The Fox News headline read "Marines Chief Warns Most Are Uncomfortable Serving With Openly Gay Troops", and the article lead off with this sentence: "As many as 95 percent of Marines would be uncomfortable serving alongside openly gay troops, the retiring commandant of the Marine Corps told Fox News in an exclusive interview." This based on General Conway's survey of his troops. Of course, when you read further down in the article, it turns out the General's idea of the word "survey" means forming an impression based on various ad hoc occasions when he asked a group of Marines for a show of hands on the subject.
Now we learn from a leaked Pentagon report that an actual survey (you know, the real scientific kind) of 400,000 servicemembers showed that there is minimal risk to lifting the gay ban. More than 70% of the respondents thought that the change would be positive, mixed, or neutral. The Marine Corps was only slightly more resistant to the change, with about 40% expressing concern for unit cohesion. Nothing like General Conway's 95% based on his own "survey".
Am I the only one who's concerned that the leader of one of our military services trusts his personal impressions over actual data when it comes to making decisions?
Thursday, November 11, 2010
Saturday, October 02, 2010
FILM: The Social Network
Sunday, September 05, 2010
FILM: Eat Pray Love
Sure, the film leaves out much of the more profound spiritual and emotional elements of the book, but there's only so much you can expect from a 2-hour movie, and there was a lot of ground to cover. Depth of emotional character development just wasn't going to fit. But as a romantic-comedy version of a journey of self-discovery set against a travelogue of beautiful places and exotic characters, we found it thoroughly enjoyable.
Sunday, August 29, 2010
Founding Mothers of New France
On our recent vacation to Canada, we learned a lot about the history of the settlement of "New France" in the 1600s, when French colonies were established in Québec in 1608 and Montréal in 1642. As with most cities, the great figures in their history, the founders of their civic institutions, are memorialized in statues and stained glass windows, and in the names of streets and squares. Such was certainly the case in Montréal, but as we wandered through the charming cobblestone streets of the old town, one thing slowly dawned on me as being rather unique. A number of those founders memorialized in statues and streets were women. And I'm not talking about some post-feminist politically-correct honoring of honorable women recently excavated from "herstory". I'm talking about women in leadership roles who founded major civic institutions from the very establishment of the colony, and were recognized from their time onward as founders.
The first one that caught my attention was in the Notre-Dame Basilica, where a series of stained glass windows depict scenes from the history of the city, and one shows Jeanne Mance, founder of the city's first hospital. We came across the name again in a street name, rue Jeanne-Mance, which runs "north-south" from the convention center, past the Guy-Favreau and Desjardins shopping centers, past the Contemporary Art Museum and the Place des Arts, and up to the Hôtel-Dieu, the hospital that she founded, and which still exists (though not in its original location). Today the Hôtel-Dieu is one of Montréal's major hospitals, and is part of the Université de Montréal. There is a monument to Jeanne Mance in front of the hospital. And had the Place d'Armes (a central square in old town) not been under reconstruction, we would have seen a statue of Jeanne Mance as one of the five leading Montréal historical figures memorialized there. We learned that she was one of the original settlers on Montréal in 1642, along with Paul Chomedey de Maisonneuve, the first governor. Maisonneuve and Mance were both recruited by the Societé de Notre-Dame de Montréal, an organization incorporated to fund the establishment of a missionary colony in New France. As we visited Montréal's historical sites, we learned of the great hardships faced in its establishment, the often-dangerous voyages across the Atlantic, the attacks on the settlement by the Iroquois, occasional threats from the English, as well as natural threats from floods and disease. It clearly took great fortitude and courage to be a pioneer in such a place.
Another prominent figure we learned of was Marguerite de Bourgeoys. If you visit the charming Notre-Dame-de-Bon-Secours church, you can't help but learn about her. Governor Maisonneuve returned to France to recruit someone to establish a school in Montréal, and he returned with Marguerite de Bourgeoys. Shortly after her arrival in 1653, she initiated construction of the Notre-Dame-de-Bon-Secours Chapel, and established Montréal's first school. She made a number of trips back to France in subsequent decades to recruit additional teachers and funding, and the women she brought back formed the Congregation de Notre-Dame, a unique community of uncloistered women who established and operated a number of schools for colonists and for native children. She was truly a courageous and remarkable leader.
In another part of town, we came across a couple of streets and a square all named for Marguerite d'Youville. Though she lived in the 1700s, nearly a century after the establishment of the colony, she too played a leading role in Montréal's civic life. After becoming a young widow when her drunkard bootlegger husband died, she answered a religious calling, and established the Order of Sisters of Charity of Montréal, a group that operated a home for the poor, and also took over operations of a bankrupt hospital outside the city walls, bringing it back to financial stability. The "Grey Nuns" (the common nickname for the order) carry on her legacy to this day, continuing to operate numerous women's shelters, food dispensaries, and other services for the poor.
We also saw an obelisk in old town, erected in 1892, with a plaque listing the founders of the city, both those including Jeanne Mance who actively worked on site to establish the colony, but also those back in France who backed and funded the venture, such as one Angélique Fauré de Bullion, a wealthy widow who played an ongoing active investment role in the development of the colony. (She insisted on being identified only as "an unidentified benefactress" in records of her donations, and her role only came out after her death.) Several other female names appeared on this plaque, including the intriguing Madame La Chanceliere Louise Fabry, of whom I've not been able to find out more.
I'm just intrigued by this whole women pioneer thing, and wonder what unique combination of things made this happen in New France? Obviously, the whole pioneer thing is one factor. When founding a colony in a new world, obviously you need all hands on deck, and certainly the women who were among the original settlers in America (the settlement of "the West" as well as the English colonies) were strong and courageous. But I'm not aware of any of our American pioneer women having such leadership roles and establishing civic institutions in the same way. Generally, our streets are all named Washington, Jefferson, and Adams, and our statues are of men. (The nearest exception I can think of was Anne Hutchinson in Rhode Island.) And here in "New Spain" where I grew up, I don't even think the Spanish missionaries (and certainly not the soldiers who supported them) included women at all. So while establishing a new colony created a natural demand for leadership, most social structures of the time didn't enable women to rise to fill that demand. What then was different about New France? Another factor is the Catholic church, which distinguishes New France from New England (our Protestants didn't have the same tradition of nuns and orders that the Catholics had, cloistered or otherwise). And perhaps we have to distinguish the French Catholic church, since Spain too was Catholic. These French women pioneers certainly worked within the context of the church: Marguerite Bourgeoys started her own order of sorts (though an unconventional one that only finally received full church authorization near the end of her long life), and Marguerite d'Youville worked with the church to start her order. (Both of these women were eventually canonized a couple centuries later.) Jeanne Mance, though devout and religiously motivated, was and remained a laywoman, though her hospital was staffed with women of orders. What was it about 17th century Catholic France that enabled such women (and the wealthy widows who funded them) to take on such leadership roles?
In another part of town, we came across a couple of streets and a square all named for Marguerite d'Youville. Though she lived in the 1700s, nearly a century after the establishment of the colony, she too played a leading role in Montréal's civic life. After becoming a young widow when her drunkard bootlegger husband died, she answered a religious calling, and established the Order of Sisters of Charity of Montréal, a group that operated a home for the poor, and also took over operations of a bankrupt hospital outside the city walls, bringing it back to financial stability. The "Grey Nuns" (the common nickname for the order) carry on her legacy to this day, continuing to operate numerous women's shelters, food dispensaries, and other services for the poor.
I'm just intrigued by this whole women pioneer thing, and wonder what unique combination of things made this happen in New France? Obviously, the whole pioneer thing is one factor. When founding a colony in a new world, obviously you need all hands on deck, and certainly the women who were among the original settlers in America (the settlement of "the West" as well as the English colonies) were strong and courageous. But I'm not aware of any of our American pioneer women having such leadership roles and establishing civic institutions in the same way. Generally, our streets are all named Washington, Jefferson, and Adams, and our statues are of men. (The nearest exception I can think of was Anne Hutchinson in Rhode Island.) And here in "New Spain" where I grew up, I don't even think the Spanish missionaries (and certainly not the soldiers who supported them) included women at all. So while establishing a new colony created a natural demand for leadership, most social structures of the time didn't enable women to rise to fill that demand. What then was different about New France? Another factor is the Catholic church, which distinguishes New France from New England (our Protestants didn't have the same tradition of nuns and orders that the Catholics had, cloistered or otherwise). And perhaps we have to distinguish the French Catholic church, since Spain too was Catholic. These French women pioneers certainly worked within the context of the church: Marguerite Bourgeoys started her own order of sorts (though an unconventional one that only finally received full church authorization near the end of her long life), and Marguerite d'Youville worked with the church to start her order. (Both of these women were eventually canonized a couple centuries later.) Jeanne Mance, though devout and religiously motivated, was and remained a laywoman, though her hospital was staffed with women of orders. What was it about 17th century Catholic France that enabled such women (and the wealthy widows who funded them) to take on such leadership roles?
Sunday, May 23, 2010
FILM: Letters to Juliet
Sunday, May 16, 2010
FOOD: Church and State
Last night George and I checked out Church & State. No idea where the name came from. It's not on the corner of Church and State, nor could I detect any disestablishmentarian themes in the cuisine or the venue. It's on the corner of Industrial and Mateo (near Alameda and 7th), in the bottom of the old National Biscuit Co building, in a tiny pocket of trendy lofts surrounded by gritty industrial stuff a few blocks beyond Little Tokyo. In other words, one of the green shoots of the new urbanization of downtown. We'd heard of the restaurant itself from mentions in LA foodie circles (Evan Kleiman, Jonathan Gold, the usual suspects), and our downtown friends were all onto it. With no plans for a Saturday night, we decided to be check it out. Though we were able to snag a table for two on very short notice, the place was pretty hopping the whole time we were there. There was no valet, and we had to park a couple blocks away, in front of the still-industrial looking stuff. We did get approached by one panhandler, but in the short walk to the restaurant, we noticed lights in windows of inhabited lofts, and a few nicely-tended urban landscapes on roofs or between buildings. Right near the restaurant, we noted another nice restaurant across the street, as well as a respectable-looking convenience market and a gym. Inside the restaurant, the scene was that of traditional French bistro furnishings placed in the industrial rehab context, with the extra-high ceiling leaving the construction unapologetically exposed, and strings of lights strung festively around. I thought it worked quite well, being true to both its urban setting and its Belle Epoque themes.
The menu is very traditional French bistro, with mussels, steak frites, frisée aux lardons, roasted chicken, and authentic country touches like pigs feet, pigs ears, roasted marrow bone, and charcuterie. I was delighted to discover a cassoulet on the menu, and was also intrigued to find a "cassoulet aux légumes". I was imagining a cassoulet filled with carrots, parsnips, broccoli, and peas, all cooked with the white beans in magical duck fat, which sounded just as marvelous and slightly healthier than the traditional cassoulet which is filled with wondrous artery-clogging sausages, duck legs, and other fatty bits. Alas, our waiter was unmistakably French, not only in his accent, but in his demeanor, and didn't really sell the vegetable cassoulet when I asked him to describe it. (It is not the style of the typical French waiter to be at all chatty the way American waiters are, nor to spontaneously compose paeans of praise when asked to describe a dish.)
We both started with salads, George with the frisée, and me with a "salade au marché, which had arugula, beets, pine nuts, and thin strips of charcuterie. Mine was delicious and George, while initially looking askance at how lightly poached the egg was (he's the sort that does not like his eggs runny), tucked in and left nothing. I was also intrigued by an item called "pois chiches" on the hors d'oeuvre menu, which was lightly fried green chick peas, so we gave that a try. They were tasty, with a nice seasoning on the outside, although a bit awkward to eat. Like edamame, the good stuff is inside a husk that you really don't want to eat. Unlike edamame, these didn't easily pop out, or if there was a neat trick to eating them, we didn't discover it, so we just squeezed the tasty soft center out in our mouths, while also getting the seasoning off the husk, and then awkwardly removed the crinkly husk. (Anyone have any tips on eating these?)
For mains, I went for the traditional cassoulet au Toulouse, which had succulent white beans, savory sausages that tasted like fresh ground lean pork with garlic and herbs, lardons, a crispy duck leg, and bread crumbs to texture the rich goodness of it all. George had a bit of a time making a selection, as the chef was being extra cautious about the gluten issue, and so steered him away from anything that went into the same frier that other stuff with flour had been in, and said to scratch the au jus on everything. So he ended up having steak frites with bearnaise sauce (but no au jus), and roasted potatoes instead of the usual frites. It was disappointing to have so many limitations, but it was appreciated that the chef was being conscientious (as opposed to another restaurant we'd been to recently that didn't take allergies seriously), and they did go to some effort to accommodate us. (The pois chiches are normally made in the frier, but the chef prepared a special batch for us in a separate frying pan.) The wine list was thoroughly French, and with a nice range of wines to choose from, including selections by the glass. I neglected to get the details (left my iPhone in the car), but George had a nice Medoc (cab-merlot blend) with his steak, and I was pleased to find a Languedoc wine offered by the glass, which was lovely with the cassoulet.
For dessert, the waiter presented us with a tempting display of tarts (the chocolate-raspberry tart looked particularly intriguing), but we decided to share a citron mousse which was lovely. The creamy mousse had a light lemon flavor which was contrasted with a topping of tart lemon shaved ice. It was light and refreshing, and the contrasting lemon/tart/sweet/creamy flavors tickled the tongue. On our way out, George caught sight of an interesting looking glass jar with two small spigots on either side. We asked the waiter who was carrying it, and he explained that it contained ice water and was part of a service for absinthe. Intriguing! We'll have to try that next time.
The menu is very traditional French bistro, with mussels, steak frites, frisée aux lardons, roasted chicken, and authentic country touches like pigs feet, pigs ears, roasted marrow bone, and charcuterie. I was delighted to discover a cassoulet on the menu, and was also intrigued to find a "cassoulet aux légumes". I was imagining a cassoulet filled with carrots, parsnips, broccoli, and peas, all cooked with the white beans in magical duck fat, which sounded just as marvelous and slightly healthier than the traditional cassoulet which is filled with wondrous artery-clogging sausages, duck legs, and other fatty bits. Alas, our waiter was unmistakably French, not only in his accent, but in his demeanor, and didn't really sell the vegetable cassoulet when I asked him to describe it. (It is not the style of the typical French waiter to be at all chatty the way American waiters are, nor to spontaneously compose paeans of praise when asked to describe a dish.)
We both started with salads, George with the frisée, and me with a "salade au marché, which had arugula, beets, pine nuts, and thin strips of charcuterie. Mine was delicious and George, while initially looking askance at how lightly poached the egg was (he's the sort that does not like his eggs runny), tucked in and left nothing. I was also intrigued by an item called "pois chiches" on the hors d'oeuvre menu, which was lightly fried green chick peas, so we gave that a try. They were tasty, with a nice seasoning on the outside, although a bit awkward to eat. Like edamame, the good stuff is inside a husk that you really don't want to eat. Unlike edamame, these didn't easily pop out, or if there was a neat trick to eating them, we didn't discover it, so we just squeezed the tasty soft center out in our mouths, while also getting the seasoning off the husk, and then awkwardly removed the crinkly husk. (Anyone have any tips on eating these?)
For mains, I went for the traditional cassoulet au Toulouse, which had succulent white beans, savory sausages that tasted like fresh ground lean pork with garlic and herbs, lardons, a crispy duck leg, and bread crumbs to texture the rich goodness of it all. George had a bit of a time making a selection, as the chef was being extra cautious about the gluten issue, and so steered him away from anything that went into the same frier that other stuff with flour had been in, and said to scratch the au jus on everything. So he ended up having steak frites with bearnaise sauce (but no au jus), and roasted potatoes instead of the usual frites. It was disappointing to have so many limitations, but it was appreciated that the chef was being conscientious (as opposed to another restaurant we'd been to recently that didn't take allergies seriously), and they did go to some effort to accommodate us. (The pois chiches are normally made in the frier, but the chef prepared a special batch for us in a separate frying pan.) The wine list was thoroughly French, and with a nice range of wines to choose from, including selections by the glass. I neglected to get the details (left my iPhone in the car), but George had a nice Medoc (cab-merlot blend) with his steak, and I was pleased to find a Languedoc wine offered by the glass, which was lovely with the cassoulet.
For dessert, the waiter presented us with a tempting display of tarts (the chocolate-raspberry tart looked particularly intriguing), but we decided to share a citron mousse which was lovely. The creamy mousse had a light lemon flavor which was contrasted with a topping of tart lemon shaved ice. It was light and refreshing, and the contrasting lemon/tart/sweet/creamy flavors tickled the tongue. On our way out, George caught sight of an interesting looking glass jar with two small spigots on either side. We asked the waiter who was carrying it, and he explained that it contained ice water and was part of a service for absinthe. Intriguing! We'll have to try that next time.
Friday, March 26, 2010
Why I Am Happy About Health Care Reform
While the Health Care Reform bill is far from ideal, I think it's a big step in a mostly good direction. Let me explain why I think so.
First, I think the status quo was untenable, for two basic reasons: cost and structure. Health care costs currently represent 16% of our GDP (that's higher than any other nation), and have been rising at a rate nearly double the rate of inflation and much higher than GDP growth. For people who have insurance, the rising cost of health care is initially buffered by the insurance companies, although it is eventually reflected in rising premiums. For people who purchase their insurance directly on the individual market (a market in which they have no leverage), they are feeling the premium pain acutely. Several of my friends are among the Californians who got whacked with a 39% increase in their premiums from Anthem Blue Cross this year. For those lucky enough to work for a large employer, the insurance costs are partly absorbed by the employer and the rest buried in an automatic payroll deduction. But the employers are feeling the pain of the rising insurance premiums, which are rising even faster for small and medium-sized businesses than for the large ones. In one recent survey, large companies (more than 50,000 employees) saw their premiums increase 5% in 2009, while small (less than 5,000 employees) and medium-sized companies saw premiums rise as much as 10%. For the employees, that eventually translates into a lack of raises, and lack of new jobs. Some friends have experienced effective pay cuts due to no raises and increased payroll deductions for those rising insurance premiums.
Some would say that the answer to rising costs is less regulation and to let the free market do its thing. Now don't get me wrong, I'm generally a free market fan, but our current system of mostly-employer-provided health insurance bears little resemblance to a functional market. For one thing, I can think of no other segment of the economy where both the consumer and provider of a service are so dysfunctionally disconnected from the cost. Anyone who's on a PPO insurance plan like me is familiar with the insanity: you go to the doctor just for a basic office visit, maybe get some blood drawn and/or an X-ray. The result is three to five bills from your doctor, a lab, the X-ray technician, and maybe some other doctor who reviewed the labs or the films. Then you get a flurry of "explanation of benefit" statements from your insurer saying "the blood labs billed $750, but our negotiated rate with them is $300, of which $78 was unallowable (reference mysterious codes), $113 was covered, $63 goes against your deductible, and you owe 20% of the remaining $46." If I'd have just walked in off the street without an insurance card, that basic office visit would have had a nominal cost upwards of $1,000. (Of course part of that is because the doctor has to employ at least one full-time person just to keep the insurance billing sorted.) It's a bit like airline tickets, where you can find three people sitting on the same flight in the same row who paid $212, $756, and $1640 for their tickets. But at least on an airplane, you know the cost before you buy the ticket. With medical care, you don't know the cost, you usually don't even ask up front (cause you're not paying it), and you don't even know the destination or the length of the flight. When was the last time you cost-comparison shopped a doctor, or asked about the cost-effectiveness of a recommended test or treatment? So how exactly is the "unseen hand" going to get any grip on this?
You might say that you don't need to worry about cost, because your insurance company has done the cost comparisons and cost-effectiveness studies. That's somewhat true, but that just shifts the focus to the insurance market. There you have a number of factors at work. First, there is the negotiated cost of services, which comes down to the relative leverage between insurers and service providers (doctors and hospitals). In areas where an insurance provider has a large number of subscribers and there is a choice of hospitals, the insurance companies can negotiate more competitive rates with the hospitals. In areas where there are fewer hospitals (or the hospitals are nearly all owned by one company, e.g., as in northern California), and where an insurance company has less of a local market, they are in a weak negotiating position and can't get as competitive rates. The key observation to be made here is that increasing competition among insurance companies can work to drive costs up rather than down, insofar as it weakens their leverage to negotiate with service providers. Another factor is the market for selling health insurance, which is very uneven. Rather than a large market of individual consumers, the health insurance market is a lumpy amalgam of large companies buying group plans, small and medium businesses buying group plans, and individuals buying individual / family plans. Large companies obviously have the leverage to get relatively good rates. Small and medium businesses, not so much. And individuals totally get the shaft. These submarkets also operate under very different terms. In the large company sub-market, the insurance company typically agrees to accept all employees regardless of pre-existing conditions, while the company promises to enroll all employees in the plan. The scale creates a broad enough pool such that the insurance business model makes sense: you have enough healthy people in the pool to cover those who are sick. In the individual market, it's a different story. If people could buy individual health insurance policies at any time, regardless of pre-existing conditions, nobody would buy insurance until they got sick, and only sick people would buy insurance. Obviously, that would make the individual insurance pool unsustainable, which is why the insurance companies need to screen for pre-existing conditions to make the current system work.
This uneven insurance market incentivizes some counter-productive behavior in the labor market. Some employees may stick with a job for the sole reason that they can't give up the medical coverage. They may have a child with a pre-existing condition, and if they left their current job, they would be unable to replace the coverage. This may prevent them from moving to a more effective job, or it may prevent them from venturing out and starting a new business. Employee mobility is a key efficiency for an effective economy, and especially so in our modern information and services economy. We recognize the importance of entrepeneurship, and of small and medium business in job creation and economic growth. Our system of employer-provided healthcare insurance made more sense in the 1950s and 60s when the majority of people worked for large employers and often stayed with the same employer. Today, employer-provided insurance is not only a quaint relic of that bygone era, but it is a source of structural inefficiency and distortion in our modern economy, insofar as it hampers employee mobility and entrepeneurship. We'd be much better served by scrapping employer-provided insurance altogether, and creating a robust and level individual insurance market. But massive change like that is politically infeasible, and our economy is like a battleship that needs to be steered slowly.
The recent Health Care Reform bill is a positive step in that direction. By organizing the individual insurance market into state-run insurance exchanges, this key structural change will enable the individual insurance market to effect the same bargain as large group coverage: everyone participates in order to create a rational insurance pool and no one needs to be screened for pre-existing conditions. Those who had been urging incremental change failed to understand how these things need to come as a package in order to work. In order to eliminate pre-existing conditions, you need to make sure the insurance pool is rational by mandating that everyone be in the pool. And in order to make a mandate reasonable, you need to provide premium subsidies for those least able to afford them. The elimination of pre-existing condition screening only makes sense together with the mandate, and the mandate only makes sense with the subsidies. It could not have been done incrementally. (Likewise, those with hopes for a repeal are going to realize that you can't repeal the mandate without also restoring the pre-existing conditions screening.)
