January 31, 2005

Buzzkill

I love blogs. Somehow, though, I think that if I had been introduced to blogging by taking Eszter Hargittai's class, it would have, you know, killed the buzz.

Posted by Carey at 10:27 PM | Comments (0)

Erisa excitement

Jeremy Blachman's reaction to the first session of a law school class called "Health Care Institutions" is one that I can sympathize with:

But it seems like the most interesting parts of some of the subjects we can study -- the most compelling pieces of the puzzle, the most engaging angles to look at -- are not the legal ones. I think talking about how to improve patient care is a lot more interesting than talking about the legal regime surrounding managed care health insurance programs.

Fortunately for Jeremy, I can offer some encouragement. If his class is good, he'll soon be wrestling with the issue of whether changes to the legal regime governing managed care plans can, in fact, lead to improved patient care. My whole Note is focused on that exact topic.

Ordinarily, I would not have given two stones about managed care or ERISA. That all changed this summer when I was working for a managed care organization. The Supreme Court decided Aetna v. Davila in a way that preserved (and strengthened) the virtual immunity from liability that MCOs enjoy under ERISA for a very particular type of decision (a type of prospective utilization review). This kind of decision is one that often has profound consequences for the quality of patient care, and yet the Supreme Court had treated it as merely a decision about payment.

Bullshit, I thought. These are effectively medical decisions, and MCOs ought to be held accountable when they are made negligently. Unjust! Unfair! Meanwhile the managed care industry was practically peeing in their pants with excitement, which made it all worse.

Maybe I'm just fortunate that my experience last summer sparked an interest in ERISA. More likely I'm just weird. But I still think there's hope that Jeremy's class will get much more interesting in a few weeks.

Posted by Carey at 09:47 PM | Comments (0)

These online quizzes cut me no slack

kiss my ass2
congratulations. you are the kiss my ass happy
bunny. You don't care about anyone or anything.
You must be so proud


which happy bunny are you?
brought to you by Quizilla

(Via Amber.)

Posted by Carey at 06:07 PM | Comments (1)

I'll stick with the PBR

Bartender, Pour Me Another Cup
Perhaps Inevitably: Caffeinated Beer

By Peter Carlson

America's largest brewing company, Anheuser-Busch, released its latest product last week -- a beer that contains caffeine.

Obviously, this is a monumental cultural milestone and it raises important questions that we as a society must answer. For instance: Is adding America's favorite stimulant to America's favorite alcoholic beverage the greatest scientific breakthrough of the 21st century? Or the beginning of the end of civilization as we know it? Or what?

. . . "It tastes like a citrus-flavored Red Bull," says Rhonda Kallman, creator of the caffeinated Moonshot, which has no ginseng or fruit.

Beer is like coffee. The more extra stuff you put into it, the bigger the risk that you'll just mess it up.

Posted by Carey at 09:14 AM | Comments (3)

January 30, 2005

Merck: "about" means "exactly"

Merck's recent string of bad news was extended by last Friday's ruling by the Federal Circuit invalidating its patent on once-a-week Fosamax:

Merck received yet another blow yesterday when a federal appeals court unexpectedly invalidated a patent on Fosamax, an osteoporosis treatment that is Merck's second-best-selling drug.

. . . The decision reverses an August 2003 ruling in Federal District Court in Delaware that upheld a patent on a once-a-week formulation of Fosamax. The patent on Fosamax in its original daily dosage expires in 2008. The vast majority of patients take the weekly dose, whose patent protection had been expected to last until 2018. Yesterday's decision means Merck could face generic competition for both the daily and the weekly versions of Fosamax as early as February 2008.


The main issue in the case, Merck v. Teva Pharmaceuticals (2005 WL 181711), was whether Merck's patent on once-weekly Fosamax was invalid as obvious. An interesting subsidiary issue was whether Merck had successfully redefined the word "about" in its specification. Merck's argument was that when the claim used the words "about 35 mg" of alendronic acid, it really meant "exactly" 35 mg.

The CAFC rejected this argument, but it's not as patently absurd as it first seems (please forgive the pun). A patentee is "its own lexicographer," meaning it can define the terms in its claims however it wants. Merck argued that it wasn't just redefining the word "about." Instead, it defined the entire phrase "about 70 mg of alendronate monosodium trihydrate, on an alendronic acid basis" to mean "whatever amount of total compound is necessary to provide exactly 70 mg of alendronic acid."

The case may still have come out against Merck even if it had won this claim-construction argument, but the argument is still pretty fierce. There's a vigorous dissent from Judge Rader about the claim construction issue, and about the issue of Fed. Cir. deference to trial courts. If you're a patent law junkie, it makes for good reading.

Posted by Carey at 05:28 PM | Comments (0)

January 28, 2005

Here's an exciting post for ya.

Last semester's classes were all very interesting, but if I could do it all again, I think I'd make some scheduling changes. Specifically, I'd take Administrative Law instead of Federal Antitrust.

Not that I have anything against antitrust, mind you. Antitrust is now my bitch. So to speak. But with administrative law, the situation is sadly reversed: I am administrative law's bitch.

After months of wrestling with my Note (even if only intermittently), I have come to the sad realization that it all comes down to administrative law. And I don't know anything about it. I'm trying to argue about the relative merits of different regulatory schemes for managed care organizations (since, of course, their regulatory immunity under the status quo is unacceptable.) My knowledge of federal antitrust law has not helped me very much with this.

I've been forced to do what every good law student should do if they have to write something about which they know very little: make shit up.

Perhaps it's all for the best. I'll come back later and shore up my arguments with some admin law that I learn on the fly. I'll continue to read newspaper articles about lawsuits against Microsoft with the deep understanding that comes with having taken Federal Antitrust in law school. And maybe I'll sign up for Administrative Law next year.

Posted by Carey at 02:20 PM | Comments (2)

January 26, 2005

Winter weather

Winter weather in Michigan isn't exactly the most blissful thing I've ever experienced.

I'm not one of those folks who hate it so much that I'd rather kill myself or someone close to me in order to escape this parade of gray days with an unbroken string of below-freezing temperatures as far as weather.com can see.

Being from Colorado, however, I do miss the variety. Winter in Denver or Colorado Springs typically means high temperatures that vary, from week to week, from the 60s and even low 70s down to the single-digits and rarely below zero. There are gray days, and clear days with a crystal-blue sky. A little of this, a little of that. Not too much of any one thing.

The whole year, in fact, is packed with variety. Colorado Louis has managed to identify nine seasons in Denver, and his is a very plausible list.

Here in Michigan, it's all 14 degrees, all the time. At least until March!

Posted by Carey at 10:03 PM | Comments (2)

where's the scandal?

The Washington Post reports that:

In 2002, syndicated columnist Maggie Gallagher repeatedly defended President Bush's push for a $300 million initiative encouraging marriage as a way of strengthening families.

