Monday, April 25, 2005

Best Healthcare System in the World?

This week in the Bronx, a 13 year old kid died of a toothache. Seriously.

This case seems to encapsulate everything that's wrong with out healthcare system. The kid, Teron Francis, has a family that clearly has lots of challenges and not a lot of resources, and Teron showed up for a root canal last week without the proper accompaniment or parental authorization. So, of course, the healthcare system did what it typically does when it encounters a bureaucratic hurdle--it threw up its hands and said, "sorry, we can't give you the treatment you need."

In the "greatest medical system in the world," a 13 year old died of a toothache because he didn't have the right paperwork. That's bat shit insane.

And, of course, there's a Schaivo-esque twist to all this: according to news reports, Teron is brain-dead, but his family is insisting he be kept on a respirator. There's some dispute between the hospital and the family--the family claims the hospital planned to take Teron off the respirator (which makes sense if he's brain dead), so the family filed an injunction to prevent it. The hospital, which apparently received Teron as a transfer patient when it was already too late to do anything for him, disputes the family's charge. And the icing on the cake is watching the Bronx's notoriously sleazy judiciary descend to a new low: this weekend, in a brilliant stunt, the wife of the judge who issued an injunction against removing the feeding tube ventilator prayed over the poor child's braindead body.

I can't imagine a better parable for our medical system: when it comes to preventive care, we're going to make it as difficult as possible for you to get the care you need in order to stay healthy. The roadblocks will be formidable, and if you fail to pass any of the system's tests--financial, bureaucratic, language or any other--it's going to be up to you, the sick person, to figure out the right way around them. But once you're dead, baby, you've hit the jackpot! The bureaucracies will magically align and they will move heaven and earth to preserve your quality of life.

Best medical system in the world? Tell it to Teron.

Thursday, April 14, 2005

DOD: Health Benefits Corporation with War as a Sideline...

I've said for awhile (and Lee Iacocca said something similar first) that at some point, healthcare costs were going to escalate to the point of an identity crisis for big business: they'd begin to realize they could be as easily characterized as a health benefits provider that sold cars to cover their employee health costs as they could be characterized a car-sellingcompany that employed people to make the cars.

It appears that the Pentagon is the most recent victim of this mission creep (via healthsignals).

With healthcare costs blowing up the bottom line, people are wondering why we have a wage and employment crisis?

Sunday, April 10, 2005

Doom. Gloom. And Nuclear Power.

So, Kevin Drum is going off again on peak oil, and Kristof is telling environmentalists that nuclear power is their friend.

Now, True Blue is going to play futurist: as we are forced to find affordable replacements for oil, the dominant power source of the next century will be nuclear power. Fundamentally, there is no replacement for oil today--it's an easily transportable, dense energy source that's easily converted to a usable form. Even when using other fossil fuels, nothing's nearly as good as oil. But we're not going to run out of oil overnight; it's going to become gradually more expensive as it becomes more difficult to obtain. So, it's a marginal benefit issue: as oil becomes gradually more expensive, what's going to replace it where it's replaceable?

Every alternative energy source except nuclear has some sort of glaring technical problem that makes it unworkable: solar and wind are far too unreliable, geothermal/tidal/hydropower are too local (hydro, especially, has significant political repercussions in water use battles), and we can't get fusion to pay off on planet Earth. If we could figure out a way to efficiently store and transport electrial power, we'd be more willing to work on the technical issues for these alternative energy sources and make the continuing investments that made them more and more efficient, but it turns out that storing electricity ain't easy.

Today, the path of least resistance is to substitute nuclear-generated electricity for oil wherever possible. To be reductive, when it comes to keeping the lights on, burning uranium is the most like burning coal or oil. This path of least resistance won't change without a major investment by government--it's pretty clear that finding the technical solution to storing energy will be a phenomenally expensive high-risk venture, and making energy cheaper looks far too much like a public good for any business to reasonably anticipate a meaningful ROI.

Today, we've got an administration that refuses to make this investment in a meaningful way. Even if we manage to get a progressive in office by 2008, the window of opportunity for investment is closing--the next officeholder is going to have to spend all their political capital digging the nation our from under Bush's fiscal mismanagement and preparing us to take the fiscal hit (Medicare/Medicaid health costs and Social Security) of the retiring boomers in 2011. There will be no spare change to invest in the kind of basic energy research that's needed to make most alternative energy sources a viable option.

Barring a lucky discovery by a genius scientist, there's little chance we're going to move off our current energy path--we're just not making the investments in the science that would make it possible. Oil will become more and more expensive, and our solution will be substitutions of less desirable energy sources (mostly nuclear) at the margins of consumption. Ironically, we'd be better off if we were going to run out of oil on a set date--we need a major technological breakthrough to maintain and improve our current standard of living, and without an impending crisis, it appears we are unwilling to make the investment necessary to create this breakthrough.

It took FDR's leadership and the terror of Nazi triumph to make the nuclear breakthrough. What's it going to take for us to make the next one?

Tuesday, April 05, 2005

Sympathy for the Devil

Terrorism: "the unlawful use or threatened use of force or violence by a person or an organized group against people or property with the intention of intimidating or coercing societies or governments, often for ideological or political reasons."

Sen. Cornyn: "It causes a lot of people, including me, great distress to see judges use the authority that they have been given to make raw political or ideological decisions. [Sometimes] the Supreme Court has taken on this role as a policymaker rather than an enforcer of political decisions made by elected representatives of the people....I don't know if there is a cause-and-effect connection but we have seen some recent episodes of courthouse violence in this country. Certainly nothing new, but we seem to have run through a spate of courthouse violence recently that's been on the news and I wonder whether there may be some connection between the perception in some quarters on some occasions where judges are making political decisions yet are unaccountable to the public, that it builds up and builds up and builds up to the point where some people engage in - engage in violence." [Senate Floor, 4/4/05]

There you have it--what causes this United States Senator "great distress" isn't the grisly spectre of judges' corpses in a pool of blood--nope, what's distressing is the entirely legal spectre of judges ruling laws unconstitutional, and applying the law correctly to specific cases Schaivo . We've got a Senator suggesting on the floor of the Senate that when judges exercise the appropriate powers of their office in a lawful manner, their lives and the lives of their families may be forefit.

Tell me, what do you call a guy who supports his political agenda by making excuses for criminally murderous thugs and suggesting death at their hands is the consequence of opposing his policies?

Friday, April 01, 2005

100,000 Indian Doctors to Social Security's Rescue!

The Social Security debate has crystallized into Republican claims that it's a big crisis and the way to solve it is to get rid of Social Security; while Democrats are saying, aided immeasurably by the facts, that it's a small problem, and the way to fix it is to increase the payroll tax (preferably on higher earners), to cut benefits (preferably on wealthier folks) or some combination of both.

What I find bizarre is that neither side is saying that the solution to the Social Security funding problem is to expand the taxpayer base by bringing in more adult workers through increased legal immigration. So, instinctively I've assumed it's because someone's run the numbers and figured out that immigration wouldn't fix the problem.

But then I see noted smart guy Brad DeLong (either him or his buddy Bob Gordon, I can't tell which) point out that, "[r]aising immigration by 0.3% of the workforce every year wipes out nearly half of the 75-year Social Security deficit," and I really don't get it. I mean, the problem with social security is that we need more adults to work and pay taxes. Yet outside our borders there are literally millions of adults desperate to get into America so they can work and pay taxes! And because we write immigration policy, we can even cherry-pick the world's best and brightest, maximizing America's return on other counties' investments. It's an endless spigot and we've got our hand on it. Why aren't we bringing that into the debate?

Is it because everyone is afraid of anti-immigrant sentiment? Is it because nobody wants to come to America anymore? Because there's some quirk in the numbers and immigration really does create more problems than it solves? Am I not understanding what it means to raise the immigration rate by 0.3% of the workforce annually and missing some weird compunding effect (you know, like those penny-a-day and double it things)? Seriously, why aren't Democrats saying "don't worry, we let in 15,000 more Jamaicans and we're back on easy street...what, you don't like Jamaicans? I got Trinidadians, if you want them instead...how's about some nice Poles? Chinese?"

UPDATE: Or, alternatively, we can just cut back on border patrols, let in a few more illegal immigrants and screw them over until the Social Security shortfall is met...