Friday, November 06, 2009

The massacre at Fort Hood -

Just cleaning things up at the end of the week, and with the news of Fort Hood breaking on the radio...

I am sitting here listening to Portishead "Third", and as I write the track "Machinegun" is playing, and the neighbours are setting fire to money again in the form of fireworks to celebrate the unsuccessful attempt by Catholic terrorists to blow up the Protestant-run English Parliament.

Machinegun

I saw a saviour
a saviour come my way
I thought I'd see it
at the cold light of day
but now I realise that I'm
Only for me

if only I could see
You turn myself to me
and recognise the poison in my heart
there is no other place
no one else I face
remedy, we'll agree, is how I feel
here in my reflecting
What more can I say?
for I am guilty
for the voice that I obey
too scared to sacrifice a choice
chosen for me

if only I could see
You turn myself to me
recognise the poison in my heart
there is no other place
no one else I face
The remedy, to agree, is how I feel


(Subject to all of the strictures of copyright etc which is why I have included the link to the source in the heading)

Those lyrics I find strangely appropriate to the sad events at Fort Hood. This was not a political or terrorist act any more than Columbine, or the Pennsylvania shootings were the work of terrorists.

It is a criminal act, carried out by a man who has to fall into at least two of the "mad, sad, bad" categories. That in no way lessens the nature of the shootings. It in no way lessens the impact on families and their community.

So that is why I put the lyrics in.

I can hear the screams of rage against all Muslims. I can imagine the more extreme wanting to lynch all of the Muslims and anyone else who dresses funny just to be sure.

I saw a saviour
a saviour come my way
I thought I'd see it
at the cold light of day
but now I realise that I'm
Only for me


If you can find a P2P copy of "Machinegun" have a listen. I enjoy Portishead's music because it makes me think

Thursday, November 05, 2009

On the state of health - 1

There was an interesting comment over at TF's place stating (and I can't for the moment think of a reasonable response to it) that the Federal government "has no place in providing health services". As should be well known to readers here, that is certainly not the case in NZ. Mind you, the commenter did continue to say that it was a State responsibility, and that perhaps is the reason why I am at a bit of a loss about it.

There is one very direct parallel between NZ and the US though, and it centres on the role of the private system and medical insurance providers.

To that end there was a very interesting and somewhat blood-chilling little article in SST this week...
RISING HEALTHCARE costs have reached crisis point, pushing families to give up their health insurance and fall back onto the straining state system, says Ian McPherson, chief executive of Southern Cross Medical Care Society.

The not-for-profit insurer saw claims rise by $61 million in the year to June and McPherson said factors behind the claims blowout included the amount private surgeons earned and costly new medical technologies with little or no proven clinical benefit.

For the time being, my salary package includes medical insurance through Southern Cross at a cost of something like $35 per week. That looks like increasing by a bit in the near future.
"How much will people be able to continue to pay and not object?" McPherson asked.

"We have seen a significant downgrading from policies that are far more general to policies covering the extreme emergencies. It is difficult for people to downgrade any more. There is a significant number sitting on the bottom rung and about to jump off into the public system again."

Exactly.
Rising costs for Southern Cross could also feed the already rapid rise in the state's healthcare bill. Consultant Paul Winton, author of a report in August – Health, New Zealand's untreated addiction – said current trends suggested healthcare costs could grow from 20% of core government spending to 40% in 15 years.

McPherson said Southern Cross had begun engaging with GPs on the premium-affordability crisis, and the subtext is clear – the insurer wants to see GPs direct patients away from the more expensive private surgeons.

"We are not going to tell GPs who to refer their patients to," McPherson said, but "we would like GPs to be mindful about the cost rather than referring out of habit. Giving them an incentive to help manage our budgets is something we are exploring with them now."

Southern Cross has been developing a network of affiliated providers, but McPherson said as yet it would be a step too far to require their use in the same way a car insurer would require a claimant to go to an approved panelbeater.

Now there is little wrong with the Southern Cross response to the problem so far as I am concerned.

The truth of the matter is though that McPherson's prognosis in the opening paras is only too true. Even given the present premium levels there is little chance that I will be able to afford the present cover into my retirement. There is no question that I will become increasingly reliant upon the public health service. Not that I have any problem with that, as it has certainly been "good value" for me.

McPherson said there were instances where it appeared that profit motive and not clinical outcomes were driving that price upwards.

He cited the example of robot-assisted prostatectomy surgery which costs $30,000 compared to the $15,000-$20,000 of conventional surgery, without evidence of faster recovery or better clinical outcomes.

