Meaningful research and the "antibiotic apocalypse"

I wanted to share a recent article at BBC news that caught my eye, especially considering a conversation Mike, Jim, and I had just the other day regarding the argument that any kind of public health service in the U.S. would hurt medical research, which is currently funded in large part by American pharmaceutical companies.  It seems to me, at least, that the general assumption behind that argument is that nobody else in the world is making real, significant contributions to medical discovery and that if the U.S. offers a public option, which could hinder pharmaceutical profits, then research will suffer.

The BBC news article discusses a new project examining life from isolated areas of deep oceanic trenches for fresh ideas on antibiotics.  The two things I wanted to sort of highlight from the article are: 1) the research is being led by scientists from Aberdeen University in Scotland, a country that coincidentally has a public health service; and 2) the last sentence of this quote - the bold font is mine:

"Project leader Marcel Jaspars, professor of chemistry at the University of Aberdeen, said: "If nothing's done to combat this problem, we're going to be back to a 'pre-antibiotic era' in around 10 or 20 years, where bugs and infections that are currently quite simple to treat could be fatal."
He said there had not been a "completely new" antibiotic registered since 2003 - "partially because of a lack of interest by drugs companies as antibiotics are not particularly profitable"."

It's cherry-picking, I know, but I wanted to share because we were just talking about the idea.  Money is absolutely important when it comes to research. But maybe the approach and general philosophy behind research can and should sometimes be of greater importance than who can dump the most money into a problem (and the foreseeable profit that can be made from a discovery).

The Incredible Shrinking Medicare Tab

Every year in January the Congressional Budget Office releases its Budget and Economic Outlook for the next decade (they also produce an abbreviated update to the year's outlook in the late summer, as they did last August). Just this week they released this year's: The Budget and Economic Outlook: Fiscal Years 2013 to 2023.

In these documents the CBO, among other things, projects how much the federal government is going to be spending on Medicare in each year. What's fascinating is that if you look at each of these documents, every time they release a new one their projections for Medicare spending each year shrink. Click on this, a simple compilation of their Medicare spending projections (in billions of dollars) going back to the January 2010 report (i.e. the last budget outlook before health reform became law):

What the CBO is doing here is just acknowledging what's already known: Medicare spending growth right now (particularly on a per capita basis) has slowed to a crawl. A turn of events that is, to borrow a phrase from HHS, "unprecedented in the history of the Medicare program." What's amusing is that it continues to surprise the CBO and they have to keep revising their already-revised-downward projections even more. But as they say in this week's report:

In recent years, health care spending has grown much more slowly both nationally and for federal programs than historical rates would have indicated. (For example, in 2012, federal spending for Medicare and Medicaid was about 5 percent below the amount that CBO had projected in March 2010.) In response to that slowdown, over the past several years, CBO has made a series of downward technical adjustments to its projections of spending for Medicaid and Medicare. From the March 2010 baseline to the current baseline, such technical revisions have lowered estimates of federal spending for the two programs in 2020 by about $200 billion—by $126 billion for Medicare and by $78 billion for Medicaid, or by roughly 15 percent for each program.

This doesn't mean Medicare doesn't still face big challenges: even if it sustained last year's per capita growth rate of just a bit more than 0% (a big if and a major challenge), the Baby Boomers are going to continue aging into the program. That means total spending is going to swell, even if per capita costs remain at historic lows. But it's worth remembering sometimes that things are not always quite as grim as they seem.

Sociological Thought of the Day

Pierre Bourdieu on Rethinking the State: Genesis and Structure of the Bureaucratic Field:

Concentration of the capital of physical force requires the establishment of an efficient fiscal system, which in turn proceeds in tandem with the unification of economic space (creation of a national market). The levies raised by the dynastic state apply equally to all subjects--and not, as with feudal levies, only to dependents who may in turn tax their own men. Appearing in the last decade of the 12th century, state tax developed in tandem the growth of war expenses. The imperative of territorial defense, first invoked instance by instance, slowly become the permanent justification of the "obligatory" and "regular" character of the levies perceived "without limitation of time other than that regularly assigned by the king" and directly or indirectly applicable "to all social groups."

Thus was progressively established a specific economic logic, founded on levies without counterpart and redistribution functioning as the basis for the conversion of economic capital into symbolic capital, concentrated at first in the person of the Prince. The institution of the tax (over and against the resistance of the taxpayers) stands in relation of circular causality with the development of the armed forces necessary for the expansion and defense of the territory under control, and thus for the levying of tributes and taxes as well as for imposing via constraint the payment of that tax. The institution of the tax was the result of a veritable internal war waged by the agents of the state against the resistance of the subjects, who discover themselves as such mainly if not exclusively by discovering themselves as taxable, as tax payers. Royal ordinances imposed four degrees of repression in cases of a delay in collection: seizures, arrests for debt including imprisonment, a writ of restraint binding on all parties, and the quartering of soldiers. It follows that the question of the legitimacy of the tax cannot be raised (Norbert Elias correctly remarks that, at its inception, taxation presents itself as a kind of racket). It is only progressively that we come to conceive taxes as a necessary tribute to the needs of a recipient that transcends the king, i.e. this "fictive body" that is the state.

No Delay

A friendly suggestion today:

Obama Health Law Needs Delay, State Insurance Head Says

President Barack Obama may need to delay his health-care overhaul or risk “chaos” when subsidized insurance plans go on sale in October, the head of the National Association of Insurance Commissioners said.

It’s unclear how well the federal government or any of the participating states will perform on Oct. 1, when millions of Americans are supposed to begin shopping at online markets created by the law, Jim Donelon, the NAIC’s president, said in an interview at Bloomberg headquarters in New York. While the administration has shown no sign of seeking a delay, it may be in the president’s best interest, he said.

“It’s his calling-card, signature issue and to rush it into implementation before it’s ready would not be in his overall interest,” said Donelon, a Republican who’s also Louisiana’s insurance commissioner. State officials around the U.S. “don’t want it to create chaos.”

But we've seen this movie before.

Health Care Plan Falters In Massachusetts Slump

Published: April 11, 1991

BOSTON— The Massachusetts plan to guarantee health insurance for all, once hailed as a model for the nation, is faltering under the weight of a soured economy, a hostile new Governor and the fierce opposition of small-business owners, who would be required to pay for coverage of employees.

The pathbreaking plan was adopted in 1988, as Gov. Michael S. Dukakis promoted universal health care in his campaign for the Democratic Presidential nomination, and was to be phased in over several years. Major parts of it resemble proposals being considered in other states and Congress as the nation confronts spiraling health costs and widening gaps in the insurance system.

The plan's centerpiece -- a requirement that businesses employing six or more workers offer them health insurance or pay the state to do it -- was originally scheduled to take effect next January. But it now seems unlikely to materialize for years, if ever. The new Governor, William F. Weld, a conservative Republican, has asked the state legislature to repeal it, calling the requirement "an obstacle rather than a vehicle for improved health benefits for all."

The 1988 law required every resident of Massachusetts to have an offer of coverage by April of 1992. But given the challenges noted in the 1991 New York Times article above, the state delayed implementation of the law's linchpin, the employer mandate.

Even proponents of the mandated employer benefits want a delay to let the recession ease, and the Democrat-controlled state legislature voted last month to postpone the requirement until 1994.

Ultimately that delay proved indefinite and the employer mandate was repealed in 1996. And while some pieces of the 1988 law stood and were expanded upon in the same 1996 legislation that repealed the employer mandate, the fact remains that delaying implementation hollowed out and ultimately killed the centerpiece of that reform law. And it was a full 18 years after its 1988 universal health care law was passed that the state went all in and tried again.

There may well be some chaos later this year. But no delays.

Philosophical thought of the day

Cheer up: even if you didn't have a good day today, someone indistinguishable from you did, somewhere.

Philosophical Implications of Inflationary Cosmology

It is said that the ancient Greek philosopher Diodorus Cronos once put forth a powerful argument for a peculiar view about the relationship between the possible and the actual. Diodorus claimed that everything that could possibly happen is either occurring right now or will occur at some point in the future. His claim, in other words, was that there are no unrealized possibilities. Unfortunately, the works of Diodorus have been lost, and although a number of modern philosophers have tried valiantly to reconstruct his argument, no one really knows exactly how it was supposed to go.

Nonetheless, we think that Diodorus's conclusion was essentially correct, and we will here provide a new, entirely modern argument for it. Unlike the orignal argument of Diodorus, however, our argument draws on inflationary cosmology and quantum mechanics. It follows from inflationary cosmology that the universe is infinite and can therefore be divided into an infinite number of regions of any given size. But it follows from quantum theory that the total number of histories can occur in any one of these regions in a finite time is finite. We draw on these two premises to argue for our central conclusion: that all possible histories are realized in some region of the universe.

Cognitive dissonance

The Cleveland Clinic's CEO had some words of warning in July:

Cosgrove also said the health care law, which was recently upheld by the U.S. Supreme Court, doesn't control costs or contain many incentives for people to take care of themselves.

Same guy talking to the Wall Street Journal last week:

WSJ: How does the health overhaul affect you?

Dr. Cosgrove: We knew that we had to reduce costs and we had to drive a more efficient health-care delivery system. [The law] just gave additional impetus to get that done.

"Impetus" for major groups of hospitals and doctors to cut costs yes, "control costs" no.

Saving Ohio

One in eight jobs saved by the auto rescue. Cops', firefighters', and teachers' jobs saved by the stimulus' aid to state governments. Small businesses saved by the avoidance of Great Depression II and the unfreezing of credit.

Today's Ohio's unemployment rate is below the national average. It's small exaggeration to point out that the Obama administration saved our state from calamity. His opponent is on the record as saying he wouldn't have done any of that. One man decided to let Ohio live, the other would've condemned it to die.

The choice is easy, Ohio.