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Opioid Solutions When the Government Refuses to Address Problems

In his recent essay on this site, Dr. Stephen Skoly described the consequences of legislation seeking to regulate prescription opioids, but he stopped short of broad conclusions about the politics involved.  As it happens, one such conclusion fit in well with the other topics that John DePetro and I discussed on December 30.

We can, of course, debate whether a new $5 million fee for opioid manufacturers and wholesalers is actually about solving a social problem, rather than finding a new source of revenue.  But taking the politicians at their word for their motivation, one can at least say that such policies infantilize the people, as if our legislators and governor are the only adults in the state and therefore must protect patients from their irresponsible selves and from greedy doctors.

Something milder and, in its way, worse is probably going on, as well.  The theme that John and I happened upon in our segment was that government officials in Rhode Island shy away from addressing actual problems.  They look for all sorts of ways to get at them without actually naming and attacking the root causes.

When it comes to a failing education system, they seek work-arounds and small tweaks like, like shifting authority toward principals, rather than draw attention to the labor-union structure that makes the system all about the remuneration of adults rather than the education of children.  When it comes to teenage fights at a mall, the focus goes to things like community programs to give kids something to do, rather than unraveling the progressive assumptions that lead to gang-friendly policing and suspension-unfriendly school regulations (not to mention identity-group entitlement).

Just so, going after fentanyl and heroin on the criminal market would manifest in urban areas and among minorities.  Many people in those communities would be grateful for the improved environment, but the enforcement and incarceration statistics would look bad and draw the attention of groups like the ACLU.  So instead, government tries to find a solution from the other side, making things more difficult (literally more painful) for law-abiding citizens, in the hopes that they can limit the market for the drugs and make the dealers go away for lack of profit.

If that approach also produces a $5 million fee for government, so much the better.

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Political Monday with John DePetro: RI’s Avoidance of Real Problems

My weekly call-in on John DePetro’s WNRI 1380 AM/95.1 FM show, for December 30, included talk about:

  • Elorza’s interest in being governor
  • Causes and effects of Providence Mall brawls
  • Disappointment in Raimondo’s failure to succeed
  • Stephen Skoly’s warning about opioid nannyism

Open post for full audio.

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A Far-Reaching Conversation on State of the State

State of the State co-host Richard August invited me on for a full hour of the show to cover a broad range of topics, from Tiverton’s recall election to broad political philosophy.

12-9-19 A Different View of Matters from John Carlevale on Vimeo.

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Vaping Shows How Quickly They’ll Take Away Rights

Note this, from Guy Bentley on Reason:

The Centers for Disease Control and Prevention (CDC) has finally identified a primary suspect in the wave of vaping-related lung illnesses and deaths.

Examining lung tissue samples of patients hospitalized with vaping-related illnesses, 100 percent tested positive for vitamin e acetate, often used to cut marijuana oils. This was not a surprise to those who have been arguing that the cause of these illnesses is not the commercial e-cigarette market, but the illicit market for THC vapes.

Now recall that Democrat Governor Gina Raimondo moved quickly to hurt Rhode Island businesses by unilaterally banning a legal product that even then looked likely not to be the culprit.

Yes, we’re decades into a campaign by government to create a superstitious dread of nicotine products, but still… part of me can’t help but feel like every incident like this is a test to see how willingly Americans will give up their rights and their freedom.  The results of this test were not encouraging, at least in Southern New England.

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Political Monday with John DePetro: A Creature of Their Own Making

My weekly call-in on John DePetro’s WNRI 1380 AM/95.1 FM show, for November 25, included talk about:

  • Insider Alves and the radical caucus
  • The union view of employer responsibility
  • Gaspee versus campaign finance laws
  • Paint on the statute becoming blood on government’s hands
  • Blood on the police officer’s hand gets a slap on the wrist

Open post for full audio.

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Freedom… From the Progressive Point of View

Perhaps the most clarifying statement in Rhode Island politics, recently, came from one of the candidates now involved with Matt Brown’s Political Cooperative (which, despite the name, is not an alt-country band):

“Thought I may be the epitome of the American dream I cannot sit around and watch while many of my brothers and sisters are denied a shot at that very dream,″ said Jonathan Acosta, tracing his own story from “first generation American born to undocumented migrants from Colombia″ to the Ivy League.

“I believe that we are not free until we have dismantled structural inequality, developed sustainable clean energy, enacted a $15 minimum wage that pays equal pay for equal work, extended healthcare for all, provide[d] affordable housing, ensured quality public education starting at Pre-K, undergone campaign finance reform, criminal justice reform, and implemented sensible gun control,″ said Acosta, running for the Senate seat currently held by Elizabeth Crowley, D-Central Falls.

