"There is always a philosophy for lack of courage."—Albert Camus

Monday, November 05, 2007

And So The Decay Begins

The Centers for Medicare and Medicaid Services announced last week a final rule that will reduce Medicare physician reimbursements by 10.1% on Jan. 1, 2008, unless Congress acts to reverse the reductions, as reported by Congressional Quarterly HealthBeat (November 2). Under the rule, Medicare will pay $58.9 billion to about 900,000 physicians in 2008. CMS officials said that the agency "has no choice but to implement" the rule under current law.

And so just as with Medicaid, the single-payer squeeze on the providers now proceeds apace under Medicare, as politicians and bureaucrats respond to their powerful incentives to reduce budget expenditures at the expense of patients. The longer-run effect of this process is not difficult to predict: Physicians will retire earlier than otherwise would have been the case, fewer will enter medical school and generalized practice, more foreign and fewer experienced doctors will come to characterize medical practice; in short, quality will suffer. Medicare beneficiaries will find it increasingly difficult to find physicians willing to serve them. And so yet again we will come to experience the fruits of government compassion.

[cross-posted from www.medicalprogresstoday.com/blog/]

One Size Does Not Fit All

The august Los Angeles Times ran an article Sunday by Charles Ornstein on his efforts to help his Mom pick a plan for her Medicare health care and prescription drug benefits, from among the thousands of Medicare Advantage plans and Medigap plans and Part D options and combinations available. The plans are characterized by significant differences in coverages, premiums, co-payments, and all the other attributes that collectively make up health insurance products for seniors.

Ornstein's exasperation is clear given the task of sorting through all the options to find the best one for his Mom. What is clear as well is the utter failure of both him and, as usual, the LA Times to see the forest for the trees: Thousands of options are available because the market---unlike the Beltway---understands and has incentives to respond to the myriad differences in preferences and conditions shaping the health-care choices of millions of American seniors. Would Ornstein be happier with one choice? Well, perhaps, if that choice just happened to be the one fulfilling his Mom's needs most fully. But what are the odds of that?

Ornstein is not alone in his failure to understand that the hassle of sorting through the offerings of the market are nothing compared with the hassle of dealing with government policies and agency bureaucrats who do not have customers to satisfy, and so whose central incentive is to cut budget costs. Would Ornstein be more pleased with a bureaucracy that simply will not spend dollars on given medical services for people older than, say, 75? Don't bet on it. But do bet on that very kind of outcome as a result of socialized health-care finance, if the U.S. ever is sufficiently misguided to adopt such a monstrosity.

[cross-posted from www.medicalprogresstoday.com/blog/]

Friday, November 02, 2007

Rudy Is Right and Krugman Is Wrong

From the Manhattan Institute City Journal website:

Malignant Rumor

On cancer survival rates, Rudy’s right and his critics are wrong.
David Gratzer
31 October 2007

This week, Rudy Giuliani’s presidential campaign released a radio ad in which the candidate praised American health care for curing him of prostate cancer and wondered what might have happened to him under the socialized medicine practiced in the United Kingdom, where survival rates for that condition are far lower. In the ad, now running in New Hampshire, Giuliani says: “I had prostate cancer, five, six years ago. My chance of surviving prostate cancer, and thank God I was cured of it, in the United States, 82 percent. My chances of surviving prostate cancer in England, only 44 percent under socialized medicine.” He drew those statistics from an article that I wrote for the Summer 2007 issue of City Journal.

The ad has already aroused intense criticism, most of it claiming that survival rates in Britain aren’t nearly so low. ABC News’s Rick Klein, in a blog entry entitled “Rudy’s Fuzzy Healthcare Math,” writes: “To hear Rudy Giuliani describe it in his new radio ad, the British medical system is a scary place. . . . But the data Giuliani cites comes from a single study published eight years ago by a not-for-profit group, and is contradicted by official data from the British government.” Kevin Drum, blogging at CBS News, declares simply: “Giuliani is full of shit.” Ezra Klein of American Prospect agrees on his blog: “It’s—no pun intended—crap. England and America have vritually [sic] the same mortality rates from prostate cancer.”

Let me be very clear about why the Giuliani campaign is correct: the percentage of people diagnosed with prostate cancer who die from it is much higher in Britain than in the United States. The Organisation for Economic Co-operation and Development reports on both the incidence of prostate cancer in member nations and the number of resultant deaths. According to OECD data published in 2000, 49 Britons per 100,000 were diagnosed with prostate cancer, and 28 per 100,000 died of it. This means that 57 percent of Britons diagnosed with prostate cancer died of it; and, consequently, that just 43 percent survived. Economist John Goodman, in Lives at Risk, arrives at precisely the same conclusion: “In the United States, slightly less than one in five people diagnosed with prostate cancer dies of the disease. In the United Kingdom, 57 percent die.” None of this is surprising: in the UK, only about 40 percent of cancer patients see an oncologist, and historically, the government has been reluctant to fund new (and often better) cancer drugs.

So why do the critics think that Britain’s survival rates are as high as America’s? The main reason is that they are citing overall mortality rates, which are indeed, as Ezra Klein writes, similar across various countries. That is, the percentage of all Americans who die from prostate cancer is similar to the percentage of all Britons who do. But this misses the point, since a much higher percentage of Americans than Britons are diagnosed with prostate cancer in the first place. If you are a patient already diagnosed with prostate cancer, like Rudy Giuliani, your chances of survival—as Giuliani correctly said—are far higher in the United States.

Likewise, though Rick Klein is right that official UK data differ from mine, those data look at five-year survival rates—that is, they track cancer patients for five years and report on their survival. Their approach is different from mine. They don’t examine what we might call a “snapshot,” as my data do: that is, examining how many people with a particular disease die during a given interval of time—say, a year.

True, the OECD data are seven years old, as Rick Klein also points out. However, newer studies show a similar trend: Americans do better when diagnosed with cancer than their European counterparts do. Since the publication of my City Journal essay, the prestigious journal Lancet Oncology has released a landmark study on cancer survival rates. Its findings:

  • The American five-year survival rate for prostate cancer is 99 percent, the European average is 78 percent, and the Scottish and Welsh rate is close to 71 percent. (English data were incomplete.)
  • For the 16 different types of cancer examined in the study, American men have a five-year survival rate of 66 percent, compared with only 47 percent for European men. Among European countries, only Sweden has an overall survival rate for men of more than 60 percent.
  • American women have a 63 percent chance of living at least five years after a cancer diagnosis, compared with 56 percent for European women. For women, only five European countries have an overall survival rate of more than 60 percent.

These data, recently released, are now the best available. They too confirm Giuliani’s point: he was fortunate to be treated here.

I’m not denying that American health care has its problems. On the contrary, I’ve just written a book advocating reform. And the Giuliani campaign isn’t denying it, either—the mayor has advocated reforms of his own. But as Americans consider how to improve our health care system, we should understand what we do well and what other countries do poorly. Failing to do so would be the public policy equivalent of malpractice.

Dr. David Gratzer, a physician, is a senior fellow at the Manhattan Institute. His most recent book is The Cure: How Capitalism Can Save American Health Care. He advises the Giuliani campaign.

Let the Violins and Tears Begin

Well, now, some unions and other pressure groups have started running ads targeting Republicans who voted against the new, improved, improved and new, old-wine-in-new-bottles version of SCHIP. "What if your daughter didn't have health coverage...? What if you had to work two jobs to make ends meet, but still couldn't afford insurance? Would you still back George Bush's vetoes?" (New York Times, November 2)

Sniff. Why, oh defenders of compassion with other people's money, is it the case that some working people cannot afford insurance? Could it be because of the regulatory mandates for this and that coverage that you have supported for years? Could it be because of the absence of interstate competition in health insurance plans, a barrier that exists because of your allies in the various state insurance regulatory commissions? Could it be because of the restrictions on underwriting and rating---the allocation of premiums in accordance with expected costs---in the absence of which insurance for most kids would be very cheap? Could it be because of "guaranteed issue" regulations---don't buy insurance until you get sick---engendering the worst kind of adverse selection problem?

Or could it be... all of the above? Well, yes. Emphatically. And have the unions and pressure groups supported all this meddling in the competitive market for health insurance? Ditto. And now they're blaming others for resisting another long step toward a system in which government pays for "coverage," squeezes the doctors and hospitals for "savings," and then squeezes patients as well with rationing, underinvestment in technologies, and restrictions on the services that patients may obtain. Anyone who actually believes that this political balderdash is for "the children" shouldn't worry too much about vetoes. The Tooth Fairy will come to the rescue.

