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March 29, 2011

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President Obama's supporters don't help their case by presenting inccurate or contradictory excuses. The current Governor of Hawaii, a Democratic supporter of Obama, recently announced that he would obtain Obama's long-form BC and release it, thus ending all controversy. However, he subsequently changed his mind, saying he couldn't release the BC because that would be illegal. That excuse isn't exactly accurate. A BC could be legally released if Obama gave permission. Or Obama could simply request a copy and put in out on the web.

Now Adam Serwer has a new excuse. He says Hawaii doesn't even issue a long-form version of a birth certificate. That contradicts the Governor of Hawaii, who ought to know what forms Hawaii produces.

I don't doubt that Mr. Obama was born in Hawaii, but I do think he has chosen not to release his official long-form BC for some unknown reason.

Ezra Klein is such a clever writer that his preposterous column almost seems to make sense. A good example of Presidential leadership was President Johnson's push for civil rights. Not only did he get a strong civil rights law passed, he also changed the prevailing attitude in the country to one where racism was no longer acceptible. Would Ezra Klein assert that more civil rights progress would have occurred if LBJ had ignored the problem and instead spent his time handicapping basketball games? I don't think so.

I've been in private companies that were doing badly and had to cut costs. The CEOs played a crucial role, not only in finding ways to save money, but in changing the culture so that every employee looked for things s/he could do to economize. If a US President provided that kind of leadership, his efforts would help Congress and all Federal workers to focus on reducing spending.

However, Mr. Obama has not treated the deficit as an urgent catastrophe. He spends money with no apparent concern. E.g., he didn't weigh on how the cost of Libya would affect the deficit. One might say the President is providing anti-leadership on the issue of federal spending.

Brendan thinks the article about the amount of diagnosis under Medicare implies that the US health care system is over-treating and over-diagnosing patients. I agree that they found differentials in the amounts of treatment and diagnosis, but I think the implication is that many of us are under-diagnosed and under-treated. Here's why:

The cited blog endorses this comment from their quoted JAMA article:

What the chart shows is that, controlling for number of chronic conditions, mortality rates are lower in regions with higher rates of diagnoses. The more the population is diagnosed, the less they die.

In other words, those of us who get more diagnosis are actually being helped to live longer. In general, the people who get less diagnosis are underdiagnosed. If they got more diagnoses, they would live longer.

This conclusion fits my own personal experience. Because retirement allows more time for medical diagnoses and treatments, and because they're mostly paid for by Medicare and supplemental insurance, and because I live near Stanford University, I've been getting much more medical diagnosis and treatment than I used to. It's mostly been helpful.

E.g., I recently chose to have a sleep test, which I might not have done absent the three factors mentioned above. I discovered that I have obstructive sleep apnea. Research has shown that this condition can be fatal, leading to death from stroke or heart problems. However, the use of a CPAP machine can avert these problems. I probably should have started using this machine many years ago.

The CPAP should also improve my quality of life by making me less drowsy during the day. Other medical treatments have improved my quality of life, even if they may not affect mortality. Of course, changes in quality of life aren't reflected in mortality statistics, so that quality of life gains have to be measured some other way.

Speaking of Presidential leadership, Chuck Schumer made the mistake of discussing strategy when he didn't realize that reporters were already connected to his conference call.

"Chuck Schumer did us a favor. He exposed their tactic. He's telling his members to deem any spending cut as unreasonable. I don't see how we can do anything if they're not set serious." Cantor said.

[Schumer] told fellow Democrats that they should frame the GOP view as "extreme" and associated with the Tea Party.

"[I] always use the word extreme, that's what the caucus instructed me to do the other week, extreme cuts and all these riders, and [House Speaker] Boehner's in a box. But if he supports the Tea Party there's going to inevitably [be] a shutdown," Schumer could be heard saying.

IMHO if the President were providing proper leadership, all Americans would be acknowledging that significant spending cuts are necessary.

The Jackson Citizen Patriot reports that following a rousing presentation by Robert Wood Johnson Scholar Brendan Nyhan, a posse of two dozen pensioners wielding pitchforks set out on their walkers to find and ventilate Betsy McCaughey.

I see John Sides is an Asst. Prof of Political Science at GWU, but the linked post at The Monkey Cage raises some questions, such as

1. Sides's measure of the economy is "% change in real disposable income" -- presumably the change from the prior year. Is it reasonable to ignore the unemployment rate and the inflation rate? In effect, his economic measure is rate of change of the economy. Maybe Americans do react more to the change in the economy than the absolute state of the economy. I don't know.

2. Sides writes: "The economy explains about 75% of the variance in trust. If you delete 1964, which looks like a potential outlier, the economy still explains 73% of the variance." Is it acceptible practice in Political Science research to casually delete anything that looks like an outlier with no further explanation? I think that would be malfeasance in most sciences.

3. When the outlier was deleted, I would have expected the economy to explain more of the variance, but Sides says it explains a little less.

4. Sides first chart shows that trust has declined, albeit unevenly, from around 80% in 1960 to around 30% - 40% today. What's the cause of this huge drop. It's not accounted for by the economy. IMHO the cause is that government has greatly expanded in the last 50 years, but it's handling its responsibilities worse and worse. In short, I think trust in government has declined, because government has become less trustworthy.

RE: "Media Matters' war against Fox - Ben Smith The liberal group abandons its role as a traditional media critic and focuses on undermining Fox News"

This is news? :-)

It seems to me that David Brock's mission is more personality driven than politically driven. Up until 1997, he was a smearmonger for the right. Once he changed political stripes, it didn't seem as though the way he operated changed.

The fact that 5% of enrollees consume 54% of Medicaid spending is not a reason to implement Atul Gawande's suggestions. Note first of all that the 5%/54% statistics was for a single year, FY 2008. Presumably similar percentages apply in other years. However, it's not the same 5% each year. If one looked at a longer period, the benefits would be seen to spread out more.

A key value to insurance is that it covers particularly costly situations. A lot of money will be paid for the largest claims. It's typical of insurance that a small per cent of cases accounts for a big per cent of
costs.

Gawande's suggestions may be good ones, but I wouldn't expect them to change the fact that a small number of claims account for the lion's share of costs.

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