Wow, what a week

I think it’s time to start re-opening our society. Last I heard, 50,000 Americans died from coronavirus. And throughout the world? 191,000. There are 7.6 billion people living today.

I think most of the arguing from here on out will be: 1) on whether the relative dearth of deaths was because of the lockdown, 2) why the data don’t match up, and 3) ___________ (fill in the blank, use the ‘comments’).

I think that, here in the States, there will be enough pushback that a lockdown on such an epic scale won’t happen again. Americans long ago chose money over public health, and that’s not necessarily a bad thing.

Check out these numbers.

This thing is far from over. Singapore has seen a rise in cases. But I think it’s time to open up shop again. Government schools can close for good. Don’t go shopping just because you’re too lazy to pick up a book. Nursing homes have always scared me, so why not rethink the whole concept? This is manageable. Government proved that it is unfit for the task. Government also proved that it is responsive to the people. Same old story, same old song and dance. That’s not a bad silver lining for a pandemic like this one.

I have more to say about federation as a foreign policy. I just don’t know what yet. I’d like to focus on present-day India, the Caribbean, and Mexico, as well as the 19th century’s Federal Republic of Central America, Five Civilized Tribes, and Gran Colombia. It’ll be a long, slow process.

A Reflection on Information and Complex Social Orders

In the year 2020, occidental democracies face a time of lock-downs, social distancing, and a sort of central planning based on epidemiological models fueled by testing methodologies. An almost uniform consensus on the policy of “flattening the curve and raising the line” spread worldwide, both in the realms of politics and science. Since the said public policy is not for free, but nevertheless it is out of discussion, the majority of the efforts are focused on gathering data concerning the rate of infection and fatalities and on achieving accurate and fast methods of early detection of the disease (COVID-19). The more the data is collected, the more efficient the policy of “flattening the curve” will be, i.e.: minimizing the economical costs. Technology -in a broad sense- seems to be the key ingredient of every successful policy.

Nevertheless, since the countries that undertook the said task are democracies -and they were urged to do so because they are democracies-, there is a lot more than data provided by technology to take into account. Science and technology could reach a conclusive study about infection and fatality rates, but the outcomes of the societal discussions about the value of life and the right of every individual to decide upon the way of conducting their own plans of life will always remain inconclusive. Those discussions are not only philosophical and, fundamentally, are not only to be conducted in the terms of an academic research, since the values at stake entitle every human being to have their own say and, at the same time, are so deeply rooted in the upbringing of the individuals that seldom they might be successfully articulated -and surely that is why such questions are of philosophical interest.

In the race to determine the political agenda, technology plays with a significant advantage over philosophy: in times of emergency, conclusive assertions -despite proving right or wrong afterwards- enable political leaders with a sense of determination that any philosophy can hardly achieve. It is true that philosophical considerations mark the legitimate limits of science and its uses, but the predictable models and plausible scenarios depicted by the technology might lift the barriers of what had been considered at the time as politically illegitimate, i.e.: to describe a given situation as a state of exception.

However, there is still a dominion in which philosophical considerations might have high expectations of winning the competition against technology: the making of the abstract criteria to judge the fulfillment of the due procedures to be followed by the authorities given the account of the data gathered by the technology. Such philosophical considerations on which base authorities should personally account for their decisions, despite having been discussed by academics and writers, have being treated for centuries in particular legal procedures that crystallized the standards of conduct of the Civil Law (the diligence of a good father of a family, or of a good businessman, etc) or Common Law concepts (the reasonable person, the ordinary prudent man of business) or more recent -in terms of the evolution of the law- formulae, such as the Hand’s rule.

Such legal standards, concepts or formulae do not oblige the political authorities in their public sphere, but they perform as an incentive to be taken into account by the agent who is invested with the public authority; since he, eventually, will be personally accountable for his decisions. Moreover, those legal parameters to judge the personal responsibility of the agent in charge of the political authority are a true guarantee for the public servants, more reliable than the changing public opinion measurements to be provided by the technology.