"The Bush marriage initiative would emphasize the importance of marriage to poor couples" and "educate teens on the value of delaying childbearing until marriage," she wrote in National Review Online, for example, adding that this could "carry big payoffs down the road for taxpayers and children."

But Gallagher failed to mention that she had a $21,500 contract with the Department of Health and Human Services to help promote the president's proposal.

The recent wave of payoffs to political pundits by campaigns and interest groups has a scandalous flavor, but why?

It isn't as if we expect these openly partisan pundits to present fair and balanced arguments. Does it really matter whether they're collecting checks from the people who benefit the most from their work? Are we really upset because these columnists haven't disclosed these payments? Again, I don't think obviously slanted punditry has to worry about preserving its appearence of impartiality.

The real scandal may be that these political hacks have become so influential. Pressure groups believe that these pundits influence public opinion to such an extent that it's worthwhile to throw them a bunch of cash to keep them from wandering off the reservation.

As the major media conglomerates continue to tear down the walls between their entertainment and news divisions, and corporate profits have made ratings more important than the quality of the news reporting, responsible journalism is less and less able to counter the ravings of political hacks and pundits. More and more of the information we receive about public policy is just ranting for ratings. In this environment, the pundits have more influence over the public's opinion than they would have in the presence of respectable journalism.

That's the real scandal. I don't think the problem is solved when the left pays its own political hacks to provide equally irresponsible blather on the other side. Citizens must still wonder, "where's the beef?" What if all of these clowns are wrong? Responsible reporting can never be completely objective, but it can distinguish itself from punditry. It is more likely to avoid the undignified language that, as Don Herzog points out, can have unintended and undesirable consequences.

So, at the end, I suggest we not get our underwear in a twist about these pundit payoffs. We need to focus instead on the replacement of journalism with punditry, and the continuing influence of corporations over the raw information that we need to sustain healthy political discussions in a democracy.

Posted by Carey at 09:12 AM | Comments (1)

January 24, 2005

Accusations of treason fall easily from the lips

Of the many unsavory influences that the so-called "war on terror" has had on our political culture, the eagerness of some (mostly conservative) commentators to accuse other citizens of "treason" is perhaps the most pernicious.

The latest example comes from Stephen Bainbridge:

A report by Barton Gellman in yesterday's Washington Post revealed the existence of battlefield intelligence units within the Pentagon that work directly with Special Operations forces on counterterrorism missions. Now it's all over the MSM...
["MSM" = "mainstream media" -- conservative code used to refer to the New York Times, CNN, etc. Basically, MSM refers to every major news organization except for FoxNews and the Wall Street Journal.]
Did the Pentagon intend to disclose this program or did only to do so in response to Gellman's investigation? If the latter, why isn't his conduct basically treasonous? Did he put personal self-interest as a journalist ahead of the national security? If operatives are killed or missions blown as a result of this story, will Gellman feel any remorse? If the countries named in his story as targets of the missions pull out of the war on terror, will Gellman accept any responsibility for the resulting harm to our national security? I think he and his fellow members of the MSM owe us answers to these questions.
Treason is a serious charge, and yet it seems to fall so easily from the tongue of folks like Bainbridge. He seems incapable of recognizing that many things other than Gellman's "self-interest as a journalist" may have motivated the article. Public service, for one thing.

Unlike dictatorships and tyrannies, democracies can only work well when citizens have enough information to pass judgment on their leaders. Our current leaders have arguably damaged our national security with a ill-considered invasion of Iraq, in support of which the Bush administration mislead the American people by alleging connections between that country and Al Qaeda, and by mischaracterizing uncertain intelligence as a "slam-dunk" case showing that Iraq had stockpiles of WMDs such that it constituted an "imminent threat."

Given this recent history, American citizens have a vital interest in learning that the Bush administration is continuing to rewrite law and custom to make itself less accountable to the Congress and to the American people:

Pentagon officials emphasized their intention to remain accountable to Congress, but they also asserted that defense intelligence missions are subject to fewer legal constraints than Rumsfeld's predecessors believed. That assertion involves new interpretations of Title 10 of the U.S. Code, which governs the armed services, and Title 50, which governs, among other things, foreign intelligence.

Under Title 10, for example, the Defense Department must report to Congress all "deployment orders," or formal instructions from the Joint Chiefs of Staff to position U.S. forces for combat. But guidelines issued this month by Undersecretary for Intelligence Stephen A. Cambone state that special operations forces may "conduct clandestine HUMINT operations . . . before publication" of a deployment order, rendering notification unnecessary. Pentagon lawyers also define the "war on terror" as ongoing, indefinite and global in scope. That analysis effectively discards the limitation of the defense secretary's war powers to times and places of imminent combat.

Under Title 50, all departments of the executive branch are obliged to keep Congress "fully and currently informed of all intelligence activities." The law exempts "traditional . . . military activities" and their "routine support." Advisers said Rumsfeld, after requesting a fresh legal review by the Pentagon's general counsel, interprets "traditional" and "routine" more expansively than his predecessors.

"Operations the CIA runs have one set of restrictions and oversight, and the military has another," said a Republican member of Congress with a substantial role in national security oversight, declining to speak publicly against political allies. "It sounds like there's an angle here of, 'Let's get around having any oversight by having the military do something that normally the [CIA] does, and not tell anybody.' That immediately raises all kinds of red flags for me. Why aren't they telling us?"

The essence of dictatorship is that the dictator alone decides what is in the nation's best interest, and what actions are necessary for national security. One of the burdens of democracy is that our government is accountable to the people for these decisions. This is one reason why we enacted laws requiring the CIA to submit to a certain amount of Congressional oversight; another reason was to prevent our government from abusing covert operations.

Gellman has told us the story of the Bush administration's attempt to circumvent these laws. This is not treason, it's patriotism. It may turn out that there are good reasons for the administration to give the Defense Department greater control over covert ops, but that decision is not for the executive branch to make unilaterally.

Posted by Carey at 10:55 PM | Comments (3)

Tax cheaters

Just another example of how law and policy favors those who make money from investments, and disfavors those who make money from work:

Overstating of Assets Is Seen to Cost U.S. Billions in Taxes
By DAVID CAY JOHNSTON

Published: January 24, 2005

Investors, entrepreneurs and landlords annually avoid paying at least $29 billion in taxes by overstating the price of stocks, businesses and real estate, two professors say in an article being published today in Tax Notes, an influential tax policy journal.

...Congress could easily reduce this cheating to a minor problem through changes in tax laws that, the professors wrote, would apply the same rules to those harvesting capital gains that now apply to workers, home owners and parents.

...The problem, the professors wrote, is that the Internal Revenue Service has no effective means to determine the price, known as the basis, paid for an asset that has been sold.

Capital gains and losses are reported on an honor system, unlike the rigorous verification regimes that Congress has imposed for wages, home mortgage interest deductions and tax breaks for parents.


