Author Archives: markorton

Healthcare Crisis

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Originally written in 2005

The healthcare crisis in the US is growing in severity and yet is not the subject of any real public debate. More than 44 million Americans are without health insurance and almost 65 million will experience a lack of coverage during the year. Emergency rooms are the primary care provider of necessity. All of this despite the fact that, as a nation, we spend more than any other country in the world; 11% more than the next closest country; 90% to 100% more than countries like Germany, Japan, Canada, Australia, and France. Yet the outcomes for our healthcare system are completely second tier and nearly third world.

You may be shocked to see exactly how poorly our phenomenally expensive health system is performing. Just to add some further context, note that Sweden (1st in Infant Mortality to the US 41st position) has a per capita income roughly equal to that of Mississippi (the poorest US state) and spends almost exactly half of what the US does per capita on health care. Examine the Comparative Health System Data in which I have color-coded a few countries for quick comparison.

During our quadrennial presidential personality sweepstakes, neither candidate offered real solutions, really not even a discussion of the issues. We are stuck in a political environment in which neither the Republicans nor the Democrats are offering, and I would argue, are capable of offering real solutions.

Lets make a one basic observation about the situation:

This is not a money problem. As demonstrated by the data on the Comparative Health System Data chart, we clearly are spending enough money in aggregate.

But, this crisis is about money, namely, who gets it and what do they do with it. And, starting from the last serious attempt to tackle the problem during the first year of the Clinton administration, it is very clear that the political system is completely in the pockets of the various interests who have the money now, namely insurance and drug companies, hospitals, and doctors.

It seems obvious to me that we just need to look at any of a number of the top performing countries for the solution. Then, we need to have the political forces in place to tell some of the current participants that the rules have changed.

Central to any solution will be the participation of all US residents in the system. Healthcare is a basic human right and we should not be treated as “risk” factors in insurance company profit calculations. If everyone is part of the healthcare system, then we can effectively share the individual risks and expenses of healthcare across the whole population. Healthcare should not be an actuarial game to derive profit. It should be a system that delivers a reasonable level of service to everyone in the society.

Two players clearly are at the top of the hit list. First, most assuredly the insurance industry, which adds no value to our health care, but consumes by many estimates 15% to 20% of the resources, must go. Second, the drug companies can be brought into reasonable competition for prices that will bring market forces to bear.

Ironically, given the long history of doctors opposing national or single-payer systems in the US, doctors have now been reduced to the status of wage slaves like the rest of us. Many, if not a solid majority of doctors, will support real reforms to the system.

I close here with two basic notions:

  • our healthcare problems are not about a lack of money, and
  • we need to develop political forces that can overcome the control of government (Federal and state) health policies by the current players in the healthcare system.

Given the current Bush administration, I believe the focus of reform must be at the state level. It seems feasible to envision a single-payer system that covers all residents in a state like Massachusetts. We should try it.

North Korea – a visit to the "Axis of Evil"

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Bruce Cumings -North KoreaRecently, in the context of some discussion of the Bush regime, my step-son Jonathan pointed me towards several books on Korea. He said that Bruce Cumings is simply the best author writing in English on Korea. So, a quick trip to the local library and I had this compact little book in my hands.

The book is organized around five topics: (1) the impact of the Korean War on North Korea, (2) the genesis of Korea’s nuclear programs, (3) the legend of Kim Il Sung, (4) daily life in North Korea, and (5) the current leader (dictator) Kim Jong Il. The text is not what one might expect of an academic from the University of Chicago. Cumings writes in an openly polemic style that is directed to providing maximum exposure to North Korea and our miserable knowledge of this country.

This book is relatively brief and a compelling introduction to North Korea and a portion of our foreign policy history that was substantially new to this reader

Book Note – Before the Dawn: recovering the lost history of our ancestors

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Before the Dawn by Nicholas WadeEarlier this year I read Charles Mann’s 1491: New Revelations of the Americas Before Columbus and was rewarded with another reminder of how thin my understanding of our hemisphere’s history is and how much new knowledge is being added by multiple disciplines. Here was a whole new world to be explored.

