Rationing of Health Care

July 24, 2009 | etbe

Peter Singer wrote an interesting article for the New York Times which makes a good case for rationing health care on the basis of a ratio of the amount of money spent to the health benefits provided [1]. It’s obvious that given a finite amount of money to spend on health-care and a limited portion of the working population who can be employed in providing it there will be limits to the care that each individual can receive. Therefore it seems inevitable that some people will miss out on care that they need – sometimes to the extent of significantly decreasing the length or quality of someone’s life – at least until we can manufacture fully autonomous medical robots or other futuristic technology to greatly reduce the amount of person-time involved in providing medical care.

The majority of the article concerns the need for rationing health care. Really this is obvious, and it’s also obvious that it takes place right now all around the world. The article is mainly focussed on the US where private health insurance for everyone is being considered and people are afraid of government rationing of health care. But right now they have health care being rationed not for the purpose of saving other people but for the benefit of share-holders and executive bonuses! I wouldn’t really be thrilled if a government agency told me that instead of paying the necessary money to save my life they would rather pay the same amount of money to save two other people, but if a private company wanted to deny me treatment in order to pay the down-payment on another executive Mercedes I would totally flip out! Dr Gabriella Coleman (who is famous for her Anthropology research on “free and open source software hacking”) has written Housebreaking Your Health Insurance [2] to offer some tips for dealing with private health insurance companies in the US with the first tip being “Ideally you should tape record all conversations” – I think that single point adequately demonstrates the problem with health insurance (but there is a lot more).

In the common culture of the US, Australia, and Western Europe it is generally regarded that children are inherently more valuable than adults to such a degree that a choice between saving the life of a child or an elderly person really requires no consideration. So Peter advocates having a measure of the expected years of life remaining before determining an amount of money to be spent – this is logical, reasonable, and fits with the common moral standards in our society.

Peter then goes a bit off track when talking about putting seat belts in buses. One significant thing to consider is that there is a world of difference between preventing an injury and curing it. If you cure an injury then there will be some pain and suffering during the process and the result probably won’t be a full recovery. Being able to walk away from a crash because of a seatbelt is a really good thing (been there, done that).

But things really go awry when he starts talking about medical treatment for the disabled. Firstly he mentions quadriplegia as an extreme case, but to differentiate on the basis of disability you would have to categorise the various disabilities in order of severity. Then of course there are awkward issues such as comparing a quadriplegic who is employed in the computer industry (such as a former colleague of mine) and someone who is apparently fully capable but sleeps on a park bench.

He expressed the idea that someone who would give up a year of their life to cure a disability assigns a lower value to their life. By using that logic anyone who undertakes cosmetic surgery (which has a non-zero probability of a fatal outcome and therefore statistically decreases the life expectancy of the patients) would also assign a lower value to their life, as would anyone who enjoys hobbies such as bungee-jumping and parachuting. But if someone would not be prepared to have their life shortened in exchange for curing a disability that doesn’t mean that there is no value in trying to cure the disability.

I think that the greatest problem in this area is that of making excessive attempts to reach some absolute standard of fairness. No matter what you do someone will end up not having the budget for their health care and they WILL consider it to be unfair. If the amount of money to be spent was strictly based on age then it would be a simpler system to operate which if nothing else would save on administrative expenses and therefore allow more money to be used on providing health care.

I believe that the health care problem is the biggest economic problem that first-world countries face (little things like a mortgage crisis are temporary while health care that is provided now will affect tax revenues in 40 years time). Even if you regard people as being merely assets which are owned by the government then you would have to consider such valuable assets to be worth protecting – particularly children as you never know which ones are valuable until about the age of 21!

I find that in such discussions it’s not uncommon for the more right-wing Americans to advocate allowing people to die if they haven’t taken out appropriate insurance – it’s supposedly their fault. There are two major problems with this, one is that children who are unfortunate enough to have parents who are too poor or unwise to get appropriate insurance will lose. Another is that most people have no ability to understand probability (everyone who has purchased a lottery ticket has demonstrated their inability to make good decisions on such matters). It seems to me that some minimal level of health insurance for everyone along with comprehensive health insurance for children aimed at preventing problems should be provided by the government from tax revenue, the moral and economical justifications for this are both independently compelling.

