Monday, April 02, 2018

Gun talk

The reason why discourse about firearms never seems to provide any insight, much less useful thought, is that such discourse is not so much policy discussion as political campaign. The goal of a political campaign is to achieve political power, not to collaborate in analysis of social problems.

This circumstance is understandable; the people who are in favor of restricting the right to bear arms have little interest in exercising that right themselves. If they can give up something that is of no value to them for something which is an ultimate goal, political power, the decision to do so is a no-brainer.

However, the popular appetite for relinquishing rights, regardless of the breadth of their exercise is unpredictable and volatile. The experience with alcohol prohibition is a good example. It is difficult to convince people that they are better off foregoing a right that they have exercised for generations.

Tuesday, March 27, 2018

Political Courage

There is one thing that modern political movements, such a #MeToo, Antifa, and #MarchforOurlives have that previous, more substantive historical movements, e.g. abolition, civil rights, fair labor laws, etc. lacked: fashion. Likewise there is something that the historical movements had that their contemporary counterparts lack: courage.

Marches on Washington in which a speaker addresses a gathering of hundreds of thousands of like-minded and approving activists, with the support of mass media and pop culture figures takes little courage. The payoff is not in achieving the stated goals of the underlying movement but in garnering the accolades of fellow travelers, all withing the safety of popular emotional trends. The courage of the mob really isn't courage, it is pandering.

If someone asserts that they are courageous for standing up to the "patriarchy," or "fascists," or the "gun lobby," ask them if they would continue to do so if it meant being labelled a racist, by one's peers. would they still be courageous? The neighbors of the San Bernadino killers weren't. The Broward county school district wasn't. the police in Rotherham weren't either. Emotional trendiness is not courage. If someone asserts that there is nothing more important than school safety, ask them if they support doing research into all of the factors that might bear upon teenage violence including race, single parent families, psychological history and drug use. Would they advocate this even though it means being accused of "shifting the focus" or injecting race, or doing something that must be similar to something the Nazis did not did not do?

Hashtag advocacy, guerrilla theater on sympathetic campuses and social media celebrity are reflections of transient emotional appeal. They lack the essential spine necessary for long lasting and just change.

Saturday, March 03, 2018


Equality is one of those virtues so esteemed that we seem not to care that our conception of it is totally contrary to our experience. It has assumed sort of a free-form righteousness that anything other than unthinking deference to it is scandalous.
Equality is of course something, and our western tradition is that it is something desirable. (“…did not regard equality with God a thing to be grasped.” [Phil 2:6]; Liberté,Égalité, Fraternité; and “We hold these truths to be self evident that all men are created equal.”) But the concept enjoys much greater esteem in slogans than in practice. Evolutionary biology is possible precisely because individual organisms are not equal. The field of metrology exists only because things are unequal, and in fact the only reason to measure and rank things is because they are unequal. The number of ways that humans are unequal to each other are too numerous to list, or even contemplate. Individuality is a consequence of inequality in certain characteristics. "All animals are equal" of course, but some are more equal than others.This witticism would not resonate if the political concept of equality did not carry its own inherent contradictions.
Equality is the very rare exception to the natural rule; yet when it comes time to criticize social and political institutions, confuse sentiment with thought, and look for a cudgel with which to bludgeon social order, equality vaults to the top of the list of virtues. When the reality of inherent inequality makes us tongue tied and confused, we regain our bearings by talking about fairness.
None of this is to say that equality, in those interstices where it is actually found or seriously pursued, is bad or foolish, but those instances are limited. Religious traditions at least postulate an equality that makes sense: that humans are equal in the eyes of God. All persons are endowed with equal human dignity until they relinquish it by their choices.The legal concept that all persons are equal before the law can at least be given the benefit of the doubt. Beyond this, reality demands consideration. People are not biologically equal. They are not equal with respect to fortune and misfortune; they are not economically equal. They are, in general, not equal in any way that can be remedied by social engineering, government meddling or use of force. Decent people and wise governments treat people equally, all else being, well… equal, but they do not make people equal. The moral is that it is not equality itself that it the virtue, it is the way we freely treat each other that is. That is what we should really care about, not how we measure it, not how we enforce it, not how we codify it, but simply how we do it when no one is watching.

The role of government

With regard to the proper role of government, the issue is not whether centralization is good or bad per se, or whether people would be happy with any amount of government service as long as it is provided well. There are some things that I would want government and only government to do, and there are some things I would not want it to do at all regardless of how well it is perceived at doing them.
I want government and only government to provide an army. Same with local police protection. I only want the government to investigate the cause of plane crashes, perform foreign espionage, and operate criminal courts. I do not want the government to run newspapers, churches or social organizations (implicating respectively freedom of the press, religion and association). I don’t want the government to be responsible for the details of airplane design, or fashion design for that matter. I don;t want the government to manage musical bands or comedy tours.
These preferences arise from consideration of how different types of incentives affect different institutions. Some institutions thrive with a profit motive, others are corrupted by it. Some institutions function well because of a sense of community that is missing from larger entities. The incentives that optimize the performance of government are different than those that do the same for private enterprise or charitable organizations. Sometimes this works in favor of the government doing stuff, sometimes it means the government should defer to better options.
As a general observation, by no means rigorously verified, government seem to be at its best with projects; defeating the nazis, going to the moon, building the interstate highway system, etc. and at its worst with the ongoing management of the mundane. Hence the familiar jokes about the DMV,, Amtrak and less funny jokes that are the Veterans Administration and the Indian Health Service.
The choice is not dichotomous between government and private industry. My own personal opinion is the the hospital system in this country was at its best when it was primarily a charitable enterprise, organized by religious orders and civic organizations, and it has not been improved by intervention of either government or profit-seeking institutions. I would not want to see the Boy Scouts listed on either the New York Stock Exchange or the Blue Pages of the phone book.
Government, private enterprise and charitable organizations are all necessary and beneficial. Each does some things better than the others; and there are certain things to which each is ill-suited.
Because diversity or something.

Name calling

It is remarkable how much progressive policy discourse consists of name-calling. Rather than refine and hone the principles and substance of a particular position, energy is diverted into discovering new ways of implying malignant character on the other side. The contemporary political vocabulary contains a dearth of rights, obligations, duties, compromise and political philosophy, and an excess of racist, sexist, homophobe, climate denier, rape apologist, hater,Iislamophobe, white supremacist, bitter clinger, etc. The governor of California described those who disagreed with his views on immigration enforcement as “troglodyte.” In addition, there are more subtle forms of name calling, less directly offensive but equally content-free such as denouncing another’s “privilege,” insinuating that another is aggressive or violent by claiming they make one feel “unsafe,” and by implying that the only possible basis for disagreement is “hate.” There is also the cynical and rather deluded gibe that one;s political opponents are “on the wrong side of history.”
It is interesting to contemplate the details of this phenomenon. When did we decide that the argument methods of second graders is preferable to reason and common courtesy? When did we decide that logic is subordinate to emotional satisfaction? I would suggest that name-calling is simply a cheap way of exploiting a socializing instinct, a boorish way of implying that if ones opponent does not agree or at least silence his own argument, that he is “the other.” It attacks the emotional security one finds in a good reputation and explicitly declares that a person;s beliefs either conform with those of the name-caller, or are the result of bad character. This approach to discourse lacks room for complexity or the notion of “however.” Thus, when it moves people to action (usually poorly thought out and silly action) it is prone to excess and obsession, such as pulling the Dukes of Hazard from TVLand, disinviting commencement speakers, sanctioning fraternities, for the conduct of other fraternities (or conduct that turns out to have been imaginary) and banishing those who are insufficiently outraged by the "right" things.
I suspect that our age invented none of these things; that there have always been principled thinkers of all political orientations as well as mountebanks and populists, bullies, sophists, con artists, and demagogues. But our age seems to have been overcome lately with a discourse of name-calling and political opportunism that not only obscures thoughtful and innovative dialogue, but hinders real progress. We seem to be more interested at the moment in emotional indulgence rather than thinking through many of the complex problems in our civic life.

