Healthcare Reform of Titanic Proportions

Please--Write Your Senator TODAY

I'd much rather be quietly celebrating the holidays with my family--but this issue is much to important to let slip by through Congress. My heart sinks at the thought that the Senate will pass the health care reform bill, over the objection of the majority of the people in the United States. What hubris motivates the Democrats in the Senate? Their strident support seems only to increase as the polls show plummeting support for this bill. Like children, unable to admit a mistake, they plunge us headlong toward fiscal and political disaster.

Please take time TODAY to write to your senators and express revulsion at the health care bill in general, and the individual mandate in particular.

Below is from an email I received from AAPS, followed by email I sent to my Senators. Feel free to use it.

Other talking points are available through AAPS (especially their series on health care myths) or from FIRM.

From AAPS:

There are two more chances to kill the healthcare bill in the Senate tomorrow, so more action is needed.

First, there will be a vote on the constitutionality.

Second, will be the final cloture vote around 2 pm before proceeding to the final vote on the bill, which is now scheduled for 8 am Christmas Eve. Votes needed for cloture are 60. Today, Sen. Barrasso, M.D. (R-WY) talked about John F. Kennedy’s book, “Profiles in Courage” and said that we need one Democrat to exhibit courage and stand up and say that this is a bad bill, and that these sweetheart deals are unfair. Maybe we can convince Ben Nelson (D-NE) to go back to his previous courageous stand against the bill.

TWO ACTIONS BEFORE WED NOON EST:

1. Write a letter to Sen. Ben Nelson expressing your position on his flip-flop. If you intend to help any opponent he may have in his re-election, you might mention that in your letter.

We will deliver the letters to Sen. Nelson’s office before the vote tomorrow.

An easy form is posted on www.TakeBackMedicine.com

2. Contact your Senators to tell them to vote that the bill is unconstitutional, largely due to the individual mandate. You can find your Senators' contact information at http://www.contactingthecongress.org/

SOMETHING FOR EVERYONE TO DESPISE

Two big announcements from groups on the left today grabbed our attention.

The self-acknowledged government single-payer doctors from Physicians for a National Health Plan wrote to Senators:

"We have concluded that the Senate bill's passage would bring more harm than good."

The negatives, the group says, “include the individual mandate requiring that people buy private insurance policies, large government subsidies to private insurers, the unfair taxing of high-cost health plans, and cuts of $43 billion in Medicare payments to safety-net hospitals.”

And MoveOn.org put out a list of “5 Critical Flaws in the Senate Healthcare Bill” including: #4: Tax American workers' health coverage to pay for reform.

CONSTITUTIONALITY

Senators Jim DeMint (R-South Carolina) and John Ensign (R-Nevada), raised a Constitutional Point of Order on the Senate floor against the Democrat health care takeover bill on behalf of the Steering Committee, a caucus of conservative senators. The Senate will vote tomorrow on the bill’s constitutionality.

Further, during our “Virtual Vigil” webcast Sunday night, national radio talk show host, Mike Siegel, who is an attorney, explained that the bill violates a basic legal concept of “breadth.”

PROCEDURAL ARROGANCE

Once again, the Senate leadership is ignoring its own rules.

It’s complex, but the net effect is that Sen. Harry Reid inserted language into the health care legislation changing the Senate rules so that internally the Senate must have two-thirds of the Senate in agreement to consider any future amendments to Obamacare on the floor. Oh, the Senate is actually supposed to vote on rules changes.

Dear Senator,

Please consider carefully before you vote on the current health care reform bill.

An individual mandate is a disaster to our freedom and will not make medical care more available or more affordable.

The experience in Massachusetts should make clear that mandating insurance coverage only serves to increase public debt and decrease the actual availability of medical care. Health insurance coverage is not the same as medical care. This bill will force the use of price controls and rationing--the antithesis of freedom and the end to quality medical care.

I know you have worked very hard to try and construct a health care reform bill---but this bill will not solve the problems that you hope it will and IT DOES NOT HAVE THE SUPPORT OF THE POPULACE!

Please vote NO.

Public Option and Individual Mandate BOTH Destroy Real Choice

Thanks to 3 Ring Binder for posting this. It's short, to the point and spot on.



Hopefully, the public option is dead. This is not really much cause for celebration, however, as long as the individual mandate is alive and well.

A mandate would make it illegal to not have health insurance coverage--which is just a sneakier way of accomplishing the same damn thing as a public option. If you have to purchase health insurance BY LAW, then the law will have to define just what constitutes "health insurance". What better way to surreptitiously open the door to full and total control of medical care?

The ability to decide what must or will not be paid for by a legally mandated insurance program is the ability to decide what medical care will be purchased.

In addition, if either a requirement for community rating, or outlawing the ability to exclude pre-existing conditions end up as part of the reform, it will be the death knell of financially viable private insurance.

And then we will be back to the public "option"---and a choice of one, is no choice at all.



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Copenhagen Central Planners Fail at Planning

Environmentalists gathered to attend the global warming conference in Copenhagen, only to find out that the organization they are hoping will control the weather and plan for all our energy needs can't even properly organize their meeting.

The UN chose to hold what was billed as “the most important meeting in the history of the world” in a conference center that only holds fifteen thousand people. The environmental NGOs sent lists of delegates that added up to over thirty thousand. The UN looked at these two numbers and decided everything would work out fine...

On Tuesday, it was announced that only 1,000 NGO delegates would be allowed to attend on Thursday and Friday and that the method for choosing the lucky few would be announced later in the day. A notice was posted that said the decision would be made by 6 PM. At 6, another notice said come back at 7. At 7, we were told that NGO representatives would meet with Yvo De Boer, the head of the Secretariat, at 7:30 and to watch our e-mails for an announcement of when we would meet. At 7:45, we were told to assemble at 8 to find out which lucky thousand would be allowed to attend the last two days of the conference. At 8, the meeting with Mr. de Boer was still going on. So we sat and waited. Ditto 8:30. Ditto 9. At 9:35, our NGO representatives appeared...

Then the NGO representative told us that UN security had advised Mr. de Boer that no NGO delegates should be allowed to attend the last two days, when over one hundred prime ministers and presidents, including President Obama, would be in the building. But de Boer had insisted on the rights of “civil society” to be represented and had secured a compromise. Instead of a thousand passes for NGOs, there would be three hundred.

Thus the approximately thirty thousand NGO delegates who traveled from around the world to Copenhagen to attend COP-15 were limited to seven thousand on Tuesday and Wednesday and to three hundred for the last two days.

Perhaps some individuals who support efforts at a world-government takeover of energy production and use do so with good, although mistaken, intentions. However, it is difficult to understand how can anyone with even a modicum of honesty and historical knowledge can fail to understand the enormous hubris of such a central planning effort.


