It’s Not About You

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Over the past few weeks, America’s colleges have sent another class of graduates off into the world. These graduates possess something of inestimable value. Nearly every sensible middle-aged person would give away all their money to be able to go back to age 22 and begin adulthood anew.
But, especially this year, one is conscious of the many ways in which this year’s graduating class has been ill served by their elders. They enter a bad job market, the hangover from decades of excessive borrowing. They inherit a ruinous federal debt.
More important, their lives have been perversely structured. This year’s graduates are members of the most supervised generation in American history. Through their childhoods and teenage years, they have been monitored, tutored, coached and honed to an unprecedented degree.
Yet upon graduation they will enter a world that is unprecedentedly wide open and unstructured. Most of them will not quickly get married, buy a home and have kids, as previous generations did. Instead, they will confront amazingly diverse job markets, social landscapes and lifestyle niches. Most will spend a decade wandering from job to job and clique to clique, searching for a role.
No one would design a system of extreme supervision to prepare people for a decade of extreme openness. But this is exactly what has emerged in modern America. College students are raised in an environment that demands one set of navigational skills, and they are then cast out into a different environment requiring a different set of skills, which they have to figure out on their own.
Worst of all, they are sent off into this world with the whole baby-boomer theology ringing in their ears. If you sample some of the commencement addresses being broadcast on C-Span these days, you see that many graduates are told to: Follow your passion, chart your own course, march to the beat of your own drummer, follow your dreams and find yourself. This is the litany of expressive individualism, which is still the dominant note in American culture.
But, of course, this mantra misleads on nearly every front.
College grads are often sent out into the world amid rapturous talk of limitless possibilities. But this talk is of no help to the central business of adulthood, finding serious things to tie yourself down to. The successful young adult is beginning to make sacred commitments — to a spouse, a community and calling — yet mostly hears about freedom and autonomy.
Today’s graduates are also told to find their passion and then pursue their dreams. The implication is that they should find themselves first and then go off and live their quest. But, of course, very few people at age 22 or 24 can take an inward journey and come out having discovered a developed self.
Most successful young people don’t look inside and then plan a life. They look outside and find a problem, which summons their life. A relative suffers from Alzheimer’s and a young woman feels called to help cure that disease. A young man works under a miserable boss and must develop management skills so his department can function. Another young woman finds herself confronted by an opportunity she never thought of in a job category she never imagined. This wasn’t in her plans, but this is where she can make her contribution.
Most people don’t form a self and then lead a life. They are called by a problem, and the self is constructed gradually by their calling.
The graduates are also told to pursue happiness and joy. But, of course, when you read a biography of someone you admire, it’s rarely the things that made them happy that compel your admiration. It’s the things they did to court unhappiness — the things they did that were arduous and miserable, which sometimes cost them friends and aroused hatred. It’s excellence, not happiness, that we admire most.
Finally, graduates are told to be independent-minded and to express their inner spirit. But, of course, doing your job well often means suppressing yourself. As Atul Gawande mentioned during his countercultural address last week at Harvard Medical School, being a good doctor often means being part of a team, following the rules of an institution, going down a regimented checklist.
Today’s grads enter a cultural climate that preaches the self as the center of a life. But, of course, as they age, they’ll discover that the tasks of a life are at the center. Fulfillment is a byproduct of how people engage their tasks, and can’t be pursued directly. Most of us are egotistical and most are self-concerned most of the time, but it’s nonetheless true that life comes to a point only in those moments when the self dissolves into some task. The purpose in life is not to find yourself. It’s to lose yourself.

China update

IT BEGINS: China To Do 2-3 TRILLION Yuan Bailout Of Indebted Local Governments

China Faces Two New Inflationary Pressures, Even As The Economy Slows

SocGen: "The China Domino Has Fallen!", Big-Time Inflation Coming All Around The World

Did Bain Just Buy Another Chinese Fraud?

Jim Rogers Explains The Crisis That Could End The China Boom

Jim Rogers spoke to BBC's HardTalk about his investments in Asia, what he's short, and where he remains bullish.
Rogers defends his long-term position in Asia, noting that, while there are certain to be hiccups, it's a much better place to be investing than in the bankrupt countries of the west. He admits that there is a bubble in coastal Chinese real estate, but does not see it as being similar to the situation in U.S.
Rogers also spoke on what he sees as the number one problem for China's economy.
"I don't mind if China has civil war, epidemics, panics, depressions, all of that. You can recover from that. The only thing you cannot recover from is water," says Rogers. "If China doesn't solve its water problems than there's no China story." He says they're spending large amounts of money to solve this problem.
Rogers also engages in an impassioned fight over the role of speculation in the water market.

18 Facts About China That Will Blow Your Mind

More On The Chinese Domino Fundamentally Changing The World's Economic Outlook

China’s Economy Is Starting to Slow, but Threat of Inflation Looms

China’s economy is starting to slow, after two years of torrid growth achieved following the global downturn.
Chinese manufacturers’ backlogs of orders are gradually shrinking in many industries. Purchasing managers have become less optimistic about their businesses’ prospects. And after surging past the United States in car sales over the last two years, the Chinese auto market unexpectedly stalled last month, as carmakers curtailed production plans.
Because China’s cooling economy is partly a result of Beijing’s efforts to contain inflation, some economists are not worried, saying a slight slowdown could be positive. And they say that after the government eases off the brakes, economic growth should quickly pick back up.
But other experts worry that inflation is already so entrenched that the government may be forced to continue braking the economy for a considerable time.
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The problem lies in China’s extremely heavy dependence on investment in factories, infrastructure and apartment buildings to sustain growth. The slowly rising levels of debt at local governments and large companies that have financed that investment indicate it may not be sustainable.
At the same time, the economic returns on new highways and other public infrastructure projects are declining, now that the best locations have already been built up, and as planners extend construction to less affluent and more remote areas. While some economists predict this effect will take five or more years to become serious, others warn it could hit sooner.
“Growth will slow significantly in two or three years — the timing will be determined politically,” said Michael Pettis, an associate professor of finance at the Guanghua School of Management at Peking University. “And the slowdown will last much longer than anyone expects — perhaps over a decade.”

California update

Some guidelines on how to be a true Angeleno. Don't fawn over celebrities, use your turn signals and, perhaps most important, appreciate legendary Dodgers broadcaster Vin Scully. There are others, of course, and you can add your own. It's all part of loving L.A.

Ex-Vernon leader will continue receiving $500,000 pension despite pleading guilty to misusing city funds

Loophole allows officials convicted of public corruption to keep hefty pensions

Capitol Journal: An on-time budget for a change? As the political landscape shifts around them, California lawmakers have several compelling reasons this year to deliver a budget when the state Constitution says they must.

The landscape will be shifting at the state Capitol. Political dynamics are in transition. And the first unmistakable sign may be the Legislature's meeting its budget deadline for the first time in a generation.
The California Constitution says flat-out that "The Legislature shall pass the budget bill by midnight on June 15…." Yet, the lawmakers haven't completed their budget work on time since 1986.
Who cares? Teachers sweating layoff notices, not knowing whether there'll be enough money to fund their jobs in September. Vendors who sell to the state, wondering whether they'll be stiffed again this summer. There's a long list.
Then there are millions of disgusted people who don't feel directly affected by the budget, but just understand instinctively that well-paid elected officials with generous perks should do their work on time. No excuses. That's why the Legislature's job approval rating among voters is mired in the sorry teens.
I'm an eternal optimist who admittedly too often overestimates the common sense of politicians. But I do detect some rehab underway. I'm thinking they'll kick their habits of intransigence and vacillation and pass a final budget by the deadline.

Ridding the state of foam. Legislation that would ban foam in much of California is a big step forward, but it should be amended to allow a more gradual shift.

California authorities deny state's first medical parole case. A quadriplegic inmate serving a 150-year term for kidnapping, beating and raping a San Diego woman in 1998 will not be released to the care of family members under a new law, parole board rules.

Droughts and deficits in California. Whether it's rain or revenue, one good year doesn't mean California should be imprudent.

This Brand New $105 Million High School In Riverside, California Is Too Broke To Hold Any Classes

Environment and food update

U.S. Declines to Protect the Overfished Bluefin Tuna

Curbing our junk-food appetite. Regulating the country's way to slimness is a complicated task, if it can be done at all.

If only food were as simple as cigarettes. There are no ambiguities about the evils of smoking. It sickens people who do it and endangers those around them. Despite remarkable progress in persuading people not to take up the habit in recent decades, smoking is still the No. 1 preventable cause of death in this country, and it has no known health benefits.
Overeating, especially of low-nutrition junk food, is a bad habit too. Obesity is a fast-rising threat to American health. Yet, unlike with cigarettes, we can't "quit" food. An occasional indulgence in dessert or potato chips is unlikely to hurt most of us as long as our overall diets are sound. While it is illegal to sell cigarettes to children, it's not illegal to manufacture junk foods that are meant to appeal to children or to sell junk food to them.
Regulating the country's way to slimness, then, is a complicated task, if it can be done at all. For the last two years, the Federal Trade Commission has headed up a multi-agency group attempting to tackle one corner of the obesity epidemic by proposing rules on the marketing of junk food to young children. Food commercials are a staple of children's programming on television, and most of the ads are not pushing fresh broccoli and steamed halibut. The clever ads and promotions aimed at consumers who are too young to be aware that they're being duped are a troubling part of life in the American marketplace; kids can be easily persuaded to do things that are unhealthy for them, and they have little concept of long-term consequences. The appealing advertising makes it harder for even conscientious parents to keep a lid on the amount of soda, sugared cereal and fast food in their children's lives. The nagging for a Happy Meal can be nonstop, and the peer pressure is intense.
This spring, the FTC panel produced a preliminary set of voluntary guidelines for the food industry, a document that could be labeled "Advertise This, Not That." It calls on companies to promote foods to children that contain fruits, vegetables, whole grains and other nutritious ingredients, and to steer away from marketing products high in saturated fat, sugar, salt and the like. After the public comment period (which ends June 13) and amendments, the guidelines would take effect in five years, enough time for food companies to reformulate their products and make them healthy — or at least healthier.

The guidelines have been fiercely criticized for being just that — guidelines, rather than mandates. We certainly don't expect them to have a huge effect on American nutrition or obesity. The hope is that companies will feel pressure to comply voluntarily, but the reality is that companies will probably make just enough improvements in their foods, and remove enough of their most egregious ads, to look like good citizens. PepsiCo, which sells Fritos corn chips, Cracker Jack and many other snack foods along with its sodas, has been reformulating products on its own — experimenting, for instance, with salt crystals that give chips the same flavor with less sodium. The big profits are in processed foods, and as long as that's true, Saturday morning cartoons will not be interrupted with pitches for homemade broiled chicken and brown rice but for somewhat more nutritious versions of the same old stuff.

Obama taps John Bryson for Commerce secretary, highlighting green energy initiatives at Edison

NASA's Sustainability Base generates buzz for its eco-friendly architecture. The $20-million Silicon Valley office building, expected to be completed by mid-July, incorporates technology used by astronauts and will generate more electricity than it consumes.

Wal-Mart's green hat. The company gets that a smaller carbon footprint is good for business.

Since 2005, Wal-Mart's "evil empire" has lowered the carbon footprint of its stores by more than 10% and of its trucking fleet by several times that amount. Better fuel and energy efficiency, streamlined trucks, energy-saving lighting and refrigeration and better route planning have saved Wal-Mart hundreds of millions of dollars. The retailer also has shown its suppliers in the United States and China how to lower their carbon emissions and energy bills by 20% to 60%.
Reducing packaging, meanwhile, has saved hundreds of millions in shipping and materials costs and comparable numbers of trees, and an ongoing effort to shrink all product packages by 5% and make what's left more recyclable will save the company an estimated $3.4 billion. (The most familiar example: A Wal-Mart demand to manufacturers to shrink laundry detergent bottles saved, over three years, 400 million gallons of water, 95 million pounds of plastic, 125 million pounds of cardboard and half a million gallons of diesel fuel because of the reduced shipping weight and bulk.)
A seemingly unrealistic goal of zero waste to landfills is suddenly looking attainable; the company cut its waste 81% in California, a pilot program now going nationwide. The trick to it was finding new uses for former trash: turning plastic waste into dog beds, food waste into compost sold in its stores, expired but still healthful foods into food bank donations. The waste Wal-Mart once paid to have hauled away is now earning the company more than $100 million a year.
Big manufacturers such as Unilever and General Mills, as well as sustainability pioneers that once criticized Wal-Mart — Patagonia and Seventh Generation — have partnered with the retailer on green efforts. Lately, whole industry groups, including leading apparel companies, electronics and dairy, have announced related initiatives to become greener and to go public with the information on how clean — and dirty — their products are.
The golden age of environmentalism is long over. The days when 20 million Americans showed up forEarth Day and pressured Congress into creating landmark bipartisan legislation to protect air, water and endangered species are unlikely to return any time soon. Back then the enemy of the environment was big business. Today, businesses provide one of the few encouraging trends on the environment, a way to turn the tables and show that opponents to investing in green are the ones hurting America.
Outsourced global companies like Wal-Mart can never be completely green or sustainable. But they can do better, and some of them are doing better. Their realization that profit and planet can and must live on the same side of the ledger sheet puts them way ahead of most politicians and voters.
For environmentalists, this business case for sustainability should be one of the most critical messages of our time. There's a lot of talk about it among insiders and true believers at green business conferences, but it's barely a whisper as far as Washington and the American public are concerned. It ought to be a drumbeat.

Healthcare update

Physician-owned hospital fights reform limits

Medical data protections ramp up

Feds hold execs accountable for health fraud

To the dismay of the corporate C-suite, federal enforcers are tackling healthcare fraud by targeting the top executives of healthcare enterprises, nursing homes, drug companies and medical device manufactures.
To prevent repeat offenses, the federal government, including the Food and Drug Administration and the Justice Department, is laying down the law and increasing penalties. In addition to the standard fines normally associated with settling fraud, corporate executives are facing criminal charges and exclusions from government health programs, according to the Associated Press.
"When you look at the history of healthcare enforcement, we've seen a number of Fortune 500 companies that have been caught not once, not twice, but sometimes three times violating the trust of the American people, submitting false claims, paying kickbacks to doctors, marketing drugs which have not been tested for safety and efficacy," said Lewis Morris, chief counsel for the inspector general of the Health and Human Services Department.
The idea of targeting select individuals for wrongs committed by an organization is based on the Park Doctrine, a 1975 Supreme Court ruling in which a company president was held accountable for corporate noncompliance.
Medicare fraud costs taxpayers $60 billion each year, according to the AP.

Many in GOP who oppose health insurance requirement used to favor it. Before Obama's healthcare law, mandating medical coverage was a mainstream Republican idea.

Administration Opposes Challenges to Medicaid Cuts

As Physicians’ Jobs Change, So Do Their Politics

Doctors were once overwhelmingly male and usually owned their own practices. They generally favored lower taxes and regularly fought lawyers to restrict patient lawsuits. Ronald Reagan came to national political prominence in part by railing against “socialized medicine” on doctors’ behalf.
But doctors are changing. They are abandoning their own practices and taking salaried jobs in hospitals, particularly in the North, but increasingly in the South as well. Half of all younger doctors are women, and that share is likely to grow.
There are no national surveys that track doctors’ political leanings, but as more doctors move from business owner to shift worker, their historic alliance with the Republican Party is weakening from Maine as well as South Dakota, Arizona and Oregon, according to doctors’ advocates in those and other states.
That change could have a profound effect on the nation’s health care debate. Indeed, after opposing almost every major health overhaul proposal for nearly a century, the American Medical Association supported President Obama’s legislation last year because the new law would provide health insurance to the vast majority of the nation’s uninsured, improve competition and choice in insurance, and promote prevention and wellness, the group said.

A lid on health insurance rate increases. California regulators should be given the power to reject unreasonable increases in health insurance premiums.

Medicare Plan for Payments Irks Hospitals

For the first time in its history, Medicare will soon track spending on millions of individual beneficiaries, reward hospitals that hold down costs and penalize those whose patients prove most expensive.
The administration plans to establish “Medicare spending per beneficiary” as a new measure of hospital performance, just like the mortality rate for heart attack patients and the infection rate for surgery patients.
Hospitals could be held accountable not only for the cost of the care they provide, but also for the cost of services performed by doctors and other health care providers in the 90 days after a Medicare patient leaves the hospital.

Education update

Steven Pearlstein: Mark them tardy to the revolution

Now that’s about to change. The cost of education has gotten so high, student achievement has become so disappointing, and the technology and computerized pedagogy are now sufficiently developed and ubiquitous that the long-awaited revolution in education is about to begin.
It’s not just me who thinks so. Just last week, at a digital run-up to the G-8 summit meeting in France, Rupert Murdoch announced that his News Corp. would be getting into the business of developing digital learning content and systems “in a big way.” There is now an entire ecosystem of venture capitalists, social entrepreneurs, angel investors and philanthropists eager to provide risk capital for technology-based education startups. A blue-ribbon advocacy group, the Digital Learning Council, was launched last fall by former governors Jeb Bush of Florida and Bob Wise of West Virginia. And, naturally, there’s even a new blog devoted to the subject, EdSurge, launched by my former Washington Post colleague Betsy Corcoran.
The person who has emerged as the pied piper of this movement, however, is Salman Khan, a former math geek and young hedge fund analyst who five years ago began making 10-minute videos to help his struggling nieces with their math homework. For convenience sake, he posted them on YouTube and found to his surprise that other people liked them, as well.
Today, the Khan Academy Web site boasts 2,300 separate math tutorials, from simple addition to vector calculus, that have been viewed more than 50 million times by more than 2 million students and are in active use in more than a thousand classrooms across the country.

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What is even more exciting — or threatening, depending on your point of view — is what the Khan Academy model might do to the rest of the educational establishment.
Think about it for a minute. If education moves to a teaching model in which students learn through online tutorials, exercises and evaluations created by a handful of the best educators in the world, then how many teachers will we need preparing lesson plans and delivering lectures and grading quizzes and tests? Surely we’ll need some for one-on-one tutoring, or to run small group discussions, or teach things that can’t or shouldn’t be taught online. Despite assurances to the contrary, however, there’s likely to be fewer than we have now — fewer but better-paid with more interesting jobs — just as has happened in nearly every other industry that has gone through a similar transformation.
The disruption doesn’t stop there. If students are allowed to progress through each subject at their own pace, they won’t be second-graders or sixth-graders any longer, since at any time they are likely to be at different grades in different subjects. Indeed, the whole notion of a 45-minute “class,” or the six-hour “school day,” or even the August through June school “calendar” — the entire framework of the educational experience — will become somewhat irrelevant. And as Khan loves to point out, grading will suddenly become simple: Everyone gets an A in every course, with the only question being how long it takes each student to earn it.
Given these implications, you can understand why the education establishment has been in no hurry to embrace a digital future. The battles over standardized testing and adoption of common national standards were just the warm-up. Now that the opposition to them has been largely overcome, capital and creative talent will pour in to develop both the hardware and the software of the new education technology.
Over the next decade, look for teaching to be transformed from an art into something much closer to a science, look for learning to become highly individualized, and look for education to go from being a cottage industry to one that takes full advantage of the economies of scale and scope. And as in every other industry, look for quality to go up and cost to go down.
Sal Khan, of course, had none of that in mind when he set out to help his niece Nadia with her seventh-grade math homework. But the fact that he and his “academy” have drawn so much support and attention is a pretty good indication that this revolution is finally about to begin.

Instead of Student Loans, Investing in Futures

Sneider’s dream was to attend college so he could become a nurse and serve his community. To do so, he needed $8,500 — a sum that is close to the average annual income in Colombia. The problem is that financial aid and student loans are far less abundant in Colombia than they are in the United States. Sneider, who was unable to provide collateral or a cosigner, had little hope of getting a loan from a traditional lender.
Here’s the deal that Lumni struck with him: In exchange for $8,530 in financing, Sneider agreed to repay 14 percent of his salary for 118 months after he graduated. At that point, regardless of how much he has paid, his obligation terminates. Although this might sound similar to a loan, an “income contingent” repayment plan like this is far less risky for a low-income student like Sneider. If he has trouble finding a job or switches careers and earns a lower salary than expected — very distinct possibilities — his payments will drop automatically. The terms are, in fact, determined based on his expected earnings. If he ends up earning the average salary for nurses in Colombia, he will end up paying the equivalent of an interest rate of 17 percent, which is the average rate in the country for a student loan. And if he ends up doing better, he will pay more, and Lumni will share in his success.

Healthcare update

Wait! Paul Ryan has a point

Put this numbers game aside, however, and you still have the multitrillion-dollar point: In any other wealthy nation, a Ryan-sized voucher would more than suffice to ensure high-quality health care for seniors. In Singapore, it would be seen as offering an outrageous bonanza for the Medical Industrial Complex.
If you’re with me so far, the Democratic case on Medicare (as well as the GOP’s case last election) is therefore caught between two claims that can’t both be true: (1) we spend much more on health care than anybody else without better results; and (2) if we cut the growth of this spending to below the rate of GDP growth, we’d have to curtail Americans’ access and quality of care. No matter how often and how loud the interest groups, politicians and other forces of the status quo scream the latter, it cannot be true if the former is a fact.
And America’s health-care inefficiency is, in fact, a fact.
Ryan’s plan is thus a roundabout way of bringing us to the question of how we can best wring out the excess in American health care. The politics of any such effort are perilous not only because seniors are easily scared, but because every dollar of health care “waste” is somebody’s dollar of income.

Don’t Scorn Paul Ryan

Patients not taking medications cost $300B

The GOP 2012 Hopefuls Who Supported a Health Care Mandate

Why Medical School Should Be Free

Huge medical school debts — doctors now graduate owing more than $155,000 on average, and 86 percent have some debt — are why so many doctors shun primary care in favor of highly paid specialties, where there are incentives to give expensive treatments and order expensive tests, an important driver of rising health care costs.
Fixing our health care system will be impossible without a larger pool of competent primary care doctors who can make sure specialists work together in the treatment of their patients — not in isolation, as they often do today — and keep track of patients as they move among settings like private residences, hospitals and nursing homes. Moreover, our population is growing and aging; the American Academy of Family Physicians has estimated a shortfall of 40,000 primary care doctors by 2020. Given the years it takes to train a doctor, we need to start now.
Making medical school free would relieve doctors of the burden of student debt and gradually shift the work force away from specialties and toward primary care. It would also attract college graduates who are discouraged from going to medical school by the costly tuition.
We estimate that we can make medical school free for roughly $2.5 billion per year — about one-thousandth of what we spend on health care in the United States each year. What’s more, we can offset most if not all of the cost of medical school without the government’s help by charging doctors for specialty training.

Hospitals hunt substitutes as drug shortages rise

Can managed care help save Medicaid?

This week, California will begin to place all of its elderly and disabled Medicaid patients — the costliest, most illness-prone beneficiaries — into managed care programs under a waiver it received from the Obama administration in October. Although these long-term care patients make up only about a quarter of Medicaid patients nationwide, they’re responsible for two-thirds of the program’s expenditures. Certainly, the projected cost-savings of California’s plan are ambitious: The state budget calls for 10 percent savings through managed care over traditional fee-for-service, giving insurers a fixed lump sum for each Medicaid rather than directly paying doctors and other providers for individual services. Managed care proponents argue that these systemic changes — which include better care coordination, closer assessment of which services are necessary, and incentives for doctors to choose more cost-effective treatments — will save states money without sacrificing the quality of care.
Similarly desperate to rein in Medicaid costs, states including Tennessee, Rhode Island, Kentucky, New Jersey and Florida have also pushed to expand managed care to cut Medicaid costs. In recent months, for example, a handful of states have followed California’s lead by placing elderly and disabled Medicaid enrollees — known as “Seniors and People with Disabilities,” or SPDs — into mandatory managed care. In some respects, the move is simply the next step of the managed care expansion that began in the 1990s and has grown steadily since then. Over 70 percent of Medicaid beneficiaries nationwide are in some version of managed care, and the current fiscal crunch has accelerated its expansion.
But the California example is also telling of the concerns and questions surrounding the growth of managed care for Medicaid patients. In 2005, then-Gov. Arnold Schwarzenegger similarly proposed to make managed care mandatory for SPDs — a bill that was ultimately scuttled due to concerns that would compromise good patient care. Although some managed care companies have now spent decades covering Medicaid patients, they’ve mostly covered the program’s youngest and healthiest patients and have comparatively little experience overseeing elderly and disabled patients who require long-term care and have far greater medical demands.
The worry among consumer advocates is that HMOs and other managed care companies will end up cutting corners at the expense of a particularly vulnerable population. “The details matter a lot. SPDs have unique needs we don’t meet particularly well,” says Harold Pollack, chair of the University of Chicago’s Center for Health Administration Studies. What’s more, some have cast doubt on the projected savings that HMOs have touted: A 2005 study by the Robert Wood Johnson Foundation, for example, showed that an earlier expansion of managed care in California’s Medicaid actually increased costs to the state by as much as 17 percent without improving health outcomes.

Random Links

Tornadoes made of fire and water

Real Pirates Actually Terrifying, Discovered Shipwreck Reveals

A Trip to the Creation “Science” Museum

In Florida, Criminals Pose as Police More Frequently and for More Violent Ends

Human behavior: What's bugging you? Annoyance captures elements of other emotions but belongs exclusively to none.

Human memory: What did you do last Sunday? Why is it so hard to recall mundane events? Because they are mundane.

Gregory Rodriguez: The unhappy white majority. Over the past decade, we've seen a rising tide of aggrieved white folks. This doesn't bode well. When even the majority group sees itself in a struggle for status and respect, it erodes any notion of the collective good.

Brains Now Grow in Petri Dishes

The quote says it all

Saudi prince calls for lower oil prices

Saudi Prince Al-Waleed bin Talal said Sunday that he wants oil prices to drop so that the United States and Europe don't accelerate efforts to wean themselves off his country's supply.
In an interview broadcast Sunday on "CNN's Fareed Zakaria GPS," the grandson of the founding king of modern Saudi Arabia said the oil price should be somewhere between $70 and $80 a barrel, rather than the current level of over $100 a barrel.
"We don't want the West to go and find alternatives, because, clearly, the higher the price of oil goes, the more they have incentives to go and find alternatives," said Talal, who is listed by Forbes as the 26th richest man in the world.

Wake up America!!!

Middle East Update

Pay Attention

Egypt’s economy has nose-dived since the uprising, and the new government really does need the money to stay afloat. But I only hope that Obama and Secretary of State Hillary Clinton understand that right now — right this second — Egypt needs something more from Washington than money: quiet, behind-the-scenes engagement with Egypt’s ruling generals over how to complete the transition to democracy here.
Here’s why. After the ouster of Mubarak in February, his presidential powers were shifted to a military council, led by the defense minister. It’s an odd situation, or as the Egyptian novelist Alaa Al Aswany, author of “The Yacoubian Building,” put it to me: “We have had a revolution here that succeeded — but is not in power. So the goals of the revolution are being applied by an agent, the army, which I think is sincere in wanting to do the right things, but it is not by nature revolutionary.”
To their credit, the Egyptian generals moved swiftly to put in place a pathway to democracy: elections for a new Parliament were set for September; this Parliament will then oversee the writing of a new Constitution, and then a new civilian president will be elected.
Sounds great on paper, and it was endorsed by a referendum, but there’s one big problem: The Tahrir Square revolution was a largely spontaneous, bottom-up affair. It was not led by any particular party or leader. Parties are just now being formed. If elections for the Parliament are held in September, the only group in Egypt with a real party network ready to roll is the one that has been living underground and is now suddenly legal: the Islamist Muslim Brotherhood.

The Weak Foundations of Arab Democracy

The preconditions for democracy are lacking in the Arab world partly because Hosni Mubarak and other Arab dictators spent the past half-century emasculating the news media, suppressing intellectual inquiry, restricting artistic expression, banning political parties, and co-opting regional, ethnic and religious organizations to silence dissenting voices.
But the handicaps of Arab civil society also have historical causes that transcend the policies of modern rulers. Until the establishment of colonial regimes in the late 19th century, Arab societies were ruled under Shariah law, which essentially precludes autonomous and self-governing private organizations. Thus, while Western Europe was making its tortuous transition from arbitrary rule by monarchs to democratic rule of law, the Middle East retained authoritarian political structures. Such a political environment prevented democratic institutions from taking root and ultimately facilitated the rise of modern Arab dictatorships.
Strikingly, Shariah lacks the concept of the corporation, a perpetual and self-governing organization that can be used either for profit-making purposes or to provide social services. Islam’s alternative to the nonprofit corporation was the waqf, a trust established in accordance with Shariah to deliver specified services forever, through trustees bound by essentially fixed instructions. Until modern times, schools, charities and places of worship, all organized as corporations in Western Europe, were set up as waqfs in the Middle East.
A corporation can adjust to changing conditions and participate in politics. A waqf can do neither. Thus, in premodern Europe, politically vocal churches, universities, professional associations and municipalities provided counterweights to monarchs. In the Middle East, apolitical waqfs did not foster social movements or ideologies.

Politics and government links

Paul Ryan gets a taste of his own shameless demagoguery

21st-Century Regulation: An Update on the President's Reforms. Federal agencies are eliminating unnecessary rules to save businesses money.

Army report: Military has spent $32 billion since ’95 on abandoned weapons programs

Judd Gregg Hired By Goldman Sachs As International Advisor

Report: Major weapons makers see networks breached by hackers

Patriot Act renewed despite warnings of 'secret' law

Does Anyone Think Sarah Palin Can Handle A Crisis? The White House Isn't American Idol

George Will: Everyone Knows Sarah Palin Should Not Be Trusted With Nuclear Weapons

