Apple's iPhone Calendar makes me miss my parents' anniversary

I blogged about this four months ago, but it's the Apple gift that keeps on giving.

For the seven or more years that I used various versions of Gorilla Haven's DateBk on my Palm, I got 2-3 week warnings of birthdays, anniversaries on the like.

It was great. I rarely missed a card or an event

Then I got my 21st century iPhone, with a locked down, no API, Apple authored Calendar.app. A calendar that allows a maximum 2 day reminder of events.

Events like my parents' anniversary, now 2 days away.

Two $!#$#$ days!

That's the problem with devices built by children. In their world, 2 days is a long time.

Nettie, how many days warning does the Pre calendar allow you?

Update: It's unchanged in iPhone 3.0.

Update 6/20: The Pre isn't all that much better - suprisingly!
Via Nettie:

... for all-day events in the Pre calendar you can remind 1/2/3/7 days before. For meeting-type events you can remind 5/10/15 mins and 1 day...

It must be something in Cupertino water supply.

Why smart software can be so stupid – the Microsoft Access example

This is one of my favorite examples of the wrong way to deliver smart software.

Microsoft Access 2003 (2007 too I think) tries to be smart when importing an Excel spreadsheet. Rather than look at Excel’s data types, it looks at the data in the first 25 rows. Then, based on the patterns it sees there it infers a data type … (emphases mine)

Import, export, and link data between Access and Excel - Access - Microsoft Office Online

Data type  By default, Access scans the first 25 rows to guess the data type of the column. If Access encounters values beyond the 25th row that are not compatible with the chosen data type, it will simply ignore those values and not import them.

… You cannot change the data type of the destination field during the import operation.

It’s the combination of oh-so-smart cleverness (infer the data type) and pure stupidity (no user override of the inferred type) that makes this such a priceless example.

The lessons?

First, be very conservative about making your software “smart”. In general, you’ll make it stupid.

Second, if you’re going to make your software smart, let the user override the clever code.

It’s not like Access is a consumer tool anyway.

I can’t measure what an amazing amount of pain this stupid design has caused me over the years. It even afflicts linking to a spreadsheet from Access.

H1N1 (swine) flu – it’s back in Minnesota

Actually, it never went away – which is a bit weird.

We’re seeing a fair amount of it in Minnesota.  This blurb came from the University of Minnesota and it’s not bad as these things go.

Emergency Preparedness : Academic Health Center Office of Emergency Response

As I’m sure you’ve been hearing in the news, spread of the novel H1N1 influenza (swine flu) is increasingly common and occurring throughout Minnesota. I thought it would be a good time to provide you with an update.

Currently all patients in Minnesota with flu symptoms such as fever, cough or other respiratory symptoms are considered likely to have the H1N1 novel influenza virus. The Minnesota Department of Health is now only conducting diagnostic testing on severe, hospitalized cases of possible influenza.

Given the increasing spread of H1N1, this is a good time to be reminded of the following:

• If you are sick with flu-like symptoms, you should stay home. You will be considered infectious for 7 days after the onset of symptoms or 24 hours after you are symptom-free, whichever is longer.
• Use excellent hand washing techniques and cover your cough. It is our best first line of defense against the spread of influenza.
• If you are pregnant, immune-suppressed or have a chronic health condition such as diabetes, heart disease, asthma or emphysema, you are at increased risk for severe flu or flu complications. You should contact your health care provider if you have flu symptoms or have been exposed to people with flu symptoms.
• Keep hard surfaces such as workstations, door handles and bathroom surfaces clean using household disinfectant.

The following links can also help answer any questions you may have:

• General Information
• Camp Recommendations
• What to do if you get flu like symptoms
• General Q&A

Pretty good, but their list of increased risk is not complete. This one is from the MN Dept of Health

• Children aged less than 5 years, particularly those less than 2 years of age;
• Persons aged 65 years or older;
• Women who are pregnant;
• Adults and children who have chronic health conditions including chronic lung problems such as asthma, metabolic diseases such as diabetes, heart disease, kidney disease, liver disease, and certain blood diseases;
• Adults and children who have a lowered immune system from medications or chronic health conditions such as HIV;
• Residents of nursing homes and other chronic-care facilities.

The implication, not explicitly stated, is that if you’re not at increased risk you’re supposed to stay home.

The CDC and departments of health need to do a much better job of providing guidance about home management of H1N1 flu -- including a description of the expected course and instructions to contact a physician if the disease is NOT following the expected course.

As I’ve mentioned before, I think the CDC has blown this one. We’re just lucky this flu hasn’t been unusually severe – so far. Though any influenza is nasty enough.

Fear in China's government

I don't think this has much to do with porn ...

China lambasts Google again for disseminating porn - Ars Technica

.... Google is guilty of 'disseminating pornographic and vulgar information' and should stop immediately, according to China's Internet Illegal Information Reporting Center. The organization made the accusation Thursday after making several requests to Google to remove what it has deemed inappropriate content, and said that Chinese authorities should take action if Google won't conduct a 'thorough clean-up"...

China's economy is under severe strain. International coverage of the 20th anniversary of the Tiananmnen square protests must have leaked back into China. China is mandating use of government controlled filtering software on all computers. South Korea is a huge cultural influence in China, and the inevitable collapse of North Korea will eliminate China's last remaining communist ally. The Iranian protests must be unnerving, and disturbingly reminiscent of Tiananmen and the fall of the Berlin wall. Lastly, with Bush gone, it's harder to find an inspiring example of a criminally stupid western government.

Installing monitoring software and attacking Google are not things the Chinese communist government does when it's feeling confident.

Interesting times.

Apologies to politicians of 1990s Japan and 1930s America

In 1930's America, Krugman shows us that a big majority of Americans thought it was critically important that Roosevelt try to balance the budget.

So he did.

And the Great Depression returned.

Today Americans want to make the same mistake, just as the Japanese did in the 90s. We need to cut the past politicians who blew this decision a bit of slack. It's hard to fight a national urge to suicide.

We Americans have less excuse than the people of that era. I hope Obama can convince America not to repeat the same old mistakes.

The CDC flunks the H1N1 test

The CDC is whining ...

Health Care Workers Muffed H1N1 Flu Precautions - ABC News

... A snapshot of the health care workers who came down with the H1N1 flu in the first few weeks of the outbreak suggests that proper infection-control practices weren't uniformly followed, the U.S. Centers for Disease Control and Prevention said today....

Bah, humbug!

I've been checking the CDC's web site for provider oriented recommendations over the past few months.

Shall I be delicate?

Heck, no.

The CDC's H1N1 recommendations were, and have been, a fuzzy pile of worthless pap. They've provided no practical guidance on managing patients with fever and cough, very little useful information on infection control, almost nothing on diagnostic procedures and criteria, and very few concrete therapeutic recommendations.

They've weaved, dodged, hemmed and hawed.

And now they're whining.

Ptui!

A good thing happens: fiber optic connections to the Horn of Africa

We’ve had a bit of a good news deficit lately, though there’s no doubt things could be (much) worse.

So this bit of good news is most welcome. Among other things it’s potentially a significant business opportunity for Minnesota’s large Somali and Ethiopian communities.

Emphases mine.

Economist.com – June 2009

… THE Horn of Africa is one of the last populated bits of the planet without a proper connection to the world wide web. Instead of fibre-optic cable, which provides for cheap phone calls and YouTube-friendly surfing, its 200m or so people have had to rely on satellite links. This has kept international phone calls horribly overpriced and internet access equally extortionate and maddeningly slow.

But last week, in the Kenyan port of Mombasa, a regional communications revolution belatedly got under way when Kenya’s president, Mwai Kibaki, plugged in the first of three fibre-optic submarine cables due to make landfall in Kenya in the next few months. They should speed up the connection of Burundi, Rwanda, Tanzania and Uganda, as well as bits of Somalia, Ethiopia and Sudan, to the online world. Laying the cable cost $130m, mostly at the Kenyan government’s expense; Mr Kibaki hailed the event for bringing “digital citizenship” to his countrymen.

The new cable will compete with the other two to be welcomed onshore, perhaps later this year. The hope is that the high bandwidth and fierce competition between the three cables will slash costs and help create new business. With a mass of young English-speakers only an hour or two ahead of Europe’s time zones, east Africa should, with luck, be well-placed to compete with India and Sri Lanka for back-office work for Western companies. Broadband, say its promoters, will transform the lives of millions in countries such as Kenya and Sudan, almost as dramatically as mobile telephones have done—all the more so because of the parlous state of east Africa’s more old-fashioned infrastructure, especially roads and railways.

A few call centres have already got a toehold in the market and expect to expand fast when the cables arrive. Security experts say cybercrime and junk mail may increase too. Still, mobile telephones, not internet cafés, will continue to grow the fastest. The number and quality of handsets should rise. In a couple of years even fairly poor east Africans may be getting knowledge, news and entertainment on robust versions of existing Apple iPhone and Palm Pre models. That, in turn, may prove to be a political as well as economic boon, as information gets shared “horizontally”, among people rather than “vertically” via media outlets run by the political and commercial elites.

Rwanda may emerge as a winner. Its president, Paul Kagame, has long identified the internet as a key to his country’s development, offering concessions to software companies setting up there. But Kenya also wants to cash in. It has abolished sales tax on computers and in last week’s budget ended the sales tax on new mobile phones. It has also let businesses write off bandwidth purchases in the hope of dominating the regional internet market. That may make other countries push companies to drop their prices…

There will be problems of course. Stolen infrastructure, corruption, cybercrime, etc.

Even so. Change you can believe in.

Martha, what do you think?

The very cool Layar mobile augmented reality browser (for iPhone)

Flying in to MSP the other day I really wanted icons on the landscape. Click to find out what that lake is. Click to identify that ballpark.

Seems that’s coming sooner than expected, though perhaps not for plane use just yet …

Gizmodo - Layar: First Mobile Augmented Reality Browser Is Your Real Life HUD – Layar

Layar combines GPS, camera, and compass to identify your surroundings and overlay information on screen, in real time. It is available for Android now and it will be available for iPhone soon, but exclusively for the 3GS.

The reason is that Layar needs a compass to work, as Maarten Lens-FitzGerald—from developer SPRXmobile—tells us:

We are definitely going for the new iPhone 3GS because of the compass! We're aiming for release after summer, but we depend on Apple accepting it…

Yes, all those science fiction stories are now passe. I’m looking forward to when they incorporate the facial recognition module …

The backup problem – sometimes the backup isn’t worth the cost

Halamka has a great review of backup strategies and costs, but my favorite bit is in the last paragraph …

Life as a Healthcare CIO: Our Storage Backup Strategy

Over the past year, Harvard Medical School has worked with research, administrative, and educational stakeholders to develop a set of storage policies and technologies that support demand, are achievable in the short term and are affordable.

I recently gave a keynote at Bio-IT World where I described the HMS storage strategy to ensure scalability, high performance, and reliability.

Since that presentation, we've refined our strategy for replication/backup/restoration of data for disaster recovery. In many ways backup is a harder problem to solve and a more expensive project than data storage itself.

Our best thinking (a strawman for now that we are still reviewing with customers) is outlined on this slide. For databases and Microsoft exchange, we're using Data Domain appliances to replace tape …

…  Some departments have asked not to replicate at all, since it is cheaper to rerun an experiment than to replicate the terabytes of data each experiment generates. …

I recently sat through a fascinating recounting of a corporate IT outage. They thought they had sufficient redundancy, but there’s always a limit.

Backups aren’t just a problem for home users. Our current technologies don’t scale as well as one might imagine.

Gmail: I don’t love you any more, but we can still be friends

I’ve been using Gmail since the week it was “released”. There’s a lot I like about it, but I’ve finally decided it’s killing me.

There’s more than one set of problems, but the number one problem is the bloody obligate subject line threading model.

It wouldn’t be so bad if they used some kind of message unique identifier to implement usenet style threading. It would be immensely better if Gmail allowed me to edit the subject lines of incoming messages and thus to create new threads (like this).

In the current state though, it’s a killer. I have too much trouble picking out critically important messages from threads. Searches return the thread, and trawling through the thread is too error prone.

The obligate threading was and is a mistake.

There are other Gmail problems. Google’s only recently fixed up the Contacts model, and I despise the UI for creating mailing lists and working with Contacts. Gmail can be intermittently slow and unreliable – this past week has been very annoying. The IMAP implementation intersects badly with labels; my use of labels means Spotlight searches in OS X Mail.app return multiple instances of a single message.

There’s still a lot I like about Gmail, especially when I use it with iPhone Mail.app. I’m not going to abandon it, but I’m considering simplification measures. I might return to POP style access on OS X for example and use OS X Mail.app when I need to get real work done.

As long as Gmail was used primarily for personal email, their lowest common denominator approach wasn’t necessarily wrong. That’s often a good way to win. Now, though, Google wants to support large enterprises on their Google Apps platform. There are going to be more users like me.

If Google doesn’t start listening to its more demanding customers I won’t be the only one to start seeing other software.

Update: I realize that Gmail contributes to hiding messages in mis-identified threads by hiding the subject line on reply. Sigh.

Choosing a brand? check GoodGuide

I'm delighted someone's doing this ...

An App, the GoodGuide, Aids in Careful Shopping - NYTimes.com

... GoodGuide, a Web site and iPhone application that lets consumers dig past the package’s marketing spiel by entering a product’s name and discovering its health, environmental and social impacts....

Kellogg got an OK rating.

Subversive theophysics - Greg Egan

I've been composing a post about Greg Egan's Permutation City for a while. I'm afraid I'll never get to the whole thing, so I'm going to toss off the short version. (Warning, contains spoilers)

Greg Egan is usually said to write "hard" science fiction. That's inadequate. He writes neutronium grade science fiction. His mathematical physics bent has become so extreme that his latest book is a thin layer of fiction around a core of speculative physics (Amazon promises me a copy in 3-4 weeks, apparently they have to retype it. Egan has put a prequel to the story on his web site).

Permutation City is one of his best works. Despite the math science bent several of the characters have stuck with me.

The best part though, is the fusion between theology and physics -- theophysics. In Permutation City reality is fundamentally mathematical, much as imagined by Stephen Wolfram and many more conventional physicists. A group of experimental modelers creates an artificial world with a different sort of mathematical reality.

No wait, hang in here for a minute. I'm really going somewhere.

The creatures of this new world are fantastically alien, but like us they're compelled to understand their world. Problem is, their world is fundamentally incomprehensible. It was created by omniscient and omnipotent Creators. Gods.

So the alien critter(s) is(are) "anguished". They are compelled to understand, but they cannot understand. The human Creators are sympathetic, and decide to manifest themselves in the alien world. The Truth shall be known, and the aliens will understand.

Except, the aliens come up with their own Theory of Everything; their equivalent of quantum gravity. It looks crazy and absurd, but it's internally consistent. It explains everything but the appearance of the Creators, and that detail can be quickly forgotten.

The Creators suddenly find themselves written out of the script, but that's a different story. I'm telling the story of the subversive aspects of Egan's fiction.

Obviously, the invented aliens of Permutation City aren't alone. We too are compelled to comprehend, and modern physics is getting pretty damned absurd...

State of the Art; The Origin of Life

This article does a great job of describing one of biology's great questions, and describing the state of the art. Superb work. Unfortunately it's so good I'm obliged, for the sake of my own reference, to replicate the whole darned thing. Please click on the link so the NYT gets a visit. Emphases mine.

New Glimpses of Life’s Puzzling Origins - Nicholas Wade - NYTimes.com

.... 3.9 billion years ago, a shift in the orbit of the Sun’s outer planets sent a surge of large comets and asteroids careening into the inner solar system. Their violent impacts gouged out the large craters still visible on the Moon’s face, heated Earth’s surface into molten rock and boiled off its oceans into an incandescent mist.

Yet rocks that formed on Earth 3.8 billion years ago, almost as soon as the bombardment had stopped, contain possible evidence of biological processes. If life can arise from inorganic matter so quickly and easily, why is it not abundant in the solar system and beyond? If biology is an inherent property of matter, why have chemists so far been unable to reconstruct life, or anything close to it, in the laboratory?

The origins of life on Earth bristle with puzzle and paradox. Which came first, the proteins of living cells or the genetic information that makes them? How could the metabolism of living things get started without an enclosing membrane to keep all the necessary chemicals together? But if life started inside a cell membrane, how did the necessary nutrients get in?

The questions may seem moot, since life did start somehow. But for the small group of researchers who insist on learning exactly how it started, frustration has abounded. Many once-promising leads have led only to years of wasted effort. Scientists as eminent as Francis Crick, the chief theorist of molecular biology, have quietly suggested that life may have formed elsewhere before seeding the planet, so hard does it seem to find a plausible explanation for its emergence on Earth.

In the last few years, however, four surprising advances have renewed confidence that a terrestrial explanation for life’s origins will eventually emerge.

One is a series of discoveries about the cell-like structures that could have formed naturally from fatty chemicals likely to have been present on the primitive Earth. This lead emerged from a long argument between three colleagues as to whether a genetic system or a cell membrane came first in the development of life. They eventually agreed that genetics and membranes had to have evolved together.

The three researchers, Jack W. Szostak, David P. Bartel and P. Luigi Luisi, published a somewhat adventurous manifesto in Nature in 2001, declaring that the way to make a synthetic cell was to get a protocell and a genetic molecule to grow and divide in parallel, with the molecules being encapsulated in the cell. If the molecules gave the cell a survival advantage over other cells, the outcome would be “a sustainable, autonomously replicating system, capable of Darwinian evolution,” they wrote.

“It would be truly alive,” they added.

One of the authors, Dr. Szostak, of the Massachusetts General Hospital, has since managed to achieve a surprising amount of this program.

Simple fatty acids, of the sort likely to have been around on the primitive Earth, will spontaneously form double-layered spheres, much like the double-layered membrane of today’s living cells. These protocells will incorporate new fatty acids fed into the water, and eventually divide.

Living cells are generally impermeable and have elaborate mechanisms for admitting only the nutrients they need. But Dr. Szostak and his colleagues have shown that small molecules can easily enter the protocells. If they combine into larger molecules, however, they cannot get out, just the arrangement a primitive cell would need. If a protocell is made to encapsulate a short piece of DNA and is then fed with nucleotides, the building blocks of DNA, the nucleotides will spontaneously enter the cell and link into another DNA molecule.

At a symposium on evolution at the Cold Spring Harbor Laboratory on Long Island last month, Dr. Szostak said he was “optimistic about getting a chemical replication system going” inside a protocell. He then hopes to integrate a replicating nucleic acid system with dividing protocells.

Dr. Szostak’s experiments have come close to creating a spontaneously dividing cell from chemicals assumed to have existed on the primitive Earth. But some of his ingredients, like the nucleotide building blocks of nucleic acids, are quite complex. Prebiotic chemists, who study the prelife chemistry of the primitive Earth, have long been close to despair over how nucleotides could ever have arisen spontaneously.

Nucleotides consist of a sugar molecule, like ribose or deoxyribose, joined to a base at one end and a phosphate group at the other. Prebiotic chemists discovered with delight that bases like adenine will easily form from simple chemicals like hydrogen cyanide. But years of disappointment followed when the adenine proved incapable of linking naturally to the ribose.

Last month, John Sutherland, a chemist at the University of Manchester in England, reported in Nature his discovery of a quite unexpected route for synthesizing nucleotides from prebiotic chemicals. Instead of making the base and sugar separately from chemicals likely to have existed on the primitive Earth, Dr. Sutherland showed how under the right conditions the base and sugar could be built up as a single unit, and so did not need to be linked.

“I think the Sutherland paper has been the biggest advance in the last five years in terms of prebiotic chemistry,” said Gerald F. Joyce, an expert on the origins of life at the Scripps Research Institute in La Jolla, Calif.

Once a self-replicating system develops from chemicals, this is the beginning of genetic history, since each molecule carries the imprint of its ancestor. Dr. Crick, who was interested in the chemistry that preceded replication, once observed, “After this point, the rest is just history.”

Dr. Joyce has been studying the possible beginning of history by developing RNA molecules with the capacity for replication. RNA, a close cousin of DNA, almost certainly preceded it as the genetic molecule of living cells. Besides carrying information, RNA can also act as an enzyme to promote chemical reactions. Dr. Joyce reported in Science earlier this year that he had developed two RNA molecules that can promote each other’s synthesis from the four kinds of RNA nucleotides.

“We finally have a molecule that’s immortal,” he said, meaning one whose information can be passed on indefinitely. The system is not alive, he says, but performs central functions of life like replication and adapting to new conditions.

“Gerry Joyce is getting ever closer to showing you can have self-replication of RNA species,” Dr. Sutherland said. “So only a pessimist wouldn’t allow him success in a few years.”

Another striking advance has come from new studies of the handedness of molecules. Some chemicals, like the amino acids of which proteins are made, exist in two mirror-image forms, much like the left and right hand. In most naturally occurring conditions they are found in roughly equal mixtures of the two forms. But in a living cell all amino acids are left-handed, and all sugars and nucleotides are right-handed.

Prebiotic chemists have long been at a loss to explain how the first living systems could have extracted just one kind of the handed chemicals from the mixtures on the early Earth. Left-handed nucleotides are a poison because they prevent right-handed nucleotides linking up in a chain to form nucleic acids like RNA or DNA. Dr. Joyce refers to the problem as “original syn,” referring to the chemist’s terms syn and anti for the structures in the handed forms.

The chemists have now been granted an unexpected absolution from their original syn problem. Researchers like Donna Blackmond of Imperial College London have discovered that a mixture of left-handed and right-handed molecules can be converted to just one form by cycles of freezing and melting.

With these four recent advances — Dr. Szostak’s protocells, self-replicating RNA, the natural synthesis of nucleotides, and an explanation for handedness — those who study the origin of life have much to be pleased about, despite the distance yet to go. “At some point some of these threads will start joining together,” Dr. Sutherland said. “I think all of us are far more optimistic now than we were five or 10 years ago.”

One measure of the difficulties ahead, however, is that so far there is little agreement on the kind of environment in which life originated. Some chemists, like Günther Wächtershäuser, argue that life began in volcanic conditions, like those of the deep sea vents. These have the gases and metallic catalysts in which, he argues, the first metabolic processes were likely to have arisen.

But many biologists believe that in the oceans, the necessary constituents of life would always be too diluted. They favor a warm freshwater pond for the origin of life, as did Darwin, where cycles of wetting and evaporation around the edges could produce useful concentrations and chemical processes.

No one knows for sure when life began. The oldest generally accepted evidence for living cells are fossil bacteria 1.9 billion years old from the Gunflint Formation of Ontario. But rocks from two sites in Greenland, containing an unusual mix of carbon isotopes that could be evidence of biological processes, are 3.830 billion years old.

How could life have gotten off to such a quick start, given that the surface of the Earth was probably sterilized by the Late Heavy Bombardment, the rain of gigantic comets and asteroids that pelted the Earth and Moon around 3.9 billion years ago? Stephen Mojzsis, a geologist at the University of Colorado who analyzed one of the Greenland sites, argued in Nature last month that the Late Heavy Bombardment would not have killed everything, as is generally believed. In his view, life could have started much earlier and survived the bombardment in deep sea environments.

Recent evidence from very ancient rocks known as zircons suggests that stable oceans and continental crust had emerged as long as 4.404 billion years ago, a mere 150 million years after the Earth’s formation. So life might have had half a billion years to get started before the cataclysmic bombardment.

But geologists dispute whether the Greenland rocks really offer signs of biological processes, and geochemists have often revised their estimates of the composition of the primitive atmosphere. Leslie Orgel, a pioneer of prebiotic chemistry, used to say, “Just wait a few years, and conditions on the primitive Earth will change again,” said Dr. Joyce, a former student of his....

A cogent, and funny, observation on health care costs

I don't agree with the premise, but I rather liked Gail Collins' aside ...

Health Care Follies - The Conversation Blog - Gail Collins - NYTimes.com

... The big problem is that the economy is sinking under the rising cost of medical treatment, one cause of which is doctors recommending unnecessary and overly costly procedures. (For which I do not blame the doctors. If we lived in a desirable world in which people were insured against not getting enough news, I can guarantee you that I would come up with some really excellent additional products.)...

She really is a wonderful writer, and she's getting better.

Unfortunately, as recently illustrated by Atul Gawande, the premise is sadly simplistic. It's not simply that all these procedures are "unnecessary", it's rather that most people, if they had to pay for them, would choose something cheaper even it were less effective.

So if we had to pay for our shoulder MRIs, we'd probably give "rest" a longer try before looking for a (probably inoperable) rotator cuff tear. If we had to pay for our anterior cruciate repair, we might decide to live without inline skating -- like we used to.

This is why these decisions are much more troublesome than anyone but an unpaid blogger is willing to publicly acknowledge.

We won't really get universal coverage until we close our eyes, grit our teeth, seal our nostrils, and embrace crummy care (aka "good enough" care).

Health War II

America's Health War I ended about 14 years ago.

We lost, the bad guys won.

Now Health War II has begun ...

Roert Reich's Blog: The Healthcare War is Now Official

Yesterday the American Medical Association came out against a public option for health care. And yesterday the President reaffirmed his support for it...

... All major lobbying firms in Washington -- many of them brimming with ex-members of Congress -- are now crawling all over the Hill. Lots of money is on the table. AMA's political action committee has contributed $9.8 million to congressional candidates since 2000, and its lobbying arm is one of the most formidable on the Hill. Meanwhile, Big Insurance and Big Pharma are increasing their firepower. The five largest private insurers and their trade group America's Health Insurance Plans spent a total of $6.4 million on lobbying in the first quarter of this year, up more than $1 million from the first quarter last year, and are spending even more now. United Health Group spent $1.5 million in the first quarter, up 34 percent from the $1.1 million it spent in the first quarter last year. Aetna spent $809,793 between January and the end of March, up 41 percent from last year. Pfizer, the world's biggest drugmaker, spent more than $6.1 million on lobbying between January and March, more than double what it spent last year. It also spent nearly $3.3 million lobbying in the fourth quarter of 2008. Every one of them is upping their spending....

... The President can't do this alone. You must weigh in and get everyone you know to weigh in, too. Bombard your senators and representatives. Organize and mobilize others. And let the White House know how strongly you feel...

In Minnesota our senators are Al Franken (still not seated) and Amy Klobuchar. I'm not worried about Franken, he'll do the right thing. I'm very concerned about Klobuchar. I've sent her an email through her extremely sluggish contact form.

This won't be pretty. I'd expect Obama to lose this one, except he's a pretty resourceful guy.

We know where we have to end up. We need to get to "Crummy Care".

Crummy Care is healthcare with dingy carpets and peeling (lead free) paint. Crummy Care is delivered by physicians, but also by a lot of cheaper routes. Crummy Care sends films to be (double) read in Malaysia, uses CT scanners that are four years past cutting edge, has waiting lists for services, and has tight formularies and highly optimized low cost standard care protocols.

Crummy Care is not what most of us want, but it is what we can afford to provide to everyone in America. (No, I'm sorry, electronic health records aren't really a miracle solution -- though they can make Crummy Care quite a bit better.)

Crummy Care is the good enough, affordable, minimalist solution. If you have money you can buy Mercedes care, but if you don't you'll get reasonably state of the art treatment for your breast cancer (sorry, probably not a bone marrow transplant) and reasonable preventive care (no PSA for your prostate).

So we know where we have to go. The problem is it's a lousy, harsh, innocence crushing trip. We won't travel that road if we try do do business as usual

Which is why we need the "public option".

If we don't get it, then I think we'll eventually decide we lost Health War II.

So what happens if we lose?

We wait 5-7 years for Health War III.