Third-Party Pay Health "Coverage" Meets The Real World

One of the accepted propositions of modern progressivism, on which it is difficult to find dissent in the precincts that I inhabit, is that in any "decent" society, everybody "should" have healthcare "coverage."  I put the word "coverage" in quotes because that word is often intentionally used by advocates to create confusion with the very different idea of insurance.  The word "coverage" gives the impression that somehow magically somebody else will take care of all of your expenses in the medical area, and you can consume as much medical care as you feel like while paying nothing.  And we come to a world where some large majority of people have healthcare "coverage" that takes care of not just major and unexpected expenses like a hospital stay or a heart attack, but also all kinds of routine and ongoing expenses like routine checkups, doctor visits, and prescription drugs.  Nobody in their right mind would buy insurance for such things absent massive government arm-twisting (in the form of tax-deductibility for employer-provided "coverage" as well as Obamacare mandates).  Would you buy insurance for the cost of your daily lunch?  As I wrote in that linked article (from 2013), in a world of third-party pay for routine expenditures, "you can be sure that [people] will buy the most expensive options and that the cost will zoom out of control."

In the medical arena, people have been pointing out the problematic incentives of third-party pay for a long while.  But it seems only in the last few years that medical providers like hospitals and pharmaceutical companies have perfected their pricing strategies to get the absolute last dollar out of the third-party payers like government and insurance companies.  Two examples recently came to my attention in my personal life, that I thought I should share with readers.

The first involves the former Official Manhattan Contrarian Summer Intern, who was my research assistant for this blog in the summer of 2014.  Today she is off attending the University of Chicago.  A few months ago, she fainted briefly while at school.  It turns out that she had also fainted a couple of times previously, in circumstances where she had let herself become a little dehydrated.  On those occasions she had thought little of it, and hadn't gone to a doctor or hospital.  But this time the U of C packed her off to their affiliate University of Chicago Medical Center.  With a well-insured (or "covered") warm body in their clutches, the hospital staff took the opportunity to run up every expense that their creative minds could think of, and then a few more.   The bill was $6000.  And the diagnosis?  "Nothing wrong that we can find."  

In this instance, the insurance company negotiated the bill down to about half that.  The parents got a bill for a co-pay of $75, which they gladly paid.  But do you get an idea of why health "coverage" may be getting so pricey?

The second example involves one of my own daughters.  Several months ago she jumped out of a tree (don't ask what she was doing in the tree) and landed the wrong way on one of her feet.  By the next morning, the foot was swollen and painful to walk on.  She hobbled over to the very fancy new "urgent care" center in our neighborhood in Manhattan, run by a hospital system known as North Shore/LIJ (currently in the process of changing their name to Northwell), and made the mistakes of first telling them that she had insurance and then allowing them to examine her without agreeing to a price in advance.  They took an x-ray, and, after a wait of a couple of hours she spent about 5 minutes with a physician, who evaluated the x-ray.  He said that it was not clear whether the bone needed to be set, and he did not treat her; but he recommended that she see an orthopedist promptly.  A couple of days later she got an appointment with an orthopedist, who also recommended that no treatment was necessary.  However, he advised her to keep weight off the foot and it would heel within a few weeks.  Sure enough, it did.

The bill from the orthopedist was about $400.  Expensive, but hey, this is Manhattan.  The bill from the urgent care center was $4700.  My daughter has insurance through her job, and again, the insurance company negotiated the bill down, in this case to about $2600, of which they paid about $1300.  That left a remainder of about $1300 that consists of various deductibles and co-pays applicable to various parts of the bill. 

I don't know about you, but I live in Manhattan and pay outrageous Manhattan prices for everything, and still $4700 -- or even $2600 -- struck me as rather wildly out of line for a visit that involved five minutes of doctor time evaluating an x-ray and no actual treatment of any kind.  

Meanwhile, I have recently become aware of a new kind of walk-in medical clinic springing up around our area, catering to an uninsured clientele that pays cash on the spot.  So in recent weeks I walked into a couple of those, described the circumstances of my daughter's visit to the urgent care center, and asked what their price would be for the same service to an uninsured patient walking in and paying cash.  The two were Union Square Urgent Care, on 14th Street, and CityMD, on 23rd Street.  In both cases their answer was the same:  $185.

I would be 100% sure that no individual paying out of his or her own pocket has ever paid North Shore/LIJ the $4700 -- or even the $2600 -- for a visit of this type.  Very few people would have that kind of money for an unexpected expense of this type, and the few who did would rightly refuse to pay it.  These numbers are purely picked out of the air by the hospital to see what they can game out of the insurance company, and in circumstances where if the insurance company refuses to pay the hospital knows that the insured will first blame the insurance company rather than the hospital.

The $185 price of the walk-in clinics is a clear demonstration that a functioning market of people paying with their own money has no trouble finding a reasonable price.  Sure, some people can't pay even that.  That's why there's charity in the world.  Or do you think that replacing "third-party pay" with "single payer" can suddenly magically do away with the phenomenon that everybody games whatever system there is to their own advantage?  Good luck with that! 

How To Fix The Problem Of Government Consensus Science

It's just eleven days ago on January 20 that I posted my first book review on this blog, of "The Big Fat Surprise" by Nina Teicholz; and now just nine days after that on January 29 the Wall Street Journal has published an op-ed on the subject of the book.  Dr. Steven Nissen of the Cleveland Clinic co-authored the op-ed, which is titled "The Food Pyramid Scheme."

Like Nina's book, the op-ed describes how our government in 1980 issued dietary guidelines promoting a low-fat diet to then 220 million Americans, even though the science supporting such guidelines was known to be weak at best and plenty of evidence was available even at that time to suggest that the recommendations were unsound.

Scientists should have known in 1980 that the recommendation to cut fat was unsound.  Large clinical trials at the time did not support the theory, according to a systematic review published last year in the cardiology journal Open Heart.  "It seem incomprehensible that dietary advice was introduced for 220 million Americans," the authors wrote, "given the contrary results."   

So how did a counter-productive diet get foisted on the American people in the face of such adverse evidence?  Easy.  A small group of avid promoters of the high-fat-diet/heart disease hypothesis had managed to get control of the principal government funding institutes, and of the peer review process at the key journals.  Dissenters got cut off from funding and from publication.

Meanwhile, the bad consensus science has proceeded to do untold damage to the health of the American people.  Teicholz and Nissen describe how even as new evidence has continued to come forth showing that low fat diets do not improve heart disease outcomes (and may well have much responsibility for the increase in obesity and diabetes), little has been done to change the government's guidelines:

What's disturbing is how little this new evidence has been heeded.  The guidelines continue to insist that Americans choose reduced-fat dairy products like skim milk.  But even epidemiological evidence now contradicts this advice, and a randomized trial published last month in the American Journal of Clinical Nutrition found that people eating full-fat dairy, including whole milk, showed a number of better heart-disease outcomes.

So what is to be done?  Teicholz and Nissen favorably endorse, with some recommended modifications, an upcoming "independent" government review, just funded by Congress, and to be conducted by a somewhat but not very different crowd from the people who got us into this mess.  While generally supporting the independent review concept, Teicholz and Nissen do suggest that a "disinterested referee" be appointed to lead the review, "from outside the field of nutrition."

Well, maybe that will make some difference.  But how about this idea:  the government should entirely get out of the business of meddling in the diet of the American people.  Any next round of recommendations to come out of the government is very likely to be just as wrong as the last round.  It's in the nature of giving some people government authority to lord it over others that the ones given the powers will lose all humility and be overtaken by the thrill of ordering other people around based on what they believe to be their own superior knowledge and expertise.  It's just one more example of why socialism doesn't work.  See also, climate science. 

In Venezuela They've Been Reading Manhattan Contrarian!

I have repeatedly declared subsidized public housing to be the "worst possible public policy."  (Well, actually it's subsidized public housing in Manhattan that is the worst possible public policy; elsewhere subsidized public housing is just almost as bad as the worst possible public policy.)  But the things that make subsidized public housing so terrible as public policy are the very things that make it so attractive to cynical left-wing politicians.  Subsidized public housing creates a permanent and immobile dependent class trapped in poverty that perceives itself as owing its somewhat desirable homes to the incumbent politicians, and therefore can be counted on as a secure bloc of bought votes.  For the cynical politician, what's not to like?

Down in Venezuela, Hugo Chavez was everybody's favorite caricature of the socialism-inspired evil dictator for a fourteen-year reign spanning from 1999-2013.  In that period he did everything he could to drive his country into the ground -- all in the name of socialism and justice, of course. And naturally, blow-out construction of subsidized public housing was at the top of Chavez's political program.  After nibbling at the subject in the early years of his tenure, in 2010 he embarked on what he called his "great housing mission," setting out to build some 350,000 units of public housing in 2011 and 2012, and then 300,000 per year thereafter.  An article here in Britain's left-wing Guardian from 2013 of course gives a favorable review to Chavez's efforts and recommends the same for Britain.  To give an idea of the massiveness of Chavez's public housing efforts, the Guardian reported that construction went from 5% to 16.8% of the national economy in this period. 

And boy did it all seem to be going great -- at least if you believed the totally phony numbers for the economy put out by Venezuela at the time.  Historical economic data compiled by Focus Economics here shows that Venezuela reported economic growth of almost 25% in 2011 over 2010, and another 20% in 2012 over 2011.  Of course, in reality the economy was undoubtedly shrinking and the numbers were completely cooked.  How much of the supposed "growth" came from putting a totally fake value on the currency, and how much came from counting blowout wasteful government spending at 100 cents on the dollar in GDP, and how much came from the luck of temporarily high oil prices, and how much came from other phony manipulations, is anybody's guess.  Anyway, in 2013 Venezuela reported that growth had leveled off to about zero, and then in 2014 and 2015 they just stopped reporting economic statistics altogether.  By that time, from things like multi-hundred-percent inflation and completely empty store shelves, not to mention the collapse of oil prices in late 2015, the economic disaster was becoming too obvious to continue to put out the phony statistics with anything close to a straight face.

Those who follow world events will know that last month the opposition in Venezuela finally scored massive victories in legislative elections, and took control of both houses of the National Assembly.  They have stated an explicit agenda of undoing much or all of the massive state expansion under Chavez and his successor Maduro.  But the public housing blowout is something that is particularly tricky to undo.  After all, the whole idea here was to create a massive bloc of permanently bought votes that could always be counted on to support the leaders and political party that provided the largesse.  Telesur here puts the number of public housing units built in Venezuela in just 2011 to 2014 at 642,000.  Taking all public housing residents, we're talking about a voting bloc of probably a couple of million in a population of around 30 million.  Propose to take those units away from their occupants, and no politician could survive.

And that's where the Manhattan Contrarian proposal comes into play.  Back in November 2014 I laid out how a new crowd of elected leaders could get out from under the disaster of public housing without forfeiting all political viability.  The simple answer is -- give away the public housing to the residents!  No charge.

Now, I am not saying by any means that this policy is perfect.  It definitely gives an undeserved windfall to those who happened to win the lotteries to get into the public housing.  It treats the taxpayers of the country shamefully.  But the perfect can often be the enemy of the good.  Exiting from the burden of public housing will provide tremendous benefits both to the country as a whole and also to the residents.  To be perfectly cynical, a way needs to be found to make a topping bid for the residents' support, without which any exit strategy will be politically blocked.  Giving the housing to the residents provides that missing piece.  And, at no additional cost to the taxpayers, for whom the public housing is just an ongoing burden so long as it is in public ownership or control.

And thus we come to the report in yesterday's New York Times of the latest proposal from the new leaders of Venezuela's National Assembly.  The headline is, "Old Adversaries of Chavez Take a Page From His Playbook."    Yes, they are proposing to give away the housing to the occupants:

Twenty thousand people live in this concrete bastion built by President Hugo Chávez. He gave them the keys, and they gave him their votes.  There was one thing Mr. Chávez promised but never handed over en masse, though: the property titles that would allow his supporters to sell their homes and cash out.  But now that Mr. Chávez’s old adversaries have taken over Venezuela’s Parliament, they are adopting the tactic and doing it one better. They want to give away the deeds to hundreds of thousands of homes that Mr. Chávez and his movement built — and win the loyalties of the nation’s poor for years to come.

They must have been reading Manhattan Contrarian!  The genius of the proposal is that it has Maduro and his supporters completely flummoxed.  If it's a good idea for the government to give to some people a lifetime right to occupy a unit of public housing, why isn't it an even better idea to give them a deed so they can sell the unit, or mortgage it, or rent it, or otherwise turn it into cash income?  The true-blue socialist approach of no real ownership is revealed as just a device to keep the poor poor and dependent.  Here is how Maduro has responded, according to the Times:

In a fiery State of the Union address before legislators this month, Mr. Maduro vowed to do what he could to block his opponents’ work.  “You will have to topple me first to approve a privatization law,” he said to the applause of leftists.

The Times even includes quotes from some people who were awarded the public housing units only to then realize that the socialist dream isn't what it's cracked up to be.  For example:

Coromoto Carmona, 40 and unemployed, looked out a window that was laden with bars. She told the story of how she got her home here and how it has become a place where she feels trapped. . . .  In 2004, she received a thrilling call from the government: She would attend a meeting at Mr. Chávez’s presidential mansion, La Casona, where he would personally award her a new home.  She moved into her two-bedroom home with nine members of her family. But problems soon emerged. . . .  Mr. Chávez’s government had promised her and others the titles to their homes. But Ms. Carmona received only a laminated piece of paper saying she was allowed to live there. If she leaves, it is unclear if she will be able to find anywhere else to live.  “It’s like jail here,” she said.

Ah, the joys of socialism.  This will be playing out for a while.  But meanwhile, Maduro and his henchmen have no real answer to the proposal.  The likelihood is that the longer the discussion goes on, the more support they will lose from what had been a group of core supporters.

Now, meanwhile, back here in Manhattan, isn't there any way we can get this proposal onto the table?

FDA Decides To Kill Thousands Of Innocent Teenage Boys

In a post back in September, I had this to say about the FDA:

The FDA would gladly see half of the American people die while they consider and reconsider for years approving some drug, in order to establish the proposition that the FDA and only the FDA has the bureaucratic say-so to determine when and how a drug can be marketed. 

And, to prove that I'm not making that up, the FDA a few days ago issued its ruling on a new drug application from a company called BioMarin for a drug called Kyndrisa intended for the treatment of Duchenne's muscular dystrophy.  The ruling is that the company has not yet submitted sufficient proof that the drug is effective to satisfy the FDA.  Tests must continue, unless the company gives up.  Oh, meanwhile there is no approved treatment whatsoever for this disease.  It arises from a genetic defect limited to boys.  About one boy in 3500 gets it, meaning about 500 new cases per year in the U.S.  It is 100% fatal.  Typically, the boy is in a wheelchair by his early teens and dead somewhere between the ages of 20 and 30.

The issue here is not that the FDA legitimately thinks this new drug is some kind of snake oil, or even that it has harms that outweigh the benefits.  The opposite.  The cause of Duchenne's has been identified (at least, within the limits of our flawed scientific processes), namely lack of a protein called dystrophin; and the drug in question (along with others under development by other companies) has been specifically designed to supply the missing protein.  Nor is the issue that no patients in trials to date seem to have benefited from the new dystrophin-supplying drugs.  For example, this from the Wall Street Journal on January 20 (relating to another one of the drugs, on which an FDA ruling is expected imminently, but anticipated to be equally negative):

Kathryn Wagner, a leading Duchenne physician at Johns Hopkins School of Medicine, says she plans to speak in favor of the Sarepta drug at the coming FDA meeting. She said she has seen patients benefit from the drug in clinical trials.      

Instead, the problem is that the disease is rare enough and serious enough that it is very difficult to get sufficient numbers of patients into the clinical trials to meet the FDA's standards of "statistical significance."  (One of the clinical trials for the drug Dr. Wagner was discussing is reported in the Journal article to have only 12 patients in each of the treatment and control groups.)  So the bureaucrat's answer is obvious: the trials will continue -- and continue, and continue, and continue -- until our standard for establishing our prerogative and maintaining our fiefdom has been met.  Meanwhile, thousands of innocent boys and young men become crippled and die unnecessarily?  What does that matter, when bureaucratic control is at stake?

