Health care reform 2007 - the Massachusetts plan

The discussion begins again. Gawande begins with the assumption that we introduce a new plan without removing the existing system. It's a practical approach.

Curing the System - New York Times
By ATUL GAWANDE
Published: May 10, 2007

....Experts have offered half a dozen more rational ways to finance all this than the wretched one we have. But we cannot change everything at once without causing harm....

...Option 1 is a Massachusetts-style reform.... Enacted statewide last year, the law has four key components. It defines a guaranteed health plan that is now open to all legal residents without penalty for pre-existing conditions. Using public dollars, it has made the plan free to the poor and limited the cost to about 6 percent of income for families earning up to $52,000 a year. It requires all individuals to obtain insurance by year end. And it requires businesses with more than 10 employees to help cover insurance or pay into a state fund.

The reform gives everyone a responsibility. But it leaves untouched the majority with secure insurance while getting the rest covered. As a result, it has had strong public approval. Experience with delivering the new plan is accumulating. And best of all, it offers a mechanism that can absorb change. The guaranteed health plan may cover 5 percent of the state at first, but as job-based health care disintegrates, the plan can take in however many necessary...

The Massachusetts plan seems very much like the Clinton plan, or at least something that would evolve to it. The employer burden is interesting, I assume it's there so employers don't ditch health care coverage en masse.

The "shared responsibility" part sounds like a political slogan. In any event this is consistent with my prediction of how it will all turn out.

Slouching towards world government: the police force

Phil Carter joins a call for an international policing mission...

INTEL DUMP - New articles of interest

... The time has come to develop standing constabulary forces at several levels: U.S., NATO, and U.N. Such a building block approach would allow national and regional operations, as well as global U.N. efforts....

...Policing and crime control skills must be integrated into strategic and operational responses to peace operations and related conflicts that challenge transnational stability. A global framework of standing or composite constabulary forces could fill this need...

Global warming management, global standards for food and drug safety, global police forces, a recent 'parliament of the united nations' meeting... world government is in the air again.

Age of wonders: A North Korean Bush joke

The author of a post on a Hong Kong journalism student site seemed mostly concerned with the affront to American dignity, but I found this story both marvelous and encouraging ...

International News (JMSC 0042): North Korea general tells Bush joke

When military chiefs from the two Koreas met on Tuesday for talks, a general from the North, Kim Yong-chol, started off by telling a joke about Bush on the internet.

He then retold the joke about Bush who goes out jogging one morning and as Bush is preoccupied with international affairs, fails to notice that a car is heading straight at him.

A group of schoolchildren pull the president away just in time, saving his life, and a grateful Bush offers them anything they want in the world as a reward. However, the children ask for a reserved place for them in the Arlington Memorial Cemetery. Bush asks them why.

“Because our parents will kill us if they find out what we’ve done.”

Incidentally, it's funny, albeit a bit politically improper. Bush isn't run over, the children are fine, and it's a variation on a very old and well established joke.

Much more importantly, we see that Kim Yong-chol is rather well connected. He (or one of his intelligence people) reads jokes off the internet, knows Bush is very unpopular in the US, and he tells a joke that's a bit chancy but is quite topical.

Why is this good news? Remember the common American perception that North Korea is full of delusional madmen cut-off from reality. That's clearly not true at a fairly senior level. The more they know about the world, the less likely they are to do something that will work against their own best interests. And if North Korean knows its own best interests, then there's a lot that can be done ...

Pet poison chemistry: more on cyanuric acid

So cyanuric acid was not merely a byproduct of melamine production, it was a fraudulent ingredient in its own right ...

Another Chemical Emerges in Pet Food Case - New York Times

... Two of the Chinese chemical makers say that cyanuric acid is used because it is even cheaper than melamine and high in nitrogen, enabling feed producers to artificially increase protein readings which are often measured by nitrogen levels of the feed. The chemical makers say they also produce a chemical which is a combination of melamine and cyanuric acid, and that feed producers have often sought to purchase scrap material from this product.

Competition among animal feed producers here is intense. But the practice of using cyanuric acid may now provide clues as to why the pet food in the United States became poisonous.

Scientists had difficulty pinpointing the precise cause of the deaths, for neither melamine nor cyanuric acid are thought to be particularly toxic by themselves. But scientists studying the pet food deaths say the combination of the two chemicals, mixed together with perhaps some other related compounds, may have created a toxic punch that formed crystals in the kidneys of pets and led to kidney failure.

“I’m convinced melamine can’t do it by itself,” said Richard Goldstein, an assistant professor at the Cornell University College of Veterinary Medicine. “I think it’s this melamine with other compounds that is toxic.”

On May 1, scientists at the University of Guelph in Canada said they had made a chemical discovery that may explain the pet deaths.

In a laboratory, they found that melamine and cyanuric acid may react with one another to form crystals that could impair kidney function. The crystals they formed in the lab were similar to those discovered in afflicted pets, they said...

Another quote in the article says cyanuric acid is allowed in food in China, even though it's only known use is to produce deceptive protein measurement.

On the brighter side, there are hints in other articles today that China may start taking food safety very seriously, basically requiring exporters to support the standards of the importing country. That is potentially politically explosive, however, given the poverty of the rural areas where the fraud is rampant ...

The end of Down syndrome and the rise of the modern eugenics movement

Down syndrome will become very rare within US schools by 2020.

Prenatal Test Puts Down Syndrome in Hard Focus - New York Times

...About 90 percent of pregnant women who are given a Down syndrome diagnosis have chosen to have an abortion...

90%. We may be sure that abortion will not go away in the US, though it may lose public funding.

Since Trisomy 21 is not a rare cause of cognitive disability, this will slightly reduce special education costs in the US starting 6 years from today.

The Times article describes people with Down syndrome advocating against the diagnostic test. This is similar to deaf persons arguing against the use of acoustic nerve prostheses. Whatever social noises we may make, abortion is a pretty clear statement of honest perception. I don't think the advocacy will change the numbers, and I don't think our modern eugenics movement will stop with Downs syndrome. Many less disabling disorders will be also aborted. If we devise gene testing for dyslexia or Asperger's ...

I have personal reasons to both understand and empathize with those who campaign against the abortion of children of Down syndrome. Much that is good and joyful will be lost to parents and to society. The neurotypicals who will instead be born will, I suspect, produce greater harm than the Down children who will never be.

Remember, it won't stop with Down syndrome. We will have our eugenics movement, for better and for worse.

Update 5/11/07: Steven Levitt, the well known economist and writer (Freakonomics), has a poignant comment on this topic. He's not asserting a position, he is speaking a truth. I would not have chosen the life I now live, but I would not undo it either.

Bismarck and Mother's Day

If Bismarck's mother had not sent him to a boarding school at age 6, would we have avoided WW II and possibly even WW I?

In Our Time reviewed the Iron Chancellor a few months back. I was left with the impression of a very talented and not particularly evil man who set up Germany and the world for colossal tragedy. If he'd had more mental flexibility, fewer internal demons he couldn't shake, less insecurity at the core of his massive confidence, could Germany have taken a far healthier route to modernity?

Boarding school at age 6 is not a good idea. Thus does one mother's personal error have non-trivial consequences. A thought my wife will doubtless treasure come Mother's Day ...

PS. Liberate In Our Time!

Experiments in employment: DoMyStuff

This will be most interesting when you're able to hire a very smart person from a nation where a good wage is $5/day.

Website Does Your Stuff

... DoMyStuff.com is as entertaining as it is easy to use. Unlike the other legitimate Work-at-Home web sites, DoMyStuff.com allows posting of the old-fashioned, “gal-Friday” type of jobs. From grocery shopping to laundry, babysitting to mowing the lawn, changing the oil to arranging a party, you’ll see it on DoMyStuff.com...

The fallacy of delayed retirement

This data is consistent with they hypothesis that, for the average American, functional decision making deteriorates after about age 53:

Marginal Revolution: Eight more years to go

....The sophistication of financial decisions varies with age: middle-aged adults borrow at lower interest rates and pay fewer fees compared to both younger and older adults. We document this pattern in ten financial markets. The measured effects can not be explained by observed risk characteristics. The sophistication of financial choices peaks at about age 53 in our cross-sectional data. Our results are consistent with the hypothesis that financial sophistication rises and then falls with age, although the patterns that we observe represent a mix of age effects and cohort effects....

It's a long downhill ride to age 68.

Unless we can find a way to slow the natural Alzheimer's process, we should expect the employment situation and income of the average non-"tenured" workers [1] to deteriorate after age 55. Remember that the next time you read about how baby boomers will work so much longer than their parents ...

On the upside, I'm betting that today's 30 yo will be on preventive meds by the time they're 45 -- they may well be able to work into their 70s.

[1] Tenure as in academia, but also the "tenure" of senior executives who are no longer "at will" employees.

Geeks crush DMCA

The aggregate geek mind is on the war path. Yesterday tatoos and color coded t-shirts were used to protest the ownership of a 128 bit integer, now geeks are using the DMCA to seize personal control of other digits.

Slashdot | Own Your Own 128-Bit Integer

.... the folks at Freedom to Tinker would like to point out that you too can own your own integer. They've set up a script that will generate a random number, encrypt a copyrighted haiku with it, and then deed the number back to you. You won't get a copyright on the number or the haiku, but your number has become an illegal circumvention device under the DMCA, such that anyone subject to US law caught distributing it can be punished under the DMCA's anti-trafficking section, for which the DMCA's Safe Harbor provisions do not apply.

Alas the server is a cooling puddle of liquid metal. Try it in a few days ...

Money and software features

CH wrote a nice post on programming quotes (you have to read his bleak favorite), including one from Larry Wall about buying things:

Coding Horror - a Larry Wall quote

...I think that the biggest mistake people make is latching onto the first idea that comes to them and trying to do that. It really comes to a thing that my folks taught me about money. Don't buy something unless you've wanted it three times. Similarly, don't throw in a feature when you first think of it. Think if there's a way to generalize it, think if it should be generalized. Sometimes you can generalize things too much. I think like the things in Scheme were generalized too much. There is a level of abstraction beyond which people don't want to go. Take a good look at what you want to do, and try to come up with the long-term lazy way, not the short-term lazy way...

Great advice for software, but even better advice for spending.

SciAm on the Pet Poisons: chemistry at last

SciAm has a reasonable update, with a bit of science. The headline is misleading; the companies using melanine did not expect it to injure animals -- they didn't really want to get caught.

Were Our Pets Deliberately Poisoned?: Scientific American

..."We have found cyanuric acid, which is somewhat related to melamine," says Stephen Sundlof, director of the FDA's Center for Veterinary Medicine. Both compounds have high levels of nitrogen, which are a measure of protein in a food product. Wheat, rice and corn glutens are forms of vegetable protein that are used as binders in soft (or wet) pet food. They can also be added to dry food to enhance the protein content, says Dave Griffin, owner of the independent pet store Westwood Pet Center in Bethesda, Md. Griffin, who has worked in the pet industry for 35 years, adds that because of lax labeling requirements, pet food manufacturers are not required to specify the source of protein—that is whether it is from meat or meal.

Brent Hoff, a clinical toxicologist and pathologist at the University of Guelph in Ontario, confirmed the presence of cyanuric acid in both the rice protein concentrate as well as in crystals found in the urine and kidneys of sick animals. Late last month, those crystals, which are brown and round in shape, were found to be made up of 30 percent melamine; the composition of the other 70 percent has yet to be determined, although it is known to contain cyanuric acid as well as amilorine and amiloride, which are by-products of melamine.

Cyanuric acid may have been added separately to the feed, however it's also likely it was present because it can result from the bacterial degradation of melamine, says Richard Goldstein, a kidney specialist at the Cornell University College of Veterinary Medicine. Much like melamine, cyanuric acid, which is typically used in chlorination during pool cleaning, is not known to have a high toxicity. "People swallow it all the time" in pool water, Goldstein says. However, he adds, "It does have a toxic effect on the kidneys in very high doses…. Combining it with melamine may cause it to crystallize and hang out in the kidneys a lot longer than normal."

Hoff and his colleagues at Guelph are continuing to analyze the crystals found in sick pets to determine "how close the crystals are to the precipitate [the solid that results when two chemicals react] of melamine and cyanuric acid." For now, though, Hoff cautions, "We haven't got it down pat."

The FDA also announced that it is taking preemptive steps to try to prevent further damage by testing protein ingredients for melamine in a variety of pet and human food, which contains protein additives—like wheat gluten and rice protein concentrate—that are imported from outside the U.S. David Acheson, chief medical officer for the agency's Center for Food Safety and Applied Nutrition, says the new measures are to determine "where else may this be" in order to keep the contaminant from sickening any more pets and, perhaps, people as well....

..."As part of this approach," Acheson says, the "FDA and the state authorities are going to raise awareness with manufacturers and processors about the importance of knowing all there is to know about their suppliers." Thus far, contaminated wheat gluten and rice protein concentrate has been discovered in North America, and melamine-containing corn gluten was also used in pet food in South Africa. All of the tainted protein additives have been sourced to Chinese manufacturers...

