Archive for August, 2009

Healthcare

August 31, 2009

For reasons that I’ll elaborate on later I’m very skeptical of the new healthcare legislation that is being proposed. I do not think that it’s a panacea though I’m not convinced that it’s the disaster that many people, mostly on the right, are predicting. Cries of socialism are more than a bit silly when you consider that a massive (and growing) chunk of healthcare expenditures are backed by the government in the form of medicare and medicaid, and that the healthcare industry is already among the most heabily regulated in existence.

I do think that one issue that is generally ignored by both sides concerns the rationing of health care. The debate would be much more open and honest if only people would admit that healthcare always has been and always will be rationed in one way or another:

http://meganmcardle.theatlantic.com/archives/2009/08/confronting_the_r-word.php

Limiting health care’s availability by the criterion of personal wealth rightly offends our sense of the dignity of the individual. Are the lives of the poor not of the same intrinsic value of those of the wealthy? To be fair, it is rare in the United States that poverty alone prevents the uninsured poor from receiving lifesaving intervention in a healthcare crisis. A poor man having a heart attack is not turned away from the emergency room, nor is the poor woman in labor sent away to have her baby at home. (I am not arguing that such enormities never occur, but the fact that such occurrences remain scandalous and newsworthy is a testament to their rarity.) Yet it is equally undeniable that the poor get a lesser share of the preventive care that can maintain health or of the quotidian care for the less dramatic challenges to their health.

There are two major alternatives to the allocating of health care on the basis of personal wealth. Both involve a large number of individuals agreeing (or having imposed on them) that the amount of health care they receive will not be in strict accord to how much they have paid for it. The cost will be distributed over the healthy as well as the sick, even though the benefit will inure only to those who are ill or who need health care to prevent illness. People accept the certainty of a bearable cost to avoid the risk of an unbearable one. But to the extent that these collective programs sever the connection between paying for health care and receiving it, they generate increased demand for health care. The individual feels that he has already paid for health care. When he is sick, or thinks that he is sick, he feels fully entitled to care with no consideration of cost. After all, he has already paid for it, hasn’t he? Given the limited amount of health care that may be bought with the aggregate funds of the group, this untrammeled demand for it must always result in rationing. This is true whether the collective effort is a private insurance plan or a government program. Rationing is inevitable in all collective health care financing schemes.

Rationing must occur, but it need not be admitted. Denying the truth of rationing is more common in government-run health care schemes than private ones, because the government is reluctant to have the people know this ugly fact. Government-run programs, therefore, are more likely to disguise the rationing. This plausibly deniable form of limiting health care is called implicit healthcare rationing, and it assumes many forms. Rationing by termination occurs when patients are discharged from the hospital earlier than is medically optimal. Rationing by dilution occurs when second-best rather than first-best treatment is provided. Rationing by rejection or redirection involves healthcare providers turning away patients whose care will be inadequately reimbursed. This is commonly seen now in the Medicare and Medicaid programs, because those programs reimburse providers at a rate substantially lower than private insurance plans. Perhaps more common than those forms of rationing is rationing by delay, as exemplified by the outrageous amount of time patients in Canada must wait for hip replacement surgery or colonoscopy. The unifying theme in all these forms of implicit rationing is that, without admitting it, they force some patients to forego medical care that they want and are ostensibly entitled to receive.

SCIENCE

August 20, 2009

While coming home from school during Christmas break in 2007, I struck up a conversation with a very eccentric fellow on the LIRR after getting in on Jamaica, starting the last leg of my journey home. He wore a hearing aid, beat up sneakers,  an old pair of jeans, and a sweatshirt underneath an old jacket.

After sitting down he loudly asked anyone within earshot how long it would take to get to Mastic, a town on Long Island a bit further east from my hometown. I assumed that he was mentally retarded, extremely eccentric, or some combination of the two. As space cleared up on the train, he took a seat across the aisle from me. The conductor came by to take our tickets.

“I just came back from a very important meeting in India,” he announced in a loud monotone. “I delivered an important lecture and my flight back to New York was delayed by 5 hours.” The conductor smiled, looked at his ticket, and walked on, as she probably does 100 times throughout the day confronted with delusional passengers.

I don’t think I would have paid closer had I not I glanced down at the tag on his bag. It said “Andrew Beckwith” and listed an affiliation with a lab somewhere in the Midwest.

We managed to strike up a conversation – he asked me how much it would cost to take a cab from Patchogue (the last stop of this train, around 10 miles east of my home town) to Mastic. Eventually he told me that he was a physicist, and was returning from presenting a paper in India. He mentioned some of the work that he did, and claimed that Edward Witten (one of the few modern physicists I know by name—and a Brandeis alum!) was very arrogant. Soon enough I came to my hometown; he feebly shook my hand and thanked me for my help. I was on my way back home.

I Googled his name after getting home. He wasn’t lying; apparently he really was a physicist. In fact, he has quite a reputation on usenet. See here:

http://www.ennui.org/rone/other/beckwith-quotes

What I found striking about this interaction is that I can’t recall so obviously seeing such a massive gap between actual intelligence/brainpower and perceived social status. If I hadn’t glanced down at his bag and noticed this guy’s nametag, I would have gone on thinking that he was just your run of the mill Very Weird Person on Public Transit, which is what I’m sure most people who saw him that day perceived him as.

This made me think of Phil Greenspun’s excellent article on women and science. Below is an excerpt, but read the whole thing:

Having been both a student and teacher at MIT, my personal explanation for men going into science is the following:

  1. young men strive to achieve high status among their peer group
  2. men tend to lack perspective and are unable to step back and ask the question “is this peer group worth impressing?”

Consider Albert Q. Mathnerd, a math undergrad at MIT (“Course 18” we call it). He works hard and beats his chest to demonstrate that he is the best math nerd at MIT. This is important to Albert because most of his friends are math majors and the rest of his friends are in wimpier departments, impressed that Albert has even taken on such demanding classes. Albert never reflects on the fact that the guy who was the best math undergrad at MIT 20 years ago is now an entry-level public school teacher in Nebraska, having failed to get tenure at a 2nd tier university. When Albert goes to graduate school to get his PhD, his choice will have the same logical foundation as John Hinckley’s attempt to impress Jodie Foster by shooting Ronald Reagan.

It is the guys with the poorest social skills who are least likely to talk to adults and find out what the salary and working conditions are like in different occupations. It is mostly guys with rather poor social skills whom one meets in the university science halls.

What about women? Don’t they want to impress their peers? Yes, but they are more discriminating about choosing those peers. I’ve taught a fair number of women students in electrical engineering and computer science classes over the years. I can give you a list of the ones who had the best heads on their shoulders and were the most thoughtful about planning out the rest of their lives. Their names are on files in my “medical school recommendations” directory.

http://philip.greenspun.com/careers/women-in-science

Marx Bros.

August 13, 2009

I’m a bit ashamed to say that I only recently discovered the Marx brothers, or perhaps re-discovered them. It’s really shocking to think that these films are nearly 80 years old. They haven’t aged at all. They were very far ahead of their time and, to an extent, still are.

Nickeloden

August 11, 2009

Nickelodeon in the early 90’s was the king of campy TV shows. You Can’t Say that on Television, 15, Salute your Shorts, and—campiest of them all—Hey Dude.

One of the shows that really sticks out in my mind is Welcome Freshmen, which chronicled the misadventures of a group of high school freshmen at Hawthorne High School. There were also some more bizarre elements such as Myrtle the Safety Turtle, an eponymous named reptile who warned against unsafe household practices and often became the victim of what he warned against. There was also Mr. History, whose shtick I can’t quite recall beyond that it had something to do with re-telling historical episodes.

I remember many of the episodes being quite funny at the time and, even in hindsight, I think it was one of the better shows on Nick. It was no Pete & Pete, to be sure, let along a Rocko’s Modern Life, through the writing was reasonably clever. There is a dearth of clips of the show on YouTube, though I was able to come up with this:

First, the show was an obvious rip-off of Saved by the Bell and the Simpsons. It copied the former’s general high school scenarios and some of the latter’s humor. In of the clips above, for example, we see a Scottish janitor reminiscent of Groundskeeper Willy (is there some sort of Scottish school janitor stereotype?) and principal Lippman’s run in with an angry school superintendent, not unlike Chalmers. I’m almost certain that Lisa’s band teacher inspired the principal’s love of John Sousa, and I seem to remember a Simpsons episode that took the form of a mock court as featured above.

Second, the character Walt was consistently characterized as being a dull, dimwitted jock. Watching now he seems to be much more clever than I remember him being, and his antics are reminiscent of Chico and Harpo Marx.

I think that the writers of this show were actually quite clever, but forced to dumb down their writing for the under-10 set. I do wish that this show was available on Netflix or DVD, though I doubt that we’ll see it any time soon given it’s short (3 season) run.

Subprime Solution

August 3, 2009

A few months ago I stumbled across academicearth.org, which has videos of full courses in a wide variety of areas, mostly from Yale professors. I worked my way through Robert Shiller’s course on financial markets. He’s most well known for his work in behavioral finance, which applies concepts from psychology to analyzing decision making in financial markets.

The course was very similar to the upper-level finance elective I took in college, except more interesting and less dry. So when I saw Shiller’s new book, “The Subprime Solution,” available for $3 at the local used bookstore, I immediately jumped on it. I wasn’t disappointed, even if I took issue with some of his arguments.

Shiller’s prognosis of the crisis is that no one expected to see home prices decline, which led to a massive bubble in home prices. This led to people doing all sorts of silly things, like taking out mortgages that they couldn’t pay off or creating financial products that were riskier than they appeared.

As important as the “bubble mentality” is when explaining the current situation, I think he spends too little time analyzing the microeconomic conditions that formed this mentality to begin with. He seems a bit too taken by his own work in behavioral finance, and I was surprised to see no discussion of the perverse incentives faced by ratings agencies (http://www.econtalk.org/archives/2009/02/cochrane_on_the.html), the political pressure on Fannie and Freddie, etc.

Moving on to part two, Shiller’s solutions center around a.) short run bailouts to prevent a panic in the near/intermediate term and b.) a “democratization” of finance to guard against speculative bubbles in the future. I’m still skeptical about the argument for short-term bailouts, though I still think that there is a powerful case to be made for them. I’m more thoroughly skeptical about his arguments on how to make the financial system more transparent and accessible, however.

Some of them, such as making financial advice tax deductible, seem patently unrealistic. 3rd party financial advice will never be completely free of bias, and it’s not difficult to imagine financial planners taking advantage of a newfound market of uneducated people. His idea to create a sort of financial products safety commission seems equally uncompelling—It’s difficult to see why bureaucrats in a government agency would have better knowledge of the risk and return profiles of new products than people who invest in them. Some of the other ideas, such as a liquid futures market for housing market indices and “livelihood insurance” indexed to a people active in a certain occupation over a given area seem more sound, though the cynical libertarian in me wonders why these products have not been able to get off the ground by now.

Thankfully, he doesn’t jump on the populist “throw the CEO’s in jail and stab demon finance right through the heart,” which is quite refreshing to hear from someone who I (vaguely) associate with the left.

This book is well worth reading, even if Shiller is a bit too in love with his own work in behavioral finance to look at some of the other causes of the bubble. Not al of his diagnoses seemed realistic, though his analysis cogent and it was all certainly good food for thought.

The Squid & the Whale

August 1, 2009

I just finished watching The Squid and the Whale. This has been high on my list for a long time, due to both the recommendation from my brother and the fact that it was produced by Wes Anderson, who’s one of my favorite directors.

The movie follows a pair of boys coping with the divorce of the writer parents, and manages to be funny and heartfelt without coming off as saccharine. I think that it’s a genuine reproduction of the pain and awkwardness that comes from family disasters, as well as growing up more generally. No one ever plans to get divorced; everyone has to wing it and make it up as they go along. Kids grow up too fast, parents look like they don’t know what they’re doing, and friction ensues. It has the feel of the Royal Tenenbaums, minus Wes Anderson’s tendency to create delicate, miniature worlds.

The trailer never quite appealed to me, which probably explains why it’s taken a long time for me to get around to watching it (that, and I only recently signed up for netflix). Reviewers have heavily criticized the trailer on Amazon and other sites due to supposedly misrepsenting the story of a divorcing family as a light comedy. I think that that’s only half true.

It is genuinely funny, mostly through Jeff Daniels’ one-liners and some more subtle incidents that come through more visibly on a second viewing. I think that people tend to look back on their youth—even negative memories from it—more fondly than when they were actually occurring, so in that sense it feels very much like a re-told memory.

Anyway, I highly recommend. If you like Wes Anderson, you should love The Squid and the Whale. And even if you don’t enjoy Wes Anderson, there’s still a lot in this movie to like.