I'm feeling some genuine love for...Herbert Hoover?

Yup. More here....

Should Norway kill Anders Breivik?

Norway doesn't impose capital punishment. If it did, would I want to kill this man who committed a calculated atrocity on behalf of a genocidal cause? I don't know.  More here.

OK, now I'm mad

I participated in the 2008 campaign because I believed this country had a real chance to pass universal health coverage and achieve other worthy goals. I was positively inspired by Candidate Obama's intelligence and grace at the top of American politics. I still admire President Obama. But I'm finding a more negative source of motivation these days.

(Cross-posted At the Reality Based Community)

As we lurch towards possible default, the debt ceiling fight is no longer merely about taxes and spending. It’s no longer just a battle about the size of government, social insurance, and mutual obligation, either.

This has become a conflict with a nihilist minority among Republicans. This minority exudes contempt for the craft of public policy. It eagerly seeks whatever violation of our nation's implicit legislative norms might offer some momentary advantage. This minority now holds hostage the full faith and credit of the United States—a maneuver whose one likely consequence would be to spike interest rates, raise the deficit, and damage the economy.

It’s important for President Obama to win reelection. It may be even more important to defeat the Tea Partiers. This movement’s ideas, bullying tactics and harmful policy agenda must be emphatically defeated and repudiated.

President Obama has sought to strike some reasonable bipartisan deals with Republicans. Sadly, the most extreme Tea Party partisans exert near-veto power over any such deals. The president's conciliatory approach might even have made disastrous confrontation more likely. His openly-acknowledged concessions to hostage-takers seem to have emboldened them. 

I liked the president's fire today. I hope the Tea Partiers overreach proves to be their undoing. If not we're all in trouble.

"The First 100: Police and public safety under Mayor Emanuel"

In case you are curious what I sound like, alderman William Cochrane and I appeared on Chicago NPR's 848 program discussing Chicago crime issues...

Is this it for the CLASS Act?

The gang of six apparently wants to kill this troubled but worthy piece of health reform. In a less polarized political moment, CLASS might have been modified to meet an important social need with reduced fiscal risk. The hole in American disability policy just got a little bigger.

More here.

More about balancing business, humanity, and restraint in cancer care

For reasons of space, my Kaiser Health News column this morning couldn't include one section, which notes that oncology has become an ecosystem of multi-billion-dollar public, private, and nonprofit ventures in pharmaceutical development, imaging, acute care, and more. This ecosystem draws upon and then reinforces broader cultural biases that promote overly aggressive approaches to diagnosis and care. I wanted to add some more discussion, and one revealing advertising table. More here

It's not just the money: combining humanity and restraint in cancer care.

Me at Kaiser Health News. 

Health reform raises central ideological questions about the size and scope of government, about progressive taxation, about the individual mandate and more. It's easy to forget that cost control will be a huge challenge, no matter how these ideological matters are resolved, indeed under any health system. Finding the right combination of humanity and restraint will be particularly hard in addressing life-threatening or life-ending illness. Economic incentives, American culture, a changing doctor-patient relationship and fundamental uncertainties at the boundaries of clinical care conspire against our efforts to provide more humane, more financially prudent care. 

The necessity and the difficulty of these tasks were underscored by a beautiful New England Journal of Medicine essay, Bending the Cost Curve in Cancer Care, by Thomas Smith and Bruce Hillner. Their essay received favorable attention from health policy journalists. Yet because it didn't push the usual partisan buttons, it didn't receive much wider attention. That's too bad, because Smith and Hillner raise many issues that apply beyond the realm of advanced cancer care. For instance, they offer a brave model of skilled providers identifying specific opportunities to reduce costs within their own specialties. They also present suggestions to address the burdens imposed by cancer overtreatment and undertreatment on patients and society as a whole.....

KHN cut for space a beautiful chart I will blog elsewhere. Otherwise that is my take. And props to Smith and Hillner for a gutsy effort to take cost control seriously within their own specialty. And thanks DFA colleagues for responding to my queries.

A Twitter exchange recalls classic economic analysis: The problem of future costs [wonky]

Emma Sandoe and Austin Frakt had a twitter exchange that raised classic questions of "future costs" in medical cost-effectiveness:

Suppose I implemented an intervention in the year 2000 that controlled your blood pressure so you didn’t die of a stroke in 2005. When I consider the cost of the intervention, should I consider the cost of treating the heart attack you survived in 2010? How about the cost of the eyeglasses, Lipitor, and Viagra you will be alive to consume in future years? What about the cost of that hamburger you enjoyed in 2007? Should this count as a cost of the intervention, too?

Yup. For more, see my Incidental Economist posting here 

Good policy but maladroit politics produces bad public health [Peer review]

Me on the politics of public health and health reform, in the University of Pennsylvania Law Review.

Sustainable public health policy requires more than the passive support of a political majority.  One must design policies to nurture the loyalties and investments of specific interest groups and constituencies who have reason to defend these new policies. Political durability is no guarantee of policy success.  Yet good policy that rests on poor political foundations rarely remains good policy for very long....

The CIA should not impersonate public health folks

I have no problem with the CIA mounting devious black ops to find Bin Laden. Yet as Mark Goldberg reports, it's especially damaging for CIA operatives to mount a fake vaccination campaign in Pakistan to gather intelligence.

