Posted tagged ‘Health Care’

Your Daily Apocalypse, Outsourced Antibiotic Edition

November 21, 2013

Go read this piece by Maryn McKenna — who is, in my never humble opinion, one of the handful of very best reporters on matters of infectious disease, global health, and really scary stuff.

I was born in 1958, fifteen years into the era of clinically-available antibiotics.  I was my mother’s third child.  Had we shifted that timeline back a few years, that would have meant that there would have been a measure of luck in mom simply making it to and not through her third lying in.  As Maryn writes, before antiobiotics, five out of 1,000 births ended with the death of the mother.  No worries by the time I popped my head out into the maternity floor at Alta Bates.

But this a must read not because of any remembrance of the pre-antibiotic era, but because Maryn plausibly analyzes a post-antibiotic future.

Plaguet03

Here’s a sample:

Doctors routinely perform procedures that carry an extraordinary infection risk unless antibiotics are used. Chief among them: any treatment that requires the construction of portals into the bloodstream and gives bacteria a direct route to the heart or brain. That rules out intensive-care medicine, with its ventilators, catheters, and ports—but also something as prosaic as kidney dialysis, which mechanically filters the blood.

Next to go: surgery, especially on sites that harbor large populations of bacteria such as the intestines and the urinary tract. Those bacteria are benign in their regular homes in the body, but introduce them into the blood, as surgery can, and infections are practically guaranteed. And then implantable devices, because bacteria can form sticky films of infection on the devices’ surfaces that can be broken down only by antibiotics

Dr. Donald Fry, a member of the American College of Surgeons who finished medical school in 1972, says: “In my professional life, it has been breathtaking to watch what can be done with synthetic prosthetic materials: joints, vessels, heart valves. But in these operations, infection is a catastrophe.” British health economists with similar concerns recently calculated the costs of antibiotic resistance. To examine how it would affect surgery, they picked hip replacements, a common procedure in once-athletic Baby Boomers. They estimated that without antibiotics, one out of every six recipients of new hip joints would die.

As Maryn reports, the problem is tangled and complex — but there are clear actions that could be taken and aren’t, most obviously ending the reckless use of antibiotics in agriculture, which consumes something like 80% of the total produced.  But don’t waste time here: go read the whole thing. Get scared; get mad; call your congressfolk.

Image: Josse Lieferinxe, St. Sebastian prays for plague victims, 1497-99.

Republican Health Care Plan (Die Sooner) Implemented Via Shutdown — Salmonella Outbreak edition

October 9, 2013

Ok.  That title is a bit of hyperbole (you think?–ed.).  No deaths have yet been reported from this:

This evening, the Food Safety and Inspection Service of the US Department of Agriculture announced that “an estimated 278 illnesses … reported in 18 states” have been caused by chicken contaminated with Salmonella Heidelberg and possibly produced by the firm Foster Farms.

Vincenzo_Campi_-_Chicken_Vendors_-_WGA3826

The news and its context (and lots of links, now updated) comes from the invaluable Superbug blog written by the equally prized Maryn McKenna (known to her friends as the internet’s Scary Germ Girl, perhaps for books like this one.)*

That’s not the punch line, though.  Something else makes this latest demonstration of the risks inhering to the US food supply system so infuriating and so scary — something with a distinctly GOP reek wafting through it:

 [The Food Safety and Inspection Service] is unable to link the illnesses to a specific product and a specific production period,” the agency said in an emailed alert. “The outbreak is continuing.”

This is the exact situation that CDC and other about-to-be-furloughed federal personnel warned about last week.

As Maryn emphasizes:  we are confronting a potentially deadly public health crisis with legally enforced ignorance:

 At the CDC, which operates the national foodborne-detection services FoodNet and PulseNet, scientists couldn’t work on this if they wanted to; they have been locked out of their offices, lab and emails. (At a conference I attended last week, 10 percent of the speakers did not show up because they were CDC personnel and risked being fired if they traveled even voluntarily.)

To mix metaphors — when you have a political party determined to spin the cartridge on the whole country, eventually the hammer will find a loaded chamber.

Go read the whole of Maryn’s reporting.  This isn’t skittles. It’s illness and misery, the possibility of life-long diminishment…and maybe deaths too, as always with the most vulnerable, kids and the elderly, squarely in the cross hairs.

Even if, as I deeply hope, the current outbreak passes with minimal harm to our fellow citizens, that just means we got lucky.  As long as Republicans see the shut down as a game in which they must put “points on the board” we’re on the hook for the news we know will come.

To take it one step further:  the dominant view within the modern Republican party is one that in essence denies the existence of society.  In the Tea Party view — the one shaping the entire party’s vision — the US is and must be a nation of individuals, atoms; there is no concept that we might act in concert to ends other than those we can address one by one.

From that perspective deciding we don’t need food safety inspectors makes sense.  It’s my job or yours to make sure we cook that chicken breast all the way through, that we sterilize our cutting boards, that we never forget to soap off our knives between cuts, that we never eat with friends less cautious than ourselves. (I’m following Maryn’s argument here, btw.)

One could choose to live that way.  Kids would die, from time to time, and maybe grandpa too, before he needed to go.  Such deaths would be the price of my freedom, a definition of liberty renders every other person around me a kind of ghost: there, but not so much so that I need act as if they are just as real as me.

That’s what’s at stake in the current impasse in Washington.  I don’t want to live with ghosts. I want friends, I want colleagues, I want a society — civilization.  Hell!  I want chicken inspectors, and it’s a privilege, not a burden, to live within a system that’s figured out how to  have them.  That the Republicans don’t seem to get that is why the current version of the party (no longer) of Lincoln must be ground into the dust.

Factio Grandaeva Delenda Est.

Update:  Per Mike the Mad Biologist, this news:

A sweeping salmonella outbreak has become so serious that the Centers for Disease Control and Prevention has called back 10 furloughed staff members to monitor this and other outbreaks.

Progress.

*You can get the word directly from Maryn via my conversation with her on the Virtually Speaking Science podcast.

Image:  Vincenzo Campi, Chicken Vendors1580.

By The Way, David Brooks Is Still Always Wrong

November 13, 2011

I know this is already long since fishwrap, but amidst the many disembowelings of David Brooks discovery that he has always been at war with Eurasia   always  loved Mittens, I have to rage, rage, at the relentless, endless, fetishization of the deepest, most degrading fantasy of the right.  No, not that one.  Nor that one either.  Nor this.

No it’s the almost touching faith evinced by Mr. Brooks and the entire GOP presidential field in the existence of a free market in health care.  So, just to flagellate a truly dead horse, let’s take a look at one specific passage from Our Lady of Perpetual Broderism’s Romney tongue-bath:

True Medicare reform replaces the fee-for-service system with premium support. Government gives people money, rising slowly over time, to shop around for their own private insurance plans. The system would reward efficiency and quality, not just quantity. Competition between providers would unleash a wave of innovation.

The only problem is that the marketplace for health care that exists in the world real people inhabit bears little or no resemblance to Brooks’ pleasant vision of informed consumers, with full information in hand, shopping around for the perfect combination of benefits and price they need — not just now, but through the life (and death) cycle all of us endure.

 

That is: most evocations of the free market in just about anything call up spherical cows, simplified (and dangerously convincing) models of what actually happens in the world.  But to imagine a genuine Ec. 101 free market in health care — and to praise someone as “serious” for building policy on the assumed reality of such delusion — that takes real effort, a true commitment to avoid knowing inconvenient facts.

At least, so says such a DFH as Daniel McFadden.  That would be the 2000 Nobel laureate in economics who has taught at such dens of raving lefty lunacy as USC, UC Berkley, and (ahem) MIT.  And that would be the same fellow who has spent quite a bit of time analyzing the notion of consumer driven health care.  Here’s what he had to say in 2008 in a working paper co-authored with Joachim Winter and Florian Heiss:

Most, but not all, consumers are able to make health care choices consistent with their self-interest, even in the face of novel, complex, ambiguous alternatives. However, certain predictable irrationalities appear – excessive discounting of future health risks, and too much concentration on dimensions that allow easy comparisons, such as current cost and immediate net benefit. Some consumers are inattentive, particularly when prior choices or circumstances identify a default “Status quo” alternative.