Until Bush's "ownership society" frees us all from making a living with our hard work, we'd best keep trying to find a way to live on our investments.

Good luck.

Posted by Carey at 08:27 AM | Comments (0)

January 23, 2005

Client and patient responsibilities

A post by Carolyn Elefant got me thinking about what kinds of responsibilities clients have to their lawyers. Are these anything like what patients owe to their physicians?

Elefant writes about Rompilla v. Beard, an ineffective-assistance-of-counsel case that was recently argued before the Supreme Court. Apparently, the inmate-client in the case is arguing that his lawyers didn't review the court files diligently enough to find evidence in the record of the client's low IQ, alcoholism, and troubled childhood that might have saved the client from the death penalty. The lawyers apparently claim that they asked the client directly whether he had any problems with alcohol, and the client said no.

Elefant writes:

A court ruling finding the attorney rendered ineffective assistance won't just impact criminal practice - but will affect how all of us deal with our clients. Essentially, such a ruling would require the court to find that we cannot take our clients at their word. Now sure, attorneys have an obligation to diligently investigate a client's case - but that's more to determine whether the case is feasible rather than to continuously question what our clients have told us. And when clients begin to realize that it doesn't matter what they say because attorneys can't take them at their word, the trust so integral to the attorney client relationship will diminish.

Do clients have any obligation to tell their lawyers the truth? A quick search of the ABA model rules of professional conduct turned up very little on the subject of client responsibilities in general, and nothing on any obligation of truthfulness.

In comparison, the AMA expects patients to tell their physicians the truth. Policy E-10.02 states that:

(1) Good communication is essential to a successful patient-physician relationship. To the extent possible, patients have a responsibility to be truthful and to express their concerns clearly to their physicians. (2) Patients have a responsibility to provide a complete medical history, to the extent possible, including information about past illnesses, medications, hospitalizations, family history of illness, and other matters relating to present health.
These patient responsibilities don't excuse the physician from her duty to seek out the information, but the idea is that the relationship between a professional and an autonomous client can only work if both parties act responsibly.

Surely this must be the same for the lawyer/client relationship, unless it's a whole lot more paternalistic than the ideal physician/patient relationship. To the extent that lawyers are expected to treat their clients as autonomous persons, the clients ought to shoulder their share of the burdens. Otherwise, attorneys might turn into babysitters, and clients into children. Elefant writes:

Moreover, I want to empower my clients, not coddle them. Clients deserve as much. So, I take my time to explain the applicable law, why my clients must provide me with certain pieces of information and why that information must be accurate. But if we send a signal to clients that their input doesn't matter, and if they don't provide it, then the attorney and not the client will pay the price, we encourage them to remain passive bystanders rather than active participants in the judicial process. And that makes us attorneys caretakers rather than advocates.

Posted by Carey at 09:37 PM | Comments (0)

Old gods

Julie Saltman points me via email to Brad DeLong's post heaping scorn upon Tom Bombadil.

DeLong thinks Tom is a disaster. It will probably surprise no one that I don't share his esthetic judgment; I think Tom Bombadil is one of the most fascinating characters in LotR. I've mentioned my ambivalent feelings about literary criticism, but I'll point to some of comments on DeLong's post as examples of lit crit's power to enrich one's understanding of art.

My favorite is a part of a longer comment by Troy McClure: "Maybe the old gods weren't all Lovecraftian horrors, perhaps they were beautiful like Goldberry."

So long as thinking and writing about literature leads to provocative gems like this, you won't hear me complaining too much.

Posted by Carey at 08:05 PM | Comments (0)

January 22, 2005

psst!

Want to see an origami chicken?

Posted by Carey at 01:35 PM | Comments (0)

A radical inauguration

President Bush's second inaugural speech may well turn out to be one of the most important speeches in our nation's history. It was certainly eloquent enough to stand alongside the speeches of Kennedy and Roosevelt, if not quite those of Lincoln.*

The thing that struck me most powerfully about the speech, though, was how un-conservative it was.

There is only one force of history that can break the reign of hatred and resentment, and expose the pretensions of tyrants, and reward the hopes of the decent and tolerant, and that is the force of human freedom.

It used to be that conservatives distinguished themselves from Marxists by their scorn for junk concepts like the "forces" of history. Apparently, no longer. While the Marxists proclaimed that the forces of history would result in the end of class struggle, Bush enlists these same forces to proclaim the approaching "end" of tyranny. Ending tyranny would be like ending sloth and envy. It's a radical utopian dream, which would require a transformation of human nature far more radical than anything the Marxists ever dreamed of.

Inauguration speeches are occasions for overblown rhetoric, but every political creed can draw on their own rhetorical tradition for suitable excesses. Why does Bush use the rhetoric of the radicals?

We go forward with complete confidence in the eventual triumph of freedom. Not because history runs on the wheels of inevitability; it is human choices that move events.

Bush acknowledges here that human beings are responsible for historical events. Why, then, should he have "complete confidence" in their eventual outcome? Real conservatives ought to recognize a bone when it's thrown to them. Conservatives have always been the last people to have "complete confidence" in the outcome of human endeavors on this earth. This is because most conservatives would agree with what Elrond said in Peter Jackson's version of the Lord of the Rings: "Men are weak."

Bush can have complete confidence about the human future only if he doesn't really believe that stuff about human responsibility. Which means that either (a) Bush is really an old-time radical who believes in the perfectibility of mankind, or that (b) the "triumph of freedom" he talks about isn't really a human endeavor after all.

Some I know have questioned the global appeal of liberty, though this time in history -- four decades defined by the swiftest advance of freedom ever seen -- is an odd time for doubt.

It may be true that Bush is a leftist radical in conservative clothing, but the better explanation for his lack of any doubt about the future is his fervent belief that God is guiding his hand.

Our President's fervent beliefs about what God is up to aren't due merely to his Christianity. Many Christians are much more comfortable than Bush is with the idea that God's actions in this world are indirect. Humans were made by God, and the nature and timing of the end of the world will be decided by God, but the time in between is mostly up to us. Christians of this sort can afford to be confident about the afterworld, but not about this world. Human free will makes earthly life a crapshoot, where doubt and uncertainty are as necessary for survival as breathing in and breathing out.

If, however, you think the lines between the earthly and the heavenly realms are blurred, you might plausibly achieve the level of confidence about human events exemplified by George W. Bush.

When our founders declared a new order of the ages, when soldiers died in wave upon wave for a union based on liberty, when citizens marched in peaceful outrage under the banner "Freedom Now," they were acting on an ancient hope that is meant to be fulfilled.

History has an ebb and flow of justice, but history also has a visible direction, set by liberty and the author of liberty.

It's no wonder that Colin Powell is no longer a member of Bush's cabinet. His realism and doubt was incompatible with Bush's fervent belief in a God who "means" our hopes to be fullfilled on earth, and who "authors" not only our liberty but our history as well. I've heard that Colin Powell is quite a religious man, but Dick Cheney and Don Rumsfeld (both of whom are quite possibly areligious) are a far better fit for the Bush cabinet than Powell.

