August 9, 2009
The subtlety of Cervantes' satire
--Don Quixote, Part I, Book IV, Chapter VI, 'The Novel of the Curious Impertinent'
(The joke is that the mathematical process described here is Algebra, learned by the Europeans from the Moors.)
August 7, 2009
Two Health Care Systems: One works, the other doesn't
Universal health insurance is on the American policy agenda for the fifth time since World War II. In the 1960s, the U.S. chose public coverage for only the elderly and the very poor, while Canada opted for a universal program for hospitals and physicians' services. As a policy analyst, I know there are lessons to be learned from studying the effect of different approaches in similar jurisdictions. But, as a Canadian with lots of American friends and relatives, I am saddened that Americans seem incapable of learning them.
Our countries are joined at the hip. We peacefully share a continent, a British heritage of representative government and now ownership of GM. And, until 50 years ago, we had similar health systems, healthcare costs and vital statistics.
The U.S.' and Canada's different health insurance decisions make up the world's largest health policy experiment. And the results?
On coverage, all Canadians have insurance for hospital and physician services. There are no deductibles or co-pays. Most provinces also provide coverage for programs for home care, long-term care, pharmaceuticals and durable medical equipment, although there are co-pays.
On the U.S. side, 46 million people have no insurance, millions are underinsured and healthcare bills bankrupt more than 1 million Americans every year.
Lesson No. 1: A single-payer system would eliminate most U.S. coverage problems.
On costs, Canada spends 10% of its economy on healthcare; the U.S. spends 16%. The extra 6% of GDP amounts to more than $800 billion per year. The spending gap between the two nations is almost entirely because of higher overhead. Canadians don't need thousands of actuaries to set premiums or thousands of lawyers to deny care. Even the U.S. Medicare program has 80% to 90% lower administrative costs than private Medicare Advantage policies. And providers and suppliers can't charge as much when they have to deal with a single payer.
Lessons No. 2 and 3: Single-payer systems reduce duplicative administrative costs and can negotiate lower prices.
Because most of the difference in spending is for non-patient care, Canadians actually get more of most services. We see the doctor more often and take more drugs. We even have more lung transplant surgery. We do get less heart surgery, but not so much less that we are any more likely to die of heart attacks. And we now live nearly three years longer, and our infant mortality is 20% lower.
Lesson No. 4: Single-payer plans can deliver the goods because their funding goes to services, not overhead.
The Canadian system does have its problems, and these also provide important lessons. Notwithstanding a few well-publicized and misleading cases, Canadians needing urgent care get immediate treatment. But we do wait too long for much elective care, including appointments with family doctors and specialists and selected surgical procedures. We also do a poor job managing chronic disease.
However, according to the New York-based Commonwealth Fund, both the American and the Canadian systems fare badly in these areas. In fact, an April U.S. Government Accountability Office report noted that U.S. emergency room wait times have increased, and patients who should be seen immediately are now waiting an average of 28 minutes. The GAO has also raised concerns about two- to four-month waiting times for mammograms.
On closer examination, most of these problems have little to do with public insurance or even overall resources. Despite the delays, the GAO said there is enough mammogram capacity.
These problems are largely caused by our shared politico-cultural barriers to quality of care. In 19th century North America, doctors waged a campaign against quacks and snake-oil salesmen and attained a legislative monopoly on medical practice. In return, they promised to set and enforce standards of practice. By and large, it didn't happen. And perverse incentives like fee-for-service make things even worse.
Using techniques like those championed by the Boston-based Institute for Healthcare Improvement, providers can eliminate most delays. In Hamilton, Ontario, 17 psychiatrists have linked up with 100 family doctors and 80 social workers to offer some of the world's best access to mental health services. And in Toronto, simple process improvements mean you can now get your hip assessed in one week and get a new one, if you need it, within a month.
Lesson No. 5: Canadian healthcare delivery problems have nothing to do with our single-payer system and can be fixed by re-engineering for quality.
U.S. health policy would be miles ahead if policymakers could learn these lessons. But they seem less interested in Canada's, or any other nation's, experience than ever. Why?
American democracy runs on money. Pharmaceutical and insurance companies have the fuel. Analysts see hundreds of billions of premiums wasted on overhead that could fund care for the uninsured. But industry executives and shareholders see bonuses and dividends.
Compounding the confusion is traditional American ignorance of what happens north of the border, which makes it easy to mislead people. Boilerplate anti-government rhetoric does the same. The U.S. media, legislators and even presidents have claimed that our "socialized" system doesn't let us choose our own doctors. In fact, Canadians have free choice of physicians. It's Americans these days who are restricted to "in-plan" doctors.
Unfortunately, many Americans won't get to hear the straight goods because vested interests are promoting a caricature of the Canadian experience.
August 6, 2009
Obama and Neoliberalism
... By neoliberalism I mean the ideology that replaced New Deal liberalism as the dominant force in the Democratic Party between the Carter and Clinton presidencies. In the Clinton years, this was called the "Third Way." The term was misleading, because New Deal liberalism between 1932 and 1968 and its equivalents in social democratic Europe were considered the original "third way" between democratic socialism and libertarian capitalism, whose failure had caused the Depression. According to New Deal liberals, the United States was not a "capitalist society" or a "market democracy" but rather a democratic republic with a "mixed economy," in which the state provided both social insurance and infrastructure like electric grids, hydropower and highways, while the private sector engaged in mass production.
When it came to the private sector, the New Dealers, with some exceptions, approved of Big Business, Big Unions and Big Government, which formed the system of checks and balances that John Kenneth Galbraith called "countervailing power." But most New Dealers dreaded and distrusted bankers. They thought that finance should be strictly regulated and subordinated to the real economy of factories and home ownership. They were economic internationalists because they wanted to open foreign markets to U.S. factory products, not because they hoped that the Asian masses some day would pay high overdraft fees to U.S. multinational banks.
New Dealers approved of social insurance systems like Social Security and Medicare, which were rights (entitlements) not charity and which mostly redistributed income within the middle class, from workers to nonworkers (the retired and the temporarily unemployed). But contrary to conservative propaganda, New Deal liberals disliked means-tested antipoverty programs and despised what Franklin Roosevelt called "the dole." Roosevelt and his most important protégé, Lyndon Johnson, preferred workfare to welfare. They preferred a high-wage, low-welfare society to a low-wage, high-welfare society. To maintain the high-wage system that would minimize welfare payments to able-bodied adults, New Deal liberals did not hesitate to regulate the labor market, by means of pro-union legislation, a high minimum wage, and low levels of immigration (which were raised only at the end of the New Deal period, beginning in 1965). It was only in the 1960s that Democrats became identified with redistributionist welfarism -- and then only because of the influence of the New Left, which denounced the New Deal as "corporate liberalism."
Between the 1940s and the 1970s, the New Deal system -- large-scale public investment and R&D, regulated monopolies and oligopolies, the subordination of banking to productive industry, high wages and universal social insurance -- created the world's first mass middle class. The system was far from perfect. Southern segregationist Democrats crippled many of its progressive features and the industrial unions were afflicted by complacency and corruption. But for all its flaws, the New Deal era is still remembered as the Golden Age of the American economy.
And then America went downhill.
The "stagflation" of the 1970s had multiple sources, including the oil price shock following the Arab oil embargo in 1973 and the revival of German and Japanese industrial competition (China was still recovering from the damage done by Mao). During the previous generation, libertarian conservatives like Milton Friedman had been marginalized. But in the 1970s they gained a wider audience, blaming the New Deal model and claiming that the answer to every question (before the question was even asked) was "the market."
The free-market fundamentalists found an audience among Democrats as well as Republicans. A growing number of Democratic economists and economic policymakers were attracted to the revival of free-market economics, among them Obama's chief economic advisor Larry Summers, a professed admirer of Milton Friedman. These center-right Democrats agreed with the libertarians that the New Deal approach to the economy had been too interventionist. At the same time, they thought that government had a role in providing a safety net. The result was what came to be called "neoliberalism" in the 1980s and 1990s -- a synthesis of conservative free-market economics with "progressive" welfare-state redistribution for the losers. Its institutional base was the Democratic Leadership Council, headed by Bill Clinton and Al Gore, and the affiliated Progressive Policy Institute.
Beginning in the Carter years, the Democrats later called neoliberals supported the deregulation of infrastructure industries that the New Deal had regulated, like airlines, trucking and electricity, a sector in which deregulation resulted in California blackouts and the Enron scandal. Neoliberals teamed up with conservatives to persuade Bill Clinton to go along with the Republican Congress's dismantling of New Deal-era financial regulations, a move that contributed to the cancerous growth of Wall Street and the resulting global economic collapse. As Asian mercantilist nations like Japan and then China rigged their domestic markets while enjoying free access to the U.S. market, neoliberal Democrats either turned a blind eye to the foreign mercantilist assault on American manufacturing or claimed that it marked the beneficial transition from an industrial economy to a "knowledge economy." While Congress allowed inflation to slash the minimum wage and while corporations smashed unions, neoliberals chattered about sending everybody to college so they could work in the high-wage "knowledge jobs" of the future. Finally, many (not all) neoliberals agreed with conservatives that entitlements like Social Security were too expensive, and that it was more efficient to cut benefits for the middle class in order to expand benefits for the very poor. ...
