Tag Archives: health care

2017 in Review

Most frightening stories of 2017:

  • January: The U.S. government may be “planning to roll back or dilute many of the provisions of Dodd-Frank, particularly those that protect consumers from toxic financial products and those that impose restrictions on banks”.
  • February: The Doomsday Clock was moved to 2.5 minutes to midnight. The worst it has ever been was 2 minutes to midnight in the early 1980s. In related news, the idea of a U.S.-China war is looking a bit more plausible. The U.S. military may be considering sending ground troops to Syria.
  • MarchLa Paz, Bolivia, is in a serious crisis caused by loss of its glacier-fed water supply. At the same time we are losing glaciers and snowpack in important food-growing regions, the global groundwater situation is also looking bleak. And for those of us trying to do our little part for water conservation, investing in a residential graywater system can take around 15 years to break even at current costs and water rates.
  • April: The U.S. health care market is screwed up seemingly beyond repair. Why can’t we have nice things? Oh right, because our politicians represent big business, not voters. Also, we have forgotten the difference between a dialog and an argument.
  • May: We hit 410 ppm at Mauna Loa.
  • JuneThe Onion shared this uncharacteristically unfunny observation: “MYTH: There is nothing mankind can do to prevent climate change. FACT: There is nothing mankind will do to prevent climate change”. It’s not funny because it’s probably true.
  • July: Long term food security in Asia could be a problem.
  • August: The U.S. construction industry has had negligible productivity gains in the past 40 years.
  • September: During the Vietnam War the United States dropped approximately twice as many tons of bombs in Southeast Asia as the Allied forces combined used against both Germany and Japan in World War II. After the Cold War finally ended, Mikhail Gorbachev made some good suggestions for how to achieve a lasting peace. They were ignored. We may be witnessing the decline of the American Empire as a result.
  • October: It is possible that a catastrophic loss of insects is occurring and that it may lead to ecological collapse. Also, there is new evidence that pollution is harming human health and even the global economy more than previously thought.
  • November: I thought about war and peace in November. Well, mostly war. War is frightening. The United States of America appears to be flailing about militarily all over the world guided by no foreign policy. Big wars of the past have sometimes been started by overconfident leaders thinking they could get a quick military victory, only to find themselves bogged down in something much larger and more intractable than they imagined. But enemies are good to have – the Nazis understood that a scared population will believe what you tell them.
  • December: A lot of people would probably agree that the United States government is becoming increasingly dysfunctional, but I don’t think many would question the long-term stability of our form of government itself. Maybe we should start to do that. The Consumer Financial Protection Bureau has been doing a decent job of protecting consumers and reducing the risk of another financial crisis. The person in charge of it now was put there specifically to ruin it. Something similar may be about to happen at the Census Bureau. A U.S. Constitutional Convention is actually a possibility, and might threaten the stability of the nation.

Most hopeful stories of 2017:

Most interesting stories that weren’t particularly frightening or hopeful, or perhaps were a mixture of both:

  • January: Apple, Google, and Facebook may destroy the telecom industry.
  • February: The idea of growing human organs inside a pig, or even a viable human-pig hybrid, is getting very closeTiny brains can also be grown on a microchip. Bringing back extinct animals is also getting very close.
  • March: Bill Gates has proposed a “robot tax”. The basic idea is that if and when automation starts to increase productivity, you could tax the increase in profits and use the money to help any workers displaced by the automation. In related somewhat boring economic news, there are a variety of theories as to why a raise in the minimum wage does not appear to cause unemployment as classical economic theory would predict.
  • April: I finished reading Rainbow’s End, a fantastic Vernor Vinge novel about augmented reality in the near future, among other things.
  • May: The sex robots are here.
  • June: “Fleur de lawn” is a mix of perennial rye, hard fescue, micro clover, yarrow, Achillea millefolium, sweet alyssum, Lobularia maritima, baby blue eyes, Nemophila menziesi, English daisy, Bellis perennis, and O’Connor’s strawberry clover, Trifolium fragiferum.
  • July: Ecologists have some new ideas for measuring resilience of ecosystems. Technologists have some wild ideas to have robots directly counteract the effects of humans on ecosystems. I like ideas – how do I get a (well-compensated) job where I can just sit around and think up ideas?
  • August: Elon Musk has thrown his energy into deep tunneling technology.
  • September: I learned that the OECD Science, Technology and Innovation Outlook named “ten key emerging technology trends”: The Internet of Things, Big data analytics, Artificial intelligence, Neurotechnologies, Nano/microsatellites, Nanomaterials, Additive manufacturing / 3D printing, Advanced energy storage technologies, Synthetic biology, Blockchain
  • October: Even if autonomous trucks are not ready for tricky urban situations, they could be autonomous on the highway with a small number of remote-control drivers guiding a large number of tricks through tricky urban maneuvers, not unlike the way ports or trainyards are run now. There is also new thinking on how to transition highways gradually through a mix of human and computer-controlled vehicles, and eventually to full computer control. New research shows that even a small number of autonomous vehicles mixed in with human drivers will be safer for everyone. While some reports predict autonomous taxis will be available in the 2020s, Google says that number is more like 2017.
  • November: It’s possible that the kind of ideal planned economy envisioned by early Soviet economists (which never came to pass) could be realized with the computing power and algorithms just beginning to be available now.
  • DecemberMicrosoft is trying to one-up Google Scholar, which is good for researchers. More computing firepower is being focused on making sense of all the scientific papers out there.