To the extent that Bush intends to serve as God's right-hand man in His inevitable plan to end tyranny and fulfill ancient hopes of freedom, the worldly, neoconservative faith in bombs, covert operations, and interrogations free from court oversight is much easier to live with on a day-to-day basis. Bush, for his reasons, and Cheney, for his, share the same overt hostility towards doubt and reflection.

Seymour Hersh has an article in this week's New Yorker about this lack of doubt in the White House:

Despite the deteriorating security situation in Iraq, the Bush Administration has not reconsidered its basic long-range policy goal in the Middle East: the establishment of democracy throughout the region.
If the mess in Iraq will not give this administration pause, it's unlikely that any arguments against "bold action" in Iran will carry much weight with our President or his advisers either. We'd better hope that Bush is right about God's plan, and that Tom Friedman is right that "many young people [in Iran] apparently hunger for Mr. Bush to remove their despotic leaders, the way he did in Iraq."

Forgive me, Lord, but I'm doubtful.

---------
* It was at least an eloquently written speech. Bush might have bungled the actual speaking part. Prof. Bainbridge reports: "It was poorly delivered, even by Bush's minimal standards. He consistently accented the wrong words and mucked up the flow. There was no grace to his speaking style whatsoever; indeed, he seemed to be going through an unpleasant exercise.

Posted by Carey at 09:51 AM | Comments (2)

January 21, 2005

Maryland governor shows signs of life

Ehrlich Gives Public Colleges a Lift
Private Schools Are Allotted Less Than State Formula Suggests

By David Snyder
Washington Post Staff Writer
Friday, January 21, 2005; Page B01

Maryland's public colleges and universities received a boost from Gov. Robert L. Ehrlich Jr.'s budget this week, in the form of a $43 million funding increase that school system leaders say should help rein in soaring tuition costs.

But for the 17 private colleges that receive state dollars, the governor's spending plan represents the fourth straight year that the state has provided significantly less money than recommended by a state formula -- funds that advocates say are vital to the overall well-being of the state's higher education.

Chip DiPaula Jr., Ehrlich's budget secretary, said the state's chronic budget shortfalls in recent years have forced leaders to "focus on its core missions and responsibilities."

The disparity between public and private institutions has opened debate about whether Maryland's decades-long commitment to funding the entire spectrum of higher education institutions is wavering.


If this reporter is going to make declining state support for private colleges in Maryland the focus of the article, he should have given us more details about Maryland's "decades-long commitment" to funding private schools. What is the state formula based upon? Do any other states have formulas like Maryland's?

It seems to me the real "news" here is that Gov. Ehrlich is responding to higher tuitions at public colleges with more state support--a rare thing in this era of state cutbacks. The loud complaining on the part of private schools like Johns Hopkins just blurs the real issue, which is whether our state governments will remain committed to funding their own public institutions.

Posted by Carey at 11:06 AM | Comments (0)

January 20, 2005

Bill Frist: Health Care in the 21st Century

Bill Frist is exercising a lot of restraint these days. For example, in his recent article ($$) about the future of healthcare published in the New England Journal of Medicine, Frist manages to resist any mention of the "marketplace" until the 48th word.

It might have been this extraordinary display of self-control on Frist's part that convinced me to read the rest of his article with an open mind. Whatever it was, I found that I agreed with most of what Frist wrote. I know it's weird, but I might even say that I shared his vision. Of course, we shouldn't get too carried away; I'm referring only to what Frist described in his article, which might be quite different from what's in his heart of hearts. (He is, after all, a Republican politician.)

Certain details in Frist's vision of the future are quite frightening, most of them having to do with some guy named Rodney, who "chooses" to have a "tiny, radio-frequency computer chip implanted in his abdomen that monitors his blood chemistries and blood pressure." To whom will this chip report, pray tell? Rodney's insurer? Frist neglects to say.

But apart from these (horrifying) details, I share many of Frist's common-sense aspirations for the American health-care system. For example, I'd love to have a system that was "responsive primarily to individual consumers, rather than to third-party payers." Hallelujah! Personal responsibility is as good for the average McDonald's eating, chain-smoking couch potato as it is for Dennis Koslowski, Ken Lay, and Martha Stewart. Isn't it?

Most importantly, Frist acknowledges that we must provide access to health care for everyone. Forget for a moment that this is the Republican Senate majority leader, and listen to this:

"First, we must agree on a guiding principle: all Americans deserve the security of lifelong, affordable access to high-quality health care. Despite pockets of tremendous quality, we are a long way today from realizing the goal of secure, lifelong, affordable access to quality health care for all. . . .

"The focus of the 21st-century health care system must be the patient. Such a system will ensure that patients have access to the safest and highest-quality care, regardless of how much they earn, where they live, how sick they are, or the color of their skin. . . .

"Organizing a system primarily around the needs of consumers and patients does not mean that people should simply go it alone. Government plays a crucial role. . . . [Government] must also provide a sturdy safety net with basic protections and additional assistance for the physically, mentally, or financially vulnerable. . . .

"The government must enroll all 5.6 million children eligible for Medicaid and S-CHIP within 24 months through a combination of streamlined enrollment procedures, increased financial incentives for outreach programs, and a new national "Cover the Kids" enrollment campaign. . . .

"To make sure every vulnerable American who needs health care gets health care, the United States will always need a strong safety net. The capacity of our community health centers should be doubled over the next 10 years, and sufficient resources should be allocated to maintaining the network of these centers. . . .

This kind of language reminds me of how fortunate we are to have Ted Kennedy Bill Frist in the Senate.

Frist, surprisingly, has enough breath left to wax poetic about things other than universal health care. Electronic medical records get a big boost. (See THCB for interesting commentary.) One of the better ideas from John Kerry's presidential campaign is resurrected--a "Healthy Mae" to administer a secondary market for health insurance. I'd have passed out if Frist had suggested amending ERISA §502(a)(3) to provide for consequential damages in lawsuits against welfare benefit plan fiduciaries, but I'm nothing if not a realist. I realize that even the most hard-core progressives have to take things one step at a time.

Some Democrats, undoubtedly, will suspect that Frist's words are just rhetoric. I know, I know, but that's politics for you. These worriworts might consider that the easiest way to make sure that Frist doesn't forget what he claims to stand for--health care for all--is for the Democrats to work with him to make this vision a reality. It's the perfect opportunity for bipartisanship, and you know how much the American people miss bipartisanship these days. Heck, between the Democrats helping out Frist on healthcare, and the fiscally conservative Republicans breaking with Bush and opposing Social Security privatization, George W. Bush's second term might just begin to overflow with bipartisanship.

At least, until our President decides to invade Iran.

Posted by Carey at 07:41 PM | Comments (3)

January 19, 2005

Working out

I go trail running to have fun. It's never a matter of "willpower" for me. Sometimes, though, I like to try something else. Today I spent some time on this contraption:

This is a Concept 2 rowing ergometer, and anyone who's used one will understand why I call it the Machine of Death. Sure, the first few minutes are tolerable, but things quickly descend into a miasma of exquisite pain and suffering.

If this was the only way I could get a good workout, I'd probably let myself get fat and slobbery. Oh, I hurt just as much on some of my hilly trail runs, but it's different. I'm concentrating on the trail, seeing the land pass underneath me--it's almost meditative, and it's always fun.

For people who haven't found an activity that they can do for the pure fun of it, "working out" is more than just a physical challenge. You need as much mental energy as physical energy to force yourself to do something boring. Many people's New Year's resolutions to "exercise more" peter out after a few weeks because they haven't found a workout that they think is fun.

If I was a personal trainer, I'd level with people: if you're not having fun when you're working out, you need to try a different exercise, or you're doomed.

Posted by Carey at 06:59 PM | Comments (5)

January 18, 2005

Law school privatization, again

Brian Leiter posts National Jurist data on law school tuition hikes. Unsurprisingly, state schools are at the front of the pack as they struggle with declining support from state government.

In lieu of public funding, some of these law schools are aggressively supplementing tuition revenue with private funds. Wings&Vodka describes what this means.

Posted by Carey at 04:34 PM | Comments (3)

Governor or physician?

Thomas Mayo at HealthLawProf Blog raises questions about whether a physician, who also happens to be a Governor, violates medical ethics by signing an inmate's death warrant.

The Kentucky Board of Medical Licensure says that Gov. Ernie Fletcher, who is a physician, did not violate medical ethics when he authorized the execution of an inmate on the state's death row, despite the AMAs prohibition of physicians from participating in executions. "The committee, which examined the issue at the request of four death-penalty opponents, said Fletcher was acting as governor, not as a doctor, when he signed a Nov. 8 death warrant for Thomas Clyde Bowling."

After reading Mayo's post and looking at the information he links to, I think the Board got it right. Yes, we should worry when docs avoid their ethical responsibilities by trying to remove their "physician" hats at convenient times. But we should also avoid falling into the trap of defining the person by their profession. The AMA's code of medical ethics doesn't completely define the ethical obligations of every human being who happens to have chosen the profession of medicine.

Ernie Fletcher may be a physician, but he's also pursuing another profession. If Fletcher had refused to sign the death warrant, would he have been violating his ethical responsibilities to Kentucky's citizens as Governor? Those obligations come from Kentucky law and the promises he may have made to the citizenry before he was elected, and have nothing to do with medical ethics. It's crucial that a person be able to set aside his role as a physician, because otherwise he might find it difficult to do anything else in his life ethically.

I knew an emergency doc once who also served as a reserve police officer. He couldn't have done that job well if the code of medical ethics had attached to his person 24/7. Conversely, he couldn't have been an ethical physician if he was bound to treat patients with the ethics of a cop.

Posted by Carey at 08:05 AM | Comments (0)

January 16, 2005

Thumbs-sideways

When it comes to literary criticism I never know whether to sneer or cheer. One part of me laughs at how silly it is to argue about the "merits" of art. (Esthetic taste is not the sort of thing that's influenced by arguments, right?) The other part of me is amazed at how writing about art can make our experience of it so much richer.

For example, critics can talk to me all day about Tolkien's supposedly "wooden" characters, but in one sense, I couldn't care less what they think--his characters don't seem wooden to me. They can argue that LoTR glorifies heirarchies and the status quo, or that Tolkien is really just proselytizing his Catholicism in his books. If they've read the story closely they might convince me that a reasonable reader could draw those conclusions, but I'm not (just) a reasonable reader. I've already read the book, and my own idiosyncratic reactions to it (namely, love) don't have anything to do with whether anyone else likes it or not.

Which is to say, literary criticism seems irrelevant to the most important question we ask of a literary work: do you like it?

On the other hand, I'm amazed at what a perceptive critic can say about a work of fiction. Good criticism can seem like revelation when it isn't trying to argue that your esthetic reaction to a story is "wrong." When it tries to just describe what the critic has noticed about the story, criticism is enormously fun to read--even if I don't myself agree with the critic's descriptions or explanations.

In light of my conflicted reaction to literary criticism, then, I'll give the posts over at Crooked Timber about China Miéville's work (and a lot about Tolkien, too) a solid thumbs-sideways. With some wiggles.

[the same goes for Helen Bainbridge's scornful review of a movie I liked, Sideways.]

Posted by Carey at 08:14 PM | Comments (1)

January 15, 2005

Marie Antoinette

Laura Bush has modernized Marie Antoinette's "let them eat cake" defense of privilege in the face of suffering:

WASHINGTON, Jan. 14 - With less than a week to go until her husband's second inauguration, Laura Bush on Friday defended the decision to hold the $40 million celebration as planned despite a war abroad and the tsunami disaster in the Indian Ocean.

Inaugurations, Mrs. Bush said, are "an important part of our history."

"They're a ceremony of our history; they're a ritual of our government," she said in a round-table interview with reporters in the White House map room. "And I think it's really important to have the inauguration every time. I think it's also good for Washington's economy, for people to come in from around the country, for the hotels to be full, and the restaurants to be full, and the caterers to be busy. I think that's important."

Our soldiers may be dying, and whole villages may have been washed away, but Laura, undistracted, still recognizes the value of full hotels and busy caterers.

Posted by Carey at 08:37 AM | Comments (3)

Medical school tuition

Should we be worried about skyrocketing medical school tuition rates and ballooning debt for new doctors? An article in this week's NEJM says yes. The solutions it proposes reinforce my growing conviction that our society has abandoned any commitment it may once have had to ensuring equality of opportunity through education.

Gail Morrison, the Vice-Dean for Education at Penn's medical school, says tuition hikes contribute to two undesirable trends in medical education. First, medical students are increasingly drawn from affluent families, and second, graduates are choosing well-paid specialties partly because their debt loads are so high:

At the same time, for the past two decades, approximately 60 percent of medical students have come from families in the top quintile of income, with the bottom three quintiles together accounting for about 20 percent,3 arousing concern that medical education may be beyond the reach of students from middle-class and working-class families. A recent national survey of underrepresented students indicated that the cost of attending medical school was the number-one reason they did not apply. An Institute of Medicine report found that though Hispanics constituted 12 percent of the population, they accounted for only 3.5 percent of all physicians, and though 1 in 8 Americans is black, fewer than 1 in 20 physicians is black. Continuing this trend has far-reaching consequences for the national health care workforce, which needs diverse physicians in order to address the needs of an increasingly heterogeneous patient population.

