Saturday, July 9, 2011

"Uncle Tom" Sowell: As Disingenuous and Clueless as Ever!

It appears that Uncle Tom Sowell is back at it again, trying to bamboozle and befuddle his readers into buying even more of his hogswill and PR. So let's get right down to it and skewer his latest bull crap:

He writes:

The data show that "the rich" supplied less tax revenue to the government when the top income tax rate was 73 percent in 1921 than they supplied after the income tax rate was reduced to 24 percent in 1925.

Sowell here is more than disingenuous! The reason the rich supplied "less tax revenue in 1921" was because loopholes littered the tax landscape. By the time these were eliminated in the Eisenhower Administration (with the highest marginal rate at 91%) the benefits were immediate and obvious (as economists Medoff and Harless also note in their book ‘The Indebted Society’- showing that high tax rates correlate to higher productivity, investment and employment).

Several things I recall regarding those seriously high tax Eisenhower years:

- Unemployment was at its lowest in the last 60 yrs.

- Banks actually provided decent interest rates (e.g. 4-5%) so workers didn’t have to risk their money in a stock market

- A one income family was the norm as opposed to being an aberration.

- There was no need for health insurance companies. Doctors saw patients one on one, and if payment options were needed, they gladly gave them.

Meanwhile, the lowering of the highest marginal tax rate to 2.4% in 1925 was an economic catastrophe. It engendered so much “cheap money” that it fueled a speculative mania on Wall Street, encouraging speculators and moneymen to invent “investment trusts” touted as stock market alternatives for the little people. But after millions bought in with their fragile earnings, the speculators manipulated the markets (owing to the low aggregate demand)and the stock market crashed in October, 1929 setting off the Great Depression.

This was a direct result of speculation overreach fueled by the too low Coolidge tax cuts on the wealthy. (Who were able to use all the extra money to buy off lawmakers on Capitol Hill to render the investment trusts legal.) Meanwhile, unmentioned by Sowell, is that tens of thousands of elderly were left to die by themselves because they lacked any money, adequate personal resources or health care. Hence the case for providing social insurance to the majority at the end of life, despite the cant and rant of the individualist battalion.

More fungible nonsense from Sowell:

Because high tax rates can easily be avoided, both then and now, "the rich" were much less affected by high tax rates than was the economy and the people who were looking for jobs. After the Coolidge tax cuts, the increased economic activity led to unemployment rates that ranged from a high of 4.2 percent to a low of 1.8 percent.
But that is only a fact about reality -- and, for many, reality has no such appeal as talking points.

Again, this is a deceitful or pseudo-fact, so its priceless that HE'S the one talking of reality having no appeal! The only reason high tax rates can be avoided –whether then or now- is because of the loopholes allowed, e.g. for charitable trusts, etc.. When these are eliminated or minimized, as in the Eisenhower years- then the whole society can benefit. ALSO, the nonsense that high tax rates mean more people “looking for jobs” is unsupported. In fact, the highest level of job creation over the past 25 years (20 million jobs added) was during the Clinton administration when the marginal tax rates were only a few percentage points more than now (39.5% vs. 36%). Meanwhile, in the administration of George W. Bush – when the Clinton rates were lowered, job creation fell off by more than 45%. During the last 4 years of the Bush administration more jobs were lost than created.

Sowell blathers again:

The same preference for talking points, and the same lack of interest in digging into the facts about realities, prevails today in discussions of whether to have a government-controlled medical system. Since there are various countries, such as Canada and Britain, that have the kind of government-controlled medical systems that some Americans advocate, you might think that there would be great interest in the quality of medical care in these countries.

Here Sowell again evinces his trademark typical dishonesty by failing to distinguish between government-controlled health systems and single payer systems. This exploits the ignorance of the typical American (whose knowledge level is next to pathetic) and was last seen two years ago when Obama’s health care plan was demagogued as “Socialist” when it was really a rehash of a REPUBLICAN alternative to ‘Hillarycare’ from 1993.

