Quotulatiousness

August 14, 2009

If it isn’t Astroturf . . .

Filed under: Health, Politics — Tags: , — Nicholas @ 12:34

. . . maybe it really is grassroots? Jesse Walker decodes some of the hysteria around both the protests and the official responses:

Clashes keep breaking out at the “town hall” meetings devoted to discussing health care reform. Usually the excitement amounts to some angry questions and heckling, but sometimes there’s more. Six people were arrested at a demonstration outside a meeting in St. Louis. Violence erupted at a town hall in Tampa after opponents of ObamaCare were locked out of the building. A North Carolina congressman cancelled a meeting after receiving a death threat; the pro-market group FreedomWorks, which was involved in some of the protests, fielded a death threat of its own. Supporters of the president’s health care reforms, who used to tout the support he’d received from the pharmaceutical and insurance industries, are now accusing the very same companies of riling up “mob violence” to stop the plan.

As the charges and countercharges fly, here are three maxims to keep in mind:

1. It isn’t Astroturf after the grassroots show up.

[. . .]

2. It isn’t unprecedented if there are obvious precedents. When someone like New York Times columnist Paul Krugman claims that the “mob aspects” at the meetings are “something new and ugly,” all he’s demonstrating is that he’s an economist, not a historian. When it comes to bands of angry citizens being disruptive, it isn’t hard to find earlier examples in American history. It isn’t even hard to find earlier examples in 21st century American history. Just go to Google and punch in phrases like “guerrilla theater,” “antiwar protest,” and “Code Pink.”

[. . .]

3. It isn’t fascism if…actually, you can stop there. IT ISN’T FASCISM, you numbskulls.

August 12, 2009

QotD: “an abject failure for the Obama administration”

Filed under: Health, Politics, Quotations, USA — Tags: , , , — Nicholas @ 12:34

But who would have thought that the sober, deliberative Barack Obama would have nothing to propose but vague and slippery promises — or that he would so easily cede the leadership clout of the executive branch to a chaotic, rapacious, solipsistic Congress? House Speaker Nancy Pelosi, whom I used to admire for her smooth aplomb under pressure, has clearly gone off the deep end with her bizarre rants about legitimate town-hall protests by American citizens. She is doing grievous damage to the party and should immediately step down.

There is plenty of blame to go around. Obama’s aggressive endorsement of a healthcare plan that does not even exist yet, except in five competing, fluctuating drafts, makes Washington seem like Cloud Cuckoo Land. The president is promoting the most colossal, brazen bait-and-switch operation since the Bush administration snookered the country into invading Iraq with apocalyptic visions of mushroom clouds over American cities.

You can keep your doctor; you can keep your insurance, if you’re happy with it, Obama keeps assuring us in soothing, lullaby tones. Oh, really? And what if my doctor is not the one appointed by the new government medical boards for ruling on my access to tests and specialists? And what if my insurance company goes belly up because of undercutting by its government-bankrolled competitor? Face it: Virtually all nationalized health systems, neither nourished nor updated by profit-driven private investment, eventually lead to rationing.

I just don’t get it. Why the insane rush to pass a bill, any bill, in three weeks? And why such an abject failure by the Obama administration to present the issues to the public in a rational, detailed, informational way? The U.S. is gigantic; many of our states are bigger than whole European nations. The bureaucracy required to institute and manage a nationalized health system here would be Byzantine beyond belief and would vampirically absorb whatever savings Obama thinks could be made. And the transition period would be a nightmare of red tape and mammoth screw-ups, which we can ill afford with a faltering economy.

