Sapiens by Yuval Noah Harari - a brief review

I'm a fairly average sleeper for my age, but this morning I gave up a bit before 4am. With the unexpected time I finished Yuval Harari's 2015 book "Sapiens: A Brief History of Humankind". (The "finishing" part is a bit unusual, I too often lose interest 80% of the way through many books.)

Sapiens was, I've read, quite popular with the Silicon Valley set. So I was prepared to dislike it from the start. In truth, while I can see why the Captains of Industry were fans, it's not a bad book. I'd grade it as very good to excellent.

I didn't learn much new -- I have read many of the same things as Harari. I was reminded, though, of things I'd forgotten -- and he touched on many of my favorite themes. If I'd read this as a young person I might have found it astonishing.

What are the flaws? He has a weird definition of "The Liberal" and he really dislikes whatever he means by that. He has a thing about Hosni Mubarak -- a loathsome person, but an odd choice for chief villain. He is glib, but that's a necessity in a book like this.  The glibness is somewhat offset by his habit of critiquing his assumptions at the end of each chapter. He's weakest when he strays into the sciences, particularly biology. Since he wrote this book we’ve seen Trumpism, the rise of Xi, and the slow burn of the Left Behind — events that might cause reconsiderations.

I liked the repeated reminder that non-human animals have paid a terrible price for the rise of humanity. Most books of this kind don't consider them.

In a book of this sort one constantly tries to decipher the author's agenda. What does Harari truly think? He clearly admires Buddhism; I would be surprised if he were not a practitioner of the more intellectual forms of Buddhism. He has a love and admiration for capitalism that outshines his self-critique. On the current American spectrum of political ideology he'd be a techno-optimist libertarian to the right of Obama and me (his characterization of the British Empire is more than slightly incorrect.)

Most of the time the book affirmed my own beliefs and reminded me of things I'd forgotten. Sometimes it annoyed me, but in a way that forced me to examine my priors. It's aged well -- even if some of his 2014 near-future predictions look to be still a decade or two away. I recommend it.

Clark Goble 1967-2019

Clark and I had different opinions on the future of ISIS. This was years ago, when we conversed often on app.net/ADN. He under his own name, me, less boldly, using my John Gordon pseudonym. (Clark knew I was John Faughnan, we corresponded by email too.)

Clark was a slippery fellow in a debate so I suggested a wager based on the state of ISIS in a year or so. I forget what I wagered, but Clark offered to pay off in Amano artisan chocolate. His company’s chocolate that is.

Some time later, a bit prematurely I thought, Clark decided I was right and he shipped me a wonderful supply of some of the finest chocolate I’ve ever had. I tried to stretch out the supply but I’m bad with chocolate. I ate it too quickly.

I was in Clark’s debt after that. I thought I’d have a way to pay it back, but I didn’t expect that to be a donation to his posthumous gofundme account. He died 9/6/2019 of a ruptured cerebral aneurysm. He was 52yo, married, with five children.

My wife’s mother died the same way at the same age. I remember, from medical school days, a young woman dying suddenly the same way. It’s like being hit by lightning. Here one day, gone the next.

I never met Clark in person. We chatted for years on app.net, then continued on Twitter. We had some things in common. We both loved the outdoors - mountain biking and, in his case, mountaineering. We enjoyed science and especially physics — though he was the real thing and I am just a hobbyist. Both of us were happy fathers; Clark's youngest child was about a year old when he died. 

We were both born in Canada. We both liked travel, he wrote often of his mission work in Louisiana.

Politically and spiritually we were pretty different. Clark took his faith and Mormon theology seriously, I’m a functional atheist. Clark was a Western old school Republican, I’m an Obama-Democrat. Many of our discussions were on politics — he loved the ins and outs of democracy.

I miss Clark's voice. I’m sad I’ll never get to drop in for chocolate. I mourn for his family and all who loved him.

• David Clark Goble Obituary - Visitation & Funeral Information
• Remembering Clark Goble | Times & Seasons 
• Clark's Tech Blog | Trying to figure it all out a post at a time
• Clark and my last twitter conversation - Aug 27, 2019

Gordon's platform 2020

It is my privilege to announce that I will running for the Presidency of the United States of America.

I understand that, as a foreign born dual citizen of the United States and Canada I am technically not eligible for the Presidency. On the other hand, America elected Donald Trump. Compared to him I’m eminently qualified.

My Presidential Platform is achievable and focuses on our core challenges as a nation and wannabe world leader ...

1. Free community college. This was, I think, part of HRC’s platform. Didn’t get much media coverage but just makes sense. Unlike free college, which is dumb. Quebec basically does this and it has worked very well for them. A lot of health care workers can be trained in 3 years of community college.
2. Restore ACA, including the individual tax penalties for non-participation, with a public option that leverages experience from Canada and Veterans Health Administration. Incorporate broad support for physical activity (aka exercise) in health care system. Attack agricultural subsidies for unhealthy foods and subsidize healthy foods. Move the dial on obesity and lifestyle diseases.
3. Restore Obama’s carbon control framework, not including a carbon tax. I love the idea of a carbon tax, but I’ve seen my fellow citizens. Some costs are better buried.
4. Increase employment income of the non-college. Reduce taxation incentives that favor automation (it will happen anyway, but slower is better). Create plug-and-play packages for small businesses that employ non-college. Provide subsidies for training in skills accessible to non-college. Extend the framework used for disabled employment to subsidize and support non-college work including public sector employment. Subsidize minimum wage. Tax breaks to employers that promote employment. This will be a core pillar of my administration.
5. Strong antitrust; promote competition among corporations and consumer choice. May include breaking up several MegaCorp.
6. Transit, bikes, walkability, parks, attractive infrastructure. Make car ownership optional. Require new motor vehicles to incorporate technology that makes pedestrians and cyclists safer. Require autonomous vehicles to meet strict standards for safety of the non-armored.
7. Taxes. Of course. VAT. Restore the "death tax”. Various forms of wealth tax. Tax soda and the like. Fund my platform, start to beat back dysfunctional wealth concentration.
8. Attack political corruption, particularly post-political employment, at every level. Public funding for elections including mandated free media time.

There’s more, but you get the idea.

Vote for me. 

Whatever my name is.

All those "Democrats and white middle class" articles explained in four lines.

I’m going to translate the subtexts and signals of What’s Wrong With the Democrats? - The Atlantic into plain language:

1. Democrats should have disowned Black Livers Matter.
2. Democrats shouldn’t run a woman for the presidency.
3. Democrats should have lied more.
4. Democrats should have paid more attention to the economic collapse of the non-college (peak human, mass disability)

I agree with the fourth. I was worried about that before Trump took over. I don’t agree with #3, I think lying works a lot better on the GOP base than the Dem base.

Number one and two remind me of the Al Gore’s choice to embrace gun management measures. It was a progressive and brave act, but Americans showed they didn’t want it. Dems have not pushed it since.

I don’t think we’ll see a woman running for the presidency of the United States in the next ten years. Maybe 20 years. I was shocked that almost half of white college educated women voted for Trump. HRC was less excellent than Obama, but she was pretty good. Since white men are  hopeless the lack of support from white women was a killer.

I also think Dems will shy away from BLM like movements - at least for another decade. We won’t say that loudly, but watch what happens. American racism is stronger than many thought.

The are sad predictions. I hope I’m wrong, but I don’t have a lot of faith in post-Trump America. 

Now that we’ve got that out of the way, can journalists top writing these articles?

Investment things I learned in Crisis-T

All the money Trump will take from the poor and give to the rich has to go somewhere. So share prices should rise.

On the other hand, a 10% import tariff will lead to a global trade war. I’m particularly looking forward to the carbon tariffs an angry China applies to the US. So share prices should fall.

Corporate behemoths will increase monopoly and monopsony powers and fully leverage regulatory capture in an era where corruption exceeds living memory. So share prices should rise.

Trump will, WTF, resume underground nuclear testing or something like that. So share prices should fall…

Hey, I don’t know what the market is going to do. If I knew I’d hire people to manage the billions we don’t have. I do know the our equity investments have grown over the Obama years, I see some warning signs, and our portfolio is now equity-heavy. So it makes sense to rebalance. Crisis-T just means I made myself do it.

I chose to rebalance primarily in our retirement accounts, so the sales had no tax implications. I sold shares and parked the cash. In a few months, when we learn if the GOP Senate has a spine, we may sell more in our taxable accounts and shift the retirement back into equities. It’s probably not an orthodox way of proceeding, but it’s relatively easy to adjust.

Since I rarely mess with our investments (largely S&P, extended market, and whole market index funds — plus college 529 plans I don’t touch) I learned a few things. In no particular order …

1. If you sell shares in Vanguard’s ultra-cheap low overhead index funds you can’t buy back into the same fund until 30 days post-sale. So if you make it one big sale if the timing is good. Vanguard makes it easy to create a cash fund to hold sales within a particular account family.
2. Fidelity’s 401K accounts are completely different business from their HSA accounts which are unrelated to their … Oh. Heck. I don’t like Fidelity.
3. It takes a long time for these mutual fund orders to sell. They seem to sell at near market close the day after the order is placed — and the online accounts aren’t updated for a while. So you can’t do any of this under market pressure. I placed a sell order at 7pm on Thur, they were in process Friday, the web site was updated Sat pm.
4. If you’re not using a SEP IRA you might as well roll it into a regular IRA. You can always create a new SEP IRA in future.
5. Rollovers are complicated and slow. Even the Vanguard ‘concierge’ people seemed unsure about all the rules. You can borrow against 401K funds, but the investment options may be poor. You may be able to rollover a former employers 401K into a new employers 401K — but it’s all special cases. There may be a way to create an IRA account that a 401K can roll into and still be able to rollover into a 401K — but that’s just weird. Once you mix a 401K with IRA funds you can’t reverse it, it’s all IRA then. There’s a reason people spend money for tax lawyers.
6. Vanguard has a much better web site than Fidelity and Vanguard message responses are excellent.
7. Vanguard is in the midst of switching all their funds into a brokerage framework. I worry that it will increase costs but I’m naturally suspicious. I’d like to read something about why the change.

Fallows: "the most grievous blow that the American idea has suffered in my lifetime"

The Atlantic, Jan/Feb 2017

Despair and Hope in Trump’s America - James Fallows - The Atlantic

… I view Trump’s election as the most grievous blow that the American idea has suffered in my lifetime. The Kennedy and King assassinations and the 9/11 attacks were crimes and tragedies. The wars in Vietnam and Iraq were disastrous mistakes. But the country recovered. For a democratic process to elevate a man expressing total disregard for democratic norms and institutions is worse. The American republic is based on rules but has always depended for its survival on norms—standards of behavior, conduct toward fellow citizens and especially critics and opponents that is decent beyond what the letter of the law dictates. Trump disdains them all.

Fallows seems to think Facebook-empowered Russian led infowar was quite powerful.

TNC has an eulogy for the Obama era in the same issue. Grief.

Excerpts from Remnick's recent Obama interview

Read it …

Obama Reckons with a Trump Presidency - David Remnick - The New Yorker Nov 28, 2016 issue

… I’m half Scotch-Irish, man!” he said. “When folks like Jim Webb write about Scotch-Irish stock in West Virginia and Kansas and so on, those are my people! They don’t know it, always, but they are.”..

… The official line at the White House was that the hour-and-a-half meeting with Trump went well and that Trump was solicitous. Later, when I asked Obama how things had really gone, he smiled thinly and said, “I think I can’t characterize it without . . . ” Then he stopped himself and said that he would tell me, “at some point over a beer—off the record.”

… So it is a mistake that I think people have sometimes made to think that I’m just constantly biting my tongue and there’s this sort of roiling anger underneath the calm Hawaiian exterior. I’m not that good of an actor. I was born to a white mother, raised by a white mom and grandparents who loved me deeply. I’ve had extraordinarily close relationships with friends that have lasted decades. I was elected twice by the majority of the American people. Every day, I interact with people of good will everywhere.”…

…I think now I have some responsibility to at least offer my counsel to those who will continue to be elected officials about how the D.N.C. can help rebuild, how state parties and progressive organizations can work together…

… But at some point, when the problem is not just Uber but driverless Uber, when radiologists are losing their jobs to A.I., then we’re going to have to figure out how do we maintain a cohesive society and a cohesive democracy in which productivity and wealth generation are not automatically linked to how many hours you put in, where the links between production and distribution are broken, in some sense…

and "You don’t start worrying about apocalypse. You say, O.K., where are the places where I can push to keep it moving forward.”

Evidently his retirement has been canceled. These are hard times, but this time Lincoln is still in the game.

After Trump: reflections on mass disability in a sleepless night

I’m having trouble sleeping. There are a few boring reasons for that, but the election is not helping. So it’s time to write while sleep-impaired. I’ll try to keep this short, but I’m also going to break it into sections.

Context

My son has a substantial cognitive disability and little prospect of self-sustaining employment. His temperament is different from mine. I am novelty-seeking and instinctively skeptical of authority, he loves routine and structure. I am Vulcan, he is Klingon.

I am elite. He is not. Obama is my ideal President, he declared for Trump (though, interestingly, he chose to abstain in the end). I used to be uneasy around police, he loves K9 cops.

My son’s growth and development has shaped my life and thought for 20 years. He has informed my thinking about mass disability, something I’ve been writing about for 8 years. Because of him I have sympathy even for the Deplorables, angry and lost in a world that doesn’t want them any more.

The Big Picture

I don’t think any period in human history has seen as much cultural change as America 1950-2016. Civil Rights. Feminism. Gay Rights. Atheist Rights. Gender Rights. I have a flexible mind, and I feel a bit awed by all I have had to unlearn and learn. It’s not just America that’s changed of course. I believe that, in addition to ecological collapse and economics, the 9/11 world is a reaction to the education and empowerment of women.

And then there’s the demographic transformation of America. There’s a fertility transition that continues to drop family size; without immigration America’s population would be shrinking.  There’s the rapid aging of the post-war boomers. There’s the transition of the euro-american to minority status.

Now add China. No period of human history has seen anything comparable to the rise of China — if only because it is nation of a billion people. The economic transformation is severe; there is a limit to how quickly economies can adapt.

And, of course, no period of human history has seen an intelligent machine. We live in the AI era. Not the sentient AI era, or at least not so far as I know. But we now have distributed, almost ubiquitous, machine intelligence. Pre-AI technologies have already eliminated much of the work that supported the non-college middle class. The service work that remains pays far less and demands strong emotional control. A control that many men, and some women, don’t have.

The AI era is the era of mass disability. An era when the work that is valued and compensated requires cognitive and emotional skills that perhaps 40% of the US population does not have. No, more college will not help.

Extreme cultural transformation. Demographics. China. The AI era and mass disability. I haven’t even mentioned that pre-AI technologies wiped out traditional media and enabled the growth of Facebook-fueled mass deception alt-media.

We should not be surprised that the wheels have come off the train.

The GOP in 2016

We will lose the consumer protections and financial regulation slowly built over the past 8 years. We will lose Obamacare. The Gender Rights movement will stall.

I’ve seen some talk of the Senate minority slowing this, but we are also going to lose the filibuster.  We are unlikely to win the House or Senate in 2018 — so this will happen.

This will be sad and it will hurt a lot of people, not least Trump supporters.

It may not be as bad as some fear though. ObamaCare was failing. It was a tough political compromise that ran into GOP hellfire; the GOP blocked the post-launch fixes any big legislation needs. It was from the start intensely corporate and bureaucratic, with a misguided focus on analytics and top-down controls. GOP Representatives and Senators are not going to risk the wrath of their constituents, especially the non-college whites who are at risk of losing coverage. There will be a replacement. It will cover fewer people but perhaps it can be built up.

CO2 control seems to be hopeless now, but I’m not so sure about that. Sure, Trump is an idiot, but not everyone in the GOP truly believes that global warming is a good idea. There’s a chance the GOP will make changes that Obama could never get past the GOP.

This was all going to happen with any large GOP victory. Indeed, with his political core of white non-college voters Trump is going to be more cautious that Cruz or Ryan.

Trump: the mass disability conversation

I once wrote a blog post titled "Donald Trump is a sign of a healthy democracy. Really.”. It was really prescient:

… I enjoy seeing the GOP suffer for its (many) sins, and it would be very good for the world if the GOP loses the 2016 presidential election, but Trump won’t cause any lasting political damage. Unless he runs as a third party candidate he’ll have no real impact on the elections.

Hah-hah. Laughs on me.

This part holds up better:

Trump appears to be channeling the most important cohort in the modern world — people who are not going to complete the advanced academic track we call college. Canada has the world’s highest “college” graduation rate at 55.8%, but that number is heavily biased by programs that can resemble the senior year of American High School …

… about 40-50% population of Canadians have an IQ under 100. Most of this group will struggle to complete an academic program even given the strongest work ethic, personal discipline, and external support…

… this cohort, about 40% of the human race, has experienced at least 40 years of declining income and shrinking employment opportunities. We no longer employ millions of clerks to file papers, or harvest crops, or dig ditches, or fill gas tanks or even assemble cars. That work has gone, some to other countries but most to automation. Those jobs aren’t coming back.

The future for about half of all Americans, and all humans, looks grim. When Trump talks to his white audience about immigrants taking jobs and betrayal by the elite he is starting a conversation we need to have.

It doesn’t matter that Trump is a buffoon, or that restricting immigration won’t make any difference. It matters that the conversation is starting. After all, how far do you think anyone would get telling 40% of America that there is no place for them in current order because they’re not “smart” enough?

Yeah, not very far at all.

This is how democracy deals with hard conversations. It begins with yelling and ranting and blowhards. Eventually the conversation mutates. Painful thoughts become less painful. Facts are slowly accepted. Solutions begin to emerge…

I guess we’re having the conversation now. Too bad we didn’t have it four years ago. Obama, my ideal president, missed that one. He wasn’t alone, as recently as 2015 I complained “Both DeLong and Krugman missed the college vs. no-college white middle-age cohort, and I think that’s the important story” (K had a false start in 2012.)

Late in the campaign Obama picked up the theme with work on labor market monopsony and “predistribution”. Some of the Bernie Sanders themes that Clinton adopted, like free community college, were a first step. Overall though my team missed this one. It was a huge miss. They should have been reading Gordon’s Notes …

Trump: white nationalism and patriarchy

Half of college educated white women voters voted for Trump. I can’t quite get my head around that one. That cohort would have given Clinton the election.

Half.

What do we understand that? We need to resurrect anthropology and fuse it with journalism. How? I’ve no idea, but we need a way to explain ourselves to ourselves. A NYT piece made a good start with an interview of some of these women. Rage about the Black Lives Matter movement and critiques of police (prime job for the blue collar) were a factor; as well as susceptibility to Facebook-fueled right wing agitprop. I suspect these women are also relatively comfortable with traditional male-female roles. They want a “strong leader”; maybe they favor “enlightened patriarchy”. (The article had one significant error, it claimed white college-educated women voted for HRC. They did not. If they had we wouldn’t be talking about this.)

The whites are acting like a tribe. It’s different from acting like we own the country. This is shades of old racism mixed with aggrievement, loss, and bitterness. Unfortunately, unlike other tribes, the white tribe votes.

Reagan pioneered the use of white racism to win power. Trump has kicked it up several notches. He has summoned  our demons at just the right wrong time. Now we live with the consequences. Trump isn’t going to beat these demons back, he is much more racist than Reagan was (more than most of us imagined).

On the other hand the GOP is going to get nervous about this. The party is not going to be comfortable with overt white racism. There will be some GOP help with stuffing the Nazis and Klansmen back in the bottle. We will need that help.

The Resistance

In my home town of St Paul Minnesota a mob has been blocking a freeway. That’s dumb team. Stop doing that. We need more leadership. There’s a guy I know who’s going to be out of a job in seven weeks…

Ok, so Obama is probably going to want to take a break. We are going to need someone though. This isn’t just one crazy election. Remember the “Big Picture”. There are huge forces at work, especially the lack of demand for non-elite labor (what I call “mass disability”). If you think we’re in trouble now, imagine what’s going to happen to China in the next few years. (Russia is toast.)

We need to oppose Trump. He’s a twisted wreck. I suspect, however, that he’s going to find a lot of long knives in DC. The GOP leadership are not nice people, and they prefer Pence to Trump (not that Pence is good news).

We need to oppose Trump, but we also need to remember why we have Trump. We need to focus on the big picture - there are solutions. We live in whitewater times; we need to hold onto each other while we try to steer the raft. Because there’s a waterfall ahead …

See also: 

I’ve been writing about this for a bit over 8 years …

KRISTOF: Watching the Jobs Go By - his weakest column in years 2/2004. Very early thoughts in this direction.

