Every day I try to be as generous as I can be

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Koons, meanwhile, has always seemed the sort of clever, wildly successful artist-cum-businessman one could afford to hate, or at least to distrust with bilious envy. But if the audience were expecting someone who wore his intellectual flair on his body, along with, say, funny hair and multicolored tennis shoes, they were disappointed. (There were some funny-haired people in the audience, and they were sitting together – does LACMA provide a special row?) Either he is a very good actor, or Koons is in reality a soft-spoken, thoughtful and articulate man who believes that the artist’s “journey” begins with the “acceptance of self.”

At one point a questioner in the audience addressed the result of Koons’ own self-acceptance, suggesting that his work is “cynical.” Koons seemed to take a slightly deeper breath; he’s heard this before. “I’m not cynical,” he said with deliberation. “My definition of cynicality is when you have more information than you reveal. I try to reveal everything I know. Every day I try to be as generous as I can be.”

more from the LA Weekly here.

Rubinstein on Levitt

The very talented economist and game theorist Ariel Rubinstein on Steven Levitt’s Freakanomics (via Tom Slee over at Whimsley):

Freakonomics lashes out at the entire world from the Olympus of economics. My response is an outline of “my new book”—Freak- Freakonomics. In my (“brilliant . . . ”) book, I will borrow from the structure and text of Freakonomics. I will show that if one also looks upon economists, including Levitt, as economic agents, one can use the insights of Freakonomics to lash out against . . . economics and economists.

Like Levitt, I have no central theme. My book will be a series of observations—some about economics, some about Freakonomics—that I hope the reader will find intriguing.

Chapter 1: is imperialism still alive?

Economists believe that they have a lot to contribute to any field—sociology, zoology or criminology. The academic imperialism of economics has something in common with political imperialism. Therefore, I will begin my chapter with a fascinating historical review where we will learn that imperialism stemmed from the perceived superiority of the conquering people over the conquered peoples, and that the role of the conqueror is to disseminate its lofty culture.

From here, I will move to describe Freakonomics as a typical work of academic imperialism. The complex interplay of feelings of superiority and deficiency has driven every empire, and economics is no different. Levitt: “Economics is a science with excellent tools for gaining answers, but a serious shortage of interesting questions”(xi). Freakonomics makes statistical reasoning, which is used in all the sciences, look like a subdued colony of economics. Furthermore, Freakonomics expresses the aspiration to expand economics to encompass any question that requires the use of common sense.

Akhmatova

In Slate, Clive James, author of Cultural Amnesia, takes a look at the great lyrical Russian poet Anna Akhmatova.

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Born in Odessa, educated in Kiev, and launched into poetic immortality as the beautiful incarnation of pre-revolutionary Petersburg, Anna Akhmatova (1889–1966) was the most famous Russian poet of her time, but the time was out of joint. Before the Bolshevik Revolution in 1917, Anna Andreyevna Gorenko, called Akhmatova, already wore the Russian literary world’s most glittering French verbal decorations: Here work was avant-garde, and in person she was a femme fatale. Love for her broken-nosed beauty was a common condition among the male poets, one of whom, Nikolay Gumilev, she married. After the Revolution, Gumilev was one of the new regime’s first victims among the literati: The persecution of artists, still thought of today as a Stalinist speciality, began under Lenin. Later on, under Stalin, Akhmatova included a reference to Gumilev’s fate in the most often quoted section of her poem “Requiem”: “Husband dead, son in gaol/ Pray for me.”

In the last gasp of the czarist era, she had known no persecution worse than routine incomprehension for her impressionistic poetry and condemnation by women for her effect on their men. But the Russia of Lenin and Stalin made her first a tragic, then a heroic, figure. After 1922 she was condemned as a bourgeois element and severely restricted in what she could publish. Following World War II, in 1946, she was personally condemned by Andrey Zhdanov, Stalin’s plug-­ugly in charge of culture. She was not allowed to publish anything new, and everything she had ever written in verse form was dismissed as “remote from socialist reconstruction.”