Camille Paglia, “Obama’s healthcare horror: Heads should roll — beginning with Nancy Pelosi’s!”, Salon.com, 2009-08-12

August 10, 2009

Healthcare systems compared

Filed under: Cancon, Economics, Health — Tags: , , — Nicholas @ 12:55

No, not the usual red-in-tooth-and-claw US system of mercenary medicine against the shimmering city-on-the-hill of [Canadian | British | Swedish | Generic European] socialized medicine. This one is a bit easier to compare: human verses pet healthcare. Theodore Dalrymple discusses the issue:

As a British dog, you get to choose (through an intermediary, I admit) your veterinarian. If you don’t like him, you can pick up your leash and go elsewhere, that very day if necessary. Any vet will see you straight away, there is no delay in such investigations as you may need, and treatment is immediate. There are no waiting lists for dogs, no operations postponed because something more important has come up, no appalling stories of dogs being made to wait for years because other dogs — or hamsters — come first.

The conditions in which you receive your treatment are much more pleasant than British humans have to endure. For one thing, there is no bureaucracy to be negotiated with the skill of a white-water canoeist; above all, the atmosphere is different. There is no tension, no feeling that one more patient will bring the whole system to the point of collapse, and all the staff go off with nervous breakdowns. In the waiting rooms, a perfect calm reigns; the patients’ relatives are not on the verge of hysteria, and do not suspect that the system is cheating their loved one, for economic reasons, of the treatment which he needs. The relatives are united by their concern for the welfare of each other’s loved one. They are not terrified that someone is getting more out of the system than they.

And, yes, I know it’s extremely bad form to quote yourself, but here is what I wrote on the subject back in 2004:

It boggles the mind to think that it is possible for pets to receive faster, better-organized, more personalized, and more friendly healthcare than their human owners are able to get. And it’s absolutely true.

My wife works in a vet clinic. I know how much the staff at the clinic care about their patients and the families of their patients. They do their very best to ensure that the cats are properly diagnosed and treated. But they are paid for their work . . . by the families of the patients.

One of the comments on Marcel’s original post talks about “the Vet’s next Porsche purchase”. That by itself shows the utter ignorance of the commentator: you do not go into veterinary medicine to get rich. For the length of academic study, it’s probably the worst-paid bio-science field there is. The veterinarians, vet assistants, and vet technicians could all earn significantly higher wages in other fields for the same investment of time and money in training.

Medicine, whether for humans or for other animals, is an expensive field: typical Canadians don’t really know this, as a rule, because we don’t pay for it directly. Vets, as a rule, don’t have the latest and greatest equipment because they are running private businesses which have to finance equipment purchases out of their own funds. They generally have the best compromise they can manage between what’s available and what’s affordable.

Treatment for patients must be decided with an eye to costs: Fluffy may need treatment X, but if it’s going to cost hundreds or thousands of dollars, Fluffy’s owner is left with an unwelcome decision to make. We never think of this in terms of our own healthcare: instead of rationing by dollars, we ration by time. The resources are still scarce, but we pretend that delaying surgery for a painful ailment is better than paying extra to get the surgery done sooner; in fact, in Canada, there’s no choice involved at all.

The other pernicious effect of hiding the actual costs is to increase the demand for relatively trivial treatments (which could often be taken care of by family doctors, walk-in clinics, or even pharmacists). If you never see a bill, you never feel any reason to limit your personal demand on the system. It’s rational for you to extract as much personal benefit from the system as possible: you paid taxes to support it, right?

August 8, 2009

Dieting and obesity

Filed under: Health — Tags: , , — Nicholas @ 00:13

Megan McArdle had an interesting-but-lengthy post earlier this week on obesity and both the scientific and political issues surrounding it:

I don’t agree with Paul Campos about everything, but I do agree with some of his core propositions:

  • Study after study shows that most people are unable to lose more than a small percentage of their body weight and keep it off without major surgery
  • There is evidence to show that this is physiologic rather than pyschological — it is nearly impossible for very heavy people to simply “eat less and exercise more” to a “normal” weight (given that 2/3 of the country is overweight or obese, normal weights, aren’t.)
  • The fact that this often operates through the appetite system does not mean it’s “all in their heads” or a lack of willpower. Appetite is a signal as powerful as thirst or pain. Most people can’t ignore it.
  • The largest environmental determinant of this trend is probably simply cheaper, tastier calories, which will be very hard to reverse

[. . .]

This really is a pattern that you see over and over again in obesity research. It’s as if researchers are terrified to say anything that might be viewed as giving people license to get fat. The CDC researcher who sharply revised downward the estimates of deaths from obesity, finding that overweight was actually healthier, fell all over herself proclaiming that of course, this didn’t account for quality of life. Because we know that a woman who weighs 160 pounds couldn’t possibly have a decent quality of life . . . ?

[. . .]

I know, I know . . . it’s for the children! I am very fond of children. But I do not actually think that they are some sort of master race in whose name anything at all can be justified. And if I did, I’d be a lot more worried about, oh, abortion, than McDonalds ads.

Two final points. Everyone likes to focus on their favorite boogeymen. To read a left-wing blog, you’d think that about 95% of the leading cause of obesity was agribusiness, chain restaurants, and automobiles. To read a right-wing paper, it’s all the infamous lack of self-control displayed by the poor.

But in fact, most of the things effecting kids are side effects of other efforts a lot of people are rather fond of. Processed foods and chain restaurants have exploded in the last two decades because Mom spends more time outside the home, generating more market income, and less time for home cooked meals. Kids exercise less not because crime is higher, or even because we’ve become more suburban, but because they’re no longer allowed to operate unsupervised until they’re quite old, and Mom and Dad both work. Schools don’t have P/E because they’re using the time to teach kids to read. Maybe those were bad tradeoffs. But they’re not irrational tradeoffs, and switching them back is not costless.

One thing Megan doesn’t touch on in the post (although she had done in earlier posts on this topic) is that metabolic changes over individuals’ lifetimes can actively sabotage good intentions on maintaining a given weight. Up until my late 20s, I could lose weight just by thinking about it, and then suddenly in my early 30s, I discovered that taking weight off was something that now needed a more conscious effort. Now I’m finding it even tougher to manage my weight (and also harder to make and take advantage of opportunities to get some exercise). My innate laziness and enjoyment of good food and good wine can usuallyalways overwhelm any urge to go do something healthy instead.

And no, I didn’t copy the entire post . . . there’s lots more, and it’s all worth reading.

August 7, 2009

The error of being generous to your opponents

Filed under: Economics, Government, Health, USA — Tags: , — Nicholas @ 12:48

Megan McArdle is called to task for making a mistake . . . through being too generous to her opponents:

I erred so low because I was trying to be charitable to the cause of national health care. You see, the reason that insurance premia are so high in New York State is that New York State enjoys community rating, guaranteed issue, and a very generous bevy of mandatory services. The result is that the cost of insurance is very, very high. What I failed to realize was just how radically out of line New York’s rules had pushed its health care costs. The average premium across the United States has increased about 25% since 2004. In New York, the rate of inflation has apparently been about 16 times that. I wasn’t “aware” that insurance premiums have doubled and tripled over the last seven years, because for the country as a whole, this isn’t true.

So yes, John, the Atlantic’s economics expert didn’t realize just how much the kind of regulations Democrats are now pushing had managed to screw up New York’s health insurance market. In trying, while writing a blog post on the fly, to err on the side of charity towards my ideological opponents, I grossly misled my readers. Massive state interference in the insurance market is clearly much, much worse than I — the eternal pessimist! — managed to imagine. Thanks for calling that oversight to my attention.

QotD: It’s not insurance, it’s welfare

Filed under: Health, Quotations — Tags: , — Nicholas @ 00:06

Have [New York Times writers and editors] no understanding of risk management? If it is controversial for health insurers to reject sick applicants, it should be controversial for life insurers to refuse to insure the already dead, and for car insurers to refuse to insure cars that have already been wrecked.

Doing that may be required by Congress and cheered by the New York Times, but that doesn’t make it a good thing for America. It doesn’t even make it insurance. It’s welfare. We can debate whether such welfare is good policy, but let’s discuss it honestly. Calling welfare “insurance” muddies thinking.

Requiring insurance companies to cover the sick takes away insurers’ power to encourage safer behavior. This will soon turn insurance into a form of expensive, taxpayer funded welfare.

John Stossel, “Welfare, Not Insurance”, John Stossel’s Take, 2009-08-05

August 6, 2009

QotD: Depression

Filed under: Health, Quotations — Tags: — Nicholas @ 00:01

I will meet October with a great weight off my chest. I will meet December with the novel mostly done. In between now and then I just want to be happy and content and useful. The last two weeks have been a bit unfortunate, with the Black Dog prowling and growling in the bushes outside the reach of the campfire light; I just lost enthusiasm for my enthusiasms. I think it’s lifted. The worst thing about Depression isn’t the sense that you’re ac-centuating the negative, it’s that you’re seeing things the way they really are, stripped of the illusions you use every day to divert yourself from the Yawning Maw of Futility. It’s the wind that blows off the snow and reveals the stone.

James Lileks, Bleat, 2009-08-04

August 5, 2009

Blotting out Rorschach tests

Filed under: Health, Technology — Tags: , , — Nicholas @ 07:50

Colby Cosh examines the furor around James Heilman’s posting of the original Rorschach inkblots to Wikipedia:

It is probably no great loss. Critics of Heilman complain that “decades” of research will have to be abandoned if the Rorschach test becomes impossible to use. But most of this research has been shown, in the last 20 years, to be flapdoodle. As soon as the test became popular — so much so that it became a staple of comedy routines about Freudian psychotherapists, along with couches and thick German accents — it had critics who pointed out that there was little or no statistically validated basis for its interpretation. After the psychiatric profession got around to trying to establish such a basis — and this happened disgracefully late in history — there was little or nothing left of what had once been perceived as the broad general usefulness of the Rorschach.

Much of the folklore that had grown up around specific elements of the test had to be thrown in the trash. It appears to have modest predictive or diagnostic power for a few very specific aspects of personality, and even this surviving foundation is shaky. Yet supporters gave, and some are still giving, the same indignant defences that pseudoscience always receives. Interpreting responses to Rorschach blots is more “art” than “science,” they have insisted. (The mating call of the quack.) Only those who are intimately familiar with the test — i. e., those who believe in it and have come to depend on it — are really qualified to judge whether it “works.”

But can the thousands of psychologists and psychiatrists who have considered the Rorschach test a useful item in the healing toolbox for generations really all have been wrong? Keep in mind that the same practitioners were eagerly recommending and performing lobotomies throughout the same period, and you have your answer.

July 28, 2009

QotD: Re-interpreting that number

Filed under: Government, Health, Quotations, USA — Tags: — Nicholas @ 07:38

There have been two trends in US health care over the last decade. On the one hand, a lot of Americans have become, in any rational sense, over-insured: They get tested for things they’ll never get. On the other, there has been an abandonment of health insurance by the rich. If you peel the Census Bureau and DHHS figures, of those alleged “45 million uninsured Americans”, one-fifth aren’t Americans; another fifth aren’t uninsured but are covered by Medicare; another two-fifths are the young and mobile (they don’t have health insurance, but they don’t have life insurance or home insurance, either: they’re 22 and immortal and life’s a party); and the remaining fifth are wealthier than the insured population. Really. According to a 2006 Census Bureau report, 19 per cent of the uninsured have household income of over $75,000. Since the last round of government “reform” in the Nineties, wealthy Americans have been fleeing insurance and opting to bring health care back to a normal market transaction. And, if you look at the “uninsured discount” offered by doctors, one can appreciate that, for everything but chronic disability, it’s not an irrational decision to say I’ll get a better deal for my broken leg or my colonoscopy or my heavy cold if I just write a check for it.

Mark Steyn, “The Nationalization of Your Body”, National Review, 2009-07-28

July 22, 2009

Looking for Canadian health stats?

