Letters
Mars: Fact or Folly?
After reading John Tierney's "Martian Chronicle" (February), I was reminded that extraterrestrial libertarian millenarianism is not a new phenomenon. In the early 1970s, an organization called the International Society of Free Space Colonizers arose in Seattle committed to the colonization of the asteroids by the 1990s as a decisive act of liberation by the "creator class."
Fortunately, Robert Zubrin has a credibility that these earlier enthusiasts lacked. However, I think he substantially discounts the necessary technological and economic dependence of any interplanetary colonization program on earthly civilization–not to mention the currently insuperable level of government regulation over transport to and from outer space. As appealing as his colonization plan may be, it may have to await a time when access to space is as unfettered by government interference and as available to the general public as high-power computation is today. This would place the necessary emphasis on economic exploitation, rather than pure exploration, which accords more completely with a laissez faire conception of man's mastery of outer space.
Michael J. Dunn
Auburn, WA
Robert Zubrin is cited in John Tierney's "Martian Chronicle" as proposing that only hydrogen be transported from earth to Mars, there to be combined with the abundant CO2 to form methane (CH4) and oxygen. These two gases would then be used to propel the spaceship back to earth. Zubrin had a piece in The New York Times some time back along these lines as well.
Now, this Ph.D. chemist (admittedly specializing in history of chemistry, not engineering) has a problem with this. CO2 is a very thermodynamically stable compound. Reacting it with H2 requires an input of some 82 kilocalories of free energy per mole of methane formed (over 5,000 cal/g). I have tried to figure out whence this energy might come and asked friends too. We have come up empty (one suggested, tongue in cheek, cold fusion). Tierney states, "Zubrin built a machine to demonstrate how easily it could be done," but this undoubtedly uses an energy input from the local Edison company. Where would that energy come from on Mars? Solar energy is comparatively feeble there (perhaps a quarter of what it is here; I don't have the numbers), and surely Zubrin does not suggest carrying a nuclear reactor, which would defeat the whole goal of a light payload.
So please enlighten me, for I am at a loss. I am willing to violate many a law, but the laws of thermodynamics are more Draconian than anything Congress might pass.
Albert S. Kirsch
Brookline, MA
askirsch@compuserve.com
Robert Zubrin replies: Mr. Kirsch is mistaken. CO2 has a heat of formation of 92 kilocalories per mole; methane, 18 kilocalories per mole; hydrogen, 0 kilocalories per mole; and water, 57 kilocalories per mole. The methanation reaction is: CO2 + H2 => CH4 + 2H2O.
The binding energy on the right hand side of the equation is 92 (for the CO2), but the left is 18 + 57 + 57 = 132. So the net binding energy is increased during the reaction by 132 — 92 = 40 kilocalorie per mole. The reaction is thus highly exothermic.
Of course, the water electrolysis reaction that will produce oxygen from the H2O is endothermic. Which is why we do ship a nuclear power plant to Mars.
Doctors Take on HMOs
I cannot imagine what Thomas Hazlett's point was in writing "HMO Phobia" (February), nor in REASON's publication of it in a journal for "free minds and free markets." I do not write to support Dr. Smith nor to comment on his opinions. Instead I wish to rebuke Mr. Hazlett and shed light on the health care "crises."
An HMO is an insurance company and cannot practice medicine. Therefore, in answer to Mr. Hazlett's rhetorical question, physicians–not HMO shareholders–have brought health care to the masses for the last 2,500 years. And whose business is it what a doctor does in his free time? And since when do contributing editors to REASON use income to support or castigate any group (in this case, doctors)?
Most doctors don't own MRI units, pharmacies, physical therapists, or hospitals and therefore cannot control costs. When a patient is sent to a specialist with a surgical diagnosis, the only treatment is usually surgery. Yet if the doctor is busy and does a lot of surgery, the HMO will label him an "overutilizer" and explain to the other doctors in the HMO that their reimbursement will be lower this year because too many surgeries were done and costs were too high. The only way to solve the problem in the HMO model is to deny treatment.
The fundamental problems in health care today are twofold: First, patients want unlimited health care and don't want to pay for it. Second, too many health care dollars go to bureaucracy in the form of HMOs and insurance companies.
