Not to Praise WFB but to Bury Him

Cross-posted from FrumForum.

As you may have heard, the novelist Christopher Buckley and the popular historian Richard Brookhiser have each written a book about Buckley’s father, the late William F. Buckley Jr. Neither is just about WFB. Buckley’s Losing Mum and Pup tells what it was like – from battling grief to ghostwriting eulogies – to bury both parents in one year. Brookhiser’sRight Time, Right Place gives his perspective on a career’s worth of political history, from Nixon’s downfall to Bush v. Gore. (WFB appears in Right Time, Right Place only a handful of times.) Still, most readers will be looking for the gossip, and for what those closest to WFB really thought of him. The answers in both cases are surprising.

The most scandalous bits in Losing Mum and Pup are already so notorious that by the time you read it they’ve lost their shock. Among them: To empty his bladder, WFB would open the car door and urinate on the highway without so much as telling his driver to slow down. (I can’t figure out how exactly WFB managed the feat without soiling himself or the limo, though I trust Buckley could tell us.) Told that his 11-year-old son might be dying, WFB flew back through eight cities en route to the hospital bedside. (He arrived with an armful of exotic gifts.) Ten minutes into Christopher’s Yale commencement, WFB walked out, leaving Christopher to wander campus in search of his family before settling for a hamburger at the neighborhood dive.

You might think – and many do that these revelations dishonor WFB’s memory. If anything, they do the opposite. As Buckley says, WFB was a “great man.” He founded a movement, edited a magazine (which he also founded), wrote 56 books and 5,600 columns, and hosted an acclaimed television program. He also sailed the Atlantic and the Pacific, played the harpsichord with the Phoenix Symphony Orchestra, delivered thousands of lectures, and kept up perhaps the most prolific correspondence in American history. Plainly this was not a man centered in the sphere of common duties. I would have been more surprised to learn that WFB actually made a point of finding a men’s room before taking a leak.

His own son is as much in awe of WFB as his legion fans. The public only saw him on TV. Christopher saw him suffocating and collapsing, yet still able to dictate prose of the kind that the rest of us will never match in perfect health. He saw WFB sail into a Nor’easter as if it were a favonian breeze. He saw WFB complete one book in 12 afternoons. Again and again, Buckley returns to the theme: his father was a great man.

Losing Mum and Pup solves one important but neglected mystery of WFB’s greatness, namely, his spending habits. The cash burn in the Buckley household far exceeded what others in their station can afford. They had a Park Avenue maisonette, a waterfront house in Connecticut and a succession of sailing yachts, not to mention limousines, a swimming pool that WFB had installed in his basement and a Bosendorfer grand piano. They kept a full time staff of five, including a chauffeur and a butler, chartered yachts in Bermuda and rented a castle in Switzerland every winter. They entertained the good and the great virtually every night. I meet not a few of the superrich in my day job. The Buckleys lived better than nearly all of them.

They also indulged in unparalleled generosity. Once the Buckleys invited my wife and me to dinner; midway through dessert, the Yale Whiffenpoofs arrived to sing us goodnight. That was perhaps a $10,000 evening, spent to please two young friends WFB had only just met. The abundance in the Buckley household seemed so natural that one rarely stopped to wonder where it even came from. His friends just took it for granted that, like the Count of Monte Cristo, WFB was sitting on an inexhaustible fortune.

Yet he didn’t actually have a fortune to exhaust. WFB’s father, a swashbuckling oil man, lost as many millions as he won. What wealth he died with would have been divided among WFB’s nine siblings, leaving only a modest provision for each. WFB’s wife Patricia Taylor hailed from a prosperous British Columbia family. Presumably, some of the Taylor fortune was held for her benefit (she did not manage it herself: like many a grand dame, she couldn’t put two sums together). Still, the Buckleys spent far more than any trust fund would pay out. WFB in any case would never have put himself at anyone’s financial mercy, the Taylors included.

In Losing Mum and Pup, Buckley confirms in a footnote that his parents were not “rich rich.” His mother had a trust fund, but it was “not nearly sufficient to sustain their lifestyle.” In the 1950s, WFB lost all his inheritance in the stock market. Christopher Buckley himself does not live in the Lucullan fashion of his parents. He makes his own living; his father, he says, did too. Gary Wills in a recent essay in The Atlantic agrees. Put together the twice-weekly column, the annual books, the television program and the lectures and maybe you do come up with enough to pay for all that the Buckleys enjoyed. Contrary to legend, WFB was a self-made man.

Nonetheless, the Buckleys were as insouciant about money as French aristocrats idling in the gardens of Versailles. Most professional writers, living from check to check, think about money a lot. WFB didn’t. I suspect that he saved almost nothing — at least, I can’t imagine WFB squirreling away a few dimes in the hope of funding a quiet retirement (or, for that matter, passing on some wealth to his descendants). That WFB never saved explains why one never heard the buzz of accountants, lawyers and advisors who normally swarm the super-rich. Great men don’t worry about making ends meet.

He faced danger with the same nonchalance. In his “literary autobiography,” Miles Gone By, WFB recounts two particularly appalling incidents. Then a freshman at Yale, WFB and some chums purchased a small airplane. After a total of 1 and 1/2 hours of flying lessons, he volunteered to fly a friend to Boston. It was no problem getting there, for the friend had flown 20,000 hours in WWII. Too impatient to stick around Beantown, WFB flew back solo, only to miscalculate the hours of daylight left. He followed the New London railroad tracks through the darkness before at last spotting a runway and landing. A few months after this harrowing flight, WFB pulled an all-nighter, finished his last exams, went up (this time with a license), and fell asleep in the cockpit. Miraculously, he woke up in time to land. To the things that fright ordinary souls — death, injury, running out of money — WFB paid no heed at all.

He paid almost as little heed to the future of National Review and the conservative movement he founded. As Right Time, Right Place reveals after thirty years of secrecy, when Brookhiser was 23, WFB promised to hand over ownership of National Review to him. The story should alarm all who care about National Review and what it stands for – that is to say, all who at any time have identified with the conservative movement. National Review meant too much to too many people to have been pledged to a twenty-three-year old, no matter how talented. Brookhiser says that WFB liked the Big Gesture. I think he liked the Big Gesture more than what the Big Gesture signifies. WFB delighted in his god-like powers to mark out another as a man of destiny.

On a much smaller scale, he did something like that to me. We were living in Denver when he called. He asked whether I would take part in National Review’s upcoming “novation” – a word I’d encountered in contracts class in law school but had already forgotten. Not having the foggiest what he meant, but also not wishing to displease the great man, I complaisantly agreed to whatever he was asking. The conversation took all of a minute. A month later, a friend called to congratulate me: The New York Times was reporting that WFB had transferred his National Review shares to a 5-man board of trustees. I was the only one under 50.

Why was I chosen? WFB claimed that he wanted someone who was “extremely young and extremely talented.” In fact, WFB knew nothing about me (apart from my youth). I had had dinner with him a handful of times and had been invited on a couple of his Friday evening sails. He never asked about my convictions or ambitions, nor did he ever clue me in on what he expected of me. His estimate of my talents was based on no more than a few thousand words. Once I had to correct a Times reporter doing a follow up story. No, I told him, I had not made Harvard Law Review – as, I suppose, WFB had simply assumed. His decision to appoint me as Trustee made no sense. But it was a Big Gesture — big enough, at least, to catch the attention of the Times.

WFB’s caprice changed Brookhiser’s life forever. He declined an offer from Yale Law School to work full time at National Review. He performed well; as all agree, Brookhiser would have made a superb editor-in-chief. A decade later, the inevitable: WFB wrote Brookhiser that “It is by now plain to me that you are not suited to serve as editor-in-chief of NR after my retirement.” WFB gave reasons, but, as Brookhiser writes, the real one was that he never became the dazzling phenom that WFB himself had been. Who else could have? Brookhiser writes ruefully that WFB might as well have written: ”It is now plain to me that the evidence of your name is indicative of a larger truth: you are, in fact, not me.”

Not surprisingly, Brookhiser does not subscribe to Christopher Buckley’s Great Man theory of WFB. He writes with great restraint — learned perhaps from many years of repressed bitterness and disappointment — that only occasionally slips. At one point, he compares WFB to Klingsor, the villain of Wagner’s Parsifal, then tells us that according to a psychoanalyst who taught Brookhiser’s wife, “a narcissist no more considers the feelings of other people when he makes demands on them than we ask a lightbulb if it wants to be turned on.” The argument goes from WFB to Wagner to Brookhiser’s wife to Brookhiser’s wife’s mentor before it is clear that, by property of transitivity, Brookhiser is calling the beloved William F. Buckley Jr. a narcissist.

Where Christopher Buckley sees greatness, Brookhiser sees egotism. He calls the suggestion made one evening that WFB run for president “one more roof tile in the tornado of flattery that whirled around him.” (To be precise, Brookhiser says that it seemed that way at the time, thus leaving the reader to judge for himself whether the suggestion was flattery in fact.) On the next page, Brookhiser confesses that he too felt entitled to praise, even if undeserved. “Bill wasn’t the only victim of flattery,” he concludes. Complete that line of reasoning, and it’s clear that Brookhiser doesn’t think that WFB deserved all the praise he has received.

How overrated does Brookhiser think WFB was? He gives hints. Comparing WFB to Reagan, Brookhiser writes that “in certain circumstances, [WFB] spoke as well.” Others would have written that Reagan and WFB spoke differently but both very well – extraordinarily well. Brookhiser reports that he only read the Blackford Oakes novels to quiet WFB’s importuning. Eventually, Brookhiser gave his opinion that “the characters never came alive, the writing was functional, the sex scenes were ludicrous. The third and fourth novels seemed no good at all.” Critics have routinely panned WFB’s fiction, though even the harshest call Saving the Queen a success. Brookhiser is asking – or, to be precise, was asking a bit much from a series of spy thrillers. If he finds anything remarkable in WFB reinventing himself mid-career as a best-selling spy novelist, Brookhiser does not say so.

Even when acknowledging WFB’s achievements, Brookhiser’s praise stops short. He says that Cruising Speed – WFB’s first book retelling a week of his life – had “the freshness of pulling off a new trick, and Bill’s own freshness in the media-god life he lived.” “Media-god” would today suggest vanity, showiness, lack of substance. Elsewhere he describes WFB’s prose as having “tingle.” “The effect at its best was a lively rattle, like someone playing a harpsichord or a washboard.” In other words, WFB’s writing compares favorably to an instrument best known in popular culture from the Adams Family TV show. At its best.

Brookhiser most admires WFB for founding the conservative movement. By the end, however, he is puzzling over WFB’s late ambivalence about the Iraq War. Charitably enough, Brookhiser rejects first racism (WFB had no faith in dark-skinned peoples), then venality (WFB sought money or praise) and finally callousness (WFB had no sympathy for the oppressed) as the reason. Finally, he concludes that WFB had simply grown weary. WFB had lost his stomach for the good fight.

Even for WFB’s critics, this is an implausible judgment. Not once does Brookhiser consider that he and WFB had an honest disagreement. Brookhiser writes matter-of-factly that in Iraq, “we took the war [initiated by 9/11] to our enemies.” But Brookhiser’s view that invading Iraq was an appropriate response to 9/11 is not self-evident. (For one thing, it was not Saddam Hussein who attacked us on 9/11.) Rather, it rests on a variety of assumptions (for example, that lack of democracy causes of Muslim terrorism) that should at least be articulated, if not defended. WFB did not have to be weary to reject some of these assumptions, only skeptical. (Though there is truth in what Brookhiser says: Towards the end, WFB probably was too weary to take a stand on Iraq clear enough to provoke the chirping of more zealous friends.) He deserves better than to have his views reduced to some underlying character flaw.

In the end, it seems that Brookhiser wrote Right Time, Right Place not to praise WFB but to bury him. WFB blessed Brookhiser at a young age with something like divine favor. The Lord giveth and the Lord taketh away. Brookhiser has made his peace with a man whose whims changed lives forever, his included. Like Job, he prospered, suffered, and prospered again. It would be impious to ask for more.

Oddly, Brookhiser never finishes the story. WFB offered him ownership of National Review in 1978. Twenty-six years later, WFB turned his shares over to an independent board of trustees. Today, however, NR is effectively owned by the management. I can’t say that my time on NR’s board of trustees deepened my faith in director control. Directors of a corporation seldom have an incentive to collect enough information to challenge what the officers tell them. Even if one director does bother to understand a corporation’s affairs, to make a difference he still needs the support of his colleagues, who themselves won’t know enough to reach an informed judgment. The problem is compounded in a non-stock corporation such as the one WFB created to control National Review. At least in a for-profit corporation, directors must ultimately respond to shareholders, who demand a return on investment. The trustees of NR, by contrast, are responsible to nobody. Lacking any incentive to second-guess management, they are no match for the insiders.

NR’s board was in fact completely neutered less than two years after WFB’s handover, when the one insider on the Board contrived to stack it with two more. The plan was announced as fait accompli before my dissent or anyone else’s could even be registered. For better or worse, Rich Lowry’s leadership is unlikely ever to come under any serious question. The package of rights and powers that he enjoys as Trustee and Editor-in-Chief gives him as much control as WFB ever enjoyed. In thirty or forty years, he can even handpick his own successor.

I wish I could say I resigned on principle. In a sense I did: I wanted to resign but didn’t have an excuse. The excuse came in a letter from WFB a few weeks later. ”I know busy people,” he wrote, “but you must be in the company of the busiest” — quite a remark coming from the author of Cruising Speed and Overdrive. Noting my unexcused absences from NR events, he said he regretted appointing me as Trustee and asked me to resign. He wasn’t right on the specifics, but he was right in general. Some basked in WFB’s attention; I fled from it like Jonah into the mouth of the whale. On the whole, I didn’t really enjoy his company. Plainly, he liked me, but I found his constant boredom embarrassing. I lacked the skill in speech to relieve it.

I resigned promptly. In my last letter to WFB, I reproached him for showering me with honors that I could not live up to, and myself for accepting them. Not that I always had a choice. ”Fifteen hundred conservative grandees,” I reminded him, truthfully, “once heard you compare my writing to that of Seneca.” Seneca! Inevitably, I wrote, I had “swelled the rout / of lads who wore their honor out.” I thanked him for his kindnesses, but told him that “each one hung on me like lead.” “Your final kindness,” I concluded, “is to let these burdens drop.”

So ended my brief and ignominious career as a Buckley protege. Unlike Brookhiser’s, my life went on as before — though under a cloud of failure of regret. Brookhiser, who found fame as a popular biographer of the American Founders, eventually dispelled his. William F. Buckley Jr. gave and took away. One could not ask for more.

Who is "Spengler?"

Cross-posted from Taki's Magazine.

Has Franz Rosenzweig’s time come? Beats me. Let’s start with: who the hell was Franz Rosenzweig? Like many, I would never have heard of him had it not been for sometime Takimag contributor David P. Goldman, who for the past decade has been putting events in world-historic perspective under the pseudonym “Spengler” at the Asia Times Online. (Goldman recently revealed some interesting autobiography here.)  With impressive, almost demoralizing confidence, Spenger/Goldman asserts a number scandalous theses, all of which he claims to have learned or derived from the early 20th century philosopher and theologian Rosenzweig:

1. Anti-semitism exists because the gentiles naturally envy the Jews’ exemption from the rule that all tribes eventually die out.

2. Christianity prevailed because its message of universal salvation assuaged the gentiles’ fear of tribal extinction.

3. Christianity needs the Jews, because they stand as a living proof of divine favor; without that proof, Christianity could not offer the gentiles any hope of immortality.

4. When Christianity recedes, the gentiles’ Jew-hatred returns, often with calamitous results (e.g., the holocaust).

5. Europe is literally dying—that is, failing to go through the trouble of reproducing—because both ethnocentricism and Christianity have been discredited, which leaves Eurpeans nothing but to accept the ultimate fate of all gentile tribes (i.e., extinction).

6. Islam is a cover for pure racism and barbarism, against which Judaism and Christianity are necessarily at war.

The Spenglerian theses are on one level wonderfully explanatory. Europaean population decline, American pre-eminence, Muslim fanaticism, the “new” Anti-Semitism, even the current economic depression all fit into Goldman’s theories. As his pseudonym suggests, Goldman accounts for pretty much every past development as well, from the triumph of Christianity to the rise of nationalism. The whole performance can be quite diverting.

At the same, it’s hard not to suspect that Goldman is peddling moonshine. I herd my wife and kids to church on Sundays, sit through the sermon and find an excuse to skip coffee hour all because .... I am rebelling against the “incurable necrosis” of the Anglo-Saxons?

So far in my introspections I haven’t uncovered evidence of that. Nor do I know many Christians of whom it can plausibly be said that deep in their souls they are seeking some simulacrum of Jewish survival. Further, while individuals fear death in a fairly straightforward way, only in a metaphorical sense does fear of death grip whole peoples.

Goldman’s willingness to consider tribal loyalty as a factor in history is refreshing, but fear of tribal extinction is an unlikely candidate as the hidden spring of all human action. As for population decline, birthrates aren’t just declining in post-Christian Europe. What reason do the Koreans have for accepting tribal extinction as their fate? Finally, Spengler ignores the more straightforward explanations of Muslim fanaticism, such as that they don’t like seeing their lands occupied by Westerners. (In fairness, Goldman has recently urged a sensible policy of leaving the Muslims alone.)

Back to Rosenzweig.  As noted, Goldman does not claim originality, but says that most of his ideas come from Rosenzweig, to whom Spengler pays frequent, almost fulsome tribute. Just how profound was this man Rosenzweig?  I picked up a copy of his magnum opus, The Star of Redemption, to find out (or, to be precise, the William Hallo translation that Goldman recommends).

It is immediately apparent that Rosenzweig does not practice what in some English-speaking philosophy departments is churlishly called “real” philosophy. Briefly, there are two contrasting styles of doing philosophy. One—called “analytic” and generally carried out in English—values precision, clarity, and valid argument. The other—called “continental” and generally carried out in French or German—values charisma and oracular utterance.  Not surprisingly, continental philosophy thrives mostly in English departments, while analytic philosophy self-consciously subordinates itself to the physical sciences and mathematics. The distinction doesn’t fit all cases—Nietzsche, a continental, could be quite rigorous, while Wittgenstein, an analytic, was notoriously obscure—but still holds up fairly well.  If you seek understanding, you read the analytics; if it’s prophecy you’re looking for, you read the continentals.

Rosenzweig’s style is continental. Consider the following passage:

Two paths lead from the Nought to the Aught—or, more precisely from the Nought to what is not Nought, for we seek no Aught—the path of affirmation and the path of negation.  The affirmation is the affirmation of the demonstrandum, the non-Nought; the negation is the negation of the given, the Nought...Like every affirmation through negation, affirmation of the non-Nought points to something infinite; negation of the Nought, like every negation, points to something limited, finite, definite.  Accordingly, we behold the Aught in twofold guise and in twofold relationships to the Nought.

Or this one, which goes so far as to introduce mathematical symbols:

Let us attempt to capture [divine freedom] in a symbol...We must place divine freedom, as original Nay, on the left side of the future equation. It is, moreover, a Nay which, as original subject, reaches beyond itself with unlimited power—albeit, as we must repeatedly emphasize, beyond itself only with God.  Thus its symbol will have to be formed on the pattern ‘y=.’  And finally, although this freedom is finite in its ever-renewed uniqueness, it is infinite in its continue novelty. Nothing can precede it for nothing exists beside it. It is ever unique but never a unicum. Therefore the symbol for this freedom turns out to be ‘A=.’

Und so weiter. Can we now derive proofs about divine freedom using the symbol “A=”? Writing of this kind has its defenders, who take pains to extract something from it that is both intelligible and reasonably compelling.  Myself, I plead philistine indifference.

I consider only the political implications of Star, of which, surprisingly enough, I find very few. The Spenglerian theses in particular seem more like a creative gloss or “misprision” of Rosenzweig than an accurate restatement of his views.  For all Spengler’s obeisance to Rosenzweig, I suspect that Goldman came up with his stuff on his own.

To be sure, one can certainly find the passages that inspired Spengler. The Jews, writes Rosenzweig, are the “eternal people” or simply “the people,” as opposed to other peoples, who are only “the peoples of the earth.” Jews are a pure “blood community,” while other peoples “sink their roots into the night of earth,” that is, they identify with a specific piece of land, from which they must ultimately be expelled.  The gentile peoples, unlike the “eternal people,” believe that “death [that is, tribal death, as opposed to individual death], even although it be at a very distant juncture, must come eventually.” Gentiles have suffered “inner conflict ever since Christianity with its super-national power came upon them.” The Christian church counterattacked “the pagan idea [surviving] in the form of memory,” but eventually Christian unity was “sundered at every point” by “pagan figures come back to life,” including in the form of “nations” and “states.” The gentiles’ various secular states, which “emerged as rebels” against the Church, created a “sham” sense of eternity.  To reestablish a unified Christianity, the church needs the Jews as an actual and not merely “idealized” promise of immortality. Jew-hatred for the Christian is then really self-hatred.

