Congratulations to this week’s winners:
Spiked Online - After Gaza: what’s behind 21st-century anti-Semitism?
Complete voting here.
Ockham’s Razor – Since October 2001 – by Scott Kirwin
Archive for January 2009
Congratulations to this week’s winners:
Spiked Online - After Gaza: what’s behind 21st-century anti-Semitism?
Complete voting here.
I’ve been with the Wife now for going on 19 years, and one of the keys to our marital success is the fact that I found someone more sensible than I am. So when I started going off on the President the other day, the wife made a sensible comment.
“He’s the commander in chief. He deserves our respect.” She then followed up the comment with a reminder of how the “nutroots” slandered Bush throughout his presidency, and that we should not follow their example.
It’s a sensible statement, and over time she might be proven right. However the fact is that those “nutroots” defined the 2008 Election and won it with their candidate. So while we might disagree with their methods, they beat us.
The Rise and Fall – and Rise of the Deaniacs
The force behind Obama was not new. It is the same force that lay behind the Howard Dean candidacy in 2004. The anti-war/pacifist constituency of the Democratic Party propelled Dean’s candidacy. This constituency was media savvy, well funded and had gained serious traction the year before the ‘04 primaries.
Howard Dean scared the pants off of DNC chair Terry McAuliffe at the time. McAuliffe was a Clintonite who was a caretaker of the party until Hillary was strong enough to take over the party apparatus after running for – and winning the presidency in 2008. But 2004 was too early for the Clintons, and the netroots weren’t too keen on the Clintons anyway – blaming them for the failure of Gore in 2000 and worse, for backing Bush’s war in Iraq.
McAuliffe and the party leadership strongly opposed Howard Dean’s candidacy. That opposition didn’t stop the AFL-CIO backing Howard Dean in November 2003. In December 2003 Al Gore endorsed Howard Dean. Dean was already ahead in the polls in the 9 person race for the Democratic nomination at that point, when a month later Bill Bradley announced his endorsement.
Howard Dean was riding a juggernaut – upending the Democratic establishment built under the Clintons, so it came as a relief to them when his candidacy flamed out during the early primaries and McAullife was able to find a “more electable candidate” than Dean. The grassroots support of the party that Dean cultivated evaporated with his candidacy, and the party was left to draw money from its list of “usual suspects” – unions, limousine liberals, and city machines.
The Democratic loss in 2004 ended McAullife’s tenure as DNC chief and weakened the Clinton grip on the party. This allowed Howard Dean to return to where he had left off a year earlier and shape the party to his liking.
New Electoral Math: Grassroots Power > Party Leadership
Howard Dean did not choose to use the loss of the ‘04 election as the start of his own run for the presidency in ‘08. Instead Howard Dean ran for and won Terry McAullife’s chair of the DNC. Dean chose to be king-maker not king, and in retrospect this move was pure genius. It enabled Howard Dean to use the Democratic Party apparatus to put in place a 50 State strategy to take back the White House with a candidate he supported instead of having that apparatus used against him in an expected presidential run by Hillary Clinton. Dean must have realized that he could win the party or lose the nomination, but he couldn’t secure both. That is a pretty astute realization that a politician can make.
But Dean made it and in February 2005 Dean took over the very same party apparatus that had been wielded against him by McAullife a year earlier. Now he had his netroots supporters – all he needed was the right candidate – and he found it in a young, ambitious junior senator from Illinois who was ideologically his twin. Obama was a better speaker, had the charisma that Dean himself lacked and the mainstream media loved his narrative. Add in the exhaustion of the Republican party from an unpopular president, a very unpopular presidential candidate within the Republican Party (McCain), a party that simply appeared to be tired of being in power, and the stage was set for Howard Dean to win the 2008 election.
Dean appealed to hard core Democrats – those who would never compromise their principles. He electrified it and turned it into a force that failed to elect him, but succeeded four years later in electing Barack Obama. By striking Dean down – to use a well-worn Star Wars cliche – the Clintonistas made Dean more powerful. Now Terry McAullife is looking for a job, Hillary Clinton has a new boss, and the once powerful Clinton faction has been superceded by the Obama faction.
Lessons of the Nutroots
So what example does Dean’s rise offer the Republican Party? First it shows that the current leadership should fall on its collective swords, and if it doesn’t it must be forced to do so. Second the party rank and file should stick to the topics that are at the core of the party no matter how unpopular and “unelectable” they may appear: small government, free enterprise, religious freedom and strict constitutional interpretation. Third the rank and file should elect leaders that reflect these ideals instead of those who promise “bi-partisanship” or compromise and fall all over themselves to get photographed standing next to President Obama. It doesn’t help when these same Republicans appeal to Obama only to be rebuffed with a curt “I won.” They must be reminded that he did so without support from the constituents of those same GOP pols.
Instead of taking Obama’s advice to ignore Rush Limbaugh, the Republican Party needs to embrace him and his “ditto-heads” because they are the GOP’s “nutroots”. We need to stand in opposition to Obama as much as the Democrats did to Bush. If Obama says he’s for the stimulus, we should say we are against it and explain why. If Obama says he wants to save the American car companies we should be standing outside of BMW, Honda and Toyota plants in the south and midwest laying out why we believe it’s a bad idea. If he says that the sky is blue, we should quip that he should look out the Oval Office window at midnight.
It would help if the Republican party had its own Howard Dean; unfortunately there doesn’t seem to be one around. Until the party finds one it will lack having its own voice, and merely sound like an echo of the Democrats. That’s exactly what the Democrats sounded like until Howard Dean showed up, and our party will suffer a similar fate until we find our own Howard Dean.
I came through the door after walking the dogs to find my wife and son wailing over the limp body of our main cat. She had been purring away with the wife enjoying the warm air near a heating grate when she made a funny sound and gasped her last in the Wife’s arms.
She had been rescued in Japan from a “pet shop” that sold endangered species and kittens in filthy cages to feed exotic pets. The owner was protected by Yakuza – but that protection wasn’t enough to keep it from getting shut down a few years later. The Cat tended the Wife through her pregnancy, and was the Kid’s special pet throughout his childhood.
The Cat loved everybody equally. She was friendly to strangers, never missed the litterbox and loved snuggling with us under the covers.
As far as death’s go, it was a good one. But knowing that doesn’t take the sting away.
Maybe it’s because I’ve gotten older, or maybe it’s simply that good movies are rare these days, but I’m finding that most new movies I see aren’t memorable. Take for example Wall-E. Wall-E was a cute movie with great special effects and I had a good time in the theater for an hour and a half. But the feeling faded quickly after I left the theater, and within days I forgot most of it. Even today I’d be hard pressed to summarize the movie.
Contrast this with Bringing Up Baby – a movie the Wife and I caught on cable a few weeks ago. In this Howard Hawks romantic comedy Cary Grant bumbles his way through a series of lies, schemes and traps set by Katharine Hepburn in order to win his heart. It’s one of the best movies I’ve seen in awhile, and it reminds me how great an actress Katharine Hepburn was.
I bring up this topic today because it’s less than 2 days after I sat through Obama’s inauguration speech, and I feel pretty much the same way I did after seeing Wall-E. While I listened intently and applauded because I recognize him as my president (even though I didn’t vote for him), I can’t recall much about the speech.
I’m sure there are those who still feel a glow after hearing his words, just like there are those who believe that Wall-E is the best movie ever.
Philadelphia sports fans have a nasty reputation. This is partly due to myth – such as the 40 year old snow-balling of Santa – as well as fact – when fans threw D-cell batteries at Phillies-holdout signed by the Cardinals JD Drew in 1999. Philly fans encourage this myth whenever they can; after all, it simply adds to their smack-talk when visiting teams come to town. It doesn’t help that the city is cursed with a borderline-gay motto, “the city of brotherly love, ” no doubt coined in an early era when the city was run by Quakers instead of the current era of machine politics (a better motto would be “Pay to Play” but Chicago had already trademarked it.)
In the case of the Santa attack, the nuances of the story are lost in the soundbite - how Eagles fans were attending the last game of a pathetic 2-12 season, hated the quarterback Norm Snead, as well as Coach Joe Kuharich and owner Jerry Wolman. Being presented with a pathetic excuse for Santa Claus at a cold and wet game at the tail end of that otherwise forgettable season was simply too much for the fans to bear and they let fly with boos, catcalls and a few snowballs. All this happened in 1968 four decades ago. As for the JD Drew appearance at the late lamented Vet, only two batteries were thrown at him – not the shower one would expect from the story telling by visiting sports commentators, nor the fact that eight people including the battery throwers were promptly arrested.
Perhaps lacking such a colorful history themselves, an idiot duo in Phoenix took it upon themselves to prank Eagles’ QB Donovan McNabb by burning “Go Cards”, “Go Kurt,” and “I heart AZ” in his lawn with diesel fuel. McNabb called police when he smelled the diesel in his yard. The Associated Press’s calling the attack a “prank” kind of makes you wonder how they would similarly describe a KKK cross-burning: “Just some good old boys wearing bedsheets and playing with matches.”
I’m left to wonder if Phoenix fans will be unfairly tarred and feathered by the national media for the actions of these two middle-aged underachievers. Somehow I doubt it.
I for one am not surprised.
If one can stay awake through his work, one can realize that Karl Marx was a pretty bright guy – even if History has proven his ideas wrong and in most cases, catastrophic. Marx believed that Capitalism was doomed to fail because it carried within itself the seed of its own destruction: greed. Interestingly it is the same seed that lies within the body of the Democratic Party, and while it has yet to destroy Capitalism (although the current state of the economy makes me wonder at times) or the political party that dominates the American political landscape, a kernel of greed is planted deep within the Democrats.
Actually that’s a pretty lame metaphor: it’s not a seed; it’s a cancer that has existed within the party and as the party gains more power it spreads, metastasizing into scandal. Last month the scandal was Illinois Governor Rod Blagojevich, following quickly on the heels of New York congressman Charlie Rangel. Meanwhile the clock ticks away on Sen. Chris Dodd’s promise to release mortgage documents originating from his sweetheart deal as a “friend of Angelo” with Countrywide Mortgage.
Lord Acton observed that power corrupts; the Democrats have not been immune to the temptations that power brings. The historical list of Democratic scandals is lengthy, and with each passing month the list gets longer as the Democrats control the Executive branch, Congress, and a majority of state governorships and state legislatures.
While the Democrats may have taken power with the best of intentions, Lord Acton’s observation was that power tended to corrode the moral compass of all but the most virtuous. They will talk themselves into compromising their principals “for the good of the people,” or “just this once,” and the rot will set in – making it easier for the next compromise and the next until at the end of it all there is nothing left but the wreckage of a political career gone horribly wrong. In many respects it’s like the alcoholic who has just one and the next morning wakes up in a jail cell with a terrible hangover wondering how he got there. The only difference is that alcoholism is recognized as a disease whereas political corruption is not.
The situation is made worse for the Democrats due to the 2008 election in which the Republican Party was beaten soundly. There is no opposition to curtail the actions of the party, no threat that helps maintain order. Instead you have the political equivalent of a room full of drunks at an open bar. Wise men will avoid the temptation altogether and leave after a term or two, but those that don’t are going to end up regretting their actions one way or another.
So the Democrats will overreach themselves as they always have historically, and eventually the mainstream press will tire of blaming the Republican Party and ex-President George W. Bush for all perceived wrongs in the country. After all the powerbrokers of Wall Street – the ones that use taxpayer bailout money for corporate retreats – backed President Obama and his party more than McCain and the Republicans. Obama and the Democrats will own the problems they have caused as well as those they have not, and the electorate will vote accordingly. The cancer will spread slowly, inexorably, until the Democrats begin to remove their party affiliations from their yard signs* and speak about how they have worked in a spirit of bipartisanship.
The Republicans will eventually take back what they have lost, and someday become ascendant in the same way that the Democrats are today. And the seed will be inside them – the cancer in their body politic – and the cycle will begin anew.
This is the way our political system is, and it’s the way, god-willing, it will always be.
Here’s another perspective on the American health care crisis. A group called “Doctors Unite” has published an open letter to the American public here. Here’s a sample:
We believe the following factors have made our current healthcare system unsustainable:
- The insurance industry’s undue authority and oppressive control over healthcare processes
- Excessive and misguided government regulation
- The practice of defensive medicine in response to a harmful and costly legal environment
We, the physicians of the United States, will no longer remain silent. We will not tolerate a healthcare system where those without medical expertise or genuine interest in our patients’ health have absolute control. This letter is merely a summary of the most important problems in our current system. We believe that by partnering with the public we can start to demand real change and formulate practical solutions.
I just traced the Wife’s ancestry back to 1170 by finding a source connecting her great-great-great-great-grandfather’s marriage into the Throckmorton family. It took a Google search on a misspelling of the man’s name. The connections are well-documented; I even found a reference to his name – misspelled but in the right place and time.
I’m stunned. I knew she was a blue-blood but dang!
As a kid growing up in St. Louis I was fated to come of age in the 1970’s, just after the St. Louis Cardinals baseball team dominated the sport and before Whitey Herzog became a St. Louis legend by bringing the championship back to St. Louis. Jack Buck, one of the country’s greatest sports announcers ever, called them all – from Lou Brock’s record breaking base stealing to the Ozzie Smith’s home run in the 1985 World Series “Go crazy, folks! Go crazy!” Jack Buck, along with his sidekick Mike Shannon, was the voice of the St. Louis Cardinals, and decades later I can still hear the love of the game and excitement in Jack Buck’s voice as he called games for a pretty sad and mediocre baseball team the Cardinals had become in the 1970’s. Soon after that I left one of America’s greatest sports town, but as I have learned over the years, I may have left St. Louis but St. Louis has never left me. The older I get the more I’ve come to appreciate St. Louis, and although you wouldn’t know it if you met me, I am a die hard sports fan.
Now I live in another one of America’s great sports towns – Philadelphia. And while I still bleed Cardinals red, I have had a deep appreciation for the town that poached Steve Carlton away from the Cardinals, and beat the hapless Football Cardinals (the “Big Red”) mercilessly in the NFL during the ‘70s. Philadelphia has suffered through some bad times; laughable baseball teams, football teams that choke in the stretch, and even a basketball team whose finest hours occurred generations ago. Maybe that’s why it’s been easy for me to pick up a love of this town’s teams. When the Phillies won the World Series, I was just as happy as anyone else and even shot off fireworks in celebration.
I have suffered with Philadelphia Eagles fans as our team started the season with high hopes (some commentators called the Eagles Super Bowl contenders) – only to have the team play some of the worst football one game, and some of the best a game or two later. The team has been wildly inconsistent, losing to the Washington Redskins in a game where the Eagles offense seemed like someone had spiked the Gatorade with thorazine. A week later they beat the Cowboys to the point where even the Wife – hardcore doesn’t begin to describe her love of the Eagles – began to feel sorry for Tony Romo. I just couldn’t; the scars from the thrashing the Big Red suffered at the hands of Roger Staubach’s Cowboys stop me from going that far. The team was all puff and glamour back in the 1970s, and they are even worse today.
Over this season I have come to realize something that native Philadelphia fans have known for awhile: Joe Buck hates Philadelphia. This season most of the games Philadelphia has played have been broadcast on Fox, announced by Joe Buck and Troy Aickman. I thought it was Buck’s passionless, dry style – more Howard Cosell than his Old Man in which his play-by-play has all the enthusiasm of a DMV worker calling out “next” at 4:59 on a Friday. But no, Joe Buck spends more time talking about the Philly opponents than the Philly team. I noticed this first during the baseball playoffs when Buck spoke glowingly about Manny Ramirez while Philly was at bat.
It became downright distracting today. Joe Buck just couldn’t shut up about the New York Giants while the Eagles were moving the ball. Troy Aikman isn’t much better. I realize he was a great quarterback, but his play analysis and commentary is about as insightful to football as mine is on Buzkashi. Perhaps it’s seeing his overrated and overpaid ‘Boys getting the tar smacked out of them by Brian Dawkins and Asante Samuel by the Birds that curbs his enthusiasm.
Either way it’s a shame that sports fans have to suffer with these two. I noticed that when the local Fox affiliate showed a highlight of the game playing on a flatscreen in their studio, the announcer was none other than Merrill Reese, who does play by play on WYSP-FM. It’s taken me this long to figure out that the solution to Joe Buck and Troy Aikman has been right there all along: turn down the volume on the television and turn on the game on the stereo.
In the last several months there have been reports in medical journals about an impending shortage of primary care physicians. This spring in the health policy journal Health Affairs, researchers at the University of Missouri
Columbia and the federal $147,000 nationally. Starting salaries are about $20,000 below that on average. This conceals tremendous variation depending on region and locality. For example starting salaries in the Philadelphia area for PCPs are roughly $90,000, while it’s no secret that the highest salaries are in the rural South and Midwest that can approach $180,000 for physicians fresh out of residency.
Why the difference? Because Philadelphia has 5 medical schools; medical students tend to apply to residencies near where they went to school and newly minted physicians tend to practice where in the same area that they do their residencies. Philadelphia is a large metropolitan area with the amenities that come with it. It therefore has an abundance of primary care physicians, although managed care and malpractice insurance rates that border on the obscene are starting to force them out of the area.
Meanwhile few doctors want to live in places like Grant New Mexico or Greeley Nebraska. Rural areas such as these don’t offer many opportunities for single physicians to meet potential spouses, nor do they have many job openings for the minority of new physicians with spouses. The migration of American population from rural areas to urban began a century ago and continues today. Doctors are no different from the general population.
What results is an imbalance of supply and demand, with low supply/high demand in rural areas and low demand/high supply in urban areas. The salaries offered by rural areas although substantial have so far failed to attract physicians away from the urban settings. But given the depressed economics of rural America this “rural premium” on PCP salaries has most likely already reached the maximum rural areas can bear.
In order for primary care physician salaries to draw residents away from the urban areas they would most likely have to double to $240,000-$300,000. Since Medicare makes up about a third to half of a PCP’s patient load, Medicare reimbursements would have to quadruple for rural doctors. Currently Medicare reimburses a third less than private insurers, discouraging doctors from taking new Medicare patients and pushing them to replace those they do have with the privately insured.
While most Americans would be happy to make $147,000 a year, they might think twice about doing so when other factors are considered. The AMA estimates that in 2007 the average medical student graduated with $140,000 in educational debt. The average medical school loan is for a term of 15 years, and at 4% interest requires a monthly payment of just over $1,000 every month for the life of the loan. Loan repayment of $12,000/year + taxes paid on that income (another $3,000 – medical school debt is not tax free) reduces that salary down to $125,000. Physicians usually work far beyond 40 hours a week, with the average PCP putting in 53 hours a week (specialists tend to work even longer.) Therefore on an hourly basis the average primary care physician earns $45/hour after debt repayment and before taxes.
Finally all PCPs operate with the threat of malpractice hanging over their heads. This threat varies by state with some being more litigious than others (Pennsylvania is notoriously bad). The threat of possible litigation makes PCPs practice “defensive medicine” whereby the doctor does procedures and orders tests that may not be necessary for the health of the patient, but could fend off a line of attack by an aggressive malpractice attorney should the doctor wind up in court. This drives up costs for everyone from the physician to the insured and his or her provider and employer.
Is $45/hour worth 4 years of undergrad, 4 years of medical school, 3 years of training and a week per year of continuing education with the ever present threat of having to explain one’s actions in court? Evidently fewer doctors think so as Dr. Chen points out.
Whenever the supply of something decreases while demand for it goes up, its price must also rise. Yet this has not happened for doctors practicing in primary care. Why? Managed care. Primary care physicians are reimbursed on a per patient, per procedure basis with rates set by the insurance company or Medicare. These rates are not based on the time or effort required by the doctor, nor are they negotiable except in rare time consuming cases when doctors must challenge insurance companies to allow an off-schedule prescription or procedure. This forces doctors to either accept the reimbursements as they are and choose to bill the patient for the difference or refuse the insurance. Since there is little competition between insurance companies within a region, there is no incentive for them to listen to their patients who want to see a particular doctor. At the same time a doctor who refuses to accept patients from a particular provider can freeze herself out of a significant chunk of the market.
This shifts the payment burden from the insurance company to the physician who must decide whether to bill the patient for the difference. Since the physician is bound both morally and legally by an oath to provide care regardless of cost, the doctor is the one forced to provide services to patients who can’t afford them, then turn around and bill the patient at a reduced rate, market rate, or not recoup the cost of his or her services. Most either bill their patients at a reduced rate or not at all.
As a capitalist society we do not expect people to work for free, yet we expect doctors to perform their services for free or reduced cost in the managed care system. The so-called savings promised a decade ago from the managed care system have yet to materialize even as doctors face declining reimbursements from providers; as a result doctors are burning out and patients are left receiving substandard and expensive care.
Once a doctor establishes his or her practice in an area, it is extremely difficult to uproot and move somewhere else where the malpractice climate and reimbursements are better. In response doctors are leaving primary care for more lucrative and less taxing boutique practices, positions in the pharmaceutical industry, or better paying specialties. This forces patients to find new doctors within their area, and since many of the remaining doctors refuse new patients this leaves people to rely upon emergency rooms and urgent care centers for their primary care needs – something that these facilities are not intended nor designed for.
So what is the answer? There isn’t a single problem within the medical system in America; there are more than one. Irresponsible patients who refuse to leave a doctor’s office without a prescription for their common colds or viral infections. Others who gamble with their own health care by avoiding the expense of insurance only to end up seriously ill in the hospital. A legal system that demands perfection from doctors and a society that refuses to bear the burden of that level of care. Huge bureaucracies shuffling paper in independent and loosely regulated insurance companies, each with its own unique codes for procedures and treatments. Electronic medical records systems that cannot communicate with each other let alone their own billing modules. The misapplication of HIPAA by health care professionals who don’t understand it. A society that treats medical care like any other business yet blanches when medical care providers act like one. Doctors who receive no formal training in the business of medicine. The grey area separating public from private health care.
These are just a few of the problems facing the American medical care system. Each is complex and a microcosm of competing interests with no obvious solution. As HL Mencken quipped “For every complex problem there is a solution that is simple, neat and wrong.” Medical care seems to fit his aphorism nicely.
One of the foreign policy’s most influntial scholars passed away on December 24, 2008. Samuel Huntington is best known for his work “Clash of Civilizations”, a copy of which went with me to the Tanzanian bush in 1994. Although rightly criticized for glossing over internecine strife, the work did counter liberalist idealism sparked by the end of the Cold War.