The Insightful Troll

Rants and ruminations.

Costa Rica’s Successful Health Care System

| Comments

Atul Gawande investigates how Costa Rica has achieved a higher life expectancy than the US for a fraction of the cost.

Life expectancy tends to track national income closely. Costa Rica has emerged as an exception. Searching a newer section of the cemetery that afternoon, I found only one grave for a child. Across all age cohorts, the country’s increase in health has far outpaced its increase in wealth. Although Costa Rica’s per-capita income is a sixth that of the United States — and its per-capita health-care costs are a fraction of ours — life expectancy there is approaching eighty-one years. In the United States, life expectancy peaked at just under seventy-nine years, in 2014, and has declined since.

People who have studied Costa Rica, including colleagues of mine at the research and innovation center Ariadne Labs, have identified what seems to be a key factor in its success: the country has made public health — measures to improve the health of the population as a whole — central to the delivery of medical care. Even in countries with robust universal health care, public health is usually an add-on; the vast majority of spending goes to treat the ailments of individuals. In Costa Rica, though, public health has been a priority for decades.

The Covid-19 pandemic has revealed the impoverished state of public health even in affluent countries — and the cost of our neglect. Costa Rica shows what an alternative looks like. I travelled with Álvaro Salas to his home town because he had witnessed the results of his country’s expanding commitment to public health, and also because he had helped build the systems that delivered on that commitment. He understood what the country has achieved and how it was done.

This is in contrast to United States for profit health care system that favors private individuals who can afford it to get access to better lives, at the expense of everyone else. It is unconscionable that the wealthiest country the world has ever known refuses to make public health a core policy of its society.

The concern with the U.S. health system has never been about what it is capable of achieving at its best. It is about the large disparities we tolerate. Higher income, in particular, is associated with much longer life. In a 2016 study, the Harvard economist Raj Chetty and his research team found that the difference in life expectancy between forty-year-olds in the top one per cent of American income distribution and in the bottom one per cent is fifteen years for men and ten years for women.

Vaccines Are Saving Lives

| Comments

With Delta endemic in the country, the vaccines are providing extraordinary protection against infections severe enough to land folks in the hospital. In a recent CDC study of infections and hospitalizations in Los Angeles County, the hospitalization rate of unvaccinated people was 29.2 times that of fully vaccinated persons. 29 times is an amazing protection outcome.

For anyone still debating if you should take the vaccine - do it as soon as possible.

Rethinking Employment

| Comments

Paul Krugman in an opinion piece for The New York Times:

My guess, however — and it’s just a guess, although some of the go-to experts here seem to have similar views — is that, as I suggested at the beginning of this article, the pandemic disruption of work was a learning experience. Many of those lucky enough to have been able to work from home realized how much they had hated commuting; some of those who had been working in leisure and hospitality realized, during their months of forced unemployment, how much they had hated their old jobs.

And workers are, it seems, willing to pay a price to avoid going back to the way things were. This may, by the way, be especially true for older workers, some of whom seem to have dropped out of the labor force.

To the extent that this is the story behind recent “labor shortages,” what we’re looking at is a good thing, not a problem. Perversely, the pandemic may have given many Americans a chance to figure out what really matters to them — and the money they were being paid for unpleasant jobs, some now realize, just wasn’t enough.


What Freedom in America Looks Like

| Comments

Ignorance. Entitlement. Paranoia. That is what freedom looks like in America. Even with over 600,000+ dead, Americans are still hesitant to take the vaccine. When did we become a nation that is this selfish and cruel?

It’s infuriating. But what more can be done?

How about broadcasting the funerals of the dead every evening on the nightly news? Maybe allow cameras in the hospital wards. Let us have a list of the people that die due to Covid-19 in every town square in every community. Maybe if people see the senseless death and suffering we can scare people into taking the vaccine and wearing a mask.

Because so far, logic does not seem to be working.

FDA Approves Pfizer/BioNTech Covid-19 Vaccine

| Comments

Jacqueline Howard over at CNN:

The US Food and Drug Administration on Monday granted full approval to the Pfizer/BioNTech Covid-19 vaccine for people age 16 and older. This is the first coronavirus vaccine approved by the FDA, and is expected to open the door to more vaccine mandates.


