Is The Mass Hysteria About Climate Starting To Dissipate?

Immerse yourself in the Democratic Party/Mainstream Media/Manhattan bubble, and you almost certainly have the impression that all is going swimmingly in the ongoing battle to "save the planet" by forcing others to use less energy (while you fly around on your private jet).  Hey, everybody agrees that "climate change" is the hugest, most existential problem the world has ever faced!  And also everybody in the world just agreed to the big Paris non-treaty!  Here is Obama in the State of the Union last month:

“Look, if anybody still wants to dispute the science around climate change, have at it,” Obama said. “You’ll be pretty lonely, because you’ll be debating our military, most of America’s business leaders, the majority of the American people, almost the entire scientific community and 200 nations around the world who agree it’s a problem and intend to solve it.”       

And any mainstream media outlet worth its salt publishes multiple articles every month on why it's the "hottest [something] ever" and shaming anyone who dares to disagree.  So, is anything changing, particularly on the political front?

I would say that the first fissures on the political front had appeared as early as 2009, when the President of the Czech Republic, Vaclav Klaus was quoted as saying that "Global warming is a politician's myth."  But, you say, the Czech Republic is a tiny country.  Well, next came India.  Nobody could call them tiny.  The new Prime Minister Narendra Modi, elected in 2014, started talking about India's "right to growth" -- unsubtle code for a plan to use a lot more energy from the cheapest sources available (otherwise known as coal).  In May 2015 the Guardian quoted Prakash Javadekar, Indian Minister of Environment and Forests, as follows:

Our emissions will grow because we are not developed and we have a right, every person on this Earth has a right, to develop. If today the world is 0.8C warmer [than it was in pre-industrial times], it is not my fault.    

Now we're not talking fissures, but big cracks.  An article just yesterday in the increasingly appalling Scientific American asserts that "India is becoming increasingly anti-science."   Well, guys, since when is saying "we have a right to develop" "anti-science"?  Do you really think that you can shame India into keeping a billion or so people in abject poverty in order to stroke your precious Western environmental sensibilities (while you yourself continue to fly around on your private jet)?  I for one would not see India backing down any time soon.

And now how about the latest news out of Australia?  Today's Sydney Morning Herald reports that the organization known as CSIRO (Commonwealth Scientific and Industrial Research Organization) has announced some 350 upcoming layoffs due to government budget cuts, with the layoffs apparently including most or all of those dedicated to researching issues of the climate.  The Herald quotes what it calls "one senior research scientist" as saying "Climate will be all gone, basically."  OK, I'm sure he's exaggerating, but it's still the first sign anywhere of a serious cutback on the government-funded climate parasites.  Well, boys, you said the science was "settled," so what's the need to spend billions on further research?

And meanwhile, has anything changed in the United States?  Consider this:  four years ago I went to a fundraiser for Romney, and was appalled to hear him blathering on about how seriously he took climate change and how he was somehow going to save the planet as President.  And before him, McCain in 2008 had equally drunk the Kool-Aid.  Today?  It's becoming increasingly likely that the Republican candidate is going to be one of the three of Trump, Cruz and Rubio -- and all three of them have said, at the least, that they are not going to allow the American economy to be damaged by the futile crusade to restrict carbon emissions.  For example, here is Marco Rubio in response to a question from Jake Tapper of CNN at the September 16 debate:

We're not going to make America a harder place to create jobs in order to pursue policies that will do absolutely nothing, nothing to change our climate.

Cruz went so far as to organize a big hearing in the Senate back in December at which a number of dissenters from the climate orthodoxy got to present some real evidence.  And Trump?  He has famously tweeted that climate change is a hoax invented by the Chinese to put American manufacturers out of business.

So here in the bubble, it may seem to the New York Times and the rest of the Manhattanites that not much has changed.  But then, we have long known that they are not very good at getting outside and observing what is going on.

 

 

Third-Party Pay Health "Coverage" Meets The Real World

One of the accepted propositions of modern progressivism, on which it is difficult to find dissent in the precincts that I inhabit, is that in any "decent" society, everybody "should" have healthcare "coverage."  I put the word "coverage" in quotes because that word is often intentionally used by advocates to create confusion with the very different idea of insurance.  The word "coverage" gives the impression that somehow magically somebody else will take care of all of your expenses in the medical area, and you can consume as much medical care as you feel like while paying nothing.  And we come to a world where some large majority of people have healthcare "coverage" that takes care of not just major and unexpected expenses like a hospital stay or a heart attack, but also all kinds of routine and ongoing expenses like routine checkups, doctor visits, and prescription drugs.  Nobody in their right mind would buy insurance for such things absent massive government arm-twisting (in the form of tax-deductibility for employer-provided "coverage" as well as Obamacare mandates).  Would you buy insurance for the cost of your daily lunch?  As I wrote in that linked article (from 2013), in a world of third-party pay for routine expenditures, "you can be sure that [people] will buy the most expensive options and that the cost will zoom out of control."

In the medical arena, people have been pointing out the problematic incentives of third-party pay for a long while.  But it seems only in the last few years that medical providers like hospitals and pharmaceutical companies have perfected their pricing strategies to get the absolute last dollar out of the third-party payers like government and insurance companies.  Two examples recently came to my attention in my personal life, that I thought I should share with readers.

The first involves the former Official Manhattan Contrarian Summer Intern, who was my research assistant for this blog in the summer of 2014.  Today she is off attending the University of Chicago.  A few months ago, she fainted briefly while at school.  It turns out that she had also fainted a couple of times previously, in circumstances where she had let herself become a little dehydrated.  On those occasions she had thought little of it, and hadn't gone to a doctor or hospital.  But this time the U of C packed her off to their affiliate University of Chicago Medical Center.  With a well-insured (or "covered") warm body in their clutches, the hospital staff took the opportunity to run up every expense that their creative minds could think of, and then a few more.   The bill was $6000.  And the diagnosis?  "Nothing wrong that we can find."  

In this instance, the insurance company negotiated the bill down to about half that.  The parents got a bill for a co-pay of $75, which they gladly paid.  But do you get an idea of why health "coverage" may be getting so pricey?

The second example involves one of my own daughters.  Several months ago she jumped out of a tree (don't ask what she was doing in the tree) and landed the wrong way on one of her feet.  By the next morning, the foot was swollen and painful to walk on.  She hobbled over to the very fancy new "urgent care" center in our neighborhood in Manhattan, run by a hospital system known as North Shore/LIJ (currently in the process of changing their name to Northwell), and made the mistakes of first telling them that she had insurance and then allowing them to examine her without agreeing to a price in advance.  They took an x-ray, and, after a wait of a couple of hours she spent about 5 minutes with a physician, who evaluated the x-ray.  He said that it was not clear whether the bone needed to be set, and he did not treat her; but he recommended that she see an orthopedist promptly.  A couple of days later she got an appointment with an orthopedist, who also recommended that no treatment was necessary.  However, he advised her to keep weight off the foot and it would heel within a few weeks.  Sure enough, it did.

The bill from the orthopedist was about $400.  Expensive, but hey, this is Manhattan.  The bill from the urgent care center was $4700.  My daughter has insurance through her job, and again, the insurance company negotiated the bill down, in this case to about $2600, of which they paid about $1300.  That left a remainder of about $1300 that consists of various deductibles and co-pays applicable to various parts of the bill. 

I don't know about you, but I live in Manhattan and pay outrageous Manhattan prices for everything, and still $4700 -- or even $2600 -- struck me as rather wildly out of line for a visit that involved five minutes of doctor time evaluating an x-ray and no actual treatment of any kind.  

Meanwhile, I have recently become aware of a new kind of walk-in medical clinic springing up around our area, catering to an uninsured clientele that pays cash on the spot.  So in recent weeks I walked into a couple of those, described the circumstances of my daughter's visit to the urgent care center, and asked what their price would be for the same service to an uninsured patient walking in and paying cash.  The two were Union Square Urgent Care, on 14th Street, and CityMD, on 23rd Street.  In both cases their answer was the same:  $185.

I would be 100% sure that no individual paying out of his or her own pocket has ever paid North Shore/LIJ the $4700 -- or even the $2600 -- for a visit of this type.  Very few people would have that kind of money for an unexpected expense of this type, and the few who did would rightly refuse to pay it.  These numbers are purely picked out of the air by the hospital to see what they can game out of the insurance company, and in circumstances where if the insurance company refuses to pay the hospital knows that the insured will first blame the insurance company rather than the hospital.

The $185 price of the walk-in clinics is a clear demonstration that a functioning market of people paying with their own money has no trouble finding a reasonable price.  Sure, some people can't pay even that.  That's why there's charity in the world.  Or do you think that replacing "third-party pay" with "single payer" can suddenly magically do away with the phenomenon that everybody games whatever system there is to their own advantage?  Good luck with that! 

 

 

 

How To Fix The Problem Of Government Consensus Science

It's just eleven days ago on January 20 that I posted my first book review on this blog, of "The Big Fat Surprise" by Nina Teicholz; and now just nine days after that on January 29 the Wall Street Journal has published an op-ed on the subject of the book.  Dr. Steven Nissen of the Cleveland Clinic co-authored the op-ed, which is titled "The Food Pyramid Scheme."

Like Nina's book, the op-ed describes how our government in 1980 issued dietary guidelines promoting a low-fat diet to then 220 million Americans, even though the science supporting such guidelines was known to be weak at best and plenty of evidence was available even at that time to suggest that the recommendations were unsound.

Scientists should have known in 1980 that the recommendation to cut fat was unsound.  Large clinical trials at the time did not support the theory, according to a systematic review published last year in the cardiology journal Open Heart.  "It seem incomprehensible that dietary advice was introduced for 220 million Americans," the authors wrote, "given the contrary results."   

So how did a counter-productive diet get foisted on the American people in the face of such adverse evidence?  Easy.  A small group of avid promoters of the high-fat-diet/heart disease hypothesis had managed to get control of the principal government funding institutes, and of the peer review process at the key journals.  Dissenters got cut off from funding and from publication.

Meanwhile, the bad consensus science has proceeded to do untold damage to the health of the American people.  Teicholz and Nissen describe how even as new evidence has continued to come forth showing that low fat diets do not improve heart disease outcomes (and may well have much responsibility for the increase in obesity and diabetes), little has been done to change the government's guidelines:

What's disturbing is how little this new evidence has been heeded.  The guidelines continue to insist that Americans choose reduced-fat dairy products like skim milk.  But even epidemiological evidence now contradicts this advice, and a randomized trial published last month in the American Journal of Clinical Nutrition found that people eating full-fat dairy, including whole milk, showed a number of better heart-disease outcomes.

So what is to be done?  Teicholz and Nissen favorably endorse, with some recommended modifications, an upcoming "independent" government review, just funded by Congress, and to be conducted by a somewhat but not very different crowd from the people who got us into this mess.  While generally supporting the independent review concept, Teicholz and Nissen do suggest that a "disinterested referee" be appointed to lead the review, "from outside the field of nutrition."

Well, maybe that will make some difference.  But how about this idea:  the government should entirely get out of the business of meddling in the diet of the American people.  Any next round of recommendations to come out of the government is very likely to be just as wrong as the last round.  It's in the nature of giving some people government authority to lord it over others that the ones given the powers will lose all humility and be overtaken by the thrill of ordering other people around based on what they believe to be their own superior knowledge and expertise.  It's just one more example of why socialism doesn't work.  See also, climate science. 

 

 

 

In Venezuela They've Been Reading Manhattan Contrarian!

I have repeatedly declared subsidized public housing to be the "worst possible public policy."  (Well, actually it's subsidized public housing in Manhattan that is the worst possible public policy; elsewhere subsidized public housing is just almost as bad as the worst possible public policy.)  But the things that make subsidized public housing so terrible as public policy are the very things that make it so attractive to cynical left-wing politicians.  Subsidized public housing creates a permanent and immobile dependent class trapped in poverty that perceives itself as owing its somewhat desirable homes to the incumbent politicians, and therefore can be counted on as a secure bloc of bought votes.  For the cynical politician, what's not to like?

Down in Venezuela, Hugo Chavez was everybody's favorite caricature of the socialism-inspired evil dictator for a fourteen-year reign spanning from 1999-2013.  In that period he did everything he could to drive his country into the ground -- all in the name of socialism and justice, of course. And naturally, blow-out construction of subsidized public housing was at the top of Chavez's political program.  After nibbling at the subject in the early years of his tenure, in 2010 he embarked on what he called his "great housing mission," setting out to build some 350,000 units of public housing in 2011 and 2012, and then 300,000 per year thereafter.  An article here in Britain's left-wing Guardian from 2013 of course gives a favorable review to Chavez's efforts and recommends the same for Britain.  To give an idea of the massiveness of Chavez's public housing efforts, the Guardian reported that construction went from 5% to 16.8% of the national economy in this period. 

And boy did it all seem to be going great -- at least if you believed the totally phony numbers for the economy put out by Venezuela at the time.  Historical economic data compiled by Focus Economics here shows that Venezuela reported economic growth of almost 25% in 2011 over 2010, and another 20% in 2012 over 2011.  Of course, in reality the economy was undoubtedly shrinking and the numbers were completely cooked.  How much of the supposed "growth" came from putting a totally fake value on the currency, and how much came from counting blowout wasteful government spending at 100 cents on the dollar in GDP, and how much came from the luck of temporarily high oil prices, and how much came from other phony manipulations, is anybody's guess.  Anyway, in 2013 Venezuela reported that growth had leveled off to about zero, and then in 2014 and 2015 they just stopped reporting economic statistics altogether.  By that time, from things like multi-hundred-percent inflation and completely empty store shelves, not to mention the collapse of oil prices in late 2015, the economic disaster was becoming too obvious to continue to put out the phony statistics with anything close to a straight face.

Those who follow world events will know that last month the opposition in Venezuela finally scored massive victories in legislative elections, and took control of both houses of the National Assembly.  They have stated an explicit agenda of undoing much or all of the massive state expansion under Chavez and his successor Maduro.  But the public housing blowout is something that is particularly tricky to undo.  After all, the whole idea here was to create a massive bloc of permanently bought votes that could always be counted on to support the leaders and political party that provided the largesse.  Telesur here puts the number of public housing units built in Venezuela in just 2011 to 2014 at 642,000.  Taking all public housing residents, we're talking about a voting bloc of probably a couple of million in a population of around 30 million.  Propose to take those units away from their occupants, and no politician could survive.

And that's where the Manhattan Contrarian proposal comes into play.  Back in November 2014 I laid out how a new crowd of elected leaders could get out from under the disaster of public housing without forfeiting all political viability.  The simple answer is -- give away the public housing to the residents!  No charge.

Now, I am not saying by any means that this policy is perfect.  It definitely gives an undeserved windfall to those who happened to win the lotteries to get into the public housing.  It treats the taxpayers of the country shamefully.  But the perfect can often be the enemy of the good.  Exiting from the burden of public housing will provide tremendous benefits both to the country as a whole and also to the residents.  To be perfectly cynical, a way needs to be found to make a topping bid for the residents' support, without which any exit strategy will be politically blocked.  Giving the housing to the residents provides that missing piece.  And, at no additional cost to the taxpayers, for whom the public housing is just an ongoing burden so long as it is in public ownership or control.

And thus we come to the report in yesterday's New York Times of the latest proposal from the new leaders of Venezuela's National Assembly.  The headline is, "Old Adversaries of Chavez Take a Page From His Playbook."    Yes, they are proposing to give away the housing to the occupants:

Twenty thousand people live in this concrete bastion built by President Hugo Chávez. He gave them the keys, and they gave him their votes.  There was one thing Mr. Chávez promised but never handed over en masse, though: the property titles that would allow his supporters to sell their homes and cash out.  But now that Mr. Chávez’s old adversaries have taken over Venezuela’s Parliament, they are adopting the tactic and doing it one better. They want to give away the deeds to hundreds of thousands of homes that Mr. Chávez and his movement built — and win the loyalties of the nation’s poor for years to come.

They must have been reading Manhattan Contrarian!  The genius of the proposal is that it has Maduro and his supporters completely flummoxed.  If it's a good idea for the government to give to some people a lifetime right to occupy a unit of public housing, why isn't it an even better idea to give them a deed so they can sell the unit, or mortgage it, or rent it, or otherwise turn it into cash income?  The true-blue socialist approach of no real ownership is revealed as just a device to keep the poor poor and dependent.  Here is how Maduro has responded, according to the Times:

In a fiery State of the Union address before legislators this month, Mr. Maduro vowed to do what he could to block his opponents’ work.  “You will have to topple me first to approve a privatization law,” he said to the applause of leftists.

The Times even includes quotes from some people who were awarded the public housing units only to then realize that the socialist dream isn't what it's cracked up to be.  For example:

Coromoto Carmona, 40 and unemployed, looked out a window that was laden with bars. She told the story of how she got her home here and how it has become a place where she feels trapped. . . .  In 2004, she received a thrilling call from the government: She would attend a meeting at Mr. Chávez’s presidential mansion, La Casona, where he would personally award her a new home.  She moved into her two-bedroom home with nine members of her family. But problems soon emerged. . . .  Mr. Chávez’s government had promised her and others the titles to their homes. But Ms. Carmona received only a laminated piece of paper saying she was allowed to live there. If she leaves, it is unclear if she will be able to find anywhere else to live.  “It’s like jail here,” she said.

Ah, the joys of socialism.  This will be playing out for a while.  But meanwhile, Maduro and his henchmen have no real answer to the proposal.  The likelihood is that the longer the discussion goes on, the more support they will lose from what had been a group of core supporters.

Now, meanwhile, back here in Manhattan, isn't there any way we can get this proposal onto the table?

 

 

 

 

 

  

 

FDA Decides To Kill Thousands Of Innocent Teenage Boys

In a post back in September, I had this to say about the FDA:

The FDA would gladly see half of the American people die while they consider and reconsider for years approving some drug, in order to establish the proposition that the FDA and only the FDA has the bureaucratic say-so to determine when and how a drug can be marketed

And, to prove that I'm not making that up, the FDA a few days ago issued its ruling on a new drug application from a company called BioMarin for a drug called Kyndrisa intended for the treatment of Duchenne's muscular dystrophy.  The ruling is that the company has not yet submitted sufficient proof that the drug is effective to satisfy the FDA.  Tests must continue, unless the company gives up.  Oh, meanwhile there is no approved treatment whatsoever for this disease.  It arises from a genetic defect limited to boys.  About one boy in 3500 gets it, meaning about 500 new cases per year in the U.S.  It is 100% fatal.  Typically, the boy is in a wheelchair by his early teens and dead somewhere between the ages of 20 and 30.

The issue here is not that the FDA legitimately thinks this new drug is some kind of snake oil, or even that it has harms that outweigh the benefits.  The opposite.  The cause of Duchenne's has been identified (at least, within the limits of our flawed scientific processes), namely lack of a protein called dystrophin; and the drug in question (along with others under development by other companies) has been specifically designed to supply the missing protein.  Nor is the issue that no patients in trials to date seem to have benefited from the new dystrophin-supplying drugs.  For example, this from the Wall Street Journal on January 20 (relating to another one of the drugs, on which an FDA ruling is expected imminently, but anticipated to be equally negative):

Kathryn Wagner, a leading Duchenne physician at Johns Hopkins School of Medicine, says she plans to speak in favor of the Sarepta drug at the coming FDA meeting. She said she has seen patients benefit from the drug in clinical trials.      

Instead, the problem is that the disease is rare enough and serious enough that it is very difficult to get sufficient numbers of patients into the clinical trials to meet the FDA's standards of "statistical significance."  (One of the clinical trials for the drug Dr. Wagner was discussing is reported in the Journal article to have only 12 patients in each of the treatment and control groups.)  So the bureaucrat's answer is obvious: the trials will continue -- and continue, and continue, and continue -- until our standard for establishing our prerogative and maintaining our fiefdom has been met.  Meanwhile, thousands of innocent boys and young men become crippled and die unnecessarily?  What does that matter, when bureaucratic control is at stake?

Researching this post, I came across a 2014 debate sponsored by the Southwestern Law School Law & Medicine Society and the Federalist Society between libertarian NYU law professor Richard Epstein and a law/medicine guy from Southwestern named Ryan Abbott.  The subject of the debate was the closely-related subject of the FDA's unending efforts to quash speech about off-label uses of otherwise-approved drugs.  Abbott took the pro-FDA side of the debate.  Abbott's presentation gives a good sense of the progressive's reverence for the all-knowing and perfect bureaucrats -- who are always referred to as "we" because the true progressive feels himself to be one of this privileged elite.  And meanwhile, the mere non-bureaucrat is treated as ignorant, helpless and completely incapable of making any decision or acting for himself.  Excerpts:

The central problem with off-label drug use is that we have an information deficit. When the FDA approves a drug for on-label use, that approval is based on scientifically valid and statistically significant evidence that says, we are going to give you a drug, which is potentially dangerous, but it is likely that the benefits outweigh the risks. We know that because we have studied the drug in a controlled environment. That information is simply not available with off-label use.

Over 70% of off-label prescriptions used are not based on scientific evidence or significant scientific evidence.2 That’s a real problem because all drugs have a risk of serious side effects, and patients shouldn’t be exposing themselves to risk without evidence that a drug will be effective. . . .    

So not only are patients using drugs we don’t know are safe and effective, but we are not getting good feedback to inform future practice. . . .  How do we balance patient access with preventing harm, and what role should the FDA play? 

The whole approach is based on the dead-wrong idea that an elite can achieve perfect knowledge and make better decisions than individuals acting in their own interest.  Could a guy fancy enough to have both law and medicine degrees not know that all important human decisions are based on imperfect information and involve some degree of risk?  The answer is yes.  And it's not just Mr. Abbott, and not just the pooh-bahs at the FDA who keep drugs off the market while thousands die, but the entire federal bureaucracy that has bought into this narrative.