Moral outrage

The term “moral outrage” is misleading. The subjects are not selected for their moral basis but for their immediate emotional appeal. The progressive enterprise is not a twilight struggle between good and evil, it is a ceaseless campaign of emotional bullying. Strident emotional appeals are used, not because there is some moral principle in need of a champion, but because the tactic is a useful to those whose ultimate goals are political power.
H.L. Mencken observe that “the whole aim of practical politics is to keep the populace alarmed (and hence clamorous to be led to safety by menacing it with an endless stream of hobgoblins, all of them imaginary.” “Moral outrage” is simply a newer version of this same principle. Now the premise is that the “good” people are in constant moral peril from the “bitter clingers” who will not see the light and therefore must have their views delegitimized.
Plaintiff’s lawyers are quite transparent about the underlying principle. A good number of them have adopted the “Reptile Strategy”, so named because it appeals to the emotional “reptile” part of jurors’ brains, rather than the more troublesome, rational part. Recall that, after the Sandy Hook shootings that gun control advocates explicitly demanded that action be taken before passions cooled. Emotions tend to override reason in the short term and therefore emotional appeals demand immediate action. Emotions also tend to be notoriously bad counselors, and the strategy of using them to whip up the populace has a rather shameful pedigree: lynchings, pogroms, riots, and revenge massacres.
As practiced in modern politics, the “moral outrage” gambit has a few distinguishing characteristics:
1.) Being an emotional appeal, it cannot bear rational scrutiny; something must be done now without reflection. The science after all, is settled; the counter arguments are invalid because they were advocated by the Cato Institute or heard on Fox News (the ad hominem fallacy); “Reagan did something similar” (the tu quoque fallacy,) “a new poll says that….” (argumentum ad populum), “Experts say…” (argumentum ad verecundiam), etc., etc., If you are appealing to emotion, fallacies are your friend.
2.) There is a clearly defined, malevolent other. Dissent can only be based in bad character with no room for good faith disagreement. The goal is not to persuade but to divide and demonize. “We” are entitled to have our way because we ‘think right’.” If the opponents words are insufficiently outrage inducing, resort to one of President Obama;s favorite rhetorical device, “there are those who say…,” the straw man fallacy; there can be no good faith disagreement.
3.) Because the other is defined solely by their opposition, consistency of the proponent’s arguments is unnecessary. Therefore, President Obama can “evolve,” Senators can be for something before they are against, and we can take credit for successes that we actively opposed. It doesn’t matter if Elizabeth Warren, or Diane Feinstein, or Al Gore has one set of rules for themselves and another for everyone else, because the contest is between “us and them,” not between differing concepts of what is best for the country.
4.) People who do not think right should be banned from participating in civic life. “Moral outragers” like to ban things. Support traditional marriage, lose your job. Question global warming or campus rape statistics, face expulsion from professional institutions. Show insufficient fealty for the emotional play of the day and endure death treats on Twitter. “Moral outrage” does, and always has created a lot of ugliness; bigotry pretending to unearned virtue.
This is not to say that there are not true moral outrages. The proper response however requires a resort to reason and not emotion; to think, and not merely to feel. It is a real tragedy when moral people do immoral things because they are “outraged.”

Competition, collaboration and regulation

Competition and regulation are not alternatives for each other. Competition, collaboration and government regulation serve different purposes. I would not leave it to competition to replace the FDA or the FAA.
Competition and collaboration are optimizing mechanisms, but they are not interchangeable. Competition optimizes processes whereas collaboration optimizes resources. Both have their role. 
Competition and collaboration are concerned with optimization. Regulation is (or should be) concerned with general welfare. Optimization relates to the maximum possible, regulation to the minimum acceptable. They serve different purposes and are essential in different ways. Successful societies seek out that elusive balance between competition, collaboration and regulation, and flourishing societies come close to finding it, but of course, being human, never quite get it exactly right.

Gun policymaking

There is one circumstance that even the must ardent gun control advocate must admit, if not of the fact, at least of the possibility: that the people who would profit or otherwise benefit from circumventing gun control regulations are smarter and better motivated than those doing the regulating. We see this phenomenon played out regularly with, for example, reference to the prevalence of illicit drug use, and historically with the prohibition of alcohol. The motivated creativity of someone who would make tens of thousands of dollars providing firearms manufactured in Mexico or Honduras to street gangs in a given American city is likely to trump the naive determination of earnest bureaucrats who do not understand the limited influence that government has on human nature. The semi-literate gang enforcer in Chino has much more in the way of practical smarts, at least in acquiring the minimum firepower necessary to an international criminal enterprise, than Dianne Feinstein or Bret Stephens. This disparity is likely to widen with advances in technology. Say what you will about bump sticks, the guy who came up with the idea was pretty sharp.
This is not an argument against gun control; it is an argument against the notion that restrictions will do much good. For good or ill, the technology of repeating firearms is about 150 years old; gun smithing is a community college degree, not an advanced course offering in the theoretical physics department at Harvard. An advanced civilization is much more reliant on the decency of its citizens for its survival than it is the force of its statutes. The Second Amendment applies only to the right to keep and bear arms, it is not necessary to their existence, nor to their availability in the criminal underground. Firearms themselves are not essential to the madness that perpetrates mass murder.
If Mr. Paddock, the perpetrator of the Las Vegas had not provided his own demise, one might reasonably wish to ask: was his primary motivation to shoot or to kill? Would he have foregone the anticipated satisfaction of killing if he had to forego the expected pleasure of shooting? We of course will never know, but even so, we can note, with just a cursory, off-the-top-of-the-head list, dates verified by Wikipedia, the following sample:
Date Number killed
May 18, 1927 45
December 12, 1986 98
December 7, 1981 43
April 19, 1995 168
March 24, 2015 150
March 20, 1995 12
March 11, 2004 192
June 11, 1964 10
December 19, 2016 12
March 1, 2014 31
February 27, 2002 59
May 17, 2010 44
June 3, 2017 8
July 7, 2005 56
The means used for these deaths included airplanes,, knives, sarin gas, explosives, motor vehicles, a flame thrower(!) and matches.
This list is not a sample of inadequate regulation, it is rather a specimen of psychopathic depravity against which the most competent of government is impotent.
The call for gun control is a symbolic protest against an uncomfortable fact: people that are crazy in their motives might be quite rational in their methods; they may in fact be quite ingenious in them. It is a form of inexcusable arrogance to assume that people who seem so illogical in their motives cannot outwit well-intentioned regulation, and the advice of “experts.”
None of which is to say that there should be no limits on guns or gun ownership. Reasonable regulation should be expected to have reasonable results. Expecting to confine the darker and disordered impulses of the psychopath by assuming that decent people cannot be trusted with the means of emergent defense is not reasonable.

Wednesday, April 26, 2017


Scientism, like any ism, is an ideology, and, like any ideology, is driven as much by ambition, wishful thinking, and base emotion as it is by rational analysis. Science is not the fount of human perfection and happiness; it is a product of humankind’s ability to reason and to apply reason in human affairs. The beneficial application of science requires moral guidance and ethical scrutiny, because blind pursuit of scientific knowledge leads to uncomfortable spaces.
The Nazis dunked soviet POWs in frigid water in a “scientific” attempt to devise strategies to help downed Luftwaffe pilots survive in the North Sea. One conclusion of such experiments was that exposure to cold caused cerebral hemorrhages. This “scientific” discovery turned out to be wrong. The United States government scientifically investigated the course of untreated syphilis in African-Americans; very scientific, yet somehow unpraiseworthy. The Imperial Japanese Unit 731 did competent scientific work, so much so that their biological warfare experiments were able to decimate several Chinese villages. (The scientifically oriented American government, rather than opting for war crimes complaints gave many of the perpetrators immunity, because, hey, SCIENCE!). The soviets' use of psychiatry on political dissidents is probably not an example of “improved policies and regulations that serve our best interests.” Orbiting the white nationalist fringe is the “human biodiversity” movement that uses scientific evidence to argue that certain racial and ethnic groups have intelligence, behavioral and personality traits that are heritable and therefore partially genetically determined, a scientific hypothesis that would likely be rejected by scientism on grounds unrelated to method.
One concern that naturally arises is that of avoiding "abuses" of science. Science has no reliable way of identifying “abuses” apart from human values. Science has no inherent conscience.
The modern scientist has much in common with the prehistoric thinker who thought that virgin sacrifice kept volcanoes from erupting or that fickle gods made the sun rise and rains come., Both applied the evidence at hand to questions relevant to their interests and reached conclusions constrained by the state of their knowledge. Much of what modern science knows is wrong; there is even a book, “Ending Medical Reversals” that focuses on the harm done by adopting  therapies and theories as scientific based more on apophenia and wishful thinking than on rational rigor This is why “consensus” is irrelevant to the advance of scientific knowledge, and is no substitute for it. Remember saccharin and how it causes cancer? Or how drotrecogin was the holy grail of sepsis treatment? What was the state of consensus regarding phlogiston theory 400 years ago? What does one one say about the scientific certainty regarding “gender fluidity?”
Science, is a tool without an inherent moral or ethical constraint. The scientific method is useful, for both good and ill, but is not infallible. Its usefulness derives from the ability of human reason to make sense of objective evidence, and that is all it is. It is not something to be venerated or blindly believed. It is something that can be cynically exploited by charlatans. It may be used as a prop to argue for greater government control over people’s lives just as hucksters with knowledge of solar eclipses were able to con those innocent of astronomic knowledge by implying some mysterious power. Science does not validate atrocity or immorality (as the Tuskegee syphilis and Unit 731 experiments show) merely by their being scientific, and science does not validate any ideology or political fashion that presumes otherwise. The use of science for political ends does not have a happy history.

Saturday, April 08, 2017

Healthcare policy principles

There are a few principles that should govern healthcare policy-making:

1.)  The fundamental characteristic of a sustainable healthcare system is not compassion, or comprehensiveness, or justice, or equality, or cost effectiveness. It is predictability. Predictability is why we have written laws it is the characteristic that allows engineers to design aircraft and computers, and chemists to develop new pharmaceuticals. Predictability is what allows actuarial analysis and rational assessment of risk. Predictability is what allows people to make plans with a reasonable expectation of favorable outcomes. The first step in formulating a sustainable healthcare policy is to excise as much caprice, and uncertainty as possible.

2.) Healthcare policy does not determine who gets care, it determines who gets rich. In point of fact there is almost no one in this country who does not have access to at least least some healthcare. It may be inefficient; it may not be cost effective and it may not be particularly thoughtful, but no one need die of tuberculosis or typhus or beri-beri unless psycho-social factors intervene. The future of healthcare as asocial asset will be determined more by technology and the principles of economics; the future of healthcare as an industry will be determined by regulation and policy.

3.) The Pareto principle applies to healthcare: 80 % of the care can be delivered for 20% of the cost.

4.) All systems of benefits and resource allocation become multi-tiered. There is a multi-tiered educational system in this, and every country. There is a multi-tiered judicial system. there is a multi-tiered public health system and a mult-tiered infrastructure system. It does not matter if policy prescribes a single payer system, some sort of hybrid, or a totally market-based system, it will be multi-tiered. This is not the avoidable result of corruption or malign intent on the part of policy makers, although that will certainly make matters worse. It is rather the result of the uneven distribution of inherent advantages and disadvantages, tangible and intangible, across any sizable group of people.

5.) The next big revolution in healthcare will be probabilistic medicine driven by enormous strides in data processing. the cognitive aspects of computers will yield to a significant degree to massive decision algorithms that incorporate huge volumes of data from tens of millions of patients.

Sunday, March 26, 2017

The future of healthcare

There are a few principles that will dictate the future of the American healthcare system:

1. There will always be a two-tiered system. This will not be due to a flaw in system design or implementation, but is due to the unalterable dynamics of societies. there is not a country on earth that does not have multi-tiered healthcare. The United States will not have a single tiered system for the same reason that it does not have, in fact, a single tiered educational system, or a single tiered legal system, or a single tiered social welfare system. Economics, technology and data management will have a much greater influence on the shape of the American healthcare system than will politics. Politics however, will have a much greater influence on who becomes rich as a result.

2. Healthcare in general, and medical care in particular, can be divided up into three functional categories:
     i. The technical or procedural aspect. This is the part of healthcare where someone takes out your appendix, adminsters chemotherapy, does endoscopy, or performs a CT scan;
     ii. The cognitive aspect. This is where someone interprets data and makes decisions about interventions, and
     iii. The clerical aspect. This is where data is collected, collated,and and packaged.

These three aspects will become more distinct and regardless of what type of healthcare reform or payment system is implemented, will dictate the future of healthcare.

The procedural aspect will be taken over by technicians. this trend has been underway for a couple of decades and has resulted in niche practices by "proceduralists.: It is also apparent in the now common practice of attending physicians or primary care providers referring patients to specialists who perform procedures on request, with no other role in diagnosing or managing a patient;s condition. In the future, these people will be less educated in broad aspects of medicine and will be hyper-specialized technicians. Since these procedures will be will established and understood, the practitioners performing them will be more like tradesmen than professional decison makers. They will have less education and more procedural training, and consequently will be expected to do less and will be paid less.

The cognitive aspect will largely be displaced by massive data management systems. This will commonly be referred to as AI, but will involve computer algorithms classifying each patient and processing huge amounts of epidemiologic, genetic, and clinical data to arrive at diagnostic and treatment plans for individual patients. These systems will become more reliable as experience is gained and they will drive down the costs associated with routine care. One offshoot of this will be a new medical specialty: the "outlierist" or the "anomalist" who will be looked to for the artisanal elements of medicine when the data driven computer algorithms are unsuccessful.

The clerical aspect is taking up a larger portion of providers time right now. They spend significant time gathering and entering data that eventually will form the databases on which the artificial neural networks, inference engines, Bayesian belief networks, and other computer modeling systems will operate. Provider systems and payers will soon realize that these tasks can be both largely automated and performed by medium skilled workers without medical degrees.


If you earn respect, you will have self respect.
If you demand respect, you will have self pity.

There are two things with which self respect should never be confused: self pity and self esteem.

When faced with challenges, self esteem often becomes self pity; self respect becomes courage and determination.

Sunday, March 12, 2017


It is very difficult to teach a person something that he is convinced he already knows.

Monday, February 20, 2017

Speech as action

A piece by David Solway entitled "Free Speech vs. 'Hate Speech'" makes the following assertion:

Of course, speech itself can be an act, as philosopher J.L. Austin has shown in How to Do Things with Words: in his most famous example, when the minister states “I now pronounce you husband and wife,” an act has been performed since it changes the status of the participants.

This is wrong. The words themselves are innocuous absent other considerations. If a second grader speaks the quoted words to two other second graders,the latter are not thereby married. More importantly, if a minister says the words to two people who do not wish to be married, or in fact merely disagree with those words, their status does not change. In the former case, the words are powerless because of the status of the speaker. She has no authority to change the status of her classmates, regardless of the words used. The latter case is more fundamental, because it is an example of a larger principle: the effect of words in the absence of external force is dependent on the acceptance of the hearer. Certainly, when a judge pronounces a sentence, the words used wold be of little significance apart from a mechanism to enforce them. The same result holds if the judge has no authority to pass such a sentence, as for example if  jury had acquitted the accused.

The effect of words in such case would depend on the subjective acceptance of their object. To put the matter more succinctly, no one is obligated to be offended by speech, and no one is required to perceive injuries in mere opinions. 

Saturday, February 18, 2017

Safe spaces

The concept of civilization only makes sense in the context of interactions between humans. A solitary individual having no interactions with others would have no use for norms and traditions that are useful in public life. A civilized society is one in which the clashes and confrontations that inevitable arise when human beings interact are managed by certain understandings regarding tolerance, accommodation and compromise. The norms and institutions of civilization are means by which the clashes of individual interests and diversity of opinions are processed so as to make social interactions worthwhile. Civilization is a consequence of the public benefits which arise from preserving individuality. Civilization thrives when individual differences are allowed to compete.

A "safe space," in the current usage of the term, is a place that is free from distressing opinions or disquieting deviations from uniformity. They are precincts where feeble ideas are allowed to persist unchallenged and unimproved, not because of the intellectual validity of those ideas but because of the emotional discomfort occasioned by alternative views. Safe spaces only appear so because of uniformity and conformity, and as such are intellectually stagnant. The aversion to individual thought and dispute makes them intellectually inert and emotionally anesthetic. The adjective "safe" is a euphemism intended to disguise an environment that is intellectually desolate, intolerant and craven.


The most significant difference between Donald Trump and Hillary Clinton, at least as it concerns practical politics, is that there was a significantly greater risk of corruption being normalized under a Clinton administration than under Trump. This is independent of whether a Clinton led government would be any more or less corrupt than the current administration. In the former case, corruption would be viewed by institutions such as the media and entrenched interests as a price to be paid for favorable policies; in the latter case, it is a target of opportunity by which to advance one's agenda and protect one's interests. Normalization of corruption is far more damaging than any policy which could be reasonably implemented by either candidate.

Sunday, February 12, 2017

Thought experiment

Consider a woman, a citizen in a western democracy, Now consider that it is desirable to someone, for whatever reason, to have her behave in a particular way, to conform to some model, or submit to some reform. One way to accomplish this would be to use coercion, to invoke force or the prospect of undesirable consequences to influence her in the desired direction. Another alternative would be to use persuasion, appeal to reason, and try to convince her of the wisdom and benefit of the desired behavior, model or reform.

The first method is the resort to force. She will be made to conform regardless of her her own reason, values or choice. The second is a resort to rational discourse, to principles of analysis and evidence. Only the second of these is consistent with a respect for dignity; i.e. that a person is worthy, all else being equal, of living her life in accord with her own conscience.

Now image that the second method, the use of persuasion, is discouraged on grounds that the method of persuasion, i.e. free speech, might cause offense to someone. Thus we have in stark relief the malignancy at the heart of political correctness: that it is better to use force and the threat of personal consequences to bring about some policy or other, because to allow reasoned debate might offend subjective sensibilities. Rejection of political correctness is rejection of the notion that the benefits and individual dignity must be surrendered to protect the sensitive from disquieting opinions..

Wednesday, March 02, 2016


Charges of racism seem to be an inexhaustible element of public discourse in the United States. Race is injected into a wide swath of public debates and the allegations of racist motives are regularly used to discredit and silence opposing views. Some people claim that the United States is an inherently racist country; others that the single minded search for any hint of potentially racist or race-tinged thought has reached the point that it is doing more harm than good.

Certainly, overt and institutionalized racism has declined steadily since the second World War. Certainly there are those, in all races who still harbor racist attitudes, and there is a corresponding disparity in perceptions of just how racist America really is. A simple explanation for this phenomenon is found not in comparing attitudes and conduct to some mythical non-racist standards, but in understanding different peoples' priorities in considering matters of race.

Let us assume you have two people of different races, each of whom honestly considers herself non-racist. Now construct a list of attitudes and actions that are, or could potentially be considered racist, and rank them, from most obviously racist to spurious at best. this list would range from the egregious, such as lynching a teenager for kissing a person of a different race, to things like refusing to hire a person because of their race, to telling stereotyping jokes, etc, to the silly, such as objecting to terms like "black sheep" or "black mark, to the weird, like complaining about "cultural appropriation" to the just plain ignorant, such as claiming that the word "niggardly" has anything at all to do with race.

If we take our two subjects and present them with this list and ask them to prioritize each item on the list against other social concerns, such as economic efficiency or freedom of expression, it is likely that there would be a great deal of agreement at the more flagrant examples; both would agree that lynching is abhorrent racism. There would most likely be agreement that discrimination in employment and housing are improper, and that stereotyping jokes do reflect racist attitudes. But as you go down the list, it would be expected that there will be a point that the two people will disagree on whether a particular act or attitude is sufficiently serious that it should override other concerns. there will be a disagreement on the priority that a potential racist thought or action should be given in everyday life, and it is at this point that one person will accuse the other of racism. And it is not just an accusation as to that contested point; it will be assumed that the point of disagreement, e.g. that "Taco Tuesday" should be condemned is simply the point where the closet racist lets the mask slip, Thus, what should be simply a good faith disagreement as to whether an arguably innocuous, or even an obviously innocuous view can be transformed by racial prospectors into invidious racism. This is why the vast majority of people honestly do not consider themselves racist, and those who suspect others of racism readily think they have evidence to support their suspicions.

The clearest example of this is affirmative action. There are competing priorities here: countering the prospect that qualified minorities will be denied opportunity because of their race, and ensuring that race-neutral merit is the basis for allocating potentially limited opportunities. Neither view is necessarily racist. The allegation of racism, when it inevitably comes out is not directed at the principles underlying either position, rather it is directed solely at opposition to the accuser's position. The allegation is not that merit is racist it is that prioritizing merit over racial considerations is.

Of course, there are racists. There are those who believe that there are certain genetic traits that justify treating races differently. But for the majority of people what determines how they treat one another regardless of race depends on their experiences. It is much more likely that a black man who loves his wife and raises his children, and respects others has much more in common with a white man who loves his wife and raises his children and respects others than either has with a black drug dealer who abuses women or with a white methamphetamine addict who steals to support his habit and abuses women.

Sure, there are racists. There are also race hustlers who would contort facts and logic to smear otherwise decent people in support of  a cynical narrative that is destructive to people of all races.

Tuesday, March 01, 2016


A libertarian view begins with the premise that liberty is incompatible with coercion, and that a civil society should not substitute instruments of violence for persuasion. This view requires that all uses of force be justified, because force is never assumed to be just. There are certain categories of force, such as government force used against one person for the exclusive private advantage of another, or force used to protect subjective sensibilities, or to vindicate matters of etiquette that should never be justified.The rules for use of force should be predictable and of general application, neither singling out nor exempting particular parties. No person who is capable of reason should be subjected to force solely on grounds that it is for his or her own good.

Force and governmental violence is sometimes necessary but its legitimate use usually signals the breakdown of reason. The lapse of reason is not always on the part of the person against whom the force is directed. Force, or the ability to resort to force by authorities, is a tempting shortcut to assure compliance with questionable policies or to promote partisan interests, or worse, to attempt to compensate for incompetence in administering the laws. It is the enabler of oppressive laws and a hallmark of governing interests at odds with the will of the people.

Force is inherently inelegant and imprecise. There is no guarantee that "non-lethal" force will remain "non-lethal" just because the circumstances do not justify more severe measures.

Friday, November 01, 2013


Of all the drawbacks of an excessive regulatory, bureaucratic state, perhaps the most significant is that all of the necessary mandates and prohibitions eventually mkes the government adverse to the citizenry.

Friday, October 11, 2013

Restorative forces

There is a corollary to yesterday's post on stability. When a stable system is perturbed, forces inherent in the system act to return it to equilibrium. In political systems, these forces are popular reactions against reform. Political systems differ from physical ones, in that the public responses are often delayed as a result of public perception, remoteness of experience, or initial misperception of the scope and purpose of the reform. The forces seeking equilibrium are present and relentless however, and eventually overcome the transient and artificial dispruptions imposed by authorities. This is why dictatorships fall, or stagnate, and why socialist utopias eventually encounter crises between promises and realities.

Thursday, October 10, 2013


An essential characteristic of a stable system is the tendency to return to a state of equilibrium after being disturbed by some influence. This is true not only of physical systems but biological and political ones as well. The baseline or ground state is an inherent property of the system, and determines the response to perturbation.

Societies are highly complex and heterogeneous systems that, if they are to be stable, will have defined baselines in terms of institutions, economics, and social values. It is of course possible for these to evolve over time, but this evolution tends to be a response to environment and a constellation of circumstances rather than a discrete influence. When reformers and idealists seek to alter these fundamental characteristics of a society they often succeed in achieving only a transient and artificial change that cannot persist without the threat and use of force. Such enterprises, even if they initially have popular approval, eventually collapse under the strain of human nature.

It is difficult, almost to the point of impossibility, to "fundamentally change" a society through legislation or political machination. The natural tendency is for politics to eventually reflect the underlying values of the society, rather than to shape them. The fact is it is not possible for politicians of any type, whether they be tyrants, democratically elected legislators and executives, or appointed functionaries to prescribe what people want or what people value.

The forces necessary to fundamentally change a society, that is to change the baseline or ground state at which a society functions in the absence of force or duress, ultimately derive from people's experience and subjective interests. The instincts and subjective experiences that influence how people interact with each other are much more robust and enduring than political policies or ideological ambition.

Wednesday, October 09, 2013

A technological paradox

An article published in the medical literature in 2011 documented a significant increase in the number of pulmonary emboli that were diagnosed since the introduction of sensitive tests for them. The mortality associated with that condition, however, did not improve significantly over the trends that had existed prior to the adoption of more sensitive diagnostic methods. The number of complications associated with therapy of pulmonary embolism did increase in the same manner as the number of diagnoses. The implication of this is that the introduction of sensitive diagnostic technology led to a dramatic increase in the number of cases diagnosed, but that that increase did not have a significant impact on patient outcomes. Pulmonary embolism began to be overdiagnosed, and some patients experienced significant complications from therapy that previously would have been unnecessary.

This circumstance is not limited to pulmonary embolism, nor to a small number of similar conditions. Diagnostic technology has advanced to the point that resolution of diagnostic studies has out-paced our ability to interpret them. We are finding more minute and unanticipated anomalies for which we do not know the significance. As a result, physicians are making diagnoses, often based on incidental findings, and providing treatments where they would not have only a few years ago. The benefits and risks associated with making these diagnoses and treating these patients is unclear. In the case of pulmonary embolism, increase diagnostic sensitivity clearly carries the risk of overdiagnosis, providing treatment where none is required, and causing unnecessary complications.

The tendency to overdiagnosed and over treat arises not only from technological advancement. Fear of litigation, patient expectation, and the proliferation of protocols and algorithms also influences medical decision-making in the direction of more frequent and less efficacious treatment. Paradoxically, while diagnostic technology enables greater detail of unclear significance, the use of protocols and algorithms homogenizes diagnostic data and disregards other clinical information of significance to a particular patient.

These factors contribute to an undesirable praxis in American medicine. The desire to provide diagnostic certainty when there actually is none, to medicalize everyday difficulties and consider them as diseases leads to such excesses as overprescribing antidepressants and stimulant medications, a proliferation of unnecessary procedures for treatment of ill-defined "syndromes," and an explosion in the number of patients claiming disabilities of one type or another. A peculiarity of American medicine is that many diseases and medical conditions are associated with their own interest groups. Diseases have lobbies. It is an undeniable and likely inescapable fact of American medicine that some interests benefit from overdiagnosis and overtreatment, and those interests are active in perpetuating what is fundamentally bad medicine.

This is only one of an innumerable number of factors for which the affordable care act provides no answer.

Tuesday, October 08, 2013

Government healthcare

With all of the angst accompanying the roll out of the Affordable Care Act, the foibles, the unintended consequences, the unanticipated costs; it may be instructive to review the findings of a previous investigation into government run healthcare. These were the findings of a Senat Committee on Indian Affairs investigation into the operation of the Indian Health Service in the Aberdeen Area in 2010:

Among the investigation’s major findings:
• Chronic mismanagement, lack of employee accountability and financial integrity;

• Several service units experienced substantial and recurring diversions of reduced
health care services, due to lack of qualified providers or funds;

• Five IHS hospitals in the Aberdeen Area are at risk of losing their accreditation or
certification from the Centers for Medicare and Medicaid Services (CMS);

• Several facilities have been cited as having health care providers on staff who
lacked proper licensing or credentialing;

• Key senior staff positions remained vacant for long periods of time, contributing to
the lack of proper management;

• Employees with a record of misconduct or poor performance being transferred to
different health facilities within the Indian health system;

• Pharmaceutical audits of narcotics and other controlled substances are not
regularly performed, and three service units within the region have a history of
missing or stolen narcotics.   Source:

Morbid curiosity

There is perhaps an intuitive sense that human life is protected by the odds. It seems reasonable that the risk of cataclysm is sufficiently small to have enabled human beings to thrive for millennia, and expect to do so for many more. Most commonly perceived threats are associated with vanishingly small likelihood of occurrence. A worldwide extinction such as that which befell the dinosaurs is likely rare enough to have been considered a one off. This perception applies to most conventional threats, such as a catastrophic asteroid impact or nuclear calamity. The odds, simply, appear he to be in our favor.

It may however be the case that there are mortal threats lurking in far more likely scenarios. To take one such example, it is reasonable to assume that there is at least one, and likely several amino acid sequences that would code for a pathogen that would be devastating to human life. Imagine, for example if the human immunodeficiency virus had a genetic makeup that would allow it to be passed by casual contact, or to be transmitted with the ease of the common cold. It is possible to conjecture the existence of such a genome and wonder how likely random mutation is to produce it. Is such a peril thirty base pairs away? ten thousand? A million? It is also possible to consider that such a fateful genetic sequence might be the result of human manipulation.

This is not to imply that human beings are necessarily doomed, or that a biological catastrophe will wipe out the species. It is to suggest however that it might not be unreasonable to wonder what the true odds of disaster are, and when luck might run out.

Monday, October 07, 2013

Thursday, October 03, 2013

The limited competence of public institutions

One thing that you learn from coaching or watching football is that not everyone can do everything well. Certain players can do certain things well that other players cannot do at all. The same applies to entire teams. You also learn that not everyone who does something well does so indefinitely. Players age, skills fade, and times change. Likewise, even though someone may do something very well there is always the possibility that someone will come along and do it better. These principles apply not only to sporting contests but in civic life. No one institution does everything better than the others. Institutions that do something well initially may get progressively worse at it as time goes on. Institutions may be so hampered by bureaucracy that they are unable to adapt to changing conditions, or they may assume responsibilities for which they are wholly unsuited.

These principles weigh against the progressive notion that the government should be relied upon for nearly all important endeavors. The fact is that there are some things that charities, and private enterprise do much better than public institutions. There are also things that public institutions may have initially done well that they have increasing difficulty doing competently. There are things that may best be done by government initially that private enterprise, or dedicated nonprofit organizations eventually do better.

The list of things that require public institutions because private or charitable institutions tried and failed is vanishingly short. There are of course some things which, on the whole, are proper objects of public enterprise; these include such things as law-enforcement, management of roads and thoroughfares, and providing fire protection services. Other areas in which public institutions to have a role, but which benefit from the participation of other entities include such things as managing hospitals and education. Scientific research likewise benefits from not being reliant on a single source of support, and undertakings such as space exploration are areas in which public institutions have been largely left behind.

The fallacy that, unless the government does something, it will not get done, or alternatively, that unless the government does something it will not be done well, is detrimental to both progress and to civic life in general. Governments and public institutions are inherently bureaucratic and hence inherently limited. There is no reason for a free and thriving society to inflict such limitations upon itself without good cause.

Friday, September 27, 2013


President Obama has indicated, in discussions regrding the debt ceilling that "America pays its debts." The fallacy of this appeal lies in the fact that, if you are borrowing money to pay off your debts, you are not paying off your debts, you are just shifting them around.

Thursday, September 26, 2013

The end of Islamism

I An interesting biological phenomenon is that simple organisms such as bacteria, viruses, and fungi are capable of wreaking havoc on more complex and highly developed beings. This is not surprising, as entropy favors destruction and decay. It is always easier to destroy than to build. This concept applies not only to biological organisms but to societies and cultures as well.

The destinies of civilizations are not always in the direction of greater advancements. There is no guarantee that the future is limited to greater artistic, intellectual and humanitarian achievement. The triumphs of civilization are often fragile and barbarism is always a threat.

