UPDATE: This post reflects an earlier draft, not the final one. Seems WordPress ate the final edit when the coffee shop suffered a Wi-Fi blip. Please forgive typos, grammar problems, and missing hyperlinks. Ill try to re-edit tonight. JEG 4/2/12.

UPDATE 2:  Lightly revised. JEG 4/8/12. 

Bear with me; there’s a lot on the docket (so to speak).

N.B. — This post clocks in at roughly 2,300 words. I’ve bolded the various sections so you can read only the content that interests you.

Obamacare and the High Court

So picture it: The District of Columbia, 2012. The federal capital seized up in gyrations of agony and ecstasy as our black-robed overlords grace us with the gift of their public hearings on the constitutionality of the Patient Protection and Affordable Care Act. Conservatives delighted in both the slap-down delivered to Solicitor General Donald Verrilli and the paroxysms of rage the SG’s performance induced among the progressive commentariat. Some liberals took solace in their Kennedyology, trying to predict how the “swing justice” will rule by divining hints from questions posed by the learned jurist (augmented, no doubt, by a careful reading of the cracks upon heated chicken bones) and suggesting that the court could uphold the law 6-3.

Well.

The Court will do as the Court will do. More intriguing was the general sense among the Left that Obamacare’s constitutionality is a slam-dunk. Across the board, from Verrilli to the lowest FDL blogger, the progressive movement as a whole doesn’t seem to have seriously considered the conservative counter-argument. Verrilli was caught unprepared for questions that conservatives have been asking, loudly, for two years. If you thought Speaker Pelosi’s “Are you serious?” stammering about the constitutional authority of the statute was just Nancy being Nancy, think again.  It’s not for nothing that most of the left-wing legal commentators made a point of referring to justices by ideological label as they summarized the questioning, and it’s an excellent case study in the politics of ideological echo chambers that CNN’s Jeffrey Toobin went from a “strong uphold” to a “OMG, all is lost” based solely on two hours of questioning.

I won’t predict what the Court will do. I will hazard a guess, though, that if the Supremes strike down the mandate (or even the entire PPACA) then we will endure long and loud laments about the Court is too right-wing or that it’s engaging in judicial over-reach or that it’s no longer a legitimate reflector of American virtues and requires radical reform. The Left loves the judiciary until the judiciary proves non-compliant; then the judges become black-robed tyrants. Yawn-worthy in its predictability.

I hope the entire law gets voided. We need to hit the “reset button” on health reform. As a person whose day job lives within a hospital revenue cycle, I can tell you that the real financial crisis for health care isn’t access to insurance, but in the lack of meaningful patient financial participation in the system. It’s as if you’ve got insurance, so you don’t care about pricing or service utilization. To effect a real “bending of the cost curve,” we need to cut out unnecessary tests and procedures (read: tort reform) and give patients meaningful skin in the game about what their treatments really cost. Consumer-driven health care, with high-deductible plans and HSAs to bridge the gap,  makes more sense than mandatory free-lunch coverage. Until you change behaviors and attitudes, no amount of tinkering with the reimbursement model will prove viable in the long run.

[Note: My opinions on health reform are my own and don’t reflect my hospital’s position on this subject.]

Contraception — The Bishops and the Flake

What’s not to love about a good public row about contraception?

This sordid tale of social discontent started during the final votes on Obamacare. To secure passage, the administration had to promise a gaggle of Congresscritters, led by former Rep. Bart Stupak, that the feds wouldn’t upset the abortion apple cart. Obama agreed, providing a wholly insubstantial fig leaf that conservatives decried but let Pelosi and Hoyer get the Senate’s astonishingly incoherent bill to the President’s desk.

Fast forward to 2012: HHS Secretary Kathleen Sebelius announces regulations that force pretty much everyone to cover abortion and contraception services as part of their employer-provided health insurance (so much for that Executive Order, eh Bart?). A storm of protest follows, led by the Catholic bishops. Who, may I proudly add, finally figured out that they really do have spines.

