I Don’t Understand the Hep B Vaccine Brouhaha

I want to admit from the start that I don’t understand the brouhaha over administering Hepatitis B vaccines routinely to infants. I don’t understand why the administration chose to pick a fight by altering the guidelines; I don’t understand why the reaction has been what it has. Perhaps someone can explain it to me.

For background in 1991 the Centers for Disease Control (CDC) and the Advisory Committee on Immunization Practices (ACIP) recommended that the Hepatitis B vaccine be administered too all newborns, a change from the previous risk-based recommendation. This is estimated to have prevented 16,000 to 18,000 cases of Hep B in children with some subpopulations having a higher prevalence than others. That in turn reduced the number of other liver diseases including cancer later in life. The complete course of immunization is three doses.

The risk of adverse reactions appears to be nominal. There is no identified relationship between the immunization and autism, for example. Allergic reactions are most common and those are rare. Last year there appear to have been no reported deaths from administering the vaccine to newborns.

The cost appears to be fairly nominal (around $300 for the entire three-dose course) with little out-of-pocket. Like everything else in healthcare the markups and administration fees are high but the figure cited above includes those.

Routine immunization has reduced the number of diagnosed cases but hasn’t eliminated them (it’s stated objective).

So, the bottom line is that I don’t understand the argument at all. Immunization reduces the number of cases at the margins and is fairly harmless and inexpensive to the extent that anything in healthcare is. I don’t understand why there’s an argument. On either side since it hasn’t achieved its stated objective and it’s obviously not much of a profit center. Is it a turf battle?

Perhaps someone can explain it to me.

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A Little Family History (Updated)

My German ancestors arrived in the United States in the 1820s, settling in a German-speaking part of Southern Illinois on land they had purchased from a land developer while still living in Germany. My French ancestors arrived in the United States in the 1840s. Since by 1850 they were already quite prosperous and marrying into some of St. Louis’s most prominent “original settler” families, it’s reasonable to speculate they were not impoverished when they arrived.

My Irish ancestors arrived pre-famine in the 1840s. All indications are that they were dirt-poor. My great-grandmother (a third generation American), grandmother, and family were among the poorest people in St. Louis at a time when there was no such thing as public assistance.

My Swiss ancestors arrived immediately after the American Civil War. Since the 1870 shows them as living on their own farm, clearly they were not impoverished. “Schuler” was originally spelled with an umlaut which was dropped when they arrived since there was no umlaut in the English alphabet. My great-great-grandfather Schuler spoke German and, presumably, accented English. His sons spoke German but were also fluent in English and although my grandfather spoke a little German he primarily spoke English.

Basically, my father’s family was middle class or upper middle class while my mother’s family was working class or class-less (depending on how you classify entertainers). What they had in common was the mutual desire for a stable, solid family life, something neither one of them had while growing up.

Update

There are several lines I neglected to mention, the most notable being the Blanchards who are, shall we say, complicated. My great-great-grandfather Blanchard was born in Clinton County, New York in the 1820s. They may have arrived earlier than that. They were either French or Irish. Who knows? The records seem to have been lost.

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Plaintiffs Withdraw Case Against ICE

It’s been news here but I haven’t seen it in national news outlets so I’ll pass it along. The plaintiffs in the case filed against ICE for its use of anti-riot measures against protestors have moved to dismiss it. Jason Meisner reports at the Chicago Tribune:

In what appears to be a longer-term legal strategy, the plaintiffs in an injunction case limiting the use of force by immigration agents during Operation Midway Blitz on Tuesday abruptly moved to dismiss the underlying lawsuit in the midst of an appeal by the Trump administration.

In the request—which followed ominous signs from the 7th Circuit U.S. Court of Appeals—lawyers representing a consortium of media outlets and other plaintiffs said that Chicago’s immigration enforcement surge “has ended” for now, with no reports of unconstitutional behavior by agents in nearly a month.

