Why US Health Care Costs So Much

(via Matthew Yglesias): Atul Gawande explains, in the New Yorker, why US healthcare costs so much.

It is hard to summarize, but it is the cultural practices of the health care professionals that results in high or low healthcare costs.

This is a must-read article.

The road to success

Ken Johnson begins his review in the NYT of a exhibition of Luis Meléndez paintings at the National Gallery of art thus:

Here is a time-tested recipe for success: fail at what you want to do, then do what you really can do.It worked for Luis Meléndez. He desperately sought appointment as a salaried court artist like his contemporary Francisco Goya, but his petitions to the king were rejected. So instead of producing unctuous portraits of nobles, grandiose history paintings and saccharine mythic scenes, he painted small, intensely realistic pictures of fruit, vegetables and kitchenware. Today he is considered the greatest still-life painter of 18th-century Spain.

Image from Wikipedia: "Still Life With Watermelons and Apples in a Landscape (1771)"

Foerter Farm

If the pictures here are of interest, it is because of the effort to save Foerter Farm from development. Foerter Farm is one of the key open areas along Lawrence Brook. You can read about it here, http://lbwp.org/index.htm .

There are no pictures of the farm here. What the farm lends is open space and an ambience to the surroundings. Photographically, it is a lot of flat land. Currently the areas I saw are fallow.

The Ved Mandir is the next-lot neighbor to the farm. In this view, the farm is behind me. (Blast that street-light pole!)


Farrington dam is north of the farm. Pictures from the top of the dam I posted already. Here are pictures from the base of the dam.





Bicentennial Park abuts the lake formed by the dam. Here is one of the park residents.
Yes, I blew highlights in the background.)


Finally, something totally unrelated. My niece spotted the opportunity. This is the door of a restaurant at the beach in Long Branch. (Remember, east is the Atlantic. The setting sun hits a not-so-pretty skyline, so the way to capture a sunset is by reflection.)

My first panorama

I've never done one before! The results are modest.

This is from the top of Farrington dam, on Lawrence Brook, in East Brunswick, NJ.



PS: Not sure why this one has a peculiar outline, very much more pronounced than the one above (before a rectangular crop of the Photoshop output).

More on The Case for Working With Your Hands

Matthew B. Crawford's essay, about which I posted yesterday, can be found here.

There are other thoughts there that may be a starting point for elaboration.

The common desi hazard is not Indian-only.

There is a pervasive anxiety among parents that there is only one track to success for their children. It runs through a series of gates controlled by prestigious institutions.

The philosophers of science do not understand why many times one hypothesis wins out. Simplicity and beauty are not quantifiable, nor are reliable guides to scientific truth. But all hypotheses are not created equal. The motorcycle mechanic encounters it, though in a different way.

Measured in likelihood of screw-ups, the cost is not identical for all avenues of inquiry when deciding which hypothesis to pursue. Imagine you’re trying to figure out why a bike won’t start. The fasteners holding the engine covers on 1970s-era Hondas are Phillips head, and they are almost always rounded out and corroded. Do you really want to check the condition of the starter clutch if each of eight screws will need to be drilled out and extracted, risking damage to the engine case? Such impediments have to be taken into account. The attractiveness of any hypothesis is determined in part by physical circumstances that have no logical connection to the diagnostic problem at hand. The mechanic’s proper response to the situation cannot be anticipated by a set of rules or algorithms.

There is an ethical dimension to the very process of thought:

...habits of mind have an ethical dimension that we don’t often think about....The slap of worn-out pistons hitting their cylinders can sound a lot like loose valve tappets, so to be a good mechanic you have to be constantly open to the possibility that you may be mistaken. This is a virtue that is at once cognitive and moral. It seems to develop because the mechanic, if he is the sort who goes on to become good at it, internalizes the healthy functioning of the motorcycle as an object of passionate concern. How else can you explain the elation he gets when he identifies the root cause of some problem?....
There is good reason to suppose that responsibility has to be installed in the foundation of your mental equipment — at the level of perception and habit.

