Minor Thoughts from me to you

Happy Birthday America. Let's remember how it all began.

And here's the best dramatic reading I've seen, of the entire Declaration of Independence.

I just learned about two new books that I'm interested in reading. (Editor: Isn't that true of every book you hear about?)

This one interests me because Dr. John Walton interests me. I transcribed a sermon he gave on Genesis one, Why Didn't God Call the Light, Light?, and have read some shorter pieces he's written. His perspective on the Origins debate and Genesis one is unique and thought provoking. I've wanted to learn about it in more detail ever since I heard his message. This book is my big chance.

Westminster Books has a PDF with some sample pages from the book. The publication date is "July 30, 2009", but Amazon claims to have it in stock. Amazon also includes two brief blurbs for the book:

This book presents a profoundly important new analysis of the meaning of Genesis. Digging deeply into the original Hebrew language and the culture of the people of Israel in Old Testament times, respected scholar John Walton argues convincingly that Genesis was intended to describe the creation of the functions of the cosmos, not its material nature. In the process, he elevates Scripture to a new level of respectful understanding, and eliminates any conflict between scientific and scriptural descriptions of origins. ----Francis S. Collins, head of the Human Genome Project and author of The Language of God

Walton's cosmic temple inauguration view of Genesis 1 is a landmark study in the interpretation of that controversial chapter. On the basis of ancient Near Eastern literatures, a rigorous study of the Hebrew word bara' ('create'), and a cogent and sustained argument, Walton has gifted the church with a fresh interpretation of Genesis 1. His view that the seven days refers to the inauguration of the cosmos as a functioning temple where God takes up his residence as his headquarters from which he runs the world merits reflection by all who love the God of Abraham. -- The Publisher

This one interests me because John Calvin interests me and this is a novelization of his life. Since I discovered it through Tim Challies's review, I'll let him do the talking.

The Betrayal, published by P&R; Publishing, comes from the pen of Douglas Bond who has written several historical fiction novels in the past. In this new book, he writes from the perspective of a lifelong sworn enemy of Calvin--a boy who grows up in the same town and who, as a man, remains involved with Calvin's life to the very end. As the publisher says, "This fast-paced biographical novel is a tale of envy that escalates to violent intrigue and shameless betrayal." I hesitate to say too much about the plot lest I inadvertently ruin it for those who would like to read the book.

... As for me, well, I'll be honest and say that I read fiction only on rare occasions and my preference would always be to read a standard biography over a historical novel. However, I do know that a lot of readers prefer fiction and for these people, I think The Betrayal will be a great way of getting a useful overview of Calvin's life. I was sometimes amazed at just how much of Calvin's life is present in this book but never in such a way that the novel becomes bogged down in irrelevant details. Bond has done a great job of integrating reality with fiction so the reader will hardly know when one begins and the other ends.

If you are a fan of novels or of historical fiction, and if you are anxious to learn a little bit about John Calvin, this man who is so fondly remembered even five hundred years after his birth, you cannot go far wrong in reading The Betrayal.

I like novels a lot more than I like most biographies (killing the memory of great people and events under a pile of dusty prose since the beginning of time), so this is the "biography" of Calvin that I'd like to read.

Michael J. Totten: The Future in Iraq, Part 1.

On the Jaysh al Mahdi, Moqtada al Sadr's radical Mahdi Army militia:

Hajji Jasim, General Nasser's guest from the office of the Mahdi Army's "political wing," sat next to Major Kareem on the couch. "Understand something," he said to Captain Heil. "In the media, JAM only pretends to oppose the Status of Forces Agreement. Privately, we like it. It helps Sadr more than anything else. Those committing violence are going against Sadr's orders. You wanted the occupation to last 20 more years. Now, under SOFA, it's down to three years. That's great for us."

When I met Tom Ricks a few weeks ago, he relayed to me an interesting anecdote from his new book about the surge called The Gamble. "Sadr's people entered into secret negotiations with the United States in, I think, 2007, about whether or not to have negotiations," he said. "They said before we begin any talks, we have to have a date certain when you will withdraw from Iraq. The American policy said we can't do that. So the Sadrists said well, then we can't have talks. Then the Americans said, well, just out of curiosity, what was the [withdrawal] date you had in mind? The Sadrists said 2013. Which put them on the right-wing of the U.S. Congress."

On the use of force in Iraq:

Iraq has never been successfully governed by anyone but a strongman. You might even say Iraq has never been successfully governed at all. Who today sincerely believes the use of force by Saddam Hussein's Baath Party regime was an effective "remedy" for the Iraqi people, as General Nasser put it? Still, despite my unease with what he was saying, I don't think he necessarily meant a totalitarian system is the solution to what ails Iraq.