For the more selfish readers, even if you don’t care about other people becoming sick or dying and you don’t believe that economic benefits will help you there is still the issue of disease transmission. Every time you are in a city area and find yourself downwind of a beggar you have to hope that either they don’t sneeze or that decent health-care is available to everyone. Extremely drug resistant Tuberculosis sounds nasty…

Fixing the Correct Network Bottleneck

April 10, 2009 | etbe

The latest news in the Australian IT industry is the new National Broadband Network (NBN) plan [1]. It will involve rolling out Fiber To The Home for 90% of the population, the plan is that it will cost the government $43,000,000,000 making it the biggest government project. Kevin Rudd used Twitter to say “Just announced biggest ever investment in Australian broadband – really exciting, infrastructure for the future” [2].

Now whenever someone says that a certain quantity of a resource is enough you can expect someone to try and refute that claim by mentioning that Bill Gates supposedly stated that “640K is enough” when referring to the RAM limits of the original IBM PC. As an aside, it’s generally believed that Bill Gates actually didn’t claim that 640K would be enough RAM, Wikiquote has him claiming to have never said any such thing [3]. He did however say that he had hoped that it would be enough for 10 years. I think that I needed that disclaimer before stating that I think that broadband speeds in Australia are high enough at the moment.

In any computer system you will have one or more resources that will be limited and will be bottlenecks that limit the overall performance. Â Adding more of other resources will often make no difference to performance that a user might notice.

On the machine I’m using right now to browse the web the bottleneck is RAM. Â A combination of bloated web pages and memory inefficient web browsers uses lots of memory, I have 1.5G of RAM and currently there is 1.3G of swap in use and performance suffers because of it. Â It’s not uncommon for the machine to page enough that the mouse cursor is not responsive while browsing the web.

My options for getting faster net access on this machine are to add more RAM (it can’t take more than 2G – so that doesn’t gain much), to use more memory efficient web browsers and X server, and to simply buy a new machine. Dell is currently selling desktop machines with 2G of RAM, as they are 64bit systems and will therefore use more memory than 32bit systems for the same tasks they will probably give less performance than my 32bit machine with 1.5G of RAM for my usage patterns.

Also the latest EeePC [4] ships with 1G of RAM as standard and is limited to a maximum of 2G, I think that this is typical of Netbook class systems. I don’t use my EeePC for any serious work, but I know some people who do.

Does anyone have suggestions on memory efficient web browsers for Linux? I’m currently using Konqueror and Iceweasel (Firefox). Maybe the government could get a better return on their investment by spending a small amount of money sponsoring the development of free web browsers. A million dollars spent on optimising Firefox seems likely to provide good performance benefits for everyone.

My wife’s web browsing experience is bottlenecked by the speed of the video hardware in her machine (built-in video on a Dell PowerEdge T105 which is an ATI ES1000). The recent dramatic price reductions of large TFT monitors seem likely to make video performance more of an issue, and also increases the RAM used by the X server.

Someone who has reasonably good net access at the moment will have an ADSL2+ connection and a computer that is equivalent to a low-end new Dell machine (which is more powerful than the majority of systems in use). In that case the bottleneck will be in the PC used for web browsing if you are doing anything serious (EG having dozens of windows open, including PDFs and other files that are commonly loaded from the web). If however a machine was used for simply downloading web pages with large pictures in a single session then FTTH would provide a real benefit. Downloading movies over the net would also benefit a lot from FTTH. So it seems to me that browsing the web for research and education (which involves cross-referencing many sites) would gain more of a benefit from new hardware (which will become cheap in a few years) while porn surfing and downloading movies would gain significantly from FTTH.

The NBN will have the potential to offer great bi-directional speeds. The ADSL technology imposes a limit on the combination of upload and download speeds, and due to interference it’s apparently technically easier to get a high download speed. But the upload speeds could be improved a lot by using different DSLAMS. Being able to send out data at a reasonable speed (20Mbit/s or more) has the potential to significantly improve the use of the net in Australia. But if the major ISPs continue to have terms of service prohibiting the running of servers then that won’t make much difference to most users.

Finally there’s the issue of International data transfer which is slow and expensive. This is going to keep all affordable net access plans limited to a small quota (20G of downloads per month or less).

It seems to me that the best way of spending taxpayer money to improve net access would be to provide better connectivity to the rest of the world through subsidised International links.

Brendan makes an interesting point that the NBN is essentially a subsidy to the entertainment industry and that copyright law reform should be a higher priority [5].

Australian Democracy is “Microsoft Compatible”

April 6, 2009 | etbe

Here is the Australian Electoral Commission documentation on how to register a political party [1]. It includes the requirement for “A Microsoft compatible electronic membership list (and paper copy) providing the following information“.

So a prerequisite for registering a political party appears to be the ownership of a PC running Windows. While it may be the case that I could create a plain text file on a Linux machine and append some CR characters to each line, or create a CSV format spread-sheet/database file the most common interpretation of this is likely to be that MS-Office is required.

Such blatant promotion of a software vendor in a government document is unacceptable. Anyone who wishes to use other software for their political activities should be permitted to do so without restriction.

[1] http://www.aec.gov.au/Parties_and_Representatives/Party_Registration/Handbook/application.htm

Censorship, Piracy, and Movie Ideas

March 31, 2009 | etbe

Flame has written a satirical post about the different methods used to try and prevent unauthorised use of copyright movies and the distribution of illegal porn [1]. He has also written an amusing rant about how offended he was by the false advertising of an erotic movie [2].

I think that both these issues need to be addressed at the same time. We need to have an erotic movie about a senator and some movie executives who go on a cruise. It could start with the senator wearing fishnet stockings under his suit while giving a speech about the need to prevent the distribution of pornography and “protect the children“. Then when on the the cruise he meets a young looking woman who likes wearing school uniforms and spends some of his spare time photographing her in artistic poses.

Most of the film would have gratuitous shots of people wearing less clothing than usual and spanking each other (including the senator giving a good impression of Dr Frank n Furter [3]). An element of mystery would also be good – who did the senator sleep with while blindfolded? The finale would have the senator in bed with the movie executives in an analogy of what senators do in real life (except that real life has a lot less spanking).

This plot wouldn’t necessarily imply a movie of Ed Wood [4] caliber. Let’s face it, most Hollywood movies don’t have a plot (the exceptions being those that are copied from successful movies from other times or places).

Disclaimer: This plot idea is strictly a work of fiction and bears no resemblance to any real people (I wouldn’t want my blog to end up in a secretive government blacklist). That said, if you want to imagine that any male politician who gives a speech about “protecting the children” is wearing lingerie while doing so, then go for it (you might even be right).

The Cost of Car Crashes

March 19, 2009 | etbe

An article from 1999 suggested that car crashes caused a financial loss in OECD countries equivalent of 2% of their entire economies [1]. An article from the Sydney Morning Herald in 2001 gave a conservative estimate of the cost of a road fatality at $1.5 million [2], it also notes that due to different analysis methods American transport economists derived a figure of $5.5 million. $1.5 million in 2001 adjusted for CPI would be close to $2 million now.

Currently that $2M cost is an externality of the car industry. Most of it is paid by the government, IE we all pay for it through our taxes. This means that there is little financial incentive for drivers and car companies to make the roads safer. Many of the attempts to legislate road safety fail due to the legal system being unable to manage the rapidly changing range of vehicles on the market.

The insurance companies have very detailed analysis of the relative safety of vehicles, so it seems that the only sensible way of enforcing safe driving is through economic measures implemented via insurance.

I believe that for every person who is killed or seriously injured on the road a fine of $2M should be levied. Every driver should be compelled to have insurance to cover such fines (driving without insurance should be illegal).

Then the government could cease being involved in regulating what types of car someone can drive. If someone who is less than 25 years old can get insurance for a turbo-charged car then it probably means that a statistical analysis suggests that the combination of driver and vehicle is likely to be reasonably safe (EG there are many turbo-charged cars on the market that are not particularly fast).

