Tag Archives: politics

The Coordination Problem of DJT

I haven’t written much about Trump because, mostly, it upsets me that he matters. (The frequent reader knows that one of the things I hate the most are people who feel good about themselves when they have no reason to.) Unfortunately I have to care a little because we’re entering Super Tuesday with Trump mattering, which leads me to wonder “why?!”

It’s hard to remember now, but the Republican field was actually quite solid at one point, representing multiple strands of conservative thought – even my favored libertarianism was represented – and a solid mixture of successful legislators and executives. Then Trump entered and everything went to hell. It wasn’t until the 10 debate in late February that some of the front runners finally attacked Trump, and very effectively, too. Why did it take so long to make the move?

Mostly, I think, it was a coordination problem. As I tweeted earlier today:

Tweet re Trump

Trump was the proverbial guy with 6 bullets and something like 16 enemies – 10 if you limit it to the main stage. At the time he ruled the polls because he had name recognition, not because he had any policy ideas (still doesn’t). Any combination of sustained attacks would have taken him down with relative ease then. Why didn’t anyone go after him?

Well, why would they?

Six bullets will protect you from ten enemies because none of them want to be one of the first six. There was no incentive for any individual candidate to go after Trump and draw his attention.* Better to wait for others to take the hit, or let Trump fade away on his own, rather than risk one’s candidacy to take Trump down for the good of all. If you rewatch the early debates (and I suggest you don’t) you can see an air of “it might be dangerous; you go first” among the non-Trumps, especially as Trump rebuffs the occasional uncoordinated attack.

*”Never argue with a fool. People might not know the difference.”

Of course, coordination problems can lead to disaster. Trump now has more ammunition than enemies and is now on a level playing field with legitimate candidates. Whatever the benefits of his unmasking the press for the weak partisan wannabe elite that they are, the mainstreaming of populist nationalist authoritarianism is too high a cost to pay.

Now pardon me as I go dust off the Mad Dog chapter from my Game Theory class.

McArdle on Scalia

Blog-favorite Megan McArdle has a column on replacing Justice Scalia, which largely tracks what I wrote yesterday. The reason she’s a blog-favorite, though, is the insight she adds about the political process:

But [getting your way through the court rather than legislature] doesn’t fix the political problem. It only moves it to the question of how the justices are picked, a question that is about to catapult our political system into a new, and more dangerous, level of crisis. For if you leave people no way to work through the system, they are apt to start working against it instead.

I failed to point this out yesterday, but she’s right that the fights you would normally have in the legislature through voting and lobbying (on abortion, gay marriage, campaign finance, etc) are now fights about stacking the federal courts. Getting your way on an issue here or there is nice for the people involved, since it’s difficult to pass constitutional amendments on a contentious issue, and also rare that SCOTUS overrules an important precedent quickly. However, The same goes on issues you lose on, so for most people in the political mainstream it’s a wash. (Worse, making something constitutional law is an inflexible approach, while democratic legislating is at least adjustable.)

Now, instead of having to lobby for a law, you have to make sure to elect senators who will approve judges you like. All the issue-specific voting and lobbying is now transferred to the legislative level. This has led to higher and higher polarization as all issues, effectively, are handled this way, rather than one-by-one. Meanwhile, the energy and money spent on lobbying has to go up because each election is so much more consequential.

Basically, this is a stupid system.

Book Review: Submission

Submission, by Michel Houllebecq

Part 2 (Camp of the Saints being first) of my topical reading list for this fall. By sheer coincidence, I began reading it in Paris the day after the terrorist attack that resulted in hundreds of casualties there.

The novel essentially has two non-traditional plots. Francois, a middle-aged college professor in Paris, goes through a midlife crisis, having recently stopped banging his most recent and favorite student. (That’s one “plot.”) In the background, meanwhile, the real events happen, and we learn about them in bouts of exposition. The Muslim Brotherhood, a new party in France, finishes second in the presidential election, qualifying for the runoff against the far right National Front. The leftist parties, following a disrupted runoff election (but at those behest?) agree to a deal, throwing their support to the Muslim Ben Abbas in a power-sharing deal. (Something similar happens in Belgium, coincidentally the site of post-Paris terror.)