Notwithstanding the Realist assertion about the division between law and politics might earn certain relevance in times of turmoil, individual rights and legal procedures should endure in the long run, in order to work as a benchmark to judge the personal performance of the political agents.

Such times of political and social upheaval are useful to test political theories and doctrines as well. Certain strains of Political Liberalism -particularly Classical Liberalism- have been largely criticized for -supposedly- trying to replace the political with the law. However, the law is there to remind the political agents that the state is an abstraction run by individuals who are expected to be personally accountable for their decisions. In this case, the true function of the law, although conceding that it should remain outside of the political sphere, is to provide the correct incentives for the political agents, who are not mere abstractions -and so, maximize their own plans- to take their own decisions. If technological devices might be the key instruments for public policy, the rule of law is its inescapable framework -or at least so it is, of course, for every democracy.

Coddle the Old, Spoil Them; Everybody Else, Back to Work!

I am more worried by the day about the economic consequences of the current isolation policy intended to change the shape (not the numbers) of the corona-virus epidemic in America. This, in spite of the a large infusion of (national debt) money, that I would approve regretfully if it were my sole decision. (Note: I am not an economist but I have been reading the Wall Street Journal daily for thirty years. I am also a scholar of organizations including businesses.) What inspires most of my fear is that the issue of small-scale entrepreneurship is seldom discussed, as if it did not exist.

I believe that the larger businesses, those that survive the current crisis, may well come back with a roar (as the president seems to predict for the whole US economy.) The problem is that small businesses, restaurants, but also dry cleaning establishments, hair dressers, bookstores, and the like, have short financial lifelines. Many must be dying like flies, right now. It will be difficult or impossible for them to make a comeback once the health emergency is gone. Also we can’t count on fast replacement of those failed business by new entrepreneurs. The collection of small business that accrued over many years at a particular location is not going to be replaced in the course of a few months, I think. (Yes, I know something about this topic. Ask me.)

All the above, in spite of large infusion of my granddaughter’s money by the federal department. (She is 11.) And, repeating myself, I would do it too if it were my decision, but regretfully.

The ruinous strategy of idling much of the workforce could have been avoided and could still be modified quickly, it seems to me. The alternative solution would be to confine all the sick and most of the aged, and to keep children out of school (because they are veritable cesspools, as everyone knows).

Everyone else would be invited to go back to work by agreement with his employer. Some financial dispositions should be offered at state’s expense to help parents who lose income because they must stay home to care for their children. Under such conditions, the economy would grow again and many irreplaceable small businesses would survive. Sweden is currently trying something like this policy. That country never ordered most people to stay home. I hope this experiment stays in the news. It may not because the liberal media are afraid of rational responses and of responses that don’t proceed from panic.

I only know two people who have consistently advocated for an American policy and a California policy of confining only the old and the sick. The two are myself and Jimmy Joe Lee, a singer composer musician from Boulder Creek, near Santa Cruz. Both of us are old dudes. We are both close to the center of virus’ target. I am 78 and Jimmy Joe may be even slightly older. (OK, let the whole truth come out: He is taller, straighter than I am and a much, much sharper dresser.) I am just pointing to the obvious: neither of us is speaking out of selfishness.

Now, let’s imagine the old are confined from, say, the age of 65, even 60. First, some of them wouldn’t even know anything has changed because they don’t go out much anyway. For the rest of us, all you would have to do is serve us promptly two hot meals a day. They would have to be of gourmet quality. That would be easy to achieve because so many expensive restaurants are idle and hurting. It would be a nice touch if the meals were brought and served by a youngish woman wearing a short skirt. We may not remember why we like it but we do. Yes, and speaking for myself and I am sure, for Jimmy Joe, don’t forget to send along each meal a couple of glasses of really, really good old wine. I assure you that however extravagant you went with that last component of our confinement regimen, it would be a lot cheaper than what you are currently doing. At least, promise to think about it.

Again: Never reason from a fatality change

The future isn’t written yet

Last week Richard Epstein predicted around 500 fatalities in the United States (I originally misread his estimate to be 50,000 for the US, not the whole world). His estimate was tragically falsified within days and he has now revised his estimate to 5,000. I still think that’s optimistic but I am hopeful for less than 50,000 deaths in the United States given the social distancing measures currently in place.

Today, several US peers have become excited about a Daily Wire article on comments by a British epidemiologist, Neil Ferguson. He has lowered his UK projections from 500,000 to 20,000 Coronavirus fatalities. The article omits the context of the change. The original New Scientist article (from which the Daily Wire is derivative with little original reporting) explains that the new fatality rate is partly due to a shift in our understanding of existing infections, but also a result of the social distancing measures introduced.

The simple point is:

Policy interventions will change infection rates, alter future stresses on the health system, and (when they work) lower future projections of fatalities. When projections are lower, it is not necessarily because the Coranavirus is intrinsically less deadly than believed but because appropriate responses have made it less deadly.

Life

Screenshot 2020-03-26 at 12.15.15

No matter how old, frail or vulnerable it may be, a life isn’t something to take or risk at another’s discretion. Nor does it undermine culpability when someone dies as a result of negligence. The common law ‘eggshell skull’ rule reflects this moral principle.

During the Coronavirus pandemic, some erstwhile defenders of the famous Non-Aggression Principle (NAP) appear to have forgotten that natural rights are conceived to protect life as well as liberty and property. They seem to think that the liberties we ordinarily enjoy have priority over the right to life of others. The environment has changed and, for the time being, many activities that we previously knew to be safe for others are not. They are not part of our set of liberties until a reformed set of rules, norms and habits establishes a sufficiently hygienic public environment. To say that bans on public gatherings violate natural rights a priori is as untenable as G.A. Cohen’s claim that a prohibition on walking onto a train without a valid ticket is a violation of one’s freedom.

The clue for anarcho-capitalist state-sceptics that this is a genuine shift in social priorities is that even organized criminal gangs are willing to enforce social distancing. You do not have to believe that the state itself is legitimate to see that the need for social distancing is sufficiently morally compelling that it can be enforced absent free agreement, just as one does not need free agreement to exercise a right to self-defense.

Not every restriction is going to be justified, although erring on the restrictive side makes sense while uncertainty about the spread of infection persists. Ultimately, restrictions have to balance genuine costs with plausible benefits. But rejecting restrictions on a priori grounds does not cohere with libertarian principles. Right now, our absolute liberties extend to the right to be alone. Everything else must be negotiated under uncertainty. Someone else’s life, even two-weeks or so in the future, is a valid side-constraint on liberty. People can rightfully be made to stay at home if they are fortunate enough to have one. When people have to travel out of necessity, they can be temporarily exempted, compensated or offered an alternative reasonable means of satisfying their immediate needs.

Nightcap

  1. The role of the libertarian in non-libertarian societies Fabio Rojas, Bleeding Heart Libertarians
  2. Did I have the coronavirus? Ross Douthat, New York Times
  3. Hospital bed access across Canada Frances Woolley, Worthwhile Canadian Initiative
  4. The future of public employee unions Daniel DiSalvo, National Affairs

Pandemic responses are beyond Evidence-based Medicine

critical-appraisal-of-randomized-clinical-trials-14-638

John Ioannidis, a professor of medicine at Stanford University, fears that the draconian measures to enforce social distancing across Europe and United States could end up causing more harm than the pandemic itself. He believes that governments are acting on exaggerated claims and incomplete data and that a priority must be getting a more representative sample of populations currently suffering corona infections. I agree additional data would be enormously valuable but, following Saloni Dattani, I think we have more warrant for strong measures than Ioannidis implies.

Like Ioannidis’ Stanford colleague Richard Epstein, I agree that estimates of a relatively small overall fatality rate are plausible projections for most of the developed world and especially the United States. Unlike Epstein, I think those estimates are conditional on the radical social distancing (and self-isolation) measures that are currently being pushed rather than something that can be assumed. I am not in a position to challenge Ioannidis’ understanding of epidemiology. Others have used his piece as an opportunity to test and defend the assumptions of the worst-case scenarios.

Nevertheless, I can highlight the epistemic assumptions underlying Ioannidis’ pessimism about social distancing interventions. Ioannidis is a famous proponent (occasionally critic) of Evidence-based Medicine (EBM). Although open to refinement, at its core EBM argues that strict experimental methods (especially randomized controlled trials) and systematic reviews of published experimental studies with sound protocols are required to provide firm evidence for the success of a medical intervention.

The EBM movement was born out of a deep concern of its founder, Archie Cochrane, that clinicians wasted scarce resources on treatments that were often actively harmful for patients. Cochrane was particularly concerned that doctors could be dazzled or manipulated into using a treatment based on some theorized mechanism that had not been subject to rigorous testing. Only randomized controlled trials supposedly prove that an intervention works because only they minimize the possibility of a biased result (where characteristics of a patient or treatment path other than the intervention itself have influenced the result).

Picture4

So when Ioannidis looks for evidence that social distancing interventions work, he reaches for a Cochrane Review that emphasizes experimental studies over other research designs. As is often the case for a Cochrane review, many of the results point to uncertainty or relatively small effects from the existing literature. But is this because social distancing doesn’t work, or because RCTs are bad at measuring their effectiveness under pandemic circumstances (the circumstances where they might actually count)? The classic rejoinder to EBM proponents is that we know that parachutes can save lives but we can never subject them to RCT. Effective pandemic interventions could suffer similar problems.

Nancy Cartwright and I have argued that there are flaws in the methodology underlying EBM. A positive result for treatment against control in a randomized controlled trial shows you that an intervention worked in one place, at one time for one set of patients but not why and whether to expect it to work again in a different context. EBM proponents try to solve this problem by synthesizing the results of RCTs from many different contexts, often to derive some average effect size that makes a treatment expected to work overall or typically. The problem is that, without background knowledge of what determined the effect of an intervention, there is little warrant to be confident that this average effect will apply in new circumstances. Without understanding the mechanism of action, or what we call a theory of change, such inferences rely purely on induction.

The opposite problem is also present. An intervention that works for some specific people or in some specific circumstances might look unpromising when it is tested in a variety of cases where it does not work. It might not work ‘on average’. But that does not mean it is ineffective when the mechanism is fit to solve a particular problem such as a pandemic situation. Insistence on a narrow notion of evidence will mean missing these interventions in favor of ones that work marginally in a broad range of cases where the answer is not as important or relevant.

Thus even high-quality experimental evidence needs to be combined with strong background scientific and social scientific knowledge established using a variety of research approaches. Sometimes an RCT is useful to clinch the case for a particular intervention. But sometimes, other sources of information (especially when time is of the essence), can make the case more strongly than a putative RCT can.

In the case of pandemics, there are several reasons to hold back from making RCTs (and study designs that try to imitate them) decisive or required for testing social policy:

  1. There is no clear boundary between treatment and control groups since, by definition, an infectious disease can spread between and influence groups unless they are artificially segregated (rendering the experiment less useful for making broader inferences).
  2. The outcome of interest is not for an individual patient but the communal spread of a disease that is fatal to some. The worst-case outcome is not one death, but potentially very many deaths caused by the chain of infection. A marginal intervention at the individual level might be dramatically effective in terms of community outcomes.
  3. At least some people will behave differently, and be more willing to alter their conduct, during a widely publicized pandemic compared to hygienic interventions during ordinary times. Although this principle might be testable in different circumstances, the actual intervention won’t be known until it is tried in the reality of pandemic.

This means that rather than narrowly focusing on evidence from EBM and behavioral psychologists (or ‘nudge’), policymakers responding to pandemics must look to insights from political economy and social psychology, especially how to shift norms towards greater hygiene and social distancing. Without any bright ideas, traditional public health methods of clear guidance and occasionally enforced sanctions are having some effect.

Screenshot 2020-03-23 at 23.57.13

What evidence do we have at the moment? Right now, there is an increasing body of defeasible knowledge of the mechanisms with which the Coronavirus spreads. Our knowledge of existing viruses with comparable characteristics indicates that effectively implemented social distancing is expected to slow its spread and that things like face masks might slow the spread when physical distancing isn’t possible.

We also have some country and city-level policy studies. We saw an exponential growth of cases in China before extreme measures brought the virus under control. We saw immediate quarantine and contact tracing of cases in Singapore and South Korea that was effective without further draconian measures but required excellent public health infrastructure.

We have now also seen what looks like exponential growth in Italy, followed by a lockdown that appears to have slowed the growth of cases though not yet deaths. Some commentators do not believe that Italy is a relevant case for forecasting other countries. Was exponential growth a normal feature of the virus, or something specific to Italy and its aging population that might not be repeated in other parts of Europe? This seems like an odd claim at this stage given China’s similar experience. The nature of case studies is that we do not know with certainty what all the factors are while they are in progress. We are about to learn more as some countries have chosen a more relaxed policy.

Is there an ‘evidence-based’ approach to fighting the Coronavirus? As it is so new: no. This means policymakers must rely on epistemic practices that are more defeasible than the scientific evidence that we are used to hearing. But that does not mean a default to light-touch intervention is prudent during a pandemic response. Instead, the approaches that use models with reasonable assumptions based on evidence from unfolding case-studies are the best we can do. Right now, I think, given my moral commitments, this suggests policymakers should err on the side of caution, physical distancing, and isolation while medical treatments are tested.

[slightly edited to distinguish my personal position from my epistemic standpoint]

Nightcap

  1. Why didn’t we see this coming? Scott Sumner, MoneyIllusion
  2. Against ageism Irfan Khawaja, Policy of Truth
  3. Expose the young Robin Hanson, Overcoming Bias
  4. Humility, not certainty Victor Davis Hanson, City Journal

I stopped French kissing. (Coronavirus alert!)

About 40 US deaths so far. The French have double that with 1/5 the population. My skeptical fiber is on full. Still I am washing my hands. When I run out of rubbing alcohol, I will use cheap brandy – of which I have plenty, of course. Oh, I almost forgot: I have decided to stop French kissing completely if the occasion arises! Extraordinary times require extraordinary measures! Count on me. I am wondering what the libertarian response should be to this public crises (plural).

My best to all.

A Small Reason Why I Don’t Want Big Government

Santa Cruz, California is really Silicon Valley Beach. It’s the closest; the next one is quite far. That’s in addition to drawing visitors from deep into the Central Valley of California, and a surprising number of European visitors.

One attractive beach close to its municipal wharf has only two (2) toilets. On Labor Day weekend Sunday, one of the two toilets was out of order. I estimate there were between 500 and a thousand people on that particular beach.

The day before, Labor Day weekend Saturday, the same toilet was already out of order. It was still out of order on Monday, Labor Day itself.

It was only a few months ago that the City of Santa Cruz joined a class action suit by a number of government entities against major oil companies for causing climate change. The first judge to look at the suit send the plaintiffs packing, of course.

So, this city of 60,000 wants to stop global warming but it does not have the ability to place two working toilets at the disposal of hundred of visitors who leave thousands of dollars in its coffers. The city cannot afford to hire a competent plumber on an emergency basis to fix the problem immediately. It does not have the timeX2 that would be required. Make it timeX3 on the outside. The total would come to $500 tops. Make it $1,000. It does not change anything.

The same happened last year or the year before. Surprise!

This is pathetic. We are governed by morons. Their gross incompetence is not natural, I am guessing. It’s learned stupidity. Our fault. We vote them in – with big help from UC Santa Cruz undergraduates who don’t care one way or the other, just want to feel good by electing “progressives.”

No one told our City Manager that Labor Day weekend, and its crowds, were coming. How was he supposed to know?

Nightcap

  1. White saviors abroad – social doctors at home? Tine Hanrieder, Duck of Minerva
  2. The case against Woodrow Wilson Philip Conway, et al, Disorder of Things
  3. Tragedy, statecraft, and world order Neville Morley, War on the Rocks
  4. “All leaders are constrained by their underlings” Rick Weber, NOL 

Nightcap

  1. The promise of liberalism in a world of groups Mark Koyama, Areo
  2. Becoming a man William Buckner, Quillette
  3. Choosing your own family Nora Caplan-Bricker, New Republic
  4. Home sweet home (California) Kerry Jackson, City Journal

Nightcap

  1. After Federalist No. 10 Greg Weiner, National Affairs
  2. Photos of the Paris “Yellow Vest” Riots Alan Taylor, the Atlantic
  3. A century of HIV Thomas McDow, Origins
  4. The long, entwined history of America First and the American dream Kevin Kruse, the Nation

Nightcap

  1. A libertarian case for postmodernism Candice Holdsworth, Spiked
  2. South Sudan and wealthy LA enclaves have same vaccination rate Olga Khazan, the Atlantic
  3. The rise of Turkey’s new ultranationalism Burak Kadercan, War on the Rocks
  4. Past Masters of the Postmodern Simon Blackburn, Inference

The Real Cost of National Health Care

Around early August 2018, a research paper from the Mercatus Center at George Mason University by Charles Blahous made both the Wall Street Journal and Fox News within two days. It also attracted attention widely in other media. Later, I thought I heard sighs of satisfaction from conservative callers on talk show radio whenever the paper came up.

One figure from the study came and stayed at the surface and was quoted correctly many times (rare occurrence) in the electronic media. The cost of what Senator Sanders proposed with respect to national health care was:

30 trillion US dollars over ten years (actually, 32.6 over thirteen years).

This enormous number elicited pleasure among conservatives because it seemed to underscore the folly of Senator Bernie Sanders’ call for universal healthcare. It meant implicitly, federal, single-payer, government-organized health care. It might be achieved simply by enrolling everyone in Medicare. I thought I could hear snickers of relief among my conservative friends because of the seeming absurdity of the gigantic figure. I believe that’s premature. Large numbers aren’t always all they appear to be.

Let’s divide equally the total estimate over ten years. That’s three trillion dollars per year. It’s also a little more than $10,000 per American man, woman, child, and others, etc.

For the first year of the plan, Sanders’ universal health care amounts to 17.5% of GDP per capita. GDP per capita is a poor but not so bad, really, measure of production. It’s also used to express average gross income. (I think that those who criticize this use of GDP per capita don’t have a substitute to propose that normal human beings understand, or wish to understand.) So it’s 17.5% of GDP/capita. The person who is exactly in the middle of the distribution of American income would have to spend 17.5% of her income on health care, income before taxes and such. That’s a lot of money.

Or, is it?

Let’s imagine economic growth (GDP growth) of 3% per years. It’s optimistic but it’s what conservatives like me think is a realistic target for sustained performance. From 1950 to 1990, GDP per capita growth reached or exceeded 3% for almost all years. It greatly exceeded 3% for several years. I am too lazy to do the arithmetic but I would be bet that the mean annual GDP growth for that forty-year period was well above 3%. So, it’s realistic and probably even modest.

At this 3% growth rate, in the tenth year, the US GDP per capita will be $76.600. At that point, federal universal health care will cost – unless it improves and thus becomes more costly – 13% of GDP per capita. This sounds downright reasonable, especially in view of the rapid aging of the American population.

Now, American conservative enemies of nationalized health care are quick to find instances of dysfunctions of such healthcare delivery systems in other countries. The UK system was the original example and as such, it accumulated mistakes. More recently, we have delighted in Canadian citizens crossing the border for an urgent heart operation their nationalized system could not produce for months: Arrive on Friday evening in a pleasant American resort. Have a good but reasonable dinner. Check in Sat morning. Get the new valve on Monday; back to Canada on Wednesday. At work on the next Monday morning!

The subtext is that many Canadians die because of a shortage of that great free health care: It nice if you can get it, we think. Of course, ragging on the Canadians is both fair and endlessly pleasant. Their unfailing smugness in such matters is like a hunting permit for mental cruelty!

In fact, though, my fellow conservatives don’t seem to make much of an effort to find national health systems that actually work. Sweden has one, Denmark has one; I think Finland has one; I suspect Germany has one. Closer to home, for me, at least, France has one. Now, those who read my blogging know that I am not especially pro-French or pro-France. But I can testify to a fair extent that the French National Healthcare works well. I have used it several times across the past fifty years. I have observed it closely on the occasion of my mother’s slow death.

The French national health system is friendly, almost leisurely, and prompt in giving you appointments including to specialists. It tends to be very thorough to the point of excessive generosity, perhaps. Yes, but you get what you pay for, I can hear you thinking – just like a chronically pessimistic liberal would. Well, actually, Frenchmen live at least three years longer on the average than do American men. And French women live even longer. (About the same as Canadians, incidentally.)

Now, the underlying reasoning is a bit tricky here. I am not stating that French people live longer than Americans because the French national healthcare delivery system is so superior. I am telling you that whatever may be wrong with the French system that escaped my attention is not so bad that it prevents the French from enjoying superior longevity. I don’t want to get here into esoteric considerations of the French lifestyle. And, no, I don’t believe it’s the red wine. The link between drinking red wine daily and cardiac good health is in the same category as Sasquatch: I dearly hope it exists but I am pretty sure it does not. So, I just wish to let you know that I am not crediting French health care out of turn.

The weak side of the French system is that it remunerates doctors rather poorly, from what I hear. I doubt French pediatricians earn $222,000 on the average. (Figure for American pediatricians according to the Wall Street Journal 8/17/18.) But I believe in market processes. France the country has zero trouble finding qualified candidates for its medical schools. (I sure hope none of my current doctors, whom I like without exception, will read this. The wrong pill can so easily happen!)

By the way, I almost forgot to tell you. Total French health care expenditure per person is only about half as high as the American. Rule of thumb: Everything is cheaper in the US than in other developed countries, except health care.

And then, closer to home, there is a government health program that covers (incompletely) about 55 million Americans. It’s not really “universal” even for the age group it targets because one must have contributed to benefit. (Same in France, by the way, at least in principle.) It’s universal in the sense that everyone over 65 who has contributed qualifies. It’s not a charity endeavor. Medicare often slips the minds of critical American conservatives, I suspect, I am guessing, because there are few complaints about it.

That’s unlike the case for another federal health program, for example the Veterans’, which is scandal-ridden and badly run. It’s also unlike Medicaid, which has the reputation of being rife with financial abuse. It’s unlike the federally run Indian Health Service that is on the verge of being closed for systemic incompetence.

I suspect Medicare works well because of a large number of watchful beneficiaries who belong to the age group in which people vote a great deal. My wife and I are both on Medicare. We wish it would cover us 100%, although we are both conservatives, of course! Other than that, we have no complaints at all.

Sorry for the seeming betrayal, fellow conservatives! Is this a call for universal federal health care in America? It’s not, for two reasons. First, every country with a good national health system also has an excellent national civil service, France, in particular. I have no confidence, less than ever in 2018, that the US can achieve the level of civil service quality required. (Less in 2018 because of impressive evidence of corruption in the FBI and in the Justice Department, after the Internal Revenue Service).

Secondly, when small government conservatives (a redundancy, I know) attempt to promote their ideas for good government primarily on the basis of practical considerations, they almost always fail. Ours is a political and a moral posture. We must first present our preferences accordingly rather than appeal to practicality. We should not adopt a system of health delivery that will, in ten years, attribute the management of 13% of our national income to the federal government because it’s not infinitely trustworthy. We cannot encourage the creation of a huge category of new federal serfs (especially of well-paid serfs) who are likely forever to constitute a pro-government party. We cannot, however indirectly, give the government most removed from us, a right of life and death without due process.

That simple. Arguing this position looks like heavy lifting, I know, but look at the alternative.

PS I like George Mason University, a high ranking institution of higher learning that gives a rare home to conservative American scholars, and I like its Mercatus Center that keeps producing high-level research that is also practical.