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An interesting convergence took place in the pages of The Jan. 12th New Yorker where the famed author Malcolm Gladwell reviews Steven Brill’s tome on health care and its reform. (Brill is the guy who started Court TV and the magazine American Lawyer.) Unfortunately, it uncritically accepts the premise the government should be trying to fix what has already been broken by government interference. That caveat aside, this long article is worth reading because he will introduce you to David Goldhill’s “Catastrophic Care” which asks the questions we might wish were more central to Gladwell’s piece and to the whole debate itself.
… Near-history, the journalistic reconstruction of contemporary events, has come to be dominated by two schools. The first is represented by Michael Lewis. Lewis wrote about the 1996 Presidential election through the story of a Republican candidate no one had ever heard of, the eccentric millionaire Morry Taylor. “The Big Short” was an account of the financial crisis told through the eyes of four obscure short-sellers. Lewis’s interest is psychological and moral. His books have won him many admirers (including me) because they offer deceptively simple narratives in the service of a grand canonical theme. “Liar’s Poker,” which recounts the young Lewis’s stint in the Wall Street of the nineteen-eighties, is Daniel in the lion’s den. “Money Ball,” about the strategies of small-market baseball teams, is David and Goliath. “The Blind Side” is the Good Samaritan. “The Big Short” is Noah’s Ark, and “Flash Boys” is Jesus casting the money changers out of the temple.
The second school is associated with the Washington Post reporter Bob Woodward. Woodwardian history is kaleidoscopic. The reporter makes many telephone calls and office visits, and reads many documents. All key players are represented and events detailed. The approach is sociological: the great theme of the Woodward school is the interaction of institutions and vested interests. In a Lewis, if you remove the titles of the characters and simply identify them by their first names, nothing is lost: an individual’s character, not his position, is what matters. In a Woodward, the opposite is often true. Names may be irrelevant; titles tell you what you need to know. That is what makes Woodward and Carl Bernstein’s “All the President’s Men” a masterpiece: its great achievement was to show how the institutional power of the White House led to the President’s personal corruption. The Lewis brings drama to what we thought was prosaic. But when the underlying subject is inherently dramatic, and when the heart of the story lies behind doors that only dogged reporting can unlock, the Woodward is what we need. You don’t want Michael Lewis on Watergate. He’d get distracted by Rose Mary Woods and would never make it into the Oval Office.
“America’s Bitter Pill” is Brill’s attempt at a Woodward. …
… Brill devotes fifty pages to another Obamacare shortcoming, the early malfunctioning of the Web site. He originally thought that the site would be a showcase for what government could do. But, on the train back from his initial round of interviews in Washington, he glanced at his notes and realized that he had been given seven different answers to the question of who was in charge of the launch of the federal exchange, including an “incomprehensible” organizational chart with four diagonal lines crossing one another and forming a “lopsided” triangle:
“Should we be amazed, and disappointed, at how Obama treated the nitty-gritty details of implementing the law as if actually governing was below the pay grade of Ivy League visionaries?
Absolutely. This failure to govern will stand as one of the great unforced disappointments of the Obama years.” …
… It is useful to read “America’s Bitter Pill” alongside David Goldhill’s “Catastrophic Care.” Goldhill covers much of the same ground. But for him the philosophical question—is health care different, or is it ultimately like any other resource?—is central. The Medicare program, for example, has a spectacularly high loss ratio: it pays out something like ninety-seven cents in benefits for every dollar it takes in. For Brill, that’s evidence of how well it works. He thinks Medicare is the most functional part of the health-care system. Goldhill is more skeptical. Perhaps the reason Medicare’s loss ratio is so high, he says, is that Medicare never says no to anything. The program’s annual spending has risen, in the past forty years, from eight billion to five hundred and eighty-five billion dollars. Maybe it ought to spend more money on administration so that it can promote competition among its suppliers and make disciplined decisions about what is and isn’t worth covering. …
… Goldhill takes a far more radical position than the economic team at the White House does. He believes that most of our interactions concerning health care are actually no different from our transactions concerning anything else: if we trust people to buy cars and houses and food and clothing on their own, he doesn’t see why they can’t be trusted to do the same with checkups, tonsillectomies, deliveries, flu shots, and the management of their diabetes. He thinks that the insurance function—inserting a third party between patients and providers—distorts incentives and raises prices, and has such an adverse impact on quality that health insurance should be limited to unexpected, high-cost occurrences the way auto insurance and home insurance are. These ideas are unlikely to make their way into policy anytime soon. But, in elaborating the market critique of the health-care status quo, Goldhill helps us understand what the argument we’re having right now is about. It is not just a political battle over Obama. It’s a battle over whether health care deserves its privileged status within American economic life. …
Matt Lewis in Daily Beast wonders if Chris Christie will regret being in Jerry Jones’ box when watching Detroit lose to Dallas last Sunday. Next Sunday Dallas will be at Green Bay. Will Scott Walker sit in the cold with the folks, while Christie sits in a luxury box?
… Christie has problems, and they begin with the fact that photos and videos and memes can haunt us. You don’t have to go back too far to find examples … Joe Lieberman “kissing” George W. Bush or Barack Obama hugging Charlie Crist … or, for that matter, Chris Christie “hugging” Barack Obama. (Maybe the guy is just a hugger?)
In each scenario, it matters greatly whom you hug. And let’s be honest, while the Dallas Cowboys might represent America’s team, Jerry Jones represents the worst qualities about the one percent. I mean, if you were casting a villain, he’d be on your short list. This is a guy who has his son-in-law clean his eyeglasses, for crying out loud. The man makes Dan Snyder almost seem likable. In other words, being pictured hugging him—in the owner’s box—works to undermine Chris Christie’s Springsteen-esque image as a blue collar working man’s Republican. (The fact that he was celebrating another loss for the star-crossed city of Detroit only enhances the symbolism.)
Now, I don’t want to make too much of this. Christie may have his faults, but he oozes the everyman persona. His hero, Bruce Springsteen, is a gazillionaire, but he still manages to come across as a regular guy, so perception is reality. Mitt Romney seemed like a rich guy. Chris Christie seems like a Joe Sixpack. It’s really hard to undermine our perceptions about someone’s natural temperament, but it is possible—and that’s why this is potentially dangerous for Christie. The most dangerous attacks are those that undermine your perceived strength. …
When it comes to colds, turns out mom was right. Real Clear Science article shows that we’re more susceptible to cold viruses when we’re cold. Florida anybody?
If your parents or grandparents were like mine, you probably heard this as a child heading out to play in the snow: “Put your hat and scarf on. If you don’t, you’ll catch a cold.” Years later, all grown up with a microbiology doctorate hanging on my wall, I know that viruses cause colds, not chilly weather. Their admonitions, while well-intentioned, were based on nothing but folklore and superstition. Right?
Perhaps not. New research published in PNAS shows that colder temperatures may make your immune system more susceptible to rhinoviruses, the most common cause of colds. …