History, the FDA, and Cognitive Biases

For reasons set forth in an earlier post, the author recently had reason to read Thomas Hager’s The Demon Under the Microscope: From Battlefield Hospitals to Nazi Labs, One Doctor's Heroic Search for the World's First Miracle Drug (2006) (Demon). Demon is a highly recommended account of an episode in history, the discovery of the first effective antibiotics, which despite its world-shaking, near-miraculous consequences to the most of the planet’s inhabitants is curiously unknown even to the educated.

Chapters 17 and 18 in Demon (p. 207-233), however, concerning the events leading to the passage of the Food, Drug, and Cosmetic Act of 1938 which for the first time empowered the FDA to control what medications Americans can make, sell, or take, is curiously unsatisfactory. This is not because the facts recounted therein are incorrect, incomplete, or biased, but because these facts are in such stark contradiction to the chapter’s tone lauding the FDA. That this contrast should have escaped the author, his editors, and presumably most readers is a prime example of certain near-universal, powerful cognitive biases.

Risk Corridors and Credibility

The ObamaCare risk corridors provide subsidies to insurance companies that make losses on the marketplaces while collecting revenues from those that make above-normal profits. Until recently, everybody—from the CBO on down—knew that the risk corridors would generate multi-billion dollar surpluses for the federal government. Now everybody knows, and has always known, that they would generate multi-billion dollar losses for the federal government.

Health Care Is Like Other Services

Note: Please see the opening note there. It applies here too.

One frequently hears the argument that there can be no markets in health care. Those who so argue strenuously deny that they are Communists (or some other form of collectivist) and disclaim any intent to generally abolish the capitalist mode of production. It is just that health care is so very different from all other goods and services that—for just this little special case covering 18% of the U.S. economy—we need to adopt a collectivist approach.

To draw this distinction two differences are invoked: one with a grain of truth but far from justifying collectivism; the other, entirely spurious.

Health Care Costs Money

Note: Please see the opening note there. It applies here too.

The provision of health care requires the services of doctors, pharmacists, nurses, medical researchers, and their various managers. These services are not free for all of these people have alternative uses for their time, labor, and effort—leisure or other work. Many of these people are well-off, and so are willing to pay a high opportunity cost for leisure. Many of them are also quite intelligent and well-educated, and so have the option of other professions with high salaries they must forgo if they work in medicine. Ever since the Phoenicians invented money, the preferred means to induce these people to work in medicine has been remuneration in excess of these high opportunity costs. So health care will not merely cost money, but a lot of money.

David Kessler, Serial Groper

In 1992, the FDA under David Kessler, to great fanfare and cheer from feminist activists, banned silicone breast implants in response to national hysteria fueled by daytime talk show allegations of leakage and rupture. Even then, the FDA did not justify this ban on the basis that these fears were well-founded or even plausible—they were not—but hid behind its determin[ation] that the manufacturers had not adequately addressed public concerns about certain complications.

The Best Part About Hitting Oneself in the Head with a Hammer

There is a fad, which the author was surprised to find even friends one otherwise respects to be engaged in, of natural childbirth. By that is understood to be meant a voluntary choice to give birth in the same manner our prehistoric ancestors did—without sophisticated medical assistance or pain relief. As one is reliably informed that human childbirth generally involves at least hours of substantial pain, and sometimes days of excruciating pain, one is rather surprised that any woman would volunteer herself for this ordeal. But whenever one inquires into what might motivate such a strange choice, one hears a variation of one or more of the following:

Planned Parenthood Baby Part Sale Kerfuffle

Planned Parenthood, the nation's largest abortion provider, sells the body parts of late-term babies they aborted for medical research. A videos of a sting operation showing senior Planned Parenthood executives discussing such sales, including abortionists buying Lamborghinis with the proceeds, have been posted to YouTube. Predictably, Pro-Lifers are outraged and the mainstream media have either been ignoring the story or focused their outrage on the violation of Planned Parenthood's privacy.

Lawyers Live Forever

With the gloom and doom besetting the legal profession, one bright spot is perhaps worth noting. According to a '99 paper,The Impact of Specific Occupation on Mortality in the U.S> National Longitudinal Mortality Study, quoted by Robin Hanson, being a lawyer seems to be just about the healthiest profession you could have.

If I interpret the graph in Hanson's post correctly, being a lawyer is associated with about a 30% decrease in death rate, compared with the population average. This appears to be the case with or without adjusting for age, gender, race, income, and education. Other healthy jobs include MathSciLib (math/science librarians?), RelgSocSv (religious social service providers?), OffManNEC (?), MedEqMchn (medical equipment mechanics?), and farmers, but—perhaps surprisingly—not physicians.

Equally surprising are some of the high death risk jobs. Why do office workers have a 120% (unadjusted)/60% (adjusted) increase in death risk? Why do food service workers suffer a 160%(unadjusted)/55% (adjusted) increase? While fire fighters and police only have their risk increased by 40%(unadjusted)/10% (adjusted)?

Congratulations to My Progressive Friends

You have succeeded in remaking the United States. Now nothing substantial stands between you and a total nationalization of health care. We can agree that America will never be the same again; you may cheer, we may mourn. But it is a done thing.

There'll be a lot of political brouhaha for the rest of the year and your party will likely lose some power in Washington; perhaps even majorities in the House or the Senate. But you know—and we know—that these short-term swings don't really matter. In the long run, you will have turned a large part of the population into your clients, depending on your favor for their health. They'll vote accordingly. In the long run, you'll be stronger than ever for it.

Sometimes I wish that you didn't listen so well to my advice to you less than two months ago when things seemed the darkest for you. Or, at least, that there was a place one could escape you.

Sincere Advice to Progressives

If you are a smart progressive and think long term, listen to Krugman, listen to Yglesias: Pressure your leaders to pass ObamaCare now! Pass the senate bill, pass the house bill, pass it with or without a reconciliation side-car, pass anything—as long as the effect will be to push the already tottering private system over into a state of complete dysfunction (and any of the bills will do for that), you will have won an enormous long-run victory.

Do not delude yourself that this achievement will be without short-run pain. Probably it will increase Democratic losses in the 2010 elections.¹ But permanently putting health-care on an branch-less path towards total state control will be more than worth the price to you. Henceforth, any deficiency in health care will be blamed on stingy Republicans who refuse to fund it adequately; large and powerful constituencies like health care workers, including doctors, will accrete to your base as well as that of your union allies; private health care will become like private primary and secondary education—a luxury good with a few percent market share used only by those rich enough or motivated enough to pay for the public version at the tax office and once more for their private version.

You and your successors will reap these benefits of these shifts for decades and generations when the outcome of the 2010 mid-terms will be a bit of trivia unremembered by any but the most devoted election geeks.

Needless to say, this author views this outcome with as much horror as you should view it with glee. If a similar opportunity had arisen in reverse—that is, permanently reforming the health care sector on a consumer-driven competitive-market basis in return for a temporary loss of political majorities—the author would have gone hoarse urging all who would listen to grasp it with both hands. So he is puzzled that progressives are letting victory slip from their hands so easily.

¹ Of course, most of the losers will blue dogs, moderates, and other weak sisters, so don't shed too many tears for them. Most of your favorites will not lose their seats. You may even retain a small, but more ideologically homogeneous majority in both houses of Congress.

So much gloating, so little time

Also: ObamaCare and AirAmerica are dead.