Is Koolaid a sin?

In the article "Miracle Tax Diet" in today's New York Times, the author writes:

A starting point is to recognize that risky teen behavior these days can involve not just alcohol, drugs or sex but also extra-large Cokes.

Seriously, people.  I'm in public health. I understand that obesity is both a health and economic problem in the US, which is why it becomes a public health problem.  Ordinarily, government wouldn't care if you were fat or skinny.  But when your largesse goes from annoying the person in the airline seat next to you, to becoming a tax burden to everyone who has to pay for your disability compensation, then we begin to care.  

Nevertheless, I'd imagine parents have to pick their battles in trying to sway teen behavior.  For example, I was never taught about the perils of alcohol, drugs or sex.  Extra-large Cokes, Koolaid, and glorious refreshing Root Beer, on the other hand, were highly regulated. Did it work? Well - I'm not obese, and I don't do drugs. You decide. 

I think that we should devise some kind of litmus test for which issues merit public service announcements, billboards or sin taxes.  Let's weigh the options:

The author wants us to put Alcohol, Drugs, Sex and Sugary beverages in the same pot. 

Let's think of the members of that pot (ie: Alcohol, Drugs, Sex and Soft Drinks) as X

1. The AIRLINE SEAT test.  

Imagine you are flying coach from DC to LA, got to the airport late so you have to board in 'group 5' and are consequently stuck in a middle seat between two people. Would you rather be stuck between 2 drunk teenagers, 2 stoned teenagers, 2 teenage mothers or 2 teenagers having Cokes? 

Perhaps I'm not considering the full health consequences of my statement.  Fair enough.

2. The TIME WARP AIRLINE SEAT test

Let's imagine those two teenagers continued their risky behavior of choice (behavior X) for 15 years, and you have the unfortunate luck to sit between them once again.  15 years of alcohol or drugs could result in you sitting between 2 individuals who are not well kept, maybe having some unfortunate odor, perhaps in withdrawal during the 5 hour flight. They would be quiet, want a dark environment, and be skinny, because all of their money has been spent on booze and rocks. The teenage mothers, 15 years later,  - well, they'd be young mothers, maybe sporting some bling, maybe nursing a kid, but I don't think they'd bother you much. Ah, but 15 years of sugary drinks later, you'd be upgraded to business class because your middle seat would be occupied by the expanding laps of your two neighbors. 

I think so far, I've made a case for stopping the public service announcements on sex. But we know that is wrong, since sex doesn't just lead to babies [isn't that right, Sarah Palin?]. 

3. The RATIONAL INCENTIVES test

The sin tax. What a great invention. If you tax a product, it costs more. If it costs more, people will buy less.  It worked for cigarettes, booze costs more in Canada and I'll bet they have fewer alcoholics than we do in the US...

But wait - Alcohol is particularly cheap in Europe (all those stories about how beer costs the same as water in Germany are true!) but they are healthier than we are.  How does that work? Does it have to do with the drinking age, and not the tax? Could it be that teenagers are not rational, and when they are forbidden from something, they seek it out with greater passion?

Drugs - we could tax them, but first we'd have to figure out who sells them. So, I guess that's out.

Sex - hmm... a condom tax. Interesting idea. If you tax it, it costs more. If it costs more, people will use it less. More unprotected sex = bad. So, what if we gave them away for free? Just on the hunch that when being lectured to about the virtues of abstinence in high school, the impressionable young minds are wandering, checking out their neighbors, passing notes, or sleeping, it might not be a bad idea. 

I guess this is how the Gov. of New York has come up with the tax on sugary beverages. Let's call it the Koolaid tax.  Where do we draw the line? Do we tax all sodas? Just the non-diet sodas? What about "juice beverages"  like Hi-C and Fruit Punch (Does Hi-C still exist?). Do you tax those koolaid packets where you have to add your own sugar, or just the ones where you add water? Juice has sugar. Should we tax juice? What about chocolate milk?

I see a really slippery slope here. One where we have to redefine beverage to exclude juice, milk and alcohol. Or engage in an effort to make water more exciting. 

I know. Let's give it bubbles and make it sweet. 

Cuban Health System Presentation

After my trip to Cuba in July of 2007, my classmates and I organized a presentation at JHSPH to share our findings and impressions of the Cuban health system. There was some request for this to be made available more publicly, but I have only just figured out how to do so. Some photos had to be deleted due to the size of the presentation, but I assure you they were beautiful.

