Friday, April 20, 2007

Mini-hiatus.

My students have an exam at the end of next week. Blogging will be light (if not non-existent) until I've dealt with all last-minute questions and graded the damn things.

Monday, April 16, 2007

Shootings in Virginia.

This is horrific. (And, no, I'm not just talking about the tactless headline.) As soon as I notice any new news on who this guy was and why he decided to shoot over 20 people, I'll put it here.

EDIT: 3:45pm EST: The Star has updated their article. Estimates are now up to 31 or 32 dead, including the gunman. Still no indication of why he did it. Apparently, early in the morning they locked down the campus, after an initial round of shooting. Once the lockdown was lifted, at around 8am, another round ensued. So, at least some of the deaths are partially due to ineptitude. Nice.

EDIT: 6:20pm EST: Updated again. Estimates are up to 33 dead, including the gunman, and 26 wounded. Still no indication as to a motive.

Friday, April 13, 2007

Elizabeth May and the Liberal Party.

There's a certain amount of concern (see here, for example) about the deal concocted between Elizabeth May of the federal Greens and the Liberal Party, i.e., that the Libs won't run a candidate against May in Central Nova, and May will endorse Stephane Dion for Prime Minister. Personally, I'm having a hard time seeing what the fuss is about.

Electorally, as Wikipedia shows, the Greens don't stand a chance. The second-place finisher in the last election was the NDP candidate, Alexis MacDonald. If you combine the previous Liberal and Green tallies, they don't come close to the NDP tally. So, assuming, as one reasonably might, that only a fraction of the NDP votes at best will go to the Greens, and assuming, as one unreasonably might, that the Greens and Liberals all vote for May, Peter MacKay still takes it in a cakewalk. (FWIW, fighting against a MacKay in Central Nova seems to be political suicide. Peter's father, Elmer, held the riding for years.) That's also assuming that MacDonald doesn't manage to increase her own vote tally at the expense of the Libs and the Greens.

Politically, it looks like a smart move on May's part. The NDP is the only party that can really give the Greens a significant challenge on their central issue, i.e., the environment. By teaming with the Liberals, May likely hopes to keep the NDP at bay and, simultaneously, put the Greens forward as presumptive potential partners, ahead of the Dippers, in a formal coalition with the Libs. (The Jurist makes similar points. EDIT 3pm: Actually, my error here. For some reason, I thought the Jurist was talking about how this might be bad for the NDP: he's talking about how it would be bad for the Liberals.)

As far as principle goes, I don't really see the problem with an informal agreement between a smaller party and a larger one. After all, formal versions of these agreements are what make up coalition governments, and, as far as I'm concerned, coalitions are a good thing. Idealistic Pragmatist tries to argue that the informal version is bad because it "disenfranchises" voters, but that doesn't really make sense. After all, suppose the Greens had simply chosen not to run 308 candidates in the election. Would voters in the ridings that didn't have a Green candidate be "disenfranchised"? Or would their options have simply been narrowed? As long as we do this crazy, voting-for-some-guy-in-your-riding system, then the fact that you can't vote for your first choice of party in no way disenfranchises you: you just don't have that right. (Now, maybe you should, but that's an argument against the system, not an argument that has traction within the system.)

So, overall, it's a somewhat cynical move, but also one that has at least one good principle behind it. I do think, though, that May has screwed herself in trying to run in Central Nova. She really has no chance against MacKay, and so all this maneuvering will be for naught.

Now, go read CC: it made me laugh.

Wednesday, April 11, 2007

Here we go again.

The CN strike is back on. Whoo-hoo.

FWIW, I really hope Parliament has the sense to vote down any back-to-work legislation. We've already seen ferry workers in BC refuse to obey a provincial back-to-work order (here, although it should be noted they agreed to binding arbitration the next day). I wouldn't want to lay money on whether rail workers, after having already been threatened once, rejected an offer, and gone back on strike would be any more willing to obey a similar order from the feds. It's bloody dangerous to use the club of legislation too freely, as (with justification) unions start seeing reason to respond in kind.

How's about the, allegedly conservative, government does something crazy and lets the market work this one out, hmmm?

Another quiz.

I love these.

a Man with No Name
You scored 9 Honor, 5 Justice, 7 Adventure, and 2 Individuality!
It's one thing to be a gunslinger. It's another to wander into town, leave nothing but a trail of those who'd try your skill and take the town's gratitude and cash with you. Hero or villan? It's all in how you look at it and whose side you're on.

Cigar in your teeth and colt on your hip, you are ready to step into the hazy desert horizon. You'll do just fine.




My test tracked 4 variables How you compared to other people your age and gender:
free online datingfree online dating
You scored higher than 99% on Ninjinuity
free online datingfree online dating
You scored higher than 99% on Knightlyness
free online datingfree online dating
You scored higher than 99% on Cowboiosity
free online datingfree online dating
You scored higher than 99% on Piratical Bent
Link: The Cowboy-Ninja-Pirate-Knight Test written by fluffy71 on OkCupid Free Online Dating, home of the The Dating Persona Test

Hacks and healthcare.

