American Elephants


“Economics Is Organized Common Sense” by The Elephant's Child

Economists Craig Newmark and AEI’s Mark Perry dug up Nobel economist Thomas Sargent’s shortest U.S. graduation speech ever. A simple list of twelve valuable economic lessons. The speech was delivered at his undergraduate alma mater University of California at Berkeley, May 16, 2007.

“I remember how happy I felt when I graduated from Berkeley many years ago. But I thought the graduation speeches were long. I will economize on words.”

“Economics is organized common sense. Here is a short list of valuable lessons that our beautiful subject teaches.”

1. Many things that are desirable are not feasible.

2. Individuals and communities face trade-offs.

3. Other people have more information about their abilities, their efforts, and their preferences than you do.

4. Everyone responds to incentives, including people you want to help. That is why social safety nets don’t always end up working as intended.

5. There are tradeoffs between equality and efficiency.

6. In an equilibrium of a game or an economy, people are satisfied with their choices. That is why it is difficult for well-meaning outsiders to change things for better or worse.

7. In the future, you too will respond to incentives. That is why there are some promises that you’d like to make but can’t. No one will believe those promises because they know that later it will not be in your interest to deliver. The lesson here is this: before you make a promise, think about whether you will want to keep it if and when your circumstances change. This is how you earn a reputation.

8. Governments and voters respond to incentives too. That is why governments sometimes default on loans and other promises that they have made.

9. It is feasible for one generation to shift costs to subsequent ones. That is what national government debts and the U.S. social security system do (but not the social security system of Singapore).

10. When a government spends, its citizens eventually pay, either today or tomorrow, either through explicit taxes or implicit ones like inflation.

11. Most people want other people to pay for public goods and government transfers (especially transfers to themselves).

12. Because market prices aggregate traders’ information, it is difficult to forecast stock prices and interest rates and exchange rates.

That is a remarkably valuable short list. Pin it up beside the mirror in your bathroom so you can read it every morning until you know it by heart.



A Thirteen-Year-Old Girl Hunting With Her Golden Eagle by The Elephant's Child

Here is a remarkable look at a thirteen-year-old Mongolian girl hunting with a golden eagle, from the BBC.  Beautiful photography, beautiful young Mongolian girl, and a glimpse of her school, and the beauty of Mongolia. Enjoy.



The Worst Lies Are The Ones You Tell Yourself by The Elephant's Child

Ross Douthat had an excellent column on Sunday about “the serious moral defect at the heart of elite culture in America.”

He began with a look back at a column by a Harvard undergraduate, Sandra Y.L Korn, which got some attention thanks to its daring view of just how universities should approach  academic freedom. She claimed such freedom was dated and destructive and that a doctrine of “academic justice” should prevail instead. Harvard should not permit its faculty to engage in work tainted by “racism, sexism, and heterosexism.”  She could come up with only one contemporary example of a Harvard voice that ought to be silenced, a “single conservative octogenarian” the renowned political philosophy professor Harvey Mansfield. Possibly because there are no conservatives to be found at Harvard.

Douthat says he tries to be a “partisan of pluralism, which requires respecting Mozilla’s right to have a C.E.O. whose politics fit the climate of Silicon Valley, and Brandeis’s right to rescind degrees as it sees fit”… but it’s hard to maintain respect “when these institutions will not admit that this is what is going on. Instead, we have the pretense of universalitythe insistence that the post-Eich Mozilla is open to all ideas, the invocations of the ‘spirit of free expression’ from a school that’s kicking a controversial speaker off the stage.”

It would be a far, far better thing if Harvard and Brandeis and Mozilla would simply say, explicitly, that they are as ideologically progressive as Notre Dame is Catholic or B. Y.U. is Mormon or Chick-fil-A is evangelical, and that they intend to run their institution according to those lights.

I can live with the progressivism. It’s the lying that gets toxic.

Do read the whole thing. We desperately need to clearly understand just what is going on around us. Propaganda fails if everybody knows that it is just propaganda. Lies, recognized, are just embarrassing.

Journalist Jack Kelly asks “Why Aren’t Public Officials Held to Account for Lying?” He contrasts the penalty imposed on a television con man with the whoppers told by government officials, and suggests that the penalties for lying should be equally applied.

It was chiefly the concept of equal protection of the laws — the idea that the rules should apply to the rulers as well as the ruled — that made our government different from most others in the history of the world.

It is the lying that gets toxic.



The Administration Will Not Surrender U.S. Protection of the Open Internet—for Now. by The Elephant's Child

The Obama administration has backed off from its plan to abandon U.S. protection of the open internet in 2015, only a month after announcing its plan to do so. Objections from Bill Clinton, a warning letter from 35 Republican senators, and critical congressional hearings and the administration now says the change won’t happen for years, if ever.

The proposed change is an agreement under which the U.S. retains ultimate control over the Internet Corporation for Assigned Names and Numbers, known as Icann. Assistant Commerce Secretary Lawrence Strickling told Congress last week they can extend the contract for up four years.

A House panel voted along party lines on Thursday to delay the administration’s plan to surrender oversight over certain internet management functions. Republicans worry that the proposal to transfer power to an international nonprofit group could open the door to an Internet takeover by authoritarian regimes.The bill would block the transfer of Internet powers for up to a year while the Government Accountability Office investigates the administration’s plan. The bill now goes to the full Energy and Commerce Committee for consideration.

Subcommittee chairman Greg Walden (R-OR) argued that the United States should carefully study the proposal before moving forward.”We know what China has done to silence dissent and Vladimir Putin wants to use the powers of the [International Telecommunications Union] to control the internet.”

Democrats accused Republicans of being paranoid. Ranking Democrat Anita Eshoo said “It is not a conspiracy or a digital black helicopter.”

The policy in question is the protection of the Internet’s domain name system (DNS) and the vital Internet Assigned Numbers Authority (ANA)— functions that are the lifeblood of the free flow of information online—linking easy-to-remember domain names to numerical Internet Protocol (IP) addresses. Bill Clinton issued a directive to Commerce in 1997, to maintain “a market-driven policy architecture that will allow the new digital economy to flourish while at the same time protecting citizens’ rights and freedoms.” Icann has worked under the auspices of the federal government since 1998 to perform the oversight role.

Obama wants to forsake these essential protections in the name of global accommodation, potentially allowing countries or even bodies like the United Nations to impose their own definition of internet “freedom.” Obama’s decision would be consistent with his views on net neutrality, recent efforts of the FCC to place monitors in U.S. newsrooms and the Justice Department’s surveillance of professional journalists.

There is significant evidence that international groups are big on the “international” or “we are the world” idea, and not so much concerned about freedom and equal access. Many authoritarian countries already try to control and censor the internet. Not everyone believes in freedom of information—and we have considerable evidence in our own country of the current struggle to control speech that is unpopular or provocative or simply disagrees. The recent flap about NSA surveillance has made many international activists concerned, although Internet freedom would seem to offer Internet surveillance free to all comers.

When Icann’s contract with the federal government expires in 2015, it simply means that one government contractor is no longer responsible for the administration task. It does not mean the federal government has agreed to cede the oversight role. Only a vote of the U.S. Congress could do that.



The Standoff At the Bundy Ranch Ends— For Now. by The Elephant's Child

580x375xarticle-2603026-1D0F67D100000578-703_634x411-600x388.jpg.pagespeed.ic.Bu8r1HkGwH

The Standoff at the O.K. Corral Bundy Ranch is standing off. The overarmed and overaggressive Bureau of Land Management has announced that because of the risk of violence, it is withdrawing its forces, some 200 armed agents, including snipers and guard dogs. The county sheriff negotiated the settlement.

It’s not at all clear what this was all about. The family settled in the area in the late 1800s and has ranched in the area ever since. The federal government has allowed Nevada ranchers to graze their cattle on tracts of adjacent public lands for generations. The federal government later created the Bureau of Land Management (BLM) to administer and “protect” the vast “federal lands”* including the land the Bundy family’s livelihood is and was dependent upon.

*These lands are frequently called “federal land.” This is inaccurate. They are public lands, owned by the people, and the government supposedly “manages” them for the American people. I don’t think anyone has challenged this frequently used terminology in court, but they should.

I don’t know about you, but I have a real objection to all these armed forces, SWAT teams, and snipers attached to agencies of the government. The Coast Guard, Border Patrol (we read that they were reduced to firing beanbags), and ICE,need to be armed, but this is really going too far. The federal agency did quite a few dumb things. It tasered Cliven Bundy’s son Ammon, rounded up a bunch of the Bundy cattle, and then fenced off a “First Amendment Area” in the middle of nowhere to demonstrate the protection of an “endangered” desert tortoise.

The federal government told the Bundy family that a tortoise existed on the land and therefore the land’s usage for cattle would have to decrease — attacking the Bundy family livelihood, which has led to a 20-year legal battle.The legal battle would seem to have gone against the Bundy family, but the Bundy family can in fact claim to have enjoyed generations of grazing rights on public land — with an arrangement originating in the 1870s when ranchers were offered those rights an enticement for settling the West.

I have no knowledge of the legal aspects of the case, and I suspect that you can’t fight city hall or the federal government. I am deeply suspicious of any claim of “endangered species,” because those so designated usually aren’t actually endangered, and are only used as a tool to accomplish some other purpose. I don’t believe that the Endangered Species Act has ever “saved” a species. The problem is often a simple increase in the number of predators.

Breitbart has done a fine job of outlining the case, the rumors, the law, and the problems involved. I would suggest that the American people are troubled by our imperialistic government and the increased militarization of so many federal agencies who have no business with SWAT teams and armed attacks on ordinary citizens. The Bureau of Land Management brought the angry resistance on themselves, with overreaction.



The Social-Engineering Approach to Health Care by The Elephant's Child

John Goodman offers two fundamental ways of thinking about complex social systems: the economic approach and the engineering approach.

The social engineer sees society as disorganized, unplanned and inefficient. Wherever he looks, he sees underperforming people in flawed organizations producing imperfect goods and services. The solution? Let experts study the problem, discover what should be produced and how to produce it, and then follow their advice.

Goodman, the father of the health savings account, calls this “cookbook medicine” which gives doctors rules and protocols for treating patients with various symptoms, and they must record each step along the way. Cookbook medicine does not bother with the differences among people, and is the opposite of personalized medicine which aims to tailor the therapy to the characteristics of the patient.

While it is useful to consider the standard protocols, people are not all the same. Medicine adapted to the genetic makeup of a person is in its infancy, but shows promise. When the cookbook becomes a rulebook to be followed slavishly, we’re in trouble. When complying with endless checklists takes valuable time away from patient care — that’s what’s happening in American medicine. A recent study of emergency room physicians found that they spend more time interacting with screens than patients, clicking the mouse 4,000 times in a 10-hour shift.

The Affordable Care Act was heavily influenced by the engineering model. After all, our bureaucrats are certified experts, and what are experts for if not to tell everybody else what to do and how to do it. Only social engineers would think of running “pilot programs” to control health care costs. What is the purpose of a pilot program if not to find something that appears to work, so you can order everyone else to copy it. Therefore you have the mess of digitizing all medical records and the result that hospitals have different systems that cannot talk to each other?

Dr. Virginia McIvor, a pediatric physician at Harvard Medical School explains the problem:

When a healthy child visits, I must complete these tasks while reviewing more than 300 other preventative care measures such as safe storage of a gun, domestic violence, child-proofing the home, nutrition, exercise, school performance, safe sex, bullying, smoking, drinking, drugs, behavior problems, family health issues, sleep, development and whatever else is on a patient’s or parent’s mind. While primary-care providers are good at prioritizing and staying on time — patient satisfaction scores are another quality metric — the endless box checking and scoring takes precious time away from doctor-patient communication.

If you have been to a doctor recently, you have probably noticed the multiplication of forms you must fill out, questions you must answer. I have noticed that the form now contains a line for “refuses to answer,” which may indicate progress of a sort.

John Goodman is the father of the “health savings account” which works precisely as promised and has been a great favorite. He is president of the National Center for Policy Analysis (NCPA) and he blogs regularly on health care matters (you can sign up to receive his columns), and his book Priceless takes on the health care problem.

There are great things happening in medicine that are promising for the future. The engineering rulebook is not interested in other people’s expertise or innovation.

The social engineer sees society as disorganized, unplanned and inefficient. Wherever he looks, he sees underperforming people in flawed organizations producing imperfect goods and services. The solution? Let experts study the problem, discover what should be produced and how to produce it, and then follow their advice. – See more at: http://healthblog.ncpa.org/cookbook-medicine-2/?utm_source=newsletter&utm_medium=email&utm_campaign=HA#more-36412
The social engineer sees society as disorganized, unplanned and inefficient. Wherever he looks, he sees underperforming people in flawed organizations producing imperfect goods and services. The solution? Let experts study the problem, discover what should be produced and how to produce it, and then follow their advice. – See more at: http://healthblog.ncpa.org/cookbook-medicine-2/?utm_source=newsletter&utm_medium=email&utm_campaign=HA#more-36412
The social engineer sees society as disorganized, unplanned and inefficient. Wherever he looks, he sees underperforming people in flawed organizations producing imperfect goods and services. The solution? Let experts study the problem, discover what should be produced and how to produce it, and then follow their advice. – See more at: http://healthblog.ncpa.org/cookbook-medicine-2/?utm_source=newsletter&utm_medium=email&utm_campaign=HA#more-36412


