Summarizing the Patient Protection and Affordable Care Act – in two pages and 10 titles

You may have heard that the Senate passed a health care bill. It is likely that it will be further amended by the House, and of course there will be challenges, but it is probable that the directives in the bill will be turned into law.

It is conceivable that this bill will have some implications for the future of health care, so it is useful to learn what is in it. It is quite a large bill.

Uwe Reinhardt, a well known health economist, recommended a summary prepared by the Congressional Research Service [1]. Even the summary takes a while to read. One can, however, get a sense of it simply by looking at the headings. I’ve excerpted them below. There are quite a few odd bits in there, but the scope of this bill is occasionally breathtaking.

Patient Protection and Affordable Care Act – Summary of Senate Bill – Library of Congress March 2010

Title I: Quality, Affordable Health Care for All Americans
Subtitle A: Immediate Improvements in Health Care Coverage for All Americans
Subtitle B: Immediate Actions to Preserve and Expand Coverage
Subtitle C: Quality Health Insurance Coverage for All Americans
Part I: Health Insurance Market
Part II: Other Provisions
Subtitle D: Available Coverage Choices for All Americans
Part I: Establishment of Qualified Health Plans
Part II: Consumer Choices and Insurance Competition Through Health Benefit Exchanges
Part III: State Flexibility Relating to Exchanges
Part IV: State Flexibility to Establish Alternative Programs
Part V: Reinsurance and Risk Adjustment
Subtitle E: Affordable Coverage Choices for All Americans
Part I: Premium Tax Credits and Cost-sharing Reductions
Subpart A: Premium Tax Credits and Cost-sharing Reductions
Subpart B: Eligibility Determinations
Part II: Small Business Tax Credit - (Sec. 1421, as modified by section 10105)
Subtitle F: Shared Responsibility for Health Care
Part I: Individual Responsibility
Part II: Employer Responsibilities
Subtitle G: Miscellaneous Provisions

Title II: Role of Public Programs
Subtitle A: Improved Access to Medicaid
Subtitle B: Enhanced Support for the Children's Health Insurance Program
Subtitle C: Medicaid and CHIP Enrollment Simplification
Subtitle D: Improvements to Medicaid Services - (Sec. 2301)
Subtitle E: New Options for States to Provide Long-Term Services and Supports
Subtitle F: Medicaid Prescription Drug Coverage
Subtitle G: Medicaid Disproportionate Share Hospital (DSH) Payments
Subtitle H: Improved Coordination for Dual Eligible Beneficiaries
Subtitle I: Improving the Quality of Medicaid for Patients and Providers
Subtitle J: Improvements to the Medicaid and CHIP Payment and Access Commission (MACPAC)
Subtitle K: Protections for American Indians and Alaska Natives
Subtitle L: Maternal and Child Health Services

Title III: Improving the Quality and Efficiency of Health Care
Subtitle A: Transforming the Health Care Delivery System
Part I: Linking Payment to Quality Outcomes under the Medicare Program
Part II: National Strategy to Improve Health Care Quality
Part III: Encouraging Development of New Patient Care Models
Subtitle B: Improving Medicare for Patients and Providers
Part 1: Ensuring Beneficiary Access to Physician Care and Other Services
Part II: Rural Protections
Part III: Improving Payment Accuracy
Subtitle C: Provisions Relating to Part C
Subtitle D: Medicare Part D Improvements for Prescription Drug Plans and MA-PD Plans
Subtitle E: Ensuring Medicare Sustainability
Subtitle F: Health Care Quality
Subtitle G: Protecting and Improving Guaranteed Medicare Benefits

Title IV: Prevention of Chronic Disease and Improving Public Health
Subtitle A: Modernizing Disease Prevention and Public Health Systems
Subtitle B: Increasing Access to Clinical Preventive Services
Subtitle C: Creating Healthier Communities - (Sec. 4201, as modified by Sec. 10403)
Subtitle D: Support for Prevention and Public Health Innovation - (Sec. 4301)
Subtitle E: Miscellaneous Provisions - (Sec. 4402)

Title V: Health Care Workforce
Subtitle A: Purpose and Definitions - (Sec. 5001)
Subtitle B: Innovations in the Health Care Workforce - (Sec. 5101, as modified by Sec. 10501)
Subtitle C: Increasing the Supply of the Health Care Workforce
Subtitle D: Enhancing Health Care Workforce Education and Training - (Sec. 5301)
Subtitle E: Supporting the Existing Health Care Workforce - (Sec. 5401)
Subtitle F: Strengthening Primary Care and Other Workforce Improvements- (Sec. 5501, as modified by Sec. 10501)
Subtitle G: Improving Access to Health Care Services - (Sec. 5601)
Subtitle H: General Provisions - (Sec. 5701)

Title VI: Transparency and Program Integrity
Subtitle A: Physician Ownership and Other Transparency - (Sec. 6001, as modified by Sec. 10601)
Subtitle B: Nursing Home Transparency and Improvement
Part I: Improving Transparency of Information - (Sec. 6101)
Part II: Targeting Enforcement - (Sec. 6111)
Part III: Improving Staff Training - (Sec. 6121)
Subtitle C: Nationwide Program for National and State Background Checks on Direct Patient Access Employees of Long Term Care Facilities and Providers - (Sec. 6201)
Subtitle D: Patient-Centered Outcomes Research - (Sec. 6301, as modified by Sec. 10602)
Subtitle E: Medicare, Medicaid, and CHIP Program Integrity Provisions - (Sec. 6401, as modified by Sec. 10603)
Subtitle F: Additional Medicaid Program Integrity Provisions - (Sec. 6501)
Subtitle G: Additional Program Integrity Provisions - (Sec. 6601)
Subtitle H: Elder Justice Act - Elder Justice Act of 2009 - (Sec. 6702)
Subtitle I: Sense of the Senate Regarding Medical Malpractice - (Sec. 6801)

Title VII: Improving Access to Innovative Medical Therapies -
Subtitle A: Biologics Price Competition and Innovation
Subtitle B: More Affordable Medicine for Children and Underserved Communities - (Sec. 7101)

Title VIII: Class Act - Community Living Assistance Services and Supports Act or the CLASS Act - (Sec. 8002, as modified by Sec. 10801)

Title IX: Revenue Provisions -
Subtitle A: Revenue Offset Provisions - (Sec. 9001, as modified by section 10901)
Subtitle B: Other Provisions - (Sec. 9021)

Title X: Strengthening Quality, Affordable Health Care for All Americans -
Subtitle A: Provisions Relating to Title I - (Sec. 10101) Revises provisions of or related to Subtitles A, B, and C of Title I of this Act
Subtitle B: Provisions Relating to Title II
Part I: Medicaid and CHIP - (Sec. 10201)
Part II: Support for Pregnant and Parenting Teens and Women - (Sec. 10212)
Part III: Indian Health Care Improvement - (Sec. 10221)

[1] These summaries are written in a programming language for the creation of regulations. The bulk of the omitted material begins with command verbs that tell regulators what to do. I created this summary by regex operations on paragraphs beginning with the command operators which include:

Allows
Amends
Applies
Appropriates
Authorizes
Declares
Directs
Establishes
Excludes
Expands
Expresses the sense
Provides
Reauthorizes
Redesignates
Requires
Revises
Sets forth

It’s a very structured document that resembles generated software code and could indeed be created from a regulatory meta-language.

If you laid every virus head to toe ...

You would get a very slender string of significant length ...

Welcome to Your Viral World | The Loom | Carl Zimmer for Discover Magazine

...Line up all the viruses on Earth end to end (go ahead, I’ll wait), and they’ll stretch over 10 million light years....

Is this conceivable? I know our planet is a seething ball of virii, but even a single light year is a very great length.

See also:

• The most marvelous world of the virus
• Why would a virus fatten an animal? (2006)
• Dark matter DNA
• Reflections on my personal bacterial companions
• Computers, viruses, intelligent design, natural selection, memes, mitochondria and, of course, the Fermi Paradox

Best health care reform commentary

I'm waiting for week's end to write mine, but I'll be working from these early commentaries:

• Economist Brad DeLong: The Curious Triumph of RomneyCare
• Physicist Sean Caroll: Obamacare | Cosmic Variance
• Science fiction author John Scalzi: Health Care Passage Thoughts
• NYT Infographic: How the Health Care Overhaul Could Affect You

I think it's pretty damned awesome that the three* most intelligent commentaries I've read were written by amateur blog-only journalists. (Ok, so Sean is probably paid for his science blog).

Incidentally, I expect my "taxes" will rise to pay for this. More on why, how and where the quotes come from in a later post. We're good with that.

PS. DeLong: RomneyCare Passage Aftermath - support Betsy Markey (for her courage)

* I wrote "four" originally but I moved one to the PS and didn't decrement!

Update: The Christian Science Monitor has a detailed breakdown. Well done.

Update 3/24/2010: Leonhardt focuses on the distributive nature. This is why the GOP is enraged.

Update 3/24/2010b: Uwe Reinhardt points to the readable references. He discretely but clearly points out the cost will be higher than the CBO score -- but much less than the Bush Part D boondoggle.

Update 3/28/2010: HCR and labor motility

Farewell Palm

I work in an IT shop. I can almost always find a home for my old gear. Tomorrow will be a real test though, I'm bringing in my Palm stuff to give away ...

The five PalmOS devices shown above are probably 1/2 to 1/3 of the total Emily and I bought between 1998 and 2006. I underwent the exquisitely painful Palm to iPhone transition in Aug 2008 (in some ways it's still continuing).

I don't think anyone will want the devices, but the chargers and accessories might be of interest. I have zillions of styli.[1]

One SONY made device uses AA batteries. It's the only one that would still work; I might keep it around for grandchild show and tell (I bet there's still an AA equivalent in 30 years. If there's civilization.) The others had LiOn batteries that are pretty dead by now.

Ahh, Palm. They were great in their time, but they peaked in the 90s with the Graffiti One Vx. Even after they lost their way, the company was sustained by some terrific developers like Pimlico Software (DateBk).

I'm not tossing everything. I added the Vx manual and Pogue's PalmPilot book to my shelf of computer book honor:

Even though Palm Inc's WebOS seems to have no relationship to PalmClassic, I'd hoped it would provide some inspiring competition for Apple. Judging by their share price, however, that seems unlikely ...

They fell of a cliff in the past week or so. I assume the price was being sustained by hope of a Nokia or Microsoft acquisition, but that news of Windows Mobile 7 made that unlikely. Instead the key people are likely to go to Microsoft or Google and someone will buy up any useful patents.

Farewell Palm.

See also:

• AvantGo RIP - memories of the roaring 90s
• The descent of the PDA: Newton, Palm, Blackberry and iPhone
• What the iPhone needs is Gorilla Haven’s DateBk6

Update: Details on the sad future from Gasee (via Gruber).

Update 3/23/2010: The best pre-iPhone smartphone was the PalmOS Classic Samsung i500. Also, the Palm Vx pioneered the non-removable LiOn battery.

[1] Update 3/24/2010: My coworkers took almost every accessory, but nobody wanted a device. I love Minnesota -- the home of geeks who hate throwing things away.

Ancient wisdom: Their experts are like your experts

This one is the converse of "No man is a prophet in his own country".

On average, their experts are a lot like your experts.

No, it's not that your experts are right and their experts are wrong. It's rather that experts you don't know are as vain, clever, mistaken, thoughtful, rushed, insightful, venal and proud as the experts you know.

Just because you're reading them in a newspaper, or hearing them on TV, doesn't mean they're a different species of expert. Be as trusting of them, and as suspicious of them, as you are of the very human experts you know personally.

Try it the next time you read a recommendation about estrogen use, or a political opinion, or a CEO's strategic insights, or a blog post. Think of it as coming from an expert you know. Chances are you'll give the words respect and consideration, but not the unthinking acceptance of prophecy.

Top 50 children's film

I like this "top 50" list because I'd totally forgotten about #1. Our children would probably like it. Added to netflix queue ...

E.T. voted greatest ever children's film

1. E.T: The Extra-Terrestrial
2. Toy Story
3. Mary Poppins
4. Lion King
5. Wizard of Oz
6. Bambi
7. Back to the Future
8. Shrek
9. Finding Nemo
10. Labyrinth
11. 101 Dalmatians
12. Aladdin
13. Beauty and the Beast
14. The Goonies
15. The Jungle Book
16. Chitty Chitty Bang Bang
17. Alice in Wonderland
18. Home Alone
19. Ice Age
20. Harry Potter and the Sorcerer's Stone
21. Snow White and the Seven Dwarfs
22. Annie
23. Cinderella
24. Monsters Inc
25. Madagascar
26. Sound of Music
27. Wallace and Gromit – The Wrong Trousers
28. Mrs Doubtfire
29. Babe
30. Beethoven
31. Beetlejuice
32. Black Beauty
33. The Little Mermaid
34. The Railway Children
35. A Bug's Life
36. Dumbo
37. Wall-E
38. The Lion, the Witch and the Wardrobe
39. A Little Princess
40. Bill and Ted's Excellent Adventure
41. Jurassic Park
42. Kung-Fu Panda
43. Who Framed Roger Rabbit
44. Billy Elliot
45. Lady and the Tramp
46. Neverending Story
47. Short Circuit
48. Sleeping Beauty
49. An American Tail
50. Chicken Run

Things I suspect: generic meds

Things I suspect without much evidence ...

... That our quality problems with generic medications are much bigger than we imagine.

Update 4/5/2010: see comments for more on this. A recent WSJ Health blog mentioned increased safety recalls for generics. I had not heard of the examples they cited.

Investing today

Burton Malkiel wrote “A Random Walk down Wall Street” in 1973. He believed the prices of publicly traded assets reflected all publicly available information. John Bogle, influenced by Malkiel, created index funds to reduce the risks of random market fluctuations and to profit from this rational pricing.

Peter Lynch wrote “One up on wall street” in 1989. He didn’t agree with Malkiel; he felt that “local knowledge” and personal experience could detect under and overpriced shares.

I suspect each was more or less right for his era. That is, I suspect share prices in the mid to late 1960s were more or less rationally priced. I suspect share prices in the late 1970s and early 1980s were not rationally priced, and that the anomalies were potentially discoverable by a rational investor with limited resources.

Of course by the time each person wrote their book, their era had passed.

Which brings me to our current era.

Since Lynch’s book we have experienced 20 years of economic turbulence fundamentally driven, I suspect, by the commercialization of the microprocessor and the industrialization of what we once knew as the third world. As a side-effect of these fundamental changes, including the collapse of the fourth estate, we have shifted towards the upper end of the historic scale of corporate and governmental corruption.

So what is the rational small investor strategy of today?

Of course I don’t know. My only personal insight is that I don’t yet see much short term correlation between share prices and the value of most of the goods and services I buy. Companies that deliver lousy value seem to track with their industry. The exceptions are a few companies that are intensely monitored (Apple, Google, Microsoft, etc); I think they are rationally priced but they are, of course, very volatile.

This would suggest we’re still in a Lynch era, where one should be able to use local knowledge to detect anomalies and profit from them. Over the past 10 years though you couldn’t detect the anomalies using the “local knowledge” he described – you had to be an insider who was able to sniff out fraud and corruption. In the past decade some have done very well detecting evidence of corruption and de facto fraud, and shorting companies like Lehman.

Of course by the time people like me decide shorting corrupt corporations is a good strategy, its time has passed.

I where are we today? I’m guessing that we’re in transition back to a Malkiel era. So for a few years shorting corruption might still work, but increasingly share prices will be a random walk. Even if index funds were a crummy investment over the past decade (everything was, except shorting fraud), this might be their time again. I wouldn’t mind some 1960s style dull dividend paying companies though.

Of course by the time anyone writes the “Random walk” or “One up” book of our era, that strategy will have passed into history.

Oh, and if you take investment advice from me, you totally deserve your impending financial ruin.

Why we need to retire at sixty

Ten years ago there was talk of the boomers working into their seventies. The "me generation" was said to be "young at heart".

Then reality set in. Contrary to popular belief, brain decay is not a late life disorder. It starts in our twenties ....

This Is Your Faulty Brain, On a Microchip - Memory forever - Gizmodo

... Starting in your 20s—not old age—behavioral evidence suggests that you enter a linear cascade of general cognitive decline....

This decline is notably seen in tasks that are highly mentally demanding, like speed of processing (how quickly you handle incoming information), attention, working memory (how well you manipulate and keep information active in your mind), and, of course, long term memory.

In real life, these effects are seen in everything from how long it takes to learn a new skill to how quickly you can recall a factoid....

The Gizmodo article, clearly written by a young chap, imagines we'll outsource our recall and declining cognition to an onboard chip (vs., say Google). Sure.

While we're waiting to be chipped, however, knowledge work is becoming ever more demanding - and non-knowledge work doesn't pay too well (unless you're CEO, then non-knowledge work can pay very well).

In the post-modern world, unless we can bend that decay curve (hello? dementia meds?) many of us will have a hard time doing competitive knowledge work into our 60s - much less our 70s. Bagging groceries yes - genomic engineering not so much.

That could be a bit of an economics problem.

We really should be spending more money on trying to bend that curve. We need my generation to earn money until we take our dirt bath.

Why geek genes win

How is that that many of my fellow homely geeks are happily married to women so much more attractive than we are?

Geek genes (yes, we are "effeminate" no matter how many mountains we might climb)turn out to become desirable in high tech civilizations. Since geeks make tech, geek genes thereby support and create the environments that make more geek genes. Talk about the selfish gene ...

The battle of the sexes: Face off | The Economist

... Mating preferences, too, vary with a society’s level of economic development. That, at least, is the conclusion of a study by Ben Jones and Lisa DeBruine of Aberdeen University, in Scotland, published this week in the Proceedings of the Royal Society.

Dr Jones and Dr DeBruine, themselves a married couple, examined what might be called the Deianira paradox. Hercules, demigod and paragon of masculinity in the ancient world, was indirectly done for by his own sexual prowess—his jealous wife, Deianira, accidentally poisoned him with a potion she thought would render him eternally faithful. Deianira’s predicament is a woman’s ultimate dilemma. In a man, the craggy physical characteristics associated with masculinity often indicate a strong immune system and thus a likelihood of his producing healthier offspring than his softer-featured confrères will. But such men are also more promiscuous and do not care as much about long-term relationships, leaving women to raise their kids alone.

Nowadays, sound parenting is often more important to the viability of a man’s offspring than Herculean strength. That, some researchers suspect, may be changing the physical traits that women look for in a mate, at least in some societies. A study carried out in 2004, for example, discovered that women in rural Jamaica found manly types more desirable than did women in Britain, which led to questions about whether those preferences were arbitrary or whether women in different parts of the world might be adapting to circumstances that place different emphasis on manliness in the competitive calculus.

Dr Jones and Dr DeBruine therefore looked to see if there is an inverse relationship between women’s preference for masculine features and national health. Sure enough, they found one. In environments where disease is rampant and the child-mortality rate is high, women prefer masculine men. In places like America and Britain, where knowing how to analyse health-care plans is more important than fighting off infection, effeminate men are just as competitive...

... Neither wealth nor mating pattern had much impact on women’s preferences for manly men. Disease rates, by contrast, seemed to be directly related to how they went about choosing a mate—the healthier the society, the less women valued masculinity. Hygiene and wimps, it seems, go hand in hand....

So non-geeks really do need to destroy civilization. This explains the GOP.

Health insurance companies: only the demonic survive

Under the current system of incentives, only demonic health insurance companies can prosper…

Demons And Demonization - Paul Krugman Blog - NYTimes.com

The usual suspects have been attacking Obama for “demonizing” insurance companies; but saying that people do terrible things isn’t demonization if they do, in fact, do terrible things.

And health insurers do, because they have huge financial incentives to act in an inhumane way — most obviously, by revoking coverage when people get sick, using whatever rationale they can devise.

Read this report by Murray Waas on Assurant Health (previously called Fortis), which used a computer algorithm to identify every client with HIV, then systematically revoked coverage on the flimsiest of grounds — and appears to have systematically hidden any paper trail showing how it made its decisions…

…  the evidence is that the overwhelming majority of rescissions, not just at Assurant but across the board, are, in fact, without justification…

… And to repeat what I and other have repeatedly explained, you need the whole package to make this work. You can’t end discrimination based on medical history unless you require that health as well as sick people have insurance, to broaden the risk pool. And you can’t mandate coverage unless you provide aid to those who otherwise couldn’t afford it.

Right now, we have a system that creates huge incentives for bad, one might say demonic, behavior: Assurant made $150 million by revoking coverage, almost always without cause…

In this system of incentives and a competitive marketplace, a virtuous corporation will lose out to one that follows the incentives. The virtuous corporation must either abandon virtue or die. Soon, only the demonic survive.

The same incentives, of course, apply in education. If a provider is judged by educational outcomes, the most successful strategy is to use “recission” to get rid of low performing students. Only the demonic survive.

We need to change the system.

Incidentally, it’s typical that the very first (asinine) comment on Krugman’s post is by someone who didn’t read the second to last paragraph. Eliminating patient discrimination while allowing patient choice on coverage timing is a recipe for bankrupting insurance companies. At that point,the patients are demonic.

We need the entire package.

Texan textbooks: Hallucinations that may backfire

Another reason why friends don't let friends live in Texas ...

Editorial - Rewriting History in Texas - NYTimes.com

... The Texas Board of Education, notorious for its past efforts to undermine the teaching of evolution in public schools, has now moved to revise the social studies curriculum to portray conservative ideas and movements in a more positive light and emphasize the role of Christianity in the nation’s founding.

Clearly a loss for Reason in Texas, but, really, there wasn't much to lose. Publishers have been anticipating this, textbooks are being designed so that Texas-specific editions can be inexpensively created.

Even if the these books were widely read though, the consequences may be unexpected. I have some personal experience to share on this.

I grew up in a theocratic state. My public school history book was written by the Catholic church. I wish I'd stolen a copy; it may be the only book written in modern times praising the Children's Crusade as a noble cause.

How did we react to these books? Most of the students paid no attention to history at all, but the smarter students got angry. Whatever the impact of propaganda on individual students, the theocratic state shortly self-destructed. Within 10 years Quebec's Quiet Revolution swept the church away.

Farther afield, the communist propaganda of 1960s China laid the foundations for the most rabidly capitalistic state in modern history.

Who knows? Perhaps the 2010 Texas board of education is laying the foundations for an Enlightenment 2.0 Texas of 2025.

Climate - How will history judge the Wall Street Journal?

When the WSJ iPhone app provided free access to the WSJ, I tried reading it. Alas, it was already the post-Murdoch era. The raving madness of the editorial pages had begun to infect the rest of the newspaper. I gave up after a few months. Now, even friends of mine who have been longtime WSJ readers are also losing interest.

The WSJ has a lot of tribal power however. It will last at least another twenty years. Perhaps long enough that this will matter ...

Breaking the Climate Debate Logjam: Scientific American

... The Wall Street Journal leads the campaign against climate science, writing editorials charging that scientists are engaged in a massive conspiracy. I have made repeated invitations to the Journal editors to meet with climate scientists publicly for an open discussion or debate, but all have been rebuffed...

When the WSJ closes up, will their climate change dismissal and denial be seen as the fatal turning point? The moment at which tribal ideology made them worse than irrelevant?

I'll put a reminder in my Google Calendar to update this post fifteen years from now.

Political reform: Let's license legislators

Americans are grumpy. It's been a bleak decade, and the next one doesn't look too promising. Our politicians are going to have to work through the end of American exceptionalism, the beginning of the end of oil, the age of mass disability, the challenge of CO2 management, the rise of China and India, the Fall of North Korea, nukes galore, the ghost of Malthus and sentient machines.

Just kidding about the last one. Skynet is fifty years ahead and we don't survive it, so no need to worry.

America has the talent to manage these problems. Trouble is, none of the people we need are crazy enough to run for office, and voters wouldn't like 'em anyway. GOP voters would especially dislike the rationalists we need - and we Dems need a sane GOP opposition.

So how do we grow a sane government? I've thought of drafting people to serve, but it's easy to come up with too many objections. I really can't come up with a great alternative to elections, though I still like the idea of taxing campaign related activities at 50% to enable publicly funded campaigns.

So what can we do to improve the system we have now? Let's license legislators. After all, we license lawyers, accountants, physicians, barbers, and realtors -- why not legislators?

It's not hard to image an appropriate curriculum -- starting with courses and evaluation on basic probability, logic 101, business operations, economics, history of science, history, and comparative theology. An intensive 12 month program should do it for most legislators. Grading could be pass-fail -- I'm fine with that.

Legislators would, like physicians, redo their board exams every five years.

Clearly we'd need to compromise on certain topics. For this group there's no problem with "teaching the controversy". By all means, give biologists and Creationists equal time to discuss natural selection. We can balance climate scientists with hobbyists and eccentrics. Different religions can argue for their own creation myths; and our exam questions can cover both scientific and Hindu explanations of biological diversity.

As is the common custom we'll grandfather in current politicians. Maybe we'll even have an interim time when licensure is only needed for those seeking public financing. Eventually though, all legislators will be licensed.

Or we can just stay as we are and die in the cold and the dark. We always have a choice.

See also:

• American crisis – imagining a way out
• Gordon's Notes: The publicly traded politician - and other reform proposals
• Campaign Finance Reform: Voluntary Mandated Sharing (1999)

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France has a carbon tax

Who knew? France now has a carbon tax:

The year it didn't happen - Winnipeg Free Press - Gwynne Dyer

... France became the largest economy to impose a carbon tax on individuals and businesses using coal, gas or oil, with the explicit intention of changing people's patterns of energy use. The tax is US$24 per tonne of emissions now, but it will rise over the years...

Go France!

This is the first time I can remember France leading on anything. It certainly didn't get much coverage in the US, though that's hardly surprising. What could be less popular in America than global warming + taxes + France?

Happily, Gwynne Dyer posts his article notices on Twitter (see also) so I look forward to hearing more news that's forbidden in America.
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