Moreover, 32 percent of students who graduated in 2002 indicated that their level of debt influenced their choice of specialty. Indeed, the latest match conducted by the National Resident Matching Program shows a continuing decrease in the number of medical students pursuing careers in primary care (37 percent in 2003, as compared with 49 percent in 1997) and an increase in the number gravitating toward careers in radiology, orthopedics, ophthalmology, and dermatology, which offer higher discretionary income.

It's a reflection of our era that Morrison is pessimistic about finding solutions in state or federal government policies:
How do we stop this vicious circle of increasing tuition and student debt? Although the federal government contributes to undergraduate medical education by guaranteeing low-cost student loans, it needs to do more. Securing adequate funding for Title VII health professions programs, reauthorizing the Higher Education Act, expanding and protecting the National Health Service Corps Loan Repayment Program, and broadening the tax-exempt status of medical scholarships would ameliorate debt. But these initiatives may not be top priorities for a government dealing with war in Iraq, a growing national debt, and threats of terrorism.

State legislatures could provide additional financial support to public medical schools to enable them to cap tuition, allow tax deductions for interest on loans, and authorize more programs whereby new physicians can pay off loans in the form of state service. But most states are also facing a precarious financial balance.

Morrison suggests that in the absence of any governmental commitment or ability to assist, the burden rests entirely on individual medical schools to find ways to slow tuition hikes. Ironically, she suggests that schools pursue the same kinds of "de-facto privatization" that others have suggested as a way of allowing schools to raise tuition.

It's a shame that there seems to be no vigorous efforts to push back against the continuing withdrawal of community support for education. Perhaps it's a sign of Grover Norquist's governmental baby being almost drowned that no one dares to propose that government use tax revenue to subsidize tuition. It would have been fantastic if Morrison had pushed a little harder for government responsibility, instead of accepting as a fait accompli the sad fact that our government sees no problem in diverting tax revenue to our President's dubious adventure in Iraq, and that it prefers to watch the middle class slowly crumble rather than rethink its huge tax cuts for the super-wealthy.

I suppose, if the battle is already lost, that all medical schools, law schools, graduate schools, and colleges should immediately privatize themselves. They should all start chasing after private donors to raise their endowments and abandon the myth that there are any such thing as "public" schools in this country. At least this might allow the schools themselves to survive. Whether it will do anything to protect against the inequities that Morrison's article complains of is much more uncertain.

Posted by Carey at 08:26 AM | Comments (0)

January 14, 2005

Preemption

Our government's infatuation with military preemption is one of the worst consequences of the Bush presidency. Even if George W. Bush was being honest when he said that his invasion of Iraq was part of the "war on terror," the aftermath of the invasion has certainly been a monumental setback for the United States. The Washington Post's Dana Priest provides a juicy overview of a new report by the National Intelligence Council, which describes how Iraq has eclipsed Afghanistan as a breeding ground for terrorists.

Low's comments came during a rare briefing by the council on its new report on long-term global trends. It took a year to produce and includes the analysis of 1,000 U.S. and foreign experts. Within the 119-page report is an evaluation of Iraq's new role as a breeding ground for Islamic terrorists.

President Bush has frequently described the Iraq war as an integral part of U.S. efforts to combat terrorism. But the council's report suggests the conflict has also helped terrorists by creating a haven for them in the chaos of war.

"At the moment," NIC Chairman Robert L. Hutchings said, Iraq "is a magnet for international terrorist activity."

Bush's little adventure in Iraq has hurt the United States in the "war on terror." It's also been a disastrous demonstration of the kind of preemptive strike that Bush embraced in his post 9-11 National Security Strategy. The United States has sunk itself in a quagmire of its own making, for the sake of preemptively striking a nation with no WMDs and which did not ever constitute an "imminent threat." In exchange for all this, we've created the world's most fertile breeding ground for the Islamic terrorists who do constitute an imminent threat.

I'm glad George W. Bush recognizes the value of "resolve," because it's about the only thing his policies have left us. Unfortunately, resolve won't do us any good until we pick the right things to be resolved about.

Bush still wants to spread "democracy" and "freedom" at gunpoint--which is not surprising given his simplistic belief that "freedom is the non-negotiable demand of human dignity; the birthright of every person—in every civilization." This language warms the heart and stirs the soul, but it doesn't tell us anything. What kinds of freedom are non-negotiable? Is war the only alternative to negotiation? Bush hasn't troubled himself with these questions, and our soldiers are paying the price for their president's lack of curiosity.

In some ways this report put out by the National Intelligence Council is an antidote to the naivete of Bush's National Security Strategy. It describes the real effects of some real acts inspired by that strategy, and shows how the U.S. has suffered because of them. In other ways, though, the report isn't very helpful. For example, it remains too uncritical of preemption as a security strategy. From the report's Section 4:

Until strategic defenses become as strong as strategic offenses, there will be great premiums associated with the ability to expand conflicts geographically in order to deny an attacker sanctuary. Moreover, a number of recent high-technology conflicts have demonstrated that the outcomes of early battles of major conflicts most often determine the success of entire campaigns. Under these circumstances, military experts believe preemption is likely to appear necessary for strategic success.
This language is entirely useless. It doesn't explain why it might be so important to be the attacker in an "early battle," and it ignores the lessons of Iraq that preemptive attack is often based on false beliefs of imminent danger and may leave the attacker in a worse strategic position.

But enough of this. The fact is that Bush decided to invade Iraq, and the American people have decided that Bush should deal with the consequences of his decision. The important thing now is what Bush does next. Mere "resolve" is not an answer. The status quo is unsustainable.

Posted by Carey at 02:32 PM | Comments (0)

Via Heidi, the king nerd


I am nerdier than 77% of all people. Are you nerdier? Click here to find out!

Posted by Carey at 09:13 AM | Comments (0)

January 13, 2005

Practice makes professional

The professor who's teaching my Law & Bioethics class said something today that reminded me indirectly of a book by Gavin DeBecker called The Gift of Fear. One of DeBecker's main points is that our intuition is often based on solid sensory data and valid (if unconscious) analysis. Sudden fear, for example, may often be justified even when we can't consciously explain why we're afraid.

DeBecker might just as well have said that when it comes to personal safety, we're all professionals. This is because professional reasoning of the sort that lawyers and doctors and architects do turns out to be mostly intuitive. Atul Gawande describes this process in his book Complications, where he tells the story of his own intuitive sense that a patient of his in the ER with a probable cellulitis should nevertheless be taken to the OR to rule out necrotizing fasciitis. The decisions physicians make are often based on pattern recognition, much of which may be unconscious. If it weren't, the typical doctor would take much, much longer to make decisions than he in fact does. The same is true for lawyers and other professionals.

