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Why Republicans failed

July 28, 2017

Ramesh Ponnuru wrote an article a couple of weeks past on Republican struggles, that now seems almost prescient:

The health-care bill is hated by many and loved by almost no one, in part because it does not reflect any coherent understanding of what our health policy should be. That may be the kind of legislation one should expect when neither the Congress nor the president has thought through a policy agenda. The health debate has shown that moderate Republicans, especially, never worked out the implications of the party’s loud opposition to Obamacare, which they joined with gusto. If they had, they might have realized that it was impossible to repeal Obamacare while also refusing to modify in any way its protections for people with preexisting conditions.

In short, the Republican politicians are believing their party’s own propaganda mills. And those lies weaken them.

The Democratic caucus in the US Senate deserves accolades for standing united without a single defection against Trumpcare. The Republican moderate senators Collins and Murkowski deserve special recognition, for refusing both McConnell’s bribes and Trump’s threats. And McCain, in the end, couldn’t bring himself to vote for a piece of crap just to pass anything that counted as Obamacare repeal.

Short white elephants

July 27, 2017

Even if you don’t like Hemingway — maybe especially if you don’t — you might enjoy this curt satire of one of his stories, from the woman’s viewpoint.

The use of CRISPR to edit human embryo DNA is just the start of a new wave of biotechnology. It will have large implications for healthcare. And part of that will be upending reproductive choices. Expect lots of froth and spittle from the usual religious mouths.

Surgery is a great placebo

July 26, 2017

Many surgeries have obvious result, such as removing a ruptured spleen. That’s not at all elective. But what about surgery on a joint, for long-term pain relief? How can anyone know that it actually works? The acid test is a blind study: divide patients into two groups, do the surgery on one, and do a sham surgery on the other. In three-quarters of such studies on elective surgeries, the actual surgery works no better than sham surgery. Which isn’t to say it doesn’t work at all:

There’s something powerful about believing that you’re having surgery and that it will fix what ails you. Green hypothesizes that a surgery’s placebo effect is proportional to the elaborateness of the rituals surrounding it, the surgeon’s expressed confidence and enthusiasm for the procedure, and a patient’s belief that it will help.

Without the studies, surgeons would have as much reason to believe the surgeries are working as their patients do:

Surgeons who perform only real surgeries never see the benefits of sham procedures and so may falsely attribute their patients’ success to the surgery without recognizing that regression to the mean and the placebo effect might also contribute.

Political norms

July 25, 2017

Democracy is not and cannot be sustained merely by the words in the Constitution and the laws. There is tradition and understanding behind those words. By tradition, a US President doesn’t use military speeches to rally the troops to his political side. That violates the norm that as commander in chief, he acts for the US, not his political party. So, what happened at the commissioning of the USS Gerald R. Ford was at least a breech in protocol.

By tradition, presidents also do not politicize speeches to youth. There are a variety of reasons for that. In theory, both parties are working for future generations. The young are easily led into political fervor, and the history of that is not a good one. Ah, well, another breech, in a speech to the Boy Scouts.

The Justice Department, and especially a Special Counselor, is supposed to act independently, and presidents are expected to respect that, not draw “red lines” they may not cross. Are such threats merely more breeches in protocol? Or as Jonathan Chait writes, portent of something worse?

Perhaps Il Donald’s use of words is less Machiavellian than it is ignorance and awkwardness. This Joy Reid segment (youtube) makes the case for that, worth watching for Ron Perlman’s parody alone. Somehow, I am not much comforted.

Russia, the media, and lies

July 24, 2017

Matt Taibbi reminds us of some recent history that makes Russia-US relations look a bit different from their side. Russia’s home media can make Alex Jones seem near normal.

Of course, it’s now normal in the US for the president to tweet a lie that Fox and Friends spread the day before. The Leader reinforcing his propaganda channel.

Cash and its absence

July 21, 2017

Visa is offering small businesses cash incentives to go cashless. For both businesses and individuals, there is a complexity in having to manage both cash and digital payment systems. Needless to say, Visa wants there to be only one. There is a political as well as business effort toward cashless societies. India has eliminated its larger denomination notes. Not without significant resistance and pain.

The problem with cashless transactions is that they require some financial intermediaries who want a cut. Except from those of us with good credit scores, who get a rebate. The card companies years back realized they could make quite a bit of money from prepaid debit cards (2012 article) needed by those who don’t have credit or bank services, to pay merchants who don’t take cash. And for the poorest? The homeless? I guess we’ll just outlaw them.

Fraud and theft

July 20, 2017

With everyone’s attention on healthcare, the Trump administration has rapidly moved forward in other areas. First, it has opened the federal purse to bogus for-profit colleges. These especially target young veterans, and saddle them with debt. Trump, of course, created his own scam college and recently settled a fraud suit stemming from that. Second, Jeff Sessions has eased the rules and is pushing the states to do more civil asset forfeiture.