Thursday, August 27, 2009

View: Zeitgeists through Science Fiction, Part One

I recently saw the movie District 9, and it has de-throned Battlestar Galactica and Lost as the movie/TV show for this, the first decade of the 21st century. The themes present in District 9 are themes not only for South Africa, but for the world as well.

Aliens arrive, and hover over Johannesburg in the 1980s. The South African government of the 1980s concludes that the aliens are, well, not white, and are partitioned from society in the epynonymous District 9 neigborhood outside Johannesburg. Twenty years later, the management company that runs District 9 decides to move the aliens to a new neighborhood. They send a bureaucrat in to do the job, and everything goes wrong.

The director of the movie, Neill Blomkamp, shows Apartheid explicitly. Other themes are present as well. The government of South Africa has essentially outsourced a civic responsibility to a private company. A refugee situation from nearby countries, complicates the situation. Several worlds collide, and English, the alien clicking language, Swahili, and Afrikaans are shouted. The bureaucrat can understand the alien's clicking language, and the aliens can understand spoken and written English. This mutual understanding proves essential to the story.

District 9 is not only science fiction for the current period, it is practically beyond the ken of the world that produced 2001: A Space Odyssey. In that movie, aliens are absent. Their interactions with humans are abstract and enigmatic to say the least. World society is distant, though presumed to have advanced enough to have rotating space stations, moon bases, etc., all by 1999. The 2001 book mentions a global food problem that affects even Americans, but this detail is not explored. Also, by 1969, the Green Revolution in food production had been underway for more than two decades.

Nevertheless, 2001 is way more optimistic about people and societies than District 9 is. Corporate entities in 2001 are benign, compared to amoral-at-best in District 9. Technocrats are smooth, subdued, nearly soporific Heywood Floyd's and David Bowman's. Technocrats in District 9 hook up guns to unwilling humans to practice firing alien weapons. Bear in mind that the former quality is a personality type, whereas the latter describes a specific act. People in 2001 sleep-walk through a space age, while people in District 9 go about their duties in a blunt, clumsy manner. Even the aliens are disorganized!

2001 showed a path to personal (and species-wide) enlightenment via the help of alien gods. The aliens reward various "stages" of human development by dropping monoliths in key points. If a hominid touches a monolith, they suddenly learn the ability to make tools. Millions of years later, the humans have equipment that can measure magnetic anomalies, and detect where a monolith sends a signal. Then, they build a spaceship for a trip to Jupiter, and give it a very smart computer...

District 9 promises nothing. Humans treat aliens, and each other, like garbage. Johannesburg has Houston-style hi-rises and suburbs, with miles of ghettos all around. The one positive aspect is that the races appear de-segregated (at least within the bureaucracies). One odd scene for this blogger was when the bureaucrat tries to buy food at a fast food joint called "Gunter's", which has a cheesy, vaguely German-looking cartoon character on the front of the building. The staff and clientele are almost all African-descendants. A TV set plays constantly near the order/pick-up counter, and staff equipment includes a shot gun.

2001 can be interpreted as a critique of what people were becoming - zombies with less personality than a computer. District 9 critiques many, many things - mostly short-sighted, narrow-minded thinking, that pervades all sentient beings - human and alien.

Debate: US Health Insurance Reform

While people are yelling in town halls, please remember that blaming "socialism" or "big pharma" is not enough to understand why health-care costs have risen so much over the decades. As the articles below indicate, it is not illegal immigrants, high-tech facilities (not directly), nor lawsuits (at least in Texas). The public arguments so far have trouble progressing due to the fact that much of the way that health-care is financed is invisible.

It is impossible to make rational expenditures without knowing what one is paying for -- where does the money go? Before you say, "to the CEOs and shareholders", read The Atlantic article -- the companies do not make enough money to justify the inflation.

These articles are long reads. The health-care cost issue is very complex, and trying to get one's head around it, as people who live, is something best done thoroughly.

The Cost Conundrum

What a Texas town can teach us about health care.

by Atul Gawande

"...McAllen has another distinction, too: it is one of the most expensive health-care markets in the country. Only Miami—which has much higher labor and living costs—spends more per person on health care. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns...

"...Yet public-health statistics show that cardiovascular-disease rates in the county are actually lower than average, probably because its smoking rates are quite low. Rates of asthma, H.I.V., infant mortality, cancer, and injury are lower, too. El Paso County, eight hundred miles up the border, has essentially the same demographics. Both counties have a population of roughly seven hundred thousand, similar public-health statistics, and similar percentages of non-English speakers, illegal immigrants, and the unemployed. Yet in 2006 Medicare expenditures (our best approximation of over-all spending patterns) in El Paso were $7,504 per enrollee—half as much as in McAllen. An unhealthy population couldn’t possibly be the reason that McAllen’s health-care costs are so high. (Or the reason that America’s are. We may be more obese than any other industrialized nation, but we have among the lowest rates of smoking and alcoholism, and we are in the middle of the range for cardiovascular disease and diabetes.)...

"...And yet there’s no evidence that the treatments and technologies available at McAllen are better than those found elsewhere in the country. The annual reports that hospitals file with Medicare show that those in McAllen and El Paso offer comparable technologies—neonatal intensive-care units, advanced cardiac services, PET scans, and so on. Public statistics show no difference in the supply of doctors. Hidalgo County actually has fewer specialists than the national average. ..."


Policy September 2009 Atlantic

After the needless death of his father, the author, a business executive, began a personal exploration of a health-care industry that for years has delivered poor service and irregular quality at astonishingly high cost. It is a system, he argues, that is not worth preserving in anything like its current form. And the health-care reform now being contemplated will not fix it. Here’s a radical solution to an agonizing problem.

by David Goldhill

How American Health Care Killed My Father

"...About a week after my father’s death, The New Yorker ran an article by Atul Gawande profiling the efforts of Dr. Peter Pronovost to reduce the incidence of fatal hospital-borne infections. Pronovost’s solution? A simple checklist of ICU protocols governing physician hand-washing and other basic sterilization procedures. Hospitals implementing Pronovost’s checklist had enjoyed almost instantaneous success, reducing hospital-infection rates by two-thirds within the first three months of its adoption. But many physicians rejected the checklist as an unnecessary and belittling bureaucratic intrusion, and many hospital executives were reluctant to push it on them. The story chronicled Pronovost’s travels around the country as he struggled to persuade hospitals to embrace his reform. ...

"...Keeping Dad company in the hospital for five weeks had left me befuddled. How can a facility featuring state-of-the-art diagnostic equipment use less-sophisticated information technology than my local sushi bar? How can the ICU stress the importance of sterility when its trash is picked up once daily, and only after flowing onto the floor of a patient’s room? Considering the importance of a patient’s frame of mind to recovery, why are the rooms so cheerless and uncomfortable? In whose interest is the bizarre scheduling of hospital shifts, so that a five-week stay brings an endless string of new personnel assigned to a patient’s care? Why, in other words, has this technologically advanced hospital missed out on the revolution in quality control and customer service that has swept all other consumer-facing industries in the past two generations? ...

"...Indeed, I suspect that our collective search for villains—for someone to blame—has distracted us and our political leaders from addressing the fundamental causes of our nation’s health-care crisis. All of the actors in health care—from doctors to insurers to pharmaceutical companies—work in a heavily regulated, massively subsidized industry full of structural distortions. They all want to serve patients well. But they also all behave rationally in response to the economic incentives those distortions create. Accidentally, but relentlessly, America has built a health-care system with incentives that inexorably generate terrible and perverse results. Incentives that emphasize health care over any other aspect of health and well-being. That emphasize treatment over prevention. That disguise true costs. That favor complexity, and discourage transparent competition based on price or quality. That result in a generational pyramid scheme rather than sustainable financing. And that—most important—remove consumers from our irreplaceable role as the ultimate ensurer of value. ...