"Twelve JAM members were brought to court recently," he said. "They asked to be put under American justice because you are softer and jail people under better conditions. Iraqis are not like Americans. You are educated, we aren't. Without force, Iraqis cannot be civilized. Americans don't use real force. You talk to people nicely and worry about human rights."

On peace in the Middle East:

"If the U.S. solves three problems," the general said, "American-Arab relations will be very good. First, resolve the Arab-Israeli conflict. Second, promote democracy in the Arab world. Third, destroy the Wahhabis. If you solve these problems, all will be well."

On pro-American Iraqis:

Sometimes it's hard to tell if Iraqis who talk the pro-American talk are sincere or if they're just blowing smoke. General Nasser, I think, was sincere. His body language and tone of voice said so, as did the naked calculation of his own interests.

"I had Iraqis here at my house recently," he said. "I told them Americans are better than you because they keep their word and they are disciplined. American people are not profiteers. Their wisdom led them to this. I want Iraqis to learn about American honor."

On the feelings toward American soldiers:

Iraqi public opinion is hard to read. Most Arabs are exceptionally polite and hospitable people, and they'll almost always conceal any hostility as a matter of course. That's true everywhere in the Arab world as long as the people aren't violently hostile.

Much of Iraq used to be violently hostile. Even kids in Sadr City used to throw rocks at American soldiers. Some Baghdad neighborhoods were so dangerous that Americans who left the relative security of their base had a 100 percent chance of being attacked. Overt hostility is rare now, and violent attacks are even rarer. Something important has changed. Reconciliation between Americans and Iraqis is real.

On the rule of law:

"The insurgency now is more criminal than anything else," Colonel Hort said. "The Al Qaeda threat isn't down to that point yet, but Shia insurgents are becoming more and more criminal than anything else. We're working closely now with Iraqi judges, as well as Iraqi Security Forces, to ensure that when we identify a guy we're getting a warrant and arresting the guy that way. It's a significant change for us that we now need a warrant to make an arrest like we do in the States."

Some American officers I met are worried that more terrorists and insurgents will remain at large now that warrants are needed for their arrest, but others are convinced this is wonderful news. It is, at least for the time being, just barely possible to wage a counterinsurgency using law enforcement methods instead of war-fighting methods. There is such a thing as an acceptable level of violence, and Iraq is nearer to that point than it has been in years. Baghdad is no longer the war zone it was.

Some also say a transition to warrant-based arrests now instead of later gives American officers time to train their local counterparts how the rule of law works instead of letting the Iraqis sink or swim on their own later.

Read the full article, please.

Between Two Worlds: All of Grace:

Jerry Bridges, The Discipline of Grace (p. 19):

Your worst days are never so bad that you are beyond the reach of God's grace.

And your best days are never so good that you are beyond the need of God's grace.

And from pp. 22-23:

Pharisee-type believers unconsciously think they have earned God's blessing through their behavior.

Guilt-laden believers are quite sure they have forfeited God's blessing through their lack of discipline or their disobedience.

Both have forgotten the meaning of grace because they have moved away from the gospel and have slipped into a performance relationship with God.

Together for Adoption: The Forgotten Part of James 1:27

The world tells us that our fundamental identity is determined by our performance not by the performance of another (i.e., Jesus). It seduces us to believing (often unknowingly) that our main sense of significance is found in what we do or in what we're involved in.

It might look like this: "God is pleased with me because I have given my life to caring for the least of these." Now, does God smile at us when we care for orphans? Yes, but if the main way we sense his smile is by our efforts to care for orphans, then chances are we've become stained by the world.

If our primary sense of God's smile upon us comes from our involvement in caring for the least of these, then it's highly likely that to some extent our lives are performance-based rather than grace-based. In other words, it may be that my functional paradigm of Christian living is: "I share God's heart for the orphan; therefore, God is pleased with me," rather than "God is pleased with me because of Jesus; therefore, I am freed to care for the orphan." There is a massive difference between these two ways of thinking. To think the first way is to be stained by the world. To think the second way is to be unstained by the world.

I've been spending time this weekend catching up on some of the articles that I marked for reading over the last couple of months. This morning, I read How David Beats Goliath by Malcom Gladwell.

He tells several stories throughout the article to illustrate his main points: underdogs have to change the rules of the game.

How?

• Change the speed of the game
• Supplant superior ability with superior effort: work harder than the competition.
• Do what is socially horrifying: "challenge the conventions about how battles are supposed to be fought".
• Accept the disapproval of the insider's.
• Be prepared for Goliath to insist on unfair rules -- rules that only benefit Goliath.

