Sunday, June 15, 2008

Running Update

Well, the official results are online for the Race for the Cure, and there were only 7,637 finishers, far fewer than I had been told on race day. I was 517th, with a time of 26 minutes and 23 seconds. I was 23rd out of 222 in my gender/age group.

I ran today, to/from my front door, about 3.1 miles, based on a path I traced with Google Earth. It was 88 degrees, 18% humidity, and rolling hills. I couldn't even run a full 2 miles without stopping to walk this time. It took me 31 minutes & 31 seconds, about a pint of sweat, no known blood loss, and my weak link was breathing (again). For my next race, I may downgrade from a run/walk to a run/walk/stagger.

Tuesday, June 10, 2008

Rationing Health Care

Heresy! No one in their right mind would support rationing health care. Would they?

Well, since there is a finite amount of health care, and that amount is less than everyone would use if they could, the fact is that health care is rationed now. The current rationing mechanisms are complex, and involve many intertwined interactions between the free-market, public and private health insurance plans, health provider management organizations, volunteers, and other components. It's complex now, it's not going to become simple, and there are ways to improve it and ways to make it worse. In fact, most changes that would make one aspect of health care better will make other aspects of health care worse. So it would be prudent to make changes very carefully, understanding as much of the trade-offs as possible.

But not now. Now, it's national-electioneering time, and most candidates are going to be talking about health care. Lots of them are going to use the phrase universal health care, but what they'll actually talk about will be universal health insurance. It pains me to observe that there are so many people running for office that use "health care" and "health insurance" as synonyms.

The Politics of Health
Most politicians are not morons, so the reason they talk like this is likely that they are simply pandering for votes with sound-bites instead of carefully reasoned positions. I can't help but wonder, though, how many even realize that health care and health insurance are not the same thing. People don't need health insurance, they need health care -- health insurance is just one of several mechanisms to ration health care.

Universal Health Care. Sounds great! But people will never get what many politicians are promising... extending health care to everyone, without compromising quality. Politicians will never fulfill those promises because it's not economically possible for any society to accomplish that. Some of them make know that, but all of them will yammer about it and pass legislation that deals with health care, and they'll claim victory based on such legislation, regardless of the actual results of the legislation.

Ain't Gonna Happen
I'll use two extremes to illustrate why universal health care is not possible. The concepts are the same whether applied to a single nation or the globe, but since we're using the term "universal", I'll use global terms for this example. So let's assume a world population of 6 billion and total global wealth of 1.1 quadrillion dollars. Let's set aside an extremely meager 10% of wealth for food, housing, transportation, and all those other things people seem to like, leaving us with an even 1 quadrillion dollars for health care.

Great Health Care
For the first extreme, suppose researchers develop a vaccine that will make a person immune to all disease, but that the process to manufacture it results in a cost of one billion dollars per dose. (The pill requires a superconducting super-collider to spawn reactions that result in a molecular accrual rate wherein the energy and maintenance costs equal the billion per dose.) While were at it, let's pretend that there are no safety/side-effect concerns.

If we were to spend our 1 quadrillion dollars for health care on this super pill, we could create doses for exactly one million people, or less than two-tenths of one percent of the world's population. Um, that's noticeably less than universal. But, we run the machine because the researchers hope to discover a way to substantially lower the cost, and while they're researching, they create a few hundred of the pills. Who gets them? Who decides who gets them?

Good news! The researchers have discovered how to significantly lower the costs! Unfortunately, it still isn't enough for everyone. So, you chose... do you want the pills to go to the oldest people, the children, or random chance selection? Okay, say we chose the children for the noblest of reasons. Now, at maximum production, we can provide one pill to 80% of all children born. Sorry, there's just not enough wealth to get to 100%. Maybe if we took some of our health care money and used it to improve the economy we could get there, but that would mean we have to create fewer pills now. How could you possibly chose to reduce pill production to cover only 70% of the children now in order to get to 100% some day in the future? Those are hundreds of millions of children you're leaving exposed to deathly disease. Okay, 80% it is. Which 80%?

Great Health Care Equality
Here's the other extreme. All world governments agree to a global health care plan that will be absolutely equal. In order to ensure that it is equal, everyone reluctantly agrees not to allow any health care other than the what is provided by the global health care plan, so the rich people can't have anything better than the poorest person. Yeah! Now that's truly fair to all! Okay, we know we can't afford to give everyone the best of everything, so we have to start from the other direction. We'll come up with a list of health care benefits that can be provided to every person on the planet, adding one item at a time until we reach our 1 quadrillion dollar limit. Now let's see how much we have to spend. One quadrillion divided by 6 billion people equals... $166,666.67!

Wow, jackpot! That's a whole lot of health care for every man, woman, and child on the planet! So, we can allocate for each person for their entire life. Oh, let's say, two boxes of band-aids, two emergency-room visits for broken bones, and we don't have those super-pills under this scenario, so we'll dedicate some funds for vaccines, one-heart attack emergency room visit, a few drugs such as cholesterol and blood-pressure control, and we'll allocate the rest to cancer chemotherapy and radiation. Unfortunately for you, you need a heart transplant, and that didn't make it onto the list.

Well, that's no good, so we'll make the universal health care plan so that everyone gets up to $166,666.67 worth of whatever they need. All right! Oops, it seems that your heart transplant would cost $200,000. Sure, if you sell your house, you can come up with the extra $33,333.33 to throw into the pot, but you're not allowed to. That would be unfair to all the people who don't have any extra money, and a fundamental principle of the universal health care plan is that we absolutely must be fair. No one can get anything extra just because they can afford the extra costs. Besides, we forgot about the time you broke your arm on the playground and had a doctor put a cast on it. Now you're an additional $500 short.

But then you realize that there are a lot of people who are healthy their whole lives and never need any health care at all. The health care money those folks don't use should be made available, equally of course, to all the folks who do need it. And joyously, it turns out to be $33,833.33, so it will cover your heart transplant!

Unfortunately, it took quite a bit of effort to get the world to agree to the universal health care plan, and now its managed by a United Nations bureaucracy, so it may take a little longer to get them to change things than you have left on your old ticker.

Promises, Promises
Okay, so what's my point? The point is that universal health care is what people need, but that universal health care without compromising the maximum quality of health care is not possible, and any political candidate who says otherwise is either woefully ignorant or is lying. So, please don't vote for morons or liars.

Sunday, June 8, 2008

2 Months, 2 Minutes

My son David & I completed another 5K yesterday, the Susan Komen Race for the Cure, which raised over $3,000,000 to fight breast cancer. The temperature was about 72 degrees and humidity was about 80 percent at 6:30 AM, but the temperature climbed fast and the humidity went down a bit by the time the race was over.

The race was to start at 8:00 AM, and David and I got to the starting area at 7:20. There were so many thousands of people scheduled to run, I figured it'd be crowded at the starting line by 6:00, and I didn't want to wait there that long even if it meant having to spend as much time running side-to-side to avoid other runners as I spent running forward, so 7:20 is when I planned for us to get there. Much to my surprise, there was only one other person standing at the starting line, though there were at least a hundred on the shoulders of the road nearby.

We took places front-and-center, and I laid down to rest and wait. Normally, I don't recommend that anyone lay down in the middle of the street on Constitution Avenue. Immediately after the starting barriers were removed, about two minutes before the race started, a couple of dozen people pushed their way to the front. You could tell these were the serious runners who wanted to win or place, so I didn't mind giving way to them.

As the race began, I ran my pace, and instead of having to pass other people, other people were passing me. A lot of these folks were those who don't know their pace, so they go real fast to start, then have to walk. I wasn't able to run the whole way, but I ran my pace as long as I could, and I made the first mile in 8 minutes flat, and the second in 8 minutes and 4 seconds. It wasn't long after that, though, that I had to walk a bit, and alternated between walking and running until the last quarter mile or so, when I was actually able to put in a little kick to the finish line. It was so warm, around 2.5 miles, I had started if I would have to walk the rest of the way, but I was able to mush through it.

This race didn't use the sensors attached to shoes, so they had lanes at the finish line. You enter a lane and someone manually writes down your time, in order. Someone else tears off your bar-coded ID from your race bib and puts in on a spindle, in order, so that if it works right, they get a fairly accurate time. Unfortunately, by the time David came through, there were so many people jammed up at the finish line, he had to wait to get counted. That was the case for most of the runners, and there were tens of thousands, so I was told. David still finished in under 40 minutes, though.

I haven't found an estimate by the organizers as to when official times and places will be posted. By my stopwatch, I finished in 26 minutes and 29 seconds, so I shaved a little over 2 minutes off my time from my race in April. This time, I didn't push myself quite as hard, and wasn't completely exhausted afterward. My average speed was 7.02 miles per hour, and my pace was 8 minutes and 33 seconds per mile. Not bad considering this time last year my muscles hurt so badly without knowing the cause that I wasn't sure if I'd be alive this year. My next goal is to be able to run an 8 minute pace without stopping for a full 5 kilometers. Once I can do that again, I haven't decided if my next goal will be speeding up or increasing distance. Isn't that a wonderful dilema?!

After the finish line, I turned right and walked over to the path around the
Smithsonian Museum of Native Americans and scooped up some water to splash on myself while I waited to meet up with David there. Almost everyone else turned left to go onto the National Mall, where the organizers had lots of tents set up. Despite the enormous crowd, only a dozen or so people came over to the museum, so it was a great choice for a meet-up. That museum is such a peaceful place.