Saturday, October 17, 2015

Epstein on Natural Law, Ancient and Modern

A few brief thoughts I may return to later, time and study permitting.

One of the many wonderful things about our modern life is how quickly and easily accessible things are which would have been either inaccessible or time-consuming to access just a few brief years ago.  I recently stumbled upon a couple of Richard Epstein talks recorded on youtube.   They virtually allow one to attend those talks from the past – from any time and place.  How remarkable, if you pause for a moment to not take the development for granted.

This one here, in particular, is well worth watching: https://www.youtube.com/watch?v=R_ge4tYI8Vk

It is entitled “Natural Law in Ancient and Modern Guise.”  It is from 2010, and runs about one hour, with extra time for questions/answers. 

Epstein, a prolific academic writer and thinker, speaks, as always, in complete paragraphs, quickly and effortlessly.  He clearly knows his topics backwards, forwards, and sideways.  Even if one is inclined to disagree with him altogether, or in part, it is always most challenging and rewarding to hear the opposite side of the argument cogently argued.

For those inclined to agree, watch it twice. 

Or thrice.

I find that many who think well and deeply about political theory and philosophy are relatively uninformed about, or ignore altogether, economics and the revolution in economic life over the last quarter millennium.  Economists, however, often have a naïve or diminished view – or even an unmanly contempt for - the political and cultural structure that necessarily provides the foundation for a free and peaceful economic life.  

Epstein falls into neither camp.  He has a commanding grasp of both economic theory and of political philosophy.  He comes at all this, somewhat uniquely, from the standpoint of the law, and as a law professor.  As a non-lawyer I find this intriguing.  When he talks about economics and political theory, he typically thinks about not just the theory and broad “constitutional” questions (meant here not to only refer to the US constitution) but also the very specific legal issues that arise.  His description of Roman law and the pre-Thomistic “natural law” is fascinating.   He ties this to Anglo-American law, written and unwritten.

(There is also an insightful question and answer exchange around the question of natural right and natural law.  One is reminded that Leo Strauss pointed out that the ancient philosophers contrasted “nature” and “law/custom[nomos].”  Justinian Roman law, one assumes, could think about laws which are natural [not customary] since the Empire had created a universal political and legal system, a situation distinct from that of the ancient city).

Epstein's strong preference is for the classical liberal position, in politics, in law, and in economics.  He explains how these are intrinsically linked.

The concluding remark is this:  “Essentially the lesson is, unless you can master the ancient conceptions of natural law, you will never be able to do modern public policy well.”  How he gets there is an hour well spent.




Epstein also has a “new” book out (2014) that is on my list to read.  “The Classical Liberal Constitution: The Uncertain Quest for Limited Government”

Amazon link:  http://www.amazon.com/The-Classical-Liberal-Constitution-Government/dp/0674724895

He gives another fine talk on that book and on Hayek here:  https://www.youtube.com/watch?v=DhqXIc5CEpU

Friday, July 3, 2015

The Best Defense is to Take Offense?

This week Dr. Bob Wachter wrote a blog post that is the first attempt I am aware of by a member of the ABIM leadership to defend the organization against the now widespread allegations of egregious waste and derelict stewardship.  It can be read here:  "The ABIM Controversy: Where the Critics are Right, Where They’re Wrong, and Why I Feel the Need to Speak Out."

He starts his piece in a pique of moral indignation: 

With the help of social media and a journalist who has turned this matter into a cause célèbre with an unfortunate mixture of half-truths and innuendo, the critics have managed to control the debate, and people who believe in the values of the Board have been cowed into silence. It feels vaguely McCarthyish, and there comes a time when silence is immoral. This feels like such a time.

Joseph McCarthy was of course the U.S. Senator interrogating possible communists.  However, an investigative reporter, an electrophysiologist blogger, et al. do not sit in the seat of power.  No, it is the ABIM that holds great power over the lives and careers of 200,000 physicians in this country.  Indeed, if one must use a 20th century Republican politician’s name as an adjective appropriately in this case to describe a person who holds a position of great responsibility and power and believes himself to be persecuted against all evidence, the correct word is:  Nixonian, and it applies not to his detractors but to the good doctor himself.

