Ross Douthat replied yesterday to my post earlier this week on assisted suicide. Among other things, I argued that allowing assisted suicide was unlikely to lead us down a slippery slope in which suicide becomes far more widespread than it is now. Here's Douthat:

Well, yes: The slippery slope that I discussed in the column doesn’t amount to much if you don’t disapprove at all of people deciding to take their own lives....I was making an argument premised on the idea that suicide is generally wrong and helping someone kill themselves is generally a form of murder, and addressing myself primarily to readers who share that premise.

But here's the thing: nowhere in Douthat's original column did he make the case that we should disapprove of suicide per se. I knew perfectly well that he did, of course, because I knew that he's a committed Catholic and Catholic doctrine holds that suicide is a sin (in Dante's telling, it gets you into the 7th circle of hell). But again: this is the problem with trying to make an essentially religious argument in secular form. If you accept a priori that suicide is sinful, then of course assisted suicide is also sinful and anything that potentially encourages even a little bit more of it is sinful too. But if you decide to forego the religious argument, then you need to make a secular case for suicide being unacceptable before you can make a case for assisted suicide being unacceptable. Douthat never did this.

At the end, he tosses things back to me:

For Drum, though, a question: Assuming that the would-be suicide is of sound-enough mind and uncoerced, are there really no secular, non-Judeo-Christian reasons to think that assisting in self-slaughter might be morally problematic? And a follow-up, in the spirit of the daughter test: If Drum had, let’s say, a middle-aged friend confined to a wheelchair by an accident who had spent a few years battling waves of entirely-understandable despair over his condition, and a “merciful” Swiss clinician then prescribed that friend a fatal dose of sodium pentobarbital (after subjecting him to a battery of “common sense” psychological evaluations, of course), would he see no non-religious grounds on which to describe that doctor as a murderer?

For what it's worth, I don't really see suicide as morally problematic. It's obviously tragic, and no one ever wants to see a friend (or anyone else, really) descend to a state in which suicide seems preferable to life. But that's a pragmatic concern, not a moral one. I'd want them to get all the help and support we could offer, but in the end I accept that it might not be enough. So while I'd be heartbroken if a close friend ended up asking for that dose of sodium pentobarbital, I wouldn't have any moral qualms about their decision. Nor about the doctor who prescribed it.1

But that's a personal view. And I'm going to take a guess here: aside from our religious differences, I suspect that one big difference between Douthat and me is that I've suffered from chronic depression nearly my entire life and he hasn't. Luckily, my case is moderate, and I've never felt like drowning myself in a bathtub. Still, I understand keenly what it feels like, which makes it easy for me to have a pretty good sense of what it would feel like if it were more serious. And that deep-seated understanding of what serious, long-lasting, incurable depression probably feels like is part of what drives my policy preferences here. I can actually imagine myself being in a situation where I'd want that prescription available to me, so reasons of self-interest dictate that I'd prefer it to be legally available. If you can't even conceive of such a situation in your own life, you'll probably feel differently.

1With the usual caveats that I assume I don't have to repeat here.

Joe Romm has the right take on yesterday's announcement of a "massive" new oil find in the Gulf of Mexico:

The discovery doesn’t prove we have ‘abundant’ oil reserves, as [House Natural Resources Committee Chair Doc Hastings] claims. It proves the exact opposite, that ‘Drill, Baby, Drill’ can’t solve our problems. Steve Greenlee, president of Exxon Mobil’s exploration business, unintentionally admitted that when he said, “This is one of the largest discoveries in the Gulf of Mexico in the last decade.”

One of the clearest indications that the planet is running out of oil is the fact that discoveries of giant oil fields have slowed so dramatically in the past couple of decades. This new field in the Gulf is supposed to hold 700 million barrels of recoverable oil, which puts it at the low end of the category (a "giant" oil field contains 500 million barrels or more of crude), and these days that counts as a major find. But historically speaking, this is a pipsqueak, and we're finding damn few fields of even this size. The fact that this is so big a deal is a bad sign for the oil industry.

Irvine, California, 8:37 am.

America the Fanciful

Welcome to America:

A large majority of Americans say the U.S. economy would probably suffer serious harm if Congress fails to give the federal government more borrowing authority. But barely half support raising the government’s debt limit, even if lawmakers also sharply cut spending.

Is this just an example of pure fantasy-based thinking? A cri de coeur that's nothing more than an inchoate expression of frustration? A token of tribal solidarity? Proof that many Americans simply have no idea what the debt ceiling really is? Evidence that many Americans think America deserves to be seriously harmed? All of the above? Something else? Somebody needs to do some kind of in-depth interviewing to figure out what's really going on here in the minds of our countrymen.

Ryan Chittum takes a look at two stories about delays in writing new financial regulations, and concludes that the Murdochization of the Wall Street Journal's news pages is proceeding apace:

The Journal’s frame is that Wall Street is upset over the delay of derivatives rules and that it’s causing “uncertainty.”....The Times, though, points out that it’s Wall Street that is delaying the rules.

....This is a prime example of the Times out-Journaling the Journal, giving us the context and background we need to get our arms around what’s really going on. The WSJ misleadingly presents the story almost as if it’s a natural disaster—delays that just happen for no reason or, if you read between the lines, government incompetence....Which just goes to show you, as we’ve seen before with the Journal, that “uncertainty” is a red flag that an argument is almost surely utterly bogus corporate PR.

The Journal's news pages used to be first rate. There's still plenty of good stuff there, but hackery has been advancing steadily ever since Rupert Murdoch bought the paper and started installing his own retainers in top positions. It's pretty sad.

Matt Steinglass:

David Brooks had an op-ed in the New York Times yesterday that proclaimed the near impossibility of restraining costs in health care through centralised government efficiency evaluations, which is being justly ridiculed by people (Jon Chait, Jonathan Cohn, Ezra Klein) who note that every single one of the world's centralised government-regulated health-care systems is far cheaper than America's relatively decentralised private-sector one. Mr Brooks has surely had this explained to him a thousand times by now, and his failure to process the fact or incorporate it into his worldview seems to me most likely to reflect an absence of the ideological furniture on which the fact could sit.

My post about Brooks's op-ed was a little lighter on the ridicule than many, and this might be a good chance to explain why. There are two things to be concerned about in the world of healthcare costs: levels and rates. That is, we want to know how much we spend on healthcare in America compared to other rich countries and we want to know how fast it's growing compared to other countries.

On the former, the evidence is clear: our spending is far higher than any other comparable country's. Adjusted for wealth (richer countries don't just spend more on healthcare, they spend a higher percentage of GDP on healthcare), America spends $2,500 more per person than any other country in the world. Aaron Carroll probably has the best single summary of this state of affairs here (or you can just read the conclusion here), and it turns out that we simply spend more on everything. More on doctors, more on insurance, and more on drugs. And we also provide more treatment. We love our diagnostic tests in America.

The fact that other countries do better on this score is almost certainly a testament to centralized planning. France and Japan and England mostly have overall healthcare budgets set by the state, and since those budgets depend on taxpayer dollars, there's a strong incentive to keep them pretty tight. And they do. As a result, they pay less for doctors, less for administration, less for drugs, less for everything. Individuals are mostly free to spend more on themselves if they want to, but the state itself has a pretty firm limit on what it will pay.

But that's only half the story. What about rates of growth? Here's a chart based on OECD data collected by the Kaiser Foundation, and it shows that spending is increasing everywhere. The U.S. growth rate is high, especially considering that we started from such a high point, but it's hardly an outlier. The problem of healthcare spending growth isn't something that centralized systems have been able to solve much better than we have.

So Brooks is wrong to be so dismissive of expert panels and top down budget control. They really do work. At the same time, they aren't panaceas, and various forms of competition — between hospitals and insurers, between healthcare organizations bidding for Medicare contracts, and between doctors competing for patients — is something worth trying too. You don't have to drink the tea party Kool-Aid to think that it's worth keeping an open mind on this stuff.

Reading Tim Pawlenty's paean to double plus supply-side-ism yesterday made me wonder, once again, why conservatives think we liberals are opposed to it. I mean, if it actually worked, why would we be? It's politically popular, and by their accounts it would generate trillions of dollars in extra revenue that we could use to finance our beloved lefty social programs. What's not to like?

The only answer I can come up with is that conservatives are now completely invested in their theory that we liberals loathe rich people so much that we don't care. We all want to screw the wealthy so badly that we're willing to forego the elections we'd win and the mountains of revenue we'd gain if we lowered their taxes. We hate them that much.

Or is there some other wacky theory that's popular in conservative circles but that I'm unaware of?

