Mike Kueber's Blog

April 30, 2011

A horse-racing primer

One of my favorite drinking buddies, Kevin Brown, is a life-long fan of horse racing.  He has been handicapping races for decades and even wrote a book on the subject that describes some of his thinking. 

The granddaddy of all horse races, the Kentucky Derby, is held annually on the first Saturday in May (next Saturday), and Kevin is having a viewing party at his house.  To prepare for Kevin’s party, I decided to bone-up on horse racing. 

Handicapping is the real essence of horse racing.  It is the art or science of predicting which horses are likely to do well in the race – win, place (2nd), or show (3rd).  Most handicappers rely on The Daily Racing Form (DRF), a newspaper-style publication, to handicap a race.  The DRF details statistical information about each horse entered in a race, including detailed past performance results, lifetime records, amount of money earned, odds for the particular horse in each past race, and a myriad of other information available for casual or serious study.  I will obtain and study a copy of the DRF before the party.

Aside from handicapping the race, I decided that a little well-placed research would enable me to avoid sounding like a dilettante, and I might even add something to the conversation.  For instance, I have previously asked Kevin what percentage of the parimutuel bets was siphoned off by the track, and he didn’t know.  I do now.  Tracks on average take about 17% of the betting pool, which sounds reasonable to me.  FYI – parimutuel betting differs from fixed-odds betting in that the final payout is not determined until the pool is closed – in fixed odds betting, the payout is agreed at the time the bet is sold.  Thus, the odds for the race may change dramatically in the last few minutes if an inordinate number of late betters favor a particular horse.

Kevin might not know that there are generally three types of horses that race – Thoroughbreds, Arabians, and Quarter Horses, with Thoroughbreds being the most popular.  All Thoroughbreds can be traced to three Arabian stallions and 74 foundation mares of English and Oriental blood in 17th and 18th century England.  They are bred to race at a distance of 5-12 furlongs (with a furlong being one-eighth of a mile).  Quarter horses, as suggested by their name, are bred to run a quarter of a mile (two furlongs), while Arabians are best a long distances – between ten and 100 miles.

(Incidentally, a height of a horse is taken at its shoulders (withers), as opposed to cattle, which are measured from their hips.  The unit of measurement is called “hands.”  A hand is equivalent to four inches.)   

Kevin has previously described to me the difference between a stakes race, maiden race, and a claiming race, but he wasn’t able to list all six categories.  Now I know:

  • Handicap race.  A handicap race is one in which the runners have been “handicapped” by carrying more weight, also called an impost, according to their performance in other races. Theoretically, all horses have a chance of being competitive in a race that is correctly handicapped.
  • Stakes race.  A stakes race is higher-class race for bigger prizes.  They often involve competitors that belong to the same gender, age and class. These races may, though, be “weight-for-age”, with weights adjusted only according to age, and also there are “set weights” where all horses carry the same weight. Furthermore, there are “conditions” races, in which horses carry weights that are set by conditions, such as having won a certain number of races, or races of a certain value.  Examples of a stakes/conditions race are the Breeders’ Cup races, the Dubai World Cup, the Kentucky Derby, the Preakness Stakes, the Belmont Stakes, and the Travers Stakes.
  • Maiden race.  A maiden race is one in which the runners have never won a race. Maiden races can be among horses of many different age groups. It is similar to a stakes race in the respect that horses all carry similar weights and there are no handicapped “penalties.”  This is the primary method for racing a two-year-old for the first time, although only against other two-year olds. Three-year olds also only race against their own age in maiden races early in the year.
  • Allowance race.  An allowance race is one in which the runners run for a higher purse than in a maiden race. These races usually involve conditions such as “non-winner of three lifetime.” They usually are for a horse which has broken its maiden but is not ready for stakes company.
  • Claiming race.  A claiming race is one in which the horses are all for sale for more or less the same price (the “claiming price”) up until shortly before the race. The intent of this is to even the race; if a better-than-class horse is entered (with the expectation of an easy purse win), it might be lost for the claiming price, which is likely less than the horse is worth. Someone may wish to claim a horse if they think the horse has not been trained to its fullest potential under another trainer. If a horse is purchased, a track official tags it after the race, and it goes to its new owner.
  • Optional claiming race.  An optional claiming race is a hybrid of allowance and claiming race, developed to increase field sizes. A horse who does not fit the conditions can still “run for the tag”, i.e. be run conditional on also being offered for sale.