[cross-posted from www.medicalprogresstoday.com/blog/]

Thursday, November 01, 2007

Are You Feelin' Lucky, Punk?

The august NY Times reported yesterday that the Chinese chemical firm "Honor International Pharmtech was accused of shipping counterfeit drugs into the United States" even as it "was openly marketing its products in October to thousands of buyers [in Milan] at the world's biggest trade show for pharmaceutical ingredients."

Yeah, yeah, but so what? After all, the prices are low, and isn't that what really counts? So what's the problem? Actually, there isn't one, in the context of the long-running debate over the importation of foreign drugs subject to price controls overseas, except in the case of contagious diseases. If someone takes a fake or adulterated drug because the price looked good, well, isn't that really their problem, the issue of infecting others aside? The proponents of parallel trade in pharmaceuticals---again, importation of "cheap" drugs from overseas---fail even to consider that problem, in their rush to subsidize their constituencies at the expense of others.

More generally, they are keen to ignore all the problems---contagion, the dilution of brand-name capital and the resulting implications for trust in the health-care system, the inevitable horror stories for individual patients given adulterated drugs without any warning at all, the bonanza for the lawyers---as they pursue price "discounts" with no consideration of any adverse implications at all. And they are the ones demanding truth in advertising from everyone else. Have they no shame? That question answers itself.

[cross-posted from medicalprogresstoday.com/blog/]

Wednesday, October 31, 2007

Trust Me

There's a rather silly article in the October 1 issue of Pharmaceutical Executive in which twelve "brandmeisters" weigh in on the issue of how Big Pharma can restore "trust" where it now is lacking or weak. The various commentaries offer the usual war-on-insomnia platitudes about not overpromising, whatever that means, constant communication, putting the customer/doctor/patient first, and blah blah blah.

Actually, competitive markets solved this problem ages ago: Investment in such assets as brand-name capital, the value of which collapses if the firm fails to live up to its promises, sends a clear signal to the market that the firm makes more money by behaving in a trustworthy fashion than the opposite. Advertising is the most obvious example, even given the constraints and mandates enforced by the FDA; that is why virtually all consumers, given a choice between a brand-name drug and its generic equivalent at the same price, would choose the former. Other examples are a long-term commitment to charitable endeavors, indicating that the firm is not a fly-by-night, construction of specialized facilities not easily transferable to other firms, etc.

And so yet again we find a reason that the political attacks on pharmaceutical marketing are mindless, even as we can be amused in supreme fashion by accusations of "misleading advertising" hurled by the permanent Beltway establishment.

[cross-posted from www.medicalprogresstoday.com/blog/]

Tuesday, October 30, 2007

Is There A Prize For Stupidity?

It sounds so simple. Eliminate patents and exclusivity for new pharmaceuticals, substitute a system of government-determined prizes for innovation instead, and presto! We can preserve incentives for research and development investment in new and improved medicines, while avoiding the high prices attendant upon the patent-protected monopoly positions of drug innovators.

If only it were that simple in practice. Anything---anything---that government touches becomes politicized, and drug development is no exception. Under a proposal offered by Senator Bernie Sanders (I-Pyongyang), new drugs would be approved by the FDA and patented. But exclusivity would be a thing of the past; instead, a government board would dole out prize dollars from a fund in accordance with a list of criteria, the latter obviously subject to changes driven by Congressional whim. The criteria would include: the number of patients who would benefit from a new drug, the extra benefit compared to existing drugs, and the degree to which a drug is targeted to "vulnerable" populations, global infections, or neglected diseases.

So: No openings there for politicization of drug development, nosiree. Let's see. Who can determine, ex ante, the number of patients who would benefit from a drug? How would the extra benefit be predicted? Ex ante! What is a "vulnerable" population, and how big is it? Ad infinitum.

Follow-on drugs would get smaller prizes, apparently regardless of how much better their effects are compared to the original. Thus would the "me-too" principle be enshrined in federal law. Who would appoint the Board? How politicized would it be? And since no one product could get more than 5 percent of the fund, can it possibly be the case that the one-time prize would equal the present value of the stream of returns from a blockbuster drug?

These problems, and many more, are so obvious that it is easy to conclude that the real objective is an end to patent protection and temporary monopoly pricing, and thus a reduction in government drug spending. The obvious adverse effects on future drug development in terms of distortion and reduced returns? That's someone else's problem. Specifically, future patients, and to a far lesser degree, future policymakers. The current system, whatever its distortions and rigidities, at least is driven by market forces to some substantial degree, a highly useful condition not to be discarded too lightly.

[cross-posted from www.medicalprogresstoday.com/blog/]

Monday, October 29, 2007

Giving It a Myth

My correspondent, cited in my previous piece, included this paragraph in her response:

I never claimed that the myth had to be true or it did not; I define the term "Myth" as such: a story that codifies the collective moral codes of the people they represent. All moral codes are arbitrary, as can be proven by the fact that Nazis did what they did (their moral code excluded Jews as human beings), why homosexuality was condoned in ancient Greece and Japan, and even why the Torah condones slavery and genocide (as in the case of Amalek). All a Myth does, regardless of the truth behind it, is codify beliefs in story form.

Rather startling, my friends, the spectacular moral blindness promulgated in the halls of "higher education" today. Not to mention the lack of willingness to reason from a premise. I can imagine the demolition job a G.K. Chesterton or C.S. Lewis would do on this, but they are not here, so it falls to me to do my worst. This is a very lovely girl who essentially means well - I am permitted to be patronizing; I have daughters of my own - and is trying to sort out the world of ideas with, sadly, disappointing early results.

O.K. Let us count the ways:

1) Myth is a story that justifies the moral code of the people it represents.

Again, as I said earlier, this is a clever Orwellian construction designed disingenuously by anthropologists. By using a phrase that always historically meant "a story that is an expression of a fantasy, not a reality" to serve as the word to designate the central narrative of a given society, they undermine the notion of objective truth in either history or ideology.

My theory (offered in my role as public intellectual, without benefit of a degree in the specific discipline) better describes life and better predicts events. I said that the central narrative of a group or movement is the truth of its history and purpose. To the extent that falsehood creeps into the main recounting of events and presentation of ideas, to that extent is the society or grouping doomed.

Thus any effort to replace truth with a myth can only have staying power in direct proportion to the amount of objective verity that is inserted into the mix. Bill Clinton did not use his war contribution as a central theme of his candidacy, so his draft-dodging did not defeat him. John Kerry made his military service the centerpiece of his campaign, so when it turned out to be flawed that brought him down.

The reason why the Bible saved the people whose existence depended on it through 3300 years of ups and downs, including multiple defeats, destruction, dislocation, separation into small exilic clusters, and even a Holocaust, is simply because it is true. As such it always survives the temporary setbacks.

2) All moral codes are arbitrary, as can be proven by the fact that Nazis did what they did (their moral code excluded Jews as human beings).

Frightening, really. The proof that moral codes are arbitrary is from the fact that someone arbitrarily made a bad one. Can we prove that all marital vows are arbitrary from some commune which announced they are initiating communal free love as their form of marriage? Can we prove that all property rights are arbitrary from some dictator nationalizing everyone's businesses in his country? Grabbing the reins of power and proclaiming that your violation of universally accepted normative ethics is actually the introduction of a New Ethics is intellectually and philosophically meaningless. It proves nothing at first.

Later, when objectively awful damage is wreaked upon humanity by applying that code, it serves to prove the original code is the truth.

3) As to the Torah condoning slavery, that is true, but it does not promote slavery.

It accepts the fact that slavery exists in the economic reality of a pre-industrial world. It creates workplace protection for the slave, by revoking ownership if the master wounded the slave's body, even if he only knocked out a tooth. If a slave is killed, the murderer is culpable. These protections did not exist in secular or idolatrous societies.

Once the machine age replaces the slave, there is nothing in the Bible encouraging people to capture new slaves.

The genocide of Amalek is not condoned, it is commanded. This accepts the premise that the Creator can decide a particular nation has lost the right to live and may prophetically command another nation to administer that penalty.

The proof is in the pudding. If Jews took this as an invitation to wipe out infidels on their own volition, they would be a mean, aggressive society. Instead they have been gentler and less violent that any other nation of history. As the late philosopher-poet Abraham Elijah Kaplan, head of the Berlin Rabbinical Seminary, wrote (On the Trail of Awe) circa 1925: "Where are our bloodbaths, where are our massacres, where are our genocides?"

To sum up, the modern "secularist" ideology is a religion of its own, the faith of anti-religion. To escape the strictures of being instructed, it will deny truth, logic, good faith, morals, ethics, reason, intuition, conscience and finally, even the very fact of our humanity.

The Torah says to live by its truth or be an animal; they answer that as animals they are not bound by any code. So, you see, in the most profound sense of things there is no disagreement at all. The lady or the tiger? Turns out the lady thinks she is a tiger.

Send In The Clowns

The U.S. government's main disaster-response agency apologized on Friday for having its employees pose as reporters in a hastily called news conference on California's wildfires that no news organizations attended.---Reuters, October 26

It really, really, really doesn't get any better than this. Among the questions posed by the "reporters" for FEMA deputy administrator Harvey Johnson was this beauty: "Are you happy with FEMA's response so far?" Well, Harvey, what say you? "[I am] very happy with FEMA's response so far."

Well, there's a shock. What is not shocking---not one iota---is the phoniness that permeates Beltway policymaking writ large, a condition far more threatening than the pseudo questions thrown at mindless bureaucrats by pseudo reporters.

Consider the ongoing debate over expansion of SCHIP. The current proposal is for extension of the program to families with incomes well over $60,000; that is, to the phony poor. There is the ongoing eligibility of SCHIP for adults, that is, phony children. There are the preposterous projections of tax revenues to be generated by the increase in tobacco taxation proposed as a vehicle with which to fund SCHIP expansion; in a phrase, phony revenues. There is the five-year projection of SCHIP budget costs, in which the projection for fiscal year 2012 is a number two-thirds lower than current spending, inserted just for purposes of making the five-years spending projection more palatable; in a phrase, phony budgeting.

And let us not forget the long-term effects of government health-care compassion, as certain as the sunrise: a degradation of quality and access, as budget pressures yield powerful incentives for rationing, underinvestment in new technologies, and the other perversities familiar in all single-payer systems. In a phrase: phony health care.

So: We have phony phoniness at FEMA, which will have no adverse effects at all, and real phoniness in health-care policy formulation, which will yield enormous costs and increased human suffering over time. Which type has drawn the attention of the Beltway? The question answers itself.

[Cross-posted from www.medicalprogresstoday.com/blog/]

Friday, October 26, 2007

They're Inhaling. Big Time.

SCHIP is back on Congress' plate, and the House yesterday passed a new version of the bill to extend schalami-schlice schocialism in health care to the middle class. Put aside the adverse implications for the budget. Put aside the adverse consequences---as certain as the sunrise---for the future quality of medical care and the advance of medical technology. Put aside the future rationing, dehumanization of the old and sick, and other blessings of government compassion.
Let us focus instead on the narrow issue of finance; whence the dollars---$20 billion of them per year---in the new bill? The proponents of SCHIP expansion claim that the increase in the tobacco tax in the bill---from 39 cents to a dollar per pack---will pay for this monstrosity. Oh, please. The resulting enhanced incentives for black-market cigarette sales, for purchases from Indian tribal lands, for internet sales, and the like will be powerful, and there is no chance---none at all---that the net revenues will prove to be those claimed. Under a broad set of assumptions, net revenues will be zero or negative, as untaxed sales reduce revenues not only from the new tax but from the existing one also. And this is true not only for federal tobacco revenues, but for state and local revenues as well, since the substitution of untaxed sales for taxed ones will affect all government budgets dependent upon the vices of smokers.
And so El Presidente W is absolutely correct to threaten a second veto over this finance issue, as well for a host of other reasons. Maybe Congress will override this time---or maybe not---but a stand for principle never hurts. In this case, if a stand against an inefficient tax intended to pay for more health-care schocialism is wrong, W shouldn't want to be right.

[Cross-posted from www.medicalprogresstoday.com/blog/]

Thursday, October 25, 2007

Myth America

A Jewish college student, bright, well-intentioned, sincere, was writing me some of the tired cliche copout stuff about how religion is myth-making and the Bible is a compilation. Here is a segment from a letter I wrote in response:

The theory of myth-making actually misleads people into a fallacy. By using the word "myth" in place of guiding narrative, they build in a bias toward the presumption that the myth is, in fact, a myth. This is a rhetorical trick by social scientists who know darned well they are cheating by coining this verbiage. Ironically, what they have done to gull their students is itself a form of myth-making. As the Talmud says: "Those who call names are usually guilty of those very faults."

A more perceptive analysis might be to take the following approach. Every society needs to be founded around a truth. The United States, for example, built a polity upon a set of principles, eventually enshrining most of them in a Constitution. The premise of that founding is that these are truth, or as accurate a representation of truth as human investigation could identify.

Most people who have read the founding documents of the nation, both the official ones like the Declaration and the unofficial ones like the Federalist Papers are impressed by the good faith effort to seek truth without fear or favor. The loyalty they evoked in fellow citizens is in large part a function of that recognition. As the Talmud says: "Words of truth are recognizable."

What myth does, as in Indian or Central American idolatrous fantasies, is attempt to mimic truth as a basis for founding a society.

However, history proves that myth cannot last. No belief system from the time of Judaism's founding is still extant. No national dynasty from the time of Judaism's founding is still extant. This is because, as the Talmud says, "falsehood cannot remain standing".

The best example of this actually occurred in recent times in the form of Soviet Communism. This ideology was so passionately believed by people that they overthrew existing systems and starved tens of millions. People left the United States in the 1920s to move to Russia and experience the dream. In the end, it took only seventy-four years to puncture the chimera.

Yet Judaism not only continues to exist after 3300 years, dislocations, massacres, tortures, you name it, it actually generated enough spirit in the past hundred years to reclaim its homeland and its language. This, despite experiencing a Holocaust in the very same time period.

Hey, I put in my years in college. The professors spend their lives patting themselves on the back and trying to seduce undergraduates while real men and women get out into the world and live life where it bleeds. I had the privilege of knowing great Jewish scholars who lived by principle and eschewed convenience. Those are the people I trust. They, along with the texts that made them great.

It's Baaaaaaaaack

Like a horror film monster that refuses to die, Congressional efforts to force Medicare to "negotiate" drug prices with the pharmaceutical producers---killed earlier this year---for the Part D drug benefit have surfaced again. In support of such efforts, Consumers Union and the Medicare Rights Center have issued a "report" finding that price discounts negotiated privately for Part D are smaller than those imposed by the federal leviathan under Medicaid.

Well, duh. The private-sector insurers and others administering the Part D drug benefit---pharmacy benefit managers---have customers who want both low prices and large formularies, that is, lists of approved drugs. The federal government, on the other hand, has not customers but instead interest groups fighting to get their snouts into the federal budget trough. And so the central incentive is to generate Part D budget savings in the here and now---applauded by other interest groups seeking increases in their favored programs---at the expense of formularies more restrictive. And if Part D patients become unhappy with that tradeoff? Go ahead: Write your Congressman. That'll show 'em.

Unlike our horror movie, in the production of which no actual humans were harmed, federal price negotiations for drugs will yield massive costs in terms of reduced life expectancies over time. Why? Because lower prices will reduce incentives for the research and development investments yielding new and improved medicines. It happens that I examined this issue about a year ago, and a conservative estimate of this adverse effect is a loss of about 5 million life-years annually. But fear not: Maybe the feds can negotiate with the viruses, cancers, and other sources of human suffering.

[Cross-posted from http://www.medicalprogresstoday.com/blog/]

Wednesday, October 24, 2007

You Just Can't Make This Stuff Up

When last we checked, the advocates of expanded SCHIP eligibility to kids (and adults) in families earning up to 300 percent or even 400 percent of the poverty line were arguing that such low- or lower-middle income families simply cannot afford private health coverage. "Ten million kids are without health care." "The Bush proposal to keep the limit at 200 percent of the poverty line is mean." Or something like that.

Forget the fact that kids in the majority of such families actually do have private health coverage. Forget the fact that 300 percent of the federal poverty level is about $62000 for a family of four; and 400 percent translates to $82600.

No, what is really amazing is a letter just sent from Congressman John Dingell to HHS Secretary Mike Leavitt, in which Dingell "disputes the claim that the cigarette tax [proposed to finance the SCHIP expansion] would unfairly impact lower-income residents, citing government data finding that 60% of adult smokers have incomes above 200% of the poverty level." (The Hill, 10/24)

So there we have it. Two hundred percent of poverty is way too poor to be a cutoff for SCHIP eligibility, but at the same time is wealthy enough for a new tax. You just can't make this kind of stuff up. The Beltway is a world unto itself.

[Cross-posted from www.medicalprogresstoday.com/blog/]

Utterly Shameless Self-Promotion

I am ashamed. Deeply, deeply ashamed. But do I care? Well, not by an amount sufficient to induce me to refrain from promoting my latest contributions to right-wing confusion, sure-fire cures for the most invincible insomnia. And so I offer these links, all driven by my new paper on the heart of Krugman health care rantings, to wit, the argument that a single-payer (i.e., government) system of health insurance would save so much on administrative expenses that all of the uninsured could be covered (whatever that means) at no increase in total health-care spending.

Yes, my friends, the Great Krugman offers the eternal free lunch. So: Read. Enjoy. Keep Krugman in his cage.




Pro Life, Pro Choice?

According to Michael Medved, the majority of Americans are just this, as is a certain candidate running for the Republican nomination for president. In a USA Today Op-ed, Medved is seeking to highlight a distinction between Rudy and all the Democrats, who are not only pro-choice but pro-abortion as well. I think he makes an important distinction. Giuliani is pro-choice, but anti-abortion, but there are conservatives who claim he is pro-abortion. As Medved rightly states, that distorts his record. Look at the differences between Giuliani’s positions and any of the Democrats:
Consider, for instance, the key differences between Giuliani's platform and those of the leading Democratic candidates. Giuliani has committed to preserve the Hyde Amendment, banning taxpayer money for abortions; the top Democrats urge repeal and favor federal funding. Giuliani applauded the recent Supreme Court decision upholding a ban on partial-birth abortion; all leading Democrats condemned it in harsh terms. The former mayor supports tougher rules requiring parental notification (with a judicial bypass) for underage girls who seek abortions; Clinton and Barack Obama oppose such legislation. Most significant of all, Giuliani has specifically cited strict-constructionists Antonin Scalia, Samuel Alito and John Roberts as his models for future justices of the Supreme Court — and all three of those jurists have signaled their support for allowing states more leeway in limiting abortions. The top Democrats regularly express contempt for the conservative jurists whom Giuliani admires, and worked against the Alito and Roberts nominations.
If he does happen to get the nomination, social conservatives need to understand this and not get suckered into sitting on the sidelines or throwing away their vote on some minor party candidate. And if we think about this clearly, what more could a pro-life/anti-abortion president do? What more did Reagan, Bush the elder and Bush the younger do?

The depressing truth is that Medved is right; a majority of Americans are distinctly squeamish about abortion and know it is more than discarding worthless tissue, but would not vote to outlaw it. Americans have come a long way toward the anti-abortion position since 1972, because the truth is just too obvious. I trust in time they will come all the way. So social conservatives could do a lot worse then Rudy as president. The name Clinton should scare them all enough to do the right thing if it comes down to that choice.

Update: Interesting that I should find an article in the LA Times that I think proves my point. A new poll that distorts Giuliani's position is the mainstream media template that many social conservatives are buying into:
But danger looms for Republicans should they nominate the politically moderate Giuliani: About one-third of GOP voters said they would consider supporting a third-party candidate in the general election if the party nominee supported abortion and gay rights.
If a candidate or politician "supports" abortion then it is assumed they are "pro-abortion," and as I stated above, that simply is not the case with Giuliani. Too many social conservatives have fallen for the MSM line, because guess who they would prefer were president. And notice how they brand the Mayor as "politically moderate." I bet that's news to the ACLU and other New York City liberals who fought him every step of the way when he was mayor.

Thursday, October 18, 2007

Nearly Half of Americans...

think that the US is in a recession, according to this CNN poll. Gee, I wonder why?

When I teach democratic theory, I'm often tempted to try and structure a class with the expressed goal of convincing my students that democracy is a bad form of government. Instead, I usually just have a class or two on some of the more profound critiques (Plato, mostly) and usually offer my "Britney Spears" critique as well. What's the "Britney Spears critique"? Well, it's pretty simple: lots of people thought that she was talented and interesting enough to make her fabulously wealthy, wealthier than I will ever be. But in fact she's a no-talent hack who made lots of money basically by playing up the naughty/innocent schoolgirl routine and conning millions of Americans (and folks worldwide, I'm sure) into forking over their money. Why in the world should we trust those same people to govern themselves if they can't even choose decent music or entertainment?

Friday, October 12, 2007

Crashing the Inquest

Have you been following the Paris inquest into the passing of the late Princess of Wales, Lady Diana? I find it to be the most fascinating exercise. As an opinion journalist I have nothing to add to the record itself; no bravura pronouncements, no penetrating insights, no whizbang deductions, no counterintuitive analysis. But as a person, as a student of life, I see here an earth-shattering event of Biblical proportions. I see the Tower of Babel, Jacob wrestling the angel and Moses demanding to know why he was sent.
This is mankind railing against Fate, rebelling against majesty, trying to put romanticism before Romance, literalism before literature. There is such rage against her death not because it was illogical and jarring, but because it was so sharply logical that it shouts out the dominance of a higher order.
Consider. Diana accepted the proposal of Charles, Prince of Wales, and was apotheosized in a grandiose processional marriage seen by most of humankind. She could do no wrong with the British populace ever after, her visage on that magic day holding them in thrall. She bore two princes, one of them a potential king. She made various formal appearances, generally true to her depiction of the aethereal fairy-tale princess.
Suddenly things went awfully awry. Word came that people were drinking and drugging and straying, that Diana was bucking Buckingham. Then the usual tawdry palace affairs, the princess with the equestrian and the prince with a married noblewoman. Butlers and valets and lady’s maids were talking to the tabloids, and relationships deteriorated all around. Charles’ brother Andrew married a similar woman, affectionately dubbed Fergie, and their marriage followed about the same pattern. Eventually everyone decided to give bills of divorce all around and the madness settled into a routine that came to simulate normalcy.
To make matters worse, or more sordid anyway, an audio tape surfaced with Charles and his paramour cooing at each other in the sort of amorous jargon for which privacy was invented. Once and for all it could be said that Charles had humiliated Diana, Diana had humiliated Charles, both of them had humiliated their parents and their children, and all this was true regardless of who could be faulted in the breakdown and the breakup.
Still, all the dirt was royal dirt. Pathetic, derivative, cliché, history-repeating-itself (to the point that Camilla introduced herself to Charles by reminding him her grandmother was his grandfather’s mistress), boring dirt, but within the traditional gamut of royal obliviousness and stupidity. Everyone could still walk around pretending no change of substance had occurred. There may have been a few extra princesses in the deck, but all that was still ace.
Then suddenly Diana is dating a pretender, a nobody, a nothing, a rich Arab living off his father’s dubious money, an international playboy, a man without purpose, without talent, without credentials, without substance, without depth, what the old Yiddish speakers used to call “a pusteh keli (empty vessel)”. His father had assumed ownership of Harrod’s with money whose provenance could not be traced, making numerous representations about himself and his family that all proved false when probed. So the gadabout son of a spurious financier wins the heart of the princess: whuh?
On the day she died, he died, they died, her beau slipped off into the jewelers to pick up the magnificent engagement ring he would present. Who knows what blood ran over that diamond, what sweat of the downtrodden, what tears of the oppressed, what heinous fraud, what vile treachery, what inequity and iniquity? That was Romance? Bull, Lady Love shunned Lady Diana that night, just as Cupid scorned the cupidity of her suitor.
It was not possible for this world, if it is indeed a created place, a place of purpose and dignity, a place where kingship confers a spiritual stature, where majesty is a reflection of godliness, to suffer such an affront. Fate cried out in anguish, Romance wilted in despair, Poetry waxed plaintive and Literature was florid in protest. This could not stand.
In his new book, biographer David Michaelis explains why Charles Schulz died on the day his farewell Peanuts strip was published. “To the very end his life had been inseparable from his art. In the moment of ceasing to be a cartoonist, he ceased to be.” How much more true is that of a princess! The day she ceased to be a princess is the day she ceased to be. And now, if you don’t mind, I will bang the gavel. Inquest concluded.