The More Things Change…

How can we explain the mess—the morass—in which we find ourselves today as a society? 

One commentator on the public scene offers this answer: “The demoralization of war. A spirit of gambling adventure, engendered by false systems of public finance. A grasping centralism, absorbing all functions from the local authorities, to control the industries of individuals by largesses to favored classes from the public treasuries of moneys wrung from the body of the people by taxation…”

So this commenter, one Sam Tilden, seems to blame our malaise on the demoralization following the Iraq War; the federal guarantees backing Fannie and Freddie leading to a “gambling adventure” with mortgage-backed securities, as Wall St. functionaries played a game of heads they win, tails the taxpayers picked up the losses; the progressive destruction of Federalism—“absorbing all functions from local authority”—during the Bush and Obama years; the bailouts (“largesses to favored classes from the public treasuries”); the crushing taxes (“wrung from the body of the people.”)

And this may all be true, in which case Sam Tilden was quite prophetic, because Samuel J. Tilden was the liberal Democratic candidate for President in 1876, 134 years ago. He was speaking not of our current predicaments but of the similar corruptions of the post-Civil War Republican Grant administration and their favored business interests.

It gets worse, for Tilden, in the quoted passage, was comparing his time with what he saw as similar growth and corruption towards the conclusion of the first Adams administration at the end of the 18^th century, not two decades into the American experiment with limited government, as Hamilton and his cronies moved away from the promise of the Declaration to centralize government power in Washington. 

In Tilden’s time the Federal government spent 3% of GDP, compared to about 20% under Bush II and 24% under Obama. But small as it seems now, that represented a 2-fold (100%) growth in government compared to the antebellum years of less than two decades before. Thomas Paine had noted a century earlier that fighting wars grows government.

At the time Tilden spoke, the Democratic Party was the party of laissez-faire, limited government, and free trade. The Republican Party was the party of high tariffs, government projects for favored businesses interests, and subsidies to the politically powerful; it was a pro-business rather than pro-market party. The Democrats were the party of individual freedom while the Republicans were the party of industrial policy, the mercantilists of their day. 

To paraphrase Nixon, we’re all mercantilists now. 

The French say, “Plus ça change, plus c’est la même chose,” the more things change the more they remain the same. The Democrats are, to say the least, no longer the party of laissez-faire, but the Bush administration was filled with special business interests. Hank Paulson, Bush’s Treasury Secretary, easily—happily—confused an impending bankruptcy of Goldman-Sachs (and the loss of his personal fortune) with societal collapse, to be averted by a taxpayer-funded bailout of his industry, “wrung from the body of the people.”

This battle between Liberty and Power is not new. It is older than the Republic, and people whose idea of a Revolution is raising the federal budget less fast than Obama are not up to the task of reversing Power’s latest advance.

What is to be done? Edwin Lawrence Godkin, a contemporary of Tilden’s and himself a liberal in the 19^th century mold, the editor of New York’s Nation, offered this advice: “The remedy is simple. The government must get out of the ‘protective’ business, and the ‘subsidy’ business, and the ‘improvement’ and ‘development’ business. It must let trade, and commerce, and manufactures…alone. It cannot touch them without breeding corruption.” The New York Nation was a respected venue and Godkin a leading voice in his time. But today calls to merely drop the federal budget to 2008 levels are condemned as “extreme” and the idea of the government letting trade, commerce, and manufactures alone is…simply unheard of.

 The Tea Party has a long road ahead of it. As Santayana said, “Those who do not learn from history are doomed to repeat it.” Expanding government’s societal take from 3% to 24% of GDP in a century and a half is extreme. Fighting to reverse the tide is just, as Paine would say, common sense.

Is the Mental Illness Epidemic a Medical or Economic Problem?

If you study things long enough, you can anticipate…

For example, if you listen to enough Barack Obama speeches, you can feel pretty confident you will at some point come across the phrase, “Let me be clear…”

I considered this phenomenon on reading the recent excellent two-part article, “The Epidemic of Mental Illness: Why?,” in The New York Review of Books (Part I: 6/23/11; Part II: 7/14/11) by Marcia Angell, MD, a well-known academic physician who is, among other distinctions, a former editor of The New England Journal of Medicine. Angell, reviewing three fresh books on the subject, investigated the putative benefits of psychotherapeutics (neuroleptics, anti-depressants, etc.), and even the reputed reality of psychiatric diagnoses.

