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Archive for the ‘Health Care’ Category

My little sister attends the University of Vermont, and today she noted she was “one of three people at UVM not excited about the date“. I share her ambivalence. (more…)

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Because Keith Olbermann and I agree on something.

I know, I’m scared too.

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Quick thoughts on a Monday. Springtime is the best season. By far. The first day of sundress season should be a national holiday.

Ahhhhh Sweet Spring

Anyone care to argue any of these claims?

1. The American health system has been broken for a long time.

2. This bill won’t improve quality of service.

3. It won’t decrease prices to patients.

4. It won’t decrease costs to doctors and hospitals.

5. It won’t reduce the deficit. It will follow ignominious history.

6. It isn’t constitutional.

7. The six-month enactment period will give lawyers for all conceivable parties AMPLE time to scout for plaintiffs, jurisdiction shop, and draft briefs and motions. This will lead to a period of litigation, lasting anywhere from three years to a decade.

8. If the Republicans do win control of either the House or the Senate, a bill will be introduced to repeal this law within the first two months of the new Congress.

9. Reihan Salam will be right: “Coming soon: the Democratic Dolchstoss strategy: “Of course it didn’t work. It was a moderate Republican bill! What we really need is …”

On Intrade, the prop bet that Republicans control the House after November has gained about 43% in just over a year. Given that, it’s bizarre that liberals are still haunted by the specter of libertarianism.

I watched the Maryland – Michigan State game in Baltimore in a bar full of Maryland fans, and it was heartbreaking. On State’s last possession, the clock didn’t start for about a half second. The buzzer beater went up with .4 on the clock. Brutal.

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This morning the New York Times is trying to justify anti-abortion measures in the Senate health-care overhaul. Sort of.

The most likely path forward is for the House to approve the Senate’s version and for both chambers to approve amendments that would make it more palatable to House members. To get those amendments past a Republican filibuster, Senate Democrats plan to use “reconciliation.” That only requires a majority vote, but it is just for budget-related issues, which means the abortion provisions can’t be changed.

Representative Bart Stupak, a Michigan Democrat, says that unless the Senate’s anti-abortion provisions are strengthened, perhaps a dozen House Democrats who voted for the House version won’t vote for the Senate’s bill. Before they push their party’s signature domestic issue over a cliff they need to recognize how incredibly restrictive the Senate’s provisions already are.

I don’t believe in the pretense of journalistic objectivity; that’s a crock of self-serving nonsense. It’s interesting to see the Times dispose of it so plainly, in favor of such strong direct marketing to one particular political interest group (and power base).

Those restrictions are a blatant government interference in a serious health care decision that should be made by a woman and her doctor. But for some House members they are still not enough.

They want a House provision that would not allow a woman even to use her own premium contributions to pay for abortion coverage in any plan that accepts subsidized enrollees; she would have to buy a separate rider that few insurers would likely offer.

This highlights one of the main problems of centralization; some people with serious and considered objections to abortion on moral, intellectual and religious grounds could be forced to subsidize activities they strenuously oppose.

The Times points out that this is a serious and personal concern, as closely tied to one individual and their family as possible. I agree, but the Times contention that because it’s an important decision it requires government intervention doesn’t follow. If something is deeply personal, should responsibility lie with the person? I also like how the Times editors can predict the market reactions months and years ahead of the actual market conditions. Get those men and women out of their offices and on the trading floor.

Watching the Times rally House Dems to the party line is good theater; a macabre and depressing choreography. Polls from both Rasmussen and Gallup show Americans are mostly opposed to this bill, and I’m interested in how the party of ‘democracy’ will pass this off. Give that I’ve said that point is window dressing and not a serious principle, the answer will probably be, easily.

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Robin Hanson investigates a new study on antidepressants which shows they don’t really work.

The only reason Menand can imagine resisting such artists is a perverse religious desire to suffer:

What if there were a pill that relieved you of the physical pain of bereavement—sleeplessness, weeping, loss of appetite—without diluting your love for or memory of the dead? Assuming that bereavement “naturally” remits after six months, would you take a pill today that will allow you to feel the way you will be feeling six months from now anyway? Probably most people would say no. … Gerald Klerman once called “pharmacological Calvinism” … the view, which he thought many Americans hold, that shortcuts to happiness are sinful, that happiness is not worth anything unless you have worked for it.

Numbers schmumbers – only uncivilized animals, or religious nuts, would not let eloquent authors soothe their savage doubts, until they accept being comforted by their culture’s conventional ways to show that folks care.

Years ago I read Elizabeth Wurtzel’s uneven but fascinating Prozac Nation and noticed the same dynamic. Despite a long intense and varied regime of drugs, depression haunted her until a personal epiphany. This pattern is repeated in most anecdotal accounts of depression I’ve come across. (I would recommend this book to anyone interested in mental disorders, but at all costs avoid the movie, it’s total shit.)

While antidepressants are based on the hard scientific evidence of brain chemistry, someone could explore the causal relationship between moods and brain chemistry; does depression cause a self-perpetuating change in chemical activity? This kind of sudden shift in both mood and brain activity seems to be strongly correlated.

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At least Matt Yglesias does. Via his twitter feed, he writes:

It’s a bit strange that a majority of Americans approve of Obama’s job performance, seeing as he’s so unpopular and all

He’s referring to this Gallup poll, which shows the President with a slim nine-point advantage in overall job approval. Twitter is certainly the place for snarky one-liners, but Matt’s being disingenuous.

First, as polling goes, this question is pretty ridiculously broad. The sample is “adults”, and the question is whether they “approve or disapprove of the job Barack Obama is doing as president.”

Rasmussen gets unfairly slammed as being partisan, but their results are amazingly accurate. Their more detailed Daily Presidential Tracking Poll uses much different method, but asks a similar question. The main differences are that Rasmussen targets only ‘likely voters’ and not the general population, and that Rasmussen only compares those groups with strong feelings either for or against the president. The differences are significant. Rasmussen pegs approval at -7 (as of today), although he’s recently hit a low of -19. The distance between +9 and -7 is vast.

So which view is correct? I think Matt is guilty of seeing what he wants to see. Would he argue that Bush was “popular” in 2005? I doubt it. But that’s the last time he polled a similarly positive number from Gallup, in March.

The most damning criticism from Obama isn’t generalized, it’s specific. CBS has him pulling a -18 on health care. On Cap and Trade, a joint NBC/WSJ poll reported in October that the bill was rapidly losing steam, and the Journal cited other polls from The Atlantic on how confused the public was. I’ve seen nothing to alleviate any of those problems; the old adage is that a confused mind says ‘no’. On safety (which I think is a misguided goal, but certainly one that weighs heavily in the minds of many voters), only 36% believe the country is “safer” than pre-9/11. Finally, and most problematic, only 26% think the nation is “headed in the right direction”.

Some of my liberal acquaintances have argued that polling only likely voters skews the numbers. However, this seems to conflict with the other liberal claim, made often on this blog by frequent commenter Tom, that the majority of the masses are stupid, and we shouldn’t pay attention to them. It seems disingenuous to discount the majority of the public when they disagree with you, and cherry pick popular sentiment when it’s handy.

Maybe it’s me. Maybe I’m seeing what I want. I certainly agree that we’re on a bad path, and I agree with most of the policies referenced above are wasteful, arbitrary, prone to corruption and graft, and generally bad ideas. But I’ve examined the methodology of the polls, and looked at my suppositions. My bias is for results, not ideological harmony. I agree we could discount those unlikely to vote, in all cases. As mentioned, I am in the minority on some of these issues.

I don’t know how Rasmussen determines ‘likely voters’, but so far the firm is vindicated by results. It will be interesting to see if they can continue this track record, given that Obama’s supporters in the last election are traditionally apathetic in election cycles (minorities and young people have the lowest turnout rates, and those were two core Obama support groups).

That’s why I think Matt is seeing what he wants to see.

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Apologies for the light-to-non-existent posting during the holiday season.  Life gets in the way of all good things.

I was struck by this post from Prof. Bourdeaux, on the cost-free signaling aspects of polls and elections, and how this relates to an ongoing argument in our comments on the rationality or credibility of the electorate.  Cost-free signaling should be discounted heavily; as Prof. Hanson might say, it’s an argument for ‘ought’ divorced from ‘is’.

One of the biggest reasons to advocate for market-processes and individual responsibility is the knowledge problem.  We reference it in this blog’s subtitle, but it has deep epistemological implications that we glance over.  Since there’s often no clear consensus on ‘is’, principled consensus on ‘ought’ is much harder to form.  Instead we get political wrangling like health-care, where the argument is over who gets what, not either ‘is’ or ‘ought’.

The Austrians made the point that markets contain significant truth-determining mechanisms, and that the subjective value of a good or service was essentially a consensus, not intrinsic.  Otherwise, how could we explain radical price drops like this?

When I was a philosophy student, we talked endlessly and circularly about the nature of reality, about the limits of perception, and how that should shape a consensual view of existence.  Things like colors are social constructs, since we can never experience something through another set of eyes.  But it’s wrong to take the next step and say that all reality is consensual.

This goes towards my central objection to centralist/liberal/neocon ideology; that we can arbitrarily decree ‘is’ from some discreet principle or emotion, and dictate ‘ought’ in politics.  To put it differently, freedom and markets determine ‘ought’ through accurate and efficient signaling, and in turn tell us much about what ‘is’.

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