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August 29, 2009

Rational Rationing

The healthcare reform debate has generated much heat but very little light.  (And it’s also getting a lot of coverage, so there’s very little else to report about this week.)

I wrote a couple of months ago my opinion of two simple (but unpopular) steps that would make high-quality healthcare affordable to virtually everyone: abolishing the employer tax deduction for health insurance, and slowly phasing out Medicare.  The entire national debate is going in the opposite direction, with one party offering Medicare (or something like it) to everyone, and the other party opposing this because it would threaten Medicare.

In this hullabaloo, there is one word being shouted that I think deserves more explanation: rationing.

Classical economics is founded on a rule called the principle of scarcity which states that the sum of everything that everyone wants exceeds everything that exists.  People want more stuff than all the stuff in the world.  That means that some desires go unmet.  Every economic system is essentially a system to address scarcity by establishing rules that determine who gets what – which needs are met and which are not.  That is the definition of rationing: a method of distributing stuff in a world of finite resources and infinite demands.

That means that every economic system that has ever existed has used rationing in one way or another.  In a feudal system, the local lord distributed land to his vassals.  In centrally planned economies the government allocates all goods and sets prices.

Free economies have rationing too.  In free economies virtually all transactions are voluntary.  No one is forced to buy or sell a good or service, and the price depends only on the consent of the involved parties.  No one is forced to sell me apples, I don’t have to buy apples, and the price of apples can be whatever I and the grocer both agree to.  This is also a kind of rationing; it is rationing by price.

Rationing by price has lots of advantages.  The first is that I ultimately decide which of my desires are met and which are not by choosing what I will buy in exchange for my finite dollars.  Since everyone has different values, preferences and goals, there is no better way of getting the most for your dollars than in making these decisions yourself.

Rationing by price also results in the best products and services at the cheapest prices.  Suppliers, forced to compete with each other for customers, can only survive by continually making better stuff cheaper.

Now, there are some goods and services that, by their nature, just can’t be distributed through free markets because they are delivered to entire groups, not to individuals.  For example clean air, local law enforcement and national defense couldn’t be pragmatically purchased by each individual citizen in whatever quantity she chooses.  But for the vast majority of other goods and services, rationing by price has led to better products at cheaper prices than any other method.  Moreover, in a history marked almost entirely by grinding poverty, free markets and rationing by price is the only method that has produced societies with any degree of comfort and affluence for its average citizens.

If healthcare is important, maybe we should consider distributing it the way that works best – by each of us spending what we can afford to get what we believe we need.  There would still be a role for government programs and private charities in the care of the indigent, but the rest of us would have access to terrific inexpensive care.

Instead we spend our (and our employers’) money on an insurance policy and wait for them to tell us what’s covered, while our elected officials debate whether government should control more of the healthcare marketplace or all of it.

Learn more:

For someone (like me) with virtually no formal background in economics, I know of no better introduction than “>The Healthcare Meltdown – Part IV, A Recipe for Reform

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor despite the fact that you read or comment on my posts.  Leaving a comment on a post is a wonderful way to enter into a discussion with other readers, but I will not respond to comments (just because of time constraints).

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Ted Kennedy’s ‘quiet faith’

Forget Chappquiddick, Ted Kennedy is being remembered as a saint. But what about his quiet Catholicism? I talked about it Wednesday; tmatt has more here. And then there’s this story from CNN:

Sen. Edward “Ted” Kennedy didn’t wear his faith on his sleeve, but those close to him say Catholicism was much more than an ethnic and cultural identity.

(skip)

The Rev. Gerry Creedon, a priest at St. Charles Borromeo Catholic Church near Washington, counseled Kennedy for more than 30 years. He was chosen to deliver the opening prayer at Friday night’s “Celebration of Life” memorial service.

Asked if he considered Kennedy a religious man, Creedon said, “Very much so.”

Kennedy not only attended Sunday Mass, Creedon said, but also sought him out to discuss the tenets of Catholicism.

“Most people sat there either disagreeing with me or sleeping. I’d walk out of church, and Ted Kennedy would come up to me and continue the theme I was preaching on,” he said.

It doesn’t do much more to enlighten, but you can read the rest here.

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Ado and the Leap of Faith

Every time you enter a restaurant, you take a leap of faith.  Last night, at Ado in Venice, I took a huge frickin’ jump.

Right over S. Irene Virbila’s head.

Ado is a new Italian place, located in a yellow, two-story bungalow just where Main Street curves into Abbot Kinney.  I’ve passed it sereval times since it opened a few weeks go, then Googled it to find it’s the newest venture of Chef Antonio Mure, who opened Piccolo, Locana Veneta and Il Botte. I’d eaten his food at all those places and never had a bad meal, and comments on Yelp confirmed that he was doing a good job at Ado as well.

So, when my wife asked me to make a reservation somewhere special for my mother-in-law’s 87th birthday party, I called. “How many people in your party?”

“24,” I said.

“24?”

“24.”

We had relatives in from out of town, from Israel, from Toronto and San Francisco and Boston and New York.  The tribe was gathering around the matriarch for a feast, and I was pretty damn proud of myself. I’d scored a big reservation at a new Italian place in a funky, oh-so-Venice location with a tried and true chef.

This was Wednesday. I gave my credit card, and confirmed the reservation for a Thursday night dinner.

About an hour later my dad called. “Did you see the review in the LA Times?” he said. “They hated Ado.”

I went online.

This was the headline: “Chef-owner Antonio Muré has impressed elsewhere, but the indifferent service and a pricey and scattershot menu outweigh the handful of dishes that work.”

It gets worse.

The Times’ restaurant reviewer, S. Irene Virbila, goes on to accuse Mure of gouging customers by pushing high-priced bottled water on them, misleading them about the price of a pasta and black truffles. She calls the wine list overpriced, the food heavy and fussy for the season, and the service rushed.

Coup de grace? When Mure’s partner Paolo attempts to kiss her good night, she recoils.

“I don’t know the guy, and I’m not playing,” she writes.  “[Paolo] steps back and says, shrugging, ‘I am Italian.’”

Virbila calls the Paolo-tried-to-kiss-me attempt “patently insincere.”

(Okay, I have to wonder: did she expect flowers and chocolate first?  Has she ever given anyone an air kiss without expecting to go home with them? Has she been to Italy? To Argentina? To Hollywood?  It’s not love, it’s a handshake with your lips).

I put my computer to sleep and panicked. They had my credit card, I had the solemn responsibility to not screw up a dinner for 24 loved ones.

And the calls kept coming. “Where did you say we’re going?  Did you read that review?”

It was suggested that we skip Ado and gather for pizza and beer somewhere.

Here is where I needed my faith to start leaping.

A restaurant, after all,  is one more place where faith and food intersect. You walk into any restaurant, you never know.  The kitchen is hidden. Even a so-called open kitchen is anything but—it reveals nothing of the hours of prep, of how the ingredients were stored, of who did what to your fish from the boat to the dock to that morning. 

You are eating food that has passed through many human hands to get to your mouth, and you are trusting those hands with your life.  It’s an intimate act, feeding. Nature insists that when we are first born and most vulnerable, only our birth mother can be entrusted with our food. In nature, once the mother stops feeding the animal, the animal feeds itself. But we humans, as we grow older, we let complete strangers feed us, we pay them to do it, trusting they will look out for us no less than our moms once did.  A sloppy uncaring cook can at worst literally kill us.  Or, if Irene Virbila was correct, at least ruin our night.

Would Antonio Mure ruin my night? I decided to stop by and ask him. 

It was 11 am on the day of the dinner.  When I walked in a stocky young Italian man with a mane of dark hair was at the espresso machine.

“Hi,” I said.

He turned to me.  Was this the insincere Italian himself?  I wasn’t going to fall for it. Irene had warned me. His very kisses reek of deception. Mascalzone!  I’m not falling for it. I’m not falling for it.

“Would you like a coffee?”

“Um, sure.” Okay, I fell for it.

He didn’t even know who I was, he just saw a anxious stranger walk through his door while he was making himself a coffee—and offered one to his guest.  This was Antonio, the chef.  I told him I had made the reservation for 24 that evening.  We walked upstairs and checked out the space.  It was charming—exposed beams, wood floors, windows looking down on Main Street open to the ocean breeze.  But I didn’t come to see the room.  I came to ask about that lousy review.

But I didn’t bring it up at first.  I had a couple Jeroboams of Puglian wine I wanted to celebrate with, and The Times review had led me to believe this man would gouge me for it. “I look in vain for a mid-priced Chianti Classico or Ruffino,” Virbila writes, “a lusty Barbera or even an Orvieto I’d like to drink. But this list has only a handful of wines under $50. The one Chianti I find is a 2003 Capannelle Riserva at $83. Pass.”

I turn to Mure.  “What is your corkage for large bottles?”

“Twenty-five dollars.”

Totally fair. Now I get to the point. “What about that review in the Times?”

He shrugged. “I don’t understand.  People like it here.”

He didn’t seem hurt, or defensive, or even angry.  He added, “She must not have liked it.”

So that was how he saw it: one diner’s opinion.  You can’t thrill everyone.  So what if she reviews for the largest newspaper in LA? She didn’t like it. 

Antonio moved on to the next topic. “Your espresso.”

It was sitting on a small table by the front door—a demitasse filled with creamy espresso, placed on a saucer, along with two sugar cubes and a tiny spoon.  I drank it—perfect.

“Thank you,”  I said.

I took one final look around the place,  and then I saw it: the review.  He had cut out Virbila’s scathing review—she gave him a half star out of four—and taped it to his front door. I was stunned.  It was like cigarette companies putting the warning label on the front of the package.  Could it be he didn’t read English? Or was it a macho thing—you think you’re tough, here, hit me, so what?  Or could it be his way of saying he had nothing to hide, nothing to be ashamed of?

Whatever it was, I liked it. I was coming back that night with 23 relatives.

The leap began at 6:30. We gathered car by car.  At the door Paolo said hello and welcome—INSINCERE! How dare he smile and welcome people he doesn’t know to his restaurant. 

He acted delighted at the giant wine bottles I had brought. “You have to taste it,” I said.

“Of course,” he said. “I better.”

The waiters were attentive. It was a warm night, and we drank some of that Italian sparkling water Virbila found to be such a rip off. But is it?  We could have ordered tap water—she could have too.  There’s no law that says a restaurant has to sell bottled water cheap. Or is that now in some Diner’s Ten Commandments—Thou Shalt Break Even on Bottled Water? Ado’s food, I’d see, was labor intensive and high quality—if water was where they wanted to make a little profit, so be it. 

The appetizers I tasted were great.  Remember, there were 24 of us, so I’m going to assume I got to taste, smell and see more of Mure’s dishes than Virbila did in her visit (or was it visits? She never says how many times she dined there before judging it an insincere rip off—an omission that borders on the unjust).

Crudo d’orata – a sea bream carpaccio with red onion, capers, olive oil, lemon and some heat— was the standout.  But there was rich tuna tartar set off by blood orange, a watercress salad with hearts of palm and the day’s special, asparagus soup with quail egg and shaved black truffles. All delicious on a warm Venice night.

By then everyone had drunken a couple of glasses,  enjoyed their appetizers, and munched through the baskets of freshly-baked foccacia.  We were a big happy noisy family.  My sister-in-law gave a toast and my mother-in-law sighed with joy.  I relaxed.  The main courses would have to be shoe leather and shaving cream to turn the tide against this place.

“I feel like I’m in Italy,” a relative who has been there several times said.  I knew the feeling: of being taken care of, of being cooked for by somebody who cared as much or more about what was on your plate as you did.  Someone who understood that it was faith that brought you to him, and it was his duty to restore that faith—isn’t “restore” at the root of the word restaurant, after all?

The next courses were uniformly very good. Little gnocchi with diced tomatoes, arugula, and almonds.  A snapper filet grilled and napped with a light blood orange, tagliatelle sautéed with fried zucchini, teardrop tomatoes, walnut pesto.  The aroma from my mother’s pasta—homemade beet pasta with quail ragu on a pool of molten taleggio cheese—just the smell of it alone—was enough to challenge my faith not in Ado, but in the LA Times. Ms. Virbila, if you tried that dish and did not like it, your next sparkling water is on me.

We ate late into the night. We split some panna cotta and ricotta cheesecakes for dessert, and some cups of espresso. We sang “Happy Birthday” to my mother-in-law, and it was good.

Paolo was at the bottom of the stairs as we filed out. 

“Ciao bello,” he said to me. “How was everything?”

I hugged him, sincerely.

Ado on Urbanspoon

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Disc jockey DJ AM dies

CNN.com: Nearly a year after surviving a plane crash in South Carolina, disc jockey Adam “DJ AM” Goldstein was found dead in his New York apartment Friday afternoon, his publicist said. He was 36.

“The circumstances surrounding his death are unclear,” his publicist, Jenni Weinman, said in a statement confirming the performer’s death. “Out of respect for his family and loved ones, please respect their privacy at this time.”

Read the full story at CNN.com.

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