(spoilers below)

French society slows drifts toward a religious conservatism. Subsidies for stay-at-home moms drive women out of the workforce and remove unemployment. Suspiciously, crime in the heavily Muslim banlieus drops precipitously. Ben Abbas uses his influence to invite Turkey, Lebanon, Morocco, Tunisia, and Egypt (for now) into the EU, slowly reconstituting the Roman Empire that he ultimately hopes to rule. Most relevant, the Muslims take control of the educational sector, reforming education in line with Muslim beliefs, and the to plots begin to intersect.

Francois, removed from his post for not being Muslim, is later recruited to come back, and his main concern with his conversion is how many wives he would be allowed under the new practice of polygamy. The dean recruiting him has several, ranging from 15 to 40, while even the nerdiest elderly professor is provided with a young coed.

That, roughly, summarizes the story. Houllebecq spends a lot of time telling us about Francois’ love life, though mostly it reads like an old man’s dirty fantasies. (One fun part is the annual ritual wherein his last year’s fling tells him she met someone over the summer.) The political analysis is somewhat superficial. While Houllebecq admits he accelerated the predicted demographics of the 2040s into the 2020s, so I give him a pass on that, but he misunderstands present-day Europe badly. The sort of leftist elite that would rather elect a Muslim than a far-rightist would also NEVER cede the education of their children to someone else. The political elites that could barely get southern and eastern Europe into the EU would and could not get any Muslim countries admitted except perhaps Turkey. The refugee crisis and the response thereto, if extended into the next couple of decades, would make this resistance stronger, not weaker.

Houllebecq’s strongest talent is showing the Islamic takeover as non-threatening, even welcome for a society whose liberal decadence has left it defenseless from strong convictions. There’s an insidious inevitability to this story that doesn’t hit you until you think about it for a bit.

Mildly recommended. It’s a quick read.

SCOTUS Follow-Up

As predicted, it begins:

Following Friday’s Supreme Court decision, two of Texas’ top officials, Gov. Greg Abbott and state Attorney General Ken Paxton, issued opinions directing state agencies to “respect and preserve Texans’ religious liberties,” in essence encouraging county clerks to refuse to issue licenses to gay couples if it conflicts with their religious beliefs.

While the comments don’t quite say what the USA Today says they mean, let’s assume that some states will permit certain government officials to refuse to perform certain acts on behalf of the government due to their religious objections. How does this shake out?

Practically, it’s easily avoidable. The state has an obligation to comply with the law, so as long as a clerk’s office performs marriage, someone in that office must be available to perform same sex marriages. If that’s the accommodation, that’s fine with me and not particularly intrusive.

The legal question is a bit thornier than it appears. The hypothesized clerk isn’t acting on his own behalf; he’s an agent of the state. The state is obligated to perform this task. By giving the clerk an out (and not providing an immediately available alternative) the state can effectively opt out from complying with the law. That’s ultimately untenable. Further, agents of the government, as a general rule, must be able to perform those actions that the state must perform. It’s an essential requirement of employment. If I had to pick the next legal battle in the culture war, I may well pick a clerk refusing to perform same sex marriages, being fired, and suing for infringement of his religious freedoms under the First Amendment and the various Religious Freedom Restoration Acts.

Commentary on SCOTUS

I’ve mostly ignored the commentary on the Supreme Court’s blockbuster cases the past couple of days (most of it is not interesting, legally speaking) but I suppose I should offer my thoughts, having followed the court more intensely than ever before this term. (I’m serious. My pump-up mix contains the Scalia dissent from Maryland v. King.) I’ll comment in general, though you’ll see a theme.

King v. Burwell (The Obamacare subsidies case)

The outcome was predictable, of course, and I can’t get too worked up about the result. A few million people get subsidies, which is a rounding error for the bloated federal budget, so whatever; it’s not like forcing the Democrats back to the legislative table would have taken us very far. (Yay politics.)

