Jessica Tarlov

Click

I was not really hip to her My Bad. Just saw her on a Kara Swisher PIVOT episode. Her new book is very, very nice. Update: I just finished it. Well worth my time. She reminds me somewhat of CNN alum Laurie Segall. I particularly like the frank personal life revelations in both of their memoirs. (As I did in geologist Marcia Bjornerud's autiobiography. We exchange emails now & then. I always call her "Dr. Smarty-Pants." It was her line.)

 

BELOW: RAGING MODERATES PODCAST

 

One impressive woman. Doctorate in PolySci from the London Scholl of Economics. Humane, clear thinker. Encourage you to watch the foregoing in its entirety.

 

Also, watch her recent podcast interview with Kara Swisher. 

 

I GUESS I MIGHT QUALIFY AS A "RAGING MODERATE."

''eh, Ma?

______

 

FOLLOW-ON NOTE

 

At the end of her book, Jessica lays out a short list of policy reform and interpersonal attitude adjustment ideas:

1. Medicare for All / Single Payer Healthcare
2. National High Speed Rail
3. Merit-Based Immigration
4. Actually Drain the Swamp
5. Reverse Learning Loss (e.g., COVID upshot)
6. Rehire Veterans
7. Career Opportunities for the non-College Educated
8. Zero Interest Home Loans
9. Talk Openly & Neutrally About Religion
10. Stop Being Reflexively Offended / Aggrieved 

Interesting. 

 

JESSICA ON MEDICARE FOR ALL

I’ve never typed those words before. At least not in the context of expressing my own sentiments. But considering how unaffordable and unsatisfactory American health care is, the time for incrementalism is behind us. Fighting to merely restore Obamacare subsidies that still leave Americans with a huge bill just isn’t fair. When I was writing this, I asked my mom if she thought we should have a single-payer system. It was the fastest she’s ever responded to a question. “Yes, of course.” She continued, “I’ve been on so many different plans: employer insurance, COBRA, and Medicare. Medicare is leagues better. Health care is part of the social contract.” Then we talked about how my dad used to say that the job of the government is to alleviate as much anxiety as possible. What are Americans afraid of? Crushing health care costs. Two thirds of them, according to KFF. Nearly 60% can’t afford a surprise thousand-dollar medical expense, and 95% of insured adults worry about hospital bills from an emergency. The cost of Medicare for All isn’t as high as people think: Many businesses and working-class Americans would pay additional taxes but come out ahead because they’re no longer paying for insurance, copays, or deductibles. It’s also not some fringe, socialist cause. Congresswoman Debbie Dingell is as pragmatic and bipartisan as they come, and even she backs the bill, saying, “Every American has the right to health care, period.” I know getting this to sixty votes in the Senate is an enormous hurdle. But it would save nearly seventy thousand lives each year and give all Americans the confidence to get treated when they’re sick. That is change worth fighting for.

 

Tarlov, Jessica. I Disagree: Winning Arguments Without Losing Friends (pp. 211-212). (Function). Kindle Edition.  

 

I can only speak personally and as a relative SME to her #1, having been a Medicare Peer Review analyst (and repetitive next-of-kin acute caregiver). From my 1994 grad school Single Payer "argument analysis" paper.

ABSTRACT

Notwithstanding public misgivings about making significant public policy driven changesin the U.S. health care industry, there is extensive and persuasive empirical evidence of costly inadequacies in the system-such as lack of access/coverage, uneven levels of quality of service and outcomes, market-driven rather clinical priorities, waste and duplication, etc.-that can best be corrected by a unified approach to improvement driven by a scientific focus on quality issues (broadly defined) rather than those of short-term cost-control, competition, and piecemeal regulatory strategies and tactics. A single-payer health care system reformed byn implementation of the ten principles detailed herein would at once extend medical access to all, reduce costs, improve clinical outcomes of the sick and injured, and elevate the overall health stafus of the nation, resulting in win-win consequences for providers and citizens alike.

I got a dad-gumbed 100 hours in that one paper. 28 years hence, we've not made all that much sustained, systematic progress. See my 2015 "Shards" post.

 

Go, Jesse... 

We in the U.S. just want health care "PLANS," not actual health care, I guess

"Obamacare is a radical expansion of the status quo." —JD Kleinke

    

Sept 2012

December 2025

When SCOTUS initially upheld the constitutionality of "Obamacare" (the PPACA), lyrics to a song promptly fell right outa my head in about 10 minutes. Two days later I posted a goofy YouTube music video.

 

BTW: Noted medical economist / novelist JD Kleinke is my friend (fellow guitar cat). He once told me "an economist is someone who sees something that works in practice and tries to determine whether it'll work in theory." 

 

OK, BACK UP TO 1994

 

My first grad school paper. An "argument analysis & evaluation" assessment of the "Single Payer" proposal published in JAMA.

UNLV EPS 701 Fall 1994, Argument Analysis Paper (pdf)

A Better Quality Alternative:
Single-Payer National Health System Reform

Gordon D. Schiff, MD, Andrew M. Bindman, MD, Troyen A. Brennan, MD, JD, MPH; 

Physicians for a National Health Program Quality of Care Working Group.
JAMA, September 14, 1994—VoL 272, No. 10

Argument synopsis:
Notwithstanding public misgivings about making significant public policy driven changes in the U.S. health care industry, there is extensive and persuasive empirical evidence of costly inadequacies in the system—such as lack of access/coverage, uneven levels of quality of service and outcomes, market-driven rather clinical priorities, waste and duplication, etc.—that can best be corrected by a unified approach to improvement driven by a scientific focus on quality issues (broadly defined) rather than those of short-term cost-control, competition, and piecemeal regulatory strategies and tactics. A single-payer health care system reformed by implementation of the ten principles detailed herein would at once extend medical access to all, reduce costs, improve clinical outcomes of the sick and injured, and elevate the overall health status of the nation, resulting in win-win consequences for providers and citizens alike.

I first flowcharted every declarative sentence / sub-clause "truth claim" sequentially to get at what the authors were precisely advocating ("seek first to understand'). Only after that would I go on to "evaluation" ("seek then to be understood")—basically making my argument going to the cogency of the proffer. (Basically, think "ASSUMING - BECAUSE - DESPITE - THEREFORE - ELSE" logic and concomitant evidence)

 

I had at least 100 hours in that paper. Great fun. Notwithstanding a 2nd grad course in "History of Ethics" (11 required textbooks) and my day gig at the Nevada Medicare Peer Review.
 

I'm revisiting my conclusions (to wit, pg 54).

Overall Evaluation:
The following alternative courses of action are generally advanced in the health care debate:

1. Status quo: the system works fine, and normal incremental quality improvements at the provider level will suffice. Get a job.
2. Insurance reform: prohibit exclusion and enforce community rating to reduce the insurance premium stratification characteristic of the present system.
3. Expand existing public payer programs such as Medicare to cover the working poor and otherwise uninsurable.
4. Capitated managed competition, with "employer mandates" to provide choices in beneficiary alliances for pooled coverage bry*g power, administered though the workplace.
5. Tax inducement programs such as the "Medi-save" approach in which workers use pre-tax dollars to purchase catastrophic coverage and pay for routine health expenses themselves.
6. The public single-payer system based more or less on the Canadian model.

No one can dispute that the health care industry can be improved. Any system an be improved. Problems such as lack of access, arbitrary and often wildly excessive pricing, inexplicable variations in clinical practice and outcomes are well-documented and cry out for solution. That tends to rule out option 1. The question is one of extent: has the case been made that the health care industry requires comprehensive national reform?

In sum, the authors' argument has many strengths, particularly in their exhaustively documented enumeration of the shortcomings of our present health care system—to the extent to which it can be characterized as a "system." There is, however, a plausible alternative to a public national single payer system that would meet many of the goals sought by these advocates, and it is not a theoretical one. Utah's IHC (Intermountain Health Care) organization is a private, vertically-integrated health care corporation serving Utah and western Wyoming residents. It is a large for-profit network of hospitals, clinics, physicians, and related operations such as home health services. IHC is essentially a managed-care system with subscribers who pay set fees and minimal co-payments. Unlike other HMO-type operations in the state that typically experience subscriber turnover rates of approximately 15% per year, IHC’s turnover rate is less than 0.5% (that's 0.005), at competitive prices. They accomplish this by an organization-wide, enthusiastic, almost religious commitment to the very CQI principles outlined above. IHC quality improvement programs are directed byDr.  Brent James, a surgeon and nationally respected leader in health care CQI education. Having myself undergone their health care CQI training course over the period of the past six months as a part of my work, I can attest that IHC, while not yet perfect, effectively applies nearly all of the recommendations cited in this article, albeit on a smaller scale (and that may indeed be a significant virtue). They  are in essence a microcosmic single-payer system, but one successful in the private sector, driven not by publicly imposed mandates, but by their own thorough knowledge of and dedication to CQL IT is difficult to see at this point whether the asserted advantages of a national public system would add net value beyond the type of operation that IHC represents.

To be fair, IHC operating in a fairly prosperous, culturally homogeneous region enjoying a great deal of social and political unity. Here in Nevada, by contrast, though we share a common border and similar population size and geography with Utah, the social milieu could not be more different. IHC might not encounter the same level of success in other regions, and their successes do not impact those who cannot obtain coverage-and a central issue of this article has been about the significant negative impact of such a deficit. The IHC example does, however, stand in stark relief to both the inadequate business-as-usual attitude, and the proposition advanced above that a national single-payer system is the best path to effective health care reform. other examples exist around the nation also; one that comes to mind is Northwest Hospital in Seattle whose presentation at the Annual Quality Congress of the American Society for Quality Control this year revealed yet another organization deriving significant cost savings and quality improvement from diligent application of CQI methods. 

Rule Number One of CQI is "listen to the customer," and thus far the customers are prohibitively wary of the idea of creating a huge new national program, a political reality that is unlikely to shift anytime soon. The argument presented by Schiff et al takes into account an enormous amount of evidence and theory generated from within health care and the wider quality sciences, but serious questions remain unresolved with respect to the needs and concerns of health care consumers, whose overwhelming support would be needed to implement a single-payer health care system. 

I've been gumshoeing this topic for a long time. e.g., see "Public Optional." "Shards of Health Care" anyone?

 

Stay tuned...

"PROVE ME WRONG." Follow-up

 "Debate?"

 

 

Saw this (below) on Facebook today.

The misinformation surrounding Charlie Kirk is astounding—and I’m not talking about average people sounding off on social media—I’m talking about the BS being spread by major news outlets.

While Kirk’s shooter was obviously overly steeped in internet whackadoo memelord culture—the “normies” don’t have a clue about how internet culture works at all.

Charlie Kirk wasn’t someone who was looking for honest debate. He was a political operative spreading hate and divisiveness. When you show his fans his racist, sexist or bigoted rhetoric—they defend it by saying “That’s not (racist, sexist, bigoted)—it’s true.” And that was his goal.

The whole “Prove Me Wrong” setup that made Kirk famous wasn’t really about proving anyone wrong. It was about creating content. Kirk mastered a specific type of performance that looked like debate but functioned more like a carefully orchestrated show designed to make his opponents look foolish and his positions seem unassailable.

The basic formula was simple—set up a table on a college campus, invite students to challenge conservative talking points, then use a combination of rhetorical tricks and editing magic to create viral moments. What looked like open discourse was actually a rigged game where Kirk held all the advantages.

First, there’s the obvious setup problem.

Kirk was a professional political operative who spent years honing his arguments and memorizing statistics. He knew exactly which topics would come up and had practiced responses ready.

Meanwhile, his opponents were typically 19-year-old students who wandered over between classes. It’s like watching a professional boxer fight random people at the gym—the outcome was predetermined.

Kirk used what debate experts call a corrupted version of the Socratic method. Instead of asking genuine questions to explore ideas, he’d ask leading questions designed to trap students in contradictions or force them into uncomfortable positions. He’d start with seemingly reasonable premises, then quickly pivot to more extreme conclusions, leaving his opponents scrambling to keep up.

The classic example was his approach to gender identity discussions. Kirk would begin by asking seemingly straightforward definitional questions—“What is a woman?”—then use whatever answer he received as a launching pad for increasingly aggressive follow-ups. If someone mentioned social roles, he’d demand biological definitions. If they provided biological definitions, he’d find edge cases or exceptions to exploit.

The goal wasn’t understanding or genuine dialogue—it was creating moments where students appeared confused or contradictory.

Kirk also employed rapid-fire questioning techniques that made it nearly impossible for opponents to fully develop their thoughts. He’d interrupt, reframe, and redirect before anyone could establish a coherent argument. This created the illusion that his opponents couldn’t defend their positions when really they just couldn’t get a word in edgewise.

The editing process was equally important. Kirk’s team would film hours of interactions, then cut together the moments that made him look brilliant and his opponents look unprepared. Nuanced discussions got reduced to gotcha moments. Students who made good points found those parts mysteriously absent from the final videos.

What’s particularly insidious about this approach is how it masquerades as good-faith debate while undermining the very principles that make real discourse valuable. Kirk wasn’t interested in having his mind changed or learning from others—he was performing certainty for an audience that craved validation of their existing beliefs.

The “Prove Me Wrong” framing itself was misleading. It suggested Kirk was open to being persuaded when the entire setup was designed to prevent that possibility. Real intellectual humility requires admitting uncertainty, acknowledging complexity, and engaging with the strongest versions of opposing arguments. Kirk’s format did the opposite.

This style of debate-as-performance has become incredibly popular because it feeds into our current political moment’s hunger for easy victories and clear villains. People want to see their side “destroying” the opposition with “facts and logic.” Kirk provided that satisfaction without the messy reality of actual intellectual engagement.

The broader damage extends beyond individual interactions. When debate becomes about humiliating opponents rather than exploring ideas, it corrupts the entire enterprise of democratic discourse. Students who got embarrassed in these exchanges weren’t just losing arguments—they were being taught that engaging with different viewpoints was dangerous and futile.

Kirk’s approach also contributed to the broader polarization problem by making political identity feel like a zero-sum game where any concession to the other side represented total defeat. His debates reinforced the idea that political opponents weren’t just wrong but ridiculous—a perspective that makes compromise and collaboration nearly impossible.

The most troubling aspect might be how this style of engagement spreads. Kirk inspired countless imitators who use similar tactics in their own contexts. The model of setting up situations where you can’t lose, then claiming victory when your rigged game produces the expected results, has become a template for political engagement across the spectrum.

Real debate requires vulnerability—the possibility that you might be wrong and need to change your mind. Kirk’s format eliminated that possibility by design. His certainty was performative rather than earned, and his victories were manufactured rather than genuine.

The tragedy of this approach is that college campuses actually need more genuine dialogue about difficult political questions. Students are forming their worldviews and wrestling with complex issues. They deserve engagement that helps them think more clearly, not performances designed to make them look stupid.

Kirk’s assassination represents a horrific escalation of political violence that has no place in democratic society. But it’s worth remembering that his debate tactics, while not violent, were themselves a form of intellectual violence that treated political opponents as objects to be humiliated rather than fellow citizens to be engaged.

 From an earlier post of mine.

SEPT 17th UPDATE 

In the wake of reviewing a number of Charlie Kirk's "Prove Me Wrong" Step-Up-To-The-Mic ad hoc micro "debates," I have to conclude that trying to critically, factually question his positions would be a waste of time.

 

"Charlie SAID it. I BELIEVE it. That SETTLES it!" 

I watched Charlie Kirk "debate" a questioner on a YouTube video, a fellow who asked him about "Universal Healthcare." Mr. Kirk dismissively replied that "it's never worked anywhere it's ever been tried."

 

Well, I worked in health care analytics for a long time, delving into the broad gamut of issues ranging from clinical workflow process, outcomes research, and economic factors. I wrote my first grad school semester paper in 1994, wherein I composed a 51-pg "argument analysis" of the JAMA 1994 "Single Payer" proposal (pdf). I flowcharted the "truth claims" logic of every declarative assertion ("seek first to understand"), followed up by point-by-point evidence-based pro & con evaluations of every claim ("seek only then to be understood"). I have more than 100 hours in that one paper.

 

I subsequently spent years as a next-of-kin caregiver, beginning with my now-late elder daughter, followed by serving for years as POA and legal guardian for both of my now-late, then progressively ailing, nursing home-bound parents. Finally I finished up that journey by seeing my younger daughter out of this life in 2018, a victim of crushing stage IV pancreatic cancer. My knowledge of the health care system is at once broad and deep. And, oh, yeah, done my share of acute care patient time. See my "Shards of Healthcare" writings.

 

But, Charlie Kirk some months back simply told his questioner--and would surely condescend to me--that "90% of our heath care problem is a matter of lifestyle: exercise, diet, vitamin-D, and supplements."

 

Decide for yourselves.

I never took a "debate" course nor took part in any formal "debates." I did, however, intensely study and subsequently teach collegiate "Critical Thinking" and "Argument Analysis." Which, I'm sure, would simply be shrugged off by TPUSA/Kirkist devotees as merely confirming my dismissable status as one of those "leftist secular elites" whose views are summarily blown off.

 

PROVE ME WRONG. 

"PROVE ME WRONG"

[ *"Terms & Conditions Apply." ]

    

I redacted this fellow's name merely to throw some sand in the gears of anyone who might want to ID and harass him. "Gish Gallop." Yeah, also known in The Olden Days as the enervating "Yes, but..." fallacy whack-a-mole loop.

 

I'll have my sport with the now-deceased All-Knowing Super-Debater Of Our Time Charlie Kirk shortly. Stay tuned. I'm as worn out as y'all must be from the relentless Cat47 NeuroStorm of Synaptic Stupid since September 10th.

 

SEPT 17th UPDATE 

 

In the wake of reviewing a number of Charlie Kirk's "Prove Me Wrong" Step-Up-To-The-Mic ad hoc micro "debates," I have to conclude that trying to critically, factually question his positions would be a waste of time.

 

"Charlie SAID it. I BELIEVE it. That SETTLES it!" 

I watched Charlie Kirk "debate" a questioner on a YouTube video, a fellow who asked him about "Universal Healthcare." Mr. Kirk dismissively replied that "it's never worked anywhere it's ever been tried."

 

I worked in health care analytics for a long time, delving into the broad gamut of issues ranging from clinical workflow process, outcomes research, and economic factors. I wrote my first grad school semester paper in 1994, wherein I composed a 51-pg "argument analysis" of the JAMA 1994 "Single Payer" proposal (pdf). I flowcharted the "truth claims" logic of every declarative assertion ("seek first to understand"), followed up by point-by-point evidence-based pro & con evaluations of every claim ("seek only then to be understood"). I have more than 100 hours in that one paper.

 

I subsequently spent years as a next-of-kin caregiver, beginning with my now-late elder daughter, followed by serving for years as POA and legal guardian for both of my now-late, then progressively ailing, nursing home-bound parents. Finally I finished up that journey by seeing my younger daughter out of this life in 2018, a victim of crushing stage IV pancreatic cancer. My knowledge of the health care system is at once broad and deep. And, oh, yeah, done my share of acute care patient time. See my "Shards of Healthcare" writings.

 

But, Charlie Kirk some months back simply told his questioner--and would surely condescend to me--that "90% of our heath care problem is a matter of lifestyle: exercise, diet, vitamin-D, and supplements."

 

Decide for yourselves. 

Gotta move on to other topics.

Robert F. Kennedy Jr

confirmed by the Senate 52-48 to head HHS.

 

Try to imagine my disgust. Click either post above.

 

My late elder daughter, Sissy

YO, MR "MAHA" RFK JR

 

Scientific American

Our brains are full of plastic.

This was the fun news I read earlier this week while picking up dinner take-out, packed in plastic containers, crammed in a plastic bag and accompanied by Styrofoam cups. Great, I thought, convenience culture is killing us.

But is it? This is the problem with the slew of research finding microscopic shards of plastic in our arteries, kidneys and livers, the findings that our oceans, food, soil and air are teeming with tiny bits of Tupperware. Scientists still don’t know what this plastic is doing to us. And because research takes time, while scientists are trying to answer question, we just keep inhaling, eating and drinking tiny pieces of plastic.

Why? Regulatory action has never really stopped the U.S. plastics industry from cranking out more plastic, even as clean air and water advocates try to fight the industry’s pollution problems in court and locals wage grassroots wars to slow the permitting of more plants that spew all those toxic chemicals. And now, back in office, is a president beholden to fossil fuel interests (where petroleum and natural gas are plastics precursors), a leader who uses his new powers to demand the use of plastic straws, and an administration that is hell-bent on crippling EPA’s mission to keep us safe rather than empowering it.

Meanwhile, we do not know what all this plastic is doing to us. And no one currently in charge seems to care… [ read all of it ]

ERRATUM

ERRATUM

Click above.

UPDATE

Sonya Stokes, an emergency room physician in the San Francisco Bay Area, braces herself for a daily deluge of patients sick with coughs, soreness, fevers, vomiting, and other flu-like symptoms.

She’s desperate for information, but the Centers for Disease Control and Prevention, a critical source of urgent analyses of the flu and other public health threats, has gone quiet in the weeks since President Donald Trump took office.

“Without more information, we are blind,” she said.

Flu has been brutal this season. The CDC estimates at least 24 million illnesses, 310,000 hospitalizations, and 13,000 deaths from the flu since the start of October. At the same time, the bird flu outbreak continues to infect cattle and farmworkers. But CDC analyses that would inform people about these situations are delayed, and the CDC has cut off communication with doctors, researchers, and the World Health Organization, say doctors and public health experts.

“CDC right now is not reporting influenza data through the WHO global platforms, FluNet [and] FluID, that they’ve been providing information [on] for many, many years,” Maria Van Kerkhove, interim director of epidemic and pandemic preparedness at the WHO, said at a Feb. 12 press briefing.

“We are communicating with them,” she added, “but we haven’t heard anything back.”

On his first day in office, President Donald Trump announced the U.S. would withdraw from the WHO…

Ugh. 

_________

  

Assassination in Manhattan,

United Healthcare CEO gunned down.

  

 

It has been a chaotic few days. Culminating in a grotesque, brazen murder caught on surveillance video.

 

Social media reactions:

 

 

apropos of "Single Payer," my first grad school semester paper (pdf) 30 years ago comprised a detailed argument analysis evaluation of the Single Payer proposal published in JAMA in 1994:

Argument synopsis:
Notwithstanding public misgivings about making significant public policy driven changes in the U.S. health care industry, there is extensive and persuasive empirical evidence of costly inadequacies in the system-such as lack of access/coverage, uneven levels of quality of service and outcomes, market-driven rather clinical priorities, waste and duplication, etc.-that can best be corrected by a unified approach to improvement driven by a scientific focus on quality issues (broadly defined) rather than those of short-term cost-control, competition, and piecemeal regulatory strategies and tactics. A single-payer health care system reformed by implementation of the ten principles detailed herein would at once extend medical access to all, reduce costs, improve clinical outcomes of the sick and injured, and elevate the overall health status of the nation, resulting in win-win consequences for providers and citizens alike.

I put at least 100 hours into that 57-page project. I had just finished my first stint (of 3) with the Nevada Medicare QIO at the time.

Fast forward to 2015, and my post "The U.S. healthcare "system" in one word: "shards"

My interaction with our healthcare industry is at once lengthy, broad, and deep—Medicare analyst, next-of-kin caregiver (both daughters, both parents, spanning 16 years), and acute care patient (now a Medicare"Bene"). I'm as exasperated as anyone by our "system."

 

But you don't accomplish anything by murdering people.

 

APRIL & MAY 2017 REFLECTIONS

 

My examination of Elisabeth Rosenthal's writing. Here, here, and here. 

I can keep going. Lots more from where that stuff came. Again, though, murdering this or that CEO is not gonna do anything to mitigate things.

UPDATE

I would think the authorities will collar this perp before long.

No, neither would I celebrate the assassination of the President-Elect, In case the rhetorical point escapes you.

UPDATE

Police in Altoona PA caught the ID’d suspect, 26 yr old Baltimore native Luigi Mangione. Physical forensic evidence is piling up at warp speed. More in subsequent posts.

_________

  

Another Code Red day in Baltimore

 

Cheryl and I on the I-83 about 6:15 pm, northbound toward Towson from the kids' house near Camden Yards. The air today was simply wretched. Code Red Baltimore.

 

 

IN CASE YOU LACK ENOUGH OF EXIGENT CONCERN

 

…Hyatt’s invention [celluloid], often described as the world’s first commercially produced plastic, was followed a few decades later by Bakelite. Bakelite was followed by polyvinyl chloride, which was, in turn, followed by polyethylene, low-density polyethylene, polyester, polypropylene, Styrofoam, Plexiglas, Mylar, Teflon, polyethylene terephthalate (familiarly known as pet)—the list goes on and on. And on. Annual global production of plastic currently runs to more than eight hundred billion pounds. What was a problem of scarcity is now a problem of superabundance.

In the form of empty water bottles, used shopping bags, and tattered snack packages, plastic waste turns up pretty much everywhere today. It has been found at the bottom of the Mariana Trench, thirty-six thousand feet below sea level. It litters the beaches of Svalbard and the shores of the Cocos (Keeling) Islands, in the Indian Ocean, most of which are uninhabited. The Great Pacific Garbage Patch, a collection of floating debris that stretches across six hundred thousand square miles between California and Hawaii, is thought to contain some 1.8 trillion plastic shards. Among the many creatures being done in by all this junk are corals, tortoises, and elephants—in particular, the elephants of Sri Lanka. In recent years, twenty of them have died after ingesting plastic at a landfill near the village of Pallakkadu.

How worried should we be about what’s become known as “the plastic pollution crisis”? And what can be done about it? These questions lie at the heart of several recent books that take up what one author calls “the plastic trap.”

“Without plastic we’d have no modern medicine or gadgets or wire insulation to keep our homes from burning down,” that author, Matt Simon, writes in “A Poison Like No Other: How Microplastics Corrupted Our Planet and Our Bodies.” “But with plastic we’ve contaminated every corner of Earth.”

Simon, a science journalist at Wired, is especially concerned about plastic’s tendency to devolve into microplastics. (Microplastics are usually defined as bits smaller than five millimetres across.) This process is taking place all the time, in many different ways. Plastic bags drift into the ocean, where, after being tossed around by the waves and bombarded with UV radiation, they fall apart. Tires today contain a wide variety of plastics; as they roll along, they abrade, sending clouds of particles spinning into the air. Clothes made with plastics, which now comprise most items for sale, are constantly shedding fibres, much the way dogs shed hairs. A study published a few years ago in the journal Nature Food found that preparing infant formula in a plastic bottle is a good way to degrade the bottle, so what babies end up drinking is a sort of plastic soup. In fact, it is now clear that children are feeding on microplastics even before they can eat. In 2021, researchers from Italy announced that they had found microplastics in human placentas. A few months later, researchers from Germany and Austria announced that they’d found microplastics in meconium—the technical term for an infant’s first poop…

…Plastics are made from by-products of oil and gas refining; many of the chemicals involved, such as benzene and vinyl chloride, are carcinogens. In addition to their main ingredients, plastics may contain any number of additives. Many of these—for example, polyfluoroalkyl substances, or PFASs, which confer water resistance—are also suspected carcinogens. Many of the others have never been adequately tested.

As plastics fall apart, the chemicals that went into their manufacture can leak out. These can then combine to form new compounds, which may prove less dangerous than the originals—or more so. A couple of years ago, a team of American scientists subjected disposable shopping bags to several days of simulated sunlight, in order to mimic the conditions that they’d encounter flying or floating loose. The researchers found that a single bag from CVS leached more than thirteen thousand compounds; a bag from Walmart leached more than fifteen thousand. “It is becoming increasingly clear that plastics are not inert in the environment,” the team wrote. Steve Allen, a researcher at Canada’s Ocean Frontier Institute who specializes in microplastics, tells Simon, “If you’ve got an IQ above room temperature, you have to understand that this is not a good material to have in the environment.”…

…Precisely because plastic is now ubiquitous, it’s difficult to imagine how to replace all of it, or even much of it. Even in cases where substitutes are available, it’s not always clear that they’re preferable. Franklin-Wallis cites a 2018 study by the Danish Environmental Protection Agency which analyzed how different kinds of shopping bags compare in terms of life-cycle impacts. The study found that, to have a lower environmental impact than a plastic bag, a paper bag would have to be used forty-three times and a cotton tote would have to be used an astonishing seventy-one hundred times. “How many of those bags will last that long?” Franklin-Wallis asks. Walker-Franklin and Jambeck also note that exchanging plastic for other materials may involve “tradeoffs,” including “energy and water use and carbon emissions.” When Schaub’s supermarket stopped handing out plastic shopping bags, it may have reduced one problem only to exacerbate others—deforestation, say, or pesticide use.

“In the grand scheme of human existence, it wasn’t that long ago that we got along just fine without plastic,” Simon points out. This is true. It also wasn’t all that long ago that we got along just fine without Coca-Cola or packaged guacamole or six-ounce bottles of water or takeout everything. To make a significant dent in plastic waste—and certainly to “end plastic pollution”—will probably require not just substitution but elimination. If much of contemporary life is wrapped up in plastic, and the result of this is that we are poisoning our kids, ourselves, and our ecosystems, then contemporary life may need to be rethought. The question is what matters to us, and whether we’re willing to ask ourselves that question.

Excerpted from her long-read article.

__________

 

And, away we go...

Buckle up, folks.

"Shards," anyone?

 

US Covid19 daily incidence rate (new confrmed cases) is now nearly 400,000. Deaths have now surpassed 825,000 in the US.

See my ongoing post on Medium.

__________

 

The scourge of medical billing

I know this stuff all too well. As I'm sure do many of you.

From NPR:

MARY LOUISE KELLY, HOST:
This is what having cancer in the U.S. these days entails - grueling treatment, yes, but also surprising medical expenses, insurance denials, depleted savings accounts, even bankruptcy. Anna Gorman reports from Texas on one family coping with the financial fallout of cancer.

ANNA GORMAN, BYLINE:
Carol Marley is 50 years old. She has pancreatic cancer. Every day counts. And every day brings a frustrating phone call with an insurer or medical provider.

CAROL MARLEY:
This is Carol Marley calling. I'm getting ready to be going out of town for a treatment for my cancer, so I really - I need some help. If you could please call me today, I would appreciate it.

GORMAN:
Even though pancreatic cancer is one of the deadliest cancers, Carol's doctors caught it earlier than most.

C MARLEY:
I have faith in God that my cancer is not going to kill me. I have a harder time believing that this is going to get straightened out and isn't going to harm us financially.

GORMAN:
Carol is a nurse near Austin, Texas. She was diagnosed in July, and the cancer hasn't spread beyond her pancreas. Her health and the finances weigh on her.

C MARLEY:
It's incredibly stressful. I mean, I don't sleep at night. I take anxiety medication, you know, more often than I want to...

Just what you need when you're fighting serious, life-threatening illness.

This is a particularly pernicious area exacerbated by chronic data opacity / siloing, and what I irascibly call health IT "interoperababble."

My own 2015 experience with prostate cancer consumed most of that year. My head-scratching hassles with the medical billing industry were mostly a recurrently eye-rolling annoyance. See my prior post "The U.S. healthcare 'system' in one word: 'shards'."

Ten months after losing my younger daughter to pancreatic cancer on April 27th 2017, I continue on her late behalf to foist off aggressive attempts to collect absurd amounts of money (though by now it is abating). Twenty years prior to her death, we lost her elder sister to (unrelated) cancer. Similar postmortem bureaucratic hassles ensued.

Both of my girls died beyond flat broke as a result of their illnesses. Not that any of that mattered to medical bill collectors. But, the money gumshoes all eventually came to learn that they were messin' with the Wrong Irishman.

Danielle is survived only by her son, my grandson Keenan. Notwithstanding that I am not legally on the hook from any of her residual debts, I try to shield him from most of this crap so he doesn't get gamed into assuming liabilities for which he is not responsible. The Wrong Irishman knows the ropes. I used to work in subprime risk management. I know all about delinquency, collections, and charge-offs.

Listen to the entire NPR episode. Read the transcript. I so wish this woman well.

"Every misspent dollar in our health care system is part of someone's paycheck" -- Brent James, MD, M.Stat

Yeah. An observation in passing:

“I don’t think in ideological terms. I never have,” Obama said, continuing on the health care theme. “Everybody who supports single-payer health care says, ‘Look at all this money we would be saving from insurance and paperwork.’ That represents one million, two million, three million jobs [filled by] people who are working at Blue Cross Blue Shield or Kaiser or other places. What are we doing with them? Where are we employing them?”

Graeber, David. Bullshit Jobs: A Theory (p. 157). Simon & Schuster. Kindle Edition.

Stay tuned. Once again, political talk of "Medicare for All" and "Single Payer" (my 1994 Argument Analysis pdf) are in the air as the 2020 presidential race heats up. It will no doubt be as contentious as the "Obamacare" reform, if not more so.

apropos, see my post on the CATO Institute book "Overcharged" (a post which cites other relevant reads as well).

UPDATE: SPEAKING OF BOOKS

Reviewed at Science Magazine:

A science writer probes the one risk factor shared by a bevy of devastating diseases

Chronic disease states—including diabetes, most cancers, and cardiovascular and neurodegenerative syndromes—have become the leading drivers of morbidity and mortality. Medicine has set out to develop therapies for each condition separately, and yet they share a common denominator: aging. This has led to the revolutionary idea that interventions that slow aging will have the biggest impact on our collective health: not just extending life span but also delaying or preventing the onset of many diseases and improving functional parameters later in life.

But what causes aging, and how do we intervene? In Borrowed Time, Sue Armstrong describes proposed hallmarks of aging—which include accumulation of cellular damage, loss of stem cell function, cellular senescence, and others—and makes a cogent case for the role of each in driving age-associated dysfunction. Along the way, she describes the origins and development of the aging research field…

 Looks interesting. Only $9.99 Kindle price. In the wake of the stresses of the past couple of years here, I'm certainly feeling and seeing the effects of aging, at 73 now. 
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More to come...