Hoping this will finally allow proof of vaccination mandates for restaurants, bars, stores, schools, air and train travel. Everything. Get vaccinated or get left behind.

Billionaires Don't Give a F**k

| Comments

Julia Horvath makes an excellent point:

It would cost a few billion dollars to end the world’s most painful, aggravating problems, like poverty, homelessness, and famine.

Any billionaire could pick one such problem and halt it tomorrow. Yet, they choose not to.


They squeeze their workers like lemons for profit while they hoard more money than they could spend in several lifetimes. Therefore, stop reading about billionaire morning routines. Stop writing about good billionaire habits. Don’t look up to them, paint them as role models, and encourage others or yourself to replicate their success.

In short: Don’t defend the indefensible.

The American Dream

| Comments

The vast majority of the people who still believe in the American dream are looking at the past, not the future. They’re looking at their peers in the top 10 or 20 percent, and not everyone else.

They simply don’t see the 60 percent of Americans who can’t afford to pay for a basic emergency. They don’t see the rising tide of young adults who’ve decided they won’t buy homes or start families, because it’s simply too expensive. They don’t see the 52 percent of us who have to move back in with their parents, a trend that’s accelerating.

They don’t want to.

These are the people who defend the American dream. Of course, the truth is a little bit darker. They were simply given an extra pair of dice and more startup money. Now they’re laughing in your face, and moving your piece around the board for you. It’s the American way.

These people are straight up bullies, and what they need more than anything is a hard punch in their pocket books. They need to be reminded that all their “hard won success” was supported by an infrastructure that no longer exists for the vast majority of Americans.

CNN Has Fired Three Employees for Going Into Office Without Vaccinations

| Comments

Ted Johnson in Deadline:

CNN head Jeff Zucker said that the network has fired three employees for going into the office without being vaccinated against Covid-19, and that parent WarnerMedia may ultimately require proof of the shots. […]

“In the past week, we have been made aware of three employees who were coming to the office unvaccinated,” Zucker wrote in an email to staff. “All three have been terminated. Let me be clear — we have a zero-tolerance policy on this. You need to be vaccinated to come to the office. And you need to be vaccinated to work in the field, with other employees, regardless of whether you enter an office or not. Period. We expect that in the weeks ahead, showing proof of vaccination may become a formal part of the WarnerMedia Passcard process. Regardless, our expectations remain in place.”

Each individual has a right to choose for themselves. However, that right ends when it infringes on my right to be healthy and safe. We do this in every part of society. We mandate seat belts, make drinking and driving illegal, etc. We enforce all kinds of restrictions for the safety of the greater population.

I have been saying this for a long time - if the federal government can’t issue a mandate to force vaccinations - its is upto society to enforce vaccinations. This should be the case for boarding a flight, going to a restaurant, checking into a hotel, going to shopping/entertainment venues. And yes - going to your place of employment.

I am tired of stupid American privilege. There are people in other countries that are literally dying waiting for a covid-19 vaccine dose. We have people in this country who are refusing vaccine doses out of ignorance, misguided delusions of ‘freedom’, or a ridiculous sense of ‘owning the libs’.

You are done. We have had over 600,000+ deaths from covid over the past year and a half. Sorry but your right to not vaccinate ends when it infringes on my right to live. The time has come where you will get vaccinated if you would like to participate in society. And it’s not the right wing liberals, the media, or the federal government that is enforcing this. It’s we the people.

Creative Minimal Photography

| Comments

Anna Devís and Daniel Rueda create minimal photographs that incorporate themselves creatively into the image.

From their website:

Their particular style is characterized by their visual sense of humor, creativity, precision, and a delicate aesthetic inspired by the city, geometry, and minimalism. By combining their spatial awareness and their artistic vision, primarily based on simple shapes and bold patterns, they have succeeded in establishing magnetic and joyful narratives that smartly suggest both the nature of human relations and the fascination with the urban environment.

Although it may seem surprising or hard to believe, besides some basic image processing, Anna and Daniel create these surreal scenes without the use of photo editing software. Instead, they carefully set the scene in real life using all sorts of everyday objects, unexpected locations, and tons of natural light.

Check out this great interview with the duo at The Darkroom Podcast:

Here are some images from their website:

To All the 'Apple Is Doomed' Folks

| Comments

Josh Centers over at TidBITS:

Apple has not just a diverse portfolio, but a diverse portfolio of strong products backed by both physical and online distribution options that keep revenues balanced even in the toughest times. A brick-and-mortar retailer like Dollar General would be devastated by store closures, but for Apple, it was only an annoyance that could be mitigated by the Apple online store. Netflix lives or dies by its subscriber figures, but a dip in Apple TV+ subscriptions is mitigated by a music service, a credit card, warranties, and even a fitness service. HP is nothing without PC and printer sales, but the Mac can coast along at times thanks to Apple’s other offerings.

Even the iPhone, the linchpin of Apple’s renaissance, doesn’t make or break the company, as shown in the tumultuous Q2 2020, when the Services and Wearables category pushed Apple to very slight growth despite declines in every other category (see “Apple’s Q2 2020 Was a “Very Different Quarter” Than Expected,” 30 April 2020). The company can monetize the millions of existing iPhones with services and accessories, and then bolster its financial results with Mac and iPad sales.

To think that Apple is just an iPhone company is ignorant.

Mandate Vacinnations

| Comments

Aaron E. Carroll, chief health officer for Indiana University in a guest essay :

Many may read the C.D.C.’s continued focus on masking and distancing as an acknowledgment that the vaccines don’t work well enough. Leaning heavily on masking and distancing is what we did when we didn’t have vaccinations. Today, such recommendations are less likely to succeed because they are more likely to be followed by those already primed to listen — the vaccinated — and to be fought and ignored by those who aren’t.

Hospitalizations and deaths are rising in some areas not because someone didn’t wear a mask at the ballgame. They’re occurring because too many people are not immunized.

This is why I’ve advocated vaccine mandates. I don’t understand how we can mandate wearing masks but not getting vaccinations.

Mandate proof of vaccination for basic access - sports stadiums, restaurants, boarding public transportation and airlines. In addition we should mandate masks and social distancing.

Programming in Your 50s

| Comments

Next year will mark my 30th year as a professional developer. Thats nearly three decades in the software industry. When I took my first programming job - cell phones were not common, Apple was about to go bankrupt, the Web wasn’t a thing yet, IBM was the largest computer company, Windows 95 was just about to be released, we watched movies and consumed music on physical media, Google/Facebook/Netflix didn’t exist.

Yea. I am freaking old.

The development industry is more fickle than the fashion industry. I have worked on every shift from desktop command line software to modern SAAS serverless environments. Assembler, C/C++, Java, Delphi, Ruby, NodeJS to Rust. From procedural to object oriented and back to functional. From microcontrollers with 4k firmware to multi gigahertz workstation software to cloud software (I really hate that term.) Been there, done that.

We still deal with the exact same problems I dealt with in the industry from the business and management as I did when I was in my 20s.

I am tired. I need a break. Been thinking about a career change. Just to get the creative juices flowing again.

Then I came across Yossi Kreinin’s excellent article - Do you really want to be making this much money when you’re 50?. And this excerpt really spoke to me:

What else do you want to be doing when you're 50? Give me a profession remotely close to programming in the following ways:

- Little or no required education
- Good compensation, even for mediocre performers
- Millions of jobs
- No physical effort
- No health or legal risks

Programming is money for nothing. Programming is very easy to enter and extremely hard to quit. What would you do instead?

It gave me pause. We, the development community, really do have it good. And the more I think about it the more I realize - I just need to adjust my outlook. Or maybe just develop/concentrate on other hobbies away from coding.

Looking at the alternatives - I truly don’t want to do anything else.

Ted Lasso - the Curious Idiot

| Comments

Co-creator and star Jason Sudeikis on where the idea for the show came from:

The thing Bill and I talked about in the pitch was this antithesis of the cocktail of a human man who is both ignorant and arrogant, which lo and behold, a Batman-villain version of it became president of the United States right around the same time. What if you played an ignorant guy who was actually curious? When someone used a big word like “vernacular,” he didn’t act like he knew it, but just stops the meeting like, “Question, what does that mean?”

Covid-19 Is Endemic. What Now?

| Comments

Lets face reality. Covid-19 is endemic now — how do we live with that? Susan Matthews has a great write up for those of us who are vaccinated and trying to figure out what their risks are regarding the much more transmissible delta variant of SARS-CoV-2.

All of this is making people — yes, probably mostly vaccinated people — rethink the basic questions they thought their vaccine had answered for them: Can I go to restaurants and bars unmasked? Can I go back to the office? Can I see my grandma? Can I go on vacation? Can I unmask at my people-facing job? Can I have a wedding, or a party? The answer to those questions is not quite as easy as “yes, if you’re vaccinated.” It depends partly on how many in your group are vaccinated, but the actual answer is basically the same as it’s been all pandemic: It depends on your risk tolerance, it depends on what is happening with case counts locally (though, as more people travel, this might become a less reliable tool), and it depends on any unique risk factors in your group. Kass’ perspective felt novel to me: She said she suspects that in the end, a lot of people are going to end up boosting their immunity by suffering through a mild case of COVID. So no one should feel that bad about getting sick after they’re vaxxed. What matters is getting the order right: “If everyone who gets vaccinated still gets COVID but doesn’t die, that’s a success,” she said. The issue is that it doesn’t feel like a success for vaccinated people. Plus, “if you get infected after you’re vaxxed, it’s all you talk about,” she said. And right now, that’s understandably freaking out a lot of vaccinated people who thought they were in the clear.

Going to Space Is Tone Deaf

| Comments

Shannon Stirone in writing for The Atlantic:

Could there be a worse time for two über-rich rocket owners to take a quick jaunt toward the dark? Especially in the United States, the climate crisis is now actually starting to feel like a crisis. The western U.S. is in the thick of fire season, experiencing record-breaking drought and temperatures. Last week, Bezos’s hometown of Seattle hit 108 degrees. Hurricane season is starting early, and a once-in-200-years flood just ravaged northern Mississippi. Oh yeah, then there’s the pandemic that is very much still not over. Anyone would want a break from this planet, but the billionaires are virtually the only ones who are able to leave.

Leaving Earth right now isn’t just bad optics; it’s almost a scene out of a twisted B-list thriller: The world is drowning and scorching, and two of the wealthiest men decide to … race in their private rocket ships to see who can get to space a few days before the other. If this were a movie, these men would be Gordon Gekko and Hal 9000—both venerated and hated. Maybe, I don’t know, delay the missions a bit until people around the world are no longer desperately waiting for vaccines to save them from a deadly virus.

Back to Reality

| Comments

And while it’s painful to pay subsidy-free prices for our extravagances, there’s also a certain justice to it. Hiring a private driver to shuttle you across Los Angeles during rush hour should cost more than $16, if everyone in that transaction is being fairly compensated. Getting someone to clean your house, do your laundry or deliver your dinner should be a luxury, if there’s no exploitation involved. The fact that some high-end services are no longer easily affordable by the merely semi-affluent may seem like a worrying development, but maybe it’s a sign of progress.

This is a good thing for everyone going forward.

The New Real Estate Normal

| Comments

Jared A. Brock makes an interesting point about the new real estate normal:

For years, banks and ultra-elites (bankrolled by years of money-printing, corporate socialism, and bailouts) have been using their wealth to take control of the world and rent it back to us.

Apple did it with music.
Netflix did it with movies.
Nestle did it with water.
Uber did it with cars.
Airbnb hosts and landlords did it with houses.
The lecherous gig economy did it with employment.

Instead of buying and owning products, now we’re all just renting “services.”

After all, why should people like you and me build equity when a multinational corporation can build equity instead?

So long as your monthly housing-as-service payment remains relatively “affordable” (AKA half your income), the ownership class doesn’t care if it’s rent instead of a mortgage. Thus, house prices continue to rise against all reason as private equity and rent-seeking investors outbid families for control of shelter. Sure, there might be more real estate price crashes, but they’ll just be bigger versions of 2008 — buying opportunities for the hyper-elite. Your home is now a future hedge fund investment

So what can you do about it? It’s actually simple. Here are the three simple rules that have worked for me:

  1. Buy a home as soon as possible that is well below your means.
  2. Pay off the mortgage in less then 10 years. Do what ever it takes (within the law and ethical conduct) to do this.
  3. Never upgrade to a larger home unless you are paying for it in cash.