1. Life on the home front is progressing smoothly. I’ve added a few extra things to the apartment, including a pair of lovely oak bookcases from my mother and a self-built chalkboard with magnetic primer in my office. Not bad, although I may sand the chalkboard and repaint it just to smooth it out a bit more.
2. Two recent neighborhood additions: A new person in Apt. 3 — a ”mid-20s guy” as my landlord put it – and a 1-year-old German Shepherd puppy. The latter belongs to my neighbor, a police officer, who has now joined the K9 unit with his new little bundle of black furry yipping. Which isn’t bad, actually, and I give Todd credit for bringing me cigars to defray the dog’s occasional noise. He’s more bothered by it than I am, I think.
3. The writing group seems to be flowing well. They’re a fun(ky) bunch and although we don’t do a whole lot of writing, we do socialize and pass witticisms in lieu of generating work product. So it works out in the end. Plus there’s pizza.
4. Time flies. It wasn’t that long ago that I sat down and thought out what I wanted to accomplish in the spring/summer seasons … and now we’re in mid-May. I won’t hit a few goals as soon as I had planned, but others are actually ahead of schedule. For example, in a few weeks I’m heading to Kalamazoo for FCC amateur radio license testing.
5. Saw The Avengers yesterday, in 3D. It was a fun movie. The brief scene with Hulk and Loki at Stark Tower was, all by itself, worth the admission price. From a cast perspective, I have cautious optimism that Chris Hemsworth could be more than just another brainless beefcake actor and I rejoice that Robert Downey Jr. found his way again after a rough spot a decade ago.
6. Last week I met my old college friend Matt for cigars at Grand River Cigar, but because the smoke shop was hosting a Xicar event the place was packed with more than 30 people, including a local priest, a biker with a home humidor the size of my office and several upstanding citizens engaged in local GOP politics. I lingered for more than four hours and had a couple of cigars, a few drams of Dalwhinnie and so much great conversation that I ended up a bit hoarse.
7. A few weeks ago I attended a fun and oh-so-nerdy game night in DeWitt with a group of guys. Picture it: Three rounds of a game focused on the Constitutional Convention, with three lawyers and me. Woohoo.
8. In a week or so Rob is hosting the next cigar night; we’ll have grilled steaks and Brad is tentatively scheduled to bring his homebrew. Should be a grand old time.
9. Work has been crazy — I’ve had so much contract stuff crossing my desk that it’s a challenge keeping up. Nice problem to have.
10. So … Barack Obama was outed by Joe Biden. Cute.
11. The Vegas trip is coming up. I’m excited. We’ll start the week on the Strip and end up downtown — on Freemont Street, I hope, instead of the hoosegow.
12. It’s still not clear where I’ll be in early August — I’ve been invited to an Italy trip with my church choir, but I’m also required to chair a session at this year’s Joint Statistical Meetings in San Diego. Of course, the two events overlap. I thought I might be able to get out of the JSM commitment, but now it appears I will be presenting a new Web strategery for our section at the executive committee meeting, so … ugh.

I’ve been reading a really rather unexpectedly snarly book about English use and abuse, but the contents leave me scratching my head. In all my years in West Michigan, for example, I can’t recall ever hearing miscellaneous enunciated as misk-uh-LANE-us.

All for now.

In the moments when their lives are laid barest, the sick, dying and imprisoned fall into two camps. The first remembers happy memories and remains at peace with whatever lies ahead. The other obsesses about things left undone or sentiments left unsaid. But the latter group’s obsessions relate to people or to experiences — almost never to each person’s material condition. I have yet to meet a person in prison or in a hospital who spent much time thinking about property or money or financial histories or credit scores.

The life lessons I’ve gleaned from ministering to the sick and imprisoned came into sharp relief this week, subsequent to a casual conversation with a few friends over cigars and adult beverages. The TL;DR version: Financial freedom as a concept is important to a fully flourishing life, but there’s remarkable disagreement as to what the idea entails.

I thought about it and it seems like we can put “financial freedom” on a scale of sorts:

1. No income, no assets, no or bad credit. Significant life constraints.
2. Limited income or assets. Bad credit. Routine difficulty in meeting life needs.
3. Limited income or assets, but average or good credit. Holding one’s own.
4. Adequate income, bad credit. Potential for comfort demolished by personal financial mismanagement.
5. Adequate income, average/good credit. Lives a comfortable, if not luxurious, lifestyle.
6. Above-median income or assets. Bad credit; does fine day-to-day but options for major purchases (mortgages, auto loans) reduced.
7. Above-median income or assets, good credit. All needs met and can “splurge” without really thinking about it.
8. Significant income/assets. Life’s an oyster.

