Thursday, November 4, 2010

Principles for public provision of health care.

Divide health expenditures into three categories:

1. "public good" health care (mostly prevention of infectious disease, provision of clean water, and so forth)

2. care whose benefit to the patient is very large compared to its cost (fixing broken legs, antibiotics, or any potentially curative treatment of children and working-age people).

3. care whose benefits to the patient are not large compared to its cost (fill in your favorite draconian examples here).

Categories 1 and 2 can in fact be taken care of by publicly subsidized care at modest cost -- if you don't want to believe me, read Amartya Sen's piece from 1993 in Scientific American on Kerala (India) vs. Harlem.

But on the whole single payer schemes for doing this simply cost too much in terms of foregone medical progress due to the difficulties of central planning.

In the US, public health (category 1 expenditures) is mainly a state and municipal responsibility, and they do it well enough.

The US is rich enough that it can afford to subsidize category 2 health care, and if governments concentrate on that more thoroughly they will do the job better and at less cost. But it would be best if actual provision was handled by competing HMO's, each offering a modest basket of high benefit to cost services, with membership in these funds subsidized for low earners out of taxes, and mostly out of state taxes. People who wanted fancier surroundings or more rapid access to specialists than the basket requires would pay out of pocket or buy supplemental health insurance coverage. This would be an American version of the Israeli system, and that, too, works well enough.

But no scheme can pay for all the care that has a reasonable prospect of providing health benefit to the patient. And it is most reasonable (and equitable) if paying for care that neither (a) improves the health of the public (as opposed to the patient), nor (b) provides a benefit much larger than its cost, is the responsibility of the patient and his or her family.

Thursday, May 13, 2010

Letter to an American Gentile Friend

Once, there was a great King, the King of Kings, Ahasverosh, who ruled over a mighty Empire: from India to Ethiopia, from the islands of the Aegean to the great plains of central Asia (Esther 1:1). And yet this King was afraid: even his Queen had failed to obey him (Esther 1:10-13). Even his doorkeepers, his most trusted bodyguards, had plotted against his life (Esther 2:21-23).

So the Great King of Kings elevated a new man, whose origins lay in a foreign land. He put him over all his other ministers and servants (Esther 3:1). The King gave to this man, this Haman the son of Hamedatha the Aggagite, the ring that was the instrument of royal power. The King also gave him the license to do as he saw fit unto the Jews (Esther 3:10-12).

In the fall of 2008 the American people were afraid. They were weary of war, and facing economic crisis the likes of which few had seen in their lives.

Out of these fears, the American people have put their trust in a new man, with new ideas different from those that brought America to greatness.

Unlike Haman, this new man bows before others instead of demanding they bow before him. But like Haman, this new man is determined to destroy the Jews, for they will not bow to him (see Esther 3:2-7). Like Haman his plan is to disarm the Jews and so leave them naked in the face of their enemies

Though I am a Jew, I do not write for the sake of the Jews. God will preserve us Jews from our enemies when and to the extent that we turn to him (Psalms 106:44-46, 107:19-20, etc.). As Mordecai vouchsafed to Esther: "Prosperity and salvation will come to the Jews from another Place" (Esther 4:14). I cannot prophesy whether we Jews will do our part, but I can see with certainty what will happen to you if you fail to do yours.

The question that concerns me in this letter is what will happen to you. What will the judgment of God be upon an America that abandons her principles and her allies?

You ask yourself, "What can I do?" Perhaps you even say to yourself: "I didn't even vote for this man. Why is it up to me?"
But in truth it is not too late to do what you can to check this new Haman in his evil schemes. Men and women dedicated to stopping these schemes exist in every town and county. They have already put themselves forward, whether they call themselves "Tea Partiers," "Republicans," or even "Democrats." God has no concern with these names, but only with their deeds -- and yours!

What have you done to help these brave men and women? Have you given your time to join their rallies, to distribute their pamphlets? Have you even taken thirty seconds to forward their emails to your friends, colleagues and neighbors?

Ask yourself: Have I done enough? And if not, take some time every day to reflect on the events of the day. Reflect on what you see on the news, read on the web or in the newspaper. Remind yourself that a great day of judgment is coming, a day when you will be judged by which side you have chosen: the side of God's chosen people, or, God forbid, the side of their enemies. The future of God's people is in God's hands: it is your future and that of your family and community that depends on your choosing correctly.

But be strong and of good courage! It is true that this new Haman has many friends, many of them rich or powerful. You ask yourself: "If I act against him and his friends will I offend my boss, my colleagues, my teacher, even my pastor?" Perhaps you even supported this man, unknowing or inattentive to who he was and what he stood for. Perhaps you too were afraid in November of 2008, and sought salvation from this man.

But will you serve God or man? In your heart, you know that nothing this man has done since he received your trust, whether at home or abroad, has benefited you. How could it, when everything he has done has contradicted the principles that you have cherished for so long, and under which you have gained a prosperity and power that God has heretofore given to no nation upon this earth?

Know that it not too late to take a stand to do what you can to bring this man and his wicked friends down. It is not too late to witness this truth before those who may be swayed by it.

Remember, this man is doomed to fail in his evil schemes against the Jews. The only question is: will his failure drag America and the American people down too?

If this letter speaks to you, please send it to anyone you know whom you think might be open to its message

Only if the hearts of millions are open to God's truth in time will God give to the American people the benefit of the blessing he gave to Abraham: "I will bless them that bless thee, and curse him that curseth thee: and in thee shall all families of the earth be blessed" (Genesis 12:3).

Haman, too, was humbled before his fall, when by the order of the King he was made to honor Mordecai the Jew, whom he had sought to destroy (Esther 6:10-14). God has given the American people, from now until November of 2010, the opportunity to be the instruments of the humiliation of this Haman.

Fear God and do your part, and He who gives strength to His People will give strength to you as well.

{And feel free to write to me with your thoughts and suggestions,}

Tuesday, March 30, 2010


The Boomers will leave the future a twofold legacy: Obamacare and Microsoft Windows.

Sunday, January 24, 2010

Hilllary channels her inner neo-con!

Remarks on Internet Freedom -- Hillary Clinton
"On their own, new technologies do not take sides in the struggle for freedom and progress, but the United States does."
Speak for America, Hillary!
But after Obama's fiascos on Honduras and Iran, we have to wonder if she is speaking for the administration.