The real disaster, and there’s really no other way to phrase this, is the precedent this sets for the future. It encourages sloppy legislation at the very least, with the understanding that courts will give you a break if you get it wrong. It will probably encourage intentionally vague drafting with the hope that a court will give you more than you could have gotten in the political process. (Lawyers will sometimes leave a contractual provision vague for the same reason. …I hear.) This has been a trend in legislative interpretation for decades, with doctrines of “saving constructions” and “constitutional avoidance” going out of their way to invalidate or otherwise restrict bad laws. (Bond v. US and Canning v. NLRB are recent examples of this.)

Also, on a personal note, I hate the idea that “established by the State” can also refer to things “not established by the State.” Words have meanings. Please stick with them.

Obergefell v. Hodges (The Same Sex Marriage case)

This wasn’t exactly a stunner, since Kennedy has been telegraphing his desire to be the one to address this issue, but I admit I was surprised by the reasoning of his majority opinion. It’s perhaps the least useful opinion written in the last few years, worse than this year’s Elonis v. US (which passed up an easy chance to pick a mental state requirement rather than saying “the lowest one isn’t it.”). While he can count on being quoted at weddings for the next few decades, the opinion offers very little in terms of legal reasoning that can be translated to any other context. Equivocating between Substantive Due Process and the Equal Protection Clause, Kennedy ultimately concludes that the constitution requires all states and territories to recognize same sex marriages mostly because it would be a good thing to do.

In many ways, Obergefell could be similar to Brown v. Board of Education, another important opinion that suffers from the same legal infirmities but has obviously had a tremendous legal impact. (I would argue, however, that all the hard work for Brown had been done by Justice Harlan’s famous dissent in Plessy v. Ferguson, as tremendous a piece of legal writing as you’ll ever see.)

The four dissents don’t offer much in terms of rebuttal, although I imagine they didn’t really bother to. Thomas and Alito do provide a decent constitutional analysis that makes me think this should have gone the other way, but this was not anyone’s finest writing hour.

I should say, I’m very happy about the outcome, and I definitely think it’s the correct social policy. I’ve voted in favor of SSM in all elections I’ve participated in, and I would have liked to see it go national this way, rather than through a very dodgy legal ruling that could undermine the rule of law and trust in the court as an institution. That said, if I were denied a right, I know I couldn’t care less about those other things if the court ruled my way. So this decision is a good thing.

That said, be worried. Burwell and Obergefell have made the Supreme Court more important than ever. Control of the court will become essential, and it’ll make presidential and senate politics even worse than it is now. (Yes, it’s possible.) It opens the doors to constitutional rulings on religious freedom or gun laws, for example, that should have been left to the states and people. In fact, some early analyses wonder if the court’s reasoning in Obergefell translates to the rights under the Second Amendment. Watch for that fight in the near future.

I’ll skip the other decisions of this term, although there have been some interesting ones, but I will note that the court has not impressed with clarity this year. I’d imagine the early October cases next year being tamer than usual to offset the acrimony of the last few weeks.

Blog Note/Brain Dump

As you may have noticed, the blog has been very quiet until tonight, when I discovered a coding error and released a bunch of backed up reviews. The reason for the silence is my continued high workload, which is why I stick to reviews (easy) instead of commentary on current events (hard). Before I go back into hiding, scattered thoughts about recent events:

