Medicaid: it's the Alzheimer's and the strokes

Economist.com | Medicaid reform

The Economist thinks that Bush's social security redesign will fail and that attention will turn to Medicaid. They helpfully illustrate the article with a picture of a Hispanic family. Idiots. The article is mostly worthless, save for one prize paragraph:

Set up in 1965 to provide health care for the poor, Medicaid, with a total cost of over $320 billion, is now, alongside Medicare, America's biggest government health-care programme. Uncle Sam pays between 50% and 77% of the tab, depending on how poor a state is: on average, 57 cents out of every dollar Medicaid spends. Over 50m Americans rely on the programme for their health care. Most of those who enroll are poor families with children, but most of Medicaid's money is spent on old and disabled people, particularly on nursing-home care. (Medicare, the federally-funded programme for the old, covers only doctor visits, hospital visits and, from next year, prescription drugs.) Medicaid pays for two-thirds of all nursing-home residents in America.

Idiots and cowards. They ought to have featured a picture of an elderly middle class person in a nursing home bed. The medicaid fight is really about nursing home care, most nursing home care is for demented persons, and the vast majority of long term nursing home residents are white middle and upper-middle class adults. The latter group most often managed an informed divestiture of assets that allowed them to pass wealth to their children and transfer their ongoing expenses to medicaid.

To put it mildly, this problem has been predicted for while. We've known for decades that unless we came up with way to slow the onset of Alzheimer's (stroke reduction we may be able to do) there was no solution short of Soylent Green that was going to prevent an explosive increase in nursing home costs. The future is now.

I'll make the bold and radical prediction that the Bush administration will cut costs by denying benefits to the family in the Economist's photo. This will advance the cause of the "ownership agenda" but it will do nothing about Medicaid's costs. (Sound familiar?) True cost reforms will come only by preventing asset transfers from demented adults, encouraging euthenasia, preventing Alzheimer's, setting up nursing homes in low wage nations, or developing fully automated nursing homes (preferably with virtual reality entertainment for the residents).

Of this list I like the Alzheimer's prevention part. Make me president and I'll match 10% of the yearly federal medicaid bill ($32 billion or so) with research funding. (Not likely! :-)

Otherwise I've long considered the other two options (Guatemalan nursing homes and robotic care facilities with virtual reality entertainment) to be great investments.

Now you can completely ignore the Bush medicaid kerfuffle to come.

How to write a paper in one draft

Brad DeLong's Website: Advice on Paper Writing

In way too many years of writing papers, I'm ashamed to admit this trick has never occurred to me. As someone who wrote too many one draft papers, I would have benefitted greatly from Professor DeLong's advice:

Nobody ever told them that if you are going to hand in a first draft, an easy way to significantly improve it is to, when you are finished, cut the last paragraph from the paper and paste it at the beginning. Your final sum-up paragraph--written at the end, as you have by trying to write down what you think discovered what you really do think--is almost always going to make a better first paragraph than the first paragraph that you wrote.

Alzheimer's "disease": the decline of denial and the redefinition of "normal"

It may be Alzheimer's, not old age

Many years ago it was popularly believed that senility was a normal outcome of aging. Then, in the past few decades, many academics came to believe (hope?) that the brain did not decay all that much with aging, and that senility was the result of infrequent or preventable disease processes.

Hah.

Those of us who know the glass is half-empty (and poisoned besides) never bought this obviously false hope. We of the dark and suspicious nature have long suspected that it was (by definition) abnormal to avoid brain decay, and those "sharp as a tack" 90 year olds represented very anomalous genes. Happily for we skeptics the data is increasingly supporting the depressing hypothesis that Alzheimer's is a "normal" consequence of aging that, like bad joints and bad hearts, very few will entirely avoid.

Not that denial is dead. Note below how the researchers and journalist confuse "normal" with "healthy" or "optimal". Bah. Weak muscles and flabby hearts are a normal part of aging. So are bad brains. If normal is what happens to most of us, and if most of us develop forgetfulness with aging, and most forgetfulness is due to Alzheimer's or vascular disease, then most of us (if we live long enough) will get Alzheimer's -- so Alzheimer's is "normal". What clearly does vary is the age of onset, not the common process.

Get used to it. If you don't like it, then support funding for research to slow the "normal" decay of the brain. (Not that I personally have anything at stake here.)

So read the article, but also appreciate the profound confusion afflicting both the journalists and (less forgiveably) the researchers. I've added a few comments to help out :-).

A new study refutes the notion that forgetfulness is a normal part of aging. Among elderly people who had mildly impaired thinking and memory before their deaths, autopsies revealed that more than three-fourths had Alzheimer's disease or small strokes. ...

