Author: Tony

Politicians should get merit-based pay.

Andrew Sullivan links to discussion about Barack Obama floating the idea of merit pay for teachers. I wonder if the idea has any staying power. In the system we have, it’s necessary and there should be no resistance to such common sense. Of course, debating this distracts from the need to get government out of the provision of education, but we may need to try smaller market-based reforms first. So be it.

It won’t make me vote for Sen. Obama, though. I have a hard time getting excited about a politician wanting to give some people a pay raise when all he intends to do with that raise is tax it more than it’s already being taxed. That’s nothing more than a shell game. I’m not interested.

Stirring Incomplete Information from Michael Moore

I touched on this yesterday, especially in the comments, but Michael Moore has trouble with facts. I wouldn’t call him a liar, because he’s a skilled propagandist. The facts, out of context, are still the facts. Forget that such abuse of context fails to reveal anything intelligent about policy. As long as it’s a fact, it can be defended.

That’s his tactic today in challenging CNN’s reporting on Sicko, with the requisite omission of any context. For example, Moore praises Cuba’s health system, although the WHO ranks Cuba 39th compared to the U.S. ranking at 37. Moore rebuts this “gotcha” moment from CNN by stating that he put this figure in the movie. Fair enough; I don’t doubt that he did. He’s generally guilty of omission, not commission. He’s a propagandist, so no surprises.

What he fails to do is provide any context for those rankings. The latest link I can find describes it’s methodology in determining that ranking:

In designing the framework for health system performance, WHO broke new methodological ground, employing a technique not previously used for health systems. It compares each country’s system to what the experts estimate to be the upper limit of what can be done with the level of resources available in that country. It also measures what each country’s system has accomplished in comparison with those of other countries.

WHO’s assessment system was based on five indicators: overall level of population health; health inequalities (or disparities) within the population; overall level of health system responsiveness (a combination of patient satisfaction and how well the system acts); distribution of responsiveness within the population (how well people of varying economic status find that they are served by the health system); and the distribution of the health system’s financial burden within the population (who pays the costs).

Broke new methodological ground. Oh, and employing a technique not previously used for health systems. Don’t forget comparing to what the experts estimate. Is it possible to have methodological flaws, or to at least draw irrelevant conclusions based on estimates?

But let’s get to the last two measures. For distribution of responsiveness, how many people in the United States are denied adequate health care, a question independent of whether or not they’ll face an economic burden from that health care? In the answer, would you rather be the average American or the average Cuban? I suppose if you believe that Moore’s visit to Cuba first-rate hospitals was more honest than mere propaganda from a Communist state, the answer isn’t obvious. But any answer other than the U.S. is wrong.

Of course, that doesn’t mean we have the financial burdens perfectly figured out, which is the last measure from the WHO. Again, no one is denied medical care, which should matter. Moore ignores that when he (apparently¹) fails to mention long waits and rationing for essential services in countries with single-payer health care. But specifically to funding, it’s not objective to decide that too many people face economic ruin (not a percentage of bankruptcies, as Moore states, but how many people?) from the system we have, so we should place the burden exclusively on taxpayers. That’s a pre-determined solution without concern for the actual problem, which is economic burden.

If we’re looking to reduce the economic burden from a health crisis, insurance to cover catastrophic medical care is the way to go. Have people pay for their own preventive care, or buy separate insurance for that, if they choose. But disentangle coverage for catastrophic events from coverage for routine care. The current situation we have where the two are co-mingled is largely a government-created problem. Fix the broken government incentive problem by removing improperly targeted incentives, such as tax-subsidized employer health insurance.

Instead we’re left with disingenuous framing of the problem while ignoring what would actually resolve the issues we face. This quote exemplifies focusing on wrong assumptions:

“It is especially beneficial to make sure that as large a percentage as possible of the poorest people in each country can get insurance,” says [Dr Julio Frenk, Executive Director for Evidence and Information for Policy at WHO]. “Insurance protects people against the catastrophic effects of poor health. What we are seeing is that in many countries, the poor pay a higher percentage of their income on health care than the rich.”

Dr. Frenk’s opening sentence is fine, if he understands the true problem. The rest of his quote suggests he does not. If he understood, he would’ve stated that insurance against catastrophic medical events protects people from the catastrophic financial effects. He didn’t, offering only the empty, obvious fact that the poor pay a higher percentage of their income on heath care than the rich. Of course they do, just like the poor pay a higher percentage of their income on food, housing, gasoline, clothing, and every other generally necessary expense. This is not news, nor is it specific cause for government intervention through economic redistribution² and health care financing and provision, contrary to what Moore believes.

Moore also thinks the 20 to 30 percent of Canadians who disapprove of their waiting times for health care don’t matter. The minority never matters to a populist, or the liberty lost to mob rule. Now ask yourself if Moore’s comparison of American and Cuban infant mortality rates, for example, might have a bit more nuance than he’s letting on.

Link to Moore’s rant via Boing Boing. Moore’s rant on CNN here.

¹ Full Disclosure: I still haven’t seen Sicko. Viewing it isn’t necessary for my analysis here. Also, I have no respect for the WHO, since it promotes a gender bias in unnecessary, forced genital cutting, and it’s incapable of understanding that circumcision to prevent HIV infection is better suited for sexually active adults who volunteer for the procedure based on their own evaluation, rather than forcing the surgery on infants who will not be sexually active for well over a decade.

² I wonder what Dr. Frenk’s position would be on taxes to pay for health care. Would he be as distressed that the rich pay a (much) higher percentage of their income in taxes than the poor? If it’s about fairness in percentage, a little fairness in analysis might be useful.

Spot the error.

Ronald A. Williams, Aetna’s chairman and CEO, and Troyen A. Brennan, Aetna’s chief medical officer, have an op-ed in today’s Washington Post regarding health-care reform. See if you can spot the flaw here:

…we do not pay for care that is unnecessary according to the best evidence-based guidelines produced by medicine.

Now, journey over to the Aetna’s list of eligible health care expenses and scroll down to the blurb on circumcision, where you’ll find an “X” under “Covered”:

Amounts paid for infant circumcision are qualified medical expenses, even when performed by a rabbi in the home.

According to Aetna, performing unnecessary surgery on children is somehow “evidence-based”. The absence of medical need is somehow “evidence-based”. Parental preference because the foreskin is “icky” or “ugly” or any other irrational opinion parents may have about the body of their child, the patient, it’s still “evidence-based”.

Medically unnecessary genital cutting of infants is not evidence-based, no matter how many potential benefits Mr. Williams and Mr. Brennan can name. (Or how many potential complications and actual results they can ignore.) If they believe there’s evidence to support routine infant circumcision, it’s clear that their medical incompetence extends to ethical incompetence. It’s irrational to place the lack of medical need to the patient (i.e. the one having his genitals cut unnecessarily) below the desire to accommodate parental whims.

I might have Bush Derangement Syndrome.

Who does James Taranto think he’s fooling with this Best of Web Today?

In the sixth paragraph [ed. note: this story], the AP accurately describes the program: “President Bush authorized warrantless monitoring of international telephone calls and e-mails to or from the United States when one party is believed to be a terrorist or to have terrorist ties.” But in both the headline and the first paragraph, the wire service refers to the monitoring of international communications as “domestic spying.”

Such misreporting–and the AP is far from the only offender–is scurrilous. Moreover, it is potentially threatening to civil liberties. Remember the boy who cried wolf? If a future administration does engage in warrantless domestic wiretapping, how will the AP let us know? Who will believe it is the real thing?

Don’t complain about this illegal spying or we won’t believe you when there really is illegal spying. Nice try, but international telephone calls and e-mails to or from the United States involve a domestic point in a two-point connection. Everyone who isn’t being intentionally obtuse (or dishonest) understands this. I suspect that after six years of this sort of partisan blindness, Taranto actually believes what he’s selling. That wows me more than the unlikely possibility that his silly argument will be accepted by thinking people.

Why do you support the enemy?

Glenn Reynolds (approvingly?) links to Victor Davis Hanson highlighting an atrocity, but only provides the concluding rant. That rant:

For a self-congratulatory culture issuing moral lectures on everything from global warming to the dangers of smoking, the silence of the West toward the primordial horror from Gaza to Anbar is, well, horrific in its own way as well…

The primordial horror he says we’re ignoring a story of al Qaeda terrorists literally baking a child and serving him to his family. Figurative show of hands here… who isn’t repulsed by that story? Who believes the murderers capable of doing that aren’t the vilest scum possible?

If you haven’t spoken out against it, Victor Davis Hanson wants you to know that you should be ashamed of yourself. You’re part of a self-congratulatory culture committing a horror of your own, since your silence – and probably any sort of questioning of the current administration’s efforts to prevent such horrors – clearly indicates your approval that the act he mentioned is somehow not despicable. Or at least no worse than Paris Hilton’s troubles or whether or not you were able to score an iPhone last week.

Clearly punditry has few minimum requirements beyond smug, ignorant self-righteousness.

Let’s debate, but using only my arguments.

Via Radley Balko comes a bizarre, uninformed attack on libertarians from Amanda Marcotte, at Pandagon. At the entry is a bingo card designed to poke fun at libertarians, except each space is little more than a boiler-plate attack based on uninformed assumptions about libertarians. Mr. Balko calls it trite, which is the perfect description.

I can’t say I’m surprised, though. I had my first introduction to Pandagon and Ms. Marcotte a couple of weeks ago when she blogged her reaction after Egypt banned FGM. We obviously agree on the merits of banning FGM, although I was (and remain) less optimistic about this law’s effectiveness. What irked me then is the same lack of intellectual thoroughness evident in the libertarian bingo card. Her post:

Counting down to the “WHAT ABOUT TEH MEN?!” trolls who want to equate male circumcision with female genital mutilation. Look, you can oppose the former without blowing it all out of proportion. Dan Savage did a bang-up job in The Kid, for one instance of arguing against the practice of circumcision without drawing parallels to a much more horrific practice. And that’s just the first that comes to mind.

That’s a very typical response I encounter. Unfortunately, it’s a weak argument that seems to indicate a willingness to shout down debate rather than engage in a debate open to ideas.

I’ve never said anything contrary to the fact that FGM is almost always worse than male genital mutilation. It’s important that almost always doesn’t get lost in the focus on worse. It does. The World Health Organization recognizes four types of FGM. Not all are more severe than MGM. And not all are practiced specifically to reduce or eliminate the female’s capacity for sexual pleasure. (The outcome doesn’t depend on good intentions, but that could be said about male circumcision, too.) The overwhelming majority of cases are worse, of course, and many are done specifically to affect the female’s capacity for sexual pleasure. But we must not ignore the exceptions. Our ignorance permits us, as a society, to turn a blind eye. That is wrong.

Intellectually, the argument is obvious. Forced genital cutting for non-medical reasons on a non-consenting invdividual is wrong. The violence involved is still violence, and the mutilation is still mutilation, no matter how much the cut individual eventually likes the result or how much society approves. Gender is irrelevant.

Disagreeing is understandable and the precursor to enlightening debate. But squashing dissent before it arrives is little more than forced intellectual conformity. Such non-thinking stifles progress.

To her credit Ms. Marcotte makes several statements in the comments – where the comparison did erupt, to much bandying of the term troll – that she doesn’t support male circumcision, labeling it “a mildly barbaric practice that is cruelty to children”. She is open to more than just what our society believes about cutting the genitals of children. That’s what makes the original statement in her entry so frustrating, and what makes several of her other remarks in the comments section disconnected. For example:

Ah, I figured the false equivalence trolls would come out. Shameless. They probably think cutting off the foreskin is worse that slicing girls apart and letting many die, but they at least know better than to say that. Instead, they just equate the two and imply that anything less than calling circumcision the worst crime ever is supporting the practice.

No, I don’t think cutting off the foreskin is worse than slicing girls apart and letting many die. But that’s not really a fair comparison, is it? As I mentioned, not all forms of FGM are worse than MGM. But where they are, I’m not making a quantitative comparison. We don’t judge whether an action is wrong on the amount of wrong. It is or it isn’t. Qualitatively, genital cutting is genital cutting. That’s the argument, and why there is no “false” equivalence.

