Saturday, November 22, 2014

Peering at the Future...

This weekend's posting is mostly a potpourri of interesting miscellany. But we'll start and end with some items about... prophecy!

No, not reading tea leaves or goat entrails, but the kind that obsesses everyone from bureaucrats to corporate heads to school teachers to stock brokers to moms n' dads. Using those "lamps on our brows" -- our imaginative prefrontal lobes -- to poke a stick into the future we are running across, discovering opportunities and errors just in time.

I'll start with an item in the news.  Today -- very, very quietly -- the U.S. House of Representatives Intelligence Committee finally issued its report on the tragic deaths of four American diplomats at the hands of terrorists in Benghazi, Libya.  The predictions about this report, touted for upwards of three years by Fox News and almost every Republican pundit and office-holder... (and many of you out there)... had been that the Obama Administration would be at-minimum revealed as incompetent and deceitful and more-likely criminally negligent cowards engaged in a Nixon-level illegal cover-up, possibly leading to impeachment.

Those of you who made -- or religiously repeated -- this forecast, do have the honesty to raise your hands?  

We'll have a look at the actual outcome from that committee -- chaired by my own republican representative Darrell Issa, lower down in this blog -- and see how you scored.

== Can we forecast the future? ==

Elsewhere, I explore this idea more formally, starting with the obsessively delusional methods of our astrologer ancestors and moving on to today's favorite delusions. For example, I have long called for a predictions registry that could track the simplest but most important metric of a public figure’s credibility… whether they turn out to be right a lot… or seldom!
 Go have a look at how I lay it out. There is probably no more-useful endeavor that some philanthropist might fund (cheap) than a service to score -- in a non-partisan way -- who in our civilization tends to be right a lot. 

It's a criterion we should use a lot more than the current standard for allocating power... those who are persuasive.

Is this a start?  Now Nate Silver’s gives an A through F score for pollsters over the last decade... rating which ones have some credibility and which seem relentlessly biased or do poorly.

Can we use these scores to refine how to more accurately predict the future?

== Some people do want to achieve this? ==

In an article for Salon, Predicting the Future for the U.S. Government: Matthew Burrows -- author of the new book The Future Declassified: Megatrends That Will Undo the World Unless We Take Action (for which I provided a cover blurb) -- describes the work he has done in the past for National Intelligence Council’s Global Trends report. These reports explore changes that may take place in the near future -- over the next 15 to 20 years.  

I have read many of these reports and found them very useful cogently laying down a range of possible futures that policy-makers and implementers may have to face as we weave the minefield of the near future.

They are, of course, most useful when they offer choice points and potential branchings that might still be under human control

== College and Success: The miscellany begins! ==

My Ice Bucket ALS challenge video is up!  It's all YOUR fault!!!  (Those of you who ponied up for a good cause.  Clearly I suffered terribly, at the hands of my new-freshman son, who delivered the icy deluge! The important thing is -- not to view this as a prank -- but as an opportunity to give to worthy causes -- exercise your power of Proxy Activism.

Speaking about freshmen, heading off to college. Want them top get the most out of these university years? Every autumn I pull out my ten minute video of “Advice for College Students” and offer it to you all to pass along to that bright young person you know.  There are several tricks for making the most of his or her time at university, but the best and coolest one I save for last.  Any student who does this one trick is guaranteed — yes, guaranteed — to have a far more positive and enriched four+ years.

Ahem, while we're speaking of colleges, there’s news about college rankings....can I be forgiven for preening a bit about my alma maters? Okay I lucked out.  My bachelor’s degree is from the 12th best university in the world (10th in the U.S.) — according to the CWUR system.  My doctorate is from the planet’s 20th best campus (15th U.S.)  Oh, they’re #5 and #6 in the world, in the category of “influence.”  Gotta work on that.  Caltech would rank even higher if it weren’t too small to have a heap of majors.  

UCSD is still quite young (established in the 1960s) -- by far the newest in the top 20 --and we just set up the Arthur C. Clarke Center for Human Imagination, which ought to boost the campus a few more slots!  

Bragging? Well, in fact, I kind of stumbled into attending both places.  And stumbled a bit, while there! But the key point is that I came away having squeeeeeeezed them both, using the methods I recommend in that advice video above... methods that any college student can use, to double value that they get out of their years at university. 

Again, my advice to college students.

== On Aliens and Religon ==

An interesting question: Which religions would have the hardest time accepting aliens? io9 starts off the discussion…

…referring to book: Religions and Extraterrestrial Life: How Will We Deal With it? by David A. Weintraub.

Alas, in this Scientific American interview, Weintraub displays some worrisome shallowness.  For example when he says: “In Judaism it doesn’t matter—there’s very little in Hebrew scripture that relates to the question.” But this is false when it comes to Talmudic and rabbinical commentaries.  Likewise, when I get the book I hope I will find the catholic discussions of C.S. Lewis and James Blish and other eminent science fiction authors who dealt with the theological implications of alien life with extensive thoughtfulness.

I do intend to buy this tome, which overlaps two areas of special interest to me.

== Miscellaneous Items ==

Giant Manta Ray Tangled in Fishing Line appears to 'Ask for Help' from Divers.  Actually, I mulled on events like this one long ago, in STARTIDE RISING... in that I sense that animals have a powerful sense of hierarchy in Nature.  Dolphins will play with orcas, till they sense they are hungry. Creatures who come to humans for help know that the humans are both powerful and not in a hunting mode.... All of this comes into whether it would be right to "uplift" animals.

Miscellany?  You want miscellany? Okay then let's veer to... scan through the photographs: all the stuff soldiers carried in battle from the 11th century to today.

What was that? A guide to the military gear adopted by police departments since 9/11 and used in Ferguson.

The Moscow Times is reporting that Bulgarian pranksters are repainting Soviet-era monuments so that the Soviet army types depicted are recast as American Superheroes.
A stunning video shows just how much skill and hard work goes into some of the fantastic “photo-shopped” images we are seeing nowadays.  Anyone who says we aren’t in an era of truly high art is crazy.  There’s never been a “renaissance” like this one, and we should shout it!  

Sci fi - historical-ish humor?  How to explain the Internet to an 1835 London street urchin.  

The more someone smoked pot as a teenager, the more likely that person would struggle as a young adult.

How prosthetic limbs are becoming more bionic. Amazing TED talk by Hugh Herr, with a very moving final ending.  

Okay, now I am just proud to be human. 3D gun makes - and shoots(!) paper planes.

Okay… here’s yet another reason to be proud to be human. ‘ The Airgonay drone club, based in the French Alps, organized a race in the forest for lightweight drones that bob, weave, and generally fly at up to 40 miles per hour. These are remote controlled drones, not autonomous, so operators have on-board cameras to see where their devices are going and take snazzy in-race footage.’  Reminiscent of the best scene in “Return of the Jedi.”  The report is in French, but you'll understand what's happening within a minute.

== Back to Benghazi ==

Okay, so, how did you fellows do?  You who predicted impeachment, prison terms and roiling scandals, when the GOP-run U.S. House of Representatives Intelligence Committee finally issued its report on the tragic deaths of four American diplomats at the hands of terrorists in Benghazi, Libya.  How did you score?

Ah, let's see. "An investigation by the Republican-led House Intelligence Committee has concluded that the CIA and U.S. military responded appropriately to the attacks on U.S. facilities in Benghazi, Libya, in 2012, dismissing allegations that the Obama administration blocked rescue attempts during the assault or sought to mislead the public afterward."

Further: "After a two-year probe that involved the review of thousands of pages of classified documents, the panel determined that the attack could not be blamed on an intelligence failure, and that CIA security operatives “ably and bravely assisted” State Department officials who were overwhelmed at a nearby but separate diplomatic compound."

And: "The committee also found “no evidence that there was either a stand down order or a denial of available air support,” rejecting claims that have fed persistent conspiracy theories that the U.S. military was prevented from rescuing U.S. personnel from a night-time assault that killed U.S. Ambassador Christopher Stevens and three other Americans."

Earlier this year, the United States captured one of the militants accused of orchestrating the attacks in a raid in Libya. Ahmed Abu Khatalla now faces trial in the United States.

So... how did you score?  Note that this was issued by the most partisan U.S. House in 50 years, under a republican leadership that routinely and regularly threatens the president with impeachment for everything under the sun. Indeed, this house -- the laziest in 200 years -- held almost half of its total hours of hearings on just this one "heinous" matter. (They never showed the slightest interest in investigations the eleven "benghazis" that occurred under George W Bush, see accompanying image.)

No, there is only one "conspiracy" here. Delaying this stupendously exonerating report till after the election. Fox News covered this report in less than 30 seconds. Oh and Darrell Issa, chairman of the committee? After two years of grandstanding and tirades promising to "hold the criminals and traitors accountable?"

Mr. Issa's office ignored calls requesting a statement. He has been avoiding the press.  It seems... for once... he has nothing to say.


locumranch said...

I read about the Bengazi report results last night on and my first thought was 'good news for Hilary Clinton in 2016', but my second thought was it probably won't make any difference because the GOP will still use 'Bengazi' as a weapon (a rallying cry) in order to highlight H Clinton's criminal ineptitude, just as the Birther movement continued to accuse Obama of illegality long after the release of Obama's birth certificate.

I liked your advice to university students, btw, even though such terminology is woefully out-of-date, as the rape culture concept of (masculine) 'ferocity' is now considered politically objectionable and the new watch-word is 'timid humility', so much so that your (regrettably male) son would be better served by a thorough reading of California's SB 967 'Affirmative Consent Law' and a dozen 'mea culpas'.


Mark said...

I thought Darrell Issa was chairman of this committee as well. Apparently the chairman of the Intelligence committee is Mike Rogers. Issa is the chairman of the Oversight Committee, which apparently gives him the ability to grandstand over whatever he wants.

But it isn't Issa that made this report.

LaryHart said...


Issa was chairman of the committee that has been engaging in partisan witch hunts for two years.

The formation of that new committee to investigate the same thing was pretty much a slap in the fact to Issa by his own party. Not for being too partisan, but for being too embarrassing.

David Brin said...

As usual, I scratch my head and wonder what language locum is speaking... it SEEMS to be English. But the, at times, he almost seems to be living on this planet. And so I keep trying. But cannot even parse WTF he's talking about this time.

Mel Baker said...

Issa is also losing his chairmanship of that committee. Hopefully he'll cry just like he did when Schwarzenegger took over the recall campaign of Governor Davis. I remember with great fondness Issa's resignation speech, where you could all but hear "Waaaay... I paid for this recall campaign, I get to be the governor, waaaay." Please David convince your neighbors to keep this fool out of the House in 2016.

Stefan Jones said...

Benghazi will continue to get used as a rallying point by conservatives because a fair chunk of their base doesn't follow any news source that will report on the recent, exculpatory findings.

Heck, many true believers will use the report as an excuse to double down! Obviously a conspiracy is at work.

In time a new crazy conspiracy will get top billing, but Benghazi, Obama's birth certificate, and scurrilous rumors about the president's academic career will remain in circulation.

I don't think this toxic craziness will end until we have generation in charge that has better things to do than sit watching cable news eight hours a day. Fortunately, I think that it will just be a matter of time.

sociotard said...

A good post on why that shirt scandal with the Philae Lander is relevant:
[a href=""][/a]
As this relates to GamerGate, and its attendant smartmob and transparency issues, I do look forward to Dr. Brin's post on how to deal with evil transparency.

150 years ago, this week was Sherman burning Atlanta. A good article on the subject, and it'll fire up Dr. Brin on his "5 phases of the civil war" theory.
[a href=""][/a]

sociotard said...

Gah, forgot to use < marks.


Tacitus said...

Oh good grief I just noticed the word juxtaposition..
Philae Lander and Philander. No wonder the poor fellow got so much grief about the shirt.


Neoreactionary said...

Here’s a question that interests me: the last few hundred years clearly demonstrates that civilizations which don’t embrace science and technology get crushed by civilizations that do – i.e. we live in a “might is right” universe. But this is often conflated with moral goodness – that America and Western liberal civilization wins not just because of our superior weaponry, but because we’re the good guys -- the shining city on the hill, where freedom, justice, equality, etc. are held sacred.

That’s all well and good, but what would prevent a civilization from emerging that pursues science, technology and industry aggressively in order to acquire power, but dispenses with liberal values? Might a small group of billionaires and neoreactionary nerds who control disruptive technologies be able to challenge the liberal order in the no-too-distant future? Didn’t fascist nations like Germany, a technologically innovative and dynamic state, offer a powerful model that modern nations like China can emulate -- seeking unlimited technological power but dispensing with the inefficient processes of liberal democracy? What is the “secret sauce” that ensures that scientific and technological leaders must also be champions of liberal values? I'm sure you're all familiar with autistic, Aspergers, sociopathic geniuses -- what is going to prevent these guys (my kind) from taking over the world?

Duncan Cairncross said...

Hi Neoreactionary

I don't think it is a given BUT so far a more open society has tended to outperform a more closed society like a fascist state

I think it was Edward Teller who said that keeping secrets was counterproductive and that the boost from being open was worth more than the advantages of secrecy

Or to take a leaf out of our patrons book
Criticism is the only known antidote to error
A society that does not allow criticism will be overtaken by one that does

Your example - Germany
Was out done by Britain - largely because of technical advantages
Radar - in the Battle of Britain
Microwave radar - submarines
Computers and mathematics - Enigma code breaking

And that was before they drove so many of their best minds abroad

Tacitus said...

Since I, unlike normal folks, am awake at 4am local time I suppose I could answer briefly.

Societies that tell people what they must think generally quashing innovation. Germany is the prime example. Very innovative through most of the last 150 years but much less so during the Third Reich. Their relative martial success was due to organizational abilities and discipline.

See also Soviet Russia.

China may be more of a "Borrowers" Empire. Like Rome, willing to acquire oddities from lesser cultures so long as the Party/Emperor is nominally worshipped.


Pietro said...

A minor nitpick: C.S. Lewis was not Catholic, but Anglican.

Also, apparently Weintraub described the Eastern Orthodox Church as "a branch of Catholicism", which is completely wrong: it's an entirely independent Church, with a different -- although related -- theology and traditions.

And while we're talking about Catholicism and aliens, two facts worth mentioning are that

1. Brother Guy Consolmagno (SJ), the planetary scientist leading the Vatican Observatory, said that aliens probably exist and he'd be willing to baptize them if they asked;

2. Pope Francis also said that he'd be willing to baptize aliens if they asked.

Laurent Weppe said...

"Benghazi will continue to get used as a rallying point by conservatives because a fair chunk of their base doesn't follow any news source that will report on the recent, exculpatory findings."

No: Benghazi will continue to get used as a rallying point by right-winger because it became a tribal rallying cry and their base will continue to dutifully fake outrage because they never gave a shit about the accusations being true or not in the first place


"Might a small group of billionaires and neoreactionary nerds who control disruptive technologies be able to challenge the liberal order in the no-too-distant future?"

It wouldn't last for more than a couple of generations: technology dependent civilization rely on their educated citizenry to function: and educated people always end up revolting against unfair regimes. Your group of billionaire nerds would be trapped in a catch 22: either keep sending their subject's children to school, thus preparing the uprising that would eventually overthrow their heirs, or make education a dynastic privilege, thus sabotaging the very civilization that sustains them.

Of course, if your goal is to enjoy as much privilege and material comfort now and you don't care that your own children will end up on the receiving end of the next dekulakization, then a couple generations of autocracy will probably seem like a sweet deal.

Beside, why using nazi Germany as an example? Between the laughable incompetence of the USSR's invasion planning (which can be summarized as "we'll win in three months because we're genetically superior") and the fact that the Rooseveltian US crushed it in every technology & industry related department the second it started flexing its muscle, it's pretty clear that Hitler's regime had managed to become the epitome of inept decadence in record time. That... not a model one would want to emulate, even if one were a complete psychopath who just want palaces, servants and harems for oneself and don't care about what comes after.

Tony Fisk said...

@Pietro: I don't think David was referring to C.S. Lewis as a member of the (Roman) Catholic Church, but was simply describing his discussions as 'catholic' in the common dictionary sense (ie: 'including a wide variety of things', according to the OED)

As for the Pope being willing to baptise aliens on request, it would be amusing, if highly unlikely, to have a scene showing this in the forthcoming production of "Childhood's End".

Today's capcha test is '345'. Getting a bit lazy there, aren't we?

Paul Shen-Brown said...

I remember a lunchtime discussion I had with a student about the Pope's statement about baptizing aliens. We wondered if any aliens who came here would actually want to be baptized. My student figured that any intelligence capable of star travel would have the wisdom to see through our superstitions and not be at all impressed by the offer. I suggested that the ability to create technology does not necessarily imply wisdom, only technical cleverness. But we both noticed the sheer hubris of the statement. Yes, it's a nice change from the constant denial of the possibility of life elsewhere in the Universe, or the assumption that such life must be demonic in nature. However, the idea that an ancient set of assumptions and ad hoc explanations for phenomena that utterly befuddled people with an Iron-Age understanding of reality, confined to one tiny sphere in an almost unimaginable multitude of stars and worlds in this vast Universe would just happen to be The Truth seems not just a little implausible, but a case of sheer, simple-minded arrogance. "Yes, we, who are members of a vast and powerful interstellar alliance of diverse and ancient beings wish to come to Earth and be baptized because you backward, primitive people just happen to be absolutely right."

On another matter, Larry Hart, I hope others have read the post you wrote for the last conversation. Your observations, and extended quotes from Kurt Vonnegut, were quite enjoyable, but once Dr. Brin has cried "Onward!" probably few will go back to see if any more has been added.

Tacitus Dos, on being awake at 4 a.m., in a psychology class I took ages ago we learned a little about sleep patterns through the lifespan, and one observation was that the 8 hour/day thing is typical for most of our lives, but when we start getting old and grey we start losing out on sleep. This is not insomnia, where you can't get to sleep in the first place due to stress, but waking up at early hours and not able to get back to sleep. Although my source for this is old, it was confirmed much more recently in a lecture by Robert Sapolsky. Hopefully there is some way to get that sleep time, because it is not healthy.

Tacitus said...

OLD? GREY?! Hey, I work as an ER doc and am on the night shift. Oh, OK, I am also old and grey but be fair.

Carpe Circadium


Pietro said...

@Tony: Fair enough, that makes sense. Thanks!

@Paul Shen-Brown: Not to start a religious debate, but what does the size of the Earth compared to the universe have to do with anything?

I mean, Israel itself was a minor, geographically and politically near-insignificant power; and one of the main themes of Jewish Scripture is that God chose it precisely *because* of that.

If -- and I realize that it is a big if, but bear with me here -- the Divinity chooses to reveal itself to sapient beings in such a way, then that's what will happen: and, if anything, it would be terribly arrogant to assume that the Divinity could never choose to do so.

Now, one may well disbelieve that this happened for other reasons; but the relative size of the Earth and the lack of scientific knowledge of ancient people are non-arguments.

locumranch said...

The likes of Paul_SB slumber away the night, defenseless in bouts of nocturnal catatonia, pontificating endlessly about their privileged normalcy, believing themselves to be movers, shakers and universe-masters, even though they (their lives, things and conveniencies) exist at the mercy the nyctalops, the modern morelock, this legion-of-the-damned known as 'night-shift workers', who perceive the world without blinders and curse the glarish day, rising up, always up, when these eloi hide their eyes:

"We will rise, rise up, my brothers, with the coming of the night but, for now, we must flop in darkened houses, console ourselves with redeye and plug our ears against the noise incessant that the dawners make, always inconsiderate, to celebrate their enlightened, privileged lives".


Paul Shen-Brown said...

Tacitus Dio, Sorry, no offense intended. I was just concerned. I haven't asked anyone their age, and I have been thinking about this lately because I'm starting to have that problem myself, a good decade before I should. Besides, if you can attach a number to your name, it only means you aren't dead yet. We are, after all, only as old as we act.

Pietro, we could just as easily discuss the Strong and Weak Anthropic Principles as debate theologies here. My point about the size of the Universe versus Earth and the (albeit charming) offer of baptism is this - if the Universe were created intentionally by some being, a being which we have tended to equate with all that is good, it hardly makes sense that it would reveal Itself only to one small group of sapient beings and not to all the rest as well. If failure to know of and accept this being results in eternal damnation, then failure by this being to reveal itself to all is a crime against Its own creation. Playing favorites is a very human fault, and it should surprise no one that the Israelites (or anyone else, for that matter) should want to see themselves as favored and privileged. However, it stretches any reasonable definition of good to accept a creator that plays favorites with its creations, condemning the vast majority for merely being in the wrong place. So yes, in this case, size does matter. That ethnocentric tendency to see your one little tribe as the only true people and damn all the rest to Hell is hardly an admirable trait. I don't claim to know what the divine being has in mind, but to my mortal mind it would seem that either It would reveal Itself to all, to none, or It is not credible as a good and caring creator. Thus any aliens who should visit would have no need to be baptized by any human hand, unless it is merely to get along. They will have already performed whatever rituals are required by their own society to see to their own mortal souls. They might even offer to do the same for the Pope and all the rest of us humans.

Dr. Brin, my daughter just watched your advice to college students video, and was quite pleased. In fact, she had already done some of the exploration you recommended, though without the use of dice or other props. The video was still inspiring. She also thinks you look a little bit like Mr. Garibaldi from Babylon 5, which I would take as a complement, as she likes that character.

I have to get back to grading, so Happy Cogitation!

rewinn said...

Pietro and Paul: if God chose Earth as the sole site of Revelation, and plays fair with alien species, then God must either get us a stardrive pretty darn soon so we can be about our missionary work, or get some other species to find us. Otherwise His Divine Plan has a pretty big hole in it.

Perhaps it's all encoded in Leviticus and so forth. If we would just stop shaving and mixing fabrics, we could go FTL?


About Benghazi - the Committee report only shows how deep the conspiracy has grown. Even House Republicans are in on it !!!!!11111


"The Future, Declassified" is now on my reading list (thanks!) but the question is: how do we get things done? Domestically, the New Oligarchy is firmly in the saddle, and abroad, the strategy of shooting peasants until they agree with us is a complete failure, so what is the path for what C.S.Lewis might call Mere Rationality?

Neoreactionary said...

OK thanks for the replies. Laurent, I mentioned Germany because it was the first example that came to mind of a non-liberal society that was technologically impressive, being pioneers in aircraft, computers, rockets, automobiles, etc. But yeah, the Reich’s ideology was pretty irrational, so that might not have lasted. A 21st century technofascism wouldn’t make that mistake.
Criticism is useful to a point, after which it becomes counter-productive. Maybe liberal democracies have gone beyond that point? As far as needing educated citizens, sure, but how many do you really need? As technology replaces more of the workforce, aren’t we heading toward a regime where fewer and fewer people will be doing necessary work? This is also true for the military, if robots live up to their promise. But I agree that technofascism would only last if enough of the smart guys were in on the plan. Basically you tell them: we’re the intellectually superior, we do all the productive work, so we deserve to rule. We also deserve to dominate the gene and meme pools, because isn't that what intelligence is for?

It’s just a thought experiment, but it really seems to me like it could work, and the real “Singularity” is the possibility of a small techno-elite ruling the world indefinitely. In fact, it looks to me that this is where things are headed, even if some of these nerds use slogans like “don’t be evil”, preach about “Enlightenment diamonds”, act like hipsters and pursue philanthropic mad science schemes in the third world. LOL, right...

Pietro said...

Paul: you say that

"If failure to know of and accept this being results in eternal damnation, then failure by this being to reveal itself to all is a crime against Its own creation."

and I would agree; but that premise is not one to which the Catholic Church accepts.

Catholicism is *somewhat* different from American Fundamentalism, on this as in on many other issues.

As per the doctrine of the Catholic Church, people who strive to do good and, through no fault of their own, are not formally united to the Catholic Church are not necessarily damned. The position of the Church on this topic is quite nuanced, and this is perhaps not the right venue to discuss it in detail; but just to mention the aspect which is most relevant to the topic at hand, you might want to read item 847 of the Catechism of the Catholic Church:

"Those who, through no fault of their own, do not know the Gospel of Christ or his Church, but who nevertheless seek God with a sincere heart, and, moved by grace, try in their actions to do his will as they know it through the dictates of their conscience - those too may achieve eternal salvation."

So no, the relative smallness of the Earth and the fact that if intelligent aliens exist (and they probably do), most of them will almost certainly never hear about Catholicism is not an argument against it.

Now, as I said, there may well be *other* arguments against it, and it's not really my desire to start a rambling religious debate about them all in here; but that particular argument only works if one assumes that Catholic theology is the same thing as Southern Baptist theology.

LarryHart said...

Paul Shen-Brown:

but once Dr. Brin has cried "Onward!" probably few will go back to see if any more has been added.

Yeah, I sometimes post before I've seen that "onward" has already been declared.

That one is mostly a re-run, though. I've posted the identical Vonnegut quote many times here already.

LarryHart said...


I work as an ER doc and am on the night shift...

Hey, doc. Serious question about the medical system.

My wife has had a pain spreading from the head downward for months now. She's seen a dental surgeon, an ear-nose-throat guy, a neurologist, and a neuro-surgeon, none of whom have found anything wrong in their areas of specialty. Next up is an infectious disease specialist.

The problem is that each visit to a new doctor requires about a week's waiting time, and then another week or two for the new round of tests they order to come in. Meanwhile the pain gets more debilitating and she's actually been to the emergency room twice because she couldn't wait for her next appointment--only to be given more pain pills (which don't work) and sent home.

I'm not going to ask for you to diagnose her case, but my question is: We're obviously doing something wrong as far as navigating the system goes. What do you think is the correct procedure we should be following?

The fact that I'm asking a virtual stranger on the internet a question of this nature is indicative of desperation.

Tony Fisk said...

@LarryHart. dumb question: has your wife seen a GP? (specialists in diagnosis)

David Brin said...

Neoreactionary, fascist -modernist nations like the Nazis repulsed actual science. The created environments in which most free-thinking scientists simply fled… leaving a skilled engineering culture that rapidly devoured its seed corn. Stalinist Soviets did better, extolling science, but they, in turn, also stifled it in many ways. Indeed, much of what made the West increasingly moral was a willingness to allow science to demolish old stereotypes that had little basis in fact, allowing us to stop wasting the human potential in many races, or in women. Which in turn benefited science. Hence, what you assert is a mere choice of fashion, for us to have openness and fairness as moral virtues is instead a necessary feature of the Enlightenment’s success.

As is the habit of reflective doubt and self-criticism which YOU expressed by posing this very issue.

But yes, I am very concerned that if an elite manages to end our diamond-shaped enlightenment experiment and re-forge the inheritance-power pyramid, they will use science to create new advantages for their sons that the old feudalists never knew. Including (as I portray in Existence) selective breeding with the brightest kids of the middle class, till the aristocracy is truly and verifiably genetically superior. Indeed, this is likely the pattern among extraterrestrials, till they lose even the conceptual ability to understand positive sum games.

Pietro CS Lewis was of the wing of Anglicanism that considers itself -to this day — to be “catholics-whose priests-can-marry”.

Duncan Cairncross said...

Hi Neo

IMHO like a lot of "intellectuals" you are massively underestimating the skills required to do a lot of "blue collar" jobs
You can't run a a modern civilization with a small number of intellectuals
You need a huge number of competent people
Like the factory that only needs four operators
But you forget about the 40 maintenance people and the 100 people at the suppliers who provided and look after the equipment

You don't need everybody to be competent but you do need a relatively large percentage - 30%???
So you can't operate with just an "elite"

Paul Shen-Brown said...

Larry, the situation with your wife sounds serious! I hope you get some relief soon! I've been through the American medical roundabout before, too (though not with so serious an issue) so I know how you feel.

Pietro, thanks for the link there. I definitely have much more experience with the more Fundamentalist sects in the Western U.S., although I have taken Catholic mass before. Still, though Item 847 sounds much more humane than anything I was taught in church as a lad, I work with a whole lot of Catholic children, families and coworkers. Few of them, judging by words and deeds, have taken this to heart. They are as quick to render a judgement of damnation as their neighbors in other sects.

I do not see this as a criticism of the Catholic Church, or any church, for that matter. Rather I see it as a problem that is endemic to religion. Religions begin in specific places, among specific peoples, yet make claims to universal truths. Yet people everywhere interpret those truths in their own individual and culturally-mediated ways. We are not divine and are unlikely to be capable of perceiving divinity in any way more accurate than an ant might perceive an automobile. When I was in Asia for a summer, I visited a Tao temple, and was disappointed to see people on their knees worshipping some local god. What I had read of Taoism seemed much more practical and said nothing whatsoever about rituals and incense, but every individual will interpret their culture's sacred texts in their own ways, ways which conform to a great extent to social expectation. As I see it, all we can really do is try to be the best people we can be, and cross that bridge when the time comes.

Happy cogitation!

LarryHart said...

Tony Fisk:

@LarryHart. dumb question: has your wife seen a GP? (specialists in diagnosis)

Dumb answer: yes, she's the one sending us to all the specialists.

I just wish they could be done in parallel instead of in series. It's the whole starting over fresh with each specialist that is agonizing.

Laurent Weppe said...

"I am very concerned that if an elite manages to [...] re-forge the inheritance-power pyramid, they will use science to create new advantages for their sons that the old feudalists never knew. Including [...] selective breeding [...] till the aristocracy is truly and verifiably genetically superior."

Given the kind of incestuous endogamy favored by aristocracy through the ages, I seriously doubt that such a future is possible: the much more likely outcome could be tech-savvy feudal rulers taking the same inbreeding habits than their predecessors and producing shoddy eugenist pseudo-rationalizations to justify their parasitic behavior, except with a little more scientific-sounding jargon thrown in the propaganda.

Tacitus said...


I suppose we are virtual strangers in the sense of operating in virtual space. I prefer to think of the various entities here as being akin to early, low budget Star Trek aliens...coherent energy clouds with benevolent or (less often) malevolent purposes.

I am very sorry to hear what you are going through. 90% of what comes through the door is routine stuff. Hell, I often hazard a guess when the patient is still registering, based on age, presenting concern etc.

This is in the other 10% and potentially the very tough .1% of stuff.

Tony Fisk's suggestion was cogent, a thoughtful GP (FP in these parts) can often steer you to the right department and to someone in that area who is thoughtful. My first take on this was "sounds like neurology" and I have seen a few of them get fooled.

Think of it as an engineering problem. Time frame....something present for weeks to months is different than years to forevers. Progressive is a big clue, differs from waxing and waning.

Distribution and scope of symptoms. Any sensation, reflex, motor weakness, or (sorry) continence issues put this on a much different stage.

Infectious disease docs....are we drifting out into Lyme disease consideration?

Another thing that helps is that the various Wise Ones have access to prior info. You would expect a universal electronic sharing of information...often does not happen. Consultant notes, lab summaries, imaging does not hurt to have your own paper copies.

I have some other thoughts and would be happy to "decloak" if you want more direct ideas. I can be contacted at:

I am sure the ER was a frustrating experience for you. Sorry, I have faced this very clinical scenario many times and it is damnable.


Alex Tolley said...


I can empathize strongly. I am going through something similar with my back. It is becoming a joke that every specialist requires insurance authorization (1 week+) then long delays (up to a month for a consultation) then further weeks for treatment that doesn't work.

Each specialist will say "this is serious" we must get moving on this now, but it still takes weeks to get treatment.

I'm beginning to think Kaiser would work a lot better - with all the specialists under one roof and all the data in a common system and some hope that the process would be sped along.

All the while my condition just deteriorates.

I'm no longer impressed with the US H/C system, and I have "gold plated" insurance.

LarryHart said...

@Alex Tolley,

Yes, my situation also is not because of a lack of health insurance.

At the risk of turning Dr Brin's blog into a gabfest about health problems--I had terrible unexplained back pain a few years ago, and a chiropractor did me a world of good, pretty quickly too. Is that an option in your case?

Paul451 said...

"But yeah, the Reich's ideology was pretty irrational, so that might not have lasted. A 21st century technofascism wouldn't make that mistake."

Why do you think they'd be immune?

That's part of what people were talking about, the difference between closed and open societies, CITOKATE, etc. A closed society doesn't tolerate criticism of itself, its beliefs. That starts first within the leadership and followers in the core movement, as they start gaining power; in modern terms, a "reality bubble" develops, and any criticism is seen as a sign of either a outsider to be hated, or a traitor-within to be exiled or punished into silence.

Re: China
One of the interesting things about the "Great Wall" filter and Chinese media censorship is that apparently you are free to criticise the leaders and even philosophies of the party, the government up to a point. And when criticism on a subject becomes widespread, it often does influence the direction of politics. The line you aren't allowed to cross is promoting protest or other political action, nor form a movement out of which such action will inevitably arise. (This means that a very popular individual critic is a risk, because they are, in effect, a "popular movement" in their own right.)

So you can complain about corruption, or incompetence, and that is okay. So long as you are, in effect, asking The Government to do something about the issue, not asking The People to do something about The Government.

The effect is that you have a limited but real avenue to criticism and thus correction. Actively avoiding the flaw of a completely closed (at least closed to criticism) society. China seems to be quite unique in that, and it's an interesting distinction to the Maoist era. It's not that technology has allowed it them to suppress dissent, it's that they've (so far) found a way to be open to criticism but closed to dissent, in spite of technology. (I don't know how long it can last, or if it can survive a serious economic downturn.)

Paul451 said...


I hesitate to "say the Devil's name lest he hears you", but I notice the lack of Oncologist on that list. Has that possibility been ruled out? (Bone cancer is often associated with severe pain.) I would expect that to be prioritised well above infectious disease if there's no direct symptoms of infection. (Jaw-rot/migraine/cancer seem to be the top three. Only then do you get to down to the obscure stuff.)

More generally, I share your frustration at the one-at-a-time, wait-and-wait-and-wait, nature of specialists. (And a particular personal bug, the doctors who tell you of the test result which rules out the first thing they thought of, then act as if the negative result somehow solved your problem.)

Tony Fisk said...

re: Benghazi. David Roberts of Grist doth tweet:

Graham: House GOP Benghazi report 'full of crap' Epistemic closure, ladies and gentlemen.

Also known as not letting the facts get in the way of a good smear campaign.

raito said...

On the nature of prediction:

Our fair governor made a prediction, of sorts. Actually, he tried to take credit for something he believed would happen in the future. And as politician's do, he stated this prediction as if he would be responsible for it happening.

Naturally, it didn't come to pass.

My prediction was that if it didn't, his press machine would go into overdrive blaming it on others' obstructions.

My opinion was that if he were able to predict that well, it would be a point in his favor.

If he didn't it didn't matter why, he was an ineffective predictor. And thus a poor politician.

Apparently, I was a poor predictor, because his machine didn't much bother to explain away his poor predictive abilities.

And we're stuck with him again. At least until he washes out as a presidential candidate. I hope.

Tony Fisk said...

@raito to be fair, I don't think 'good predictor' is an essential part of being a politician. Good administrator, perhaps... predictions are more in the way of knowing a good advisory service than an innate requirement.

Alfred Differ said...

I don't see how a 21st century technofascist would be able to avoid the same fate as older ones. I know our host worries about it and dutifully warns against the risks, but a new regime would still face the fundamental error of their predecessors even if they fix the genetic inbreeding trap.

Ultimately, the vast majority of knowledge is stored in individual brains and simply can't be centralized quickly enough to enable centralized wise minds to make decisions for peripheral individuals that are better (on average) than what the individuals could do themselves. One can make seemingly trivial examples that show this with ease.

1. If you stand at a crosswalk, look both ways for traffic, you can usually decide for yourself whether it is safe to cross and no help from a central mind could do better than you. In all likelyhood, a central mind would do worse due to the time lag one suffers which is amplified beyond your own personal time lag using a custom-built lump of neurons and synapses.

2. On the notion of economic planning, do you know what you want for breakfast 10 years from tomorrow morning? If you don't, a central planner can't either, thus they have to fudge a bit with probabilistic planning. That's precisely what a market does, but much better due to the nature of the pricing mechanism. A central planner can't possibly do better.

One might point out that it doesn't matter what we want for breakfast a decade from now. Also, we don't need to intervene in street crossing decisions. Doing that, though, means one draws a line between decisions that are left to the individual and those that aren't and that is where the trap for future fascists lies. As long as there is an 'enlightened' society on Earth somewhere, those people in their market draw the line far over toward the side that leaves individuals using the best knowledge they have available to them. The other fools don't and are thus doomed unless they can kill the enlightenment group.

People who make the best decisions they can using the best information they have win more often than those who don't. Serfdom isn't just immoral, it's dumb.

LarryHart said...


I don't know that bone cancer has been ruled out, but I think it has. She's had so many scans of the head and neck that she should have super powers by now.

And yes, I can't count the times we've been told "Well, it isn't fill-in-the-blank." with a happy smile, as if the problem has been solved.

locumranch said...

As described by Larry_H, the problem with the US Healthcare system is one of unrealistic expectation which has altered the modern conception of 'health', redefining it as 'the presence well-being' rather than the (more classic) 'absence of disease' definition.

All Larry knows is that someone he cares about 'hurts' (professes 'discomfort'; feels 'unwell'), so he returns to the 'Emergency Room' time after time -- for a chronic 'non-emergent' problem no less, consumes vast amounts of medical resources, and demands a 'cure' for a subjective 'unwellness' complaint which does not appear to be organic (and/or physical) in nature despite intensive clinical, laboratory & radiographic testing.

Of course, Larry finds this experience to be frustrating as insanity (defined as repeating the same actions over & over while expecting a different outcome) often is. Now, I didn't say that this headache complaint is caused by insanity because (1) I bloody well didn't and (2) the medical ER technocrats may someday discover the cause (and/or cure) for this particular case of unwellness. I only said that these repeatedly fruitless actions -- these increasingly frequent ER presentations for a chronic complaint -- represent an insane (and/or irrational) course of action.

I would hope that Larry_H sticks with a single physician and pursues appropriate medical testing -- which involves the sequential elimination of a series of increasingly unlikely medical causes rather than a single magical confirmatory test -- but experience tells me he won't. Instead, he will most likely resort to quackery, seeking certainty at the cost of rational thought, convinced the some yet undetermined problem (diagnosed 10 years hence) was the physically retrospective cause of unwellness, rather than the presence of unrealistic expectations.


raito said...


I disagree (obviously).

I think it's essential for a politician to have a good idea of what is going to happen so that they may act appropriately in the public interest.

My point may be that I care less that a politician tries to ride a positive wave than that they know the wave exists.

And, apparently unlike most of the rest of society, when the politician knows things are going to go badly, they tell me and tell me what they're going to do about it. As opposed to making stuff up.

Alex Tolley said...

@locum - I fail to see why it is an 'unreasonable expectation' to expect the H/C system to correctly diagnose a problem, and treat it if there are treatments available. In the past you have suggested that you have denied access to disability assistive devices for patients who felt they needed them. I'm starting to wonder about your ethics.

Alex Tolley said...

And Lindsey Graham is already in denial about teh Benghazi report - calling it 'garbage'

Sen. Lindsey Graham: GOP-led Benghazi report is 'full of crap'

LarryHart said...

From the Benghazi article linked to in the main post:

So, how did Fox cover these findings? Chief White House correspondent Ed Henry, sitting in for Bret Baier on Special Report Friday evening, spent just under 30 seconds discussing the report and the aspects he chose to highlight speak volumes.

“The House Intelligence Committee says the initial assessment of the Benghazi terror attacks two years ago, that they were in fact terrorist in nature, was accurate,” Henry reported. “It says CIA and Obama administration officials later supported the incorrect scenario that the attacks were motivated by an internet video and stuck with that for several days.”

By what reasoning does the right flog the notion that "terrorist attack" and "motivated by an internet video" are mutually exclusive options? Could it not easily have been a terrorist attack that was (partially) set into motion by the video thing, either as direct revenge for the video, or else (more likely) making use of the crowds protesting the video as convenient cover?

I simply fail to see how "It was a terrorist attack" somehow disproves that the video had anything to do with it.

LarryHart said...


I only said that these repeatedly fruitless actions -- these increasingly frequent ER presentations for a chronic complaint -- represent an insane (and/or irrational) course of action.

I would gladly have my wife see her regular physician instead of the ER. The thing is, seeing a doctor requires an appointment, generally a week or two out from the time you make it. If tests are involved, that's another week. And if the patient is in such distress that she can't wait a week to see someone--the doctor's office tells her to go to the effing emergency room.

Believe me, the insanity is not my own.

LarryHart said...

Alex Tolley:

And Lindsey Graham is already in denial about teh Benghazi report - calling it 'garbage'

Sen. Lindsey Graham: GOP-led Benghazi report is 'full of crap'

That definitely calls for some creative headline editing:

Sen. Lindsey 'full of crap'

Tony Fisk said...

@raito: I certainly think a political leader must be able to contemplate forward planning, and that a great leader should be able to do it for themselves. My point was that it is usually sufficient to have access to advisors.

Ferguson... a fuse has been lit.

locumranch said...

There's an old Chinese curse that goes 'May you get exactly what you want (desire; wish for)' and, in this sense -- the sense that many like Alex confuse 'wanted' healthcare with the 'best' (most appropriate) care -- the US healthcare system is well & truly cursed by a plague of entitled-demanders who confuse the healthcare they want with the healthcare that is best for them, which is why some resort to the easy validation of quackery, why so many demand those medicines, therapies & devices that cripple as well as heal, and why others are quick to defame those physicians who defend their patient's best interests with zeal. May those wretches receive exactly what they wish for.

And, as for Larry & spouse, whose situation I feel for, I propose that it is their very sense of urgency -- their desire for a decisive diagnosis & an immediate fix -- which does them great disservice by forcing them back to an emergency room when no emergency and only a chronic condition exists. They should feel reassured by their physician's inability to locate an easy cause of symptomatology (because an easy diagnosis is usually very bad news) and, in the meantime, they can calmly discuss empiric pain control options with their GP until a definitive diagnosis can be made.**


** Sorry about the third-person bs.

Alex Tolley said...

I don't see 'wanting' being confused with 'best' when wanting is getting rapid service, diagnosis and treatment, rather than interminable waiting for appointments and tests. I just saw my physician today who tells me that he is now ruled by the insurers so that he cannot determine what is 'best' care for me because the insurers determine that. Given how costly the US H/C system is compared to other countries but with poorer outcomes, I don't see how the this is delivering close to 'best' H/C unless the claim is that quackery is rampant or that patients are demanding and actually receiving useless treatments. That seems unlikely. More likely the high costs are due to the defensive medicine practiced.

If quackery is practiced, how exactly are patients supposed to determine what is useless? Specialists are supposed to be experts and referrals are expected to be for good treatment.

Jerry Emanuelson said...

Few people realize the extent to which the practice of medicine is controlled by insurance clerks with minimal education (and certainly without a license to practice medicine). Even your local pharmacist is at the mercy of insurance clerks.

I have actually saved an incredible amount of money over the past three decades by going to physicians who do not accept insurance. (Fortunately, in the U.S., we still have this option.) I have always had a primary care physician within the insurance system; but at least once a year, I go for preventive care to a physician who does not accept insurance.

I have found that the very best way to find an excellent physician in private practice is to look for one that refuses to accept any kind of insurance. These physicians are either quite outstanding or on the verge of losing their license to practice (and there are easy ways to tell if a physician is in the latter category).

Similarly with pharmacies, I always do business with one pharmacy who knows nothing about my insurance status. I have another pharmacy that I use for insured medicines. In the past, I have had prescriptions held up for days in order to save me 5 dollars (while my health suffered for the lack of the medicine).

In one case, I had a prescription held up for days while the pharmacy was trying to confirm with my insurance company that I could obtain the prescription for a 10 dollar co-pay. So I finally asked the pharmacy clerk how much it would cost if I paid the full amount out of my own pocket. The answer was 9 dollars. (This sounds incredible, but it is not an isolated case.)

sociotard said...

The metadata recording thing applies to snail-mail to, evidently. All mail gets its picture taken and stored for later perusal. As with phones, a warrant is required to see the contents, but not to see the outer edges.

Not sure how this transparency can be made reciprocal.

locumranch said...

You want fries with that?

If you want fast care, fine, but you can't have fine care fast.

Rapidity requires duplication of effort, aka 'testing in parallel' as you requested earlier, ordering tests (to save time) that you probably wouldn't need if you were tested in series; more tests are thought to be better (best) in our 'more is better' culture; more tests are also thought 'more productive' because they lead to more procedures and higher billing; the average doc can order 10 tests in the time necessary to explain one test result; and most US patients demand certainty which requires more tests.

Insurance companies also demand certainty (proof) which requires more tests; more tests lead to economies of scale which is thought to reduce the cost of individual tests by 'improving cost effectiveness'; and economies of scale lead to increased practice volumes, less physician autonomy & less physician time with patients, leading to an increased reliance on tests & testing, which means more tests but less care.

Specialists are experts and they can help you (really) if they have the time, but more tests lead to more specialty referrals, meaning larger 'economies of scale', higher patient volumes per specialist, more procedures, shorter visits, little discussion, less communication and (in turn) a higher reliance on tests. Hurry, hurry, hurry...

Other NHC systems lack these economies of scale, meaning that they are less productive & cost-effective. They also believe that 'more is less'. They order fewer tests which leaves more time for patient visits & care, results in fewer procedures, fewer specialty referrals and improved patient satisfaction but less certainty, which results in huge cost-savings but ends terribly on the off-chance that the patient is truly ill.

That is the conundrum:

The US healthcare system treats everyone as if they were seriously ill even though few are, resulting in great outcomes for the ill but poor outcomes for the healthy, while most NHC systems treat everyone as if they're healthy, resulting in great outcomes for the healthy but poor outcomes for the ill.

Which would you choose??


Duncan Cairncross said...

"The US healthcare system treats everyone as if they were seriously ill even though few are, resulting in great outcomes for the ill but poor outcomes for the healthy, while most NHC systems treat everyone as if they're healthy, resulting in great outcomes for the healthy but poor outcomes for the ill."

Sorry locum but you are wrong again!

Tacitus said...


From the admittedly narrow, fun house perspective of the ER, locum is about half right. You would not believe the degree of over testing for things that have perhaps a .0001% chance of being a heart attack for instance.

I am late enough in my career to hopefully not get fooled too often and will frequently just make my notes such that I would be willing at need to defend my clinical judgement in court.

"Patient is demanding a CAT scan to evaluate abdominal pain of 3 years duration. In that time span our facility alone has already done 8 CAT scans. Exam does not suggest acute condition. Studies suggest that this degree of radiation exposure in a 25 year old has significant long term cancer risk."

Good medical practice but a hell of a lot more work than just clicking the order button again.

otoh I also have patients who decline major care that most of us would leap at. Had a guy teetering on the edge yesterday who was on a "do not intubate" directive. Had to tell his family that the guy was making me work a bit harder but that we would pull him through anyway.

Off to another fun shift!


LarryHart said...

Jerry Emanuelson:

Few people realize the extent to which the practice of medicine is controlled by insurance clerks with minimal education (and certainly without a license to practice medicine). Even your local pharmacist is at the mercy of insurance clerks.

That's what's so laughable about the anti-Obamacare claims about death panels and the like. "Do you want government bureaucrats between you and your doctor?" As opposed to corporate bureaucrats, which the Tea Baggers apparently are just fine with.

Duncan Cairncross said...

Hi Tacitus
I was mainly disagreeing with
"but poor outcomes for the ill." from other NHC

I just don't see that the US system has any significant advantage over the other systems for the sick or the well
Although possibly for the very rich

Saying that my experience is once our system has identified something it CAN do it clicks into gear and does it very well

Actually identifying what is wrong seems to be a more difficult problem

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Paul Shen-Brown said...

I hesitate to jump into a discussion of medical practice, as I am not in a field anywhere near it and can hardly even imagine the complexities of the system's inner workings. However Tacitus Er (Mandarin, this time) brought up a factor I can speak to. He mentioned some patients who demand expensive and unneeded procedures on the one hand, and others who refuse treatments on the other. This brings up the level to which we tend to overgeneralize, then harden our opinions with Confirmation Bias. This is a very human tendency that has application almost anywhere. In education there is a tendency among teachers to assume that all students are bad and must be treated as criminals on the one hand and the opposite, that all students are perfect angels and must be treated with cheer and trust. The reality is that they are all individual human beings with their own individual personalities, and must be treated as fairly as possible, given the problems of scale.

But there lies the rub! Scale. The bigger the system, the more quirky, individual human beings are in it, the more difficult it becomes for decision makers to balance these disparate needs. The typical solutions to scalar stress issues have always been to divide anything that is too large into smaller parts with greater autonomy, but since the US system is largely administered by extremely large for-profit insurance companies, I doubt it would be possible.

locumranch said...

Duncan, as usual, jumps to conclusions, because I wasn't bragging about the US healthcare system. I was simply pointing out that the USA, more often than not, takes an individual-based approach to health, spending a disproportionately high percentage of its budget on individual treatment, whereas most NHC systems tend to take a population-based (preventative model) approach at the expense of individualised treatment, statistics being non-comparable, neither being better nor worse than the other, unless we adopt an individual and/or herd bias, in which case the US does better at sick individual survival but sickly when compared to average life-expectancy in NHC countries where the sick die sooner but the healthy live longer.

raito said...


I think we're pretty close to agreement. And I think that being a legislator at the state level or higher is a larger job than one person can do by himself. Hence the need for advisors. But a lot of people forget this, and also forget that you need good advisors. Some of those guys have their own agendas that don't align well with either their boss or the people.

And as far as medical care goes...

One of my misgivings about the ACA is the idea that cost can somehow be controlled by regulating the middleman. I'm not entirely certain how I feel about the whole insurance thing. On the one hand, the insurance companies ought to be able to negotiate the best prices they can. But on the other, is it really reasonable to say that an insurance company pays a tenth of what someone off the street would pay? And a problem that often goes unaddressed that some co-workers are having is that the insurance company can't/won't tell them how much they'll have to pay for particular procedures. Not even with the caveats.

A.F. Rey said...

I wouldn't trust that university ranking that much, David. They ranked U.C. Santa Cruz way down at 163, 71th for the U.S. I know the Banana Slugs are better than that. :)

Just ask Gregory Benford. ;)

matthew said...

Any university ranking that puts Colorado School of Mines at 345 is just plain wrong. I don't like the culture at CSM but their graduates can sure build stuff. They are always ranked in the top 5 American engineering schools.

The methodology of the rankings is quite suspect with a very high reward for "international recognition." Recognition that is usually earned through backslapping, not research. Note that educational outcomes are rated by how many graduates are CEOs. In other words, this list is for the 1% to use to pat themselves on the back for how great their alma mater is.

David Brin said...


Duncan Cairncross said...

"in which case the US does better at sick individual survival but sickly when compared to average life-expectancy in NHC countries where the sick die sooner but the healthy live longer."

In population term I am having difficulty with this
With the same ratio of sick/healthy if the sick live longer the population live longer

Healthy people don't die of Health related issues - they have to get sick first (even for a short time)
So if the sick live longer the total population live longer

Unless you are saying that the USA has a higher ratio of sick people
Which is a cop out for a worse health system