Molly Ball’s article at Time.com gave me the giggles:

“I am very, very worried,” says Marianne Burke, a 62-year-old special-ed teacher. “I’m terrified. We’ve got to get it together as Democrats.” But she can’t make up her mind either: Buttigieg is inspiring but inexperienced; Klobuchar’s debate closing was powerful, but does she have a chance? She worries that the strong economy is giving Trump a boost and doesn’t understand why no one seems bothered by his outrageous behavior.

“I just want to be inspired,” she says. “I’m so tired of Trump and everything he represents. We need somebody who’s going to bring out the best in all of us.”

Perhaps Buttigieg, who’s elevated inoffensiveness to an ideology, is the right vessel for this yearning for unity. But these days Democrats don’t feel like they can trust their own instincts. There’s a pervasive longing for a deus ex machina—something to free them from the pain of making this decision, with its awful weight. Won’t someone just figure it out for them?

If New Hampshire voters are concerned about making “the right choice”, they should worry no longer. They will make the wrong choice. There is no right choice. There are likes and dislikes but there is no one right choice. Where did they ever get that idea?

I hate to be judgmental but a very large number of people in New Hampshire, particularly southern New Hampshire, are actually tax refugees from Massachusetts. There is a characterization for fleeing higher taxes and then voting in support of them: cognitive dissonance. They should change the license plates from “Live Free or Die” to “The Cognitive Dissonance State”.

In an op-ed at the Wall Street Journal health care policy expert Sally Pipes argues that Medicare for All could have some unforeseen deleterious effects on care in the United States:

Some doctors evidently believe Medicare for All would deliver better health care for Americans. Some no doubt think more insurance would mean more patients. But it would also force physicians to work longer hours for less pay.

A single-payer program would pay doctors at rates similar to Medicare reimbursement levels, already at least 25% less than private insurance pays, according to estimates by Charles Blahous of the Mercatus Center. Under the current legislative drafts of Medicare for All, government rates over the first decade would be 40% lower than those paid by private insurers.

That amounts to an enormous pay cut for doctors. U.S. physicians earned on average $313,000 in 2019, according to Medscape’s international physician compensation report. The average physician in the U.K. earned only $138,000. The Commonwealth Fund reports that American general practitioners earned a little more than $218,000 on average in 2016, compared with $146,000 in Canada and $134,000 in the U.K.

Drastic pay cuts would inevitably drive physicians to give up the practice. Patients can’t afford an exodus of doctors. Nearly 80 million people live in areas with too few primary-care professionals, the Kaiser Family Foundation reports. Even under current policies, the country may face a shortage of as many as 120,000 doctors in a decade, according to the Association of American Medical Colleges.

The prospect of lower pay and stressful work would also discourage young people from entering the profession. Medical school is expensive; the median graduate takes on $200,000 in debt. It’s time-consuming, too. The typical doctor spends four years in medical school, followed by three to seven years in residency and fellowship. Lucrative jobs in finance, technology and law require far less preparation time.

I’m not a health care expert but I do understand our policies pretty well. Let me make a few observations.

First, the difference between $218,000 and $146,000 per year looks suspiciously like the difference between health care costs in the U. S. and those in the rest of the developed world. Maybe it’s just a coincidence. Second, she’s not just making a case against Medicare for All. She’s making a case against reducing U. S. health care costs. Everything to which she points applies equally well to reducing costs in the sector which necessarily means reducing compensation. Anyone who claims that we will be able to control not just health care costs but the increase in health care costs without reducing health care compensation probably also has a bridge they’d like to sell you.

Let’s examine her claims one by one. They are:

• Physicians would leave the practice of medicine for some other field.
• Fewer students would apply to medical school.
• Students would be drawn to specialties more lucrative than general practice.

The incomes of full-time practicing physicians place them somewhere between the top 5% of income earners and the top 1% of income earners, depending on specialty, and there are roughly a half million practicing physicians. There is no job other than the practice of medicine that those fleeing the practice of medicine could take that would provide that level of income. That’s the reality of work in the U. S. If a newly-minted anything (other than physician) walks into the typical American business, demanding a job that will pay over $200,000 per year, they’ll be laughed out of the place.

Some of those physicians might return to their home countries. It might also have an impact on the life decisions of women who are more likely to work part-time as physicians than their male counterparts. That’s not misogyny. It’s just a recognition of the facts of employment in the health care sector.

Over the period of the last 20 years, the number of students applying to medical school has grown from around 40,000 to around 50,000 for about 20,000 positions. Young people, too, recognize that no field other than the practice of medicine offers the opportunity of “doing good and doing well”, as the NEJM put it some years ago. If that number fell by 20% it would just be what it was 20 years ago.

You might wonder why, given the enormous increases in physician pay over the last 50 years, far more than any other profession, why the number of med school slots isn’t twice or even three times what it was then? The Medicare system pays a stipend for each and every medical resident in the country of around $80,000 per year (the last time I checked) and meters the number of graduates accordingly. I can discern no benign reason for that. It’s just what’s being done.

However, that tells us that the number of medical school slots and the number of graduates entering each specialty is actually under our control. If we reform the formula by which stipends are awarded, it will change the number of med school slots and the number of those entering various different specialties.

As you know, I love a good polemic. Although I don’t necessarily endorse it, I wanted to bring a passage from Andy Kessler’s most recent Wall Street Journal column to your attention:

Is he a disease or a cure? Like him or hate him, there’s tons of spilled ink trying to assess President Trump’s governing style. To me, the key to understanding Trumpism is remembering why he was elected.

What do I mean? Voters chose Donald Trump as an antidote to the growing inflammation caused by the (OK, deep breath . . .) prosperity-crushing, speech-inhibiting, nanny state-building, carbon-obsessing, patriarchy-bashing, implicit bias-accusing, tokey-wokey, globalist, swamp-creature governing class—all perfectly embodied by the Democrats’ 2016 nominee. On taking office, Mr. Trump proceeded to hire smart people and create a massive diversion (tweets, border walls, tariffs) as a smokescreen to let them implement an agenda of tax cuts, deregulation and originalist judges.

I’m not entirely convinced that Trump’s bluster is a strategy. I think it’s Trump being Trump. I also think he’s giving increased investment following the cut in the personal and corporate income taxes more credit than they deserve. He may be right about deregulation. I wish that better statistics were kept about the effects of specific regulations and their removal. Most of what we have now is just partisan bickering.

I continue to hold the naive beliefs that persuasion is better and longer-lasting than power politics, that honesty is the best policy, that you catch more flies with honey than with vinegar, and you should model in your own behavior the behavior you’d like to see from others. It’s sad that those homely policies don’t attract bands of ardent followers.

The editors of the Wall Street Journal noticed the responses of the Democratic presidential candidates, too:

One of Vice President Joe Biden’s better lines in 2012 was “Osama bin Laden is dead, and General Motors is alive.” The crowd at the Democratic convention loved it. This year it sounds like the Democratic campaign theme may be that Iranian terror master Qasem Soleimani is dead and the world is more dangerous because of it.

That’s a fair judgment from Friday’s debate in New Hampshire when ABC’s David Muir asked the candidates “if your national security team came to you with an opportunity to strike, would Soleimani have been dead or would he still be alive under your Presidency?”

Pete Buttigieg responded: “In the situation that we saw with President Trump’s decision, there is no evidence that made our country safer.” He deplored Soleimani’s “murder and mayhem” but then zagged to the Iraq war, the Iranian nuclear pact, and a wounded veteran friend he saw in an airport. Mr. Muir tried again, but the former mayor came down with a decisive, “It depends on the circumstances.”

Mr. Muir then moved to Mr. Biden, who at least didn’t fudge. “No. And the reason I wouldn’t have ordered the strike, there is no evidence yet of imminent threat that was going to come from him,” Mr. Biden said, before veering to “America First policies” and NATO. No mention that bin Laden wasn’t an “imminent threat” by the time he was killed.

Next up was Bernie Sanders, who listed several of the world’s “very bad leaders” but said we can’t “assassinate” them because that would open the door to “international anarchy.” He said the only recourse is diplomacy.

The answers were revealing and mark a sharp difference in the coming campaign. Mr. Trump shares some of the isolationist impulses of Democrats, but he is willing to use force to kill America’s enemies. The mayhem that critics said would follow the killing of Soleimani hasn’t happened. Mr. Sanders’s answer is no surprise. But Messrs. Buttigieg and Biden missed a chance to show they would act decisively as President to deter those who kill Americans.

When President Obama sanctioned the assassination of Osama bin Laden, he at least had the Authorization to Use Military Force of 2001. By no stretch can that be extended to Soleimani.

Note that they buy the consequentialist arguments, they just have different projections of the consequences. I think that consequences are very tricky things to predict. Can it really be true that the same act may be just or unjust depending on circumstances beyond your control?

Make no mistake. Killing people in the absence of Congressional authorization, legal judgment, or self-defense is murder. Where does it stop? Kim Jong Un? China’s President Xi? Vladimir Putin? Maduro? Erdogan? Angela Merkel?

I have some problems with Julie Sunderland’s determination at Project Syndicate that we are overreacting to the coronavirus outbreak in China:

Every few years, humanity succumbs to mass hysteria at the prospect of a global pandemic. In this century alone, SARS, H1N1, Ebola, MERS, Zika, and now the coronavirus have all generated reactions that, in retrospect, seem disproportionate to the actual impact of the disease. The 2002-03 SARS outbreak in China (also a coronavirus, likely transmitted from bat to human) infected 8,000 people and caused fewer than 800 deaths. Nonetheless, it resulted in an estimated $40 billion in lost economic activity, owing to closed borders, travel stoppages, business disruptions, and emergency health-care costs.

Such reactions are understandable. The prospect of an infectious disease killing our children triggers ancient survival instincts. And modern medicine and health systems have created the illusion that we have complete biological control over our collective fate, even though the interconnectedness of the modern world has actually accelerated the rate at which new pathogens emerge and spread. And there are good reasons to fear new infectious diseases: the Coalition for Epidemic Preparedness Innovations (CEPI) estimates that a highly contagious, lethal, airborne pathogen similar to the 1918 Spanish flu could kill nearly 33 million people worldwide in just six months.

Nonetheless, the fearmongering and draconian responses to each outbreak are unproductive.

She wants to

1. Increase presumably public investment in “science and technology”
2. Reinstate the National Security Council’s unit for coordinating responses to pandemics
3. Have a “coordinated global response”.

Let’s start with the last one first. If she wants a coordinated global response, she’s addressing the wrong audience. The article should be in Chinese. How is such a response possible when the country in which the pandemic if it is one originated and in which there are several orders of magnitude more people with the disease and more mortality refuses to allow external observers to come to their own assessment of the scale of the risk? Giving those who believe in world government the benefit of the doubt, I think their intentions are good. However, if there is one thing we should have realized over the last 30 years it is that there is no global consensus either about means or ends, there are very few common values. Without some sort of consensus about values world government is unworkable.

I have no opinion about the NSC’s unit for coordinating responses to pandemics. I can’t make a determination as to whether it was a titanic boondoggle and waste of money or a vital contingency factor. It was probably some of both.

As to the first the federal government alone spends over $1 trillion per year annually on health care with the states spending nearly as much. Health care reached the point of diminishing marginal returns to incremental spending decades ago. Every penny of that is spending on “science and technology”. Presumably, that’s not what she means.

However, if she means research, the same argument applies. The numbers are just smaller. There is at this point essentially zero evidence that more spending on medical research will produce more results faster. It might or it might not. What I will predict is that the biggest effect of a lot more research spending all at once will mostly be giving raises to researchers without producing more results faster. The supply of researchers with the appropriate knowledge, background, and credentials just isn’t that elastic. Substantially increasing medical research in a productive manner will require a gradual effort taking place over many years.

There’s something else she doesn’t seem to understand. The money to spend more, as she appears to want to do, must come from somewhere. What is it that she doesn’t want to do that we are presently doing?

There are really only a handful of candidates. We can spend less on pensions, we can spend less on health care, or we can spend less on our military. Our military is already underfunded relative to the tasks we’re asking it to perform. What missions does she think should end?

Finally, I don’t know how one can determine whether we are overreacting to the outbreak in China, responding exactly as we should, or drastically underreacting. I think something depends on what’s actually happening in China and the truth is we just don’t know. I think it matters whether there have been 1,000 fatalities in China or 50,000. It might be that we are overreacting to the facts as we understand them but drastically underreacting relative to the risk. We just don’t know.

I was somewhat disappointed by George Friedman’s analysis at Geopolitical Futures of the geopolitical implications of the coronavirus outbreak in China. On the one hand, he’s prudent to point out that the last few years have been sort of a perfect storm for China. There have been a significant number of events that did have geopolitical significance happening in rapid succession: their handling of the Uighurs in Xinjiang province, Trump’s trade war, and political unrest in Hong Kong. I would add to those President Xi’s consolidation of power in his own hands. If American and European analysts do not consider that of geopolitical significance, I can only speculate that they have short memories.

Unfortunately, I think he cops out on the coronavirus outbreak:

Now, to the coronavirus. Assume that the fears that are being expressed do not turn out to be exaggerated. Assume that in response to this, massive trade restrictions and embargoes were imposed on China and that freighters were not permitted to dock in Long Beach or Rotterdam, nor would they be permitted in Shanghai. With the Russians already screening China’s northern border, China would be isolated.

China is a nation whose core dynamic is based on international trade. Under pressure from the United States, a dangerous virus would inevitably cripple that trade at best. At this point, the Chinese government, like any government, would be blamed for what went wrong, and it would be blamed for mismanaging the virus and failing to understand the economic consequences. From here you can play out the game.

The reason for this exercise is to point out that the coronavirus is neither a geopolitical nor a political event. Diseases emerge with some frequency. But given the Chinese dynamic and China’s current condition, the virus could readily evolve into a geopolitical and political event, in which tension within China might explode, with the coronavirus the last straw and China’s international position transformed.

To emphasize, I have no idea what “2019-nCoV” is or what it will do, but judging from what is being said about it and the level of anxiety, I will assume for the sake of argument that it is more dangerous than not. Then, given the evolution of the past year or two, and given the fear that always follows new, deadly diseases, we could see a fundamental transformation of the international system.

Not all events are geopolitical. They do not arise out of relations between nations. But events that are unconnected to geopolitics can connect themselves to the system and disrupt it. This is meant as an exercise in geopolitical theory. It is not insignificant in the case of China, which has had a difficult period and doesn’t need to be quarantined by the world.

To the contrary, I think the coronavirus outbreak is already of geopolitical significance and that is entirely a creation of the Chinese authorities. Had they been more forthcoming than they have been and opened up to outside observers that might have been avoided. The only questions now are whether its effects will be persistent and precisely the form they will take. Those remain to be seen.

in her Wall Street Journal column Kimberley Strassel describes the internecine warfare being waged within the Democratic Party:

That there are two, extremely polarized sides is also the one clear takeaway from the Iowa muddle. While the Sanders and Pete Buttigieg campaigns argue over how many state-delegate equivalents can dance on the head of a pin, the bigger point is that they ended the final vote with near equal numbers. Overall, the two candidates unapologetically pushing Medicare for All (Bernie and Elizabeth Warren) took 47% of the final vote, while the three more “moderate” contenders (Mr. Buttigieg, Joe Biden and Amy Klobuchar) took 51%.

The chasm in the party has been on display particularly under Speaker Pelosi’s leadership. It brewed in the bitter spring fights over which wing got its way on how to sanction Rep. Ilhan Omar for anti-Semitic comments; which wing spoke for the party on climate and health care; which wing set its antigun agenda. And most consequentially, which wing won the day on impeachment. Mrs. Pelosi ultimately gave in to threats against her speakership and allowed her firebrands to serve as the face of the party in a weak and doomed impeachment proceeding.

The present circumstances, with one half of the Democratic Party seeking to purge the party of its history, oust the other half of the party who won’t support their ideological program, and rebuild the party in their own image on the skeletal remains of the party of Jefferson, Jackson, Wilson, Roosevelt, Kennedy, and Clinton who will become un-persons. That explains the panic expressed by Hillary Clinton, Rahm Emanuel, and James Carville among others. They’s concerned they’re about to become oustees.

In his Wall Street Journal column Daniel Henninger suggests that the Democrats in general and Nancy Pelosi in particular have been producing a great trilogy of movies, based on Star Wars:

The first episode was “The Russian Collusion Narrative” in which “Trump” conspires with the head of the Russian Empire to destroy American democracy. The second installment, taking up where the Mueller cliffhanger left us, was “Obstruction of Justice,” which after the “Collusion” blockbuster had a strikingly short run.

Then came the “Trump” trilogy’s final installment: “Impeachment,” with headliners Adam Schiff and Jerry Nadler. The box office for “Impeachment” was awful, and it ended up getting 52 thumbs down in the U.S. Senate.

Like a Hollywood studio over-invested in sequels, the Democratic Party has bet the ranch and its chances of winning the presidency on the American people concluding from this saturation that they are in the grip of “Trump.” And that’s not going to change.

I agree with Scott Adams’s claim that Trump supporters and Trump haters are playing different movies in their heads. What movie are Trump supporters playing?

Contrary to my normal practice, I listened with at least half an ear to the Democratic candidates’ debate last night. I am away profoundly discouraged.

The question that got my dander up was about the assassination of Soleimani. After listening to mealy-mouthed answer after mealy-mouthed answer, I blurted out angrily, “They’re a bunch of consequentialists and I’m a deontologist!” My wife, puzzled, asked “What does that mean?” “It means I think you don’t murder people because it’s wrong.”

We are not at war with Iran. Iran has been provoking us for years. Some think that we have been provoking them for years, too. I think that is greatly exaggerated and the belief is largely the result of Soviet propaganda. Before we go to war with Iran we should declare war. If we are at war we should destroy their command and control facilities, not pursue and murder individual generals or leaders.

When you’re not at war, seeking out and killing someone is murder. Murder is wrong. You don’t sit around and argue whether murdering someone would be good for Middle East peace. You don’t do it because it’s wrong. It would be wrong for me. It was wrong for Trump. It would be wrong for Biden. It would be wrong for Buttigieg or Amy Klobuchar or Elizabeth Warren. It’s wrong.

In my opinon consequentialists, people who believe that the morality of actions can only be judged based on their consequences, cannot be trusted with power. Under the right circumstances they would murder me, you, your family, or their own families. Everything depends on the consequences including the political consequences.

I also don’t think that we can survive as a nation or as a society with such beliefs.

Presumably, all of the above disqualifies me from being president, for which I thank God.