Shining a Light on the Dark Corners of Big Bloated Government by The Elephant's Child

Coburn

How many bureaucrats does it take to screw in a lightbulb? According to USA today, It takes 10 different offices at the HHS to tun programs addressing AIDS in minority communities. Autism research is spread out over 11 separate agencies. Eight agencies at the DOD are looking for prisoners of war and those missing in action. Schriever Air Force Base in Colorado has 8 different satellite control centers to control 10 satellite programs.

These are simply 26 new areas pointed out by the Government Accountability Office, where federal government programs are overlapping, duplicative, fragmented or just inefficient. There are 162 areas so identified in part reports. This gives Congress a clear map for saving tens of billion of dollars a year.

We owe this list to Senator Tom Coburn (R-OK), who wrote the legislation requiring this annual report, which is now in its fourth year.  “Turning this ready-made list of cuts into savings is one of the best ways Congress can regain the trust and confidence of the American people”, he said. “At the end of the day there are no short cuts around the hard work of oversight and identifying and eliminating waste.” The prepared testimony said:

It is impossible to account for how much money is wasted through duplication, in part because the government doesn’t keep track of which programs each agency is responsible for.

“One of the most troubling things in GAO’s report is the number of agencies that have no idea just how much taxpayer money they are spending on their programs,” said House Oversight Committee Chairman Darrell Issa (R-CA). He has sponsored legislation , the Digital Accountability and Transparency Act, that would require the government to better track spending data from Congress to an agency to its ultimate recipient. The bill has passed the House 388-1 last year and waiting for a vote from the Senate.

The agencies in question will object. Every agency in question will feel their slice of the pie is more important, and losing budget and personnel diminishes the agency. Bureaucracies always have empire-builders in their ranks. They just are not often recognized, because they have been good at telling their superiors how necessary that budget and that staff are to the good of the nation.

Many of GAO’s recommendations deal with some of the most complex and challenging areas across the federal government,” said Beth Cobert, the deputy director for management at the Office of Management and Budget, in a statement. “Fully addressing them is a long-term process that in many cases will take years to implement.”

Uh huh. Shine a spotlight on them and see what happens to the dark corners. Last year, the GAO reported that the two main groups responsible for POW/MIA issues were “unable to resolve disputes”  about who was responsible for what. When last month, National Public Radio detailed how bureaucratic and slow the search for remains was, DOD Sec. Chuck Hagel ordered that POW/MIA efforts be streamlined into a single office.

This is what transparency and sunlight are all about. A media that is too lazy,  uninterested, or partisan to do their traditional job as governmental watchdog, actually costs taxpayers money. A bloated, expansive government that is more interested in being important and powerful than in freedom and thrift harms everyone.



The Shame of Brandeis University by The Elephant's Child

Brandeis University invited Ayaan Hirsi Ali, the Somali-born activist to speak at their upcoming graduation ceremonies and receive an honorary degree. Well deserved. She has focused on the brutal treatment of women and girls rampant in Islamic societies like the one in which she was raised. Her efforts to call attention to them as a legislator in the Netherlands led to fear for her life and her eventual flight to the United States.

Since they thought her brave advocacy deserved the recognition of an honorary degree, it was somewhat startling that the controversial aspect of her views was new and surprising information that led to Brandeis President Fred Lawrence to claim that he had to withdraw the degree because of information he had only lately discovered. Ayaan Hirsi Ali was not surprised that she came under attack from the Council on Islamic Relations.  Such attacks are not new.

One might think that she had given $1,000 some six years ago to the campaign to recognize marriage as a contract between a man and a woman, as it has been for several thousand years. At Rutgers University, faculty and students objected to Condoleezza Rice’s selection as graduation speaker, based on her association with the Iraq War, but so far Rutgers seems to have more character than Brandeis.

