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Let's consider the most important legislative accomplishments in recent times:

1) The relaxation of COVID policy in Red States

2) The radical expansion of school choice in red states

3) The current conservative Supreme Court

All of these were the result of one sided partisan politics. They got no bi-partisan support. Some required flat out dirty tricks (the Supreme Court).

What was the last bi-partisan legislative accomplishment you can think of? The Iraq War?

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Which red states have been expanding school choice? That is really good news I hadn't heard of!

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https://www.edweek.org/policy-politics/6-more-states-will-soon-let-almost-all-students-attend-private-school-with-public-money/2023/06

https://www.washingtonexaminer.com/policy/education/every-state-passed-expanded-school-choice-2023

There are now several states where anyone regardless of income can get access to their entire state per student funding to go to whatever school they want. This amounts to close to $10k in most cases.

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Great, thanks! Like I said, good news.

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The problem with the Republican establishment is that they are, at best, the equivalent of the German army on the eastern front in 1943. The war is over, Arnold- we lost.

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"Right-of-centre administrations in the Western world....have been allotted plenty of years ‘in power’ by voters wanting them to fight their traditional corner. They certainly did not vote for the cultural dismemberment that actually happened in those years but most have tended nevertheless to accept all the ‘woke’ nonsense around them with a shrug, a bit like they accept the weather. But a new, fiercer wind is blowing in conservative journalism – particularly in America....." https://grahamcunningham.substack.com/p/mrs-thatcher-and-the-good-life

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Helen Joyce claims the trans movement is a civilization-ending movement. Why?

"you can expect dire consequences if you lie in your law and your policymaking and your education of all sorts at every level in school and universities about something absolutely fundamental to the nature of humanity."

This is related to but separate from feminism and the integration of feminist empathy for each person, especially the most sick, most needy, most vulnerable, most marginal people. What are the constraints imposed by reality? as opposed to changeable custom? The Constrained vision folk understand that XX & XY people are fundamentally different in their sex.

We have medical procedures to allow males to stop being men - but this does not make them women . We don't have a word for them, q'women; and q'men for females who reject being women. They are a tiny, ABNORMAL minority - who also need some empathy and reasonable accommodation. Dishonestly make q'women legally the same as women is not reasonable, and should not be the law.

If Levin doesn't want the USA unified in rule of law where the law protects female women from male q'women, his words are mostly sophistry. (But I won't listen to his youtube - where is transcript?)

We need Republicans to fight this - but the GOPe has been notorious about fighting weakly. The Dems will change - after the lose "enough". If they don't change, they haven't lost enough.

(On Trump's "losing" in 2020, his 2016 62 mln winning votes was dwarfed by the 75 mln votes he got in 2020, but in an election rigged against him. I call it stolen, Kling thinks rigging is ok.) No non-Trump GOP candidate will get more than 61 mln votes.

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" I received zero favorable comments on my “case for the Republican establishment” post."

You got 20 Likes.

I said, "Lots of good points in there. ..." and continued to only add something about urban violence. (Yes, opioids kill more but I'd argue the economic and community disruption from urban violence is worse per death.)

I didn't look to see who else was positive.

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This is a bit ruthless, but if 19th and early 20th century surgeons had thought like Robin Hanson, we would never have developed any effective surgical procedures.

New developments are making surgery of all sorts less invasive and more precise. We should be pressing forward even with procedures that currently have mixed results, because that will likely not be true for long.

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I think, and admittedly this is based a little on the writing of a few doctors and largely on James Herriot (vet), that 19th and 20th century surgeons did tend to think more like Robin Hanson. There is definitely a sense that they understood their ability to fix things was very limited and that trying everything and the kitchen sink was likely to be merely expensive, not helpful, if not outright harmful. Not that they didn't try various things of course, and definitely they did push things forward, but for whatever reason there seemed to be a more conscious sense of costs and benefits, and they shared that with the patients and their families. It seemed to be a little more accepted that end of life spending was often a lot of money for no gain, and just making people comfortable was about the best you could hope for, not the sense that everyone can live forever if only they do enough tests and spend enough money.

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"Robin Hanson has pointed out that populations receiving more medical care do not on average get better health outcomes."

Certainly some medical care doesn't improve health outcomes but not at all?

- vaccines?

- antibiotics?

- are not people with all kinds of chronic conditions living longer? Diabetes? Heart disease? Cystic fibrosis? Breast cancer? ...

