Archives: 08/2007

Romney's New Rx

我有一篇关于米特罗姆尼新的医疗保健计划的文章。简短版(192字)here.  Long version (745 words)here.

一个有趣的方面,我在专栏中没有提到:之后批评鲁迪·朱利安尼依靠减税让更多的美国人负担得起医疗保险,罗姆尼建议这样做。

这将是一场有趣的运动。

话题:
一般,请,请 Health Care,请,请 税收和预算政策

America's Longest War

In the current issue of外交政策magazine,伊桑·纳德尔曼,head of the Drug Policy Alliance,has a brisk,强烈要求毒品合法化的文章。不幸的是,它是subscriber-only,请但这里有一个更具煽动性的段落:

Looking to the United States as a role model for drug control is like looking to apartheid-era South Africa for how to deal with race.美国的人均监禁人数居世界第一,不到世界人口的5%,but almost 25 percent of the world's prisoners.被关押在美国的人数drug-law violations has increased from roughly 50,000 in 1980 to almost 500,000今天…In 2005,the ayatollah in charge of Iran's Ministry of Justice issued afatwadeclaring methadone maintainance and syringe-exchange programs compatible withsharia法律。人们只希望他的美国同行也同样开明。

几周前,theWashington Post'sOutlook section featured an indictment of drug prohibition written by Misha Glenny:他说:“这是一个很好的选择。”战争失败了。”他说:“这是一个很好的选择。”Glenny concludes with the following:

In Washington,the war on drugs has been a third-rail issue since its inauguration.It's obvious why – telling people that their kids can do drugs is the kiss of death at the ballot box.但那是在911之前。Now the drug war is undermining Western security throughout the world.In one particularly revealing conversation,英国外交部的一位高级官员告诉我,他说:“这是一个很好的选择。”我常常认为,我们会回顾一百年后的禁毒战争,讲述“皇帝的新衣服”的故事,这太愚蠢了。他说:“这是一个很好的选择。”

他是多么正确。

对于卡托在这个问题上30年的工作,starthere.

奖金星期五乐趣链接:转到第4页,共页这份文件[.pdf] to read about how Richard Nixon's Archie-Bunker-style social theories led him to ramp up the war on marijuana.

话题:

Some Bad Ideas That Won't Help Solve the Organ Shortage

In他说:“这是一个很好的选择。”The Solvable Problem of Organ Shortages"他说:“这是一个很好的选择。”[New York Times,请8/28/07],Jane Brody makes suggestions which,如果实施,will rob Americans of fundamental rights and do nothing to solve the organ shortage.她的建议甚至可能使问题更严重。

器官短缺只能通过增加not decreasing,控制者控制着他们的器官。只是自由的增加,不是限制自由,has any chance of solving the organ shortage.New and innovative ways to motivate individuals to donate,包括对死者和活体器官捐赠的赔偿选择,我们需要的是,未经人们同意,不接受器官移植的新方法。

One option Brody discusses is donation after cardiac arrest.There is nothing wrong,in principle,with retrieving organs after cardiac arrest,but what defines death and when to give up on a patient are not decisions that should be motivated by a need for organs.It is never appropriate for a doctor to alter how he treats one patient in order to provide an organ to save another patient.就在上个月,a San Francisco transplant surgeon was charged with three felonies for allegedly hastening the death of a patient in an attempt to harvest his organs.

A policy of donation after cardiac arrest will drastically erode an already waning trust in the medical profession.这样的政策很可能导致对一般医疗行业和器官捐赠的强烈反对。People will see such a policy as encouraging doctors to give up on patients when in fact there might still be some hope of improving their condition,just in order to harvest their organs.The net result will be a decrease,not an increase,in organs available for transplant.

布罗迪讨论的另一个主要选择是假定同意。推定的同意根本不是同意,除非一个人足够了解政府预先确定的反对方法,否则它是不经请求就采取机关。

Brody writes:"在欧洲,where you are considered a potential donor unless you expressly declare[s] that you do not want to be one,90%以上的人是器官捐赠者。”美国人,unlike Europeans,will not give up their right to self-determination so easily.There will be an outcry both on religious grounds and from those who believe in patient autonomy.Americans will demand to be asked,更不用说这样的法律是否符合宪法了。

现在这些建议,对人类尊严的极大侮辱,could perhaps have some utilitarian appeal if they had the slightest chance of solving the organ shortage,正如布罗迪的书名所暗示的。Donation after cardiac arrest and presumed consent,即使同时实施,没有预测到的反冲,对于解决器官短缺几乎无能为力。

如果每个美国人都是器官捐赠者,the U.S.implemented universal organ harvesting after cardiac arrest,采用欧式假定同意,there would still be people dying on the transplant list waiting for organs that never come.This would be so because of the simple fact that not enough Americans die each year under conditions that make harvesting their organs for transplantation feasible.Estimates very greatly,but there is no doubt that even if every death that could possibly result in a donation resulted in the maximum number of harvestable organs,我们仍然没有足够的器官供每个需要的人使用。

真正的解决办法是找到新的方法来要求和激励美国人捐款,不得早于自己的意愿取下器官和/或不经请求而取下器官。第一,废除1984年《国家器官移植法》,禁止对人体器官进行补偿,and be creative in putting together incentive packages to encourage people to donate.为他们提供终身健康保险,医疗储蓄账户的种子资金,长期护理保险,scholarship money to send their kids to college,这些或任何其他创造性方式的组合,以鼓励人们捐赠。Along with these incentives,应该努力增加人们对他们的医疗保健专业人员的信任,向美国人保证他们将永远被要求——而且他们的器官在没有他们的同意的情况下永远不会被拿走!你说什么?

此外,必须努力确保知情同意是一种切实有效的工具,以确保人们知道他们同意什么,他们是否同意在死亡时捐献器官,或捐献活体肾脏或肝脏(目前可以相对安全地进行的两种活体捐献)。

Only if these measures are taken to increase options,不限制他们,is there any chance that the organ shortage can be solved.Hopefully,unlike this week's article,布罗迪的活体器官捐赠专栏,promised for next week,将提供一些更现实和自由友好的解决方案。

话题:
一般,请,请 Health Care

Stossel Critiques Commonwealth Fund 188金宝搏反恐精英Study

John Stossel has a goodcolumnon a recent Commonwealth Fund188金宝搏反恐精英comparing the U.S.health care system to those in Australia,加拿大Germany,New Zealand and Great Britain.  That 188金宝搏反恐精英study reports,他说:“这是一个很好的选择。”尽管拥有世界上最昂贵的卫生系统,美国在表现的大部分方面都表现不佳,relative to other countries."他说:“这是一个很好的选择。”

But Stossel observes that the United States does well in some measures while other measures are practically stacked against us:

The proportion of patients who say they got infected at a hospital counts about the same in the"quality"以医生使用自动化计算机系统提醒他们告诉病人他们的测试结果的比例来衡量。Those things aren't equal in my book.

这项研究188金宝搏反恐精英的作者还认为,与等待四个月或更长时间接受手术的患者相比,拥有较高的管理成本和在医疗保健上支出占GDP的最大份额更糟糕。This seems designed to make the U.S.看起来很糟糕。

最后,这项研究188金宝搏反恐精英惩罚了那些花费超过1美元的病人。从口袋里拿出1000个医疗保险,as if third-party payment is somehow superior.

斯托塞尔对未投保人提出了一个不准确的要求。他说:“这是一个很好的选择。”同样的人不是年复一年没有保险的。”That's mostly true.  The estimate that there are 47 million uninsured Americans includes a lot of people who are temporarily uninsured and will regain coverage even if we do nothing.

但是很多人年复一年都没有保险。9 million26.4 millionAmericans are long-term uninsured (i.e.,have spells without coverage that last more than two years).

That doesn't mean those chronically uninsured people aren't eligible for government programs.很多是也不意味着他们买不起健康保险。Many can.  But they do exist,and we should be scrapping the government regulations and subsidies that make coverage and care unnecessarily expensive for them.

话题:
一般,请,请 Health Care

理查德·朱厄尔,安息

There were scores of federal agents working at the 1996 Summer Olympics,但那是个私人保安Richard Jewell他发现可疑的背包里装满了炸药,并发出了警报——挽救了无数人的生命和受伤。为了他的善行,Jewell found himself in the crosshairs of a desperate FBI investigation.  Federal agents leaked his name to media outlets and Jewell was smeared as a killer who only wanted topose作为一个英雄。当实际证据指向其他人时,联邦调查局不得不支持,but a lot of damage had already been done.  The life that Jewell had been hoping for was gone.  People treated him as if he had the plague.  Sadly,,请Jewell died yesterday他只有44岁。

“珠宝案”提醒人们,政府有权对人民的生活造成严重损害,即使在法庭上没有定罪,即使没有起诉书。

Note that Cato will be hosting杜克大学学生座谈会who got smeared in another investigation that went awry.

还要注意对弗兰克·夸特隆的指控被驳回。起诉书是一篇第一页的故事,但解雇是在D部分,第2页.

Krugman on Education,Health Care

几天前,,请New York Timescolumnist Paul Krugmandrew政府为儿童提供教育和医疗服务的等效性:

We offer free education,and don't worry about middle-class families getting benefits they don't need,because that's the only way to ensure that every child gets an education — and giving every child a fair chance is the American way.And we should guarantee health care to every child,for the same reason.

如果政府真的保证每个孩子都受到教育,他的论点将更有说服力。

有一次,我和一群保健大人物一起参加了一个晚餐讨论会。一个受过高等教育的女人——她都是医学博士。和A J.D.–晚餐开始时宣布,他说:“这是一个很好的选择。”我们需要在这个国家使医疗保健成为一项权利,就像我们使教育成为一种权利一样。”他说:“这是一个很好的选择。”

晚餐晚些时候,she complained that her organization's materials must be written at an 8th-grade level to be understood by their target audience.

I interrupted to ask how she reconciled those two statements: if we really have created a right to education,why the poor reading comprehension?如果我们创造一个类似的医疗保健权,有多少人的医疗服务将停留在八年级?Her answer was non-responsive.

如果克鲁格曼和其他人至少承认这一点,那就太好了。

话题:
教育和儿童政策,请,请 一般,请,请 Health Care,请,请 税收和预算政策

No,a Disco Ball

In aninterview in this morning'sUSA Today,请美国Secretary of Education Margaret Spellings is back to unbridled hyping of the No Child Left Behind Act (NCLB).AShas been her custom,请她的回答充满了毫无根据的言辞,也许最让人无法容忍的是她坚持认为NCLB在公共教育领域的广泛但看不见的失败已经在某种程度上得到了光明的启示。She says,例如,that before NCLB the nation took"the ostrich approach"对我们的学校,but with the law we're at last"在未取得成就的情况下发出明亮的光芒。”他说:“这是一个很好的选择。”

Oh,加油!Americans have known about their awful schools for decades.I mean,大家都认为底特律的一切都很美好吗?纽瓦克华盛顿,直流电,New York,Los Angeles,奥克兰and on and on until,suddenly,NCLB came along and revealed that – gasp!– the schools in those and many other places were actually dangerous,破败的无知地牢?Of course not!并没有A Nation At Risk让美国人对1983年的学校感到困惑?Oh,不是鲁道夫·弗莱希的Why Johnny Can't Read50年代的畅销书?是吗?

那NCLB的聚光灯呢?最多,it's a disco ball – it shines light,but light designed to dazzle much more than illuminate and confuse much more than clarify.So,while NCLB requires all states to bring kids to something called"proficiency"– enabling federal politicians to boast about their steely determination to educate all children – it leaves it to the state and local school officials who's feet are supposedly being held to the fire to define proficiency and write the standards and tests.The result,作为a recent 188金宝搏反恐精英study from Spellings' own department已经显示,has been that state officials and federal education fans have been able to point torising state test scoresto"prove"that NCLB is working,but the state test results themselves have essentially been lies,主叫分数”proficient"that the feds themselves would call"“基本”或“below basic."他说:“这是一个很好的选择。”

那当然是一个古怪的聚光灯!我们现在需要的,especially with reauthorization of NCLB expected to begin when Congress returns from vacation next week,不是为了让我们的学校成为焦点,but on both NCLB and all the damning evidence of Washington's failures throughdecades of federal education policy.Then we'll see that far from offering a solution to our education problems,华盛顿是其中很大一部分。别担心:当我们把华盛顿的聚光灯移开时,我们似乎永远都知道的那些学校里的麻烦几乎肯定还会存在,回到他们身上。