And on starting to read, I knew, with a high level of confidence, that at some point in her review, Angell would say something to the effect that “more research has to be done.”  Sure enough, the last sentence of the penultimate paragraph of the second-part of her review starts, “More research is needed to study…”

I knew this would appear because, as I said, Dr. Angell is an academic physician, and this is how academic physicians make money—they get grants, sometimes from businesses but mostly in today’s culture from the tax-payer, to investigate matters they wish to investigate. In Dr. Angell’s ideal world, patients compliantly do what doctors tell them, and tax-payers compliantly pay for what doctors do, be it studies, procedures, surgeries, or (above all) research conducted by academic physicians, often designed to tell other physicians in the trenches how to practice—what is “appropriate care.” It’s a Platonic, hierarchical system with Dr. Angell and her friends at the pinnacle, the physician-kings.

A decade and a half ago, Dr. Angell and the NEJM were among the great champions of “Hillarycare.” More recently, she has supported “Obamacare.” Her view of good medicine includes a single-payer system, with health-care divorced (she might say “released” or “freed”) from banal concerns over cost.

And this is the great irony of her excellent recent review. Because the many problems she points out regarding the growth of mental illness diagnoses and the risk of ineffective psychopharmaceuticals are fundamentally not problems of medicine. They are problems of economics, and they would be magnified, not eliminated, by the single-payer system Dr. Angell herself supports.

The story Angell tells in recounting the recent exposes of modern psychiatry is one where doctors don’t understand the underlying mechanisms of the supposed diseases they allegedly treat, don’t understand how the medications they administer work, and don’t really care as long as symptomatic relief is achieved (which, in the case of psychoses, often means not so much that the patient feels better but that the people around the patient feel better…). She notes, in recounting the work of psychologist/researcher Irving Kirsch (The Emperor’s New Drugs: Exploding the Anti-Depressant Myth) and journalist Robert Whitaker (Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America) that many of these drugs—heavily pushed by the pharmaceutical industry—work no better than placebos. That is to say, these drugs may work no better than (many) herbs.

Which leads one to ask: Herbal medicine is big business. Herbs are now sold not only in herbal medicine stores, but even in Walmarts and regular supermarkets. Tens of millions of people take herbs as a substitute for or in addition to regular medicines. Hundreds of millions of dollars are spent. Yet we don’t see the problems in the selling of Ginkgo biloba and St. John’s Wart that have developed in the selling of Prozac and Chlorpromazine.

As Angell says in her introductory remarks, “It seems that Americans are in the midst of a raging epidemic of mental illness, at least as judged by the increase in the numbers treated for it.” Yet we see no epidemic in the use of St. John’s Wart…no concern need be raised over those choosing to self-medicate with Ginkgo biloba. If both categories—psychopharmaceuticals and herbal remedies—work no better than placebos, why is one category simply rising and falling with market demand while the other is growing as a “raging epidemic?”

Dr. Angell raises two concerns in her review. One is that psychopharmaceuticals, despite being widely prescribed and used, are not really efficacious. The other is that mental illnesses, due to industry and other financial incentives, are multiplying without regard to underlying medical justification. The irony is that both problems, although they sound medical, are really economic in nature. And they apply more broadly than the good doctor is willing to consider.

Why is it a problem if a depressed patient feels better after taking a placebo? Why is it a problem if a depressed patient feels better after going to a comedy club? It’s a problem because of third-party payers. If psychiatrists claimed that depression could be cured by visiting comedy clubs, and patients felt that therefore the expense of attending comedy clubs should be covered by their health insurance carriers, we could expect certain consequences. First, we could expect objections by the carriers. Second, we could expect a marked increase in claims of depression among those Americans who enjoy attending comedy clubs.

This is of course more problematic when we discuss treatments, especially medications, for diseases whose very existence is merely a function of a psychiatrist’s claim, but similar problems exist even for diseases outside of the psychiatrist’s couch, or domain. More and more vaguely defined diseases—from chronic fatigue syndrome to fibromyalgia to restless leg syndrome—are defined without clear pathologic correlates, based solely on presentation and exclusion of more well-defined disease entities. 

Why is it important, today, for all physicians, not just psychiatrists, to make specific diagnoses, even when it requires linguistic creativity more than diagnostic savvy? Why is it important to say to a perplexing patient: “You have chronic fatigue syndrome,” say, rather than reporting, “You seem chronically fatigued; I have no explanation for your symptoms.”? Could it be because third-party payers pay by diagnosis? Could it be that a physician is concerned he won’t be paid without registering, not diagnosis and treatment, but an established ICD10 code? These codes have exploded in number in the last generation [1], as more and more diseases, both inside and outside psychiatry, have been discovered—invented?—to the point where no one is now told, on presenting with complaints, “don’t worry; you have nothing wrong with you.”

Why are there ICD codes in medicine, but not in other businesses, like restauranteuring? It’s because one needs “objective” criteria to bill third-party payers. It’s not enough to merely have, as in a 5-star restaurant, a satisfied clientele. You could practice at the Mayo Clinic or Boston’s Massachusetts General Hospital and yet mere reputation for high quality will not suffice. You still need the codes. And when your payment hinges on the codes, bewildering complaints without clear pathologic basis will no longer do. It’s one thing to repeatedly see a patient who has nothing wrong with them as far as you can tell if they’re paying their bill. It’s quite another if the insurance company is refusing compensation because you can find nothing wrong.

Are there medications that make those diagnosed with fibromyalgia or restless leg syndrome or any other of various infirmities diagnosed without known pathologic correlate feel better? Perhaps. Are they but placebos? And here an interesting question arises: If we allow illnesses, as we always have in psychiatry and are allowing more and more in general medicine…if we allow diseases diagnosed solely on their symptoms, what is the difference between a placebo and a real cure, if both relieve the symptoms?

It doesn’t matter if others call something that makes you feel better a placebo, whether it's chiropractic or cleansing enemas or sugar pills. But it matters greatly who pays for it. Government regulations and tax rules since the 1950s have created an environment where most people don’t pay for their own health care. Over 50% is paid by the government, and most of the rest is paid by nominally private insurance carriers who are highly regulated and restricted by the government. This has a clear effect on incentives, both for patients and practitioners.

The dramatic cost increases associated with third-party payments extend beyond diseases that may not really exist. The Oct 8-9, 2011 Wall St. Journal has a front-page story of a growing problem: doctors gaming the system to maximize their incomes, not constrained by patient cost-concerns. The article discusses spine surgeons who not only do back surgery, but also create their own companies and patent their own fusion devices (each a minor variant of the other), so as to get a double-cut, as it were, in the billing process. Does the patient really need surgery? Will it improve outcomes? Hard to say, but clearly the surgeons marketing their own devices have an interest over and above patient welfare in performing surgery. In a competitive market, this would be handled by second opinions and the patient’s concern that it all is getting too costly. With third-party payers, however, such activity not only persists but thrives. Not surprisingly, failed back surgery (continued, or recurrent, or worsened back pain after surgery for back pain) has become increasingly common… 

Now, if the problem is related to third-party payers, to the need not merely to please the patient but to justify one’s treatment “objectively” to third-parties, is this problem likely to be resolved or to worsen in an environment like Obamacare? The obvious answer is that it will worsen. It would worsen even more under a single-payer system. Yet, ironically, Dr. Angell is a strong proponent of single-payer systems. 

As Thomas Szasz, the iconoclastic psychiatrist whom Angell references obliquely in her review, noted long ago, we live in an age where 'most any complaint is viewed as caused by a disease. Combining the growing list of vague medical diagnoses with the explosion of diseases listed in the latest DSM catalog, it begins to appear as if the entire human condition is one big disease. From stuttering to shaky legs, from bullying to being bullied, from general aches and pains to being a general pain—most any complaint can now get you diagnosed with a disease, and allow a physician to bill for services. These wouldn’t always be services you’d willingly and voluntarily pay for. For some physicians—perhaps Dr. Angell—that’s the whole point.

[1]:  See the Wall St. Journal front page story http://online.wsj.com/article/SB10001424053111904103404576560742746021106.html , and the ensuing letters to the editor.

Heal Thyself: A Response to Dr. Donald Berwick

Much changes in less than a year. Yet much stays the same. 

Last spring, Dr. Donald Berwick was the administrative head of the Center for Medicare & Medicaid Services (CMS). Now he is out, having left in December, 2011, staying only long enough to arrange $1 billion in funding for Partnership for Patients, a program that gives money for research in what happens to be his old area of work.   Conflict of interest? No, simply the ways of Washington.

But while Berwick is no longer at CMS, the ideas he supported still run rampant there, and will impact on Obamacare. With the Supreme Court’s upcoming review of that legislation, I thought it worthwhile to critique an important op-ed Berwick authored in the April 29^th issue of the Wall St. Journal last year.

Dr. Berwick said, in his argument “The Right Way to Reform Medicare,” that “Improving quality while reducing costs is a strategy that’s had major success in other fields. Computers, cars, TVs and telephones today do more than they ever have, and the cost of these products has consistently dropped.” That is to say Berwick--then the head of a major government agency--thought the way to save money in Medicare was...Wait For It…to lower costs while improving quality. Such insight! One recalls Lenin’s view that capitalism had made producing goods so simple that any bookkeeper could run an economy.

Dr. Berwick stated a goal but showed little understanding as to how to accomplish it. You don’t get venture capitalists to invest by noting your key insight in running a business is to “lower costs while improving quality.”

Berwick obviously couldn’t have done it as the computer, car, television, and telephone companies did. They did it in a competitive marketplace. Telephone costs didn’t drop under the government monopoly given Ma Bell, and Detroit cars did not show a dramatic improvement until forced to compete against Japanese and European models. Televisions aren’t even made in the USA anymore—competition drove the business overseas—yet with free trade American consumers are continually offered better television products at lower prices. 

In each of these areas, quality improvement and cost savings came about by allowing anyone to try anything they thought would most interest and best serve consumers. Yet the model Dr. Berwick recommended we follow in medicine was for a small group of experts to investigate what is the “one best way” to treat or work up or diagnose various diseases. This is exactly the method used by the French government in the 1970s to make the world’s best computer [see “Plan Calcul” and the major French government subsidies to CII and Honeywell in this time frame.] Despite spending billions of dollars on it, you don’t hear much about French computers these days (though if one had outlawed market competition, as the US government has largely outlawed competition in medical care, we might today speak of the wonders of the French computer, able to hold up to 100 MB of data and upload information in mere hours from state-of-the-art floppy disks.)

Another obvious difference between the industries Dr. Berwick commended and medicine is that people pay for their own computers, cars, televisions, and telephones. Did Dr. Berwick think smart phone prices would remain low if the government picked up 90% of the tab? That doesn’t seem to have happened in higher education, whose costs—like medicine—have skyrocketed since government loans and subsidies became the order of the day.

Rather than appreciating the connection between consumers paying for goods and services and producers having an incentive to lower prices, Dr. Berwick condemned last year’s “GOP plans” that “would shift costs to seniors and people with disabilities.” That is, he condemned as a flaw the very essence of the process by which the industries he commended are forced to keep prices low.

One of Dr. Berwick’s command-and-control ideas to keep prices low was to set up a bureaucracy to “[reduce] duplicative tests and procedures that hassle patients and do them [in his judgment] no good at all.” He makes it sound so benign. Yet car companies don’t insist their customers refrain from buying “duplicative” cars, and Steve Jobs was happy to sell people as many iPads as they wished to pay for, even if an outside observer might think one iPad for the den and another for the study is “duplicative.” Prices of cars and computers continue to drop, and I doubt even Dr. Berwick thought the solution in healthcare is to have an oversight committee devoted to preventing consumers from making duplicative purchases.

Here’s the take of a long-practicing radiologist on Dr. Berwick’s idea of duplicative testing, a real-world intrusion on Berwick’s administrative bureaucratic fantasy-land: 

A person gets an abdomen CT at a small community hospital. They have general radiologists who do pretty good work but are not among the top-tier in the country. They work with fairly modern but not cutting edge CT machines. They do pretty good, but not state-of-the-art work. And they’re right most, but not all, of the time. Then the patient takes these images to subspecialty expert radiologists working on advanced, cutting edge equipment, and is told the study is inadequate and needs to be repeated to meet their exacting standards. This is a commonplace in medicine. No one here has done anything wrong. Was Dr. Berwick prepared to tell Mayo Clinic or Mass General radiologists that they cannot repeat what to their mind are inadequate exams? Was he ready to tell general radiologists around the country that if they cannot match the quality and standards of subspecialty experts at medical Meccas like Mayo that they should get out of the business or be prepared to not be paid for their efforts? Did he intend to tell patients that to get even basic studies they must travel to Boston, or Rochester? Scottsdale or Jacksonville? Or did he think any physician should be capable of achieving Mayo/MGH standards if they just work and study harder (that is, was he completely oblivious to meritocracy in medicine?)

No one expects a general radiologist to do as good a job as an academic sub-specialist, any more than they expect a Chevrolet to be as good as a Rolls Royce or a Compaq to be as good as an Apple. But in competitive markets Compaq and Chevrolet can say, “Yes, we may not be the best in quality but the bottom line is we’re sufficient for your needs the vast majority of the time and we’re cheaper.” No one in medicine can do this. And no patient insists on it because, after all, they don’t suffer any significant financial cost from the duplication. 

The Medicare system Berwick headed pays all radiologists the same for an “abdomen CT,” whether they are a recognized world expert or just out of training. It’s part of the “objective” RBRVS payment system Medicare set up years ago that measures inputs like time and effort but completely ignores differences in quality. Not exactly how Honda and Apple manage things. 

Is the solution to have the government pay for services based on their assessment of quality? That depends on whether or not you believe the government is the best judge of the quality of a study you received. Comparing the USPS with FedEx, most would conclude the government is not the best judge of quality in mail delivery, but perhaps judging the quality of medical care is easier…

So, having created a system that pays for services independent of quality, based on time and effort, unshackled from cost concerns of actual consumers who receive the services but do not pay the bills, Dr. Berwick was shocked to find it doesn’t run quite as smoothly or save as much money over time as the computer or cell phone businesses. Did he really think that if a select group of experts determined what the one best phone or computer was that phones and computers would continue to dramatically improve while their prices continued to drop?

Do we want Berwickian experts dealing with questions like this: You have cancer; there are two treatment options. One is painful. The other costs $30,000 more but isn’t painful. Which is the one best method? Clearly it’s not a medical question at all. It is a question of value: How much money are you willing to spend to avoid pain?  Did Dr. Berwick think the answer to such questions was completely independent of whether the patient was paying the bill or could foist it off on others? I personally am willing to spend inordinate amounts of Dr. Berwick’s money to avoid pain.

Before they were sent back to the drawing boards, having failed to get any significant buy-in from major medical organizations, Dr. Berwick explained his Accountable Care Organizations by noting they would “coordinate better care for patients” by holding doctors and hospitals “to a strict set of quality standards to ensure they aren’t lowering costs by cutting necessary care.” He then immediately followed this with “Seniors will not have their choice of physician or hospital limited at all.” He apparently couldn’t see the obvious contradiction. What if a senior’s choice involves a doctor or hospital who disagree with Berwick’s experts as to what constitutes “a strict set of quality standards”? It’s as if an educational bureaucrat said “Parents will have no restriction in their choice of teacher, as long as every teacher teaches exactly as we tell them to.”

Meanwhile, nursing staff is rapidly buried in paperwork, and simple procedures have had associated paperwork balloon in the files from 1 page to 15, so as to track and confirm the “strict set of quality standards” are being complied with. Nurses more and more complain that over 50% of their day is spent NOT taking care of patients, because national regulatory agencies demand a growing list of forms be properly documented. 

Every pediatric patient seeing the doctor in the United States must now be asked, "Do you feel safe at home?" and "Is there a gun in your house?" This, not cutting edge computer-industry-like-efficiency, is what Dr. Berwick's "strict set of quality standards" becomes: politically correct intrusions on medical practice.

This is why I say Dr. Berwick was an excellent bureaucrat, if a poor economist. He was happy to develop layer after layer of accounting and justification devoted to the claim he would control prices. And when prices rose anyway, as they did during his tenure, no doubt had he stayed he would have been happy to develop even more layers. What he wouldn’t do—for it scares bureaucrats and others whose income is a function of their control of medical dollars—is allow patients to choose for themselves with their own money and allow a market to work. He recognized, and paid homage to, the market in cars, computers, televisions, and telephones, but he wouldn’t dare duplicate the mechanisms of their successes in any but the most superficial of terms.

It’s as if Dr. Berwick had an Escher print—the one, say, of Penrose stairs, or the one of an object having three prongs on the bottom but only two roots at the top—and said he intended to build them in reality. When it’s pointed out that such objects cannot exist in reality—any more than a centralized yet efficient bureaucratic government medical system can work in reality—Berwick would respond that cars and computers and telephones and televisions are all becoming physically more complex yet they are all built in reality, so it’s simply a matter of talking to the right engineers. But technocratic efforts do not solve what Nobel economist Friedrich Hayek called the “Socialist calculation problem,” the inability of centralized systems to take account of the millions of constantly changing facts, desires, and preferences that the market price system deals with automatically. The Soviet Union finally learned that lesson, the hard way. 

