The Self-Reflecting Mirror of Good Intentions

“The most interesting, under-discussed, and potentially revolutionary aspect of the law is that it doesn’t pretend to have the answers. Instead, through a new Center for Medicare and Medicaid Innovation, it offers to free communities and local health systems from existing payment rules, and let them experiment with ways to deliver better care at lower costs. In large part, it entrusts the task of devising cost-saving health-care innovation to communities like Boise and Boston and Buffalo, rather than to the drug and device companies and the public and private insurers that have failed to do so. This is the way costs will come down—or not.”Atul Gawande, The New Yorker (via Real Clear Politics)

Or not? Or not? Or not?

Wait a minute. Proponents of Health Care Reform insisted that a crisis existed in American medicine – a crisis of steadily increasing costs and the uninsured. Forget for a moment the pages and pages and pages of regulation: the essential steel-frame structure at the heart of the bill consists – it seems to me! – of committees that have yet to write the myriad of rules that will govern the future of health care in this country. Isn’t that the case? Am I getting it wrong? And if I am, it’s not like the authors of the legislation took care to write something a layperson like me could understand. Do even the authors know what is in it?

I respect the good Dr. Gawande very much, but I cannot understand how any physician or scientist – who ought to pride him or herself on evidence-based medicine – would sign off on something like this? It’s all supposition. It’s all promises. It’s all the self-reflecting mirror of good intentions.* There’s no there there. Not really. Not if you look beyond the gimmicks.

Hey, if I’m being unfair, or misunderstanding, drop a line in the comments box, okay?

* I used the above phrase in this comment at zenpundit on an entirely different subject. I’m pretty sure I made it up on the spot, but somehow, I always have a subterranean fear that I am plagiarizing someone a lot more clever than I am. Not sure what that is about, but now, thanks to my penchant for TMI, you all know that about me!

Update: I am not saying the uninsured or costs are not a serious problem. What I am arguing is that the very legislation intended to solve the problem of cost is a roll of the dice in that regard. Why do we need an oxymoronic government “department of innovation” anyway? Why not break down government-set barriers and allow the experimentation to take place in the absence of said barriers? Honestly, I couldn’t understand a bit of the logic behind that article.

Another Update: “Two Views On Health Care From The New Yorker,” Peter Suderman (Reason – Hit and Run)

Self-Esteem vs Self-Respect

An interesting essay by Theodore Dalrymple, a British psychologist who has worked extensively in prisons. Via psychiatrist Dr Sanity, who adds thoughts of her own.

My sense is that the self-esteem movement started benignly enough, with the sensible idea that it is usually better to focus on praising people for things they do right rather than on condemning them for their inadequacies. But it soon fell into the hands of various airheads, many of them professors in “education” schools, who too frequently have been hostile to the whole notion of individual achievement and individual accountability.

Read more

Image / Meme Needed

I know it can be done. I know it needs to be done. But I lack the skilz to do it.

Here’s the request.

Take this famous image:

obama joker socialism

Put the Joker’s wig on the head, and put the collar and shoulders of the Joker’s nurse uniform on the torso. Put the word “healthcare” in the box, in the same typeface.

I know that ChicagoBoyz readers have the capacity to do this properly, or will send this request to someone who can.

If want to send it to us, send it to:

jokernurseimage@gmail.com

If it is awesome, I will post it here on CB with credit to whoever sent it.

I saw two efforts to do this on Google images and I did not like either of them. This should be exactly the same as the famous image, only slightly modified to include the wig and the shoulders and collar of the nurse’s uniform. There are plenty of images of the Joker’s nurse wig and uniform on the Internet, which a skillful Photoshopper could use.

Note that I will not use any such image for commercial purposes. All I want is a compelling, easily replicable image / symbol that can be spread widely as part of the ongoing fight against Obamacare, starting here.

Taxes and the Rich

On the opinion page at the Wall Street Journal Alan Reynolds of the Cato Institute wrote an excellent article titled “The Rich Can’t Pay for ObamaCare“.

The key concept is what he describes as “the elasticity of taxable income” or ETI. ETI measures how taxable income is impacted as tax rates increase; if you use a rate of 0.5 you assume that an increase in tax rates that would yield $1 if prior behavior held stead would yield 50 cents after the impact of behavioral changes is taken into account. However, instead of an ETI of 0.5, per the article:

For incomes above $500,000, Treasury Department economist Bradley Heim recently estimated the ETI at 1.2 – which means that higher tax rates on the super-rich yield less revenue than lower tax rates.

The article describes, in practical terms, how rich individuals can take action that illustrates this ETI:

– dump dividend paying stocks (you will probably want to do this anyways because they are likely to fall in price because part of their value is tied to the reduced tax rate) when the 15% rate is raised
– avoid selling stocks with capital gains when the rate rises, or sell stocks with unrealized losses at the same time to “net out” any gains owed to the government
– reducing income near the $250k range when “phase outs” raise the MARGINAL tax rate to a very high rate through tax deferral strategies such as 401(k) contributions and the like
– consider becoming a one-earner couple instead of a DINK if the penalty on incremental income becomes too great to make up for the cost of child care and the general decremented quality of life

I really like this paragraph that should be an epitaph for tax policy:

Punitive tax rates on high-income individuals do not increase revenue. Successful people are not docile sheep just waiting to be shorn.

A sound tax policy has two main elements 1) it raises the amount of revenue that it is supposed to raise 2) it provides the minimal distortion of productive economic activity.

Super high tax rates on the rich accomplish neither of these two attributes. They don’t raise the money as planned (in fact you could likely end up with LESS money overall) and they distort the economy by having our most valuable members of the economy step back from working at a time when their entrepreneurial drive is needed most to jump-start the economy.

Cross posted at LITGM

Around Chicago

Recently I took a few photos around Chicago of things that caught my eye.

Upper left – someone started an impromptu art project by putting orange string on the bridges across the Chicago River.

Upper middle – a car escapes the impound lot on Halsted avenue near the projects

Upper right – a strange bell that shows the weather; unfortunately it seems to be stuck on “colder”. Maybe this is the “misery bell” because this spring has been lousy…

Lower middle – I recently saw a guy trying to steam the junky, dirty snow off the street. This was new to me. Unfortunately he just gave up and started chipping away with a shovel and put it into the street, old school-style

Lower center – there is a big “Palm” advertisement with Trump Tower in the background. I remember when I bought my first palm pilot, probably a decade ago, and Palm was “cool”. Recently a stock analyst put a price target of ZERO on Palm’s common equity for their stock price… um that’s not good. But at least they can afford an expensive billboard

Lower right – another new billboard appeared in the neighborhood – this one is for “Cats Against Clay“. Apparently kitty litter is bad for cats. Or the price of a billboard is now so low that anyone can rent one. Perhaps one for LITGM, or Chicago Boyz?