Archive for May, 2011

Irresponsible Medicine

Thursday, May 26th, 2011

Are they insane? Have our elected leaders never heard of evidence-based medicine? What kills me is that our congresswoman, Tammy Baldwin, makes universal health care her signature issue, but we never, ever hear her resolving to create a medical system that emphasizes health. It is always about more medicine at all costs. Let’s face it folks, more medicine is bad. Less medicine is good. What we need is a federal spending paradigm that emphasizes health over health care. That starts with creating healthy, active, community environments and continues with a medical system that is less hubristic and positively non-heroic.

Universality of medical coverage is certainly a necessity, but it must be done right.

In the first instance, active community environments, doing it right means winding down spending on unhealthy infrastructure such as paving and power plants, and instead focusing on creating healthy, people & community oriented places. Less pavement, more green. Less distance, more convivial interactivity. In short: healthy communities, not sprawl. (Unfortunately, on this front, all we got with the “recovery” money — when Democrats were fully in control — was just more money for more sprawl-inducing highways; crumbs for anything healthy.)

In the second instance, it means looking at health systems which de-emphasize medicine and emphasize healthy living. It also means judiciously applying medicine only where the evidence merits the application of medicine. The fee-for-service model is harmful, at best; deadly in all too many instances. Gawande’s thesis rings true for my spouse who has practiced in for-profit, non-profit and government medical systems; the amount of waste that goes into uncoordinated wheel-spinning on the for-profit side is unconscionable. In a fully-accountable medical system (typically government-run), you have much more of a focus on the patient, with positive outcomes. Profit should not have an overriding role in medicine. Or at a minimum, profit should only derive from population-wide improvements in outcomes.

If US senatorial candidate Rep. Baldwin wishes to impress her constituents in this district & state — a leader in the most cost-effective health care delivery in the country (examples of excellent health care at reasonable costs exist right here in Wisconsin; see p. 7 of the Gawande article above) and active community environments (Madison routinely ranks high on every measure of biking & walking) — she should make patient-centered, evidence-based medical delivery and active community environments the center-piece of her campaign. She could begin a Ryan-style campaign that delivers both cost savings and quality improvement to Medicare & Medicaid now. It is time to call the Republicans on their savage cost-cutting. The thing is, if Democrats were in the least bit savvy, they could show that better health can be delivered at lower costs. So far, I haven’t seen that.

Unfortunately, in the world of Democratic politicians, an ounce of prevention means less government spending — anathema to them, even when less is more.

Update 1: Death Panels & Rationing & Bears! Oh My! Here is a very, very powerful series of views on how we could “cut” Medicare/aid while improving health. There are over a trillion (with a ‘T’) $$ in savings from very low-hanging medical fruit here. Easy fixes. No deathpanels required. Heck, no exercise, no diet change even! And none of it is new. I’ve heard some variation of virtually all of these solutions from several friends/family members who are involved in the medical system in one fashion or another over the course of decades. And still, our good liberal politicians resist good sense. That the troglodyte right blocks out the truth doesn’t even need to be stated. But when the people who claim to be smart liberals block out good information, we are in trouble…..From January 2008 to January 2011 they had it all….And squandered it.

 

Surprise! Surprise! Budgetary Surprise! (Not!)

Thursday, May 19th, 2011

Wow, what a budget surprise!

Not.

I love these told-ya-so moments. Actually, I don’t. I just wish our elected leaders weren’t so easily intimidated by engineers who demand giant highways. I wish instead that they would listen to their constituents who have researched this stuff so that we can move forward to a better, less paved, place.

It’ll be interesting to see if our new crop of alders are alert to the wastefulness of creating places that suck through highway expansion. Brenda has an interesting take on it (make sure to read down through the comments as well).

