Posted by: bridget | 19 March 2008

No one tells us the really fun stuff – like whether the results of story #2 helps to avoid those of #1

The NY Times points out that we can’t really expect better of Eliot Spitzer; after all, the animal world is full of infidelity

It’s been done by many other creatures, tens of thousands of other species, by male and female representatives of every taxonomic twig on the great tree of life. Sexual promiscuity is rampant throughout nature, and true faithfulness a fond fantasy.

Animals have never built skyscrapers, written poetry, developed MRIs, or gone to the moon.  Let’s be just like them!  For a fun exercise, substitute “social welfare” (or a grammatically-appropriate equivalent thereof) for “monogamy” in the article.  If animals don’t abscond with each other’s paychecks, why should we?

——-

None of this would have to do with Medicaid, Medicare, and lawsuits, would it?  No, not at all.  It’s all about our looks-obsessed world and has nothing at all to do with the fact that it’s tough to pay off $300,000 in student loans on government reimbursement rates (not to mention the fact that malpractice premiums run into the six figures every year, too).  No, kids, it’s all about our looks-obsessed society!

——-

U.S. District Judge Andrew S. Hanen has repeatedly refused to let the government access private land for the building of a border fence.  (Story here.)  After Kelo v. New London was handed down in 2005, Texas moved to invalidate the decision within its borders by limiting the scope of “public use” takings (here). This won’t be of much help to the Texas landowners, as a border fence would certainly fall within “public use,” and the Texas law only applies against the state government and not the Department of Homeland Security.

Much of the controversy in this case arises from the fact that the Department gave landowners a form to sign, in which they would be given $100 for 12 months of access to their land.  “Access” was not defined.  Those who did not sign the form were promptly sued.  Judge Hanen has repeatedly required negotiations between the government and landowners. 

——-

Britain’s Royal College of Psychiatrists warns that abortions can lead to mental illness (story here).  Yes, folks, several million years of evolution have lead us to love our children.  We are not meant to lose them without the most profound grief.

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Responses

  1. Why would Medicare or Medicaid cause the phenomenon described?

  2. Ian,

    Thank you for asking… I wasn’t sure if anyone would follow. (I try to avoid making my “round up” posts too long.)

    Young physicians are going into fields like dermatology and plastic surgery. Some people theorise that they are going into “looks-based” fields (perhaps for the prestige? better hours?). Radiology, anaesthesiology, and opthamology also have good hours, but those aren’t cited as the top choices for talented medical students. (There is a saying that the ROAD to a stable life is radiology, opthamology, anasethesiology, and dermatology.)

    Plastic surgery is mostly voluntary. (Yes, there are cleft lips, burn victims, and mastectomy patients who desire reconstruction, but they are in the minority.) As such, insurance tends to not pay for it. Providers charge – and receive – the prices they desire; there is no need to accept lower Medicare/Medicaid reimbursement rates. (It’s fascinating, for those interested in health care finance, to see the market-based approach in that area. Google a certain type of plastic surgery, and you can find out exactly how much it will cost. Now, there are several reasons why this doesn’t translate into other areas, such as high-risk surgery with less predictable expenses, but it’s still neat to see the market in action.)

    Medicare and Medicaid reimbursement rates are below average for what doctors normally receive. (Off the top of my head, less than 1/2 of MDs accept Medicaid for this reason. They often have no choice but to accept Medicare, for various reasons.)

    Anyway, plastic surgery tends to not be covered by Medicaid/Medicare, so providers don’t have to accept reduced reimbursement rates.

    It’s a fairly well-known fact that many doctors are seeing their real (not even when adjusted for inflation) salaries decrease, while their hours increase. This is due, in part, to reduced reimbursement rates – you have to see more patients to keep the same income. If you go into a speciality that, by its nature, allows you to avoid Medicare/Medicaid, you can make a lot more money, or keep better hours, or what-have-you.

    That’s just my theory. I was surprised to see it not mentioned, that’s all.

  3. “The NY Times points out that we can’t really expect better of Eliot Spitzer; after all, the animal world is full of infidelity.”

    That was a rather lame apologetic. If indeed it was that. Poor Spitzer, railing against Johns and prostitution and busted at said crime. You know he actually wanted to significantly raise the penalties against men who purchased the services of prostitutes. Amazing.

  4. Re: NYT Piece…

    that’s so lame. Where do they come up with that stuff… and they are aware that animals don’t have divorce court, aren’t they?

    I would respectfully submit from the fact that millions of people for thousands of years have managed to be truly faithful that it is indeed possible. I would also respectfully submit that the NYT editors, if they think we are all like animals, be allowed to live in true harmony with nature and be unleashed upon the jungle in South America with no food, no clothing, and NO modern HUMAN developments. I don’t think that they would be missed.

  5. TT,

    Oh, of course. Maybe he thought that increased penalties would help to break him of his habit. Maybe he’s a total hypocrite.

    W&F,

    ROFL. Oh, I love it. :)

    To be serious: there are huge benefits that arise out of long-term monogamous marriage. It’s pretty much the best thing for you, psychologically. (Being single comes next. Divorce comes after that, followed by widowhood.) There are a lot of things that humans do that really suck at the time (like law school!) that they do for the long-term benefit. One of the great things about our species is the ability to plan ahead, think ahead, and defer gratification for an ultimate good.

  6. I completely agree, theo.

    There are other ways in which hoomans are superior, including the fact that we have way superior toys. I.E. Kick-butt laptops with dual-core processors and massive hard drives that take up zero space and Ferraris that go from 0-60 in less than five seconds > rubber balls to slobber all over. Of course, I suppose the NYT editors would rather have a slobbery ball.

  7. That’s an interesting point. I hadn’t considered it. If true, it’s certainly a fascinating distortion in the market. Still, though, doctors don’t *have* to accept Medicare or Medicaid–there’s a local doc in Brooklyn who doesn’t accept insurance at all, actually. Really fascinating dude:

    http://www.jayparkinsonmd.com/

    The hours point makes more sense, though. I know quite a few lawyers who specialize in tax for that reason. For example, Orthodox Jews would likely have a tough time keeping the Sabbath holy on a litigation schedule; tax is (so I’m told) more plastic in this regard and so you meed a lot of Orthodox Jewish tax attorneys in New York. Neat, eh?

  8. Oh, true, doctors don’t have to accept either. I seem to recall, however, that there is almost a necessity for doctors in many specialties to accept Medicare. (Medicaid is a different story.)

    I’ve heard of doctors who have stopped accepting insurance. Turns out that it costs much less money, as they aren’t spending (IIRC) $43 per patient to process insurance information. Those savings can be passed along to the patients, who have co-payments anyway.

    New York, as I’ve blogged about before, has freakishly expensive individual health insurance. (It’s roughly $30,000/year per person.) Much of this is because insurers cannot give different prices based on health history, age, sex, etc.. The healthy, young people drop out of the insurance pool, which gradually drives up the price for everyone else. Insurance death spiral. At any rate, there is certainly a market incentive in NY for doctors who don’t accept insurance. IIRC, many hospitals and doctors actually charge the uninsured more than the insured, as they negotiate discounts for insurance companies. Even if they don’t, the uninsured, whose billing is much less expensive, subsidise the insured.

  9. For example, Orthodox Jews would likely have a tough time keeping the Sabbath holy on a litigation schedule;

    Why? I’m told that most of litigation gets dumped on you on Friday evening. Seems like it would be fine to work Saturday night, straight through until Monday.
    /utter facetiousness

  10. As far as I know, there is no prostitution in the animal world.

    And some animals are quite faithful to their mates.

  11. “As far as I know, there is no prostitution in the animal world. ”

    Bonobos apes have been observed trading food for sex…not sure if that counts as prostitution…but, there you are.

    That doesn’t mean that WE should do it…it just means that higher-level functions are layered on top of lower-level functions. The lower-level functions are pervasive and persistant. It doesn’t mean it’s OK for us to violate our morals because of them, but I guess it means that it’s a little silly to be surprised and outraged when it happens as some people in our society are.

    as a matter of fact, I am finding some of the outrage to be raising uncharitable “Methinks they doth protest too much” thoughts in me…which I am trying to repress and be not-snarky about.

    It’s not a completly sucessful struggle as you see.

    :-)

  12. SST/Teresa – I’ll let you two bicker about prostitution in the animal world. I’ll watch from here with (chocolate-covered?) popcorn.

    Teresa,

    I think that a lot of the outrage (compare with his successor, who just admitted to an extramarital affair) stems from several sources:
    *Spitzer’s incredible hypocrisy in selling himself as a moral person, who, in part, cracked down on money movement and prostitution, while engaging in the same (illegal) activity himself;
    *The illegality, vis-a-vis an extramarital relationship;
    *The money involved – $4,300 for a romp between the sheets;
    *the lack of emotional aspects – she’s a lot younger, it’s not an extramarital affair driven by mutual love and caring. It’s not about someone whose marriage is failing, who is staying with his wife for the kids, and who, either in a moment of weakness or through a long development of a relationship, began an extramarital affair.

    Bill Clinton caught a lot of flack for the age and power differential. Whether or not it’s “biological,” the fact is, you’ll get a lot of grief for going after vulnerable women. I think we ought to encourage that. If you’re JFK and going after Marilyn, well, she can tell you to screw off. Find someone who is a babe and powerful in her own right, and have your affair with her. The public won’t be nearly so upset.

  13. There are other ways in which hoomans are superior, including the fact that we have way superior toys.

    Damn straight! :)

  14. Theo,

    I don’t intend to bicker about prostitution in the animal world. Just offering something that might be of interest.

    Along that line…in reletive proportion, the 6-meter-tall towers of some species of termite might be considered sky-scraper equivilants. :-)

    Sorry…I was only allowed to watch educational television as a child (watching TV was one of the things that I conspired to “get away with” as a child – per our mommy zabs convo)

    This is the only use I will every have for such knowledge. Please don’t hit me.

    I wear glasses.

    And snort when I laugh.

    :-)

  15. Theo,

    I’d never deny that Spitzer is a monumental skank on many levels, and it is satisfying to see him hoisted on his own pitard (why does that always sound vaguely dirty, even if you know what it really means?).

    There’s just a few shrill public voices (not here) that seem to always pipe up with their hyperventallating in a case of near-vapors over infidelity as though it were the most inhuman thing imaginable.

    The fact that it appears to be partly a result of a ubiquitous bilogical tendancy doesn’t excuse it, but it might perhaps explain why it seems to keep happening to people in spite of themselves.

    To me, it describes the struggle rather than arguing aginst the struggle.

  16. Teresa,

    I use “bicker” in a very mild sense. :) Hey, I spent more time as a child reading than I did watching TV. My mum said that books were always allowed. We got read to at night before bed. Made for a terrific nerd.

    (Laughing) at “hoist on his own petard”. For those wondering, it was an Elizabethan-era explosive.

    Query whether there is value to the condemnation. I believe there is – it reinfornces community values and decries the action. Pretty much every thing that someone does wrong is because they gave in to their animal, amoral/immoral natures without consideration for their long-term contentment (lacking a better term – maybe honour?) and others around them. Perhaps all of those motivations are evolutionary, or animalistic, but that doesn’t make them right. I joke about substituting “welfare” for “monogamy,” but what about “murder”?

  17. Theo,

    LOL about the reading. When we were kids, reading was one of the few things that were a “get out of jail free” card for being assigned random tasks. If mom found somthing that needed to be done, and went in search of a kid to do it…you were off the hook if you were reading when she came to find you. Not for regular chores mind you, but for the other ones. We were allowed one show/week to watch on our own. I ping-ponged between Cosmos, Monty Python’s Flying Circus, and Dr. Who (we only got two TV channels living out in the sticks…and one was PBS)

    Can I clarify a little here? Not sure it’s necessary, but you can’t be too careful in the written word.

    I’m not saying people shouldn’t condemn his actions.

    I’m just saying that in this case (and many others) the “condemnation” exercised by some people borders on onanistic. That’s all.

    As for a left-over fitness trait from a different time with a different set of selection pressures not having inherent moral value, I completely agree.

  18. Almost all of the condemnation I’ve seen has been about his asking/allowing his wife to stand beside him in the press conference.

    The rest has been about the hypocrisy of his running people into the ground on the least hint of impropriety, while he was doing this.

    I hated his speech. He needs to spend time with his wife. The man was going to prostitutes right up till the second he was caught, no evidence of remorse or any intention to quit before that moment, and NOW he has to spend time with his wife? He couldn’t have thought he needed to do that last week?

  19. Teresa,

    Clarification always welcome. :) I think we agree with each other.

    Laura,

    Preach it, sister! (I mean that in a good way.) You’re completely right.

  20. What ought to be leaping to mind with dermatologists are the phrases luxury good, monopoly, and restricted supply. The source of payments isn’t what drives the pricing there. It’s the extreme scarcity of highly-qualified providers.

    If Medicare/Medicaid were responsible, oncologists and cardiologists would be starving. Instead they’re up at the top of specialty pay ranks for physicians. By some small coincidence, they’re also the top users of the most expensive technology and do the highest volume of delicate surgical procedures. As are dermatologists. Imagine that.

    And if you look at the lower end of physician specialty pay, you see the reverse. By that same small coincidence the lowest salaries go to specialties such as family practice and internal medicine that are geared more to diagnostics and treating the more common illnesses, not to surgery and high-tech treatments. There Medicaid/Medicare does have an impact, as the more common and easily administered tests and procedures are generically down-priced and flat-rated.

    The impact of malpractice insurance varies greatly from state to state and by specialty. The two specialties hit hardest by malpractice insurance rates are obstetrics and neurology. Babies and brains.

  21. I don’t know about cardiologists, but the oncologist supply is shrinking.

    Cardiologists do get to put their hands on new technology, but it seems to be helping people live longer, which is the goal, right? Whereas heart disease used to be the #1 killer, now people live long enough to get cancer — which went from #2 to #1.

    Oncology is a tough business. My income has steadily gone down the past 3 years. It is still good, mind you, but going down. Yet I am busier than ever. The stress is higher, patient expectations are higher, treatment options and patient cases are more complicated, and time with my family much less.

    The real bottom line here is that medicine now operates in a price-controlled system. That sort of thing has never worked.

    A doctor’s overhead (rent, employee wages, supplies, regulatory fees, etc) goes up with the price of everything else. Yet the government (Medicare) and private insurance arrangements prevent us from making the necessary adjustments.

    On the other hand, as Theo points out, services which fall outside of insurance and government strangleholds work in a free market where supply and demand set the price. In addition to the cosmetic services mentioned, I would also add things like Lasik and other ophthalmology procedures.

    This is also why you see more cosmetic dentistry. Dentists kept themselves out of the insurance game for years. But as they have gradually succumbed, the smart ones are backing out and getting into cosmetics.

    None of this is necessarily what is good or right, but it is the reality of the way things are…

  22. If Medicare/Medicaid were responsible, oncologists and cardiologists would be starving

    No, because Medicare/aid reimbursement rates are much, much higher for those professions than for other professions. There are some 400 or 500 codes used for reimbursement, which are then adjusted based on geographic area (and a few other things). I seem to recall that cardiologists do quite well under government reimbursement, although other professions suffer.

  23. Vance,

    I’m glad you weighed in. Thank you for your perspective. :)

  24. No, because Medicare/aid reimbursement rates are much, much higher for those professions than for other professions

    And that would be why, again? Think it through.

    Price controls can indeed restrict income, but price controls from the government can only affect that portion of income that comes from government. And price controls from private insurors are part and parcel of the market process.

    No argument that our health care system sucks major in spots, including for some providers. But blaming it all on the government is missing the forest for the trees, and believing that the free market can somehow “solve” the many problems is naive. The best we can do is make the system as efficient as possible, and suck up the fact that costs will keep increasing anyway. Making the system more efficient will NOT give doctors more free time and income.

    Then we get the joy of deciding who gets to do without what care, and on what basis. Because when you have unlimited demand for limited resources, rationing is inherent.

  25. Tully,

    I thought the point of the Libertarian viewpoint was that it is “more fair” to allow the market to do the rationing.

    Kind of like that exercise in Philosophy 101 where the prof asks the moral quandry of the train hurlting toward the cliff with a couple hundred people on it. You could throw the switch and save them all, but it would swtch the train onto another track, where a toddler is sleeping.

    The
    “moral answer” of course, is to do nothing, because if you leave things as they occure naturally, natural phenomenon do not have a moral componant, so there is no moral weight to allowing the trainful of people to die.

    However, if you interfere and throuw a switch, you have made a considered action, and decided to kill the toddler.

    If a bunch of people go without healthcare due to the amoral (or for some Libertarians inherantly moral) market forces, that is just the way things are, but as soon as you start making concious decisions…then you bear moral reponsibility for the outcome.

    But I’ll let the Libertarians in the bunch have the final say if they think my understanding of the situation is correct. I’m still trying to figure out the philosophy.

  26. “The ‘moral answer’ of course, is to do nothing, because if you leave things as they occure naturally, natural phenomenon do not have a moral componant, so there is no moral weight to allowing the trainful of people to die.”

    It’s natural to ride on trains?

  27. Laura,

    don’t look at me…I was just there to fulfill my requirements distribution. :-)

  28. Briefly, because I’m hungry and want to go running….

    Yes, there is a moral distinction between acting so as to harm a person and failing to act in a way that does not avert harm. James Childress discussed this in his treatise on bioethics.

    The relevant question is not whether or not a train is found in nature, or any other situation would be present in the pre-Bronze Age (perhaps the Stone Age is acceptable?), but whether or not there is a moral duty to avoid the harm, and whether avoidance of such harm can justify harming other individuals. Consider that we could save several lives, right now, by harvesting all of my organs. Two (very) healthy lungs, incredibly strong and cholesterol-free heart, two kidneys in great working order that would save the lives of people in dialysis, a liver that could be cut in half to save the lives of two people – heck, even a pancreas whose sole problem is producing too much insulin. Think of the lives that could be saved! Yet, no one (thankfully) has thrown me on the operating table and declared that my life ought to be sacrificed in order to save a half-dozen other lives, as there is no way I can claim my existence to be superiour to theirs.

    The primary duty we all owe to each other is that of non-aggression. When other duties – such as beneficience – conflict with that (such as with the train example), we ought to let non-aggression trump beneficience.

    Now, how this all applies to health care… I’ll get to that in a few. :)


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