Now, there are many aspects of this ABIM controversy.  They include, but are not limited to 1) the issue of certification, re-certification, MOC, etc. 2) the existence of, reason for, politics of, and funding of the ABIM Foundation, and 3) the financial details.

In the interest of space and time, and since it is covered so exhaustively elsewhere, I will leave aside #1 and #2 for now. 

Regarding number 3:  After reading Dr. Wachter’s post I have re-watched Dr. Cutler’s debate with Dr. Baron from December of 2014 and re-read Dr. Westby Fisher’s posts and Kurt Eichenwald’s Newsweek stories.  What does Dr. Wachter have to say about the allegations of egregious waste, lavish spending, exorbitant salaries, and derelict stewardship of trust and resources?  Does he dispute the facts?  If not, does he offer an explanation that addresses the specifics? 

Let’s looks at his piece.  Against the charge that “The Board is All About the Money” he writes: 

As Board members, we constantly struggled with balancing our fiduciary responsibility to the organization (including to pay the salaries and the costs of doing the Board’s current work and innovating) with the burden to the diplomates. ABIM’s MOC process currently costs physicians about $200-$400 per year (the low end for the internal medicine certificate only; the higher range is for those maintaining multiple certificates, like IM/cardiology/interventional cardiology). These costs are consistent with the fees of other ABMS boards. The argument that this represents an impossible expense to the vast majority of practicing physicians is hogwash.

That’s it.  They “struggled,” and the cost is not that much per person anyway, so “shut up” (leave aside for the moment those that dispute the true cost). [Edit 7/7/15 I will add that it should go without saying that when the Board authorizes wasteful spending it does neither its fiduciary duty to the organization nor its duty to the Diplomates]

His section regarding salaries and the Condo is equally pithy.  He only addresses the CEO’s salary, for example.  Let’s ignore that for now and assume the CEO deserves every penny. If I round up to one million for his salary/benefits, we are still left with salaries/benefits for the ABIM and its Foundation of $29,000,000/year!  This is to run what should essentially be a testing and record-keeping company, if a large and sophisticated one at that.  And again, this is not the budget, just the payroll.  What about the assistant to the President who Dr. Cutler pointed out made $689,000 in 2011?  Do we finally learn her job description or why she was worth this from Dr. Wachter?  He was on the Board of Directors at the time and presumably voted on the budget.  No, it’s not mentioned.  How about the two researchers on the benefits of MOC who made $450,000/year?  Are the salaries mentioned?  Is the embarrassing conflict of interest mentioned?  No, nothing.  Even the “Senior Vice President of Communications” reportedly was compensated $293,000 in 2013.  The point is it takes a lot of employees earning large salaries to reach a sum of $29,000,000/year.   I should point out that these are not my facts.  I am simply repeating what I have seen and read reported.  No one from the ABIM has substantively disputed the numbers, nor defended them.  Despite the length of his post, Dr. Wachter also simply ignores them.

Regarding the Condo he essentially admits that it looks bad, but was really “designed to be revenue neutral” compared to hotel room costs for consultants.  This is thin gruel, if not outright laughable.  First, the only reason to buy rather than rent is to save money, not break even; and if looking to save money Dr. Cutler points out less expensive units practically across the street.  He relates having been told that the Condo the ABIM did purchase was the most expensive real estate in Philadelphia per square foot!  One comes to the inevitable conclusion that thrift was not exactly a concern at the ABIM in those days.  With the caveat that any analysis of the finances of the condo vs. hotel rooms obviously leaves aside the fact that the condo would not suffice if more than three rooms were needed at a time, let’s take a quick look at the numbers.  Traditionally, financial theory in retirement has suggested that 4%/year may be spent from a well-invested nest egg without affecting the long-term real principal.  Some argue that this is too high given today’s interest rates and equity valuations.  So, let’s be very conservative and take 2.3 million invested in index funds and treasuries, and spend 2.5%/year on hotel rooms.  This comes to $57,500/year.  The condo’s expenses (not taking into account depreciation) were roughly $42,000/year (per Dr. Wes’ post).  So we have at least $100,000/year in hotel costs that the condo represents if “revenue neutral.”  I will let this speak for itself.

As we see, then, Dr. Wachter does not seriously address any of the allegations of financial waste that have come to light in the last seven to eight months.  On salaries, Four Seasons meetings, etc. he simply ignores most of the points made by Dr. Cutler in December, let alone the mountain of additional information that has surfaced since.  In the end, one can only assume that he neither disputes the facts of the allegations nor defends the ABIM’s actions (assuming the facts correct) for a simple reason:  There is no credible defense.

In his penultimate paragraph he states:

I further believe that this process must be crafted by members of the profession itself – and if we abrogate that responsibility, others will fill the void.

Well, to that a great chorus of readers cries out:  “If the unelected, unaccountable, unrepresentative, monopolistic, and profligate ABIM is self-government, then give me George III.”

He ends with a martial metaphor:

“Throw the bums out!” can feel like progress. But, as the Arab Spring protesters have learned, sometimes it’s relatively easy to tear down institutions. Rebuilding them is much harder.

This is hyperbole, or course, but I will indulge it.  It is true that more often than not bloody political revolutions and coups do not turn out well.  There is a document, 239 years old tomorrow, that addresses this fact:

Prudence, indeed, will dictate that Governments long established should not be changed for light and transient causes; and accordingly all experience hath shewn, that mankind are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations, pursuing invariably the same Object evinces a design to reduce them under absolute Despotism, it is their right, it is their duty, to throw off such Government, and to provide new Guards for their future security.

Busy internists are not your typical torch and pitchfork crowd.  Prudence is their virtue. 


I do not know how this controversy will ultimately end, but I do know that Dr. Wachter’s post is not an apology, not an adequate defense, and not a way forward.

Wednesday, April 29, 2015

Why the ACP needs to comment on the ABIM scandal


It has been now over four months since Dr. Wes Fisher’s post on the ABIM luxury townhouse and since Dr. Charles Cutler’s debate with Richard Baron: events which began the exposure of the details of the ABIM financial scandal. 

It has now been roughly two and six weeks respectively since Kurt Eichenwald’s Newsweek articles on the ABIM and its financial scandal.

While they have commented on the maintenance of certification process at the ABIM, the American College of  Physicians - which regards itself as the organization for internal medicine - has yet to issue a statement regarding the ABIM financial scandal or its details. On the ACP advocate blog  (authored by Bob Doherty, ACP’s head lobbyist) over this period of time, one can read about not just the recent SGR saga, but also handguns, and on his twitter feed he shared a story about the POTUS and the new Surgeon General addressing the “health effects of climate change.”  However, nowhere is there any coverage of this huge story, a scandal that directly affects internists.

So:  Handguns and Global Warming from the ACP, but not a word on these very serious allegations of fiscal impropriety at the certifying board.

How can this be? 

Some suggest that the ACP has a conflict of interest in that they profit from test prep materials and courses. 

Some also suggest that there is a revolving door, of sorts, between many of these organizations.  A case in point:  the former longtime CEO of ABIM, Christine Cassel, has listed on her bio at the National Quality Forum that she is a Master of ACP and former President of ACP.  So far as I know, no one at ACP has publicly questioned her leadership while at the ABIM.  

For the moment, however, put aside these thoughts.  Moral courage (to overstate the ethical requirements in this case, certainly) is not doing the right thing when it easy and profitable.  Quite the contrary, courage is doing what is right when it is difficult, or otherwise against one’s personal interests.

The ACP should do what is right on behalf of its current and potential members and publicly express concern about the allegations of financial mismanagement at the ABIM. At some point, the failure to condemn is to condone.  That point, if not yet behind us, will be past soon. 


In the end, can a voluntary organization afford not to speak on behalf of its dues-paying members when the cause is right?



References:

Newsweek articles:  

Tuesday, March 10, 2015

The Board of Directors at the ABIM: Will they defend their record? Or were they apathetic, incompetent, or deceived?

For readers that would like more detail, I will refer to my prior post, as well as to Dr. Westby Fisher’s comprehensive coverage of the ABIM scandal, on his blog: http://drwes.blogspot.com/

Today, in Newsweek, Kurt Eichenwald wrote a piece, that updates this scandal on a mainstream media site. Link here: http://www.newsweek.com/ugly-civil-war-american-medicine-312662

With gems such as: “…the ABIM went from being a genial organization…to something more akin to a protection racket.” And, best of all: “the ABIM Foundation that does…well, it’s not quite clear what it does. Its website read like a lot of mumbo-jumbo.”

So, we have here a protection racket with its spin-off “mumbo-jumbo” cousin. For those counting, that’s mumbo-jumbo with a $30,000,000/year payroll (not total budget, just salaries and benefits between the two organizations! [source: tax records as documented by Charles Kroll]).

All of this brings me to this point. Some like to imply that blame for this scandal should be placed mainly on the prior president/CEO (the beleaguered Christine Cassel, currently the head of the National Quality Forum, who was forced to resign last year from high-paying corporate boards due to serious conflicts of interest: http://www.propublica.org/article/payments-to-ceo-raise-new-conflicts-at-top-health-quality-group).

However, sitting on the board of any organization is a serious endeavor that deserves to be treated as such. It is not only a CV-builder and not only a place to nurture relationships. Unless they can prove that they were actively deceived by Dr. Cassel, et al., the board members past and present are ultimately responsible for what the ABIM has become. The current names and bios of board members are readily available at the ABIM and ABIM foundation websites.

These men and women who have served on the board of the ABIM over the last ten to fifteen years have only two possible primary responses to this scandal and their involvement with it:

1) Defend the organization as currently constituted.

No human institution is perfect, of course. An adequate defense, however, would recognize that while there will always be minor shortcomings a clear and convincing argument is necessary regarding both the charges of impropriety (luxury townhouse, etc.) and how it is that the ABIM needs a thirty million dollar payroll. It is not easy to imagine such an argument being a cogent one.

2) Demonstrate that he or she actively voted against or otherwise fought against these developments.


Other than 1 or 2, the only other possible explanations for the board members' work at ABIM are the ones I list in my title: apathy, incompetence, or having been deceived by the leadership.

Which is it?

Monday, February 9, 2015

Five Questions for Richard Baron

First some background:

There is controversy of late regarding the ABIM (American Board of Internal Medicine) and its financial dealings. Allegations range from poor fiscal stewardship to worse. This includes the purchase (and now sale at a loss) of a 2+ million dollar condo in Philadelphia, etc.

Dr. Westby Fisher’s blog has many of the details and links:  http://drwes.blogspot.com

Original piece on the condo: http://drwes.blogspot.com/2014/12/the-abim-foundation-choosing-wisely-and.html

Description of a Philadelphia medicine town hall meeting regarding ABIM and MOC, but also the condo, salaries, poor stewardship of funds at the ABIM, etc. featuring a debate between Charles Cutler (former chair ACP board of regents) and Richard Baron (CEO of ABIM): http://jedismedicine.blogspot.com/2014/12/abim-has-lost-its-way.html

Not to be missed is this excellent video of that debate:

http://www.pamedsoc.org/MainMenuCategories/Education/MOC/Video-MOC-Debate.html

All of which leads to my five questions for Richard Baron, CEO of ABIM:

1. Do you dispute Dr. Cutler’s facts from your recent debate with him in Philadelphia?

2. Were you the Treasurer of the ABIM at the time of the condo purchase?

3. What is the job description of the non-M.D. employee (assistant to the president) at ABIM who made $700,000 in one year?

4. As a follow-up to #3, do you stand by your reply to Dr. Cutler that “salaries get set as salaries get set?”

5. Depending on your replies to questions #1-4, how does ABIM have credibility when it comes to hectoring physicians on the cost-effective use of limited resources?

Saturday, November 29, 2014

Picking on Piketty

Much has been written about the weighty bestseller: Thomas Piketty’s Capital in the Twenty-First Century.

For brief, column-length responses that take the other side, consider, e.g. the great Richard Epstein:

The Piketty Fallacy

Piketty's Rickety Economics 

And now, a comprehensive and lengthy review, that, as expected, is an economic education - nay, an education - in itself. For those who are by nature sympathetic to Piketty’s assessment and conclusions, think more clearly about the revolutionary political and economic change in the world over the last two centuries. A better critique, after all, deserves a better initial understanding:

 Measured, Unmeasured, Mismeasured, and Unjustified Pessimism: A Review Essay of Thomas Piketty’s Capital in the Twenty-First Century Deirdre Nansen McCloskey

Monday, November 25, 2013

Is the Examined Life Worth Living?

