Thursday, April 01, 2010
South Dakota - state of denial
Monday, March 29, 2010
Apple's next surprise: A Facebook alternative
Remember how "fun with Al Gore" turned out? We got Dick Cheney.
Maybe we should give Google a bit more credit, because the main rival to Google is the Dick Cheney of the online world - Facebook. Their motto isn't so much "be evil" as "whatever it takes".
Facebook is bad. I no longer suggest friends join up. Fortunately most of my friends who did join are drifting away, tired of account hacks, app scams, and the hopeless task of working with a demonic vendor (shades of pre-reform health insurance). Facebook's numbers keep rising, but there are fewer people I know participating. That's a bit funny. Does anyone audit that stuff?
It's a bit of a shame though. There are a lot of non-App things that Facebook did that I like. I hoped Google would give us a real alternative, but instead we got Buzz. There's more wrongness at Google than we know about.
So if Google can't do it, who has the brand and the money and the reach and the business savvy and just-enough evilness to deliver Facebook type services and a first-class user experience without Facebook-class evil?
Cough.
Ok, so I admit Apple has struggled with the online world for a while (emphases mine) ...
AOL - Wikipedia, the free encyclopedia
... In May 1988, Quantum and Apple launched AppleLink Personal Edition for Apple II and Macintosh computers. In August 1988, Quantum launched PC Link, a service for IBM-compatible PCs developed in a joint venture with the Tandy Corporation. After the company parted ways with Apple in October 1989, Quantum changed the service's name to America Online ...I used AppleLink, it was pretty good. So too was 1990 AOL for that matter. Since then, not so good. Online hasn't been Jobs thing.
Still. We know Apple has built data centers they're not yet using. We know Apple has an increasing consumer platform reach with the iPhone and the iPad. We know Apple isn't adverse to entering a market and turning it upside down.
I believe Apple is going to go up against Facebook. Soon.
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Sunday, March 28, 2010
Health care reform – the road ahead
Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.
Winston Churchill, 1942.
One way or another I'm gonna find ya
I'm gonna getcha getcha getcha getcha.
Blondie.
In the original Senate version of the Health Care reform bill we find this clause …
Subtitle D: Improvements to Medicaid Services - (Sec. 2301) Requires Medicaid coverage of: (1) freestanding birth center services …
Yes, there are a lot of funny bits in this sausage. We don’t know the half of ‘em, but I do know my family will pay for them. Now that the bill done (for now) I can say that the wingnuts were right about some things; my team’s “$250,000 and above” slogan was nonsense. “One way or another” upper 30th percentile “tax-equivalents” [1] will go up.
I’m good with paying for this; I expected to pay for it when I campaigned for Barack Obama. Altruism aside, there are tangible personal benefits for my family:
- We’re no longer lashed to my employer. Since I expect to be an involuntary entrepreneur within 8 years this is rather good.
- Not all of our children are equally suited to life in the post-modern world. This bill increases the probability that they will, at least, receive health care after my warrantee expires.
- Now my insurance provider doesn’t have to be demonic to survive
- America is less likely to turn into Haiti of the North. I really don’t like broken glass topped walls.
What’s next? We’ve been stuck in the headlights for a generation, but now we’re moving. We might be charging towards the oncoming truck, but even that may be an improvement on standing still. At least with motion comes opportunity.
The question isn’t where we need to go. We’ve known that for at least thirty years. We’re going to the same place as everyone else on earth – good enough care for everyone and luxurious care for those with money. The question is how we get there.
Until now the American people have been completely unwilling to think about health care cost. It would have been nice if we could have cut costs before increasing access, it would have been nice if we’d come up with a reform plan that made it easier to cut costs, it would be nice if we weren’t charging towards the right fender of that oncoming truck. Nice – but not going to happen in a world where the GOP has gone mad.
Now, however, we’ll all be, at last, considering costs and value. It won’t be pretty, but if it were pretty it wouldn’t be real.
That’s progress.
See also:
Post-passage commentary
- Summarizing the Patient Protection and Affordable Care Act – in two pages and 10 titles (worth a scan, really)
- Best health care reform commentary (all the things I don’t need to say)
- Health insurance companies only the demonic survive (Just before passage, but fits here. Now insurance companies can explore non-demonic options.)
- How the Health Care Overhaul Could Affect You - Graphic - NYTimes.com (try it – it’s great)
Older general discussions that are still relevant
- Discovering medical prices and the problem with paying cash
- Health insurance we're defeated by a complexity attack
- The hidden insurance problem they can play the game better than we can
- Gawande and NEJM cost of care roundtable
The future: “pretty good care”, aka “good enough care” – where we’re going
- Health care reform – lessons from Quebec (pretty good care)
- Healthcare Reform The One Slide Presentation
- Staggering towards health care access
[1] Federal “Taxes” rarely include anything so obvious as a rate increase. Tax equivalents include
- actions that shift services burdens to the states – which either reduce state services or increase state or local taxes
- unfunded federal state or local mandates of all varieties including regulatory or reporting burdens
- means testing that remove tax breaks (the AMT is the mother of means testing)
- elimination of tax dodging programs such as the Flex plan we enroll in (I’ll be glad to see that evil scam die)
- user fees
- service taxes (such as the 10% tanning tax – which, amusingly, is aimed squarely at the Tea Party demographic of less educated paleskins).
Rwandan genocide and the Zani score
I imagined it in the context of an industrial society, but I asked a friend who's an expert on the Rwandan genocide to try to apply the metric to that setting:
- A belief that the ends justify the means, or, in other words, "extremism in the defense of liberty is no vice". NOT SURE.
- A sense of grievance and injustice. YES.
- A charismatic leader. NOT REALLY. NO ONE WAS CHARISMATIC, BUT AUTHORITY WAS TOTAL.
- Celebration and admiration of violence. WELL, SINCE 1990. IT WAS SPECTACLE FOR SOME.
- Tribal or ethnic boundaries; a division into the "chosen" and the "other". YES.
- Anti-intellectual, in particular anti-geek. YES, INTELLECTUALS WERE AMONG THE FIRST KILLED.
- Denial of skepticism. Skeptics are outcast, dissent is forbidden. NOT SURE.
- Welcoming and affirmation of the convert. NONCONFORMITY WAS NEVER ENCOURAGED GENERALLY.
- Membership alone is proof of virtue. IN TERMS OF ETHNICITY.
- Scorn for the weak; denial of pity or sympathy for the other. NOT SURE.
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Saturday, March 27, 2010
Three NYT OpEds on the latest American extremism
- Krugman - Going to Extreme - March 25 NYTimes.com
- Charles Blow - Whose Country Is It? - March 26 NYTimes.com
- tFrank Rich - The Rage Is Not About Health Care - NYTimes.com
The GOP's Zani score is probably about five. We should really worry if it hits 8.
Incidentally, Palin's Facebook page still uses gun sight cross hairs to mark our her enemies.
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Miep Gies and the Zani score
I knew the story of course, but, until now I'd missed the book, the movie and the play. Seeing it at this point in my life I am awed by the endurance and compassion of Otto and Edith Franck, sympathetic to the less favorably portrayed refugees, and curious about the heroes Victor Kugler, Johannes Kleiman, Jan and Miep Gies, and Johannes and Bep Voskuijl. Curious too about what kind of man Otto Franck was to create such love and loyalty in his employees.
Of the heroes we know the most about Miep Gies, in part because of her astounding longevity. She passed for an ordinary person before and after World War II. She claimed, somewhat convincingly, that she was motivated not by courage but by a fear of unbearable guilt should she fail to perform her duty. It may be relevant that she was, by necessity, given up for adoption by her birth mother.
I wondered then, and wonder now, how extraordinary Gies was. In coverage of her death this past January I recall that of 81 people asked by the Dutch resistance to shelter Jews, 7 accepted. Clearly they did not ask just anyone; if we guess that only 1/10 were considered candidates, and 7/81 of those accepted, then Gies-class heroes were, and are, perhaps 1/100. Unusual certainly, but more common than world class athletes.
That feels right. I can believe that somewhere between 1/30 and 1/100 of humans are heroes born, and another 1/10 to 1/20 heroically inclined. Likewise it feels like 1/5 of us are Nazi-capable and 1/50 Nazi born. The rest of us, in most circumstances, favor the good. Which is why civilization is possible.
I expect the epidemiology of heroism has been studied by scholars of later genocides in Cambodia and Rwanda. I know one such, so maybe I'll update my post with some real data.
Do the demographics of hero and villain vary by society? Obviously some societies are far more evil than others; Germany of 2010 is not Germany of 1940. I would not be surprised to learn, however, that the frequency of fundamental human heroism and villainy is fairly constant. It might instead be chance and circumstance that leads to the rare, but cataclysmic, ascendance of the villainous.
Could villains win in modern America? Obviously yes. Even if there had been any past doubts, the recent widespread public support for governmental torture has put them to rest. We, like most nations, are quite capable of industrial evil.
Given that we Americans, like most nations, have a low but real risk of repeating the worst of modern human history, shouldn't we put some measure in place so we can estimate and track our risk?
We can't call this the "Nazi score" because the word Nazi has too much baggage. It cannot, for example, be applied to readily applied to Israel and it is historically bound to a peculiar form of industrial organization. In any event a Nazimeter score would be a Godwin's Law violation.
Still, the lessons of Nazism are so powerful, and so often studied, that it would be insane to ignore them. So I'll permute some characters and name this metric the Zani score.
It only remains then, to assemble the metric. Tradition dictates a 10 point scale, so we need to come up with 10 distinct indicators of roughly equal weight. As a rough guide we can assume that the National Socialists get 9-10 points and the American Tea Party movement must score less than 5.
Given that rough outline here's my start on the 10 indicators that sum to a Zani score for any social movement or organization. Suggestions are most welcome and I hope to refine the scale over time.
- A belief that the ends justify the means, or, in other words, "extremism in the defense of liberty is no vice".
- A sense of grievance and injustice.
- A charismatic leader.
- Celebration and admiration of violence.
- Tribal or ethnic boundaries; a division into the "chosen" and the "other".
- Anti-intellectual, in particular anti-geek.
- Denial of skepticism. Skeptics are outcast, dissent is forbidden.
- Welcoming and affirmation of the convert.
- Membership alone is proof of virtue.
- Scorn for the weak; denial of pity or sympathy for the other.
Thursday, March 25, 2010
Dinosaurs born of CO2
The new bit is the Triassic transition, but an Economist article is a handy summary of current thoughts on the Permian and later extinctions (emphases mine):
Economist: Rise of the dinosaurs
… This cycle has happened five times in the history of modern life. The most famous occasion was 65m years ago, when the dinosaurs were wiped out and the mammals emerged victorious from the wreckage. A bigger mass extinction, at the end of the Permian period 251m years ago, killed 70% of the world’s land vertebrates (and 96% of all marine animals) and paved the way for the age of reptiles.
Exactly which sort of reptile would come out on top, however, was not something that was decided until later—201.4m years ago, to be precise. This was towards the end of the Triassic period. Then, the ranks of aetosaurs, phytosaurs, shuvosaurs and many other uncrocodile-like relatives of the crocodiles were suddenly thinned, and a previously obscure group came to the fore. The result, once natural selection had done its work over the course of millions of years, was the now familiar cast of Allosaurus, Diplodocus,Triceratops and Tyrannosaurus rex…
… The dinosaurs were done for, as everybody knows, by a collision with an asteroid. The Permian was curtailed by massive volcanism. But what exactly happened towards the end of the Triassic has been much debated. A study just published in the Proceedings of the National Academy of Sciences, by Jessica Whiteside of Brown University in Rhode Island and her colleagues, pretty well nails it down. It was the geological chaos that created the North Atlantic Ocean.
… The initial volcanism as North America split from Europe released carbon dioxide from deep inside the Earth. That produced a greenhouse effect which, in turn, melted seabed structures known as methane clathrates, which trap that gas in ice. This caused a massive release of 12C-rich methane into the atmosphere, explaining the initial drop in 13C concentrations. The methane, being a much more potent greenhouse gas than carbon dioxide, exacerbated things, while the carbon dioxide acidified the oceans, killing most of the animal shellmakers and fertilising the photosynthesis of planktonic plants. The subsequent plankton bloom sucked up the12C and the isotope ratio veered off in the opposite direction.
The greenhouse warming and the acid rain also did for the forests and many of the reptiles. Only once things had settled down could the survivors regroup. New species of trees took over. The forests grew back. And a bunch of hitherto not-so-terrible lizards began their long march.
So a spike in CO2 from deep sources led to a methane spike. Together the two baked and acid burned the planet. A plankton bloom sucked down the CO2 and things settled down again.
We, of course, are on track to repeat history.
CO2 or not, we are in the midst of a mass “holocene” extinction anyway. What comes from that remains to be seen, but if humans last a bit longer it might be retrospectively labeled the transition to the age of the machines.
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 ProvisionsTitle 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 ServicesTitle 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 BenefitsTitle 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:
It’s a very structured document that resembles generated software code and could indeed be created from a regulatory meta-language.Allows
Amends
Applies
Appropriates
Authorizes
Declares
Directs
Establishes
Excludes
Expands
Expresses the sense
Provides
Reauthorizes
Redesignates
Requires
Revises
Sets forth
Wednesday, March 24, 2010
If you laid every virus head to toe ...
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.
Monday, March 22, 2010
Best health care reform commentary
- 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
Sunday, March 21, 2010
Farewell Palm
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
[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
Saturday, March 20, 2010
Top 50 children's film
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
... That our quality problems with generic medications are much bigger than we imagine.