Sunday Linkies

• The ACLU has come out in favor of M2F participation in biological women's sporting events, an announcement that was immediately panned by Martina Navratilova:

  I love you ACLU, but you are wrong on this. Unless you want to completely remake what Women’s Sports means, there can be no blanket inclusion rule. There is nothing stereotypical about this- it’s about fairness and it’s about science. Thank you.

  — Martina Navratilova (@Martina) March 13, 2019

  The ACLU's source for this claim is a data-free essay from ... Everyday Feminism.
• Reason ran a fine essay on sex differences in athletics that probably won't do much to change the current situation, larded as it is with loud advocates resting on spectral evidence that doesn't really address the differences between M2F transgender athletes and biological women. 
• A terrific thread from @FondOfBeetles showing how adolescent boys routinely break records set by the best women in track. Opening shot:

  In 2004, I was privileged to watch Kelly Holmes win the female Olympic 800m gold, in a run that kept everyone on tenterhooks until that final glorious sprint finish. Her finishing time was 1:56.38. 1/ pic.twitter.com/6EkVF5ZFxe

  — Dr FondOfBeetles (@FondOfBeetles) March 11, 2019

• A useful article from T Nation on the subject of transgender athletes:
  

  Most experts say that the average testosterone production for biological females ranges between 0.52 to 2.8 nmol/L. The Mayo Clinic put that range even lower (2). And while experts may vary in what they consider average among females, the consensus is almost always below 3 nanomoles/L.
  
  But remember, federations like the IOC require a male-born person to suppress and maintain testosterone production at 10 nanomoles/L.
  
  So even if a woman was genetically blessed with testosterone levels that reached 3 nmol/L, that would still be less than half of what a trans woman would be allowed to have during the competition. To look at it another way, her male-born competitor would have just over three times as much testosterone, even with hormone-altering drugs.

• Sex differences in the human brain show up before birth. The last refuge of the blank slate-ist is gone.
• Kirsten Gillibrand has zero endorsements. 
• Finland's government has collapsed following failed efforts to reform the country's healthcare delivery system.  This is interesting for a lot of reasons, not least because Finland has better per-capita spending on healthcare than France, which is often used as a model for US single-payer/M4A advocates (the light blue line below is Finland):
  
  
  

Sarah Kliff, Promoter Of Democratic Healthcare Fantasies

Vox's Sarah Kliff, last seen before 2016 election whistling past the Obamacare graveyard, now chirps about the number of Democratic health care proposals! Yay, team!

It’s notable to me that Democrats seem really keen on having another health care debate. They’re preparing for it by putting all these different options on the table, to sort through where a consensus might exist.

And the "options" really boil down to a Hobson's choice: how do you want your government-controlled health care delivered? All from the government right now (single-payer, a consistent loser at the polls)? Pretending that single-payer isn't the endgame right away (Medicare/Medicaid buy-in, i.e. the public option)? However you cut it, the belief in magical government intervention as an elixir is central to all of them. None of these will fix the physician shortage, nor will it fix the patent system, nor the regulatory moats around pharmaceuticals. Kliff doesn't concern herself with those kinds of details; her job is that of cheerleader. We know this because the second half of her article goes on to explain the wonders of the Murphy-Merkley plan, during which she writes the following:

The Choose Medicare Act envisions that individuals and companies would cover their costs for buying into Medicare, meaning actuaries would need to determine what those premiums would look like. There is some reason to expect these premiums would be lower than premiums for private insurance, because Medicare typically pays lower prices.

There are a lot of things to say about that, not least the shifting terrain that a large influx of new "insureds" would look like; recall that the Obamacare cohort was sicker than the general population, i.e. the incentives are for such people to seek out such care. There's hardly a reason to think a "public option" would save material costs, and considerable reasons to think it would do worse (i.e. the Democrats would be sure to goose the actuarial realities by way of further subsidies).

Another problem is the quip sometimes attributed to Stalin, that quantity has a quality all its own. Kliff is right that private payers pay more for their services than Medicare. But assuming Medicare expansion will fix costs also assumes that physicians will continue to accept Medicare patients. While data is hard to come by, Texas Medical Association figures showed a dramatic drop in the acceptance of new Medicare patients from 2000 (when 67% of physicians accepted all comers) to 2010 (only 31%). Moreover, given that Medicare represents a relatively small fraction of physician income (as of 2011, around 40% in Texas, see PDF page 5), expanding it would demand physicians take a substantial pay cut. That they might opt out of accepting new patients or stop seeing Medicare patients altogether. Second-order effects: we can haz them!

Vermont Learns Why Single-Payer Won't Work

Vermont's Gov. Peter Shumlin today bailed out of a statewide single-payer plan because of "the big tax increases that would be required to pay for it". This should come as utterly no surprise, save to the people for whom single-payer constitutes a panacea. (Extra bonus points in that article to Jonathan Gruber for helping grease along that inevitability.) Megan McArdle back in April wrote a piece giving a lot more reasons than I have, but at its core, the argument is this: if you start from a high basis, and you don't do a good job of controlling cost growth, and your peers applying single-payer (or outright socialized medicine) aren't doing a good job of that, you will not restrain costs.

Once we pulled away from the other countries, even an average growth rate meant that the gap between our spending as a percentage of GDP, and theirs, would continue to widen -- especially if their GDP grew faster than ours for any length of time.

That is why we cannot count on financing single-payer with the fabulous cost savings to be gained by making our system more like Europe's. Europe didn’t gain fabulous cost savings by making their systems more like Europe's: Its nations started from a lower base, and held down cost growth, but they did not actually use single-payer systems to cut what they were spending.

"Once spending is in the system," she continues, "it’s hard to get rid of." Yes. Just ask anyone who's followed the Medicare Sustainable Growth Rate fiasco, which has had no fewer than eight votes post-Obamacare-passage to keep higher rates in place than the required statutory cuts. Vermont was never going to get there from here, and they found out in a big hurry that just papering over the costs with somebody else's money was going to require some very hard choices.