Now this will increase the car insurance costs for everyone, but it will decrease the amount of general tax money that is spent on issues related to road fatalities, which would allow the income tax rates to be decreased. This means that any tax-payer who has a good driving record and who drives a type of car that tends not to be crashed could expect to save money overall. Any tax-payer who doesn’t drive a car would save even more money.

But the main point of this idea is to increase road safety by forcing bad cars and drivers off the road. Currently defective cars are only removed from the road if police notice something unsafe about them and cite them for being unroadworthy – this only happens if it’s a problem which can be observed from outside the vehicle (EG worn tires or broken lights). In some states elderly drivers have no requirement for periodic health checks to determine their ability to drive, I know of one case of a woman who was certified as legally blind, ordered a white cane, and then drove home afterwards! I’m sure that insurance companies would implement whatever tests are necessary to reduce the risk of being hit by multiple $2M fines from a single crash.

Lobbying for Free Software

March 17, 2009 | etbe

I am not aware of any Linux Users Group (LUG) being active in informing it’s members of how the policies of the various political parties compare with regard to free software and the other issues that are of interest to most members. I believe that this is a grave mistake.

Shortly before an election there are many social groups that send lists of questions to all the parties. They ask about the policies the parties have in regard to the issues that they care about, and helpfully mention the number of members that will receive the response. This of course doesn’t mean that every member of the group in question will cast their vote in the same way, merely that they will take note of the answers.

The committee members of the parties in question will then decide how to answer the questions and whether policy should be tweaked to allow answers that the lobby groups will like. So this process not only helps members of a group make informed voting decisions related to issues that they care about, but it also helps political parties choose policies that are least offensive to the group in question.

Here is a draft of a list of questions that I think should be asked of all political parties on behalf of Linux users:

It is important for all citizens to access all government data without being forced to buy new software or hardware, open standards allow everyone to access the data with free software. Do you support the use of open standards for data on government web sites and other forms of electronic communication between government agencies and citizens?
For long term archival of records it is important that file formats remain readable. The only effective way of doing this is to use open file formats that are implemented in free software. Do you support mandating that all data submitted to government agencies (by citizens or corporations) be in open file formats wherever possible?
In these difficult economic times there is a great interest in keeping jobs in the country instead of sending money overseas. To what extent do you support the use of free software that is installed and managed by locals (keeping the money in the economy) instead of importing software at great taxpayer expense?
Commercial software has a limited support period, after that time has elapsed there is no further support and systems become increasingly unreliable. Do you support mandating that all systems relating to the emergency services run on free software to allow quality long-term support by local citizens?
There has been a lot of concern recently about the spread of child-porn. The best available evidence shows that insecure home PCs that run “Trojan Horse” programs are a key part of distributing it and other illegal material. Do you support the introduction of government programs to train parents in installing one of the more secure free operating systems on their home PC to protect their children?

This is just a rough draft. Obviously there needs to be local differences (EG don’t use point 3 in the US because MS brings money into the US economy).

Does anyone have any suggestions for other questions?

A Police SMS about Fire Risk

March 2, 2009 | etbe

My wife and I have each received SMS messages from “Vic.Police” that say:

Extreme weather expected tonight (Monday) & tomorrow. High wind & fire risk. Listen to the ABC local radio for emergency update. Do not reply to this message.

Presumably the police are trying to contact everyone in Victoria. The problem seems to be related to the high wind speed that is forecast, the temperature is only predicted to be 32C (as opposed to the 38C that they were forecasting a few days ago and the temperatures of 46C or more a few weeks ago).

The last reports were that the firefighters were still working on putting out fires, and the unclear news coverage seemed to suggest that some of the fires had been burning since the 7th of February. A day of extreme fire danger that starts without any fires would be bad enough, but starting with some fires that are already out of control is destined to give a very bad result.

Below is the link to my previous post about people trying to take advantage of a tragedy to benefit their own political causes. For anyone who wants to rail against abortion, homosexuality, or the Greens party, please show some decency and do so based on relevant facts and do it at an appropriate time. I suggest that anyone who writes later this week about ways to avoid bushfires should be careful to check their claims for accuracy and scientific evidence (hint – the CSIRO and NASA have published a lot of useful background information).

http://etbe.coker.com.au/2009/02/25/tragedy-and-profit/

Tragedy and Profit

February 25, 2009 | etbe

Every time something goes wrong there will be someone who tries to take advantage of the situation. The recent bushfires in Australia that have killed hundreds of people (the count is not known yet) are a good example. Pastor Nalliah of Catch the Fire Ministries [1] claims that it is due to legalising abortion. This is astoundingly wrong.

In a more extreme example representatives of the Westboro Baptist Church were planning to visit Australia to launch a protest in support of the bushfires [2]. I have not yet found any news reports about whether they actually visited Australia or protested – it’s most likely that they decided not to visit due to the Australian laws being very different to US laws regarding the relative importance of freedom of speech and incitement to violence. Apparently the insane Westboro Baptist Church people (who are best known for GodHatesFags.com and GodHatesAmerica.com) believe that God hates Australia and caused the fires (presumably due to Australia not persecuting homosexuals). Danny Nalliah has permanently damaged his own reputation by acting in a similar way to the Westboro Baptist Church. The reputation of Catch The Fire now depends on how quickly they get a new pastor…

Please note well that the vast majority of Christians have nothing in common with Westboro or Catch The Fire. I don’t recall the last time I met an Australian Christian who was strongly opposed to homosexuality or abortion.

Now we do have to try and investigate ways of avoiding future tragedies, and the work to do this needs to begin immediately. John Brumby (the Premier of Victoria) has announced that Victoria will get new strict building codes for fire resistant buildings [3]. There have been many anecdotes of people who claim to have been saved by attaching sprinkler systems to their homes, by building concrete bunkers to hide in while the fire passes, and using other techniques to save their home or save themselves. Some more research on the most effective ways of achieving such goals would be worthwhile, an increase in funding for the CSIRO to investigate the related issues would be a good thing. The article also has an interesting quote “As the fallout from the disaster widened, the union representing the nation’s 13,000 firefighters warned both the federal and state governments to take global warming seriously to prevent a repeat of last weekend’s lethal firestorm“. However given that traditionally Australia and the US have been the two nations most opposed to any efforts to mitigate global warming it seems unlikely that anything will change in this regard in a hurry.

The attempts to link bushfires to abortion and homosexuality are offensive, but can be ignored in any remotely serious debate about politics. However there are some other groups trying to profit from the tragedy that make claims which are not as ridiculous.

On the 9th of February the Australian Green party was compelled to release an official statement from Spokesperson Scott Ludlam, Sarah Hanson-Young, Rachel Siewert, Christine Milne, and Bob Brown following some political discussion about Greens policies [4]. There have been attempts to blame the Greens for the tragedy which were politically motivated, some of which came from groups that traditionally oppose the Greens for other reasons (I’m not going to provide the detail – anyone who is really interested can do google searches on the people in question). On the 16th of February Bob Brown (the leader of the Green party) felt obliged to make another media release reiterating the fact that the Greens support prescribed burn-offs to limit the scope of wild fires [5], he also decried the hate mongering that has been occurring in the wake of the disaster.

One of the strange memes that seems to be spread by opponents to the Greens is that the Greens are all supposedly from the city and know nothing about the country. To avoid being subject to such attack I feel obliged to note that on one of the bad fire days I visited my parents. I spent the morning with my father and some friends at a park that was not far from the fire area, my friends then returned to their home which was not far from the fire area. I then had lunch with my parents and watched the smoke through the dining room window. After that my friends didn’t respond to email for a while and I was concerned that they may have lost their house or maybe suffered injury or death. I didn’t know them well enough to feel it appropriate to try a dozen different ways of contacting them (I’m sure that many other people were doing so), but I was rather concerned until my wife received an email from them.

But I don’t base my political beliefs on what I personally observe or my connections to people on the edge of the fire zone. I believe in the Green principles of “Peace and Non Violence, Grassroots Democracy, Social and Economic Justice, Ecological Sustainability” and the use of science and statistics to determine the best ways of achieving those goals.

How to Support Straight Marriage

January 30, 2009 | etbe

There is currently a lot of discussion about how to protect “marriage“, such discussion is based on the issue of whether Gay Marriage should be prohibited to protect Straight Marriage. Some straight people believe that their own marriage would be better if homosexuals were allowed to get married, some have even declared that they won’t get married until discrimination in this regard is ended. I don’t believe that whether some other people get married will make any difference to my marriage.

I believe that any two consenting adults who are not closely related should be allowed to get married, but I am not going to write about that today. What I will address is some positive steps that can be taken by a government to protect Straight Marriage without regard to Gay Marriage.

By the most objective criteria, death is the greatest obstacle to marriage. To protect someone’s marriage you should first protect them from becoming a widow or widower for as long as possible. Also protecting the lives of children (both biological and adopted) is important for protecting marriage. Here are some of the many ways of preventing needless death:

Don’t start wars except in the most extreme situations. Wars inevitably involve the death of soldiers (some of whom are married) and any war that is anything other than the smallest border incident will involve the death of civilians (married people and children).
Protect the food supply and the environment. When toxic chemicals, heavy metals, or radioactive material are released in the environment it results in a statistical increase in the death rate from cancer.
Increase the funding for medical research. Today there are many medical situations which can be routinely and safely resolved which would have been likely to be fatal 10 or 20 years ago. More medical research will lead to more diseases being cured.
Spread positive technology around the world. Protecting marriage should have a larger scope than your local region, therefore life-saving medicine needs to be affordable in all countries. Patents that prevent this need to be voided in the poorer regions of the world.
Increase the research on car safety. Car crashes are one of the largest causes of death and significant injury in the first world which can be easily reduced. Unfortunately there has been little research on making cars safe for women and children (crash-test dummies for woman and children are to a large extent scaled-down models based on research on men due to the lack of female and child cadavers for research [1]). Also I believe that the majority of car safety research in regard to crash test dummies was done in the US and therefore is biased towards caucasians and afro-americans – I believe that research on other races is needed to give equal protection to all races (caucasian and afro-american races are in a minority in the world).

This is by no means a comprehensive list, but it does cover some issues that are current and well known.

Now the next objective way to analyse this issue is to look at statistics related to divorce. It seems that money is an issue related to divorce and therefore protecting the finances of married people is a way of protecting marriage.

The first thing that can be done is to give people more continuity of employment. Being in a situation where you could lose your job at short notice is stressful and has to have a negative impact on a married couple. Recently the supposedly “conservative” Liberal government in Australia was trying to ban Gay Marriage while also introducing legislation to make it easier to lay off employees who have done nothing wrong (based on business issues). Among other things the Work Choices legislation made it more difficult for such employees to take out bank loans (which means that they often pay higher interest rates).

A final issue that causes stress for married couples is the school system (which is broken in many ways). I’m not going to try and cover this in detail here, but I will note that installing flag-poles (as the Liberal government wanted to do) is not the solution to problems with the education system.

Addressing these real issues will take some government funding, but it’s not a lot and a much greater amount of money could be saved by ending the “war on drugs”.

If the people who claim to be protecting straight marriage can address these other more serious problems that threaten straight marriages then I still won’t agree with calls to ban gay marriage. But it would make then seem less hypocritical.

[1] http://en.wikipedia.org/wiki/Crash_test_dummy

Voting and Linux Australia

January 29, 2009 | etbe

Dhanapalan writes about the small number of voters for Linux Australia elections [1]. I guess that blacklist-voting is partly to blame for my inactivity in this regard. Linux Australia is running pretty well so I don’t think there’s a great need for me to go out of my way to vote.

One thing that could be done given that LCA is an LA event is to give a voting session keynote status at LCA. Have it happen just after a keynote speech and have some prize given away to a random person who attends – the free laptops that were given away one year are not required, a free lunch voucher would be more than enough to increase the attendance.

A final factor that needs to be considered is the number of elections that we may vote in. I vote in Australian elections (state and federal), Debian votes (General Resolutions and DPL elections), and sometimes my local LUG. The amount of attention that I can focus on political issues is limited and divided with other elections that are more important.

[1] http://www.dhanapalan.com/blog/2009/01/27/participation-in-the-nation/

etbe – Russell Coker

Linux, politics, and other interesting things

Category Archives: Politics