Category: Government

A Vision of a Future America

Smokers receive little sympathy for their habit and its consequences. Some of that is warranted, as I’ve told both of my brothers who smoke. It’s a stupid habit that’s known to cause serious health problems. Who in their right mind would start today, knowing what we know. But there are no apparent bounds to human stupidity, so smoking survives¹. That informs the public debate, but should not dictate it. It does, though, an it will increase if we move to a single-payer health care system. Are we immune to liberty-despising lunacy like this?

Smokers who refuse to give up the habit should be denied some types of surgery, a respiratory expert says.

Matthew Peters said denying smokers joint replacement surgery, breast reconstructions and some other types of elective surgery was justified because the operations were more risky and costly when performed on smokers.

“In healthcare systems with finite resources, preferring non-smokers over smokers for a limited number of procedures will deliver greater clinical benefit to individuals and the community,” Associate Professor Peters said in the latest issue of the British Medical Journal.

“To fail to implement such a clinical judgment would be to sacrifice sensible clinical judgment for the sake of a non-discriminatory principle.”

To be fair, in the context of a silly idea, it has its logic. But the rules must be convoluted to get there.

To Mr. Peters, greater clinical benefit to individuals results from denying procedures to smokers. I’m quite certain that the smokers will not derive greater clinical benefit. What Mr. Peters really means is the community. There is no individual in single-payer health care, just a utilitarian cost-benefit analysis where the parameters are set by an outside party. Perhaps the smoker values hip replacement surgery enough to pay for it himself, where the non-smoker will only have it done because it’s paid for by the government. There are only two people who can make that decision, and the bureaucrat isn’t one of them.

In a private market, the smoker would pay the added insurance expense for his habit, and would weigh the risk decision with his physician. All people are not alike, so it’s feasible that smoker X will have a different risk than smoker Y. Again, who is better qualified to make that individual decision, based on relevant facts, the doctor or the bureaucrat?

“Therefore, so long as everything is done to help patients stop smoking, it is both responsible and ethical to implement a policy that those unwilling or unable to stop should have low priority for, or be excluded from, certain elective surgical procedures,” he said.

I have no interest in seeing this in America. I don’t smoke, I don’t drink, and I’m a vegan. According to the standards of a bureaucrat, I probably come out alright, unless a bureaucrat deems insufficient milk intake a danger to bone health, for example. Then, like everyone else in America who isn’t perfect, I’m screwed. Should I be sent for dairy re-education to make sure my bones don’t become brittle? Extreme, yes. Impossible, no. “So long as everything is done to help patients stop …” and “those unwilling or unable to stop” are the clues.

I’ve determined the possible effects of my health choices. I understand what I could face and I’ve compensated as well as I can. And I’m willing to pay for the consequences, both in health and dollars if I’m wrong. That individual calculation gets pushed aside in the world of single-payer health care. Liberty demands that we not embrace that nonsense, but economics and quality of care dictate the same. Pick your preference. Unless you hate both, the choice is easy.

Source: Bodyhack

¹ I’m not talking recreational smoking, although that’s dangerous. I’m talking about addiction. When smoking begins to cause serious health problems and the smoker can’t quit, that’s the where stupidity can lead. Or should I say excess stupidity. And yes, as the rest of this entry will show, people are entitled to what is in my opinion excess stupidity to harm themselves.

What prices do they deserve?

Someone should remind Rep. John Dingell that many Americans can think beyond what we’re told. For example, his comments about the Medicare drug bill have another side:

“Republicans had their shot at making the drug bill work, and seniors are still not getting the prices they deserve,” said Representative John D. Dingell of Michigan, the chief sponsor of the Democratic proposal.

“Republicans chose to take care of their friends in the drug industry,” Mr. Dingell said. “It’s our turn to prove that the bill can work for seniors.”

And now Democrats have their shot at making the drug bill work. Does anyone doubt that Democrats will choose to take care of their friends in the “senior citizen industry”? All they’re trying to prove is that Congress can ignore the laws of economics. Good luck with that. I’m sure the Republicans are to blame for not effectively repealing those laws. But Democrats will have better luck. Right?

Economic Thought of the Day

George Will gets it right today on the coming push to increase the federal minimum wage:

But the minimum wage should be the same everywhere: $0. Labor is a commodity; governments make messes when they decree commodities’ prices.

That’s spot on. The essay is not perfect, as Kip at A Stitch in Haste points out with a useful economics lesson, but the conclusion is the same. The correct minimum wage is $0. If the uninitiated come away with the wrong justification but the correct conclusion, we can work on the reasoning. Short-term isolated problem versus long-term widespread damage. Easy choice if those are my alternatives.

Of special note, I love this line that Kip wrote to explain Will’s loose semantics:

…sloppily knocking a foul ball down the right-wing line…

His entire post is worth reading, and shows why he should be widely read, but that phrase by itself is excellent. I wish I’d written it.

Government sanction is not a defense

I thought about writing something about the execution of Saddam Hussein, but decided against it because I couldn’t figure out what I wanted to say beyond the obvious. Saddam’s despicability doesn’t change my opposition to capital punishment. My reasons are based on my beliefs about government as much as they are on the ethics of condoned murder. I will lose no sleep over Saddam’s execution, but that doesn’t mean I have to agree with it as a punishment. That I even feel compelled to write that last sentence is sign enough that too many capital punishment supporters (dare I say fans) would accuse me of sympathy for Saddam because I don’t believe we should’ve been complicit in his murder. Don’t we deplore murder?

Until today, I couldn’t find the words to explain why I can disagree, even with a figure so worthy of such a punishment as Saddam Hussein. The only drawback is that Jacob Sullum wrote the right words at Reason’s Hit & Run before I could express them. I’ll quote him here discussing the etiquette of what happened:

… I’m a little puzzled by the expectation that one really should be polite to a gentleman one is about to kill. …

No, the taunts bother people because they’re undignified and emotional, revealing too much about the true nature of the event, which is a dressed-up, cold-blooded version of vengeance, prescribed and limited by law. They bother people for the same reason we don’t have public executions anymore, with crowds gathering to jeer and cheer after a nice picnic lunch. But what is the right way to kill a man who deserves to be killed? Calmly, professionally, and rationally, or angrily and triumphantly, while shouting “die, motherfucker, die”?

That’s it exactly. We want to make the event solemn, more for us than the condemned. He is going to die and we’re going to take joy in the act. But we want to pretend that it’s just. It is not. We are complicit in murder, for no better reason than vengeance. It’s unpleasant and unbecoming of a civilized society, but at least be honest about it. I respect honesty. That would be an improvement over an unconvincing argument that execution is necessary without the threat of imminent danger.

How do we protect government from itself?

This is a few weeks old, but I’m just seeing it now. Accidental vacations have a way of encouraging information delinquency. Anyway, the underlying concepts won’t age, so here it is:

Trans fats are largely synthetic fats widely used in fried foods and baked goods. There is substantial medical evidence that they are significant contributors to heart disease (perhaps increasing the incidence of heart disease by as much as 6 percent) because they both raise the cholesterol that is bad for you (LDL) and lower the cholesterol that helps to protect your arteries against the effects of the bad cholesterol (HDL). About half of New York City’s 20,000 restaurants use trans fats in their cooking; and roughly a third of the caloric intake of New Yorkers comes from restaurant meals.

That’s from Richard Posner, at The Becker-Posner Blog. It’s a fair enough assessment of trans fats and why health officials think it’s bad. There is no harm in information, right? But how do those facts justify a complete ban on the ingredient in all New York City restaurant meals?

What is missing in this analysis is a cost that, ironically, a great Chicago economist, George Stigler, did more than any other economist to make a part of mainstream economic analysis: the cost of information. It might seem, however, that the cost of informing consumers about trans fats would be trivial–a restaurant would tell its customers whether or not it used trans fats, if that is what they’re interested in, and if it lied it would invite class action suits for fraud. But there is a crucial difference between the cost of disseminating information and the cost of absorbing it.

When I first read through this, I’d intended to discuss “the cost of absorbing it” in this context. But that would be less interesting than this, from later in the paragraph:

Actually the danger would be impossible to explain to diners, because it would depend on the diner’s average daily consumption of trans fats, which neither the diner nor the restaurant knows.

Want to take any guesses about who else doesn’t know the diner’s average daily consumption of trans fats? The government, of course, although it’s less far-fetched to believe that the government wants to know. Rather than the invasive, suspect process needed to keep an accurate, or even approximate, tally, it’s easier to just ban everything. That way, the government knows how much trans fat diners will consume in restaurants.

The acceptance of paternalism continues:

In such a situation, even those of us who distrust government regulation of the economy should be open to the possibility that the ban on trans fats would produce a net improvement in the welfare of New Yorkers by satisfying a preference that most of them would have if the cost of absorbing information about the good in question were not prohibitive.

There are tidbits of possible solutions sprinkled throughout the entry. Instead of less troublesome tactics such as mandatory labeling and government marketing against trans fats, Judge Posner finds government prohibition amenable. Unreal. The cost is less prohibitive in either of my hypothetical solutions, although they’re still far from libertarian dreams. Judge Posner’s conclusion is incompatible with liberty.

Hat tip: Hit & Run

Wish hard enough and prohibition still won’t work

It’s all in how you approach the issue, isn’t it?

Federal officials are concerned that teenagers are abusing prescription medications and over-the-counter cold remedies even as their use of illegal drugs has generally declined over the past five years, according to a government survey released yesterday.

Illegal drug use by teenagers has fallen 23 percent since 2001, but their use of prescription narcotics, tranquilizers and other medicines remains “relatively high,” government investigators said.

There’s never a better time to incite more drug hysteria than the present. “Relatively high” is persuasive.

“This is now an area of drug abuse that we need to pay more attention to,” said Lloyd D. Johnston, the University of Michigan researcher who led the annual “Monitoring the Future” survey, now in its 32nd year. “My guess is that young people do not understand the dangers of abusing these drugs.”

Young people don’t understand the dangers of anything. Maybe we should just lock them in their rooms until they reach 18 21 an age where they’ll listen to government nannies who know better.

“If there is one thing that every adult can do today to help protect young people against prescription drugs, it is go to your medicine cabinet, take those prescription drugs you are finished using and throw them away,” said John P. Walters, director of the Office of National Drug Control Policy. “If you have teens in your house, remove this hazard today.”

I thought the current plan was to allow people only what they should “reasonably” use, leaving no pills in the bottle when whatever it is the pills are supposed to correct is cleared up. Did I miss something? I smell more invasive oversight of prescription drug use. If your doctor prescribes too many pills, he definitely wants to get your kids hooked on abusing drugs. He should be arrested. Oh, never mind. I bet kids would never think to look in the trash. Just in case, we should probably implement government-provided hazmat bins for old prescription drugs. Or we could have a central office in each town where people come to receive their daily pills. Consider it a community nurse’s station. That would work. For the children. Of course, I’m quite thankful that kids aren’t stupid enough to use other household items to get high when other, more effective, less dangerous items aren’t around because government has protected them.

“We’ve had in the past a tendency to take our eye off the ball,” he said. “We want to continue this decline, and that requires us to stay at it. If we fail to send anti-drug messages across multiple contexts with young people — especially given the contrary drumbeat that still appears in popular culture and on the Internet — we risk losing our progress.”

Kids aren’t media-savvy enough to decipher propaganda from the messages they want to hear? Nonsense. Our drug policy doesn’t work, and can never work.

Who should we blame for dereliction of duty?

A dozen years of Republican power, yet if the Democrats perform even the fiscal cleanup reform necessary, they’ll be to blame for any of the pain involved. Consider:

So will the Democratic Congress be any better than the Republican Congress was? A look at half a dozen likely policy proposals makes clear the answer will probably be no:

  • Tax Increases…
  • Spending Increases…
  • Alternative Minimum Tax. A 1969 tax increase that was enacted to soak the rich is suddenly going to seriously soak the middle class. Some 3.5 million taxpayers paid the AMT this year. But unlike the regular tax, the AMT is not indexed to inflation, which means the number of taxpayers the AMT hits is expected to balloon–by some estimates to as many as 23 million in 2007. Less than 5% of families with incomes between $100,000 and $200,000 are now paying the AMT, but more than 80% may pay it in 2008. Almost no families with incomes of $50,000 to $100,000 pays the AMT today; but as many as 35% of such families will in 2008.

    To eliminate these very unpopular AMT increases would cost about $750 billion over the next 10 years. What taxes the new Congress will raise to solve this dilemma is unclear, but either AMT or other taxes will have to rise.

  • Protectionism…
  • Energy…
  • Social Security. Just 10 years from now Social Security benefits paid out will exceed taxes paid in, so something will have to be done to fix the system. Individually owned Social Security accounts would help by allowing workers to enjoy bigger returns. But Democrats are dead opposed to the idea of turning millions of Americans into owners of stocks and bonds, which will lead to the liberal solution of raising Social Security taxes and reducing benefits. The forthcoming plan will likely be to raise the cap on earnings subject to Social Security taxes ($97,500 in 2007). That would raise taxes on everyone earning more than this amount, especially the most productive wage earners. If the cap went up to $150,000, for example, it would mean a tax increase of $6,510 on a worker earning that amount.

The Alternative Minimum Tax and Social Security are absolutely problems that must be addressed. The longer we wait, the worse the pain will be. Obviously someone will take the blame. But it’s shameless to acknowledge that the Democrats will have to address the crisis and then blame the unpleasant reality on them.

I don’t seek to absolve the Democrats of any guilt, for they surely must share. Still, I have to come back to the reality that the allegedly fiscally conservative Republicans had six years of complete control over the two branches of government necessary to implement reform on these issues. They did nothing. When the weeds got thick, the party punted in favor of attacking gays and Janet Jackson’s breast.

Both parties are to blame for creating the problem, and I’m certain the Democrats will come up with stupid non-solutions to both. But I know who to blame for letting the problem get this severe.

Six days

I predicted this, but I’m amazed at the speed and audacity with which the United Nations discarded the words adult and voluntary.

“These (African) countries should now prepare how to introduce circumcision on a large scale,” UNAIDS chief Dr. Peter Piot told Reuters. “The science is clear.”

Baby boys should be targeted first but then attention should switch to adolescent boys and adult men, said Piot, who is in New Delhi to meet Indian officials on how they plan to tackle the world’s largest HIV/AIDS caseload.

The HIV crisis is raging in Africa among sexually-active adults, and UNAIDS wants to focus initial resources on circumcising baby boys. Baby boys can’t fight back, and if you circumcise them young, they’re much more likely to grow up and circumcise their own children. It’s indoctrination to perpetuate an otherwise unthinkable practice. That’s how it occurred in the United States in the early 20th century. It’s how it will occur in Africa in the 21st century.

The United Nations is a despicable organization in the circumcision debate. It lacks any legitimate notion of human rights or gender equality. Baby boys are human beings with inherent rights, not tools for ideological social experimentation.

Science isn’t the primary facet of this debate.

One point of follow-up on the Scottish article I discussed this morning. Further along in the article, this:

“The presumption against male circumcision in Scotland should be lifted,” said Dr Tim Hargreave, a urologist at Edinburgh University and a senior adviser to the WHO.

“There needs to be a policy shift in light of this evidence. Parents who seek circumcision for non-religious reasons should have ready access on the NHS.”
…

“There is an enormous anti-circumcision lobby that has very real concerns. But you have to separate the science and the evidence from the emotional baggage,” he said.

Isn’t it convenient how easily Dr. Hargreave lumps “real concerns” into emotional baggage, since the science is so convincing? That would be truthful if it were true. Dr. Hargreave’s position, like most who support infant circumcision, falls into the realm of truthiness.

Yes, I’m angry about being circumcised, a fact I admit. That does not change my argument. My “emotional baggage” appears in the tone and lack of patience I sometimes take surrounding the issue of infant circumcision, but there are facts and logic behind what I say. I do not deny the science, instead explaining why it isn’t enough to overcome the ethical concerns and the reality that less invasive procedures exist to resolve medical issues if they arise.

Orac, at Respectful Insolence, has an interesting take on the battle against vaccines that I think can be applied equally to the circumcision debate. I have no idea if Orac would agree with me, but his words speak truth to what I’m trying to say. Consider:

Supporters of pseudoscience … always have the advantage in such events, because the pseudoscientist can throw canards, dubious data, and distortions with abandon and force the skeptic or scientist on the defensive batting the canards aside, so much so that it is very difficult and sometimes impossible for a skeptic to get his message across.

Obviously the pro-infant circumcision lobby would classify me as the pseudoscientist in the circumcision debate, but that doesn’t fit. Skeptic versus non-skeptic is the key. Skepticism to Dr. Hargreave, and presumably most pro-infant circumcision folks, is “emotional baggage”. Circumcision is the panacea for all that ails society. Males should accept that the men and women who came before them and made their decision for them were wise and only acting with the best of intentions. The skeptic sees that this is modern medicine’s version of snake oil. Some people will improve by accident, but most are getting nothing measurable out of it. Does that mean everyone should drink up because it might work? Of course not. But that truth is “emotional baggage,” stifling the debate away from where it should be.

To their credit, the NHS stated that the recent results are not sufficient for it to reconsider its current policy that circumcision is unnecessary and should not be funded.

Thanks to Kip for the Science Blogs link.

Who needs brains when we have other people’s money?

One sentence, three flaws:

Scottish parents who wish to have their male infants circumcised should have the procedure paid for by the NHS to prevent the transmission of AIDS, a World Health Organisation (WHO) expert said yesterday.

First, allow me to repeat the obvious counter-argument to this. Male infants are not sexually active and parents have more ability to teach their children safe sex practices and responsibility than ability to predict their child’s personal behavior 15 or more years into the future. So, unless their sons intend to have unprotected sex with HIV-positive women, something parents can’t know, circumcising male infants to protect them from HIV is unconscionable folly.

Second, the World Health Organization is strongly pro-male infant circumcision and strongly anti-female infant circumcision. I understand the reasoning depends on centuries of what’s socially acceptable, but I’ve already pointed out the hypocrisy in applying different rules to boys and girls when they apply equally. Specifically, human rights are subject to more than just a clean operating room and good intentions. The World Health Organization should read through its own literature with a keener eye.

Third, for those in the United States longing for socialized healthcare, this is the sort of quandary you’ll be in. Fanatics will seek to allow parents to chop off parts of their sons on the national dime. That’s absurd enough, since there is no medical need for the surgery, but it should be clear that national resources are not unlimited. Every penny unnecessarily removing a foreskin is a penny not spent curing disease. I suspect socialists don’t think this way. There’s always another rich person who can be forced to pay her fair share, right? That’s unjust, but also false. People will die now so that little boys might not die six or seven decades from now of diseases with causes not specific to their foreskins. It’s stupidity.