GK Chesterton observed that barbarism does not always describe only those cultures that are insufficiently advanced in civilization, but also describes those that, having advanced, become hostile and threatening toward it. The source of this contempt and enmity for values and traditioms that oppose, for example terrorism, genocide, and religious persecution vary from time to time and place to place. The most prominent doctrine that now opposes liberal values is that of radical Islam. The stated goal of this movement is to establish worldwide sharia law and dominance of political Islam. The ideological springboard for this regressive and destructive movement is not based in religious piety but in an emotional, supremacist fantasy.

There in fact will never be a worldwide caliphate. There are many reasons for this which include:

1.) Sharia law results in relatively weak political systems, that are not well suited to the complexities and rapid change of modernity.

2.) The present worldwide Islamic terrorist movement is not capable of achieving and maintaining power, as terrorism itself is unstable..

3.) The strategy of attempting to establish demographic dominance by emigration to Western countries fosters an atmosphere of dependence and insularity that is inherently unstable.

4.) While religion has provided an organizing framework for many cultures and societies, there is a limit to the influence of any particular religious doctrine in pluralistic societies. Human beings are simply not religious enough to accede to religious dominance in all areas of life.

5.) If political Islam were capable of creating and maintaining desirable cultures and societies, the net immigration would be from Western societies to Muslim ones rather than the other way around.

6.) Chauvinism is a poor basis for a system of government.

7.) There's a reason why Ataturk ditched the agonal Caliphate about eighty years ago. The present campaign to reestablish political Islam through terrorism, wanton violence, demographic hegemony and narcissistic complaint is a doomed effort to reinvigorate a failed idea.  

8.) The more establsihed that Islamism becomes, the more susceptible it is to the barbaric instincts that inhere in human nature. It will become the target, rather than the aggressor.  

9.) Threatening to behead those who "insult" you or cause you offense is a hallmark of weakness; any doctrine that cannot accommodate ridicule cannot accommodate reality.

Tuesday, September 24, 2013

Common sense gun legislation

Advocates of gun control legislation frequently feel the need to burnish their proposals with the adjective "common sense." Thus, appeal is often made to public support for "common sense gun control legislation." One of the first requirements of common sense legislation is that it accomplish its intended purpose. "Gun control" legislation that does not control guns, or more specifically, does not reduce criminal gun violence does not legitimately bear the appellation "common sense."

Cosmetic legislation that serves only as an emotional bromide can legitimately be called neither common sense nor gun control. Gun violence is first and foremost violence, and it is the pathologies that predispose certain individuals to violence that are at the heart of the crisis. Seung Hui-Cho, Eric Harris, James Holmes, Anders Breivik, Jared Lee Loughner, and Aaron Alexis all perpetrated mass shoootings of strangers, and all had previously been referred for psychiatric evaluation. What is equally troubling, is that all were relatively intelligent and capable of intricate planning. It is inobvious how magazine capacity limits or ammunition surcharges, or outlawing firearms with flash suppressors would have thwarted disturbed but cunning minds. It is quite likely that they would outsmart the most heartfelt of firearm restrictions. It is also worth noting that Anders Breivik killed eight people with a bomb, and that James Holmes rigged his apartment with incendiary devices. The essence of a mass murderer is a malignant motive and will. The weapon to be used is secondary.

Whether or not some idea qualifies as "common sense" depends upon context. If a community were suddenly gripped by a violent crime wave, in which the authorities could do little more than show up after the fact, it might certainly be "common sense" that the citizenry be armed in its own defense.

The people who insists on retaining the right to own firearms for their own personal use do not thereby condone the actions of psychotic murderers; they do not provide the impetus to slaughter by mentally unstable, but quite resourceful miscreants. They do not excuse the acts of madmen; the people who focus on the weapon rather than the act do. The people who support the Second Amendment do not condone the lawless gunfire in gun control venues such as Chicago or Washington DC. They do not assume moral culpability for refusing to play along with the deluded fantasy that "common sense" gun control legislation is anything of the sort.

Monday, September 09, 2013

The Dissolution of Obama

I have previously noted the difference between power, authority and influence. After more than 4 1/2 years it is apparent that Pres. Obama retains all of his presidential authority, but possesses significantly diminished power and vanishingly little influence.

The President's deteriorating stature has not so much to do with dominating events or cruel fate as it does the inherent limitations of the man. These limitations were not so much revealed by this financial crisis or turmoil in the Middle East as they were ignored by a media and publicenamored with a vaporous abstraction. The fact that Obama was president of the Harvard Law Review, yet produced no significant legal scholarship should have at least suggested caution in evaluating Obama as a man of substance. His habit of voting "present" when the public did not support his individual ideology, his vacillation regarding gay marriage, his pathological avoidance of responsibility for the scandals and corruption that pervades the administration, as well as the complementary usurping of credit for good fortune or the sacrifice of others all bespeak a defect, avoid of character hidden in an illusion.

It has become obvious that many of Obama's most desirable qualities are not personal characteristics that inhere in him, but are rather romantic yearnings that the public and media have projected onto him. His lack of influence is seen in the rebuff of his efforts to have Chicago host the Olympics, his absence of leadership in the various political upheavals in Iran, Libya, Egypt and Syria, his inability to advance a gun control agenda, and the disarray accompanying implementation of the Affordable Care Act. These deficiencies are all the more remarkable when one considers that the first two years of Obama's presidency included large majorities in both houses of Congress, and a historically compliant media.

There is no denying that the economy has underperformed, that race relations have endured several affronts to which he was a party, that American diplomacy has become more amateurish and ineffective, and that America has become a tepid ally and a timid adversary. Those who continue to defend him, complaining about what he "inherited," or the intransigence of political opposition, or the complexity of modern politics are simply in denial. His greatest "accomplishments" are both unpopular and unfinished; his failures cannot be undone by media spin, finger-pointing, or whining.

It would be tempting to attribute all of Obama's shortcomings to hubris, or lack of seriousness, or ideological blindness. The reality however is not so simple. Obama's strengths and virtues have always been an abstraction, a semi-conscious daydream in which imagined virtues were given parity with unforgiving reality. Obama actually believed that the thoughts in his Cairo speech were original and that peace in the Middle East eluded the world because he had not yet expressed those thoughts. He believed he could impose "fair" economic regulations without adversely affecting economic activity. He thought he could make the oceans recede. He thought he could reason with despots whose ambitions dismissed reason. He thought he could morally bully those who had no reason to recognize his moral authority.

The dissolution of Obama is not a tragedy nor a lamentable example of unfulfilled promise. It is simply the natural consequence of people looking at a man and seeing what they want to see, rather than what is actually there.

Wednesday, August 21, 2013

Drone on

Several questions come readily to mind regarding the use of drones in the war on terror: is the intelligence used to identify targets valid? Does the use of drones entail an unacceptably high risk of killing innocent bystanders? Is the use of targeted drone strikes effective in bringing about a successful conclusion to the war on terror?

The answers to these questions, and to a plethora of others just like them, are difficult to ascertain from readily available information, and do not even begin to address the deeper and perhaps more important questions regarding the legality and morality of such tactics. It is not at all clear that terrorist organizations respond predictably to threats of death, or that their operational effectiveness is irreversibly degraded by serial assassinations of their leadership. Israel has eliminated multiple senior leaders of Hamas, yet the terror threat posed by that organization persists. Discussion of these issues certainly is beyond the scope of a simple blog post, but there is one point that should not be neglected in the hubbub.

Terrorism is, after all, a tactic of demoralization. Whether blowing up spectators at the Boston Marathon with a couple of pressure cookers, or obliterating an Al Qaeda commander with a hellfire missile has the greater effect on the opponent's morale depends not so much on the operational details, but upon the opponent's state of mind. The crucial point is this: the West is losing confidence in its institutions and the terrorists are not, and this fact is wholly independent of the violence that either side uses. The West is losing confidence in its institutions, not because they are being attacked by the Muslim world, but because they are being attacked from within. Liberal values such as freedom of speech, the dignity of human life and equality before the law are not succumbing to an alien invasion, they are being disparaged and degraded by self loathing elites, cynical opportunists, and anti-human nihilism.

Being able to incinerate a jihadist in the Hindu Kush or Yemeni desert is simply going through the motions of fighting a war on terror. The fact is that a terror war cannot be lost without the consent of the losing side. A terror war is won when resolve, rather than fighting ability, is overcome. One's resolve to defend something tends to flag when he does not value the thing being defended.

The lethal enemies in the clash between Western civilization and the Islamic world are not the bomb makers, or hijackers, or psychotic morons that celebrate the death of innocent children. The lethal agent is the one who, given the benefit of Western-style freedom, is disdainful of human dignity and who nurses an irrational resentment of the freedom of others.

Sunday, August 18, 2013


The concept of "narrative" is prominent in political discourse. This describes the effort to manipulate public perception to accept an underlying doctrine or theory as valid. Some common contemporary narratives include those that portray Tea Party as backward racists, Global warming empiricists as superstitious and malign conspirators, and those that oppose gay marriage as "hateful." If the proponents of a particular narrative do not find the facts sufficiently compelling, they create their own, such as showing up at an immigration rally pretending to be the opposition and holding an embarrasing sign, or editing audio and video recordings to create false impressions.

The concept of narratives has a deep, if not honorable past. There was a common narrative in twentieth century Europe regarding the relationship between Jews and money. Red baiters promoted a narrative regarding the ubiquitous infiltration of American institutions by communists. The Jim Crow south played on the narrative of the predatory black putting the virtue of white women at risk, and being used to justify and even brag about lynching.

The narratives of the past and those currently used to attack critcs of the president, silence global warming discussion, advocate for amnesty, and any number of insular political interests have one thing in common: they are all base bigotry. A narrative is simply a prejudice sent to college, and adorned with sham virtue.

Saturday, June 01, 2013

The use of force

There are many interventions in medicine that are life-saving when used acutely but detrimental when applied chronically. Steroids produce highly desirable results when used for brief periods in such conditions as asthma or rheumatoid arthritis. When used for extended periods they cause abnormalities in bone and skin, psychiatric disturbances, weight gain and cataracts. Antibiotics are useful for acute infection but when used long-term do more harm than good. Surgery is often necessary in an acute, discrete crisis but is impractical as a continuing intervention. The underlying principle is that certain actions and interventions that are indispensable in confronting dire, but focused emergencies do not function as well when used as indefinite strategies.

The same principle that applies to medical therapy of human illness has an analog regarding the use of force in civic life. The use of force, and particularly armed force, is often indispensable and necessary in the management of discrete crises, such as violent criminal behavior and hostile military confrontations. The use of force is much less efficacious, and in fact detrimental when used as a governing principle for day-to-day life. This is true not only for actual armed incidents such as SWAT team actions or law enforcement raids, but also for the coercive legislation that serve as the rationales for such actions. Bans and prohibitions, mandates and imperatives, while perhaps necessary to transient exigencies are detrimental and corrupting when relied upon for social order.

A society cannot succeed, progress or even survive when daily life occurs under the shadow of government coercion. Dictatorships and tyrannies have limited lives because the inevitable result of rigid force is destruction and decay. Societies thrive as a measure of the character of their members rather than the force of their rulers. The transient efficacy of force is not dependent upon the rationale for its use. Force and coercion can be employed for malevolent as well as benevolent purposes. They can be used to suppress virtue as well as vice. The indiscriminate use of force tends to become a substitute for reasoned policy and the consensus that results from civil discourse. Bans and mandates are the tools of the impatient, incompetent, misguided and corrupt.

Once force is employed as the basis of a particular policy, especially when such is contrary to popular sentiment, it creates a self-perpetuating cycle of increasingly intrusive and coercive interventions that eventually become unsustainable. The bonds that exist between members of a thriving society are not bonds of submission. The use of force and its antecedents are malignancies in the body politic, consuming more and more of civic life and corroding the societies that host them. If society that requires the use of force and government intrusion for survival is doomed regardless.

Sunday, April 21, 2013


The practical consequences of the Administrative State are limited not only by legal and constitutional considerations, but by less arbitrary ones as well. Bureaucracies quite simply, and as a general rule, get worse the longer they exist. This is because they are subject to corrupting incentives that cannot be changed by “law”:

- Everyone likes things that make their jobs easier; give bureaucrats discretion and they will use it to make their jobs easier, even if it frustrates the purposes of those jobs in the first place.

- Turf guarding. Bureaucracies have survival instincts, and these affect their operation. Give bureaucracies discretion and they will expand as a matter of self-preservation and self-perpetuation, regardless of the public benefit or detriment.

- Insularity. Stuff a bureaucrat into a life tenure and his or her world gradually shrinks to the limits of the bureaucratic fiefdom. The external becomes the extraneous, and bureaucracies become unmoored from the common interest.

- Loss of proportion. Bureaucracies breed petty tyrants, for whom authority becomes a substitute for common sense.

-Risk aversion. Bureaucracies become more and more intolerant of risk as they age, to the point that obscuring responsibility, dodging accountability and suppressing any activity that may require a tough decision eventually become the guiding principles.

These influences arise from common psychology, rather than any particular ideology or political philosophy. All “administrative states” eventually become inefficient, sclerotic, senseless, abusive and obsolete. The more authority that is delegated to them, the faster they become so.

Saturday, April 20, 2013

Common thread

Psychologists, criminologists, historians and those who are simply curious will expend a great deal of effort trying to find a common threat that links the perpetrators of spectacle crimes. Surely, there must be some relatively simple and indeed common element that connects Eric Harris, Seung-Hui Cho, Anders Brevik, Mohammed Atta, James Holmes, Adam Lanza, Jared Loughner and Tamerlan Tzarnaev; and indeed there is. Some of these were psychotic, some ideological, some reigious fanatics. There is a great deal of heterogeneity in the motives, and cognitive processing of these individuals, but there is one thing common to them all: fantasy. Each of theme had a fantastic notion of how his crime related to some goal, with such relationship reinforced not by rational analysis but by emotional compulsion.

It is assumed that each had a pathological lack of empathy, and this is true, but one of the things that fantasy provides is a mechianism that makes empathy unnecessary. Movie villains and video game characters can be killed wantonly without moral qualm because they are acknowledged to be only part of a fantasy. this mechanism also works the other way, however. Not only can reality be projected onto fantasy, but real people can be perceived as the characters in a fantastic episode, in which everything; the motive, the outcome, the emotional satisfaction, is ultimately a figment of imagination.

Social media

The biggest benefit to the emergence of social media is not that it will help keep people more informed, but that it should make them more skeptical.

Tuesday, January 08, 2013

Efficiency and rationing

What will happen if the government institutes universal coverage, while trying to contain costs? The system will become more efficient, but not in the way the government intends. Take for example ear nose and throat specialists. Right now, such pracitce involves ear tubes, tonsillectomies, thyroid surgery, neck dissections to remove tumors, sinus surgery and more specialized procedures involving the inner ear, trachea and larynx. Much of the ear tubes and tonsillectomies are performed on pediatric patients, and involve a disproportionate number of medicaid recipients. If you give everyone coverage and begin to limit reimbursement for particular services, say for example, ear tubes, otolaryngologists will respond by making their pracitces more efficient; not more efficient in terms of performing more procedures in a given amount of time, but more efficient in terms of concentrating their time in other procedures. If a physician can get the same reimbursement for doing two hours worth of sinus surgery that he does for three hours worth of ear tubes, that physician will eventually focus on the former procedures and do less and less of the latter. He will focus his marketing efforts and networking to the more lucrative procedure, leaving the less remunerative surgeries to less senior surgeons or less established practices. Micro-specialization will occur, with the result that the less remunerative procedures will experience longer wait times, and less choice of qualified physicians. This has already happened to some extent in neurology, where physicians discovered that their time was much better compensated doing nerve conduction studies in thier offices than in doing inpatinet consultations. As a result, many hospitals had no emergency department coverage for neuroly patients. Pulmonary specialists also gravitate to bronchoscopy or sleep specialties at the expense of intensive care unit coverage.

This phenomenon is also observable in the growth of boutique practices, where physicians decide that it is better to get reasonable compensation for reasonable services than to get paid a little more for a lot more effort.

If the government provides universal coverage with price controls, it will not discourage unnecessary or inefficient care, it will discourage access to time-intensive and poorly-reimbursed care. The incentives will be such that costs will be saved, not by discouraging patients from seeking care, but in discouraging doctors from providing it.

Cost effectiveness

Here's a quick question for those who advocate a government role in cost effectiveness research: Is it cost effective to treat aspiration pneumonia? The answer, of course, is yes. Or no. Well, yes and no.

If a forty year old trauma patient aspirates immediately after urgent surgery, then yes, it is relatively inexpensive and efficacious to treat with a short course of antibiotics. On the other hand, if the patient is a 74 year old stroke patient with recurrent aspiration, end stage renal disease, and prostate cancer, treating his most recent pulmonary event will prolong the course of dialysis, potentially involve future stays in the ICU on a ventilator, gastrosomy tube, etc., all for the expected benefit of the patient being kept alive so he can die of something more horrible. It is easier to see that treatment might not be cost effective if we consider the patient to have widely metastatic prostate cancer.

If we take this last patient and start removing, one by one, the co-morbidities that make treating aspiration pneumonia such an expensive proposition, at what point do arrive at the objective cut-off that treating him is cost-effective? It is the fact that identifying such a cut-off seems reasonable that is problematic, because it implies that whatever body decides cost-effectiveness will eventually be forced to decide on case-by-case bases. This is the achilles heel of all high minded healthcare system reformers, and all of those overly academic types that worship at the altar of "evidence based medicine." The practice of medicine is founded on the doctor-patient relationship, not the doctor-population relationship or the doctor-health board relationship, or the doctor-utopian social justice fantasist relationship.

It should be axiomatic that a doctor not give a patient medicine to treat the anxiety of a family member. The principle at work is that the provision or withholding of a therapeutic intervention should not be for the benefit of third parties. Similarly, we should not conclude that an intervention is not cost-effective for a particular patient, merely because some egghead has decided that it is not cost effective for a heterogeneous population.

Population studies and statistical models and various and sundry other such are useful for identifying general principles that a competent physician may incorporate into the treatment decision that he makes for his specific patient. They are not reasonable bases upon which to dictate those same decisions from a remote authority for whom that patient is just a data point.

Typical and atypical healthcare

The more socialized healtchare systems of western Europe ("European medicine") do some things very well. So does Cuban medicine, and Honduran medicine, Chinese medicine, etc. Kaiser does some things very well, as does the VA. But none of these systems do everything well, and all of thses systems, including the European ones benefit from America’s willingness to take the risks necessary to advance medical science for the benefit of all.

If you look at the medical system of the Europeans, and Cubans, etc. you will notice that they do a good job of providing a particular type of medical services. So does Kaiser and the V.A., and if you were an astute reformer, you would immediately perceive both a rational approach to reform, and immediately spot the problems with current healthcare reform legislation.

All reform begins with a simple task: classifying aspects of the thing to be reformed into groups according to their beneficial and non-beneficial attributes. Now we can do this with healthcare in any number of ways; trauma and non-trauma, catastrophic and non-catastrophic, preventive and acute, experimental and non-experimental, pre-existing and not, publicly financed and private pay, etc. Whether or not reform is successful depends crucially on which distinctions are selected as the bases of reform. When it comes to talking about cost savings, the classifications degenerate into rationing on the basis of condition (like the Oregon medicaid system) on the basis of who the patient is (e.g. Obama’s reference to patients who are better off taking pain pills), or on some homogenized metric of efficacy (comparative research panels.) Each of these approaches requires a trade-off at the expense of liberty and values of individuals, and this is the reason why “Obamacare” is unpopular, and actually antithetical to the purpose of healthcare.

A more reasonable approach is to realize that there is a natural discriminant in healthcare services: typical and atypical care. Typical care is that which you receive for uncomplicated pnuemonia, coronary artery disease, diabetes, etc. It includes preventive care and management of chronic diseases. Atypical care is everyting else: ICU stays for complicated pnuemonia, costs for defensive medicine, experimental care, elective surgery, the more exotic imaging techniques, care for extremely premature babies, etc.

Europe and China and Cuba (and Kaiser and the VA) do very well with typical care for a very straightforward reason: typical care is relatively inexpensive. If so inclined a national formulary could consist only of drugs that Target provides for $4 a month. Furthermore, the vast majority of people could get by with only typical care. It would suck for some people if we didn’t provide for end of life ICU care, or organ transplants or reconstructive surgery, but these would affect a comparatively small portion of the population. If you reformed healthcare to only provide for typical care, the cost effectiveness would sky-rocket, at the expense of course of those for whom typical care is not good enough.

Over time, things that start out as atypical become accepted and routine (and cheaper) and naturally become typical type of care. Laparoscopic surgery, statin drugs, PET scans, Herceptin, and so forth. Subsidizing atypical care eventually benefits everyone because it advances the state of the art. Admittedly, there is a huge amount of waste in the atypical category, including defensive medicine, futile care and needlessly expensive interventions where cheaper ones would suffice. We Americans put up with this for a number of reasons: 1.) because as mentioned, it advances the state of the art for everyone, 2.) because we have adopted a societal ethic that we will not discriminate on the basis of health, and 3.) that we will not intrude on the patient’s determination of what an acceptable quality of life or benefit of therapy is. Note that ineffective or inefficient therapies would not be accepted as “typical,” or if that is already the case, be replaced by better therapies that start out as atypical.

 An astute reformer would begin by assuring access to “typical care.” This is in fact the only thing that the European model has done, with very little downside, because those nutty Americans are traditionally disposed to uderwriting the benefits of care that others regard as atypical. If you were so inclined you could reform American healthcare to cover “typical” care and let people contract individually for “atypical care” and get the best of both worlds.

Of course what Congress has done is to do the opposite. An insurance mandate is an artifice by which atypical care is treated as typical. It imports the inefficiencies of providing extraordinary and costly care into a market designed for cost effective and predictable care. It imposes the inflationalry pressures of private third party payers on a portion of the system that should be actuarily sound, and necessitates the replacement of discarded efficiencies with explicit rationing. Worse, it shoehorns providers into a system where the mandated inefficiencies will be addressed by preferentially treating those who are less ill, (which not surprisingly is more cost effective than treating very ill people) thus discriminating against those who receive adequate care now, and would receive such care in Cuba, China etc.

You are correct when you note “if you increase Medicare payments with no thought about the effectiveness of what you are buying your country will go bankrupt even faster.” This is exactly what “Obamacare” does. It divorces payment for medical services from a rational allocation based on the expected risks, benefits and costs. It stifles innovation because it falsely treats newer and promising therapies as typical care before experience and ingenuity have enhanced their effectiveness, and efficiency. In short, no one, including Europe, could afford it if everyone’s healthcare system were like Europe’s. And our tradition of liberty and personal autonomy wouldn’t take well to it either.

Thursday, January 03, 2013

Predictability and economy

One concept that runs throughout Mr. Greve's post is that of predictability. Predictability is the reason why we have written laws, constitutions, contracts, stare decisis, etc. etc. Predictability is essential to the rational expectation that the future can be made better than the present. This same idea forms the basis of credit, and ultimately, of capitalism. It is much easier to have faith in the future if we have some reason, beyond hope, to expect that it will contain something worth striving for.

 Predictability is also central to an unalterable truth. The economy is healthy so long as enough people expect the future to be better than the present. It is an uncomfortable fact, to the point that it can scarcely be spoken, that the value of something is only an opinion. Tulip bulbs, and Facebook stock are ultimately only worth what people think they are worth, and this is largely dependent on what people think they will be worth in the future. Debt is the same way. We can go on borrowing forever if someone will lend us money forever. However, the price of tulips, and corporate stock, and debt and equity markets collapse upon a fairly uniform occurrence. It is not necessarily when debt-to-revenue ratios reach a certain level, or when short term bond yields bear some relation to those of long term instruments. Bubbles burst, systems collapse and economies tank when enough people realize that they are going to get screwed. The predictability that makes economic growth possible is that which makes risk of being screwed something measurable and manageable. Right now our political class is destroying predictability with abandon.

We are all going to get screwed.