Map of life expectancy at birth from Global Education Project.

Thursday, March 30, 2017

More simple proof that libertarianism is a crock

The right to ride a motorcycle on public highways without a helmet is a classic liberty claim. So what if it's risky, or the nanny state thinks it is? It's my right to make the choice -- it's my life.

As the linked essay by Busko, et al demonstrates, it is in fact risky, although opponents of helmet laws will often proffer alternative facts. In 1967, under the oppressive rule of Communist president Ronald Reagan, the Department of Transportation issued a program standard making helmets mandatory for motorcyclists, and congress voted to withhold federal highway funds from states that didn't enforce the guidelines. Soon, all but three states had helmet laws. There ensued a sharp decrease in motorcycle fatalities and head injuries.

All glory to Her Holiness Ayn Rand, freedom again prevailed in 1976, when people's choice president Gerald Ford signed legislation repealing the mandate. The following year, motorcycle-related fatalities increased by 23%. Free at last, thank God almighty we're free at last! By the way, just so you know, motorcycle fatalities are 14% of traffic deaths, even though motorcycles account for less than 1% of miles traveled; and motorcyclists are 27 times as likely to die in a crash as automobile occupants. Have fun!

Now maybe you think it's just fine if fools want to kill themselves and it's no business of the government to tell them not to. (I won't speculate about what freedoms you don't want people to have, I'll stipulate for the sake of argument that you aren't an outrageously blatant hypocrite. But do think about that.)

Here's the problem.  Two thirds of the cost of treatment for motorcycle-related injuries are borne by the public, mostly Medicaid. Bikers who are disabled cannot work, and usually become public charges. They, along with the dead ones, no longer pay taxes and their families are deprived of support, may also become public charges, and in any event their children and other loved ones will suffer. While your liberty to be a moron is at stake, so is my liberty not to have to pay for your foolishness.

This is the fundamental problem with libertarianism. All decisions involve tradeoffs between one person's liberty and another's. Your liberties don't stop with you.

Tuesday, March 28, 2017

Ratcheting up

Here's a long form piece in the Gray Lady about the history, present and likely future of Medicaid. I think you should read the whole thing but I'll give you a couple of pull outs.

Medicaid started small, as a minor add-on to Medicare. Originally, it was coupled to what was generally called "welfare," Aid to Families with Dependent Children, and hardly anybody noticed. But over the years, bit by bit, Democrats managed to expand its scope to include people with disabilities, elderly people in nursing homes, and low income families that were not on welfare. By now, the assumption that able-bodied adults should be able to afford health insurance is decisively false.

In fact, far from creating a culture of dependency and discouraging people from working, Medicaid makes work possible for people with children with disabilities and/or severe health care needs; or elderly relatives who need care. And it keeps people in the labor force who need health care to be able to work. So part of the cost is recouped in taxes. Anyway, people generally don't seem to understand that government spending isn't like household spending. Every dime spent on Medicaid is income for health care providers, pharmaceutical and medical device manufacturers, and related services; and profit for shareholders.

Medicaid pays for half of all childbirths in the U.S. A large majority of Americans either benefit from it themselves, or have friends and relatives who do. The Republicans' disastrous American Health Care Act would have taken Medicaid away from the population that benefited from the ACA expansion, and then gradually reduced funding over the years forcing the states to spend more of their own money, or drop beneficiaries and services. That turned out to be politically impossible.

The Republicans aren't going to take away Medicare or Social Security either. Once people got these benefits, and realized how much better they made life for everybody, eliminating them became politically impossible. He was obviously lying, as he always does, but when Ronald T. Dump was campaigning for president, he promised to protect Medicare, Medicaid and Social Security, and even to provide health care for all. He knew he needed to speak those lies in order to have a chance. Of course, in reality, he supported Paul Ryan's bill that would have destroyed Medicaid. But they failed. Now we can go about the business of continuing to expand Medicare and Medicaid, providing a public option on the ACA exchanges, and one day --

Universal, comprehensive, single payer national health care. That is our right.

Monday, March 27, 2017

Reclaiming Truth

When the Internet, and particularly the World Wide Web were young, many people had a utopian vision of a global free market of knowledge and ideas. Everyone could contribute to the total mass of truth, logic and debate, and we would ultimately enter an age of enlightenment.

Something like the opposite seems to have happened. Lots of people have gone through the looking glass into their own alternate realities. We have a "president" who lies so habitually that it's a surprise if he says anything that's true. Yet his true believers enthusiastically follow him into opposite world. We have the outlandish pizzagate, global climate change denial, birtherism  . . .

A partial explanation is this concept of blue lies. (Apparently that's supposed to be somewhere between white and black but I think it's horribly kludgy term.) The idea is that lies that don't hurt your own tribe or in-group, but are directed outward, strengthen group solidarity. It overlaps somewhat with confirmation bias, because deciding we were wrong about something doesn't only threaten our own ego, it may threaten our group identification.

I don't claim to be completely immune from these afflictions, but I think I'm less susceptible than most, because I am trained as a scientist and I make a conscious effort to practice critical thinking. I work hard all the time to evaluate evidence and not to come to firm conclusions that don't have strong support. And I do change my mind when confronted with good evidence that contradicts my previous beliefs. That is why, for example, I am now an atheist after once preparing for confirmation.

We are in desperate trouble if we can't get more people to think critically and start basing their beliefs on good evidence. The first thing people need to do is put more trust in the scientific enterprise. Yes there is scientific fraud and there are unreproducible findings. Scientific claims lie along a continuum of credibility. Don't believe the hype about a single clinical trial or a finding in laboratory rats -- it's a long way from initial observations and hypotheses to strong scientific consensus.

However, there is a great deal that we know. The universe is more than 13 billion years old. Life on earth is more than 3 billion years old and we got here by way of evolution. People are burning so much fossil fuel that we are putting carbon dioxide into the atmosphere at a rate which is causing the climate to warm, storms to become more violent, and the seas to rise. Cutting taxes on wealthy people does not make working people better off. And so on. We need to accept a common reality, or we are doomed.

Friday, March 24, 2017

The Art of the Fail

Orange Julius spent the campaign, the transition, and the first month of his occupancy of the office of president proclaiming that his great new health care plan would cover everybody, with better health care, at lower cost. Only a few fringe lunatics like Paul Krugman and Cervantes had the audacity to claim this was not possible.

After 8 years of screaming about death panels and socialism, and passing -- what was it, 36? -- bills to repeal the ACA, secure in the knowledge that president Obama would veto them, Republicans suddenly found themselves in the untenable position of actually being able to do what they had campaigned on for the past 8 years. What we learned from the exercise is that they do not in fact know anything about health care policy.

There is no such thing as a free market for health care, there are no free market solutions, and the only way to secure liberty for people is through a market that is structured and regulated by government. The best way is universal, comprehensive single payer national health care; but some countries manage to do it with kludgier solutions. Switzerland, for example, has Obamacare +. It has private insurance companies competing for customers, selling tightly regulated policies. They cut out the middleman with the individual mandate and subsidies, and instead give everybody a voucher to buy insurance, funded by taxes. Britain has real socialized medicine, with physicians as government employees. Canada's physicians are mostly private entrepreneurs, but their customers have insurance provided by the government.

There are a few ways to do it but the reality is:

  • Every affluent, capitalist democracy on earth spends less -- a lot less -- on health care than the U.S.
  • Every one of them covers 100% of their citizens and legal residents, with good, comprehensive insurance.
  • Their populations are healthier than ours and live longer.
  • Their people are more content with their health care systems than we are.
  • They all enjoy freedom or liberty or whatever you want to call it more than we do, because they don't live in perpetual fear of being wiped out by serious illness or dying on the street. 
This is reality. It is the truth.  There are no alternative facts.

Sunday, March 19, 2017


Really, fucking nuts. The news media and politicians of all stripes are struggling with how to respond to a "president" who is manifestly insane.

To be clear, I have absolutely no interest in this ridiculous debate over whether psychiatrists should apply a diagnostic label to him. The very idea that there are entities called "personality disorders" that constitute specific, identifiable diseases is nonsense, as far as I'm concerned. Some people behave in ways that create unnecessary difficulties for themselves and/or others. There is nothing to be gained by declaring that this person has "narcissistic personality disorder," or "psychopathy," or whatever word you care to sling.

But, he does what he does, which is to habitually assert preposterous falsehoods and then refuse to back down in the face of overwhelming evidence and reason; and order his flunkies to participate in his alternative reality. That is insane, in the vernacular use  of the word.

