Blocking health care key to GOP's survival

A great article via Tim Bray on USA health care politics.

Michael F. Cannon, a pundit at the libertarian Cato Institute, has written a blog post that highlights the importance of what I believe will be one of the most important issues in play once Barack Obama assumes the U.S. presidency. "Blocking Obama's health plan," he writes, is "key to the GOP's survival."

Note this was written in December, just after Obama's election. Very prescient, and it explains a lot.

Britain serves as an important political lesson for strategists. After the Labor Party established the National Health Service after World War II, supposedly conservative workers and low-income people under religious and other influences who tended to support the Conservatives were much more likely to vote for the Labor Party when health care, social welfare, education and pro-working class policies were enacted by labor-supported governments. ...

Whence Obesity?

I'd be interested in real invesigative research into the causes of obesity, but here are my suspicions: it's a combination of economics and modern life - but mostly economics.

Corporations selling food like money (it's a corporation's job to make money, as much as possible)

• The more people eat, the more food they buy
  
• Agribusinesses like this, it makes them money
  
• Agribusinesses encourage you to eat more (and fight tooth and nail any government policies intended to get people to eat less - read Marion Nestle for some shocking data on this).
  
• People who eat more get fat
  

Corporations selling food like high margins (make more money)

• Corn is subsidized by the government
  
• Thus corn is unnaturally cheap
  
• Thus you can make a lot of money selling things made with corn - high margins
  
• In particular, corn syrup - it's in everything. Particularly the cheap things.
  
• Poor people buy stuff with lots of corn syrup because its sweet and cheap
  
• Processed sugars, including corn syrup, makes you fat.
  

Maybe at some point the health care costs will change our policies, but I think agribusiness will be dragged into accepting this kicking and screaming. Health care costs are there, but they really don't affect their bottom line enough for them to want to change their behavior.

If I Were King, I would find a way to include the cost of disease based on overeating into the costs of foods, so there is a motivation by businesses not just to sell more food but also to keep people healthy. Also, we need to stop subsidizing large farmers and certain crops like corn. That's just incredibly counterproductive, and is based on very old rationales having to do with struggling family farmers, not agribusiness.

But I don't believe these kinds of changes can get very far as long as business runs government, because politicians need money. I would love to find a way for politicians to get their word out and get votes without the poisoning need for money. Solve that problem, and a whole slew of other problems solve themselves. I know it's not simple - even if the politicians themselves don't spend the money, "political action committees" and specially-funded "positioning ads" will do the job for them. I don't have good answer, but I do think this is a key problem.

P.S. At the Santa Cruz boardwalk they were selling (and people were in line for) deep-fried cheesecake and deep-fried Twinkies. OMG.

P.P.S. Just after I posted this I read Paul Krugman's editorial on health care:

We tend to think of the way things are now, with a huge army of lobbyists permanently camped in the corridors of power, with corporations prepared to unleash misleading ads and organize fake grass-roots protests against any legislation that threatens their bottom line, as the way it always was. But our corporate-cash-dominated system is a relatively recent creation, dating mainly from the late 1970s.

And now that this system exists, reform of any kind has become extremely difficult. That’s especially true for health care, where growing spending has made the vested interests far more powerful than they were in Nixon’s day. The health insurance industry, in particular, saw its premiums go from 1.5 percent of G.D.P. in 1970 to 5.5 percent in 2007, so that a once minor player has become a political behemoth, one that is currently spending $1.4 million a day lobbying Congress.

That spending fuels debates that otherwise seem incomprehensible. Why are “centrist” Democrats like Senator Kent Conrad of North Dakota so opposed to letting a public plan, in which Americans can buy their insurance directly from the government, compete with private insurers? Never mind their often incoherent arguments; what it comes down to is the money.

Things to See and Do In Berkeley

Chris Anderson from the CouchDB community just landed in Berkeley, astonishingly near my house.  I had a nice cuppa with him yesterday and realized there was a list of fun things to do, and particularly great eating places, in Berkeley.  So I sent him my list of the Best of the Best, and thought I'd post it here too:

Places to See

• I mentioned Tilden Park and Lake Anza.  There is also a working farm where you can visit and feed the animals, an old-fashioned merry-go-round, and a real working scale-size steam train you can ride on.  
• Walk in the North Berkeley Hills.  There's a book around that gives you a bunch of walks to take
• Fourth Street in West Berkeley, a street of nice (albeit pricey) shops and restaurants just N of University
• Solano Avenue, particularly at the Colusa intersection
• Rockridge shopping area at the Rockridge BART station - a nice place to stroll, browse stores, have a cuppa.  Lots of nice restaraunts.
  
• Ashby and College is also a very nice walking shopping area.
  
• The Bone Store on Solano.  Just check it out, it's weird and interesting :)
• Botanical Gardens up Strawberry Canyon behind the University
• Berkeley Rose Garden is a pretty stroll, but dog must be on leash I think
• Briones Park on the other side of the hill is a stunning set of rolling hills with trails, I think it's dog-friendly.
• Swimming at the El Cerrito Pool.  It's a salt water pool, affordable, they have hours for "fun" and for laps.  There's also King Pool right up Hopkins from Monterey.
• At some point you might want to stroll around Bay Street mall - an outdoor mall, much less offensive/oppressive than other malls.  They have an Apple Store! :)  And of course a big movieplex.

Restaurants:

• Lalime's on Gilman - really nice "night out" California Cuisine
• Rivoli on Solano - even nicer
• Cesar - a great tapas bar on Shattuck
• Cha Am on Shattuck - Thai food
• Cha Ya on Shattuck - veggie sushi
• Acme Bakery on Cedar and San Pablo - incredible, delicious fresh bread and pastries
• Cafe Fanny on Cedar and San Pablo - really good, pricey French cafe
• Vik's Chaat Cafe in West Berkeley (forget exact location) - excellent, cheap Indian "fast food".  Indians from all over the Bay Area know of this place and swear by it
• Ajanta on Solano for nice Indian
• A lot of people like Breads of India on Sacramento and Dwight.  I've never been there
• Picante Mexican - wow, *excellent* Mexican food, very affordable.  We go there all the time.  6th street south of Gilman.
• La Farine Bakery on Solano - chocolate croissants to die for
• Barney's Hamburgers on Solano - fun, delicious gourmet burgers, veggie available
• Jimmy Bean's on Gilman and 6th - excellent cafe, delicious sandwiches, fries, etc.
• Zachary's Pizza on Solano - you *must* try their stuffed spinach/mushroom pizza.  Bay Area award winner for years
• A lot of people like The Cheese Board pizza, I don't care for it
  
• Gioia Pizzeria on Monterey and Hopkins - New Yawk pizza by the slice with fresh California ingredients. The real deal.  Another regular haunt for our family.
• Loard's Ice cream in El Cerrito Plaza - not the best ambiance, but definitely the best (affordable) ice cream around
• If you want good, expensive gourmet ice cream, there's a little place on 4th street (thou must check out 4th street, a fun walkable set of stores, 4th N of University)
• Homemade Cafe on Dwight and Sacramento - nice breakfasts, although I haven't been there in a while
• Cafe Mediterranee at Ashby and College - excellent Greek/Mediterranean food
  

Groceries/Markets

• Wine store on Cedar and San Pablo - my wife swears by their help and selection
• Berkeley Natural on Gilman
• Monterey Market on Gilman and Hopkins - cheap, fresh, delicious, local produce
• Farmer's Market Saturday mornings in downtown Berkeley between MLK and Milvia.  There are others around town during the week.
• The Country Cheese Shop on Hopkins/Monterey.  While you're there, check out the fish market and the butcher (and of course Gioia Pizza and Monterey Market).  A real gem of a corner.

Enjoy!

What is "Erlang Style Concurrency"

In my spare time I continue to try to slowly educate myself about the new concurrent programming languages like Erlang and Scala.  I ran into this article by Ulf Wiger on What Is Erlang-Style Concurrency? which I thought was an excellent overview of what's there and why it's important.

I loved the bit about the value of process monitoring - the system itself takes care of watching processes and if one crashes restarts it.  Serious fault tolerance, embedded in the language runtime.  Cool.

SDD - Scenario Driven Design

The engineering leadership here at Symantec has a strong commitment to TDD - Test Driven Development.  I have been enjoying practicing this approach and experiencing its benefits.

Through this process I have also seen a similarity between TDD and an approach to design that I have applied, which I shall now moniker "Scenario-Based Design" or SDD.

One approach to design is to get a sense of the requirements from a functional spec, and then put together a design that looks like a good fit.  You come up with a set of initial abstractions and then go from there, using TDD to refactor as needed.

Although that approach works, you can commit yourself to a lot of rework if your initial design is off the mark.  You can still get to a good design, but it takes time, and who has time these days?

So I think it behooves to apply TDD principles to design. 

First of all, identify the scenarios you want to support.  Your functional spec should describe the scenarios as use cases.  Even if you're designing an API for a service rather than a user-visible feature, your functional spec should still describe use cases.

At the first draft, just write out all the use cases as one or two sentences, following the principle of "actor- initial condition - goal"  For example "A developer is using the IncidentManager and wants to find out how many incidents exist for a given resource" or "A system administrator has a system which is CPU bound and wants to find out which processes have the highest CPU usage."

Identify which higher-priority scenarios you think will have the biggest impact on design.  Normally this is fairly easy to determine.

Start with the first scenario, and come up with some abstractions that seem reasonable for that scenario.  You can do this with CRC cards or just on a whiteboard or a piece of paper.  Exercise the abstractions with the scenario, refine as needed.  You're looking for a high-level design, don't define the signature of each method; save that for your TDD.

Then go to the next scenario, and repeat.  Normally you'll find that you have to rejigger things a bit to address the new issue.

I recommend thinking about some of the more common error conditions, work through them too.

The value of this approach is similar to TDD - you design only what you need, and you do it based on real-world scenarios, not on your own concepts of what makes sense.  Personally it's quite fun to watch the design evolve on its own.  

This approach reminds me of stories of two great artists/designers in other fields.

When I was in Florence, I went to the museum that had the statue of Michelangelo's David, which is wonderful, but in the same building were a series of unfinished sculptures by Michelangelo.  It was immediately clear that the sculpture was "born" out of the stone - he wasn't forcing his own ideas onto the stone, but was letting the image evolve out of the nature of the stone itself .  When I read his biography later, my impressions were confirmed.  He says "Every block of stone has a statue inside it and it is the task of the sculptor to discover it."[1]

The other story (perhaps apocryphal) [2] is of a woman who was the architect for a huge college in England.  She had the entire campus built, but without any pathways.  When asked about this, she said, "wait until the first snow."  Then when the snow came, she took pictures of all the paths carved out in the snow by the students, and placed the pathways there.  Genius.


[1] http://www.brainyquote.com/quotes/quotes/m/michelange386296.html
[2] Steward Brand, How Buildings Learn

Lies, damn lies, and statistics - health care rescission

Great article by Taunter Media about the damn lies behind the quote from insurance exec Don Hamm that "Rescission is rare. It affects less than one-half of one percent of people we cover. Yet, it is one of many protections supporting the affordability and viability of individual health insurance in the United States under our current system."

When you really do the math, it's clear that that small percentage is actually a very very large percentage of people who have expensive illnesses.  Here's Taunter telling us the disturbing facts around this number:

If the top 5% is the absolute largest population for whom rescission would make sense, the probability of having your policy cancelled given that you have filed a claim is fully 10% (0.5% rescission/5.0% of the population). If you take the LA Times estimate that $300mm was saved by abrogating 20,000 policies in California ($15,000/policy), you are somewhere in the 15% zone, depending on the convexity of the top section of population. If, as I suspect, rescission is targeted toward the truly bankrupting cases – the top 1%, the folks with over $35,000 of annual claims who could never be profitable for the carrier – then the probability of having your policy torn up given a massively expensive condition is pushing 50%. One in two. You have three times better odds playing Russian Roulette.

If we suspect that the insurance industry targets rescission against those people who have expensive illnesses, then it's not an accident, it's very intentional, and basically tells you that you get to have insurance only until and when you really need it, then you're on your own. So we Mr. Hamm says health insurance is affordable, I can only assume he means for his company, not for those who are seriously sick.

But hey, let's let the free market decide who should be covered and how.  The government is only going to get in the way - of making money, that is...