So, to Mr. Acosta, we’re not free until we’ve taken from some categories of people to give to others, limited people’s energy options to benefit fashionable technologies, forbidden employers and employees from setting a mutually agreeable value on work to be done, taken money from some people in order to pay for others’ health care (as defined by a vote-buying government) and/or put price controls on what providers can charge, placed restrictions on who can live where and what they can build, tightened the regulation of politics with limits on the donations and privacy of those who become politically active, and reduced the rights guaranteed under the Second Amendment of the United States Constitution.

If that doesn’t match your understanding of “freedom,” you’re not alone.  Indeed, by its mission, this “cooperative” is cooperating against anybody whose understanding of freedom differs, because it cannot possibly cooperate with anybody who disagrees.  You simply can’t hold a definition of freedom that doesn’t have satisfactory outcomes for the interest groups that progressives have targeted.

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Fundamental Questions Vaped

Joanne Giannini’s essay in this space yesterday points in the direction of fundamental questions our society doesn’t seem interested in asking these days — much less answering.

A former state representative, Joanne was in office during a time when state government was cracking down on smoking.  She sees the rise of vaping as an as-bad-or-worse substitute cropping up and (one infers) probably deserving of the same response.

The first question is whether the rash of illnesses is actually an indication that vaping is truly dangerous.  Robert Verbruggen writes for NRO that reports of “the mystery vaping disease” merit investigation and concern, but indications are that they may be highlighting a tangential, not endemic, problem:

… while a lot remains to be learned about the illness, there are strong suggestions it’s caused by bad or counterfeit products, not by normal vaping. The cases cluster geographically, and in some states they have been found exclusively among those who vape cannabis products, not nicotine. Scott Gottlieb, the former FDA director who launched a crackdown on vaping when studies showed teen use on the uptick, told KHN he suspects the problem is counterfeit pods, both because of the clustering and because the FDA inspects the facilities of legitimate manufacturers to ensure the products aren’t contaminated.

This, in other words, may be less like cigarettes, which cause disease by their nature, than like food poisoning.  If that’s the case, then regulation should be less about limiting access as a way of discouraging use than about helping consumers differentiate between safer and riskier products.

Either way, the question remains what our society ought to do when the short- and long-term effects of a consumable are unknown or are known to be bad.  Limiting their use by minors, who are presumed to be unprepared to make informed decisions, is an obvious possibility.  But shouldn’t adults be permitted to balance the risks and rewards of these things for themselves?

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A Disabled Society in an Abled Social Body

The headline of Ashley Taylor’s JSTOR Daily essay doesn’t so much articulate the problem as illustrate it: “The Complicated Issue of Transableism.”

In the late 1990s, the Scottish surgeon Robert Smith performed elective, above-the-knee amputations on two people. (The hospital he was affiliated with eventually compelled him to stop.) Smith’s patients are just two examples of people who have body integrity identity dysphoria, also known as being transabled: They feel they are disabled people trapped in abled bodies. Some people feel that they are meant to be amputees and will even injure themselves in order to create the desired amputation or make it medically necessary for a surgeon to perform it. Other people feel that they were meant to be blind or deaf.

A healthy society would not find “transableism” complicated at all.  It is an indication of deep mental illness, and it should be treated, not indulged.  To the extent our society cannot articulate this unambiguously, we are clearly falling into social illness.

At the very core of this question is a denial of our right as a community to hold Platonic ideals — not to mention the necessity and even inevitability of doing so.  Being able-bodied is the objective norm, the ideal.  When people are disabled, we make allowances and provisions for them in order to close the gap to that ideal.  It is therefore objectively wrong to expect society to offer those accommodations to somebody who deliberately moves away from the ideal.

Somebody of an opposing view might turn this argument around and suggest that all they’re doing is accommodating the person’s psychological distance from the ideal of feeling like an able-bodied person.  But making permanent physical changes compounds the distance rather than relieving it: the person is now disabled and still averse to being able-bodied.

The best one could say is that the person is closer to the ideal of being comfortable, but that is potentially fleeting.  After all, it is always possible to be more disabled.

Elevating the ideal of individual comfort is also destructive of the possibility of objective norms.  On the social scale, such principles have to be taken as simply true, else the utility of culture evaporates and society simply falls apart.

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Continuing Education for Professionals

Dan McGowan’s review of some claims that have recently been made about problems in the Providence school district is worth a read.  Broadly speaking, the claims about the school facilities themselves proved to have been exaggerated, while problems with management of teachers were not so much.

This item raises something that I’ve wondered about before — specifically, how much emphasis people really put on “professional development”:

Teachers get one day of professional development a year.

Grade: C

During a series of public forums following the release of the report, Infante-Green often asked attendees the same question: Would you go to a doctor who only received one day of training each year? While it is accurate that the current union contract only requires one professional development day during the school year, more nuance is required. Union president Maribeth Calabro and the Elorza administration maintain most teachers receive significantly more training each year. As an example, Calabro said at least half of her members have attended professional development sessions during their current summer vacation.

To be honest, I’d have no problem discovering that my doctor has only “one day of training each year.”  Doctors spend every day analyzing patients and determining the best treatments for their ailments.  One can expect that they are continually reviewing the latest information that might help them to do their jobs better.

The idea that they’ll simply coast along for their entire careers — doing the equivalent of handing out photocopied worksheets year after year — just seems strange.  Some will be better about this and some will be worse, but the fact that a doctor dedicated more than one day to some government-approved course of study that may or may not be relevant to my health and that may or may not have focused on some medical fad or PC indoctrination would not impress me at all.

So the question, then, is why we shouldn’t expect the same from teachers.  They have a 180-day work year.  Why should we assume that if we don’t use up some of those days for “professional development” instead of teaching, they’ll just let their skills atrophy and knowledge become antiquated?

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A Better Way to Cover Americans

With the State of Rhode Island writing ObamaCare into state law with this year’s budget, it’s worth noting a proposal floating around in conservative circles and the Trump Administration, as Avik Roy articulates here:

Last week, the White House finalized a new rule that allows employers to fund health reimbursement arrangements (HRAs) that can be used by workers to buy their own coverage on the individual market. This subtle, technical tweak has the potential to revolutionize the private health insurance market. …

The administration estimates that as many as 800,000 employers — mostly smaller businesses — will choose this option, expanding health care choices for 11 million workers in the next decade. These employers will benefit from having fiscal certainty over their health expenditures. And workers will benefit from being able to choose their coverage and take it from job to job.

This is the health-care-market fix for which I’ve been advocating for years.  Everybody would get accounts, and employers could put money into them for their employees.  So could the government, as welfare benefits, and so could charities.  So could parents or even concerned members of a community after some surprise accident or illness for a neighbor.

At the same time, eliminate most mandatory coverages for health insurance so people for whom it makes sense can buy catastrophic coverage inexpensively.  That way everybody is covered for emergencies and nobody ever has a preexisting condition, because everybody has always had some sort of coverage.  At the same time, Americans would be better able to make health care decisions because they’d more often be paying directly for the services they receive and doing the cost-benefit analyses that people several steps removed from their situations can’t possibly do.

Of course, under such a system politicians attempting to buy votes would have to be more direct about it.  They’d be limited to transparently depositing taxpayer money into accounts instead of implicitly driving up costs in our opaque system by requiring insurers to cover certain benefits.  But in a fair analysis, a better, more-sustainable health care system that doesn’t distort the employment market is probably a little bit preferable to enabling corruption in politics.

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Rhode Island: An OK Place to Live

Obviously, the more subjective the thing an index attempts to measure, the more subject it will be to interpretation, and WalletHub has made a cottage industry of cranking out subjective rankings.  That said, the Web site’s “Best States to Live in” ranking from June has some interesting considerations for the Ocean State.

Notably, the Ocean State is supposedly the 29th best state in which to live… which seems OK, considering Rhode Islanders’ expectation to come in at the very bottom of all rankings.  OK begins to look not so good, though, when one zooms out on the map.  WalletHub claims Massachusetts is #1 and New Hampshire #3.  Vermont and Maine are both in the teens, and Connecticut comes in at #20.

Looking at the subcategories, RI’s worst result was in “affordability,” which shouldn’t surprise anybody.  The Ocean State was the fourth least affordable state, after New York, California, and New Jersey.  But here’s the thing:  No New England states are very affordable.  Massachusetts, for example, is 43rd and New Hampshire is 42nd.

So what makes the difference?  Massachusetts is in the top 5 for everything else:  economy, education & health, quality of life, and safety.  New Hampshire only misses the top 5 in quality of life.  Meanwhile, Rhode Island only breaks the top 20 on the safety subcategory (at #5).  The conclusion is that Rhode Island might not be able to avoid being expensive, but that only means it can’t afford to be unattractive by other measures.

Here’s where the subjectivity of the index becomes important.  Quality of life includes things that Rhode Island can’t help, like the weather, and things that depend on one’s values and interests.  The importance of “miles of trails for bicycling and walking” will vary from person to person.

But quality of life also includes things like the quality of the roads, which is pretty universally valued.  Meanwhile, multiple criteria that the index uses center around leisure activities that cost money, which means disposable income is a factor, as is the ease with which businesses can pop up to answer the demand.

MIT’s Living Wage Calculator states that a single Rhode Islander needs to make $12.35 per hour over a 2,080-hour workyear.  However, $1.86 of that goes to taxes.  For comparison, in New Hampshire, only $1.50 per hour goes to taxes.

This all suggests an unsurprising solution for improving Rhode Island’s standing:  lower taxes, use the money that is collected for things that are of more universal value, and decrease regulations.  We’d all have more money to spend, we’d feel better about our day-to-day life, and we’d be better able to answer each other’s needs.

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Straight Up Taxpayer Dollars for Promise of a New Treatment

After Steve Ahlquist firstbrought attention to the million dollar handout that the Rhode Island House wishes to give to Dr. Victor Pedro for his Cortical Integrative Therapy (CIT), a WPRI report covered the history of Pedro’s taxpayer funding.  One can’t help but feel that there must be more to the story:

  • Legislative leaders have long gone to bat for the doctor.
  • The executive branch has apparently made extra efforts to secure Medicaid funding for his treatments.
  • And even mild-mannered Lieutenant Governor Daniel McGee has spoken well of Pedro, including his activities in Cumberland schools back when McKee was mainly known as a mayor for that town.

Amazingly, though, nobody has yet mentioned the connection of pop star Paula Abdul, which takes an only-in-Rhode-Island turn.  Says Abdul:

I wish I’d had Cortical Integrative Therapy when I first discovered I had RSD, and I wish Dr. Pedro had been a part of my support system then like he is now.  The treatment replaces the old tapes in your head that have held onto the tapes of pain.  It helps your brain to allow for new experiences and new memories that don’t involve pain.  Think of it in terms of a computer — you’re deleting old files so you can free up more space.  I didn’t find out about Cortical Integrative Therapy until recently, and it has proved to be a life-changing treatment for my RSD.

The strange Rhode Island turn is that Abdul has another connection to Rhode Island as the long-time girlfriend of John Caprio, son of Caught in Providence star judge Frank Caprio and brother of the former treasurer and gubernatorial candidate of the same name as well as former representative David Caprio.  Various online sources also seem to indicate that Abdul has set up various businesses at 2220 Plainfield Pike in Cranston in the past.

This topic could certainly take a serious turn into political theory as an example of why government shouldn’t be in the investment and research business, why Rhode Island should end legislative grants, and why the governor should have the line-item veto.  If Pedro is an innovative practitioner of alternative medicine for the stars, he shouldn’t need government subsidies.

For this post, though, let’s just close with a sincere hope that Rhode Island’s press is sufficiently interested to unravel this entire peculiar tale.

Somewhere around Twitter, I saw somebody complain that people are spreading "lies" about Virginia Democrats.  The on-point response from somebody else (paraphrasing):  "People are spreading direct quotes."

The Danger of Saving a Child’s Life

Even if I could somehow adjust for the fact that I agree with his views on abortion and human life, I think I would still struggle to understand how a story like that of Argentinian doctor Leandro Rodriguez Lastra could fail to spark cognitive dissonance among supporters of abortion:

Rodríguez is the head of the department of gynecology at the Pedro Moguillansky Hospital in Cipoletti. In May 2017, he treated a 19-year-old woman who was suffering severe pain due to ingesting misoprostol, the first of a two-part abortion pill regimen, which had been administered by an abortion group.

The doctor confirmed that the woman was almost 23 weeks pregnant and the baby weighed more than 1 lb. 2 oz., so in conjunction with the medical team and the hospital board, he decided not to terminate the pregnancy.

Rodríguez stabilized the patient and when the baby reached 35 weeks gestation, labor was induced. Days later, the baby was adopted and will soon be two years old.

This is in the news, right now, because Rodriguez faces two years in prison for the act of saving two lives.  One of the two wanted him to finish the job of killing the other, which she had started.

How — How? — could anybody think of that now-two-year-old child and think to him or her self, “This doctor must be punished because that child is alive”?  Is the child Damian, the Antichrist?

Of course it’s not this specific child.  Rather the motivation is to make of Dr. Rodriguez an example, so that doctors’ desire to save lives cannot disrupt the principle of infanticide — or, one step closer to the higher principle, complete sexual liberty.

Whether the focus is the child or the doctor, however, a society that sees either as a danger requiring punishment could not have a clearer need for self reflection.

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Dr. Stephen Skoly: Opioid Tax Bill Would Harm Families and Businesses and Do Nothing to Address the Problem

The opioid epidemic is a widespread, complicated problem, and only a collective effort will begin to solve it. The healthcare community and lawmakers need to work in tandem to find policies that effectively lessen opioid abuse while still keeping our state’s economic health as well the health and safety of the patient in mind. It’s unfortunate, however, that Senate Bill S0798, the Opioid Stewardship Act, fails on both accounts.

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