Time Passes On

Hot Air mocks Shinseki's claims to be serious about VA reform now, after five years on the job.

But hey, after six years of 'unexpectedly' slow growth, and endless White House 'pivots' to the economy as its top issue, that same economy is back in contraction. So really, we're right where we should expect to be.

Those of you who are veterans (or have a very high tolerance for salty language and bloody-minded humor) might want to watch the RangerUp video on the VA. (Bonus: the Wicked Witch of Westboro!)



RU says about this today:

When we launched our VA Damn Few episode, some people said it was too harsh. In light of the IG determining that they were, in fact, pretending vets didn't exist, this makes this episode that much better (and worse). Watch it now or the VA will ignore the problem and not even fire the guy that is in charge of this whole mess! (oh wait)

Sometimes it's hard to be too harsh.

Doctors without competition

When you take away the profit motive, you don't get altruism, you get non-monetary self-interested incentives.  Unfortunately, there's no reason to suppose that the alternative incentives lead to improvement in performance.  The point isn't profit or non-profit, it's whether customers have choices.

From a doctor's OpEd in the WSJ today:

In my experience, the best thing that a patient in the VA system could hope for was that the services he needed were unavailable.  When that is the case, the VA outsources their care to doctors in the community, where their problems are promptly addressed.  But these patients still need to return to the VA system for other services and get back on a long waiting list.

The VA vs. the NHS

Will things improve if Obamacare enthusiasts get their wish and parlay the law's spectacular failure into what they wanted from the beginning, which is single-payer?  Charles Cooke describes the future in the form of what the NHS already is in Britain:

Because mistakes in delivering health care are catastrophic for those seeking reelection or trying to push an agenda, politicians in Britain spend the vast majority of their time worrying about perceived rather than actual improvement.  Government, by definition, has no competition, which means that those who staff it can lie and spin and cover up mistakes not just with impunity but with the full force of the state at their back.  Thus do results become less important than statistics, reforms less important than spending, and patients less important than careers.  Dishonesty is widespread.  Per the Telegraph, the British National Audit Office discovered in 2013 that

one in four hospitals is recording false waiting list times, with patients waiting on average three weeks longer than NHS records show.

Patients groups have said the findings were “scandalous,” and that hospital managers had been able to routinely fiddle figures so they could claim to be hitting Government waiting time targets, when patients were enduring far longer waits for care. 

Sound familiar?

Obviously people can lie to their customers whether they're in the private or the public sector.  The problem is enormously more difficult to handle, though, when the customers are stuck with a single provider in a state-protected monopoly.

Texas is the Alamo

Bill Whittle on how the Tea Party thrives in Texas, if nowhere else. Tea Party candidates swept the primary runoffs yesterday.

Legacies

From Andrew Klavan:

Now, we don’t want to dwell on the distant past when Democrats defended slavery against Abe Lincoln and his Republicans… or when they formed the Ku Klux Klan or passed oppressive Jim Crow laws… or when Democrats like Al Gore Sr. or Robert Byrd… or George Wallace or Lester Maddox… or Bill Clinton’s mentor J. William Fulbright… stood as staunch segregationists.

The modern Democratic party is much different. Appalled by the way evil slavemasters once tore black families apart, Democrats fashioned welfare to subsidize unmarried motherhood so that free African Americans could tear their families apart themselves.

Just make the Potemkin village bigger

People stuck in a monopoly (unexpectedly!) find that service is terrible:

So far, the VA affair is running the usual course of Obama administration scandals, with the requisite denial and lack of accountability.  VA Secretary Eric Shinseki has referred to the incidents as “isolated cases” (even though 26 facilities are now under investigation).  No one has been fired.  One of Shinseki’s deputies, Dr. Robert Petzel, resigned, but was scheduled to retire this year anyway.  It was an appropriately Potemkin departure in a scandal involving Potemkin waiting lists. 

The White House has reverted to its default position of maintaining that it doesn’t know much about what’s happening in the vast government it always wants to make bigger.

It's pretty much like the public schools:  until they're credibly threatened with the ability of their customers to go elsewhere and take their funding with them, no amount of money will make them deliver good service, let alone good service at a reasonable cost.

