The best articles on gun control

Since the shootings in Connecticut earlier this month, I am sure that every one is interesting in learning more about the history of guns and gun control in the United States.  A friend of mine passed along a very interesting article last year about how the Black Panthers started gun control hysteria by marching on Sacramento armed to protest a gun control bill written by a Republican and eventually signed by Governor Ronald Reagan.  The modern NRA began with a coup in 1977 led by Harlon Carter which moved the organization’s focus from hunting and marksmanship to a zero tolerance policy for sensible gun laws.

And for those concerned that the world will end (or at least get more violent), I recommend listening to this interview with Steven Pinker about the decline of violence worldwide about how murder and violence and war are at historic lows.  Crime is at historic lows in the United States, and war is becoming (surprisingly) much less rare.  To paraphrase John Lennon, “War is ending, if we notice.”

Links

Atlantic Monthly – “The Secret History of Guns“

WNYC – “Steven Pinker on why violence has declined“

Dear Dr. Gawande

Dear Dr. Gawande,

        As the nation (or media’s) most foremost health policy expert, I must object to your recent article comparing hospital chains to restaurant chains.  Since I am pretty sure the New Yorker will not publish my letter to the editor, I will share this letter publicly with my dear readers. 

       Comparing health care to the Cheesecake Factory is ludicrous. Anyone in health policy knows that health care is meal ordered by one person, eaten by another person, and paid for by a third. Competition does not bring down prices in health care because patients do not know what they want and do not know how much it costs and there are no standard national prices. This is not like choosing between Olive Garden and Carabba’s.

       There are narrow niches which could be competitive like the cited example of the author’s mother’s knee replacement. But these are elective procedures in which the patient has time and knowledge about exactly what he/she needs. That is not most of health care or most patients. Low spending regions in the United States are generally dominated by local monopolies. The CMO at Scott & White Hospital in Temple, Texas (a low spending region) openly told me competition increases prices in America.

       What motivation do hospital chains have to bring down actual prices? Consumers don’t pay hospital bills directly, and CMS rules forbidding charging anyone lower than the Medicare rate effectively rule out any downward pressure on prices. Instead hospital chains focus on increasing volume and usually fraudulently as Hospital Corporation of America has done with cardiac catherization labs. Most of these chains will be like HCA and not like semi-noble physician-run enterprises like the Cleveland Clinic or Mayo Clinic.

       Quality of care contracts will not lower costs much either. A recent study (New England Journal of Medicine, September 8, 2011) comparing spending in Massachusetts Blue Cross/Blue Shield’s quality contract with non-quality contracts showed that quality contracts merely slowed the increase in health care spending by 1.9% or a princely $15 per quarter per enrollee. Meanwhile Partners Healthcare’s anti-competitive contract with Blue Cross/Blue Shield contributed $1 billion in excess profits.

         You are the eloquent defender of changes already in progress, pretending that those in charge of healthcare will be like the ICU quality improvers and not like hedge fund managers only interested in bilking the public. A for profit health care systems means that medical clinics and facilities want to make more money, every quarter, every time.

        The proletariazation of American physicians from Jeffersonian small businessmen into wage labor for “Hamiltonian” hospital systems will not make health care better or more affordable or even higher quality. It will concentrate wealth and power further to distant elites. Health care quality improves for the uninsured and insured (NEJM, July 5, 2012) when more people get insurance. A nonprofit, universal health care system will lower overhead and standardize payments and care. Fairness is cost-effective.

        Hamilton may have brought America money, but Jefferson brought us justice. Beware of technocrats who think that tweaking a corrupt and unjust system will fix its ills and not their salaries.   

 

Sincerely,

A working physician

 

Issue LVI: Manufacturing Consent – TED Talks and the ideology of innovation

Facebook went public this month, and a 28 year old kid is now one of the richest people on Earth.  Combining technology and an innovative idea, Facebook went from being a fun diversion in college to one of the most valuable companies on the planet.      

Mark Zuckerberg may be a bit strange according to the media, but billionaires of his generation differ from generations past in a few ways.  They appear to have earned their money in their own lifetime instead of inheriting it.  Perhaps as a consequence of their earning their own fortune from their own “innovation”, they like to socialize in gatherings quite different than the country clubs of their forefathers.  They like to apply their agile minds to solving the world’s “big questions.”   

Their preferred setting?  Davos, Switzerland for the World Economic Forum or the Aspen Ideas Festival in Colorado.  Or there is the Clinton Global Initiative in its many locations. 

But the best known to the general public is probably TED – Technology, Entertainment, Design.  It began as a Silicon Valley conference in 1984 that started to take off in the 1990s.  By the late 1990s, the conference was sold to a British businessman named Chris Anderson.  Born in Pakistan to the son of missionaries, he made the conference focus on global issues like war and the environment.  Anderson also jacked the price up and demanded that all conference attendees prove that they were “TED-worthy” of attending.  Exclusivity meant your ability to innovate and a history of changing the world.  In 2006, the conference began to stream their 18 to 20 minute talks online to the general public as TED Talks with the slogan “ideas worth spreading.” 

The talks were a hit and some of the lecturers became mega-famous in their own right.  A Swedish professor named Hans Rosling launched Gapminder at a TED Talk about inequalities in health and income in the world.  Google bought the software and hosts the website.   

The talk is usually a Powerpoint presentation in front of a rich and high IQ audience.  Topics usually focus on a single issue and how it affects the world.  The solution usually has a simple (often high-tech) solution that will fix the problem soon. 

There is a general idea that the problems of the world can be addressed by the presence of influential, high IQ, and affluently TEDworthy people at these sort of conferences.  Thorny questions of politics, power, history, and social injustice can (and have to be) glossed over in the less than twenty minutes allotted.  Bonus points if the solution involves entrepreneurship.       

But this month, a talk by a venture capitalist did not get published on the TED website because for being overly political.  The capitalist, a traitor to his class, pointed out that the rich do not create jobs if they can avoid it.  Hiring is the last resort of the businessmen (he should know, being one).  Taxes on the rich have fallen, and the incomes of the 99% have been stagnant or shrinking.  The solution was to redistribute wealth to people who can spend more to increase consumption and grow the economy.  This was considered too partisan by Chris Anderson and only after a public outcry did the speech get published online.     

I cannot bash the new elite too much; they aren’t like the Russian oligarchs blowing their fortunes on English football teams or ties at Harrod’s.  At least they like to show that they care, and their concerns will lead to ameliorating the lives of many people.  But just as the rejection of philosophy is a philosophy too so too does the rejection of ideology and the “political” become an ideology in itself. 

Centrist wise men (like the cartoonish Thomas Friedman) will prattle about how a “non-ideological, centrist, and technocratic” approach to the solutions of the world is needed.  These solutions will not threaten entrenched corporate power.  It also ignores the actual track record of technocrats and their record of disasters: money-laundering in Russia by Harvard University, food riots in Venezuela by the IMF, a second Great Depression in Argentina in 2001, and counterproductive mass austerity and unemployment imposed on Southern Europe by the current European Central Bank.  In contrast, the markets reacted negatively in 2002 when Brazil elected Lula da Silva (a former shoeshine boy and steelworker) as president.  He managed the country so well over two terms it continues to grow during the Great Recession.  Sometimes the smartest aren’t so smart. 

The nonprofit sector that elite idea conference industry hopes to attract have their own downsides.  The nonprofit foundations can defang the most strident critics of injustice and turn them into salaried professional NGO workers.  A recent speech by Arundhati Roy pointed out how business foundations have shaped public discourse unaccountably for decades in the United States.  The first foundations were by Ford, Carnegie, and Rockefeller.  The Gates Foundation today plays a destructive role domestically by funding every significant university, think tank, and media outlet promoting their vision of charter schools and a business approach to public education (see my previous post on this topic).  Roy points out how big business in India is now adopting these tactics by sponsoring literary festivals and philanthropic endeavors. 

Foundation money saps the anger of the community organizers most capable of fighting for radical change.  By giving Indian activists big money, social status, research fellowships, “genius grants”, and accolades at conferences internationally it mutes their criticism of the structural causes of injustice and inequality in society.  They too want to climb the NGO ladder in a way similar to the corporate ladder.  “Justice [has been transformed] into the industry of human rights,” she says.    

But a conference of the 1% talking about the problems of the 99% will never solve any of the big problems in the world.  It is only when the 99% wakes up and takes power with its own hands will humanity make this a fairer and more just world. 

 

Now that is an idea worth spreading. 

 

References

New York magazine – “How the TED Conference started an Intellectual Movement”

Salon.com – “Don’t mention income inequality please, we’re entrepreneurs”

Arundathi Roy – “Capitalism: a Ghost Story”

Atlantic Monthly – “The Rise of the New Global Elite”

Issue LV: The numbers do lie: why statistics won’t save health care

My latest post has been published on the British journal of current and international affairs, openDemocracy.  It is a nonprofit publication focusing on human rights and democracy.  It is widely read in the US, UK, EU, and India. 

Enjoy!

 

openDemocracy – “The numbers do lie: why statistics won’t save health care“

Issue LIV: When the Arab Spring plays Cricket

A civilian ambassador to the United States is recalled home after asking the American military to help prevent a military coup in his home country.  The president denies asking America for help.  The military denies it runs things or wants to run things.   The ex-ambassador remains in house arrest while the president (alternatively known as corrupt, depressed, schizophrenic, and a numbskull) flees to Dubai for medical treatment.

As the rotting edifice of Pakistani politics sinks further in disrepute and shame, it begs the question, “Is there any chance it will get any better?”  If the Pakistani military were as good defending the nation as playing politics, perhaps Pakistan would still have Bangladesh, taken Kashmir, and wouldn’t be dealing with so much terrorism in their own backyard.  If President Zardari, a man so grotesquely out of touch with his people that he visited his French chateau during the worst floods in Pakistan’s history, was as good at governing as he was at stealing, perhaps he would not have to worry about being overthrown every other week.  And if the opposition was not so full of incompetent crooks, perhaps they would actually win an election.

But that brings us to perhaps the only rays of light in Pakistani politics, the perhaps last two honest men in a world of sleaze, nepotism, and murder.  One is Chief Justice Iftikar Chaudhry, a man who lost his job because he said General Musharraf could not be president and general at the same time.  His firing led to a political revolt that led to the overthrow of Musharraf and the return of “democracy” to Pakistan.  Unfortunately, this led to the return of Asif Ali Zardari who managed to use his wife’s death and her famous last name to win Parliament and then the presidency.  He reluctantly let Judge Chaudhry back into office after protests only to see him sue Zardari for corruption.  The Supreme Court could dismiss his government at any time.

The only other honest man is perhaps Imran Khan, the Pakistan cricket captain who won the 1992 World Cup.  An Oxford-educated ex-playboy, his political party has only won one seat in 15 years….. his own.  But in an era where Pakistanis are tired of the rigged two party system (three if you count the military), he has drawn hundreds of thousands to his political rallies.  In the era of  worldwide revolution, why him and why now?

Imran Khan built an honest charitable cancer hospital named after his mother from money he won from the World Cup.  75% of patients are treated with support from the 25% that are private patients.  In a nation where wealth is inherited or embezzled, his money comes sport not stealing.  Building a support base from a middle class that has not participated in politics on a grand scale, Imran Khan hopes to win the next election with the support of young people tired of politicians living in palatial wealth while giving nothing to regular people.  He also pushes for an end to the war in Afghanistan and for drone attacks that have killed hundreds of innocent  people.  Khan frightens Washington.  India, on the other hand, would likely be delighted if he does as he says and uses cricket and common sense to build bridges between the two nations.

But Imran Khan has had some blind spots in the past.  He supported Musharraf’s coup against Nawaz Sharif and is allegedly supported by the Pakistani military.  As a Johnny-come-lately to Islam after years of women and womanizing, feminists fear that he would fail to repeal medieval Islamic rape laws to show how Muslim he is.

One thing is clear though.  If there is one man to watch in South Asian politics in the next year, keep your eyes on this former cricket captain.  After 15 years in the political wilderness, now is his time.

 

India Today - ”Want a new beginning with India“

Issue LIII – Dispatch from Austin: Pass the Biscuits, Perry

While the world waits with baited breath whether ex-Democrat Rick Perry decides to throw his cowboy hat into the ring for president, those familiar with his Aggie antics roll their eyes.  Much ink will be spilled over his “record” as a career politician.  Starting out as a conservative Democrat representing West Texas in the 1980s in the state legislature, Rick Perry switched parties in 1989 to run against the populist Jim Hightower for agriculture commissioner.  In a dirty campaign advised by Karl Rove, Perry narrowly defeated this hero of the liberal wing of the Democratic Party by focusing on agriculture issues like, you know, Hightower’s endorsement of Jesse Jackson and stance against a flag burning constitutional amendment.

In 1998, Perry narrowly won a race to be the first Republican Lieutenant Governor of Texas of the 20th century.  In this position (widely believed to the be most powerful job in Texas), Rick Perry’s oh-so-lucky timing got him into the governor’s mansion when then-Governor George W. Bush resigned to become President.  Slick Rick’s never looked back since and has defeated every opponent to his governorship since.  Rick Perry is now the longest serving governor in Texas history having been in office since 2000.  He won’t leave until at leastJanuary 2015.

Counter-narrative to the “Texas Economy”
Rick Perry’s claim to fame is that the Texas economy has low taxes and little regulation of business.  Being so business-friendly has made it successful his boosters claim.  This is not really a new development though.  The business lobby has always controlled Austin and focused on making it “bidness” friendly.  Our poor rankings in health, environment, and education honestly pre-date Perry (or even Bush) so it is not fair to blame those problems on Rick Perry.  The fact that he has never tried to fix Texas’s widespread poverty and lack of social services is his fault.

But honestly, Texas is (or was) booming relative to the rest of the nation.  Can Perry’s blathering about a “Texas Century” or the Economist’s praise of us being the “New California” have any merit?  There is something to see, but perhaps not for the reasons conservatives like to think.  Honestly, a lot of it had to do with the 1980s, industrial policy, high taxes, regulation, and good luck.

Let’s start with the housing crisis.  Anyone who was around in the 1980s remembers that Texas in the 1980s was in a depression.  Oil prices plummeted when the Middle East began exporting oil back to the United States.  High gas prices had led investors to splurge in real estate and oil speculation.  Many of those companies (like Bush’s oil company) drilled dry wells and/or busted when cheaper, foreign oil started flowing in.  Of course, the banks that loaned money to these real estate and oil companies all went bust.  As a consequence, every local bank in Texas went bust or had to be bailed out by the FDIC except for Frost Bank.  With Texan James Baker running the White House in the Reagan/Bush administration, he covered up the huge disaster that was the savings and loan scandal of the 1980s (which was worst in Texas).  Many people (professional or otherwise) lost their shirts.

How does that relate to today?  So many bankers lost out on the 1980s and early 1990s that they didn’t make as many stupid loans as bankers in other states.  Also Texas’s farmer-written constitution forbids many types of loans and has lots of regulations on home loans that other states don’t have.  Texas also has very high property taxes relative to the value of the property because it has no income tax.  Texas property taxes are three times that of California’s.  You are less likely to speculate on property when you have to pay thousands of dollars a year in property tax.

Let’s not forget oil prices were doing well and compared to the rest of the nation Texas maintained an industrial base.  Texas exports more than any other state in the nation by far.  It also benefits from high tech sectors in Dallas and Austin, and a large military presence throughout the state.  Houston also has another federal government spending projected called NASA.

So what made the Texas economy do so well recently?  Dumb shit luck and cheap houses is probably the best guess anyone can make.  Again, Rick Perry was at the right place at the right time.  But he did nothing to continue that success by focusing on, say, education.  Which brings us to his most glaring failure.

War on Higher Education

     People have been saying for years that Texas needs to focus on improving education, increasing its Tier 1 colleges, and increasing the number of minorities going to college.  And actually, surprisingly, Texas public schools were improving steadily over the last twenty years.  The key failure of the school system is actually the very high poverty rate of children in Texas.

Perhaps that can be excused, but more fascinating is Rick Perry’s “war on higher education.”  Perry graduated from Texas A&M and is the first Aggie governor of Texas.  Ordinarily you would think the second most important university in the state would be happy with that fact, but Aggieland is not pleased at all with their first governor.

Rick Perry wants to destroy tenure at Texas universities using the different board of regents for each system.  He wants them to operate like businesses and evaluate each professor by how much “productivity” they have.  Through his control of the A&M board of regents, he is pushing through a loopy evaluation system created by a for-profit college owner, Jeff Sandefer.  He focuses on “seven breakthrough solutions” to improve higher education by de-emphasizing research and increasing the number of large classes.  Although he has never been on the board of regents of any university, Sandefer is the most important man in higher education because Perry listens to him, and Perry controls the regents.  It also helps he has donated $300,000 to Perry as well.  Defense of the autonomy of higher education and research are coming from the UT System’s Bill Powers and Francisco Cigarroa, and an alliance of Aggies and Longhorns has been struck to fight Perry’s attacks on research.

But the politicization of the boards of regents and higher education has a long pedigree in this state.   The University of Texas at Austin has always been a very political campus.  For a decade, LBJ buddy and regent Frank Erwin dominated the campus and hired and fired deans on a whim.  He sacked every single university president in the system except for Truman Blocker at UT Medical Branch.  He separated the college of arts and sciences into the College of Liberal Arts and College of Natural Sciences over the objections of the faculty and Dean Silber.  He fired Silber who moved on to become president of Boston University.

 

       Rick Perry also fires anyone who disagrees with him.  In 2009, he fired several university regents who were supporting Kay Bailey Hutchison over himself in the Republican primary.  The boards need a cleaning out for sure, but he only cleans them out when they turn against them.

Honestly, Rick Perry’s attacks on academic freedom are reminiscent of the first student protest that ever occurred in Austin.  In the 1930s, a cartoonish conservative radio talk show host named W. Lee “Pappy” O’Daniel got elected governor with his radio and country-western band.  Ol’ Pappy “pass the biscuits” O’Daniel stacked the Board of Regents with right-wing no-nothing hacks.  These hacks were upset about all the “liberal” and “atheist” professors running around the University of Texas.  They particularly did not like that  who were upset that the state university had pro-New Deal economics professors.

The Board handed then-President Homer Rainey a notice that he needed to fire these professors.  President Rainey declined to and told the faculty that he was being pushed to fire tenured professors illegally.  They supported Rainey, and then the board fired Rainey and fired the New Deal economics professors too.  This lead to UT being reprimanded by most academic accreditation boards and the American Association of University Professors for almost a decade.  This will probably happen again if the current path is not altered.

Can a state that only has two public Tier 1 universities really afford to have them kicked out of the American Association of Universities?  Should the state really try to kill research at a university system that invented cardiac stents?  What is the long term purpose of this “reform” of education that Perry promotes?  Rick Perry doesn’t understand that slogans against “lazy professors” won’t fix the fact that he deregulated college tuition and underfunded K-12 and colleges.  In a state that has succeeded by stealing other states’ brainpower, he does not recognize that a new, high-tech economy comes from more Tier 1 colleges not less.  He succeeds by making us dumber.

Of course, we don’t have to make that mistake when he decides to run for president.  Spread the word about Perry’s attacks on universities.

 

Links
Washington Post – Rick Perry wages an assault on university establishment
Texas Coalition for Excellence in Higher Education – A group to defend UT and A&M’s research

What you should read

These are some of the latest and greatest articles that I have meant to send to you.

• Mother Jones ran a fantastic article a few months ago explaining how the American oligarchy has succeeded in its war against the middle class.  Key to their strategy was the the destruction unions in the United States through Ronald Reagan’s  attack on the working class.  These fascinating charts show how the bottom 80% of Americans have had a net loss of income over the last thirty years that has been transferred to the top 10%.  Most of that went to the top 1%.  That means that every year $743 billion is lost from 80% of Americans and $673 billion of it goes to the top 1%.  Inequality has also slowed economic growth as money circulates through fewer and fewer hands.  A must read.
• TIME ran an interesting article on a number of myths about the recession and the “recovery.”  They end concluding that the solution for America’s jobs crisis is German style industrial policy.  Not everyone should go to college, and it is important for the economy to produce middle and lower tier jobs that rely on skilled labor developed through technical or community colleges.  That also relies on re-emphasizing industry over services, something the United States has refused to do.  Besides Obama’s bailout of the automobile companies, he has made no significant efforts to support heavy industry in the United States.
• Is India developing into an oligarchy? – Raghuram Rajan warns that India’s development is very unequal and could potentially turn into oligarchic capitalism like Russia or many Latin American countries.  Economic development would proceed up to a point and then fall into a middle income trap whereby any further development of the country would depend on breaking the power of large, powerful, and well-connected industrial families.  India is not there yet, but if the connections between businessmen and politicians grow even more then the country will come to resemble Mexico and not South Korea.  Given that Rajan  warned that financial deregulation was making the world economy more unstable long before the financial crisis, he is worth listening to.
• Are vaccines a CIA plot?  – a common complaint heard in the Muslim world is that vaccine drives are really a conspiracy against poor people by the United States.  Polio drives in India fail often in Muslim neighborhoods where this belief is common.  Unfortunately, The Guardian, reveals that the CIA really did run a fake vaccine drive in Pakistan to “find” Osama bin Laden.  Naturally, Doctors without Borders is not amused.  This can undermine public health everywhere!