Thus, I see this as a positive step toward reforming the structure of our health care insurance market. Regretably, it appears not to address the overall healthcare cost problem, except for a few small but promising gestures (such as a Medicare pilot to explore alternatives to payment-for-service). Even so, I see it as a huge accomplishment. I think the opportunity to make such a change occurs only once or twice in a generation. The last grand attempt at healthcare reform was in 1994, and if this effort had failed, it would have been another 15 or 20 years before anyone would take it up again. The political process was messy, but Washington is messy on the best of days, and one can't expect filet mignon from a sausage factory. Despite the mess, I would say the process worked the way it is supposed to, in that a wide range of views were accommodated in the final bill. Anyone who thinks the entire Democratic delegation has a monolithic view that can be meaningfully labeled "the left" simply hasn't been paying attention. I was also glad to see that the final wrangling to get the needed votes in the House was focused on the actual substance of the bill, and we didn't see the kind of obscene special deals (like the Nebraska tax exemption -- shame on you Senator Nelson) that took place in the Senate. (Thankfully, the most egregious of those were deleted in the reconciliation.) Even the Republicans, with their complete stonewalling, played a role in shaping the bill, by forcing the Democrats to come to a complete consensus across their intra-party spectrum. (Tolkien tells us that even Golem had a role to play in the Lord of the Rings. I reckon the GOP played the Golem role here.)
Frankly, I'm puzzled by the people who are proclaiming that HCR represents the end of life as we know it, or that it implements some revolutionary radical leftist ideas. Compared to the fears many on the right have expressed -- of a government-run healthcare system, or the government as single payer -- what we got is not that, not even close. It didn't even include so much as a public option. What we got was a way to enable a viable independent insurance market without adverse selection and pre-existing conditions, preserving the framework of a free-market competitive private sector to provide the insurance and to provide the healthcare. Anyone who looks at that and sees "socialism" or "government takeover" is just deluded. This was a completely market-oriented reform. Even in the context of market-oriented reform, the reform wasn't all that revolutionary. It did not abolish employer-provided healthcare and immediately establish an individual market for everyone. It did not even tax employer-based health benefits (which I'd love to see them phase in, shifting the tax deduction to individuals). The reform was heedful of people who like what they have now, and it enabled the reform in a minimally disruptive way. Many of the significant reforms don't take effect for several years, allowing people and businesses to plan for the transition. Not exactly the French Revolution here.
What is sad is the apparently intense polarization of attitudes in this country along the alleged left-right divide, when in fact there are broad areas of agreement. I think most folks would agree that healthcare costs are out of control, that the practices of pre-existing condition screening (and rescission) are ugly, and that market-oriented solutions are better than government central planning. The Health Care Reform that passed, with an absolute zero of Republican support, contained many elements that Republicans themselves have pitched in the past. It's like the Republicans and the Democrats are about six inches apart in the middle of a twenty-foot ruler, and they're arguing about the dire chasm of "right" and "left" between them. How pathetic is that? In reality, it serves only to enrich the pundits who thrive on fanning the flames.
Some folks are offended by the idea of an insurance mandate, or question its constitutionality. On the practical side, I'd like to ask those folks: would you have preferred a single-payer system, or direct government-provided healthcare (a la Britain or Canada)? We could eliminate the mandate, and do one of those instead. We only need the mandate if we want to do a market-oriented reform. But if you're really bothered by that mandate, we can go Canadian style. No? I didn't think so. On the constitutional side, while I admit the idea of a mandate does chafe a bit at my libertarian bones, I also concede that it's not really outside our Constitution as it has been interpreted for quite some time. The government has the power to compel things: paying taxes, educating children, serving in the military. Like it or not, the Supreme Court has been pretty deferential to the constitutional power to regulate commerce, as well as the power to levy taxes. I know the challenges are already being filed, but it would be surprising if the Health Care Reform bill is found to have exceeded those well-established powers.
Some folks are just generally nervous about the growth of federal government, and I share that sentiment. But I do believe that it is the proper role of the government to regulate the healthcare market, to ensure that it functions effectively. Just as it is appropriate for government to have a significant role in infrastructure (think roads and airports), as a key enabler of a vibrant economy, I think that healthcare and education are the "infrastructure" of an information economy workforce. In the 1950s it made sense to everyone that your employer should provide your healthcare. It was a reasonable investment for the employer to make sure that the employees were healthy and secure. Today, almost nobody has a single employer their entire life. We move from job to job, place to place, career to career, re-train, start new ventures -- the labor mobility that an effective 21st-century economy requires. But it still makes sense to invest in the health and security of our workforce, so that people can focus on their work and not be distracted by health insecurity. It's just that employers are no longer the logical source for that investment. Given labor mobility, the government is the logical source for that investment, as it is the only stable long-term constant. I think this is what is required for the American economy to remain competitive in the 21st century.
So, that's why I am happy about the passage of the Health Care Reform bill.
First, I think the status quo was untenable, for two basic reasons: cost and structure. Health care costs currently represent 16% of our GDP (that's higher than any other nation), and have been rising at a rate nearly double the rate of inflation and much higher than GDP growth. For people who have insurance, the rising cost of health care is initially buffered by the insurance companies, although it is eventually reflected in rising premiums. For people who purchase their insurance directly on the individual market (a market in which they have no leverage), they are feeling the premium pain acutely. Several of my friends are among the Californians who got whacked with a 39% increase in their premiums from Anthem Blue Cross this year. For those lucky enough to work for a large employer, the insurance costs are partly absorbed by the employer and the rest buried in an automatic payroll deduction. But the employers are feeling the pain of the rising insurance premiums, which are rising even faster for small and medium-sized businesses than for the large ones. In one recent survey, large companies (more than 50,000 employees) saw their premiums increase 5% in 2009, while small (less than 5,000 employees) and medium-sized companies saw premiums rise as much as 10%. For the employees, that eventually translates into a lack of raises, and lack of new jobs. Some friends have experienced effective pay cuts due to no raises and increased payroll deductions for those rising insurance premiums.
Some would say that the answer to rising costs is less regulation and to let the free market do its thing. Now don't get me wrong, I'm generally a free market fan, but our current system of mostly-employer-provided health insurance bears little resemblance to a functional market. For one thing, I can think of no other segment of the economy where both the consumer and provider of a service are so dysfunctionally disconnected from the cost. Anyone who's on a PPO insurance plan like me is familiar with the insanity: you go to the doctor just for a basic office visit, maybe get some blood drawn and/or an X-ray. The result is three to five bills from your doctor, a lab, the X-ray technician, and maybe some other doctor who reviewed the labs or the films. Then you get a flurry of "explanation of benefit" statements from your insurer saying "the blood labs billed $750, but our negotiated rate with them is $300, of which $78 was unallowable (reference mysterious codes), $113 was covered, $63 goes against your deductible, and you owe 20% of the remaining $46." If I'd have just walked in off the street without an insurance card, that basic office visit would have had a nominal cost upwards of $1,000. (Of course part of that is because the doctor has to employ at least one full-time person just to keep the insurance billing sorted.) It's a bit like airline tickets, where you can find three people sitting on the same flight in the same row who paid $212, $756, and $1640 for their tickets. But at least on an airplane, you know the cost before you buy the ticket. With medical care, you don't know the cost, you usually don't even ask up front (cause you're not paying it), and you don't even know the destination or the length of the flight. When was the last time you cost-comparison shopped a doctor, or asked about the cost-effectiveness of a recommended test or treatment? So how exactly is the "unseen hand" going to get any grip on this?
You might say that you don't need to worry about cost, because your insurance company has done the cost comparisons and cost-effectiveness studies. That's somewhat true, but that just shifts the focus to the insurance market. There you have a number of factors at work. First, there is the negotiated cost of services, which comes down to the relative leverage between insurers and service providers (doctors and hospitals). In areas where an insurance provider has a large number of subscribers and there is a choice of hospitals, the insurance companies can negotiate more competitive rates with the hospitals. In areas where there are fewer hospitals (or the hospitals are nearly all owned by one company, e.g., as in northern California), and where an insurance company has less of a local market, they are in a weak negotiating position and can't get as competitive rates. The key observation to be made here is that increasing competition among insurance companies can work to drive costs up rather than down, insofar as it weakens their leverage to negotiate with service providers. Another factor is the market for selling health insurance, which is very uneven. Rather than a large market of individual consumers, the health insurance market is a lumpy amalgam of large companies buying group plans, small and medium businesses buying group plans, and individuals buying individual / family plans. Large companies obviously have the leverage to get relatively good rates. Small and medium businesses, not so much. And individuals totally get the shaft. These submarkets also operate under very different terms. In the large company sub-market, the insurance company typically agrees to accept all employees regardless of pre-existing conditions, while the company promises to enroll all employees in the plan. The scale creates a broad enough pool such that the insurance business model makes sense: you have enough healthy people in the pool to cover those who are sick. In the individual market, it's a different story. If people could buy individual health insurance policies at any time, regardless of pre-existing conditions, nobody would buy insurance until they got sick, and only sick people would buy insurance. Obviously, that would make the individual insurance pool unsustainable, which is why the insurance companies need to screen for pre-existing conditions to make the current system work.
This uneven insurance market incentivizes some counter-productive behavior in the labor market. Some employees may stick with a job for the sole reason that they can't give up the medical coverage. They may have a child with a pre-existing condition, and if they left their current job, they would be unable to replace the coverage. This may prevent them from moving to a more effective job, or it may prevent them from venturing out and starting a new business. Employee mobility is a key efficiency for an effective economy, and especially so in our modern information and services economy. We recognize the importance of entrepeneurship, and of small and medium business in job creation and economic growth. Our system of employer-provided healthcare insurance made more sense in the 1950s and 60s when the majority of people worked for large employers and often stayed with the same employer. Today, employer-provided insurance is not only a quaint relic of that bygone era, but it is a source of structural inefficiency and distortion in our modern economy, insofar as it hampers employee mobility and entrepeneurship. We'd be much better served by scrapping employer-provided insurance altogether, and creating a robust and level individual insurance market. But massive change like that is politically infeasible, and our economy is like a battleship that needs to be steered slowly.
The recent Health Care Reform bill is a positive step in that direction. By organizing the individual insurance market into state-run insurance exchanges, this key structural change will enable the individual insurance market to effect the same bargain as large group coverage: everyone participates in order to create a rational insurance pool and no one needs to be screened for pre-existing conditions. Those who had been urging incremental change failed to understand how these things need to come as a package in order to work. In order to eliminate pre-existing conditions, you need to make sure the insurance pool is rational by mandating that everyone be in the pool. And in order to make a mandate reasonable, you need to provide premium subsidies for those least able to afford them. The elimination of pre-existing condition screening only makes sense together with the mandate, and the mandate only makes sense with the subsidies. It could not have been done incrementally. (Likewise, those with hopes for a repeal are going to realize that you can't repeal the mandate without also restoring the pre-existing conditions screening.)
Thus, I see this as a positive step toward reforming the structure of our health care insurance market. Regretably, it appears not to address the overall healthcare cost problem, except for a few small but promising gestures (such as a Medicare pilot to explore alternatives to payment-for-service). Even so, I see it as a huge accomplishment. I think the opportunity to make such a change occurs only once or twice in a generation. The last grand attempt at healthcare reform was in 1994, and if this effort had failed, it would have been another 15 or 20 years before anyone would take it up again. The political process was messy, but Washington is messy on the best of days, and one can't expect filet mignon from a sausage factory. Despite the mess, I would say the process worked the way it is supposed to, in that a wide range of views were accommodated in the final bill. Anyone who thinks the entire Democratic delegation has a monolithic view that can be meaningfully labeled "the left" simply hasn't been paying attention. I was also glad to see that the final wrangling to get the needed votes in the House was focused on the actual substance of the bill, and we didn't see the kind of obscene special deals (like the Nebraska tax exemption -- shame on you Senator Nelson) that took place in the Senate. (Thankfully, the most egregious of those were deleted in the reconciliation.) Even the Republicans, with their complete stonewalling, played a role in shaping the bill, by forcing the Democrats to come to a complete consensus across their intra-party spectrum. (Tolkien tells us that even Golem had a role to play in the Lord of the Rings. I reckon the GOP played the Golem role here.)
Frankly, I'm puzzled by the people who are proclaiming that HCR represents the end of life as we know it, or that it implements some revolutionary radical leftist ideas. Compared to the fears many on the right have expressed -- of a government-run healthcare system, or the government as single payer -- what we got is not that, not even close. It didn't even include so much as a public option. What we got was a way to enable a viable independent insurance market without adverse selection and pre-existing conditions, preserving the framework of a free-market competitive private sector to provide the insurance and to provide the healthcare. Anyone who looks at that and sees "socialism" or "government takeover" is just deluded. This was a completely market-oriented reform. Even in the context of market-oriented reform, the reform wasn't all that revolutionary. It did not abolish employer-provided healthcare and immediately establish an individual market for everyone. It did not even tax employer-based health benefits (which I'd love to see them phase in, shifting the tax deduction to individuals). The reform was heedful of people who like what they have now, and it enabled the reform in a minimally disruptive way. Many of the significant reforms don't take effect for several years, allowing people and businesses to plan for the transition. Not exactly the French Revolution here.
What is sad is the apparently intense polarization of attitudes in this country along the alleged left-right divide, when in fact there are broad areas of agreement. I think most folks would agree that healthcare costs are out of control, that the practices of pre-existing condition screening (and rescission) are ugly, and that market-oriented solutions are better than government central planning. The Health Care Reform that passed, with an absolute zero of Republican support, contained many elements that Republicans themselves have pitched in the past. It's like the Republicans and the Democrats are about six inches apart in the middle of a twenty-foot ruler, and they're arguing about the dire chasm of "right" and "left" between them. How pathetic is that? In reality, it serves only to enrich the pundits who thrive on fanning the flames.
Some folks are offended by the idea of an insurance mandate, or question its constitutionality. On the practical side, I'd like to ask those folks: would you have preferred a single-payer system, or direct government-provided healthcare (a la Britain or Canada)? We could eliminate the mandate, and do one of those instead. We only need the mandate if we want to do a market-oriented reform. But if you're really bothered by that mandate, we can go Canadian style. No? I didn't think so. On the constitutional side, while I admit the idea of a mandate does chafe a bit at my libertarian bones, I also concede that it's not really outside our Constitution as it has been interpreted for quite some time. The government has the power to compel things: paying taxes, educating children, serving in the military. Like it or not, the Supreme Court has been pretty deferential to the constitutional power to regulate commerce, as well as the power to levy taxes. I know the challenges are already being filed, but it would be surprising if the Health Care Reform bill is found to have exceeded those well-established powers.
Some folks are just generally nervous about the growth of federal government, and I share that sentiment. But I do believe that it is the proper role of the government to regulate the healthcare market, to ensure that it functions effectively. Just as it is appropriate for government to have a significant role in infrastructure (think roads and airports), as a key enabler of a vibrant economy, I think that healthcare and education are the "infrastructure" of an information economy workforce. In the 1950s it made sense to everyone that your employer should provide your healthcare. It was a reasonable investment for the employer to make sure that the employees were healthy and secure. Today, almost nobody has a single employer their entire life. We move from job to job, place to place, career to career, re-train, start new ventures -- the labor mobility that an effective 21st-century economy requires. But it still makes sense to invest in the health and security of our workforce, so that people can focus on their work and not be distracted by health insecurity. It's just that employers are no longer the logical source for that investment. Given labor mobility, the government is the logical source for that investment, as it is the only stable long-term constant. I think this is what is required for the American economy to remain competitive in the 21st century.
So, that's why I am happy about the passage of the Health Care Reform bill.
Saturday, February 06, 2010
FILM: Los Abrazos Rotos
Friday, February 05, 2010
BOOKS: The Post-American World
I came across this book in an unusual way. I received an email from someone who regularly sends me the worst right-wingnut scare rumors, and this particular email was all panty-twisted over a photo of President Obama holding a book which, upon closer look had the title "The Post-American World", and it was written by a Muslim! "See," the email howled with horror, "look what Obama is reading! He really is part of a secret Muslim cabal intent on destroying America!" Being appropriately sceptical of such emails, I looked a bit closer and made out the partly-obscured name of the Muslim-terrorist author of this evil tome: Fareed Zakaria, international editor for Newsweek, and a widely respected expert on foreign policy. I immediately added the title to my list of books to read. So glad I did.
His provocative title, it turns out, is not about the fall of America, so muc as it is about the "rise of the rest". The book is a shrewd analysis of how America's role as the world's sole superpower is inevitably going to be soon eclipsed by China and India, and what that will and won't mean. I'd never read Zakaria before, but I found him to be tremendously insightful, as well as very knowledgeable. The book is eye-opening in its quantification and qualification of the rise of China and India (as well as other countries), but at the same time it is reassuring in its assessment that the surpassing of the US economy need not be the catastrophe many may fear. In fact, he cites Roosevelt's dictum that the only thing to fear is fear itself. Our worst possible policy choices in reaction to the rise of the rest of the world would be ones based on a fearful retrenchment into protectionism and isolation. Our best possible policy choices continue to embrace open trade and immigration, key drivers that have advanced America and can continue to do so. He compares and contrasts the present US situation not to Rome (as is so often done), but to the British Empire in its decline, which given where Britain is today was obviously not the end of the world. He offers some interesting observations about military might versus the soft power of legitimacy and being a center of ideas and innovation. And he had some interesting insights into econometrics, noting that our current measures of savings and consumption are based on an industrial economy. For example, spending on research and development, or a college education, gets measured as consumption, when it's really more of an investment, especially an in information economy.