The problem the mid-level manager faces is described:

A manager has to make many decisions for which he is accountable. Unlike an entrepreneur with his own business, however, his decisions can be reversed at any time by someone higher up the food chain (and there is always someone higher up the food chain). It’s important for your career that these reversals not look like defeats, and more generally you have to spend a lot of time managing what others think of you. Survival depends on a crucial insight: you can’t back down from an argument that you initially made in straightforward language, with moral conviction, without seeming to lose your integrity. So managers learn the art of provisional thinking and feeling, expressed in corporate doublespeak, and cultivate a lack of commitment to their own actions.

The remoteness of the decision-makers from the content of the work that they make decisions about is described, leading to this:

Rather, my supervisor and I both were held to a metric that was conjured by someone remote from the work process — an absentee decision maker armed with a (putatively) profit-maximizing calculus, one that took no account of the intrinsic nature of the job. I wonder whether the resulting perversity really made for maximum profits in the long term. Corporate managers are not, after all, the owners of the businesses they run.

The scarcity of good jobs:

A good job requires a field of action where you can put your best capacities to work and see an effect in the world. Academic credentials do not guarantee this.

Nor can big business or big government — those idols of the right and the left — reliably secure such work for us. Everyone is rightly concerned about economic growth on the one hand or unemployment and wages on the other, but the character of work doesn’t figure much in political debate.

Telling it like it is

Matthew B. Crawford has a essay in tomorrow's NYT Magazine (no link available yet).
The blurb reads "After acquiring a Ph.D. and an information age resume, I opened a motor-cycle repair shop. And that's where I learned to think". The title of the essay is "The Case for Working With Your Hands".

As it happened, in the spring, I landed a job as executive director of a policy organization in Washington. This felt like a coup. But certain perversities became apparent as I settled into the job. It sometimes required me to reason backward, from desired conclusion to suitable premise. The organization had taken certain position, and there were some facts it was more fond of than others. As its figurehead, I was making arguments I didn't fully buy myself. Further, my boss seemed intent on retraining me according to a certain cognitive style — that of the corporate world, from which he had recently come. This style demanded that I project an image of rationality, but not indulge too much in actual reasoning. As I sat in my K Street office, Fred's life as an independent tradesman gave me an image that I kept coming back to: someone who really knows what he is doing, losing himself in work that is genuinely useful and has a certain integrity to it. He also seemed to be having a lot of fun.

Indian mythology

From "Stuffed & Starved : The Hidden Battle for the World Food System" by Raj Patel

Economist Utsa Patnaik has followed the statistical sleight of hand that have enabled India's poor to vanish since the 1970s, and she has calibrated her observations by going back to one of the central features we associate with poverty - hunger.

At the beginning of the 1970s, over half the population was classed as poor. Two decades later, in 1993-94, the number of poor people had fallen to just over one-third. This progress was achieved in no small part because the official threshold for poverty had been lowered. In the 1970s, being on the poverty line afforded you 2,400 calories per day — in the early 1990s, you were afforded only 1,970 calories per day. By 1999-2000, just over one quarter were poor — an impressive reduction. But the threshold for poverty meant consuming fewer than 1,890 calories per day. Says Patnaik, 'by the 60th Round, 2004-05 [the poverty line] is likely to be below 1,800 calories and correspond to less than one-fifth of the rural population.

Today, when the official figure for poverty in India is around 27 per cent, a more accurate calculation based on the implied calorie norm of 2,400 per day puts three-quarters of the population under the poverty line. To put it slightly differently, around half a billion people have been written out of poverty, by the simple expedient of shifting the goal-posts and the diligent advertising of present and future prosperity. This is how the story of 'Shining India' is told - with an official narrative about poverty that directly contradicts the facts. Jobs have been created for the educated middle class, but for those without access to education, the story has been rather different.

Is genius necessary to do math?

Terence Tao is a mathematics genius, but here are his thoughts on
Does one have to be a genius to do maths?

The brief answer is - No!

Personally, I feel that the huge quantities of energy that a lot of people spend in wondering where they and their colleagues stand in the genius and intelligence pecking order would be better spent elsewhere.

Pakistan Watch - 10

Oldies

Courtesy youtube.







or try this.

Hume's problem of induction

The library had this very slim "Philosophy of Science - A Very Short Introduction" by Samir Okasha, and of course, I had to pick it up.

A quick scan of the book seems to indicate that the practice of science has rather loose philosophical foundations. A bigger mystery than any in the book then is why is it that science works? A second question is - are there ways of doing science that we have not yet imagined (this thought because perhaps the incompleteness of our knowledge is what leads to this philosophical mess).

Hume's problem of induction: Inductive reasoning is essentially the generalizing we do from a set of particular instances (e.g., having observed the sun to rise in the east every day, how do we justify that it will do so tomorrow? The process we use is induction). Hume argued that it is impossible to provide a rational (deductive) argument to justify induction. When we try to do so, we find we have to make additional assumptions, such as the uniformity of nature (which begs the question, because we cannot justify the uniformity of nature without induction).

From my point of view, errors of induction abound. A most common one is when someone justifies their prejudices against an entire people based on their experience with a handful of them. But it extends to science, too. Induction would lead us to believe that all matter is made of atoms (or various arrangements of atomic constituents). And yet when we look into deep space, we find that to explain what we see there is that there must be dark gravitating matter that is unlike any matter we are familiar with; consistency with known laws requires this matter to be non-baryonic (i.e., not the familiar atomic constituents).

The answer that, yes, science gives us provisional knowledge, and the laws (or models) that we have are of limited scope still does not answer the problem of induction; because even within the limited scope of the law we have to assume nature behaves uniformly.

Now, I'm not a philosopher, let alone a competent one. Still, here goes. From the point of view of the Indic traditions, before addressing the problem of induction, the focus would be on this rational creature that we are trying to convince from some self-evident premises and logical reasoning that induction is justifiable. My intuition is that the very existence of such a being is knowable to us only by induction. Why does language have any meaning? because we can connect it to the world - the real world, or the mathematical world - through induction. "Cat", "gas", "point", "Euclidean geometry" only make sense because there is some stability of memory and experience. "I", "I think" are concepts arrived at by induction. Perhaps only the God of the Bible or Quran can apprehend the world without induction; we humans cannot. Therefore we cannot properly pose Hume's question. "Convince this creature that knows of itself solely through induction that induction is a valid means of knowledge".

PS: Descartes' "I think, therefore I am" is inductive, not deductive.

Brock Farms Watch

Brock Farms is a garden nursery near where I live. Infinitely more fun than following the news from Pakistan.

If you think about it, in some ways gardening is the most basic of pleasures. In another, it is the ultimate luxury.

Pakistan Watch - 9

Syed Mansoor Hussain in the Daily Times:

Many in the English language media within the country as well as in the foreign media maintain that the fight against the Taliban in Pakistan is somehow a fight between the forces of liberalism and democracy against the forces of religious extremism and a theocratic impulse. This is entirely wrong.

The forces of liberalism, democracy and secularism lost the fight sixty years ago when the Objectives Resolution was passed by the Constituent Assembly of Pakistan. Since then, at best these forces have a fought a losing battle against the Islamisation of Pakistan. Today, Pakistan is firmly and without argument an Islamic state with a constitution that clearly and unambiguously states that no laws can be repugnant to Islam.

What Pakistan has seen since the death of Mohammad Ali Jinnah in 1948 is essentially a fight between competing visions of piety. For the first twenty years of its existence, Pakistan was under the sway of a ‘kinder and gentler’ version of Islamic practice as envisioned by the Sufi influenced Hanafi-Barelvi majority of the country.

