Tuesday, February 24, 2009

"State of the Union" Live-Blog

Welcome back to the Doctor's Office in scenic Pittsburgh, PA. I've been meaning to getting back to the blog, and the President's pseudo-State of the Union speech seems as good an entry point as any, so here goes. As usual, I'm watching on MSNBC:

8:58 - Unprofessional move by Chris Matthews, taking a huge whack at Bobby Jindal, the Louisiana Governor, who is giving the GOP response to the President's speech. Says he's "not at all impressed with Jindal". Way to make MSNBC look ridiculous!

9:00 - That reminds me, and just skip to the next one if you don't watch MSNBC kind of a lot, but are you as annoyed as I am with that ridiculous "Hardball" commercial where Matthews says "I hate to teach politics to the experts, but it's fun." in just the jerkiest way possible?

9:04 - Whilst they're still introducing people, let me point you over to an article on fivethirtyeight.com written by a Berkeley linguistics professor about Obama's use of language as unconscious persuasion.

9:08 - Can't they cut out all the slowly introducing people while everyone just sort of mills about and shakes hands with people they've worked with in Congress for 20 years? Isn't there a huge economic crisis y'all could be working on?

9:10 - It's weird, but I still don't really think of Obama as the President. Like, my first-hundredth-of-a-second "how do you think of Barack Obama?" reaction does not include being President. He's still a candidate in my mind.

9:13 - Did Orrin Hatch just grab Obama by the back of the neck? I know he meant it as a friendly gesture, but the man is President!

9:14 - Damn, while typing I apparently missed Hillary kissing Obama (presumably on the cheek). Oh the perils of live-blogging

9:15 - The applauding continuously while the "star" thanks everyone in an attempt to quiet them is strangely "Tonight Show"-ish.

9:16 - Once again Obama steps on a line. He was supposed to wait for Speaker Pelosi to introduce him, but instead started right in on the first few words of his speech.

9:18 - Oh thank God, MSNBC has the opinion meter thingy where two on-screen lines represent how much Obama or McCain voters "like" what he is saying! Now I don't have to worry about forming my own opinion

9:19 - It is oddly hypnotic, though

9:20 - Let's see how smart McCain voters are. He's setting up to trash Bush's policies. I wonder when McCain voters realize it.

9:24 - OK, he didn't go at it nearly as hard as I thought he might. But he definitely gave a few jabs that went unnoticed

9:25 - Aw, look at Joe act all surprised and embarrassed after being complimented by the President. It's like he didn't know it was coming.

9:27 - He's trying to be more optimistic tonight than he's been previously, emphasizing not the "we're in trouble" and more on the "we won't be forever".

9:29 - So why are people worried about nationalizing banks? These banks, by all laws of capitalism, should have gone out of business. But the government stepped in and kept them afloat. So why should people get to keep their shares of a company which should have gone out of business? The only moral argument for people being rich is that the market determined their value to be that high. The market dictates that people who had millions of dollars in Citigroup, AIG etc should have lost their entire investment. So why are we worrying about wiping out the fake "value" of their investment?

9:33 - My oh my, but that opinion meter graph is distracting

9:34 - It's fun when there's a partisan issue that only the Democrats stand up and applaud for. Then you can see a stark representation of their dominant majority in Congress.

9:37 - It's so bizarre to have a President who argues for government, and not calling it the problem.

9:39 - Maybe this is a sign I watch too much sports, but Pelosi is killing Biden at starting standing ovations. Is Biden injured?

9:41 - All this bailout stuff has totally crushed my sense of the value of money in politics. When Obama mentions $15 billion a year for green energy research, my first response is "hmmpf! chump change..."

9:43 - I always thought they rehearsed when to burst into applause. Like, someone would go through the speech with the VP (and Speaker, if they're all the same party) and figure out when to stand up. Pelosi clearly has her own agenda.

9:44 - Isn't it ridiculous that whatever spellchecker this site uses still doesn't recognize "Pelosi" or "Obama"?

9:46 - Thoroughly uninspiring section on health care. I don't have anything to say about it.

9:49 - Having as your national goal reclaiming the highest percentage in the world of the population with college degrees doesn't quite have the inspirational cache of sending a man to the moon

9:51 - He's starting to overuse the "no red or blue states, on the United States"-"not a Democratic issue, not a Republican issue, but an American issue" construction.

9:53 - Oh, in case you didn't hear, the White House announced today that, instead of having all our troops out of Iraq in 16 months, as Obama aimed for during the campaign, he will now aim to have all combat troops out in 19 months. Damn

9:56 - Nice job pointing out the ridiculousness of the Bush policy to not include the costs of the wars in Iraq and Afghanistan when calculating the deficit. That's hundreds of billions of dollars a year that they just didn't include on the supposed "bottom line".

9:57 - Of course, it is not without advantage to Obama to make this change. It's rhetorically easier to double a trillion dollar deficit than triple a half a trillion dollar deficit

10:00 - How sad that I'm glad to hear the President say we don't torture and to believe him. How was that not always a given?

10:05 - Bland, "inspirational" section here. Not really much to say

10:06 - ...so let's talk some more about the audience reaction lines. McCain's voters have pretty consistently been higher than the Obama voters' line. I guess the redliners are trying to be bipartisan or something.

10:08 - In the audience, Ohio Sen. looks like he just had a stroke.

10:09 - He really is pushing hard for the stimulus and budget being mostly things he wants to do anyway (health care, green energy, etc.). Starting out his term going for a home run. OK speech without any particularly memorable moments.

10:13 - Getting ready for Jindal. I honestly don't know why the opposing party always does these. It's pretty much impossible to invent a juxtaposition that makes you look shittier than comparing yourself while standing in an empty office to the Leader of the Free World addressing a joint session of Congress.

10:15 - And Matthews comes around again to dump on Jindal before he even speaks. I really would like it if MSNBC would make at least some effort to separate their opinion people from their news people.

10:24 - Did someone just say "Oh god" under their breath as Jindal came on? Was that Keith?

10:25 - Having never heard him talk in this setting before, I can tell you that my first impression is that he's not very good at this. Neither conversational nor formal. Just kinda silly and fake.

10:29 - Neither he nor Obama have had much in terms of specifics. Such a shame

10:32 - As a doctor, I can tell you that we already have a system where decisions are NOT made by a patient and their doctor. Insurance companies have a lot of say. To state that universal care would ruin a pure patient/doctor relationship is ridiculous

10:33 - Obama voters are not feeling the obligation that McCain voters were to support the other guy. Much lower blue scores for Jindal than red scores for Obama

10:36 - Not great. Nothing memorable from either. I don't think anyone will remember tonight on either side.

Tuesday, February 10, 2009

Things Only Government Has Motivation to Do

One of the things about free-market capitalism is that, if there's no one who has an economic incentive to do a particular thing, it's very unlikely that thing will be done. Government, by having vast sums of money (stolen at gunpoint from the people, I'll grant you) along with incentives other than profit, is uniquely situated to perform those tasks in our society which, while beneficial to society as a whole, are not economically beneficial to the performer.

An example is the FDA. Pfizer/Merck/et. al have a huge motivation to get new drugs on the market. They devote billions of dollars a year to development and marketing of new medications. There are few entities, however, who stand to profit by having new drugs not reach the market, or by ensuring that side effects are minimized. Even insurance companies will often not have an economic incentive to stop new drugs; just because a few people might die because of a new med doesn't mean that there's not money to be made by providing it to the other patients who don't have a problem with the med.

In the days before the FDA, anyone could bring any product to market. Since there was no one to oppose new products, we wound up with an era of snake oil salesmen and quack doctors. Eventually, because government had motivation to test and regulate new meds even though they would lose money doing so, we are now relatively protected from potentially harmful products.

Of course, it is imperfect protection. Due to the massive sums of money involved, along with chronic underfunding of the FDA, pharmaceutical companies are still able to ram harmful drugs through the process. Teams of lawyers, marketers, lobbyists and paid researchers line up on one side versus, usually, a single FDA scientist who is tasked with verifying thousands of pages of research on a new medication. And this single scientist is tasked with convincing FDA commissioners who know they have a lucrative drug company job waiting for them if they are perceived as being "industry-friendly" to rule against that industry. So the FDA is not without its problems, but it's better than nothing, which is what we'd get if it were left up to the market.

The economic stimulus, as discussed by President Obama last night, is another example of government stepping in when the market does not provide incentive for changes that benefit society. Because people are afraid of a continuing worsening of the economy, few are spending and investing money. Therefore, the economy continues to suffer, leading to a downward spiral of increasing fear and decreasing spending. A single, private entity isn't going to be the first to jump out to break the cycle; they'd lost all their money. In this market, if a CEO is able to keep his company afloat, he'd probably get huge bonuses, based on the bonuses Wall Street gives to people who drive their companies into the ground. So what's the motivation for this CEO to risk his company's future, even if failing to take that risk hurts the general economy?

It is up to government, therefore, to act. Only government has both the access to resources as well as the motivation to spend those resources now. Only government spending can break the cycle we're in. Giving a few hundred billion in tax cuts isn't going to do it; there's already trillions of dollars in private money that is on the sidelines in this economy, waiting for a sign to jump into the market.

One more place where government can act where no one else has an economic motive to do so is in social programs, an example of which is free condom programs. For lots of reasons (embarassment, not thinking ahead, etc.), young folk often don't use condoms. And society then has to deal with increased numbers of STDs and unintended pregnancies. Based on insurance companies' refusal to provide free condoms, it appears there is no private entity with an economic motivation to give teens free condoms. So it falls to government to do so. Let's hope voters keep giving government non-economic motivation to keep at it.

Monday, February 2, 2009

Things Only Government Can Do

Driving in Morgantown ,WV (home of WVU and where I'm doing my pediatrics residency) when its snowing can be truly awful. Numerous hospital staff who have worked in Morgantown for decades swear to me that the snowplows don't even come out if school is cancelled that morning. And so, after a 70 mile commute, on a snowy day I spend at least an extra half-hour sitting in traffic on the 2 miles of fairly-major-but-not-Interstate roads between I-79 and the hospital.

Most of my readership probably remembers the widespread blackout in August 2003, where power was lost throughout the eastern United States.

In Kentucky, Americans are dying because of poor infrastructure. Carbon monoxide poisoning was to blame, killing people who were attempting to warm their homes that were left without electricity during record cold.

And then there's the 13 Americans who, like me and presumably you, take the risk to drive across a bridge every day lost their lives when the I-35W bridge in Minneapolis collapsed into the Mississippi River.

The American Society of Civil Engineers (i.e., people who are the experts when it comes to this sort of thing) give the existing infrastructure in the United States a "D" grade. They estimate that it would cost $2.2 trillion to get our roads, power lines and other infrastructure up to code.

As someone who loses hours to traffic, is more productive with electricity powering my workplace and my computer, and doesn't want to drown in my Honda, I really wish our leaders, knowing that they A) are tasked with creating jobs (and/or allowing private industry to create jobs) for millions of Americans, and B) have to maintain and improve the infrastructure that allows Americans to be productive and live modern lives, could figure out a way to get millions of Americans working on maintaining and improving infrastructure.