Saturday, December 01, 2007

CNN: The Corrupt News Network?

I woke up this morning to fire alarms in my house (fortunately no fire), which will certainly get the sleep out of your eyes really fast. I almost felt the same way when I made my typical morning trek to the LA Times website when what do I see? A headline that I still don’t believe I read: “CNN: Corrupt News Network: A self-serving agenda was set for the Republican presidential debates.” Can this be? Objective news from the LA Times? I wonder if it showed up in the print version, but maybe not, because next to it was a little red “Discuss.” Oh boy, I’ll discuss.

In case you are not familiar with the disgrace CNN heaped upon itself this week at the so-called Republican debate, you can read about it here or here. One of those two is Howard Kurtz of the Washington Post. That amazed me of course, but what’s next, the New York Times? I believe in miracles, but that would actually be irrefutable proof of the existence of God.

So here is some of what that LA Times media guy, Tim Rutten, had to say:

The United States is at war in the Middle East and Central Asia, the economy is writhing like a snake with a broken back, oil prices are relentlessly climbing toward $100 a barrel and an increasing number of Americans just can't afford to be sick with anything that won't be treated with aspirin and bed rest.

So, when CNN brought the Republican presidential candidates together this week for what is loosely termed a "debate," what did the country get but a discussion of immigration, Biblical inerrancy and the propriety of flying the Confederate flag?

In fact, this most recent debacle masquerading as a presidential debate raises serious questions about whether CNN is ethically or professionally suitable to play the political role the Democratic and Republican parties recently have conceded it.

Selecting a president is, more than ever, a life and death business, and a news organization that consciously injects itself into the process, as CNN did by hosting Wednesday's debate, incurs a special responsibility to conduct itself in a dispassionate and, most of all, disinterested fashion. When one considers CNN's performance, however, the adjectives that leap to mind are corrupt and incompetent.
This could have come right out of the mouth of Rush Limbaugh! In fact, much of it did! I grew up politically in the era BR (before Rush), which means before talk radio, cable news, and the blogosphere, and this story is indicative of just how much the playing field has changed since Reagan was in office. Then CBS, NBC, ABC, Public television and radio, and the big dailies ruled the roost. When they determined what the reigning paradigm would be on a story it was very difficult to challenge and get heard. Hey CNN, it’s a new day!

Friday, November 30, 2007

The Silly Season Arrives

The holidays approach and the elves are busy, and not only at the North Pole. A friend who works at the UCLA Medical Center forwarded to me the following paean to silliness, distributed to all employees:

THE GREAT PEN EXCHANGE! Once again, UCLA is leading the way. This time in adopting new guidelines for our relationship with industry. To start, we're asking everyone to bring any pens (as well as mugs or other items) that bear the imprint of a medical company or product, to exchange for a brand new, spiffy UCLA Health system pen. Don't be left out! Starbucks $5 gift certificates to the first 100 participants at each location!

So, let's see here. Quite apart from their poor grammar, the august administrators of the UCLA Medical Center---world renowned for reasons that remain curiously obscure---apparently believe that their staff will sell out the interests of their patients for... a ballpoint pen. And how, precisely, would such perfidy proceed? Well, that is far from clear; presumably, the doctors will prescribe drugs ineffective for a given patient rather than an effective alternative because their morning coffee (not from Starbucks) was consumed from a mug bearing the logo of the producer of the former. Can the UCLA bureaucrats actually believe anything so stupid?

Well, the obvious answer is "Yes." Emphatically. Notice that this corruption on the part of the doctors would be observed not in the case of new gifts---shiny pens and the like---but also for such goodies already received and presumably with the removable pen caps already chewed. Why would an old gift yield continuing corruption? The UCLA bureaucrats offer no clue. And notice as well that the mere presence of a gift is not enough; no indeed, it is the gifts that "bear the imprint of a medical company or product" that raise the concerns of the UCLA green-eyeshade types. Someone might see it! And, by the way, did UCLA buy the Starbucks gift certificates? Or were they donated? In either case, the potential for corruption is immense---after all, five dollars would buy only a small latte, but a whole packet of pens---and the only difference is the identity of those to whom the doctors will have prostituted themselves.

So there we have it. Gifts not bearing logos are kosher; so, how about some cash in an envelope? Obviously---obviously---it is not actual corruption that concerns the UCLA bureaucrats; it is instead the potential appearance of corruption in a form so trivial that only modern journalists---political science majors who failed to be admitted to law school---could actually believe it. Along with, of course, the deep thinkers among the UCLA administrators, spineless, stupid, and self-satisfied in their moral superiority.

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

Thursday, November 29, 2007

Is it Heroic or Not?

An article by John Hulsman today at OpinionJournal takes on Michael Gerson’s “heroic conservatism.” It is by far the most concise and most devastating critique of compassionate/big government/heroic conservatism I’ve yet seen. I’m convinced that the big split in conservatism is not between social/religious conservatives and whatever we call the other side, but between limited and big government conservatives. To give you some indication of where I come down on this; it is very difficult for me to type the words “big government” next to the word conservative. In my mind they are mutually exclusive, oxymoronic and inherently at war with one another.

I love the way Hulsman draws the distinctions, which are incredibly important and need to be made over and over again. I'll take out a few paragraphs for your rumination.

What about the longtime conservative belief that limited, accountable government works best--that it is the form of government least likely to squander resources, thwart private initiative, impinge on freedom and avoid harmful, unintended consequences? Unheroic, says Mr. Gerson. What about the quaint notion that government should live within its means? Short-sighted when people are suffering, says Mr. Gerson. Little wonder that Mr. Gerson's co-workers in the White House (from which he retired earlier this year) called him, only half-jokingly, "the Christian Socialist." As it happens, Christian socialism--going back to R.H. Tawney and Tolstoy--has an honorable intellectual tradition. But its tenets are an awkward fit for America in general and for the Republican Party in particular.

The U.S. government has been pouring billions and billions of dollars into the welfare state since Lyndon Johnson's Great Society, with results so wayward that, for decades now, a cottage industry has grown up among policy intellectuals to document all the disappointing results and ill effects. The welfare reform of Bill Clinton's first term grew out of such a critique. Still, Mr. Gerson equates "caring" with government spending, as though, self-evidently, yet more "visionary" programs are the best way of dealing with poverty, addiction and children at risk.

To the traditional conservative, it is more heroic--that is, more honest and realistic--to acknowledge that such problems are too deeply ingrained to be solved by a far-away Washington bureaucracy. Traditional conservatives since Edmund Burke have put their faith in the organic forces of society--family, community, civic institutions. In America, such faith has made common cause with commercial dynamism and the opportunities it creates for upward mobility.

Mr. Gerson will have none of it. Siding with FDR and Woodrow Wilson, his acknowledged heroes, he assumes that traditional conservatives do not care about American society's problems. He never stops to ponder whether traditional conservatives disagree with his statist prescriptions precisely because they do care.
Spot on! The self-righteousness of these big government types is a perfect contrast with the inefficacy of their supposed solutions. Yet it’s we limited government types who are heard hearted Scrooges who don’t care about the poor. Clearly we have a more difficult time making the case for limited government, because it’s easier to demonize and spew platitudes, as big government types tend to do. Americans are also more easily persuaded that big government isn’t a threat to our way of life. Of course that is only true until it's too late. And self-government and personal responsibility are just tougher sells, but sell we must.

The Nanny State Looms Ever More Obese

"FDA Contemplating Crackdown On Salt"---Los Angeles Times, November 29, 2007.

So there it is: Bureaucrats, do-gooders, politicans, and the morally superior have their eyes on salt in processed foods, and next week the ingredients in cookies, and then the recipes for pies made at home from scratch. Talk about an obesity crisis: There is no limit---none whatever---to the meddling in individual choices available to those who believe profoundly in the infinite perfectibility of man; can an exercise requirement be far behind?

And let us not forget that the central justification for such nanny-statism is the public budget for health care: The government (actually, the taxpayers) pays for health care, and so the government has a regulatory interest in individual health. Forget for the moment the fact that the bureaucrats often enough get even the scientific questions wrong, or the larger reality that such judgments inevitably must be politicized. Will this dynamic be reduced if the U.S. moves ever closer to a system of government single-payer health care? Don't bet on it.

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

Wednesday, November 28, 2007

This Is Entertainment

The New York Times, aka the Journal of Record, published an editorial on Sunday entitled "The High Cost of Health Care," eliciting from readers a stream of letters to the editor published today.

One Reno DiScala makes the crucial point that health care reform faces "true complexities," and will never be achieved until "there is fundamental compromise," which faces obstacles from those "guided only by their political ambitions." Thank you, Reno!

Mr. Peter Hanauer weighs in with a plea for "Medicare for all," justified by the fictoid that "the administrative costs of Medicare are approximately 20 percent of [those] of private insurance," an utter non sequitur, and utterly incorrect anyway, as demonstrated in recent Manhattan Institute research located here. Please forgive me, Peter.

Melvin H Kirschner, M.D. finds single-payer government-run health care to be a panacea. No, I am not kidding: Dr. Kirschner likes "one form to file, one payer, one set of rules... and the assurance that everyone has health care coverage..." Why, then, are so many doctors fleeing Medicare and Medicaid? Alas, Dr. Kirschner is unavailable to comment further.

Professor Jan Warren-Findlow believes that the U.S. should "allocate our economic, medical, and research resources to provide good health to every American; then we can figure out how to do it cost-effectively." All right, then!

Mr. Allan Ostergren believes that we should raise taxes, and then allow patients to choose between a Canadian-style system and private insurance operating under a guaranteed-issue, community-rating system. He seems not to realize that only the sick would buy private coverage, and the government would get all the healthy people. A bonanza for the Beltway!

The ineffable Marcia Angell, M.D.---not economics Ph.D---opines that "some sort of single-payer system will be necessary to control costs, even if not sufficient," an observation utterly clueless about the difference between reported and hidden costs. That's our Marcia!

Joshua U. Klein, M.D., reminds us that "there's no such thing as a free lunch." Truer words were never spoken.

Mr. John A Rowland supports federalism: "The federal government should not develop a one-size-fits-all national program." (Applause track here.) Uh, will the states pay for this themselves? Or will they demand Uncle Sam's dollars? The question answers itself, but seems not to have occurred to Mr. Rowland. But he gets a B+ for class participation.

Mr. William L. Burge points out that "health care costs cannot be contained without addressing the legal issues," to wit, the tort system. Mr. Burge goes to the head of the class with Dr. Klein.

And finally, Kenneth A. Fisher, M.D. complains that too many die in costly intensive-care facilities. True enough; that is one outcome when patients spend other people's money.

And so remember: All this wisdom was published on one day in the NYT! Proving, of course, that it all was fit to print.

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

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?