If the dismissal is granted, it would effectively end a case that came to symbolize the havoc Midway Blitz caused in Chicago and led to U.S. District Judge Sara Ellis issuing a scathing ruling limiting the use of chemical munitions against journalists and protesters, among other restrictions.

In a statement Tuesday, the board for the Chicago Headline Club, the lead plaintiff in the case, claimed victory, saying that Border Patrol Cmdr. Gregory Bovinaud and his team of agents left town soon after Ellis’ injunction was entered on Nov. 8.

I can’t help but think that “longer-term legal strategy” is a remarkably rosy way of putting it. Several other possibilities come to mind.

One is that Judge Ellis had gotten out over her skis and her judgment had already been stayed by a three judge panel at the Court of Appeals. Might the plaintiffs have recognized that the decision was about to be struck down anyway and the precedent would be quite bad for them? If the case were being handled pro bono (which I suspect) it was about to become very expensive very quickly. Besides, since Operation Midway Blitz was already completed, they had already accomplished much of what they set out to accomplish—ICE leaving Chicago.

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Beware! Batman Is Watching

I found this interesting. Frank Landymore reports at Futurism:

Folks, we have some revolutionary sociological research to share with you today.

After making a guy dressed as Batman stand around in a subway car, a team of researchers found that the behavior of people around him suddenly improved the moment he showed up. No longer was everyone completely self-involved; with the presence of a superhero, commuters started helping each other more than they would’ve without him around.

Behold: the “Batman effect.”

The findings of the unorthodox study, published in the journal npj Mental Health Research, demonstrate the power of introducing something offbeat into social situations to jolt people out of the mental autopilot they slip into to navigate the drudgery of everyday life.

Batman showing up is just one — albeit striking — way of promoting what’s called “prosocial behavior,” or the act of helping others around you, via introducing an unexpected event, the researchers write.

“Our findings are similar to those of previous research linking present-moment awareness (mindfulness) to greater prosociality,” said study lead author Francesco Pagnini, a professor of clinical psychology at the Università Cattolica in Milan, in a statement about the work. “This may create a context in which individuals become more attuned to social cues.”

Conscience, a fully internalized force, promoting “prosocial behaviors” is not a culturally universal characteristic—it is limited to what are called “guilt cultures” (as opposed to “shame cultures”) which is what ours has historically been. It’s amazing how belief in an omniscient, watchful, and potentially vengeful God will do for those behaviors.

Such behaviors can also be promoted by less internalized forces such as universal, omnipresent surveillance. That is the direction in which many societies are heading. Maybe even our own.

Since Batman is unlikely to cooperate, all things considered I think that more widespread belief in an omniscient, watchful, and, potentially vengeful God would be preferable to Big Brother but, believe me, we will have one, the other, or both.

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The Administration’s Caribbean Attacks

There is no dearth of criticism of the Trump Administration’s most recent attack on a boat departing Venezuela, allegedly carrying drugs and “narcoterrorists”. The editors of the Washington Post are not happy about it:

The U.S. military’s summary killing of more than 80 people suspected of transporting drugs in the waters around South America rests on a shaky legal foundation. Transporting drugs is a crime, not an act of war. Suspected criminals — even the guilty — ought to be apprehended when possible, not shot on sight.

The Post reported Friday that the military is not just bombing the small boats, but in at least one instance intentionally killed shipwrecked survivors. After Defense Secretary Pete Hegseth reportedly gave a spoken order to kill everyone on board a boat in September, the Special Operations commander overseeing the mission ordered a second strike that killed two men clinging to the wreckage.

The revelation ought to prompt a recognition that these killings were rotten from the start. It seems to at least be puncturing the complacency of several congressional Republicans who have previously bit their tongues about the attacks. The leaders of the Senate and House Armed Services committees are promising inquiries.

The editors of the Wall Street Journal are perplexed about it:

Congress is mostly a media circus these days, so credit the members who take their duties seriously. Lawmakers are doing a public service by trying to get to the truth on whether the Trump Administration killed defenseless survivors of a drug-boat strike.

The controversy involves a Washington Post report that Defense Secretary Pete Hegseth ordered that no one survive a Sept. 2 missile strike on an alleged drug boat in the Caribbean. The story cites unidentified sources claiming that the U.S. military, on Mr. Hegseth’s orders, conducted a second strike to finish off survivors clinging to the destroyed boat.

Mr. Hegseth called the story “fabricated, inflammatory and derogatory,” and said U.S. actions have been “in compliance with the law of armed conflict—and approved by the best military and civilian lawyers, up and down the chain of command.”

President Trump added Sunday that the Secretary “said he did not say that, and I believe him, 100%.” Mr. Trump added that he’ll “look into it, but no, I wouldn’t have wanted that, not a second strike.”

The Pentagon is certainly full of people who might leak a derogatory story because they’d like to see Mr. Hegseth fired. The U.S. campaign against drug boats has also riled civil libertarians and progressives who want to constrain the President’s ability to conduct military action.

But the charge of deliberately killing the defenseless is serious enough to warrant a close look from Congress. That includes Mr. Hegseth giving an account under oath. The Administration so far seems to think it can ride out the story with ritual denunciations of the media.

and George Will is apoplectic about it:

Defense Secretary Pete Hegseth seems to be a war criminal. Without a war. An interesting achievement.

In 1967, novelist Gwyn Griffin published a World War II novel, “An Operational Necessity,” that 58 years later is again pertinent. According to the laws of war, survivors of a sunken ship cannot be attacked. But a German submarine captain, after sinking a French ship, orders the machine-gunning of the ship’s crew, lest their survival endanger his men by revealing where his boat is operating. In the book’s dramatic climax, a postwar tribunal examines the German commander’s moral calculus.

No operational necessity justified Hegseth’s de facto order to kill two survivors clinging to the wreckage of one of the supposed drug boats obliterated by U.S. forces near Venezuela. His order was reported by The Post from two sources (“The order was to kill everybody,” one said) and has not been explicitly denied by Hegseth. President Donald Trump says Hegseth told him that he (Hegseth) “said he did not say that.” If Trump is telling the truth about Hegseth, and Hegseth is telling the truth to Trump, it is strange that (per the Post report) the commander of the boat-destroying operation said he ordered the attack on the survivors to comply with Hegseth’s order.

Forty-four days after the survivors were killed, the four-star admiral who headed the U.S. Southern Command announced he would be leaving that position just a year into what is usually a three-year stint. He did not say why. Inferences are, however, permitted.

The killing of the survivors by this moral slum of an administration should nauseate Americans. A nation incapable of shame is dangerous, not least to itself. As the recent “peace plan” for Ukraine demonstrated.

I don’t think that “moral slum” quite covers it. The Trump Administration does not feel constrained by law, custom, mercy, or even common decency. Note, too, how consistent it is with President Trump’s pardoning of drug trafficking Honduran President Orlando: clearly, he does not believe that heads of government should be constrained. That is among the reasons I have been wary of electing rich guys to the presidency (see my posts when Mr. Trump was running). The rich are different from you and me.

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Still Opposed

I’m still opposed to the strikes on Venezuelan boats the Trump Administration has been carrying out. I was opposed as soon as I heard about the first one back in September.

That said I want to remind people that something being a war crime and proving it are two different things. The administration has a low bar to clear.

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It’s the Incentives, Stupid

I was working on a post about the healthcare system. All was moving along nicely until, as if by coincidence, Ezekiel J. Emanuel (Rahm’s physician brother) posted an op-ed in the Washington Post, covering much of what I wanted to say and providing me with an ideal “hook”. Here’s his opening statement:

Democrats succeeded in elevating health care affordability to the top of the national agenda during the shutdown fight. Indeed, they forced President Donald Trump to offer proposals — albeit wrongheaded ones — under the rubric of affordability. Count that as a win.

But simply defending the Affordable Care Act does not a health plan make. About 150 million Americans have employer-sponsored insurance, where a family plan now costs workers an average of nearly $7,000 per year from their wages and $27,000 in total — the equivalent of a new Toyota Corolla every year. Half of Americans worry that they cannot afford health care. Congress — and the American public — desperately need new ideas.

While Trump and the Republicans dither, Democrats can seize the advantage and craft a more comprehensive health care affordability bill. These five reforms can be immediately implemented to control costs…

His five points are:

  1. Change hospitals’ incentives with price controls
  2. Change physicians’ incentives by changing to a capitation system
  3. Change insurers’ incentives by forcing them to compete
  4. Change pharmaceutical companies’ and PBMs’ incentives with price controls
  5. Reduce administrative costs through standardization

Read the whole thing. If you are a close reader, you may notice the connecting thread among these proposals.

Democrats are shrewd in chiding Republicans for having no plan for healthcare. Dr. Emanuel has said, as they say, the quiet part out loud: Democrats have no plan, either, at least not beyond extending the ACA and the COVID emergency subsidies indefinitely.

Unfortunately, I’m afraid it’s vanishingly unlikely that we will see any sort of real reform along the lines proposed in the op-ed. I say that with confidence based on experience. Sustainable Growth Rates were approved more than 25 years ago. Their biggest failing was that, if Congress had the courage to stick with them, they might have worked. When they at long last repealed the requirement a few years back, the jig was up. There will be no plan for reducing costs forthcoming from Congress..

We do not have a healthcare system. We have a rent-seeking system. In 1965 the federal government spent less than $3 billion per year on healthcare. Today we spend almost $2 trillion per year. The percentage of GDP represented by the healthcare sector has risen from around 5% to around 17%. There is no metric that shows Americans’ health improving commensurate with that increase in spending. Yes, there have been marginal improvements. At least until 2010 when gains in life expectancy slowed dramatically. The reason is simple.

Not one of Dr. Emanuel’s proposals is a new idea. We have known that the fee-for-service system was a problem since back when Harry Truman was president in the findings of the Hoover Commission. Standardization could have been implemented at any point during the last 60 years with obvious benefits.

Today LLM AI has the potential to increase the productivity of our healthcare system substantially at a lower cost. That could be facilitated by regulatory reform and applications being approved on an accelerated basis by the FDA. Unless that is done in a way that disrupts the present system it will suffer the same fate as previous attempts at reform.

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One Small Detail

I wanted to call attention to Andreas Umland’s piece at The National Interest on the nature of security guarantees for Ukraine. Mr. Umland opens:

Since spring 2025, the term “security guarantee” has become a buzzword in international debates about future Western support for Ukraine. Following the conclusion of a ceasefire, ensuring Ukraine’s security is to be a central component of international engagement with the embattled country. However, the term is currently often used in a way that leaves important political and strategic challenges to the implementation of these guarantees unaddressed.

In general, the term “security guarantees” can be misleading: a complete security guarantee is an unattainable illusion, not only for Ukraine but also for every other nation. Expert discussions distinguish between guarantees and (weaker) security commitments, as well as between positive and negative guarantees. As a rule, a positive security guarantee—the type of promise Ukraine is seeking—implies strong commitments on the part of the guarantor to protect the beneficiary.

The different definitions and interpretations of security guarantees, as well as the ambiguities and contradictions implicit in their planning and implementation, pose a problem. Open questions must be clearly identified at the outset. Transparency can help move from purely discursive progress on Kyiv’s future defense needs to a real improvement in Ukraine’s security situation.

In the body of the piece Mr. Umland, successfully in my opinion, argues against stationing a European “reassurance force” in Ukraine but in support of something he calls “the SkyShield plan”:

A limited engagement of their air forces over and in western and central Ukraine appears less problematic than the deployment of ground troops and warships. Such support with Western interceptors—also known as “SkyShield”—would already be possible and sensible now, before a ceasefire is concluded.

The establishment of joint air defense zones over entire regions of Ukraine, or at least over important cities such as Uzhhorod, Lviv, and Kyiv, or critical infrastructure, carries less risk of escalation, as the deployment of Western interceptors can be limited in two ways.

I have no objection in principle to either version of security guarantee that he describes with the following caveats:

  • in either case other European countries should be providing the funding and manpower for it
  • U. S. security guarantees to Ukraine should primarily be in the form of negative reciprocity

The devil, as usual, is in the details. One glaring omission is where would the forces for the “SkyShield plan” be stationed? And, if stationed in Ukraine, how would that differ from the “reassurance force” plan he discards?

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Writing My Congressman

I have written at least one letter to every Congressman I have ever had. I have received responses from all of them. The best response I ever received was from Jan Schakowsky; the worst from Rahm Emanuel. What made Rep. Schawkosky’s letter the best is that it was a direct, considered response to the letter I had written; what made Rahm’s the worst is that it was a form letter.

Last week I wrote a letter to my present representative, Mike Quigley. It was my first letter to him. I expect to receive a response. When I do I’ll tell you about it.

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Why Sam Is Wrong

OpenAI’s Sam Altman has expressed his support of a Universal Basic Income (UBI) in the United States on many occasions. Here’s one of them.

I want to explain why he’s wrong and why I think that a UBI in the United States is highly unlikely for the foreseeable future. Here’s the TL;DR version. UBI only works if implemented globally, because any country that offers a meaningful unconditional income becomes a magnet for global migration. But global UBI is impossible to coordinate, impossible to fund, and impossible to enforce. Therefore, UBI is inherently impractical and cannot be implemented in the real world. Anything less than global implementation is not universal, not sustainable, and ultimately self-defeating.

The economic problems

The price tag for a UBI is staggering. Even for a minimal $10,000 per year program for 260 million adults it would cost $2.6 trillion per year. In the absence of real material production rising that would produce inflation. Indeed, increases in the prices of housing and other essentials diminish the value of the UBI. It becomes a positive feedback situation.

Furthermore, raising taxes to pay for it is not a practical solution. The topmost income earners (or possessors of wealth in the case of a wealth tax) can and do leave.

From a technical standpoint a value-added tax is the only one capable of generating enough revenue and not only has that been historically unpopular in the U. S. it would run into the same positive feedback dilemma mentioned above.

The resistance to cutting presently existing programs is enormous. We are seeing that right now. The costs of a UBI would exacerbate that.

The social problems

The United States is, perhaps, peculiarly ill-suited for a UBI. Here in the U. S. identity, dignity, self-worth, and status are closely tied to work and the income realized from work. A software engineer who loses a job paying $180,000 a year to AI will have emotional and social difficulty receiving the same “basic income” as an individual who never graduated from high school or, possibly, worked a paying job in their lives.

The political problems

There is little or no coalition to support a UBI in existence. At present the overlap among progressives, moderates, and conservatives is so small it’s hard to imagine such a coalition forming. There are already substantial, active constituencies for Social Security, Medicare, and the Affordable Care Act. There aren’t any for a UBI.

The irony of LLM AI

The irony of LLM AI is simple to state. It’s expensive. The data centers required for LLM AI:

  • produce huge, concentrated loads
  • require constant cooling
  • draw power even when human usage drops
  • strain transmission lines
  • require substation expansions and new peaker plants

Their demands will tend to raise the price of electricity. LLM AI threatens entry-level white collar jobs and the incomes associated with them, popularizing the idea of a UBI among progressives, tech-utopians, displaced workers, and futurists.

It should also be mentioned that a UBI will induce migration from areas of the United States where the climate is harsher, e.g. North Dakota, Minnesota, to places where it is milder, e.g. California, Florida, and North Carolina producing price increases in the destination areas and fiscal collapse in the origin areas. Furthermore, those destination areas are those most vulnerable to increases in the price of electricity and vulnerable to outages.

AI raises the floor of human needs while lowering the ceiling of what society can afford.

In conclusion it should be obvious why I think that a Universal Basic Income is unlikely, at least in my lifetime. More likely will be reinforcement of existing programs, however poorly constructed they might be.

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