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Pure Self-Interest Promotes Energy Efficiency

from Carpe Diem.

Bottom Line: These significant increases in energy efficiency for both our homes in general and also for the appliances that we have in our homes have happened gradually, but steadily, for many decades, and many of these improvements in energy efficiency probably took place without any government intervention, stimulus or rebate programs. The incentive to save money ensures that there will always be an incentive to become more energy efficient out of pure self-interest, since increased energy efficiency translates directly into monetary gain.

Listening to Obama, one might get the impression that we have become less and less energy efficient over time, and we energy gluttons now need nanny state hectoring to become energy misers. The truth is just the opposite - we have become more and more energy efficient over time, not less.

Global Warming in Perspective

Original images from Watts up with That?
Video clip and narration from The Autopsy

I posted a similar set of graphs over a year ago. Be sure to check out the last graph of the post which plots temperature and CO2 levels--going back 600 million years. I don't think even Mr. Gore could say it fits together any more.


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Copenhagen: A Travesty for Freedom and Prosperity

George Will has an excellent editorial on the subject of climate change. Here are a few choice paragraphs:

The climate-change travesty

George F. Will, Washington Post, Sunday, December 6, 2009

With 20,000 delegates, advocates and journalists jetting to Copenhagen for planet Earth's last chance, the carbon footprint of the global warming summit will be the only impressive consequence of the climate-change meeting. Its organizers had hoped that it would produce binding caps on emissions, global taxation to redistribute trillions of dollars, and micromanagement of everyone's choices...

Barack Obama, understanding the histrionics required in climate-change debates, promises that U.S. emissions in 2050 will be 83 percent below 2005 levels. If so, 2050 emissions will equal those in 1910, when there were 92 million Americans. But there will be 420 million Americans in 2050, so Obama's promise means that per capita emissions then will be about what they were in 1875. That. Will. Not. Happen...

Copenhagen is the culmination of the post-Kyoto maneuvering by people determined to fix the world's climate by breaking the world's -- especially America's -- population to the saddle of ever-more-minute supervision by governments. But Copenhagen also is prologue for the 2010 climate change summit in Mexico City, which will be planet Earth's last chance, until the next one.

The rest is worth reading as well.

(HT my wonderful husband.)

Medical Services Received: The Uninsured in U.S. = Canadian Universal Coverage

While researching on the origin of the oft quoted "47 million uninsured," I stumbled onto a wonderful article by June and Dave O'Neill, "Who are the Uninsured?" One of several aspects of the health-care coverage issue which they analyze is a comparison of the amount and type of services received between those with insurance in the U.S. and those without. As you would expect, those with insurance obtain more medical services, but there are some fascinating details about this.

First, when looking at who received a routine check-up, flu shot, mammogram, PAP smear, PSA test (screen for prostate cancer) and a blood pressure check with the past 2 years, the uninsured received 50-60% of the services that those with insurance received! Not bad. When measured as dollars per capita, the uninsured received only 40% of what the insured received, significantly less but still a substantial amount of health care.

But most interesting of all, the authors compared cancer screening rates of the U.S. uninsured to rates in Canada under universal health coverage. Forty-nine percent of uninsured U.S. women aged 40-69 had a mammogram within the last 2 years, whereas 65% of these women had one within the past 5 years--which is identical to the percent of Canadian women who received a mammogram over the same time period! This equivalence also holds for PAP smears, with 80% of both Canadian women and U.S. uninsured women receiving this cervical cancer screen within the past 5 years. The rate for insured U.S. women is higher at 92%.

Men fare even worse in Canada. In the past 5 years, 16% of Canadian men aged 40-64 received PSA testing, compared to 31% of U.S. uninsured and 52% of U.S. insured men.


(Click on image to enlarge)

Our system is not perfect. Too many individuals are currently priced out of health insurance and consequently forgo needed medical care. But as the above figures demonstrate, the answer is not more government involvement. The solution is to understand what has made the cost of health insurance premiums and of medical care rise faster than the the general rate of price inflation.

But that will have to wait until another post.

The General Welfare and the Sacrifice of One

Wisdom of the Month via Walter Williams' Homepage

"They are not to do anything they please to provide for the general welfare.... [G]iving a distinct and independent power to do any act they please which may be good for the Union, would render all the preceding and subsequent enumerations of power completely useless. It would reduce the whole instrument to a single phrase, that of instituting a Congress with power to do whatever would be for the good of the United States; and as they sole judges of the good or evil, it would be also a power to do whatever evil they please."
-- Thomas Jefferson

When, if ever, does the end justify the means?

How can the "general welfare" justify violating individual rights?

Individual rights are the moral basis for preservation of the general welfare, for what is the general welfare but the welfare of the individuals of which the "general" consists? There can be no "general welfare" apart from the individual rights upon which it rests. An act which violates an individual's right to life, liberty or property destroys that which it claims to be promoting.

The sacrifice of one human being entails the sacrifice of the very principle of the right to life--whether it is done in the name of helping the poor or saving the environment. Both are worthy goals----but remain worthy only if they are accomplished through means which respect as an absolute the right of each man to his own life----and only to his own.


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"Must Read"s on Climate Change

Two superb articles on now available on-line, each of which addresses one of the two major aspects of the climate change debate: the science and the politics.

For the science, read Richard Lindzen's WSJ editorial "The Climate Science isn't Settled." I have been following Lindzen's presentations for several years and find him one of the most reasonable and well-credentialed of those who are speaking out against the existence of catastrophic anthropogenic global warming. In this editorial, Lindzen briefly summarizes the state of the science, offering an excellent explanation of what is known and generally agreed upon, as well as where opinion diverges. His explanation is easily understood by an intelligent layman.

For the political economy of how to solve our need for energy, read "Human Ingenuity: The Real Renewable Resource" by C. August, posted on his blog Titanic Deck Chairs. August's main point is that all resources derive their utility from human ingenuity, whether it is oil, sun, wind or coal. Without the human mind to "transform inanimate matter into life-sustaining values," natural resources would simply be rocks, poisonous goo and weather. The best way to solve our problems of energy access and environmental quality is to identify and protect the condition which maximizes the "inexhaustible resource" of human ingenuity: capitalism.

Capitalism unleashes the political and economic possibilities of the best within humanity. All of the creative, positive, progressive aspects of human activity are fostered -- not oppressed -- by the socio-political framework of capitalism, which means the system that fully and consistently protects individual rights in all areas of human interaction, leaving men free to produce, to solve problems, and to make enormous sums of money in the process. Nearly every modern convenience and life-sustaining technology that we take for granted today is ultimately the product of men who were free, at least in part, to use their minds, to innovate, and to produce.

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Will all adults please stand up....for your freedom

The nanny state continues to trample on our liberty, one law or regulation at a time. Are we adults, responsible for our own lives, free to make our own decisions and judgments, or are we incompetent idiots who need to be protected from ourselves and others by the increasingly invasive set of government bureaucrats?