Southern Cross's reaction in this case was to pay only a "contribution" to the cost of the robot-assisted surgery.

Why were surgeons using it? "Because it is fun. Because it is interesting. Because you can get a margin on your investment."

Hmmm, sounds a bit like "boys toys" no?

Let's set the parameters here.

First, medicine is about curing diseases, mending injuries, and providing palliative care for the dying.

Second, it is a very highly skilled and for most a stressful occupation. (I am basing that on the comments made to me by the three medical doctors in the club I belong to). People who fit those parameters in any field deserve to earn more than those of us who cruise below the radar doing little more than subsist. There is also, as any capitalist will tell you, the need and justification for recovering a return on capital invested; let's face it, I will tell you that as an accountant.
Terry Moore, president of the Private Surgical Hospitals Association, said: "We are conscious of the increases in costs which ultimately, if left unchecked will mean fewer people will be able to afford to go private themselves."

Moore said uncontestable clinical proof of new technologies could take years to emerge, but acknowledged they were stoking cost escalation along with wages and surgeons' fees.

McPherson also hit out at fees in his annual report to members last month. "We hear the argument that [surgeons] are part of a globalised workforce; we point out that if their prices increase to reflect overseas rates, fewer New Zealanders will be able to afford private surgical services."

Boscawen [right wing MP] is of similar mind, arguing that the globalised workforce is more of a westernised workforce, because the wages earned by quality doctors from India, for example, where cataract surgery is cheap, are having no effect on the fees charged by private surgeons here.

Moore countered: "Surgeons are generally independent practitioners and contractors so they pretty much set their own fees in a competitive market, but I don't think the fees have gone up much more than the medical inflation rate. They have become more efficient so they are probably earning more, but probably working harder for it and doing more procedures."

He said rising premium costs for health insurers were also driven by the sheer number of procedures being done, not just the cost of each one.

All true, well I have difficulty disagreeing with most of it so it must be. No confirmation bias here!

But there are some interesting contradictions. For example, the hospitals (Moore, above) are trying to argue that "economies of scale" ideas do not apply; "rising premium costs for health insurers were also driven by the sheer number of procedures being done, not just the cost of each one." I would have thought that (as my wife found out when she had cataracts removed from one eye) being able to "mass produce/production line" operations would lead to some savings. If it costs the insurer $4M to provide 1100 cataract operations then does increasing the number by 20% mean a 50% increase in cost? It does if "industry" is currently running at or above capacity.

There is a secondary impact too, coming out of the combination of developing technology (and that is everything including drugs and personal skills) together with societal expectations. The best indicator I can give for this effect I wrote on some while back (2006?? Sheesh!) is the example of herceptin - a treatment drug for a specific kind of breast cancer. That example ended up as a $3 million programme to treat roughly 20 women per year or about $150,000 each.

No one can blame those women for wanting (or deserving) the best possible treatment, and outcome. Exactly the same justification existed in the 1970's when open heart surgery was being developed by the likes of Barratt-Boyes and the other researchers in US, Europe and South Africa. Today, that surgery is routine. Auckland Hospital does two or three operations per day at a cost each of (I was told) about $75,000.

[To be continued...]

Sunday, November 01, 2009

On MY god-given rights -

I am sitting here listening to Fat Freddie's Drop that SWMBO has playing on the stereo, there is a tui outside with what seems at first to be a one note welcome "toot-toot" to the world. Shut off the ambient city-noise and a huge repertoir of clicks, gurgles, whistles and honks becomes apparent.

OK, so let's assume for the moment that I live in an "enlightened" country where RKBA applies. Let's assume for the time being that government imposed restrictions on road traffic do not exist.

First, forget about the killer for the moment in the three frames that follow. I want to discuss the "rights" of the victim. I want to discuss the reaction of the lady standing on the footpath. It could be a scene from any American corner store. It could be anywhere from Alaska to Florida. It could be right out of Tom Waits' "Small Change" (...got rained on with his own 38).

The question has to be - "What protection would he have gained from RKBA?" The answer to that question is not improved in any way by gun controls, let's be honest about that. It does point up what I see as the total futility of RKBA as it is presented by the NRA and supporters - you know the kind of thing; "big hairy man jumps out of the shadows and makes to rape your wife... "
>


In a similar vein, there is a continual pressure for "Them" (the Government) to lighten up on the strictures on road users. The speed limit is the usual one; the "government revenue-rasing law". At this time the vexed question of alchohol levels are in the sights as well with proposals to impose a "zero tolerance level" for under-25's and the same "05" law as applies in Australia and many other countries. The resistance comes from groups who consider that they have a god-given right to determine the speed at which they drive. They have a god-given right to decide when they are p'd out of their tree. So, take a look at the following. The consequences; two dead, several injured, one critically. The two fatalities came from the van; thrown out by the impact. The driver of the van was a 16 y-o girl who was "pissed as a fart". But look on the left side of the photo. There is another vehicle there also badly damaged. It is the occupants of that vehicle, their rights to use the roads safely, that I am pointing up.
So there are two small reasons why, when the likes of TF start prating on about "their God-given right" to do this, that or the other, I start getting hot under the collar.

Perhaps it would be appropriate to suggest that if the paramouncy of the rights of the individual to act as he/she sees fit without regard to the rights of others is to apply then it is appropriate too that they be isolated into their own little society. There they can kill, murder, have state-imposed murder, stop abortions, stop pornography, lie, steal, and cheat, to their collective hearts' content.

If humble and somewhat "socialist" countries are able to exist without those so-called "freedoms" then those who promote the rights of the individual over all others can stay away.

It is probably significant that NZ, the Scandinavian countries, in total 82 countries, all rank higher in "freedom indices" than does the US of A.

I wonder why?

Oh, and the three photos of the shooting are actually from Italy. Not that that fact in any way would change what I have said.

Thursday, October 29, 2009

On getting heated -

I have until now retained a (hopefully fairly dignified) silence on the subject of global warming, climate change and carbon dioxide levels. That in large part is because I am somewhat undecided on the merits (and otherwise) of the various people involved.

There are two parts to the “problem” –

First, whether the planet is getting warmer or not.

Second, if it is getting warmer, what is causing the change.

I (quite intentionally as it happens) got somewhat passionate about TF’s post that further distributes the idea (that Monckton has put forward) that the Copenhagen agreement on global warming is going to spell the end of the US and freedom as we know it; that the agreement is the first step toward socialist (read communist as well) dominated world government. That “passion” also requires an explanation.

Now I know that TF will protest once more that the “End of the USofA” he wrote of is something other than climate change. We have a disagreement there for a starter; primarily because in the speech advertised by TF, Monckton is actually slating the climate change movements as “just another step” toward socialist world government and domination. I intend not to pursue that line any further than I have already pursued the climate change argument.

I want to introduce a third line of thought at this point.

Over this last weekend (a four day weekend for the lucky ol’ probligo as NZ celebrates the advent of the 40 hour week – a total victory for socialism!!!) there was a discussion on radio about the relative “natures” of talkback hosts and bloggers. One of the questions that started the discussion was why most if not all talkback hosts espoused right-wing political positions rather than liberal, centrist or left-wing. Among the opines given in response to the question was that the liberal/left-wing faction were more given to thoughtful presentation and logic compared with the right-wing penchant for bald, largely specious, statement.

The consequence is (and I “know” this empirically) that the talkback radio audience is largely dominated by people of the “far” right who listen in order to get more of their confirmation bias fix, there are a smaller number of people from the left who still have that misguided ambition and fire in their bellies to try and “save the world from itself”, there is that confused part of humanity who will believe anything said by someone with authority in both voice and stance, irrespective of how specious the statement. Oh, and there is the small proportion of unfortunates, the drunks and the over-tired who call in total confusion because there is no “reality” on their tv and thinking that something is “really happening” on the radio.

I can not say that the blogiverse is dominated in the same way by “liberals”. There are enough right-wingers around the blogiverse to keep me happy for a whiles to come.

Having those thoughts in mind, I want to return to Monckton. Well, no. I want to return to a group which includes Monckton along with the likes of Michael Moore (the American one, not the retired head of WTO), Al Gore (as TF rightly points out), even Michael Laws, Paul Holmes, Phil Hannity, Phil Donahue and even perhaps the ol’ probligo if it comes to that.

The common personality trait with all of these people is not the nature of their politics, their style or their message. The common link is that they have a message which they promote without stint nor favour; a message that they present with a minimum of justification and logical support; the message is in reality no more than the presentation of themselves to people who want to believe them.

