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Ben A. |
Ben H. |
Doug |
Later |
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57 Varieties of Kerry Schadenfreude?
All of Teresa Heinz's money won't put his shattered campaign together again. If he wasn't done before, he's done now. And, to add additional irony to the Kerry train wreck, Gore's endorsement prompted the following email, sent to The New Republic among others:
From: Stephanie Cutter [mailto:scutter@*******]
Sent: Monday, December 08, 2003 5:09 PM To: 'David Wade'; 'mdonilon@*******'; 'Mark Mellman'; 'Michael Meehan'; 'David Morehouse'; 'Mary Beth Cahill' Cc: 'scutter@*******'
Subject: STATEMENT OPTIONS -- NO OTHER CANDIDATE HAS BEEN QUOTED YET, ONLY SPOKESPEOPLE
HERE ARE SOME OPTIONS. I don't think kerry should comment, unless asked at a press event?. Not other campaign has issued a statement...
Contact: Stephanie Cutter
STATEMENT OF JOHN KERRY
On Gore Endorsement of Dean
"I respect Al Gore. I worked with him in the Senate, and I endorsed him early in his hard fought campaign for the presidency four years ago. But, this election is about the future, not about the past. I have the experience and the vision to reverse George Bush's radical agenda and putting America back on track on my first day in office. This election will be decided by voters, across the country, beginning with voters in Iowa."
Yeah you should probably remove the internal positioning, "here are some options" talk before sending it out to the press. Haw Haw!
Also, Ben H, the official motto is "A glorious mosaic of public sector unions"
[12/10/03 18:41] |
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"Health issues," as most readers know or could surmise, are what has kept me from posting in a while. In other words I've been way frigging sick. I have good news though: most of my symptoms are gone and the doctors don't think I have a chronic condition.
Just about everyone who travels to Vietnam gets sick, mostly from gastrointestinal microbes. If you scroll back to my posts you'll see that my own problem was more original. About a week after getting off the plane my right ankle started to feel sprained; I attributed this to too much walking in sandals. But then the left ankle started hurting too, and hurting worse -- for a period of two days it felt like a car battery was being hooked up to an exposed nerve at my ankle every 30 to 90 seconds. After that other weird symptoms cropped up. I had pain in my knees and knuckles, and my wrist tendinitis flared up. I had some fever and fatigue. I had intermittent diarrhea.
All this made me suspect the onset of a genetic autoimmune disease, because they run in my family, where, oddly, they tend to be triggered in tropical countries. My grandfather died of lupus that first appeared in Mexico, my uncle has rheumatoid arthritis that first appeared in Puerto Rico, and my sister has that too (although her first symptoms appeared in Traverse City I think). A positive anti-nuclear-antibody (ANA) blood test is what really suggested the autoimmune hypothesis. ANA's are rogue immune thingies that destroy your own DNA or RNA. (It might be poetically just if I had these, given how much time I spend scoffing at stupid movies and TV shows where magical "DNA changes" have immediate and marvellous effects on people's bodies.) Anyway, this test came back positive.
My parents came to Hanoi on a previously scheduled vacation and suggested I get back to the West for better medical care. I've been in France for more than two weeks now. For a while certain symptoms -- diarrhea -- got much worse. (Only well-timed drugs kept me from experiencing the airborne diarrhea Ben H. spoke of having on his Japan flight.) Now, however, most of the symptoms are gone, and a more thorough blood test taken in Paris showed nothing except aftereffects of infection (high white blood cell count). Some fortuitous personal connections let me see France's top rheumatologist yesterday. His suspicion was that I had a severe rheumatological reaction to a weird infection in Vietnam. This happens in something called "Reiter's syndrome", although I was missing some of its classic symptoms. There remains one special ANA test that wasn't done and that could still indicate a chronic condition, but the doctor didn't think it was worth doing. Probably I'll have it done anyway. For the moment, though, we're extremely happy to have a good diagnosis. Last night we went out and had a super-rich French dinner to celebrate -- soupe de poissons (with the toast and garlic rouille) and venison parmentier and creme brulee. This may again wreck my digestive tract, which had just stabilized after weeks of seeing nothing but rice and bananas. But at least the wreckage will be temporary, it seems.
Thanks to everybody who has called or e-mailed their support during this spooky month and a half!
Right now we're trying to figure out where to live and what to do, given that Vietnam seems not to agree with me. New York is the front-runner, with Paris a ways behind. I'll keep everyone updated on our deliberations.
[12/10/03 04:25] |
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Unilaterilism (D'oh!) Goes Multilateral (Woo-hoo!)
The U.S.'s "unilateral" stance opposing the Kyoto treaty on greenhouse emissions has gotten a little more multilateral. Russia has now passed on the treaty. Andrei Iliaronov made the announcement, which means that this post may well be premature. He's probably the sharpest, most western-thinking figure in the Russian economic team (almost unique among Putin's team, he actually has a good sense of humor), but he has a tendency to announce his own (sensible) opinions as though they are settled policy. Though he espouses broadly "western" views, he is no water-carrier for the Bush administration. I saw him at a conference skewer then-CEA chairman Glenn Hubbard on the U.S. steel tariffs. The Times sees Russia's rejection as a reaction to the less expansive emissions-credit market envisioned by the current treaty. In 1990, the treaty's benchmark year, Russia was still running wildly uneconomical industrial enteprises, which generated a huge amount of greenhouse gas. Without any particular effort, they have cut around 30% from their emissions over the past decade. The Russians would love to monetize this inframarginal windfall by selling emissions credits to the rest of the world. No doubt, this is part of their motivation. But the Times, as usual, misses the elephant in the room. What Russia could ever earn from emissions credits is dwarfed by what it stands to lose on its major export -- oil and gas -- if other countries cut their consumption of fossil fuels. The Times tries to suggest that Russia objects to a mere technical provision of the treaty. I think their opposition arises from a much more fundamental interest, one which no technical chance can possibly address.
[12/3/03 08:03] |
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Here's To Infidelity!
"Cecilia" almost tops "Hey, Joe", but not quite. A contender I haven't heard, but probably only because I haven't attended any weddings west of the Hudson or south of the Mason-Dixon line (Florida excluded), is Hank William's rendition of "Your Cheatin' Heart." I'll have to ask some of my Dallas colleagues if this one makes appearances on wedding playlists down there. Care to make odds?
So why do people play/sing/dance to blatantly inappropriate songs? Most people are very poor, or at least unpracticed, readers. They swim all day in a sea of words, but have grown up ill-equipped to interpret much of what they hear. Song lyrics might as well be in Chinese or consist of euphonious grunting, for all the meaning the average listener extracts from them. Perhaps this explains why a gag I once saw Greg Nagy and his wife do (I think they were hosting an a capella concert) was so funny. They took turns reciting lines of lyrics from popular songs of the day, but they read them in a slow, deadpan lecture style. It was, I think, the first time most people in the audience really considered those words as a semantic unit. And they realized in a moment how friggin' stupid they were, thus considered.
So what meaning do listeners extract from popular songs? Songs function as reminders of where and under what circumstances they've typically heard them. So "Cecilia" reminds means "fun times at summer camp" or suchlike. Some of these really inappropriate songs are played so often at weddings that they probably mean, to most people, "connubial bliss", their anti-romantic literal meanings notwithstanding.
[12/1/03 09:57] |
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Inappropriate Wedding Music: A New Personal Best
It was an engagement party at the Harvard club, repleat with all the trimmings -- wood panels, an oil portrait of JFK, and an open bar -- that evoke entrenched plutocracy. Well, it here that the bride (a lovely, serious, young woman) and her friends sang an a capella rendition of Simon and Garfunkle's "Cecilia":
Making love in the afternoon with Cecilia
Up in my bedroom
I got up to wash my face
When I come back to bed
Someone's taken my place
I know we're all supposed to love Simon and Garfunkle's carfree hippie ways, but ... Ick! And in the end, they get back together ("jubilation, she loves me again..."). Double ick! If you want a paean to romantic love, Jimi Hendrix's "Hey, Joe" (Ben H's platonic ideal of inappropriate wedding music, as I recall) fits the bill better than "Cecelia."
What is going on? I don't think the usual culture war arguments suffice to explain inappropriate music. The culture may be a sink of vulgarity, or it may not, but music definitely receives a free pass that other forms of communication do not. Maids of honor do not recite Margaret Atwood's "You Fit into Me at an engagement party, nor do proud parents toast the new couple with "here's to anonymous sex!" So the presence of a beat must render equivalent sentiments unobjectionable to most. I confess myself non-plussed.
[12/1/03 01:46] |
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Adios, Presidente!
The last day of the signature drive to call a referendum to recall Venezuela's autocratic President Hugo Chavez is wrapping up. It appears that the Reafirmazo has succeeded beyond the organizers' expectations. That hasn't stopped Chavez and his minions from resorting to the Big Lie, a favorite chavista tactic. El Comandante hit the streets this afternoon, basking in the adoration of the shoeless rabble that constitutes his dwindling base at a state-sponsored megamarket. This is basically a huge street market where the government sells subsidized staples. And amid this example of brazen bribery, Chavez had the nerve to accuse the opposition of committing a "megafraud." Mind you, the opposition already collected sufficient signatures for a referendum months ago (in the original Firmazo), but the supreme court, reduced to a miserable creature of chavismo, suddenly discovered a punctilious legalism and disqualified the effort because the government had not set out in minute detail the rules for a petition drive. Chavez has done everything he can to prevent the signature drive from succeeding: interfering with the Electoral Tribunal in order to delay the formulation of norms to govern the signature drive, using state resources to bribe voters, threatening retaliation against state employees who might sign, hijacking the state-owned media for anti-recall propaganda, and sending his goons to scare voters away from the signing stations. And yet the Venezuela people dared to defy him. The ball is now in Chavez's court. Will he try to pressure the electorial commission to use pretexts to disqualify masses of signatures? Will he resign to try to force early elections before the opposition can agree on a single standard-bearer? Or will he cross the line and drop the tattered mask of the democrat, revealing in all its squalidness his autocratic nature, thereby risking intevention on the part of the so-far quiescent military? Whatever path he chooses, it seems like his days are numbered.
Of course, the bien-pensant leftists who have been packing into Film Forum and the Angelika to watch the arrant chavista agitprop of The Revolution Will Not Be Televised will screech that they detect the hand of the villaneous George Bush behind his removal, that it is a 21st century repeat of the coup against Allende (another story they've gotten all wrong, but that's for another post). These pierced psychodramatists, so alert to the scent of gringo imperaliasm, fail to note their own stench. THe Reafirmazo is the work of a brave Venezuelan people that has, in the face of tyranny, awakened from 40 years of political torpor to take control of its own destiny. Yet, the caviar left simply can't conceive that these unsophisticated Latinos could actually accomplish anything on their own initiative. Leaving the theater, they repair to their favorite coffee-house and conjure up chimerical American conspiracies that fit better with their monomaniacal anti-Americanism. (What would they say if they knew, as those who follow Venezuela closely do, that Chavez is the one trying to buy off the United States, having approached the U.S. administration with a proposal for PDVSA to help insure U.S. "energy security", the implicit price tag for the U.S. being that it turn a blind eye to stepped-up repression in Venezuela?) Chavez's days as President of Venezuela are numbered. Unfortunately, his days as leftist icon like Allende or Che are probably just beginning.
[11/30/03 17:54] |
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That depends what your meaning of "health-care" is
I am not suggesting that the real exchange explains the entire difference between healthcare costs in the U.S. and elsewhere. However, don't underestimate this effect. Non-tradeables prices can be pretty wildly divergent across countries. Would you be shocked to see that housing costs a much higher percentage of GDP in New York relative to, say, Toronto? (In fact, it is around 150% according to the Mercer survey.) Differences of that magnitude should not be ruled out in the case of healthcare.
Note also a corollary of "Baumol's disease." Service sector industries with lower-than-average productivity growth will exhibit higher inflation. If the U.S. has massive productivity growth in its non-healthcare service industries, a consequence will be startlingly high healthcare inflation (in its true sense, price level, not in the confused sense many people use the term, namely overall expenditures). Assuming that demand for healthcare is price-inelastic, that inflation will lead to strong growth in the overall level of healthcare expenditure. If, at the same time, other countries have lower service-sector productivity growth ex-healthcare than the U.S. but the same productivity growth in healthcare, they will experience lower healthcare inflation. Should these productivity differentials persist, over time healthcare price levels could diverge sharply. Have you sampled U.K. services lately? Not impressive.
That's obviously not the whole story. I think a lot of the rest of the difference has to do with the fact that, as you say, "higher spending purchases better care." The U.S. system has a different objective function from the socialized systems of Europe and Canada. Consumer preference plays a much larger role in the case of the former than the latter.
In the U.S., if you need an MRI, you'll get it quickly. Probably 90% of the scans make no contribution to reducing mortality. But not having to wait worrying for six month does have value for consumers. We choose to dedicate resources to purchasing piece of mind, which is not right or wrong, but a revealed preference. Americans may even choose procedures that contribute to mortality in order to improve perceived quality of life: on the frivolous and uninsured end, liposuction (note, though, that OECD statistics make no distinction between insured costs and uninsured costs, so using them to make an argument about the cost of insurance is tricky; people routinely ignore this nuance), on the more serious side, hip replacement. Or consider infant mortality figures. Do you think that all the risky multiple births arising from expensive, aggressive fertility treatment that has become increasingly common here might contribute to the U.S. performance?
To the extent this argument holds, then to point to our higher healthcare costs as some kind of "crisis" is deeply misleading. It is no more a "crisis" than any other collision of unlimited consumer desires and the household budget constraint. And that's exactly what this pseudo-crisis is about. The press serves up sob stories about workers who "can't afford" health insurance. Of course, what they really mean is they can't afford it and at the same time pay for 100 channels of cable TV, a car, an apartment of the size they think they deserve, and all the other baubles and modern contrivances that have somehow come to be considered natural rights.
Finally, if the U.S. system is so wasteful, why do so many foreigners from countries with supposedly superior public systems come to the U.S. and pay out-of-pocket for American healthcare? Given the choice between a six-month wait for an MRI and an immediate MRI for $1,000, thousands of Canadians indicate by choosing the latter that the extra cost for a shorter wait is a good value. They would make that choice at home if they could, but a socialized system discounts consumer preference. My company has offices in Tokyo and London. Most of the employees postpone medical check-ups until they are scheduled to visit Dallas headquarters. I think we even have some sort of a discount deal with Baylor for periodic diagnostic workups. The one overseas employee who faced a life-threatening illness took a leave and returned to the U.S. to receive treatment (it paid off, he's recovered).
[11/27/03 00:54] |
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A Conundrum It Is
I'll take the exchange rate point, Ben H, but let me offer some numbers (all #s 2000, from OECD data reported in The Economics of Health Care Folland, Goodman, Santo)
------Per Capita GDP----Health Spend (Per Capita)----Health spend as % GDP
US-------36,000-----------------4,631-------------------12.9
UK-------23,900-----------------1,763-------------------7.4
Japan----25,600-----------------2,012-------------------7.9
As the economists say at the outset, there are three possible explanations for this disparity:
a) US has higher average level of services
b) US has higher resource cost of services
c) US has inefficient provision of services.
As you note, explanation b does some of the work via the real exchange rate mechanism. But surely the exchange rate can't be the whole story with differences as large as these. So what gives?
Marcia Angell, et. al., want to lever us into a single player plan via the inefficiency argument. I doubt that the US market demonstrates inefficiency of such a staggering degree. Rather, I suspect higher spending purchases better care. The most macro measures (life expectancy, infant mortality), and this puzzles me. I would love to identify analyses that could demonstrate quantitative benefit from superior US care.
I should note also that one of the hardy perennials of the healthcare debate, namely the crucial role of the alleged inefficiency of US healthcare administration, gets a sharp rebuke from Brookings economist and famed slugger Henry Aaron in the August 21 New England Journal of Medicine:
Since 1986 Woolhandler and Himmelstein, along or with others, have written a series of articles that follow a simple template. In them, the authors measure the administrative costs of the U.S. and Canadian healthcare systems , subtract the second from the first, and note the difference. … This literature has been motivated, in part, by speculation that the savings in administrative costs from switching to a single-payer system without cost-sharing could pay for the added health care services that would result under a national insurance system.
In reviewing this literature an economist is struck by how hard it is to identify and estimate administrative costs accurately at a single point in time in a single nation, how doubly hard it is to compare costs at a single point in time among nations, and how triply hard it is to make meaningful international comparisons of trends in administrative costs over time. All estimates depend on assumptions about which costs are purely administrative and how much of the costs of multipurpose functions should be allocated to administration. Accurate international comparisons must also account for differences among accounting conventions and institutional arrangements. In addition, international comparisons over time must deal with shifting exchange rates and divergent trends in relative wages. As a practical matter, the conditions for accurate comparison have proven impossible to satisfy.
….
Although differences between U.S. and Canadian spending on health care administration are probably smaller than Wollhandler and colleagues suggest, they may be large. But so what? The most important question is what these differences should tell policy makers. I believe the answer is “Not much.” The differences certainly do not tell them whether administrative savings from adopting a single payer, no cost sharing plan would cover the added service costs that would result from such a system.
….
For these reasons careful scrutiny of how the United States administers its health care system, with an eye to how it can be improved within the limits imposed by history, politics, and economics, is useful. But analytically flawed comparisons with other nations, whose systems differ greatly from our own and that we are most unlikely to emulate, may titillate policy makers and others but provide little in the way of useful guidance.
Compare and contrast with coverage of the latest Woolhandler study here, here, and
here.
[11/26/03 19:40] |
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It's a lot, it's a lot, it's a lot like life...
I know as well as you do that the fever of political correctness peaked in the U.S. a long time ago. Yet it has not ebbed to the point where we need not fear episodes of recrudesence, blistering outbreaks of cultural shingles such as this.
One could easily spend the afternoon assailing the ignorance behind the story, but in the end one would merely end up rehashing stale arguments from the old D.C. "niggardly" episode. Nonetheless, please indulge me to make one observation. Isn't it the complainer to the "Affirmative Action Commission" who has shown himself up as a racist by making the implicit assumption that "slave" is derogatory to black people? After all, slavery has existed throughout history and people of all races have been relegated to the status of bondsmen. Think of Rome, Greece, or the Ottoman Empire. Why does this complainer immediately assume "slave" has something to do with black people? Are they all just "slaves" in his eyes? In any case, it's not the name that should offend him; it's the relationship. How long will we allow certain electronic components to lord it over others? Underneath it all, are they not all silicon and copper, created equal (in China)?
[11/26/03 14:38] |
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Health Care Conundum
Critics of U.S. healthcare expenditure efficiency make an elementary mistake when comparing per capita costs across countries: they don't consider the real exchange rate. Non-tradeable good may generally cost more in one country than another, even if they are of comparable intrinsic quality. One economics textbook definition of the real exchange rate, in fact, is the ratio of non-tradeable goods price levels. Healthcare consists mainly of non-tradeable goods: labor of physicians and nurses, real estate (hospitals and physician offices), administrative processing, etc. Drugs at first glace look like tradeables, but price control regimes mean they behave more like non-tradeables. So how surprising is it that U.S. healthcare costs surpass those of the other countries? Well, to take one example, the U.S. real exchange rate vis a vis Canada has been on a fairly steady secular increase for twenty years (with a sharp reversal in the past 6-8 months). What is the most powerful determinant of real exchange rates? Relative productivity. To the extent the U.S. is more productive than the rest of the world, you would expect nontradeables to be more expensive here than elsewhere. It would be interesting to make in the area of legal service the same sort of comparison you cite, Ben, for medical care. Undoubtedly, people in the U.S. spend much more on legal services than do Brits or Swedes. Probably you'd find the same thing for haircuts, too. Ditto for real estate. So, the first thing I'd need to see before I take seriously these jeremiads about U.S. healthcare costs is a set of figures adjusted for the real exchange rate.
Also, the emphasis on healthcare outcomes strikes me as misplaced. True, if you are concerned with the efficacy of different healthcare protocols, you would focus on outcomes, but that is not where one should start in an assessment of relative costs. You don't talk about the relative cost of, say, cable TV in the U.S. versus Mexico in terms of a subjective assessment of how entertained your average American or Mexican viewer finds himself after a few hours in front of the tube. You would look at the average cable bill, and you might come to the conclusion that the average U.S. cable bill is higher exactly in proportion to the real exchange rate; or it is more expensive due to higher line item prices; or it is more expensive because the average U.S. household subscribed to more channels than the average Mexican household. U.S. healthcare may likewise be more expensive due to real exchange rate effects, relative price effects (i.e. each item / service costs more in terms of its home country real exchange rate), or because U.S. patients consume more healthcare. If it is the last, then we may legitimately ask the question of whether that extra care contributes to superior outcomes, but that is a more medical than economic question.
Ben A. will surely concur that true health outcomes have proven very difficult to measure. Mortality, aside from its obvious paramount instrinic importance, is the traditional benchmark because it is easy to measure. Command economic systems have demonstrated over and over their ability to generate impressive results on narrow measures. The planners can peremptorily direct resources toward any specific goal they choose, even if that goal conflicts with the preferences of individual agents. Socialized medical systems I would guess dedicate their resources toward reducing mortality, but stint on improving more-difficult-to-measure health outcomes. THe U.S. system, on the other hand, strives, like any market system, to meet customer preferences. And customers put a tremendous premium on subjective quality-of-life issues. Feeling low? Here's some Prozac. You hurt your knee at 50 years old but you still want to ski the double-diamond trails? Arthroscopic surgery for your knee. Having trouble conceiving? We've got myriad expensive fertility treatments to offer. Anyone who's walked the streets of London and witnessed the Boschean tableau of lameness and deformity will testify that "arthroscopic knee surgery" is not in the NHS's vocabulary. They have an equivalent, though: it's called "a cane." Of course, none of these lifestyle enhancements will make much of a difference to mortality statistics. Ben A. makes this point in abstract terms with his chart demonstrating the diminishing marginal measurable health outcomes per dollar of expenditure.
Finally, socialized medicine imposes hidden costs. Many prices in socialized systems are controlled, but often the control regime shifts costs in subtle ways. We need to look at these costs shifts and calculate "shadow prices." In many socialized systems, physicians work in the direct employ of the government and wind up earning much less than they could in a free system. As a result, physicians emigrate to countries where they can earn more (note that this effect may be colinear with real exchange rate differences). The home country still needs a certain number of physicians and compensates for emigration by educating more physicians than it would otherwise need to. To the extent the educational system is also socialized, the cost of physician services gets pushed into the education budget. In the case of controlled pharmaceutical prices, the gap between the "shadow price" and regulated price is typically born by U.S. consumers, who live in one of the only free pharmaceutical markets in the world. Limited hospital capacity leads to long waits for surgeries. Leaving aside the impact on mortality, the waits force patients to live with functional limitations for long periods of time. The cost of those functional limitations may be borne by their employers, state income support (disability) programs, or by the patient himself (lower earnings). Those costs are entirely real and entirely missing from the health cost statistics.
[11/20/03 16:06] |
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How Bad is US Health Care?
The United States spends more per capita on health care than other developed countries, but gets equal (or worse) results. This claim is a staple in discussions of government funded health care. Macia Angell gives a fairly good summary of the case:
We spend roughly $4500 for every American, whether they have insurance or not. Switzerland spends maybe $2500 for every citizen. Canada spends maybe $2,000. Great Britain, poor little Great Britain, spends about $1,000 for every British citizen. And what do we get for it? What do we get for that $4500? Well, we certainly don't get our money's worth. We have roughly 43 million people with no insurance whatsoever, and among the rest of us, many of us are underinsured. That is, we have shrinking packages. This might be covered, but that won't be covered.
Our life expectancy is shorter. Our infant mortality is higher. Our childhood immunization rate is lower. And look at how often we get to see the doctor, how long we get to stay in the hospital. Canadians see their doctors far more often than we do.
The data are as Angell describes. The US does spend more per capita, and does not have a higher life expectancy to show for it. (you can some the data, and the discussion by Brian Wetherson that prompted this comment here.)
It’s far less clear, however, that the data support Angell’s conclusion that Americans don’t get their money’s worth. Aggregate figures provide a poor guide to the value of an unequally distributed good. Let’s stipulate that the bottom quartile or ten percent of Americans get really lousy medical care, and that this care is substantially worse than that received by the bottom 10% or 20% in the UK, or Sweden. If so, then even if all the high-cost expenditure bought by the rich provides substantial benefit, the US will still show poor aggregate health figures. Let me construct a quick example:
-------------------$ per capita----------“Health Quotient”
Group A ---------------100---------------------100
Group B ---------------50----------------------75
Group C ----------------0-----------------------0
Under these assumption a nation made up 50% from group A and 50% from group C will have worse results per $ than a nation made up 100% from group B. Putting everyone in group B is more cost-effective – it’s clear as day. But that doesn’t mean group A doesn’t get what they pay for – that depends on the value they place on an extra 25 HQ points.
This is hardly rocket science. But does it in fact explain the comparison between the US and other developed nations? The short answer is: I don’t know. And I can imagine many difficulties with assembling the data. Global measures of health seem immediately unhelpful. I would bet that infant mortality responds very quickly to fairly minor expenditure (pre-natal care is pretty cheap), and then quickly plateaus off. But the cost/result curve will look different for other situations.
What you really would like is a study randomizing people with the same disease into US standard of care vs. UK standard of care. Anecdotage abounds, of course. Our physician advisors have recommended European clinical studies because of the difficulties in finding “sick enough” patients for certain diseases in the US. I’d love to do a global comparison of patients *entering clinical studies* in the US vs. Europe to see if baseline disease looks the same. I’ve been meaning to investigate this subject for my own edification, so perhaps I’ll report back after giving the pharmaco-economic literature a scan.
[11/20/03 14:33] |
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Save the Steyns!
Mark Steyn is a rare bird, a smart, snappy conservative columnist. Unfortunately, like many rare species he finds his habitat under threat. It's probably not a big story outside of the financial press, so you may have missed it, but Conrad (Lord) Black has been forced to resign from Hollinger due to allegations he took unauthorized payments. Hollinger is the holding company for several media properties, including The National Post, The Daily Telegraph, and The Chicago Sun-Times, all of which stand out as exceptions to the general leftward slant of the mainstream press. Steyn graces the opinion pages of these Hollinger outlets.
The ideological cast of the Hollinger properties comports with Lord Black's own advertised political beliefs. As a result of his disgrace, it seems that Hollinger will soon find itself on the block. I am distressed to report that the Washington Post Company is rumored to be among the prospective buyers. Even if the haughty Graham clan doesn't take over, I can think of no realistic suitor unimpeachably committed to the sort of outlook fostered by Black.
Well, I guess they'll always be the Speccie, but the painfully unfunny cartoons are almost bad enough to ruin the experience of reading a Steyn column...
[11/19/03 17:19] |
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The Caloric Theory of Wealth
This is just my name, if nobody has thought of it before, for an old mistake. Many people complain about "wealth disparity" and "unequal distribution of wealth". I am among them. The danger in talking like this is that wealth can end up sounding like a substance , even like a natural resource, whose flow through a community can and should be regulated. When you think this way you tend to forget that wealth is really nothing but people's actions . By assuming that there is some given quantity of the substance "wealth" floating around, and by trying to make it flow more equitably to people, you usually end up reducing the incentives for work and investment -- the real basis of wealth.
This mistake is well known; what prompts me to mention it now is its similarity to an old physics mistake. Before modern thermodynamics, heat was pictured as a fluid called "caloric". If you wrapped a hot stone in a cold blanket, caloric would literally "flow" from the stone to the blanket, warming it. We now understand heat as nothing but the movement of individual molecules in a whole. The more vigorously they move, the more heat they "have". If more critics of Republican economics kept an analogous understanding of wealth and individual actions, their criticisms might get the hearing they deserve.
[11/17/03 09:00] |
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Now Who's Laughing at My Theory
I've bored the both of you with my theory of the Platonic dessert, and as I recall, the critical boredom thresshold was reached long before I could convince you. Now, Doug, it seems that actual immersive experience in non-Western dessert culture has achieved what my rhetoric couldn't!
In case you've forgotten, I believe in the existence of a Platonic form of "dessert." This arch-dessert consists of loads of refined sugar, dairy products, and sweetened chocolate. We all have the idea of this Platonic dessert deep in our brains, but through history most cultures have lacked the substanced required to realize the form. Only Western culture has long had all the key ingredients. You can see other cultures' attempts to approach the ideal with their inadequate materials. Some use fruits to achieve sweetness; others honey. Asian cultures are the most bereft, lacking pretty much all the key ingredients. Of course, they don't lack them anymore. I believe that international trade has rendered non-Western desserts obsolete dessert technology. They ought to admit it and start importing chocodiles in quantity.
This fits into my broader structuralist theory of food, but I'll leave that for another time, as I am sure I have already tested your patience...
[11/14/03 13:06] |
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Yes, I Speak English, 125th Street English!
Even on the shortest trip to Paris you will probably notice the metro advertisements for "Wall Street English", an English language course for professionals. Typically they feature a young Frenchman dressed up as a caricature of an I-banking associate. One shows a guy walking down a skyscraper canyon yelling into his cell phone, and gesturing excitedly with his free hand. Another shows a goateed guy sitting (among computer screens?) with this super serious expression on his face, as though in the midst of excogitating a brilliant financial strategy, or perhaps squeezing out a reluctant fart. Now the obvious question is whether Wall Street English intends these portraits of satisfied customers to be caricatures. The answer is complicated. You have to remember that France is (envisioned with pride by the majority of its citizens as) the land of art and literature and civilization, the land with the righteous mépris for the money-grubbing patronat, whose government hobbles anyone with the temerity to start a business and join this patronat. The problem is that your various human personality types occur in roughly the same proportions in all societies, and France still has its share of citizens predisposed for enterprise. (Just as America, the land of business and Babbitt, still has its idlers and intellectuals.) These French people, their natural inclinations thwarted, tend to yearn for some far-off place where there inclinations might be set free. And yearning tends to block irony; an overdrawn portrait of the yearned-for thing will make you desire it even more, rather than convince you that your desire is silly. So I suspect that these caricatures of businessmen really do attract customers to Wall Street English. (Plus, there are caricatures and there are caricatures. Businessmen are always drawn in Le Monde with a fat dollar-sign-emblazoned cigar in their mouths. I'm not kidding.)
My standard mockery of these ads was to propose "Yes, I Speak English, Milwaukee English!" -- advertisements of fat men in bowling alleys etc. Another alternative, however -- "125th Street English" -- now strikes me as feasible ... in Vietnam.
As Ben H. astutely hinted in his "So - pho - ware" post, the Vietnamese (and maybe Asians in general) have difficulty with consonant clusters and with certain consonants at the end of a syllable. One of the karaoke DVD's Dao bought me had a song with an English title, "Hold me". It was listed on the box as "Hole me". I suppose they could have done worse with "Ho me". When I thought this, I realized that there is an honest-to-God home-grown American dialect with a similar pronunciation pattern: black English. (I know there are many variants of black English across the country, but I'll ignore this for the moment. I should also confess that I really like black English; by and large, it seems to me that blacks and Jews are the only ethnicities in America that regard talking as an art form.)
Vietnamese people have such a terrible time trying to reproduce the consonant in "the" and the final consonant in "door": why not then just teach them to say "Da Doh", as in "Yo, when I park my car on aigk-shtreet, I lock da doh." Way easier! And more hygienic -- the only result of my attempt to teach my Vietnamese hotel clerks to pronounce "th" was a mutual shower of spittle. Similarly, I'm sure you'd have more success teaching "Anferny Hardaway" than "Anthony Hopkins".
I may just get my chance to launch the 125th Street School of English. An English guy just moved in across the hall, who teaches English at this new start-up business school in Hanoi. Seems it's terribly managed and on the verge of falling apart. Maybe I can go talk to the owner, apparently a rich Vietnamese-American, and suggest my radical bail-out strategy.
Of course, getting government approval here to teach a language in which "Ho" is a slur may be tough ...
Breakfast of Champas?
The caretaker of our building has started bringing me pho for breakfast. Pho is great. But at 7:30 am? One of the things that takes getting used to here, especially if you've just come from France, is that they eat savory dishes at every meal. You rarely see anything sweet. Last year I stayed with Dao's family in California for a week around Tet, and although the food was outstanding, it was the same (salty) type of food three times a day. A few times I had to sneak out for a chocolate donut at the corner strip mall where the Mexican house-painters hung out.
This all-salty approach is hard to fathom until you've tried Vietnamese attempts at sweets. Perhaps I need say no more than that their main ingredient is usually mung beans. And yet I will say more. Right now is "côm" season, the season when green immature rice, tasting kind of like chewy Crispix, is sold. They also turn it into "bánh côm", or côm cake. It's the standard mung bean/shaved coconut mixture stuck between two green glutenous patties of cooked côm. As a matter of fact it does not taste awful, so Dao bought a bunch for me and took back a bunch to France. The problem is that the housekeeper saw them on my table, and thinking that I had a taste for Vietnamese sweets, got me some other varieties. One is called bánh gai. It looks like what washes up on beaches after a tanker spill, and tastes like a mixture of lacquer and ibuprofen. (And believe me, with my ankle pains, I know from ibuprofen.) And bánh khao, which looks, and for all I know tastes, like suede eraser. It makes you understand why they're so excited for bánh côm season. (I do mean excited: they just baked a one-ton bánh côm here and are petitioning Guiness.)
Worst of all is this vile stuff called "che". Ben A. knows this stuff from the time we went down to Little Saigon with Dao. Perhaps you know them as "green bean shakes", although they come in other flavors like red bean and avocado. What the hell are these people thinking? It's almost like a missionary arrived with sugar for the first time last week, and they can't figure out how to incorporate it into their food. "I dunno, Huong, maybe pour it into a glass with mung beans and shaved ice?" Moreover, a friend we met here, an M.D., says that in most of the stomach-bug cases he hears about he can find a che parlor in the victim's last 24 hours.
Speaking of misguided sweetness and of breakfast, you may remember the cloying wake-up song they blasted from the corner near our hotel. The broadcast point near our apartment usually plays a different song, with the same chord progression as "It's a Small World". The refrain (and there's not much more than the refrain) goes like this:
Vietnam, Ho Chi Minh,
Vietnam, Ho Chi Minh;
Vietnam, Ho Chi Minh,
Vietnam, Ho Chi Minh.
The Noams of Zürich?
You guys may think Soros is a mung bean, but for me his largesse could be a job opportunity. For a while I've been thinking about looking for a think-tank or policy analyst job. What put me off was the fear of having to immerse myself in the concerns of some narrow economic lobby ("Towards a Reappraisal of Goat-Milk Tariffs", by Doug M?) and of having to do a lot of actual boring research. But with a gig at one of these newly rich pro-Democratic-party outfits, I could probably just get paid to pad out my Bandarlog musings. And I'm not just being flippant here -- I think some of the ideas I harp on should be made the core of the Democratic Party platform. I may look into it.
[11/14/03 07:40] |
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The Negative Sequel
Aliens 3, Highlander 2, Godfather 3 – these rotten films, while separated by genre, aspiration, and time, share one essential feature: they are sequels which in retrospect make the originals less enjoyable. These movies ignore the arrow of time, and reach into the past to sap the narrative strength of their progenitors.
Science fiction and fantasy seem particularly susceptible to this phenomenon. While a sequel can ruin the original with a plot arc that takes characters in implausible directions, or squanders previous development (you know that cute kid from Alien 2 that Ripley labored to save? She’s killed off-screen. Thanks, losers!), negative sequels do the most damage when they alter the laws of the fictional universe so as to make previous conflicts, choices, and plot elements meaningless or paradoxical. As science fiction and fantasy rely so much on establishing rules of action to control the plot, these genres stand particular threat from sequel erosion. There’s a danger analogous to introducing a teleporter into the last chapter of a locked room mystery.
Will it surprise anyone to learn that what prompted me to muse on this topic? In the unlikely event that a reader of this site has not already seen Matrix Revolutions, let me strongly, strongly caution against doing so. It’s the negative sequel par excellence, not so much revising the earlier movies as contemptuously ignoring them – it could not damage the original more if the action took place entirely inside the Smurf Village. Avoid it.
Addendum
Actually, the title of negative sequel par excellence must still be granted to Highlander II, wherin it was revealed that the immortal Scotsmen, Spaniards, and Steppes-dwelling barbarians whose backstories were so carefully established in the first movie (and whose battles through history comprised perhaps 50% of the plot) were in fact Space Aliens from the planet Zeist. Hard to top.
Double Addendum
Doug, you are in for a treat with The Heritage Foundation and Peace.
[11/10/03 19:29] |
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Malignest Ligaments
I've been lying here alone in my room in Vietnam watching the ceiling fan go round and round for so many days now that I'm almost expecting a secret upriver mission to be delivered. Failing that, all I can think to do is churn out more Bandarlog copy.
Why am I confined to my apartment? You may recall that I sprained my ankle a few weeks ago. Long story short, it morphed into (or was revealed to be an early symptom of a deeper problem that has now caused...) severe tendinitis in both ankles and both wrists. I've been basically immobilized for three weeks, and the brief sprain-worsening escapes I've made from my confinement do not explain why the problem spread or why it still seems not to be improving. I've come up with several hypotheses. Could be an auto-immune disorder -- they run in my family. Could be a side effect of an antibiotic I was taking. If I'm not better in a week when my parents come to visit, I suppose I'll take enough corticosteroids to let me visit with them a little bit, and then think of coming back to the U.S. for more serious medical tests.
I'm not complaining. I could just as easily be hit by cancer or an Arab bomber. But I must say it's made my Vietnam experience far different from what I expected. Thankfully Dao is here to keep me company and keep me fed.
One thing it's let me test out is whether my meditation practice can help me deal with severe pain. It can. During the (thankfully few and short) periods of severe pain, I have been somewhat able to detach myself from my pain, to remind myself that pain its transitory and necessary part of the universe, that there is no "me" to be lamented since the universe does not divide into discrete entities. Not that I've achieved the total equanimity of an enlightened yogi. I just think that the experience would suck even more without my meditation practice.
The Muslim World -- Now with 100% Less Muslims!
Just about the only thing I have to talk about is TV. I'm amused by these tourism-board commercials for various countries -- rather, those that tout Muslim countries. The one for Egypt's "Red Sea Riviera" could be advertising Miami Beach, except that there are fewer dark skinned people in evidence. The one for Dubai Media City seems to be advertising a Star Trek-style utopia of indeterminate purpose. (Maybe Ben H. discovered the purpose on his recent trip?) And there's this sort of infomercial for Indonesia where they go on and on about their Hindu and Buddhist past and show all these temples and monks and shit and never once mention Islam, let alone the fact that they're the world's most populous Muslim country. Whom are they fooling?
I also watched an almost complete soccer match, which ended (of course) tied 0 - 0.
Two-Bit Cultural Speculation
I suppose I should say at least one thing about Vietnam, so let me remark on the weird houses in Hanoi. Maybe one of you, or a reader, can tell me if things are similar in other Asian cities. Houses here tend to be tall, narrow, and made of concrete. What's striking to me about them is how ugly every side but one is. The sides and rear of the house are usually flat unadorned concrete that looks like it was painted once and left to deal with the subtropical elements. Now my speculation about this concerns the importance of family in Vietnam. With their Buddhist past and c0mmunist present, the Vietnamese are supposed to be very thoughtful of others in the community, but in practice there's a gap in how they consider people inside and outside their families. They care deeply about their families, and since one's family lives inside one's house, one tries to make its interior as comfortable as possible. However, since one's family only occasionally has to look at the exterior of one's house, one does not care all that much about it. If everybody thinks this way, it results in really ugly-looking neighborhoods.
The one exception is the façade. The fronts of houses here are kept as pretty as you please. This strikes me as a very literal application of the Asian concept of "face". You keep up appearances not because you genuinely care about them in themselves (otherwise you'd paint all four sides of your house) but because your honor is tied up with this superficial front.
P.S. I have no news about Noam E. -- I'm surprised he hasn't proved the Riemann hyppothesis yet.
[11/10/03 03:34] |
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Blowback
Maybe now the Saudi princes will regret their coddling of lunatic violent fundamentalists among their clerical class. It was madness to think their hate could be entirely deflected on to external enemies. The Islamic appetite for blood grows with the eating. Let's make sure the INS remembers the first strategy the princes resorted to when faced with fundamentalist wrath, when the House of Saud finally falls and wave of corpulent polygamists in bedsheets seek refuge in the U.S....
Noam Emerging From His Lair
Do you happen to know if Harvard has finally decided to let Noam E. out of protective custody in Lowell House?
[11/9/03 22:35] |
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The Noams of Cambridge
I'd love to see your old Chomsky interview, Ben H. I tend not to pay any attention to Chomsky, though, because his goal is so obviously to keep himself in a state of agreeable, haughty, and stoical indignation, rather than to come up with real political solutions. I still might read him if, like the New York Times magazine, he put me in an agreeable state of indignation. But he's so dry that he just puts me to sleep. (His "footnote" dodge is very typical from what I know of him.) There was an excellent critique of his sort of useless solipsism, by Michael Walzer, in Dissent. It should be required reading for all progressives. (Obviously I learned of this from ALDaily.com, not from my subscription to Dissent!)
Also, hearing the actual Chomsky interview might be better than reading a transcript. I'd love to hear him speak that last line in the Times interview, "The U.S. is the best country in the world." Was it in the tone of voice Barry Goldwater might have used to call the USSR a workers' paradise?
A somewhat more interesting Noam of Cambridge, Noam Elkies, had his "Brandenburg Concerto #7" premiered this season by the Metamorphosen chamber orchestra, a Harvard-bred Boston-based group. I learned of his upcoming performance because Carl Voss (Ben H knows him at any rate) is also having a piece played by them. The one piece of Carl's that I've heard is great. Ben A, it might be worth checking out.
Sweeping Generality, Vindicated
The "Neos" guide to Vietnam -- Michelin's weak attempt to compete in English against Let's Go, Lonely Planet, etc. -- did make, despite its weakness, one confident pronouncement that turns out to be true. Quoting from memory (having lost the book) I think it said: "The Vietnamese consider not marrying and having children to be a tragedy." The caretaker of our building is a 48-year-old unmarried woman. She does not look very happy. The first thing she will tell you, in fact, is that she is unhappy because she is unmarried. She is nice though and sometimes comes by, even when not cleaning, to commiserate about being stuck in this building all day. Oh well. It's good to have someone to practice Vietnamese with even if most of the words I learn are of the "unlucky fate" variety. (Actually that's unfair; today she taught me the word for "gecko," as a particularly big specimen on my wall now reminds me.) Hopefully my comically stumbling Vietnamese will cheer her up at least a little.
"We Have the Strength to Further Satisfy You"
... is the motto, not of my favorite Hanoi massage parlor, but of Dongguan Qisheng Electronics Industrial Co., Ltd, makers of the DVD player Dao bought for me today. I never thought I'd own a DVD player; in France we didn't even have a TV. Then again in France I didn't face the prospect of long-term confinement to my apartment. I guess I might watch some movies. The real goal, though, is to learn Vietnamese via karaoke. Dao scored some *awesome* Vietnamese karaoke CDs. Irresistibly kitschy. While Vietnam as a whole is modernizing admirably, their pop music is stuck in 1982. Really, every single pop song here sounds like a transcription of a first-term-Reagan top-40 hit. I'm not arguing that their having missed out on subsequent pop music trends is bad -- it's just odd.
And Dao got me something else to pass the time, which I will encode as a cryptic clue:
Washington think-tank: "Peace ... that would be novel" (3, 3, 5)
Also, somebody needs to point out that that Kierkegaard/foreign-policy article's title begins with "Towards," so I will.
[11/6/03 21:46] |
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W-H-R-amBush
Stern and I did interview Nim Chimpsky on our radio show back in '91 or '92. It didn't go much better than for the Times, but the result was certainly more amusing. Chomsky agreed to come on the show and do a live interview, probably assuming that two Jewish guys on Harvard Radio would be capable of producing nothing other than standard angry, leftist, collegiate drivel. As such, I imagine he expected adulation more than a real interview. Anyway, after a few context-setting questions, Stern challenged him on his contemporary apologies for and defense of the Khmer Rouge. Chomsky got very flustered and basically denied it; at which point, we pulled out a copy of (I think) Deterring Democracy and read a passage in which Chomsky charges the U.S. government with unfairly denigrating Pol Pot and his genocidal maniacs. Then he switched his story and objected that we were misrepresenting his position and as evidence he pointed to the "footnotes." We didn't have time on the air to scour the footnotes, but later on we did, and found nothing relevant there. Slippery bastard!
Another point he kept returning to in the interview was that the U.S. oppressed its citizens by a diffuse conspiracy of "mechanisms of cultural filtration" serving to softly quash dissenting views. Really, Prof. Chomsky, isn't it odd then, we asked, that you chair the very well-endowed Noam Chomsky Institute, from which you disseminate your rather idiosyncratic opinions? And aren't you a frequent guest on television and radio? He replied that he only could get his message out on "marginal" outlets like Pacifica radio. From his own press kit though, we had a list of all the major media channels that had featured him. We also noted how many books he had sold, another factoid his materials boasted of.
He didn't leave the studio happy.
Postscript: Stern is now a co-worker and he claims that he still has the Chomsky tape at his parents' house in L.A. He is going to transfer it to digital format next time he is out there, and we will then attempt to share the highlights with the blog's (few, but dedicated, I hope) readers.
[11/5/03 07:10] |
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Bedridden
One of the first things we were told by a Vietnamese person here was prompted by Dao's over-bandaged finger: "Cong chua dut tay bang an may so ruot," roughly, "To a princess a cut finger is like a disemboweling to a beggar." Needless to say, this has made me very self-conscious about traipsing around Hanoi with my crutches, especially considering that I stick out like an albino thumb even when healthy. So whenever my sprained ankle's felt a little better, I've tried hobbling around a little. Of course it's then instantly reverted to its worst state. I've now accepted reality and decided to stay off it entirely for a week or more. Today [actually Saturday -- I've not been able to post since then; just bought a modem] we moved in to our apartment, which is somewhat worse a place to be bedridden than our hotel, and night-for-night just about as expensive. It's a fifth floor walkup, has no HBO or CNN [update: found both, plus a couple other cable channels], no hotel guys to berate for their English pronunciation, plus I just saw a roach [update: looks like geckos will be a bigger nuisance than roaches] in the kitchen. If only I felt like working on my book ... but I don't. Speaking of which, Ben A., thanks for your latest philosophical missive in the thread initiated by my draft. I'll get back to you soon. But I'm afraid our whole discussion is leading me to the conclusion: philosophy, even excluding the wankery that is academic philosophy, consists of individual people's idiosyncratic worries, whose importance they have no chance of conveying to other people, and which they have no chance of resolving. I suppose I'll just start meditating during the time I had planned to work on the book.
I'm also fairly despondent about my chances of becoming conversant in Vietnamese. The only words I can recognize in others' speech are either very basic or very funny-sounding (to me). Unlike French, which is a smooth river of sound, however fast-flowing it might be, Vietnamese is staccato, and many of its speakers actually sound like they suffer from Tourette's syndrome. This is especially true when they say "các ban," which basically means "you" when spoken by a television announcer. (See below on pronoun difficulties. "Các ban" literally means something like "all [you] friends.") It wouldn't be funny if people did not routinely pronounce it so fast and so loud that, again, they sound like they have Tourette's. Try saying "cac ban" loudly and as quickly as possible, and then realize that that was a lame attempt, and say it louder and twice as fast. Maybe then you'll agree that the effect is humorous. I go around saying "cáac ban" a lot, and it always jumps out at me when I'm watching TV, the way dogs can pick out their name in their family's conversations. I also recently got into "mo uoc," meaning wish or desire, because it sounds like a perfect name for a Cthulhu god (the pronunciation is more evil than you'd guess from the spelling, which anyway is missing various little marks and accents here). My current assessment is that I will never learn this language unless I go through successive periods of finding every one of its words hilariously funny.
Yesterday I was so bored hanging around in the hotel room that I entered that ultra-somnolent state that Joel (roommate of Ben H. and me) used to get in during the slowest times at college (I suppose I got into them too, to a slightly lesser extent). I logged about ten hours of sleep at night, and then at least two more at various times during the day. At one point, one of the hotel guys knocked while I was having a very vivid dream. I was walking around Midtown when Ben H. called and suggested we get together at a certain address for breakfast. I agreed, and walked to that address, expecting to find a diner or something. But it was this super-fancy restaurant with high ceilings and white tablecloths and a maitre d' who insisted that I check my unfashionable coat rather than drape it over my chair for all to see. I thought this was pretty strange since you (Ben H.) usually avoid snobby restaurants like the plague. What was even weirder was your appearance: you had gotten one of those super-fancy hairdos like the guys in the "International Hairdresser Association Assault on Mount Everest" Monty Python sketch; more, you had gotten some kind of over-the-top facial that not only rendered your skin smooth and shiny, but gave it these very artistic freckle-configurations. I remember thinking to myself -- hey, I'm not going to pass judgments, he can do whatever makes him happy -- when I was woken up. Still I was very curious about what had gotten into you.
Sadly, that's all the news here. Could be worse though: the best friend we've made here thinks he might have meningitis. [update: it was probably a mild case.]
[11/4/03 06:24] |
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