From “Requiem” (translation by Sasha Soldatov, but you should look for the Stanley Kunitz-Max Haward translation, or the D.M. Thomas translation.):

Not under foreign skies/Nor under foreign wings protected -/I shared all this with my own people/There, where misfortune had abandoned us.

[1961]

INSTEAD OF A PREFACE

During the frightening years of the Yezhov terror, I spent seventeen months waiting in prison queues in Leningrad. One day, somehow, someone ‘picked me out’. On that occasion there was a woman standing behind me, her lips blue with cold, who, of course, had never in her life heard my name. Jolted out of the torpor characteristic of all of us, she said into my ear (everyone whispered there) – ‘Could one ever describe this?’ And I answered – ‘I can.’ It was then that something like a smile slid across what had previously been just a face.

[The 1st of April in the year 1957. Leningrad]

DEDICATION

Mountains fall before this grief,/A mighty river stops its flow,/But prison doors stay firmly bolted/Shutting off the convict burrows/And an anguish close to death./Fresh winds softly blow for someone,/Gentle sunsets warm them through; we don’t know this,/We are everywhere the same, listening/To the scrape and turn of hateful keys/And the heavy tread of marching soldiers./Waking early, as if for early mass,/Walking through the capital run wild, gone to seed,/We’d meet – the dead, lifeless; the sun,/Lower every day; the Neva, mistier:/But hope still sings forever in the distance./The verdict. Immediately a flood of tears,/Followed by a total isolation,/As if a beating heart is painfully ripped out, or,/Thumped, she lies there brutally laid out,/But she still manages to walk, hesitantly, alone./Where are you, my unwilling friends,/Captives of my two satanic years?/What miracle do you see in a Siberian blizzard?/What shimmering mirage around the circle of the moon?/I send each one of you my salutation, and farewell.

[March 1940]

Over 100 Dinosaur Eggs Found in India

From The National Geographic:Dinosaurphoto

Three Indian explorers are giving amateurs a good name. The fossil enthusiasts recently set out on an 18-hour hunt near the central city of Indore and ended up with more than a hundred dinosaur eggs (some of which are pictured above, apparently arranged for photographers), the Hindustan Times reported today.

“They are the typical, spherical eggs that researchers interpret as having been laid by sauropod dinosaurs,” paleontologist Hans-Dieter Sues told National Geographic News via email after viewing photos of the find. Sues is an associate director for research and collections at the National Museum of Natural History in Washington, D.C., and a former member of the National Geographic Society’s Committee for Research and Exploration.

Distinguished by their long necks and tails, plant-eating sauropods are among the largest creatures known to have roamed the Earth. These particular sauropod eggs were found in clusters of six to eight, one of the discoverers told the Hindustan Times. The eggs were laid during the Cretaceous period, roughly 146 to 66 million years ago, by dinosaurs between 40 and 90 feet (12 and 27 meters) long, he added.

More here.

Repressed memories a recent development?

From Nature:Memory_2

The idea of repressed memory — when traumatic events are wiped from a person’s conscious memory but resurface years later — has had a chequered past. Some have cited it as evidence in court, yet others dismiss it as nothing more than psychiatric folklore. A new study adds a literary layer of evidence to the debate. To see how long the idea of repressed memories have been around, a group of psychologists and literature scholars turned to historical writings.

They could not find a single description of repressed memory, also referred to as dissociative amnesia, in fiction or factual writing before 1800. Harrison Pope of Harvard Medical School in Boston, Massachusetts, and his colleagues harnessed the power of the Internet to gather information, advertising on more than 30 websites and discussion boards a US$1,000 prize to the first person who could find an example of repressed memory after a traumatic event in a work published before 1800.

More here.

Lost and the Decline of Western Civilization

With this season of Lost set to resume tomorrow, The New York Times’ Alessandra Stanley weighs in.

