Saturday, August 29, 2009
Buenos Aires, while a great and beautiful city, is dotted with slum areas, or "villas" ("villas miserias" -- villages of misery) as they were called. These areas were considered open game for missionaries, and it was not uncommon to see us, suits and all, working the alleys of the worst of these villa areas. Hairless, diseased dogs and shoeless children were running everywhere.
I can still remember the smells: sewage mixed with alcohol. I can still remember the sights: a dirty 4-year-old child coughing up a 6-inch worm from her throat. I can still remember the feelings: a punch to my nose as we were being robbed one afternoon in broad daylight. I can still remember the judgments I made: pity and compassion, sometimes, heartless contempt, at other times, and a bit of fear. Sometimes, these places seemed quite ordinary, with children playing, mothers cleaning, milenesa cooking. These friendly but destitute villa dwellers, I came to understand, were not so different from you and me.
One place stands out in my memory, though, an abandoned wine factory filled with indigent squatters, a high-rise slum, basically, surrounded by filth and garbage, with dark and gloomy hallways, hallways that would have echoed with a million tales of woe and suffering. The place was called the the Vino Toro building. It was a "casa tomada" or "taken house," an old building filled with squatters. The police, we whispered, didn't even dare go into the Vino Toro. And yet we did.
The Vino Toro was a strange place. I remember going inside one Friday night, later than we should have. We entered a large room, what once appeared to be a factory floor, a place where people had constructed dozens of shanty homes, almost like cubicles stretching out all around us. The Friday night drinking was just underway, and the air smelled of cheap beer. I could hear bottles smashing, men laughing. It was quite dim inside, but I could feel the eyes of the slum were looking at me, sizing me up, wondering why I had entered their world. For a kid from suburban Utah, this was almost like going to the moon. I had never been anywhere even remotely comparable and I have never been since.
One time, we were visiting a family who had set up their home in what might have been an abandoned office suit. A whole family (maybe 6-8 people) lived in this office. They had a few chairs, a table, and an old mattress spread out in the corner, nothing more. The father who we were speaking with was guarded and somewhat hostile; if I recall, he was involved in some sort of criminal activity. The children were very dirty, and I doubt they had ever seen the inside of a school. I remember hearing what sounded like running water, turning around, and seeing one of the children urinating in the corner of the room. By the smell of things, this was not uncommon.
In such children, I was confronted face-to-face with what I refer to now, in a very sanitized way, as "inequality of opportunity." That kid peeing in the corner of this slum high rise, why did he have so little, while I had so much? As a boy, I was surrounded by toys, he was surrounded by garbage; I went to schools to learn, he went to the streets to beg; I wondered how I would pay for college, he wondered what he would eat for breakfast; I had hope, he had misery; I had everything, he had nothing. The villas of Buenos Aires taught me I have little to boast of, little to feel proud of, and little to feel like I have earned. I had a head start in life that the peeing kid could never overcome. These slums were schools in humility: they changed me forever. I went to Buenos Aires to teach people, and they ended up teaching me.
Thursday, August 27, 2009
The placebo effect is mysterious enough on its own. But there's more. It turns out that placebos work better in some countries than other others. It also turns out that ratings by trial observers vary significantly from one testing site to another. But what's most mysterious is that the placebo effect actually seems to be getting stronger over time. Not only are new drugs having a harder and harder time beating out placebos, but older drugs that have been retested are having problems too:
In many cases, these are the compounds that, in the late '90s, made Big Pharma more profitable than Big Oil. But if these same drugs were vetted now, the FDA might not approve some of them. Two comprehensive analyses of antidepressant trials have uncovered a dramatic increase in placebo response since the 1980s. One estimated that the so-called effect size (a measure of statistical significance) in placebo groups had nearly doubled over that time.
It's not that the old meds are getting weaker, drug developers say. It's as if the placebo effect is somehow getting stronger.
....But why would the placebo effect seem to be getting stronger worldwide? Part of the answer may be found in the drug industry's own success in marketing its products. Potential trial volunteers in the US have been deluged with ads for prescription medications since 1997, when the FDA amended its policy on direct-to-consumer advertising. The secret of running an effective campaign, Saatchi & Saatchi's Jim Joseph told a trade journal last year, is associating a particular brand-name medication with other aspects of life that promote peace of mind: "Is it time with your children? Is it a good book curled up on the couch? Is it your favorite television show? Is it a little purple pill that helps you get rid of acid reflux?" By evoking such uplifting associations, researchers say, the ads set up the kind of expectations that induce a formidable placebo response.
Tuesday, August 25, 2009
The "new consumer protections" it refers to are these:
· No discrimination for pre-existing conditions
· No exorbitant out-of-pocket expenses, deductibles or co-pays
· No cost-sharing for preventive care
· No dropping of coverage if you become seriously ill
· No gender discrimination
· No annual or lifetime caps on coverage
· Extended coverage for young adults
· Guaranteed insurance renewal so long as premiums are paid
Update: A fun video explaining the benefits of a larger government role in health care.
What is interesting is how the emotions that are generated seem to have little to do with the scope of the policies under discussion. The proposals emerging from various congressional committees are, in reality, quite modest. We have proposed some new regulations on health insurance (for example, that insurers can't deny coverage based on preexisting conditions), we have a proposed health insurance exchange to help people find good deals on insurance (which is important in a market otherwise dominated by state monopolies), and we have new subsidies proposed to help poorer people and small businesses buy insurance. We also have various proposals to help cut costs by trimming inefficient aspects of Medicare, by doing more research on effectiveness of treatments, and by creating a not-for-profit health plan to compete with health insurance monopolies.
None of this seems radical. These proposals bend over backward to preserve the existing system (somewhat unfortunately in my mind). Granted they will cost a lot, with the highest CBO estimate I've seen being $1.4 trillion over ten years. To put this in perspective, though, the tax cuts of president Bush cost $1.3 trillion, so this hardly seems radically new or different from a fiscal perspective. Moreover, there are serious proposals out there about paying for the health reform, which (if they are implemented) would actually mark it as much less radical than the Bush-era tax cuts that were not paid for and that led to the skyrocketing budget deficits. So why the outrage now?
Much of it probably has to do with the symbolism of health care. Universal health care has long been the defining aspect of the democratic "welfare state," so its symbolic importance goes beyond the actual reforms themselves, however moderate they might be in this case. It is symbolism over substance.
I think another part, though, is that there is a group Americans who see the country as changing in ways that make them feel out of place. Much of contemporary America doesn't fit the image of what they think America has been or should be, or who Americans are or can be (of course, it never really did). They hear foreign languages spoken on the street, see a man with a funny name as president, watch cities growing and rural life shrinking, observe new technologies -- which they do not use or understand -- come and go in a dizzying whirlwind. It makes them feel like "others" have taken over the country. People "not like me" are in charge, and it is frightening to them. It is this sense of being displaced that motivates the emotions we are seeing rather than anything having to do with health care policy per se.
I think I can understand that. When I'm a little older, I'll probably feel much the same way about certain things. I reserve the right when I reach that point to shout like a crazed madman during a town hall meeting.
One of our senators, Sherrod Brown, held a town hall meeting the other day at OSU. I wasn't there, but from what I've heard, Steven Gabbe, senior VP for health services at OSU, gave a great presentation in favor of reform.
After bashing the media a few posts ago or their lack of interest in "facts," I suppose I should give credit where credit is due.
Thursday, August 20, 2009
Here we are at the Great Circle Earthwork -- you can fit four football fields inside this amazingly perfect circle.
The earthen wall is about 20 feet high in places, with a deep mote on the inside. The pictures don't really do it justice.
The Octagon earthwork: An astronomical device (they think) that is more accurate than Stonehenge.
The Octagon earthwork is now a par three golf course. Ugh! Ohio does not do well preserving its history, and this is another unfortunate example. You can't even look around because you might disturb the country club golfers. From the outside, though, this place looked even more impressive than the Great Circle.
Overall, great trip.
Monday, August 17, 2009
We'll see what happens in the next few months.
The Economic Policy Institute
"A substantial portion of the improvement registered in the second quarter can be attributed to the effects of the American Recovery and Reinvestment Act (ARRA). Both Goldman Sachs and Mark Zandi of Moody’s Economy.com have estimated that ARRA added approximately three percentage points to growth in the second quarter. Both of these estimates are confirmed by the Economic Policy Institute’s own calculations."
"A huge influx of federal stimulus money to state and local governments more than offset a sharp drop in tax collections, helping to put the brakes on the nation's economic decline, new government data show. The stimulus funds helped reverse six months of spending declines, pushing state and local government expenditures up 4.8% in the second quarter, reports the Bureau of Economic Analysis."
Economist Paul Krugman
"A few months ago the possibility of falling into the abyss seemed all too real. The financial panic of late 2008 was as severe, in some ways, as the banking panic of the early 1930s, and for a while key economic indicators — world trade, world industrial production, even stock prices — were falling as fast as or faster than they did in 1929-30....So what saved us from a full replay of the Great Depression? The answer, almost surely, lies in the very different role played by government.
Probably the most important aspect of the government’s role in this crisis isn’t what it has done, but what it hasn’t done: unlike the private sector, the federal government hasn’t slashed spending as its income has fallen. (State and local governments are a different story.) Tax receipts are way down, but Social Security checks are still going out; Medicare is still covering hospital bills; federal employees, from judges to park rangers to soldiers, are still being paid.
All of this has helped support the economy in its time of need, in a way that didn’t happen back in 1930, when federal spending was a much smaller percentage of G.D.P. And yes, this means that budget deficits — which are a bad thing in normal times — are actually a good thing right now....Last and probably least, but by no means trivial, have been the deliberate efforts of the government to pump up the economy. From the beginning, I argued that the American Recovery and Reinvestment Act, a k a the Obama stimulus plan, was too small. Nonetheless, reasonable estimates suggest that around a million more Americans are working now than would have been employed without that plan — a number that will grow over time — and that the stimulus has played a significant role in pulling the economy out of its free fall."
Friday, August 14, 2009
- Before leaving, I remember turning the thermostat up to 85 degrees, not wanting the house (and our pets) to become super hot while we were away. When we returned, though, we found that the thermostat had been turned back down to 75 degrees and the AC had been turned off.
- There were towels placed in our bathroom where we would never have left them (that is, they were hanging neatly inside the shower itself).
- The gate outside had been closed, but we always leave it open.
So, we figure there are four possibilities:
- Our house is haunted.
- We had a very nice home invader who didn't take anything, and who politely closed the gate, turned off the AC, and who hung up the towels neatly.
- Someone is playing tricks on us.
- We are losing our minds, thinking that we had done things before leaving that we hadn't.
Wednesday, August 12, 2009
Upon arrival, we were quickly ushered off to see a premier of the new Harry Potter movie. Here we are with the Merkley clan in matching Harry Potter T-shirts.
The next day, we headed east with Ellie's parents and sister, Emily, to visit Eastern Utah. Here we are in Vernal, Utah, where we stayed in some cute little cabins.
I wanted to go to Vernal to recreate some of the beloved vacations of my youth that were spent in Dinosaurland National Monument. Here we are at the new (to us) Vernal natural history museum.
I think my favorite part of Vernal was the dinosaur garden. Alas, the famous fossil quarry in the monument was closed for renovation, but we did get to see some great scenery within the park, as well as some historical sites. (Although, in a horrifying parental moment, Andrew picked up a rock and hurled it at a window of one of the historical buildings -- luckily, it didn't break.)
About 30 minutes south of Vernal is a breathtaking, undiscovered place called Fantasy Canyon. It is a small area, way out of the way, but it is one of the most unique places in Utah (which is saying something). The delicate rock formations are absolutely wondrous.
After spending a day in Vernal, we headed down to Moab, Utah. To get from Moab to Vernal, you need to go through Colorado, a long drive which I think we were all dreading. But, in the end, we found that the road to Moab takes you through some gorgeous mountain scenery.
The kids, overall, were real troopers. Our little trip consisted in much driving and hiking, which they largely bore without complaint.
When we arrived back in Salt Lake, we spent a few days with my family. We did a lot of fun stuff. Here we are playing in a river (building a dam actually), in Cedar Hills, Utah, where my brother and his family live.
Uncle Ruston took both Nora and Andrew on motorcycles rides. They loved it. Here is Andrew, holding on for dear life.
One of the best parts of the trip was that the kids were able to spend some quality time with cousins. They had an enormous sleep over on Sunday night.
Another highlight was visiting Kennocott Copper mine. Now, to be sure, this place is an environmental travesty. But it sure is impressive (and I guess I use my share of copper, so who am I to complain?). Here is the tire of the massive dump trucks they use there.
Tuesday, August 11, 2009
As I paid for my purchase, an employee leaned over the nearby ice-cream counter and asked, "Excuse me, sir, would you like this free chocolate malt?" Arrgh! Apparently, they had made an extra malt during a training session and wanted to give it away.
I tried to resist, but couldn't. I am a weak and sinful man.
Claim: "The Democrat-backed health care reform plan will require (Americans) to subsidize abortion with their hard-earned tax dollars."
Politifact says: False
Claim: "Page 992 of the health care bill will establish school-based 'health' clinics.Your children will be indoctrinated and your grandchildren may be aborted!"
Politifact says: Pants-on-fire false. (Nothing like that has been proposed)
Claim: "Health care reform legislation is likely to mandate free ‘sex change’ surgeries.”
Politifact says: False. (No such mandate has been proposed)
Claim: "All non-US citizens, illegal or not, will be provided with free health care services"
Politifact says: Pants-on-fire false. (The proposals say exactly the opposite)
Claim: "In the health care bill, the 'Health Choices Commissioner' will decide health benefits for you. You will have no choice. None."
Politifact says: Pants-on-fire false. (The proposed health insurance commissioner has nothing do do with choosing your benefits, only making sure insurance companies stick to the rules)
Claim: "The health care reform bill would make it mandatory — absolutely require — that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner."
Politifact says: Pants-on-fire false. ("The sessions are an option for elderly patients who want to learn more about living wills, health care proxies and other forms of end-of-life planning.")
Claim: "Under a public health care option, 120 million Americans will lose what they now get from private companies and be forced onto the government-run rolls as businesses decide it is more cost-effective for them to drop coverage."
Politifact says: False.
Claim: "Under the Obama plan all the health care in this country is eventually going to be run by the government."
Politifact says: False.
Check it out yourself.
Friday, August 07, 2009
Question: Do the Democratic plans involve a government takeover of health care?
Answer: "There are lots of valid criticisms that can be made against the health reform plans moving through Congress -- I've made a few myself. But there is no credible way to look at what has been proposed by the president or any congressional committee and conclude that these will result in a government takeover of the health-care system. That is a flat-out lie whose only purpose is to scare the public and stop political conversation. Under any plan likely to emerge from Congress, the vast majority of Americans who are not old or poor will continue to buy health insurance from private companies, continue to get their health care from doctors in private practice and continue to be treated at privately owned hospitals."
Question: So what do the Democratic plans entail?
Answer: "The centerpiece of all the plans is a new health insurance exchange set up by the government where individuals, small businesses and eventually larger businesses will be able to purchase insurance from private insurers at lower rates than are now generally available under rules that require insurers to offer coverage to anyone regardless of health condition. Low-income workers buying insurance through the exchange -- along with their employers -- would be eligible for government subsidies. While the government will take a more active role in regulating the insurance market and increase its spending for health care, that hardly amounts to the kind of government-run system that critics conjure up when they trot out that oh-so-clever line about the Department of Motor Vehicles being in charge of your colonoscopy."
Question: Won't health care reform cost a trillion dollars?
"Another lie. First of all, that's not a trillion every year, as most people assume -- it's a trillion over 10 years, which is the silly way that people in Washington talk about federal budgets. On an annual basis, that translates to about $140 billion, when things are up and running.
Even that, however, grossly overstates the net cost to the government of providing universal coverage. Other parts of the reform plan would result in offsetting savings for Medicare: reductions in unnecessary subsidies to private insurers, in annual increases in payments rates for doctors and in payments to hospitals for providing free care to the uninsured. The net increase in government spending for health care would likely be about $100 billion a year, a one-time increase equal to less than 1 percent of a national income that grows at an average rate of 2.5 percent every year."
Question: But don't the Republicans want to save costs?
Answer: "The Republican lies about the economics of health reform are also heavily laced with hypocrisy. While holding themselves out as paragons of fiscal rectitude, Republicans grandstand against just about every idea to reduce the amount of health care people consume or the prices paid to health-care providers -- the only two ways I can think of to credibly bring health spending under control.
When Democrats, for example, propose to fund research to give doctors, patients and health plans better information on what works and what doesn't, Republicans sense a sinister plot to have the government decide what treatments you will get. By the same wacko-logic, a proposal that Medicare pay for counseling on end-of-life care is transformed into a secret plan for mass euthanasia of the elderly. Government negotiation on drug prices? The end of medical innovation as we know it. ... Reduce Medicare payments to overpriced specialists and inefficient hospitals? The first step on the slippery slope toward rationing."
Question: Who is being honest in this debate?
Answer: "The recent attacks by Republican leaders and their ideological fellow-travelers on the effort to reform the health-care system have been so misleading, so disingenuous, that they could only spring from a cynical effort to gain partisan political advantage. By poisoning the political well, they've given up any pretense of being the loyal opposition..."
Question: So, what is at stake in this debate?
Answer: "Health reform is a test of whether this country can function once again as a civil society -- whether we can trust ourselves to embrace the big, important changes that require everyone to give up something in order to make everyone better off. Republican leaders are eager to see us fail that test. We need to show them that no matter how many lies they tell or how many scare tactics they concoct, Americans will come together and get this done."