All Americans have a duty to honor Memorial Day

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As a boy I had a vague appreciation for Memorial Day because my father, a Vietnam veteran, treated it as sacrosanct. After watching the morning parade in our home town, he spent time alone, somber and distant, while my friends flocked to the beaches and malls with their families to celebrate the beginning of summer.
Were they wrong to celebrate, I wondered.
I didn’t know. My father rarely spoke about his five years in the Marines. It wasn’t until I was an adult that I realized he still carried the war with him every day, along with the faint scar across his cheek from an enemy bullet that somehow didn’t kill him in a jungle 13 years before I was born.
My father was conflicted when I received a Marine Corps-option ROTC scholarship for the University of North Carolina at Chapel Hill. As pleased as he was that I had chosen to serve, he knew the costs of war. He knew that the U.S. military could be misused, as it had been in Vietnam. He knew that the line between defender and aggressor is permeable, and that good men can cross it easier than many of us imagine is possible.
I didn’t understand any of this as a teenager, and I was confused by his ambivalent response to my career choice. I didn’t see his hidden dichotomy, a divide that affects many veterans. For as much friendship, meaning and identity as the Marine Corps gave him, it also crippled his body and darkened his spirit.
My father never acknowledged his wounds publicly, in part because so many gave everything. Memorial Day is theirs — the war dead — and that is why it is sacrosanct. It belongs to the fallen in each of our nation’s wars, including the misguided ones. For better and worse, each death shaped our nation. Each death contributed to what we are today.
My own war experience in Iraq in 2005 and 2006 was far different from my father’s. I wasn’t wounded. Fortunately, none of the men in my company were killed in action during our tour. But now I know my father’s melancholy on Memorial Day. I feel it, and it’s the reason I found myself on the verge of lashing out last week when a salesman on the street thrust a flier into my hands titled “Memorial Day Blow-out Sale.”
I regained composure and thought about the question I had asked myself as a child: Were they wrong to celebrate?
Few Americans would disagree with the sanctity of Memorial Day. Yet the holiday has become a shopping spree, a party. Retail sales surge as stores release new summer offerings. The holiday weekend is among the top 10 shopping periods each year. Meanwhile, the local parade in my home town is more sparsely attended, and fewer people appear to travel to cemeteries to pay respects to the war dead.
These trends are likely to continue now that the levels of violence have dropped in Iraq and Afghanistan, and American service members appear less frequently in the media. They will continue unless we are more deliberate with our time. After all, our values are shaped by where and how we spend our time.
Memorial Day weekend doesn’t need to be a somber event for all. Naturally, it will be different for those families whose lives have been scarred by combat. But you don’t need to have experienced war to pay your respects.
So this Memorial Day weekend consider taking a half-hour to honor our war dead. Have a conversation with your children or your parents. Pause. Reflect. If you can make more time, visit a cemetery or take a child to a local parade, then talk to them about service. If you can’t travel, watch a Memorial Day concert or parade. Whatever it is, do something deliberate and out of your way.
Is it wrong to celebrate?
No, it’s not wrong. But it will be a far more meaningful celebration if it starts with recognizing why we have the opportunity to celebrate.
Rye Barcott is the author of “It Happened on the Way to War: A Marine’s Path to Peace.”

Walmart's How Big? What the Huge Numbers Really Mean

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When it comes to companies, it can be hard to get a feel for their size. They may say they're "big," but what does that actually mean? Consider Walmart (WMT), for example. This year, for the seventh time in the past decade, Fortune magazine awarded the retailer the No. 1 slot on its annual list of the 500 largest American companies, as measured by revenues (total earnings before subtracting out expenses).
But how big is Walmart really? The numbers provided by Fortune are so insanely large that they're hard to wrap your head around in the abstract. So I did a little digging and came up with some pretty stunning comparisons.
According to Fortune, Walmart sold $421,849,000,000 worth of stuff last year. The largest purchase most of us will ever make is our house: If all Walmart sold were new homes, which averaged $268,900 in April, that would be almost 1.59 million homes.
That's also just about the same amount of money that the United States spent in 2009 for the entire year's worth of Medicare, the government program that provides health insurance to senior citizens and younger Americans who are permanently disabled. That $421.8 billion is also about $9 billion less than Taiwan's 2010 gross domestic product -- the total value of the country's goods and services in a single year -- and $7 billion more than Norway's 2010 GDP. In other words, if Walmart were a country, it would be the 25th largest economy in the world.
Speaking of countries, let's talk population: Fortune reports that 2.1 million people work at Walmart, which means there are about as many Walmart employees sprinkled across the globe as there are people living in the African country of Namibia (yes, that Namibia, where Anegelia Jolie gave birth). There are another 95 countries with populations smaller than the retailer's sprawling workforce, including Botswana, Kosovo, The Gambia, Trinidad and Tobago, Bahrain, Cyprus, Qatar, Luxembourg, Belize, Iceland, The Bahamas and Greenland.
And how much land would Walmart the country hold? The company has 952,203,837 square feet of retail space, or roughly 34.16 square miles. That's just about 1.5 times the size of the borough of Manhattan. And that's just the stores: We're not even including their offices or distribution facilities ... or their gigantic parking lots.
Discussing parking lots, naturally, brings us to driving. According to Fortune, the company's nearly 8,000 drivers logged 749 million miles in 2010, the equivalent of circling the Earth not once, not twice, not a thousand times, but 30,000 thousand times. No wonder Fortune once called the retailer "Planet Walmart." It does feel like they are creating a branded, discount world in which we are all headed for citizenship, whether we like it or not.

Climate change and energy update

Shell Gas Plant To Be Biggest Floating Object Ever

Texas drought has farmers on the ropes. West Texas farmers and ranchers struggle to survive the worst drought in the region since the Dust Bowl of the 1930s.

Detroit’s Rebound Is Built on Smaller Cars

Facing Up to End of 'Easy Oil'

Using steam to extract oil isn't a new idea. Chevron has been using the method to recover heavy oil at its Kern River field in Bakersfield, Calif., since the 1960s. That field yielded less than 10% of its oil using traditional methods. Using steam injection, Chevron is now on its way to pumping as much as 80% of the crude.
The Wafra project, however, is far more of a challenge than traditional steam projects. As in most of the Middle East, the oil at Wafra is trapped in a thick layer of limestone that also contains minerals that can build up inside pipes and corrode equipment.
An even bigger challenge is getting the two crucial elements for generating steam: water and a source of energy to boil it. Most successful steam projects are in places with easy access to relatively pure water and a cheap fuel source, usually natural gas. Saudi Arabia and Kuwait have little of either.
With no fresh-water sources in the Arabian desert, Chevron has been forced to use salt water found in the same underground reservoirs as the oil. That water is full of contaminants that must be removed before it can be boiled and injected into the ground.
Finding the energy to boil the water will be even tougher. Chevron could use oil instead of natural gas—literally burning oil to produce oil—but that would burn profits, too. So the company likely will be forced to import natural gas from overseas, an expensive process that involves chilling it to turn it into a liquid, then shipping it thousands of miles.
Some experts are shaking their heads.
"They're in trouble," says Robert Toronyi, a retired Chevron engineer who now serves as chief operating officer for Quantum Reservoir Impact, a Houston-based consulting firm. He says the project is so challenging that it will be hard for Chevron to turn much of a profit.

Shale Boom in Texas Could Increase U.S. Oil Output

Worst ever carbon emissions leave climate on the brink

Greenhouse gas emissions increased by a record amount last year, to the highest carbon output in history, putting hopes of holding global warming to safe levels all but out of reach, according to unpublished estimates from the International Energy Agency.
The shock rise means the goal of preventing a temperature rise of more than 2 degrees Celsius – which scientists say is the threshold for potentially "dangerous climate change" – is likely to be just "a nice Utopia", according to Fatih Birol, chief economist of the IEA. It also shows the most serious global recession for 80 years has had only a minimal effect on emissions, contrary to some predictions.
Last year, a record 30.6 gigatonnes of carbon dioxide poured into the atmosphere, mainly from burning fossil fuel – a rise of 1.6Gt on 2009, according to estimates from the IEA regarded as the gold standard for emissions data.

The Massive Sea Change Happening In The American Energy Industry

U.S. Energy Consumption Is Well Below Peak, And That's Not A Good Thing

Germany to scrap nuclear power by 2022

The Nuclear Industry Just Took Its Second Devastating Blow This year

Ignorant fool: Sarah Palin bus tour starts, No bus, but there are motorcycles.
Former Alaska Gov. Sarah Palin rides into a motorcycle rally at the Pentagon wearing black leather and declaring, 'I love that smell of the emissions!' It's an untraditional start for such an event, which is usually highly orchestrated.

Economics and finance links

In Today's Economy, There Are Only TWO Factors That Explain A Country's Growth

In Germany "Corporate Orgies Have Grown In Popularity"

U.S. Regional Unemployment Rates

U.S. manufacturing attempts a high-tech comeback. An unusual public-private partnership to build a high-tech industrial cluster in Albany, N.Y., could provide the framework for economic revitalization nationwide.

French President Says Bondholders Must Share Greek Pain; Greece Mulls Setting up Bad Bank; Lagrade Says Greece Needs "Support" Not Restructuring

Greece’s Debts Are Europe’s Problem

Here's What's Going To Happen When Greece Defaults

Why Are Investors Still Lining Up for Bonds?

In Today's Economy, There Are Only TWO Factors That Explain A Country's Growth

Billionaire Howard Marks On The One Question That Every Investor Should Ask About Every Investment

GREECE: There Are New Emergency Bailout Talks That Could Spell The End Of National Sovereignty

The Time For Soft Options In Greece Is Over As The Crisis Escalates To The Existential Level

Currency Guru Stephen Jen Gives 4 Reasons The Euro Crisis Will Only Get Worse

Europe at the Abyss; US Housing in the Abyss; Who is to Blame?

Panic Capital Flight in Greece, Depositors Yank 1.5 Billion Euros in 2 Days;EU Wants Severe Bail-Out Conditions Including International Tax Collection

Here Are The Latest Details On Greece Vs. "The Troika"

Against Learned Helplessness

20 Questions To Ask Anyone Foolish Enough To Believe The Economic Crisis Is Over

Greece set for severe bail-out conditions

European leaders are negotiating a deal that would lead to unprecedented outside intervention in the Greek economy, including international involvement in tax collection and privatisation of state assets, in exchange for new bail-out loans for Athens.
People involved in the talks said the package would also include incentives for private holders of Greek debt voluntarily to extend Athens’ repayment schedule, as well as another round of austerity measures.
Officials hope that as much as half of the €60bn-€70bn ($86bn-$100bn) in new financing needed by Athens until the end of 2013 could be accounted for without new loans. Under a plan advocated by some, much of that would be covered by the sale of state assets and the change in repayment terms for private debtholders.
Eurozone countries and the International Monetary Fund would then need to lend an additional €30bn-€35bn on top of the €110bn already promised as part of the bail-out programme agreed last year.
Officials warned, however, that almost every element of the new package faced significant opposition from at least one of the governments and institutions involved in the current negotiations and a deal could still unravel.
In the latest setback, the Greek government failed on Friday to win cross-party agreement on the new austerity measures, which European Union lenders have insisted is a prerequisite to another bail-out.
In addition, the European Central Bank remains opposed to any restructuring of Greek debt that could be considered a “credit event” – a change in terms that could technically be ruled a default.
One senior European official involved in the talks, however, said ECB objections could be overcome if the rescheduling was structured properly.
Despite the hurdles, pressure is building to have a deal done within three weeks because of an IMF threat to withhold its portion of June’s €12bn bail-out payment unless Athens can show it can meet all its financing requirements for the next 12 months.
Officials think Greece will be unable to return to the financial markets to raise money on its own in March – as originally planned in the current €110bn package – meaning that the IMF is now forbidden from distributing any additional cash. Without the IMF funds, eurozone governments would either be forced to fill the gap or Athens could default.
To bring the IMF back in, the new deal must be reached by a scheduled meeting of EU finance ministers on June 20.

What happens if Congress goes home

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You should really read Brad DeLong’s survey of the economy, circa 2011. An excerpt:
It is a fact that if congress simply goes home — doesn’t do anything for the next 10 years except keep the federal government on autopilot, or if it does do things if it pays for whatever increases in spending it enacts by raising taxes and pays for whatever tax cuts it enacts by cutting spending — that we do not have a long run deficit problem. If congress goes home for ten years our program spending is matched to our tax revenues, which means a declining debt burden because the growth rate of the economy is larger than the interest rate on our debt.
Our belief that we have a long-run deficit problem is based upon the belief that congress will pass laws that increase spending and that cut taxes--that it will repeal the Independent Payment Authorization Board’s authority to try to make Medicare more efficient, that it will repeal the Affordable Care Act’s tax on high-cost health plans. Given that the fear is based on a belief that some future congress will bust the budget, it is hard to see how we can address this fear through any possible piece of legislation today--for no congress can bind its successors.
Related: The do-nothing deficit plan.

Several links to excellent essays

Deepwater Horizon’s Final Hours

How American Health Care Killed My Father

How the Obesity Crisis Is Like the Mortgage Crisis

The Serpent King

What Killed Aiyana Stanley-Jones?

Why the Rich Are Getting Richer

How a Different America Responded to the Great Depression

Inside the Battle to Define Mental Illness

Immigration update

Yes, we can fix immigration

Let in the Super-Immigrants! The best way to improve the U.S. economy fast is to poach entrepreneurs from the rest of the world. So why do we make it so difficult for them to immigrate?

E-2 visa helps many non-U.S. citizens start small firms

Economics and finance links

The Internet Is 20% Of Economic Growth

There's A Whole Bunch Of New Evidence That The Economy Is Slowing Down

Hyperinflation Nonsense in Multiple Places

Which countries are most in favor of the free market?

On Investing: The many hats of great investors

Republican leaders say budget cuts would aid economic growth immediately

G.O.P. Lawmakers Vote to Delay Derivatives Rules

Banking industry posts best quarter of profits since early 2007

Bailing Out the ECB; Hidden Cost of Saving the Euro; ECB Time Bombs Continue to Tick

Florida foreclosures mired in overburdened court system

Fed Gave Banks Crisis Gains on Secretive Loans Low as 0.01%

Federal Reserve Lending Revelations Intensify Criticism Of Central Bank's Secrecy

Environment update

EPA delays rule on industrial emissions. The regulation to limit pollutants at power plants at major industrial facilities is suspended after protests from industry. It is the Obama administration's latest concession on the environment.

Making Sense of a Toxic World

In the 2012 campaign, environmentalists don't matter. That's the message President Obama is sending as the administration caters to smokestack and other industries.

Considering the future of Louisiana's levees. Put in place to protect land along the Mississippi, the system has also been funneling sediment from the delta, to be replaced by seawater. New Orleans could be practically an island by 2100, scientists say.

From 1932 to 2000, about 1,900 square miles of land were lost and replaced by seawater. At the current rate, scientists say, more than 500 additional square miles will be gone by 2050. By 2100, they say, New Orleans could be little more than an island.
If there's one thing environmentalists, politicians and locals like those living in Pointe-aux-Chenes agree on, this year's floods have proved that something has to change.
"Right now there's a historic flood carrying record amounts of sediment, and we have no way to capture any of it," David Muth of the National Wildlife Federation said at a conference this month in New Orleans that brought together scientists, politicians and lobbyists to discuss ways of reversing land loss. "It is ridiculous that we're sitting here and all that sediment is going past, and most of it is going to be lost."

Mississippi flooding: Let the river run. What began on the upper Missouri River in 1951 is playing out this month in the flooding of the lower Mississippi and dozens of communities in its delta.

Had we not built dams on the Missouri, had we refrained from building homes and cities on Missouri River floodplains, periodic floods would have occurred, but without the catastrophic consequences we see today. Floods would have replenished the river bottoms with alluvial silts (producing bumper crops) and deposited nutrients on the barrier islands in the gulf. Those islands, which once protected New Orleans from violent gulf storms, have vanished in the 50 years since the dams were built. This double-whammy — New Orleans vulnerable to storms from the gulf side, and the lower Mississippi and its delta vulnerable to flooding from the upstream side — can be laid at the feet of Pick-Sloan.

Random Links

Incredible Satellite Image Of Alabama Tornado Damage

Antipodes Map: See the other side of the world

Religion and Sex Quiz

Awesome Photos Of The World At Night

How the AK-47 Rewrote the Rules of Modern Warfare

Tornado Ravages Joplin, Missouri

Shocking before and after images reveal how giant tornado ripped apart Joplin's city landmarks

Southern Tornadoes: NASA Imaging Shows Storms Forming From Space (VIDEO)

The Deadliest Years

The Facts (and Fiction) of Tornadoes

Google Search Volume by Language

STEPHEN COLBERT: The Most Powerful Fake Newsman In America

China update

Why A Popsicle Stick Manufacturer Just Moved From China To Canada

CHINA STOCK FRAUD SHOCKER: Banks Were Complicit In Longtop Fraud

Longtop Financial (LFT), a popular Chinese software company, has just been exposed as a colossal fraud.
The "cash balance" on Longtop's balance sheet, it turns out, was fake--a fiction created by the company's managers and helpers.
The Longtop fraud follows other China stock frauds that have made many of Wall Street's best and brightest look like fools. It has also increased the skepticism of American investors toward Chinese companies.
As well it should.
Unlike some of the more famous American-company frauds in recent years--Enron, Worldcom--it turns out that Longtop had institutional help in perpetrating its fraud. The reason Longtop was able to fend off skeptics for so long, despite multiple analysts arguing that it was a fraud, was that Chinese banks were complicit in the scam.

Jim Chanos' One Big China Regret

China Real Estate: 100,000 Apartments Waiting To Be Sold In Beijing

Yesterday, Xinhua reported that there are now some 66,113 apartments in Beijing currently under construction are now waiting to be pre-sold, and 34,755 completed apartments are now waiting to be sold.  Totally, there are 100,868 apartments waiting to be sold in Beijing according to the Beijing Branch of Centaline.  This is the first time in four months that inventories reached 100,000.
This is hardly surprising of course.  Under new and tougher buying restrictions in Beijing, as well as tighter credit, the pool of potential buyers are shrinking fast, yet the number of apartments waiting to be sold surge naturally because the land acquisitions spree in the past two years means that the new supply will start entering the market now.
Facing tighter credit condition and shrinking pool of potential buyers, cash flows for Chinese real estate developers are turning negative as I have previously pointed out.  With declining profits, poorer cash flows, higher level of unsold inventories and higher level of debts, the question now is for how long can these developers hold the prices at high level.  Sooner or later, these developers will have to cut prices and cash in.

So the overall picture now is getting obvious, that a correction in property prices is inevitable.  The only question is when that will happen, and for how much. 

The Entire Chinese Bull-Bear Debate In One Huge Slide

Richard Koo On China: There Will Be Blood

China’s Interest in Farmland Makes Brazil Uneasy

Richard Koo Explains How China Will Try Busting A Bubble, And Sustaining A Boom Simultaneously

The Latest Chinese Methods Of Hiding Debt And Priming Growth

As of 2010, the total assets of China’s banking industry have grown to 2.39 times the amount of national GDP, breaking records once again at nearly 100 trillion yuan.  In comparison, according to OECD data, Japan’s banking assets in 2008 stood at US$ 9.81 trillion, 2.27 times the amount of its GDP, which was US$ 4.32 trillion. Germany, another country representative of economies that rely on banks for financing, had 6.6 trillion euros for banking assets and 2.48 trillion euros for GDP in 2008. Its 2008 banking-assets versus GDP ratio was 2.66, almost the same as it had been in previous years.
The surge in China’s banking assets, which took off in 2009, was attributed to political directives rather than monetary policies. In 2009, huge amounts of loans were made at the order of government. The central bank did not cut interest rates; in fact, it conducted a net absorption of liquidity from the market through its open market operations. Meanwhile, the market capitalization of domestic stock exchanges more than doubled from a year earlier, an indication of too much capital flowing around.

After Being Followed Around By Chinese Government Agents, This Reporter Confronts Them And All Hell Breaks Loose

8A striking look at a reality of China. Australian reporter Stephen McDonnell went to China to do a report on religion in the country, including underground Christian churches, and was followed around for days by Chinese government agents.
After a bunch of this, he decides to confront them (in fluent Mandarin) in a hotel lobby and all hell breaks loose.
The rise of religion, and in particular Christianity, in China, just may be one of the biggest macro stories of the 21st century. The religion is growing really fast in the country and the government doesn't like it. It tries to co-opt them with officially sanctioned state churches, but underground churches are flourishing as well.
If the Chinese start converting to Christianity en masse, that could have a profound impact on Chinese society, government, and therefore given the rising importance of China, geopolitics. It sounds unlikely today, but in his day Stalin quipped: "How many divisions does the Pope have?" and it turned out that the Pope played a significant role in the fall of the Soviet Union.

Healthcare update

Expanding side-effect labels 'overwhelm' docs

Fewer tests, less antibiotics improve primary care

When Doctors Are Called to the Rescue in Midflight

Vermont Health Plan Advances

Vermont is moving one step closer to a goal of its Democratic governor: a state-run health plan that would insure most of its 625,000 residents.
The bill Gov. Peter Shumlin plans to sign on Thursday would create a panel whose goal would be to figure out how to pay for a new system intended to reduce the rate of overall health-cost increases.
The challenge is to figure out how to finance such a system and convince the federal government to allow the experiment to proceed as soon as 2017. It's far from clear Vermont can make it all work.
In an interview, Gov. Shumlin said Vermont needs the change because its health costs have doubled over the last decade. Between 2004 and 2008, health-care spending in Vermont grew at an annual rate of 8%, three percentage points higher than the national rate. Among the cost drivers is that Vermont requires insurers to offer coverage to all applicants regardless of their health status.

Sharing Costs Is No Way to Fix Medicare

Perhaps the most famous research on consumer cost-sharing is the RAND Health Insurance Experiment, which was conducted with 2,750 families from 1971 to 1982. Each family was randomly assigned to one of five formulas determining how much of their medical expenses they would pay themselves.
The RAND results showed that the introduction of cost- sharing can reduce medical spending without causing harm to health -– that holy grail of health policy. The biggest reductions in the RAND study, though, came in moving from zero expense for families to at least some cost-sharing. As we already have some cost-sharing in our current system (co-pays and deductibles), that finding doesn’t suggest a new path to savings. And, unfortunately, the results from raising cost- sharing above current levels were generally more modest.

ER docs order tests to avoid lawsuits first, help patients second

Patient safety checklists mandated by state law

Squandering Medicare’s Money

Much has been said about the growing gap between the program’s spending and revenues — a gap that will widen as baby boomers retire — but little attention has been focused on a problem staring us in the face: Medicare spends a fortune each year on procedures that have no proven benefit and should not be covered. Examples abound:

...

Why does Medicare spend so much for procedures and devices on patients who get no benefit and incur risks from them?
One reason is that Medicare’s reimbursement procedures are not sophisticated enough to track the appropriateness of the care provided. Medicare delegates its claims administration to private local contractors based on how quickly and cheaply they can process claims.
These contractors have few incentives to audit the taxpayer dollars they are paying out, and even if they wanted to, they would need information often not available on the claim form. For example, a claims administrator, processing a claim for a screening colonoscopy, does not know when the patient’s last colonoscopy was, or whether there was a new clinical reason for repeating it. While this information is available, finding it would require extra steps, and there are no incentives to do so.
Moreover, denying payment after a procedure is performed invites the wrath of both patient and physician. Medicare and private insurers are also keen to avoid situations that could be viewed as telling doctors how to practice medicine — even if such advice is in the patient’s best interest. The political sensitivity of limiting services based on age, for example, was illustrated by the uproar over the Preventive Services Task Force’s findingtwo years ago that women in their 40s do not benefit from routine mammography.
Another factor is the shocking chasm between Medicare coverage and clinical evidence. Our medical culture is such that if the choice is between doing a test and not doing one, it is considered better care to do the test. So while Medicare is obligated to follow the task force’s recommendations to cover new preventive services, it has no similar mandate to deny coverage for services for which the task force has found no benefit.
Changing the system would be relatively easy administratively, but would require a firm commitment to determining whether tests and procedures truly benefit patients before performing them. Unfortunately, in a political environment in which doctors providing end-of-life counseling are called death panels, and in which powerful constituencies seek to preserve an ever-increasing array of procedures and device sales, this solution remains hidden in plain view.
Of course, doctors, with the consent of their patients, should be free to provide whatever care they agree is appropriate. But when the procedure arising from that judgment, however well intentioned, is not supported by evidence, the nation’s taxpayers should have no obligation to pay for it.

Vermont Becomes First State to Pass Single-Payer Health Care

Peter Orszag, Former OMB Director, Reveals The 'Biggest Gap' In Obama's Health Care Law

From a substantive perspective this was perhaps the biggest gap along [the encouraging best-practices] dimension: If we had a medical malpractice system that reinforced that emphasis on best practices we would be in a much better position; so if that pop up screen for my doctor in five years also meant that the doctor knew that if he or she followed those best practice protocols I couldn't sue him or her that would help to drive a lot more medical practice.
The debate over tort reform and medical malpractice is, I think, significantly off. The whole debate is over whether we impose caps or not or whether we dial down liability when you are found to be negligent. The core problem in the medical malpractice system, however, is the entire basis upon which it is operational. That basis, so called customary practice, means that it is a nebulous standard and doctors inevitably line up sort of following the social norms among doctors in their area in part because that customary practice protocol means that they have to in order to avoid liability. We should have a best practice emphasis whenever possible.
Tort reform was, in fact, addressed during the course of the health care debate, offered by the president late in the process as a concession to demonstrate the extent of his reach for bipartisan support. But the final agreement, sending grants to states for projects to study how to decrease medical liability and increase patient safety, fell far short of what Republicans wanted. Their vote for the overall bill was never contingent on strong tort reform measures in the first place.

To Fix Health Care, First Reward Failure

Tim Harford has an unusual fear about government failure. He’s not worried that the government fails too often. He’s worried that it doesn’t fail often enough. The British economist is the author of the compelling new book,"Adapt: Why Success Always Starts With Failure."

In it, he warns that "we face a difficult challenge.The more complex and elusive our problems are,the more effective trial and error" -- which is to say, failing and learning from those failures -- "becomes, relative to the alternatives. Yet it is an approach that runs counter to our instincts, and to the way in which traditional organizations work."
Health-care costs prove his point perfectly. Few policy problems are more confounding than the inexorable rise in health-care spending. It threatens the economy even as the health-care system fails at its basic task of making us healthier. But the only way to fix it runs counter to both our instincts and our political system: we need to allow ourselves to fail -- often, enthusiastically and, above all, constructively.
When you hear the words "health-care costs," it’s good to apply a quick mental auto-correct. What people really mean are "sick-person costs." When five percent of patients account for 50 percent of spending, you’re not talking about the costs that most Americans with health-care insurance rack up over the course of a year. You’re talking about the costs racked up by a tiny fraction who suffer from serious health conditions.
...

But we have not been failing in the right way. Encouragingly, the Affordable Care Act might change that. There’s the Center for Medicare and Medicaid Innovation, whose job is to generate pilot and demonstration projects that might help us learn to do things differently, and better. There’s the clunkily named Patient-Centered Outcomes Research Institute, which is tasked with compiling evidence on the effectiveness of various treatments, and when and how they’re best used. And there’s the Independent Payment Advisory Board, a group of experts empowered to take the best of these experiments and replicate them through the Medicare system.Taken together, those agencies could do a lot of constructive failing and a bit of real succeeding, too.
The only question is whether we’ll let them. In a two-party political system, one party is often better off if the customers are very, very unhappy. In fact, the minority party’s route to majority status is to keep the customers unhappy, which means contributing to failures and then obstructing the governing party’s efforts to fix them.
Failure’s Cost
Identifying, preserving and highlighting policy failures is a great way to win an election. But from a policy perspective, it’s a bad way for the government to fail. It makes the governing party overly averse to policy risks and leaves the political system incapable of learning from mistakes.
"Any politician knows he can have 50 policies going well and one failure," Harford tells me from his hotel room in Seattle, "and that failure will dominate the next campaign. So the politician is just desperate to avoid provable failure." That means politicians won’t discover the kinds of successes that emerge from constructive failures.
So when it comes to health care costs, politicians who fear failure -- or exploit it for political gain -- should ask themselves what, exactly, they think the alternative is. If we can’t learn to fail well, then we’re going to -- well, fail.

Random stat of the day

There are an estimated 9.7 trillion unredeemed miles in frequent-flier accounts, according to InsideFlyer.com.

Here are some examples of how massive that total is:
Value at 1.5 cents per mile: $145.5 billion
Number of business-class or first-class tickets that could be purchased with total unredeemed miles (at 150,000 miles per ticket): 64.7 million
Number of basic 25,000-mile awards: 388 million
Number of times a person could circumnavigate the Earth at its equator: 449 million
Number of round trips to the moon that could be made with total unredeemed miles: 19.4 million
Number of round trips to the moon represented by American Airlines' 587-billion miles outstanding: 1.2 million

California update

A prison system we deserve. America generally — and California in particular — simply sends too many people to prison for too long relative to their offenses.

Monday's ruling is as much an indictment of this state's politics as it is of our correctional system, and it ought to prod us into considering a couple of unpleasant truths: One, America generally — and California in particular — simply sends too many people to prison for too long relative to their offenses. Two, this state's prisons are perhaps the prime example of our relatively recent popular impulse to insist on having things for which we don't want to pay — in this case, mass incarceration of nonviolent offenders. The situation has been exacerbated by the intrusion of another recent trend: the infusions of single-issue politics into our criminal justice system.
Sometimes this has amounted to wholesale overhauls, as with the 1990 Proposition 115 or the 1994 three-strikes initiative; sometimes, it involves people coalescing around a particular kind of crime and demanding huge increases in prison time for committing it. In either instance, prison funding is an afterthought.
Like the court's dissenters, California prosecutors and the Legislature's Republican leaders predicted that Monday's ruling will set in motion a wave of criminality. Given the significant number of prisoners incarcerated for nonviolent crimes or for violating their parole after conviction for such offenses, that doesn't seem inevitable. Moreover, Gov. Jerry Brown's plan to shift prisoners into county jails would seem a good hedge against a crime wave, providing the Legislature will fund it.
There again, though, we encounter the problem of chronic governmental dysfunction. On Monday, Senate Minority Leader Bob Dutton (R-Rancho Cucamonga) muttered darkly that the Democrats simply "are looking for any excuse they can to try to have more taxes." His solution was fast-tracking the construction of new prisons and persuading Washington to take custody of the undocumented immigrants serving time for felonies in California. In the current climate, there is no conceivable way either of those things is going to happen — hence, more wishful thinking.
If there's anything to which a fair degree of humility ought to attach itself these days, it's an opinion on the causes of crime and their remedies. About the same time the Supreme Court released its ruling in the California prison case, the FBI put out its updated set of national crime statistics. To the bewilderment of experts in virtually every camp surrounding this highly politicized issue, crime has continued to decline to the lowest levels in 40 years. These declines certainly confound those criminologists who are inclined to link crime to economic deprivation and joblessness. Despite the savagery of the current recession, for example, robbery rates fell by 8% in 2009 and by 9.5% last year. By the same token, the national prison populations actually have fallen over the last few years. So much for the incarceration-rate-is-destiny argument.
The issue California now confronts, however, doesn't really turn on solving this social scientific mystery. Our problem is, as the court pointed out, that overcrowding has reduced this state's prisons to a state of constitutional and human indecency — and that's a moral and legal scandal. Though it's been quoted with the frequency of cliche, Dostoyevsky's admonition remains true: "The degree of civilization in a society can be judged by entering its prisons."

California legislators risk voter backlash if they try to use no-pay loophole. California voters passed Proposition 25 to punish lawmakers if they fail to pass a budget by the June 15 deadline. And the budget must be balanced.

Hope for reform of California's prison system?