Tort Reform Fools' Gold

"Whats in it for me?" seems the rallying cry of the stakeholders involved in the discussion over universal health care in the United States. The American Medical Association has made it clear that its price for universal health care in the United States is tort reform. And, if major health care reform should pass it is very likely that some sort of tort reform will pass. But, while this is a long sought after dream of physicians, one would be mistaken to believe that it will be a gold mine of health care spending savings.

Tort expenses represent a small percentage health care costs. Physician groups claim that the amount in claims is actually a small part of the problem. They claim that fear of litigation require them to preform unnecessary procedures and tests to reduce liability.

Physician's fear of being sued is obviously quite real. The human body is almost infinitely complex. Random things often happen. Further the health care system itself is incredibly complex and has many qualities which introduce systemic risk to the patient which are largely beyond the physicians control. Further the nature of the insurance market distributes the cost of litigation mostly on the risk associated with a procedure rather than on the quality of work by the physician. Just as you will be charged more for health insurance if, through no fault of your own you happen to be a female of child bearing age a physician is charged more if they perform procedures with a higher risk of catastrophic failure. Thus a obstetrician is charged more from her insurance company because the cost of a botched delivery can be catastrophic not because she is a bad physician. The physician therefor charges more to the insurance company for deliveries and the insurance company charges more to the lady buying health insurance on the possibility that she might get pregnant.

It is a frustrating system which provides very little incentive for good care. But remember the obstetrician pays more primarily because of the way that insurance companies and physicians decide to charge for risk throughout the health care system. Physicians could agree to share the risks equally and then vary insurance rates on the physician's performance rather than the risk inherent in their specialty.

However physicians chose to use a system which does not give strong incentives to good performance. Almost universally a bad physician in a low risk specialty pays far less than excellent Physician in a high risk specialty. By seeking to cap large awards Physicians may reduce insurance premiums for high risk specialties but may not reduce premiums at all in low risk specialties. Further, it will do nothing to place more incentives on quality care.

Thus physicians will have very little reason to change their "defensive medicine" habits -- if a large amount of health care spending is related to "defensive medicine." In fact there is very little reason to believe that expenses attributed to "defensive medicine" would disappear absent the threat of tortuous action.

Physicians may be bad patients. But they are even worse clients to their lawyers. We all have to take measures to reduce our liability at work. We may curse the frustration of it, but physicians often seem to believe that they are immune from the responsibilities associated with almost any business. They believe that it is somehow an intrusion for lawyers to intrude into their business and resent their advice. But, is a Physician's judgment actually superior to their attorney's.

The answer seems to be no. Certainly no for limiting the physician's liability. But also no for patient care. The last thing a lawyer would advise is to through every test and treatment under the sun at a problem. After all every test and treatment extends the physician's liability as well as possibly reducing it.

The uncomfortable truth about the supposed "defensive medicine" is that health care providers get paid for it. Are they doing test as a defense against being sued or are they doing tests to make more money? Unfortunately, as office staff will tell you, the greatest determiner of what tests and procedures are performed is what the insurance company will pay for.

The burden of proof is on the physicians to show that money spent on "defensive medicine" is a reasonable response to liability in the tort system. A reduction in punitive damages for example would provide no change whatsoever in the calculus of whether to perform defensive medicine in specialties in which that would provide little reduction in liability and no reduction in premiums.

Since it is far from clear that defensive medicine is the logical response to current liability, it is very difficult to see how it would be less logical after tort "reform." It is even less likely that tests and treatments will be substantially reduced.

So, see tort reform as what is, a probably necessary concession to the AMA. It is unlikely to be a source of health care savings.

What's the Mission

Commentary's current catchphrase is "It's not a just a Magazine it's a mission. But what is that mission exactly? There has been much talk lately about the "Israel lobby" and it's nefarious influence on American policies. There may or may not be an "Israel lobby" but a quick read of Commentary makes it clear that if such a thing does exist it Commentary is certainly not one of its organs.

The recent posting "Does Will Prefer a Nuclear Iran to a Neocon Washington?" by Jonathan Tobin is a case in point. The article basically makes two points. First that the neocons where right about Iraq and they are right about Iran as well.

I will deal with the two arguments in reverse order. The argument that Iran is an existential threat to the United States is patently ludicrous. Iran does not have a nuclear bomb. Iran doesn't have missiles which can reach the United States. And even if they were to take out an American city, this would not put the United States in mortal danger. Iran might in a couple of years pose an existential threat to Israel.

But even this would almost certainly not truly manifest for years probably decades. Iran has been nothing if not a logical operator. Iran's suppression of the pro-democracy demonstrators was quite restrained. The Chinese who do have nuclear weapons ready to launch capable of taking out several US cities were more violent in putting down the Muslim demonstrators in it's western provinces. But one hardly hears about China on Commentary. Iran is clearly not suicidal. The chances of a first strike on Israel, which probably has hundreds of nuclear weapons is incredibly remote.

The real fear that Israeli partisans have is that with a nuclear deterrent Iran could through the support of terrorism in Lebanon and Israel grind Israel down to the point where it would be overwhelmed with demographic disasters posed by the occupied territories, and the recent decision to throw away the forty years of remarkable loyalty of Arab Israeli citizens over a few peaceful demonstrations. The inflation of the Iranian threat seems to be a pro-Israel position. But it must be remembered that the real threat to Israel is the demographic pressures of Arabs in Israel and in the occupied territories. Iran could only facilitate the crises which is almost entirely of Israel's own making.

But the real indication that Mr. Tobin's heart is not with Israel is the first argument. One could make an argument that Iraq has been a success for the United States, though there are great difficulties. However, it is almost impossible to make the argument that the Iraq war has been a success for Israel. The destruction of the Hussein government allowed Iran to greatly expand its power in the peninsula. The ability of Iran to pose a real threat to Israel though terrorism is almost entirely the result of the Iraq war. A true Israeli partisan could not call the Iraq war a success without qualifying that statement with an acknowledgment of the war's cost to Israel's strategic decision.

What then is the mission? If Commentary is not primarily advancing America's interest and also not primarily advancing Israel's interest, whose interest is advancing? One could argue that the magazine is advancing the interest of the Republican party. It is true that the articles are almost universally critical of the Democratic party and supportive of the Republican party and Jennifer Rubin does seem to envision herself as as Jewish Sarah Palin, but even this association misses the mark.

Deep down Commentary is a neocon magazine. And neocon's are their own true north their own mission. They are no more loyal to Israel than America or the Soviet Union. They are no more Jewish than Atheist than Jewish. They are loyal to capitalism no more than socialism no more than communism. Their only faith is in the sufficiency of their own human actions.

We're So Vain (Why We Are Losing or Have Lost the "War on Terror")

Asymmetric warfare, commonly known by its Orwellian pseudonym "terrorism" has been the holy grail of warfare since the dawn of time. It supposedly allows a less well armed, but larger force defeat a more well armed larger force. Since the discovery of pointed stick, wealth has been the overwhelming determiner of success on the battlefield. Even the man who personified the hope of Asymmetric warfare, Mao, wrote "Power flows from a barrel of a gun."

To understand success of the use of Asymmetric warfare by Muslim conservatives is to understand just how wrong Mao was. Power does not flow from the barrel of a gun. Mao's revolution died with barley a shot being fired. The greatest significance of Mao's victories and those of Allied forces over the Axis forces was certainly the election of Dwight Eisenhower as president.

The greatest fiction woven by the writer of alternative histories, is that wars are lynch pins on which history turns. If World War II had been won by the Axis powers it is hard to imagine that the lives of the vast majority of people around the world would differ in any significant way from the lives they live now.

One of the many perversions of those civil war buffs who spend their life in the fetid detritus of Southern secession, is the pitiful significance they place on the various battles of the war. Southern independence never had a chance. Once it became clear that the European powers would not join the Southern cause and that the naval blockade was somewhat successful, any faint hope of success for the Confederacy was extinguished.

All the battles that so many study with such passion were utterly meaningless. The north could have lost virtually every battle and even the war itself and virtually nothing would have changed. The value of agricultural goods would have diminished in any case. The northern industrialist would have come to power in any event.

The true wisdom of battle was that Lao Tzu. Nations rise and fall of there own accord. A victorious general is one who knows how to fight the battles that are winnable. Battles determine who stands at the captain's wheel, but these captain's wheel is not connected to a rudder.

Mao won for one reason and one reason only. The cities had become dependent on the great powers. The destruction of the Japanese and British Empires in the war doomed the power of the cities and allowed them to drown in the countryside. When the cities were reborn the Mao's tide ebbed away. The millions of lives lost, the millions of dollars wasted, all the plans of mice and men mattered not.

A similar change in the stars is occurring now. The center of the gravity of the world is shifting East. The institutions that supported the post World War II era are being swept away. The old battles of Europe go on, but their significance is diminishing to zero.

The old battles of the East are ascendant. You can date the graves in the Middle East by the direction in which the bodies are lain. As one influence wanes the bodies themselves turn to the future. And the future is with the rising sun and the East.

One could read the above and suppose that there is a certain fatalism, in the author's approach. How, if the outcome of test of arms is insignificant to the flow of history, can one triumph over terrorism.

