Courage is rightly esteemed the first of human qualities because it is the quality which guarantees all others.—W. Churchill

Tuesday, November 27, 2007

The New England Journal of Political Ideology

Well, I don't know about that "on loan from God" stuff---methinks that Comrade Van Dyke has been hitting the schnapps a bit too hard---"rejected by God" might be far more accurate; but, anyway, Mr. John K. Iglehart is a national correspondent for the august New England Journal of Political Ideology, oops, Medicine. Why the NEJM needs a "national correspondent" is a question to which the answer is less than immediately obvious, but, in any event, Mr. Iglehart has an editorial---sorry, article---in the November 22 issue entitled "The Fate of SCHIP---Surrogate Marker for Health Care Ideology," the central theme of which is captured wonderfully in this priceless passage:

President George W. Bush vetoed [a reauthorization of SCHIP despite the fact that] many legislators, a large majority of the public, major private stakeholders, and 43 governors strongly support expansion of the program. By contrast, in an effort to appeal to the conservative base of their party, the leading Republican presidential candidates agreed with Bush's veto---despite the fact that the program, though signed into law by a Democratic president, originated in a bipartisan compromise and was enacted by a Republican-controlled Congress.

It really, truly, absolutely does not get any better than that. Supporters are bipartisan, and have a large majority of the public on their side, not to mention major private stakeholders, whatever that means, and 43---count 'em---governors who absolutely, positively are not influenced by the prospect of getting their snouts ever deeper into the federal trough. And the opponents? They are craven ideologues, pandering to their political base, and dismissive of the fact that SCHIP began as a great compromise passed by a Republican Congress.

Is Iglehart actually this stupid? Or is he merely dishonest? He glosses over the problem of substitution of public coverage in place of private insurance with the assertion that "the compromise would have required states to prepare a plan to prevent families from enrolling children in SCHIP if private insurance was available to them." A requirement to prepare a plan! And if "available" private insurance is deemed by someone to be unaffordable? Can anyone possibly believe that this requirement would have reduced the crowd-out problem by even one family?

Iglehart simply repeats the budget numbers without any acknowlegement at all that the fiscal 2012 figures were fraudulent, as a means of reducing the official five-year budget projections. He ignores the longer-term problem of weak incentives on the part of public policymakers to feel constrained by the preferences of patients. Ad infinitum.

Anyway, you get the idea. Everyone wants their few minutes of fame, and so the NEJM simply cannot limit itself to medical science. Does this mean that the scientific articles also are politicized? It is hard to see how an editorial process fixated on politics can avoid that outcome.

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

Monday, November 26, 2007

A War on Christmas Question

Now that it's officially the "silly season," when all sorts of mostly inconsequential disputes break out over what to call that tree in the airport lounge or how close the Santa has to be to the manger in order for the creche to stay in the town square, I have a question, dear readers.

My mailbox is being assaulted by scads of catalogs, all urging me to "buy! buy! buy!" if I really love my wife and children. (And I do mean assaulted - I noticed yesterday that my mailbox post has a large crack in it - I'm sure it was the 50th LL Bean catalog that did it). Now, of course, they all want me to buy presents for "the Holidays," but just as surely they swathe the catalogs in red and green and cram in as much "Christmas" imagery as they can. More generally, we might say they trade on the idea of Christmas in order to get you to buy without mentioning it as a way of avoiding offense to those who don't celebrate Christmas.

Fine and dandy. I find the whole image/word thing pretty ironic, but kind of humorous as well. My question is this: would people who don't celebrate Christmas be particularly offended if, say, Toy Company X just switched out "Christmas" for "Holiday"? Would it be a problem? My sense is that it wouldn't and that the companies are being, well, prematurely non-offensive, but I'm not really in a good position to say, since we're pretty big on keeping the "Christ" in Christ-mas around our household. Any thoughts?

Friday, November 23, 2007

Michael Gerson, Christian? Idolator!

The libertarian-minded Cato blog endorses Kara Hopkins' swipe at Michael Gerson's new book, Heroic Conservatism:

[None of this is] to say that social justice isn’t a Christian concern. But Gerson is more stirred by abolitionists and activists like William Wilberforce and Martin Luther King Jr., and the sweeping social change they wrought, than he is by Christ’s own model, which was conspicuously short on political impact and long on individual acts of mercy. He implies that his giants—--poverty, AIDS, illiteracy, genocide—are too big for hand-to-hand combat. Thus the Biblical call to “do unto the least of these”—--the hallmark of which is personal sacrifice—--must be replaced by government programs—the wellspring of which is coercion. If this constitutes an act of worship, it honors a failed god.


