Tuesday, May 20, 2008


History holds many examples of political philosophies that have been put into practice with varying degrees of success. Many ideologies that sounded benign in concept have left bloody ruins when put into practice. Whether this is the result of a psychological quirk or cynical political expedience, many ideologies of the past several hundred years have led to slaughter.

The unfortunate fantasy of many political visionaries is to be able to eliminate people they find inconvenient. This is not limited to the underlying philosphies of the left or right, but rather seems to grow out conviction that hardens into fanaticism. Apologists often lament the death of innocents while opining that such deaths are somehow necessary to a better future. This "break some eggs to make an omelet" approach to human life afflicts the values of utopians, communists, fascists, socialists, capitalists, religionists, and nearly everyone else who thinks with sufficient conviction that he or she knows how others must live.

The concept that some people are impediments to a better life for others led to the excesses of the French revolution, the Ukranian harvest of shame, the Cultural Revolution, the killing fields of Cambodia, and places in the world to this day where some people think that a political idea justifies the death of another. The true totalitarian fantasy is to eliminate innocent people with impunity because it is justified by an intellectual abstraction.

The more we are given to tolerate these homicides, the easier it is to accept that sometimes innocent people can be sacrificed, not for some debatable greater good, but simply to satisfy our subjective wants.

Friday, May 16, 2008


In the physical sciences, something is considered abnormal if it varies from the norm. The trend in the social sciences however is to regard something as abnormal if it varies from the ideal, even if the ideal is unobtainable. Further, there is a reliable tendency to ascribe the variation from the ideal to someone’s bad character. In modern thought, to alter nature is an abomination; to alter man, a necessity, as though there is no such thing as human nature.

The cheapest way of appearing virtuous is to accuse others of lacking virtue.

Wednesday, May 14, 2008


Much has been made of the assertion that race is an element in many votes that will be cast against Barak Obama this year. A fair question may be asked as to whether this is a reflection of a deeply ingrained racism, or if there is at least the possibility that race is an incidental factor in a more general concern.

If some people are moved to vote for anyone but Obama because his father was black, a decent curiosity would prompt one to ask "Why?" It may be, of course, that some people distrust, hate, or fear anyone of African appearance. That this is in fact the case is supposedly illustrated by the hypothetical "If Obama were to choose an African American as a running mate he would be less likey to be elected, and this is because Americans are too racist to vote for an all-black ticket, regardless of the qualities of the individuals." In fact, if Obama were to select a black running mate, he would be less likely to be elected, but not because people simply do not want a black person to be president.

The issue is not one of race, as much as the perception that a candidate will advance a narrow agenda. This is the reason that John F. Kennedy had to clarify the role that his Catholicism would play in executive decisions. The reason that his speech to Baptist ministers was effective was because the issue was not whether he was Catholic or not, it was whether he would pursue Catholic interests as president.

The public does not want an executive whose priorities lie in a narrow, insular agenda. Consider if a ticket composed of Hillary Clinton and Madelein ALbright ran against a ticket of Patricia Ireland and Kate Michelman. Who do you think would win? How about if Tom Tancredo ran with Pat Buchanan? The odd fact is that single issue voters will vote for politicians that agree with them on a given issue, but few people will vote for single issue candidates.

Barak Obama must contend with the suspicion that he harbors a narrow, black-centered agenda. This is part of the fallout from his association with Jeremiah Wright, who has been explicit in advocating for such an agenda. If Obama were to pick an African-American running mate who is associated with the same views, Obama will be viewed with the same suspicions that John Kennedy faced regarding his religion. Unfortunately, Obama probably would not be given the benefit of the doubt, even if he chose a black running mate with less activist background, such a Colin Powell. People who might otherwise vote for Obama might become suspicious that he thinks race is important, and on that basis decide that his motivations are to narrow for President of the United States. It may not be fair, and it may not be old-time bigotry, but it is part of the politics of perception.

Thursday, May 08, 2008


One of the reasons that healthcare in the United States is so expensive is that a significant portion of healthcare expenditures is, in effect, a tax we pay pay to maintain certain illusions. We willingly pay millions of dollars to maintain the illusion that nonagenarians who have suffered massive strokes might somehow completely recover. We pay to sustain the illusion that our healthcare policy is concerned primarily with what is best for the patient. We fund the illusions that self-destructive behaviors are just bad luck, that all people access the system only for health-realted reasons, rather than a small portion who do so for secondary gains. We pay to accommodate the fashions that various forms of quackery are therapeutic, that the natural course of many objectively terminal diseases is cure rather than death, and that a hospital that looks like a hotel is somehow better than one that does not. One of the reasons that the American healthcare system is so expensive is that there is little seriousness about making it otherwise, because we like our illusions and are willing to have "the system" pay for them.

There is a contradiction regarding the quality of the American healthcare system, in that it is sometimes described as the best in the world and othertimes derided as being the most expensive but inferior to most of the developed world. The resolution of this anomaly lies in acknowledging that both views are correct. The fact is that the American healthcare system is designed to achieve different goals than those of other countries. If the goal of the U. S. system is limited to providing universal preventive care, it could probably do that quite efficiently. If its focus is limited to provide a catastrophic safety net it could probably do that as well. But the American healthcare system is intended to fulfill many roles, which have the effect of benefitting the rest of the world. The American system advances the state of the art, and is to a large degree resonsible for much of the progress of the art of medicine worldwide. The American system encourages access to technologies that are not always economically beneficial (there are probably way more CT scans performed here than need to be) but which may make the underlying technologies more economically available in the future. In addition, there is a large sociological component to the delivery of healthcare that would go unnoticed if the goal were simply to queue people up to receive their alloted share of services. Part of this is because American society is more diverse than say, Japan or Cuba. We have expenditures for artificial joints in octogenarians, which would be unlikely to be priorities in a more "efficient" system.

There are many ways that the American healthcare system can be improved, but first we have to realize that not all of the problems are due to greed or the bad character of "them." A lot of it is due to choices that we make, and interests that we protect.

Wednesday, May 07, 2008


All healthcare systems involve some form of rationing. This is an inescapable reality that arises from the fact that healthcare is not an abstract right, it is a service that must be provided from a limited supply of resources.

Different system use different criteria upon which to make rationing decisions. Sometimes these are explicit, as in the Oregon Medicaid system, and sometimes they are inherent, such as the Canadian practice of rationing by queues. In the United States, there is a patchwork of rationing, varying by region of the country, medical condition of the patient, and socio-economic factors.

Reform of our healthcare system should start with selecting and designing an appropriate rationing criterion. As a foundational step, it should begin by constraining the definition of "healthcare." It would be next to impossible to design and implement a viable healthcare system if it includes practices of limited application and dubious merit. The first step in overhauling healthcare should thus be to define healthcare as "those practices and interventions that have been shown by rigorous scientific study to have a cost-effective benefit in management of acute and chronic health conditions." For purposes of this definition, "cost effective" would mean the amount of therapeutic benefit per unit of resources expended. Cost-effectiveness would be determined by market mechanisms; i.e. competition among various therapies with those yielding the most benefit per unit cost survivng, and those

This approach would be exactly counter to present practice, which is to take an entitlement and expand the definition of it to ensure that it not so much grows as metastasizes.

Tuesday, May 06, 2008


There are many factors that make private enterprise more efficient than government in providing a particular service or accomplishing a particular task. One such factor is that government is constrained by things that need not necesssarily inhibit the private sector. For some reason having to do with the quirks of politics, a major impediment to government efficiency is that it is effectively not allowed to undertake activities in a manner which hurts anyone's feelings. Government must maintain the most ludicrous of facades to appear sensitive, inclusive and "fair." Even when providing services that few would argue should be the province of government, such as law enforcement, malignant sensitivity and pandering to grievance politics not only impairs efficiency, it sometimes defeats the purpose of undertaking those activities at all.

Thursday, May 01, 2008


All successful societies develop traditions, and in fact traditions are a marker of societal achievement. Tradition serves many purposes: it acts as a repository of experience; it serves as a reminder of past achievements and worthy enterprises; it provides a frame of reference for future endeavors; it provides recognition of virtues and other admirable qualities; and it supplies some measure of structure for more intricate and complex organization.

Tradition is necessary to futrure enterprises because, regardless of the form it assumes, or how it formally exists in society, it helps provide one element essential to progress: predictability.

Predicatability is an indispensible element of human progress. The reason why scientists and engineers can use scientific principles for technological advancement is that the principles of science are predictable. It would be impossible to have electric lights if a conductor moving in an electric field produced an electric potential some times, but not others; it would be impossible to travel by air if lift prodiced on a wing occurred randomly, instead of following well-behaved realtionships between air density, velocity and pressure. The same princle applies to social progress. If laws had no predictable application, there would be no point in having laws, and it should be noted that frequently in human history, tradition formed the basis of legal systems. The Anglo-American concept of stare decisis is simply a principle which promotes predictability in a system vulnerable to caprice in individual cases.

A society that eschews tradition, in the name of enlightenment, or fashion, or even progress does not simply discard its past. To a real extent, it corrupts its future as well.