Sunday, August 27, 2006

Of Pretenses and Perpetual Motion

I had a chance to take a look at the August 19th issue of The Economist today (for some reason it always seems to get misplaced between the mailbox and my inbox) and there's plenty of grist for the mill. Right next to the ToC, where one might expect to find an advertisement for a trans-Atlantic airline, is a pitch for a company claiming to have developed a technology that produces "free, clean and constant energy". The add goes on to say that the company, Steorn, is looking for a panel of twelve people (presumably scientists) to publicly validate and report on their technology. So what, exactly, is their technology? Microgenerators with "a coefficient of performance greater than 100%" (shouldn't that be "greater than 1"?). There's a discussion about Steorn at PhysOrgForum; of particular interest is a post by one Jacob Bohall positing that its a test of distributed debunking or a PR stunt. Possibly, but its an awfully expensive stunt what with the add in The Economist. My first thought (apart from "We've secretly switched this man's copy of The Economist with Conspiracy Digest; let's see if he notices") is who the hell is ponying up for the add? Other questions: Steorn's been researching this for years, but they just got their domain and haven't gotten around to getting an Exchange server? And what about The Economist's standards? They'll take anyone's money, even someone pitching a perpetual motion machine? But enough of that, on to other things. In international politics there's an overall well-written editorial about the implications of the cessation of hostilities in Lebanon. But I have to question the wisdom of one suggestion:
A better idea would be to deprive Hizbullah of the pretexts it has invented for keeping up its war. It would be useful, for example, if Israel gave up the Shebaa Farms, the bit of Syrian territory Hizbullah says is Lebanon's, and accepted a prisoner swap.
This suggestion seems to rest on the assumption that there are a finite number of pretenses. But isn't that the beauty of pretenses? When you run out you can always fabricate more. As the editorial goes on to state
Six years ago Israel withdrew from Lebanon to a border painstakingly demarcated by the UN. Hizbullah fought on anyway. Like Iran, it says its aim is Israel's destruction.
This would suggest that Hizbullah will not be satisfied, regardless of the overtures made by Israel. If your aim is to reduce Hizbullah's moral authority it would seem prudent to obtain a fixed list of grievances in advance (though it seems improbable that Mr. Nasrallah would be willing to sign off on such a list); otherwise Hizbullah retains the option of moving the goalposts to its heart's content. On the domestic front Lexington has an interesting article about Rahm Emanuel and "The Plan". Again, both their take and "The Plan" itself seem reasonable, but I'm going to quibble with Mr. Emanuel's assessment of ways to reduce health-care costs:
Probably the main reason wages have not risen much in recent years is that health-insurance premiums, which many American employers shoulder, have soared. The Plan lists ways to curb them. Doctors, rather than being paid for every test and injection they provide—an arrangement that inevitably leads to over-doctoring—should be paid by results. Patients should be given better incentives to stay healthy: insurers, for example, should push them to take free physical exams to spot ailments early.
I'd like to know how he came to the conclusion that financial incentives cause doctors to over-treat their patients. In some high risk practices/depts. (OB and EM are the ones I'm familiar with) there's a large incentive to over-doctor, but its not driven by financial concerns (at least, not directly). My wife and her colleagues in OB and EM are driven to over-doctor as a defensive measure against lawsuits; in the current legal climate there's nothing to be gained by not ordering another test. This would suggest that reform of medical malpractice laws are just as reasonable an arrangement as paying doctors "by results" (whatever that means). As far as getting people to seek preventive care, this won't happen until there's an incentive for insurance companies to push such treatment. With people switching insurance all the time its actually in an insurance company's interest not to push preventive care; after all, that would amount to spending their money to lower the next insurer's costs. Insurance companies won't have an incentive to focus on preventive medicine until people stick around on their roles for prolonged periods of time. And for this to happen medical insurance would have to be decoupled from a particular job/employer; not necessarily socialized medicine, but certainly different from the current system. And that's all there is to say about that.


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