Medical Malpractice Mythology

Apparently things work like this at the Washington Post. They find an interesting topic, find a person with good qualifications to author a piece on that subject, then... run the resulting work on the editorial page so that they don't have to fact-check. Today, they present a magnificent example of distortion through an editorial on medical malpractice, by William R. Brody, president of Johns Hopkins University.

Brody announces that there are five myths of medical malpractice, and sets about advancing various myths in the guise of "rebutting" his contrivances. His first "myth" is that "The medical malpractice crisis is someone else's problem, not mine." to which he replies by asserting that people are losing access to medical care and "doctors are leaving practice in the face of unaffordable insurance premiums", or otherwise cutting back on services. He does not explain how doctors can increase their incomes, even taking malpractice insurance into consideration, by quitting their highly compensated profession. Nor does he explain in what, if any, specialty a medical professional can see a significant drop in malpractice premiums by "cutting back on the services they offer". That is, without so dramatically changing their practices they effectively qualify for insurance under a different specialty or subspecialty.

Further, where is the evidence that doctors are fleeing the profession? Florida had more licensed doctors in 2003 than in 1998, with an increase in new applications, despite a supposed "malpractice crisis". This year the chairman of the Pennsylvania Medical Society was forced to admit that he made up his three-year claim that doctors were leaving the state in large numbers, when confronted with documentation of an 800 doctor gain. In 2003, the GAO documented that in 2001 there were more doctors in Washington, in both rural and urban settings, than there had been ten years earlier. Ohio had a five percent increase in medical licenses issued between 1998 and 2003. Illinois showed a 30% increase in doctors between 1994 and 2004. North Carolina documented an increase in OB/GYN's from 843 in 1997 to 937 in 2001, despite the fact that the specialty has borne some of the highest premium increases of any field of medicine.

Other than in insurance industry and lobbyist rhetoric, where is this supposed "flight" from the profession actually manifested?

Brody also suggests that malpractice insurance costs may make medical care unaffordable. That claim may sound like a bad joke to anybody who is uninsured or underinsured, as medical care is already unaffordable. And the adequately insured aren't particularly concerned, because... well, they have insurance to pay the bill. As Brody later addresses the cost of "malpractice" under a later myth, I'll leave this issue for the moment.

Brody's second "myth" is "We need to preserve the current legal system to guarantee a fair hearing and provide compensation for patients harmed by the health care system.". Brody argues that the present system is unfair and is "essentially a lottery" - a claim doctors seem inclined to make. To back up this claim, Brody first misrepresents the findings of a 1991 study which "found that nine out of 10 victims of disability-causing malpractice go uncompensated The study actually found that only approximately 1 in 8 malpractice victims, as defined by the study protocol, pursue claims against the medical professionals who harmed them.

By contrast, our estimate of the statewide ratio of adverse events caused by negligence (27,179) to malpractice claims (3570) is 7.6 to 1. This relative frequency overstates the chances that a negligent adverse event will produce a claim, however, because most of the events for which claims were made in the sample did not meet our definition of adverse events due to negligence.

CONCLUSIONS. Medical-malpractice litigation infrequently compensates patients injured by medical negligence and rarely identifies, and holds providers accountable for, substandard care.

I agree completely with the study's authors that the malpractice system is a poor tool for identifying substandard practice, and obviously a great many patients forego any effort to receive compensation for their injuries. But to claim that because only a small number of people who are harmed by malpractice choose to sue, the system is a lottery, is a rather shameful distortion of the study's purpose and findings. If anything, the study is good news for doctors - it suggests that the vast majority of patients understand their humanity and forgive their errors.

Further, the logical consequence of Brody's misrepresentation is that the system would be more "fair" if every patient harmed by malpractice filed suit. That would mean a literally exponential increase in malpractice litigation. And I think he knows that - but was simply anticipating that nobody would look behind his numbers.

Brody's next claim takes on the other side of the coin, claiming, "a recent study by Harvard University researchers found that 80 percent of malpractice claims were filed against doctors who had made no error whatever." This appears to be a reference to the 1991 Harvard Study which, consistent with the New England Journal of Medicine study, found that in 1984 only one in eight bona fide victims of malpractice sought legal remedy. (This is recent?)The study presents some issues of methodology and definition which weaken some of the arguments made from its findings, both for and against "malpractice reform". Brody, though, probably should have mentioned this finding: The tort system "appears to do a surprisingly accurate job of sifting out the valid from the invalid claims (in the latter cases paying the claimants nothing or just a small amount of damages)."

Brody's last point is similarly dishonest - he claims on the basis of recent medical findings that certain past litigation over cerebral palsy is called into question. It is a good thing to revisit old science, and certainly there have been vast improvements in medicine and medical care as a result of a better understanding of disease and its causes. However, you can only apply that science going forward. Brody appears to intend to mislead his readers into thinking that juries relied on bad science, rather than the best available science, in deciding cerebral palsy cases - and that simply isn't true. Don't get me wrong - there is plenty of room for improvement in the litigation of "bad baby" cases - but Brody's approach to the subject is fundamentally (and in my opinion intentionally) misleading.

Brody's third "myth" is that "The malpractice system is necessary to punish and remove incompetent health care providers." I'm not sure who is supposedly arguing this "myth" - the malpractice system is meant to compensate victims of malpractice. Discipline and removal of incompetent physicians is an entirely separate matter, handled by hospitals, licensing boards, and peer review panels. And on this subject, Brody's argument is wacky:

Unfortunately, the system that rarely provides just compensation for patients also perversely protects doctors who need to be removed from practice, by enabling them to sue other physicians who might step forward to question their competence. This undoubtedly has a chilling effect on whistle-blowing, and those who regulate doctors are often reluctant to suspend or revoke licenses without expert medical testimony.

He's, in my opinion quite deliberately, conflating medical malpractice litigation with lawsuits over defamation. While both are forms of tort litigation, from a lawyer's perspective there is a world of difference between litigating a defamation claim and a claim for professional negligence. Lawyers are reluctant to take defamation cases, as they tend to be difficult to prove and tend to result in small damages awards. Defendants cannot be sued over their opinions, and truth is an absolute defense to a defamation suit.

There is no rash of absurd or frivolous defamation cases by doctors against peer review panels - and, plainly, none that the tort reform lobbyists or the author of the editorial are willing or able to present. To the extent that a peer review panel smears the reputation of an innocent doctor, or abuses its position in order to exclude a competitor from practice, shouldn't there be legal recourse for the injured doctor? If not, why not?

Brody continues with the half-truth, "Nor does the current liability system provide a way to make health care safer." In a purely literal sense, that's true. But in practice, litigation has resulted in dramatic changes in the administration of health care, and significant improvements in patient safety. Anesthesiology used to be very much a "hit or miss" practice, with a very high level of injury and fatality particularly with general anesthesia. Following a wave of lawsuits, the science of that profession improved dramatically, with malpractice and maloccurrence dropping dramatically.

Brody goes on to claim,

What we need is a system that allows health care providers to work together to study errors and put practical improvements in place to prevent recurrences. The current system discourages doctors from talking about system failures for fear of being sued.

The "system" he appears to be describing is called "peer review", where doctors examine incidents of maloccurrence behind closed doors and make findings which are kept secret from the patients, their families, and the courts. What more does he want, in that respect? In terms of open discussion to improve patient safety, contrary to Brody's arguments, that is also occurring at a growing number of hospitals - and I haven't heard anything to suggest that the discussions have increased litigation, although there have been significant improvements in patient safety (e.g., with Ventilator-Associated Pneumonia).

Brody continues by arguing his fourth myth, "Malpractice costs are not a big deal -- they amount to less than 2 percent of total health care costs.". Brody correctly notes that two percent of a $1.66 trillion system is a lot of money. However, for obvious reasons, he doesn't return to his earlier claim that only about 10% of malpractice victims are compensated - given that earlier claim, shouldn't Brody be exceptionally pleased that the cost of malpractice is not ten times higher?

Also, Brody doesn't mention that approximately 10 to 20% of every health care dollar goes to... waste. As Physicians for a National Health Program noted,

Jobs with Justice will release a report on Oct. 7 showing that approximately $245 billion is wasted on private insurance red tape and protecting drug company super-profits each year. The study concludes that by providing insurance more efficiently and making drug companies sell in a more competitive market, the savings could be used to provide secure, affordable health care for all.

While I understand that medical malpractice is a personal issue for doctors, while waste is not, if a purported expert on the subject is going to make an economic argument that "2% of health care costs is a lot of money", it is not unreasonable to expect that the professional might put it into context by noting that it is far from the most significant area of potential cost savings.

Additionally, Brody presents no evidence that the figure is too high. (His evidence, as previously noted, is that the figure is actually too low.) He might as well be arguing that new cars cost too much on the basis of the percentage of an average household's income that goes to pay for a car - the fact that something is costly does not of itself mean that the cost is too high. And while I grant that it makes sense to work to lower the cost of something that is costly, it seems that the hundreds of billions presently going to pure waste would be an easier target for prompt and effective reform.

Brody next introduces the subject of "defensive medicine", claiming that if you go to a hospital with a headache " You are as likely to get a CAT scan as a couple of aspirin". I certainly hope that the standard of care at Johns Hopkins is higher than its President just suggested. However, it should be noted that the cost of "defensive medicine" is borne by the patient (or the patient's insurance company), and that if Brody's specific claim is true it is exceptionally profitable for his hospital and its radiology department. And while Brody claims "The added costs of defensive medicine are estimated at $50 billion to $100 billion per year", he provides no source for that claim, nor any explanation as to how the estimate was made.

If we turn to Harvard studies, as Brody did, we find that in 1990 a study by the Harvard University School of Public Health "did not find a strong relationship between the threat of litigation and medical costs". Or, more recently, a 1999 study from the Journal of Health Economics on the cost of Caesarean sections in states with or without damages caps, found "cost savings" of only 0.3% - and this in one of the areas ballyhooed by "tort reformers" as a centerpiece of defensive medical practice.

The study to which Brody apparently means to allude is the Kessler-McClellan study, a 1996 reporty by two Stanford economists. The General Accounting Office has found that the Kessler-McClellan study cannot be extrapolated in the manner chosen by Brody:

Because this study was focused on only one condition and on a hospital setting, it cannot be extrapolated to the larger practice of medicine. Given the limited evidence, reliable cost savings estimates cannot be developed.

This January, the Congressional Budget Office agreed:

When CBO applied the methods used in the study of Medicare patients hospitalized for two types of heart disease to a broader set of ailments, it found no evidence that restrictions on tort liability reduce medical spending. Moreover, using a different set of data, CBO found no statistically significant difference in per capita health care spending between states with and without limits on malpractice torts.

Brody could, of course, demand a systematic study of "defensive medicine", its costs, and how savings might be achieved. But as his point is actually political, not economic, he instead prefers to make what he cannot resonable believe to be an accurate economic projection.

Brody's last "myth" is that "The current malpractice insurance system is in crisis because insurance companies are trying to cover losses from unwise financial investments made during the dot-com boom." His response to this is to argue that there has been an increase in the median malpractice award granted by juries between 1995 and 2000, and that there has also been an increase in the median settlement. That, of course, is fasinating - but in no way supports his argument. It is possible for the median award or settlement to rise for a large number of reasons, even as the overall cost of malpractice drops.

The best source of information on malpractice costs would come directly from insurance companies - but they are loathe to reveal it. So claims of increase in the median settlement or verdict come instead from informal sources, such as the reports of Jury Verdict Research, Inc., despite the disclaimer by JVR that its figures should not be used for public policy purposes. JVR, for example, makes no claim that its reports include all jury verdicts, estimating that they cover about 60% of jury verdicts. JVR also ignores all verdicts which return no damages award, verdicts reduced by judges, and verdicts overturned on appeal. It does not obtain its data in a methodological manner, and does not consider post-verdict settlement figures. JVR also makes no effort to distinguish between physician liability and hospital liability.

On those rare occasions when actual insurance figures are made available, as was recently the case in New Jersey, Massachusetts, Mississippi and Missouri, those actual figures revealed, in the words of an insurance industry executive, "Severity has not gone up, and in fact, it has gone down a little". Additionally, despite population growth, data from the National Association of Insurance Commissioners (NAIC) demonstrates a four percent reduction in medical malpractice lawsuits between 1995 and 2000.

So Brody presents flawed "median" figures, a tactic which suggests that "average" and "overall" figures don't support his claim. He doesn't present industry figures which show a decline both in damage awards and the frequency of malpractice litigation. And again he skips merrily past his earlier argument that 90% of malpractice victims go uncompensated - something that, if remedied, would escalate the cost of malpractice far beyond the increases in "median" verdict and settlement he claims.

Near the end of Brody's missive, there is a small truth: "A few new caps on liability costs aren't going to solve the problem.". For anybody interested in justice, caps are anathematic. Surely not even Brody would argue that it would increase fairness for the 90% of malpractice victims he believes to go uncompensated, for an additional group of severely injured malpractice victims to be grossly undercompensated as a result of arbitrary damages caps. Further, there is little evidence to suggest that caps will have any appreciable impact on the cost of malpractice insurance.

There is also something incredibly disingenuous in Brody's complaint that too much of a typical malpractice award is eaten up by attorney fees and costs. Doctors lobbies and the insurance industry have worked extremely hard to drive up the cost and burden of litigating malpractice cases - this is the inexorable result of their prior tort reform "victories".

Yes, it is possible to look at reform in a more global manner, and to try to work for a system that maximizes justice for both doctors and for patients injured by preventable medical error. But, given this "fast and loose" play with the facts, I am not optimistic that people like Brody are sincerely interested in achieving such a system.

But These Children Are Supposed To Be Left Behind

Amazing. Apparently some educators believe that "No Child Left Behind" is supposed to work like this: A school is declared "failing", so parents of children with substandard test performance transfer their kids to other schools, the better performing children stay behind, and the school performance magically "rises" without a lick of effort.

The legislation is intended to give struggling students the chance to move from high-poverty, low-performing schools, but Fairfax school officials have found that the students who take the transfers generally aren't the ones who need extra help.

Instead, they are like Umaid: higher-scoring students from middle-class homes. The trend, evident in suburban school districts nationwide, means that the receiving schools don't have to augment their remedial programs or worry about test scores dropping. It also means that resources spent on transfer students aren't going to the students who need them most, some educators said.

Yup. That's right. Smart kids don't need resources, and can do just fine in crappy schools. To his credit, a spokesman for Rep. George Miller (D-Calif.), one of the principal authors of the legislation, expressed that "the law also envisions times when successful students will transfer."

And this gets to a big part of the problem - schools can't fix what is going on at home. We as a society seem to think that a school should accomplish over the course of a few hours per day, in an ever-shrinking school year, what many parents can't be bothered to do for themselves. Why is it a surprise that the parents of higher-achieving kids are more attuned to their children's needs, and are more willing to take advantage of alternative educational opportunities when their children's schools are declared "failing"? That should have been expected - and it certainly should not be distorted into a problem.

More Red, Blue and Purple America

Maps with commentary from Michael Gastner, Cosma Shalizi, and Mark Newman at the University of Michigan.

The Demise of Democracy

Today, David Broder takes on the issue of redistricting - the creation of "safe districts" where the incumbent often runs unopposed, describing the account of a Florida resident.

"I pointed out to an election official at our polling place that there was no House race on the ballot, even though congressmen and women were up every two years. She immediately called the Volusia County supervisor of elections for an explanation.

"While she was on the phone . . . I was informed that my congressman, John Mica, was unopposed. I said, 'I knew that, but shouldn't his name be on the ballot, with a line below it for a write-in candidate?' That seemed traditional to me. I asked whether Mica didn't need to get at least one registered vote somewhere so he could be returned to Washington as an 'elected official' to serve another two years. The answer came back over the phone that Mica had been 'automatically reinstated in Washington.'

Last year, the Supreme Court came pretty close to declaring redistricting to be a "political issue", not ordinarily subject to judicial review. The Court was ostensibly frustrated with the fact that its prior decisions of the subject had not proved to create workable standards for the lower courts, and the growing minority argued that (absent patent illegality, such as redistricting with a racially discriminatory intention) the issue belongs in the political arena, not the courts.

Of course, as the Florida case detailed above indicates, and as the Republicans demonstrated in Texas, if you leave this to the politicians, they will do their utmost to skew the system away from democracy. (It is my cynical belief that, now that the Texas model has created a precedent, absent a legal declaration of its unconstitutionality that model will be followed by both parties in the future. But then, isn't it easier for all of us when our politicians are "automatically reinstated", and we don't have to be bothered with those unseemly elections, challengers at the polls, and recounts?)

Fascism or Puritanism?

In "The Puritanism of the Rich", George Monbiot challenges the notion that Bush embraces "soft fascism" (or any other sort of fascism), suggesting that Bush instead represents puritanism.

Puritanism was primarily the religion of the new commercial classes. It attracted traders, money lenders, bankers and industrialists. Calvin had given them what the old order could not: a theological justification of commerce. Capitalism, in his teachings, was not unchristian, but could be used for the glorification of God. From his doctrine of individual purification, the late Puritans forged a new theology.

At its heart was an "idealisation of personal responsibility" before God. This rapidly turned into "a theory of individual rights" in which "the traditional scheme of Christian virtues was almost exactly reversed". By the mid-17th century, most English Puritans saw in poverty "not a misfortune to be pitied and relieved, but a moral failing to be condemned, and in riches, not an object of suspicion ... but the blessing which rewards the triumph of energy and will".

* * *

Of course, the Puritans differed from Bush's people in that they worshipped production but not consumption. But this is just a different symptom of the same disease. Tawney characterises the late Puritans as people who believed that "the world exists not to be enjoyed, but to be conquered. Only its conqueror deserves the name of Christian."

If we're headed into a new Republican world of "Upstairs, Downstairs" or "Manor House, on which side of the staircase do you expect to find yourself?

What Bush and Mao Have In Common

According to The Guardian, in an article on China's "one child" policy:

"Liberalism," [Chairman Mao] wrote in his 1937 tract, Combat Liberalism, "stems from petit bourgeois selfishness, it places personal interests first and the interests of the revolution second ..."

Minor Distractions IV

While taking Emma to the hospital for her hearing test (a standard screening), I had to maneuver through some crowded spaces. Emma was in her car seat, as she was sleeping quite soundly and it is ideal that she be sleeping during the hearing test.

Typical male reaction: To not even notice that I was carrying a baby. One man glared at me as he walked in my direction, as if I was obstructing his path with a large suitcase rather than carrying a baby. (And I wasn't even blocking his path - he just wanted to pass on the right, where Emma was, as opposed to the left.)

Typical female reaction: Broad smile.

Red, Blue, and Purple America

What are purple mountain majesties, anyway, if not a symbol of America? Some fascinating maps of the red, blue and purple that constitutes America from lies.com.

Why does anybody take him seriously? II

Babbling Brooks shares his words of... well, his words in today's Times:

But the same insularity that caused many liberals to lose touch with the rest of the country now causes them to simplify, misunderstand and condescend to the people who voted for Bush. If you want to understand why Democrats keep losing elections, just listen to some coastal and university town liberals talk about how conformist and intolerant people in Red America are. It makes you wonder: why is it that people who are completely closed-minded talk endlessly about how open-minded they are?

I guess he doesn't recognize his own hypocrisy, or how he is describing himself in his last remark?

Why does anybody take him seriously?

Andrew Sullivan on Bill Maher's show: "Don't demean people and expect them to vote for you."

Right - and any liberal who disagrees should take his tax-hiking, government-expanding, latte-drinking, sushi-eating, Volvo-driving, New York Times-reading, Hollywood-loving, left-wing freak show back to a blue state, where it belongs.

Quality Reporting

ABC News tells us of "conflicting reports on Arafat's health":

There are more conflicting reports today about the health of Palestinian leader Yassar Arafat. The Palestinian Foreign Minister says Arafat is not getting better, but his spokeswoman says his condition is not deteriorating.

You think he might be, say, stable? (Where do they find these "reporters"?)

I obviously don't know the full story, and certainly won't get it from that type of news story, but I do know this much: When the leading debate seems to be over where you will be buried, having your condition declared medically stable seems a small consolation.

Smoking III

I guess by now you're curious? The answer is, "lifelong non-smoker". ;-)

Smoking II

News about nicotine addiction:

Researchers say they have identified brain cell receptors that appear to be responsible for nicotine addiction, a finding of clear importance for smokers who are desperately trying to kick the habit.

The receptors normally are activated by acetylcholine, a molecule that carries signals between nerve cells and has multiple functions in the body. A large number of acetylcholine receptors have been identified, each with subunits adapted for a specific function. Twelve of those receptors also are activated by nicotine.

"Best Speech Ever"

Four years ago, the media related that Al Gore gave an extraordinary concession speech, and it was even suggested that if his concessionary persona had been evident during the campaign he might have won the election. Now, we're getting the same type of spin about Kerry's concession - e.g., "Tearful Kerry leaves best speech to the bitter end".

Is this the new motto for the Democratic Party? They can't win a national election to save their lives, but they're extraordinarily gracious in defeat? ("Bush also did 10 points better this time among voters who told exit pollsters that government should intervene more, not less, to solve problems." If you even lose the "nanny state" vote to the Republicans, what hope is there?)

Smoking

It has long been said that cigarettes are addictive in the same way as heroin (sometimes misunderstood as cigarettes being as addictive as heroin, which they aren't) - and now, following up on similar results from animal studies, UM researchers help explain why:

It's the first time smoking has been shown to affect the human brain's natural system of chemicals called endogenous opioids, which are known to play a role in quelling painful sensations, heightening positive emotions, and creating a sense of reward. It's the same system that is stimulated by heroin and morphine.

* * *

"It appears that smokers have an altered opioid flow all the time, when compared with non-smokers, and that smoking a cigarette further alters that flow by 20 to 30 percent in regions of the brain important to emotions and craving," says David J. Scott, a graduate student in the U-M Neuroscience Program who will present the results.

Demockery In Action

So the wave of the future is that the Democrats work to bring out the vote, and then the Republicans send out "poll watchers", backed by legions of trial lawyers, to interfere with voters' exercise of their rights and to prevent the votes from being counted?

And certain Democrats will complain that the youth vote that didn't show up to vote for Kerry would have shown up to vote for Dean (even if nobody else did).... Color me skeptical. When people don't bother to show up for the polls in any significant number, it's hard to believe that they have sufficient interest to do so for any candidate.

Troublemakers At The Polls

... In Detroit.

Looking For The Exceptional

It would have been interesting to see one of the also-rans from 2000 running in this election - John McCain instead of George W. - as parts of the campaign would have been very different, particularly given McCain's pointed criticism of Bush campaign's grotesque misrepresentation of his own Vietnam record back during the 1999 primary season. I don't think that type of slander, or the "Swift Boats" nonsense, would have gained traction in a battle between the two principled Vietnam War veterans. (And both are principled, particularly by "Washington standards", even if you don't agree with their principles.)

Also, whatever you make of their lives in politics and their questionable conduct during this campaign, both McCain and Kerry did extraordinary things when they were younger. Kerry opted to serve in Vietnam, and came back to forcefully oppose that war. McCain chose to decline an early release from the "Hanoi Hilton", suffering worsened treatment during the remainder of his incarceration, out of solidarity for his fellow POW's. I can't think of anything similarly extraordinary in the privileged background of either Al Gore or GW Bush - nor do I have any confidence that anything in either man's character would have ever led them to be similarly extraordinary.

Given McCain's ability to shoot from his hip, and to shoot straight, and the fact that his episodic candor has earned him significant bipartisan respect (including by many who question many of his political stances), a Kerry-McCain match-up could have been very interesting. It may well have been, at least in comparison to the now-traditional mud wrestling contest, relativley honest and clean.

I think McCain would have beaten Gore in 2000, but apparently he was too much of a maverick - too much of "his own man" - for his party. I think that there's a good chance that McCain would beat Kerry in 2004, were he the candidate.

Interesting Headline

The International Herald Tribune observes, "Rehnquist delays return, prompting new questions". Okay, the questions they raise are different, and more relevant, but with tongue firmly in cheek, doesn't the following question come to mind: "Without Rehnquist's vote in his favor, whatever the merits of the case, won't 'Bush v Kerry' end with a 4:4 tie?"

Lies, Lies, and More Lies

Today, Robert Samuelson touches on something that bothers me a lot about politics in this country. At least in a typical Western parliamentary system, between heckling on the floor of parliament and a weekly question period, there are frequent opportunities for bovine excrement to be called by name. Here? The media doesn't seem to do its job - or want to do its job - preferring to treat any allegation as a "he said, she said" to be resolved by two talking heads (representing the "pro" and "con") and a jabbering news anchor, or to run a sensational rumor apparently to sell additional papers or draw viewers for a later program, rather than spending the five or ten seconds it would take in many of these cases to find and report the truth.

The other day, Larry King was truly scraping bottom with Ann Richards, Al Sharpton, Dennis Prager, and Marc Racicot trading official "talking points" and absurd prevarications, along with pathetic answers to any direct question posed, while Larry played the part of, as Jon Stewart might say, the happy monkey. I just don't know how anybody who is even slightly informed on the issues, given that group of people and that opportunity, would be so seemingly taken in by each side's nonsense, and so unwilling to cry foul when the more absurd falsehoods are presented. And this is now the norm.

Samuelson notes,

While everyone has emphasized the differences between George Bush and John Kerry, what's more revealing are the similarities. Both have avoided some of the nation's most obvious problems: the coming spending explosion to pay baby boomers' retirement benefits (mainly Social Security and Medicare); the relentless advance in health costs that's squeezing wages and other government spending; the rising tide of immigration and the associated social problems; Americans' uncontrolled thirst for insecure foreign oil; and the perils of letting Iran and North Korea go nuclear.

To be sure, the candidates had positions. But these consisted mostly of appealing platitudes that said what people wanted to hear.

Well... yes. And let's not forget George "I cut your taxes" Bush, who refuses to address the Alternative Minimum Tax (AMT) which will soon claw back most or all of the "middle class tax cut" from about 90% of its beneficiaries, or Kerry who is very much aware of that issue but apparently afraid to make it a campaign issue - after all, current budget and deficit projections anticipate the continued expansion of AMT revenues.

Samuelson opines,

At the root of all these glaring omissions is public opinion. On these issues, pleasant solutions don't exist. ... If the public won't abide honest discussion of clear problems -- and our leaders can't lead opinion -- then the problems simply fester. In this campaign, neither Bush nor Kerry has risen above that dilemma.

That suggests that many of our largest social problems will progressively worsen until they get so bad that we're forced to deal with them. Or they deal harshly with us. This is the true deadlock, and it may be incurable.

Still, I wonder what would happen if an incumbent President, particularly one with a majority in both houses, truly took on the hard issues, rather than making every significant initiative take effect in his second term. What if a President dared to tell the truth and to lead during his first term, rather than treating it as an audition. After all, are we so stupid to think that Bush truly thought that the Israel-Palestine "road map" would be more or less complete in 2005? That the Medicare prescription benefit wasn't put off until 2006 because it is anticipated that many (or most) seniors will find it horribly lacking? That Afghanistan's Parliamentary elections won't take place until 2005 (even as its first Presidential election was moved up to make Bush-friendly headlines)? That although nominal sovereignty was handed over to a new, appointed council of Iraqi's, no election will occur until 2005? Everything difficult goes into the second term.

Well, yes... maybe we are that stupid.

(I single out Bush not because this is unique, but because he is the incumbent, and likes to pretend that he is a leader. By way of Democratic example, the roots of Clinton's failure in his Israel-Palestine peace efforts lie largely in his failure to address the hard issues, such as borders, settlements, and refugees, until his last six months in office.)

Minor Distractions III

Grandma: She's much cuter than you were when you were a baby.
Dad: I think she's much cuter than most babies.
Grandma: All parents think that.
Dad (to self): (Except you?)

Okay - so I can't be too hard on Grandma for thinking her grandkids are cuter than her kids were. ;-)

The Iceman Cometh

A bulge? A communications device? This looks like a cooling device to me - to avoid a sweaty brow on primetime TV.

Minor Distractions II

Don't Ask, Don't Tell....

Urgent Message from Jonathan Garthwaite of Townhall.com - "Vets Want To Expose Kerry, Need Your Help".

Minor Distractions

Emma Katherine Larson
Born October 28, 2004
9:40 A.M.

Of Presidents and IQ

Why the obsession with GW's IQ? For the past five years, there has been one feeble "analysis" after another intended to assure us that he's actually pretty bright. Whether it is the analysis of his SAT scores or, more recently, his Air Force Officer Qualifying Test score.

A friend of mine once commented that what he found surprising is that it is quite easy to tell when somebody is not as smart as you are, but it is a lot harder to tell when somebody is smarter than you are. That's not to say that you cannot identify a situational brilliance - most will concede that Stephen Hawking can outdo them in the field of theoretical physics. But there's another side to this - even with his physical limitations removed from the equation, few would thereby conclude that Stephen Hawking was highly qualified to be President.

That's not to say we don't want a smart president - we obviously do. And obviously a great number of Bush supporters are sufficiently obsessed with "proving" that their candidate is sufficiently smart that they pore over dusty academic records and apply mathematical formulae they, well, seemingly make up, to prognosticate that when Bush was at one young age or another his IQ was somewhere in the mid-120's. A respectable IQ, although probably not particularly remarkable for Capitol Hill, which (whether or not you like the way they apply their intelligence) has more than its fair share of bright people.

We can easily get past the "IQ is meaningless" argument - it is apparent that IQ is quite meaningful within a broad range of common contexts. Bush's IQ is extrapolated from his SAT score - what, then, should we make of Paul Allen's combined 160, or Bill Gates' combined 1590 SAT scores? Is it a mere coincidence that two men whose SAT scores were "perfect" and "near-perfect" are co-founders of Microsoft (even if we wouldn't necessarily want either as President)?

But IQ isn't everything. A person can have a very high IQ but lack the social skills or even the thinking skills which make the IQ relevant. A high IQ score, of itself, doesn't make you conscientious or motivated. Of itself, it doesn't make you honest or trustworthy. Of itself, it doesn't make you a good or creative thinker. Of itself, it doesn't make you realize what every truly "smart" person knows - that learning is a lifelong experience, and that you will never have all of the answers. That is, life answers more questions than answers - and that the more you learn, the more you realize you do not yet know. And, of course, the measure of few IQ points one way or another is more likely to tell you something about the test and its margin of error, or how tired or bored the subject was when tested, than it is to tell you about any given individual.

President Bush may well have an IQ in the mid-120's. But if he does, he doesn't apply it well. He gave up on the journey of learning a very long time ago, apparently before he even got to college, and in many ways his campaign is effectively centered on his concrete operational thinking patterns - those which make him so certain that he is right and so unwilling to reconsider his mistakes. His more intelligent supporters who recognize these patterns - and recognize that they are indicative of a lower intelligence - obsess over proving he is "smart". And they keep going back to the same tired issue, over and over, because they know that Bush's public statements suggest that by Capitol Hill standards, whatever his IQ, Bush is at best a middling intellect.

Those supporters should remember two things. The reason that candidates like Clinton, Gore and Kerry aren't defensive about their intelligence is that they are confident of their intelligence - and their supporters share that comfort. And they should also remember that bragging that your friend is a few IQ points, or a few percentage points, higher than somebody else is a playground taunt, without any real world significance.

Well, That Settles That!

Rupert Murdoch on Fox News:

We're not in the least bit biased, we're a fair and balanced company.

The "Integrity" of the Election

Believe it or not, despite his legendary (some might even say "mythic") balance, George Will has somehow managed to editorialize that the elections must be saved from evil Democrats and their trial lawyers - you know, like the ones who worked so vociferously for GW to block the 2000 Florida recount - and informs us of a shocking case in St. Louis, where they got a liberal judge to keep the polls open late such that more people could vote, but somehow forgot to mention the recurring problem of efforts to suppress the vote, or even recent criminal indictments surrounding a Republican vote suppression effort and redistricting effort.

But then, perhaps it's only worthy of mention if the questionable conduct might allow more registered voters to access the polls and cast lawful ballots.

Still, one wonders how he can comment on fraud associated with the use of absentee ballots, without even breathing a word about the legendary vote whores of Texas.

Jon Stewart & Crossfire

Okay... The Washington Post ran a puff piece, addressing the Crossfire criticism at the end - and 'doesn't get it'. The New York Times tried a serious commentary, and really 'doesn't get it'.

Fortunately, although you have to travel all the way to Phoenix, not all is lost - this guy gets it.

The Flu Vaccine

One of the prevarications that Bush is presently spreading, to avoid taking any responsibility for the flu vaccine shortage, is that vaccine manufacturers are afraid to produce the flu vaccine because of litigation. Fascinating, then, that we have no shortage of, say, DPT vaccine, MMR vaccine, chicken pox vaccine, polio vaccine, hepatitis vaccine... heck, even yellow fever vaccine.

It is also interesting that, not being aware of any litigation over the flu vaccine, all I could find on the Internet were a handful of apparently unsuccessful lawsuits - three between 1976 and 1990 - alleging that the flu vaccine caused Guillain-Barre Syndrome (a form of peripheral polyneuritis characterized by pain and weakness and sometimes paralysis of the limbs, cause unknown).

Meanwhile, why no mention of the National Childhood Vaccine Injury Act, or the Vaccine Injury Compensation Program, which have removed most vaccine-related injuries from the courts?

So it does not appear that there is any appreciable litigation over the flu vaccine, some very effective "tort reform" measures are already in place to protect both manufacturers and consumers, so... could Bush be "making stuff up"? Um... yeah. that would be it.

Kerry's Most Contentious Statement on Vietnam

In 1971, John Kerry made the following statement:

It is impossible to describe to you exactly what did happen in Detroit [in a meeting with 150 Vietnam veterans], the emotions in the room, the feelings of the men who were reliving their experiences in Vietnam, but they did. They relived the absolute horror of what this country, in a sense, made them do. They told the stories at times they had personally raped, cut off ears, cut off heads, tape wires from portable telephones to human genitals and turned up the power, cut off limbs, blown up bodies, randomly shot at civilians, razed villages in fashion reminiscent of Genghis Khan, shot cattle and dogs for fun, poisoned food stocks, and generally ravaged the country side of South Vietnam in addition to the normal ravage of war, and the normal and very particular ravaging which is done by the applied bombing power of this country.

The Swift Boat Liars and affiliated groups like to misrepresent that quote, as if Kerry is attributing the atrocities to all veterans as opposed to describing stories from individuals who were confessing to have committed atrocities. We know, both from military records and from extensive photojournalism, that at some level the described atrocities did occur. And while in retrospect I'm sure Kerry would have tacked on a whole host of disclaimers, I think he made pretty clear that he was relating individual confessions and was not accusing the average G.I. of having beheaded civilians.

When Life, Look, and other publications of the time published large format, black and white photographs of the atrocities Kerry described, nobody of consequence pretended that they were depicting the conduct of every soldier, or even the average soldier. And while I understand why nobody wants to dredge up those photographs (save, perhaps, for Vietnam - they are prominently featured in the War Museum in Ho Chi Minh City), would the Swift Boat Liars and their ilk make similar accusations at those publications if the images were brought forward by the mainstream media?

And for "documentaries" such as "Stolen Honor", which speak of prisoner mistreatment at the infamous "Hanoi Hilton", what was the greater sin? Kerry's testimony, which doesn't seem to relate to the conduct of the soldiers held at that prison, or Life's photo spread, carefully orchestrated by the North Vietnamese to make it appear that the prisoners were exceptionally well fed, housed and treated. When a prisoner, Lieutenant Paul Galanti, tried to convey a message, "This is all B.S.", by posing for a picture with his middle fingers extended, Life opted to edit out the middle fingers before publishing the picture - so as not to offend its audience.

A Presidency By Popular Vote?

David Broder today complains, with some basis, that if states apportion their electors in accord with the popular vote it is likely to result in a significant number of elections being decided in the House of Representatives. He defends the electoral college on the basis that it provides disproportionate voice to less populated states:

When Congress debated it after George Wallace threatened electoral deadlock with his third-party candidacy in 1968, opposition came from small states, whose senators feared they would be overlooked by the candidates, and from urban constituencies, who feared diminution of their power to swing big blocs of electoral votes through the unit rule.

But it is not at all clear from his comment why small states should have that type of veto power, even if rarely manifested in an effect on the election result. Even less compelling is his complaint about the possibility of run-off elections:

Most proposals for direct election specify a minimum percentage for victory -- usually 40 percent or 45 percent -- with a runoff between the top two contenders if no one reaches that threshold. But as soon as you introduce the possibility of a runoff, you create an incentive for minor parties to form, in hopes of bargaining for favors or policy concessions from the runoff opponents.

It seems easy enough to, say, not hold a run-off election, or (if people insisted) to put the threshold much lower (e.g., 34%) such that it would rarely if ever be a factor. Another response? Why is it "good" in Broder's mind that small states can bargain for favors or policy concessions due to their overrepresentation in the Electoral College, but not for "minor" parties (who carry enough clout to deliver a candidate a majority of the popular vote) to do the same?

Most voters in this nation are effectively told, well in advance of a Presidential election, "Your state is solidly blue or solidly red, so your concerns won't factor into the upcoming election unless they correspond to what a 'swing state' wants to hear. Oh - and you might as well stay home, because your vote for President doesn't actually count." I somehow doubt that's what the Founding Fathers had in mind, even if Broder is satisfied.

Kristof is Perplexed

Poor Nicholas Kristof today declares, "I understand the painful ethical choices of Abdelrahim's family, of Mr. Hassan and of the international aid agencies. But what I can't fathom is our own moral choice, our decision to acquiesce in genocide".

We in America could save kids like Abdelrahim and Muhammad. This wouldn't require troops, just a bit of gumption to declare a no-fly zone, to press our Western allies and nearby Arab and African states, to impose an arms embargo and other targeted sanctions, to push a meaningful U.N. resolution even at the risk of a Chinese veto, and to insist upon the deployment of a larger African force.

Instead, President Bush's policy is to chide Sudan and send aid. That's much better than nothing and has led Sudan to kill fewer children and to kill more humanely: Sudan now mostly allows kids in Darfur like Abdelrahim to die of starvation, instead of heaving them onto bonfires. But fundamentally, U.S. policy seems to be to "manage" the genocide rather than to act decisively to stop it.

Well, Nicholas, if you can convince Karl Rove how doing more will translate into votes for Bush (and not for Kerry), perhaps Bush will have a moral awakening.

Is It Really That Simple

Jonathan Freedland suggests that the Presidential election represents a conflict between faith and reason. While Freedland may overstate that conflict, even in his expression of grave concern he may well be understating the effect of a second Bush term on the United States.

An American Crybaby In London

I had no idea Americans were so easily reduced to tears.

After going on at considerable length about how rude Londoners hate and attack Americans (something Paul Craddick forgot to mention in his recent travelogue), we're informed that the British are even worse than anti-American...

Here is what I perceive as the explanation: Europe has always been a seething hotbed of anti-semitism. England, sadly, has the distinction of being the very first country to expel its Jews and initiate the blood libel. The Jews were not allowed back into England until the time of Cromwell, and feel to this day that they worship by the grace of the sovereign.

Um... do I sense a slight bias in the author's perceptions?

When the author whines, "I cannot conduct business or even take a taxi ride in Britain without a scathing tirade about the scurrilous Yanks", I can't help but wonder if her London is even on the same planet as the one which holds the London that I vist from time to time. On my last trip, the most memorable taxi conversation involved a driver who, upon learning that I had lived in Manchester when I was five, started querying the extent of my expected resultant devotation to Man United. Ah, this crazy post-9/11 world....

Past Presidential Races

First off, you have to remember that my opponent is a trial lawyer. A trial lawyer. Can we really afford to elect a president who is a trial lawyer?

Second, I have to say that my opponent doesn't talk straight. He uses complicated words to weave around the issues. I talk about my parents, he's talking about his "forefathers". I say "eighty-seven years ago", he's going on about "four score and seven years ago". What's up with that?

Third, and this is a big one, he's a flip-flopper. One day slavery is morally wrong, the next day he wants to keep it in place. Which one is it? This isn't a little issue, folks, whatever you think of that Dred Scott decision. I offer moral clarity.

Did I mention he looks funny? Does he even look like a President?

Should Debates Have Background Music?

These are dangerous times. I believe I offer tested, strong leadership that can calm the waters of the troubled world. And I believe that we can together do things that are within the grasp of Americans.

Perhaps this?

[Caution - that link will automatically play a .wav file.]

Stupid Questions, And How They Might Be Answered

The New York Times today permitted political partisans to pose "questions" that they would like to ask the other party's candidate (Questions for Bush; Questions for Kerry). I guess this is the power of celebrity - they got low-caliber "questions" which the letters editor would have trashed, and printed them anyway. Let's take 'em on.....

Charles Murray - Five percent of Americans pay 54 percent of all personal income taxes. They do not use more government services than other Americans; they use fewer. Why is this fair?

Mr. Murray, as you certainly know, the tax figure you present ignores payroll taxes. Yet payroll taxes, which are another form of income tax, take a huge bite out of the paychecks of working men and women. As you also know, you are ignoring sales taxes, state and local taxes, property taxes, gas taxes, so-called "sin" taxes, and many other taxes which fall on the shoulders of this nation's working men and women. You are also ignoring user fees and license fees. But you know all of that. You wish to distract people from tax realities in order to justify even more tax cuts for the richest of the rich. I favor a system of taxation that is fair to all people, Mr. Murray, rich and poor, not one that favors any particular group of people, and that is what I will work for.

Charles Murray - Would you be willing to sponsor tort reform that requires plaintiffs to have used common sense before being eligible for damages?

Mr. Murray, do you mean a calculus whereby the judge or jury deciding the case would allocate a percentage of fault to the victim, and adjust the verdict in proportion to the parties' fault - or even eliminate an award where a plaintiff was more than 50% responsible for his own injury? Such adjustments already occur, Mr. Murray, and they have existed for hundreds of years at common law. I am surprised you don't know that.

Charles Murray - You promise to create millions of jobs, but many people who run businesses say that nothing in your life has taught you how much effort, risk and sometimes heartbreak goes into creating one real job. Could you describe your experiences when you last had to meet a payroll, or when your boss had to meet a payroll?

Mr. Murray, as a Senator I have an office staff, which I manage, and for which I have a budget. This is not really different from any other mid-management position. In terms of "making payroll", during the Clinton Presidency the government made payroll and turned a tidy profit - call it an enormous budget surplus. Under Bush, the government cannot make payroll, and has borrowed astronomical figures to make ends meet. Call it a record-breaking budget deficit. If you are suggesting that President Bush's dubious record in business is a qualification as President, the facts suggest something completely different.

Christie Whitman - You have been critical of President Bush's rejection of the Kyoto Protocol, yet in 1997 you joined 94 of your Senate colleagues in effectively rejecting its terms. What has changed to make you accept now what you then rejected?

Christie, as you know, President Bush has done far more than reject Kyoto. He has politicized the EPA, rejected scientific opinion, buried official reports, and has otherwise taken a very non-scientific approach to the issue of climate change. Meanwhile, evidence of climate change is all around us, perhaps nowhere more strikingly than in the President's brother's state of Florida. You ask what has changed? What hasn't changed? Whatever disagreement may exist as to its cause, climate change is very real and it would be a priority for any competent President.

Christie Whitman - The president's Clear Skies proposal calls for a 70 percent reduction in some of the worst air pollutants, including mercury, over the next decade. While the current Clean Air Act has made a difference, it is cumbersome, it almost always involves lengthy litigation that delays any benefits, and it doesn't set any specific level for the reduction of mercury. Why haven't you led the fight to avoid lawsuits and instead demand the results the president has advocated?

Christie, it is almost comical that you mention mercury levels, given that one of President Bush's first acts when he took office was to attempt to raise the acceptable level of mercury in drinking water - water than the men, women and children of this nation trust to be safe and clean. And while portions of the President's proposal would diminish harmful emissions, independent analysis indicates that it will be less effective in doing so than the existing legislation. You should also know from your extensive experience in government that "simpler" is not always "better". The President has attached a pretty name to a proposal which is in many ways a license to pollute. It is better to fix the existing legislation, flawed though it may be, than to replace it with a pro-industry bill - which is I guess what people like you would have us call "results" - that will damage our environment, and endanger the health of the people of this nation.

Stephen L. Carter - During the long period it would take to carry out your plan to improve the public schools, would you, in the interest of racial justice, support a system of vouchers to enable the parents of poor inner-city children to pay for private schooling to cover the transitional years? Throughout the five or more years that your plan envisions, many inner-city children will continue to receive substandard educations, and to suffer in other material and spiritual ways.

Stephen, I would of course encourage states to develop the systems they deemed necessary to ensure that inner city children get quality education during the transition, and states may well choose to use vouchers. But as you surely realize, you cannot "fix" a system by emptying it of its best students, nor can you transfer students into private schools and charter schools which don't exist. A voucher system does not magically create additional space in existing schools - that takes years, and as you have implicitly stated we can't wait. Unfortunately, opportunists who latch on to voucher and charter school programs can create cataclysmic failures for parents and students, as occured in California this fall when a single "charter school" provider failed, shuttering sixty schools around the state, and leaving 6,000 students scrambling to enroll elsewhere. You don't fix an educational system by diverting resources to untested programs and profiteers.

Stephen L. Carter - If the answer to the first question is no, would you call on well-to-do Democrats to show their support for public education, and for the poor, by voluntarily sending their children to the schools that the inner-city parents are required to use? After all, a sudden influx of middle-class families might force a cure for many of those schools' deficiencies.

Stephen, as you know, that is a ridiculous question. I want to ensure that all parents, rich or poor, receive quality education. I don't begrudge President Bush his years at Andover, Yale and Harvard, even though his well-connected family might have pressed for serious improvement in any public schools he might have instead attended, because they wanted to provide him with the best education and opportunities. That, as you know, is achieved by making the system better, not through absurd stunts such as the one you propose. I wouldn't ask you to send your children to the worst school you could find, merely to prove a point, and if I did I would fully expect you to reject my invitation. Where did your kids go to school?

Stephen L. Carter - If the answer to the second question is no, are there any sacrifices that you would call upon middle-class Americans to make for the sake of improving the condition of the worst-off among us?

Stephen, perhaps you aren't aware of this, but the middle class pays a tremendous price to fund the public education system. States like Michigan have enacted elaborate systems to create fairness in educational funding, such that the City of Detroit has funding per pupil which exceeds the state average. Again, I am very surprised that you don't know this, but the middle classes are already contributing.

David K. Shipler - You speak of "compassionate conservatism," yet you rarely talk about the poverty that afflicts millions of Americans, including many who work hard at low-wage jobs. Your administration has inadequately financed or reduced the budgets of housing, child care, job training and other programs vital to helping the working poor. What do you see as government's proper role, and how would you change policies in a second term to demonstrate true compassion?

David, there is a difference between being "compassionate" and giving handouts. If I see a vagrant on a street and give him change, I may subsidize a sandwich, or perhaps a bottle of booze, but I do nothing to lift him out of his situation. I see the government's role as being to help people climb the ladder, not to subsidize them so that they are comfortable sitting on the floor when they could be climing. Not that I like to resort to the cliche, but compassionate conservativism is a hand up, not a handout. It's teaching a man to fish. There's no compassion in keeping poor people poor, even if you make their poverty somewhat more comfortable. You display compassion by helping them to achieve.

David K. Shipler - The federal government has begun to finance "faith-based initiatives." Previously, religious groups had to create separate, secular entities to receive federal money for services for the poor. Now, grants go to religious organizations that can discriminate against people of other faiths in hiring. Some will inevitably use tax dollars to promote their religious beliefs. Are you trying to break down the First Amendment's wall separating church and state?

No. Further, the Supreme Court is the final arbiter of the boundaries between church and state, and to the best of my knowledge my proposals have been held constitutional. What I will not do is put arbitrary hurdles in front of an organization that wants to help people, merely because it is affiliated with a religious organization.

David K. Shipler - Using the Patriot Act and other means, you have tried to evade the courts and minimize the rights of those accused of terrorism. Your administration has conducted searches without warrants, obtained gag orders on those forced to turn over records, monitored conversations between lawyers and their clients, employed unverified intelligence reports in criminal proceedings, and claimed the power to imprison Americans indefinitely without indictment or trial. Now that a couple of major cases have collapsed, what proof exists that these measures are actually being used against the right people? How many terrorist plots have they foiled?

David, you have asked a lot of questions there, perhaps because you are aware that your questions don't stand on an individual basis. On September 11, 2001, our nation faced a terrorist attack on an unprecedented scale, and it became obvious that we needed to root out sleeper cells which might be planning additional attacks on our people. Congress passed the legislation required to achieve that necessary end. How many terrorist plots has this foiled? So far, on the home front, all of them. But we can't drop our guard, because while we have to succeed 100% of the time the terrorists only have to succeed once. Congress is presently revisiting provisions of the Patriot Act which are due to expire under the sunset provisions of that legislation, and if provisions are deemed unnecessary Congress will presumably permit them to expire.

Alice M. Rivlin - According to your former Treasury secretary, Paul O'Neill, Vice President Dick Cheney believes that "deficits don't matter." Do you agree with the vice president? If so, why promise to cut the deficit in half in your next term? If not, what dangers do you think large sustained deficits pose for our economy? Do you worry about burdening your daughters and their children with rapidly growing federal debt and interest payments?

Alice, I have expressed that deficits matter, and I have expressed that I intend to halve the deficit over the next four years. It is not always bad to have a deficit - sometimes it is necessary to stimulate the economy, and sometimes it is the necessary result of national emergency, sometimes both. And that's what we faced after 9/11. But I have consistently advocated for eliminating the deficit.

Alice M. Rivlin - You say that you want to allow young workers to put part of their Social Security taxes into personal accounts. They could invest these accounts in stocks or bonds and leave them to their heirs. At the same time, you promise not to reduce scheduled benefits for current and soon-to-be retirees. But taxes paid by working people are used to pay benefits to current retirees. If the taxes paid by younger workers are diverted to their personal accounts, where will the money come from to pay those benefits? Would you try to borrow the additional money (estimated to be at least $1 trillion)? Would you take money from other programs? Would you raise taxes?

Alice, obviously the plan would be for a savings program that also permits Social Security to continue to self-fund. That would not require any new taxes or debt.

Alice M. Rivlin - In a recent open letter, 169 economists and business school professors, including 56 professors from Harvard Business School, your alma mater, sharply criticized your economic policies. They said your proposals for Social Security and making the tax cuts permanent "only promise to exacerbate the crisis" and that "your tax policy has exacerbated the problem of inequality in the United States." Do you dismiss these critics as uninformed? If not, what would you say to persuade them they are wrong?

Alice, if you have ever tried to have a discussion with a group of economists, you would know that they rely upon theoretical models, and they frequently disagree over the most basic of economic projections, and it just so happens that they disagree with this Administration's economic advisers. For every fifty six economists who are adamant that their projections are 100% right, there are countless others who are just as certain that they are 100% wrong. The classic joke about an economist, stuck at a bottom of a hole, is that his solution for escaping is "first, we assume a ladder". With all due respect to Harvard's economists, life gets more complicated outside the ivory tower.

Alan Ehrenhalt - As a candidate in 2000, you argued in favor of compassionate conservatism and a restoration of decency and moderation to the national government. Those of us who voted for you took this seriously. But your personal demeanor as president has been belligerent and dismissive of virtually anyone who opposes your policies. You state flatly that anyone who is not with you is against you, and at least imply that disagreement is equivalent to disloyalty. You refuse to admit making mistakes, even when it is obvious that you made them. You all but invite attacks on the country with "bring it on" taunting that makes you sound more like a gang leader than a responsible head of state. What happened to your promise of compassion? Have you concluded that moderation and decency are not useful qualities in a president?

How can I respond to your question without first observing that, as you caricature and misrepresent my statements and record, you engage in the very conduct you are supposedly criticizing me for having done. I have already addressed the compassion my Administration seeks to bring, and I am sorry that it is not the welfare state you want. There we disagree, and there, presumably, despite all evidence of the failures of the welfare state, you will stick adamantly and without reflection to your desire for the expansion of the failed welfare state. Moderation and decency are very useful qualities in a President. But adhering to a failed welfare policy is not moderate, is not decent, and is just plain wrong.

Alan Ehrenhalt - When you were governor of Texas, you complained about the long list of mandates that Washington was imposing on the states without supplying the money to pay for them. You criticized the Republican Congress for ignoring legitimate state complaints. "Mandates are mandates, regardless of the philosophical bent of the person doing the mandating," you said in May 1998. "It starts at the White House." But your administration has imposed billions of dollars in mandates without even a pretense of offering sufficient money for states to meet them. Did your concern for fairness to Texas and the 49 other state governments simply evaporate when you moved into the White House?

Alan, I am not sure what you are trying to criticize. You don't appear to have a problem with unfunded mandates, just the fact that I have in the past criticized them. I think if you had a problem with any particular mandate I have created, or had evidence that it was unfunded, you would have presented it as an example. The usual example people bring up of a supposedly "unfunded" mandate is "No Child Left Behind". Yet that Act brought billions of dollars of federal revenue to the states. While you seem to think that we can tax and spend, tax and spend without regard to consequences, we face real world budget constraints. You surely aren't proposing that we eliminate "No Child Left Behind", so are you asking me to raise taxes? People who want to pay more taxes already know who to vote for, and it's not me.

Things I "Learned" In Law School

Over on mythago's blog, there is a brief discussion of the insurance industry-sponsored venture known as "tort reform", and the extent to which the insurance industry distorts facts - or just plain fabrications - in their effort to advance industry-friendly litigation. A couple of example fabrications, described in the Washington Monthly, brought back fond memories of law school....

In 1977, the venerable insurance company Crum & Forester sponsored one of the first print ads that included what would become a staple of anti-lawsuit rhetoric: the fictional lawsuit horror story. The ad told the story of a guy who collected a $500,000 jury verdict after he was injured using a lawnmower as a hedge clipper. The agency later conceded that it had no factual basis for the story, but that didn't keep it from circulating widely in the media and in conservative political speeches.

More than ten years later, my torts professor related this story as being about a man who had cut off his thumbs while using a lawn mower as a hedge trimmer. (Think about that for a minute - even if you were to try to cut a hedge with a lawn mower, how could you hold it such that it would be your thumbs which were injured?) A quick Nexis search confirmed the story to have been a fabrication. Another example came from a different professor, I believe in Civil Procedure:

Back in 1986, [60 Minutes] profiled the owner of a ladder manufacturing company who claimed his company had been hit with a $300,000 jury verdict in a suit by a man who fell off a ladder because he set it in a pile of manure. The business owner claimed the lawsuit alleged the company should have warned buyers of the dangers of setting ladders in dung. The real lawsuit had nothing to do with manure; the ladder had broken with less than 450 pounds on it, even though it had a safety rating that said it could support up to 1,000. Tedesco says the show never ran a correction.

That story, also, was recounted as fact.

Another portion reminded me of a recent effort to discuss issues of malpractice with doctors. One kept bringing up the claim that the medical industry wastes $100 billion per year on "defensive medicine" - never mind that not one doctor in the discussion would admit to having ever engaged in defensive medicine, and not one could explain why an HMO or other managed care organization would pay for medical care it did not deem necessary. One claimed that an example of "defensive medicine" was the provision of pregnancy tests to infertile women before certain radiological procedures - although, given that infertile women cannot conceivably suffer fetal injury, it is not at all apparent how this could be classified as "defensive" as opposed to "stupid" or "profit-maximizing". Obviously, if we include profiteering and stupidity in the definition of "defensive medicine", it will be possible to derive an exhorbitant price tag. But generally, it is easier to just fabricate the price, and get it embedded in the public consciousness:

Take the idea of a "tort tax," the financial hit allegedly taken by every citizen because of the legal system, which Taylor raised in his December Newsweek article. It dates back to 1988, when Manhattan Institute fellow Peter Huber coined the term in his book, Liability, and claimed that the tort system cost Americans $300 billion a year. Three years later, the figure made its way into a speech given by Vice President Dan Quayle, who blamed lawyers for wrecking the economy. After the speech, several researchers examined the methods Huber had used to arrive at that figure. Huber, they found, had simply made it up. As The Economist observed in 1992, "the $300 billion figure has no discernible connection to reality."

What was also interesting was seeing that the doctors had no conception of the actual cost of medical malpractice, which the insurance industry estimates at 2 - 3% of the health care dollar, subject to being reduced by approximately 0.4 - 0.5% if all current "tort reform" measures are implemented. And the current "reforms" would have no effect on "defensive medicine", because they are uniformly aimed at limiting the recovery of the most injured victims of malpractice in the most meritorious cases.

Meanwhile, the same doctors who obsessively whinge about trial lawyers, malpractice liability, and the "need" for the tort reform measures which will "save" at most a half-percent of health care costs... yawn at the notion of eliminating bureaucratic inefficiency that results in the outright waste of 10 - 20% of every health care dollar.

My own experience supports the article's observation that most tort recoveries are small, and many tort victims are undercompensated. I also have experience receiving inquiries from people who have come to see the tort system as a slot machine, where an inconsequential or effectively self-inflicted injury can return millions. This, as the Washington Monthly points out, is an impression created largely by the insurance industry's own, decades-long disinformation campaign.

Some academic researchers suspect that all the hype about the litigation crisis might actually be making Americans more litigious by giving them the erroneous impression that compensation is available through the courts for most injuries. As McCann says, "Tort reformers may have produced more frivolous claims while making legitimate claims harder to bring."

Executing An Innocent (But Unsavory) Person?

The New York Times today gives a cursory cry of "injustice" to the case of Paul Gregory House, who appears to be on death row for a murder he did not commit. The Times notes that the en banc Court of Appeals for the Sixth Circuit split down partisan lines (according to which party appointed them), with the Republican appointees voting to keep Mr. House on track for execution and the Democratic appointees voting for acquittal or a new trial. The Times opines

It's hard to dismiss the thought that the Republicans voted as a show of support for capital punishment, not on the merits of the case.

More likely, it was a vote for "finality" - literally for form over substance - although not as explicitly stated as in some other cases. (Read the opinions - PDF Format)

The majority opinion is not unconvincing, until you read the dissent and learn the facts the majority conveniently omitted to make its rendering seem plausible. It is difficult to justify not granting at least a new trial if you actually look to the facts. But the Republicans in the House and Senate, and the Rehnquist Supreme Court, have long been pushing for "reforms" of the appellate process and the right of habeas corpus which place a near-exclusive emphasis on "procedural due process" and diminish the importance of "substantive due process". That is to say, if all of the procedural rules were sufficiently followed, and a conviction resulted, the preference of many "conservatives" is to uphold the conviction in the name of "finality". Arbitrary deadlines and restrictions have been imposed on the use of exculpatory evidence discovered after conviction.

And if a some innocent people rot in prison, or perhaps even suffer execution at the hands of the state, our conscience can be clean - because whatever the facts, we know that the I's were dotted and the T's were crossed, and the need for "finality" must sometimes be placed ahead of facts establishing innocence. Right? (And as any good fascist can tell you, if you're innocent and in prison, you probably deserve to be there for some other crime anyway.)

A Closing For Kerry

If you recall the Presidential debates eight years ago, you will recall the friendly presence of a President who was not angry and combative, who did not feel a need to continually insult his opponent. A President unafraid to admit his mistakes, but confident in his accomplishments. A President who was comfortable with his record, and had no need to be hostile and angry. Today, you have a President who is hostile and embittered, insulting and angry, because he knows his record cannot withstand scrutiny.

Non Sequitur

On the VP debate,

But Ken Mehlman, Mr Bush's campaign manager, told the Guardian the vice-president had made clear the fundamental philosophical differences between the two tickets. "He was saying in a world where 19 people with boxcutters can kill 3,000 Americans in the course of 20 minutes, allowing to remain in power a brutal dictator who defied the world, who had a weapons of mass destruction capability... wasn't acceptable and wasn't safe.

Does that follow? Maybe we should have invaded China, as that is probably where the boxcutters were made....

This Is Sad....

A Bush supporter penned a blog entry for the Racine, WI "Journal Times", entitled "The vice president strikes back".

Cheney easily quoted facts and figures, names and situations, voting records and current trends with the ease that some of us quote "Simpsons" episodes. (Or "Star Wars" movies.)

Um... Leaving the fact-checking to others for the moment, the author expects us to be impressed that Cheney's abilities parallel her uncanny ability to quote "Star Wars"? So she is telling us that we should cast our votes for Senator Palpatine? (Does that put GW in the role of Darth Vader?)

The Vice Presidential Debate

What to me was perhaps the most significant result of the VP debate was the fact that, as combative and pointed as it often was, it had no estimable impact on my opinion. That is, nothing about the Vice Presidential candidates or their respective performances had an appreciable impact on how I view the heads of their respective tickets. That might not have been the case, had one of them had an on-stage meltdown, but obviously that didn't happen.

If I were to declare a "winner" in the context of which candidate looked most Presidential, it would be Edwards. If I were to declare a "loser" in the context of which candidate clung most desperately to a pathetic lie, it would be Cheney and his continued advancement of an Iraq-Al Qaeda nexus with an implied link to 9/11.

If I were to give a candidate bonus points for refusing to bend his personal convictions to the will of his party, they would go to Cheney for his silence on the issue of rights for domestic partnerships. Certainly it isn't bravery to sit in silence, rather than speaking one's conscience, but it demonstrated that there are lines Cheney will not cross with respect to his family and his party. When Cheney's boss was put to a similar test, and could have spoken out against the smear campaign over Kerry's war record, he failed - that is, unless his claimed personality traits of courage and credibility exist only as fiction. I am not sure that similar tests have yet been put to Edwards or Kerry.

At the same time, if I were to give penalty points for stubborn idiocy, it would be for Cheney's insistence that he would handle Iraq in exactly the same way if he were to do it again. That simply can't be true.

The "Zap Them With A Cattle Prod And Wake Them Up" award goes to Babbling David Brooks and Narcoleptic Mark Shields, who provided some post-debate commentary on PBS. They found the Iraq material exciting, but were bored by the domestic issues. Thus, declared Brooks, this election really does turn on Iraq. What a pathetic way to prioritize the many important issues this nation faces.

David Brooks On Crack

No, not that type of crack.

The coming elections and the battles for the cities will either put Iraq on a path to normalcy or introduce us to some new hell. Yesterday, Rumsfeld said Iraq had "a crack" at being a success. At least he's not overhyping.

Mr. false dichotomy strikes again.

Gearing Up for Halloween

A Detailed Plan For Iraq?

Throughout the campaign, the media have demanded that John Kerry detail a strategy for dealing with Iraq. Never mind that the situation has changed dramatically, month-by-month, throughout the campaign. Never mind that even if it were possible to propose a "perfect solution" for today's situation, that solution would be hopelessly out-of-date by January. Never mind that, no matter what the plan, the Bush Campaign would ridicule any element that it could not coopt. (That led to the recent pecularity, following Kerry's first clear speech on an Iraq plan, in which the unreflective Bush Campaign declared through parallel statements to the media, "His ideas are the same as ours" and "He's advocating 'defeat and retreat'".) Never mind that no similar demand has been made of the Bush Campaign.

I'll give David Ignatius this much - at least he's breaking with the nonsensical pattern of demanding the challenger to outline precisely what he would do in Iraq while failing to make any similar demand of the Bush Campaign. But any person who can assert,

The coming offensive in Fallujah could be the bloodiest combat that U.S. forces have faced yet in Iraq. Worse, it could push interim Prime Minister Ayad Allawi's fragile interim government toward the breaking point. One early warning sign was this week's comment by interim President Ghazi Yawar, a Sunni Muslim, criticizing recent U.S. airstrikes on Fallujah as "collective punishment." It was Yawar's threat to quit the interim government last April that helped halt the previous U.S. offensive in Fallujah.

has to also know that a strategy for the present situation in Iraq, let alone an exit strategy, could be dramatically changed by the success or failure of such a venture - and that even a military success could result in a profound setback if it inspires the collapse of the Allawi government, broadens the "resistance", or prevents elections.

Ignatius continues,

If you try to put yourself in the boots of a U.S. soldier in Iraq, what you want to know from the candidates is: Can we win this thing, and if not, how can we get out? Unfortunately, the debate didn't really illuminate those essential questions. The most difficult days in Iraq may well lie ahead, but neither candidate has leveled with the country about how severe that test will be, or what fallback plans he has if his assumptions prove overly optimistic.

The questions are not entirely unfair, but Ignatius again ignores the fact that what might work today might not work tomorrow, let alone next month. The answer to "can we win this thing" seemed a bit different when Bush was strutting beneath his "Mission Accomplished" banner than it does today - and the colossal mistakes made since that time make it much less likely that we will achieve the results we most desire. Then, "winning" was defined as creating a stable nation with a secular, democratic government. Today, "winning" seems to be defined as achieving stability, preventing civil war, and creating a government that is not hostile to western interests. Would Ignatius call a plan to achieve that end a plan for victory?

Bush, the person in the best position to provide the type of answers Ignatius demands, won't provide them. His answers would be an admission of the failure of his central promises in the "liberation" of Iraq, and would also reveal that he has no "exit strategy". And his campaign can't simultaneously accuse Kerry of "defeat and retreat" while simultaneously proposing Bush's plan for doing precisely what he ridicules.

Bush would love for Kerry to paint a strategic picture on Iraq that addresses the present realities. "See how negative and pessimistic he is. Defeat and retreat. He's setting back our interests in the region." Columnists like Ignatius need to place the onus on the Bush Administration to announce its plan - to which the Kerry camp could then be called upon to respond with what it would do differently. And Bush knows that had he clearly enunciated his plan for Iraq and "exit strategy", he would have had to update the plan so frequently as to be (in his parlance) the quintessential flip-flopper, or would have had to repeatedly admit failure. Or both.

Perhaps, before being allowed to write columns like this, columnists like Ignatius should be required to propose their own plans to achieve victory in Iraq, and their ideas of a viable exit strategy. Perhaps such a demand would be the only thing that would wake them up to the realities of the situation, and why their demands are rather silly.

Leading Them By The Nose....

When I hear criticisms of Kerry as the Democratic candidate, I am often left wondering what it is that inspires those criticisms. That is, the speakers will declare something silly like, "Kerry doesn't excite me", or "He was picked because he was considered the most electable", as if... as if either statement has any significance, or as if parties should pick unelectable candidates. Or "Bush reminds me of a guy I'd drink a beer with", or "I like his swagger and confidence - he's like me" (which is pretty much what a blue collar attendee at a Nascar event said a few months back - as if Bush is anything like him). When you hear something more substantive, such as "Kerry flip-flops", and press for details, you're lucky if you get any. In my experience, pressing for details reveals these comments to be inspired not by the candidate, but by news coverage of supposed voter ambivalence and of the other side's attack ads.

I am often left to wonder what these people want in a candidate. Whose idea is it that you should want a candidate you would drink a beer with, or that you shouldn't want a candidate who instead drinks wine and likes fancy food? Or that you should have an (unelectable) candidate who excites you, rather than a staid, intelligent, and competent candidate who seems, well, staid, intelligent, and competent instead of "exciting". The media, I suppose, started to buy into the packaging and selling of a candidate, over the substance and competence of a candidate, after the Nixon-Kennedy debates. So "Dukakis looks silly in that helmet"-type nonsense often becomes the media's central focus, as opposed to the candidates' positions on the issues. (The media's distractability was very well highlighted by their response to the "Swift Boat Liars" nonsense - and the effort of even the New York Times to blame a candidate for its poor work. Sure, Dukakis didn't have to put on the helmet and get into the tank, but was that really a story?)

If you were "surprised" by John Kerry's performance at the first Presidential debate - which he is widely regarded as having "won" - here's some news for you: If you had been paying attention to the candidate as opposed to the spin, you wouldn't have been surprised.

You want a candidate who thinks in simple terms and speaks in pre-packaged sound bites, instead of one who understands the world's complexities and whose comments reflect thought and abstraction? Perhaps, then, you should do us a favor and limit yourself to voting for the county dog catcher. If you want more from a candidate, stop regurgitating the media's latest spin, and start listening to what the candidates are actually saying.