Via Jamelle Bouie, via Paul Krugman I see that Glenn Kressler doesn’t like this quote by Kathleen Sebelius

“I think there’s no question if you take a snapshot, people will run out of money, very quickly [under the GOP Medicare plan if you have cancer]. And if you run out of the government voucher and then you run out of your own money, you’re really left to scrape together charity care, go without care, die sooner. There aren’t really a lot of options.”

Kressler says

Her answer was strong stuff, suggesting that the GOP plan could cause people to “die sooner” if they had cancer and ran out of money. We have been critical of some of the ways Republicans have described the plan, but is this even remotely possible?

I didn’t read it that way. I thought she was saying that dying sooner was the alternative to either getting charity or going without care. This is an essentially correct riposte to an argument I have been making.


For a while, the prevention people tried to make the case that taking action to detect and treat disease early would bring down costs. I, among others, argued this was nonsense. The real way to bring down health costs is to eschew prevention and let disease progress to the point where death comes quickly and without warning.

The earlier you catch a disease the more likely you are to spend a bunch of money treating it. This is only made worse in the rare case that the treatment is successful. At that point you have already dumped a bunch of money into someone who is likely going to come back with another disease later.

In response, folks began arguing that people like me thought the best way to save money is to have people die quickly. And, in my case that is utterly true. I do believe that. Though my point really centered around early detection.

I hoped that this realization would help people get at the problem of affect.  Saving money sounds like a good thing. Early detection sounds like a good thing. Its natural to think that they go together. However, they are actually opposites.

This happens all the time. People think that bad things beget other bad things and that good things beget other good things. But, good and bad are properties assigned in the mind. Cause and effect extend from the relationship between real things in space-time.

The two don’t necessarily overlap. We make major reasoning mistakes when we assume that doing good things will have good consequences. Consequences have nothing to do with good or bad. They simply are.