They’re salting the earth, not salt-of-the-earth

Last Friday New York Times columnist Roger Cohen wrote a profile of Obama-voter-turned-Trump-voter Shannon Kennedy, One Honorable American’s Love of Trump.   Trump voter profiles, particularly ones which take a “forgotten man” angle and suggest that the Democratic Party needs to listen to them, are a regular thing in the Times and elsewhere.   I’ve read a fair number of them.  None have made me go, “Wow.  I hadn’t appreciated that.  I see where they’re coming from.”   I get where they’re coming from.  We have different values and different visions of what we’d like our country to be.   What irks me about columns like Cohen’s is that they don’t acknowledge that we do hear Trump voters and we understand what they’re saying.  The core problem isn’t a lack of understanding.  The problem is that we want fundamentally different things for our country.

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“The Left wants to give people the chance to do something with their lives, by giving them time and space away from the market.”

The Left wants to give people the chance to do something with their lives, by giving them time and space away from the market.

Corey Robin

Many people (perhaps you) may have a difficult time believing that but it’s true.  The goal is give people more control over the narrative of their lives.  Robin gives a specific example:  Why one might favor single-payer over Obamacare –

In the neoliberal utopia, all of us are forced to spend an inordinate amount of time keeping track of each and every facet of our economic lives. . . . We saw a version of it during the debate on Obama’s healthcare plan. I distinctly remember, though now I can’t find it, one of those healthcare whiz kids — maybe it was Ezra Klein — tittering on about the nifty economics and cool visuals of Obama’s plan: how you could go to the web, check out the exchange, compare this little interstice of one plan with that little interstice of another, and how great it all was because it was just so fucking complicated. I thought to myself: you’re either very young or an academic. And since I’m an academic, and could only experience vertigo upon looking at all those blasted graphs and charts, I decided whoever it was, was very young. Only someone in their twenties — whipsmart enough to master an inordinately complicated law without having to make real use of it — could look up at that Everest of words and numbers and say: Yes! There’s freedom!

“Not just any cough suppressant. This is oxycodone.”

An excerpt from Douglas Coupland, “Oxy!”:

So I was in Atlanta.  I checked into the hotel, a nice place, but my room, upon entering, was a dank meat locker. I looked around for the thermostat but I couldn’t find one, and I went to open the windows and they were sealed shut. So I asked the front desk how to make the room slightly less frozen and was told: ‘We keep all rooms at a consistent temperature. Guests seem to prefer it this way.’ I figured, what can possibly go wrong sleeping a few nights in a room like this?

By my third morning I have a cough: hack-hack. The next morning, my last at the hotel, the hack-hack has turned into a deep cough-cough. As the week progressed elsewhere in Georgia, the cough turned into bronchitis, and I could feel foamy bubbles percolating in my lungs when I lay down to sleep. Yes, there’s nothing sexier than wheezing, a bodily function seemingly designed to remind us all that death lurks around every corner. Finally, I dragged myself to a local medical clinic, and this is when things got really American.

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MA Medicaid waiver

From Rep. Mike Capuano’s newsletter last week:

On Halloween evening, October 31st, the Patrick Administration announced it had reached an agreement with the federal government on a five year Medicaid waiver [link added]. This is funding that will go to certain Massachusetts hospitals providing health care to the state’s most vulnerable patients. Two of the so-called “safety net hospitals” are in the 7th Congressional district [link added]. While the agreement should suffice for the first three years, it does not include funding for years four and five, putting the entire Massachusetts health insurance program in jeopardy starting in 2018. The amount agreed upon is almost half a billion dollars less than previous funding agreements. I applaud the efforts of Massachusetts Secretary of Health and Human Services Polanowicz but I am truly disappointed that the Obama Administration would jeopardize the first-in-the-nation health care system upon which the President based his legacy legislative accomplishment. I am especially disappointed because the Administration funded longer term waivers in other states, including Texas, whose governor, state legislature, and majority of members of Congress continue to be opposed to the Affordable Care Act. I find such disparate treatment incomprehensible and troubling. The current agreement leaves our Commonwealth at the mercy of the next President and the next Governor, and could result in increased cost to ratepayers. I hope my concern proves to be unfounded but I will pay close attention to the implementation of the agreement, particularly with respect to its last two years.

