Month: June 2007

Health care economics are not different.

Sebastian Mallaby is correct in explaining that Republicans have embraced economic stupidity surrounding globalization, as evidenced by its stance on immigration. Although the root cause appears to be more xenophobia than economic ignorance, the point is taken. However, Mr. Mallaby quickly loses any credibility when he switches to health care and Rudy Giuliani’s proposal to fix the system. His intro:

Giuliani is also spouting nonsense about health care — a challenge that the nation must address if it is to assuage middle-class anxiety about a turbulent globalized economy. As employers have stopped offering coverage, Americans have discovered that it’s almost impossible to buy decent insurance because the market for individual purchasers is plagued by a vicious cycle. At the start of this cycle, insurance premiums reflect the cost of covering the average person, so healthier-than-average people realize they are getting a bad deal and choose not to buy coverage. That leaves a sicklier group in the market, which forces premiums up, which drives more relatively healthy people to exit, which drives premiums up still more, and so on.

I’d like to see some statistics verifying that claim. I’m a healthy individual insurance purchaser, and I’ve found my premiums to be reasonable enough. That doesn’t mean I think my insurance shouldn’t and couldn’t be cheaper. I do. But I realize that the disincentive to switch to a robust insurance market devoid of a sole reliance on groups organized around individual employers is based on our flawed tax code, not Mr. Mallaby’s absurd theory:

This market failure is a basic fact of health-care economics. But Giuliani is oblivious to it. In an interview with the Wall Street Journal last week, he indicated that he wants to triple the number of people in the dysfunctional individual insurance market without taking the one step that might fix it, which is to force every American, healthy or not, to buy coverage. Depending on whether he understands how dumb this is, Hizzoner is either a coward or a lightweight.

There’s so much to challenge. Most obvious, he trips himself in the beginning. If “health care” economics (economics is a science, remember) states that society will see a race to the bottom where only sick people will have an incentive to minimize their risk through insurance, then how exactly is this adherence to economics a market “failure”? It sounds to me as if the market is behaving exactly as expected. Yes, we have to rely on Mr. Mallaby’s misunderstanding of economics, but in his worldview, market failure cannot happen according to “health care economics” unless insurance companies ignore profit incentives and offer health insurance at a loss. I don’t believe that’s happening, but maybe Mr. Mallaby has evidence to the contrary.

That could be our endpoint, as it’s enough to dismiss his argument. That wouldn’t be any fun. There’s so much more wrapped into one paragraph. Not getting the results we want? Blame the market without looking at all inputs in that market. Ideology over facts!

I don’t know enough about Guiliani’s plan to critique it fairly, but using what I have here, how would expanding the pool of candidates for individual health insurance, which would spread risk further across the client pool for the individual insurance companies, exacerbate the problem? If it would work with employers, what would be different?

The answer is obvious if you look not at intention (affordable health care) and look instead at intended action. Here Mr. Mallaby offers only force. He has no interest in incentives, only playing the role of central planner. His justification is obvious later in the essay:

Instead, the Democratic candidates are focusing on helping the economy’s losers without restricting trade, which is exactly what they should be doing.

Why does he show no concern for why there are economic “losers”? I assume he believes that our benevolent government can’t possibly create losers. That’s capitalism’s fault. Because capitalism is only “I win, you lose”. It’s a fascinating narrative, even though it’s 100% incorrect.

From the rest of that paragraph:

John Edwards, the contender who sounded most protectionist in 2004, seems to have turned over a new leaf. He has admitted that trade benefits poor countries and has declared that arguments over labor standards should not be an excuse to obstruct liberalization. Meanwhile, Edwards has proposed a thoughtful health-care reform that would require everyone to buy insurance. He supports market-minded social programs such as an expanded earned-income tax credit and housing vouchers.

Market-minded social programs is as informative as it is bone-headed. (Mr. Edwards shouldn’t get credit for proposing stupidity.) Mr. Mallaby wants a socialist solution with a few free market curtains to pretty up the proposal. It won’t work in the way he predicts. Incentives matter. You don’t fix a disincentive by encouraging the offending entity to create new misguided incentives.

Hear the wind blowing through his ears.

I’m not ashamed to have voted against Bush for Kerry-Edwards in 2004, but it gets harder every day.

Responding to a question at a bookstore here, John Edwards said he has never heard of PETA, the animal rights group.

“I can honestly say I have never heard of PETA,” said Edwards. “They don’t want people to eat meat? Well I am not in favor of that.”

Can he possibly be that moronic? If he is so unaware of the news to not know who PETA is, he’s clearly not capable of ever being fully informed about our world. We have a president like that now, we don’t need another.

On a more fundamental note, is he really be such a dunce that he thinks somehow meat-eating versus vegetarian/veganism is going to become a campaign issue requiring a public stance? Alright, now I’m a little ashamed.

Link via Elaine Vigneault.

Voters as Spoiled Children

Courtesy of an e-mail Andrew Sullivan received from a reader, here’s an ill-informed defense of majoritarianism, referencing Mitt Romney.

What’s wrong with politicians doing whatever it is we want, regardless of their own personal views? Isn’t that what we elect them for, to do the will of the people? It’s better than politicians who stick to their own asinine views as a matter of principle, the will of the people be damned.

No, that’s not what we elect them to do. We elect them to uphold the Constitution of the United States, as expressed in the oath of office found in Article II, Section I.

The will of the people plays a part, as it’s our government, but the president’s role does not involve indulging our whims. He who will pander instead of upholding the Constitution should not be president. Few can live up to this simple standard, requiring us to do the best we can with who we have. But that’s why we have constitutional checks on the executive (and other elected, political offices).

Semantic lunacy demonstrates intellectual lunacy.

Via Hit & Run, I see that Nebraska has an interesting understanding of the Constitution and legislating.

A member of the Kansas group that has drawn criticism for protesting at soldiers’ funerals has been arrested for letting her 10-year-old son stomp on a U.S. flag during a demonstration. She promised Wednesday to challenge the state’s flag desecration law in court.

Shirley Phelps-Roper, 49, will be charged with flag mutilation, disturbing the peace and contributing to the delinquency of a minor, Sarpy County Attorney Lee Polikov said Wednesday.
…

Nebraska’s flag law says: “A person commits the offense of mutilating a flag if such person intentionally casts contempt or ridicule upon a flag by mutilating, defacing, defiling, burning, or trampling upon such flag.”

Let me understand this. In Nebraska, it’s illegal to “mutilate” a flag, but it’s legal to mutilate a boy’s penis. <sarcasm>That seems reasonable.</sarcasm>

No Lacky Left Behind

Fouad Ajami may find it compelling to call on President Bush to pardon I. Lewis “Scooter” Libby for his loyal service as “a soldier in your–our–war in Iraq”, but I find it dangerous and intellectually immature. For example:

The men and women who entrusted you with the presidency, I dare say, are hard pressed to understand why former Deputy Secretary of State Richard Armitage, who was the admitted leaker of Mrs. Wilson’s identity to columnist Robert Novak, has the comforts of home and freedom and privilege while Scooter Libby faces the dreaded prospect of imprisonment.

It’s quite the conservative principle to pardon a guilty man so that we don’t feel bad about another guilty man being free. You know, since there’s no other solution. I’m unconvinced, and again find it dangerous, by the rhetoric that Libby “can’t be left behind as a casualty of a war our country had once proudly claimed [factual sic] as its own.”

Not Acting Presidential

This lovefest for Democrats and their progressive rebuke of “Don’t Ask/Don’t Tell” is fascinating:

The presidential candidates are dividing starkly along party lines on one of the signature fights of the 1990s: whether the 14-year-old policy of “don’t ask, don’t tell” should be repealed and gay men and lesbians allowed to serve openly in the military.

In back-to-back debates in New Hampshire this week, every Democratic candidate raised his or her hand in support of repealing that policy, while not a single Republican embraced the idea. Democrats argued with striking unanimity that it was time to end the uneasy compromise that President Bill Clinton reached in 1993, after his attempt to lift the ban on gay men and lesbians in the military provoked one of the most wrenching fights of his young administration.

Right. Allow me to quote Kip:

… If Biden, Dodd, Obama and Clinton are all so yippee-ki-yay to abolish this abomination, then why haven’t any of them actually introduced a bill in the Senate to do so? Recall that the House version already exists (although it is languishing in committee) — all any Senator has to do is introduce the same text. …

That’s obvious, and as Kip also points out, Sen. Clinton is on the Senate Armed Services Committee, where such a bill would begin. So why exactly should those of us who think that members of our military should be judged solely on their conduct be happy about this?

Geoffrey Garin, a Democratic pollster who also works for the Human Rights Campaign, a gay rights group, argues, “Iraq and the war on terror have created a whole new narrative around the issue of gays serving in the military.” Advocates of changing the policy increasingly argue that it is costing the military talent and manpower it badly needs.

On the other hand, there are political risks, which Republican candidates hinted at this week. If the Democrats emphasized the issue, even in their primaries, it could seem a distraction from issues that are more important to most Americans, including the war, gasoline prices and health care, said David Winston, a Republican pollster. Beyond that, in the view of some Republicans, the issue feeds into the criticism that surfaced in the early 1990s — that the military should not be a laboratory for social engineering.

Why should I vote for a Democratic candidate who can’t figure out that a narrative explaining why booting translators, who are in short supply, from the military during a war in which those skills are most needed is the perfect, impenetrable argument against such nonsense that the war demands institutionalized bigotry? If they can’t understand that, they are idiots incapable of formulating any strategy more complex than basic pandering. If they understand it, they are cowards afraid to challenge stupidity. I’ll vote for neither.

Post Script: Mitt Romney believes that now is not the time to repeal “Don’t Ask/Don’t Tell” because we should not undertake a “social experiment” in a time of war. First, as currently defined, that war is permanent. Quite the convenient catch-22. Second, Romney believes that equality under the law is a “social experiment.” I don’t know which point makes him more unfit to be president.

HIV Conferences are dangerous to genital integrity.

Following up on my previous post, some typical and not-so-typical arguments appeared at the Third South African AIDS Conference earlier this week. First, the typical in describing the apparent risk-reduction from the recent HIV studies:

“The effect was long-lasting, there wasn’t disinhibition [increased sexual risk-taking], they didn’t screw around more, they didn’t use condoms less,” said Neil Martinson¹.

Remember that both circumcised and intact groups in the studies saw a more significant drop in their rate of HIV infection over their national HIV infection rate than the effect presumably provided by circumcision. But it’s easier to keep focusing on circumcision, because that (allegedly) removes the human factor from HIV prevention. Sure.

Next:

“There’s no question that we need a male circumcision programme, but a mass programme is more debateable. Operationalising it is going to be complicated,” said Professor Alan Whiteside of the University of KwaZulu Natal.

He advocated routine opt-out male circumcision at birth. “Thirty years from now we’ll be so glad we did it.” He believes that “if we’d started 25 years ago we wouldn’t be in this godawful mess.”
…

An audience member suggested that op-out circumcision should also become standard practice for adult males who attend sexually transmitted infection clinics.

…routine opt-out male circumcision at birth. When talking about saving for retirement, opt-out programs make sense. It involves only the person whose money will be siphoned off into a separate, presently untouchable account. There is a (mostly) objective rationale behind the requirement. It’s a form of “we know better what you should do”. But he can easily reject this. He can also reverse his decision later.

Routine opt-out male circumcision at birth requires a specific action from one group (parents) to avoid violating another’s (their male child) right to not have part of his genitals cut off without medical need. There is an entirely subjective reasoning behind the requirement. Parents could reject this, although they’d likely receive information with overblown, fear-based hysteria. The experts are counting on the well-intentioned parental desire to protect children, with a bit of residual goodwill toward the procedure if the father’s chosen it for himself. But the male child can never reverse this decision. This is little more than social engineering with children and their genitals as pawns for the public health nannys.

If African nations had started routine infant male circumcision 25 years ago, they might not be in this “godawful mess, but they’d also have a generation of cut males to demonstrate that HIV infection is still possible and that more effective, less invasive methods of prevention already exist. But don’t bother to learn from the United States the lessons that are inconvenient to learning what you want to learn from the United States.

Now, for a moment of respite from insanity, something non-typical:

However Professor Timothy Quinlan of the Health Economics and HIV/AIDS Research Division at the University of KwaZulu Natal was sceptical about the need for a mass programme, arguing that the evidence doesn’t justify it.
…

… he said, prevention needs to focus on the two factors known to have the biggest effect on HIV transmission rates: concurrent partnerships and high viral load during primary infection.

There’s a need for clearer messages to communicate these facts,” he said. “We need to promote serial monogamy.”

I know, that’s unworkable because it assumes some sense of personal responsibility and ability to learn among African men.

And now a return to the typical:

Audience members raised some of the practical issues that are likely to arise in the implementation of any sort of circumcision programme. Traditional healers in particular will need to be brought on board, said numerous speakers.

“Don’t talk about circumcision in isolation from the initiation processes going on in all the different cultures in South Africa,” said one male audience member.

But there was general agreement that traditional healers who carried out circumcision during the initiation of young males into adulthood had a captive audience for passing on important prevention messages, and that this potential wasn’t being exploited.

Yes, what about those traditional healers? Ahem:

A 22-year-old unregistered traditional surgeon was arrested for illegally circumcising two boys in Libode, the Eastern Cape health department said on Saturday.
…

Meanwhile, police were searching for another unregistered traditional surgeon who allegedly circumcised 24 under age boys in Mthombe.
…

Kupelo said three of the boys were taken to hospital with serious complications.