The solution is simple and was the model for medicine in this country until 1945, when it was corrupted by employer-funded insurance and later by Medicare. The solution is fee-for-service medicine (sounds like free markets, doesn't it?). Under this model, the only role for insurance companies is to cover catastrophic illness or injury, with routine office visits, prescriptions, etc. paid for by the patient. At today's prices that would be unaffordable, but with downward market pressures we would see significant deflation in the medical arena. Some things would suffer, like drug research and development, and we have to be prepared to accept that.
It is a fundamental non sequitur to "pressure providers to constrain spending." In what other area in life do we tell providers not to provide? The only one that comes to mind is the Agriculture Department's policy of paying farmers not to grow. Is this the free market model Mr. Hazlett endorses? I don't want lawyers, Congress, or Mr. Hazlett involved in medicine, and I'll bet he won't raise the issue the next time he's in the emergency room with a broken arm facing an "overutilizing" provider.
Terry Wintory, D.O.
Aurora, CO
cowintory@aol.com
As much as I usually admire Thomas Hazlett's writings, he has managed to trivialize a very complicated and important issue by going after a classic "bad guy."
I don't see what Hazlett's problem is with Dr. Smith's desire to make as much money as patients are willing to pay him. As far as I can tell, almost every serious investigator who has researched the origins of the high cost of medical care in the United States has concluded that after World War II employers, restricted by wartime wage and price controls, bid up the cost of third-party medical insurance benefits to prospective employees in an effort to recruit returning workers in a highly competitive environment.
This bidding war wrecked the market in low-cost health insurance, making employers the single largest purchasers of insurance (the feds only recently having surpassed them as a source of health care benefits) and divorcing the patient from tradeoffs between benefits and costs.
Naturally the feds couldn't leave well enough alone and mandated that all larger employers who offered any health care benefits had to offer an HMO as an alternative to their employees, further warping the market. Now the feds can't resist bashing the same concept they were touting just a decade ago.
For most ordinary middle-class people, the best option is to pay ordinary medical fees for ordinary visits as we go, insuring only against unexpected, high-cost illnesses and injuries. A wide range of tradeoffs between annual premiums and point-of-service co-payments is available, and employers can limit their costs by designing cafeteria-style benefits packages, allowing employees to choose the insurance plan and contribute more or less out of their own pockets to get their favorite choices.
There are many ethical and professional physicians who legitimately believe that the intrusion of powerful third parties into the practitioner-patient relationship has harmed the practice of medicine and been detrimental to the patients themselves. There are many excellent HMOs, and no one seriously believes they should be banned. The power struggle among government agencies, physicians' groups, patients' rights advocates, and employers is not relieving the situation.
Marshall Anderson, M.D., M.P.H.
Deer Park, TX
mwander@ppco.com
I enjoy REASON but don't find Mr. Hazlett's thoughts in "HMO Phobia" very reasoned. Income baiting is expected in other publications, but Dr. Smith's presumed golf habits seem out of place here. Instead of golf, I spend my afternoon off filling out forms for the latest Medicare perks–"free" batteries for blood sugar monitors, among other things. How much would that battery cost if time and paper shuffling were considered, and could my patient with the Mercedes afford a 59-cent battery?
Believe it or not, a patient and physician are concerned primarily with the patient's outcome, rather than his money. Where is the logic in promoting an organization that "saves" perhaps 30 percent by denying recommended medical intervention while taking that 30 percent to reward its efforts? "Health care," as they like to call it, is overpriced because the monetary worth of the individual is inflated by our legal system beyond all reason. Mr. Hazlett starts in the middle of the story, where physicians without autonomy are held liable for perfect results while forbidden, by Medicare and some insurers, from obtaining even basic screening studies.
We are second-guessed at a distance, perhaps by an idiot with a cheat sheet, on clinical decisions that require a hands-on assessment. Being damned either way is having predictable results. Realizing that 23-plus years of training and your practice can be destroyed by one "malpractice" suit has encouraged some to maximize income and minimize years at risk–do procedures, make some money, and get out. It isn't fun anymore.
A lot of money changes hands in health care. Receiving only a small portion of it, physicians assume most of the risks. We realize that costs would be hugely reduced without fear of litigation driving excessive studies and treatment. Go to the E.R. with a headache, and see how long it takes to get your CT brain scan.
The earnest concern voiced now about "patient rights" to sue HMOs seems intended to serve those attorneys not already flush from tobacco litigation and ambulance chasing.
Stephen DeGray, M.D.
Bluefield, VA
Thomas Hazlett replies: Dr. Wintory asks: "In what other area of life do we tell providers not to provide?" The answer is simple: in every area of economic life. In fact, just the other night I told the waiter not to bring me the 1991 Crystal Champagne. Hey, I was paying. The trick doctors, just like farmers harvesting USDA subsidies, have discovered is that getting Uncle Sam to pay (Medicare, Medicaid) or limiting customers' options by mandating HMO coverage is a whole lot easier than squeezing the actual consumer for cash. But please, enough of the "next time you're sick" threat. I am not happy to report that loved ones have indeed gotten sick with a lot worse than a broken arm, have had their health insurance deny coverage, and have heard not a peep (nor received a cent) from doctors only too eager to cash their unreimbursed checks.
Dr. Anderson wonders why I have a problem with Dr. Smith's wanting a chance to make as much money as patients are willing to pay him, but it's no problem at all. It's just that Dr. Smith won't settle for what people are willing to pay him! He wants government to force medical costs onto third parties so the expensive service looks cheap to the patient. It's an accounting gimmick, one which encourages patients to spend without restraint and leaves a mounting burden of expenses for taxpayers and ratepayers–many of whom respond by dropping coverage until the emergency room beckons.
I was blessed to have a terrific surgeon, Dr. Robert Appleman, pluck out my gummed-up gall bladder in 1995. It is tragic that this gifted physician folded up his practice after 30 years due to the paperwork headaches now haunting medicine. (Mine was his very last operation.) But the open-ended demand which consumers thought they enjoyed busted the bank, and now they are searching for more affordable health care. The HMO pencil pushers so decried by the M.D.s are, in fact, consumer cost-containment agents. If doctors (and their newfound friends, the lawyers) pledged fealty to "consumer sovereignty" they could assist in devising systems which limited costs while bestowing bonuses on dedicated practitioners like Appleman.
Regarding Dr. Anderson's statement that there are many excellent HMOs and no one seriously believes they should be banned: Of course they do! Not only is for-profit medicine denounced, single-payer plans in Congress and the highly touted HMO "bill of rights" regulation aim to cripple the competitive position of low-cost health plans.
Dr. DeGray's comments do not seem to cross my article except insofar as I have ignored the degree to which his profession is forced to account for its paper clips. He claims to be offended by comments he calls "income baiting," but then goes on to bash Mercedes-Benz owners for low deductibles. I think he mocks.
The litigiousness of the American medical system is surely our common foe. But I do not understand the rage of doctors who, having the ability to band together to compete with HMOs and insurance companies, opt instead to (literally) sell out to them while yakking about what others will pay for.
If you think the HMOs are screwing up patients' health and doctors' wealth, then build a better insurance vehicle. If the HMO system is oppressing conscientious physicians with idiotic rules crafted by inept empty suits, then providing better and more popular doctor-run health networks ought to be the hottest thing on Wall Street since "dot-com" was virtually born.
Competing in the arrogance department would not likely be a problem for the doctors. To wit, Dr. DeGray: "Physicians assume most of the risks." Really? Is that what you whisper in patients' ears when rolling them into the O.R.? Well then, thanks for the warning, Doc.
Muddies Waters
Richard Epstein concludes his review of The Shape of the River, a long defense of racial preferences in college admissions by William Bowen and Derek Bok, by advocating "decentralized decision making" ("Unexplored Tributaries," February). That way, each school could decide on its own whether to discriminate on the basis of race and ethnicity in selecting its students.
Professor Epstein cheerfully acknowledges that this approach runs afoul of current law, and he calls for that law's repeal. But while we are waiting for Congress to revoke the Civil Rights Act of 1964–and I hope Professor Epstein isn't holding his breath, as I would hate to lose him–the issue we face in the real world is this: Should colleges and universities be barred from discriminating against whites and Asians, just as they are now barred from discriminating against blacks and Hispanics?
One can defend the decentralized scheme that Professor Epstein advocates. One can also defend the law that was actually written and passed in 1964, prohibiting colleges that receive federal money from discriminating against anyone because of race or ethnicity. What is indefensible, however, is the law as it is currently interpreted by the federal bureaucracy and defended by Messrs. Bowen and Bok: a ban on discrimination against some people (blacks and Hispanics) but not others (whites and Asians).
Roger Clegg
General Counsel
Center for Equal Opportunity
Washington, DC
How did clearheaded Richard Epstein end up so muddled in reviewing The Shape of the River?
"Just the facts"? That is hardly what Bowen and Bok offer readers. Indeed, as our article in the February issue of Commentary makes clear, they often misleadingly spin the reliable data they do offer, while averting their gaze from the facts that do not support the racial preferences they–as former presidents of Princeton and Harvard–worked so long and hard to institute and implement.
While they assert that many factors other than race entered into the admissions process at the five private schools they studied intensively, in fact their own numbers prove that racial considerations were of overwhelming importance. Black applicants to elite schools in 1989 had very strong credentials, they say, by the measure of student SAT scores in 1951–as if that standard had even a smidgen of relevance. Three-quarters of those students had scores better than the national average for all white test-takers–again, an irrelevant comparison. The whites and Asians admitted to the five schools had scores that put them in the 96th percentile or higher. Contrary to Bowen and Bok's claims, those who have been admitted do not do well; their grades put the black students, on average, in the bottom quarter of their class, and their dropout rates are high by the standards of the schools they attend. Bowen and Bok pretend that racial preferences are integral to the making of a black middle class, but most of the preferentially admitted students come from families that are already relatively well-off.
This is a very abbreviated list of flaws in the "factual" arguments contained in The Shape of the River. Epstein casts a too-uncritical eye on the work in great part, we suspect, because he does not dispute its fundamental premise–that racial preferences are needed. (Of course, neither the authors nor Epstein call them "preferences," although that is clearly what they are.) Precisely why we can't abolish them is not clear. Epstein says that, given the "heavily subsidized nature of public education," the demand for preferential treatment of non-Asian minority students is "hard to resist." Because? If public funding demands a student body that "looks like America," then surely there are too many Asians and Jews at Berkeley and other highly selective public institutions, and too few white Christians. The working class is also underrepresented. If Professor Epstein believes in proportional representation, then surely these schools have an obligation to take the task much more seriously than they do.
Texas, which cannot engage in racially preferential admissions, now guarantees admission to the top 10 percent of every high school class. If courts are to strike down racial preferences, Epstein says, they must be prepared to invalidate the policies that states will substitute. But the 10 percent plan, since it does not engage in racial classifications, is not as bad as quotas, and critics like us would be delighted to see suits brought against practices that simply camouflage race-driven policies. Why can't courts take one step at a time?
If private colleges can decide who gets in on the basis of their skin color, Epstein asks, why can't public schools do so as well? He forgets that private colleges are likewise constrained, if Title VI of the 1964 Civil Rights Act has any meaning. We realize Professor Epstein would have Congress repeal the entire statute, but that is just one more place where he and we part company.
Abigail Thernstrom
Stephan Thernstrom
Lexington, MA
Authors, America in Black and White
Richard Epstein replies: I am sorry to have tread on the formidable toes of Roger Clegg and the Thernstroms in my review of Bowen and Bok's The Shape of the River. But their criticisms require some answer.
Roger Clegg's letter does not take me to task in principle for arguing that the 1964 Civil Rights Act is a mistake, but he insists that we have to make appropriate adjustments in the second-best world by disallowing discrimination against whites and Asians as we now disallow it against black and Hispanics. The uncomfortable social truth, however, is that the strict color-blind rule will empty out the major colleges, professional schools, and graduate programs of virtually all their minority students.
The relevant tradeoff (for those who are not agnostic about academic merit) is how much of an academic discount should be made for minority students in order to avoid that result. I don't have the answer for all institutions. But I suspect that the one unacceptable answer for most institutions is no compromise at all. It is silly to contend that the persistent use of affirmative action–or racial preferences; the phrasing is not decisive–comes without any cost, when clearly the costs are high. But it is equally naive to contend that the refusal of private institutions to bend from the color-blind principle has no costs either, when clearly it does in terms of their social legitimacy. The world is full of painful tradeoffs, but these are better made at the institutional, not the social level.
The first part of the Thernstroms' letter is directed less toward me than toward discrediting Bowen and Bok's claims about of the successes of affirmative action. On this question, the Thernstroms have a lot of ammunition and, for all I know, may well be correct. But that factual dispute is a sideshow to the main event. If Harvard and Princeton want to run affirmative action programs that succeed by their own lights but fail by ours, let them, even if the Thernstroms and I might do things otherwise. My call is for institutional autonomy, not proportionate representation, as the Thernstroms suggest. When Bowen and Bok oversell their program, they should have to answer not to outsiders but to their respective institutions, whose ardor for racial preferences might cool with a full and accurate accounting of its costs. But if these institutions remain undeterred, there the matter should end.
Public institutions present a much harder nut to crack because of the obvious concern about equal treatment of all citizens. By the same token, it is troublesome to use general revenues drawn in part from the poorer groups in society to subsidize the children of the intellectual elites. Perhaps the constitutional command for equal protection requires not only equal treatment between applicants, but equal benefits to all individuals taxed, which in turn means that they have in practice an equal chance of admission. I am very unhappy with both extremes and would resist writing either into law. By the same token, I fear that public institutions, buffeted as they are by political pressures, are not equal to the task of making the necessary marginal adjustments through the affirmative action thicket. Instead they tend to lurch first too far in one direction, then in the other. No easy choices here.
Finally, the Civil Rights Act of 1964 does not put the matter to rest. The act, as drafted, clearly implements the color-blind position, just as the Thernstroms state. But the Supreme Court has construed the act to allow for voluntary affirmative action programs intended to remediate past discrimination. My clear sense is that this once-large exception will gradually close. But the battle over racial preferences will not end, for its real impulse today comes from the call for diversity in the face of unequal qualifications.
If forced to choose, I would rather keep the current unhappy status quo than put all institutions in a straitjacket by allowing no minority preferences at all. But that is a strict second-best judgment, based on the hope that it is possible to temper some of the present excesses. The first-best position is to reduce government involvement in education, however unrealistic it seems at the moment.
Blocked Track
In "Fast-Track Impasse" (February), Brink Lindsey says, "In reality, globalphobia rests on economic illiteracy." Perhaps the free-traders should examine their own logic before accusing others. With free trade and an income tax, there is no tax on imports at the border and no tax at the point of sale. Imports get a free ride. Because the income tax increases the price of domestic products, we are currently pricing our domestic products out of the marketplace.
Before the 16th Amendment of 1913 gave us the income tax, imports did not get a free ride. Then imports and domestic products both were taxed. It is folly and economic illiteracy to discuss free trade without taking into account the changes in our tax system that occurred after 1913.
Bert Loftman
Atlanta, GA
b.loftman@gte.net
Brink Lindsey replies: The argument that duty-free imports enjoy a tax advantage because they don't bear the full burden of U.S. income taxes assumes that foreign producers are exempt from corporate income tax in their home jurisdictions. That assumption is, by and large, unfounded. More broadly, all forms of taxation distort economic activity in one way or another; the trick is to avoid those taxes that do the most damage. While I'm no fan of income taxes, import duties–which reduce incentives to innovate in the face of foreign competition, block access to needed inputs and supplies, inhibit exports, and restrict consumer choice–are even worse. They have no role whatsoever in any sensible tax policy.
Tax Theories
David Levenstam ("Constitutional Challenge," January) is quite correct that merely repealing the 16th Amendment, which created the income tax, would not prohibit future Congresses from reintroducing an income tax. This is particularly true give the inclination of the Supreme Court during the last 50 years to assign powers to Congress that are nowhere found in the Constitution. What I and most national sales tax advocates support is a constitutional amendment that has been proposed by Rep. Sam Johnson (R- Texas). Johnson's simple amendment states: "The sixteenth article of amendment to the Constitution of the United States is repealed, and the Congress shall have no power to lay and collect taxes on incomes, except in time of war declared by the Congress." I think Mr. Levenstam would agree that this should do the trick.
Stephen Moore
Director of Fiscal Policy Studies
Cato Institute
Washington, DC