Nicholas Wade’s book is another must read for those of us educated before the impact of the decoding of DNA had begun. He attempts to summarize what we have learned based on contemporary genetics combining it with the vast base of earlier research from paleoanthropology, archaeology, linguistics, and other fields.

Wade opens the book with a great little story about how genetics has determined a probably date for when human beings first began wearing clothing. Based on the fact that body lice are descended from head lice and show a special adaptation specifically providing body lice with the means to hang on to the fibers of our clothing, genetics is able to date our adoption of clothing to be about 72,000 years ago “give or take a few thousand years”.

While discussing the evidence for the paths of human migration away from the African homeland, Wade mentions that the biggest region for the paucity of physical data is that because we were in glacial period, seal level was some 300 feet lower than today. Thus, since early humans would have followed the coast line to be close to a ready source of food, their early habitations are now well below water.

I won’t attempt to summarize the book. Rather I urge you to retrieve it from your local library.

A Fog of War or a Fog of Ethics?

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Through our friend Esther Hanig we attended a showing of Errol Morris’s new documentary, The Fog of War: Eleven Lessons From the Life of Robert S. McNamara. at the Kennedy Library in Dorchester on December 14, 2003. This documentary is an extended adventure into the historico-biography of Robert S. McNamara, most famous as the Secretary of Defense during the Kennedy and Johnson administrations. The movie intersperses close up head shots of McNamara (always shown off center) responding to questions posed by the interviewer (never seen, but clearly the director Morris) with historical footage and graphics illustrating events or concepts.



McNamara today at age 87 McNamara as Sec. of Defense ca 1966.
Photos appropriated from the New York Times web site


One of the most effective sections reveals McNamara’s role in the planning and execution of bombing campaigns during WWII under the command of Gen. Curtis LeMay. This bombing campaign attacked 67 Japanese cities. Morris uses historical footage of the results and then flashes the names of the Japanese cities with their populations on the screen immediately followed by the names and populations of similar-size American cities. In one night a fire-bombing of Tokyo incinerated 100,000 civilians. In the movie, Mr. McNamara tells Mr. Morris. “Lemay said, `If we’d lost the war, we’d all have been prosecuted as war criminals.’ And I think he’s right. He — and I’d say I — were behaving as war criminals.” He asks, “What makes it immoral if you lose and not immoral if you win?” (thanks for this quote to the movie review article “War and Never Having to Say You’re Sorry” by Samantha Power, Published: December 14, 2003 in the New York Times)

Later, covering the Vietnam War, Morris provides audio tapes of both Kennedy and Johnson speaking with McNamara about the war. These add more fuel to the argument that if Kennedy had lived that he would not have enlarged the US involvement. And, on the other hand, Johnson comes across as clearly responsible. No surprise there.

When asked during the post-screening discussion about why he waited for over twenty years to reveal that he had come to think the Vietnam war a mistake even while still Sec. of Defense, McNamara repeated his claim that as a former Sec of Defense he could not say critical things of the war policy because it would have been giving comfort to the enemy and endangering US troops.

This is a cruel bit of logic.

When McNamara left his position roughly 25,000 Americans had died and probably 10 to 20 times that many Vietnamese. By the time the war actually ended seven years later, more than twice that many had died on both sides. It remains a galling outrage that this man, so intimately involved with the development and prosecution of the Vietnam War, could be seeking absolution twenty years later. It is the minimum we human beings owe to each other that, when confronted with obvious wrong doing, we speak up. This obligation is all the more important for those in positions of power and authority. But, one of Morris’s points in his movie is that evil and evil doers are never quite so easily categorized as might be in an old Western movie.

The end of the post-screening discussions with McNamara displayed this point with fresh vigor. After the program was officially closed, McNamara called for a few more moments of the audience’s attention. He wanted to add to his call for work on developing and deploying a real policy on proliferation of nuclear weapons with a call for international standards for behavior by political leaders enforced by international judicial tribunals. Perhaps we might think of him in the dock for his role in the Vietnam War. Just as a small starting point for the prosecution: during the movie McNamara himself pointed out that more munitions were dropped on Vietnam during the war than all that were used in the European theatre of WWII. And, this, in a country that is just about the same land area as our states of Wisconsin and Minnesota and then, as now, one of the poorest countries in the world.

But, then, McNamara seems incapable of connecting the ethical dots in his own life. How can acknowledge that his role in the fire-bombings of Japan might be considered a “war crime”, his policy in Vietnam wrong, and call for international standards of behavior enforced by international courts??

PS: I highly recommend the movie. It is challenging and very well made.

12172003

Michael Crichton’s Congo and the Transformation of the Western Mind

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Original Book Review/Essay  2/97 ((originally published on markorton.com ))

(REVISED 1/29/02 – MAPS ADDED AT BOTTOM) (REVISED 6/25/03 – MAP OF ANGOLA SUPERIMPOSED ON THE US)

Michael Crichton’s 1980 pulp novel Congo opens with an introduction that is truly arresting . I quote here the first two paragraphs in their entirety.

 

“Only prejudice, and a trick of the Mercator projection, prevents us from recognizing the enormity of the African continent.

Covering nearly twelve million square miles, Africa is almost as large as North America and Europe combined. It is nearly twice the size of South America. As we mistake its dimensions, we also mistake its essential nature: the Dark Continent is mostly hot desert and open grassy plains.

In fact, Africa is called the Dark Continent for one reason only: the vast equatorial rain forests of its central region. This is the drainage basin of the Congo River, and one-tenth of the continent is given over to it – a million and a half square miles of silent, damp, dark forest, a single uniform geographical feature nearly half the size of the continental United States. This primeval forest has stood, unchanged and unchallenged, for more than sixty million years.”

This reader was gripped by his own ignorance of the facts and yet skeptical.  He could recall all those geography lessons of grade school. He had traveled a bit. But none of this brought enough confidence to bear for these first two paragraphs in this pulp novel not to send him off to his maps, atlases, encyclopedias, even the internet.

Mercator. Yes, that is the projection so familiar from grade school. It even sticks in the mind that one of its key features is that the latitude and longitude lines are straight lines.  This is convenient for rectangular pieces of paper, but it creates great distortions of area. This rectangular display of the surface of the nearly spherical surface of the earth produces a Greenland that appears almost as large as the US. The farther away you go north or south from the equator the larger this error becomes.

So, OK this Mercator, who on investigation in the ‘97 Grolier CD Encyclopedia, turns out to be a Flemish cartographer, Gerardus Mercator (1512-1594), produced cylindrical projections of a spherical surface.  This of course lead to this readers present state of misapprehension.

Well, let’s take a closer look at this matter. A few simple comparisons of territories that he has driven across will put this into better perspective (this reader does have a bit of trouble with abstractions).

So here is a chart neatly drawn up in tabular form (again courtesy of the above referenced CD encyclopedia). The data on Africa seems to hold up Crichton’s assertions. Hopefully the American reader (obviously of the East Coast persuasion) will find some suitable reference point to investigate the data for themselves. The India entry is just for fun and effect.

   
Area (sq. miles)
Population
 
Texas
267,277
18,378,000
 
New England
71,929
13,239,000
 
New England, NY,PA,OH,IL
274,423
66,244,000
 
United States (continental)
3,106,231
261,429,000
 
Africa
11,710,500
720,000,000
 
Nigeria (most populous in Africa)
357,000
98,100,000
 
Zaire
905,567
41,200,000
 
South Africa
471,445
43,500,000
 
India
1,269,345
911,600,00
 
Wisconsin
65,503
5,038.000
 
Illinois
57,918
11,697,000
 
Vietnam
127,242
71,800,000

What strikes this parochial mind is that the Mercator effect is at work even in our views of the United States.

Let’s investigate this a bit.

First a couple of numbers to illustrate my thesis. Texas is 801 miles north to south and 773 miles east to west.

By contrast, think of a car trip from Boston to Chicago. The American Automobile Association preferred yellow-line triptych calls this out at 925 miles. Boston to Washington DC is approximately 600 miles. Do these numbers and our mental images on the map jive?

Let me close this bit of geography with a historical note about Vietnam. During the Vietnam War I found it useful in political discussions, during my college days in Wisconsin, to point out that Vietnam is very close to the combined land area of the states of Wisconsin and Illinois . In this area the US government dropped as much munitions as consumed during all of World War II in all theaters.

mercator Mercator Projection (circa 1596)
robinson Robinson Projection(most widely used by National Geographic and others during the 20th centuryh until 1980’s)
Both maps borrowed without permission from geography.about.com  

6/25/3

Yesterday I was scanning through the New York Times and saw an article, “Latest Peace Hopes Thwarted on Africa’s Battlefields” by Somini Sengupta. It was accompanied by a series of maps, including this one: (text added by me)Congo_over_US_map

 

 

 

 

 

 

 

 

 

As for the balance of the 314 pages of this pulp novel, it’s entertaining…lots of gorillas and other beasts ………a page turner.

Enron, Trust and Malfeasance

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January 23, 2002 (revised 1/29/02)

The collapse of energy giant Enron over the last six months has produced a surprising level of outrage especially for a cynic like me.

As this drama continues to unfold, I have been trying to understand how Enron structured their business and made money. Until just last night I was operating on the belief that the cleverness and sophistication of Enron’s managers simply outstripped my analytical skills. But, as I have been following the writing in the NY Times and Wall St. Journal, slowly it has come to me that they don’t understand the maze of structures and deals employed by Enron for years either.

Then, last night, on the Jim Lehrer News Hour on PBS, Paul Solman, one of the regular financial reporters, gave his analysis of what has been going on. After listening to Solman’s report, it is clear that Enron has been engaging in massive deceit, deception, and downright criminal activity for years.

Now, I must admit to some familiarity with the habits and attitudes of managers. I am used to the aggressive behavior of managers trying to stretch the accounting systems to make the most recent quarter look good. In fact, I have participated in such activities. But, Enron has engaged in a long-term shell game aided and abetted by its accounting firm, Arthur Andersen, LLC. The failure of the government (the SEC) and more importantly, the audit companies, to provide oversight, transparency, basic facts, and above all the application simple commonsense ethics to a huge company’s activities is outrageous. It undermines the credibility of the economy. If Arthur Andersen, one of the oldest and most prestigious audit firms can be so blind over so many years, what are we to make of their, and other audit firms’ reliability for oversight of all the other firms so many of us hold in our 401K funds?

It will be interesting to see how the government and the financial institutions of capitalism react to this. It is a basic tenant of the capital and equity markets that timely, transparent information is essential not only to the best and highest use of our capital resources, but also to the maintenance of trust in a reasonably fair play space.

You can see the Solman report on the PBS web site (opens in a separate window)

And, from Friday January 25, 2002, here is more Solman on Enron (opens in a separate window)

Whose Opinion (Advice) Is This?

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Whose Opinion (Advice) Is This?

The Problem

At a time when we are quite aware of the need for and value of transparency in the reporting of the activities of corporations (thanks most recently to the Enron affair), we could quite usefully extend this transparency metaphor to other parts of day-to-day life. The print press, TV, radio, and internet are filled with opinions and advice from all sorts of people. Many of these pass for expert status just based on affiliation with universities, institutes, and think tanks.

Increasingly we must ask ourselves, “whose opinion is this?” Who is being served by the expertise?

Although many in the academic and chic cultural world (not to mention the various right-wing types in political and religious quarters) may think that relativism is the creation of post-WWII French philosophy, most of the rest of the world knows full well that “truth” is in fact relative, that is, relative to who is paying. No surprise, the “experts” know this too, and regularly seek to hide or obscure who is paying. Now, even the pinnacle of prestige in the medical world, The New England Journal of Medicine, has had to strengthen its guidelines that seek to separate research performed at arms length from the pharmaceutical/medical industrial complex from that more directly controlled.

A Step Towards a Solution

What can we do to provide a substantial increase in the transparency of our information sources while keeping things simple?

We should begin to demand that every expert, commentator, think tank institute, or university laboratory reveal the sources of 80% of the funds supporting its research/organizational activities. In the vast majority of case the list of sources will not exceed three or four. This protocol will provide a revealing base of background information without substantial burdens.

A Caveat

Although the protocol proposed here will increase the transparency of our sources of information, it will not relieve us of the work of making sense out of the data and theories presented in any given situation. Just because a given piece of research is funded by “bad people” does not mean that the data is not meaningful and the analysis correct.