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    Ebola Thrives on Poverty and Disparity

    Ebola–like many viruses, including the recently popular enterovirus 68–is spread by filth. Ebola thrives on poverty and disparity. Decency for the poorest is what makes a developed country a developed country: a place where one does not die from easily prevented diseases (among other things). Decency isn’t our long suit.

Ebola Thrives on Poverty and Disparity Oct 1st, 2014 | By | Category: Featured Articles, Lead Article, Public Health

Ebola
With the first confirmed case of Ebola in the United States, I suspect at least a few of you are freaking out.

Ebola–like many viruses, including the recently popular enterovirus 68–is spread by filth. You need exposure to infected body fluids (blood, tears, sweat, vomit, diarrhea) to get it.

Ebola thrives on poverty and disparity: Places were the people at the bottom of the ladder have no access to clean water to drink and wash with, no access to decent healthcare, no public health providers to track and contain outbreaks. West Africa is nearly ideal for Ebola. Increasingly, so is Central Texas and the rest of the United States.

To protect yourself, your household, your community from communicable diseases like Ebola requires decency for the poorest, the most marginalized in your community–the people who pick your produce, make your food, clean your streets and workplace, working the myriad of minimum-wage service jobs that make most of our lives possible.

Decency for the poorest is what makes a developed country a developed country: a place where one does not die from easily prevented diseases (among other things). Decency isn’t our long suit.

***

You’d be correct to be exasperated with the emergency room in Dallas, sending home with a handful of antibiotics a man recently arrived from West African, with classic symptoms of Ebola. How could this happen? Why weren’t we better prepared?

The CDC has actually been a leader in responding to the crisis. It’s helped that so many American doctors and experts, at significant personal peril, have been involved in the response in Africa. Reams of guidelines are available.

Still, there needs to be local public health experts–someone to translate the guidelines into concrete steps and plans for a given community–before a plan can work. It’s tough work. How do you get a patient from an outlying clinic to an isolation room in a proper hospital without exposing ambulance crews? To which hospital should the patient be taken? Who is going to clean up the vomit, blood, other bodily fluids, and medical waste? How will those people be protected from exposure. Where will the waste be taken? Who will incinerate it? Who will track down others who might have been exposed, and watch them for symptoms? Who will check arriving airline passengers for symptoms? Which symptoms should be looked for?

Even in King County (still a high-water mark for public health in the United States), years of cutbacks–cheered on by the likes of the Seattle Times editorial board and Tim Eyman–have degraded the infrastructure to answer these questions and implement the answers.

It’s not time to panic. Honestly, the biggest risk for most people in the US remains the flu (get vaccinated!). For new things floating around, Enterovirus 68 is probably a bigger risk than Ebola. If you want to sleep better at night, vote for better public health funding.

The American Health Care Market Just Became Less Opaque May 8th, 2013 | By | Category: Featured Articles, Lead Article, Medicine

How much a plate of spaghetti is going to cost you isn’t usually a mystery. Sure, the price can vary quite a bit–from a few cents if you’re making the plate yourself from groceries, to dozens of dollars at a fancy restaurant. You shouldn’t be too surprised by the bill at the end; the price is right there on the menu, or on the box–same for you as anyone else.

The American healthcare system remains remarkably opaque–particularly if you are among the uninsured. The cost of a hospitalization for a heart attack varies tremendously depending upon the hospital giving the treatment. And, unlike a restaurant, hospitals generally refuse to state the price up front.

To reduce healthcare costs, the plan for the past few decades has been to pass on costs to the consumer. The idea here is to use the market (in the Adam Smith sense of the word) to force down prices–expecting patients to find the most efficient, cheapest, hospital for a given problem. (Spoiler: It hasn’t worked.)

But, how can you decide which hospital is most efficient, if you have no idea what they’re charging? The net result is most Americans understand that getting sick–thanks to a lack of insurance, or tremendous copayments–is a good way to end up bankrupt, without any real sense of how to pick a more efficient provider.

Something exciting has happened this week, possibly changing this dynamic: The Center for Medicare Services, for the first time, has published the list prices charged by hospitals around the country (to Medicare) for the top one hundred reasons patients end up in the hospital.

Let’s look at what hospitals are charging, and receiving, in the Seattle area. In each of these charts, the blue bars is the bill charged to Medicare by the hospital, the red the payment the hospital actually received from Medicare as well as all copayments or deductibles paid by the patient. You’ll note, like almost all insurers in the US, Medicare pays a significant discount from the billed cost. A patient without insurance can expect the full, undiscounted rate.

