Chart of the day

Wow, after being relatively steady for a long time, the percentage of medical practices owned by doctors has dropped from about two-thirds to under half in the last five years:

More here.

One of the most interesting movie reviews I've ever read

A. O. Scott's review for Greenberg pretty much stands on its own. :-)

Humility

It's late and it's been a long day, but I just feel the need to briefly write a few lines. I spent most of it at the office working in the familiar corporate environment. But this evening I had a four hour shift, ending at midnight, at a detox unit (aka the drunk tank).

Today I was exposed to the folks struggling on the street, to the people who were bringing them in and taking care of them (who probably never really imagined it'd be like this when they decided to go into public service), and to the men and women fortunate enough to work in a clean, well-tended environment by day. No one knows what anyone else's life is really like, and walking in everyone's shoes is different. But today I got a hefty dose of humility with respect to the many walks of life that people take and gained a stronger sense of respect for the difficult jobs that so many people step into. It's a rough world out there.

Song of the day

"Love is All Around" by Sonny Curtis... here's the second season version from the one and only Mary Tyler Moore Show.

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Quote for the day

Complacency is a state of mind that exists only in retrospective: it has to be shattered before being ascertained.

-- Vladimir Nabokov

Public warming up to healthcare reform

Gallup conducted a poll on Monday, the day after the House passed the Senate's version of healthcare reform. Their findings: 49% thought it was a good thing, 40% a bad thing, and the rest were undecided. Independents were evenly divided.

Considering all the rhetoric about this bill "being shoved down the American's people throat," it looks like we're moving in the right direction.

Quote for the day

There's always something to suggest that you'll never be who you wanted to be. Your choice is to take it or keep on moving.

-- Phylicia Rashad

A life I've never lived

My life is different now. And it's different in a way that allows me to see how what seemed different before was largely more of the same.

I'm not saying my life is better now. Nor that it's worse. But rather that the overall flavor has changed.

For about twenty years--from my college graduation through the end of 2008--my life was largely variations on a theme. There were wonderful times and some lousy times and a bunch of plain ol' run-of-the-mill times. But my life was characterized by a certain set of assumptions about what I wanted and who I was.

Last year was a transition year. Last year was a fire year. Last year was just about as bad a time as I've ever had.

This year seemed to be starting out on the same footing. But when I felt myself at my lowest, I listened to a friend and took a drive to the coast. Standing on the beach, I opened myself up to the universe and asked for a sign. And within a couple of hours, a conversation with a stranger made all the difference. She simply said a few words that turned on the lights in a darkened room, and in that moment I saw where I was going again.

I don't know exactly what next year is going to look like, but I know it will be different than this year. I don't know what 2012 will be like, but I know it will be a change from 2011. For much of the last 20 years, I wouldn't have said that. Despite the apparent drama of those times, I pretty much knew what I'd be doing: striving for love, working a high tech job. For much of those two decades, in fact, the changes that seemed so monumental from season to season were, in retrospect, pretty minor. Fabulous and wonderful and heartbreaking... but not in ways that called on me to push myself much or grow in any significant ways.

I'm finally dangling my feet into a new pond... learning new skills for work in a new industry. Starting at the bottom again. Continuing to learn. Being unable to coast anymore. Looking at working two jobs and going to school at the same time, struggling in ways that I never had to the first time around. Living with new priorities.

Maybe this feeling right now is a delusion. Maybe in 20 years I'll look back and think that these times were no different than any of the others. And if that's the case, it'll mean that I've got some other lesson to savor.

But everything is telling me right now that my life is different. And I'm going to live it that way.

Quote for this historic day

Listening to Republican Congressmen tonight, as well as conservative callers to C-SPAN, I was dumbstruck by the number of people claiming that Congress was somehow overriding the will of the people and ramming something down America's collective throat. Do they really believe that our government only does things that have more than 50% support in opinion polls? And if they believe that, how can they explain that the Iraq War continued long after the war lost support? It boggles the mind.

On that note, I thought this observation from Andrew Samwick was right on target:

I don't think anyone will hold up the bill that will pass as exemplary, but it does reflect elements of health care reform that Democrats campaigned on and won on in 2008. So I have a hard time seeing this as doing violence to the will of the people as it is typically expressed in our electoral system. Elections matter. This is how they matter.

Another conservative take on today's consequences from David Frum; he thinks passage of healthcare reform is a disaster for the Republican Party. And Ross Douthat, also on the right, is somewhat relieved that America will finally get the opportunity to see who is right about this bill: its supporters or its opponents. He is skeptical, but also hopeful.

