UPDATED: Health care statistics, undermining health care debate?

Peter Orszag
Image via Wikipedia

UPDATE: I had originally written this post based mainly off of the NY Times piece linked to below, coupled with my own knowledge of health care policy, but it seems that this article has sparked a vigorous debate in the blogosphere regarding just how accurate it's claims about the Dartmouth Health Atlas are.  I have edited parts of my post below to take into account new information, but for more, see Kevin Drum at Mother Jones, David Leonhardt at the NY Times, or the Dartmouth Health Atlas authors' response.  Needless to say, the situation is far more complex than the Times writers acknowledge, involving statistical analysis and the extrapolation of data.  More info below my blog posting.

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There's a fascinating article out today in the New York Times about a Dartmouth study on health care spending and the resultant health outcomes across hospitals, states, and regions of the U.S.  The study was used by the Obama Administration and Congressional Democrats to make the case for the efficacy of cutting health care spending while actually improving patients' health outcomes.  The article paints a picture of the Administration's efforts to sell their plan via the study:

Mr. Orszag even displayed maps produced by Dartmouth researchers that appeared to show where the waste in the system could be found. Beige meant hospitals and regions that offered good, efficient care; chocolate meant bad and inefficient.

The maps made reform seem relatively easy to many in Congress, some of whom demanded the administration simply trim the money Medicare pays to hospitals and doctors in the brown zones. The administration promised to seriously consider doing just that. (emphasis added)

Mr. Orszag is Peter Orszag, Budget Director of the Office of Management and Budget at the White House, and one of the primary cheerleaders for health care reform within the Administration.  Color-coded maps are like catnip to legislators eager to provide pseudo-intellectual cover for their legislative aims, as they can simply point to the maps to make their overly simplistic arguments to their constituents.  The idea that politicians would ever think that health care reform is easy is truly scary.  We really need more economists and statisticians in Congress.

But while the research compiled in the Dartmouth Atlas of Health Care has been widely interpreted as showing the country’s best and worst care, the Dartmouth researchers themselves acknowledged in interviews that in fact it mainly shows the varying costs of care in the government’s Medicare program. Measures of the quality of care are not part of the formula. (emphasis added)

Did you catch that?  The Dartmouth study solely looks at the cost of care, not the quality of care, yet somehow or another the link between lower spending and better care was made by policymakers in Washington.  How did that happen?

In addition to their hospital rankings, the Dartmouth researchers have also done separate studies of how Medicare spending affects patient care regionally. A 2003 study found that patients who lived in places most expensive for the Medicare program received no better care than those who lived in cheaper areas.

Because some regions spent nearly a third more than other regions without any apparent benefit, the Dartmouth team concluded that at least one dollar in three was wasted by Medicare. When applied generally to the nation’s health care system, that meant about $700 billion could be saved.

But as it began publicly discussing its research, the Dartmouth team often extrapolated beyond this basic finding. Not only do high-spending regions fail to provide better care, the Dartmouth team began to argue, but those regions actually offer worse care. 

While I haven't seen the exact data the Dartmouth team examined in making these claims, the argument that one-third of Medicare spending is wasteful seems like a rather large extrapolation to make.  The blunt instrument of health care spending statistics does not lend itself to nuanced analyses of the quality of doctors or nurses at a hospital or of their clinical judgments in deciding what treatments to order for patients.

Last year, New Yorker writer (and practicing doctor) Atul Gawande wrote a major article about McAllen, Texas, the city with the highest per-capita Medicare spending in the country after Miami, a city with a much higher cost-of-living and more elderly population.  Gawande describes a meeting he has with a group of McAllen doctors, one of whom responds to Gawande's inquiry about the high spending thusly:

“Come on,” the general surgeon finally said. “We all know these arguments are bullshit. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures. 

