Per capita health care spending of $10,739 per person sounds like a lot of money. And it is. But it’s not as bad as it might have been as noted by Jessie Hellman at The Hill:

National spending on health care reached $3.5 trillion in 2017, or about $10,739 per person, according to new data released Thursday by the Trump administration.

Overall, health spending grew at a rate of 3.9 percent last year, after increasing by 4.8 percent in 2016 and 5.8 percent in 2015.

It’s the slowest increase in spending since 2013, before most parts of the Affordable Care Act took effect, including the expansion of Medicaid to more low-income adults.

Consider that figure in perspective. the median family income for a family of four last year was $61,372. If health care spending were distributed evenly across the population and if people actually paid for their own health care, it means that family would be spending two-thirds of their income on health care. Subtract another $22,000 (education spending per pupil) and what’s left is…nothing. Is it any wonder that economic growth outside of health care and education is slow?

3.9% sounds like a slow rate of growth. It’s also three times the non-health care rate of inflation. It’s also more than twice as fast as incomes.



In an op-ed at USA Today Alex Berezow demands we start irradiating meat and produce:

The United States is being hit by two large foodborne illness outbreaks — first, the E. coli outbreak in romaine lettuce, and now a salmonella outbreak in beef that has sickened more than 200 people. These high-profile cases underscore the inadequacy of the safety measures meant to protect our food supply. If we are serious about addressing this issue, we must implement food irradiation.

Every year, the Centers for Disease Control and Prevention estimates that 48 million cases of foodborne illness occur, hospitalizing 128,000 and killing 3,000, usually older or immunocompromised people. Those of you who have ever had the“24-hour flu” or “stomach flu” should be aware that those aren’t real diseases; instead, you probably had food poisoning.

As (I suspect) like most of you that idea makes me a bit queasy. Maybe I’m just the victim of propaganda.

There is one factor that Mr. Berezow is not considering: moral hazard. E. Coli isn’t endemic in romaine lettuce. It’s introduced there by bad field sanitation practices. If I understand it correctly, salmonella in meat is a consequence of bad sanitation practices in processing. It’s not the same as milk and, consequently, not the same as pasteurization. Will irradiating meat and produce increase or decrease the the number of bacterial infections from food? I don’t know and I suspect that Mr. Berezow doesn’t, either. How would you go about conducting an experiment?

There are actually real life experiments. In the EU irradiated spices and herbs are a commonplace and Belgium, Czech Republic, France, Italy, Netherlands, Poland, and the United Kingdom allow the irradiation of a wider variety of foods. You’ve probably got irradiated foods in your refrigerator since a lot of produce imported from abroad has been irradiated.

On the con side of the argument there have been instances of serious illness that may have been caused by very highly irradiated foods. Would DoA inspectors be better at overseeing radiation than they are at other food processing?


Yellow Jackets

The yellow jacket protests that began a month ago in France have continued and spread into other French cities. From NBC:

An estimated 10,000 yellow jacket protesters flooded Paris’ otherwise largely deserted streets on Saturday, while 125,000 demonstrated around the country, according to Interior Minister Christophe Castaner. Police arrested over 1,000 people. In addition, 135 were injured, including 17 police officers, he added.

Police and protesters also clashed in other French cities, notably Marseille, Toulouse and Bordeaux. The effects of the protest were felt beyond France’s borders as well, with protesters donning yellow jackets as a symbol of resistance in Belgium Saturday and Iraq earlier this week.

As noted above they have spread into Belgium, the Netherlands, and now Iraq as well. They started as protests against fuel tax increases but I honestly don’t know what they’re protesting in each country. Perhaps a generalized dissatisfaction.

The greatest commonality among the protests seems to be that they’re using the Internet (Facebook in particular) to organize. Anti-globalization? Anti-EU bureaucracy? Anti-elite? Just unhappy?


The Four Scandals of Khashoggi

I think that Adam Garfinkle’s dissection of the “Khashoggi Affair”, to use a word ghoulishly appropriate to the matter, at American Interest is interesting but, unlike Mr. Garfinkle, I don’t find a thing funny about it. I think it’s scandalous.

The first scandal is the fascination with the gruesomeness of what apparently happened to Jamal Khashoggi in the Saudi consulate in Istanbul. Sadly, that’s a commonplace reaction but I find it no more becoming than cock-fighting.

The second scandal is that we have anything to do with the parties involved at all. The Turkish authorities, the Saudi authorities, and Mohammed bin Salman in particular are all awful people. They are vicious, cruel autocrats and while pragmatism may dictate we need to deal with them we shouldn’t pretend that we like them or can believe a word they say.

The third scandal is that the affair so quickly transmogrified into a domestic political issue. That should never have been the case and I don’t much care where the blame resides.

The fourth scandal is that the Washington Post should consider Jamal Khashoggi “one of their own” at all. In an age when a comic is defenestrated for nasty wisecracks made a decade ago that they should think of Jamal Khashoggi, whose history suggests that he supported views illiberal in the extreme, in such a light or even favorably regardless of how charming he was in person is a sad commentary. By all accounts Hitler was charming in person, too. I think that journalism has lost its way.

1 comment

Meaningful Lives for Ordinary People

I want to draw your attention to a joint report from Opportunity America, the American Enterprise Institute, and Brookings, “Work, Skills, Community: Restoring Opportunity for the Working Class”. I’m still making my way through the complete 136 page report. The one-page summary is here.

It does not seem to cover any new territory. A lot of the ground was covered nearly 20 years ago in Robert Putnam’s Bowling Alone. Their prescriptions are pretty quotidien: higher pay even if subsidies are required, education, opportunity zones, expanded public assistance.

I’m afraid that my view will not please a lot of people. For the last 40 years policy has been focused unerringly on the needs and wants of upper class and upper middle class Americans. Frankly, those needs and wants are destructive to the vast number of the people.

It began in the 1960s and has accelerated since. Wages per wage earner began to decline. The awful truth is that women don’t enter the workforce to pursue a career or for personal fulfillment. That’s for upper class and upper middle class women. Middle and working class women work to support their families and, as their husbands’ paychecks stagnated, declined, or vanished altogether, they went to work so their families could pay the bills. The institutions on which working class and middle class people depended, noted here:

Since the late 1970s and still today, working-class America is bearing the brunt of automation and globalization: entire industries are disappearing, and wages have been flat since the 1970s. Marriage has declined faster among the working class than in any other group, richer or poorer. Civic institutions that once sustained blue-collar enclaves—churches, union halls, neighborhood associations, the local VFW or Lions Club—are closing their doors or moving elsewhere. And as the social fabric frays, a host of new problems are arising, from opioid addiction to what Anne Case and Angus Deaton have called “deaths of despair” caused by drugs, alcohol or suicide and correlated with distress and social dysfunction.

depended on women, largely on a volunteer basis. When women were too tired or busy to run their churches, neighborhood associations, and other organization, those institutions declined. As families became viable without marriage, marriage declined.

What’s pushing wages down for ordinary people? Competition from overseas, a significant influx of immigrant workers willing to work for less, and subsidies for the well-to-do which push the costs of the services that people in the upper middle class up.

Education will do nothing for most people unless our economy creates more jobs for people with educations. Opportunity zones just move money from one pocket to another. And wage subsidies of themselves merely prevent desperation. They don’t rebuild the institutions that brought meaning to people’s lives and they don’t foster the conditions that result in the creation of more jobs that pay better.

The twelve step programs preach that the first step on the road to recovery is admitting that you have a problem. Our problem is that the “reforms” put in place over the last 40 years have left millions of casualties in their wake. What was built over hundreds of years and destroyed in the matter of a couple of generations will not be rebuilt overnight.



We have come to a pretty pass when DNA tests can determine the viability of a presidential candidate.

1 comment

The New Religion

In his latest piece in the New Yorker Andrew Sullivan writes:

Our modern world tries extremely hard to protect us from the sort of existential moments experienced by Mill and Russell. Netflix, air-conditioning, sex apps, Alexa, kale, Pilates, Spotify, Twitter … they’re all designed to create a world in which we rarely get a second to confront ultimate meaning — until a tragedy occurs, a death happens, or a diagnosis strikes. Unlike any humans before us, we take those who are much closer to death than we are and sequester them in nursing homes, where they cannot remind us of our own fate in our daily lives. And if you pressed, say, the liberal elites to explain what they really believe in — and you have to look at what they do most fervently — you discover, in John Gray’s mordant view of Mill, that they do, in fact, have “an orthodoxy — the belief in improvement that is the unthinking faith of people who think they have no religion.”

But the banality of the god of progress, the idea that the best life is writing explainers for Vox in order to make the world a better place, never quite slakes the thirst for something deeper. Liberalism is a set of procedures, with an empty center, not a manifestation of truth, let alone a reconciliation to mortality. But, critically, it has long been complemented and supported in America by a religion distinctly separate from politics, a tamed Christianity that rests, in Jesus’ formulation, on a distinction between God and Caesar. And this separation is vital for liberalism, because if your ultimate meaning is derived from religion, you have less need of deriving it from politics or ideology or trusting entirely in a single, secular leader. It’s only when your meaning has been secured that you can allow politics to be merely procedural.

So what happens when this religious rampart of the entire system is removed? I think what happens is illiberal politics. The need for meaning hasn’t gone away, but without Christianity, this yearning looks to politics for satisfaction. And religious impulses, once anchored in and tamed by Christianity, find expression in various political cults. These political manifestations of religion are new and crude, as all new cults have to be. They haven’t been experienced and refined and modeled by millennia of practice and thought. They are evolving in real time. And like almost all new cultish impulses, they demand a total and immediate commitment to save the world.

That’s certainly what G. K. Chesterton thought, viz. “You hard-shelled materialists were all balanced on the very edge of belief — of belief in almost anything.”

My own view is that just about everything that Mr. Sullivan values, be it political, social, or intellectual is part of the superstructure of Christianity and will not survive its absence.

1 comment

No Place For Ambitious Men

From a Wall Street Journal article about American entrepeneurs departing China:

SHANGHAI—Fifteen years ago in California, a tall technology geek named Steve Mushero started writing a book that predicted the American dream might soon “be found only in China.” Before long, Mr. Mushero moved himself to Shanghai and launched a firm that Amazon.com Inc. and Alibaba Group Holding Ltd. certified as a partner to serve the world’s biggest internet market.

These days, the tech pioneer has hit a wall. He’s heading back to Silicon Valley where he sees deeper demand for his know-how in cloud computing. “The future’s not here,” said the 52-year-old.

For years, American entrepreneurs saw a place in which they would start tech businesses, build restaurant chains and manage factories, making potentially vast sums in an exciting, newly dynamic economy. Many mastered Mandarin, hired and trained thousands in China, bought houses, met their spouses and raised bilingual children.

Now disillusion has set in, fed by soaring costs, creeping taxation, tightening political control and capricious regulation that makes it ever tougher to maneuver the market and fend off new domestic competitors. All these signal to expat business owners their best days were in the past.

The article is accompanied by a graph illustrating foreign direct investment in China. I don’t think it shows what the editors presumably think it does since FDI in China remains at a very high level. Yes, it has plateaued since 2015 but it hasn’t declined.

A more interesting graph illustrate’s China’s net capital outflows.

I can’t disaggregate capital flight from Chinese overseas investment from FDI’s plateau. I can only relate an anecdote. 35 years ago I stood in the boardroom of my Fortune 500 then-employer trying to explain the complexities of doing business in China to a group of men with dollar signs dancing in their eyes who could only see the headline number: 1 billion population. They had asked me to head up their technical organization there, an opportunity I was about to decline. I suspect that tens of thousands of Americans went to China with dreams of fortune and that many have been disappointed. China was and may still be a place where great fortunes can be made. But not by the laowai

1 comment

Discussion Question: Anti-Semitism vs. Anti-Zionism

Anti-Semitism is a fear or hatred of Jews. Anti-Zionism is fear or hatred of a Jewish state, particularly Israel.

The question: is it possible to be anti-Zionist without being anti-Semitic?

I think it is but, depending on your terms, it may be quite difficult and there is so much overlap between the two it may be difficult to distinguish one from the other. I think that Gulf Arabs tend to be both anti-Zionist and anti-Semitic.

I am most definitely not anti-Semitic; if anything I’m philo-Semitic. I also do not think I’m anti-Zionist. Rather I am indifferent to the state of Israel and hold the view, out-of-step for an American, that Israel is a state just as Russia, China, or Saudi Arabia are. The people who created the state of Israel do so in the way most states did: they took it by force of arms and the Israelis will keep it as long as they can do so by force of arms. Israel has its interests; we have ours. Sometimes those interests coincide; sometimes they conflict; sometimes we just don’t give a darn.

I am uneasy when we pursue Israel’s interests uncritically just as I am when we pursue the United Kingdom’s or Germany’s interests, particularly when they do not coincide with our own. I don’t think that makes me an anti-Semite.


WASP Nostalgia

I am not a white Anglo-Saxon Protestant. I do not aspire to be a WASP. I have never wanted to be a WASP. I have been subjected to anti-Catholic bigotry nearly all of my life, largely by WASPs, since I knew that there was such a thing as anti-Catholic bigotry, just about the same time as I learned about anti-Semitism. I think that the wave of nostalgia about WASPs is foolish, ill-considered, and uninformed.

Fareed Zakharia’s latest column in the Washington Post is pretty typical of the lot:

The death of George H.W. Bush has occasioned a fair amount of nostalgia for the old American establishment, of which Bush was undoubtedly a prominent member. It has also provoked a heated debate among commentators about that establishment, whose membership was determined largely by bloodlines and connections. You had to be a white Anglo-Saxon Protestant to ascend to almost any position of power in the United States until the early 1960s. Surely, there is nothing good to say about a system that was so discriminatory toward everyone else?

That’s a lie. Yes, you had to be a WASP to be elected president until 1960 and even then the Catholic elected was the son of the richest man in the world at that time. But that points to the real problem: the altar at which all too many Americans worship is Mammon.

Roger B. Taney, Chief Justice of the U. S. Supreme Court from 1836 to 1864, was a Maryland Catholic. There have been Catholic Congressional representatives and U. S. senators as long as there has been a Congress.

And that highlights another basic misconception. The overwhelming power and importance of the federal government is a 20th century phenomenon and, indeed, a late 20th century phenomenon. Prior to that the real power and influence was at the state and local level and there have always been non-WASPs in positions of influence in state and local governments.

Yes, George Washington and George H. W. Bush were WASPs. So were Benedict Arnold and Nathan Bedford Forrest. So is Donald Trump.