Civil Discussion Between Liberals & Conservatives

2009-05-19T11:46:00.001-07:00

I apologize to all for going AWOL for the last two months; I've been very, very busy with my business. But now I have some thoughts that I'd like to articulate. It occurred to me that one problem with modern political discourse is that it is disconnected. One side makes its statement, and the other side issues its rebuttal, but the two declarations are sufficiently disconnected that neither side needs to be honest about responding to the other's statements. So we get an awful lot of talking past each other, ignoring each other's points. This only adds to the confusion.

The standard way to handle this is to have a face-to-face debate, but these confrontations never work because the two opponents either talk over each other, or one side hogs all the time.

I'd like to offer an ancient rhetorical device as an interesting alternative: the dialog. This time-honored technique permits an author to present his own arguments as well as the responses of his opponent. Now, a lousy author will put stupid words into the mouth of his opponent, and any reader can easily see through such inanities. However, a good author can use the dialog form to carry through his arguments in such a way as to expose the fundamental flaws in the opponent's reasoning.

A dialog is not meant to be even-handed; it is intended to make a case. Its value lies in the fact that, if well-written, it can demonstrate that the best honest rebuttal still fails to rebut the points being made. It does not address the counter-offensive of the other side; it only shows that the other side's defense doesn't work.

With that in mind, I would like to present a dialog about the use of torture. I have been surprised that conservatives have been defending this policy; it's a loser and they really should leave well enough alone. But by aggressively defending this policy, conservatives have made it an important discussion, and so I'd like to present an argument showing just how indefensible torture is as a policy.

My two advocates in this dialog are Libicus and Conicus.

Lib: So, Conicus, you support the use of torture, right?

Con: Indeed I do, Lib.

Lib: I assume that you do not support the arbitrary use of torture.

Con: You assume correctly.

Lib: So you require that torture be used only under a set of rules, correct?

Con: Indeed so.

Lib: What might those rules be? For example, do you have any rules about WHO can be tortured?

Con: Yes, of course.

Lib: Would you permit women to be tortured?

Con: Um... no, I don't think so.

Lib: So if al-Qaeda were to recruit women for its tasks, our nation would have no defense against them?

Con: You're right. I suppose we would have to permit the torture of women.

Lib: Would rape be an acceptable form of torture for women?

Con: No, of course not!

Lib: Why not?

Con: Because it's uncivilized!

Lib: I see. So you would permit only civilized forms of torture, correct?

Con: Yes, only civilized forms of torture.

Lib: And can you tell me what forms of torture are civilized?

Con: I'm not sure what you mean.

Lib: Is waterboarding civilized?

Con: I suppose so.

Lib: What is it about rape that makes it uncivilized while waterboarding is civilized?

Con: Well, rape is nasty...

Lib: So waterboarding isn't nasty?

Con: Rape is very ugly.

Lib: Waterboarding isn't ugly?

Con: OK, here's the answer: the rapist enjoys it, but the waterboarder doesn't.

Lib: So your rule is that torture is civilized when the torturer doesn't enjoy doing it?

Con: Yes, that's the rule.

Lib: So rape would be civilized if it were carried out by a gay man?

Con: Well, no, but that's because we can't be certain that the gay man won't enjoy raping a woman.

Lib: Can we be certain that a waterboarder isn't a sadist?

Con: We can have psychological tests to insure that sadists are not permitted to become torturers.

Lib: So couldn't we have psychological tests to insure that gay rapist-torturers don't enjoy raping women?

Con: I suppose so...

Lib: Ergo, rape is a civilized form of torture so long as we use rapists who are guaranteed not to enjoy the experience?

Con: That doesn't seem right...

Lib: If you find people who truly don't enjoy torturing other people, won't they refuse to do it?

Con: I suppose so...

Lib: Isn't this a Catch-22: the only people whom you can trust to torture in a civilized fashion are the people who refuse to do it?

Con: Yes, I suppose so. I think I need a different rule for keeping the torture civilized.

Lib: Can you think of any other possible rules?

Con: What if we make the distinction based on long-term harm to the victim?

Lib: So, if it doesn't permanently injure the victim, it's not torture?

Con: Yes, that was essentially the argument of Mr. Yoo.

Lib: So rape is back on the table because rape doesn't permanently harm the victim.

Con: No, not at all. Studies have shown that rape inflicts permanent psychological harm on its victims.

Lib: What have studies shown about the use of waterboarding?

Con: We don't have any scientific studies on waterboarding.

Lib: So we don't know if waterboarding inflicts permanent psychological harm.

Con: True.

Lib: So how can you say that waterboarding is civilized torture? You don't know!

Con: Well, OK, but surely there are techniques known not to cause long-term harm.

Lib: Can you name any?

Con: No, I can't.

Lib: So this rule doesn't solve your problem, does it?

Con: No, I suppose not.

Lib: So can you think of any other rules we might use?

Con: We could differentiate based on citizenship: you can't torture Americans, but you can torture foreigners.

Lib: Because foreigners don't enjoy the Constitutional protections afforded to Americans?

Con: Yes.

Lib: But the Constitution doesn't talk about citizens when listing rights. It doesn't say WHOM the government can't do things to, it says WHAT the government cannot do.

Con: But still, it's obvious that the Constitution applies only to Americans.

Lib: Really? So a foreigner on our soil has absolutely no rights? I can shoot any foreigner I please and nobody can do anything about it?

Con: No, that's ridiculous!

Lib: So do foreigners have rights?

Con: Of course they do! They just have different rights.

Lib: And where are the differences spelled out?

Con: I don't know.

Lib: Can we torture British citizens? Germans? French? Canadians? Australians?

Con: That would never happen!

Lib: Why not? What would prevent it from happening?

Con: Because they're not terrorists!

Lib: Some of the 9/11 hijackers came here from Germany.

Con: Yes, but they were still Arabs.

Lib: So the rule is that we can torture Arabs, but not Europeans?

Con: No, we can only torture terrorists.

Lib: How do we know who is a terrorist?

Con: The President decides.

Lib: You mean the people that the President appoints to do the job?

Con: Yes.

Lib: What if they're wrong?

Con: They won't be wrong.

Lib: How do you know?

Con: Because the President doesn't make mistakes.

Lib: But you said it's the people whom the President appoints.

Con: Yes, yes, it's the same thing.

Lib: Who are they?

Con: I don't know.

Lib: You don't know who they are but you're certain that they won't make mistakes?

Con: They won't make mistakes because they follow rules.

Lib: What rules?

Con: The rules that the President sets down.

Lib: Where are those rules?

Con: They're secret.

Lib: Why do they need to be secret?

Con: So the terrorists don't take advantage of them.

Lib: So it's possible to be a terrorist but not fit the rules?

Con: Yes.

Lib: But that would lead to mistakes, wouldn't it?

Con: Sometimes.

Lib: But you said that the President doesn't make mistakes.

Con: You're impossible!

Capitalism just doesn't work

2009-03-16T08:51:00.000-07:00

For years, people have characterized socialism as a noble concept ruined by the evils of human nature. Sure, it would be wonderful if everybody pulled together, working as hard as they could for public benefit, but the sad truth is that people are selfish and lazy. In a socialist system, hard-working people won't work hard because the fruits of their labors are given to others. Capitalism is the superior system because it provides a better match to human greed and selfishness.

I think that's a myth. Not the part about socialism -- I agree that people are selfish and greedy and will not work hard for the public good. But I reject the claim that capitalism is founded on a flawless model of human behavior; indeed, I think that the personality model underlying capitalism is only effective when applied to individual efforts: one person manufacturing one product. As soon as capitalism is extended to apply to groups of people, interpersonal dynamics begin to intrude into the process; and when we talk about very large corporations with very indirect and abstract economic functions, all of Adam Smith's clear and simple explanations are thrown by the wayside.

Indeed, I claim that the effectiveness of capitalism is inversely proportional to the size of the economic units operating in a capitalistic system. This is easily demonstrated by the same logic that demonstrates the failure of socialism. We all agree that socialism fails because the hard-working people who produce are not fairly rewarded for their efforts. There's no mechanism for engaging their greed and selfishness towards public benefit. The invisible hand is tied behind the invisible back.

It is true that the single proprietor enjoys a direct relationship between the effort they invest and the reward they enjoy. More effort always means more reward. But this does not apply in the corporate environment. If I am one employee among a thousand, then my efforts are averaged with the other employees. If I work twice as hard and am twice as productive, the company as a whole only enjoys a net gain of 0.2% in overall productivity. It's still socialism -- only now I labor for the benefit of the corporation instead of society as a whole.

Ah, counters the capitalist, that's not quite right: the corporation will recognize my contribution and promote me or give me bonuses. I will be fairly rewarded for my contribution.

Yeah, sure. The advocate of capitalism knows little of the real corporate world. Advancement and reward in the corporate world are poorly correlated with productivity. Political acumen is always more important than productivity. Kissing up to the boss still works better than just doing your job well. And aggressive greediness is rewarded more than patience.

Socialism doesn't work because humans are selfish and greedy. And big-organization capitalism doesn't work because humans are scheming social manipulators.

The current brouhaha with AIG illustrates this problem with textbook clarity. The managers at AIG intend to take $450 million dollars of the taxpayers' money and hand it out as bonuses to the same people who bankrupted AIG. They intend to reward AIG managers for their spectacular failure. This is not capitalism -- this is corporate-level socialism. It violates the fundamental principles of capitalism. The irony is that conservatives who scream "socialism" about the policies of the Obama Administration are pointing their fingers at the wrong targets. The real socialists are the people at AIG.

I have profound respect for Christianity as a philosophy; it's Christians that I can't stand. In the same way, I agree that capitalism is the best overall economic system -- it's capitalists that I can't stand. If we can just get rid of all the damn capitalists, maybe we can restore capitalism.

Conservatives and the Truth

2009-03-14T07:49:00.000-07:00

American conservatives have been having some major problems with the truth. Let's review just a few illustrative cases:

1. The WMD falsehoods in the run up to the attack on Iraq.

2. The continuing belief among some conservatives (including Ari Fleischer) that Saddam Hussein was involved in the 9/11 attacks.

3. Global warming denialism. It's ALL based on lies.

4. Creationism. Same story.

5. Fox News on earmarks. They had a big story a few days ago that Mr. Obama had violated his campaign pledge to slash earmarks. Mr. Obama made no such pledge. He pledged to look at them closely and cut any that made no economic sense. Daily Kos TV had a wonderful compilation of video clips from the debates showing Mr. Obama repeating that promise, in the same words, over and over.

6. Bobby Jindahl on "the $8 billion train from Disneyland to Las Vegas". He claimed that the Democrats had inserted this boondoggle into the budget. Later on, reporters at Fox News extended the train line from Las Vegas to a Nevada brothel 400 miles north of Las Vegas. No such train line appears or has ever appeared in the budget.

7. Socialism. It is now a commonplace among conservatives that Mr. Obama is dragging this great country into socialism. Why? Because he's raising the top income tax rate for wealthy people to 39%. Under that staunch believer in capitalism, Mr. Reagan, the top income tax rate was 50%. Under Mr. Eisenhower, another presumably anti-socialist Republican, it was 90%.

I could go on and on -- the list of untruths embraced by modern conservatives seems endless. And this, I think, deserves serious consideration. Why have conservatives treated the truth with such disdain? There's nothing intrinsic to conservatism that demands abuse of the truth. Indeed, the intellectual integrity of conservatism right up until 1992 was no less than that of liberalism. I disagreed heartily with Mr. Reagan, but I did not consider him a liar. Conservative loyalty to the truth seems to have begun its erosion in the late 1990s and is now nonexistent. Conservatives don't even blink when their lies are disproven -- they simply re-assert them more loudly.

