Category: Activities (Page 34 of 48)

Discussion leader: Jim Phillips
Just because we can extend life, should we? The U.S. is expected to spend $2.8 trillion on health care in 2012. Medicare alone will cost taxpayers $590 billion, with over 25% going toward patients in their last year of life. If health care is a scarce resource, limited by its availability and our ability to pay for it, should government step in to ration care, deciding whose life is worth saving? In other words, how much is an extra month of life worth?

For The Motion
The U.S. spends more on health care than any other industrial nation—in 2012 we are expected to spend $2.8 trillion. We cannot afford our health care system and expensive end-of-life care costs are a major contributor to this problem.
Rationing means getting better value for the trillions we spend every year.
Rationing already happens. Medicare decides what it will reimburse, private insurance decides what they will cover, and individuals go without care and medicine every day when they can’t afford it.
We must ration based on cost-effectiveness, not on an individual’s ability to pay.
If we spent less on those who, with or without treatment, have only a few months left to live, we would be better able to help those who may have decades.
Against The Motion
The government should not have the power to determine who lives, who dies, and who gets treatment based on calculations of quality and quantity of life.
Health care costs can be reined in without rationing care.
Targeting “end-of-life” care specifically would result in very little cost savings.
Rationing care will lead us down a moral slippery slope. How many years of life is enough? Who is productive and worthy, and who is not?

https://www.intelligencesquaredus.org/debates/ration-end-life-care

In 1994, Oregon voters passed the Death with Dignity Act, which legalized physician-assisted suicide for the terminally ill. Since then, it has become legal in 4 more states, including New Mexico, where the state court ruling that it is constitutional is under appeal. Is it, in the words of the American Medical Association’s code of ethics, “fundamentally incompatible with the physician’s role as healer”? Will these laws lead to a slippery slope, where the vulnerable are pressured to choose death and human life is devalued? Or do we need to recognize everyone’s basic right to autonomy, the right to end pain and suffering, and the right to choose to die with dignity?

For The Motion
The right to die as one chooses—and to decide when life is no longer worth living—is integral to human freedom, liberty, and personal autonomy. Neither the government, nor religious institutions, should impose their own conceptions of morality upon individuals who are not harming others.
As an option in end-of-life care, aid in dying would allow terminally ill, mentally competent individuals to retain dignity and bodily integrity in the face of insurmountable pain and suffering.
In places where assisted suicide is legal—namely, Oregon and the Netherlands—there is no evidence that the law is being abused, that vulnerable populations are being targeted, or that patients are being coerced by doctors and/or their families to choose death.
If physician-assisted suicide remains illegal, lesser and more dangerous alternatives—shooting oneself, enlisting doctors or family to break the law, DIY suicide—will spread in its place.
Against The Motion
If assisted suicide is legalized, we will be led down a slippery slope towards pervasive medical killing, endangering vulnerable populations—disabled, elderly, minority, or poor—whose lives are seen as a burden on society.
If pain is treated effectively, there is no need to treat the patient as if the patient were the “problem to be eliminated.”
Starting with the Hippocratic Oath, medical professional codes prohibit killing, holding the intrinsic value of human life and dignity above all other ethical principles. Assisted suicide erodes the doctor-patient relationship and has grave potential for misuse and abuse.
Many physicians do not want to have God-like power over others, and they should not be pressured, against their own convictions, to assist in a patient’s suicide.
https://www.intelligencesquaredus.org/debates/legalize-assisted-suicide

As people approach the end of their lives, they and their families commonly face tasks and decisions that include a broad array of choices ranging from simple to extremely complex. They may be practical, psychosocial, spiritual, legal, existential, or medical in nature.

http://www.apa.org/topics/death/end-of-life.aspx

End-Of-Life Policy Solutions: A Cautionary Note
https://www.healthaffairs.org/do/10.1377/hblog20170710.060992/full/

Ethical Issues Surrounding End-of-Life Care: A Narrative Review
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934577/

How to Curb the High Cost of Caregiving
https://www.barrons.com/articles/how-to-curb-the-high-cost-of-caregiving-1521253021

HOW TO ENROLL IN VETERANS HEALTH INSURANCE (TRICARE)
http://www.dummies.com/personal-finance/veterans-benefits/how-to-enroll-in-veterans-health-insurance-tricare/

How to grow old in your own home
https://www.fidelity.com/insights/retirement/aging-in-place

Paying for Care
https://www.nia.nih.gov/health/paying-care

Problems and Solutions in End-of-Life Healthcare
http://www.healthleadersmedia.com/leadership/problems-and-solutions-end-life-healthcare#

https://www.wsj.com/articles/how-to-talk-with-your-dying-loved-one-1523891127

Discussion leader: David Mace

Here is a good overview piece from the Pew Research Center on refugees

http://www.pewresearch.org/fact-tank/2017/01/30/key-facts-about-refugees-to-the-u-s/

IQ2  Debate:

Since the Syrian Civil War began in 2011, more than 4 million Syrians have fled the country, creating the greatest refugee crisis since World War II. Most have fled to Turkey, Lebanon, and Jordan, but many have risked death to reach Europe and the possibility of a better life. Unlike Europe and Syria’s neighbors, the United States has had the advantage of picking and choosing from afar, taking in just over 2,000 Syrian refugees since the war’s start. The Obama administration has pledged to take another 10,000 in 2016, but there are some who suggest that we are falling well below the number that we can and should accept. What are our moral obligations, and what are the cultural, economic, and security issues that must be taken into account? Should the U.S. let in 100,000 Syrian refugees?

https://www.intelligencesquaredus.org/debates/us-should-let-100000-syrian-refugees

Fact sheet supporting the debate:

https://dariendma.org//wp-content/uploads/Refugee-Facts-Oct-2015-FINAL.pdf

And a rebuttal to the fact sheet:

https://cis.org/Report/FactChecking-Fact-Sheet-Refugee-Resettlement

Discussion leader: Bryan Hooper

The American Dream is still alive, but it has been fading into the distance with the growth of inequality of income and wealth distribution over the past few decades. There are some good research guides to help us understand the current situation and provide a basis for discussion of how changes in automation might affect the situation in future. In particular, the economists Thomas Piketty of the Paris School of Economics and Raj Chetty of Stanford University specialize in the study of inequality and its causes and possible cures, and the reading items suggested in these notes draw on their work.

• The first recommendation is the World Inequality Report, which was part-authored by Thomas Piketty, and released in December, 2017. Download the executive summary from their website below and you will see in pages 4 through 16 a comprehensive review of the global situation, including an analysis of reasons for the rise in inequality and some suggestions to change the situation into a more equitable distribution. The use of well-designed charts is outstanding, and Figure E3 that illustrates the comparison between the USA and Western Europe is a good example. It shows that in the USA over a period of 36 years the share of national income of the top 1% doubled to 20% through 2016, while the bottom 50% saw its share decline from 20% to 13%. In Western Europe, in contrast, the top 1% share grew from 10% to 12%, and the bottom 50% declined from 24% to 22%. Figure E8 shows that the share of wealth (as opposed to income) rose for the top 1% in the USA from 22% in 1980 to 39% in 2014. The report is on:
  http://wir2018.wid.world/

  For those of you with really limited time go to the review of key findings from the report in a New York Times article from 12/14/2017:
  https://www.nytimes.com/interactive/2017/12/14/business/world-inequality.html

  • The second major recommendation is to pull up The Equality of Opportunity Project website, and look at the second chart on the home page that provides the support for the first sentence of these notes. To quote, “Our work shows that children’s prospects of earning more than their parents have fallen from 90% to 50% over the past half century.” One of the Project Directors is Raj Chetty and a podcast on Freakonomics Radio expands on his research on the American Dream: there is a link to the podcast in the second paragraph of the item on Project Motivation next to the chart. You can either listen to the 40 minutes of the broadcast, or for the time-challenged, try reading the on-screen transcript instead. To save even more time read a summary of his key points below:
  Young kids who move out of a high-poverty neighborhood do much better later on in life because of several factors:
  – Residential integration.
  – Income inequality.
  – Family influence.
  – Social capital.
  – School quality.
  The investment in moving these children is repaid to society by the income taxes they pay back on the higher earnings they eventually make as adults.
  The website is:
  http://www.equality-of-opportunity.org/

  Chetty is also working on a project using Facebook data to help understand better the causes of inequality:
  https://www.politico.com/story/2018/02/19/facebook-inequality-stanford-417093

  The Brookings Institution has Chetty in 14 Charts on this site:
  https://www.brookings.edu/blog/social-mobility-memos/2018/01/11/raj-chetty-in-14-charts-big-findings-on-opportunity-and-mobility-we-should-know/

  • A third suggestion is to read the key points from the IPPR report titled Managing Automation which is mainly about the UK economic outlook in this area, but contains on page 17 chart 1.6 using data from the McKinsey study cited below indicating that 60% of occupations in the USA consist of activities that are 30% automatable. (Does that mean that 18% of those jobs will disappear?) It also states that occupations with zero chance of being automated include psychiatrists and legislators! The executive summary on pages 2 to 5 is a quick read, but section 2 on pages 24 to 30 covers their forecast for the growth of inequality due to automation. The potential loss of wages associated with automating activities is estimated as $1.1 trillion in the USA.
  https://www.ippr.org/files/2018-01/cej-managing-automation-december2017.pdf

  • The fourth recommendation is to review the key findings of a McKinsey Global Institute study titled A Future that Works: Automation, Employment and Productivity. Pages ii to iii provide a quick summary. The subsequent executive summary is on pages 1 to 3, and for those with perseverance the full report covers an additional 16 pages of analysis and opinion.
  https://www.mckinsey.com/~/media/McKinsey/Global Themes/Digital Disruption/Harnessing automation for a future that works/MGI-A-future-that-works-Executive-summary.ashx

  • For the fifth reference point, if you still have the time and energy, have a look at the debate on Intelligence Squared from October, 2014, Income Inequality impairs the American Dream of Upward Mobility. Again, you can download a transcript to read in a shorter time than listening takes – 1:44 hours – and it will also save you having to listen to the self-centered moderator. Note that the motion was judged to have failed by their scoring system, but a majority of the audience ended up supporting it.
  https://www.intelligencesquaredus.org/debates/income-inequality-impairs-american-dream-upward-mobility

  • And for those with even more stamina here is a selection of newspaper articles to browse on this subject:
  From the New York Times 2/28/18: The Unmet Promise of Equality:
  https://www.nytimes.com/interactive/2018/02/28/opinion/the-unmet-promise-of-equality.html

  As the World Economic Forum convenes in Davos, the powerful are feeling optimistic because of waning worries about populism and global economic growth.
  https://www.nytimes.com/2018/01/22/business/davos-world-economic-forum-populism.html

  From The New York Times: Open Societies Under Siege. Trump is a symptom, not a cause. That is why he will be hard to dislodge.
  https://www.nytimes.com/2018/01/26/opinion/open-societies-under-siege.html

  Hidden in the middle of this article is McKinsey’s estimate that “roughly half of all jobs are at risk of automation in the next 20 years.” Increased expenditures on training and development of people is suggested as the answer to the problem.

  From The New York Times: How C.E.O.s Should Spend Their Tax Cuts. Bonuses are nice, but the best investment is in training your employees.

  https://www.nytimes.com/2018/02/08/opinion/ceo-tax-cuts.html

  From The New York Times:The Redemption of Chris Hughes. The Facebook co-founder’s rise was meteoric. He argues that the same forces that helped him succeed have made it harder for others. In a new book, “Fair Shot,” he proposes a bold solution.
  https://www.nytimes.com/2018/02/21/books/review/chris-hughes-facebook-fair-shot.html