Isolating these passages—scattered across the last 150 pages—in this way gives a very misleading picture of Star. Unlike Spengler, Rosenzweig does not seem particularly interested in the rise and fall of peoples. Rosenzweig apparently wrote Star on postcards while serving in the German army in WWI. It shows, for the book consists of several hundred more-or-less independent meditations, each coming under a separate rubric (“Love,” “China,” “Miracle,” Shame, “Commandment and Freedom” “The Oecumene,” “The Grammar of Eros”) and each just a few hundred words each.  Rosenzweig finally arranged his meditations in three parts of three books each, so that the whole book resembles the overlapping triangles of the eponymous Star of David. About a dozen of Rosenzweig’s meditations could be turned into gripping underground-style pamphlet proving that all history consists of the rise and fall of tribes striving to match the survival of the Jews. That is essentially what Spengler has done in his columns.

But the pamphlet wouldn’t be Rosenzweig. Of the hundreds of meditations in Star, few have anything to do with geopolitics.  The range of topics is encyclopedic.  Here a history of how miracle reports were turned from a proof to an embarrassment for religion; here is a critique of the modernist Protestant theologian Friedrich Schleiermacher; here an analogy between art and revelation; here is a defense of Goethe’s claim to be the only Christian of his age. At the same time, the point of Star isn’t hard to discern: The world can’t be adequately comprehended à la Hegel in a single philosophical system; on the contrary, one needs revelation; specifically, Jews need Judaism and the gentiles need Christianity. Rather like Pascal’s Pensees or Wittgenstein’s Philosophical Investigations, the argument of Star emerges from the fragments.

In short, Rosenzweig wants to vindicate orthodox Jewish and Catholic religions against German idealistic philosophy. While Spengler broadly equates “paganism” with tribalism, but Rosenzweig’s understanding of “paganism” is even broader. In Star, Rosenzweig is apt to call “pagan” anything that threatens Christainity unity, including not just tribes and nations (Spengler’s hobbyhorses) but states, artists, and individualists. Spengler takes the meditations on the “peoples of the world” as more or less literal interpretations of history, but they are probably best understood as illustrations of how religion, says Rosenzweig, captures some things that Hegel can’t.

Spengler’s discussion of Rosenzweig’s distinction between “Petrine,” “Pauline” and “Johannine” Christianity similarly misses the point. Spengler takes these as literal references to Catholicism (the church of Peter), Protestantism (the church of Paul), and Orthodoxy (the church of John).  As Rosenzweig uses these terms, however, they have only rough temporal and geographic correspondences. They can refer to Catholic, Protestant and Orthodox or South, North and East, but also to works, faith and hope or Christianity conquering the world, struggling against disunity, and finally achieving redemption. The Petrine/Pauline/Johannine distinction doesn’t explain history but rather illustrates moments in the Christian life. As the title of the book might suggest, Rosenzweig is talking more about redemption than actual events.

In the end, even to the casual reader it is clear that Rosenzweig was not, as Spengler contends, the major thinker of the 20th century. In Star, he wrote an apology for religion directed almost exclusively at the philosophical school that (somewhat regrettably) he took to be dominant—Hegelianism. Rosenzweig certainly makes interesting reading, and Star is full of arresting passages, but one can just as certainly get by without him.

The FDA Does Diabetes

So far, patients can breathe a sigh of relief.

The U.S. Food and Drug Administration’s Endocrinologic and Metabolic Drugs Advisory Committee met today, and will continue its discussions tomorrow, on two important diabetes drugs which are under review at the FDA.

The first drug, reviewed today, was Bristol-Myers Squibb’s saxagliptin, an oral pill which treats diabetes in a similar way to Merck’s Januvia and Novartis’ Galvus. (Galvus has been in limbo at the FDA for years, for no discernible reason.) Tomorrow, the FDA panel will review Novo Nordisk’s Victoza, an injectable drug similar to Byetta (a marketed drug from Eli Lilly and Amylin Pharmaceuticals).

The FDA had been somewhat concerned about a slight increase in cardiovascular side effects of saxagliptin relative to placebo in Bristol’s late-stage clinical trials, but the panel voted 10-2 that the clinical data provided appropriate evidence of saxagliptin’s safety profile. The panel did recommend additional clinical trials for cardiovascular safety after the drug makes it to market, but such recommendations are not so easy to implement.

Tomorrow, on April 2, the panel takes up Novo’s Victoza (liraglutide). The FDA has raised concerns about major adverse cardiac events and thyroid tumors. Novo will probably have to do an additional post-marketing trial. We will have a more complete review of the Advisory Committee meeting at that time.

Investors in Amylin and Lilly cheered when the FDA’s briefing documents on liraglutide contained no questions regarding inflammation of the pancreas, a side effect associated with their drug Byetta.

More on this tomorrow…

Apologies

I mean it.

For those who have checked back recently and not seen any postings, I'm sorry. Had a busy few days. My intent is to post at least one item daily to this website, if not multiple postings. One more is on its way...

This Week in Wonkery

Your weekly guide to the wild world of healthcare policy research.

Joseph Antos of the American Enterprise Institute describes Obama's approach to healthcare as "a meal eaten in reverse order. We started with dessert, in the form of new subsidies for insurance. Whether we like it or not, we will have to eat our vegetables before the year is out."

John Calfee and Elizabeth DuPre of AEI complain about the anti-drug industry bent of The Lancet and The New England Journal of Medicine.

Newt Gingrich wants to create some new government programs to combat Alzheimer's Disease.

Darrell West and Edward Miller of the Brookings Institution have published a new book entitled Digital Medicine: Health Care in the Internet Era.

Alice Rivlin of Brookings is concerned that Obama won't raise taxes enough to pay for his healthcare plan.

Judy Feder and Harriet Komisar of the Center for American Progress urged the Senate to take "action to improve long-term care services and supports."

J.D. Foster of the Heritage Foundation reflects on how to make Medicare sustainable by means-testing benefits.

James Copland and Paul Howard of the Manhattan Institute think it's a good idea to tax pharmaceutical companies to cover tort liabilities in the wake of Wyeth v. Levine. (Whatever happened to tort reform?)

Uwe Reinhardt, the Princeton economist, explains the terminology behind health care reform.

Joseph DiMiasi and Laura Faden of Tufts reviewed the histories of 298 drugs approved by the FDA between 1996 and 2006 to identify "factors associated with multiple FDA review cycles and approval phase times."

Nicolaus Henke, Sonosuke Kadonaga, and Ludwig Kanzler of McKinsey argue that Japan's healthcare system is unsustainable, and suggest that the Japanese undertake a "comprehensive, well-funded national review of the system." I bet they find that 2 plus 2 still won't equal 5.

John Graham of the Pacific Research Institute "reviews three decades of the Food and Drug Administration's performance and concludes that the agency is overfunded, overstaffed, and denies hundreds of thousands of Americans timely access to new medicines."

Henry Willis et al. of the RAND Corporation believe that the Cities Readiness Initiative has succeeded at improving the ability of large cities to respond to large-scale biological warfare.

Next Week: On Tuesday, March 31, the Cato Institute will host (and webcast) a policy forum entitled "Can the Market Provide Choice and Secure Health Coverage Even for High-Cost Illnesses?"

An Examination of Sen. Baucus' Arguments: "We Cannot Afford to Wait" to Reform Healthcare

Whether or not you agree with the President's proposed healthcare reforms, they're based upon flawed assumptions.



On Friday, Sen. Max Baucus (D-MT), a.k.a. "Mr. Healthcare", and chairman of the influential Senate Finance Committee, delivered a speech on healthcare reform at the Center for American Progress, entitled "Now is the Time for Action." The speech was cheered by Jonathan Cohn as a "clear rejoinder to those who say health care reform must wait, because of the economic crisis" and described as a "useful restatement of principle" by Ezra Klein (who published Baucus' full remarks). But Baucus makes a number of flawed arguments as to why healthcare reform is "an economic imperative":

Between 2000 and 2007, average premiums rose nearly 80 percent. At the same time, average wages rose just 15 percent. How can a family keep up?

Last year, the average household spent more than a quarter of its income on health insurance premiums. If we don’t act to reduce the rate of health spending, then in seven years — before the end of President Obama’s second term — most American households will spend nearly half of their income on health insurance.

To be more precise, if wages rise by exactly 15% in the next seven years and if insurance premiums rise by another 80% over the same time frame, a family which spends 25% of its income on health insurance today will spend 39% seven years from now (without adjusting for inflation). While that would be an increase, Baucus exaggerates the degree.

More importantly, it is arbitrary to assume that premiums will rise over the next seven years by the same degree that they did between 2000 and 2007. Indeed, according to the Kaiser Family Foundation, the rate of increase in family insurance premiums has declined for 6 straight years, from 13.3% in 2003 to 4.7% in 2008. If insurance premiums increase for seven years at 4.7%, the total increase is 38%, not 80%. And none of these numbers reflect how the present economic crisis is affecting premiums and wage growth.

This is not to say that Baucus' projections are inconceivable. But it is to say that they are arbitrary. Affordable healthcare is an important goal—but we won't get there if we don't understand healthcare economics.

If we don’t act, increasing costs will result in more and more individuals and families without health insurance.

According to the Kaiser Family Foundation, 160 million Americans get their health benefits through an employer. That means that when people lose their job, they often lose their coverage.

This month, the unemployment rate rose to eight point one percent. Work done here at the Center for American Progress shows that — every day — 14,000 more people lose their health insurance coverage.

This problem is a serious one, but it was caused by government intervention: the taxpayer subsidy of employer-provided insurance. Baucus proposes to solve a problem caused by unwise government regulation by nationalizing healthcare. A simpler, and more efficient approach, would be to end the subsidy for employer-provided insurance. President Obama is, apparently, now open to this approach. But when John McCain proposed this in the 2008 campaign, then-Senator Obama described it as "the largest middle-class tax increase in history."

Imagine if you could shop for health insurance the way you shop for auto insurance or life insurance. You could find a plan that made sense for you, that covered the things that are important to you. You could organize a community of like-minded people to purchase insurance in bulk. Most of all, you would create competition for your business, the surefire way to bring prices down and quality up.

Anthem Blue Cross in California just notified most of its individual policyholders that they face double-digit premium increases — many more than 30 percent. Blue Cross of Michigan is seeking approval for an increase in premiums of nearly 60 percent.

That means that if we don’t act, then workers who lose their jobs will not be able to afford coverage. It means that many of those purchasing coverage in the individual market will be forced to drop their coverage.

Insurance companies, like most businesses, operate in the real world of supply and demand. They can't raise prices forever without losing customers, just as car companies can't suddenly double prices on cars. Simply put, it is not in insurers' interests to lose customers, and that self-interest will keep a lid on premiums. Ultimately it is up to insurers to decline to pay for the most expensive treatments if they can't afford to offer them. The problem comes when states mandate what insurers must cover, forcing the price of insurance higher.

An individual obligation to get health coverage is essential for several reasons. It is the only way to stop the cost-shifting related to uncompensated care. Today, the costs of care for 46 million Americans without health insurance are largely borne by those with insurance.

This is an idea, pioneered by Mitt Romney in Massachusetts, which deserves bipartisan support. Libertarians raise instinctive concerns about any government mandate. But federal law requires hospitals to treat anyone who comes into an emergency room, regardless of his ability to pay, thereby taxing those who buy health insurance at the behest of those who don't. Most states require auto insurance, yet libertarians don't spend a lot of their time seeking to repeal those laws.

The manufacturing industry is facing stiff international competition. American manufacturers pay $2.38 an hour for health benefits. What do you suppose America’s major trading partners pay? 96 cents. Talk about an uneven playing field.

American manufacturers spend nearly three times as much on health benefits as our major trading partners. If we don’t act, then that gap will continue to widen.

The uneven playing field between U.S. and our major trading partners is not health benefits, but corporate taxes. Corporate income tax rates in the United States are the highest in the developed world: 39.25% in 2008, vs. the OECD average of 26.63%. And that's without the tax increases that inevitably would accompany a nationalized healthcare system.

And if we don’t act, then the burden on taxpayers will continue to grow. In 2009, Medicare spending is projected to be nearly $500 billion. By 2018, it will be almost double that.

If we don’t act, then in the next 10 years, spending for both Medicaid and Medicare will more than double. Meanwhile, our economy will grow by just 64 percent.

So the solution is to spend more on healthcare while inducing economy-contracting tax increases?

Already, we spend twice as much on health care as any other industrialized nation. And yet our outcomes are poorer.

I will address this point in a future blog post, but the data does not support this argument.

The way that we pay providers contributes to higher health costs. Existing payment systems reward the use of specialty care and high tech equipment.

We pay more to a hospital whose patients experience a readmission after being discharged. And we pay less to a hospital that does the job right the first time and avoids a second hospital visit.

Spending and utilization varies widely from one part of the country to another. But those who are spending more are not getting more for their money.

In many parts of the country, providers have answered the siren call of the payment systems. They order more tests. They schedule more visits. They do more procedures. They perform more imaging services. And they prescribe more medications.

Here we get to a critical point: cost. We are constantly told that it is a terrible thing that Americans are spending too much on healthcare. Somehow, we're never told that we spend too much on cosmetics, or televisions, or automobiles. According to the Bureau of Labor Statistics, Americans spend nearly as much on entertainment (5.6%) as they do on healthcare (6.0%), and far more on food (12.3%), housing (32.6%), and transportation (18.1%). Indeed, it could just as easily be argued that it is a good thing that Americans spend more on healthcare. We have access to the newest drugs and the latest technologies. We can see specialists when we have specialized medical problems. We can pay for medical procedures that we want to undergo. Efforts to provide universal healthcare coverage routinely ignore the question of rationing. That is, if we are to provide healthcare for all, how much healthcare will we provide for all? All you have to do is look at Massachusetts for a preview of what's to come: price controls and rationing.

That is not to say that there aren't times when too many tests are ordered by physicians. But more often than not, this practice is driven by a desire to avoid malpractice litigation, a practice dryly termed "defensive medicine" by physicians. An important way to reduce healthcare costs which Baucus doesn't address is tort reform: limiting unnecessary litigation by requiring, as most developed countries do, the losing side to pay the winning side's legal costs.

Another unspoken driver of healthcare costs is Medicare. The government underpays hospitals for the cost of caring for elderly Medicare patients. Hospitals make up the difference by overcharging people on private insurance. In other words, on top of the Medicare tax which you see on your paycheck every month, you are being taxed silently every time the government underpays a hospital for a Medicare patient. But if the government started paying hospitals fairly for their services, the Medicare trust fund would go bankrupt.

That path necessarily involves bipartisan support. Why? Because in the end, in the Senate, a bill needs 60 votes. Attempts to circumvent this requirement using reconciliation would also require trade-offs...

If we do not act this year, then we won’t have another opportunity for another decade. Next year, we’ll be in the midst of Congressional elections. The following year, we’ll be in a Presidential cycle. We have to act now.

Baucus gets to the political reasons why enacting sweeping changes to the healthcare system has proven so difficult. Importantly, he appears skeptical of using reconciliation, a parliamentary procedure which would do an end run around Republican opposition, presumably because it would engender increased Republican hostility to other Democratic priorities.

Baucus, a Democratic senator in Republican Montana, has a record of crossing party lines. He was a key supporter of George W. Bush's tax cuts in 2001, and worked with Republicans on the Medicare prescription drug benefit. So far, on the Great Healthcare Debate of 2009, he has adopted a traditional Democratic policy posture. Will he stay there?

The Snowboarder Menace

Cross-posted from Taki's Magazine.

In honor of the 2008-09 North American ski season, I give you the following rant.

As of March 18, 2008, Taos Ski Valley in New Mexico, Alta and Deer Valley in Utah, and Mad River Glen in Vermont were the last skiers-only resorts in North America. The next day, Taos Ski Valley opened up its slopes to snowboarders. Now only three resorts free of snowboards remain. 

The fall of Taos—as alarming to North American skiers as the fall of the Bastille to the ancien regime—typifies everything obnoxious in American life today: the sacrificing of the will of the majority to the complaints of the obstreperous few, the cloaking of every cause in the phony garb of victimhood, the wanton destruction of the traditions that make life worthwhile, the relentless homogenization of the cultural landscape in the name of “diversity.”  Even non-skiers may take it as a warning.

To review, skiers get down the mountain on two planks facing downhill.  Snowboarders get down on a single board facing sideways. The difference means nothing to snowboarders but everything to skiers.

First, while skis make a euphonious swishhhh, snowboards pollute the atmosphere with a cacophonous crrrrunch!

Second, snowboarders make wider turns than skiers, thereby leaving less room on the slope for others.

Third, while skiers face downhill, snowboarders make half their turns blind, forcing everyone on the slope to get of their way to avoid getting hit.  A trial lawyer in Colorado once told me that he makes all of his money litigating injuries from snowboard-skier collisions. 



Fourth, while skiers rest standing up, snowboarders plop their bottoms on the ground every time they need to catch their breath.  Clusters of snowboarders now obstruct almost every slope in North America.  Indeed, snowboarders have cultivated whole ethos of loafing.  A pack of them can be found menacing passers-by at the base of almost every resort in America.

The foregoing harms are ultimately forgivable What makes snowboards truly intolerable is that they destroy great snow conditions.  While skiers carve turns, snowboarders (even the best of them) plow.  Groomed trails turn to ice under the snowboards’ punishment.  Worse, fresh powder disappears the instant the first snowboarder slides his way down the mountain.

Fresh powder!  One day of powder skiing—nay, one run of powder skiing—makes up for years of inflated lift ticket prices and disappointing weather.  In the past, almost all North American resorts had powder days. No longer. With grooming, high speed lifts and slope-side development to lure more and more skiers onto the slopes, new snow these days gets packed down or skied out within minutes.

Until recently, only three resorts in North America still gave you a fighting chance of finding untracked snow: Alta, Mad River Glen, and Taos.  Each limits the number of skiers on the mountain at any one time.  Alta—William F. Buckley Jr.‘s favorite American resort—gets so much snowfall that to prevent avalanches it has to fire canons for days before opening its terrain.  As soon as they stop firing, almost every skier can hike or traverse to an untracked run. 

The only way to get to the top of Mad River Glen in Vermont is via a 1948 diesel-powered single chair lift.  Riding it is the skiing equivalent of driving a Model T.  Meanwhile, Mad River barely grooms its trails and keeps them only about as wide as a closet. While novices go to Killington or Stowe, experienced skiers can thread through the woods at Mad River and find untracked runs for days after a snowfall. 

Then there’s Taos. Owned by the Blake family since 1955, Taos operates under an agreement with the United States Forest Service that caps the number of ticket-holders who can ski each day. Until recently, the agreement dampened Taos’s enthusiasm for development. To this day, you can’t get to the top of the mountain with a lift; instead, you have to hike. My wife and I once took four hours hiking to the top with reluctant friends of ours from Nebraska. It was one of the best days skiing of our lives, even if our Nebraskans might not agree. Above the ski lifts, Taos features some of the finest drops to be found anywhere in the world.

In sum, up until March, skiers in North America had three resorts where they could find great conditions.  (Deer Valley, which also bans snowboards, grooms its trails relentlessly and has therefore never really counted as a great ski resort).  Snowboarders, meanwhile, had already overrun almost 500 North American resorts, where their very presence now makes great skiing impossible. 

You would think that they would be content to leave Taos alone.  But you would be wrong. Instead, snowboarders did what all aggrieved groups do these days:  They formed a pressure group! “Free Taos” they called it, by which they really meant that snowboarders were unfree because not allowed at Taos.  They accused Taos of perpetrating a grave injustice against snowboarders—all of whom, like skiers, hail from the whitest, most privileged backgrounds imaginable.  Open your minds!  Equal rights!  Sign the petition!  Down with elitism! Winter sports diversity!  No slogan was too rebarbative for the Free Taos movement.  I once read a sports columnist liken, with a straight face, Taos’s policy of banning snowboarders to the African slave trade.

We cannot know what went on in the board meeting where the corporation decided to turn against its most loyal customers.  Some speculate that the younger scions of the Blake family want to turn Taos into an insipid profit center like Vail in Colorado. Given Forest Service restrictions, however, it is unclear how Taos can ever make much money.  All it had to offer was great skiing and eccentric local tradition. It is far from clear that Taos will make more money abandoning its market niche and instead offering what one can find at every other resort in America already. The Taos that generations of skiers loved is now gone—sacrificed, like everything else that is charming and worth preserving in America, to the demands of the impudent few.

Even if you care nothing for skiing, be forewarned: Eventually, the vandals will overrun even the most beloved and stalwart institutions.