The administration made another make-believe deal but the USCCB rejected it, as did many other conservative and evangelical groups. The drama continues to unfold. But when the House of Representatives got involved, the story took a different turn. Denied the chance to present witnesses for timing reasons at one of Issa’s hearings, the Democrats made Georgetown law student Sandra Flake their poster girl for contraception. That this 30-something grad student at Georgetown should be considered an ideal role model, I find baffling. But there you have it.

The Democrats announced a Republican “war on women.” Republicans were not amused, but then Rush Limbaugh intervened with his infamous “slut” screed and soon the issue blew far out of proportion. Media Matters tried (and woefully failed) to attack Limbaugh. Bill Maher and Louis C.K. earned targets. Hypocrisy raged in typical MSM/Washington style.

Here’s the thing, though:

1. Contraception in the form of condoms isn’t hard to find. Most bars and health centers have them. If you can’t find a free condom, then something’s seriously wrong with you. Especially if you live in a metro area. Like, ummm … THE DISTRICT OF COLUMBIA. Heck, you can grab free condoms by the handful from any fishbowl at any self-respecting gay bar. That a grad student at one of America’s leading universities should insist that her school pay for her birth control instead of just dealing with it marks an astonishing sense of entitlement and a thought-provoking example of what’s wrong with higher education.
2. Contraception in the form of birth-control pills aren’t expensive. Flake suggested it would cost her more than $3k per year unless her Catholic school (to which she voluntarily enrolled, knowing its character) paid the bill. Seriously? Is she buying them in platinum bottles? You could get a copper-T IUD for $647 in 2008 or now you can pay $240 per year for The Pill from Planned Parenthood clinics.
3. If you can’t afford birth control, you always have the right to reduce your “risk” of pregnancy by curtailing your sexual activity. Seriously. Abstinence works, as does non-vaginal sexual behavior.  Point is, no person has a right to force other people to subsidize his or her sexual behavior.

But, hey. How ’bout that war on women? Apparently the politics of demonization is a heck of a lot easier than encouraging responsible behavior among people who really ought to know better.

Trayvon Martin, George Zimmerman and Gun Control

No question, it’s a bad situation. A black Florida teen, Trayvon Martin, was shot and killed by a “white Hispanic” (whatever that is) slightly nutty neighborhood watch patroller named George Zimmerman while the youth was cutting through a gated neighborhood. The facts in this case aren’t clear despite quite a bit of grandstanding; the evidence and witness testimony suggests that both Martin and Zimmerman made repeated, significant and avoidable errors in judgment.

Three observations:

• This isn’t a slam-dunk case, either for or against prosecuting Zimmerman. As such, the March of the Race Brigade, led by Sharpton and Jackson, probably does more harm than good. No matter how you slice it, this isn’t a case of institutional racism. Of bad judgment? Sure. Of a police department and prosecutor’s office that may or may not be correctly interpreting Florida law? Perhaps. But this isn’t a flash point in a racial war, and every time the usual suspects come out with their manufactured outrage and their political opportunism — including yet more unnecessary meddling in local law enforcement from Barack Obama — justice for both Martin and Zimmerman fades and cynicism about race relations spikes up.
• I’ve heard people suggest that the real problem here is Florida’s “stand your ground” statute. Florida is one of 30 states with this type of law;  it’s the converse of “duty to retreat” statutes. In Florida, if you’re attacked, you’re authorized to hold your position and fight back when confronted. The argument I’ve heard is that “stand your ground” allows too much of an escalation path for hard cases, and that less violence would result under a “duty to retreat” regime. Maybe. But it seems like rewarding violence and aggression by privileging it under the law empowers the criminals at the expense of the law-abiding.
• The million-dollar question — and one not really subsumed under the Martin incident — is the extent to which a person is legally entitled to defend himself against aggression. Concealed-carry, castle and stand-your-ground laws represent a swing back from the over-reliance on spotty police protection. Even now, liberals are torn; on one hand, they often excoriate police departments for being hotbeds of brutality, racism and misogyny — but these same departments are the gold standard of community policing, whose mere presence justifies any opposition to more relaxed self-defense statutes. Which is it? Are the cops ignorant buffoons, or Teh Awesomz? Pick one position and stick with it, please. In any case, the presumption that civilians are incapable of exercising good judgement while police officers remain beyond reproach is blown out the water by the fact that a police officer is 11 times more likely to engage in wrongful shooting than a validly licensed citizen. (Read the link; it’s a Cato study that outlines the history of gun-control laws and reveals just how much of an innovation they really are in U.S. history.)

