Lab by lab in and around San Francisco

Monday

SAN FRANCISCO conjures up images of hippies and of free love, the psychedelic 60s and leftist politics. A member of Jefferson Airplane, a rock band, described it as “49 square miles surrounded by reality”. It has always had that air. In a letter written in 1889, Rudyard Kipling wrote of “a mad city, inhabited for the most part by perfectly insane people.”

But as someone who writes about science (and in the interests of full disclosure, practices it for a living), I see a different side of San Francisco and the broader Bay Area around it. I don’t see a region full of people looking to escape reality; I see scientists and engineers at universities, companies, and national labs probing and investigating that reality on a daily basis. Instead of mind-altering drugs, I see the world-altering technology that flows out of Silicon Valley.

A city built on science

Plutonium was first discovered in a Berkeley lab (as were the aptly-named berkelium and californium). The Bay Area is the birthplace of “big science” and of the atom smashers that have told us so much about the fundamental building blocks of matter. Quarks were first discovered just down the peninsula at the Stanford linear accelerator.

In the 1970s, two professors from Stanford and the University of California, San Francisco (UCSF) figured out how to use bacteria to clone segments of DNA. In the process, they gave birth to genetic engineering and the modern biotechnology industry. South of the city, Silicon Valley gave us the personal computer, the mouse, and the verbs “to google” and “to tweet”. Sit down in any local coffeeshop and you’re just as likely to end up next to someone nursing a startup as you are someone nursing a cappuccino. Now, the Valley’s venture capitalists are hoping that their magic will work just as well on the clean-technology industry.

The Bay Area hosts the world’s biggest laser (at the National Ignition Facility in Livermore), the world’s most intense X-ray source (at the LCLS at Stanford’s national lab) and an institute devoted exclusively to the scientific search for extraterrestrial intelligence (the SETI Institute in Mountain View). NASA’s outpost here just launched a probe that will slam into the lunar surface in search of water.

Between them, Stanford, Berkeley, and UCSF employ some 50 Nobel laureates spanning the full range of scientific disciplines. True, a handful of these are for economics, but we’ll cut the dismal science some slack.

Science and technology are to the Bay Area what finance is to New York and what cars are (or were) to Detroit. They underpin the region’s economy, influence its culture and shape the very character of this region as much as its notoriously active seismic geography does.

Over the next four days, I intend to explore a few of the different faces that science and technology present to residents here. From the stem cell research that promises to revolutionise medicine, to the science of growing and making the best wine, to the science-fiction sounding search for extraterrestrials, we’ll be taking a scientific road trip around the San Francisco Bay Area. Think Thelma and Louise meets Watson and Crick.

Tuesday

I WAKE up slightly disoriented at 5:45am. Waking in darkness makes me feel more like a farmer than a scientist, but perhaps that’s appropriate for the task at hand today. I’m on my way to the University of California, Davis for their annual RAVE conference, a gathering of scientists, winegrowers and winemakers meant to share the most recent advances in the disciplines of viticulture and oenology.

Gulping down a large coffee, I head east on I-80 across the Bay Bridge and through the sprawl of the East Bay. I pass the exit for Highway 37, which winds its way north and west to Napa and Sonoma, the heart of California’s wine country. In Napa alone, over 40,000 acres of vines produce an annual crop of grapes worth $400m. I manage to resist the pull of the wineries and instead follow I-80 east into the brightening dawn.

The wine before the bottle

You may not realise it when you pop the cork on a nice bottle of cabernet sauvignon, but many scientists spend their lives studying every facet of wine, from the best pruning and watering techniques for growing the tastiest grapes to the genetics of the bacteria used in their fermentation. And UC-Davis is one of the world’s great centres for wine science.

Its Robert Mondavi Institute for Wine and Food Science, founded with a donation of $25m from the father of California’s wine industry, boasts 75,000 square feet of state-of-the art labs, kitchens, and sensory-testing equipment. Inside, the halls literally smell of wine and the researchers seem to be having a lot more fun than the typical science PhDs.

Studying wine seems like a far cry from curing cancer or weaning the world off of fossil fuels, but the scientists who do so are no slouches. They make use of the latest techniques in biochemistry and biotechnology. Their analyses are sprinkled with complex mathematics and multivariate statistics.

As I learn later in the morning, “whole genome shotgun sequencing”, originally developed for the Human Genome Project, was put to work on pinot noir in 2007. Besides shedding light on fundamental issues of plant evolution, wine scientists hope the grapevine genome will reveal some of the pathways that control wine flavour and resistance to various pests.

The packed program includes lectures on viticultural practices, techniques for drying grapes into raisins, the perils of something called “berry shrivel” and how microbes contribute to flavour during fermentation. We hear about genomics, proteomics, and the “wired vine”, where all aspects of growing are monitored and controlled by sensors. Terpenes, norisoprenoids, oak lactones—the biochemical jargon comes thick and fast and eventually overwhelms me.

