Alone Together

I just finished reading Sherry Turkle’s new book, Alone Together: Why we expect more from technology and less from each other (book website, Amazon) and I can’t recommend it highly enough. She reports on her research into how people experience social media and social robots, and asks many important questions about where we’re headed. I found the second half of the book, on social media, more compelling than the first, on robots, though Turkle’s analysis does bring the two topics together nicely.

The Complexities of Dying in a High-Tech Era

I thought this recent Fresh Air interview with Robert Martensen was very good: End of Life Care in America, A Doctor's Diagnosis. Martensen discusses the problem of medical intervention in the very final stages of life.

He has written a book called A Life Worth Living: A Doctor's Reflections on Illness in a High-Tech Era.

From the book description:

Critical illness is a fact of
life. Even those of us who enjoy decades of good health are touched by
it eventually, either in our own lives or in those of our loved ones.
And when this happens, we grapple with serious and often confusing
choices about how best to live with our afflictions.
A Life Worth Living is
a book for people facing these difficult decisions. Robert Martensen, a
physician, historian, and ethicist, draws on decades of experience with
patients and friends to explore the life cycle of serious illness, from
diagnosis to end of life. He connects personal stories with reflections
upon mortality, human agency, and the value of “cutting-edge”
technology in caring for the critically ill. Timely questions emerge:
To what extent should efforts to extend human life be made? What is the
value of nontraditional medical treatment? How has the American
health-care system affected treatment of the critically ill? And
finally, what are our doctors’ responsibilities to us as patients, and
where do those responsibilities end? Using poignant case studies,
Martensen demonstrates how we and our loved ones can maintain dignity
and resilience in the face of life’s most daunting circumstances.

Novelist Jim Harrison's blurb gets to the heart of the matter:

A Life Worth Living is a deeply engaging book. It can be read
as a self-defense manual. In fact it should be read by, say, anyone
over forty-five because we are all destined to do battle with the
medical industrial complex which seems quite confused about helping us
out of life. Martensen, who is both an M.D. and an historian of
medicine, gracefully illumines the problems we all face.” – Jim
Harrison, author of Returning to Earth


Republican Wacky Math on Health Insurance

I apologize for going off-topic and getting all political but some things are more important than technology right now. And in this post I'm responding to another blog that's nominally related to technology and society: the Diagnosis blog at The New Atlantis. They don't have comments so I thought I'd rant here.

The New Atlantis publishes some good work occasionally, but at times they stray too far into (their right-wing) politics. In a post last week called Biden's Phony Health Care Argument, The New Atlantis's "health care policy expert" James Capretta tried to set the record straight on Joe Biden's statements about McCain's health insurance plan during the VP debate — the plan where McCain wants to give you $5000 to go buy your own health insurance (actually $5000 for families, $2500 for individuals). Biden pointed out that employers are paying $12000 per person on average, leaving a $7000 gap for you to make up on your own.

Here is the first part of Capretta's argument:

Where’s the additional $7,000 going to come from?

Here’s how it would really work.

Suppose a worker gets $50,000 in cash wages and $12,000 in health insurance.

now, he pays federal income taxes on the wages but not the health
insurance. Let’s assume, for reasons of simplicity, that the tax rate
he is paying is a flat 25% on his wages. He therefore pays $12,500 in
federal income taxes. His after-tax, after-health-care income is

Now, under the McCain plan, his employer keeps paying
the premium, which is now counted as income to the worker. He therefore
pays federal income taxes on $62,000, or $15,500.

But he also
gets a tax credit of $5,000 for health insurance, which means that, all
in all, he owes $10,500 in federal taxes, or $2,000 less than he does
today. His after-tax, after-health-care income is $39,500.

Ignore the fancy tax math — it's irrelevant here. Capretta is figuring out the best case scenario — you get the tax credit and your employer still pays for your insurance. That's not very likely, given how employers will have every reason to drop health insurance coverage once McCain sets them free.

What about the other case then? Capretta:

If the worker decides to buy his insurance in the open market instead
of through the employer, the result will be the same. His employer is
indifferent to how he pays his worker as long as total costs are the
same. So instead of paying premiums, the employer pays his worker
$62,000 in cash wages and does not pay anything toward insurance. The
worker again owes $15,500 in taxes on this compensation, and he also
must buy health insurance costing $12,000. So, his pre-tax income is
$62,000, he owes $12,000 in health insurance premiums, and he owes
$10,500 in federal taxes (after claiming his credit). His after-tax,
after-health-care income is the same: $39,500 ($62,000 – $12,000 –
$10,500), or $2,000 more than today. 

First off, I love the illusion of choice — "if the worker decides" — as if everyone will have that luxury. Second, he's assuming your employer will give you a $12000 raise! Is he serious?

That second sentence is quite a howler: "His employer is indifferent to how he pays his worker as long as total costs are the same." Ha! Employers are struggling to pay health insurance costs. They want this plan because it will offload their costs to others.

Capretta also deceives by ignoring the rising cost of health insurance. For many companies it's increasing by double digits every year, I believe. Will McCain's tax rebate keep pace? How about those fantasy raises?

I'm not sure if The New Atlantis is just repeating Republican talking points on this or if this is their original analysis. My guess is the former, given how McCain and others are saying that "if you do the math," his plan will benefit you. This is some kind of math… more like nonsense and deception.

I'm no health policy analyst and I confess I don't know all the details of either candidate's plan. Nor do I think Obama's plan goes far enough, but it's clearly the better choice. More than that — it's the only choice that isn't insane.

In my fantasy world I envision a president Obama with an overpowering mandate to clean up the current messes and enact some truly rational, liberal, people-centered policies. One of which would be single-payer health care or something like it. I've been reading this new fantasy book: 10 Excellent Reasons for National Health Care (see also Physicians for a National Health Program). It's fantasy in the US, of course, but not in the rest of the civilized world.NationalHealthCare

Considering long-term ramifications of technologies

The New York Times has a good article today by Cornelia Dean about our growing need (and ill-preparedness) to consider the long-term impact of new technologies, particularly geoengineering and nanotechnology.  Excerpt:

Last year, a private company proposed “fertilizing” parts of the ocean
with iron, in hopes of encouraging carbon-absorbing blooms of plankton.
Meanwhile, researchers elsewhere are talking about injecting chemicals
into the atmosphere, launching sun-reflecting mirrors into stationary
orbit above the earth or taking other steps to reset the thermostat of
a warming planet.

This technology might be useful, even life-saving. But it would
inevitably produce environmental effects impossible to predict and
impossible to undo. So a growing number of experts say it is time for
broad discussion of how and by whom it should be used, or if it should
be tried at all.

Similar questions are being raised about
nanotechnology, robotics and other powerful emerging technologies.
There are even those who suggest humanity should collectively decide to
turn away from some new technologies as inherently dangerous.

“The complexity of newly engineered systems coupled with their
potential impact on lives, the environment, etc., raise a set of
ethical issues that engineers had not been thinking about,” said
William A. Wulf, a computer scientist who until last year headed the
National Academy of Engineering. As one of his official last acts, he
established the Center for Engineering, Ethics, and Society there.

Rachelle Hollander, a philosopher who directs the center, said the new
technologies were so powerful that “our saving grace, our inability to
affect things at a planetary level, is being lost to us,” as
human-induced climate change is demonstrating.

Link: Handle With Care

Aging with Aubrey de Grey Event

Aubrey de Grey's Methuselah foundation is having an event in LA later this month called Aging 2008.  From the description:

Applying the new technologies of regenerative and genetic medicine, the engineering approach to aging promises to dramatically extend healthy human life within the next few decades.

How do you and your loved ones stand to benefit from the coming biomedical revolution? Are you prepared? Is society prepared?

At Aging 2008 you will engage with top scientists and advocates as they present their findings and advice, and learn what you can do to help accelerate progress towards a cure for the disease and suffering of aging.

It looks to be a fairly one-sided affair, with no ethicists or skeptics on the program, but nonetheless it's free and might be interesting if you want to hear more about what these people are up to.

You can win "VIP" entry to the event and free admission to a dinner with Aubrey et al. by going to a contest page and describing what you'd do if you lived to 150.