Here is one take from the estimable Josh Marshall. "The real story here is that the President, by force of his office and audacity, was able to inject into the national conversation a preposterous claim which the country has spent two weeks debating. . . . I would say that this ability - both the President's pathological lying and our institutions' inability to grapple with it - is the big, big story." He concludes that "this is a warning case of people in power deciding what's true and false which is a harbinger of free government dying." (I draw to your attention what I believe is the relatively new motto of the Washington Post: "Democracy dies in the dark.")

However, I am more inclined to Simon Malloy's view. The fact is that nobody except for Trump's equally deluded juggalos credits his fantasies. The spectacle of Republican politicians trying to evade forthright comment, or of reporters unable to find the letters l, i and e on the keyboard is disheartening, but none of this will lead to any sort of concrete result. In other words the Justice Department isn't about to prosecute Barack Obama and the U.S. isn't going to recall the British ambassador. (No doubt about that -- there isn't one.)

So for the immediate term, this is basically a distraction. The real danger is that we have a "president" who nobody with any sense will believe about anything. So what happens when there is a crisis of some sort and the nation, and the world, depend on presidential leadership? Congress doesn't have to pass the worst atrocities in his budget proposal, and they won't, but the time will come when a president with no  credibility will be catastrophic.

Monday, March 13, 2017

And another outrage you probably never heard about

A component of the Affordable Care Act which doesn't get a lot of attention is called the Prevention and Public Health Fund. Most of the money goes to CDC which uses it to track disease outbreaks and get vaccines to places where they are needed and vaccinate people who can't afford to pay. It also sends $625 million a year to the states, which using the money for vaccination and other preventive services. The bill in congress to "replace" the ACA eliminates all of this funding.

The BMJ asked the Dept. of Health and Human Services whether this has anything to do with "president" Trump's belief that vaccination causes autism, but got no response.

Now, if you're a Republican, you think that government spending is evil a fortiori because it requires taxation. But you might consider the following information from the linked article:

The $1bn funding also covers all of CDC’s lead exposure testing and risk reduction efforts. CDC estimated that the current rate of lead exposure, with at least 535 000 children with toxic blood concentrations, will cost America $59bn in lost lifetime productivity. Research has shown that each dollar spent on reducing exposure to lead delivers a return of $17 to $221.5

CDC has estimated that vaccination among American children born from 1994 to 2013 would prevent around 21 million admissions to hospital and 732 000 deaths over the course of their lifetimes, with a net savings of $295bn in direct costs and $1.38 trillion in total societal costs.6
But it's more important that rich people not pay taxes.

Tuesday, March 07, 2017

Okay, so why Trumpcare?

Ezra Klein is puzzled. Why are the Republicans in congress proposing an Affordable Care Act replacement that will:

  • Balloon the federal deficit;
  • Take insurance away from maybe 15 million people; and
  • Make it more costly for millions more
  • Destroy the market for individual insurance
Klein says: :

It is difficult to say what question, or set of questions, would lead to this bill as an answer. Were voters clamoring for a bill that cut taxes on the rich, raised premiums on the old, and cut subsidies for the poor? Will Americans be happy when 15 million people lose their health insurance and many of those remaining face higher deductibles? 
Well, the voters weren't clamoring for cutting taxes on the rich, but that's all the Republicans in congress actually care about. But Krugthulu has one additional point:

Obviously, Republicans backed themselves into a corner: after all those years denouncing Obamacare, they felt they had to do something, but in fact had no good ideas about what to offer as a replacement. So they went with really bad ideas instead.
Not to worry, it isn't going to pass as it is. But I still expect something bad to happen.

Monday, March 06, 2017

The worm Ouroborous

We don't expect the reporters who work for the corporate media to be very intelligent, so let me help them out.

Donald Trump is the president of the United States. If he has information that Barack Obama ordered somebody (presumably the FBI) to "tap his wires," as he put it, for political reasons, he can produce it. It is within his power to declassify and make public any information at all. For him to call for a congressional investigation of this charge is ridiculous. The congress would simply subpoena records which are, at this very moment, in his possession. He is asking them, in other words, to investigate himself in order to force him to produce what he can already produce if he so chooses.

Ergo, no such records exist and he is a big fat liar. But we already knew that. The problem is that our "journalists" can just say so. Oh yeah, then there are those Republicans in congress  . . .

Then there's the case of James Comey, who is screwed, but I have no sympathy for him, it's his own fault. Expect him to be fired shortly. Then the DoJ Inspector General's report will come out . . .