These behavioral shortcomings imply that some degree of paternalism is essential if Consumer Directed Health Care is to allocate resources satisfactorily. Health care markets need to be regulated to keep out bad, deceptive products, particularly those that offer “teaser” current benefits but poor longer-run benefits. Consumers need good comparative information on products, and they need to have this information brought to their attention. Consumers appear to underestimate the probabilities of future health events, [or] anticipate the resulting disutility, and as a result they systematically underspend on preventative or chronic care. Socially optimality will require that these services be subsidized, or choices regarding them be framed, to induce desired levels of utilization.

[From the second paper listed on McFadden’s website, linked above: “Consumer-Directed Health Care: Can Consumers Look After Themselves?” pp. 19-20]

Note what McFadden et al. do not say.  They don’t say market mechanisms can’t work.

They do say that human beings display predictable behavior that makes it impossible to rely on an unregulated market to deliver health care.  They point out that those irrationalities fall most heavily in the area of guessing what you or I might need some years down the road…i.e. when we are likely to need good care the most.*

Hence, the need for what the authors above call “paternalism,” and what I would term the normal function of the concept of universal insurance — mandated if necessary under the particular policy choice — against risks all members of a society face.

McFadden and his colleagues are hardly the only ones who get this.  This paper is exemplary, not determinative.  And again, it’s not that these writers represent some radical wing of anti-classical economics clinging to the margins of the profession.  In fact, McFadden and his co-authors display some familiar, reflexive thinking.  I’d argue with the Nobel laureate in his offhand dismissal of a different approach, what he terms “a government single payer/single provider program.”

Partly, the difficulty I have with the expert here is that single payer is not the same as single provider.  Conflating the two allows one to damn one with the flaws of the other — which is hardly cricket in a serious policy discussion.  And when anyone — even a distinguished fellow like McFadden — says that he “believes” the problems of such a system will be the same as for private plans, then I become an honorary Missourian: “Show me.”

But that’s an aside.  The core point is that even folks with a deep institutional and disciplinary engagement with the idea of markets understand that you can’t run health care on the principle that the customer knows best.  We don’t — we can’t, really.  And that’s why Romney, and Ryan, and all the other GOPsters trying to transfer risk to the American people and profits to American insurers are never, ever “serious.”

Which is just another long way round to repeating the obvious. David Brooks is always wrong.  He kind of has to be, given how he has dedicated his career to the notion that Republicans belong in power, no matter what.

*Brooks — like the GOP candidates — might argue at this point that they never have contemplated an unregulated private market in health care.  Which may be accurate, but not true (to channel my inner Sally Field).  That is — the degree of regulation in the market to which all calls to repeal Obamacare would return us was the one in which a host of problems along the lines McFadden et al. point out, and many more besides.  More broadly — even if you take the GOP as sincere in its stated principles, they oppose “paternalism” in individual decisions.  Which means they oppose exactly what is needed in the delivery of health care.

Images:  Edouard Manet, The Dead Bullfighter, 1864-1865

Pompeo Batoni, Time Orders Old Age to Destroy Beauty, c. 1746

Megan McArdle is Always Wrong: On So Many Axes It’s Hard To No Where To Start/Outsourced Edition.

September 17, 2010

Yes, this will be largely outsourced, but just to get everyone in the mood let me quote from the introduction to Andrew Bacevich’s important new book Washington Rules (about which I’ve been blogging a bit this week).

That introduction channels (and explicitly cites) Henry Adams on the subject of education, which in both men’s tellings tends to begin only when one discovers the capacity to break free of the fetters forged through years of imbibing truths too obvious to be examined.

As Bacevich quotes Adams, “Nothing is so astonishing in education as the amount of ignorance accumulates in the form of inert facts.”

That revelation prompted this next reflection.  I want to emphasize that the identification of it with Megan McArdle is all mine — Bacevich bears no responsibility for that specific connection.  But as I read his couple of sentences describing those who attempt to get ahead within the Washington establishment by showing existing powers how perfectly you can recite your lessons, it seemed to me to describe McArdle to a tee.

Bacevich writes that:

Adopting fashionable attitudes to demonstrate one’s trustworthiness — the world of politics is flush with such people hoping thereby to qualify for inclusion in some inner circle — is akin to engaging in prostitution in exchange for promissory notes.  It’s not only demeaning but downright foolhardy.

Bacevich is a better man than I am: he writes to warn, to educate.

I don’t, at least not here.

I think Megan McArdle is past instruction.  She has made her petty-Faustian deal with the the little Lucifers of DC, and it is my bet that when the bill comes due, it will be far too late for any education to have effect.

Which leads me to today’s update in the Always Wrong™ chronicles.  This one belongs almost entirely to Susan of Texas, the stalwart at The Hunting of the Snark who has more stamina than I will ever have in documenting the case study in the death of American journalism that is the Business and Economics Editor of the Atlantic (sic!). (h/t TBogg).

Basically, McArdle links to a post citing an anonymous source accusing HHS Secretary Sebelius and the Obama administration of silencing a critic — a health insurance company — through the threat of regulatory retaliation.

Astute readers would (and did in McArdle’s comment thread) smell the obvious rat.  McArdle has long since demonstrated that she will say anything, no matter how risible, to defend her required position that the health care bill is an abomination (i.e. required by her overlords. See “promissary notes,” above).

So it comes as no surprise that she would leap at the attempt to advance the radical right-meme that government regulation = government jackboots at the door of innocent corporate citizens.  But given the convenience with which this post supports the pre-existing narrative, those who are familiar with her work know that one’s must needs check each claim.

Which her commenters do, admirably, and which Susan O’T meticulously chronicles. Go read Susan’s work — it’s fun.  Here I’ll just give you the short form, and one thought (all I got left on a busy Friday morning.)

Shorter:  McArdle takes another writer’s claims based on a “vetted” anonymous tip that a health insurance company has been silenced by a “gag order” issued by the  government.  Turns out (a) the “threat” was a widely publicized letter Secretary Sebelius sent to the head of the health insurance lobbying organization saying, in effect, that as the law requires, that insurers will be subject to regulatory review of potentially unjustified premium increases, and if that review returns confirmation, sanctions will follow.  To which she added the warning that falsely claiming that the new health care law drove the increases would not turn an unjustified increase into a justified one.

Now, you might not like it when a regulator in your business says the regulations apply to you, but McArdle had a great deal of difficulty explaining to her comment thread how this was a gag order — and in particular how this bore, at all, on her imputation that the administration was trying to suppress political speech (“dissent” in her grubby appropriation of a word whose associations with the to-her foreign concept of courage she seeks to steal).  Basically, she just made that bit up.

Actually, McArdle more or less told her readers right up front that she was doing so.  Susan noted that McArdle’s discussion of the so-called gag order began with this phrase:  “Whatever the facts….”

My FSM!  She might as well have taken out an ad in Variety to shout that this was all bullsh*t.

I’m sure no one reading this will be surprised to learn that the facts aren’t with her.

The health insurer in question, when finally contacted by the initial poster denied the existence of the gag order.  That blogger excused his error by saying that it seemed likely to him that the adminstration might threaten someone, and that if they had, and succeeded, the gag order would have prevented the company from telling him so. Sic.

McArdle ultimately updated her post to reflect this fact, after being contacted directly by the company in question.  She added this remark:

I shouldn’t have linked the HCSC situation to Sebelius’ letter, which I’ve been meaning to write about for days; I took the words “gag order” to mean something they didn’t, for which I apologize.

Uhhh…”I took the words “gag order” to mean something they didn’t?”

Is is it just me or is she telling us here that she is functionally illiterate?

How many other things can those words mean than the one we all assumed she was talking about: that someone with power uttered a command to someone else to shut up?

Of course, this is really just word salad, the one dish I know that McArdle knows how to whip up.

Her problem was that she committed a fundamental journalistic sin in a journalistic setting.  She got something big wrong, and even admits, within the body of the piece, that she didn’t even try to get it right.

Remember: McArdle accused the Obama administration of doing something very bad that it did not do.   She used words like “creepy” and  “thuggish” to describe this alleged exercise of totalitarian power.  There is nothing here that turns on a misunderstanding of the phrase “gag order.”

Instead what you see McArdle doing is to mask this great sin with a lessor one: I’m sorry, dude, but I just didn’t understand the vocabulary.  And the dog ate my homework.  And I was kinda right anyway.

To put it another way:  honest folk don’t have to make such excuses.

Last (hell of a shorter–ed.):  Whatever else happens, remember that Megan McArdle is not a journalist.  She is a shill.  A journalist would, affirmatively, actually report on claims before publishing them.

They’d ask. They would, at a minimum, read something as brief as a letter with some attention and care.

(Again, I’m just gobsmacked by that “I took the words…to mean” line.  Bluntly — if you can’t read declarative sentences in plain English with reasonable comprehension, then journalism is the wrong trade for you.)

Negatively, of course, “journalists” who routinely get basic facts in their stories wrong get fired.

If The Atlantic were even vaguely serious about its own reputation as an elite journal, it would react to the damage that McArdle daily does to the reputation of that publication and all who publish there, even those who are truly excellent writers and thinkers (thinking of you, James Fallows and TNC).

Again, there’s a simpler way to put it:  someone who can write — and not quail at pressing the upload button — the phrase, “whatever the facts”…

…is unworthy of your trust.

Image:  “Chiron instructs young Achilles,” fresco from Herculaneum.

David Brooks is Always Wrong — NPR Edition, Part Two.

March 30, 2010

Back in Part One, we covered one of David Brooks’ many transgressions as a financial pundit, his claim, repeated last Friday on NPR’s “All Things Considered” that the new health care law is a budget buster.

I called it an error.  It is more precise to term it a lie, as the best available data, stuff that Mr. Brooks cannot fail to have encountered  — CBO estimates and other, less formally constrained estimates — all support what proponents of the law have said, that the reform is mildly deficit reducing over the next decade, with the potential, at least, for major savings to come in later years.

But now, let’s shift to a wider frame.  In that same NPR appearance, Mr. Brooks offered a corollary of the presumed budget busting nature of health care reform:  a familiar, ritual claim that portrays current deficits or deficit trends as inherently destructive, unsurvivable.  Brooks complained in the piece that if the deficit did remain at a projected 90% of GDP level by the end of the decade, that would be a disaster.

He’s wrong.

Here’s why:

First, the American experience with deficit levels in that range does not suggest disaster.  Since the start of World War II, US deficits as a percentage of GDP topped at over 120% in the late 1940s (after the war, as the US was rebuilding Europe and ramping up military expenditure at the onset of the Cold and Korean Wars.  As I recall, most folks thought the 1950s were a reasonably successful time in US history, at least as far as economic growth and the creation of a thriving middle class went.

You can see a similar dynamic in the chart of Great Britain’s national debt as a percentage of GDP.  Twice in the modern period, Britain’s debt rose to more than two and a half times GDP.  The timing of the second such peak is probably easy to guess; it correlates with the combined burdens of World War One, the Great Depression, and The Great War, The Sequel demanded all the resources the British could bring to bear and more, engendering debt levels that touched the 200 percent mark in the early ’20s, never went below about 120 percent before rocketing up to over 250 percent  in the late 1940s.  The other similar spike also came in the context of extended conflict — the long-century of war that Britain waged from the late seventeenth century through the defeat of Napoleon in 1815.  British government debt climbed to over 100 percent of GDP in 1750 or so, and topped out above 250 percent shortly after Napoleon met his Waterloo in 1815.*

What is all this history doing here?  Because of what must be obvious already to the readers of this blog.

Think what happened in Britain’s nineteenth century.  Think what happened in the US during the ’50s and 60s.

Observe the fact that Britain and the US both managed to bring their debt levels down as a fraction of GDP after their rises to historic highs and the US did it again in the 1990s after twelve years of GOP transfer payments from the middle class to the rich once again unhinged the budget.

And last, for a quick, back of the envelope correction to current hankie clutching by Mr. Brooks et al., consider this from Paul Krugman.

The shorter of that already brief post:  cutting away at the debt incurred in our current attempt to use Keynesian methods to return from recession will require only modest shifts in either revenue or expenditure (or, of course, of both).  Same deal as in the fifties and early sixties — or rather a less draconiann one than that which that famous socialist, Dwight Eisenhower achieved with his 90% highest marginal tax rate.

In other words, this is yet one more case of the GOP and its useful-idiot allies like Mr. Brooks inventing facts to advance a purely political calculation.

Pay no attention to the real world, they say, nor the record of historical experience. Listen instead to the mewling and puking of the GOP deficit babies until the cry “we’re doomed! doomed!” comes to be seen as fact.

But in making decisions about what the government should or should not attempt to do, reality does matter.  And here the story is clear:  deficits  — even ones much higher than Mr Brooks has said he fears — do not imply in and of themselves extended periods of economic hardship.

What’s more:  why you borrow matters.

Certainly, there is certainly spending that is truly wasteful, in the sense that it adds little to GDP as a return on government borrowing. (See the quote from Bilmes and Stiglitz* about half way down the post at the second link; I’d link to the Harper’s original, but it’s behind a subscription wall.)

But the lesson of historic rises in debt levels and their return to lower percentages in the US and elsewhere over the last century and before is that debt properly employed is not just acceptable, but remains a critical tool to foster both economic growth and social strength.  (Once again: Keynes, much?)

And on that point, health care reform clearly falls into the realm of policy that forms part of the long term context of economic growth (and by extension, healthy government revenues, which then constrain the expansion of a public deficit).

Why?  Because, as David Brooks could have discovered had only read his own newspaper, the social contract matters. All he had to do was to check out — and grasp –some of the coverage from the exemplary David Leonhardt, for one.   (Leonhardt remains one of the most significant reasons one still has to read the New York Times.)

Consider this one, on the significance of health care reform on innovation.

This is not to suggest that Mr. Leonhardt, as good a reporter as he is, is some gold standard of judgment on economic policy.  But his work and that of many people who actually know things about fiscal policy and health care economics have noticed that the particular form of a nation’s health care system can have enormous consequence for seemingly completely unhealth-related sectors of the economy.

For jsut one example: the social safety net helps in difficult-to-quantify ways because, it turns out, it is when people feel secure in their basic needs that they accept more risks.  They leave bad jobs to seek better ones; they invest in their own education; they, as Leonhardt details, are more willing to gamble on their own vision as entrepeneurs.

It may be difficult to quantify, or rather to predict the degree to which such easing of care will add to GDP, and hence increase government revenues, and hence to reduce the scale of government borrowing, but the underlying concept is just not that hard to grasp. The idea that you will be more adventurous economically f you know that you or your kid won’t lack for access to health care if something goes wrongis beginning to penetrate the mass media in such distant locations as the Fort Worth Star-Telegram.  Apparently, the news has yet to reach the more hypoxic floors of the Great Grey Lady (formerly) of 43rd St.

Update: Via Brad DeLong, see Mark Thoma saying the same thing, only better.

From that thought, let me hand the next step of the argument over to old friend Tim Ferris, who in his recent book, The Science of Liberty notes that Democrats have consistently achieved a better economic growth outcome through that party’s commitment to a market system with a social network and a regulatory framework, compared with the GOP’s pursuit of policies that underregulate the market and undermine — at least confidence in — the social safety net.

Arguing from a classically liberal viewpoint  Ferris reports what is available to anyone (are you paying attention, Mr. Brooks?) (No.  SASQ — ed.) with access to Teh Google, that economic growth is much better maintained by Democratic adminstrations and policies than by the GOP lip-service he pays so readily to the icons of budget puritanism.

Specifically, Ferris writes,

Party politics may be a crude metric, but the United States in the past half century has experienced faster GDP growth, lower unemployment, and higher corporate profits during Democratic than during Republican administrations. The stock markets performed better, too, with annualized returns on investment averaging almost 9 percent when Democrats were in office against less than 1 percent for the Republicans. (The Science of Liberty, p. 25.   Emphasis added.)

The details of what parts of the two competing approaches to governance actually make the difference are (a) enormously complex and subject to debate and (b) beyond the scope of this blog post.  But the key point is, or should be obvious.  Deficit spending in itself is not the driver of outcomes.  It’s what you do with the money, and whether you address critical social/economic needs with your borrowing that counts.*

Which means: the general claim of deficit apocalypse is bullsh!t, a right wing mantra now being pushed to counter Democratic efforts to solve some of the problems that eight years (and most of the last thirty, in fact) of often criminal misrule have left behind.

In that context, health care reform is more than a moral victory, a statement by our society that tens of thousands of people per year should not die for lack of insurance.

Health care reform is more than mildly deficit reducing, a small down payment on the much larger reform that could both enhance the quality and reduce the cost of care by creating a national body of knowledge about best practices whilst paying for care rather than procedures.

Rather, or on top of those public goods, health care reform as just enacted is one of a number of critical steps towards creating the economic context for the next sustained epoch of growth.  A society whose members gain a greater share of numbers three and four of Franklin Delano Roosevelt’s iconic freedoms is one that will be far better placed to prosper (and thus shrink deficits as a percentage of GDP) than one in which sclerotic institutions and an ever less flexible labor force constrain every attempt to come up with the Next Big Thing.**

In that context, I guess the only remaining question is why David Brooks — and his too-many allies on the right — so hate America that they’d rather see a budget balanced on the ill-health of the nation instead of a society betting on its own members to create a richer future.

*All this is not to say that medical care cost inflation isn’t a serious problem in the medium to long term.  It is.  But (a) the problem is worse without health care reform than with it; and (b) the real significance of health care reform is that it creates the context for further reform.  Clearly the proof will be in the pudding, but several next steps are obvious, and the new law contains several elements of cost-control mechanisms and the capacity to perform policy experiments

**And of course — if you take Ferris’s historical analysis seriously, and I do, then the first two of Roosevelt’s four freedoms are equally important to the formation of a creative and scientifically innovative society.

Images:  Maria Fyodorovna, “The Miser,” 1890

Great Depression photograph, courtesy of the Franklin Roosevelt Library and Museum,”Public Health nursing made available through child welfare services.”

Thomas Eakins, “The Agnew Clinic,” 1889.

David Brooks is Always Wrong — NPR Edition, Part One.

March 27, 2010

I know, I know.  It should be Megan McArdle up there; in some views, she’s retired that title, and it sits up there above the right field bleachers next to the 1, the 4, the 6 and the rest.  (Sacrilege!  Must this blog stoop so low?)

But the problem is, David Brooks is always wrong.  I keep on not finishing the piece I’ve been trying to get to you about a column he published last December, just because my brain explodes twice a week, and I faff and fiddle trying to figure out how to nail down that slab of jello that is Mr. Brooks’ approach to the task of reasoning.

Seriously.  His picture is next to that entry in the dictionary of quotations that reads ““It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.”

And so, though McArdle’s body of work remains a uniquely target-rich environment, Brooks, vastly more influential than Mme. Galt, and hence the more dangerous, must needs become the object of our attention with ever greater regularity.

Hence, this. (And this:  part two here.)

The occasion?  His weekly appearance last Friday on NPR’s All Things Considered, opposite E. J. Dionne.  There discussing the politics of the health care bill, he repeated two claims he’s making with increasing frequency as he grapples with the ongoing refusal of Barack Obama to take his advice.

These were that, for all that he applauded Obama and Pelosi for succeeded in the mechanics of passing the bill, he still hated it, because it was (a) a fiscal disaster, and (b) implicated in the projection that the deficit will be 90% of GDP by the end of the decade, which he termed calamitous (not his exact words — but the sense was there — Mr. Brooks sees current policy as driving us over a precipice.

The only problem?  Both of these statements are convenient nonsense. This is what conventional wisdom looks like.  Everyone knows — especially that professional everyman, Mr. Brooks — that spending on social programs is purely optional (and has no society-wide positive effect), that the current federal tax rate is the highest that it is possible to imagine sustaining, and that hence every choice to spend must drive deficits ever upward — and, as well all know, that deficits are the devil.

Now, this isn’t the post in which I’m going to dive deep into the usual — and true — observation, that it’s hard to take deficit hawks seriously who cheerfully swallow unfunded wars while rejecting explicitly budgeted reforms like the recent health care effort.  But it is important to push back on what seems to be the “serious” USDA approved™ meme on the health care issue — nice job, Dems, but you’ve bankrupted the country again.

So here’s the scoop.  Without being a Congressional Budget Office fetishist, it is important at least to acknowledge the data that one can gather.  And, as everyone knows who has paid even a scant bit of attention to the whole HCR farrago, the CBO has scored the bill that finally passed for its impact on the deficit.

It’s conclusion:  that the bill will lower the deficit by 130 billion dollars over the next ten years, and those savings could reach past a trillion over the next decade (though the CBO notes that such long term forecasts are wildlly unreliable).  For further discussion of these points, and some more conservative estimates of the deficit lowering capacity of this bill, see here, here and here.

That is to say, Mr. Brooks had it exactly reversed when he claimed that this bill was fiscally irresponsible.  It saves federal budget dollars.  It doesn’t do enough, IMHO, and I hope the murmurs are true that the public option and other cost-saving and coverage-expanding measures will make their way into the reform over the next few years, but it is better than what we got.  It is, to state it plainly, more fiscally responsible than any of the realistic alternatives, whether the status quo or the GOP death by rationing approach, by any coherent understanding of the term, “responsible.”

But for all of the annoyingly lazy repetition of what has been a false GOP talking point for months, (I heard you were supposed to be the thoughtful one, Mr. Brooks), it’s the second of the genial pundit’s two claims that is truly dangerous.  The campaign, in which Mr. Brooks is really no more than a willing subaltern, to portray the deficit as a kind of domestic policy al Qaeda, is really an effort to lock the current balance of power and social distribution of wealth into more or less it’s status quo.  It’s up and running with a vengeance, and at stake are not merely the spoils of wealth now, but the long term prosperity (and hence power) of the nation.  For details, please turn to part two.

For the second half of Mr. Brooks’ errors of fact and argument, please turn to part two.

Image: Albert Bierstadt, “Falls of Niagara from Below” before 1902.

Quickie Post, to let you know that David Brooks has finally revealed the secrets of conservative math.

March 23, 2010

I’m on the road again in yet one more Newtonpalooza, so no substantive posting is going to happen, but I saw in my morning check of Balloon Juice (the only source for news you can really use) that David Brooks has produced another of his considered analyses to explain the real meaning of critical events.

The whole thing is yet one more sample of the unique combination of credulousness and really dangerous hackery-in-defense-of-establishment-power that characterizes Mr. Brooks’ work, and I’m going to try to go blog-medieval on it in the near future.   But here I just want to point out the implications of the delicious sentence that Mr. Brooks writes one truly revealing sentence, the one quoted by DougJ in his BJ snark:

Nobody knows how this bill will work out. It is an undertaking exponentially more complex than the Iraq war, for example.

The overt dumbness has already been dealt with at Balloon Juice.

As the commenters there point out, the only honest response is “Uh…..noes.”  It is also all you need to explain why the GOP so badly botched everything about that war.  They thought and think this is true, that destroying a country and rebuilding would be simpler and cheaper than regulating insurance companies.

(On that note — about two years into the Iraq war I had the chance to talk, completely informally with Madeleine Albright.  Among much else interesting, she told me that in the briefing she and other former high-ranking Clinton and Bush I officials received in the run-up to the war, the Rumsfeld DOD had made essentially no after-conflict plans, which we know now to be exactly right.  She told me she raised the thought that this was wrong, that real post-conflict planning had to be done to deal with all kinds of things, from the vacuum in civil power to economic matters.  She was, she said, brushed off by the Bush version of the Best and the Brightest — the So-So and the Not-Quite-Set-To-Be-Watered-Twice-A-Day).

But enough of ancient history.  I’m still wallowing in the mess of trying to understand  Mr. Brooks tortured diction.  Just what the hell could he mean by “exponentially” in this context?

Well — math jokes are not for amateurs, and I certainly don’t want to dive into xkcd territory (No! No! No!  Quantum leaps are really smalllllll), but it occurs to me that Mr. Brooks’ statement is more than usually meaningless if you don’t know what exponent he’s thinking about.

And then it became clear.  The only way any of Mr. Brooks’ attempts to assert some connection between his thought and that fundamental tool of science, mathematical reasoning actually makes sense, given the gap between reality and his accounts of it, is if that exponent contains the factor “i.”

That is all.

Image:  Nicolas Neufchâtel, “Nürnberger Schoolmaster Johann Neudörffer and a Student,” 1561.