HIV screening in the emergency department [peer review]

Every year, tens of thousands of Americans living with HIV pass through the health care system with their infections undetected and thus unaddressed. This is a big problem for these patients. This is a big problem for HIV prevention, too.

Hospital emergency departments provide one largely untapped opportunity to detect HIV infection. Yet the obstacles to doing this are great. Patients arriving for a broken bone or a rash don’t necessarily want to be tested. There isn’t much time or privacy to conduct the testing in many settings. It’s not easy to effectively link patients to HIV care.

Annals of Emergency Medicine published a special supplement with a series of studies on this topic. I was involved in two studies, Torres, et al, and Hsieh, et al. Two thoughts for readers to ponder from my experiences in the first study, which involved site visits to six EDs around the country:

First, a simple yardstick of cost-effectiveness is given by the cost per previously-undiagnosed detected case. Across most of the sites, this number was about $10,000. Second, the prevalence of new detected cases was uncannily similar across the sites: About 1% of patients tested.

Are you surprised by either of these numbers? Are they large or small, compared with what you otherwise expected? How should one judge?

Talking Medicaid with Sara Rosenbaum 9pm tonight

Tonight at 9pm eastern time, I will pilot Doctors for America's monthly Policy Call. The call is titled: Medicaid: How It Works and How We Can Improve It. Tonight I'll be leading a conversation with one of the nation's leading Medicaid experts, Sara Rosenbaum of George Washington University.  If you want to listen in, click here for details.

Professor Rosenbaum is the Harold and Jane Hirsh Professor and founding Chair of the Department of Health Policy at The George Washington University School of Public Health and Health Services. Between 1993 and 1994, Professor Rosenbaum worked for President Clinton, directing the legislative drafting of the Health Security Act and developing the Vaccines for Children program. She has also served on the Presidential Transition Team for President-Elect Obama.

She's written a huge number of articles. This recent NEJM commentary is especially pertinent for tonight.

White vs. Skinner at JHPPL on the Dartmouth Atlas

(This is a catch-up post I put up at the Incidental Economist. Some folks may have missed it the first time around.)


I edit a new feature at the Journal of Health Politics, Policy, and Law titled "Point-Counterpoint." In our very first feature, political scientist Joseph White hurls a broadside against the Dartmouth Atlas. Dartmouth’s Jon Skinner, a major investigator in the Atlas efforts, respectfully disagrees. In part this is a specific debate about the Dartmouth Atlas. In part, this is a more fundamental debate about the relative merits and promise of regulating prices and regulating utilization as paths to improving the quality and efficiency of our health care system.


Our next Point-Counterpoint will concern whether to tighten personal belief exemptions for vaccines. Stay tuned.

It's official.....

This blog is now called HaroldTribune. Paul Kelleher wins $5 for being closest to the final name.

On not mocking people based on their religious beliefs

"If we are to judge people, we should do so based on how they live, not on the basis of forbidding religious beliefs we presume them to hold."


(Fixed Link--Me in the Reality Based Community.)

One candidate's progressive economic platform

(From the Reality Based Community)

In response to economic pain in the heartland, which candidate proposed

…support for a federal job training program, safeguards for collective bargaining, a higher minimum wage, and better protection for people who lost their jobs or could not afford adequate medical care.

Two quick comments on the Oregon Health Insurance Experiment

From The Reality Based Community and TCF's Taking Note section.

I’ll have more to say about the Oregon Health Insurance Experiment (OHIE) in another venue. (Until then, Naomi Freundlich, Jonathan Cohn, Ezra Klein, Gina Kolata, Austin Frakt, and Aaron Carroll have the study well covered. I envy the unique and timely access, opportunity, and the simple craftsmanship of this experiment. Hats off to the entire OHIE study team.)

For the moment, I want to address one bad argument and one good argument made by conservatives in response to OHIE’s strong findings which document the value of Medicaid coverage for so many people.

Oh–one more thing about misguided talking points. After reading the OHIE results, can liberals please stop claiming that covering the uninsured will reduce emergency department use? Can conservatives please stop claiming that health insurance doesn’t improve health? Deal?

John Noble WIlford on the Shuttle's demise

Me in the Reality Based Community.

I once earned a living designing guidance systems for missiles. I am an electrical engineer, and I followed religiously the New York Times‘ John Noble Wilford’s fantastic coverage of the space program, and much else besides. How poignant that the chronicler of Apollo 11 and America’s other great space triumphs was on hand to chronicle the Shuttle’s final flight.

How new autism studies are misconstrued (me in the New Republic)

New epidemiological studies show that "the environment" plays a large role in autism. But the environment is a big place. Me in the New Republic. Yeah--sorry for the "woefully misconstrued" title. 

“There are so many ways a brain can let you down. Like an expensive car, it’s intricate, but mass-produced.” So wrote Ian McEwan in his short work, Saturday. The British novelist wasn’t pondering autism’s heartbreaking and mysterious symptoms when he wrote those words. But he might have been. 

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This blog

At the behest of an incidental economist who shall remain nameless, I am setting up this site.

Its main purpose is to provide a simple RSS feed for my friends. At present I don't intend to post independent content, but we'll see if anyone uses it.

Query: Has anyone tried Adsense or any of these other ways to potentially monetize traffic?