Why Health Care Costs so Much

Yet another fascinating article by Atul Gawande, whose main inquiry is why some cities spend so much more on health care than elsewhere, with no better results. He ultimately ties it to the financial incentive doctors have to do more procedures (and some places are more successful than others in resisting that incentive):

Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coördination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check.

This last point is vital. Activists and policymakers spend an inordinate amount of time arguing about whether the solution to high medical costs is to have government or private insurance companies write the checks. Here’s how this whole debate goes. Advocates of a public option say government financing would save the most money by having leaner administrative costs and forcing doctors and hospitals to take lower payments than they get from private insurance. Opponents say doctors would skimp, quit, or game the system, and make us wait in line for our care; they maintain that private insurers are better at policing doctors. No, the skeptics say: all insurance companies do is reject applicants who need health care and stall on paying their bills. Then we have the economists who say that the people who should pay the doctors are the ones who use them. Have consumers pay with their own dollars, make sure that they have some “skin in the game,” and then they’ll get the care they deserve.

These arguments miss the main issue. When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician. The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care. Otherwise, you get a system that has no brakes. You get McAllen.

Classics in Translation

I enjoyed John McWhorter's piece arguing that Shakespeare should be performed as translated into modern English, because even when he used words that exist to this day (such as "character"), he was using older meanings that are rather different than what we would understand.

I've recently been trying to read Dante's Divine Comedy. Emphasis on "trying," because it's rather hard going, mostly because so much of the meaning lies in Dante's placement of so many then-modern-day Italian politicians, popes, and bishops in one of the levels of hell. But all of those politicians and church officials are now totally obscure, at least to me.

Thus, translating Dante into English doesn't quite take things far enough. In order for the work to produce the same effect that would have been experienced by an Italian circa 1300, one would have to see (just for example) Pope John XXIII, Nancy Pelosi, Rembert Weakland, Dick Cheney, and perhaps Newt Gingrich in hell. Not that I'd consign any of them to hell, of course; the whole point would be to mimic the shocking (and perhaps humorous) effect that the Divine Comedy originally would have had.

Integration in Schools

Michael Meyer has a NY Daily News op-ed decrying some New York charter schools that happen to be mostly black:

Today marks 55 years since the Supreme Court outlawed intentionally racially segregated public schools, declaring that "separate educational facilities are inherently unequal."

Back then, blacks welcomed the news that we would never again have to "prove" that segregation harms black children in ways unlikely ever to be undone - as demonstrated persuasively by my mentor Kenneth Clark's breakthrough experiments using black and white dolls.

All that is yesterday's headline. Today liberals of all skin colors cheer all-black schools and separate classes for boys and girls as the means to the end of raising these children's "self-esteem" in their "race" (race is a term I don't believe in) and gender. , , ,

Opportunity Charter School is 92% black and 8% Hispanic. Sisulu-Walker Charter School of Harlem is 92% black and 8% Hispanic; Luis Munoz Marin Bilingual School is 92% Hispanic and 7% black. Harlem Day Charter School is 94% black and 6% Hispanic. Harriet Tubman Charter School is 94% black and 6% Hispanic. . . .

Here's one "why not": because Kenneth Clark's research, which in 1954 helped sway the Supreme Court by demonstrating the damage that segregation does to the development of children - even when separate is "equal" - hasn't changed.

Leave aside the fact that Meyer is equating charter schools voluntarily attended by black students and established for their benefit, with a system of state-wide oppression that was neither voluntary nor intended for the benefit of blacks. Meyer's argument is still wrong: while forced segregation is wrong for many reasons, it's not because of Kenneth Clark's research.

As law professor Roy Brooks points out in his book Integration or Separation: A Strategy for Racial Equality, Clark's research was misrepresented to the Supreme Court. On page 14, Brooks notes:

Clark’s conclusions regarding the effects of segregation . . . were not scientifically compatible with several crucial findings in the study inself. First, the responses to questions 1-4, which indicate racial preference, actually reveal a lesser percentage of out-group preference among southern children who attended segregated schools than among northern children who attended racially mixed schools. Thirty-seven percent of segregated children, compared to 28 % of integrated children, preferred to play with the brown doll; 46% of the segregated children, compared to 30% of the integrated children, believed that the brown doll was nice; 49% of the segregated children, compared to 71% of the integrated children, said that the brown doll looked bad; and 40% of the segregated children, compared to 37% of the integrated children, felt that the brown doll had a nice color.

Moreover, Clark's research was hardly the last word on the issue of segregation and self-esteem. Many researchers looked at the same question over subsequent decades, and found that segregated schools produced black children with higher self-esteem (with the theory usually being that blacks in a segregated school were isolated from the discrimination that they would have experienced in an integrated school).¹

By 1980, one researcher noted that “the weight of empirical evidence suggests that segregated blacks evidence self-esteem significantly higher than that of their desegregated peers.” The same researcher found, in a study of 194 southern schools, that black self-esteem was “lower in racially balanced schools than in predominantly black schools.”²

Again, forced segregation is wrong for many reasons. But dubious and outdated social science isn't one of them.


¹ See Benjamin J. Hodgkins and Robert G. Stakenas, “A Study of Self-Concepts of Negro and White Youth in Segregated Environments,” Journal of Negro Education 38 no. 4 (1969): 370-77; James E. Greene, Sr., “A Comparison of the ‘School Morale’ of White and Negro Students in a Large Southeastern School System,” Journal of Negro Education 31 no. 2 (1962): 132-38; E. Earl Baughman and W. Grant Dahlstrom, Negro and White Children: A Psychological Study in the Rural South (New York: Academic Press, 1968), pp. 417, 445-447; Gloria J. Powell, Black Monday’s Children: A Study of the Effects of School Desegregation on Self-Concepts of Southern Children (New York: Appleton-Century-Crofts, 1973), pp. 255-261.

²Darrel W. Drury, “Black Self-Esteem and Desegregated Schools,” Sociology of Education 53 no. 2 (1980): 88-103.

Op-ed on Obama

Here is an op-ed by a law school classmate of mine.

Lessons Learned from Movies

There's almost nothing a criminal likes better than to cover an entire bulletin board (or better yet, a wall) with newspaper clippings. Criminals have a keen appreciation for journalism. In addition, the best way for a criminal to plan further attacks or murders is to highlight various passages of the news clippings such that any FBI or police who execute a search warrant will then be able to figure out the plan. This is all preferable to looking up the newspaper articles on a computer and then making a mental note of what to do next.

Dumbest Generation

I recently read Mark Bauerlein's The Dumbest Generation: How the Digital Age Stupefies Young Americans and Jeopardizes Our Future (Or, Don't Trust Anyone Under 30). Although the title might be just a bit overstated (there's no way to tell whether today's generation really is dumber than all previous generations), he did hit on quite a few disturbing trends.

Chief among them, in my view, is the way in which digital technology magnifies and makes ever-present what is often a harmful force: teenage peer pressure. Here's Bauerlein on that point, from his new introduction:

Youths undergo an intense awareness of one another, a high-pressure social feeling. The stakes are high — is anything worse than exclusion? — and so they have to tune in, to manage that omnipresence. They don’t really enjoy it, for when they leave my class and flip open the cell they register concern, not glee. But if they don’t check in, they don’t know whether something big might have happened. Peer pressure long preceded the microchip, of course, but e-mail, cell phone, and the rest have cranked it up to critical levels, fostering an all-peers-all-the-time network. Communication is horizontal, centered on a narrow age-bracket, while parents and teachers hover outside the loop baffled by the immersion.

If parents and teachers don’t contain it, if they don’t find occasional substitutions for it, it will only get worse. The natural inclinations of the young flow toward one another, and each new tool speeds them faster on their way. Late-teens and early-twenty-somethings stand at a delicate threshold that marks the most important intellectual growth of their life. They have passed the basic skills of elementary and middle school, and now they acquire the higher knowledge and understanding requisite to good citizenship and tasteful consumption. These are the years in which they read good books, discuss great ideas, judge past events, and form moral scruples. If it doesn’t happen in high school, in college, and in the home at this time, it probably never will. Once out in the workplace, raising kids, paying bills, and doing laundry, people don’t have time, energy, or guidance to ponder the Federalist Papers or read The Divine Comedy. Every hour on MySpace, then, means an hour not practicing a musical instrument or learning a foreign language or watching C-SPAN. Every cell-phone call interrupts a chapter of Harry Potter or a look at the local paper. These are mind-maturing activities, and they don’t have to involve Great Books and Big Ideas. They only have to cultivate habits of analysis and reflection, and implant knowledge of the world beyond.

They mark the opportunity costs of digital diversions, and as they accumulate over the months, the costs rise higher than they seem at any one moment. The Dumbest Generation counts them up and sounds an alert. It doesn’t invoke an ideal past of multitudes of studious kids preferring Shakespeare to cartoons and activist kids debating the size of government. That never existed and never will. What did exist, however, was a climate in which the voices of elders and the value of history and civics, books and ideas, exercised more pressure on the young. Teen social life had a limit, and in those other hours the forces of adulthood were felt, if resented. When I was 16, I went to school and hung out with friends, and after school I played some basketball, hung out some more, and headed home. When I crossed the threshold and sat down to dinner, social life was over. I listened to parents converse about money, work, the household, travel plans, while Walter Cronkite reported on Vietnam and Watergate. I didn’t like them and didn’t want to talk to them, but I couldn’t reach under the table with my handheld and connect with buddies. I couldn’t go up to my room, flip open the laptop, and blog about the new biology teacher. Leisure options were fewer, and without ready access to friends, books, libraries, museums, and homework enjoyed a larger presence.

Young people mature in large part by being acclimated to grown-up society. But if they are more and more able to opt out of grown-up conversations and activities by shuttling off to communicate with their equally ignorant and immature friends, when does maturation -- in any sense but the purely biological -- occur?

Douglas Kmiec, Now vs. Then

Douglas Kmiec, now:

Based upon his own teaching at the University of Chicago, look for Obama to favor a nominee who is not afraid to challenge either result-oriented liberal judging or the incompleteness of the conservative method that has dominated the Court since Nixon appointed Warren Burger to the bench in 1969. Burger, and especially his successors William Rehnquist and Antonin Scalia, have plied the notion--so-called Originalism--that it’s not up to them to do justice, since they are just following the plain, public meaning of the words ratified two hundred plus years ago.

Plain public meaning is a beguiling idea, until one actually looks for it. Conservatives intone that it virtually delivers itself like the morning paper. (Remember those?) But like far too many departed dailies, it is often not to be found. There was no single public mind in 1787 any more than there is now. Back then, public meaning was no doubt very much like it is today: an admixture of both shared and different conceptions of what a given constitutional phrase was intended to accomplish. Obama’s task is to find a jurist who not only comprehends the limits of James Madison’s dictionary, but also appreciates how real wrongs can be made right with words that have a meaning in the here and now.

Notice the scorn for the "incompleteness of the conservative method" and for "so-called Originalism."

But that's now. This was then:

Douglas Kmiec, October 2007, stating that we shouldn't have a President who doesn't fully agree with "conservative legal thinking":

At the same time, the debate revealed how, despite his protestations to the contrary, Giuliani is not really a supporter of conservative legal thinking.
* * *
The times and circumstances facing our country do not permit us a president who can so easily be misled. We cannot afford to have a president faked out by bogus constitutional arguments. More directly, we cannot afford a president who is only faking his attachment to conservative legal principle.

Douglas Kmiec, in a lengthy 2007 article praising Romney for being committed to appointing originalist judges:

Do "we the people" really have sufficient confidence that the justices will objectively seek out this original meaning and apply it? Unfortunately, because some members of the judicial branch have imposed their personal will in the past, there is legitimate doubt as to whether America today still lives by the rule of law.
* * *
Governor Romney recognizes that the best way to respect the Second Amendment - like other protections in the Bill of Rights - results when, but only when, the justices are fairly guided by the original meaning of the constitutional text.
* * *
I am confident that when the people of Iowa and New Hampshire have spoken, my fellow travelers promoting original understanding, limited government, and human freedom will rally to the side of the best candidate.

Douglas Kmiec, in yet another 2007 article, proudly noting his association with Romney, precisely because of Romney's belief in originalism:

Mother always told me to be careful about the company I keep.

In this case, Mitt Romney is in the company of the most erudite exponent of the original understanding of the Constitution bar none, Justice Antonin Scalia, and Ronald Reagan who knew that the three most important words in the Constitution were “we the people.”

Douglas Kmiec, August 2005, arguing that the Court should have been "faithful to the original understanding" of the Constitution:

As a matter of law, IJ was right to ask the Court to observe the actual words of the Fifth Amendment: "Public use" means what it says - public, not private use. And the Court should have said so.

This bright line rule would have supplied needed reassurance to homeowners and viable small stores and shops, been faithful to original understanding, and kept the Court out of the sticky business of second-guessing municipal judgment.

Douglas Kmiec, May 2005, heavily criticizing those who are opposed to the "original understanding of the Constitution":

Almost any nominee for the Supreme Court who is serious about observing the original understanding of the Constitution and a restrained judicial role can be expected to be caricatured as "out of the mainstream" and trigger the Democrat's "extraordinary circumstance" pretext to filibuster anew.

Douglas Kmiec, in a 2005 article honoring Ed Meese:

“Ed Meese was the founding father of original understanding,” says Douglas Kmiec, professor of law at Pepperdine University and former dean of Catholic University of America’s law school. “Everyone on the Supreme Court today is an originalist,” Kmiec argues. “That was not the case,” he says, “prior to Ed Meese.”

Douglas Kmiec, Feb. 2004, arguing that the Establishment Clause should be interpreted according to the "original understanding":

I don't think it's radical at all because I think it's based on the original understanding and I think the Court itself is returning to the original understanding. Where it went wrong was to adopt a metaphor of separation of church and state, a metaphor that Thomas Jefferson used in private correspondence, not with regard to the establishment clause but with regard to free exercise, where he was comforting Baptists who were being prosecuted and persecuted and physically assaulted because of their religious beliefs. And of course, that was a violation he said of free exercise. The Supreme Court has actually in my judgment, in the last two decades, understood better the Establishment Clause than it had done in the 1940s and '50s when some of these problematic tests first emerged in terms of our jurisprudence.

Douglas Kmiec, testifying before the U.S. Senate in 2001, arguing that judges are "simply to enforce the Constitution and laws as they were written, according to their original understanding":

Hamilton responded to this criticism by emphasizing that it was not the job of judges to make law, that their role under the Constitution was simply to enforce the Constitution and laws as they were written, according to their original understanding. By doing so, Hamilton explained, federal judges would be acting as agents of the sovereign people themselves, and would do their part in implementing the rule of law. It was true that judges might sometimes be called upon to declare statutes invalid because of the dictates of the Constitution, but this was the role envisioned in those specific, and one might hope, rare cases. . . . Sadly, this is forgotten far too often today. Courts are casually discussed as merely alternative policymakers.

Douglas Kmiec, 2004, praising Reagan for changing the outlook of the federal judiciary:

"Faithfulness to the original understanding of the Constitution is now an acceptable methodology, as is a reaffirmation of federalism and separation of powers," [Kmiec] says. "President Reagan turned a system dominated by party courtesy and patronage into a systematic process that was an extension of his policies."

Also worth noting are some of Kmiec's articles:

Douglas W. Kmiec, The Original Understanding of the Free Exercise Clause and Religious Diversity, 59 UMKC L. Rev. 591 (1991)

Douglas W. Kmiec, The Original Understanding of the Taking Clause is Neither Weak Nor Obtuse, 88 Columbia Law Review 1630 (1988).

Douglas W. Kmiec & John O. McGinnis, The Contract Clause: A Return to the Original Understanding, 14 HASTINGS CONST. L.Q. 525 (1987).

Proceed, Procession

When a wedding party proceeds down the aisle, that's a procession. Right? When and why did people start using the verb "processed" or "processing," as in "the groom is now processing"? It reminds me of a friend who said that his father used the word "conversating" instead of "conversing" . . . it's that same process of taking a verb, converting it into a noun, and then backwards converting it into a different verb that means the same thing. It's duplicative.

Furniture Commercial

I wonder if this ad (via Made to Stick) is for real.

Important New Study

The headline from ScienceNews: "Texting While Driving Can Be Deadly, Study Shows." Thank goodness we now have a study with which to refute those who say that such behavior is safe.

Language Studies and Political Correctness

Via Rod Dreher, I came across this interesting New Yorker article about a linguist named Dan Everett, who has extensively studied a Brazilian tribe called the Piraha. Everett has claimed that the Piraha's language lacks recursion, i.e., inserting phrases inside other phrases, such as "the girl who was wearing a red cloak ate a wolf."

What's interesting is how some professors reacted to Everett's claim:

Some scholars believe that Everett’s claim that the Pirahã do not use recursion is tantamount to calling them stupid. Stephen Levinson, the neo-Whorfian director of the Language and Cognition Group at the Max Planck Institute for Psycholinguistics, in the Netherlands, excoriated Everett in print for “having made the Pirahã sound like the mindless bearers of an almost subhumanly simple culture.” Anna Wierzbicka, a linguist at the Australian National University, was also troubled by the paper, and told me, “I think from the point of view of—I don’t know—human solidarity, human rights, and so on, it’s really very important to know that it’s a question that many people don’t dare to raise, whether we have the same cognitive abilities or not, we humans.”

Everett dismissed such criticisms, since he expressly states in the article that the unusual aspects of the Pirahã are not a result of mental deficiency. A Pirahã child removed from the jungle at birth and brought up in any city in the world, he said, would have no trouble learning the local tongue. Moreover, Everett pointed out, the Pirahã are supremely gifted in all the ways necessary to insure their continued survival in the jungle: they know the usefulness and location of all important plants in their area; they understand the behavior of local animals and how to catch and avoid them; and they can walk into the jungle naked, with no tools or weapons, and walk out three days later with baskets of fruit, nuts, and small game. “They can out-survive anybody, any other Indian in this region,” he said. “They’re very intelligent people. It never would occur to me that saying they lack things that Levinson or Wierzbicka predict they should have is calling them mindless idiots. ”

1. Note that for Everett's critics -- at least as represented here -- the truth of the matter doesn't seem to enter their thinking at all; all that matters is whether Everett's position seems appealing.

2. Ironically, it is Everett's critics, not Everett, who betray a sense of cultural superiority. Everett appreciates all of the cognitive tasks that the Piraha have indeed mastered -- tasks that are necessary for survival in their surroundings, and that few of us could even hope to accomplish. Everett's critics are the ones acting as if the Piraha's "cognitive abilities" are to be judged solely based on Western criteria and assumptions.