Back to Sleep

If you have had a child recently or, for that matter, in the last 15 years, you are probably familiar with the National Institute of Health Back to Sleep Campaign intended "to educate parents, caregivers, and health care providers about ways to reduce the risk for Sudden Infant Death Syndrome (SIDS)." It is an educational program that recommends, among other things, to place infants in the supine (face up) position for sleep. This recommendation comes from a correlation between prone (face down) sleeping and SIDS.

Despite the recommendation, my wife and I have chosen to place our two children (now 2 years and 5 months) on their stomachs to sleep. There are various reasons why we made this decision that I may discuss in a follow-up post, but the reasoning is not really relevant to this discussion. While enrolling our 5 month old at a local daycare, we learned that the Texas daycare licensing organization (Texas Department of Family and Protective Services) does not allow caretakers to place infants on their stomachs without a letter from a healthcare professional.

I respect the recommendation of the NIH (and the AAP recommendation it is based on) but I never imagined we would run into difficulties with the choice we made. After all, isn't this the parents' decision? In their own justification within the "Minimum Standard Rules for Child-Care Centers", DFPS says "After 30 years of research, scientists still cannot find a cause for SIDS; however, research has found the risk of SIDS may be reduced by placing a healthy infant on his or her back to sleep" (emphasis added). The text goes on to discuss several specific instances where a doctor may recommend stomach sleeping. The problem I have with this is that the government has taken a perfectly reasonable recommendation and turned it into a firm rule that ignores the preferences of parents.

It is important that the government provide educational programs to help the general public keep up with the latest understanding of medicine but it is also critical that government agencies not overstep their bounds and make unbendable policy when a recommendation should suffice. The appropriate policy would restate the recommendation but provide parents the right to have their children placed on their stomachs with a simple letter stating that they are aware of the Back to Sleep campaign and waive the daycare center and the state of liability in a SIDS case.

Healthcare Debate: Is Reform Necessary?

The best place to start in discussing healthcare reform is whether or not it is even necessary. The two primary pushes for healthcare reform are to provide universal coverage and to reign in cost increases.

Universal coverage proponents like to say that 45 million Americans are without health insurance and it is our moral responsibility to provide it. FactCheck has a fairly thorough analysis of the number of uninsured and reasons for lack of insurance. A portion of the uninsured are illegal aliens while a large percent are likely uninsured by choice, however, it is clear that there are still millions of Americans who cannot currently get and/or afford health insurance.

Ignoring the fiscal side of the equation for now, it makes sense for healthcare to be available to all. Of course, emergency care must already be provided to anyone who needs it and there are many free clinics available nationwide so lack of health insurance does not necessarily correlate to lack of healthcare. This fact makes the morality arguments fall apart.

The fiscal argument is a different story. Healthcare costs are rising considerably faster than inflation. It is obviously not sustainable for our economy if costs continue to increase at their current rates. Working for a small company, I have seen first hand the struggle to keep costs down so my emotional response is that we need reform.

The question, though, is can Government reform fix this problem. First of all, we must recognize that increases in healthcare spending are not isolated to the U.S. Proponents of reform are quick to point out that U.S. healthcare spending is far higher than other countries but neglect to mention that those countries are seeing similar increases in costs. That is to say that healthcare is cheaper elsewhere but it is getting more expensive at a similar rate (sources: Canada, the U.K. and France).

Perhaps, we are seeing a healthcare bubble that will self-correct. We know from the dot-com bubble of the late 90s and the recent housing bubble that unsustainable growth in particular markets has a way of eventually correcting itself without Government intervention (or, in the case of housing, in spite of Government intervention). For this reason, I lean towards limited Government intervention; however, I do think there are appropriate reforms that should be made. In upcoming posts, I'll get into the specifics of the proposed reform and weigh the pros and cons in much more detail.

How Not to Rationally Analyze Healthcare Reform

I generally like the posts on the mint blog because they aim to provide information for ordinary people and are typically unbiased. "How Health Care Reform Would Impact You" is an exception. It reads like the regurgitation of a political speech from a healthcare reform proponent rather than a thoughtful piece on impact of reform. I guess this is yet another lesson that you shouldn't blindly trust anything you hear or read, even if from a reputable source.

Hopefully, I'll address most of the issues in my healthcare series but I'll talk about the ridiculous financial statements real quick. The author states that the plan will be paid for by those making more than $1 million and it makes them angry because they will have to by $900 bottles of wine rather than $1000 bottles. This has become a common chorus recently that the super rich can easily support the rest of us. According to the 2006 IRS records (the most recent available), there were only 350,000 returns over $1 million so these statements rally the vast majority of taxpayers. Unfortunately, the same records show that those tax payers earned a total of $1.08 trillion so it would take 10% of their income just to cover the $1 trillion (over 10 years) in healthcare. But, let's not forget that they already pay $280 billion in taxes, or 26%.

This, along with other tax raises planned for the wealthy will soon have them paying over 50%. I'm not against increasing taxes on the super wealthy to help cover healthcare reform, but it is dishonest to tell people it is the answer to all problems.