Now let’s make it clear: Single payer systems such as in Canada and Barbados are NOT “government controlled”! Doctors still maintain their own services, offices, times of appointment etc., set rates and the hospitals take in people – who may choose what level of care they wish, including private or public rooms (which are cheaper). For example, when I had my tonsils taken out in Barbados, I elected to have a private room and private surgeon who was affiliated with the Queen Elizabeth Hospital but not “controlled” by the government. The only thing he was subject to was a maximum rate or standard to be charged for the operation.

Now, instead of having to rely on some health insurance company or other (whose standards vary) the government paid the surgeon for the operation, while I paid a little more for the private room.

Thus, like in Canada, single –payer means just that: there is ONE payer, the government, as opposed to hundreds of potential private payers. This means the administrative waste is vastly less, so in Barbados and Canada health care is less per capita. This means more of every health care dollar actually goes to health care, as opposed to paper pushing! While 2.9% is spent on administration in Canada and 5% in Barbados, fully 32% of all medical costs are eaten up by administrative paper pushing in the States – precisely because there are so many private payers, each of whom has its own paperwork, standards, and rules. This paper work also has a tendency to expand on and on, for example if a treatment or procedure is rejected and the claim must be re-submitted. This is IDIOCY by any standard, but evidently Uncle Tom (like his many clones) loves it!

As for quality of care, it is superior in many ways to the U.S. particularly because the stays in hospital are provided on a genuine NEED basis, as opposed to being chucked out before a surgery wound heals and getting complications. (As occurred to my wife when she had a gall bladder operation here in the U.S. in 1993, and had to leave the next day, getting complications)

In addition, the medical error fatality rates in Barbados and Canada are far far less than in the U.S. While 98,000 die per year from medical mistakes in the U.S. system, the per capita death rates in Canada and Barbados are some 55-65% lower. Again, I suspect this is a function of greater attention to details such as disinfection, while in the money grubbing U.S. the emphasis is on speed and profit.

More bunk from Uncle Tommy:

The data are readily available as to how many weeks or months people have to wait to see a primary care physician in such countries, and how many additional weeks or months they have to wait after they are referred to a surgeon or other specialist. There are data on how often their governments allow patients to receive the latest pharmaceutical drugs, as compared to how often Americans use such advanced medications.

Again, Sowell plays on engrained American ignorance and their penchant for exceptionalist bunkum. As a case in point, 8 yrs. ago in Canada my niece had injured her back and required some surgery as well as therapy. She was admitted to hospital in Toronto within 3 days, recuperated and received therapy immediately after. In the States similar treatments would have left her bankrupt. Meanwhile, in 1991, my wife’s medical emergency occurred with a fall and her needing a hysterectomy. She was admitted within 24 hours, recuperated for one week, and was released with no ill effect – including to our savings!

The bit about the pharmaceutical drugs is overplayed. All patients, and citizens in both Barbados and Canada, can access a National Formulary and obtain whatever prescription drugs needed there, for small ($5) copays. In addition, drug companies are not allowed to advertise their wares in those countries – which translates into fewer specious or unnecessary prescriptions provided to patients (who just want it because it was seen on TV).

“Advanced medications” is a claim open to further examination and scrutiny. The evidence is that, in fact, most Americans are over-medicated with TOO MANY medications, advanced or otherwise, leading to additional, increased medical costs. For example, ‘Lamisil’ is often prescribed for toenail fungus but the complications – including liver damage- are never mentioned to prospective patients. Similarly with Statins, which can cause not only kidney and liver failure but other problems and thus add to the medical burdens. Blood pressure medications taken over time, can also affect the glomerular filtration rate of the kidneys- leading to kidney damage. As the author of Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer notes, many of these “advanced medications” are majorly adding to our health care costs via their complications!

More Sowell slop:

But supporters of government medical care show virtually no interest in such realities. Their big talking point is that the life expectancy in the United States is not as long as in those other countries. End of discussion, as far as they are concerned.

