Monthly Archives: April 2010

I’m cool like that

Turns out watching Jon Stewart’s Daily Show is a contradiction in personality terms. Who knew.

Last week I read that I’m cool – apparently, according to the Globe and Mail’s TV columnist, Conan O’Brien’s move to cable was a brilliant tactical move because only stodgy middle aged people watch Leno and Letterman at 11 on whatever networks they’re on; the truly edgy folk (such as yours truly) watch Jon Stewart on cable.

This explains why I keep having these urges to shave my head and make up rap lyrics.

Then again, I can’t understand why anybody would ever watch the two L’s – wherever they were. Never seemed like a good notion to me to watch creepy guys telling recycled, antediluvian jokes that weren’t funny when Henny Youngman told them, particularly as you’re getting ready to go to sleep. Bound to give you bad dreams.

Then, tonight, I found out – on Jon Stewart naturally – that according to Fox News’s Bernie Goldberg (Bernie Goldberg?!  What kind of name is that for a person on Fox, I ask you) Stewart is merely pandering to his small, “unsophisticated” cable audience (when he points out some of Fox News’s’ idiocies and contradictions).  All in patronizing tones that made me want to hit him – particularly when he seemed to take umbrage at Jon Stewart actually being polite to his guests, even when he disagreed with them. Wow. What a concept. Politeness. Obviously one Fox is unaware of.

So there you have it. According to Fox,  only unsophisticated people watch Jon Stewart.

Now I’ve been called a lot of things – cranky, curmudgeonly, stubborn, irritating, even childish and idiotic – but unsophisticated? Please. I’m sophisticated enough to recognize a gentleman when I see him and Mr. Stewart is a gentleman. And clearly a very nice man.

We don’t get the Fox News Network in Canada which is just as well. Even flicking past it would probably make me apoplectic. It seems to embody the absolute worst of this experiment they call America: boorish, xenophobic, crude, partisan and – let’s not mince words – stupid. The snippets I’ve seen on the Daily Show and the first segment of Colbert make me shudder and do not bode well for the future of the American republic. Particularly since Fox is the fastest-growing network in the U.S.

That’s even scarier than Letterman’s face, frankly. (Since that poor man had quadruple bypass surgery he looks like a zombie walking). Someone should have told him that a massive heart surgery is not “preventive” of anything, particularly dying of heart disease.

But back to Fox. I guess they’re trying to prepare America for the challenges of the 19th century.

My  impression of Goldberg and Glen Back and Sarah Palin and the Tea Party movement they’ve spawned is of a sad, scared group of people who are so terrified of Obama and any change – even if it means an improvement to what’s been – that they will literally cut off a nose to spite a face. Who seem to think the fifties were some kind of Xanadu. When men were men and women were women and little green men were little green men from Mars.

It was a time when America was #1 (because Europe was still rebuilding after the second world war) and in many ways the idea of America was amazing.  As a Paris cab driver once wistfully said to me, when he was a child in the sixties, America was jazz and cowboys, civil rights and the space program, walking on the moon. It was science and innovation, Hollywood and glamour.  American was cool. No more.

Now, it’s Goldman Sachs and Wall Street, wars in Iraq and Afghanistan, Walmart and kids’ toys made in China contaminated with lead (because nobody’s willing to pay more than $5 for anything).

It’s a pity the folks at Fox haven’t twigged to the fact that things have changed and being unpleasant ends up working against the America they profess to love. In any event, change, no matter what they think about it, simply happens. It doesn’t care. Seasons change, babies grow and later grow old and die.  We change. Things evolve; true, not always for what you or I might consider as the “best”, but hey, that’s life. Life is change.

Screaming just makes you hoarse. And rudeness and spite, as Robespierre found out, only begets more anger and sometimes that guillotine you’ve built to get your enemies with ends up getting you. Fox should perhaps be careful what it wishes for – it might not like the result.

But hey,  I’m cool with that.

ObamaCare – damning with faint praise all one can do

Two weeks ago President Obama signed what is being called an “historic” health care bill, and belated the United States is to have a sort-of-almost-maybe national health care system. Except that much like the Holy Roman Empire, which was neither Roman, holy nor an empire, US health care will not be universal (some fifteen million people are still left out in the cold), national (people still have to buy health insurance) or particularly historic, since everybody else in the western world got health care 40+ years ago. So, er, hurray.

comme-ci, comme-ca health care*

Of course everybody hates it.

The left because they maintain, not unreasonably, that Obama gave up the public option (early on he seemed to be harbouring the vain hope that it would lead to some bipartisan support) and as such Medicare, the existing system for seniors, was not expanded – which would have at least provided a kind of national health care without starting from scratch. Pity. That would have been the logical route. But nooo. Not in America. So, the basic, dysfunctional structure of American health care remains – and insurance continues to stand firmly between the patient and the health care provider.

The right hates it more and for a lot more reasons – although there’s some serious irony here since the genesis of this bill was the Republican proposal to counter what was dubbed HillaryCare back in the 90’s.

First and foremost, the right is cranky because a lot of them listen to Glenn Beck and Fox News and hang out at those tea parties where there aren’t any sandwiches, and they simply hate anything Obama does. More rationally, however, they object to the form of the bill, which forces individuals to purchase health insurance (which, if they can’t afford, the government will subsidize). Here they have a point, since you have to admit it does seem a touch undemocratic to make people buy something whether they want to or not.

Republicans add that the the bill makes no attempt to cut costs or deal with the ludicrous consequences of  litigation; this argument is true albeit disingenuous since if they had actually got involved, as Obama had asked, they could have added that in.

Business is not too keen on this bill either, probably because health insurance is currently provided, for the people who have it, through their employer, and business has no idea what this bill implies for them, and they loathe uncertainty.

(The bill would tie health insurance to the person, so even if they lose their job they keep their insurance. There is also talk of creating some kind of risk ‘pooling’ for people who are not employees but self employed or what-have-you. Plus, in theory at least, insurance companies will no longer be allowed to turn away people with pre-existing conditions – though I’m sure some clever lawyers are already figuring out other ways to reject people they think will cost too much. Too tall, perhaps or too freckled.)

My problem with this bill is its fundamental premise, namely that health care has to be administered by insurance companies. It’s a nincompoop idea and only one that a country besotted with business could endorse.

Insurance companies, boys and girls, are what are known as bu-si-nesses. This means that they exist to  make money: their raison d’etre is profit. If it were otherwise we’d call them, oh, NGO’s. Not-for-profits. (That’s what we used to call charities before we opted for the more unwieldy name.) Except that health care, medicine, is not and cannot be (ever!) a business. Economists long ago realized that it simply does not fit the market model.

Health care is not a commodity. You cannot make money on health care. Never mind that you shouldn’t. Why? Well, for those of you who missed Econ 101, I’ll explain. Please pay attention, there’ll be a quiz later.

The free market is at heart transactional: I make hand-embroidered doilies; you, for reasons that elude everyone else, like and want hand-embroidered doilies. So, I make them and you buy them from me. And we’re all happy. I, in turn, use the money I make to buy things I want/need, like food and shelter and some really cool stilettos. Supply and demand.

But (and here’s where it gets tricky), if a villager in China can make aforesaid doilies that are just as nice for a lot less, then you will get them from her so I will be out of business, unless I move my manufacturing to an even cheaper place, Bangladesh, say. This, in a nutshell, is the free market, which, in Adam Smith’s immortal baker metaphor, does not rely on the goodness of anyone’s heart but is inherently rational. As are consumers.

Now you and I both know that this is patent nonsense. Not only are most people not rational consumers, most of the time they  are crazy. Or, as a psychiatrist would say, stark raving bonkers. Why else would tens of thousands of people line up on Boxing Day to get a gizmo they don’t need? Or pay good money to buy a piece of bacon wrapped in a pancake with a list of ingredients too long to read? (I could go on but you get the picture.)

Even if consumers aren’t nuts their actions are often dictated by a lot of things other than reason, price and need. Otherwise nobody would ever buy a Kelly bag or have eighteen pairs of virtually identical black trousers. But for the sake of argument, let’s stick to the model – this is 101, remember, and we don’t have time to veer into behaviorial economics and all that complicated stuff like status and advertising and whatnot.

So homo economicus operates on simple efficiency and if he or she can afford it, they will get the best darn doily or car or house they can get. So, people with money get the nice stuff, the cashmere sweaters and the Prada belts, while everybody else makes do with Joe Fresh and H&M. That’s life according to economics.

Health care doesn’t work that way. Nobody gives up a trip to the Bahamas to check themselves into the hospital for a quadruple bypass for fun. That’s because, in economics-speak, health care is not a direct “purchase” but is subject to agency issues. In other words, there is a person or a group between the person and whatever is being bought, whether it’s a bypass or a prescription. When I feel sick, no matter how many internet sites I surf or friends I text, I really don’t know the reason; I need a doctor. Or a nurse. Or a faith healer if that’s what I happen to believe in. Even if I did figure it out the diagnosis, I can’t write myself a prescription or do surgery on myself. I need someone else, an “agent”, to confirm my choice. (In terms of that quadruple bypass I should really go back to the internet and do some serious research because there’s no evidence it is in any way preventive if I’m feeling all right, but that’s another post.)

Medicine, unlike cars and refrigerators and new tiles for the bathroom, is about a patient, a person who is sick and vulnerable and scared and in no position to make rational choices about anything. This is also why there are medical ethics and professional organizations and the Hippocratic Oath (though that’s just a metaphor, the actual Oath hasn’t been used for nearly a century no matter what TV shows would have you think.)

“Enough”, when it comes to cars and refrigerators and trips to sunny Spain is only limited by your budget and, presumably, greed and appetite: if you really want thirty six SUV’s, or feel the need to stuff your kitchen with 97 Sub-Zero fridges full of chocolate ice cream and would like to give Imelda Marcos a run for her money when it comes to shoes – well, if you can afford it, it’s your choice. Medicine is not like that.

Too much medicine – too many medical interventions – can kill you.

It’s called iatrogenesis. A term from the Greek, meaning harm caused by medical treatment. One aspirin can take away your headache; popping the whole bottle is a suicide attempt. One operation could save your life (if it goes well) but if you have an appendectomy and for whatever reason things screw up and you end up in ICU with sepsis and need four more operations, well, you could easily end up maimed or dead. In fact the more you get done medically, the lower your chances.

As Peter Davis writes in the Canadian Medical Association Journal (“Health Care as a Risk Factor”,, close to 70,000 preventable adverse effects occur each year, some 20% of which result in the person’s death. This, writes Davis, is not because hospitals are inherently dangerous places but because the “unchallenged therapeutic imperative” tends to move people to ever-higher (and more complex) levels of care, levels that they are unable to sustain.

When people proudly proclaim that American health is “the best in the world” therefore, as they are wont to do, what they mean is that they have access to more MRI’s and operating theatres and doctors than anyone else. The model they’re using is that of the market. Except they’re dead wrong (so to speak). By any objective measure American health care is the worst in the developed world. Life expectancy is lower, infant mortality is higher and your odds of surviving healthily after a heart attack are considerably lower than they are anywhere else in the west. Why? Iatrogenesis. Americans do too much. Too many tests, too many surgeries; too many drugs. In short, overtreatment. Because medicine in the US is treated like a commodity, like cars and refrigerators and Prada bags, which it is not.

That’s what Obama’s bill didn’t even begin to address. True, some of the currently uninsured might, if  all goes well, not end up bankrupt if they get sick. More people will have access to health care. The notion that health care might be a basic mark of a civilized society has at least come up and might even be discussed further. It will continue to cost too much (16% of GDP at last count versus an average of 10% in Canada and France and everywhere else); doctors will continue to practice “defensive” medicine and Americans will continue to get sub-standard care. But at least it is a start.

Too bad it was so fitful.

* photo c/o creative commons and

Entropy and economics

Entropy. It means disorder, more or less, and refers to the tendency that all things in the universe have  to gradually lose coherence. To fall apart.

The term comes from thermodynamics – heat and work – and explains, with blinding simplicity, howeven the most efficient of closed systems will lose energy and become less efficient with time. So be it a steam engine (which Nicolas Carnot, one of the early 19th century thinkers in thermodynamics, used) or a plane, bird or Superman, its inevitable fate (at least if it’s not a fictional superhero) is to fall apart. Or, in the immortal words of my adored Flanders and Swann: “Heat is work and work’s a curse; and all the heat in the universe is gonna coooool down. That’s entropy, man.”

That’s why airplanes are painstakingly taken apart and greased, fixed and rejiggered so they don’t fall apart when we’re flying on that cheap flight to Tahiti; it’s the reason  cars and refrigerators and everything else eventually end up in landfills. And it’s why pristine comics or teddy bears or whatnot are worth a fortune: there’s not a lot of them about.

But we’ve forgotten about entropy; the term is barely used. I remember it from a 70’s era Isaac Asimov short story which gives you an idea of long ago it even touched popular culture. No, we like to think of ourselves as having imposed a lasting order – not least because of our clever algorithms and chic equations.

Take this economic crisis we’ve created. At its epicentre was the belief that markets are knowable, rational, explain-able. Of course even a  child who’s tried to trade a baseball card knows this makes no sodding sense, but greed and hubris and a lot of money all came together at once and people really came to believe that this time it was different.  What went up wasn’t going to come down.

After all, there were these equations ….

Turns out some really clever people came up with some algorithms that seemed to work for a time. So, like all greedy eejits they believed their own press clippings (not to mention the fat bonuses) and soon all of Wall Street and much of London and Zurich and the rest followed suit, rolling the dice convinced that it wasn’t luck but science. Hey, everybody loves it when things that seemed unpredictable and unknowable can be reduced down to a quantitative model – probably because so few of us actually understand any of the math. So the “quants” (for “quantitative”) directed the finance industry towards the Kool Aid. Now of course, there’s analysis and backtracking and people who knew it was going to happen (see via @globeandmail for a review of a book on the subject) but really what happened is that people wanted to believe  they understood how it all worked.

Why else would otherwise quite clever people set aside all rationality to invest in acronyms they didn’t understand? And it is a comforting notion, that markets are über-rational and what had always seemed random could be reduced down to a handful of equations. So, staggering sums of money ended up in chopped up pieces of debt,  mortgages, and then it all came tumbling down. (Of course at every step of the way a hefty commission was being pocketed so it was to many people’s advantage not to rock the boat, whatever their private beliefs in the rationality of markets.)

What these “too big to fail” banks and funds forgot was that expressing anything in quantitative terms requires thought, not computers; you have to understand,  in depth, what that equation fundamentally means. And all its ramifications. One of the most seemingly simple equations – E = mc2 – occupied Einstein his entire life. D’you think he was just slow? Or that with computers he’d have managed it in a weekend?

The universe just doesn’t give a damn. Civilization, progress, is just our feeble attempt to thwart entropy.

“My name is Ozymandias, King of Kings …. Look on my works ye mighty and despair .. “

But here we all are, in spite of it all still bright-eyed and bushy tailed, convinced we’re so much cleverer that all those silly oafs who came before (including Boyle and Carnot and Nernst and all those other clever johnnies who actually managed to came up with thermodynamics). After all, we have Google Earth and iPads and we’re good at expressing ideas numerically. Unfortunately, no matter how much we like things to be neat and fit into those cool spread sheet boxes; no matter how much we’d like to think our rules, our ideas, are those of the universe, real rules are few and far between and almost never apply across the board to all situations.

But we don’t believe that, so we don’t agonize about the moral dimensions of our economic theories as Adam Smith did or stop to wonder if our exuberance might be irrational. No, we actually think that what we’ve come up with – our rules and theorems and guidelines and ideas and metaphors; the narratives we’ve constructed to explain how markets work (efficiently), or how physiology might function (neatly, mechanistically) or biology operates (hierarchically) – are real.

As the geneticist Richard Lewontin writes in The Doctrine of DNA: Biology as Ideology (HarperPerennial, 1992) writes, we’ve succumbed to the delusion that our metaphors and narratives exist. So often have we heard our genes described as the “blueprint” of life that we have come to believe biology is destiny. So often have we heard mechanistic metaphors used to describe our organs that we believe replacing a defective heart is akin to changing the engine on an aging Camaro. So ubiquitous is our reverence for our own cleverness that we forget previous generations thought they had it right too.

Memories are short these days and we forgot. Forgot that whether it’s finance or physiology, real life is messy.  Not quantifiable.