Smart people saying smart things

Smart people saying smart things December 3, 2012

James Surowiecki: “Disaster Economics”

The size of our current deficit does not change this calculus. In fact, there’s never been a better time for a Delta Plan in the U.S. With interest rates so low, it’s cheap to borrow money, and there are plenty of unemployed workers and unused resources that can be put to work. In a time of austerity, there’s bound to be opposition to expensive infrastructure projects. But if the government — and, by extension, taxpayers — is already on the hook for all the damage caused when disasters strike, we owe it to ourselves to do something about how much those disasters cost.

Erik Loomis: “Triangle Repeated in Bangladesh”

The movement to globalize industrial production was an explicit choice by corporations to avoid the workplace and environmental regulations that increasing made work and life safe and dignified in the United States. Such regulations might have improved American lives, but they also slightly cut into corporate profits. …

And thus we see Bangladesh suffer its own Triangle Fire. A clothing factory caught on fire this weekend near Dhaka, killing at least 117 workers. Like at Triangle, most of the dead workers are women. Like at Triangle, an unsafe building choked with highly flammable materials did not have proper safety equipment or fire exits. Like at Triangle, desperate women chose to jump to their deaths rather than burn.

Jo Hilder: “Just love ’em”

We create this system of silence, lies and hiding whenever we promote a culture of perfection and shame. When we say the only true and authentic expression of the Christian life is a successful life, an abundant life, a life where nobody gets sick or hears voices, or dies or divorces, where nobody is anything but English-speaking, employed, middle-class and heterosexual, where nobody is addicted or abused or bitter or angry, or could possibly have ever been hurt, offended or abused by us, then we tell A Great Lie. Great Lies force people underground, into the dark, and sometimes that darkness is within ourselves. We force people to turn away from their pain and their truth, we make them split themselves in two, and sometimes into even more little pieces. And folks learn they can only ever show us one kind of face, tell us one kind of story. The perfect face. The story with the happy ending.

But these happy, perfect stories and faces are not what Jesus came to heal.

Bushra Rehman: “The Assembly”

By the end of the movie, we were glued to our seats, paralyzed. In what we thought was the last scene, there was a movie still of one of the men. Underneath his name was written: Died, December 13, 1983. He was frozen in his hospital bed–the man who had been laughing with his friends just a few minutes before. We were stunned, and then there were girls crying in the audience.

We thought the movie was over, so we started clapping. Something we had stopped doing for The Red Balloon. But no – another picture came of a man from the movie. This man had died, too, only a few months later. And then the other, and the others. After each picture, after each man died, we clapped, wanting the movie to be over, wanting to do something with our fidgety hands.

After the lights came on, Ms. Cooperman was furious. She took us back to the room and held us during lunch. We tried to explain to her that we thought the movie was over.

“Again and again? You’re smarter than that.” She looked like she was going to scream or cry. Two things we never imagined her doing.

How could we explain to her we were clapping because we were terrified? We had never seen people dying this way. We were only ten years old and still didn’t understand what this illness was and what we knew was happening all around us.

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  • EllieMurasaki
  • What I find moving is that write-up about the assembly at school.

    And all too realistic is the way adults sometimes unknowingly set children up for pratfalls in ways which allow them to blame the children for misbehaving, even though it was not the case.

    Assuming that ten-year-olds have the ability to make cognitive connections that adults do is not reasonable. For example, Fred’s recent “Biblical Families” entry? The fact that only two of Abraham’s children are recorded as having children themselves strongly suggests that the others died in early childhood.

    I wouldn’t have been able to make that connection when I was ten and reading all the “begats” because I hadn’t learned about the concept of the Demographic Transition yet, and the implications for birth rates as a result of rising health care standards.

    This is the stuff of “victim blaming” structures of behavior: expecting an innocent party to act as though they had full knowledge, control, and understanding of a situation in which one, or more, of the three elements is absent.

  • ReverendRef

    James Surowiecki points out that its cheaper to prepare for disaster than to repair afterward

    Well, yes.  But this isn’t only a problem for our infrastructure.  Specifically I’m thinking back to when we had our daughter’s teeth filled (or lined or whatever they did) with this porcelain-type stuff to help prevent her from getting cavities — and the insurance company would not cover it.

    How many times do we see people not covered because an insurance company will not cover “prevention.”  They would rather pay for the hospital visit and surgery post-heart attack than pay for a “preventative plaque cleaning” (or whatever — you get the point).

    At some point we need to decide that preaction is much more better and profitable than reaction.

    **And, yeah, I know . . . much more better . . . a phrase my daughter started using around age 3 and it’s stuck with the family.

  • EllieMurasaki

    Being proactive in this context means preparing for a crisis that the preparation might prove unnecessary, and of course if the crisis never happens then the preparation was unnecessary (even if there’s good reason to believe that the reason the crisis didn’t happen is because of the preparation). Being reactive, well, the crisis is in progress, there is an obvious need.

  •  I share your frustration at our unwillingness to invest in prevention, both in health care and in infrastructure.

    That said, it’s a systemic problem, and I’m not really sure how to address it.

    The problem is, it’s relatively easy to distinguish real treatments from quackery. Roughly speaking: I get sick, I undergo treatment, I get better => it’s a real treatment.* By contrast, how do we distinguish real prevention from quackery? I’m healthy, I engage in this practice, I remain healthy… that’s not as compelling.

