Living beyond your means -- the US

[GGT]

Receipts from income taxes are down 2% of GDP ($300 billion) since 2007, or roughly down a quarter, corporate taxes are down about 1.5% of GDP ($225 billion) since 2007, or roughly down 2/3, and an assortment of other taxes are down by smaller amounts. It's basically the government acting like chicken little and giving tax breaks to everyone and their dog.

Edit: Actually, looking at other recessions, the issue isn't so much that we have sharply lower revenue, it's that we already had a historically low revenue when the recession hit (thank you Bush!).

Those Bush tax cuts sounded oh so good, didn't they? Now the GOP is acting like deficit hawks, while saying extend Bush tax cuts, keep fighting in Afghanistan, and don't touch SS or Medicare. They're a little late to the game about living beyond our means.

[Lewkowski]

Receipts from income taxes are down 2% of GDP ($300 billion) since 2007, or roughly down a quarter, corporate taxes are down about 1.5% of GDP ($225 billion) since 2007, or roughly down 2/3, and an assortment of other taxes are down by smaller amounts. It's basically the government acting like chicken little and giving tax breaks to everyone and their dog.

Edit: Actually, looking at other recessions, the issue isn't so much that we have sharply lower revenue, it's that we already had a historically low revenue when the recession hit (thank you Bush!).

Lower revenues forcing more government cuts? SWEET!

[GGT]

Lower revenues forcing more government cuts? SWEET!

The wrong things are being cut. Instead of whittling bloated administration or duplicate services, they're firing teachers, going to 4-day school weeks, closing fire stations, laying off police. Localities are turning off street lamps, letting roads crumble, closing libraries.

But I suppose to you it sounds lovely. All you need is a gun, a homeschooler wife, an education from the Bible, and your insurance policies. Screw everyone else.

[Loki]

Lower revenues forcing more government cuts? SWEET!

Are we living in the same country? Lower revenues haven't led to government cuts since probably WWII.

The wrong things are being cut. Instead of whittling bloated administration or duplicate services, they're firing teachers, going to 4-day school weeks, closing fire stations, laying off police. Localities are turning off street lamps, letting roads crumble, closing libraries.

But I suppose to you it sounds lovely. All you need is a gun, a homeschooler wife, an education from the Bible, and your insurance policies. Screw everyone else.

It's the states that are firing teachers, not the feds. The feds are doing business the same as always.

[Nessus]

I'd like to see the doctors tell that to their own parents (or to themselves). Of course the doctors probably have enough money saved to pay for their own procedures.

But that's the point. Current liberal democratic Western culture is pretty much diametrically opposed to the kind of reasoning that is actually called for in the circumstances Wiggy outlined. Life, as much as possible, for as long as possible, life is precious, life is always a value in itself, so on. Old people are hated and negatively stereotyped partly because they remind young consumers that the reality the market propaganda bombards them with is ultimately false and fleeting. People cannot let go, ever, and their gut response to euthanasia and "denying life-preserving care" (which'd only help to keep the patient suffering for another 2 months instead of a week) is horrified disgust, because the thought that they'd be faced with that choice themselves is unbearable. There is no reverence for the dead, only the pity that they could no longer keep living.

So a cultural zeitgeist would be in order. As far as this issue is concerned, anyway.

[Loki]

But that's the point. Current liberal democratic Western culture is pretty much diametrically opposed to the kind of reasoning that is actually called for in the circumstances Wiggy outlined. Life, as much as possible, for as long as possible, life is precious, life is always a value in itself, so on. Old people are hated and negatively stereotyped partly because they remind young consumers that the reality the market propaganda bombards them with is ultimately false and fleeting. People cannot let go, ever, and their gut response to euthanasia and "denying life-preserving care" (which'd only help to keep the patient suffering for another 2 months instead of a week) is horrified disgust, because the thought that they'd be faced with that choice themselves is unbearable. There is no reverence for the dead, only the pity that they could no longer keep living.

So a cultural zeitgeist would be in order. As far as this issue is concerned, anyway.

I'm sorry, but no amount of pleading will override self-interest. People are genetically and socially programmed to like living, and you'll never convince a sizable portion of them that they should lay down and die for the good of mankind. Hell, even Hobbes (writing 400 years ago) noted that man will not (and shouldn't be expected to) fulfill any contract that likely leads to his death.

[Being]

I'm sorry, but no amount of pleading will override self-interest. People are genetically and socially programmed to like living, and you'll never convince a sizable portion of them that they should lay down and die for the good of mankind. Hell, even Hobbes (writing 400 years ago) noted that man will not (and shouldn't be expected to) fulfill any contract that likely leads to his death.

Unless they are so impoverished that it is the best contract they can get. We're getting to the point that middle class is getting close to that.

[Nessus]

I'm sorry, but no amount of pleading will override self-interest. People are genetically and socially programmed to like living, and you'll never convince a sizable portion of them that they should lay down and die for the good of mankind. Hell, even Hobbes (writing 400 years ago) noted that man will not (and shouldn't be expected to) fulfill any contract that likely leads to his death.

Who said anything about pleading? Or self-interest, really, if viewed objectively. Or are you a cultural nihilist, that there was, is, and always will be one culture? That's kinda myopic, my distaste for the humanities notwithstanding. Obviously the amount of cultures which've fostered situations where participants were eager for their own death is diminutive, but a larger amount of cultures have had atmospheres where death and ageing were considered not with revulsion and fear, but hesitant acceptance.

I get the feeling from your response that you think Wiggin and I want to start a series of info-mercials asking people to die quietly, but that's not really what a change in culture entails. And if your next question is "well what do you want to do then, smart-alec?", obviously I will have to throw my hands in the air; I am not aware of any reliable means of changing culture in a designed, purposeful way.

[Loki]

Who said anything about pleading? Or self-interest, really, if viewed objectively. Or are you a cultural nihilist, that there was, is, and always will be one culture? That's kinda myopic, my distaste for the humanities notwithstanding. Obviously the amount of cultures which've fostered situations where participants were eager for their own death is diminutive, but a larger amount of cultures have had atmospheres where death and ageing were considered not with revulsion and fear, but hesitant acceptance.

I get the feeling from your response that you think Wiggin and I want to start a series of info-mercials asking people to die quietly, but that's not really what a change in culture entails. And if your next question is "well what do you want to do then, smart-alec?", obviously I will have to throw my hands in the air; I am not aware of any reliable means of changing culture in a designed, purposeful way.

That's precisely my point. There's literally nothing that will make a significant portion of the elderly decide to forego life-prolonging treatment. I do dispute your assertion that there's somehow a different culture when it comes to death on the other side of the pond. The reality is that socialized medicine has incentives in place that make it difficult to access this kind of treatment, which leads to the resignation you mention.

Unless they are so impoverished that it is the best contract they can get. We're getting to the point that middle class is getting close to that.

About 90% of the world would love to be as "impoverished" as the American middle class, and I haven't heard of them killing themselves yet.

[Nessus]

That's precisely my point. There's literally nothing that will make a significant portion of the elderly decide to forego life-prolonging treatment. I do dispute your assertion that there's somehow a different culture when it comes to death on the other side of the pond. The reality is that socialized medicine has incentives in place that make it difficult to access this kind of treatment, which leads to the resignation you mention.

I know we've had this whole capitalism vs. socialism US vs. EU thing going on for years, but I actually did not suggest that the situation is currently different here, either. I know anecdotally that there's segments of the population here very pro-euthanasia and who personally abhor the idea of life-prolonging treatments at all costs, but that is just anecdotal, and beside the point anyway in a discussion about US health care.

[Being]

About 90% of the world would love to be as "impoverished" as the American middle class, and I haven't heard of them killing themselves yet.

Wow, that went right over your head. Middle class America doesn't want to be like that 90% of the rest of the world but that's where the money changers are dragging us.

[GGT]

I'm sorry, but no amount of pleading will override self-interest. People are genetically and socially programmed to like living, and you'll never convince a sizable portion of them that they should lay down and die for the good of mankind. Hell, even Hobbes (writing 400 years ago) noted that man will not (and shouldn't be expected to) fulfill any contract that likely leads to his death.

Unless they are so impoverished that it is the best contract they can get. We're getting to the point that middle class is getting close to that.

About 90% of the world would love to be as "impoverished" as the American middle class, and I haven't heard of them killing themselves yet.

Wow, that went right over your head. Middle class America doesn't want to be like that 90% of the rest of the world but that's where the money changers are dragging us.

That was an interesting exchange. It does appear that Loki didn't grasp what Being was saying about the middle classes.

Our "contract with America" is being held hostage when it comes to healthcare. Not that we want to lay down and die, but that our Insurance companies don't leave us much choice, as they hold the keys.

We still have 40% uninsured or uncovered, meaning almost half of our nation is left twisting in the wind. The wealthy can afford top notch, the elderly have Medicare, the poor can get Medicaid, but the middle class just goes broke or has to declare bankruptcy if they get seriously ill.

Developing nations might still think the US is the Land of Opportunity, Freedom and Justice for All....but methinks developed nations look at the US as a nice place to visit, but they wouldn't want to live here.

[wiggin]

I'd like to see the doctors tell that to their own parents (or to themselves). Of course the doctors probably have enough money saved to pay for their own procedures.

You're absolutely wrong on this one. The doctors I'm thinking of most definitely did recommend that to their parents, and probably have similar arrangements for themselves planned. I'm not talking about refusing medical care when you're 70 years old, but when you're 90 and you have a chronic condition that isn't going to get better (e.g. aortic stenosis). You can't even reliably perform surgery on a 90 year old because of the poor morbidity and mortality, so you're largely stuck with non-invasive interventions that will ultimately fail - but at extraordinary cost. If you throw in surgery (which many people do, foolishly), the cost skyrockets and the results do not.

The reason why the physicians I know are motivated by this, though, is not cost - they rarely see the money one way or another (most work in hospitals so don't get extra money for performing expensive procedures, and they know Medicare will cover most of the procedures anyway). Oh, sure, cost is part of the calculation, but it's a distant second to quality of life issues. Have you ever watched people die, day after day, in a drawn out, painful process that is only elongated for a few months by medical science? We can normally do this for most people, but it's an awful way to go. Doctors are very aware of this reality and feel that maybe people need to learn when to let go.

And before anyone starts, don't argue this is a cultural thing. Most of the doctors who I've had this conversation with are religiously observant Jews working at top-notch hospitals. Both their professional and their personal lives place an enormous amount of value on preserving life. I think that people who disagree with them are either morbidly afraid of death or haven't experienced the same day-in, day-out reality of the very old dying.

[LittleFuzzy]

Current liberal democratic Western culture is pretty much diametrically opposed to the kind of reasoning that is actually called for in the circumstances Wiggy outlined. Life, as much as possible, for as long as possible, life is precious, life is always a value in itself,

I.e. secular humanism.

but a larger amount of cultures have had atmospheres where death and ageing were considered not with revulsion and fear, but hesitant acceptance.

You know what is pretty much always a component of those cultures? A belief in an afterlife, that death is not actually the end.

[GGT]

Have you ever watched people die, day after day, in a drawn out, painful process that is only elongated for a few months by medical science?

Yes.

Back to the end-of-life counseling. Doctors have been doing this for ages, and finally asked for some reimbursement for their time. Insurance companies denied these kinds of claims. The issue came before congress for review of Medicare patients and physician payment. That's when Grassley and Palin began the DEATH PANEL hysteria.

[Nessus]

I.e. secular humanism.

Mr. Huggles will prevail! Just because R'lyeh has the left side of the map isn't conclusive proof!

Wait what

You know what is pretty much always a component of those cultures? A belief in an afterlife, that death is not actually the end.

The Nazi volksgemeinschaft idolized death and down-played cliche after-life, though the movement did not have enough time to settle these dogmatic differences either way. I don't see the point of your argument unless you mean to argue that the converse is also true, that atheistic cultures cannot view death through anything else than the lens of hysteric fear and revulsion. Certainly, again, the reverse situation, faithful Christians are absolutely mortified over the idea of the death of a loved one let alone themselves. I will buy your majority argument on the face of it, however, since I asked Low-key to do the same to my own claim. I'm not exactly sure what we're to glean from this vis a vis changing the culture around US "health care" used to prolong one's death, however.

[GGT]

Dr. Atul Gawande, a Harvard Medical School surgeon and writer who just published a long article in The New Yorker about hospitalized patients’ suffering before death, called the study “amazing.”

During the debate over President Obama’s 2009 health care bill, provisions to have Medicare and insurers pay for optional consultations with doctors on palliative and hospice care led to rumors, spread by talk-show hosts like Rush Limbaugh and Glenn Beck and by the former vice-presidential candidate Sarah Palin, that the bill empowered “death panels” that would “euthanize” elderly Americans.

Legislators eventually removed the provisions. In practice, Medicare and private insurers do pay for some palliative care, said Dr. Gail Austin Cooney, a former president of the palliative medicine academy. “But it’s piecemeal,” she said. “The billing is complicated, and for many physicians that’s enough of a deterrent to not bother.”

For anyone who's interested. http://www.nytimes.com/2010/08/19/he...r=1&ref=health