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."

Hot time in the city, again

It turns out, 2021 wasn't the hottest on record for the planet, nor were the most records set, nor was Arctic sea ice at its lowest level, or rainfall at its highest. But 2021 was the 7th year of a 7-year run of the hottest years ever:

In 2021, global temperatures were between 1.1 and 1.2 degrees Celsius (2.2 degrees Fahrenheit) above the preindustrial average, according to new data from NASA, the National Oceanic and Atmospheric Administration and Berkeley Earth.

Despite a La Niña weather pattern in the Pacific Ocean, which tends to cool the planet, 2021 was roughly tied for sixth-hottest year ever observed, scientists say. All of the seven hottest years on record have happened in the last seven years.

The year 2021 was the seventh in a row in which global temperatures were more than 1 degree Celsius above the preindustrial average. It’s unlikely anyone alive will see the world’s temperature drop below that 1-degree benchmark again.

The United States endured at least 20 weather disasters costing $1 billion or more last year, the second most on record, NOAA announced this week. Hurricanes, wildfires, tornadoes and floods — almost all of them made worse by climate change — killed at least 688 people and caused at least $145 billion in damage.

I meant to post about this yesterday when I read it. After all, we stand a pretty good chance of having one of the 8 hottest years on record this year.

There are still 9 more Greek letters

SARS-Cov-2-omicron continues its march through the world, aided in part by a lack of tests that could detect and mitigate Covid infections early on. The Times reports that a Texas man died of the omicron variant despite his fantastical belief that a previous Covid infection rendered him immune. One would hope this would cure the metastasizing delusions of "herd immunity" incubated within the thick skulls and vulcanized brains of the voluntarily unvaccinated, but no, we live in 'Murica.

Meanwhile, Omicron looks more and more like a mild but super-contagious virus that probably won't send vaccinated people to the hospital. And the Walter Reed Army Research Institute quietly announced yesterday that they have developed a vaccine that targets all SARS viruses, not just Cov-2. So for people who have either the sense or the compassion to get vaccinated (and boosted), Covid-19 looks well on its way to becoming just another coronavirus, like the common cold.

Don't celebrate victory just yet, though. In the war against Covid-19 we may have gotten to December 1944, but Germany hasn't surrendered. The UK announced 100,000 new Covid cases just yesterday, a new record, and here in the US we've passed 51 million cases and 805,000 deaths, on course to hit 2 million deaths by the lockdown's 2-year anniversary in March.

This map does not make me happy:


About that WWII analogy: By December 1944, the Allies knew they would win eventually. But people living through the war had no idea how long it would continue. Even if they had known, at that point war would continue in Europe for six more months and in the Pacific for three more after that, killing millions more people. Imagine living in eastern France that winter, with the Allies fighting Germany for every hectare of land and you between them, starving. That's where we are today.

I think next summer will feel a lot like the summer of 1945. We'll have a lot to clean up, but we won't be dying as much. Then we can get back to eroding our democracy one congressional district at a time.

Update, 14:15 CST: The Atlantic's Yascha Mounk has similar thoughts.

Your evening reading

Just a few:

And finally, atheist sci-fi author John Scalzi...bought a church?

Cassie is bored

The temperature bottomed out last night just under -10°C, colder than any night since I adopted Cassie. (We last got that cold on February 20th.) Even now the temperature has just gone above -6°C. Though she has two fur coats on all the time, I still think keeping her outside longer than about 20 minutes would cause her some discomfort.

Add that it's Messiah week and I barely have enough free time to give her a full hour of walks today.

Meanwhile, life goes on, even if I can only get the gist of it:

Finally, journalist Allison Robicelli missed a connection at O'Hare this past weekend, and spent the wee hours exploring the empty terminals. The last time I stared down a 12-hour stay at an airport, I hopped into the Tube and spent 8 of those hours exploring the city instead, but I'm not a professional journalist.

Lunchtime links

We've just completed Sprint 50 at my day job, which included upgrading our codebase to .NET 6 and adding a much-desired feature to our administration tools. Plus, we wrote code to analyze 500,000 emails from a public dataset for stress testing one of our product's features. Not bad for a six-day sprint.

The sun is out, and while I don't hear a lot of birds singing, I do see a lot of squirrels gathering walnuts from the tree across the street. It's also an unseasonably warm 7°C at Inner Drive Technology World Headquarters, going up to 10°C today and 12°C by Thursday. So Cassie and I will head to the dog park in just a few minutes.

First, though, just a couple things of note:

And with that, Cassie has some running around to do.

Nice fall you've got there

While running errands this morning I had the same thought I've had for the past three or so weeks: the trees look great this autumn. Whatever combination of heat, precipitation, and the gradual cooling we've had since the beginning of October, the trees refuse to give up their leaves yet, giving us cathedrals of yellow, orange, and red over our streets.

And then I come home to a bunch of news stories that also remind me everything changes:

  • Like most sentient humans, Adam Serwer feels no surprise (but plenty of disgust) that a Wisconsin jury acquitted Kyle Rittenhouse: "This is the legal regime that a powerful minority of gun-rights advocates have built—one in which Americans are encouraged to settle their differences with lethal force, preferably leaving as few witnesses capable of testimony as possible."
  • Charles Blow worries about the follow-on effectsi.e., vigilantism. Says Blow, "Right-wing gun culture is not unlike the wellness industry, in that it requires the cultivation of a sustained insecurity in its audience, in order to facilitate the endless purchase of its products."
  • Dan Friedman finds Rittenhouse's acquittal terrifying: "[M]ost reasonable people would agree that armed vigilantes facing off with armed protesters, or rioters—while police hide blocks away in armored vehicles—is, by and large, bad. But in Kenosha, and much the country, it is legal. And it is becoming normal. ... [T]he biggest failure was that the events of the trial, and the public perception of it, will not deter the kind of conduct that led to it. It seems sure to cause more right-wing vigilantism, more armed confrontations, and more political violence in the streets."

Outside of Kenosha:

Finally, Israel's government has loosened the certification process for Kashrut inspectors, to the outrage (do they express any other emotion?) of the Haredim. One possible factor? "The head of the Chief Rabbinate’s kashrut division was indicted on bribery charges in 2020 after being videotaped allegedly accepting envelopes of cash from food importers." Oy gevalt!

Take this job and help me get out of my status-quo bias

In his subscriber-only newsletter this morning, economist Paul Krugman speculated about why so many people have left their low-wage jobs recently:

The experience of the pandemic may have led many workers to explore opportunities they wouldn’t have looked at previously.

I’d been thinking vaguely along these lines, but Arindrajit Dube, who has been one of my go-to labor economists throughout this pandemic, recently put it very clearly. As he says, there’s considerable evidence that “workers at low-wage jobs [have] historically underestimated how bad their jobs are.” When something — like, say, a deadly pandemic — forces them out of their rut, they realize what they’ve been putting up with. And because they can learn from the experience of other workers, there may be a “quits multiplier” in which the decision of some workers to quit ends up inducing other workers to follow suit.

I've got a lot of anecdotal evidence to back this up. People I know or interact with in the service industry have consistently said they don't tolerate things they used to tolerate. (You've probably heard the same thing.)

Krugman also suggests that the pandemic gave people time and space to think about other jobs they might do instead, where the phenomenon of status-quo bias might have had them in a rut beforehand.

It may take years to see, let alone explain, all the changes Covid-19 has wrought upon the world. Krugman's observations make sense as a starting point for this bit, though.

Tsar Bomba

Sixty years ago yesterday, on 30 October 1961, the Soviet Union detonated the most destructive bomb ever designed:

The bhangmeter results and other data suggested the bomb yielded around 58 Mt (243 PJ),[13] which was the accepted yield in technical literature until 1991, when Soviet scientists revealed that their instruments indicated a yield of 50 Mt (209 PJ).[4] As they had the instrumental data and access to the test site, their yield figure has been accepted as more accurate.[4][12] In theory, the bomb would have had a yield in excess of 100 Mt (418 PJ) if it had included the uranium-238[14] fusion tamper which figured in the design but which was omitted in the test to reduce radioactive fallout.[14][15] Because only one bomb was built to completion, that capability has never been demonstrated.[14] The remaining bomb casings are located at the Russian Atomic Weapon Museum in Sarov and the Museum of Nuclear Weapons, All-Russian Scientific Research Institute Of Technical Physics, in Snezhinsk.

In the summer of 2020, Russia declassified a 40-minute documentary film about the explosion, which you can watch here:

It's fascinating, not only for its direct content, but also for the historical fun of trying to figure out which parts are total lies and which parts are merely whitewashing. (When they start talking about the lack of significant explosion effects on nearby settlements, that game gets more interesting.)

Catastrophe?

I said before lunch I wouldn't post barring catastrophe. This may qualify:

Over the weekend in California, a storm system dropped to a barometric pressure of 945.2 mB, making it the strongest storm to affect the Pacific Northwest on record. For perspective, this is equivalent to the central pressure you would see with a strong hurricane.

For Sacramento, the stats are even more startling. Sacramento picked up 5.44 inches of rain Sunday, making it their wettest day in history (or any calendar month). Making this even more remarkable is that this came on the heels of a record dry streak of 212 days in a row with no measurable rain. That just ended on Oct. 18.

This example of drought to deluge, also known as precipitation volatility, is exactly what's expected to occur more frequently in California with climate change, where a moisture-loaded Pacific storm system brings a brief period of record rainfall in the middle of an extreme drought exacerbated by record high temperatures.

I mean, wow. And right now, the storm that battered Chicago this morning will head east on a trajectory to give the East Coast a hell of a Nor'easter tomorrow and Wednesday.

But by all means, let's forget about climate legislation to save the last 36 coal jobs in West Virginia, shall we?