They say that Thoroughbred racing is the sport of kings.  I don’t know about that, but I think I will try playing a king on May 7th

btw – the Daily Racing form won’t be available for the Derby until Thursday or so.  After reviewing that form, I will try to handicap the race and post a blog entry so that my readers can make some easy money on Saturday.

Traditional values – Obama vs. Romney

Filed under: Culture,Issues,People,Politics — Mike Kueber @ 12:25 am
Tags: , , , ,

The NY Times has vigorously charged that President Obama’s “birther” problem was due to unreconstructed racists.  As NY Times blogger Timothy Egan recently blogged, “This shameful episode has little to do with reality and everything to do with the strangeness of Obama’s background — especially his race.” 

In his blog, Egan attempted to substantiate his argument by pointing out that both white-bread Mitt Romney and dark-skinned Obama successfully emerged “from the blender of American ethnicity and lifestyle experimentation,” yet only Obama is challenged as too exotic to be “American.”  According to Egan, Mitt Romney’s background is just as strange as Obama’s, but no one has focused on it because Romney and his family look “like it came from a Betty Crocker mold, circa 1957.” 

What does Egan find strange about Romney’s background?  His great-grandfather was a polygamist.  Incredibly, Egan thinks that stain should disqualify Romney from being “an icon of traditional family values.”  Yet, he doesn’t think Obama’s exotic background raises any legitimate questions about whether Obama possesses traditional American values.

I think Egan is wrong in suggesting that the influence of a great-grandfather is comparable to the influence of parents who chose to live their lives away from America.

April 27, 2011

Comparative-effectiveness research and healthcare rationing

A few days ago I blogged about the Independent Payment Advisory Board (IPAB), which was created by ObamaCare to reduce the rate of growth in the cost of Medicare.  Although IPAP is intended to recommend changes to Medicare reimbursement rates and is specifically prohibited from making any recommendation to ration health care, Republicans and some Democrats are actively attempting to terminate the Board because they believe that draconian cuts to reimbursement rates would be equivalent to rationing. 

Rationing is currently a dirty word in Washington.  Any program that arguably leads to healthcare rationing is at risk.  Although Republicans are loathe to admit it, RyanCare is a variation of rationing because its Medicare vouchers will not be adequate to buy today’s full-coverage Medicare.  We can fully expect partisan Democrats to demagogue this issue as much as Republicans do.  Let’s hope this bipartisan demagoguery fails to damage the invaluable comparative-effectiveness research (CER) contained in ObamaCare.

CER has been defined as the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, or treat a clinical condition or to improve the delivery of care. CER attempts to measure the relative effectiveness of treatment, whereas standard research focuses on efficacy (whether the treatment works or not). 

An expert in the field of CER who has studied geographic variation in healthcare that patients in the U.S. receive – a phenomenon called practice-pattern variation – has concluded that if unwarranted variation were eliminated, the quality of care would increase and healthcare savings up to 30% would be possible.

Another study has revealed that patients in the highest-spending regions of the country receive 60 percent more health services than those in the lowest-spending regions, yet this additional care is not associated with improved outcomes.

Council for Comparative-Effectiveness Research

President Obama is a big supporter of CER, and he took advantage of the American Recovery and Reinvestment Act of 2009 (the Stimulus Act) to set aside $1.1 billion for CER and to create a Council for CER to coordinate the research across the federal government.  In the development of the law, there was disagreement over whether CER could be used to limit (rationing?) healthcare options, and ultimately, the law provided that CER should only be used to increase the quality of treatment, not to limit options.  That doesn’t make any sense – why should government pay for treatment that is relatively ineffective? 

Because of the explicit prohibition on rationing and the fast-moving nature of the Stimulus Act, the $1.1 billion for CER stayed under the radar.  That changed, however, when President Obama made further changes to CER under the Patient Protection and Affordable Care Act of 2010 (so-called ObamaCare).  When Sarah Palin and her cohorts demagogued ObamaCare for rationing and death panels, they never identified the provisions in the law that prompted this concern.  Subsequent commentators, however, have focused on the Patient-Centered Outcomes Research Institute (PCORI), which replaced the Council for Comparative Effectiveness Research.

