Friday, January 11, 2008

No More Bradley

Brrrr. It was a cold day in New Hampshire, where Hillary Clinton had climbed off the mat to post a significant, if less than decisive, victory. This coincided, oddly enough, with the day on which Barack Obama had come down off the mountaintop to post a significant, if less than decisive, defeat. The Iowa Bounce effect had bumped up against the Spalding-off-the-Wall effect which states: “Every bounce must be answered by an equal and opposite bounce.”
The scarier theory for Obama underperforming his overhyped overcoming of underdog status is known as the Bradley Effect. This refers to the actor Karl Malden who, after playing General Omar Bradley in the movie Patton, became the spokesman for American Express, repeating the slogan: “Don’t leave home without it.” People could buy their travelers checks and fantasize they were off to Normandy to fight the Krauts instead of sitting like beached whales in loud ill-fitting swim trunks on the beach. In the case of Obama, winning a caucus where people vote in the open air led him to fantasize that he could win in a closed booth.
Ha, ha, just kidding. The Bradley Effect actually refers to the New York Knickerbockers championship NBA basketball team in 1989, in which Princeton grad Bill Bradley injected a cerebral element into the game by “moving without the ball”. This later led to him becoming a United States Senator from New Jersey who did not have very much on the ball. Barack Obama played some high school ball in Hawaii, and mistakenly thought that he could beat Hillary Clinton one-on-one in New Hampshire. He found out that white women can jumpstart a campaign from a sitting position. Add to that the fact that Senator Bradley endorsed Obama just two days ago, and you can see the whole thing unfolding, or perhaps unraveling.
Ha, ha, just kidding yet again. The Bradley Effect actually refers to philosopher Francis Herbert Bradley (1846-1924), a leader of the Idealist school. These idealists make the classic mistake of thinking that nice guys don’t really finish last. They assume their underlying sincerity will serve them well, not realizing that no one is more adept at underhanded lying than the Clintons of this world. Bradley fought against the school known as Hedonism, which believed that morality is designed to create a more pleasurable world. The parallel to trying to defeat a Clinton is undeniable.
Well, if you must know, I fooled you one last time. Now that my credibility is totally shot (although the points are not without validity) I will fill you in on the real deal. The Bradley Effect was based on former Los Angeles Mayor Tom Bradley leading George Deukmejian in the polls of the gubernatorial race, then losing on Election Day. The theory was that white voters will tell pollsters, especially members of minority groups, that they will vote for the black candidate. But when Election Day dawns, they dump the dusky fellow and go with the alabaster.
You would think that the questioners in these polls would learn how to factor in these biases. A good follow-up question might identify subtle leanings that the yes-or-no format fails to elicit accurately. Here are some sample indicators of the Bradley Effect in cross-examining potential voters. “I would be thrilled to vote for a black guy for President, especially if he invites me to the White House for fried chicken and watermelon.” “I think it is high time those people got their chance just like everyone else.” “This is wonderful. Some of my best friends are blacks. Boy, my cleaning lady will be so thrilled!”
All in all, I suspect all of this is baloney, the result of too many pundits trying to slice the salami. The fact is that Obama and Hillary share this quality of being a historical vote, at least in the bean-counting modern world where race and gender stats are painstakingly tabulated. The Republicans had hoped to capture some of this energy by promoting Colin Powell a few years ago, but he would not bite. Bottom line, the country is disgusted with the absurd allegation that they would reject the better candidate for lack of testosterone or excess of melanin.
From my perspective, neither of these candidates is good for America. Black or white, man or woman, I need someone unafraid to send the Bradley tank out into the world’s hot spots. Until then, it is a cold day in New Hampshire. Brrr.

Brezhnev Lives!

Yes, it is official: Universal coverage is the opposite of health care. Don't believe it? Well, then, please pay attention to the position of the federal government---yes, that same federal government that many believe should guarantee health care coverage for all---in a lawsuit filed by a couple of veterans' groups arguing that the VA health care system "illegally denies care and benefits..."

As reported by the San Francisco Chronicle (January 11): "The government had argued that it was required to provide only as much care as the VA's budget allowed in a given year."

Now, it is absolutely clear that the Constitution vests the power of the purse in Congress, and not the judiciary. Congress has the power to spend whatever it chooses, and if given interest groups deem that amount insufficient, they have every right to petition the Government for a redress of grievances.

But let us shunt that legal/constitutional issue aside. What is fascinating is the policy dimension: The bureaucracy has just agreed that resources are limited---duh!---and therefore that not everything can be covered and that the beneficiaries of government spending programs might not get everything they would like. In other words: They will not be fully "covered" despite future promises of "universal coverage."

And that is for a small (and politically untouchable) population of beneficiaries: veterans. What would the system "cover" when everyone is the special interest, competing with everyone else for slices of the federal pie in the context of health care expenditures skyrocketing? The short answer: Not everything, not the universe, and not the free lunch that so many believe is within reach.

This little spat reminds me of the old joke about the time that the great Leonid Brezhnev was on the phone listening to the desperate pleas of Todor Zhivkov, the general secretary of the Bulgarian Communist Party, as he begged Brezhnev for increased economic aid. "Comrade Leonid Ilyichovich, we desperately need 10 million tons of grain." Brezhnev: "You will have them." "We need 25 million tons of oil." "You will have them." "We need 5 million tons of steel, 40 million tons of cement, 10 million pairs of shoes, 15 million winter coats, and 25 million tons of potatoes." "Fear not, Todor Hristovich: You will have them."

"Leonid Ilyichovich, you are a giant among the defenders of the proletariat, and the savior of the Bulgarian workers. But I have only one question. Do you really think that the Czechs will be able to deliver?"

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

Thursday, January 10, 2008

Correction

I previously wrote:

I, of course, support Fred Thompson, who, altho a down-the-line conservative, is at least mellow, and undoubtedly to my lefty pal's delight, also stands not even a snowball's chance.


According to the estimables John Podhoretz, Frank Luntz and National Review in general [which endorsed Mitt Romney as the only viable conservative], after tonight's South Carolina debate, please upgrade to

...stands a snowball's chance.


Hey, stranger and far worse things have happened. Like Jimmy Carter...

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Professor Reich Speaks

Robert Reich opined in yesterday's Wall Street Journal about the mudfight among the Democratic presidential candidates on the issue of whose individual "mandate" (a requirement that health insurance be acquired) would yield the most extensive coverage. And Reich is right: The differences are small, and the most extensive (or more stringently enforced) mandates are a way of imposing a tax on the young and healthy so as to subsidize other purchasers of health insurance. And thus does the great struggle over health care and "the children" boil down, as usual, to a fight over who gets to have greater snout privileges at the federal trough.

Reich claims that all the Democratic plans would cover roughly the same number of people; but nowhere does he delve into the issue of precisely what "coverage" means in a world in which government mandates insurance. Even apart from the larger reality that all the Democratic plans would lead toward a single-payer system and all the perversities thereto pertaining, government does not have infinite resources, and so must make choices about whom to "cover" and for what. And this dynamic proceeeds in the context of the eternal struggle over budget dollars, in which patients are just another interest group among many.

And that is why "universal coverage" is the opposite of health care, as government squeezes patients and providers so as to engender "savings" that can be used for other budget priorities. Where does the quality of actual care fit in that Beltway universe? The question answers itself, just as it has in the UK and Canada and other places where government compassion reigns supreme.

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

Wednesday, January 09, 2008

Can't We All Just Get Along? [apparently not Some of Us, even with Each Other]

I remember saying about a year ago I'd be happy with John McCain as president, even tho he often departs from conservative philosophy, if it would get America---left and right [the folks I work with lean left and they're always jawing at me]---off each other's throats.

I'm sick of all this, too.

A lefty pal o'mine writes:

[T]he most exciting development for me so far in the primaries has been McCain's victory in New Hampshire and possible resurgence. I've long thought that the key to bringing sanity back to American politics lies with the GOP...


Well, of course he would say that, since Ann Coulter's indiscretions are headline news, whereas Bill Maher's and Al Franken's and Michael Moore's and even Democratic Party Chairman Howard Dean's are so par for the course that we on the right don't even raise an eyebrow anymore.

But without getting into strict disagreement with him, a look at the GOP field shows McCain and Rudy Giuliani with established maverick credentials, Mitt Romney managing to get hisself elected governor of the only state that George McGovern carried, and Christianist Mike Huckabee more a believer in government as the solution to people's problems than any Republican in recent memory.

[I, of course, support Fred Thompson, who, altho a down-the-line conservative, is at least mellow, and undoubtedly to my lefty pal's delight, also stands not even a snowball's chance.]

So, the GOP has already de facto done its part in Our National Healing. On the other side, only HRC could possibly be construed as center-left rather than simply left, and that takes a ton of mental creativity.

And from what I see in the headlines, Herself and Sen. Barack Obama are getting ready to take the gloves off. Not mellow, atall, atall.

But if Obama prevails as the Dem nominee, there's a chilling possibility that any legitimate criticism of his candidacy might be seen as racially insensitive or offensive or divisive or whatever. Al Gore's 2000 campaign manager Donna Brazile made that charge against Bill Clinton His Ownself today.

For him to go after Obama using "fairy tale," calling him a "kid," as he did last week, it's an insult. And I tell you, as an African-American, I find his words and his tone to be very depressing.


America's First Black President disses his own. Very depressing indeed. All that healing he did, circling the bowl.

This all might get a helluva lot uglier before it get prettier, folks, but it has zilch to do with the Party of Lincoln.


[Me, if Obama slapped Ms. Brazile down in a Sista Soulja moment and gave ex-President Clinton's remarks a pass as histrionic but legitimate campaign fare, he might even win my vote, his Senate voting record being identical to Teddy Kennedy's notwithstanding. Did I mention I'm sick of all this?]

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It's Just Improper

What is it this time, you ask? Unsurprisingly, given the election season now entering full bloom, it is some types of drug marketing, according to a couple of disgruntled former employees of Amgen, who now are immersed in arbitration proceedings after having been fired for... well, it's not quite clear. The LA Times reports today that the two are accusing Amgen of requiring sales staff to engage in "aggressive and possibly improper marketing practices to boost Enbrel sales beyond its approved uses." (Enbrel is an expensive psoriasis treatment.) One former employee "contends that the company required salespeople to gain access to patient medical information in doctors' offices and market the drug directly to patients, many of whom may not have needed the medication."

It's not quite clear why the doctors would allow the drug reps to look through patients' files. But the larger policy issue that arises out of such cases as this one is whether off-label drug use, as prescribed by a doctor not being bribed by a pharmaceutical producer, is useful for patients. The evidence---crude, indirect, but compelling--- is that it is indeed. This is not very surprising given the powerful incentives of the FDA to approve drugs too slowly and for too few uses.

And so beware newspaper articles sympathetic to the argument that it is "improper" for the private sector to find ways to serve the interests of patients more fully. Once we allow bureaucrats to define the boundaries of propriety, we will have taken a long step toward serfdom, higher drug prices, and increased human suffering.

Tuesday, January 08, 2008

Stop The Presses

You'd better sit down. The Washington Post offers the following headline today: "Medicare Helps Push Drug Spending Up."

No kidding. When patients get a subsidy, they take advantage of it! And not just any subsidy: a federal subsidy defined as a budget entitlement for the purchase of prescription drugs under Medicare Part D.

Down around paragraph 2,938 it is noted as well that "The primary driver of the higher drug spending was increased consumption, not price increases..." This is not very surprising---notwithstanding the predictions of the usual suspects that prices would rise in the absence of federal negotiations of prices---in that Part D has expanded the market, for better or worse, and thus allowed the pharmaceutical producers to exploit the sizeable scale economies that characterize the cost conditions under which most drugs are produced.

And so we have some indirect but important evidence that an expansion of drug advertising would have a similar salutary effect on prices, again contrary to the simple-minded arguments of many that such advertising costs money, and so obviously it must drive prices up. How is it possible for some to get everything wrong? Good question.

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

Who'd A Thunk It?

The January issue of Archives of General Psychiatry---we labor mightily day and night so that you, dear Reader, do not have to read such stuff---has a nice article reviewing the California data on thimerosal and childhood autism. You may recall that the purported link between thimerosal---a vaccine preservative containing ethylmercury---and autism is one of those conspiratorial fads promoted by the likes of Robert F. Kennedy Jr., and believed with religious fervor by thousands of desperate parents despite the utter absence of systematic evidence showing any such effect.

Anyway, the article reports an examination of the evidence reported by the California Department of Developmental Services. The removal of thimerosal from childhood vaccines was accelerated between 1999 and 2001, and the data report the incidence of diagnosed autism by age and birth cohort from January 1995 through March 31, 2007. The finding? "Since 2004, the absolute increase and rate of increase in DDS clients aged 3 to 5 years with autism were higher than those in DDS clients of the same ages with any eligible condition including autism."

What does that mean? "The DDS data do not show any recent decrease in autism in California despite the exclusion of more than trace levels of thimerosal from nearly all childhood vaccines. The DDS data do not support the hypothesis that exposure to thimerosal during childhopod is a primary cause of autism."

Maybe Bobby the Child now will argue that Californians are just weird. And you know what? He's right.

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