  • I once independently discovered Sam Harris’s question about morality of national governments, which is what they would do if they had the “perfect” weapon that could destroy their enemies. The United States, in my mind, had always done well in that measure, since it could have carpet bombed from Libya to India and never even came close to using its maximum firepower. With the torture report, however, the US can no longer get the benefit of that. The activities in the report are vile, and the fact that slight majorities approve of them are sickening reminders that us vs them is everywhere and always a bad influence.
  • The two grand juries who failed to indict the killers of Michael Brown and especially Eric Garner would not have done the same if the shooters were not cops. I think that’s clear. I also think it’s obvious that a prosecutor who works WITH the police every day shouldn’t also be in charge of investigating that same police. The fact that we let this happen (or that we let the chief of police be in charge of the unit that also investigates police corruption) is a sign that we’ve let a warrior caste arise in our midst that’s now violent and unaccountable, protected by both law and public opinion even at their worst.
  • It’s unfortunate that the fallout from the grand jury decisions has become so racialized, as exemplified here by Smith College president Kathleen McCartney who had to apologize for saying “all lives matter” instead of “black lives matter.” This is not to deny that black Americans suffer more of the consequences of the police state gone wild – they clearly do. The unfortunate aspect is that making race so salient is probably not the best way to effect change; paradoxically, by not emphasizing race one could reach the best outcomes for those discriminated against on racial grounds. By focusing on the universal aspects of police overreach, one could build more public support for reforms, the effects of which would be felt more strongly in those communities currently suffering the worst effects. By making it race-specific, you turn on the us vs them parts of the brain and just don’t reach certain people whose support is necessary for real change. It seems that the black community faces the unfortunate choice of solving the problem or being heard, but not both.
  • One in five American college students does not get raped. You know that if you’ve been near any college, which is not a constant scene of war-crime-level assault. Sexual assault is still too common (“too common” defined as “above zero”) but by emphasizing a wrong figure proponents are doing a disservice to the cause of minimizing the problem, once again by excluding reasonable people whose support is important.
  • Obviously the previous bullet was inspired by the Rolling Stone story that’s since been all but retracted. I think it’s obvious that most part of the story as reported were not true, and the Washington Post has done some excellent reporting on the issue. That said, it’s not like it proves that nothing ever happened to “Jackie.” I don’t have much sympathy for those who file false reports but I can’t help thinking that the best way to describe this young woman is “troubled.” Rolling Stone, of course, has no such excuse, and the Greek organizations suspended on the basis of this story have a legitimate beef with the magazine.
  • Of course we should have normalized relations with Cuba decades ago. Contact means exchange, of goods, services, and ideas. The Chinese are better off for participating in the world, the Vietnamese are, and the Cubans will be, too. As for us, try some Havana Club before you knock freedom.

Book Review: Left Turn – How Liberal Media Bias Distorts The American Mind

Left Turn: How Liberal Media Bias Distorts The American Mind, by Tim Groseclose

The title may be a little strong, but this book is a solid demonstration of the ideological slants of mainstream media relative to the average voter. It’s not a surprise to anyone remotely familiar with the average national journalist and the average voter, but you’d be surprised how few people understand both groups. Groseclose is a true conservative – not a libertarian like myself, but a social and fiscal conservative – in a liberal field (academia) who is very good at showing the pernicious effects of unstated ideology. Those are perhaps the most galling anecdotes in the book: journalists claiming that their strong and uniform ideology has no effect on their reporting. Wish that they were such angels, but they are not. Groseclose also quickly takes care of the usual objections to liberal media bias (corporate bosses are conservative! media just give people what they want! etc.) before measuring its effects.

Groseclose provides evidence from elections that journalists (political correspondents, specifically) vote Democratic ~93% of the time, compared to 50% for the average voter. That makes the average journalist much more liberal than the average citizen of Massachussets, or even of Berkeley, CA. The empirical evidence of journalist bias is overwhelming, and the conversion of ideological leanings onto a numerical scale is helpful in comparing magnitude of bias (although Groseclose treats the numbers as more precise than they are – there’s a big error margin around his estimates).

The best parts of the book take individual stories and show how reporters can put together a biased story using only true facts – by choosing the topic, the facts to show (and hide) and the experts to cite (or omit). Thus, a story of entirely true facts can tell you that the number of black students at UCLA is falling (when it is not) or that the Bush tax cuts are regressive (they were not). Of course, the audience doesn’t know what’s being omitted, so they have no way to compensate for these choices.

A similar omnipresent journalistic tactic is the insertion of qualifiers for anything that is conservative while omitting the same from liberal equivalents. You are told that someone is “the conservative regent” but not “the liberal dean” – she’s just “the dean.” Conservative viewpoints tend to get a “so-called” or “what critics call” prefix, while liberal viewpoints don’t. And now that you’re aware of this, you won’t be able to unsee it wherever you look.

The last quarter of the book is a little more speculative, purporting to show what the average American voter would be like if the information she had access to were undistorted. (Answer: Kansas.) The methodology here is a little less reliable, assuming linearities where that’s not necessarily warranted, but it’s hard to disagree with the conclusion that the average voter would be even more conservative if media were less biased.

Recommended, with the aforementioned error bars around precise measurements.

PS: If you have any doubt about the conclusions of this book, here are the stories that happened while I was reading it:

Politics Makes You Stupid, Part X

A baffling story:

One of the nation’s largest public-sector unions is severing its ties with the United Negro College Fund because the group accepted donations from the Koch brothers and its president spoke at a Koch-funded summit.

In a letter sent Tuesday, AFSCME President Lee Saunders wrote that the UNCF has taken actions “deeply hostile” to public employees, which he considers a “profound betrayal of the ideals of the civil rights movement,” and that the union will end its relationship with UNCF.

Saunders cited the UNCF’s decision to accept a $25 million grant from Koch Industries, Inc. and the Charles Koch Foundation as a reason for the split, as well as the decision by UNCF President Michael Lomax to speak at a summit hosted by the Kochs in California.

So…the Koch brothers are out $25 million which goes to black Americans, and this is a problem for the AFSCME? If they want to weaken the Koch brothers, having them donate money to causes AFSCME approves is a good way to go.

I’m A Doctor, Help Me Please

(Long post warning.)

Someone purporting to be a doctor posted an open letter on Quartz recently with a litany of complaints about how hard it is to be a doctor in America. This may be tough to explain to most people, given that the top nine, no, ten, no, seven, no twenty-one highest-paying occupations in America are medical professions, and doctors & surgeons average $168,650-$234,950 annually,* but our dear doctor spends many excessive words trying to explain to us how tough life is.

*I understand that salary goes up big time later, so young doctors tend to make less than that. That’s true of most professions, which is why they’re pretty good investments in the long run even if they make you poorer in the short run.

Keep an eye out for the repeated slamming of basically all other professions and the possibly rose-colored view of doctors’ motivations as you read this. I’ve tried to trim the fluff, but there are a lot of words here that are just unnecessary.

Dear Washington, D.C.:

I am writing this letter because I feel that our leaders and lawmakers do not have an accurate picture of what it actually entails to become a physician today; specifically, the financial, intellectual, social, mental, and physical demands of the profession. This is an opinion that is shared among many of my colleagues. Because of these concerns, I would like to personally relate my own story. My story discusses what it took to mold, educate, and train a young Midwestern boy from modest roots to become an outstanding physician, who is capable of taking care of any medical issues that may plague your own family, friends, or colleagues.

This is not going to work for me. Let’s try this again.

I am writing this letter because I feel that our leaders and lawmakers do not have an accurate picture of what it actually entails to become a physician today; specifically, the financial, intellectual, social, mental, and physical demands of the profession. This is an opinion that is shared among many of my colleagues. Because of these concerns, I would like to personally relate my own story. My story discusses what it took to mold, educate, and train a young Midwestern boy from modest roots to become an outstanding physician, who is capable of taking care of any medical issues that may plague your own family, friends, or colleagues.

Somewhat better, Mr. Outstanding Physician. But we’re not here to mock your writing ability; we’re here to mock your ideas.

I then enrolled at St. Louis University to advance my training for a total of eight years of intense education, including undergraduate and medical school. The goal was to prepare me to take care of sick patients and to save the lives of others (four years of undergraduate premedical studies and four years of medical school). After graduation from medical school at age 26, I then pursued training in internal medicine at the University of Michigan, which was a three-year program where I learned to manage complex problems associated with internal organs, including the heart, lungs, gastrointestinal tract, kidneys and others. I then went on to pursue an additional three years of specialty medical training (fellowship) in the field of gastroenterology. The completion of that program culminated 14 years of post-high school education. It was as that point, at the tender age of 32 and searching for my first job, that I could say that my career in medicine began.

I quote this in its entirety because it’ll be important later. I will just note here that the US has a shortage of primary care doctors, not specialists, so if your goal is to “take care of sick patients and to save the lives of others” you might have done that. If you were really as selfless as you claim, you’d have done in Somalia.

 For me, it began in college, taking rigorous pre-medical courses against a large yearly burden of tuition: $27,000 of debt yearly for four years. I was one of the fortunate ones. … I was fortunate to have graduated from college with “only” $25,000 in student debt. Two weeks after finishing my undergraduate education, I began medical school. After including books, various exams that would typically cost $1,000-$3,000 per test, and medical school tuition, my yearly education costs amounted to $45,000 per year.

Unlike most other fields of study,

You know, the easy ones. Like yours.

the demands of medical school education, with daytime classes and nighttime studying, make it nearly impossible to hold down an extra source of income. I spent an additional $5,000 in my final year for application fees and interview travel as I sought a residency position in internal medicine. After being “matched” into a residency position in Michigan, I took out yet another $10,000 loan to relocate and pay for my final expenses in medical school, as moving expenses are not paid for by training programs.

… I stared meekly at numbers on a piece of paper listing what I owed for the two degrees that I had earned, knowing full well that I didn’t yet have the ability to earn a dime. I didn’t know whether to cry at the number or be happy that mine was lower than most of my friends. My number was $196,000.

Rookie. I borrowed three quarters of that in less than three years.

$196,000. That was the bill, for the tuition, the tests, the books, the late-night pizza.

You don’t get to claim pizza. You’d have eaten regardless. Same for rent. Those costs apply in every other universe.

I then relocated to Michigan and moved into a small condo in Ann Arbor, where I started my residency. As a resident in internal medicine, I earned a salary of $39,000.

I wonder if you could have known what a starting resident in internal medicine earns before you started med school. Seems like there should be some sort of place where information can be looked up.

All the while, interest continued to accrue on my motherlode of debt at the rate of $6,000 per year due to the high-debt burden. Paying down this debt was not possible while raising two children. My wife began working, but her meager salary as a teacher was barely enough to cover daycare costs.

A lot of people I know believe that poor people are at fault for having children they can’t afford. You probably know those people, too. You’re probably also one of those people, then.

During residency, my costs for taking licensing examinations, interviewing for specialty training positions, and interest on the large loan ballooned my debt further, now exceeding $230,000, all before I began my career as a “real doctor.”

Occupational licensing is a pest indeed, but I feel less bad for you than for people forced into debt to be permitted to braid hair.

Relatives and friends often ask me, “Now that you are a ‘real’ doctor, aren’t you making the big bucks?” While I am fortunate to now be making a higher salary, some basics of finance make my salary significantly less than meets the eye. First, I was 32 years old as I began training and I now had over $230,000 in debt. Had I invested my talents in other pursuits such as law school, I would not have built up this level of debt.

You clearly weren’t paying attention up there, or to the world around you.

In addition, as physicians, though we make more money than many others, we are not reimbursed for many of the services that we provide.

“We make lots of money, but it should be more.”

We, as physicians, are always available for our patients no matter the time of day. We do not record time spent with patients as a means to our reimbursement as other professions do. No, we listen to patients and answer their questions, however long it may take. Even if it is the 30-second straight hour of work, which happens very often, we listen, respond, and formulate a logical plan.

Yup, this is exactly the experience we’ve all had with doctors. Always available and endlessly patient. I see nothing to object to here.

And if we don’t do our work well, we don’t just lose business, but we can lose our livelihood through lawsuits.

Don’t you just hate it when you’re held accountable like literally everybody else (outside of government officials)?

You may ask why do we do all of this? It’s because we have pride in what we do. We truly care for the well-being of the human race. We have been conditioned to think, act, talk, and work as a very efficient machine, able to handle emotions, different cultures, different ranges of intellect, all to promote the health of America. We are doctors.

That seems accurate.

In reading this letter, one may think that one has to sacrifice a significant amount to become a great physician. You may think we face physical and mental stress that is unparalleled. You may begin to think that doctors not only have to be smart, but they have to know how to communicate with others during very emotional times. You may think that we must face adversity well and must develop very rough skin to handle all walks of life, especially when dealing with sickness and death on a daily basis.

No, I think you should not have skipped English and math class.

Now that you see this additional aspect to our career, you may think that we have a tough job to tackle several tasks at once, demanding much versatility. You may think someone needs a great work ethic to do what we do. You must think that not only do we have to know science extremely well, we also have to know other areas such as writing, history, math, even law given the multiple calculations we go through in our heads on a daily basis and conversations we have with families. And finally, you must think we know finance, as we have to try balance a $230,000 loan while making $50,000 at age 30.