Goliath doesn't like to lose. He'll stack the deck and insist on playing on terms that are favorable to him. Your job -- whether in sport, business, or battle -- is to exploit every loophole he gives you, to change the rules as much as possible, and to resist the pressure to conform to Goliath's rules.

Here's a few of my favorite quotes from the article:

What happened, Arreguin-Toft wondered, when the underdogs likewise acknowledged their weakness and chose an unconventional strategy? He went back and re-analyzed his data. In those cases, David's winning percentage went from 28.5 to 63.6. When underdogs choose not to play by Goliath's rules, they win, Arreguin-Toft concluded, "even when everything we think we know about power says they shouldn't."

... David's victory over Goliath, in the Biblical account, is held to be an anomaly. It was not. Davids win all the time. The political scientist Ivan Arreguin-Toft recently looked at every war fought in the past two hundred years between strong and weak combatants. The Goliaths, he found, won in 71.5 per cent of the cases. That is a remarkable fact. Arreguin-Toft was analyzing conflicts in which one side was at least ten times as powerful--in terms of armed might and population--as its opponent, and even in those lopsided contests the underdog won almost a third of the time.

... We tell ourselves that skill is the precious resource and effort is the commodity. It's the other way around. Effort can trump ability--legs, in Saxe's formulation, can overpower arms--because relentless effort is in fact something rarer than the ability to engage in some finely tuned act of motor coordination.

... This is the second half of the insurgent's creed. Insurgents work harder than Goliath. But their other advantage is that they will do what is "socially horrifying"--they will challenge the conventions about how battles are supposed to be fought. All the things that distinguish the ideal basketball player are acts of skill and coordination. When the game becomes about effort over ability, it becomes unrecognizable--a shocking mixture of broken plays and flailing limbs and usually competent players panicking and throwing the ball out of bounds. You have to be outside the establishment--a foreigner new to the game or a skinny kid from New York at the end of the bench--to have the audacity to play it that way.

... The price that the outsider pays for being so heedless of custom is, of course, the disapproval of the insider. Why did the Ivy League schools of the nineteen-twenties limit the admission of Jewish immigrants? Because they were the establishment and the Jews were the insurgents, scrambling and pressing and playing by immigrant rules that must have seemed to the Wasp elite of the time to be socially horrifying. "Their accomplishment is well over a hundred per cent of their ability on account of their tremendous energy and ambition," the dean of Columbia College said of the insurgents from Brooklyn, the Bronx, and the Lower East Side. He wasn't being complimentary. Goliath does not simply dwarf David. He brings the full force of social convention against him; he has contempt for David.

... But let's remember who made that rule: Goliath. And let's remember why Goliath made that rule: when the world has to play on Goliath's terms, Goliath wins.

The Safeway grocery store chain created its own health plan for its employees. That's not unique -- many employers do that. Over the past four years, the average U.S. company has seen per-capita health care costs rise by 38%. Over the past four years, Safeway's per-capita health care costs have remained flat. That's a tremendous accomplishment and a great competitive advantage.

They did it by giving their employees responsibility over their own health and their own healthcare costs.

Safeway's plan capitalizes on two key insights gained in 2005. The first is that 70% of all health-care costs are the direct result of behavior. The second insight, which is well understood by the providers of health care, is that 74% of all costs are confined to four chronic conditions (cardiovascular disease, cancer, diabetes and obesity). Furthermore, 80% of cardiovascular disease and diabetes is preventable, 60% of cancers are preventable, and more than 90% of obesity is preventable.

... As with most employers, Safeway's employees pay a portion of their own health care through premiums, co-pays and deductibles. The big difference between Safeway and most employers is that we have pronounced differences in premiums that reflect each covered member's behaviors. Our plan utilizes a provision in the 1996 Health Insurance Portability and Accountability Act that permits employers to differentiate premiums based on behaviors. Currently we are focused on tobacco usage, healthy weight, blood pressure and cholesterol levels.

Safeway's Healthy Measures program is completely voluntary and currently covers 74% of the insured nonunion work force. Employees are tested for the four measures cited above and receive premium discounts off a "base level" premium for each test they pass. Data is collected by outside parties and not shared with company management. If they pass all four tests, annual premiums are reduced $780 for individuals and $1,560 for families. Should they fail any or all tests, they can be tested again in 12 months. If they pass or have made appropriate progress on something like obesity, the company provides a refund equal to the premium differences established at the beginning of the plan year.

Not only have these incentives saved employees a lot of money, they've also dramatically improved employee health.

Our obesity and smoking rates are roughly 70% of the national average and our health-care costs for four years have been held constant. When surveyed, 78% of our employees rated our plan good, very good or excellent.

Safeway would like to make their program even better. But the Federal government won't let them.