First up, the charge for a pneumonia admission:
Pneumonia

For a COPD (rotten lungs, usually after a lifetime of smoking) flare:
COPD

Coronary artery disease, requiring a stent (either a heart attack or a heart-attack-to-be):
CAD-DES

The overbilling is (in part) a negotiation tactic between the hospitals and the insurers–a way of amplifying the percentage discount to a prospective insurer while maintaining revenues. The side effect is to leave the uninsured or underinsured as road-kill–charged two or three times the total bill payed from an insured person.

If nothing else, the Affordable Care Act (i.g. Obamacare) will make this better by shifting a majority of people from the uninsured into the insured group–paying the discounted rate, with insurance picking up most of the total tab.

The Fukushima Disaster Mar 17th, 2011 | By | Category: Featured Articles, Lead Article, Nukes

Like many of you, I’ve been closely following the developments at the Fukushima reactor complex. Below is a set of links to articles I’ve written for the Stranger, as the events have unfolded.

3/12/2011
Explosion at Fukushima Nuclear Plant, Cesium Detected

3/14/2011
Don’t Panic

Geiger Counter Readings Rise in Tokyo

3/15/2011
What’s on Fire at the Fukushima Reactor?

Will Radioactive Particles from the Leaking Reactor Reach Washington State?

The Fukushima Fifty

3/16/2011
“We believe that radiation levels are extremely high” (A discussion of acute radiation injury)

3/17/2011
Video from a Helicopter Flyover of the Fukushima Plant

The Health Effects of Radioactive Isotopes from Fukushima

3/20/2011:
Radiation from Fukushima, in Seattle

3/24/2011:
How Radiation Is Measured

3/27/2011:
Radiation From Fukushima, in Seattle, Tells the Story

The Gold Standard: Inflation, Wealth and Economic Growth Oct 12th, 2010 | By | Category: Economics, Featured Articles, Lead Article

Conservative commentators have been riling up their audiences recently with lots of talk about America ‘devaluing our money’ and expressing the horrors that befell us after the United States left the Gold Standard in 1972. Beck, as always, provides the well-crafted prototype of this line of reasoning.

What’s going on here? Let’s talk macroeconomic theory!

Money, as an abstraction, represents a sliver of the total productive ability of the economy. So, the value of the $20 bill in your pocket is ultimately determined by the productive ability of the economy divided by the total amount of money available at the moment.

Let’s assume that the productive capacity of the United States is stable. If North Korea manufactured a million $20 bills and handed them out to people on the street, the value of your twenty dollar bill would decrease. The term for this–when the growth in the supply of money exceeds the growth in the productive capacity of the economy–is inflation. If you have a wallet thick with $20 bills (you have lots of savings), inflation is working against you. If you owe money, inflation is great. Paying off the same debt (in dollar terms) requires less productive effort.

Assuming again the intrinsic productive capability of the economy is stable, let’s think through what would happen if trillions of dollars were suddenly evaporated–say by a gigantic retail bank failure obliterating checking accounts. Now, the $20 in your pocket represents a larger share of the economic output. That’s deflation. The winners and losers are opposite from inflation. The more savings you have, the better deflation is for you. If you’re indebted, you’re doomed.

Borrowing and saving are both critical for the health of the economy. Inflation discourages saving, deflation strongly discourages borrowing. Therefore, keeping a stable relationship between the productive output of the economy and the total money supply in the economy is the goal.

Here’s the rub: The productive capability of the economy is constantly in flux, and affected by an astonishing multitude of factors: New technologies, the availability of resources, monopolization of supplier companies for other companies, the weather, the overall enthusiasm of entrepreneurs, the number of work-capable people, the amount of labor each person can produce, the number of new ideas worth investing in, the state of infrastructure and on and on and on. Observing this, objectively, is beyond a difficult task; predicting the future productive state of the economy is even more difficult.

The old way to deal with this problem was to ignore it. Under the gold standard, the amount of money is fixed to be equal to the amount of gold in reserve. You could, at any time, exchange your crumpled dollar bill for a fixed amount of shiny metal. Therefore, the growth in amount of money was determined by how fast this one metal could be mined and refined from the earth. You can’t eat gold. You can’t make a home out of gold. And gold clothing is just tacky. The gold production rate is a poor correlate for the growth of the overall economy. The result–particularly during periods of rapid technological advancement in areas beyond metallurgy–were repeated cycles of catastrophic crashes. When an advancement dramatically increased the productive capacity of the economy, the money supply stayed relatively fixed–resulting in sharp, rapid deflation. The deflation stopped borrowing, stopping investment in new endeavors, crashing the economy over and over again. It was a terrible system, whose success depended almost entirely upon luck and faith in divine providence. Of course, Beck loves it.

Instead, we now attempt to measure as well as we can the state of the economy, and forecast how fast it is growing, and then ‘print’ enough new money (or, in theory subtract enough money) so that the ratio of the two stays roughly the same. While not perfect, it’s the far more rational way of dealing with the problem–harnessing mathematics, economic theory and plain-old empiric data.

Assessing and predicting the current and future state of the dollar-based economy is the primary mission of the Federal Reserve. Based on these predictions, the Federal Reserve adds (and theoretically subtracts) from the total money supply–in an attempt to keep the ratio of productive capability to money stable. Hence, the Beckian feverish repetition of, “…. how much money we’re printing at the Federal Reserve.” They (the Fed) are ‘printing’ money to replace that lost by catastrophic (entirely abstract) investments and reflect growth in the productive capability of the nation.

In it’s arsenal–to accomplish this herculean task–the Fed collects data on almost every aspect of the economy. Among all this data is a calculation of the inflation rate of the economy. A basket of goods (representing a cross section of productive output of the economy) is priced out in dollar terms on a regular basis. The rate of change in the price for the collection of goods is used as a measure of the inflation rate. This measure is probably the best sign of how well the Fed has done their matching job. High inflation rates mean too much money supply, low rates of inflation (or negative rates, reflecting deflation) represent too little money is being ‘printed’. Since the economic crisis that started in 2008, the rate of increase in this measure has been historically low–despite the historically large increases in the money supply by the Fed. Based on this measure, the Federal Reserve hasn’t printed enough money, to replace that lost by bankers in their spreadsheets.

There are reasons to be concerned about run away printing of dollars by the Fed–but it’s worth noting that the Fed is a quite conservative organization. At a baseline, the Federal Reserve tends to err on the side of too little growth in the money supply–fitting with the catering to the needs of the wealthy before the needs of the working that dominates US leadership generally. For now, there is no reason underlying the hysteria of the right-wing commentators.

Take Your Generosity and Shove It, Buddy Sep 3rd, 2010 | By | Category: Lit Round-up

Who would you vote off the island: the selfish ass or the generous spirit? The selfish ass, right? Rational.

WSU scientist Craig Parks along with Asako Stone set out to figure out exactly how much loutish behavior a group will tolerate before throwing the selfish out. What they discovered is far more interesting:

…we also observed a completely unanticipated and, we argue, more interesting result: Those who give much to the group effort yet take little of its subsequent reward are not applauded but rather targeted for expulsion. The effect was replicated across three subsequent studies. Two of these studies ruled out some rather mundane explanations for the finding (lack of understanding of the task by the benevolent other, the other behaving unpredictably), and a third suggested that people are motivated to expel the benevolent other either for self-image reasons or because the other is not adhering to common rules of behavior. In this article, we report on this series of studies.

What the hell. The authors go on to attempt to explain why:

These data, then, provide potential explanations for why people want to remove a benevolent individual from the group. In some cases, the individual makes others feel they look bad in comparison, and, in other cases, the person is seen as violating rules of social interaction for mixed-motive situations. As we solicited these explanations after the expulsion preference had been stated, it is certainly possible that they represent not motivations for removing a benevolent other but rather rationalizations for why subjects want the benevolent person removed.

If you were looking for an empiric basis for the “Keep the government’s hands off my Medicare” red state, federal subsidy dependent elderly white teapartier, this is a good place to start.

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Ebola Thrives on Poverty and Disparity

Ebola–like many viruses, including the recently popular enterovirus 68–is spread by filth. Ebola thrives on poverty and disparity. Decency for the poorest is what makes a developed country a developed country: a place where one does not die from easily prevented diseases (among other things). Decency isn’t our long suit.

The American Health Care Market Just Became Less Opaque

How much a plate of spaghetti is going to cost you isn’t usually a mystery. Sure, the price can vary quite a bit–from a few cents if you’re making the plate yourself from groceries, to dozens of dollars at a fancy restaurant. You shouldn’t be too surprised by the bill at the end; the price […]

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Like many of you, I’ve been closely following the developments at the Fukushima reactor complex. Below is a set of links to articles I’ve written for the Stranger, as the events have unfolded. 3/12/2011 Explosion at Fukushima Nuclear Plant, Cesium Detected 3/14/2011 Don’t Panic Geiger Counter Readings Rise in Tokyo 3/15/2011 What’s on Fire at […]

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