Monday, September 30, 2013

Politics and Memory Manipulation

Alison Winter has produced a fascinating book titled Memory: Fragments of a Modern History. She recounts a century of contention by two opposing views of human memory, and of society’s attempts to deal with the subsequent confusion. 

One school of thought believes that memory is capable of recording precise details of experiences and preserving them indefinitely even if the individual may not be able to access them.

Another school believes that memory is a complex physical process whose goal is not accuracy but functionality. Memory is used to support the response the individual is programmed to make to a given type of stimulus. In encountering a perplexing stimulus, an individual might alter a program to incorporate the event, create a new program to respond should it occur again, or simply discard the observation.

Winters does not actually come out in favor of one view or the other. Rather, she records a history in which the former view is continually discredited, and produces a description of memory as a construct that is highly malleable and easily manipulated.

Science also tells us that the human brain abhors uncertainty. Uncertainty implies indecision, and indecision has been dangerous for humans through most of their existence. Consequently, responses that have been firmly programmed can be difficult to change.

What do these considerations tell us about humans and politics? A person receiving new input that is inconsistent with an established political view can easily reject that input as incorrect. The converse will also be true. A person receiving false information that is consistent with an established political view is biased toward accepting that information as being true and incorporating it in memory.

Winter includes several examples to illustrate how easy it is to establish a false memory in an individual. She describes a simple experiment conducted by Elizabeth Loftus. Loftus was interested in assessing the accuracy of childhood memories that were supposedly "repressed" and only remembered many years later as an adult. Her experiment was designed to investigate the role suggestion might play in producing false childhood memories in adults.

The study included participants between the ages of eighteen and fifty-three. A relative of each subject participated in the project and provided a written description of four events that supposedly occurred in the subject’s childhood. Three were actual events, while the fourth was an invented account of the subject being lost in a mall.

The net result was that twenty-five percent of the subjects claimed to remember the mall event. The false information provided by the relative had an element of credibility due to its trusted source. It seems a little "truthiness" goes a long way.

With this experiment, Loftus demonstrated how easy it was to manipulate memory. Winter also described another experiment that brings memory manipulation into the political arena. This one was constructed by the online journal Slate.

"Slate altered several photographs in its files in dramatic ways, to create scenes that had never happened—for instance, it manufactured a picture of Barack Obama shaking hands with Iranian president Mahmoud Ahmadinejad. It mixed these fake photographs with real ones. Then Slate asked thousands of research subjects to describe their memories about each event. The false memory response rate ranged from 26 percent to 68 percent. When it revealed the hoax, Slate pointed to the power an entity like itself could wield if memory was so easily manipulated...."

The explanation for why planting false memories was so easy involved providing invented information that aligned with preexisting biases. They had to possess a bit of "truthiness."

"The scenes related to suspicions, prejudices, or imagined possibilities already present in some people’s minds, which Slate was about to ‘confirm’ into memories. Some of Loftus’s own work had suggested the same: she and colleagues had been able to show that memories for political events could be altered using doctored photographs. All of this implied not only memory’s changeability but its manipulability, on both an individual and a collective level."

If you have ever wondered how people can believe the lies that your political opponents are feeding them, wonder no more. It is a simple fact of human nature. A more important question for you to ponder might be: "What lies have I been fed?"

Thursday, September 26, 2013

High-Speed Rail: If You Build It They Will Come

High-speed rail (HSR) is viewed as an expensive boondoggle in the United States. This is in spite of the fact that HSR is now an established technology and systems have been built in much of the developed world. The French built the first European high-speed line in 1981. It has been expanding its high-speed-system ever since. HSR was immediately popular with the public and viewed by governments as economically beneficial. Why is the United States so different?

An example of the arguments made against HSR can be found in an article in the Washington Post by Robert J. Samuelson: High-speed rail is a fast track to government waste.

Samuelson tells us that his argument is based on history.

"Passenger rail service inspires wishful thinking. In 1970, when Congress created Amtrak to preserve intercity passenger trains, the idea was that the system would become profitable and self-sustaining after an initial infusion of federal money. This never happened. Amtrak has swallowed $35 billion in subsidies, and they're increasing by more than $1 billion annually."

"High-speed rail would transform Amtrak's small drain into a much larger drain. Once built, high-speed-rail systems would face a dilemma. To recoup initial capital costs - construction and train purchases - ticket prices would have to be set so high that few people would choose rail. But lower prices, even with favorable passenger loads, might not cover costs. Government would be stuck with huge subsidies. Even without recovering capital costs, high-speed-rail systems would probably run in the red. Most mass-transit systems, despite high ridership, routinely have deficits."

Yes, Amtrak fails to support itself on the revenue from the fares it charges. The expectation that Amtrak be self-supporting forces it to charge large fares and make itself less competitive with other modes and less able to modernize and compete for traffic.

But why in the world should Amtrak be expected to break even in revenue? Amtrak, like the railway systems in Europe, provides a needed service—a service without which societies and economies would suffer. The value of that service never shows up in Amtrak’s balance sheet. The benefits that accrue are secondary in nature and difficult to quantify, but the Europeans, the Japanese, and now the Chinese are capable of understanding this logic.

Samuelson complains that even highly utilized mass transit systems tend to require subsidies to operate. Has he ever tried to live in a city without a mass transit system? It is impossible. Even Los Angeles recognizes the need. Mass transit allows people to get to work and to go shopping throughout the city. Those simple functions alone justify subsidized transport priced at a level that will allow and encourage people to use it.

There are several arguments made in favor of HSR. An article in the New York Times provides an example of one that is based on secondary benefits. It discusses a report issued by the U.S. Conference of Mayors that looked at benefits that are expected to accrue to cities that serve as hubs for HSR traffic.

"The benefits of traveling between 110 and 220 miles per hour will mean better connectivity, shorter travel times and new development around train stations, according to the report. The changes will create 150,000 new jobs and some $19 billion in new businesses by 2035."

"The rail network will spur tourism, give businesses a wider pool of workers to choose from and help grow technology clusters in cities, said Steve Fitzroy, director of operations for the Economic Development Research Group, which conducted the study, during a phone interview."

Albany, New York is expected to become a rail hub one day.

"Albany, which is a political center in New York but not well-connected to the metropolitan area, will be pulled into New York City's economic core, said Fitzroy. A high-speed rail link connecting Albany to New York City, Syracuse and places as far off as Montreal have been proposed at various points by state legislators."

"If the network does goes up, the report states that it would create $2.5 billion in new business in Albany and would add 21,000 jobs. It would increase gross regional product, a measure of the size of the local economy, by $1.4 billion. The train station would spur development, with new additions, hotels and other mixed-use projects coming up in the area, said Fitzroy."

Some of that might sound like wishful thinking to doubters such as Samuelson. Fortunately, there is a recent example of HSR entering into operation that provides some support. An article by Keith Bradsher in the New York Times carries this catchy title: Speedy Trains Transform China.

"Just five years after China’s high-speed rail system opened, it is carrying nearly twice as many passengers each month as the country’s domestic airline industry. With traffic growing 28 percent a year for the last several years, China’s high-speed rail network will handle more passengers by early next year than the 54 million people a month who board domestic flights in the United States."

"Li Xiaohung, a shoe factory worker, rides the 430-mile route from Guangzhou home to Changsha once a month to visit her daughter. Ms. Li used to see her daughter just once a year because the trip took a full day. Now she comes back in 2 hours 19 minutes."

"Business executives like Zhen Qinan, a founder of the stock market in coastal Shenzhen, ride bullet trains to meetings all over China to avoid airport delays. The trains hurtle along at 186 miles an hour and are smooth, well-lighted, comfortable and almost invariably punctual, if not early. ‘I did not think it would change so quickly. High-speed trains seemed like a strange thing, but now it’s just part of our lives,’ Mr. Zhen said."

China purposely maintained HSR fares low enough to encourage people to use the system. It seems they are capable of understanding the importance of secondary benefits from a public service.

"Chinese workers are now more productive. A paper for the World Bank by three consultants this year found that Chinese cities connected to the high-speed rail network, as more than 100 are already, are likely to experience broad growth in worker productivity. The productivity gains occur when companies find themselves within a couple of hours’ train ride of tens of millions of potential customers, employees and rivals."

"’What we see very clearly is a change in the way a lot of companies are doing business,’ said Gerald Ollivier, a World Bank senior transport specialist in Beijing."

"Companies are opening research and development centers in more glamorous cities like Beijing and Shenzhen with abundant supplies of young, highly educated workers, and having them take frequent day trips to factories in cities with lower wages and land costs, like Tianjin and Changsha. Businesses are also customizing their products more through frequent meetings with clients in other cities, part of a broader move up the ladder toward higher value-added products."

These changes taking place in China look a lot like those anticipated by the writers of the report issued by the U.S. Conference of Mayors.

California seems to be the only state willing to put up its own money to initiate an HSR system. It provides a rather compelling explanation for why such a move was necessary. Steve Falk elaborates on California’s transportation needs and why HSR is the best option for meeting them.

"Over the next two decades, California’s population will grow by more than 10 million people....By the year 2050, the state’s population is expected to reach 60 million people. California’s current transportation infrastructure simply cannot accommodate this level of growth. Doing nothing is simply not an option. Major investments are needed to serve the future of our state."

"Building high-speed rail will not be cheap. The revised business plan puts the total construction cost for the 800-mile-long project at $98.1 billion spread over 20 years. That’s a big number that is bound to leave some amount of sticker shock. But this cost must be measured against the second alternative, creating the equivalent capacity within our existing transportation infrastructure."

"To achieve the same level of mobility delivered by the high-speed rail system, the state would need to add 2,300 miles of new highways, 115 new airport gates and four new runways — all at a combined cost of $170 billion. That’s $71 billion more than building high-speed rail."

Yes costs are high, but let’s at least try to consider all costs—and all benefits.

Monday, September 23, 2013

Parenting: The Importance of Reading to Young Children

PISA (Program for International Student Assessment) is an outfit sponsored by the Organization for Economic Cooperation and Development (OECD). PISA provides comparative testing between nations every three years in math, reading, and science proficiency for fifteen-year-olds. It is this PISA test that is referred to when people claim that the students of the United States are merely average (mediocre, if you prefer) compared to the rest of the developed world.

PISA decided to add a survey for the parents of the students taking their test. This questionnaire would assess various parenting approaches and look for correlations between student performance and parental performance. The United States chose not to participate, but fourteen other countries did. The results are discussed here.

"The questionnaire was distributed in Denmark, Germany, Hungary, Italy, Korea, New Zealand and Portugal (which are OECD member countries) and in Croatia, Hong Kong-China, Lithuania, Macao-China, Panama and Qatar (which are not members of the OECD)"

Reading comprehension is the basis for education, both while in school and in later life. It is critical that children get off to a good start. Perversely, our education system is designed to exacerbate differences in performance in children, accelerating those most ready to proceed, and allowing the laggards to lag behind. According to PISA, there are a few rather simple things we can do to prepare our children for school. The most import thing is to read to our children in their preschool years.

" far the strongest relationship is between reading to a child during his/her early years and better reading performance when the child is 15. PISA found that....students whose parents read books to them as they entered primary school are more likely to have higher reading scores at age 15. The relationship is particularly strong in New Zealand and Germany, where students whose parents read to them in their early school years show higher scores on the PISA reading test – by 63 and 51 points, respectively – than students whose parents had not read to them. To put that in perspective, in PISA, 39 score points is the equivalent of one school year. That means that 15-year-olds whose parents had read to them when they were just starting school read at least as well as their peers one grade above them."

The differences persisted even when students and parents with similar socio-economic backgrounds were compared.

"But PISA results show that even among families with similar socio-economic backgrounds, reading books to young children is still strongly related to better performance when those children reach the age of 15. This association is particularly strong in New Zealand, where there was a 44-point difference in reading scores between those students whose parents read to them regularly when they were younger and those whose parents didn’t, Germany, where the difference was 29 points, and Qatar (27 points)."

If you intend to play word games with your children, you are advised to focus on stories, poems and songs, as opposed to alphabet games.

"PISA also found that parent-child activities that involve putting words into broader contexts, such as telling stories or singing songs, as compared with activities that isolate letters or words, such as playing with alphabet toys, help to instill an enjoyment of reading in children."

Maryanne Wolf provides an elegant explanation for why reading stories to children is helpful in developing reading skills in her book Proust and the Squid: The Story and Science of the Reading Brain. Children are not born with any pre-wired reading skills. They have to be developed from existing sensory capabilities. Eventually they have to rewire their brain so that the recognition of sequences of letters as words is done subconsciously. This allows the proficient reader to concentrate on the meaning of the pattern of the words rather than on interpreting the individual words. This takes time and a lot of effort. She provides this perspective:

"....although it took our species roughly 2,000 years to make the cognitive breakthroughs necessary to learn to read with an alphabet, today our children have to reach those same insights about print in about 2,000 days."

PISA provides some additional suggestions of things parents can do that seem to help children perform as readers. One is to just spend time talking to your children about things in general; show interest in what they are reading or thinking.

"In general, 15-year-olds whose parents show an active interest in their lives and thoughts are more proficient in reading. As with parent-child activities when children are very young, some types of parental engagement with older children are more strongly associated with better reading proficiency than others. For example, talking with 15-year-olds is more beneficial than going to the library or to a bookstore with them. Students seem to benefit particularly from discussions with their parents about political or social issues."

Parents can also set a good example by demonstrating that reading can be a pleasant pastime.

"Children whose parents are more inclined to read and hold positive attitudes towards reading are better at reading than children whose parents do not share those positive attitudes. In all countries and economies assessed, the children whose parents do not think reading is a waste of time or who spend more time reading at home for enjoyment have significantly higher scores in reading."

Children are complex creatures and raising one from an infant to an adult can be a harrowing experience. Parents must wade through all sorts of often contradictory advice on how to deal with their young child. It is refreshing to come across information on how parents can do something beneficial that requires no complex thought, and is actually fun. The only training required is that you must be able to read a children’s book.

Thursday, September 19, 2013

PTSD and Memory

Nic DeNinno spent fourteen months in combat in Iraq. He returned home to what he hoped would be a normal life. For a time things went well, but then he began to have nightmares and flashbacks. The Army diagnosed him as suffering from posttraumatic stress disorder (PTSD). David Finkel provides a moving account of DeNinno’s struggles in an article in The New Yorker: The Return.

DeNinno received what was apparently a standard form of treatment. He was provided anxiety suppressants and anti-depressants, but they seemed ineffective. Counseling was provided as well. When his behavior became erratic and potentially dangerous to himself and others he was sent off to a residential treatment center for a 28-day stint. He and others would receive group therapy and counseling. The main emphasis of the treatment would be to encourage "habituation."

Habituation is based on the notion that the more often one can review a traumatic memory the less the emotional impact will be from recall. One becomes used to the memory and its effect diminishes and eventually can be dealt with.

Finkel had detailed discussions with DeNinno about his memories and dreams, and described the issues others are having by letting the reader sit in on one of these habituation sessions. The trauma that bedevils these soldiers seems to be associated more with guilt than with terror or shock. In the bizarre environment of occupied Iraq, they were compelled to take actions, and justify those actions to themselves with logic that allowed them to carry on, but provided no justification now that they had returned to their home environments.

DeNinno repeatedly refers to himself and his dreams with the term "monster." He has difficulty relating what happens in his dreams and what happened in Iraq to his wife. He is afraid that she will hate him if she knows.

"’I’m afraid to tell her stuff,’ Nic said, breaking down. ‘I don’t want to tell her about the dreams I have. I don’t want to tell her about the nightmares I have. I don’t want her to know that her husband, the person she married, has nightmares about killing people. It just makes me feel like a monster’."

The use of habituation as treatment for people like DeNinno is based on a particular view of what human memory is and what it is used for. This view of the function of memory can by no means be assumed to be correct.

Alison Winter has produced a fascinating book detailing how the different theories about memory have struggled for dominance and affected society over the past century: Memory: Fragments of a Modern History.

Winter provides a history of contention between those who believe that memory is capable of faithfully recording every experience encountered, and those who believe that memory is a tool the brain uses to help it make sense out of situations encountered. According to the latter theory, it was never intended to be "photographic" in detail or accuracy. Indeed, accuracy is not even necessary for memory to serve its purpose. Winters tells the reader that these two radically different views are still dominating the discussion of memory today.

"From about 1940, forensic experts, military psychiatrists and administrators, clinical psychologists, filmmakers, and others were increasingly portraying memories as stable, permanent entities that could be ‘revived’ (if they were inaccessible) and in some cases even re-experienced given the requisite techniques. This became a foundation for the treatment of psychiatric casualties during World War II....and a widely accepted way of thinking about autobiographical memory in general."

These beliefs have been carried forward and applied to PTSD via habituation treatment.

"One of the most tenacious themes of twentieth-century memory research was the idea that people tormented by memories of terrible experiences could benefit from remembering them better. The assumption—broadly indebted to psychoanalysis—was that psychological records of traumatic events often failed to be fully ‘integrated’ into conscious memories. As long as these records remained ‘dissociated,’ the sufferer was compelled to ‘relive’ them instead of benignly remembering them. The more fully and appropriately one remembered terrible events, the more attenuated would be their emotional power."

The history Winter recounts provides little support for the notion of memory as an accurate recorder of the past. Instead, data indicates that memory is a poor observer of events and that it is easily misled by individual biases and expectations. It is also relatively easy to plant false memories in subjects and induce them to believe them to be true. Research has shown that people who claim to remember an event "as if it had just happened" will have unknowingly altered or embellished their recollections over time.

Winter attributes a theory of memory more consistent with research to Frederic Bartlett an Englishman who worked in the early twentieth century.

"Bartlett has come to stand for a kind of claim about memory that has become commonplace among academic psychologists: that memories have a constructive or reconstructive character. We do not merely forget information over time, we ‘reconstruct’ the content of our memories by adding to or otherwise altering them."

Bartlett believed memory was a support function for frameworks that the brain (mostly subconsciously) derived to help decide how to respond to a given stimulus. All new perceptions were compared and graded against an established framework and either used to modify that framework, or were disposed of.

"Bartlett believed that consciousness was unusual in most mental processes, but he retained the idea that all new information must be placed in the context of a well-organized existing framework in the mind. When material would not fit easily into that framework, either the framework would change or, if no accommodation could be made, material would be discarded."

A simple thought experiment adds credence to this view. Consider a Republican and a Democrat listening to a speech describing the Affordable Care Act (Obamacare). Then ask each what they had learned from the speech. Every comment they heard would be passed through a partisan filter and some of what survived may have been committed to memory.

Given this view of memory, what might one conclude about PTSD and the problems of Nic DeNinno?

It is reasonable to postulate that constant dwelling on the offending memory might be counterproductive. Given that memory is malleable and reconstructive, there is no reason why each reenactment isn’t subtly modulated to obtain some effect the subconscious brain desires. The net effect could be to make the emotional response more powerful.

The notion that a memory unused decays also suggests that in some cases simply avoidance is the best strategy.

"This new approach asserts something more along the lines of ‘out of consciousness, out of mind.’ It follows suggestions....that the more often a memory is recollected and described, the more vivid it becomes. This raises the question whether merely trying not to think about a particular memory could weaken it—something the old psychoanalytic paradigm would have rejected. Michael Anderson and John Gabrieli, psychology professors at the University of Oregon and Stanford, claim to have found support for this idea. When their test subjects avoided a specific memory it became weaker....It was also part of a new account of PTSD. It proposed that PTSD worsens as you think about it, because each time you recall the painful events, the stress hormones that accompanied the painful memory are triggered and intensify that memory, making the emotions more vivid the next time it is recalled."

It is disturbing that those who study memory can look at the same world and arrive at two opposite conclusions. But it should not be surprising; voters do it, politicians do it, economists do it, why not psychologists? The very fact that individuals are using perception and memory in biased ways to support existing mental frameworks should be proof that Bartlett was correct. This puts the notion of "rational deliberation" in doubt.

One is also troubled by the imposition of any "one-size-fits-all" solution to PTSD. It is likely that both approaches, habituation and its opposite, might be appropriate for different individuals. Dwelling on a memory might make sense when the emotion aroused is fear; it might make no sense when the emotion aroused is guilt.

Iraq and Afghanistan did not provide soldiers with the same set of experiences as World War II.  Joshua Phillips provided a look into what it was like for soldiers trained for combat to spend months enmeshed in a civilian population in which friendlies and enemies were indistinguishable.  His book is titled None of Us Were Like This Before: American Soldiers and Torture.  Phillips was concerned with the reasons soldiers resorted to rough tactics, including what most would classify as torture.  It is a tale we all should read.  What is of concern here is the effect of that behavior on the soldiers.  The trauma for many was guilt for the deeds they had performed that were so inconsistent with who they were before combat, and so inconsistent with who they wanted to be when they returned home.  What the soldiers Phillips interacted with described is eerily similar to the story DeNinno told Finkel.  Phillips also included these results from a study of PTSD in veterans of Vietnam.
"The researchers found a strong correlation between increased exposure to combat and psychological trauma. But the report also found that ‘abusive violence had the strongest correlation with PTSD’ for Vietnam veterans. This abusive violence included, but wasn’t exclusive to, the ‘degree of involvement in torturing, wounding, or killing hostages or POWs.’"