It’s a lesson that Dr. Berwick, his successors, and President Obama, will learn sooner or later as well…

Sharks!!

Shark Tank is an hour long show airing Friday nights in the ABC line-up, now in its third year. The format is of interest to any libertarian. People with entrepreneurial ideas--some brilliant, some apparently crazed--are invited to pitch their concepts and products to major businessmen and women...people like Mark Cuban, owner and chairman of HDNet (and the Dallas Mavericks); venture capitalist Kevin O’Leary; Lori Greiner, “Queen of QVC;” technology innovator Robert Herjavec; fashion and branding expert Daymond John; real estate mogul Barbara Corcoran. All of these people are “self-made.” None was born into wealth. They are now at the least worth hundreds of millions of dollars each. Cuban and O’Leary are both billionaires.

Each week, on hearing the pitch, five “Sharks,” as these wealthy wheeler-dealers are called, may shoot down the idea, explaining why they think it won’t work. Or one may make an offer, perhaps less than the entrepreneur wishes. Or they may fight among themselves, offering progressively more lucrative bids if they think the idea highly profitable. Or 2 or 3 may form temporary alliances to overcome another bid, or to avoid offering “too much” to the “contestant.” 

Some “contestants” leave without a deal. Some leave with a deal less than they desired. Some leave having sold a product to a Shark. Others leave with a needed cash infusion in return for partnering with a Shark, who then has a profit incentive to mentor the contestant so both can make money. None of this is “made-for-TV.” These all represent real products being launched or expanded, and the potential gains and losses are real as well.

Even those who “lose” in the Shark Tank may get insight into how to make their product better. On the latest episode, Kelly Chaney, a young woman, pitched her four-year-old business, Puppy Cakes, which produces cake mixes for dogs. She asked for $35,000 in return for 25% equity stake in her company. Several Sharks asked for her current sales. In four years running the business she hadn’t yet broken into 6-figure revenue. But, she explained, that was only because she hadn’t had the capital necessary to make it to the national trade shows where she could make the necessary contacts. “Have you gone to local pet stores to try and get your product out?” she was asked. “No. Sales is not really my strength,” she replied. No Shark was willing to do the deal with someone not eager to promote her own business. In addition, several were concerned that dog birthdays come but once a year, and suggested she consider expanding into other doggie delicacies. Interviewed after leaving the Shark Tank, she thanked the Sharks for showing her what she needed to do to succeed. And if you go to her website now, she has a “Let’s Show The Sharks They Missed Out” sale. 3 cake mixes for only $20...

Sometimes even contestants who couldn’t convince a Shark to invest find their exposure on the show highly profitable. They get calls on returning home. Someone saw the show and is eager to invest when the Sharks were not.

Sharks use their own money to invest, and make or lose money depending on how things turn out. This is the best educational example of capitalism I’ve seen on national television. Everyone wins. People’s lives change in an instant for the better, not from alms, but from people excited to help them in exchange for a return.

And ABC calls it the Shark Tank...Sharks are evolutionarily ancient, the current versions not that much different from when our ancestors diverged from theirs 460 million years ago. They are highly evolved killing machines, programmed for nothing but predation, achieving little else while they live. They are fearsome destroyers. And thus they represent the typical caricature of capitalism. 

Yet all who walk out of ABC’s Shark Tank have benefited. Some greatly, moving rapidly from the lower middle-class to affluence. Some slowly, getting advice that they use to improve their ideas or their products and try again. Even the viewers gain, not merely from the entertainment--and the show is hugely entertaining--but from the educational experience of seeing how successful people quickly grasp the value of an idea, see how to make it better, recognize its flaws, search for ways to overcome them. Perhaps from this viewers might begin to appreciate the value added by some who are members of the 1%. 

The show also teaches basic economics. Donny McCall lives in a depressed part of North Carolina. He has developed a collapsable rack for the back of pick-up trucks that allows better cargo management. It can be locked into place or unfolded in seconds. Several Sharks are initially interested in McCall’s idea, and his offer of 10% of his new company for $100,000. But then it becomes clear that Donny has a secondary goal of making sure everything is made in America, to help his neighbors. McLeary points out it doesn’t help his neighbors if his plant closes because he can’t keep his costs down, and suggests the rack could be made for much less overseas. McCall is resistant, and McLeary is out. McCall pleads with Robert Herjavec, now worth hundreds of millions but born into poverty, whose father was a miner. Herjavec can barely hold back tears telling him how he understands the plight McCall and his neighbors are in, but ends up explaining he cannot invest in a company not dedicated to keeping costs low; that business is different from charity; that his customers have also been hit by the Recession, and can’t afford to pay more; that it is better to make a profit and use it to support his community than to start a business for the main purpose of employing workers. In the end, no Shark invested in Invis-a-Rack. And viewers learned something about global competition. Meanwhile Invis-a-Rack still benefits from the exposure, including McCall’s compelling story and link to his company on ABC’s Shark Tank website.

No, Cuban, McLeary, and the others are not Sharks. The term for venture capitalists who invest their own money in promising start-ups is "Angel."

Sharks destroy lives. Sharks take a bite out of you. Sharks are remorseless at taking what they want. Sharks live at the expense of others. People like that exist, of couse, but Cuban et al are not examples. 

ABC could do a show that better lived up to the title of Shark Tank. A show set in Washington, D. C., with President Obama and key leaders in the House and Senate, on both sides of the aisle, could justifiably be called Shark Tank. Each week special interests could plead their case, and be rewarded with tax-dollars, as viewers see how large a chunk of flesh each deal will cost them. But if the continued drop in audience for the State of the Union, and the flat to falling turn-out in GOP primary races now compared to 2008, are any indication, THAT would be a show no one would watch. Sad...it, too, would be very educational.

Do Pundits Oppose the Secret Ballot?

A few weeks back we celebrated the two year anniversary of the Citizens United decision so upsetting to liberals, though breaking news indicates President Obama is now eager to have supporters set up a SuperPAC for his benefit. (see this LA Times story. )

A major riff from the establishment opinion-making class after the 2010 election was: our democracy was being stolen by secret money fueling the election campaign. Unless you listened carefully, it appeared this money only came from the right. In fact, in the 2010 election, the Supreme Court’s Citizens United decision was taken advantage of most by the American Federation of State, County, and Municipal Employees, the government workers’ union AFSCME, to the tune of over $87 million. But the pundits seemed more concerned about groups like Karl Rove’s American Crossroads, or Dick Armey’s Americans for Prosperity. AFSCME obtains the funds it gives to politicians from forced union dues—one cannot work without joining the union, and one cannot join the union without paying dues—but the pundits were not worried about forced political contributions. Instead, they were worried about “lack of transparency” because “we don’t know who contributes” to groups like Armey’s and Rove’s. We don’t know their motivations for donating. So for America’s pundits, corruption of the political process from forced contributions was not the issue. Corruption of the political process due to lack of transparency was. With the 2012 elections now only 9 months away, there is no doubt these concerns about secret influence through funding political ads will soon again be discussed on the nation’s editorial pages and Sunday talk shows…

Yet--isn’t it strange?--no one complains about the secret ballot (also known as the Australian ballot), a relatively recent 19^th century invention—Grover Cleveland was the first US President elected using this technique—that was criticized in the United States when first adopted… because of concerns over the potential for corruption, the lack of transparency. 

Barack Obama won the Presidency in 2008 by 10 million votes, and I don’t know who these people are, or what their motivations were for supporting him! Maybe some of them voted for Obama because they expected special favors. Maybe some voted for Obama just because he was black. Maybe some voters chose Obama because they believed he’s a Muslim and they long for an Islamic caliphate in the U. S. If we don’t know their names and motivations for voting, isn’t that a threat to democracy?

Isn’t non-transparently voting more dangerous than non-transparently raising money to urge other people to vote? Consider a well documented problem with secret voting: the tendency of dead people to vote. If you have to put your signature on the ballot, it is harder for dead men to vote. It is even harder to get dead men to contribute funding than it is to get them to vote, yet no one concerned about secrecy in fund raising and advocacy is concerned about the secret ballot. 

Frankly, the “money in politics” argument is bogus. It raises the importance of the messenger above the importance of the message. It implies that if you see an ad that you find repugnant, you’d suddenly find it brilliant and incisive were you to learn it was produced by a political group you support.

In this country we spend more money advertising potato chips than politicians, yet no one thinks we’re forced to buy potato chips, or believe we can’t eat just one. We watch advocacy ads daily, produced by the Ad Council (“and this station”). No one watching those ads knows who sits on the Ad Council. Yet no one is concerned about this…

Chronicle of Power...

A just released film getting strong critical acclaim, Chronicle, is a science-fiction tale distributed by 20th Century Fox. 

From trailers, one might get the impression it’s a variant of the hilarious 2010 film “Kick-Ass,” where a gawky teen tries to make his dreams of being a super-hero come true. While there are some similarities, there are more differences. For all it’s violence, Kick-Ass is much more light-hearted than Chronicle. This new film offers the tale of teenagers getting actual super-powers, not merely training and skills to fight crime. And not once do any of the three teens in Chronicle even suggest they should use their new found powers to “fight crime.” Indeed, the opposite tendency occurs…

No, the best pre-cursor of Chronicle is not Kick-Ass, but Allen Moore’s 1980s comic series, Miracleman (called Marvelman in the original English version; it was changed to avoid trademark issues on arriving in the US). 

Just as Moore created his better known Watchmen characters out of old Charlton super-heroes from the 1960s, so, too, he based the Miracleman series an English super-hero character out of the 1950s. The original version was a frankly cartoonish concept, creating not only Miracleman, but Kid Miracleman, Young Miracleman, Miraclewoman, and other members of the Miracleman family.

But Moore transformed them, from cartoonish comics for children to a dystopic vision of what happens when power runs amuck. Kid Miracleman--who obtained his powers as a young child and who had no adult guidance because of the sudden decades long departure of Miracleman from the scene--has become a sociopath, employing power wantonly and without regard to consequence. In the end of an epic battle between Miracleman and his once-young ward and companion, London is decimated and 40,000 lie dead and dismembered. 

This was, perhaps, Moore’s riff on the famous saying of another Englishman, Lord Acton: “Power tends to corrupt, and absolute power corrupts absolutely.” We see that theme at play again in Chronicle. Three teenagers are mysteriously given telekinetic powers...powers that become stronger over time. Each boy is a prototype: there is the geek, Andrew, with his many resentments; his cousin Matt, the intellectual (he tries to reference Jung at a rave as a pick-up line); and their new friend Steve, the young and upcoming politician, a teenage Barack Obama, friendly, outgoing, always trying to help. What political statement is being made, that he is the first to die?

Andrew’s mother is dying and his father is abusive. As his power grows and strengthens over time, he becomes more divorced from petty human concerns. He uses telekinesis to kill a spider he sees crawling on the floor, first elevating it in the air, then stretching all 8 limbs in star-like fashion, only to finally tear it apart in a chillingly effective special effects effort. He refers to himself as the Apex Predator, a biologic/sociologic concept referring to predators who have no predators of their own, predators at the top of the food chain. And now his telekinetic powers have grown. No longer is it useful only to change the arc of a thrown baseball and do cute magic tricks with. Now he can move cars. And crush them. Now he can fly…

Now nothing can stop him, save his cousin Matt, the intellectual...the philosophical one...the one who wanted to impose rules on the use of their powers. But Matt is not the boss of Andrew. No one is. Nothing good can come of this. Power corrupts.

The story ends in Tibet, a place symbolizing peace and tranquility, reflection and purity of soul. But the story ending is not a happy one. For Tibet is reached by one alone.

Chronicle is a captivating story of the trauma of adolescence and the danger of power. It is a dark but fascinating investigation of Acton’s dictum, and perhaps a political metaphor of those in Washington living a continued adolescence--of believing wish fulfillment can work if only backed by law--with all too much power, from which nothing good can come.

The State of Tennessee Meets Simple Logic...

The state of Tennessee decided last year to provide Ark Encounter, a theme park owned by the Creationist Institute, with state tax incentives that could allow them to recover 25 percent of the facility's cost. My understanding of the state’s justification for involving the state in a matter of religion is that it allows their citizens to hear “both sides of the debate.” 

As reported by NPR, a major ride at the park, to open in 2014, is Noah’s Ark meets the Dinosaurs. I take it this is some kind of roller-coaster ride (though perhaps given the nature of Noah’s Ark, maybe it’s a variation of a plume ride), where the kids, on Noah’s Ark, pass by those great reptiles, moving animatronically ala Disney.

The commentators on NPR made fun of the ride, based on current well-established scientific evidence that humans evolved millions of years after dinosaurs became extinct…that cavemen and dinosaurs did not co-exist.

My concern is different. If the creators of the Creationist Institute take their own beliefs seriously…if they believe in the reality of Noah’s Ark and the great flood, if they believe that man coexisted with the dinosaurs…why does Noah’s Ark have to meet the dinosaurs? Aren’t there already two dinosaurs on Noah’s Ark?