The Compulsive Explainer

The Diet is Working!

I haven't been too impressed myself, I have only been losing two pounds a week. But this morning my nutritionist seemed happy with my progress - and even put a little sugar in my diet.

I have developed a new relationship to food: it is no longer as important or as satisfying. I have lost one pleasure in life: a food addiction - but replaced it with another: the satisfaction of knowing I am in control, and not my stomach.

I got my swine flue shot two months ago

My doctor recommended I do this while the supplies were available. I asked about the public health service, which gives flu shots for free. He laughed and said "They won't be getting this until sometime next year."

Down here, there are two tiers to medical care: the public and the private. In the Central Area, I had a good public health doctor, and the public clinic I attended was excellent.

When I moved to Orosi, I was shocked by poor health care provided by the local clinic. After stumbling around for awhile, I found a private doctor for my primary care - but he can write prescriptions for the public health service, so I can still get my meds there.

I kept my public health insurance for $40 a month, so I can go to the public hospital in Cartago for something serious. 

This morning, I was surprised to find the US doesn't have swine flue shots yet - courtesy of their incompetent pharmaceutical industry. Costa Rica imports its from Europe, which uses more advanced techniques. I can afford to pay for my flue shots: $30, but the poor will have to wait.

Barbara Ehrenreich has a piece in TomDispatch about this.
---
Optimism is supposed to be good for our health. According to the academic "positive psychologists," as well as legions of unlicensed life coaches and inspirational speakers, optimism wards off common illnesses, contributes to recovery from cancer, and extends longevity. To its promoters, optimism is practically a miracle vaccine, so essential that we need to start inoculating Americans with it in the public schools -- in the form of "optimism training."

But optimism turns out to be less than salubrious when it comes to public health. In July, the federal government promised to have 160 million doses of H1N1 vaccine ready for distribution by the end of October. Instead, only 28 million doses are now ready to go, and optimism is the obvious culprit. "Road to Flu Vaccine Shortfall, Paved With Undue Optimism," was the headline of a front page article in the October 26th New York Times. In the conventional spin, the vaccine shortage is now "threatening to undermine public confidence in government." If the federal government couldn't get this right, the pundits are already asking, how can we trust it with health reform?

But let's stop a minute and also ask: Who really screwed up here -- the government or private pharmaceutical companies, including GlaxoSmithKline, Novartis, and three others that had agreed to manufacture and deliver the vaccine by late fall? Last spring and summer, those companies gleefully gobbled up $2 billion worth of government contracts for vaccine production, promising to have every American, or at least every American child and pregnant woman, supplied with vaccine before trick-or-treating season began.

According to Health and Human Services Secretary Kathleen Sebelius, the government was misled by these companies, which failed to report manufacturing delays as they arose. Her department, she says, was "relying on the manufacturers to give us their numbers, and as soon as we got numbers we put them out to the public. It does appear now that those numbers were overly rosy."

Five Mini-Meals a Day

I just finished a session with my nutritionist; it lasted for 1 hour and 40 minutes; I was exhausted when we were done. Now I really need a computer program to figure out my diet. It really is complicated, although it is probably as simple as they can make it. I should mention that she speaks good English.

I had been eating two meals a day and had managed to loose 6 pounds in a month. Five meals a day sounds difficult, even if the meals are tiny. She put me on Splenda to take care of my sugar craving. 

I was up to 180 pounds, which I thought was shocking. She assured me that I was merely overweight, not obese. I wanted to go back down to 60 pounds, what I used to weigh, be she said 150 pounds was a better interim target. If you lose weight too fast, you can easily get it right back again.

How can food be so complicated?

An American Health Plan is not Going to Happen

By an American health plan, I mean a plan that is of the people, by the people, and for the people - as Lincoln said. In other words, a plan that is good for America.

There are two reasons for this: (1) the way Obama works, and (20) the way America works. Let's start with Obama.

(1) Let's be cynical, (and realistic) Obama's first objective was to become president. Now his objective is to become president again. Everything he and his administration does is focused on that. We need to keep this in mind. Whatever you can say about Obama he is not stupid. He understands America and Americans very well. He knows Americans will not re-elect him just because he has been good to America. This brings up the next point.

(2) Americans no longer think of themselves as Americans - but as members of special interest groups. They will deny this emphatically, but all one has to do is watch what they do, not what they say. Often the two are entirely different - as is often the case with the human race.

And the perfect case in point is their response to Obama's health plan. Except for the radical fringe, they seem to be completely stupified, and unable to comprehend it. They want something handed to them on a silver platter with no price tags attached. Since this is impossible, they are baffled, and end up watching television, trying to find a group they can identify with. 

George Lakoff, a cognitive psychologist, has a long piece on this. I used to be very impressed with this guy, I bought two of his books. But I think he expects too much from Americans - who are in bad shape, and barely able to think. For them to understand something, it has to be really simple. If you read carefully, he says much the same thing, in many more words. He speaks of the policy-speak disaster:

Policy Speak is the principle behind the president's new Reality Check web site. To my knowledge, the Reality Check web site, has not had a reality check. That is, the administration has not hired a first-class cognitive psychologist to take subjects who have been convinced by right-wing myths and lies, have them read the Reality Check web site, and see if the Reality Check web site has changed their minds a couple of days or a week later.

To many liberals, Policy Speak sounds like the high road: a rational, public discussion in the best tradition of liberal democracy. Convince the populace rationally on the objective policy merits. Give the facts and figures. Assume self-interest as the motivator of rational choice. Convince people by the logic of the policymakers that the policy is in their interest.

But to a cognitive scientist or neuroscientist, this sounds nuts. The view of human reason and language behind Policy Speak is just false. Certainly reason should be used. It's just that you should use real reason, the way people really think. Certainly the truth should be told. It's just that it should be told so it makes sense to people, resonates with them and inspires them to act. Certainly new media should be used. It's just that a system of communications should be constructed and used effectively.

Then he gets down to details:

The basic values are empathy (we care about people), responsibility for ourselves and others, and the ethic of excellence (making ourselves better and the world better).

These values form the basis of democracy: It's because we care about our fellow citizens that we have values like freedom and fairness, for everyone, not just the powerful.

From that, it follows that government has two moral missions: protection (of consumers, workers, the environment, the old, the sick, the powerless; and empowerment through public works; communication, energy and water systems; education; banks that work; a court system, and so on. Without them, no one makes it in America. Taxes are what you pay for protection and empowerment by the government, and the more you make the greater your responsibility to maintain the system.

And he identifies evil where it is: the health insurance companies and the pharmaceutical industry. This is the kind of simple idea Americans can understand immediately, but even he backs off from saying so too loudly.

The villainizing of real insurance company villains should have begun from the beginning. As it is, the right wing turned the tables. They attributed to government all the disasters of insurance company health care: rationing, long lines, waits for authorizations and visits to specialists, denial of care. The administration is trying to turn that around, but it is harder now.

He then goes into his theory:

Policy Speak is supposed to be reasoned, objective discourse. It, thus, assumes a theory of what reason itself is - a philosophical theory that dates back to the 17th century and is still taught.

 Over the past four decades, cognitive science and neuroscience have provided a scientific view of how the brain and mind really work. A handful of these results have come into behavioral economics. But most social scientists and policymakers are not trained in these fields. They still have the old view of mind and language.

 The old philosophical theory says that reason is conscious, can fit the world directly, is universal (we all think the same way), is dispassionate (emotions get in the way of reason), is literal (no metaphor or framing in reason), works by logic, is abstract (not physical) and functions to serve our interests. Language on this view is neutral and can directly fit, or not fit, reality.

The scientific research in neuroscience and cognitive science has shown that most reason is unconscious. Since we think with our brains, reason cannot directly fit the world. Emotion is necessary for rational thought; if you cannot feel emotion, you will not know what to want or how anyone else would react to your actions. Rational decisions depend on emotion. Empathy with others has a physical basis, and as much as self-interest, empathy lies behind reason.

Ideas are physical, part of brain circuitry. Ideas are constituted by brain structures called "frames" and "metaphors," and reason uses them. Frames form systems called worldviews. All language is defined relative to such frames and metaphors. There are very different conservative and progressive worldviews, and different words can activate different worldviews. Important words, like freedom, can have entirely different meanings depending on your worldview. In short, not everybody thinks the same way.

As a result, what is taken as "objective" discourse is often worldview dependent. This is especially true of health care. All progressive writing supporting some version of health care assumes a progressive moral worldview in which no one should be forced to go without heath care, the government should play a role, market regulation is necessary, and so on.

Those with radical conservative worldviews may well think otherwise: that everyone should be responsible for their own and their family's health care, that the government is oppressive and should stay out of it, that the market should always dominate, and so on.

He gives the conservatives credit:

Conservative tacticians may not know about brain research, but they know about marketing, and marketing theorists use that brain research. That is why conservatives place such importance on language choice, from the classic "socialized medicine," to Luntz's "government takeover" to Palin's "death panels." When repeated over and over, the words evoke a conservative worldview, with many of the specific bogeymen - abortion, socialism = communism = nazism, euthanasia, foreigners, taxes, spending, the liberal elite, Big Brother, and so on. The most effective language has emotional appeal and, to conservatives, a moral appeal because it activates the conservative moral worldview. And such language, repeated every day, changes brains, strengthening the synapses of those who listen.

By now, your brains have probably turned off. But you should really understand this. It will make you understand why people seem to be so stupid.

The Gorilla Dust of Health Care

From Truthout

This is long, and the interesting part is at the end:
------
   What's interesting is that there appears to be an emerging backlash from some of the more reasoned thinkers of the conservative movement. It seems to have begun late last week with a blog entry by former Bush speechwriter David Frum on his website, NewMajority.com. He asked, what if the right wins the health care fight? What happens then? "The problem," he wrote, "is that if we do that ... we'll still have the present health care system.... We'll have entrenched and perpetuated some of the most irrational features of a hugely costly and underperforming system, at the expense of entrepreneurs and risk-takers, exactly the people the Republican Party exists to champion."

    Frum elaborated while in conversation with my colleague Bill Moyers on the current edition of public television's "Bill Moyers Journal." "They're going to pass something," he said of the health care reform fight. "So the question for Republicans is what do you want that to be? You have an interest here, too. You would like to see the rise in health care costs slow. And you would like to see more room in the federal budget for tax cuts in the future.... But if the Republicans win, this is not going to be a great victory for individual liberty. It's going to be a victory for the status quo."

    Frum's sentiments have been echoed and amplified by conservative economist Bruce Bartlett. He's worth citing at length. Writing on the Daily Beast website on August 12, Bartlett noted that, "Because reforming Medicare is an important part of getting health costs under control generally, Bush could have used the opportunity to develop a comprehensive health-reform plan. By not doing so, he left his party with nothing to offer as an alternative to the Obama plan. Instead, Republicans have opposed Obama's initiative while proposing nothing themselves.

    "In my opinion, conservative activists, who seem to believe that the louder they shout the more correct their beliefs must be, are less angry about Obama's policies than they are about having lost the White House in 2008. They are primarily Republican Party hacks trying to overturn the election results, not representatives of a true grassroots revolt against liberal policies....

    "Until conservatives once again hold Republicans to the same standard they hold Democrats, they will have no credibility and deserve no respect."

    One way to reestablish some shred of that credibility would be any kind of viable health care reform alternative from the GOP. Another would be to engage in a more reasoned debate. Neither has happened so far, and in the heat of the current ugly fray, neither seems likely.

    Too much of the gorilla dust they're throwing has blown back into their own eyes.
------
If only Americans at large were so well-informed!

What do the Blue Dogs Want?

Paul Krugman in the NY Times

Krugman starts off like this:

To grasp the problem, you need to understand the outline of the proposed reform (all of the Democratic plans on the table agree on the essentials.)

I'm glad to hear this, he must know more than the experts on the Bill Moyer's Show did. But he goes on:

Now, however, they face their moment of truth. For they can’t extract major concessions on the shape of health care reform without dooming the whole project: knock away any of the four main pillars of reform, and the whole thing will collapse — and probably take the Obama presidency down with it.

Is that what the Blue Dogs really want to see happen? We’ll soon find out.

The American Health Mess

I have been saying one simple thing over and over: America is busted; its problem-solving powers are broken—and without these kinds of skills: mental skills and social skills, we cannot long survive.

The proof of this is in our health system, the poorest in any rich country. It is broken and we cannot fix it. Bill Moyer's Journal has a special on this, with Trudy Lieberman, director of the health and medical reporting program at the CUNY Graduate School of Journalism, and Marcia Angell, senior lecturer in social medicine at Harvard Medical School and former editor in chief of the New England Journal of Medicine.

You can't get much more brainpower than these gals have, but their talk is fuzzy because the subject itself is fuzzy, as they try to make clear. Unfortunately, Americans are bad at fuzzy logic. For them it has to be simple and clear-cut—or it goes right over their heads. So let me simplify it for them: health care should not be for-profit. Unless we get that straight, there is no sense in trying to reason about the thing.

But Americans will immediately say "But the health system we have is not like that, the economy we have it not like that, and changing either one is out of the question." In other words, "We are helpless to make any changes in the American Way of Life. The Powers That Be cannot be challenged." And in this case the Powers That Be are the Health Insurance Industry and the Pharmaceutical Industry, who have so much money they control Congress—and indirectly, through the Media, control everyone else. This cannot be changed; money talks louder than words.

If we could just accept this, we would be way ahead; we would know where we are. Instead, we get lost in the fog: 1000 pages of gobbledygook, that are designed to say nothing. Obama has learned from the Clintons: if you have a solid plan, it will get shot down. So his plan is fuzzy by design, hoping that it will be massaged by The Powers into a form acceptable to them—and the Administration and Congress will somehow be able to get some public options included. 

This is like operating on a battlefield where the enemy is much stronger—but you hope to get something out of the bargaining at the peace conference—if you are lucky.

I think America's luck is running out.

ADHD

My youngest sister mentioned this in a recent email. She was having a hard time coping with it—in others. I didn't even know what it meant. So I looked it up on Wikipedia. Then I went on with my breakfast. I didn't think it applied much to Costa Rica, where I live now.

Then it came to me that it did—I know people down here that act that way. One of them is a gringo who is always bragging about his money-making projects—whether you want to hear about them or not. They always have a fantastic future, even though his many projects in the past have always fizzled. He is hyperactive this way, although I never categorized him this way before. I just thought he was a loud-mouth.

And I know a young Tico who cannot pay attention to his business, which really needs it, but has grand plans to become all kinds of things: a opera singer, a ballet dancer, or an actor. If he were still an adolescent, this would be understandable, but he isn't. He takes after his mother, who is also flits from one obsession to the other, never settling down.
------
A friend replied:

I think it's pretty much an American thing. It's often applied to children who have a hard time sitting still and paying attention. Adults can be diagnosed as well. I think wayyyy more research needs to be done to confirm its etiology.