"’We can go into long philosophical discussions of torture....but the one thing the research has shown is that it is not good for the people doing it,’ said Dr. Richard Kulka, the chief author of the study."
The point is not to accuse anyone of torture.  The point is that harming others, in any way, can induce feelings of guilt.  Guilt can be a strong, all consuming emotion.  Habituation just doesn't seem appropriate.

 It is difficult to be optimistic about PTSD treatment—or just about anything else to be honest.

Sunday, September 15, 2013

The Jellyfish Are On the Move: Apocalypse Soon

Once in a very great while one encounters an article that is so startling, so fascinating, and so scary that it is necessary to go back over it to make sure that someone isn’t playing a joke. I encountered such a piece in the New York Review of Books by Tim Flannery: They’re Taking Over! Who is the "they?" Jellyfish!

The story Flannery tells is extracted from a book by Lisa-ann Gershwin: Stung! On Jellyfish Blooms and the Future of the Ocean. Gershwin has spent a good portion of her life studying jellyfish.

Jellyfish are perhaps the oldest species of marine animal. They are thought to predate the Cambrian era when nature went wild experimenting with new types of creatures. Given half a billion years of evolution, they exist in many different forms and they have learned how to survive in much more hostile environments than exist today. The theme of Gershwin’s book is that as we upset the delicate balance in the marine ecosystem by overfishing, polluting, and changing the chemistry of the oceans, we are creating an environment where jellyfish can thrive at the expense of other species.

By eliminating or diminishing jellyfish predators, lowering the oxygen level, and raising the acidity level in our oceans, we are creating conditions that are difficult for many species, but leave jellyfish relatively unaffected. Flannery includes this quote from the book:

"We are creating a world more like the late Precambrian than the late 1800s—a world where jellyfish ruled the seas and organisms with shells didn’t exist. We are creating a world where we humans may soon be unable to survive, or want to."

Shellfish seem to have a dim future. Acidity rises as more carbon dioxide is absorbed into the water.

"Already our oceans are 30 percent more acidic than they were thirty years ago, and creatures with shells are suffering. In recent years, there has been mass failure of oyster spawning off the American Northwest, and tiny snails in the Arctic and Antarctic oceans are having their shells eaten away by the acid. Jellyfish lack hard parts: they, it seems, will pull through the acidification crisis admirably."

Jellyfish are also designed to survive in the oxygen-poor environment we are creating in our oceans.

"Jellyfish are almost ubiquitous in the oceans. As survivors of an earlier, less hospitable world, they can flourish where few other species can venture. Their low metabolic rate, and thus low oxygen requirement, allows them to thrive in waters that would suffocate other marine creatures. Some jellyfish can even absorb oxygen into their bells, allowing them to "dive" into oxygen-less waters like a diver with scuba gear and forage there for up to two hours."

Jellyfish unleashed make a formidable foe. The box jellyfish, native to the waters around Australia, is referred to as the "most venomous creature on earth."

"Box jellyfish have bells (the disc-shaped "head") around a foot across, behind which trail up to 550 feet of tentacles. It’s the tentacles that contain the stinging cells, and if just six yards of tentacle contact your skin, you have, on average, four minutes to live—though you might die in just two."

"Most jellyfish are little more than gelatinous bags containing digestive organs and gonads, drifting at the whim of the current. But box jellyfish are different. They are active hunters of medium-sized fish and crustaceans, and can move at up to twenty-one feet per minute. They are also the only jellyfish with eyes that are quite sophisticated, containing retinas, corneas, and lenses. And they have brains, which are capable of learning, memory, and guiding complex behaviors."

And then there is the nasty little jellyfish known as Irukandi, an Aboriginal word.

"The Irukandjis are diminutive relatives of the box jellies. First described in 1967, most of the dozen known species are peanut- to thumb-sized. The name comes from a North Queensland Aboriginal language, the speakers of which have known for millennia how deadly these minuscule beings can be."

"It’s now known that the brush of a single tentacle is enough to induce "Irukandji syndrome." It sets in twenty to thirty minutes after a sting so minor it leaves no mark, and is often not even felt. Pain is initially focused in the lower back. Soon the entire lumbar region is gripped by debilitating cramps and pounding pain—as if someone is taking a baseball bat to your kidneys. Then comes the nausea and vomiting, which continues every minute or so for around twelve hours. Shooting spasms grip the arms and legs, blood pressure escalates, breathing becomes difficult, and the skin begins to creep, as if worms are burrowing through it. Victims are often gripped with a sense of "impending doom" and in their despair beg their doctors to put them out of their misery."

Jellyfish really are on the move—including Irukandi.

"....Irukandji have recently been detected in coastal waters from Cape Town to Florida."

What makes jellyfish a worldwide problem is their efficiency in reproduction. Consider the specimen known as Mnemiopsis.

"One of the fastest breeders of all is Mnemiopsis. Biologists characterize it as a ‘self-fertilizing simultaneous hermaphrodite,’ which means that it doesn’t need a partner to reproduce, nor does it need to switch from one sex to the other, but can be both sexes at once. It begins laying eggs when just thirteen days old, and is soon laying 10,000 per day. Even cutting these prolific breeders into pieces doesn’t slow them down. If quartered, the bits will regenerate and resume normal life as whole adults in two to three days."

Jellyfish eggs hatch as polyps that attach themselves to hard surfaces. These polyps then proceed to produce a stream of jellyfish.

"As they grow, the polyps develop into a stack of small jellyfish growing atop each other that look rather like a stack of coins. When conditions are right, each "coin" or small jellyfish detaches and swims free. In a few days or weeks, a jellyfish bloom is observed."

Jellyfish do not make good neighbors. They are voracious eaters with apparently unlimited appetite.

"Mnemiopsis is able to eat over ten times its own body weight in food, and to double in size, each day. They can do this because they are, metabolically speaking, tremendously efficient, being able to put more of the energy they ingest toward growth than the more complex creatures they compete with. And they can be wasteful. Mnemiopsis acts like a fox in a henhouse. After they gorge themselves, they continue to collect and kill prey. As far as the ecosystem goes, the result is the same whether the jellyfish digest the food or not: they go on killing until there is nothing left. That can happen quickly."

For those who are not yet worried about the effects of uncontrolled jellyfish population growth, consider what occurred when Mnemiopsis infiltrated the Black Sea.

"Would you believe, Gershwin asks, that ‘a mucosy little jellyfish, barely bigger than a chicken egg, with no brain, no backbone, and no eyes, could cripple three national economies and wipe out an entire ecosystem’? That’s just what happened when the Mnemiopsis jellyfish (a kind of comb jelly) invaded the Black Sea. The creatures arrived from the east coast of the US in seawater ballast (seawater a ship takes into its hold once it has discharged its cargo to retain its stability), and by the 1980s they were taking over. Prior to their arrival, Bulgaria, Romania, and Georgia had robust fisheries, with anchovies and sturgeon being important resources. As the jellyfish increased, the anchovies and other valuable fish vanished, and along with them went the sturgeon, the long-beloved source of blini toppings."

"By 2002 the total weight of Mnemiopsis in the Black Sea had grown so prodigiously that it was estimated to be ten times greater than the weight of all fish caught throughout the entire world in a year. The Black Sea had become effectively jellified."

If jellyfish can destroy that ecosystem, they can destroy others. The term "jellification" is not as bizarre as it sounds.

"Even sober scientists are now talking of the jellification of the oceans. And the term is more than a mere turn of phrase. Off southern Africa, jellyfish have become so abundant that they have formed a sort of curtain of death, ‘a stingy-slimy killing field,’ as Gershwin puts it, that covers over 30,000 square miles. The curtain is formed of jelly extruded by the creatures, and it includes stinging cells. The region once supported a fabulously rich fishery yielding a million tons annually of fish, mainly anchovies. In 2006 the total fish biomass was estimated at just 3.9 million tons, while the jellyfish biomass was 13 million tons."

Gershwin believes we have passed some point of no return with respect to our oceans. They will evolve to an unknown, but definitely undesirable state. Flannery provides her final thoughts.

"When I began writing this book,… I had a naive gut feeling that all was still salvageable…. But I think I underestimated how severely we have damaged our oceans and their inhabitants. I now think that we have pushed them too far, past some mysterious tipping point that came and went without fanfare, with no red circle on the calendar and without us knowing the precise moment it all became irreversible. I now sincerely believe that it is only a matter of time before the oceans as we know them and need them to be become very different places indeed. No coral reefs teeming with life. No more mighty whales or wobbling penguins. No lobsters or oysters. Sushi without fish."

Her advice to humanity:


All of this may seem a bit overwrought. However, in the grand sweep of the earth’s history it has often become a rather hostile place for life. There have been several instances that have risen to the category of "mass extinctions." The most severe episode occurred about 250 million years ago and earned itself the title "The Great Dying."

"’The Great Dying was the biggest of all the mass extinctions,’ said study researcher Darcy Ogden of the Scripps Institution of Oceanography in San Diego. ‘Estimates suggest up to 96 percent of all marine species and 70 percent of all land species were lost’."

Who knows? Perhaps what we are facing is the second edition of "the revenge of the jellyfish."

It is good to encounter articles like this occasionally. They give one something to worry about when they grow weary of worrying about the economy.

Friday, September 13, 2013

The Welfare Trap

Establishing an appropriate social safety net to provide for those who are in need is a complex problem. The issue is also affected by societal attitudes. If a nation believes that most people wish to work and few would take advantage of a welfare system then the problem can be simplified by providing everyone with a guarantee of an income sufficient for survival. If a nation believes that choosing to live on welfare is a moral affront that must not be allowed, then complex means tests and conditions must be imposed in order to make sure that everyone is at least trying to work and not taking advantage of the system. In both cases the level of benefits available can disincentivize seeking a job on the part of the welfare recipient if the benefits are sufficiently generous.

An interesting article in The Economist addresses some of these issues as they apply to the United States, a country determined to avoid excess generosity. In fact, conservatives are once again attacking the current system as being too comfortable for the nonworking. The author of the article points out that it is difficult to either support or dispute this claim because the system is so complex.

"Measuring the benefits that flesh-and-blood Americans actually receive is difficult because the system is unbelievably complex. Cato [Institute] counts 126 separate federal anti-poverty programmes, including 72 that provide "cash or in-kind benefits to individuals". The states have many more."

It seems some sort of counseling must be required for a poor person to navigate such a system. It is conceivable that there are ways to game the system, but probably more ways to miss out on potential benefits with so many programs available.

One characteristic of welfare benefits in this type of system is that they are means tested on the basis of income. As a recipient’s income rises, benefits are withdrawn. This is a crucial part of any functional approach. If benefits are too lavish as income rises, there might be little incentive to take a low paying job instead of continuing to live off of welfare payments. If the benefits are withdrawn too quickly, a person could see little benefit to accepting work and might even be worse off, considering the new costs associated with working outside the home.

The Congressional Budget Office (CBO) found an excellent means of illustrating this issue. It tracked the manner in which benefits would change for a single mother with one child in a typical state (Pennsylvania) as her income increased. The CBO chose to represent this progression as an equivalent marginal tax rate.

The mother is, in effect, treading water economically as her income rises because the withdrawal of benefits consumes most of the increase in income as the equivalent marginal tax rates go as high as 95%. A welfare recipient who only has work available at or near the minimum wage of $7.25 will see little if any benefit from working.

"If the prospect of keeping only five cents of each extra dollar earned does not discourage work, it is hard to imagine what might. And the CBO’s calculation does not include Medicaid and several other means-tested benefits."

One should recall all the arguments about multimillionaires being disincentivized by that "outrageous" 40% marginal tax rate.

The real issue for both conservatives and liberals is having a path whereby people receiving benefits can obtain paying work that will allow them to survive without government benefits. The current system does not do that well. How might this approach be improved?

Given the existing complexity, and the difficulty in getting even common sense laws passed, it is not clear that there is a path forward from within the welfare system itself. Arguments over program details and benefit levels could go on indefinitely.

A more fundamental issue seems to be the mismatch between the income required to escape poverty, and the income available from minimum wage jobs. The best way to create an incentive for people to seek work as an alternative to welfare is by making work financially advantageous.

If the major path for exiting welfare is to assume a job at or near the minimum wage of $7.25, it feels to a welfare recipient as if they are working for free. The problem is not that benefits might be too high; it is that wages are too low.

Those who argue that the minimum wage should be raised are correct. A value in the $12-15 range could produce a much better economy, a much more stable workforce, and eliminate a lot of welfare expenses.

Let’s go for it!

Tuesday, September 10, 2013

Producing Teachers: Finland vs. United States

Amanda Ripley has written a wonderfully insightful book on education: The Smartest Kids in the World: And how They Got That Way. Ripley was concerned with the fact that kids from the US seemed to be locked into what might best be called mediocre performance levels on international tests of academic competence. She became aware that a number of countries had produced remarkable improvements in their students’ performance in a rather short period of time. If they could do that, why couldn’t the US?

Ripley was determined to discover what other countries had done in order to compare their approaches with what is happening in US education. She chose to attack the problem by tracking three exchange students who would compare their experiences in the schools of Finland, South Korea, and Poland with what they had encountered in their home high schools.

Ripley’s book contains a number of intriguing conclusions and suggestions about how education can be made better in this country. Here we will focus on what she learned from examining Finland and its dramatic improvement in educational performance.

We are shown Finnish education mainly through the experiences of a young high school student from Oklahoma named Kim. It is instructive to compare the educational background of the Finnish language teacher (Stara) that Kim encounters with one of her teachers (math: Scott) from back home in Oklahoma. While the focus on teacher education in Finland is well known among educators in this country, few bother to make the comparison that Ripley does, and few dare come to the same conclusion as her.

"Like Kim’s math teacher back in Oklahoma, Stara was a veteran teacher, approaching two decades in the profession. Both teachers had jobs that were protected by powerful unions, and neither could easily be dismissed. This pattern held true in most developed countries around the world. Teachers’ unions held a lot of power, and teachers rarely got fired anywhere."

In well performing countries and bad, teachers had considerable job security. That was not what differentiated the good from the bad.

We in the US let almost anyone become a teacher and once they become established we begin to grade them and demand that they be an excellent teacher. Finland had discarded this approach long ago and replaced it with one that actually made sense. Why not allow only the best students to study to become teachers, provide them rigorous education and training, and demand from them excellence before becoming teachers?

Stara wanted to become a Finnish language teacher. She knew early on that attaining that goal would require a lot of hard work.

"At the time, all of Finland’s teacher-training colleges had similarly high standards, making them about as selective as Georgetown or the University of California, Berkeley in the United States. Today, Finland’s education programs are even more selective, on the order of MIT."

Finland’s teachers embark on a rigorous six-year plan of study that is equivalent to attaining a master’s degree. This master’s required the equivalent of a degree in the subject to be taught plus extensive practice teaching, and evidence of the capability to do original research in their field of study.

"....Stara spent the first three years studying Finnish literature. She read intensely and wrote multiple twenty-page papers. She analyzed novels, poems, and short stories—something English trainee teachers do not generally do in the United States. At the same time she took other required courses, including statistics. In the fourth year....she began the teacher training program."

"For one full year of her master’s program, Stara got to train in one of the best public schools in the country. She had three teacher mentors there, and she watched their classes closely. When she taught her own classes, her mentors and fellow student teachers took notes. Afterward, she got feedback, some of it harsh, in much the way medical residents are critiqued in teaching hospitals."

"Like all Finnish teachers, Stara also had to do original research to get her degree, so she wrote a two-hundred-page thesis on the ways that teenagers’ spoken Finnish shaped their written Finnish."

Ripley compares the teaching profession in Finland to the medical profession in the US. This comparison is critical. In the US, teaching is an occupation. In Finland it is a profession with imposed standards. In a profession one must demonstrate competence before being accepted in, not afterwards. By undergoing education and training that is recognized as being rigorous, doctors and Finnish teachers show up for their first assignment already having earned the respect of patients or students.

"Getting into a teacher training program there [Finland] was as prestigious as getting into medical school in the United States."

Just as no brain surgeon would ever be told that this year he would have to switch to heart surgery, no person who teaches the Finnish language would be asked to switch to math. Each discipline is recognized as requiring a demonstrated expertise.

Contrast Stara’s path with that of Kim’s math teacher in Oklahoma.

"He’d decided to become a teacher mostly so that he could become a football coach. In America this made sense."

"....he’d always been pretty good at math. So he figured the best way to become a coach was to become a math teacher. [He] was one of several coaches that Kim had as teachers over the years, a hybrid job that would be considered bizarre in Finland and many other countries where sports lay beyond the central mission of schools."

"In Oklahoma alone, [he] could choose from nearly two dozen teacher training programs—almost three times as many as in all of Finland, a much bigger place. Oklahoma, like most states, educated far more teachers than it needed. At most U.S. colleges, education was known as one of the easiest majors. Education departments usually welcomed almost anyone who claimed to like children. Once students got there, they were rewarded with high grades and relatively easy work. Instead of taking the more rigorous mathematics classes offered to other students, for example, education majors tended to take special math classes designed for students who did not like math."

Kim’s math teacher attended a respected school that produced more teacher graduates than any other institution in the state.

"However, it also has a 75 percent acceptance rate, which means that it admits, on average, students with much weaker math, reading, and science skills than Finnish education schools. The university’s typical ACT score is lower than the national average for ACT-takers—a pattern that holds true for many teacher-training programs all over America."

When he applied to enter an education degree program in his sophomore year, he

"....had to have a grade-point average of just 2.5 or higher (out of 4)....To be a teacher, he also had to have at least a C grade in freshman English and a C in speech or a class called the fundamentals of oral communication"

A score of at least 19 on the ACT test was also required at a time when the national average was 20.6. This was, in effect, announcing that teachers didn’t have to have been very interested in their own education, or even be very smart in order to be given responsibility for teaching our children.

A master’s degree is not required of teachers in the US, but a bump in salary is often available for those who have one.

"But since the typical education college had low standards and little rigor, an advanced degree did not mean much. In many states, teachers were not required to get degrees in their subject area, so they got a master’s in teaching instead. A master’s degree did not make American teachers better at their jobs, generally speaking, and some research suggested it made them worse."

Ripley adds this opinion of the current state of affairs.

"The combination of low standards and high supply plagued education systems around the world, dumbing down the entire teaching profession."

Finland now scores near the top on the international tests, much higher than the US. However, it once had a system like that of the US and much lower performance.

"Interestingly, Finland’s landscape used to be littered with small teaching colleges of varying quality, just like the United States."

"In the 1970s, Finnish teachers had to keep diaries recording what they taught each hour. National school inspectors made regular visits to make sure teachers were following an exhaustive, seven-hundred-page centralized curriculum. Central authorities approved textbooks. Teachers could not be trusted to make their own decisions."

The Finns realized that if they were ever to get to a stage where they could compete in the modern, globalized world they would have to get there via education. They made the bold decision to upgrade their system by providing their students with the best teachers in the world. This involved consolidating teacher education in their major universities so that it would be treated like any other academic discipline. The eventual result was the highly selective, rigorous process that Stara endured before entering the teaching profession.

Once the Finns upgraded their teacher education approach they discovered that the education system worked better if they allowed these highly qualified teachers a great degree of autonomy. Teachers and schools were free to create their own lesson plans and to experiment with different approaches.

"Finland’s top-down, No-Child-Left-Behind-style mandates became unnecessary. More than that, they were a burden, preventing teachers and schools from reaching a higher level of excellence."

"The government abolished school inspections. It didn’t need them anymore."

Providing excellent teachers is a necessary step in upgrading a school system, but it is only one step. Ripley describes the No Child Left Behind and Race to the Top efforts in our country as attempts to keep children from falling below some floor in achievement. She explains that the schools that successfully turned around their educational systems did it by trying to "raise the ceiling."

Teachers can teach, but it is the students who must do the learning. Children, parents, industry, and government must all buy into the notion that education is important—critically so. That is what happened in Finland, South Korea, and Poland. Each at one point felt in economic peril and each decided that education would provide the solution to their difficulties. Their children now show up at school not only ready to learn, but determined to learn.

Upgrading our teacher education process would be a necessary first step for us as well. Unfortunately, our problems are much deeper and more insidious.

Saturday, September 7, 2013

Race, Discrimination, and Illegal Drug Policies

William J. Stuntz was a distinguished professor of law at Harvard University. Just prior to his death he assembled a book describing the failings of our justice system: The Collapse of American Criminal Justice. His description of the defects in our legal processes is both fascinating and frightening. One of the topics Stuntz focused on was the rise of legal discrimination against blacks.

"....discrimination against both black suspects and black crime victims grew steadily worse—oddly, in an age of rising legal protection for civil rights. Today, black drug offenders are punished in great numbers, even as white drug offenders are usually ignored. (As is usually the case with respect to American crime statistics, Latinos fall in between, but generally closer to the white population than the black one.) At the same time, blacks victimized by violent felonies regularly see violence go unpunished; the story is different in most white neighborhoods."

Stuntz tells us that there are roughly 30 million users of illegal drugs in our country; far more than all the prisons conceivably could hold and far more than the number of law enforcement personnel who might apprehend them. In such a situation, one should be asking whether or not we are writing some really dumb laws.

Stuntz is more concerned with the fact that laws that define a large fraction of the population to be criminals invite—necessitate—discrimination in enforcement.

"Discretion and discrimination travel together. Ten percent of black adults use illegal drugs; 9 percent of white adults and 8 percent of Latinos do so. Blacks are nine times more likely than whites and nearly three times more likely than Latinos to serve prison sentences for drug crimes."

Is this bias in law enforcement due to racism? Carl Hart tells us that our drug laws have been informed not by scientific data but by false, racially-motivated stereotyping. Michelle Alexander claims that the large and preferential incarceration of blacks is part of a "new Jim Crow" system formulated to maintain second-class citizenship for blacks. Conviction of a felony can lead to prison as well as the rescinding of the right to vote and limited access to a number of government programs.

Alexander makes a compelling "circumstantial" case for her contention. If a system actually is racially biased, and it has as an end product a large number of black people who have been deprived of the normal rights of citizenship, then isn’t it a new form of Jim Crow whether or not the implementation was intentional? Good question!

David F. Musto has written the definitive history of anti-drug legislation in the United States: The American Disease: Origins of Narcotic Control. Let’s see if he can provide us any enlightenment on the issue of drugs and race.

First, here is some background.

"Crude opium is the dried juice of the opium poppy and contains many alkaloids with varying properties. About ten percent of crude opium is extractable as morphine, the chief active ingredient. A simple chemical process discovered in the last quarter of the nineteenth century converts morphine into diacetylmorphine, more commonly known as heroin. Another alkaloid found in crude opium, codeine, is less addictive than morphine and is relatively assessable in cough medicines and analgesic preparations. Crude opium can also be prepared for smoking by dehydration and concentration."

"The active alkaloid in the coca leaf is cocaine. Cocaine produces euphoria and hyperactivity and is similar in many respects to the amphetamines."

Drugs such as opium, morphine, and cocaine were freely available throughout the nineteenth century. Musto suggests that this period can stand as an example for those who would suggest legalization of these drugs.

The drugs were regularly used by physicians as medications and were widely available in commercial formulations generically referred to as "patent medicines." Cocaine could even be purchased in a syringe for self injection. Until 1903, Coca Cola contained cocaine. Afterward, the cocaine was replaced with a new stimulant: caffeine. Children were subjected to narcotics as a remedy for crankiness and sleeping difficulties. There were no labeling and disclosure requirements at the time so patients and consumers might not have known exactly what they were consuming.
"In the United States the exhilarating properties of cocaine made it a favorite ingredient of medicine, soda pop, wines and so on. The Parke Davis Company, an exceptionally enthusiastic producer of cocaine, even sold coca-leaf cigarettes and coca cheroots to accompany their other products, which provided cocaine in a variety of media and routes such as a liqueurlike alcohol mixture called Coca Cordial, tablets, hypodermic injections, ointments, and sprays."

Not only was cocaine freely available, but its use was encouraged by respected sources of knowledge.

"Cocaine achieved popularity in the United States as a general tonic, for sinusitis and hay fever, and as a cure for the opium, morphine, and alcohol habits. Learned journals published accounts which just avoided advising unlimited intake of cocaine."

Such widespread use would necessarily create a subset of users who would develop a destructive habit. As the threat of addiction became more widely recognized, a movement to restrict access to these drugs began to grow. Those interested in restricting the drug included those who merely thought controls on usage were required as well as those who thought pleasure-inducing drugs were morally wrong and all recreational use should be prohibited.

Initiatives launched towards imposing restrictions were countered by those who had a financial interest in keeping drugs freely available. The first successful attempt at limiting access involved the prohibition of the importation of smoking opium in 1909. As in all legislative attempts at drug restrictions, politics rather than facts seemed to be the dominant motivator.

The US was approaching an international conference where it hoped to limit the unwelcome British trade in opium with China. The US was embarrassed to note that it itself had no opium restrictions in place. Hurriedly, an embargo was negotiated and signed into law.

In order to obtain this legislation, it was politically expedient to claim that the danger came from the spread of the opium smoking habit from the already reviled and mistreated Chinese minority. The "evil" habit of the "Chinamen" was said to be spreading even into white society. There were claims that Chinese men were seducing white women with drugs and essentially keeping them as sex slaves.

This use of a targeted minority to focus popular disgust in order to obtain desired legislation was effective and became the normal approach with respect to criminalizing drug usage.

"The most passionate support for legal prohibition of narcotics has been associated with fear of a given drug’s effect on a specific minority. Certain drugs were dreaded because they seemed to undermine essential social restrictions which kept these groups under control: cocaine was supposed to enable blacks to withstand bullets which would kill normal persons and to stimulate sexual assault. Fear that smoking opium facilitated sexual contact between Chinese and white Americans was also a factor in its total prohibition. Chicanos in the Southwest were believed to be incited to violence by smoking marijuana. Heroin was linked in the 1920s with a turbulent age group: adolescents in reckless and promiscuous urban gangs. Alcohol was associated with immigrants crowding into large and corrupt cities."

The association of cocaine with blacks was intimately tied to the repressive conditions that the South believed were necessary to keep blacks in their "place." First their guns were taken away, then their civil rights, followed by prohibition of alcohol and a call to stop the selling of something called "Coca Cola."

As usual, the Southern bloc of legislators was needed to get laws passed. To obtain their votes, the fear mongering they engaged in by relating blacks to cocaine became an important part of the political dialogue.

"The fear of the cocainized black coincided with the peak of lynchings, legal segregation, and voting laws all designed to remove political and social power from him. Fear of cocaine might have contributed to the dread that the black would rise above ‘his place,’ as well as reflecting the extent to which cocaine may have released defiance and retribution. So far, evidence does not suggest that cocaine caused a crime wave but rather that anticipation of black rebellion inspired white alarm. Anecdotes often told of superhuman strength, cunning, and efficiency resulting from cocaine. One of the most terrifying beliefs about cocaine was that it actually improved pistol marksmanship. Another myth, that cocaine made blacks almost unaffected by mere .32 caliber bullets, is said to have caused southern police departments to switch to .38 caliber revolvers. These fantasies characterized white fear, not the reality of cocaine’s effects, and gave one more reason for the repression of blacks."

Musto provides a further insight into drug politics that must be remembered in trying to understand how we arrived at our current situation.

"The occasion for legal prohibition of drugs for nonmedical purposes appears to come at a time of social crisis between the drug-linked group and the rest of American society."

The drug laws of the 1970s and 1980s incorporating extremely severe sentences for drug possession or sale came after a period of high crime rate and urban rioting. In circumstances eerily reminiscent of the post-Reconstruction-era South, whites feared that the blacks, in their segregated urban sectors, might be getting out of control. Drugs were already prohibited but, nevertheless, were widely available. The goal of legislation then turned to pouring more resources into crime/drug control. Can it possibly surprise anyone that the tried and true tactic of scaring people with suggestions of cocaine-crazed blacks on a crime spree was resurrected?

Michelle Alexander draws this conclusion:

"A new race-neutral language was developed for appealing to old racist sentiments, a language accompanied by a political movement that succeeded in putting the vast majority of backs back in their place. Proponents of racial hierarchy found they could install a new racial caste system without violating the law or the new limits of acceptable political discourse, by demanding ‘law and order’ rather than ‘segregation forever’."

It is becoming harder and harder to argue with her.

Michelle Alexander is the author of The New Jim Crow: Mass Incarceration in the Age of Colorblindness

Carl Hart is the author of High Price: A Neuroscientist’s Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society

Tuesday, September 3, 2013

Medicare: The Fiscal Outlook Continues to Improve

Medicare is at the heart of the national debt issue. It is the entitlement program that is always projected to produce the greatest impact on our future budget deficits. It has been repeatedly argued here that healthcare costs are excessive and wasteful. Consequently, we should wait until savings have been wrung out of these costs before we decide what might be done in determining the future of Medicare. It is too early to define an affordable level of benefits.

Given the above stance, it seems appropriate to report occasionally on recent developments in medical costs and in cost projections. Let us begin with recent projection by the Congressional Budget Office (CBO) as reported in the New York Times.

"....the Congressional Budget Office said it had erased hundreds of billions of dollars in projected spending on Medicare and Medicaid. The budget office now projects that spending on those two programs in 2020 will be about $200 billion, or 15 percent, less than it projected three years ago. New data also show overall health care spending growth continuing at the lowest rate in decades for a fourth consecutive year."

For the third straight year the CBO has had to lower its Medicare cost projection below that of the previous year.

"The slowdown has occurred in both government and overall health spending. From 2009 to 2011, total health spending grew at the lowest annual pace since the government started keeping records 52 years ago, a trend that seems to have continued last year. In the 2012 fiscal year, Medicare spending per beneficiary grew just 0.4 percent. The new Congressional Budget Office data said that overall Medicare outlays grew 3 percent in 2012, the slowest rate since 2000."

Two factors are at work in determining this decrease in costs: the financial crisis and its associated impact on consumer spending, and longer-term changes in the manner of healthcare delivery. Most who report on this issue believe that a significant fraction of the diminished rate of growth in costs is due to the latter factor. It seems the events surrounding the passage of the Affordable Care Act (Obamacare) and the terms of the new law have convinced the healthcare industry that it must change its ways of doing business. This article in Health Affairs provides a summary consistent with that point of view.

"We find that the 2007–09 recession, a one-time event, accounted for 37 percent of the slowdown between 2003 and 2012. A decline in private insurance coverage and cuts to some Medicare payment rates accounted for another 8 percent of the slowdown, leaving 55 percent of the spending slowdown unexplained. We conclude that a host of fundamental changes—including less rapid development of imaging technology and new pharmaceuticals, increased patient cost sharing, and greater provider efficiency—were responsible for the majority of the slowdown in spending growth. If these trends continue during 2013–22, public-sector health care spending will be as much as $770 billion less than predicted. Such lower levels of spending would have an enormous impact on the US economy and on government and household finances."

The Medicare Trustees issued their annual report recently. The New York Times provided analysis of the findings. The trustees are appropriately conservative and have previously included little if any savings from fundamental reform of healthcare delivery in their projections. While they project slightly lower programmatic spending in the near future, they attribute this to specific actions already taken by the administration.

"The Medicare trustees — four federal officials and two public representatives — said in their annual report that the ‘modest improvement’ in the outlook for Medicare’s long-term finances reflected lower projected spending for skilled nursing homes and private Medicare Advantage plans."

"The administration said the outlook for the Medicare trust fund was brighter because of the 2010 health care law. The law squeezed nearly $500 billion out of Medicare over 10 years, in part by trimming payments to many health care providers, including nursing homes and private health plans."

The changes observed and accounted for in the current projection provide an additional two years to get our house in order.

"Under current law, the administration said, Medicare’s hospital insurance trust fund will be exhausted in 2026...The administration said in its 2012 report that the Medicare trust fund would run out of money in 2024...."

A revealing graphic presentation of healthcare cost history is provided by the S&P Healthcare Economic Indices. From the latest report:

"The S&P Healthcare Economic Indices estimate the per capita change in revenues accrued each month by hospitals and professional services facilities for services provided to patients covered under traditional Medicare and commercial health insurance programs in the U.S. The annual growth rates are determined by calculating a percent change of the 12-month moving averages of the monthly index levels versus the same month of the prior year."

This chart is provided:

Note the general decrease in growth of expenditures after the financial crisis occurred. This was followed by an uneven but uniform decrease in the rate of growth. Note also that Medicare expenditures were relatively unaffected by the financial turmoil and have followed a simpler path of lowering growth rates, with most recent numbers hovering at the 1% level.

The fact that Medicare expenditures are growing more slowly than the economy is a rather dramatic accomplishment. One could claim that the program had become sustainable except for the fact that these are per capita expenditures and the number of people covered under Medicare is expected to grow by about 40% between now and 2025. There is a long way yet to go.

One of the fears expressed about Medicare is that the cost savings measures and the administrative requirements might drive doctors out of the program and leave patients in a worse position. An editorial in the New York Times addresses this issue.

"In the critics’ most dire scenarios, baby boomers nearing retirement age could find that their current doctors are no longer willing to treat them under Medicare and that other doctors are turning them down as well. Those concerns have always been greatly exaggerated. Now a new analysis by experts at the Department of Health and Human Services should demolish that mythology for good."

"The analysts looked at seven years of federal survey data and found that doctors are not fleeing Medicare in droves; in fact, the percentage of doctors accepting new Medicare patients actually rose to 90.7 percent in 2012 from 87.9 percent in 2005. They are not shunning Medicare patients for better-paying private patients, either; the percentage of doctors accepting new Medicare patients in recent years was slightly higher than the percentage accepting new privately insured patients."

The number of doctors exiting the Medicare program is small, but it does have a large effect on their patients.

"Roughly 9,500 practicing doctors have currently opted out of Medicare, according to the Centers for Medicare and Medicaid Services. If patients want to stay with these doctors, they have to pay the bills themselves; neither the doctor nor the patient can receive any payment from Medicare."

"The number of doctors opting out is tiny compared with the number of doctors, 735,000, who remain in Medicare. In addition, they are augmented by hundreds of thousands of nurse practitioners and other non-doctor providers."

Significant evolution is underway in our healthcare delivery systems. Until the outcome of these changes is clear, there can be no reliable projections of medical expenditures and budget deficits. While it is likely that some increase in charges or taxes will be required to maintain current benefit levels, it is too early to be able to respond intelligently to the problem.

We still have time to sit back and observe. Why not relax and do that, and enjoy whatever good news can be found.
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