Related links:

“The primary tenet of nuclear, chemical, and biological warfare defense is contamination avoidance.”

UPDATE:  10/26/2014:

This post was originally titled, “Ahhh!!!  The stupid, it burns!  (Ebola edition)”.   I decided to retitle it to better reflect what motivates my thinking.  As I noted in an earlier post, I worked for about 15 years on chemical and biological warfare defense-related projects.  I wrote a number proposals for R&D funding which started off “The primary tenet of nuclear, chemical, and biological defense is contamination avoidance.”  (The other two are force protection and decontamination.)  Anyhow, “The primary tenet of nuclear, chemical, and biological defense is contamination avoidance.” is where I’m coming from.  Spread of highly contagious and lethal diseases like Ebola don’t follow from malicious intent like a bio-warfare attack but, from a public health standpoint, there’s no difference in what constitutes an appropriate response.


From the NY Times, Doctor in New York City Tests Positive for Ebola:

A doctor in New York City who recently returned from treating Ebola patients in Guinea tested positive for the Ebola virus Thursday, becoming the city’s first diagnosed case…  Dr. Spencer had been working with Doctors Without Borders in Guinea, treating Ebola patients, before returning to New York City on Oct. 14, according to a city official.

Please explain to me why the @#$% Dr. Spencer was not put immediately into quarantine when he showed up at U.S. Customs?  He was treating individuals with a highly contagious and lethal disease for chrissakes.  Checking his temperature is all well and good but people infected can be asymptomatic for up to three weeks.  Stupid.  Stupid.  Stupid.   And, yes, I support denying entry to persons who have been to CDC Level 3 countries within the past 21 days.   Have Customs check passports.  If you’ve been in a CDC Level 3 country with the past 21 days then straight to quarantine.  No discussion.  No debate.  Sorry for the inconvenience.

Another thought:  Multidrug-resistant tuberculosisContinue reading

On the importance of having a good decontamination protocol and executing it properly

This post is inspired by the two nurses, Nina Pham and Amber Vinson, who contracted Ebola virus after treating Thomas Eric Duncan at Texas Health Presbyterian Hospital.  See the timeline of events surrounding Duncan’s diagnosis and treatment here.

I was somewhat surprised – and moderately alarmed – when Nina Pham was diagnosed last weekend.  That Amber Vinson also contracted Ebola is also alarming but as we learn more about how the hospital treated Duncan it’s not a huge surprise.  When Pham’s diagnosis was announce, while the possibility of Ebola having mutated and “gone mobile” was scary it also seemed remote.   More likely it seemed to me was that the nurses either didn’t have good personal protective equipment (PPE) or that the hospital didn’t have a good decontamination protocol for workers coming out of the hot zone.   It now appears that not only was the PPE used insufficient but that there was no decontamination protocol in place.   Given that, it doesn’t surprise me that several health care workers became ill.  When working with highly toxic materials or contagions good PPE is essential but if you don’t have a good decontamination protocol in place then you can easily expose yourself to the hazard when removing your PPE.  Good practice is to decontaminate your PPE before removing it.  My understanding is that bleach kills Ebola virus so, with the caveat that a little knowledge can be a dangerous thing, my take is that proper decon of potentially-exposed health workers would involve spraying them down with bleach before they removed their PPE.  Continue reading

Donald Berwick on Single-Payer Health Care

No, I didn’t vote for Berwick in the primary but he is spot on about making health care more affordable.  From an interview he did with Carey Goldberg:

I asked Dr. Berwick about the reaction to his single-payer position in his many campaign-season travels, and he said the biggest surprise was how positive the response had been from voters who would likely not call themselves progressives. They either already agreed with the idea, he said, or responded instantly after one sentence of explanation with, “That sounds right to me. Let me tell you my story.”

“I remember a carpenter in Hingham,” he said. “I don’t think he would have said he was a progressive — he was a somewhat older carpenter struggling to make ends meet, sitting on a sofa at a gathering, a meet-and-greet, and I started talking about this, and I guess — embarrassingly, to me — I was expecting some pushback. But he immediately said, ‘I’ve got to tell you a story.’ And he told me about his struggle to get health insurance.

“He very carefully went through the policy options, he had picked one that had a maximum deductible that was pretty stiff, and he was ready to swallow it. And he did, he signed up for that plan. And then, the problem was that he had three major illnesses the following year. And he discovered — to his dismay — that the deductible did not apply to the year, it applied to each separate episode. So this guy, who’s working with his hands and trying to just get through and have his family’s ends meet, suddenly found himself tens of thousands of dollars in debt, because of the complexity [of health insurance.] And he said, ‘Enough of this!’ He immediately understood and was fully on board, and that kind of experience has been pretty constant for me.”

Overall, Dr. Berwick said, “The response has been extremely positive beyond anything I would have anticipated. When I took the position, I had no polling information. I did it because I was looking at the state budget and seeing the erosive impact of rising health care costs on everything else we need to do. The numbers were stunning to me. I got briefed by the Mass. Budget Policy Center and they said — as I remember the numbers and have been quoting them — Parks and Recreation were down 25 percent, local aid was down 40 percent, higher education was down 30 percent.

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Not a happy day

From The Washington Post, Why the escape of numerous Ebola patients in Liberia’s worst slum is so terrifying:

People gathered near the entrance of an Ebola isolation unit, where dozens of patients, many of whom were suspected if not confirmed to be infected, were getting treatment. Pictures showed some in the crowd had masked their faces with T-shirts or shawls. Others, including a woman in a red dress named Batu Flowers, tried to convince the mob that Ebola was real, they weren’t being lied to, that news of the outbreak wasn’t a hoax. But the crowd wouldn’t be dissuaded.

It pushed against the gates of the Liberian primary school, which had been converted into a treatment center in the middle of West Point, which some call the most squalid community in Liberia if not West Africa. Thanks to poor sanitation and open sewers, the community of tens of thousands crowded onto a peninsula jutting into the Atlantic Ocean has long been prone to debilitating sicknesses from typhoid to malaria to lethal diarrhea. Now it has one more to contend with — a virus spread through feces, blood and vomit.

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The value of good sanitation

From the NY Times, Poor Sanitation in India May Afflict Well-Fed Children With Malnutrition:

[A]n emerging body of scientific studies suggest that … many of the 162 million … children under the age of 5 in the world who are malnourished are suffering less a lack of food than poor sanitation.

Like almost everyone else in their village, Vivek and his family have no toilet, and the district where they live has the highest concentration of people who defecate outdoors. As a result, children are exposed to a bacterial brew that often sickens them, leaving them unable to attain a healthy body weight no matter how much food they eat.

“These children’s bodies divert energy and nutrients away from growth and brain development to prioritize infection-fighting survival,” said Jean Humphrey, a professor of human nutrition at Johns Hopkins Bloomberg School of Public Health. “When this happens during the first two years of life, children become stunted. What’s particularly disturbing is that the lost height and intelligence are permanent.”

Mortality Rate vs Survival Rate

Aaron Carroll, Zombie arguments defending the US healthcare system:

There’s a new Commonwealth Study that ranks the US [healthcare system] pretty poorly. Nothing new there. Nothing new to some of ways that people defend the US. So let’s dispense with them in rapid fashion…

He makes three points, one of which is that when evaluating the effectiveness of a country’s healthcare system mortality rates (mortality rate = deaths per year per 100,000 people for a specified illness) are a better measure than N-year survival rates (survival rate = the probability that you’ll be alive N years after diagnosis).  It’s not that survival rates are irrelevant in the grand scheme of things, just that they’re not a good measure of how effective a healthcare system is.   Here’s his explanation for why mortality rates are more relevant than survival rates: