Yes, Yes, Becoming an M.D. Involves Traveling Down a Long, Expensive Road

Still, I would feel more sympathy for this guy if he hadn't forgotten to tell us his starting salary when he completed his residency and got his first gig at full pay.

First, I was 32 when I began training and I now had over $230,000 in debt. Had I invested my talents in other pursuits such as law school, I would not have built up this level of debt.

True, but you also might not have a job. So there you go.

Here's the thing: If your first job as a full-fledged M.D. pays, say, $250,000.00 per year,¹ you can live very comfortably while paying off your entire student debt load in five or six years. If you're already used to surviving on the "salary of $39,000" that you earned as a resident, even with that type of rapid pay-down it should be a very comfortable transition.

Also, as I did not start saving when I was younger, financially speaking, I have lost the past 10 years without the ability to save and invest to earn compounding interest.

You traded one type of investment for another, and ended up in a career that (I hope) you love. Do you have any regrets?

In addition, as physicians, though we make more money than many others, we are not reimbursed for many of the services that we provide.

That could mean a lot of things, but I suspect that he's saying that when you agree to accept insurance you're often going to end up being paid by a scheme other than straight fee-for-service, such as a D.R.G., and thus you may not (technically) be paid for the full scope of services you provide to a specific patient because you've agreed to accept a specific fee for any treatment that falls within the D.R.G. That's not the same thing as going unpaid, and obviously you think it's a good deal on the whole because you continue to accept insurance and continue to make a large salary. Most businesses could only look with envy upon such a definition of "not reimbursed".

I want to make it clear that this letter is not just another story about the difficulties of becoming a doctor and being successful in medicine. I do not want you to think I am complaining about how hard my life is and used to be. In fact, I love my job and there is no other field I would ever imagine myself doing.

In other words, on the whole you got a very good deal for your investment of time and money.

My true wish is to illustrate the sacrifices doctors do make because I feel we are not represented when laws are made. These sacrifices include a lack of quality family time....

That's going to vary with specialty. There are highly paid specialties with regular office hours, for those who choose that path. Some doctors choose to become administrators. Some choose lower-paid specialties that allow them to spend lots of time with their families. These are the choices we make.

Let's be clear here, other well-paid professions have the same or greater demands. The lawyers you complain about may be working 80 hours per week, and virtually all of them make less money than you did on your first day of full-fledged practice. Some accountants can barely come up for air during tax season.

Yes, it would be ideal if everybody could earn a massive paycheck without their work ever impinging upon family time, but if you look around you'll find that a great many people sacrifice family time for their jobs while collecting a pretty meager wage. Next time you stop by a 24-hour big box store, grocery store, pharmacy or gas station at midnight, ask yourself - how many people working at that store have families?

...our large student loan debt...

Large, but easily manageable. Many other graduates with high debt loads would find your position enviable - and with cause.

...the age at which we can practically start saving for retirement...

Median household income in Michigan is around $50K per year. Typical compensation for a gastroenterologist is about $330K per year. So in the space of six or seven years, you'll earn roughly the same amount as a pretty typical U.S. family will earn over a career, perhaps more. So tell me again, how hard it is to save for retirement.

...and the pressure we face with lawyers watching every move we make.

Sorry... I'll try to avert my eyes next time.

No, seriously, I recognize that nobody likes to be accused of malpractice, and acknowledge that doctors feel some pressure from the fact that they can be investigated and sued for malpractice if things go terribly wrong for one of their patients, but what does that have to do with the cost of a medical school education? Besides, bringing malpractice into the picture belies your prior argument that doctors "are not represented when laws are made" - states have for the most part bent over backwards to create legal environments in which it's exceptionally difficult and costly to pursue malpractice litigation, and where damages are artificially capped even when it's beyond dispute that a patient has suffered catastrophic injury from the most egregious malpractice. What more do you want?²

I'm not going to argue with you, that the cost of obtaining a medical degree is high, and that there are significant burdens on those who enter the medical field. You want the public to subsidize medical schools and residencies, so that you graduate with a lower debt load and, after your initial medical education, have a more comfortable lifestyle? I'm listening - if we give you that, what are you offering in return? How about we reduce compensation for medical care to an amount more in line with the amounts paid by the rest of the world? Do we have a deal?
----------------
1. That's on the low side for a gastroenterologist.

2. The implied answer is "absolute immunity". One of the things that "tort reform" advocates gloss over is that with low "pain and suffering" caps on malpractice verdicts, the big exposure is for economic damages - largely future medical care. One of the reasons our malpractice costs are higher than the costs in nations with comprehensive national health insurance is that a national health plan will cover much, sometimes all, of that future cost. I would happily take the trade.

Is it Really Hamid Karzai Who is Confused?

Stephen Biddle and Michael O'Hanlon opine,

For most Americans, Afghan President Hamid Karzai’s words and actions are difficult to understand and hard to accept. He often seems ungrateful for the efforts of U.S. troops, cavalier in his ideas of how to change the Afghan-NATO military campaign and irresolute in his commitment to the war effort. He has suggested that our troops stay out of Afghan villages even before Afghan forces are ready to handle security there. He has chastised NATO soldiers for occasional, and clearly unintentional, mistakes that led to civilian casualties. He has withheld a promise to give our troops legal immunity if they stay in his country beyond 2014. He has even equated the U.S. role in prolonging the war with that of the Taliban.

We are among those who wish Karzai would stop this behavior.

So far, nothing to explain Karzai's behavior, just a wish that it will stop. Insert obligatory 'wish' clip here:

Come on. It's not like Karzai's the new kid in town. He was selected to govern Afghanistan more than a decade ago. His predilections are well known and, at this point, even predictable. The authors explain,

Karzai is not, as some have claimed, crazy or a fool. He is confused.

Seriously, he was selected by the U.S. and put in charge of Afghanistan back in 2001. He's been presiding over as much of his country as the U.S. can control for more than a decade, he has access to local Afghans, the military, the CIA, U.S. political leaders, and... he's confused? If that's true, then he is fairly characterized as a fool. If he's no fool, it stands to reason that the people who are confounded by his actions are the ones best characterized as confused.

In his view, the world’s only superpower is surely able to defeat a ragtag force of Taliban guerrillas — if it really wanted to. In his view, the United States could surely force Pakistan to stop harboring Afghan Taliban insurgents — if it really wanted to. Yet Washington does neither. On the contrary, Karzai watches Americans look the other way while their logistical contracts are siphoned off to support the Taliban (albeit less so lately), and he sees Americans give billions of dollars in aid each year to their ostensible Pakistani tormentors. Karzai concludes that there must be some hidden reason for the apparent contradictions.

We could start by traveling back in time to 2002 or so, when people like Michael O'Hanlon were cautioning us that an invasion and occupation of Iraq would require a massive military force and many years to complete, then proceeded to cheerlead for military intervention. Somebody in the position of Hamid Karzai might look at the shift of attention and military resources from Afghanistan, the Taliban and the ungoverned regions of Pakistan, as evidence that the U.S. could have done more for Afghanistan and its immediate region but chose other priorities. The authors admit as much in their essay - while conveniently neglecting to mention O'Hanlon's own support for the Iraq war.

A president of a nation like Afghanistan might consider, "What happened to the last president of this nation, put in place by a foreign power, after that power's priorities changed," and be a bit... nervous. Particularly if he considers that during the last years of that president's rule, after withdrawal of the foreign power, the western world looked on and speculated, "How long can the Soviet puppet government last," with it eventually collapsing and being replaced by the Taliban, in early 2001 received significant U.S. financial support based upon their being anti-drug.

The message to Karzai, or anybody else in his position, is that they can only count on the U.S. to serve its own interests, and that once the U.S. withdraws they have to choose between staying in the country and trying to govern based upon their own political and military power, or getting out before another collapse. A lot of people in Karzai's administration seem focused on the latter approach - skim and loot as much money as possible, stash it overseas, and prepare for a very comfortable "life in exile". But if you give Karzai the benefit of the doubt, he is not so much trying to undermine the U.S. as he is trying to position himself to survive and govern once the U.S. withdraws - so again, if we're assuming Karzai is no fool, while we might prefer that he not engage in acts of self-preservation that conflict with U.S. goals for the region, and while we may prefer that he find other ways to prepare for the future, we should not find his actions to be confusing.

The authors concede that many of Karzai's "apparent contradictions are unintended byproducts of U.S. efforts to craft a nuanced policy". That is, a balance between the "limited" security interests of the U.S. in Afghanistan, vs. concerns about al-Qaeda. The authors don't mention that a stable Pakistan is considerably more important to the U.S. than a stable Afghanistan. By this point the authors are contradicting their earlier insinuation, that Karzai is inferring "hidden reason for the apparent contradictions" in U.S. policy, and are effectively admitting that the U.S. could do more to defeat Afghan guerrillas or to pressure Pakistan (or act unilaterally) to strike Taliban forces on the other side of the Pakistani border, but that the U.S. has other priorities.

In the author's words, Karzai "frequently elevate his domestic political interests above the needs of his alliance with the United States or of the war effort." That's not "confusion" - that's grasping the reality of the situation. To the extent that the authors are correct, that Karzai displays a level of emotional instability that is not helpful, it's reasonable to respond that his personality is no secret. Whether is outbursts are genuine or calculated, it's reasonable to infer that he does enough to advance U.S. interests to remain in power. The fact that he's engaging in actions that frustrate O'Hanlon and Biddle suggests that he wants to maintain that hold on power, rather than hopping onto the last helicopter out of Kabul when U.S. forces finally depart. Frankly, if you're concerned about the future of Afghanistan, you should be more concerned about a president who always bends to the will of the U.S., as odds are he's planning a future in exile and... if he's not, odds are you'll be dealing with his successor a very short time after U.S. forces withdraw.

Shipping Cost Fraud and Misrepresentation on Ebay

One of the problems with buying on eBay is that, although there are many legitimate sellers, there are also many sellers who engage in dubious or even fraudulent business practices, and even in cases of unambiguous fraud eBay seems to do nothing to shut down dishonest sellers. (Similar problems seem to be arising on Etsy - it looks like they shut down some obviously fraudulent sales, but the vendor is still going strong.)

One convenience of eBay is that you can search by price, with or without shipping, to sort through the offerings of vendors who are selling the same product at various price points. By including shipping in your sort, you avoid the vendors who try to trick you into buying what seems like a low-priced item, but makes up for it (or more than makes up for it) with excessive shipping fees.

Or, at least, that's the way it should work. eBay's listing policies should ensure that there's no confusion:

When you create a listing, make sure all your text and other information are complete and consistent throughout. For example, you can't say one thing in the title and then describe it differently in the description....

Not Allowed: Inconsistent details throughout your listing (titles, descriptions, product details, shipping, payment information, and so on)

To push misleading shipping costs into the search feature not only necessarily involves hiding additional fees somewhere in your listing other than the area in which shipping costs are to be described, it undermines the integrity of the search feature - the abusive seller can rank above honest sellers who accurately list their shipping costs.

I expect that regular users of eBay are well aware of this type of fraud. It's the less frequent user who is apt to get burned. Shipping cost manipulation has been going on long enough that last year somebody did a study of how hidden shipping charges affect sales. They did not do the experiment on the U.S. eBay site because the U.S. site is designed to "automatically reveal[] shipping charges in its search listings". But that, of course, presupposes an honest vendor.

Let's take a look at how this works. Here's a screen capture of a sale by a vendor named garrys_world_exchange_square (Yee Mei Tam):

Very clearly, shipping to the U.S. is listed as $3. Does that seem low? If so, you probably click on "See details" to see additional terms.

And right there, you find a shipping calculator. Enter your ZIP code and, sure enough, it confirms that shipping to your address is $3.

So you place your order and next thing you know, you're being told that you have to pay an additional shipping charge. "What?", you say, "I made this purchase based upon the flat shipping fee you described in your listing. I confirmed it with your calculator! What gives?" And a vendor like garrys_world_exchange_square will respond, "If you read the description for the product you'll see that I said there's an additional charge for shipping to the United States."

Note that as eBay listings are described, when you click that "See details" link for shipping - you know, to get to the place where any additional details related to shipping are supposed to be described - the description is no longer visible on the page. So unless you click back to the description and scroll way down "below the fold", you are not going to learn about the additional charge. The content is hidden from the "Shipping and payments" view of an eBay sales page.

Again, this seems to be a painfully obvious violation of eBay's rules for listings - you aren't allowed to have inconsistent details in your listing, including inconsistent details pertaining to shipping. But a very useful site called Toolhaus provides a more comprehensive look into a seller's conduct than you can get directly through eBay - particularly given the games and tricks that dishonest sellers use to get negative feedback removed from their profiles.

With this particular seller you learn that he has a long history of misleading consumers about his products (e.g., for movie sales, "Never told in description it is uncut. Already listed the total running time" and "I have never mentioned that it is the remastered version"), has many complaints about misleading shipping prices ("False Advertising - stated shipping 3.00 then wants 30.00 let money to pay ebay"; "If you buy from this seller, scroll all the way down for TRUE shipping charges"; "Ensure DVD region code works in your country +Read fine print on his shipping"), and on top of it all he's obnoxious ("Refused to pay and left me -ve feedback! Are you nuts?"; "I already return your money order, Why do you leave bad feedback? How absurd !!"). I like this one:

Feedback: Dvd did not contain complete movie. No reply to my emails. Got Taken !

Response: You're already left Negative for me, How can I refund payment for you ? Crazy !!

I had no idea that it became impossible to refund a purchase price if the buyer complains that you sent a poor product. You learn something every day.

Seriously, hasn't eBay established a sufficient base of sellers that it can afford to enforce its rules and purge sellers who engage in sales tactics that are fraudulent or intentionally misleading, even to the point of diminishing the quality of its search and rendering its postage calculator useless?

"This Court Will Not Tolerate Allusion!"

Michigan has a crime commonly known as "fleeing and eluding," MCL 257.602a. One might argue that if you are brought before a court on that charge, your very presence undermines the prosecutor's contention that you are guilty of eluding, but... I split too fine a hair - the actual statute does not require that you be proved to have been successful in eluding your pursuer.

A couple of years ago the Court of Appeals apparently took an entirely different view of what it means to... elude:

Defendant appeals by leave granted his guilty-plea convictions of third-degree fleeing and alluding, MCL 257.602a(3)(a), and driving while license suspended, second offense, MCL 257.904(3)(b). Defendant was sentenced as a third habitual offender, MCL 769.11, to 30 to 120 months' imprisonment for the fleeing and alluding conviction and 144 days in jail for the driving while license suspended conviction. We affirm.

People v Kade, No. 285402, 2009 WL 1941372 (Mich Ct App July 7, 2009). A sentence of 2-1/2 to 10 years for alluding? I wonder if that includes a sentence enhancement for mixing metaphors.

Teaching and the Measure of Greatness

The other day I saw a brief interview with Michelle Rhee, in which she defended her stance on the apocryphal sign she claims to have seen in a school, "Teachers cannot make up for what parents and students will not do". If I believed the sign existed, I might point out that it's true. Rhee would be correct in arguing for nuance - teachers can't make up for everything that's missing at home, some parents and students are lazy, and teachers can only do so much, but problems outside of the school are not an excuse for not making the strongest effort possible to close the gap. But Rhee uses the sign (which, again, I'm not convinced that she actually saw) as a basis for a blunt attack on the teaching profession.

Rhee claims that she can attest to the power of great teachers because, on an apocryphal occasion when she visited a school, she talked to some teenagers who told her that their teacher for their first period class was wonderful. After... I guess it was roughly an hour-long visit to the school, after that class ended, she saw them walking out of the building after their first class. "Where do you think you're going," she asked. "Our first teacher is great, our second teacher isn't, so we're outta here," they replied.

Rhee argued that these kids weren't lazy - you might see them cutting class and think, "What a bunch of ne'er-do-wells who won't amount to anything", but Rhee assures us that they were sufficiently motivated to get to their first class so... I guess the rest is on the teachers.

But I couldn't help but wonder, why didn't Rhee ask the obvious follow-up questions? "What's great about your first period teacher?" Or, "What don't you like about your second period teacher." She simply assumed that the teacher for the first period class was a gifted, extraordinary educator, and the teacher for the second period class was not.

Back when I was in high school, if you were to hear a similar group of kids talk about how a teacher was "great", a follow-up question, "What makes him great," might result in the answer, "All we do is watch movies." Or, "We just talk the whole time." Or, "She lets us hang out in the back of the room and talk with our friends." I don't recall ever encountering a student who displayed the casual attitude toward attendance that Rhee describes indicating that a teacher is "great" because you work hard, learn a lot, have high expectations, no excuses accepted.... In my experience, that's going to inspire a different descriptor, "His class is hard."

In Rhee's anecdotes she seems to believe that kids will go to school for what kids of my era described as "hard" classes, and go home instead of staying for the classes they then described as "great". I don't think it's that kids have changed - I think the problem is that Rhee asked the wrong questions, and as a result drew the wrong conclusions.

I don't want to diminish Rhee's accomplishments with the D.C. schools, but at this point I continue to see her successes as largely administrative. For example, creating a new, efficient system for the distribution of textbooks. Yet she has refused to take any responsibility for the cheating scandals inspired by her high-stakes testing, for the accounting irregularities that had money magically disappearing and reappearing in the school budget, or for the successful lawsuit brought by teachers she defamed. In her view, is that living up to a standard of "No excuses" - ignore your mistakes so that you never have to talk about them, and you can't be accused of making excuses for yourself?

If so, alas, she continues to personify what is wrong with educational administration in this country - administrators, well-intentioned though they may be, engage in what amounts to wholesale experimentation on kids and who, after leaving or being forced out, blame everything that continues to be wrong on the size of the job they faced, or their successor.

The story of education reform goes pretty much like this: Every ten years we embrace educational reform. We throw a lot of money into the reform ideals. They fail. Lather, rinse, repeat. Rhee and the high-stakes test seem to be yet another entry in that recurring story line. The problem as I see it is that the high-stakes testing, the diminishment of teaching as a profession, and the wholesale effort to privatize schools, break teacher's unions, lower teacher pay and reduce their benefits is likely to have a profound, long-term negative impact on schools. Why be part of the problem?

The End of Google Reader and the Future of Blogging

For those who use it, Google's announcement that it's killing off Google Reader is probably a bit of a surprise. After all, with the simplification of the Reader shortly after the introduction of Google Plus, it seemed like it was in a pretty easily supported maintenance mode. But... there's no profit, and no future, in maintenance mode products.

The actual announcement has resulted in some reactions that are, oh, perhaps a bit over-the-top. The idea that you won't use a new Google product because an older one you like is being phased out is superficially understandable, but the fact is that even products that are immensely profitable for a company can eventually become obsolete. There's nowhere you can go in the online world with certainty that the product you know and love won't be discontinued, in some form of maintenance mode, or suddenly and dramatically reinvented into something you barely recognize.

What Google's action says to me is that people are continuing to shift from using RSS feeds to follow blogs and news sources and toward other means of aggregating content or finding interesting links. Yes, the skeptics are likely correct that Google wants Reader users to shift over to Google Plus, even if it doesn't offer the same functionality. But I suspect that the biggest issue for Google is that people truly are shifting away from Reader, and although those of us who use Reader may find it extremely useful, we're a shrinking minority of Internet users.

My personal reaction to the news was two-fold. First, it's difficult to monetize RSS feeds, so people have been pretty passive about pushing them on the public. Second, people are shifting away from blogging, as such, and are switching over to more casual or less time-intensive means of sharing their thoughts or keeping in touch with friends. The push toward Google Plus is not just about use our new product, not our old one, it's consistent with a general shift away from blogging.

Although the numbers are approximate, blogger is shown by compete.com as being down by more than 2 million unique visitors per month over the course of a year, more than 40% of its traffic. Although the drop-off on blogspot (the URL that serves blogs hosted by Google) is less significant,

If the content is being created elsewhere, eventually the traffic will go there as well.

I am left wondering about the future of blogging. I've never seen blogs as much more than a simple CMS (content management system) that allows people to easily publish content, albeit in a somewhat constrained format. It's treated a bit differently than other content by search engines - on the whole, it appears to be treated as being of shorter-term interest so, although a page can generate authority by drawing in links or hitting a sweet spot for search terms, for the most part blog posts are lost to time. I haven't spent enough time browsing blogs in general to see whether blogs are becoming "more serious" - whether on the whole it's the lighter, more casual conduct is what's drifting off to other mediums. If it is, then perhaps blogging will ultimately evolve into something more serious. But if the trend is across-the-board, it's quite possible that conventional blogging platforms will go the way of livejournal - once an Internet phenomenon that remains significant, but... appears to have lost about half of its traffic over the past year.

One way or another, if public interest is plummeting and the future lies in another direction, major companies are going to shift their resources in the new direction - and eventually will discontinue their support for the dying platforms. If it worries you that because Google discontinues one product it might later discontinue another, you're right - it could happen. But unless you're content to limit yourself to what you save on your own hard drive, that's true of any company and product. If you are going to grouse, "I won't use Google Keep because Google is killing Reader", great... and are you switching your phone to Apple, a company that has at times killed products and services, Microsoft, a company that has also at times killed products and services, or RIM/Blackberry, a company that is in danger of being unable to support its proprietary mobile OS?

If you're posting your complaint on a blog, as I intimate above, you may be missing the forest for the trees.

Plagiarism or Miscommunication

When you watch syndicated columnists and talking heads, most notably those on the political right, you can see how quickly a particular theme or argument can be distributed - how the same words suddenly appear in the columns or are heard from the mouths of dozens of partisan opinion leaders. While sometimes a catchy turn of phrase will catch on quickly, in many cases it's more than fair to assume that they've received those talking points from a common source. More so when the words fit with a new political attack, or are part of a Frank Lutz-type effort to skew the language to be more favorable to a Republican cause.

Also, it's not particularly unusual to see a major newspaper carry an opinion column by a prominent person who otherwise has not demonstrated either the necessary interest or capacity to pen a coherent opinion column. Sometimes a co-author is credited, but sometimes it's pretty clear that the column was written by somebody else. That could be a staff member, but let's not forget that advocacy groups often write opinion pieces that they shop around to politicians - "Stick your name on this, and we can get it into the Post or the Times."

At the next level, we have the payola-type scandals that periodically hit the news, when it is revealed that a columnist is taking money to advance a particular cause or idea. Columnists caught with their hands in the cookie jar typically protest, "I took the money, but I wrote exactly what I would have written had I not been paid." But... do you believe it? Obviously the people paying them do not.

So when I hear that a columnist like Juan Williams has plagiarized, yes, the theory of double plagiarism could be true. It could be that Juan Williams believed that he was only plagiarizing his assistant, and that using his assistant's words without attribution was fair game because "everybody does it". But it could also be that the intern was given an instruction that he simply misunderstood. Something along the lines of,

Get me some content from an immigration organization that I can use to pump up my argument.

Under this theory, the intern may have believed he was tasked with researching the findings of organizations that had written reports on the subject, and then communicate that information back to Williams. But Williams may have expected that the intern would contact somebody within an organization whose beliefs were aligned with the argument he hoped to "pump up", not to get their published findings, but to get a pre-written passage or column that it was understood would be plugged into his column with few or no changes.

Many years I heard an interesting story from the employee of a manufacturing consortium. She was tasked with putting together the newsletter, and they were coming up on a deadline to send it to the printer. Her boss had instructed her that one of the articles needed to be more compelling, and told her to contact a specific U.S. Senator's office to get a quote supporting the article's thesis. She tried to get a quote, but was unable to get through. "Don't worry about it," she was told, "Run the quote and we'll get him to clear it after-the-fact."

When you have sufficient prominence and sufficient connection, the rules don't apply to you in the same way that they perhaps did during your earlier career. It's not really a surprise that some columnists think it's okay to take a payoff to write opinion pieces that they rationalize, "I would have written anyway," that they think it's okay to plagiarize their interns without attribution, that they borrow words, phrases, and even entire columns from advocacy groups who are trying to push the same message. What harm is there in letting somebody else do the heavy lifting for you, if you're already essentially on the same page, right?

The sad part, it seems to me, is that these games are played on a massive scale, the efforts to rein them in seem half-hearted, and the consequences for getting caught usually amount to nothing.

Ruth Marcus, Susceptible to Self-Satire

Ruth Marcus appears amused that some of her peers can't recognize obvious satire,

The item was too delicious to resist: New York Times columnist Paul Krugman, he of the don’t-worry, be-happy approach to the federal deficit, had been forced to declare personal bankruptcy.

Except it wasn’t true. The tidbit was satire, from a Web site called the Daily Currant. The Currant’s “tell” was obvious to anyone who took introductory economics: Krugman, it said, had attempted, like a good Keynesian, to “spend his way out of debt,” after “racking up $84,000 in a single month . . . in pursuit of rare Portuguese wines and 19th-century English cloth” — a wink-wink reference to the classic examples of comparative advantage in international trade.

The piece would be stronger, of course, if it didn't open with Marcus caricaturing Krugman's views, or even if it were clear that Marcus knew what she was doing. It would have taken even the more credulous of her peers mere seconds, minutes at most, to determine the source of the Krugman satire, or that Krugman had not declared bankruptcy. So what's Marcus's excuse for not knowing the views of an economist who has been anything but a wallflower on these issues?

Here's Krugman on debt:

Now, the fact that federal debt isn’t at all like a mortgage on America’s future doesn’t mean that the debt is harmless. Taxes must be levied to pay the interest, and you don’t have to be a right-wing ideologue to concede that taxes impose some cost on the economy, if nothing else by causing a diversion of resources away from productive activities into tax avoidance and evasion. But these costs are a lot less dramatic than the analogy with an overindebted family might suggest....

So yes, debt matters. But right now, other things matter more. We need more, not less, government spending to get us out of our unemployment trap. And the wrongheaded, ill-informed obsession with debt is standing in the way.

And more recently:

Bear in mind that the budget doesn’t have to be balanced to put us on a fiscally sustainable path; all we need is a deficit small enough that debt grows more slowly than the economy. To take the classic example, America never did pay off the debt from World War II — in fact, our debt doubled in the 30 years that followed the war. But debt as a percentage of G.D.P. fell by three-quarters over the same period....

So we do not, repeat do not, face any kind of deficit crisis either now or for years to come.

There are, of course, longer-term fiscal issues: rising health costs and an aging population will put the budget under growing pressure over the course of the 2020s. But I have yet to see any coherent explanation of why these longer-run concerns should determine budget policy right now. And as I said, given the needs of the economy, the deficit is currently too small.

In simple terms, Krugman is explaining that deficits matter, but that if they're at a sustainable level they're not a threat to the economy, and that the time to worry about balancing the budget is when the economy is booming in part so that you can avoid self-destructive austerity measures and afford sufficient stimulus spending when the economy is faltering. It doesn't seem that hard to understand... unless, as it seems, you're a Beltway pundit or a Republican partisan.

Do you remember who actually took the position that "deficits don't matter"? A guy whose administration used the Clinton surplus as an excuse to slash taxes for the rich, ran up huge deficits during a period of economic recovery, and crashed the economy on its way out of town. Did Marcus ever so much as whisper a word of criticism? If so, I missed it.

But, oh, something seems familiar about Marcus's quip. "Don't-worry, be-happy." Oh, right, the time Marcus humiliated herself by trying to take on Krugman in public. (Do I give her and her peers too much credit by assuming she's been introduced to at least one take-down of that piece? Mark Thoma: "Ruth Marcus Tries to Show Her Beltway Badge of Seriousness"; Brad Delong piles on. Krugman commented primarily to point out that Marcus didn't understand the statement that she had used as the centerpiece of her attack.)

I really think it's time for Marcus to do the tiny bit of work that she recognizes would have saved her colleagues from embarrassment, and take the few seconds to read what Paul Krugman is actually saying about the economy and deficits, even if it's more fun to believe the satire.

Paul Ryan's Playing Dumb Again

One hardly knows what to say.

"The question is, is [President Obama] going to go out on the campaign trail and start campaigning against us again like he has been since the election?" [Paul] Ryan said on MSNBC's "Morning Joe."...

"Look, I ran against him, so we have different views. But at least we started talking. This is the first time I ever had a conversation like that with him. So I think that's a good, constructive start. The question is, is there follow through? The question is, does the campaign start back up or does the engagement continue in a real, constructive and promising way? I don't know the answer to that question. Time will tell."

Ryan seems to remember that he is a politician, and seems to recall having run against the President in a recent election. I assume he also recalls losing that election. But is he simply pretending to be stupid or does he sincerely not understand that he and the President are in different political parties, and that he is presently campaigning against the President's agenda?

If A Case Can Be Made for Ryan's Medicare Vouchers, How About Making It

Sometimes I get a bit tired of how bad analysis can be in a "leading" newspaper. Here's what passes for the work of a "health care correspondent" in the National Journal, on Paul Ryan's latest budget stunt:

The plan would not eliminate traditional Medicare. Democrats have gotten political mileage from accusing Ryan of wanting to “end Medicare as we know it.” That is not the same thing as ending Medicare. Ryan’s plan would give seniors a fixed amount of money that they could use to buy traditional Medicare coverage or a private plan with similar benefits. It would convert the program from a single-payer monolith into a marketplace of competing plans. But unlike his budget of two years ago, it would not remove traditional Medicare from the menu of options. Here’s where the “as we know it” part comes in: Because traditional Medicare would have to compete on price with the private plans, there’s a chance it could become too expensive for every senior who wants it to buy it. The plan, which limits how much the payment can increase each year, could also shift costs to even those seniors who buy the cheapest option in the marketplace.

I think it would be more accurate to say that mediocre reporters have gotten mileage out of snarking at an accurate description of Ryan's Medicare plan which, as any healthcare correspondent should know, has been repeatedly revised due to a recognition that current Medicare recipients would go ballistic if it had been implemented as originally proposed. Seriously, if you buy the conceit that Ryan's privatization plan doesn't change Medicare, but merely gives you ample money to buy full Medicare coverage along with any number of additional private plans, why do you think Ryan continues to be such a coward about the implementation of his plan - pushing off full implementation for a decade? Why wouldn't seniors rejoice at the new choices, rather than being anticipated to recoil with such horror that implementation must be put off into the distant future? If the Ryan plan breaches the promise of Medicare to current recipients, how clueless do you have to be to believe it won't change anything for future recipients? How clueless do you have to be to go along with the pretense that Medicare as we know it could be sustained under his voucher plan?

The author, Margot Sanger-Katz, suggests that under Ryan's voucher plan "there’s a chance [traditional Medicare] could become too expensive for every senior who wants it to buy it". A chance? Could? Is she completely ignorant of the genesis of this plan?

If you believe that the purpose of the Ryan plan is to save money - that Medicare costs too much, and that the voucher plan will significantly curtail spending - how difficult is it to figure out that the savings have to come from somewhere. Ryan and his party engaged in some pretty egregious demagoguery against Obama's cuts to Medicare providers - cuts designed to ensure a consistent level of care for seniors. Those cuts... remain part of Ryan's proposed budget. But that's not enough cutting. From where does Ms. Sanger-Katz believe additional savings will be derived? As should be obvious, Ryan's plan is to ensure that the "fixed amount of money" grows at an artificially capped rate well below the rate of medical inflation.

It's also pretty astonishing that Ms. Sanger-Katz is unaware that the Ryan voucher plan is designed to shift healthier seniors out of Medicare - that is, now that he's willing to allow some form of Medicare to continue to exist. Returning to an earlier point, Ms. Sanger-Katz bashed Democrats for supposedly getting "political mileage from accusing Ryan of wanting to 'end Medicare as we know it.'" If the original plan did not end Medicare as we know it, because his vouchers would happen to be called "Medicare", why is Ms. Sanger-Katz claiming that its the continued ability to buy "traditional Medicare coverage" that keeps Ryan's plan from ending Medicare as we know it? If she believes that to be the case, as is implicit in her argument, then it's time for her to respect the facts and admit that the Democrats were correct

As for the goals of the voucher plan, as should be obvious, healthy seniors with lower healthcare costs are more profitable for private insurers. The sickly, money-losing senior citizens are a population that insurers don't want to serve and have never wanted to serve. Ms. Sanger-Katz would apparently have us believe that she has no comprehension of why Medicare exists in the first place. Seniors who need a lot of medical care will end up on "traditional Medicare" (if they can afford the premium), with the result being that Medicare's per patient costs will rise at a much higher rate than the private plans that are able to cherry-pick from a healthier population. While Ms. Sanger-Katz does not hold herself out as an insurance correspondent, she should still be able to figure out that the operative words are not "chance" an "could".

If Ms. Sanger-Katz knows the basic facts, she should admit them. From there, she could describe the probable impact of Ryan's proposed cuts and voucher plan and, if she nonetheless believes the cuts to be appropriate and a voucher plan to be a reasonable alternative to single payer, lay out the policy case for the Ryan plan. If I give her the benefit of the doubt based upon what she instead wrote, I have to regard her as credulous and lazy - as willing to take at face value representations from hyper-partisan politicians that, if made to a better reporter, would instead inspire a series of probing follow-up questions, or at least the performance of basic research to determine if she's being sold a bill of goods.

Mr. Canard, of the AEI

Earlier today on the radio, I heard the host pose a question to "Mr. Canard" of the American Enterprise Institute. I thought she was referring to Edward Conard, but... the reference suddenly seems ambiguous.

Saving Money by Ending Medigap Coverage?

Among the various proposals offered by Ruth Marcus, ostensibly to help balance the budget, is this:

Another idea, from MIT’s Jonathan Gruber, would attack Medicare costs from the consumer side. It would deal with the current risk of catastrophic costs by adding an out-of-pocket maximum tied to beneficiaries’ incomes so that poorer seniors would face less risk.

But it would also heavily tax seniors’ supplemental insurance plans that fail to impose adequate cost-sharing on beneficiaries. Again, this proposal could appeal to both sides: The Obama administration has suggested limiting Medigap policies, and the Ryan approach is all about giving consumers incentive to control costs. Estimated savings: $125 billion over 10 years.

But wait - I thought the magic of markets and private insurance would "fix everything", so how is it that the healthcare market will become more rational and efficient if we all-but-eliminate Medigap coverage? Well, Ruth Marcus isn't a "free markets" fundamentalist, so I can't hang that one on her, but the underlying concept seems questionable. If Marcus is speaking of savings to Medicare, then she presupposes that without Medigap coverage a huge number of seniors will seek less care. The nominal assumption is that if you shift more cost to the patient, the patient will be more reflective about seeking care, and will be less likely to see a doctor unless it's absolutely necessary. The reality is that this type of cost-shift has a very poor record of reducing the cost of care to the consumer. The nature of Medicare makes it less likely that the consumer is going to be convinced to choose costly options, when an insurance company might require significantly less costly options to be tried first, so real savings could only be achieved if the patient foregoes medical care. From what I've seen in the private health insurance market, that's not likely to happen unless copayments become uncomfortable to afford - in which case you're going to end up denying necessary care.

And yes, according to the Medicare Payment Advisory Commission (MedPAC), if implemenented this proposal would result in seniors going more heavily out of pocket:

Congress should add a new charge for Medicare beneficiaries who buy supplemental insurance, according to a recommendation from its advisory panel.

The size of the fee for Medigap plans was not specified but left up to the secretary of HHS, according to a unanimous recommendation by the panel (PDF). Medicare Payment Advisory Commission members and other health policy experts have frequently criticized such plans as cost drivers for Medicare because they often cover all out-of-pocket costs for beneficiaries, which critics contend leads to overutilization of healthcare services.... Marcus also suggests eliminating fee-for-service and instead "giving Medicare providers a set amount to cover beneficiaries" - an idea that is difficult to reconcile with her Medigap proposal, which appears to be predicated upon the continuation of fee-for-service with copayments for those individual services.

“This whole effort is not motivated by a desire to achieve savings, but it's really motivated by a desire to have a benefit package that works for beneficiaries,” Michael Chernew, a panel member and professor in the Department of Health Care Policy at Harvard Medical School, said before the vote.

The person Marcus references, Jonathan Gruber, appears to believe that the impact of this change can be mitigated for less affluent seniors by offering them a greater subsidy in lieu of Medigap - that is to say, they would get what amounts to Medigap as part of their basic Medicare benefit. If the goal is to prevent "overutilization of healthcare services", does that make sense? Are we to believe that only more affluent seniors overutilize medical services, and they'll suddenly stop if they don't have Medigap coverage? For that matter, what evidence is there other than assumption that this overutilization exists, or that it can be affected by imposing a massive tax on Medigap policies?

So seriously, rather than pulling numbers out of... who even knows where, let's have an explanation of why we should believe that this proposal is sound public policy, why should believe it will result in cost savings to Medicare and the degree to which it will increase cost to seniors. Let's compare healthcare utilization rates of seniors to other nations, to see if in fact the level of care our nation's seniors receive is unusually high or is pretty typical. Let's perform a sufficient analysis that we can be reasonably sure we're not going to increase costs, by having a senior neglect a medical condition such as a diabetic abscess, odd symptoms that turn out to be a first heart attack or the onset of kidney failure, or a TIA, until they have a much more costly medical crisis.

Too much to ask? It's easier to simply roll out a massive reinvention of Medicare as a giant, nationwide experiment, but I believe it's appropriate to do some bona fide analysis and testing before engaging in a large-scale experiment that will materially affect the lives of real people, based upon little more than untested theory and assumption.

Rand Paul for... Unsuccessful Presidential Candidate!

Ross Douthat wants to turn Rand Paul into a mountain, but qualifies his statements to such a degree that it's clear he views the man as a molehill. One he would prefer to become an influence within the Republican Party, but a molehill nonetheless.

Officially, Paul’s filibuster was devoted to a specific question of executive power — whether there are any limits on the president’s authority to declare American citizens enemy combatants and deal out death to them. But anyone who listened (and listened, and listened) to his remarks, and put them in the context of his recent speeches and votes and bridge-building, recognized that he was after something bigger: a reorientation of conservative foreign policy thinking away from hair-trigger hawkishness and absolute deference to executive power.

Or they might see Rand as engaging in cynical grandstanding over an issue that, yes, he probably believes in - but in a manner that he knew would not amount to a hill of beans. He knew that his party was, in essence, using him to create headlines - ideally some negative press for the President, but also cover for their actual filibuster of the nomination of Caitlin Halligan to the D.C. Circuit Court. As for listening to Rand Paul, did anybody actually do that? If they did, among other things, they would have heard him criticize President Obama over his skepticism of Lochner v. New York, a century-old case that held limits on the length of an employee's workday or week to be unconstitutional. Yes, a handful of libertarian scholars have made it their pet case, but it has largely been regarded as a bad decision (Robert Bork called it an "abomination) by legal scholars across the political spectrum. To put it another way... I refer you to Charles Pierce's 5 minute rule ("This rule states that, for five minutes, both the son and the father, Crazy Uncle Liberty (!), make perfect sense on many issues. At the 5:00:01 mark, however, the trolley inevitably departs the tracks.") Even if we assume that Paul sincerely wants to move the Republican Party in the direction of opposing military adventurism, hawkishness and deference to executive power - a deference they insisted be shown to G.W. Bush but are happy to permit Paul to question when the other party's guy is in charge - Douthat admits that his party is not at all inclined to follow:

And he’s exploited partisan incentives to bring his fellow Republicans around to his ideas, deliberately picking battles — from the Libya intervention to drone warfare — where a more restrained foreign policy vision doubles as a critique of the Obama White House. Those incentives, rather than an intellectual sea change on the right, explain why his filibuster enjoyed so much Republican support. (Most of the senators who gave him an assist were just looking for a chance to score points against a Democratic White House.)

Might? A gratuitous qualification. Once Rand was done with his song and dance, Brennan was promptly confirmed. But Douthat hopes more will come of Rand's display:

But if Paul hasn’t won the party over to his ideas, he’s clearly widened the space for intra-Republican debate. And if he runs for president in 2016, that debate will become more interesting than it’s been for many, many years.

Why, it would be like the race would have been in 2008 or 2012, had Ron Paul chosen to run. Oh... right. It might be fun to see Paul questioned about his more bizarre political positions, and his somewhat bizarre sense of history (e.g., that the Lochner decision was a strike against Jim Crow... perhaps even Douthat had stopped listening by that part of the filibuster), but I don't expect Rand to have any more influence on his party than Ron. He's an ambitious man, and he clearly wants to advance within the party, but while Douthat may believe it to be impressive that Rand's "two big interviews after his filibuster were with Glenn Beck and Rush Limbaugh", to me that choice screams that the man understands that he's far from ready for primetime.

There’s a lesson here for his fellow Republican politicians — though that lesson is not, I repeat not, that they should all remake themselves as Paul-style libertarians.

Does Douthat truly believe that any Republicans are about to make that mistake? (Should I interject that, although Douthat appears to be unaware of it, Rand Paul does not view himself as a libertarian?)

Rather, the lesson of Paul’s ascent is that being a policy entrepreneur carries rewards as well as risks — and that if you know how to speak the language of the party’s base, it’s possible to be a different kind of Republican without forfeiting your conservative bona fides.

Nobody questions Pat Buchanan's "conservative bona fides", and he can still give speeches on a variety of subjects that are in the right language to fire up the Republican Party's base, but... that's not a formula for winning elections. Douthat's hanging his hopes on the wrong guy.

Engage in Mindless Obstruction of Congress and Win a Dinner With the President

Kathleen Parker is skeptical about the President's "charm offensive".

Not to be cynical, but does anyone really suppose that a Republican representative or senator is going to go against the party because Obama gave him a call? The president is charming, all will concede. And his smile, such a delightful reward, tempts one to, well, give a thumbs up. It was fun. It was delicious. But read my wine-stained lips: No new taxes.

“It was nothing but a PR move,” says one seasoned insider. “Obama wants to run against obstructionist Republicans. The fact of the matter is, unless something really bad happens, there’s no reason for [Republicans] at this point to cave on taxes. Why would [House Speaker] John Boehner ever cave on taxes at this point?”

Parker had to quote a "seasoned insider" to make that point? The "seasoned insider" didn't want to make a point that banal on the record? And Parker is so intent on accuracy that she uses editorial brackets, lest this anonymous person... protest? She lives in an odd world.

Okay... so why would the President think such an obvious P.R. move were necessary? Perhaps it has something to do with the vast number of her peers who keep talking about "likability" and suggesting that the only reason more isn't getting done on Capitol Hill is that Obama doesn't treat legislators to enough lunches and dinners. (Parker can't pretend she hasn't noticed that phenomenon.) I expect that part of what the President hopes to accomplish is to get that particular faction of beltway pundits to stop droning on about invitations to dinner parties, and to start covering the facts.

Back to Parker's rhetorical question, "does anyone really suppose...", a few column inches away Ruth Marcus supplies an answer:

It is hard to imagine a breakthrough without intensive presidential involvement, which makes the new outreach so welcome. I know Republican senators, prospective members of Obama’s common-sense caucus, who have waited in vain over the past few years for a call from the White House chief of staff, never mind the president himself.

So there you go.

Cheney On Tour, Selling Alibis

Dick Cheney's quite a guy:

Mr. Cheney still hearts waterboarding. "Are you going to trade the lives of a number of people because you want to preserve your honor?" he asked, his voice dripping with contempt.

Here's the thing, Dick: Such decisions are harder when you have honor to begin with. "When you ain't got nothing, you got nothing to lose".

Achieving Medicare Savings for Durable Medical Equipment

Charles Lane has discovered the problem that Medicare often pays an inflated price for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). My reaction is two-fold: First, although Lane has identified an area of Medicare spending in which savings could be obtained, he's focusing on a tree. Second, Lane only hints at the resistance that is likely to be encountered should Medicare attempt to minimize DMEPOS expenditures.

Lane tells us that "between 2000 and 2010, Medicare spent $69.4 billion on DMEPOS, almost all of it based on the old, inflated reimbursement rates." So, roughly $7 billion per year. In 2010, the Medicare budget was $560 billion. Even if we assume that there was significant growth in the cost of DMEPOS over that decade, such that by 2010 we were spending $12 billion per year, we would still be talking about just over 2% of spending. If we assume reforms not yet implemented could save 1/3 of that amount, we would be looking at saving $4 billion per year. That type of reform is significant - but only makes a material difference to the cost of Medicare in the aggregate.

One of the arguments often made in response to President Obama's proposed tax increases is that they're too small to make a difference.

The proposed tax increase would fail to address the deficit seriously. According to the Joint Committee on Taxation, the proposed tax increase would raise only $68 billion by shifting the top tax bracket from the Bush era rate of 35 percent up to 39.6 percent (plus a few from the health care law). The government expects to spend $9.9 billion per day, or a projected $3.627 trillion for this year. Based on these numbers, the addition $68 billion from a tax increase would pay for 6.8 days of government operation.

It's a fundamentally dishonest argument, and it's absurd to pretend that we could identify a single tax increase that could bring the budget into balance - at least without tanking the economy. The modest savings that can be achieved by cutting waste in DMEPOS spending should not be overlooked, as small steps are worth taking, but Lane seems to overstate the importance of that one aspect of Medicare spending to its overall budget picture, using ten year figures to exponentially increase the size of an average year's expenditure, and omitting any mention of the size of the Medicare budget.

Lane argues that the "obvious solution" is "competitive bidding". Certainly, one way to avoid excessive cost would be to allow Medicaid to use its market power to negotiate with manufacturers, perhaps leaving Medicare recipients free to choose other equipment but making them responsible for any cost in excess of the negotiated price for equipment on its approved list. Distributors could be paid a percentage of the approved cost as their fee for handling the equipment and training recipients in its use. Manufacturers and distributors, I expect, would go ballistic, and would attempt to scare Medicare recipients by talking about "government bureaucrats deciding what equipment you get", and the like. It would be interesting to see Lane flesh out his "obvious" solution in a future column - and if he has the space, he can also address how we can convince the Republicans in Congress that Medicare should be allowed to use its market muscle to achieve savings not just here, but also (and more importantly) for pharmaceuticals.

It's worth noting that a great deal of DMEPOS, despite its substantial cost, is effectively abandoned when the patient no longer needs the equipment. It would be nice if it were possible to recover, refurbish and reuse some of that equipment. Unfortunately, even before considering patient resistance to being given refurbished, older equipment, the cost of recovering, refurbishing and redistributing medical equipment would likely exceed the potential savings.

Would You Even Want a An Apple Watch

In what I expect to be another entry in my unbroken record of making incorrect predictions about future Apple products, why not comment on the rumored "Apple Watch" and the rumored 100 engineer team working hard to get one to market?

Interestingly, we're also told that Apple's chosen to rework the full iOS to run on the watch instead of building up the iPod nano's proprietary touch operating system — although the previous nano was already watch-sized and seemed like a great starting point for a wrist-sized device, Apple's betting on iOS across product lines.

If Apple actually figures out a way to get a useful interface to iOS onto the face of a watch, all the more power to them. I expect Siri would play a huge role... if you have an Internet connection.... But I find myself thinking back to my youth. Sure, the few remaining people who read the comic strip thought Dick Tracy's watch phone was cool, but the craze of the day was the digital watch. I recall the efforts to put more and more features into watches, including an effort to make a TV watch and any number of successfully marketed calculator watches. Tiny screens, tiny buttons. These days, the cool watches are once again analog.

I have to admit a personal prejudice: The only piece of jewelry I wear is my wedding ring. I have a watch, but I don't like to wear it. The idea of wearing a "smartwatch" of some type is not appealing. The more battery life you give it, the more you try to make it a primary device instead of a secondary device, the more you are going to load up the watch band with batteries, antennas and the like. For the advantage, I suppose, of being able to easily look at a tiny screen and perhaps make Dick Tracy-type FaceTime calls. I'm again taken back to the expensive, overly featured digital watches of my youth - wearing one could be cool, could indicate that you had money to burn, could prove that you're on the bleeding edge of technology, but was otherwise not very practical.

What about exercise? You are on the stepper at the gym or out jogging. You're seriously going to run your headphones to your wrist? An oversized wrist band isn't going to feel sweaty and gross? Granted, not everybody exercises, but.... Google glasses, by way of comparison, seem much more practical (although they face the same sort of issues if you try to make them a primary device as opposed to drawing their data from your cell phone.)

And what about heat dissipation?

Obviously Apple has time to resolve these issues, just as it had to when it reworked OS X to work on the iPhone instead of building up the iPod's operating system in the late 2000s. And it should be motivated to resolve these problems quickly: financial analysts are already starting to latch onto watch rumors as a growth opportunity for Apple's battered stock price since the fabled TV project looks increasingly unlikely in the current media climate. (That Bloomberg report is headlined "Apple's Planned 'iWatch' Could Be More Profitable Than TV," in case any investors missed the underlying subtlety.)

I used to wonder more about the Apple TV before I saw how my daughter interacts with her iPad. We already have Apple TV - a personal screen that supports streamed video - the parts that are missing are the licensing agreements that would make it a viable alternative to premium cable, and the software interface that would let you quickly and easily filter your options. I would not be surprised if Apple has a strong concept for the software, but without a licensing agreement there's not really a good reason to push beyond what we see in iTunes or the actual Apple TV product.

If analysts are anticipating that Apple's next big breakthrough is going to be a fancy wristwatch, even with due consideration to how popular wrist devices reportedly are in Japan, I think their focus is misplaced. Let's see... that gives Apple about six or seven months to prove me wrong.

Why Girl Scout Cookies Aren't Sold Online

At Marketing Pilgrim, Cynthia Boris is perplexed,

This isn’t the first time we’ve had this discussion, but it’s even more ridiculous now than it was two years ago. eCommerce is a thriving, legitimate means of selling a product. Yet, the Girl Scouts say it doesn’t foster entrepreneurial skills. Really? I think there are several dot.com billionaires that would disagree.

Selling online taps into the same basic business rules as offline selling – customer service, marketing, inventory control, shipping. Meeting the customer face-to-face isn’t a requirement for success, nor is learning to handle paper dollars.

That's the thought I had when somebody told me, way back in the day, about Amway's "Quixtar" online service. You were in effect being asked to sell an interface to online shopping, but you couldn't market the 'product' online. The "why" seems pretty obvious - if you were highly effective at getting people to sign up for the service via your online marketing, you would grab prospects from all over the country (or world). That would undermine the traditional MLM model behind Amway's historic success - building local networks through friends, colleagues, family members, and local networking events.

The Girl Scout cookie sales thing... back when I was young (and in another country) once a year the Girl Scouts would come to your door peddling mediocre sandwich cookies. I recall chocolate, vanilla, and... perhaps a combo back that included both types of cookie. By the time I next paid attention, somebody was showing me the panoply of cookie choices from the U.S. Girl Scouts, with big tables set up outside of stores - a very different product, and I expect much easier to sell. More recently, the manner in which Girl Scout cookies are sold seems to be this: A parent tells you, "Little Jillian is selling Girl Scout cookies again. Would you like to order some?" If you say "Yes," they give you an order form and tell you how you can collect your purchase when it arrives. Other than at supermarket tables, the role of the Girl Scout in this process seems quite small.

What difference does it make if Girl Scouts start selling the cookies online, with nationwide sales? You erode the local aspect of the business, and the funding that the sales produce for the local chapter. I'm not sold on the "it teaches leadership skills and confidence" aspect of sales - door-to-door sales are pretty unusual these days, and they are typically very closely monitored. I suspect it is parents who hand out those forms who have diminished the number of door-to-door sales - in the past you may be planning to buy cookies from your niece, but what's the harm in buying another box from a kid at the door. Now you have an order form from your niece and you'll have six, eight boxes of your favorites coming in, and odds are the kid at the door is only taking orders, so it's "Sorry, I've already ordered cookies." But if you turn this into a website design and marketing contest, you'll end up with a handful of websites raking in the lion's share of cookie sales. "Sorry, Jillian's mom, but I already placed my order."

The national organization is not without sin, here. I've seen "limited edition" candy that uses the Girl Scout brand and cookie flavors on sale in convenience stores. Push hard enough in that direction and you may as well market them like any other seasonal confection found in your local grocery or convenience store.