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.


http://article.nationalreview.com/?q=Y2QwYjYzNTUyYjlmYmI5NDE2ZDFjZWJmYjkyNGUzM2E=

http://www.investors.com/editorial/editorialcontent.asp?secid=1502&status=article&id=277422477465708

http://www.manhattan-institute.org/html/mpr_05.htm

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.