But in a way it IS ‘end of discussion’! After all, if the most “advanced” medications and health care (so claimed) can’t deliver either greater longevity or lower infant mortality (we still have among the highest rate in the world) then what use is it? So Sowell has no basis on which to complain! If the U.S. medical care was worth its actual cost and private system, men should have an average life expectancy of 85 years (as opposed to 75 years) and women should be at 90 years, as opposed to 82. The tragic truth is that nearly 90% of all advanced medical technology (and with it, major expense) is commandeered over the last 6 months of life, trying to medically extend it. It seldom if ever works, meaning hundreds of thousands of dollars are often spent to gain a couple extra months (using advanced medical technology, surgery, etc.) when a stay in a hospice would be more sensible and cost-effective.

Lastly Sowell babbles:

They have no interest in the reality that medical care has much less effect on death rates from homicide, obesity, and narcotics addiction than it has on death rates from cancer or other conditions that doctors can do something about. Americans survive various cancers better than people anywhere else. Americans also get to see doctors much sooner for medical treatment in general.

But again Sowell uses a clever dodge. In many ways those indices he claims that are beyond control (homicide, obesity, narcotics addiction) can be directly tied to the accessibility of medical care. For example, nearly half of all homicides are triggered by depression or some other mental aberration. In most of those cases the perpetrators have no health insurance so can’t afford to get therapy or even anti-psychotic medications. This brings up a recent Colorado case in which a woman found guilty of vehicular homicide (killing a family of 5) was found to have been out of the health system for more than five years, and without ability to get medication. (This occurred after major state budget cuts in Colorado which left psychiatric care unfunded.) Obesity also is more prevalent among those lacking health insurance. It is also a result of a nation which places private profits above the value of its citizens’ health.

For example some studies have found that as much as 70% of American obesity can be tied to the prevalence of high fructose corn syrup in hundreds of products. (It’s even in cough medicine!) This stuff is a spin-off from corn production, but rather than throw it away – and lose profits – corn producers sell it to food or other manufacturers to be incorporated at a high (health) cost to consumers!

As for cancers, it is debatable that Americans survive cancers better than people anywhere else. While it is true we have much more advanced screening – from colonoscopies, to PSA tests, to mammograms- much of this translates to OVER-screening, which is having a compounding effect of adding to the medical costs and burdens without proportional positive results. For example, the PSA test – for prostate cancer- is capable of yielding many false positives. Even when it does yield a valid positive, the finding often occurs so late in life that it is arguable that getting surgery (leading to incontinence – other complications) is worth it. Many findings show the person more likely to die of old age than from the cancer (since most prostate cancers are slowly growing). As the author of 'Overtreated' observes (p. 201):

"The evidence suggests that PSA testing is not saving any lives, and even if it is, the large numbers of men who are treated unnecessarily are paying a terrible price. They're the equivalent of civilian casualties in our war on cancer."

The same applies to other screenings which are creating some 16% more people per year seeking cancer treatments – at great cost- and little benefit. As one medical worker, an oncologist, put it in a recent TIME magazine special article: "At the rate we’re generating cancer patients from our screenings, we won’t be able to treat them all in another 10 years! We're running short of chemo drugs now!”

The author of 'Overtreated' attributes this overuse of diagnostics and screenings to "magical thinking". As she puts it (ibid.):

"We all want to believe that early diagnosis of cancer will protect us, that if we dutifully head to the doctor for our yearly screening tests we can avoid disease and even thwart death. And yet many of the screening tests we imagine will protect us- mammography, colonoscopy and more recently CT scans to screen for lung cancer- suffer from many of the same drawbacks as the PSA test. The only cancer screening that has been shown unequivocally to decrease mortality is the venerable Pap smear for cervical cancer."

This suggests there is a diminishing returns threshold for all such screenings. Maybe some Americans, perhaps most, need to learn to live with their cancers as opposed to becoming hysterical about removing them. (The same 'TIME' piece noted the name for many of these cancers that "accidentally" turned up, e.g. during MRIs or CT scans, as "accidentoplasms". Thus, increasing use of scans is actually generating MORE cancers, needing more treatments, adding MORE costs!)

Maybe Sowell needs to finally get HIS facts straight before going to print again!

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