They apologized and said they’d have lots more in another hour. I chuckled and commented that hopefully this means they’re doing better than they expected. The girl at the counter said they were doing better than anyone expected (which seemed to imply that potential funding sources were included there).

The dire economy does not seem to exclude people from enjoying life - specifically enjoying simple basics like staple foods and neighbors and community. Little coffeehouses and bakeries do this much better than upscale bars and bistros, let alone vacations to the Galapagos.

Maybe my dream of opening a bakery/coffeehouse on Butler in Arsenal is a little closer today… Hmmm…

Personally, I don’t think the legislation currently on the block goes far enough. From what I’ve been able to glean so far it seems mainly to compete with current state-regulated insurance plans to create a subsidized plan for the poor and those who are routinely turned down for affordable coverage due to health conditions.

Fine, good go, let’s get people covered. But we can do better.

The fact is, people use the health care system too much, considering how little good it really does. For instance, if you look at “improvements” in Americans’ life expectancy over the past 100 years, it’s hard not to note that almost all of the statistical improvement is a result of improvements in infant mortality rates. If you remove infant mortality rates form the equation (mortality that is much easier to combat with low-cost things such as sanitation, vaccines, better protection of women, and improved access to contraceptives and neonatal care for the poor), you could easily conclude that “humans live for 70 years” is a self-evident fact of our existence, regardless of technology or insurance coverage metrics.

All of the hundreds of trillions of dollars spent in that century on pharmaceuticals, MRIs, CTs, and the many expensive new treatments only now coming into regular use, have essentially not really improved the quantity of human life.

I would personally question whether improving the number of bed-ridden years cancer patients survive or the number of vegetative years stroke victims and Alzheimer’s patients survive provide those individuals with any quality of life to go along with the quantity they are being given - because these are the only real years that we are tacking on to human life spans. Healthy people who don’t meet an unnatural demise and make it past age 5 lived for 70-75 years in 1700 and still live 70-75 years today.

Put simply, we are spending 16% of our income, at a minimum, on medical costs, without any return on equity. Why?

I speculate that a big portion of these costs are due to Americans’ horrendously unhealthy lives. We are all overstressed, overfed, and our bodies underutilized, and thus we are devoting most of our medical resources to maintaining the same life quantity we’ve had for most of history in spite of our increasingly poor health.

A national, socialized, single-source system of health care which rations use to prevent abuse is absolutely necessary. Eliminate state-regulated insurance; buy up all private insurance plans and consolidate them under a national system. Nationalize state and local medical facilities and make all other providers decide whether they will be private or public. Cut off any access to public funds for the former, and prohibit public health funds from the new national system from being used in private practice. Private ‘insurance’ plans can continue to be allowed, but I guarantee they will no longer offer such all-points-covered plans as modern HMOs and PPOs.

The point of modern health insurance, in fact, seems to be to subsidize the relatively well-off at the expense of the working class, in many respects. High-premium plans are provided to middle-class and upper-class professionals through their work, or to the self-employed and those who choose to carry pricy individual plans. These plans, by and large, are not “insurance” so much as “health payment plans” that spread the cost of health maintenance over a lifetime relative to their earnings rather than “insuring” against catastrophic health crises.

People with an HMO or high-end PPO expect most of their medical needs to be mostly subsidized by their “insurer”. This translates into a type of collective price-bargaining capability where the insurance providers can demand pennies-on-the-dollar deals for the vast number of services provided to their members, which massively inflates the cost of all medical services to pay-as-you-go users (especially the poor, uninsured, and underinsured). Thus those with high-deductible plans tend not to use them (often including even annual preventive care office visits), and those with low-deductible copay-based plans use them constantly (and have a higher rate of pharmaceutical usage to boot).

Spending a night in a hospital bed with pneumonia costs a Blue Shield patient $10,000, but costs an uninsured patient $25,000. Many would argue that this is because the uninsured usually don’t pay their bills, but I would argue this is because facilities lose so much money from their payment agreements with insurers and Medicare that they have to make it up somewhere (like the uninsured who actually ever pay, or the government subsidies thrown at the unpaid bills).

Perhaps our main problem is just that thrift in general is still out of vogue, despite the dire economy. Dropping 15% of our national income (which is not only what we earn, but what we borrow - note that federal deficit spending is included in GDP) for health care is not seen as immoral to most people, but somehow splurging on a latte twice per day is. Unless we change this phenomenon, no reforms will change how unaffordable (and futile) health care spending is.

Creating a competing government ‘insurance’ plan will not lead to any efficiencies. It might cover more people, at tremendous additional cost, but the only way to create a sustainable health care system is to drastically slash the total resources we, as a society, devote to health care. Create a national plan that requires semi-annual office visits but prohibits excessive reimbursements to hypochondriacs.

The modern system of mixed health care economics is already socializing the burden of health care costs, but specifically in a way that benefits those who are most able to pay for standard, non-catastrophic care. This is ruining our economy and making us far less healthy and efficient as a people. If the only way to stop this is to ration care and centralize the “allowable charges” bureaucracy into the hands of a master-payer federal plan, so be it.

I’ve often gotten carried away with my scathing hatred for Richard Florida, but I think that’s mainly because I’ve spent so many years being a fabulous homosexual living in Ueber-Creative San Francisco, and seen the casualties of creative cities - namely drug addiction, AIDS, and dead-end careers that will do nothing for people when total social collapse comes in the next decade or so.

Florida seems to have no original ideas: his philosophy is basically “attract the hottest new businesses and have lots of distractions for young people who don’t care about their future” - pretty much the same thing civic leaders of hot cities have at least paid lip service to since the dawn of settled humanity. The specific priorities have just changed.

I tried debating Jim Russell over Florida a couple times on his blog, but every time Russell would accuse me of being some xenophobic, racist, non-cosmopolitan, religious bigot to shut-down the discussion - ILLYRIAS did the same thing; it’s too bad people aren’t allowed to criticize Florida from a liberal urbanist perspective. It’s automatically assumed that if you don’t like him, you don’t like cities or hate homos or something.

Richard Florida himself even has a paranoia that every American critic he has is a right-wing conservative, so it’s not hard to see why all his boosters immediately ignore what I actually write about him and simply conclude that I’m a right-wing homophobe for not fawning over the man.

Some people, including me at times, have argued that homo culture is a sort of dissent, and succumbing to normalcy is a bad thing. But normal in this context was so much different than normal as seen in its dark light by certain authors.

This sort of normal was amazingly diverse, celebratory and empowering. Seeing families with kids and all manner of parental combinations, and all manner of people of ambiguous sexuality enjoying the perfect normalcy of ambiguity was quite touching. The commerce taking place was pretty hardcore too; if this many people can work this hard to put on a festival dedicated essentially to sex that only 10%-20% of the population has, then no amount of economic doom will destroy us.

This is the sort of economic ambition we need more of. If cities and regions can put on this sort of show in this sort of economy, we’re really going to be OK. Seeing certain parts of San Francisco completely car-free was interesting; and watching Latin gangsta gayboys walking through the schwag booths holding hands was just so beautifully… normal.

I admit that many times in the past I have ridiculed Pride, and also ridiculed normal. I have spent way too much of my life being an ideologue with little personal experience to back it up. In the words of Michael Pollan, “ideologies are ways of organizing large swaths of life and experience under a set of shared but unexamined assumptions.”

Two things have made me test my assumptions in recent years. One was the death of Jane Jacobs, quite possibly one of the least ideological philosophical minds of the modern era. I read all of her work and researched a lot about her after her death and what I found changed the way I looked at the world. The other was my sobriety. Someone else recently mentioned that when they got sober, they actually started caring about people because they cared so much more about themselves and their place in the world. Until very recently I had never thought of it this way, but it’s pretty accurate.

My feet are still sore from so much walking yesterday, so I might sit today’s celebrations out. But enjoy your perfectly normal, but perfectly fitting celebration, queers and non-queers alike - you’ve earned it.

Over those five years I’ve become ever more convinced at what a good decision this was. It’s coincided with my witnessing of some severe chemical dependency struggles on the part of someone very close to me, and made me quite happy that my own lack thereof was a low-maintenance lifestyle decision.

Thank you to all those friends who don’t complain that I don’t go to clubs or bars with them, and who make an effort to accommodate for me a social life outside such a setting even if it’s a large part of their own social life. Thank you to those friends who don’t think twice when I want to toast with iced tea or water in my champaign glass. Most of all, thank you to those friends who’ve stuck around longer than the past five years and not even thought much of the fact that a major change happened in my life and who I was in that time.

Whilst I no longer hold the hardcore anti-regulation view I once held on cigarettes, I really can’t understand regulating cigarette flavors. The idea just seem silly.

Yes, we should protect workers who are clinging to their jobs from having to sacrifice their health for their job. I agree that tobacco products should have big fat warnings so that there is no ambiguity about their safety, regardless of which type of product they are (hello, cigars!).

But regulating flavors? Really?!

But I do have a few opinions on the events taking place in Iran. Take them for the views of a person with limited education on the situation that they are.

The opposition frontrunner is not some liberal reformer who will bring an immediate toppling of the Ayatollah and the pouring of bikini-clad girls into the streets of Tehran. He’s just got some substantially different conservative domestic views than the current president. The Iran the West would see under his stewardship would not be discernibly different.

Note I am not using the term ‘leadership’: foreign policy power, and most domestic power, in Iran is held by unelected theologians. The significance of this election is that a fairly run-of-the-mill conservative such as Mousavi was considered too dangerous to install as a small-fry political figure.

America and Israel both need to engage with Iran much more on a diplomatic level. We’re too broke to bomb them into oblivion at this point, like we could have done in 2001. Now it’s time to try to influence them by recognizing that they are a superpower in the Middle East, and let them have a say in how outsiders apply policy in the region.

It’s odd that so many Arab countries fail to engage Israel and so many Western countries fail to engage Iran, when Israel and Iran are essentially the two biggest military and economic powers in the region. Recognizing this and normalizing relations across all states in the region (including Syria) would give us all more influence over one another, and allow us to cooperatively tackle even bigger problems of human misery such as the genocide in Sudan and the disintegration of Somalia.

One issue Americans need to come to terms with is also how important Iran is to the future economy of the Middle East. If we were to draw a comparison between Iran and its nearest big-power cousin, I would compare it to Russia in the 90s - a very cosmopolitan society with lots of domestic political issues that also happens to export a lot of petroleum. It is not a petro-state - it could re-gear its economy quite quickly in the absence of this export.

Whether Iran emerges 10 years from now looking more like Iraq today or more like Russia today is largely dependent upon the domestic policies of its rulers rather than anything outsiders can affect. Incidentally, the same could have been said ten years ago about Russia, despite what Western pundits wished were true about Western influence on Russia’s development.

Iran has lots of promise right now: a well-educated, technologically-savvy society with a fair amount of civic cohesion and quite a few civil liberties (if you have an unbiased understanding of what civil liberties really are - eg, the ability to choose your career and move from one city to the next have a bigger impact on your sense of personal freedom than whether you can drink beer in public or practice naked Yoga on the waterfront).

Will the response to this (s)election cause the government to reverse this social evolution and turn this society into a dystopian version of Iraq today, or will they build on this and create new and better ways for the citizens to air their opinions and prove that they are willing to respond to those opinions? In either case, America can’t really make much impact except to support the concept that the citizens should have a say, and emphasize that we won’t interfere in the matter. The best quote I’ve seen is a fairly simple one:

For all the criticism that President Obama has taken for not criticizing the mullahs [sic] crackdown more harshly earlier, at least he recognizes that the protests are not about outside powers, but about the people of Iran.

We need to write off our losses now, not later. I doubt our city government has the courage to admit these realities (otherwise they would not have announced this at the last minute on a Friday), but
it’s not their place to be rational, independent thinkers, I suppose - otherwise they’d get real jobs (oh, wait - there aren’t any).

Like the Trillions of dollars that went into housing stock that is now idle or massively devalued, that money is gone - it’s not coming back. Let it go, but stop adding to it.