You can tell this is an odd US federal election coming up next year, for the right-wing hacks are coming out of the woodwork to raise all the old bugbears about universal health insurance. Let us point and laugh at this little piece from two Cato Institute drones.
Many countries provide universal insurance but deny critical procedures to patients who need them. Britain's Department of Health reported in 2006 that at any given time, nearly 900,000 Britons are waiting for admission to National Health Service hospitals, and shortages force the cancellation of more than 50,000 operations each year.
Argument by meaningless "scary" stats. How many operations are cancelled in the US? How many Americans can't get access to hospitals? As far as the drones are concerned, context doesn't matter; 900,000 is a big number, and that's enough to frighten the peons into voting Republican!
In Sweden, the wait for heart surgery can be as long as 25 weeks, and the average wait for hip-replacement surgery is more than a year. Many of these individuals suffer chronic pain, and judging by the numbers, some may well die awaiting treatment. In a 2005 ruling of the Canadian Supreme Court, Chief Justice Beverly McLachlin wrote that "access to a waiting list is not access to health care."
This is just sad. The numbers they're quoting for heart surgery make no distinction between people who need a quadruple bypass and people who are waiting for exploratory procedures. There's not, on the face of it, any reason to suppose that it's the former who are having their surgeries delayed, yet that is exactly the conclusion the drones draw. Furthermore, the citation of the wait-times for hip-replacements is irrelevant: living in "chronic pain" (which is actually a technical medical term, but never mind) may suck, but if it's a choice between that and people dying of preventable diseases, then the correct choice is clear. (And this is all ignoring the fact that these stats are, also, given without context.)

Finally, citing McLachlin is simply bizarre. Because she's a judge that means she can't be wrong?

Here comes a howler:
Supporters of universal coverage fear that people without health insurance will be denied the healthcare they need. Of course, all Americans already have access to at least emergency care. Hospitals are legally obligated to provide care regardless of ability to pay, and although physicians do not face the same legal requirements, we do not hear of many who are willing to deny treatment because a patient lacks insurance.
Oh. My. God. I don't think they could have more effectively missed the point if they'd tried. First, hospitals are required to provide care regardless of ability to pay if one is actually in need of emergency care. They can refuse to provide care if they judge that care is not necessary. Since there's a big gap between "in need of urgent care" and "perfectly healthy", there's a clear problem. Second, that we don't hear of physicians who deny treatment due to lack of ability to pay doesn't mean it doesn't happen. Third, the issue is more about the uninsured or underinsured deliberately refusing to seek care -- or, worse, deliberately refusing care that is medically indicated -- because of their inability to pay.
You might think it is self-evident that the uninsured may forgo preventive care or receive a lower quality of care.
You will be forgiven for thinking this is a prelude to a reasonable assessment of an important issue.
And yet, in reviewing the academic literature on the subject, Helen Levy of the University of Michigan's Economic Research Initiative on the Uninsured and David Meltzer of the University of Chicago, were unable to establish a "causal relationship" between health insurance and better health. Believe it or not, there is "no evidence," Ms. Levy and Mr. Meltzer wrote, that expanding insurance coverage is a cost-effective way to promote health.
I'll ignore the annoying dropping of Meltzer and Levy's deserved "Dr." honorifics (after all, this may be the copy-editor's doing). And the drones know damn well that one paper doesn't prove a case. But, let's actually go find the paper in question, shall we? According to Meltzer's CV (.pdf) and Levy's webpage (here), the paper was published as a book chapter, and it's not one that York has as an e-book. But wait! Levy has a working paper version available on her webpage (.pdf). And, from the fucking abstract:
Very few of these studies, however, establish a causal relationship between health insurance and health. Causation is difficult to establish because we almost never observe truly random variation in health insurance status. Instead, people who have health insurance and people who do not almost certainly differ in many ways in addition to the difference in their health insurance coverage. Moreover, the causal relationship between health insurance and health is likely to run in both directions; health status may affect insurance coverage and insurance may affect health. This makes it difficult to determine whether a correlation between health insurance and health status reflects the effect of health insurance on health, the effect of health on health insurance, or the effect of some other attribute, such as socioeconomic status, on both health insurance and health status.
So, because of technical problems in establishing causal relationships, Levy and Meltzer are counselling caution in drawing causal conclusions. And, reading the abstract still further:
Our critical review of the literature on this question suggests that when we restrict our attention to studies that convincingly address the endogeneity of health insurance, the bulk of the evidence suggests there is a small, positive effect of insurance coverage on health outcomes among the populations most likely to be the targets of public coverage expansions: infants, the elderly, and the poor. There is also evidence to suggest that in some cases, expansions in health insurance may not result in measurable improvements in health.
In other words, where they can establish a causal relationship, expanding insurance coverage has a positive effect, although a small one, on health outcomes. In other cases, there are no measureable improvements in health -- which, if we read higher up in the abstract, is partially explained by this:
Second, health itself is also a complex, multidimensional construct, and our ability to measure it is imperfect.
And, I couldn't let this little gem go by:
the most plausible pathway through which health insurance may have a causal effect on health is through improved access to medical care: having health insurance increases the quality and/or quantity of medical care, which in turn improves health.
In other words, Levy and Meltzer proceed by presuming that the drones' central claim is false.

