Sunday, January 23, 2011

Are We Still Discussing Health Care?

Well, yes, sorry.

This NPR piece on health care was interesting, relevant to a discussion we had recently. It's an interview with Atul Gawande on ways he radically lowered costs of a few systems by providing more comprehensive care to the biggest consumers of medical care in those groups.

Sometimes I go off about the huge RAND study, which showed that giving people free care can lead to greater costs without improved outcomes, except for in a few areas like heart health and optics. Well, there's a moment in the interview above where Atul Gawande essentially agrees that it's a bimodal* issue, but he adds mental health issues to the list where cheap substitutes (or skipping care) is really, really bad. He then notes that those are the areas where most expenditures are found (maybe not optics, but literal hearts and minds).

*ie, there's two clusters in the data. (Here, one overconsuming unnecessary care and another underconsuming necessary care. Gawande would argue that, by the numbers, the second group is a bigger worry.)

I still think we should partition our health care approaches by medical issue, but Gawande changed my mind in one important way: I feel much better about erring on the side of more care now.

My favorite NPR piece on health care is still from This American Life, on all the ways patients, doctors, insurers, drug companies and hospitals each make things worse in their own way. (Part Two)

And it's always important to note that medical bills cause two out of three bankruptcies. There's this common cycle where expensive consumers of health care have to miss large amounts of work. The incentives and the justification are there for the employer and insurance company to push this person out of work. The individual now has impossible bills and no job.

It's a fact that was common in the rhetoric of the bill, but wasn't directly addressed. Some costs are lowered and caps are used for consumers, but medical bankruptcy law remains essentially the same. It remains to be seen how this will turn out.

So, I'll confess I was against this bill because I wanted a more strict decoupling of employment and insurance, and more of an issue by issue solution. But now that it takes some steps that way, I'm strongly against repeal.

Repeal was recently debated at IQ²US, most of that audience agreed with me.

Saturday, March 13, 2010

From Groklaw, "An Explanation of Computation Theory for Lawyers"

Groklaw, "An Explanation of Computation Theory for Lawyers," from back in late 2009:

Consider the following list of statements.

* All software is data.
* All software is discovered and not invented.
* All software is abstract.
* All software is mathematics.

If my understanding of the US patent law is correct, whether or not any of these statements is true could determine whether or not software is patentable subject matter. The resolution of this issue has serious consequences to the computer electronics and software industries.

When you know computation theory, you know without a shred of a doubt that each of these statements states a fact that is grounded in well-established mathematics. If you don't know computation theory, these statements will probably look to you like debatable issues.

Tuesday, December 08, 2009

While Thinking About Climategate, Copenhagen

Freakonomics recently had a nice article on Climategate as a Rorshach test. Original coverage here. For the record, I originally read Climategate thinking, "One the one hand, a lot of academics have these sort of aggressive private conversations about their dissatisfaction with their data. On the other hand, the data really should have been released years ago if we're going to set global policies based on it."

Fossil fuels have undeniably bad side effects, but cheap energy means cheap everything. Not just luxury goods, but also cheap food on the table and cheap clothes on the backs of a ton of impoverished folks around the world. Research facilities, schools and hospitals all benefit from cheap power. Moves to reduce access to cheap energy will work like a consumption tax on everything. Consumption taxes are regressive, so ultimately higher energy prices end up as just another way to rape the poor.

Not only is cheap power good for the poor, it also has conservational benefits. We often substitute water for power and vice versa, reduced use of one necessarily means increased use of the other in agriculture and manufacturing. (See NYT journalist Charles Duhigg's work on water conservation for details).

So granting that fossil fuel consumption leads to terrible harms, reduced access to cheap energy leads to terrible harms as well.

There's a scene in Gore's film where he says that moving off carbon it's a question of rich people getting piles of gold or global annihilation. That's an unfair picture on both sides of the analysis, and it trivializes the problem.

But here's the part of the story that excites me. Solar, unlike any other power technology, responds to Moore's Law. As Ray Kurzweil points out, we are generating twice as much of our power from solar panels every couple years. While every other power generation technology is increasing linearly, or stalling out in competition with cheap-as-in-nearly-free coal, solar is doubling its deployment every two years. In a decade and a half, we can generate all the world's power through then super-high-density solar collectors. We're talking about collectors that are one hundred times as effective per square inch as current technology.

Even if the doubling doesn't continue, we have a finite amount of improvements to make in this technology before it will always be more efficient than coal.

So at Copenhagen, we can fight human nature and tell folks to stop using the cheap mountains of energy beneath their feet, and in so doing, punish the people who are worst off around the world. Or we can try to pour resources into hastening the day when we have ubiquitous cheap (as-in-unmetered) solar power for rich and poor alike.

I'm not a global warming skeptic, I'm just for option two.


The FT is discussing climate in advance of Copenhagen. Found here, or here (alternate link).

In it, Martin Wolf makes two arguments especially worth noting.

1) "[I]t is not enough to argue that the science is uncertain. Given the risks, we have to be quite sure the science is wrong before following the sceptics."

This is a bit like Pascal's Wager, so let's revisit Pascal's Mugger. Suppose I write Mr. Wolf a letter saying that I have uncovered new data which shows me a way to avoid global catastrophe, but I need $100 to do so. It's uncertain that I'm telling the truth, but the risks I outline are horrendous. We'll see if Mr. Wolf is willing to bear this small cost after performing the probability calculus.

This is not to say that carbon consumption has no risk, but we're now determining how aggressive our response should be, so we need concrete analysis and a concrete timeline. Must we radically deindustrialize tomorrow or face the destruction of the world? Or, as India recommends, can we put this whole thing off 40 years? If we take the most uncertain model simply because it has the most dire consequences, we will undoubtedly make the wrong decisions about how to proceed.

2) The World Bank suggests that costs of carbon reduction to the poor will be low.

Well, not exactly. The World Bank has pointed out that the poor consumer spends far less on power than the rich consumer. But the World Bank has also noted that poor consumers spend far higher percentages of their income on power.[PDF, p11] We should measure the impact to a consumer not in raw dollars, but in how much additional income must be diverted to overcome this new cost. I stand by my assessment that blanket increases in energy prices hurt the poor more than anyone else.

In principle, I agree with Mr. Wolf that with any abatement, "the cost should fall on the wealthy." But this is easier said than done. The factory and merchant who supply low cost clothing to the poor, might themselves not be poor. The research facility which designs and manufactures solar panels might itself not be poor. The hospital which admits poor patients might itself not be poor...

Also notable, Superfreakonomics has some climate coverage which has raised some eyebrows, you can find out more on their blog. Here's a post responding to criticisms, explaining how they came about.

Friday, October 09, 2009

Are Professional Sports Diseased or Dying?

The incomparable Wright Thompson (a fellow Mizzou alumnus), has a fascinating story on ticket prices and their effect on the social contract held between sports teams and their fans.

As a sports fan I agree with the general tone of the article. While owners and athletes quibble over who should be portrayed as the greediest, the fans are continually asked to pay more and more exorbitant prices. If fans unite in solidarity attempting to leverage demand against supply to drive down prices, owners can simply move the entire franchise to another attention starved city (see Oklahoma City, Oklahoma (NBA) or Jacksonville, FL (NFL)).

Tuesday, September 22, 2009

Breaking News: Boris Yeltsin was a Drunk

If there were any questions as to why relations with Russia have become noticeably more difficult since Bill Clinton left office, it could be the foreign policy of the Bush administration.

...Or it could be that Boris Yeltsin likes to walk around the U.S. in his underwear.

I guess we'll never know.

Wednesday, September 16, 2009

No Such Thing as "East Coast Bias"

One thing that is consistently brought up when critiquing the sports media is the concept of an 'East Coast Bias'. I've long held this to be less a stereotype and more of a truism. I have found today that this concept is false. Kind of. Deadspin (one of the most vitriolic websites in all of sports) had the writers of the now defunct FJM website on as guest editors. They enlightened me today with their deconstruction of multiple articles claiming the greatness of Derek Jeter (and his deservedness of the AL MVP ----- baseball, people).

It became clear to me (combined with the knowledge that the BBWAA gives writers in each city hosting a MLB franchise two votes) that an 'East Coast Bias' does not exist. In its place, there is merely a lack of rational, well-crafted sports writing on the East Coast.

At least in baseball.

Thursday, September 10, 2009

Newcastle United Football Club and Relegation

Following a team through relegation has its upside: you get to see your team win. Solid consolation.

Newcastle somehow got crushed by Leyton Orient in the preseason, but now that the league has started, they lead the table with 13 points (4-1-0).

UPDATE: ESPN360 offers a wide variety of live sports online, from Eurobasket to Australian Rugby. The Football League (the second highest league in the UK) is available, and access is free on college campuses. I can watch Cardiff City play Newcastle United Sunday morning legitimately and for free.