Patient-Centered Outcomes Research Institute (PCORI)

Section 6301 of ObamaCare provides, “The Secretary may […..] use evidence and findings from research conducted […..] by the Patient-Centered Outcomes Research Institute.”  According to Republican senator Kyl, “That means the government, not patients and doctors, has the power to make health care decisions that affect you. A bureaucrat decides if your health care is an effective use of government resources.”

ObamaCare also says the following about comparative-effectiveness research:

  • Defines comparative clinical effectiveness research as “research evaluating and comparing health outcomes and the clinical effectiveness, risks, and benefits of 2 or more medical treatments, services, and items.”
  • Establishes that the purpose of the Institute is “to assist patients, clinicians, purchasers, and policy-makers in making informed health decisions by advancing the quality and relevance of evidence concerning the manner in which diseases, disorders, and other health conditions can effectively and appropriately be prevented, diagnosed, treated, monitored, and managed through research and evidence synthesis that considers variations in patient subpopulations, and the dissemination of research findings with respect to the relative health outcomes, clinical effectiveness, and appropriateness of the medical treatments, services, and items.”
  • Provides that the Institute “shall identify national priorities for research, taking into account factors of disease incidence, prevalence, and burden in the United States (with emphasis on chronic conditions), gaps in evidence in terms of clinical outcomes, practice variations and health disparities in terms of delivery and outcomes of care, the potential for new evidence to improve patient health, well-being, and the quality of care, the effect on national expenditures associated with a health care treatment, strategy, or health conditions, as well as patient needs, outcomes, and preferences, the relevance to patients and clinicians in making informed health decisions, and priorities in the National Strategy for quality care established under section 399H of the Public Health Service Act that are consistent with this section.”
  • Instructs that the Office of Communication and Knowledge Transfer, “in consultation with the National Institutes of Health, shall broadly disseminate the research findings that are published by the Patient Centered Outcomes Research Institute … and other government-funded research relevant to comparative clinical effectiveness research…. The Office shall provide for the dissemination of the Institute’s research findings and government-funded research relevant to comparative clinical effectiveness research to physicians, health care providers, patients, vendors of health information technology focused on clinical decision support, appropriate professional associations, and Federal and private health plans….   Shall not be construed as mandates, guidelines, or recommendations for payment, coverage, or treatment.”

Section 1182 of the Act explicitly limits the Secretary’s use of comparative-effectiveness research:

  • “The Secretary may only use evidence and findings from research conducted under section 1181 to make a determination regarding coverage under title XVIII if such use is through an iterative and transparent process which includes public comment and considers the effect on subpopulations.”  (This provision was quoted above out of context by the Republican Senator Kyl.)
  • Nothing in section 1181 shall be construed as (1) superceding or modifying the coverage of items or services under title XVIII that the Secretary determines are reasonable and necessary under section 1862(l)(1); or (2) authorizing the Secretary to deny coverage of items or services under such title solely on the basis of comparative clinical effectiveness research.”
  • The Secretary shall not use evidence or findings from comparative clinical effectiveness research conducted under section 1181 in determining coverage, reimbursement, or incentive programs under title XVIII in a manner that treats extending the life of an elderly, disabled, or terminally ill individual as of lower value than extending the life of an individual who is younger, nondisabled, or not terminally ill.”
  • “Paragraph (1) shall not be construed as preventing the Secretary from using evidence or findings from such comparative clinical effectiveness research in determining coverage, reimbursement, or incentive programs under title XVIII based upon a comparison of the difference in the effectiveness of alternative treatments in extending an individual’s life due to the individual’s age, disability, or terminal illness.”
  • The Secretary shall not use evidence or findings from comparative clinical effectiveness research conducted under section 1181 in determining coverage, reimbursement, or incentive programs under title XVIII in a manner that precludes, or with the intent to discourage, an individual from choosing a health care treatment based on how the individual values the tradeoff between extending the length of their life and the risk of disability.

Thus, the language appears to give the Secretary authority to rely on research from the Patient- Centered Outcomes Research Institute to assist in making coverage decisions.  But the Institute’s research focuses on the relative effectiveness of various treatment options, not on rationing coverage based on a cost-benefit analysis.  Thus, the 85-year-old guy appears able to get his knee replaced. 

Deficit hawks have complained that the Council for CER in the Stimulus Act had greater promise for slowing the growth of healthcare spending and that its replacement PCORI is currently precluded from examining the most important component of CER – i.e., cost-effectiveness.

Cost-effectiveness

Cost-effectiveness analysis considers the comparative effectiveness and costs of different treatments. The goal is to provide evidence of which treatments provide the most health benefit per dollar of expenditure. Deficit hawks argue that the expanded use of cost-effectiveness analysis is desirable and inevitable to limit growth in U.S. medical costs.  Incorporating costs into the analysis of comparative effectiveness can help focus resources on treatments and interventions that provide greater value for the money. But conducting and using formal cost-effectiveness analysis in treatment and insurance coverage decisions is highly controversial. Cost-effectiveness analysis raises the prospect of formal rationing of medical care because it costs too much.

The concept of cost-effectiveness is central in the economics of healthcare.  Although cost-effectiveness for Medicare is currently hugely controversial, it is already being applied by the Veterans Administration and, thought the states, in Medicaid.   Big-government types believe that cost assessments and judgments of benefits in relation to costs should be left to patients and physicians, but deficit hawks like me believe that a centralized government system for comparing cost-effectiveness is an essential part of CER.  American government has limited resources, and it needs to decide how much to spend on healthcare and how to most effectively spend it.

April 26, 2011

Title IX

Has Title IX outlived its usefulness?  According to an article in the NY Times, there is a strong argument that it has.   

Title IX provides as follows:

  • No person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program or activity receiving Federal financial assistance.”

The law, which was enacted in 1972 at the height of the women’s-rights movement, was primarily directed at college employment practices.  Conservative legislators, however, were concerned about its effect on athletics, so while the Department of HEW was developing regulations to implement the law, Senator Tower of Texas in 1974 attempted to amend the law to exempt revenue-producing sports.  Unfortunately, Tower’s effort was unsuccessful, and only a watered-down provision by Senator Javits of New York was adopted – instructing HEW to include “reasonable provisions concerning the nature of particular sports.” 

The Department of HEW subsequently put the hammer down on men’s athletics by issuing a Policy Interpretation that articulated three ways to achieve compliance with Title IX:

  1. Providing athletic participation opportunities that are substantially proportionate to the student enrollment, OR
  2. Demonstrate a continual expansion of athletic opportunities for the underrepresented sex, OR
  3. Full and effective accommodation of the interest and ability of underrepresented sex.

Thus, Title IX as implemented by HEW regulations essentially implemented a quota system to equalize the participation of men and women in college athletics.  As with most government programs, however, it tends to encourage superficial compliance while defeating the fundamental purpose of the program.  The Times article reports on a plethora of superficial techniques that many colleges have applied to remain Title IX compliant, including the following:

  • Triple-counting women in cross country, outdoor track, and indoor track.
  • Encouraging women walk-ons who have no serious prospect of competing.
  • Counting women who participate on a men’s rowing team.
  • Counting men (as women) who practice with a women’s team.
  • Creating a women’s indoor track team when the climate doesn’t require it.
  • Eliminating popular men’s programs, such as wrestling, track, golf, and tennis.

The Times article doesn’t suggest how this problem should be fixed, but it does promise that “This is the first in a series of articles examining how colleges approach compliance with Title IX since 1972 and the obstacles to enforcing the law.”  That suggests to me that the Times thinks the problem is with ineffective enforcement.  I think that substantive problems with the law that should be corrected before technical compliance issues are addressed.

Facebook friend Bill Jones commented that he thinks the first fix to Title IX would be to remove self-sufficient sports from the quota calculation, which was suggested by Senator Tower in 1974.  I agree.  Self-supporting sports, like football and basketball, have nothing to do with gender-based discrimination, and have more to do with running a successful business.  Having a self-supporting football team of 115 guys does nothing to deny opportunity to women athletes, and it shouldn’t require the elimination of other men’s sports with 115 participants to create equity.

The Times article noted that as many as 57% of American college students are female, so ironically this disturbing trend will probably diminish the severity of the Title IX quota in the future.  In any event, the Title IX quota should not require proportionality between enrollment and athletic participation.  A much better analysis would compare the relative interest of men and women in athletics. 

A year ago, the United States Commission on Civil Rights agreed by criticizing the Title IX regulations for “unnecessary reduction of men’s athletic opportunities” and by advocating of surveys to measure interest.  With enlightenment like that, perhaps we can get this thing fixed.

April 25, 2011

Hawks

Washington Post blogger Greg Sargent posted an interesting entry today about “deficit hawks.”  According to Sargent, the term has been unfairly appropriated by the Republican Right, even though the Right is often more interested in drying up all streams of government revenue than it is in eliminating the deficit. 

This deficit-hawking started with Ronald Reagan in the late 70s, when he argued for lowering taxes, balancing the budget, and rebuilding America’s defenses.  When pressed to prioritize these conflicting values, Reagan said there was no conflict.  This prompted a moderate Republican opponent (Bush-41) to coin the term “voodoo economics.”

I think blogger Sargent makes a good point.  If you claim to be a deficit hawk, that should mean that reducing or eliminating the deficit is so important to you that you are willing to sacrifice other values – such as your opposition to raising taxes – in order to address the deficit problem.  If you aren’t willing to raise taxes to reduce the deficit, then you are more accurately described as a believer in smaller government or an adversary of big government.  Paul Ryan is a believer in smaller government, not a deficit hawk.  By contrast, the Gang of Six senators are deficit hawks.

Sometimes I think the anti-war liberals are still resentful of being labeled doves during the Vietnam War, as opposed to the pro-war conservatives being labeled hawks.  Most alpha Americans think doves are a little squishy.  NY Times columnist Maureen Dowd has tried for years to get back at the hawks by name-calling those who didn’t serve in Vietnam – she particularly enjoys calling VP Dick Cheney a chickenhawk.  (Although that term is considered an epithet, the NY Times is apparently OK with its usage by columnists.)  I wonder, however, if Dowd has taken this labeling to its logical conclusion – i.e., under his classification, Bill Clinton and Barack Obama are chickendoves.  Don’t think they’d like that appellation.

April 23, 2011

Let’s hear it for the boys

Filed under: Business,Culture,Issues,Politics — Mike Kueber @ 4:30 pm
Tags: , , , ,

Last week, when I blogged about the new movie Atlas Shrugged, I noted that the villains were government bureaucrats and failing capitalists – the so-called “looters.”  Then yesterday, I saw a TV story reporting that, despite women purchasing 50% of all movie tickets in 2010, there was a dearth of women characters in the movies.  Instead of claiming blatant discrimination, the report suggested that the “content developers” were predominantly male and they naturally developed movies from their perspective.

What’s the connection between these two stories?  They both speak to the issue of diversity.  As everyone knows, diversity is an American political objective because (a) it is more fair and equitable, and (b) a diverse group will out-perform and out-produce a homogeneous group every time.  That’s a win-win proposition for America. 

Unfortunately, the facts do not support this political theory.  You will find robust diversity programs permeating every government bureaucracy and most failing capitalistic enterprises.  But two of the least diverse industries in America – movies and technology – are dominated by men, yet they consistently develop products that the people of the world are eager to buy.  America may have a huge trade deficit, but not in movies and technology.

As Ronald Reagan warned, there is a tendency to tax anything that moves; if it keeps moving, they regulate it; and finally if it stops moving, they subsidize it.   Let’s hope the looters keep their grubby hands of these crown jewels of America.

Texas ban on texting while driving

I previously mentioned that the Texas legislature was considering a ban on texting while driving (TWD).  My son Mikey responded by asking if he would still be able to surf the internet while driving.  Good question, so I promised to read the law.

By doing a little research, I learned that several texting bills have been filed, but only one has been passed by the House and forwarded to the Senate – H.B. 243.  The relevant language in this bill provides:

  • “An operator may not use a wireless communication device to write or send a text-based communication while operating a motor vehicle unless the vehicle is stopped.

In its original version, H.B. 243 prohibited sending or receiving texts, but it was amended to apply only to sending texts despite a proponent’s argument that it would be an “administrative nightmare” for police to have to determine whether a driver was reading or typing.  As a practical matter, I think police officers would need to examine the cell phones for evidence of a violation, and I don’t think they have the right to conduct that type of search. 

Incidentally, while reviewing legislation in other states, I noticed that some states ban sending or receiving texts, while others take a broader position by prohibiting “distracted driving,” which would include texting.  That broader sort of law makes a lot more sense, but Texas legislators have rejected it in favor of a narrow law that may be virtually unenforceable. 

Thus, the answer to Mikey’s question is that, even if the Texas bill passes the Senate and becomes effective in September, he not only can surf the internet while driving, but also can receive and read texts.  And I’m not sure how the police would ever be able to charge him with texting while driving unless the police officer is in his back seat looking over his shoulder.

The ultimate objective, however, is not to arrest people, but to change behavior, and as one police chief explained a municipal ban on texting:

  • You know, the criticism has been, ‘Officers won’t be able to enforce it, people will say they were dialing the phone,’ McManus said. “But here’s the bottom line for me: If a law is passed, there are going to be people who obey it simply because it’s on the books. There are folks out there who will obey a law because it’s on the books. There are others who will probably not. But the fact of the matter is, I believe there will be fewer people texting, which will make our roads safer.”

April 22, 2011

Krugman, IPAB, and doctors

Yesterday I blogged about health-care rationing, price-controls, and IPAB.  Today NY Times columnist Paul Krugman wrote about the same subject.    Not surprisingly, we have a different perspective.   What did surprise me was that instead of charging that opponents of IPAB are engaging in scare tactics by referring to rationing, Krugman seems to concede that IPAB is about rationing:

  • “Before you start yelling about ‘rationing’ and ‘death panels,’ bear in mind that we’re not talking about limits on what health care you’re allowed to buy with your own (or your insurance company’s) money. We’re talking only about what will be paid for with taxpayers’ money. And the last time I looked at it, the Declaration of Independence didn’t declare that we had the right to life, liberty, and the all-expenses-paid pursuit of happiness. And the point is that choices must be made; one way or another, government spending on health care must be limited.”

I agree with Krugman that the government is entitled deny treatment that is too costly, but that is rationing .  I am confused, however, by Krugman’s insistence that the “almost sacred” doctor-patient relationship is somehow greater than a vendor-consumer relationship, while at the same time Krugman acknowledges that we can’t afford “the blank-check approach”:

  • “We have to do something about health care costs, which means that we have to find a way to start saying no. In particular, given continuing medical innovation, we can’t maintain a system in which Medicare essentially pays for anything a doctor recommends. And that’s especially true when that blank-check approach is combined with a system that gives doctors and hospitals — who aren’t saints — a strong financial incentive to engage in excessive care.”

Later in his column, Krugman returns to characterizing doctors as having higher standards than the average professional and being heroic.  I think Krugman is guilty of depicting doctors according to whatever furthers his political arguments.  That’s like mixing metaphors when he does it in the same column.

April 21, 2011

Health-care rationing, price controls, and IPAB

This morning, I visited my orthopedic doctor to receive the first of five weekly injections of hyalgan that are intended to improve my arthritic knee.  I’ve tried glucosamine chondroitin, but the functioning of my knee continues to deteriorate. 

After receiving the injection, I stopped at HEB to buy some groceries and noticed an 80-year-old guy slowly walking to the store.  Although I feel slight discomfort in my arthritic knee when I walk, I can still move at a normal pace and thus walked by the old guy like he was standing still. 

The old guy reminded me of the limited functionality that will be afflicting me in a few years.  My conservative 62-year-old friend Kevin has an arthritic knee a little worse than mine, and he is considering a knee replacement.  His doctor has warned him, though, to make the decision in the next couple years while he still has USAA’s health insurance for retirees because his ability to have the surgery done under Medicare after he become 65-years old is not assured.

I thought Kevin’s doctor might be “crying wolf,” but an article in the NY Times yesterday reported that the Obama administration is attempting the expand the power of the 15-member Independent Payment Advisory Board (IPAB), which was created by ObamaCare to reduce the rate of growth in the cost of Medicare. 

IPAB replaces the current Medicare Payment Advisory Commission (MedPAC), which makes recommendations (often regarding reimbursement rates) that Congress is free to accept, but usually ignores.  By contrast, IPAB recommendations will automatically become effective unless Congress overrules the recommendations. 

Currently, IPAB is specifically prohibited from making any recommendation to ration health care, and although President Obama didn’t mention what additional powers he wanted for IPAB, Republicans and some Democrats have decided not only against expanding the powers of IPAB, but in favor of eliminating IPAB.  They claim that IPAB “would usurp Congressional spending power over one of the government’s most important and expensive social programs.”

GOP budget guru Paul Ryan led the way by demagoguing the issue, calling it “a rationing board” and declaring that the board would “impose more price controls and more limitations on providers, which will end up cutting services to seniors.”  Texas Senator John Cornyn more accurately said the president’s proposal “punts difficult decisions on health spending to an unelected, unaccountable board of bureaucrats.”

But the Republicans are not acting alone.  Three prominent Democrats have weighed-in:

  • Representative Allyson Y. Schwartz, a Pennsylvania Democrat prominent on health care issues, said: “It’s our constitutional duty, as members of Congress, to take responsibility for Medicare and not turn decisions over to a board. Abdicating this responsibility, whether to insurance companies or to an unelected commission, undermines our ability to represent our constituents, including seniors and the disabled.”
  • Representative Pete Stark, a California Democrat on the Way & Means Subcommittee on Health, said: “Why have legislators?” He suggested that expanding the power of the board could be as bad as giving vouchers to Medicare beneficiaries to buy private insurance. “In theory at least, you could set the vouchers at an adequate level.  But, in its effort to limit the growth of Medicare spending, the board is likely to set inadequate payment rates for health care providers, which could endanger patient care.”
  • Nevada Representative Shelley Berkley said she wanted to repeal the Medicare board. “I have great faith that this administration can put together a strong, independent and knowledgeable board,”  but she said she had less confidence in future administrations.

Despite Paul Ryan’s protestations about rationing, the main concern, as noted by Representative Stark,  is that the Board will reduce the reimbursement rates to medical providers to unacceptable levels.  Although that would not be rationing, it would be a typical liberal response that does nothing to solve the underlying problem of risings costs.  Price controls don’t work.

The other concern, as articulated by Senator Cornyn, is that IPAB implies that, because our elected officials are incapable of making tough decisions, Americans are better served by having those decisions made by an unelected bureaucracy appointed by the president.  That may be President Obama’s vision of a new and improved America, but it isn’t mine.  To paraphrase Wm. F. Buckley, I would would rather be governed by the first 500 names in the San Antonio phone book than by 500 wise men selected by Barack Obama.

Sunday Book Review #29 – The Roots of Obama’s Rage

You may think that it’s a bit early for a Sunday Book Review, but earlier today the NY Times published one of its reviews, so I decided that if it was timely for the Times, it would be timely for me.   

The Times book review was actually an abridgement of A Singular Woman: The Untold Story of Barack Obama’s Mother by Janny Scott.  The abridgement was fascinating, especially because I was just finishing Dinesh D’Souza’s The Roots of Obama’s Rage.

The contrast between the two books is dramatic.  Whereas Janny Scott sees Obama’s mother, Stanley Ann Dunham, as the defining person in his life, Dinesh D’Souza suggests that Obama’s absentee father, Barack Obama, Sr., was the driving force that caused Obama to be who he is today.

Obviously, the seed for D’Souza’s thesis comes from the title of Obama’s first book, Dreams from My Father, which was written shortly after Obama graduated from law school.  Janny Scott tries to downplay the title by noting that Obama in the Preface to a later edition of the book said:

  • “I think sometimes that had I known she would not survive her illness, I might have written a different book – less a meditation on the absent parent, more a celebration of the one who was the single constant in my life.”

Those are beautiful words, but they were written in 2004 at a time when Obama may have decided that his fascination with an African father who deserted him and his mom did not show good judgment. 

D’Souza’s book is credible.  Unlike many conservatives who merely string together dozens of quotes from Obama that can be twisted to suggest all sorts of outrageous things, D’Souza sparingly relies on quotes only after providing context and often gives Obama the benefit of a doubt.

According to D’Souza, Dunham thought Obama’s father was a great man who would do great things.  Although he failed to do great things, at least he tried.  By way of contrast, Dunham thought her Indonesian second husband was co-opted by the Establishment after he left college in Hawaii and returned to Indonesia.  Not surprisingly, she thought her African son Barack was brilliant and destined for great things, whereas her Indonesian daughter was not so much.  As Barack himself admitted, Dunham thought he could be a combination of Albert Einstein, Franklin Roosevelt, Jackie Robinson, and Harry Belafonte.  And she never stopped defending her first husband, even when she was on her deathbed, “During the writing of this book [Dreams of My Father], she would read the drafts, correcting stories that I had misunderstood, careful not to comment on my characterizations of her, but quick to explain or defend the less flattering aspects of my father’s character.

I’m not sure what good aspects of his father’s character were.  Yes, he was brilliant and charming, but clearly irresponsible.  He had a wife and children in Kenya whom he abandoned to move to Hawaii, and then he had a wife and child in Hawaii whom he abandoned to move to Massachusetts.  When his political career in Kenya failed, he turned into an unemployed drunk who killed a person in a car accident, then lost his legs in another car accident, and finally lost his life in a third car accident.

The aspect of his father’s character that attracted both Barack and his mom was his belief in freeing Kenya from the bonds of colonialism.  Kenya had been a British colony until elections in 1957 that culminated in the Republic of Kenya in 1964, but even with its freedom, countries like Kenya were arguably exploited by its former colonizers – so-called neo-colonialism.

That is essentially the thesis of D’Souza’s book – i.e., that Obama’s father wanted to stop the developed world from taking advantage of Third World countries, and that world view, adopted by Obama, helps to explain why Obama takes the actions that he does.

Although it may seem a stretch to believe that a son would idolize a man who deserted him and his mother, who failed in politics, and then became an unemployed drunk, D’Souza does a credible job of persuading the reader.  Not only does Dunham help create a mythological father, but then the father makes a one-time appearance in Hawaii when Obama was ten-years old and captivates the son before disappearing again to Africa.

So in D’Souza’s eyes, Obama hates not only the colonizing countries that exploit the disenfranchised, but also their instruments of exploitation – i.e., multinational corporations.  Although most Americans don’t think of America as a colonizing country, Third World countries think America and its multinationals are the worst transgressors. 

It’s not that Obama is a Manchurian candidate who wants to weaken America, but he wants America to be less dominant in world affairs.  D’Souza is concerned that this philosophy or world view will lead to a weakened America. 

P.S., a couple of weeks ago, I tried to read Dreams from My Father, but found it boring.  Now I’m ready to give it another try.  I have already read and blogged about The Audacity of Hope.    The following is my discussion of Chapter Eight, which seems remarkably consistent with D’Souza’s view of Obama as a hater of colonizers:

Chapter Eight is titled, “The World Beyond our Borders.”  This chapter consists of Obama’s description of America’s foreign policy since the days of Washington.  Not surprisingly, he took a shot at manifest destiny – “the conviction that such expansion was preordained, part of God’s plan to extend what Andrew Jackson called ‘the area of freedom’ across the continent.  Of course, manifest destiny also meant bloody and violent conquest – of Native American tribes forcibly removed from their lands and of the Mexican army defending its territory.  It was a conquest that, like slavery, contradicted America’s founding principles and tended to be justified in explicitly racists terms, a conquest that American mythology has always had difficulty fully absorbing but that other countries recognized for what it was – an exercise in raw power.”

I don’t know where Obama learned his American history, but it sounds like he learned it in Indonesia or while being home-schooled by his mom.  Texians earned their independence by defeating an invading army from Mexico.  Several years later, Texas sought and achieved annexation by the United States, and this annexation caused a war with Mexico over a boundary dispute.  In no way was this a “bloody and violent conquest… of the Mexican army defending its territory.”  And in no way is manifest destiny a racist evil comparable to slavery.  The frontier was waiting to be developed, and Native America and Mexico were not up to the task.

Regarding America’s current foreign policy, Obama reasonably argues against isolationism and in favor of our unilateral right to defend ourself (such as going after Al Qaeda and the Taliban).  But:

  • “Once we get beyond matters of self-defense, though, I’m convinced that it will almost always be in our strategic interest to act multilaterally rather than unilaterally when we use force around the world.”
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