So I’m enjoying the heck out of this Vanity Fair article from the November issue.  It really manages to highlight the chaos of the time, the impotence of the leading government authorities (able to only make uncompelling and rather simplistic recommendations… Think of a basketball fan e-mailing Bryan Colangelo ESPN Trade Machine links to get Andrew Bogut on the Raptors…  Not that I’ve been trying to or anything), some of the rather obvious personal concerns of the parties concerned (think Paulson’s relationship with Goldman Sachs), and the degree that the big investment banks were at the whim of momentum.  And the investment bank’s exposure to an unconventional bank run of hedge fund withdrawals.

Fascinating stuff with the usual classy photos that make Tim Geithner look like an angry loaner with a blog, and Henry Paulson look like the goddamn devil himself.

All the names and characters are presented in a manner (whether accurately or not, I have no idea) that leaves them practically interchangeable… save one: Citi’s CEO Vikram Pandit.  Please read the whole article if you have an interest, but here is one caption that captures Pandit’s oddly logical thinking, lacking in some of the bravado and personality-infusion that characterizes much of the utterances of the other major players [all emphasis mine]:

““I haven’t been able to reach you for four hours,” Geithner barked into the phone. “That’s unacceptable on a day like today!”

Apologizing, Pandit explained that he had been talking to his team about the Goldman proposal, which they had ultimately rejected. “We’re concerned about taking on Goldman,” Pandit said, trying to explain his rationale for turning them down. “I don’t need another trillion dollars on my balance sheet.”

Geithner could only laugh to himself—Pandit should have been so lucky as to own Goldman. “This is a bank,” Pandit said. “And a bank takes deposits and a bank has a prudency culture. I cannot envision a bank taking its deposits and investing them all in hedge funds. I know that’s not what Goldman is, but the perception is that they’d be taking deposits and putting them to work against a proprietary trade. That can’t be right philosophically!””

I think his bank is a monumental failure, but this Pandit guy I feel I can understand.  Lord knows how he managed to get where he is with that kind of thinking though.

[I should add the article is actually an excerpt from Andrew Ross Sorkin's book, Too Big to Fail.  Interesting stuff in a diary-of-a-mad-man sorta way.]

… and the cow goes moo

The author (not Simon Johnson) of this post at The Baseline Scenario (found via Some Assembly Required) operates on the very logical assumption that rationing exists and will continue to exist, and tries to devise a not-too-complex (it’s health care.  It won’t be simple) modification to our current system, in broad strokes, that would accomplish many of the goals being sought after.

Go check it out.  Lots of jazzy charts to start and a simple proposal to end with.  The assumptions are fair and logical, without being unduly laborious in supporting references, and the outcome itself is palatable to almost all parties.

… and the cow goes moo

(this was supposed to be a more frequently-updated series; I’ve been meaning to follow-up this post for quite some time)

One of the interesting, but entirely misrepresented (intentionally at times, due to ignorance and parroting at other times) concepts considered at the center of the debate would be: RATIONING.

Rationing, triage, actively deciding who gets what, or constructing a system that makes the decision based on certain factors is a very interesting and messy topic that no one wants to talk about, but that is what rationing is.  And that is the decision afoot.

The debate, not surprisingly, revolves around the word and the negative connotations to it (ideas of poverty and government distribution) rather than the very complex matter of actual rationing.

The fact is, when someone doesn’t get the exact medical attention that they desire and could benefit them, we are looking at rationing.  And believe it or not, in Barack Obama’s America and even before it, we will have medical rationing.  Sadly, this is a statement so obvious that it rarely merits mention.  Sadder still, some people seem to be unaware of it entirely.

The entry of the term “rationing” in the health care debate has been KILLING me for the past few months, as no one seemed willing to point out the obvious that health care is rationed to a much greater degree now than should any prospective plan including a public option or insurance mandate be enacted.

Thankfully, this very obvious fact is finally making inroads, warranting mention in Jon Stewart’s unwatchable mess-of-a-debate with Betsy McCaughey (CDN link here, US here), the one informative bit of that entire 10 minute trainwreck, and getting solid treatment in this Matt Taibbi blog posting about the attractively pouty and vapid Maria Bartiromo’s interview with Congressman Anthony Weiner.

Taibbi’s post is, as usual, worth reading in its entirety but here is the segment that I hope to see more of:

“It drives me crazy when people make this argument. Fuck a fancy boutique drug like Erbitux — I have a very expensive private plan and I can’t even go to a doctor, not even to ask a simple question, unless it’s an emergency. [...] Hell, forget about paying for Erbitux, if I wanted to get a colonoscopy to find out if I needed Erbitux, I wouldn’t be able to — I’d probably have to wait until I was a fully symptomatic cancer patient before I could even have that conversation on my insurer’s dime. And I’m one of the lucky ones, I actually have money to pay for care out of pocket, if I had to. No country in the world rations care more than the U.S.”

Exactly.  Why does it take the closest thing we have to a renegade major journalist to point out that Americans don’t get all the treatment they want either!

Worse yet, uninsured (or under-insured, or simply less wealthy) Americans may be prone to skipping out on the most cost-effective care: preventive care, as Taibbi implies.

The great fear, living under an Obama regime, is that a screening system would be designed that would preclude older people from getting the best treatment available if the costs were too high to justify (by some crazy liberal metric) being spent on someone who might not live that much longer regardless of the care they receive.  Kind of like those organ waiting lists that everyone-but-Steve-Jobs is mercy to: With a finite resource such as transplant organs (as opposed to the apparently infinite resource of health care dollars), we must invest wisely.  Currently in America, organs are provided to those in greatest need, with the highest chance of benefiting (i.e. surviving the transplant and extending the quality or length of life as a result of a successful transplant).  Oh, and being “a youngish, white male with a big bank account and great health insurance” helps too, according to this article interviewing Dr. Benjamin Samstein, MD, assistant professor of surgery at Columbia University College of Physicians and Surgeons.  Of course, being youngish is less important if you’re a man of means, say $6 billion or so, who can move to Memphis to get equal treatment to locals on a much shorter waiting list than that of his actual state of residence.

Now, how horrible does applying the terms of transplant organ distribution to other forms of medical treatment sound?  As the good doctor Samstein says about organ ‘rationing’: “one of the fairest and most advanced we have for the allocation of healthcare resources here in the US.”

If politicians who support health care reform would just admit that there, of-fucking-course, will be rationing under any new system, and just explained how an imperfect system would be devised to replace our currently very imperfect system, we might be able to choose between the health care options that provide the best, you know, care.  And in an even crazier world, we could have a real debate about who Americans think deserve and don’t deserve every degree of care available.  Rather than trying to throw scary sounding words at a reform movement and hope they stick.

HEALTH CARE IS A FINITE RESOURCE, MOTHERFUCKERS!  HOLY CHRIST!

[Sorry.]

… and the cow goes moo

Just a quick thought comes from this headline and capsule summary in my New York Times daily e-mail:

Japan’s New Leadership
“The end of economic decline and political stagnation will take real leadership, not just trading one group of politicians for another.”

I guess I find myself wishing more comments like these were made by the left-leaning papers in regards to US leadership.  Though ‘political stagnation’ would be quite a euphemistic manner of describing the state of Washington.

… and the cow goes moo

Caught a fleeting glimpse of the wall-to-wall coverage of the late Senator Edward Kennedy.

Why does his tenure, albeit long, in Senate deserve this coverage?  One news station literally had video of a Kennedy dog (named ‘Splash’, I believe).  I left the room before I presume they began to interview Splash.

Even Michael Jackson’s death coverage may have been more deserving of this circus-level coverage.  At least his death was a bit of a surprise and under dubious circumstances.  Haven’t we all been on Ted Kennedy Deathwatch for about a year now?

I would have preferred if Robert S. McNamara have received this sort of send-off.

Actually, I would prefer if no one ever received this sort of send-off.

… and the cow goes moo

I guess I’m a bit late getting to this one after my bitchy/sarcastic post about The Washington Post’s for-pay brainstorming sessions (see said bitchy/sarcastic post here).

Apparently, The Atlantic Monthly (I will never feel comfortable calling it The Atlantic.  I think the body of water had the name first, so should get dibs) has a long history of such influence-peddling sessions of their own, according to Talking Points Memo.  It seems like The Washington Post hasn’t broken a story or even made a meaningful news innovation since Watergate…  Key snippet will follow, but please read the entire article.  It’s not long and touches on some of the broader reasons why these ’salons’ are held and how some journalistic integrity is maintained by The Atlantic Monthly and others:

“These aren’t one-off events, by a long shot. The Atlantic has held approximately 100 of them since 2003, according to Zachary Hooper, a spokesman for the magazine.

And they’re by and large initiated by the corporation that pays for them, according to Hooper. “The corporate sponsor” — with whom the magazine generally has a longstanding business relationship — “comes to us and says, ‘We’re interested in having a discussion on a certain topic.’” The magazine’s business staff, said Hooper, takes things from there.“

TPM was nice enough to link to a copy of the flyer so you can see what those wishing to purchase advertising time within a respected journal’s editorial get to see.  Former Massachusetts governor and one-time Presidential nominee Michael Dukakis is listed among the past attendees.  They make no mention if tank rides were included.

… and the cow goes moo

For those who are still waiting for their issue of Fraud Magazine in the mail, Bob Morris at Polizeros produces some rather shocking excerpts from their article about Harry Markopolous.

My favorite excerpt:

“Her supervisors told her to stop her Madoff inquiry and work on mutual fund investigations instead. Her supervisor was Branch Chief Mark Donohue, who answered to Eric Swanson, director of the department, according to Post reports. Eric Swanson is the one who later married Madoff’s niece.”

Alliances formed through marriage.  How old-timey.

(Note to self:  Father many attractive daughters and marry them to the dim-witted and morally-suspect guardians of the nation’s wealth)

At least that relationship hasn’t escaped the scrutiny of law enforcement, according to the Wall Street Journal Law Blog.  No news yet on whether or not Eric Swanson managed to marry off a daughter to a higher-up at the SEC or the Justice Department in-time to save his skin.

Check out the article and Bob’s post if you find the whole “Bernie Madoff stealing tens of billions of dollars over decades with no real scrutiny by law enforcement” thing interesting.  It’s nice to have a blogger whose partner is a Certified Fraud Examiner who reads something like Fraud Magazine.

Though I do wonder how Markopolous feels about posing for a magazine with a big “FRAUD” over his head.  I guess it’s a good thing the magazine probably doesn’t have much newstand presence.

… and the cow goes moo

Long villainized and rightfully so, Mr. McNamara managed to live to 93 and change many of our conceptions of him in his later years (the documentary film of which he was the subject, The Fog of War – Eleven Lessons from the Life of Robert S. McNamara, introduced me to the New McNamara, so much more human than the one that still resides in history).

He struggled with difficult decisions to his final years in regards to his crucial role, but perhaps not quite as great a role as suggested my the moniker “McNamara’s War”, in the prosecution of the War in Vietnam under JFK and LBJ.

Many of the decisions he made in the ’60s seem barbaric and callous to those of us with the benefits of hindsight, and millions at the time who would be considered dovish to the war.  But as time passed, and political and personal restrictions seemed to loosen, Mr. McNamara was able to voice the reservations he had about the nation’s course that he hid behind a politically-necessary facade at the time of its persecution.

In The Fog of War as well as his books (such as In Retrospect: The Tragedy and Lessons of the Vietnam War), McNamara discloses some of his decision-making processes and mounts a convincing partial-defense.  He doesn’t abdicate responsibility, nor hide regrets, but he does fill some of the holes in the public story.

His adult life was a testament to intellect and cold calculation:  His last years were a testament to the regrets that come from his years of great power, which he wielded to great effect.

His life, taken as a whole, reveals many of the once-secret processes of the executive, and attempts to reveal some of the still-secret processes of the exceptional individuals whose name are used to recall great events and great tragedies.

Let us hope that death shall salve the regrets that haunted McNamara for the past half-century, and let us hope the story of his life serve as a lesson for those who to accomplish great things without repeating all of his mistakes.

“Robert S. McNamara, Architect of a Futile War, Dies at 93 By TIM WEINER

Mr. McNamara helped lead the U.S. into the Vietnam War and spent the rest of his life wrestling with its moral consequences.”

… and the cow goes moo

I have very little to say about each of these links except that it’s been a glorious week or so of online reading.  I could not bring myself to close these articles from my Firefox tabs without recording them for posterity (as self-centered as I am, it appears I believe widely-circulated articles available on the Internet cease to exist when they leave my screen).

First, from The Atlantic Monthly (yes, I still call it that):

What Makes Us Happy? – By Joshua Wolf Shenk

An excellent, beautiful in that New Yorker-sorta way interrupted (by experiment subject narratives) interview with the man that has been behind the decades-old longitudinal Grant study at Harvard.  It makes me think my Bachelors in Psychology isn’t such a scarlet letter after all.

George Vaillant, head of the study for the past 42 years tries to plumb from the disparate measurements and surveys conducted since 1937 – questions changing to reflect the interests and eras that the study has now outlived – and from the ups, downs, ups and downs again from the cohort of Harvard men the cues to living well and growing up.

The author of the article beautifully ties Vaillant’s near-theology – which often sounds little different than self-help pablum – to Vaillant’s own surprising neuroses and private scandals.  Perhaps in doing so revealing a little known property of Psychologists (and Psychology students) outside of the discipline:  Our interest in mental illness is entirely self-serving.  Physician heal thyself.

And despite the shames of the researcher and the researched, the article lifted my spirits.  The technical feat of the collection, the triumph-against-adversity of the project itself to remain fecund and funded, moreso than even the subjects, is story of a hero.  Even if the hero is a collection of bits and bytes, papers in aged folders, and punch cards stuffed away in some filing cabinet monument in Boston.

Now from Chinese finance and economics magazine, Cai Jing (don’t worry, it’s in English):

Tight Spot for Fed, Blind Spot for Investors – Andy Xie

Mr. Xie provides what seems to me a very thorough and intuitively consistent synopsis of the state of American and international investment, with a US-centricity to his analysis despite the source of the article.

He provides a good anaylsis of the various push and pull forces active in the currency, Treasury, and commodities markets, tying his observations to current action within the equity markets and providing some broad predictions that may give pause to those on the sidelines (like myself) that have been failing to decipher all the noise of the market into something that resembles language.

On Mr. Xie’s implicit recommendation, I think I’ll invest in something loud with two wheels wrapped in Pirelli Diablo Super Corsa SPs.  I think that’s what he’s saying, anyways.

And now for something completely different!

The Ninth Life of a Berkeley Boomer – John Dolan (single page view)

Mr. Dolan always writes wonderfully (though the low-rent site which I enjoy and frequent doesn’t seem to stress spellchecks) and has some especially fascinating insights into the life of the near-literati; the failed writers who became failed academics who became just plain poor.

Here he captures the story of a friend much like himself: talented, but lacking the good sense to slow his pace to stay within the proximal zone of his ‘betters’ that would ultimately judge him and decide his fate.

In its telling, he reveals the life of some of the members of the true American elite: The filthy rich and the chieftains of academia who rule their roosts.  And even to them, a smart person cannot escape subjugation by them.  And a crazy person doesn’t escape their useful purposes.

He describes a secret bit of life that I probably always lacked the talent to access, or at least the high school extracurriculars.  And my entrance essays truly sucked.

… and the cow goes moo

I thought I’d pull together a bit of a collection of points and points of view in regards to the debate on health care.  The debate over health care is probably the most significant political discussion Americans will have during the Obama presidency, so I couldn’t pass up mentioning it.  And it happens to be a subject where I, as a former pre-med student, have more than a passing curiousity.

There certainly is a lot of noise that can be left out of the discussion, but this is one of the most important and appropriately handled political discussions that I have witnessed.  There is a fair ratio of sound-minded opinion and factual presentation to character assassination (very little so far, outside of the usual Obama-is-Black-Lenin talk) and misrepresentation and I’ve been happy to read most of the analysis that has crossed my path.  It’s like I’m in a room full of adults, for the most part.

As a Canadian who is very satisfied with our health care system, even if I am often upset with it’s practitioners and the more general prevailing approach to health care (I was born here and have never had to seek medical attention abroad, so I cannot compare directly), I enjoyed the NYT’s Nicholas Kristof’s (This Time, We Won’t Scare – June 10, 2009) anecdotal example of health care experiences from someone who had to experience both the Canadian and US approaches in succession.  Certainly as anecdotal evidence, it is meant for memorable impact more than analysis, it nonetheless manages to include a very important part of the debate that may be under-represented in statistics:  The experience.

The article points out two very poignant facts that are often overlooked as being perhaps more of emotional value then practical value, but in the field of medicine where impractical emotions can have drastic effects on physiological and behavioural responses to treatment, I would argue the lack of attention to matters such as these represent an ongoing failure of medical practice.

The two facts Kristof (and his subject, Diane Tucker) bring to the fore are: (1) the creature comforts that can be lost in a medical system like Canada’s, where there is less of a first-class and economy-class segregation of medicine (though you can certainly pay to get more even in Canada, the ‘more’ in question is irrelevant to the actual treatment); and (2) the apparent weighting of priorities in the US system, between treatment and payment.

Kristof’s subject, Diane Tucker, pays the paltry sum of $49/m for her health coverage as a Canadian resident (a deal even from my perspective, as a 20-something year old with heart like bull) and for it she receives prompt emergency service and initial response, albeit in less luxuriant quarters and with high school cafeteria-level food and perhaps (depending on what tier of American health care you wish to compare to) longer wait times for health visits required for non-emergency concerns.

The more acute and shocking revelation in the article to me, as a Canadian, is the clear message being sent by medical corporations in America when services are needed:  Before we decide to treat you, we have to be sure you can afford to pay us for it.  Apparently the first thing that Ms. Tucker needed to do when she visited a US hospital was to prove she was afford the treatment she required (or for the hospital to ascertain how much ‘treatment’ she could afford to obtain… I’ll get back to this in a second).  Perhaps I am misinterpreting this aspect of American health care, but to me the message is clear:  Prove to me you are worth helping before you prove to me you need helping.

Kristof spends much of the rest of the short article assassinating (justifiably) the character of some of those spearheading the movement against anything approaching universal health care, which interested me very little.  But the contrast between Canadian and American treatment approaches for Ms. Tucker are worth considering befor ean outcome is reached.  Weigh out the benefits of one system over the benefits of the other before you pick a favorite.  And please keep in mind what medicine should be.

[Note: I plan to continue commenting on this subject over the next bit, as I already have a few other articles and news sources saved.  Time permitting.]

… and the cow goes moo