Monday, April 21, 2014

Liberal Dem, Conservative Doc

As a front-page blogger at Daily Kos and creator of the site's popular Daily Pundit Roundup, Dr. Greg Dworkin (f.k.a.DemFromCT, now blogging under his real name) is a high-profile political liberal.  On Twitter, he is an enthusiastic if scrupulously evidence-based proponent of the Affordable Care Act, defending the efforts it embodies to extend access, control costs and improve quality in healthcare delivery.

As a pediatric pulmonary physician with nearly 25 years in private practice, however, Dr. Dworkin spontaneously describes his approach to systemic change in the medical delivery system as "conservative."  He is not hostile to concepts such as coordinated care, bundled payments or risk-based payment -- in fact he has adapted to many changes along these lines over the course of years. He just sees innovations on this front as incremental and experimental -- and to be judged on the basis of evidence that's not in yet.

Dr. Dworkin's thinking about healthcare reform is also, to a degree, conservative in a more political sense.
While he sees no clear benefit as yet from reforms in the way doctors and hospitals are paid, he does witness patients growing ever more cost-conscious as health plan deductibles rise and prescription drug coverage grows more restrictive. In a recent discussion of what healthcare reform looks like from the physician's point of view, he placed more emphasis on the effect of newfound cost-consciousness in patients than on changing incentives for doctors.

As with bundled payments, he said, the advent of consumer cost-consciousness is "a process that's been happening for a long time -- it predates and goes in parallel with the Affordable Care Act."

Sunday, April 20, 2014

Program note

Blogging has been slower here because I'm working on two reported pieces. One, which I'll post tomorrow morning, is an interview with  Dr.Greg Dworkin, pediatric pulmonary physician and headline Daily Kos blogger, exploring what efforts to control healthcare costs look like from a physician's standpoint. While obviously politically liberal, Dr. Dworkin, like most doctors, is an empiricist and therefore "conservative" in the sense of requiring evidence before crediting any given reform measure.

Happy Easter, everyone. I gather it's all about "chocolate eggs and Jesus risen," as C.S. Lewis once heard a 4 year-old murmuring to himself.  In metro New York this year, it's also all about glorious sunshine and refreshingly cool breezes.  So here's to worshiping outside.

Wednesday, April 16, 2014

Racism in service of plutocracy: Beutler's response to Chait

Jonathan Chait's two-front argument that 1) the Republican policy platform has deep roots in slavery and racism, but 2) Democrats are too quick to ascribe racism to individual conservatives, their policy positions and utterances, angered a lot of progressives, who see false equivalence as well as neglect of the real effects of conservative policies on African Americans and other minorities.

On the false equivalence front, Brian Beutler argues that Chait has mischaracterized progressives' case that the Republican gestalt is racist:

Tuesday, April 15, 2014

Tell me your ACA-shopping story

Always fair-minded, Jonathan Cohn pauses in his celebration of lower-than-forecast ACA premiums (as highlighted by the latest CBO update) to acknowledge:

In the transition from the old system, in which insurers could charge higher prices to the sick or avoid them altogether, to a new system, in which everybody pays the same price regardless of pre-existing condition, some young and healthy people must now pay more for their individual policies
The "and" in "young and healthy" is interesting, because, as the conjunction suggests if you look twice, it's not just the young who are paying more under ACA rules. Some if not most healthy older buyers who were in the individual market in 2013 are now paying more -- that is, if no one sharing the insurance has a preexisting condition.*

If you're in the individual market and you're paying more for your insurance in 2014 than you did in 2013, I'd like to speak to you (or, for that matter, if you're unsubsidized and paying less or about the same).  I'd like some detail about what your prior policy covered vs. what your current one does -- what were the tradeoffs. (I wrote up two such stories last month, and I'd like to do more.)

Cognitive dissonance on Passover

I suffer from it, as recounted in this June 2011 post:

Jeffrey Goldberg, Excommunicator

Jeffrey Goldberg has ignited a blog conflagration with an attack on Allison Benedikt's coming-of-age tale of her progressive disillusionment with the gung-ho Zionism she sucked up in summer camp. I found Benedikt's  narrative riveting, and Goldberg's critique smotheringly self-righteous.

Goldberg asks of Benedikt: "Does she ever try to answer for herself why Israel exists? Or is she happy to subcontract out her thinking about the most important questions facing Jews first to her camp counselors, and then to her husband?"  It's true that Benedikt's stances on the issues are barely sketched in, but that in itself suggests neither a lack of thought nor of due diligence. Her focus is on how her changing perceptions registered emotionally, not on the data points that caused them. Hers is not a policy piece; it's a chronicle about how she navigated the family mania for Israel -- and later, her husband's antipathy toward the country -- over the course of a decade and a half or so. Benedikt's response to Goldberg makes this point better than I can.