The big question is, will the tough-guy engineers be able to stare down & intimidate the elected officials into compliance as they traditionally have. Judging from our last neighborhood council meeting, that ugly history will likely repeat itself. I asked my alder, Marsha Rummel point blank what questions she asked when the capital paving budget was presented to the city council a couple of weeks ago. Her reply: “We weren’t allowed to ask questions. It was an informational presentation.” We know who is boss, when city councillors are intimidated from asking questions — at a city council meeting — about the biggest item in the city budget.

 

 

Walker Planning Martial Law

Friday, May 6th, 2011

Indeed.

Herr Walker has been violating a court order to return open access to the Capitol for some months now. According to the Milwaukee Journal Sentinel, he has now activated the National Guard to develop military responses to further dissent.

So the military — every officer, every soldier, individually — comes to that line: To kill, maim, brutalize their own citizens; or, to dig deep into their moral being.

This is the time for each & every officer and soldier to review their oath, and understand the constitution — as well as it’s amendments — which they swore to uphold & defend. A quick review of Nuremberg precedents is in order as well.

While I’m no fan of the Egyptian military, and I’m not saying they behaved perfectly this spring, but, civilized people everywhere should applaud their moral bearing in respecting their civilian populace’s right ‘peaceably to assemble.’ In civilized societies, militaries have no business in politics.

This will be a true test of our National Guard’s moral mettle.

As someone who has commissioned service under his belt, I know which side of the line I would be on.

Now.

 

 

Peripatetic Cyber-Peregrinations May 4 – 7, 2011

Friday, May 6th, 2011

My random perusals….updated periodically.

There are always alternatives to fossils!

June 1 – 4  New Urbanism conference–Learn about how to make sprawl pretty! Ok, I’ll be nice. Maybe they have some good ideas. But over the years of watching development projects come through the city, I’ve come to the conclusion that for the most part, the New Urbanist concepts just get co-opted and buzzworded to death by developers who have no intention of ever actually putting the concepts into practice. But the words sound good, and by saying them during presentations at city commissions, they sail on through. Lipstick on a pig, as it were.

The Bicycle Federation of Wisconsin jettisoned all the Madison “radicals” — even going so far as to purge their website of all evidence of any bike activism in the 1990s — in order to cozy up to the rightist businessmen….Wonder how that’s working out for them?

A powerful piece on how nature — the earth — is up against it, thanks to our gluttony.

 

Talk: The Urban Forest is Broken: Solutions for a Pending Crisis

Monday, May 2nd, 2011

Large Trees, Suspended Pavement & Stormwater Management will be discussed by Peter McDonagh

When: 6:30pm, Thursday, May 5th, 2011

Where: Bethany Evangelical Free Church, 301 Riverside Dr., Madison

What: This one-hour session highlights how large soil volumes under pavement for Urban Forests are currently being installed around the world. The integration of these green utilities with uncompacted soils, trees and stormwater into our urban areas substantially improves their design sustainability. These are Urban Forests that fulfill their promise of alleviating some of our most pressing ecological challenges – including air and water quality, climate change, flooding and erosion from daily rainfall events. Research tree projects 7 and 25 years old show the superior performance of suspended pavement with loam soil for these dangers. MARQ2, transit streets in Minneapolis, the 2010 Winter Olympic Village in Vancouver, Canada and Waterfront Toronto case studies will be presented showing Urban Forests at scale.

How: Learning Objectives:

* Understand the impacts of current stormwater management and the role of green infrastructure in solving this crisis.

* Understand the elements and complementary roles of soils, large urban trees, and management of urban stormwater.

* Understand technical issues associated with developing effective urban forest systems.

Who: Presenter: Peter MacDonagh, ASLA, CSLA, RHS, ISA, LEED, Director of Design & Science, Kestrel Design Group, Inc. & Adjunct Faculty, Departments of Architecture
and Landscape Architecture, University of Minnesota

& All are welcome!

Questions? Call Anne Walker @ (608) 241-4211

Peripatetic Cyber-Peregrinations

Monday, May 2nd, 2011

Miscellaneous readings of late:

Free will does exist.

Buses have history, too!

Jack up the gas tax! For decades I’ve been pushing for radically higher gas taxes, at the pump, as well as carbon taxes & such. This little article earned me many enemies among good liberals*, and my public testimony against Mayor Pave’s dirty air budget earned me threats of violence from rightists like Vicki Pyzinski (a.k.a. Vicki McKenna) . And now, finally, years later, it looks like the big brains at Harvard have finally figured out that higher carbon taxes are the only way to get ourselves off of that filthy addiction.

*Whenever a gas tax gets talked about, good middle class liberals wail about “the poor! What about THE POOR?!” What they really mean is, what about their own ability to wastefully deathmobile everywhere. The poor don’t drive much to begin with — about 1/10 as much as a typical middle class suburbanite — and furthermore, there are ways to recycle carbon/fuel taxes on machines back to people through lower income taxes (or higher EITC). If done progressively, this could end up putting more money back into the hands of the poor than any other mechanism out there.

Pave, Baby, Pave!

Sunday, May 1st, 2011

Do I hear four dollars?!!!

Tee-hee!

And it is all the more laughable because the lessons that should have been learned  30 & 40 years ago

….Seem to have gone unlearned.

Consider the upcoming couple of weeks at city council & commissions (thanks to a well-informed neighbor for these insights):

1. Tuesday May 3 5:30 PM City Council Discussion of Transportation Improvement Plan 2012-2017.(Actual TIP schedule here in pdf.) Why should a government body use the word ‘Transportation’ as cover for Road Building? It’s one thing for the Road Builders to use it. It’s clever, actually. To change your name from the “Road Builders” to the “Transportation Builders” it appears to furnish much broader cover for your interests. But if 99.4% of what will be discussed Tuesday is paving, shouldn’t it be listed as Council Discussion of Paving?

[And let's not forget the loaded term "Improvement." Um, improvement for whom? The paving expansions are certainly not improvements for people who breathe. Or who don't like wars. Or who like clean drinking water. Or who like neighborly communities.]

2. City Streets Division says, First give us new pavement, too.
Board of Public Works Wednesday May 4 Agenda Item 29.
Here’s a top City priority! In this time of tight dollars ~ ‘We have no money’ ~ we apparently have money for the Streets Division to repave its 1501 West Badger Road asphalt parking lot and pavement area. There’s some kind of twisted irony in having Streets Division pavement be a top City priority. Here’s an opportunity for the City to demonstrate how Sustainable it is by installing permeable pavers as a demo project. Show the New Urbanism Conference people how thoughtful, progressive we are.

[Ditto the proposed expansion of the death zone known as Dutch Mill Park & Ride (Agenda Item 14). In fact, why expand it at all? Park & Rides are so 1973. The right thing would be to simply allow it to become more of a "kiss & ride" (drop off spot for inter-city bus passengers) rather than an isolated, "free" parking lot attracting crime (and it is a hot spot). Add to that, all of the ills associated with over-pavement: sealing off our aquifer, magnifying water quality problems, heat island generator, etc.]

3. Coming Attractions! MORE PAVEMENT AT MATC!!
MAY 16 Plan Commission set to consider tons more pavement at MATC – Yah! More impermeable surface! That’s what we need! There’s Education in Action!, heh? There’s educators setting a model. Add to Free Parking. Pave more of the earth. Tell kids (single-occupancy vehicles) to drive ever farther to get an ‘Education’. Drive, Kids. Don’t Worry! Plenty of Free Parking!

[Downstream from MATC's planned flood generator? Emerson-East-Eken Park, Darbo-Worthington, Schenk-Atwood-Starkweather-Yahara neighborhoods. Throw-away places, trashy people in the eyes of MATC administrators. The physical safety of your neighborhoods are not their concern. For those residents, le deluge.]

So there you have it: A city hardwiring itself for mandatory driving, mandatory energy gluttony, mandatory dirty water, mandatory flooding. Pave, Baby, PAVE!

But I would like to keep hope….

La Speranza

I really would.