Karl Smith:

To my mind there are few things that tax intellectual ethics more profoundly than whether the psychotropic debate should be had in public. It is my general feeling that it should not.

My blog is not read by the general public but I will make no attempt to be transparent. Those in the know, know what I am talking about.

Hmmm. I don't know for sure what Karl is referring to, but I assume he's talking about the ongoing debate over whether or not psychoactive drugs like antidepressants actually work. There's a growing body of evidence that they don't — at least not the way we think they do. Rather, they're mostly very expensive placebos.

Is this dangerous to talk about in public? Sure, to some extent. After all, relief is relief, regardless of whether it's caused by a known biologic reaction or by a more mysterious placebo effect. If you had a friend who was taking, say, Prozac, and they reported feeling a lot better, would you take them aside and inform them that research suggests Prozac is nothing more than a complicated sugar pill and their response is probably just a placebo effect? Sure, if you're an asshole. After all, telling them this has a good chance of making their belief in the drug vanish, and they'll go back to feeling crappy. Nice work, alleged friend!

But that's quite a different thing from discussing this as a general topic in public forums. Here's the problem: there are enormous commercial forces pushing to make sure that we all continue to think these drugs work, and a non-public discussion is almost certain to be far less effective than a public discussion at applying pressure for change. Without public pressure, we'll get an endless faux-analytic debate in industry circles that's dominated far more than anyone wants to admit by the financial interests of the drug makers. Their ability to control these debates by selective release of data, financial incentives to researchers and doctors, and sophisticated industry marketing campaigns aimed at physicians, is hardly a secret.

My take on the historical record is that it usually takes public pressure — and plenty of it — to really move the needle on this stuff. There are just too many powerful industry interests fighting to maintain their financial stakes and willing to manufacture endless doubt about results they don't like. Examples of this are simply legion. So if we want to get to the truth of this — and in the long term, that's the most helpful thing we can do for everyone — we need to have this debate in public. It's messy, but the net result will be for the best.

Here's a great new timewaster. Slate managed to talk the folks at the movie review site Rotten Tomatoes into giving them access to their database so that you can create graphs of how well various Hollywood luminaries have been reviewed over the past couple of decades. Let's try it out. Last night I was watching Dangerous Liaisons on cable, so let's check out Michelle Pfeiffer's career. Here it is:

Interesting! Her role in Dangerous Liaisons is nearly her career high point (93% rating), second only to her star turn in The Fabulous Baker Boys (96%). After that her career takes a steep dive, bottoming out in 1996 with To Gillian on Her 37th Birthday (15%) and then steadily working its way back up.

Of course, this is pretty much what any film critic could have told you too. But this is much quicker and more quantitative, aggregating the preferences of thousands of reviewers over dozens of years. The graphing tool is here (scroll down). Have fun!

Via Doughnut Orbitals.

Dirty Tricks

So I'm browsing through The Corner this morning to see if anyone has said something outrageous that's worth a bit of mockery, when I come across a post from Christian Schneider about the ongoing recall elections in Wisconsin. It starts off with some stuff about Republicans claiming that the elections are being handled unfairly, and then offers up an interesting bit about Randy Hopper, a recall target who's in hot water because when demonstrators came by his house a while back, they "were told by Hopper’s wife to buzz off because he lived down in Madison with his 25-year-old mistress." Ouch.

But then there was this odd bit about Hopper and another guy who's likely to lose his recall election:

In order to delay recall elections, the GOP has planned to run fake Democratic primary candidates against the GOP challengers, which would push the elections back another month. That would give Republicans an extra month’s worth of distance from the collective-bargaining imbroglio that got them in this situation, and would allow more time to campaign.

Yet this will almost certainly be seen as a “dirty trick” by media and some voters.

Well, yes, I suppose it would be "seen" as a dirty trick. In fact, it would be a dirty trick. It wouldn't be the first time in campaign history this has been done, but still, it's unquestionably a dirty trick. Schneider, in defense, suggests that "it can be argued that the recall elections in themselves are merely dirty tricks," and I suppose that can be argued. Pretty much anything can be argued, as Sarah Palin's fans have conclusively proven over the past few days. But the plain truth is that a recall election isn't a dirty trick, while running a fake candidate merely to artificially extend a campaign (and cost taxpayers a bunch of extra dough in the process) is a dirty trick. That's why these candidates are called "fake." I hope this clears things up for everyone.