I am puzzled that Megan McArdle generates such controversy and attention. Recently, for instance, Crooked Timber has been refuting her, and a number of blogs have pointed out that her rousing defense of big pharma, which she apparently published in the Washington Post (they all dribble down to the Washington Post eventually, all the fun contrarian rightwingers, into the open arms of Fred Hiatt), was based on such non-starter factoids as “Pharmacy companies make 80 to 90 percent of their profit in the American market”. The latter fact, as she said in her defense later, came from her voices, voices that she trusts – voices of big pharma lobbyists, who apparently come to her in her dreams.
And here I am, giving her attention myself. But I’d like to use her merely as a hook to observe two things. One is that the Atlantic and the Washington Post hire and promote people who seemingly are way too lazy to do any reading. This is why, between 2002-2008, Limited Inc was a much more informed resource for finding out what was happening in Iraq than either of those two media venues. When I write a post about, say, the pharmaceutical industry – like this post here – I don’t just add value by gilding the lilies of my prejudice with obfuscatory prose – McArdle’s sole job in this vale of tears – but I – it is a secret, but I’ll disclose it to all - I, well - be prepared, this is big -I – okay, here it comes, my great revelation that will change the media forever! – I use my library card, provided free by the library (socialism at its deadly work!). Thus, instead of waiting around to see if someone will email me some spin, or reading the back issues of Reason Magazine, I can actually go to Ebsco and JSTOR and look up shit. Amazing! It is called research. Surely Atlantic magazine might actually spring for, I don’t know, making available Light and Lexchin’s 2004 article in the BMJ entitled Foreign Free Riders and the High Price of U.S. Medicines.
Anyway, I’m now going to drop the McArdle thing and make a few general comments about the sheer comedy of the right’s so far successful attempt to destroy Obama’s healthcare plan. Of course, that success is partly generated by the fact that Obama doesn’t seem to have a healthcare plan so far, just a plan to tell his liberal core not to be bedwetters and a plan by his staff to drop hints in Politico that really, the “progressives” are children that need to be spanked. In other words, the Daschle strategy, always a favorite in a town in which the oligarchy and its media pets form a corrupt stanglehold on the dying republic. Business as usual.
In these struggles, the first thing to go out the window is reality. Thus, the current controversy pits conservatives, who are against government in healthcare, against liberals, who are for it. That at least is the image. Of course, it is bullshit. Conservatives, if you have memories stronger than that of a debilitated tse-tse fly, voted in the most expensive addition to Medicare since Johnson under Bush. There is no real conservative opposition to the government in medicine. Rather, the opposition is to the balance of benefits. Bush’s pill bill, for instance, nicely sluiced money to pill companies. It was so designed that the government voluntarily gave up using its buyer power to pull down the price of pills. In other words, conservatives happily went along with a program that would enrich investors. And, in fact, government money in medicine has long made American pill companies, American doctors, American hospital companies, and American insurance companies fabulously wealthy. It is this status quo that real conservatives – the GOP politicians – want to preserve, and have voted time and again to expand. Imagine the government making a regulation that Walmart could not use its scope to bring down the price of goods it gets from its suppliers – imagine the reaction from so called conservatives. But as long as they can stuff the government with such rules, they are happy.
Now, the American people have become noticeably more servile over the past couple of decades, but even in this state of spinelessness, a robust proposal to make the rich richer by whatever means possible would probably shock them. Conservatives can’t go out and say, government should be by and for the wealthiest and the noblest, as they used to in the 18th century. Although conservatives are free to float cockeyed theories that the richest have the highest IQ, and are the geniuses who, like Rumpelstiltskin at his spinning wheel, turn straw into gold. The idea that the producers produce the wealth, a commonplace in the nineteenth century, has long been replaced in the media with the fairy tale of CEO Rumpelstiltskins.
Thus, the conservative and neo-liberal strategy is to make sure that any argument about healthcare is immediately shunted to a discourse that only distantly touches on reality. Reality, of course, shows that long before medicare – since the cholera epidemics of 1830, in fact – government has been involved in public healthcare. John Holbo unfortunately replied to McArdle by granting her points some philosophical merit – and thus discussed this: “People have no obligation to perform labor for others. I may not force a surgeon to save my mother at gunpoint. (To be sure, I might. But society would justly punish me for doing so.)” This is arguing at the twelve year old level about a libertarianism designed by twelve year olds. Here’s what the government can do to you in your own house, if you happen not to keep it clean and rats breed in it: they can fine you. They can take it from you. At gunpoint! And if you are a surgeon, but you don’t pass the state’s test for being a surgeon – let’s say you skipped medical school, cause it is full of propaganda, and have set up your business with a table knife and a bottle of ether – they can haul you off to prison! Imagine that. Government has been able to do this for a long, long time. They determine if you are a surgeon or not. Thus, they could easily write it into that determination that you have an obligation to do a certain amount of public service. That, oh heavens, is what happens when you agree to let the government determine the labor market. Now, you could put your foot down and demand that the government not license surgeons. That would be the twelve year old thing to do, but alas, the 'libertarian' point is not called, here, at all, but treated as though it had some serious relationship to the world we live in. So, getting the government out of “healthcare” would not only entail taking down medicare – a position which the Washington Post might be more hesitant to give space to, instead of fun contrarianism in defense of bigpharma – but opposes two hundred years of public health policy involving filtering water for drinking, sanitation, quarantines, vaccination, spraying for mosquitoes and ticks, regulations on the placement of slaughterhouses, livestock inspection, etc. In fact, of course, it is the state’s “intervention” that has produced the lion’s share of the improvement in our health in developed economies. As anyone with a cursory acquaintance with the facts of health history can tell you, rates for things like tuberculosis, cholera, yellow fever, and an enormous other mass of killers all fell precipitously before prophylactics for them were developed, due to public health measures. The widespread treatment of cholera through saline solutions was painfully delayed in the twentieth century, but the treatment of water, beginning in the late 19th century, essentially crushed the epidemic threat posed by the disease. It is amazing what separating e coli from the water you drink can do to help the young and old.
So, I’ve run out of the time I was going to use in writing about Donald Light’s articles about BigPharma R and D. I’ll do that tomorrow.
Today’s motto, which I urge upon Crooked Timber, is: don’t feed the stupid.
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