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December 31, 2004

No breaks from cat blogging!

Over the past week I've taken a much-needed break, and not just from blogging. I haven't read many blogs, and I haven't kept up with the newspapers. Instead, I've been reading some good books and going to church.

But today is Friday, and that means it's time for some good cat-blogging.

Here's Allie relaxing.

Here's Allie and me, last summer. We were probably reading blogs.

December 24, 2004

Friday cat blogging

This big cat's name is Chuck. Short for Charlene, 'cause she's a girl.

Chuck is as friendly and cooperative as Allie is feisty. Her paws are huge and her claws are sharp, but she's never scratched me or anyone else I know of even once. Which is a good thing, because she's big enough to tear your hand and arm to ribbons if she wanted to.

December 22, 2004

Traveling gripes

Why is it that every time I get on a plane, the person in front of me has to lean their seat back as far as possible for the entire flight?

I never lean my seat back on planes. Well, I suppose I might if I was on my way to Europe or Hawaii, but for a 2.5-hour flight to Denver from Chicago? Come on, people. If I can sit upright through a 4-hour health law exam, you can sit up straight on the plane.


December 20, 2004

Happy Holidays

Turquoise Waffle Irons passes along a nice little holiday greeting from Harlan Ellison.

No European hockey for Bertuzzi

Todd Bertuzzi, the Vancouver Canucks forward who was suspended by the NHL for much of last season, has now been barred from playing in Europe as well.

Bertuzzi sent Colorado Avalanche player Steve Moore to the hospital with a sucker punch from behind. Criminal charges have been lodged against Bertuzzi in Canada; his trial is scheduled for January.

December 19, 2004

"Safe" drugs

In a NYT article discussing the controversy over the drug industry's heavy marketing of COX-2 inhibitors like Vioxx and Celebrex, we read the following:

But the rapid rise and now shaky future of [COX-2 inhibitors], some researchers say, is emblematic of the way drug companies' efforts to spur the use of costly new medicines can distort the medical realities of safety and effectiveness.
Is there such a thing as a "medical reality of safety"?

We often talk as if there is such a thing as a "safe" drug and an "unsafe" drug, and as if the FDA's job is to distinguish one from the other. But safety is like beauty--it's in the eye of the beholder. When I go on solo backpacking trips, it doesn't seem to me like I'm doing anything that's particularly dangerous. I suspect that my mom often disagrees with me. Who's right? Answering this question is like trying to figure out once and for all if Georgia O'Keefe's paintings are pretty or not.

There is really no such thing as an objectively "safe" medical treatment. The question we should be asking of the FDA is whether it is protecting the public in the way that we think is most appropriate. This means that critics and supporters of the FDA will have to make messy political arguments, because we will often disagree about what "appropriate" means. The crucial questions are who gets to decide whether a drug is safe, and what limitations we ought to place on efforts to influence that decision.

It's tempting to think that there's some sort of objective standard of "safety" to which we can appeal to short-circuit the political disagreement, but alas, there is no such standard. Anyone who tells you different is trying to sell you something.

December 17, 2004

A great environment

Three exams down, one more to go.

A conversation I remember from a few days ago reminded me how important it can be to have a encouraging and supportive group of people around you. If, say, you work in an organization where the people around you don't have a very high opinion of themselves, let alone you, it shouldn't be surprising if you don't perform as well as you would otherwise. Certainly you won't have as much fun.

Watching the Appendices from the extended edition of ROTK, I think it's clear that one of the reasons the film was so good was that the day-to-day working environment for everyone on the crew was fantastic. They got along, they had fun, and they believed in each other. Peter Jackson made an offhand comment one day about how nice it would be to have a dead mumakil on the set, and in three weeks the props crew had a huge dead mumakil all sprawled out on the set. I don't think a crew that wasn't confident and that wasn't having fun would have seized on an offhanded suggestion like that.

Things are never perfect, but surrounding yourself with energetic and supportive people will usually be more than good enough for government work.

December 14, 2004

ROTK (unabridged)

The last time I cried so much was when I finished reading the rabbit story.

That's how good it was.

(Small spoilers below.)

Just like in the first two extended editions, the extra material really lets the story breathe. For instance, the part where Sam starts crying on the stair above Minas Morgul, and Frodo tells him to go home, didn't make a whole lot of sense in the short version.

This time, it works. The crying scene itself is unchanged, but the few seconds of extra dialogue between Frodo, Sam, and Gollum that's sprinkled in much earlier makes this scene different.

Another bonus: remember that really ugly Orc with the strangely-shaped head that says "the age of men is over; the time of the Orc is at hand?" Well, we find out how he dies.

And I'm not telling. :)

December 13, 2004


What's on the schedule for Tuesday? Well, let's see...

Ah, yes. The Return of the King extended edition is released!

Looks like tomorrow's schedule is darned near full already...

December 12, 2004

Pavlov's dog = me

I'm like Pavlov's dog. Not because I'm furry and bark, but because I can't concentrate in the Starbucks when I hear the beeping of a two-way radio.

This morning I sat in the Starbucks for hours, studying patent law and antitrust, oblivious to all sounds--including the annoying giggling and even more annoying Michigan accents of the undergrads that surrounded me. Then I heard a faint "chirp CHIRP!" from a two-way radio or walkie-talkie phone somewhere.

The year I spent working on an ambulance has thoroughly conditioned me. My subconscious kept telling me "the dispatcher wants to talk to you! There's a code-3 [a call requiring a lights-and-sirens response] somewhere and the pagers aren't working! Lives are at stake! Your job is at stake!"

No wonder I couldn't concentrate. I've been Pavlovized.

December 11, 2004

Social Security privatization

Aaron Larson over at The Stopped Clock has a nice response to David Brooks' column in today's NYT. Brooks equates opposition to Bush's scheme to privatize Social Security with a generalized hostility to "the market." Larson sees through this:

So obviously I'm not one of Brooks' mythic people who opposes this faux "reform" because I am "instinctively" suspicious of the market. It is because I am sufficiently knowledgeable of the market, and of pork barrel politics, government budgeting and long-term financial projections, to be inherently skeptical of this type of "privatization".
I agree with Larson's perceptive list of reasons for rejecting privatization, except for his #1 and #2.

1. Some people will lose out, big time. Investing in the markets is a "zero sum game" - for everybody who makes a dollar, somebody else loses a dollar.

If markets succeed at allocating wealth to productive uses, then everyone could conceivably win. It's not necessarily a zero-sum game, but of course it is a game where some people could lose.

2. Nobody is going to manage these accounts 'for free'.

Well, that's technically true, but it isn't a sufficient reason to reject privatization. The reason fees are a problem is that they may be so high that investors don't realize the putative benefits of their investment, and/or that the prospect of such fees corrupts the decision to privatize Social Security. Larson identifies this last point, though, so this is just a minor quibble.

Wilderness for the wealthy?

I got a new NOLS catalog in the mail today. Something about the pictures in that thing make very happy. No matter what else I'm doing or where I am, the catalog reminds me that the world's a stunningly beautiful place. And fun. Cold and wet, too, but that only adds to the sense of adventure.

The NOLS catalog has gotten more luxurious. It's thick enough now to need a squared-off binding; and it's printed entirely on glossy magazine paper. When I took my last NOLS course in the late '90s, the catalog was folded over with staples and printed on lighter-weight paper. The tuition has gone up, too. The Yukon Backpacking course is just a hair under three thousand dollars. The Semester in the Rockies costs around $9500. The Semester in New Zealand? $11,136.

There are scholarships available for students who can't drop that kind of cash, but I'm sure they're not easy enough to get. Many non-wealthy people are probably lucky just to hear of NOLS. Most students probably begin their NOLS adventures with a trip to the career office at schools like Bowdoin or Pomona. I wonder how many of the seductive catalogs are readily available at the local community college? I hate to think that wilderness adventures should be a perquisite of wealth. The earth, you see, belongs to all of us, but sometimes it seems that you need to be a millionaire to see it in the rough.
EDIT: a reader phones in to point out that the Boy Scouts get people into the wilderness for a lot less money than NOLS does. Good point. But there are still differences: the Scouts are for kids. What's a 30-year-old of limited means to do?

December 10, 2004


Mark Schmitt over at the Decembrist posts a searching commentary on Peter Beinart's suggestions for the democratic party.

While Schmitt is a bit more sympathetic with Beinart's views than I am, he does put the smack-down on the idea that the Democrats should renounce Michael Moore, MoveOn.org, and everyone else who opposed the war in Afghanstan.

There exist true pacifists, Esperanto-speakers, and Level 5 vegans who won't eat anything that casts a shadow, as well as garden-variety infantile leftists. Is it my problem that they find the Democratic Party marginally more congenial to their views than the crazy-interventionist Republican Party?? Why is it my obligation to renounce them?
Read the whole thing. Meanwhile, I need to tear myself away from the blogs and study for my final exams(.)

[Oops. I was such a hurry I forgot the period...]
[So I'm compensating with ellipses.]

December 08, 2004

Real people and "medical error"

Maria at Intueri describes what it can be like to make one of those "medical errors" that the policy wonks keep talking about. At least we know that Maria's a real person and not a robot.

Speaking of robots, I wonder whether the Massachusetts Blue Cross/Blue Shield's decision to finance a new electronic medical record system portends a greater involvement by health insurers in the push for systemic reforms that might reduce medical mistakes. I suppose it will come down to whether the insurers believe that the reforms will lead to lower costs. Scratch that: if it will lead to lower costs for the insurers. We're talking about the health care industry, and that means cost-shifting first and foremost.

Al From or Howard Dean?

DLC leaders Al From and Bruce Reed describe where they'd like to take the Democrats in an op-ed piece in today's Wall Street Journal ($$ or 2004 WL-WSJ 98743742 if you have Westlaw). Coincidentally, former Vermont governor Howard Dean delivered a major speech today outlining his own vision for the party. It's easy to see after comparing these two statements that the Democrats have a real choice to make.

It is ironic if nothing else that From and Reed would announce their agenda on the opinion pages of the Wall Street Journal. Their solution to the electoral woes of the Democrats consists, predictably, of quickly moving to occupy the still-warm spot on the political spectrum so recently vacated by the Republicans, before that party made their most recent shift to the right.* This "DLC shuffle" has become such a frequent feature of our political experience that it's almost become a caricature--almost. According to From and Reed, the Democrats need to "come to terms with the main reason we lost the red states: too many Americans doubt whether Democrats will be tough enough in the war on terror."

If that's true, the solution would seem to be for the Democrats to find more effective ways of persuading people that fighting to preserve civil rights, and upholding the rule of law, is a grittier and more courageous response to terrorism than unilateral war in Iraq and authoritarian secrecy at home. Despite From and Reed's quite sensible suggestion that the Democrats "put the same muscle into persuasion that we put into turnout," these DLC mavens seem to have forgotten that "persuasion" can't be an end in itself. First, you must believe in what you're trying to persuade people of. The DLC and Bill Clinton have defined the Democrats as the party that stands for nothing. Their only ideal is the electoral strategy of "triangulation," where the Democrats win the Presidency at the expense of their principles. (NAFTA? DADT? "End welfare as we know it?" Pardon Marc Rich?)

The Republicans have courted their base and have persuaded the country from the strength of their convictions to follow them further and further to the right. Al From and Bruce Reed seem to miss the lesson. The only people they seem to dislike more than Republicans is their own base: "to be a grass-roots national party again, we have to realize that grass won't grow in the desert."

The Democrats would do better to listen to Howard Dean:

What I want to know is at what point did it become a radical notion to stand up for what we believe?

Over fifty years ago, Harry Truman said, "We are not going to get anywhere by trimming or appeasing. And we don't need to try it." Yet here we are still making the same mistakes.

Let me tell you something: there's only one thing Republican power brokers want more than for us to lurch to the left -- and that's for us to lurch to the right. What they fear most is that we may really begin fighting for what we believe -- the fiscally responsible, socially progressive values for which Democrats have always stood and fought. . . .

It is time for the Democratic Party to start framing the debate. We have to learn to punch our way off the ropes. We have to set the agenda.

Nothing could be more clear than that the Democrats will never "set the agenda" so long as people like Al From lead the party. He and his DLC brethren have overstayed their welcome; they should be politely escorted off the stage and into retirement as soon as possible. Perhaps they could bend their powers of persuasion toward getting the Wall Street Journal to offer them a regular columnist spot. Who knows. They'd do far less damage to the Democrats if their right-wing criticism came from outside the party.

The Democrats will not miss them. The party has a wealth of potential leaders, not least among them Howard Dean. Dean has a track record, you may remember, of setting the agenda. He championed universal health care in Vermont for years. He still champions it now. Dean was the only major Democratic candidate in the primaries to unambiguously oppose the war in Iraq. That's what it means to set the agenda. Dean is not the only person who can lead a rejuvenated Democratic party, but he is a good example of the kind of person the party badly needs at the helm. Al From and Bruce Reed may be great people, but they are not the kind of people who lead the Democrats out of the wilderness.

Before the Democrats can win back the country, they have to win back their party.

*Ignoring for the moment that Bush is far more radical than he is conservative.

December 07, 2004

Bad writing is not surprising

I stumbled across two discussions today that highlight two different kinds of horrifically bad writing. I think both kinds can be blamed on our modern consumer culture.

Brian Leiter's post cited a NYT article describing how corporations were spending billions to provide remedial writing instruction to their employees. Some of the examples in the article seem to implicate a basic illiteracy traceable to chronic instant messaging:

hI KATHY i am sending u the assignmnet again, i had sent you the assignment earlier but i didnt get a respond. If u get this assgnment could u please respond . thanking u for ur cooperation.
In addition to simple illiteracy, corporations are plagued with bad writing of a sort that seems a bit more insidious. PTDR links to a BBC article that provides a few good examples of "corporate gobbledygook." This kind of bad writing is probably due less to illiteracy and more to the corporate toleration (encouragement?) of hyperbole, obfuscation, and cliché:
The combination of Gerry Anderson's creativity and state-of-the-art high-definition animated production and production facilities, Sony's global strength in providing a one-stop global solution to develop Captain Scarlet product iterations across all media platforms, ability to define and launch a business management strategy leveraging Sony's market strength in each category and our ability at TriMedia to converge the film and music worlds independently with vertical and street marketing expertise will prove to be of great benefit for all involved.
In other words, "we've got a plan to sell a lot of shit and make a lot of money."

The Business Roundtable may complain about bad writing, but the business community may have brought it upon themselves. Both kinds of bad corporate writing--illiteracy and gobbledygook--may have a common source in our marketing-mad consumer culture. Illiteracy is encouraged when multiple advertisers ceaselessly compete for tiny fragments of our attention with soundbites and slogans. This environment might help to boost sales, but it also discourages the kind of sustained attention that is a prerequisite for the development of good writing skills.

Corporate gobbledygook is merely the other side of our society's dependence on advertising. Businesses of all kinds are constantly trying to sell themselves on the basis of hyperbolic slogans. Much of the English we're subjected to every day is the kind of bloated gobbledygook that is the meat-and-potatoes of business-to-consumer communication. It's no wonder that many of us can't help but imitate this style when we try to write something ourselves.

EDIT: My own bad writing is due entirely to that Jonathan Franzen novel I read a few years back.

December 06, 2004

Democratic foreign policy

To paraphrase Edward Abbey, when I hear the words "new liberalism," I reach for my .357. The kind of liberalism we need is the old one, the one that the Democrats have all but forgotten.

Howard Dean has announced that he'll be giving a major speech on Wednesday about the future of the Democratic party. I suspect, and hope, that Dean's recommendations will help to crystallize a foreign policy platform that's quite different from the "new liberal" approach embraced by Peter Beinart.

Beinart says:

On health care, gay rights, and the environment, there is a positive vision, articulated with passion. But there is little liberal passion to win the struggle against Al Qaeda--even though totalitarian Islam has killed thousands of Americans and aims to kill millions; and even though, if it gained power, its efforts to force every aspect of life into conformity with a barbaric interpretation of Islam would reign terror upon women, religious minorities, and anyone in the Muslim world with a thirst for modernity or freedom.
Beinart gets it exactly wrong on both foreign and domestic policy. Domestically, the liberals have done their best to sideline the few of them who have advanced a positive vision with passion. As for the struggle against al Qaeda, the liberals (sans Christopher Hitchens, if anyone still gives him that label) have been the only people who haven't forgotten that one of our most potent weapons against stateless terror groups is our "soft power."

As the terrorists are sending forth their suicide bombers and fomenting chaos, the most effective response the U.S. can make is to model the opposite kind of behavior, which most of us would call "civilized." This means abiding by the rule of law, using military force only when necessary and only against targets that cannot be dealt with better in any other way (such as, arguably, the Taliban regime in Afghanistan), and demonstrating what it means to be a responsible member of the international community.

(Julie Saltman's responses to Beinart here and here are both on-target.)

December 05, 2004


One of the really bad things about college and professional school as I've experienced it has been the way it's made staying in touch with friends so difficult. I've spent time with so many good people, but never, it seems, for very long. As soon as we become friends, we all seem to scatter to opposite ends of the country (or world).

I miss people. I miss the people I used to know as an undergrad at the University of Chicago, and whom I lost touch with when I transferred to Reed. You know who you are--you can't forget losing your keys at a North Side underage dance club on my 21st birthday (some of us were still under 21), driving like a madman on the grass of the midway at 3 am, and running all the way to from Hyde Park to McCormick Place and back. And you, you can't forget dragging me to the weight room in exchange for agreeing to go running with me on the midway, or rigging up our dorm room phone up so we could make free long-distance calls (even though we were all too honest to actually use the power).

I miss the people at NOLS--both courses! On the semester course where we sat around in the dark at Red Rocks outside Las Vegas, playing spades and listening to you screeching Nirvana lyrics over your earphones. Or when we were all freezing in 11 below zero on the Idaho/Wyoming border, digging quinzloos to stay warm and building elaborate kitchens out of snow. I miss the three of you that went off with me without instructors for three days on the North Rim of the Grand Canyon, back to the "Bit & Spur panel" with all the pictographs carved into the rock. I miss the people I hung out with after the course in the Noble Hotel, right before we all went our separate ways after three months where all we saw was each other--day after day!

I miss you folks from the leadership course in the Pacific Northwest, doing all that backcountry stuff but finding it hard to resist the call of Starbucks in Squamish, B.C. Some wilderness freaks we were!

I miss my friends from Alaska. Hanging out at the fire pit, back before they made the crew at Lynx wear dumb uniforms and got rid of the fire pit so that the tourists wouldn't be able to tell they were in Alaska and not Disney World. You remember that yahoo trip to the Brooks Range, where we left that bottle of Kahlua on the Dalton Highway at Atigun Pass? These pictures might jog your memory.)

At Reed, I remember taking little driving trips to Astoria and other places on the coast. I miss that. I miss playing poker in the basement. Rawls was sometimes mentioned, but usually we just goofed off and tried to win our hands.

I miss my friends from medical school, whom I never got to rotate with, but hey, control over our schedules the last two years was not something that any of us had much of. You in Colorado and Oregon and the West--I don't plan on losing touch. And you, out in Vermont, in Philadelphia, Ann Arbor (wow!), Nebraska, Virginia, etc. --sheesh, now you know why I tend to lose track of people. Write to me, you goofballs! Some of your programs don't list your email, and I can't find you on Google. The ball is in your court!

And I miss the gang from Tattered Cover -- that was a great year for me because I got to hang out with people like you. I'm talking about the bookstore folks: I don't think I had so much relaxed good times since Alaska. I'm also talking about the people from the coffee bar in LoDo. You know who you are, F.! You were witty and merciless, and I wish we'd had the chance to hang out more.

Now I'm in law school, and I'm fortunate enough to have made a lot of new friends. But I'm already feeling us peel apart again. We'll all be off to different parts of the country this summer; we're all busy with our own things during the year, and we don't hardly see enough of each other. That doesn't mean I don't appreciate you, though. I've been lucky enough to have done some cool things, but I've been even luckier to have done them all with great people.

December 04, 2004

New blog

Via a long and winding path that began with IrishLaw, I've found:

The dullest blog in the world.

Fortunately, I've also found Adam Wolfson's new blog. Now if only Larry would post more often, and Mark Ashton would submit to the inevitable (return to blogging), everything would be great.


As Ralph McInerny writes in his NYT op-ed about Notre Dame football: "The sad thing about the Willingham firing is that winning at all costs now seems paramount." One could say the same about the drug scandals in cycling, baseball, and track.

Winning is kind of a catch-22. Very often, the sweetest victories follow an effort that we remember as being somehow "all-out, whatever it takes." We speak of the "sacrifice" of other goals and pleasures that we make in order to grab victory by the throat, and not let go. "Cheap victories" somehow don't feel as good--the glory of winning depends upon the single-minded sacrifice that comes before.

On the other hand, we often say that winning "at all costs" somehow tarnishes the achievement. We recognize that victory can come at too high a price. Cheating may be one example--when the price of victory is playing the game differently, we're less eager to respect the "winner."

The drug scandals seem to be a kind of cheating. But what about Notre Dame football? McInerny points out that victory in big-time college football these days might require that the athletes be treated like highly-paid gladiators, that we give them every athletic advantage possible, but at the cost of dropping all expectations of them as students, or even as dignified citizens (something that schools like Colorado and Nebraska seem so willing to do when their players are accused of rape). This isn't the same kind of thing as "cheating" at football, but it still seems to tarnish the glory of victory.

Where is the right balance? How much sacrifice for the sake of winning is too much? How much is too little? Though this question might not be easy to answer, it's clear that winning isn't valuable in itself. The sweetness of victory depends crucially on how you play the game.

December 03, 2004

Magic words

In today's good news department, it seems the words "national security" haven't yet attained the shamanistic power to establish secret government whenever they are spoken.

The U.S. Army Court of Criminal Appeals has suspended a preliminary hearing for three soldiers charged with murdering an Iraqi general, and given the officer in charge of the hearing ten days to show why the non-classified portions of the hearing should not be open to the public.

Capt. Robert Ayers had taken the rare step of closing the entire hearing to the public on the grounds of "national security" and the risks of publicity to the defendants.

Legal analysts said it was extremely rare for a military preliminary hearing to be closed to the public, and appeals courts frown on such decisions. Media attorney Steve Zansberg had asked Ayers to close only portions of the hearing that could threaten national security.

"This is information the American people are profoundly and legitimately interested in knowing," he told Ayers on Thursday. He also said many details in the death have already been publicized.

It's Cat Time!

You might remember the little cat on the right; that's Gus. You met him last week.

The big cat on the left is Merlyn. He reminded me of a black panther. When we were introduced, I was told to "watch out for the big one; he's mean." Well, he was a formidable cat, and he wouldn't put up with any shit. But he wasn't mean at all! He loved to cuddle! It just took a while for him to get to know you, but after that, he'd be in your lap purring every chance he got.

December 02, 2004

private-sector obeisance

I'm no economist. To my layperson's mind, an article in this week's New England Journal of Medicine ($$) demonstrates how our nation's irrational fondness for the private sector can cloud our thinking and lead to obfuscatory doublespeak.

But I'm not an economist. Perhaps someone more well-versed in the subtleties of the dismal science can help me out. Seriously!

The article addresses the shortage of vaccines, both the episodic shortages exemplified by this season's flu vaccine debacle, as well as the more chronic shortages of childhood vaccines. The authors acknowledge that there are many reasons for vaccine shortages, but they emphasize the limited number of suppliers as the major target for reform efforts.

Although it is not obvious why a greater number of suppliers would necessarily result in fewer vaccine shortages (there is nothing beyond the bald assertion that this is so), the authors focus on reducing barriers to entry and increasing the incentives for private vaccine producers. They dredge up a 2003 Institute of Medicine report on financing vaccines, and they write:

An alternative that was proposed in the 2003 Institute of Medicine (IOM) report Financing Vaccines in the 21st Century attempts to find a balance that limits governmental intervention while ensuring market stability. The IOM report identified the large and growing government share of the vaccine market (55 percent of childhood vaccines) as a key disincentive for investment and market entry. It consequently recommended elimination of the Vaccines for Children program in order to remove the government from the business of directly purchasing vaccines. Because research and development are driven by anticipated profits, the IOM report recommended that the government subsidize the costs of vaccines to further stimulate private investment in the field [internal cites omitted].
I'm no economist, but this seems kind of goofy. Why would it make any difference whether the government is purchasing vaccines, or subsidizing the costs of producing them? Why couldn't the government merely increase the price it pays for vaccines, if what it wants is to encourage more private firms to enter the market? Either way, the government is providing money to private firms to produce vaccines, and the real issue is whether the government is providing enough.

My suspicion is that the major difference between "purchasing" and "subsidizing" is psychological. "Purchasing" carries connotations of direct government control of markets, and in this country, the idea is a major risk factor for anxiety disorders and interrupted sleep. "Subsidies," on the other hand, have that "public-private partnership" ring to them, which usually implies some scheme or another to privatize what the government is perfectly capable of doing on its own, as well as or better than the private sector.

The authors of the article are not blind to the indispensibility of government for any reasonable vaccine program:

Vaccines have strong spillover effects — for instance, since they prevent the spread of contagious diseases, they benefit those who are not vaccinated as well as those who are. Consequently, some people will avoid the cost and inconvenience of getting vaccinated and rely on others to maintain community protection. Such products tend to be underused unless the government promotes them. Thus, subsidization has a clear economic rationale.
Even so, this being America, any proposal for government subsidies has to tout its eminent reasonableness by simultaneously emphasizing its iron resolve to "remove government from the business of directly purchasing vaccines."

It all sounds pretty goofy to me. But hey, I'm no economist.

December 01, 2004

Return of the King

In just a few days we'll all get to see the richer, fuller, more true-to-the-story version of Return of the King.

Go here and follow the link!
Edit: I just won a small argument about Tom Bombadil's clothing. Blue jacket. Yellow boots. Ha!

Health care costs

"Everyone knows" that health care costs in America are out of control. I don't use scare quotes to suggest that this is incorrect, only to emphasize that it's a matter of common knowledge. If there's one thing everyone agrees on, it's that we're spending "too much" on health care.

Our nearly universal agreement that costs are too high provides opportunities for meaningful reform. Unfortunately, it can also tempt us to tolerate conditions that are unjust and harmful, simply because they can can plausibly be spun as cost-control measures.

For example, we continue to tolerate the immunity from state liability suits that HMOs enjoy under ERISA. Our collective concern for overall health care costs has repeatedly scuttled efforts in Congress to ensure that HMOs are held accountable for the decisions they make.

Because of the federal ERISA statute, an HMO that negligently denies care recommended by a patient's physician is often immune from state suits alleging malpractice, breach of good faith, and other claims. Even in cases where patients are able to successfully sue HMOs under ERISA, the remedies available are often woefully inadequate to compensate injured patients. We've encouraged HMO's to "manage care" by involving themselves in treatment decisions, hoping that this will lower costs. This might be a wise thing to do. We've also refused to hold HMOs accountable for the decisions they make, mostly because we fear cost increases. This decision may not be as wise.

Apart from the obvious problem that privilege without responsibility is generally a recipe for abuse, our toleration of HMO immunity under ERISA may burden physicians with lawsuits they would not otherwise have had to face. An injured patient may feel that the HMO bears some or all of the responsibility for a negligent treatment decision, but because of ERISA, most lawsuits against HMOs will go nowhere--especially if the decision results in a lesser quantity of medical care. In these situations, the physician and the hospital are the only viable targets for lawsuits. The docs end up in court, and the HMO gets off the hook. I don't have any empirical data on how often this happens, but it is a plausible scenario.

Our obsession with costs may also lead us to overlook the equally serious problems of lack of access to care and the rising number of uninsured Americans. For example, as we hype HSAs and defined contribution plans primarily because they promise to relieve the burden on employers to pay for their employee's health care coverage, we may not pay enough attention to what effect these cost-control measures will have on access to care.

My point is not that high overall health care costs aren't a problem, only that we ought to make sure that other serious problems that plague our health care system aren't overlooked.