Where will it end? Are there no limits to the control people are willing to accept?

Go here to donate to the Institute for Justice to support their efforts in defending our freedom.



(HT 3 Ring Binder)

Lasik: A Model for Health Reform

(HT Carpe Diem)

FTC blog rules attack free speech

Abolish the FTC: New Blogging Rules

by Ari Armstrong (HT Rational Capitalist)

1. The FTC's rules constitute censorship and onerous controls.
2. The FTC's rules are capricious and nonobjective.
3. The FTC's rules open the door to further political abuses.
4. The FTC's rules undermine the equal protection of the laws.
5. The FTC's rules violate privacy.
6. The FTC's rules are unnecessary.

Read the post for a more detailed analysis.

And it's not just blogging...watch what you twitter or put in your Facebook status reports! As Diana Hsiesh puts it, they are Regulating Speech to Death.


Any one feeling warm yet?




And from the site where I stumbled on the above image:

"The framers of the Constitution knew, and we should not forget today, that there is no more effective practical guaranty against arbitrary and unreasonable government than to require that the principles of law which officials would impose upon a minority must be imposed generally. Conversely, nothing opens the door to arbitrary action so effectively as to allow those officials to pick and choose only a few to whom they will apply legislation, and thus to escape the political retribution that might be visited upon them if larger numbers were affected. Courts can take no better measure to assure that laws will be just than to require that laws be equal in operation." - United States Supreme Court, Eisenstadt v. Baird, 405 U.S. 438 (1972)


Serendipitous?

Climategate should be irrelevant to government policy

As I have argued before, just the simple fact that all the prominent global warming alarmists promote statist solutions to the "global warming problem" and that NONE argue for increased freedom, wealth and prosperity should make their motives suspect.

We can always hope that the recently leaked emails will draw attention to this fact, but many powerful special interests are heavily vested in the catastrophic scenarios, so it still may not be enough to shift such entrenched beliefs.

Ultimately, however, the science is irrelevant to the politics.

John Derbyshire states it well when considering the relationship between science and politics:

That one stands higher than the other in the great scale of things, is a value judgment, based probably on one's temperament. I could argue it either way. Without rational politics and a stable social order, not much science would get done. Without some true understanding of the natural world, politicians would commit gross errors and fail.

Both fields have their crucial contribution to make to human well-being. The problem arises when scientists and politicians claim that a scientific fact (or theory) implies a particular political policy. It does not. Not for alarmists nor for skeptics.

Derbyshire continues, reminding us of the dangers posed by conflating these two subjects:

Does the political connection corrupt science? Yes it does, though in different ways in different areas of science. It has the biggest corrupting effect on the softest science — things like GW, where the data is indecisive enough (it seems to me) to be open to easy political manipulation.

The greatest gift of science is perhaps its emphasis on the scientific method, which is really just reason applied to the study of the natural world: observations lead to pattern recognition, which leads to theories of causation, which must then be verified through experimentation and the power to predict. The goal is a continued refinement of our knowledge and understanding of the world.

But scientific facts pertaining to the non-human natural world provide no guidance for determining a political response to those facts. There is nothing in climate science which informs us on the question of whether the proper response is more government or more freedom. To answer that question requires an adequate understanding of the social and political requirements for man to thrive. A robust literature exists* which demonstrates those conditions to include the recognition of individual rights (including the right to property) accompanied by the systematic exclusion of the initiation of force from the realm of acceptable human behavior.

Respecting the rights of life, liberty, and property leads to the wealth and prosperity which will allow us to continually improve and adapt to our environment.

Wealth is not the problem. Wealth is the solution.



*For just a few sources to substantiate this claim, see my list of recommended books in teh side bar.

CO2, Climate Sensitivity and Politics

I'd like to respond to a comment made following the Hide the Decline post. Garret Seine states:

I think we need to stay very focused on one item, CO2. All the justification for control hinges on CO2 driving global warming. No one has been able to truly establish that there is a link and the fraudsters efforts are going up in smoke.

The justification for catastrophic anthropogenic global warming is not simply CO2, but the presence of positive feedbacks triggered by CO2.

Carbon dioxide has risen, and my understanding of the science is that through analysis of isotopes, it is possible to demonstrate that this rise is indeed caused by the burning of fossil fuels. However, the simple rise of this trace greenhouse gas would not be a problem without a significant positive feedback acting to significantly increase atmospheric water vapor content. It is this claim of a "climate sensitivity" to CO2 that drives fears of catastrophic warming.

The scientific work of Lindzen and others challenges the intensity and even the direction of these feedbacks. That these challenges have not been disproven, nor even seriously considered, should cause scientists to question the alarmist scenarios. The lack of candor and reasonable humility amongst promoters of catastrophic anthropogenic global warming is evidence that too many people have too much invested in catastrophe to maintain an objective perspective on this subject.

Honduras: Lessons in Constutionality

Thanks to Gus Van Horn for linking to an excellent article on the latest developments in Honduras. The appropriateness of ousting former Honduran President Zelaya for his unconstitutional activities has been reinforced by further details and this week-end's election.

America, North, South and Central, still struggles to understand the prerequisites for freedom, but recent events in Honduras provide an example worthy of emulation.

WSJ In Elections, Honduras Defeats Chavez, by Mary Anastasia O'Grady

And from Honduran, Rodrigo Cantero:

Time and time again we have seen "democrats" like Hugo Chavez, like Evo Morales, like Rafael Correa and now Daniel Ortega trying to turn their countries into their own private ranches, and we have seen the International Community stand by and just applaud rigged election after rigged election.

Cantero's scare quotes are unnecessary though. Chavez, Morales, Ortega, Correa...and Hamas, and Ahmadinejad, and unfortunately Obama and the U.S. Congress, are democrats. Democracy is not commensurate with liberty--but with unfettered majority rule: mobocracy. The presence of elections, in-and-of themselves, do not preserve liberty. What preserves freedom, in Honduras, in the United Sates, and anywhere, is a constitution which places the protection of individual rights above the will of the majority as well as beyond the control of a would-be-dictator.

This is a lesson the United States will have to relearn if we wish to continue to live in liberty.



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More wealth for everyone

(HT Steve Horwitz via Carpe Diem)

In the US, wealth is increasing at every income stratum. But, as all of our fathers told us as we were growing up, money doesn't grow on trees. Best we learn just what conditions promote prosperity and well-being before voting on the current health-care and climate change legislation. We stand on the precipice of self-destruction.


More from Carpe Diem:

The reasons for the significant improvements in living standards for all Americans (at all income levels) include innovation, technology improvements, supply chain efficiencies, increases in productivity and other market-driven efficiencies that drive prices lower and lower year by year, measured in what is most important: our time, and the amount of labor it takes to earn the money to purchase household appliances and other goods and services.

Bottom Line: As much as we hear about declines in median income, economic stagnation, the disappearance of the middle class, falling real wages, increasing income inequality, the data tell a much different story: The rich are getting richer and the poor are getting richer.

Wealth is not the problem.

Wealth is the solution.

Hide the Decline

If you haven't heard about Climategate, you aren't paying attention. But then, if you thought the "science is settled" and that there is a "consensus" agreement on anthropogenic global warming, you haven't been paying attention either. If you get you information from Wikipedia, I can understand why you might not be aware of scientific work that challenges the conventional "wisdom." The recent bruha over the science only confirms the importance of keeping science separate from politics and political funding--but the "truth about climate change science" is irrelevant in deciding the proper role of government in climate matters.

You can read about how their goose is cooked while I cook a turkey today (for a second Thanksgiving, as there is so much to be thankful for one wasn't enough this year.)

On a more serious note, a lot more work must be done to carefully read through all the emails, making the best effort possible to not take them out of context. Even then, the exposed emails are not the complete record of correspondence. Private emails contain meaningless venting more often than evidence of criminal activity and conspiracy.

That said, the emails I have read are disturbing and the authors have some serious explaining to do. The authors and the recipients are major players in the Global Warming debate and significant contributors to the IPCC: Michael Mann (the "hockey-stick" guy) James Hansen, Gavin Schmidt, Stephen Schneider (of "being honest vs. being effective" fame), Ben Santer, Tom Wigley. Some of their view point can be read on RealClimate. (Do check the links to these scientists, as some are quire amusing.)

Climategate: The Fix is In Robert Tracinski , RealClearPolitics

Real Climate Spin Marlo Lewis, OpenMarket.org

Climate Science and Candor WSJ (unedited emails)

Three Things You Absolutely Must Know About Climategate Iain Murray, pajamasmedia.com

And to understand the video clip below, read Mike's Nature Trick Watts Up with That?, and then enjoy:




On a more serious note, here's a Who's Who in Climategate and a few of their quotes:

Woe to the people who can not limit the state.

"The state tends to expand in proportion to its means of existence and to live beyond its means, and these are, in the last analysis, nothing but the substance of the people. Woe to the people that cannot limit the sphere of action of the state! Freedom, private enterprise, wealth, happiness, independence, personal dignity, all vanish."

-- Frederic Bastiat (1801-1850) French economist, statesman, and author. He did most of his writing during the years just before -- and immediately following -- the French Revolution of February 1848. Source: Sophisms, 141 (HT Liberty Quotes)

Note:
I am currently just posting good quotes to contemplate while I am researching for a detailed post on the number of uninsured Americans. Where does the figure 47 million come from? How much confidence should we place in that number? The size of the problem tells us nothing about the solution, but it does provide a measure by which we can gauge the degree of urgency appropriate to the problem. Stay tuned!

Ancient Wisdom

"The object of life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane."

-- Marcus Aurelius (121-180) Roman emperor (161-180)

(HT Liberty Quotes)

Emerson Electric Shrugs

From Manufacturing and Technology News:

Emerson Electric Votes With Its Feet, Saying The Government Is Destroying American Manufacturing Nov. 17, 2009

The federal government is "doing everything in [its] manpower [and] capability to destroy U.S. manufacturing," says David Farr, chairman and CEO of Emerson Electric Co., in a presentation at the Baird 2009 Industrial Conference in Chicago Ill., on Nov. 11. In comments reported by Bloomberg, Farr added that companies will continue adding jobs in China and India because they are "places where people want the products and where the governments welcome you to actually do something. I am not going to hire anybody in the United States. I'm moving. They are doing everything possible to destroy jobs."

In his Powerpoint presentation available on the Emerson Electric Web site, Farr notes that the federal government is damaging prospects for U.S. economic growth with a $1.41 trillion federal deficit (10 percent of GDP); $12 trillion in government debt that will grow to $20 trillion in 10 years; a policy of printing money; a "non-targeted $800-billion stimulus"; bailouts for Wall Street and the automobile companies; the prospect for cap and trade legislation; a "government takeover" of health care to the tune of more than $1 trillion; increasing taxes and regulations; and a "lack of U.S. $ support" for manufacturing. The global stimulus "soon will fade," says Farr.

Emerson Electric did major down-sizing in response to the recession (14% decrease in headcount and shut down 75+ facilities) and plans to build back up over seas, leaving the increasingly interventionist U.S. Government behind, and unfortunately U.S. workers as well.

A few choice slides from his PowerPoint presentation:

Slide #7

Slide #11

Slide #13

Senate Begins Discussion of Health Care Bill that 56% of Americans Oppose

Read about the new Rasmussen Poll.

Also, for a succinct explanation of just what Saturday's vote was all about, read this post by Dr. Paul Hsieh.

Senate Votes to Start Debate on Health Care

Voting along party lines, the Senate voted tonight to begin debate on the Healthcare bill following Thanksgiving break.

Here's the explanation from Take Back Medicine:

Senate schedule & next steps

The Senate will begin formal debate on the healthcare bill after the Thanksgiving recess. At that time amendments may be introduced as well, which will likely number into the hundreds. Debate will probably take up to 3-4 weeks, so that brings us up to Christmas recess. Even if it passes the Senate then, it would have to be reconciled with the House bill, which is significantly different.

Senate proceedings

First, let's be clear - the vote tonight was only to proceed with formal debate. The bill can be filibustered, and some have indicated that they will do so. That means that the Senate would again have to invoke cloture to end that debate. The votes required for that are 60.
Those votes would come before we even get to a final vote on the bill. So when you hear that the Senate voted to pass the health care bill - THAT IS NOT CORRECT!

On the same page, they posted an interesting piece on cloture. Scroll down (at TBM site) to read the whole article, but here is the brief history which is quoted:

March 8, 1917 Cloture Rule

Woodrow Wilson

Woodrow Wilson considered himself an expert on Congress—the subject of his 1884 doctoral dissertation. When he became president in 1913, he announced his plans to be a legislator-in-chief and requested that the President’s Room in the Capitol be made ready for his weekly consultations with committee chairmen. For a few months, Wilson kept to that plan. Soon, however, traditional legislative-executive branch antagonisms began to tarnish his optimism. After passing major tariff, trade, and banking legislation in the first two years of his administration, Congress slowed its pace.

By 1915, the Senate had become a breeding ground for filibusters. In the final weeks of the Congress that ended on March 4, one administration measure related to the war in Europe tied the Senate up for 33 days and blocked passage of three major appropriations bills. Two years later, as pressure increased for American entry into that war, a 23-day, end-of-session filibuster against the president’s proposal to arm merchant ships also failed, taking with it much other essential legislation. For the previous 40 years, efforts in the Senate to pass a debate-limiting rule had come to nothing. Now, in the wartime crisis environment, President Wilson lost his patience.

Decades earlier, he had written in his doctoral dissertation, “It is the proper duty of a representative body to look diligently into every affair of government and to talk much about what it sees.” On March 4, 1917, as the 64th Congress expired without completing its work, Wilson held a decidedly different view. Calling the situation unparalleled, he stormed that the “Senate of the United States is the only legislative body in the world which cannot act when its majority is ready for action. A little group of willful men, representing no opinion but their own, have rendered the great government of the United States helpless and contemptible.” The Senate, he demanded, must adopt a cloture rule.

On March 8, 1917, in a specially called session of the 65th Congress, the Senate agreed to a rule that essentially preserved its tradition of unlimited debate. The rule required a two-thirds majority to end debate and permitted each member to speak for an additional hour after that before voting on final passage. Over the next 46 years, the Senate managed to invoke cloture on only five occasions.

Reference Items:

U.S. Congress. Senate. The Senate, 1789-1989, Vol. 2, by Robert C. Byrd. 100th Cong., 1st sess., 1991. S. Doc.100-20.

Also worth reading is an article by Jane Orient, "Forget the Trees; Look at the Forest on Healthcare." Nothing earth-shakingly new, but just a clear and succinct explanation about the Republicans and Democrats quibbling over how they are going to take over medicine, while the real issue is that they shouldn't be involved at all!

Senate Votes Tonight on Healthcare

The Senate vote tonight is a vote to "invoke cloture" on the motion to proceed on the bill. Sixty votes are required.
If the motion does pass tonight, we are likely looking at several weeks of further debate on the Senate floor before a vote on the actual bill takes place.

From Take Back Medicine:

Breakdown of the Senate's schedule for today:

The Senate convened at 9:45 AM est and resumed debate on the motion to proceed to H.R. 3590 (shell for the health care bill) until 8:00 PM. The time will be equally divided and controlled in one hour alternating blocks until 6:00 PM, with the Majority controlling the first hour.

The time from 6:00-6:30 PM will be under Majority control, the time from 6:30-7:15 PM will be under Minority control, the time from 7:15-7:30 PM will be under Majority control and the final 30 minutes will be divided equally between the two leaders with the Republican Leader controlling the first 15 minutes.

At 8:00 PM the Senate will proceed to vote on the motion to invoke cloture on the motion to proceed to H.R. 3590. If cloture is invoked, all post-cloture time will be yielded back, the motion to proceed will be agreed to and the Majority Leader will be recognized to offer a substitute amendment which will be reported be number only.

Please let your Senators know that you do not support government take-over of healthcare. If you are in an area where you do not think your voice will change your Senator's vote, consider writing to a Senator who may still be "on the fence" and let them know that you will financially support their opposition next election if they vote yes tonight. Or choose from the list below:

(via TIA Daily)
Richard Chudacoff of MillionMedMarch helpfully provides contact information for four senators considered to be persuadable on this vote.

Senator Bill Nelson (NE)
Chief of Staff: Tim Becker (timothy_becker@bennelson.senate.gov)
Washington, DC (202) 224-6551 / (202) 228-0012 fax
Lincoln (402) 441-4600 / (402) 476-8753 fax
Omaha (402) 391-3411 / (402) 391-4725 fax

Senator Blanche Lincoln (AR)
Chief of Staff: Elizabeth Burks (elizabeth_burks@lincoln.senate.gov)
Washington, DC (202) 224-4843 / (202) 228-1371 fax
Little Rock (800) 352-9364 / (501) 375-7064 fax

Senator Mary Landrieu (LA)
Chief of Staff: Jane Campbell (jane_campbell@landrieu.senate.gov)
Washington, DC (202) 224-5824 / (202) 224-9735 fax
New Orleans (504) 589-2427 / (504) 589-4023 fax
Baton Rouge (225) 389-0395 / (225) 389-0660 fax
Shreveport (318) 676-3085 / (318) 676-3100 fax
Lake Charles (337) 436-6650 / (337) 439-3762 fax

Senator Mark Warner (VA)
Chief of Staff: Luke Albee (luke_albee@warner.senate.gov)
Washington, DC (202) 224-2023 / (202) 224-6295 fax
Abingdon (276) 628-8158 / (276) 628-1036 fax
Norfolk (757) 441-3079 / (757) 441-6250 fax
Roanoke (540) 857-2676 / (540) 857-2800 fax
Midlothian (804) 739-0247 / (804) 739-3478 fax

Act now to help preserve freedom of choice in health care!


(Correction: Deleted sentence which erroneously stated that filibuster would be prevented by passage of tonight's motion.)


.

Mammograms: The Road to Rationing?

Four days ago, the New York Times reported on the updated recommendations for breast cancer screening as announced by the United States Preventive Services Task Force (USPSTF), an "independent panel of experts" commissioned by the Agency for Healthcare Research and Quality (AHRQ), a division of the Department of Health and Human Services.

New analysis of existing research led the task force to change their previous recommendations for breast cancer screening. In 2002, the USPSTF guidelines called for "screening mammography, with or without clinical breast examination (CBE), every 1-2 years for women aged 40 and older." The new 2009 recommendation for mammograms states: "For women aged 40-49 years, do not screen routinely. Individualize decision to begin biennial screening according to the patient's context and values."

Not all screening that is technologically available is cost effective. At some point, the benefit to be gained is outweighed by the costs, whether you measure the costs in terms of physical resources, negative side effects, price in dollars, or even just the time involved to have the test performed. Medical research is constantly advancing the base of data from which we evaluate this cost/benefit ratio. An analysis which provides us a more accurate assessment should be welcomed with cheers. Instead, this pronouncement has triggered an angry controversy. Why?

The ruckus is the result of the degree to which government mandates effect our health-care options. New recommendations from a government agency will in all likelihood have significant effects on reimbursement policies for government-financed medical care and quickly followed by reverberations throughout the private insurance industry.

From the NYT article:

The guidelines are not expected to have an immediate effect on insurance coverage but should make health plans less likely to aggressively prompt women in their 40s to have mammograms and older women to have the test annually.

Congress requires Medicare to pay for annual mammograms. Medicare can change its rules to pay for less frequent tests if federal officials direct it to.

Private insurers are required by law in every state except Utah to pay for mammograms for women in their 40s. But the new guidelines are expected to alter the grading system for health plans, which are used as a marketing tool. Grades are issued by the National Committee for Quality Assurance, a private nonprofit organization, and one measure is the percentage of patients getting mammograms every one to two years starting at age 40.

That will change, said Margaret E. O’Kane, the group’s president, who said it would start grading plans on the number of women over 50 getting mammograms every two years.

It is no idle concern that these recommendations will be adopted and enforced by the government. Provisions within the Medicare Improvements for Patient and Providers Act of 2008 (MIPPA) grants authority to HHS to use USPSTF recommendations in determining Medicare coverage. As experience with DRGs demonstrated in the post, how goes Medicare, so follows private insurance.

The recent drive for increased government control of payment for medical care (HR 3962) only heightens concern that what starts out as a simple dissemination of knowledge and informal recommendation will turn into legal mandates and rationing. A closer look at the full report from the USPSTF, and criticisms raised by other informed institutions, further increases suspicions that politics inordinately influenced the work of this "independent panel."

First, a little back ground on the disease of breast cancer.

According to the USPSTF's own article published in the Annals of Internal Medicine, breast cancer is the "most frequently diagnosed non-cutaneous cancer and the second leading cause of cancer deaths among women in the Untied States." A woman in her forties has a 1 in 69 probability of developing breast cancer. The risk increases to 1 in 38 in her 50s, and up to 1 in 27 in her 60s. In 2008, over 250,000 women were diagnosed with breast cancer, and just over 40,000 women died of this disease. Additionally, as the American Cancer Society points out, 17 per cent of breast cancer deaths occur in women diagnosed in their 40s.

The benefits

Developing breast cancer is a real and significant health risk for women in America. Early detection is known to improve survival. Routine mammography, instituted in 1990, has contributed to a 30 per cent reduction in the breast cancer mortality rate. Even the USPSTF report recognizes that annual screening of women in their forties will reduce breast cancer deaths by 15%--but it still concludes this reduction does not warrant routine, annual mammograms.

Here's some numbers presented in the study:

For women in their 50's, 1339 individuals must be screened in order to save one life. For women in their 40s, 1904 must be screened. An additional 565 women aged 40-49 must be screened in order to obtain equal life-saving results as for women in their 50s. Lives can be saved by earlier and more frequent screening...but is this benefit worth the cost?

Maybe. Screening costs money, resources and time, and is not risk free.

The harms

What "harms" did the task force look for? The task force ran no studies of their own but performed an extensive review (a meta-analysis) of the literature. Below is a brief summary:

1. Radiation exposure and risk of causing cancer
(No studies were found that looked directly for an increased risk of breast cancer due to the radiation exposure of mammography. Studies of other types of radiation exposure demonstrate a clear connection between high-dose radiation exposure and breast cancer, but inconclusive results for low-dose exposure. Mammograms are considered a low-dose radiation exposure.)

2. Pain during the procedure ("but few would consider this a deterrent from future screening.")

3. Anxiety, distress and other psychological responses. (Important to note but difficult to translate into policy decisions due to their subjective nature.)

4. Over-diagnosis (Studies were "too heterogeneous" to provide statistically significant results.)

5. False-positive results leading to additional imaging and biopsies; false-negative results leading to missed diagnoses.

Let's take a closer look at the findings for false-positives as this "harm" is the only one with measurable consequences and appears to have significantly influenced the task-force's evaluation of the cost-benefit ratio.

False-positives occur more frequently in women aged 40-49 (97.8 per 1000 women per screening round) vs. 86.6/1000/round for women aged 50-59 years. This led to more frequent "additional imaging" in the younger age group (though fewer biopsies), increasing the number of tests and thus the expense of detecting each additional case of cancer. The category "additional imaging" includes tests widely varying in cost and time. It could simply refer to one additional x-ray or to obtaining an ultrasound, or it could indicate referral for the more involved and expensive procedure of contrast MRI. These tests were not distinguished in the paper so there is no way to tell what proportion of the "additional images" were simply a single extra mammogram view. This omission severely hinders the ability to discern just how burdensome "additional imaging" is and undermines the value of this finding.

The benefits not accounted for

Another very important limitation of the task forces' review is their use of mortality as the only end-point for assessing benefit. No effort was made to consider the increased morbidity and disfigurement, or the increased cost (either in money or in personal suffering) of therapy necessary to induce cure following delayed diagnosis. Mortality does provide a more easily determined objective end point than measuring for morbidity. However, it is curious that the pain and suffering resulting from delayed diagnosis was ignored but the pain of the mammogram procedure was taken into account.

Professional Criticisms

The new USPSTF recommendations do provide useful information to consider when weighing the personal cost-benefits of obtaining breast cancer screening. Two important professional organizations, The American Cancer Society and the American College of Radiology, have released statements (here and here) strongly disagreeing with the task force's conclusions. This is all part of healthy and necessary debate which should be encouraged.

American College of Radiologists (ACR) claims that the USPSTF report is seriously flawed:

Ignoring direct scientific evidence from large clinical trials, the USPSTF based their recommendations to reduce breast cancer screening on conflicting computer models and the unsupported and discredited idea that the parameters of mammography screening change abruptly at age 50. In truth, there are no data to support this premise.

Also:

The task force commissioned its own computer models that had never been subject to critical peer review, ignoring previously published computer modeling studies and direct scientific evidence from large clinical trials that contradict their conclusion. The recommendations also ignored peer reviewed journal articles that critiqued studies on which their recommendations rely. They did not consider literature that didn’t evaluate mortality as an endpoint.

Notably, the USPSTF does not even mention the actual published data from Sweden and the Netherlands that directly show what happens when new therapies and mammography are introduced into the population. These studies demonstrate that it is mammography screening and not new therapies or practices that are responsible for most of the decrease in deaths over the past 20 years.

And elsewhere, an ACR statement confronts the unspoken implications of the task force recommendations:

Although USPSTF states that their recommendations were not motivated by cost savings, based on the above, we cannot help but draw the conclusion that the taskforce recommendations amount to rationing on the basis of financial costs. The USPSTF’s analysis evaluates the number of lives lost under a variety of screening scenarios and then blatantly recommend the most “efficient” (i.e. less expensive) screening interval, not the one that saves more lives. Not only are these numbers based on the lowest estimate of benefit, but they have no meaning for the women being screened. Each woman has a single screening study each year regardless of the yield of cancers. Numbers only suggest the relative “cost” of curing a cancer by early detection and the USPSTF has, arbitrarily, decided that the cost of saving women ages 40-49 is too high. (Emphasis added.)

It is this real and reasonable fear of government limitations restricting or even prohibiting free choice in medical decision-making that has many clinicians alarmed.

Dr. James Thrall, chair of the American College of Radiology Board of Chancellors, stated in his initial response:

I am deeply concerned about the actions of the USPSTF in severely limiting screening for breast cancer. These recommendations, in combination with recent CMS imaging cuts, jeopardize access to both long proven and cutting-edge diagnostic imaging technologies. Government policy makers need to consider the consequences of such decisions. I can’t help but think that we are moving toward a new health care rationing policy that will turn back the clock on medicine for decades and needlessly reverse advances in cancer detection that have saved countless lives.

From Dr. Phil Evans, M.D., president of the Society of Breast Imaging:

The USPSTF recommendations are a step backward and represent a significant harm to women's health. To tell women they should not get regular mammograms starting at 40 when this approach has overwhelmingly been shown to save lives is shocking. At least 40 percent of the patient years of life saved by mammographic screening are of women aged 40-49. These recommendations are inconsistent with current science and apparently have been developed in an attempt to reduce costs. Unfortunately, many women may pay for this unsound approach with their lives. (Emphasis added.)

From Otis W. Brawley, M.D., chief medical officer, of the American Cancer Society.:

The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40. Our experts make this recommendation having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider. When recommendations are based on judgments about the balance of risks and benefits, reasonable experts can look at the same data and reach different conclusions. (Emphasis added.)

This table (see pg 35 AHRQ Evidence Synthesis) summarizes the current recommendations of various professional medical organizations for breast cancer screening for average-risk women:



Task-force Study vs. Task-force Recommendations

Perhaps most telling, however, are the details mentioned in the "Limitations," "Future Research" and "Conclusions" sections of the Systematic Evidence Review Update for the USPSTF
published by the task-force itself. The different tone and the overall impression one gets from these sections of the report emphasizes the danger of drawing conclusions from press releases and "executive summaries." The full story is so much more complex. It is worth quoting those sections at length:

Breast cancer is a continuum of entities, not just one disease that needs to be taken into account when considering screening and treatment options and when balancing benefits and harms. None of the screening trials consider breast cancer in this manner. As diagnostic and treatment experiences become more individualized and include patient preferences, it becomes even more difficult to characterize benefits and harms in a general way. Many patients would consider quality-of-life an important outcome, although it is a more difficult outcome to measure and report in trials...

No screening trials incorporating newer technologies [digital mammography and MRI] have been published, and estimates of benefits and harms in this report are based predominantly on studies of film mammography. No definitive studies of the appropriate interval for mammography screening exist, although trial data reflect screening intervals of 12-33 months...

Additional research on benefits and harms of mammography screening with quality-of-life outcomes, as well as morbidity and mortality outcomes, would provide further understanding of the implications of routine screening...

Our meta-analysis of mammography screening trials indicates breast cancer mortality benefit for all age groups from 39-69 years, with insufficient data for older women. False positive results are common in all age groups and lead to additional imaging and biopsies. Women age 40-49 years experience the highest rate of additional imaging whereas their biopsy rate is lower than older women. Mammography screening at any age is a trade off of a continuum of benefits and harms. The ages at which the trade-off becomes acceptable to individuals and to society are not clearly resolved by available evidence. (Emphasis added.)

Cui bono?

This brings us back to the original question: Are the benefits worth the cost?

That depends on how you answer the questions: Of benefit to whom? Of cost to whom?

And that is the entire crux of socialized medical care.

In a system dominated by third-party payers, cost is distributed beyond those who directly benefit. At least with private insurance, an individual still retains a significant degree of choice: How much coverage am I willing to pay for? Which plan will I choose to participate in? In contrast, the more government steps in to regulate insurance and medical care (or even go so far as to provide payment and/or care directly) the more those decisions must and will be taken away from the individual patient and shrink toward a one-size-fits-all policy.

The more that "society" picks up the tab, the further removed the real-life effects on the individual patient will be from cost/benefit calculations, and the less the unique circumstances of the individual most affected by the decision will determine the decision.

Medical research and analysis is fluid and rapidly changing. Attempts to legislate standards of care are slow, cumbersome and unable to account for individual variation. Government-controlled medicine must lead to unnecessary delay in implementing the latest knowledge. Lives will be lost and suffering will be increased while Congress or some bureaucrat work to catch up with medical progress.

Additionally, it is dangerous for government to step between a patient and his doctor, especially for critical life-and-death decisions. Yet, if government is paying for medical services, the requirement of protecting taxpayer money demands that it do precisely that. Recommendations from government-sponsored panels must always be suspect of putting budget needs before patient needs--its part of their job!

Fortunately, there is an affordable alternative to government-guaranteed medical care that preserves individual choice, protects the patient-doctor relationship, allows for a quick response to advances in medical knowledge and technology, encourages innovation, personal responsibility and the efficient use of resources: the free market¹. And for those unfortunate few who are hit with disaster above and beyond their ability to provide for themselves, history has shown this country to have the most generous people in to the world.

This week's announcement of the new breast cancer screening recommendations from a government-sponsored review panel set alarm bells ringing: Watch out for rationing! Whether or not the fears are justified in this particular instance, the fears are definitely justified by the accelerating trend toward greater and greater government control of medical care. Let's hope that Congress starts listening to its constituents and allows medical care to return to a private matter between patients and their doctors.


Update 11/24/09 WSJ has an editorial which makes many of the same points as here, but without the detailed analysis. A Breast Cancer Preview

Notes

1. Much has been written on free market solutions to the rising cost of medical care. See my current reading list for books which address this topic. Brief papers include:
Cannon, Michael "Yes, Mr. President, A Free Market Can Fix Health Care", Cato Policy Analysis No. 650, Oct., 2009
Friedman, Milton "How to Cure Health Care" Hoover Digest, 2001, No. 3
Whitman, Glen and Raad, Raymond, "Bending the Productivity Curve: Why America Leads the World in Medical Innovation" Cato Policy Analysis No. 654, Nov. 2009
Conko, Gregory and Klein, Philip, "Political Malpractice: Health Insurance Misdiagnosis and the Destruction of Medical Wealth" CEI Issue Analysis 2009 No. 5

Bibliography

Bourque, Steven "Just Take the Blue Pill, Lady" One Reality
Nov.17, 2009

Kolata, Gina "Panel Urged Mammograms at 50, Not 40" NYT, Nov. 17, 2009

Mandelblatt, MD et al., "Effects of Mammography Screening Under Different Screening Schedules: Model Estimates of Potential Benefits and Harms," Ann Int Med, 2009;151:738-747

Nelson, Heidi D., et al., "Screening for Breast Cancer: An Update for the U.S. Preventive Services Task Force, Ann Int Med 2009;151:727-737

Nelson, Heidi D., et al., "Screening for Breast Cancer: Systematic Evidence Review Update for the U.S. Preventive Services Task Force," AHRQ Publication No. 10-05142-EF-1, Nov. 2009

USPSTF, "Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement," Ann Int Med, 2009;151:716-726

USPSTF, "Screening for Breast Cancer: Recommendations and Rationale," 2002 statement

American Cancer Society Responds to changed to USPSFT Mammography Guidelines http://www.cancer.org/docroot/MED/content/MED_2_1x_American_Cancer_Society_Responds_to_Changes_to_USPSTF_Mammography_Guidelines.asp

"Detailed ACR Statement on Ill Advised and Dangerous USPSTF Mammography Recommendations" http://www.acr.org/HomePageCategories/News/ACRNewsCenter/UPSTFDetails.aspx

"USPSTF Mammography Recommendations Will Result in Countless Unnecessary Breast Cancer Deaths Each Year" http://www.acr.org/HomePageCategories/News/ACRNewsCenter/USPSTFMammoRecs.aspx

The Legal Plunder of Healthcare

Originally posted May 15, 2008 at RedPlanetCartoons with the following quote by Frédéric Bastiat, 1850

“The war against illegal plunder has been fought since the beginning of the world. But how is… legal plunder to be identified? Quite simply. See if the law takes from some persons what belongs to them, and gives it to other persons to whom it does not belong. See if the law benefits one citizen at the expense of another by doing what the citizen himself cannot do without committing a crime. Then abolish this law without delay … If such a law is not abolished immediately it will spread, multiply and develop into a system.” –from The Law

An elaboration on the meaning of Selfishness

(The following is my response to a comment¹ on my recent post The Virtue of Selfishness.)


Many proponents of the morality of rational egoism strive to reclaim the term "selfishness" as a virtue. From the perspective of most other moral theories, including today's most prevalent--altruism--selfishness is condemned as the heartless consideration only of oneself, and usually characterized as attending only to the immediate and obvious effects of one's actions.

It is crucial to note, however, that proponents of rational egoism also condemn myopic attention to only oneself, especially when divorced from the wider implications of one's actions. This myopic self-centeredness is not what is meant by their use of the term selfishness.

How can we move beyond these semantic disagreements? We obviously need two separate terms: one to designate myopic self-centeredness, and another to designate the selfishness of rational egoism. One step toward clarification might be to explain why proponents of selfishness view it as a reasonable term to signify rational self-interest (see below). An even better place to start, however, is to ask and then answer the more fundamental questions: What is the purpose of morality? Why are moral principles even necessary?

The entire question of morality arises from two facts of human nature:
1) Our existence is conditional.
2) Possessing freewill, we must choose between alternatives.

Life in general, and human life in particular, requires that we achieve certain conditions--or die. The details of those conditions are not automatically (instinctively) known but must be discovered. Moral principles are the fundamental abstractions we must discover (and then choose to use) which serve as guides for our thinking and our actions. The ultimate purpose behind these principles is the preservation and promotion of our lives. This is what is meant by stating that "life is the standard of value." Life is the goal of our actions and thus becomes the standard by which we measure good and bad, right and wrong. "Good" actions promote our lives; "bad" actions are harmful to our lives.

Since life is an attribute of an individual organism (it is the individual that lives and dies), it is the life of the individual which is the relevant moral unit. Each man's standard of value must be his own life--his own Self. This is what is meant by selfishness as a virtue: the recognition that one's own life (self) is the ultimate goal and proper purpose of one's actions. These moral principles are required even when living alone on a desert island. They are not simply rules of social engagement, but the identification of the proper stance we must take toward reality. However, we neither live in isolation, nor simply for the moment. For actions and policies to truly promote our lives, we must take into account their long-term and full-context consequences.

Political rights extend the moral principle of valuing the self and individual life into rules for social engagement. Rights outline the freedoms of action open to individuals in a social context, delineating boundaries which can not be crossed without violating the prime right--the right of each individual to his own life, and only to his own. When this is understood and consistently applied, it is possible to also see why interactions between human beings must be voluntary--and why to initiate force is to violate a man's right to his own life.²

None of this alters the fact that people can benefit greatly from one another--emotionally, materially, spiritually. It does not preclude or prevent positive, voluntary collaboration between human beings: as communities, nations, businesses, families or lovers --provided the interactions are truly life promoting for each individual involved. Selfishness simply points to the fact that each individual rightfully lives for the sake of his own life (self) and happiness. Extension of this understanding of selfishness into social interactions requires prohibiting the initiation of force against others from the realm of morally justifiable actions. (Defining just what is force and elaborating on how to distinguish between its initiation and self-defense are crucial areas requiring clarification, but that task takes us beyond the purpose of this particular essay.)

What is the tool we use to identify and analyze "the good" and attempt to understand and apply it in the widest context possible? Our faculty of reason: the process of observing reality, and then drawing inductive and deductive conclusions based on those observations, checking for consistency (eliminating contradictions) and assuring that we have sufficient knowledge to justify our conclusions.

Are mistakes possible? Of course! The fact of our fallibility, however, does not invalidate reason. The ability to error only magnifies the importance of reason and the need for careful deliberation, to always be vigilant, to constantly check and expand the context of our knowledge.

The fact of our fallibility also does not make selfishness, properly understood, dangerous. That we are creatures of free will gives rise both to the need for moral principles and to the fact of our fallibility. We have choice, and we are not automatized to choose correctly. Choice brings with it the ability to choose wrongly. Those truths do not change that the standard of value (good/bad, right/wrong) must be each individual's own life (the moral principle of selfishness) any more than the fact that errors in calculations can and do occur invalidates a mathematical principle. "Complete rationality of all decisions" is the goal. That there is no automatic guarantee this goal will always be achieved does not invalidate it as a goal.

Selfishness is a virtue because it identifies the individual self as the origin and the beneficiary of moral action. The only kind of "selfishness" which achieves this goal, consistently through time and across all areas of action, is one that is rational. Thus, the concept selfishness as a moral virtue subsumes rationality, and to state "rational selfishness" is to state a redundancy. The essence of rationality is non-contradiction. Applied to the field of ethics, reason leads us to the recognition that all human beings have the same right to life as ourselves.

In conclusion, I think there are good reasons for trying to reclaim the term "selfishness" as a virtue--but I also do not want the discussion distracted away from addressing the underlying meaning and turned into bickering over terminology. I am open for suggestions for a different terminology, one that that adequately captures the difference between selfishness consistent with reason, and the irrational, truncated "selfishness" which fails to include the full context.

Make some suggestions, or better yet, address the concept which underlies the term. Until convinced otherwise, I will continue to advocate for selfishness.


Notes
1. from Anonymous1 (10/29/09): Your treatment of the 'full concept of selfishness' implies the complete rationality of all decisions. This is inconsistent with human experience as much research in economics, safety, and psychology is beginning to understand. More often than not selfishness is just that. Selfishness. Fixation on the immediate benefit to one's self without consideration of the long term, even to the detriment of one's self.
2 Ayn Rand goes further and demonstrates the epistemological basis for the evil of initiating force--why man's unique rational faculty is his means of self-preservation and life promotion--and why for proper functioning it requires protecting the freedom to use one's own judgment--why persuasion is the only moral path to changing another man's actions--0r as I have distilled it: Convince me, or let me be.