But what's the source of professional intuition? In another part of his book, Gawande asks about what things make for a good surgeon. His answer: practice, practice, practice. Gawande's discussion focused on the motor aspects of surgery, but the same could be said for the mental aspects of making diagnoses. A physician can intuitively diagnose a case of appendicitis only after she's seen hundreds of cases. My professor in class today pointed out that lawyers develop the ability to pick out the few winning arguments out of many logically valid arguments only after lots and lots of practice--reading cases, making arguments and observing what happens. When they do, it feels to them like intuition, and it probably is.

So when Gavin DeBecker urges us to trust our instincts when it comes to personal safety, he's saying that we're "professionals" when it comes to our own security. That makes sense, because assessing threats to our selves is something that most of us have practiced again and again, for our whole lives.

Posted by Carey at 11:34 PM | Comments (0)

January 12, 2005

Traveling

Traveling is good for at least two things. First, it's the most effective means I know of for breaking the anal-retentive habits that you accumulate from too much time in law school. Second, travel can expose you to diverse and surprising cultural treasures. For example, wandering around the streets of Alajuela yesterday, I passed a store displaying various kinds of panties in the front window. One of them was lime green. It had a cartoon frog printed on the crotch, with the words "Un sapito rico." "A Rich Frog."

Is this a peculiarly Costa Rican fetish? Maybe they're selling the English version of these panties at Wal-Mart, and I just missed it.

Posted by Carey at 11:53 PM | Comments (0)

January 10, 2005

pura vida

I was last in Costa Rica 15 years ago. The thing I learned then was: don't worry too much about the schedule, 'cause it will change

We used to say "whereever you are, there you are." And it's true. Here I am in rural Costa Rica, and I can't get back to Michigan on time because of torrential rains.

So I think I'll just have to go buy a mango con leche, an empanada, and sit on the beach for a while.

Pura Vida!

Posted by Carey at 08:33 PM | Comments (0)

January 06, 2005

Homeland

I don't know whether I'll follow Amber's lead (via Will Baude) and do the 50-book challenge this year. I will, however, try to blog about the books I read a bit more often.

Homeland, by Dale Maharidge, looks at how the terrorist attacks of 9-11 and the "war on terror" that's followed has affected working-class America. The book describes the fervor with which some economically dislocated blue collar workers adopted a hyper-patriotic nationalism in response to 9-11, and the damage this has done to people who've dared to question the Bush administration's authoritarian response. Meharidge tells the stories of Katie Sierra's suspension from her West Virginia high school for wearing an anti-war T-shirt, the anti-arab response by underemployed workers on Chicago's southwest side, and the effort by white-supremacist groups to use the country's new nationalist mood to recruit members.

The stories Maharidge tells are fascinating, but they're not particularly shocking or numerous. This is why it's hard to immediately agree with him when he compares the nationalism of post 9-11 America to Weimar Germany. Maharidge is careful to point out the limitations of his comparison, though:

As history shows, everything about the Weimar era was steroid-packed with extremes--violence by thugs that no modern democratic society would tolerate, bizarre currency fluctuations, a Great Depression. In the recent war, the nations of Europe had lost millions of citizens. There was stunning bitterness across the continent.

It may seem inconceivable to us that a new Hitler could emerge in modern times, trying to force armed revolt, suspending elections, dragging a country into a world war. The latter could only happen under a weak parliamentary form of government. The American two-party system may be flawed, but it's much harder for a fringe group to gain power.

As for race, the norms of contemporary society would not allow open racial hatred (p. 163).

The interesting thing about this book is that it forces you to ask the question: how precisely is American hyper-nationalism different from that of Weimar Germany, or from pre-Mussolini Italy, or from the Balkan states in the 1990s? Certainly we have something in common with all of them. We've got a growing number of unemployed and underemployed workers who are frightened both by their bleak futures and by the threat of more terrorist attacks. We've got ideologues like Ann Coulter and Rush Limbaugh who aren't shy about using this anger and fear for their own partisan ends. We've got a President who capitalizes on fear to justify the extension of the state's police powers. George W. Bush gives the rich huge tax cuts while simultaneously engaging in preemptive war, driving up deficits and increasing the financial burdens on government services.

Where will all this end? We're a long way from fascism, but how much should we be worrying about trends that seem to be taking us closer?

My own first thoughts are that we should be worried. If I believed that the Patriot Act and the invasion of Iraq were necessary to counter a real terrorist threat, that would be one thing, but I don't believe that either was necessary. Both were probably counterproductive.

Meharidge describes America as divided into ideological thirds: the extremes of right and left, and the middle. His book is a description of how working-class citizens in the middle can fall under the spell of the far right. Maharidge has seen things that convince him that American ultra-nationalism is a real threat. Although I haven't seen the same things myself, I think I'll keep his warnings in the back of my head somewhere. Hopefully, I won't ever need them.

Posted by Carey at 07:03 PM | Comments (0)

January 05, 2005

Some new standard questions

Here's a good chance to practice our (hopefully) renewed skepticism in the face of the influence that big drug manufacturers have over clinical research.

The results of two new clinical studies on heart disease are grabbing headlines, and are likely to get a lot of public and professional attention. Both studies were sponsored by big pharmaceutical companies that make cholesterol-lowering statin drugs. According to the NYT, both studies suggest that C-reactive protein, or CRP, is an independent marker for important clinical endpoints--in the case of one study, heart attacks, and in the case of the other, heart disease progression. These studies might suggest that physicians should try to reduce their patients' CRP levels as well as their cholesterol levels. More aggressive use of statin drugs would be one way for physicians to do this.

The drug companies will almost certainly encourage patients, in the sonorous tones of the inevitable Pfizer ad, to "ask your doctor about CRP, and whether Lipitor is right for you." Bristol-Meyers-Squibb will trumpet the results of these studies in their Prevachol ads weighing down the next issue of American Family Physician. Both firms will certainly instruct their sales force to mention both studies in the detail lunches they provide in the back room of doctors' offices across the country.

Before the docs start reaching for their prescription pads, we can hope that they'll subject these studies to the usual close statistical and clinical scrutiny that responsible physicians should direct at any study. They'll note that neither study demonstrates that CRP is a cause of bad clinical outcomes. They'll realize that both studies looked at patients with known heart disease, and question the applicability of the results to healthy patients. Perhaps they'll also (God forbid) remember that exercise reduces CRP too.

Since we're wishing on stars, let's hope that they'll subject the studies to an economic and political scrutiny, too. How many studies may have been started or finished (but never published) which showed no independent correlation between CRP and any clinical endpoint? How much control did Pfizer and BMS have over the data in these two studies?

Seems to me, that's the physician's job. To exercise his or her best judgment on behalf of patients.

Posted by Carey at 07:28 PM | Comments (0)

January 04, 2005

Dumb and dumber

Majikthise links to this hilarious compilation of stupid tattoos. Check out #4. The tattoo isn't all that bad; the hairstyle and the pot belly are hideous.

Transmogriflaw gives us a link to some photographic evidence which tends to support the thesis that women are smarter than men. Smart guys will counter with Tattoo #10, above.