Filed under: Bureaucracy, Cancon, Health — Tags: , , — Nicholas @ 09:59

Kathy Shaidle has some useful advice for Americans who may be looking for information on the Canadian healthcare system.

Up here, the key word in discussions is “wait times”. That’s what we say, when you say “rationing.” The ONLY way for our system to work is to “hope” somebody ahead of you in the line for care dies, and you can take their place. A very cynical, nasty way to run a country, to say the least.

So go to Google.ca (especially the “News” section) and look up “wait times” if you want to get the real Canadian conversation on our health care system.

July 21, 2009

iPhone as convenient marijuana lookup device

Filed under: Health, Technology — Tags: , , — Nicholas @ 14:50

This is quite a cool idea:

We’ve seen a lot of unexpected, and sometimes cool, iPhone apps approved by Apple, but today’s news might top the rest. Apple has approved a marijuana — that’s right, marijuana — app called “Cannabis,” which lets users find the nearest (don’t worry: legal) supplier of medicinal marijuana.

Created by the founder of Ajnag.com, which was founded in 2006 and was the first medicinal marijuana locater on the Web, the new app is quick and easy to use. Simply open it up on your iPhone or iPod Touch and you’ll see a map with the nearest distributors. The app gives you information on each of the locations, and even step-by-step directions with Google Maps.

That’s not all, though — the creators thought of everything. If you run into any, erm, legal troubles with your newly-secured marijuana, Cannabis also gives you the locations of the nearest lawyers who specialize in marijuana cases. And, if you happen to live in one of the 37 states where marijuana is not legal, the app also provides you with the location of the nearest marijuana activist groups — so you can do your part to promote reform.

July 20, 2009

QotD: TANSTAARTHC

Filed under: Economics, Health, Liberty, Quotations — Tags: , , — Nicholas @ 12:37

There. I said it. Someone had to.

The acronym would be TANSTAARTHC. Nowhere near as euphonius as TANSTAAFL.

I broach the subject because I can’t seem to turn on a TV or radio without hearing, “Health care is a human right.” The phrase has entered the zeitgeist. Google it and you’ll get 25k hits. Google “right to health care” and you get 200k. Maybe I’m not listening hard enough, but I hear no one questioning its validity.

A right is intrinsic. It’s not given to you, it’s something you’re born with. Its existence is not dependent on the actions of others. In fact, only by the actions of others can it be taken from you.

F. Paul Wilson, “There ain’t no such thing as a right to health care “, Libertarian Enterprise, 2009-07-19

July 18, 2009

Healthcare costs

Filed under: Economics, Health — Tags: — Nicholas @ 17:43

Several years back, Elizabeth worked as an office manager at a vet clinic. She enjoyed the work, although it didn’t pay well. One of the most frequent complaints from the customers was the high cost of vet care. This graph from The Enterprise Blog shows that the rates of increase in healthcare costs are intriguingly similar between pets and their owners (note the different scales on the left and right side of the chart):

Health care costs: pets versus people

The chart [. . .] shows spending on veterinary care, which I pulled from the Consumer Expenditure Survey, and national health expenditures (for people) from the National Income and Product Accounts. Two things are interesting here: first, the rate of growth of spending from 1984 to 2006 wasn’t all that different — and in both cases, spending grew faster than the rate of economic growth. As new technologies are developed for humans, we adopt them for Bowser and Fifi — because we can afford to and we think it’s worth it.

Here in Canada, where we almost never know the actual costs of the healthcare services we receive, the stark reality that healthcare costs money is a nasty surprise. We don’t spend anything like the same real dollars on our dogs, cats, and other pets as on ourselves or our family, and the fact that we don’t have a clue how expensive it is fuels the constant political demand that we provide more “free” healthcare.

On the other hand, in much of Canada, it’s possible to get X-rays, MRI, CT scans, and other diagnostic tests done in hours or days . . . for your pet. For you, weeks or months before you’ll get your appointment. If only there were some obvious conclusion we could draw from these data points . . .

I wrote about the pet health/human health disconnect all the way back in 2004.

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