Everything You Need to Know About Health Care

Recently, there have been a ton of good pieces of media about health care.

This American Life: More Is Less This is part 1 of 2-part series about what's causing growth in health costs. Focuses on the incentives doctors face, because they want to make money and because patients are so risk-averse and because people will sue them.

This American Life: Someone Else's Money Part 2 of the series. Focuses on health insurance companies, although not as a cost-driver. Mainly as just confusing.

If Health Care Is Going to Change, Dr. Brent James's Ideas Will Change It An 8-page article from the New York Times about evidence-based medicine and this guy named Dr. Brent James who has totally remade this hospital system in Utah to save money and improve outcomes.

The Henry Ford of Heart Surgery A short piece in the Wall Street Journal about this guy in India named Dr. Shetty, who has created these factory hospitals where doctors specialize and they use economies of scale to keep costs down and prevent errors.

The point of all these pieces is that we need to stop pretending our doctors are all-knowing sages.

My Real Column On Forties

This is my Pitt News column for Monday, 9 November 2009. The version in Pitt News is awkward and horrible, because editors have a fascist gag reflex to natural sentence construction. Anyway...

This column is addressed to gentlemen but may be pleasant and edifying to the ladies as well.

I read somewhere that you should marry your best friend. I don't know if that's true, but the idea behind it is definitely true of beer. That is why I endorse the forty ounce bottle of malt liquor--a.k.a. "the forty"--a.k.a. "the fo dog"--a.k.a.--your best friend and life-long companion for party-going.

The forty might not be the most elegant, charming or sexy choice of beverage. Hell, it might be kind of fat. But everyone needs something to hold onto, and the forty is always there, through thick and thin. You don't have to be rich to cut up with the forty. It accepts you and $3.25 just as you and $3.25 are deep down inside.

First off, what is a forty? I know some of you have not yet passed 21 years on the Earth and therefore have no familiarity with strong drink. So, I will elaborate.

Malt liquor is a type of beer, but whereas what we always call "beer" is brewed from barley, oat, hops, and other weird horse foods, malt liquor comes from real food that men eat, like corn and wheat. It is like the Franzia of beer. It's also got about 8% alcohol, instead of a mere 5% like beer.

Now, for some reason, in every place and every age that man has wet his gullet with malt liquor, he has preferred to drink it in the largest possible containers. It is a rule.

Sometimes, malt liquor comes in 16 oz. cans--heavy enough to exercise with--which is the biggest size of can in the whole world. Other times, malt liquor comes in titanic 40 oz. bottles--drums, if you will. This is 3.5 times a normal beer bottle, for a consumer who is 3.5 the man. And since there's 50% more alcohol, this means the forty packs the punch of 5 or 6 beers.

A forty is so big that you keep the forty in the paper bad it's sold in, so you can hold on better. But the paper bag is not just a practical necessity. It engenders mystique.

Wine also comes in big bottles, but no one ever walks around with a bottle of wine in a paper bag. Even drinking wine straight from the bottle feels weird; you want to pour it in a glass no matter how cheap the wine is.

On the other hand, a paper bag is the forty's natural gown. It's naked without the paper bag--and if you go so far as to peel the label off...well, that's just pornographic. Meanwhile, it is a historical fact that malt liquor has never been poured into a glass. Go ahead and say it: "I'll have a tall glass of "Four O" Brand Malt Liquor, please." It sticks in the throat.

Now, when you roll up in the party with the forty in hand, literally every dude will gape and nod at the forty. It's like you walked in with a falcoln on your shoulder. They'll say, "What up?! Rockin the forty ounce!" Though all smiles, these dudes fear the forty, for it is grand and linked to rappers of fierce renown...awesome men who replenish their fluids with little else.

Others at the party will have good beers, which everyone calls "brews," because these are the only types of beer that are brewed. They have names like, "Sand Bag Summer-in-a-Leap-Year Chrysanthemum Ale." The problem with brews is that people constantly ask to take a sip and steal them from the fridge. Mononucleosis and heist are the brew's constant company.

In contrast, once you start on your forty, no one asks to take a sip. Partly it is that the specter of backwash is too glaring, but mainly it is that the signature taste of malt liquor sears the dainty palates of lesser men. Everyone who can handle the forty already has one.

Another peril of beers is that you have to be careful what you wish for, because some beers are made especially for dandy ladymen. Sipping on the wrong beverage can get you banned from the armed forces.

Not so for forties. As long as you clutch a fo-dog of any make at all, you can trapse--nay, skip--merrily through a Klan meeting in a "Sexy She-Devil Costume" and evoke naught but the deepest awe in your fellows.

There is simply no Ladyman Major at Forty Ounce University, no direct flights to Ladyman International Airport on Forty Ounce Airways, no hit single from The Ladymen on the Top Forty Ounce Countdown. That's because, while brewing malt liquor to strength does depend on copious amounts of sugar, spice and everything nice are kept at great distance--replaced by lion piss and everything needlessly aggressive.

The most important thing you can learn about forties, though, is to drink responsibly. With just one forty, you're already drinking like a man. There's no need to die like one.

Who Wants to be a Millionaire?

This is a pretty awesome WaPost article about the Nobel Prize winner Daniel Kahneman:

How Rich People Spend Their Time:

People who make less than $20,000 a year, for example, told Kahneman and his colleagues that they spend more than a third of their time in passive leisure -- watching television, for example. Those making more than $100,000 spent less than one-fifth of their time in this way -- putting their legs up and relaxing. Rich people spent much more time commuting and engaging in activities that were required as opposed to optional. The richest people spent nearly twice as much time as the poorest people in leisure activities that were active, structured and often stressful -- shopping, child care and exercise.

Kahneman and his colleagues argued that many people mistakenly allocate enormous amounts of their time and psychological focus to getting rich because of a mental illusion: When they think about what it would mean to be wealthy, they think about how enjoyable it would be to watch a flat-screen TV set, play lots of sports or get a lot of pampering -- our stereotypical beliefs of how the rich spend their time.

What I think is weird about this is that you would think that rich people aren't just people who make more money per year. They also make more money per hour. So, you'd think that they would just work less hours.

But I guess life doesn't work out that way. I guess you have to work like 60 hours/week in order for each hour to be worth $400 to an employer. There's like economies of scale with our time.

Scary Scary

From Paul Krugman:

Super Spooky Halloween Special

This is my Halloween column, two days after Halloween:

The Story of the Ghost Story.
Last year I took a graduate course in game theory. I failed the midterm so I had to study hard for the final. I cooped myself up for about a week in the kitchen copying solutions to problems and then trying to solve the problems myself. Pretty soon my kitchen table was piled high with papers covered in cryptic Greek letters.

Then one night, there was a thunderstorm. Suddenly, a crash of thunder shook the whole house, and a gust of cold air extinguished my old whale oil lamp. When I finally lit a candle, I noticed something was awry with my papers. The Greek letters were drifting about on the page. At first, I thought that a ghost was making corrections, but the Greek letters turned out to block up in paragraphs. The Greek, of course, was Greek to me, so I took the pages over to my neighbor Old Dame Kalopolis, to whom it was also Greek but nevertheless readable, because she knows Greek.

Old Dame Kalopolis, reading by the dance of candlelight, voice straining over the din of thunderclaps, translated the ghost’s message. It was a story, albeit not a very good one. It was hard to follow and the scenes were not rendered vividly. About halfway through we put it down.

“I’ve got to wrap up studying,” I said.

“Yeah. And I was gonna watch ‘Golden Girls’,” Old Dame Kalopolis said.

Sometimes I wish I remembered the story better. The next day Old Dame Kalopolis died of self-inflicted strangulation and then my house burned down, so the ghost’s story was lost. If I can’t remember, though, maybe it just goes to show how forgettable the story was — at least the first half.

Ghost Cell Phones.

Have you ever had a phone die while you were roaming? Well, death is just the beginning for that cell phone, just a gateway. The cell phone is destined to roam across the land.

You know how, when you’re around speakers and the cell phone rings it makes that weird sound in the speakers? Well, have you ever heard the weird sound, but then your cell phone didn’t ring? That’s a ghost getting a phone call on a ghost cell phone. And later on, you’ll find some discrepancies in the phone bill, and if you call the phone company, they’ll give you the run around. They’re in on it with the ghosts, I tell you.

Ghosts of Girlfriends Past.
This is also the title of a popular ghost porno movie.

Ghost of the Ghosts.
One time I lived in a haunted house on Meyran Avenue. It was so lousy with ghosts that I got a priest to come in and exorcise the joint. But he was only an Episcopal priest, so he only got one of the ghosts.

Some days later, I was eating some cereal and I lifted my spoon to my mouth, but much to my chagrin it was full of blood. I spat and knocked over my cereal bowl. The milk in the bowl had turned to blood, as well. It was blood galore everywhere. The spilled blood spelled out, “Help me.” I started to cry over the spilled blood, which was, I would like to point out, not spilled milk anymore. Then it said, “I’m a ghost.” I said, “Duh!” Then it said, “The one ghost you exorcised is haunting the sh*t out of us.” I told the ghost that now he knew firsthand what it felt like to be haunted by a ghost, but later on I was nice and I got a zombie priest to come in and exorcise the ghost of the ghost. Afterward, the zombie priest and I watched “The Exorcist,” but I had to turn it off cause he kept snorting and saying, “This is so unrealistic!”

Ghost of Roommates Past.
Dimitri was a good friend. A week after he was gone, I put up a plaque on his door that said, “In memoriam, Dimitri Gouldov.” But the plaque only emphasized how empty the room seemed without him.

Empty ... until one day it was abuzz with activity. The lights would turn on and off. On a warm evening, we would find the window open. Dimitri’s bed would be unmade at night, but then every morning made neatly, with the signature geometry that our old friend used to bring to the task. And as a final declaration that Dimitri was, in a sinister way, still with us, one night a dreadful creaking roused us all to find the memorial plaque turned around on the door. The black backside faced out, denying any change had come.

That was it. I didn’t want to hurt Dimitri, but how would the wounds heal with the restless haunt settled ever more cozily? So, I called up Dimitri. I said, “I know you’re busy in Memphis at Teach for America, but you gotta come back here and take care your damn ghost. It’s not paying rent, and we can’t get someone to sublet.”

Dimitri came home and chatted up the ghost. He explained that Memphis has new friends and new bars and new adventures waiting. Life is more than fun, Dimitri said. It’s also about giving others the opportunities, like college, that we enjoyed so much. The ghost moved on.
After that, Dimitri and I had a talk about the plaque, which he found much weirder than the ghost.

Black Action Society Responds

Jahmaiah Lewis, president of Black Action Society, wrote the following Letter to the Editor about my column Monday:

To the editor,

As representation for black students on this campus, the Black Action Society does not agree with or subscribe to the definitions of Blackness described in Lewis Lehe’s Oct. 26 column, “Cultural identity separate from race.” Blackness is not something that can be easily defined. Unfortunately, Lehe applies a rather simple definition.

In many circles Black is used to describe black people of the diaspora. In others, it’s used to describe people who are descendants of those enslaved in the mid-Atlantic slave trade. And in some circles, as I’m led to believe in the article, Black is used to describe people who participate in typical “black” activities, like moving to innercity Chicago, going to a black church and marrying a black woman. It is a term some people identify themselves with, while others prefer not to. There is not a typical experience one must have to be Black. People who identify themselves as Black in Harlem will grow up with an experience completely different from a black person raised in Portugal, Tanzania, Cuba or Paris.

It must be noted that identification is a choice, an individual choice that should not be judged by anyone else. The article tries to justify the most appropriate and convenient way to categorize a very large group of people. It is not people of African descent that it is trying to categorize. People of African descent come in all racial and cultural backgrounds. It is people with a shade of brown skin and coarse hair that the article attempts to categorize. Unfortunately, though it may be inconvenient, there is no proper term to identify us all.

This act of endorsing the term “Black” over “African-American” itself is irresponsible. It is not our place to tell anyone who they are — or who they were. At most we can educate and learn from one another. Let’s engage one another in dialogue. If we are curious as to how someone identifies, we should simply ask.

Jahmaiah Lewis
President, Black Action Society

I think she makes some valid points. Especially when I talked about Obama, I might it seem like there was a check-list for Blackness. That is pretty offensive. Overall, my column was not as tight as it could have been. I have to write very fast about things I think will be interesting, in a way that will make people want to read it.

But I disagree that the meaning of a word can be whether or not someone uses it to describe his or herself. That doesn't seem like a useful definition of a word. I still think that a word we use all the time like Black ought to be a descriptor, so it should be grounded in actions and circumstances. Oh well. Not everyone is going to agree.

Column on Black vs. African American

From the Pitt News:

Lehe: Terminology not a Black and White issue

In 2004, Alan Keyes was running against an upstart lawyer named Barack Obama in a U.S. Senate race. Down for the count, swinging wildly, Keyes made the following accusation:

“Barack Obama claims an African-American heritage ... Barack Obama and I have the same race — that is, physical characteristics. We are not from the same heritage ... My ancestors toiled in slavery in this country.”

Obama not an African-American? It is hard to argue that you are an African-American only if your great-great-great-great grandfather was born in Africa, but not if your dad was. Are you only an Irish-American if your ancestors fled the potato famine? The denial rings especially false from Keyes’ lips: He believes Obama was born in Kenya.

Keyes is clearly fumbling for a word, though. His quip illustrates the need for a word that means more than “an American of African descent” — something like what W.E.B. Du Bois had in mind when he titled his book “The Souls of Black Folk.” Fortunately, we do have such a word. The word is “Black.” As in “Black people.”

Today I endorse saying “Black” sometimes, instead of saying “African-American” in every case. Here is what I mean by Black:

First of all, Black is a capitalized word. Black people are not black.What makes Black people Black is that they participate in Black culture — the culture that has evolved from the culture of West Africans who were brought over to the New World as slaves.Black people aren’t just Americans, if by “American” we mean “United States of America.” Black people live all over the Western hemisphere.

Here are a few reasons to embrace “Black” over “African-American:”

First, it takes a long time to say “African-American.” The phrase has seven syllables — one more than just outright saying “of African descent.” It’s rare that a noun elongates its own definition.

Second, because of how awkward it is to say, “African-American” has become a phrase White people use when they are afraid of offending Black people. It says, “Look how much effort I’m spending to show I respect you.” But respect is something better revealed in actions, not word choice. Black and White friends nearly always say “Black.”

Third, replacing “Black” with “African-American” implies that all people of African descent participate in Black culture, and thereby cut-and-pastes an identity onto African immigrants. These people are African-Americans, but might not want to be Black.

Fourth, if we use “African-American” to denote exclusively what I call “Black,” as Alan Keyes does, then what will we call recent arrivals from Africa? We would have to call them “African-African Americans,” or “American-Africans” or something else stupid that no one will ever actually say.

Fifth, “Black” preserves conformity across languages and places. “Negro” is the word used in Latin American Spanish and Brazilian Portuguese. it translates directly as “Black.” These are two of the three languages that Black people speak in numbers, so they should influence the English usage. In the United States, we have gotten away with confusing “African-American” and “Black” only because the United States happens to not share borders with countries that have many Black people — all the Black people we meet are also African-Americans. But elsewhere, Black cultures span national borders. Should we expect Colombians to call a woman Afro-Colombiana when she is in Colombia and then Afro-Venezuelana when she crosses the border 10 miles to visit her sister in Venezuela on the weekend?

Finally, cutting “Black” from the language leaves an asymmetry, since no one actually says “Caucasian-Americans.” I could never explain to my child that he is White — at least half — but that his friends are African-Americans. And if you can’t explain such a common word to a child, to hell with it.

Now for the question you’ve been waiting to take offense at. Is Obama a Black man? I say that Obama is, today, a Black man. He has become Black by moving to Chicago’s South Side, marrying a Black woman, joining a Black church and immersing himself in Black culture. So, he participates in Black culture. But he grew up in Indonesia and Hawaii, outside of Black culture. So, I would say that, before he was in his 20s, no, Obama was not Black.

However, there is plenty of room for ambiguity. Who’s to say for sure a man is African-American, African, American, Caribbean, Latino or Black? Words are just useful tools we have. And language, therefore, is never African-American or White.

E-mail Lewis at ljl10@pitt.edu.