Why your daughters should be roofers — not architects 3/2004. Precursor ideas.

On redistribution 6/2004. From an article in The Atlantic: “It is doubtful that in any society with universal suffrage the majority is going to sit on the sidelines and watch, generation after generation, while a handful of investors and corporate managers reap almost all the benefits of technological and economic progress."

The limits of disaster predictions: complex adaptive systems 2/2007. We have survived doom before.

Mass disability and Great Depression 2.0 3/2008. 

"I believe that about 20% of adult Americans aged 25 to 65 are effectively disabled in our current globalized post-industrial economy. I believe this number will rise as our population ages. I believe this is the fundamental problem, along with network effects, driving modern wealth concentration.

Over time the economy will change to develop niches for unused capacity (servant economy?), but the transition need not be comfortable. In the meantime technological shocks, such as ubiquitous robotics, may induce new disruptions to a non-equilibrium economic structure — risking extensive economic breakdown."

Causes of the Great Recession: China, GPSII and RCIIIT. Now for Act III 4/2010

Civilization is stronger than we think: Structural deficits and complex adaptive systems 5/2010. Hope.

Post-industrial employment: adjusting to a new world 5/2010. College is not the answer.

Unemployment and the new American economy - with some fixes. 1/2011 “In a virtualized economy workers with average analytic and social IQ less than 125 are increasingly disabled. Since this average falls with age the rate of disability is rising as the we boomers accumulate entropy …Start applying the lessons learned from providing employment to cognitively impaired adults to the entire US population.” Looking back this is when my thinking about mass disability began to crystallize.

Mass disability goes mainstream: disequilibria and RCIIT 11/2011. I thought we’d have the conversation then, but it didn’t go forward. Unfortunately.

Life in the post-AI world. What’s next? 9/2011

The Post-AI era is also the era of mass disability One of my favorites. 12/2012

Addressing structural underemployment (aka mass disability) 5/2013 Some ideas on solutions. Good ideas by the way.

Donald Trump is a sign of a healthy democracy. Really. 8/2015

Trump explained: Non-college white Americans now have higher middle-aged death rates than black Americans 11/2015 “Both DeLong and Krugman missed the college vs. no-college white middle-age cohort, and I think that’s the important story” 

Trumpism: a transition function to the world of mass disability 8/2016

How does the world look to Trump’s core supporters? 9/2016.

After Trump: information wants to be free, but knowledge is expensive 11/2016. This feels fixable, but it’s a fundamental problem.

In defense of Donald Trump.

Trump is more racist and sexist than most 70+ yo white men. He is amoral and a con man. He may be a sociopath and probably has a narcissistic personality disorder. He is living proof that we need drug and dementia testing for presidential nominees. He is dim. Even by the standards of presidential contenders he is a nasty person.

Trump is the anti-Obama. Irrational, impulsive, thoughtless, intemperate … it’s a long list.

Trump makes paranoid H. Ross Perot look good. He exceeds the sum of the worst of GWB and Richard Nixon. I cannot think of a post WW II major party candidate this bad.

He may be worse that Cruz.

Yeah, America’s two leading contenders for the GOP nomination in 2016 were both awful. Two of the worst options in the past 100 years. That means something. It means despite our immense wealth and overall prosperity, despite our social and environmental progress, America is in trouble. Trump isn’t America’s festering abscess, he’s the fever. It’s not enough to treat the fever. We need to drain the abscess.

So where is the abscess? Why did the GOP drift further and further from reality? How did a political party that once supported science become anti-evolution and, most insanely, pro CO2 production?

I think Noah Smith has a part of the answer. The GOP had deep internal divisions and over the past 15 years the glue gave way.  The Party is broken, it has to reform.

Maybe that’s the whole story. I don’t think it is though. I think the abscess is the bottom 40% of white America. The great unwanted. The Left Behind. The new disabled. A cohort that has seen 40 years of shrinking opportunity. The economy has moved on; we don’t have vast office buildings full of thousands of people who move paper from cabinet A to cabinet B.

The odds are we’ll fix the Trump fever. Hell, even the Koch brothers favor Clinton. Obama is in the game and on top of his form. Women are starting to realize sexism is no more dead than racism.

But the abscess will still be there.

Sometimes fever is a friend. It tells you something bad is happening.

The Obama doctrine -- I will so miss our Vulcan President

From the Obama Doctrine, quoting the President:

… Right now, across the globe, you’re seeing places that are undergoing severe stress because of globalization, because of the collision of cultures brought about by the Internet and social media, because of scarcities—some of which will be attributable to climate change over the next several decades—because of population growth…

… As I survey the next 20 years, climate change worries me profoundly because of the effects that it has on all the other problems that we face. If you start seeing more severe drought; more significant famine; more displacement from the Indian subcontinent and coastal regions in Africa and Asia; the continuing problems of scarcity, refugees, poverty, disease—this makes every other problem we’ve got worse. That’s above and beyond just the existential issues of a planet that starts getting into a bad feedback loop.

By “collision of cultures” I think he means “existential threats to patriarchy” — because he’s obviously reading my mind. Must come with his Vulcan heritage.

We are never ever going to get another President this good (even though he’s wrong about encryption). HRC isn’t bad, but she’s no Obama.

Minnesota explained: Rubio, Sanders and the President Gordon agenda.

My home state of Minnesota, most annoyingly, uses caucuses. I attend the Dem variety in the bluest of neighborhoods. They are crowded, disorganized and well meaning. When I ride my bike to caucus cars slam to a stop as though I were a family of 5 on foot. Which is wrong and dangerous, but I appreciate the sentiment.

The Dem caucus is not representative of the Dem voter. You have to be very persistent to fight through traffic and crowds to hit the narrow window for voting. Only the most committed can get there. The caucus system is a bad, bad idea. I think the same is true of the GOP caucuses here.

So the caucus results last night were not too surprising.

The GOP, as usual, went for the extreme right candidates. This year there were three of ‘em - Trump, Rubio and Cruz. Since we have one of the strongest economies in the US, with unemployment under 5% for years, Trump didn’t have his usual vote-of-despair left-behind advantage. So the three extremes ended up with fairly similar numbers, but the anti-Trump movement focused on Rubio and he won.

My team went, as usual, for the more left candidate. Sanders won by 20%, so he might even have won a primary. I voted for HRC, but the MN DFL is effectively to the left of me — which is saying a lot.

I’m backing HRC but, in truth, we need to go down some variation of the Sanders road over the next two decades. We’re going to have to bias the post-AI globalized economy to generate jobs for the non-college — even at the cost of economic efficiency. We have to build more social supports for people who aren’t working, with some kind of rethinking of what we do for disabled workers. We may end up with a non-binary definition of disability, or even some kind of guaranteed income.

We will end up taxing wealth in one form or another and we’ll do a  lot more government redistribution. We should also, and this is not so much Sanders, execute on the old Gore “reinventing government” mission, refactoring regulatory systems. We need to break the accounting, tax and regulatory frameworks the mega-corporations (“neo-Chaebol is a term I like) have built; the foundations of a great stagnation ecosystem wherein new companies are built only for acquisition.

We need to build supports that enable entrepreneurial types to pick business designs off a shelf and implement them. We need to strip benefits from employment completely, and both fix and finish the mission the ACA started — while breaking the corporatization of that great compromise.

Phew. It’s a big mission, but it is doable. We have to do it, or we get President Trump. Or worse. Sooner or later. 

So I don’t feel that bad that Sanders won Minnesota. It’s a good sign for the future. I don’t want him to go up against the GOP though. By the time their attack machine is done with him he’ll be hiding in a stone shelter in the wilderness. HRC’s great strength is she’s lived that machine for decades. Nobody short of Obama can equal that. (And, of course, I would love him to keep his job. Alas, even if our constitution allowed that I think he’s ready for a change.)

See also:

• The AI Age: Siri and Me 12/2011
• Causes of the Great Recession: China, GPSII and RCIIIT. Now for Act III. 4/2010. Holds up pretty well, but I now add a third somewhat related factor of a mega-corp created environment that’s toxic to the startups that historically create employment.
• Amerisclerosis? Why US underemployment (and probably inequality) persists 9/2013. Secular stagnation is the current term.
• Mass disability goes mainstream: disequilibria and RCIIT 11/2011. In the new age there jobs for the high EQ/IQ. Others are not so needed.
• Ants, corporations and the great stagnation 12/2011
• Causes of the crash of ’08 - how much fraud? 2/2009. Good to look back, but I know think these were secondary causes. For example, IT enabled complexity and complexity enabled fraud.
• Civilization is stronger than we think: Structural deficits and complex adaptive systems 5/2010. Trumpism is scary, but it’s also the way the “meta-mind” approaches big hard changes.
• Donald Trump is a sign of a healthy democracy. Really. 8/2015. The problem of the unwanted non-college (“working class”) isn’t going to be solved by more education. Remember, the non-sentient AI revolution will come for you too.
• For American adults are poverty and disability the same thing? 10/2013. I think this is true for white and asian men in America, for others racism also drives poverty. (I mention this at the end of the post but should have had it up front.)

Why DOJ should block Aetna and Anthem acquisitions: A story of strategic pre-authorization delays

The health insurance industry is consolidating. Aetna acquired Humana and Anthem bought Cigna. That leaves UnitedHealth, Aetna and Anthem as the mega-corporate rulers of US healthcare. Unless, of course, the US Justice Department blocks these mergers. 

Like most people who pay attention to healthcare policy I very much hope the DOJ does its job properly. I’m glad we have the Obama DOJ to stand up for us, at least now we have a fighting chance. That’s not why I’m writing this blog post though, and it’s not the reason why I’ll be writing Senator Klobuchar to ask her to work against these mergers.

I’m writing this because, of course, I’m personally mad at Aetna. I think I know why Aetna and Anthem are in a position to do the acquiring, and it’s not because they’re better at delivering health care. I think they’re winning because they excel at both strategic incompetence supported by a tobacco-industry class executive culture.

In my case a physician ordered a radiology procedure for me that requires pre-authorization by my insurance company - Aetna. The order, alas, was placed in early December — perilously close to the end-of-year period. A period where cost can shift, depending on deductibles, from the insurance company to the insured, or from one carrier to another.

Aetna could decline the authorization. That might have been a reasonable act — not every physician recommended procedure is a good idea, particularly when the physician owns the imaging process. I’m guessing they don’t have grounds for denial, so instead they simply stall. Information is provided … and Aetna can’t find it. They ask for the same information several times. They will succeed in running out the clock. My physician’s staff tell me Aetna excels at this game, even by industry standards they’re good at not delivering what we pay for. Which is usually considered theft.

Aetna’s executives don’t have to write up a formalize this profitable process. They don’t need to put anything in writing. All they have to do is underfund their pre-authorization process (a “cost center”), or provide financial incentives to delay payments, or not staff for the holidays, or promote executives who are good at cost control. Most likely they do all four. 

I suspect Anthem has the same skill set, but Humana and Cigna probably aren’t quite as good at being evil. There are so many ways in healthcare to do well by doing wrong; it’s a rough rule of thumb that the more profitable a healthcare operation is the less good it’s doing.

Aetna is going to win their little battle with me. The best I can do to get even is write Senator Klobluchar (I know Senator Franken will oppose) and complete their legally mandated complaint form.

And I can write a blog post.

See also

• Happy accident fraud - Feds move on Aetna and other health insurers with deceptive provider listings 5/2015. “Don’t put your Disability Claims office on the fifth floor of a building with a faulty elevator to defraud anyone, just do it for the cheap rent.” After signing up you discover there you actually can’t get healthcare
• Anthem - Putting the Hell in Health Insurance 8/2010. Strategic incompetence in action. Their profits let them buy Cigna.
• Emergent fraud: Anthem and automatic payment denials 9/2010. We really don’t want Anthem owning Cigna
• Big GOP stealth donors: aetna, coke, koch, exxon; pfizer, unitedhealth, walmart, Microsoft. Yeah, Aetna and UnitedHealth.
• Gordon’s Notes: Emergence: how entropy and incentives create scams 2/2009. A systemic problem where information asymmetry exists.
• AMA asks Justice Department to block Aetna-Humana, Anthem-Cigna mergers 11/2015. I don’t often agree with the AMA, but they are right about this one.

Update 12/30/2015

After completing the official complaint form, and separately posting a public message to Twitter @aetnahelp and follow-up email to socialmediacustomerservice@aetna.com, I received this message on the morning of 12/30:

Of course it’s too late now, Aetna ran out the clock. As we knew they would. Even though the bad guys won this one, I would try public Twitter messages and email to socialmediacustomerservice@aetna.com in future. A kind of special service track for the geek elite. 

Happy accident fraud - Feds move on Aetna and other health insurers with deceptive provider listings

Happy accident frauds are emergent frauds — nobody needs to plan them. Don’t put your Disability Claims office on the fifth floor of a building with a faulty elevator to defraud anyone, just do it for the cheap rent. Then save costs by replacing your customer support staff with an automated call management system.

The insurance industry is great at emergent frauds enabled by complexity and powered by perverse incentives. It’s baked into their business model; any player who doesn’t cheat will go bankrupt.

So it’s not surprising that health insurers competing in public marketplaces have produced inaccurate physician directories. It’s not limited to public ACA style coverage, we get our Minnesota health care through an employer plan, and after we chose Aetna we discovered their oral surgery listings were fictional. They seemed to have many providers available in our area, but all the ones we called said the listing was wrong.

Why pay the costs to maintain an accurate listing when an inaccurate listing gets you customers who can’t actually make claims?

The good news is that the Obama administration is now starting to address the problem. Alas, the fines are likely to be pathetically small, we’ll need class action litigation to really change things or find ways to drive the worst offenders out of business by failure of ‘network adequacy’. (emphases mine, note the related problem of prince concealment in the industry, another part of a fundamentally murky business)

White House Moves to Fix 2 Key Consumer Complaints About Health Care Law - NYTimes.com

The White House is moving to address two of the most common consumer complaints about the sale of health insurance under the Affordable Care Act: that doctor directories are inaccurate, and that patients are hit with unexpected bills for costs not covered by insurance.

Federal health officials said this week that they would require insurers to update and correct “provider directories” at least once a month, with financial penalties for insurers that failed to do so. In addition, they hope to provide an “out-of-pocket cost calculator” to estimate the total annual cost under a given health insurance plan. The calculator would take account of premiums, subsidies, co-payments, deductibles and other out-of-pocket costs, as well as a person’s age and medical needs.

Since insurers began selling coverage through public marketplaces 19 months ago, many consumers and doctors have complained that the physician directories are full of inaccuracies. “These directories are almost out of date as soon as they are printed,” said Kevin J. Counihan, the chief executive of the federal insurance marketplace.

Medicare and Medicaid officials have found similar problems in the directories of insurance companies that manage care for beneficiaries of those programs. In December, federal investigators said that more than a third of doctors listed as participating in Medicaid plans could not be found at the locations listed.

The new standards significantly strengthen an earlier rule, which required insurers to publish directories online and to make paper copies available on request. In the federal exchange, violations are subject to civil penalties of up to $100 a day [ed: 0.000001% of revenue?] for each person adversely affected.

Federal officials said that inaccurate provider directories could be a sign of larger problems. If doctors listed in a directory are not available or are not taking new patients, consumers may not have access to covered services, and the insurers may not meet federal standards for “network adequacy,” the officials said. Consumers must often pay extra when they use doctors outside the network of their health plan, so an inaccurate directory could also lead to higher costs for patients.

… Aetna says that data in its directory is “subject to change at any time.” UnitedHealth tells Medicare beneficiaries, “A doctor listed in the directory when you enroll in a plan may not be available when your benefits become effective.” …

See also:

• Emergence: how entropy and incentives create scams: 2009, Aetna’s FSA management - just make it hard to process a claim
• Mobile phone fraud - The accidental data charge and other scams: 11/2009. A lot of these scams have gone away during the Obama administration, thanks to more competition between carriers and a lot of regulatory action. Government can work.
• Emergence: how entropy and incentives create scams 2/2009.
• Emergent fraud: Anthem and automatic payment denials 9/2010
• Anthem - Putting the Hell in Health Insurance 8/2010
• Health insurance: we’re defeated by a complexity attack 11/2009
• Employment benefit complexity: we are sheep 11/2007
• The hidden insurance problem: they can play the game better than we can 11/2007

American psychology and civil war in Egypt

An acquaintance from my Quebec High School is active in Egypt's secular resistance to Morsi's rule. She's frustrated by Obama's tolerance of the Muslim brotherhood; I think she would prefer the freedom rhetoric of Bush II. Personally, I prefer Obama.

That's not what's interesting though. The interesting bit is she seems genuinely confident that Egypt won't break down, like Syria and Iraq, into civil war. That confidence seems strange to an American, even an immigrant American like me. We believe in Civil War; we had a big one not long ago. There are still flare ups in old battlefields.

For an American it's easy to imagine Civil War in Egypt. There are many things that are strange to us, but not civil war.

What's so bad about a bit of torture?

"... The Guardian newspaper unveiled the results of a year-long investigation purporting to show that U.S. military advisers, with the knowledge and support of many senior officials, including former Secretary of Defense Donald Rumsfeld and disgraced Gen. David Petraeus, oversaw a vast program of torture inside Iraqi prisons..

..Col. James Steele and Col. James H Coffman, ran a high-level secret program inside Iraqi prisons to extract information from alleged insurgents and Al Qaeda terrorists...." (10 Years After the Invasion of Iraq, a World of Hurt )

I run into Republicans on occasion. There's my beloved Uncle D for one, and there are some at work and in my Facebook feed.

I run into them, but we don't discuss politics. Similarly I don't consume any GOP media; neither Murdoch's nor talk radio nor right wing blogs. So what I know of Republican thinking is filtered by the NYT, NPR, Ezra Klein, Paul Krugman and the rest of my 400 feeds.

Except for app.net. That's the one place where I get to correspond with intellectual Republicans. It was there that some of us worked through a discussion on the role of torture in modern warfare. During our conversation, I was challenged to defend my scorn for the Bush/Cheney/Rumsfeld (BCR) torture program. I was surprised -- it's been a long time since I've had to think about why the BCR program was a terrible idea.

It's good to have surprises like that, and good to use this blog to think through my position, starting with a contrary "pro-torture" perspective of my own. (I'm not trying to represent my correspondent's position, I'd likely distort it unfairly.)

My pro-torture argument has nothing to do with whether torture is effective or not. That's a red herring; for the sake of argument let us assume that a skilled torturer always breaks any resistance and hears whatever the victim believes to be true.

Instead I, playing the role of Dick Cheney, will argue that torture isn't so bad. After all, we Americans routinely kill combatants and civilians in our many wars, not to mention our domestic execution chambers. We, more than most nations, sentence vast numbers of citizens to particularly nasty prisons.

Those are nasty fates. Given the choice, many of us might opt instead for a bit of sensory deprivation, flogging, waterboarding, electric shocks, and thumbscrews.

So then why should we be particularly averse to torture? If torture is no worse than routine warfare, shouldn't we retroactively pardon the torturers we imprisoned after World War II? Should we apologize to North Korea and North Vietnam for the mean names we called them; and discard our meager loyalty to the Geneva Conventions once and for all?

These are strong arguments, but history tells me they are misguided. There's a reason that torture was slowly removed from the legal code, and that 'cruel and unusual punishment' was a part of the English Bill of Rights in 1689.

One reason is that people who inflict torment on prisoners, who are by definition helpless, are changed by their experience. Some are repelled by the work, but some are attracted to it. The historical record tells us the practice spreads quickly, from special circumstances to general circumstances. From a few isolated rooms to a vast network of American supported Iraqi torture chambers. From the battlefield to Homeland Defense, and from Homeland Defense to the Ultra-security prison, from the Ultra-security prison to the routine prison, from the prison to the streets ...

Torture, history suggests, is habit forming. If humans were machines we might be able to manage torture as readily as we manage prison sentences. We're not though. Our culture fares badly when we make torture acceptable.

Our military knew that in 2005.

We should remember that now.

See also

Gordon's Notes

• Obama – leading us out of the darkness and the torture chamber 1/2009. Obama shut down the detention centers very publicly. The GOP blocked the closure of Guantanamo - with the help of some Dems.
• Inmate Kyle Foggo – Creator of the post-2003 torture facilities 8/2009. His Wikipedia entry is here. Contrary to my thoughts in 2009, Obama turned away from the torture trail.
• America's Inquisition 1/2012. The Inquisition followed the same time honored procedures.
• The Argentinian solution 3/2005. We should ask Argentinians about the impact of their torture program on their society.
• No, religion does not make you a better person 4/2009. Religious Americans tend to approve of torture. This makes a lot of sense given the concept of Hell.
• The right declares in favor of torture - responding to the ticking clock 11/2007. Clive Crook is often an ass, but he wrote very well about this topic.
• That which does not kill me is not torture 6/200. John Fredman - "If the detainee dies, you're doing it wrong"
• CIA Torture tapes destroyed 12/2007. Destroying the evidence paid off.
• Bush didn't want to know the location of the CIA's torture facilities 12/2007. Plausible deniability.
• American torture - what's next 1/2009. Obama pledged to follow the Geneva convention. We're still waiting for the Truth Commission.
• The classification and heritage of American torture 3/2009. We're "Anglo-Saxon modern".
• Another Cheney fan rediscovers waterboarding really is torture 5/2009. Radio fruitcake discovers what torture is.
• Restoring American civilization: 12 steps NYT 3/2007. Still waiting.
• American fear and our shredded honor - two ringing voices against torture 5/2007. Retired military leaders "As has happened with every other nation that has tried to engage in a little bit of torture -- only for the toughest cases, only when nothing else works -- the abuse spread like wildfire, and every captured prisoner became the key to defusing a potential ticking time bomb."

Others

• Waterboarding is Torture... Period (Links Updated # 9) | Small Wars Journal 10/2007. A SERE graduate.
• What do the Bushies and the Khmer Rouge share? - Kristof 12/2008. Waterboarding.
• 183 - Krugman 4/2009. KSM was waterboarded 183 times in one month. Some people get to like doing torture. Cheney tortured and tortured until his victims told him Iraq had WMDs.
• Franken’s torture smackdown | MinnPost 7/2012
• U.S. Says Rendition to Continue, but With More Oversight - 8/2009 I'd like the NYT to f/u on what has happened over the past four years.
• Pentagon's link to Iraqi torture centres The Guardian 3/2013: Rumsfeld era, but ties torture program to Pentagon and to Petraeus.

The Right will drop Climate Change Denialism within the next six months

My prediction for 2013 - the American Right will effectively drop Climate Change Denialism by April of 2013. They'll never admit it of course. They'll act as though they always accepted that human activity was warming the earth and that effete Liberals have been responsible for all inaction.

This is a good thing.

Some may wonder how this could happen so quickly. I used to think it would take longer myself but I've changed my mind.

A year ago I thought this would only happen after a crushing GOP victory, but since then we've seen the GOP make a complete policy reversal on immigration. We've seen Christian evangelicals purge all record of decades of anti-Mormon sentiment. We've seen a hard-right primary candidate morph into an Obama-clone, and his base act as though nothing had changed. We've realized that the GOP elite often believe what they say, and believe they've always believed whatever they now believe.

If you are not anchored to data, and to reality, then it's not hard to change direction. The  U.S. military's preparation for climate change disruption (and climate engineering wars) will be tied to budget requests, and it's hard for the GOP to say no to increasingly large sums of military money. The combination of military requests, electoral defeat, and Sandy are sufficient to precipitate radical realignment.

Don't be shocked if a Carbon Tax, in one form or another, makes it into the 2016 budget process.

Post-election reflection

I don't often pull down my posts for a rewrite, but this one was up for a few hours before I took it down for a rework. Here's the revised edition with a strikeout.
------
My team won the big one. I read my Talking Point, Krugman, and Salmon, so I wasn’t surprised. On the other hand, since I’m a bit mathic,  I wouldn’t have been surprised if Romney had won either. So not surprised, but very grateful.

My team won even bigger in Minnesota. Voter-ID, anti-gay marriage amendment, GOP State House – all gone. I didn’t expect all of that. So there I’m surprised, and very grateful.

I'm grateful to the Obama and Biden families, to Bill Clinton who may have earned some forgiveness for delivering himself to his enemies so long ago, to the Millenials who seem to like voting (and that will change many things), to all the Obama donors big and small, to my friends Kathy and Lin who won their fight, to Paul Krugman who rails against ignorance, to Obama voters, and especially to the campaign team. I listed to Obama’s acceptance speech, and some parts were obligatory filter – but his gratitude to his volunteers and campaign team was very sincere.

I'm also grateful that, despite some dire predictions, most of the white GOP voters I know seem to be going on with their lives without riot. Even those who claimed they'd go Galt may be sobering up, though there may be rare exceptions. It's as though they didn't entirely believe Fox/Rove TV. Certainly Boehner and McConnell didn't -- they went to bed early on election night.

I’m grateful, but I ain’t exactly joyous. I’m not sure entirely why, but it's not hard to list potential contributors.

First there was the tidal wave of stupidity that infested even commercial-free NPR as both parties fought for the allegiance of the inattentive, uninformed, and unmotivated. It felt like pledge week on steroids.

Then there was the partial success of the House GOP's scorched earth policy over the past two years, and the success of the GOP governors' redistricting policies that keep the House Red even when the nation goes Blue.

The GOP's voter suppression tactics were depressing -- and Florida is still a democracy disaster area. (It's time for a federal intervention). Romney's jaw dropping whoppers were much worse than McCain's -- and they never seemed to cost him all that much. His "budget plan" was a bad joke. Overall, the etch-a-sketch worked depressingly well. He ought to have lost by a huge margin, he lost by a few percent.

Dare I mention the billionaires? Yeah, we learned (again) that wealth is no measure of intellect or even cunning, but I suspect they did more harm than we are willing to admit.

Maybe it’s also a primitive tribal responsibility thing. Sadly, I am not a blue-eyed husky mix. Like John Scalzi, I am “the GOP “demographic” down to the last jot and tittle”. So, while I think it would be crazy for President Obama to feel depressed about black men behaving badly, I feel badly that so many of my tribe [2] of very-advantaged relatively-wealthy and somewhat educated white men behaved like fear-infested pithed fleshbots with an etch-a-sketch memory ... made very bad choices.

*Cough*. Yeah, that's the problem sentence. It's a bit ... harsh.

I'd like to know what's going on in the heads of my white folk tribe. To consider that let's set aside the elderly; they are vulnerable and easily manipulated. Let's set aside the cynical wealthy; for them Romney is a logical choice. Let's even assume that a fraction of the GOP (all white) base is truly opposed to abortion on genuine religious or ethical grounds -- and not just using 'pro-life' as a tribal flag. Set them aside. Lastly, set aside the less educated or the white impoverished who are disconnected from the world.[4]

That still leaves a large group of people who should know better, and whose justifications for voting for today's GOP [3] don't make sense. Except that 80% of GOP voters are overtly racist [1].

So maybe I don't really want to know what's going on in the heads of white male GOP voters.

I think I know why I'm not joyous. Grateful though.

[1] I know at least white GOP voter who isn't, and who was still convinced Obama would destroy America. She may be in the same mysterious category as black Republicans.
[2] Really I have several tribes, but I can't escape the male and pigment-deficient one.
[3] Some have stated reasons, but they are either data-free or contradicted by simple data. This doesn't mean it's impossible to rationally vote for any Republican candidate, just not the ones we have now.
[4] GOP voting Libertarians don't get exempted because today's GOP is less "Liberty" friendly than today's Dems. A third party vote is absolutely defensible however.

Usability of electronic health records: test cognitive cost first

Obama raised mileage standards for my industry.

Ok, so it wasn’t him personally, and it’s not mileage, and I don’t exactly own the health care “IT” industry. Even so, I can better imagine now what it was like to work for GM in the 70s when mileage standards were first set.

For my industry the ‘mileage standards’ are known as ‘meaningful use’, as in MU1, MU2 and MU3. Despite the confusing name these are effectively increasingly stringent performance standards for electronic health records, akin to mileage and emission standards for automobiles. They’re reshaping the industry, sometimes for better and sometimes for worse. (Should we, for example, measure the value of all of our measuring before we do more measuring?)

The industry has moved through MU1 and is now digesting MU2 with MU3 on the horizon (assuming Obama wins, though Gingrich was a great fan of this sort of thing.) MU3 is still under construction, but one consideration is the inclusion of ‘usability standards’.

For various reasons I’m not thrilled with the idea of setting usability standards, but the term is broad enough to include something I think we really ought to study: The impact of complex clinical documentation and workflow systems on the limited cognition and decision making budget of the human brain…

I’ve written about this before …

Gordon's Notes- Electronic health record use and physician multitasking performance 4/2010

Llamas and my stegosaurus: Living with a limited brain
Some interesting research has come out recently about the processing capacity of brains. For example, that the medial prefrontal cortex can only handle two tasks at once, or that working memory can only handle about 7 items at a time (but what's an item?), or that when people are actively trying to remember something complicated, their impulse control is reduced…

Since then this topic has gotten a bit more attention, particularly from a study of Israeli judges …

Do You Suffer From Decision Fatigue- - NYTimes.com 8/2011

… There was a pattern to the parole board’s decisions, but it wasn’t related to the men’s ethnic backgrounds, crimes or sentences. It was all about timing, as researchers discovered by analyzing more than 1,100 decisions over the course of a year. Judges, who would hear the prisoners’ appeals and then get advice from the other members of the board, approved parole in about a third of the cases, but the probability of being paroled fluctuated wildly throughout the day. Prisoners who appeared early in the morning received parole about 70 percent of the time, while those who appeared late in the day were paroled less than 10 percent of the time…

… Decision fatigue helps explain why ordinarily sensible people get angry at colleagues and families, splurge on clothes, buy junk food at the supermarket and can’t resist the dealer’s offer to rustproof their new car. No matter how rational and high-minded you try to be, you can’t make decision after decision without paying a biological price….

… These experiments demonstrated that there is a finite store of mental energy for exerting self-control. When people fended off the temptation to scarf down M&M’s or freshly baked chocolate-chip cookies, they were then less able to resist other temptations….

Patient care is an endless series of decisions (though over time more behavior, for worse and for better, becomes automatic). All physicians start with a cognitive budget for decision making, and every decision depletes it. Unfortunately using an EHR also consumes decision making capacity – perhaps far more than use of a paper records. There’ve been a few studies over the past fifteen years hinting at this, but they’ve gone largely unnoticed.

So, if we’re going to study ‘usability’, let’s specifically study the impact of various electronic health records on cognitive budgets. We now know how to do those experiments, so let’s put some of that MU3 money to good use, towards supporting tools that enable better decisions – because they’re less tiring.

Think of it as meeting mileage standards through aerodynamic design.

Voted. Easy choices. Again.

I'll be traveling Nov 6th, so tonight was voting night for me. If you've read this blog at all you can guess that that the top of the ballot was pretty simple. We have a great slate of Democrats from the Presidency to our State Rep and I'd vote No on constitutional amendments even if I thought they were a good idea. Which they aren't.

The bottom half gets tricky - judges, soil and water commissioner and so on. Voting by mail used to have a big advantage -- but now any Minnesotan can see the ballot in advance and vote intelligently. A quick visit to judicial web sites made it easy to vote for the incumbents. County offices were covered by a Minnesota DFL page.

It's traditional in this sort of post to say something about why I voted for Obama/Biden. It's not hard. I can't think of any policy domain where I think Romney would make good choices. He'd be a disaster in international affairs. I think he'd neglect and even actively hurt the non-powerful He's terrible on science, horrible on the environment, and a disaster on climate change.

Meanwhile, Obama's choices make sense to me within the scope of his constraints. I don't agree with all his choices. He's too involved in choosing drone strike targets, his school reform programs are misguided, and his health care reform initiative is far too friendly to corporate solutions. Unfortunately, even in the cases where Obama is weak, Romney would be far worse.

I'm not happy that my voting choices are so easy. America needs a sane alternative to the Democrats. If Romney loses maybe we'll get one. If he wins, we won't.

A shot in the dark - Am I my brother's keeper?

Roger Ebert wrote a column on gun control and received 650 comments.

He read them all.

Then he responded, with one of his best columns ever. Some of the lines are so well said I've excerpted them below. I've written about this many times, but, of course, not with his eloquence.

A shot in the dark - Roger Ebert's Journal

Catie and Caleb Medley went to the doomed midnight screening of "The Dark Knight Rises." It was a movie they'd been looking forward to for a year, her father said. Gunfire rang out. The bullets missed Catie, who was pregnant. Caleb was shot in the eye. On Tuesday, their son Hugo was born. Caleb is listed in critical condition, and the cost of emergency treatment for his head wound has already reached $2 million. The Medleys were uninsured.

... Many of the comments were about health care, and one of the arguments frequently heard was: "I don't want the federal government taxing me to pay for the medical costs of people who don't care enough to provide for their own costs."...

... In our imagination it's always other people who get sick. I have a reader who tells me he's never been sick a day in his life. I tell him that's interesting from an autobiographical point of view, but otherwise not relevant. I can assure him that unless he's killed in an accident, sooner or later he will most surely get sick, and sooner or later he will most surely die.

Are we our brothers' keepers? Many people who resort to scripture are under the impression that we are not. They forget that it was Cain who said he was not his brother's keeper, after murdering Abel. In a similar sense, if our fellow citizens die because they have no access to competent medical care, they argue that we are not their keepers...

... I quote from the Bible for a particular reason. Many of the opponents of Universal Health Care identify themselves as Christians, yet when you get to the bottom of their arguments, you'll find them based not on Christianity but on Ayn Rand capitalism...

Ebert is talking about prosperity theology (wikipedia, see also Prosperity Theology | Christian Bible Studies [1]), a belief that wealth is a sign of god's approval, and poverty of god's disapproval. Since sin earns god's disapproval, the poor are sinners.

Although American Christians have brought prosperity theology to new heights, it's not unique to Christianity or to Mormonism. Hinduism's justification of caste maps well to the idea that poverty goes with sin, and wealth with grace.

In 2012 the fundamental difference between the right and the liberal is how we answer the question: "Am I my brother's keeper". Ironically, avowed Christians often give the answer of Cain and Ayn, while secular humanists often give the answer of Abel.

Cain and Abel. Romney and Obama. Some things never change ...

[1] Probably the only time I've ever linked to Christian Bible site.