Anyone who thinks it’s a good sign that “Lost” is back has not spent enough time at the Web site of James Randi, a skeptical scholar of the pseudoscientific and the supernatural.

A fan recently posed this question online at randi.org: “Is a fascination and increased belief in the supernatural a sign of social decline?”

The answer came as categorically as the words under the Magic 8-Ball: “Yes. Absolutely.”

By itself, “Lost” may not be a harbinger of the decline of Western civilization. But alongside “Heroes,” as well as “Medium,” “Ghost Whisperer” and “Raines,” a new NBC drama that begins in March and stars Jeff Goldblum as a detective who solves murders by appearing to commune with dead victims, the collapse looks pretty darn nigh.

“Lost,” on ABC tonight, is the most intriguing of all the series that traffic in the supernatural, mostly because it defies its own illogical reasoning. As the third season resumes after a three-month hiatus, nothing about the fate of the plane wreck survivors marooned on a paranormal island (or is it an archipelago?) makes much sense. But the real mystery of “Lost” is not the Dharma Initiative, the Others or why some characters are named after British philosophers (John Locke, Edmund Burke). It’s whether the writers actually have a cohesive story line that ties together all the unexplained subplots.

(I agree with her and have for a while… but am still going to watch it.)

Why and How to Care About Inequality

In the wake of rising inequality, Julian Sanchez offers some clarification on its relationship to moral and political goods over at Notes from the Lounge:

For various reasons, inequality seems to be a hot topic of late, and in particular I seem to be seeing a lot of folk taking up the abstract question of whether it’s inequality per se that we ought to be concerned with, or only whether the absolute level of the badly off is sufficiently high. All of which got me wondering: Does anyone really care about (material) equality in itself as an independent moral good? Lots of people profess to, but I want to suggest that if we get a little nitpicky about it, perhaps they don’t really think what they think they think.

First, for clarity’s sake, let’s distinguish three possible views of economic justice. First, there’s what you might call a Threshold View: What matters is that as few people as possible should be below some absolute level of well-being. On this view, it’s a matter of political concern when people lack adequate food or shelter, basic healthcare, education, opportunities for meaningful work, and certain other of what John Rawls would have dubbed “primary goods.” But our obligations here have a cutoff: Once (almost?) everyone has reached this minimum level, it is at least not a matter of political concern—not a question of justice—how much people have. If some people are only a bit above the minimum, while others have very much more, that is neither here nor there as far as public policy goes.

Next you’ve got the view that I suspect most self-described egalitarians actually hold, which (again borrowing from Rawls) we’ll call the Maximin View. Here again, what actually matters is the absolute level of well-being of the badly off. The only difference is that the obligation here has no upper-boundary; there’s no cutoff point past which we’re relieved of a duty to better the lot of those at the bottom of the distribution. Now, this will sometimes look like a concern with inequality per se, but the concern with inequality here is actually epiphenomenal. In other words, on this view, if some people have enormously more wealth or resources than others, the core problem is not that some have more as such. Rather, the disparity is taken as evidence that we could be doing a great deal more to improve the condition of the worst off (through redistribution), and are failing to do so.

searle’s mind

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IDEAS: You think that questions about the mind are at the core of philosophy today, don’t you?

SEARLE: Right. And that’s a big change. If you go back to the 17th century, and Descartes, skepticism — the question of how it is possible to have knowledge — was a live issue for philosophy. That put epistemology — the theory of knowledge — at the heart of philosophy. How can we know? Shouldn’t we seek a foundation for knowledge that overcomes skeptical doubts about it? As recently as a hundred years ago, the central question was still about knowledge. But now, the center of philosophical debate is philosophy of mind.

more from Boston Globe Ideas here.

in the shadows

Komarmelamid

Victor I. Stoichita, Professor of the History of Modern and Contemporary Art at the University of Fribourg, Switzerland, is the author of A Short History of the Shadow (Reaktion, 1997). In exploring the writings of Plato, Pliny, Leonardo, and Piaget, Stoichita explains how the shadow has always been integral to theories of art and knowledge, and investigates the complex psychological meanings we project into shadows. Christopher Turner spoke to him by phone.

Your book is the first study of its kind. Why do you think the subject was previously so overlooked?

I actually started my research with that very question. Just before the publication of my book, an exhibition on shadows was organized at the National Gallery in London, accompanied by a short but interesting text by the late Ernst Gombrich. But previously art historians took a long time in paying attention to shadows because shadows are, so to speak, heavy, dark, and ugly. Perhaps this is because for the Greeks, the shadow was one of the metaphors for the psyche, the soul. A dead person’s soul was compared to a shadow, and Hades was the land of shadows, the land of death.

more from Cabinet here.

teeming with a lifetime’s scrupulously collected detail

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Hogarth’s art bursts with life, and with characters fictional and real, sometimes side by side. Moll Hackabout, Tom Rakewell and the Earl of Squander rub shoulders with Colonel Francis Charteris, a notorious abuser of women, while Sir Francis Dashwood prays at an altar to lust. Hogarth’s characters are as various as his age, and only rarely do they become caricatures. Early in his career, he made a stab at illustrating Don Quixote, but gave it up – perhaps the characters and situations were already too one-dimensional. For the same reasons, one can envisage him rejecting Dickens but illustrating De Sade. I imagine him appreciating the film director Robert Altman – the weave of stories, the characters, the situations. Hogarth knew his talents were as much those of a storyteller as of a painter or a printmaker; nowadays, he would probably have written and directed movies. The brilliantly orchestrated crowd scenes in Election are crying out for animation.

more from The Guardian here.

Tranquil Star

Primo Levi, posthumously in this weeks New Yorker:

After the death of the Arab, al-Ludra [“the capricious one”, the name given to the star], although provided with a name, did not attract much interest, because the variable stars are so many, and also because, starting in 1750, it was reduced to a speck, barely visible with the best telescopes of the time. But in 1950 (and the message has only now reached us) the illness that must have been gnawing at it from within reached a crisis, and here, for the second time, our story, too, enters a crisis: now it is no longer the adjectives that fail but the facts themselves. We still don’t know much about the convulsive death-resurrection of stars: we know that, fairly often, something flares up in the atomic mechanism of a star’s nucleus and then the star explodes, on a scale not of millions or billions of years but of hours and minutes.We know that these events are among the most cataclysmic that the sky holds; but we understand only—and approximately—the how, not the why. We’ll be satisfied with the how.

An observer who, to his misfortune, found himself on October 19th of 1950, at ten o’clock our time, on one of the silent planets of al-Ludra would have seen, “before his very eyes,” as they say, his gentle sun swell, not a little but “a lot,” and would not have been present at the spectacle for long. Within a quarter of an hour he would have been forced to seek useless shelter against the intolerable heat—and this we can affirm independently of any hypothesis concerning the size and shape of this observer, provided that he was constructed, like us, of molecules and atoms—and in half an hour his testimony, and that of all his fellow-beings, would end. Therefore, to conclude this account we must base it on other testimony, that of our earthly instruments, for which the event, in its intrinsic horror, happened in a “very” diluted form and, besides, was slowed down by the long journey through the realm of light that brought us the news. After an hour, the seas and ice (if there were any) of the no longer silent planet boiled up; after three, its rocks melted and its mountains crumbled into valleys in the form of lava. After ten hours, the entire planet was reduced to vapor, along with all the delicate and subtle works that the combined labor of chance and necessity, through innumerable trials and errors, had perhaps created there, and along with all the poets and wise men who had perhaps examined that sky, and had wondered what was the value of so many little lights, and had found no answer. That was the answer.

Outside-in, upside-down — and now in color!

From Lensculture:

Morell_2

Abelardo Morell travels the world and converts full-size rooms (some spare, some ornately rococo) into immense camera obscura devices. He brings the outside in through a tiny pin-hole, and by the alchemy of optics, the outside is projected quite naturally upside down superimposing and hugging the surfaces of everything in the room. Then, he photographs the resulting “installation” with his 8 x 10 view camera and enlarges the prints to mural size.

The effect is dizzying and delightful. And the photographs get better and better as you study them and soak in the exquisite overlapping details.

More here.

Death key to sex in butterflies

From BBC News:

Butterfly_3 Bacteria that kill off male butterflies can actually lead to increased promiscuity in female butterflies, scientists have found. The Current Biology study looked at the Hypolimnas bolina species, common to the Pacific and SE Asia. The team discovered as the bacteria caused male populations to fall, females mated more frequently to boost their chances of becoming impregnated.

The study has revealed the bacteria’s powerful effect on mating systems. The Wolbachia bacteria are passed from mother to son in some species of tropical butterfly, and kill the embryo before it hatches. The bacteria are so effective, some islands can be left with one male to every 100 females. Theoretically, an excess of females should lead to an increase of mating opportunities for males and a decrease in the average number of matings per female, as males become increasingly rare.

More here.

Dispatches: Nihari Redux

Last week, Abbas posted a little video I made of a journey to Karachi’s Burns Road to have one of my very favorite foods, nihari.  So I thought I would supply some more information about this gastronomic epiphany.

Nihari is a dish of spiced, braised meat that has achieved sentimental status for many Pakistanis and Indians.  Shanks, which can be beef, lamb, or goat, are simmered overnight in a broth flavored with red pepper, black pepper, garlic, mace, coriander, and other spices.  Often they are left to braise in a pot covered in embers to maintain an even and low temperature.  After six to eight hours of simmering, when the shanks have tenderized, the cooking liquid is thickened and flavored with fried onions, and the finished stew is served with chopped coriander, minced green chilies, slivered ginger, lime wedges.  It is eaten with plain fresh naan, usually for breakfast or brunch – especially after long nights for its restorative qualities.  I think its combination of deeply flavored, earthy meat, the fresh zest of the toppings, and the perfection of a proper tandoori naan is one of the greatest bites there is to eat.

The nihari shops of Karachi and Lahore do bustling business, but mention it to many expatriate Pakistanis and you will hear consecutive sighs.  (I hold that Pakistani nihari is better.  Why?  Because Pakistan is better.  Kidding.  It’s because it’s best made with beef, which is uncommon in India.)  Good nihari is not commonly available in this country.  The great wave of Indian restaurants that colonized the US and Britain, mostly run by Bangladeshi entrepreneurs starting in London’s Brick Lane and New York’s Sixth Street, denatured a group of regional dishes into a standardized scale of chili heat: vindaloo, jalfrezi, do piaz, madras, etc.  Nihari, a much more singular dish, didn’t make it into this list, and is thus only found in restaurants catering to South Asian immigrants, and even then usually only available as a weekend special.

The number of cultures that have restorative dishes made from long-simmered, gelatinous cuts of meat served with fresh seasonings makes one wonder about the possibility of a universal index of deliciousness.  In Mexico, so similar to the subcontinent in ingredients and general approach to cuisine, there is goat’s head stew as well as  the great hangover cure, posole (hominy corn in pork and chicken broth topped with fresh radishes, lime, and salsa).  In Italy, osso buco combines braised lamb shanks with gremolata, or lemon zest mixed with chopped parsley.  In Turkey, tripe soup is a weekend brunch special.