Once General Zia-ul Haq took over and the Afghan war started, the religious centre of the country rapidly shifted under official patronage towards the more austere and extreme Wahhabi-Deobandi interpretation of Islam. The Taliban are a product of that interpretation and find support within the country from those that adhere to that vision of Islam even outside the border areas.
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Once the non-Taliban types are fully mobilised, what we will see is not necessarily a victory of secular democratic forces but rather of the Islamic ideation of a different mindset; but still very much Islamic and perhaps even equally extreme in its own way. I do not believe that Pakistan is headed towards an Iranian-style theocracy but we might not end up too far from it either.

The Rise of Islamic Terrorism

Searching in the New York Times archives for the term "Islamic terrorism", the following is found:

1851-1980 - 0 results
1981 - 0 results
1982 - 0 results
1983 - 0 results
1984 - 1 result

DIRE STRAIT; IRAN AND IRAQ TURN UP THE HEAT IN THE GULF

...But Riyadh also fears that a visible American embrace or presence could open the door to Soviet intervention or to Islamic terrorism. So, Washington's overtures toward sending military help are resisted. The Saudis spent the week in full diplomatic...View free preview

May 27, 1984 - By LESLIE H. GELB - Week in Review - 1120 words

1985 - 0 results
1986 - 1 result

BOOKS OF THE TIMES

...In a discussion entitled ''Islamic Terrorism?,'' the scholar Bernard {Lewis} ...character than other religions, Islamic terrorism as practiced today is essentially...about the Western roots of Islamic terrorism, while analyzing some of the...

April 25, 1986 - By John Gross - Arts - 1000 words

1987 - 2 results (One refers to Amir Taheri's book, Holy Terror - Inside the World of Islamic Terrorism)
1988 - 0 results
1989 - 1 result (a reference to Amir Taheri's book, thusly

MINDS THAT NEVER MET

...client ties or Western-Muslim relations. Mr. Taheri, the author of ''Holy Terror: Inside the World of Islamic Terrorism,'' prefers to view the story as more akin to a psychological study of the principals, using the relationship...

April 9, 1989 - By LISA ANDERSON; Lisa Anderson is an associate professor of Middle East politics at Columbia University. - Arts - 973 words

1990 - 0 results
1991 - 0 results
1992 - 1 result, appears as follows:

About the B.C.C.I. Agenda

...nothing "Islamic," about B.C.C.I. Radical Islam opposes banks in general as they are ipso facto "un-Islamic." Terrorism, money-laundering, influence peddling, etc., are political, not religious tactics. As for banking, most...

August 16, 1992 - Business - 202 words

1993 - 5 results (only! despite Feb 26, 1993 WTC bombing)
1994 - 1 result (story about Algeria)
1995 - 4 result (three stories related to Israel, one to Bosnia)
1996 - 4 results
1997 - 1 results
1998 - 4 results
1999 - 3 results
2000 - 8 results
2001 - 40 results
2002 - 26 results
2003 - 24 results
2004 - 56 results
2005 - 36 results
2006 - 42 results
2007 - 40 results
2008 - 21 results

I know I should search for other variations, such as "Islamic terrorist(s)", and so on, but my guess is that it would be borne out that it took two attacks on its hometown for the New York Times to report news through the lens of Islamic terrorism.

Pakistan Watch - 8

Asia Times reports (h/t BRF):

he high-profile arrest of a group of Pakistani militants in mid-April in the restive Afghan province of Helmand by the Afghan army and their subsequent handover to the North Atlantic Treaty Organization (NATO) for grilling exposed a jihadi network running to the heart of urban Pakistan.

In the course of interrogation, the militants confessed to being recruited, trained and then launched into Helmand after spending some time in places such as the southern port city of Karachi and Quetta, the capital of Balochistan province.

They also gave details of their Pakistani leaders and their activities, including how these leaders could move around freely and how they owned huge religious establishments.

The report of the interrogation of the militants, circulated to all tiers of NATO command, including the top military and diplomatic command, raises immediate questions on the competence and the commitment of the Pakistani government in controlling militants.

.....
.....

While US officials were shuttling back and forth to Pakistan, seven youths were seized by the Afghan National Army (ANA) in the Gramsir district of Helmand province.

Pakistani youths from the tribal areas and the cities have frequently been arrested or killed by NATO troops in Afghanistan. Most of these youngsters went to the country in the zeal of jihad, and they could usually be linked to particular stand-alone point-persons.

This time it was different.

Three of the men have been identified as Enyatur Rahman (North-West Frontier Province - NWFP), Saeed (NWFP) and Imran (Punjab). When they were apprehended along with the four others, a Pakistani Taliban commander named Mansoor, based in Helmand, aware of the possibility of them exposing a major jihadi network inside Pakistan, tried his level-best to negotiate with ANA to prevent them from falling into the hands of NATO.

But a little mishandling caused ANA to turn them over to NATO.

There is an arrangement between the Taliban and ANA all over the south of Afghanistan, especially in Khost, Paktia, Paktika, Helmand and Ghazni provinces.

Under this, when ANA troops are sent on patrol inside Taliban areas, they pay the Taliban to avoid being killed. The price is arms, ammunition or rockets, which is handed over and then reported as having been lost during an encounter with the Taliban.
In turn, when ANA arrests any Taliban fighters, they demand cash money for their release. If the fighters are Pakistani or non-Afghan, ANA takes a little longer to negotiate a price, but if the fighters are Afghans, ANA personnel will not take unnecessary risks. Either they strike a deal then and there and release the Taliban fighters, or within a few days they hand them over to NATO. The reason is to avoid direct confrontation with the Afghan Taliban and their tribal constituencies, which could cause problems in any prolonged negotiations.

Under this arrangement, as the seven men were Pakistani, Mansoor started negotiations with ANA for the release of his men. ANA demanded US$200,000, Mansoor countered with an offer of 2 million rupees (US$25,000), which was refused. Mansoor then arranged for 10 million rupees to be paid, but since almost 10 days had passed, ANA handed the Pakistanis over to NATO.

Mansoor mishandled the situation on two counts. First, he did not involve the Afghan Taliban command, and secondly he took too long in reaching an agreeable figure.

Apparently, the youths soon began talking under interrogation. In particular, they gave details of a jihadi network known for its past association with the defunct Jaish-e-Mohammad. They also gave details of their backgrounds and how they were recruited and how they had spent time in different Pakistani urban centers, where the leaders of their network openly ran religious establishments.

This information was shared with concerned Pakistani quarters, but by that time all senior Pakistani Taliban commanders had gone underground. In the bigger picture, though, the incident provided Washington the ammunition it needed to really go after the Pakistan national leadership and warn that the entire country needed to stand up as one to fight against all sections and groups of the Taliban in the country. They reminded that it is not any particular government or political party, but the state of Pakistan that is running out of time.

This is where a new joint government involving Sharif could come into play, and Pakistan will once again be dancing to American tunes.

The Pakistani Taliban and their al-Qaeda allies obviously will not stand back. Al-Qaeda's command has already drawn up plans to stir up a reaction all across the country - the masses will be urged to show their allegiance in black and white.

Pakistan Watch - 7

Retired Pakistani Lt. General K. Matinnudin writes in Jang about the pressing concerns of the Islamic Law zealots: (hattip BRF)

Our religious clerics talk about referring matters to the Council of Islamic Ideology established by General Ziaul Haq. There is an interesting case of what kind of work they were engaged in. Once on my way from Karachi to Islamabad. I was sitting next to the then chairman of the Islamic Ideology Council (CII) in the plane. When I asked him what was the issue presently being undertaken by the CII, he told me that they were working on the issue of whether transplanting a non-Muslim’s kidney into a Muslim person is permitted in Islam.

PS: with only some 3% of the population non-Muslim (and that too, in part because Ahmeddiyas are declared to be non-Muslims) one wonders where this non-Muslim supply of kidneys is coming from. In the Pakistani context, this has to be an entirely theoretical question. Maybe they were doing this for the edification of their co-religionists in India, who number about 15% of the population? I doubt it is for Saudis and other wealthy Middle Easterners, who presumably can find a way to purchase organs in India, because they would not look on Pakistanis as authorities on Islam.

Installing Microwave Ovens

When a headachy installation finally completes, it is a matter for celebration.

I had to replace my dead twelve-year old under-the-counter microwave (model Whirlpool) that had been installed when I moved in. I naively thought that if I could find a model with the identical dimensions and identical mounting hardware, then replacement would be fairly easy, a job I could do myself.

A search on the web revealed my assumption to be dubious. While the 30 inch wide, 16 inch high space for the microwave is supposed to standard, all the Whirlpools showed a dimension of 17 something. When I went to Lowes, however, the salesman there said, no, no they are all 16 inch, don't trust the manual. Well, Lowes did itself out of a nice healthy installation fee! because based on the salesman's assurances, I decided to not pay for the hefty installation that Lowes' charges (almost worth a microwave in itself!), and to try to do it myself.

If you've read "Zen and Art of Motorcycle Maintenance", there is the notion of gumption. You should try handyman's work only when your gumption is high. The trick is to have a functioning kitchen during the periods gumption is low, and the work is temporarily abandoned half-done.

The first part was getting the right color and model of machine, and that took a week. Then while the package was not very heavy, it was packed with a lot of padding and was bulky and difficult to handle. Mentally rehearsed moves before actually moving the item made that a snap.

Then the next part was gathering the steam to do the install. Work schedule, garden stuff and so on made for a delay of almost two weeks.

The instructions say, two persons are necessary to remove or lift the microwave into position. That can't be true, because the store would send only one installer. And it isn't true. First, unpacked, the microwave is much more manageable. Second, a small stool, a telephone directory and a set of kitchen chopping boards turns out to be more than adequate to position the microwave for removal or installation. (The telephone directory is essential because you need some "give" in the support). You basically first position the stool (stool is standing on the countertop) then put the microwave on it. Lifting the microwave with one arm, you slide the necessary extra supports one by one.

The real problem was the hardware. The store guy was wrong, this was really 17+ inches. Moreover the plate that goes against the back wall has entirely changed in the last 12 years. That had to be deinstalled and replaced with the new much smaller plate. The old plate covered the entire back of the microwave. The new is simply a strip at the bottom. The old plate had 8 supports - four screws into studs and four drywall supports. The new one has four - two bolts into studs and two drywall supports. Anyway, the installation there is essentially on a flat surface, so with reasonable care, it is a finite job.

Then there are the two bolts that fasten the microwave at the top to the cabinet above it. My first calculation was that an existing hole and a new hole would do. The new hole I drilled after what I thought were reasonable measurements. Disaster! (not really, it just felt that way). The bolts were way off. The problem is that looking from the bottom, the cabinet surface is not flat, there are all kinds of wooden reapers going this way and that.

Ultimately, the solution was, hoist the microwave into final position. Mark on it the edge of the cabinet. Mark the cabinet with key positions on the microwave. Go to Home Depot and get a right-angle (very important, relying on the edge of your ruler for a right angle can be fatal), and a contour gauge. (Cute tool, a contour gauge. Think of a tightly packed comb of moveable parallel pins. You press it against a surface and pins slide to conform to the surface.) Measure in every which way the position of the bolt receptacles on the microwave - from the centerline, from the edges, from each other. Make measurements and markings every which way on the cabinet. Measure five times to verify. Make a prayer. Drill holes. Install.

Yay! it worked! Took half of Saturday and half of Sunday! (remember the gumption thing?) The exhilaration comes from having done it entirely solo!

Now to put all the tools away.....

PS: the completed installation -