Dare to hope?

With the Rombot cratering in the polls, most people started to look forward to the era of divided government, dangerous brinksmanship, and policy paralysis continuing. That would at least be better than what we had been dreading: full control of federal power by a coalition of psychopathic plutocrats and delusional religious fanatics.

But now the real possibility arises of a complete reversal of the 2010 election. Democratic control of the Senate appears likely, and now we are seeing well informed conclusions that the House may go Democratic. If this does happen, it will force me and like-minded people to file the sharp corners off of our cynicism. It will mean after all that reality and logic have enough of an intrinsic advantage in public discourse to overcome billions of dollars deployed in the service of lies and obfuscation at least some of the time.

Not that I'm expecting Democratic control to usher in a golden era, but at least it will delay utter disaster.

But consider also the importance of random events in history. A storm destroys the Spanish armada; Lieutenant Colonel Stanislov Petrov chooses to ignore an alarm and therefore, human civilization has survived. (Yes, this really happened. Do follow the link.)

Romney was already trailing and looking like a bad candidate, but it took an anonymous waiter or bartender and a reporter who happened to get on the trail, to destroy his candidacy with a (probably illegally recorded) video. More than Romney's candidacy got walloped of course, so did the entire right-wing narrative. I am quite sure that the tale of the 47% has done real harm to Republican congressional candidates and is very much behind the turning tide in down-ticket polling.

What if Petrov had pushed that button? What if we had never seen that video? It really does come down to "shit happens."

Medical Nemesis

I'll largely outsource today to Marshall Allen, who reviews the evidence that some unknown hundreds of thousands of people are harmed each year in the United States by medical errors. He bemoans that we don't keep track of all these errors, ergo it's hard to know how to fix them.

Okay, but his main premise is that people who are harmed by medical errors don't take advantage of the systems that are available to report them. That's just ridiculous. In the first place, most people have never heard of these systems. (Basically, you can complain to your state medical licensing board, and if you're a Medicare beneficiary, your state has what's called a Medicare Quality Improvement Organization.) Even if they have, most of the time they have no idea that they were harmed by a medical error, unless the doctor told them, which obviously isn't likely to happen.

If they do know it, or believe it, they might sue, but just making a mistake isn't enough to get a doctor successfully sued -- they have to be negligent, which is a whole other level. And who's going to go to the trouble of tracking down how to complain to the state licensing board? Especially since the truth of the matter is, the board won't do anything with your complaint anyway.

Hospitals are supposed to report certain categories of errors, but they don't. And how are you going to make them do it?

This is really a problem of the culture of medicine. Doctors make mistakes, they're human, and so do nurses and pharmacists. But we have had fewer and fewer plane crashes over time and now flying is safer than hanging out at home. We got there through a concerted effort by regulators and yes, the airline industry, which doesn't like plane crashes any more than you do. Of course, we don't have to worry about crashes being reportable, but the industry also documents errors that don't actually lead to crashes, as well as reverse engineering every crash that does happen and, at least eventually, fixing the problems that led to it on a systems level. Medicine can do that too.

Science Marches On

The 2012 IgNobel Awards are out, and I trust you will join me in a rousing round of applause for the winners.

I particularly commend to your attention this study, in which the investigators used functional magnetic resonance imaging (fMRI) to show that a dead salmon can determine the emotional experiences of humans depicted in photographs.

The point is that there is currently an avalanche of these studies, mostly funded by you through the National Institutes of Health, in which the investigators claim that they can detect which regions of the brain are active when carrying out certain cognitive tasks, reacting to particular stimuli, or having certain internal experiences. Here is a reasonably accessible explanation of how they have very often gotten it wrong. I'll try to fit it into a pistachio shell for you and just say that the method divides the brain into thousands of "voxels" -- small regions equivalent to 3-dimensional pixels -- and obviously, some of the same ones will happen to light up on the fMRI image of several subjects exposed to the same stimulus, purely by coincidence. There may be a very low p value for these correlations, which the investigators interpret to mean they are not coincidental after all, but that logic is spurious because they fail to account for having made thousands of comparisons.

This misuse of statistics is actually surprisingly common and manages to get past peer review in other fields as well. It just drives me nuts that it continues. Yeah yeah, the spurious findings eventually get forgotten because they don't lead anywhere. Once in a while somebody might even try to replicate them and fail, but that doesn't happen often because it is very difficult to get a study published that only replicates, or refutes, a previous finding. Editors are much more interested in original stuff, and they also don't like to be embarrassed by findings that call into question previous peer review and editorial judgment. (Viz my earlier post about the experiences of Russell Lyons.) We really need to shake up this culture.

Obamacare is not actually unpopular

I have been saying all along that people know they're supposed to hate it, but they don't know why. Michael Saks on the Health Affairs blog has a lot of interesting observations.

The first is that when people are asked what they actually want to happen with the ACA, 28 percent want it expanded. They disapprove of it because it doesn't go far enough, i.e. no public option or they are single payer advocates. Only 38 percent actually want it repealed or replaced with a Republican plan -- and since the Republicans haven't come up with any, I guess that also just means repealed. So it isn't unpopular after all.

But what about the people who really do think it "creates too much government involvement in health care," which is what a bare majority of people who disapprove do think. As Saks points out, it creates much less government involvement than does Medicare, and Medicare is overwhelmingly popular. So what's the disconnect? Easy. They don't know what is actually in the act. As we already know. More than a third think it contains death panels or other provisions it does not. Basically, people are just reflexively against government, or at least against Democrats.

When read lists of actual provisions that are in the act, overwhelming majorities are favorable. And, although majorities say they don't like the individual mandate, once it is actually explained to people, they end up supporting it.

So here's my question: Why won't Democratic candidates for office, including Mr. Obama, stand up and publicly mount a full-throated defense? It's a winning issue. The radio silence on this was devastating in 2010, and it's not helping now. Take credit for it, help people understand it, and promise to make it even better. That's the way to a House majority.

A series of unfortunate events

John Auerbach, Massachusetts Commissioner of Public Health, has resigned. I have known John for at least 15years, since he was Commissioner of Health for the City of Boston. He is one of the most effective, progressive and selfless public servants there ever could be.

The news of the reason for this tragic turn of affairs is disturbing and perplexing. The Department of Public Health operates a laboratory in Jamaica Plain where they do the usual public health stuff: test mosquitoes for West Nile Virus, test bats for rabies, nasal swabs for influenza, identify the culprit in outbreaks of food-borne illness, yadda yadda yadda.

Presumably because it was convenient, the legislature gave the DPH laboratory the job of testing samples of suspected illicit drugs for law enforcement. (Hey, they already have a laboratory, let them do it.)  This has nothing to do with the Mission of the Department of Public Health, so it would not be terribly surprising if the Commissioner and other high-level functionaries in DPH didn't spend their days paying a whole lot of attention to what was going on there.

Now it turns out that since 2003, a chemist working in that laboratory was apparently faking it. The full details of what she was doing have not been made public, but apparently she was not following test protocols, would do things like add drugs from another case to make amounts large enough to qualify for a more severe charge, and possibly just flat reporting negative results as positive. Nobody has said why she might have done this, but one has to suppose that she thought her job was to help the cops get convictions, rather than determine the truth.

Anyhow, now that this has been discovered, it's the biggest mess since the Harlem wastewater treatment plant caught fire. (Bet you didn't remember that one.) Bigger. Much bigger. She worked on something like 34,000 cases, and now the defense attorneys are lining up to get tens of thousands of convictions overturned. Nobody has even started to imagine the lawsuits yet, the mind cannot encompass it.

Now, I don't happen to think that non-violent drug offenders should be criminally prosecuted in the first place. What's actually most disturbing about this, to me, is that there were 34,000 cases for her to work on. What a catastrophic waste of public resources and destruction of people's lives. Drug enforcement is fundamentally racist and socially counterproductive. But it is happening, and now the Commonwealth is going to be snarled in litigation and paying out damages that will drown the courts and drain the public coffers for a decade.

Actually it will be all for the good if they have to empty out the jails of people whose only offense was to be caught with pot or pills. But the political consequences will be appalling.

The most appalling thing . . .

about Romney's no longer secret fundraiser? A whole bunch of rich people paid $50,000 apiece to have a malignant narcissist babble offensive nonsense at them.

The rich are not like you and me. Evidently they are a lot stupider.

Fat Chance

JAMA this week is  a theme issue on obesity. You pitiful rabble are not allowed to read most of it, but they will let you in on this:

 

 

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I have to tell you, that's a very shocking picture -- more than 1/3 of adult Americans are classified as obese by BMI. It's not a perfect measure -- a few of these people may be very muscular, but most of them are just plain fat. Yes yes, it's starting to look like people on the lower end of the official obesity index may be okay, if they have good cardiovascular fitness, but most of these people are not at that lower bound.

Now listen up. This didn't happen because our gene pool suddenly changed, or people suddenly because lazy and gluttonous. Yelping mindlessly about "personal responsibility" isn't going to fix it. And it isn't just tough luck for all these folks, it's tough luck for all of us, because they are at increased risk for disability, and for costing the health care system -- which means all of us who pay insurance premiums and/or taxes -- a whole lot of money.

This happened for a combination of reasons. Fewer people do physically demanding work. When not at work, people spend more time in front of various kinds of electronic screens. High calorie, low nutritional density food is everywhere, comparatively cheap, and aggressively marketed. Humans evolved mostly under conditions of caloric scarcity, so we're wired to eat too much when food is easily available.

The solution, if one is to be found, has to be in public policy. Mayor Bloomberg wants to restrict sale of gigantic tubs of sugar water, which people are seeing as a violation of their personal freedom and the first step down the slippery slope to communo-fascism. It does seem like kind of a crude measure that largely misses the point.

But there are potential approaches that get at the problem at a deeper level. Obviously it doesn't help that we've been cutting phys-ed in schools, and we can certainly make school lunches more nutritious. Safer neighborhoods with more physical recreational opportunities, better mass transit, subsidies for vegetable farmers rather than corn farmers, programs to help neighborhood store owners carry healthier foods, limitations on marketing junk food to children (good luck with that) -- there's a lot we can do. But it requires an activist government that's looking out for the common welfare -- in smart ways that increase our freedom rather than limiting it.

Yep, that's right. Liberty doesn't grow up naturally when government gets out of the way. It has to be protected, and nurtured, by democratic government. That's one way that Paul Ryan and his sidekick are completely wrong. 

Words are inadequate

My mother is 80 years old. She lives on a schoolteacher's pension, which is not in addition to Social Security, it's in lieu of it. Her savings were wiped out by my father's long, terminal illness with frontotemporal dementia. She pays no federal income taxes.

Willard M. Romney, who wants to be president of the United States, says "My job is not to worry about those people. I'll never convince them they should take personal responsibility and care for their lives."

I'm going to take personal responsibility and say that W.M. Romney is evil, ugly, ignorant, and has the morals of a tapeworm. He is worthless. Money cannot make him human.

Deep thoughts

The escape hatch for free market fundamentalism in the face of resource depletion and environmental degradation is the faith-based premise that technological developments will always come along to solve the problems. Too bad that cold fusion thing didn't pan out.

Quite a few people have noticed that the Mittbot seems to think he's still running in Republican primaries -- the Etch-a-Sketch never shook after all. The reason is obvious: the Christian religious fanatics, racist ultra-nationalists and ignoratti who constitute the Republican primary electorate couldn't be counted on to hold their noses and vote for him after all. He has to continually prove and re-prove his allegiance to them, and that is not a formula for winning in November. Hopefully that's true regardless of Sheldon Adelson's Chinese money.

How in tarnation can 15 guys carrying RPGs just walk onto a U.S.-run military base in Afghanistan and start blowing up $20 million jets? Don't they even have a perimeter? Meanwhile the Afghan police and military the U.S. is spending $4 billion a year to pay, support logistically, and train, seem equally as interested in killing Americans as in killing Taliban. Even after we supposedly "leave" in 2014 -- which actually means staying -- we're going to be spending that money to pay the Afghan forces because the Afghan government has absolutely no way of finding a fraction of that much dough. It might be helpful if someone would explain the reason for this.

The Republican position on Medicare is that we absolutely must cut Medicare spending drastically, but anybody who proposes to cut Medicare spending wants to put Granny on an ice floe.

Economics is a branch of theology, not science.

Spin Doctors

This page has from time to time opined about the pervasive overhyping of medical research by the corporate media. Every experiment on mice or Phase II trial gets reported as promising to eliminate cancer or make the blind see.

I have mostly assigned the blame to journalistic credulity or the commercial value of sensationalism, but this study in PLoS Medicine puts the blame elsewhere -- in the actual abstracts of the published studies. In my view, that doesn't let the reporters off the hook -- if they're going to write about medical science, they should be competent enough to read the whole paper, understand it critically, and interview the authors with perspicacity. (Look it up when you get home.)

But, there is something to this. I cannot tell you how many times I've downloaded a bunch of abstracts, gotten the articles that looked relevant for whatever I was thinking about, and found out that half of them don't deliver what the abstract promises. This is a big problem for several reasons, not the least of which is that few practicing physicians have time (or for that matter, the technical knowledge of research methods and statistics) to read research reports. They just read the abstracts. The presence of research results in the world is 99% just the abstract; hardly anybody actually reads the papers.

This happens because peer reviewers and journal editors, in my experience at least, pay no attention to the abstract. Journals usually have a required outline -- something like background, methods, results, and discussion -- but they have no standards about how the abstract should reflect what's in the paper. Abstracts often announce results on endpoints that weren't specified in advance, with p values. Without bothering your beautiful mind once again with Bayes, this is totally inappropriate. They basically never discuss limitations, alternate interpretations, adverse effects, or prior plausibility. They exist to sell the study, not to summarize it.

It seems to me there need to be standards about this in medical publishing. It's long overdue.

Vile, repulsive, and small

That would be WM Romney. He has always creeped me out, but it does bring me up a bit short to have to reconcile his basic incompetence with his success at accumulating vast wealth. It just proves that intelligence -- whether cognitive, social or emotional -- is largely unrelated to success at finance capitalism. The only qualities that really matter are greed, the luck to get an opportunity, and utter lack of conscience.

Now that we have that out of the way, some of the discussion of his latest mendacious assault on Barack Obama, in the midst of a very dangerous international crisis, by the way, makes a couple of category errors.

1) As I have said here many times, I think that all religions are equally ridiculous and I am not personally offended by mockery of religion as a general principle.

2) Yes, we have in this country both a constitutional protection against government suppressing political speech (although it has been inappropriately extended to commercial advertising), and a cultural norm in general against private suppression of speech, as by employers, schoolmasters, boycotts and so on.

3) However, that does not mean that some specific instance of mockery of religion cannot be legitimately called objectionable. Satire is ethical when it enlightens more than it wounds. Pious people do have sensitivities which compassionate people must respect, and we certainly won't get anywhere in the cause of persuasion by ignoring them.

Those principles aside, the film The Innocence of Muslims, as PZ tells us, happens to be offensive, false, and inane in many ways. It is deliberately offensive, in fact, and intended to provoke just the reaction it has gotten. U.S. diplomats everywhere, and particularly in predominantly Muslim countries, are doing the job of diplomats by condemning it and trying to make clear to people that the U.S. government does not condone it.

Romney is rightly taken to task for falsely implying that the Cairo embassy issued it's denunciation of the film after the attacks on that embassy and the consulate in Benghazi; and for falsely claiming that this constituted Obama's first response to the violence. It wasn't a response to the violence at all, nor was it in any way a statement by the administration, but only by local diplomats. However, that is actually all tangential. It would be completely appropriate -- indeed called for, in my view -- for the administration to condemn the film now. Not censor it, obviously, but just say that it's ugly and stupid and wrong -- just like Mitt Romney.

To my sibling Christians . . .

For I was hungry, and you gave Me nothing to eat; I was thirsty, and you gave Me nothing to drink; I was a stranger, and you did not invite Me in; naked, and you did not clothe Me; sick, and in prison, and you did not visit Me.’ “Then they themselves also will answer, ‘Lord, when did we see You hungry, or thirsty, or a stranger, or naked, or sick, or in prison, and did not take care of You?’ “Then He will answer them, ‘Truly I say to you, to the extent that you did not do it to one of the least of these, you did not do it to Me.’

Perhaps this should have some bearing on how Christians vote, but from all I hear nowadays, it does not.

Can the people get clear on the concept?

As you may have heard, Mitt has been furiously flip-flopping on health care reform, telling Press the Meat that of course there are provisions of Obamacare that he wants to preserve, such as guaranteeing coverage for people with pre-existing conditions. Then a couple of hours later his campaign said he didn't exactly mean that, he meant this:

His campaign later told TPM he wasn’t signaling a shift in policy and was instead referring to his existing stance in favor of protections on preexisting conditions only for those with continuous insurance coverage — not for first-time or returning buyers. 

Do you see what is wrong with that statement? If you already have insurance, then by definition you have already not been denied insurance for a pre-existing condition. Any medical conditions that you develop after you have acquired your current insurance policy are, a fortiori, not pre-existing. 

Even Romney's critics, including TPM and Paul Krugman, have apparently failed to notice this basic semantic problem. Why is Mitt trying to have it both ways? Because a) guaranteeing coverage for people with pre-existing conditions is popular and b) it is impossible without the individual mandate, which is not popular and which he claims -- even though it's at the heart of his own Massachusetts reform which is otherwise essentially identical to Obamacare -- is a tool of the Antichrist.

What we need to get through the heads of the casually informed public is the following True Fact:

• If you require coverage for pre-existing conditions without requiring that everybody have health insurance  ->
• healthy people will not buy insurance because they know they can buy it if they get sick -> 
• only sick people will have insurance which means it will be too expensive for most people -> 
• ergo, you haven't really required coverage for pre-existing conditions because it won't be affordable and furthermore you will have destroyed the market for health insurance.

That's the reason for the individual mandate. There's no other way to do it. Good, affordable insurance requires universal buy-in. That's how the world works. Even if you're a Republican.

What really matters

It's great that the president at least mentioned global climate change in his acceptance speech -- specifically, he said it is not a hoax. But that was about all he had to say about it, and as far as policy, he introduced nothing new, just his previously stated intentions to support development of sustainable energy while also supporting more fossil fuel extraction.

Naturally he focused on the issues, largely of self-interest, that are likely to win over persuadable voters, and that means more and better jobs, and you'll still get Medicare and Social Security when you're old. Fine, but that's not going to happen if, say, agricultural production collapses or major coastal cities end up under water, and wars over dwindling resources engulf the planet.

The very unpleasant fact is that climate change is happening faster than just about anybody predicted even a couple of years ago. The scientists who study the arctic are completely gobsmacked. It's starting to look more and more compelling that positive feedbacks are driving an accelerated rate of change and that we could very easily undergo an abrupt transition to a very different state, with unforeseeable consequences.

There are plenty of Cassandras out there, my little voice won't much matter. But I will add my two cents. We have entered a peculiar age of apathy. I grew up in the midst of the Civil Rights Movement and the Anti-War Movement and the energized, grassroots left that flourished around them. The Great Depression generated an immense wave of progressive activism that powerfully shaped the government response to the economic disaster.

We have just as much -- indeed, hard as it is to encompass, even more -- to be worried and angry about today. But the response of  much of the broad public has been self-centered, tribal and divisive. Other than the very brief and apparently now entirely spent paroxysm of the Occupy movement, political activism has largely been limited to the feckless activities of blogging and tweeting and commenting on blogs. That's a fine thing to do, but it's only going to reach the people who already want to read what you have to say. We have got to find a way to build a real movement, and soon.

The strange case of Marc Hauser

As you may recall, Hauser was the well-known Harvard psychology professor and author of several popular books who resigned after he was accused of research misconduct. The National Institutes of Health has now completed its investigation, and yep, he did it.

In fact, it sounds worse than the accusations which have previously been made public. What we knew about was that he coded observations of monkeys without establishing intercoder reliability, and without being blinded to the stimulus, and that the results were not replicable when others viewed the videotapes. That is definitely unacceptably sloppy research, but may not have constituted deliberate fraud -- he could have been fooling himself. The investigation finds that he also outright fabricated some findings.

(I'll digress for a brief comment on research methods. In social psychology, sociolinguistics, and sociological research, we often want to classify behaviors, such as categories of speech acts, orienting toward a stimulus, categories of gesture or body language. Identifying these requires human judgment. In order for us to believe that the coding decisions really do reflect some underlying reality, and not just the idiosyncratic or possibly biased, we want to see the same data coded by multiple people and that there is a high level of agreement. That's called intercoder or interrater reliability. Second, if the point of the study is to show that a particular behavior results from a particular stimulus, we want the coder not to know what the stimulus condition is, to prevent conscious or unconscious influence on the results. Without both of those conditions, nobody should believe the findings.)

Okay, he's not the first person to commit scientific fraud, that's for sure. But what is, as far as I know unique about this case, and also strange, is the apparent lack of motive. Usually these sorts of cases involve post-doctoral fellows or junior investigators trying to win grants or out-compete their peers and get ahead. Hauser already had a large body of apparently sound work and he was a tenured professor at Harvard. And his prior work, reputation, and program of research certainly did not depend on a specific species of monkey being able to parse syllables or syntax, or whatever it was he was specifically looking at. A negative finding in this particular experiment would not have somehow caused him any major problems.

Why risk everything for so little, really nothing at all? People are hard to figure.

A confusing day at the Gray Lady

Reading the Paper of Record™, I learn that organic meat and produce is no safer than conventionally grown food, according to a meta-analysis. Turning to the science section, I learn that feeding antibiotics to farm animals is causing an alarming rise in contamination of meat with antibiotic resistant bacteria, and more presence of such superbugs around generally.

What's a pointy-headed east coast liberal to think? I think what we have here is a serious case of missing the point. While it is probably true that the nutritional value of conventional and organic meat and produce is generally similar, and that the amount of pesticide contamination of conventional produce is small enough that it doesn't cause demonstrable problems for the typical consumer, that isn't really what organic farming is all about.

It's about the relationship of farming to the social and biological environment as a whole, not just to your individual biology over the next 24 hours. Aside from antibiotic resistant bacteria, we're talking about broad ecological impacts of pesticide use, soil quality, erosion and runoff, eutrophication of bodies of water, social and economic consequences of the scale of farming, fossil fuel consumption, air pollution, substitution of capital for labor -- a whole lot worth worrying about and arguing about. Whether that particular head of lettuce has as many vitamins as the next one is not the issue.

Got it?

By the way, on a personal note, yesterday I made dinner for my family -- my mother, aunt and cousins -- mostly using stuff I grew myself. It tasted fantastic -- fresh pesto made with home grown garlic and basil, home grown sweet corn, home grown salad. All of it 100% organically grown of course. Everybody went home very happy. Economics and the nutritional value of a given hunk of biomass don't begin to tell the story. It's the story of how we live, in our entirety.

The answer to one puzzle

Last night I had a chance to catch up with my farmer friend Festus at a party. I haven't seen him for quite a while -- Festus and his wife just work when they aren't sleeping. 

He only has a high school education but I've found him pretty savvy about politics and policy, fully aware of the plutocracy that's out to screw hard working basically poor people like himself. But last night a Glenn Beckish streak emerged that I hadn't noticed before.

It started with his foaming at the mouth outrage that he would be forced to buy health insurance or pay money not to. He has no intention of buying it, which he assumes means the government is just going to come along and grab some of the little money he has. By the way he has an eight year old daughter. I asked him, "Well Festus, suppose you're hit by a bus or your girl gets sick, and you can't afford the health care you need. Who do you think is going to pay for that?"

Try as I might, I could not get him to think through the idea that everybody -- people who pay insurance premiums, and taxpayers including him, pay for critical care of people who are uninsured, because the hospitals jack up their prices to cover it. They charge more to people who pay out of pocket than they do to insurance companies, he said. That's true -- because insurance companies have bargaining power, I explained. But a lot of those people who pay out of pocket never do pay -- and the hospitals write off the debt. And if the person isn't going to die in the ER, they won't get the cancer treatment or other expensive care they need, and they'll just die. I told him he'd get a big subsidy and the insurance would be cheap for him, maybe even free.

That didn't work either. Now he's complaining that insurance doesn't cover "alternative" medicine, just doctors who are all about poisoning people. He's an organic farmer and he's convinced that the earth is being poisoned by air pollution and it's ruining the biology of the soil he depends on. He considers medicine to be unnatural and pharmaceuticals just another form of industrial toxin. Then he starts ranting about how regulation is destroying small business. He sells peppers to a hot sauce maker who has to get a sanitary inspection every year. I said well, I don't want to get food poisoning. But, says Festus, they make him sterilize the factory with toxic chemicals, and that ends up in the food.

There was no arguing with him. I don't think he's going to vote at all, and I doubt he would ever consider voting for Republicans, but his hot sauce making friend is obviously planning on it. He doesn't want the government telling him he has to produce a safe product. Festus is really worried about pollution, but it doesn't occur to him that government could do something about it, by you know, regulating business. And he doesn't want health insurance, even cheaply, because it infringes on his freedom to get ripped off by quacks and die.

The fact is there are a lot of people whose thinking goes around in those sorts of circles and there is nothing anybody can do about it.