And looking back on this historic day, it's important to note that Teddy Roosevelt campaigned for president on a platform which included national health insurance back in 1912. Almost 100 years later, we've finally achieved that goal. The New York Times has a timeline here.

They passed the damn bill...

It's about time. The funny thing was, I was watching the House vote on C-SPAN, and after the 219-212 vote, it took me a moment to realize that they just passed healthcare reform.

And making good on my earlier comments about "no $$$ until action," I just sent $20 to the Democratic Party.

President Obama speaks about the passage of health insurance reform here. The New York Times summarizes the legislation's provisions here.

GOP Congressman justifies racial slurs

I saw this earlier today on C-SPAN and just had to turn off the television. GOP Congressman Devin Nunes' justification of the use of racial slurs, along with his blatant lies about the legislation being voted on today and how it was crafted, was so disgusting I just had to turn the television off.

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They're not just voting on health insurance reform today...

The bill that modifies the Senate healthcare legislation also cuts out the middlemen in the government's student loan programs, ensuring that more money actually ends up benefiting students rather than lenders.

To sleep, perchance to dream

Jonah Lehrer distills the latest research on dreams and why we have them: it appears that they serve as a mechanism for allowing us to replay what's happened to us during the day, sort out the useful knowledge from the chaff, and look for useful correlations with existing knowledge.

Sometimes I just don't understand the world

A Portland middle school bans "out of control" hugging.

WTF?

Milgram lives

In France, participants appearing in what they thought was a pilot for a new game show were quite willing to deliver "dangerous" shocks to people. And, apparently, they were even more obedient in this experiment than those in the original one conducted by Milgram in the 60s.

Blunt feedback to Israel from the State Department

From the New York Times:

In a tense, 43-minute phone call on Friday morning, Secretary of State Hillary Rodham Clinton told Prime Minister Benjamin Netanyahu that Israel’s plan for new housing units for Jews in East Jerusalem sent a “deeply negative signal” about Israeli-American relations, and not just because it spoiled a visit by Vice President Joseph R. Biden Jr.

Mr. Biden, in Israel this week to declare American support for its security, had already condemned the move as undermining the peace process. But Mrs. Clinton went a good deal further in her conversation with Mr. Netanyahu, saying it had harmed “the bilateral relationship,” according to the State Department spokesman, Philip J. Crowley.

Such blunt language toward Israel is very rare from an American administration, and several officials said Mrs. Clinton was relaying the anger of President Obama at the announcement, which was made by Israel’s Interior Ministry and which Mr. Netanyahu said caught him off guard.

The Israeli leader repeated his surprise about the plan to Mrs. Clinton, a senior official said, and apologized again for the timing. But that did not appear to mollify Mrs. Clinton, who said she “could not understand how this happened, particularly in light of the United States’ strong commitment to Israel’s security,” Mr. Crowley said.
Hours after the phone call, Israel was again condemned for the plan in a statement issued by the United States, Russia, the European Union and the United Nations, which work together in a group known as the Middle East quartet to mediate Israeli-Palestinian peace talks.

The Israeli ambassador to Washington, Michael B. Oren, was summoned to the State Department on Friday by the deputy secretary of state, James B. Steinberg, a senior American official said. The Israeli Embassy declined to comment on Friday evening.

The coordinated moves were a remarkable show of displeasure by the Obama administration, which has been rebuffed in its yearlong effort to persuade Israel to freeze construction of settlements as a first step toward reviving the long-stalled peace talks. Mr. Obama has been personally involved, discussing the matter with Mrs. Clinton in their regularly scheduled Oval Office meeting on Thursday.

How to think about healthcare spending

Here's an interesting article by Victor R. Fuchs, Ph.D, in the New England Journal of Medicine. It looks at future healthcare spending costs; here's what it has to say about advances in medical technology:

Equally important, and equally difficult to predict, are advances in medicine, or in economic terms, changes in medical technology. New drugs, new devices, new imaging techniques, and new surgical procedures have had a huge impact on health care expenditures in the past and probably will in the future as well.

Those who create biomedical innovations usually claim that they reduce costs by detecting or treating diseases more effectively than existing interventions. Most health economists believe that biomedical innovations increase health care expenditures. Both can be correct. Some interventions, such as antihypertensive drugs and cardiovascular surgery, have been found to be cost-effective — that is, the value of their beneficial effects, in terms of lives saved, has been judged to exceed their costs. But because these interventions are used in many more patients than they were in the past, their effect is to increase total expenditures. The scale has tipped particularly far in the case of new interventions for cancer and other diseases that have resulted in only modest improvements in health despite large increases in expenditures....

The role of new medical technology deserves special attention in thinking about future health care spending because biomedical innovations as a whole have been the primary source of both improvements in health and increasing expenditures. On the one hand, it is fiscally irresponsible to continue to accept innovations regardless of cost, even if they pass tests of safety and efficacy — and it is particularly irresponsible when the interventions are provided at public expense. On the other hand, we must avoid an innovation policy that cuts off new interventions prematurely. Some interventions that are not cost-effective at first may prove to be so over time and with greater experience in implementing them.

Fuchs also looks at how a public/private paradigm for determining how much we should spend on healthcare helps to frame the question in a useful way. Full article here.

Who is Obama?

David Brooks takes a stab at an answer... and notes that few Americans can really see the reality of who Obama is because of being nestled too snugly in their own "information cocoons."

Most idiotic fundraising letter ever

Alternative title: Does the GOP leadership really think Republicans are this stupid?

Two years ago I sent John McCain a $5 contribution to get on his mailing list. Yesterday I received what must be the dumbest request for money I've ever seen. It came from the National Republican Congressional Committee (all emphasis in the original):

The enclosed 2010 Campaign Battle Plan outlines the National Republican Congressional Committee's (NRCC) strategy to elect a new GOP majority and remove Nancy Pelosi as Speaker of the House.

I'm sharing this information with you because as a long-time Republican activist, you've done a lot for our principles and our Party over the years. As a GOP leader and a patriot, you have a lot at stake in the outcome of this year's elections.

But please keep in mind that your copy of our Campaign Battle Plan is CONFIDENTIAL - it is intended "for your eyes only" so please take care not to leave it lying around for others to see it.

In fact, I'm going to ask you a special favor: After you've read this confidential proposal, please return it in the postage paid envelope I've provided.

That way I will know that you've received and examined your copy of our Campaign Battle Plan. I've only sent a limited number to a select group of knowledgeable and experienced Republicans, and each one must be accounted for.

The contribution form (at the bottom of my copy of the 2010 CAMPAIGN BATTLE PLAN) offers contribution levels from $25 to $720 along with "other." It also has a space labeled "I have reviewed and approved these plans. - Initial here."

I sent it back with a checkmark and one Canadian penny. I mean, come on... really?

Chart of the day

This chart helps to explain why a Big Mac is cheaper than a salad: look how the federal government allocates agricultural subsidies compared to recommendations for a healthy diet. Ridiculous.

More here and here. For more information on the cost of producing various meats, check out this old post.

The power to choose what we think about

I just finished reading one of the best commencement addresses I've ever come across: David Foster Wallace's speech given to the Kenyon College Class of 2005. Wallace talks about the true value of a liberal arts college and the choice we have of what to think about--and how to think about it--every waking moment of our lives.

A couple of excerpts, the first on our default assumptions and ways of thinking:

Because a huge percentage of the stuff that I tend to be automatically certain of is, it turns out, totally wrong and deluded. I have learned this the hard way, as I predict you graduates will, too.

Here is just one example of the total wrongness of something I tend to be automatically sure of: everything in my own immediate experience supports my deep belief that I am the absolute centre of the universe; the realest, most vivid and important person in existence. We rarely think about this sort of natural, basic self-centredness because it's so socially repulsive. But it's pretty much the same for all of us. It is our default setting, hard-wired into our boards at birth. Think about it: there is no experience you have had that you are not the absolute centre of. The world as you experience it is there in front of YOU or behind YOU, to the left or right of YOU, on YOUR TV or YOUR monitor. And so on. Other people's thoughts and feelings have to be communicated to you somehow, but your own are so immediate, urgent, real.

Please don't worry that I'm getting ready to lecture you about compassion or other-directedness or all the so-called virtues. This is not a matter of virtue. It's a matter of my choosing to do the work of somehow altering or getting free of my natural, hard-wired default setting which is to be deeply and literally self-centered and to see and interpret everything through this lens of self. People who can adjust their natural default setting this way are often described as being "well-adjusted", which I suggest to you is not an accidental term.

