Explaining USA Health Care Debate: Repairing Humans and Our Systems

USA Health Care debate is clearly about the allocation and distribution of cost. I keep hearing it expressed as a poor health care. Most instances where USA death tolls are higher could be attributable to relative affluence (affordable illegal drugs, affordable guns, affordable sugar).

Take Cancer. USA's system developed the best responses in the world, and help explain not just the increased rates of survivorship in the USA, but actually floats a lot of other boats as well.

The hypothesis being debated by politicians is not that cancer rates would be lower in a single-payer system, or that treatment of injury would improve, but that costs would be distributed differently. Right now you get very affordable health care if you have Medicare (are over 65) or are eligible for Veterans Administration hospitals, or perhaps are poor enough for Medicaid (I know less about that). But under those systems, you are better off if you have an extremely expensive ailment (like cancer) but not clearly better off (red tape) than if you go to the emergency room of a private hospital.

This blog was developed after a conversation with one of my kids who attended United World College in Bosnia y Herzogovina. All 3 of my kids have lived as ex-pats and wind up trying to explain a system that most people don't even understand in their own countries. If a nation can't even manage its own appliance repairs, how can it manage human bodies?

The answer is as complex as the question is simple. In the USA, people who are the smartest in their class go to Med School or get employed by pharmaceutical research firms. Those people are not available to fix laptops, the money is in fixing hearts and livers. In Ghana, only a slight fraction of smart people have the opportunity to go to med school. I means there are more smart people available to repair laptops.

Environmental Malpractice, Part I: Due Disclosures

[Note:  Last week I had initial meetings at the IQPC "E-Waste Summit" at Caesar's Palace with Jim Puckett and Mike Enberg of BAN.  We had a chance to try to clear the air a bit following the infamous Donald Summers blistering of "fair trade recycling" at Chicago Patch, Jim's equivocation of fair trade recycling and "poisoning people" in E-Scrap News, the effect of fake math on real people in the developing world, and the collapse of the California Compromise.    They in turn shared their genuine hurt over insinuations of racial profiling and accusations of financial motives, via my blog.   I need to treat that carefully, but have already cut this post into 3 parts after writing on the redeye from Phoenix.  It is hard to find the time to write this as carefully as it demands, but also vital to strike while the iron is hot... ]

First things first: The study of holistic environmental health parallels the evolution of the human health sciences.   Species diversity, carbon, toxics, ecosystems, sustainable consumption, over-population, etc. connect in ways we must study in order to understand them.  Western medicine has made monumental strides, but on the way to discovering a cure for AIDS and smallpox, we went through waste-centric periods of giving tapeworms for weight control, and liquid mercury as a laxative.

Western medicine grew up by making mistakes, discovering them, and admitting to them.  It has developed certain principles, like primum non nocere "first, do no harm".   But when well-meaning doctors accidentally do harm their patients, we don't call accuse them of "racism" or "poisoning people".  We have another more professional term.

"In law, malpractice is a type of negligence in which the professional under a duty to act fails to follow generally accepted professional standards, and that breach of duty is the proximate cause of injury to a plaintiff who suffers harm. It is committed by a professional or her/his subordinates or agents on behalf of a client or patient that causes damages to the client or patient."

-wikipedia 2012.11.16

Basel Action Network and Fair Trade Recycling offer different remedies to imbalances in the trade of used electronics.   Junk exports, or "toxics along for the ride", can happen either because a shortage is created (California SB20) or because of over-supply, or changes in prices of new product.  It is not the intention of the "E-Steward" to create a shortage, nor the intention of ISRI's overseas clients to pay for shipping of useless material.  We both agree that improvements can be made which will help the people in the developing world, emerging world, or non-OECD.

It's not a major concession on my part to swap the word "malpractice" for "accidental racism".  E-Stewards / BAN really want to be treated deferentially, as environmentalists, as watchdogs, as protectors of the poor, not "parasites of the poor".   But here is why I think it's a step forward:  Malpractice insurance is something well-intentioned health professionals need in case of an accident.

One of the first tests in court to differentiate accidental malpractice (unintentional harm) from criminal malpractice is how quickly the do-gooder responds to the mistake.   If a doctor takes a follow up X-Ray and sees she left a surgical tool in your belly and has to re-open the abdomen to fetch it, it's a lot worse if she pretends not to see it or refuses to review the x-ray.

Facts is facts.   It is time for BAN to give Due Disclosure about their "export statistics".

BAN may be excused for using the statistics "80%" a few years ago, and could say there wasn't good information.  They may have missed their own 2006 researcher's paper from Kenya, estimating 90% reuse.  They may have been skeptical of the paper by Williams and Kahhat, showing 87% reuse in Peru imports.  They may not accept my experience in estimating acceptable fallout when the cost of shipping to African ports is over $7000 - In Monkeys Running Environmental Zoo article, we calculated 85% reuse based on prices paid for product and shipping.  And they have loudly objected to the reports by ISRI and IDC that over 80% of used electronics are treated in the USA prior to export.

But a year ago, in 2011, the United Nations Environmental Program and the Basel Secretariat issued studies from in depth research (279 sea containers, following exports from Nigerian Joseph Benson from London to Lagos), and found - again - that 70% of the imports were fully functional, and half of the rest (15%) were repaired and reused.   That makes FIVE reports which estimate that between 80-90% of the used electronics purchased by Africans were legitimate.