At Prof. Larry Arnhart’s blog (here:  http://darwinianconservatism.blogspot.com/2013/11/natural-right-and-natural-history.html) I pose a question in the comment section that is, perhaps, unfair in its length.  Here I will attempt to answer my own question.

Like many questions, the answer implies questions:  In this case two, namely the chief philosophic questions of 1) reason vs. revelation and 2) the philosophic life vs. the non-philosophic life (or the philosopher vs. “the gentleman,” or philosophy vs. “the city”).  These two questions are related, in that the non-philosophic life is commonly, if not always, also religious.

Since reason (i.e. philosophy and science) can never disprove theology, and since theology and revelation do not explain through proof, there is an unresolvable mystery, conflict, or tension at some basic level between the two.  

In Arnhart’s extended argument, a human desire for religion is natural, and human happiness comes from leading a good life, one that is overall in accordance with what is best for us by nature over the arc of one’s life.  He lists twenty natural desires, of which one (number nineteen) is this desire for religion.  I will add here, that I find the argument reasonable and empirically cogent.

However, it is still uncertain how this works logically.  How can reason, science, show that human nature desires religious belief - while remaining agnostic itself by necessity - without discussing the truth of the religious belief, and hence without undermining religious belief?  Or, put another way, who leads the fuller and hence happier life in this formulation, the religious believer, or the scientist/philosopher who makes the argument that, among other things, religious belief is one component of a happy life, while at the same time not believing (even if not denying belief)?

Even if we leave the question of reason vs. revelation aside and approach these natural desires (and true human happiness) from the standpoint of reason alone, we do not avoid paradox (I would suggest).  As I claim in my original question, our natural sense of justice typically desires a support that is not fully supplied by reason alone (even if nihilism itself is avoided).  Who then is happier, the just and moral non-philosophic man, or the “philosopher/scientist” who understands better the natural basis for morality (again, within this argument)?  This too would seem to be unresolvable.  Certainly human reason cannot prove itself to be an inferior way of life, using its own tools, or that would simply be a peculiarly circular form of self-destruction.  But how exactly does one show that humans have a natural desire for justice - and then claim that true natural justice is more limited than our desire often demands – yet prove the superiority of living with this understanding (as compared to the simpler but seemingly more fulfilling sense of justice that is innate)?

This question about the superiority, or lack thereof, of the philosophic way of life, is not new, of course, but is coeval with the beginning of the philosophic way of life.  Arnhart has addressed it explicitly on his blog several places, such as here:  http://darwinianconservatism.blogspot.com/2011/07/strauss-on-supremacy-of-philosophic.html. and here:  http://darwinianconservatism.blogspot.com/2012/05/anastaplo-on-strauss-aquinas-and.html




Update 9/2015

Very tardy here, but I should update the above post to note that six months ago Prof Arnhart in responding to my second comment on this post:  http://darwinianconservatism.blogspot.com/2015/03/nietzschean-nihilism-natural-right-and.html  addresses a version of my long question from 2013 that is the first link at the top of this post:

WB:  "Is it possible that - rather than being Nietzschean - Strauss was open to something akin to your extended argument as being true, but still a "deadly truth" at that? (Even, of course, if you reject this conclusion).

You have written that a virtue ethics based on our human nature is narrower than a “cosmic” morality. However, one could argue that when we consider truly ghastly and heinous crimes our natural moral sentiments seem to desire such a cosmic morality, or at least something closer to it. If this is true, then it is our evolved human nature itself that desires a morality grander in scale than can be supplied by the natural right based on that human nature alone.

Perhaps Strauss could have accepted the broad bases of your argument (as he hints at them in the introduction to NRH), but would have been skeptical of them as being a sufficient ground for most "non-philosophers'" conception of justice? "

LA:  "That's a good suggestion. As you indicate, Strauss did say that the lack of cosmic support for what we care about was "the most terrible truth," and a Darwinian natural right would teach that terrible truth.

Similarly, the Nietzsche of "Human, All Too Human" thought that Darwinian science would not satisfy those human beings who needed a metaphysical purposefulness for life."

Saturday, November 23, 2013

Arnhart Reviews E.O. Wilson

http://darwinianconservatism.blogspot.com/2013/11/natural-right-and-natural-history.html

Larry Arnhart reviewing E.O. Wilson in the Claremont Review of Books is a must-read, and does not disappoint. 