By the time Barack Obama was inaugurated, the neoliberal capture of the presidential branch of the Democratic Party was complete. ...
Instead of the updated Rooseveltonomics that America needs, Obama's team offers warmed-over Rubinomics from the 1990s. Consider the priorities of the Obama administration: the environment, healthcare and education. Why these priorities, as opposed to others, like employment, high wages and manufacturing? The answer is that these three goals co-opt the activist left while fitting neatly into a neoliberal narrative that could as easily have been told in 1999 as in 2009. The story is this: New Dealers and Keynesians are wrong to think that industrial capitalism is permanently and inherently prone to self-destruction, if left to itself. Except in hundred-year disasters, the market economy is basically sound and self-correcting. Government can, however, help the market indirectly, by providing these three public goods, which, thanks to "market failures," the private sector will not provide.
Healthcare? New Deal liberals favored a single-payer system like Social Security and Medicare. Obama, however, says that single payer is out of the question because the U.S. is not Canada. (Evidently the New Deal America of FDR and LBJ was too "Canadian.") The goal is not to provide universal healthcare, rather it is to provide universal health insurance, by means that, even if they include a shriveled "public option," don't upset the bloated American private health insurance industry.
Education? In the 1990s, the conventional wisdom of the neoliberal Democrats held that the "jobs of the future" were "knowledge jobs." America's workers would sit in offices with diplomas on the wall and design new products that would be made in third-world sweatshops. We could cede the brawn work and keep the brain work. Since then, we've learned that brain work follows brawn work overseas. R&D, finance and insurance jobs tend to follow the factories to Asia.
Education is also used by neoliberals to explain stagnant wages in the U.S. By claiming that American workers are insufficiently educated for the "knowledge economy," neoliberal Democrats divert attention from the real reasons for stagnant and declining wages -- the offshoring of manufacturing, the decline of labor unions, and, at the bottom of the labor market, a declining minimum wage and mass unskilled immigration. One study after another since the 1990s has refuted the theory that wage inequality results from skill-biased technical change. But the neoliberal cultists around Obama who write his economic speeches either don't know or don't care. Like Bill Clinton before him, Barack Obama continues to tell Americans that to get higher wages they need to go to college and improve their skills, as though there weren't a surplus of underemployed college grads already.
Environment? Here the differences between the New Deal Democrats and the Obama Democrats could not be wider. Their pro-industrial program did not prevent New Deal Democrats from being passionate about resource conservation and wilderness preservation. They did not hesitate to use regulations to shut down pollution. And their approach to energy was based on direct government R&D (the Manhattan Project) and direct public deployment (the TVA).
Contrast the straightforward [emphasis added*] New Deal approaches with the energy and environment policies of Obama and the Democratic leadership, which are at once too conservative and too radical. They are too conservative, because cap and trade relies on a system of market incentives that are not only indirect and feeble but likely to create a subprime market in carbon, enriching a few green profiteers. At the same time, they are too radical, because any serious attempt to shift the U.S. economy in a green direction by hiking the costs of non-renewable energy would accelerate the transfer of U.S. industry to Asia -- and with it not only industry-related "knowledge jobs" but also the manufacture of those overhyped icons of the "green economy," solar panels and windmills.
While we can't go back to the New Deal of the mid-20th century in its details, we need to re-create its spirit. ...
[*Medicare for all. Higher gas tax.]
August 5, 2009
Wind Turbines Give You Spots
These photos are from Yvonne Sheehan in County Cork, Ireland. Click the title of this post to read her diary of life with her grandson in the shadow of industrial wind turbines. The ill effects don't stop with spots.
wind power, wind energy, wind turbines, wind farms human rights
August 4, 2009
Taking note of wind turbine syndrome
Earth2Tech (picked up by Reuters)
Treehugger
C-Questor Carbon Markets and Climate Change
Geoffrey Lean (Telegraph)
Cambs Times—Fen Diary
Fast Company
Nordic Briefing
Impact Lab
Grist
Sideways News
Bayou Renaissance Man
The Independent
NHS Choices
World Of Mysteries, World of Facts
Thermonuclear Thought
Curb Global Warming
This Magazine
Lake Ontario Waterkeeper
Wild Singapore
Tinnitus Treatments Info
David Jones, MP
Roger Helmer, MEP
Jo Abbess
Business Green
Neat Stuff
wind power, wind energy, wind turbines, wind farms, environment, environmentalism, human rights, animal rights
August 2, 2009
A Wind Farm Is Not the Answer
How would you imagine an environmentalist would react when presented with the following proposition? A power company plans to build a new development on a stretch of wild moorland. It will be nearly seven miles long, and consist of 150 structures, each made of steel and mounted on hundreds of tons of concrete. They will be almost 500 feet high, and will be accompanied by 73 miles of road. The development will require the quarrying of 1.5m cubic metres of rock and the cutting out and dumping of up to a million cubic metres of peat.
The answer is that if you are like many modern environmentalists you will support this project without question. You will dismiss anyone who opposes it as a nimby who is probably in the pay of the coal or nuclear lobby, and you will campaign for thousands more like it to be built all over the country.
The project is, of course, a wind farm - or, if we want to be less Orwellian in our terminology, a wind power station. This particular project is planned for Shetland, but there are many like it in the pipeline. The government wants to see 10,000 new turbines across Britain by 2020 (though it is apparently not prepared to support the Vestas wind turbine factory on the Isle of Wight). The climate and energy secretary, Ed Miliband, says there is a need to "grow the market" for industrial wind energy, and to aid this growth he is offering £1bn in new loans to developers and the reworking of the "antiquated" (ie democratic) planning system, to allow local views on such developments to be overridden.
Does this sound very "green" to you? To me it sounds like a society fixated on growth and material progress going about its destructive business in much the same way as ever, only without the carbon. It sounds like a society whose answer to everything is more and bigger technology; a society so cut off from nature that it believes industrialising a mountain is a "sustainable" thing to do.
It also sounds like an environmental movement in danger of losing its way. The support for industrial wind developments in wild places seems to me a symbol of a lack of connectedness to an actual, physical environment. A development like that of Shetland is not an example of sustainable energy: it is the next phase in the endless human advance upon the non-human world - the very thing that the environmental movement came into being to resist.
Campaigners in Cumbria are fighting a proposed wind development near the mountain known as Saddleback, a great, brown hulk of a peak which Wordsworth preferred to call by its Celtic name, Blencathra. Wordsworth thought the wild uplands a place of epiphany. Other early environmentalists, from Thoreau to Emerson, knew too of the power of mountain and moor to provide a clear-eyed and humbling view of humanity.
Many of today's environmentalists will scoff if you speak to them of such things. Their concerns are couched in the language of business and technology - gigawatt hours, parts per million of carbon, peer-reviewed papers and "sustainable development". The green movement has become fixated on a single activity: reducing carbon emissions. It's understandable, what the science tells us about the coming impacts of climate change is terrifying. But if climate change poses a huge question, we are responding with the wrong answers.
The question we should be asking is what kind of society we should live in. The question we are actually asking is how we can power this one without producing carbon. This is not to say that renewable energy technologies are bad. We need to stop burning fossil fuels fast, and wind power can make a contribution if the turbines are sensitively sited and on an appropriate scale.
But the challenge posed by climate change is not really about technology. It is not even about carbon. It is about a society that has systematically hewed its inhabitants away from the natural world, and turned that world into a resource. It is about a society that imagines it operates in a bubble; that it can keep growing in a finite world, forever.
When we clamour for more wind-power stations in the wilderness, we perhaps think we are helping to slow this machine, but we are actually helping to power it. We are still promoting, perhaps unintentionally, the familiar mantras of industrial civilisation: growth can continue forever; technological gigantism will save us; our lives can go on much as they always have.
In the end, climate change presents us with a simple question: are we going to live within our means, or are we, like so many civilisations before us, going to collapse? In that question lies a radical challenge to the direction and mythologies of industrial society. All the technology in the world will not answer it.
See also: Confessions of a Recovering Environmentalist, by Paul Kingsnorth.
wind power, wind energy, wind turbines, wind farms, environment, environmentalism
July 30, 2009
Social stigmata
“Not every windfarm should be licensed, but the great bulk of them will need to be. In a country that is serious about tackling climate change, raising objections might need to become something that carries a certain social stigma, as the climate secretary, Ed Miliband, has suggested.” —The Guardian, Editorial, July 30
Anything other than entertain the possibility for a moment that for tackling climate change windfarms are useless ...
This is the same paper that consistently defends horrible and useless animal experimentation against stigmatization by those who are serious about tackling unnecessary cruelty. For a supposedly “liberal” paper, it might be upsetting to note that the common thread is a defense of corporate violence, whether against animals or against the landscape and rural residents – both activities pointless except as demonstrations of power.
wind power, wind energy, wind turbines, wind farms, environment, environmentalism, human rights, animal rights, anarchism, ecoanarchism, anarchosyndicalism