    If I’m allocating funds to health care, I want to avoid funding quackery. And this isn’t just because I’m a soulless bureaucratic twit, it’s actually  kind of important, because if I’m not reasonably good at filtering out quackery, then the quackery will displace the real health care, because quackery has a low cost of delivery relative to real health care, and people will get sick and die.

    The only way out of this dilemma I know of is to really embrace evidence-based medicine. Fund preventative care where it is shown to have benefits, and not otherwise, and trust the population to endorse this strategy and dismiss the self-serving howling of quacks.

    But I can’t blame institutions for not trusting the American population to do that.

    * Of course, even this isn’t straightforward. Some treatments are real, but don’t show results quickly. Some treatments show benefits, but are nevertheless quackery. Some treatments show no benefit but we’re so socially conditioned to believe in them that we are unwilling to dismiss them as quackery. And sometimes it’s hard to know whether we’re seeing a benefit or not.

  • ReverendRef

     Yeah, your thoughts on not paying for quackery make sense.  And since my only experience with preventative health care is of the non-quackery type, I sort of forget to think about that.

    But on the other topic (infrastructure), there’s really no good reason not to do preventative maintenance to our roads, sewers, airports, levees, etc.  I’m faced with this in my parish.  We have an older building that needs upkeep.  It needs preventative maintenance.  But since people in the congregation didn’t want to deal with those expenses (because everything’s working fine now), I was faced with a broken sewer line, asbestos removal, a new hot water heater, a new furnace, and some other things that needed to be dealt with because once the sewer line breaks you really can’t decide to put it off for another year.

    I just think that, as a whole, people are not very good at planning for the future.  And there’s a whole theological issue in that that sort of comes with the territory of my vocation.

  • The analogy that works really well for anyone who knows cars is this:

    1. You can pay for four $50 oil&filter changes per year. This, along with other forms of maintenance, can keep a car’s engine going for 10, 15 or 20 years.
    2. You can ignore that cost, and 3, 4, 5 years later, your engine will hate you and die horribly*. This is a $1000 repair/replacement job.

    Infrastructure is like that. You can spend $x to have people check city water pipes.

    Or you can NOT spend $x, and then end up spending $x^Z where Z is proportional to the length of neglect when a pipe bursts and the city water supply is lost.

    * I’ve heard a story of a guy who thought you never needed to change the oil. Cue his surprise when the inside of the block was scored badly because the oil was becoming less effective with time, since it was getting more crap in it with each day.

  • ReverendRef

      I’ve heard a story of a guy who thought you never needed to change the oil.

    Why change the oil?  It’s a sealed system, right????

    At least, that’s the reasoning I’ve heard as to why people don’t change the oil.

  • EllieMurasaki

    People have reasoning? In my experience, this is one of the tasks that people simply forget needs doing.

  •  Yeah, agreed that the quackery problem doesn’t really arise wrt physical infrastructure.

    I mean, sure, there’s always a certain amount of fraud and graft in the construction industry, but that’s more a regulatory capture problem than an epistemological one… it’s relatively easy to recognize fraudulent work, the only question is whose job is it to look for it and why do we trust them, which is a whole different (and comparatively easier) problem.

    And, yeah, planning is an unnatural process.

  • indifferent children

     The decision that insurance companies make to not cover many preventive treatments is not thoughtless, and (from their perspective) is not stupid.  That decision is driven by the fact that, on average, you will change health insurance companies every four years.  So they do not want to pay a nickel to prevent an expensive cure, if it is some other insurance company that has to pay for the cure.  In our healthcare and health insurance “system”, the incentives are aligned to cause more suffering, sickness, death, and expense.

  • Actually, many people change their oil far more often than is necessary, because dealers nag you to do it every 3,000 miles regardless of what the manufacturer says (modern cars frequently need it much less often than that).

    That’s a complicating factor in medical prevention too: unnecessary preventive treatment can be wasteful even if it’s not outright quackery. I get the impression that part of the goal of “evidence-based medicine” is to try to figure out when the prevailing standard of preventive care does or does not actually make sense.

  • To be fair the car manual usually states the service interval is ~every
    six months but recommends more often than that if you do a lot of city
    driving. I usually “stretch” my oil changes so I do one every four
    months, but I try not to go longer than that.

    Incidentally, that
    $1000 engine rebuild/replacement? Can easily double if your car has a
    high-end engine to begin with, and/or the cost of labor in the shop is
    very high. That’s five or ten years of oil changes.

    To circle
    this back to infrastructure, there’s a certain amout of maintenance that
    HAS to be done, and being penny wise and pound foolish by playing games
    with servicing intervals can sometimes be okay, but the longer the
    maintenance gets put off, the more chance there is that something will
    go poop.

    And the “get it done NOW” emergency that comes from
    having to recover from neglecting, say, sewer pipes, akin to how the
    cost of getting a car back on the road shoots up tremendously, the cost
    of getting a vital part of the modern way of life we live back in
    operation will go up a lot since people have to be paid overtime, parts
    need to be rushed, et cetera and so on.

  • Sgt. Pepper’s Bleeding Heart

    That’s a complicating factor in medical prevention too: unnecessary preventive treatment can be wasteful even if it’s not outright quackery.

    Routine population prostate screening and surgery for prostate cancers being an example of where prevention is not necessarily always better than cure. But it’s very hard for people to hear “let’s wait and see if you develop any symptoms”, let alone “you have cancer but the best bet for now is to just watch it”.

  • syfr

    My car actually needs to be changed every 10,000 miles, according to the dealer.

  • My car actually needs to be changed every 10,000 miles, according to the dealer.

    XD I only wish I got a new car every 10K!

  • syfr