https://reformclub.blogspot.com/2018/09/peak-conlawprof-i-and-ii.html
Too short to quote; worth clicking.
Politics
Something Nasty in the Woodshed
The Kavanaugh-Ford-Feinstein kerfuffle appears to be this week’s progressive-tantrum du-jour, just as the Kavanaugh hearing itself was of last week, and John McCain’s funeral and epic post-mortem diss of his former running mate was that of the week before. The whole thing a hazily recalled teenage memory of a clumsy grope at a booze-fueled suburban bacchanal reminds me nothing so much as Great Aunt Ada Doom in Cold Comfort Farm and her incessant insistence on having “seen something nasty in the woodshed” which sight so traumatized her that she was able to ride roughshod over the rest of the clan at Cold Comfort for decades. What the ‘something nasty in the woodshed’ was is never actually described in the story but Great Aunt Ada wields her hysterical claim of having suffered from it with the expertise of a master in conducting guided guilt trips through most of the book, until she is talked down from her room by the clever heroine.
Summer Rerun: Catalist, “The 480”, and The Real 480
There was much discussion in 2014 of Catalist, a database system being used by the Democratic Party to optimally target their electioneering efforts…see Jonathan’s post here. I’m reminded of Eugene Burdick’s 1964 novel, The 480
Simulmatics was a real company. It was founded by MIT professor Ithiel de Sola Pool, a pioneer in the application of computer technology to social science research. Data from 130,000 interviews was categorized into 480 demographic groups, and an IBM 704 computer was used to process this data and predict the likely effects of various alternative political tactics. One question the company was asked to address by the 1960 Democratic campaign, in the person of Robert F Kennedy, was: How best to deal with religion? There was considerable concern among some parts of the electorate about the prospect of choosing a Catholic as President. Would the JFK campaign do better by minimizing attention to this issue, or would they do better by addressing it directly and condemning as bigots those who would let Kennedy’s faith affect their vote?
Simulmatics concluded that “Kennedy today has lost the bulk of the votes he would lose if the election campaign were to be embittered by the issue of anti-Catholicism. The simulation shows that there has already been a serious defection from Kennedy by Protestant voters. Under these circumstances, it makes no sense to brush the religious issue under the rug. Kennedy has already suffered the disadvantages of the issue even though it is not embittered nowand without receiving compensating advantages inherent in it.” Quantitatively, the study predicted that Kennedy’s direct addressing of the religion issue would move eleven states, totaling 122 electoral votes, away from the Kennedy campbut would pull six states, worth 132 electoral votes, into the Democratic column.
It is not clear how much this study influenced actual campaign decision-making…but less than three weeks after RFK received the Simulmatics report, JFK talked about faith before a gathering of ministers in Houston. “I believe in an America where religious intolerance will someday end,” Kennedy said, “where there is no Catholic vote, no anti-Catholic vote, no bloc voting of any kind.” (Burdick’s novel also suggests that the Kennedy campaign used Simulmatics to assess the effects of a more-forthright posture on civil rights by the campaign, and furthermore to analyze Kennedy’s optimal personality projection during the debatesI don’t know if these assertions are historically correct, but the religion analysis clearly was indeed performed.)
Considerable excitement was generated when, after the election, the Simulmatics project became publicly known. A Harper’s Magazine article referred to to the Simulmatics computer as “the people machine,” and quoted Dr Harold Lasswell of Yale as saying, “This is the A-bomb of the social sciences. The breakthrough here is comparable to what happened at Stagg Field.” But Pierre Salinger, speaking for the Kennedy campaign, asserted that “We did not use the machine.” (Salinger’s statement is called out as a lie in the recent book, The Victory Lab: The Secret Science of Winning Campaigns
In Burdick’s novel, the prospective Republican candidate is John Thatch, head of an international engineering and construction company. Thatch has achieved popular renown after courageously defusing a confrontation between Indians and Pakistanis over a bridge his company was building, thereby averting a probable war. Something about Thatch’s personality has struck the public imagination, anddespite his lack of political experiencehe looks to be an attractive candidate. But initially, the Republicans see little hope of defeating the incumbent Kennedy“the incumbent is surrounded by over four years of honorific words and rituals,” a psychologist explains. “He seems as though he ought to be President. He assumes the mantle.” This outlook is deeply disturbing to a Republican senior statesman named Bookbinder, who strongly believes that defacto 8-year terms are bad for the country…but if it is true that Kennedy is unbeatable, then the best the Republicans can hope to do is lose as well as possible. Things change when Kennedy is assassinated and the election becomes a real contest.
Bookbinder and Levi, another Republican senior statesman, are introduced to Simulation Enterprises by a young lawyer named Madison (Mad) Curver and his psychologist associate (quoted above), a woman named Dr Devlin. Mad and Dr Devlin explain that what Sim Enterprises does is different from the work done by garden-variety pollsters like the one they have just met, Dr Cotter:
“The pollster taps only a small fragment of the subject’s mind, attention, background, family influence, and habits. The Simulations thing, just because it can consider thousands of elements influencing the subject, even things he may not know himself, gets much better results.”
“And one further thing, Book,” Mad said. “Simulations Enterprises can predict what people will do in a situation which they have never heard of before. That was the whole point of the UN in the Midwest example. No one has gone out there and asked them to vote on whether we should get out of the UN, but Dev outlined a procedure by which you can predict how they will react…if they ever do have to vote on it.
Again Bookbinder had the sharp sense of unreality. Unreal people were being asked invented questions and a result came out on green, white-lined paper…and when you got around to the real people six months later with the real question they would act the way the computer had said they would.
Where is health care going ?
UPDATE: A new analysis of Obamacare’s role in the conversion of American Medicine to an industry with corporate ethics.
The health system is now like a cocaine junkie hooked on federal payments.
This addiction explains why the insurance companies are lobbying furiously for these funds alongside their new found friends at left-wing interest groups like Center for American Progress. The irony of this alliance is that the left-wing allies the insurers have united with hate insurance companies and want to abolish them. The insurance lobby is selling rope to their hangman.
Hospital groups, the American Medical Association, the AARP and groups like them are on board too. They are joined by the Catholic Bishops and groups like the American Heart Association and the American Lung Association. (If you are donating money to any of these groups you might want to think again.) This multi-billion dollar health industrial complex has only one solution to every Obamacare crack-up: more regulation and more tax dollars.I practiced during what is more and more seen as a golden age of medical care. Certainly the poor had problems with access. Still, most got adequate care, either through Medicaid after 1965, or from public hospitals, many of which were wrecked by Medicaid rules and by the flood of illegal aliens the past 40 years.
Obamacare destroyed, probably on purpose, the healthcare system we had. It had been referred to by Teddy Kennedy, the saint of the Democrats Party as “a cottage industry.” As far as primary care was concerned, he was correct. What we have now is industrial type medicine for primary care and many primary care doctors are quitting.
So why is there waning interest in being a physician? A recent report from the Association of American Medical Colleges projected a shortage of 42,600 to 121,300 physicians by 2030, up from its 2017 projected shortage of 40,800 to 104,900 doctors.
There appear to be two main factors driving this anticipated doctor drought: First, young people are becoming less interested in pursuing medical careers with the rise of STEM jobs, a shift that Craig Fowler, regional VP of The Medicus Firm, a national physician search and consulting agency based in Dallas, has noticed.
“There are definitely fewer people going to [med school] and more going into careers like engineering,” Fowler told NBC News.
There are several reasons, I think. I have talked to younger physicians and have yet to find one that enjoys his or her practice if they are in primary care. That applies to both men and women. Women are now 60% of medical students. This has contributed to the doctor shortage as they tend to work fewer hours than male physicians.
Physicians are the most highly regulated profession on earth. The Electronic Health Record has been made mandatory for those treating Medicare patients and it has contributed a lot to the dissatisfaction of physicians.
THE MOUNTING BUREAUCRACY
This “bottleneck effect” doesn’t usually sour grads on staying the course, Fowler finds, but he does see plenty of doctors in the later stages of their careers hang up their stethoscopes earlier than expected. Some cite electronic health records (EHRs) as part of the reason — especially old school doctors who don’t pride themselves on their computer skills. New research by Stanford Medicine, conducted by The Harris Poll, found that 59 percent think EHRs “need a complete overhaul;” while 40 percent see “more challenges with EHRs than benefits.”
If I remember my arithmetic, that adds up to 99% unhappy with the EHR.
Most primary care physicians I know are on salary, employed by a hospital or a corporate firm. They are require to crank out the office visits and are held to a tight schedule that does not allow much personal relationships with patients. The job satisfaction that was once a big part of a medical career is gone.
Seth Barrett Tillman: My Post on CONLAWPROF: On Elected Judges and Elected Prosecutors
It strikes me that the complaint against judicial elections (as voiced on this listserv) is rooted in the absence of life tenure — not elections per se. You could have elections filling judicial vacancies — but with the candidates’ receiving life tenure. And you could have appointments by political authorities to fixed and limited judicial terms — with the possibility of reappointment. The threat to the rule of law (such as it is), lies with the prospective candidate for reelection/reappointment to judicial office biasing his/her decision for self-interested reasons. But that conflict of interest will appear whenever you have terms of limited duration with the possibility of reelection/reappointment. It is not elections per se that create the conflict.
This is an excellent point.