Cliff Mass (meterologist, and a smart man with a consistently different take on global warming issues), makes an interesting point in a recent post: By focusing on global warming as a moral issue (and from his perspective, using scare tactics about the weather to promote concern) environmental activists are failing to convince the public to make needed changes now. Instead, we should talk about sustainability–switching the conversation to how to adapt to climate change and preserve out lifestyle better, less destructive, technologies.

Cliff Mass’s prescription?

1. Since substantial global warming is certain, we must prepare society for inevitable changes. That means adaptation and making society more resilient. For Washington State, the probably means more storage of water during the spring, since snowpack will be less. Getting folks away from rivers that will flood more often. Fixing the damaged forests of eastern Washington.

2. Global warming is a technological problem and technology is our only hope. New energy sources, better energy storage, ways to remove CO2 from the atmosphere, safe nuclear and new energy technologies that we can’t imagine today. But developing these technologies will require substantial investments for research and development on a much larger scale than occurring today….

3. Society should use cost effective energy-saving and renewable technologies that are cost effective today, like more efficient appliances, high-mileage and electric cars, smart devices, and better insulation in buildings, better mass transportation, and others. They may not solve the problem, but they will help.

4. Environmentalists have hurt themselves by being fixated on global warming. They, and their political allies, should broaden their view to think about sustainability.

Cliff Mass is worth reading on climate change matters. He in no way is a global-warming denialists. But he is skeptical, in a scientific manner, to claims made by environmentalists, science writers, and politicians. Overall, the net result adds credibility to the reality of our present: we’re due for serious trouble from global warming, and unlikely to do much to avoid it. As Cliff noted:

Few people have thought more about how societies deal with existential threats than Professor Jared Diamond of UCLA, the author of Collapse and Guns, Germs and Steel. Last year, after giving a lecture at the University of Washington, I asked him:

“Can you think of a single example when a society took economically costly and disruptive steps to avoid a future problem that had not been previously experienced?”

He could not. Musing, I can offer one example: Joseph’s warning to Pharaoh above 7 drought years.

I can think of one example, in our own society, that might be a model of where to go from here: Our response to discovering chlorofluorocarbons (CFCs) destroy the ozone layer of our atmosphere. It was a new problem, borne out of relatively new technologies (aerosol cans and refrigeration) people loved, involving damage to a relatively abstract thing (a particularly layer of the high atmosphere), with long-term concequences but relatively few immediate concequences to those in areas with the most emissions. A proper response to the problem required the worldwide banning of the use of CFCs. In many ways the challenge of CFCs is quite similar (and in fact intertwined with) the problem we face with carbon emissions. Surprisingly, we’ve been modestly successful at this challenge.

How have environmentalists been more successful saving the ozone layer than combating global warming?

Viable alternatives were available, in part because of direct scientific work by environmental NGOs. Greenpeace funded development of replacements for CFCs, Hydrofluorocarbons or HFCs. Your car’s AC probably uses HFCs rather than CFCs. Despite aggressive propaganda, even domestic refrigerators are slowly transitioning over as well. The response by key environmental groups to ozone depletion was a sustainability focused one. In addition to education, a sustainable alternative was researched, vetted, and promoted.

With the revelation that Exxon knew about climate change since the late seventies, we know that such a response is unlikely to come from the industry heavyweights. Much like the railroad companies thinking of themselves as rail not transportation companies, energy-industry heavyweights think of themselves as fossil-fuel companies, not energy companies–and devote their significant resources to propaganda to prop up their fatally flawed product, not R&D into sustainable energy (despite having all of the needed basic scientific knowledge about solar, wind, and nuclear power to be successful). It’s an opportunity.

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.

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:

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

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

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.

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

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.