His blog is excellent, in general.  His books, Darwinian Natural Right, and Darwinian Conservatism, should be required reading.  His writing is clear and erudite and speaks for itself.  "DC" is emphatically not "social darwinism."  It could just as easily be called "How human nature and biology support classic liberalism."

The subtitle to DNR, "The Biological Ethics of Human Nature" is instructive here.  Another summary might be "how modern biology is compatible with an Aristotlean ethics."  I cannot recommend it highly enough.


Links to books:

http://www.amazon.com/Darwinian-Natural-Right-Biological-Philosophy/dp/0791436942/ref=la_B001K8DKAI_1_2?s=books&ie=UTF8&qid=1385253757&sr=1-2

http://www.amazon.com/Darwinian-Conservatism-Disputed-Larry-Arnhart/dp/1845401565/ref=la_B001K8DKAI_1_3?s=books&ie=UTF8&qid=1385253757&sr=1-3

In Praise of Hobbies

It is only recently, in middle age, that I have developed any understanding for the ubiquitous blank on the personal information form:  “hobbies.” 

In my youth, I assumed a hobby – such an antiquated term - must be stamp-collecting, or flying radio controlled airplanes as part of a club, or some such endeavor.  What is more, and what is worse, it seemed like such a commitment.  “These are my hobbies.”  “I collect civil war books, and to the end of my days I will spend all my free time collecting, memorizing, and ruminating on only things pertaining to the civil war.”  “I will join a club with like-minded members.”  Etc.

But a hobby – an avocational pursuit or interest - is in actual fact the non-committal pursuit par excellence.  Whether sport, recreation, simple pleasure, or intense intellectual interest, an avocational pursuit has the virtue that it can be pursued for its own sake.  And like any whim, disregarded whenever time no longer permits, or when the fire of that passion abates; and, if desired, picked back up next month or next year.

The hobbyist need not make the fatal error of confusing vegetable gardening with agriculture.   The landscape gardening enthusiast need never run a nursery nor supervise a crew planting petunias at a strip mall. 

To try one’s hand at learning to cook well may be a simple joy.  How wonderful to not need, in that case, to find employment as a chef!

And in this modern world, one need not always look far to find information about one’s current whim.  An obscure book is always one Amazon click away.   And likely some discussion board exists that may point one to more questions, or occasionally a clear answer.  The “long tail” (http://en.wikipedia.org/wiki/Long_tail) contains every niche interest and is available now to all at the speed of one’s broadband connection.

Vocationally speaking, we are all usually specialists, of one sort or another, in the end.   Ricardian comparative advantage demands it.  And, as the recipients of the resulting productivity and economic growth, we are all much the better for it.  Those of us who love our professions are doubly blessed.

But in a hobby, one need not change careers nor manage disagreeable people nor make payroll - nor collect stamps.  One is never too late to start.  One can always delay, restart, or quit.  This is the realm of the novice, the amateur, the polymath, the autodidact. 

I think I now, finally, understand that blank.    

Saturday, November 16, 2013

New vs. Old Keynesian Stimulus (Cochrane)

John Cochrane is a professor at the Univ. of Chicago in financial economics.

His blog, The Grumpy Economist, is quite good.

Friday’s post, New vs. Old Keynesian Stimulus, is simple, clear, and excellent.  Before you talk about the truth of the models, the evidence or lack thereof, or argue about good and bad, better and worse, understand the assumptions.  I’ll leave his post to speak for itself.

Also, if you have any interest in financial economics I’d highly recommending returning to the main section of his blog and reading the posts about his father-in-law (E. Fama)’s recent Nobel prize, shared with two others.  While there read about the two others (Shiller and Hansen).   

If you don’t mind a little math, and want to read a nice in-depth survey of asset-pricing research, you might also try Cochrane’s “Presidential Address: Discount Rates.”  It can be found here:  http://faculty.chicagobooth.edu/john.cochrane/research/papers/discount_rates_jf.pdf

For an excellent book length review of research on expected returns (with less math), Expected Returns By Antti Ilmanen (a Chicago PhD) is well-regarded, and worth reading twice. And what is more he’s a Finn – how often do you see that?