The Ryan Budget

Paul Ryan released a kick-ass budget that just passed the House comfortably. It reduces the deficit, moves to a premium-support model for Medicare and protects defense spending. In short: The gentleman from Wisconsin seems to be the only serious adult in Washington when it comes to spending and entitlement reform. Not only has Ryan submitted a workable model, he’s succeeded in changing the entire intellectual dynamic about taxing, spending and reform in Washington. He’s put Obama on defense.

[Read the passage story about the Ryan budget, including a summary of its major points, from WaPo, then digest commentary from Doug Schoen in Forbes.]

Three cheers for Paul Ryan.

Political Etch-a-Sketches

Eric Fehrnstrom’s comments about Romney and the political Etch-a-Sketch seem overblown. Every politician emphasizes some things in a primary race and other things in a general race. To the extent that the election in its final 12 weeks will look radically dissimilar to the GOP nomination fight, the proper reaction to Fehrnstrom’s statement is … duh.

I can understand liberals trying to make hay from his comments, but for conservatives to keep swiping at Romney — well, it feels like an ongoing tantrum. Look, guys, Romney’s our man in 2012 whether you like it or not. We’re not going to have a brokered convention. Paul won’t win the nomination. Gingrich has no path to victory and increasingly looks like a bad-faith candidate. Santrorum lacks organization and money and his negatives (even apart from his self-inflicted gaffes) make an Obama re-election seem more likely than not. At this point, whether you like it or not, the time has come to circle around Romney and focus on sending Obama back to Chicago for good.

Conservatives and Science

One of the big news stories of last week flowed from a survey that suggests that conservatives have little faith in science. Plenty of stories abound about the study; Ars Technica did a decent job of summarizing the key points.

I think the focus is a bit off. I don’t believe that conservatives distrust science per se; you don’t see many Republicans pretending like organic chemistry is a hoax or that the moon landing was staged or that the laws of physics are a left-wing conspiracy to increase taxes by denying people the ability to fly through the air like Superman. What you see, rather, is conservative distrust in what seems like increasingly obvious alignment between “scientific results” and progressive policy preferences. Like scientists, conservatives are also capable of conducting linear regressions to arrive at reasonable conclusions.

Consider:

• The theory of anthropogenic global warming is based on science that pretty much everyone acknowledges requires refinement. Climate scientists have done an excellent job of trying to piece together historical evidence of climate change. Much of it is compelling. When they’re up-front about known problems with the data, I trust their conclusions even more. But there’s a world of difference between saying, “here’s the trend over the last 2,000 years” versus “observation X is definitively caused by human behavior, and therefore we scientists must now dictate to you the specific sociopolitical reforms you must immediately execute to avoid Armageddon, conveniently written up for you by your friends from Greenpeace, so STFU and bow to the consensus we’ve manufactured by suppressing contradictory findings.” Climate science can tell — imperfectly, so far — what’s happening. It can speculate as to why. The leap from observation to political change isn’t the realm of science, however. It’s the realm of politics. When scientists insist that disaster is upon us because of our behavior, when their leaked emails note to the contrary, is it any wonder that people lose confidence in those scientists?
• Watch the Discovery Channel or read some of the scientist profiles in higher-brow popular science magazines. One thing will strike you: No matter the discipline — and, surprisingly, one of the most susceptible seems to be theoretical physics — the group think and polarization is so high that plausible theories don’t get a hearing because senior researchers and theoreticians get an almost partisan adherence to their preferred perspective and won’t listen to countervailing ideas. Study the development of string theory for a case study. Anyone who says “science” isn’t political has never tried to advance a complex theoretical argument lately.
• Scientists are human beings. Human beings tend to be ideological. Why, oh why, must people assume that scientists are immune to ideology? The jig is up, I think, when scientists sign on to a great number of things (the nuclear freeze, global warming scaremongering, etc.) that almost always fall on the left side of the spectrum. Gee. Can you blame conservatives for being skeptical?

All for now.

UPDATE: This post reflects an earlier draft, not the final one. Seems WordPress ate the final edit when the coffee shop suffered a Wi-Fi blip. Please forgive typos, grammar problems, and missing hyperlinks. Ill try to re-edit tonight. JEG 4/2/12.
UPDATE 2:  Lightly revised. JEG 4/8/12. 
Bear with me; there’s a lot on the docket (so to speak).
N.B. — This post clocks in at roughly 2,300 words. I’ve bolded the various sections so you can read only the content that interests you.
Obamacare and the High Court
So picture it: The District of Columbia, 2012. The federal capital seized up in gyrations of agony and ecstasy as our black-robed overlords grace us with the gift of their public hearings on the constitutionality of the Patient Protection and Affordable Care Act. Conservatives delighted in both the slap-down delivered to Solicitor General Donald Verrilli and the paroxysms of rage the SG’s performance induced among the progressive commentariat. Some liberals took solace in their Kennedyology, trying to predict how the “swing justice” will rule by divining hints from questions posed by the learned jurist (augmented, no doubt, by a careful reading of the cracks upon heated chicken bones) and suggesting that the court could uphold the law 6-3.
Well.
The Court will do as the Court will do. More intriguing was the general sense among the Left that Obamacare’s constitutionality is a slam-dunk. Across the board, from Verrilli to the lowest FDL blogger, the progressive movement as a whole doesn’t seem to have seriously considered the conservative counter-argument. Verrilli was caught unprepared for questions that conservatives have been asking, loudly, for two years. If you thought Speaker Pelosi’s “Are you serious?” stammering about the constitutional authority of the statute was just Nancy being Nancy, think again.  It’s not for nothing that most of the left-wing legal commentators made a point of referring to justices by ideological label as they summarized the questioning, and it’s an excellent case study in the politics of ideological echo chambers that CNN’s Jeffrey Toobin went from a “strong uphold” to a “OMG, all is lost” based solely on two hours of questioning.
I won’t predict what the Court will do. I will hazard a guess, though, that if the Supremes strike down the mandate (or even the entire PPACA) then we will endure long and loud laments about the Court is too right-wing or that it’s engaging in judicial over-reach or that it’s no longer a legitimate reflector of American virtues and requires radical reform. The Left loves the judiciary until the judiciary proves non-compliant; then the judges become black-robed tyrants. Yawn-worthy in its predictability.
I hope the entire law gets voided. We need to hit the “reset button” on health reform. As a person whose day job lives within a hospital revenue cycle, I can tell you that the real financial crisis for health care isn’t access to insurance, but in the lack of meaningful patient financial participation in the system. It’s as if you’ve got insurance, so you don’t care about pricing or service utilization. To effect a real “bending of the cost curve,” we need to cut out unnecessary tests and procedures (read: tort reform) and give patients meaningful skin in the game about what their treatments really cost. Consumer-driven health care, with high-deductible plans and HSAs to bridge the gap,  makes more sense than mandatory free-lunch coverage. Until you change behaviors and attitudes, no amount of tinkering with the reimbursement model will prove viable in the long run.
[Note: My opinions on health reform are my own and don’t reflect my hospital’s position on this subject.]
Contraception — The Bishops and the Flake
What’s not to love about a good public row about contraception?
This sordid tale of social discontent started during the final votes on Obamacare. To secure passage, the administration had to promise a gaggle of Congresscritters, led by former Rep. Bart Stupak, that the feds wouldn’t upset the abortion apple cart. Obama agreed, providing a wholly insubstantial fig leaf that conservatives decried but let Pelosi and Hoyer get the Senate’s astonishingly incoherent bill to the President’s desk.
Fast forward to 2012: HHS Secretary Kathleen Sebelius announces regulations that force pretty much everyone to cover abortion and contraception services as part of their employer-provided health insurance (so much for that Executive Order, eh Bart?). A storm of protest follows, led by the Catholic bishops. Who, may I proudly add, finally figured out that they really do have spines.
The administration made another make-believe deal but the USCCB rejected it, as did many other conservative and evangelical groups. The drama continues to unfold. But when the House of Representatives got involved, the story took a different turn. Denied the chance to present witnesses for timing reasons at one of Issa’s hearings, the Democrats made Georgetown law student Sandra Flake their poster girl for contraception. That this 30-something grad student at Georgetown should be considered an ideal role model, I find baffling. But there you have it.
The Democrats announced a Republican “war on women.” Republicans were not amused, but then Rush Limbaugh intervened with his infamous “slut” screed and soon the issue blew far out of proportion. Media Matters tried (and woefully failed) to attack Limbaugh. Bill Maher and Louis C.K. earned targets. Hypocrisy raged in typical MSM/Washington style.
Here’s the thing, though:

