Later On

A blog written for those whose interests more or less match mine.

Archive for December 9th, 2013

Meme-strength puts Jesus as number 1

leave a comment »

It sort of surprises me that the Buddha didn’t make the top 10:

1. Jesus
2. Napoleon
3. William Shakespeare
4. Muhammad
5. Abraham Lincoln
6. George Washington
7. Adolf Hitler
8. Aristotle
9. Alexander the Great
10. Thomas Jefferson

What’s being ranked, ostensibly, is “significance,” as measured by…  well, read the article.

Written by LeisureGuy

9 December 2013 at 4:25 pm

Posted in Science

Seymour Hersh: Obama “Cherry-Picked” Intelligence on Syrian Chemical Attack to Justify U.S. Strike

leave a comment »

Reminds me of Iraq’s nuclear-weapons program: “We don’t want the smoking gun to be a mushroom cloud!!!” – C. Rice. But I guess once a tactic is found to work, it will inevitably be repeated, especially since the last time there was no accountability for the false stories that got the US to invade Iraq. Amy Goodman interviews Seymour Hersh at Democracy Now!, where the interview is available on video or as a transcript. The blurb:

Investigative journalist Seymour Hersh joins us to discuss his new article casting doubt on the veracity of the Obama administration’s claims that only the Assad regime could have carried out the chemical attacks in the Damascus suburb of Ghouta earlier this year. Writing in the London Review of Books, Hersh argues that the Obama administration “cherry-picked intelligence to justify a strike against Assad.” The administration failed to disclose it knew Syrian rebels in the al-Nusra Front had the ability to produce chemical weapons. Evidence obtained in the days after the attack was also allegedly distorted to make it appear it was gathered in real time.

Written by LeisureGuy

9 December 2013 at 3:09 pm

David Simon: ‘There are now two Americas. My country is a horror show’

leave a comment »

From the Guardian:

The creator of The Wire, David Simon, delivered an impromptu speech about the divide between rich and poor in America at the Festival of Dangerous Ideas in Sydney, and how capitalism has lost sight of its social compact. This is an edited extract:

Ameica is a country that is now utterly divided when it comes to its society, its economy, its politics. There are definitely two Americas. I live in one, on one block in Baltimore that is part of the viable America, the America that is connected to its own economy, where there is a plausible future for the people born into it. About 20 blocks away is another America entirely. It’s astonishing how little we have to do with each other, and yet we are living in such proximity.

There’s no barbed wire around West Baltimore or around East Baltimore, around Pimlico, the areas in my city that have been utterly divorced from the American experience that I know. But there might as well be. We’ve somehow managed to march on to two separate futures and I think you’re seeing this more and more in the west. I don’t think it’s unique to America.

I think we’ve perfected a lot of the tragedy and we’re getting there faster than a lot of other places that may be a little more reasoned, but my dangerous idea kind of involves this fellow who got left by the wayside in the 20th century and seemed to be almost the butt end of the joke of the 20th century; a fellow named Karl Marx.

I’m not a Marxist in the sense that I don’t think Marxism has a very specific clinical answer to what ails us economically. I think Marx was a much better diagnostician than he was a clinician. He was good at figuring out what was wrong or what could be wrong with capitalism if it wasn’t attended to and much less credible when it comes to how you might solve that.

You know if you’ve read Capital or if you’ve got the Cliff Notes, you know that his imaginings of how classical Marxism – of how his logic would work when applied – kind of devolve into such nonsense as the withering away of the state and platitudes like that. But he was really sharp about what goes wrong when capital wins unequivocally, when it gets everything it asks for.

That may be the ultimate tragedy of capitalism in our time, that it has achieved its dominance without regard to a social compact, without being connected to any other metric for human progress.

We understand profit. In my country we measure things by profit. We listen to the Wall Street analysts. They tell us what we’re supposed to do every quarter. The quarterly report is God. Turn to face God. Turn to face Mecca, you know. Did you make your number? Did you not make your number? Do you want your bonus? Do you not want your bonus?

And that notion that capital is the metric, that profit is the metric by which we’re going to measure the health of our society is one of the fundamental mistakes of the last 30 years. I would date it in my country to about 1980 exactly, and it has triumphed.

Capitalism stomped the hell out of Marxism by the end of the 20th century and was predominant in all respects, but the great irony of it is that the only thing that actually works is not ideological, it is impure, has elements of both arguments and never actually achieves any kind of partisan or philosophical perfection.

It’s pragmatic, it includes the best aspects of socialistic thought and of free-market capitalism and it works because we don’t let it work entirely. And that’s a hard idea to think – that there isn’t one single silver bullet that gets us out of the mess we’ve dug for ourselves. But man, we’ve dug a mess.