The answer is simple. Wars decide the fate of individuals, not peoples. Those who understand this have the power to influence the personalities who lead claim to rule the world, and means that they follow to do so. To the extent one values such things, there is a clear path to "winning" asymmetric wars.

Successful people by definition rarely fail. If they appear to fail, chances are, that observer was mistaken about their goals. If there is a rich patriot, he is no more common than other madmen. The powerful of the world overwhelming are motivated by their own desires, caring little for what happens to the people they claim to represent.

Leaders both civilian and military are motivated much more by their own careers than the fate of their nations. Throughout history, the vast majority of the leaders of a defeated power, if not killed, immediately and with apparently very little reservation switch their allegiance to victor.

Understanding Asymmetric warfare is understanding why that very few who remain loyal to their lost cause do so. The answer is simple. They do not have the means to do join the victors. As Lucifer so eloquently says "It is better to reign in hell." By attaining leadership position amongst the resistance these leaders can benefit either from a change in fortune between the two powers, or much more likely, reach the position were they can betray their followers for a position of power with the victors.

We in our vanity say things like "They hate us for our freedom." These people don't hate us at all. They couldn't care less. And, if they had been offered a position of power on our side they almost surely would have taken it.

The goals of several of the recent strategies of combating terrorism are based upon thwarting the supposed goals that terrorist leaders have for their people. The Reagan doctrine of not negotiating with terrorist, hopes to make it clear that nothing is to be gain by terrorist activity. The Powell doctrine of overwhelming force is also premised on the resistance is futile meme. Perhaps the least effective anti-terrorism method is Israel's "Crazy Boss" strategy which tries to leave fear in the terrorist's mind that any violence could result in overwhelming force.

These strategies have been a total failure, because they are based on the vain nation that the terrorist care about us at all. To the terrorist, the only thing that matters is their position of power within their own movement. Terrorism gives them power not because it weakens the enemy but because it increases their power in the movement. The power of terrorism is not its effect on the enemy but the sense amongst the resistance that something is being done as opposed to nothing.

Thus the most effective course to ending terrorism negotiation. In negotiations the illusory nature of a the terrorist's "resistance" is immediately exposed and the true power differential is made immediately apparent. After decades of trying. Israel was easily able to defeat Arafat with negotiations. One could argue that the defeat of Fatah and the splintering of the Palestinians would result in a few more feet of land for Israel in the final resolution of the matter, but even this is highly unlikely.

By negotiating with Hamas could Israel easily defeat them as well. The significance of such a victory or even its desirability are debatable but the certainty of the victory is almost certain. The clear eyed leader is not confused. The song is not about us, at all.

The Life Aquatic with Steve Zissou - Criterion Collection (2-Disc Special Edition)

I have recently watched The Life Aquatic with Steve Zissou - Criterion Collection (2-Disc Special Edition). I am a big Bill Murry fan. Scrooged has been one of my favorite movies for some time. Lost in Translation really seemed to be a transcendent role for Murray. The Life shows Murray inhabiting a character much more like the character played in Scrooged. But despite this the movie has unexpected pathos.

It was advertised as a comedy, a parody of the Jacques Cousteau documentaries. But this is just the premise for a much more serious exploration of aging, and relationships. In many ways The Life is a worthy mate for Lost in Translation. If anything Murray provides a braver and richer exploration of the liquid realities of an aging movie star.

Rag: To haze

We tend to think of English as being either British, or American. But the reality is that English is widely used in many countries in the world and has quite different vocabularies in different cultures. If one is going to remain current in English one must realize that these different vocabularies will have as much chance if not more of surviving than the language we use here in the states. For this reason I try to read widely the English used throughout the world.

In this, article: 7 Sanawar boys sent home for ragging found in the Times of India to rag is used in the sense of to haze, meaning physical violence or bullying in a school setting.

Re: Why Israel Will Bomb Iran

This article scares me. The logic seem impeccable especially for Israel's attack on Iran. I do not believe however that a two state solution is in the offing. I believe that it will be hard not to make the argument that Iran's desire to retaliate makes the formation of the Palestinian state too dangerous.

The reality is that the growth of the settlements is simply incompatible with the formation of a Palestinian state. Israel never stopped increasing the settlements. The rhetoric from the Israel's seems more and more absolutist against the Palestinians. And, a victory against Iran will only increase the power of the conservatives in the Israeli government.

I think it is harder and harder to argue against President Carter's arguments in Palestine: Peace Not Apartheid.

Re: The New York Times, the Charles Freeman Controversy, and the Israel Lobby Issue

I truly fear that members of the Jewish right engaging in activities that may in end cause dreadful danger to the Jewish community in the United States. I used to imagine that there might be some sort of truth to The Israel Lobby and U.S. Foreign Policy by John J. Mearsheimer . But more and more reading, especially The National Review and Commentary, has lead me to believe most commentators who would be lumped with the "Israeli lobby" are not only not directed from Israel but that their "pro-Israel" polices arise from domestic political considerations more than any special loyalty to Israel. After all if the primary motivation was Zionist, wouldn't they be in Israel?

But for some time I have noticed a disturbing trend. Israel and some of commentators have become more abrasive and accusatory. If find myself more and more offended by Israel's demands that we accept their versions of events. Rarely is there any attempt to woo Americans. I believe that this attitude is behind the repetitively low support for Israel's actions After all Americans barely bat an eye at oppression far greater than the Israeli's inflict of the Palestinians.

But with the Charles Freedom incident there truly does appear to be the outlines of a conspiracy. There is no question that the attacks on Freeman originated from ardent supporters of Israel. But, any careful reading of the attacks along with other writings by the same authors make it clear that the attacks were largely motivated by domestic political considerations, unrelated to Israel.

If people would just say something like this, all would be probably be fine. The problem is that authors like Ron Radosh and the Washington Post editorial board made the declarative statements that the motivation for those who led the opposition to Freeman was not his statements about Israel. This is simply false and obviously false. Supporters of Israel risk actually forming a conspiracy to lie about the events leading to Freeman's withdrawal.

Times of economic insecurity such as now are dangerous times. Politics can lurch quickly between extremes and people are looking for a scape goat. If the question of whether there is a conspiracy involving Jewish supporters of Israel, changes to what is the nature of the conspiracy, the danger of Pogrom against the Jews would greatly increase.

Supporters of Israel need to work on their message. Focus on the people at large, not just the powerful. And studiously avoid actions that could give demagogue an place to start.

Ron Radosh, it seems went beyond his lies about the Freeman incident to suppressing my similar post in regards to his article. I submitted two versions, both of which seem to have been rejected. They are provided below. Believe me it is far better to let your opponents express their opinions, odious though they may be, than to have them quietly advancing their agenda.

Update: Both comments were posted in the comments section provided for Mr. Radosh's article.. I also corrected some spelling and grammar errors.



Here is why this article and especially the Washington Post editorial is dangerous to American Jews. I was aware of the Freeman controversy early on, precisely because I read the New Republic, and Commentary. The attacks against Freemen did start with people who consider themselves proponents of a conservative policy regards to Israel.

Freeman’s attitude towards China has, sadly, been the de facto policy of the United States, since Bush, the lesser evil, sent secret emissary to China shortly after the massacre of the protesters in Beijing and certainly was pursued with more vigor by Clinton, Bush, the greater evil, and Clinton again as Secretary of State.

Saudi Arabia is our oldest and most helpful ally in the middle east. We have such close ties with them that we constantly play down their own involvement in terrorism and the spread of violent Islam.

By denying these facts which are are easily available to anyone who reads wider than the Washington Post deniers of the strong influence of proponents of a right wing Jewish policy are just feeding into the conspiracy nonsense regarding Jewish partisans of conservative Israel party.

After reading the Washington Post editorial I myself was wondering why the Washington Post was denying the the opposition was lead by proponents of a conservative policy regarding Israel, when those proponents themselves where claiming credit.

There should be a response to dark claims of an Israel lobby conspiracy which are obvious untruths. But this very message is distorted by seeming to deny that the attacks against Freeman were started by people who opposed his Israel policy.

Here is why this article and especially the Washington Post editorial is dangerous to American Jews. I was aware of the Freeman controversy early on, precisely because I read the New Republic, and Commentary. The attacks against Freemen did start with people who consider themselves proponents of a conservative policy regards to Israel.

Freeman’s attitude towards China has, sadly been the de facto policy of the United States, since Bush sent secret emissary to China shortly after the massacre of the protesters in Beijing and certainly was pursued with more vigor by Clinton, Bush, and Clinton again as Secretary of State.

Saudi Arabia is our oldest and most helpful ally in the middle east. We have such close ties with them that we constantly play down their own involvement in terrorism and the spread of violent Islam.



By denying these facts which are are easily available to anyone who reads wider than the Washington Post deniers of the strong influence of proponents of a right wing Jewish policy are just feeding into the conspiracy nonsense regarding Jewish partisans of conservative Israel party.

After reading the Washington Post editorial I myself was wondering why the Washington Post was denying the the opposition was lead by proponents of a conservative policy regarding Israel, when those proponents themselves where claiming credit.

There should be a response to dark claims of an Israel lobby conspiracy which are obvious untruths. But this very message is distorted by seeming to deny that the attacks against Freeman were started by people who opposed his Israel policy.