Heath care reform – wake me up when they start talking about the Lexus

Health care reform has gone underground into the realm of dark politics, but I believe Gail Collins when she says Obama isn’t going to let this go easily. It will be back.

In the meantime, I’m not paying much attention. I’m waiting for a sign that we’re getting to something real. For me that sign will be the first time someone starts using the American version of an automotive analogy.

That will be the day someone compares the Lexus and the New York subway …

Gordon's Notes: Healthcare Reform … the One Slide Presentation

versus

If all you care about is getting from point A to point B in Manhattan the smelly, noisy, subway is often a better choice.

If you care about comfort and pleasure the Lexus is almost always a better choice. Money aside, it’s the better choice for most people most of the time. Faster, more comfortable, you can carry more things, it’s simply better.

If you don’t have a lot of money, the subway is your only choice.

Health care is like that. It’s an inexhaustible good. You can always do more things at the margins. You can have nicer waiting rooms, better parking, faster phone call return, multiple messaging systems, better IT support, more elegant tests, more intra-specialists conferences, RNs instead of aides, more convenient medications, better home care, better hospice care .. and I’m not even trying here. Some of these things improve efficiencies, but mostly they just provide a better care experience. Not “better”, better.

The scope to improve health care is limitless. Give me a trillion dollars and I could spend it on US health care. Give me 500 trillion and I could spend it (though at that point I’d be into national exercise programs and dietary revisions!).

Why is the scope limitless? Because you can’t make suffering vanish. We age, we get sick, we die. The only “health care” initiatives that clearly save money involve floating chunks of ice.

It’s not a matter of getting incentives right, as Brad DeLong recently wrote. That would work if there were an end point, and we were seeking the most efficient path. In this game there’s no end point unless you consider incentives that encourage ultra light plane travel. Sorry Brad, but this time I have to disagree.

Health care is largely a compromise between reach and grasp. It’s about buying a Honda Accord rather than a Lexus, or taking the subway rather than a helicopter. It’s always about rationing.

Wake me up when we start talking about taking the subway.

Jon Stewart on the Birthers

I've been ignoring the birther whackos for months, but they do seem to be the face of the modern GOP.

So I figured I should look to Jon Stewart for news on the Birthers.

Poor Jon. On the one hand, great material. On the other hand, watch where he buries his face in the papers. That looked sincere.

Recommended. It tells you all you need to know about where Liz Cheney's GOP is today.

iPhone trouble: Apple rejects Google Latitude, possibly Google Voice

Apple appears to have rejected a long anticipated native iPhone app from Google -- Google Latitude ..

Daring Fireball Linked List: Google Latitude for iPhone, But Only as a Web App:

... Translation: Apple rejected their native iPhone app...

Google has introduced their Google Voice native app for every phone but ... the iPhone.

The worrisome state of the Palm Pre may have emboldened the darker side of Apple. I'm going to be downplaying my iPhone enthusiasms until we get some clarity about where Apple is going with this.

Update: I've got a fix for Google. The problem with Latitude is that it only updates my position when I use it. I don't have that much use for it, so updates will be infrequent. On the other hand, I use apps like Byline a lot.

So all I need is for Byline to "ping" my location to Google Latitude after startup. That should update me reasonably often. Other apps could do the same thing.

Why would they bother? I'm guessing Latitude will have a business model. Google can share revenue on a per ping basis.

Update 7/31/09: AT&T's Location Finder costs $15/month for a family of five. Guess we know why this one was banned.

The organ trade mafia of New Jersey

The mob goes where the money is, though this time it’s not Italian …

Dozens Arrested in New Jersey Corruption Probe - WSJ.com

… The alleged money-laundering operations run by the rabbis laundered about $3 million for Mr. Dwek since June 2007, according to the court documents and a person familiar with the matter. The rabbis used charitable, nonprofit entities connected to their synagogues to "wash" money they understood came from criminal activity, prosecutors alleged.

Levy Izhak Rosenbaum of Brooklyn was charged separately with conspiring to broker the sale of a human kidney for a transplant, at a cost of $160,000 to the transplant recipient. According to the FBI's complaint, Mr. Rosenbaum said he had been brokering the sale of kidneys for 10 years…

"The rings were international in scope, connected to Deal, N.J., Brooklyn, N.Y., Israel and Switzerland," said Mr. Marra, the U.S. attorney, at the news conference. "They trafficked in the cleaning of dirty money all across the world."

Rabbis doing money laundering in New Jersey is mildly interesting. The organ trade angle is truly interesting.

Update 7/24/09: TPM is tracking the organ trade angle.

Update 9/2/09: I'm getting some creepy comments on this post, of the Protocols of Zion sort. They're all being rejected, so don't bother.

Collins believes - Obama will get a health care bill

I’ve been tuning out the health care reform discussions. It’s gone into a deep pit of politics; I can’t see enough to make sense of it. I’ve no idea whether it will be a complete debacle or a genuine step towards guaranteeing “good enough care” for everyone.

I have to hope Obama knows where he’s going with this.

Gail Collins is convinced he’ll get it done, one way or the other …

Gail Collins - The Health Care Sausage - NYTimes.com:

… The point here is that neither rain nor snow nor Jim DeMint will deter Obama from delivering on health care. Not even if he has to meet with every member of Congress one by one, give an interview to every television reporter in the Northern Hemisphere and hold a press conference every single day for the rest of the year….

Minnesota science scores: bring in the grown-ups

Today’s Strib headliner is wrong like a bad tooth (emphases mine) …

Minnesota students' science test scores take big jump 

Minnesota's students made dramatic gains on state science tests this year...
Overall, 46 percent of students exceeded the expectations the state set out for them, up from 40 percent last year, when the Minnesota Comprehensive Assessments-II science exams were given for the first time. Of the three grade levels tested this spring, 45 percent of fifth-graders, 43 percent of eighth-graders and 50 percent of high school students succeeded. 

… increased familiarity with the online test this year probably contributed to the increase. 

The test results come seven months after the state's students were found to be near the top of the world in math and science, based on an international assessment …

Let me count the ways of wrongness.

Firstly, the headline on the dead tree Strib read something like “Science scores absolutely stink” (ok, I’m paraphrasing). The Strib needs to get its spin straight.

Secondly, given that the online test was still fairly new last year, is a 6.7% gain selected from a range of options (they could have chosen to compare the high school grade, etc) really meaningful? I doubt it. Neither journalists nor educators nor physicians nor, really, anyone, seems to have a working grasp of the notion of statistical significance.

Most of all, the entire process is a cosmic waste of time, money, and student psyches. A test with a 50% pass rate means the system has failed. Minnesota needs to stop, fire all the responsible executives, and restart.

Either the test is wrong, or the preparation is wrong, or Minnesota is testing the wrong group or all of the above.

Minnesota needs to take a tiny fraction of the cost wasted on its testing programs and hire a man who now keeps a very low profile – Steve Yelon. Really, I’m sure he’d do the work for a million or two, even if he’s now a “professor emeritus”.

Steve taught me about curriculum and instructional design back around 1991 or so when I was an OMERAD fellow at MSU’s College of Human Medicine (ie. not the famed vet school [1]). He was a good enough teacher that the basics still stick in my head. They’re roughly like this ..

1. Figure out what you want your learners to be able to do. This has to be something they can do.
2. Design a test that measures achievement of the desired skills.
3. Design a course that fits the test.
4. Teach the course.
5. If the results are bad, revise one or more of test, course, and tested group.

It’s really not rocket science.

Hire Professor Yelon Minnesota, and stop wasting my money. There’s a lot less of it than there used to be.

[1] If anyone from OMERAD is link checking, John Gordon is a pseudonym.

Update 9/1/2015: Wow, I had a pretty angry writing style back then. I think I'm mellower now, must be getting old. Anyway, I came across a wallet handout he did in the 90s. Copy here ...

The bidirectional arrows aren't just for symmetry. You start with real world goals, build objectives, and then build tests that demonstrate goal achievement. Each feeds back on the other. From what I remember of his teaching (mutated by time and experience) I'd add another set of arrows that drop from real world performance to terminal objectives to the tests -- illustrating importance of designing test such that "teach to the test" is a fine praise.

Yelon's 1990s book is available used on on Amazon. If copyright allows it ought to be put online.

Happiness - I told you so

"You see", I told my mother, "if you expect the worse you are often pleasantly surprised".

Turns out, I'm Danish at heart ...

Lowered Expectations - Happy Days Blog - NYTimes.com:

... Mysterious are the ways of human happiness, as anyone who has surveyed the perplexing, often contradictory research findings can attest. But one nugget in particular truly boggles: Denmark is the happiest nation in the world. More than two-thirds of Danes report being “very satisfied with their lives,” according to the Eurobarometer Survey, a figure that has held steady for more than 30 years. True, Danes tend to be healthy, married and active — all contributing factors to happiness. But why, researchers wondered, are Danes happier than Finns and Swedes, who share many of these traits, not to mention a similar culture and climate?

The answer is, in a word, expectations. Danes have low expectations and so “year after year they are pleasantly surprised to find out that not everything is rotten in the state of Denmark,” says James W. Vaupel, a demographer who has investigated Danish bliss...

I have had the common share of the bitter with the sweet, but I'm generally happy. It could be so much worse.

Oh foolish optimists, so ever cruelly disappointed...

How the iPhone has warped our sense of Japan’s mobile market

In the 70s Japan was brilliant. Smarter, faster, stronger than the rest of the world.

Then Japan seemed to lose its way. When I saw this headline I wondered if the story of Japan’s oddball cell phones held a clue ..

Why Japan’s Smartphones Haven’t Gone Global - NYTimes.com

…  Japan is years ahead in any innovation. But it hasn’t been able to get business out of it,” said Gerhard Fasol, president of the Tokyo-based IT consulting firm, Eurotechnology Japan.

Innovation? Really? It sure doesn’t feel that way. Mr Fasol is a foreign consultant (I’m guessing), so maybe he’s being diplomatic. This description is more plausible …

… Japan’s cellphones are like the endemic species that Darwin encountered on the Galápagos Islands — fantastically evolved and divergent from their mainland cousins — explains Takeshi Natsuno, who teaches at Tokyo’s Keio University…

… This is the kind of phone I wanted to make,” Mr. Natsuno said, playing with his own iPhone 3G…

and

… each handset model is designed with a customized user interface, development is time-consuming and expensive, said Tetsuzo Matsumoto, senior executive vice president at Softbank Mobile, a leading carrier. “Japan’s phones are all ‘handmade’ from scratch,”…

Lots of invention, but no ecosystem. It’s all one-offs, again and again. Does this tell us something unique about Japan?

I thought so, but then I realized that the iPhone has warped my sense of history.

If the iPhone hadn’t come along, we’d all be in the same pointless trap – except Japan and Korea would be at the high end and we’d be stuck at the low end – with “smartphones” like Windows Mobile (ugh), the Blackberry (yuch) and the ailing Palm Classic (sigh). Our pre-iPhone mobile ecosystem was just like Japan’s, only much less interesting.

It’s the iPhone that changed the game, and transformed Japan from the future to an isolated island ecosystem. Whatever may come of the iPhone, even if it should fall to Android or Pre or something else, it was genuinely revolutionary. So revolutionary, it’s warped my sense of recent history.

Japan (or, perhaps more likely, Korea) still has a chance though. In the 1970s Japan made lots of computers – using NEC’s proprietary OS. Japan didn’t surge in the PC hardware marketplace until they went to using PC/MS-DOS. (With a major US setback due to congressional trade restrictions blocking desktop imports from Japan – those were the days the US was terrified of Japan.)

If Japan’s manufacturers were to give up on their solutions and focus on Android …

Cold laughter echoes from Orwell’s grave

Novels are never as absurd as the real world. If they were, nobody would believe them. For example …

Some E-Books Are More Equal Than Others - Pogue’s Posts

This morning, hundreds of Amazon Kindle owners awoke to discover that books by a certain famous author had mysteriously disappeared from their e-book readers. These were books that they had bought and paid for…

… the publisher changed its mind about offering an electronic edition, and apparently Amazon, whose business lives and dies by publisher happiness, caved. It electronically deleted all books by this author from people’s Kindles and credited their accounts for the price…

… You want to know the best part? The juicy, plump, dripping irony?

The author who was the victim of this Big Brotherish plot was none other than George Orwell. And the books were “1984” and “Animal Farm.”

I loved Pogue’s post title.

This is Digital Rights Management in action. Like most everything, DRM can be a good thing, or a bad thing.

As the old saw goes, Bytes don’t burn Books, People burn (or disintegrate) Books.

Apple, for all their myriad sins real and imagined, seems to have found the subtle balance. Apple’s music is no longer DRMd (but your purchase can be traced back to your credit card!), but iPhone software is very subtly and appropriately DRMd.

Amazon blew this one big time.

Update 7/20/09: Nice summary in Slate. Turns out Amazon's been deleting books that were illegally distributed for a while -- this one was just too poetic to ignore. Makes you wonder if the upload was a brilliant setup. I liked this conclusion:

The difference between today's Kindle deletions and yesteryear's banning is that the earlier prohibitions weren't perfectly enforceable. At best, publishers that found their books banned by courts could try to recall all books in circulation. In 2007, Cambridge University Press settled a lawsuit with Khalid bin Mahfouz, a Saudi Arabian banker who sued for libel over a book that alleged he'd funded terrorism. Cambridge agreed to ask libraries across the world to remove books from their shelves. But the libraries were free to refuse. If bin Mahfouz had sued over a Kindle book, on the other hand, he could ask the court not only to stop sales but also to delete all copies that had already been sold. As Zittrain points out, courts might consider such a request a logical way to enforce a ban—if they can order Dish Network to disable your DVR, they can also tell Amazon or Apple to disable a certain book, movie, or song.

But that sets up a terrible precedent. Amazon deleted books that were already available in print, but in our paperless future—when all books exist as files on servers—courts would have the power to make works vanish completely. Zittrain writes: "Imagine a world in which all copies of once-censored books like Candide, The Call of the Wild, and Ulysses had been permanently destroyed at the time of the censoring and could not be studied or enjoyed after subsequent decision-makers lifted the ban." This may sound like an exaggeration; after all, we'll surely always have file-sharing networks and other online repositories for works that have been decreed illegal. But it seems like small comfort to rely on BitTorrent to save banned art. The anonymous underground movements that have long sustained banned works will be a lot harder to keep up in the world of the Kindle and the iPhone.

The power to delete your books, movies, and music remotely is a power no one should have. Here's one way around this: Don't buy a Kindle until Amazon updates its terms of service to prohibit remote deletions. Even better, the company ought to remove the technical capability to do so, making such a mass evisceration impossible in the event that a government compels it. (Sony and Interead—makers of rival e-book readers—didn't immediately respond to my inquiries about whether their devices allow the same functions. As far as I can tell, their terms of service don't give the companies the same blanket right to modify their services at will, though.)...

... To solve this problem, what we really need are new laws.

Well said! Congress should pass a law making these terms of service illegal in the United States.

When the market is your deity, there is no such thing as corruption

Paul Krugman picks two examples of the corruption of conservative political institutions …

Opinions for sale - Paul Krugman Blog - NYTimes.com

… Politico has a scoop: … The American Conservative Union asked FedEx for a check for $2 million to $3 million in return for the group’s endorsement in a bitter legislative dispute … For the $2 million plus, ACU offered a range of services that included: “Producing op-eds and articles written by ACU’s Chairman David Keene and/or other members of the ACU’s board of directors….

… Think Tank’s Ideas Shifted as Malaysia Ties Grew: ..The Heritage Foundation sharply criticized … Malaysian prime minister Mahathir Mohamad … Heritage’s new, pro-Malaysian outlook emerged at the same time a Hong Kong consulting firm co-founded by Edwin J. Feulner, Heritage’s president, began representing Malaysian business interests…

Similar examples of corruption of left-leaning institutions doubtless exist. I was most struck, however, by his closing comment …

… Despite everything that’s happened, I don’t think many people grasp just how raw, how explicit, the corruption of our institutions has become.

During the 1990s and into the Bush era, America confused The Market with The Good, and, in some Protestant groups, with the God. I’ve called this Marketarianism; it’s a kissing cousin of Libertarianism.

In the Marketarian theology they share, the Heritage Foundation and the American Conservative Union are not corrupt. They are merely obeying the Will of the Market. That is right and just.