1. Contraception in the form of condoms isn’t hard to find. Most bars and health centers have them. If you can’t find a free condom, then something’s seriously wrong with you. Especially if you live in a metro area. Like, ummm … THE DISTRICT OF COLUMBIA. Heck, you can grab free condoms by the handful from any fishbowl at any self-respecting gay bar. That a grad student at one of America’s leading universities should insist that her school pay for her birth control instead of just dealing with it marks an astonishing sense of entitlement and a thought-provoking example of what’s wrong with higher education.
2. Contraception in the form of birth-control pills aren’t expensive. Flake suggested it would cost her more than $3k per year unless her Catholic school (to which she voluntarily enrolled, knowing its character) paid the bill. Seriously? Is she buying them in platinum bottles? You could get a copper-T IUD for $647 in 2008 or now you can pay $240 per year for The Pill from Planned Parenthood clinics.
3. If you can’t afford birth control, you always have the right to reduce your “risk” of pregnancy by curtailing your sexual activity. Seriously. Abstinence works, as does non-vaginal sexual behavior.  Point is, no person has a right to force other people to subsidize his or her sexual behavior.

But, hey. How ’bout that war on women? Apparently the politics of demonization is a heck of a lot easier than encouraging responsible behavior among people who really ought to know better.
Trayvon Martin, George Zimmerman and Gun Control
No question, it’s a bad situation. A black Florida teen, Trayvon Martin, was shot and killed by a “white Hispanic” (whatever that is) slightly nutty neighborhood watch patroller named George Zimmerman while the youth was cutting through a gated neighborhood. The facts in this case aren’t clear despite quite a bit of grandstanding; the evidence and witness testimony suggests that both Martin and Zimmerman made repeated, significant and avoidable errors in judgment.
Three observations:

• This isn’t a slam-dunk case, either for or against prosecuting Zimmerman. As such, the March of the Race Brigade, led by Sharpton and Jackson, probably does more harm than good. No matter how you slice it, this isn’t a case of institutional racism. Of bad judgment? Sure. Of a police department and prosecutor’s office that may or may not be correctly interpreting Florida law? Perhaps. But this isn’t a flash point in a racial war, and every time the usual suspects come out with their manufactured outrage and their political opportunism — including yet more unnecessary meddling in local law enforcement from Barack Obama — justice for both Martin and Zimmerman fades and cynicism about race relations spikes up.
• I’ve heard people suggest that the real problem here is Florida’s “stand your ground” statute. Florida is one of 30 states with this type of law;  it’s the converse of “duty to retreat” statutes. In Florida, if you’re attacked, you’re authorized to hold your position and fight back when confronted. The argument I’ve heard is that “stand your ground” allows too much of an escalation path for hard cases, and that less violence would result under a “duty to retreat” regime. Maybe. But it seems like rewarding violence and aggression by privileging it under the law empowers the criminals at the expense of the law-abiding.
• The million-dollar question — and one not really subsumed under the Martin incident — is the extent to which a person is legally entitled to defend himself against aggression. Concealed-carry, castle and stand-your-ground laws represent a swing back from the over-reliance on spotty police protection. Even now, liberals are torn; on one hand, they often excoriate police departments for being hotbeds of brutality, racism and misogyny — but these same departments are the gold standard of community policing, whose mere presence justifies any opposition to more relaxed self-defense statutes. Which is it? Are the cops ignorant buffoons, or Teh Awesomz? Pick one position and stick with it, please. In any case, the presumption that civilians are incapable of exercising good judgement while police officers remain beyond reproach is blown out the water by the fact that a police officer is 11 times more likely to engage in wrongful shooting than a validly licensed citizen. (Read the link; it’s a Cato study that outlines the history of gun-control laws and reveals just how much of an innovation they really are in U.S. history.)