Ayaan Hirsi Ali said:

 I assumed that Brandeis intended to honor me for my work as a defender of the rights of women against abuses that are often religious in origin. For over a decade, I have spoken out against such practices as female genital mutilation, so-called “honor killings,” and applications of Sharia Law that justify such forms of domestic abuse as wife-beating or child-beating. Part of my work has been to question the role of Islam in legitimizing such abhorrent practices. So I was not surprised when my usual critics, notably the Council of American-Islamic Relations (CAIR), protested against my being honored in this way.

Our academic institutions are in bad shape. They are bastions of political correctness, conformed speech, and Leftist theology. Free speech is neither understood nor observed. You must conform. Dissent is not allowed. In such an atmosphere, it’s no wonder that graduates are having trouble finding jobs. Critical thinking, though much celebrated, doesn’t often happen. Is one to believe that Brandeis University favors genital mutilation and prepubescent little girls married off to old men, and honor killings?

Here’s Ayaan Hirsi Ali giving an earlier speech, in 2013 in Australia. We fear our activists because they might prove to be controversial. Someone might object. But then we might still be burning dissenters at the stake.

 



Progressives Don’t Really Believe Anything They Say! by The Elephant's Child

Surfing the internet, it is clear that the Obama era is a particularly frustrating period for the Right. Simply trying to understand what the Left is going on about is puzzling, and each passing year reveals the difficulty of defeating those who hold no inviolable positions or beliefs. Above all, what they say they believe has no relation to their own lives. All is fluid, depending on who is about to vote, and for what. Jim Geraghty tackles the Progressive Aristocracy which notes:

[P]rogressives wide-ranging willingness to contradict their own professed principles: gun-control proponents who travel with armed bodyguards, voucher opponents who send their kids to private schools, and minimum-wage-hike advocates who pay their staff less than the minimum wage, among others.

So what do progressives really want? If, as I suspect, the currency of progressivism isn’t policies or results, but emotions, what does that approach build? What kind of a country do you get when political leaders are driven by a desire to feel that they are more enlightened, noble, tolerant, wise, sensitive, conscious, and smart than most other people?

The evidence before us suggests progressives’ ideal society would be one where they enjoy great power to regulate the lives of others and impose restrictions and limitations they themselves would never accept in their own lives. Very few people object to an aristocracy with special rights and privileges as long as they’re in it.

President Obama had a staffer sign  him up for ObamaCare at the DC exchange in symbolic unity with ordinary Americans, but the president’s health care will continue to be provided by the military at Walter Reed, by the White House physician, and by the physician who travels with the president’s extensive entourage when he travels.

Remember when Obama envisioned a future in which Americans would sacrifice their comfort to the need for combating climate change: “We can’t drive our SUVs and eat as much as we want and keep our homes on 72 degrees at all times …and then just expect that other countries are going to say ‘okay.’” In the White House, Obama cranks up the thermostat. David Axlerod said: “He’s from Hawaii, OK? He likes it warm. You could grow orchids in there.”

“While touting green technology and lobbying the federal government on environmental policy, Sergey Brin, Larry Page, and Eric Schmidt have put 3.4 million miles on their private jets in recent years, polluting the atmosphere with 100 million pounds of carbon dioxide,” the Blaze reported. Geraghty again:

The party that spent the Bush years screaming about the “Imperial Presidency” overwhelmingly decides that the legislative branch is an unnecessary obstacle to setting its preferred environmental policy. We’ve reached the point where vehemently anti-Bush Democrats in Congress now write-up executive orders for President Obama to implement unilaterally.

The legislative branch matters, until it doesn’t. The filibuster matters, until it doesn’t. Yesterday’s positions get dropped if they interfere with today’s needs. The Right is dealing with extremely adaptive foes who, for the most part, have no hesitation about lying to get what they want.

In the Obama-era Left, a promise repeatedly emphasized with passion and vehemence can and will be suddenly dismissed with a shrug. The highest-profile example of this is “If you like your plan,  you can keep it.” Even today, long after the promise has been declared the “Lie of the Year,” the White House website has a page labeled “Reality Check” that proclaims the accuracy of the pledge:



A Grand Tour of British Accents by The Elephant's Child

The voice is that of Andrew Jack, a dialogue coach.



There Is No Right To Be Free From Being Offended. by The Elephant's Child

How did we get to this spot in the history of the world when the guiding rule of society seems to be —”You must not offend anyone.” Is it an outgrowth of the self-esteem movement that did so much damage to our national psyche?  Do not disagree with me or you might damage my self-esteem?

