JayB

Love the Econtalk podcasts he hosts. Isn't he dead? Like his ideas? Russ Roberts is very much alive! You should listen to some of his podcasts. Start with his interview of Hitchens, on his book on George Orwell: http://www.econtalk.org/archives/2009/08/hitchens_on_orw.html You might also find the Alan Wolfe interview interesting: http://www.econtalk.org/archives/2009/05/wolfe_on_libera.html

BTW - not worried about the president's address to schoolchildren. I'm much more concerned by legislators that make liberal use of "the children" as a pretext for whatever legislative agenda they're trying to promote. "[shout]Keep the sugar tariff's in place...for the children....[whisper]And the heavily subsidized HFCS lobby, and the sugar-beet lobby! And...[/whisper]" As last refuge's for the scoundrel go, children are often much more effective than patriotism.

The left wing eagerly marches towards totalitarianism - their preferred state of being. Where was your outrage at a totalitarian Bush regime stripping the nation of constintutional and consumer protections, intruding on private citizens at will, snatching people off the streets and torturing them with no due process, and establishing an imperial executive? Are you a complete fucking moron? Strange to see such profound distrust of government manifesting in a passionate zeal for a single-payer system, particularly one that will invariably be run by these same totalitarians at some point in the future.

Love the Econtalk podcasts he hosts.