The shanks, or lower legs, of cows, lambs and goats have richly marrowed bones surrounded by a ring of stringy, tough meat.  Opposite in texture to more usual star cuts such as tenderloin, shanks require long cooking to become edible and also contain large amounts of gelatin.  That’s why they are usually used in luxury Western cooking for stock.  But shanks, like many humble cuts of meat, have enjoyed a popular renaissance with the vogue for peasant foods.  So maybe it’s time for nihari to take its place alongside osso buco and barbecued ribs in the list of foods considered by gastronomes as honest and authentic regional delicacies.  As Abbas mentioned, I bet Anthony Bourdain would love it.  For many Pakistanis and Indians, it occupies that place already: its rarity in restaurants only contributes to its aura.  You might say that in the social imaginary it represents the streets of home themselves, in all their remembered specificity.  Taste, memory.

With most such foods, the genius of the place supposedly cannot be transported – if you’re meant to taste authenticity, you can’t take it with you.  Here is the point in the story where I’m supposed to admit that my grandmother cooked the greatest nihari, or that I fondly remember youthful trips to the nihariwallahs of Burns Road.  That would go along with the mythologizing impulse that we often give in to when talking about such talismanic foods.  I’d rather use the example of nihari to rebut that idea.  Actually, I tasted it for the first time at the age of about twenty at my aunt’s house, in Baltimore.  I was immediately hooked, and started cooking it for both my family and anyone else who expressed an interest in trying it.  Surprisingly, it was quite easy, and the results were always good.  There were a few early periods where I ate it every day for a week.

It was only in 2004, when I visited Pakistan for the first time in ten years, that I had the chance to try the real deal.  And so I toured the famous specialist shops (in case you’re going, I especially love Zahid’s of Saddar, Karachi and the little shop outside the Lahore’s Lahori gate, where my mother and I had a memorable lunch).  So for me the dish doesn’t hold the kind of retrospective nostalgia it does for many people.  So just as I think it’s a bit silly to wait in line for two hours with a bunch of trainspotting foodies to have a slice of Di Fara’s admittedly delicious pizza, I think one shouldn’t overly romanticize a foodstuff’s most legendary purveyors when you can have it in your own home.  This is also because I know that nihari is not hard to make, and so you can have it anytime.  Here’s how:

NIHARI

4 tablespoons oil
4 lbs. beef shanks (I think beef provides the best flavor for this dish)
6 garlic cloves, minced
4 tablespoons nihari masala (you can use a packet of Shaan, or use the one below)
2 onions, halved and sliced
1/2 cup flour
naan, made yourself or from a good restaurant (no butter!)
for garnish: chopped coriander, limes wedges, minced bird’s eye chilies, slivered ginger

Heat the oil in a large pot over medium heat and brown the meat in two batches.  Then fry the garlic until just coloring, return the meat and add the masala to the pot and add ten cups of water.  Bring to a boil, then cover and turn down to the lowest simmer.  Go to sleep.  When you wake up, or about six to eight hours later, test the meat for doneness – it should be fork-tender and the marrow should have melted out of the bones, leaving them as clean white rings in the broth.  Remove a teacup of the broth and whisk the flour into it, removing lumps.  Reintroduce the floured broth to the pot.  Now fry the onion until browned with a little more of the masala, then pour this mixture into the broth.  Turn the heat up and boil rapidly with the cover off until you reach a slightly thickened texture, though still a bit watery.  Taste for salt.  Serve with fresh naan (if bought, ride your bike back from the restaurant quite fast to maintain their heat) and small bowls with the garnishes.  Make sure to squeeze plenty of lime juice into your serving.  You won’t be sorry.

NIHARI MASALA

2 tbl red pepper
5 tsp salt
2 tbl of paprika (for redness)
2 tbl ginger powder
1 tsp powdered nutmeg
2 tsp black peppercorns
2 tsp fennel seeds
1tsp black cumin seeds
1 tsp kalongi (um, either onion or nigella seeds, can’t remember)
4 bay leaves
1 tbl whole mace

Grind the last six ingredients into a powder, then mix with the above.  This will make more than you need for one dish.

All my dispatches.

Teaser Appetizer: Health Care Agenda For Barack Obama

Here we go again! The white house contenders are piping seductive music to our ears: the loud techno-heavy metal clatter about the Iraq war and the gospel-soul music for the healthcare. And we know it well — they will play only the doleful blues after the election.

Screenhunter_01_feb_04_2341Barack Obama has promised to provide health coverage for all Americans in next six years, which means 47 million uninsured would get some kind of coverage. Obama is certainly not the first candidate to garner electoral support by espousing liberal health care. In 1883, Otto Bismarck of Germany enticed labor support by passing the health insurance bill for the factory workers and he succeeded in severing the support of labor to the social democrats. On august 6, 1912 Theodore Roosevelt called for compulsory health insurance for the industrial workers, to outwit the liberal platform of Woodrow Wilson.

The health-care-for-all rhetoric tugs your heart — the uninsured suffer unduly from denied care. The truth always lies buried in the details.

The uninsured have extremely limited access to outpatient and preventive care. They rely on the hospital emergency rooms for their needs from where the seriously sick are admitted to the hospital and others go home after treatment. The hospitals shift the cost of their care to the other insured and paying customers. It is not that the uninsured don’t get health care but they are compelled to access it deviously and often in desperation. The ER visit is free but suffused with contempt.

The annual cost of providing the care to the uninsured is approximately 250 billion dollars. The current 1.7 trillion dollar system already carries this load. Obama should not tax and spend extra 250 billion dollars but squeeze it out from the current health care expenditure and make it visible and available. The current system is morbidly obese, with redundant flab. Even the cost of administering the current system sucks up at least 25% and some believe it to be even more. Canada administers its health system at less than half the US cost. And then there are layers of clever businesses cannibalizing the system without adding to consumer health.

Obama should fulfill his promise and also differentiate himself from other candidates. Here is a five-point plan for Obama:

1. Unified Payer System

No, this is not another single payer system attempt, which will again face fierce opposition from the entrenched. In 1993, Clinton health reform exercise collapsed because the American public did not trust a government controlled single payer or a nationalized health insurance, which denied local participation.

In the early 1970s Kennedy and Mills (Chairman of Ways and Means Committee) proposed a bill, which would have created a single national indemnity insurance plan based on fee for service with co-payments. The opposition from all quarters killed the bill in the congress. The medical establishment feared it as ‘socialized medicine”, labor complained of its inadequate benefits; republicans frowned on it as expensive and Wilbur Mills, the cosponsor of the bill found amorous relief in the arms of Fanny Foxe, a night club stripper.

Currently, every insurance payer insists on its own unique processes of fixing rates for medical services, prior authorization process, credentialing health providers, prescription plans and myriad other procedures. Health insurance industry is an inefficient behemoth probably beyond repair. The system is so dysfunctional that one wonders at the wisdom of financing the health care through indemnity coverage.

Obama should propose a unified standardized payment system with multiple payers. While the insurance companies can still sell the individual products, a unified standard payment system is likely to save enormous administrative costs.

This will differentiate him from Hillary Clinton who is likely to rehash the failed 1993 attempt.

2. Health Savings Account

Market system does not work in health care because of insurmountable asymmetry of information between the physician (seller) and the patient (buyer). The seller decides what the patient should buy. Add to this the vulnerability of the ailing consumer at the point of purchase and an assurance that some third party (insurance) will pick up the tab.

The indemnity model has built in flaws: moral hazard and inducement of demand: the consumer considers the insurance a free ride and demands more services, which the economists call, ‘moral hazard.’

In a landmark study by RAND, the investigators analyzed the magnitude of moral hazard over a period of three to five years by the health care utilization behavior of six thousand individuals in six locations. The participant consumers differed in the amount of co-payments they made and were grouped in five categories: one group got completely free care and the other four had varied co-payments from 25% to 95% of the charges. The results were revealing: while co-payments decreased the utilization, free care increased the utilization by 30%; and there was no difference in the outcome health status between groups. Co-payment decreased the threat of moral hazard.

The physician also plays the system. In order to preserve or enhance his income, the physician induces demand for more services. Victor Fuchs studied the correlation between the supply of surgeons and the demand of operations. (Journal of Human Resources, 1961) He found that 10% increase in the number of surgeons in a community would increase the demand of surgeries by 3%.

Hospitals also induce demand. Roemer, an economist, described a hospital in upstate New York, which had 139 beds and average occupancy of 108 beds in 1957.The hospital increased its size to 197 beds in a new building in 1958 and the occupancy increased to 137. Though there was no inappropriate care, yet there was no health enhancing benefit to the community either.

The traditional health insurance has responded to moral hazard and demand inducement by creating managed care, capitation, HMOs and other innovations. These organizations work on the principle of curtailing the seemingly unnecessary care and resource utilization. The proponents of these organizations claim that in 2005 the system spent 300 billion dollars less because of their intervention. But it is unlikely that the whole health system benefits much, because the cost saving shows up in the profit column of these organizations and insurance companies. The previous income of health provider now becomes the revenue of the middle meddlers.

That is why Obama must encourage the ‘Health Savings Account’ where the consumer saves money regularly in this account and pays for her care from the savings. The unspent money belongs to her. Coverage for major medical catastrophe supplements the savings account. The consumer has incentives to spend her money wisely, which may partially curtail moral hazard and the demand inducement.

3. Import Drugs

Every one knows by now, that the drugs are more expensive in the US compared to Canada, Europe and other countries. Obama should create mechanisms of approving, accrediting and inviting a selected few reputed foreign drug manufacturers to sell their products in the US at a negotiated cost similar to their home countries. The USA is in a strong negotiating position as it is the largest market for foreign drug manufacturers. An FDA approved accreditation and licensing process of the manufacturer will eliminate the fear about the quality and efficacy.

Under Mr. Clinton’s global initiative, some reputed foreign pharmaceutical companies are already selling drugs for AIDS in the rest of the world at a fraction of the US cost. There is no reason why it can’t be replicated here.

Obama will win the wrath of the US pharmaceutical industry and the votes of the senior citizens. Both are laudable goals.

4. Health IT

All health care facilities in the nation should be connected on an interoperable Internet platform. Each citizen should have a secure access to her life long health record and should be able to authorize its use to care providers of her choice. The technology is already here; what we need is a legislative push to expedite the process. This single important step will benefit the patients and decrease excessive testing, redundant procedures, length of hospital stay and medical errors. The electronic billing and payment will cut the fraud and abuse.

While considerable progress in this direction has occurred lately, Obama should encourage a time bound plan with an end point in next six years.

5. Liability Reform

It would be good for Obama to suggest caps on punitive damages to differentiate himself from John Edwards who made a fortune as an injury lawyer. He will endear himself to the medical establishment whose support he will need to push other reforms.

Barrack Obama needs neither a magnifying glass to search the glaring faults nor a hearing aid for the screaming inefficiencies of the current system. While some wisdom is desirable, mere common sense will suffice for the most part. His chances of achieving the reform in health are brighter than retreat from Iraq. There is enough money in the current system to cover the uninsured. Let the gospel-soul music play for long this time.

PERCEPTIONS: monkey business or learning hindustani

The_forsaken_1999

Walton Ford. The Forsaken. 1999.

Watercolor, gouache, ink, and pencil on paper; 60 x 40 inches.

“When I painted the monkey wife, I painted her individually and I named it ‘The Forsaken.’ And my idea is that what Richard Burton did as part of his colonial enterprise was to actually learn languages. When he would go to a new place…he would have a woman set up house for him and become his mistress. And he said he would learn the language that way. So this thing with the monkey wife seemed to be perverse once you know that about him.”
— Walton Ford

More here & here.
The just-ended Brooklyn Museum show here.

Thanks to my friend Vimala Mohammed.