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."

Winter, CPS, CTU, and THC

Every so often in the winter, a cold front pushes in overnight, giving us the warmest temperature of the day at midnight. Welcome to my morning:

The sun actually came out a few minutes ago—right around the time the temperature started dropping faster.

The forecast says temperatures will continue falling to about -12°C by 3pm, rise ever so slightly overnight and tomorrow, then slide on down to -17° from 3pm tomorrow to 6am Friday. And, because it's Chicago, and because the circumpolar jet stream looks like Charlie Brown's shirt right now, between 6am Friday and 9pm Saturday the temperature will steadily rise more than 20°C (that's 36°F to the luddites out there), peaking at 3°C around 9pm Saturday.

Before the cold front hit last night, the Chicago Teachers Union voted to halt in-person teaching, citing alarming Covid numbers. The Chicago Public Schools promptly locked them out of virtual teaching, giving about 100,000 nothing to do and nowhere to go. (Some CPS staff have at least opened the school buildings so kids can get lunches and stay warm, but the SEIU won't cross what it sees as a picket line, so...)

Since most of the area's colleges and universities have moved back to virtual instruction for the next two weeks, I have trouble understanding the CPS position here, or why CPS locked the teachers out. Sure, the teachers may lose a day's pay, but the kids will suffer more harm than either organization.

Chicago's public health officials say the schools are safe, with Chicago Mayor Lori Lightfoot complaining that "There’s no reason to shut down the entire system, particularly given the catastrophic consequences that will flow." But the CTU didn't call a work stoppage; they called for virtual classes, something CPS has done for almost two years. That leaves me with the impression that Lightfoot and CPS want to stand up to the CTU more than they want to find a solution.

Frankly, both sides look bad here. And again: the kids get the worst of it.

Hard to imagine why Illinois recreational marijuana sales doubled to $1.38 billion in 2021.

Crisp fall morning

Cassie and I both love these crystal-clear autumn days in Chicago, though as far as I know she spent her first two autumns in Tennessee. Does Nashville have crisp fall mornings? I don't know for sure, and Cassie won't say.

I meant to highlight these stories yesterday but got into the deep flow of refactoring:

I will now make Cassie drool buckets by using salmon skin as a training tool.

Dying for the cause

Former Chicago Fraternal Order of Police president Dean Angelo died yesterday of Covid-19. And yet the current FOP president, John Catanzara, has promised to sue the City over the requirement that police officers either show proof of vaccination by Friday or go on a twice-a-week testing regimen if they want to keep getting paid:

"It literally has been like everything else with this mayor the last two and a half years," said FOP President John Catanzara. "Do it or else because I said so."

In a social media post Tuesday, Catanzara urged his members to not comply with the vaccine mandate.

"We're notifying the city the demand for expedited arbitration along with filing unfair labor practice with the labor board," he said Tuesday. "Tomorrow we'll be filing court paperwork for a temporary restraining order."

The dispute comes as a new report from the National Law Enforcement Museum reveals that a full 62% of all line-of-duty law enforcement deaths across the country last year were from COVID-19.

(Emphasis mine.)

In related news, I'm about a quarter through Ruth Ben-Ghiat's Strongmen: Mussolini to the Present, in which she details the patterns of authoritarians throughout the last century. In almost every case, the authoritarian leader demands his followers show loyalty by embracing lies, even when those lies kill them.

Ben-Ghiat's book, like the story today of Angelo's death, frustrate the hell out of me. We make the same mistakes over and over and over. Ultimately, though, we haven't had enough time away from the savannahs of Africa to stop acting like frightened apes half the time.

How many steps must a person take?

About 7,000 a day, though it won't hurt to do 10,000:

[T]wo studies, which, together, followed more than 10,000 men and women for decades, show that the right types and amounts of physical activity reduce the risk of premature death by as much as 70 percent.

But they also suggest that there can be an upper limit to the longevity benefits of being active, and pushing beyond that ceiling is unlikely to add years to our life spans and, in extreme cases, might be detrimental.

[A]t 10,000 steps, the benefits leveled off. “There was a point of diminishing returns,” said Amanda Paluch, an assistant professor of kinesiology at the University of Massachusetts Amherst, who led the new study. People taking more than 10,000 steps per day, even plenty more, rarely outlived those taking at least 7,000.

Both studies pinpoint the sweet spot for activity and longevity at somewhere around 7,000 to 8,000 daily steps or about 30 to 45 minutes of exercise most days. Doing more may marginally improve your odds of a long life, Dr. O’Keefe said, but not by much, and doing far more might, at some point, be counterproductive.

I get about 13,000 per day, in part because of Cassie. Which seems fine, according to the report. Note that neither study actually found a causal link between steps and health; the effects only appear related.

Taliban victory

Religious extremists, emboldened by lucky tactical and political successes over the past few years despite declining popular support, today won a major victory in their campaign to return women to a state of subjugation that they had only recently escaped. Supporters and allies of the religious leaders imposing the harsh new laws against women celebrated, driving around in pickup trucks while displaying traditional symbols of oppression.

Afghanistan? Iran? Saudi Arabia?

Nope. Texas:

[T]he Supreme Court on Wednesday confirmed what it had previously only implied through its failure to act the night before: The court rejected a request to block enforcement of the law, which abortion providers say will bar at least 85% of abortions in the state and will likely cause many clinics to close, while a challenge to its constitutionality is litigated in the lower courts. The vote was 5-4, with Chief Justice John Roberts joining the court’s three liberal justices – Stephen Breyer, Sonia Sotomayor and Elena Kagan – in dissent.

The case, Whole Woman’s Health v. Jackson, had come to the court on an emergency basis on Monday, with a group of abortion providers asking the justices to intervene. It was the first major test on abortion rights for the Roberts court since the death of Justice Ruth Bader Ginsburg in September 2020, and Ginsburg’s replacement by the conservative Justice Amy Coney Barrett was likely decisive in the outcome.

The court’s inaction on Tuesday night that allowed the Texas law to go into effect and its brief order on Wednesday night denying any relief to the abortion providers unquestionably represented a victory for abortion foes, but the five-justice majority emphasized (and Roberts in his dissent reiterated) that the court was not endorsing the constitutionality of the law. The ruling also revealed a court that is deeply divided, not only on the merits of the case but also on the procedures that the court uses to resolve these kinds of emergency appeals.

Justice Sotomayor pulled no punches:

The Court’s order is stunning. Presented with an application to enjoin a flagrantly unconstitutional law engineered to prohibit women from exercising their constitutional rights and evade judicial scrutiny, a majority of Justices have opted to bury their heads in the sand. Last night, the Court silently acquiesced in a State’s enactment of a law that flouts nearly 50 years of federal precedents. Today, the Court belatedly explains that it declined to grant relief because of procedural complexities of the State’s own invention.

[T]he Act is a breathtaking act of defiance—of the Constitution, of this Court’s precedents, and of the rights of women seeking abortions throughout Texas.

The Court's two conservative justices (Roberts and Breyer) joined with the Court's two liberals (Kagan and Sotomayor) but could not overcome the five Republican justices demonstrating their true loyalties.

The immediate effect of the Court's shadow-docket lawmaking is that about half of all abortion services in Texas have closed as of this afternoon.

Tennessee punishes teenagers with health mandate

The Tennessee Dept of Health will stop telling adolescents about vaccinesespecially about the HPV vaccine:

The Tennessee Department of Health will halt all adolescent vaccine outreach – not just for coronavirus, but all diseases – amid pressure from Republican state lawmakers, according to an internal report and agency emails obtained by the Tennessean. If the health department must issue any information about vaccines, staff are instructed to strip the agency logo off the documents.

The health department will also stop all COVID-19 vaccine events on school property, despite holding at least one such event this month. The decisions to end vaccine outreach and school events come directly from Health Commissioner Dr. Lisa Piercey, the internal report states.

After the health department's internal COVID-19 report was circulated on Friday, the rollback of vaccine outreach was further detailed in a Monday email from agency Chief Medical Officer Dr. Tim Jones.

Jones told staff they should conduct "no proactive outreach regarding routine vaccines" and "no outreach whatsoever regarding the HPV vaccine." 

Staff were also told not to do any "pre-planning" for flu shots events at schools. Any information released about back-to-school vaccinations should come from the Tennessee Department of Education, not the Tennessee Department of Health, Jones wrote.

Decisions to ratchet back outreach comes amid pressure from conservative lawmakers, who have embraced misinformation about the coronavirus vaccine, said Dr. Michelle Fiscus, Tennessee's former top vaccine official.

Despite being Cassie's birthplace, not to mention the state other close friends come from, we must remember that it also hosted the Scopes trial in 1925. The state government has a long history of anti-science legislation. This mandate seems particularly idiotic, but we also have to remember that with the modern Republican Party, the cruelty is the point.

Yeah, so, 10k steps isn't all that

The New York Times throws cold water on a health fad:

According to Dr. I-Min Lee, a professor of epidemiology at the Harvard T.H. Chan School of Public Health and an expert on step counts and health, the 10,000-steps target became popular in Japan in the 1960s. A clock maker, hoping to capitalize on interest in fitness after the 1964 Tokyo Olympic Games, mass-produced a pedometer with a name that, when written in Japanese characters, resembled a walking man. It also translated as “10,000-steps meter,” creating a walking aim that, through the decades, somehow became embedded in our global consciousness — and fitness trackers.

But today’s best science suggests we do not need to take 10,000 steps a day, which is about five miles, for the sake of our health or longevity.

A 2019 study by Dr. Lee and her colleagues found that women in their 70s who managed as few as 4,400 steps a day reduced their risk of premature death by about 40 percent, compared to women completing 2,700 or fewer steps a day. The risks for early death continued to drop among the women walking more than 5,000 steps a day, but benefits plateaued at about 7,500 daily steps. In other words, older women who completed fewer than half of the mythic 10,000 daily steps tended to live substantially longer than those who covered even less ground.

Another, more expansive study last year of almost 5,000 middle-aged men and women of various ethnicities likewise found that 10,000 steps a day are not a requirement for longevity. In that study, people who walked for about 8,000 steps a day were half as likely to die prematurely from heart disease or any other cause as those who accumulated 4,000 steps a day. The statistical benefits of additional steps were slight, meaning it did not hurt people to amass more daily steps, up to and beyond the 10,000-steps mark. But the extra steps did not provide much additional protection against dying young, either.

I've hit 10,000 steps 139 days in a row, but I have to keep that up through December 31st to tie my record of 312 days. In fact, in the last year, I've hit the goal 345 times, and since getting a Fitbit in October 2014, I've hit the goal 91.4% of the time. Will it kill me to stop after 9,000 steps? No. But it's an easy goal to understand and to work towards.

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?

It's over (mostly)

After 448 days, the State of Illinois and the City of Chicago have lifted all capacity limits and most other intrusive Covid-19 mitigation factors. We haven't gone completely back to normal, but it feels a lot more so than it did even a month ago.

The Tribune has a round-up of what rules remain in place and what has lifted. Mainly we still need masks on public transit and in places where owners or managers require them, and some "Covid theater" will continue where people demand it. But restaurants, movie theaters, and grocery stores can now go back to business as usual.

Even before today, some businesses had changed their signs to require masks only for unvaccinated customers. I will continue to mask up in those places, as well as in confined areas where I can't predict whether the people around me have gotten their jabs. If I'm in an airplane or a hospital, I'll even use a KN-95 instead of a decorative cloth mask.

Still, it's really (mostly) over. And we're all incredibly relieved.