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Thursday, May 3, 2007

Going thin or going thick

In a note on whether blogs are "infotainment" for the educated, AS writes about the worries of shallow versus serious writing.

First, it's a worthy that AS even worries about it, because you can imagine that Michelle Malkin, for example, never does (unless "deep" is serious arguments about interning fellow citizens or something ...).

Clearly, there are some people who are quite skilled at knowing everyone who has an informed opinion, rather than actually having an informed opinion themselves. Make up your own mind about how to judge that, if it needs to be.

Second, I think it is a false tradeoff. When you get to be around sixty or so, I imagine, you can write with both depth and width, if you played your cards right, along the way, and don't fail to keep getting the facts (as Safire, for instance, failed to do when he started writing about the UN oil-for-food scandal). Unless you are John Stuart Mill.

A while back AS made a list about things that he was going to pay more attention to, including gerrymandering and some other things, like healthcare. My 2-cents is to jettison the other things (including gerrymandering...) and get healthcare into the top ten, so that writing about it is more than "I like drug companies" and "I don't like socialized medicine", etc. With luck, healthcare reform may be one of the issues that defines the next Presidency and the early legacy of this generation's politics in this century.

If there is a citizen's literacy test to be formed, it might include things like:

  1. Do you know the difference between a single-payor system and a single-provider system? Why do some people think single-payor is a good idea? Who are the 'vested interests' likely to be against such a shift (and what lies would they tell ... or costs, emphasize)?
  2. Who do you think should be making rationing decisions about health services, individuals or some system of experts that handles them indirectly, or markets that set a price that you can either pay or not?
  3. What are the pros and cons of paying doctors for treating people, rather than paying doctors a fixed salary or for broader concepts, such as wellness. Are there important hybrid cases, in which doctors receive both fixed salaries and "incentives" for good care or hard work?
  4. What are the advantages and disadvantages of giving people the money to buy their own insurance (rather than depending on their employers to provide it)? Will that create more efficiency or less efficiency? What impact, if any, will that have on preventive care - and how important is preventive care from a cost-benefit perspective?
  5. Are there incremental steps that one might try toward a larger goal, without revolutionizing everything at once? If so, which ones?
  6. Do you know the basics about how health care money is spent (on who and on what) and how it ties in with difficult decisions about end of life, etc.? Where are the major costs and any 'monopsony'-like powers in the value-chain in the American system? In other systems?

There are other frameworks too. There is a Cato Institute guy who put together a 'Gordian knot' of three 'fundamental' trade-offs, with the dictum that he found it impossible to simultaneously solve all three equations at once, so to speak. That is, that they were necessary trade-offs.

This is just my off-the-cuff list.

The blogosphere is alight with discussion of health topics.