What do doctors and nurses think of health reform? Updated! [Bryan]

So what do doctors and nurses think of the health reform proposals? My sense is they are all over the map [actually not: see update], just like the rest of the country. It is worth pointing out, though, that health care reform has strong support from the vast majority of professional medical organizations. According to the Health Care Reform Debate Blog, the following medical organizations have backed the House Bill 3200 (or something close to it), which is the strongest health reform bill in place.

The American Osteopathic Association, American College of Physicians, American Society of Pediatrics, American Academy of Family Physicians, American College of Surgeons, American College of Obstetrics and Gynecology, American Gastroenterological Association, Society of Hospital Medicine, American College of Cardiology, and American Society of Clinical Oncology.

The following organizations seem to support the general idea of reform, but have withheld judgment until the bill is more advanced:

American Academy of Ophthalmology, American Academy of Orthopedic Surgeons, American College of Radiology, American College of Emergency Physicians.

The following groups have opposed the H.R. 3200 until their reimbursement concerns are met:

American Society of Anesthesiology

Meanwhile, the American Nurses Association issued the following comment:

Members of the American Nurses Association (ANA) joined President Obama today to demonstrate their strong support for the President and his speech to the joint session of the U.S. Congress last night urging action on health reform that would provide more security and stability to those with health insurance and guarantee access to affordable health care for those without it....

ANA President Rebecca M. Patton, MSN, RN, CNOR praised President Obama at his first public appearance on health care reform since addressing Congress for advocating for people who lack access to basic health care services in the nation’s “broken system” and for fighting for consumer protections in the health insurance market. Long ranked as the nation’s most trusted profession by Gallup’s annual survey, nursing has advocated for health system reform for two decades.

The Mayo Clinic, a leader is efficient and cost-effective medical delivery, issued a strong statement in favor of reform:

Mayo Clinic strongly supports President Obama’s call for health insurance reform and health care delivery reform, and agrees with the President’s position that the status quo is not acceptable.

The AMA strongly supports reform:

Today, the American Medical Association sent a letter to House leaders supporting H.R. 3200, "America's Affordable Health Choices Act of 2009." "This legislation includes a broad range of provisions that are key to effective, comprehensive health system reform," said J. James Rohack, MD, AMA president. "We urge the House committees of jurisdiction to pass the bill for consideration by the full House."

Update:

Actually, doctors are not as divided as I thought. According to a poll in the New England Journal of Medicine, most doctors support a public plan of some sort:

A large majority of doctors say there should be a public option.

When polled, "nearly three-quarters of physicians supported some form of a public option, either alone or in combination with private insurance options," says Dr. Salomeh Keyhani. She and Dr. Alex Federman, both internists and researchers at Mount Sinai School of Medicine in New York, conducted a random survey, by mail and by phone, of 2,130 doctors. They surveyed them from June right up to early September.

Most doctors -- 63 percent -- say they favor giving patients a choice that would include both public and private insurance. That's the position of President Obama and of many congressional Democrats. In addition, another 10 percent of doctors say they favor a public option only; they'd like to see a single-payer health care system. Together, the two groups add up to 73 percent.

I had no idea the medical profession was staffed by America-hating communists who want to kill grandmas.

The perfect mashed potatoes [Bryan]

Over the past 11 years, I have been experimenting with mashed potatoes. Like Ahab pursuing Moby Dick, dogged and determined, relentless, I have been pursuing the best way to prepare them. I have stalked them like a psychotic lover, dreamed of them, yearned for them. I was beginning to doubt myself, to second guess myself, to think that, like Plato's Forms, they were an ideal that could never be actualized in this fallen, material world. Today, though, I think I finally achieved it: the perfect bowl of mashed potatoes!

Here is my recipe:

Bryan's Creamy Garlic Mashed Potatoes

8 medium size potatoes (6 peeled, 2 with skins still on)
1 tsp. minced garlic
1/4 cup heavy cream
2 big gobs sour cream
1 big gob plain yogurt
1/3 stick of butter
A bit of milk
Sea salt
Fresh ground pepper

1. Cut potatoes and boil until soft. Drain water.

2. Add garlic, cream, sour cream, yogurt, butter. Whip well with mixer. Add milk and mix some more to achieve a fluffy and creamy consistency.

3. Add salt and pepper to taste.

4. Enjoy!

Nice win, BYU [Bryan]

I just gave credit to President Bush, so I guess I will shock everyone and give credit to BYU. I was starting to think that only Utah could beat the big boys. BYU proved me wrong on Saturday. A nice win for the scrappy, disciplined, underdogs.

See you in November, Cougars!

Remember all the hand-wringing... [Bryan]

Remember all the hand-wringing about the big, $700 billion bank bailout last year? How is that turning out? It actually seems to be turning out well, although it is still probably too early to tell. So far, taxpayers have made about $4 billion. The New York Times reports:

Nearly a year after the federal rescue of the nation’s biggest banks, taxpayers have begun seeing profits from the hundreds of billions of dollars in aid that many critics thought might never be seen again. The profits, collected from eight of the biggest banks that have fully repaid their obligations to the government, come to about $4 billion, or the equivalent of about 15 percent annually, according to calculations compiled for The New York Times.

At this point, I guess I should, um, give some credit to President Bush who pushed this through over Republican objections. (I think that this a first for this blog!)

Now, remember all the hand-wringing over the $800 billion stimulus package? How is that turning out? The Wall Street Journal reports:

The U.S. economy is beginning to show signs of improvement, with many economists asserting the worst is past and data pointing to stronger-than-expected growth. On Tuesday, data showed manufacturing grew in August for the first time in more than a year....

Much of the stimulus spending is just beginning to trickle through the economy, with spending expected to peak sometime later this year or in early 2010. The government has funneled about $60 billion of the $288 billion in promised tax cuts to U.S. households, while about $84 billion of the $499 billion in spending has been paid...

Economists say the money out the door -- combined with the expectation of additional funds flowing soon -- is fueling growth above where it would have been without any government action.

Many forecasters say stimulus spending is adding two to three percentage points to economic growth in the second and third quarters, when measured at an annual rate. The impact in the second quarter, calculated by analyzing how the extra funds flowing into the economy boost consumption, investment and spending, helped slow the rate of decline and will lay the groundwork for positive growth in the third quarter -- something that seemed almost implausible just a few months ago. Some economists say the 1% contraction in the second quarter would have been far worse, possibly as much as 3.2%, if not for the stimulus.

The next time someone says that the government should cut spending in the recession, feel free to snicker.

Slums of Buenos Aires [Bryan]

Ellie and I watched Slumdog Millionaire last night. A fine film, if very difficult to watch. Much of the action takes place within the brutal slums, garbage dumps, and crushing poverty of urban India. It was hard for me to watch partly because it transported me back to Buenos Aires, where I served as a Mormon missionary for two years.

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.

Falling in love with Christian Community [Bryan]

"One thing I've learned from believers and from activists alike is that community can be built around a common self-righteousness or around a common brokenness. Both are magnetic. People are drawn toward folks who have it all together, or who look like they do. People are also drawn toward folks who know they don't have it all together and are not willing to fake it.

Christianity can be built around isolating ourselves from evildoers and sinners, creating a community of religious piety and moral purity. That's the Christianity I grew up with. Christianity can also be built around joining with the broken sinners and evildoers of our world crying out to God, groaning for grace. That's the Christianity I have fallen in love with."

--Shane Clairborne

The mysterious placebo effect [Bryan]

Weird. A "placebo effect" refers to any benefit that comes to people when they think they are taking a medicine, but really aren't. The placebo effect is sometimes amazingly huge -- people think they will feel better, and they often do. In drug trials, new drugs have to show they work better than placebo. Kevin Drum writes:

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.

Health reform graph -- updated with video [Bryan]

Here is a clear graph that illustrates the major ideas behind health reform. Click it if you can't read it.


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.

On screaming people [Bryan]

People have been doing a lot screaming lately, much of it done by opponents of health care reform. I have watched the debate about health care degenerate for months now. What began as a fairly seriously discussion of policy issues has devolved into a strange debate about whether reform advocates want to kill old people. Where we once debated individual mandates and health care cooperatives, we now discuss whether Obama is Hitler; where we once debated comparative effectiveness research and Medicare reforms, we now seem to be seriously talking about whether there are going to be "death panels." Behold, our country turned, once again, into a farce.

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.

Update:
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.

Update:
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.

Newark Earthworks [Bryan]

The family headed east today to see the famous Newark Earthworks. "The Newark Earthworks," you should know, "were the largest set of geometric earthen enclosures in the world. Built by prehistoric Hopewell people between 100 BC and AD 500, this architectural wonder of ancient America was part cathedral, part cemetery, and part astronomical observatory." It has been proposed as a World Heritage Site and it is only 40 minutes from Columbus -- another reason to visit us!

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.

Is the economic stimulus working? [Bryan]

So far, the answer appears to be yes. Most of the initial money has gone to tax cuts and keeping state and local governments afloat. This has prevented massive layoffs and has helped maintain essential services. Over the next few weeks, the rest of the public-works spending kicks into gear, hopefully bringing with it more jobs (which we really need). In short, things appear to be turning out as anticipated, even though the recession was far worse than was originally thought.

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."

USA Today
"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."

A very polite home invader [Bryan]

When we returned from our trip to Utah, we confronted a mystery. There were certain things around the house that appeared to be, well, not quite as we left them. While none of our valuables (such as they are) appeared to be missing, there were a few things that were different.

• 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.

We were quite perplexed by this and asked everyone we could think of if they, for some reason, had been inside the house. No one said yes, but they did encourage our suspicions. The person we had asked to watch over the house had felt that something was strange and had driven by numerous times to make sure everything was okay. We were, and still are, baffled by all this.

So, we figure there are four possibilities:

1. Our house is haunted.
2. 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.
3. Someone is playing tricks on us.
4. We are losing our minds, thinking that we had done things before leaving that we hadn't.
   

I'm leaning toward #4 now, but I'm more open than I thought I would be to the other possibilities.

Utah trip 2009 [Bryan]

We returned from our trip to Utah a few weeks ago. Finally, here are some pictures.

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.

The kids loved looking for lizards and imagining shapes in the rocks.

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.

Here we are at Arches National Park, just outside of Moab. That is me making the triumphant V with my arms.

The kids, overall, were real troopers. Our little trip consisted in much driving and hiking, which they largely bore without complaint.

Cute Andrew picture. I loved to see Andrew and Nora climbing and exploring, but it sure made me nervous. Another paradox of parenting I suppose (freedom versus caution).

Random Stephen picture.

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.

Here is Nora.

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.

Here is the big hole. Amazing.

Overall, we had a wonderful time. Many thanks to our friends who took time to visit with us, even while somtimes destroying us at tennis. Many thanks to Ellie's parents for being patient with our mad dash across Eastern Utah. Many thanks to my parents and family for their unending hospitality. We feel very loved when we go home and, perhaps even more important, we know that our kids can feel that love, too. Whenever we visit, our children come to know that there are people who care about them very much, even though they may live far away. It is important to us that they realize this.

My trials and tribulations [Bryan]

So, I went to the office today with a firm commitment: I was not going to eat any junk food. No way, no how, no bad food. To help me with the commitment, I went to go buy some sugar-free gum, a crutch to help me get over the moments of temptations. I walked to a nearby convenience store, picked up a package of gum, and proceeded to the service counter.

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.

Sorting out the truth [Bryan]

Sometimes, people ask me how they can determine who is telling the truth in political debates. The mainstream media isn't very good about this. They usually tell us that "Republicans claim X" while "Democrats deny X," and don't try to explain who is telling the truth. The best way, in my mind, to determine the truth in such matters is to look at prominent fact checking websites like Factcheck.org and Politifact.org. These sites bend over backwards to try to be fair, and they can be found debunking claims by both liberals and conservatives. The other day I heard someone claim that health care reform would euthanize the elderly, and I thought I would check Politifact about this and other such claims about health care. Politifact classifies each claim according to a scale, the lowest scales of truth being "false" and, last of all, "pants-on-fire false."

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.

Pearlstein on Health Care Nonsense [Bryan]

Washington Post business writer Steven Pearlstein, hardly a flaming liberal, has a breathtakingly honest piece about health care reform today.

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."

Cruel Paradoxes of Parenting [Bryan]

Parenting is full of contradictions. On the one hand, you want your children to grow up, becoming more independent, maturing, developing their personalities, their confidence growing and horizons expanding, testing themselves against the world. On the other hand, you treasure those little hands, those eyes who see in you ultimate wisdom and protection, who see you as ultimate playmate, who beam with joy and laughter when you come home from work. I have never known a relationship as intimate as I have with my children. I have watched them every step of their lives, and there is little, if anything, I don't know about them.

And yet, this will all change. And it is my job to make it change, to turn my little ones into people that I might only see once or twice or year (as I see my parents), or talk to on the telephone every now and then. In some ways, I can't wait for them to grow up; in other ways, I can't imagine anything more dreadful.

And Michael Gerson writes today, "So this is the independence we seek for our children -- to turn our closest relationships into acquaintances. Of course, I knew this getting into parenthood. But the reality remains shocking. For a time, small hands take your own -- children look upward, and you fill their entire universe. They remain, to you, the most important things in the world. To them, over time, you become one important thing among many. And then an occasional visit or phone call. And then a memory, fond or otherwise."

I want this car [Bryan]

Cool.

Krugman on Health Care Nonsense [Bryan]

More health care blogging today.

Paul Krugman has an excellent column today in the New York Times. He begins with an amusing anecdote about a man who recently exclaimed during a recent town hall meeting: "Keep your government hands off my Medicare." Not only is this quote funny (Medicare is, of course, a government program), but it is also instructive. People simply don't know how health care works in this country. Americans covered by Medicare generally report being more satisfied with their coverage than do people covered by private insurance; however, they often don't think of Medicare in terms of a government program. It is, in fact, America's best example of "single payer," socialized medicine. In short, people love "socialized" medicine, but don't know it. The same goes for other government interventions. Krugman argues:

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....

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....

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.

Health Care Nonsense [Bryan]

I’ll be the first to admit that, like most other things, the health care debate is too complex for me to get my mind around. But there are some things that are clearly true, some things that are unknown, and some things that are just nonsense. Here is my attempt to sort of facts from nonsense.

Claim: We have the best health care system in the world.

Truth: This is wrong by pretty much any broad-based measure. We pay much more for health care than any other nation, yet many health outcomes (like life expectancy, infant mortality, and so forth) are worse here than in many other OECD countries. The World Health Organization ranks the USA health care system 37th, below such countries as Dominica and Costa Rica. True, we do some things well, like treat cancer. Overall, though, we are less healthy and we are paying much more money. Polls show that Americans are more dissatisfied with their health care than they are in many other developing countries.

Health Care Spending as Percent of GDP

Claim: But in other countries you can’t choose your own doctor.

Truth: The reality is, in fact, that in American you can’t choose your own doctor. I, for example, have a very limited choice of primary care doctors under my plan, which is a very generous plan.

Claim: But in other countries, you have to wait a long time for procedures.

Truth: Actually, polls show that our wait times are often longer than in other countries. In my family, for example, we have waited weeks to get a procedure for our baby Stephen (and, again, we have good insurance).

Claim: In other countries, they ration care.

Truth: We ration care in the this country. You may have noticed that your insurance company decides what you can and cannot have.

Claim: I don’t want a government bureaucrat making medical decisions.

Truth: Well, right now you have a corporate bureaucrat making your medical decisions. The trouble is, the corporate bureaucrat has a vested interest in denying you medical care. When insurance companies deny claims, they make more money; indeed, they have no interest is providing you care if they can legally get out of it. (And they do try to get out of it: check out the highly questionable practice of “rescission” sometimes exercised by insurance companies. If you made any sort of mistake at all in providing your medical history, no matter how trivial, they can void any claim you make thereafter at any time. Hence, we have people being denied treatment for breast cancer because they failed to list past acne treatments. Check out this report, about 30 minutes in.)

Claim: I don't want socialized medicine.

Truth: We already have "socialized" medicine, just a very inefficient form of it. We are socialized in that everyone can receive health care if they just go to the emergency room. Unfortunately, this is probably the most expensive way to take care of sick people, and guess who pays for it. You do. You are, in effect, already paying for an very inefficient type of socialized medicine. The question is not about socialized medicine, it is about being smart about socialized medicine.

Claim: But those darn liberals are going to take away my choices in medical care.

Truth: You don't have choices now. In most states, for example, you don’t have much choice in health insurance providers. Most states have a near monopoly of insurance providers. And, if you are employed, you have to take what your employer gives you.

Claim: Well, Obama is out to take away the few choices that remain.

Truth: No, actually, what he and Democrats have proposed is intended to give you more choices. You can keep what you have, if you want it, or enroll in a not-for-profit public insurance plan if that might better meet your needs. The public plan, if it is included in the bill, will give you a choice you don’t have now.

Claim: Markets are the best way to allocate resources. Government should not be involved.

Truth: I'm a big fan of markets. Markets are cool, nifty things. But markets are not a good way to allocate health care, morally speaking. For markets to work, we have to admit that it would be okay if certain people did not have a certain good. If some people can't afford a plasma TV, we must be prepared to accept that some people will go without. That is how demand is reduced. But, are you going to refuse breast cancer treatment to that single mom because she didn't have adequate insurance? True, if things are too expensive the market may adjust to make things cheaper. But let's be clear: things would adjust in such a way to maximize profit, not to take care of all the sick people.

Flexitarianism [Bryan]

So, people ask once in a while how our "semi-vegetarianism" is going. If you are one of those people curious to know about the food the Warnicks are shoveling into their bodies, this post is for you. I am pleased to report we have successfully cut out much of the meat from our diet. We usually only eat meat on weekends and special occasions. I'm told that this sort of diet is called "flexitarian." So be it.

Some comments on our experience:

1. Alas, our new diet actually hasn't saved us any money. Buying more fresh fruits and vegetables ends up costing as much as the meat did.

2. It has made me really enjoy cooking. Before, it was easy to just let meat carry the meal. Cooking without meat has made me more adventurous and made cooking really exciting for the first time. Ellie will tell you that I've pretty much taken over in the kitchen.

3. It has opened up a whole new world of food to us. I've been making Dal and Falafals, and perfecting the art of Kung Pao Tofu. Some favorite recipes we've found online include: Artichoke Lasagna, Hot and Spicy Tofu, Linguine With Snow Peas, Cucumber, and Peanut Sauce

4. We don't feel any sense of loss. We feel like we are doing the planet good and that we are living better the precepts of our religion (albeit a minor precept). I think we feel a little better physically. You could say, I guess, that it has been a success.

Sarah Palin [Bryan]

She really is a piece of work, ain't she? Her resignation speech was one of the least coherent ramblings I have ever heard from a politician, and that is saying something. Between her and Mark Sanford, it appears all the right-wing governors of the country are going insane.

Summer Pictures [Bryan]

A busy summer so far, camping trip with friends, playing outside in the unusually nice weather, going to Cincinnati for a friend's wedding (congrats again Sarah!), celebrating holidays, taking care of the yard, and so forth.

One of the best parts of the Summer has been having Ellie's brother Sam and his wife Emily around. Sam is working up in Akron over the Summer. They have really made us feel connected to family again in a new way.

Here we are celebrating the Fourth. We went to the Hilliard parade, grilled hamburgers and brats out back, lit sparklers, and went to the Hilliard fireworks display (well, Ellie and the kids went anyway). Ellie said it was fun to watch the kids watch the fireworks, their eyes glued to the sky, mouths frozen in an awestruck smile, gasping and cheering. After each burst, Andrew would say, "That was my favorite." Then the next one would come and he'd say, "THAT was my favorite."

Ellie celebrated her 32nd birthday. Here she is opening presents. I gave her some "body butter" from Crabtree & Evelyn. Flavor: Avocado, Olive Oil, and Basil.

Sam also celebrated his birthday while he was here a few weeks ago. He turned 56.

Bryan and Ellie playing Guitar Hero.

Baby Stephen picture. Notice the strategically placed wash cloth.