Today, we are constrained by current laws from increasing these incentives. We reward plan members $312 per year for not using tobacco, yet the annual cost of insuring a tobacco user is $1,400. Reform legislation needs to raise the federal legal limits so that incentives can better match the true incremental benefit of not engaging in these unhealthy behaviors. If these limits are appropriately increased, I am confident Safeway's per capita health-care costs will decline for at least another five years as our work force becomes healthier.

That's reform that won't cost taxpayers anything. That's reform that will actually "bend the cost curve" and reduce the cost of insurance. That's reform that will improve health not just finances.

Why isn't Washington working on that kind of reform? Why does Washington prevent insurance companies and employers from offering more of those incentives?

I just had two nice, young college age boys stop by my house. They were in the area representing a window installation company. Their company is trying to drum up business by setting up appointments for their "consultants" to tell me how their energy efficient windows will save me money on my energy bills.

That's a sales pitch that only works for those who don't think about it. I have thought about it, so I made them think about it.

I asked a simple question: "what's the payoff time? how long would it take for the new windows to pay for themselves?"

Well, they tried to duck the question. "That'd be a great question for our consultants..."

I interrupted: "Do you have a ballpark estimate?"

"No."

"Tell your consultants to send you out with a ballpark next time and I might be willing to talk." I didn't let them leave me a flyer either.

I've done the math on this before. My gas / electric bill is $170 a month. Installing new windows throughout the entire house will cost us between $2500 and $7000, depending on the make, model, and installer. It's a simple problem of division. Assuming their windows were miracle windows and eliminated my entire energy bill (hah!), it would take between 15 and 41 years for my new windows to pay for themselves.

There are many good reasons to install new windows. Energy efficiency is not one of them. Not even close.

Shawn Tully, at Fortune, details 4 reasons why the current healthcare "reform" bill will do more to raise costs than lower them.

First, they will impose rich, standard packages of benefits, with low deductibles, for all Americans. Those policies, typically containing everything from in-vitro fertilization to mental health benefits, are usually far more expensive than anything most people would pay for with their own money.

Second, the plans would impose on a federal level the doctrine of community rating, in which all customers have to be offered the same rates, regardless of their health risks. Community rating forces young people to pay far more than their actual cost, a main reason for today's 46 million uninsured, while it subsidizes older patients.

Third, Obama would ban consumers from buying private insurance across state lines, perpetuating the price differences in today's fragmented market, instead of allowing all Americans to shop anywhere for the best deals.

Fourth, both plans propose what's known as a "public option," or a Medicare-style plan that would compete with the private offerings. The previous three proposals would make the private plans extremely expensive. With the same subsidies, the Medicare-style plan could put them out of business.

This plan will only lower the price of health care if by "price" you mean premiums and payments made directly to insurers or health care organizations. But if you include the necessary taxes and subsidies in your definition of "price", well, the price is going to go straight through the roof.

Adam, I'm ecstatic to hear about Sam Dodson's recent success. It's about time we libertarians see something positive happen.

And yet, I'm not sure that I feel free to emulate his example. After all, I have a wife and children to support. They depend on my job to keep our house, keep our healthcare, and keep us in groceries that don't come from a dumpster. That's a big responsibility and one I feel daily.

I'd love to follow in his footsteps. I'd love to challenge the State -- and win. I'd love to pledge "my life, my fortune, and my sacred honor" to the service of Lady Liberty. She's a fine Lady. But doing so feels like a self-indulgent hobby when I have more than myself to worry about.

Perhaps some forms of resistance are best left to those who are relatively unattached -- or who feel the jack boot of oppression more strongly. For now, I'm more inclined to support a series of libertarian tracts than I am to risk serious jail time. I don't think that our fellow citizens are beyond persuasion yet.

Perhaps a two pronged approach may yet be successful.

Earlier today, the American Academy of Physician Assistants issued an urgent Action Alert:

In a speech before the American Medical Association today, President Obama once again restated his commitment to building America's primary care workforce of "physicians and nurse practitioners" - omitting PAs from the discussion.

Please contact President Obama today. Let him know that PAs are listening- and that we are gravely concerned that we're not hearing a similar commitment to physician assistants.

PAs are the future of health care, and must make their voices heard. Contact the President today with a special message: PAs are a Critical Part of Health Care Reform.

I knew about it because a friend -- who's studying to become a PA -- emailed me and asked me to contact President Obama. She asked me to emphasize how important it was that PA's be part of the solution. Here was my response.

I can't do that. I disagree with the entire premise of healthcare "reform". The AAPA and Congress are both operating on a flawed assumption: the idea that it's even possible to create a plan that works for all Americans. It's not.

No one person, or group of people -- no matter how smart -- has the ability to create a health plan that meets the needs of 300 million unique individuals. No one group has enough information to make good decisions for everyone. Every patient has different needs, different backgrounds, different abilities, different family structure, different reactions, and different prejudices. I know you've seen this in your experiences in healthcare.

Through family, through friends, through my wife and through my job, I've heard a lot of stories about healthcare. One thing I've learned is that doctors (and PA's) have trouble coming up with a treatment plan that works for one patient. Often, the patient and the doctor have to work together over a period of time to figure out what works best for the specific condition and patient. How much harder -- how much more impossible -- is it to define a plan that works for everyone?

The necessary knowledge doesn't exist in one database, one field, one speciality. It's dispersed through many different people, each holding incomplete and sometimes seemingly contradictory information. I'm not just talking about medical information either. Each patient has a different willingness to undergo treatments, a different tolerance for discomfort, and a different preference for how long to continue treatment. How can one committee, how can one plan, possibly work for all people?

The answer is not to centralize decision making in Washington, D.C. or even in Madison, WI and Albany, NY. The answer is to give each patient, each doctor, each PA, the full freedom they need to reach the decisions that work best in the individual circumstances.

In the end, it's the patient that must be free to make all of the required decisions. Doctors, nurses, PAs, and healthcare organizations ultimately listen to whoever is paying the bills. Right now, that's Medicare, Medicaid, and the insurance companies. As a result, healthcare professionals are far more responsive to the desires of big government and big insurance -- not to patients. The solution is to return control to the patients -- not to take it further away from them.

Here's an interesting statistic (page 417): in 1960, 55 cents of every dollar of health care was out-of-pocket. In 2003, it was down to 16 cents. Today, the rest is paid through taxes and insurance premiums. And all of that insurance hasn't saved anybody any money. Healthcare costs today are 80% higher than they were in 1960. Put a different way, patients are only paying 16% of the costs out of pocket but the total costs have skyrocketed. That hasn't exactly turned out to be a great deal.

I feel very strongly that we'd be much better off if we started paying for healthcare the same way we did in the 1960s. If patients pay more out of pocket at the place of service, they'll ultimately get higher quality care. Overall costs will drop (through increased price transparency and competition) and patients will save money in the end.

And, yes, there will always be people who's injuries and illnesses exceed their financial resources. But they would be better served through block grants than through government plans, payments, and rationing. If they need financial assistance, give them extra finances. But allow them to control how, when, and where they're treated.

That's healthcare reform that will truly change things. Trying to create a nationwide plan by getting all of the special interests involved will just result in more of the same failed healthcare policies that we've seen over the last 20 years.

Confirming what I've suspected: "So far, June's chill is one for the records". http://bit.ly/o5LKx

Last week I said that "my health insurance reform plan would involve shifting healthcare spending from large premiums and all-inclusive health "insurance" plans to small premiums and plans that only offer catastrophic insurance coverage. Patients would have more money left in their pocket, to allow them to pay more money out of pocket".

Two days ago, while driving to work, I saw a gentlemen standing by the side of the road holding a sign. It proclaimed "Doctors support affordable healthcare for all". Great! I'm glad to hear it. We need more people on board with affordable healthcare.

But affordable healthcare isn't always what you think it is. Paradoxically, charging people more -- paid directly, out of their own pocket -- can actually lead to people paying less. And this isn't just pie-in-the-sky ivory tower theory. The savings effects of higher out of pocket costs are real.

The paper contends that, contrary to recently recommended policy changes by the Centers for Medicare and Medicaid Services that exclude incentives through copay or co-insurance for chronically ill beneficiaries and high-value medications that target chronic conditions, the effectiveness of such incentives in driving business-based results is documented: At Caterpillar, for example, generic statins for cholesterol management were moved to a $0 co-pay; brand-name statins, to $35 per month or no benefit paid, depending on the dose. The plan, which covers 90,000 people, saw increased medication compliance, contributing to a $750,000 per month savings to the company and $175,000 savings per month to employees.

"These barriers to the implementation of incentives actually reduce their impact and have the potential to reduce any measurable progress," the report says of the CMS recommendations.

At Caterpillar, patients were given a financial incentive: the cheaper drugs cost them less and the expensive drugs cost them more. Normally, these price differences are hidden behind a one-size fits all copay which is supported by the monthly premiums. Normally, the cost of individual healthcare treatments is obfuscated by the overcall cast of the healthcare "plan".

Caterpillar brought some of those costs out into the light -- and reduced them. Obama and the Democrats have been discussing healthcare "reform" for the pat several months. They're desperately looking for a way to "bend the cost curve" and hold down the cost of healthcare. I think Caterpillar found a way. It's simple: charge patients more and they'll pay less.

I hope everyone who supports "affordable healthcare for all" will support my plan.

Something I've been thinking lately. Am I different as a Christian than I would be if I wasn't a Christian? Am I just wasting my life?

In My Blood

Katongole offers a clear and insightful history of what happened in Rwanda before the genocide, including the fast advance of Christianity. He then offers compelling analysis of what happened during the genocide, particularly amongs Christians, who were using machetes to violently kill one another. But Katongole doesn't stop there. He challenges us to learn lessons from this ugly history. He challenges us to never think that "I'd never do that!" or "That will never happen here!"

Last night I read these words in Mirror to the Church: "Maybe the deepest tragedy of the Rwandan genocide is that Christianity didn't seem to make any difference. Rwandans performed a script that had shaped them more deeply than the biblical story had. Behind the silences of the genocide, Hutus and Tutsis alike were shaped by a story that held their imagination captive." Then, Katongole goes on to offer this challenge: "Paying attention to history helps us to see that this was not just Rwanda's problem. The story that made Rwanda is the story of the West. When we look at Rwanda as a mirror to the church, it helps us realize what little consequence the biblical story has on the way Christians live their lives in the West. As Christians, we cannot remember the Rwandan genocide without admitting that the gospel did not seem to have a real impact on most Rwandan's lives. Seeing this, we have to ask: does Christianity make any real difference in the West?" Wow.

Don't Waste Your Life

Suffer/ Yeah do it for Christ if you trying to figure what to do with your life/ if you making a lot money hope you doing it right because the money is Gods you better steward it right/ stay focused if you ain't got no ride/ your life ain't wrapped up in what you drive/ the clothes you wear the job you work/ the color your skin naw you Christian first/ people living life for a job/ make a lil money start living for a car/ get em a house a wife kids and a dog/ when they retire they living high on the hog/ but guess what they didn't ever really live at all/ to live is Christ yeah that's Paul I recall/ to die is gain so for Christ we give it all/ he's the treasure you'll never find in the mall/ Your money your singleness marriage talent and time/ they were loaned to you to show the world that Christ is Divine/ that's why it's Christ in my rhymes/ That's why it's Christ all the time/see my whole world is built around him He's the life in my lines/ I refused to waste my life/ he's too true ta chase that ice/ here's my gifts and time cause I'm constantly trying to be used to praise the Christ/ If he's truly raised to life/ then this news should change your life/ and by his grace you can put your faith in place that rules your days and nights.

Health Reform's Savings Myth, by Arnold Kling:

Anyway, what I was looking for on the web was a link to this article, which says that modern doctors are too beholden to insurance companies, rather than to patients. Nowhere does the the author mention that in 1960 fifty percent of personal health care expenditures were paid for by patients themselves, whereas now it is only ten percent. Instead, he writes as if modern doctors are greedier than they used to be.

Doctors have bills to pay into. But most patients expect their doctor to ignore the person paying the bill and listen to the person demanding that they (the doctor) do something that might reduce the payment. And then the patient gets angry when the doctor does no such thing.

That's why my health insurance reform plan would involve shifting healthcare spending from large premiums and all-inclusive health "insurance" plans to small premiums and plans that only offer catastrophic insurance coverage. Patients would have more money left in their pocket, to allow them to pay more money out of pocket.

Do that and you'll discover that doctors are suddenly more responsive to patient needs and desires.

Keith Hennessey: Basic facts on the General Motors bankruptcy. http://bit.ly/kJJFg

Ian Murray on GM: Cut out the union liability and the requirement to build small cars and you have a profitable company. http://bit.ly/7cmsz

GM files for bankruptcy. http://bit.ly/axWCW It should have happened a year ago and it should have happened without government bailouts.

Law professor Richard Epstein doesn't like Judge Sotomayor either. He points out that she issued a lousy opinion trampling all over property rights.

Here is one straw in the wind that does not bode well for a Sotomayor appointment. Justice Stevens of the current court came in for a fair share of criticism (all justified in my view) for his expansive reading in Kelo v. City of New London (2005) of the "public use language." Of course, the takings clause of the Fifth Amendment is as complex as it is short: "Nor shall private property be taken for public use, without just compensation." But he was surely done one better in the Summary Order in Didden v. Village of Port Chester issued by the Second Circuit in 2006. Judge Sotomayor was on the panel that issued the unsigned opinion--one that makes Justice Stevens look like a paradigmatic defender of strong property rights.

I have written about Didden in Forbes. The case involved about as naked an abuse of government power as could be imagined. Bart Didden came up with an idea to build a pharmacy on land he owned in a redevelopment district in Port Chester over which the town of Port Chester had given Greg Wasser control. Wasser told Didden that he would approve the project only if Didden paid him $800,000 or gave him a partnership interest. The "or else" was that the land would be promptly condemned by the village, and Wasser would put up a pharmacy himself. Just that came to pass. But the Second Circuit panel on which Sotomayor sat did not raise an eyebrow. Its entire analysis reads as follows: "We agree with the district court that [Wasser's] voluntary attempt to resolve appellants' demands was neither an unconstitutional exaction in the form of extortion nor an equal protection violation."

She may be empathetic towards plaintiffs but I'm not sure how that's suppose to reassure me. I didn't grow up poor and I didn't graduate from Yale law school, but Greg Wasser's demand sure sounds a lot like extortion to me. If her court will allow rich, politically connected developers to use government connections to demand payoffs from politically weak property owners -- where exactly does that leave the poor?

Was Bart Didden's case just not sympathetic enough for her?

The pharmacy profession likes to think of itself as an indispensable part of the healthcare landscape. The APhA (American Pharmacists Association) says that pharmacists are "essential in patient care for optimal medication use". That implies that pharmacists spend a lot of time educating patients about their drugs and advising doctors on the best drugs to use.

But talk to a retail pharmacist about her job sometime. Listen closely to what she does most often. You'll find that she's basically a human vending machine. When she's not grabbing drugs off of a shelf and putting them in a bag for patients, she's probably swiping an insurance card and figuring out how much they owe. Occasionally, she'll get to answer questions about how the drug works and how it interactions with other medicines, but that's comparatively rare.

Enter the pharmacy vending machine.

Integrity Urgent Care, 4323 Integrity Center Point, in northeast Colorado Springs, recently installed a machine stocked with dozens of common prescriptions -- antibiotics, painkillers, asthma inhalers and oral steroids. It dispenses patients' medications like a bag of potato chips or package of Skittles, and it is the first such machine in Colorado, according to the Minneapolis-based manufacturer, InstyMeds.

The process works like this: The doctor or physician's assistant submits the prescription electronically to the machine and gives the patient a code. The patient types in the code and a birthdate and receives the medicine after the bar code is triple checked.

A phone on the machine connects the user directly to a pharmacist 24/7 if the customer has questions or concerns.

If you're job is to perform the function of a vending machine, you probably won't be too happy that an actual vending machine is being used. Enter, the APhA spokesperson:

Kristen Binaso, a New Jersey pharmacist and spokesperson for the American Pharmacists Association, said people need quick access to their medications, but she said people should understand that a drug is not a package of Ritz crackers. Even certain common drugs can increase sensitivity to the sun, react negatively to alcohol, cause diarrhea, or interact with vitamins, herbs and over-the-counter drugs.

Her statement ignores something: the FDA mandates that all drugs come extensively labeled with warnings about every possible danger or complication. So, it sounds like a vending machine can replace much of what a retail pharmacist does on a regular basis.

And, this is a good thing. I wish that more pharmacists would recognize this. There is a very limited future in taking an average prescription, putting the pills in a bottle in a bag, reading the list of drug warnings, and taking payment.

The future of pharmacy is in the work that machines can't (yet) do: helping a patient recognize what the "blue pill", "red pill", "square yellow pill", and "round yellow pill" actually are. Helping that patient understand what each drug is supposed to, how it should make them feel better, what to be aware of when it it's not working, knowing which side effect goes with which drug(s), etc. Pharmacists have a great future in helping patients know whether their particular cocktail is safe or whether there's a potentially deadly interaction between multiple drugs.

But all of that counseling work can't be done well in today's retail setting. Today's retail setting is focused around volume, not around thorough counseling sessions. And that's not going to change until retail pharmacists are willing to allow vending machines to take over the tedious, rote work of actually dispensing pills.

On a closing note: what does it mean when people talk about a shortage of pharmacists? Are they referring to a shortage of dispensers? Well, technology can help with that? Or are they referring to a shortage of counselors? Technology can help with that too. By freeing pharmacists from the drudgery of being a vending machine, technology will create more pharmacist hours to be used for counseling. It will be as though thousands more pharmacy graduates entered the market, ready to help.

Thank you InstyMeds. You're helping to take us forward to the future.

President Barack Obama nominated appeals court judge Sonia Sotomayor to the Supreme Court today. I don't like her, as a judge.

Here's what I mean. The Law is the bedrock foundation of society. It is the set of rules by which society operates. For a society to be just, it must have one set of rules that applies to all people. Judges apply the rules to individual events as cases are brought before them.

For a society to be just, the judges must apply the Law the same way every time. It doesn't matter if the plaintiff is rich or poor, young or old, of minority or majority race, male or female, popular or unpopular, respectful or vulgar, thin or obese, short or tell, blonde or brunette -- it doesn't matter. The justice must apply the Law the same way to everybody. Any other standard is an injustice.

Now, it's true. Certain legislation may lead to unjust outcomes. But that is a political issue, not a legal issue. People must work through their government representatives to change the Law. Judges can only apply the Law as it is written. If each judge hands down the opinion that he or she feels is most "right", a person's rights and privileges depend not on impartial Laws but on the whims of powerful, unaccountable individuals.

I don't think that Justice Sotomayor meets that standard. She has fallen short in both her words and her previous judicial rulings.

In 2001, she gave a speech entitled A Latina Judge's Voice. She said:

Justice O'Connor has often been cited as saying that a wise old man and wise old woman will reach the same conclusion in deciding cases. I am not so sure Justice O'Connor is the author of that line since Professor Resnik attributes that line to Supreme Court Justice Coyle. I am also not so sure that I agree with the statement. First, as Professor Martha Minnow has noted, there can never be a universal definition of wise. Second, I would hope that a wise Latina woman with the richness of her experiences would more often than not reach a better conclusion than a white male who hasn't lived that life.

Here she is explicitly saying that "wise" judicial rulings don't come from an impartial application of the rules. Instead, she believes that "wise" judicial rulings depend on one's gender and cultural background. Apparently, she believes that the Law changes with each person ruling on a case, that there is no fixed standard. That scares me.

While speaking at Duke University in 2005, Judge Sotomayor said that the Federal Appeals courts are "where policy is made". She didn't see her job as an impartial application of rules. She saw it as a place to decide what the rules are. If you're going before Judge Sotomayor, you can't know in advance what to expect. You can expect her to decide what the Law is based on who you are and how sympathetic she is to your case. That's a recipe for tyranny, not liberty.

So how has she decided cases? Well, let's take a very recent example: Ricci v. DeStefano.

In 2003, the New Haven, Connecticut, Fire Department sought to fill captain and lieutenant positions. Because its union contract required promotions to be based upon examinations, the City contracted with Industrial/Organizational Solutions, Inc. ("IOS") to develop exams, which were administered to qualifying applicants.

Pursuant to a City regulation known as the "rule of three," once test results are "certified," the Department must promote from the group of applicants achieving the top three scores. Immediate application of the "rule of three" to these exams would not have allowed for the promotion of any black firefighters. More broadly, black applicants' pass rate on the lieutenant exam was approximately half of the rate for white applicants - a disparity more marked than for prior exams. However, if additional vacancies opened, black applicants would have been eligible to be considered for those promotions, based upon these exams' results.

Because of these outcomes, the City's independent exam review board, which must vote to certify test results, held hearings to consider the possibility that the tests were racially biased. The board heard from a representative of an IOS competitor, who testified that the results showed "adverse impact" and that he could design tests with less disparate results and better measuring the jobs' requirements. He also conceded that the City's tests did not show an adverse impact greater than that allowed by law. Another witness, an experienced firefighter, testified that the exams were comparable to those he had taken in the past.

A City official testified that if the board chose to certify the results, then the city could be subject to a disparate impact suit from the minority applicants who did not qualify for promotions. Yet, his testimony may have been contradicted by IOS's "technical validity report." There is some evidence to suggest IOS was prepared to issue such a report, which might have "establish[ed] the City's lawful use of the test results." However, the City argues that IOS never offered to prepare the report nor would the report have "proved" the legality of the test.

Because the exam review board split evenly, 2-2, on whether to certify the exam results (with one member recusing herself based upon a conflict of interest), they were not certified.

A group of white firefighters, one of whom is also Hispanic, who scored some of the highest results on the administered exams, filed suit against the City and its officials, alleging that the City's action violated Title VII and the Equal Protection Clause. On cross-motions for summary judgment, the district court granted the City's motion, agreeing that the City did not need to certify the results because doing so could subject it to litigation for violating Title VII's disparate impact prohibition.

Basically, the District Court threw out the case saying that even though the firefighters had met the stated criteria for promotion, the city did not have to promote them if the promotion would unduly benefit one racial group over another. The firefighters appealed their case to the Second Circuit Court of Appeals.

Judge Sotomayor was one of three judges who upheld the decision of the District Court. Judge Sotomayor failed to engage the Constitutional issues at stake and failed to defend the firefighters who had played according to the rules. By signing on to the flimsy opinion of the majority, she upheld a racial ruling instead of making a colorblind ruling according to the Law.

Justice should be blind. Judge Sotomayor has shown a willingness to take off the blindfold and decide which side of the scales she likes better. For that reason, I consider her unfit to serve as a United States Supreme Court Justice.