But what comes through is a sense, as one speaker puts it, that wine is truly “chemistry in a glass”. Wine contains hundreds of complex chemical compounds, some of which are active in startlingly small amounts. Methoxypyrazine, which gives sauvignon blanc a slight bell-pepper odour, can be detected by the nose at less than two billionths of a gram in an entire bottle.

To the purist, all of this measuring and quantifying might destroy the beauty of a perfectly balanced bottle paired with a delicious meal. But I think of the child who looks up at the night sky and grows up to become an astronomer. Science begins with and returns to beauty and wonder.

As I hit the road back to the city, I think about the theory that it’s better to give grapes slightly less water than they want in order to stress them and to concentrate their intense flavours. Out of great struggle comes great wine—and great science.

Wednesday

TONIGHT I’ve got two of the hottest tickets in town. As the bouncer checks my ID, I can hear the low bass emanating from the DJ’s turntables inside the glass doors. The crowd is dressed in slinky skirts, tight jeans, and sport coats. This is not the hippest new club in the city, but the normally staid halls of the California Academy of Sciences. My girlfriend and I head off for a stiff gin and tonic at one of the many bars (though not the one sitting beneath the watchful eye of Tyrannosaurus rex).

To most people, the words “science” and “nightlife” don’t usually go together. This spring, however, the Academy opened its doors for a series of boozy evenings intended to give the residents of this young, tech-savvy city another view of the science museum. “NightLife”, as the event is called, has been selling out, with more than 3,000 people attending each week.

It was only last September that the Academy returned to its home in Golden Gate Park. After the 1989 Loma Prieta earthquake damaged the aquarium here, the Academy undertook a complete rebuilding project that took $488m and the better part of a decade. Designed by Renzo Piano, the museum is now the largest public building in the world to have a LEED Platinum rating. Its design, which melds modern glass and steel with the classical architecture of the original building, reminds me of science itself—a combination of the new and modern with the solid, tested principles of the past.

Inside, an exhibit demonstrates some of the building’s environmentally friendly features. Recycled blue jeans are stuffed into the walls to serve as insulation (which seems fitting, as San Francisco is home to both Levi’s and The Gap). Half of the building’s cement was made with recycled waste products from coal combustion and steel production, and the glass canopy outside houses 60,000 photovoltaic cells. Instead of using treated freshwater for the aquariums, water is pumped in directly from the Pacific at the other end of the park.

We continue our stroll past the 90-foot diameter glass dome that houses a living rainforest. Next to the DJ, people are gaping through a glass window at scientists in white coats working on specimens—perhaps a nod to the traditional view of scientists in a museum.

Downstairs, the Steinhart Aquarium is packed and people are noticeably tipsier. An alligator drifts towards the thick glass, having recently sent its albino tankmate Claude to the hospital with a nasty bite on the toe. A scantily clad girl sticks her tongue out at a lizard in its tank. It responds in kind and then lazily drops off its branch.

We head back upstairs and onto the museum’s “living roof”, which is planted with native Californian grasses and flowers. They help reduce runoff and, from a distance, cause the building to mirror the hilly landscape of the city around it. A line is patiently snaking its way to a docent with a telescope trained on Saturn’s rings and the moon Titan.

After we’ve had our fill of stargazing, we spill out into the beautiful evening and stroll out of the park. I’m left with the inescapable feeling that this taste of the nightlife has been high on style but a little light on the scientific substance. But that’s no terrible thing. Science will survive and grow, as this museum has.

Thursday

IT IS a classic San Francisco morning. The downtown skyline is shrouded in a blanket of fog. By noon the sun has finally burned its way through, but the fog will likely roll back in with the cool evening breeze. It’s a bit like scientific progress, actually—an endless ebb and flow from haziness to clarity and back again.

Today I’m downtown to cover a town hall meeting hosted by the California Institute for Regenerative Medicine (CIRM). From the subway I head to one of the Palace Hotel’s elegant chandeliered ballrooms. It holds around 300, and eventually fills to standing capacity.

Though it seems like a euphemism, “regenerative medicine” does not refer to plastic surgery (that is, dare I say, an Angeleno rather than a San Franciscan pastime). From its office in San Francisco’s Mission Bay, CIRM oversees California’s $3 billion investment in stem cell research.

Soldiers awaiting orders

In November 2004, California voters passed Proposition 71, a ballot measure allowing the state to fund research into human embryonic stem cells. Overnight, California became one of the largest backers of stem-cell research in the world. At a time when the federal government was unwilling to invest in regenerative medicine, the message from the state’s voters was clear: the incredible therapeutic promise of stem cells outweighs the moral objections to using them.