Of course, strictly, the drones are cleverer than this: they actually don't say there is no causal relationship between health insurance and improved health; they simply allow the reader to infer that from their claims. Which is blatantly dishonest, but not an outright lie.
Similarly, a study published in the New England Journal of Medicine last year found that, although many Americans were not receiving the appropriate standard of care, "health insurance status was largely unrelated to the quality of care."
I simply couldn't find this study. I'd be surprised, though, if their report of its results was any more accurate than their report of Levy and Meltzer's paper.

It does get even worse, shockingly.
Another common concern is that the young and healthy will go without insurance, leaving a risk pool of older and sicker people. This results in higher insurance premiums for those who are insured. But that's only true if the law forbids insurers from charging their customers according to the cost of covering them. If companies can charge more to cover people who are likely to need more care – smokers, the elderly, and others – then it won't make any difference who does or doesn't buy insurance.
This is completely insane. If companies charge more to cover those who need more care, then that creates an incentive for those who need more care to refuse insurance. In other words, the weak and vulnerable are sacrificed in favour of the strong and powerful. How this is a good thing is opaque to me.

Furthermore, in the case of "smokers, the elderly, and others", it's at least as likely that insurers will either refuse to provide insurance or revoke insurance once a health condition comes to light as it is they will simply increase premiums (ignoring that increases could go beyond ability to pay, which would accomplish the same thing as refusing to provide insurance). So, if you are, genetically, predisposed to develop diabetes (Type 1), you can either reveal or not reveal this information to your insurer. If you do, they may charge you double -- or triple, or whatever -- premiums, or they may simply refuse to insure you, leaving you on your own to obtain the insulin necessary to keep you alive, should diabetes develop. If you don't, and diabetes develops, then the insurer may decide to cancel your policy, on the grounds that you lied to them. Thus, again, leaving you to obtain the insulin you need in order to live entirely on your own.

That is one of the central concerns of advocates of public, universal health insurance (and, indeed, universal pharmacare, dental coverage, etc, etc.). And the drones blow right by it.

In short, if companies can charge more, it will make a different to who does and doesn't have insurance. To assert otherwise is simply to lie.
Finally, some suggest that when people without health insurance receive treatment, the cost of their care is passed along to the rest of us. This is undeniably true. Yet it is a manageable problem. According to Jack Hadley and John Holahan of the left-leaning Urban Institute, uncompensated care for the uninsured amounts to less than 3 percent of total healthcare spending – a real cost, no doubt, but hardly a crisis.
According to The National Coalition on Health Care (no clue if the data's reliable; it's the first thing that came up on Google for "total healthcare spending us"), spending in the US on healthcare in 2004 was $1.9 trillion. 3% of that is $57 billion. I'm elated that $57 billion is a "real cost" in the eyes of the drones. I also note, in passing, that the way in which this problem could be managed is left entirely unaddressed; we are, apparently, supposed to take their word for it that it can be done. I would suggest that the best -- read: fairest and most cost-effective -- way to do so would be to simply insure the uninsured.
Everyone agrees that too many Americans lack health insurance. But covering the uninsured comes about as a byproduct of getting other things right. The real danger is that our national obsession with universal coverage will lead us to neglect reforms – such as enacting a standard health-insurance deduction, expanding health-savings accounts, and deregulating insurance markets – that could truly expand coverage, improve quality, and make care more affordable
I'm confused here, honestly. How does a standard health-insurance deduction differ from a universal healthcare premium? How are HSAs supposed to handle the problem of uninsured people receiving treatment? And when the fuck has deregulation ever made anything better and more affordable? (Electricity market, I'm looking at you.) Do the drones just not live in the same world as the rest of us?
As H.L. Mencken said, "For every problem, there is a solution that is simple, elegant, and wrong." Universal healthcare is a textbook case.
Mencken also said this:
The whole aim of practical politics is to keep the populace alarmed (and hence clamorous to be led to safety) by menacing it with an endless series of hobgoblins, all of them imaginary.
This is why sane people try to back up their arguments with reasons, not with empty appeals to pseudoauthorities.

Pharmaceuticals and patents.

Back in the day (August of last year, no less), I blogged about the pathetically thin arguments that drug companies tend to use when anyone suggests reforming patent laws. Right here, we find that the government of Thailand is threatening to break drug patents. In reaction, drug companies have either refused to release new meds to the country (which is laughably inept) or... slashed prices. So, really, they don't need to charge as much as they do in order to recoup their costs and make a little profit. I, for one, am shocked.

Tuesday, April 10, 2007

Turnitin and plagiarism.

According to this, a handful of high school students in the US are suing Turnitin for keeping digital copies of their submitted work. The article is confused; so, let me extract the key issues. First is the question of originality of work submitted to an instructor for credit. Second is the question of copyright on submitted work. Third is the question of coercing students to submit to Turnitin or a similar service.

With regard to the first, I don't think it's as significant a problem as many seem to think. Maybe other universities differ; maybe high schools differ. But, in my experience, I've only run into one -- maybe two -- plagiarized papers in six years of marking papers. That's a pretty good percentage, methinks. (For what it's worth, Turnitin did catch the one I'm sure was plagiarized.) But, with that said, digital methods have their limitations. They're only going to catch pretty exact matches -- if a student switches enough words for synonyms (or simply misspells enough), then the algorithm will be fooled. So, yes, something like Turnitin is another tool, and it might catch a plagiarized paper here or there. But, on the whole, the value is questionable.

With regard to the second, I'm honestly surprised at the number of students who believe they have copyright on work submitted for credit. AFAIK, they don't. It's equivalent to work for hire. Universities make this explicit for grad students: they own the dissertation, not the student. (In practice, no university worth the name would be dickish enough to prevent a student from using his or her own research in other venues; but, in principle, they do own it.) Maybe this should be made explicit to undergrads and high school students as well, but I would think the principle is basically the same. The work is not original, creative work; it is an assigned exercise, directly analogous to completing a report (or some other document) for an employer.

With regard to the third, it really relates back to the first, in that if plagiarism is a serious problem, then students should be forced to comply with any measure the instructor wishes to use in order to ensure that the work is original. If there is no serious problem, then coercive measures don't seem to be justified. The problem I see is that some students believe they should never be coerced to do anything to prove that their work is original, which is (perhaps unsurprisingly) a fairly juvenile attitude. If honesty is generally suspect at a given institution, then everyone must prove that they are honest; dishonesty is the presumption. However, if honesty is generally not suspect at the institution, then outrage at being coerced to comply with some sort of anti-plagiarism measure seems to me quite reasonable.

Funny stuff.

Told ya so.

The Star has an article today (here) which confirms what I blogged about yesterday vis-a-vis the False Creek clinic. Namely that once for-profit clinics are allowed to offer more money to physicians, those physicians will, more often than not, take the bait and leave their current jurisdiction. The Star describes the same phenomenon happening across the Canada-US border (not to our favour, shockingly). How can it possibly be a good thing to have the same thing happening across the inter-provincial borders?

Monday, April 09, 2007

The return of the son of the revenge of the wife of private healthcare, part XVIII.

I have to give Mark Godley, medical director of the False Creek clinic in Vancouver, some credit. He doesn't give up. According to the Globe and Mail, the clinic is reopening after being shut down under legal threat by the provincial government. His plan now is to try to do an end-run around the legal challenge by hiring physicians from out of province, who aren't under BC's Medical Services Plan. (A better argument for nationalizing the insurance scheme I have yet to hear.)

It's not news that physicians can do this. (AFAIK, there's nothing in Ontario law to prevent a physician from just opting out of OHIP altogether and trying to privately bill.) It's, more often than not, bloody stupid, though: most people walking in off the street aren't going to be thinking about carrying cash; instead, they'll pull out their health cards. It's sort of like operating a fast-food restaurant and not taking debit cards (I'm looking at you, Tim Hortons): you can do it, but you'll lose customers that way. What Godley et al. are gambling on, clearly, is that there's enough people with enough money to jump the line and keep the clinic afloat.

They may be right. But there are two worrying things about this development. The first is that physicians, who are in short supply across the country, have been poached from different provinces. I find the moral reasons behind taking a physician away from, potentially, thousands of patients in order to serve hundreds (at best) to be quite weak, if not non-existent. (Apparently, Godley et al. are more concerned with a quick profit than thousands of Albertans and Manitobans who have lost potential physicians.) T

he second is that it's a clear step towards two-tier medicine. Not because the backing for the clinic is private, but because money has been used to lure physicians away from the public system. This is exactly the kind of thing that opponents of for-profit healthcare have been warning is a necessary consequence of opening up the public scheme to monied interests, and it has now happened. It's not necessarily the case, of course, that the physicians hired by for-profit clinics are better than those who remain in the public system. But, ceteris paribus, when confronted with the option of doing less work for more money, physicians will tend to take it; and, when given the choice between a mediocre physician and a good one, those offering the money will take the latter; thus, already has begun the process of bleeding good physicians away from the public system in order to serve a select few in a private one.

I knew I couldn't rely on the Campbell government to do anything to actually help people in BC, but come on: can they really not see the problem here?

Oversight of higher ed.

On the face of it, this attempt to further high-schoolize higher education. The idea is that the US federal government wants some kind of legal oversight of colleges and universities. Often, "oversight" is a cover (that seems to be a theme for today's blogging) for control: in the case of higher ed, it's control of content, both in classrooms and research, which is a curtailment of due academic freedom. It's not that there's something wrong with knowing where the money is going. What's wrong is with trying to apply cookie-cutter "outcomes" to higher education as a way of throttling money from institutions in the name of political expediency. Evaluating the efficacy of any given department (let alone institution) is an extremely difficult task; and what training or experience do government bureaucrats have which legitimates their taking on this role?

There are two proposals. The first is to make information that is currently subject to peer-review by accreditation boards available to students. The second is to, somehow, measure student achievement more "rigorously". As for the first, it's really an odd idea. Students already have access to quite a lot of information when it comes to choosing colleges or universities. I'm not sure what more this data could add to their decision-making process. As for the second, it's subject to the danger I outlined above, as well as the danger that the pressure on instructors to inflate grades and relax standards will increase beyond even its current level.

And these points strike me as obvious, which makes me wonder if the suspicion I outlined above is correct: namely, that this is a cover for trying to exercise control over higher education in the US. It's no secret that the current President refuses to condemn such blatant pseudoscience as "Intelligent Design", nor that the current administration has put pressure on its scientific agencies to suppress results that the administration does not care for. Is this another attempt to make higher education curricula sway with the political winds? I wonder, and worry, that it may be.

Civility.

Over here is an NYT article on blogging "civility". The tone of the article is generally favourable towards the idea of voluntary codes of conduct, but reasons why are thin on the ground. The idea seems to be that a voluntary code of conduct will somehow exert sufficient pressure on bloggers that "mean" or "nasty" comments and postings will be driven to the margins. (Let us ignore the implicit presumption that these are not generally marginal already.) I'm unclear how a voluntary code of conduct is supposed to perform this miracle. I'm also unclear as to why there's any pressing need to codify standards of discourse. My rule around here is simple: I decide what goes up and I decide what does not. My house, my rules (or, strictly, my judgement).

On a more important note, though, I do think that calls for civility in discourse are, more often than not, a form of cover: a way of trying to silence aggressive or controversial voices and views without engaging with their substance. (This is a common tactic of both the modern right and left, the former tending to appeal directly to courtesy, the latter to nebulous if not vacuous notions of "hate".) If a comment or other piece of writing is so far beyond the pale that it is directly harmful to someone, then the problem isn't that it's rude -- the problem is that it's wrong (and possibly illegal). But there's a space between writing that is wrong and writing that is (morally or legally) permissible, and it is in this space that the notion of civility would have real impact, for not all uncivil writing is wrong. And this is what I find to be cause for concern. That something is rude or mean or unpleasant doesn't imply that there's anything wrong with saying it, and, given what I've seen of codes of conduct in other contexts, a blogging code of conduct would probably collapse this distinction. Which would mean that, instead of addressing the issues and views raised in a "mean" comment, people could, by appeal to this code, simply dismiss the comment on the basis of "tone".

This is, at heart, a distortion of the notion of civil discourse. Civil discourse is not discourse in which no one's feelings are hurt or everyone "gets along". That's kindergarden. Civil discourse is importantly different, for it is a way of organizing debates and disputes between various camps such that they progress without lapsing into stalemate, violence, and other unproductive outcomes. And the reason this counts as "civil" is not, as said, because no one's feelings get hurt ("civil" does not necessarily mean "nice"), but because of the origins of "civility" (and, for that matter, "politeness"). Civility and politeness are the behaviour appropriate to people who live in cities; that is, people who live and work bunched up together, and somehow have to learn to get along without killing each other and have to learn how to advance their collective goals.

That should be the point of a code of "civil" conduct, but it is a point that is already well-served by two other sorts of codes: law and ethics (or, if you like, ethics contextualized). Anything else is either redundant (in which case, stupid but harmless) or an attempt to strangle views that one does not wish to address honestly and openly.

Friday, April 06, 2007

Thursday, April 05, 2007

Sessionals.

Read this. Ignore the comments, but read the article. It's an ever-looming future for your humble scribe, and it's starting to worry me.

I hate when biologists try to do philosophy.

This article starts fairly sanely. Primates have certain social behaviours which serve as necessary preconditions for human moral behaviour. That's very probably true; we can also probably point to necessary preconditions in the environments humans evolved, and even within the human genetic code. Here's the stupid, stupid move, repeated throughout the article:
Biologists argue that these and other social behaviors are the precursors of human morality. They further believe that if morality grew out of behavioral rules shaped by evolution, it is for biologists, not philosophers or theologians, to say what these rules are. [emphasis mine]


*sigh* I'll say it again, although I'm sure I'll see this error repeated in the near future. If primate behaviour is a precondition of human moral behaviour, then, insofar as primate behaviour is the purview of biologists, biologists can tell us about the preconditions. These preconditions will probably (it would be surprising if they did not) limit the possible moralities that humans can follow. These preconditions do not exhaust morality any more than the preconditions for being able to see exhaust the contents of everything you can see. Biologists can say a lot about how my eyes came to be as they are, but they can't say anything about why I'm seeing lines of type appear on a computer screen. (Unless they stop being biologists, that is.)

It gets worse:
But biologists like Dr. de Waal believe reason is generally brought to bear only after a moral decision has been reached. They argue that morality evolved at a time when people lived in small foraging societies and often had to make instant life-or-death decisions, with no time for conscious evaluation of moral choices. The reasoning came afterward as a post hoc justification. “Human behavior derives above all from fast, automated, emotional judgments, and only secondarily from slower conscious processes,” Dr. de Waal writes.


Gah! Ack! And other such exclamations. It's almost self-evident that humans use reason in a whole range of moral decision-making contexts. (Hands up everyone who's actually sat down and tried to think about what they should do: say, go to work or sleep in for another hour.) Talking about cases of snap judgement, as de Waal does, is pure ignoratio elenchi; there's no clear reason to take them as the rule and moral reasoning as the exception. Furthermore, snap judgements could still be judgements that are based on reasons, even if they are not based on conscious reasoning, in that one could construct a process of reasoning which would have justified the judgement actually made. (This is like the formal reconstructions of arguments and formal derivation procedures used in formal logic.) Moreover, he's slid again from talking about the preconditions of morality to talking about morality. (In fairness, the latter could be the reporter, and not de Waal.)

It gets worse:
However much we may celebrate rationality, emotions are our compass, probably because they have been shaped by evolution, in Dr. de Waal’s view. For example, he says: “People object to moral solutions that involve hands-on harm to one another. This may be because hands-on violence has been subject to natural selection whereas utilitarian deliberations have not.”


Oy. I get tired of reading this sort of thing. de Waal (and, again, it may actually be the reporter) seems to think this is a radical conclusion. He should read David freakin' Hume. Sentimentalism, as it was called, was a big movement in the Enlightenment period; sentimentalists, like Hume and Adam Smith (yes, the economist guy), believed that moral judgement had nothing to do with reason and rested entirely on "fellow-feeling" or sympathy. This view can be traced back even to the pre-Socratics, in some form or another (Empedocles believed that two forces or principles, Love and Strife, were responsible for the physical relations between pieces of matter). Moral emotions are still a big philosophical topic. For a biologist to wade into this kind of philosophical dispute as if it wasn't even there is the height of arrogance (and, indeed, is actually typical of pseudoscience).

Finally, Sharon Street highlights the is-ought problem, and Jesse Prinz suggests a big role for culture in moral development. And what does de Waal do? What is his response? *drum roll*
Dr. de Waal does not accept the philosophers’ view that biologists cannot step from “is” to “ought.” “I’m not sure how realistic the distinction is,” he said. “Animals do have ‘oughts.’ If a juvenile is in a fight, the mother must get up and defend her. Or in food sharing, animals do put pressure on each other, which is the first kind of ‘ought’ situation.”


Ten points to anyone who said "completely misunderstands the issue". I swear, there is something seriously wrong with this guy. The is-ought problem has nothing to do with what he's talking about. "Putting pressure" on others is not an "ought" situation at all; it's "do what we tell you, or bad things will happen". The same applies to the defense situation. It only becomes an ought, i.e., something normative when we can genuinely claim that it's something that should be done. A set of descriptive facts isn't enough; they may be required to underwrite the norm, but the norm adds something to the descriptions. de Waal has just blatantly missed the point.

It's also rather disgusting to note that de Waal is, implicitly, denying that Street and Prinz have anything relevant to say -- despite the fact that both have grounding in empirical sciences and in philosophy. Unlike de Waal.

Part of the problem is surely his bizarre conception of morality:
Dr. de Waal’s definition of morality is more down to earth than Dr. Prinz’s. Morality, he writes, is “a sense of right and wrong that is born out of groupwide systems of conflict management based on shared values.” The building blocks of morality are not nice or good behaviors but rather mental and social capacities for constructing societies “in which shared values constrain individual behavior through a system of approval and disapproval.” By this definition chimpanzees in his view do possess some of the behavioral capacities built in our moral systems.


Yes, it's true, that if this is the definition, chimps seem to have a morality. (I'm ignoring the snark of the opening sentence, as I'm 90% sure it's the reporter.) However, on this definition, law and etiquette also count as morality. Those are both systems "in which shared values constrain individual behavior through a system of approval and disapproval". Something has gone very wrong if there's no difference in kind between the illegality of murder, the immorality of lying, and the rudeness of spitting on the street.

State-based universal healthcare.

Over here, we have Mike (of Rational Reasons fame) trying to argue against state-based universal healthcare. It doesn't work; and here's why.

The first error comes in a contrast between the American and Canadian systems. He's right that these don't exhaust the options. He's wrong in saying the following:

The Canadian system, on the other hand, resorts to rationing in order to ensure universality. The system is more efficient, to be sure, and the rationing is done via time rather than choice (that is, we wait for longer times for procedures and tests, rather than making the choice between a hip replacement and a broken leg operation, although that does happen) but the system is still expensive and unresponsive to health care consumer’s needs. Both systems have conspired to take away free choice from consumers of health care and driven up costs of these services, so that only the wealthy can get decent care, in either system.


There's at least two major errors in here. First is the slide from "needs" to "choice" from the end of the second-last sentence to the beginning of the last. It's a slide Mike needs to make, else he has nothing to browbeat the state-based system with: the state-based system is responsive (or as responsive as any system can reasonably be, which amounts to the same thing) to healthcare needs. To claim that it isn't would require finding a non-insignificant set of cases where healthcare needs were not met. However, what is usually presented in response to that kind of challenge is a set of cases where healthcare wants or preferences are not met. Hence, the introduction of the word "choice". Choices are, indeed, blocked; but so what? Liberty is not license (as Locke taught us), and it's rather bizarre to blame what is, at heart, a rationing system for blocking certain individual choices from being realized.

The second error is the claim that only the wealthy get decent care. There's really no evidence given to support the claim; we're just supposed to take it for granted that being rich is required in order to get "decent" care. Note that word: "decent". It's not to get great care, or fantastic care, but "decent" care. "Decent" generally refers to some basic threshold that needs to be cleared; so, the implication of the sentence is that not being wealthy implies getting less care than is required by some minimum threshold of adequacy. But when did this happen in Canada? When did those who are not wealthy fail to get care that falls above a minimum threshold of adequacy? It's not absurd; but it doesn't seem empirically well-grounded, either.

