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On the Hidden Dangers of Comparative Effectiveness

Posted on 10 April 2011 by Editor

Originally posted 2009-06-18 21:15:49. Republished by Blog Post Promoter

As part of the stimulus spending package approved by the government earlier this year, funding in the amount of $1.1 billion was included to sponsor research into comparing the relative effectiveness of one form of medical treatment to another. Such research, as the program’s sponsors and supporters argued, would over time reduce the net cost of medical services by determining which medical procedures offer the lowest cost treatment to address common ailments. Armed with such information, it was further argued, doctors and medical professionals would apply this additional economic data in their decision to prescribe specific medicines and treatments.

On the surface this would seem to make good common sense in that it would provide some stabilizing relief to the increasing costs to the government of operating the country’s medicaid, medicare and veteran benefit systems. However, some of the less known aspects of the research bring out a number of troubling issues. Among these is the inclusion of studies which add the dimension of patient characteristics (such as age, gender, lifestyle) into the formula of overall effectiveness. As a result, effectiveness is defined in terms of a cost-benefit ratio as applied to a specific type of individual. For example, a comparative value is placed on the benefit of curing an illness in an 80 year-old versus 20 year-old man.  When faced with limited resources the results of the research would then be intended to provide guidance as to how those limited resources should be applied and when to apply available cures relative to the cost and benefit that such cures would provide. In the case cited, the 80 year-old man has little chance of receiving priority consideration.

While such policy is widely accepted in many European countries, I dare say to any American pondering such gross delegation of power over life and death decisions this has to be deeply concerning. There are numerous specific opportunities to bring new efficiency and reduce the resulting costs associated with providing healthcare. National electronic medical records, individual (not employer) management of healthcare insurance subscription, tax incentives to support wellness and health awareness are all excellent examples.

The recipe is to make individuals more responsible for the management of their health and medical matters. Delegating this to a disinterested third part, especially a government bureaucracy is tantamount to relinquishing one’s freedom.

* * * * *

Quotation of the Day:

“Liberty means responsibility. That is why most men dread it.”
George Bernard Shaw (1856 – 1950)
We welcome your comments and suggestions, either directly inline, or via email to editor@nakedliberty.com. If you would like to have your article published in Naked Liberty, please contact the editor at the above email address.

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The Lobbyist Does Not Speak the Peoples’ Voice

Posted on 10 April 2011 by Editor

Originally posted 2009-07-23 21:55:57. Republished by Blog Post Promoter

The Constitution lays the foundation for a relationship between the people and their government. This relationship is, to a significant degree, founded on the trust that each citizen places with their elected representatives. These representatives, whether local, regional or national, by being elected to their posts, accept the responsibility of supporting their constituents’ ideals, goals and principles. They become servants of the people, an extension of their individual voices in the collective government they comprise.

There is a game we used to play as kids called “echo,” where each player would whisper something in their neighbor’s ear, who in turn would whisper what they thought they heard to their neighbor, and so on. Inevitably, a humorous concoction of snippets of the original sentence would emerge at the end of the line. A completely innocent game of listening and interpretation, with each player having only one objective – to relay the message with as much accuracy as possible. Even with only three players – a source, middle and recipient – very rarely would the recipient receive the original message intact.

Now let’s inject an agenda into the game. How would the outcome be affected if the middle player was induced by the school bully to distort the message and to influence the recipient’s apprehension of the original message’s content? Surely meaning would be lost. In the innocence of the game, one might even ascribe humor to the outcome. But what if the stakes were higher, much higher?

In the dynamics of communications between the people and their government, a highly biased and results-motivated middle man agent is injected. He is called The Lobbyist and he enters directly into the path of the people’s voice. His intentions are indeed highly motivated. His agenda has nothing to do with accurately communicating the people’s voice. His intentions are in fact highly distortive to the communications process.

Most sources attribute the birth of the Lobbyist to the administration of Ulysses S. Grant. Grant would often walk to lobby of the Willard Hotel not far from the White House to enjoy his favorite cigars. His routine was quickly picked up by politicians who would find this time a perfect opportunity to solicit him with special requests for support of various matters. The term “lobbyist” emerged from these interactions.

Political lobbying has historically been regarded as an “unclean” activity, shunned away from by most politicians who otherwise prided themselves on the purity of their intentions and reputation. This attitude changed dramatically in the 1980’s as political lobbying became more and more lucrative (and thereby corrupted), and professional lobbying firms sprouted all across the political landscape, backed by large enterprises and their financial sponsorship of various causes. According to a Washington Post article, “The number of registered lobbyists in Washington has more than doubled since 2000 to more than 34,750 while the amount that lobbyists charge their new clients has increased by as much as 100 percent. Only a few other businesses have enjoyed greater prosperity in an otherwise fitful economy.”

In the first 2 weeks in office President Obama nominated 17 professional lobbyists to several key advisory positions in his administration. These included Eric Holder as attorney general, Tom Vilsack as secretary of agriculture, William Lynn as deputy defense secretary, and fourteen others. Notwithstanding his campaign promise to keep his administration clean of ex-lobbyists, he continues to follow, with perhaps even more vigor than his predecessors, the practice of surrounding himself with influence-peddling bureaucrats. As HotAir.com points out, the president has conspicuously offered himself “For Sale” to all interested (and willing to pay-to-play) interest groups, and his actions since then, including the scandalous deal with the UAW in connection with the GM bailout, are a testament to the fact that he is indeed a player.

Are all lobby activities necessarily bad? Don’t lobbyists sometimes also represent the people’s interest on important issues? Doesn’t the NRA, for example, do good work on behalf of citizens concerned about protecting the 2nd Amendment of our Constitution (our right to keep and bear arms)? What about the lobbies that work to protect the rights of the underprivileged, to protect our borders, to promote education?

Inasmuch as many such lobby organizations may be motivated by righteous ideals, the institution of the lobby system is by its own formulation corrupt. When influence is bought with currency, if not directly into a politician’s pocket, then through the barter of monetize-able influences, good intentions are quickly polluted by commercial transactions and ethical compromises. The lobbyist necessarily becomes the undesirable relay agent a political game of Echo, placing himself in line of the people’s communication path with their government.

In a government “of the People, by the People and for the People” (Lincoln’s Gettysburg Address) there is no place for a translator of the people’s voice in government. Our elected representatives are our channel of communication. With the rise in the influence of the lobbyist, it seems we’ve empowered a commercially incentivized third party to interpret our voice. And while our elected representatives have become too lazy to directly listen to our needs and calls for action, the lobbyist-translated messages do not reflect our original interests, meaning and intent.

There is increasing peril in allowing our representative form of government to continue to be warped by the influences that a financially motivated and ethically tainted system of lobby influences has on our relationship with our government. While attempts to reform the present system by imposing registration requirements, disclosing contributions and other transparency measures are a good first start (see Ethics and Lobbying Reform Act of 2006 and Lobbying and Ethics Reform Act of 2007, they fall far short of tangibly reducing the influence the lobby industry has on the activities of our government and re-connecting the people back to their elected representatives.

If our elected officials want our respect, trust and vote, then engage with us in a real and direct dialog without the middle man. Playing “echo” was fun when we were kids. Now let’s grow up and take responsibility for having a serious, adult conversation.

Mr. Government Representative – please look me straight in the eyes, listen to me and tell me what you stand for. You might be surprised to find out that I might actually believe you.


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John Stossel Airs Program on Atlas Shrugged

Posted on 10 April 2011 by Editor

Originally posted 2010-01-06 00:32:30. Republished by Blog Post Promoter

Ayn Rand's sign.
Image via Wikipedia

John Stossel, the respected reporter who in October last year joined Fox Business after quitting his affiliation with ABC as an anchor on the popular “20/20” news program, will be airing a program discussing topics from Ayn Rand‘s great work “Atlas Shrugged.”  The program will air this Thursday, January 7 at 8:00 PM Eastern on Fox Business.

For those familiar with this work, John has published a poll on his blog asking who do you believe Wesley Mouch, one of the leading characters in the book, most resembles in today’s administration. Visit the pool at:

http://stossel.blogs.foxbusiness.com/2010/01/04/updated-atlas-shrugged-poll/

If you don’t receive the Fox Business Channel, I believe John’s program will stream live on their web site at:

http://live.foxbusiness.com/fblive.

I encourage readers to go to the Ayn Rand Institute site to check out the many references to her work and learn more about the revival of her philosophy of Objectivism. Click on the corresponding image below.

Update after program was aired:

John Stossel’s program on Atlas Shurgged, watch it here in 6 parts:

Part 1 of 6

Part 2 of 6

Part 3 of 6:

Part 4 of 6:

Part 5 of 6:

Part 6 of 6:

Ayn Rand's sign.

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It’s All About Common Sense

Posted on 10 April 2011 by Editor

Originally posted 2009-09-01 22:54:29. Republished by Blog Post Promoter

Thomas Paine.
Image via Wikipedia

August 23, 2009

Each and every day a child is born into a world of truths and lies, rights and wrongs, haves and wants.  From its first breath, it is conditioned to understand the forces of action and reaction, the relationship between wanting and getting, and how to manipulate the circumstances to best serve its needs. Whether it’s crying to receive its milk or copping a smile to get a hug, the child quickly begins to understand how to acquire material and non-material things.

Our mind is conditioned to think in terms of acquisitions and possessions. It is human nature and, just like with any other emotion, there too is an emotion attached to one’s possessions. The value of one’s possessions (regardless of whether they are material, like a home or a car, or non-material, like professional respect or rich family traditions) is directly related to the effort exerted in obtaining them. The depth of the emotion attached to these possessions is similarly directly correlated to this effort, as well as their value.  The three form an inextricable triad which is deeply rooted in human nature and natural law. From this simple observation, a basic conclusion about the human condition can be summarized as follow:

Your happiness is directly related to the value of the wealth (material and non-material) you’ve created and the effort you’ve contributed in creating it.

When we are first taught to play in the sandbox, we are told not to take the other children’s toys. Why? Because first of all those toys don’t belong to us – we haven’t earned the right to have them. Secondly, it would make the other children sad, since that for which they likely had to do something to get (i.e. earn it), would be unjustly taken away from them. It’s just common sense, isn’t it?

value-effort-happiness

But some time very soon after the sandbox stage in a child’s development, these nascent links and deep-rooted relationships between ownership, effort and happiness begin to be eaten away. In the home this happens through parents who too easily accept the commercial media version of the world and who are not willing (or intellectually able) to espouse the basic principles of natural law and individual responsibility onto their offspring.   Outside the home the society takes over with incongruent representations of the real world, manifested in attitudes such as:

  • debt is good (and you don’t really have to pay it all back)
  • your mistakes are everyone else’s problem
  • less capable does not mean less deserving
  • every effort is just as good as any other, and should deserve the same outcome (i.e. it’s the effort that counts)
  • opportunity should not be equally apportioned, but instead should be skewed toward those who need it most, even (or particularly) if at the expense of those who can produce a better outcome from such opportunity

Does that make sense? Is a society which has these as its principles efficient, fair, equitable and sustainable?

Clearly, the answer must be “no,” since each violates one or more basic laws of human behavior and indeed common sense. Yet over the better part of the 20th century the American society has adopted and inculcated each of these values into its daily life and its government, media and cultural centers continue to promote even greater departures from the basic principles which make up the human behavioral DNA.

A modern society which is based on principles of liberty and freedom cannot at the same time be one which imposes unnatural laws and ordinances on its citizens. It is not, as most progressive liberals would like to see, a place and time where all are guaranteed an equal outcome, regardless of their individual contribution.  It certainly cannot be one which irresponsibly uses its financial and human resources and violates the most basic principles of supply/demand economics.

Like the sea farer that knows the immovable nature of the stars and how they provide him guidance to navigate the stormy waters, so too a modern society must have its anchor in tried and tested core founding principles. And this is particularly true in a world where change is occurring at increasing speed and where losing its national compass, a society risks eternal disorientation in the sea of conflict and divergence.

In his 1776 political pamphlet “Common SenseThomas Paine looks at the political systems of his time, the monarchy, the British parliament, commons and constitution and questions many of the prevailing ideas of the role of government and its relationship to the citizens. In so doing he applies a rigorous discipline of logic and of common sense, and exposes nonsensical laws and political traditions. Most constitutional historians agree that this scrutiny and deep analysis of the British system of government at the time made a significant impact on the writing of the United States Constitution.

We could say that much common sense was applied by the authors of the American Constitution in formulating the principles of our founding. We know that because of its common sense it has withstood the test of time.

Each time we step away from these guiding principles, we lose one more star in the sky to guide us by.

. . . . . . . . . . . . . . .

Article may be published with attribution to the author and the NakedLiberty.com web site

Article is Copyrighted (c) 2009, XCIOS, LLC

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On the Court Holding Up the Chrysler Sale to Fiat

Posted on 10 April 2011 by Editor

Originally posted 2009-06-08 14:37:44. Republished by Blog Post Promoter

Could it be that finally a ray of hope has peeked through the dark clouds of insanity that was the initial decision about re-ordering creditor priorities in the Chrysler settlement? And of all places, from the left-leaning court?

It would indeed be a breath of fresh air to see someone at least paging through our Constitution to understand what our laws state in these matters. Let’s hope this is not just a momentary relapse but a first step toward righting the original decision to comply with our long-standing and time-proven bankruptcy laws.

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