[video:youtube]grbSQ6O6kbs "Dying patients A group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death. Published: 4:08PM BST 03 Sep 2009 SIR – The Patients Association has done well to expose the poor treatment of elderly patients in some parts of the NHS (report, August 27). We would like to draw attention to the new “gold standard” treatment of those categorised as “dying”. Forecasting death is an inexact science. Just as, in the financial world, so-called algorithmic banking has caused problems by blindly following a computer model, so a similar tick-box approach to the management of death is causing a national crisis in care. The Government is rolling out a new treatment pattern of palliative care into hospitals, nursing and residential homes. It is based on experience in a Liverpool hospice. If you tick all the right boxes in the Liverpool Care Pathway, the inevitable outcome of the consequent treatment is death. As a result, a nationwide wave of discontent is building up, as family and friends witness the denial of fluids and food to patients. Syringe drivers are being used to give continuous terminal sedation, without regard to the fact that the diagnosis could be wrong. It is disturbing that in the year 2007-2008, 16.5 per cent of deaths came aboutafter terminal sedation. Experienced doctors know that sometimes, when all but essential drugs are stopped, “dying” patients get better. P. H. Millard Emeritus Professor of Geriatrics University of London Dr Anthony Cole Chairman, Medical Ethics Alliance Dr Peter Hargreaves Consultant in Palliative Medicine Dr David Hill Fellow of the Faculty of Anaesthetists of the Royal College of Surgeons Dr Elizabeth Negus Lecturer, Barking University Dowager Lady Salisbury Chairman, Choose Life " http://www.telegraph.co.uk/comment/letters/6133157/Dying-patients.html In a letter to The Daily Telegraph, a group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death. Under NHS guidance introduced across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away. But this approach can also mask the signs that their condition is improving, the experts warn. As a result the scheme is causing a “national crisis” in patient care, the letter states. It has been signed palliative care experts including Professor Peter Millard, Emeritus Professor of Geriatrics, University of London, Dr Peter Hargreaves, a consultant in Palliative Medicine at St Luke’s cancer centre in Guildford, and four others. “Forecasting death is an inexact science,”they say. Patients are being diagnosed as being close to death “without regard to the fact that the diagnosis could be wrong. “As a result a national wave of discontent is building up, as family and friends witness the denial of fluids and food to patients." The warning comes just a week after a report by the Patients Association estimated that up to one million patients had received poor or cruel care on the NHS. The scheme, called the Liverpool Care Pathway (LCP), was designed to reduce patient suffering in their final hours. Developed by Marie Curie, the cancer charity, in a Liverpool hospice it was initially developed for cancer patients but now includes other life threatening conditions. It was recommended as a model by the National Institute for Health and Clinical Excellence (Nice), the Government’s health scrutiny body, in 2004. It has been gradually adopted nationwide and more than 300 hospitals, 130 hospices and 560 care homes in England currently use the system. Under the guidelines the decision to diagnose that a patient is close to death is made by the entire medical team treating them, including a senior doctor. They look for signs that a patient is approaching their final hours, which can include if patients have lost consciousness or whether they are having difficulty swallowing medication. However, doctors warn that these signs can point to other medical problems. Patients can become semi-conscious and confused as a side effect of pain-killing drugs such as morphine if they are also dehydrated, for instance. When a decision has been made to place a patient on the pathway doctors are then recommended to consider removing medication or invasive procedures, such as intravenous drips, which are no longer of benefit. If a patient is judged to still be able to eat or drink food and water will still be offered to them, as this is considered nursing care rather than medical intervention. Dr Hargreaves said that this depended, however, on constant assessment of a patient’s condition. He added that some patients were being “wrongly” put on the pathway, which created a “self-fulfilling prophecy” that they would die. He said: “I have been practising palliative medicine for more than 20 years and I am getting more concerned about this “death pathway” that is coming in. “It is supposed to let people die with dignity but it can become a self-fulfilling prophecy. “Patients who are allowed to become dehydrated and then become confused can be wrongly put on this pathway.” He added: “What they are trying to do is stop people being overtreated as they are dying. “It is a very laudable idea. But the concern is that it is tick box medicine that stops people thinking.” He said that he had personally taken patients off the pathway who went on to live for “significant” amounts of time and warned that many doctors were not checking the progress of patients enough to notice improvement in their condition. Prof Millard said that it was “worrying” that patients were being “terminally” sedated, using syringe drivers, which continually empty their contents into a patient over the course of 24 hours. In 2007-08 16.5 per cent of deaths in Britain came about after continuous deep sedation, according to researchers at the Barts and the London School of Medicine and Dentistry, twice as many as in Belgium and the Netherlands. “If they are sedated it is much harder to see that a patient is getting better,” Prof Millard said. Katherine Murphy, director of the Patients Association, said: “Even the tiniest things that happen towards the end of a patient’s life can have a huge and lasting affect on patients and their families feelings about their care. “Guidelines like the LCP can be very helpful but healthcare professionals always need to keep in mind the individual needs of patients. “There is no one size fits all approach.” A spokesman for Marie Curie said: “The letter highlights some complex issues related to care of the dying. “The Liverpool Care Pathway for the Dying Patient was developed in response to a societal need to transfer best practice of care of the dying from the hospice to other care settings. “The LCP is not the answer to all the complex elements of this area of health care but we believe it is a step in the right direction.” The pathway also includes advice on the spiritual care of the patient and their family both before and after the death. It has also been used in 800 instances outside care homes, hospices and hospitals, including for people who have died in their own homes. The letter has also been signed by Dr Anthony Cole, the chairman of the Medical Ethics Alliance, Dr David Hill, an anaesthetist, Dowager Lady Salisbury, chairman of the Choose Life campaign and Dr Elizabeth Negus a lecturer in English at Barking University. A spokesman for the Department of Health said: “People coming to the end of their lives should have a right to high quality, compassionate and dignified care. "The Liverpool Care Pathway (LCP) is an established and recommended tool that provides clinicians with an evidence-based framework to help delivery of high quality care for people at the end of their lives. "Many people receive excellent care at the end of their lives. We are investing £286 million over the two years to 2011 to support implementation of the End of Life Care Strategy to help improve end of life care for all adults, regardless of where they live.”

The major unstated premise here seems to be that, even under conditions of open competition, profits can only be realized by cheating consumers. you're going to the extreme there jay. its not "cheating consumers" its "maximizing share holder value". you see, it isn't all bad...because someone is winning! the shareholder. that why the corporation exists. I'll repeat what I said earlier. I'm all good with a doctor making a good salary and benefits - they earned it. Ditto for his/her nurses, administrative staff, etc. But I'm not good with a corporate hierarchy (or governmental one) telling the doctor how much he can/should charge to maximize profits (or implement price controls), stating what treatments are allowed and when (to control costs), etc, etc. All the more reason to develop mechanisms that keep insurers and government out of such decisions as much as possible IMO. Whether it's students or patients, the best way to insure that the incentives are structured around their interest is to let them control as much of the money spent on their behalf as possible. Catastophic+HSA plans with income indexed vouchers would eliminate these conflicts of interest as well as anything that I've heard proposed thus far.

