The American Spectator

Obama and his cohort seemingly want to tax anything that moves, including non-union provided health care. As a retiree from GM (all such benefits including life insurance are now gone) I have been deprived of heath care insurance despite the fact I worked at GM at less than half the going rate for attorneys because of such benefits. I want to add some suggestions for additional items to tax. It seems only fair that Obama and his equally clueless helpmate Michelle (she of the worthless non profits) be taxed on their affirmative action scholarships at Columbia, Harvard, and Princeton. After all, all of these institutions are recipients of federal money in some form or other even though they do all they can to restrict the presence of the military on campus. The really sad, but probably symbolic of something, fact is that these two clueless dunces (is that redundant?) are essentially at most half-educated despite the thousands of dollars spent on them. Scary!
— Jack Wheatley
Royal Oak, Michigan

GETS BETTER AND BETTER
Re: Ilan Berman’s Iran’s Revolutionary Moment?

Sooner or later, everything old is new again. Thirty-some years ago, an Iranian mass movement overthrew the Shah and replaced his government with an Islamic theocracy. Now a new generation, who are too young to remember the Shah, but do know what the mullahs have wrought, are on the move.

Maybe this time around, they could seize the American embassy, too…
— Robert Nowall
Cape Coral, Florida

WATCH OUT FOR FRIENDLY FIRE
Re: R. Emmett Tyrrell, Jr.’s Obama’s Senior Moment:

I am a conservative health policy researcher and I have started working in the area of comparative effectiveness research. I think some clarification needs to be made about what comparative effectiveness research is and how it can be used advantageously for patients. Comparative effectiveness is not cost-effectiveness, and conservative health economist Gail Wilensky has made the case many times for the need for comparative effectiveness separated from cost effectiveness. Comparative effectiveness should also not be based on age, but on the outcomes associated with treatment. For example, I am developing a study to look at the comparative effectiveness of bisphosphonate treatment for women on Medicare. My outcomes are death, hospitalization due to fracture, and other treatment of fractures. I am interested in whether brand name has an advantage over generic, whether the dose administration (daily, weekly, or monthly and oral vs. infusion) has an impact on outcomes, and whether people are more adherent and persistent with one drug versus another. Of course we look at patient characteristics so that we can control for differences based on sex, age, race, etc.

In clinical trials, drugs of the same type are usually not tested against each other. Trials test the drug vs. placebo or drug vs. another class vs. placebo. They also limit the patient population to a healthier group than those who may eventually be prescribed the drug and don’t follow people over long periods of time. Comparative effectiveness research will give us the ability to say “drug X is better than drug Y” or “Drug X and Drug Y are the same.” If age or other characteristics can be interpreted from the data, all we would be able to say is “Women between the ages of 65-80 have fewer fractures than older women on Drug X” or “Women over age 80 have lower mortality rates on Drug Y than on Drug X.” It would not eliminate or preclude treatment based on age; it would measure the differences in outcomes. My study, if funded, will not consider the cost of treatment as a factor. If my research shows that a brand name drug is better than a generic, then how does that hurt people? I want them to get the best drugs to treat their conditions, regardless of cost.  

I recognize that the Federal Council on Comparative Effectiveness can eventually wield a great deal of power over health care decisions if the Democrats have their way, but I don’t think it is appropriate to vilify comparative effectiveness as a whole. There are many of us who are only interested in which treatment improves health the most, not which treatment is most cost-effective. Drugs work differently in different people. I, and many people that I know, benefitted more from using Vioxx than Celebrex, whereas others preferred Celebrex or Vioxx. If we had been doing more comparative effectiveness research in the past, we could have discovered more about the risks associated with Vioxx and learned if it was any different than the risks for Celebrex and Bextra. However, without the benefit of head-to-head comparisons, Celebrex is the only Cox-2 inhibitor left on the market and patients who benefitted more from Vioxx or Bextra are left with a poor substitute for their treatment. And the important point to emphasize is that, even with comparative effectiveness research, drugs may have different effects in different people and doctors need to be able to make choices that will benefit their patients. I want to be able to inform them about treatment effects in large populations, but not make the prescription decision for them.

I’m sorry for the long-winded response, but I really believe that comparative effectiveness research is not the enemy, but the Federal Council on Comparative Effectiveness could turn out to be so if it misuses the results of comparative effectiveness research. I wish that conservative commentators would not lump both the researchers and the Council in their condemnation, but focus on the power that the Council may have and who sits on the Council. You’ll notice that Dr. Wilensky is not a member, despite her numerous articles calling for more comparative effectiveness and guiding the development of comparative effectiveness research. Because she was a Republican administrator of HCFA under President George H.W. Bush and worked with President George W. Bush, I am assuming that she has been deemed persona non grata. The Obama administration seems to be doing the same thing that Democrats accused the Bush administration of doing — not entertaining opposing viewpoints.
— M. Paige Powell, PhD
Assistant Professor of Health Services Administration,
University of Alabama at Birmingham
Birmingham, Alabama

HECHOS, POR FAVOR
Re: Angelo M. Codevilla’s Pro-Mexico:

I read the “Pro-Mexico” feature by Angelo Codevilla with interest but was disappointed to find it was just another leftist talking-point piece. Codevilla suggests that smaller numbers of young Americans are not inclined to work with their hands and in the service industry, but never suggests that a reason might be suppressed wages due to an expanding illegal labor pool. Codevilla suggests that opening the borders would sustain Medicare and Social Security, but it doesn’t occur to the author that those programs are broken and unsalvageable to being with. Codevilla calls “the right” ignorant for characterizing illegal aliens as welfare freeloaders, yet chooses not to acknowledge or argue against the sizable amount of data collected on the issue. Of course, Codevilla unfortunately chooses to play the race card by mentioning the “racial contempt” “gringos” have for Mexicans. I have to admit, I didn’t expect that kind of race-baiting collectivism to be in a conservative magazine like The American Spectator.

Mexico is a country with two coasts, multiple ports, tremendous natural resources, access to U.S. technology and a willing workforce, yet the Mexican government is rarely held accountable for abusing and ejecting its own working poor. Instead, the U.S. citizen is held to blame. The U.S. welcomes more legal immigrants per year than any other country in all of human history and is still the most pro-immigrant country on earth, despite what the leftist, ethnocentric grievance organizations might say. This is Dependency Theory (Lawrence Harrison) at its ugliest. Further, it’s interesting how Mexican cultural values are never evaluated in this context. Certainly some cultural values are economically more useful than others.

Scholars such as Codevilla can blame the American citizen all he wants for “fouling our own nest.” But the hard data remains: when you import poverty, you get more poverty. Shall we absorb entire unskilled, uneducated, impoverished populations of foreign countries at the expense and detriment of our own working poor and tax-funded infrastructure? Why it is that facts, data, information, culture and relevant history are still left out of this debate?
— Charles Johnson
Chicago, Illinois