The surgeon came to McAllen in the mid-nineties, and since then, he said, “the way to practice medicine has changed completely. Before, it was about how to do a good job. Now it is about ‘How much will you benefit?’ ”

Naturally, when the incentives for doctors are to over-prescribe treatments so that they are compensated, they will tend to run more tests than necessary, and to focus on moving their patients into the more expensive treatment programs, rather than lower-cost preventive medicine treatments, which may be more effective.  So when the Dartmouth researchers make the arguments that higher cost equates to worse outcomes, that may indeed be true, as more health care does not always mean better health care, but it cannot be the case universally across the country.  If a doctor correctly diagnoses a serious ailment, and prescribes a necessarily expensive treatment regimen for it, then simply looking at the spending figures will not be able to take into account the correct diagnosis of that ailment.

In interviews, Dr. Fisher and Mr. Skinner acknowledged that there was no proven link between greater spending and worse health outcomes. And Dr. Fisher acknowledged the apparent inconsistency between his statements in interviews with The New York Times and those made elsewhere, saying that he was sometimes less careful in discussing his team’s research than he should be.

In any case, the more-is-worse message has resonated with insurers, whose foundations now help to finance the Dartmouth Atlas. Dartmouth researchers also created a company, Health Dialog, to consult for insurers and others on Dartmouth’s findings. Valued at nearly $800 million, the company was sold to a British insurer in 2007 and still helps to finance the Dartmouth work.

It appears that, surprise, if as a researcher you make arguments that resonate with insurance companies, they will take a financial interest in your research.

Ultimately, the problem here is twofold: 1) high per capita Medicare spending in an area may signify the overutilization of care by doctors, but to make the conclusion that higher spending is always wasteful goes too far; 2) researchers and academics who create studies that fit neatly into the narrative that the powers-that-be seek to promulgate (in this case the Obama Administration and the health insurers) will have their conclusions amplified, despite arguments to the contrary.  This resulted in the further muddying of the already opaque health care reform discourse in which nothing is quite as cut-and-dry as we might wish.  While I still believe the reform bill was a good step towards a healthier America, it's unfortunate that the system has been gamed by so many parties.

UPDATE, cont...Further muddying of the waters:

3. Some research has shown that even the most glaring cost
differences noted in the Dartmouth research are associated with
improved outcomes for those conditions where something close to random
assignment of patients to alternative patient regimes occurs. The guy
who is doing this work is Joseph Doyle at MIT. If the Times article
had described some of his work, readers would have learned something.
For example, you can be pretty sure that people who suffer coronaries
while on vacation do not choose in which county to have the heart
attack. Doyle studied such patients. He found that they did better
in Florida counties that spent most, the very counties that the
Dartmouth folks have held up for their poor average outcomes. He also
found that preemies who were a couple of grams under the threshold at
which they are described as in need of intensive care did materially
better than did preemies a couple of grams over that threshold and,
hence, treated as normal births. The weight difference was too small
to matter medically and went in the wrong direction; the intensity of
care mattered.

Doyle's reasearch and the finding on the inverse relationship between
Medicare spending and private spending, together with the fact that we
can't predict worth crap who will and who will not benefits from many
procedures means not that the Dartmouth people are wrong, but that any
savings will be very hard to achieve without doing more harm than good
and will be very slow in coming. The Administration, and Orszag in
particular, were wrong in neglecting the warning to forecasters of
Scottish economist, Alec Cairncross, 'Give a number. Or a date.
Never both.'

The future of finance?

My schedule has not permitted me to post anything fully-developed for quite a while, but tonight I have a few multimedia treats for you, building off of the news themes of recent weeks.

First off, "Quants, The Alchemists of Wall Street."  A film made about the mathematical geniuses who created the models that have been largely running the financial world for a number of years now.  While that may not sound like the most interesting subject matter, I highly recommend taking 45 minutes and watching the film, there's lots to learn:

I thought this was an interesting little film as it stood, however the second half takes a surprisingly prescient turn in that the interviewees (or "quants," short for "quantitative thinkers," I assume) begin to discuss "high frequency trading," a term that sprang into the wider international consciousness following last Thursday's as-yet-unexplained 1,000 point drop in the Dow.  The idea of high frequency trading (or HFT) is that arrays of computers are set up to catch any variations in a stock's price that exceed or fall below certain parameters, or that follow Google search terms and will buy or sell stocks based on what's "hot" on Google at that moment.  Those parameters are set by mathematical models created by quants.

There are a host of scary implications that result from high frequency trading (not least of which is that these computers essentially set up parallel market structures that operate outside of public scrutiny) however there is a somewhat more mundane detail that the film raised that I'd like to focus on.

One of the quants notes that the NYSE is going to be (or perhaps already has by this point) setting up a warehouse in New Jersey that will house huge arrays of computers, each belonging to the various financial firms, where they will engage in further HFT.  The idea is that the computers will be closer to the NYSE than before, and therefore they will have a faster data connection to the stock market.  A further implication is that certain firms will get "privileged" connections that will afford them a tenth of a second advantage over the other firms; how those firms are chosen, be it through lottery or through financial transactions with the NYSE (read: bribes), is unclear.

There are certain industries in the world that are capital-intensive, in the sense that those industries required a large amount of resources, be it money, physical inputs, or large areas of land, to operate.  Steel is a capital-intensive industry, as is telecommunications, which requires the development of a significant amount of infrastructure to operate.  Clearly the world of finance is a capital-intensive industry, as a firm generally requires large amounts of money to operate, however "boutique firms" have always existed that were able to operate with smaller amounts of cash.  With this impending shift to a computer- and geographically-dominated business model, I wonder if finance is becoming more capital-intensive too?

Consider that if you're a small player, you're going to be forever outmaneuvered by the big firms who have prime locations for the fastest connections for their computer servers in New Jersey, plus offices full of top-quality quants figuring out the most accurate (or at least, the least wrong) algorithms that are then fed into the computer systems constantly.  How is a small firm supposed to compete against that?  This sort of situation can only lead to further consolidation of the financial sector into fewer firms controlling more of the wealth in this country.  As I discussed in my previous post, further consolidation of wealth is a very bad thing indeed.
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And now for something only slightly different...

A further interesting implication of the film was the concept put forth by a couple of the quants that economists in recent years have begun to regard themselves as "scientists;" that their models predicting financial market movements and concepts were "laws" that would be proven correct no matter the circumstances.  This, despite the fact that economics has, since its inception, been considered to be one of the social sciences, these economists who were running the world of finance believed themselves to be masters of the financial universe.

There is a small problem with the underpinnings of these economists' views of the world, however: humans are messy.  To the extent that any sort of "science" is based on looking at human behavior in the aggregate there will always be room for inputs that simply break one's perfectly-calibrated model of the world.  So to the extent that finance is based off of the actions of many individual stock traders and firms run by financiers, perhaps it, too, should be considered a social science?  At least the world of theoretical finance, such as the world in which these quants operated should be, as they're modeling human actions in the aggregate, much in the same way that economists do.  Therefore, as even the quants recognize in the film, their models may not have failed, but the ways that the models were used and manipulated by the non-quant stock traders to make money is at least one part of what contributed to the financial meltdown in 2008.  Humans are unpredictable, and while it's a valiant effort to try to model human behavior, the more I read and the more I learn, the more futile, ultimately, I think it may be.  Just a small observation...

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Finally tonight, the terrible, terrible story of what happens when the financial markets run out of subprime mortgages to invest in: they turn to "commodities."  Commodities markets trade derivatives of actual, physical goods, such as corn/maize futures, oil futures, or gold.  I don't wish to get into how the derivatives contracts work (partly because this post is already long enough and partly due to the fact that they're bloody complicated) but suffice it to say that firms betting on the futures markets can drive the prices of commodities up in a way that is completely unrelated to the underlying supply and demand fundamentals of that commodity.  Witness the continued high price of oil despite the fact that oil consumption is the lowest its been in years (see the link above for more on that).

These effects can be devastating for the poor and middle classes around the world, and sadly, the financial reform bills currently being debated in the Senate may do little to nothing to halt the devastation.