The conclusion: The Cuban health system has done impressively with few resources. It has better health statistics than the US, spends minimally on its citizens, yet each doctor in Cuba is in charge of less than 250 households, and is charged with managing their psycho-social well being as well as their physical well being, for a more holistic view of health.

Here is the presentation for your viewing pleasure:



I do not want to be presumptuous and think that someone might want to appropriate any of these slides, but just in case, please don't. They aren't yours.

To Secretary-designate Daschle

The Obama transition team, in its brilliantly technological effort to make all Americans with a computer feel involved, created the change.gov website. So, I was wandering the site, and discovered that I can write to the transition team for health care, and share my thoughts with them. I can also post them on the site for all to see and argue with, but I wasn't ready for that yet.

Here are my thoughts as of today. Help me refine them, or send Daschle your own email.

What we have today in the US cannot be called a health care system. It is not integrated, does not have stated goals, and does not serve the lifetime health needs of our citizens.

We badly need health care reform in the US, but it will have to be implemented incrementally, and with popular support. This support should be measured not in the number of dollars a particular industry or professional organization is able to muster, but in the number of citizens, academics and health professionals in favor of the measures.

In order to build a health system that allows everyone access to the human right of health, reform must address many sectors.
1. Health Education
2. Pharmaceuticals
3. Medical Malpractice Laws
4. Distribution of physicians and health services
5. Financial incentives for health professionals

1. HEALTH EDUCATION
The education of our doctors needs to be adjusted in two ways. First, preventive health and primary health care should be highly emphasized in the medical curriculum. Second, young doctors should not be burdened with so much debt that they are no longer able to consider going into primary health care and must consider specialty training.

Furthermore, health education should be promoted by the government through the use of public service announcements, rather than motivated by the producers of certain products or procedures. The food stamp program should be adjusted to make the purchase of fruits, vegetables and juices more attractive than various forms of corn syrup (soda, chips, cookies, etc.) Health needs to be recognized as not just the domain of the DHHS, but intertwined with agricultural policies and welfare polices.

2. PHARMACEUTICALS
It is clear that one of the major costs of health care today resides in drug prices, and drug prices in the US are higher than anywhere else in the world. Americans should no longer have to shoulder the unfair burden of subsidizing R&D expenses, nor should we be bombarded with advertisements for prescription medicines. The government should seriously consider creating a national list of essential drugs, and mandating that all of those drugs be available in their generic formulation.

3. MEDICAL MALPRACTICE LAWS
A cap needs to be placed on medical malpractice payouts, so that the insurance costs for physicians does not prevent motivated doctors from taking up certain specialties. Legal oddities such as the fact that the obstetrician can be sued for a child's disabilities until the time that child is 18 years old need to be revised. If physicians are better protected by the law, they will not feel obliged to order a myriad of tests in order to prevent their diagnoses from being questioned by lawyers, keeping medical costs down and morale up.

4. DISTRIBUTION OF PHYSICIANS AND HEALTH SERVICES
While physicians all over the world flock to urban centers, provisions need to be made to make health care, particularly high quality primary health care, available in an equitable fashion nationwide. Perhaps doctors need to render service to under-served communities as part of their medical training. Perhaps physicians receiving certain federal assistance repay their "debt" by practicing in less desirable locations. Once all Americans have access to health insurance, physicians serving in rural, poor, or remote communities will be assured of payment for services rendered.

5. FINANCIAL INCENTIVES FOR HEALTH PROFESSIONALS
Whether it is the medicare payment scheme, or incentives given by insurance companies, physicians and hospitals in this country are financially incentivized to do more procedures, more tests, and even change diagnoses to those which pay more. What if doctors were paid to keep people healthy rather than make them healthy? What if illness were seen as a failure of the medical establishment to have done something sooner, rather than as an opportunity to rake in money? Obviously, this does not apply to all illnesses, but considering the number of chronic conditions which are preventable, having the primary function of the health system be health rather than healing is not revolutionary.

Suppose the motivations of the health system became realigned so that primary care physicians prevented heart disease by counseling over-weight individuals, or so that a great deal of kidney failure was prevented because a primary care doctor ensured that a poorly educated patient was able to monitor and control his insulin levels. Unemployed cardiologists and un-used dialysis machines could then be viewed as a sign of success.

Think about it.

And while you are thinking, do not forget to make use of those experts who are not funded by special interest groups.

Do we need the big 3?

The last time we were in recession, (2000-2001), it could be attributed to the collapse of the dot com bubble, the scandals with Enron, Anderson, and other accounting companies, and, of course, Sept. 11. However, the official word was that the recession actually was over by the end of 2001, indicating that little blame can be placed on our reduced propensity to travel, and much more on speculation in companies that didn't actually make anything, or a company that bought, sold, traded and managed a product that it created. Why does that history matter?

The major argument of the big 3 automakers is that they cannot meet their financial obligations because they cannot borrow money. And they need to borrow money because they are operating in the red. But according to economists, the state of Michigan has been in recession since 2001. It never came out of it, because for the last 8 years, it has continued it's stubborn reliance on the backwards economic ways of US automakers. In order to keep their stock prices up, US automakers boosted sales by offering one stop shopping at the dealerships - pick a car, get your loan, hug your warranty while you pay minimal insurance.

So now, GM and Ford want taxpayer money in order to turn their financing arms into commercial banks. They want taxpayer money to pay their workers, suppliers and no doubt, their executive salaries. Chrysler, a private company owned by a venture capital firm, wants taxpayer money because it can't admit that after being rescued from the dead by Lee Iacoca, it is again going to die.

And, to top it all off, lawmakers aren't asking for any guarantees from the car companies. There is a lot of rhetoric being spewed about "how do we know you'll pay it back" and "how do we know you won't come back for more dough in six months" and even some petulance because they did not get to ask the same questions to AIG and Citigroup since those deals went directly through Treasury. But no beef. No conditions, no demands, no muscle.

Today, the Dept of Labor reported that unemployment is up again, and more people are out of jobs. Ok - it is a recession. What do they expect. In fact, if the definition of a recession is a contracting economy, how is it possible for the economy to get smaller while the workforce gets bigger. We aren't the Soviet Union. We haven't nationalized our industries. YET.

I predict that despite the consternation and disfavor of large swaths of this country, the wise old fools in Congress will give money to the car companies. Because they fear that somehow, the lack of new jobs, and the loss of current jobs will put them out of a job. They have 2 years of job security. They shouldn't worry about their own skin, and should concern themselves instead with making the automakers :

1. Consolidate - 3 to 2. Get rid of GM.
2. Go into bankruptcy, so that they can renegotiate their contracts with the UAW
3. Get rid of the UAW. This union is worse than the mafia. A group of a few hundred thousand, or maybe a million members is holding all of America hostage by equating our economic well being with the well being of the only 3 car companies which will hire them.
4. Close their car dealerships. Tough shit for the car salesmen. We can use their large lots to create more parks, which will help the car companies with their pollution problems which will no doubt be the next reason they will come begging to Washington when they can't meet cap-and-trade requirements.
5. And finally, disassociate the well-being of the overall US economy from the fate of the car companies.

Yes, they indirectly control many jobs and industries. But we forget that all of the foreign automakers also buy parts from various US companies for their US plants. What if we increased the import duties on cars and car parts? We already flount the WTO when it serves our purposes. Why gain a conscience now? Raise import duties, make it more economical for foreign car companies to build their entire cars in the US, and keep the majority of those suppliers in business. Even better, while raising import duties, create tax credits for specific energy efficient goals - factories, cars, fuel. All of this will build an alternative industry, which the US car companies may not be able to keep up with. Again. Tough shit. Maybe they will grow again in the future. Maybe Henry Ford's internal combustion engine will suffer the same fate as Watt's steam engine.

Congress needs to calm down. We've yelled fire too many times in the last 6 months. And none of those fires have been properly put out by blanketing them in greenbacks. So perhaps, instead of using the same poorly functioning extinguisher, we should do a little controlled burn, and build a nice deep fire line which we can construct over a few months instead of a few days.

The revenge of trivia

It was my first trivia night in Baltimore, and probably my first trivia night in a very long time. I recall one other time, at that great pizza place on the corner 4th year - I want to call it Magic Mushroom, but I have a feeling that isn't right. At any rate, trivia had its dark revenge last night, not allowing me to sleep for hours, being the fodder for some truly bizarre dreams, and no - there were no mushrooms and very little beer involved.

Trivia's categories:
Secret identities
Wrestling managers
Dead irish writers
Wu Tang Clan
Ku Klux Klan

Clearly, going home with thoughts of the Klan in my head did not bode well. In fact, as I tossed and turned, I dreamt of protests on the national mall against the display of the confederate flag. But these protests were conducted - literally conducted - by Leonard Slatkin. However, the protesters were surrounded by civil war soldier types, and in a great denouement, a counter protest began, led by a white sheeted freak galloping down the mall on a horse. There was more, but it has lost its clarity in my head. Thankfully!

As for future adventures in trivia...we'll have to see.