Here's a great series of howlers:
The biggest problem in our health care system today is a shortage of doctors. This is one of the biggest reasons for our long waiting lists and the kind of rationing we see. Combine this shortage with the fact that a doctor is needed for nearly every medical decision, no matter how minor, and we see via simple supply and demand why many health care costs are so high. This is not an accident of organization, though, but a well designed strategy. Medical organizations - essentially the doctor’s union - have colluded with the state to ensure that the supply of doctors has been kept artificially low. They ensure that provincial governments keep enrollment in medical schools are low, that foreign-trained doctors find it difficult or impossible to become licensed and that doctors, as opposed to nurses, nurse-practitioners or pharmacists, must be the ones to make even obvious medical decisions. This not only reduces the supply of doctors, but all but eliminates any competition for and among them. Right now in Ontario, you cannot shop around for a doctor as you are lucky to even have one - any one - in the first place. As a result, doctors are able to negotiate high fees from the government, often making twice as much as their European counterparts. And the a person has no choice but to go to a doctor - and only a doctor - for their health care needs. A monopoly control of supply, with all the common high prices, low quality and inefficiencies that accompany all monopolies.


Where to begin? He's right that a doctor shouldn't be needed to make absolutely every medical decision. You don't need a full-fledged lawyer to make any legal decision, only the big ones. Similarly, a further professionalization, in the form of greater division of labour, of the medical profession would be a good thing. However, the lurid conspiracy referred to is simple nonsense. Medical organizations have a vested interest in keeping the number of practicing physicians high, not low, and the reason is simple economics. The more physicians there are, the more the physicians' organizations (and there are several, not one monolith; but that is the least of the errors contained in this argument) get in membership fees.

Moving on, I'm quite perplexed as to the second conspiracy Mike sees, namely between doctor's organizations and provincial governments and medical schools in keeping enrollments "low". I'm not sure what counts as a low enrollment; I'm also not sure as to what Mike's solution would be to provide the requisite instructors, facilities, and residency spaces for training more physicians, not to mention the economic drain that would result from taking more able-bodied young people out of the workforce for the extended period of time required to adequately train a physician.

The difficulties of foreign-trained physicians are well-documented, and The College of Physicians and Surgeons of Ontario (CPSO) is moving to try to accommodate them. This is a general problem of foreign training not always being fairly recognized, though, and is not simply limited to the practice of medicine. I would suggest that it is even less plausible that teachers' organizations are conspiring against foreign-trained colleagues than that physicians' organizations are conspiring in a similar fashion. The increased mobility of professionals which has arisen over the past few decades is something that all governments are going to have to come to terms with across the board. To blame a state-based universal healthcare system for it is bizarre.

Mike suggests that nurses, nurse-practitioners, and pharmacists should be making some medical decisions. The former and latter would need some retraining in order to make that work, but it's not, in principle, impossible, and it would take some pressure off the supply of doctors. It's hard to see why there's no way for a state-based system to introduce incentives in order to encourage this. Indeed, it seems to me that a state-based system could implement such a change with greater rapidity and efficacy than a market-based one, given that the government could deliberately direct the implementation of the policy, instead of relying on blind market forces.

He also claims that "doctor-shopping" is impossible. It is in certain areas, but not in all. What's not clear to me is why that's a bad thing. He doesn't explain; instead, just assumes that this is a problem.

Finally, he claims that physicians negotiate high fees. This is beyond absurd. Physicians are underpaid, generally speaking, in Canada. The evidence for this is obvious: compare Canadian and American fees. The comparison he draws to Europe is almost useless, given that many areas of Europe have lower costs of living than in Canada. This is the strength of a comparison between Canada and the US. Of course, the reason Mike doesn't draw that comparison is it shoots his argument to hell. American physicians have comparable cost of living to Canadian physicians, but make much more money, on average. (If anyone has stats to support or undermine this, I would be interested; I've been told it's the case, but can't actually find data to back it up.)

Now it gets really bad:
Without the state, the consumer would have the choice in the market. Doctor’s would no longer be the bottle neck in the system. You could choose to go to a GP or a nurse practitioner.Indeed, you could choose a witch doctor, herbalist or a homeopath if you want. If you have a recurring ailment or condition, you would merely go to the pharmacist and request the medication. You could request your own tests and diagnostics. You would be able to mitigate your risks by being informed and having health competition for these services. And the competition, combined with a lowered barrier to entry, would drive the costs of these services down. Anyone properly trained (in you opinion, not a medical association, though association membership would likely be a deciding factor) could enter the market and compete on quality and price.


What Mike is advocating here is healthcare anarchy, writ large: no authority, no control, no assurances, caveat emptor. If consumers and producers were as well-informed and honest as rarefied economic theory requires them to be, then this might work; however, when dealing with actual people in actual circumstances, this is a recipe for disaster. GPs and NPs are not equivalent to each other, despite both receiving adequate training; and they are certainly not equivalent to witch doctors, herbalists, and homeopaths. Without state-based guidance as to the relative worth of various practitioners, we'd be left with a medical analogue to the height problem in politics. (That is, people tend to vote for the taller candidate, all things being equal.) The idea that there would ever be a fair competition on quality and price in this sort of market-based system is a laughable fantasy at best. I wonder how, exactly, Mike thinks the average person with a stomachache is going to have the time and resources necessary to adequately research the options in his system.

