On the “Mosque” Near Ground Zero.

I think that I understand both sides of this issue.  For those who oppose the building of an Islamic community center near ground zero (it’s closer to being a YMCA than it is to being a mosque), their most vivid memory of Muslims is the attack on 9/11.  They feel that it is insensitive of the builders of the community center to remind them (and families of those who were murdered on 9/11) of this attack on the World Trade Center by building the community center so close to ground zero.

For Muslims, they are sensitive to being conflated with those who destroyed the World Trade Center on 9/11.  They are also sensitive to the many lies that are being told by those who oppose the community center.  (Contrary to the false claims, it is not a mosque.  It is not on ground zero; it is two blocks from ground zero and not even visible from it.  Imam Rauf, who has advocated the building of the community center, is a moderate Muslim who traveled with members of the Bush administration to improve relations between the Muslim world and the US. )  They are also sensitive to the anti-Muslim hatred that is being revealed in so many different parts of the U.S.

So, on one side, there are the sensitivities of those who have so little personal knowledge of the Muslim religion that they automatically think of 9/11 when they think of Muslims.  They don’t even think of the 10s of millions of Iraqis or Afghanis for whom we are fighting, let alone the Muslims who were among those murdered on 9/11.   On the other side, there are the Muslims (especially, moderate Muslims) who are sensitive to being constantly compared to terrorists.

I think that the Muslims have a much better case on this one.

The solution is not to treat both types of sensitivities as morally equivalent.  Rather, Americans should try to understand their Muslim neighbors better and overcome any misinformed associations that they may have.  With 1 billion Muslims in the world, it is possible (and preferable) for Americans to have a much more nuanced position than to think that all Muslims believe the same thing.   We especially should not associate Muslims with Al Qaeda, which is hated by a majority of Muslims around the world.

As for politicians who have deliberately inflamed this situation for narrow personal or political interests (Newt Gingrich, I am especially referring to you), they provide support to those radical Islamists who want to convince others that Americans hate Muslims; and they have made this world a more dangerous place.    They bring dishonor and shame to themselves and to the United States.

Joe Barton on “misconstruing the misconstruction”

After a recent meeting with Boehner and Cantor, Joe Barton took back his apology to BP and his accusation that Obama had shaken them down for $20 billion.  The transcript of the conversation was just released**, and I print it here without alteration.

Boehner.   Joe, you know why I’ve asked you to meet with Eric and me.  We want you to apologize to the people of the Gulf coast for apologizing to BP.

Barton.   No, I don’t understand.  Yesterday, both of you accused Obama of shaking down BP by asking them for $20 billion.  You told me it was perfectly OK for me to apologize to BP for Obama’s actions.  You even encouraged me to do it.   Why is today different from yesterday?

Cantor.   Joe, you missed the most important part of the message.  We said, “Apologize in private.”    The point was to make BP believe that you cared more about them than you care about the citizens of the Gulf Coast.

Barton.  But I do care more about BP than the citizens of the Gulf Coast.

Cantor.  And so do we, but that’s not the point.  We also like winning Congressional seats in those states.   You can believe what you want, as long as you vote and talk the way that we want.  And we want you to apologize to the Gulf Coast for apologizing to BP.

Barton. I hate apologizing. If I had to apologize every time I said something stupid or offensive, I’d spend all day every day apologizing.  Besides that, I’m no good at it. What if I refuse to apologize?

Boehner.   You know how you are the top Republican on the Energy and Commerce Committee.  It would be a shame if you lost that position.   You might no longer be the top recipient of donations from oil companies in the Congress, and you wouldn’t have nearly as much political power.

Barton.   This sounds like you are “shaking me down.”

Boehner.   We never shake anyone down.  That’s for bad people or Democrats.  But I repeat myself.   (Audible laugh from all three).  We just reason with people, and occasionally make them offers that they can’t refuse.   That’s why Republicans almost always vote the way we want.  And that’s why businesses give us so much money.  We’re very persuasive.

Cantor.   Anyway, it’s easy to apologize.  All you need to do is to apologize that people are too stupid to understand what you said.   It helps if you say it in a way that is confusing.

Barton.  How about if I said this?  “And if anything I said this morning has been misconstrued to the opposite effect, I want to apologize for that misconstrued misconstruction.”

Cantor.  It’s a start, but I’d get some help from a speech writer.  After all,  you don’t want to sound like a complete idiot.

**   For international readers, it is worth noting that this is entirely made up, with the exception of Barton’s last quote, which is accurate.

The Health Care Debate and Basic Research

There are two fundamental issues dealing with health care in the U.S.:  coverage and costs.  Currently, far too few people are covered by health care plans, and the costs of health care delivery is very high and increasing rapidly.

In the recent health care debate, the Democrats focused almost entirely on coverage issues, while making efforts to “do no harm” with respect to costs.   They developed an imperfect bill, with many flaws, but which is a very good step forward in dealing with the issue of coverage.  On the other hand, the Republicans were not responsible in their approach to this issue.  They appealed to people’s fears in ways unbecoming of the opposition party.  They talked about “killing grandma, the loss of freedom in America, and killing babies, all of which were based on lies.  They pretended to be the defender of Medicare, which showed amazing chutzpah on their part.  They also focused on secondary issues such as complaints about the process, lack of bipartisanship, complaints about the length of the bill, and so on.  Although they did talk about serious policy issues such as tort reform and increasing taxes, the serious issues were lost in the fog of their secondary complaints and their fear mongering.

Hopefully, we can come together and address the issue of maintaining costs in a serious and productive manner.  Everyone is affected by the costs, which are increasing much faster than inflation.    Operations Research can definitely help with this issue.  O.R. has a long history of improving the efficiency of systems, including many efforts in health care.    But I think that we can do much more, especially when we work closely with those outside of our field.

Serious efforts require serious funding.   I propose that the government spend from $5 billion to $10 billion per year in research   that is dedicated to reducing the cost of health care while improving health outcomes.  This reflects a .5% to 1% proportion of our federal government’s spending on health care.   A one-time 1% sustained reduction in health care costs would pay for this program in perpetuity.   A much larger reduction is likely.

Here are some questions that the government funding agency may wish to consider?

1. What can government do to reduce the costs of bringing an important drug to market?  If they dramatically reduce the cost of bringing a drug to market, how can they ensure that the drug companies will keep the costs of the drug reasonably low?
2. How can hospitals be run much more efficiently?
3. What less expensive alternatives are there to hospitals for people who do not require hospital care, but do require monitoring and help?  How effective are these alternatives?
4. How can electronic medical records be maintained at a low cost while ensuring the right level of privacy?
5. What medical screening tests can be developed that will dramatically reduce the costs of current testing procedures?  Here I am thinking of tests that are cheap, and have few false negatives.  People who test positive would be given the more expensive and more reliable tests.  People who test negative would need no further tests.   This would improve costs dramatically if the diseases were rare and if most test results were negative.
6. How can we reform our tort system while ensuring that patients who receive harmful and incompetent care are compensated for losses?  How can we ensure that incompetent doctors lose their license to practice?

The list can go on and on.   Health care offers so many opportunities for improved efficiencies.  I hope we will take full advantage of these opportunities.  We certainly need to.

It’s not hypocrisy. It’s lying.

Democrats and many in the media are accusing the Republicans in Congress of hypocrisy in opposing the stimulus package and then asking for money for their districts from the stimulus funds.  This is not actually hypocrisy on the part of the Republicans and can be viewed as reasonable.  One could argue that it is a bad idea for the US to go into even more debt to create temporary jobs; but given that the US is going to go into more debt, everyone wants their share.  Wanting a share of money that shouldn’t be spent at all is as American as apple pie.  (However, it is hypocritical for a Congressman to consider any government spending to be wasteful unless it is in his or her district or state.  But this type of hypocrisy is so common in Congress that it is hardly worth mentioning.)

On the other hand, many Republicans in Congress are arguing that the stimulus bill did not create any new private sector jobs at the same time that they are going to ribbon cutting ceremonies and touting their role in getting stimulus money that leads to new jobs.  This position is not hypocrisy.  It is lying.  They are either lying to their constituents at the ribbon cutting ceremonies or they are lying when they say that the stimulus is not working.  Possibly, they are lying both times.

On a side note, ex-Governor Mitt Romney said that the stimulus “did not create any net new jobs other than in government.”  He was not lying.  He was just being totally sleazy by inserting the word “net” where it did not belong and where it would cause confusion.  This is not to say that Romney doesn’t routinely lie.  It is just to say that he prefers being sleazy to lying when given a choice.

The game theoretic advantage goes to the Republicans

Pundits have asked themselves why it is so difficult for the Democrats to get things done even with 60 votes in the Senate, whereas the Republicans seem to do just fine with 50 votes in the Senate.  I suspect that there are a number of reasons for this.  But one reason that deserves mentioning is that Democrats believe in the importance of the federal government, and Republicans believe in the importance of thwarting Democrats.

Consider the following table, which illustrates the values to Democrats and Republicans when the Democrats are in majorities in Congress.

	When Democrats control congress
	keep government going	gridlock
Republicans	1	9
Democrats	9	1

The numbers are made up.  But the key element is that Republicans would rather see nothing done at all than seriously compromise with the Democrats to pass legislation.

On the other hand, consider the reverse situation in which Republicans are in charge.

	When Republicans control Congress
	keep government going	gridlock
Republicans	7	3
Democrats	7	3

Here the Democrats really don’t want government to shut down, and they are willing to go far more than half way to meet the Republicans.  In this case, even the Republicans are willing to compromise a little.  For example, the Republicans were willing to greatly increase the National debt under Bush rather than having permanent gridlock so long as the wealthiest Americans could get a tax cut and Bush was able to start two wars; however, on other important issues such as having two ultra-conservative judges appointed to the Supreme Court, they stood by their principles and were even willing to get rid of filibusters.

I’m not sure what the moral of this story is, except perhaps that is sucks to be a Democrat.

Random thoughts on the Massachusetts election

Yesterday, Scott Brown (a Republican) defeated a Martha Coakley (a Democrat) for the Senate seat in Massachusetts.  The Senate seat was generally known as Ted Kennedy’s Senate seat because Kennedy was the Massachusetts Senator since 1962.   I have a number of thoughts on the election.  Here they are, in somewhat random order.

1. The election of Scott Brown will kill the health reform bill because it will give Republicans 41 Senate seats, enough to filibuster any bill.   Most Americans will be grateful, with notable exceptions including those who can’t afford health insurance, those with preexisting medical conditions, and those who are very sick and are being dropped from their coverage by private insurers.
2. The election confirmed the adage that Republicans are much better at getting elected than they are at governing.   My suspicion is that Republicans are so good at campaigning because they are largely unencumbered by shame (think of Mitt Romney), whereas no matter how hard the Democrats in Congress try, they still let shame get in the way of unadulterated hypocrisy.
3. Coakley was up in the polls by 20% a month before the election.  It’s pretty clear that Coakley lost in large part because her campaign was “asleep at the switch,” especially since there were no external events in the last month that made much of a difference.  It didn’t help that Coakley came across as arrogant and unwilling to do what it took to get elected.
4. Scott Brown is a bad choice for Massachusetts.  While I disagree with many of his positions, the most important aspect is the fact that he will support the Republicans in the Senate, who are filibustering almost all Democratic initiatives.   Brown claims to be his own person, and he will vote against the Republican Senate leadership if he disagrees.  Perhaps he is much more independent than all the other Republicans in the Senate, but I doubt it.   I dare him to prove me wrong.  (OK.  If I am wrong, I won’t claim that he accepted my dare.)

The Senate is broken!

US Citizens strongly believe in the United States Constitution and support it wholeheartedly.  This is somewhat paradoxical since most Americans cannot name the three branches of government (on the brighter side, 3/4 can name the three Stooges 🙂

I could go on about how little Americans know about the Constitution, but I really want to address a different point.   The U.S. Senate is broken.  Paul Krugman articulated this point well, and I fully agree.  Here are three ways that it is broken:

1. Because of the incredible overuse of “filibusters”, Democrats need 60 senators to get any bill voted on.  This has given enormous power to some Senators who least deserve it, such as Lieberman and Nelson.  It is also undemocratic and unfair, and it is not what the writers of the Constitution intended.
2. The Senate is absurdly slow in confirming appointments for the Executive branch.  Obama is in charge of 519 appointee nominations.  After Obama’s first year in office, the Senate has approved only 58%.   Nominees are rejected for trivial reasons (the media encourages this approach), and the vetting process is so burdensome as to be deemed out of control.  Worse yet, a single Senator (let’s call him Senator D-bag) can prevent a nominee from being considered just because the Senator is a D-bag.  If you prefer, you can call him Senator Vitter.
3. The Congress is largely corrupt, and most of the corruption is fully legal.   The corruption comes from the following huge conflict of interest.  Congress needs to rely on industry for massive campaign contributions, and then votes on issues that strongly effect these industries.  In other countries this is called “bribery.”  In our country, it is called “private funding of election campaigns.”

All three problems are fixable, and they don’t even require amendments to the Constitution.  The US might have a chance of addressing these issues if the US press focused on governance issues rather than on whether the President is using the word “terror” enough or on news about some couple named “Jon and Kate”.   But I understand why the press does not want to focus on governance issues.  After all, most Americans cannot even name the three branches of government.

On the Failed Airplane Bombing Attempt

When geese “attacked” US Air Flight 1549, and Captain Sully Sullenberger landed the plane in the Hudson river, Americans were overjoyed that disaster had been averted.   When Abdul Mudallah ignited an explosive device on Northwest Flight 253, and no one was injured, Americans spent the next week afraid, with countless criticisms of our government (many of which were justified).  In reality, we should all be very thankful.

First of all, we should be thankful that disaster was averted.  This was great news.  We should also be thankful because we have learned a great deal of what went wrong, and security will improve in the future. Al Qaeda is not likely to succeed if they use the same technique again.  And it takes lots of time to develop new techniques.

I understand why people were so upset.  This event revealed that we were not nearly as safe as we hoped we were, and it revealed that the government is still not sharing information about terrorism well enough.  In other words, the event was the messenger of “bad news.”  Since we couldn’t “shoot the messenger”, Americans sought out others to shoot.

But we really have much to be thankful for.  And the Department of Homeland Security has their work cut out for them.  We all hope that this department has learned a lot of how to prevent the next incident.

Side note to Janet Napolitano:  it really is OK to be honest the first time around.  But other than your first statement about how our security system works, you are doing a heck of a job.

Side note to Dick Cheney:  we are getting very tired of seeing the Mr. Hyde part of your personality. (Perhaps Obama likes this side, since you constantly remind Americans of why voting for Obama was a good idea.)  When will we see the Dr. Jekyll side again?  Please let this side out more frequently.  It seems that we only see it when you talk about your daughter.

Side note to Senate Republicans:  Thanks to you, we still don’t have a head of the Transportation Security Administration (TSA).  “Advise and consent” should not mean “prevent the President from running the Executive branch.”

Traveling Incognito

Sarah Palin, in a recent vacation trip to Hawaii, wore a “McCain for President” visor, but crossed out the words.  Her explanation was:  “I Sharpied the logo out on my sun visor so photographers would be less likely to recognize me”.  So, if I understand correctly, she thinks that photographers recognize her by her logo instead of the way she looks.  Or perhaps she thought that crossing out the logo would make her invisible.  In any case, despite all these strenuous efforts at traveling incognito, she was recognized.  Who could have guessed that photographers would see through her clever ploy?  (Perhaps they relied on mathematical modeling approaches.)

How to make mammogram testing cheaper and more effective.

New recommendations concerning mammogram testing have upset a lot of people.   Previously, doctors recommended that women be tested yearly starting at age 40. The new recommendations say that most women should start mammogram testing at age 50, and only do it every other year.  The analysis relied on the following empirical result: one cancer death is prevented for every 1,904 women age 40 to 49 who are screened for 10 years, compared with one death for every 1,339 women age 50 to 59, and one death for every 377 women age 60 to 69.  (These recommendation make sense, as pointed out by Mike Trick.)   However, if the ratio of cancer deaths prevented per mammogram could be improved for women aged 40, then mammograms would be recommended.

What this highlights is the importance of a cheap preliminary test with reliability that is pretty good.   For example, suppose that there was a test for which no women with breast cancer had false negatives, and where 1 out of 10 women with no breast cancer had a false positive.  With such a test, approximately 90% of women would be screened out as negative, with all of them having no cancer.  The remaining 10% would test as positive, with the vast majority of them being false positives.  These women would be given mammograms.  (Women would need to be reassured that the preliminary test is not a test for cancer but a test on who should be screened using mammograms.)    Since only 1/10^th as many women would be given mammograms, this would result in cancer death prevented for every 190 women being tested, a huge improvement over the current system, with huge savings in terms of health outcomes and dollars.

Even if the test had a false negative rate of 10%, the prevention of cancer deaths would be almost as high.  There would be 1 cancer death prevented for approximately 210 mammograms.  Unfortunately, the false negative could lead to 1 cancer death for every 17,000 women not given mammograms (because of a negative test.)   At the same time, it would eliminate the health risks of mammogram testing for 17,000 women who didn’t have cancer.

The conclusion is that a cheap test with pretty good reliability (say around 90%) can dramatically improve the health outcome of mammogram testing,  while dramatically decreasing the cost of health care.   The NIH should dedicate research funding to find such tests.