“On Thinner Ice”

…from the Asia Society. Recommended.

Amory responds to Stewart Brand

…in Grist. Longer paper here (pdf).

New header…

…thanks to David Burdeny. Extraodinary photographs. This is from the Antarctica/Greenland 2007 series, titled Iceberg Remains. Appropriate for our warming climate…

Whole Earth Discipline

I went to the Long Now seminar last night to hear Stewart Brand talk about his new book, Whole Earth Discipline. Stewart is always cutting edge and thought-provoking, and I’m looking forward to reading this new book. Stewart has also made all of his research and notes available on-line, which should add to the experience.     

Michael Pollan’s rules for eating

Michael Pollan posted a request earlier this year in the NYT for reader’s rule about eating. Here is his illustrated list of the top 20, and here is a sample…

My personal favorite rule is Miss Piggy’s: Don’t eat more than you can lift.

Houses for $100 in Detroit

Take your pick…

Detroit is going through a miserable time. Check out the Time magazine photo story, including this picture of a classic theater now a parking lot:

Don’t get sick until you get Medicare

One of the irritations about the dumb debate about national health care is that many people love Medicare but oppose national health care. As this New York Times article explores, this is especially true is you’re already a beneficiary of Medicare, but don’t want to share the benefits with others. Not a very flattering depiction of civil society in America.

This is a worthy cause

Let’s give the Blue Dogs a run for their money…literally:

Change Congress, by Lawrence Lessig at Stanford, is the best political activism to support today.

Raphael Saadiq is cool…

Other daughter is in San Francisco at Outside Lands, and calls me from the Raphael Saadiq concert. Wish I had been there, but will settle for this…

How civilized countries provide health care

“5 myths about health care around the world” by T.R. Reid in the Washington Post. He can also be heard talking about his forthcoming book “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care” in a Fresh Air interview. It’s a great story because he traveled around the world going through the process in each country of trying to get treatment for a problem shoulder, so he’s not talking health care policy, but the health care realities as we all experience them when we call our HMOs. Quite informative. The kind of reporting that would really elevate the health care debate in this country.

Update: Nice review and summary on Daily Kos.

Whew…

Lots of rain, big waves, nothing happened. Good news.

Gulp

My daughter is spending the weekend in Martha’s Vineyard which sounded great, until I see this…

Hope they have an umbrella.

Cyber attacks and unintended consequences

I’m putting this in the new category “inevitable surprises” because I think it’s talked about but not appreciated or prepared for. We depend on the internet for everything now–big change in a very short time. And the bad guys know it. I’m glad the US government is starting to get prepared–hope they do enough.

Here’s in interesting story about a knew kind of “friendly fire” consequences–when you go after your enemies you can hurt a lot of spectators.

U.S. Weighs Risks of Civilian Harm in Cyberwarfare

By JOHN MARKOFF and THOM SHANKER

It would have been the most far-reaching case of computer sabotage in history. In 2003, the Pentagon and American intelligence agencies made plans for a cyberattack to freeze billions of dollars in the bank accounts of Saddam Hussein and cripple his government’s financial system before the United States invaded Iraq. He would have no money for war supplies. No money to pay troops.

“We knew we could pull it off — we had the tools,” said one senior official who worked at the Pentagon when the highly classified plan was developed.

But the attack never got the green light. Bush administration officials worried that the effects would not be limited to Iraq but would instead create worldwide financial havoc, spreading across the Middle East to Europe and perhaps to the United States.   (…)

Mark Seiden, a Silicon Valley computer security specialist who was a co-author of the National Research Council report, said, “The chances are very high that you will inevitably hit civilian targets — the worst-case scenario is taking out a hospital which is sharing a network with some other agency.”

And while such attacks are unlikely to leave smoking craters, electronic attacks on communications networks and data centers could have broader, life-threatening consequences where power grids and critical infrastructure like water treatment plants are increasingly controlled by computer networks. (…)

Krugman on health care

I think he’s got it right.

July 31, 2009

Health Care Realities

At a recent town hall meeting, a man stood up and told Representative Bob Inglis to “keep your government hands off my Medicare.” The congressman, a Republican from South Carolina, tried to explain that Medicare is already a government program — but the voter, Mr. Inglis said, “wasn’t having any of it.”

It’s a funny story — but it illustrates the extent to which health reform must climb a wall of misinformation. It’s not just that many Americans don’t understand what President Obama is proposing; many people don’t understand the way American health care works right now. They don’t understand, in particular, that getting the government involved in health care wouldn’t be a radical step: the government is already deeply involved, even in private insurance.

And that government involvement is the only reason our system works at all.

The key thing you need to know about health care is that it depends crucially on insurance. You don’t know when or whether you’ll need treatment — but if you do, treatment can be extremely expensive, well beyond what most people can pay out of pocket. Triple coronary bypasses, not routine doctor’s visits, are where the real money is, so insurance is essential.

Yet private markets for health insurance, left to their own devices, work very badly: insurers deny as many claims as possible, and they also try to avoid covering people who are likely to need care. Horror stories are legion: the insurance company that refused to pay for urgently needed cancer surgery because of questions about the patient’s acne treatment; the healthy young woman denied coverage because she briefly saw a psychologist after breaking up with her boyfriend.

And in their efforts to avoid “medical losses,” the industry term for paying medical bills, insurers spend much of the money taken in through premiums not on medical treatment, but on “underwriting” — screening out people likely to make insurance claims. In the individual insurance market, where people buy insurance directly rather than getting it through their employers, so much money goes into underwriting and other expenses that only around 70 cents of each premium dollar actually goes to care.

Still, most Americans do have health insurance, and are reasonably satisfied with it. How is that possible, when insurance markets work so badly? The answer is government intervention.

Most obviously, the government directly provides insurance via Medicare and other programs. Before Medicare was established, more than 40 percent of elderly Americans lacked any kind of health insurance. Today, Medicare — which is, by the way, one of those “single payer” systems conservatives love to demonize — covers everyone 65 and older. And surveys show that Medicare recipients are much more satisfied with their coverage than Americans with private insurance.

Still, most Americans under 65 do have some form of private insurance. The vast majority, however, don’t buy it directly: they get it through their employers. There’s a big tax advantage to doing it that way, since employer contributions to health care aren’t considered taxable income. But to get that tax advantage employers have to follow a number of rules; roughly speaking, they can’t discriminate based on pre-existing medical conditions or restrict benefits to highly paid employees.

And it’s thanks to these rules that employment-based insurance more or less works, at least in the sense that horror stories are a lot less common than they are in the individual insurance market.

So here’s the bottom line: if you currently have decent health insurance, thank the government. It’s true that if you’re young and healthy, with nothing in your medical history that could possibly have raised red flags with corporate accountants, you might have been able to get insurance without government intervention. But time and chance happen to us all, and the only reason you have a reasonable prospect of still having insurance coverage when you need it is the large role the government already plays.

Which brings us to the current debate over reform.

Right-wing opponents of reform would have you believe that President Obama is a wild-eyed socialist, attacking the free market. But unregulated markets don’t work for health care — never have, never will. To the extent we have a working health care system at all right now it’s only because the government covers the elderly, while a combination of regulation and tax subsidies makes it possible for many, but not all, nonelderly Americans to get decent private coverage.

Now Mr. Obama basically proposes using additional regulation and subsidies to make decent insurance available to all of us. That’s not radical; it’s as American as, well, Medicare.

What’s wrong with the South?

From Washington Monthly: