Month: April 2009

From the NYT today:

In the meeting with reporters in her office last week, she expressed little distress over lawmakers’ revisions to legislation she favored. She also said she prays for “the revelation of truth” to combat what she says are persistent lies about her and her family.

Alex Massie and James Joyner say some very kind things about me and this blog. Johann's profile which prompted them is also a very generous one, largely because he did me the great favor of reading my stuff from the very beginning and trying to see it from the inside out. That's rare:

Sullivan is often accused of flip-flopping according to political expediency, but it’s revealing that almost all the later tensions in his thought are prefigured in his writings about Oakeshott from his early 20s, recently published as “Intimations Pursued”. In 1984, he wrote that Oakeshott offers “a conservatism which ends by affirming a radical liberalism”—precisely the charge against Sullivan since 2004.

The reason I am such a bore on Oakeshott is because reading him and thinking deeply about him at the  end of the 1980s was a breakthrough for me. Until then I had struggled badly in trying to reconcile a deep philosophical conservatism with the modernity I had come to enjoy and that had been so kind to me. (Any Tory in love with America would feel the same cross-currents, I suspect. And any gay man unaware of the blessings of the contemporary West needs a lesson in history and geography.)

I can't say my reconciliation has been without complication or some rough edges, but whose hasn't? And one feels a little less self-contradictory in this regard because most of the really interesting conservative icons I revere – Hobbes, Hume, Burke, Oakeshott and Hayek come to mind – show that liberal strains are intrinsic to sophisticated conservatism. (One recalls also, of course, that the founder of English Toryism was an Irish Whig. And the greatest statesman of the last century, Churchill was both a Liberal and a Conservative – can you imagine the ridicule he'd face today on Fox News for his flip-floppery? And the greatest conservative statesmen of the nineteenth century, Disraeli and Lincoln, advanced modernity more than their more liberal peers.) But their lack of political monochrome is not, I think, a function of weakness or expediency, but of being instinctive conservatives in a civilization constructed on liberalism. And the epistemologically conservative defense of classical liberalism – the Oakeshottian riddle – is the place I ended up by a process of elimination and a few years of care-free study. Such a conservative liberalism pushes at times against an emotional impulse to correct injustice and punish cruelty, but this tension is an adult one and I see no reason to abandon it now.

And what I love about the free-form unfinishedness of blogging is its capacity to embrace these various strains, sometimes one, sometimes another, in response to a fluid world and an evolving soul. To do it alongside others, however, is the real joy of this medium – with fellow bloggers and writers and above all readers. For Oakeshott, the ideal human interaction is conversation; and I know no form better designed for it than this one. And so I am, in a way, lucky to have stumbled upon this idiom in this time and place because it suits me, and teaches me, and reproves me in ways no other can, and allows contradictions to become internal and external conversations.

Where it ends I cannot know. Which is one reason to carry on.

A reader writes:

I'm 36, married, no kids, professional services job.  Good health insurance in Massachusetts.  I work a lot, I drink a little much, eat a little too much (of the wrong stuff), smoke about a pack of cigarettes a year.  I also work out 5-6 times a week, never been hospitalized, no chronic symptoms or conditions, no major health issues.

For the past 6 years I've seen the doctor once a year for my physical.  This will be the last year I see her annually.  Why?  B/c my insurance changed – in my age group, I now get charged – and a lot – for a routine visit more than once every three years.  I discovered this when I went for my previously scheduled physical and promptly got a bill for $1200!

So that's the "good news" – if you want people to spend less on health care, they have to bear more of the costs of using health care themselves.  When I saw that bill there was no controversy, no uncertainty – I'll just wait.  If I break my wrist or have unbearable stomach pain I can still go and see my primary care physician.  But for the routine stuff – I just won't go.

The concept of moral hazard is right, but the semantics seem wrong. I wasn't trying to exploit anything to which I had no moral right.  On the contrary, I'd (thought I'd) paid for a service – relatively limitless visits to a medical professional to confirm my health.  Not availing myself of the service was leaving money on the table, like watching frequent flyer miles expire.  No one does this – rational homo economicus should do exactly what I did to capture all of my surplus.

So what's the bad news?  The bill I received was opaque (other than the amount due).  I called the insurance company, and asked what gives.  The very helpful customer service rep explained that my policy had changed, and that the services attached to my routine visit were billed as shown.  But, since I'd gotten an Xray for some lingering foot pain, she  contacted the Dr. and ask her to recode the entire visit (which she did).  So it was covered.

Of course, I accepted this 'offer' (frankly, she didn't really ask – she just did it).  It is (again) what a rational consumer would do – not leave money on the table.  And obviously, whether I pay or the insurer, this event doesn't change the total amount paid for health care.  But as I pointed out to the customer service rep, next time I want a physical, I could just complain my ankle is sore.

If the institutions (insurers and doctors) provide proper price signals to consumers, by and large they will be understood and responded to.  If they don't – or can't (because our moral system doesn't tolerate the consequences) – they won't and the market will fail.  And people will spend a lot of money on health care.

The book blogosphere is still teed off about Amazon Fail, Amazon's apparently unintentional de-listing of LGBT books. Here's Kassia Krozser and here's Scott Esposito. Clay Shirky takes a different stance:

We’re used to the future turning out differently than we expected; it happens all the time. When the past turns out differently, though, it can get really upsetting, and because people don’t like that kind of upset, we’re at risk of finding new reasons to believe false things, rather than revising our sense of what actually happened.

We shouldn’t let that happen here; conservation of outrage is the wrong answer. We can apologize to Amazon while not losing sight of the fact that homophobic bias is wrong and we have to fight it everywhere it exists. What we can’t do, can’t afford to do if we want to think of ourselves as people who care about injustice, is to fight it in places it doesn’t exist.

Just One Minute explains why the right isn't being completely hypocritical for whining about that DHS study:

Andrew Sullivan chooses to miss the point and savor an "I told you so moment", exulting in his criticism of Bush's shredding of the Constitution and expansion of the "Surveillance State".  Uh huh – the problem with this DHS study is not that they are threatening extra-Constitutional surveillance and interrogation of people; it is that they are coming very close to attempting to criminalize non-violent political dissent.  That is deeply problematic even if they do it with all the proper warrants.

And when the Bushies cordoned off demonstrators and tapped phones without warrant, and tracked protesters at the GOP conventions in New York and St Paul, the right-wing blogosphere was complaining, right? Right. I remember now. Glenn Reynolds, another libertarian who suddenly re-discovered civil liberties  and fiscal discipline on January 20, 2009, addresses the point by claiming he was complaining under Clinton! Doesn't that, er, somewhat prove the point: that Reynolds is a libertarian, as long as Democrats are in power? If a Republican is in office, the executive branch – even taken to the absurd extremes of Bush and Cheney – can do no wrong.

Now I'm not just a racist for criticizing Jindal and a heterophobe for criticizing Palin; I'm a misogynist.

A reader writes:

From your blog entry  about the tea parties:

"Protesting government spending is meaningless unless you say what you'd cut."

Isn't that holding them to a higher standard than that to which you're holding the Administration?  If anything, the party that holds the reins of power should be subject to a higher standard.

The budget shows a structural deficit (even post recession), with spending over the next several years running at 22 – 23 % of GDP and tax revenue running at 18 -19 % of GDP.  The problem is neither high spending nor low taxes; it's the combination of the two.  The Administration and the Democrats are not being honest about how they will fix the problem; neither are the Republicans.  Any solution that will honestly address the problem is going to be hugely unpopular, and the first side that moves is going to be demagogued by the other.  (Just as with conventional wisdom about contract negotiations: the side that first proposes a number is at a disadvantage.)  You can be, and have been, honest; they haven't and won't.

So the Administration takes credit for all the goodies included in the budget without being responsible about paying for it, and the Republicans indulge themselves with this mindless theater of the tea parties.  The Administration won't address how they might raise taxes on the middle class anymore than the Republicans will address where they would cut spending.  Let's criticize them both, while recognizing that neither side is going to be honest without protection from the other. 

They might want to listen to Kristen Soltis. She looks at younger voters feelings about taxes and government:

There is a belief structure among young voters that is slightly in conflict with a core principle of the Republican Party – the belief that the free market trumps government. Young voters have a more positive view of government and are not as convinced that the free market provides better solutions than government.

Yet on the issue of taxes, young voters do believe tax cuts can improve the economy, despite their uncertainty about whether or not tax cuts are the best option.

 If the Republican Party wants to win young voters in the future, an understanding of the ways that young voters view the economy is essential. Messaging that focuses on the need for less government and lower taxes is not likely to be as well received or convincing to this generation. This isn't to say these messages won't work, to be sure. But the spectre of Big Government is not as frightening to young voters, nor is the devotion to the free market so prevalent. In order for the Republican Party to grow long-term, they must work to impact these belief structures and spend the effort convincing a new generation of the sorts of beliefs that are taken for granted among older cohorts.

The Dish is getting so full these days that I thought a daily late-night round-up of the day's highlights might be helpful for some readers (let me know if it is). So today was the day that Glenn Reynolds and the tea-baggers threw their tea-bags in the air, Althouse claimed I hate the straights, DOMA appeared to be on its heels, Richard Posner blamed all of us for the recession, the Palin-Johnston circus continued to entertain, Peter Suderman exposed the hipsters, a soldier spilled the beans on Iraq, Anderson Cooper helped explain tea-bagging, and Obama is about to show us if his commitment to ending torture was real or "just words."

And the beat goes on.

A reader writes:

What this physician wrote really summed it up for me: "Ultimately, the American sense of entitlement, so long appeased and encouraged by our commercial culture, is what is poisoning the healthcare system.  Doctors have played into it and are just as guilty for caving in when they know better, or billing for procedures a patient doesn't really need."

Coming from Sweden, I have experienced a health care system that is often heavily criticized domestically for its sometimes long wait times for some surgeries (hip replacement for example), but generally people appreciate it because it works and it is reasonably cost-efficient, and tax-payer funded, in other words, everyone is insured. I personally loved the peace of mind the system brought, but I am not ideologically opposed to a private system. I just don't think we have a very good one here in the US.

But a recent incident reminded me about the main difference between the health care system in the US and the system in Sweden.

My grandmother, who is in her mid eighties, had fallen and injured her shoulder. This was on a Saturday, and she was taken to the hospital to have it tended to. They put her in a room, and she had it looked at by a nurse, but there was no doctor available to deal with it until after the weekend. They sent her home and set an appointment for her for Monday, and that was when a doctor looked at it. He determined that nothing needed to be done, except giving her drugs for the pain, and if need be antibiotics for any inflammation.

Now, having this story told to me, I was at first horrified. They just dumped her in a hospital room and then sent her home until Monday! The doctor didn't DO anything! I couldn't imagine how they could treat her in such an awful manner – here, she would have been looked at right away, they would surely have done some sort of procedure and sent her on her way. Much better!

But of course, as I found out, maybe I have just gotten so used to the "fix me, NOW!" mentality here in the US. My grandmother turned out to heal very nicely. She had gone home on Saturday with her arm in a sling, spent Sunday relaxing at her house (with pain medication, of course), went to the doctor on Monday. Amazingly, she managed to survive those extra 36 hours or so. Her shoulder healed completely, it took a few weeks.

Obviously, I have no idea exactly what would have been done in the US, and I don't know the details of the injury. I just have this nagging feeling that in the US, a team of staff would have done all sorts of tests, a doctor would have worked extra on Saturday to deal with it, a lot of therapy, drugs, maybe some surgical procedure would have been administered… just to make my grandmother feel like someone was DOING something… and then, in the end it would probably have had about the same result, just for a lot more money, but with the sense that something was "done".

I think what happened to my grandmother would have been completely unacceptable in the US for someone covered by private insurance. Hell, I thought it sounded unacceptable. But the more I was thinking about it, it just made sense. The doctor made the call that nature would do what it always does. And it did. What else did he REALLY need to do? The answer seems, to me, to be that if it had been here in the US, he would have needed to put up a whole charade in order to pretend that HE healed the patient, and that it wasn't just nature taking its course. Because, after all, we pay to be healed by doctors, not to just let time and the body heal itself.