The Ryan Budget
Paul Ryan released a kick-ass budget that just passed the House comfortably. It reduces the deficit, moves to a premium-support model for Medicare and protects defense spending. In short: The gentleman from Wisconsin seems to be the only serious adult in Washington when it comes to spending and entitlement reform. Not only has Ryan submitted a workable model, he’s succeeded in changing the entire intellectual dynamic about taxing, spending and reform in Washington. He’s put Obama on defense.
[Read the passage story about the Ryan budget, including a summary of its major points, from WaPo, then digest commentary from Doug Schoen in Forbes.]
Three cheers for Paul Ryan.
Political Etch-a-Sketches
Eric Fehrnstrom’s comments about Romney and the political Etch-a-Sketch seem overblown. Every politician emphasizes some things in a primary race and other things in a general race. To the extent that the election in its final 12 weeks will look radically dissimilar to the GOP nomination fight, the proper reaction to Fehrnstrom’s statement is … duh.
I can understand liberals trying to make hay from his comments, but for conservatives to keep swiping at Romney — well, it feels like an ongoing tantrum. Look, guys, Romney’s our man in 2012 whether you like it or not. We’re not going to have a brokered convention. Paul won’t win the nomination. Gingrich has no path to victory and increasingly looks like a bad-faith candidate. Santrorum lacks organization and money and his negatives (even apart from his self-inflicted gaffes) make an Obama re-election seem more likely than not. At this point, whether you like it or not, the time has come to circle around Romney and focus on sending Obama back to Chicago for good.
Conservatives and Science
One of the big news stories of last week flowed from a survey that suggests that conservatives have little faith in science. Plenty of stories abound about the study; Ars Technica did a decent job of summarizing the key points.
I think the focus is a bit off. I don’t believe that conservatives distrust science per se; you don’t see many Republicans pretending like organic chemistry is a hoax or that the moon landing was staged or that the laws of physics are a left-wing conspiracy to increase taxes by denying people the ability to fly through the air like Superman. What you see, rather, is conservative distrust in what seems like increasingly obvious alignment between “scientific results” and progressive policy preferences. Like scientists, conservatives are also capable of conducting linear regressions to arrive at reasonable conclusions.
Consider:

• The theory of anthropogenic global warming is based on science that pretty much everyone acknowledges requires refinement. Climate scientists have done an excellent job of trying to piece together historical evidence of climate change. Much of it is compelling. When they’re up-front about known problems with the data, I trust their conclusions even more. But there’s a world of difference between saying, “here’s the trend over the last 2,000 years” versus “observation X is definitively caused by human behavior, and therefore we scientists must now dictate to you the specific sociopolitical reforms you must immediately execute to avoid Armageddon, conveniently written up for you by your friends from Greenpeace, so STFU and bow to the consensus we’ve manufactured by suppressing contradictory findings.” Climate science can tell — imperfectly, so far — what’s happening. It can speculate as to why. The leap from observation to political change isn’t the realm of science, however. It’s the realm of politics. When scientists insist that disaster is upon us because of our behavior, when their leaked emails note to the contrary, is it any wonder that people lose confidence in those scientists?
• Watch the Discovery Channel or read some of the scientist profiles in higher-brow popular science magazines. One thing will strike you: No matter the discipline — and, surprisingly, one of the most susceptible seems to be theoretical physics — the group think and polarization is so high that plausible theories don’t get a hearing because senior researchers and theoreticians get an almost partisan adherence to their preferred perspective and won’t listen to countervailing ideas. Study the development of string theory for a case study. Anyone who says “science” isn’t political has never tried to advance a complex theoretical argument lately.
• Scientists are human beings. Human beings tend to be ideological. Why, oh why, must people assume that scientists are immune to ideology? The jig is up, I think, when scientists sign on to a great number of things (the nuclear freeze, global warming scaremongering, etc.) that almost always fall on the left side of the spectrum. Gee. Can you blame conservatives for being skeptical?

All for now.