Egyptian versus U.S. health care system

I’m on Day 10 of a nasty cold with an unusual (for me) amount of sinus congestion. Most people in Boston seem to have flu or strep so I guess I should count my blessings. Anyway, I decided to see if antibiotics would help (science says that it doesn’t (example), but science also says that science is wrong (Ioannidis) and I do think that previous similar incidents have been helped by antibiotics).

I did this back in the early 1990s in Egypt. I walked from my sister and brother-in-law’s apartment to a pharmacy, described my symptoms to the pharmacist, and walked out five minutes later with antibiotics at a total cost of less than $5.

My primary care doctor was busy so this morning I went to a walk-in clinic at Mt. Auburn Hospital in Cambridge, which has a pretty good reputation for delivering ambulatory care without crazy wait times. Nonetheless I did have to spend some time in a crowded windowless waiting room surrounded by flu victims wearing masks. I interacted with seven different people (reception/admission, walk-in clinic front desk, triage nurse, intake nurse, physician, physician in training, discharge nurse), which involved a certain amount of repetition of story and measurements (e.g., my temperature was taken twice). Ultimately I was prescribed antibiotics, though I did not specifically ask for them and the exam room contained a big poster saying “antibiotics are not helpful for viral illness”. Then I went to CVS to get my prescription filled. I had to update them with new prescription drug plan numbers so that I wouldn’t be charged $61 for generic amoxicillin (cost = 42 cents according to UNICEF). Thus what had taken five minutes and $5 in Egypt with one interaction, one payor, and one vendor took three hours and cost perhaps $500 here with eight interactions (including at CVS). There were three payors in the U.S.: me, Blue Cross, and Medco (for the pills). There were at least three vendors, I think: the hospital, the doctor, and the pharmacy.

Related:

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Stupid question #672: How is eco-detergent different from Tide and Cascade?

My Caveman Chemist model of the world is that all detergents are the same (e.g., see this soap, shampoo, and shaving cream in one bottle or this laundry detergent that can also be used to clean floors). Thus there would be no difference in damage to the environment from using Tide to wash clothing versus some other brand. Ditto for Cascade versus some other brand of dishwasher detergent. Now that phosphates have been more or less banned there isn’t a distinction among detergents based on phosphate content. Yet Whole Foods carries a whole aisle of detergents whose labels imply that somehow the Earth will be better off if I buy those brands, e.g., Seventh Generation, rather than the poisonous products of devil-worshiping Procter & Gamble. The Seventh Generation web site isn’t very informative. Their laundry detergent is “non-toxic” (so it is actually better for drinking than Tide? Straight or with ice and soda?). They have no “dyes or synthetic fragrances,” but Tide has a fragrance-free variant. And is fragrance harmful to the planet? If we are going to roast our planet about 5.4 billion years ahead of schedule (when the red giant Sun would have done it for us), what’s wrong with a pleasant odor?

So… can our household reduce the amount of environmental harm that we cause by using “eco” detergents in the kitchen and laundry? And is the answer different whether we are putting this into a septic versus a municipal sewage system?

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Standing and treadmill desk ideas and experience?

Folks:

Since I failed to keep any of my previous New Year’s resolutions… It is time to set up a standing/treadmill desk in the home office.

The best idea that I’ve seen is the Steelcase Sit-to-Walkstation. Since I am a big Steelcase fan, why not just buy it?

  • the treadmill has a maximum speed of 2 mph, making it unsuitable for getting a little more of a workout when desired
  • the treadmill cannot be inclined like a regular treadmill, again making it tough to get a workout
  • the treadmill is of unknown provenance
  • the product gets a bad review (but from a site that is run by a competitor, without very clear disclosure of the fact)
  • the desk has a plastic top (good for durability but maybe not the best aesthetic for home)
  • the monitor arm costs extra and might not work that well for a serious monitor, such as a 30- or 32-inch 4K display

Some of the advantages of the Steelcase product include treadmill controls that can slide underneath the desk, a great width (78 inches), and presumed sturdiness.

An alternative is to get the treadmill from a company that specializes in treadmills and a separate desk and any monitor supports.

The Human Solution manufactures its own standing desk, the UPLIFT, and puts a LifeSpan treadmill underneath. This is a well-regarded treadmill company. The treadmill costs about $1000 and could be swapped out easily if an improved treadmill becomes available. This treadmill won’t incline but it will run up to 4 mph and the belt is bigger than on the Steelcase (20×56″ versus 18×53″). The desk can be ordered in 80×30″ solid maple or cherry. It doesn’t have the big cross-brace of the Steelcase so it is tough to see how it can be as rigid. I haven’t found any independent reviews of the UPLIFT.

Instead of a monitor that swings back and forth between the treadmill and standing/sitting side I was considering just getting two monitors, two keyboards, and two mice. Hook them all up to one computer and then program in a keystroke command to swap which is the primary monitor (I think Display Changer from 12noon.com will do this on Windows; is it easy to do the Mac as well?).

One idea might be to combine the presumably bomb-proof Steelcase desk with the LifeSpan treadmill. One has to dig a bit but it seems that Steelcase does sell the 78×29″ height-adjustable desk separately (dimensions). And it might even be possible to get the Steelcase base without the plastic laminate work surface (and then get a solid wood desktop of one’s choice?).

What do readers say? Has anyone used the Steelcase or the UPLIFT or some other packaged system that will do treadmill, standing, and sitting?

[Note: IKEA has been playing around with a height-adjustable desk, but it is not wide enough to compete with the Steelcase or UPLIFT products.]

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Latest New Yorker: getting together with family at the beach and Armenians in Turkey

The latest New Yorker has some great writing. David Sedaris gives us “Leviathan,” an ode to hosting extended family at the beach. The topics covered are small but the writing is big. If you insist on something weightier, “A Century of Silence” has a good history of the Armenian experience in Turkey.

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Thank the hostess or the guy who paid for the party?

In the round of Boston-area holiday parties that I attended, a couple had been paid for by divorce lawsuit defendants not in attendance.

The alimony-fueled party was particularly lavish and fully staffed with caterers (at parties hosted by rich people who got their money by working or from a property division lawsuit, the cooking and serving was done by the hosts with help from guests). Although adults in Massachusetts are more likely than average Americans to have advanced degrees and earning abilities sufficient for self-support, alimony cash flows in Boston are 330 percent higher than in an average U.S. city (New York Times Dec 12, 2014 analysis; I am pretty sure that this is adjusted for the difference in incomes from city to city). Thus it is common for someone to have a $200,000 per year income (3X the Massachusetts median household income) and yet be officially dependent on a former spouse, from whom an additional $200,000 per year is collected and spent annually. Here’s an excerpt from our book that explains why the money has to be spent shortly after being received:

Attorneys report that both winners and losers tend to become profligate with money. “The defendant might have been a saver before the lawsuit,” said one attorney, “but then he’ll see how the courts penalize parents for being prudent with money. His plaintiff’s lavish spending on herself will become a ‘need’ used by the judge to justify higher child support and alimony awards. After mom wins she spends like a drug dealer because she’s spending someone else’s money and also because she doesn’t want to lose a modification motion on the grounds that her banking money every year demonstrates that her ‘need’ was overestimated. The father spends whatever he can too because he realizes that his plaintiff and the court will take away whatever he tries to save. Children who would have been very comfortably established in life end up with nothing from their parents.”

I already thanked the hostess of the catered party but does etiquette require me to track down and thank the guy who paid for the house, the caterers, and the $2 million in legal fees (in 2014 dollars; the divorce started decades ago) that opened the alimony taps?

Separately, one of the parties I attended was both to celebrate the New Year and also a housewarming. The approach was up a driveway that was the same length, width, and quality as a secondary highway in England or Wales. This terminated in a 50-car parking lot at the top of the hill. Given that the parking lot looked like the result of successfully robbing a BMW/Audi dealership I was confident that I had not arrived too early. Once inside I learned that part of the renovation of this house had involved the installation of a three-ton circular marble bathtub. We were all awed by the resulting Homeric scale of the master bathroom. The host intruded on our reverie, however, by pointing out that three tons of marble has a lot of thermal mass. “After you fill it with hot water, the water immediately becomes too cold. So you have to drain it and fill it up again.” He has been taking showers.

Related:

  • “If I borrow your car and donate it to charity, does that make me a charitable person?”
  • from a reader, “Make divorce tougher on women, says leading lawyer” (Independent (UK), December 31, 2014) where “the outgoing chair of the Bar Standards Board” notes that young women in England would likely realize their maximum spending power by remembering “Never mind about A-Levels, or a degree or taking the Bar course – come out and find a footballer.” (From our book: A professor of economics in Massachusetts, a typical “winner take all” state, said “The best career advice that I could give to a female freshman would be to drop out and stop paying tuition. Get pregnant with a medical doctor this year. Get pregnant with a business executive two years from now. Get pregnant with a law firm partner two years after that. She’ll have three healthy kids and a much higher after-tax income than nearly all of our graduates in economics.”)
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Immigration to increase the supply of programmers

Paul Graham has written a pro-immigration essay titled “Let the Other 95% of Great Programmers In”.

The anti-immigration people have to invent some explanation to account for all the effort technology companies have expended trying to make immigration easier. So they claim it’s because they want to drive down salaries. But if you talk to startups, you find practically every one over a certain size has gone through legal contortions to get programmers into the US, where they then paid them the same as they’d have paid an American. Why would they go to extra trouble to get programmers for the same price? The only explanation is that they’re telling the truth: there are just not enough great programmers to go around.

I asked the CEO of a startup with about 70 programmers how many more he’d hire if he could get all the great programmers he wanted. He said “We’d hire 30 tomorrow morning.”

I’m pretty sure that this is an illustration of my hedge fund manager friend’s mantra: “When the market gives you an answer you don’t like, declare market failure.” Presumably Graham’s pal could hire 30 great programmers tomorrow if he offered compensation significantly in excess of what Google, Apple, and Microsoft are paying and/or simply called up great programmers to ask “How much would I have to pay you to quit your job?” and then agreed to whatever price was quoted.

This is also an example of our philosophy around imprisoning drug dealers to end drug dealing. People are born with an innate calling to drug dealing, rather than having chosen the field due to the economic incentives presented by the market. Thus if we put all current drug dealers in prison there will be no more drug dealers. The analysis of the situation that Graham describes is similar. Just as there is no way to turn a retail clerk into a drug dealer (since he or she lacks the genetic disposition toward drug dealing) there is no way that if companies nationwide paid programmers more than the BLS’s median pay of $74,280 per year (source), additional Americans would be attracted to this field.

[Note that in my home state of Massachusetts, $74,280 pre-tax is $52,192 per year after tax (ADP Paycheck Calculator), i.e., comparable to what a person could get in annual tax-free child support following a one-night encounter with a $300,000/year earner. A person who wanted to have two children could collect more than $52,192 per year by having sex with two different Massachusetts residents, each earning $135,200 per year or more (see worksheet).]

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Happy New Year to my readers!

Happy New Year to my readers!

Here’s a picture from plague-ridden Boston of our healthy 1-year-old and a stocked fridge. Hoping for more of the same in 2015…

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And so that this blog doesn’t become indistinguishable from my Facebook feed…. let’s talk about what we’re (realistically) hoping to see in the aviation, technology, and economics world during 2015.

I’ll start off…

  • the long-delayed Icon A5 amphibious seaplane delivered to customers (see my review from 2010).
  • an announcement (but not a delivery) of the BendixKing AeroVue retrofit flight deck for the Pilatus PC-12 (currently King Air only)
  • that the flight recorder from MH 370 will be found (I predicted to friends that it would be found in January 2015 so I hope that it will be found very soon indeed)
  • a little progress toward the ground-based copilot idea that I wrote about in September 2008. (Could have been useful for preventing a lot of the aviation accidents that occurred in 2014, actually, which might motivate action (oddly enough probably to add a third pilot to the two-pilot airline crew rather than my idea of supplementing the single-pilot private flight).)
  • sufficient progress on OLED that there will be a consumer-priced 4K OLED television announced by the end of 2015, which I think will pave the way for a 4K OLED desktop computer monitor (in the meantime maybe this LG 31″ IPS LCD monitor that my friend Gary loves is the best option).
  • despite the fall in oil prices, continued gradual progress in electric cars, solar power, and wind power (due to investments made years ago coming to fruition)
  • a further reduction in the percentage of the U.S. labor market where wages are set by a market. Employers will increasingly either be hiring people they wouldn’t otherwise have hired (due to government-established quotas) or they will be paying some of their workers more than a market-clearing wage (due to government-established minimum wages or anti-discrimination orders, e.g., people who call in sick a lot will get paid the same as people who never call in sick due to new requirements around sick leave). This should result in a fall in the percentage of Americans who are working, as companies substitute capital for labor, but the effect will be masked for a few years by the fall in commodity prices. (Why this prediction? It is based on the 2014 election. Voters don’t seem to care what percentage of Americans are working, but are very concerned that every American who does work gets a package of wages and benefits that seem subjectively fair.)
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When will hardcopy holiday cards become obsolete?

I’ve invested more than a day of time in getting Happy New Year cards designed, printed, addressed, and mailed. It will also cost about $400 paid to Shutterfly and the USPS. Part of the time and effort is inquiring about the current home addresses of friends who have moved (a task that serves no purpose except to enable me to mail them cards). In the old days this was a great opportunity to reconnect with distant friends and relatives. It occurs to me that today nearly all of our friends and relatives learn about our lives on a continuous basis through Facebook. Does that mean that the custom of sending hardcopy holiday cards with family photos and news will wither away and die? The young people that I know don’t seem to have mailing addresses in their smartphones so I’m not sure if they would have any way of sending hardcopy holiday cards even if they wanted to.

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Why can’t math and science professors be incompetent instead of racist?

The New York Times ran an article on Dec 26, 2014 titled “Colleges Reinvent Classes to Keep More Students in Science”. It describes the ineffective lecture-based approach to teaching and contrasts that with active learning in the classroom. That students learn from solving problems rather than from sitting passively has been known for a long time. (I figured it out myself after giving a few lectures in software engineering at MIT and then realizing that broadcast communication to the students could be much more easily accomplished by giving them a Web page or email (see http://philip.greenspun.com/teaching/teaching-software-engineering for more).) Why haven’t universities adopted active learning? The simplest explanation is that it is more work and they haven’t faced any competition so why bother trying to do a good job? Complacency and incompetence, in other words, the twin gods worshipped in the typical American workplace.

The Times, however, has decided that the most credible explanation for this phenomenon is not that customers keep handing over $50k/year for the easy-to-produce lecture-based product. It is that professors are trying to keep students, especially women and blacks, from majoring in their subjects. The journalist didn’t ask what seems like an obvious question: Why would people in a bureaucracy want to shrink their section of that bureaucracy? Wouldn’t it make more sense for math and science professors to try to get more students majoring in their subjects, which would justify larger budgets, more staff, new buildings, etc.?

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AirAsia 8501

New England Cable News wants to interview me regarding AirAsia 8501, which motivated me to search Google News to find out what is known about this missing Airbus A320. So far the most significant piece of information is that the pilots were seeking a deviation from their planned route to avoid clouds at 32,000′. In latitudes closer to the Equator there is more energy pumped into the atmosphere by the sun and therefore thunderstorms are more intense and cumulonimbus clouds that generate thunderstorms extend higher in the atmosphere, e.g., to as high as 60,000′. Airliners typically fly no higher than 40,000′ and therefore must divert around, rather than fly over, the most severe thunderstorms. By far the best Web page on this incident that I could find was the Wikipedia page, showing thunderstorms and the flight path on the same map. Also see the video at CNN, which says that the T-storms during that particular flight were forecast to extend up to 52,000′.

What’s bad about flying into a thunderstorm? Turbulence can be severe, exceeding the 2.5G load factor for which airliners are designed (light planes must tolerate up to 3.8Gs by regulation, but heavier airplanes have more inertia and are therefore less likely to experience heavy G loads in turbulence). Lightning can damage the electrical system, without which a modern airplane simply cannot be controlled (you need the electrics to run the hydraulic pumps that actually move the ailerons, elevators, and rudder against the heavy airloads; the Airbus A320 is also a fly-by-wire system that gets rid of the traditional mechanical connections from pilot yoke out to the hydraulic controls near the flight controls (truly light airplanes don’t have hydraulics; there are simply cables or pushrods out to the flight controls and pilot muscle power is used to move them, though sometimes with the help of trim tabs that are powered by air rushing over the flying plane)). Hail can slam into the airplane and damage windshields, wing leading edges, etc. (most hail-damaged airplanes remain flyable, however) Thunderstorms can also generate airframe icing, which, if severe, may exceed an airplane’s anti-ice/de-ice capabilities. An airplane covered in ice cannot climb and cannot fly at slower airspeeds without entering an aerodynamic stall. (De-icing on a heavy turbojet-powered airplane such as the Airbus A320 is generally accomplished with compressed (“bleed”) air from the engines fed into metal tubes on the leading edges of the wings, tail, and engine cowlings.)

How does a pilot avoid dangerous weather like this? It is relatively easy flying over heavily settled regions such as North America and Europe where ground-based RADAR can see the rain and that turns into a map (example). If the airplane has a datalink of some sort, a slightly delayed version of the map can appear on a multi-function display along with the airplane’s planned course. There are some limitations of such maps, starting with the fact that the map is two-dimensional and there is no fine-grained information on cloud or thunderstorm tops. I have been at 20,000′ in clear New York air flying over a line of solid red and yellow (heavy rain) but the same flight in Texas over the same map image might have resulted in being in clouds/turbulence/rain/ice/etc. Airliners also have on-board weather RADAR that can look ahead and see if there is rain in a cloud, but these images require a lot of experience to interpret. Someone who flies at low altitudes around the Caribbean and Florida would be great at this. A modern jet pilot usually isn’t because, most of the time, jets climb out of the bad stuff so quickly. If you’re out in the middle of the ocean and can’t get an accurate map from ground-based stations, you might have to rely on the on-board RADAR (not sure if that was a factor here; the plane was never all that far from land, though I am not sure if Indonesia has invested in as many RADAR stations as we have (air traffic control RADAR is not set up to paint an accurate weather picture)).

So the specifics of the incident remain a mystery but even a modern airliner is no match for a real thunderstorm and there is some evidence that this flight encountered one.

Related:

  • my June 2009 posting on Air France 447 (post-crash speculation including “The autopilot tripped off in response to a failure or disagreement. This is normal behavior, though much more common in light airplanes than in jets. A couple of pilots who were tired and deprived of a natural horizon by the darkness, open ocean, and clouds, turned out not to be heroes, at least not this time. There is probably more to it, but this is my best guess.”
  • a May 2011 follow-up after the flight recorders had been recovered
  • thoughtful article by a retired 747 captain
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