Map of life expectancy at birth from Global Education Project.

Monday, October 16, 2017

Death Panels


One of our medical students, Vishal Khetpal, has a column in Slate about the "R" word, that is "rationing" of health care. He says we need to do it.

If you've been viewing this space for many years, you know that I used to talk about this quite a lot. One of the most popular tropes of right-wing opponents of government-provided health care, whether we're talking single payer or kludgier methods, is that it will mean "rationing." The horror! The horror!

That was of course supposed to be the single most evilest thing about the Affordable Care Act, that it included death panels that would supposedly decide who would get the privilege of meeting Jesus in the sky. Obviously, it doesn't have any such provision. Nor does it have any rationing, however conceived or implemented. On the contrary, prior to the ACA most policies had lifetime dollar limits. But now they don't. To quote health benefits consultant Ryan Seimers:

On the eve of the ACA, most plans still had a lifetime dollar limit . . . often at $1 million or $2 million. The actual occurrence of a $1 million claimant was very rare. [But now] "No longer did hospitals have to "tap the brakes" as costly care approached $1 million. Specialty drug developers (and their investors) were provided a limitless runway to fund therapies . . . potentially costing $100,00s per year.
He cites surveys showing various insurers facing increases in claims above $1 million of three times or more. You might want to read the whole slideshow to understand the issue.

So there were all sorts of rationing before the ACA -- including annual and lifetime limits. And of course, denial of insurance entirely to people who would likely be expensive. And limited benefit packages -- no vision, no dental, no behavioral health, that sort of thing. There wasn't a group of people in black robes sitting around a table deciding that Pemberton P. Throckmorton of Nutley, New Jersey, must be denied medical treatment. But there were plenty of reasons why Pemberton might be shit out of luck.

The fact is, we condemn people to death in this country every day because they can't afford medical care. The difference now is that thanks to the ACA, we do it to fewer of them. And if we had universal, comprehensive single payer national health care, we'd do it to even fewer.

But -- and this is the part that people have trouble with -- it would be a bit more obvious when it did happen. And it would have to happen. Resources are finite. It is always possible to find ways to spend more money to give desperately sick people a small chance at extending their very unpleasant life by a few days. And there are other demands on society's resources, including investing in improving population health and reducing the prevalence of disease. Health care could easily devour the economy if we let it.

So no, we don't need any panels to rule specifically on the individual fate of Pemberton Throckmorton. But we do need to decide that there are some treatments that just aren't worth the cost. If you're as rich as the Koch brothers, you can still pay for them yourself if you want to, but as a taxpayer, you need to set limits. That's just the way the world works. But as long as we're doing it -- and we are, right now, today -- we should find ways of doing it more fairly and transparently.

Friday, October 13, 2017

The Base

There is a great deal I can say about the recent executive orders regarding health insurance, but let's start with this from David Anderson (formerly known as "Richard Mayhew" on Balloon Juice.)

The executive orders basically do three things:

  • Eliminate the cost sharing reduction payments to insurers, which subsidize premiums for low-income individuals
  • Allow people to buy insurance through "associations," which does not meet the minimum benefit standards of the ACA
  • Allow people to buy so-called "limited duration plans" for up to a full year. These also offer limited benefits and can exclude people with pre-existing conditions
There are two basic effects from this. First, it will enable people who are relatively young and healthy to evade buying insurance with the minimum benefit standards. Over time this will have the effect of segregating lower-cost and higher-cost people into separate risk pools. That, along with elimination of the cost-sharing subsidies, will drive up premiums on the ACA exchanges.

Funny thing though -- people with incomes below about $48,000, or families below $98,000, are eligible to receive subsidies for buying ACA policies on the exchanges, and the subsidies are based on cost. So their subsidies will go up along with the rising premiums, and their insurance will remain affordable. The subsidies, of course, come out of tax dollars and so this will increase the federal deficit. However, people with incomes above those amounts do not receive subsidies -- they will bear the full brunt of the premium increases.

By the way, contrary to conventional wisdom, that's where the Trump voters are. Funny thing about that.

