Stephen Hawking sounds the alarm

I wanted to share something I discovered last night. It appears that Dr. Hawking is a little pessimistic about our ability to exist on this planet.



For those who don't know, Stephen Hawking is pretty smart. However, he seems to be preoccupied with space, and I'm not as down on our chances as he is.

Though I agree with him that we have "aggressive and selfish instincts" that don't help our chances of survival at this point in the race's history, I think the human race has the ability to overcome our "aggressive and selfish instincts" with more farsighted ideas. Further, I think that nature has the ability to regenerate from the damage we have done to it.

Ultimately, it is up to us whether we will continue down the road of excessive consumption, or whether we  will find a way to exist as part of our natural ecosystem.

Why Congress really really sucks

Jon Stewart is a comedian. And he's often funny. And this video is funny, and sad. But we have a fundamental problem in Congress. The folks who are there, are more concerned with scoring political points than actually getting anything done.

I'm not sure of all the circumstances surrounding this bill, but it wouldn't surprise me if the Democrats are specifically bringing this bill to the floor to help them politically during the long summer of an election year.

Regardless, it's a pretty good bill. If my understanding is correct, it would give lifetime health care coverage to the folks who helped out at ground-zero immediately following 9/11. Sounds great, and it is.

One crux of the problem was that in order to pay for the measure (a good idea), Democrats proposed a "new tax" that would prevent foreign-registered companies from avoiding taxes on income earned in the U.S. This, also, seems fine to me. It's essentially closing a tax loophole.

However, Republicans took issue with the tax. It was rumored that they were going to motion to recommit which would have sent the bill back to committee and would have asked that the bill be paid for by other means (e.g. from the health care legislation that was passed early this year). Further, the Republicans introduced an amendment that would prevent any of this money from going to illegal immigrants.

In order to prevent ANY Republican amendments, Democrats used a procedure that requires a 2/3 vote rather than a majority vote and the measure failed. 

So that's the set-up. Let me be clear that Democrats are playing politics here. This is a great bill to bring to the floor during an election year. Further, they were probably not too upset about Republicans making a stink over it and voting it down because it looks really bad for the GOP (I could be wrong, but that's my hunch). So, what the Democrats did here really bothers me.

What bothers me more is what the Republicans did. They took a good bill that was paid for and injected the immigration issue into it. You know what, I doubt illegals were at ground-zero helping out, but if they were, I wouldn't mind them getting health care for the health problems they contracted while helping us out in our time of need.

That's bad enough, but Republicans took this further. The real sin here was their opposition to closing the tax loophole. Some segments of our political establishment act like tax evasion is something to be smiled upon and encouraged. My perspective is that corporations that earn money here should have to pay U.S. taxes.

Finally, it seems disingenuous to me to threaten to overload a bill with amendments and then cry foul when the opposition out-maneuvers those attempts and forces you to vote "no."

While I don't agree with everything Jon Stewart said in his segment, the final portion of the sketch does resonate with me. Republicans need to come out and state unequivocally that they are more concerned about the welfare of corporations than average folks like you and me, or quit stonewalling measures that rein in corporate greed. On the other hand, Democrats need to stand up for what they believe in and not hide behind procedural trickery, or accept that they'll never get anything done and will continue to be bullied by their opponents.

Calling out incompetence

Disclaimer: I am no expert on health care. While I've studied data on health care systems in the more global sense (to keep up with last summer's health care debate), I know next to nothing about day-to-day care. This post is entirely from personal experience and a few data searches.

Today I came to the conclusion that hospitals deliberately screw old people in order to make them more enthusiastic about dying.

My grandfather fell and broke his hip two weeks ago. After contracting pneumonia in the hospital (this is so typical we even have jokes about it), the hospital staff finally figured out they weren't giving him the correct antibiotics. Then they decided that since he needed his daily medication (that he took prior to being admitted to the hospital), but couldn't swallow the pills, they would shove a tube down his throat so they could administer the pills that way. That was a perfectly fine idea, except that they decided they couldn't give him ANY sedation because of his condition (later we found out this was not true, but that's the conclusion they came to at the time). So, for an extended period of time, they attempted to ram this tube down his throat while he choked and struggled. After some time, they gave up. This experience proved so traumatic for my grandfather, that he wouldn't allow hospital staff near him for the rest of the day.

Unfortunately this is not the end of the story. After almost a week, they decided to try again. This time they gave him sedation (thank goodness) and were able to get the tube to his stomach. A subsequent x-ray showed that they had put too much down his throat and that it was coiled up in his stomach. So they pulled about 10 inches out. Another x-ray showed the problem remained, so they pulled another 12 inches out.

Now, I'm fairly good at math, especially arithmetic. My special math powers tell me that these trained professionals shoved almost two feet of excess tubing down my grandfather's throat. How complicated can this be? Look at the distance between your mouth and your stomach. I just measured mine and it's less than two feet. So, what happened here is these people put twice the necessary amount of tubing down into my grandfather's stomach. Wow.

Again, I'd like to stress that I really don't know much about this procedure, but is it really that complicated?

Medical error is frighteningly common. According to an Institute for Medicine report published in 2000, medical errors account for anywhere from 44,000 to 98,000 deaths in the United States every year. That makes medical errors either the 9th or 5th leading cause of death among Americans.

This article from ABC News reported in 2007 that doctors at Rhode Island Hospital performed brain surgery on the wrong side of a patient's head on three separate occasions in the space of a single year. Consequently, the Department of Health finally had to fine the hospital $50,000.

This report from the Commonwealth Fund reports that in July of 2005 improvements to the medical system have taken place since the original report. These improvements included, "the development of performance standards, an increase in error reporting, integration of information technology, and improved safety systems." Personally, while these "improvements" sound overdue, I'm not too optimistic about the effects of these measures in hospitals.

An even more underlying problem is the attitude of some doctors and nurses. Often, health care professionals are trained to be aloof. I understand the need to be emotionally separated from patients, but this attitude can't be helpful in treating a patient's needs especially when most patients need more than just physical care (see post on palliative care and my extension of it below). Nor is being aloof helpful when medical errors are so widespread. Complacency is the last thing we need in a system that needs such fundamental change. 

Proposed solutions vary, but it seems that we ought to be looking at what other countries are doing in order to address such a systemic problems. Subsequent posts on health care will focus on some of the debate that took place last summer over the health care bill as well as more personal information from my friends who are currently being trained to be health care professionals. 

Expansion on "The beauty of death panels"

There is a great article on end-of-life care written by Atul Gawande in the August 2 New Yorker. To supplement my explanation of hospice and palliative care, I'd like to quote from the article.

Outside, I confessed that I was confused by what Creed was doing. A lot of it seemed to be about extending Cox's life. Wasn't the goal of hospice to let nature take its course?

"That's not the goal," Creed said. The difference between standard medical care and hospice is not the difference between treating and doing nothing, she explained. The difference was in your priorities. In ordinary medicine, the goal is to extend life. We'll sacrifice the quality of your existence now--by performing surgery, providing chemotherapy, putting you in intensive care--for the chance of gaining time later. Hospice deploys nurses, doctors, and social workers to help people with a fatal illness have the fullest possible lives right now. That means focussing on objectives like freedom from pain and discomfort, or maintaining metal awareness for as long as possible, or getting out with family once in a while. Hospice and palliative-care specialists aren't much concerned about whether that makes people's lives longer or shorter.

Part 3 of 3: What to do with the Department of Defense

So, here are my two solutions:

Solution 1. Cut the Defense Department budget. This might make them more cognizant of where their billions go.

We're in a period where people on both sides of the aisle are calling for a reduction to the deficit. I've got some ideas for how to more effectively allocate social spending, but the military budget is an easy target for budget cuts. A spending freeze on the defense budget might be the least painful, but with the draw-down in Iraq proceeding on schedule, we should be able to directly cut portions of the budget.

Solution 2. Join the rest of the civilized world and ban the use of Mercenaries (military contractors hired to kill) and go one step further; ban all military contractors.

This will take a transition period, but I'm confident that our military can handle the duties of these contractors. Further, this will help with Solution 1 because we pay contractors far more than we do our own soldiers to do the same job. So, we'll save money and reduce fraud while improving quality and morale. This is what's called a "win-win situation."

Note: This is part 3 of 3. 

Part 2 of 3: What to do with the Department of Defense

If you read the Guardian article from yesterday's post, you'll notice that most of the problem seems to be military contractors. Certain types of military contractors (those that can accurately be called mercenaries--like Blackwater and similar companies) have been declared illegal and banned by international law. Unfortunately, the United States did not sign that particular treaty, so we continue to use mercenaries.

Consequently, we have problems like Blackwater employees shooting civilians at a random intersection in Iraq (more on that story here and here and here), or cases like David H. Brooks, a military contractor who was reimbursed $6 million for personal expenses, including a $100,000 belt buckle. I want to highlight just one paragraph from the article:

A lawyer for Mr. Brooks, Kenneth Ravenell, told the jury on Monday afternoon that his client represented the realization of the American dream, someone who made money while helping his country “when the military called.”

From what I've read, this sort of attitude pervades military contractors and the supporters of their behavior. This short clip from the movie Iraq for Sale details some of the worst problems with companies like Blackwater. This video may be a bit of an overreach, it uses the tone of conspiracy, but I think it also provides an interesting perspective.  

Though it seems clear that there are significant problems with combat military contractors, I think other types of military contractors are also problematic. Actually, anyone who has eaten in the Walla Walla University cafeteria can understand the problems and limitations of profiteering contractors. We have contractors doing everything from washing our clothes and serving our food to guarding our generals and training local law enforcement. These four articles outline the problem even more explicitly (here and here and here and here). And this blogger talks candidly about his own experience as a military contractor and the problems with the system. In short: contractors care less about quality service than they do about making money and this translates into a lot of problems--bad service, fraud, etc.

Instead of hiring contractors, why can't the military perform more of these duties in-house? Why do we have to pay a corporation to do our laundry? Why can't our own soldiers guard high-ranking officials instead of private security that get paid far more, but don't do a better job? I think they can and they should. Not only would we save money, but we'd also increase morale because our soldiers wouldn't have to fight alongside private contractors who are making several times more than they do.

I think we're giving money to the wrong people. We ought to be paying the members of our armed services who signed up to defend the tenants of our democracy, rather than military contractors who signed up to make a buck.

Note: This is part 2 of 3. 

Part 1 of 3: What to do with the Department of Defense

The Defense Department just misplaced $8.7 billion. This story is similar to when we misplaced $12 billion back in 2007. And these two mishaps taken together are like the time Alban (one of my housemates) didn't deposit his rent payment on time and caused us to get an overdraft fee... except a billion times worse.

When something is so large and complicated that either we can't keep track of $20 billion going through the system, or we don't care, it's about time to cut it down to a more manageable size.

Note: The following figures are from this page that details the issue much better than I can.

When compared to the rest of the world, our military budget is out of control. We spend more on our military than the next 14 largest spending countries combined (data here). For a rundown of what this looks like in list form, go here.

So, we spend a lot compared to the rest of the world. In fact, these figures make us look a little silly, kinda like the New York Yankees of defense spending. No wonder everyone hates us. Here's what this looks like for our budget:

The reason for the discrepancy between the two graphs is that the first is only taking into account "traditional" sources of tax revenue. The second graph looks at federal spending as a whole, which includs Social Security and Medicare/Medicaid that are funded a little differently.

Note: A lot of folks who don't think we spend too much on the military like to use a graph that can be found here. However, after a little checking, this other graph has a few accuracy problems and dubious sources (plus they separate defense spending from Iraq War spending to make them look smaller). For those reasons I've decided to stick with my OMB numbers.

What I'd like to stress is that we are spending too much on the military. These sorts of spending levels aren't about safety anymore. These sorts of spending levels are about our politicians funneling money to whomever they want and being able to point to national security as the reason. This is unacceptable.

Note: This is part 1 of 3.