I am sensitive to the criticism that I might be extrapolating the claims of a few extremists to the entire conservative camp. It's a common ploy used to discredit one's political opponents. But look again at the list of falsehoods I offered above. The sources of these falsehoods -- Bobby Jindahl, Ari Fleischer, FOX News -- are not the raving fringe of conservatism; they're dead center in the conservative movement.

I have a possible explanation for this phenomenon, and I hope that this hypothesis will stand up to criticism more successfully than my previous one about population densities. I believe that the conservative loss of contact with the truth arises from the unfortunate combination of two phenomena.

The first of these phenomena is the proliferation of special interest media. It's most obvious with television. Back in the 60s, 70s, and well into the 80s, there were just four television networks: ABC, NBC, CBS, and PBS. Each had to reach the American audience as a single bloc, and so each presented the news in what it felt was the closest approximation to the middle of the road. The network's news programs were editorially indistinguishable; nobody could claim back then that any network was further to the right or to the left than any other. But with the proliferation of cable channels, the audiences could fragment and comparative advantage could be gained by zeroing in on a specific audience. Such was certainly the case with Fox News, which is undoubtedly the most politically biased news channel.

But it wasn't just television that developed special-interest channels. Radio also developed plenty of sources of special-interest news, most notably Rush Limbaugh. The demographics of radio made this medium strongly conservative in its biases. And then there is the Web. We have seen a huge explosion of political material on the Web. This medium favors the liberals, and so we see a greater leftward bias on the Web. (Oh, and if you're wondering about "the eastern liberal media", such as the New York Times -- you've been watching too much Fox News).

The end result of all this is that the modern consumer of news has a gigantic array of sources of information from which to choose -- far more than could possibly be digested. Hence, that consumer must carefully pick and choose their sources of information.

Here's where the second phenomenon comes into play. Conservatives value loyalty. (See my earlier comment on this phenomenon: http://civildiscussonbetween.blogspot.com/2008/10/conservatives-and-loyalty.html)

Indeed, they value loyalty more than integrity. And when you combine loyalty with the ability to choose whatever source of information you desire, the result is predictable: everybody getting the same narrow supply of information. If that information contains falsehoods, there's nobody to correct them. The falsehoods are blindly accepted as truth.

The Founding Fathers valued freedom of speech and of the press not because they saw some sort of inherent, God-given right to speak one's mind, but because they knew that the only way to keep the Republic honest was to insure a broad supply of ideas and opinions. We have no sure way of ascertaining the truth; therefore, rather than attempt to censor falsehood, we must rely on a flood of opinion, a competitive marketplace of ideas in which only the most truthful ideas prosper. But conservative loyalty drives conservatives out of the competitive marketplace of ideas and into a small, uncompetitive corner, where falsehoods can go unchallenged.

What can be done about this? I counsel sage patience: this problem is self-correcting. Conservatives are so completely out of touch with reality that they will continue to lose credibility and hence political power. Every day the evidence in favor of global warming rises, and their deceitful denial of AGW only exposes them as liars. Every day the mounting evidence of the financial crimes enabled by the unregulated capitalism of the Bush Administration makes the screams of "Socialism!" look ever more out of touch. Just about everything that the Bush Administration did was wrong, and the undying loyalty of 20% of Americans to those policies only serves to convince the other 80% that the Bush-lovers are insane.

Conservatism is in for a rough future. After the November election, I thought that there would be a battle royale within the Republican Party, with the moderates ultimately ejecting the crazy 20% and beginning the long road to recovery. However, I now believe that the lying conservatives have a death-grip on the Republican Party, and their loyalty to the cause will prevent them from seeing the truth. There is a very real possibility that the conservative cause has been dealt a death-blow from which it will take a generation to recover. If conservatives respond to electoral failure by circling the wagons and redoubling their tribal loyalty, then they will remain out of touch with reality indefinitely, and their political fortunes will continue to sink.

I would not be happy with such an outcome. I believe in the First Amendment because I know that truth is best achieved by vigorous debate; if the only serious debate is that which is done inside the Democratic Party, I don't think it will be robust enough to serve us well. We need a healthy, robust conservative element in American politics to keep the government honest. The sickly, rabid conservatism we now have is feckless; it serves no end other than to advance the vanity of people like Rush Limbaugh.

So we're probably looking at a generation of Democratic dominance in the government. It will probably take that long to fix the mess that Mr. Bush has gotten us into. But I fear that, along the way, we'll see increasing problems from some of the Democrats' bad habits: protectionism, expanding government spending, etc.

Population density and politics

2009-03-12T11:46:00.000-07:00

I wish to argue an odd hypothesis today: that higher population densities tend to push societies further to the left.

A simple statistical analysis of existing societies lends some support to the hypothesis. The urban societies of Western Europe are definitely more liberal than others, and the high-density societies of India, China, and Southeast Asia seem to lean more towards liberalism. But urbanization muddies the issue. The USA, Australia, and Canada all have areas with very low population densities as well as densely populated urban areas. Yet in all three of these countries, the urban regions are more liberal than the rural areas. So I think that there is some empirical support for the hypothesis.

But the stronger case, I think, is the analytical one. Let's compare two extremes: the farmer in Nebraska in 1880 and the apartment dweller in Manhattan today. The farmer is living very much in a YOYO situation. There is no police protection, so he must carry a gun. The apartment dweller, by contrast, has little need for a gun because the police force is pretty good at keeping criminals at bay (on a relative, not absolute scale). The farmer is almost entirely self-reliant for everything, excepting the metal tools he uses; to purchase those, he sells a portion of his produce, reserving the bulk for his own family's consumption. The apartment dweller, by contrast, is entirely dependent upon millions of other people for his needs: food, water, police and fire protection, health care, sewage, clothing -- everything.

If we think about these two extremes in terms of their connectedness with other people, we see that the Nebraska farmer has just a few links to the rest of humanity, while the Manhattan apartment dweller is connected to millions of people all over the world. His food supply includes components from every continent except Antarctica; the petroleum products he uses could have come from any continent save Australia and Antarctica. He uses products whose parts were manufactured in China, Japan, Malaysia, Taiwan, Mexico, Europe, South America, and the USA. The raw materials for the things he consumes come from just about everywhere. The Nebraska farmer, by contrast, has most of his links to the closest town, and maybe a few links to Chicago -- that's it.

The Nebraska farmer can pee anywhere he wants; not so the Manhattanite. The Nebraskan can shoot his gun at anything and at anytime; such behavior would rightly land the Manhattanite in jail. The farmer can make as much noise or sewage stink as he wants; the city dweller has no such freedom. The farmer can get on his horse and ride anywhere he pleases, at any time he pleases, by any route he pleases. The Manhattanite must follow an intricate set of rules when he drives his car: stopping when required, going when required, driving at the required speed, not blocking traffic -- he has very little freedom.

The basic principle here is simple: your freedom ends where my nose begins. If the nearest nose is 20 miles away, you have a lot of freedom. If the nearest nose is 20 feet away, you freedom is necessarily more constrained.

Populations are increasing and noses are getting crowded more tightly together; that necessarily means that individual freedoms must be eroded. Americans tried to evade this squeeze by creating expansive suburbs that gave each person his own plot of land and private home. But the rising price of oil is pricing this strategy out of reach of the middle class, forcing people to accept higher density living -- and with it, the conservative fantasy of the rugged individualist taking care of himself.

The American frontier closed in 1890, over a hundred years ago, yet conservatives today still dream of the good old days when men were men and freedom was preserved with firepower. The problems of the 21st century are all problems arising from more and more people crowding together. This will necessarily drive our society further and further to the left. In this narrow sense, liberalism is the wave of the future and conservatism is the flicker of the past.

I hope our conservative readers will step forward with a robust attack on my thesis.

YOYO vs WITT

2009-02-28T18:27:00.000-08:00

A new meme bouncing around the blogosphere is "YOYO vs WITT". It's meant to be a summary (from the liberal's point of view) of the difference between conservatives & liberals. The first acronym stands for "You're On Your Own", and reflects the conservative notion that the state should not redistribute wealth to support the unfortunate. The second acronym stands for "We're In This Together" and reflects the liberal notion that all of us, rich and poor, have a responsibility to each other.

I won't argue from any fundamental grounds that WITT is intrinsically superior to YOYO. But I would like to nibble around the edges of this distinction with a few thoughts.

My first thought really doesn't take us very far: why are conservatives so selfish? Their biggest, most important gripe is that the government is taking away too much of their hard-earned money. Well, OK, I can understand the basic desire to keep the fruits of one's labor. Yet at the same time, I can't help but wonder how people can be so selfish as to deny basic care to another human being in need.

Let's move on with an observation that, in effect, shatters the underlying principle on which conservatives base their position. Let's ask the conservative, would you refuse to share some of your wealth to feed a starving child? Of course, nobody is monster enough to insist that property rights are more important than the life of an innocent child. And that admission pulls the rug out from underneath the conservative's claim that property rights are sacred. This example establishes that property rights must be subordinated to some sense of basic human decency.

So the issue here is not any sacred principle, but drawing a line between two principles. Where should we draw that line? How much money should a wealthy person surrender to provide food, clothing, shelter, and education to a poor person? We have already established that the answer is not "zero". And since the idea of taking money from the rich and giving it to the poor constitutes socialism, we come to the conclusion that all non-monstrous conservatives have already accepted the principle of socialism. "Garsh, I thought I was just writin' stuff, but now it turns out that I've been writing prose all my life!" Yes, even Rush Limbaugh, I would guess, is a socialist.

So having dispensed with the black and white nonsense, let's zero in on the numeric decision: how much wealth should be transferred from the rich to the poor? I don't think that any of us can provide a clear answer to that question. We end up duking it out in the political arena, and if a conservative wants to argue for less, and a liberal for more, I don't think any of us can find a fundamental principle to gainsay either. Ultimately, it boils down to a simple question:

How selfish are you?

On Growth and Change in Government

2009-02-25T08:31:00.000-08:00

Let us begin by thinking of government as a regulatory system for society. At one extreme, where a society consists only of one person, there is no need for any government. However, as soon as you add a second person to that society, you have need for some system to regulate the interaction between the two people, lest they destroy each other in conflict. The complexity of that regulatory system must be proportionate to the complexity of the interactions between the members of society. Those interactions grow more complex in two ways: with size and with the intrinsic complexity of the interactions.

The size effect is well-known and often referred to as "the network effect". There is only one possible pairing between two people; three pairings between three people; six between four people; ten between five; and so on in a steep growth curve. In a society with a million people, adding one more person adds a million new pairings. The complexity really takes off when you get big.

But the complexity can also grow intrinsically. In an economy with just a handful of people, barter is the easiest form of economic transaction. A larger economy creates a demand for a standardized unit of exchange -- money -- to facilitate transactions. An even larger economy requires indirect forms of money -- bills of exchange, or checks -- to handle more complicated transactions. From there, as the economy grows more complex, we add all sorts of financial instruments: credit cards, stocks, bonds, T-bills, CDs, and so on. Size demands complexity.

Thus, as a society grows, so too must its government. The government must grow not only in absolute terms, but in relative terms. In other words, the government must, by necessity, consume an ever-greater share of the GDP in order to fulfill its function of regulating an ever more complex society.

This does not mean that a government must eventually reach the size where it crushes the economy under its weight. If government increases the productivity of the citizens, then some portion of that excess productivity can be diverted to the government, and the citizens will still grow wealthier.

At this point, I must refute a common misunderstanding about government: that it produces nothing, and only consumes wealth. This is not correct; government increases the productivity of the citizens. It does so by increasing social capital, the lubricant that enables the engine of the economy to run smoothly.

A simple example of government's role in increasing productivity is the security it provides its citizens. If there were no criminal law and no police forces, each citizen would be responsible for their own safety. We'd have to carry guns, double-padlock our doors, armor our cars, and put bars on our windows. The costs of all this personal security would surely be greater than the costs of the criminal justice system; government saves money for more productive uses.

At the other extreme, I am able to invest in stocks because I am confident that I will not be swindled. Without the SEC, no sane person would invest in stock, and our whole system of capital formation would not exist, and new companies would not be created. Our economy would be much smaller than it is. Again, the miniscule cost of the government regulation provides us with gigantic increases in economic productivity.

So we conclude that government must grow as society grows. But how is that growth to be managed? I shall have to defer that discussion to another topic.

Morality is an intellectual middleman

2009-02-20T21:04:00.000-08:00

I find myself increasingly impatient with arguments that are founded upon morals. Not because I am amoral, but because I find such arguments intellectually vapid. We have too many moral principles, and this inevitably leads to conflicting moral standards. For example, let's take one of the most obvious moral precepts: thou shalt not kill. That's something we can all agree upon, right? But wait a minute -- there are exceptions. It's OK to kill the enemy if you're a soldier. It's OK for a police officer to kill somebody according to some standard rules. It's OK for me to kill in self-defense.

The same thing goes for every other moral precept. Don't rob or steal? Well, yes, that's a good one -- except that we've riddled the definitions of robbery and theft with so many exceptions that the concept loses its universality. It's OK to steal (we admit) to feed your baby. And what about all those horrible gray areas where somebody uses the law to acquire property that might or might not truly belong to them? How do we even know who's right in such disputes? And if we can't say for sure who's right, how can we say that somebody's stealing?

How about lying? It's always wrong to lie, isn't it? Well, we all agree that there are white lies. And sometimes a doctor will lie to a patient for his own good. It's even possible to tell a noble lie that causes harm to yourself but spares another person pain. Is that wrong?

If something has exceptions, it's not a principle: it's a guideline. So how can we argue from moral principles if we don't have any?

Actually, I think that there is a fundamental moral principle that has no exceptions: the Golden Rule. I can't think of a single act that I would call moral that violates the Golden Rule. However, we need a slightly extended version of the Golden Rule: do unto others as you would have them do IF YOU WERE IN THE SAME CIRCUMSTANCES. If I see an injured person by the roadside, I could argue that I myself have no reason to go to the hospital, so why should I take him to the hospital?

I confess that there remain lots of deep philosophical arguments that can be used to muddy the waters here. I won't really claim that the Golden Rule is in fact the one absolute principle of morality. My point is that all the normal moral precepts such as those against killing and stealing are derived from deeper moral principles. These explicit moral concepts are middlemen in the flow of reasoning from morality to policy. The fact that we admit to exceptions clearly shows that they are not, in fact, moral principles. So it's rather pointless to use them in political discussions. If you want to bring morality into it, keep to the basics where you're on solid ground. Cut out the middlemen.

Let's take the case of Hiroshima as a particularly extreme example. The USA killed something like 100,000+ people in order to win the war. There were very few military personnel in that city: most of the victims were old men, women, and children. Clearly this has to be chalked up as a hugely evil act. But war kills people; the goal in war is not to avoid killing people, but to minimize the amount of killing necessary to get the job done. The worst possible kind of war is a war of attrition, where people die in a diffuse and regular manner, day in and day out, until it becomes so routine as to escape the notice of the opposing government. If you want to use violence to win your war, then you want big, showy, dramatic violence, violence that grabs people's attention, violence that terrifies and disgusts and demoralizes. It's better to broil 100,000 people than to starve a million people to death, because the horror of the 100,000 deaths is so much greater than the horror of the million deaths. And in fact, the attacks on Hiroshima and Nagasaki did exactly what they were intended to do: they so shocked the Japanese Emperor that he told his government to surrender. Ultimately, fewer people died because of the horror of Hiroshima and Nagasaki.

I was inspired to write this item by a comment in a previous discussion during which one of our correspondents wrote about the importance of morality in policymaking. My point here can be boiled down to asking "What morality?" There is no fundamental moral principle that one man's property is his to dispose as he pleases. There's a secondary moral precept to that effect, but we all know that there are exceptions to that precept -- so what's the point of citing it as a principle when it is in fact only a precept?

My claim here is that we cannot use moral precepts as fundamental principles that brook no contradiction. Pro-life people claim that the sanctity of life is absolute -- but most of them have no objection to violating the sanctity of Islamic lives. Advocates of small government try to apply grand principles to show that government should not tax the people. I'm reminded here of the classic tale of Winston Churchill offering an English aristocratic woman 5 millions pounds to sleep with him. When she expressed a willingness to contemplate the idea, he then asked if she would be willing to sleep with him for 5 pounds. She responded rather huffily "What kind of woman do you think I am?" To which Mr. Churchill answered "We've already established that, now we're merely determining the price." Advocates of small government have already conceded the principle that government is necessary and desirable; beyond that, it's only a matter of determining the price.

We cannot dodge the complexities of policymaking by taking refuge in absolute moral principles, because there aren't any absolute moral principles beyond the Golden Rule. Whenever we consider tax policy, legislation, public spending, or anything else that government does, we must rummage through all the implications and give each of them due consideration. There's no shortcut to these answers.

Is Economics Philosophy or Science?

2009-02-17T08:28:00.000-08:00

Yesterday I had a long exchange with one of our correspondents, of which I'm not particularly proud. We had more than the normal share of miscommunication, and instead of responding with elevated care, I was a little too cocksure. But the purpose of this post is not to belabor that sad scene; rather, while contemplating what happened, I had a realization that -- to some degree -- explains our orthogonality of viewpoints.

This is a simplification, of course, but I think that the underlying assumptions were (on his part) that economics is a form of political philosophy and (on my part) economics is a science that can be used to illuminate political decisions. How I came to this realization helps explain its significance.

My interlocutor had mentioned the Austrian school of economics and Ludwig von Mises. This recalled to my mind something that I had read about how von Mises had written an entire book purporting to show that redistribution of wealth is immoral. That struck me as grossly silly. Redistribution is a policy option, no different from any other. Is a gasoline tax immoral? Are national parks immoral? Is public education immoral? Is the existence of an army immoral? These questions all strike me as silly. Yes, the desirability of these policies is debatable -- but to reduce it all to black and white questions of morality strikes me as pure dogmatism.

However, history is on the other side. Adam Smith's first book (before his "On the Wealth of Nations") was entitled "Theory of Moral Sentiments" and indeed, much of the early work on economics was closely tied to philosophy.

However, I can counterargue that, in the 20th century economics moved away from philosophy and towards science. It embraced mathematics and developed a strong yen for empiricism.

Let's now apply this to a specific example. At one point, my interlocutor declared that free markets are the best way to organize economies. I agree with that statement; but I suspect that the two of us interpret that in completely different ways. I suspect (and I hope he'll correct me if I'm wrong), that my interlocutor means that in a moral or dogmatic sense: that the superiority of free markets is an axiom, a starting point, and that it might be necessary under some unfortunate circumstances to compromise on this basic principle, but we should nevertheless defer to this principle whenever possible.

My interpretation of the same statement is scientific: it represents a useful rule of thumb that has been shown to work well in many cases, but is always subject to modification based on immediate circumstances. For example, when we apply this concept to electrical power transmission lines, we both admit that it's best to have a single monopoly build and maintain those lines, and we both agree that this is an unfortunate necessity, but I shrug my shoulders and leave it at that, whereas I would expect my interlocutor to see this as a theoretical thorn in his side, desiring to figure out some way to make electrical transmission fit into his free market principle -- and failing.

The nub of the issue between us, I think, is the degree to which the free market principle must be compromised by real-world circumstances. I expect that my interlocutor would see such circumstances as rare, oddball situations that do not threaten the universality of the free market principle. I, however, see them as more frequent, so frequent, in fact, that we must downgrade the free market principle from Universal Principle to Rule of Thumb. My approach is more flexible; his is more principled. And this brings us to a question for which there is no real answer: should policy be made on pragmatic grounds or principled grounds?

I am very much the pragmatist, not because I am cynical, but for two reasons:

1. Principled approaches all too often lead to evil. There's no political principle that cannot, under the wrong circumstances, yield evil consequences. The noble desire to preserve life leads some people to bomb abortion clinics. The love of democracy contributes to America's decision to attack non-democratic nations. A respect for the value of labor leads to the starvation of those unfortunate enough to be unable to work. At every turn, the real world forces us to compromise one principle with another. When we have dozens of often-conflicting principles, how can they be of any value in guiding us?

2. Ultimately, principles are just shorthand for empiricism. Why is it wrong to lie? Because life experience shows that lies ultimately catch up with you and hurt you. So we boil the empirical results down to a principle. Killing is wrong because it only leads to more killing. Property crimes are wrong because they discourage people from creating wealth. In other words, principles are ultimately just shorthand for pragmatism. So why adulate the middleman? Why not put all our money on the true foundation on which the principles are based: empiricism?

This should get 'em going...

Lose the Partisanship!

2009-02-14T16:21:00.000-08:00

Congress passed the economic stimulus bill, despite the Republicans' many efforts to torpedo the bill. I am disgusted with the blatant partisanship demonstrated by the Republicans during this episode. There is absolutely no question that an economic stimulus is necessary, nor is there any question that the bulk of the stimulus must take the form of government spending. But the Republicans put all of their energies into cutting taxes. The Democratic majority, under pressure from the White House, compromised repeatedly; the final bill is 60% spending and 40% tax cuts, a pretty fair compromise considering the fact that the Republicans are in the minority. Moreover, I think that, in strictly economic terms, the bill has too much tax cut and not enough spending -- and this seems to be the thinking of many economists. Yet the Republicans were obsessed with tax cuts and demanded more and more tax cuts and less and less spending. In the process, billions of dollars for education and infrastructure were cut out of the bill to satisfy the Republicans -- and STILL they fought!

The economy is in desperate straits and we needed to get a stimulus bill through. It deserved harsh scrutiny, and I expect everybody, Republicans and Democrats alike, to poke at and question every line item in that bill. But that's not what we saw these last few weeks; what we saw was simple partisan obstructionism. I consider it a shameful case of putting party above country.

Remember, these were the same Republicans who spent wildly during the Bush years. They spent $500 billion on prescription subsidies because that was a Republican bill. They spent a trillion dollars on the wars in the Middle East. They pushed through, with very little scrutiny, a bill to throw $700 billion at financial institutions to prop them up.

I'm not claiming that these were all bad expenses. I grudgingly admit the necessity of the bank bailout. But the Republicans are hypocrites to wrap themselves in the mantle of fiscal conservatism when they were spending like drunken sailors on their own pet projects. Do not forget that a huge budget surplus under Clinton became a gigantic budget deficit under the Republicans.

All in all, these last few weeks have demonstrated the perfidy and bad faith of Congressional Republicans. I'm glad we clobbered them last November and I hope we clobber them even worse in 2010.

Change we can certainly admire

2009-02-06T09:19:00.000-08:00

The Obama campaign promised change, and it has already delivered a number of significant changes. But I would like to consider some of the symbolic changes. I was inspired to do this by a photograph that appeared this morning. Mr. Obama was striding out to Marine One, the Presidential helicopter. At the foot of the stairs stood a Marine in dress uniform, ramrod-straight, frozen in salute. When Mr. Obama reached the stairs, he turned and greeted the Marine, offering his hand. At that instant a photographer took one of those timeless shots that shows the human condition. The young Marine is just lowering his salute and turned his face towards Mr. Obama. His face shows a mixture of amazement and terror, as if he were thinking "The President is talking to ME?!?!?! What do I do now?" What a moment.

Later that day, on Air Force One, Mr. Obama went back to the press corps section to chat with reporters. In eight years, Mr. Bush did this only once. What a change.

But the most striking change came when Mr. Obama, a few days ago, responded to the stories about his two candidates for office who removed themselves from consideration after tax problems surfaced. He simply declared, "I screwed up." In eight years of the most disastrous Presidency in American history, Mr. Bush never once admitted making a mistake. Billions of dollars disappeared, crimes were committed, thousands of Americans died on his orders, yet he never once admitted a single mistake.

What's especially interesting here is that Mr. Obama did NOT himself screw up. Both problems arose because the candidates in question had been insufficiently candid with Mr. Obama's staff. Mr. Obama made no mistake, and his staff made no mistake. But that didn't stop Mr. Obama from accepting full responsibility for the errors.

The contrast with the Bush Administration is stark. Where Mr. Obama would have flatly declared, "The buck stops here", the Bush Administration would have released the following statement: "The so-called 'buck' is a fantasy created by left-wing extremists and taken up by the left-wing media as just another effort to divert the nation's attention from the many successes of this Administration."

I like the difference between the old and the new. This is change we can admire.

Is American justice blind?

2009-01-23T09:50:00.000-08:00

One of the concepts we pay a lot of lip service to is the notion of blind justice. Justice applies the law equally to all persons regardless of their identities. Rich man, poor man, powerful man, powerless man—in our ideals, all are treated equally by the law. But our adherence to our ideals is seldom strong; we are all too quick to set our ideals aside.

The case in point is the current discussion over the news report that one of the released Guantanamo detainees has now appeared in a leadership position at al Qaeda. We didn’t have enough evidence against him, we released him, and now he’s actively working against us. Oops. This is not good. Should not we have detained him indefinitely?

Ah, but isn’t justice blind? If we truly believe that justice is blind, then we should argue the law and the evidence, not the individual. The law and the evidence are clear: there was no basis for holding him. Releasing him was the right thing to do, even though there was a risk of him returning to undesirable behavior.

We all recognize that justice is imperfect, that mistakes will be made. So we attempt to specify the amount of risk we are willing to take with the old saw that we would rather let a hundred guilty men go free than convict one innocent man. OK, we can argue about the exact value—should it be 50, or 20, or 10? But we all agree that, whatever number we choose, it must be a lot bigger than one.

But not in the case of foreigners. When it comes to foreigners, American justice is not blind; it actively discriminates against foreigners. If you’re an American citizen, then we apply the 100 to 1 rule to you. But if you’re a foreign Muslim, then that figure is more like 1 to 100. We’d rather incarcerate 100 innocent foreign Muslims than release 1 guilty foreign Muslim. You think I exaggerate? Look at the numbers. We’ve released about 500 prisoners from Guantanamo. Of those, the Department of Defense claims that some 60 have “returned to terrorist activities”. Their definition of “returning to terrorist activity” includes “having your lawyer write a letter of protest”, because that’s the basis on which one person has been so categorized. In terms of actually participating in violent activity, there are only two cases that have been publicly announced, and perhaps five cases that have been mentioned. These numbers are squirrelly; they seem to change every month, so I won’t attempt to document them. Whatever the real numbers are, they’re obviously tiny. So I think it fair to say that, in actual practice, our “guilty to innocent” ratio for detaining foreign Muslims is about 1 to 100, the exact reverse of our ratio for American citizens.

The best way to expose the ugliness of hypocrisy is to demand that it be made explicit. OK, if we’re going to use 100:1 for Americans and 1:100 for foreign Muslims, what ratio should we use for American Muslims? Do they still get the 100:1 ratio? What if they’re not American citizens but they are legal immigrants? Does that confer better odds on them? What about Africans? Do we make a distinction between Nigerian Muslims and Nigerian Christians? Does the fact that they’re Christian mean they should get, say, 1:1 odds? And what about Germans? Surely they deserve something better than foreign Muslims—but maybe not the full 100:1 that we grant American citizens. Perhaps we should use 80:1 when we’re dealing with Germans. And Russians? Well, they’re not as good as Germans—let’s give them only 50:1.

So let’s at least be honest about this. If we don’t want to apply the same standards to foreigners as we apply to American citizens, we should at least figure out a table of standards for different nationalities. We should also include adjustments for religion, language, and gender (men are more dangerous than women). While we’re at it, we should probably add an adjustment for race, too.

If you find this all rather tedious, I can suggest a much simpler solution: “All men are created equal…“ What a concept!

The high road

2009-01-17T21:37:00.001-08:00

It is becoming clear now that Mr. Obama has no intention of prosecuting the crimes of the Bush Administration. He is charitable to Mr. Bush and, in reference to suggestions that his Administration investigate those crimes, he has repeatedly spoken of the importance of moving forward rather than stewing over the past.

As much as it rankles me to admit this, he is right. I say this knowing full well that the Bush Administration committed many crimes. The list of criminal activities is long: the violations of the Geneva Conventions, FISA, the abuse of supposedly nonpartisan offices for political purposes, the outright lies to Congress, denial of habeus corpus rights, tampering with elections -- it truly is the most breathtakingly lawless administration in American history. I make no excuses for this criminal administration. If we truly were a strictly law-abiding country, the majority of the members of the Bush Administration would probably end up in jail -- including Mr. Bush himself.

However, the political health of this country is more important than even the rule of law. If we were to enforce the law rigidly, we would tear this country apart. It is grossly unfair that so many Americans put politics ahead of the rule of law, and object even to the notion of an investigation of criminal activities. Politics should not excuse lawbreaking. But the ugly truth is that Americans are not fair-minded enough, and they are not dedicated enough to the rule of law to accept such investigations. Like it or not, we have to live with these people, and shoving things down people's throats may be fine for the Bush Administration, but it's not acceptable to me.

The Bushies were amoral, vicious, tribal in outlook, and utterly without any true patriotism. Their loyalty was solely to their party, not their country. And much as it rankles, we should rise above that sordid thinking and refuse to respond in kind now that Democrats are in control. Mr. Bush dishonored the Presidency and the country; he brought American politics to new lows of partisan ugliness. We must now show true dignity and nobility by refusing to play the game the way they play the game. We're better than that.

The Republicans will likely continue their destructive behavior, spewing their bile and slandering everybody who's not part of their tribe. That Rovian crap worked for ten years, but it has burnt out the American public. There are still millions of hateful and hate-filled Americans who will continue their negative, cynical antics. They will cheer on Ms. Palin and who knows -- she might even win their nomination in 2012. If that happens, the Republicans will suffer the most ignominious defeat since McGovern's disaster in 1972. Let them revel in their sewage. The jig is up, the American people finally recognize how bankrupt that whole style of politics is, and the Republicans have no hope until they learn to purge those partisans from their ranks. I for one will be glad to see the Limbaughs, Kristols, Roves, Palins, and Cheneys sent back to their caves where they can gnaw on bones and growl at the world.

Moralism Kills

2009-01-09T16:17:00.000-08:00

I noticed something the other day about the debate that is now raging over the Israeli/Palestinian conflict: for the most part, it's an argument over who is The Good Guy and who is The Bad Guy. We see dueling photosets: an Israeli partisan offers a pile of gory photos of Israeli victims of Palestinian violence. Meanwhile a Palestinian partisan offers an equally gory set of photos of the Palestinian victims of Israeli violence. I shake my head in disbelief: OF COURSE this conflict is violent and gory -- what do you think happens when conflicts turn violent? I should think that the goal of both sides would be to end the violence. But no: the goal is only to prove that the other side is The Bad Guy.

This moralistic approach to foreign policy is a favorite with conservatives: they love to talk about how the USA is The Good Guy and its enemies are Bad Guys. I've always wondered what they think is going on inside the heads of their enemies. Do conservatives really believe that the enemies of the USA agree that they're the Bad Guys? Do conservatives fail to realize that, in the eyes of these enemies, it is America that is the Bad Guy? It seems odd that conservatives could fail to appreciate such a simple point.

But the problem is not limited to conservatives. The recent attack by Israel upon Gaza has produced an outpouring of anger from the left, condemning Israel as the Bad Guy. I have been surprised that some of these people rely solely on the moralistic argument.

These moralistic arguments don't solve anything; they just further the violence. After all, killing Bad Guys must be a good thing, so all we have to do is prove that the other side has some Bad Guys and voila! -- we have a simple solution to the problem.

This is precisely the thinking that is going on among many Israelis and Palestinians. They have seen the suffering and they see the other side as the Bad Guy, and they just want to bash the Bad Guy. So Israelis kill Palestinians, Palestinians kill Israelis, and the cycle of violence goes on forever.

If we're ever going to stop the killing, the first step must be to dispense with these pointless arguments over who is the Good Guy and who is the Bad Guy. Those are zero-sum arguments; they can only lead to the conclusion that one side must win and the other side must lose. And neither side will sign up for a deal that they think they are losing.

The only deal that will work is one that is win-win: something that each side sees as a victory. The two sides do not have mutually exclusive objectives. Israelis want security; Palestinians want their own country. These are not incompatible goals; a win-win solution should be easy to design. But the moralists on both sides of the conflict refuse to accept a win-win solution: they insist that the other side must lose. And that attitude will forever doom any chances of ending this conflict.

I therefore suggest that Americans put an end to these stupid arguments over who's right and who's wrong and just focus on how we can stop the killing. And when I say "we", I don't mean Israel nor do I mean Palestine. It's a waste of time to engage in wishful thinking along the lines of "If only the Palestinians would do X, then peace would be easy." Like it or not, neither the Palestinians nor the Israelis are capable of doing the magic "X" that will bring peace. They've been at it for 60 years now and they have failed. They can't make peace happen. The USA is the only country that can bring peace to these two countries. And so it is "we" -- Americans -- who must take the initiative and impose a solution to end the killing.

National Health Care Part V

2008-12-13T08:55:00.000-08:00

Deriving value from the database

At last I come to the point where I can explain how the data will be used. The first step in the process will be to wait. It will take some time to build up a database large enough to provide us with useful results. Common problems will build up a strong dataset sooner than rare problems.

Of course, there won't be a simple collection of ailments linked to treatments. For any given ailment, a variety of treatments will be used depending upon the specifics of the case. Nevertheless, we will be able to start off drawing some useful conclusions. Let's start off with a simple example: a broken leg. We get lots of broken legs showing up in emergency rooms. They range in complexity from simple clean breaks to compound fractures to smashed legs. For starters, though, when we have little data, we'll begin by lumping all broken legs together. For each case of a broken leg, we have two critical pieces of information for our first estimate: the total cost of the therapy, the degree of success of the therapy (how much QALY the patient subsequently enjoys). By the way, this second value -- the success of the therapy -- cannot be determined anytime soon after treatment. We will need to wait some time in most cases. Cancer cases may well take years before we can assign QALY values to them. The database will not be of any use for the first two years; after that, we should be able to start getting SOME useful information out of it. After ten years, we should be able to get a lot of useful information, but some issues will take 20 years to satisfactorily resolve.

So for every combination of ailment and treatment, we use these two values (total cost of treatment and QALY result, to calculate a net cost-benefit number in terms of how many dollars we paid, on average, per QALY.

This number, the number of dollars paid per resulting QALY, is our fundamental metric for the value of any therapy. Our goal is to maximize the benefits obtained by a limited number of dollars, so we will make all of our determinations based on the value of that number as established in the database.

No two cases are alike; every broken leg differs from every other in many different dimensions. This problem does not prevent us from drawing useful conclusions; it only makes those conclusions less applicable to any given case. Initially, we'll have to lump all the data on all the broken legs into one big group, yielding a single cost-benefit value for all broken leg treatments. The trick is that whatever final number we get for the average will have a broad range of uncertainty. Thus, the final criterion will not be "$X per QALY for treating broken legs" -- it will be "$X plus or minus $Y per QALY". This number will be what comes out of the computer.

But we're not going to simply accept numbers coming out of the computer unquestioningly. When a result comes out of the computer, it must still pass one more hurdle: expert approval. We'll need to set up a deliberative body that vets the numbers coming out of the computer. This group must include a broad array of experts in its makeup: doctors with direct clinical experience; medical academics and researchers; statisticians; representatives of health insurance companies; and a few token Scrooges who are charged with protecting the taxpayers' money.

I expect this group to be more than a committee; it will likely need its own staff to examine the particulars of each issue. For something of this much importance, we can afford to set up a department within the NIH devoted exclusively to this vetting process.

Each number that comes out of the computer is presented to the vetting department, along with all the supporting data on the number of cases, variability in the ailment in question, differing kinds of treatment, and cost considerations. The committee has just two options: it can accept the number as a sound basis for policy, or it can send it back to wait for more data. A common reason for sending back a number would be excessive variability in treatments. In the example of broken legs, the committee might well defer accepting a number until it could be broken down into subclasses based on the severity of the injury. This would decrease the uncertainty value of the final results.

None of this will have any application in the early years. The scheme will build up a set of results for many different conditions and treatments, and this process will take several years before we have built a set that's large enough to be useful. But eventually we will have enough data to start using it effectively. Here's how we'll use it:

Remember, our final results will be a table of conditions and treatments and the cost per QALY arising from that treatment of that condition. The next step will be to sort that table by the cost-benefit ratio of the treatment. This yields a sorted list of conditions + treatments and cost-benefit values.

The next step is to estimate the net cost of treating each such condition, weighted by frequency of occurrence. In other words, we use existing data to estimate how many such cases arise per year, and multiply that by the average cost per case. If we know that on the average year we'll see 11,000 compound fracture injuries to the leg, and that the average cost of treating each case is $20,000, then we'll calculate that the total cost of treating all those cases will be $220 million. We carry out this calculation for every entry in our table.

Every year we go to Congress and present them with this table and ask them to draw a line anywhere they want. Anything above that line (less cost-effective) will not be paid for by the government. Everything below that line (more cost-effective) will be treated at government cost. We use the cumulative cost data in the table to tell Congress how much this should cost. Congress debates just how generous it wishes to be, and then writes the final value into the budget.

Now we have a rational basis for providing health care. All the condition-treatment pairs that are below Congress' line are automatically approved for treatment. If you show up at the hospital with that condition, you will be treated and the Feds will pick up the bill.

By the way, this process could also be used for preventative health care such as annual health exams. While we would not be able to rigorously measure the actual value of such preventative measures, we could indirectly measure that value by measuring costs arising from diseases that would be likely to be detected more quickly in health exams. A similar process could be used for preventative medications such as aspirin as a preventative for heart attacks.

But what happens if you have a condition that does not fall below the magic line? If you have no health insurance, you die. Presumably the American people will be willing to fund generously enough to keep the mortality rate of the indigent to some reasonable level. However, you can also purchase health insurance that, in effect, raises your limit. The benefits of health insurance are defined in terms of the same cost-benefit numbers that come out of the national database.

For example, suppose that the Feds cover all conditions costing less than $3,000 per QALY. You could then purchase insurance covering you for conditions up to $5,000 per QALY; if you're willing to spend more money on your insurance payments, you could get coverage for conditions up to $10,000 per QALY. (Of course, deductibles could still be written into the insurance contract.)

With the passage of time, the national database grows and the precision of our estimates grows. We will be able to estimate costs for treating specific medical conditions with ever greater fineness. That will take time, of course.

Believe it or not, this (I think) concludes this series. I'm sure that many objections will arise; if significant holes are pointed out, I may write up a sixth essays to patch up the mistakes.

National Health Care Part IV

2008-12-07T18:37:00.000-08:00

It is now incumbent upon me to address a frequently-raised objection: the data can't be perfect. Every case is different. Applying a one-size-fits-all approach to medical care is bureaucratic nonsense; it won't work.

This objection arises from people who don't understand the use of statistics in multivariate situations. Yes, there are many variables to consider in each case, but all variables are not equal. For example, in breast cancer cases, the height of the patient is a less important consideration than the age of the patient. There are priorities, with some factors playing a large role and other factors playing a lesser role. That means that you start off with the most important factors and make an estimate based on those factors. If you consider additional factors, then the reliability of your estimate improves. Even with all the factors in the world, there are STILL uncertainties. Treating a patient is not a simple black-and-white process in which the doctor either knows the answer and the treatment or doesn't know. It's all based on informed estimates that are more or less reliable.

Indeed, we can measure the degree of reliability of any estimate in a statistical calculation, and we take that reliability into consideration in our judgements.

Now let me present a simplified explanation of how you handle multi-variate analysis (Warning: statisticians, please do not read further if you have any undigested food in your stomach). Let's start with an absurdly simple situation in which there are only two patient variables affecting a particular ailment. We'll call them X and Y. Let's imagine drawing a simple graph showing X against Y. Now, suppose that there is only one approved treatment for this ailment.

So now let's start populating our graph. We have Case #1, a patient with X=24%, Y=87%, and the patient was cured after a total expenditure of $8,473. We make a dot at the X and Y coordinates and give it a vertical bar whose height is proportional to the cost. Now we plunk down another patient, then another, and another, and another, until we've gotten a big graph with thousands of tiny bars at different points. Now, all these bars together create an upper surface. This surface will have some unevenness, but there will probably be a general shape to the upper surface of those bars. Let's just say that it has a peak near X=81% and Y=42%, and a valley at X=17%, Y=90%. We now have a rational basis for determining the cost-effectiveness of the treatment based on the patient's values of X and Y. We know that patients with values of X near 81% and values of Y near 42% are going to cost us more to treat -- perhaps more than we think is worthwhile.

But wait! What about individual variation? What about the fact that patients have their own idiosyncracies? That fact shows up in our graph as the unevenness of the upper surface. If idiosyncratic differences have little effect, then the surface will be smooth. If idiosyncratic difference DO have a big effect, then the surface will be uneven. We can measure the unevenness of that surface and express it as a plus-or-minus value (that's "local sample deviation" for the purists). We can then use that plus-or-minus value to temper our judgement. We would say that, for a patient with an X of 74% and a Y of 44%, the likely cost of treatment will be $16,455 plus or minus $3,221. So when we actually make a decision to fund or not to fund, we err on the side of caution and use the value of $16,455 minus $3,221, or $13,234. If we want to be really careful, then we use an estimate of $16,455 minus twice $3,221, or $10,013 for our decision.

The beautiful thing about this system is that bad data makes us more generous to the patient. If we only have a little data, and it's all over the map, then we can get an answer of $16,455 plus or minus $23,334 -- in other words, it's conceivable that the treatment will cost us next to nothing. That's actually a statistical absurdity requiring a different kind of statistical analysis, but for our purposes it allows us to say that we simply don't know and we have no rational basis for denying payment. Someday, after we have millions of cases in our database, we might be able to predict the cost down to the last penny. We really don't need to be that precise. For our purposes, we'll be setting one basic number: the all-important Threshold of Cost-Benefit Acceptability. We use this number for deciding what to pay for and what not to pay for.

For example, suppose that we have set the value of Threshold of Cost-Benefit Acceptability (TCBA) to $50,000 per QALY. Patient Joe comes to us and wants a kidney transplant. We consult our database and find that, for people like Joe, kidney transplants yield a cost-effectiveness of $43,251 plus or minus $13,256. That's easy: Joe's transplant is a good expenditure, so we approve it. But now Mary comes to us. She's older than Joe and not in such good health. Our database shows that, for people like Mary, kidney transplants yield a cost-effectiveness of $63,876 plus or minus $9,483. She's within two sample deviations of the upper limit -- that's good enough. Mary gets her kidney. But now Greta comes to us wanting a kidney transplant. She's really old and is fighting a bad case of cancer. Her numbers come out at $115,287 plus or minus $13,979. Sorry, Greta, you're out of luck. You die.

Let me point out that right now decisions like this are being made all over the country all the time. They're made by a variety of groups, all of whom use their best judgement. And in most cases they probably make the best decisions. But they still exercise life-and-death power over people. I don't think it's fair to dump that kind of responsibility on individuals. If I'm going to condemn somebody to death, I want to know that I'm doing so by a completely fair and well-reasoned process. More important, the patient wants that, too. And so does everybody else. How do you like the thought that someday your life might lie in the hands of some unknown committee? Are you sure that none of them will be affected by their bad mood when they decide your fate? Not a warm and cuddly feeling, is it? Wouldn't you prefer a system in which they make the decision based upon principles agreed upon by an open political process?

That political process is the subject of my next essay.

National Health Care Part III

2008-12-05T16:14:00.000-08:00

Using the data to reduce costs and measure benefits

In our last exciting episode, I offered a scheme for gathering lots of data about patients, symptoms, treatments, and outcomes. That data will have enormous value to the nation; it will permit significant reductions in the costs of health care, and, more importantly, it will permit rational decisions about who lives and who dies.

Its first benefit will be providing us with clinical data on the efficacy of various treatments. Currently we base our evaluations of efficacy on carefully designed clinical trials. These are certainly desirable as a means of establishing a starting point, but the huge variability of patients means that data from clinical trials is of limited value. The best measure of the efficacy of any therapeutic regimen is a direct measure of the outcomes of that regimen on a wide variety of people.

For example, let us consider a hypothetical drug used for lowering blood pressure. In clinical trials, we can determine how well it works with a narrow range of otherwise healthy patients. But a national health database would give us data on how well it works with old people, young people, men, women, current smokers, past smokers, obese people, skinny people -- all possible variations. We could identify special conditions that would counterindicate the medication. Perhaps the drug has differing degrees of efficacy for people of different blood types. With the mountain of data available in a national health database, such fine points could be discovered. This would in turn permit us to refine our estimates of the best course of treatment for individual patients -- lowering costs and achieving higher health care productivity.

But that is not the primary purpose of all this data: the primary purpose is to establish cost-benefit ratios for various treatments. To explain this, I must first explain a standard term used in health care: the Quality-Adjusted Life Year, or QALY. This is a standard measure of how much "life" a person enjoys. A person in perfect health enjoys 1.0 QALYs per year. A person on kidney dialysis is posited to enjoy 0.5 QALYs per year. A dead person gets 0.0 QALYs per year. This allows us to take into consideration the fact that some medical treatments don't make a person perfectly healthy, but the person still gets some benefit.

I will not get into the question of how QALY values are determined. A person in a coma is obviously getting a tiny QALY rate: not zero, because there's a chance that the person will emerge from the coma, but still tiny. A person with cancer who is bedridden will get a small QALY rate, while a person with a slight limp will get have a large QALY rate. This is complicated by the fact that old people are not as physically strong as young people. But for now, we can skip over this problem, because the methodologies for establishing QALY rates are broadly agreed-upon.

If you combine the cost of a treatment with the outcome in terms of QALYs, you get a measure of the cost-effectiveness of that treatment. For example, suppose that we have a ten-year old child with a broken arm. It will cost $5,000 to properly treat that broken arm, and the treatment will restore the child to perfect health. Without the treatment, the child will suffer a loss of QALY rate to say, 0.95 QALYs per year. We expect the child to live to the standard life expectancy, let's say 80 years. So the treatment gains 0.057 QALYs per year for 70 years. That's a benefit of 4 QALYs for a cost of $5,000, so the cost effectiveness of the treatment is $1,250/QALY.

Now lets consider a 78 year old man on kidney dialysis. Let's say that the dialysis costs $100,000 per year and yields an improvement in his life of 0.25 QALYs per year. Since this is a continuous process, we can immediately calculate the cost-effectiveness of the treatment without guessing his life expectancy: $400,000 per QALY.

This two numbers tell us one thing for certain: treating the child's broken arm is much more cost-effective than the dialysis for the old man. Is the old man's dialysis worthwhile? That's a decision for society to make.

Currently, there's a standard value used in most developed countries: one QALY is worth $50,000. That's the number used by health services in a variety of countries to determine which medical treatments are worth paying for. It is used by some insurance companies in America for making the same determination.

Here's the important point: that number ($50K per QALY) is not applied consistently. In fact, the actual numbers used are all over the map. When a soldier is killed in combat, the US government provides a death benefit of $500K to his family -- equivalent to ten QALYs, but most soldiers can look forward to a lot more than 10 QALYs. In some wrongful death cases, juries award damages of far more than $50K per QALY, and in some they award far less than that figure. It just depends on the jury. For airplane safety and nuclear power plant accidents, we spend much, much more than $50K per QALY to prevent accidents, but for automobile safety, much less than $50K per QALY. And some medical care decisions expend far more than $50K per QALY, and some expend far less than $50K per QALY. We are in deep need of some rationality in this situation.

The particular part of the problem that I propose to address is to get a better assessment of cost per QALY for real-world situations. Now, there are lots of studies attempting to determine this number for many procedures, but they are always done on an ad hoc basis, and they sometimes use different methodologies for determining the cost per QALY. Some of the numbers that have been produced are impressively reliable, while others are little more than educated guesses. If we want a reliable system for deciding what gets paid for and what does not get paid for, we need a comprehensive standard system that is applied to all treatments. Carrying out the measurements on an ad hoc basis, piece by piece, is simply too expensive.

Once we have built up a big enough database, we can use it to obtain better estimates of the cost per QALY of various treatments in various situations. Those cost per QALY values can be used to determine what to pay for and what to reject.

In Part IV I will address the problem of individual variations among patients.

A National Health Care Plan: Part II

2008-12-04T08:30:00.000-08:00

Data Gathering

In order to make rational decisions about health care, we need to know exactly how much money any given therapy will cost, and how much benefit that therapy will gain for us. The cost is easy to define, but we need to gather complete data on the cost of various therapeutic regimens as carried out in the real world. Every drug approved by the FDA must undergo tests to ascertain its efficacy and safety, but these tests are seldom carried out on a representative sample of people, because a lot of people have multiple health issues. Every patient is different, and a therapeutic regimen that works for one patient may not be effective for another patient. We need to gather data on these differences so that we may more rationally assess the costs of any proposed therapy. Instead of organizing limited studies, we should learn from everything that's done.

Much of this data will concern the medical state of the patient. We'll need to know lots of information about patients to evaluate the cost as well as the benefit of any given therapeutic regimen. And we need lots of data, so this effort must be carried out on a national level.

I therefore propose that the starting point of any national health care system is the creation of a national system for gathering and analyzing all possible data on all treatments carried out in the country. This could be carried out by the National Institute of Health. They'd first convene a collection of experts to determine a structure for data collection. Exactly what information should be gathered? How should it be formatted? There already exists a standard system for medical record keeping, but I am proposing something much more ambitious: a complete record of every symptom, diagnosis, therapy, and outcome in the country. Fortunately, this is a standard technical problem in database management, so the implementation of such a system does not pose any serious technical obstacles. The development of the database software and the installation of the client support software at all medical facilities in the country will take a lot of money, but not a great deal of time; the whole task could be carried out in two years.

Whenever a patient is treated, everything about the patient and the therapy is recorded in the treatment log on the computer, and that information is transmitted to the national database.

Obviously, many people will be paranoid about the privacy issues, and we need to address those. The first step in privacy protection is the enactment of fierce laws for misuse of this medical data for ANY reason, including national security or the enforcement of other laws. In other words, medical data must be legally inviolate. Any person who violates the privacy of any individual's medical records, or orders a subordinate to do so, must go to jail. There must be no exceptions to this rule; even if done in an official capacity, it's still a crime that carries automatic jail time. That's our first level of privacy protection.

The second level of privacy protection is that the separation of medical information from identifying information. The database is primarily a record of treatments and outcomes. Those treatments and outcomes are linked to an actual person through only one identification number, the Medical Care Number. Every participant in the national health care system is assigned a Medical Care Number. That number will NEVER be revealed to any human; it is an internal computer record that exists only in the national database.

So how do people use their number? Through biometric information. I would recommend a number of biometric standards be used independently for patient identification: fingerprints, retinal scans, and even face recognition as a backup. I would expect that fingerprints would be the most common means of quick identification, with retinal scans used only when there is some question or problem.

It might also be possible to insert subcutaneous identification chips into patients who are willing and for whom there is some problem with using other biometric standards.

So when a patient checks into a medical facility, he simply places his index finger on a fingerprint scanner, which brings up medical information, but NO personal information. Nobody in the hospital even knows the name of the individual (well, OK, we could allow first names if the patient is willing).

The third level of protection lies in the software. The software will transmit encrypted information over the Internet, but access to the data will be restricted to those people who have been approved -- mostly doctors and researchers. And these people will gain access to the database through the same biometric checks used to identify patients.

By the way, the personnel who access the system will also have a large degree of privacy. The purpose of this is to permit anonymous criticism of a health care provider's professional decisions. It is conceivable that, further down the road, algorithms could be developed that detect abnormally low performance from a health care provider. In such a case, it would be useful if that criticism could be presented with complete anonymity. If a doctor knows that the critic has no idea of their identity, they will be more open to criticism

Participation in the National Health Care System is strictly voluntary. I expect that everybody would want to be part of it, but I see no need for the FBI to lay siege to compounds in Idaho, with the defenders screaming "We'll NEVER get registered with your commie-fascist computer!!!" Let 'em pay for their own medical care, if that's what they want.

That's another important point: People should never be restricted from obtaining private care. There are plenty of national health care systems that permit private treatment, and they have had no problem with private and public care co-existing.

The end result of all this will be a huge database of patients, procedures, physicians, and health care facilities. What we do with all that data will be addressed in the next essay in this series.

A National Health Care Plan: Part I

2008-12-02T15:25:00.000-08:00

In a series of upcoming essays, I shall attempt to define a proposal for a national health plan that I believe will be more effective than those I have seen to date. In this prefatory essay, I shall declare the principles underlying my proposal.

1. Emphasis on lowering total costs. Many of the health plans that I have read seem to be little more than programs for wealth redistribution. I have no objections to redistribution (if that's what citizens want), but I believe that we can accomplish a great deal more by lowering overall health costs. I believe that a lowering of health costs would give us the slack we need to establish a national health plan.

2. Free basic health care for children. I do not believe that it is appropriate to limit health care for children based upon the incomes of their parents. The definition of "basic health care for children" is complicated and will be offered in a subsequent essay.

3. Free basic health care for adults. This is not as big a concept as it seems, because the whole trick lies in the definition of "basic health care for adults". I shall propose a process for determining precisely what this means.

4. Reduction of administrative costs through IT. There's still way too much paper moving around between hospitals, labs, the government, and insurance companies. I believe that we spend billions figuring out who should pay how much money. If it were easier to make that determination, we'd save a lot of money.

5. Reduction of costs by better analysis of data. Our health care system generates enormous amounts of data every day on the costs and efficacies of various tests and treatments. Some of this data is used for improving treatment. I believe that we could all do better if ALL of the data were organized and accessible for analysis.

6. Financial incentives for healthier life styles. Life style should be a factor in determining how much a person pays for health care. People who engage in unhealthy behaviors should not have their bad habits supported by the taxpayers.

7. We can't cure everybody. It simply costs too much to provide every person with the very best medical care that is possible. We must acknowledge these ugly limitations and devise a plan that provides the greatest benefits for the amount of money that we can spend.

8. This is a biggie: Health care should be provided on the basis of its cost-effectiveness in improving the future of the patient. For example, we should not spend millions of dollars on exotic treatments for an old person who is likely to die of natural causes in a short time. In my proposal, I shall offer a system for deciding exactly how this determination is to be made.

9. Doctors, hospitals, and insurance companies should not be held liable for the deaths of those who die because they are denied health care for financial reasons.

These are the nine basic principles that will underly my proposals. I expect that I have overlooked something or used poor phrasing in describing them. I invite criticism to improve these principles.

Socialism for children, capitalism for adults

2008-11-29T17:59:00.000-08:00

Here is a simple political concept that deserves discussion: should not all children be provided complete care by the state? I do not mean to suggest that children should be taken away from their parents, but instead that the cost of their upkeep should be borne by the state. Note that I am talking about the cost of their upkeep, not any luxuries. We already provide educational upkeep at state expense; should we not extend this principle to all forms of child care: feeding, clothing, health care, and education behind secondary school?

The moral principle behind this is simple: children cannot be held responsible for their lack of earning power; they cannot provide for themselves. Therefore, should they not be provided for by the state?

For all of human history, the financial burden of raising children was borne by the parents, and there was a strong financial incentive for parents to do so because children provided their support in their old age. But the economics have completely changed. Children are no longer taking care of their parents in their old age; indeed, older people are wealthier than the young. Old people are sustained by the state (through Social Security and Medicare), so they don't need the support of the young.

At the same time, we have already assigned the state some of the financial burden of child care. The state provides education and the state provides partial financial support in the form of tax deductions for dependents. Should not we consolidate these basic principles into an overarching principle that the state bears the financial responsibility for the preparation of future citizens?

It is certainly in our financial interest to do so. Every child is a future taxpayer; those children will be paying taxes to support me in my old age. I want to see lots of healthy, well-educated children with high earnings potential coming of age every year. Moreover, every child is also a possible criminal, and I want to minimize the risk of that child committing a crime against me. So that also argues that it is my own interest to pay additional taxes now to support children.

Supporting this principle is a remarkable economic statistic: the correlation between a person's net worth and their parents' net worth is higher in the USA and the UK than in any of the other OECD countries. In other words, all that guff about America being the land of opportunity is a load of crap: family connections are more important for your ultimate financial success than hard work, talent, drive -- you know, all those silly things that those socialist Europeans believe in. So if we really want to get closer to this chimera of "the land of opportunity", perhaps a little socialism for children would be a good thing.

So, should we ordain a new political principle: socialism for children, capitalism for adults?

And now for something completely different...

2008-11-22T16:59:00.001-08:00

It seems to me that the approach taken by archaeologists with respect to the looting of ancient sites is entirely too self-righteous. I do not question the correctness of their position -- I agree that our heritage should be protected and investigated by professionals. However, it seems rather feckless to complain that there are people who do not share our values. We live in a big and complicated world with all manner of heterogeneous value systems. To merely stamp one's feet and insist that one's own values are the only right and proper values is a futile exercise. We can prod governments to pass laws imposing these values upon others, but such laws are unenforceable to any useful degree. They have some value in certifying those values to the general public, but they are ultimately insufficient to the problem.

As it happens, we already have a system in place that communicates human values with great precision to every single person on the planet. It is our economic system, and money is, in the words of one writer, "frozen values". Unfortunately, this values system is working against us -- the amount of money favoring the destruction of archaeological material is pretty impressive, and the amount of money favoring the preservation of such material is insufficient to the task.

Theoretically, the solution to this problem is to convince society at large to dedicate more funding to the forces that would preserve archaeological material. But we know full well that such an increase in funding is not forthcoming. Thus, we are faced with a complicated situation: some participants in the economy are willing to devote a limited amount of money to preserving archaeological information, while other participants in the economy are devoted to destroying that information.

And this raises a truly worrisome question: how do we know we're right in insisting on awarding exclusive control of the archaeological heritage to academics? The common argument offered here is that professionals are preserving the archaeological heritage for all humanity by publishing their work. But there's a counterargument that deserves consideration: that professionals are just as selfishly concerned with their own careers and interests as the looters. What god on high can declare that the selfish-interest of professionals is superior to the self-interest of looters?

I don't quite buy this argument because in fact the profession IS giving its results away to humanity. But we cannot dismiss this counterargument out of hand, because the looters are also performing a service to humanity: they are allowing regular people to touch and to own a fragment of history. Is it not reasonable to argue that the tactile experience ultimately motivates a heightened awareness of history and our heritage in millions of people?

Let me tell you about something I built some years back. I call it my "history necklace". I started with a tiny fragment of a meteorite, which I drilled a hole into and placed on a necklace. That meteorite is 4 billion years old. I added more beads: a 2 billion year old piece of banded iron, a 1 billion year old stromatolite, a trilobite at half a billion years, and so on. Fossils of life forms from all the epochs of history. Yes, I also included many artifacts: an Egyptian faience bead, a fragment of pumice from Pompeii, a bit of coal recovered from the Titanic, a fragment of a piece of eight recovered from the Concepcion wreck, a piece of a Minie ball from the Civil War, a bit of Trinitite from the first atomic explosion, a bit of pure silicon from Silicon Valley, and many more things. I show my history necklace to children and teenagers, and let them finger the beads as I tell the story of each one. It can take hours, depending on how much detail the youngster wishes. And when I'm done, I hold up the necklace and conclude: "and it's all right here where you can touch it." The impact of that on kids is immense. They start to think of history as a big picture, a parade of stories. And they want to learn more.

I didn't need to use anything questionable in my necklace; it's all simple stuff, available in large quantities or blessed with an untainted provenance. But it demonstrates the power of the tactile experience, and that's important.

I believe that archaeologists have committed a huge error by insisting upon exclusive access to ancient artifacts. I agree entirely that the market for expensive antiquities is undesirable and I would support laws prohibiting the sale of any antiquity of serious value. However, I think that there is a place in our world for the distribution of low-value antiquities. I believe that archaeologists, by resisting even this, do more harm than good.

Here's one possibility, although it's off the top of my head and so likely has some flaws that would require alteration to the scheme. Archaeologists and museums have accumulated a vast collection of ancient coins. The information value of many of those coins has already been extracted. Possession of them, in many cases, no longer has much scientific value. Yes, we want to retain all the best exemplars of every type of coin we have, and yes, we want to retain good representatives of particular sites and time periods. But there are huge numbers of poor quality coins whose continued possession provides little of value.

I am not claiming that we can afford to, in effect, throw away these coins. What I am suggesting is that the information provided by these artifacts be obtained and published, and then the artifact itself can be disposed of. I expect that archeologists are now building databases of artifacts and I would certainly expect numismatic databases to be the first among these.

Let's consider a coin hoard recovered from a proper excavation. Once the contextual information is established, each coin could be cleaned, identified, weighed, photographed, and entered into the database. After that, it could be sold with no loss of information.

In other words, I'm suggesting that we put the looters out of business by outcompeting them. A coin from a looter is described as nothing more than the coin itself. It doesn't have a story. Its value to the customer is limited. But suppose that, instead of merely selling a bare coin, it came with a link to a webpage presenting the story of the coin: where it was found, how it was found, the history of the site, the significance of the site, and so on. This is important: the story is what makes the artifact valuable. The looters can't tell the story; the professionals can. A coin with a long story behind it is a fragment of history; a coin without a story is just a disk of metal.

By combining the artifact with the information discovered as part of the excavation, we create value that didn't exist before. And people will pay for that value. They'll pay a lot more for the professional product than they'll pay for the looters' product.

Moreover, the income generated by such a strategy would make it easier for researchers to carry out more excavations -- archaeologists could compete with the looters both in price AND in "production".

We'll never eliminate the looters. But a scheme like this would put a lot of them out of business.

2008-11-15T12:25:00.000-08:00

Some genuinely constructive criticism for conservatives

OK, you got clobbered. You've lost the White House and Congress. For at least the next two years, you're going to be on the outside looking in. You might be able to block some of the most egregious leftward moves, but for the most part you're going to have to stand on the sidelines and watch as the Democrats get their turn to run things.

Although I object to some parts of your political philosophy, I believe that our democracy is better when there is robust political competition between the two parties. With that in mind, I'd like to describe what I think is the single most fundamental mistake that you as a group have been making for at least the last eight years: you have lost your internal skepticism and compromised your dedication to rationalism.

By internal skepticism, I mean the nagging uncertainty that checks you before you make a decision: "Am I really sure that this is right?" A good thinker is always most skeptical of what he wants to believe, always trying to beat up his favorite beliefs to insure that they're correct. And over the last eight years I have seen repeated cases of conservatives giving short shrift to their internal skepticism.

Let's start with the most obvious case: creationism. Now, I realize that creationism is not quite a signature of the conservative movement -- but I think we'd have to agree that the vast majority of creationists are conservatives, and very, very few creationists are liberal. Although there are plenty of rational conservatives who reject creationism just as forcefully as liberals, there remain a large number of "closet creationists" in the conservative movement. They're the most extreme example of "wishful belief": they believe something despite the overwhelming evidence against it. Now, I myself don't think that this is terribly important; if you want to reject evolution for creationism, that's your business and I really don't care. But the embrace of creationism is an indication of a willingness to reject even a modicum of rationalism. I urge Republicans to tell creationists, "We appreciate your support, but we cannot accept your beliefs as a part of our political philosophy, because we believe in rationalism." I realize that this will cost you votes -- but I argue that the overall attitude of anti-rationalism costs you even more votes.

Here's another example of anti-rationalism in the conservative movement: the rejection of the hypothesis of anthropogenic global warming. Let's face it, folks: the opposition to the AGW hypothesis is an anti-rational conspiracy theory. The huge weight of scientific evidence falls in favor of the AGW hypothesis. Recognizing this, both Mr. Bush and Mr. McCain, who surely can't be called liberals, have grudgingly accepted the AGW hypothesis. Your best and your brightest accept AGW; why do you encourage the anti-rationalists who reject it? Again, your best option here is to insist that the Republican party endorses rationalism and embraces the AGW hypothesis.

The effects of anti-rationalism and a rejection of internal skepticism can be disastrous. Consider, for example, Mr. Bush's handling of the Iraq War. He went into the war loudly declaring that Iraq possessed WMD. Why? Because he had intelligence to support that belief. Yet we now know that his Administration actively promoted intelligence that supported their preconception, and minimized intelligence that called their preconception into question. Had Mr. Bush surrounded himself with skeptical minds who challenged assumptions, it is likely that he would have concluded that there was insufficient evidence to support the claim of WMD in Iraq and not proceeded with the invasion -- and America would be a lot better off today.

Another example is the handling of the occupation. The Bush Administration chose to believe that the Iraqi people would welcome us with open arms and we would not need a large occupation force -- despite warnings from the Pentagon. Generals who expressed doubts about the chances of success with only 150,000 men were replaced with generals beaming with optimism. Optimism is a nice thing -- but when it's misplaced, it just leads to disaster. Had Mr. Bush heeded the warnings of the brass early in the occupation, we would already be out of Iraq, and it would be a happier place than it now is.

I realize that you will disagree with me about some of these details. I don't want to try to convince you that the invasion of Iraq was wrong. My point here is that, had Mr. Bush been more skeptical, more willing to listen to people saying things he didn't want to hear, America would be better off and the Republican brand would not be so tarnished.

There are a great many minor examples of inadequate skepticism or flat out anti-rationalism among conservatives. How about the claims floating around the Mr. Obama is a Muslim? That's a flat lie, and all the reasonable conservatives rejected it -- but the lie kept circulating through the conservative movement. Mentions of it kept popping up over and over -- and the rational conservatives, who should have put a stop to that nonsense, went along with it.

Or let's consider the many suggestions that Mr. Obama is a communist or a Marxist. Those are patently ridiculous, but the rumors just wouldn't go away. Even the suggestion that he is a socialist is absurd -- his talk of increasing the progressivity of the income tax would merely revert American tax policy to where it was in the 1950s -- and no, America was not a socialist country in the 1950s. Although Mr. McCain never bandied about that trash-talk, his running mate did, and conservative discussions were rife with accusations that Mr. Obama is a socialist. Where were the rational conservatives who should have ridiculed such talk? They were nowhere to be found. I know they're out there -- I've spoken with many of them. But they seemed to feel that the anti-rationalists were too powerful and too important to be offended.

You may well defend yourself with the observation that there were plenty of left-wingers who smeared Mr. McCain in much the same way. I disagree. Yes, of course, there was plenty of trash-talk coming out of the left as well as the right -- but the leftist criticisms of Mr. McCain were much more reserved. I heard plenty of accusations from the right that Mr. Obama is a socialist, but I heard damn few accusations from the left that Mr. McCain is a fascist. Mr. Obama's patriotism or "Americanism" was denigrated on a daily basis, where just about everybody on the left bent over backwards to recognize Mr. McCain's heroism in captivity. I'm sure that we'll always disagree on the magnitude of these matters, but I think it fair to claim that the more wild-eyed accusations came from the right.

Consider how Republican optimism led to the current financial crisis. I realize that there are many, many factors that got us into this hole, and many of those factors were out of control of the government. But two factors stand out as contributing to the disaster. The first is the huge deficit that Mr. Bush saddled us with. This was a very indirect factor and a small one -- but it definitely contributed. Much more important was the overly optimistic approach to financial regulation. It was Republicans who stymied every effort to tighten up the regulatory system, and the lack of regulation was a major factor in the financial disaster. Again, the mistake was a failure of internal skepticism -- a sunny belief that large financial institutions would do "the right thing" without government intervention. And that lack of skepticism proved to be disastrous.

Again, I don't want to offend you here -- if you refuse to believe some of my points, that's fine. But there is a definite pattern here for your consideration. The conservative movement has been infiltrated by anti-rationalism, and that attitude will poison your movement. You have a core of about 25% of the American public that is fiercely loyal to the conservative cause, and some portion of that group is ferociously anti-rational. But the fact remains that a far larger number of Americans are pretty rational. They really do listen to the facts. When people on your side claimed that Mr. Obama is a socialist, many Americans concluded that your side is crazy.

Another symptom of anti-rationalism in the Republican Party is the rejection of education and intellectualism. Just look at the educational credentials of Mr. Bush, Mr. McCain, and Ms. Palin. Compare them with the educational credentials of Mr. Clinton (a Rhodes scholar), or Mr. Obama. I don't expect you to agree with me on this point, but Mr. Obama and Mr. Clinton are both obviously (to me) more intelligent than Mr. Bush, Mr. McCain, or Ms Palin. Why is it that your party seems so enamored of such dumb people? I know that there are brilliant conservatives -- how come you don't give leadership positions to them? Some of your denigrations of Mr. Obama -- that he's "elitist", "not like us", and "merely eloquent" -- were, in my opinion, spin words for "smart". And the frequent approving comments that Mr. Bush, Mr. McCain, and Ms. Palin were people you'd like to have a beer with are, in my opinion, ways to spin the fact that they're obviously pretty dumb.

I realize that you have a tough dilemma here. The anti-rationalists in your ranks have plenty of passion, energy, dedication, and discipline. They're powerful. But they are also taking you down a path to ruin. You cannot command the respect of the American people with a political philosophy that is fundamentally anti-rational. As you reconsider your political philosophy, you will be forced to choose between the anti-rationalists (personified by Ms. Palin) and the rationalists, who at present have no leading representative. If Ms. Palin's partisans take control of the Republican Party, then it will suffer a crushing defeat in 2012 and your party will be politically impotent until at least 2016. If you start rebuilding your party on rationalist foundations, you'll need to convince those anti-rationalists to abandon some of their wilder beliefs. You may lose their passion and energy for a time. But at least you will have a future.

I apologize if I have offended you. I acknowledge that you will reject many of my points. But again, I implore you to look at the big picture. Right now, the Democrats have a lock on the rationalism angle. Until you can meet and defeat them on that field of battle, you will continue to lose.

Assessing modern Presidents

2008-11-08T12:14:00.000-08:00

Perhaps it would be fun to discuss the track records of the Presidents of our living memory. I'm going to start with Kennedy even though some of us are too young to remember his Presidency. My approach will be to avoid vague, generalized assessments and instead focus on the specifics: what were the major achievements and failures of that President's administration? Here then is my first cut, which I expect to suffer from many oversights. Furthermore, I'm using a simple ratings system of 1, 2, or 3 pluses or minuses.

Kennedy: +2

- Vienna meeting with Krushchev

+++ Cuban Missile Crisis

- failed civil rights legislation

- Vietnam

+ Peace Corps

+ aim for the moon

Johnson +1

+++Civil Rights Act

---Vietnam

+Great Society program

Nixon -2

+++ opening to China

--- Vietnam

+ arms control

--- Watergate

Ford +1

+ Nixon pardon

Carter +1

+ Energy policy

Reagan -5

-- voodoo economics

- military spending

-- Iran-Contra

- S&L disaster

Bush I +1

+ Gulf War

Clinton +2

--- couldn't keep pants zipped

++ fiscal policy

++ NAFTA

+ reducing military spending

+ Balkans war

- Somalia

Bush II -18

--- Iraq War

-- mishandling of Afghanistan War

--- torture

-- FISA

--- unitary executive

--- budget deficit

-- global warming

-- abuse of allies

These results surprise me; I thought that Clinton was a pretty good President, but when I list his achievements and failures, he doesn't come out looking that good. I knew that Bush II was the worst President in American history, but I didn't expect that he'd come out looking so horrendously bad.

I'm certain that EVERYBODY will take exception to this assessment. In particular, I'm sure that conservatives will rail over the negative rating for Mr. Reagan. That's my point: let's see if we can't nail down some of these factors. And I definitely want to establish a fundamental rule for this discussion: no vague opinions or claims! We should confine our comments to specific achievements or failures that can clearly articulated and unquestionably assigned to the President.

And anybody who wants to claim that Mr. Reagan deserves credit for winning the Cold War is "crusin' for a bruisin' " !

A proposal for campaign finance reform

2008-11-01T09:33:00.000-07:00

The ever-rising costs of political campaigns continues to plague American democracy. "We have the best Congress money can buy" goes the joke -- but it's hard to laugh when you know how true it is.

I think it's possible to make a dent on this problem by separating two very different aspects. The first is the inherent unfairness of a rich candidate buying electoral success. There's not much we can do about this. There is just no way to prevent people from spending money on political messages.

The second problem is easier to deal with: the pernicious influence of campaign contributions on politicians. Despite endless denials, we all know that a politician is beholden to the people who provide campaign contributions. It is far too easy for the wealthy to purchase political influence via campaign contributions. And when the money for those contributions comes from profits made by bilking the public, then we have a truly ugly kickback system at work.

I would like to offer a possible solution to this problem. I'm sure that somebody else has already come up with this idea, and if so, I'd like to hear about it and why it never became law.

Here's the plan: we outlaw all direct contributions to a politician's campaign fund. Instead, all contributions must go through a government office which I'll call the "Campaign Funds Repository". The Repository pools all the contributions to each politician and disburses payments to the candidates on a monthly basis. The idea here is to hide individual contributions in a mass of contributions.

Suppose, for example, that Acme Widget Company wants Congressman Joe Forsale to support a special tax break for Acme Widgets. Acme figures that the tax break will save them $1,000,000. So they want to offer Joe $10,000 in campaign contributions out of the goodness of their hearts. Currently, Joe gets the check from Acme Widgets with the $10,000 and Joe knows that he should lick the hand that's feeding him, so Joe votes for the tax break for Acme Widgets. However, under my scheme, Acme can tell Joe that they'll make a $10,000 campaign contribution, but Joe has no way of knowing if they actually did. All he knows is that he got $74,323.19 in campaign contributions this last month.

What would make all this particularly effective would be the possibility of citizen's groups making small donations of odd values to every campaign. If the League of Women's Voters, for example, were to donate something like $236.27 to Joe Forsale this month, and $167.53 to Senator Hotpockets, and $22.57 to somebody else, then any attempt to make a contribution recognizable by making it some peculiar value would be ruined.

One other benefit of this scheme is that the contributor could be required to include his Social Security Number or EIN number with the contribution, so that it will be automatically entered into IRS records for purposes of tax deductions -- and it will also guarantee that nobody breaks the limits on campaign contributions.

I can see a flaw in the scheme: it would make it impossible for citizen's groups to expose massive contributions from corporations who benefit from legislation that the politician supports. However, that capability seems to have little effect these days -- corporations are able to launder the money through intermediaries, allowing the politician to avoid the taint of apparent quid quo pro.

Another, less important flaw is that politicians would not have immediate access to their money. I could see how this would be inconvenient. But inasmuch as every politician would be equally impeded, I do not consider this a serious flaw.

So have at it, readers. Can you shoot down this idea?

Group loyalty: the fatal flaw

2008-10-26T09:50:00.001-07:00

I just had a realization I'd like to discuss with the group. One of the most striking characteristics of the right is its emphasis on group loyalty. The Republicans are disciplined while the Democrats are heterogeneous. This is not a new phenomenon: back in the 1930s Will Rogers said, "I'm not a member of an organized political party, I'm a Democrat." Loyalty to the group is profoundly important to conservatives. It shows up in their blogs: if you offer anything contradictory to the group's received wisdom, you are pounced upon as a troll and subjected to intense verbal violence. Sarah Palin talks are "real Americans", Michelle Bachmann claims that liberals are anti-American, Anne Coulter broad-brushes all liberals as traitors. When Colin Powell endorsed Mr. Obama for President, the right erupted with angry assaults on Mr. Powell for his "betrayal" of the Republican Party. Conservatives have a strong sense of loyalty to the group and rejection of outsiders.

This has given them a lot of political power. By hanging together no matter what, the "further right" (I hate calling people 'far right' or 'far left') faction has taken over the Republican Party and achieved a surprising number of their political goals despite their small numbers (perhaps 30% of the American public).

But blind loyalty has its costs, the most important of which for today's discussion is a loss of perspective. Without the discipline of opposing ideas, without a true marketplace of ideas, any school of thought eventually loses contact with reality.

One factor in particular has heightened conservative loyalty: the development of a richer set of communications media. Back in the 1980s, all political discussion took place via mass media: big-circulation newspapers and the four national television networks. Because these were mass media, they had to supply a broad range of ideas. They really did represent a marketplace of ideas, and the body politic was richer and stronger for it.

But starting in the 1980s, we began to see a flowering of heterogeneity. First it was radio, which began to offer stations with purely conservative points of view. Then cable made a multiplicity of television channels available, and we saw Fox News with its strong conservative slant. The real explosion came with the Web and the wide range of blogs.

The good news is that this made available a huge range of information and opinion. With a bigger marketplace of ideas, and more ideas bouncing around, the body politic gains vitality.

But conservative loyalty insured that conservatives stayed in their own corner of the marketplace, never straying into other areas. Nowadays a conservative listens to Rush Limbaugh on the radio while driving, watches Fox News on television, and reads any of the many conservative blogs for conservative news and opinion -- without ever being exposed to opposing points of view.

The end result is that these people live in an alternative reality of their own creation. Ideas bounce around in this "conservasphere", picking up more and more momentum until they have reached absurd proportions -- and there's no reality to hold them in check.

For example, consider this sequence of ideas: Mr. Obama's middle name is "Hussein". This suggests to some people that he is in some way similar to Saddam Hussein. Saddam Hussein hated Israel, so next we start hearing tales that Mr. Obama hates Israel. The idea gets spun even further, suggesting that Mr. Obama hates Jews. Then somebody else takes it a step further, publishing a drawing of Mr. Obama in Nazi costume. All because of his middle name!

Here's another example of how the closed conservative communications system produces wildly incorrect results. Somebody notes that Mr. Obama once served on the same board of directors of a charity with Mr. Ayers. 40 years ago Mr. Ayers was a member of a group that bombed some government buildings. So Mr. Obama was connected to Mr. Ayers, who was connected to terrorists. This grows into the conclusion that Mr. Obama is a terrorist sympathizer. This grows into the claim that Mr. Obama is a terrorist himself. The ideas just spin faster and faster around in the conservasphere, getting wilder and wilder, and nothing corrects them.

The end result is that many conservatives believe the craziest things. Those crazy beliefs have spurred them to fight fanatically against the forces of evil that they believe lurk in every corner of the world. But you can't fool all of the people all of the time, and eventually the stupidity of conservative beliefs becomes clear for all to see. Sure enough, here we are in the worst position America has been in since the Civil War. Our geopolitical position is in the toilet, our economy is a shambles, our national debt is at historically record levels, we're caught up in two disastrous wars -- our overall situation is a disaster on every front. At long last the conservative foolishness has caught up with us and now we are paying the price for giving them power.

But their disaster is even greater. The bankruptcy of their thinking is now obvious to all. The big question is, how will many of them react once the covers are thrown back and they emerge, blinking, into the light of reality? Some of them will never abandon their crazy beliefs and will continue to spout their nonsense. But how many conservatives, when confronted with the patent incorrectness of their beliefs, will change?

I am not optimistic. I fear that a goodly number of American conservatives -- perhaps 20% of the entire population -- will continue to cling to their unreal beliefs, denying reality even as it hits them over the head. I have lost hope that these idiots will ever come to their senses. I think that America's best hope now lies in forming a "Rational Center" (remember the "Moral Majority"?) that flatly rejects the wild fantasies of the die-hard conservatives.

Idle hands

2008-10-19T16:04:00.000-07:00

"Idle hands are the devil's workshop", the nuns used to tell us kids whenever they found us insufficiently busy, and set us to work on some make-work project. I wonder if the aphorism has some applicability to bodies politic.

Consider the American response to the bombing of Pearl Harbor. Partisan differences gave way to a universal desire to win the war, and people pitched in where-ever possible. The entire nation concentrated its considerable energies on the single task of winning the war. And it succeeded brilliantly.

Consider now the last twenty years of American history. With the collapse of the Soviet Union, the great threat that had imposed a certain degree of seriousness upon the country was removed. We entered a period of peace and prosperity unlike any in our history. The economy boomed. People were happy.

And in the idleness of peace, people started manufacturing conflict. The impeachment of Mr. Clinton was the first big example of this "artificial controversy" phenomenon. A stupid sexual dalliance led to the impeachment of a President. The rest of the world watched in bafflement. Sure, it was clumsy and embarrassing, but to make a national scandal out of this struck most of the world as bizarre.

Then came 9/11. Hard as it seems, conservatives managed to blow this all out of proportion. Yes, it was a disaster, and yes, it was the most serious attack on American soil since Pearl Harbor. But the right wing transformed a single act of terrorism into a to-the-death war between civilizations. We had to give up some of our civil rights, spend billions on self-defense, and invade not one but two countries in response to 9/11. The overreaction has already cost us more lives than the stimulus, and a trillion (perhaps two trillion) dollars in excess costs.

The right seems to revel in crises. We've got the terrorist crisis, and the abortion crisis, and the gay marriage crisis, and of course the financial crisis. Mr. McCain recently claimed that the activities of the voter registration group ACORN presented a threat to the "very fabric of our democracy".

Back in the 50s and 60s, it was a common joke to accuse conservatives of thinking that there was "a Red under every bed". Now it has gotten worse: they see threats to our very existence everywhere: Democrats are really socialists who will destroy our economy; terrorists are lurking in every shadow, ready to unleash weapons of mass destruction upon us; gays are going to destroy marriages all around them by marrying; abortion will ruin our society; Donald Duck is running rampant...

(The Donald Duck line is quote from two sources. Erasmus wrote a letter with a long list of horrors descending upon Europe, ending with "and Erasmus is scribbling!" Later on, in a Walt Disney cartoon, the hero was chased by a wild collection of Martian monsters, each hooting its alien sound as it pursued the hero... and the last Martian in the exotic series was Donald Duck. Oh well, when you're eight years old that kind of thing is overpoweringly funny.)

Is it the lack of challenge that brings out these Chicken Littles? It may well be that America in the next few years will face enormous challenges: economic setbacks, military problems, the increasing determination of other countries to go their own way. It may be that we will be cut down a notch. And if we're faced with REAL problems, things that truly threaten our nation, will the silliness stop? Will people agree to set aside the stupid little problems if there are enough big ones to keep them busy?

The answer to this question will determine the fate of the nation.