And:

2006 Eastern Cape summer-season circumcision deaths have declined markedly compared to 2005, Eastern Cape provincial health department spokesperson Sizwe Kupelo said, adding that only four would-be initiates had died so far this season, compared with 24 in 2005.

Of those four, only two were the result of complications of the circumcision operation. …

And. And. And.

This reliance on traditional healers is an acceptance that, among several challenges, the public health community doesn’t have the resources to provide full, clinical circumcision in Africa. Yet it pushes the notion that it must be done both “mass” and “soon”. Why is it so difficult to see how this will end? How many deaths are acceptable? Are we really ready to rely solely on the utilitarian argument that more lives will (probably) be saved with mass circumcision than will be taken through mass circumcision? I’m not, since I’m capable of understanding individual rights.

¹ To another point by Dr. Neil Martinson:

“It’s all about cold steel – it’s more akin to sterilisation, it’s not like giving people clean water, it’s not like breastfeeding that we can all get warm and fuzzy about.”

Promoting mass circumcision is primarily about giving advocates warm and fuzzy feelings that they’re doing something monumental. Otherwise, why the rush to circumcise infants based on three studies of voluntarily circumcised adult males? It also reassures parents with a warm and fuzzy feeling that they’ve “protected” their sons from HIV rather than violated his rights.

Also:

There was confusion about who would be targeted with messages about circumcision. Would it be young men, or would it be their parents? Or must their future sexual partners be targeted, “so that they say `I won’t sleep with you unless you’re cut’,” asked Neil Martinson?

“I won’t sleep with you unless you’re cut.” Let’s promote such non-thinking. Maybe, if we work at it enough, we can convince African women that they prefer, and sh
ould prefer, the aesthetic look of the circumcised penis. It’s okay if that implies that men should change themselves to meet a woman’s expectation. The reverse is sexist and unacceptable, of course, but we all know that’s okay.

I don’t gamble online, but I like liberty.

I’m watching today’s proceedings by the House Committee on Financial Services. The subject is “Can Internet Gambling Be Effectively Regulated to Protect Consumers and the Payments System?”. I’ve already learned that Alabama Congressman Spencer Bachus is a moron. I’m paraphrasing until I can find a transcript, but he had the nerve to suggest that Congress should not repeal last year’s anti-gambling bill because the NBA, NFL, MLB, and NCAA have all come out against online gambling. I’m fairly certain that the Constitution matters more than what David Stern and Bud Selig believe is best for America. I don’t recall electing them to any public office.

Also worth noting, there are several witnesses for the Committee. I’m only familiar with Radley Balko. While I’m sure he’ll overwhelm the Committee with something most politicians aren’t comfortable with (logic), I’m pessimistic simply because several members of the committee have already gone out of their way to praise a minister who will testify that his son ended up in jail as a result of his addiction to internet gambling. Good grief.

Also, Rep. Barney Frank is slaying the nonsense of the conservative members when they claim that no one should have the liberty because a few people can abuse that liberty in a way that harms themselves. Bravo. Now, maybe he’ll apply that to his other, less liberty-minded economic ideas.

Update 1: Rep. Frank smacked down Rep. Bachus by referring to our professional sports leagues as “arbiters of absolute moral superiority.” He drew a large chuckle from the tiny crowd.

Let’s have a ‘mass ethics program’.

Not news:

Aids [sic] experts have called for a mass circumcision programme in South Africa, condemning a “deafening silence” from policy makers since studies revealed it sharply cut infection rates.

News:

“I am surprised there is no action on male circumcision. Where are the male activists? Studies show a 60 percent reduction (in risk) but there is silence,” Glenda Gray, who will oversee the first HIV vaccine trials run in the country, told a panel discussing prevention research.

She probably means that male activists should be calling for government funding of mass circumcision so they can be “protected” from HIV. I’m going to read the other meaning in her statement. Where are the male activists? Right here, demanding that males be left to decide for themselves how much of their healthy genitals they’d like to keep.

Living in a country where the epidemic isn’t as wide-spread and pervasive, it’s easy for me to say that. But even in a country like South Africa, HIV is still transmitted through specific, identifiable actions. There are additional issues involved in applying solutions to prevent the spread of HIV, including, but not limited to, ethics, individual rights, and cost-benefit disparities in prevention methods. These must be included in the discussion, whether or not they come from male activists.

There is also the reality that too many women in African nations don’t have a say in protecting themselves during sex. That does not justify the forced circumcision of infants. It is wrong to attempt to protect one innocent group (adult women) by violating the rights and bodies of another innocent group (infant males).

Fight HIV, yes, but do so ethically. Any circumcision that involves an individual who can’t and/or doesn’t consent is unethical, immoral, and unworthy of support.