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."

What to teach law students

UC Berkeley Law School dean Erwin Cemerinsky and UTA Law & Government professor Jeffrey Abramson try to keep a stiff upper lip when teaching in the shadow of the most partisan Supreme Court in a century:

For the first time in American history, the ideology of the justices precisely corresponds to the political party of the president who appointed them. All six conservatives were appointed by Republican presidents and all three liberals were appointed by Democratic presidents.

If students are to one day become effective litigators on constitutional rights, they will need to understand the ideologies of the justices interpreting the law. In the past, we certainly discussed the ideology of the justices with our students, but we must focus on it far more now as the ideological differences between the Republican-appointed justices and judges and those appointed by Democratic presidents are greater than they have ever been.

Second, we must remind students that there have been other bleak times in constitutional law when rights were contracted. From the 1890s until 1936, a conservative Supreme Court struck down over 200 progressive federal, state and local laws protecting workers and consumers. In the late 1940s and early 1950s, the court refused to stand up to the hysteria of McCarthyism. The current court will not last forever, though it may feel like that to them.

Third, we should direct focus on other avenues for change. Students need to look more to state courts and legislatures, at least in some parts of the country, as a way to advance liberty and equality. For instance, the Massachusetts Legislature passed a law known as the “Roe Act,” protecting a woman’s right to abortion under state law, no matter what the Supreme Court decides.

In case you didn't already notice it's 1890 all over again, I suppose. I also quibble with "For the first time in American history, the ideology of the justices precisely corresponds to the political party of the president who appointed them." I believe that was also the same situation in 1790, with the first Court appointed by Washington.

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.

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.

The sign of a dying culture

In his final novel, Friday (1986), Robert Heinlein spoke through an atavistic character to warn America of its impending doom:

Sick cultures show a complex of symptoms such as you have named...but a dying culture invariably exhibits personal rudeness. Bad manners. Lack of consideration for others in minor matters. A loss of politeness, of gentle manners, is more significant than is a riot. ... It is a bad sign when the people of a country stop identifying themselves with the country and start identifying with a group. A racial group. Or a religion. Or a language. Anything, as long as it isn't the whole population.

David Brooks spent his column today saying we've gotten to that point:

[S]omething darker and deeper seems to be happening as well — a long-term loss of solidarity, a long-term rise in estrangement and hostility. This is what it feels like to live in a society that is dissolving from the bottom up as much as from the top down.

Some of our poisons must be sociological — the fraying of the social fabric. Last year, Gallup had a report titled, “U.S. Church Membership Falls Below Majority for First Time.” In 2019, the Pew Research Center had a report, “U.S. Has World’s Highest Rate of Children Living in Single Parent Households.”

And some of the poisons must be cultural. In 2018, The Washington Post had a story headlined, “America Is a Nation of Narcissists, According to Two New Studies.”

But there must also be some spiritual or moral problem at the core of this. Over the past several years, and over a wide range of different behaviors, Americans have been acting in fewer pro-social and relational ways and in more antisocial and self-destructive ways.

Right on cue, the National Park Service reported that "Adrian, Ariel, Isaac and Norma" defaced a 3,000-year-old piece of indigenous rock art at Big Bend National Park in Texas just after Christmas. And author Alex McElroy says toxic masculinity has given way to "petulant masculinity," which she does not see as an improvement.

In other news, perhaps not as dire:

And apparently, I have to try some Paper Thin Pizza.

About as well as expected

NPR's Steve Inskeep worked for six years to land a 15-minute interview with the XPOTUS, and yet no one felt any shock or surprise when it ended abruptly:

Trump and his team have repeatedly declined interviews with NPR until Tuesday, when he called in from his home in Florida. It was scheduled for 15 minutes, but lasted just over nine.

After being pressed about his repeated lies about the 2020 presidential election, Trump abruptly ended the interview.

When pressed, it was excuse after excuse — it was "too early" to claim fraud, his attorney was no good, things just seem suspicious.

But it all comes back to the same place: He has no evidence of widespread fraud that caused him to lose the election.

The tone of the interview changed. Trump then hurried off the phone as he was starting to be asked about the attack on the Capitol, inspired by election lies.

Philip Bump rolls his eyes at "the eternal lure of reasoning with the irrational:"

Many or most of us like to consider ourselves rational, considering the evidence before us and reaching reasoned conclusions based on what we see. Presented with a refutation of a belief, we like to think, we would change our minds and acknowledge our errors. Ergo: Present Trump with refutations of his claims, and he’d crumble.

The problem, of course, is that this isn’t how it works. Humans are emotional more robustly than they are rational, and when a belief is rooted in emotion — desire, fear, anger — you can’t reason your way around it. Put succinctly, you can’t combat irrationality with reason.

This pattern repeated a few times. Inskeep would offer a rational, accurate, indisputable point about the election results, and Trump — uninterested in rationality or accuracy but very interested in disputes — would wave them away.

Why bother even trying to convince Trump of reality when it’s not going to make a dent?

The answer, I think, is in keeping with the spirit of this article. Emotionally, I and others in the media think it’s important to confront falsehoods with accurate information. Rationally, I know it won’t make a difference; rationally, I’m sure Steve Inskeep understood it was unlikely that Trump would suddenly cop to simply making things up. But the virtue of combating misinformation holds an appeal that rational consideration can’t uproot.

I refuse to believe that it’s unimportant to tell the emperor that he’s not wearing clothes, even if it doesn’t prompt him to put on pants.

I listened to the first few minutes of it this morning, and marveled at Inskeep's ability not to laugh in the XPOTUS's face. Inskeep, of course, is a professional, unlike the interviewee. And Bump has a good point: when arguing with a fantasist, there is no middle ground.

Winter in Chicago

The temperature bottomed out at -14.4°C around 1:30 am, and has climbed ever so slowly since then to -0.3°:

Will we get above freezing? The forecast says yes, any moment now. But the sun will set in about 5 minutes. Anyway, a guy can dream, right?

Meanwhile, Chicago's teachers and schools have agreed to let the kids back tomorrow, even as the mayor herself tested positive for Covid. And the Art Institute's workforce has formed a union, which will operate under AFSCME.

And that's not all:

And finally, just as no one could have predicted that more guns leads to more gun violence, the same people could not have predicted that the NFT craze would lead to NFT fraud.

Cold again

Today's temperatures have hovered around -9°C, with a forecast of bottoming out around -18°C tomorrow morning. But hey, at least the sun is out, right?

Meanwhile, in the rest of the world:

Finally, if you're looking to get away from it all, you might have to pass on the Isle of Rum off the coast of Scotland. Its population has almost doubled in the past couple of years, to 40.

Quick links

The temperature at Inner Drive Technology World Headquarters bottomed out at -16.5°C around 8am today, colder than any time since February 15th. It's up to -8.6°C now, with a forecast for continued wild gyrations over the next week (2°C tomorrow, -17°C on Monday, 3°C on Wednesday). Pity Cassie, who hasn't gotten nearly enough walks because of the cold, and won't next week as her day care shut down for the weekend due to sick staff.

Speaking of sick staff, New Republic asks a pointed question about the Chicago Public Schools: why should their teachers be responsible for making life normal again?

The Washinigton Post asks, what will people do with the millions of dogs they adopted when they (the people, not the dogs) go back to work?

The lawyers for Cyber Ninjas ask, who's going to pay their fees after the grift-based organization shut down abruptly?

And North Michigan Avenue asks, will any more pieces of the Hancock Center fall off the building?

And I ask, will Cassie ever let me sleep past 7am?

School's still out

The Chicago Public Schools and the Chicago Teachers Union keep butting heads, resulting in CPS closing the schools for another day tomorrow:

Chicago Public Schools and the teachers union have filed unfair labor charges against one another, with each side asking state officials to end the current dispute over in-person learning in their favor.

The latest escalation in the conflict over adequate COVID-19 safety measures in schools comes as CPS saw a new record number of coronavirus cases Tuesday — the last day of classes before the lack of agreement with the Chicago Teachers Union shut down schools districtwide for two days.

As CPS and the union continued their fight Thursday, Illinois reported another record-shattering day for new COVID-19 infections, with 44,089 new confirmed and probable cases reported statewide, with a record 7,098 people hospitalized with the virus overnight Wednesday.

The Mayor and CTU have been at loggerheads for most of her term. Naturally, the parents wish a pox on both their houses:

It’s not clear how long the impasse could last. The city filed an unfair labor practice complaint against the union, and officials are considering litigation to force teachers back to their classrooms if negotiations continue to stall, Mayor Lori Lightfoot said Wednesday.

Parents said they’re desperate for a resolution — and a stable learning environment for their kids.

Numerous parents said they scrambled to find last-minute child care Wednesday. The union did not announce its vote to go remote and CPS didn’t officially inform families there wouldn’t be classes until about 11 p.m. Tuesday.

Jennifer Jones, whose two teenagers attend large Northwest Side high schools, said she fully supports the union’s vote to go remote and she was disappointed CPS canceled classes. Jones said her sons are prepared to learn remotely and feel safer learning from home with cases spiking citywide and inconsistent mask-wearing at school.

“Given the ongoing pandemic, CPS should have been prepared for a switch to remote learning,” Jones said.

Josh Marshall sees similar fights brewing in other cities, and concludes that the people making decisions about schools aren't the ones affected:

There’s a deep conventional wisdom out there which has it that liberal Twitter and the broader Blue State commentariat is a hotbed of demands for school closures. The reality is almost diametrically opposed to this. From mid-2020 the country’s most esteemed and prestigious liberal/cosmopolitan publications, electronic broadcasts and university programs have been dominated by voices of highly educated, affluent and mostly white people demanding schools never close, even for brief periods, and almost always in the name of students from minority and/or marginalized communities.

But there is an upside down character to the image these demands create. In fact, during the pre-vaccine period, when significant sections of the country remained in remote leaning, it was precisely these communities which were most resistant to going back to in-person education. The blunt reality is that the staunchest voices against school closures of any sort for any duration are people with PhDs working from home.

And Chicago Mayor Lori Lightfoot's re-election chances took another hit today when former CPS CEO and US Education Secretary Arne Duncan made some noises about running against her.