In the same comment where she labeled male circumcision “mildly barbaric”, she offered this:

It also troubles me to describe circumcised penises as mutilated when so many owners of them like them that way. Again, they don’t know any different and I think that they should stop to consider that they might be prejudiced, but still, it’s hardly mutilation to the same degree as FGM. …

… I think the proper analogy is to other minor cosmetic surgeries, like Botox injections. My opposition to it is that it’s better to leave well enough alone when the results of interference are dubious at best.

Ms. Marcotte’s absurd comparison to Botox aside, I don’t need to convince happily circumcised men that they’re damaged. If they like it, great. But mutilation is still mutilation. Not everyone is happy with it, and most who aren’t wouldn’t dream of having it done. That and it’s almost universal lack of medical necessity are enough for us to know that both are wrong. Again, both are wrong because they are the same action, medically unnecessary genital cutting forced on a non-consenting individual.

Well, hello (again)

A few stories to catch up from my unplanned absence.

First, Don Boudreaux offered a fascinating comparison of Sen. Barack Obama’s fund-raising and economic populism.

… Last quarter Sen. Obama raised, as the Times puts it, “a whopping $31 million.”

These funds, of course, are all voluntarily contributed. The fact that I, personally, do not care for much of what Sen. Obama espouses is irrelevant: lots of people like what he says. They like it enough to contribute to his campaign. The result, designed by no one, is a huge campaign chest for Sen. Obama. He will be well-financed to pursue his ambition. (In my opinion, this ambition is an especially greedy and venal one, but that’s just my opinion.)

In May, however, the very same Sen. Obama called for Senate hearings into allegedly excessive pay for CEOs of corporations.

The rest of Mr. Boudreaux’s analysis is perfect. When someone earns achieves superior results through voluntary exchange, any action to alter those results by a third party is wrong. “Too much” success notwithstanding.

As I think I’ve mentioned before, I will not be voting for Sen. Obama if he wins the Democratic nomination precisely because he is an economic populist. I did not vote Democratic in the last election to institute economic populism. Severe displeasure at the current administration and climate should not be seen as an overwhelming desire to be economically stupid.

Next, I still think public money for this is questionable, at best, but I like the approach this writer uses to explain proposed funding for circumcision as an HIV prevention.

One of the suggested health campaigns reviewed by the Global Health Program is provision of adult male circumcision to decrease individual likelihood of sexually acquiring HIV infection. Some recently published studies performed in Africa suggest circumcision may offer an impressive 60 percent margin of protection against HIV infection, which is well below consistent condom use and complete sexual abstinence, but far better than any other currently available interventions for men. Ambassador Mark Dybul, who runs the PEPFAR program, told the Council that he would provide funds for circumcision programs if the governments of the 15 countries PEPFAR works with requested such support. But strong concerns have been raised regarding the quantity and skill level of medical personnel required to perform this bloody surgical procedure. Though the procedure itself is inexpensive, adult circumcision risks exposing both healthcare workers and patients to blood-borne infections, including HIV. Diverting scarce health talent to large circumcision campaigns could impede other public health and clinical efforts.

In that context, my only concern is the public financing. The writer mentioned all the key aspects of circumcision as an HIV prevention technique. It should be up to the adult male, it’s effectiveness is significantly outpaced by non-invasive methods, and there are considerable risks to be addressed before applying it to African countries facing a severe epidemic. Radical solutions should be tied to real-world facts, considerations, and consequences.

Speaking of radical solutions needing to be tied to real-world facts, I haven’t seen Sicko yet. I don’t make it a priority to pay for propaganda. Anyway, I’m fairly certain what my opinion will be when I get around to it. I imagine it’ll be something like Kurt Loder’s opinion. (Someone else deserves credit here, but I can’t remember where I saw this link.) The entire piece is worth reading, but I like this best:

Moore’s most ardent enthusiasm is reserved for the French health care system, which he portrays as the crowning glory of a Gallic lifestyle far superior to our own. The French! They work only 35 hours a week, by law. They get at least five weeks’ vacation every year. Their health care is free, and they can take an unlimited number of sick days. It is here that Moore shoots himself in the foot. He introduces us to a young man who’s reached the end of three months of paid sick leave and is asked by his doctor if he’s finally ready to return to work. No, not yet, he says. So the doctor gives him another three months of paid leave — and the young man immediately decamps for the South of France, where we see him lounging on the sunny Riviera, chatting up babes and generally enjoying what would be for most people a very expensive vacation. Moore apparently expects us to witness this dumbfounding spectacle and ask why we can’t have such a great health care system, too. I think a more common response would be, how can any country afford such economic insanity?

I guess we’re supposed to fall back on the argument that it’s somehow free. No need to trouble ourselves with economic laws or evidence that demonstrates those laws or even the nuances of any argument that millions of Americans don’t have health insurance. The facts, although interesting, are irrelevant. Right?

I will see Sicko at some point, if only to understand what stupid people are believing. I don’t really want to give Moore any money, but I’m thinking back to how people paid for a different movie and saw Fahrenheit 9/11 instead. It’s tempting as a “gotcha”, but I wouldn’t do it. Unlike Moore, I consider honesty an asset. Whatever small price he’ll get from my (matinée) viewing is surely worth remaining above his level.

The law is for you, not for me.

I guess I’m not surprised that the editors of the Wall Street Journal believe that partisan attacks are a one-directional mess aimed at the Bush Administration, but to somehow turn the commutation of Scooter Libby’s prison sentence into a profile in non-courage by President Bush is really beyond all intellectual credibility. Reading through the short essay, I shook my head wondering how the editors can consider themselves “conservatives”, as a conservative surely wouldn’t sully the rule of law with excuses, blame-shifting, and a fair dose of language abuse. For instance:

As Mr. Fitzgerald’s obsessive exercise ground forward, Mr. Libby got caught in a perjury net that we continue to believe trapped an innocent man who lost track of what he said, when he said it, and to whom.

An truthful man needn’t worry about losing track of what he said, when he said it, and to whom. The truth is the truth. If you tell it exclusively, the story never changes. If your story changes, you’ve lied. It’s possible to argue that Mr. Libby did not lie to the grand jury, I suppose. The jury disagreed. The judge disagreed. I’m convinced. He lied.

And President Bush is a small-minded partisan at a time when he claims we need leadership.

I have more faith in intellect than steel.

Let’s just keep pretending that not can we predict the future, but we also know that future definitively will not contain better treatments for HIV. Or even possibly a cure:

In a breakthrough that could potentially lead to a cure for HIV infection, scientists have discovered a way to remove the virus from infected cells, a study released Thursday said.

The scientists engineered an enzyme which attacks the DNA of the HIV virus and cuts it out of the infected cell, according to the study published in Science magazine.

The enzyme is still far from being ready to use as a treatment, the authors warned, but it offers a glimmer of hope for the more than 40 million people infected worldwide.

Clearly any sense of optimism that the human mind can discover better treatments or a cure is irrational. The only caring action to stave off the inevitable horror of HIV for all humankind is to circumcise infant males shortly after they arrive from the womb. If he’s not circumcised at birth, he won’t live long after he becomes sexually active. He’ll be thankful.

How does one develop a mind closed enough to believe that?

Link via Fark.

P.S. How many more of these articles do we need before people stop believing the unfounded sentiments expressed by a reader’s e-mail to Andrew Sullivan?

Will it be enforced?

Egypt finally banned female genital mutilation. This is a pleasant surprise, and should be commended.

Unfortunately, a recent case in Egypt reveals a key flaw in medical thinking that dismisses complications from unnecessary genital cutting, whether on girls or boys.

In the latest fatality, 12-year-old Bedur Ahmed Shaker was taken by her mother to a private clinic in Minya, a town on the Nile south of Cairo, for the operation. She died before she could be transferred to hospital.

Her mother accused the woman doctor of negligence, charging that her daughter’s death was linked to the anaesthetic and not the removal of the clitoris, for which she had paid 50 pounds. Police have arrested both women.

Any time you read of more serious circumcision complications in America, it’s almost always attributed to some other factor. Claims of negative reactions to anesthetic are common, and probably factually true in most, if not all, cases. But when the cutting is not medically necessary, it is ethically wrong to blame only the anesthetic. If we don’t allow the unnecessary genital cutting, there would be no reason to use anesthetic.