Map of life expectancy at birth from Global Education Project.

Sunday, January 13, 2019

Sunday Sermonette: The psychic

Genesis 40 continues Joseph's story with the literary craft that separates it from the rest of the biblical narrative so far. But if you read between the lines you might decide that something is going on here that is not what it seems.

 Some time later, the Egyptian king’s baker and wine taster did something their master didn’t like. So Pharaoh became angry with his two officials, the chief wine taster and the chief baker. He put them in prison in the house of the captain of the palace guard. It was the same prison where Joseph was kept. The captain put Joseph in charge of those men. So Joseph took care of them.
KJV has "butler" rather than "chief wine taster," as does ASV. One would think the Hebrew for butler and chief wine taster would be distinctly different, so this is odd. Keep in mind always that we are at the mercy of the translators.
Some time passed while they were in prison. Then each of the two men had a dream. The men were the Egyptian king’s baker and wine taster. They were being held in prison. Both of them had dreams the same night. Each of their dreams had its own meaning.
The graceless repetitiveness of verse 5 reads more elegantly in the KJV.
Joseph came to them the next morning. He saw that they were sad. They were Pharaoh’s officials, and they were in prison with Joseph in his master’s house. So he asked them, “Why do you look so sad today?”
Again we have this odd repetition of information.
“We both had dreams,” they answered. “But no one can tell us what they mean.”
Then Joseph said to them, “Only God knows what dreams mean. Tell me your dreams.”
Joseph's statement seems contradictory, unless he is claiming to have a direct line to God.
So the chief wine taster told Joseph his dream. He said to him, “In my dream I saw a vine in front of me. 10 There were three branches on the vine. As soon as it budded, it flowered. And bunches of ripe grapes grew on it. 11 Pharaoh’s cup was in my hand. I took the grapes. I squeezed them into Pharaoh’s cup. Then I put the cup in his hand.”
12 “Here’s what your dream means,” Joseph said to him. “The three branches are three days. 13 In three days Pharaoh will let you out of prison. He’ll give your job back to you. And you will put Pharaoh’s cup in his hand. That’s what you used to do when you were his wine taster. 14 But when everything is going well with you, remember me. Do me a favor. Speak to Pharaoh about me. Get me out of this prison. 15 I was taken away from the land of the Hebrews by force. Even here I haven’t done anything to be put in prison for.”
16 The chief baker saw that Joseph had given a positive meaning to the wine taster’s dream. So he said to Joseph, “I had a dream too. There were three baskets of bread on my head. 17 All kinds of baked goods for Pharaoh were in the top basket. But the birds were eating them out of the basket on my head.”
18 “Here’s what your dream means,” Joseph said. “The three baskets are three days. 19 In three days Pharaoh will cut your head off. Then he will stick a pole through your body and set the pole up. The birds will eat your flesh.”
Of course, we know now that dreams are not prophetic. But they don't have to be in this case. Joseph and everyone else presumably know that Pharaoh's birthday is in three days. Furthermore, the prison warden presumably knows the men's sentences and Joseph is his trustee and confidante. So Joseph doesn't need magic powers to interpret these dreams, he already knows what's going to happen. He's trying to con the butler into getting him out of jail.
20 The third day was Pharaoh’s birthday. He had a feast prepared for all his officials. He brought the chief wine taster and the chief baker out of prison. He did it in front of his officials. 21 He gave the chief wine taster’s job back to him. Once again the wine taster put the cup into Pharaoh’s hand. 22 But Pharaoh had a pole stuck through the chief baker’s body. Then he had the pole set up. Everything happened just as Joseph had told them when he explained their dreams.
23 But the chief wine taster didn’t remember Joseph. In fact, he forgot all about him.
 Both KJV and ASV have the baker beheaded and hung from a tree, but NIV has him impaled, for some reason.  I don't suppose it much matters, but it is an omission that we never learn what his crime was.

Saturday, January 12, 2019

Suddenly we have permission to say what everybody already knew

The New York Times story about the FBI investigation into whether Individual 1 is actually a Russian tool is maybe news to some people. Evidently it is news to Benjamin Wittes who is moved to fundamentally reexamine his understanding of the FBI investigation of which the Office of Special Counsel is just a part. The Wittes piece is long but it's important.

The Mueller investigation is fundamentally a counterintelligence operation. The focus of the investigation is Russian interference in our election, and Russian infiltration into our government. There is no distinction between the "collusion" and "obstruction" portions of the investigation either. Obstructing the counterintelligence investigation into Russian actions is collusion.

The conclusion that Donald J. Trump is a Russian asset has been apparent to many people for a long time. The formal, legal charge of treason requires that a state of war exist. However, it is not illegal to use the term in a vernacular sense. Perhaps Lindsey Graham and Mitch McConnell will reflect on that.

Thursday, January 10, 2019

Logical Fallacies

From time to time I point out common logical fallacies that unfortunately infest our public discourse. Today's lesson is argumentum ad hominem, in which the debater claims that some characteristic of the proponent of a view renders that person's argument invalid.

This has three forms. Tu qoque is pointing out that the proponent has said or done something in the past which is contrary to his or her position. This may be embarrassing, but it does not in any way invalidate the argument the person is currently making. And of course, people can change their minds, although this is something politicians apparently are not allowed to do ("flip-flopping").

The second form is guilt by association. This essentially means pointing out that someone who we should consider unsavory holds or held the same position. For example, Hitler was a vegetarian so that invalidates arguments for vegetarianism.

But the one I specifically want to discuss today is called the circumstantial ad hominem fallacy. This is claiming that some characteristics of the opponent make him or her likely to take the position, so why should we pay attention to the logic of the argument? Again, this is a distraction which is in no way a valid responses to an argument. Another problem with this is that it often is not even true.

For example, suppose someone made the claim that my argument for single payer national health care is invalid because I have never held a private sector job, or been self-employed, therefore I am not like most people and can't possibly understand what is good for them. A valid counterargument would have to show that for people in private sector employment, or people who are self-employed, having health insurance might be bad for them. This seems to me difficult to justify, but that's the only logical reason my employment history could matter.

However, I have in fact been self-employed and I have worked exclusively in the private sector my entire life, unless you count teaching a course for one semester at a community college when I was in graduate school. Some of my employers have been non-profit organizations, but many have not. My first job was as a stable hand. I managed the concession stand at the town beach in the summers when I was in college. I worked in a razor factory as a material handler, and I worked in a radiator factory bending tubes and pressure testing. I had a carpentry business with my brother-in-law. I worked as a security guard. I worked for a small mom and pop consulting business, then I worked for United Way. While I was getting my doctorate I was self-employed as a consultant to community organizations and government. I worked for a community organization in Boston for 15 years and only then, in my fifties, did I take a full-time academic job.

During my periods of self employment and low-wage employment I did not have health insurance. I wish I did. For one thing an untreated fracture in my left hand would not have led to osteoarthritis many years later which required very painful surgery and a long recovery period. If Obamacare had been available I would have been very grateful.

Oh, by the way, I do not hate America. I'm not sure why advocating for single payer health care would lead to that conclusion. You fucking moron.

Wednesday, January 09, 2019

Health Insurance 101

Over the course of the years, decades and centuries I have found I need to spell out some elementary facts for the newbies who come here unenlightened.

Health care is not like most commodities, say for example cheese or oven mitts. People who make remarks to the effect that it's a violation of their liberty to make them buy health insurance or tell them what the minimal contents of their insurance must be and how would you feel if the government forced you to buy cheese and it had to be cheddar only think they're being clever.

If you want to drive a car, the government requires you to buy insurance and tells you what that insurance must at a minimum cover. Think about that for a moment and also notice that just about nobody objects to it. True, you don't have to buy a car, but the difference is that you do have to live.

So what happens when somebody who doesn't have health insurance falls off a ladder or has a heart attack? The ambulance takes said person to a hospital where they receive services which, if they don't really cost $75,000 probably cost more than you can afford to pay. Which means the rest of us get stuck with the bill, one way or another. Furthermore, if you'd had insurance and been getting primary care you might not have had the heart attack in the first place.

As with motorcycle helmets, it is not merely and exclusively your own safety and well being that are at issue, in which case many people would agree that the nanny state should leave you alone. You likely have dependents, and you need to be able to work and make a living at the very least to take care of yourself. If you can no longer do that, you become a dependent of the state. And even if you think that people in that condition should just be turned out on the street to die, the people who live on the street on which you die will not like that. Society just won't accept that situation.

But health care is not like cheese and oven mitts in many other ways. You know what kind of cheese you like and whether or not you bake and therefore need oven mitts. However, you don't know what health care you need because you are not a doctor. The doctor has to make the diagnosis and tell you what the treatments are. Also, you cannot anticipate our need for health care, just as you don't know when or if you will crash your car or your house will burn down and you will therefore need a new car or a new house. That's why you have insurance. But again, if you're out of luck and don't have a car or a house, society can tolerate that, but again, they can't tolerate a lot of sick and dying people wandering around the neighborhood and they also don't want to have to take care of your kids.

Another thing about insurance is that some people have a lot of medical expenses and some people don't. Again, we can't entirely predict. So the way we get the money to pay for the expensive people is to have everybody pay into the premium pool. That way the money is there for people who need it, because of the premiums paid by the people who don't need it. If you have employer-provided insurance, you are in fact paying for it, whether or not you know it, because it's part of your overall compensation package and if the employer didn't provide it, you paycheck would be bigger.

All of this is to say that it is socially desirable for everybody to have health insurance. Also, everybody needs to buy into at least a minimal package that includes essential benefits because otherwise the risk pool for those essential benefits won't be big enough.

A single payer system is the simplest, most efficient way to organize this. And yes, people have to pay for it. You can do it through taxes, obviously. If you don't like to call it taxes you can call it premiums and have a sliding scale based on income. But it would be cheaper than it is for you now, unless you already get Medicaid or an ACA subsidy, because Medicare has much lower administrative overhead costs than private insurance and doctors and hospitals also wouldn't have to spend so much money on complicated billing systems to multiple different payers.

And yes, people who are now over 65 and receiving Medicare paid into it during their working lives, so what? If we provided Medicare to people under 65, they would obviously have to pay for it, again either through premiums or taxes, with a subsidy for low income people. That seems pretty simple.

Is this socialism? You can call it whatever you like but the people of Canada, Norway, France and the rest of Western Europe don't think they live in a totalitarian dungeon and in fact are very happy with their systems, which differ considerably but still provide everybody with basic coverage for a lot cheaper than what we spend here. That is an empirical fact. Yes, you can't opt out and not have insurance and yes, people have to pay for it. That is the inexorable logic of the problem.

If you don't like it, move to a different universe.

Update: Let's make a couple of concepts absolutely clear, although it's probably a waste of time because some people don't actually want to understand.

Insurance shifts risk to the risk pool --  the money accumulated by premiums, or if you prefer in a government run system, taxes. That's just a name, it comes to the same thing. You could isolate the premium on the tax return and withholding just as they do now with Social Security if you want to be transparent. People called actuaries calculate the likely future cost to the risk pool and adjust the premiums accordingly. Of course there might be an unexpected even such as a pandemic or an epidemic of idiocy -- oh sorry, that's already happening -- which might require an adjustment in next year's premium. Or we could have a good year and it would go down. But that's the idea of insurance, to spread risk. Its not your individual risk that's at issue, it's the population aggregate risk.

Second, right now Medicare beneficiaries have to pay a premium for what's called Medicare Part B, and if they don't pay it they lose coverage for a period. I don't know whether that's a good idea or not, it probably isn't, but it's intended to make people who have the means put a little skin in the game. People who are too poor to afford the premium become what's called "dual eligible," which means they also get Medicaid and they don't have to pay the premium. The design of a Medicare for all system could or could not include that feature, it would be up to Congress.

And yes, if you were affluent and wanted to buy supplemental insurance you could do so, as is the case right now. Medicare beneficiaries can buy whatever additional insurance they want.

Monday, January 07, 2019

A charitable institution

A few days ago I told the bizarre tale of my mother's hospital bill. As you may recall it was itemized and came to total of more than $75,000. Then it had an "insurance adjustment" which reduced the bill to about $6,000. Then they actually billed her for $200.

We had a presentation here last week from Harvard researcher Ateev Mehrotra who studies, among other subjects, medical billing, and we got into a discussion of this weird practice. One of the many ill consequences of our fragmented system of organizing and financing health care is that hospitals and physician practices must interact with numerous different payers -- private, usually for profit insurance companies, Medicare and Medicaid. They post these ridiculous prices as a starting point, then they negotiate separately with the private insurance companies to set the actual price. (Medicare and Medicaid have fixed prices, that they just have to take.) So the price will be different for each insurer.

Another wrinkle: yes, my mother is a Medicare beneficiary. However, she has a Medicare Advantage plan, which means that Medicare pays the insurer a fixed amount for each patient and the insurer then negotiates prices with the hospitals. So many Medicare beneficiaries actually have private insurance. Anyhow . . .

"Price transparency" is an effort to get consumers to make economical choices by making providers post their prices. But posting the $4,500 a day room and board price is a) going to insure that nobody ever undergoes elective surgery and b) is totally fictitious since nobody actually pays it. For that matter, nobody pays the price the insurer pays because, you know, the insurer pays it. All you care about is your co-pay, and the insurance company tells you that.

Ordinarily hospitals will cut deals with all of the important insurers in their area, because obviously they want the business. They can actually send the bill for $75,000 to an uninsured person, but they aren't likely to collect. But now it turns out that Zuckerberg San Francisco General Hospital has deliberately not contracted with any private insurance plans because it wants to be able to send people with private insurance enormous bills. This includes emergency department bills and I think you can see the problem here: the ambulance crew takes people to the ED and generally doesn't ask them where they would prefer to go, especially if they are, you know, unconscious. Then they get billed for tens of thousands of dollars for services that other hospitals are happy to provide for $3,000 in insurance payments.

Does this seem, I dunno, unethical? For a supposedly non-profit charitable institution?

Here we go:

We need universal, comprehensive, single payer national health care. Badabing badaboom.

Sunday, January 06, 2019

Sunday Sermonette: Count your blessings

Okay, the strange interlude is over and we get back to our pal Joseph in Chapter 39. This is a better yarn than most of what we've seen so far but in some ways it doesn't bear close scrutiny. Here goes.

Now Joseph had been taken down to Egypt. Potiphar, an Egyptian who was one of Pharaoh’s officials, the captain of the guard, bought him from the Ishmaelites who had taken him there.
 Okay this is maybe not a big deal but here's Genesis 37:36: " And the Midianites sold him into Egypt unto Potiphar, an officer of Pharaoh's, and captain of the guard." As we noted before, the story keeps mixing up the Ishmaelites and the Midianites. Somehow there must have been two versions of the story and the scribe never sorted them out.

The Lord was with Joseph so that he prospered, and he lived in the house of his Egyptian master. When his master saw that the Lord was with him and that the Lord gave him success in everything he did, Joseph found favor in his eyes and became his attendant. Potiphar put him in charge of his household, and he entrusted to his care everything he owned. From the time he put him in charge of his household and of all that he owned, the Lord blessed the household of the Egyptian because of Joseph. The blessing of the Lord was on everything Potiphar had, both in the house and in the field. So Potiphar left everything he had in Joseph’s care; with Joseph in charge, he did not concern himself with anything except the food he ate.
Keep in mind that Potiphar does not worship Joseph's God. Ancient Egyptian religion was polytheistic, as  just about everyone knows. Pharaoh was himself divine, and had the responsibility of interceding between the people and the deities, who represented various natural forces and entities.
Now Joseph was well-built and handsome, and after a while his master’s wife took notice of Joseph and said, “Come to bed with me!”
But he refused. “With me in charge,” he told her, “my master does not concern himself with anything in the house; everything he owns he has entrusted to my care. No one is greater in this house than I am. My master has withheld nothing from me except you, because you are his wife. How then could I do such a wicked thing and sin against God?” 10 And though she spoke to Joseph day after day, he refused to go to bed with her or even be with her.
11 One day he went into the house to attend to his duties, and none of the household servants was inside. 12 She caught him by his cloak and said, “Come to bed with me!” But he left his cloak in her hand and ran out of the house.
Here again the NIV seems to clean things up. Most translations, including KJV and ASV, have "garment" rather than cloak, and the implication is that Joseph flees the house naked. Using the word "cloak" makes this seem more plausible.
13 When she saw that he had left his cloak in her hand and had run out of the house, 14 she called her household servants. “Look,” she said to them, “this Hebrew has been brought to us to make sport of us! He came in here to sleep with me, but I screamed. 15 When he heard me scream for help, he left his cloak beside me and ran out of the house.”
16 She kept his cloak beside her until his master came home. 17 Then she told him this story: “That Hebrew slave you brought us came to me to make sport of me. 18 But as soon as I screamed for help, he left his cloak beside me and ran out of the house.”
19 When his master heard the story his wife told him, saying, “This is how your slave treated me,” he burned with anger. 20 Joseph’s master took him and put him in prison, the place where the king’s prisoners were confined.
I will just note that Potiphar immediately presumes that his wife is telling the truth, and makes no effort to get Joseph's side of the story. But note the pattern, which will continue. God supposedly favors Joseph, and the way he shows it is by continually screwing him over and then elevating him within his screwed-over status. First God sends him dreams in which his brothers are subservient to him, so the brothers sell him into slavery. Then God makes him head slave. Then Joseph gets thrown into prison for a crime he did not commit. Then .. . Well, read on. But it seems to me that God could have gotten to the denouement by a more direct route.
But while Joseph was there in the prison, 21 the Lord was with him; he showed him kindness and granted him favor in the eyes of the prison warden. 22 So the warden put Joseph in charge of all those held in the prison, and he was made responsible for all that was done there. 23 The warden paid no attention to anything under Joseph’s care, because the Lord was with Joseph and gave him success in whatever he did.

 So he goes from a cushy gig as a slave to a cushy gig as a prisoner. I dunno, if the Lord favored me, I'd hope for  a little better.

Friday, January 04, 2019

Hold onto your hats . . .

In about 2 billion years the Large Magellanic Cloud will collide with our galaxy. It's not actually a cloud, of course. It was named before people had powerful telescopes and could figure out that many of the so-called nebulae were actually galaxies. The LMC is a satellite of our galaxy, which we call the Milky Way. We have many such satellites but the LMC is the biggest.

The collision will result in an influx of material into Sagittarius A*, the black hole at the center of the galaxy, "waking up" the Milky Way to become an active galaxy, with powerful jets of high energy radiation emitted from the poles of A*. This won't affect the earth particularly, although there is a small chance the sun's orbit could be disrupted and the solar system expelled from the galaxy. I know you probably figure you won't be around that long . . .

This interests me because it's a reminder of how radically our understanding of the universe and our place in it has changed in a short time. In fact, it was less than 100 years ago that Edwin Hubble discovered the universe. Literally. Galileo figured out that the earth was not at the center of the universe, but it was not until just a couple of years before Hubble's discovery that Harlow Shapley was able to describe the Milky Way galaxy and expand our vision of the universe by what we now know was a minute increment. We now estimate that Hubble's universe contains about 200 billion galaxies, and that our own quite typical galaxy contains more than 200 billion stars.

This knowledge has not affected the philosophy of most people, who still put humanity at the focus of concern of an imagined creator God. If in fact God created this universe of 200 billion galaxies 14 1/2 billion years ago for the essential purpose of bringing to consciousness some bags of organic carbon soup in a thin layer of slime on an infinitesimal speck of dust, he is mighty damn inefficient.

In reality, it doesn't matter what happens to us. We are nothing. The earth, the solar system, the galaxy, the universe, will go on without us until they do no longer, billions of years after we are gone. We only matter because we matter to ourselves. This profoundest of all revelations, once again, is less than 100 years old. Think about that.

Tuesday, January 01, 2019

A republic if you can keep it

Sean Illing interviews historian Edward Watts about the fall of the Roman Republic and parallels to the present day United States. The comparison is somewhat strained in ways that Watts and Illing do not discuss. The republic really dissolved in a civil conflict between competing warlords. Caesar seized power by military force, which is not a likely scenario for us. (The end of the Republic is usually formally said to have happened in 27 BC with the bestowal of the title "Imperator" on Octavian who was also allowed to call himself Caesar Augustus. However, the Republic had ceased to function as such under Julius Caesar, in 48 BC.)

Nevertheless Watts sees the failure of the Republic as essentially a loss of legitimacy of its representative institutions. As Watts says:

There’s a pivotal period in Rome, around the middle part of the 2nd century BC, in which there’s an economic revolution that displaces a lot of people who had belonged to a hereditary aristocracy and moves them off the top economic rungs of the state.
At the same time, it’s creating economic conditions that prompt people in the middle to basically become very frustrated that their economic prospects are not increasing either. And what ends up happening is the people who win from this economic revolution try to preserve their gains through just about any means they can, and that includes gross political obstructionism, the rigging of elections, and a total unwillingness to compromise.

While the rise of economic inequality and the stagnation of working class incomes are clearly central to our present institutional crisis, it has important other dimensions that do not resemble the Roman case. Carlos Lozada in WaPo reviews some books by lapsed conservatives and a couple of them put it well.

Charles J. Sykes: "For me 2016 was a brutal, disorienting, disillusioning slog. There came a moment when I realized that conservatives had created an alternative reality bubble and that I had perhaps helped shape it . . . Did we — did I — contribute to this prairie fire of bigotry and xenophobia that seemed to grip so many on the Right? . . . For years, we ignored the birthers, the racists, the truthers, and other conspiracy theorists. We treated them like your obnoxious uncle at Thanksgiving . . . whose quirks could be indulged or at least ignored."

Max Boot: "Upon closer examination, it’s obvious that the whole history of modern conservatism is permeated with racism, extremism, conspiracy-mongering, ignorance, isolationism, and know-nothingism."

The essential problem of conservative politics is that the true goal of conservatism is to protect the privilege of the wealthy. In order to win elections, conservatives need to get people to vote against their own interest. And that is what the racism, conspiracy mongering and ignorance are all about. They take the place of Caesar's army, in other words.  And so they must be defeated, or we will lose our republic.