I want to focus on Goldberg's most poisonous charge -- which he saves for last. I think it reveals more about him than about Benedikt:
And then there is a whole set of other questions:  Does she ask herself whether she has a responsibility to make Israel a better, more humane, place? Does she question herself about the consequences of abandoning Israel? Does she think about the sin of the wicked son in the Passover story, and how that sin might echo in her own life? 
Abandoning Israel? Goldberg seems to have derived that idea from Benedikt's kicker at the close. Let's take a look:

Monday, April 14, 2014

Why the South doth prevail (and why to some extent it didn't)

A 1957 essay by William F. Buckley, Why the South Must Prevail, was making the rounds on Twitter last night (thanks to Erik Kleefeld). In it, Buckley pretends to some regard for the ultimate welfare of Southern "negroes" but asserts that Southern whites have the right to preserve their cultural superiority by denying their black neighbors the right to vote --because  "the claims of civilization supersede those of universal suffrage."

That is, southern whites don't want to integrate and so pollute their...culture, so they have the right to keep "negroes" from voting to force them to do.  How can a minority claim to speak for "civilization"? "[T]he White community is so entitled because, for the time being, it is the advanced race."

People well-versed in Buckley's oeuvre and career, and in the legislative civil rights battles of the of the late 50s, will doubtless weigh in with appropriate context and analysis. Lacking more than passing familiarity with the latter and interest in the former, I still think it's worthwhile to note a couple of points that struck me, coming to this cold.

Sunday, April 13, 2014

The moral (and economic and social) equivalent of war, revisited

William James' prescient 1910 essay The Moral Equivalent of War was written in part as a rebuttal to pre-World War I theorizing about the role of war in human society that to post-world-war eyes look rather shocking:
Other militarists are more complex and more moral in their considerations. The Philosophie des Krieges, by S. R. Steinmetz is good example. War, according to this author, is an ordeal instituted by God, who weighs the nations in its balance. It is the essential form of the State, and the only function in which peoples can employ all their powers at once and convergently. No victory is possible save as the resultant of a totality of virtues, no defeat for which some vice or weakness is not responsible. Fidelity, cohesiveness, tenacity, heroism, conscience, education, inventiveness, economy, wealth, physical health and vigor — there isn't a moral or intellectual point of superiority that doesn't tell, when God holds his assizes and hurls the peoples upon one another.
James did not dismiss such views out of hand. Asserting, "The war-party is assuredly right in affirming and reaffirming that the martial virtues, although originally gain by the race through war, are absolute and permanent human goods," he wondered how humanity might martial those virtues in less destructive ways. And as I noted in The Moral Equivalent of Warmongering, Steinmetz's sentiments maintain a persistent half-life in in common attitudes, expressed via boomer-bashing and other (eternal) moralizing that excoriates those who have concerned themselves mainly with peacetime pursuits.

Today it's not acceptable to suggest that war is a consummation devoutly to be wished. But Ian Morris, in War! What is it Good For?* has updated the argument that war has so far been a major spur of human development -- not only technological, a reality impossible to ignore -- but social and political as well.  In effect, it seems Morris argues (I haven't read the book yet -- excuse the blogger's license) that war has taught us peace. From David Crane's review in The Spectator:

Thursday, April 10, 2014

Chait channels Obama

When I read Jonathan Chait's extended argument that a) many Republican policies have deep roots in slavery and racism, but b) for liberals to assume that advocacy of core conservative policies is itself a marker of racism is illegitimate, my immediate thought was that Chait was echoing Obama:
 Apr 7 Hey, didn't Obama say that in March 2008?
In a followup post, Chait himself notes that Obama had more recently stolen his fire -- in an interview with David Remnick published this past January:
“There is a historic connection between some of the arguments that we have politically and the history of race in our country, and sometimes it’s hard to disentangle those issues,” he went on. “You can be somebody who, for very legitimate reasons, worries about the power of the federal government — that it’s distant, that it’s bureaucratic, that it’s not accountable — and as a consequence you think that more power should reside in the hands of state governments. But what’s also true, obviously, is that philosophy is wrapped up in the history of states’ rights in the context of the civil-rights movement and the Civil War and Calhoun. There’s a pretty long history there. And so I think it’s important for progressives not to dismiss out of hand arguments against my Presidency or the Democratic Party or Bill Clinton or anybody just because there’s some overlap between those criticisms and the criticisms that traditionally were directed against those who were trying to bring about greater equality for African-Americans. The flip side is I think it’s important for conservatives to recognize and answer some of the problems that are posed by that history ...”
That is in fact a pretty exact match with Chait's thesis, as Chait asserts. But like almost everything Obama says -- in fact like almost everything most of us say -- it was close kin to prior pronouncements.  Here's what I had flashed back to, from Obama's great speech on race in the immediate wake of the Jeremiah Wright controversy. After recounting the roots of African American anger, Obama pivoted, in his on-the-one-hand-on-the-other manner: