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December 31, 2003

New Year's Predictions

Watching the TV over the last few days has been a grueling exercise in a) avoiding CBS and its Michael Jackson "coverage," and b) suffering through the pundits' predictions for the coming year.

Rather than listen to another conservative talking head describe how Bush will lead us all to the promised land in 2004, I thought I'd turn off the TV and make some of my own New Years predictions:


  1. Cold Mountain will win the Oscar for Best Picture.
  2. By the end of the year, most people will have forgotten it. They will, however, still remember The Return of the King.
  3. Microsoft Windows will continue to be plagued with viruses, and more people will be switching to OSX and Linux.
  4. Karl Rove will meet his political match in the person of Joe Trippi.
  5. I will boldly predict that we won't be referring to "President Lieberman" anytime in the future. Ever.

December 29, 2003

Here's how Bush apologists think

Donald E. L. Johnson of The Business Word criticizes an article in the Denver Post about the Bush medicare reforms.

He apparently believes the only proper response to Bush's $400 billion giveaway to the pharmaceutical industry in return for inadequate drug coverage and ballooning deficits is gratitude:

The Medicare Prescription Drugs, Improvement and Modernization Act of '03 (PDIMA '03) is a huge gift to today's seniors and almost seniors who have never paid for the benefit and will never pay enough premiums to cover the prescription drug benefits that many of them will receive.

But Democrats and their mouth pieces in the media, like the Denver Post's Jim Spencer are spinning PDIMA '03 as an insult to seniors rather than as the gift that it is. . .

This debate is an example of the kind of politicing that would go on if the U.S. were to adopt a single-payer system for all Americans. Articles about such a system would be silly, incomplete, pandering and outrageously dishonest, just as the the complaints about the PDIMA '03 donut hole are. Articles like this are being written by editorial writers, columnists, politicians and ungrateful seniors all over the country. . .

You've got to read the whole thing to see the disapproving tone of the column.

Egad! Imagine how ungrateful you'd have to be to write a column with a disapproving tone about Bush's policies!

Johnson's post doesn't actually defend these policies at all. Instead, it merely demonstrates that Bush apologists and right-wing bloggers all over the country are writing articles that are "silly, incomplete, pandering," and conclusory.

I won't say "dishonest," because I really do think these bloggers are more blinded than dishonest. They simply can't comprehend how anyone with any common sense could possibly disagree with the Bush agenda.

For this, they deserve pity more than criticism.

Aragorn has "acute hydrophobia"?

I haven't taken a personality test in a while, so I took this one:

aragorn
Congratulations! You're Aragorn!


Which Lord of the Rings character and personality problem are you?
brought to you by Quizilla

December 28, 2003

My kind of conservative thought!



Bill McKibben's recent book Enough is sounding an alarm. Its thesis is that the new and converging technologies of germline engineering, robotics, and nanotechnology will destroy what little meaning is left in our lives.

If, as McKibben expects, these technologies succeed in extending our lifespan, increasing our intelligence, improving our emotional makeup, and solving the problems of material scarcity--in other words, if the techno-visionaries' dreams come true, we'll all be profoundly worse off for it.

From Enough, by Bill McKibben:

It has perhaps crossed even your dull old-fashioned human mind that there is something of an irony at work here. Even as the genetic engineers work busily to upgrade us, adding IQ and memory, the robotics engineers are hard at work making sure we'll be surpassed, and the nanotechnologists to make sure all our wants will be satisfied by pushing buttons. What, on other words, are we being enhanced for?

* * *

Look--I don't know for sure what this world would feel like. What it would mean if we were "seamlessly articulated with intelligent machines" or if "the realm of the born and the realm of the made. . .become one." I can imagine what a cat feels like stretching in the late afternoon sun, but I can't quite channel what it would be like to inhabit "a warm, energized, super-sensual morphing device of graceful complexity and beauty." It's a thought experiment almost beyond our powers. . . Having focused on our own kind to the exclusion of others, we're urged on to a kind of species suicide. Instead of backing down a little, leaving room for the rest of nature, we're firing up the pyre for man as well.

* * *

We need to do an unlikely thing: we need to survey the world we now inhabit and proclaim it good. Good enough. Not in every detail; there are a thousand improvement, technological and cultural, that we can and should still make. But good enough in its outlines, in its esssentials. We need to decide that we live, most of us in the West, long enough. We need to declare that, in the West, where few of us work ourselves to the bone, we have ease enough. In societies where most of us need storage lockers more than we need nanotech miracle boxes, we need to declare that we have enough stuff. Enough intelligence. Enough capability. Enough.

I think McKibben has it right. Although the stakes may be higher because the consequences are more profound, the current crop of what McKibben calls "technoprophets" are nothing new. They're simply the most recent version of people who've had a pseudo-religious conversion. Although most of them would vehemently deny that they were anything other than strictly secular, these people share a religious faith in the power of technology to solve all of our problems.

Rather than confront the problems generated by our behavior and its consequences, these technoprophets seek to transcend the difficult question of "how should I live?" with technological solutions that make it all a moot point.

Confronted with a consumer society that ignores long-term consequences for short-term pleasures, the technoprophets mean to conjure the problem away with nanoassemblers which, they promise, will eliminate the dilemma. We'll be able to consume as much as we want with no waste. Voila, problem solved.

Confronted with the problems of uncertainty about our children's futures, and the difficult parenting choices that this entails, the technoprophets propose to give parents the ability to select genetic upgrades for their kids, ensuring that they'll be smart, athletic, and happy. Voila, problem solved.

McKibben reminds us of the story of King Midas, whose wish that everything he touched would turn to gold was granted. The poor bastard suffered. And so will we, McKibben argues, when germline engineering gives a kid the ability to run fast but causes him to question whether it's really him that's doing the running, or some company's running-gene that his parents picked out of the catalog.

This faith in the magic of technology is analogous to the faith in the magic of the free market. Both of these pseudo-religious cults are so attractive because they relieve us of the burdens of facing the consequences of our actions. Just as technology conjures away tough choices, the belief in the free market as a failsafe mechanism for allocating goods relieves us of confronting the distribution of wealth in our society and asking the tough question: is this just? The free-marketeer can replace this tough question with an easy one: is this a result of market mechanisms? The moral weight of the question drains away in one easy step, leaving the free-marketeer carefree, light-hearted, and untroubled.

Needless to say, neither of these abnegations succeed. And thankfully, there are people like Bill McKibben around who will call our attention to these easy cop-outs and remind us that merely feeling good about our choices isn't enough.

December 27, 2003

"Many are sick, and have no insurance. Can the free market give it to them, Frodo?"

Dr. Chris Rangel and I (among others) have been going back and forth about single-payer national health insurance.

Dr. Rangel's latest post, while failing to quote any characters from The Lord of the Rings, nevertheless deserves a response. Especially because among its many accurate and perceptive observations are scattered misleading and conclusory statements purporting to locate the solution to our health-insurance woes in the free market.

I believe the free market is inherently incapable of achieving a goal which virtually everyone agrees is a worthy one: covering every American citizen.

Let's start with a treatment that ought to be near and dear to our fatty-plaque plagued hearts: automatic implantable defibrillators.

"Despite what Carey claims, you don't have to be "rich" to get one of these devices."

What counts as "rich" is in the eye of the beholder. From the perspective of the typical Wal Mart-esque service industry employee (an increasingly common perspective among American citizens), having adequate health insurance is, like owning a yacht, increasingly an exclusive privilege of those much wealthier than themselves.

"You just have to have insurance. This is not the same as rationing. And his analogy comparing defibrillators to organ transplants typifies the scary mindset of most liberals when it comes to their approach to rationing in health care. Even if we take into account the extreme expense of transplantation the real reason that these are rationed is because there are simply not enough organs to go around! The last time I checked we didn't have any problems with manufacturing defibrillators nor any lack of physicians to implant them."

To the contrary, this is rationing of the worst kind. Unlike the case of organ transplantation, however, where we ration organs because of their limited availability, in the case of implanted defibrillators we ration them because of the limited opportunities to profit from their implantation.

Because Dr. Rangel is right that there is no shortage of defibrillators nor any lack of physicians to implant them, their differential availability based on the profit potential of implantation in this patient versus that patient is scandalous.

"Why the difference in the coverage of defibrillator indications between private insurance and Medicare? Private insurance companies have just as much incentive as Medicare to cut costs (to maximize profits) but unlike Medicare (or any government program) they have incentives to increase the amounts and kinds of care they will cover in order to make their product more attractive to consumers in a competitive market"

Again, Dr. Rangel misses the point. Only people who can afford insurance are "consumers" in the healthcare market. Private insurance firms have no incentive whatsoever to provide any care at all to "non-consumers," i.e., people who work low-wage jobs and can't afford private insurance. Medicare, in contrast, is directed to provide cost-efficient care to all qualifying American citizens, regardless of whether or not they've got the money to act as "consumers."

If Medicare chief Tom Scully made a mistake when he limited eligibility for implanted defibrillators, as Dr. Rangel suggests, it is only because he failed to consider that this treatment is medically effective and cost-efficient. Dr. Rangel is right that anyone could make this mistake, especially if he or she is under pressure to cut costs.

But this pressure to cut costs will not, contrary to Dr. Rangel's assertions, necessarily increase under a single-payer system. If everyone is covered, there will be greater pressure on the program to make medically-sound decisions as well as economically-sound ones, since everyone is medically as well as economically affected by the consequences of every coverage decision. Under our current system, every taxpayer is economically affected, but not everyone is medically affected. The rich opt out of the common system, and lobby only for reduction of costs, not for improvement of care.

"Because in a socialized single payer system the first treatments to get the ax are the newer, advanced, and expensive ones and it only goes downhill from there."

This isn't true, as Dr. Rangel's own source shows. According to that source, Medicare approved higher payments for drug-eluting stents before these devices received FDA approval. On the contrary, the first treatments to go under an effective single-payer system will be the overpriced ones with dubious or unproven medical benefits. Why? Because the whole nation will have a stake in what's covered, instead of only few special-interest groups and medical device manufacturers.

"You just have to have insurance."

"You just have to have insurance" to get an implanted defibrillator. That's true, and it sounds so simple until we remember that because of our current predilection for reflexively deferring to the private market, many people can't afford to just go out and get private insurance.

Now, profit is a good thing, like water is a good thing. But just like water, it's not good in every place, every time, or every quantity. Relying on profitability as a yardstick for making medical decisions makes about as much sense as relying on water in our gas tank to take us to Grandma's house for the holidays. Water is a great liquid, but it's just not the right liquid for every situation.

Anyone who pays any attention at all to the health-insurance debate knows about the incentives for private insurers to "cherry pick" the healthy and wealthy while avoiding the sick and the poor. The demands of profitability and the free market compel this behavior. And this compulsion only grows stronger when the competitive pressures in the market increase, as Dr. Rangel advocates.

Now, there's nothing intrinsically wrong with markets, and competition, and profit. Despite Dr. Rangel's frequent and wholly unwarranted intimations that supporters of a single-payer system are socialists or communists, most of us realize that a market system is indispensable for preserving our economic and personal freedoms. I like freedom and choice as much as Chris Rangel does.

But I don't like intellectual crutches, which is what the reflexive appeal to the free market as the magic bullet that will solve all of our problems has become. We need to realize that the capitalist traditions of America aren't as fragile as some right-wingers seem to think they are. We're not going to become a communist nation if we realize that, just as in the case of voting, there are some things that shouldn't be up for sale to the highest bidder, and out of reach for everyone else.

"A wise man once said, "Don't put all your eggs in one basket"!

That sounds right. I think, then, that I won't put all my eggs in the free-market basket, crossing my fingers that everything will magically work out in the end. Instead, I'll take a critical look at what the market can do well, and what it can't. Likewise, I'll take a close look at what the government can do well, and what it can't.

When it comes to basic healthcare, the past twenty years have shown that the free-market isn't going to solve our health insurance problems. If we want to extend basic healthcare to all citizens, which is a goal Dr. Rangel and I share, and which is laudable not only from the point of view of justice, but also from the point of view of public health, we'll need to try something else.

I believe that a single-payer system is the best solution. But it has to be done right. It cannot limit the ability of wealthy patients to order excessive MRIs for themselves if they want to, provided that their indulgence doesn't deprive others who need it of timely scans. It cannot merely subsidize drug companies, as the recent Medicare reforms do, without holding them accountable for the benefits of the publicly-funded research that covers the riskiest phases of new drug development.

There are potential alternatives to single-payer. But all of these, such as mandatory community rating for health insurers, also require the government to proactively ensure that everyone receives basic medical care, regardless of whether or not there's any profit in it.

As for Dr. Rangel's discussion of ED overcrowding, I'm fascinated, and I thank him for pointing out these studies. I'm persuaded that I ought to refer to the impact of the lack of health insurance on ED overuse. This assessment (pdf file) of ED utilization rates should be interesting for all of us, as it documents the increased reliance by the uninsured on the ED for their primary care needs.

December 25, 2003

Merry Christmas

In the spirit of the holidays, let's say something about bovine spongiform encephalopathy (BSE, aka Mad Cow Disease).

Imagine, if you will, a fantasy world. Imagine a world where people ate food which was produced locally, on small family farms. A world where communities of people were self-sufficient in agriculture. A world where people actually knew where their beef came from.

In such a world, Ann Veneman wouldn't need to tell us not to panic.

Happy Holidays!

December 24, 2003

Persuasive (and depressing) analysis

Mark Schmitt of The Decembrist considers what kind of a President George W. Bush really is.

Though Schmitt makes a good case for labeling Bush a "Nixonian Liberal," the post reinforces my own preferred label: a terrible, rotten, no-good, miserably bad President.

A President who, for reasons Schmitt describes, may end up having his cake and eating it, too.

December 23, 2003

Politics and The Lord of the Rings

Of all the reviews of The Lord of the Rings that I've had the pleasure of reading, none seem so shallow as those which presume to appropriate Tolkien as a spokesman for the reviewer's preferred political ideology. Or, conversely, as an exemplar of the reviewer's most despised ideology:

Can one judge a film with the morals of politics? Is Lord of the Rings seen differently in the United States than it is in Europe where the majority of people were against the invasions of Afghanistan and Iraq? A fable is “a narration intended to enforce a useful truth.” When I look at the Lord of the Rings as the fable its author, J.R.R. Tolkien, intended it to be, I see a world clearly divided into races and regions of leader and followers, I see Calvinist pre-determinism and I see the vindication and veneration of empire unfolding in frame after frame. And I feel the quick burn of shame that I always feel when realising that as a child I was taken in by a “useful truth” that now seems odious.

I've read enough of these futile efforts by now that the method is numbingly predictable.

If the reviewer is a fan of Tolkien, she will scan the story and pick out a few elements that she claims are decisive endorsements of her own conservative view of evil (or of her liberal critique of power, or of her Catholic view of immortality, or of her environmentalist love of nature). If, however, she happens not to like Tolkien, the story will inevitably be found to endorse racism, feudalism, empire, class oppression, or heretical paganism.

Perhaps the best evidence that The Lord of the Rings is too great a work for these shallow partisan appropriations is that all of these reviews can sound entirely plausible when read in isolation. The leftist counterculturalists of the 60's who decorated subway station walls with "Frodo Lives" had reason to fall in love with this story, as do today's conservative supporters of the Bush Administration's war in Iraq. If you happen not to like the story, you can plausibly claim with some sad leftists that it "stinks like an orc" or with some pitiable Christian fundamentalists that it tempts young people with witchcraft.

My criticism of these narrow political interpretations of Tolkien is not that they're all wrong. Rather, it is that they predictably fail to consider that they're all, in some sense, right. The mistake they all seem to make is the same. They claim that this is a great story because of (fill in the preferred political interpretation here), or that it's a failure because of (fill in the despised political interpretation here). None of them acknowledge the persuasiveness of the competing interpretations, or even their obvious popularity.

And is precisely why The Lord of the Rings is great literature. This is why it is one of the greatest works of the twentieth century, and this explains why people will still be reading this book in another hundred (or more) years. Whether or not the story appeals to your aesthetic tastes, it is by now undeniable that it has the power to engage, provoke, and inspire virtually everyone. People who love it, love it deeply. People who don't like it often strongly despise it. The only reviewers who are clearly wrong are those who continue to dismiss it as insubstantial, as merely a tale for adolescents, or as a passing fad which will soon be forgotten.

December 20, 2003

Who's to blame for Colorado's "woefully inadequate" law building?

By now many of us know that the ABA thinks the Fleming Law Building at the University of Colorado is "woefully inadequate." (Via en banc.)

School officials are blaming the lack of state funding, for lack of anything better to blame, I suppose. It is true that the current budget crisis prevents the state from bailing out the law school. There's just no money there.

But what I'd like to know is, did the school fail to plan for this? Budget crises can be counted on from time to time, and a state school can't reliably predict that there will always be money available from the state. Especially not a state school in Colorado, whose legislature doesn't seem to enjoy funding higher education.

Why hasn't Fleming been adequately maintained and updated? Surely this is much cheaper than an entirely new building. Who's decision was this?

Somebody, somewhere, probably dropped the ball. It probably wasn't the current Dean, David Getches. He hasn't been there long enough.

Was it the former Dean, Harold Bruff? It's hard to say. There are some postive-sounding surveys on Bruff floating around, but surveys can be woefully inadequate themselves sometimes.

What about the students? Where are they? Are they upset? Happy? Do they care? So far I haven't seen much comment on this issue from Colorado law students. If the building is really so inadequate, you'd think the students would be more upset.

Why hasn't the media looked into these questions? This would be a great piece for any student journalists at Colorado who wanted to scoop the bland, insipid reporting that's plagued this story.

Here are some articles addressing the tuition hikes solution to the funding shortfall; here's a discussion of the ABA's other concerns about the school.

Trail running

One of the things I'm going to do over the winter break is go trail running.

Why do I like trail running so much? It's hard to say. For one thing, it's perhaps the most meditative thing I do. It's also the most spiritual. You know how other people go to church?

Well, I don't go to church. I go trail running, in places like this.

Beautiful sky

Living in Colorado, it's easy to take the sky for granted. After all, it's just the sky, and you see it every day.

But after spending some time in the Midwest, when you arrive back in Colorado the beauty of the sky just hits you. The blue, the clouds, the sunset. Especially in winter. Everything seems so austere and dry and clean and stunningly beautiful.

I think I like it here. The suburbs and the traffic are just as bad as everywhere else, but the weather, the mountains, the dry air...

Mmmmm......

December 19, 2003

Single-payer opponent Rangel quotes Sam Gamgee

Anyone who can manage to quote Sam Gamgee in a post about single-payer health insurance is certainly deserving of a response.

But rather than "nit-pick every detail and nuance" of Chris Rangel's most recent attack on the idea of a single-payer system, I'll stick to rebutting the general themes.

First, there is a lot that Dr. Rangel and I agree on. Most importantly, I think we agree that it would be easy to design a system of universal health insurance that would be a disaster. I, like Chris Rangel, have little faith in bureaucrats.

The question, though, is not whether or not our health system will suffer the indignities of lazy, self-important functionaries. They will plague us under a public single-payer system and under any version of our current private/public compromise system. The advantage of a national system, at least from the perspective of total health-care spending nationwide, is that the current duplication of bureaucratic functions would be unnecessary under single-payer. A physician who sees a patient in his office wouldn't have to wrestle with all the different forms he has to deal with now, and which sometimes require that he hire more office assistants just to deal with the paperwork.

Of course, if the system were designed poorly there might be more necessary paperwork, but the argument that mistakes are possible should not be dispositive.
At some point, we have to weigh the risks of trying something else with the continued harm of continuing along our current path. Perhaps Dr. Rangel and I simply disagree about where we should jump off our current health-care train.

Another general theme I'd like to emphasize is rationing. We both agree that rationing takes place under either system--it has to, since we don't have the resources to meet the demand. We disagree, perhaps, about whether rationing would be done better under single-payer than it's done now. Some thoughts:

First, it seems odd to me that we have on one hand what seems like extravagant overspending and overuse, and on the other hand we have underavailability and underuse. Dr. Rangel points out the cases of possible extravagance very well, both in his original post and in his follow-up. But I don't feel that he acknowledges the extent of the opposite problem. One of the reasons that people seem to "love" their ERs is acknowledged by Dr. Rangel--the ER is overcrowded with "people without insurance as their only point of access to health care, [and] up to a third of these visits are unnecessary or inappropriate for what the ER was intended to be."

One of the strongest arguments for single-payer national health insurance is that it would relieve the burden on our nation's ERs. Patients with access to a primary-care physician who has seen them before and knows something of their medical history don't choose to go to an impersonal ER and wait for hours to be seen by an overworked doctor who is primarily interested in turning over the bed to make room for a sicker patient. Although ER nurses and docs are routinely abused by patients who act demanding and entitled, I believe it's short-sighted to simply say "that's how indigent ER patients 'are.'" Put yourself in their position. They're just as frustrated as we are. But they usually don't have blogs or other avenues for rationally airing their grievances, so they (unlike us) tend to take it out on the ER staff. Admirable behavior? Certainly not. But it is understandable.

Under a single-payer plan that gave these patients access to a more appropriate health-care arena, I don't think they'd "love" the ER as much as they do now, when it's their only option. The immediate effect would be a more rational and efficient use of health-care resources, even assuming no changes in overall spending. This would be better for all of us, whether we're indigent or not.

Dr. Rangel is also correct that health care spending doesn't correlate perfectly with measures of public health such as life-expectancy and infant mortality. I specifically do not mean to imply that we should reduce spending for Medicare and Medicaid; contrary to the implication in Dr. Rangel's most recent post, I would advocate increased spending for measures within both programs that went to the heart of what does influence life-expectancy and infant mortality: preventive health care. Why? It's cheaper, for one thing. Presumably we can both agree that efficiency is a good thing. But the chances of significantly increasing spending on preventive care under our current system is much less than under a single-payer system.

A private insurance company does not have much incentive to pay for preventive care. Unless a given patient will be covered by the company long-term, the insurance company's incentives are merely to deny payment for medical treatment of whatever variety. That's why utilization review is so heavily favored by private insurance carriers. Especially if the coverage is provided through an employer, and the employee is likely to change jobs every five years or so, why should any given insurance firm pay to prevent the diabetes that may develop twenty years from now? From the firm's perspective, preventive care is mere expense that can never be recovered.

Under a single-payer plan, all this changes. A citizen, by virtue of being a citizen, is covered. The incentive is to prevent costly illness through the judicious use of preventive care, and to ensure that the patient's years of productive good-health are as long as possible. This incentive will have to be transmitted to the decision-makers in some way, of course. In a private system the incentives show up in pure profit, but public systems have equally effective ways of communicating incentives. Especially if the national system covers everyone, there will be very powerful lobbies which work to keep costs down by spending adequately on preventive care.

What about catastrophic care, and (arguably) esoteric care like implantable defibrillators? Here's where the nitty-gritty rationing has to happen. Under our current system, if you're rich, and you want one, you get a defibrillator. If you're not, you don't. This method of rationing is sensible to the extent that it takes the preferences of the rich into account (you don't have to have one), but it doesn't make much sense medically. Think of the rich patient who doesn't exercise and smokes too much. If he can pay, he'll get the defibrillator regardless of how much he tries to render it useless. Meanwhile, the guy who works hard at a low-paying job and tries to stay healthy, but needs the defibrillator because of a congenital defect, doesn't get it. That's how advanced treatment is rationed under our current system.

Under a single-payer system, we might try to divvy up the defibrillators like we divvy up the transplanted kidneys and livers now. Patients who could benefit from them medically would get them faster than patients who would benefit less.

Admittedly, some people will get nervous here. In America, we're much more comfortable with unjust results that arise from providential inequities in the distribution of wealth than we are with any result that arises from our affirmative efforts to make things fair. But the unjustness of the result is not less for our comfort level with it. So here I'll have to dig in my liberal heels and say that we can do better. The fear of communism is simply overblown. We manage to ration organs, and we can likewise ration implantable defibrillators.

I won't address here the question of drug costs and the pharmaceutical companies, since Dr. Rangel chose not to respond to my arguments about this subject. I think it's rational that the drug companies learn to live with the lower profits that a single-payer plan would likely impose. Today's drug companies are the poster children for a single-payer plan, and "the conservatives" haven't been able to show why this isn't the case. I don't expect them to do so, either, since the drug companies' position is indefensible.

December 17, 2003

Is Return of the King the perfect movie?

Thankfully, it's far from perfect. That's why I love it.

A perfect movie would wrap everything up in 2.5 hours, would give us a perfectly-timed climax that doesn't last too long, would emphasize the "main" characters while allowing each "supporting" character to step in at just the right time, would comment on just the right social concerns, with just the right degree of gravitas, and would be directed by Steven Spielberg or Ron Howard.

It would win Best Picture for the year, and would be approvingly referenced by all the movie literati and highbrow critics for years to come.

The Return of the King is too good for all of that. It's imperfect in all the ways that make a movie great. Its numerous failings are all inevitable consequences of its stunning successes. Can't fit that one into a tight little box; no sirree, Bob.

December 16, 2003

Seven stars and seven stones and one white tree

"A sweet fountain played there in the morning sun, and a sward of bright green lay about it; but in the midst, drooping over the pool, stood a dead tree, and the falling drops dripped sadly from its barren and broken branches back into the clear water." (RoTK, p. 27)

The White Tree of Gondor (and, ahem, me) waits for The Return of the King.

December 15, 2003

Political Map

Via The Decembrist, a new political map from the publisher of Commonwealth magazine:



As Mark Schmitt puts it: "Anyone can talk about red states, blue states and swing states, but it takes a lot of discipline, data, and insight to understand the United States in terms of 3000 counties and their voting patterns."

Plus, it's nice to see a map that recognizes the fundamental political similarities between eastern Oregon and eastern Colorado.

Helping us win the war

From Turquoise Waffle Irons:

"It's a good thing that this 'mother fucker' and this `cock sucker' are making sure the United States Congress is taking time to address the really important issues."

I promised: a response to RangelMD

Dr. Chris Rangel's criticism of the single-payer proposal advanced by Dr. Steffie Woolhandler and the Physicians' Working Group for Single-Payer National Health Insurance is thoughtful and a pleasure to read.

Unfortunately, it suffers from a misunderstanding of the reasons for our current health-care problems, and from a misunderstanding of Woolhandler's proposal.

These twin misunderstandings are rooted in an inaccurate conception of the "free market."

Although the health care industry does not entirely fit the economic model for a free market it does have enough elements of a free market system to make it vulnerable to unintended consequences of a single payer system.

Rangel surely has it right here; in fact, there is always a risk of unintended consequences whenever a society embarks on any reform effort. For example, in the early '90s, our nation attempted to solve the problem of skyrocketing healthcare costs by introducing market reforms intended to improve efficiency. HMOs, utilization review, investor-owned hospital chains, and similar market-based mechanisms would, we hoped, introduce the "discipline of the market" into the old fee-for-service system and lead to lower prices.

Unfortunately, there are often unintended consequences of increased privatization and reliance on market mechanisms. As Woolhandler et. al. point out, these efforts have largely failed. Quality of care in for-profit hospitals is often lower than in public or non-profit hospitals; patients are frustrated by the reluctance of HMO's to cover needed services; physicians resent being second-guessed by insurance bureaucrats, and the drug industry continues to market "me too" drugs while pricing many of their other products out of reach of many sick and elderly patients who need them. This behavior continues despite the fact that the drug industry continues to have the highest per-capita return on investment of any industry in America, all while paying the lowest taxes of any industry.

Given these facts, Dr. Rangel's comparison of Woolhandler to Karl Marx, and his equation of basic healthcare to a government-secured right to own a car, is no more than hyperbolic rhetoric, and is not helpful.


Rangel eventually moves on, fortunately, and addresses Woolhandler's proposals to reign in drug prices:

It costs a drug company potentially hundreds of millions of dollars to investigate hundreds of compounds through hundreds of clinical trials just to bring one product to market and hope that it pays off. What company is going to invest so much to develop a product that the government ultimately won't pay for or won't pay enough in order for the company to cover the development costs and make a profit?

Despite Dr. Rangel's perceptive critiques of the drug industry elsewhere on his blog, this language could easily have been cut-and-pasted from PhRMA's website. That Dr. Rangel would resort to these arguments so easily is itself persuasive evidence of the success of PhRMA's attempts to aggressively lobby the public and physicians, all in the name of the following fallacy: if we can't reap outrageous, absurd, and unjustified profits, then there will be no incentive for us to develop new drugs. "Profits merely in line with the average industry profit in America? Nope, no new drugs."

The "free market" that Dr. Rangel continues to look to as the salvation of our health care system itself treats this argument of PhRMA's as complete and utter nonsense. Profit is profit. Woolhandler never proposes eliminating drug industry profits. Her proposal is for the national health service to "negotiate drug and equipment prices with manufacturers based on their costs, excluding marketing or lobbying." (JAMA 2003; 290:798-805 p. 801).

Despite the problems with Dr. Rangel's post, his descriptions of the problems with our current system are excellent:

- In America, no elderly person is supposed to die a "natural death". Even when they live in a nursing home with severe dementia at the age of 90 the second they develop shortness of breath we shove them into an ambulance, rush them to the ER, stick a tube down their throat, put them on a ventilator and spend tens of thousands of dollars on critical care for this patient as they linger in the ICU with multiple complications before ultimately dieing a month or two later (I have seen this more times than I care to count).

- Partly out of the fear of lawsuits and partly because the patient and their family expects it doctors inundate patients with a ton of radiologic scans, blood tests, biopsy’s, specialist consultations, and monitoring for even the most basic hospital admission.

- American patients expect a pill for every ailment and we do our best to accommodate them.

- Even if patients have spent years abusing and neglecting their own bodies they expect us to spare no expense when it comes time to treat their conditions when their abuse catches up with them.

- There are more MRI scanners in Washington state than there are in the entire nation of Canada and we perform almost 5 times more angioplasties per capita here in the U.S. than in Canada.

Dr. Rangel could, however, have gone further, and contrasted these examples of overtreatment with the fact that despite all this wasteful extravagance, America falls short of most of the rest of the developed world in such measures as infant mortality and life expectancy. Rangel criticizes Woolhandler's plan for it's assumption that a single-payer system would deliver the "same amount of care" as our current system. This is wrong. Woolhandler's plan recognizes that these disparities in the distribution of our heath-care resources are unjust, and suggests that her plan would change this. Presumably, it would help to decrease the wasteful spending Dr. Rangel criticizes and increase the resources currently unavailable to children and the poor, which Dr. Rangel barely mentions.

Many Americans complain about not getting what they pay for in medical care but then again most Americans have never experienced the kind of care that is the norm in countries with nationalized health care systems.

And what norm is that? Higher life expectancies? Lower rates of child mortality?

Rangel opines that the high usage of health care that Americans have become accustomed to (which Americans?) is the "single reason why a Woolhandler type nationalized health system would never fly politically in this country."

Actually, the single reason why Woolhandler's pragmatic and decent proposal won't fly is that physicians as intelligent as Dr. Rangel become irrationally apoplectic whenever the words "single-payer" or "Canada" are mentioned.

December 13, 2003

The case against single-payer

It's all laid out right here, folks, with the characteristic thoughtfulness and depth we seem to always get fromChris Rangel.

I disagree, of course, but counterposting must wait. Sleep calls.

Ten things you didn't know about me

In the spirit of these other blogs, a list:


  1. I am not married.
  2. This does not bother me.
  3. Despite all the flak I take for it, I still like hockey.
  4. For three summers, I worked at this pizza place in Alaska.
  5. I was born in Colorado Springs, Colorado.
  6. I spent time in high school in Agujitas, Costa Rica, on the Bajia Drake.
  7. When I was a kid, my favorite sci-fi TV show was Battlestar Galactica.
  8. Now, it's this.
  9. My totem animal.
  10. My nemeses.

December 12, 2003

Great blog. . . just great.

Just read this one entry (about drug-development costs) and I think you'll agree with me that this blog is fantastic.

Law and Medicine, v.2: in which strange practices are identified in both professions

The medical profession has its share of strange practices. In residency education, the most inexperienced and least knowledgeable doctors, the interns, are often the most sleep-deprived. These doctors (whose need to learn is the greatest) are often in the worst position to do it, physiologically speaking.

There are reasons for this practice, of course, although none of them seem very persuasive to me. Many of the most persuasive have nothing to do with medical education itself, but instead are economic (interns are the cheapest medical labor around) or anthropological (they've always done that way, and since doctors are mere humans, they are often irrationally resistant to change).

The good news is that the medical profession doesn't have a monopoly on strange practices. One strange practice that seems to afflict legal education is the overweening emphasis on a student's performance during the first year of law school. The stakes are highest right at the beginning, when most students still don't know what law school is really for, let alone know anything about the law itself. Nonetheless, first-year grades significantly determine whether a student will make law review, get the plum jobs, or be considered for a legal teaching position later in their career.

Several of my professors this semester have expressed their dismay at what typically happens to students after their first semester grades come back. Many students, having received disappointing grades, decide that there's no chance for them to succeed in law school at the level they had wanted, so what's the point of paying attention in class? They decide (not without reason) that the game is already over; that their Bs for the first semester make shooting for As during the second semester a fool's errand.

This behavior is properly criticized. It's true, as one of my professors pointed out, that these first three classes are just three out of 15-20 classes in law school. From the perspective of the whole law school record, it's irrational to put such great weight on first-year, or first-semester, grades.

Unfortunately, though, the "whole law school record" isn't what matters. Employers don't screen students based on the whole record; they focus mostly on first-year grades and what follows from first-year grades, like law review. While it may be true that students who succeed in the first year are obligated to continue this level of success, the students who struggle during first-year cannot readily "make up for it" by performing well in the second two years.

Does this make sense? If it's irrational for students to overemphasize the first year, is it irrational for schools and employers to do the same thing?

In one fairly obvious way, the answer is no. The system mostly works, in the sense that the students picked out for law review and for the plum jobs are often highly capable, and don't often disappoint. In other words, the system doesn't make many mistakes. Perhaps this is because of the inevitable oversupply of highly talented students for the very few coveted legal positions. There's simply too many students.

But if the system works from the point of view of the prestigious jobs, and the law reviews, and the clerkships, does it work from the point of view of the run-of-the-mill legal employers? One would think that if students were blowing off law school because of poor first-year grades, these students might not be qualified for most legal work.

I don't know what the truth is, but I suspect many students who've given a half-assed effort in law school are still perfectly capable of functioning as competent attorneys after they graduate. If this were not the case, I would expect the legal community to start raising a stink about the performance of law schools generally, which doesn't seem to be happening.

Sadly, I think one reason for this is that practicing law probably doesn't take as much formal education as getting a law license does. Those last two years of law school? Expendable. Go out and pick up a cocaine habit, or start gambling. It doesn't really matter, so long as you get your sheepskin to satisfy the state bar bureaucrats.

But if law school isn't necessary for the majority of students, why does it continue to persist without significant change? One reason might be that law school is necessary for a minority of students, namely, those that did well during first semester and who therefore didn't decide to give up and coast. Remember, some jobs are prestigious because they're very demanding, and can only be adequately performed by students who've stretched themselves to their limits in law school.

Another reason might be that law schools are fantastic generators of cash. Students are willing to take on huge debts to attend law school, in part because they realize that lawyers can get obscenely rich. So if the students are willing to pay, why should the schools cut their curricula back to one or two years? All that cash is nice. Law professors, although they don't make anywhere near as much money as the big-firm partners, are among the highest-paid academics; they certainly wouldn't want to be paid like the typical humanities professor.

Given all of this, much of which is raw speculation on my part, we should come back to the law student at the very beginning of law school. This student will either do really well first-semester, in which case all options are still open, or he will not do as well as he wanted to, in which case he has a choice to make. Continue to work hard (and maybe make things a little more interesting for professors teaching the upperclass courses), or sit back, coast, and pick up the diploma before heading off to a routine law job.

Given the (perhaps irrational) emphasis on the very earliest grades, I can't blame someone who chooses to slack off, even if it does disappoint the professors. But I have to believe that a student who is really interested in law, and who recognizes that excellence is in some sense always rewarded where it is found, should continue to learn as much as possible, struggle to perfect their skills, and zealously pursue their interests.

Just because their colleagues have a rational basis for letting up on the gas is no reason that everyone ought to do so.

December 11, 2003

An 'A' from Cato means children lose

A few months ago, George Will was crowing about Bill Owens, the governor of Colorado. Owens is beloved of conservatives, winning praise from the likes of the National Review and the Cato Institute. Along with Jeb Bush of Florida, Owens is one of only two governors to recieve an 'A' grade from Cato.

But while conservatives are crowing about how well Owens plays the game of competitive federalism and how well "Governor Asphalt" takes care of the state's business community, the state's children are paying the price: dead last in childhood immunization rates, down from a less-than-impressive 35th out of all the states a few years ago; the nation's most restrictive pediatric public health insurance programs; one of only six states that require asset testing for children enrolling in its Medicaid-funded health plan.

If this is what a governor needs to do to earn an 'A' from Cato, I wish Colorado would elect a 'C' candidate next time around. We might not get as much of George Will's attention, but more of our children would be vaccinated.

December 10, 2003

Supporters of the Patriot Act miss the point

Professor Bainbridge links to an Opinion Journal (subscription req'd) article by John Yoo and Eric Posner defending the Patriot Act.

Americans have never been eager to trust their government, yet Posner and Yoo ask us to accept the Patriot Act in part because we cannot point to any abuses of these new powers by Bush Administration officials. Even if they are correct when they suggest that the Act hasn't been abused yet, they sidestep the point of the most powerful criticism of the Act. Our civil liberties require protection more powerful than the simple goodwill of governmental officials who "choose" not to abuse their power.

This idea is not new. It is responsible for our tripartite system of government with its separation of powers and system of checks and balances. In that sense, it's the oldest and most familiar idea in America.

But it's hard to grant Posner and Yoo the benefit of the doubt. An absence of evidence, we may remind ourselves, is not evidence of absence. Here, though, we do have some evidence that the evidence (if any) is being kept secret in the name of national security.

The Patriot Act expands the ability of federal agencies to use National Security Letters (NSLs), which allow the government access to bank records and other documents without first obtaining consent from a judge, as is required for a normal subpoena. The targets of these NSLs are prohibited from revealing the existence of the NSL to anyone, including the individual whose records were obtained.

This raises the common-sense question: how can we tell if the government is abusing its powers under the Patriot act, if we can't even tell when the government is using these powers?

When civil liberties groups used the Freedom of Information Act to try to find out how many times the FBI has used these NSLs, the FBI provided a six-page blacked-out list (pdf file) with some numbers handwritten in the margins. If individuals can't know when the FBI is using its Patriot Act powers, and neither can civil-liberties groups, who can? Along with the blacked-out list, the FBI provided a memo urging its field offices to keep NSL use to a minimum for fear that Congress might allow the Act to expire under its sunset provision. So I suppose we can assume that at least one Congressional committee will be able to monitor the FBI's use of Patriot Act powers.

Is this adequate? Reasonable people will certainly disagree, but it's no surprise that many citizens aren't as prepared as Yoo or Posner to say "yes." One of the reasons is certainly that many of us just don't trust George W. Bush.

This is the same President who chose to lock up Reagan's presidential papers to keep them away from public scrutiny (and this was before September 11).

This is the same President whose Vice-President insists on keeping secret not merely the advice, but even the names of which fat-cats advised him on the Energy Policy Task Force, all in the name of "privilege" (and this was before September 11).

This is the same President who fought requests to make the findings of the 9-11 commission public.

And, of course, this the same President who likely lied about the threat from Iraq.

Posner and Yoo might wish we would all just trust the Administration, but they shouldn't be surprised if we'd rather not.

December 09, 2003

Sauron makes a contract?

For those studying Contracts (or the Lord of the Rings), this.

December 08, 2003

Professional ethics?

From a post on Ciceronian Review:

When, approximately would an American lawyer of the first half of the nineteenth century be on notice that the moral horror [of slavery] had grown sufficiently to raise questions of professional duty?

This seems like a very interesting blog; there's also an interesting discussion of the senate confirmation process for judges.

Who says nobody loves you?

To all of you studying Civil Procedure, remember:

Glorfindel loves you!

Move for a 12(b)(6) dismissal?

This goes out to all my homies in Civil Procedure.

Strict Liability, or First Bite Free?

This goes out to all my homies in Torts.

Happy incidents of the federal system

This goes out to all my homies in Constitutional Law.

Buying influence

From DB's Medical Rants, information and commentary on Big Pharma's influence on medical research:

Being a paid consultant has the veneer of appropriateness and respectability. The researchers easily delude themselves that as scientists they are immune from influence. Unfortunately, this naivety allows them to unknowingly make mistakes.

They justify their actions as necessary to support their overall research. They truly mean well. However, much like Dr. Faustus they are selling their souls. This is the dirty secret of much medical research.

We need a new ethical standard. We need to understand why we engage in this dance. We need to stop.

Unfortunately, I think we'll have to make them stop. The siren song of $$ is, again, proving resistant to wholly voluntary "ethical standards."

Selling organs

A test case for one's willingness to place their faith in the market:

Prosecutors in Durban have arraigned a South African man on charges of selling human body parts in a trans-Atlantic organ peddling scheme. . .

According to the police in Brazil, the ring canvassed poor neighborhoods for people willing to sell one of their kidneys. Those who agreed were flown to South Africa, where the transplants were performed.

Free choice, exploitation, or some mixture of both?

December 07, 2003

It's made out of people!

Via NathanNewman.org

Introducing. . .

Jessica Wilson, assistant professor of philosophy at Michigan and supporter of Howard Dean:

The purpose of this blog is to keep a record of the often disturbing, and occasionally heartening, information I come across in the course of my fairly frequent news-surfing. My current focus, news-wise, is on keeping track of the Bush administration's violations of Constitutional law at home and international law abroad (especially in Iraq), as well as lesser atrocities perpetrated (and gaffes committed) by the administration. Relatedly, I'm paying close attention to the upcoming presidential election, especially concerning how Howard Dean, my preferred candidate, is doing.

Single-payer


Thanks to Alas, a blog.

December 06, 2003

Unprecedented!

I'm going to try something unprecedented among law student bloggers.

I will not blog about final exams.

I know, I know. The audacity! The perspicacity!

The sheer overwhelming obstinacy!

December 05, 2003

Law professors say (and blog) strange things. . .

I'm so thrilled to be a 1L. Why? Because I'm likely to learn a lot in the next few years. Like, for example, how to argue against the idea of "competitive federalism" described by one of my favorite bloggers, ProfessorBainbridge.

I am an unabashed proponent of competitive federalism – i.e., the idea that having corporate law regulated at the state level promotes competition between states seeking to attract corporations to incorporate in their state, which competition tends to lead to efficient legal rules.

(Note to self: must ask how, exactly, "efficient" legal rules differ from "insufficient" legal rules, or "inadequate" legal rules. . .)

Apparently, the idea is that, since states collect franchise taxes from companies that incorporate in their state, they have an incentive to water down their regulations in order to attract more corporations and increase tax revenue:

The basic idea behind competitive federalism is that both efficiency and liberty are promoted when jurisdictions compete for the opportunity to regulate you. . . Corporations pay franchise taxes to the state that incorporated them. The more corporations a state incorporates, the more the state earns in franchise taxes. . . As I have explained before, this competition leads to a race to the top in drafting corporate law rules. Rational investors will not pay as much for securities of firms incorporated in states that do not protect investor interests. As a result, those firms' cost of capital will rise, which gives corporate managers an incentive to incorporate in a state offering rules preferred by investors. Accordingly, competition for corporate charters leads states to adopt efficient corporate laws so as to attract incorporations.

(Note to self: must ask how (or even if) it follows that society benefits when "investor interests" are protected--at the expense of, say, children's interests, retirees' interests, law-student interests, worker interests, and citizen interests generally. Or are these "interests" presumed never to conflict?)

Yes, it's great to be in law school. Soon, I'll understand "competitive federalism" and maybe I'll even like it.

(Note to self: must also remember to ask why we need "competition" to achieve these ends. Aren't investors also voting citizens? Can they not protect their interests at the ballot box, without relying on this so-called "race to the top?" Must ask if there was not maybe a typo. "Top?" Top of what?)

When firms may freely select among multiple competing regulators, oppressive regulation becomes impractical. If one regulator overreaches, as noted above, firms will exit its jurisdiction and move to one that is more laissez-faire. In contrast, when a single regulator can reach all firms, such that exit by the regulated is no longer an option, the essential check on excessive regulation provided by competitive federalism is lost.

Further note: is the assumption that, absent the "check" on "excessive regulation" provided by "competitive federalism," a state government will tend to "excessively regulate?" If this is so, why? Could it be that the normal democratic process will tend to choose regulatory schemes that, in the opinion of the citizens generally, is optimal, but in the opinion of "investors" is "excessive?"

Isn't this a powerful argument against competitive federalism?

Or have I missed something?

Joe Lieberman, sunk costs, Eomer of Rohan

In the course of describing Joe Lieberman as irrational for factoring sunk costs into his decisions, ProfessorBainbridge manages to quote Eomer from The Two Towers.

I simply must link to this.

December 04, 2003

Harry Potter

Conservatives don't yet seem to know just what to make of Harry Potter, but they're working on it:

When fundamentalists look at Harry Potter, they see a seething Hieronymous Bosch painting, a grotesque and frightening world rife with sin and temptation and devilry. When Elshtain looks at Harry Potter, she sees a Norman Rockwell painting with a Bosch painting behind it, a world of peace and family and Sunday afternoon dinners, behind which, and sometimes perilously close, is a world of sin and destruction. These two views of Harry Potter mirror two fundamentally conservative views of the world.

I, unsurprisingly, prefer Michael Bronski's reading:

He argues that fundamentalists, who find the series subversive, are on to something: "The Harry Potter books are a threat . . . not because they romanticize witchcraft and wizardry, but because they are deeply subversive in their unremitting attacks on the received wisdom that being 'normal' is good, reasonable, or even healthy."

I would only add that their romanticization of witchcraft and wizardry also makes them great.

(Left-wing Harry Potter analysis is provided by The American Prospect, with a nice blog discussion of the article here.)

Even Virginia Postrel loves Buffy

Via Demon-Haunted Girl, an article demonstrating that the Buffy the Vampire Slayer tent is big enough for all of us--even extremists like Virginia Postrel.

December 03, 2003

Fascist Mormon threat

Tyranny, like fog, sometimes creeps in on little cat (Mormon) feet. I point you to Orson Scott Card's policy preferences vis-a-vis homosexuals (via Atrios):

When I was an undergraduate theatre student, I was aware, and not happily so, how pervasive was the reach of the underculture of homosexuality among my friends and acquaintances. . . I did learn that for most of them their highest allegiance was to their membership in the community that gave them access to sex.

According to Card, then, one objectionable thing about homosexuals is their "allegiance" to a community that "gives them access to sex." One might ask if that's all that this community provides, but let's look instead at the kind of "allegiance" Card thinks might be more appropriate:

One thing is certain: one cannot serve two masters. And when one's life is given over to one community that demands utter allegiance, it cannot be given to another. The LDS church is one such community. . .

It is for God to judge which individuals are tempted beyond their ability to bear or beyond their ability to resist. But it is the responsibility of the Church and the Saints never to lose sight of the goal of perfect obedience to laws designed for our happiness. (Emphasis mine)

To point out the painfully obvious, Card is attacking homosexuals for belonging to a community that "gives them access to sex," while describing his own community as "demand[ing] utter allegiance" and "perfect obedience."

I think Card's community is less defensible on its face. But let's go on:

The hypocrites of homosexuality are, of course, already preparing to answer these statements by accusing me of homophobia, gay-bashing, bigotry, intolerance; but nothing that I have said here -- and nothing that has been said by any of the prophets or any of the Church leaders who have dealt with this issue -- can be construed as advocating, encouraging, or even allowing harsh personal treatment of individuals who are unable to resist the temptation to have sexual relations with persons of the same sex.

That's a relief. No "harsh personal treatment" of homosexual people, says Card. How about harsh impersonal treatment instead?

Laws against homosexual behavior should remain on the books, not to be indiscriminately enforced against anyone who happens to be caught violating them, but to be used when necessary to send a clear message that those who flagrantly violate society's regulation of sexual behavior cannot be permitted to remain as acceptable, equal citizens within that society (emphasis mine).

Thanks, Mr. Card. [I can't resist the temptation to address Orson Scott directly, but this entry is, dear reader, still meant for you.] Thanks for not dealing out "harsh personal treatment." What are we supposed to do? Thank you for your mercy? Your restraint? You'll refrain from advocating violence against homosexuals by instead merely condemning them as "unacceptable?" No one needs your kind of mercy.

In fact, even outside the LDS community, it has become clearer and clearer to me, since writing this essay, that gay activism as a movement is no longer looking for civil rights, which by and large homosexuals already have. Rather they are seeking to enforce acceptance of their sexual liaisons as having equal validity with heterosexual marriages, to the point of having legal rights as spouses, the right to adopt children, and the right to insist that their behavior be taught to children in public schools as a completely acceptable "alternative lifestyle."

Mr. Card, you appear to have misunderstood the meaning of civil rights. One of the most important of the civil rights is equality, and perhaps the most important sort of equality is the the equality of opportunity to lead a rich, satisfying, and meaningful life. You, of all people, recognize the importance of marriage for a meaningful life. Homosexual people recognize this too. Your conclusion that homosexuals "cannot be permitted to remain as acceptable, equal citizens within that society" is incompatible with the preservation of their civil rights.

Mr. Card, your essay seems at some points to be addressing the role of homosexuals within the Mormon Church. That is, of course, the Mormon Church's business. But the ease with which you seem to elide the distinction between the Mormon Church and "society," between the Mormon Church and "America" is troublesome.

[T]he Church has no room for those who, instead of repenting of homosexuality, wish it to become an acceptable behavior in the society of the Saints. . .

This applies also to the polity, the citizens at large. Laws against homosexual behavior should remain on the books. . .

Was this just sloppy writing? Or sloppy thinking? Or is it more than this? Are you willing to explicitly claim for the Mormon Church the privilege of governing America?

If that's what you advocate, rest assured that I will never tolerate it. I never signed on to your community of "perfect obedience." You, and the Mormon Church, will never govern America, and you will never govern me.

This much I promise you.

How to sell out without really noticing

All of the 1Ls here have (already) gotten a big white envelope from a Biglaw firm.

Quoting from the colorful catalogue inside:

[This Biglaw firm] is committed to providing a full range of services to the health care industry, including lifesciences companies, pharmaceutical manufacturers, managed health care organizations, hospitals, assisted living facilities and health care insurers. . .

While there is a clear need for attorneys to provide these "services," let me be clear: I do not aspire to serve these entities in any way as long as they continue their current practices. All of these entities are valuable participants in any health-care system, but anyone who would build a career of serving their legal needs as they now stand does not share my vision of what our nation's health infrastructure should look like, work like, or be like.

Fortunately for them, and for the Biglaw firm, there are plenty of 1Ls who disagree with me, and do so for thoughtful and respectable reasons.

But I'm afraid that too many 1Ls haven't given it any thought. Not knowing what they stand for, they'll look at the colorful brochure and gloss over the text and think, passively, "that sounds good. It sounds like a job I could be proud of. I'd be doing something 'important.' Somehow. And, wow, I can make a LOT of money!!"

If, later, they should give the matter some thought, and should decide that that's not what they stand for, I hope they'll think it's easy to give up the job and walk away from the money. Sadly, some of them won't find it so easy. They'll think they "need" the money. Their spouse needs the money. Or their kids need the money. Either way, they'll get up every day feeling trapped by a job they want no part of.

I'm almost certainly making mistakes as I plan my career; but this is a mistake I'm trying hard not to make. Check back with me two years from now and I'll let you know how it's going. . .

I'm withdrawing.

Chris Geidner calls our attention to bar-passage rates in Michigan over at En Banc.

I'm putting in an application for transfer to Ave Maria. They're clearly superior.

As Aragorn has begun, so we must go on. . .

"We come now to the very brink, where hope and despair are akin. To waver is to fall. Let none now reject the counsels of Gandalf, whose long labours against Sauron come at last to their test. . ."

--Aragorn, RoTK, Ballantine Books edition, 65th printing, April 1981, p. 192.

And let none now reject the counsel to get tickets for the midnight showing of Return of the King. To waver is to allow all the tickets to be sold, and to be condemned to wait until a later showtime. . .

Great ER blog

My dad has alerted me to a great blog by an ER nurse. I've linked to SpankysPlace under "Medical Blogs."

Several hours go by. We’re still waiting for the x-ray read. The blind radiologist was on that night and it always took him forever to read an x-ray. Blind you say? Yes, legally blind, white cane and all. His wife would drive him to work everyday and he would walk in with his white cane in one hand and his giant magnifying glass in the other. I once watched him read an x-ray. He would start in one corner and systematically cover the entire x-ray. And he had never been sued.

(I would link to my dad's blog, but he doesn't have one. . .yet.)

December 02, 2003

Rural life, v.2

Here's another link to an NYT article on rural life over at En Banc, thanks to Jeremy Blachman.

rural life: desirable?

Would you choose to live in a place like Reydon, Oklahoma?

As the plows of depopulation and decay slice through the Plains, these are the people who remain. Many would never think of moving. Some are too old or unskilled to have a choice. Many families — like the Bartons, the Yowells, the Calverts and the Lippencotts in Reydon — have members who do go away, for the Army, maybe, or college, and then come back to build new generations.

Some aspects of this kind of life appeal to me. I admit, though, that even if you could find productive and satisfying work, rural life might somehow stifle your cultural and intellectual life. You'd be reduced to eating baked beans at the diner and talking about. . .sports? Hunting?

What if you had access to broadband internet?

While the Internet is changing the world economy, technology experts say, "large parts of rural America are losing out on jobs, economic development and civic participation" because of inadequate access to the Internet. Traversing vast expanses of remote and often rugged topography presents unique financial and technological barriers.

Perhaps, if it's true that our economy is shifting to a greater reliance on "information" and away from activities that require people to concentrate in one location, the trend toward the depopulation of our rural areas might be reversed. It might be possible to live in Reydon, Oklahoma and still find a diverse array of economic opportunities.

Here's to hope.

December 01, 2003

"Best of the trilogy"

The Return of the King has premiered in New Zealand.

Wellington's streets were jammed with 100,000 people standing 15-deep to fete the stars, including Liv Tyler, Ian McKellen, Orlando Bloom, Viggo Mortensen and Elijah Wood. . .

Jackson already has anointed "The Return of the King" as the best of the trilogy. It's also the longest, at 3 hours, 11 minutes. . .

This sends chills up my spine.

Judge Posner's Cat

Want to see a picture of Judge Richard Posner's cat, Dinah?

Of course you do. (Go to second page of pdf file.)

You'll then want to read this interview with Posner at How Appealing.