As I think about my friends and family, I see them falling all over my eight-point scale. I know one person who makes due on surprisingly little income. I know another who spends every penny of the many, many dollars he makes. I also know a well-off lawyer who won’t spend to save his life.

I also think about Steve, a guy I knew from the Herald. He had one life goal: To get his degree, buy an old Airstream trailer and head for the West Texas desert. He wanted a motorcycle, a dog, a shotgun and the freedom to explore his art and photography without worrying about keeping up with the Joneses.

Inasmuch as people stress over money, when you’re on your deathbed you don’t generally lament that you didn’t have a higher credit score.

Perhaps the truth is more Biblical: Financial freedom isn’t something that Dave Ramsey confers, but rather it’s a state of mind. If you can meet your needs, you’re free; if you can’t, then it’s time to change your life plan.

Just remember: At the end, no one cares.

The newest SkyDrive release fixes these shortcomings. The beta app released on Monday adds a set of folders under the user account that background sync across connected devices and the cloud service; the devices and account are managed through a single Windows Live ID. Better yet, Mesh becomes superfluous because users can remotely traverse the complete file systems of connected computers (with SMS-based two-step authorization required) provided they’re powered-up.

Initial impressions:

• The SkyDrive desktop app installed quickly and provided adequate instruction about the new SkyDrive folder under the user’s account.
• First-pass uploading took a while. I had the 25 GB storage option already enabled by virtue of having had more than 5 GB of data on my account. I purchased an additional 20 GB ($10/year) to give me a total of 45 GB. Uploading roughly 25 GB of additional data took almost two full days. Whether this slowness is because of Microsoft bottlenecks or because our local Comcast service provides blazing-fast downloads but snail-like uploads, is a question I cannot answer.
• Once all my files migrated between my desktop computer (running Windows 8 Consumer Preview) and my netbook (running Windows 7 Professional) through the SkyDrive tool, life was good. I’ve tested a few different sync scenarios and the service performs flawlessly.
• The SkyDrive app for my Windows Phone 7.5 took it all in stride. The recently refreshed WP7 app added multi-select capability — a delicious addition to the feature set.
• For some odd reason, I cannot actually access SkyDrive on IE 10 on the Win8 CP.  The site kills the IE instance. Every. Single. Time.
• The desktop app’s notification icon provides a lovely little green bar animation to indicate a synchronization action in progress. Nice touch.

Suggestions for other SkyDrive users:

1. The SkyDrive folder tree on your local machine contains real files, not pointers to network files. If you re-map your Windows libraries to point to your SkyDrive folder tree, you get an instant, full-fledged cloud option with zero additional work and complete transparency as you go about your daily computer-related tasks.  If you work offline, you need not worry about losing data; the service will sync the next time you have a network connection.
2. Another tip: Put a desktop shortcut to a “temp” folder that’s stored in your SkyDrive folder tree to keep work-in-progress/unsorted files up-to-date across all your devices with a minimum of drama.
3. I formerly employed an external hard drive as my “source of truth” storage location, with Live Mesh keeping a subset of folders in sync between that HDD and the Mesh servers (and, thereby, a folder tree on my netbook). I no longer have a need for Mesh at all. Team Microsoft fixed the “wall between Skydrive and Mesh” that so haunted my nightmares these past few years. And I probably will use the external drive only for archiving huge raw temp audio files from the podcast I produce.
4. Have an Android tablet? Microsoft highlights a few third-party apps that integrate with SkyDrive. I use one on my dual-boot Touchpad and have no trouble with it whatsoever.

Short version: The SkyDrive update brings this cloud solution into maturity; it’s fast, easy-to-use and comprehensive — earning this humble scribe’s enthusiastic endorsement.

Responding to McClay’s reference to Alasdair MacIntyre’s argument “that emotivist propositions have replaced rational argument over objective moral ends,” Rogers advances the claim that “liberals believe that the emotivistic move reduces conflict and opens venues for conversation rather than conflict….” Why avoid conflict? Rogers suggests that the “residual horror at the devastation of the Thirty Years’ War, underlined by the English Civil Wars, still prompts a visceral reaction by many to any hint of religion in the public square,” and thus by extension, contemporary politics must answer “whether religious belief is intrinsically dangerous and whether claims of absolute truth are consistent with forms of toleration sufficiently robust to offer credible assurance that devastatingly religious conflict will not be repeated.”

Put more simply: Contemporary liberals favor language and arguments that privilege individual feelings or perspectives, because doing so provides a partial block against abstract arguments sourced from absolute truth statements that, if left unchecked, could engender wide-scale social conflict. Hence the concern about Rick Santorum establishing a “theocracy” or the fear that conservative political ends constitute a “war on [insert demographic group here]” even when dispassionate observers believe the fears rhetorically disingenuous.

Take, for example, the gay marriage debate. Proponents on the left usually stake their arguments in a broad reading of human autonomy. Liberals rarely discuss marriage as a socioeconomic institution or a sacramental event and frequently dismiss communitarian objections to gay or plural marriage as inherently discriminatory. Instead, they talk about “marriage equality” or “the right to love whomever you wish” — language that elevates a person’s experiences and his emotional response thereto as an intrinsic good. When you pit a self-referential, emotional plea against an argument that prevents someone from allegedly being true to himself because of inflexible, “uncaring” institutional rules, the progressive will typically favor the former no matter how the latter’s logic unfolds. Why? Because if dispassionate social norms may be brandished to allegedly prevent a person from enjoying the fullness of a loving relationship, what other sociocultural violence may these norms inflict? Thus, the norm itself must be challenged to protect not just gays but everyone from the risk that those rules may be used as weapons against other people in other contexts.

In short: Progressives believe that sociocultural principles founded on abstract or religious truth-claims, by their very nature, increase the risk of theoretical social violence because they infringe on the self-actualization of people who don’t support those norms.  So, hey hey ho ho, your abstract norms have got to go!

Rogers’ insight illuminates in a different way the reasons that the progressive left disdains cultural authority and religion and privileges personal authenticity and a person’s emotional response. Yet it doesn’t answer the Lenin Question: What is to be done?

Commentators decry the polarization in the American electorate, yet the lion’s share of the reason has nothing to do with partisan affiliation but rather with the latent worldview differences between contemporary progressives and everyone else. No matter how you construct the arguments about the proper size and scope of government or fair tax rates or regulatory reform, you cannot escape epistemology. If a progressive by default will often reject “common good” or “historical practice” arguments because they conflict with an emotivist rebuttal, there’s no real chance for a meeting of the minds to resolve pressing political problems. You cannot negotiate or debate in good faith when the discussants haven’t resolved the stark differences in their logic models and value systems.

The central insight into the entire question raised by McClay is that contemporary liberalism faces an existential crisis; from a purely intellectual standpoint, the progressive inheritance is largely spent, with no clear path forward for the dominant political philosophy of the Western world. The question, though, is what happens next. Can liberalism adapt and reform? Will it be supplanted by something different? Will it collapse and some other value system fill the gap (as seems to be happening with the increasingly Islamization of parts of Europe)?

As a conservative in the contemporary American ideological sense, I have a vested interest in seeing liberalism as a political system rehabilitated and strengthened. Alas, it seems that the “fix” has to occur from within, but it’s not clear that anything short of crisis will help today’s progressives to re-evaluate the long-term self-destructive ends that their worldview logically entails.

As I recall, I made some pithy comment to one of them about their observations that started our shared conversation. Short version: They thought that “older people” (defined, as best as I could tell, as folks over 30) shouldn’t try to dress like college students. I was more agnostic about it.

On their major point, I am sympathetic. On one hand, it’s not my business to tell people how to dress. If a 90-year-old wants to rock out a faux hawk with his Volcom T-shirt, leather bracelets and tartan Vans, more power to him. Just like the 19-year-old with the tweed jacket and bow tie is free to dress as he likes.

But people are people, and our clothes help tell the story about who we are. They’re an immediate visual indicator of our tastes and socioeconomic status. They identify any sociocultural tribe to which we voluntarily associate. So, although one’s apparel isn’t anyone else’s business — clothes do send a message. There’s a degree of prudence in playing the game.

As it happens, the conversation last week coincided with the the arrival of a few magazines, including Men’s Health and Details, that shared their own perspective on what men ought to wear in the summer 2012 season. Me being me, I then spent the better part of a week thinking through the somewhat insecure question of what message my own clothes send, and what a 30-something guy should or shouldn’t wear. I even scoured some style magazines and websites (well, briefly — I was interested in the subject, not obsessed by it).

Observations from the self-appointed guardians of male style:

1. Despite the comments about “men in their 30s,” the real age bracket is more like 27-to-37, although a person’s weight and visual signs of aging (grey hair, wrinkles) affect the sorting. A 35-year-old who worshipped the sun during his college years may well fall into the over-40 bucket if he looks like a wrinkled prune, whereas a 35-year-old athlete with great teeth and good hair can still pull off the 20-something look without difficulty.
2. Men who are clearly adults and no longer in their extended adolescence should wear clothes that fit. Well-tailored clothes send a message of competence. Too-tight or too-loose equals too sloppy. As do hoodies.
3. Avoid no-name “uniform” clothes, even if you’re married with children. The Gap jeans and T-shirt (or polo), or the khakis and button-down, that are worn often enough to constitute an informal uniform are a sign of surrender. Vary it up.
4. Brands matter more. Certain labels are associated with — indeed, are iconic of — youth. Think Abercrombie or Hollister, then avoid them. Some stores, like The Buckle, cross age brackets (especially if you’re a Nickelback fan), but the older you get the more ridiculous you look when you peacock. Trendy clothing for the urban chic look for the 30-somethings — the kind that gets you a pass to the front of the line at an upper-tier Vegas nightclub – usually cannot be acquired at an average suburban shopping mall, although if you’re into the vintage scene a local consignment store may prove useful. Guys with the physique to pull off a closely tailored look may find Express or its equivalents an good choice.
5. Accessories count. An expensive watch, a well-designed belt or a couple of pairs of high-quality shoes matter and can set off an otherwise routine wardrobe selection. As do jewelry choices: The clamshell should permanently retire, as should the 60-gauge spacers, but a couple of subdued bracelets or a ring or two are fine.
6. If you wear hats, substitute the ratty, backwards-turned baseball cap for something like a newsboy or a thin-brimmed fedora.
7. Hair styles convey station. If your hair says, “I could only get a job in an indie records store” and you’re in your 30s, you’re telegraphing a future of lifetime earnings in the lower quintile. Not an attractive prospect for potential mates. And if you’re thinning on top, for heaven’s sake, lose the ponytail. No one likes looking at Gallagher.
8. Tattoo with caution. When skin sags, so does the ink.
9. Always dress a half-step more crisply than everyone else, regardless of the situation.
10. Watch color palettes. If (like me) you’re brown-haired and hazel-eyed, you will look better with earth tones like browns and greens and oranges. This rule governs accessories, too — I’d look better with golds than silvers, which is unfortunate since I think black/grey/blue/silver makes the prettiest color combo. Find a way to flash color, like a pocket square or a tie or bold socks or something.

The core message that today’s style sentries share makes a lot of sense: As you age, your clothes serve as at-a-glance proxies about your socioeconomic status and cultural affiliations. Dress how you like, but the guidance seems to favor fine things — watches, shoes — and well-tailored clothes set off by bold colors.

Decent advice … that I usually manage to ignore.

You hear the lament from President Obama himself. In comments delivered last week in the Rose Garden, he said: “People’s lives are affected by the lack of availability of health care, the unaffordability of health care, or their inability to get health care because of pre-existing conditions.”

Read that again. Now pay attention to several rhetorical sleights-of-hand that too often pass unremarked:

• “…the lack of availability of health care…” — except, what Obama really means is the lack of affordability of health insurance.  Health care is generally plentiful; in fact, access to it through emergency rooms is enshrined under EMTALA, and communities across the country sponsor government- or church-run free or low-cost clinics. The only places with a lack of specific services result from local problems — e.g., communities with runaway tort awards that makes malpractice insurance for specialties like OB/GYN cost prohibitive for practitioners.
• “…their inability to get health care because of pre-existing conditions.” Well, no. Again, it’s insurance and not access that’s really under discussion. In any case, people forget that insurance is a financial hedge against a potential future problem. When that problem materializes, ongoing insurance no longer makes sense, as the risk you’re insuring against isn’t theoretical any more. (Hint: That’s why some insurance companies didn’t “insure” against pre-existing conditions, which is much like trying to buy collision insurance the day after you wreck your car.)

In fact, the major problem with the whole debate is the focus on insurance coverage instead of cost reduction. It’s not entirely clear why employer-provided health insurance should be the primary mechanism by which individual citizens gain entry into the high-cost health services market. Nor is it clear why it’s constitutional for the government to require insurance companies to engage in specific behaviors that creates a regulatory regime that later justifies massive market intervention. Justice Kennedy had it right when he asked whether it makes any sense to create commerce just to regulate it. Treating “health reform” as simply expanding the insurance pool fundamentally misunderstands the real problem with health care costs today.

Which is this: As a distressingly large number of patients remain almost entirely disconnected from the actual costs of the services they consume and because they services are covered by third-party payers, the tendency is for prices to increase well above the rate of inflation. This trend makes a degree of sense; if you are sick and directly pay for little or nothing for the care you receive, then of course you want every test, every procedure, every intervention. And why not? Not your dime, after all. Rhetorical emanations from the Progressive Left elevate medical care to the level of a civil right that shouldn’t require anyone to pay out-of-pocket for anything. In a climate where the average person pays little and some activists demand that they pay nothing, it’s not a surprise that most people don’t put a lot of thought into the real cost of the services they consume. And as any marketer will tell you, people want more when they’re not thinking about price — which is basically the same economic model as the iTunes app store and Redbox kiosks.

Funny thing about health care. Contra Obama, you don’t need insurance to access health services. You can pay out of pocket. Doctors and hospitals don’t require insurance before delivering care — you can simply write a check, swipe a credit card or even negotiate a payment plan. Indeed, routine care isn’t really that expensive. An annual physical for someone in good health may cost less than $250 with labs in many markets. And before the wage-and-price controls of World War II, employer-provided health insurance was unheard of. We survived before benefits packages; we can survive when those packages are de-emphasized.

To really get health spending under control, we need to get consumers actively engaged in what health services they receive. The first step involves tort reform — physicians need to be free to recommend the various tests and procedures that are medically indicated without worrying about the lawsuits that lead to expensive “defensive medicine.” A regime that pre-screens medical malpractice claims against a board of physician advisers may well cut off the spigot of dollars flowing from the largess of a medically unskilled jury.

The second step requires patients to have financial skin in the game. Instead of taking refuge in free-lunch insurance programs, health insurance should more accurately reflect the original concept of risk mitigation that undergirds insurance programs as a whole. The best solution — and one that seems to work in hospitals across the country — lets consumers elect high-deductible plans that cover catastrophic illnesses but require patients to front the money for most low-dollar costs up to a specific threshold. These plans generally cost less and make patients think twice about demanding unnecessary care when the funds come directly from their own pockets.

Put differently: If get a nasty head cold, do you tough it out or do you make a trip to the doctor and demand antibiotics (even though antibiotics don’t work on viruses)? With free-lunch insurance, you’ll visit the doctor, get your scrip, maybe offer a token amount as a co-pay, and move on. If you knew you had to pay for the office visit and the drugs, would you bother? Probably not. You would only seek medical services when you believed you really needed them. The Washington Post recently addressed the trend of higher-deductible plans. Although the story may be faulted for assuming that it’s an outrage that people should actually pay for what they use, otherwise the account presents a fairly well-balanced summary of the trend away from gold-plated coverage and more toward consumer-driven health care.

The researchers at RAND Corporation’s health unit have complied extensive and diverse statistics about the long-term trends in health services; the publication is well worth perusing. The reasons for today’s exploding cost model are many, but some of the major contributors include:

• Increased regulatory burden by governments that drives up costs by as much as 25 percent of the entire sector
• Increased cost of ancillary services unrelated to the provision of care (e.g., marketing departments, education teams, etc.) — a 2003 New England Journal of Medicine study suggested that administration alone costs more than $700 for every inpatient visit
• Increased utilization of expensive services like MRIs that may not be clinically warranted but protect the ordering physician from malpractice claims if the patient isn’t happy with his treatment, may raise costs by 5 to 9 percent
• Cost-shifting from protected patients to non-protected patients — case in point: because Medicare or Medicaid reimburse at less than actual costs, the “gap” is made up in higher prices for everyone else, to the tune of more than $6 billion per year
• Fixed infrastructure costs — primarily IT — drive up institutional expenses, which are then passed along to patients
• HMOs and other insurers negotiate separate contracts with providers, and if one insurer gets a sweeter deal patients covered by a different provider may make up for it with higher prices

Health reimbursement theorists look at medical care as a three-legged stool of costs, quality and access. There’s a relationship among these variables: As costs increase, access declines. As quality increases, costs increase. Radically increasing access will make costs skyrocket.

That’s the fundamental problem with Obamacare — it emphasizes increasing access to free- or low-cost medical care, but as costs increase, there’s no obvious payer. Hence the “individual mandate.” If everyone pays into the system, then free-lunch coverage for everyone becomes a more viable option. Without a mandate, there just isn’t enough money to fund all the services that will be demanded at free-lunch prices by the U.S. population. And a single-payer solution won’t fix the problem. The dollars have to come from somewhere, and if individual consumers of health services have zero personal incentive to responsibly align their utilization against their genuine medical need, the system as a whole will suffer from significant and costly inefficiencies that make the entire infrastructure unworkable in the long run.

To really fix the problems with today’s health care market, we should focus on cost reduction. If costs go down, premiums will go down and access will naturally increase. And while we’re at it, we should scrap the antiquated WWII-era model of financing health services through “insurance” and instead open the market to actual costs borne by actual people.

Disclaimer: The writer is an experienced revenue-cycle analyst for a large Midwestern health system. The opinions expressed in this blog post reflect only the writer’s opinions and do not speak for, imply or endorse any position on behalf of the health system.

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.

Apparently, the same phenomenon holds for Saul Alinsky. As a red-meat-eating, cigar-smoking, whiskey-drinking, dyed-in-the-wool Republican, I’ve listened to the anti-Alinsky propaganda for years. You know the type: Obama is an Alinskyite, and we all know those Alinskyites are pinko commie bastards who want a Soviet-style Revolution that elevates the brain-washed union workers and tears down the mighty citadel of Capital.

But … not so much, it seems, if you look at what the man actually says.

A few days ago, I purchased Rules for Radicals; I began reading it last night. I’m not too far in — I’ve covered the prologue and the first chapter, “The Purpose.” What I’ve read reveals a man and a mission that don’t quite mesh with the dehumanization of the mad activist as caricatured by the far right. Although I reserve the right to be horrified by the chapters yet to come, so far Alinsky seems far more reasonable — in principle, anyway — than the angry diatribes from Limbaugh and Hannity would have led me to believe.

A few salient points:

• Alinsky, writing in 1971, seems to think the radical student movement with its violence and nihilism was a Very Bad Idea (here, we agree). He professes a deep respect for democratic institutions and the rule of law. Indeed, what I know of his history suggests that this isn’t merely lip service. Alinsky sometimes played dirty, but he generally didn’t advocate operating outside of the law.
• He apparently has no love for communism, arguing strongly in favor of American patriotism and against the murderous collectivism of Russia, China and Cuba. For example, he thinks that the 1968 radicals were idiots for burning the American flag, because the alternative isn’t communitarian utopia but totalitarianism. Alinsky doesn’t appear to hold any illusions about the virtues of the very far left, which he argues becomes indistinguishable from the very far right.
• He views the world dualistically; there are good/evil, rich/poor, etc., etc., dichotomies. Not much appreciation for shades of grey, except insofar as he points (correctly, I think) to the push/pull relationship of the middle class relative to the very rich and very poor. I’m not sure I like this framework — it seems dangerously simplistic – but it explains much about the why of some his theory. His whole intellectual apparatus appears colored by a contemporary Manichaeism.
• He seems to respect one of Tocqueville’s core theses — that America works best when there’s a healthy mediating layer of civil society that buffers and guides the nation in its relationship between a single person and government. To the extent that his professed goal is to empower individuals to live happy, healthy and free lives, he recognizes that part of the radicals’ struggle is to keep those mediating institutions on the level.

Don’t misunderstand; I’m not an Alinskyite and will not become one. As much as Alinsky claims to be non-ideological, only the Progressive Left seems attracted to his modus vivendi, and as long as the sort of “radical change” he articulates effectively works like a leftward-twisting ratchet, then Alinsky’s approach is functionally ideological — even, were one to be charitable about it, if the ideology is a manifestation of later misappropriation instead of being inherent to the system as he defined it.

More to the point: Radical change of any kind requires polarization to get people to accept strategies that fall outside the centrist norm. He apparently defines strategies to effect this polarization later in the book, but the general principle is this: You identify a problem; you mobilize support by presenting positive arguments while simultaneously isolating/demonizing your opposition; you keep it up until you can score a success at the ballot box; you declare victory and move on to the next target. This strategy requires the manipulation of voters through tactics both thuggish and outlandish. In the end, the idea unspoken premise is that the average voter is a dolt who needs to be “guided” to the preferred position of the activists at the ballot box, whence the activists derive their claim to moral authority.

I don’t favor the broad outlines of Alinsky’s approach, for three reasons:

1. I don’t like activists. At all. Of any stripe. (Hey, I’m a conservative by dispositon.) Activists work outside the system to pressure people to engage in specific behaviors that they otherwise wouldn’t countenance: Think, for example, of the Occupy movement. If something needs to be changed, then change it. From the inside – Win elections. Write laws. Persuade voters to adopt them. Don’t play the outside pressure game to short-circuit the process. And for the record, I don’t even care much for “my” activists; you won’t see me standing at a Life Chain, for example.
2. Alinsky’s formula for radical change, rooted as it is in a pseudo-Manichaeist worldview, requires a black-and-white split of virtue to remain tenable. Activists are good people; people who oppose the activists are bad people who must be shamed and punished for their bad attitudes. The political struggle therefore becomes one of good versus evil, with the opportunity for finding a middle way eroding with every passing epithet. Wonder why Congress is polarized? It’s practically a case study in Alinskyism at work. More to the point, solutions that hail from a distinct ideology are rarely a good idea; better that people of varying perspectives gather around a complex problem and negotiate a solution than to push for an all-or-nothing resolution.
3. The politics of shame-and-conquer rewards the outrageous and the audacious, but the virtuous and the commonsensical may thereby suffer. When voters — many of whom may lack a deep understanding of the situation — cast their ballot for the best “show,” politics descends to the level of ancient Greek juries. You know the kind: The person who won the case earned favor through theatrics rather than from having more solid legal grounds for victory. Like OJ Simpson, but I digress. The political becomes the personal, and voters are manipulated to vote for people rather than for objective, well-thought policy. This is a part of why the hard Left is much more invested in the politics of personal demonization than the hard Right. Case in point: The Matthew Shepard murder in 1989 and the James Byrd Jr. murder in 1998. Very bad people tortured and killed innocent men because of race (Byrd) or sexual orientation (Shepard). These were horrific crimes, and the perpetrators deserved severe punishment. But for the hard Left, punishment wasn’t enough; with a cast of heroes in villains conveniently supplied by each murder, radical activists pushed for bias-crime legislation to make “hate crimes” more legally offensive than other crimes. Such a position was opportunistic; lost in the torrent of outrage against the criminals was any meaningful defense of the First Amendment and the silliness of criminalizing bad opinions. But those who defended freedom of thought — even odious thought — were themselves demonized as closet racists, sexists or homophobes. In the Alinsky world, discrediting your opponents is fair game no matter how reprehensible the tactic as long as you advance the chance of a political victory.

The above notwithstanding, the more of Alinsky I read, the more I simultaneously see his theory at work in various strands of contemporary Progressive Left politics, and the more sympathetic I am to Alinsky as a political thinker. I will never be a disciple of his, but engaging his thought directly — instead of the caricature presented in the conservative media — gives me a deeper respect for the man as a noble adversary rather than a demonic bomb-thrower.

And if his tactics can be unleashed on the Progressive Left, so much the better.

When I radically downsized my roster of commitments, it took me months — months — to be able to sit home and not get stressed out over doing nothing. Sometimes I’d catch myself pacing in the living room. I didn’t know how to decompress; more to the point, I didn’t have an objective measure of stress. Those early days set a dangerously high baseline. I tried to fill the gap anyway, mostly with running and karate and trips to the mall to people-watch and playing World of Warcraft until 2 a.m.

Since those early transition days, I’ve more sanely level-set my expectations about stress. I can see the warning signs and have strategies for addressing spikes. Not a big deal. But funny thing — I’m no longer capable of burning from both ends for any extended time. I’ve been doing some contract work for most of February and into March that kept me busy, and I could feel the stress levels rise. Not because the work was too much or too difficult, but because I gave up a big chunk of my normal “down time.” This marked the first time when I really noticed the impact of being persistently busy.

Put differently: I’m happier, healthier and more serene when I can dedicate time to recharging my emotional batteries. Each day, I usually spend 90 minutes or so sitting down with reading materials (either magazines or RSS feeds), a premium cigar and one standard serving of an adult beverage, usually either port or some type of whiskey. And I read and relax and let my mind engage. I’ve accomplished more reading in the last six months than in the prior six years.

I also value the time I can get away on the weekends. At least one weekend each month must be unencumbered, or I start to get crabby.

Sometimes I wonder if the issue is that I’m getting older, or if I’m adjusting to a more mature mindset. I don’t know. All I can say is, life’s too short to spend it pursuing tasks without building in the time to stop and smell the roses.

1. Oh, you silly Michigan Republicans. Yes, I voted in the primary. Yes, I voted for Mitt Romney. Yes, I want to see Romney prevail in the delegate count. No, I don’t want Saul Anuzis to put his thumb on the scale. Give Santorum his stupid delegate and be done with it. Intentions aside, retroactively “interpreting” the rules to favor a favored candidate smacks of dishonesty even if such interpretation is valid and squeaky clean. The appearance of impropriety is what matters, not the actuality of impropriety.
2. Speaking of the primary — time for Gingrich to exit stage right and Paul to exit stage kooky. This has turned into a two-man race. Actually, a one-man race, but Santorum hasn’t figured this out yet and he deserves time to internalize it. I’ll admit that Santorum surprised me a bit; I didn’t think his dogged insistence on fighting the culture wars of the ’90s would resonate with primary voters as much as it has, especially when serious matters — like national security and the economy — deserve pride of place this cycle. I think the Romney likability factor plays into it a bit. What are the odds Huntsman and Pawlenty regret pulling the ejection handle so quickly?
3. The ongoing drama over Israel’s potential response to an Iranian nuclear weapon highlights the Obama team’s lack of seriousness about Iranian threats. Nuclear Iran presents an existential threat to Israel and will almost surely ignite a nuclear arms race in one of the most volatile regions on the planet. We need more than bluster to win the long-term peace. Although I certainly don’t want a war with Iran, I also don’t want a nuclear Iran. If the latter goal cannot be achieved peaceably — and the Persian running down of the clock suggests it won’t be — then other action must be contemplated.
4. After the Holocaust, the West said, “Never again.” After half-assing it in Bosnia, we said we really meant it – next time. Then we looked the other way in Darfur and Chechnya and Tibet. And now we look the other way in Syria — because we pretend that enfeebled Russia’s protection of its sole remaining Mediterranean client remains geopolitically significant. Genocide continues, and we whine that the politics of weakness at the U.N. means that we have no more effective alternative than to lodge diplomatic protests while thousands die at the hands of a cruel despot. The technical term for this pseudolegal equivocation is “moral depravity.” On our part, as well as Assad’s.
5. I’m not all that worried about $5 gas. I am worried that $5 gas means that politicians across the ideological spectrum will put on their silly hats and promote short-term policies that make no long-term sense simply to pander to voters who don’t grasp the complexities of energy policy.
6. Have we reached a tipping point? The ongoing privacy black eyes from Google and Facebook may well prove decisive in finally getting politicians to draft consumer-friendly data protection laws. About damn time.

Life’s been good on the personal front, too:

1. A few weeks ago, columnist Florence King of National Review penned her last “Bent Pin” column. I had been a fan of hers since I was a teenager; she used to write “The Misanthrope’s Corner,” then semi-retired, then came back. Now she’s permanently retired from regular columns and will now occasionally submit reviews. Having been duly saddened by her new retirement, I wrote her a letter. To my great delight, she replied with a lovely handwritten card. I think I’ll frame it.
2. ‘Tis been lovely on the social front. Yesterday, Tony and I went to Battle Creek, to the Firekeepers casino. The original plan was to go to the smoke shop in Battle Creek, but we were delayed too much in Lansing so we detoured to the casino instead and partook of some light gambling and heaving dining. Last weekend, Tony and Jen came to town to celebrate Jen’s 30th birthday. Also attending: her brother Joe, and her friends Heidi and Pete. Tony/Joe/Jen/Jason started with dinner at Ruth’s Chris Steakhouse, then we met Pete and Heidi and trudged off to Mixology at Six One Six for cocktails; we eventually ended up at Cygnus 27 for even more cocktails before the evening met its natural conclusion. And last Thursday I enjoyed cigars and Scotch with Rick and Sondra at Grand River Cigar. All these events provided a strong measure of fun and connectedness.
3. Celebrated another writer’s event on Friday. These gatherings are more social than productive but it’s still nice to connect with fellow scribes. And I got to learn about Charlie the Unicorn.
4. My truck was victimized by a local ne’er-do-well. Someone broke into the back window and rifled through the contents of the truck cab. As far as I can tell, the only things taken were less than $2 in coin plus my spare copies of my license, proof of insurance and registration. I filed a police report anyway. And that evening, I saw my neighbor — a G.R. police officer — but he already had been informed by the detective who reviewed my report.
5. I’ve been kept full-to-brimming with contract work over the last six weeks. One of my clients invited me into a special project that has consumed a large amount of time. Happily, they’re paying above-market rates for the work I’m doing. Plus, I received a fabulous referral for some Web marketing work for a law firm in southern Michigan; contract negotiations begin next week. It’s a rare treat to make money faster than you can spend it. However, much of this work may well fund a late-summer trip to Italy. Stay tuned.

All for now.