... The FDA will finally get a shot at getting to the root of the matter now that Chinese officials have relented to requests to allow inspectors into the country to probe gluten suppliers implicated in the potential scandal. The FDA reported that it had finally received letters of invitation from the Chinese government, which are necessary to obtain visas. The agency plans to investigate the manufacturing practices of the two suppliers of the melamine-containing rice and wheat glutens that have been imported by the U.S., to determine if and how cross-contamination may have occurred.

... The Center for Science in the Public Interest, a Washington, D.C.-based group that advocates health and food safety, recommended that the FDA bar the import of grains from China....

So far the FDA hasn't made any significant changes. I don't know if they can without congressional action.

UC advice on surviving a shooter

Schneier links to the PDF. Some excerpts (emphases mine):

• If officers arrive on scene, community members should get out and move toward any Police vehicle when safe to do so while keeping their hands on top of their head and do exactly and immediately what the Police tell you to do.
  
  
• Unless you are very close to an exit, don’t run through a long hall to get to one, you may encounter the gunmen or hostage taker. Don’t hide in restrooms!
  
  
• If they do start shooting people, you need to make a choice, (at this point it is your choice) stay still and hope they don’t shoot you, run for an exit while zig-zaging, or even attack the shooter. This is very dangerous, but certainly no more then doing nothing and dying in place. A moving target is much harder to hit than a stationary one and the last thing that the shooter will expect is to be attacked by an unarmed person...
  

Hands on the head near police. No bathrooms. If he's shooting, move.

I doubt I'll ever need to know this, but ...

Fallows on the Bush attorney scandals - murder suppressed?

Fallows suggests that Bush administration gun politics may have impeded investigation of the murder of Tom Wales, a federal prosecutor. The prime suspect may have been well connected.

Fallows is an establishment journalist. Years ago I'm sure this connection would never have occurred to him, but six years of the worst presidency ever has made everything conceivable.

Incidentally, he mentions the curious timing of a plum job offer and $1.5 million dollar "bonus" that terminated the investigation of another allegedly corrupt GOP congressman. I wonder if Debra Wong Yang could be encouraged to talk to Congress ...

Cho: the system worked, until it didn't

So the system worked. Cho was identified as a danger to himself and others two years ago. Except the system had gaping holes in it. Disaster must have narrowly averted dozens of times, but humans don't learn from averted disasters. We're just not built that way.

We only learn from true disaster, and then we learn as little as possible in the smallest possible domain. It's probably part of how we got through the day in simpler times, but it's an evolutionarily obsolete behavior.

Virginia might fix their system. Will Minnesota's Secretary of Health order a review of our involuntary commitment procedures in light of the Blacksburg tragedy? Probably not, though one can dream.

Somehow we need to do better.

Eta Carinae: no need to worry

Back before the dinosaurs, in a galaxy not so far away, a big star blew. We have similar one nearby ...

Huge star explodes in brightest supernova yet seen | Science | Reuters

WASHINGTON (Reuters) - A gargantuan explosion ripped apart a star perhaps 150 times more massive than our sun in a relatively nearby galaxy in the most powerful and brightest supernova ever observed, astronomers said on Monday.

... The supernova, designated as SN 2006gy, occurred 240 million light years away in a galaxy called NGC 1260, and was studied using observations from NASA's orbiting Chandra X-ray Observatory as well as earthbound optical telescopes...

... Astrophysicist Mario Livio said the supernova may have resulted from a type of explosion mechanism that had existed only in theoretical calculations. He said the first generation of stars in the universe may have died in such a manner.

In a normal supernova, the core of a star collapses when it exhausts its fuel, and forms either a neutron star or a black hole, with scant heavy elements blown into space.

But this supernova appears to be the result of the core not collapsing but being obliterated in an explosion blasting all its material into space, the scientists said.

Dave Pooley of the University of California at Berkeley said this star appears similar to Eta Carinae, a star perhaps 100 to 120 times the mass of the sun located 7,500 light years away within the Milky Way. There has not been a supernova in our galaxy in more than 400 years, Pooley said...

... If Eta Carinae were to burst into a supernova, Pooley said, "It would be so bright that you would see it during the day, and you could even read a book by its light at night."...

... "This could happen tomorrow, it could happen 1,000 years from now," Livio said. "Is there a risk to life on Earth as a result of this explosion? Well, not very likely."

Livio said Earth could be affected if there were a gamma ray burst that potentially could harm the atmosphere and life, but the chances of this aiming directly at Earth are slim.

When I read these stories I spare a moment to reflect on whatever was "downwind" from SN 2006gy.

I liked the "slim" comment. Really, I don't need to know how slim. If Eta Carinae's future gamma beam travels our way we're toast. Happily we have far more urgent things to worry about ...