The major unstated premise here seems to be that, even under conditions of open competition, profits can only be realized by cheating consumers. Corporations seek to maximize profits. That leads to pressure from the board of directors, stakeholders, and senior management to do things like what we see today: - resist payouts - increase premium prices every year at an unsustainable rate - establish absolute lifetime maximums (and make these smaller) - establish guidelines on preexisting conditions - make application as difficult as possible That's certainly true - but it's difficult for them to do any of the above unless there are structural impediments to competition that prevent people from comparing company A to company B and switching, not getting their policy from company A in the first place because the word on the street is they don't cover the claims that they're legally obligated to, etc. There are other variables that drive premiums higher, like an aging population, medical innovation, defensive medicine, and cost-shifting from the public onto private payers that insurance companies have little or no control over. What you typically find is that the cost of premiums is highest where the mandates that all policies offered for sale have to satisfy - like guaranteed issue - are the greatest. As things stand now - in some guaranteed issue states, people who don't carry insurance can wait until they're ill to start paying premiums and drop them as soon as they've received the treatment that they need - then start all over again. The end result is that premiums go up for people who stay insured regardless of their health status, fewer people can afford the premiums, and more people go without insurance. In this case, as with those above, the shortcomings of the current regulatory model have more to do with driving up the cost of insurance than insurance companies cheating consumers. I'm sure that this happens given the incentives that you cited, but it'd be interesting to look at what percentage increase in premiums due to cheating consumers is relative to other factors. Unless we have the evidence necessary to conclude that it's impossible to address the problems that you noted by some mechanism other than making profits illegal, or centrally administered price controls - it seems worthwhile to consider other options first. Simply allowing insurers to sell policies across state lines would enable millions of people who can't presently afford insurance to do so.

would your post above indicate support for the system as it currently stands, or simply a support for critical understanding of all viewpoints/analyses? I'd say that it has more to do with support for a critical understanding of the limitations of broad statistical aggregates, particularly those of of dubious quality, when engaging in comparisons of the health care in country A versus country B. Life expectancy and infant mortality are two such measures that, like the WHO data, tell us very little about how any of the variables that come into play when patients are actually being treated compare from one country to the next. There are others that apply within the US, like the oft cited Dartmouth Atlas and the "X die because they lack insurance studies." The latter often compare two demographic cohorts that have massive and sustained differences in diet, excercise, education, income, etc and attribute 100% of the mortality difference between the insured and uninsured to their insurance status. If your aim is to fix what's broken without destroying what works, these things matter quite a bit.

The major unstated premise here seems to be that, even under conditions of open competition, profits can only be realized by cheating consumers.

I'd say that actually: 1)Looking up the rankings. 2)Taking the time to read the methodology WHO used to generate them. 3)Noting a few of the bizarre inversions in the said rankings... Comes much closer to "analysis" than people who have done none of the repeating "37th" over and over. Google away! Read the report - then we can have an informed discussion about whether or not the rankings are actually meaningful.

Scale is more important than structure? Interesting viewpoint - I hope that you'll expand on this point in more detail.

I was actually hoping that you were going to argue that Canada is a more relevant model because the scale of a health system is more significant than the structure. Or something. Disappointing.

Why bother when you know that the US is 37th - that's right, thirty...seventh - on the WHO rankings? Any further analysis is clearly superfluous.

Let me know if this is was intended as an argument or a non-sequiter and I'll repost the figure the value that Google returns when I plug "Malta Population" into the search bar.

Canada ranks 30th on the same report. Odd that we're not debating the merits of adopting a Maltese Health Care System here - 'specially since it checks in 25 places ahead of Canada!

this is what scares me: some form of "compromise". If there isn't a public option that ISN'T tied to private insurance costs, then might as well shoot the dog now. i seriously can't believe we even have these arguments when we are the LAST industrialized country without universal health care (and outspend everyone by a wide margin AND rank 37th, 30fuckin7th, in WHO's country ranking for med care). The WHO also ranks Malta 5th, and Denmark 34th. Morocco 29th and South Korea 58th. Et...cetera. Naturally, I don't expect people who endlessly cite the WHO report to spend much time worrying about the methods and metrics that the WHO uses to compile the said rankings.

I'm holding out for the retro-retro-restrospective in which we're treated to footage of boomers whistfully commentating on a film composed of a panel of boomers whistfully commentating about their experiences at Woodstock while watching documentary footage of the actual event. Perfect recursive loop of eternal self-absorption. That'd capture and dramatize the concrete cultural legacy of the event far better than any retrospective produced thus far.

Word. I was thinking the same thing. You mean you didn't like the Alpinist piece where she quoted Christina Aguilera lyrics and described the spiritual enlightenment and egoless state derived from an unelaborated vaguely alluded to personal crisis that created a tortuous personal introspection that caused her to jump from airplanes in fancy suits and ultimately led to a solitary personal journey up the Diamond with two different photographers and which begat the death of the ego and the self? As I was reading that piece I couldn't help but remember all of the anecdotal evidence that I'd heard that spending your time focusing on helping other people is much better for your mental health than an obsessive focus on your own emotional state. Not sure if logging 500 hours ladling up beef-stroganoff for transients in a Moab soup kitchen would have provided much in the way of dramatic photos or compelling narratives, but seems like it might have worked just as well for feeling better about being a fit, attractive, intelligent, educated, talented lady that lives in a pretty decent country and makes her living traveling around the world and climbing in beautiful places. The obsessive-risk-induced-hermetic-focus-on-platonic-gradations-in-one's-own-mental-state-as-a-path-to-enlightenment deal doesn't really resonate with me either, but AFIK no one can touch the guy that I mentioned above when it comes to writing terribly about climbing...

Worse than most of Pat Ament's stuff?

Medved: Caller: Medved: Right. So you can just switch plans if you don't like it! That is, unless you are: -old -sick -have a family history of illness -have ever been sick before etc. Better to have some insurance industry goon bending me over than a government bogeyman The second point he makes is even more obvious. I definitely feel better knowing that if my insurance sucks, I have the option of just paying for, say, heart bypass surgery out of my own pocket! Thank god I have the option of shelling out that extra 150,000 I had laying around for a rainy day, I mean that's why you save money, right? Just in case? Yep, the best product they can afford, beautiful system- to each according to his wallet. Just like, you don't get to buy that BMW until you make enough money, in this case, you don't get the good treatment until you work for it. If you make less than $40K a year, at least you have the freedom to buy a plan that will help delay your bankruptcy for a year or two in the event you get sick or have multiple injuries. That is, if they decide to cover it. And just bask in the freedom to switch to an equally expensive plan of a competitor that will offer equally incomplete coverage for you, AND your family! Best of all, you don't HAVE to support these insurance companies if you don't WANT to! If that doesn't sound good, then maybe you just need to work harder! Is it really true that all insurance plans offer equal value for money? That there's no way to expand the number of options that people have nor the ease of changing from one plan to the next other than via the government creating a health insurance company that they own and operate? Or that this is the only conceivable mechanism for providing coverage to folks that can't currently get it? Sufficient - perhaps. Necessary? I'm not so sure. That it represents the optimal mechanism for doing so is even less clear. I lived right next door to a hospital in NZ from October through March, and conversations about who got treated for what and how were a staple of daily conversation. This doesn't make me an authority, but it's not like I'm speaking from a position of complete ignorance when it comes to the merits of one system versus the next. Different people will take away different lessons from hearing the details of a gazillion different cases in a single-payer environment vs the environment we have here, but my observation was that if you have an accident or illness that mostly requires labor-inputs to fix, and the diagnosis/treatment are obvious - the system over there will be pretty good at taking care of you. If you have extreme trauma - all things being equal, you'd be more likely to survive the experience in the US. If you have a chronic condition that requires expensive diagnostic tests or treatments, especially imaging or expensive drugs, and/or your disease has some subtle manifestations and/or requires seeing a specialist - I think you're quite a bit more likely to suffer more and die sooner than you would here. If you have a premature/sick fetus/baby - my sense that it's less likely to survive in NZ than it is here, particularly if you're located a long way from Auckland. It didn't look like prevention was a particular strength of their medical system either, given the regularity with which advanced pathologies that showed up in the ER. Also not a terribly good place to be if you're over a certain age and have a condition that'd be particularly costly to treat - although New Zealanders did seem to be considerably more stoic and philosophical about calling it quits than we are. Also on the plus side - everyone was covered. I don't mean to understate the significance of that. Just to suggest that, at least from my perspective, it wasn't free from some fairly substantial tradeoffs that came along with the particular mode of providing that coverage via single-payer/provider model. Part of that stems from the fact that if forced to chose I'd rather be broke than dead, but I realize that not everyone shares that opinion. You are understating, grossly so, the significance of universal coverage verse the sorry state in the U.S. And the 'trade offs'? Nothing more than unsubstantiated conjecture on your part. I thought I made it clear that I was stating a personal opinion and sharing my own impressions based on what I observed. The fact that I was actually there to make the observations, discuss the merits of the system with native physicians, docs from overseas, etc doesn't make them any less subjective - but it makes it quite unlikely that my conjectures on this front are derived from a base of ignorance that's larger than your own. I'm pretty sure that if there's a apples-apples data-set that'd allow for a comparative evaluation of things like age-adjusted survival rates for cancer, heart-attacks, strokes, specific vehicle trauma's, etc that they'd bear out my conjectures - but if you can get your hands on data that proves otherwise, I hope that you'll share it.

For some reason whenever the discussion turns to the relative risks of cragging vs alpine climbing, I think of Goran Kropp and his tragic death at Vantage a few years ago. If we're dealing in broad generalities, alpine climbing is definitely has more objective risks than cragging. But...how about roped climbing at the crags vs low-end scrambling, etc, etc, etc. No matter what aspect of climbing or any other risky sport you're into, in just about every case it's possible to tweak and minimize the risks so that they at least have the appearance an acceptable tradeoff relative to their benefits for whatever stage of life you're at, but it's never possible to eliminate them completely. In attempting to do so, it's possible that you're hastening your path to the grave in other ways that are less obvious but equally significant. I made a conscious effort to try to push things harder than I might have otherwise when climbing and elsewhere over the past ten years so that I when the time came to scale back the risks, I'd have enough of skill, experience, confidence, competence etc to enjoy most of the same stuff with plenty of margin. Hopefully I've stacked the deck enough to tip the odds in my favor, but this and other accidents make it clear that there's an element of wishful thinking in that plan. While its clear that losing a parent in a preventable accident represents a staggering tragedy for a child, abandoning all of the joys and passions and challenges that make you who you are, and that they might derive a lifetime's worth of joy and memories from sharing with you also has a certain cost for both parent and child. Seems like most folks find a way to stay alive for their kids without killing big parts of themselves in the process.

Medved: Caller: Medved: Right. So you can just switch plans if you don't like it! That is, unless you are: -old -sick -have a family history of illness -have ever been sick before etc. Better to have some insurance industry goon bending me over than a government bogeyman The second point he makes is even more obvious. I definitely feel better knowing that if my insurance sucks, I have the option of just paying for, say, heart bypass surgery out of my own pocket! Thank god I have the option of shelling out that extra 150,000 I had laying around for a rainy day, I mean that's why you save money, right? Just in case? Yep, the best product they can afford, beautiful system- to each according to his wallet. Just like, you don't get to buy that BMW until you make enough money, in this case, you don't get the good treatment until you work for it. If you make less than $40K a year, at least you have the freedom to buy a plan that will help delay your bankruptcy for a year or two in the event you get sick or have multiple injuries. That is, if they decide to cover it. And just bask in the freedom to switch to an equally expensive plan of a competitor that will offer equally incomplete coverage for you, AND your family! Best of all, you don't HAVE to support these insurance companies if you don't WANT to! If that doesn't sound good, then maybe you just need to work harder! Is it really true that all insurance plans offer equal value for money? That there's no way to expand the number of options that people have nor the ease of changing from one plan to the next other than via the government creating a health insurance company that they own and operate? Or that this is the only conceivable mechanism for providing coverage to folks that can't currently get it? Sufficient - perhaps. Necessary? I'm not so sure. That it represents the optimal mechanism for doing so is even less clear. I lived right next door to a hospital in NZ from October through March, and conversations about who got treated for what and how were a staple of daily conversation. This doesn't make me an authority, but it's not like I'm speaking from a position of complete ignorance when it comes to the merits of one system versus the next. Different people will take away different lessons from hearing the details of a gazillion different cases in a single-payer environment vs the environment we have here, but my observation was that if you have an accident or illness that mostly requires labor-inputs to fix, and the diagnosis/treatment are obvious - the system over there will be pretty good at taking care of you. If you have extreme trauma - all things being equal, you'd be more likely to survive the experience in the US. If you have a chronic condition that requires expensive diagnostic tests or treatments, especially imaging or expensive drugs, and/or your disease has some subtle manifestations and/or requires seeing a specialist - I think you're quite a bit more likely to suffer more and die sooner than you would here. If you have a premature/sick fetus/baby - my sense that it's less likely to survive in NZ than it is here, particularly if you're located a long way from Auckland. It didn't look like prevention was a particular strength of their medical system either, given the regularity with which advanced pathologies that showed up in the ER. Also not a terribly good place to be if you're over a certain age and have a condition that'd be particularly costly to treat - although New Zealanders did seem to be considerably more stoic and philosophical about calling it quits than we are. Also on the plus side - everyone was covered. I don't mean to understate the significance of that. Just to suggest that, at least from my perspective, it wasn't free from some fairly substantial tradeoffs that came along with the particular mode of providing that coverage via single-payer/provider model. Part of that stems from the fact that if forced to chose I'd rather be broke than dead, but I realize that not everyone shares that opinion.

