Sunday, August 30, 2009

W00t!, or, Sanity Prevails

United States v. Lori Drew has been dismissed for vagueness. I feel like I need a pennant that says "Go Judge Wu!" or something.

Sunday, August 23, 2009

MDs Are People Too

Reading this morning's post on tort reform at Pandagon makes me want to pull out my hair. Specifically:

When you enact a system of “tort reform” that puts the people making medical mistakes in the position of not even needing to insure themselves because it would cost too much to hold them responsible, you’re increasing the cost of health care for patients.

Let me be blunt: I'd like everyone to have equal access to the legal system, but funding such access via arbitrarily large medical malpractice judgments is contrary to basic notions of justice.

Since the crowd at Pandagon seems to value personal narrative let me couch the argument in those terms. My wife is an MD in a community ER. She is not an insurance company, she is not an HMO, she is not some hot-shot plastic surgeon tooling around in her Mercedes. She frequently provides medical care to the underserved in the community who do not, for one reason or another, have a primary care physician.

Why should she be subject to arbitrarily large "pain and suffering" verdicts? Such a system simply doesn't conform to any notion of fairness. Levying a fine which, by design, bears no relation to actual damages incurred runs afoul of the principle of proportionality. That it's for a good cause makes no difference; there is no moral calculus that allows you to violate one person's rights in the service of another.

From a more practical standpoint I'd also like to point out that uncapped, non-economic damages increase costs by encouraging the practice of defensive medicine. My wife and her fellow ED physicians routinely order more medical care than is strictly necessary, a practice which is a byproduct of the current system of uncapped damages. It doesn't matter that "jackpot verdicts" are relatively rare; the fact that they happen at all is enough to encourage the behavior. There's no incentive for physicians to be cost conscious and hell to pay if they let a condition slip through undetected; as (usually) rational actors they're going to order as many tests and procedures as necessary to sufficiently cover their asses.

False Equivalence As A Framing Strategy

I'd like to propose a new truth-in-labeling law for editorials: if you call an article "A Grand Bargain Over Evolution" it must actually describe a grand bargain. I'm tired of wasting valuable Sunday morning newspaper time on the journalistic equivalent of Diet Coke.

In his opening paragraph Robert Wright lays out what seems, at first glance, to be an interesting if controversial compromise:

I bring good news! These two warring groups have more in common than they realize. And, no, it isn’t just that they’re both wrong. It’s that they’re wrong for the same reason. Oddly, an underestimation of natural selection’s creative power clouds the vision not just of the intensely religious but also of the militantly atheistic.

If both groups were to truly accept that power, the landscape might look different. Believers could scale back their conception of God’s role in creation, and atheists could accept that some notions of "higher purpose" are compatible with scientific materialism. And the two might learn to get along.

That would be a grand bargain indeed; believers will be loath to give up on god and atheists are, in the very least, going to be highly skeptical about any notions of "higher purpose". So let's see where he's going to take this argument, shall we?

There follows discussion of reciprocal altruism and how it can plausibly have lead to the development of a moral sense. Mr. Wright seems to be of the opinion that the religious side of the argument doesn't have much of a leg to stand on these days from an empiric standpoint. He wants them to develop a more modern theology which is compatible with the current state-of-the-art in evolutionary theory:

The first step toward this more modern theology is for them to bite the bullet and accept that God did his work remotely - that his role in the creative process ended when he unleashed the algorithm of natural selection (whether by dropping it into the primordial ooze or writing its eventual emergence into the initial conditions of the universe or whatever).

This is the classic characterization of god as the "divine watchmaker"; a comparison which Mr. Wright makes explicitly a little further down the road. Someone who wasn't interested in writing an apology for religion might stop at this point and highlight that a divine watchmaker is hardly different from no god at all. We don't need em to explain anything, so why bother invoking em in the first place? But maybe Mr. Wright isn't interested in digging into the religious set just yet; he's setting them up for a bargain with the nasty, agressive atheists so there's no sense in unnecessarily undermining their position, right?

Then there's some more discussion about how the moral sense captures a fundamental reality that's "out there". While this is true it's not as portentious as Mr. Wright and Steven Pinker make it out to be:

As Mr. Pinker once put it in conversation with me: "There may be a sense in which some moral statements aren’t just ... artifacts of a particular brain wiring but are part of the reality of the universe, even if you can’t touch them and weigh them." Comparing these moral truths to mathematical truths, he said that perhaps "they’re really true independent of our existence. I mean, they’re out there and in some sense - it’s very difficult to grasp - but we discover them, we don’t hallucinate them."

Sure... there are universal patterns which transcend humanity's apprehension thereof. If I give you 1 widget and you give me 1 widget and, through the synergy of a particular set of environmental/behavioral/social factors we both end up with 1.5 widgets (essentially an example of the reciprocal altruism mentioned above), we're both better off in the long run. This is true whether we're humans or chimpanzees or horrendous cephalopods from beyond space and time. The point that both Wright and Pinker seem to be missing is that there's nothing particularly mysterious or "spiritual" about this; the existence of such a universal pattern can be easily explained through a fairly transparent chain of cause and effect. The fact that humans call such behaviors "altruistic" and ascribe to them particular virtue is the only contingent part of the equation; the aforementioned cephalopods might label such behaviors a vice, but that doesn't change their efficacy as a survival mechanism.

Anyway, Mr. Wright summarizes his pitch to the religious among us as follows:

But the point is just that these speculations are compatible with the standard scientific theory of human creation. If believers accepted them, that would, among other things, end any conflict between religion and the teaching of evolutionary biology. And theology would have done what it’s done before: evolve - adapt its conception of God to advancing knowledge and to sheer logic.

Wright wants them to give up any notion they may have of a personal and interventionist deity; I don't know that he's going to get many takers for that. Maybe he should throw in a set of steak knives too.

But in this grand bargain its also necessary for the atheists to give up something. They have to acknowledge that:

...any god whose creative role ends with the beginning of natural selection is, strictly speaking, logically compatible with Darwinism. (Darwin himself, though not a believer, said as much.) And they might even grant that natural selection’s intrinsic creative power - something they’ve been known to stress in other contexts - adds at least an iota of plausibility to this remotely creative god.

And, god-talk aside, these atheist biologists could try to appreciate something they still seem not to get: talk of "higher purpose" is not just compatible with science, but engrained in it.

Wright is going to find a mixed reception for those propositions. Sure, the conception of god which he's pushing is logically compatible with Darwinism, but that's because he's completely removed god from the material sphere. As I noted above, if you've a god which leaves no fingerprints anywhere why both invoking em in the first place? But the talk about "intrinsic creative power" and "higher purpose" is going to be a tough sell...

... If you use those words as they are typically understood. After his initial brave fuisillade he engages in some slight of hand:

As Mr. Dawkins pointed out, we can now explain the origin of organisms without positing a god. Yet Mr. Dawkins also conceded something to Paley that gets too little attention: The complex functionality of an organism does demand a special kind of explanation.

The reason is that, unlike a rock, an organism has things that look as if they were designed to do something. Digestive tracts seem to exist in order to digest food. The heart seems to exist in order to pump blood.

And, actually, even once you accept that natural selection, not God, is the "designer" - the blind watchmaker, as Mr. Dawkins put it - there is a sense in which these organs do have purposes, purposes that serve the organism’s larger purpose of surviving and spreading its genes. As Daniel Dennett, the Darwinian (and atheist) philosopher, has put it, an organism’s evolutionarily infused purpose is "as real as purpose could ever be."

SO in a sense Paley was right not just in saying that organisms must come from a different creative process than rocks but also in saying that this creative process imparts a purpose (however mundane) to organisms.

<sigh>... that's it? That's your great reveal? Fine... sure... if you want to redefine "higher purpose" as "successfully propagating the species" you'll get no objection from anyone in the atheist camp. The central tenant of natural selection is "survival of the fittest"... it's totally uncontroversial to claim that natural selection would lead to organs which are "designed" to "serve the organism’s larger purpose of surviving and spreading its genes".

So, in summary, here's the meat of the bargain: Religious folk... your god doesn't get to do anything that we can actually observe, but you're welcome to continue to claim that ey exists. Atheists... carry on.

Which, of course, leads to the meta-question of "Why did he bother?". If you look up his bio1 at the New American Foundation you find out that

His most recent book, The Evolution of God, touches on a number of contemporary issues, including how to foster interfaith tolerance amid globalization. Mr. Wright is now focusing on how to shape a foreign policy that reckons with such trends, paying particular attention to issues of global governance.

Right... ok... so that makes a lot of sense. Mr. Wright's schtick is getting people of different faiths to rub along nicely together. No one likes being told that their wrong; it gets their back up and makes them less likely to compromise. So, by going through this elaborate bit of wordplay and making it look like both sides have to give up something, he hopes to increase the likelyhood that the religious bits of the audience will be receptive to his message. Which is, of course, one of the big bones of contention in current discussions about how atheists should convey their position. I take it that Mr. Wright is squarely in the "sit down and shut up" camp; we should accommodate peoples' religious quirks and work quietly to try to mitigate the worst of the accompanying irrationality.

So I don't know, you tell me. Is the cause furthered by writing elaborate opinion pieces which need to disguise their fundamental point?

1 Which, incidentally, doesn't give me much cause to trust his opinion. His alleged areas of expertise are " Civil Liberties, Europe, Foreign Policy, National Security, Religion, Telecom & Technology, Terrorism, Trade & Globalization". If I saw that list on someone's resume that'd be a sign to toss it in the round file. Gee Mr. Wright, that's an awfully big portfolio... you must be a genius or something. Either than, or you've cleverly redefined "expert" as "someone who can spout soundbites".

Saturday, August 15, 2009

Wherein I Speculate About Universal Health Care

I'm surprised at how vigorously people are tearing into John Mackey's recent op-ed about healthcare reform. The dude's not a Rhodes scholar, granted, but in the grand scheme of things he's not spouting complete nonsense either. I mean really, c'mon:

Mackey’s op-ed bills itself as “The Whole Foods Alternative to ObamaCare.” Your first signal of what might be coming, of course, is “ObamaCare,” And your second clue is the immediately following quotation from Ste. Margaret Thatcher:
The problem with socialism is that eventually you run out of other people’s money.
Needless to say, this concern for other people’s money never prompted Ms. Thatcher to renounce the socialism involved in having the taxpayers pay her own salary and give her free lodging at 10 Downing Street. But, of course, all the folks running around saying that all government spending is socialism, or fascism, or Marxism, or evil Kenyan juju, or whatever, really mean only that government spending that they don’t like is socialism.

Thatcher collecting a paycheck for her job as PM has dick to do with socialism; you're abusing the word just as much as he is.

Nevertheless Tintin does finally get down to substantive criticism, as does Jesse over at Pandagon, and their comments provide an interesting jumping-off point for a discussion about what certain aspects of a universal healthcare system might look like. For example, Tintin says

In the event that you’re not paying attention, what Mackey wants is for employers to pay less, and employees to pay more, into the health care system. Seriously.
• Repeal government mandates regarding what insurance companies must cover.
Those of you who were foolishly hoping that MackeyCare would at least prohibit insurance companies from declining care for pre-existing conditions are a bit disappointed now, aren’t you? So not only does Mackey want employers to pay less and employees to pay more, he wants the insurance companies to be able to provide less.

Similarly, Jesse has the following to say

This seems like a great, common sense reform. High deductible health insurance with a significant contribution towards the deductible. I mean, if you ignore the fact that high deductible insurance often doesn’t cover common conditions like pregnancy, have incredibly strict in-network requirements, high coinsurance rates even after deductibles are paid which far outstrip an $1800-a-year contribution, place strict limits on the allowable prices for common procedures and are tied to hour-per-week work requirements that it’s incredibly easy for companies to work around, it’s pretty much like perfect.

Both Tintin and Jesse seem to want expansive coverage of a variety of conditions under universal healthcare, but presumably "expansive" is not equal to "unlimited". If Jesse and Tintin accept that there must be some boundary to what's covered then the question I have for them is "How do you decide what's in and what's out?". I read through Jesse's recent posts on health care1 and couldn't come up with any relevant statement of principles in this area; the entirety of what ey's written recently calls for expanding existing coverage. Which is a problem since one of the legitimate issues which divides and defines opinion on this subject is deciding how much money we're going to spend on it.

Progressives want to expand coverage for everyone, which is a noble sentiment to be sure, but I can't help but feel that this desire rests on a shaky foundation. At some point you either have to say "no" to some particular request or you end up spending a metric fuckton (perhaps, even, an unsustainable fuckton) of money. Progressives aren't, as a general rule, good at saying "no", in part because they lack a coherent ethical/philosphical position which allows them to do so. Consider, for example:

Care near the end of life consumes a disproportionate share of costs and is a logical target for efforts to promote value in health care.

How do Tintin and Jesse propose tackling that? Do they envision a healthcare system that keeps people hooked up to ventilators indefinitely, or do they acknowledge that, at some point, the costs outweight the benefits?

This isn't just idle speculation; Jesse acknowledges as much in another post on the subject:

The debate over the “rationing” of healthcare has come down to two sides: conservatives who reflexively hate government and so live in fear of some government bureaucrat rationing off healthcare, and those of us who realize that healthcare is already effectively rationed off by insurance companies. There’s no way to have healthcare without it being rationed in some way, because it’s a finite good that dispensed by people who know a hell of a lot more about what works and what doesn’t than most of the people seeking it.

If rationing is inevitable under a government plan then who makes the decisions and how do they do it? The reason why the deathers keep ranting about euthenasia panels is, in part, because they're worried that someone is going to come in and pull the plug on grandma. And that, in turn, is due in part to the inability of progressives to articulate a coherent approach to the inevitable rationing which must occur. So I feel that it's incumbent on people like Jesse and Tintin who are calling for expanded coverage to also address the flipside of that particular coin. Which, unfortunately, no one seems inclined to do.

1 Couldn't find much of anything for Tintin 'cause Sadly, No! lacks a convenient "healthcare" category.

A Reminder

In discussing Israel/Palestine there's a tendency to treat "Palestinians" as a single, monolithic entity. That was never really true to start with, and it's even less true now.

Well That Sucks

Don't know what to say about this other than its a sad state of affairs.

Update: It occurs to me that the individuals and organizations seeking to suppress depictions of Muhammad have effectively won at this point when a place like Yale won't publish them dues to worries about possible violence.

Friday, August 14, 2009

Some Thoughts On 'District 9'

I had the opportunity to see District 9 this morning; I wasn't expecting much apart from your typical sci-fi/action/suspense fare and was pleasantly surprised to find that the movie is far more than things blowing up. There's plenty of that, to be sure, but the CG effects and explosions are just a vehicle for what is fundamentally a thougtful exploration of the challenges that accompany mass immigration.

The premise, briefly, is that about 20 years ago a spaceship arrived in Johannesburg carrying a million-plus aliens. That's not a terribly original concept at its core; when I first saw the trailer with a big ship hovering over a major city I thought that someone was remaking Alien Nation. There's never any mention of why the ship is there which, while it's a substantial ommission, doesn't really damage the plot, which centers around the efforts to relocate the aliens from District 9 to an area some distance away because the slum that District 9 had become is causing problems and raising the ire of the surrounding human populace. What follows is a farce/tragedy about petty bureaucracy, megalomaniacal, multi-national corporations, the power structure, and the problems that arise when vastly different cultures have to rub along in close proximity. I won't go into the details other than to say that the movie captures the tone of contemporary discussion well. At one point someone says something to the effect that they're trying to acommodate the aliens, but they're not even human; that line in particular was spot on. It's the sort of point bandied about right now when people talk about accommodating large immigrant populations: "We want to help, but they're not even ___"... fill in the blank as you see fit.

So yeah, awesome movie. But they've totally messed up the marketing; the associated commercials/trailers totally fail to capture any of the social commentary. There are a lot of people who would probably really enjoy it who are never going to see it because it looks like just another alien flick. There's also one glaring plot hole: the aliens have all these awesome weapons that only they can use. The premise of the movie is that District 9 has become an unstable, dangerous, crime-infested slum, but for all the inter-species violence which is depicted none of it involves these alien super-weapons until the very end. That doesn't quite make sense.

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