The Gibson Raid

Forbes has an article that claims the Federal raid on Gibson Guitars was in service to a labor union with whom the company was having a dispute. The raid was highly aggressive:

“What is happening?” asks Gibson Guitar CEO Henry Juszkiewicz when he arrives at his Nashville factory to question the officers. “We can’t tell you.” “What are you talking about, you can’t tell me, you can’t just come in and …” “We have a warrant!” Well, lemme see the warrant.” “We can’t show that to you because it’s sealed.”

While 30 men in SWAT attire dispatched from Homeland Security and the U.S. Fish and Wildlife Service cart away about half a million dollars of wood and guitars, seven armed agents interrogate an employee without benefit of a lawyer. The next day Juszkiewicz receives a letter warning that he cannot touch any guitar left in the plant, under threat of being charged with a separate federal offense for each “violation,” punishable by a jail term.

Up until that point Gibson had not received so much as a postcard telling the company it might be doing something wrong.

Why would you seal a warrant in a raid of this kind? There's no national security interest. Citizens should ordinarily have a right to see the warrant, for one thing so they can verify that it is lawfully executed and that the police have a right to do what they are doing. (For another, to make sure the cops are at the right address.)

It also helps you construct a defense. What if the warrant remains sealed as you await trial, so you can't really know just why you are under threat of jail?

In the end, formal charges were never filed, but the disruption to Gibson’s business and the mounting legal fees and threat of imprisonment induced Juszkiewicz to settle for $250,000—with an additional $50,000 “donation” piled on to pay off an environmental activist group....

With no clear legal standards, a sealed warrant the company has not been allowed to see too this day, no formal charges filed, and the threat of a prison term hanging over any executive who does not take “due care” to abide by this absurdly vague law, Gibson settled. “You’re fighting a very well organized political machine in the unions,” Juszkiewicz concluded. “And the conservation guys have sort of gone along.” Hey, what’s not to like about $50,000?"

As the article points out, 95% of cases brought by the Feds never go to trial, because the prosecutors set the charges at such a level that a plea deal is the only rational choice. Fifty grand as a payoff to an environmental group, and you can go home and get back to making guitars. Go to trial, and we'll do our best to put you in prison for decades.

Mourning in the Hall

Today my uncle died, following complications resulting from brain surgery. He was a great man solely because he was a good man, and that is quite an achievement.

When he was young, in East Tennessee, he looked like Elvis at a time when that was desirable. My mother, his younger sister, told me once how she was always popular as a young girl because all the other girls wanted to have a reason to come visit the girl whose brother looked like Elvis.

He married young -- too young for his own mother's liking! A few years ago I attended my cousin's wedding, his granddaughter, and the band called for a dance only for married couples. As the song progressed, they began to name off years: one, two, five, ten, fifteen, twenty. The idea was that, as they gave the length of time you had been married, you would leave the floor. He and his wife were dancing at the very last but for one couple in their nineties.

He owned a small business in civil engineering, and by means of it raised a family. Twice at least his honest nature caused him to be defrauded by people he had elected to trust, but he stood good for all the debts they had run up in his name.

For the entire part of his life that I knew him, he was a deacon in his church. He lived according to the strict rule of Southern Baptists, which he was, not drinking nor smoking nor chasing after girls. He made one exception I can recall, allowing a keg onto his property to celebrate his son's graduation from college. He was invariably kind, and almost invariably full of a gentle good humor.

He is survived by his wife, two children, four grandchildren, and several great-grandchildren -- I am not sure of the number myself.

We will miss him.

Better suspension

In God We Trust: Everybody Else, Cash Only

Dad29 suggests that the DOJ aims to destroy the ability of ammunition manufacturers, among 30 types of worrisome businesses, to operate except on a cash-only basis. That's surprising if the goal is, as the DOJ says it is, better oversight of these allegedly-worrisome industries. Generally electronic transactions leave better records. The reason to force banks to stop dealing with them can't, then, be that it would enable better oversight.

It might be a desire to destroy the business, or the industry.

UPDATE: The Sage of Knoxville on the same topic. For some reason he prefers to describe it in terms of a war on pornography, though he notes that 30 different types of businesses are being targeted. (Perhaps he thinks that Americans won't care about ammunition sales in the same way they care about access to porn.)

Memorial Day

I spent the day with family, walking a battlefield and trying both to learn and to teach something about how we came to where we are.

It is a solemn day. I trust you all spent it well.

Low humor

Never mind the cause, we need a remedy!

Sheldon Richman expresses a grudging admiration for the staying power of Keynesian economics.   One explanation is that Hayek et al. made people feel gloomy, with their insistence that misallocations of resources had to work themselves out before the economy could return to health.  Who wants to wait for that to happen?  We need jobs now!

Rather than getting bogged down in an attempt to explain the dynamics of the business cycle—a subject that remains contentious to this day—Keynes focused on a question that could be answered.  And that was also the question that most needed an answer: given that overall demand is depressed—never mind why—how can we create more employment? 

Indeed, if you’re trying to end mass unemployment, why would you want to get bogged down trying to understand what actually caused the mass unemployment?  It’s not as though the cause could be expected to shed light on the remedy.

Enter the era of stimulus spending, which is always about to create sustainable jobs, if we just keep increasing it.  In some fields, unexpected results might lead us to rethink our theories of causation.  Well, not in education, or child-rearing, or climate science, of course, but there must still be some fields somewhere that remained tethered to reality on some level.

In which I agree with the President, for once

Shocking news:  I don't think the President's proposal for a ratings system for universities is lunacy:

The rating system, which the president called for in a speech last year and is under development, would compare schools on factors like how many of their students graduate, how much debt their students accumulate and how much money their students earn after graduating.  Ultimately, Mr. Obama wants Congress to agree to use the ratings to allocate the billions in federal student loans and grants.  Schools that earn a high rating on the government’s list would be able to offer more student aid than schools at the bottom. 

Many college presidents said a rating system like the one being considered at the White House would elevate financial concerns above academic ones and would punish schools with liberal arts programs and large numbers of students who major in programs like theater arts, social work or education, disciplines that do not typically lead to lucrative jobs.

This controversy will get derailed into the usual complaints that education is too ineffable to judge accurately, but that misses the point.  The ratings system is designed to help people decide whether the federal government should subsidize tuition.  No matter how ineffably fabulous a basket-weaving studies degree is (and it would appeal to me enormously), the federal subsidies should be tied in some rational way to an increased ability to earn a living.  Cold and bourgeois of me, I know.  But when you look at a university's rating in that light, it's no mystery how to craft it, and no need to confuse the result with whatever personal views one may hold about the abstract value of education.

How did we get to the point where we worry that a system for deciding how to allocate federal subsidies elevated financial concerns inappropriately?

A break for warmth

From Bookworm Room, two happy-making videos.  One is about inclusion:  not the kind where you pretend everyone is alike, but the kind where you take your blinders off, find out what people can do instead of what you expected they could do, make a place for it, and honor them for it.  The other is about what the Bible might call the "widow's mite":  gifts from the heart, with no strings attached or guilt invoked.

Feedback plus-or-minus

This link is to an interesting comment at Watts Up With That analyzing the difficulty of deciding whether the interaction of CO2 (a weak greenhouse gas) with water vapor (a much stronger greenhouse gas) produces a negative feedback loop, which would tend toward equilibrium, or a positive feedback loop, which would spiral into permanent warming.  The question is fraught, because water vapor can serve either to warm the atmosphere, via the greenhouse effect, or to cool it, via other well-observed mechanisms.  When all the dust settles, how do these effects net out?

All alarmist climastrology in recent decades has depended on climate models that assume a net positive sign on the "feedback" or "sensitivity" factor; most of the quarreling has been over the size of the factor, especially since the past 17 years of little or no warning have demonstrated that the factor has been grossly overestimated.  In fact, however, there's scant evidence one way or the other on the more fundamental question of whether the feedback is negative or positive.  No amount of tinkering with the exact size of the positive feedback factor will help the models' ability to predict real experience if the problem really is that the feedback is negative.

Overcoming Barriers

The Wilson Quarterly has an article on economic development, relative to our recent discussion of reparations in several ways. The most obvious is this:

Geography, however, doesn’t always play a direct role—sometimes its effects are more roundabout. Rugged, mountainous terrain isn’t great for growing crops or conducting trade, but one study from 2007 found that such regions in Africa nonetheless reached higher levels of development. Why? Because historically, that same treacherous landscape protected certain areas from slave traders.

So if the most successful regions of Africa are the least well-endowed, just because it was too hard for slavers to extract their wealth and human capital, how much of Africa's suffering is directly due to the slave trade?

But there's this, too:

Other studies have shown that people matter more than institutions or locations. Many poorly endowed lands have experienced a “reversal of fortune” since 1500, producing more income per capita than their past would have suggested. Those economies benefited from the European colonizers and their human capital—a familiarity with centralized state institutions, efficient agriculture techniques, and new technologies that let one generation build upon the advances of the last.

Now that seems to be a reversal of the first argument: Europeans colonized the parts of Africa that are worst-performing, too. I assume this is a way of talking about India, which wasn't subject to the slave trade and thus wasn't plundered in the same way. But India and Pakistan sit next door to one another, and were subject to the same British rule. There's an element of responsibility that goes beyond "what did the Europeans do to them?" and lies at the question of what they have done with their inheritance.

The piece ends on a note of hope, which is where I think we should aspire to go as well. The question shouldn't be one of punishment or vengeance, but of development of human capacities. We want people to come to flourish.

The Black Monster of Santa Barbara

It is no shame to die for love. It has been the mark of many a noble death. It need not be a shame to kill for love, though it often is, but there are times when it can be right.

The Lily Maid of Astolat begged Lancelot to love her, to marry her or -- if he would not -- at least to take her as paramour. He would do neither, the one for the love of Guinevere and the other out of respect for her virtue. She took herself to her bed and died, but revenged herself on him by having her body brought to Camelot with a letter complaining that he had refused her love. It is a bitter story and a sad one, but a better story than today's.

Elaine understood that her complaint, though the sorrow of it brought her to her death, imposed no duty on Lancelot. He might be ashamed to have caused her such pain, when she had done him only good. But his defense was valid, as Camelot agreed:

And when Sir Launcelot heard it word by word, he said: My lord Arthur, wit ye well I am right heavy of the death of this fair damosel: God knoweth I was never causer of her death by my willing, and that will I report me to her own brother: here he is, Sir Lavaine. I will not say nay, said Sir Launcelot, but that she was both fair and good, and much I was beholden unto her, but she loved me out of measure.

Ye might have shewed her, said the queen, some bounty and gentleness that might have preserved her life.

Madam, said Sir Launcelot, she would none other ways be answered but that she would be my wife, outher else my paramour; and of these two I would not grant her, but I proffered her, for her good love that she shewed me, a thousand pound yearly to her, and to her heirs, and to wed any manner knight that she could find best to love in her heart. For madam, said Sir Launcelot, I love not to be constrained to love; for love must arise of the heart, and not by no constraint.

That is truth, said the king.

Rewarding failure

Why and how an institution gets money directed to it may be more important than how much it gets.  This morning's Wall Street Journal article argues that the VA has gotten all the money it ever asked for, and yet it's failing.  The same disturbing pattern afflicts public school financing, which increases endlessly even as its results deteriorate. Paul Krugman argues that freeing the V.A. from the "perverse incentives" of "profit" should be a great thing, but Daniel Greenfield points out his lunacy:

“Crucially, the V.H.A. is an integrated system, which provides health care as well as paying for it,” Krugman wrote.  “So it’s free from the perverse incentives created when doctors and hospitals profit from expensive tests and procedures, whether or not those procedures actually make medical sense.” 

Of course ‘perverse’ profit motive incentives don’t go away.  They just morph into targets that have to be met at any cost.  A quick look at anything from Soviet agriculture to No Child Left Behind would show how that works. 

Krugman was either being dishonest or remaining steadfastly ignorant of how the world works.  And the VA met its targets and budget issues by rationing health care and killing patients. 

The way socialized medicine always does.

Or, frankly, any monopoly that manages to disconnect its funding from its performance by exempting itself from the rigors of competition and therefore from the discipline of consequences of failure.

"The more you tighten your grip . . ."

". . . Lord Vader, the more star systems will slip through your fingers."  This might be a good message for the author of "When Sprawl Hits the Wall," a piece in Urbanophile bemoaning the "doughnut" syndrome around dying cities.  Indianapolis, he claims, enacted a brilliant strategy of co-opting its suburbs some decades back.  You can't let those people move out to the outskirts without expanding your perimeter and trapping them in your tax-base, right?  But then the suburbs themselves inexplicably decay, too, which evidently has nothing whatever to do with their having been trapped in your crazy urban scheme to begin with.  Then new suburbs spring up even further out and, dang it, the people with all the money and resources insist on living there instead of in your demonstrably superior urban paradise.  Sometimes they even move to a completely new city or state.

The problem continues to be that choice thingy.