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author

his view is that in the aggregate the medical care that helps is offset by the treatments that harm

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Yes, and he also presents himself as a man of data and rationality. So...citations please: That general claim would be worthy of publication in JAMA and the Proc. Natl. Acad. Sci. U.S.A. and certainly a Cochrane meta-study as that would be a contentious claim generating many studies - if it can be backed up. One would think...So, those should be easy to find.

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author

He has plenty of studies to back up the claim. https://pubmed.ncbi.nlm.nih.gov/17923332/

you can find the paper on line if you search for it

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In that paper, Hanson begins by stating 5 health policy puzzles as a given and then seeks to provide an explanatory framework involving altruism and presumably other mainstream behavioral psych and economic principles. And that makes perfect sense given his interests. Of those five puzzles that he states as given - he doesn't prove - the one closest to the general claim you state is that there is a "near-zero health-value of medical care, and placebo benefit of apparent care." To that end, of the references that I can see via sciencedirect.com for "Medical Hypotheses", the journal in which Hanson's paper appears (my campus doesn't provide access to this journal), the closest to this claim is "The marginal cost-effectiveness of medical technology: a panel instrumental variables approach", J. Economet (1997). There is "Improving health: measuring effects of medical care", Milbank Quart. (1997); "What has increased medical-care spending bought?" Am Econ Rev (1998) and others of this kind.

You wrote "...the aggregate the medical care that helps is offset by the treatments that harm." (sic) You claim an offset by "harm". That is my focus here.  That is not what I see claimed by Hanson, in particular in the assumption that he makes and that I quoted. The strongest claim I see him making is that treatment in the "aggregate," and I don't think he makes a claim that broad either, is "nearly indistinguishable" from a placebo effect. I believe that a better perhaps fairer reading of his strong claim would be this: WHERE treatment outcomes are nearly identical to a placebo effect here is a possible explanation. Details then follow.

In the broad history of medicine there are many examples of ineffective treatments, tragedy, and harm to be sure. There is certainly much to be said and much that has been said and written concerning the cost effectiveness for all manner of things. But to write as you did "that in the aggregate...medical care that helps is offset by treatments that harm" is a startling claim not made by Hanson in that article and certainly not headlined in those he cites that I can see. An offset by harm is not the claim being made.

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author

Yes it is. Read the whole paper

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I do not have access to it. I can try some of my tricks but they may not work. Would you pull quote the passage where he plainly states what you claim?

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I literally can't even parse the Levin quote. It's one run-on sentence and therefore incoherent.

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It's just an exercise in drawing exaggerated contrasts between the values and attitudes of what he is framing as his camp of gentlemanly wise sages, on the one hand, and its rivals, the cartoonishly pugnacious straw-men, on the other. Start watching the video at about 30 minutes to get enough context and build-up of the quote a few minutes later to see what he is getting at.

Levin's hobby-horse for many years has been the thesis that many of our fundamental problems could be well-addressed through implementing a set of proposals for "Reform Of Congress" and he's been pushing these ideas from several angles for a long time, indeed, Congress is usually what he's usually focusing on when using the general term, "Institutions". "Make Congress Great Again!"

The Devil's the details of that one, for sure!

A lot of people praise Levin because he's a class act smart guy with good intentions and commitment to shared high ideals, and I think they assume that his proposals simply must have merit and deserve their support. The wording of their praise for him stays at the abstract level of those ideals and intentions, which makes me strongly suspect they haven't delved into those details at all, or if they did, found them to be as lacking in merit as I did.

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I will listen to the Chau podcast you recommend. Related to the way innovation gets stifled is a marvelous talk by Bill Gurley about regulation(https://www.youtube.com/watch?v=F9cO3-MLHOM). Hat tip to Alex Tabarrok at MR.

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Without apparent irony, AK writes: "I received zero favorable comments on my 'case for the Republican establishment' post. I did not find the criticism new or persuasive." I'm dead.

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founding

https://en.wikipedia.org/wiki/Planck%27s_principle

I don't expect to change the minds of smart people in their late 60s. I also don't expect to have any need to change their minds.

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September 21, 2023
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Most of the Republicans in Congress qualify as establishment -- all but the few that are MAGA. There are fewer than a dozen real MAGA Republicans in Congress, and most of them are on the House committee now investigating January 6. You can tell them because they did not receive any RNC backing.

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