Sunday, March 29, 2009

Arrow of history

In response to the back-and-forth about the AIG exec OpEd, one reader opines about the limits, for lack of a better word, of liberal theory regarding national borders and sovereignty. I don't disagree with anything below, but I will add my two cents that that the arrow of history suggests a continued blurring of boundaries, at least as far as basic human rights are concerned.

I don't necessarily agree or disagree with your commenter on your AIG post, but he/she does raise what I have always believed to be --- within the context of political theory --- the fundamental problem, in general, with western liberalism and with American liberalism specifically: national sovereignty and national borders.

The gordian knot is something like the following: as your commenter points out, there's nothing deserved about being born in America. It's purely random chance. To the degree that one is systematically better off purely based on geographic location of birth seems to utterly undermine 18th century liberal principles (the ones that American liberals and Amercian conservatives agree on): political equality under the law and equality of opportunity in the market. Given this, no one has ever come up with a defense of national borders that satisfies liberal concerns. And plenty of people have struggled with this. It's probably the issue in contemporary political theory.

But here's the rub: if national borders are illigitmate under liberal political philosophy, then all plausible arrangments of global politics place that satisfy the concerns of American liberals imply that the the lower middle class in Amerifca (i.e. those who have family incomes in the 20k-40k range) will be among the those who will be making net transfer payments in any income redistribution system. Even under the unworkable Obama idea of only raising taxes on the top 5% and placing the burden of most of the new social safety net on them, low-income Americans would be the providers, not the recipients, of transfer payments. If we came back to reality and realized that most of the middle-class in America needs to fork over more to pay for things like health care, all of a sudden the poor in America becomes the targets of global revenue raising.

The same issue rears its head with the Iraq war: under any reasonable definiton of liberalism, we can't possilbly value random American lives over random Iraqi lives. So unless we try to gin-up a liberal defense of national borders and national sovereignty, the only relevant calculation for removing Saddam is whether more people would die if he stays or if he goes, regardless of nationality. It would be like if Arizona had a dictator who was gassing Arizonians.

To me, this is the limit of western liberalism. Because of course there are reasonable arguments to made in favor of national borders and national sovereignty. But none of them are liberal arguments. In fact, many of them are inherently anti-liberal arguments.

Maybe this can be overlooked. But I don't particularly believe that you can be an honest liberal and not be a cosmopolitian about the borders. This is one issue where I think the libertarians and the Catholic Church are exactly right: the only defensible liberal policy is complete freedom of immigration, without political or economic restrictions on such immigrants.

Of course, if that policy was adopted, we'd soon find out how liberal the average American is. My guess is "not very."

Thursday, March 26, 2009

Batter up

This disagreement with my take on the DeSantis NYT OpEd of the other day argues that I missed the boat on what DeSantis was trying to say. First, whether or not DeSantis aimed to play the role of martyr can only be known by DeSantis himself, but certainly how ones reads it is pretty much reader-dependent.

He further writes:
You call him out for saying that the downfall of AIG wasn't his fault, but what if that is the truth? Your only evidence for it not being true is the assumption that everyone who worked at AIG-FP is at fault. As to your comment about him blaming it on shadowy people elsewhere--what could he have said that would have satisfied you? Do we have to assume that he's full of shit unless he drops a footnote with the names and addresses of the people he was referring to?

Certainly, I'm not blaming AIG's downfall on this guy, and I'll give him the benefit of the doubt that he wasn't even indirectly involved in questionable financial decisions. But what I will call him out for is pointing a finger and saying "hey, don't look at me." I'm not asking him to name names, but I am asking him not to blame someone else if he's only willing to do so in the vaguest of terms. In other words, I'm suggesting that his OpEd would have been much better had he simply left out the part about who's to blame, because I'm tired of reading about whose fault it is not.

Another thing that bothered me about your response is your criticism of him for saying that he worked hard.

I'm certainly not criticizing him for hard work, but rather for wrapping himself in it to such a degree that makes him seem like he's working harder than anyone else. Indeed, in a single OpEd, we get this:

"After 12 months of hard work dismantling the company..."
"I can no longer justify spending 10, 12, 14 hours a day..."
"My hard work earned me acceptance to M.I.T...."
"We have worked 12 long months ..."
"I know that because of hard work I have benefited more than most..."

I mean, enough already! Fine, you work hard, but so do a lot of other people who don't receive giant paychecks. Your hard work is not a justification for getting paid a lot, and that is where I think Wall Street misses the sentiment of the country. The fundamental criticism of the Wall Street exec that is currently bearing the brunt of criticism is not that he is "a lazy, incompetent rich prick," although people certainly do think that -- rather, I would suggest that the underlying source of rage in the country has a lot more to do with the fact that these Wall Street execs are not out for anyone but themselves. They aren't doing anything of value, they aren't making the country any better, they are only enriching themselves, everyone else be damned. One could certainly argue the validity of that sentiment, but I don't think one could argue with its current strength. In sum, no one cares how hard you did or didn't work.

Finally, if you are going to criticize this guy for congratulating himself on his hard work while not giving enough credit to how lucky he is then, to be consistent, you should voice the same criticism at virtually anyone in America. We are all very lucky to be live here rather than Somalia.... So if you overhear a strawberry picker complain about their pay being reduced from $8 to $7 an hour, please call them out on your next blog for how ungrateful they are for living in the US.

Sorry, I think this particular critcism is off base. First, there is a huge difference between going from $8 an hour to $7 an hour (which is way more than migrant workers make picking strawberries, by the way) and some already-wealthy guy missing out on becoming even-more-wealthy. Second, DeSantis is writing an OpEd for the New York Times largely by virtue of his elite status in society -- when strawberry pickers are so lucky to have their personal missives to their bosses published in the national papers, I'll critice them too if they make stupid statements. But to suggest that I need to come down harder on the voiceless for things they haven't said is a bit odd.

What Hath Elbridge Wrought

CQ Politics has a very neat tool allowing you to look at '08 election results by Congressional District. I think I found the most gerrymandered district in the country, AZ-2, highlighted in pink on this map; it makes Massachusetts' layout look normal.


I guess someone didn't read the NYT OpEd the same way I did. My reply in a bit:
I think you completely misconstrue this letter. Do you seriously think a millionaire would be dumb enough to try to elicit sympathy for giving up his bonus during the worst recession in decades? MIT people are known for lacking social skills, and Wall Street people are known for being out of touch, but no way could this guy be that dumb. You have to read this letter in the context of the events of the past week in which people were essentially accusing anyone who worked at AIG financial products division of being a lazy, incompetent rich prick at best or criminal at worst. I think he was simply trying to rebut that caricature by showing that he is an honest, hard-working guy who had nothing to do with the downfall of AIG. I don't think he was trying to portray himself as some kind of martyr.

You call him out for saying that the downfall of AIG wasn't his fault, but what if that is the truth? Your only evidence for it not being true is the assumption that everyone who worked at AIG-FP is at fault. As to your comment about him blaming it on shadowy people elsewhere--what could he have said that would have satisfied you? Do we have to assume that he's full of shit unless he drops a footnote with the names and addresses of the people he was referring to? Ultimately, whether or not he is telling the truth is a factual question that neither of us can answer definitively, but there are some reasons for believing what he says is true: (i) he submitted this letter to the New York Times, so it would be pretty easy for read this and out him as a liar; and (ii) he worked in the commodities group, and according to the information I have seen, the vast majority of AIG's losses are from credit default swaps related to mortgage backed securities.

Another thing that bothered me about your response is your criticism of him for saying that he worked hard. It seems like you are essentially saying that white collar work can't be considered hard work. Yes, reading documents and sending emails are not inherently difficult activities, but I don't see anything wrong with calling an 80-hour week of white collar work "hard work." Picking strawberries is more physically demanding and could be conisdered harder work, but so what? This guy never said that strawberry pickers don't work hard. Also, there is no law or coherent ethical principle dictating that everyone's income must be contigent on working hard and/or everyone's income must be proportionate to how hard they have worked, so it is somewhat irrelevant (though he is the one who brought it up). Finally, if you are going to criticize this guy for congratulating himself on his hard work while not giving enough credit to how lucky he is then, to be consistent, you should voice the same criticism at virtually anyone in America. We are all very lucky to be live here rather than Somalia. A person earning the US median income of $43,000 is in the 98% percentile with respect to the rest of the world ( So if you overhear a strawberry picker complain about their pay being reduced from $8 to $7 an hour, please call them out on your next blog for how ungrateful they are for living in the US.

Wednesday, March 25, 2009

Whom amongst us?

In an attempt to put a human face on the other side of the AIG bonus debacle, an about-to-be-former employee pens an OpEd for the New York Times. The idea is to make us feel sympathetic for him and others of his ilk, to show that politicians are engaged in somewhat of a grandstanding witch hunt. While I totally agree that the latter is occuring (that is what politicians do), it doesn't then follow that I'm receptive to the former, and that's where I think DeSantis errs in judgement. I imagine that most folks will have a similar reaction.

While I agree that there are politicians grandstanding given the current populist winds (I mean, I'm sure Cuomo has accepted tons of campaign contributions from the financial sector), I'm still not going to feel sorry for a guy who received a bonus of $750,000 in very lean times for playing a slightly different version of Liar's Poker, and then has the balls to humbly compare himself to a plumber. This is grandstanding, just like Cuomo.

"Many of the employees have, in the past six months, turned down job offers from more stable employers." I'm pretty sure that Mr. DeSantis of five years ago wouldn't feel sorry for Mr. DeSantis of today -- that's the free market at work, he would say -- you made a bad choice, you lose. (By the way, I'm calling bullshit on the many other job offers out there). DeSantis is actually trolling for sympathy!

This is the sort of bullshit that drives people nuts about Wall Streeters. First, the it's-not-my-fault part -- blame the shadowy people elsewhere, who apparently have vaporized from this earth: "Most of those responsible have left the company and have conspicuously escaped the public outrage." And then the faux-populism, I've-suffered-too: "I did, however, like many others here, lose a significant portion of my life savings in the form of deferred compensation invested in the capital of A.I.G.-F.P. because of those losses. In this way I have personally suffered from this controversial activity" No, sir, suffer is what happens when you watch someone you love die because you can't afford medical insurance, suffering is not what occurs when you can return a $750,000 bonus to make a political statement.

This guy wraps himself in "the American dream" and "hard work" (a mover getting paid $8 an hour is hard work, an immigrant picking strawberries for less than that is hard work, wandering around an office in lower Manhattan talking to people, writing emails, and taking phone calls is not hard work). He argues for an honoring of commitments: "We have worked 12 long months under these contracts and now deserve to be paid as promised." That line didn't work too well for the auto unions, who have seen their promised benefits cut time and time again because someone in management made a dumb decision. Call me nuts, but I don't think DeSantis was all that upset when UAW members saw their "perks" cut due to the necessity of hard economic times.

Here's a telling line: "I know that because of hard work I have benefited more than most during the economic boom and have saved enough that my family is unlikely to suffer devastating losses during the current bust." Again, I think this guy is living in a different universe. First, note how he attributes his benefits not to lucky circumstances, not to being in an industry that lavishly compensates those who generate short-term profits, but rather to hard work, which I suppose also means that those who didn't benefit "more than most" must not have been working too hard -- take that you lazy teachers! Further, "more than most" as a clarifier means something like more than half, maybe 3/4. It certainly does not mean >99.999% percent of everyone on the planet, but that's how this guy views himself, someone whose situation isn't all that abnormal, just someone on the plus side of the normal distribution of things.

Obama was on to something the other night when he suggested that bankers need to "get out of New York." There's a whole 'nother world out there, and DeSantis' attempt to make it seem like Wall Street is a blameless victim is not only tone deaf but also dead wrong.

Monday, March 23, 2009

And you got here how?

Via Wonkette, a state rep from Texas wondered aloud today "what's Medicaid?" He was not asking a philosophical question, he was instead hoping to find out what Medicaid is. Wow.

Sunday, March 22, 2009

Google Reader

Just started using Google Reader this week, and I'm a bit mixed on it. From a technology & efficiency standpoint, it is great. You simply tell it which blogs you read a lot and, on one page, it compiles all new posts. This way you need not visit 10 different pages at various points during the day to see if there's anything new, you just need to go to one page. Nice and simple, with few glitches (if a blogger is prone to putting a lot of stuff below the fold -- Krugman does this a lot -- then you'll likely need to click from within Google Reader to visit the actual blog).

But what worries me is that the authors don't get a 'hit' to indicate that you visited their site, and obviously you didn't see any of their advertising. So instead of The Atlantic or The New York Times or whoever getting ad revenue from their banners, you instead just stay within Google (of course, Google controls a lot of the ad revenue anyway, but you see my point). Oddly, the Google Reader page itself doesn't have any ads on it, though surely that will change.

Syracuse Orange: origins

Because I've always wondered, here's how Syracuse got the nickname Orange:
In June 1872, Syracuse adopted rose pink and pea green as the official colors of the University and its athletic teams. The colors were changed the next year to rose tint and azure, later becoming pink and blue.

After a football field meet at nearby Hamilton College in 1889 which Syracuse won, derisive comments about the victors’ colors led the SU student body to the conclusion that yet another change should be made.

A committee made up of students and faculty members discovered that orange had not been adopted by any college or university as a single color. In 1890 the Alumni Association rendered a unanimous decision and orange has been the sole official color of Syracuse University since that year.

Men’s varsity teams soon became known as the Orange or Orangemen. When women began competing in varsity sports in 1971, they selected the nickname Orangewomen. In 2004, the University made the decision to have all teams, men and women, referred to as the Syracuse Orange, to reflect the original nickname of SU's teams.

No word in the article if the derisive comments were made by DU brothers.

Tuesday, March 17, 2009

Let Them Fail

If this is the best the Washington Post can muster, then newspapers can go the way of the dodo and I won't mind. Front page story, first paragraph:
President Obama's apparent inability to block executive bonuses at insurance giant AIG has dealt a sharp blow to his young administration and is threatening to derail both public and congressional support for his ambitious political agenda.

A lot of hyperbole in this paragraph. Really, a sharp blow? I would imagine that something like North Korea launching nukes would be a sharp blow, or Iraq descending into chaos, or the stock market losing half its value in a week -- these are sharp blows. Executive bonuses at AIG is, in the grand scheme of things, a pretty pointless story. Yet WaPo is happy to put it on the front cover as if it were terribly important news. The great thing about it, from their perspective, is that no actual facts or analysis are needed to run this story. And pundits can have vehement opinions on the matter too, so all much the better.

And really, this is threatening to derail support for his agenda? I can't really imagine environmentalists thinking to themselves, you know what, I was for a cap-and-trade system, but now that AIG execs got their bonuses, screw it, or that a laid off worker will now oppose Obama's health care reform efforts.

If someone brought this crap to me at the Writing Center I'd give them a hard time and might even threaten not to sign that little "I went to the Writing Center" form that was probably required by their professor. And yet these nitwits are writing for one of America's preeminent newspapers.

Monday, March 16, 2009

Much Ado About Nothing?

Paul Hogan, commenting on the AIG bonus 'scandal' and why it -- perish the thought -- might be nothing more than political grandstanding:
I think people may be jumping to conclusions about this situation. It is pretty common for executive employment contracts to contain provisions entitling the employee to a yearly lump sum "bonus" payment on the condition that the person is still employed as of a certain date. Although it is referred to as a bonus, it is more like a salary payment in the sense that it is contractually guaranteed, non-discretionary, and not based on performance benchmarks. If that is the case for these bonuses, then this is much different than the 11th hour discretionary bonuses that John Thain gave out to Merrill employees.

The relevant question is whether the government has any authority unilaterally alter the contracts of employees at AIG, whether through TARP or otherwise. From what I have read, it does not sound like they do have any such authority, but are trying to come up with a way to stop these payments regardless.

Another question that I would like to know the answer to is what authority does Andrew Cuomo have to subpoena this information? Does the AG of a state have the right to know the salaries of any employee working for a company in that state? The fact that AIG received bailout money from the federal government is a federal matter and does not increase Cuomo's jurisdiction. And I have not seen any evidence that these contracts are fradulent, especially since it appears that they were entered into before shit hit the fan, and even if there is a slight possibility that they are fraudelent, the government cannot just subpeona information based on naked suspsicions and accusations.

We might not like the fact that these idiots at AIG are still getting paid, but situations like this might just be inevitable when the government hastily hands over billions of dollars. Giving a company enough money to pay off all of its creditors means that they will have the money to pay off some creditors that we would rather them not pay off. But a company can't just pick and choose who to pay and who not to pay without getting sued.

Regardless, I don't like the idea of the government rescinding contracts without any authority to do so or prosecutors abusing their subpeona power. It might not bother you when executives AIG are on the receiving end, but we have seen what can happen when prosecutors are given carte blanche to run wild (e.g. Kenneth Star).

The real shame is that this furor over 100 million in bonuses (which amounts to about .06% of the bailout money that AIG has received) has drawn attention away from much more important issues such as the $13 BILLION that Goldman Sachs has received from AIG post-bailout, or the broader discussion of whether we need to nationalize the banks.

Sunday, March 15, 2009

District of Uganda

Apparently Washington DC's HIV infection rate has now hit 3%. That is insane and embarrassing.
Black men, with an infection rate of nearly 7 percent, carry the weight of the disease, according to the report, which also underscores that the District's HIV and AIDS population is aging. Almost 1 in 10 residents between the ages of 40 and 49 has the virus.

I've visited DC a few times and, of obvious reasons, have never visited the 'bad' parts of the city, mostly sticking to the areas near the Mall and other interesting areas (Adams Morgan, e.g.) Where are the bad parts of DC? I mean if you subtract out the good areas, which presumably have a lower HIV infection rate, then the bad areas are even higher, so it might as well be a third-world country. Again, a national embarrassment.

Thursday, March 12, 2009

Camera 1, camera 2

The Syracuse-UConn Big East tournament game has just headed to overtime after a last-second shot by the Orange was nullified (correctly) via review. I have a decent-sized HDTV so I was able to see ESPN's replays quite clearly. But the official at MSG was using a 13" screen at best and it was definitely not HD or plasma or anything. When the NFL first started using replay this was also an issue -- of course, it may still be, they just now hide the screen under a curtain. This mystifies me, why major sporting events/venues/teams go cheap on something so important to the outcome of the game.

Update: This game is now in its SIXTH overtime. I did not plan on staying up until 1:30am to watch a relatively meaningless Big East Tournament game. But it has been a good game. And the 'cuse, who have been pretty bad from the charity stripe all year, are 20 of 22 from the free throw line in the OTs... including two clutch shots by a guy who was 1 for his previous 16.

Tuesday, March 10, 2009

Krugman live

In about an hour, Paul Krugman is giving a talk at Harvard Medical School titled "Why Health Care Now." Should be pretty interesting, and if my battery doesn't die, I'll live blog it.

Krugman has been a must-read during the past few months, and he has certainly established himself as not simply a raving fan-boy of the Obama administration. In brief, his main critique is that the White House hasn't been bold enough, either in terms of the size of the stimulus or their willingness to take the appropriate steps to shore up the financial system, i.e. nationalize Citi & B of A.

His most recent blog post, however, seems to take the foot of the throttle in terms of criticism of the Obama approach. While he's been warning that the current Obama approach will lead to zombie banks, as Japan did in their lost decade, he now says:
Well, I’m sure I’m not the only person to notice this: Japan doesn’t look so bad these days.
I'm sure today's talk will hit on a lot of issues, as the health of health care plays a big role in the health of the overall economy. Looking forward to it...

3:51 - Krugman is in the building, and happened to be standing right next to me. I asked if he was nervous. He replied that he's done a few talks before. He is shorter and rounder in person that I would have thought. Also seemed to have a decent amount of perspiration going. I also see that he has changed the title of his talk to "Whither health care?"

3:55 - I'm really enjoying the looks on peoples' faces as they walk in 5 minutes before a major public figure is about to speak and are shocked, shocked, that there are no more seats.

3:58 - Previous George W. Gay lecturers include Joshua Lederberg (1983), E. O. Wilson (1980), Margaret Mead (1960), and lots of names that now can be found on streets and buildings in the Longwood area, such as Sears, Peabody, Ruggles, & Shattuck, going all the way back to John Blake in 1922.

4:07 - "I'm not a real health care economist, I just play one on the OpEd page"

4:08 - "No area of the economy works worst under a market economy than health care." "Health care reform is a values issue... it is wrong for people not to be getting health care because they can't afford it." In Jindal's response to Obama: "No American shoould have to worry about losing their health care coverage, period. We stand for universal access to affordable health care coverage."

4:11 - "Our chance to get it right comes from the fact that things are falling apart." Health care spending as a share of GDP: from 5% in 1965 to ~14% now. "Bulk of increase in cost is a result of progress... being able to treat new things." "CBO has been very good on this issue" (meaning he buys their numbers).

4:15 - "In US system, insiders get everything and outsiders get nothing." "Certainly possible that medical progress kills people, as it reduces the number of people who have effective coverage." Since 1999, health care premiums are up 119% while earnings only up 34% (inflation 29%). What can we do? "Until we had regime change in November...push was to find a market solution... argument, not entirely wrong, was that patients don't have incentive to reduce costs... what was missing from all of that was any real examples of any medical cases that people would spend less on; the overwhelming fact about health care is that the minor expenses, where people might not do something, costs next to nothing... it is the major things that cost so much... 5 % of population has half the nation's health care costs."

4:23 - "Immediate problem we face is the insider/outsider issue... growing risk to Americans of not having coverage or inadequate coverage." "Probably, this recession will be worse in terms of uninsurance, soaring rates." "How hard would it be to have everyone covered?" "Opportunity for reform is as good now as, possibly, ever." "Wouldn't covering everyone be really expensive?...Distinguish between budgetary costs and the nation's overall health care bill... there is really no question that universal coverage would be cheaper than current system... why? first, uninsured are by and large relatively young, so insuring them will cost less than most think (i.e. don't just extrapolate from what it costs to insure the other 85%)... second, don't underestimate the amount of effort that goes into insurance underwriting and how much that costs, i.e. denying people coverage, etc. -- we have huge administrative costs... Medicare admin costs are 3%, private insurance is 14%. Costs of denying people coverge is just about enough to give coverage to everyone, from a national perspective. We spend almost twice as much on health care as any other system, and see no increase in better outcomes. This is not a controlled experiment (comparing countries): lifestyle, "we eat more cheeseburgers"

4:32 - Does economic crisis make it easier or harder to make major health care reform? Historically, should make it easier, expansion of social safety net (FDR); but then again, Medicare/Medicaid under Johnson took place during a time of affluence. There are no safe havens, everyone is hit by this economic slump, even Germany. Amount of sheer human misery, however, will be higher here than in Europe b/c they have a stronger safety net -- as many as 10 million Americans might lose health insurance. Kaiser Found. poll: 2 - 1 people say it is more important than ever to reform health care in light of current crises than we cannot afford to take on health care reform right now.

4:37 - 1993 Dems were much looser coalition than now (lots of conservative Southerners). This time around, while there is not unity, it is much more ideologically cohesive. So, what form should health care reform take? Lotsa people say single-payer is the way to go, and people who say that American won't go for it are missing that Medicare is single-payer. While most Americans get their coverage from private companies, public spending on health care is 45%, because that's where most of the expensive cases are. Even a full single-payer will be at most 75% public spending, with rest consumer out of pocket. But Medicare for all is not going to happen now.. what might happen in something a lot more complicated.

4:43 - Single payer is, essentially, each according to his abilities to each according to his needs (good laugh from the audience on that). But this isn't feasible now, Congress would not pass Medicare for all. Jacob Hacker (of Yale) plan: a) community rating, same health care plan available to everyone, no underwriting, etc. b) subsidies, for lower income families to afford health care premiums c) mandates - during Dem primary Obama v. Clinton, but now agree that mandates are needed - we need healthy people in the system - maybe they'll call it something else d) public plan available to all. (d) is needed in order to keep private insurers possibly on board; without (d), insurance companies will campaign vigorously against it, e.g. Harry & Louise. Why feasible now? Comfort zone, for people who like what they have now. Can't tell people that, trust me, you'll be happy with the new public plan -- president needs to able to say you can keep the insurance you now have. Some people will say plans like this are better than single payer, but "I don't consider those arguments serious... very weak arguments." "This is an argument about political feasibility."

4:51 - Hackerish plan won't be as efficient as single-payer, will be substantial more beaurocratic, to regulate insurance companies, enforce mandates, etc. A serious cost issue is the ability of bargain with essentially monopolistic produces, i.e. drugs and medical devices, and bargaining is more effective with single payer. So do you wait for political will for single payer, or do you strike now with a Hacker plan? Brilliance of Hacker is (d), public plan available to all -- it could spontaneously evolve to single payer, and the hisory of Medicare suggests that this will happen. Extra layers of middlemen in private plans made them more expensive than Medicare. Gratifying to see >$600 billion in Obama budget for health care reform, although it is not enough (need twice that, although that is openly acknowledged in the budget).

4:58 - Notably lacking in Obama's plan is a clear statement on a public plan. "Private becomes a good word in and of itself" in this debate. All of this is about covering the gap, getting us to where other developed countries are. Even if we do this, we still have problems. Tendency of health care to grow faster than GDP is remarkably consistent, so it will likely continue in the future. Health care should be a system where "what you get out isn't necessarily what you put in... don't have to be a right=winger to see that a time where health care is 50% of GDP is a bad thing, certainly from an incentive standpoint." Reducing costs buys some time on the health care/GDP/time curve, and also by not paying for things that don't work, are pointless, etc. (see Orszag). Eventually we need to learn to say no, it will cost too much. How do we do that? "In the long run we'll all be British... the government will not just be the payer but the provider."

5:06 - Q&A time (i.e. hear my crazy idea!!!) First guy is making a statement (he is clearly a medical doctor), pontificating, there is no question in sight, jebus, shut up already. Okay, Q2 sucks too, enough of this.

Krugman was good. Thinks health care reform can and should happen now. While he certainly supports single payer, his tone suggests that a full Hacker plan would be fine with him. It'll be interesting to see if his column strike the same mood.

Sunday, March 8, 2009

Theologians should stop talking about science

The Obama administration is about to announce an end to the Bush policy banning the use of federal funds to create new ES cell lines. The science community is quite happy about this, but a negative is that we now need to hear, again, the bizarre complaints of those who think this presents an ethical dilemma, except now there is an additional 4 - 8 years of science that these folks can misrepresent, either deliberately or because they don't really get it (I think the latter is more likely).

For example, via Newsweek & the Washington Post & Georgetown, theologian Thomas Reese argues that we should limit and then end the use of embryonic stem cells in research. Reese mentions the use of iPS cells, which I've written about before, here, here, and here. He writes:

Opponents of embryonic stem cell research also point to significant breakthroughs in adult stem cell research, such as the recent development of induced pluripotent stem cells (iPS cells) that do not require the use of human embryos but can be made from skin tissue. Not only does such a process lack the ethical problems of using embryonic stem cells, it also has the medical advantage of producing cells that are less likely to be rejected since they come from the same body to which they will be returning.

In the past, the process of developing iPS cells was questioned because of the use of viruses in the process. These viruses might cause the transplanted cells to become cancerous after the transplant. This problem may have been eliminated by recently announced procedures that do not require viruses to transform adult cells into these iPS cells.

First, let's be clear on the science. The use of the phrase "in the past" is a bit disingenuous to describe questions about using virus to make iPS cells -- there have been a handful of papers that have minimized the use of virus -- although to my recollection, none were able to do it without using any virus -- and second, these papers have been in print for barely a few months, not nearly enough time to confirm the results. Also, let's understand what these papers did and did not demonstrate. One can make iPS cells, but it is a terribly inefficient process -- fewer than 0.1% of cells emerge from the selection with stem cell like properties. To me, this argues that you haven't really made cells that are truly ES cells, but rather just close enough, so in simple assays they behave like ES cells, with an emphasis on simple.

Second, iPS cells do not eliminate the ethical dilemma. The objection to using ES cells is that they have the potential to be humans, and thus are a human life. If iPS cells don't have the same properties as ES cells, then we'd agree that they are not as medically useful. But if they do have the same properties as ES cells, then they have the potential to be humans and shouldn't be used! (e.g. if A = B, and B = C, then A = C)

Reese first proposes that we only use ES cells that are going to be destroyed (or frozen indefinitely) anyway, in other words, let's not make any new ES cells solely for the purpose of research. Fine. But then his second proposal is jaw-dropping:

2. Before using human embryonic stem cells, researchers should show that the research they are doing cannot be done with non-embryonic stem cells.

Really? Researchers should prove that something cannot be done? First, there's the obvious logical objection that proving something can't be done is actually impossible. But leaving that aside (I dunno, accepting that 95% failure is good enough, however one might define that), we really want to waste a substantial amount of time and effort in an attempt to show that something isn't working? This is exactly the sort of idiotic proposal that would come from someone who clearly does not understand either the science that he is writing about or the process of doing science.

I really don't know why the reaction of the media, when some ethical issue arises in scientific research, is to find some theologian and take his (and it is almost always a he) opinion as the other side in the debate. Theologians study god, which is not exactly an experimentally tractable system -- I can't think of any profession that would leave you less prepared to form a cogent opinion on modern bioligical research.

Saturday, March 7, 2009

I guess I'll have to get HBO

In the 7th season of Curb Your Enthusiasm, it looks like George, Elaine, Kramer, and Jerry will play a part in several episodes.

A corn problem

Looks like George Will finally got around to reading The Omnivore's Dilemma by Michael Pollan, and provides a nice little book report in this Sunday's column. Essentially, the problem is that:
During World War II, when meat, dairy products and sugar were scarce, heart disease plummeted. It rebounded when rationing ended. "When you adjust for age," Pollan writes, "rates of chronic diseases like cancer and type 2 diabetes are considerably higher today than they were in 1900." Type 2 diabetes -- a strange epidemic: one without a virus, bacteria or other microbe -- was called adult-onset diabetes until children began getting it. Now it is a $100 billion-a-year consequence of, among other things, obesity related to a corn-based diet, which is partly because steaks and chops have pushed plants off the plate.

The head of the Agriculture Department is Tom Vilsack, from the corn state of Iowa. Whether this helps or hinders Obama in making real changes to our agricultural policy remains to be seen. But certainly if one is looking for a way to have a huge effect on the environment and at the same time lower health care costs, eliminating policies that make it cheap to grow corn and make America fat would be a good place to start. Obama has said the right things, but we'll see what actually gets through Congress.

Thursday, March 5, 2009

Personalized medicine

An important article appeared in the Boston Globe earlier this week, announcing that Massachusetts General Hospital will begin sequencing tumor samples from all their cancer patients. The idea is that mutations in some genes will respond better to drug A, while mutations in a different gene will respond better to drug B.

Doctors will hunt for 110 abnormalities, carried on 13 major cancer genes, that can predict whether drugs already on the shelf or in development might thwart a patient's tumor. They will use robots - and lab machines nicknamed John, Paul, George, and Ringo - that are capable of swiftly identifying genetic quirks in 5,000 to 6,000 patients a year, replacing labor-intensive techniques that had been used only selectively for a handful of cancers.

Mass. General's decision to make gene testing standard in cancer treatment - it's believed to be the first hospital in the nation to do so - represents a major step in delivering personalized medicine to the masses. But doctors acknowledge that it is unclear whether screening patients for an expanded library of tumor defects will actually save money on drugs, or whether it will translate into longer lives.

The article is rightly cautious about whether or not this program will, in the short run, lead to any better treatment for the bulk population. I'm sure there will be some cases where the sequencing analysis does give a diagnosis and treatment that proves remarkably effective, but in the majority of patients, there will be little effect, largely because 13 genes is not that many, and the current repertoire of drugs is still limited. As the base of drugs and genes gets larger -- and as the dataset of how patients with various mutations responding to various drugs gets larger -- a program such as this will be the model for how cancer is diagnosed and treated in this country.

This article also raises an important point that appeared this week in Newsweek, which can more or less be summarized as "doctors often don't know what they're doing." Sharon Begley (of Tenafly, NJ) reports the doctors seem to be averse to anyone telling them what to do, and especially balk at using research to figure out when and why to use a particular treatment, with the further implication that current treatments are given largely as a result of guesses rather than based on any sound science:

It's hard not to scream when you see how many physicians, pharmaceutical companies, medical-device makers and, lately, hysterical conservatives seem to hate science, or at best ignore it. These days the science that inspires fear and loathing is "comparative-effectiveness research" (CER), which is receiving $1 billion under the stimulus bill President Obama signed. CER means studies to determine which treatments, including drugs, are more medically and cost-effective for a given ailment than others. A study in February in the journal Lancet, for instance, compared treatments for severe ankle sprains, concluding that a below-the-knee cast is superior to a tubular compression bandage. A 2006 study of schizophrenia drugs found that old-line antipsychotics were as effective as pricey new ones.

Yet scaremongers have morphed effectiveness research into cost-benefit analysis, warning that Grandma will be denied a knee replacement because some bureaucrat decides it isn't worth spending $35,000 so a 93-year-old can walk without pain (how many years will she live, you know?). The Washington Times said effectiveness research will "threaten the lives of many Americans" as government decides "who gets lifesaving treatment and who doesn't." Sen. Tom Coburn of Oklahoma (a doctor) warned of "a Soviet-style Federal Health Board that will put bureaucrats and politicians in charge of our nation's health-care system."

You might attribute Coburn's rant to his small-government ideology, but I say blame his profession—not politics but medicine. Doctors have long resisted having science guide their practice.

Essentially, the more we can take the decision out of the hands of the doctor and instead base treatment on facts, the better off we'll be. The sequencing of tumor samples takes a step in that direction.