On a sad note, somebody bashed out my car window in an attempt to steal...I'm not quite sure what. They didn't take anything, not even the Tic Tacs in my glove compartment. Hey guys, what part of "It doesn't even have a tape deck" do you not understand? To add insult to injury, the next day, while we were in Cincinnati, parked in the Newport Aquarium parking lot, somebody bashed into the bumper of our Highlander, then drove off without even leaving a note. Nice.

Blogging and Gender [Bryan]

I am usually fairly late in adopting new technologies. The Internet, though, has been an exception. I was on Prodigy before hardly anyone else knew what the Internet was. I began reading blogs around 2002 during the debate about the Iraq war. At that time, blogging was a rough and tumble world of flame wars and impolite ranting. It was totally a man's world.

Now, however, most of the bloggers I know personally are women. They tell me that I am the "only guy they know who blogs." It has been a strange evolution.

I think my perception of change has to do with the growth in LDS culture of mommy blogs and family blogs, which consist mostly in pictures and updates on family happenings. This type of blog is particularly popular among student families, who use blogs as a way of keeping in contact with family "back home" in Utah.

This, of course, is a completely legitimate way of thinking about blogging. I like to check in on family blogs, too. But I'm sure many people find our blog to be odd, with, for example, a series on posts on economics and health care. The reason for this difference is this: I was "raised" on the Internet during my formative years to see blogs as places to debate ideas and I can't quite shake that upbringing.

Taking history into your hands [Bryan]

I've been following closely the hopeful/historic/troubling events in Iran. I don't know if the election was stolen, although I suspect that it was. I don't know much about this Mousavi guy, although he doesn't seem like much of an improvement. It has been hard, though, not to be deeply moved by what is happening -- to watch people with the courage and determination to take history into their hands and try to shape it into something better.

I watched a YouTube video today of a young Iranian girl bleeding to death in the streets of Tehran. It was horrific thing to watch -- a series of images that will stay with me for a long time. She was probably in her twenties or late teens, dressed as a more conservative Muslim. She was shot in the chest. One can see the blood spread. One can see the life drain from her eyes. One can hear the panicked screams as people realize how badly hurt she is. All for what? It could be for nothing. Or for everything.

Times like this make me feel small and trivial. Today, for example, I went to Walmart, went to the lake, and played Guitar Hero. It was a fun time, well spent with family. But I have never taken history into my hands. I have never left in the morning knowing that, during to day, I might be beaten or even killed for taking a stand. I have never really stood up to someone (or for someone) like that, fought for justice with everything on the line. What would I do? Would I find an excuse?

I pity people who face such situations. But, sometimes, I also envy them. They know something about themselves that I do not know about myself.

Why Was Our Healthcare So Expensive? Part II [Bryan]

I should clarify, I think, Dr. Gawande's position. His project is to explain why health care costs vary so much from city to city. He cites some studies about differential treatment between cities:

Health-care costs ultimately arise from the accumulation of individual decisions doctors make about which services and treatments to write an order for. The most expensive piece of medical equipment, as the saying goes, is a doctor’s pen. And, as a rule, hospital executives don’t own the pen caps. Doctors do.

If doctors wield the pen, why do they do it so differently from one place to another? Brenda Sirovich, another Dartmouth researcher, published a study last year that provided an important clue. She and her team surveyed some eight hundred primary-care physicians from high-cost cities (such as Las Vegas and New York), low-cost cities (such as Sacramento and Boise), and others in between. The researchers asked the physicians specifically how they would handle a variety of patient cases. It turned out that differences in decision-making emerged in only some kinds of cases. In situations in which the right thing to do was well established—for example, whether to recommend a mammogram for a fifty-year-old woman (the answer is yes)—physicians in high- and low-cost cities made the same decisions. But, in cases in which the science was unclear, some physicians pursued the maximum possible amount of testing and procedures; some pursued the minimum. And which kind of doctor they were depended on where they came from.

Sirovich asked doctors how they would treat a seventy-five-year-old woman with typical heartburn symptoms and “adequate health insurance to cover tests and medications.” Physicians in high- and low-cost cities were equally likely to prescribe antacid therapy and to check for H. pylori, an ulcer-causing bacterium—steps strongly recommended by national guidelines. But when it came to measures of less certain value—and higher cost—the differences were considerable. More than seventy per cent of physicians in high-cost cities referred the patient to a gastroenterologist, ordered an upper endoscopy, or both, while half as many in low-cost cities did. Physicians from high-cost cities typically recommended that patients with well-controlled hypertension see them in the office every one to three months, while those from low-cost cities recommended visits twice yearly. In case after uncertain case, more was not necessarily better. But physicians from the most expensive cities did the most expensive things.

So, in cases where the science is unclear, doctors in high-cost cities tended to adopt a "more treatment is better" approach. He points out that this can't all be explained by differences in the doctors' training. In any given city, doctors come from many different medical schools. He argues instead that, sometimes, a culture of over-treatment arises in some cities. And, sometimes, that culture arises because some doctors develop an entrepreneurial spirit about the practice of medicine. Health care costs are explained, then, by some mixture of hazy science combined and the particular culture of medicine in some cities. It's the culture, then, not simply individually greedy doctors.

What this suggests is that better science can help us reduce costs. For this reason, I think the Democrats are wise to push "comparative effectiveness research" and the Republicans wrong to oppose it (the Republican strategy appears to be to stringently oppose reforms that would save money in medical practice, and then bitterly complain that health care reform is too expensive).

Why Was Our Healthcare So Expensive? [Bryan]

We recently added up the total hospital bills for the birth of baby Stephen. Remember, we had an emergency C-Section, plus a brief visit to the NICU. Ellie's bill totaled $20,000, while Stephen's totaled about $10,000. That is a lot of money. Luckily, we didn't have to pay these bills with our insurance, but it got me wondering: Why does health care cost so much?

In addition, I've been wondering why American health care performs so poorly against other health care systems worldwide. In other countries, they spend a fraction of what we spend on health care, but their health outcomes are usually much better than ours. Why does our health system do so poorly with all the money we put in?

I think I've finally found an answer, and it has almost nothing to do with malpractice lawsuits, greedy insurance companies, or "socialized medicine" or lack thereof. The problem is, unfortunately, doctors that have become businessmen (and women). Doctors make money on tests, surgeries, procedures, referrals, and so forth. It is in their interests to maximize the use of health care, which drives up total costs and, since all medical procedures have risks, this actually makes for poorer health outcomes. Or so this article (byAtul Gawande) claims. Go read it. Most interesting thing I've ever read about the health care cost problem.

A snippet from the conclusion:

When you look across the spectrum from Grand Junction to McAllen—and the almost threefold difference in the costs of care—you come to realize that we are witnessing a battle for the soul of American medicine. Somewhere in the United States at this moment, a patient with chest pain, or a tumor, or a cough is seeing a doctor. And the damning question we have to ask is whether the doctor is set up to meet the needs of the patient, first and foremost, or to maximize revenue.

There is no insurance system that will make the two aims match perfectly. But having a system that does so much to misalign them has proved disastrous. As economists have often pointed out, we pay doctors for quantity, not quality. As they point out less often, we also pay them as individuals, rather than as members of a team working together for their patients. Both practices have made for serious problems.

Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coordination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check.

A Little Better? [Ellie]

A few months ago, I read an article in the Atlantic Monthly by Hanna Rosin called "The Case Against Breastfeeding." I'm sure they chose that title just to be provocative, since its author was, in fact, a breastfeeding mother (eerily, nursing her third and last newborn, a boy--just like mine). Rather than actually arguing against breastfeeding, Rosin was more rebelling against the powerful medical and social coercion associated with it.

I can see why she wants to rebel. Breastfeeding is such a fraught issue. I have friends who can't nurse but dearly want to. I have friends who can but wish they had a reason not to. I have friends who've nursed for years and friends who've nursed for months. I have friends who've gone to extreme measures hoping that nursing would eventually work out and then been devastated when it never did. No matter the variation on this theme, no mother I know has escaped completely unscathed. We are judged if we do (she nursed her kids for how long?) and judged if we don't (she's so selfish).

In her article, Rosin contends that, while recent studies have found only modest benefits, if any, tied to breastfeeding, women are continually bombarded with the message that you are only a good mom if you breastfeed. She is irritated by what she sees as the constant yet unwarranted cheerleading of breastfeeding advocates. Rosin would modify the "breast is best" chant of La Leche-leaguers to "breast is only a little better."

A little better? Well. I'm not here to contest her point. I haven't read the research. She might be right. But I need to believe that the sacrifices I'm making to breastfeed are not just "a little better." For instance, I recently had to turn down the invitation of some friends to go camping because I didn't know how I would manage the breastfeeding issues (To vanish or not to vanish? If not, then I'll have to wrestle with a nursing cover. . .). I've had to interrupt the writing of this blog post on breastfeeding to breastfeed (no lie). I can't really take my kids to the zoo by myself this summer because I don't know what I'd do with my other two in such a vast public place while I breastfeed. Plus the whole nastiness of having to breastfeed in public, period.

Anyway, what I'm arguing for is this: I want to retain my mistaken belief that it is a LOT better to breastfeed. I want Stephen to be healthier, smarter, richer, better looking, and better behaved. I want his guaranteed admission to an Ivy League institution. And for me I want. . .a medal.

But I'll settle for the fact that despite its myriad inconveniences, I kinda like breastfeeding. I love the physical and emotional connection it builds between me and my son. While it might not be as beneficial as I'd like to believe, it still feels like The Right Thing to Do. And I'm a sucker for that kind of stuff.

What kind of world will Stephen have? [Bryan]

Last night I watched a show that really, really bothered me. It was called 2100, an ABC News special broadcast. The premise of the show was following a fictional girl, named Lucy, through life as it might play out if some of the projections currently being made about climate change and other environmental problems turn out to be accurate. The segment claimed that these were "worst case" projections, but they seemed relatively moderate to me (at least until the end, which seemed a bit far-fetched). The effects of climate change, judged by melting sea ice and glaciers, seem to be outpacing even the most pessimistic assumptions. They did the segment with some good graphic-novel type of animation, which had a surprising impact on me.

The segment stuck with me because this could be the life of my kids. Stephen, like the character Lucy, was born in 2009. I really wonder what sort of world we are leaving behind for Nora, Andrew, and Stephen. Not a good one, I think. We've really trashed the place -- and it wasn't our place.

The projections are relatively familiar: Gas shortages and riots as oil demand vastly exceeds supply. Outer suburbs become vast slums as people abandon them to live closer to the cities (can't afford to drive). Water shortage in the American Southwest (bye, bye, Las Vegas) and in cities that depend on glacier run-offs. Water shortage and soaring cost of oil lead to food shortages and mass starvation in other countries. Thirsty and starving people destabilize national borders, populations move as islands and low-lying cities flood, leading to war and civil unrest. It is all very grim.

Now, this isn't the only scenario, and certainly the human race has avoided disaster before. There was never a nuclear war, for example, which was a prospect that used to terrify me as a kid. But, in that case, it was obvious that our short-term interest was in not getting blown up. That created restraint and, to some degree, wisdom. With these sorts of problems, our short-term "economic" interest lies in doing more of the same. Humanity has never shown much interest in thinking about long-term problems. I like to think we can avoid this, but governments (and I am looking at you US Senate) seem resistant to even the most modest measures of restraint. I hope somebody proves me wrong.

Here is the opening segment.

Earth 2100: Civilization at Crossroads

Shared via AddThis

Nora Happenings [Bryan]

Nora's Kindergarten didn't do a graduation (thank goodness!). But they did have a little open house with punch and cookies on the second-to-last day of school. Here is Nora on the school playground with some friends.

Nora and her teacher, Mrs. P., on the last day of school.

Nora's school. Not much to look at, but we like it. The school district is very short on funds (the community refuses to pass a levy), but they do great things with their very modest resources.

Nora recently wrote a series of books we've taken to calling the "Haley series" -- Haley at the Park, Haley Goes to Wal-mart, etc. Haley, from what I understand, is the name of a friend of hers at school. Here she is showing off her work.

Nora's latest piano recital.