And most (greater than 90%) of people diagnosed with cancer are “cured” and able to live many years longer. After $1,000′s in chemotherapy, surgery and radiation.

“Nowhere does John Siegel assail you personally.”

Nowhere did I say he did? I wrote that there was a selective reading on your part of what constituted “civil/uncivil” speech. I also wrote that he dodged the questions, and repeatedly dodged admitting when he had purposefully posted links that did not in the least support what he claimed they supported. I also wrote that he claimed knowledge of material he clearly had no knowledge of.

“You attack him personally: “Dr”, “are you really a doctor”,

If I question whether someone actually possesses the credentials he claims, is that a personal attack, or is it in the interest of maintaining some credibility in the exchange?

And “do you get it” is quite mild compared to some of the previous posts here, but you raised no objection to those posts, which leads me to believe you are reading very selectively. The question is why?

“how many unnecessary surgeries…”, “it’s not your job to perform unnecessary procedures”…

These are not personal attacks, and certainly not in the context in which they written (which you have neatly, even surgically, removed), but references to a specific problem noted not just by Atul Gawande in The New Yorker Magazine, but several other sources.

“By very rough count, in his 20 paragraphs, he uses derogatory language twice, or 10%. In your 39, you use it, directed at him, in 13, or 33%.”

That is truly a very rough count, given that you define “derogatory” and “civil” in a very, very selective manner.

“But you nail me with “profession you say you retired from”. Personal again. “

No, I did not “nail” you, nor do I desire to “nail” you. I simply acknowledged what profession you claimed to have retired from.

But Robert, to quote me as writing “…being broken by the white glove docility of his corporate employers” ignores that I praised James Kwak in the same sentence. The full phrase actually reads:

“James Kwak, a good and smart man who, I worry, runs the risk of being finally broken by the white-glove docility expected of his corporate employers”

and that hardly constitutes a personal attack. It is much more of a fraternal concern.

And I’m sorry, but to continually insist that someone is shouting rather than talking is to take the focus off of the questions that were asked. And that does more of a disservice to you than to myself.

You are welcome, nonetheless, to address the issue of preventive care, and the percentage by which we could reduce overall health care spending now.

You may not currently be employed by McKinsey, but you were.

Given the vast network McKinsey lays claim to, it is reasonable to ask whether anyone ever actually leaves McKinsey.

That network, and those connections, are very valuable.

I have no doubt that you understand intellectually how people are shaped and influenced by their industries… but I question – sincerely, not snarkily – whether you are conscious of how that network and those connections affects your writing on the variety of topics you handle here.

(Full disclosure: I happen to like your writing and I agree with a great deal of what you write – Posner aside.)

On a minor level: most people understand that the management consulting sector “consults” individual corporations, including pharmaceutical companies, and that alone should probably raise questions when you are writing about health care reform.

That’s not paranoia, James. That’s due diligence on the reader’s part.

Separate from that, a smaller group of people remains aware of the influence that management consulting firms have with a variety of governmental agencies. You may disagree with this premise and I respect that, but with that in mind, I do think it’s relevant for readers to ask questions about your links to McKinsey and how that might shape you.

On an individual level, when you get your law degree, do you plan to return to management consulting? I ask because your aims with this blog seem very clear – you want reform. But if you are to return to management consulting – an “industry” which neither produces any tangible goods nor actively works for anything resembling reform – we should know, and yes, it should raise questions about your goals.

Given that this blog is also devoted to exposing the “oligarchic” interests of the banks, isn’t it also valid to ask what role management consultants play in that oligarchy?

These are not frivolous questions. There is an element of public pressure here, James. If I can get you to discuss publicly your role at McKinsey, perhaps I can eventually rescue a talented and smart individual such as yourself from returning to an industry that AGAIN neither produces anything tangible, nor actually works for the reform you claim to champion here.

Having said all that, I look forward to your response, and I hope you enjoy the Slouka article.

I am thinking of physically mailing a copy to James Kwak, a good and smart man who, I worry, runs the risk of being finally broken by the white-glove docility expected of his corporate employers:

http://www.harpers.org/archive/2008/06/0082039

excerpt:

“Hess wasn’t the only one to be shocked by Webb’s behavior. Letitia Baldrige, the “doyenne of Washington manners,” termed the whole thing “a sad exchange.” Judith Martin, a.k.a. Miss Manners, made the point that “even discussions of war and life and death did not justify suspending the rules,” then declined to comment on l’affaire Webb-Bush, saying, “It would be rude of me to declare an individual rude.”

“But it was left to Kate Zernike, the author of the Times article, to place the cherry atop this shameful confection in the form of a seemingly offhand parenthetical: “(On criticizing the president in his own house, Ms. Baldrige quotes the French: ça ne se fait pas—‘it is not done.’)”

“To which one might reply, in the parlance of my native town: Why the fuck not? Répétez après moi: It ain’t the man’s house. We’re letting him borrow it for a time. And he should behave accordingly—that is, as one cognizant of the honor bestowed upon him—or risk being evicted by the people in favor of a more suitable tenant…..

After a worthwhile comparison of the how thoroughly the British press treats Tony Blair v. how our press corps babies the president, Slouka moves on to de Toqueville and finally concludes:

“There’s another possibility. Maybe we’re not out on the street protesting this administration’s abuses of power because we’re no longer the people we once were, because we’ve been effectively bred for docility. Equality, Tocqueville pointed out, “insinuates deep into the heart and mind of every man some vague notion and some instinctive inclination toward political freedom.” And inequality? Might it not, by precisely the same calculus, insinuate “some instinctive inclination” toward political tyranny? Of course it might. Once the idea of inequality is allowed to take root, a veritable forest of ritualized gestures and phrases springs up to reinforce it. The notion that some bow and others are bowed to comes to seem natural; the cool touch of the floor against our forehead begins to feel right: from classroom to corporate cubicle to the halls of Congress, deferential way leads on to deferential way, and at the end of the road, as Tocqueville foresaw, stands a baaa-ing polity “reduced to nothing better than a flock of timid and industrious animals, of which the government is the shepherd.”

“Lincoln had it right: “If destruction be our lot we must ourselves be its author and finisher.” We’re off to a fine start.”

And all the DC doyennes of civility excoriated the “bad form” of the congressperson, without ever acknowledging that the real issue of “bad form” was our hare-brained escapade in Iraq, which had already taken the lives of more US service people than ever died in the 9.11 attacks.

Some guy in Harper’s wrote about it, I can’t find the issue.

Tone it down or stop posting? I appreciate what you’re saying, but do you think there might be a double standard here?

I just want to be clear:

1) if you call what someone writes “horse pucky” and dismiss it by saying “all of it is irrelevant” as John Siegel did, that’s okay? But I’m uncivil?

2) Or if you call the current administration a “band of thugs” as Siegel did, that’s okay? But I’m uncivil?

3) Or if, when your poor understanding of enlightenment thinkers is called into question, you write “I just smile and roll my eyes” as Siegel has done, instead of actually just acknowledging that you’re perpetuating false information about a book you’ve clearly never read, that’s okay? But I’m uncivil?

4) Of if, instead of acknowledging that there is the possibility of a more comprehensive program that would actually reduce patient illness, you accuse them of desiring “a nanny state” as Dr. Siegel has done, that’s okay? But I’m uncivil?

But someone who forcefully disagrees with Siegel – or who brings a perspective that holds medicine to the standard that it probably should be held – is uncivil? Are you perhaps a little sensitive about the profession you say you retired from?

RobertL39, I’d be much more accepting of your criticism if I felt that you weren’t reading very selectively.

I’ve given John Siegel many opportunities to respond point by point. I even numbered them for him. He responded by denying that preventive care would have any impact on his practice. This is mind-boggling.

I do think it is worthwhile to ask questions when someone whips out his “credentials” as a surgeon, and then insists he has no problem with the insurance companies. That’s an unusual assertion, and people will ask questions.

Or is the part you find most objectionable the fact that I, like many other Americans who have worked in health care, people who served physicians closely, and watched them attentively – now voice serious questions about the integrity not just of the AMA, but of the medical profession overall and the institutions in which it operates?

And that we refuse to support your assertion that the majority of Americans are happy with the health care system as it exists?

I can’t apologize for that.