For Rounds 2 and 3 of the feature films tonight, I bring you an interview with Indian economist Jayati Ghosh, who explains to us that when finance gets its hands on the very food you seek to feed your family with, prices often will go up, to everyone's detriment.  This interview will infuriate you, and you'll want to yell at your computer screen "how can humans be so immoral as to create food bubbles and starve the poor???"  Well having seen "Quants" now, and gaining a bit of access into the mind of the modern financial mathematician, I can see, to an extent, how that might happen.  When you're dealing only in abstract numbers, looking for the most promising market to invest in, with no concept of the fact that your actions will increase the price of corn to be used for tortillas in the slums of Mexico, then it's very easy to buy into that bubble.  Does modern finance add any social value to our society?  It's really hard to tell these days, but I guarantee I'll come back to that theme.

Part 1:


Part 2:


I have been working on more complex postings having to do with the nature of the financial/political nexus that has developed and subsumed our political life in this country, and I hope to post those soon.  Furthermore, the oil spill in the Gulf of Mexico and the Greek debt crisis are all fodder for future postings, if there's time...

The Continuing Scourge of Too Big To Fail

Image by Getty Images via Daylife

I had the distinct pleasure of hearing Simon Johnson, an economist and professor of entrepreneurship at MIT's Sloan School of Business (and former Chief Economist for the International Monetary Fund) speak last night at a wonderful event produced by Zocalo Public Square, a local LA non-profit public affairs forum.  Johnson also is the author (with James Kwak) of the recently published 13 Bankers, about the financial crisis and how to stop another crisis from occurring again, and blogs at the Baseline Scenario, a blog I've been following for months and have linked to several times previously.

Johnson spoke quite emphatically about the need for fundamental financial reform, not as a partisan of any stripe (indeed, he claims to be a free-marketer more than anything else) but because the current financial system we have is not actually "capitalism" per se.  Why is that?  Well the phrase "too big to fail" (TBTF) signifies the problem at the center of our financial crisis, and within TBTF lies the potentiality for a future crisis even larger than the current one.  

First of all, what is "too big to fail"?  While we've certainly all heard the term bandied about since September 2008, I imagine there is some confusion out there.  The concept is that the financial institutions that were bailed out through the Troubled Assets Relief Program (TARP) instituted by former Treasury Secretary Hank Paulson, Federal Reserve Chair Ben Bernanke, and President Bush, among others, simply held too many assets in our economy, and were too interconnected, to be allowed to declare bankruptcy.  If the financial institutions (banks, such as Bank of America, and investment houses, such as Goldman Sachs) were allowed to fail, as Lehman Brothers was, then those failures would lead to an unprecedented breakdown of the global financial markets.  Furthermore, due to the interconnectedness of the various players in the markets, the thinking goes, the failure of one of the financial institutions could lead to the failure of others.  Why the institutions were all so interconnected is perhaps beyond the scope of what I'd like to say here today (in interests of length), but suffice it to say that AIG is one of the primary sources of the interconnectedness, and Goldman Sachs is another.

How did we get to this point where the banks were so big and interconnected that they could not fail without bringing down the global economy?  Well, I could try to explain, but I think I'll let Prof. Johnson explain, with the help of Steven Colbert:

The Colbert Report	Mon - Thurs 11:30pm / 10:30c
Simon Johnson
www.colbertnation.com
Colbert Report Full Episodes Political Humor Fox News

Prof. Johnson raises a few points that are worth elucidating in that segment; first of all, the idea that the TBTF banks have an incentive to act recklessly and to take foolish risks with their investors' money.  This concept is known in economics terms as "moral hazard," and is essentially the idea that if you have a guarantee that the risks you face have been either eliminated or severely reduced by another party, then you will be inclined to take larger risks than you would without that guarantee.  Take, for instance, driving a car without auto insurance versus driving with auto insurance; you're likely to drive far more slowly and carefully without insurance than you would with insurance, because with your insurer's guarantee that they'll pick up any financial losses you incur through poor driving, you are not "on the hook" for your mistakes in the same way you would be without insurance.

The implicit backing of the government that came with the TARP bailouts of the largest financial sector players creates a moral hazard scenario in just the same way.  If a TBTF investment firm received a government bailout, then the individual managers and employees at that firm will be liable to take risks that they would not otherwise, as whatever they do, the government will ensure that their poor decisions don't cause the firm to go bust.  So, far from reducing the incentives of financial firms to reduce their exposure to risky investments, the bailouts in fact increased the incentives of firms to take massive risks, and to leave taxpayers to foot the bill.

A second point to discuss that is a corollary to the first (and which Johnson spoke at length about last night) is that the TBTF firms, with their implicit government backing, are receiving preferential treatment in the financial markets that are creating advantages for the banks to become even larger.  Essentially, because the government will not allow the TBTF firms to fail, they receive reduced interest rates when borrowing from private lenders.  Because the lenders perceive the TBTF firms as "safer" investments than firms that don't have government backing, they are willing to reduce the interest rates they charge the TBTF firms compared to other firms.  Naturally, this situation distorts the market's functioning, and gives the TBTF firms an advantage over their competitors that allows them to gain even larger market shares.  Hence, the failure of capitalism due to government intervention in the marketplace.  Johnson estimated the interest rates of the TBTF firms were reduced by approximately .7-.9% compared to their non-TBTF competitors, which may not sound like much, but when applied to loans and trades of billions of dollars at a time, those fractions of percents add up to large sums of money.  

So what is Prof. Johnson's solution?  To break up the TBTF firms into smaller, more manageable (and less economically dangerous) firms.  Johnson and a number of other significant economists estimate that a $100 billion limit on total assets under a firm's control is an ideal target to aim for.  What does that figure mean?  Well the current combined holdings of Bank of America, JP Morgan Chase, Citigroup, and Wells Fargo are approximately $7.4 trillion, and there are 23 institutions in the US that have assets over $100 billion.  Therefore, there will have to be a lot of division of these large institutions into smaller ones (simple arithmetic reveals that the $7.4 trillion of the four megabanks noted above, if divided into $100 billion sub-banks, would create 74 new institutions) and it is in the process of "breaking up" the banks that a lot of complication will occur, as in any complex transaction.  Furthermore, these firms are all multi-national, meaning that the US acting alone will not achieve any significant regulatory reforms unless those reforms are accompanied by international agreements.  It will be difficult enough for Congress to pass any semblance of meaningful financial reform (as evidenced by the Republicans' continued obstinacy) without having to deal with cross-border issues as well.  

I think I'll stop there for now.  There is still lots more to discuss about the financial crisis, as my understanding of the causes and the (proposed) solutions has been growing and evolving rapidly in recent months, and I'm eager to share what I've gained with you, my readers.  Despite not being a "finance guy" in the least, I believe that the simple fact that our financial sector has become such an integral part of the world economy requires that I attempt to understand what happened and how to prevent a recession of similar scale from ever happening again.  Any understanding I gain I'll attempt to pass on, since it's such a complex topic, but worthy of understanding by many.

In this posting I've focused only on the TBTF firms and the threats they pose to the financial markets and the world economy.  In future postings, I'll look at the political implications of such concentrations of wealth and power, as well as how it is that the financial sector got to have such power and influence as it does today.  If you have any further questions or a need for clarifications (or if I've totally bungled some facts in this posting) please comment on this piece below, or email me at generationalnavelgazing -at- gmail dot com (trying to protect my account from spammers, you know).

Additional programming note: I plan on returning to the subject of the Tea Party movement soon in an additional posting following up on my post from two weeks ago, so stay tuned for that.

Brokering dialogue with the Tea Party

Image via Wikipedia

Last week was my spring break from UCLA, and instead of going to a tropical locale with umbrella drinks, I decided to get a jump on earning course credits and learn new skills through taking a class on public mediation.  For those of you not familiar with mediation as a form of dispute resolution, the basic concept is that two parties (referred to as "disputants" in our training course) will agree to meet with a neutral mediator, and the mediator will work to facilitate a dialogue between the disputants to foster an understanding of each other's interests between them.  The mediator will attempt to structure the dialogue so that the disputants can come to a resolution between each other that is mutually agreeable, not a resolution that is imposed by a judge  or arbitrator, as in other dispute resolution approaches.

The key aspects of the mediation strategy are in active listening, where the mediator seeks to give full attention to each disputant to hear their side of the story, and then, through active listening, to discover what each disputant's interests are.  "Interests" in a dispute can range from the purely economic, as in unpaid wages owed a worker, to the purely emotional, as when a person feels disrespected by his/her spouse.  Mediation is an attempt to deal with not only surface-level concerns, such as money issues, but the deeper feelings that may lie underneath those issues that conspire to prevent the disputants from reaching a mutually satisfactory resolution.  In mediation lies the idea that conflicts can be an opportunity for greater understanding and better relationships between individuals, not just power struggles where the winner takes all.

When I entered the class, I figured that I would simply learn some new skills for conflict resolution, skills that would be especially handy for me since I am a person who fears conflict with others.  What I discovered, however, was a new approach towards dialogue and communication, and a new framework through which to view political and policy debates.  By attempting to "hear" the other's concerns - to not judge the other immediately, but to give them an opportunity to feel heard and respected - I found that the disputants would be able to give voice to the feelings underlying their side of the dispute.  Once the two parties' emotions were acknowledged, resolution became more possible.

Since President Obama's inauguration, and especially with the raucous health care reform town hall meetings last August, I have been troubled by the rise of the Tea Party movement in American politics.  Beyond the basic inconsistencies of the Tea Partiers' main messages (if they're so concerned with government spending, where were they during the 8 years of the Bush Administration's unprecedented deficit-spending?  If they're so concerned with increasing taxes, why are they protesting when the Obama Administration just gave tax cuts to 95% of Americans (okay, maybe 92%)?  If they're worried about Big Government, why didn't we hear a peep out of them when President Bush presided over the largest expansion of government since the days of FDR?) I have puzzled over what is uniting all of these generally white, older, lower- to middle-class conservatives in such strident opposition to a government that is seeking to make their lives better.  Are they just mad that "their guy" lost the election?  It's doubtful that such resentment would still sustain such a large movement a year and a half after the election ended.  Are they all just racist?  I have to admit that I've certainly thought and expressed that belief in recent months, but again, it's hard to believe that such a large swath of the population would be motivated solely by racial issues.  No, I believe that race plays a significant role, but it's something more subtle than that.

Yesterday, a classmate forwarded me a link to a post by Steve Benen of Washington Monthly magazine that helped to clear up my thinking on the Tea Partiers and their sympathizers across the country.  Benen discusses a fascinating Dallas Morning News article profiling a family that is suffering under the strain of breast cancer, unemployment, and high out-of-pocket health care expenses; in other words, exactly the kind of family that the health insurance reform bill is intended to help.  But the family opposes the health reform bill, fearing government inefficiency and death panels, which Benen states

...makes the response all the more fascinating. Amy Townsend appears to have heard the right-wing propaganda, and seems inclined to believe it. "Every government program," she told the paper, "none of them work very well." 

The Townsend family is, however, currently getting by on unemployment benefits (a government program), and is holding onto some coverage through COBRA (another government program), which they can afford thanks to federal subsidies (through another government program). 

The point isn't to mock the Townsends or to question their judgment. The point is to appreciate the power of conservative political rhetoric in 2010. Many of those who stand to benefit from a stronger safety net have been led to believe they want a weaker one. Many of those who'll finally be able to get better care under a health care system that's been screwing them over have been convinced that they won't, or can't, benefit from reform.

There's a lot to unpack here.  I have thought a lot about an idea that many Democrats subscribe to (and that Benen represents well here), which is that the GOP convinces people through "rhetoric" or "propaganda" to vote against their own "interests," as if their interests are strictly economic in nature.  It's an essentialist argument on its face, that people can be defined solely by their economic concerns, and it gives credence to the widespread conservative critique of liberal conceit; that liberals believe they "know" another person's interests better than the people themselves do.