Posted by Carey at 11:27 PM | Comments (0)

James McMurtry; weightlifting with mom

What do these two things have in common? Nothing, except that I'm cramming them into the same blog post. Stand back, people, and you won't get hurt.

James McMurtry has been one of my favorite singer/songwriters since the early '90s. I'd pop in "Too Long in the Wasteland" back in the kitchen at Lynx Creek Pizza in Alaska when it was my turn to choose the music, and I'm sure I converted a few of my co-workers to the McMurtry cause by the end of the summer. (Of course, I'm sure I also planted the seeds of an undying McMurtry loathing in some of my colleagues with weaker minds, but I'm not responsible for their shortcomings.) Thudfactor now tells us that there's a new McMurtry live album out there:

James McMurtry continues to be my favorite male vocalist and performer. I recently picked up “Live in Aught-Three” which has fantastic extended jams from his entire catalog. I even like “Chocktaw Bingo” here, and I always skip the track on Saint Mary of the Woods.
Since I never skip "Chocktaw Bingo" on the studio album, I'm sure gonna love this, boy howdy.

On a different subject entirely (don't say you weren't warned), I did some weightlifting with my mom today. We went down to the gym after she got off of work, and I showed her how to use a few of the machines and how do do a few lifts with the dumbbells. When it came to moving the weights in a controlled way, my mom just seemed to "get it." Impressive.

One of the things that impresses me about both my parents is their willingness to try new things that they've never tried before. For too many people, if they haven't tried it by the time they're eighteen, they won't ever try it. I'm very proud of my mom and dad both for refusing to be sticks in the mud. They're both good role models for me.

Posted by Carey at 11:02 PM | Comments (0)

Privatization of higher education continues

The privatization of this country's institutions of higher learning continues apace. The Legal Reader highlights an LA Times article about Boalt dean Christopher Edley's response to continued cuts in state funding for California's flagship public law school. The bottom line: Boalt must seek private money to replace lost public funding, but it can't succeed unless private donors can be assured that the school will dance to their tune and not to the state's. As Edley puts it, Boalt should be able to "eat what it kills."

On a campus where departments expect to rank among the best, the law school has fallen out of the top 10 in some national ratings. Its nonresident tuition has soared to match the priciest private institutions. It is losing faculty to rivals and has outgrown its aged buildings.

As Edley points out, state money has faded from 60% of Boalt's budget in 1994 to 30%. That has been offset mainly by higher tuition: California residents pay just under $22,000 a year to attend the law school, about double the rate four years ago. Annual out-of-state tuition is nearly $34,000.

The same thing is happening to public medical schools. My own alma mater, the University of Colorado School of Medicine, is seeking "enterprise status," which will enable it to raise tuition as much as necessary to cover the loss of state funding. Dean Richard Krugman writes in the most recent issue of the alumni magazine that tuition revenue has exceeded State support for the first time in more than a century, and that this "de-facto privatization of higher education in our state has received no substantive response by the public, the Governor, or the legislature."

The privatization of higher education doesn't get as much media attention as, say, the privatization of Social Security, but its consequences may turn out to be more significant. Higher education has always been the ticket to socioeconomic mobility in America. A college or graduate degree is even more important for retaining a foothold in the middle class in the face of economic globalization. And yet we are choosing, bit by bit, to limit access to higher education only to those whose families are already wealthy. As states limit access to their public universities, the federal government chooses to make financial aid harder to get.

This is a recipe for disaster. One of the reasons why class warfare is so muted in this country is that everyone here believes that anyone can succeed and grow rich. Universal access to higher education was always a critical reason why this American myth was rooted in some kind of reality. I wonder how long the AM-radio demogogues can keep the myth alive after the reality ceases to exist.

Posted by Carey at 01:16 AM | Comments (0)

January 02, 2005

Where's that blog gone?

Does anyone know what's happened to Intueri? That blog is so good that I'm suffering withdrawal symptoms after only two weeks of not reading it.

On a different subject entirely, this is hilarious.

EDIT: Apparently Maria got her domain name back. Nick had the right link.

Posted by Carey at 04:15 PM | Comments (0)

Health care in rural areas

Our rural areas might be the canary in our health insurance coal mine. Today's Denver Post has an article describing how some rural physicians in Colorado are beginning to take single-payer national health insurance seriously:

A Nebraska-bred country boy, a Republican- voting, ranch-owning, small-town doctor, he hardly fits the profile of a wild-eyed revolutionary. But White and a handful of cohorts are, in fact, trying to foment upheaval.

The revolution they are proposing: a national health-insurance program. Nothing short of that will fix what White calls "our god-awful broken system." White says he didn't jump to this conclusion. He was pushed.

Pushed by the same forces that plague health care across the country: steep insurance premiums; soaring prescription-drug costs; 45 million Americans without health insurance; bureaucracy; and Medicare and Medicaid reimbursements that don't cover costs.


The problems facing rural areas are fundamentally the same as those facing urban and suburban regions. The growing number of uninsured patients drives up the costs of health care for patients with insurance, and simultaneously drives down reimbursement rates to physicians and hospitals (the so-called 'death spiral'). The only winners in our current system of private health insurance markets are the big nationwide insurers like Aetna.

Rural areas, with their stripped-down roster of players in the health-care industry (employers, insurers, hospitals, etc.), differ from the rest of the country only because it's easier to see what's going on. The pool of wealthy patients that can afford to pay their ever-increasing health care insurance premiums is smaller in rural areas. Fewer people in rural areas can afford to indulge their ideological preferences as a means of postponing the ultimate confrontation with the problems of our private health insurance system (and with the problems of our public insurance systems, Medicare and Medicaid).

We might hope that rural America might begin to push for national health insurance, but I remain skeptical. Rural support for George W. Bush suggests that we shouldn't underestimate the power of ideology to override common sense. Patients will continue to lose their insurance, insurers will continue to leave rural markets altogether, physicians will continue to see their reimbursements shrink and will themselves continue to relocate to more lucrative locations, hospitals will continue to close.

Based on what we've seen in the last elections, though, none of this will matter. The power of the AM-radio demogogues will keep our rural population in thrall to the extreme free-market ideology that's responsible for their health care woes. And the Democrats won't offer any real alternative, so long as they allow themselves to be led by the Clintonesque DLC under the leadership of people like Al From.

Our rural areas may be our health-care canaries, but they're not going to be our health-care saviors.

Posted by Carey at 03:30 PM | Comments (0)

January 01, 2005

Geese

Denver's winter skies are wonderful. The city sits underneath the migratory flyway for thousands of geese. You can usually hear them coming before you can see them: honk! honk! honk! The sound gets louder as they approach, and then you see them flapping past in these big V-formations. The goose in the front seems to know where he or she is going, and everyone else streams out behind like bike racers in a strong crosswind. The honking gets softer, and they they're gone.

Posted by Carey at 10:19 PM | Comments (0)