Archive - Feb 2010
In Nature's January 7, 2010, issue (in an opinion section called 2020 Visions):
...Nature asked a selection of leading researchers and policy-makers where their fields will be ten years from now. [Nature] invited them to identify the key questions their disciplines face, the major roadblocks and the pressing next steps.
Several of the items caught my attention. The first was the section on demographics by Joshua R. Goldstein. Recently I'd already been thinking about how demographic changes are on track to create an explosion of debt via health care costs in the coming decades (link). In Nature, Goldstein writes:
As population growth marked the twentieth century, population ageing will mark the twenty-first. By 2020, the average European will have fewer years of life expectancy remaining than years he or she has already lived. East Asians will soon follow. Humankind will spend much of the coming decade grappling with questions about how to organize and pay for the care of an increasing elderly population and about who will produce what the elderly consume.
In the longer term, a return to moderate fertility rates in those countries with very low fertility, and increases in immigration can do much to moderate population ageing. Sweden and Japan face quite different demographic futures, because fertility in Sweden is closer to replacement and a small but steady stream of immigrants will make up the difference. In Japan — the world's leader in longevity — fertility remains low, and immigration a major social challenge.
We need demographic research on four fronts addressing population ageing. Low birth rates can perhaps be increased by measures that reconcile work and family, enabling people to have the children they say they want. Fostering the social and economic integration of immigrants is another priority. Health research, helping people to stay younger longer, is already a priority of ageing societies; indeed, so far, the healthy period of life has been lengthening as fast or faster than life expectancy itself. But now — as the first 65-year-old baby-boomers prepare to blow out their birthday candles — we must address the larger question of rescheduling life's turning points, so that people can remain active and productive. The societies that respond to ageing successfully will be those that take advantage of longer life.
The last line of the first paragraph ("Humankind will spend much of the coming decade grappling with questions about how to organize and pay for the care of an increasing elderly population and about who will produce what the elderly consume.") reminded me of references to Atlas Shrugged. Although I still haven't read it, in the wake of the US government's response to the current economic crisis I see it frequently invoked by pundits (link) and common-man political conservatives as a prophecy that the "producers" will eventually rebel against being taxed to support the "poor" and "lazy." It's ironic that the big crisis that is coming is not whether or not the "producers" will be willing and able to support the poor and the immigrants (another common target of conservative scorn) but rather whether they will be willing and able to support the elderly (who, coincidentally, have recently been flocking to the Republican party: link)...and that our ability to successfully attract and integrate young immigrants will be crucial to facing this challenge.
Another item that caught my attention was soil. David R. Montgomery writes:
To avoid the mistakes of past societies, as 2020 approaches, the world must address global soil degradation, one of this century's most insidious and under-acknowledged challenges. Humanity has already degraded or eroded the topsoil off more than a third of all arable land. We continue to lose farmland at about 0.5% a year — yet expect to feed more than 9 billion people later this century.
During the twentieth century, the Haber–Bosch process (allowing the mass production of nitrogen-based fertilizers) and the Green Revolution effectively divorced agriculture from soil stewardship. Increased yields were supported by intensive fertilizer inputs and mechanization that simplified and devastated soil life, reducing native soil fertility. For example, research in some conventional agricultural settings shows that other species such as bacteria have virtually replaced mycorrhizal fungi, which deliver soil nutrients to most plants. In a post-petroleum world, as the era of cheap fossil-fuel-produced fertilizers comes to an end, conventional, high-input agriculture is neither sustainable nor resilient. Ensuring future food security and environmental protection will require thoughtfully tailoring farming practices to the soils of individual landscapes and farms, rather than continuing to rely on erosive practices and fertilizer from a bag.
This sentence - "In a post-petroleum world, as the era of cheap fossil-fuel-produced fertilizers comes to an end, conventional, high-input agriculture is neither sustainable nor resilient." - really caught my attention. It's not a question of if but when we will be operating in a "post-petroleum world"...and the arrival of that day will require a massive shift in our agricultural practices.
These two topics - demographics and agricultural practices - are examples of the huge problems we have before us. There's no doubt that government will have to play a huge role in solving these problems. However, there is little evidence that it's up to the task...our politics seem to be broken and incapable of producing bold and timely responses to our major problems. The fact that half of us see government as being more of a problem creator than a problem solver makes me wonder how we can possibly respond effectively to our changing world.
The third topic from the nature story that piqued my interest was lasers and their potential to be part of the solution to our energy problems. Thomas M. Baer and Nicholas P. Bigelow write:
Next-generation lasers will allow the creation of new states of matter, compressing and heating materials to temperatures found only in the centres of massive stars, and at pressures that can squeeze hydrogen atoms together to a density 50 times greater than that of lead. The resulting fusion reactions may one day be harnessed to provide almost limitless carbon-free energy. Enough fusion fuel is present in the oceans to supply the current energy needs of the entire world for longer than the age of the Universe.
When so many of our pressing problems can be reduced to problems of energy supply, breakthroughs like this seem to be critical. I realize that enormous sums of money are already devoted to research like this, but I wonder if we are making appropriately-large bets given the enormous payout of success...and if research funding can be sustained at appropriate levels in the coming decades.
Let us now praise Rahm Emanuel . No, seriously. It is the current fashion to blame President Obama’s disappointing first year on his chief of staff. “First, remove Rahm Emanuel,” writes Leslie Gelb…
Health care proposal for Obama to bring to summit: Cadillac tax stays, no public option, aides say: http://bit.ly/cJ4aH1
RT @ProFootballTalk: At some point, Tiger drifted from "buddhism" to "booty-ism."
Posters on Online Political Forums
RT @mmcauliff: Lloyd Doggett, on Austin plane: “Like the larger-scale tragedy in Oklahoma City, this was a cowardly act of domestic terrorism. "
Talk TV sensationalists and axe-grinding ideologues have fallen for a myth of immigrant lawlessness.
When ten young men from Pakistan entered Mumbai aboard hi-jacked boats on the night of 26th November 2008, they had one intention: to create a terror that would grip international media and make the world sit up and take notice of Lashkar-e-Taiba -- the Army of the Righteous, a previously little known terrorist organization based in Pakistan.
And it's this intention, despite the extreme violence, allegations against Pakistan and shocking negligence of elements in the Mumbai police force, which really sticks with the viewer of Terror in Mumbai. The more you watch, the more you realize they succeeded.
The film has a unique perspective because it incorporates the cell-phone calls that the masterminds in Pakistan used to direct the terrorists during attack and footage of the sole surviving attacker being interviewed in police custody. Here is the trailer:
I give it 4 out of 5.
I recently watched Boy Interrupted (2008).
On the night of Oct. 2, 2005, Hart and Dana Perry’s 15-year-old son Evan jumped to his death from his New York City bedroom window. This moving film is the story, told by his filmmaker parents and others who knew him, of Evan’s life and death, and his life-long struggle with bipolar disorder. It delves into the complexity of Evan’s disease, sharing his family’s journey through the maze of mental illness. In showing how one family deals with generations of loss and grief, the film defies the stigma related to mental illness and suicide and tells a human story that touches everyone.
For a parent of a kid who is presumably healthy but occasionally seems "bipolar" or makes suicidal statements, this film is chilling.
I give it 4 out of 5.
Apparently the Democrats are steeling themselves to go it alone and pass health care reform via reconciliation (link):
...Obama is saying that unless Republicans support comprehensive reform as Obama and Dems have defined it — dealing with the problem of 30 million uninsured and, by extension, seriously tackling the preexisting condition problem — they will almost certainly move forward with reconciliation.
As they do, I'm sure the claims that they're ramming an unpopular bill down our throats or ramming it through Congress will only get louder. Here is what I think is important to keep in mind (hats off to Ezra Klein and Greg Sargent)...
The health plan is unpopular.
That plot illustrates the enormous success that the opponents of reform have had in shifting public opinion. Much of that unpopularity comes from people who think it goes too far, but a significant fraction from people who don't think it goes far enough...who think single-payer or a public option is a necessary element of real reform, for example. On the other hand, the individual components of the bill are quite popular (link):
As Klein puts it (link):
Health-care reform is unpopular. But if you actually tell people what's in the health-care reform bill, then it becomes quite popular.
This says to me that the polling that says that health care reform is "unpopular" is not a strong argument for killing Obamacare. Furthermore, (link):
If polls are so important to the Republicans, why aren't they for the public option?
Obamacare gets portrayed as a radical, partisan plan...but "Republican" ideas are prominent in it (link), and the current Senate bill is much closer to 1993's proposal by moderate Republican Chafee than Boehner's plan is (link). Again from Klein (link):
We've got a situation in which Democrats are essentially pushing moderate Republican ideas while Republicans push extremely conservative ideas, but because neither the press nor the voters know very much about health-care policy, the fact that Republicans refuse to admit that Democrats have massively compromised their vision is enough to convince people that Democrats aren't compromising.
Republicans are generally wary of allowing the federal government to define the characteristics of minimally-acceptable health insurance. Klein points out that this philosophical opposition doesn't prevent them from defining minimum standards of their own (link):
Philosophically, Republicans do have a disagreement with this. It's regulation, after all. But in practice, they accept it. When Republican passed health savings accounts into law, they included definitions of the minimum standards a plan had to meet to qualify. When they passed the Medicare Prescription Drug Benefit into law, they defined what a plan would have to do to qualify for the program.
Klein makes another good point today (link):
There's a difference between the statements "America has the best health-care system in the world" and "With enough money, you can purchase the best health care in the world in America." But that difference gets run over in political conversations. Sen. John Barrasso, for instance, just mentioned that a Canadian premier recently got heart surgery in Miami. Best health care in the world, baby!
America has about 50 million uninsured people within its borders. Canada has exactly 13 premiers. People should ask themselves a very simple question: Do they think they are likelier to lose their job and fall into the health-care situation of the uninsured or become an influential politician and enjoy the health-care options available to the most powerful people in the world?
The complaint that I expect hear most in the coming days is that it will be a travesty to pass Obamacare via reconciliation (i.e. with a 51-vote simple majority rather than a 60-vote supermajority in the Senate). For example, Bill Frist in today's Wall Street Journal (link):
Senate Majority Leader Harry Reid has announced that while Democrats have a number of options to complete health-care legislation, he may use the budget reconciliation process to do so. This would be an unprecedented, dangerous and historic mistake.
Budget reconciliation is an arcane Senate procedure whereby legislation can be passed using a lowered threshold of requisite votes (a simple majority) under fast-track rules that limit debate. This process was intended for incremental changes to the budget—not sweeping social legislation.
Using the budget reconciliation procedure to pass health-care reform would be unprecedented because Congress has never used it to adopt major, substantive policy change. The Senate's health bill is without question such a change: It would fundamentally alter one-fifth of our economy.
However, as Julie Rovner pointed out (link), during the past 30 years reconciliation has been used many times and is actually the norm for major changes in health care. A quick summary:
1982 — TEFRA: The Tax Equity and Fiscal Responsibility Act first opened Medicare to HMOs
1986 — COBRA: The Consolidated Omnibus Budget Reconciliation Act allowed people who were laid off to keep their health coverage, and stopped hospitals from dumping ER patients unable to pay for their care
1987 — OBRA '87: Added nursing home protection rules to Medicare and Medicaid, created no-fault vaccine injury compensation program
1989 — OBRA '89: Overhauled doctor payment system for Medicare, created new federal agency on research and quality of care
1990 — OBRA '90: Added cancer screenings to Medicare, required providers to notify patients about advance directives and living wills, expanded Medicaid to all kids living below poverty level, required drug companies to provide discounts to Medicaid
1993 — OBRA '93: created federal vaccine funding for all children
1996 — Welfare Reform: Separated Medicaid from welfare
1997 — BBA: The Balanced Budget Act created the state-federal childrens' health program called CHIP
2005 — DRA: The Deficit Reduction Act reduced Medicaid spending, allowed parents of disabled children to buy into Medicaid
As another example, Timothy Noah chronicles how welfare reform was accomplished (link).
Finally, Ezra Klein makes another good point on this topic (link):
It's a bit annoying, though, that Democrats keep justifying the reconciliation process based on the fact that Republicans have done it, too. The reconciliation process makes sense because majority votes make sense.