My contention is that the Tea Partiers are protesting mainly against the "face" of the government that is supposed to represent them, and the changing of American culture that has been going on for decades, but the evidence of which had been remarkably suppressed by the Bush Administration and its overwhelmingly white male leadership (with the notable exceptions of Condoleeza Rice and Colin Powell, of course).  Now we have not only a black President, but a female Speaker of the House, female Secretary of State, black Attorney General, Asian-American Secretary of Energy, etc.  This is not the government that many Americans are used to, and I think that, while one can call the Tea Partiers' reactions "racism" (and I certainly have!) I have come to believe, as noted above, that it's more subtle than that.  People feel that their government no longer represents them - they can no longer "see themselves" in the government, and they can't trust those "other people" to handle their tax money, help them afford health care, protect them from terrorism, etc.  As noted above, the vast majority of Tea Partiers are conservative and white, and would likely not vote Democratic anyways.  But then watching Fox News increases peoples' levels of fear and distrust by Fox speaking directly to their feelings of being unsettled with the "new order" running the government, and telling them that those feelings are widespread and that people should act on those feelings rather than hearing what the other side actually has to say.

So all this to say that I think that people also have an "interest" in feeling that their government represents them and their interests, and that speaking to their intellects, rather than their gut feelings of disorientation, will not ultimately be very productive for Democrats.  While this family in the article quoted may be going directly against their own economic interests, they are choosing instead to act on their interest in being represented by a government they "recognize," I suppose.  I'm not at all trying to justify the Tea Partiers, and I certainly do believe there is a strong racist element in the Tea Party movement, I've just been trying to imagine what it is that people react to so viscerally, and these last few paragraphs are what I've come up with thus far.

So how does one have a productive dialogue with the other side?  I'm not really sure yet, but through my basic studies of mediation I came to this point in my understanding of the Tea Party movement, and I believe that mediation represents a potentially useful tool for engaging in that dialogue.  How one engages a national dialogue is far beyond me, but I believe that initially at least it comes down to showing respect on an individual level, and an understanding that another's experience of the world is not your own.  So if you encounter a person who holds diametrically opposite views to your own, and there is not a fear of physical violence ensuing between you, I'd say take a moment to really listen to their concerns, you might be surprised what they tell you.

I plan to revisit this topic in future posts, and I'm in the process of formulating a major research project for next year that just might involve mediation...stay tuned.  In the meantime, if you're interested in learning more about the power of engaged dialogue, take a look here.

One more thing about the energy proposal...

President Obama made the announcement that I discussed in my previous post in front of an F/A-18 "Green Hornet", a combat jet that runs on a 50/50 blend of conventional jet fuel and biofuel.  The biofuel that the Hornet runs on is derived from camelina sativa, an oilseed that has been grown primarily in Montana after being brought over from Europe in the 1980s.  Camelina shows great promise as a biodiesel and biojet fuel feedstock, due to the fact that, in contrast to other biofuels such as corn ethanol and soybean biodiesel, camelina does not compete with food crops in its growth, harvesting, and production processes.  For every acre of corn grown to be used as ethanol fuel, that is an acre that is not being devoted to food production.  Multiply that scenario by the thousands of acres currently devoted to corn ethanol production and you have a scenario where the drive for energy is driving up the price of food, which I discussed in a post a bit over a year ago.

Camelina can be grown on "marginal" land, which refers essentially to non-farm-quality land, with minimum fertilizer and irrigation needs, so that the resource intensity of camelina development is far lower than resource-heavy corn production.  Thus, camelina and other second-generation biofuels show the way forward for biofuel development globally, a future where biofuel development is a sustainable enterprise that can coexist easily with food production processes.

I'm personally very excited about sustainable, domestically-produced camelina, due to the great national security risks that importing foreign energy presents to our country, and the fact that first-generation corn ethanol is simply not sustainable over the longer term from either an environmental or economic standpoint.  I produced a Powerpoint presentation and a research paper last fall about camelina that I have now posted on the right-hand column of the blog under "Recent Works," so if you have further interest in learning more about camelina and about biofuels more generally, I encourage you to take a look.