The Daily Parker

Politics, Weather, Photography, and the Dog

Is the Covid test plan a stealth argument for single-payer? One can dream

New Republic Natalie Shure points out the absolute, crashing idiocy of getting private health insurance companies involved in procuring free Covid testing, because their whole reason for being is to prevent the efficient procurement of health care:

This rollout will be a disaster. And really, that should have been obvious: There’s a reason that the Covid-19 vaccines, monoclonal antibody treatments and antiviral drugs have been made free at the point of use, rather than routed through private insurers. It’s because the insurance industry is structurally incapable of achieving anything universally or efficiently.

That’s not hyperbole, it is by design: The role of private insurers within a for-profit multi-payer system is to restrict access as a gatekeeper, determining who is entitled to use which healthcare services and how much they pay for this. To keep these obligations profitable, they employ an army of claims assessors to argue with you, erect arbitrary hoops for providers and patients to jump through to prove you actually need certain care, raise copays and deductibles as high as possible, and foist as much of the paperwork as possible onto patients.

Insurance companies play the single ghastliest role in a legendarily ghastly healthcare system: Whatever invective you can hurl in Big Pharma’s direction, they at least produce something we actually need. Health insurers offer no value whatsoever; they have nothing to do with care itself and if the industry vaporized completely tomorrow, no one would mourn its demise—we’d all be better off. We’re maddeningly stuck with them for now, owing to a host of reasons ranging from inertia to political capture by industry.

[T]his is an object lesson: We’re in the hands of an industry that was never built to serve patients, a problem which no regulatory tweak will ever fix.

Yes, this is true. I learned that early in my career, leading to a long-standing policy of never working for a health insurer in any capacity.

Let me catalog some of my own experiences when big health-insurance companies have claimed to pay me to write software:

  • The first time, a major health-insurance company hired me to write software using a then-current technology, but the project wasn't ready to start, so they involuntarily put me on a team working with obsolete technology and a process so stultifying I didn't actually get to write code. I literally picked up my signing bonus on the way to several interviews in New York, and quit the day I got back. The entire division got dissolved about a year later.
  • Well into my professional career, I went to another major health-insurance company along with 8 other developers and managers, but under the aegis of a moderately-big consulting firm. The on-site project cost the client of about $150,000 per week. Of course, they couldn't get us network access or even a project charter. After about a month and about $750,000 spent, the company cancelled the project. I never even found out what software they proposed to build, had they gone through with, you know, building it.
  • More recently, a major health-insurance company hired me through a recently-acquired subsidiary as the 6th member of a team writing software in a language less than 3% of software developers ever use. I only took the gig because the subsidiary claimed a level of autonomy from the parent company it did not, in fact, enjoy. It occurred to me less than a week after starting that if the product we were building worked, it would undermine one of the key revenue streams of the parent company. Nevertheless, they hired a new developer to the team about every three weeks (despite an admitted 6-month ramp-up time in the language and product), at an average all-in cost of $18,000 per month per developer. I left after three months, as the team grew past 12 people and yet only completed about 5 function points a week.
    The parent company killed not only the project but also the entire acquired company about two years later. The software never shipped, though I did hear they had completed about half of the planned function points.
    On my way out the door I asked my manager what it said to him that the parent company didn't care about burning $200,000 a month on software that he and I both knew a couple of us could build in a garage in four months. He didn't say anything, but Upton Sinclair did*.

You may not see the connection between these failures, or why I jumped ship so quickly the third time, but it's actually really simple. In all three cases, the companies needed to show their shareholders ongoing investments in technology, and needed to show the general public plans for really great tools to make people's lives better any day now. But the best way any of these companies could have made anyone's lives better would be for the US government to obviate their health divisions by paying for our health care directly.

According to the World Bank, the US spends 17% of GDP on health care, behind only Tuvalu and the Marshall Islands (combined populations: 72,000). The first OECD countries on the list are Switzerland (11.9%), Germany (11.4%), and France (11.3%), all of which have vastly better outcomes than the US. How do they achieve this? By not having fat, bloody leeches draining their health spending on useless bullshit. Example: the National Institutes of Health found in a 2020 study that a staggering 34.2% of health-care expenditures in the US went into administration, compared with just 17% in Canada—and Canada has better health-care outcomes overall than we do.

Shure ends her column with an inescapable truth:

[I]t’s pretty telling that the very moment a life-threatening pandemic necessitated mass vaccination, the idea of involving private health insurance companies with that project was absolutely unthinkable. Who in their right mind would attempt to involve them in something urgent? And if they’re such a dismal way to confer access to Covid-19 testing to anyone who needs it, why the hell are they still playing the role they do in the healthcare system writ large?

Let's end this farce and get real single-payer health care in the US, so we can finally enter the 21st century with the rest of the OECD.

* "It is difficult to get a man to understand a thing when his salary depends on him not understanding it."

Fed up with all that

Three items:

  1. James Fallows reminds us that the US Senate filibuster "is a perversion of the Constitution," that "enables the very paralysis the founders were desperate to avoid," among other things. (He also links to an essay by former US Senator Al Franken (D-MN) about how cynical the filibuster has become.)
  2. Jacob Rosenberg brings together workers' own stories about how they got fed up, illustrating how "the big quit" happened.
  3. Canadian political scientist Thomas Homer-Dixon has had enough of the political disunion in the failing democracy to his south, and worries what that will mean to Canada.

On the hopeful side, though, we have the Webb Space Telescope gently nudging its mirrors into place at a rate of about 1 millimeter per day.

Visiting the remote bits of the world

I've just added two places to my shortlist of vacation spots once travel becomes a little easier.

On Tuesday, I saw Japan's entry for this year's Academy Award for best foreign film, Drive My Car (ドライブ・マイ・カー). Most of it takes place in Hiroshima, Japan. Clearly director Ryusuke Hamaguchi loves the city. For obvious reasons most of the central parts of Hiroshima only date back 70 years, but the hills and islands surrounding the postwar downtown look like the Pacific Northwest.

And this morning, the New York Times Canada Letter reported from Newfoundland. I've wanted to see the Maritime Provinces for years. Maybe Cassie and I can spend a couple of weeks some summer driving from Maine to Nova Scotia to PEI and then take a ferry to "The Rock?" (There's a ferry from North Sydney, N.S., to Channel-Port aux Basques, Nfld.)

For what it's worth, I think I'd fly to Western Japan...

Riches of embarrassment

Just a couple of eye-roll-worthy lunchtime links today:

What fun.

End of day links

While I wait for a continuous-integration pipeline to finish (with success, I hasten to add), working a bit later into the evening than usual, I have these articles to read later:

  • Canadian Prime Minister Justin Trudeau (Lib-Papineau) called a snap election to boost his party, but pissed off enough people that almost nothing at all changed.
  • Margaret Talbot calls out the State of Mississippi on the "errors of fact and judgment" in its brief to the Supreme Court about its draconian abortion law.
  • Julia Ioffe expresses no surprise that the press and the progressives have come to grief with each other over President Biden.
  • Josh Marshal examines the "crumbling firmament" signified by France's indignation at our deal to supply nuclear submarines to the Australian Navy.
  • New regulations allowing hunters to kill wolves in the northern Rocky Mountain states may have the unintended result of putting the animals back on the endangered-species list.

And I am sad to report, Cassie will not get to the dog beach tomorrow, what with the 4-meter waves and all.

The forecast didn't lie

At the moment, the 10 hottest places in the world are all in the Pacific Coast states and British Columbia. The Dalles, Ore., hit 48°C at 4pm Pacific; Portland hit 46°C, the same as Palm Springs, Calif.; and even Lytton, B.C., reports 46°C right now—the highest temperature ever recorded in Canada. All of those figures exceed yesterday's forecast and broke all-time records set just yesterday.

It's bonkers. And it won't be the last time this happens.

Here in Chicago we have a perfectly reasonable 26°C. I'll keep it.

Canadians pretending to be American

We know our neighbor to the north has its own contingent of crazy. But usually they just behave in Canadian-crazy ways. Apparently now, a group of anti-vaxxers has blockaded the Trans-Canada Highway at the Nova Scotia-New Brunswick border near Aurac, N.B.:

The main border crossing between Nova Scotia and New Brunswick has been closed for more than 18 hours, blocked by dozens of protesters demonstrating against restrictions that require most travellers from New Brunswick to self-isolate upon arrival in Nova Scotia.

The protesters include a number with anti-vaccine views. At one point, some briefly tried to stop a tractor-trailer they believed had COVID-19 vaccine, but which RCMP officers at the scene said contained blood products, from being escorted by police across the border into Nova Scotia. 

The truck eventually passed through, as did some nurses and doctors trying to get to work at the hospital in Amherst, N.S.

The Nova Scotia government announced Tuesday afternoon that most travellers from New Brunswick will continue to have to self-isolate upon arrival, a decision that came less than 24 hours before Nova Scotia opened its borders with P.E.I. and Newfoundland and Labrador without isolation or testing requirements.

Nova Scotia has for months required most travellers to quarantine for 14 days when they arrive in the province after applying for entry online. People have had to present documentation at the border showing they've been approved for entry.

Note that the quarantine rules generally don't apply to people who have gotten vaccinated against Covid-19. So only the boneheads who refuse to get the jab would have to self-isolate. And note the irony of blocking a road to protest a restriction on free travel between the provinces.

This sort of thing happens in the US, because Americans produce more batshit than any other nation on the planet. It makes me sad to see it seeping into Canada, though. Especially in the Maritimes, which I always thought had more sense than that. Ontario? Alberta? Quebec? Sure. But New Brunswick?

Douglas Coupland is annoyed with Canada's government

The author (most notably of the generation-defining novel Generation X) wants Canada to follow the science and quit screwing over my generation:

People my age and younger got the leftovers – which is fine. AstraZeneca is a terrific vaccine, people! But people my age are used to leftovers. It’s the curse of being Gen X, and it’s not very often I ever discuss Gen X qua Gen X, but I think it’s called for here. For a generation that has grown up knowing their pensions will magically vanish the moment they retire, vaccine leftovers were yet more evidence that the statistical books never seem to balance in their favour and probably never will. When some provinces began turning off the AZ tap this week, I don’t think there was even one remotely surprised 50-year-old in the country.

The fact that the announcement of AZ’s removal from the medical landscape was driven by politics and ineptitude rather than science bugged me so much that I wrote my first ever comment on The Globe and Mail’s website (which counts as some sort of milestone in my life). It said: What? Vaccines are now suddenly magically à la carte? This whole thing is starting to feel like it’s being run by Grade 11 students doing a science project.

But Andrew Potter sees freedom in our generation getting ignored:

It is commonly argued that a generation is formed by the technological ecosystem in which it grows up, and while there’s obviously something to that, what is important for Gen X is not what our technology allowed us to do, but what it protected us from.

In particular, what we were protected from was surveillance. I don’t know a single person I grew up with who doesn’t thank their lucky stars that there were no cellphones with cameras around when we were growing up, that there was no Twitter or Facebook or YouTube or TikTok. I can’t imagine what it is like to grow up under the glaring distributed panopticon of social media, knowing that all your friends, everyone at your school, and even your parents are watching your every move, judging your every utterance.  

In retrospect, it is obvious that the Gen X obsession with authenticity was anxiety caused by the growing rumblings of a culture in transition. The old technological ecosystem that fuelled the counterculture was gone, but the new web-enabled environment that made authenticity irrelevant hadn’t quite yet arrived. Gen X was the last generation to possess genuine subcultures that were able to remain somewhat unmolested by the digital meat grinder.

That is why when you hear a Gen Xer talk about being the “latchkey” generation, they aren’t really complaining — they’re bragging. There’s another word for the neglect being described here, and that’s freedom.

I've watched that technological transformation from the inside, having had an online presence since 1986. My feeling: they're both right.

Good morning!

Two travel stories arrived in my mailbox overnight. First, China has landed a probe on Mars, becoming the third country in history to do so:

The touchdown makes China the second country in history to deposit a rover on the surface of Mars. After months in orbit around the red planet, the Tianwen-1 spacecraft released the Zhurong rover for a landing in Utopia Planitia, a vast plain that may once have been covered by an ancient Martian ocean. The 529-pound rover survived a perilous descent to the surface, including atmospheric entry, slowing from supersonic speeds with a parachute, and finally using retrorockets to safely alight on the ground.

China will openly share the data from Tianwen-1 and Zhurong the same way it has shared data from its lunar exploration missions, Long says, benefiting planetary scientists around the world.

The mission will also set the stage for China’s next planned voyage to Mars—an audacious sample-return attempt scheduled to launch around 2028. Beyond Mars, the country has plans to launch a Jupiter probe, including a possible landing on the moon Callisto, to collect samples from a near-Earth asteroid, and to send a pair of Voyager-like spacecraft toward the edges of the solar system.

Closer to home, after suspending service last year because of the pandemic, Greyhound Canada announced this week that it has decided to completely end all Canadian services:

The bus company says all of its remaining routes will cease operations as of midnight Thursday.

The iconic bus carrier pulled out of Western Canada in 2018

It then put its remaining routes in Ontario and Quebec on pause when COVID-19 hit in 2020, but now it is pulling out of domestic Canadian service permanently.

The federal [New Democratic Party] also laid blame on the government. "The loss of all remaining Greyhound bus routes leaves many communities without affordable, safe passenger transportation," Transportation Critic Taylor Bachrach said in a release. "And it disproportionately affects the most marginalized residents, including Indigenous people and seniors."

Rural areas will suffer the most, as since Greyhound's suspension last year left many without any long-distance transportation services.

Today is slightly longer than yesterday

The December solstice happened about 8 hours ago, which means we'll have slightly more daylight today than we had yesterday. Today is also the 50th anniversary of Elvis Presley's meeting with Richard Nixon in the White House.

More odd things of note:

Finally, it's very likely you've made out with a drowning victim from the 19th century.