After the second world war, the west emerged with the American economy coming out of its wartime extravagance, emerging as the best product. It was the best product. It worked the best. It was demonstrating its might not only in terms of what it did during the war but in terms of just how facile it was in creating mass wealth.

Plus, it provided a lot more freedom and was doing the one thing that guaranteed that the 20th century was going to be – and forgive the jingoistic sound of this – the American century.

It took a working class that had no discretionary income at the beginning of the century, which was working on subsistence wages. It turned it into a consumer class that not only had money to buy all the stuff that they needed to live but enough to buy a bunch of shit that they wanted but didn’t need, and that was the engine that drove us.

It wasn’t just that we could supply stuff, or that we had the factories or know-how or capital, it was that we created our own demand and started exporting that demand throughout the west. And the standard of living made it possible to manufacture stuff at an incredible rate and sell it.

And how did we do that?

We did that by not giving in to either side. That was the new deal. That was the great society. That was all of that argument about collective bargaining and union wages and it was an argument that meant neither side gets to win.

Labour doesn’t get to win all its arguments, capital doesn’t get to. But it’s in the tension, it’s in the actual fight between the two, that capitalism actually becomes functional, that it becomes something that every stratum in society has a stake in, that they all share.

The unions actually mattered. The unions were part of the equation. It didn’t matter that they won all the time, it didn’t matter that they lost all the time, it just mattered that they had to win some of the time and they had to put up a fight and they had to argue for the demand and the equation and for the idea that workers were not worth less, they were worth more.

Ultimately we abandoned that and believed in the idea of trickle-down and the idea of the market economy and the market knows best, to the point where now libertarianism in my country is actually being taken seriously as an intelligent mode of political thought. It’s astonishing to me. But it is. People are saying I don’t need anything but my own ability to earn a profit. I’m not connected to society. I don’t care how the road got built, I don’t care where the firefighter comes from, I don’t care who educates the kids other than my kids. I am me. It’s the triumph of the self. I am me, hear me roar.

That we’ve gotten to this point is astonishing to me because basically in winning its victory, in seeing that Wall come down and seeing the former Stalinist state’s journey towards our way of thinking in terms of markets or being vulnerable, you would have thought that we would have learned what works. Instead we’ve descended into what can only be described as greed. This is just greed. This is an inability to see that we’re all connected, that the idea of two Americas is implausible, or two Australias, or two Spains or two Frances.

Societies are exactly what they sound like. If everybody is invested and if everyone just believes that they have “some”, it doesn’t mean that everybody’s going to get the same amount. It doesn’t mean there aren’t going to be people who are the venture capitalists who stand to make the most. It’s not each according to their needs or anything that is purely Marxist, but it is that everybody feels as if, if the society succeeds, I succeed, I don’t get left behind. And there isn’t a society in the west now, right now, that is able to sustain that for all of its population.

And so in my country you’re seeing a horror show. You’re seeing . . .

Continue reading.

Written by LeisureGuy

9 December 2013 at 12:50 pm

World of Spycraft: NSA and CIA Spied in Online Games

leave a comment »

Very interesting story. I think some game geeks convinced the NSA and CIA that letting them play on-line games all day might be useful at some point…

Written by LeisureGuy

9 December 2013 at 12:44 pm

The Punishment Cure

leave a comment »

Paul Krugman patiently deals with the GOP’s benighted worldview yet again:

Six years have passed since the United States economy entered the Great Recession, four and a half since it officially began to recover, but long-term unemployment remains disastrously high. And Republicans have a theory about why this is happening. Their theory is, as it happens, completely wrong. But they’re sticking to it — and as a result, 1.3 million American workers, many of them in desperate financial straits, are set to lose unemployment benefits at the end of December.

Merry Christmas.

Now, the G.O.P.’s desire to punish the unemployed doesn’t arise solely from bad economics; it’s part of a general pattern of afflicting the afflicted while comforting the comfortable (no to food stamps, yes to farm subsidies). But ideas do matter — as John Maynard Keynes famously wrote, they are “dangerous for good or evil.” And the case of unemployment benefits is an especially clear example of superficially plausible but wrong economic ideas being dangerous for evil.

Here’s the world as many Republicans see it: Unemployment insurance, which generally pays eligible workers between 40 and 50 percent of their previous pay, reduces the incentive to search for a new job. As a result, the story goes, workers stay unemployed longer. In particular, it’s claimed that the Emergency Unemployment Compensation program, which lets workers collect benefits beyond the usual limit of 26 weeks, explains why there are four million long-term unemployed workers in America today, up from just one million in 2007.

Correspondingly, the G.O.P. answer to the problem of long-term unemployment is to increase the pain of the long-term unemployed: Cut off their benefits, and they’ll go out and find jobs. How, exactly, will they find jobs when there are three times as many job-seekers as job vacancies? Details, details.

Proponents of this story like to cite academic research — some of it from Democratic-leaning economists — that seemingly confirms the idea that unemployment insurance causes unemployment. They’re not equally fond of pointing out that this research is two or more decades old, has not stood the test of time, and is irrelevant in any case given our current economic situation.

The view of most labor economists now is that unemployment benefits have only a modest negative effect on job search — and in today’s economy have no negative effect at all on overall employment. On the contrary, unemployment benefits help create jobs, and cutting those benefits would depress the economy as a whole.

Ask yourself how, exactly, ending unemployment benefits would create more jobs. It’s true that some of the currently unemployed, finding themselves even more desperate than before, might manage to snatch jobs away from those who currently have them. But what would give businesses a reason to employ more workers as opposed to replacing existing workers?

You might be tempted to argue that more intense competition among workers would lead to lower wages, and that cheap labor would encourage hiring. But that argument involves a fallacy of composition. Cut the wages of some workers relative to those of other workers, and those accepting the wage cuts may gain a competitive edge. Cut everyone’s wages, however, and nobody gains an edge. All that happens is a general fall in income — which, among other things, increases the burden of household debt, and is therefore a net negative for overall employment.

The point is that employment in today’s American economy is limited by demand, not supply. Businesses aren’t failing to hire because they can’t find willing workers; they’re failing to hire because they can’t find enough customers. And slashing unemployment benefits — which would have the side effect of reducing incomes and hence consumer spending — would just make the situation worse.

Still, don’t expect prominent Republicans to change their views, except maybe to come up with additional reasons to punish the unemployed. For example, Senator Rand Paul recently cited research suggesting that the long-term unemployed have a hard time re-entering the work force as a reason to, you guessed it, cut off long-term unemployment benefits. You see, those benefits are actually a “disservice” to the unemployed. . .

Continue reading. The GOP consistently claims that it helps those who need help if you don’t give them any help. They become much better off as a result. I don’t get it. When someone needs help, they need help. It’s not hard to understand.

Written by LeisureGuy

9 December 2013 at 12:41 pm

When Bishops Direct Medical Care

leave a comment »

The NY Times has an excellent editorial:

Beyond new state efforts to restrict women’s access to proper reproductive health care, another, if quieter, threat is posed by mergers between secular hospitals and Catholic hospitals operating under religious directives from the nation’s Roman Catholic bishops. These directives, which oppose abortions, inevitably collide with a hospital’s duty to provide care to pregnant women in medical distress. This tension lies at the heart of a federal lawsuit filed last week by the American Civil Liberties Union.

The suit was brought on behalf of a Michigan woman, Tamesha Means, who says she was subjected to substandard care at a Catholic hospital — the only hospital in her county — after her water broke at 18 weeks of pregnancy. Doctors in such circumstances typically induce labor or surgically remove the fetus to reduce the woman’s chances of infection. But according to the complaint, doctors acting in accordance with the bishops’ directives did not inform Ms. Means that her fetus had virtually no chance of surviving or that terminating her pregnancy was the safest treatment option.

Despite acute pain and bleeding, Ms. Means was sent home twice, and when she returned a third time with a fever from her untreated infection, she miscarried even as the paperwork was being prepared to discharge her again. The fetus died soon after.

The case has gained attention because Ms. Means is not suing the hospital for medical negligence but the United States Conference of Catholic Bishops. The A.C.L.U. is arguing, on her behalf, that having issued the mandates and made them conditions of hospital affiliation, the conference is responsible for “the unnecessary trauma and harm” that Ms. Means and “other pregnant women in similar situations have experienced at Catholic-sponsored hospitals.”

How the suit will play out is unclear, but it showcases an important issue. Catholic hospitals account for about 15 percent of the nation’s hospital beds and, in many communities, are the only hospital facilities available. Allowing religious doctrine to prevail over the need for competent emergency care and a woman’s right to complete and accurate information about her condition and treatment choices violates medical ethics and existing law.

The problem Ms. Means encountered is not unique or limited to her particular medical needs. In 2010, the Diocese of Phoenix punished a nun and stripped a hospital of its affiliation after doctors there performed an abortion to save a mother’s life.

In a statement last Friday, the president of the bishops’ group, Archbishop Joseph Kurtz, said that the religious directives did not encourage or require substandard medical treatment. He also portrayed the case as an attack on religious freedom — the same unpersuasive argument the bishops are making against the new federal health care law’s requirement that all plans include contraception coverage.

The bishops are free to worship as they choose and advocate for their beliefs. But those beliefs should not shield the bishops from legal accountability when church-affiliated hospitals following their rules cause patients harm.

Written by LeisureGuy

9 December 2013 at 12:37 pm

Republicans have Medicaid’s cost problem completely wrong

leave a comment »

Harold Pollack has an interesting column in the Washington Post:

Healthcare.gov’s troubled rollout brings new attention to competing proposals to alter health coverage for low-income Americans. One group of Republican analysts would largely replace Medicaid with  some combination of primary care supports and catastrophic coverage. Others wouldn’t go that far but would make greater use of patient cost-sharing to provide incentives for disciplined use of medical services.

Ross Douthat has put the argument well in some thoughtful columns.

[C]omprehensive health insurance is, at its heart, a deeply wasteful use of resources: Modern people, and especially modern Americans, are much more likely to overconsume health care than to underconsume it…  This doesn’t mean that social insurance shouldn’t protect people against adverse medical outcomes and unaffordable medical bills, but it suggests that there are better ways to allocate our resources than comprehensive coverage, and that most people would be better off if public policy didn’t push so much money into that direction.

Economic intuition suggests that Harold Pollack and Ross Douthat alike would use care more efficiently if we had more skin in the game, if we were less comprehensively insured. Sure enough, non-poor participants in the RAND Health Insurance Experimentused roughly one-third less care when they were enrolled in something akin to a catastrophic plan than did their counterparts who were enrolled in more generous plans. Despite their reduced service use, participants in the catastrophic plan also appeared, on average, to be just as healthy. Such findings provide a powerful argument for catastrophic plans. (Recent results from the Oregon Medicaid experiment are another matter.)

The cracks in this argument become more noticeable when one shifts attention from the typical insured person to the typical insurance dollar spent for patient care, particularly when one considers the vulnerable populations overrepresented among public insurance recipients.

Most people are light users of medical care. As Aaron Carroll regularly emphasizes, expenditures are concentrated within a group of costly patients with complex conditions, many of whom would hit any reasonable catastrophic coverage cap and who are poorly placed to manage the practicalities and financial risks associated with their medical care.

Although I’m curious to see how healthy, affluent professionals would purchase (say) knee and hip replacements if they faced the full costs, this won’t save much money. Most people in a position to make such choices don’t consume much health care. The real money is spent on patients like my relative who is recovering from a nasty stroke. For all sorts of reasons, giving him something other than comprehensive coverage seems unwise.

These distributional realities hold especially true among poor people. Figure 1 shows 2012 data for Illinois’s 3.2 million Medicaid recipients, ranked by percentile from lowest to highest expenditure. The top line shows cumulative Medicaid spending.  The bottom bars show average annual expenditures in dollars. (If you look closely, you’ll notice straight lines where I interpolated between available data points.)

harold-graph

The bottom 72 percent of Illinois Medicaid recipients account for 10 percent of total program spending. Average annual expenditures in this group were about $564, virtually invisible on the chart. We can’t save much money through any incentive system aimed at the typical Medicaid recipient. We spend too little on the bottom 80 percent to get much back from that. We probably spend too little on most of these people, anyway. For the bulk of Medicaid beneficiaries, cost control is less important than improved prevention, health maintenance and access to basic medical and dental services.

The real financial action unfolds on the right side of the graph, where expenditures are concentrated within a small and incredibly complicated patient group. The top 3.2 percent of recipients account for half of total Medicaid spending, with average expenditures exceeding $30,000 annually.

Many of these men and women face life-ending or life-threatening illnesses, as well as cognitive or psychiatric limitations. These patients cannot cover co-payments or assume financial risk. In theory, one might impose patient cost-sharing with some complicated risk-adjustment system. In practice, that is far beyond current technologies and administrative capabilities. Even if such a system were available, we couldn’t push the burden of medical case management onto these patients or their families.

The Affordable Care Act’s Medicaid-expansion population won’t include traditional dual-eligible and nursing home patients who make up much of that 3.2 percent. The new group will still include a mix of basically healthy adults alongside more costly recipients with complicated problems who will account for the bulk of actual spending.

In my view, the best way to improve Medicaid is to tackle three inter-related challenges.

First, . . .

Continue reading.

Written by LeisureGuy

9 December 2013 at 12:32 pm

Posted in GOP, Healthcare, Medical

%d bloggers like this: