Friday, March 28

Sicko and health care: Guest post #3

Post by Dr. Kao-Ping Chua, M.D.

About the Canadian health care system:

Pros: Universality, administrative simplicity, equality, high quality, free choice of doctors and hospitals (not true in the U.S.)
Cons: Quickly escalating costs (because doctors are paid fee-for-service and have an incentive to over-order), rationing of health care results in wait lists for elective surgeries (but this is completely blown out of proportion by the American media - you don't wait for emergnecies).

Is it a better system? Depends on your definition of "better." If by better, you mean more affordable and equitable, then definitely. If by better, you mean more technology, then definitely not. By my criteria, I think Canada has a better health care system for the vast majority of diseases, but if I had a rare disease or needed super-specialized care, I'd opt for the U.S. As an average citizen, though, I'd much rather deal with the Canadian health care system than the American one. As a doctor, I'd also much rather deal with Canada since there'd be fewer insurance hassles and you wouldn't have to worry about your patient's financial status - they'd get the care they need.

About the British health care system:

The British health care system (NHS) is an incredibly inexpensive, economically efficient system. It has one of the strongest primary care/preventive care systems in the world. Unfortunately, it suffers from massive wait lists, old facilities, and a lack of specialists. This is mostly due to a lack of funding, though the recent British government has been putting a lot of money into the system. I think Sicko portrayed only the good parts of the NHS, but it portrayed them very well - virtually free care, strong popular support, good pay for doctors (not quite as good as the U.S. but not bad either).

About the French health care system:

I don't have first-hand knowledge of the French health care system, but it's regarded to be the best in Europe by the WHO [World Health Organization]. It's true that people pay taxes out the wazoo for the system, but on the other hand, they got extremely high quality care.

About the American health care system:

Obviously, this movie was up my alley since I worked on universal health care in DC for a year. I think it did a great job of humanizing the problem - the stories that I heard were all very familiar, but that didn't make them any less devastating. I don't think the movie was intended to give a fair comparison of the American health care system to other systems - I think Moore intended to just shatter some illusions that Americans have about third-world health care in socialized systems like England/France, and he did that very well. The best part of the movie in my mind was the end where Moore had a monologue about American values (e.g. why can't we be a place that's willing to take care of others). Changing values is the crux of all social change, and I was thrilled that Moore seemed to recognize that.

Did I think the movie is fair? Of course not - it's liberal propaganda, in some ways. But like I said, I don't think it wasn't supposed to be intellectually fair, but rather about raising awareness, changing perceptions, and hopefully chipping away at some of our misguided social values.

Kao-Ping received his medical degree from Washington University in St. Louis and is currently a resident at Boston Children's Hospital. Previously, he worked for the American Medical Student Association on the issue of universal health care.

Earlier: Sicko: Is Michael Moore right?
Earlier: Sicko and health care: Guest post #1
Earlier: Sicko and health care: Guest post #2

Tuesday, March 25

The end of privacy

A Company Promises the Deepest Data Mining Yet (New York Times)
An Inalienable Right to Privacy (Coding Horror)

Is privacy possible in the digital age? Privacy through obscurity used to be a great strategy; the idea was that there are so many people "out there" that there's virtually no chance you will be noticed. And even if you were noticed, even if information was being kept about you, what are the odds that the information from various sources would be consolidated into one place? Who cares if you download porn, or search the Internet for information about depression, or write love notes to your secret girlfriend? And what are the chances that the information will fall into the hands of your boss, your spouse, or your insurance company?

In the digital age, I'm sad to say that privacy through obscurity has thoroughly collapsed. Once companies realized a few years ago that consumers will rarely pay for content on the Internet, the focus shifted to targeted ads as the primary way to generate revenue on the Internet. And with that shift, there has been a mad dash to collect and consolidate as much information as possible about every Internet user. There is a lot of money to be made by gathering as much information as possible about you and selling that information to every company that might want to market to you.

This short New York Times piece describes the efforts of one such company, Phorm, that has developed a tool to track every single action you take on the Internet. They are trying to negotiate deals with major broadband Internet providers in the U.S., such that their tool will be used by the Internet provider to generate massive amounts of data about each of its users, which will then be sold to third parties. Three major Internet service providers in Britain have already signed on with Phorm, which gives Phorm access to the surfing habits of 70% of British households with broadband.

This technology is not new, for sure: Spyware and other covert mechanisms for tracking your Internet activity have existed for many years. However, participation by Internet service providers represents a fundamental shift in the power and scope of this technology.