The only reason for doing this, of course, is to try to wreck the ACA, since it was stubbornly refusing to wreck itself. In other words, the purpose is to screw people out of spite.

And you don't have to take it from me. Well known Communist Chuck Todd and friends say that these moves, along with other efforts to sabotage the exchanges:

[M]ake a strong case that the Trump administration is deliberately trying to break Obamacare. After all, if fewer people enroll in the marketplaces, premiums will go up and fewer insurers will participate.“Cutting health care subsidies will mean more uninsured in my district. @POTUS promised more access, affordable coverage. This does opposite,” Rep. Illeana Ros-Lehtinen, R-Fla., tweeted last night in response to the Trump administration’s subsidy announcement. Trump himself seemed to suggest that he was ending this subsidy to force Democrats to negotiate (which they’re ALREADY doing, given the ongoing negotiations between Sens. Patty Murray, D-Wash., and Lamar Alexander, R-Tenn.)
So even if you don't think the ACA is the greatest, why deliberately make things worse? Maybe because you're a psychopath.

Monday, October 09, 2017

Flat Earth Society

I'm at a conference in Baltimore, specifically the International Conference on Communication in Healthcare. I might have something to say about the conference at some point, but today I'm going to talk about, well, today.

I actually got here yesterday. I drove, because by the time I drive an hour to the airport and pay for parking there, and a cab from BWI to here, and the time and money involved, it was just easier. I made excellent time until I got off the highway and onto the Baltimore streets, after which it took me an hour to get to my hotel which was ordinarily only ten blocks away from the Interstate.

I had no idea why the streets were blocked and the whole city gridlocked, until I saw the leading edge of what turned out to be a parade in honor of Columbus day. For this they must have paid a quarter million dollars in police overtime and probably more than that in lost business and truck idling time, to send a parade right down the main street in the heart of the city, blocking all the cross streets long the route as well, and by the way nobody, and I do mean nobody, was watching this stupid parade which consisted of old guys in medieval Italian attire carrying banners and a couple of high school bands.

In case you didn't already know, the story they told you in school was completely false. People in 1492 did not believe the earth was flat. Every sailor knew perfectly well that it was spherical. (Okay, it's only approximately spherical in reality but that's beside the point.) The ancient Greeks knew that and they also knew how big it is. The reason people didn't try to sail west from Europe to China is because they knew that if they tried it, they would run out of provisions and starve long before they got there. Columbus, however, believed that the earth was only 16,000 miles in circumference.

He was of course wrong, and he would indeed have starved to death had he not accidentally run into a continent Europeans didn't know about. (Actually the Scandinavians knew of the existence of what is now eastern Canada but they didn't know the extent of the land mass.)

What followed upon the fortunate blunder of luck fool Christopher Columbus was genocide, expropriation, and slavery. Making me sit in traffic for an hour to celebrate this evil idiot caused a big change in my opinion of Baltimore.

Thursday, October 05, 2017

Motive

People, including the Las Vegas sheriff and reporters are all obsessing over discovering Stephen Paddock's motive for mass murder. That's actually a very easy question.

He was fucking nuts.

In case you don't want to take my word for it here's neurobiologist David Eagleman explaining the possibilities. Just to summarize, Paddock wasn't schizophrenic -- that has onset typically before age 25, and he clearly was fully functional his whole life. And while it's conceivable he had some psychopathic tendencies, there isn't really any evidence of that. He wasn't the most sociable guy but he seemed generally well behaved. And even if he did have a lack of empathy that would not affirmatively motivate his actions.

The likely possibilities are a brain tumor - as Texas Tower sniper Charles Whitman was found to have on autopsy -- or frontotemporal dementia. Unlike Eagleman, I'm leaning against FTD, because Paddock didn't seem to have any noticeable impairment other than the selection of a highly abnormal purpose in life. Usually signs of FTD include such symptoms as aphasia or cognitive impairment along with personality changes. But a tumor would work.

The reason I bring this up is simply to clarify that this incident had nothing whatsoever to do with anything about the culture. It was not the result of the decline of morality, or community. It did not result from atheism or religion, liberalism or conservatism, the abandonment of traditional values, multiculturalism, or any other cause you happen to dislike. It happened because the human cerebral cortex, which we tend to take for granted because we all have one and in fact it is the very essence of what we are, is an awesomely capable machine that can also go haywire. Set it to work on the wrong objectives and you get Las Vegas, or the Holocaust.

Paddock's actions could not have been prevented by a better mental health system, because he was never ascertained as mentally ill and he never sought treatment. They would not have been prevented by him finding God, or joining a bowling league, or Making America Great Again. The only way to prevent this catastrophe would have been to make it much more difficult for him to obtain a massive arsenal of weapons of war, that have no conceivable purpose other than killing people. A registration system that alerted authorities to a guy acquiring 30 or more assault rifles, high capacity magazines, and thousands of rounds of ammunition might have been helpful. Outlawing the manufacture, import and sale of all that crap would have helped as well.

That's why this kind of thing only happens in America. By the way, owning guns does not make you more safe, it makes you less safe. Gun owners are more likely to be shot than non-gun owners, and much more likely to kill themselves. And the successful use of firearms by law abiding citizens in self-defense is vanishingly rare. You don't have to take it from me.

Monday, October 02, 2017

Terrorism

Here's the breakdown of mass shootings in the U.S. since 1982, by the race/ethnicity of the perpetrator. (I came across this in the discussion by Jen Hayden at Daily Kos, which also features tweets by Nelba Márquez-Greene whose daughter was murdered at Sandy Hook elementary school.)

So yes, the majority of mass shooters in the U.S. are white men, and very few of them are Middle Eastern terrorists. Many bloggers, such as Duncan Black, are complaining that it isn't called terrorism if white people do it. The justification you will get from the corporate media is that the word "terrorism" implies a political motive, and most of these rage killers don't have one. In other words it's not the race of the shooter, it's the reason.

Now, if you want to use the word that way, you can. As of now there is no evidence of a political motive behind the massacre in Las Vegas. This is looking like a brain tumor to me. That might change of course. But in the meantime the issue is that being worried about politically motivated terrorism, whether or not you think that includes right wing extremists and white supremacists as well as Muslims, while not being nearly as concerned about non-political violence, is irrational. People who commit mass murder of random people out of some ostensible political motive are just a particular kind of nut. They embody their rage and alienation in a political ideology but what difference does that make? The people in Las Vegas are equally dead and injured no matter what was going on in the shooter's head.

The reason why this happens in the U.S. and not so much in other places is that our country is full of firearms. In this case, clearly the shooter used an automatic rifle, probably the equivalent of an AK-47 or an M-16. It is legal to own these in the U.S. if they were first sold before 1986. They have to be registered and most of them are at specially licensed gun ranges, though private citizens can keep them in their houses. There are about 390,000 such legal weapons in the country. But it is actually very easy to convert a semi-automatic weapon to be fully automatic. So there are an unknown number of illegal automatic rifles in the U.S., and Stephen Paddock had at least one.

Update: As we all know by now, he had a dozen semi-automatic rifles that had been modified to shoot rapid-fire like an automatic rifle using a device which is perfectly legal. So it's even worse than I thought.

This could be fixed by legislation that outlaws semi-automatic assault rifles and large capacity magazines. (Based on the sound of the gunfire, which I heard on NPR, Paddock had 30-round magazines.) Instead, congress is getting ready to repeal the ban on gun silencers, because they are obviously essential to recreational shooting and self-defense.

We are insane.

Friday, September 29, 2017

Herbert L. Needleman

I just learned, via BMJ, that Herbert Needleman died on July 17. Here is a remembrance from Dr. Richard Jackson. Needleman discovered that even low level exposure to lead, below the threshold of any immediately observable symptoms, damages the developing brains of children.

At the time, exposure to lead was pervasive. Lead was in house paint and gasoline. While few children could escape its effects, the likelihood of substantial exposure was higher in children who lived near highways and heavily trafficked areas, and in sub-standard housing with deteriorating paint. In other words, poor children.

So he was a hero, right?

No, he became a pariah. He was attacked by the lead industry, hounded by columnists, snooped after by hired investigators, had his files endlessly combed over by high priced consultants, and was indifferently supported by many of his colleagues at his university. Herb and his steadfast wife Roberta went through years of attack.
Just like the tobacco industry and the fossil fuel industry, industries responsible for poisoning children with lead spent vast sums to relentlessly deny the science and persecute the scientists. This is profoundly evil.

Anyway, Needleman was ultimately vindicated and lead is now banned from fuel and paint, and other possible sources of exposure such as pottery glaze. The fake controversy over the dangers of tobacco is behind us although, sadly, the mass poisoning of populations all over the world by tobacco is not. It is long past time for people to stop pretending there is any legitimate controversy over anthropogenic climate change.

Thursday, September 28, 2017

Economics 101

Bruce Bartlett is not exactly Leon Trotsky. He was a senior policy advisor to Saint Ronald Reagan, and an architect of Reagan's famous tax cut. Bartlett states clearly and simply what economists now know to be true, at least those who try to practice an empirical science rather than a branch of theology.

In reality, there’s no evidence that a tax cut now would spur growth. . . . Strenuous efforts by economists to find any growth effect from the 1986 act have failed to find much. The most thorough analysis, by economists Alan Auerbach and Joel Slemrod, found only a shifting of income due to tax reform, no growth effects: “The aggregate values of labor supply and saving apparently responded very little,” they concluded. . . . We saw another test of the Republican tax myth in 2013, after President Barack Obama allowed some of the Bush tax cuts to expire, raising the top income tax rate to its current 39.6 percent from 35 percent. The economy grew nicely afterward and the stock market has boomed — up around 10,000 points over the past five years.
One class of people who haven't gotten the message is journalists who work for the corporate media. When Republicans say that cutting rich people's taxes will cause economic growth, they just take it for granted. This has become a truism in American political discourse, like, oh, saluting the flag. It is not true.

Marginal tax rates are much higher in most of Europe than in the U.S., and their economies grow just as fast, or faster, than ours. Cutting rich people's taxes does not cause capitalists to create jobs or raise wages. It just let's them keep more of their money and starves government of money it needs to solve problems and invest in our future.

The reason for this I have explained before. Investors only start enterprises or build up existing ones when there are potential customers out there with the money to buy their crap. And that is not rich people, who already spend all they want to. The way to stimulate growth is to put money in the pockets of low and moderate income people who will spend it, and the best way to do that is to invest in projects that will put them to work, such as health care, education, renewable energy development, research and public infrastructure. Mass transit is a good one! In times of recession, government can borrow the money. Right now, borrowing is cheap, but rich people also have far more money than they can possibly use and we can raise their taxes and put the money to work, thereby employing people and raising their wages. We could also cut taxes on low and moderate income people and yes, they would spend most of the difference.

Somebody please explain this to Chuck Todd.

Tuesday, September 26, 2017

What we have here is a failure to communicate

Even today, two days after the Sunday NFL games, the lead story everywhere seems to be the argument over the national anthem protests. The ostensible president made this the main focus of his communication with the public even as a U.S. territory of 3 1/2 million people descends into mass starvation. (Just for example, there is no running water in any hospital in Puerto Rico right now.)

The Twitter-in-Chief has apparently not miscalculated -- by most accounts, not only his fans but a majority of people disapprove of the protests, strongly enough to weaken their allegiance to their beloved teams.

Tyler Cowen offers some perspective on the anthem and sporting events. The practice of playing the anthem before every game started in World War II, then it just continued after the war was over. It's worth asking what playing the anthem and saluting the flag has to do with playing games in the first place. But, since we're stuck with it, let's remember that freedom of political speech is a fundamental value that the flag is supposed to represent, and that people have every right to interpret or reinterpret the ritual as they choose.

The players who kneel, or lock arms, or choose not to be on the field at all during the ritual are not "disrespecting the flag," they are invoking its purported meaning as a symbol of justice and equality. And even if you think they are "disrespecting" it, it is a piece of colored fabric. We don't worship graven images. A popular meme right now, in case you didn't know, is an American flag rendered in blue and white. It's supposed to represent support for the police -- or  perhaps support for their right to murder black people with impunity. Is that "disrespect" for the flag? What if I say it is?

Let's just get over this and start worrying about reality, not symbols.

Monday, September 25, 2017

Priorities

I'll outsource to Mark Sumner the necessary rant about the abandonment of Puerto Rico. The extent of the catastrophe is almost unimaginable. Nearly all of the crops have been destroyed, the entire island is without electricity except for a few generators powering hospitals and other essential services. Telecommunication is mostly down and much of the island is still incommunicado. Overflights have revealed washed out and blocked roads so that travel to many places is impossible. There can be no doubt but that people dependent on oxygen, insulin or other technical resources to stay alive have already died. It won't be long before people are literally starving.

It hasn't been so long ago that you can't remember that non-stop, wall-to-wall coverage of the disaster in Southeast Texas, and Florida. So what is on the front page of all of the corporate media web sites right now? The twitter war between Orange Julius and the NFL. Almost nothing about Puerto Rico. And Twittler himself, by the way, has said nothing about it either. Not one word.

And where is the massive response from the navy, air force and coast guard? Where is the televised fundraising concert featuring all the big pop stars? This is crazy.

Update: Case in point, on the front page of the NYT today there is absolutely no mention of Puerto Rico. Headlines are travel ban, NFL protests and attendant tweetstorm, German elections, budget bus lines.

Yes, some relief has arrived but it is not nearly enough. We're talking about 3 million people who are without food, safe drinking water, or medicine. Unbelievable.

Thursday, September 21, 2017

Oh, oh, Mexico

Unlike James Taylor, I have really been so I do really know.

As with most natural disasters, the disaster part of earthquakes is only partly natural. Apart from tsunamis, earthquakes per se aren't even very dangerous. If you were standing in an open field and experienced the most intense earthquake in history you'd just feel the ground shaking, be weirded out for thirty seconds, and then get on with your business. (Perhaps you would stop to make a sacrifice to the gods.) There's always the chance of a landslide or flooding from a displaced body of water but these are pretty rare.

What kills and injures people in earthquakes, for the most part, is architecture. In California, building codes have gotten more and more stringent over the years as tragic experience has pierced through denial. As the building stock has been replaced and upgraded, the death toll from earthquakes has gone down.

Of course making buildings and viaducts earthquake proof is more expensive, and more expensive is a harder sell in a poorer place. Mexico uses a lot of masonry construction, and a lot of the most dangerous kind, which is unframed masonry. The New York Times has a video of the scene at the collapsed Enrique Rebsámen elementary school and sure enough, you can see that it was an unframed masonry building. It consisted of concrete slabs resting on concrete pillars. There is no sign of any steel framing. This is a heart rending tragedy -- at least 40 children are known dead and there be many more.

But you will notice that the other buildings around it did not collapse. Whether the current operators of the school understood the construction or the danger I have no idea. But somebody built it, presumably as a school, and the authorities allowed it to be built and occupied. So no, this is not a natural disaster. We know that earthquakes will occur there, they do so regularly. But the consequences can be mitigated, if there is political will, and no corruption. I don't know how old the building was, whether it was non-compliant with codes when it was built, or anything more about this story than what I could see in the video. But I hope people in Mexico and beyond will learn from this.

BTW there have been similar tragedies in China where school buildings in earthquake prone areas were shoddily constructed. I hope the Chinese are taking this seriously as well.

Update: According to NPR, three quarters of the school, which was built some 40 years ago, remained intact. The part that collapsed was ten years old, built after the last earthquake. Mexico City has stringent building standards, but the problem is enforcement. Evidently the death of all those children was indeed a crime. Let's hope the perpetrators are brought to justice.

Wednesday, September 20, 2017

La Isla del Encanto


I worked for 15 years at Latino Health Institute in Boston. About half of my colleagues there were Puerto Rican. I have visited the island, and a college girl friend (it's a painful subject, but still) was Puerto Rican. So I feel an affinity for the island and its people.

I fear they are suffering a catastrophe from which they will never really recover. The country was already in trouble, due to a combination of policy changes by the U.S. federal government (into which they have no real input) that eliminated some advantages for manufacturers on the island; competition from lower-wage countries; and fiscal mismanagement, mostly by local governments. The population was actually shrinking as people moved to the mainland.

Now the infrastructure and the economy will be utterly ruined. It will likely be months before electricity is fully restored, and perhaps it will never be in some places because they will become uninhabited. The housing stock, businesses, roads and bridges, all massively destroyed. I expect a mass exodus now. It will likely never be the same.

The warming waters of the tropical Atlantic cause hurricanes to be more powerful. The horrific destruction in the Caribbean this year was absolutely exacerbated by climate change. Another place that's getting trashed is Kenya, where the rains have failed three years in a row and children are now starving. The UN report on the situation is horrifying, but nobody here in the US seems to care. We're all too busy taking health care away from 32 million of our own people so that the Koch brothers won't have to pay taxes on their blood money.

Cue the fool to tell us none of this is really happening.


Tuesday, September 19, 2017

Not subject to debate

Here is a partial list of entities and people who accept that human activity is causing dangerous changes in the earth's climate.

  • 195 sovereign nations (participants in the Intergovernmental Panel on Climate Change). That is every country on earth including the Democratic People's Republic of Korea. It also includes countries whose economies are heavily dependent on fossil fuel extraction, such as Saudi Arabia and Qatar. The Saudis are planning to leave much of their oil in the ground. 
  • Exxon Mobil Corporation (although they lied about it for decades)
  • Former Exxon CEO and current U.S. Secretary of State Rex Tillerson
  • Virtually every scientist who works in a relevant field. (The commonly cited figure is actually 97% but the work of the 3% has been discredited.)
The only major political party on the earth that does not accept this reality is the Republican party in the U.S.  Conservative parties everywhere else do accept it.

How do we know this is true? Actually, scientists have understood since the late 19th Century that the lower atmosphere is as warm as it is because of the presence of carbon dioxide. Arrhenius published this conclusion in 1896, and he later noted that burning fossil fuel would increase the CO2 in the atmosphere, presumably warming the climate. This is completely understood and it is quite straightforward. The atmosphere is largely transparent to visible and UV light. The sun's light warms the ground which then radiates heat back as infrared, to which CO2 is opaque. The CO2 absorbs the light and gets warmer, and it transfers this warmth to the other gases in the atmosphere. That's what keeps the earth warm. More CO2=more warmth. There is no doubt of this whatsoever.

Since reliable records started being kept in the 1880s, the atmosphere has warmed by about 2 degrees Fahrenheit, while the amount of CO2 in the atmosphere has increased by 43%. This is entirely consistent with model predictions. The extra CO2 is coming from humans burning fossil fuel, which is confirmed by radioactivity analysis, and also because there is no other plausible source for it. The warming is accounted for entirely by human activity. Yes, the climate has changed in the past, but over geologic time scales of thousands of years. This very abrupt change is unprecedented, as far as we know.

Most of the excess heat has been absorbed by the ocean, or the atmosphere would already be warmer. Coral reefs are dying and, as you may have noticed, storms are getting stronger. Warmer oceans make stronger hurricanes, and warmer air holds more water vapor so that rain events are more intense. At the same time, warmer places dry out faster, exacerbating the effects of droughts. And as global rainfall patterns change, some areas are becoming drier anyway. The result has been famine, and civil unrest. The collapse of Syria began with the migration of starving farmers to the cities and attendant social stresses. Agriculture has also collapsed in parts of Africa.

Sea level is now rising at a rate of about 1 foot per century, but it appears to be accelerating. Coastal areas are already experiencing more flooding, even in fair weather, just from the tides, and it's just going to get worse.

The only reason sane people deny this is because they are blinded by ideology. The Free Market™ can do no wrong. If this is really happening, we need to tax fossil fuels or otherwise find ways to reduce their use through regulation. But that can't possibly be necessary because Ayn Rand said so. Other people, such as the Koch brothers, deny it out of insatiable greed, even though they probably know that it is actually true. And some people are just easily fooled by propaganda. The tobacco companies did the same thing when it came to smoking and lung cancer, and they were just as evil.

I will not tolerate denial of anthropogenic climate change here, just as I will not tolerate holocaust denial or for that matter, a claim that the earth is flat and the sun revolves around it. This is not a matter that is open to dissent, or disagreement, or debate. It is a fact. People who refuse to believe it are not worthy of my time or attention.

P.S. If you don't want me to call you a moron, don't be a moron.


Monday, September 18, 2017

Homeland Security


Michael T. Klare makes a point about climate change that hasn't occurred to most people. While the Resident has stacked his administration from top to bottom with climate change deniers, the one federal department that still accepts reality is the military. And the military is tasked with responding to the consequences. In fact, as Klare describes, the response to hurricanes Harvey and Irma was the equivalent of a war. For example:

The military’s response to Harvey began with front-line troops: the National Guard, the U.S. Coast Guard, and units of the U.S. Northern Command (USNORTHCOM), the joint-service force responsible for homeland defense.  Texas Governor Greg Abbott mobilized the entire Texas National Guard, about 10,000 strong, and guard contingents were deployed from other states as well.  The Texas Guard came equipped with its own complement of helicopters, Humvees, and other all-terrain vehicles; the Coast Guard supplied 46 helicopters and dozens of shallow-water vessels, while USNORTHCOM provided 87 helicopters, four C-130 Hercules cargo aircraft, and 100 high-water vehicles.
Still more aircraft were provided by the Air Force, including seven C-17 cargo planes and, in a highly unusual move, an E-3A Sentry airborne warning and control system, or AWACS.  This super-sophisticated aircraft was originally designed to oversee air combat operations in Europe in the event of an all-out war with the Soviet Union.  Instead, this particular AWACS conducted air traffic control and surveillance around Houston, gathering data on flooded areas, and providing “situational awareness” to military units involved in the relief operation.
The navy also deployed an amphibious assault ship and a dock landing ship. The response to Irma was comparable but also included deployment of an aircraft carrier, a destroyer, and two additional amphibious  assault ships. Now hurricane Maria is going to re-destroy the Virgin Islands, followed by massive destruction Puerto Rico and who knows what after that. All this is going on while the U.S. military is engaged in war in Afghanistan, Iraq and Syria, and active maneuvers in the western Pacific. Climate change is likely to increase pressure on the military around the globe as well as at home, as climate disasters exacerbate conflicts and produce refugee crises, but the over-extended navy is becoming a nautical demolition derby.

I have plenty of reasons to despise the malignant clown in the oval office, but climate change denial is probably number one. The consequences are already here -- it's like passing a law repealing gravity. And it's terrifying.


Thursday, September 14, 2017

BernieCare

The details of the Bernie Sanders Medicare for All proposal aren't really important, because obviously it isn't going to become law. If you're interested there is an accessible discussion here.

It is interesting that he's rounded up 16 senatorial cosponsors. At least we're finally talking about -- yep -- universal, comprehensive, single payer national health care. The term "comprehensive" does apply, because this actually goes beyond existing Medicare to provide dental and vision coverage, and he also appears to envision lower out of pocket costs. Also, Medicare would negotiate drug prices. Long term care would still be handed off to something unspecified, which would presumptively be the existing Medicaid long-term care benefit, which requires that people impoverish themselves. We can debate that issue separately.

While at least talking about this is a necessary step, there are many reasons why it seems unlikely to happen any time soon. Here are some of the main bullets.
  • Names will never hurt me? I'm afraid they will. It's socialism! Well, maybe so, you can apply the term to it if you want to. Sure, that makes Canada and Norway totalitarian dungeons, which is not what the people who live there seem to think, but the word has power in this country. It's a government takeover of health care! No, not really, it's a government takeover of health insurance. But still, the rhetoric will fly about bureaucrats sitting between you and your doctor, just as it did with the Affordable Care Act. The largest tax increase in history! Probably so, but the taxes replace the money you're already paying for health insurance and out of pocket costs. In fact most people would save money, and for that matter, so would most employers. Which makes one wonder why big corporations aren't for it. As a matter of fact, many of them used to be. Lee Iacocca, when he ran Chrysler, favored single payer health care, arguing that having to pay for employee's health insurance put U.S. companies at a competitive disadvantage with their counterparts in more civilized nations. But it's contrary to the ideology of current corporate executives, plus which their personal taxes would increase and their personal wealth is all they care about. The corporate media won't be of any help explaining all this.
  • Yes, it would largely put the health insurance companies out of business. They might have some residual role selling supplemental insurance for people who want to get their health care without having to mingle with the riff raff, maybe some long term care insurance, maybe there would still be something like the Medicare Advantage program which would give them a role as middlemen. But basically, Aetna is history. I'm not sure what you would do about this -- there is a fair argument that the federal government would need to buy them out at the market price before passage of the act. That adds to the cost. Also their employees would be out of work. Yes, it's unnecessary make work, but so is the army. These are big political problems.
  • Drug companies would see their profits reduced. That's a good thing, but obviously they have enormous lobbying arms and they give  lot of money to politicians. Same consideration as above may apply to their shareholders. Yes, there are always political risks in owning stocks but this is pretty radical.
  • Not clear what the American Medical Association will think. They have opposed single payer plans in the past because they don't trust the government not to squeeze their incomes. 
There are  other political obstacles but these seems like plenty enough to make this very unlikely. Do you see a plausible path to single payer health care in the U.S. any time soon?

Tuesday, September 12, 2017

23 and BS

If you are unfortunate enough to watch television, you have no doubt seen ads for a company that will analyze your DNA and tell you where your ancestors come from.

A sample ad consists of a woman saying, "I used to think I was Hispanic. But when I got my results back, I discovered that I'm everything! I have ancestors from all over the world." A pie chart displays behind her showing percentages of ancestry from various places. "Now I know I'm not Hispanic after all. When they ask my ethnicity, I check 'other'."

Whoa. Talk about people unclear on the concept. She is the very paradigm of Hispanic, which means people who come from the Spanish speaking countries of the Americas. The current population of Latin America consists of the descendants of indigenous Americans, Spanish settlers, imported African slaves in some places, Africans who escaped from slavery, and lesser numbers of settlers from all over the world. The George Washington of Chile was named Bernardo O'Higgins. Italians, Germans and Jews went to Argentina in large numbers, especially around the time of WWII. A key concept in Mexican nationalism is "la raza," the "new race" that emerged from the mingling of peoples. The point is they all wound up speaking Spanish and adopting the nationalities and cultures of the places where they found themselves.

Of course some people in Latin America have a narrower set of ancestors -- some are entirely indigenous, others European -- but mixed ancestry is pretty much the norm.

Equally bizarre, although perhaps less obviously so, is the guy (I might have this exactly backwards but it doesn't matter) who says "We always thought we were Italian. We ate spaghetti and sang Santa Lucia. But it turns out I'm German!" Now he's wearing leiderhosen and drinking Lowenbrau. Listen up, this is not complicated. Over the course of history, people sometimes moved from Germany to Italy. Once they did so, they started speaking Italian and eating spaghetti, and maybe changed their name from Braun to Bruno. After a couple of generations they forgot all about Germany. Then some of their descendants moved to the U.S. and considered themselves Italian-Americans. Which they were.

This company is selling a bizarre, fraudulent and frankly dangerous racialized concept of ethno-national identity. Our ethnic identity is not encoded in our genes, it is a product of our history -- the cultural milieu in which we grew up. And to believe otherwise is to buy into the scientifically bogus concept of race which has caused global catastrophe. So getting this DNA analysis may satisfy your idle curiosity, but beyond that, it doesn't mean anything at all.