I’ll keep this on the short side. Here are a few trends I see:

Risk of War. I think I said about a year ago that if we could through the next four years without a world war or nuclear detonation, we will be doing well. Well, one year down and three to go. That’s the bright side. The dark side is that it is time to acknowledge there is a regional war going on in the Middle East. It could escalate, it could go nuclear, and it could result in military confrontation between the United States and Russia. Likewise, the situation in North Korea could turn into a regional conflict, could go nuclear, and could lead to military confrontation between the United States and China.

Decline…and Fall? A question on my mind is whether the United States is a nation in decline, and I think the surprisingly obvious answer is yes. The more important question is whether it is a temporary dip, or the beginning of a decline and fall.

Risk of Financial Crisis. The risk of another serious financial crisis is even scarier that war in some ways, at least a limited, non-nuclear war. Surprisingly, the economic effects can be more severe, more widespread and longer lasting. We are seeing the continued weakening of regulations attempting to limit systemic risk-taking for short-term gain. Without a pickup in long-term productivity growth and with the demographic and ecological headwinds that we face, another crisis equal to or worse than the 2007 one could be the one that we don’t recover from.

Ecological Collapse? The story about vanishing insects was eye-opening to me. Could global ecosystems go into a freefall? Could populous regions of the world face a catastrophic food shortage? It is hard to imagine these things coming to a head in the near term, but the world needs to take these risks seriously since the consequences would be so great.

Technology. With everything else going on, technology just marches forward, of course. One technology I find particularly interesting is new approaches to research that mine and attempt to synthesize large bodies of scientific research.

Can the human species implement good ideas? Solutions exist. I would love to end on a positive note, but at the moment I find myself questioning whether our particular species of hairless ape can implement them.

But – how’s this for ending on a positive note – like I said at the beginning, the one thing about 2017 that definitely didn’t suck was that we didn’t get blown up!

December 2017 in Review

Most frightening stories:

  • The U.S. has lost ground relative to its peers on road deaths, and is now well below average. I noted that something similar has happened with respect to health care costs, life expectancy, infant mortality, education, drug addiction and infrastructure. Maybe a realistic goal would be to make America average again.
  • A lot of people would probably agree that the United States government is becoming increasingly dysfunctional, but I don’t think many would question the long-term stability of our form of government itself. Maybe we should start to do that. The Consumer Financial Protection Bureau has been doing a decent job of protecting consumers and reducing the risk of another financial crisis. The person in charge of it now was put there specifically to ruin it. Something similar may be about to happen at the Census Bureau. A U.S. Constitutional Convention is actually a possibility, and might threaten the stability of the nation.
  • Daniel Ellsberg says we are very, very lucky to have avoided nuclear war so far. There are some tepid ideas for trimming the U.S. nuclear arsenal, and yet it is being upgraded and expanded as we speak. The North Korea situation is not getting better. Trump may be playing to religious fundamentalists who actually are looking forward to the Apocalypse.

Most hopeful stories:

  • Exercise may be even better for your brain than it is for your body, and exercising your body may be even better for your brain than exercising your brain itself.
  • Macroeconomic modeling is improving. So, just to pick a random example, it might be possible to predict the effects on a change in tax policy on the economy. Now all we need is politicians who are responsive to logic and evidence, and we could accomplish something. At least a few economists think the imperfect tax plan the U.S. Congress just passed might actually stimulate business capital investment enough to move the dial on productivity. The deliberate defunding of health care included in the bill is going to hurt people, but maybe not all that dramatically.
  • Moody’s introduced a new methodology for assessing climate risk in municipal bonds.

Most interesting stories, that were not particularly frightening or hopeful, or perhaps were a mixture of both:

  • There are life forms surviving in space right now, most likely of Earth origin. I wondered if maybe we should purposely contaminate other planets with them.
  • Microsoft is trying to one-up Google Scholar, which is good for researchers. More computing firepower is being focused on making sense of all the scientific papers out there.
  • Futuristic technologies keep coming along. Something vaguely like the “liquid metal” from Terminator 2 is being used for experimental aircraft parts. Vital signs might be monitored soon using a simple RFID device. A tiny electric shock of just the right size to just the right part of your brain might cure you of bad habits. And Magic Leap may finally release…something or other…in 2018.

the tax plan and the mandate

I assumed that the end of the “individual mandate” would seriously undermine funding for Obamacare, and in fact that is exactly what Trump is claiming. But Politifact says we all have that wrong. In fact, those penalties cover only about 3% of the cost of the Affordable Care Act. The main point of the penalty was always a psychological incentive for people to go to the exchanges and find out if they qualified for free or subsidized insurance. People wanted to avoid that penalty even if avoiding it meant they pay more for insurance than they would have paid for the penalty. Not only that, but people who qualify for Medicaid, which is free, have been more likely to find out they qualify for Medicaid because they go to the exchanges after wrongly thinking they are subject to the penalty. So it was somewhat of a psychological trick all along rather than a serious funding mechanism. This doesn’t mean that removing it will have only a 3% affect on premiums for the subsidized private plans – the effect may work in reverse, with more people never going to the exchanges and some not realizing they qualify for free Medicaid benefits. The CBO guesstimate is a 10% increase in premiums as a result of this effect. It’s still going to hurt the working class who need health insurance the most and it’s still immoral. The really immoral part is that as U.S. health care costs continue to spiral out of control in both the public and private sectors, our immoral dishonest politicians are going to point to Obamacare as the cause, and our uninformed citizens are going to believe them.

U.S. life expectancy down again

The U.S. Centers for Disease Control has released statistics on life expectancy and causes of death for 2016. Some interesting findings:

  • Overall average life expectancy fell by 0.1 year, from 78.7 to 78.6 years.
  • The average masks the finding that for women, life expectancy held steady at 81.1 years while for men, it decreased by 0.2 years from 76.3 to 76.1 years.
  • Deaths from disease were down in almost every category. The increases come from “unintentional injury” and suicide. Unintentional injury sounds like car accidents and falling off a ladder, and it does include those things. But dig a little bit and it includes “poisoning”, and poisoning in turn includes drug overdose.

The Guardian explains that life expectancy has fallen two years in a row and how unusual that is:

Drug overdoses killed 63,600 Americans in 2016, an increase of 21% over the previous year, researchers at the National Center for Health Statistics found.

Americans can now expect to live 78.6 years, a decrease of 0.1 years. The US last experienced two years’ decline in a row in 1963, during the height of the tobacco epidemic and amid a wave of flu.

“We do occasionally see a one-year dip, even that doesn’t happen that often, but two years in a row is quite striking,” said Robert Anderson, chief of the mortality statistics branch with the National Center for Health Statistics. “And the key driver of that is the increase in drug overdose mortality.”

The article goes on to explain that the last time we saw three years of decline was during the Spanish flu epidemic 100 years ago.

Comparing any two years could easily be a statistical blip, as any climate science denier could tell you. But it seems clear that over time the U.S. is losing ground to its peers in the developed world. The solution our elected politicians have identified, of course, is to take away health care and mental health coverage from the working class.

RFID vital signs monitoring

Heart rate, blood pressure, respiration and breathing can now be monitored remotely using a simple RFID chip.

Monitoring the heart rate, blood pressure, respiration rate and breath effort of a patient is critical to managing their care, but current approaches are limited in terms of sensing capabilities and sampling rates. The measurement process can also be uncomfortable due to the need for direct skin contact, which can disrupt the circadian rhythm and restrict the motion of the patient. Here we show that the external and internal mechanical motion of a person can be directly modulated onto multiplexed radiofrequency signals integrated with unique digital identification using near-field coherent sensing. The approach, which does not require direct skin contact, offers two possible implementations: passive and active radiofrequency identification tags. To minimize deployment and maintenance cost, passive tags can be integrated into garments at the chest and wrist areas, where the two multiplexed far-field backscattering waveforms are collected at the reader to retrieve the heart rate, blood pressure, respiration rate and breath effort. To maximize reading range and immunity to multipath interference caused by indoor occupant motion, active tags could be placed in the front pocket and in the wrist cuff to measure the antenna reflection due to near-field coherent sensing and then the vital signals sampled and transmitted entirely in digital format. Our system is capable of monitoring multiple people simultaneously and could lead to the cost-effective automation of vital sign monitoring in care facilities.

Sounds good, as long as they don’t make us wear these walking through airport security. But come to think of it, that could definitely happen.

Mr. Money Mustache on medical tourism

Mr. Money Mustache discusses medical insurance in general in this post. His first suggestion is to consider going without. I suppose it could be rational for a young person with no assets to take this gamble, especially if they can minimize time spent in and around motor vehicles. Beyond that, yes, retiring abroad or medical tourism are both options. I used to get an annual checkup in Singapore for $69. And in an experience I would not wish on anyone else, I had a child hospitalized in Thailand for 8 days including 2 in intensive care. The total bill was $2500 including take-home medication, probably a tenth the U.S. cost. I had to pay up front but my U.S. insurance is more than happy to pay me back. Of course, you don’t want to get a plane when you are desperately ill, but you could easily combine routine checkups and dental cleanings with travel you are planning anyway.

When Your Shitty Health Insurance Doubles in Price

 

September 2017 in Review

Most frightening stories:

  • Fueled by supercharged sea temperatures, the 2017 hurricane season was a terrible, terrible season for hurricanes devastating coastal regions of the United States. One reason is that these storms not only were powerful and hit densely populated areas, but they set records for rapid intensification. Beyond all the human suffering, one thing I find disturbing is that I feel desensitized at this point when I think back to how I felt after Hurricane Katrina. The first major city destroyed is a shock, but later you get numb to it if you are not actually there. Then finally, a remote island territory is all but wiped out in what should be shocking fashion, and the public and government response is decidedly muted. This is what the age of climate change and weapons proliferation might be like, a long, slow process of shifting baselines where the unthinkable becomes thinkable over time.
  • In a story that U.S. media didn’t seem to pick up, China seemed to make a statement in its  official state-run media that it would defend North Korea in case of an unprovoked attack by the U.S. and its allies. John Bolton  and Lindsey Graham made comments suggesting they think any number of Korean dead would be a price worth paying for an unprovoked U.S. attack. The Trump administration is openly using Nazi propaganda.
  • During the Vietnam War the United States dropped approximately twice as many tons of bombs in Southeast Asia as the Allied forces combined used against both Germany and Japan in World War II. After the Cold War finally ended, Mikhail Gorbachev made some good suggestions for how to achieve a lasting peace. They were ignored. We may be witnessing the decline of the American Empire as a result.

Most hopeful stories:

  • It’s possible that a universal basic income could save the U.S. government money by replacing less efficient assistance programs.
  • There are also workable proposals for a U.S. single-payer health insurance program, although this one would somewhat obviously mean the government spending more money, which it would have to collect in taxes. People would come out ahead financially if the taxes were less than the premiums they are paying now, which doesn’t seem that hard, but of course this is politically tough given the incredibly effective propaganda the finance industry has used to kill the idea for the last 50 years.
  • Utility-scale solar energy cost dropped 30% in one year.

Most interesting stories, that were not particularly frightening or hopeful, or perhaps were a mixture of both:

  • The FDA has approved formal trials of Ecstasy to treat post-traumatic stress disorder.
  • I learned that the OECD Science, Technology and Innovation Outlook named “ten key emerging technology trends”: The Internet of Things, Big data analytics, Artificial intelligence, Neurotechnologies, Nano/microsatellites, Nanomaterials, Additive manufacturing / 3D printing, Advanced energy storage technologies, Synthetic biology, Blockchain
  • In automation news, Tesla is testing automated truck platoons. And there’s a site that will try to predict whether robots will take your job.

the Sanders single payer plan

Bernie Sanders, Elizabeth Warren, and others have introduced a “Medicare for All” bill. Introducing a bill doesn’t mean it will become law any time soon, but it may be a good sign that something seen as politically unviable in the past is now at least being seriously discussed by mainstream politicians.

The universal Medicare proposal released this week extends health insurance coverage to every single American free of copays, premiums, and deductibles — and has long been viewed as a direct threat to highly profitable health-related industries and providers.

The bill calls for gradually expanding Medicare coverage, starting with the young and phasing in other segments of the population. The plan would cover all essential services, including routine doctor visits, emergency room care, mental health, dental, outpatient care, and forms of treatment.

Sanders’s office also released a statement this week laying out various financing methods for the bill, including an employer tax, closing tax loopholes, and a variety of progressive income-based taxes.

Taxes are unpopular of course, but we have to remember that workers and employers are all paying enormous health insurance premiums, much of which either gets eaten up by the enormous inefficiencies of the health care industrial complex, or goes into the pockets of insurance and drug companies as profits.

FDA has approved trials of Ecstasy to treat post-traumatic stress disorder

This is according to Science:

In people with PTSD, a small sensory trigger such as a sound or a smell can bring a traumatic memory rushing back. “The disabling element of PTSD is the fact that when the memory starts, the emotions completely override you and overwhelm the brain,” Nutt says. Studies suggest that MDMA can dampen the emotional response to the memory, allowing people to relive their trauma and work through it, he says. The MDMA-treatment consists of several sessions of psychotherapy, some conducted while the patient is under the influence of the drug…

A small U.S. study that first suggested MDMA could help treat PTSD was published in 2011. Since then, researchers in Canada, Israel, and the United States have jointly carried out larger phase II trials funded by MAPS; their results, which remain unpublished but have been reviewed by the FDA, were very good, says Doblin. Overall, 107 participants who had suffered from PTSD for an average of 17.8 years were treated in the phase II trials, Doblin says. Of the 90 patients who were available to be studied 12 months later, 61 no longer had PTSD.

In late July, says Doblin, MAPS and FDA agreed on how the coming phase III trials—usually the last hurdle before seeking a drug’s approval from regulators—should be conducted.

July 2017 in Review

Most frightening stories:

Most hopeful stories:

  • A new cancer treatment genetically modifies a patient’s own immune system to attack cancer cells.
  • Shareholders of big fossil fuel companies are starting to force some action on climate change business risk disclosure.
  • Richard Florida offers five ideas for solving poverty and what is wrong with cities: taxing land based on its improved value, massive investment in public transportation and public education, ending the mortgage interest tax deduction, and guaranteed minimum income.

Most interesting stories, that were not particularly frightening or hopeful, or perhaps were a mixture of both:

  • Technology is marching on, whether or not the economy and human species are. The new thing with satellites is to have lots of small, cheap ones instead of a few big, expensive ones. Even if the coal industry were to make a comeback, today’s coal jobs are going to data analysts, remote control machine operators, mechanical and electrical engineers, not guys underground with pickaxes and headlamps. But the coal can be produced with a lot less human effort (i.e. jobs) than it used to be. Iris scans like in Minority Report are now a thing.
  • Ecologists have some new ideas for measuring resilience of ecosystems. Technologists have some wild ideas to have robots directly counteract the effects of humans on ecosystems. I like ideas – how do I get a (well-compensated) job where I can just sit around and think up ideas?
  • Isaac Asimov says truly creative people (1) are weird and (2) generally work alone.

Some combination of the Trump news, the things I see every day on the streets of Philadelphia, and events affecting friends and family led me to question this month whether the United States is really a society in decline. Actually, I don’t question that, I think the answer is yes. But the more important question is whether it is a temporary or permanent decline, and what it means for the rest of the globe. I am leaning slightly toward permanent, but maybe I will feel better next month, we’ll see. Maybe I need to get out of this country for a little while. Last time I did that I felt that the social glue holding Americans together is actually pretty strong compared to most other places, even if our government and its approach to other governments have become largely dysfunctional. We need to get through the next couple years without a nuclear detonation, hope the current vacuum of leadership leads some quality leaders to emerge, and hope things have nowhere to go but up. There, I talked myself off the ledge!