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November 29, 2007

ER overcrowding

The public doesn't really care about the problem of ER overcrowding, right?

Well, maybe as a matter of public policy, Iraq and immigration have a firmer grip on the public's collective attention. But for people who have had to be a patient in an ER, and have had to wait for hours and hours to get a simple medical problem addressed, ER overcrowding is a big deal.

It's certainly a big deal for people who work in ERs. As a resident, I work in three very different ones, and I know that people often have to wait a long time before being seen -- unless they come in complaining of stabbing chest pain and have a blood pressure of 80/40. If you're not one of these lucky few, the typical ER experience is, "have a seat, I hope you brought some knitting with you to keep you entertained." My first job when they finally come back is to apologize for the long wait.

The reasons for overcrowding depend on whom you talk to. Some people say that it's because of the large and growing number of uninsured patients who can get care nowhere else. Some say, bullshit. Here's Michael Saloman, president of the California chapter of ACEP:

Crowding in the ER is actually a symptom of hospital crowding. There is a shortage of nurses and hospital beds in Modesto. Admitted patients are forced to wait on ER gurneys for hours because there is no place to put them upstairs. If all ER beds are occupied, then patients in the waiting room can't be seen. That is the reason ERs are crowded.

People, people! Let's not get hot under the collar. Just ask me, and I'll tell you that you're both right. Think about it: many of the ERs beds are occupied by admitted patients that can't go upstairs because there's no room to put them. This can effectively turn a 30-bed ER into one with ten or fewer beds. The rest of them are occupied by admitted patients, getting their q8 hour antibiotics and being forbidden to eat after midnight.

But let's be realistic: if all the people in the waiting room who need a med refill or have the flu, and who can't go see a doctor at a clinic because they don't have any insurance would get up and leave, the waiting room would be a lot emptier. Sure, these people are easily treated and released, but that doesn't mean that treating them takes no time, or that they don't need a private area where they can be seen and examined.

So what's the solution? Simple. First, build more hospital beds. Second, make sure everyone has health insurance and a nice, warm, conveniently-located clinic where they can see a doctor. Third, stop eating junk food (and don't wait for the FDA to regulate added salt in food). Fourth, get more exercise.

Like I said: simple.

November 28, 2007

Another reason not to be a republican

The NYT has an article about the differences between the Democratic and Republican candidates on energy policy:

For Democrats, the goal of energy policy is largely about reducing oil consumption and has become inseparable from the goal of reducing the risk of climate change.

For the Republican candidates, energy policy is primarily about producing more energy at home — more oil and gas drilling on the Outer Continental Shelf and in the Arctic National Wildlife Refuge; more use of American coal to produce liquid fuel; and, as with Democrats, more renewable fuels like ethanol.

By contrast, all of the Democratic candidates would repeal billions of dollars in tax breaks for oil companies, spend billions more each year to develop alternative fuels, and require cars and trucks to be far more fuel-efficient.


Republicans: icky, sicky, throw-up politicians.

November 26, 2007

We're not taking responsibility now. Don't make it worse.

If you have some time on your hands, read this post on Crooked Timber praising Michael Sandel's The Case Against Perfection.

Harry emphasizes Sandel's point that enhancement technologies might plausibly erode our understanding that many of our talents are gifted, and that this wouldn't be a good thing. Our talents and handicaps would become someone's responsibility, rather than something that we're just "given" by God or Fate.

Because we're failing to acknowledge the responsibilities we already have, I worry that giving us a whole new realm of things to be responsible for is a bad idea. It could further trivialize the importance of responsibility. It's hard enough to take proper responsibility for the effects of our technology now; adding new areas over which we're supposed to be responsible is likely to turn us off to the very idea of responsibility. We'd ask ourselves "how can anything that's so commonly observed in the breach be that important?"

The analogy is illegal marijuana, which erodes our respect for the effectiveness, and sometimes the wisdom, of law enforcement every time we smell the aroma of kine bud wafting over the walls of the neighborhood high school. The kids look like criminals, and the police look like idiots. The best solution seems to be to give up our silly and half-assed marijuana prohibition.

I'd hate to have us say the same thing about the idea of taking responsibility for our actions.

November 25, 2007

Just because you like China Miéville's books....

China Miéville is one of my favorite authors, but oh! His taste in other writers is atrocious.

I'm reading M. John Harrison's Viriconium, a collection of novels by a guy that Miéville says "is one of the very great writers alive today."

Well, I can't tell it from the stuff I've read so far. The first novel, The Pastel City, was pretty good, but A Storm of Wings was much too oblique, and In Viriconium committed the cardinal sin: it was boring.

Of course, I should have suspected Miéville and I wouldn't agree on other writers when he described JRR Tolkien as "a wen on the arse of fantasy."

Read this for more on Miéville and Tolkien.

Ron Paul's libertarian problem

A few supporters of congressman Ron Paul have discovered and responded to my posts about the libertarian presidential candidate. Since I linked to a popular DailyKos post suggesting that Paul was a racist, the least I can do is to point out two sources suggesting that he isn't -- see this and this.

If you're curious about Paul, read them all for yourself and make up your own mind.

Personally, I doubt that racism can fairly be attributed to Ron Paul.  I don't doubt that some of his supporters are racists -- Clinton and Obama and Giuliani almost certainly have their racist supporters, too -- but Paul seems like too much of a libertarian to be a racist himself.

However, racism is not my biggest problem with Ron Paul.  His libertarianism is.

Look, I don't disagree with libertarians that a large state can be dangerous.  It tries to monopolize the use of force, and its power is so great that it makes good sense to be afraid of it.  Yes, the state can never be compassionate, altruistic, or responsible in anything like the sense that an individual can be.  It's also true that an overly-large state can be an obstacle to responsible stewardship, because it substitutes an individual's direct control over some portion of his assets with a far less-direct political influence over how the state uses those assets that have been confiscated in taxes.

All of that, I get.  Libertarianism and agrarianism together have no use for an overweening, monstrous state.  (If they did, they'd be called "socialism" or "communism.")

But here is where I believe libertarianism and agrarianism part company: libertarianism picks out individual liberty from among the many human goods and holds it up as the preeminent end-in-itself.  Liberty trumps everything else.  Agrarianism holds that individual liberty must be balanced harmoniously with the health of the family, the community, and the place (or "the environment" if you prefer that term).  There is no trump; each conflict between human goods must be evaluated in the context of the particular circumstances applying at that time and place.

For libertarians, the only legitimate reason to constrain an individual's freedom of action is when that action hurts another person.  "Hurting another person" usually amounts to the same thing as reducing another person's freedom.  For the libertarian, this is the ultimate goal.  If there are pleasant side effects, then all the merrier for everyone, but the maximization of liberty is still the goal even if there are no pleasant side effects, or even if the side effects are unpleasant.

You can see this kind of thinking in Paul's response to his critics' charge that he's a racist:

The true antidote to racism is liberty. Liberty means having a limited, constitutional government devoted to the protection of individual rights rather than group claims. Liberty means free-market capitalism, which rewards individual achievement and competence, not skin color, gender, or ethnicity. In a free market, businesses that discriminate lose customers, goodwill, and valuable employees – while rational businesses flourish by choosing the most qualified employees and selling to all willing buyers.
I'm not a racist, argues Paul, because I'd never advocate using the power of the state to constrain an individual's freedom because of their race.  The true libertarian cannot be a racist because racial discrimination conflicts with the ultimate goal of maximizing freedom.

Paul also claims that there are pleasant side effects when individuals are given the maximum amount of freedom possible, namely that racism withers away in an environment where the free market "rewards individual achievement and competence, not skin color, gender, or ethnicity."  David Bernstein's comments on this view demonstrate how myopic it is.  Paul, like many other libertarians, cannot account for private racism because of his idealized and fictional view of how the market works unencumbered by the state.  Whether anything about libertarianism compels this fictional view of the market is an interesting question.  But that's not the point here.

The point is that even if you were to convince Paul that this pleasant side effect of free market economics won't pan out, this wouldn't be sufficient in itself to change Paul's opposition to any state-organized efforts to fight racism.  Because Paul is a libertarian, you'd have to convince him that that racism has limited people's liberty to a greater extent than it would be limited by government intervention.  Goal #1, liberty, must be maximized at all costs, even if those costs include the indignity of overt racism, or racism's destructive effects on the community, or its harm to the non-human environment (if any).

Ditto for any other government policy -- environmental, financial, military.  And ditto for any level of government. The libertarian doesn't care whether the constraints on an individual's liberty comes from the U.N. or the feds or the state or the town council.  All of these are "collectivist" and as such are a potential enemy of freedom.

In fact, from an agrarian perspective, libertarianism's fatal weakness is that it's an industrial, one-size-fits-all ideology.  It's "industrial" because it claims to be applicable universally, in every time and place.  When libertarians make universal claims for the primacy of individual freedom over other human goods, they're ignoring local variations of opinion and taste much the same way the neocons ignored these things when they argued for invading Iraq.

Agrarians should also reject libertarianism because it reduces the complex features of a good human life to just one of those factors: liberty.  This is analogous to the difference between agrarian agriculture and industrial agriculture, where the latter reduces a complex activity dependent on a keen awareness of local variation to just three things: phosphorus, nitrogen, and potassium.  The failings of this reductivist approach to agriculture are clearly described by Michael Pollan in his Omnivore's Dilemma, and are recognized by successful farmers who reject the industrial model, like Joel Salatin.

Sure, the government might be "too big" right now. But the libertarian's answer to this problem is akin to the guy with the arthritic knee who says to himself, "if one Tylenol is good for my knee, the whole bottle of pills ought to be really great."  That's the kind of guy that dies of liver failure.  We may be choking on bureaucracy, but the libertarian's enthusiasm for the opposite extreme ought to scare us a little.


November 21, 2007

Ron Paul: digging himself a hole

Ron Paul's campaign has released an official statement on racism.

It completely fails to remove the stench of naive blindness to "nativist" racism emanating from Paul's direction. Paul might not be a racist himself, but he seems incapable of recognizing it when it stares him in the face.

"Liberty! Liberty!" chirps Paul. But his understanding of the word seems to be limited and superficial, in the manner of most reflexive ideologues. Paul's solution to racism? Drum roll, please....

"Cut taxes!"

David Bernstein of the Volokh Conspiracy has the must-read commentary.

November 16, 2007

Off today

I have the day off today.

I suppose I need it. For some reason, the last two weeks have thrown my sleep/wake cycle into complete chaos. I don't know if it's day, or night. I don't want to exercise when I'm awake, and I can't fall asleep when I'm in bed. My apartment is a disaster. My dishes need washed and my laundry does too.

But you know what? I'm still so much happier now than I was last year at this time. Because any month in the ER is better than any month on call.

November 13, 2007

We can cath you

How do I explain what my job is like? I've found the perfect thing.

Via Symtym, this is the funniest thing I've seen in a long time. (That says a lot about my job....)

November 11, 2007

We're OK with this

The United States ranks near the bottom for infant survival rates among modernized nations. A Save the Children report last year placed the United States ahead of only Latvia, and tied with Hungary, Malta, Poland and Slovakia

The same report noted the United States had more neonatologists and newborn intensive care beds per person than Australia, Canada and the United Kingdom—but still had a higher rate of infant mortality than any of those nations.

Doctors and analysts blame broad disparities in access to health care among racial and income groups in the United States.

"Broad disparities in access to healthcare" is such vague, bloodless language. We'll never do anything about infant mortality until we start translating this policyspeak into something more inspiring but equally accurate: "In the U.S., a baby's access to healthcare is entrusted to a private insurance market where, to succeed, firms must successfully avoid covering babies who are sick, poor, or born to sick mothers."

This is where the fear of socialized medicine has gotten us.

November 10, 2007

Brian Leiter's moving.... to Chicago

The U of C Faculty Blog has the news, and Brian Leiter's blog has the details.

November 09, 2007

Why aren't you voting for Ron Paul?

For a while now I've been toying with the idea of writing a post about which major candidate for President ought to receive the "agrarian" vote.

As you know, I support Barack Obama.  But is Obama the most "agrarian" candidate?  After all, if you look at what other self-styled agrarians are saying, you'd probably want to ask me, "Why aren't you voting for Ron Paul?"

The few agrarians on the Web seem to lining up behind Paul. Daniel Larison, for example, doesn't claim that Paul is an agrarian, but supports him nonetheless in part because Paul adheres to a conservatism "that many of them [in the GOP] used to treat with respect less than ten years ago."  CrunchyCon Rod Dreher, although he's more of an agrarian than a libertarian, says "Go Ron Paul!Granny Miller says she's an agrarian, and she's for Ron Paul, too.

It's a difficult question.  The first thing that leaps to my mind -- that it would be weird for an agrarian who takes responsibility seriously to vote for a libertarian like Paul -- is a correct but far from adequate answer.  I'd have to explain why I think that libertarianism is a profoundly irresponsible political philosophy.   It's worth doing, but oh, the work and the time involved is daunting!  (Can't just say "libertarians chirp on endlessly about cutting taxes, Q.E.D."  That's a brilliantly snarky, but inadequate, argument.)

I'd also have to explain why I think agrarianism has even less to do with typical versions of conservatism than seems apparent by looking at the generally right-wing slant of the overtly "agrarian" blogs.  Yes, on some level agrarianism is radically conservative, and perhaps it's even radically "religious," but I don't think that anything about agrarianism necessarily privileges Christianity or, even less, privileges modern right-wing economic policy.  My favorite agrarian, Wendell Berry, is a Christian, but Gary Snyder and Edward Abbey -- both agrarians -- certainly are not.

My excuse for not providing either of these explanations is lame: I'm too busy!  But it's a worthwhile thing to do and maybe soon I'll do it.  For now, suffice it to say that I don't think there are any agrarian candidates running for President -- least of all Ron Paul.  Obama isn't agrarian either, but I think he's the best of the candidates who has a reasonable shot at being elected.  I've voted for Perot and Nader in the past, but this year I'm in a major-candidate mood.  (Just not Hillary-sized major candidate.)

Even though I'm not voting for Paul, I think his candidacy is a great thing, like Nader's and Dean's before him.  As Glenn Greenwald writes about Paul and Dean, "...the hallmark of both was that they tapped into the widespread and intense scorn for the rancid establishment governing the Beltway, and anything that does so is something to be cheered."

Well, maybe not anything.  You have to be wary of a candidate like Paul, when it's so easy to link him to the Ron Paul Political Report.  This should give one at least as much pause as Obama's support for ethanol subsidies, no?  And there was never anything like this in Howard Dean's closet.

(In a later post: Why are you voting for Obama?)

November 08, 2007

On telecom amnesty: what he said!

"He" being Glenn Greenwald in this post.  To use the old cliche, it's something I would have been proud to have written myself:

And that really brings us to the heart of the matter. Rockefeller, Hiatt and their friends plainly see themselves -- along with the telecom executives and lobbyists who flatter and feast them and are their peers and colleagues and friends -- as our elite vanguard. They know best, and when they break the law, it is for our own good. "Laws" are for the masses, to keep social order, to ensure that the Rockefellers and Hiatts can rule in peace and telecom executives can develop their extremely profitable relationships with government agencies without being bothered by "unfair" disruptions, such as court proceedings when they break the law.

Ok -- the only thing that I wouldn't have been proud of in this post is the unfortunate use of the word "incentivize." If I ever use this word in a post, shoot me.

November 02, 2007

Google law school rankings

From the TaxProf Blog, here's another set of law school rankings, this time from Google. The top 14 are:

  1. Harvard
  2. Stanford
  3. Yale
  4. Michigan
  5. Columbia
  6. Chicago
  7. Cornell
  8. Brooklyn
  9. Vanderbilt
  10. NYU
  11. North Dakota
  12. Wisconsin
  13. Pennsylvania
  14. Suffolk

Mark my words: North Dakota and Suffolk trolls will soon be arguing that the Google search algorithm is better than USNews' or Brian Leiter's ranking criteria.

And you know what? They may not be that far from correct. As I've said before, this entire rankings thing is pure bullsh*#t.

Who will admit to supporting Hillary Clinton?

Every week we read about the large lead Hillary Clinton supposedly has in this poll, and that poll.

For me, this is odd, because I don't personally know anyone who's really excited about Hillary.  I've met other Obama fans, and Edwards supporters.  My brother really likes Richardson, and I know many people who support Kucinich.

Will anyone here own up to being excited about another President Clinton?  Go ahead -- prove to me that I don't live in a bubble.