Wednesday, January 24, 2007

Space Funding, Nanotechnology and World Health

Time to do a quick update of ancillary matters. All sorts of misc stuff.

"The Administration is cutting missions of scientific space exploration and research to pay for space transportation," stated Louis Friedman of The Planetary Society. As always, under these guys, science is the big loser. Does anybody see a pattern? Please feel free to drop by the Planetary Society site and sign the petition (or join to show your support.)

Well, if government can no longer look ahead, at least some private and ad hoc groups are doing so. On Saturday and Sunday, January 20 and 21, members of the Center for Responsible Nanotechnology participated in a first-of-its-kind event. About a dozen people, representing four countries on three continents, and with training in a variety of disciplines, came together for a scenario creation project via virtual presence. They began the process of developing a series of professional-quality models of a world in which exponential general-purpose molecular manufacturing has become a reality. I am a member of CRN, though I was unable to participate in this event. It sounds like Global Futures Strategist Jamais Cascio and CRN Coordinator Mike Treder did a great job leading these vivid minds in an exercise that I plan to tap for ideas for my latest novel!

The urgent need for new nanotechnology policy is highlighted by breakthrough results from a recent British government funded project. For the first time ever, a group of high-level scientists assembled for the purpose of inventing something as close as they could get to the long-sought nanotechnology goal of building precise products atom by atom. The remarkably advanced projects those scientists produced suggest that the era of molecular manufacturing -- with its tremendous potential benefits and potentially grave dangers -- could arrive far more swiftly than previously imagined.

Devin Murphy clued me into this fascinating economic analysis of “econimic activity” on Second Life, or “virtual-avatar nonsense analyzed as a pyramid scheme.” And what do you expect on a frontier? Cheating and predation emerge out of human nature at any opportunity. If these people did not have a near monopoly on virtual worlds -- if VR were liberated to become an open-creative realm, the way it is when it comes to creating web sites -- then competition would alleviate such problems. It dazzles me how people can see the example of the Web right in front of them, and then forget about its lessons.

Of course, it does not help that discourse -- the exchange of cogent information -- takes place on Second Life at about the same level as caveman grunts... with apologies to cavemen,

February 22 I’ll be appearing at a conference on “Collective Intelligence Networks” near LAX, in Southern California.

Another thought provoking gem from the Progressive Policy Institute: World spending on health, according to the World Bank and the U.N.'s World Health Organization, was 10.2 percent of global GDP in 2003. This is the equivalent of about $3.7 trillion, or $500 per person. (The figure counts all money spent by governments, providers, and individuals on "preventive and curative" health services, family planning activities, nutrition programs, and emergency medical aid.) America's health bill that year came to 15.2 percent of GDP, far ahead of all competitors. So far ahead, in fact, that Americans accounted for nearly half -- $1.7 trillion of the total $3.7 trillion -- of the world's health spending.*

Now, one can already predict the cliched responses to this. Of course much of this is (the right wing answer) because we start out much richer and there is so much more care available in the US. It is also evident that (the left wing answer) there is vast healthcare inflation in the States, because the government takes almost no part in limiting price gouging or collusive market busting by powerful entities like drug companies.

Especially, there is the simple fact that medical care is obdurately immune to the corrective effects of market forces. If you or a loved one are deeply ill, you will not do normal price-comparisons when looking for hospitals, seeking “bargain” surgeons and/or other care providers. When price is no object, supply and demand are weak correctors. Hence, in most of the world’s nations, medical care has drifted into zones where socialism seems to make sense to a lot of people. Like public education, street maintenance, law enforecement and defense.

(Let there be no mistake here. One of my reasons for utterly despising the so-called “left-right political axis” has to do with the fact that, at last, we seem to have data needed in order to know what jobs government is good at and which should better be left to competitive accountability arenas. But simple-minded dogmatism infects and afflicts us, limiting our ability to be agile and re examine assumptions.)

In fact, the PPI numbers seem to reflect something fundamental. That the US subsidises the entire rest of the world by spending whatever it takes to move medical science and skills along at rapid rates. Much of that money reflects profit-driven research. And if that profit drive warps fairness in outrageous ways, in America, it also propels advances that - for example - Europeans get to exploit only a few years later, after prices have fallen. (I had personal experience with this, unable to even get an MRI in France, but paying through the nose for one here, back in 1991.) It is one more case where reflexive, indignant dogmatic-posturing simply does not accurately reflect reality OR fairness. Yes, there is more sense and justice to the European approach. But every single day thair system uses methods that have slipped a little farther down a learning curve that Americans, largely, paid for, Moreover, every day, many hundreds of people from those countries (those who can afford it, of course) climb onto jets in order to come here for treatments that are more cutting-edge than they are allowed access to, at home.

OTOH... one must always be wary of a theory that sounds just too pat! The PPI report continues:

More fundamentally, despite high spending, U.S. "outcomes" in some basic public-health indicators often remain mediocre. For example, a WHO list places the United States 30th of 192 countries in infant mortality. (Low rankings reflect in part failure to insure about 40 million people, and also failures outside health care systems per se: relatively high obesity rates, frequent road accidents, HIV incidence somewhat higher than the rich-country average, and other problems that insurers, doctors, nurses, hospitals, and pharmacists must address but can't prevent. There are also the problems inherent in absorbing fully half of the world’s total number of immigrants.) The World Health Organization lets you compare 171 health indicators across 192 countries: 
I want to thank those of you who showed such interest in my posting about cell-phone autonomy and the desperate need for a second layer of operability in those sophisticated little radios so many people carry around in their pockets. It is outrageous that these seem designed to fail at the very time when we may need them most. Requiring a simple, peer-to-peer capability for passing text messages... even restricted to times when a cell tower is not available... could be the simplest step taken by our government to ensure that civilization is capable of the kind of robust resiliency displayed by New Yorkers and Bostonians on 9/11...

...instead of the enforced helplessness that was imposed upon the victims of Hurricane Katrina. I hope some of you will continue to help spread the word.


David Brin said...


Fascinating story about "the new philanthropy".

Pierre Omidyar and Jeff Skoll - founders of eBay - and Larry Brilliant and Sergey Brin at Google - are trying to come up with new approaches to changing the world.

Don Quijote said...

Much of that money reflects profit-driven research.

wikipedia - Medical Research Funding
In the United States, the most recent data from 2003 [5] suggest that about 94 billion dollars were provided for biomedical research in the United States. The National Institute of Health and pharmaceutical companies collectively contribute 26.4 billion dollars and 27.0 billion dollars, respectively, which constitute 28% and 29% of the total, respectively. Other significant contributors include biotechnology companies (17.9 billion dollars, 19% of total), medical device companies (9.2 billion dollars, 10% of total), other federal sources, and state and local governments. Foundations and charities, led by the Bill and Melinda Gates Foundation, contributed about 3% of the funding.

Looks like the Tax Payer is seriously subsidizing that Medical Research.

Anonymous said...

about cell-phone autonomy and the desperate need for a second layer of operability in those sophisticated little radios so many people carry around in their pockets. It is outrageous that these seem designed to fail at the very time when we may need them most. Requiring a simple, peer-to-peer capability for passing text messages... even restricted

Regulating telcos is tricky. Unfortunately they have captured the FCC and therefore are always in favor of more regulation except in rare instances where it would increase competition. We would already have devices with the capabilities you describe and more if the FCC didn't enforce massive waste of the EM spectrum, or if did enforce common carriage requirements on wireless and landline companies.

Anonymous said...

Second Life a virtual Ponzi scheme? It figures.

daveawayfromhome said...

It'll be very difficult for American health care to ever rise above mediocrity, because it profit-driven, rather than wellness-driven. The bottom line will always come first, cost cutting will be the norm. That's not to say that socialized medicine cannot be cost-conscious (it can), or that for-profit medicine cannot be compassionate (especially when compassion creates good PR).
The Market System operates on a system of giving the least product possible in exchange for the highest price you can get. Between for-profit hospital chains and the skimming of (for profit) insurance company middle-men, is it any wonder that our health care is both mediocre and overpriced?

Anonymous said...

The health insurance based market is almost fundamentally broken.

One example:

There was a similar article on diabetes about a year ago, which similarly described the huge deficit in payments going to nutritionists and exercise experts that could prevent diabetes versus treating acute symptoms through surgical procedures. It should also be noted that the phenomenon I describe is related to *profits,* not to gross amounts (although percentage formulas would also of course tilt the balance toward high-ticket items).

Further, the efficiency of that "market" is horrific. Per capita payments are off the charts relative to European systems, with a little bit of speed of service to offset that difference.

This market is currently loaded with perverse incentives that work against the patient. The horrible misbalance on the hospital side for the rewards of preventation v. compensation is one thing. The other thing is that insurance companies do well not by adressing this balance (although I think HMO's do better than PPO's at this, being an integrated network), but by using every tricky dick lawyer in the book to deny claims to those that actually request care in exchange for their payments.

As with everything else, the longer the private executives allow their greed and negligence to fester in this system, the more and more attractive state control becomes.

Anonymous said...

Also, as a space monkey, I must reply to the opening deal on the new spending realignments.

I may be unpopular among scientists for saying this, but in principle, space transportation comes first. It is the groundwork, the foundation for making it easier to get to space. As that ability comes online, the gains return in making it possible to have more frequent sending of probes - and possibly even to send scientists themselves to have base camps in the areas they wish to study (planetary guys, anyways).

Now, that thing about principle is mitigated by the fact that this is the promise that has been made to scientists for 30 years now with no major returns. Due to that fact, I would be very sympathetic to anyone that says "we gave you your time and you delivered nothing. The goodwill is gone and now you have to give us our due while you finished screwing around and get serious."

Personally, I think part of the solution would be to have NASA go toward buying services only (tickets to the moon). Put Boeing, Lockheed et. al on notice that there are much hungrier competitors in this game that will gladly do without the guaranteed gold-plated contracts. This also frees up a pretty major bit of cash for the organization to pay down its outstanding commitments and re-balance to get ready to pay for some pretty expensive field trips.

Then again, I've also come up with a couple of plans to have retired Shuttle entirely after Columbia, use some of the spare cash to retrofit Delta-IV Heavies to throw ISS modules up there and take Russian taxis until the American entrepeneurs are ready. Or CEV is - whichever comes first. This would probably have given NASA an extra $5-10 B in pocket.

But, that's just my particular bent. Dr. Griffin is the only Bush appointee that I actually like. Namely that he doesn't appear to be corrupt, incompetent or out to sell the country to super-corps.

Anonymous said...

Dave: "The Market System operates on a system of giving the least product possible in exchange for the highest price you can get"

Businesses (not "markets") attempt to maximize profits. That almost never means minimizing product sold, nor setting prices at the highest point that anyone would pay.

That applies to health care too - except that it's a much more complex field than selling cars or burgers, and there's a much wider belief that the "products" should be more evenly available as a matter of right, rather than on the basis of what a person can afford.

Anonymous said...

The other problem with health care is the Pareto type problem, namely that something like 10 percent of the population generates 90 percent of the costs.

This population are those like cancer patients, those with exotic diseases and chronic conditions that require expensive treatments but are never quite sick enough to die while under therapy.

Oddly, in most businesses, these are the people that would be targeted with products (and, as I said above, this is where hospitals can pull in a lot of operating revenue). However, the perserve problem with health is that those with the greatest demand for the "product" are often the least able to acquire it. So, people buy insurance against the off chance that they are unlucky enough to be the "heavy users."

The market failure here is that many businesses, these people would be those that are the big spenders (like the porn industry and gadget lovers are for media equipment) and businesses would go out of the way to serve.

BUT, the insurance companies control the money, and their incentives are exactly opposite. They can win through hiring expensive counsel and bureaucrats to push the 10 percent out of their systems. The rub is that they charge rates as if they will be there for that rainy day.

Most of us that just need a few med services once in a while (specialist referrals, a few drugs) will likely be treated just fine. In fact, the negotiated rates at the doctors and hospitals may even be a net plus for us on a service-per-service basis. And we probably pay the bulk into the system - although we do so to avoid the risk of being that 10 percent, and this is where the promise breaks down.

David Brin said...

Odin, you are not heeding the underlying agenda of the administration’s space policy, which is to eviscerate SCIENCE ITSELF at every opportunity. Especially science that may look at planet Earth and (e.g.) verify climate change.

Moreover, I hate spending $ on “space transportaion” for another reason. It is nearly always wasted. There have been at least twenty “post shuttle” endeavors. None of them proved to be anything other than a way to siphon life blood away from the people and into the maws of parasites.

daveaway, sorry but you are naive. The cost advantages of socialized medicine do not derive from efficiencies or from “compassion.” Indeed, the Euro style socialized med systems are ruled by incredibly extensive and bureaucratic committess that ration car, deciding which classes of people are allowed access to which kinds of procedures. People past a certain age cannot have some procesdures, even if they were willing to pay extra, because the tradeoff in years or life gained (estimated) do not justify the expense to the state.

The utter drivel about “compassion” that is spread by the American left is based upon ignorance. Indeed, much of the xtra cost in the American system arises from the fact that desperate families are allowed to seek any care they want, if they are willing to pay.

What the Euro systems have is FAIRNESS -- as defined by committees, of course. The rich have very little advantage over the poor in this rationed system... except of course that the rich can climb on jets to America. Or even to certain asian countries where transplanted organs are more readily available.

The tradeoffs are not simple or clearcut. Those who prais the US market driven system are just as foolish, because they neglect the fairness issue and the parisitism of a hospital milking the last savings out of a family desperate to keep grandpa alive for three more weeks. As I said, supply demand do not affect price in a market where people refuse to shop for “bargains.”

A compromise would have been in place by now, if Hillary Clinton had not ruined her husband’s presidency and invited in the era of the NEocons with her crazy, over-ambitious Health Care Bill. All she had to say was “We’ll start incrementally and insure all the children first.”

Americans are inherently far more socialistic re: kids than adults. It would have passed. Moreover the whole Euro logic WORKS BETTER when it comes to ensuring that all young people get an equal access to a good start in life.

Anonymous said...

Finally, an issue where a self proclaimed conservative can be somewhat to the left politically of Odin!
I am a primary care doctor, and a former HMO medical director, so you can assume that I have seen it all.
Consumer demands are the biggest driving force in the machine, abetted by politicians of both stripes who describe health care as a right, without defining any boundries. Actual medical progress is expensive, especially early on, but if you follow guidelines of evidence based medicine the sting is lessened considerably. Not everyone with a headache needs an MRI. Consider doing an exam and taking a history, you can generally tell which ones should have this.
I could go on at length, but here's one proposal. Regards pharmaceuticals. The government specifies what it will pay. This is for medicare, medicaid, fed, state, local employees etc. A big hunka the market. Cost of manufacture plus a reasonable 10% profit margain. What! Where is our motivation to develop the next great drug? An impartial jury of experts (Brin can help pick 'em) awards a bonus based on how valuable a new drug is. Find a cure for AIDS? Here's a billion. A new class of drug that is a modest improvement for many or a new option for "orphan diseases?" Here's 50 mill. Tack a methyl group onto an existing drug and remarket it? Here's two bits, don't spend it all in one place, champ.
Let's see somebody get to the left of this!
(had to keep the handle, look up some quotes from the real P. Cornelius Tacitus sometime)

Anonymous said...

Odin, you are not heeding the underlying agenda of the administration’s space policy, which is to eviscerate SCIENCE ITSELF at every opportunity. Especially science that may look at planet Earth and (e.g.) verify climate change.

It's true - my tin-foil hat may have a hole in it in this direction. Most of the cover-ups I'd seen were on the report end, and putting ideologues at NOAA (NOAA versus the Weather Channel - how strange a match-up is that?!?) and such.

The other part of the admin space policy is to try and appropriate everything to the military, especially with that Chinese satellite-killing test that just happened as one of their scare tactics. The latest policy stops just short of claiming the stars for America alone, and that does indeed scare me a little.

Moreover, I hate spending $ on “space transportaion” for another reason. It is nearly always wasted. There have been at least twenty “post shuttle” endeavors. None of them proved to be anything other than a way to siphon life blood away from the people and into the maws of parasites.

That's why I said that I support transportation in principle, while realizing that all this time of horrible management may be sufficient to tell NASA to just "forget it" and let a new generation take this problem on.

X-33 was a most egregious case of these failures, where NASA tried to nickel-and-dime its way out of paying full dev cost for a vehicle. Unfortunately for them, Lockheed doesn't really care about its mission - when asked to put in its own money to finish the prototype, it simply left a 70% complete vehicle to rot, since NASA had already paid in. At one level, though, I'm guessing the Skunkworks fellows are wishing the executive that killed their project to a deep circle of hell.

This may present a false choice, but at the end of the day, this space travel thing has to get easier. Further, a much more vigorous and dynamic space science can be made available by having more (i.e., any) of our resources positioned in space. Being there already would enable more incremental (and faster adaptation of the next mission) research programs.

This is also one place were I am happy to see the private sector fighting hard. These are the first level entrepeneurs, the guys that actually care about what they are doing, and struck out on their own because the parasitic corporates blocked their ambitions. Guys like Musk and Bezos could have retired on their wealth years ago, but want to fight for the future. Bully to them.

Let's see somebody get to the left of this!

Nationalize the entire health care system, including the pharma research houses. :)

Okay, seriously. I do believe that in a modern society, health care is in the same category as food, water, shelter.

Believe me, I really would like to see medicine practiced as medicine and not some accounting exercise from hell. Evidence-based medicine, strong preventives, yes! Totally, which is why everyone should be in the system at a basic level. Not seeing a doc for five years because you can't afford it is pretty much a guarantee of poor health later.

Anonymous said...

Sounds like a standard government run 'cost-plus' contract.
The good part about 'cost-plus' is that it's fast. No negotiations, no fuss. The bad part? Define "cost". As a military member, I've seen 'cost-plus' contracts that somehow included trips to Bermuda for a Admiral and his pretty female yoeman as part of the 'cost'... and the company was reimbursed for the cost, +10%... Most of it is not as blatant, of course. Buying donuts every day for the workers, new office furniture, lots of office supplies (amazing how much stuff gets bought under the government contract that has uses for the non-government contracts)...
Not that I'm against cost-plus contracting... but I want a auditor to be watching constantly, just to be sure we're not paying for trips to Switzerland for congresscritters and thier 'secretarys' plus 10%.

Anonymous said...

David, is Sergey Brin at Google a relative of yours by any chance?

Also, regarding p2p emergency communications: I've seen network reporters using satellite phones where no cell service is available. The satphones are about the size of a toaster with a big, honkin' antenna, but they work as long as there is a communications satellite up there. Could this be miniaturized? (What did Arthur C. Clarke have in mind when he proposed commsats?)

Anonymous said...

Some have called for privatization of space launches for NASA as a way to move toward cutting the costs of launch, and eventually having humanity begin exploiting space resources.

The problem is that it'd be a lousy business - NASA just doesn't have that many payloads to launch. Furthermore, getting to LEO isn't half-way to anywhere, in terms of difficulty and cost - it's more like 95% of the way to anywhere. So this approach requires private businesses to take on high investments for unreliable income. It just isn't going to happen any time soon.

But what if we inverted the privatization idea, in a sort of "Louisiana Purchase" approach to space? The government paid out a big chunk of money up front, and then incurred expenses of opening up that territory for settlement. But in the long run it paid off hugely.

Charge a NASA spin-off with providing a heavily subsidized launch-to-LEO service, and then have the government offer to buy services from commercial space operators for anything beyond LEO.

Some obvious commercial endeavors: LEO to GEO transfer for satellites; launching probes to Mars and other destinations; transporting missions to the moon - and eventually to Mars; delivering fuel to LEO and beyond for use in space; mining the moon for oxygen for rockets. Any of these might be an order of magnitude or two less costly than establishing a private launch-to-LEO service.

How much would this cost, beyond NASA's current budget? Apparently the marginal (non-fixed) cost to launch the shuttle is around $3000/kg to LEO (counting the shuttle itself) - about $300M. Supposing it's replacement does at least as well, and 5 launches are done each year, it'd cost under $1.5B/yr - about a 10% increase in NASA's budget. "Affordable" in government terms.

Furthermore, this eliminates the "either-or" choice of "transportation or science". Those that want to do space science would eventually be able to buy space on one of the frequent launches at the subsidized price, and hire commercial outfits to handle getting their mission to it's destination in space.

Finally, by leveraging private investment in space, we might see things like building a moonbase or even colonizing Mars greatly accelerated.