Researching this post, I came across a 2014 debate sponsored by the Southwestern Law School Law & Medicine Society and the Federalist Society between libertarian NYU law professor Richard Epstein and a law/medicine guy from Southwestern named Ryan Abbott.  The subject of the debate was the closely-related subject of the FDA's unending efforts to quash speech about off-label uses of otherwise-approved drugs.  Abbott took the pro-FDA side of the debate.  Abbott's presentation gives a good sense of the progressive's reverence for the all-knowing and perfect bureaucrats -- who are always referred to as "we" because the true progressive feels himself to be one of this privileged elite.  And meanwhile, the mere non-bureaucrat is treated as ignorant, helpless and completely incapable of making any decision or acting for himself.  Excerpts:

The central problem with off-label drug use is that we have an information deficit. When the FDA approves a drug for on-label use, that approval is based on scientifically valid and statistically significant evidence that says, we are going to give you a drug, which is potentially dangerous, but it is likely that the benefits outweigh the risks. We know that because we have studied the drug in a controlled environment. That information is simply not available with off-label use.

Over 70% of off-label prescriptions used are not based on scientific evidence or significant scientific evidence.2 That’s a real problem because all drugs have a risk of serious side effects, and patients shouldn’t be exposing themselves to risk without evidence that a drug will be effective. . . .    

So not only are patients using drugs we don’t know are safe and effective, but we are not getting good feedback to inform future practice. . . .  How do we balance patient access with preventing harm, and what role should the FDA play? 

The whole approach is based on the dead-wrong idea that an elite can achieve perfect knowledge and make better decisions than individuals acting in their own interest.  Could a guy fancy enough to have both law and medicine degrees not know that all important human decisions are based on imperfect information and involve some degree of risk?  The answer is yes.  And it's not just Mr. Abbott, and not just the pooh-bahs at the FDA who keep drugs off the market while thousands die, but the entire federal bureaucracy that has bought into this narrative.

Will Trump's Controversial Immigration Plan Actually Make Any Real Difference?

Yesterday a commenter named Oddstar expressed the view that I had "missed the point completely" on the subject of the Trump candidacy.  According to Oddstar, the main focus of Trump's candidacy is not, as I had argued, seeking to transform our government by supposedly replacing incompetence with managerial competency, but rather is seeking to have the government push back against immigration to avoid having demographic transformation spell "the end of the Republican Party and the conservative movement."  I responded to Oddstar in the comments, but I thought that the subject deserved the treatment of a full post.

I admit that I don't understand what inspires the voters who say that they back Trump.  It's entirely possible that a perception that immigration is out of control and transforming the country for the worse is the biggest factor in their inspiration.  The problem I have is that even Trump's proposals, as radical as some of them sound, do not really envision major change to the fundamental aspects of our immigration regime that are bringing about the ongoing transformation (and that have continuously transformed our country since its founding).  Trump's immigration proposals would offend lots of people, foreign and domestic, for not much noticeable change even over several decades.

Here is a link to Trump's "Immigration Reform" plan.  The majority of it deals with the issue of illegal immigration from or through Mexico.   He's going to "build a wall" and "make Mexico pay for the wall."  He's going to step up immigration enforcement and make it really, really strict.  Interestingly, there is no reference in this plan of Trump's oft-mentioned proposal for a "pause" in immigration from Muslim countries.  Possibly, he came up with that one some time after this plan was posted last fall.  The subject of legal immigration does come up, but is discussed in vague terms.  He's going to require employers to "hire American workers first," and increase "prevailing wages" for immigrants under the H1B visa program.  But there's nothing on any specific lowering of legal immigration quotas or on how many legal immigrants Trump thinks should be allowed into the country in a year.  Certainly, he does not propose eliminating legal immigration.

Trump's proposals do not really deal with the big numbers in immigration that drive the ongoing demographic transformation of the country, and instead deal with what are essentially side issues.  Consider the subject of illegal immigration from Mexico.  I have long thought that most to all Mexicans who might potentially come to the U.S. were already here.  After all, there are only about 120 million Mexicans, and the segment of the population most likely to emigrate -- poor but ambitious young men aged about 20-35 -- is only a small slice of that.  Many segments of the Mexican population are proportionately far less likely to emigrate (for example, those with successful careers in Mexico, women and children) and some large groups are not likely to emigrate at all (for example, those over 50).   The 5 to 6 million Mexicans already here illegally are really a very large part of the segment of the Mexican population that might potentially seek entry here.  

And sure enough, when you look into the statistics, you find that illegal immigration from Mexico has been net negative since 2007!  That is, for eight years now, more illegal Mexicans have left the U.S. each year than have arrived.  Here is research from Pew that shows that the number of illegal Mexicans in the U.S. peaked at approximately 6.9 million in 2007, and had fallen to approximately 5.6 million by 2014.  Of course the tremendous irony here is that making it impossible to get back in may slow the outmigration of illegals and cause the number here to remain higher than it otherwise would.  But let's not trouble Mr. Trump with such complexities.  And, by the way, the Pew research also shows that illegal immigration from the rest of the world (which in the aggregate adds up to about the same amount as the illegal immigration from Mexico) has also been net negative since 2007.

Trump's proposal for a "pause" in Muslim immigration deals with relatively tiny numbers in the overall picture.  According to data compiled by Breitbart here, the number of immigrants from Muslim countries obtaining permanent resident status in 2013 was about 123,000; another about 40,000 obtained refugee or asylum status.  

But what are the big numbers in the immigration arena that are currently driving the demographic transformation?  Primarily two things: (1) Legal immigrants, and (2) children (and grandchildren and great-grandchildren) of illegal immigrants already here.  Legal immigrants currently arrive at a rate of around one million per year, and over time that adds up a lot -- the total number of legal immigrants living in the country is estimated by Wikipedia at 37 million.  (Trump uses a figure of 42 million -- close enough.)  Children of illegal immigrants under current practice receive what is called "birthright citizenship" under the 14th Amendment.  There is a controversy over whether that is a constitutional right versus something that can be changed in a statute by Congress, and I won't attempt to resolve that controversy here.  But Wikipedia here has an estimate that there are approximately 4.5 million children of illegals in the country today who have the "birthright citizenship" status, with about 300,000 per year added to the total.

So what does Trump propose to do about these big numbers?  To start with, he has no proposal at all to lower the million per year of legal immigrants, at least no quantitative proposal.  On the birthright citizenship issue, he does take the position that a statute could do away with it.  OK, but, assuming that the courts went along with that, would Trump and a Congress really try to take the citizenship away from the 4.5 million who think they already have it (as opposed to only making a prospective change going forward)?  And how about the as-yet-unborn children (and grandchildren, etc., etc.) of those 4.5 million -- would anyone really take the position that they don't have citizenship status?

In summary, with illegal immigration net negative for years now, and no real prospect for another big wave of illegals coming from Mexico, there are only really two places where the ongoing demographic change of the country through immigration can be materially altered, namely by change to legal immigration quotas and by change to birthright citizenship rules.  And either of those, if implemented today, would only proceed to effect change very slowly over many years.  The legal immigration piece is by far the bigger of the two.

Now, how do we feel about the number of about one million per year for legal immigration to this country.  Even most people in the conservative and libertarian movements support some substantial level of legal immigration, if not precisely that number.  Here is a comment by Noah Rothman from the magazine Commentary from last August:

Trump’s “plan” is an assault on not merely the illegal immigrants who have violated American laws, but those who have played by the existing rules to come to the United States. The proposal amounts to a declaration of war on America’s immigrant community, an attack on the foundational nature of America’s character as a melting pot for all the peoples of the world, and the inception of a police state that is incompatible with a free republican democracy.

So, Mr. Trump, do you propose lowering the million per year, and if so to what?  Half a million?  Ten thousand?  Obviously, this is a subject on which he does not want to be pinned down.

By the way, there are things in Trump's plan that even I can get behind.  Exhibit A:  he proposes that immigrants be permanently ineligible for welfare and handout programs.  Amen to that.  That level of foolishness is what gets us people like the Tsarnaevs.  The funny thing is that people who are ineligible for welfare, and therefore work because they have to, tend to end up grateful, while those who take handouts tend to end up resentful and angry.  It seems counterintuitive, but there is plenty of evidence to support it.

Anyway, the idea that Trump's proposals as to immigration are going to fundamentally alter demographic transformation of the country just looks to me to be wrong, and not a reason to support Trump.

Roy Spencer, Donald Trump, And The "Main Project" Of The Government

A recurrent theme here is that the "main project" of the government, and of each and every one of its agencies, is to promote and enhance further growth of the agency in particular and the government in general.  Examples of prior posts are here and here.  One of the great advances of the past twenty or so years is that the conservative movement has gradually caught on that this is a huge problem.  Without constant push back, the state has a tremendous internal incentive to grow unchecked like a cancer and rapidly take over our whole economy and our lives.

Roy Spencer had a post on Friday that addresses the climate change branch of this "main project," and is very related to my own post on Friday.  Roy's post is titled "On that 2015 Record Warmest Claim."   For those unfamiliar with Dr. Spencer, he is a research scientist at the University of Alabama at Huntsville, and is one of the people (along with John Christy) responsible for producing the satellite-based temperature series generally referred to as UAH.

Unlike the guys from NASA and NOAA, Spencer takes on the problem that the NASA/NOAA temperature series show 2015 to be the warmest year ever, while the satellite series from UAH and RSS do not.  Spencer starts out by declaring a modesty that is completely lacking in the NASA/NOAA guys -- and which, to my mind, is the fundamental hallmark of the real scientist versus the unprincipled advocate:

I’m not claiming our satellite dataset is necessarily the best global temperature dataset in terms of trends, even though I currently suspect it is closer to being accurate than the surface record — that will be for history to decide. The divergence in surface and satellite trends remains a mystery, and cannot (in my opinion) continue indefinitely if both happen to be largely correct.      

And then he gets to what he calls the "elephant in the room":

By now it has become a truism that government agencies will prefer whichever dataset supports the governments desired policies. You might think that government agencies are only out to report the truth, but if that’s the case, why are these agencies run by political appointees?  I can say this as a former government employee who used to help NASA sell its programs to congress: We weren’t funded to investigate non-problems, and if global warming were ever to become a non-problem, funding would go away. I was told what I could and couldn’t say to Congress…Jim Hansen got to say whatever he wanted. I grew tired of it, and resigned.

"We aren't funded to deal with non-problems."  I would say it's an obvious truism.  And this principle goes way beyond the climate wars.  It's the complete explanation for why no amount of government anti-poverty funding can ever eliminate (or even reduce) poverty (as measured by the government); why no amount of government anti-hunger funding can ever eliminate (or even reduce) hunger (as measured by the government); why no amount of government housing funding can ever eliminate (or even reduce) the "housing shortage" (as measured by the government; and on and on.  More generally, it's the fundamental reason why government failure is a political rather than a managerial problem.  Better management can never do away with the fundamental problem that everyone in the government has a desperate need for the problem they are dealing with to persist.  The government fails because its fundamental imperative is that it must fail.

And then of course we have stepping into the Republican presidential nominating process a guy whose message, if he has any message, is that the government is failing not because of that fundamental imperative, but rather because it is run by incompetent people and if only you put a really competent businessman like him in charge, everything will promptly be fixed.  In short, this message is the opposite of the message that the conservative movement has been gradually building for decades.  The one message is, "Government is fundamentally not competent to fix or address the personal problems of the people, and therefore it must be drastically cut back."  The other (Trump) message is "The government's only problem is bad management by incompetent people; put me in charge and I can and will fix everything."

Last week the National Review ran a big forum in which some 22 prominent conservative writers expressed their reasons for opposing Trump as the Republican nominee.  Many of them remarked on Trump's message being very much the opposite of the main conservative message of smaller and limited government.  Contributors noted that Trump had supported, among other things, the Obama "stimulus," single payer healthcare, the auto company bailouts, the bank bailouts, aggressive use of eminent domain, trade protectionism, stricter gun control, and numerous other such government-as-solution-to-everything proposals.  

To me it seems almost impossible that anyone could be such a narcissist as to believe that if only the people put him in charge of the $4 trillion annual enterprise known as the federal government, that by the force of his brilliance and managerial competence he could cause it promptly to succeed at the myriad of tasks at which it has heretofore been failing.  But then, Obama is clearly such a guy.  Now we have another one in Trump.  With any luck he won't be given the chance to fail; but if he does get the chance, the odds of failure are virtually 100%.