The prevailing notion underneath all this is probably the idea that there's something wrong with interfering in individual healthcare choice. But nothing could be further from the truth. If we were all fairytale libertarian atoms, floating in a social sea and interacting as we willed, then healthcare choice might be sacrosanct; however, we are heavily interconnected with each other basically from birth, and these connections run deeper as we grow older. Given this, interference in healthcare choice is justified on entirely libertarian grounds: if I do not prevent you (and you and you...) from going to the witch doctor instead of a GP, then the GP goes out of business and I am forced to go to the witch doctor, too; moreover, that you're all undergoing "treatment" which will cure nothing implies a whole host of consequences for me.

Perhaps the idea is that GPs, et al., will always win out in a fair market-based competition? I don't have the kind of faith necessary to believe that consumers are sufficiently rational in their market choices to accept that claim. It seems to me that the cheapest and flashiest options are the ones that will win; and the ones that are actually good will, in the long run, lose out. This is where professional associations come in, and legally-mandated monopolies, and the whole apparatus of the state-based healthcare system.

Mike's speculations on insurance alternatives fall to similar objections. It's largely the kind of libertarian myth-making that has fallen out of favour in serious political philosophy in the past twenty years or so. (Jan Narveson notwithstanding.) There is no consideration of the possibility of collusion or cabals; no consideration of the motivations which actually drive consumer choice; and pie-in-the-sky dreams of perfectly rational consumers.

And that's why you should be a statist. It's the only way to make any sense.

Trite conclusions on research.

(Note the clever ambiguity on whether it's my opinions that are trite, or my targets. Mwah-hah.)

Over here, we find Michael Geist arguing... well, it's not entirely clear what he's arguing, actually. First he seems to be saying that peer-reviewed publications are bad. Then he seems to be saying that it'd be a good thing if the general public had free access to academics' completed research. I tend to think it's the second one he really wants to put forward; the former is just so stupid I have to think it's a matter of sloppy phrasing on his part, rather than a serious claim.

Free public access to academic research is, however, a bad thing, for a number of reasons. For one, it should be noted that Geist is overstating the extent to which research is currently inaccessible for the public. All that one really requires to gain access to the wonderful world of university research is a library card at the local university. Most have a "community borrower" privilege (or some such) for a nominal fee, which grants access to the whole collection, as well as the right to request inter-library loans from across the country (and, indeed, the world). While this might seem to imply that free access isn't much of a change from the status quo, the fact is that having to pay for something (even at a nominal level, even if it's just in terms of time and effort rather than money) means that one has to bear a cost in order to obtain it. And if one is willing to bear a cost to obtain something, then it follows that (ceteris paribus) one values that thing. If there's some value in allowing people who don't value academic research free access to it, then Geist is keeping it to himself. Suffice to say, the current, fairly low, bar to access seems to be sufficient to weed out those who just don't care and thus don't need access to university research.

For two, the public as a whole lack the expertise to evaluate the quality or worth of research in any given area. That's why people have to be extensively trained before they're able to contribute to a given field. (Indeed, even with extensive training, it's rare to find academics who are qualified to interpret more than one or two areas beyond their own specialty.) Open access seems to be to be the first step in a long series of tiresome arguments where the ill-informed try to force scholars to justify their research goals. The standard always has to be: if peers say it's good, then it is good, regardless of what anyone else thinks. Given that these arguments are always a huge pain in the ass, there's some value to keeping the current barriers in place (if not erecting new ones).

For three, this is a further step in the high-schoolization (yes, I just made that word up) of universities. High school teachers already work under almost constant public supervision; and, really, no matter how good they are, that level of supervision will always find something they're doing "wrong". No one can survive under constant scrutiny. Universities are already tending towards treating their faculty, in their educative roles, as high school teachers: putting students first, trying to lower attrition rates, trying to raise test scores, etc, etc. Having the public able to access scholarly debates at every level of their development will only extend this into faculty's research roles. Sometimes debates between scholars need time to work themselves out. The last thing any academic needs is one or another busybody resurrecting a paper from two years ago that has been successfully flayed -- and abandoned -- in a series of conferences. (Which, for those who don't know, don't always result in publications.)

It seems that Geist's only argument -- that is, actual reason, instead of empty rhetoric about "falling behind" the rest of the world -- is that the public pays for academics to do their thing, and thus the public has a right to free access to what academics generate. This is absurd on its very face. Physicians are paid by the public; physicians generate patient records; does that mean the public has a right to access patient records? Of course not, and the reason is not just that there's laws preventing free access to patient records; the reason is that what the public pays for is that physicians will ply their trade for public benefit, instead of (say) their own personal profit. The public is not entitled to particular levels of access to what physicians generate, because that's not what the public has bought. The same applies to the academy: the public hasn't bought a series of papers or a book-length manuscript; they have, instead, purchased the services of academics for the benefit of the public. That is, instead of retreating to their own societies, academics agree to teach young people and to publish their work in ways that, with nominal effort, the public can access it.