I can only begin to address the implications of technology that can compile a profile of your complete Internet behavior, especially when that profile will be connected to and meshed with the other digital data that exists about you. Unquestionably, your personal data will be sold without your permission. It will make its way to individuals and companies that you wish didn't have access to that data. It will be lost (probably without your knowledge), it will be filled with errors (which you probably won't be able to correct), and it will be sold on the black market. Imagine if you could purchase a file listing the complete Internet habits of any individual for a small price. Would you buy it, to learn about your potential mate, or to get back at your ex? Would your potential employer buy it, to learn about your personal habits? Would your insurance company buy it, to see if you have written any emails about a medical condition? This is just the beginning.

Still not convinced that your privacy is worth protecting? This post on Coding Horror argues that you should protect your privacy, even if you don't think you have anything to hide.

Saturday, March 22

Sicko and health care: Guest post #2

Post by Laurin Taylor

I've lived in London for nearly 7 years now and I was entitled to NHS health care as soon as I got here (as I was a student planning to stay for more than 6 months). I haven't seen the film so I apologize if I am telling you something you already know.

The way it works is that you register at a doctor's office in your borough (an administration area, kind of like a county), and all your medical records get transferred there. When you need to see a doctor, you call and are given an appointment. There is a lot of whining about waiting lists and substandard care, and to be sure, the NHS IS underfunded - BUT I have never had to wait more than a few days to see a doctor for a non-urgent situation. And the two times that I have had an urgent situation, I went to a hospital and was seen right away. AND when you're done seeing your doctor, you walk out and go home. There is no money involved. I pay money when I need a prescription filled. I think the current rate is £7.80, which is about the same as my parents pay co-pay on my dad's insurance. If I were pregnant or had recently given birth, or if I were over or under a certain age, or disabled or on income support, I would not pay for my prescriptions.

I also pay for my NHS dental treatment - I think a check-up and clean cost me £15 last time. That might have included X-rays. I cannot remember.

The NHS also covers more specialist treatment, surgery, mental healthcare and abortions. I have heard a lot of tales about 18 month waiting lists to see a mental health specialist, but I seem to recall that when I needed this service, I was given a referral by my GP and was seen within a month.

The lack of universal healthcare is on the list of my major reasons I have no plans to ever move back to the States. I no longer understand the mentality that people should have to choose between buying food, or paying the rent, and being able to go to the doctor when they get sick.

And by the way, my take home pay is about 70% of my gross monthly salary. That's AFTER tax, national insurance and my pension contribution.

I was always on my dad's insurance when lived over there [the U.S.], so I never really thought about having to pay for health care. I think I was kicked off the plan when I turned 22. Is that the age that people are expected to have decent jobs by? What happens if you want to go to grad school or travel? And how easy is it to get a job that provides affordable health insurance right after you graduate from college? I'm honestly asking, because I don't know.

Just as a PS - I've had the flu for the past three days. I read this morning that 3.6 million people in this country have rung in sick to work this week. With such an epidemic, you'd think that doctor's offices would be swamped, right? I rang mine at 8:30 AM and was offered an appointment at 11:30 AM.

Laurin grew up in the U.S. and is now a British citizen living in London.

Earlier: Sicko: Is Michael Moore right?
Earlier: Sicko and health care: Guest post #1

Nuclear power, reconsidered

As Nuclear Waste Languishes, Expense to U.S. Rises (New York Times)

Due primarily to concerns about energy independence and global warming, there has been an increased debate in the United States about nuclear power and its role in our energy future. Although the many of the 2008 Presidential candidates have expressed support for increasing the usage of nuclear power, the ongoing problems with Yucca Mountain and other waste disposal issues make me hesitant to endorse such plans. It seems, quite simply, that the problems associated with nuclear power have never been fully resolved, with each generation of scientists and politicians trying to push the problems onto the next generation, hoping that they will be the ones to figure out comprehensive solutions.

Saturday, March 15

Sicko and health care: Guest post #1

Post by Larry Markham

Here are a few comments about the Canadian system, especially from experience with my mother:
  1. When you're sick and need to be in the hospital, there is no wait. They take care of you and keep you as long as necessary. The quality of care is very good, just as good as the U.S. The cost is minimal, unless you choose to pay extra for a private room.
  2. Poor people and rich people are treated the same.
  3. There is a waiting list for elective stuff like hip transplants. Rich people can go to other countries if they want it done quickly.
  4. I've heard that certain equipment (MRI?) is much less plentiful in Canada.
  5. No paperwork. No insurance companies aguing about everything. This is a big cost saving, and a huge time saving for the consumer.
  6. The doctors make less money, and some leave for the U.S. to make the big bucks.
  7. Some people have a hard time finding a doctor who will take new patients.
  8. Nobody goes bankrupt because of medical bills. This factor alone justifies using the Canadian system.
  9. People retire early because they don't have to worry about medical costs. This is a huge difference. People in the U.S. are afraid to retire before 65 when Medicare kicks in.
  10. The government decides when and where new hospitals are built.
Larry is an engineer with International Paper, and grew up in Ontario, Canada.

Earlier: Sicko: Is Michael Moore right?

Tuesday, March 11

Life imitates art

The Wire's War on the Drug War (TIME)

The writers of the critically acclaimed HBO show The Wire respond directly to one of the thorny questions their show inspires: What should we do about the drug war?

I guarantee their answer will surprise you.

Sunday, March 9

Sicko: Is Michael Moore right?

Michael Moore's 2007 film Sicko about the American health care system took me a bit by surprise when I first watched it: I thought it was smart, well-made, and actually quite funny. But I still came away from the film with a fundamental question that many others have also posed: To what extent is Sicko "correct" in its judgment that the American health care system is inferior to systems found in countries such as Canada, France, and the United Kingdom? I'm sure that in any country, you can find both horror and success stories about the quality and accessibility of their health care, and Moore did indeed find many compelling examples of how the American system fails people in ways that other systems do not. But what is missing from the picture he paints?

Criticism of Sicko is not hard to find; here is one of the more thoughtful pieces I read, and here is a longer piece by MTV's Kurt Loder. But I tend to trust people I know much more than any random article on the Internet, which is why I am calling on those of you with experience with other health care systems to contact me with your comments:

e-mail: contact [at] kevinmarkham [dot] com

Or, just post your comments below.

These reactions will be featured in a series of guest posts on this blog. I look forward to your thoughts!

Searching for answers

The Most Depressing Day of the Year (TIME)
Dangers (xkcd)

Google is such a fun tool. Besides its pure search engine capabilities (helping you to find the web pages you're looking for), it has amassed an extraordinary amount of data that is right at your fingertips. One way to mine the data that Google has captured is to look at it as a "voting" mechanism: Use the number of search results for a given query as a proxy for a vote in favor of that idea.

Can't decide whether to spell "traveling" with one 'L' or two? Search for both variations, and see which one has more results in Google. Not sure whether author X or author Y is the true source of a quote? See which author has more search results linked to that quote. It's not the most rigorous scientific method, but it is quick and has the benefit of drawing from a vast data source.

The TIME article takes a look at this phenomenon, as does this fun comic from xkcd (my favorite webcomic).

Monday, March 3

The future of voting :(

One way not to conduct Internet voting (The Risks Digest)
Diebold Accidentally Leaks Results of 2008 Election Early (The Onion)

As the Internet and technology become more and more ingrained into our daily lives, it's inevitable that there will be an increased demand for Internet voting as part of our elections. Certainly, Internet voting could deliver both cost savings (for the government) and convenience (for the voter); it would seem to be a technology worth exploring.

I was curious to hear that Democrats Abroad, the organization that represents Democrats living outside the U.S., was holding a "Global Primary" (which awards actual delegates to the Democratic National Convention) in which Internet voting was offered as an option. While the mainstream news focused on Obama's decisive win in the Global Primary, I focused my attention on the technology, and was not surprised to find that the "whole process was neither secure nor well run".

Voting technology in the U.S. continues to disappointment me, lagging leaps and bounds behind other high-tech industries that show evidence of constant innovation. Thankfully, the solutions are out there, and I am hopeful that all levels of government will develop the political will to ensure that our elections are both secure and accurate.

In the meantime, the "Onion News Network" delivered one of the funniest satires of our electoral process that I have ever seen.

Saturday, March 1

One Nation, Under Canada, Above Mexico

Contest: A Six-Word Motto for the U.S.? (Freakonomics Blog)

Freakonomics author Stephen J. Dubner challenged his blog readers to come up with a six-word motto for the United States, and as of this posting, over 1,300 entries have been submitted in the comments section. I looked through a few hundred of the responses, and found them to be both highly entertaining and informative. I think they provide a great insight into how the U.S. is viewed from both inside and outside of the country, albeit largely from a cynical perspective.

Dubner's follow-up post, commenting about the contest and picking his "top five" entries, is also worth a read. (My pick is #3; you can find out who won here.)