Given the triumphant academic setting here, an obvious question is how much of this work of adjusting our default setting involves actual knowledge or intellect. This question gets very tricky. Probably the most dangerous thing about an academic education--least in my own case--is that it enables my tendency to over-intellectualise stuff, to get lost in abstract argument inside my head, instead of simply paying attention to what is going on right in front of me, paying attention to what is going on inside me

And the second on the nature of worship in its most general sense:

Because here's something else that's weird but true: in the day-to-day trenches of adult life, there is actually no such thing as atheism. There is no such thing as not worshipping. Everybody worships. The only choice we get is what to worship. And the compelling reason for maybe choosing some sort of god or spiritual-type thing to worship--be it JC or Allah, be it YHWH or the Wiccan Mother Goddess, or the Four Noble Truths, or some inviolable set of ethical principles--is that pretty much anything else you worship will eat you alive. If you worship money and things, if they are where you tap real meaning in life, then you will never have enough, never feel you have enough. It's the truth. Worship your body and beauty and sexual allure and you will always feel ugly. And when time and age start showing, you will die a million deaths before they finally grieve you. On one level, we all know this stuff already. It's been codified as myths, proverbs, clichés, epigrams, parables; the skeleton of every great story. The whole trick is keeping the truth up front in daily consciousness.

Worship power, you will end up feeling weak and afraid, and you will need ever more power over others to numb you to your own fear. Worship your intellect, being seen as smart, you will end up feeling stupid, a fraud, always on the verge of being found out. But the insidious thing about these forms of worship is not that they're evil or sinful, it's that they're unconscious. They are default settings.

They're the kind of worship you just gradually slip into, day after day, getting more and more selective about what you see and how you measure value without ever being fully aware that that's what you're doing.

And the so-called real world will not discourage you from operating on your default settings, because the so-called real world of men and money and power hums merrily along in a pool of fear and anger and frustration and craving and worship of self. Our own present culture has harnessed these forces in ways that have yielded extraordinary wealth and comfort and personal freedom. The freedom all to be lords of our tiny skull-sized kingdoms, alone at the centre of all creation. This kind of freedom has much to recommend it. But of course there are all different kinds of freedom, and the kind that is most precious you will not hear much talk about much in the great outside world of wanting and achieving.... The really important kind of freedom involves attention and awareness and discipline, and being able truly to care about other people and to sacrifice for them over and over in myriad petty, unsexy ways every day.

That is real freedom. That is being educated, and understanding how to think. The alternative is unconsciousness, the default setting, the rat race, the constant gnawing sense of having had, and lost, some infinite thing.

Wake the sleeping giant...

Conservative Republicans do the darndest things

It just boggles the mind. A conservative, "family values" California state senator who has voted against every gay rights bill that's been before him gets arrested for a DUI after leaving a gay bar.

I mean, really? How do schizophrenic people like this get elected?

More here.

Timshel

Until the first DVD arrived earlier this week, I'd forgotten how much I liked Lee Holdridge's theme from the 1980 miniseries version of one of my favorite books, East of Eden.

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Ah... Jane Seymour! Such a perfect Cathy.

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The miniseries is a far truer to John Steinbeck's East of Eden than the James Dean version. But you really have to read the book which expands on the theme of Cain and Abel.

My favorite part is the passage that delves into Genesis 4:1-7. Does God order man to conquer sin? Or declare that man will? Or is there another possibility?

In East of Eden, the case is made that most versions of the Bible have mistranslated a key Hebrew word, and that the correct translation gives man free will: It's "the word timshel—‘Thou mayest’— that gives a choice. It might be the most important word in the world. That says the way is open. That throws it right back on a man."

In other words, it's up to man to choose to conquer sin; there's no command, no pre-ordainment.

Read the whole passage here.

Bill Gross on how we got into this financial mess

Here's an interesting description of how the world got into this financial mess from bond guru Bill Gross:

To begin with, let’s get reacquainted with the fundamental economic problem of our age – lack of global aggregate demand – and how we got to where we are today: (1) Twenty years of accelerated globalization incrementally undermined the real incomes of most developed countries’ workers/citizens, forcing governments to promote leverage and asset price appreciation in order to fill in what is known as an “aggregate demand” gap – making sure that consumers keep buying things. When the private sector assumed too much debt and asset prices bubbled (think subprimes and houses, or dotcoms/NASDAQ 5000), American-style capitalism with its leverage, deregulation, and religious belief in lower and lower taxes reached a dead end. There was a willingness to keep on consuming, there just wasn’t the wallet. Vigilantes – bond market or otherwise – took away the credit card like parents do with a mall-crazed teenager. (2) The cancellation of credit cards led to the Great Recession and private sector deleveraging, the beginning of government policy reregulation, and gradual deglobalization – a reversal of over 20 years of trade policies and free market orthodoxy. In order to get us out of the sinkhole and avoid another Great Depression, the visible fist of government stepped in to replace the invisible hand of Adam Smith. Short-term interest rates headed to 0% and monetary policies of central banks incorporated new measures labeled “quantitative easing,” which essentially involved the writing of trillions of dollars of checks to replace the trillions of dollars of credit that disappeared after Lehman Brothers. In addition, government fiscal policies, in combination with declining revenues, led to double-digit deficits as a percentage of GDP in many countries, a condition unheard of since the Great Depression. (3) For awhile it seemed that all was well, that the government’s checkbook could replace the private market’s wallet and credit cards. Risk markets returned to normal P/Es as did interest rate spreads, and GDP growth resumed; it was only a matter of time before job growth would assure the world that we could believe in the tooth fairy again. Capitalism based on asset price appreciation was back. It would only be a matter of time before home prices followed stock prices higher and those refis and second mortgages would stuff our wallets once again. (4) Ah, but Dubai, Iceland, Ireland and recently Greece pointed to a potential flaw in the model. Shaking hands with the government was a brilliant strategy in 2009 when it was assumed that governments had an infinite capacity to leverage themselves.

But what if they didn’t? What if, as Carmen Reinhart and Kenneth Rogoff have pointed out in their book, “This Time is Different,” our modern era was similar to history over the past several centuries when financial crises led to sovereign defaults or at least uncomfortable economic growth environments where real GDP was subpar based on onerous debt levels – sovereign and private market alike. What if – to put it simply – you couldn’t get out of a debt crisis by creating more debt?

Read the full article here; the "meat" begins about a third of the way in.

Rainbow wedding bells are ringing

Gay marriage is now legal in the nation's capital:

Washington is now the sixth place in the nation where same-sex marriages can take place. Connecticut, Iowa, Massachusetts, New Hampshire and Vermont also issue marriage licenses to same-sex couples....

The law survived Congressional attempts to block it, and Chief Justice John G. Roberts Jr. on Tuesday rejected a request from opponents of gay marriage to have the United States Supreme Court put the new law on hold.

Mayor Adrian M. Fenty signed the measure into law in December, but because Washington is not a state, the law had to undergo Congressional review, which ended Tuesday....

The city’s new law was already having regional implications.

Last Wednesday, Maryland’s attorney general, Douglas F. Gansler, issued a legal opinion concluding that his state should immediately recognize same-sex marriages performed elsewhere.

Mr. Gansler’s move is expected to draw legal and legislative challenges, but for Terrance Heath it was the turning point that convinced him to get married.

“We realized that we can finally get many of the benefits and protections that other couples take for granted,” said Mr. Heath, a 41-year-old blogger who lives with his partner, Rick Imirowicz, 43, and their two adopted sons in Montgomery County, Md.

“Before that attorney general decision we could have the legal documents, like wills and medical power of attorney,” Mr. Heath said. “But there was no guarantee that those documents would be recognized.”

He said that he and Mr. Imirowicz had worried about what might happen to any inheritance meant for their adopted sons, Parker, 7, and Dylan, 2.

“Marriage gives us peace of mind,” Mr. Heath said. “It gives my family security that we deserve.”

Mechanical Mozart

A Daily Dish reader writes in with an interesting response to a post on David Cope's computer-generated music:

I've wondered myself, too many times to count, why it is that this or that piece of music stirs me so much. I think, I'm being communicated with by a deep soul. Here is Mozart or Mahler or Beethoven speaking to me in a voice that I recognize, and it seems so clear that it must have some meaning. But if it is only notes, then there may not really be anything profound there at all, only my own projections. That's a very lonely thought.

Haven't you ever tried to share a piece of music with someone and felt frustrated by the experience? I have. I've given away CDs and dragged people to concerts, given little parlor lectures explaining how sonata form works, tried to transfer my enthusiasm about particular works to people so they would hear something the way I heard it. And yet, they usually don't. How can they react this way when I feel like I'm in the presence of God just listening to this music? And the answer is, the music itself is wonderful, but the feelings that I experience ARE my own projections. Most people may hear something sad and sweet when they listen to Mozart's Sinfonia K.364 second movement (youtube it [listen below]) but they can't possibly hear it the way I hear it. We are trapped in our own private bubbles projecting feelings and meanings onto patterns of notes and sounds that remind us of things, that trigger feelings.

Music is like a Rorschach test, although a somewhat more reliable, perhaps, in that we assume the composer wanted to convey something that we might have picked up. Cope's programs have no assumption of such intent. That creates a problem for us. And when that music sounds just like something we are used to thinking of as the voice of God, wooWEE, it's cognitive dissonance salad time. You have to give Cope credit for this, whether you care for his music or not.

And here is the second movement of Mozart's Sinfonia Concertante K. 364 which was mentioned above:

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Mom's quote of the day

The true meaning of life is to plant trees under whose shade you do not expect to sit.

-- Nelson Henderson