Later On

Front of The Wife’s right hand:

Back of her right hand:

The antibiotic IV drip:

The final bandage on the right, IV prep on the left:

All photos taken with The Wife’s new iPhone.

Atul Gawande, Donald Berwick, Elliott Fisher, and Mark McClellean have an interesting op-ed in the NY Times:

We have reached a sobering point in our national health-reform debate. Americans have recognized that our health system is bankrupting us and that we have dealt with this by letting the system price more and more people out of health care. So we are trying to decide if we are willing to change — willing to ensure that everyone can have coverage. That means banishing the phrase “pre-existing condition.” It also means finding ways to pay for coverage for those who can’t afford it without help.

Both of these steps stir heated argument, not to mention lobbyists’ hearts. But what creates the deepest unease is considering what we will have to do about the system’s exploding costs if pushing more people out is no longer an option. We have really discussed only two options: raising taxes or rationing care. The public is understandably alarmed.

There is a far more desirable alternative: to change how care is delivered so that it is both less expensive and more effective. But there is widespread skepticism about whether that is possible.

Yes, many European health systems have done it, but we are not Europe. And evidence that places like the Mayo Clinic in Minnesota or the Cleveland Clinic are doing it is likewise dismissed because their unique structures (for example, their physicians work on salary rather than being paid for each service) make them seem as far from Middle America as Sweden is.

Yet in studying communities all over America, not just a few unusual corners, we have found evidence that more effective, lower-cost care is possible.

To find models of success, we searched among our country’s 306 Hospital Referral Regions, as defined by the Dartmouth Atlas of Health Care, for “positive outliers.” Our criteria were simple: find regions with per capita Medicare costs that are low or markedly declining in rank and where federal measures of quality are above average. In the end, 74 regions passed our test.

So we invited physicians, hospital executives and local leaders from 10 of these regions to a meeting in Washington so they could explain how they do what they do…

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Megs slept on me pretty much all night, though when I finally got up this morning, there was no sign of her. I went through the apartment, calling her and looking in all the likely spots. No Megs, but she had clearly been playing in her water bowl: water on the kitchen flow. She seems to want a certain "paw" taste in the water and takes care of that herself.

Finally, I looked at the top shelf of the bedroom closet, in the corner closest to the closet door (and thus invisible if you simply look into the closet from the outside). There was Megs, looking down at me. "Meow," she said.

She’s still there, and I suspect she’ll be there a lot over the next few days as she reacclimates to being home. She’s saved from a vet visit today—The Wife must see the doctor, and she has a dental appointment, too, and I have an endocrinologist appointment. So the vet visit is scheduled for tomorrow afternoon. Probably just as well to give Megs a day to recover before the dreaded vet visit—especially since she’ll get some vaccinations.

Thanks to TYD for pointing out this video.

The soap and the aftershave are both by Woods of Windsor, and I got a very fine creamy lather from the soap with the Boreal boar brush. The Mühle with (I believe) an Astra Keramik blade was a pleasure to use, and the aftershave topped it off with élan.

The Wife came home from work and changed, and then we tackled the garage. No sign of Megs, of course, what with all the stuff stored in the garage: it’s a two-car garage, with my car on one side and lots of stored furniture on the other, along with bales of insulation for some project.

We took the 2 Million Power Flashlight from Black & Decker. It never states 2 million what, but it does cast a powerful beam, driven by a rechargeable lead-acid battery. I took it out fully charged—it’s the only flashlight I’ve had where I expect to turn it on and feel a recoil. But in 15 minutes or so, the light was dying. I guess they figure with a light this powerful, if you can’t find whatever it is right away, it’s hopeless.

The garage was hot (afternoon sun on the two doors) and stuffy—we had to keep all doors closed, of course. And it was quite dim: one 75-watt bulb for the entire garage, and that on my side, away from all the junk.

We started systematically moving stuff, cutting down on escape routes and hidey-holes, and The Wife was busily looking behind stuff. She did find Megs, tucked in behind some very heavy wooden boxes—speakers, but about 4 feet wide and 4 feet tall. (They were stacked, one above the other.) She tried to grab Megs, who fled past her to get under the car.

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Steve Pearlstein in the Washington Post:

Republican strategists and their media rabble-rousers cleverly thought they could dispatch their shock troops this month and kill health reform once and for all.

Instead, they’re on the verge of generating what they’ve been desperate to avoid — an urgent, national, rational conversation on how to make the health-care system fairer and more affordable.

To be sure, many details of health reform are still to be ironed out. But in the end, what is likely to emerge from this conversation is a health system that looks more like what President Obama has in mind than what Republicans have been peddling these past 15 years without any visible signs of success.

At his town hall meeting Tuesday in Portsmouth, N.H., Obama reminded us of the deft political touch and mastery of policy details that won him the presidency. He and the good citizens of southern New Hampshire have set the standard against which other politicians and citizens will be judged.

Here at The Post, we have our own ongoing town hall meeting on the health reform issue — online and in print — that also demonstrates how it is possible to disagree about health reform without being disagreeable. In that spirit, I’d like to call attention to three columns by friends and colleagues that appeared over the past week: …

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That seems to be the advice on the Right regarding anthrogenic climate change. I wrote about this earlier, but my post failed to take the world by a storm, so take a look at this post on Climate Progress:

Let’s assume we keep listening to the siren song of the deniers and the climate action delayers who insist human-caused global warming is not a dire problem requiring deep reductions in greenhouse gases starting as soon as possible.   So we ruin our  livable climate for our children and grandchildren and countless generations after that.

When they are done cursing our name, our descendents will try to understand how “a technologically advanced society could choose, in essence, to destroy itself,” as Elizabeth Kolbert put it.  They’ll have a long time to do this since, as a major NOAA-led study concluded this year, climate change is “largely irreversible for 1000 years,” with permanent Dust Bowls in Southwest and around the globe — irreversible, that is, if we don’t stop it in the first place.

The typical reasons why people and societies have historically made such tragically catastrophic blunders don’t apply to a great many opinion makers today.  Sure some are malicious or ignorant, and some, like David Broder, sultan of the status quo, are fatally uninformed about global warming.

But how you explain people who have a fair amount of familiarity with the issue and actually write regularly on the subject — but just get it so wrong again and again?  Many of these are people I’ve called the climate action delayers (CADs) — the folks who claim to believe in the science of global warming but obviously don’t, the folks who substitute their own opinion for an understanding of the actual science.

Their tragic flaw is hubris, which, as Wikipedia notes is:

a term used in modern English to indicate overweening pride, superciliousness, or arrogance, often resulting in fatal retribution or Nemesis.

A perfect example of modern-day hubris can be seen in the work of one Thomas Fuller, a delayer who writes as an “environmental policy examiner” for the examiner.com named.  He has his own label, as he wrote August 1:

As a global warming ‘lukewarmer,’ I believe that manmade CO2 will cause about 2 degrees Celsius of warming as concentrations of CO2 double during the course of this century.

That, of course, doesn’t make him a lukewarmer.  It just makes him someone who doesn’t understand or care about what science actually says.  On our current emissions path, we’re going to double CO2 concentrations not “during the course of the century” but almost certainly halfway through it — and we’re going to warm more than 4°C by century’s end: …

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From Paul Krugman’s blog:

A number of people have pointed this out, but here’s the latest in the “Obama’s health reform will kill people” news: Investor’s Business Daily — which poses as a reputable source of financial information — opines that

People such as scientist Stephen Hawking wouldn’t have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless.

That would be Stephen Hawking, British professor, who was born in the UK and has lived there for his whole life.

Rafael Pardo and Juan Gabriel Tokatlian have an interesting article in the Christian Science Monitor. It begins:

On Monday, President Obama restated his support for Mexican President Felipe Calderón’s aggressive tactics in the fight against drug trafficking. He also reiterated his support for a drug security plan with Mexico that is similar to the failed drug plans of past administrations.

Before Washington ramps up yet another losing war on drugs, it should take a clear-eyed look at how its current strategies are affecting the supply and demand of drugs. Congressman Eliot Engel (D) of New York has introduced a bill to do just that.

Washington would be wise to back Congressman Engel’s initiative because there has not been a thorough, frank evaluation of the fight against drugs in decades. The drug czar office’s annual report is not enough. Recommendations by an independent commission, however, could generate the consensus and strategy we sorely need.

The cornerstone of US drug policy at home and abroad is to reduce the drug supply (from crop eradication to border seizures) in order to increase the domestic price of drugs. The idea is to deter both potential consumers and producers from entering the drug market.

It hasn’t.

Since May 1971, when President Richard Nixon proclaimed a "war on drugs," Washington and the Western Hemisphere have been unable to win it. Every claimed victory has turned out to be, in the end, a fiasco.

Consider Mexico and Jamaica in the 1970s and early ’80s…

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After trying three different makes, I’ve decided that the best (for me, at least) are the these knives, the Tenmi-Jyuraku Series (Aogami Super). The exposed carbon-steel edge does require some care: rinsing and drying knife after use. Even then, that portion of the knife will discolor, but can be polished with Maas metal polish. I recommend using a folded paper towel, since the edge tends to cut the polishing cloth. The big point in its favor is that the edge seems sturdy and is easily sharpened.

The Hattori HD series are more attractive to begin with, but the edge is alarmingly fragile: I already see tiny chips. And they are not so easy to sharpen as the Aogami Super. I also tried a Korin knife, but it is somewhat boring in comparison to the Aogami Super.

So if you want to try Japanese knives, you have my recommendation. I have a Gyuto and a Petty knife. They’re terrific!

Interesting column in the NY Times by Michael Dove, a colleague of Obama’s mother:

PRESIDENT OBAMA’s late mother, Ann Dunham Soetoro, was famous for the good cheer and optimism that she preserved in the face of a complex and challenging world. Her personality went hand-in-hand with her career as an anthropologist in Indonesia and Pakistan, where she studied and worked with village craftsmen, slum-dwellers and countless others. I knew Dr. Soetoro as a friend and colleague for many years before her death from cancer in 1995. Though I only met her son once, briefly at her memorial service, I’ve watched him as he’s taken on the hardest job in the world, and often found myself wondering how her worldview might have shaped him.

Dr. Soetoro’s most sustained academic effort was her 1,043-page dissertation, “Peasant Blacksmithing in Indonesia: Surviving Against All Odds,” completed in 1992 and based on 14 years of research. This was a classic, in-depth, on-the-ground anthropological study of a 1,200-year-old industry. Her principal field site was a cluster of hamlets, containing several hundred households, on an arid limestone plateau on Java’s south coast. There, village metalworkers produced dozens of different iron blades and tools for use in farming, carpentry, and daily life.

When Dr. Soetoro began her study in 1977, the village could be reached only by walking a mile and a half from the nearest paved road. The first battery-powered television set did not arrive in the village until 1978, and was placed in a window and watched by the village en masse; electricity did not arrive until a decade later. In her dissertation, Dr. Soetoro called this village “a wonderful and mysterious place to live.”

Running through Dr. Soetoro’s doctoral research, as through all her work, was a challenge to popular perceptions regarding economically and politically marginalized groups; she showed that the people at society’s edges were not as different from the rest of us as is often supposed. Dr. Soetoro was also critical of the pernicious notion that the roots of poverty lie with the poor themselves and that cultural differences are responsible for the gap between less-developed countries and the industrialized West.

Indeed, Dr. Soetoro found that the villagers she studied in Central Java had many of the same economic needs, beliefs and aspirations as the most capitalist of Westerners. Village craftsmen were “keenly interested in profits,” she wrote, and entrepreneurship was “in plentiful supply in rural Indonesia,” having been “part of the traditional culture” there for a millennium.

Based on these observations, Dr. Soetoro concluded that …

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Jeff Stein in the Congressional Quarterly:

Former Air Force Maj. Matthew Alexander, whose questioning of a captured terrorist led to the elimination al Qaeda’s top man in Iraq, said a pervasive "intolerance" of Arabs and Muslims among American interrogators led to abuses at Abu Ghraib and other prisons.

"Soldiers referred to them as rag heads and so on," Alexander said during a Monday talk at the International Spy Museum, in Washington, D.C. to promote his book, "How To Break a Terrorist: The U.S. Interrogators Who Used Brains, Not Brutality, to Take Down the Deadliest Man in Iraq."

"They had read things like ‘The Politically Incorrect Guide to Islam,’ which characterizes its practitioners as potential terrorists, he added.

An Air Force criminal investigator for over a decade before being assigned to Iraq in March 2006, Alexander was careful not to characterize all, or even most, interrogators as bigots, although he said, "it was not just a few bad apples" who tortured prisoners.

"It was not a majority of interrogators.  If I had to guess, maybe 20 per cent," he told a packed room at the International Spy Museum, which opened its doors in July 2002.

"A small minority with a lot of power" at the top of the chain of command was responsible for fostering at atmosphere in which abuses could flourish, he said.

"Not enough of our officers stood up and refused to carry out those orders."

It wasn’t interrogators who advocated the use of water boarding and other harsh techniques, he said.

"It was thought up by psychologists, not interrogators," who knew they could get more from prisoners without torture. 

Continue reading. The American Psychological Association has a lot to answer for in its refusal to forbid its members (via the code of ethics) from participating in torture. And we do know the names of the psychologists responsible.

In view of the current healthcare debate, this article by David Goldhill in the Atlantic is worth pondering. The blurb:

After the needless death of his father, the author, a business executive, began a personal exploration of a health-care industry that for years has delivered poor service and irregular quality at astonishingly high cost. It is a system, he argues, that is not worth preserving in anything like its current form. And the health-care reform now being contemplated will not fix it. Here’s a radical solution to an agonizing problem.

The article begins:

Almost two years ago, my father was killed by a hospital-borne infection in the intensive-care unit of a well-regarded nonprofit hospital in New York City. Dad had just turned 83, and he had a variety of the ailments common to men of his age. But he was still working on the day he walked into the hospital with pneumonia. Within 36 hours, he had developed sepsis. Over the next five weeks in the ICU, a wave of secondary infections, also acquired in the hospital, overwhelmed his defenses. My dad became a statistic—merely one of the roughly 100,000 Americans whose deaths are caused or influenced by infections picked up in hospitals. One hundred thousand deaths: more than double the number of people killed in car crashes, five times the number killed in homicides, 20 times the total number of our armed forces killed in Iraq and Afghanistan. Another victim in a building American tragedy.

About a week after my father’s death, The New Yorker ran an article by Atul Gawande profiling the efforts of Dr. Peter Pronovost to reduce the incidence of fatal hospital-borne infections. Pronovost’s solution? A simple checklist of ICU protocols governing physician hand-washing and other basic sterilization procedures. Hospitals implementing Pronovost’s checklist had enjoyed almost instantaneous success, reducing hospital-infection rates by two-thirds within the first three months of its adoption. But many physicians rejected the checklist as an unnecessary and belittling bureaucratic intrusion, and many hospital executives were reluctant to push it on them. The story chronicled Pronovost’s travels around the country as he struggled to persuade hospitals to embrace his reform.

It was a heroic story, but to me, it was also deeply unsettling. How was it possible that Pronovost needed to beg hospitals to adopt an essentially cost-free idea that saved so many lives? Here’s an industry that loudly protests the high cost of liability insurance and the injustice of our tort system and yet needs extensive lobbying to embrace a simple technique to save up to 100,000 people.

And what about us—the patients? How does a nation that might close down a business for a single illness from a suspicious hamburger tolerate the carnage inflicted by our hospitals? And not just those 100,000 deaths. In April, a Wall Street Journal story suggested that blood clots following surgery or illness, the leading cause of preventable hospital deaths in the U.S., may kill nearly 200,000 patients per year. How did Americans learn to accept hundreds of thousands of deaths from minor medical mistakes as an inevitability?

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So far as I can tell, the current Conservative trope is, “Government is bad.” There are some exceptions—government giveaways to business are good, because business is good. But in general, government is viewed as undesirable—Grover Norquist, for example, proclaims that he wants to cut taxes to starve the government until it is small enough to drown in the bathtub: total rejection of government.

As to what would replace it, he does not say. Perhaps businesses can run our lives, with the free market making sure that we are treated fairly and have recourse to compensation when we’re not. But in looking at how businesses treat the environment, their customers, their employees, I don’t think I want them in charge. In fact, I want them closely regulated and watched like hawks because they are driven totally by the profit motive, and it is clear that improving profits justifies any means that they can get away with—and, by the number hauled away to prison, also by means that they were not able to get away with.

This attitude overlooks the long evolution of government before we arrived at the idea of a secular government that depends on the consent of the governed (as expressed through free election by all citizens of their representatives, with the terms requiring re-election from time to time).

The early part of The Evolution of God, which (as you can tell) I’m finding quite interesting, traces how this meme—government—evolved through trial and error. Religion was the basis for early governments—indeed, religion seemed to run most aspects of daily life. It took a long time to separate the idea of “religion” from the idea of “government” and the idea of free elections also had its own evolution—as, indeed, did the idea of “business.”

In fact, as Paul Krugman has convincingly argued, the free market simply does not work for some things—like healthcare insurance, for example. Nor does the free market seem able to deliver a comprehensive national healthcare system that covers all citizens. For that, we turn to government (or at least all modern nations but the US have turned to government).

The entire idea that secular government whose representatives are freely elected is such an astonishing achievement, looking back at human history, that it’s surprising that conservatives hold it in such low regard—and don’t seem able to articulate with what they would replace it. Just let Grover Norquist be King? No, thanks.

UPDATE: The 20th century saw some spectacular failures of government—just to mention a few: Germany, the Soviet Union, Red China, Cambodia, and others. Obviously, we’re still working on the meme. Because culture is created anew in each infant as it grows to adulthood—through education (parents, schools, churches, and other training institutions) and immersion, the preservation, protection, and advances in culture lies mainly in how we educate our young. I don’t think we are yet doing a good job: not good enough to teach the young how to protect and advance the idea of a government that depends on the on-going informed consent of the governed. But it’s early days: the US itself is not even 250 years old, and the evolution of social organizations seems to require many hundreds of years, with setbacks along the way.

Following The Wife’s advice, last night I got up at 12:30 a.m.—very difficult—and went to sit quietly on the bench in the apartment courtyard, clicking the switch on the laser pointer. I was sitting there when I saw a gray shape run—absolutely silently—along the side of the courtyard and into the garage. It could have been Megs, it could have been a mutant rat.

I went to the garage and closed the door, so I was trapped in there with whatever it was. I turned on the light, called, "Megs. Meggsy-Weggsy." and other beckonings. Finally, I sat quietly in a chair and continued clicking the laser pointer (which never did attract her, BTW). I saw the gray thing run—again, in total silence, crouched low—toward a pile of stuff. I went to the pile of stuff and looked around and then saw it again running under the car.

I did try bringing out her food bowl and adding food and rattling it, but that was insufficiently attractive. Finally, I brought out the water as well, left food and water, closed the door, and went back to bed.

Today a rescue operation involving the cleaning ladies will be mounted. I’ll post results.

Since it really wasn’t a rat, and the only gray cat in the neighborhood is Megs, and it’s quite near where she escaped from the apartment, I’m sure it is Megs. The only trick now is to return her to the apartment. She’s totally scared, so far as I can tell.

Another very fine lather. As noted previously, Kell’s Original seems to like it best when you’re stingy with the water. The Edwin Jagger ebony Chatsworth with the new head did a fine job, and Sandalwood was a good aftershave for today. The Kell’s Original samples, BTW, are good for quite a few shaves.

Memes are the units of culture, and I find it difficult to separate the concept of “meme” from the concept of “idea.” Wikipedia has:

A meme (pronounced /ˈmiːm/, rhyming with “cream”^[1]) is a postulated unit or element of cultural ideas, symbols or practices, and is transmitted from one mind to another through speech, gestures, rituals, or other imitable phenomena. (The etymology of the term relates to the Greek word mimema for “something imitated”.)^[2] Supporters of the concept regard memes as cultural analogues to genes, in that they self-replicate and respond to selective pressures.^[3] Memeticists have not empirically proven the existence of discrete memes or their proposed mechanism, and memes (as distinct from ideas or cultural phenomena) do not form part of the consensus of mainstream social sciences.

A symbol or practice or ritual is, to my mind, merely one embodiment of an idea, others being words, music, statues, roads, chairs, and so on: the idea is the essential unit, and the idea can be cloaked or realized in a variety of media.

As I sat thinking about memes last night, it occurred to me that some categories of memes—themselves a meme, of course, with children memes—advance rather rapidly over time, in the usual method of variation, replication, and selective pressure.

Mathematics, for example, has evolved quickly since around the 17th century—particularly compared to the slow evolution of, say, social structures. Part of that is that social structures have to become accepted and used by everyone, more or less, whereas mathematical memes can be developed and worked on by specialists (mathematicians).

Another highly successful and rapidly evolving meme is science. Again, not everyone works on this set of memes, so dedicated specialists (scientists) can work intensively to evolve the memes.

For both mathematics and science, progress became more rapid once some basic concepts became clear—i.e., once some guiding memes were developed. Math, for example, works by generalizing and extending existing structures. You can see this clearly in, for example, the development of number systems by extending existing systems: start with the counting numbers and successively extend them to: natural numbers (counting numbers plus zero), integers (including negative numbers), rational numbers, real numbers, complex numbers, quaternions, and other generalizations such as groups, rings, division rings, fields, and the like. Even space gets generalized: consider continuous functions on the interval [0,1]. You can define a “distance” between functions and begin to consider the functions as points in a function space and you’re on your way to functional analysis.

Similarly for science: once people thoroughly understand the notion of critical experiments—posing questions that an experiment can decide—combined with peer review and experiment replication, science began picking up speed.

Music is an example of the meme of art, which is a little different animal. The effort in art (sculpture, dance, music, painting, poetry, novels, and so on) is to create something new, something is unlike previous efforts. In effect, the goal is to create a new meme (idea), which then may or not be widely accepted and serve to inspire later memes. These memes also seem to advance relatively quickly because again specialists devote themselves to the effort.

Social organization memes—which The Evolution of God is currently focusing on—develop slowly since everyone is involved. The steps from extended families to tribes to chiefdoms to states took a long, long time. Indeed, even today many societies exist at earlier stages of social organizations.

One interesting question is what modern communications technology will do to memes. In modern times we have gradually development communication tools that enable a few to communicate to many: the book, the newspaper, movies, radio, and TV are all examples. But with the Internet we have a new tool that provides many-to-many communication. The only early examples of many-to-many communications that I can think of are battles and wars.

Memes can evolve quickly because, unlike organisms, memes (being ideas) have no mass and can be quickly reshaped. But memes that involve having large numbers of people having the same meme (such as social organizations) tend to evolve slowly—acceptance and understanding takes time, and of course the new meme must compete with earlier memes. Still, I would bet that in 3,000 years our species will have new social structures, just as a modern nation is quite unlike the ancient Egyptian empire.

If you make an effort to see the memes in which our thoughts move and among which we live, you will soon be able to identify them, give examples, look for interactions and competition for a particular niche, the local dominance of some memes, and so on. You will quickly grasp the idea, which is of course itself a meme and so far a fairly successful one.

The Eldest suggested calling local vets on the assumption that someone finding the cat might call a vet to see whether a cat’s missing. They were all very understanding and took the information willingly. Apparently, I’m not the only one to have a cat go on walkabout.

I’m having a hard time concentrating or focusing because I keep thinking about Megs—not only the "if only" thoughts, but also just missing her. I suppose that’s the downside of having a pet: if they start to mean a lot to us, then losing them hurts a lot. You can’t have one without the other.

Light blogging again today.

Death panels are not part of the health reform bills, but they do exist among healthcare insurance companies. Mike Madden at Salon.com:

The future of healthcare in America, according to Sarah Palin, might look something like this: A sick 17-year-old girl needs a liver transplant. Doctors find an available organ, and they’re ready to operate, but the bureaucracy — or as Palin would put it, the "death panel" — steps in and says it won’t pay for the surgery. Despite protests from the girl’s family and her doctors, the heartless hacks hold their ground for a critical 10 days. Eventually, under massive public pressure, they relent — but the patient dies before the operation can proceed.

It certainly sounds scary enough to make you want to go show up at a town hall meeting and yell about how misguided President Obama’s healthcare reform plans are. Except that’s not the future of healthcare — it’s the present. Long before anyone started talking about government "death panels" or warning that Obama would have the government ration care, 17-year-old Nataline Sarkisyan, a leukemia patient from Glendale, Calif., died in December 2007, after her parents battled their insurance company, Cigna, over the surgery. Cigna initially refused to pay for it because the company’s analysis showed Sarkisyan was already too sick from her leukemia; the liver transplant wouldn’t have saved her life.

That kind of utilitarian rationing, of course, is exactly what Palin and other opponents of the healthcare reform proposals pending before Congress say they want to protect the country from. "Such a system is downright evil," Palin wrote, in the same message posted on Facebook where she raised the "death panel" specter. "Health care by definition involves life and death decisions."

Coverage of Palin’s remarks, and former House Speaker Newt Gingrich’s defense of them, over the weekend did point out that the idea that the reform plans would encourage government-sponsored euthanasia is one of a handful of deliberate falsehoods being peddled by opponents of the legislation. But the idea that only if reform passes would the government start setting up rationing and interfering with care goes beyond just the bogus euthanasia claim.

Opponents of reform often seem to skip right past any problems with the current system — but it’s rife with them. A study by the American Medical Association found the biggest insurance companies in the country denied between 2 and 5 percent of claims put in by doctors last year (though the AMA noted that not all the denials were improper). There is no national database of insurance claim denials, though, because private insurance companies aren’t required to disclose such stats. Meanwhile, a House Energy and Commerce Committee report in June found that just three insurance companies kicked at least 20,000 people off their rolls between 2003 and 2007 for such reasons as typos on their application paperwork, a preexisting condition or a family member’s medical history. People who buy insurance under individual policies, about 6 percent of adults, may be especially vulnerable, but the 63 percent of adults covered by employer-provided insurance aren’t immune to difficulty…

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