic, a prominent DC-area think-speak magazine. Like all DC-area magazines, the quality of its contributors varies by an enormous margin likely explained through the dense, varicose veins of patronage and glad-handing that runs through that town. Sometimes, you can find incisive, solid commentary under the banner of The Atlantic. Sometimes, you will find contrarian white noise, and sometimes you will find grossly dishonest crap. Megan McArdle produces the last two, with gusto.

She belongs to an exceptionally stupid set of youngish libertarian Economist-esque pseudo-thinkers. Her "columns" mix the very best shallow diarist introspection of yuppie navel-gazing with the arrogant dead thought theatrics of a fake intellectual who operates with no standards of proofreading or fact-finding. She is a small fish in the great pond of bullshit punditry, but she's like a clownfish, really bright and attention-grabbing — because she's just so damn terrible. She lives in a dense tangle of white privilege anemone, which will cause a nasty rash if you touch it. There is perhaps a moray eel of intellectual accountability staring at that shiny overgrowth all bug-eyed like, "What the fuck is that?"

Here she explains why public health care is bad:

Basically, for me, it all boils down to public choice theory. Once we've got a comprehensive national health care plan, what are the government's incentives? I think they're bad, for the same reason the TSA is bad. I'm afraid that instead of Security Theater, we'll get Health Care Theater, where the government goes to elaborate lengths to convince us that we're getting the best possible health care, without actually providing it.

That's not just verbal theatrics. Agencies like Britain's NICE are a case in point. As long as people don't know that there are cancer treatments they're not getting, they're happy. Once they find out, satisfaction plunges. But the reason that people in Britain know about things like herceptin for early stage breast cancer is a robust private market in the US that experiments with this sort of thing.

Enjoy this link to the wikipedia page on public choice theory. I have now provided more citation than Megan McArdle chooses to in her entire column. Here, McArdle name drops a theory founded on the real or imagined essential ignorance of the voter in order to buttress a bog standard "The government = DMV = BAD!" argument. Never mind that the TSA in particular has been totally farmed out to the private market. That's incredibly ironic and destroys what little substance existed in that first paragraph, but, well, okay. At least there were words there.

Then we get some stuff about herceptin. Fun fact about herceptin, it was developed in a private-public partnership between the company Genetech and researchers at UCLA — like most long-term medications with no immediate profit (excluding purely elective treatments like Viagra.) Herceptin is one of many drugs originally developed in the United States through public-private partnership. In fact, this is how the plurality, if not the majority of new medical advances are produced. Moving along:

So in the absence of a robust private US market, my assumption is that the government will focus on the apparent at the expense of the hard-to-measure. Innovation benefits future constituents who aren't voting now.
Wait, what?

McArdle found the time to implicitly prove that a public option will totally destroy the pharmaceutical industry. That's rhetorical economy. Seriously, this is the next paragraph. I'm not cutting things out of context. She goes from herceptin to this. The private pharmaceutical industry has been destroyed somewhere between these two paragraphs, like in one of those side by side picture puzzles where something subtle is different between the two. In the last paragraph, it was the year 2009. Now it is 2015, and Skynet has sent the Wilford Brimbots for your diabetes testing supplies.

Of course, the usual public option threat is that it will destroy our current HMO system. But, in the McArdleverse, your conventional understandings of the relationships between related things do not apply. Cheap government health care will destroy the pharmaceutical industry beyond repair or reconstruction for some reason lurking between those two paragraphs. Deal with it.

Now that the private pharmaceutical industry is destroyed, there is only the government to fund research. And the government will only fund research with tangible short-term benefits. Because that's what they do at the National Institute of Health and the National Science Foundation. They fund things that make a short-term tangible profit, because no one else will.

This is an unusual perspective. Typically, the government funds research which will not make a profit, because if you can secure venture capital, you won't have to go through an entire grants application process. I honestly have never seen the argument that government research is too short-sighted or too results-driven. It's usually the exact opposite. This is like seeing someone criticize NASA for being all about the money. I really have no idea.

She continues:

In fact, innovation is more often a matter of small steps towards perfection. Wal-Mart's revolution in supply chain management has been one of the most powerful factors influencing American productivity in recent decades. Yes, it was enabled by the computer revolution—but computers, by themselves, did not give Wal-Mart the idea of treating trucks like mobile warehouses, much less the expertise to do it.
Yes, Wal-Mart, the model of innovation we should apply to medicine. You see, they treated trucks like mobile warehouses by storing things in trucks as they drove around the country. No one else ever had this idea. Short-term train depot storage, shipping warehouses and staged military field logistics all took the lesson from Wal-Mart, the amazing small step toward perfection that is realizing that objects in transit still exist. People in mobile homes do not merely shop at Wal-Mart — they were created by Wal-Mart.