Few people, other than Paul Krugman and perhaps Frank Rich, have commented on how deeply this corruption has infested our society. We don’t understand what this means. It might help to compare corruption to lawlessness.

You don’t create a lawful society through a police force. Obviously, policing is essential, the police are a last resort. The foundations of a civil society are cultural norms reinforced through everyday examples and interactions.

Similarly, you can’t create a health economic society through regulation. Regulations are as essential as police, but they’re a last resort. A healthy economy requires a cultural foundation of honesty and personal integrity.

We’ve lost that cultural understanding, it’s been eroded by the Marketarian meme. We need to slowly, painfully, resurrect a lost ideal of institutional integrity.

In Our Time - The Sunni-Shia Split

This IOT Program starts slowly ...

BBC - Radio 4 In Our Time - The Sunni-Shia Split

... In 680, near Karbala in Iraq, a man was killed in the desert. His name was Husayn, and he was the grandson of the Prophet Muhammad. His death was a crucial episode in the growing split between two groups of Muslims - who would come to be known as the Sunni and the Shia...

... but it picks up speed after the first ten minutes or so when Melvyn Bragg takes control. I knew only the broadest outlines of the story, and the details are amazing. For an outsider it does add some context to the relations between Iraq and Saudi Arabia.

The early (and later) days of the Catholic papacy were pretty rough, but the assassinations and wars of early Islam are right up there. It reminds me also of the assassination eras of the American presidency. The conflicts occur on so many dizzying levels -- personal, family, tribe, relation to the Prophet, and proto-nation (but not, interestingly, theological except in the sense of who rules a theocracy).

The real mystery, which this one programme can't address, is how these squabbling tribes seized and held a vast empire -- before it became a vast and coherent civilization.

It's well worth a listen for anyone with an interest or stake in the Middle East. I do hope Obama gets some moments with IOT.

This is the third from last episode of what must be at least the sixth season (it's curiously hard to find out from the site how many seasons there have been.) Melvyn says he'll be back next year. It's been a great season as always, but listening to this episode I recognize that the past season has felt relatively sluggish.

In retrospect I think Melvyn has mellowed too much. He needs to get a bit tougher on his academics, who are prone to wander and miss the fundamentals. It's a fine road to travel -- some of them are rather nervous and might break down under harder handling, but the show works best when he's riding herd with the occasional flick of the whip.

Writing this post I noticed something new. There's a blog called "After Our Time". Unfortunately it appears to have expired in October 2007. It would be nice to see a revival of that.

Hacked Twitter advises: lie on security questions

Twitter CEO: How Not To Get Hacked Like Us: "...Lie on security questions.."

Tell it to the security idiots at US Bank.

I'm still looking for a Bank security team with a 3 digit IQ.

No Google Voice for iPhone? AT&T’s deal with the Devil …

Poor AT&T. Their iPhone margins are less than expected because iPhone customers use orders of magnitude more bandwidth than BlackBerry users, but pay the same data charges.

Now with Push features they’re likely to face erosion on their mega-margin SMS charges.

Now comes Google Voice. I’ve been a GV/GC customer for years. The money I’ve saved on calls to Canada more than pays for my AT&T data plan. That money used to go to AT&T (and to Apple?), now I keep it.

Bad enough, but now GV is going public. I’ve just received another number that will go to my wife; her crummy BB Pearl will probably run the new GV client.

My iPhone will be staying with “GV Mobile”, a 3rd party app, for a while longer. There’s a mysterious delay in Google’s deployment of their client to the iPhone (emphases mine) …

AppleInsider | Google Voice released for Android and BlackBerry, but not iPhone

Google has released its mobile Voice application for the Android and BlackBerry platforms, but future release of the program on the iPhone will depend on acceptance from Apple and perhaps AT&T.

While iPhone users can currently access Google Voice from the Safari browser [jf - and GV Mobile], what Android and BlackBerry users received Wednesday was a full-fledged independent application that allows users to make calls, send text messages and check voicemail through their separate Google-provided phone number.

Google would like to release an iPhone version of the application, and is "working with Apple" to do so, according to the New York Times.

One unique element Google is touting is the ability to make international calls at a reduced rate. It also allows for text messages to be sent and received for free through the number, also bypassing the cell phone carrier. Google Voice also transcribes voicemails and reads numbers from the smartphone's phonebook.

These capabilities led Wired to speculate that AT&T and Apple could "cripple" a Google Voice iPhone application. It cites the fact that both companies have blocked video applications and forced Skype to nix a feature allowing free phone calls via the phone's data plan…

…The new application addresses one crucial problem with Google Voice: While someone might be able to call a user at their Google Voice number, they would likely receive a return call from the cell, home or office number where the person is available. Through the new program, the outgoing call will now appear as the Google Voice number…

… A blog post announcing the release of Google Voice originally included a reference to the alleged iPhone development, but it was later removed from the page…

I saw the iPhone mention on the GV blog, I didn’t know it had been later removed.

If iPhone customers want the new GV app we will need to start screaming. For now, GV Mobile isn’t bad, though I wonder how long it will be available on the App Store.

This will be a very interesting story to follow.

Poor AT&T. The iPhone turns out to be a bargain with Mephistopheles.

Geriatric computing

In the medical schools of centuries past, we were taught about illness as though problems came one at a time.

It's an obvious educational simplification, but I don't remember our faculty ever getting much beyond the basic model. In the real world, of course, adult bodies are pretty entropic. There are lots of little things that don't work quite right, even in a healthy person. Add in age, chronic conditions, multiple simultaneous viral infections (having a cold doesn't make you immune to another!) and more and it's no surprise that diagnoses don't follow textbook traditions. Geriatrics is all about this kind of multi-factorial balancing act.

Turns out, the world of computing is no different.

Even as a reformed gerserker I still have to deal with the usual bewildering array of emergent bugs (emergent bugs are one reason many underestimate the power of the GooBook to come). These are particularly common in geriatric computing systems.

For example, until recently I had a 6 year old access point/router, a 6+ yo XP box, a 5-6 yo iBook, a 3-4 yo iMac, a 1yo iPhone and a 2 yo MacBook. When I started having network problems a few months ago I thought I had one thing to fix. Turns out it was about 3-4 things! In retrospect our home system suffered multiple interacting hardware and software problems with evolving features.

A new Airport Extreme/Time Capsule solved a bunch (after adding about 2-3 manageable new bugs), some software twiddling solved others, and, most recently, I think I might have solved another mysterious bug by upgrading my EMC Retrospect iMac client software.

Geriatric computing turns out to be a lot like geriatric medicine -- it's not one thing, it's everything.

China: economy grows 8%, prices fall 1.7%

Wow. Huh? Wow.

I didn't expect this. Talk about a stimulus package - vastly bigger than ours compared to the size of China's economy. China doesn't seem to have forgotten Keynes. Emphases mine.

BBC NEWS | Business | China grows faster amid worries

China's economy grew at an annual rate of 7.9% between April and June, up from 6.1% in the first quarter, thanks to the government's big stimulus package....

... Beijing now expects China to achieve 8% growth for 2009 as a whole, which compares with a predicted contraction of between 1% and 1.5% in the US.

... The BBC's correspondent in Shanghai, Chris Hogg, said China's latest economic growth was largely due to the government's 4 trillion yuan ($585bn, £390bn) economic stimulus plan unveiled last November.

... China's state controlled banks have lent huge amounts of money to the country's state owned and private sector businesses. Companies have used the cash to try to avoid shedding jobs and to invest in new equipment...

... The many new government infrastructure projects have provided employment for many of the migrant workers who have been laid off - mainly in the export sector....

... urban per capita incomes were up 11.2% from a year earlier, and that real rural per capita incomes were up 8.1%...

... Meanwhile, China's consumer price index fell 1.7% in June compared with the same month a year earlier, the fifth consecutive monthly decline....

Massive stimulus, surprising growth, income growth (and savings growth, presumably) and prices are still falling.

So if China's growing, and the US is "only" in a severe depression recession (sorry, typo), how do we explain world economic output falls? Does this explain why US inflation is relatively low? If China is growing like this, does the US really need a 2nd stimulus? (We are, after all, all connected.)

Our struggling journalists are not giving us a clear sense of how this story is unfolding.