Tuesday, December 29, 2009
The Lomborg piece, also from the WSJ, which I recently posted, argued that we should allow warming to occur and concentrate on mitigating its effects. Today's article argues that we should be attacking atmopheric methane rather than carbon dioxide. Although there is much less methane than carbon dioxide in the atmosphere, each molecule of methane produces many times more greenhouse effect than a carbon dioxide molecule does. And the authors claim that methane only lasts about a decade compared to the much longer lived carbon dioxide, so by cutting down emissions atmospheric methane levels could be reduced very quickly.
The authors maintain that reducing atmospheric methane would be much less expensive than the proposed attacks on carbon dioxide. They thus share Lomborg's interest in minimizing the costs of solving the problem (if it is a problem), but differ in the details.
My wife and I recently toured the Coffin Butte Resource Project, near Corvallis, Oregon, where methane from a landfill is being captured and used to generate 5.66 megawatts of electricity, enough to supply an estimated 4,000 homes. This prevents the methane from escaping into the atmosphere and also somewhat reduces the need to burn coal or natural gas to produce electricity.
Cattle farms are another major source of methane, so a reduction in the amount of beef consumed per capita might also help reduce methane emissions. (The methane produced by cows could be captured and used to generate power, but unfortunately this would increase the incentive to keep the cows cruelly packed into indoor feedlots, since capturing the methane produced outdoors in pastures would be much more expensive.)
In any event it seems to me that in solving any problem we cannot afford to ignore the costs of the solutions. Accordingly, the analyses of Lomborg and of Watson and El-Ashry should be given serious consideration.
Saturday, December 26, 2009
The Chinese Communist leader, Mao Tse-Tung, once observed that "There is nothing as practical as a good theory." Unfortunately for China, he didn't have one. Even more unfortunately, Americans don't have one, either. (Just because we correctly disagreed with Mao's perverse principles doesn't mean that ours are correct. It is possible for both sides of a disagreement to be wrong.)
The fundamental error in U.S. political doctrine is our assumption, never adequately examined, that nations and "peoples" ought to have a right to independence and "self-determination." Although this principle was best articulated by President Woodrow Wilson during World War I, its roots go clear back to the Declaration of Independence and the subsequent war by which we tore ourselves loose from British rule.
The problem with a claimed right of self-determination is that government isn't like that.
Political philosophers have long understood that the essence of government is its power to impose sanctions on people, the power in the inspired language of the Constitution to deprive people of life, liberty or property. Since nobody will consent to a transaction in which they are to be executed, imprisoned or fined, our basic relationship with government is an involuntary association, not a voluntary one.
St. Thomas Aquinas was pointing out this unpleasant fact about government when he noted that "Taking away justice, then, what is government but a great robber band?" Everybody understands that the relationship between a robber and his victim is an involuntary association. Even Mao Tse-tung, being merely human, could not always manage to be wrong; he got something right when he observed that "All political power grows out of the barrel of a gun."
It is perverse to claim a right to voluntarily select the people with whom we are going to be involuntarily associated. Any foreign policy based on such a belief cannot help but confuse and disorient us and our leaders. And it throws us seriously off balance when we are dealing with terrorists.
It is often said that organizations like the PLO, the ETA (Basque separatists in Spain), the IRA (Catholic separatists in Northern Ireland), the Chechen separatists in Russia, etc., are pursuing legitimate goals with illegitimate means. This is incorrect. These organizations are pursuing illegitimate goals, national independence, with illegitimate means: terrorism.
The people for whom these organizations claim to speak may indeed have legitimate grievances. But if they are being singled out for unjust treatment by the governments they are currently under, the proper remedy is to demand that they be treated equally under the law along with everyone else in their country, not that they be allowed to go their own way.
Americans have seen how well this reformist approach works. Black people in America historically suffered from intolerable injustices, but mainstream black leaders correctly resisted the bad precedent set by the Declaration of Independence and demanded equality before the law rather than separation.
It may take Americans some time to recognize that my argument is a correct one. Understanding this will not be easy for people whose principal political holiday is Independence Day!
Of course it is too late now to repudiate the Declaration of Independence and submit once again to British rule. But the vigor with which the United States stomped on the attempt by its southern states to secede implicitly admitted that we recognize no right to self-determination when it is directed against our own government.
It is high time that we explicitly admit that our revolution was a mistake, and stop condoning efforts to secede from other countries, too.
Wednesday, December 23, 2009
Measure 66 supporters claim it will only raise the Oregon income tax for about 2% of the population. Since the essence of law is that it is a general rule of action, it is somewhat unprincipled to make its lack of generality an argument in favor of proposed legislation. However a more fundamental weakness in claiming Measure 66 will increase taxes only on the rich is that it is untrue.
More precisely, the claim is true if we look only at Measure 66’s consequences in the short run but false if we consider its longer run results.
After several years of higher surcharges, Measure 66 provides for a permanent tax increase to 9.9% for incomes above $125,000 (250,000 for couples). Incomes below $125,000 will remain at their current 9% rate. Thus, in the short run, most Oregonians will pay no more income tax.
In the long run, however, many more of us will be paying the 9.9% rate as inflation lifts our income (but not our purchasing power!) into the bracket above $125,000
Just since 2000 average salaries and prices have risen 25%, since 1994 they have risen 44%, and since 1989 they have risen 72%. So Oregonians should try multiplying their current income by 1.72 and this will give a hint of where their incomes will be twenty years from now, if they keep up with inflation. For a lot of us, it will be more than $125,000.
Inflation would not affect our taxes if the proposed changes were indexed, but Measure 66 specifically prohibits adjustment of the $125,000 point at which the higher rates kick in. “Bracket creep” will therefore push more and more of us into the higher rates, just as it has done with the notorious federal Alternative Minimum Tax, which originally was supposed to affect only the “rich.”
Bracket creep is nature’s revenge on those who think they can raise other people’s taxes without raising their own. Ironically, therefore, Measure 66 may be more general in its consequences than its supporters are acknowledging, and thus be less unprincipled than I suggested at the beginning of this analysis.
The fact that Measure 66 will ultimately raise nearly everyone’s taxes does not tell us how we should vote. I haven’t made up my own mind yet. A permanent 10% increase in the tax rates most of us pay might be a good idea. We should avoid cutting critical state programs. But we should not create a privileged class of state employees who are exempt from the restraints on and setbacks to income suffered by private employees and retirees.
Different people will come to different conclusions, and the voters will decide. I hope they will decide better if they understand the actual consequences of their decisions.
This op-ed has run in the (Portland) Oregonian.
Tuesday, December 22, 2009
The lecture was entitled "The Czar is alive and ruling in the Kremlin." It argued that Nicholas II could not have been as stupid as he pretended to be, and that actually he was a political genius. In order to avoid being constitutionalized out of real power or thrown out, Nicholas faked his own overthrow with the aid of his loyal henchmen, Lenin and Stalin. With his new low profile, he continued to rule from behind the scenes until his death in the late 1940s, when he was succeded by his son, Alexei, then by his grandson, whose name I did not know.
The evidence I presented was overwhelming. For example, the so-called "doctors plot" in the early 1950s, supposedly about a plan by Kremlin doctors to assassinate Stalin, was actually a coverup for a big dispute inside the Soviet medical profession about the proper treatment of haemophilia, from which Alexei suffered. And our inability to explain how the Politburo made its decisions was due to the fact that it wasn't making any decisions, but just rubberstamping the orders of the Czar from his backroom.
One year a student came up after the lecture and said, in all seriousness, that the lecture made more sense than anything I had said all year! And of course, this was true. Conspiracy theory can be simple and consistent, once you work out the bugs, whereas reality is often messy.
This was published on December 26, 2009 by the Wall Street Journal as a letter-to-the-editor.
Friday, December 18, 2009
Together with the abortion issue, possible coverage for "illegals" has been an obstacle to the health care reform legislation that has been slithering its way through Congress. Apparently for many people, the possibility that diverting these people from emergency rooms might actually save taxpayer and premium-payer money is outweighed by their "principles."
I always pay attention to news from Vallejo, having graduated from high school there in 1957. I was saddened by the news some months ago that it had become (I think) the first city in the U.S. to declare bankruptcy as a result of the current meltdown. I hope that not many other cities will follow Vallejo in this path.
However it would be nice if other places emulated the Vallejo experiment in providing medical care for our "undocumented" brothers and sisters.
Tuesday, December 15, 2009
Lomborg argues that it would be much more cost-effective to let global warming happen and then combat its bad effects than it would be to reduce warming by forcing drastic reductions in hydrocarbon energy sources. If his numbers are anywhere near correct, it is an argument that needs to be considered.
The recent leak of e-mails purporting to show that prominent climate scientists have cooked the books, concealed data which might undermine their arguments, and tried to prevent scientists who do not agree with them from publishing their arguments in peer-reviewed journals are a major concern, of course. But even if a totally benign interpretation is placed on these emails, there may be a more major problem with today's climate science "concensus."
As Thomas Kuhn demonstrated in The Structure of Scientific Revolutions, "normal science" operates within a prevailing paradigm, or way of understanding and interpreting observations and placing them within a meaningful frame of reference. In smaller words, scientists tend to follow the beaten intellectual path, and those who come to radically different conclusions about thingsd are shunned, ridiculed, and labeled "unscientific."
The fact that so much research today is paid for by grants from the government may act to intensify this herd effect. When the scientific estabhlishment decides that global warming is caused in large part by human activities, the scientists to whom grant proposals are sent for peer review are very unlikely to commend proposals from people regarded as skeptics.
I don't know what can be done about this, except to always take claims of scientific concensus with many grains of salt. After all, Ptolemaic, earth-centered, astronomy was the establishment position of astronomers for a thousand years.
Sunday, December 13, 2009
Friday, December 11, 2009
First, the proposal to allow people to buy into Medicare starting at age 55.
Second, allowing people to buy insurance the same way as government employees (including members of Congress), with the same government agency negotiating some standard contracts that would be available from insurance companies throughout the country.
The beauty of these changes lies first of all in their radical reduction in complexity from the previous provisions for a "public" option, an option which never did make much sense to me. Second, they do not require creation of a new government administration system. Third, these steps might indeed be only the first in a series which would ultimately end up with universal coverage in a system that approximates the single-payer provisions in numerous foreign countries.
Supporters of the legislation before these two changes thought that, bad as the bill was, it would be a camel's nose in the tent that would make further reforms easier. I was afraid that the bill might have the opposite effect, helping to freeze the current dysfunctional system in concrete. With these two changes, the camel may be beginning to enter the tent.
Tuesday, December 8, 2009
Impeccable logic underlies this requirement. A major reason people want to move here is our employment opportunities and higher wages. If you cannot be hired, sneaking in is much less attractive.
Mandatory employment discrimination cannot do the whole job, especially since enforcement has been sporadic and half-hearted. So auxiliary measures are needed, and a recent court decision in Arizona illustrates what some of these measures might look like.
In June, a federal jury convicted Walt Staton of littering. His “littering” consisted of leaving jugs of fresh drinkable water in an area near the Mexican border for entering aliens who might otherwise have died from dehydration (as a great many indeed have).
The 27 year old graduate student was sentenced to 300 hours of community service, a year’s probation, and banned from the National Wildlife Refuge in which he had done his evil deeds. Now he has refused to do the community service and the judge is threatening to send him to prison.
The logic behind making it a criminal act to give someone a drink of water is also impeccable. If more “illegals” die from thirst, this will make crossing into the U.S. less attractive and reduce the burden of policing the border.
It is clear what the next step needs to be: we must make it a criminal act to give or sell food to anybody who cannot document that they are a citizen or here with official government approval.
After that, I am not certain. Allowing or requiring everybody to shoot down undocumented people on the spot might, by more soft-hearted Americans, be regarded as going a little too far. But this too would be a logical response to a problem that so many people are concerned about.
I guess the real question is: once we assume that such a category of people as “illegal aliens” is a legal and moral possibility, where do we draw the line in doing something about it?
An alternative which would not require us to draw any such line would be to abandon the whole concept of an illegal alien and regard every human being on the planet as a member of the human race and a citizen of the world. Inside the United States no matter what state we were born in, we automatically acquire state citizenship merely by moving there. Thus I was a citizen of Michigan for 36 years despite having been born in Oregon, and my wife is a citizen of Oregon despite her birth in Connecticut. There is no reason why this system could not work at the world level, and I am sure that at some future time we will have such a system.
In the meantime we have to live with a different system, but we need to recognize just how crazy this system is and the impossible choices with which it confronts us.
Christians, for example, including fundamentalists (perhaps especially fundamentalists!), need to think about the implications of their faith here:
“For I was hungry and you gave me food, I was thirsty and you gave me a drink, I was a stranger and you welcomed me ….” (Matthew 25:35)
Does anybody really want to live in a world where it is illegal to give a fellow human being a drink of water?
This piece has run in the Adrian (Michigan) Daily Telegram and in the Corvallis, Oregon Gazette-Times. On January 7, 2010 it ran on CommonDreams, a major on-line magazine.
Friday, December 4, 2009
"Here's why tort reform is not in the bill [being considered by Congress to reform the medical system]. When you go to pass a really enormous bill like that, the more stuff you put in it the more enemies you make, " Dean said. "The reason tort reform is not in the bill is because the people who wrote it did not want to take on the trial lawyers in addition to everyone else they were taking on, and that is the plain and simple truth."
For a number of years I taught a one hour class at Adrian College in which we read and discussed Rand's novel, Atlas Shrugged. The students who took the class were always an intelligent and highly diverse group, and not just those who were predisposed to agree with her. One notable student, one of my favorites despite his political orientation at the time which was pretty much left wing, told me he took the class because his advisor told him "it would test his values." And I think it did.
Although I found Atlas Shrugged to be an excellent book to provoke student thought and discussions, my own feelings about Rand's outlook were and are very mixed. I first heard of her and read Atlas Shrugged when I was a first year graduate student in political science at The Johns Hopkins University. She was coming in to give a talk there and I always like to read something before going to hear the author talk.
The book profoundly depressed me at the time, which didn't take much doing as my first year at Hopkins was not a very happy one. Uprooted from all my friends from undergraduate days at Willamette University in Oregon and from my parents, who were living in Honolulu, I was lonely and felt socially uncomfortable at Hopkins. I was living in a rented room in a not very hospitable private home near the University. With no cooking facilities available to me, when all the University dining halls shut down for Christmas vacation I ended up eating Christmas dinner all by myself in a Chinese restaurant----the only place I could find open! (And I still like Chinese food today, in spite of this!)
This was not an ideal posture in which to plunge into Rand's book, but of course I had no idea what I was getting into. I think now that my very negative reaction to the book was due to its combination of a very sour and indeed horrible philosophy of life with a very useful and sharp distinction between voluntary associations and involuntary associations. Government is, of course, fundamentally an involuntary association, as I have discussed in my four books available on-line for free reading, linking, and even reprinting. (Click here to access them.)
Rand's big mistake, I think, was in her failure to see how important government is in setting the context within which voluntary associations on any scale are possible by protecting property rights, enforcing contracts (which are one way of creating voluntary associations), and enforcing basic rules of the road to prevent voluntary associations from interacting with one another in ways which are destructive to the general welfare (such as the recent economic meltdown in the U.S. and elsewhere).
Nonetheless I am very grateful to her for helping me grope my way, during the next ten years, to the general classification of human associations which is summarized in the "periodic table of associations" in my first two books mentioned above.
I remain of two minds about Rand. On the one hand, I still find her general philosophy quite perverse, and Atlas Shrugged can hardly be considered great literature. On the other hand it contained great insights into the nature of human associations, and on top of that, Rand made money from her books. Lots of money! As an author myself, this is one quality of hers that I would dearly have loved to emulate.
Sunday, November 29, 2009
I opined that the key to real reform is not the current Republican politicians but Republicans and conservatives at the grass roots, and that a well-thought-out campaign to convince a lot of these people that a single payer system is a good idea after all (or at least a less bad idea than either the status quo or the currently proposed reforms) might be very possible. The rapidity with which George Wallace went from campaigning on a "segregation forever" platform to a friendship and racial togetherness stance after the Voting RIghts Act of 1965 brought large number of black people into voting booths in the southern states suggests that Republican politicians could change their tune on a dime if public opinion swung towards single-payer.
Frank suggested I start a group on Facebook called "Republicans for single payer" insurance, which sounded like an excellent idea to me. But before rushing off to do this, I took the precaution of googling "Republicans for single payer." I got 359,000 hits!
I still think it is a good idea, and am glad that a few people have already picked it up and run with it.
Saturday, November 28, 2009
Tuesday, November 24, 2009
Thursday, November 12, 2009
Plato: E.E., did you ever meet that fellow Charles Tilly while you were alive?
E.E.S: I don’t think so. I didn’t get into New York City very often. What do you think of his essay, “War Making and State Making as Organized Crime”?
Plato: Perhaps he is too blunt. Why, his very first sentence reeks of contempt for government:
“If protection rackets represent organized crime at its smoothest, then war making and state making---quintessential protection rackets with the advantage of legitimacy---qualify as our largest examples of organized crime.”
E.E.S: But don’t you think he is on to something? As I pointed out in my 1969 book, “Philosophers have beguiled us with tales about the origins of government about as convincing as the fables we tell children about where babies come from . . . . In the literature of political science and political theory there is no serious theory of the formation of governments or the cause of government.” Professor Tilly is certainly trying to give us such a theory.
T. Paine: I must agree with E.E.. Only it seems to me that I beat Tilly into print by nearly two hundred years. This is what I said in my Common Sense:
This is supposing the present race of kings in the world to have had an honorable origin; whereas it is more than probable that coujld we take off the dark covering of antiquity, and trace them to their first rise, that we should find the first of them nothing better than the principle ruffians of some restless gang, who savage manners or pre-eminence in subtlety obtained him the title of chief among plunderers . . . .”
E.E. S. Oh, my, that was well-put. I’m afraid when I spoke so derogatorily about philosophers, I was not thinking of you as a philosopher.
T.Paine: Under the circumstances, I am forced to interpret that remark as a compliment. I was always a practical man, not a woolly-minded theorist.
Plato: I beg your pardon! Mao Tse-tung and I were having tea together recently, and he confided that he is more convinced than ever that there is nothing so practical as a good theory. And he was “practical” enough to control a huge country for several decades. With all deference, Thomas, you couldn’t even persuade the French Assembly that it would be folly to execute Louis XVI!
T. Paine: I did my best, but it wasn’t good enough. It is never easy to talk sense to Frenchmen. As General DeGaulle has said, how can anybody hope to govern a country that has so many different kinds of cheese? But at least I talked sense about how governments originate well before Charles Tilly.
E.E.S. Plato is a modest man, and may hesitate to blow his own trumpet. So let me do it for him. Thomas, he beat you into print by over two thousand years. I grant you, he didn’t come right out and say that government originates as organized crime. But he did speak of the two things in the same breath and in a very suggestive way. After what happened to Socrates, we can’t blame him for not being more explicit. But you don’t have to be a Straussean to see what he was getting at:
“Do you think that a city, an army, and band of robbers or thieves, or any other tribe with a common unjust purpose would be able to achieve it if they were unjust to each other?”
“When we speak of a powerful achievement by unjust men acting together, what we say isn’t altogether true. They would never have been able to keep their hands off each other if they were completely unjust. But clearly there must have been some sort of justice in them that at least prevented them from doing injustice among themselves at the same time as they were doing it to others. And it was this that enabled them to achieve what they did.” [Plato, The Republic]
Plato: How can I disagree?
Monday, November 9, 2009
Martin Luther King, Jr.: I think that the second most important thing I ever said was in that letter I wrote from the Birmingham jail cell in 1963. May I quote myself?
Justice Robert Jackson (U.S. Supreme Court, 1941-1954): By all means!
MLK: “An unjust law is a code that a majority inflicts on a minority that is not binding on itself. This is difference made legal. On the other hand a just law is a code that a majority compels a minority to follow that it is willing to follow itself.”
Jackson: I totally agree. I talked about this same idea my concurring opinion in Railroad Express Agency v. N.Y. back in 1949. With your permission, I will also quote myself:
“There is no more effective practical guarantee against arbitrary and unreasonable government than to require that the principle of law which officials would impose upon a minority must also be imposed generally. Conversely, nothing opens the door to arbitrary action so effectively as to allow those officials to pick and choose only a few to whom they will apply legislation and thus to escape the political retribution that might be visited upon them if larger numbers were affected. Courts can take no better measure to assure that laws will be just than to require that laws be equal in operation. …. [W]e are much more likely to find arbitrariness in the regulation of the few than of the many . . . “
MLK: Right on, brother!
Sunday, November 8, 2009
Origins of government
Scene: A Small neighborhood tavern in heaven. Three dead white European males are sitting together. A half-empty bottle of white wine rests on the table.
Karl Marx: I am still convinced that governments are simply mechanisms for ripping off the governed. In their original form, at any rate, governments cannot be distinguished from organized crime.
Adam Smith: Except for one major detail, my dear Karl, you could convince me that the motives inspiring the people who created the first governments were less than noble.
K. Marx: And what is the “major detail” that interferes with my ironclad historical proof?
Smith: Surely, if governments originated in the way that you contend, as protection rackets, we would have some historical record of such an unpleasant beginning.
Sigmund Freud: I’m not so sure of that. Perhaps our collective memory has repressed the bad news.
K. Marx: Oh, Siggy, is repression all you can ever think about? To hell with all that psychobabble! The truth is the historians at the time knew which side their bread was buttered on. If you irritate city hall, they’ll cut off your water.
A.Smith: And what if you were totally correct, Karl, about the origins of government? Don’t you see this tells us nothing about the governments of today? Why can’t you understand that even actions taken for totally selfish purposes may turn out to benefit people in general? If this is true in economics, why can’t it be true also in politics?
S. Freud: It is not all that easy to grow from an unhappy childhood to a happy adult life. The original governments may be dead and gone. But they are like the fish in the immortal cantata by P.D.Q. Bach, Ephigenia in Brooklyn: “All around him, fish were dying, …. And yet their stench did live on . . . .”
Saturday, November 7, 2009
Illegal immigrants burden Portland-area schools
By Guest Columnist
October 03, 2009, 5:01PM
By Richard F. LaMountain
In 1982, in its Plyler v. Doe ruling, the U.S. Supreme Court obligated America's public elementary and secondary schools to educate children who are illegal immigrants. Since then, Americans have doled out untold billions to this end.
With a new school year recently begun, let's look at what Plyler costs taxpayers in one Portland-area school district: No. 48 in Beaverton. As children from Latin America comprise the great majority of students here illegally, we'll start by examining some national statistics regarding Hispanics and work our way down to the local level.
According to the U.S. Census Bureau, some 34 percent of the more than 45 million Hispanics residing in America are under 18. The Pew Hispanic Center estimates that Mexico and its southern neighbors contribute four-fifths of our illegal immigrants (commonly believed to number 12 million to 20 million); the Federation for American Immigration Reform, that some 15 percent of illegal immigrants are school-aged children. However sensitive the fact may be, what all this means is that between 9.4 percent and 15.6 percent of Hispanic children in America are here illegally.
From these figures, how many Hispanic illegal-immigrant students can we estimate are enrolled in the Beaverton School District? In the most-recently completed (2008-09) school year, according to the district's Website, student enrollment was 37,552; 7,702 of the students were Hispanic. Between 724 and 1,202 of those Hispanic students -- 9.4 percent to 15.6 percent of their total number -- likely were here illegally. What did they cost taxpayers? According to the district, in 2008-09 Beaverton schools' base per-student expenditure was some $8,400 (the general-fund operating budget of $315.6 million divided by student enrollment of 37,552). Each English-language learner -- which, by very conservative estimate, likely included half, or between 362 and 601, of the district's Hispanic illegal-immigrant students -- cost taxpayers another $3,000.
More, each child participating in the free- and reduced-lunch program got a federal subsidy of some $260. Washington County's Hispanic children, according to the county's Commission on Children and Families, are four times more likely to live in poverty than its white children; possibly three-quarters of the district's Hispanic illegal-immigrant students, then, received taxpayer-subsidized lunches.
So the total estimated cost of Beaverton School District's Hispanic illegal-immigrant students in the 2008-09 school year: between $7.3 million and $12.1 million. Add the estimated one-fifth of illegal-immigrant students who are other than Hispanic, and taxpayers likely spent between $9.1 million and $15.2 million educating and feeding all the district's illegal-immigrant students -- an amount equal to 2.8 percent to 4.8 percent of the general-fund operating budget.
Now, to counter recession-induced budget shortfalls, in the past year Portland-area schools have reduced teaching staffs, increased classroom sizes, and slashed extracurricular activities. It must be asked: If not for illegal-immigrant students, how many new teachers could have been hired and existing ones retained? How much more attention could teachers devote to their other students? How many arts and athletic programs could be saved or expanded?
The bottom line is this: Americans do not owe educations to illegal immigrants. Our first, foremost, and most sacred responsibility is to our own children. And we beggar our children's education -- and future -- when we spend scarce tax dollars on those who are in our nation illegally.
Portland-area school boards should lobby Oregon's Congressional delegation to introduce legislation to overturn Plyler, and to allow America's school districts to require proof of U.S. citizenship or legal U.S. residence from their students.
Richard F. LaMountain is a former assistant editor of Conservative Digest magazine. He lives in Cedar Mill.
My letter in response to LaMountain came out several days later:
Richard LaMountain wants Congress to overturn Plyler v. Doe, a 1982 Supreme Court decision prohibiting public schools from excluding children who are undocumented immigrants. Since Plyler held that excluding such children violated the equal protection clause of the 14th Amendment, it cannot be reversed by Congress alone.
It would take a constitutional amendment.
More fundamentally, excluding these children would be horrible public policy, as even the four justices who dissented in Plyler recognized.
"Were it our business to set the nation's social policy, I would agree without hesitation that it is senseless for an enlightened society to deprive any children --including illegal aliens --of an elementary education," wrote the four dissenting justices in the Supreme Court decision, including Chief Justice Warren Burger. "I fully agree that it would be folly --and wrong --to tolerate creation of a segment of society made up of illiterate persons."
PAUL F. DELESPINASSE
DeLespinasse is an emeritus professor of political science at Adrian College in Michigan.
LaMountain then replied to my letter as follows:
No amendment needed
In his Oct. 7 letter rebutting my recent commentary ("Costs come at expsense of programs, other students, Oct. 4), Paul deLespinasse claimed that a constitutional amendment---and not mere legislation, as I asserted in myh commentary---would be necessary to overturn the U.S. Supreme Court ruling Plyler v. Doe . . . .
As per the Constitution's Article III, Section 2, Congress determines the subjections over which federal courts have jurisdiction. To overturn Plyler, then, Congress would need merely to pass a law doing so--a law that invoked Article III, Section 2 to exempt the law from federal courts' review.
Richard F. LaMountain
I then tried to get the Oregonian to publish a letter explaining why LaMountain's take on Article III, Section 2 is profoundly incorrect as a matter of constitutional law. However the Oregonian, after much hemming and hawing, decided not to publish my letter even though they had originally agreed to do so.
The text of my proposed letter follows:
In his recent letter to the editor, Richard F. LaMountain claims that Article II Section 2 of the Constitution gives Congress the power to take away the jurisdiction of the federal courts to hear certain cases. But Article III Section 2 does no such thing. It only gives Congress the power to take away the jurisdiction of the Supreme Court to hear some kinds of cases on appeal. If Congress were to do this, the lower federal courts would still have jurisdiction over such cases, but their decisions could not be appealed to the Supreme Court. This could result in the Constitution meaning different things in different parts of the country, a very unattractive prospect.
Monday, October 19, 2009
Douthat's key paragraph summarizes the proposal well:
"But there’s another path, equally radical, that’s more in keeping with the traditional American approach to government, taxation and free enterprise. This approach would give up on the costly goal of insuring everyone for everything, forever. Instead, it would seek to insure Americans only against costs that exceed a certain percentage of their income, while expecting them to pay for everyday medical expenditures out of their own pockets."
Sunday, October 18, 2009
Since it is often impossible to find out ahead of time what a doctor or hospital visit is going to cost, medical offices and hospitals can't be doing this to make their services seem cheaper to people who are reading the right hand side of the menu. But it certainly complicates our efforts to understand medical costs.
Reid compares the medical and insurance systems in a number of industrialized countries and proposes that the U.S. draw on their experience in designing reform legislation here. This is such a no-brainer that one would think even Congress might think it is a good idea. But ....
No doubt I will comment further on this book, especially after I finish reading an older work that examines the unsuccessful efforts to reform the U.S. during the Clinton administration. But for now I just have one observation:
Reid claims that "every developed country except the United States has designed a health care system that covers every resident." (Page 237) As a result of email discussions I recently had with a former student of mine at Adrian College now living in Taiwan and a classmate at Willamette and Johns Hopkins now living in France, I do not believe that Reid is correct here.
Lisa, who lives in Taiwan with her family reported that their daughter "had surgery to have a deviated septum fixed and because she was no longer a dependent was not covered by insurance and cost us 1700 USD for the surgery and the 3 day hospital stay. " Of course this sounds pretty good compared to $1357 a day for 3 days at our local Corvallis hospital, plus whatever the surgical fees would have been here. But clearly not all residents are covered by the Taiwan insurance system.
Maureen, living in Paris with her husband, reported that they are not covered by the French system and had to furnish proof before they were allowed to live there that they have insurance from the U.S. She also noted how hard it is to get their American insurance to pay for anything. (They are both retired, but Medicare does not pay for treatment abroad, so they are relying on insurance from their former employers.)
Despite this criticism, Reid's book is exceptionally interesting and useful and I urge anybody interested in health care reform to read it without undue delay.
Thursday, October 1, 2009
Wednesday, September 30, 2009
Public discussion of medical reform may have gotten more intelligent lately, but the legislation making its way through Congress has become increasingly outlandish. Recent reductions in the proposed fines for individuals who do not buy insurance totally undermine the purpose the fines were intended to serve. If all individuals are not required to get insurance it will be impossible to require insurers to sell policies without regard to preexisting conditions, an essential part of any reforms.
The legislation currently on the table will take our intolerable situation in medicine and make it even worse. It creates a hodgepodge of employer mandates, individual mandates (with exceptions!), taxpayer-funded subsidies, taxes on medical equipment, providers, and even on some insurance plans. We should not even be considering anything this complicated!
If we are going to require that everybody be insured, why not just go for a taxpayer financed single-payer system and be done with it? This would simplify life, minimize complexity, and eliminate all of the transaction costs involved in privately purchased insurance. (Putting the private insurance companies out of business should not be a deal-breaker. Life is tough. After enduring the bankruptcy of airlines, auto companies, and banks, we should not hesitate to put the insurance companies out of their misery if it is what the public welfare requires.)
President Obama’s unwise promise that taxes would not be raised on the vast bulk of the population has forced him to take a single-payer system “off the table” and to deny the obvious fact that compulsory purchase of private insurance is also a tax increase.
A single-payer system would require that taxes be increased on the general population, since there are not enough rich people to finance such a system no matter how much they are soaked. But increased taxes to support a single-payer system might command widespread public support since they would be offset by reductions in the payments people now are making to medical providers and insurance companies.
A powerful educational campaign would be necessary to convince people to support such a general tax increase. Such a campaign cannot succeed overnight. It would have to overcome the unfortunate fact that most people have no idea how much medical insurance is already costing them since a large percentage of the money is being paid on their behalf by employers, reducing the amount they would otherwise pay as wages. This misperception of what insurance is already costing us in reduced wages is probably the single biggest impediment to fixing our current problems.
Time will be needed to build the public understanding and support that will allow Congress to enact a single-payer system. The highest priority now must therefore be to prevent the current legislative proposals, which could permanently block real reforms, from being enacted. The obvious way to do this is for supporters of a single-payer system to join with conservative opponents of any real reforms to form a majority against the current proposals.
Coalitions of strange bedfellows are common enough in politics, for better or for worse. This is one time when such a coalition will be a really good idea.
Thursday, September 3, 2009
We are told that one reason medical system reforms are needed is that medical costs are increasing so rapidly.
“Medical costs”, however, is an ambiguous term. “Costs” may refer to the total amount of money (or percentage of the GDP) being spent on medical care each year in the United States. Or “costs” may refer to how much is charged for a specific medical procedure such as an MRI, a colonoscopy, installation of a filling, or delivery of a baby.
The percentage of GDP going to medical care is up to 16% and rising. But there is no way to know how much of the GDP ought to be spent on medical treatments. As the population ages and new medical treatments and technologies are invented, it would not be surprising if total costs were to increase. This type of increase in medical costs is therefore not inherently alarming.
If the costs of specific medical procedures are increasing, however, this is something we really need to be concerned about.
There can be no doubt that the costs of many procedures are going way up. A few years ago I found an old receipt indicating that my grandfather, a dentist, had put in a filling back in the mid-1930s for $1. Adjusting that figure for inflation, the current charge for a filling would be about $14.
The hospital bill when our daughter was born in 1969 recently turned up. My wife and our new daughter were in the hospital six days. The total bill was $471.22. (We paid $47.50 and our insurance paid the rest.) If the real (constant dollars) price for delivering a baby hadn’t increased the charge today would be $2,733.27 (but only if mother and daughter stayed in the hospital for six days).
Typical charges for having a baby in 2009 at the Corvallis hospital average between $5,000 and $6,000 but may sometimes be as much as $8,000 according to a hospital official. (This does not include doctors’ fees, which was also the case with our hospital bill in 1969.) And this is assuming mother and baby are only in the hospital two days. .
Hospitalization to have a baby----a specific procedure----now costs at least twice as much (in constant dollars) as it did in 1969.
The breakdown of costs in our 1969 bill gives further food for thought. Back then the daily charge for a hospital room (including private room surcharge and “routine nursing”) was $33.64, or $195.42 in 2009 dollars. The 2009 daily charge for a private or semiprivate room at the Corvallis hospital is $1,357, or seven times as much.
One would expect the costs of specific services and procedures to remain about the same (after adjusting for inflation) or even decrease thanks to efficiency improvements, improved technology, and economies of scale. But instead in many cases these costs have greatly increased. Somebody needs to figure out why this is and what might be done about it.
Perhaps too much attention is now being paid to the costs of medical insurance and too little to the costs of the medical services and procedures for which insurance pays. If the costs of the procedures can be gotten under better control, insurance premiums will reflect this fact and themselves become more manageable, whatever insurance system we then have.
[This article has appeared in the Portland Oregonian, The Detroit Free Press, The Adrian (Michigan) Daily Telegram, and elsewhere.]
Friday, July 17, 2009
(This article was published in the Corvallis, Oregon Gazette-Times on July16, 2009)
Congress seems to be moving towards a Massachusetts-style insurance system. Individuals will be required to purchase insurance and those who don’t will be fined. Insurers will be required to sell to all comers and cannot discriminate against pre-existing conditions.
A recent Wall Street Journal column noted that people in Massachusetts have been gaming the system. They pay for insurance just long enough to get thousands of dollars of medical care, then discontinue it and pay the nominal fine instead to save money. If they get sick again, they can once again sign up for insurance. This is like letting people carry no insurance on their houses, and then sign up for insurance after the house has burned down.
It might be possible to tweak the Massachusetts system to prevent such gaming, but this would not fix the more fundamental problems that any compulsion to buy insurance would have: enforcement costs and transaction costs.
To make purchase of insurance truly compulsory the fine for not being insured would have to be comparable to the costs of insurance----in other words, very high. A large, intrusive, and expensive governmental bureaucracy would be needed to administer such compulsion.
Transaction costs would fall directly on Americans as individuals. We would all have to choose between a large number of complex insurance policies with no way to make systematic comparisons of costs and benefits between them. It would be impossible for most of us to be sure exactly what coverage we were buying. We might benefit from expert advice, but advice would cost something, and there would still be the problem of deciding which expert to consult.
Insurance purchased household-by-household would inevitably cost more than insurance purchased on behalf of employees by businesses---retail costs are always higher than wholesale, and group bargaining is more efficient than individual bargaining.
Complexity and those transaction costs due to complexity might be reduced if insurance companies were restricted to offering only a few government-designed standard contracts, as is now the case for medigap policies purchased by many Medicare members, policy A, policy B, etc. This would help people understand what they are buying and shop for the best price.
But if we are going to require that everybody be insured, why not just go for a taxpayer financed single-payer system and be done with it? This would simplify life, minimize complexity, and eliminate all of the transaction costs involved in privately purchased insurance.
True, a single payer system would require a tax increase. But requiring people to buy insurance is also a tax increase, even though it doesn’t show up on our tax forms or in government budgets. And increased taxes would be offset by eliminating the premiums that we now pay directly, or indirectly when our employers write the insurance check.
The fact that a single-payer system would put the private insurance companies out of business (they could still sell other kinds of insurance) should not be a deal-breaker. Life is tough. A country which has survived the bankruptcy of airlines, auto companies, and banks should not hesitate to put the insurance companies out of their misery if it is what the public welfare requires.
Saturday, June 27, 2009
President Obama and the 535 members of Congress seem to have at least 600 different national medical insurance proposals, some of our leaders being of two or more minds on the subject. Analysts writing in the press push additional panaceas and utter platitudes in abundance. Mixed in with all this is propaganda from insurance companies' spin-doctors and from other corporations with major interests at stake.
Policy affecting one sixth of our gross domestic production should not be created by such a haphazard approach.
Agreement on major legislation does not seem likely in the near future. But it should be possible for Republican and Democratic leaders to create a process which could produce legislation most Americans could agree on during the second half of President Obama’s first term.
Congress should establish a bipartisan commission on National Medical Policy. Although the commission would hear testimony from representatives of the medical and health care professions and the drug and insurance companies, none of the commissioners should be representatives of these self-interested parties.
The main job of the commission would be to study all of the major countries that have national health insurance programs. It would analyze the respective advantages and disadvantages of these various national systems.
The commission would then be charged with drafting a proposal---appropriate to American circumstances--- that would to the greatest possible degree incorporate the strengths of these other systems while avoiding their weaknesses. Hopefully, a proposal would emerge from the commission that could command bipartisan support in Congress.
Our expectations for the commission should not be too high. Any possible medical system will have some defects, given the many conflicting interests and considerations. Services covered must be limited to some extent since medical technologies now exist that are too expensive to provide them to everyone who might benefit.
If the new system is a single-payer one, it will be necessary to raise taxes in order to pay for it. But this would be offset for the average person by elimination of the medical insurance premiums that we now pay, directly or indirectly in the form of reduced wages when our employer writes the check for the insurance. If the system is not a single-payer one, it will force people to make complex choices that may be beyond most of us, and may include mandatory purchase of private insurance that would be a tax in everything but name.
The commissioners must be willing to follow the evidence wherever it leads. If it leads, as I expect, to a single-payer system, the fact that this might put the private insurance companies out of business (they could still sell other kinds of insurance) should not be a deal-breaker. Life is tough. A country which has survived the bankruptcy of airlines, auto companies, and banks should not hesitate to put the insurance companies out of their misery if it is what the public welfare requires. Jobs would be lost at the insurance companies, but new jobs would be created administering the new system.
Over two thousand years ago, Aristotle compared the constitutions of the various Greek city states in his effort to determine an ideal form of government. It would likewise be intelligent for Americans to study the experience of others before coming to any conclusions about major medical reforms.
Wednesday, June 17, 2009
by Stephen Gregg
Tomorrow is my 65th birthday. I just left my private-sector health insurance roots behind and enrolled in Medicare. I'm both pleased and troubled by the transition. That split attitude was striking for me, given my long-standing philosophical and ideological commitment to "private" and "free market" views. How could I possibly view participation and dependency on a government-run Medicare program as an improvement?
Well, Medicare is a very sweet deal.
The Social Security Administration indicates my Medicare tax contributions over my working career have been $57,700. That seems far less than the costs my wife and I are likely to incur over the remainder of our lives. Surely, it will be convenient to allow politicians, lobbyists and organizations such as AARP to run the show, no matter the larger consequences. I know politics offers considerable protection of my interests. In large part, this is not a story about how the government has taken over yet another sector of our society, but how far the private sector has wandered from steadfastly serving its customers.
Turning 65 is a rare moment, allowing one to contrast before and after. "Before" meant buying individual private insurance for the past 15 years. Employer group insurance is far more benign financially. The dominant characteristics of individual insurance included:
--Volatile premium increases.
--Benefit designs loaded with popular fluff, while leaving me wondering whether coverage for the unanticipated and serious was there.
--Insistence on using predetermined provider networks irrespective of better or cheaper alternatives.
--Spotty administrative support. Changing insurance providers during those 15 years was always an iffy exercise.
The "after," of course, remains to be fully appreciated, but the initial Medicare signals seem favorable, bordering on a breath of fresh air:
--Stable premium increases.
--Ubiquitous access to almost any provider in the country.
--Assurance that the best price has been extracted (extorted?).
--Standardized supplemental insurance policies covering super-catastrophic and first-dollar coverage for just slightly higher premiums.
--A wide range of supplemental insurers.
--Ability to switch carriers, no questions asked, once a year.
--So far, decent public-private customer service throughout.
--Very little uncertainty as to whether I am covered for all the possibilities.
It's a challenge to argue that Medicare is an inferior alternative to a more responsive and dynamic private sector.
This is disturbingly superficial and self-centered, but it's where I fear many people are today. It's no one's fault in particular, and all of our faults collectively. Certainly there is near universal acknowledgment that the math of Medicare just does not work in the mid to long term.
But as disastrous as the future financial plight of Medicare is, it may prove to be secondary to political demands to reform a health care system that isn't meeting many people's needs.
Do I think the private sector has a grasp of all this? I don't see it. Perhaps you do. What a predicament we have.
Stephen Gregg is a retired Portland (Oregon)-area managed-care and hospital administration executive.
Thursday, May 21, 2009
HOW TO MAKE THE SUPREME COURT MUCH MORE REPRESENTATIVE
With the coming retirement of Justice David Souter, there is great interest in just who President Obama will appoint to succeed him. Spokespersons for various groups think that the Supreme Court should be more “representative.” Hispanics want a Hispanic, since one in six Americans is Hispanic. Women want a woman, noting that women are more than half of the population and yet only one current justice is a woman.
There is a group of Americans much more conspicuously absent from the Court than either Hispanics or women: people who are not lawyers. There are about 800,000 lawyers in the U.S., a tiny fraction of one percent of our 300,000,000 people. But every single current member of the Supreme Court is a lawyer, and this is also true of all previous justices.
We are told that diversity is important because it gives the justices more empathy with the different kinds of people who will be affected by their decisions. Also, diversity might give the justices different perspectives from which to view the legal questions facing the Court. If this is true, then having a non-lawyer on the Court could be tremendously helpful.
One or more non-lawyers on the Court might reduce its willingness to make American law more complicated by their own decisions and to tolerate excess complexity in acts of Congress.
The Court’s Fourth Amendment decisions governing arrests, searches and seizures, for example, have sometimes made the inherently difficult jobs of police officers nearly impossible. These decisions require the police to make decisions that even trained attorneys would consider close calls. The courts then have to devote scarce judicial time to second-guessing decisions made on the streets.
Tax legislation enacted by Congress has become so complex that a high percentage of Americans now have to pay experts to prepare their tax returns, or at least buy software to help them do their own. The Due Process clause of the Fifth Amendment, which requires that people have “notice” of their legal duties, might seem to forbid tax laws which are so complicated that only experts (if anyone!) can understand them. But our lawyer-dominated judiciary has never seen fit to reign Congress in here.
Lawyers are much better equipped than normal people to cope with outrageous complexity, indeed they seem to thrive on it, so they may be inclined to ignore the practical implications of their decisions. That is why we need at least one non-lawyer on the Supreme Court.
There is no constitutional obstacle to appointing non-lawyers to the Supreme Court. Indeed, the Constitution states absolutely no prerequisites for membership on the Court: no citizenship requirement, no age requirement, no educational requirement. While I doubt that the Founders had our present situation in mind when drafting the Constitution, we should be grateful that their words give us the flexibility to take the next step in improving our Supreme Court by including non-lawyers in its membership.
French prime minister Georges Clemenceau once said that “War is too important to be left to the generals.” Likewise, law is too important to be left to the lawyers.
[This column has run in the Detroit Free Press and the Portland Oregonian.]
Could St. Thomas Aquinas Address Notre Dame Graduates?
The uproar over President Obama’s speech at Notre Dame University has drawn nation-wide attention, not least so in the Pacific Northwest where I now live after 36 years in Southeastern Michigan.
The protesters’ argument that a Catholic university should not invite an abortion supporter to speak at its commencement, or last least should not have awarded him an honorary degree, is based on serious confusion about the relationship between law and morality.
The official position of the Catholic Church is that abortion is immoral and although I am not a Catholic I believe this position is a correct one. But the immorality of an action does not automatically produce the conclusion that it should be illegal. An immoral action may be good in the sense that it is the least bad option available under the circumstances.
St. Thomas Aquinas, the outstanding Catholic philosopher, pointed out that the side effects of trying to outlaw all sin may be worse than the benefits. Government has only limited resources for enforcing its laws and can easily spread itself too thin. It must therefore concentrate on preventing actions that destroy all possibility of civilization and human fellowship.
Under the unfortunate circumstances of the modern United States, laws against abortion would probably produce an increased total amount of evil and a further deterioration in our circumstances. Sexual promiscuity and illegitimate births are rampant. Were it not for the large number of abortions currently performed a higher and higher percentage of children would be brought up in underprivileged homes. Already intolerable pressures on the welfare and schooling systems would be increased.
Thus as a policy the Supreme Court’s decision unleashing abortions from the shackles of law was probably wise. The real scandal here, however, is not so much what was done, but by whom it was done. The Supreme Court is not supposed to make basic policy decisions. The constitutional reasoning which it invoked to support its Roe v. Wade decision was so flimsy that Roe supporters have been terrified ever since that a future Supreme Court might overrule it. What the Supreme Court can arbitrarily give, it could arbitrarily take away.
Congress is the branch of government in our system that is supposed to make basic policy decisions. If Congress had enacted laws protecting the right to have an abortion we could have been spared the vicious politics that have surfaced every time the Supreme Court has had a vacancy for over 30 years.
The whole situation, in a word, is a political, legal, and moral mess. One wonders how President Obama’s critics would react if St. Thomas Aquinas were brought in by time machine to speak to Notre Dame graduates next year. It is quite possible that after carefully studying the current scene, Aquinas would conclude that, although abortion remains immoral (an arena where the Church has something to say), it should not therefore be made illegal.
Would today’s protesters return to denounce Notre Dame for bringing in perhaps the greatest Catholic philosopher?
Fortunately, no time machine is likely to be available.
Wednesday, May 13, 2009
When I get to it, I will post links to three free introits for church choirs that I have written, the most recent of which was premiered last October by a 140 voice choir (100 students and 40 alumni) at the Adrian College homecoming chapel service.
In the meantime, anyone who would like PDF files of the three introits should just e-mail a request to me.
I will also post links to newspaper op-ed columns that I have written, the most recent of which discussed what to do about the pirates.
Monday, April 13, 2009
This could just be one of those changes that take place in a dynamic economy (with the percentage of income spent on food and the numbers of people working in agriculture falling dramatically during the last century, for example). But the above average pay for health care workers becomes more and more of a problem as they become a higher percentage of all workers. Unlike in Lake Woebegon, it is impossible for everyone to have above average pay.
It is no wonder, then, that even health care workers are no longer immune from employment cutbacks.
Recession Now Hits Jobs in Health Care
Sunday, April 12, 2009
Why Has the Press Failed Us In Reporting on Health Care Reform?
Friday, April 10, 2009
I am thinking about how to change this blog to a more general focus, which will not exclude medical system reform ideas but will encompass much more. Stay tuned!
An interesting article from Common Dreams:
A System From Hell: My Personal Health Care Nightmare
Saturday, April 4, 2009
Translated by Benjamin Jowett:
Well, I said, and to require the help of medicine, not when a wound has to be cured, or on occasion of an epidemic, but just because, by indolence and a habit of life such as we have been describing, men fill themselves with waters and winds, as if their bodies were a marsh, compelling the ingenious sons of Asclepius to find more names for diseases, such as flatulence and catarrh; is not this, too, a disgrace?
Yes, he said, they do certainly give very strange and newfangled names to diseases.
Yes, I said, and I do not believe that there were any such diseases in the days of Asclepius; and this I infer from the circumstance that the hero Eurypylus, after he has been wounded in Homer, drinks a posset of Pramnian wine well besprinkled with barley-meal and grated cheese, which are certainly inflammatory, and yet the sons of Asclepius who were at the Trojan war do not blame the damsel who gives him the drink, or rebuke Patroclus, who is treating his case.
Well, he said, that was surely an extraordinary drink to be given to a person in his condition.
Not so extraordinary, I replied, if you bear in mind that in former days, as is commonly said, before the time of Herodicus, the guild of Asclepius did not practise our present system of medicine, which may be said to educate diseases. But Herodicus, being a trainer, and himself of a sickly constitution, by a combination of training and doctoring found out a way of torturing first and chiefly himself, and secondly the rest of the world.
How was that? he said.
By the invention of lingering death; for he had a mortal disease which he perpetually tended, and as recovery was out of the question, he passed his entire life as a valetudinarian; he could do nothing but attend upon himself, and he was in constant torment whenever he departed in anything from his usual regimen, and so dying hard, by the help of science he struggled on to old age.
A rare reward of his skill!
Yes, I said; a reward which a man might fairly expect who never understood that, if Asclepius did not instruct his descendants in valetudinarian arts, the omission arose, not from ignorance or inexperience of such a branch of medicine, but because he knew that in all well-ordered states every individual has an occupation to which he must attend, and has therefore no leisure to spend in continually being ill. This we remark in the case of the artisan, but, ludicrously enough, do not apply the same rule to people of the richer sort.
How do you mean? he said.
I mean this: When a carpenter is ill he asks the physician for a rough and ready cure; an emetic or a purge or a cautery or the knife, -- these are his remedies. And if some one prescribes for him a course of dietetics, and tells him that he must swathe and swaddle his head, and all that sort of thing, he replies at once that he has no time to be ill, and that he sees no good in a life which is spent in nursing his disease to the neglect of his customary employment; and therefore bidding good-bye to this sort of physician, he resumes his ordinary habits, and either gets well and lives and does his business, or, if his constitution falls, he dies and has no more trouble.
Yes, he said, and a man in his condition of life ought to use the art of medicine thus far only.
Has he not, I said, an occupation; and what profit would there be in his life if he were deprived of his occupation?
Quite true, he said. . . . .
Friday, April 3, 2009
Doctors Are Opting Out of Medicare [Would this kind of problem occur under a single-payer system of insurance?]
G.E. and Intel Working on Remote Monitors to Provide Home Health Care
[Is this a step towards the "doctor in a box" that I wrote about recently?]
An Open Letter to Congress: Help Me or I Will Die [If there is a single-payer insurance system, it will either have to draw the line at some treatments that could extend lives, or it will bankrupt the country. Will Congress have the courage to draw the line?]
Wednesday, April 1, 2009
Tuesday, March 31, 2009
Interesting articles in today's press:
Treating an Illness Is One Thing. What About a Patient With Many?
Sanders Puts Single-Payer On the Agenda
For Injured Workers, a Costly Legal Swamp
Democrats Target Deals to Delay Generics
Monday, March 30, 2009
A lesson on health care from Massachusetts
Sick building syndrome; floods, mold, cancer, and the politics of public health
I would like to offer more reader reflections like those sent in by Bill Frick and John Myers. Please do not hesitate to send comments or more extensive thoughts-----I am not being inundated with mail!
Friday, March 27, 2009
It is often said that medical insurance costs are increasing faster than wages. This may be a case where it all depends on what we mean by “wages.”
Broadly defined, wages are everything of value provided for a worker by his or her employer. This would include dollars paid to the worker directly, fringe benefits (including medical insurance) where the employer writes the check that pays for them, and accrued rights to future compensation----retirement plans.
When medical insurance costs are increasing rapidly, which has been the case for a number of years, our employer may be increasing the amount paid for our insurance faster than he, she, or often “it” (a corporation) is increasing the amount paid directly to us.
In this case, our medical insurance costs are indeed increasing faster than our wages, but only if we exclude the medical insurance costs from what we consider wages. But the insurance costs are not necessarily increasing faster than our total earnings, since they are a part of those earnings. We are simply getting more of our wages indirectly rather than directly.
Of course if insurance costs rise fast enough, they will outstrip the increase in total compensation an employer may be willing and able to pay. In that event, the employer would either need to decrease the actual amount of cash paid to workers in order to make up the difference, lay off some workers (because they have gotten too expensive), or cut down on the insurance benefits purchased.
The bottom line here is that we need to be very cautious in drawing conclusions from reports that medical insurance costs are rising faster than wages.
Thursday, March 26, 2009
I am nearly done reading John Geyman, MD, Do Not Resuscitate. He does an outstanding job of pointing out all the problems with the present medical insurance system. However his argument that a single-payer system would be better at holding down costs, while it may be correct, is less convincing.
One of Dr. Geyman’s complaints, shared with many other critics of the current system, is that we have far too few primary care doctors. I have long wondered if one way around this problem might be a kind of “doctor in a box,” software that we could buy (in a box!) and load into our computers.
The Box Doctor would be an expert system that we could run when we think something might be wrong with our health. It would ask us a series of questions and on the basis of our answers might do several possible things: It might tell us to eat a bowl of chicken soup, go to bed, and see how we feel in the morning. It might write a prescription for an appropriate medicine and print it out or e-mail it to our selected local pharmacy. It might tell us that we should go to an emergency room or immediate care center right away and print out its tentative conclusions for us to hand to the receptionist there. It might suggest that we consult our primary care doctor or an appropriate specialist. It might prescribe physical therapy and print out an order to that effect. It might tell us to have certain lab tests done.
A later version might even have a set of gadgets that plug into our computer’s USB port and report certain measurements for the Box Doctor to take into account----perhaps blood pressure, blood sugar, urine tests, pulse, and so forth.
In a word, the Box Doctor would serve as a pre-primary care doctor, and in some cases as a primary care doctor. It could save immense amounts of money and of time and travel, of missed work. It could allow prompt attention to a problem when we might otherwise procrastinate about doing something about it because of the inconvenience of scheduling and going for a doctor visit.
Designing such an expert system would be an interesting challenge for a team of physicians and software engineers. A larger problem, however, might be insuring the software against malpractice lawsuits! Any company seeking to create and market a Box Doctor will need to have a very good legal department as well as top notch doctors and engineers.
It sounds like a job for Google!
Wednesday, March 25, 2009
Yesterday the article with which I kicked off this blog was picked up by the on-line version of the Portland Oregonian. To see this version published under a slightly different title, click here.
This will also get you to the comments sent in by Oregonian readers, which were up to 36 as I was writing this. A few of the comments offer useful perspectives in favor of or against a single-payer system, but many of them are stereotyped attacks on the concept or on the presumed dubious motives of anybody willing to think about such a system. There is no basis for thinking that any of the commentators have any personal experience in the medical system, have spent much time seriously thinking about it, or have any ability to think systematically about public policy issues. Furthermore, they are mostly so certain that they, and they alone, are correct!
I much prefer comments from people like John Myers and Bill Frick, whose thoughts I have posted here, who have interesting personal experiences with medicine and who frankly admit they don’t know what ought to be done but would like to help figure it out.
The kinds of comments that are sent in to newspapers like the Oregonian and the New York Times are exactly why I have chosen not to allow readers of this blog (who I hope will be more knowledgeable and thoughtful than most people who comment at the newspapers) to post comments directly to this blog. If too many comments like I read in the Oregonian appeared here, it would discourage the kinds of people I want to encourage to participate from reading postings and sending in their thoughts. In a kind of Gresham’s Law, the bad money (even from a small minority of readers) would drive out the good!
And even if they were all of high quality, if there were too many postings few of my targeted readers (who are busy and have a lot of other things to do!) would find time to read the blog. After all, sometimes there are more that 600 comments posted for a single article at the New York Times before the editors cut off further postings!
The economist Thomas Sowell says that the fact that he has never murdered an editor is proof that capital punishment really does deter. I, too, have often had unkind thoughts about editors. But I am functioning here as an editor, seeking to protect my readers from nonsense (unless it is truly interesting and original nonsense!) and also from being inundated even with too much good stuff for them to manage.
Let me hasten to add that I do not define as "nonsense" ideas with which I do not agree. So do not hesitate to send in criticisms of anything which I may have said.