The KHIT Blog: The POTUS fallacy of sunk costs?

Friday, June 28, 2024

The POTUS fallacy of sunk costs?

~~130~~ ~~129~~ 128 days now to the November 5th elections.

TOM NICHOLS

Joe Biden didn’t just have a bad night. American democracy is now more in danger than ever.

I have been harshly critical of calls for President Joe Biden to step down. I have argued with people across the political spectrum about this, including friends and colleagues. I think Biden has had a successful first term and that his age has been no barrier to his effectiveness as a leader. I still believe that. And if the choice this fall is between Biden and a man who I believe is a mentally unstable menace to American democracy, I won’t think twice about my vote.

But Donald Trump must be defeated, and after last night’s debate, I am no longer sure that Biden is electable. Politics can be a miserable business that too often turns on perceptions, and for the president, the debate was a full-blown, Hindenburg-level disaster. Biden’s performance was unnervingly bad, and it has led to a chorus of calls, including in this magazine, for Biden to step down…

I know that, for Biden loyalists, the gathering consensus around last night’s debate must feel like a betrayal: Friends and coalition partners now seem to be lining up with knives behind the back of the man who saved America from Trump in 2020. Political loyalty, although often useful and sometimes admirable, should not override practicality. Blind support of one man, after all, is the hallmark of Trump’s cult; the prodemocracy coalition is larger, and should be more resilient, than any single person in it.

Before we think about next steps, it’s important not to wave away what happened last night, and it’s especially important not to engage in random blame-storming. Biden had one job—don’t look old and befuddled—and he failed. Biden supporters are raging away on social media about how the CNN moderators should have intervened with more fact-checking (read: debating Trump themselves and saving Biden), but Jake Tapper and Dana Bash did a reasonable job of keeping the debate moving and giving Biden multiple chances to unload any number of haymakers on Trump had he wanted to do so.

Biden, however, was simply not present. Opportunity after opportunity to call out Trump passed him by as he garbled a basket of statistics and talking points. The president’s staff clearly overprepared their candidate, stuffing his head with factoids about Pell Grants and climate targets and tax rates and other things that are completely irrelevant in a debate with a deranged bully. If this was the work of the White House prep team, then they are guilty of egregious political malpractice—but in the end, the candidate is always responsible for what happens in the campaign.

I now accept that the Biden we saw last night is as good as we’ll get in the election, and that Americans—unfortunately—are likely to decide that an entertaining autocrat is less of a risk than a decent old man…

Today, in North Carolina, Biden was full of energy, self-deprecating humor, and fury. I suspect that this is Biden in a kind of late–Ronald Reagan phase, in which he is able to give a barn burner of a speech but not capable of heavier lifting; even during the North Carolina event, he looked vacant and slack-jawed while he watched others speak. He was animated at the podium—but that’s likely not going to be enough to win an election in which so many undecided voters think Biden is too old to be president…

Time is running out. The operatives out there trying to soothe nerves by invoking Reagan’s first disastrous debate in 1984 forget that Reagan was ahead in the polls at the time, with plenty of electoral cushion under him. Biden has no such margin. My friend Greg Sargent at The New Republic has argued that Joe and Jill Biden need to assure America that last night was the exception, not the rule. But I suspect that Biden has, at most, about a week to either make up his mind not to run or reassure America that he can take on Donald Trump and win. At this point, it’s very hard to imagine that such reassurance is possible…

My new hashtag coinage: #DonaldJBumpStock

Also, apropos terminology: "Gish Gallop."

UPDATE

Totally worthy your time and close attention.

DJT BUTTHURT NONETHELESS

Awww...

_________

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Brave New Health

Commonwell Health Alliance

Another important read (pdf)

I love this kind of stuff. It sustains and humbles me. "As politicians, advertisers, salesmen, and propagandists for various political, economic, moral, religious, psychic, environmental, dietary, and artistic doctrinaire positions know only too well, fallible human minds are easily tricked, by clever verbiage... Common language—or at least, the English language—has an almost universal tendency to disguise epistemological statements by putting them into a grammatical form which suggests to the unwary an ontological statement. A major source of error in current probability theory arises from an unthinking failure to perceive this."

Quotes

"An economist is a person who sees something that works in practice and tries to figure out whether it will work in theory."

- J.D. Kleinke, medical economist
___

"The only person who enjoys change is a baby with a wet diaper."

"Every misspent dollar in our health care system is part of somebody's paycheck.

- Brent James, M.D., M.Stat

“We could do healthcare, at markedly higher quality, for everyone in this country, without rationing or denying anybody the care that they need, without having the government dictate how doctors practice or whether hospitals could expand, at half the cost we do it now.”

- Health Care Futurist Joe Flower

Most of the sciences, unlike parts of medical science, are not concerned with the impossible. There is not complementary and alternative physics, or chemistry, or biochemistry, or engineering. These disciplines compare their ideas against reality, and, if the ideas are found wanting, abandoned."

- Mark A. Crislip, MD

"Q: How much alcohol is too much?
A: More than your doctor drinks."

- a physician I once heard speak during a CME presentation

“Just because science doesn’t know everything, doesn’t mean you get to fill in the gaps with whatever fairy tale most appeals to you.”

- Dara O’Briain

'[I]t is one small step from using the computer for "helping" doctors to monitoring them, judging them, dictating to them what to do, and withdrawing payment for computer non-compliance. The use of computer data is a multi-edged sword. It can be used for the "good," facilitating diagnosis and treatment and making it more accurate and up-to-date, and for “evil,” invading privacy, inviting security breechs, and making decisions based on the opinions of remote authorities rather than those present at the patient-doctor encounter.'

- Richard Reece, MD

“[T]here ARE statistics which are non-political. Just because The Washington Post/Fox News reports the temperature is 75 degrees doesn’t mean it’s really snowing and sunscreen is a liberal/conservative plot. Even if you earn a living being ideological.”

- Michael L. Millenson

"It is a generally a fairly convincing argument that people shouldn’t have to be subsidized to undertake a change which is in their best interest.

The reconciliation seems to be that EHR is not supposed to make a doctor’s practice more efficient and higher quality. It is supposed to make the system of care more efficient and higher quality, which is not the same thing. Those of you who took calc recall that maximizing the total of variables is not achieved by maximizing any one variable and this is a perfect example of that.

Those of you have served in combat certainly noticed that too — if everyone works as a team the unit takes fewer casualties. If you try to save your own hide, you might, but at the expense of more casualties overall."

- Al Lewis

"There are two ideas to keep in mind about Bayesian reasoning and how we tend to mess it up. The first is that base rates matter, even in the presence of evidence about the case at hand. This is often not intuitively obvious. The second is that intuitive impressions of the diagnosticity of evidence are often exaggerated."

- Daniel Kahneman, "Thinking, Fast and Slow"

"Physicians apply advanced scientific knowledge, but they must do so without the favorable conditions that experimental scientists create for themselves. Multitasking is forced on physicians, often in chaotic environments and under severe time and resource constraints."

- Lawrence and Lincoln Weed, "Medicine in Denial"

"It’s time to stop the whining about Obama care and acknowledge we already have universal health care. We just pay for it in the stupidest way possible that ensures problems are that much more disastrous and complicated when they’re finally treated."

- Mark Hoofnagle, MD, PhD

"Every act of conscious learning requires the willingness to suffer an injury to one's self-esteem. That is why young children, before they are aware of their own self-importance, learn so easily."

- Thomas Szasz, MD
___

"Of course, one reason that process metrics* are so popular is that processes are much easier to define and measure than outcomes."

- The Skeptical Scalpel
___

"There is an “illusion of validity” for any random data point, a seductive sense that is colored by what we hope will be true. Mountains of pharmaceutical claims are often made from mere molehills of data."

- Danielle Ofri, MD
___

"Joy empowers people. It is a source of energy that enables people to hope and plan and change their lives for the better. Spend some time around someone who is relentlessly negative and how do you feel–drained, right? More and more research shows that joy is not something that just happens to you, like a bolt of lightening out of the blue. Joy is, instead, a habit to cultivate. Negative thinking and despair are the crabgrass of our souls–weeds that take root and spread, sometimes to all areas of life. Joy, in contrast, is a soul’s rose–hardy when cared for, able to put down roots over time and withstand disease and extremes. Like a rose, however, your joy can become blighted from neglect or harsh conditions. We all need to tend to our joy–to prune away the badness, and to know that, even though it may look like a prickly bare root, if you invest time in a joyous outlook, gorgeous things will bloom, even in the harshest conditions."

- Dr. Jan Gurley
___

"'Solutions' exist only in mathematics."

- Karen Martin
___

"The issue of how to regulate clinical software is, in the long run, indistinguishable from the issue of how to regulate medicine. The only difference is that medicine is practiced in the open, without secrecy, subject to peer review, and under a merit-based state license."

- Adrian Gropper, MD
___

"Economist, rope, tree: some assembly required."

- Source unknown

DISCLAIMER:

I write this blog wholly on my own time and my own dime. The views proffered are expressly my own as a concerned and active citizen/taxpayer (in addition to being the result of my substantive experience in the various IT fields), and in no way reflect any policy views of my former employer, notwithstanding that some of the thinking has indeed obviously been spurred by the implications of the work with which I have been doing for them.

FAIR USE POLICY
I cite a ton of news and web sources spanning the breadth of relevant technical and policy domains, sometimes at substantial length. I believe I remain well within the bounds of "Fair Use," as [1] I am not doing any of this for profit, [2] I always provide attribution and links -- which, [3] far from negatively impacting any copyright holders' commercial interests, might actually increase traffic to and interest in their offerings.

Nonetheless, should I post anything of yours regarding which you have any objection, just let me know and I will remove it forthwith.

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Friday, June 28, 2024

The POTUS fallacy of sunk costs?

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