Now hold on here. Me, I like Gerson. He speaks to a void in the GOP that many in the party feel. It’s important to know who Gerson’s target audience is.

Quite so that it’s impolite to invoke God to someone who doesn’t believe in Him. [Which is why arguing from “natural law” is becoming a favored method by believers: both Suarez and Grotius submit that the natural law exists independently of deity.]

The fact remains that a certain acceptance of the New Deal and even the Great Society is entirely within the center, the mainstream, of American politics, and to ignore that fact is to lose elections. So too, we’ll find enough in Adam Smith himself to justify concern for the poor. It’s a human thing, not just religious, not to mention prudent for the cohesion of a society:


How selfish soever man may be supposed, there are evidently some principles in his nature, which interest him in the fortunes of others, and render their happiness necessary to him, though he derives nothing from it, except the pleasure of seeing it…That we often derive sorrow from the sorrows of others, is a matter of fact too obvious to require any instances to prove it; for this sentiment, like all the other original passions of human nature, is by no means confined to the virtuous or the humane…the greatest ruffian, the most hardened violator of the laws of society, is not altogether without it.
—--Smith, The Theory of Moral Sentiments


Now it’s true that Jesus didn’t order his minions to go rip off the rich man’s house and give the goods to the downtrodden. But as citizen-rulers in this here republic, just rule requires we look out for the little guy. One need not be a Christian to embrace that duty.

Gerson is simply speaking the language of many Republicans, the language of God, and that seems entirely proper since that’s where the Godites tend to hang out these days. It may be so that he makes the libertarian wing uncomfortable with such talk, but they should heed Gerson if only for practical reasons, and in response to him, perhaps should try natural law arguments themselves.

But compassion is part of the natural law, of man’s nature, so there’s a structural problem here, and the libertarian-minded must tread lightly in making their practical [and sound] arguments. As Smith notes elsewhere about how man is wired, unless we admire the other fellow’s motives, we cannot hear his arguments or respect his deeds, no matter how much they accrue to the unfortunate man’s good.

Or as GK Chesterton put it, "Reason is always a kind of brute force; those who appeal to the head rather than the heart, however pallid and polite, are necessarily men of violence. We speak of 'touching' a man's heart, but we can do nothing to his head but hit it."

Easy with that libertarian bludgeon, Ms. Hopkins. People vote with their hearts and not their heads. It's in our nature, and it's not an entirely bad thing.


_____________________________________

Wednesday, November 21, 2007

Health, Justice, Mercy, & The Beast

Our Benjamin Zycher [on loan from God] writes judiciously about a recent Los Angeles Times article: Cancer survivors Rudy Giuliani, John McCain and Fred Thompson all note that the current US health system gave them a better chance of beating the Big C than the socialized medicine found in most of the developed Western world. True fact.

Also true is Dr. Zycher's identification of Ricardo Alonso-Zaldivar's "news" story as an op-ed. The "reporter's" sympathies are clear. We've learned to expect that from the newspapers, but it should always be noted.

However, Alonso-Zaldivar is correct when he states:

All three have offered proposals with the stated aim of helping the 47 million people in the U.S. who have no health insurance, including those with preexisting medical conditions. But under the plans all three have put forward, cancer survivors such as themselves could not be sure of getting coverage — especially if they were not already covered by a government or job-related plan and had to seek insurance as individuals.
“Unless it’s in a state that has very strong consumer protections, they would likely be denied coverage,” said economist Paul Fronstin of the Employee Benefit Research Institute, who has reviewed the candidates’ proposals. “People with preexisting conditions would not be able to get coverage or would not be able to afford it.”


Dr. Zycher responds:

Perhaps [uninsurable cancer victims and survivors] are worthy of compassion and even subsidies; but that is not a very powerful argument for socialism in health insurance.


Quite so, but the GOP ignores the unfortunate reality of such folks at its own peril, and leaves the door open to the progressivists.

Better a bad system where all suffer equally than leaving the unfortunates to die. Them's the rules of the lifeboat, and they are fair.

Conservatives have got to be creative and yes, compassionate, or they---we---do not deserve to govern. It's conservatism's position, and the correct one, that ordering a society under lifeboat rules guarantees only eternal misery and privation. The genius of the free market is that it creates plenty for all. The moral question becomes not if the rich have too much, but whether the poor have enough.

Now, the collectivists have seized on health insurance as the barometer of our society's well-being, and use some people's lack of it to propose a state takeover of health. But the question is one of health care.

My UK friends are surprised to learn, contrary to their news reports, that we Americans don't exactly let the indigent die in the streets. Our safety net of last resort is the county health care system. Dare I suggest the words that make the liberal heart go atwitter, and the conservative heart turn black---that we make sure the county systems are "fully funded?"

For if the right doesn't get health care to all Americans somehow some way, the left will give them health insurance, creating the great statist beast whose hunger can never be satisfied, and whose mercilessness in the name of the public good [as Dr. Zycher documents here] is not a whit more compassionate.

Or moral. As Ben notes, first, they came for the fat people. Soon, some cancers will be less moral than others. Next, each man and woman's body will stand in judgment of the state. Such a brave new world that "progress" offers us. Conservatism is all that stands in its way, and so far, it's doing a lousy job of it.
_______________________________________

The Future Is Now

In New Zealand anyway. A British man who moved to New Zealand has been told by officials that his wife is too fat to join him.---www.Telegraph.co.uk, 11/21/07.

Yes, you read that correctly. Mr. Richie Trezise "lost weight to gain entry to New Zealand after initially being rejected for being overweight and a potential burden on the health care system... [while] his wife... has so far been unable to overcome New Zealand's weight regulations."

Can anyone actually believe that the "burden on the health care system" criterion will be limited to aspiring immigrants? Or to New Zealand? No, my friends, with the expansion of government power comes the expansion of government control, and for health care it is inevitable that the politically unpopular will bear the brunt of rationing when demands exceed resources, as they inevitably must. The overweight. Smokers. The elderly. Those with conditions expensive and incurable. The unborn with, say, Downs syndrome.

Societies utterly humane and civilized can be driven toward perversity and worse in baby steps, and do not for a moment believe that it cannot happen here. As demands exceed resources under government health care, choices will have to be made, and there is no particular reason to believe that political processes will be constrained by a bias in favor of compassion, because more compassion for one must mean less for others. Such is the path toward which political appeals on behalf of "The Children" inexorably will lead.

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

The Silliness All Around Us

The august Los Angeles Times does it again: Yesterday's edition features a front-page op-ed by Ricardo Alonso-Zaldivar in which the glaring gap in the Republican candidates' health-care plans is revealed. To wit: The reliance on private insurance yields no guarantee that those without coverage will be able to obtain it, particularly in the case of those with pre-existing conditions, since insurers purportedly have obvious incentives not to cover such individuals.

And so the utter ignorance of the journalists is revealed yet again. It is government policies---in particular, constraints or proscriptions on underwriting (allocation of premiums in accordance with expected costs)---that lead insurers to avoid those with pre-existing conditions. In the absence of such regulations, premiums would be driven by competitive pressures to reflect actuarial reality, and there would be no reason not to cover people whatever their health status, except in the case of those with conditions so expensive to treat that they would not be willing to pay the actuarily-fair premiums. Perhaps such individuals are worthy of compassion and even subsidies; but that is not a very powerful argument for socialism in health insurance.

Such regulations are exacerbated by legal/regulatory mandates for coverage of a broad set of medical services, the effect of which is higher costs for coverage, particularly given the absence of interstate competition in health insurance. And the tax subsidy for employer-provided insurance makes it easier for legislatures to pass such mandates, as the attendant costs are hidden from the employees buying the coverage indirectly.

And so Mr. Alonso-Zaldivar's central argument, in this waste of fine newsprint, is the need for government regulation to ensure the availability of coverage. That it is government regulation that has yielded this problem in the first place is a reality with respect to which Alonso-Zaldivar is utterly oblivious.

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

A Nash Wednesday

Though Ogden denies writing it:

One ought not to creye
With that jaundiced y
At milk spilled so nie
To a warm piece of pigh.

Tuesday, November 20, 2007

Attention Genesis Fans

I have to believe that some of the folks that visit this esteemed website are fans of the band Genesis, that is fans of the pre-Abacab Genesis (when they were great). If that is you, I've come across something you need to hear. If you know the album “The Lamb Lies Down on Broadway” you are probably familiar with a song called “The Colony Of Slippermen.” Classic album, wonderful song.

My brother, who is a professional musician and did some recording with a later version of Genesis, reworked the Slipperman song with a bunch of country musicians from Nashville. These guys had never heard "The Lamb" and were not at all familiar with Genesis, let alone the older stuff. They listened to it, charted it all out for a totally different sound, and the result is spectacular. Here’s some information from the Spocksbeard website:

Nick has teamed up with Nashville Engineer/Producer Mark Hornsby to record a truly unique version of an early Genesis song: "The Colony of Slippermen". Recorded at Java Jive Studio in Nashville, TN, the song features some of Nashville's best musicians, taking the song in a whole new direction. "We wanted to see what would happen if we exposed the song to a different climate of musicians," says D'Virgilio, "The early Genesis recordings are so musical and very bluesy when you get right down to it. They really lend themselves to some different interpretations." Although all of the original elements of the song are still there (drums, bass, guitar, and piano), it now takes on a more "acoustic" vibe. This, coupled with accordion, electric sitar, and a fantastic horn arrangement, takes the song to an entirely different place. "We had talked about doing something like this for awhile," says Hornsby, "With the recent success of the Genesis reunion tour and the re-release of the Genesis catalogue in 5.1, the time seemed right to see what we could come up with." "The Colony of Slippermen" is part of a larger project that has yet to be announced. The song is currently available as a free download at Nick D'Virgilio's Myspace page: myspace.com/ndvmusic.
Check it out. I promise you’ll dig it. I certainly hope they find a way to do the rest of the album.

Sunday, November 18, 2007

A Spell of In(s)anity

As Ogden Nash never wrote:

One ought not to laffe
At the poor old giraugh
He is infected with stalf
Cutting his neck in haph.

Friday, November 16, 2007

Conservatives in Academe

Inside Higher Ed reports on a new study arguing that part of the explanation for the political imbalance among college faculty (lots of liberals, very few conservatives) rests in students' preferences regarding career and family desires. Conservative students are more likely to value financial security and raising a family while liberal students want to write something "original." What's striking about the charts at the end of the study (pp 18-22) are some things that seem to be statistically significant (though perhaps don't have as much explanatory power): satisfaction with classes and visits to profs outside of office hours. Student satisfaction with humanities and social science classes drops pretty dramatically as you move from students on the "far left" to students on the "far right" and same with visits to profs. This suggests something else I've long thought (hey - a study that confirms my views - it must be right!) and that is part of the lack of conservatives going into academics is the sense that many have that it's not a place for conservatives, something they learn while as undergrads when they see all of their profs as liberal - something that would be especially obvious in...humanities and social science classes.

Thursday, November 15, 2007

The Importance of the 'net...

John Leo is entirely right: if it weren't for blogs, talk radio, and other non-MSM elements of our media culture, things like Delaware's obnoxious residential life indoctrination program would continue on under the radar.

Sure, some group might file a lawsuit, but how do you think the NYT or WashPo would report it, if they deigned take notice at all?

People pay lots of attention to what professors say or write - and they should - but mostly, I suspect, because such writings are relatively easy to find. But the truth of the matter is that colleges' and universities' residential life programs can have much more pervasive effects, as they tend to really set the tone for the whole campus (or perhaps reflect and amplify one portion of it).

And it's striking in an era when universities have largely eschewed their role acting in parents' place that they have nonetheless settled on what can only really be described as a kind of proto-totalitarian mindset. It reminds me of Vaclav Havel's classic essay "Power of the Powerless," where he talks about a greengrocer in communist Czechoslovakia who puts up posters in his shop with slogans like "Workers of the World Unite!" He knows, Havel says, that these are lies (in the sense that the state is not at all interested in the welfare of workers, united or otherwise) but puts them up anyway as a quite reasonable attempt to keep his job and protect his family. But in participating in the lies, he becomes implicated in his own oppression and, indeed, becomes a part of the oppression.

Wednesday, November 14, 2007

I, Freddie

His birthname was Freddie Dalton Thompson. You could look it up.


L to R: Ron Paul, John McCain, Fred Thompson.

Thenewswalk.com hath awarded Fred née Freddie our news ticker over in the right column because he's been the X-factor, the most interesting proposition.

But Fred's been blowing it bigtime because he's boring, and is a mouse click or two away from getting replaced by somebody worthier. [Nominations are now being taken from the floor.]

Even as an actor, His Fredness was even more boring on Law & Order than Ronald Reagan was in Bedtime for Bonzo, and at least Reagan was the star. And so far, although he's a creditable thinker in his writings here and there, Fred's about 1/100th of the politician that the Great Communicator was, and that ain't gonna cut it.


Because leaders aren't boring---even the Great Miscommunicator Dubya W. Bush's Texas sass turned C3PO [Gore] and R2D2 I'm-a-Rebel-Too [John Kerry] into robotic roadkill.


Ex-Sen. Fred has always got by on his avuncular charm. (I never quite knew what "avuncular" meant precisely until I looked it up just now---it means uncle-like, "especially in benevolence or tolerance," and ain't that Uncle Fred to a T?) But he just got handed the biggest gift of his political career.

For some odd reason, The National Right to Life Committee has just handed Federalist Fred (status quo ante Roe v. Wade, or in other words, "one by one, each to their own, let the states decide") its endorsement.

As a non-absolutist on the issue---at least on the political level---I myself am OK with Fred, although I don't see how his position differs much from Rudy Giuliani's.

Fred has a golden chance---his only real Golden Chance here. Mostly it looks like he's positioned himself to pick up the pieces if and when the all the other leading candidates get trashed by their skeletons, and rest assured, they have them. (The press so far is keeping their powder dry for the eventual GOP nominee. Even the MSM have standards---no sliming unless the Republican has an actual chance of getting elected.)


If Fred actually wants to show some leadership, he could do it right now, on the late-term abortion issue, even if only rhetorically. Most Americans are appalled at abortions---except to save the mother's life---at the point after the baby could live with all the resources of modern science supporting him. Her.

We're not much or many, just a little sliver of the American electorate I suppose, but we feel deeply about this, and love our country a little or even a lot less when it doesn't look out for him.

Or her.

Of such acorns presidents are elected. Word up, Uncle Fred---speak out. The eagle just dropped the cub into your grasp, and the auspices are good---you could look it up. Lead, follow, or go hide behind the curtains in case we need you. On a scale from one to ten, this is a ten.

Saturday, November 10, 2007

Monarchy isn't quite dead

Well, it may very well be dead, but it's not useless. Not so long as kings can cut through all the diplomatic haze and tell two-bit thugs to "shut up". Fantastic.

It's good to be the king.

Friday, November 09, 2007

A Moment of Honesty From Krugman!

The ineffable Paul Krugman today (NY Times) critiques the arguments against single-payer "reform" of the U.S. health-care system, by summarizing those arguments as such caricatures that his discussion itself truly is a caricature of itself. How does he summarize the arguments against single-payer socialism in health care? "No insurance, no problem." "It's the cheeseburgers." "2007 is better than 1950." "Socialized medicine! Socialized medicine!"

So there we have it: It's all eyewash. But now let us defer to the observations made not long ago by a prominent economist and observer of health-care reform policies: Under a single-payer system of health insurance, "the public sector... sooner or later [would] have to make key decisions about medical treatment... [and] health care---including the decision about what treatment is provided---[would become] a public responsibility."

And who wrote those words? None other than our friend Krugman, in an exceedingly rare moment of honesty (New York Times, December 26, 2005).

So: Once we agree that under a single-payer system health care services inevitably would be rationed, and that government bureaucrats would do the rationing, and that a number of other not-very-attractive effects inexorably would emerge, the arguments against health-care socialism begin to look a bit less trivial, don't they? What say you now, Professor Krugman?

Thursday, November 08, 2007

The People vs. the Beltway

ABC News, USA Today, and the Kaiser Family Foundation conduct a periodic poll on health care issues, and the findings in the most recent (September 2006) are fascinating. In particular, there is a question on satisfaction with the quality of the health care received by the respondents, of whom 87 percent have health-care insurance coverage, while 13 percent do not. Among all respondents, 89 percent are either very satisfied (52 percent) or somewhat satisfied (37 percent) with their health care. For those with coverage, the respective figures are 56 percent and 37 percent, totaling 93 percent; about 6 percent are dissatisfied.

This means that satisfaction with the quality of health care services actually received among the uninsured can be imputed to be 62 percent. Accordingly, about 37 percent of those without coverage are dissatisfied with their health care.

So: About two-thirds more of the uninsured are satisfied with their health care than are dissatisfied. And bear in mind that even the dissatisfied have access through emergency rooms and other facilities to health care services that are, to be blunt, world class. It may not be very efficient or convenient, but inhumane it is not.

Would someone please tell me why health care coverage for the uninsured in America purportedly is a crisis? Or is the real crisis the difficulty some face in terms of using this issue as a vehicle for wealth redistribution?

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

Wednesday, November 07, 2007

The Panacea goes Up In Smoke

The voters in Oregon rejected a ballot measure to increase tobacco taxes by 84.5 cents per pack to fund health care coverage for uninsured kids. The vote, in incomplete returns, was about 3:2 against. That's landslide country, folks. I wonder if the Beltway is watching in the context of SCHIP.

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

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/]