Put the emphasis on the industry to come up with the solution to present to the administration. The rules will be. Everyone must be covered. It must be affordable and a choice for options of payment of the program. Necessary procedures will not be denied!

Everyone is an expert and has ideas but most really don’t know what to do. Lobbyists can focus their efforts rather than in the halls of Congress, but within their own industry, think tanks, harvesting their own expertise to come up with a proposed solution, rather than just objections to everything you propose. Let the ball fall in their court rather than the halls of Congress.

Give them the opportunity to solve the problem covering all the rules and objectives. This should satisfy the GOP that capitalism must make it work. Let all the insurers, hospitals, Doctors, lobbyists come up with the plan for presentation to you and congress. Have them put their money where their mouth is for the solution. Give them 4-6 months ONLY!

They may have to look at some of the things that now are acceptable practices. Industries that contribute to the high long term health costs would have the industries pay proportionately more. Cigarette smoking, alcohol, fats and unhealthy foods that cause obesity. Make industry responsible and part of the solution. Let people have choices as they have now but for every product sold that is known to have long term unhealthy effects a cost will be included.

The bone for the industry would be and additional fifty million people. The incentive would be, if you can’t or won’t make it work with all of your expertise, WE WILL let the non experts decide for you!

Industry needs to buy in and have ownership or it will never work. The ways of yesterday and profit being the only motive to act for what we value for our people is unacceptable. We value the people of the United States of America. They should also.

Thank you for the opportunity to write.

Richard McKnight rqtguru@gmail.com

Although me and my family’s situation is different than yours (My IQ is above average while my body subpar) I’m not sure anything I’ve ever read “gets me” like this. That might be a rather narcissistic thing to say, but still wow and thanks.

As a parent of a son with autism, we accept him for who he is, but also want him to be able to grow and develop as much as he can, just like our other sons. Because we love him, if we can remove a difficulty for him, or give him more skills to navigate his life, we will do so. That is not inconsistent with loving him unconditionally. My wife and I have learned through extensive training how to teach and expect more independence from our son, which is dignifying for him and helpful to us. (My son has low-normal cognitive skills but has the language, social skills and judgment of a 3-year old.)

I assume you have read some of Michael Berube’s writing about his child with Down syndrome, and about the dangers of underestimating someone just because they have difficulty in some areas. Although acceptance and grace are necessary, they may become a cowardly surrender if not mixed with some kind of striving. This is part and parcel of attributing full agency, to the extent possible, to persons with disabilities, and is the underlying principle of organizations such as the Special Olympics. I have learned as a parent that it is not the size of the accomplishment that matters, but the size of the effort and heart behind it. I am always grateful when I realize the enormous gifts that I have been given and humbled when I realize how little I have done with what I have.

Two random thoughts and a larger argument:

1) Interesting that Rittlemayer dismisses the idea of life gaining meaning through a freely chosen suffering by quoting JFK — a man notoriously crippled by pain, who was also charged with hiding that fact for most of his adult life, so that he might fulfill a family destiny/ commitment to public life.

2) If, in the eyes of God, one’s worth is not measured by one’s abilities (ie, you aren’t any more likely to be given salvation because you are a math genius; or, in heaven will anyone care that you had an incredible singing voice?) then certainly the same is true of your disabilities. So it seems a stretch to argue that some disabilities are intrinsic to someone’s personhood, and FOR THIS REASON a cure can not be thought of as an automatic good. Certainly, having ONCE been disabled is always intrinsic to one’s personhood, the same way having once had childhood cancer would be. Or having once been a talented ballerina, but no longer.

3) Rittelmayer argues that “When a man’s disability is fundamental to his character, then there is no difference between wishing for a cure and wishing he were someone else.” But she never acknowledges that there is no final way to KNOW that. There just isn’t. We know that a genetic disorder simply can’t be cured. Now. In this place. But if there was no way to determine that her sister had a genetic disorder, how could it be “known” that there was no cure? Obviously the march of science isn’t going to cure everything. But the march of science DOES render the line between what can be changed and what can’t be changed quite blurry, so that even when one hears that one’s baby simply can’t be cured, one now lives in a condition of modernity that immediately prompts the silent thought “Yes, but in twenty years. . . .?”

The point might not be that science lures us into thinking we can live a life free of pain and all traces of dependence, seducing us into decadence. The point may be that science lures us into a permanent lack of certainty about which of our pains are irreducible, and which can be assuaged and helped. The question that it seems like we need to answer is: since our understanding of what can be cured and what must be endured has been permanently rendered uncertain, how then are we to understand suffering?

For reasons of this permanent uncertainty, I am sympathetic to the UN’s admittedly over-stated declaration that disability is located in the community, not the individual. In fact, Rittelmayer seems sympathetic to it in her point about Down’s syndrome and terminated pregnancies. What makes her article most interesting to me is her — not quite developed, I think — acknowledgment that disability doesn’t just happen to an individual — it happens to a family, or a system of caregivers as well, and even to the larger public. But her article seems to bounce around on this point, making it seem as if the suffering of a disability extends only as far as immediate caregivers, while the LACK of disability happens to the larger public. Her article suggests that the suffering of disability and care-giving is a private burden whose example yields a public good, but then inconsistently both seems to advocate that this is the way things should be (in her hope that those who have “hardship thrust upon them” might act nobly) and to condemn the possibility that this is the way things might become (in her point that the termination of Down’s syndrome terminations renders raising such a child a mere “private choice” on the mother’s part).

I think you misstate Autonomy. Autonomy comes to us from ancient Greek: αυτονόμος autonomos, from auto “self” + nomos, “law”: one who gives oneself his/her own law. In modern use in ethics and philosophy, this means self-determination in the context of moral choices. In medicine, for example, this often takes the form of “informed consent” - the autonomous individual chooses for his- or herself. So when you say, “They think so because they believe people are fundamentally autonomous—a strange fiction.” And you are correct, except that you, too, hold some strange fiction that inter-dependence somehow compromises autonomy. It doesn’t. Autonomy is about choice in the context of constraints, external or internal. A person with certain specific disabilities is less self-sufficient than a more or less normally functioning human being, but his or autonomy is not thereby lessened.

In your 91% are included several genetic malformations other than DS. Among them is Anencephaly, a truly horrific malformation where there is essentially no head above the eyes and no brain much above the stem. Babies who survive birth live for hours only. This does not obviate your point about 15% so much as provide a footnote - there may in fact be lives so short and horrific that to not terminate the pregnancy is to insure unimaginable suffering of the parents and the baby.

Science has no vision of the world at all. Some, or even most, practitioners of science do. That vision is as multifaceted as the human beings that hold it. Undoubtedly some human beings, scientists included, envision a perpetually comfortable and easy world. Others hope to reduce disease, or improve the environment, or find some measure of peace for the mentally ill. You have created a straw man, a scientist that may or may not exist for real, but one that surely does NOT hold the view of many, or even most, scientists.

Finally, you have presented no rationale for exchanging love for autonomy as a basis for bioethics. Explain to me how that would work on an informed consent form. Explain to me how an individual making a moral choice could sublet that choice to another, even if love was at the heart of the relationship. Who bears responsibility for the action that follows the moral choice?

As a sketch, this is more of a thin straw. I wouldn’t care that it so were it not that so many conservatives seek just such a straw to which they can cling in their efforts to shut their ears to ethics discussions rooted in autonomy.

There may be such a thing as a bioethics rooted in love. I encourage you to sketch out your thoughts more fully, so that discussion can continue.

Jake

Also, you mentioned that when the price of ’sin’ products get too high, people find purchase alternatives even if they’re illegal. This point is also central. I’m surprised anyone buys cigarettes in Canada at the retail price anymore. But I think any research would show that the Canadian government’s revenue has not grown commensurate with the tax hikes on ’sin’ products. Which brings up the last point of ’sin’ taxes. They’re a sign of a government devoid of rationale and will to actually attack real problems. They would rather take the easy route since few people argue.

Why do the anti-Zionists feel that a thousand-year old claim by Arabs who were never ruled by Palestinian Arabs has legitimacy, while a 1,900-year claim by Jews to the land should be rejected as absurd?

So let us see if we have this straight. The anti-Zionists claim that the Jews have no right to the land of Israel because before Israel was re-created in 1948, it had been almost 1,900 years since the last time that the Jews exercised sovereignty over the Land of Israel. And the anti-Zionists claim that it is absurd to argue that anyone still has rights to land that was last governed with sovereignty 1,900 years ago. And on what basis do they argue that the Arabs have some legitimate claim to these same lands? On the basis of the claim that the Arabs last exercised sovereignty over that land 1,000 years ago. Are you all with me? 1,900 year-old-claims are inadmissible. Thousand-year-old claims trump them and are indisputable. Now let us emphasize that even the thousand-year-old Arab claim is not the same thing as a claim on behalf of Palestinian [sic] Arabs. After all, the last time that Palestinian Arabs held sovereignty over the lands of “Palestine” was … never. There has never been a Palestinian Arab state in Palestine. Ever. It is true that Arabs once exercised sovereignty over parts or all of historic Palestine. There were small Arab kingdoms in the south of “Palestine” already in late Biblical days, and they were important military and political allies of the Jews, who exercised sovereignty back then in the Land of Israel. After the rise of Islam, historic “Palestine” was indeed part of a larger Arab kingdom or caliphate. But that ended in 1071 CE, when Palestine came under the rule of the Suljuk Turks. That was the last time Palestine had an Arab ruler. After that, it was always ruled by a long series of Ottomans, Mamluks, other Turks, Crusaders, British, and — briefly — French. And in any case, why does the fact that Palestine once belonged to a larger Arab empire make it any more “Arab” than the fact that it also was once part of larger Roman, Greek, Persian, Turkish, or British empires? Now it is true that historic Palestine probably once had a population majority who were Arabs, but today it has a population majority who are Jews. So if population majorities are what determine legitimacy of sovereignty, Israel is at least as legitimate as any other country. So why exactly do the anti-Zionists claim that a thousand-year old claim by Arabs who were never ruled by Palestinian Arabs has legitimacy, while a 1,900-year claim by Jews to the land should be rejected as absurd, even though the United Nations granted Israel sovereignty in 1947? The anti-Zionists say it is because the thousand-year-old Arab claim is more recent than the older Jewish claim. But if national claims to lands become more legitimate when they are more recent, then surely the most legitimate of all is that of the Jews of Israel to the lands of Israel, because it is the most recent! The other claim by the anti-Zionists is that Jews have no rights to the lands of Israel (historic Palestine) because they moved there from some other places. Now never mind that there was actually always a Jewish minority living in the lands of Israel even when it was under the sovereignty of Romans, Greeks, Arabs, Crusaders, Turks or British. Does the fact that Jews moved to the land of Israel from other places disqualify them from exercising sovereignty there? The claim would be absurd enough even if we were to ignore that fact that most “Palestinian Arabs” also moved to Palestine from neighboring countries, starting in the late nineteenth century. But more generally, does the fact that a people moves from one locality to another deprive it of its claims to legitimate sovereignty in its new abode? Does this fact necessitate the conclusion that they need to pack up and leave, as the anti-Zionists insist? If it does, then it goes without saying that the Americans and Canadians must lead the way and show the Israelis the light, by returning all lands that they seized from the Indians and the Mexicans to their original owners and going back to whence they came. For that matter, the Mexicans of Spanish ancestry also need to leave. The Anglo-Saxons, meaning the English, will be invited to turn the British Isles over to their rightful original Celtic and Druid owners, while they return to their own ancestral Saxon homeland in northern Germany and Denmark. The Danes of course will be asked to move aside, in fact to move back to their Norwegian and Swedish homelands, to make room for the returning Anglo-Saxons. But that is just a beginning. The Spanish will be called upon to leave the Iberian Peninsula that they wrongfully occupy, and return it to the Celtiberians. Similarly the Portuguese occupiers will leave their lands and return them to the Lusitanians. The Magyars will go back where they came from and leave Hungary to its true owners. The Australians and New Zealanders obviously will have to end their occupations of lands that do not belong to them. The Thais will leave Thailand. The Bulgarians will return to their Volga homeland and abandon occupied Bulgaria. Anyone speaking Spanish will be expected to end his or her forced occupation of Latin America. It goes without saying that the French will lose almost all their lands to their rightful owners. The Turks will go back to Mongolia and leave Anatolia altogether, returning it to the Greeks. The Germans will go back to Gotland. The Italians will return the boot to the Etruscans and Greeks. Ah, but that leaves the Arabs. First, all of northern Africa, from Mauritania to Egypt and Sudan, will have to be immediately abandoned by the illegal Arab occupiers and squatters, and returned to their lawful original Berber, Punic, Greek, and Vandal owners. Occupied Syria and Lebanon must be released at once from the cruel occupation of the Arab imperialist aggressors. Iraq must be returned to the Assyrians and Chaldeans. Southern Arabia must be returned to the Abyssinians. The Arabs may retain control of the central portion of the Arabian Peninsula as their homeland. But not the oil fields. Oh, and the Palestinian infiltrators, usurpers and squatters will of course have to return the lands they are illegally and wrongfully occupying, turning them over to their legal and rightful owners, which would of course be the Jews!

Now, on the other hand, I admit you may know of certain folks, and if you wanted to speak to their preferences, sensibilities, or positions, I could properly contextualize that, and would appreciate your reduction of your blanket statements to a more appropriate sphere. I adopted this myself, especially when writing about theoretical matters. It is all to easy to lecture on about economic theory or moral philosophy as relates to people. But do folks really act that way? Maybe it does sing to a sense of the pastoral, but often among those audiences, a bit of earthiness is exactly what’s needed.

Of course, in philosophy one must always be on the look-out for the dreaded, “volk”–the terrible pitfall which caught Heidegger, and many others this century. Appealing to one’s volksiness has its own dreadful connotations. But maybe this is precisely what I see in “people”. “People” has taken the humanistic role of the “volk”: those who are the sum of society, the actors of history, and the ever-present individuals (though, admittedly not HERE, per se, but you know, in theory). And, those who are often predisposed to tell me what “people” do, are those in the position most similar to those who used “volk” as their warrant.

As a last note to a long note, I would mention that my partner, who studies Folklore, is often expressing frustration at the assumptions made about the discipline based on the name. Either: A) it is not taken seriously as a literature/culture, or B) it’s very folksiness is deemed to mean that “if I say that is folklore it is: no justification necessary.” Perhaps we are simply doomed to oscillate between these two terms, giving each the authentic position in turn so that we can say continually, “those folk/people aren’t real people/folk.”

That’s all folks, Adam

Sammy Davis made a MUCH better president than Obama. I’ve got an essay, extensive photo galleries, and the entire 21 minute movie musical available for download.

There are young Hannah Arendts out there. But it’s clear enough that they know things you, Julia, don’t, and cannot. (E.g. how destructive, naive, and impermissible this exclusionary “wishing” is. Which is why foppish “intellectuals” who still assure themselves of their utility continue to say things like this, and continue to be ignored.)

To the extent that Mr. Gessen’s involvement with a trifling, silly character like Ms. Gould (purveyor of loads of absolutely nothing) has any bearing on his status as literary figure, his credibility has undoubtedly declined. No one seriously thinks Keith Gessen is “the next Lionel Trilling,” including, probably, Keith Gessen. But then, if all we ever get in New York again are copies of the last generation’s intellectuals, well, we could hardly call ours an intellectual scene that’s showed signs of “maturing.”

I don’t know what this means.

MEC

Policies that take this approach end up in effect being “natalist”. They are not however, strictly speaking natalist. A policy or set of policies that simply wanted to maximize reproduction could and would look quite different indeed.