There’s far too little talk about the problematic role of doctors and the doctors’ lobby in health care policy. I think it’s pretty well-understood in political circles that while teachers will on the one hand be important advocates for education as a policy priority, they’re also going to have interests that aren’t identical with the interests of students or the public at large. The parallel situation with regards to doctors gets much less attention, perhaps because their professional organizations and such aren’t called “unions.”

Throat clearing aside, Ezra Klein points to a study with this striking conclusion:

[A] year after surgical teams at eight hospitals adopted a 19-item checklist, the average patient death rate fell more than 40 percent and the rate of complications fell by about a third, the researchers reported.

Sounds like something we ought to implement!

Oftentimes we just kind of assume that doctors are perfectly benevolent, perfectly knowledgeable people who are doing nothing all day but diligently trying to understand what’s best for patients. Obviously, though, the world doesn’t work like that. And the actual practice of medicine involves a lot of flawed procedures and a general sort of laziness in which practice is guided by habit or by “what was taught in med school when I was in med school” or by considerations of profit rather than by serious research. Ezra says “One of the secrets of health reform is that there’s substantial opportunity within the system to make it cheaper while making it better.” And indeed there is. Much like in other fields of endeavor the key thing is to not merely increases the quantity of health care, but to increase the productivity of the health care sector by using resources more efficiently.

There are real tradeoffs between cost and quality, but the issue of productivity defines the scope of those tradeoffs. At the moment, our medical sector is very inefficient so our cost-quality curve is in a very unfavorable location. A more efficient, more productive sector would give us more appealing tradeoffs. But to get that efficiency you need to actually crack down a bit on the prerogatives of the stakeholders—insurance companies, yes, but also doctors and others.

A friend Twitters:

Service is great! But MLK’s life and work wasn’t about volunteering: it was about altering the distribution of power.

Quite so. I mean, it was about volunteering. But it was about volunteering for the cause of social justice—for a new, fairer, and more equal distribution of political and economic power. It wasn’t about doing charity work. More on this later.

Read Josh Marshall and Paul Krugman on the back-from-the-dead idea that what we need is for the government to spend hundreds of billions of dollars buying up “toxic assets” from banks and then setting up a “bad bank” to warehouse the assets and try to sell them off down the road for whatever they’re worth.

In terms of how this should work, it’s actually a close cousin to my preferred solution of nationalization. Under nationalization, you take a “too big to fail” bank whose equity value has plummeted because of problems with its balance sheet, wipe out the shareholders, and nationalize the enterprise. Then you hive off the “toxic assets” from the rest of the enterprise. You then may or may not do such things as fire top managers, put people on the GS salary scale, and force banks to operate in the public interest by lending. But the point being that you do this to some number of banks that are in serious distress. Then when there’s some measure of recovery in the economy you start re-privatizing the “good” banks and selling off the assets owned by the “bad bank” for whatever you can get for them.

Both approaches involve the taxpayers eating a substantial loss on the value of the toxic assets—there’s simply no way around that. But under a TARP scheme, the loss eaten becomes a gift to the equity stakeholders in the existing banks. Under a nationalization scheme, there is no such gift and the public cost should be lower because you get to sell off not only the toxic assets but also the “good bank” that results from the cleanup. What’s more, under a TARP scheme every bank that bought bad assets gets a gift. Under a nationalization scheme, the people who own banks really really really really really really won’t want their bank to be nationalized. Which is at it should be. The free market is good and we shouldn’t have the government running every bank under the sun. But that means that nationalization, and the resulting need for taxpayers to eat the losses on the toxic assets, will only be done to banks that are desperately in need of assistance much as the FDIC’s existing mechanism for bank failure only kicks in if the bank is actually going to fail not just if it made a bad business decision.

The TARP alternative is somewhat better for bank managers, much better for equity stakeholders in banks, much better for preserving the myths of American capitalist ideology. Nationalization would be better for ordinary citizens.

I think I’ve written some variation on this ever year now for several years, but I do always wish that praise and attention for Martin Luther King, Jr. would pay more attention to his teachings on violence and non-violence. Not that the calls for racial justice are unimportant. On the contrary. But from the standpoint of 2008, these are pretty easy lessons to take to heart. We’ve by no means conquered bias and prejudice or overcome the lingering scars of the major injustices of the past, but on the level of message nowadays you don’t see anyone within a thousand miles of mainstream politics denying the desirability of racial equality.

On violence, we’re in another world entirely. By the standards of today’s discourse, King would be considered deeply unserious. Serious people understand that if you think something is important, the serious way to go about expressing that is by voicing support for having other people go kill other people. Doubts about the ethics of such action are loathesome moral equivalence and doubts about their wisdom demonstrate naïveté. King wouldn’t qualify as a “civil rights Democrat”—not enough bloodshed.

The irony is that adherence to nonviolence is one of the main reasons King is such an admired and mainstream figure today. If he’d decided à la Tom Friedman that the white south needed a “suck on this” moment, or followed the lead of Hamas or Shimon Peres in deciding the best way to teach the population a lesson was to terrorize them, he’d be a jailed or executed despised criminal. And the ethic of nonviolence that King appealed to has deep roots in the Christian tradition that unites the majority of black and white Americans. And yet even though this Christian nonviolence is in many ways the most mainstream aspect of this radical figure who’s become a mainstream icon, it’s something that none dare take seriously today.