So if I were to listen (as I do not) to the likes of Laws or Holmes in the full flight of their “oratory” I could expect to hear statements which can only be politely described as “intending to get the audience in the mood, their breeches around their knees, while bowing to the west”. The whole process is not dissimilar to that of the more charismatic churches – there’s an idea, I should have included Bishop Brian Tamaki in the mix as well. You preach to the converted. You cater to their personal biases. You tell them what they came to hear. Then you add a little more. Then you add a little more. Before long the “truth” that people came to hear has expanded to a new idea. There is as much truth in the new as there was in the old. Then you add a little more. Before you know it you can name yourself "King"; the latest in the line of "King Davids", the chosen ones.

How many times has the “world government” conspiracy been around the traps in my time. Beyond number almost. It ranges from the UN taking over, to climate change, to Islamic extremists, even shady organisations like the Opus Dei (which does apparently exist despite The Da Vinci Code), Scientology, The Protocols of the Elders of Zion, and even perhaps the High Council of Zion.

There is a point to all of this.

Power, all Power and hence all Government, is reliant upon fear. That fear can be of your next door neighbour (who just has to be a communist or a undercover member of the House UnAmerican Activities Committee depending upon your own politics), the bogeyman under your bed, Islamists, Jews, Russians, anything that has to it an element of power that might intrude (or does intrude) on “your” lifestyle. It works the other way too – in the fear that X will stop or prevent you from attaining the ends that you deserve; be it riches beyond imagining, the right to bear arms, a 42” tv set, or 72 virgins. It can be the fear of the consequences if you fail to observe Rules, whether made through democratic or autocratic processes; the fear of failing to attain the 72 virgins in dying for your god, our burning in hell for failing to observe the right obeisances at the right time, or of being burned at the stake for speaking out against the ruling order.

What we have is the question of motivation. Why do people like Garth George and Paul Holmes write newspaper columns, especially when anyone in their right minds would turn the page before they puke? Why does Michael Laws use talkback radio to spread his particularly strange version of politik real? And why do “hosts” like Hannity and Donohue exist at all?

Each in their own way provide comfort from fears. Each in their own way builds on existing fears as a way of presenting comfort. That comfort is from the “understanding” the fear; you are not alone; together we must defeat this…

There is also the motivation of denial. “Fear not because I am right and ‘they’ (whoever ‘they’ might be) are wrong. Together we will prevail”.



So, where does the ol’ probligo stand on the climate debate?

First up, is the planet getting warmer? There is some evidence - concrete evidence - that climatic changes are occurring. The unproven question is "How fast?"

Second, is the cause human (what do they call it now? "anthropological outputs"? Not proven, either way. That is where the science is at the sharp end of the debate.

The truth is, and the reason why the “debate” is so heated and divisive, we just do not know the causes. All of the positions taken, whether scientific, political or personal, are based upon suppositions and assumptions which are very open to dispute. There is no empirical, scientific, experimental evidence strong enough to constitute “proof” to the point where it is incontrovertible. No one can take a planet like Earth, run an experiment to show "Yay" or "nay" on a repeatable basis - the essence of scientific proof.

Wednesday, October 21, 2009

On fighting a war...

Out of yesterday's Herald comes a fairly brief summary of the situation in Afghanistan and the prospects for the future of that nation and the military campaign against the Taliban.
"The weakness of state institutions, malign actions of power-brokers, widespread corruption and abuse of power by various officials, and Isaf's [International Security Assistance Force's] own errors, have given Afghans little reason to support their Government," McChrystal argued in a document leaked to Bob Woodward of the Washington Post. He said the consequence had been a "crisis of confidence among Afghans. Further, a perception that our resolve is uncertain makes Afghans reluctant to align with us against the insurgents".

That is extracted from a confidential briefing paper prepared for President Barack Obama by the senior US general in Afghanistan, Stanley McChrystal, in August 2009, eight years into the United States-led invasion of Afghanistan.
"We should honestly admit that our efforts have not led to the expected results. Huge material resources and considerable casualties did not produce a positive end result - stabilisation of military-political situation in the country. The protracted character of the military struggle and the absence of any serious success, which could lead to a breakthrough in the entire strategic situation, led to the formation in the minds of the majority of the population of the mistrust in the abilities of the regime."

"The experience of the past years clearly shows that the Afghan problem cannot be solved by military means only.

"We should decisively reject our illusions and undertake principally new steps, taking into account the lessons of the past, and the real situation in the country."

So the Americans are starting to have doubts?

Far from it, it seems. That second quote was from August 17, 1987. The writer Colonel K. Tsagalov is addressing the newly appointed Soviet Defence Minister, Dmitry Yazov.