armchair pundit

In my last post I attempted to list the things I found especially resonant last year in media, entertainment, art and journalism. I say “attempted” because I didn’t keep track of this stuff very well during 2010. In lieu of keeping track, I retroactively scoured my bookmarks in places like delicious, Instapaper and Evernote, and as a result I probably favored things I consumed toward the end of the year and forgot things I encountered in January and February.

In the spirit of trying to do better in 2011, I’ll mention over my next two posts a couple of articles I’ve read recently that are bound to make my greatest hits list at the end of the year.

In the first, Dr. Atul Gawande who writes perhaps better than anyone about healthcare had a recent piece in the New Yorker about the burden of addressing “super-utilizers,” or the most expensive patients. He examines some pioneering new initiatives which show, counter-intuitively, that hospitals can significantly lower costs by giving even more attention to these neediest patients.

He follows a doctor named Jeff Brenner in Camden, NJ who was inspired by the way urban police departments study crime statistics – clustering crimes block by block into hot spots, then targeting law enforcement to get the biggest bang for the buck. He applied a similar strategy to zero in on healthcare hotspots and found, for example that:

…a single building in central Camden sent more people to the hospital with serious falls—fifty-seven elderly in two years—than any other in the city, resulting in almost three million dollars in health-care bills.

And in one low-income housing tower:

…between January of 2002 and June of 2008 some nine hundred people in the two buildings accounted for more than four thousand hospital visits and about two hundred million dollars in health-care bills. One patient had three hundred and twenty-four admissions in five years. The most expensive patient cost insurers $3.5 million.

Armed with this information, Dr. Brenner reaches out to numerous doctors in several hospitals and offers to take on their “worst-of-the-worst” patients, and with the help of his small staff he starts to give these patients the highest degree of personal attention he can. He sees some patients every day. He nags social workers on behalf of patients and escorts them to AA meetings. With this kind of care, these patients who used to visit the emergency room half a dozen times a year, racking up tens of thousands of dollars in bills (paid for by taxpayers), suddenly don’t need the hospital at all. Daily maintenance costs much less.

Gawande visits a company called Verisk Health that specializes in “medical intelligence” for organizations that pay for health insurance. A doctor analyst named Nathan Gunn drills into patient claims and shows Gawande a typical example of the kind of patient who stands out:

All these claims here are migraine, migraine, migraine, migraine, headache, headache, headache.” For a twenty-five-year-old with her profile, he said, medical payments for the previous ten months would be expected to total twenty-eight hundred dollars. Her actual payments came to more than fifty-two thousand dollars—for “headaches.”

Was she a drug seeker? He pulled up her prescription profile, looking for narcotic prescriptions. Instead, he found prescriptions for insulin (she was apparently diabetic) and imipramine, an anti-migraine treatment. Gunn was struck by how faithfully she filled her prescriptions. She hadn’t missed a single renewal—“which is actually interesting,” he said. That’s not what you usually find at the extreme of the cost curve.

The story now became clear to him. She suffered from terrible migraines. She took her medicine, but it wasn’t working. When the headaches got bad, she’d go to the emergency room or to urgent care. The doctors would do CT and MRI scans, satisfy themselves that she didn’t have a brain tumor or an aneurysm, give her a narcotic injection to stop the headache temporarily, maybe renew her imipramine prescription, and send her home, only to have her return a couple of weeks later and see whoever the next doctor on duty was. She wasn’t getting what she needed for adequate migraine care—a primary physician taking her in hand, trying different medications in a systematic way, and figuring out how to better keep her headaches at bay.

A typical strategy companies employ to lower their healthcare costs is to require employees to pay higher premiums. Employees respond by decreasing the frequency of their doctor visits. Unfortunately, even the sickest employees put off visiting the doctor, which winds up generating higher costs in the end. Dr. Gunn and Verisk Health use this kind of information to persuade companies that better, more-focused care is a more effective strategy than higher premiums.

Finally, Gawande spends time at a clinic in Atlantic City run by a doctor named Rushika Fernandopulle who invented a role he calls “health coach” and hired eight of them to work on his staff – outnumbering his doctors, nurses and nurse practitioners. His approach is a more formalized version of what Dr. Brenner is doing, where each staff member is tasked with meeting very specific goals. One nurse practitioner for example is in charge of getting all the patients to quit smoking.

Gawande is not a political writer, and this isn’t a political article. It’s a delight to read a piece on healthcare that is completely devoid of demagoguery. It’s almost unfortunate that Gawande notes in passing at one point that the Affordable Care Act (I refuse to call it “Obamacare”) makes some money available for the kinds of pilot projects highlighted in the article, and Dr. Fernandopulle’s clinic has made use of that money. I say unfortunate because the mere mention of the healthcare bill will be read as endorsement, and for some readers this will cast a dark shadow across the whole article.

My own feeling is that conservatives who decry the healthcare bill because of its failure to address costs should perhaps appreciate the way the bill encourages private sector solutions, and the way it requires many super-utilizer patients to be insured and thereby help pay for the kind of high-touch ongoing care that keeps them healthier and ultimately saves taxpayers money.

The latest highly-publicized, hotly-ridiculed move by my adopted city of San Francisco was to ban the Happy Meal. And so once again we have lobbed a softball to conservatives and libertarians across the nation, who relish any opportunity to point west and say, “See? See the nanny state? See those people who are too dumb, or too lazy, to [in this case] decide for themselves what their kids should and shouldn’t eat?”

My libertarian-leaning friends here (yes, even San Francisco has them) were against the Happy Meal ban on principle of course. To them, it represents paternalistic government overreach. I personally dislike the ban because it’s ridiculous and trivial. But regardless of one’s reasons for disliking the ban (I don’t know anyone who supports it), I’m not aware of anyone who cared enough about the issue to take any action opposing it.

The first anti-smoking laws in the U.S. were met with similarly principled but irresolute opposition. More of the same, more recently, with New York City’s ban on trans-fats.

What is it that makes New York and San Francisco so hospitable to these nanny laws? Are we, the citizens of these cities, simply big government liberals by nature? Are we too busy with our fast-paced urban lives to get involved in politics? Are we so affluent and comfortable and free from real suffering that we need to fish for new (non-)problems to solve? Do we not value our individual rights?

Perhaps.

But there are other reasons.

For one thing, there’s no hard line between issues of individual rights and issues of public policy. It’s fuzzy. This is especially true in cities, where day and night we confront the habits and behaviors of our fellow citizens. For example, how do we reconcile one person’s freedom to smoke in public with another person’s freedom to breathe clean air? There are three options: The factions can battle it out every day in the streets. Non-smokers can silently tolerate the dirty air. Or we can ask the state to settle the issue for us and end the war.

We’ve gone with the third option because it actually gives the greatest amount of freedom to the greatest number of people. The factions are freed from daily battles with each other, and non-smokers are free to breathe clean air. The only losers are the smokers. To put it more simply, anti-smoking laws succeed in cities because most people are non-smokers. A single smoldering cigarette stirs the ire of a hundred non-smokers in its vicinity. Even people who believe on principle that a man should be free to smoke anywhere he wants are annoyed when he lights up beside them, so the principle is not enough to motivate them to oppose the anti-smoking law. People gripe about the nanny state while they enjoy the cleaner air.

Some issues are not so tangible. How, for example, do we reconcile a person’s right to drive without wearing a seatbelt with everyone else’s right not to pay that person’s emergency bill? Hardcore libertarians might wonder why we can’t have both. But how would this play out? At the crash scene, should the person calling 911 check to see who was wearing a seatbelt and who wasn’t, then look into each victims’ ability to pay, so that the ambulance knows whether to respond, whom to treat? The American obesity epidemic, and all the accompanying cases of diabetes, heart disease, etc. raises similar questions.

If we want to minimize our contribution to other people’s hospital bills – for trauma or diabetes – then one option is to make it costlier for people to drive without seatbelts and eat unhealthy fast food.

But the people still ask themselves, “What will they ban next?” They think, “this is facism!” while also thinking, “well, I try to avoid trans fats anyway, and at least now I don’t have to wonder about my restaurant order” and “I can’t remember the last time I bought a Happy Meal.” Again, the principle alone is not enough to start the revolution, because it turns out people don’t like trans-fats, and they don’t care about Happy Meals. But they continue to fret about the “next” crazy law, letting their imaginations run to logical extremes. “Where will they draw the line?” the people ask.

Eventually, there it is. The line. Someone proposes a law that actually goes too far, and the people rise up in sufficient numbers to strike it down. This is the difference between how much government the people say they want and how much they actually want.

This doesn’t mean the Happy Meal law is a good idea, but is it fascism if no one cares?

The House recently passed a major financial reform bill, and the Senate will vote on it as soon as there’s enough Republican support to push it through. By most accounts, the Republicans are mostly on board, which is probably why we’re not hearing a whole lot about it from the media. There’s not enough conflict and hysteria to make it television fodder.

18 months ago we were told we were teetering at a precipice. We felt anxiety, which subsided into anger as we learned more about how the firms we paid to rescue had precipitated the crisis. Now we’re no longer feeling the acute fear, and the anger at Wall Street has fizzled somewhat, so I’ve been a bit worried that the final reform bill won’t have any teeth.

This inspired me to do some digging. I’m not a financial whiz, but having devoured many accounts of the crisis, I feel like I have a pretty good handle on what needs to change.

Too Big To Fail is a maddening phrase we heard a lot, and we’ll never know what would have happened if the federal government had rejected the premise outright – meaning we’ll never know what would have happened if the government didn’t bail out the banks. There are lots of smart people on both sides of the debate around the bailouts, but ultimately hindsight is blind.

Given this fact, too big to fail is one of the key things that Congress has vowed to fix in the financial reform bill. Specifically, they want to be empowered to break up companies before they become too big to fail. I for one have little confidence in the government’s ability to define big in a way that would lead to action down the road. The truth is, the government will never be able to know exactly when or how they should intervene, so I don’t think this will really be a meaningful part of the final reform bill.

Another piece of needed financial reform has to do with incentives. Up and down the whole chain of cause and effect, from home buyers in the suburbs to folks on Wall Street assembling mortgage-backed securities – people had good incentives to make really bad decisions. But this is something the companies themselves need to fix.

That makes one thing the government can’t fix, and one thing they shouldn’t fix, so what should we expect from a reform bill? I think there are three obvious things:

1. Create independent ratings agencies – Agencies like Moody’s and S & P are paid by the firms whose bonds they are responsible for rating. This is the only reason a CDO made up of hundreds of garbage loans put together by Goldman Sachs was able to get a triple-A rating, and it’s obviously insane. Either the government should put together its own truly independent ratings entity, or it should require the existing agencies to operate independently. Either way this is easier said than done, but it’s pure common sense.

2. Eliminate huge private transactions – Wall Street firms routinely make multi-billion-dollar deals with each other that are not reported on anyone’s balance sheet or visible on any index. If the larger financial market is exposed to the risk inherent in these transactions – which it obviously is – then the larger market needs to know about them. The financial industry will fight this tooth and nail, and we’ll certainly hear lots of manufactured reasons why it’s a bad idea. Look for the “trickle-down” attack – you know, the one that says that any restraint imposed on big business is bad for the economy because that’s where the jobs come from.

3. Regulate “hedging” – This is a tough one, because it’s subjective. A few firms made a lot of money from the deals that led to the financial crisis by aggressively touting certain investments to customers while simultaneously making big bets that those same investments would fail. Executives from Goldman Sachs were questioned about this by Congress, and a series of deals engineered by a firm called Magnetar makes a perfect case study. Companies call this “hedging” and claim it’s just a prudent part of doing business – you make a bet, and you “hedge” it with a side bet, as insurance.

There are two problems with this argument. First, the side bets they refer to as hedging were mostly secret, back-channel deals, whereas the affected investments they promoted were very much the opposite. In other words, they aggressively sold certain investments that they secretly bet would fail, and the more of these bad investments they sold, the more money they stood to make from their failure. Secondly, many indications suggest the so-called hedges were often bigger than the bets (which means they’re the real bets and not hedges at all). This is hard to prove, given the secrecy around these “hedges,” which is its own problem.

Again, this is something the financial industry will fight tooth and nail, but we should all demand transparency. We have the right to know about both the hedges and the bets, so we – meaning not only ourselves, but our banks, mutual funds, etc. – can make informed investment decisions

One proposal put forward in the financial reform bill is to establish a new government entity called the Consumer Financial Protection Agency to alert us to red flags in potential investments (like giant side bets), and this is what the Republicans are opposed to, because they see it as unnecessary government bureaucracy. This is a valid point, but I’m not sure what else they’re offering. Alternatives suggested by Democrats in an effort to gain Republican support include beefing up  the consumer protection power within one or more existing agencies.

In any case, consumer protection should give us more freedom, serving to illuminate risks in complicated financial products without prohibiting those products. It’s transparency we need, and that’s what we should look for in the financial reform bill.

[UPDATE] The good news is that items 1 and 2 are in the bill that passed the House. Item 3 is fuzzier, although there are a number of provisions in the bill that might have some impact on the way that firms will be allowed to make bets vs. side bets. Maybe worthy of another post.

Things are ugly right now.

After the healthcare bill passed, we all heard how a few so-called tea baggers hurled racial slurs and other insults at Democratic lawmakers, broke windows of party offices and engaged in other such foolery.

Yesterday, I saw Mitt Romney’s new book on display in Borders. It’s called “No Apology: The Case for American Greatness” – an obvious swipe at Obama liberals for acting as if the United States is something short of infallible.

Glenn Beck absurdly compares progressives to Hitler and Stalin, and warns us that universal healthcare will take us down a slippery slope to tyranny.

On the other side, countless voices on the left dismiss the tea baggers entirely as the wingnut fringe and draw as much attention as they can to the most outrageous, classless antics of its most extreme members.

When Bush was president, the left portrayed him as an idiot, a manchild, a cowboy. Cheney was Darth Vader. They and their cohorts were bent on destroying everything America stands for. The Bush Administration and their supporters in turn portrayed the left as unpatriotic, soft, weak, elitist.

I admit I’m pretty squarely on one side of this ideological divide, but I’m tired of all of it.

For a decade now, we’ve all been fooled and misled into hating each other. Kids in their teens and twenties must think America has always been this divided, this polarized, and that’s sad.

The saddest thing is how it distracts us from all the things we have in common.

The tea-baggers are mad at the government, whom they perceive has been bought by Wall Street. The anger over the healthcare bill is about money (unemployment, the deficit), and it can be seen as a proxy for their anger at Wall Street – whose robber barons broke the economy, stole from the American people and then walked away richer than before. But guess what? Progressives are mad at Wall Street too. So why are we attacking each other? Wall Street must love watching us fight amongst ourselves. They could not have engineered a situation that better enables them to keep on doing what they’re doing to us – or maybe that’s exactly what’s going on. Either way, I really don’t want to let them win.

As much as it pains me not to argue with climate change deniers, Sarah Palin lovers and Fox News watchers, I hereby call for a truce. We will continue to disagree about global warming, same-sex marriage, Sarah Palin, President Obama and a host of other things. One side will make a little headway, then the other. What little progress is made by either side will be so full of compromises that it won’t satisfy anyone.

Conservatives don’t think we should all pay hundreds of billions of dollars for universal healthcare. Liberals don’t want to pay hundreds of billions of dollars to wage war in Iraq. How about we call it even now and agree that we’ve all been screwed.

Let’s not let our disagreements stop us from making real progress in the areas where we agree. Like Wall Street. Congress is finally getting ready to debate legislation to regulate the financial industry. Let’s pay attention to this, and let’s refuse to allow the political parties, the media pundits and the lobbyists pit us against each other. Let’s not blindly listen to supposed experts whose impassioned arguments invent an enemy – a “them” – that isn’t Wall Street itself. Let’s think critically for ourselves, and give each other credit for doing the same, instead of shoving each other into knee-jerk categories like “tea-baggers” and “progressives”. Let’s assume good intentions in our fellow Americans.

And after we’re done with Wall Street, there are a lot of other things we agree on. Chew on these statistics:

A recent poll found that 60% of Americans feel that improving treatment of women in other countries is “very important” and that 30% feel it’s “somewhat important.” Despite all our other differences, that’s 90% of Americans who agree on something. That’s huge. And it’s something we actually have the power to change.

Here’s another example… I was working in Southeast Asia in 2004 when the tsunami devastated the region. Despite our differences, Americans stepped up and donated 1.2 billion dollars to tsunami relief. 30% of American households contributed to the cause – across all the ideological lines that seem important enough to divide us so much of the time.

These are just a couple of random examples, but the point is let’s ignore rhetoric that would turn us against each other. Let’s be careful about how we listen to the Karl Roves and Glenn Becks on the right, and the Bill Mahers, Olbermans and Moveon.orgs on the left. Better yet, let’s take a break altogether from listening to people who would persuade “us” to oppose “them.”

Let’s not get so sidetracked by the things that divide us that we become unable to make progress in the areas where we share common ground.

Americans, it’s well known, aren’t interested in soccer. Americans prefer the other football. We don’t like hockey either, which isn’t surprising, since it’s a lot like soccer played on skates. It’s hard to find definitive rankings of U.S. sports by popularity, but every source I’ve found lists the top three as:

1. Football
2. Baseball
3. Basketball

Hockey is always fourth or fifth, or even lower, and soccer barely makes the list. UFC, NASCAR and WWE (which isn’t even a sport) are way more popular.

Soccer, of course, is the world’s most popular sport, so this yet another way the U.S. is an outlier on this earth. But why is it so?

Here’s a theory:

Soccer and hockey go for long stretches where there’s no clear winner. You see lots of players running (or skating) around in a beautiful exhibition of athleticism, but the scoreboard is the only thing that tells you what team is on top.

This is not the case with football, baseball and basketball.

Football is split up into four downs and ten yard spans. The team with the ball gets four chances to go ten yards. The game completely stops between each down. A down lasts for maybe five to ten seconds, and during those few seconds the team with the ball either moves forward or they get pushed back. If they don’t move at least ten yards forward in four tries (really, three), they have to give the ball to the other team.

So for every down – and every set of four downs – there’s a clear winner and loser. That’s a winner every five to ten seconds.

Baseball is even more atomic. Baseball is broken down into pitches, outs and innings. Every pitch results in a ball, strike, foul, hit or out. In other words, every pitch has a winner and a loser. Every inning too.

In basketball, it’s possessions. You get the idea.

Americans like things we can win, and the more opportunities there are to win, the more we like it. If a sporting event is a metaphor for life, then Americans don’t want to wait til the end to know whether they won or not. We want the opportunity to win over and over again; we want another shot after losing a down, or a pitch or a possession.

This is how we do everything in America. Look at our financial industry or our healthcare system. We seem to prefer a healthcare system with clear winners and losers, over one where everyone is protected. We prefer to an arguably corrupt financial system that we can game, over one that would guarantee prosperity for all. Not only do we like to win, we like there to be losers.

The chance to win once every few seconds  is more enticing than the idea of running around for 90 minutes having fun.

[image above via juiceanalytics.com]

Yes old friend, I’m talking to you. You with the high-paying office job, the fine house in the suburbs, the lovely wife and the precocious daughter who’s just about to start first grade at a fancy private school – a fancy private school incidentally that has not ceased to exist despite the fact that free public education exists too (some of it very good even). But I’m getting ahead of myself.

I have come into possession of something you might be interested in. It’s a one-way ticket to a place called Alternate America. An America where the federal government is small, minuscule. Where it stays out of the way and doesn’t meddle in the business of business. Where markets and men are free. It has always been this way in Alternate America. Oh, yes, and this ticket is good for your whole family.

Whoa, hold on there friend. I’ll give it to you in a minute. Let me read you some fine print first. There are some warnings and disclaimers here… I know I know, lawyers. Always covering somebody’s ass. But bear with me.

Here’s some stuff about food:

In Alternate America, there are no ingredients on many food labels. There’s no nutrition information either, because the FDA doesn’t exist. Liberals created the FDA in 1906, during what has come to be called the “Progressive Era.” Scary! On the other hand, some food labels have more nutrition information than you could ever want. There are breakfast cereals that guarantee a boost in IQ for example, and potato chips that prevent certain cancers. And there are some magical drugs. Something called “thalidomide” for example is a wonder cure for insomnia, coughs, colds and headaches. At least that’s what the advertisements say. Anyway, if you decide to take this ticket to Alternate America, you should definitely buy some of that IQ-boosting cereal for your little girl, to help her do well in school! I’m sure it’s safe.

You might want to be careful about fruits and vegetables. There’s no EPA to set pesticide residue limits or regulate the chemicals that can be used for food packaging. But all plastics are basically the same, right? I doubt there’s any chance something bad could leech out of the container into your daughter’s apple juice. And the companies that make those pesticides say there’s nothing to worry about.

Oh… says here that some people have been claiming their kids have been getting sick a lot – stomachaches, headaches, fatigue – ever since they bought some toys made in China. Just something to keep in mind. Maybe you could buy some kind of lead-testing kit, just to be safe, since no one else will be testing the toys. Some companies say their toys are 100% lead-free. Just buy those “lead-free” toys. You believe em, right? One more thing… Stay away from the tap water. Definitely.

Hmm… there’s a lot more here about food and drugs, but let me skim ahead…

Oh, liberals were responsible for that whole women’s suffrage thing, so your wife isn’t eligible to vote. But you probably don’t care about that, because you don’t like the government anyway.

Let’s see, what else…?

If you lose your job, you’re kind of screwed. There’s no unemployment insurance. More big government stuff created by liberals. At least you don’t have to pay to help other people who lose their jobs.

Medicare and Social Security don’t exist, so make sure you save your money wisely. Hopefully you’ll always have that high-paying office job, and hopefully you won’t hit any unexpected financial speed bumps in the next 25-30 years. I’ll cross my fingers for you. Some of your friends probably won’t be so lucky, but screw em.

Travel in Alternate America is a little dicey. There are no interstate highways. The roads in general are really bad, but they do the job I guess. No one really owns them, and no one has found a good way to make money by building and maintaining them. Luckily you’ll be able to afford a car with seatbelts. The nicer cars have em. Hopefully you’ll never have an accident, because most drivers don’t have any kind of insurance. Why would you pay for insurance if you don’t have to? There aren’t a lot of really beautiful things to see in Alternate America anyway. There’s no Grand Canyon for example, because the government didn’t want to get in the way of all the companies who wanted to build dams along the Colorado River.

Oh, I should also warn you that airplanes are pretty scary. Regular maintenance costs a lot of money, so the airlines in Alternate America try to milk everything they can out of the parts they have before replacing them.

I’ll skip ahead here… there have got to be some things you’ll really like about Alternate America…

Oh, here’s one… No progressive taxation! Of course, that means Alternate America was not able to wage WWII, build the atomic bomb, put a man on the moon or win the Cold War, since most of the revenue in regular America comes from progressive taxation. And you like all that awesome war stuff, right? Go America!

No progressive taxation also means there’s no Internet in Alternate America, because it cost the Department of Defense (in regular America) a lot of money to build.

Well, those are some of the highlights of the fine print. Still want that ticket?

If Sarah Palin falls in the forest and the media ignores her, does it make a sound?

I shouldn’t have to wish for Sarah Palin to go away. After all, what is Sarah Palin but the losing candidate for vice-president in an election that happened 10 months ago, and the former governor of a state most of us never think about (sorry Alaska)? If the winner of the vice presidency is awarded with “the most insignificant office that ever the invention of man contrived or his imagination conceived” (in the immortal words of John Adams), then what does the loser get?

As far as I can tell, Sarah Palin generated a lot of media buzz last summer because she was a woman that no one had ever heard of, and the GOP picked her to be John McCain’s running mate. Pure shock value basically. In a sensible world, the buzz would have quickly dwindled to the sub-audible hum that most veep candidates garner. Except that it turned out she was kind of a dimwit. OK, so that was a bit newsworthy, and Palin was good for a few ammusing “joe six packs” and “you betchas.”

But then it really should have been over.

When McCain lost the election, and she went back to Alaska, that should have been the last we heard from or about her – barring a sex scandal or some kind of meltdown. Like suddenly quitting her job.

But this is the governor of Alaska we’re talking about, and we only care about her because she ran for vice president. When a former veep candidate resigns from office in the least-populous state, it warrants a few paragraphs of coverage for a day or two.

So who’s still talking about Sarah Palin? I don’t read the conservative press, but the New York Times has run several Op-Ed pieces in the last few days and another front-page story yesterday. The Huffington Post has posted probably 50 Palin stories in the last week. The Daily Dish, which usually has better things to talk about, has been beating the dead horse too.

Can y’all stop now please?

It’s been a while since I posted here, and I’m introducing a new category: Elimination Dance.

Instructions: An elimination dance begins with a crowded dance floor.  At a signal, the band stops playing and the announcer reads an elimination, say, “Any lover who has gone into a flower shop on Valentine’s Day and asked for clitoris when he meant clematis.” Any dancer answering this description must sit down, and his partner is also disqualified. The process continues (e.g. “Any person who has burst into tears at the Liquor Control Board”) until a single couple remains.

(from the description of Michael Ondaatje’s book by the same title)

This new category, in other words, is for all the things I wish would go away. My first is small-government fanatics. For some reason I’ve allowed myself to rant in the comments of a couple friends’ blogs this week in response to passionate small-government fanaticism and comments I somewhat unfairly deemed as such.

The rest of this post is a lightly-edited re-post of a comment I left on my friend Jay’s blog…

Small-government fanatics seem to believe we are a prosperous and successful country in spite of our government – rather than because of it, whereas I believe the truth is very much both.

We are beneficiaries of two centuries of government protection and support – much of which we basically seem to take for granted at this point, and much of which few people would really want to go back and undo. Of course there have been missteps too, but the small-government libertarian crowd usually fails to acknowledge the ways in which we have benefited.

One core principle of small-government fanatics is free markets, or as my friend Jay unambiguously put it: “The free market is one of the greatest gifts to mankind in all of our history.”

I think, however, that total market freedom almost inevitably leads to “tragedy of the commons” scenarios. People and businesses will pursue their own desires even to the detriment of everyone’s needs. They pursue immediate individual gains that risk (and often cause) generalized future catastrophe.

If government does not serve to protect the commons from the individual, then what – or who – will?

Before the FDA required drug companies to prove their products were not dangerous prior to putting them on the market, there were numerous incidents of contamination – sometimes maiming or killing thousands (thalidomide, diethylene glycol). What’s the free-market alternative to this? The free-market response might be to put a company out of business because one of their products killed a few thousand people, but um… the company KILLED people. That was the free-market drug industry before the FDA.

What about a more straightforward tragedy of the commons? I have a hard time envisioning a free-market solution to protecting fisheries from individual companies competing against each other to pull in the biggest catches. The companies know when they are pushing fisheries toward collapse, but they also know that if they hold back, then others will just step in and out-fish them. What’s the free-market answer?

This is similar in nature to what happened in our financial markets. Smart people knew they were taking insane risks that were not sustainable, in order to reap huge short-term gains. But they also knew that if they didn’t do it, plenty of other people would out-gain them in the short term, and they would be fired.

For whatever reason, it’s easier for me to stomach this problem with the financial markets (as part of the cost of doing business – even if it hurts a lot of innocent bystanders), than with things like forests and fisheries. Damage done to forests and fisheries is longer-lasting.

I have a hard time believing our country’s major parks and wilderness areas would ever have been created without our government deciding to do so (imagine how many more dams could have been built along the Colorado River and how many more trees harvested in Appalachia if companies were free to do so). I’m personally happier to have the parks and wildernesses.

Scientists have been sounding alarms about atmospheric carbon and climate change for five decades, warning us about a point-of-no-return. We probably needed to start doing things differently 10 years ago to avoid the point-of-no-return, but what free market incentive existed to do so? None, and that’s why we’re in the predicament we’re in.

If you believe there are no situations when the collective good is more important than individual gains, then my argument is lost on you. I don’t believe this. And it’s hard to imagine who would aim us toward the collective good if the government was not trying to do so.

It’s fair to argue that the government does not operate effectively or efficiently enough, but I think the answer is to improve it, not to eviscerate it.

I think it’s good and necessary to debate each threshold of government intervention (currently, healthcare), but I think we need to acknowledge how much existing government protection and support we take for granted and would not want to give up.

In the tradition of The Giant Pool of Money, its spinoff Planet Money and this fine piece of writing by Henry Blodget in the Atlantic Monthly, here’s a nice piece of animation that explains how we blew up the economy:

The Crisis of Credit Visualized from Jonathan Jarvis on Vimeo.

There are a lot of people lining up for stimulus dollars, a lot of ambitious and long-dormant projects being dusted off by governors and mayors across the country.

But there’s another group of opportunists taking advantage of the debate. I’m talking about the G.O.P. who are stonewalling and stalling in the name of prudent spending. At least that’s what they’d like us to think. They’re going through the proposed bill line by line and collectively decrying as wasteful almost everything in it.

I suspect something else is behind the political theater.

It’s possible the Republicans think they have nothing to lose by delaying or even derailing the President’s plan. It’s reasonable for them to believe they won’t be blamed if the final plan they approve ultimately fails to fix the economy. If it fails, the Republicans can be pretty sure that the president and not congress will bear the blame. Likewise if it succeeds, he will get most of the credit. Congress will share very little of either.

I’m not sure I’m so cynical as to suspect the Republicans of trying to engineer a failure, but looking at it as a purely political opportunity, they have much more to gain from failure than they do from success.