Archive for November, 2007

Free Speech

Here are two thoughtful posts on free speech in the light of the Oxford Union’s less than thoughtful attempt to demonstrate it: Chris Dillow and Peter Ryley.

Oliver Kamm makes a point about the nature of the protests.

The initial invitation was an absurd and unprincipled piece of theatre. Bigots have a right to free speech (and contrary to the views of the present government, a right to be bigots), but that doesn’t mean they have a right to speak at any particular institution. The Tory defence spokesman Julian Lewis - whom I know and respect, and sometimes deputise for in debates on nuclear deterrence - was right to resign his membership of the Union in protest, and to criticise the Oxford Union President in personal terms. Yet the arguments of some other protestors were pernicious. It is not the case that, as an officer of the Oxford University Jewish Society put it, free speech is “overshadowed in this instance”. Once the invitation had been issued, it would have been wrong to withdraw it, and protestors who aimed to prevent the meeting ought - on the press accounts I have read - to have been met with a firmer police response. Griffin is a demagogue and Irving is a racist faker; but the offence you and I are caused by their views is entirely irrelevant to civic affairs.

Those that were protesting the decision invitation have my full support. For clarity on the issue of free speech, listen to Christopher Hitchens speak in Canada last year.

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Rethinking Popper

A recent conference in Prague, Rethinking Popper, has a list of contributed papers about Karl Popper. One paper listed is by Dirk Verhofstadt called The Liberal Testament of Karl Popper. Here he is talking about Popper’s view of closed societies, and pointing out that this did not mean Popper rejected strong government:

Popper rejected every political and philosophical thought that started from its own infallibility. Think about communist party leaders such as Lenin, Stalin, Mao and Pol Pot. Think about fascist leaders such as Mussolini and Hitler. Think about theocratic leaders such as ayatollah Khomeini in Iran and the pope in the Vatican. Infallibility most commonly consist within closed societies where criticism isn’t allowed, where people live without freedom of speech, without freedom of belief or disbelief, and without freedom of association. Fundamentalism and infallibility walk hand in hand without paying attention to the atrocities this brings to numerous people. Popper warned that ‘those who promise us paradise on earth never produced anything but a hell.’ Criticism is to Popper the most important way to replace established beliefs with new ones. It is not the guarantee to establishing the perfect society but it is the key to detecting and abolishing social atrocities.
The aversion to infallibility would have brought Popper up to arms today against market fundamentalism. Neo liberals and libertarians ‘believe’ that a free market and absolute freedom will always lead to a better result for mankind. Reality proved them wrong. In the book The Lesson of This Century Popper claims: “A free market without intervention does not and cannot exist”. Unconditional belief in freedom and a free market often lead to indifference towards people who can’t perform in society due to sickness or old age. It even leads to corrosion of the free market due to monopolies. A strong government is required to guard the free market from monopolies and price agreements. A strong government is required to defend the constitutional state and to guarantee the safety and freedom of its civilians. A strong government is required to help the sick, seniors and disabled, and to give children the educational opportunities to develop their own talents.

I have never understood why the UK’s libertarian Samizdata site includes Popper’s text underneath a gun, when he would have found a large proportion of their politics an anathema.

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Insurers agree to more transparent physician ratings

Just weeks after it was signed, Cigna's agreement in New York to modify its physician ranking tool is set to have a ripple effect across the country.

Aetna and Empire BlueCross BlueShield, a WellPoint company, have signed similar agreements with New York Attorney General Andrew Cuomo's office. Aetna signed its deal on Nov. 13, while Empire followed the next day.

Aetna immediately pledged to apply the terms of its New York agreement to all of its tiered networks nationwide. Cigna made a similar pledge the same day Aetna did. WellPoint said it is not ready to make such a promise.

Under their separate deals, all three plans have agreed to make the basis of their physician ranking programs transparent to members, base those rankings on nationally recognized quality standards and submit their programs to outside evaluation.

Cuomo began looking into health plan physician-ranking programs this summer, based on concern that consumers would be directed to certain physicians based solely on cost, not quality.

"Attorney General Cuomo's model ensures transparency for both patients and doctors -- patients will now understand the criteria upon which doctors are ranked, and doctors will be able to provide input into the ranking system," said Robert Goldberg, DO, president of the Medical Society of the State of New York. Dr. Goldberg is a physical medicine and rehabilitation specialist in New York.

The Cigna Care Network designation for the plan's tiered networks is used in 58 markets from Los Angeles to Washington, D.C. At the time it signed its deal with Cuomo, Cigna said it was likely the parties would expand the reach of the agreement to cover its tiered networks nationwide, though it didn't make that announcement immediately.

[...] Copyright 2007 American Medical Association. All rights reserved.
RELATED CONTENT  You may also be interested in reading:
Putting the quality in rankings - Editorial Dec. 3
New York agreement refines doctor-rating criteria  Nov. 19
Resistance builds against insurers' tiered networks  Sept. 17
New York warns of lawsuit over physician rankings by United  Aug. 6
Coping with rankings: Still time for challenges  June 18

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PHR: Pretty Half-hearted Reception

One doesn't have to look hard to find a personal health record system. A 2006 study by the Markle Foundation found that more than 200 PHR systems are available, and new products are continually being announced. But studies also show that availability is not translating into use, with only about 5% of all patients using PHRs.

Vendors have had a hard time selling the idea of a personal medical diary to healthy consumers who see their doctors maybe once or twice a year. In addition to privacy and security concerns, patients are staying away because the PHRs on the market aren't doing much to entice them, analysts say. The industry also has failed to come up with a convincing argument for why doctors should encourage their use.

But the technology is changing, along with the scope, to make PHRs more attractive. Vendors are reaching out to health plans and employers in hopes of encouraging PHR use through incentives. And expanded data sets make the records more useful to physicians.

PHRs have been welcomed by their original target audience: patients in active treatment and their caregivers, said Peter Waegemann, executive director of the Medical Records Institute, which researches electronic medical record usage and adoption.

But even among early adopters, privacy and security were major concerns, said Cynthia Solomon, founder of Sonoma-Calif.-based FollowMe. One of the first known Internet-based PHRs, FollowMe was launched in 2000 by Solomon, who was caring for her chronically ill son.

[...] Copyright 2007 American Medical Association. All rights reserved.
RELATED CONTENT  You may also be interested in reading:
Microsoft's HealthVault is the latest entrant in the PHR arena  Oct. 22/29
Personal health record venture gets new life  Oct. 8
Insurers collaborate on standards for PHRs  Jan. 1/8
An uphill climb for personal health records  Column June 19, 2006

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Union-run VEBAs taking charge of corporate health benefits

Physicians are trying to set up meetings with United Auto Workers officials to find out how the union's coming takeover of retiree health benefits from Ford, Chrysler and General Motors might affect them.

But if previous transfers from companies to unions are any indication, physicians should not expect the new managers of retiree benefits to be more generous than the old ones. In fact, a union's takeover of benefits has sometimes resulted in even more aggressive cost-cutting efforts than when the benefits remained under corporate control.

"It's a huge change of mentality," said Matthew Holt, a health care consultant and vice president of research for Emeryville, Calif.-based Professional Service Solutions Inc. "Instead of saying, 'GM, you'd better give us this, this and this,' now [the union says], 'It's our money.' "

With Ford workers represented by the UAW ratifying their new contract on Nov. 14, the automakers will begin fulfilling their commitment to put $54.4 billion -- $32 billion from GM, $13.6 billion from Ford and $8.8 billion from Chrysler -- into the union's Voluntary Employees' Beneficiary Association, or VEBA.

Congress created VEBAs in 1928, and they served as the basis for company sick funds, a precursor to private health insurance. VEBAs are tax-exempt entities, and corporate contributions to VEBAs are also tax-exempt. A VEBA can be funded by more than one employer, but in any case it needs an IRS letter of determination to prove its tax-exempt status.

[...] Copyright 2007 American Medical Association. All rights reserved.
RELATED CONTENT  You may also be interested in reading:
UAW, Ford reach tentative agreement on health costs  Jan. 2/9, 2006
Physicians brace for impact of GM's health cost cuts  Nov. 7, 2005

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