Oh, sure, computers made it possible to realize that objects in motion are objects, what with the floating points and all that, and, sure, computers were created by the government. But did the government ever think to use these computers to sell swimming trunks for $5? Did the government ever even consider that they could sell product at a loss to drive regional competition out of business, then resume normal pricing? No.

The government was aware of the possibilities behind this innovation, and attempted to prevent that last practice through anti-trust and anti-monopoly regulation, sure. But it was Wal-Mart who realized the innovative potential of having those laws thrashed through Supreme Court reinterpretation until they became meaningless.

Health care works the same way:

In the case of pharma, what an NIH or academic researcher does is very, very different from what a pharma researcher does. They are no more interchangeable than theoretical physicists and civil engineers. An academic identifies targets. A pharma researcher finds out whether those targets can be activated with a molecule.
You see, the academic researcher (government bureaucracy, TSA, DMV, EWW) is like a sidekick to the production research of the private market. You may ask, "How does this jibe with the stuff above about the government being short-sighted and unable to wait on advanced research?" Well, it doesn't, at all.

In the McArdleverse, research is conducted in phases. The original researchers "identify targets," like livers and brains and such. Then they pass on that info to the private market, like "Yo, check out the liver, dawg. You should activate that shit moleculewise." The researchers who invented herceptin would be surprised to know their research was conducted in the form of protracted two-stage alleyoop between entirely different sets of researchers incapable by structure from performing one another's research tasks.

Sure, you could try to get a public university professor to conduct animal testing trials. You could ask a guy at UCLA or wherever to test different formulations of actives for varying effectiveness. But you would only confuse and enrage the academic. Academic researchers have, as a rule, never participated in for-profit research, which is just a completely different skillset. The academic is a Shaquille O'Neal who spends all day lumbering around the paint, rebounding and, confused as to its nature and purpose, constantly dishing the rock to able power forwards who've discovered advanced basket making.

The government does not develop market-ready medicines. Penicillin is a lie. And even in the McArdleverse, the private pharmaceutical industry is dead. Fulfilling this ostensibly necessary portion of medical development would just die out because of the public option. All mechanisms related to its hypothetical function shall be lost beyond repair. There is no market purpose nor competitive niche which could possibly sustain an industry before the all-consuming destruction of public health care. Like all true free market believers, McArdle understands that the free market is the best way of doing things until you cause it to cease to exist by being mean to it or looking at it the wrong way.

It's an infinitely self-diversifying and adapting system, until you do anything that slightly inconveniences it in a way that doesn't translate to an immediate example of why it's the best system ever. It's like a Holodeck that can create any world you can dream of, but if Captain Picard even so much as outlaws simulating the Underage Babyfucking Planet of Murder III, then the whole damn thing is completely broken and unusable.

McArdle realizes there are victims, such as herself, McArdle:

At this juncture in the conversation, someone almost always breaks in and says, "Why don't you tell that to an uninsured person?" I have. Specifically, I told it to me. I was uninsured for more than two years after grad school, with an autoimmune disease and asthma.
I'm alive, writing stupid shit for a magazine on the internet! So, you go tell this on the mountain, because if my stupid-ass decision is good enough for a callow twentysomething woman, it's sure as hell good enough for everybody, including their children. The stagnant tide straightens all boats!

If you can't go for only two years out of college — you know, like everyone who didn't learn vector calculus — without insurance during the period of life in which you're least likely to die of anything, fuck you. It's like driving to the store without a seat belt. Why do you need the government to make you have seat belts? It's only up to the store.

McArdle doesn't like unnecessary risk to herself anymore than McArdle does. But McArdle soul-searched long and deep, broadening her personal experience by asking McArdle about how McArdle felt about health issues related to McArdle. This is the rare moment in punditry when the author plays the, "I know poor people and they hate welfare!" card by referencing herself. Yes, it truly is all about her.

To McArdle's question, McArdle poses a question:

Why don't you tell some person who has a terminal condition that sorry, we can't afford to find a cure for their disease? There are no particularly happy choices here.
Oh, shit, she's got hostages! Drop the health care — slowly! — or everyone dies of multiple sclerosis!

A question she answers with fat people, and elitism:

The other major reason that I am against national health care is the increasing license it gives elites to wrap their claws around every aspect of everyone's life. Look at the uptick in stories on obesity in the context of health care reform.
This canard was adapted from the trans fat bans and then just pasted unaltered onto the health care debate. You see, trans fats are horrible shit that makes you die and serves no other purpose except being marginally cheaper than other preservatives. So, when the government wanted to ban them, a lot of people became extraordinarily angry, as though the government were one step from mandating seat belts at the dinner table. The funny thing about just repurposing this shtick for health care is that fat people are NOT the primary drain on resources — it's really old people. And really old people, as a rule, are not hugely fat, or they would never have become really old. The really old, in the last years of life, are where you will find a plausible crunch in life-saving funding. It's also just as viable an avenue for a scare tactic.

But McArdle can't be bothered to know this much about things. She has an opinion to get out there and she snags whatever castoff words, phrases and ideas are available, like a lazy television writer trying to invoke current events. You could ask her, "Should we increase funding for roads by taxing rich people?" and she'd say something like, "No, that's a terrible idea. Researchers in Scandinavia found out years ago that taxing rich people makes roads explode because coffee prevents heart disease and eggs are good for you." This is the natural endpoint of education without understanding.

Play her off, fat people:

These aren't just a way to save on health care; they're a way to extend and expand the cultural hegemony of wealthy white elites. No, seriously. Living a fit, active life is correlated with being healthier. But then, as an economist recently pointed out to me, so is being religious, being married, and living in a small town; how come we don't have any programs to promote these "healthy lifestyles"?
Yes, fat people. What right has the government to try to help them not die of being fat? This is an even worse example of big city elitist mockery than the time the Surgeon General put those messages on cigarette cartons as a cruel reminder to smokers of their inevitable death. Every time I sit in a car, the government is in my face to remind me that my sideview mirror is an inaccurate measure of the distance of things, shattering again and again my happy faith in the accuracy of mirrored surfaces. The government has always been the archetypal jackass who spoils the end of the movie or reveals the wires in poorly staged shots.

It is weird to see libertarians go to the fat well so often. Fat people are a stark reminder that private consumers can make terrible choices with their money, purchasing cheap, fattening foods which slowly kill them while robbing them of their quality of life. Rational actor theory doesn't really account for fat people.

Yeah, and what's to stop the government from promoting religion, marriage, and living in a small town? Like it does already, with tax subsidies for marriage, tax exemption for religious organizations, and a state-federal tax system which puts more money into rural areas than it takes out? No, seriously.

Finally, she remembers the elderly, sort of:

Of course, the obese aren't the only troublesome bunch. The elderly are also wasting a lot of our hard earned money with their stupid "last six months" end-of-life care.

And here, an old classic. She's almost done with this, thank goodness.

Once the government gets into the business of providing our health care, the government gets into the business of deciding whose life matters, and how much.
Indeed, why should anyone ever say who gets to live and who gets to die? These are difficult decisions, and like all hard choices, they're best left unmade.

It's over. It's fucking OVER:

The real issue is the effect on future lives, and future freedom. And in my opinion, they way (sic) in overwhelmingly on the side of stopping further government encroachments into health care provision.
This argument about health care is a scrapbook of other arguments — pharmaceutical regulation, research funding systems, and so on, then propped up by a flimsy assertion. She tags "This is about health care" up top, then just rambles crap she misremembers, thinks she knows, and misunderstands. Maybe she is honest, to a point. Maybe she is a sincere believer that this mishmash of broken, scrambled factoids is an actual train of thought, and that this train actually does connect at the health care station. Maybe she's not, and she's trying to trick people, giggling that anyone in the world would buy this, literally or figuratively. This is the classic case of giving a doofus the undeserved credit of being a mastermind: The Mr. Bean fallacy.

The uninsured are unreal for the McArdles of the world. The McArdles do not listen to these people, believing their own sheltered lives are a viable facsimile for anyone's troubles or experience. They are so smart that they don't have to conduct research before reaching conclusions; they are so wise that they require no experience to understand other people's lives. They are so damn great and important that the petty problems and limited movement of their tiny orbits around unaccountable safety are the total motion of the world. Theirs is a nation of 300 some million, the vast majority of whom are extras and objects in their boring, whitebread existence.

In the McArdleverse, a rich white girl speaks with the voice of poor fat people who can't afford health insurance to deliver a dire warning about elitism and freedom of choice. Meandering, self-aggrandizing sermons about choice echo from the dotted-line mouths of people who can't afford choices. Fat people are why you shouldn't have health care. The government destroys products just cause. Pharmaceutical research is inextricably tied into the dysfunctional cash grab of corporate health care oligopoly in the McArdleverse. The silken strands of the fragile Free Market tie together all manner of unrelated things into a spiderweb of inevitability and helpless shrugging. As in our world, the poor will sicken and die needlessly in the McArdleverse, but in her world they are the empowered victims of helpless fate, and not the sacrifice offered up for the profits of a few and cowardice of many.

This "essay" is not an attempt to describe our world. It is an attempt to pull our real world into the McArdleverse, where our failure as a society is excusable, or even noble. Megan McArdle makes a living writing this crap. Think about that the next time you produce some item or service of actual quality.