... Researchers examined the brains of 180 elderly nuns, priests and brothers who had volunteered to undergo annual cognitive tests and to donate their brains after their deaths.

Of the 37 volunteers who had exhibited mild cognitive impairment, autopsies showed that more than three-fourths had suffered brain damage from Alzheimer's disease or stroke. Less than one-fourth showed no evidence of disease.

.. Everyone has memory lapses, such as forgetting a name. Mild cognitive impairment is more severe. A mildly impaired person might, for example, forget a conversation or read a story and remember only bits and pieces. However, the person would not have other symptoms of Alzheimer's, such as impaired judgment or reasoning. [jf: note the emphasis is on an inability to acquire new information.]

... There was one piece of good news in the Rush study. One-third of the participants showed no evidence of cognitive decline, even though their average age at death was 82. [jf: 2/3 had cognitive decline. That means it's "normal". but ...]

Surprisingly, autopsies revealed that about half of the people with no cognitive impairment had Alzheimer's disease. And nearly one in four had experienced strokes. Their brains apparently had a reserve capacity that enabled them to function normally despite damage done by disease, Bennett said. [jf: So even those who didn't have obvious cognitive decline still shared the same disease processes. They just weren't symptomatic yet. Might as well admit we're talking "normal" here.]

Buffett and the share cropper society

From the Berkshire-Hathaway annual letter. There are very few comparable overviews of the worldwide economy. Most such reviews are either proprietary or are political documents. I do wonder about his trade policy ideas though. They remind me of the Nixon era attempts to beat inflation through price controls. Is it our trade policies or our fiscal and monetary policies that are the problem? I'd like to see DeLong and his ilk comment on this.

I thought his most interesting comments were about how huge the 1990s bubble really was, and how we're still very much experiencing its effects. I wonder how the real estate bubble will feel. As The Economist has written recently, if we treat asset inflation as "true inflation" we're now experiencing early 1970s style inflation. We know how that story turned out.

IHT: Buffett profits on weak dollar

... When the stock market was soaring in the late 1990s, Warren Buffett now says, he should have sold stocks rather than just complain about overvaluation. Now, with the dollar still headed down in his view, he says he is acting on his opinions even though it makes him nervous that so many agree with him.

The annual report showed that of the $3.5 billion in pretax gains on investments Berkshire realized in 2004, well over half came from betting against the dollar. Of them, $1.8 billion came from foreign exchange contracts, and a portion of the $730 million in profit on junk bonds also came from foreign exchange gains. The bonds were purchased in 2001 and 2002 when such bonds traded at relatively high interest rates.

... Berkshire ended the year with $43.4 billion in cash and short-term investments, up from $36 billion a year earlier and 12.7 billion at the end of 2002. He said he was looking for good investments but having difficulty finding them.

..."The evidence grows that our trade policies will put unremitting pressure on the dollar for many years to come," he wrote. He added that Berkshire owned $21.4 billion in foreign exchange contracts, denominated in 12 currencies, at the end of 2004.

..."There are deep-rooted structural problems that will cause America to continue to run a huge current-account deficit unless trade policies either change materially or the dollar declines to a degree that could prove unsettling to financial markets," he said.

... "A country that is now aspiring to an 'Ownership Society' will not find happiness in - and I'll use hyperbole here for emphasis - a 'Sharecropper's Society.' But that's precisely where our trade policies, supported by Republicans and Democrats alike, are taking us."

Buffett's reputation was built on buying stocks, and sometimes whole companies, cheaply, and on rarely selling stock in what have become Berkshire's principal holdings. In the report, he said that Berkshire's "Big Four" stock positions - American Express, Coca-Cola, Gillette and Wells Fargo - had performed well in terms of their businesses but that he had underestimated how overvalued they had become during the bubble. Of the four, only Wells Fargo now trades for more than it sold for in 2000; Coca-Cola is worth less than half its peak value.

Should a government insure citizens against bad outcomes?

The New York Times > Opinion > Krugman: The Debt-Peonage Society

The bankruptcy bill was written by and for credit card companies, and the industry's political muscle is the reason it seems unstoppable. But the bill also fits into the broader context of what Jacob Hacker, a political scientist at Yale, calls "risk privatization": a steady erosion of the protection the government provides against personal misfortune, even as ordinary families face ever-growing economic insecurity.

Throughout most of human history self-insurance was the rule. If calamity fell, and it usually does, then financial and family assets were the main form of protection. Then came tribes, clans, feudal holdings, states and more. Each form of social organization had its own approach to risk mitigation, and its own set of trade-offs.

In the late 20th century a group of wealthy nations developed an approach that provided considerable personal freedom while also mitigating the harshness of life in a seemingly dispassionate universe. This approach has reached its most mature state in the Scandinavian nations, where there is a dynamic struggle between the limitations of human nature and the desire to help the weak.

America followed the European path from about 1945 through the 1970s. Since then we've taken a different approach. Now, in the era of the most radical presidency since Roosevelt, we seem to be moving to something that's a cross between feudalism and and 19th century England. It is an approach that may well optimize returns on investment, at the cost of creating a hereditary subclass of warriors and servants. Warren Buffet's "sharecroppers' society" or Krugman's "debt-peonage" society, or what I've called neo-Feudalism.

In all of its thousands of years of civilization, I wonder if China did something like this at least once. How did it turn out?

MetaFilter profiles infamous London Underground Map(s)

Stand clear of the closing doors | MetaFilter

I've given a lecture on computational visualization at the U of MN for the past two years. It's a fun talk. The London Underground map features in my lecture, thanks to this collection of links I'll have a better story next year.

Explore Minnesota: Firefighters Hall & Museum

Explore Minnesota: Firefighters Hall & Museum

The twin cities has a new children's attraction - fire engines to climb on. I'll add this to our family rec page.

Freedom - you were nice to know - part XVI

Dan Gillmor on Grassroots Journalism, Etc.: The Gathering Storms Over Speech

Dan Gillmor, a journalist, writes about how freedom and the press:

We're moving toward a system under which only the folks who are deemed to be professionals will be granted the status of journalists, and thereby more rights than the rest of us. This is pernicious in every way.

Mass media journalists and their bosses should be leading the fight against what's happening to bloggers. I fear they won't, because old media typically refuses to defend the rights of new entrants until the threats against the new folks directly threaten everyone. But my former colleagues in Big Media should understand that when we distinguish among kinds of journalists, discriminating against some because they're not working for organizations deemed worthy (or powerful) enough, trouble will arrive soon enough for everyone.

In a world where anyone can be a journalist, we can't let government or Big Media decide who has the right to inform the public about matters of interest or urgency. The priesthood should be dissolving, not gaining strength -- yet rulings and legislation like these move things in precisely the wrong direction.

This is a multi-pronged program:

1. Limit the global right to free speech.
2. Limit the definition of who gets the broader protections afforded journalists to those who are employed by legal corporations.
3. Control the entities that employ journalists.

An obvious short term response is to incorporate the amateur journalists. Create a corporation and charge a small fee to join. Have the corporation publish a newsletter made up of a random selection of member postings. The newsletter is financed by the feeds of the members. All the members are now journalists.

Is Greenspan demented?

NewDonkey.com

Greenspan is 79 years old on March 6th. The vast majority of humans have measurable and significant cognitive impairment by age 79. Early dementia is common, though given Greenspan's base intellect he will function well even when significantly impaired.

One of the common features of the natural and inevitable decay of the brain is a return to old beliefs, frequently with a loss of judgment and flexibility. Beliefs like these:

The Moose's post today linked to an AEI article by Bill Bradford about Greenspan's much-reported but oft-forgotten association with the Objectivist cult of novelist and proto-libertarian Ayn Rand. I thought I knew the story pretty well, but two things really startled me in Bradford's piece: (1) Greenspan went straight from Rand's inner circle (ironically but accurately known as 'The Collective') into the 1968 presidential campaign of Richard Nixon. In fact, Greenspan was already knee-deep in conventional Republican politics when he signed onto Rand's bizarre excommunication of her protege and former lover Nathaniel Brandon. (2) When asked during various Senate confirmation hearings over the years if he still adhered to Randian dogmas like abolition of all regulations and a return to the gold standard, Greenspan gave no sign of a change of heart or mind.

I don't think Greenspan has become particularly corrupt in his old age. I do think he may suffer from the typical cognitive impairment of a 79 yo man; an impairment that will be somewhat masked by his high baseline IQ.

Excellent commentary on the mad adventures of a 3 engined British Airways flight

Crossing the Atlantic with a dead engine

Great post, and Joe summed it up very well: "When someone says it's not about the money — it's about the money."

OK British Airways. It's time to fold up shop.

The universe as an infinite pile of overlapping grapefruits

Science & Technology at Scientific American.com: Misconceptions about the Big Bang -- [ COSMOLOGY ] -- Baffled by the expansion of the universe? You're not alone. Even astronomers frequently get it wrong

I think it's simpler to believe we just live in a simulation, or, if you prefer, the dream of a God. Then we push all this bizarre stuff off to whatever runs the dreamer. Don't you agree?

Observers living in the Andromeda galaxy and beyond have their own observable universes that are different from but overlap with ours. Andromedans can see galaxies we cannot, simply by virtue of being slightly closer to them, and vice versa. Their observable universe also used to be the size of a grapefruit. Thus, we can conceive of the early universe as a pile of overlapping grapefruits that stretches infinitely in all directions. Correspondingly, the idea that the big bang was 'small' is misleading. The totality of space could be infinite. Shrink an infinite space by an arbitrary amount, and it is still infinite.

...Does this prediction of faster-than-light galaxies mean that Hubble's law is wrong? Doesn't Einstein's special theory of relativity say that nothing can have a velocity exceeding that of light? This question has confused generations of students. The solution is that special relativity applies only to "normal" velocities--motion through space. The velocity in Hubble's law is a recession velocity caused by the expansion of space, not a motion through space. It is a general relativistic effect and is not bound by the special relativistic limit. Having a recession velocity greater than the speed of light does not violate special relativity.

...Astronomers have observed about 1,000 galaxies with redshifts larger than 1.5. That is, they have observed about 1,000 objects receding from us faster than the speed of light. Equivalently, we are receding from those galaxies faster than the speed of light. The radiation of the cosmic microwave background has traveled even farther and has a redshift of about 1,000. When the hot plasma of the early universe emitted the radiation we now see, it was receding from our location at about 50 times the speed of light

...Thus, we can observe light from galaxies that have always been and will always be receding faster than the speed of light. Another way to put it is that the Hubble distance is not fixed and does not mark the edge of the observable universe.

...If space were not expanding, the most distant object we could see would now be about 14 billion light-years away from us, the distance light could have traveled in the 14 billion years since the big bang...the current distance to the most distant object we can see is about three times farther, or 46 billion light-years.

... People often assume that as space expands, everything in it expands as well. But this is not true. Expansion by itself--that is, a coasting expansion neither accelerating nor decelerating--produces no force. Photon wavelengths expand with the universe because, unlike atoms and cities, photons are not coherent objects whose size has been set by a compromise among forces. A changing rate of expansion does add a new force to the mix, but even this new force does not make objects expand or contract.

...In fact, in our universe the expansion is accelerating, and that exerts a gentle outward force on bodies. Consequently, bound objects are slightly larger than they would be in a nonaccelerating universe, because the equilibrium among forces is reached at a slightly larger size. At Earth's surface, the outward acceleration away from the planet's center equals a tiny fraction (10–30) of the normal inward gravitational acceleration. If this acceleration is constant, it does not make Earth expand; rather the planet simply settles into a static equilibrium size slightly larger than the size it would have attained.

I love how the author slips in the part about "size set by a compromise among forces". Existence as a committee deliberation. I definitely don't understand any of this.

Detective Duane does impressive work

ChoicePoint Data Cache Became a Powder Keg (washingtonpost.com)

Sheriff detective Duane Decker gets a call from ChoicePoint. He sets up a routine sting operation and uncovers a massive identity theft.

The ChoicePoint story is interesting in so many ways. The most important questions are around the primary market for personal information and the indentity theft industry but there are other neat aspects. For example, are all LA Sheriffs as clever and effective as Mr. Decker? For another, I think it's fascinating how Nigeria seems have developed a "comparative advantage" (economics term) in identity theft and in fraud.

58877241. Never forget.

Daily Kos :: Political Analysis and other daily rants on the state of the nation.

Can Betty G's story be true? It would seem incredible in a work of fiction. We should know within a week or so.

Influenza is picking up late this year

CDC - Influenza (Flu) | Weekly US Map: Influenza Summary Update

As of Feb 19th Oregon and Washington are hard hit, as is much of the SouthEast. The CDC doesn't split out Northern California from southern, but I've heard anectdotal reports that suggest San Francisco may resemble Portland. Minnesota is still on the quiet side. The CDC says some of the current strains are different enough that even vaccinated persons may be susceptible. Early treatment with antivirals can significantly shorted duration of illness; this works best when a family member is known to have the flu and others start to develop very early symptoms. A script for antivirals for family members may be written when the index case is diagnosed (helps if you're seeing a family doc!).

It will be interesting to see next week's map.

Creating a reliable system out of unreliable components: Google and massive redundancy

Google's secret of success? Dealing with failure | CNET News.com

For Google, reliability is an emergent property of the system. An individual cell (computers) is not that robust. Cells die and are taken out of commission every day. The system, however, is very robust.

Sound familiar?

That's how your body works. Individual cells are not all that reliable. They are constantly mutating, breaking down, getting infected, becoming immortal (bad). The human body, however, is reasonably reliable -- we don't crash every day. Reliability is an emergent property of large numbers of unreliable components.

Google wasn't the first enterprise to product reliability through redundancy. The space shuttle flies with (I think) six computers. Five are identical, one is quite different. They all have to agree on their outputs.

What's the lesson for home? I'm not sure. I need to think about that one. System reliability (phone, pda, server, desktop, laptop, iPod ... ) is a big headache in our household. I know I need more reliable and less troublesome tools.