The fear is that what is being tabled is a "trojan horse"... Oh I see, so all the arguments about how these proposals are going to take away people's freedom and all that is based on a hypothetical fear rather than the legislation that's actually being proposed? Now I get it. Wow...Great stuff...God, this country is stupid. Being the rational guy that I am, I'll convert to an employer sponsored plan to capture the tax subsidy that I'm not currently entitled to as an individual paying premiums out of pocket. Given that unless I open my own business, my total compensation will be a combination of money-wages + benefits, I have an interest in maximizing the benefits of health insurance while minimizing the costs. If all employers have to satisfy federal guidelines for the plans they offer in five year, per the current legislation, there's a very real risk that I'll be forced to fork over quite a bit more money for a plan that's been distorted by an infinite number of lobbying groups that secured special favors from the government. That could be the unions that are currently trying to keep Safeway style prevention incentives out of health insurance plans, or the Unified Confederation of Boutique Fertility Clinics that want 84 year old monks forced into carrying insurance that covers what they're selling. Either way, that's going to translate into higher premiums and and lower cash wages - so I do have that at stake. I also suspect that in the hunt for revenue to fund whatever plan they've proposed, on top of the general hostility that most advocates of single-payer and/or public-option plans have to catastrophic/HSA plans - they'll be legislated out of existence. Massachusetts imposed a $2,000/$4,000 cap on out of pocket expenses for plans that can be sold there. Couple that with a laundry list of other mandates and you've got one of the most expensive insurance markets in the nation with no mechanism for containing premiums other than price controls. You can use price controls to hold down nominal prices, but not the actual costs, and when the prices no longer cover the costs of bringing forward the goods and services that go into providing care - the inevitable result is shortages, since there's no longer a mechanism for coordinating supply with demand. In MA, one consequence of the reforms is that more people have insurance, which is great. Unfortunately - there weren't enough primary care physicians in the state to begin with, thanks largely to Medicare's RBRVS price fixing scheme and whatever other factors make MA a crappy place to be a PCP - and now it's next to impossible to get a PCP if you don't already have one. As in, "even some tenured medical professors at Brigham and Women's hospital can't get a PCP" hard. End result - it's much harder to get a timely appointment if you're feeling sick, even if you can get a doctor - and guess what happens to ER volumes when people can't wait six weeks to see their family doc? They've moved in a particular direction, and it hasn't been down. Lower costs and better care? Actually, no - and heaven help the folks that depend on Boston Medical Center for their care, since that hospital has about two years before financial collapse under the new MA plan. Given that large elements of the MA plan seem to have served a template for the plan the democrats are putting forward, there's plenty to be concerned about even if I can still buy catastrophic coverage for the foreseeable future...

[video:youtube]hVimVzgtD6w

"Flyboys" was a pretty good read. Covers the rise of Japanese millitarism, the war in the Pacific in general, and what happened to a handful of naval aviators that the Japanese captured late in the war, and the considerations and key characters involved in the decision to use fire-and-nuclear bombing on Japanese population centers. The author clearly made an effort to be impartial in his treatment of Japanese/American conduct and motives, and whether you find this treatment laudable or objectionable will probably be conditioned by the perspective that you bring to the book. Plus you'll probably always be able to blurt out "Curtis LeMay" whenever certain questions come up in trivia games.