On medicine and policy. (Or: why everyone should read Jonathan Bernstein)

Over at A Plain Blog About Politics, Jonathan Bernstein offers an insightful post about Mitt Romney, business acumen, economic know-how and baseball.  It is a great example of why, if you don’t read Plain Blog, you should.

Paul Krugman has a nice  blog post this morning asking a great question: “why does anyone believe that success in business qualified someone to make economic policy?”

The best purchase on this question is to go back to something that Bill James wrote a long time ago, which unfortunately I can’t locate (the Abstracts were awesome, but not indexed, and I can never find my favorite bits when I want to cite them)…if I remember correctly, and it’s been some time, I wound up doing an extended riff on this once back on r.s.bb, and to tell the truth I can’t remember what was his original point and what I’m remembering from what I wrote, so my apologies overall. It’s about what it means to “know baseball.” The idea is that there are lots and lots and lots of ways to know baseball. There’s technique, such as how to throw a cut fastball or the footwork for how to take a throw at third base from right field with a runner sliding in. There’s also knowing what it’s like in a major league locker room. Both of those count as “knowing baseball.” But so does knowing what it’s like to sit in the bleachers, or knowing about what the game was like in the 19th century or the 1950. It’s also “knowing baseball” to be able to watch an 18 year old kid and project how he’ll be a as major leaguer in five years — and it’s “knowing baseball” to sit at your computer and figure out how much a single is worth compared to reaching on a base on balls, or how much striking out hurts the team objectively compared to other types of outs. It’s knowing baseball to know the business of a baseball franchise or of the industry as a whole. And it’s even knowing baseball to get involved in your roto team, or even more fictionally to read baseball fiction, whether of the DeLillo and Malamud variety or, you know, what I like.


And to get back to Krugman’s point, there’s no particular reason to believe that knowing what Romney knows about how to turn around a poorly performing business has anything at all to do with knowing how to make an overall economy perform well. Just as it’s really not important to know the footwork of how to turn a double play if you want to know whether Joe Morgan was better than Ryne Sandberg, or how it feels to be in the clubhouse isn’t important (or at best is only one very small piece of the puzzle) if you want to know how signing Prince Fielder will affect franchise revenue over the life of the contract. I could see an argument that Romney’s skills might be particularly important for managing the executive branch well, but for getting unemployment down and income up? What Romney claims to know just doesn’t seem very relevant to that part of the job.

Great stuff.  In writing about Romney and economics, Bernstein highlights why I am often reluctant to style myself an expert on healthcare policy.

There is a lot that I know about medicine.  I know my own little ambit quite well.  I know the standard vaccine schedule, what the immunological mechanisms for their activity are, and that they don’t cause autism.  I know what an infected ear looks like, which contraceptive pills are indicated for which menstrual disorders, and why trying to force a kid to potty train is a bad idea.  At any given time, I have a good idea of what contagious illnesses are rampaging through the local daycares, and what (if anything) to do about them.

But when it comes to a good, wonkish, nuts-and-bolts analysis of healthcare policy, I’m as apt to turn to Jonathan Cohn as try to figure out a good answer from within my own experience.  (That’s also largely because I’m liberal-ish.  YMMV.)  Sometimes that experience seems sufficient for me to pronounce on a subject, such as why requiring prescriptions to use Health Savings Accounts for over-the-counter medications was a stupid policy change.  But on, say, how insurance exchanges should be structured?  Not a clue.

I’ve worried that it’s a weakness of this blog that I don’t try to crack the policy side of things more, but I worry more about trying to do something that I’m not likely to do well.  And thus I found Bernstein’s post, though on a much different topic, reassuring with regard to my own strengths and weaknesses.  Not being able to comment authoritatively about the ins and outs of the Affordable Care Act doesn’t mean that I don’t “know” healthcare.  And hopefully what I do know is still worth writing about.

Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.


  1. “I’ve worried that it’s a weakness of this blog that I don’t try to crack the policy side of things more”

    It’s a shame you don’t listen to this voice more. As I’m always saying, if there’s on thing the internet needs more of, it’s people who don’t know enough about a subject speaking in a voice of confident and supreme authority.

    • But there’s also a reason you don’t let the guys in the machine shop decide what kind of space missions NASA is going to do.

        • Actually, it’s not a bad idea to drift past the machine shop and ask the guys there if your idea is batshit crazy.

          The machine shop guys know a lot more about practical possibilities (and their costs!!) than you might think 😉

          You don’t want them setting policy, but sanity checking isn’t a bad idea.

          • “How should I make this part” is a different question than “do we choose on-orbit docking of multiple vehicles or do we build a rocket big enough to launch the whole thing in one go”.

    • I suppose my point is that I sometimes feel insufficiently expert as compared to some of my LoOG confreres. Every time Likko fires off another of his kick-ass legal analyses, I wonder if I should do something like This Week in Rashes.

      • Two things:

        1. I’m going to assume you meant Likko’s kick-ass analyses. And if not, I’d like to know who’s hynie he’s kissing.

        2. It seems clear to me that you DO write about stuff that you know, and do it an an equally kick-ass way. (Though, fortunately, without relying heavily on rashes.)

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