That therapeutic promise, the meeting’s three panellists explain to us, comes from stem cells’ chameleon-like ability to turn into any of the cells that make up the body’s tissues and organs. Most cells are tailored to perform a particular function. Heart cells are good at beating, neurons transmit electrical signals and pancreatic islet cells produce insulin. While they all contain the full set of instructions of the human genome, each uses only the small subset that directs its particular task.

A stem cell, on the other hand, is a cellular jack-of-all-trades. Given the right signals, it can become a brand new heart cell or neuron or insulin-producing cell. Bruce Conklin, a professor at the University of California, San Francisco and the second speaker of the evening, plays us a dramatic video of 2,000 human heart cells that had been derived from embryonic stem cells. Sitting in their Petri dish, they wriggle and beat, just like a human heart.

Embryonic stem cells were first isolated in 1998, and since then the pace of progress has been furious. Much work has gone into figuring out how to reliably and efficiently generate the different cell types that doctors would like to use in patients. In addition, as the speakers emphasise, understanding exactly when and how implanted stem cells can go awry and cause tumours remains an essential research task that confronts all potential therapies.

Such therapies are slowly, but surely, making their way towards the clinic. In January, Geron, a biotechnology giant, got FDA approval to conduct the first clinical trial testing the safety of an embryonic stem cell therapy. It will work with patients with severe spinal cord injuries. For its part, CIRM is hoping to get ten to 12 human stem cell trials going in the next four years. In December, it will award $20m to researchers and their corporate partners with that goal in mind.

After the speakers finish their presentations, the moderator opens the floor to questions from the audience. From the front row, a young girl raises her hand. In a high-pitched, slightly faltering voice, she asks a deeply personal question: “I was burned very badly in August 2008. How might this help me, and how can I help in your research?”

After the dry PowerPoints and data-filled charts, the scientists seem slightly taken aback by the raw emotion. They stammer through some answers, but none seems satisfying. Despite stem cells’ promise, the science just isn’t quite there yet. This moment brings home both the deep hopes and the urgent desperation that surround what are undoubtedly the early days of regenerative medicine.

Friday

ONCE again I’m braving the early morning traffic on I-80, heading out of the city past Oakland and Berkeley. But just before I reach Davis, I veer north onto Interstate 5. It’s not the earthly delights of carefully cultivated varietals and nuanced terroir that concern me today. I’m heading into the mountains to get a tour of the Allen Telescope Array (ATA), a collection of 42 large telescopes that have just begun scanning the heavens for radio transmissions from intelligent extraterrestrials. Yes, you read that right—aliens.

Three hours later, my small Toyota begins the climb into the mountains of Lassen National Park. Eureka, Whiskeytown, Old Oregon Trail—the road signs here recall the miners and pioneers who trudged through during California’s mid-19th century gold rush. The two-lane road I’m driving on used to be a trail for rattling stagecoaches.

The San Francisco radio stations faded hours ago, and now only a few talk stations break through the static. Maybe I’ve lived in Haight-Ashbury for too long, but as I make a right turn into the observatory, Timothy Leary is in my head: “Turn on, tune in, drop out.” Here in Hat Creek, which is nearly devoid of manmade sounds, the ATA just turned on for science operations in May. For many years to come, it will tune into the radio sky to study the evolution of galaxies, the properties of black holes, and one of the most profound questions of all—whether we’re alone in the universe.

My tour guide this afternoon is Garrett Keating, a former cop turned astronomer. We walk out towards one of the 42 telescopes, a gleaming aluminium dish six metres in diameter. Mr Keating opens a trap door and we poke our heads inside. The main dish reflects incoming radio waves onto a smaller dish off to our left. That in turn bounces them onto the telescope’s main receiver, a long pyramid with different sized antennas poking off of it.

The antennas pick up an extremely wide range of frequencies, from those used for broadcast television on the low end up through the ones that transmit satellite television. In between is the emission frequency of hydrogen gas—the most common element in the universe and the raw material for the formation of stars and galaxies.

Off in the distance, we hear the rumbles of an approaching storm, and several lightning bolts streak across the sky. Mr Keating insists we return to the lab. The antennae, he reassures me, are well grounded. I don’t tell him that it wasn’t the antennae I was worried about.

Inside, fibre-optic cables carry the signals from the dishes to enormous racks of computers. By using the computers to combine data from each individual dish, the ATA is able to mimic a much larger telescope for a fraction of the cost. An initial donation of $25m from Paul Allen, the co-founder of Microsoft, and $25m from other sources financed these first 42 dishes. Eventually, the team hopes to collect enough funding to get up to 350.

Operating together, the telescopes are quite sensitive. And they need to be, since a single mobile phone located on the moon would give off a much stronger signal than almost every astronomical object in the radio sky. In addition to its sensitivity, the ATA also views a large patch of the sky all at once. Most other radio telescopes are like telephoto lenses, zooming into a tiny region of space. The ATA, however, is the first that can take snapshots with a wide-angle lens.

Just outside the sliding glass door to the control room, I notice a doormat with a bug-eyed alien and the caption “welcome all species”, a reminder of the ATA’s second mission. This telescope array represents a great leap forward for the enterprise known as SETI, the search for extraterrestrial intelligence.

In the past, SETI has had to squeeze precious observation time out of existing telescopes around the world. With the ATA, the search for signals from intelligent life elsewhere in the universe will be carried out constantly, right alongside the astrophysics.

So what exactly is SETI looking for? Essentially, something that seems not to belong—an odd man out in the cosmic radio haze. One possibility is a very powerful signal confined to a tiny frequency band, like the manmade transmissions that are continually leaking off of earth. As Mr Keating explains, “nature doesn’t produce pure tones”. In addition, if the signal really is extraterrestrial, its broadcast frequency should drift, as the alien planet orbits its own star.

Over its lifetime, the ATA hopes to survey 1m promising candidate stars within a thousand light years of earth, and ten billion more in the central region of our own Milky Way galaxy. And as computers and algorithms improve, so will SETI’s ability to look for more complex alien transmissions in this mountain of data.

Black holes, exploding stars, clouds of swirling hydrogen gas light-years across the galaxy—this is hallucinatory stuff. Yet if the little green men finally arrive, San Francisco—built as it is on science, tolerance and the counterculture—would seem like a natural first port-of-call.

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Full article and photos: http://www.economist.com/displayStory.cfm?story_id=14113332&source=hptextfeature&CFID=70299326&CFTOKEN=65073551

Ancient Greece had the Oracle at Delphi. The Shang dynasty had oracle bones. Contemporary America has Google.

Earlier this month, Lawrence Summers, President Obama’s top economic adviser, unveiled a new class of tea leaf to gauge the direction of the American economy: Google searches. The number of queries for “Great Depression,” which surged earlier in the year, had declined sharply, Mr. Summers noted. Economic anxiety is abating. The economy is probably turning the corner.

It was not the first time Google was invoked to show us the way. The company has a tool to track the path of the flu virus by looking at geographic trends in Internet queries for related terms. A study by Google researchers suggested search patterns could be used to track everything from home sales to the popularity of tourist destinations, and add to the accuracy of forecasts for new-home starts and car sales.

Polling has long been used by marketers and politicians to detect shifts in fashion and policy. Surveys of consumer confidence play a major role in economic forecasting. Economists have also tried to marshal collective wisdom with “prediction markets,” where people’s bets on all sorts of things are distilled into a remarkably accurate forecast. (Punters on Intrade.com, by the way, think there is a 75 percent chance that the economy will grow in the third quarter, but only a 12 percent chance that it grew in the second.)

Still, there is something new and mysterious about the high-tech oracle. Polls are a useful indicator of people’s tastes because they ask people what they like. Prediction markets require players to forecast. Google searches offer a roundabout impression of the world: what people want, what they fear, what they expect. It’s harder to tell what they mean.

What was going on when searches for terms related to suicide jumped fivefold last November? Was it the recession? Were people looking for techniques? Maybe it was the proximity of Christmas.

The number of searches for terms about depression in the economics category peaked in February, but so did searches about recovery. Anxiety about a Great Depression has abated since then, as Mr. Summers suggested. So has interest in the term “dead cat bounce.” But in June and July people became very interested in a “double dip” recession.

For all the uncertainty about the meaning of Google’s statistics, using them to help make the case that the economy is turning the corner might be a shrewd move. We might not know exactly what they signify, but they can provide any economic forecast with a populist cover.

Eduardo Porter, New York Times

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Full article: http://www.nytimes.com/2009/07/31/opinion/31fri4.html

TONIGHT, you or someone you love will likely be visited by a vampire — on cable television or the big screen, or in the bookstore. Our own novel describes a modern-day epidemic that spreads across New York City.

It all started nearly 200 years ago. It was the “Year Without a Summer” of 1816, when ash from volcanic eruptions lowered temperatures around the globe, giving rise to widespread famine. A few friends gathered at the Villa Diodati on Lake Geneva and decided to engage in a small competition to see who could come up with the most terrifying tale — and the two great monsters of the modern age were born.

One was created by Mary Godwin, soon to become Mary Shelley, whose Dr. Frankenstein gave life to a desolate creature. The other monster was less created than fused. John William Polidori stitched together folklore, personal resentment and erotic anxieties into “The Vampyre,” a story that is the basis for vampires as they are understood today.

With “The Vampyre,” Polidori gave birth to the two main branches of vampiric fiction: the vampire as romantic hero, and the vampire as undead monster. This ambivalence may reflect Polidori’s own, as it is widely accepted that Lord Ruthven, the titular creature, was based upon Lord Byron — literary superstar of the era and another resident of the lakeside villa that fateful summer. Polidori tended to Byron day and night, both as his doctor and most devoted groupie. But Polidori resented him as well: Byron was dashing and brilliant, while the poor doctor had a rather drab talent and unremarkable physique.

But this was just a new twist to a very old idea. The myth, established well before the invention of the word “vampire,” seems to cross every culture, language and era. The Indian Baital, the Ch’ing Shih in China, and the Romanian Strigoi are but a few of its names. The creature seems to be as old as Babylonia and Sumer. Or even older.

The vampire may originate from a repressed memory we had as primates. Perhaps at some point we were — out of necessity — cannibalistic. As soon as we became sedentary, agricultural tribes with social boundaries, one seminal myth might have featured our ancestors as primitive beasts who slept in the cold loam of the earth and fed off the salty blood of the living.

Monsters, like angels, are invoked by our individual and collective needs. Today, much as during that gloomy summer in 1816, we feel the need to seek their cold embrace.

Herein lies an important clue: in contrast to timeless creatures like the dragon, the vampire does not seek to obliterate us, but instead offers a peculiar brand of blood alchemy. For as his contagion bestows its nocturnal gift, the vampire transforms our vile, mortal selves into the gold of eternal youth, and instills in us something that every social construct seeks to quash: primal lust. If youth is desire married with unending possibility, then vampire lust creates within us a delicious void, one we long to fulfill.

In other words, whereas other monsters emphasize what is mortal in us, the vampire emphasizes the eternal in us. Through the panacea of its blood it turns the lead of our toxic flesh into golden matter.

In a society that moves as fast as ours, where every week a new “blockbuster” must be enthroned at the box office, or where idols are fabricated by consensus every new television season, the promise of something everlasting, something truly eternal, holds a special allure. As a seductive figure, the vampire is as flexible and polyvalent as ever. Witness its slow mutation from the pansexual, decadent Anne Rice creatures to the current permutations — promising anything from chaste eternal love to wild nocturnal escapades — and there you will find the true essence of immortality: adaptability.

Vampires find their niche and mutate at an accelerated rate now — in the past one would see, for decades, the same variety of fiend, repeated in multiple storylines. Now, vampires simultaneously occur in all forms and tap into our every need: soap opera storylines, sexual liberation, noir detective fiction, etc. The myth seems to be twittering promiscuously to serve all avenues of life, from cereal boxes to romantic fiction. The fast pace of technology accelerates its viral dispersion in our culture.

But if Polidori remains the roots in the genealogy of our creature, the most widely known vampire was birthed by Bram Stoker in 1897.

Part of the reason for the great success of his “Dracula” is generally acknowledged to be its appearance at a time of great technological revolution. The narrative is full of new gadgets (telegraphs, typing machines), various forms of communication (diaries, ship logs), and cutting-edge science (blood transfusions) — a mash-up of ancient myth in conflict with the world of the present.

Today as well, we stand at the rich uncertain dawn of a new level of scientific innovation. The wireless technology we carry in our pockets today was the stuff of the science fiction in our youth. Our technological arrogance mirrors more and more the Wellsian dystopia of dissatisfaction, while allowing us to feel safe and connected at all times. We can call, see or hear almost anything and anyone no matter where we are. For most people then, the only remote place remains within. “Know thyself” we do not.

Despite our obsessive harnessing of information, we are still ultimately vulnerable to our fates and our nightmares. We enthrone the deadly virus in the very same way that “Dracula” allowed the British public to believe in monsters: through science. Science becomes the modern man’s superstition. It allows him to experience fear and awe again, and to believe in the things he cannot see.

And through awe, we once again regain spiritual humility. The current vampire pandemic serves to remind us that we have no true jurisdiction over our bodies, our climate or our very souls. Monsters will always provide the possibility of mystery in our mundane “reality show” lives, hinting at a larger spiritual world; for if there are demons in our midst, there surely must be angels lurking nearby as well. In the vampire we find Eros and Thanatos fused together in archetypal embrace, spiraling through the ages, undying.

Forever.

In late May, dozens of health care reform activists staged a protest outside the San Francisco Federal Building while waiting to deliver petitions to U.S. Speaker of the House Nancy Pelosi.

Gail Collins: David, your writing on health care has been incredibly thoughtful, so I’m going to take this opportunity to poke you a little. Then I’ll shut up so you can talk.

The other week I said I agreed with you about the critical importance of cost controls. Then I asked — O.K., I sort of demanded — that you denounce the Republican leaders in the Senate who were flinging around proposals to make it illegal to investigate cost controls at all. You basically said that was a stupid thing to do, but that the Republicans weren’t really the problem since they aren’t in charge. 

But actually, they are. And so are we. The reason the country can’t solve the health care mess is because the people with the biggest bullhorns don’t speak honestly and clearly about it. Nobody understands the Democratic plan, and that scares the public. The irresponsible Republicans are just waiting to make whatever comes out sound terrible. The responsible Republicans are working to come up with a compromise that’s going to be even more incoherent than the Democratic version.

My version of reality is that:

A.) Since something like a third of the cost of health care is in administration, and the problem with reorganizing health care has to do with all the multitudinous plans and policies, a single-payer system would be far and away the most cost effective answer. We don’t talk much about it because it isn’t politically possible. But it isn’t politically possible because we don’t talk about it. The opponents of a public plan are afraid that people would all gradually migrate toward it, causing the insurance industry as we know it to wither away. Wouldn’t that be a good thing?

B.) There have to be limits on what doctors can prescribe. The president pretends the only limit will be on useless tests and drugs that have an equally good, cheaper alternative. But useless and equally good are in the eye of the beholder.

There are already limits unless you have a really, really good insurance plan, but a lot of the country either has very good coverage or imagines their coverage is good because they haven’t really tested it. They’re afraid of change. Yelling “rationing” every three seconds totally poisons the discussion. And that is no little matter.

I’ve already gone on longer than I promised, so there’s no C.

David Brooks: Gail, as you know, I begin and end my days by reciting Congressional Budget Office reports. I even put on tefillin, just to make it seem holy. So let me begin my reply with the sentence from the latest report. It’s from a section in which the C.B.O. analyzes what the House plan, with the strong public program and all the rest, would do to health care inflation:

The net cost of the coverage provisions would be growing at a rate of more than 8 percent per year in nominal terms between 2017 and 2019; we would anticipate a similar trend in the subsequent decade.

This is devastating. The plan was sold as a way to bend the cost curve, to reduce the rate of health care cost growth. Instead, the cost of the plan to the federal budget would rise by 8 percent a year, and there wouldn’t be anything close to offsetting revenues to pay for it.

This is a loud trumpet for all health care reformers. Start over. Get serious about costs. We can either pass this kind of reform and bankrupt the country or we can pass another kind of reform. End of story.

Now that I’ve got that out of my system, let me say I admire your get-serious list (though my sixth grade teacher once said that if you have an A and B, you should also have a C).

I’m not crazy about the public plan. I dislike the idea of the government competing in a marketplace it regulates. I think the temptation to subsidize the public entity will be overwhelming. But I’m not vociferously against it either. That’s because:

A.) I’m not that thrilled with the insurance companies.

B.) I think it will save money, but not that much (the C.B.O. agrees).

C.) (!) I think it will produce small administrative efficiencies.

Democratic politicians throw around statistics claiming that Medicare has much, much lower administrative costs than private insurers. I’ve been told by various economists that this claim is three-quarters trickery. It’s a lot cheaper to administer a targeted population that uses a lot of care than it is to administer a large population that uses little care per capita. Plus you can save a lot of administrative costs if you don’t actually regulate treatments that much.

As for your second point, that there should be limits on what doctors can prescribe, I say: “Amen to that.”

If I had to add a few other items to the list, I’d say putting a serious cap on the tax exemption is the way to measure the seriousness of a reform proposal. Without that, it’s not serious. And finally, I’d say that there have to be cost conscious consumers within a closely regulated market. Unless you get proper incentives for both providers and consumers, I doubt you’re going to get very far. In the current plans, all the emphasis is on the providers.

There’s a group called the Fresh Thinking Project, which has a sensible list of reform ideas.

I’d only add in closing that the health care system is as big as the entire British economy. There is no way something that big and complex and dynamic can be run out of Washington. We have to try to set up a dynamic system, not trying to establish a set of rules to be imposed by fiat. The smart reformers at the Office of Management and Budget are aware of this. I’m not sure the congressional staffs are.

Gail Collins and David Brooks, New York Times

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Full article and photo: http://theconversation.blogs.nytimes.com/2009/07/29/whats-wrong-with-a-single-payer-system/

What FDR and Nixon might say to their partisan heirs.

If Franklin Delano Roosevelt, president of the United States through the Great Depression and World War II—if FDR, that canny old political operator, that shrewd judger of men, that merry spinner (“First thing we do is deny we were in Philadelphia!”) that cold calculator (he put Joe Kennedy to head the first Securities and Exchange Commission, setting the fox among the foxes), that patient and knowing waiter-outer of events—if FDR were advising President Obama right now, what would he say?

He might look at the lay of the land and tell Mr. Obama something like this:

“My friend, you’re in a bit of a fix. Falling polls, decreasing support for health care. Beyond that, you’re stuck in a bit of a lose-lose. If you don’t get a bill along the lines you’ve announced, you’ll look ineffective and weak—a loser. If, on the other hand, you win, if you get what you asked for, it will all be a mess and all be on you. The system will be overwhelmed, the government won’t be able to execute properly, the costs will be huge. The new regime will thoroughly discombobulate things just in time for everyone’s complaints to reach a crescendo by Election Day 2010.

“But I have an idea, and hear me out. You already have Medicare, a single-payer national health-care system for those 65 and older. Little Harry Truman was the first American to get a Medicare card in 1965, did you know that? LBJ hauled him in for a ceremony. Anyway, Americans like Medicare. So here’s the plan. From here on in, every day, start talking about it: ‘Medicare this, Medicare that, Medicare.’ Get your people in Congress to focus on making the system ‘healthier.’ It’s rife with waste, fraud and abuse, everyone knows that. And there’s the demographic time bomb. Come together in a great show of bipartisan feeling with our Republican friends and announce some serious cost-saving measures that are both legitimate and farsighted. Be Dr. Save the System. On thorny issues like end-of-life care, put together a bipartisan commission, show you’re open to Republican suggestions.

“Then, at the end, get your Democratic majorities to make one little change in the program—it’s now open to all. You don’t have to be 65. The uninsured can enroll. Do it in the dead of night if you have to, you’ve got the votes.

“And then, and only because you’ve all made so many institutional and structural changes, you’ll have to give Medicare a new name. I’d suggest ‘The National Health Service.’

“Voilà. You now have the single-payer system you wanted.

“Everybody wins. You get expansion, Republicans get cost control, the system is made more secure, and the public for once isn’t terrified.

“Republicans of course will say they won—they defeated a brand new boondoggle nationalized health system. Fine. But people will start referring to the National Health Service every day, and they’ll believe they have one, and they’ll believe you gave it to them. And you can run in ’12 saying you did. That’s what I’d do!”

Before departing in a cloud of cigarette smoke and martini fumes, FDR just might add, “A second option, though lacking that special spark of deviousness, is the Wyden-Bennett bill. it’s cost-neutral, it’s not single-payer, but everyone gets coverage. And that was the point, wasn’t it? You can brag about health care for all and fiscal prudence. Not bad!”

***

If Richard Nixon—one of the great vote counters, a man who loved policy more than politics but was very good at the latter until he wasn’t anymore, a man who acted so very tough because his heart had been broken, not only by Watergate but by other things (he was right about Alger Hiss and still they wouldn’t honor him; he gave liberals everything in terms of domestic programs and still they wouldn’t love him)—if he met in Washington with the national Republicans of 2009, he might, just might, say something like this:

“Men, and a few ladies, and it’s wonderful to have you here, you’re in a good position and a bad one. Good: The American people are peeling off from nationalized medicine or socialized medicine or whatever you call it. Bad: I’m not sure the peeling off has anything to do with you. There’s something going on that I never foresaw, and it’s the fact that you don’t seem anymore to be the face of the party or of the movements within it. People with TV and radio shows do. Media people! There’s a plus to this but a minus, too. They’re sucking all the oxygen out of the room. You think they’re supporting you, but they’re really supplanting you! You’ve got to figure out how to come to the fore more and break through. But that’s small beer. Big thing is the current debate.

“You still haven’t given the American people coherent alternatives and arguments, or not so the people have noticed. You’ve got to have a strategy, and you’ve got to be serious. Put all internal jockeying aside and remember your philosophy, the thing that made you be a Republican and not a Dem.

They’re calling you all Dr. No, but that’s not really taking off, so don’t worry about it. But they are tagging you as guys who think this is all just about politics. Remember, the majority of the American people don’t care at all about your political prospects. Why should they? Unlike everyone in Washington and the media, they’re not political obsessives. They actually have lives. They care about what happens to them when they’re sick. So stop the ‘Obama’s Waterloo’ stuff—what a mistake that was, to make yourselves look cynical and purely partisan!—and refocus. Come back to first principles and prudent warnings, but always within a context of clear patriotism. At the end of the day, America needs a successful president. It’s dangerous to have a wounded duck six months into a presidency in a dangerous world. So help him by gently instructing him. He’ll hate that, because in his mind he’s the teacher and you’re the student. Point out that there’s a lot the president doesn’t understand, come forward every day with your ideas, talk them up, get them out there.

“For instance: As you know, doctors keep fees up and order expensive tests because they’re afraid of malpractice suits. They pay terrible insurance premiums. We have to reform that. Stop calling it “tort reform”; normal people think a tort is something you eat for dessert. Call it the Limiting Lawyers’ Windfalls bill. No one likes lawyers anymore, Perry Mason’s dead. And make it real when you talk. Here you can pinpoints an Obama weakness that you’re not even exploiting. He won’t go near legal reform because his biggest backers and contributors are the trial lawyer’s lobby. He talks about the common good—give me a break. As Jack Kennedy used to say, and so eloquently, here you can really stick it to him and break it off.

And speaking of JFK, try to seize back a bit of the issue of health in general. Remember physical fitness and vigor and 50 mile hikes on the C&O Canal? Completely captured the public imagination. JFK himself didn’t do it, he wasn’t insane, and he had the bad back. He sent Bobby and that fat Pierre Salinger. Anyway, go with that: personal responsibility, strength, health. Steal it from the Dems. But don’t imitate their censorious tone: ‘Ya can’t smoke, put down that doughnut.’ Let me tell you, doughnut eaters are the largest growing demographic in America. Don’t get crossways with them!”

Peggy Noonan, Wall Street Journal

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Full article: http://online.wsj.com/article/SB10001424052970204619004574320743837417378.html

Yesterday, Barack Obama was God. Today, he’s fallen from grace, the magic gone, his health-care reform dead. If you believed the first idiocy — and half the mainstream media did — you’ll believe the second. Don’t believe either.

Conventional wisdom always makes straight-line projections. They are always wrong. Yes, Obama’s aura has diminished, in part because of overweening overexposure. But by year’s end he will emerge with something he can call health-care reform. The Democrats in Congress will pass it because they must. Otherwise, they’ll have slain their own savior in his first year in office.

But that bill will look nothing like the massive reform Obama originally intended. The beginning of the retreat was signaled by Obama’s curious reference — made five times — to “health-insurance reform” during his July 22 news conference.

Reforming the health-care system is dead. Cause of death? Blunt trauma administered not by Republicans, not even by Blue Dog Democrats, but by the green eyeshades at the Congressional Budget Office.

Three blows:

— On June 16, the CBO determined that the Senate Finance Committee bill would cost $1.6 trillion over 10 years, delivering a sticker shock that was near fatal.

— Five weeks later, the CBO gave its verdict on the Independent Medicare Advisory Council, Dr. Obama’s latest miracle cure, conjured up at the last minute to save Obamacare from fiscal ruin, and consisting of a committee of medical experts highly empowered to make Medicare cuts.

The CBO said that IMAC would do nothing, trimming costs by perhaps 0.2 percent. A 0.2 percent cut is not a solution; it’s a punch line.

— The final blow came last Sunday when the CBO euthanized the Obama “out years” myth. The administration’s argument had been: Sure, Obamacare will initially increase costs and deficits. But it pays for itself in the long run because it bends the curve downward in coming decades.

The CBO put in writing the obvious: In its second decade, Obamacare significantly bends the curve upward — increasing deficits even more than in the first decade.

This is obvious because Obama’s own first-decade numbers were built on arithmetic trickery. New taxes to support the health-care plan begin in 2011, but the benefits part of the program doesn’t fully kick in until 2015. That excess revenue is, of course, one time only. It makes the first decade numbers look artificially low, but once you pass 2015, the yearly deficits become larger and eternal.

Three CBO strikes, and you’re out cold. Though it must be admitted that the White House itself added to the farcical nature of its frantic and futile cost-cutting when budget director Peter Orszag held a three-hour brainstorming session with Senate Finance Committee aides trying to find ways to save. “At one point,” reports the Wall Street Journal, “they flipped through the tax code, looking for ideas.” Looking for ideas? Months into the president’s health-care drive and just days before his deadline for Congress to pass real legislation? You gonna give this gang the power to remake one-sixth of the U.S. economy?

Not likely. Whatever structural reforms dribble out of Congress before the August recess will probably not survive the year. In the end, Obama will have to settle for something very modest. And indeed it will be health-insurance reform.

To win back the vast constituency that has insurance, is happy with it, and is mightily resisting the fatal lures of Obamacare, the president will in the end simply impose heavy regulations on the insurance companies that will make what you already have secure, portable and imperishable: no policy cancellations, no preexisting condition requirements, perhaps even a cap on out-of-pocket expenses.

Nirvana. But wouldn’t this bankrupt the insurance companies? Of course it would. There will be only one way to make this work: Impose an individual mandate. Force the 18 million Americans between 18 and 34 who (often quite rationally) forgo health insurance to buy it. This will create a huge new pool of customers who rarely get sick but will be paying premiums every month. And those premiums will subsidize nirvana health insurance for older folks.

Net result? Another huge transfer of wealth from the young to the old, the now-routine specialty of the baby boomers; an end to the dream of imposing European-style health care on the United States; and a president who before Christmas will wave his pen, proclaim victory and watch as the newest conventional wisdom reaffirms his divinity.

Charles Krauthammer, Washington Post

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Full article: http://www.washingtonpost.com/wp-dyn/content/article/2009/07/30/AR2009073002819.html