the goal of social distancing

Vox has an informative article with some visuals on the goal of social distancing in an epidemic. If you can reduce the total number of infections that is a bonus, but the primary goal is to reduce the peak number of infections happening at any one time. You can do this by delaying cases and spreading them out of time, so that the capacity of the health care system is better able to deal with them. This looks very similar to a stormwater or flood control engineer – often, our goal is also to reduce and delay the peak. Reducing the volume is a bonus if you can manage it. The lesson is not that epidemics are like hydrology, it’s that there are certain fundamental system structures that lead to fundamental behaviors, and they are shared between systems. A couple more that come to mind along the lines of this basic model are congestion pricing to spread traffic out over time, and batteries to store solar and wind energy and trickle them back over time.

February 2020 in Review

Ah, the innocent days of February 2020! (I’m writing this on March 14.) Just two weeks ago, the coronovirus shit hadn’t yet hit the fan in the U.S. (the Pennsylvania governor just ordered schools closed statewide, I have been strongly encouraged, though not coerced, to work from home, the governor has implemented not-strictly-enforced movement restrictions in several neighboring counties and mine could be next, and the closure of all businesses except grocery stores, drug stores and gas stations appears to be next – and yes, this appears to include bars and liquor stores. Luckily, Pennsylvania just recently lifted Prohibition and started allowing some grocery stores to sell beer and wine.) Anyway, coronavirus is about the only thing on anyone’s mind at the moment, even considering we are in an election year (Bernie Sanders looked like a front-runner two weeks ago!) But let’s rewind the clock two weeks and see what was on my mind in more normal times.

Most frightening and/or depressing story:

Most hopeful story:

Most interesting story, that was not particularly frightening or hopeful, or perhaps was a mixture of both:

  • Corporate jargon really is funny. I still don’t know what “dropping a pin” in something means, but I think it might be like sticking a fork in it.



another indicator that the U.S. is falling behind

The Atlantic has an article on just how badly the United States has dropped the ball on testing people for the novel coronavirus compared to other developed countries. We can add this to list along with overall life expectancy, child and maternal mortality, mass incarceration, depression, suicide, drug overdoses, blackouts, traffic delays, educational outcomes, drinking water quality, poverty, and the list goes on. We were great once, in the sense that we were the world’s leader on most or all of these categories. Over the last decade or two, we have not just lost that leadership position, we have fallen to the bottom of the pack and continue to lose ground. True patriots don’t just say their country is great again and hope that makes it true in the face of contrary evidence, they face the facts and do something about it.

the Flynn effect and the reverse Flynn effect

When IQ tests are taken by each generation, they are always normalized so that the average is a score of 100. However, when people are asked to take tests from older generations, they tend to do better than the older generations did. This is the Flynn effect. It was very consistent throughout the second half of the 20th century and into the 21st, but a number of studies in Scandinavia indicate that it may have reversed more recently. Immigration is one controversial explanation that has been suggested, whether due to genetic or cultural reasons. But the study I link to here tested the effect within families against the effect across unrelated people, and found that it is just as strong within families. This suggests environmental factors such as education and nutrition as the culprits, although the article does still put “migration” in this category. I suppose if you had a society with a high quality of nutrition and education, and you then have an influx of new people with more bad habits (let’s say, a high rate of smoking), that could have an effect.

private equity and surprise medical billing

This article from Center for Economic and Policy Research (I admit I don’t know much about this organization) claims that private equity firms have bought up medical practices and intentionally insert out-of-network doctors into teams treating you at your in-network hospital. Members of Congress have introduced legislation to curb this, but the financial lobby has been too powerful to beat.

Private equity-owned physician staffing firms grow by buying up many small specialty practices and “rolling them up” into umbrella organizations that serve health care systems across the United States. KKR-owned Envision Healthcare with 69,300 employees, and Blackstone-owned TeamHealth with 20,000 employees, dominate the market for outsourced doctors’ practices. A team of Yale University health economists examined what happened when private equity-owned companies EmCare (part of Envision Healthcare) and TeamHealth took over hospital emergency departments.5 They found that when EmCare took over the management of emergency departments, it nearly doubled its charges for caring for patients compared to the charges billed by previous physician groups. The researchers also found that TeamHealth took a somewhat different tack. It used the threat of sending high out-of-network surprise bills for ER doctors’ services to an insurance company’s covered patients in order to gain high fees from insurance companies as in-network doctors.6 This avoids the situation where a patient gets stuck with a large, surprise medical bill, but it raises premium costs for everyone. In both cases, healthcare costs increase when outsourced emergency rooms and other physician services are owned by private equity firms.

My take: Campaign finance reform and Medicare for All, baby!

what happens in Vegas doesn’t stay in Vegas

Axios has some interesting stats comparing the demographics of Nevada today to the projected future of the U.S. as a whole.

  • The U.S. is on track to become minority white by 2045. Nevada is one of just 4 states that are already there.
  • Hispanic people are expected to make up 25% of the American population by 2045. They’re 29% of Nevada’s population today.
  • Immigration will likely be the backbone of the U.S.’ future population growth, and will likely hit record levels by 2045. Today, immigrants’ share of the Nevada population is the 5th largest of any state.
  • The vast majority of Nevadans live in urban areas, just as 89% of Americans are projected to by 2050, according to UN data.
  • At 10% of the population, Nevada’s black voting bloc is also significant. The U.S. will be 13% black in 2045.

coronavirus 2020!

I try not to write a lot about fast-moving current events because anything I write will be instantly outdated (I’m writing this on the morning of March 1, 2020). But here are a few thoughts I have and things I am reading on the subject.

First, I plan to pay attention and do whatever the health authorities suggest I do. “Health authorities” means the CDC, my state health department, and my county health department. These sources aren’t infallible. Already, it appears the CDC could have used a test from the World Health Organization to monitor for the virus here, but they thought they knew better, dropped the ball completely, and there has been no monitoring. That means it could already be spreading undetected and the chance to contain it to just a few people could be lost. There is also concern about budget cuts to pandemic preparedness and public health in general by the Trump administration, and interference by political appointees and industry lobbyists. Despite all this, “the authorities” have the most expertise and are the most reliable source of information available. I have added these three sources (the CDC, my state and county health departments) to my Twitter feed. (I almost never use Twitter, but I do find it useful in a fast-moving situation like a snowstorm or oil refinery or power plant disaster – the first of which, there have been zero this winter and the second and third of which, there have been two, quite recently and quite close to my house.)

I have a decent backlog of food in my house and am trying to add a little extra. If “the authorities” tell me to keep my children home from school or myself home from work, I plan to do it. If they don’t I don’t plan to. I just hope the people who keep the water, power, gas, and communication systems running continue to go to work. An extended quarantine could be different from a fire, flood, or hurricane in this way, but of course it would be much longer. The CDC has not given any guidance on cabin fever, which can be an extraordinarily debilitating illness among children and their caregivers in confined spaces.

I wondered what powers the federal, state, and local authorities actually have and what the break down is between them. This Bloomberg article talks about that a little.

That’s in part because the president clearly has the power to declare a national health emergency and start ordering quarantines. This power comes from Congress, and is conferred on the president by the Robert T. Stafford Disaster Relief and Emergency Assistance Act. As the name suggests, this is the same law that lets the president declare disaster relief emergencies. President Donald Trump invoked this power in late January, when he declared a public health emergency and ordered the quarantine of Americans returning from areas of China where Covid-19 had already spread. Quarantines can also be authorized by the surgeon general, who is specifically given that power by federal law.

Bloomberg

The article says that local jurisdictions pretty much have to do what their state authorities tell them to do. The CDC can’t actually commandeer state officials, but that states can choose to place their officials under CDC direction, and they most likely would. So effectively, there really is a chain of command from top to bottom.

By definition, a quarantine limits the freedom of movement of people who are completely innocent of any wrongdoing to serve the overall good of avoiding more infections. Supreme Court doctrine directs that essentially all our individual liberties can be suspended if the government has a compelling interest to do so and if its measures are narrowly tailored to achieving that end. Slowing a pandemic is a textbook example of a compelling state interest; and quarantine is presumably the narrowest available method to do so in the middle of an outbreak.

Local police would seem to have the authority to enforce a quarantine, but how strictly they might do that and whether citizens would be able to challenge that on legal grounds has not been fully tested. I note that during “mandatory” hurricane evacuations, local police departments generally don’t drag people out of their homes against their will. Of course, in that situation they are just putting themselves and their families at risk, not others. If someone was walking down a busy street wearing a suicide vest, of course the police would shoot that person because they are a danger to others.