Healthcare Debate: Part 1

I've been thinking about an analysis of the healthcare debate for some time now. Since it's such an overwhelming topic, this will be the first of several posts. To start, FactCheck.org presents an analysis of the hype in President Obama's speech last night. He profoundly overstated several statistics, one to the tune of $4.9 trillion. I've read parts of the current healthcare reform bill in the House (H.R. 3200) though nowhere near all of the 1018 pages. I think it has strengths and weaknesses and I hope to address several of them in coming posts. For now, check out One Trillion Dollars Visualized.

Consumer Financial Protection Agency (the irony)

Obama wants to establish a Consumer Financial Protection Agency. He says: "Those ridiculous contracts with pages of fine print that no one can figure out — those things will be a thing of the past, and enforcement will be the rule, not the exception." The irony is that the draft bill to establish the agency is 152 pages long. Talk about fine print and that is a relatively short bill compared to some of the recent ones that have gone through Congress. Maybe, we need a Voter Protection Agency that forces Congress to pass short, understandable bills.

Sotomayor

President Obama's nomination of Sonia Sotomayor for Supreme Court Justice has been all over the news lately, including screaming from both sides about how great/awful she is as a pick. Now that I have had a week to wade through the nonsense, I will do my best to rationally assess the quality of the pick.

Empathy: I previously talked about Obama's desire for empathy in his pick. Well, he seems to have gotten it with Sotomayor who has said:

This wealth of experiences, personal and professional, have helped me appreciate the variety of perspectives that present themselves in every case that I hear...I strive never to forget the real-world consequences of my decisions on individuals, businesses and government

I am going to soften my position somewhat on whether empathy is appropriate on the Supreme Court. I said, "Supreme Court Justices should be apolitical, analytical, and impartial." What I should have said is, "Justices should be apolitical, analytical, and impartial in their interpretation of the law." From this perspective, there is nothing wrong with Sotomayor's quote above. It is fine, in fact admirable, for her to remember, understand, and empathize with those affected by her decisions; however, it should not change the ruling which should be based solely on interpretation of the law as the oath of the Supreme Court says:

I, [NAME], do solemnly swear (or affirm) that I will administer justice without respect to persons, and do equal right to the poor and to the rich, and that I will faithfully and impartially discharge and perform all the duties incumbent upon me as [TITLE] under the Constitution and laws of the United States. So help me God.

Diversity: Sotomayor will be the first Hispanic on the Supreme Court and the third female. Many are excited about these facts and they seem to have played into Obama's decision. I tend to agree with former Attorney General Alberto Gonzales, who said, "I don't think that any gender group or ethnic group is entitled to representation on our courts." In some ways Sotomayors accomplishments are diminished because of the focus on race and sex. If she were truly presented as the best person for the job based on experience and ability then the accomplishment could be celebrated even more. As Gonzales said:

this is a powerful message, a powerful message of hope and opportunity of hope through this appointment, just like there's a powerful message sent when an African-American is elected president or an African-American or Hispanic is appointed as attorney general of the United States

I don't think many people believe Obama was elected because he is black but the fact that he was elected is historic. Sotomayor'a nomination is similarly historic, but unfortunately, it appears that is part of why she was nominated. While on the topic of diversity, I'll refer readers to an interesting Washington Post article that talks about other diversity problems with the Supreme Court like Sotomayor joining five other Catholics on the court and the lack of a public school graduate.

Racism: This is probably the hottest topic related to the Sotomayor pick. While they have now softened their stance, some prominent republicans were very quick to label Sotomayor a racist for saying, "I would hope that a wise Latina woman with the richness of her experiences would more often than not reach a better conclusion than a white male who hasn't lived that life." This was a very unwise statement and, of course, would have caused an uproar if spoken by a white male and rephrased accordingly. However, I don't think this statement represents racism. If anything, it is arrogance. She is effectively saying that her experiences make her a better judge than others.

Resume: CNN provides a nice brief resume for Sotomayor. Very few people are debating her qualifications (i.e. experience) to serve on the Supreme Court. The real debate is whether her decisions show poor judgment. She has had several cases overturned by the Supreme Court and another upheld but her reasoning was said to "fl(y) in the face of the statutory language." Her record at the Supreme Court is not out of the ordinary, but I wonder if we should expect our Supreme Court nominees to have a better than average performance. I haven't seen any statistics on the other Justices.

The most publicized of Sotomayor's cases is Ricci v. DeStefano which is currently at the Supreme Court. In this case, the city of New Haven, Connecticut developed a promotion test for firefighters that was designed to be unbiased; however, the test resulted in no promotions for blacks despite making up 22% of the test takers. The city decided to throw out the results for fear of violating Title VII of the Civil Rights Act. It appears on the surface, however, that they are doing just that by deciding not to promote whites (and one Hispanic) based solely on their race. Sotomayor ruled that the city had the right to do this. Unless there are details in the test questions that clearly make the test biased, I would say she is wrong and it appears the Supreme Court may overturn the ruling.

Making Policy: The final topic I will cover relates to Sotomayor's statement that the "court of appeals is where policy is made." Again, this is clearly a blunder, she openly acknowledges that she shouldn't have said it, and spends a considerable amount of time trying to explain what she meant. However, she goes on to say:

On the court of appeals, you are looking to how the law is developing, so that it will then be applied to a broad class of cases. And so you’re always thinking about the ramifications of this ruling on the next step in the development of the law

I personally believe that this statement just dug the hole deeper because she is saying that judges determine the development of the law and implies that they have the right to direct that development. In reality, they should be interpreting the law as written and leave it up to the Legislative Branch to develop the law.

Summary: I've said a lot, so here is the summary. I don't think Sotomayor was the right choice for Supreme Court nominee. She is polarizing and has said some things and made some rulings that lead me to doubt her decision making. That said, Obama chose her as he had the right to do and I think she should be confirmed. She has the qualifications and, while some of her positions are questionable, none are outrageous. Also, the impact of rejecting the first Hispanic nominee could be profound.

Abortion Policy

In honor of President Obama's speech at Notre Dame Sunday and all of the controversy surrounding it, I wanted to say a some things about abortion policy. If there is one topic where neither side presents much of a rational argument, it is abortion. This is primarily due to the difficulty in defining human life. Pro-lifers would like to criminalize abortion under the belief that the fetus represents human life while pro-choice proponents argue that the fetus is part of the mother's body and she is free to do with it as she pleases. As Obama said, "the fact is that at some level, the views of the two camps are irreconcilable."

Given that, how should our abortion policy be structured? We can start with the obvious as laid out by Obama:

let us work together to reduce the number of women seeking abortions, let's reduce unintended pregnancies. Let's make adoption more available. Let's provide care and support for women who do carry their children to term. Let's honor the conscience of those who disagree with abortion, and draft a sensible conscience clause

I'm sure there will be arguments about how this is implemented but these are good goals.

Any real discussion about abortion policy must consider Roe v. Wade. Overall, the argument is logical and well presented. The decision primarily addresses the rights of the pregnant woman, saying that her right to privacy, as established by the due process clause of the 14th amendment, covers her decision to have an abortion. While the applicability of the due process clause to this decision is a bit sketchy in my opinion, I agree with that a woman has the right to do whatever she wants with her body (unless she or someone else needs protecting). Based on this, the Court decided that states should not be able to restrict abortions during the first trimester because the health risk of abortion is not substantially higher than the health risk of birth in the first trimester. Similarly, since the health risk to the mother increases in the second trimester, states have the right to regulate abortions to protect the health of the mother.

The Court addresses the rights of the fetus. The Court says:

We need not resolve the difficult question of when life begins. When those trained in the respective disciplines of medicine, philosophy, and theology are unable to arrive at any consensus, the judiciary, at this point in the development of man's knowledge, is not in a position to speculate as to the answer...In areas other than criminal abortion, the law has been reluctant to endorse any theory that life, as we recognize it, begins before live birth or to accord legal rights to the unborn except in narrowly defined situations and except when the rights are contingent upon live birth...In short, the unborn have never been recognized in the law as persons in the whole sense.

In these few statements, the Court identifies that establishing when life begins is hard and that it is not their place to make that determination. They then establish the legal precedent that life does not begin until birth or, if it does, that life has not been afforded rights. I don't guess this technically resolves when life begins and it seems that the argument should stop here and the previous discussion of pregnant women's rights should be the only consideration. The Court, however, continues:

With respect to the State's important and legitimate interest in potential life, the "compelling" point is at viability. This is so because the fetus then presumably has the capability of meaningful life outside the mother's womb. State regulation protective of fetal life after viability thus has both logical and biological justifications. If the State is interested in protecting fetal life after viability, it may go so far as to proscribe abortion during that period, except when it is necessary to preserve the life or health of the mother.

It appears, then, that they are going against precedent and making the determination that the fetus does have rights because it has the "capability of meaningful life." How can this be justified without resolving that life has begun at this point? As they pointed out, the unborn have not typically been given rights; therefore, their decision must be based on life having been established. But having decided that life has begun by the point of viability and the fetus' rights must be protected unless the mother is in danger, how can the Court say that before that point, the fetus does not have rights and the pregnant woman has the right to abort? It gets sticky here, again because the beginning of life is more belief than fact.

So, how do I think the case should have been decided? I agree with the protection of the fetus from abortion in the third trimester for the reasons set forth by the Court. I, also, agree that any legislation must make exceptions for maternal health (it is essentially self-defense). Regarding the right to abortion in the first two trimesters, I feel that decision essentially says that life does not begin until the third trimester. Since this is a controversial topic with no scientific answer and it is often a matter of religious belief, I feel that the Court should have abstained from defining hard rules particularly since the Justices themselves identified the arbitrary nature of parts of the decision. This would leave regulation to the democratic processes of states. The fact that 46 states had laws affected by Roe v. Wade may make this seem like a pro-life stance but this just represents the prevailing opinion as the democratic process should.

There is obviously much more that could be said about this topic but I've tried to address the core issues in a rational manner. There are plenty of "what if" scenarios that blur the lines but I obviously can't address them all. Incidentally, while researching this post, I found this discussion of when life begins, which is a very interesting read, covering historical, political, scientific, and religious aspects of the debate.