In the last few days, a Mozilla executive was expelled from his position at the firm he co-founded by left-wing campaigners who determined to punish him, not for something he said in his role at the company, but for a donation he made to a California ballot initiative that defined marriage in the customary terms in which it had been defined for several thousand years. A donation that was made 6 years ago. The Los Angeles Times helpfully had published a list of all donors to the anti-Proposition 8 ballot issue.

Also in the last few days, one Adam Weinstein, who writes at Gawker, called for literally sending people who have the incorrect views about global warming to prison. “Those malcontents must be punished and stopped,” he wrote. He is not the first to suggest that conservatives should be sent to prison or a concentration camp for their crime of disagreeing with liberal thought.

Charles Murray, an important social scientist of our times, was denounced as a “known white supremacist” by Texas Democrats for holding improper views about education policy.

Condoleezza Rice was invited to speak at this year’s commencement ceremony at Rutgers University where she would receive an honorary doctorate. The faculty criticized the university decision, saying “Condoleezza Rice…played a prominent role in the administration’s effort to mislead the American people about the presence of weapons of mass destruction.” The editorial staff of The Daily Targum said “Do the positive aspects of her personal accomplishments really outweigh the destruction of war she contributed to during her political career? She was a major proponent of the 2003 invasion of Iraq, which has been arguably the worst and most destructive decision in the history of U.S. foreign policy.” All of which goes to prove that if you want to major in history, you should select some other university.

Then there’s Lois Lerner who is facing contempt charges relating to her role in using the IRS as a weapon against the Obama administration’s political enemies for their improper thought and advocacy.

Harry Reid, a liberal champion of campaign-finance reform, was caught channeling tens of thousands of dollars to his granddaughter, while carefully omitting her surname (same as his) from official documents, and hiding the transaction. When discovered, he quickly wrote a check to his campaign to cover-up his indiscretion. At the same time,Mr. Reid has been viciously attacking the Koch Brothers, who are prominent philanthropists, especially in seeking a cure for cancer, for implausible crimes because the Libertarian brothers donate to conservative causes.

I don’t know what part the self-esteem movement, in which most of our current adults were raised, plays into this liberal failure to recognize that good and honest people may have opinions that differ from theirs, or if it even does; but it is all right, and they just need to suck it up. Conservatives often marvel at the march in lockstep of Liberals. They regularly espouse the same ideas in exactly the same words, and apparently assume that no one will notice.

I have generously always assumed that the wordsmiths at Think Progress come up with what they hope will be the most fortuitous description of an idea or a policy to sway the minds of potential voters, then run the preferred words by a few focus groups to assure that they’ve got the best verbiage, then send it out to every Democrat politician who might use the words in public.  If that is the case, you must also assume that the Democrats in question don’t bother their pretty little heads with boring things like economics and history, and the long-term effects of past legislation. No scientific studies for this bunch, they will be told the proper language. Consider the words “The Patient Protection and Affordable Care Act,” that’s some major wordsmithery!

As evidence, I offer the media’s longstanding effort to capitalize on Republican disagreement—all that crowing about how Republicans are at war among themselves. We don’t all think the same, we do study history, we do pay attention to how legislation actually plays out, and we even read scientific studies. We are ordinary human beings and we have our own opinions, and aren’t afraid to disagree. Disagreement is —normal.  We’ll present our evidence, and try to compromise eventually, but we never, never march in lockstep.

Jonathan Rauch said it nicely in his Kindly Inquisitors, using ‘liberal’ in the classical sense: “Liberal science is built on two pillars. One is the right to offend in the pursuit of truth. The other is the responsibility to check and be checked.”

Irving Kristol wrote: “In every society the overwhelming majority of people live lives of considerable frustration and if society is to endure, it needs to rely on a goodly measure of stoical resignation.”

Feel free to offend. Stand up for what you believe. Refuse to be cowed by those who claim to be offended. We don’t do “thoughtcrime” in the United States of America, do we?



“Mission Accomplished” says Obama. Now What? by The Elephant's Child

I had a routine doctor’s appointment last week. As she interacted with the new computer system rather than me, my doctor said “I should have gone to secretarial school instead.”

So after “Obama’s ‘Mission Accomplished’ moment—his triumphal Rose Garden speech claiming ObamaCare is now here to stay—where are we? No one believes Obama’s lofty claims for the numbers of enrolled people, and the number who have actually paid their premiums (the only point at which the numbers are real) are numbers that will have to come from the insurance companies.

The underlying signs of the health of this dreadful medical law are something quite different. Kaiser Health News published the following:

Janis Finer, 57, a popular primary care physician in Tulsa, Okla., gave up her busy practice two years ago to care full time for hospitalized patients. The lure? Regular shifts, every other week off and a 10 percent increase in pay.

Lawrence Gassner, a Phoenix internist, was seeing four patients an hour. Then he pared back his practice to those who agreed to pay a premium for unhurried visits and round the clock access to him.  “I always felt rushed,” said the 56-year-old. “I always felt I was cutting my patients off.”

Tim Devitt, a family physician in rural Wisconsin, took calls on nights and weekends, delivered babies and visited his patients in the hospital. The stress took a toll, though: He retired six years ago, at 62.

Physician stress has always been a normal fact of life, but anecdotal stories suggest a significant increase in the level of discontent, especially among primary care doctors who play the central role in coordinating patient care. Just as millions of Americans are obtaining health insurance through ObamaCare because of the threats of fines, or because their insurance policies were cancelled— often because the benefits they chose did not match the government’s one-size-fits-all standard.

A 2012 Urban Institute study of 500 primary-care doctors found that 30 percent of those age 35 to 49 planned to leave their practices within five years. The rate jumped to 52 percent for those over 50. A RAND study for the American Medical Association found that nearly half of physicians called their jobs “extremely stressful” and more than one-quarter said they were “burning out.” Unhappy doctors make for unhappy patients, and unhappy patients result in unhappy doctors.

Janice Finer, who left primary care to work with hospital patients, didn’t want to have to deal with insurers, hiring staff, and the business of a practice —sold her practice to a hospital. But hospital administrators dictated the pace. She was required to see 22 to 28 patients a day. At one point, she said, she was scheduled to see patients every 11 minutes. But meeting patients’ needs is not just busy work, but it doesn’t generate revenue.

President Obama contributed billions to help defray providers’ costs of going digital. The goal was a national system that would provide the government with statistics for further control. Not happening. Every hospital may have a different system, and none of them talk to each other. Digital records mean entering numbers and words in lots of repetitive boxes, but the old kind of personal, nuanced information that was in a doctor’s note, aren’t included. “Many physicians told us “I used to be a doctor, now I’m a clerk.” Anyone who uses a computer can recognize the potential for error. Typos are a way of life. Some doctors have started using ‘scribes’ —laptop carrying assistants who fill in the blanks and take notes— which adds another level of cost.

The association of American Medical Colleges estimates that the U.S. will be short about 45,000 primary care doctors in 2020 when 260,000 are projected to be practicing. Doctors used to encourage their kids to go into medicine. They’re not doing that anymore.

President Obama in his “Mission Accomplished” speech stressed the objective of the Democrats who drummed up this mess: “We are making sure that we are not the only advanced county on earth that doesn’t make sure everybody has basic health care.” Tinkering and improving are expected to lead to single-payer health care which is the their ultimate goal.

Nationalizing health care inevitably leads to conflicting problems.Government programs always cost more than was estimated — way more. The government’s sole incentive quickly becomes a demand to reduce costs.

The incentive for hospitals and clinics is the need to get adequately paid for their services. Those incentives lead to a reduction in innovation unless it is proved to reduce costs— so fewer medical inventions, fewer new drugs.

And pressure on doctors and personnel is to do more in less time with fewer and cheaper materials.  The incentive is also for doctors to leave the profession or for doctors to become government employees. What is inevitable is a lot of burned-out doctors who become more cynical and less caring. Ezekiel Emmanuel, who was one of the advisers for ObamaCare, has advocated disposing of the Hippocratic Oath.

The problem for patients becomes getting an appointment, getting use of expensive diagnostic equipment, and facing long waits for seeing a doctor and seeing a specialist and just getting the needed care. A frequent look at British newspapers’ accounts of the latest NHS scandal is proof of where it all leads.

If health care is free or low-cost at the point of service, the incentive is to overuse medical care which is what got us here in the first place. When someone else is paying the bill, there is no incentive for thrift,  which drives up costs and the vicious cycle repeats and  grows slowly worse, and harder to change.  Incentives matter.

 

 




Follow

Get every new post delivered to your Inbox.

Join 6,423 other followers

%d bloggers like this: