Sunday, March 22, 2026

The Wonders Of Health Care

 From a 2015 article by Arnold Kling's Askblog.

from Megan McArdle:

1950s health care isn’t expensive; this same regimen would be a bargain at today’s prices. What’s expensive is things that didn’t exist in 1950. You can say that “health care” has gotten more expensive—or you can say that the declining cost of other things has allowed us to pour a lot more resources into exciting new health products that give us both longer and healthier lives.

In Crisis of Abundance, I wrote,

The American middle class can still afford the wonderful health care that was available in 1975–easily. . .as a thought experiment, a return to 1975 health care standards would completely resolve what is commonly described as America’s health care crisis.

My guess is that if you could find a health insurance policy today that only covered diagnostic procedures and treatments that were available in 1958, the cost of that policy would not be much higher than it was then. Much of the additional spending goes for MRIs and other advanced medical equipment, as well as for health care professionals with more extensive specialization and training than what was available 50 years ago. 

These observations get at the distinctions between healthcare, health insurance, and health outcomes which too easily get mashed together. 

I'd like to have 1950s or 1975 healthcare costs.  But I don't want 1950s or 1975 health care. 

I've been on Medicare and a supplemental plan since 2016.  If I add up what Medicare has paid since then and compare it to what I pay for Medicare each year plus what I paid in Medicare taxes over the years, the government is still way ahead on the deal.

It's still true, even though a year ago today my heart stopped for a bit, I went to another place momentarily, and ended up transported by ambulance to an ICU in Tucson, where I spent the next two days and underwent an emergency procedure. I was informed that most with my condition do not make it to the hospital. I recovered quickly and completely, but the procedure I underwent was not invented until about fifteen years ago.  Prior to that time I would have had a lengthier hospital stay and been sent home for extended bed rest until my condition improved, while remaining at risk the entire time, and with a much likelier outcome where, if surviving, I'd have permanent heart damage.  The drugs I would have been prescribed also had major side effects.

Instead, the operation went well, I was discharged in 48 hours with no permanent damage, and the new medication for my condition, which only reached the market a decade ago, has had no side effects. 

I like today's medicine and the new medication and wrote about it in December.

When I got my Medicare statement a few weeks later, the nominal "cost" for those two days was $194,000 of which Medicare and my supplemental paid $38,000 and I paid $16.  The statement informed me that Medicare had "saved" me $156,000.  I put "cost" and "saved" in quotes because those words have no meaning in the healthcare lingo we use today.  If I go to a car dealer and see a car with a $50,000 sticker price and the dealer accepts my $10,000 offer, that 50K price is not real and I did not save 40K by making the purchase.  Healthcare pricing is simply crazy.

The pricing may be crazy, but I'm happy to be here. 

My thanks to the doctors, nurses, techs, EMTs, and park rangers who got me through the experience. 

Saturday, March 21, 2026

I Can't Get Next To You

 One of my favorites from The Temptations from among their cascade of hits from the mid-60s into the early 70s.  Composed by Norman Whitfield and Barrett Strong, released in 1969, hitting #1 and ranked by Billboard as the third most popular single of the year.  From their appearance on the Ed Sullivan Show in September 1969. 

Friday, March 20, 2026

Rodovia Dos Imigrantes

 Rodovia dos ImigrantesFile:Rodovia dos Imigrantes 2.jpg - Wikimedia Commons Twenty years ago on a business trip to Brazil, I arrived in Sao Paolo on a Saturday morning and took a car to spend the weekend in the city of Santos on the coast before beginning my work week in Sao Paolo on Monday.

The initial part of the drive was on the plain on which Sao Paolo and its suburbs sit at about 2500 feet above sea level.  Suddenly, we entered a heavily forested area as the descent to the coast began.  This was the Rodovia dos Imigrantes with its 44 viaducts, seven bridges, and eleven tunnels on its nearly 40 mile stretch.  The startling part of the drive was when I realized we were on an elevated highway high above the coastal rain forest, a beautiful and stunning experience.

 

We Remember

 Best comedies of the 2000s - Dodgeball, Tropic Thunder, The Hangover

 

And the man who saved Sly Stallone and The Expendables

Thursday, March 19, 2026

Haviv

Over the past few months I've been reading and listening to Israeli Haviv Rettig Gur.  He's active on twitter, YouTube, and with a podcast Ask Haviv Anything which alternates between longer in depth episodes and quick 10-15 minute explainers on a specific issue.  I find him thoughtful and able to provide some clarity to complex matters.  

I'm not sure how to categorize him politically as he's not clearly on the right or left.  This, from two days ago, gives you a flavor for his views.

Y’all know I have my disagreements with Bibi [Netanyahu]. Budget priorities, haredi welfare spending, import reforms, judicial reform, information war, avoidance of accountability, Gaza war - okay, a lot of disagreements, including on big, critical things that affect our lives and the lives of our neighbors. But the man has been planning the ayatollahs’ fall for two decades. He believes it’s why God (inasmuch as he believes in God) put him on this Earth. And damned if he isn’t seeing through this thing he has always believed was his destiny. I’ll keep criticizing the bad stuff. I’m a citizen. He works for me. That’s how the system is supposed to work. And I’ll keep praising and being grateful for this one great big huge thing. I don’t know if he’ll succeed. I can’t think of anyone else who would have been so grimly single-minded and so specifically competent in the specific skillset required to bring us to this point.  

I'll also add he's been very critical of corruption involving Netanyahu and his associates.

Some episodes I'd recommend.

Episode 69 - Israel's Great Divide - an insider's look at the judicial reform, with Moshe Koppel.  This was the first of Haviv's podcasts I listened to. Prior to 10/7/23 the issue dominating Israeli politics was Netanyahu's proposed reform of the judiciary.  From an American perspective, the power grabbed by Israel's Supreme Court over the past four decades would never be tolerated.  The lack of a written constitution has enabled the court's actions.  However, the proposed reform amounts to a reverse power grab by the executive and the lack of trust between right and left makes compromise impossible (sounds familiar, doesn't it?).  Moshe Koppel is an academic, not a politician, who was one of the authors of the reform and sounds like a man with intellectual integrity but comes across as naive about the political process.  An excellent overview of both the legal and political aspects of the dispute.

Episode 99 - Are We Winning?  Released yesterday about the Iran War.  Brings an interesting perspective not often heard in the U.S.

Episode 92 - Why does Israel hate UNRWA?  A short episode about the Palestinian relief agency.  The best quick answer to this question, which I've touched on before.

Episode 78 - Do You Still Want to Globalize the Intifada?  Short episode on the significant difference between the First and Second Intifadas and what the Globalize the Intifada means to Israelis. 

Episode 76 - How Elites drive Jew-hatred with Hussein Aboubakr Mansour.  A discussion of the situation in Western academia and in the Muslim world and why it has developed in similar ways.  Mansour is an Egyptian and Muslim, now living in the U.S.  

Episode 65 - The unseen editors rigging the information war with Ashley Rindsberg.  Rindsberg has been doing deep dive detective work on how the manipulation of information is occuring in social media, with a particular focus on Wikipedia, in which the current head of NPR played a significant role in its deterioration as a credible source of information.

I first listened to Haviv via the Unpacking Israeli History podcast of Noam Weissman, which I also recommend.  There were two particular podcasts featuring Haviv that caught my attention; the first a look back on thirty years after the assassination of Yitzhak Rabin and the other on settler violence in Judea and Samaria, which I think a disgrace with not enough done to prevent and punish the perpetrators.

Wednesday, March 18, 2026

Personal Handling

I know you will not mind my being brutally frank when I tell you that I think I can personally handle Stalin better than either your Foreign Office or my State Department.  Stalin hates the guts of all your top people.  He thinks he likes me better, and I hope he will continue to.

President Franklin Roosevelt to Prime Minister Winston Churchill, March 18, 1942, from Churchill and Roosevelt: The Complete Correspondence

I think if I give him everything I possibly can, and ask nothing from him in return, noblesse oblige, he won't try to annex anything and will work with me for a world of peace and democracy.

President Franklin Roosevelt to former Ambassador to the Soviet Union, William C Bullitt, January 29, 1943, from For the President: Personal and Secret: Correspondence between Franklin D. Roosevelt and William C. Bullitt 

 

Image 

There are many things President Franklin Roosevelt got right in the run up to, and during, the Second World War.  He recognized Germany as a threat, not just in Europe, but globally.  FDR also had an ability to spot and promote talent.  Selecting George C Marshall as Army Chief of Staff in 1939 was not obvious, as he was promoted ahead of more than three dozen more senior officers, yet FDR did so after Marshall disagreed with him in a large meeting (for the full story read Management Lessons).  Marshall proved to be a brilliant choice as was Admiral Chester Nimitz, hand picked by FDR to command the Navy in the Pacific.  He also had the good sense to keep Marshall in the U.S. and instead agree that Dwight Eisenhower should command Allied forces for D-Day.

FDR also encouraged dissent.  The military chiefs and his war cabinet engaged in ferocious arguments at time, particularly from 1939 through 1942.   At one point in 1942, Marshall threatened to resign because of his disagreement with the president on the issue of invading North Africa, an issue on which FDR was proven correct - the American army was in no shape to fight the Germans in northwest Europe in 1942, or even 1943.  Marshall, who believed military officers should be apolitical and never voted, was initially a doubter about FDR but became an admirer during the course of the war.

Roosevelt exhibited a good strategic sense in the run up and early years of the war, agreeing with the military chiefs that Germany would be the priority in the event of a conflict with both that country and Japan, and with his instincts of where American military priorities should be in the critical eighteen months after Pearl Harbor.   He also had top notch instincts as to what issues required his involvement and decision making and what didn't.

As I've noted before, in Harry Hopkins he also had an informal channel through whom the military chiefs could take issues, trusting Hopkins, whom they held in high regard, to decide whether, and how, to make the case to FDR.(1)  This stands in stark contrast to LBJ, who in the run up to the Vietnam War, had no such route outside the one official channel controlled by Secretary of Defense Robert McNamara, who prevented dissenting voices from getting to LBJ.  For a comparison of FDR with LBJ on this issue read Dereliction of Duty.

On the debit side was FDR's obsession with China in the lead up to the war.  The military chiefs constantly admonished him for his public statements and pledges in support of China which amounted to writing checks that could not be cashed, refusing to recognize the weakness of America's position in the Pacific and its very limited ability to do anything practicable to assist China in resisting Japan.  They thought his actions ran the risk of precipitating a Japanese attack on the U.S., plunging us into war and running counter to the agreed upon strategy of focusing on Germany first.  On this the chiefs proved correct and FDR was only saved by Hitler's unforced error of declaring war on the U.S. on December 11, 1941.

However, the biggest debit item was FDR's failure to understand the Soviet Union and Josef Stalin and what that meant for his vision for the post-war world.  Chip Bohlen, a Soviet State Department specialist who, in 1953, would become Ambassador to the Soviet Union said of Hopkins that "Harry was inclined to dismiss ideology" and the same can be said of FDR. Roosevelt had a vague notion that the American and Soviet systems would, over time, converge in some unspecific way.(2)  He believed in personal diplomacy and in his ability to charm anyone.  The colonial empires of Britain and France offended FDR and he thought the war should spell an end to them. Why he did not understand the same thing about the USSR, which in that respect was merely a continuation of the land-based colonial empire established by the czars is an interesting question.

That's why even into 1944, when the Allies were clearly winning and the first signs of problems with the Soviets were arising, FDR insisted on continuing lend-lease supplies to the Soviets, including shipping materials that had no obvious short-term value to the war against the Nazis and despite increased evidence of Soviet industrial espionage in America.  At the Tehran conference in November 1943 and even more so at Yalta in February 1945, FDR went out of his way to ingratiate himself with Stalin while poking fun and, at times, insulting Churchill. The President simply could not fathom that Stalin was an ideologue and had no deep understanding of communism.  He completely lacked an understanding of how the Soviets thought.(3)

To illustrate how different the thinking was let's look at Kim Philby, the Englishman turned Soviet agent who ended up in a senior position in Britain's intelligence agency.  Philby would thoroughly betray his country (and the U.S.) leading to the deaths of many East Europeans fighting Soviet tyranny after the war.

After Germany's attack on Russia in June 1941, Philby advised his Soviet handlers that Churchill ordered all British espionage efforts against the USSR to cease, causing the Soviets to wrongly suspect Philby had been turned and become a double agent working for Britain because, in their world, suspending espionage operations made no sense (the U.S., both before and during the war, did not conduct espionage against the Soviets).  After all Soviet espionage against Britain and America during the war not only continued, but was expanded.  After an extensive investigation of Philby the Soviets concluded that his reporting was accurate.

FDR's obsession with the creation of the United Nations, something not a high priority to the Russians, allowed Stalin to winkle more concessions from the U.S. before grudgingly agreeing to its creation. 

Unlike Churchill, FDR remained aloof from Stalin's domination of eastern European countries which became evident during the last months of the war.  In August 1944, when the Polish Home Army rose up against the German occupation of Warsaw, while Stalin's forces halted their advance to let the Nazis eliminate the Poles, who they saw as a threat to the communist future plans for that country, Churchill pleaded with Stalin to allow British planes to fly over Warsaw to drop supplies and then land in Soviet territory to refuel, a request refused by the dictator.  FDR refused Churchill's request to join the British in making the request to Stalin.  For more on this episode read Warsaw Does Not Cry.  During the remaining months of the war FDR continued to resist Churchill's efforts to create a strong joint opposition to Stalin's plans.

Given Roosevelt's death in April 1945, less than three months into his fourth term, we can only be thankful for the big city Democratic party bosses who, in the summer of 1944, rejected FDR's plan to retain Vice-President Henry Wallace on the ticket.  The eccentric and naive Wallace was an unwitting tool of the communists and would have been a disaster as president.(4)  Instead Harry Truman joined the ticket, becoming FDR's successor and proving a much better post-war president on foreign policy than Roosevelt would have been.

 --------------------------------------------------------------------------

(1) The extent to which Hopkins was also held in high regard by the British is shown in a remarkable incident when Field Marshal Brooke, Chief of the Imperial General Staff, came to Hopkins to ask him to intervene in a dispute the British military chiefs were having with Winston Churchill. 

(2)  According to Bohlen, on a return flight from Moscow, on Hopkins last mission to Moscow in June 1945, Harry expressed "serious doubts as to the possibility of genuine collaboration with the Soviet Union", predicting "the American belief in freedom might lead to serious differences."

(3) FDR was not alone in his disinterest in, and failure to understand, ideology.  It was a common failing across the upper rank of civilian and military leaders at the time.  I am a great admirer of George C Marshall but his greatest failure was the year he spent in China as President Truman's special envoy trying to negotiate a settlement between the Nationalist government and its Communist opponents.  Marshall simply had no understanding of underlying communist ideology and his actions undermined the Nationalists.  By later in 1947, Marshall and Truman had a better understanding of the communist threat and responded aggressively in Greece and in Western Europe but by then it was too late and too difficult to save the Chiang's regime in China. 

At the time a common line spun by the USSR about the communists in China and Eastern Europe was that they were not "real" communists but merely "agrarian reformers", and this took in many unsophisticated Americans.  At the end of the war, and in its immediate aftermath, Whittaker Chambers was a senior editor at Time, the preeminent weekly news magazine of the era.  Chambers, a former communist party member in the 1920s and a commie spy in the 1930s before breaking with the party, engaged in a series of back and forths with Time correspondents in Eastern Europe who would post stories about communists describing them as agrarian reformers at which point Chambers would edit out the characterization, despite protests by the reporters that they were the ones on the scene with local knowledge.  Chambers would point out that they did not understand communists.

In September 1939, Chambers met with Assistant Secretary of State Adolf Berle to disclose the existence of a Soviet spy ring within the Roosevelt Administration, providing Berle with a list of names, including Alger Hiss.  Berle took the information to President Roosevelt who dismissed it.

(4)  In 1948, Wallace ran as the Progressive Party candidate for president.  He blamed the U.S. for the start of the Cold War and urged America to give up West Berlin in response to the Soviet blockade (for more read Berlin Divides).  Several years later, Wallace acknowledged he had been manipulated during the campaign by the communists who had infiltrated his organization.