January 08, 2003
NANO-COMMENTS
I finally read Glenn Reynolds' article on nanotechnology and regulatory policy, and have a couple of comments, which I'd like to share with everyone rather than do the decent thing and give Prof. Reynolds the chance to respond first.
1) When discussing potential regulatory risks, I think he leaves out one that may become a big deal as the technology becomes more viable - entaglement with health-care politics. Specifically, the history of most new technologies - also applicable to new medical treatments - is that they start out hideously expensive and as such are only available to the rich, and become mass-market as the price drops (with the two reinforcing each other in a virtuous circle). I assume (correct me if you feel this is incorrect) that nanotech medical treatments would also be pretty expensive in their initial phases, even as they really work.
What happens in the interval between demonstrated effectiveness and price reduction? If such treatments are initially covered by insurance (as may be mandated by Congress) then that would place another sever stress on the system, maybe a back-breaking one. If it is not initially covered by insurance, what will happen when such treatments of demonstrated effectiveness are only available to the rich (even for a short time)? Will there be price controls? (If so, that would be an efficient way to destroy the research in the U.S.).
The caterwauling over the "digital divide" of Internet access has fortunately died down without producing any truly harmful policies. Would the same be true when the selectively-available resource is one that is directly live-saving? I'm not sure.
An excellent example of the mindset behind such potential reactions was set forth by Paul Krugman in a 1997 piece for the NY Times Magazine, discussing the potential future of health care. (Click here, then on the "American Economy" sidebar. Scroll down to and click on the 3/9/97 article.)
Some might then say ... we must abandon the idea that everyone is entitled to state-of-the-art medical care. (That is the hidden subtext of politicians who insist that Medicare is not being cut -- that all that they are doing is slowing its growth.) But are we really prepared to face up to the implications of such an abandonment?
We have come to take it for granted that in advanced nations almost everyone can at least afford the essentials of life. Ordinary people may not dine in three-star restaurants, but they have enough to eat; they may not wear Bruno Maglis, but they do not go barefoot; they may not live in Malibu, but they have a roof over their head. Yet it was not always thus. In the past, the elite were physically superior to the masses, because only they had adequate nutrition: in the England of Charles Dickens, the adolescent sons of the upper class towered an average of four inches above their working-class contemporaries. What has happened since represents a literal leveling of the human condition, in a way that mere comparisons of the distribution of money income cannot capture.
There is really only one essential that is not within easy reach of the ordinary American family, and that is medical care. But the rising cost of that essential -- that is, the rising cost of buying the ever-growing list of useful things that doctors can now do for us -- threatens to restore that ancient inequality with a vengeance.
Suppose that Lyndon Johnson had not signed Medicare into law in 1965. Even now there would be a radical inequality in the prospects of the elderly rich and the ordinary older citizen; the affluent would receive artificial hip replacements and coronary bypasses, while the rest would (like the elderly poor in less fortunate nations) limp along painfully -- or die.
The current conventional wisdom is that the budget burden of health care will be cured with rationing -- the Federal Government will simply decline to pay for many of the expensive procedures that medical science makes available. But what if, as seems likely, those procedures really work -- if there comes a time when those who can afford it can expect to be vigorous centenarians, and perhaps even buy themselves smarter children, while those who cannot can look forward only to the biblical threescore and ten. Is this really a tolerable prospect?
...For all we know, the future may belong to the medical welfare state, a state whose slogan might be "From each according to his ability, to each according to his needs."
I think that Congress would feel intense pressure to meddle with the distribution of nanotechnological medical treatments in the early stages of availability, and I doubt the consequences would be beneficial.
2) As an aside, Reynolds alludes to Cass Sunstein's arguments that requiring "best available practices" stifles innovation. Why? In the private sector, wouldn't such a requirement create an incentive to innovate, as the first to discover the new "best practice" would gain a competitive advantage over its rivals who need to catch up?
The reason I fixate on this point is that one of the Official Regulatory Policy Consultants to Blissful Knowledge, Prof. Charles Sabel of Columbia Law School (who is as yet unaware of his position), uses it as one of the bases for his ideas for saving the world, or at least U.S. regulatory policy. He argues that such pressure to innovate can be harnessed for use in the public sector. For those who are interested, check out just about any of his papers or specifically, this Columbia Law Review article (warning: it is NOT easy reading).
Posted by Dr. Manhattan at 1:10 PM | Permalink
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AND THE BAD NEWS IS...
For those of us fortunate enough to not personally know a victim of the latest terrorist atrocity in Israel, it is hard to imagine anything more that could further increase pessimism about an eventual settlement.
As usual, the Palestinians are up to the task.
Via Tal G., I saw this article in Ha-aretz about Mohammed Dahla, founder of the Palestinian legal advocacy group Adalah. Dedicated to advancing the cause of the Palestinians through legal means, Dahla would seem emblematic of the segment of the Palestinian population most likely to work for peace with Israel.
Until you see what his idea of "peace" is based on:
In the meantime, it's metropolitan Tel Aviv. Gedera to Hadera. And Mohammed Dahla, my friend and my rival, says to me: Look at this architecture - it's so foreign, so alien to the place. It's as though some kind of invasion force emerged from the sea and landed on the beach. Without any sensitivity, without any connection to the land. As though the immigrants who arrived don't feel the land and its past. And you build with dizzying speed. You build arrogantly and high, and glued - absolutely glued - to the earth.
Look at the road signs, Dahla says. Most of them are in Hebrew and English, without Arabic. Because what you want, after all, is for a tourist from the moon to be able to come and wander around the country and believe that it really is a Jewish country. That there really is a Jewish state here. But I'm in your way. I and a million other Arabs are in your way. That's why it's so complicated for you with us. And in order to be able to continue with this adorable fiction of a Jewish-European state, you are trying to hide our existence. To erase our geography, our history, our identity. Now you are even trying to erase our parliamentary representation.
Does the idea of a Jewish state truly lack all justification? Don't the Jews have the right to self-determination within the boundaries of June 4, 1967? Mohammed says that the Jewish public now living in the country has the right to self-determination. But one can understand why the Palestinians rejected the UN partition plan in 1947. And one must understand that there is no balance of rights here. There is no balance of our right v. your right. And that is because at the point of departure, the young lawyer Dahla says, the Jews had neither legal right, nor historical right, nor religious right. The only right they had was the right of distress. But the right of distress cannot justify 78 percent [of Mandatory Palestine becoming Israel]. It cannot justify the fact that the guests became the masters.
At the end of the day, it is the natives, not the immigrants, who have a supreme right to the country. Those who have lived here for hundreds of years have become part of the land, just as the land has become part of them. We are not like you. We are not strangers and we are not wanderers and we are not migrants. For hundreds of years, we lived on this land and we multiplied on it. Therefore, no one can uproot us from it. No one can separate it from us. Not even you.
In case his view of the Jewish presence in the land isn't clear, here's the kicker:
Then he tells me about his breaking point. It was during one the talks with Beilin, in Oslo, when they requested that the compensation that Israel would give the Palestinian state serve it in the same way that the German reparations to Israel served it. That was all they asked. It was a kind of gentle hint, not quarrelsome. But, nevertheless, Yossi Beilin's Israelis went wild. Because of that sentence the talks broke down. They returned empty-handed. Without even the shadow of historical justice.
This is further proof that David Brooks was right when he identified the driving factor behind the current war:
The Palestinians know that they cannot threaten the existence of Israel in a material sense. Israel's GDP per capita is over ten times that of its Arab neighbors, and its military might is unquestioned. But the Palestinians can hope to undermine the moral legitimacy of the Jewish state. More than anything, it now seems, this is what they want: for the Israelis to capitulate intellectually and morally; for the Israelis to admit that their state was founded on a crime; for them to apologize for what their existence has done to the Palestinians.
The Palestinians will not, it now appears, stop fighting until the Israelis acknowledge the justice of the Palestinian cause and absolve the Palestinians of all guilt for the terrorism perpetrated in their name. They're like a man in a bitter feud whose enemy's opinion begins to matter more to him than anything else: He craves his enemy's admission of guilt. To secure this, the Palestinians are willing to endure another century of refugee camps, road closures, violence, and conflict.
In other words, the Middle East conflict has been polarized and simplified. The whole dispute hangs on a simple question: Is Israel a criminal state? Arab populations have swung behind the idea that it is, and the Jewish population has swung behind the idea that it isn't. Not since 1948 has the issue been so stark and each side so unified. There is simply no middle position on this central question, and so all those who were trying to span the divide between the two peoples—the businessmen who want to trade with the other side, as well as the peace activists who want to build bridges—have found that the ground has vanished from under their feet.
And if the Israelis so capitulate, they will be helpless to resist Palestinian demands for the "right of return," autonomy for the Galilee and all the other items enumerated in the Ha-aretz piece that would destroy Israel as a Jewish state. In Dahla's view, this is the goal of any peace agreement.
And Dahla's demographic is that of the educated elite, in whom the Israeli peace camp placed such high hopes during the Oslo period. Reassuring, isn't it? If you want to know why Ariel Sharon is almost guaranteed to win re-election this month, look no further.
P.S. I suspect that Dahla might be the "Palestinian peace activist" featured in this Hirsh Goodman column which I blogged a while ago.
Posted by Dr. Manhattan at 12:40 AM | Permalink
PIERCING THE COCOON
Last year, Joan Didion's writings on U.S. politics were brilliantly eviscerated by Joe Klein in the New Republic:
Didion's political essays seem very dated now. They are artifacts of the most placid and prosperous moment in American history, a time when allegedly serious news organizations and journals of opinion turned to cynics and stylists--people who knew little about politics and nothing at all about policy--to make pronouncements about public life. These people practiced a form of theater criticism, assuming and sometimes even asserting that politics was a lesser branch of show business, that politicians were merely actors reading lines, that political performance consisted only of public speaking and image-making; while the quiet work of governance, the true work of elected officials, was largely ignored. This was, almost by definition, a flagrantly superficial conceit. It is probably finished now. When reality visits, there is no need for political fictions.
Unfortunately, her fatuous preaching has continued with respect to the aftermath of September 11 and the proposed war in Iraq. Andrew Sullivan has a wonderful demolition of her views and though-processes, or lack of such:
She doesn't seem to grasp that people who differ from her views about this might also have read history, theology, sociology, philosophy, and so on. Does she think that Bernard Lewis or Fouad Ajami have not devoted years to inquiring into "the nature of the enemy we faced"? Does she think that my own post-9/11 essay, "This Is A Religious War," was devoid of any historical or philosophical analysis? Does she think that John Keegan and Victor Davis Hanson are uninterested in military and diplomatic history? The sheer intellectual snobbery of Didion blinds her to the real scholarship on the other side of the debate. Which makes life easier for her, but it doesn't help shed any light for the rest of us.
Perhaps this is a function of being in a liberal intellectual cocoon. When the only educated people you know hold identical views to yours, it's an easy step to assuming that all those other mysterious creatures out there who disagree with you are simply dumb anti-intellectual jingoists. The cocoon blinds Didion in other ways as well. Many times in the piece, she recounts going out into the country to talk to real people about 9/11. She doesn't seem to realize that the people Joan Didion might meet in bookstores -- the ones who have come explicitly to hear her speak, no less -- might not be completely representative of the country as a whole. Memo to Didion: Get out a little more.
There's much more.
Posted by Dr. Manhattan at 12:07 AM | Permalink
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