Ballsy, to claim knowledge of “writing” and “math” given this letter and your shock that borrowing money causes debt to rise. Also, you make way less than the average doctor. Maybe that’s because you’re still young, or maybe that’s because you’re a terrible doctor. Either way, the problem solves itself.

Now imagine, if you would, having $230,000 dollars in debt with two young children at age 30 and listening to the news with lawmakers saying that doctors are “rich” and should have their pay cut. Or that “studies show that doctors lack empathy.”

Ugh, studies. Don’t get me started. No doctor worth his salt would pay attention to a study.

Unfortunately, we physicians do not have much of a voice on Capitol Hill. There are not enough doctors in Washington, D.C., who can give the insight of this letter while you in Washington, D.C., discuss healthcare reform. … Many of the loudest voices in the healthcare debate are those of lawyers and lobbyists for special interests. They do not care about the well being of patients; that is what doctors do.

Well, yes. Everyone but you is an asshole. They only lobby for themselves, whereas you, the selfless caregivers, only wish you were better at lobbying for yourselves.

I want to make it clear that this letter is not just another story about the difficulties of becoming a doctor and being successful in medicine. I do not want you to think I am complaining about how hard my life is and used to be. In fact, I love my job and there is no other field I would ever imagine myself doing. My true wish is to illustrate the sacrifices doctors do make because I feel we are not represented when laws are made. These sacrifices include a lack of quality family time, our large student loan debt, the age at which we can practically start saving for retirement, and the pressure we face with lawyers watching every move we make. Yet we make these sacrifices gladly for the good of our patients.

Well, “gladly” seems out of place in this paragraph.

I want to challenge our leaders

I don’t have leaders. Stop saying that.

to address the points I have made in this letter, keeping in mind that this is an honest firsthand account of the personal life of a newly practicing physician. It is a letter that speaks for almost all physicians in America and our struggles on our arduous yet personally rewarding life. It is not just a letter of my own journey, but one that represents most physicians’ path on our way to caring for America’s sick.

I have no doubt that it’s an honest account of one man’s view of his own life and his importance to the world. I doubt it’s a worthwhile to contribution to any discussion worth having.


Slow posting these last couple of days as a result of plentiful World Cup games to watch, a flurry of important Supreme Court decisions to wade through, and that full-time job I have. I’ll have a review of the WC group stage tomorrow and new knockout stage predictions on Saturday, but in the meantime, a few thoughts on miscellaneous topics from the past few days:

  • It’s been extremely pleasant to watch soccer culture grow stronger in the US by the day, even if a certain shrieking witch thinks otherwise. (I do not link to trolls.) I’m more reserved than the average American about US potential in the short term, but there’s something pleasant about universal joy and pain in a relatively harmless endeavor. I’ve written in this space before that there are plenty of reasons to dislike organized sports, and FIFA is a major reason why, but if I had to choose, I’d prefer the US be united by Fabian Johnson than by bombing campaigns abroad.
  • Relatedly, “guy famous for biting opponents bites an opponent” was a real story this week, so that’s something we all have to live with now.
  • I haven’t commented on the ongoing IRS email scandal (in short, a top IRS official claims her email relevant to the IRS’s targeting of conservative groups was lost in a computer crash days after an investigation into that began) because it’s still early, and because it’s unlikely we can ever definitively know many things I’d need to know before making judgments. Obviously it’s possible that this is an innocent mistake, made possible by the government’s awful IT policies, and it’s also possible that it was staged to avoid some embarrassing emails from emerging. What you believe probably has more to do with whom you voted for in 2012 than the evidence, so I won’t get into it. I do like that the country seems to be noticing the hypocrisy involved – the IRS wouldn’t let anyone get away with a story like that – and perhaps the abuse of the office for political purposes will make more people realize that we shouldn’t entrust a whole lot of power to these agencies.
  • There was a massive downward revision to the first-quarter US GDP estimate, and everyone is revising what it all means. All you need to know is that everyone was right initially and everyone is right now.
  • Can’t forget to congratulate my Vanderbilt Commodores for winning the NCAA baseball championship (which I refuse to call the World Series). Great accomplishment for a great school.