How much of America's healthcare crunch is dementia care?

US healthcare costs were 2.6 trillion in 2010; about 18% of the 2011 US economy. Of that, dementia care costs about $200 billion, or about 8% of our total health care bill.

Demographics, and our failure to prevent brain deterioration, means dementia costs will grow. Since demented patients often exhaust all personal and family financial resources, these costs will show up as medicaid expenditures.

Even so, dementia is less of a problem than I had long thought. Even if costs were to increase by another 50% over the next decade, it still wouldn't break the bank.

Faced with the facts, I'm now forced to examine my unexamined assumptions. I can now imagine why dementia might turn out to be a bit of a bargain.

Many, if not most, dementia patients no longer receive aggressive medical care. They do need hands-on care, but in the modern economy there's no lack of people reasonably happy to do that work for comparatively little money. Demented people don't eat that much, and they don't require costly ingredients or food preparation. They don't demand the latest gadgets or costly bandwidth or cutting edge architecture or modern art on the walls. They can live where land is cheap.

In many ways, demented people are cheaper to maintain than non-demented people of similar ages. Given that neither produce wealth, from an economic accounts perspective dementia might be a money-saver.

Even as our dementia population grows, increasing costs may be offset by advances in robotics and remote monitoring, and, in time, by widespread acceptance of euthanasia [1].

Of course dementia and pre-demential can bankrupt individual families, but in our income skewed economy those bankruptcies don't add up to all that many billions.

To answer my title question then, dementia care does not appear to be a uniquely large part of our healthcare crunch. Obesity, for example, may be more important.

That's too bad, because many of us have a personal interest in a business case for dementia prevention...

[1] I want my kids to have a robust financial incentive to pull the off switch on my future demented self.

johngordon on App.net

App.net is almost certainly doomed. Almost no-one believes that a Weibo-like communication service can run at scale other than by advertising or selling user information. I mean, it's not as though we pay for our data services, or our voice services, or for those stampy things.

App.net is a quixotic hopeless sad bit of misplaced nobility.

So, of course, I love it. Here's my app.net stream: johngordon on App.net.

Is Detroit the future of Manhattan?

This year our family trek took us through Chicago and Detroit.

Detroit was more interesting and attractive than we'd expected, but it's not hard to find collapsed houses. We didn't get to make the urban ruins tour, but we've seen the pictures. Detroit crashed hard. 

Chicago did quite a bit better. It was never a one business town.

Unlike, say Manhattan. These days it seems to be a finance and business town, just as Detroit was once a car town.

So what happens when Finance doesn't need humans any more? What happens when it's all software and AIs and rule based systems?

Will Manhattan 2050 look like Detroit?

Dear Dems: Maybe you shouldn't have spammed me so much.

The GOP may have a loose relationship with the falsifiable world, but they're tight where it matters. They have money by the truckload, mostly delivered by the deluded wealthy [1] to anonymous GOP funding streams.

So you'd think that Emily and I be inundated with pleas for donations.

Instead, crickets.

Seemed odd to me, then I remember the dense wall of filters and blocks I had to put up after our last set of donations. I had to block over thirty domains to beat back a deluge of Dem spam.

I guess our defenses are working. All those pleas and invitations are probably lost in my spam filters.

Maybe my team needs to rethink their fund raising strategy, and to implement rigorous email list control. Work on it guys.

In the meantime, I guess we'll have to send money somewhere. Google will probably come up with an address.

[1] Besides America, how many other post-industrial nations associate wealth with virtue and intellect?

I put $50 down on App.net

I was mildly (cough) irked (cough) when Google Reader Shares died.

My Pinboard/IFTTT/Twitter/WordPress replacement works better than it ought to, but it's frail. It could fall apart at any time, for many reasons. I want a solution that I can rely on, from a company that wants me as a customer -- not as a product.

That's why, like Gruber and many of the geeks I read, I put $50 down to reserve @johngordon on App.net. Time to put some money where my mouth goes.

They need a bunch of money in the next five days to launch. Take a gamble.

Update 8/17/2012: My (alpha) stream: https://alpha.app.net/johngordon. App.net is my kind of quest: quixotic, almost certainly doomed, but noble.

CAPTCHA has failed, and so anonymous comments may go too.

My most loyal commenter (that's you Martin) tells me he can't solve Google's CAPTCHAs any more.

Neither can I. I responded ...

I can't do the CAPTCHAs either. Blog authors don't usually see them, but occasionally I'm connecting with a non-owner account.

I think they've evolved to a point that only human experts and AIs can solve them, and they all work for spammers.

Problem is I allow anonymous comments and only moderate if > 4 days, so there's only CAPTCHA and Google spam detection between me and endless hordes of mosquitoes.

As an experiment I've disabled CAPTCHAs on notes.kateva.org. I'll see how good Google's spam detection is. If the volume is too high I'll turn off anonymous comments. I agree, CAPTCHA has reached the end of the road.

Even in tiny market blogs like mine, comment and discussion is problematic.

Update 8/9/12: No problems! I should have dumped CAPTCHA years ago. Turns out I did on tech.kateva.org and then forgot I had. Google's comment spam filters are pretty amazing.

Digital has finally killed paper -- and office supply stores.

One day I looked up and saw an empty space where some pay phones were. I knew then I had to get a mobile phone.

More recently, I knew the post office was shrinking, and I knew paper mills were shutting down, but I hadn't noticed that office supply stores were dying too.

It makes sense of course. When was the last time you bought a paper clip or a file folder? We buy some school supplies for our kids, but nothing that general retail stores can't handle. If not for a peculiar circumstance, we'd rarely buy printer paper. Our printer would go the way of our last typewriter -- dusted off every few months for a special project.

Apple added printing to iOS devices a few months back. Did anyone notice?

Thirty years after the PC was supposed to eliminate paper, but instead causes a printing boom, it's finally happening.

I'm sure we can't imagine all the implications. If paper becomes a nice product, for example, what happens to the cost of paper back books?

PS. A little bit of irony though. Our typewriter went away around 1990 or so. We've done a lot more hand printing since. So the world split between new tech and ancient tech.

Net security is completely broken

Matt Honan was thoroughly hacked, including having his iCloud link computers obliterated [1], because our net security infrastructure is completely broken.

Here's just one bit of the hack ...

How Apple and Amazon Security Flaws Led to My Epic Hacking | Gadget Lab | Wired.com

... It turns out, a billing address and the last four digits of a credit card number are the only two pieces of information anyone needs to get into your iCloud account. Once supplied, Apple will issue a temporary password, and that password grants access to iCloud...

... First you call Amazon and tell them you are the account holder, and want to add a credit card number to the account. All you need is the name on the account, an associated e-mail address, and the billing address. Amazon then allows you to input a new credit card. (Wired used a bogus credit card number from a website that generates fake card numbers [1] that conform with the industry’s published self-check algorithm.) Then you hang up.

Next you call back, and tell Amazon that you’ve lost access to your account. Upon providing a name, billing address, and the new credit card number you gave the company on the prior call, Amazon will allow you to add a new e-mail address to the account. From here, you go to the Amazon website, and send a password reset to the new e-mail account. This allows you to see all the credit cards on file for the account — not the complete numbers, just the last four digits. But, as we know, Apple only needs those last four digits. We asked Amazon to comment on its security policy, but didn’t have anything to share by press time....

That sound you hear is the hollow laughter of Bruce Schneier, who used to write about the madness of 'secret questions' before the sheer stupidity of it all wore him down.

It's all broke guys.

Once upon a time civilians [2] used the same password everywhere. Smart civilians made it a bit harder to guess, like "Joseph45206". They knew their passwords.

They were hacked of course. So companies began insisting on more robust passwords. Civilians stopped remembering their passwords. So they took to requesting password resets whenever their browsers forgot a password. Except email addresses fade away, so resets often failed. Then sites started asking 'secret questions' to do resets, but nobody remembers the answer they gave to their #$! secret question [3]. So now Apple support basically hands over credentials to nice sounding voices.

This system can't be fixed.

Phone based two-factor might help, but I've been using Google's two-factor since day 1 and it's still a royal pain in the ass. It's strictly for geeks. Not to mention what happens when you lose your phone.

We need to give Schneier a few drinks and get him to talk about this again. Failing that:

1. Backup for Darwin's sake.
2. Don't enable remote wipe of Mac OS X hardware. Just encrypt it.
3. Use Google two-factor (two-step verification) if you are a geek and can stomach it.
4. Fear the Cloud. Keep the data you value most close to you.
5. Don't use iCloud.
6. Don't trust Apple to get anything right that involves the Internet and/or Identity. [4]

Not being Schneier my advice isn't worth much, but fwiw I suspect the "solution" is:

1. Get rid of the secret security question.
2. Strictly limit password resets. If someone lost last access, charge them $50 to go to bank, post office or notary to establish their identity.
3. Incorporate biometrics (thumb print and speech probably).

[1] Of course he didn't have backups. Don't beat him up about that, he's busy flogging himself.
[2] As opposed to geeks with 15 yo FileMaker password databases stored on encrypted disk images. 
[3] Unless they've added a $!%!%$! secret question field to the #$!#$ FileMaker encrypted disk image database and the answer to the secret question is something like: "4hgoghi4ohh4tt".
[4] Apple needs to pay their executives less and their geeks more. 

Coin flips and climate

The weather is unusual, but is the climate truly different? How would we know?

I toss a fair coin 10 times. Which of these patterns is more likely than the other?

• HTHTHTHTHT
• HHHHHTTTTT
• TTTTTTHHHH
• HTTHHHTHTT

Now toss a fair coin nine times. I get HHHHHHHHH. What's the chance of getting T on the next toss?

The answer to the first question is that all of these outcomes are equally likely, though some seem odder to us than others. They all show five tails and five heads, the most common result of tossing a coin ten times. [1].

The answer to the second question is, of course 50%.

Now for the interesting question.

I toss a coin 100 times and I get 95 tails. What is the chance that the coin is fair [2]?

What if find one side of the coin is more magnetic than the other?

What if you inspect the rim and notice a color change from one side to the other?

Each of those three observations makes it less likely that the coin is fair. Taken together they strongly suggest the coin isn't fair.

We know that weather is not "fair". It is biased by climate.  If the distribution of weather events changes, we may infer that the climate bias is changing. If we have strong reason to suspect that atmospheric CO2 concentrations change climate, and we know CO2 is rising and weather events are changing, we have even more reason to suspect that climate is changing.

That's why we can say, beyond a reasonable doubt, that our climate is changing.

[1] Contemplation of these results doubtless leads to speculations on the arrow of time, Boltzman's brains, and the insanely unlikely probability of my certain existence. But that's not for today.
[2] Can I reject the null hypothesis of a fair coin, where a fair coin, tossed a very large number of times, will turn up heads and tails with equal frequency?

Google's Kansas Gigabit and the wireless war

The Google-Apple war continues, but it's dwarfed by the wireless war that started when Verizon and ATT used price signaling to become VerizATT [1].

Now AT&T retail sales is incented to trash talk iPhones and sell Android. VerizATT is, for the moment, allied with Google against Apple. (Which should give geek fans of Android some qualms.)

This is starting to feel like the tooth-and-claw capitalism of the 19th century railroads [2].

Meanwhile Google is going nuclear on Comcast. Will they stay loyal to VerizATT, or will they turn when Apple is wounded?

Will Comcast do a deal with Apple? Will Microsoft continue to sit on the sidelines?

Will Apple and Microsoft form a separate consortium to buy Sprint and T-Mobile?

With its massive pipes, will Google offer free net access to homeowners willing to mount a LTE-Advanced tower on their roof?

These are interesting times.

[1] They must figure that by the time antitrust kicks in the war will be done.

[2] Not the first time that comparison has been made. Railroad tracks have a lot in common with wireless spectrum. My grandfather was a railroad man when everyone was in railroad; sometimes I wonder if 19th century geeks were all in the railroads.

Microsoft: what really happened?

I finally read the entire How Microsoft Lost Its Mojo Vanity Fair article. It's worth a read for all geeks over 40, despite some obvious flaws. A few quick comments:

• The article makes Microsoft sound atypical. I don't think it is, I think it's a very typical corporation. It's no more had a lost decade than any other publicly traded company that's not Apple. (Google search is more than 10 years old. What have they done since?). It's only remarkable because it was once so extraordinary.
• Most modern corporations do something like stacked ranking, they're just not usually so obvious about it. GE's disastrous HR innovations are ubiquitous.
• Vanity Fair's fact checkers should be stack ranked. Obviously Eichenwald needed help. There are many chronological and tech history errors in the article; I especially don't get what was so remarkable about OS X 10.4/Tiger. 10.3 was the amazing version of OS X.
• I don't remember mention of the effects of the 1990s Consent decree. That's a curious omission. In the late 90s it was possible that Microsoft would be broken up for business practices that are illegal for de facto monopolies. If Gore had won in 2000 that might have happened. Instead Bush won. (I wonder who Gates funded that year.) Microsoft remained intact; now that seems a Pyrrhic victory.
• I think Google is following Microsoft's path, they're just not as far along. More importantly, I don't see how Apple can avoid Microsoft's fate. Jobs psyche and power were unique. All publicly traded corporations tend to resemble one another.

Minnesota: There is official bicycle parking at the Rosedale Mall (aka Rosedale center)

(and now for something completely different).

I made my most recent Apple store trip by bicycle. Before I set out I tried to find a bike parking slot at the typical old-style suburban mall near my office -- the Rosedale Center (mall).

All I found was a lonely picture of someone's bike padlocked to a stairway railing.

That's why I wrote this post; so that Google will now know the answer to that question.

The answer, as you might suppose from the title, is yes.

The official response is that there are "bike racks at the Food Court entrance and the entrance near Green Mill."

In my case I used a quite nice set of racks that are immediately behind the Apple Store; I wonder if they were installed for employees. (Incidentally, if you're picking up a 27" iMac you can park here for 30 minutes. Wish I'd known that prior to my last visit.)

There's another set of similar racks to the right of this location; I think they're the "food court entrance" racks and they at 45.01217, -93.17242:

Now you know. Kudos to the mall for having such fine bicycle parking, now they just need to note it on their web site.

Poverty in the west

For much of human history slavery, rape, abuse of children and women, heavy drinking, murder, cruelty, and animal torture were commonplace and accepted.

Not so much now, at least in wealthy nations. Humans are immensely imperfect and prone to regression, but we are better than we were. Progress happens.

Progress happens, but then the bar goes up. We clean the air of LA and the acid rain of the Northeast, so we get global CO2 management as our next assignment. We work through a chunk of our racist and genocidal history, and we get to work on gay marriage. Fifty years from now we won't eat animals. And so it goes.

Poverty elimination is also on the list. Might be an even harder problem than CO2 emissions. The good news is that worldwide poverty is improving very quickly...

US intelligence agency sees world poverty in sharp drop, rising fight for resources by 2030 - The Washington Post

Poverty across the planet will be virtually eliminated by 2030, with a rising middle class of some two billion people pushing for more rights and demanding more resources, the chief of the top U.S. intelligence analysis shop said Saturday.

If current trends continue, the 1 billion people who live on less than a dollar a day now will drop to half that number in roughly two decades, Christoper Kojm said...

I don't think 'virtually eliminated' means what Kojm thinks it means - but this is good news all the same.

The bad news is that poverty in America isn't going away.  Peter Edelman runs the numbers  on our brand of poverty ...

Why Can’t We End Poverty in America? - Peter Edelman - NYT NYT

... The lowest percentage in poverty since we started counting was 11.1 percent in 1973. The rate climbed as high as 15.2 percent in 1983. In 2000, after a spurt of prosperity, it went back down to 11.3 percent, and yet 15 million more people are poor today...

... We’ve been drowning in a flood of low-wage jobs for the last 40 years. Most of the income of people in poverty comes from work. According to the most recent data available from the Census Bureau, 104 million people — a third of the population — have annual incomes below twice the poverty line, less than $38,000 for a family of three. They struggle to make ends meet every month.

Half the jobs in the nation pay less than $34,000 a year, according to the Economic Policy Institute. A quarter pay below the poverty line for a family of four, less than $23,000 annually. Families that can send another adult to work have done better, but single mothers (and fathers) don’t have that option. Poverty among families with children headed by single mothers exceeds 40 percent.

Wages for those who work on jobs in the bottom half have been stuck since 1973, increasing just 7 percent...

Addressing these problems will be challenging. Children are very expensive in a post-industrial society, yet much of American poverty is concentrated in father-free families managed by a single mother. Their poverty would be easier to manage if they had made different fertility choices; simplistic income subsidies could incent politically unsustainable behaviors.

Fortunately there are strategies which eliminate perverse incentives. Tying income to managed work, providing health and child care (including easy access to contraception), and quality educational programs alleviate poverty and provides the means and incentives to make thoughtful fertility choices.

A different slice of our poverty comes from a mismatch between post-industrial employment and human skills. This isn't going a way, 3D printing of manufactured goods will do to manufacturing what full text search did to the law. Meanwhile six percent of Americans suffer from a serious mental illness every year and twenty-five percent of Americans have a measured IQ less than 90. Given changes in technology, and the automation of many jobs, is it conceivable that 20% of Americans are relatively disabled?

Again, the strategy for this community is subsidized work -- the same strategy used for the "special needs" community. (Since I won't get to retire ever, I assume I'll be in this community sooner or later.) 

We know what we need to do. We even know where the money will come from -- from taxing CO2 emissions, financial transactions, and the 5% (ouch).

Sooner or later, we'll do it.

See also:

• Median male earnings - declining since 1969? 3/2011
• Mass disability and Great Depression 2.0 3/2008
• Employment in the Great Stagnation 8/2010
• Post-industrial employment: adjusting to a new world 5/2010
• Plan B - Skip College - NYTimes.com 5/2010
• Why your daughters should be roofers -- not architects 3/2004
• Causes of the Great Recession: China, GPSII and RCIIIT. Now for Act III. 4/2010
• Neo-Feudalism: Return of the Trades 2/2004
• Unemployment and the new American economy - with some fixes 1/2010
• Is labor lumpish in whitewater times? 7/2012

Facebook's share price: based on my ads, it's going to stay in the 20s

Facebook opened at 38 and it's down to 24 (7/28/2012). Facebook has earned less money than expected.

I don't know where Facebook's money was supposed to come from, but Facebook claims advertising pays the bills:

Advertising on Facebook

Ads help keep Facebook free
From the beginning, the people who built Facebook wanted it to be free for everyone. It now costs over a billion dollars a year to run Facebook, and delivering ads is how Facebook pays for this.

You see personalized ads
Facebook tries to show you the ads you’ll be most interested in. These ads are chosen based on the things you do with Facebook such as liking a page, and info Facebook receives from you and other sources. Dig into the details.

You can impact the ads you see
Unlike ads on television, you can influence which ads you see on Facebook. Spot something that doesn’t interest you? Click the X and it’s gone.

Except ads are obviously not paying as expected. There are two reasons for this, one obvious and fixable, the other simply weird.

The obvious problem is that when i use Facebook.app I don't see ads. I assume that's why Facebook is working with Apple on a unified iOS/OS X integration strategy that will bring ads to mobile. (It's funny how many geeks claim it's app performance that's driving the rewrite.)

The weird problem shows up in my web browser. I see ads in my browser, but they are uninteresting or annoying. 

It's not I'm immune to advertising. I pay for a Silent Sports subscription so I can read their ads. So why can't Facebook give me interesting ads?

It's not that I don't try to help. I visited their 'interests' page -- but they didn't list any of my interests (I ran into the same problem with Google's ad-interests page years ago.) I "x out" the fb ads that are annoying or uninteresting, but I still don't get anything interesting. Facebook's two year old ad voting isn't working.

I'd love to read an article on why Facebook's ads are so poor, and why Google's are only somewhat better. The best minds of today's young are spent trying to get me to click on ads, I'm trying to help them, and it's not working. I get better ads on the rare occasion that I watch broadcast TV, and much better ads in magazines.

That's weird.

I can think of three possible causes. One is that the products and services I buy from don't need Facebook ads. They get more mileage from Facebook's free Pages. Another is that Facebook's leadership is mediocre and delusional. (I think the era of mega-wealth is making that age-old problem worse.) Lastly the real profit in facebook ads may come from exploiting the same population that watches daytime tv; I'm not worth bothering about.

I suspect all three answers are correct. Unless Facebook can do a great deal with Apple, or figure out how to make Pages pay without killing them[2], or come up with a new business model, their share price is going to be stuck in the 20s for years to come.

I really do need to learn how to make bets on relative spreads. [1]

See also:

• Why are Google and Facebook ads so crappy? 4/2012
• Facebook changing: it's not about friends or games any more ... 7/2012
• Facebook has the eBay disease - the Farmville story 11/2009
• Facebook's ad voting - fascinating 7/2009
• 21st century TV - preying upon the weak 3/2011
• Facebook's Ads Are Terrible, It's Amazing The Company Will Do $4 Billion In Ad Sales: Apparently an analyst named Rich Greenfield wrote on this pre-IPO, but it looks like his share price estimates were optimistic. 

[1] John A, I still have the notes you gave me! The linked article is about making bets on single trends, I'm more interested in bets on relative trends. (Ex: Divergence between Facebook/Google share prices over an 8 month period.)
[2]  About Sponsored Stories - Facebook Help Center

Google Fiber: a blog, not a G+ share

Google uses a blogspot blog, not a G+ channel, to tell us about Google Fiber.

I'm probably making too much of this ray of sunshine, but Google Fiber and open blogs are both old school GoogleMinus. My Google feeds have been shrinking since the dark day, this is the first one I've added in almost a year.

Is it coincidence that I ordered a Nexus 7 two days ago? If I'd known Google was that easy I'd have ordered a Nexus something months ago.

Really Google, if you want to win me back, just give St Paul Minnesota some of that fiber love. We're only 400 miles up highway 35E. I'll even put a mini-tower atop my home to provide data coverage to complement your t-mobile acquisition.