I came away from this book feeling more realistic and also more optimistic about the future for America. And also very glad that our President is reading books like this one.
His provocative title, it turns out, is not about the fall of America, so muc as it is about the "rise of the rest". The book is a shrewd analysis of how America's role as the world's sole superpower is inevitably going to be soon eclipsed by China and India, and what that will and won't mean. I'd never read Zakaria before, but I found him to be tremendously insightful, as well as very knowledgeable. The book is eye-opening in its quantification and qualification of the rise of China and India (as well as other countries), but at the same time it is reassuring in its assessment that the surpassing of the US economy need not be the catastrophe many may fear. In fact, he cites Roosevelt's dictum that the only thing to fear is fear itself. Our worst possible policy choices in reaction to the rise of the rest of the world would be ones based on a fearful retrenchment into protectionism and isolation. Our best possible policy choices continue to embrace open trade and immigration, key drivers that have advanced America and can continue to do so. He compares and contrasts the present US situation not to Rome (as is so often done), but to the British Empire in its decline, which given where Britain is today was obviously not the end of the world. He offers some interesting observations about military might versus the soft power of legitimacy and being a center of ideas and innovation. And he had some interesting insights into econometrics, noting that our current measures of savings and consumption are based on an industrial economy. For example, spending on research and development, or a college education, gets measured as consumption, when it's really more of an investment, especially an in information economy.
I came away from this book feeling more realistic and also more optimistic about the future for America. And also very glad that our President is reading books like this one.
Thursday, February 04, 2010
STAGE: Camelot

Not having seen any other productions of Camelot, I can't compare this one, but I found it utterly charming and moving. The set was simple and spare, a series of wooden poles and platforms, and the ensemble of eight players began the play in a self-conscious "we're about to tell you a story, so please indulge us with your imagination" manner (actually rather Shakespearean), and also a touch of self-deprecating humor -- "there was a majestic castle on a hill" as a picture of a castle is noisly unfurled and hung on one of the poles; "it was snowing" as an actress arches an eyebrow while tossing a handful of torn paper in the air. The self-conscious stuff added a nice laugh here and there, but was a light touch, and not overdone. The cast was terrific. Shannon Warne (Guinevere) reminded me of mezzo diva Jennifer Larmore, with a beautiful and powerful voice that glimmered like sunshine, and with a confident charm that commanded the stage. I think she could have got most every guy in the audience to joust against Lancelot for her! Shannon Stoeke (Arthur) did a marvelous job being a tentative idealistic boy-king in the beginning, maturing into a strong man with the conviction of his ideals even when it was torture for him to do so. Doug Carpenter brought a swaggering bearing and a rich deep baritone to realize the unself-consciously pompous Lancelot. The other three fun-loving knights and that deliciously wicked Mordred were all finely enacted too, rounding out a great ensemble. The director did a great job balancing the tone of the play, mostly light and charming with emotionally powerful moments. The climax at the end of Act I was particularly powerful, with Arthur making a desperate, passionate recommitment to his ideals, and then the breathtaking reveal of Lance and Jenny, naked in each other's arms. That was brilliant theatre. And of course I was totally charmed (as well as filled with warm nostalgic feeling) for the brilliant music and lyrics of Lerner and Lowe.
I was sad to see the show end, and sad to see the theatre close. I hope that they will be able to stage a comeback, and that the "(not so) brief shining moment" that was the Pasadena Playhouse will be the "once and future" stage.
Sunday, January 31, 2010
FILM: The Last Station
Monday, January 18, 2010
FILM: It's Complicated
Thursday, January 14, 2010
BOOKS: Fool
I was captivated by Christopher Moore's Fool, wonderfully read by Euan Morton, from this opening sentence:
"This is a bawdy tale. Herein you will find gratuitous shagging, murder, spanking, maiming, treason, and heretofore unexplored heights of vulgarity and profanity, as well as nontraditional grammar, split infinitives, and the odd wank . . . If that's the sort of thing you think you might enjoy, then you have happened upon the perfect story!"What followed from there was not only eight and a half hours of the finest British humor, but an incredibly clever Shakespearean parody and pastiche. Fool takes the story of Shakespeare's King Lear and turns it inside out, as seen from the point of view of Pocket, the king's fool. Kind of like Rosencrantz and Guildenstern Are Dead, but much much funnier and much much more engaging. Not only does he work the Fool's story seamlessly into the existing story of King Lear, but he manages to weave an entirely new tale, full of politics, intrigue, a bit of magic (and yes, lots of shagging and bawdiness) into it. It was amazing, because if you know the story of Lear, you know how part of it is going to have to go, and yet you still don't know how it's going to get there, or even how it finally turns out. And it was so much fun to get there. The story is jam-packed with Shakespearean allusions, quotes, jokes, and even a few characters (like Macbeth's witches) shamelessly imported from other plays into this story. And the story would completely stand on its own, both for humor and intrigue, even if you didn't know much Shakespeare at all. What a rollicking great romp!
Monday, January 11, 2010
STAGE: Palestine, New Mexico
Sunday, January 10, 2010
FILM: Avatar
As to the 3D thing, at first I found it slightly distracting, but I was pleased that it wasn't overly gimmicky, no projectiles hurtling straight into the camera or flying creatures hovering right in front of my face. And I think my brain adapted to it, because I realized by the end I was no longer conscious of it, and it felt pretty natural. But I think part of what made it work so well was the fantastic nature of the film. One friend of ours wondered whether this point in 3D technology might be a "game-changer" for movies in general, but I'm not so sure. Many films don't have to convince us of their reality in the same way that a sci-fi-fantasy film like Avatar does. Would Nine or A Single Man have been enhanced by high-quality 3D? I'm not so sure. But for Avatar, it was breathtaking.
Saturday, January 02, 2010
FILM: The Young Victoria
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