John Kenneth Galbraith's popular economic history of the first part of the 20th Century is called The Age of Uncertainty. My history of the present era -- once I get done with the other three books I keep meaning to write -- will be called The Age of Denial.

The presidential campaign we are now enduring is utterly surreal. Barack Obama, rightly, has gotten a major wacking for talking about a Social Security crisis, when there actually isn't one. But helloooooooooo Barack, Hillary, John, Chris, all you characters -- there really are crises out there, major problems that we need to acknowledge and get to work on. I don't expect the Republican candidates to be connected in any way to reality, but somebody has to be.

But they do try to predict health care costs ten years out. You may have seen a news brief about the new prediction that health care spending will be 19.5% of GDP by 2017. Health Affairs has made this open access, so go for it if you are turned on by wonkery.

Now, there are a lot of assumptions that go into any such prediction, and it's pretty obvious that unless the McCain campaign succeeds in its increasingly transparent plan to make voters believe that Barack Obama is a secret muslim extremist who has been planted by al Qaeda to turn the country over to Islamofascist infiltrators and give Tomahawk cruise missiles to Hamas,* some of those assumptions will be overturned somehow some way, and they probably won't all work out anyway. But, for what it's worth, the broad outlines of what these perpetrators of deep wonkery expect assuming that nothing major changes are as follows.

Back when I was in college -- not so long ago really -- the deep thinkers had us deep in the doo doo. Robert Heilbroner's Inquiry into the Human Prospect was required reading. Hint: He didn't think it was exactly fabulous. Some very convincing dismal futures were being painted by science fiction writers like John Brunner - The Sheep Look Up and Stand on Zanzibar made an impression on me, for sure. The Club of Rome, a group of high powered movers and shakers, foresaw catastrophic resource scarcities, the WorldWatch Institute was busy meticulously documenting the fall of civilization. There was Moment in the Sun and The Population Bomb and you name it.

The common theme was that the world was running out of resources to sustain its growing human population and the whole edifice of industrial civilization was heading for the crapper. Then two or three decades went by and the spring wasn't silent and the oceans weren't corrosive and whole nations didn't die of thirst. Our motor vehicles just got bigger and heavier and more and more of them and the so-called Green Revolution managed to feed a population that exceeded the maximum level of doom by a billion or more.

One of the few benefits of getting older is gaining perspective from the passage of time. What strikes me most about the large scale changes that have taken place in the course of my adult life are not those related to terrorism or torture or the conservative grip on the Supreme Court, but rather the shift in the economic structure of the country. We’ve all heard about the increasing disparity between rich and poor, which is a part of this shift, but it goes beyond that, as Joshua Holland details in this report:

Fewer than 1 percent of Americans are millionaires, but almost one in three believe they'll end up among that group at some point.

As I was taking up the subject of peak oil, Dr. Black weighed in with his disconcertingly blasé take on the whole thing. The lapsed economist writes:

I, too, generally get a bit puzzled about Kunstlerish views about the future of America in a world of rising oil prices. Certainly rising oil/gas prices, over time, might impact peoples' behavior in terms of what kind of car they use and how much they use it. Over a longer time horizon high prices might impact to some degree our land use and transit policies, and the relative desirability of certain locations. Obviously high oil/gas prices would cause economic pain for lower income people with a heavy reliance on automobile usage, and potentially tip the economy into a nontrivial recession.

Here is the CEO of the French oil company Total:

In an unusually stark prediction for the head of one of the world’s biggest oil companies, Christophe de Margerie, CEO of the French group, said it would be difficult to reach even 100m barrels a day.

The International Energy Agency, the rich countries’ watchdog, in its “business as usual” projections, has said oil supply will reach 116m barrels a day by 2030, up from about 85m b/d today. The US government has a similar forecast of 118m b/d in 2030, including a relatively small contribution from biofuels.

Like you, I really don't have a clue what exactly TF Hillary Clinton thinks she's been doing for the past couple of months, or why she's been doing whatever it is, but in any event, no matter what she says tonight, starting right now Barack Obama and the Democratic Party -- with the possible exception of Hillary and 182 fervent supporters who will continue to hold out in caves on some remote Pacific islands -- will start to run against John McCain for the office of prezneh unigh stay, as Sen. McCain pronounces it. That means that if we are very lucky, we just might hvae some conversations about public policy.

So here's my list of public health priorities. It's difficult to put them in order, and I might change my mind five minutes from now, but as of 1:42 pm eastern time they are:

The morning plenary was about HIV treatment in poor countries, mostly Africa. There is a lot I could tell you, but in the ten minutes I have between sessions I'll just mention this. It seems that one of the more common reasons that people in Africa don't take their meds as prescribed is because when they don't take the meds, they don't have any appetite, and if they don't have any food, they'd rather not be hungry.

If the clinics can get food from the World Food Program, the people will take their pills, gain weight, and stay healthy. Giving people food is also a good way to make sure they come in for their appointments. So here's a side effect of the rising global price and scarcity of food, which we are experiencing right now. Not only will people starve, they won't take their HIV meds, which means their viral loads will go up and they will become more contagious -- until they die, which will happen sooner, of course.

It's also a reminder that, while the various global funds are doing a a better job of getting medications to people, hunger is still a major problem in much of the world, and it's getting worse. It all goes together.

Flying is only slightly less unpleasant than being waterboarded, and I'm going to have to depart the east coast in the evening, to arrive in LA in what the people there think is the evening but is the middle of the night to me, and then find may way to a hotel 35 miles away. Should be a true test of character. Then I have to spend Monday in a meeting, presumably awake. So if I don't post tomorrow, you'll know why.

Today, I've been thinking -- inescapably -- about our corporate news media and the profound harm they do to our culture and our national interest. Lots of people in the blogosphere are on the case -- which is pretty much the only place we have to criticize them since they are incapable of insight or self-criticism, and do not allow substantial criticism from the outside to make it onto their letter pages, op-ed columns, or TV gab fests. Oh, you'll see some faux media criticism, but it's guaranteed to miss the target.

(From WGA Member Joss Whedon, originally posted on Whedonesque)

We're a week away from Mutant Enemy Picket day! Since the AMPTP have generously offered us a thimble of sputum in exchange for everything written ever, I think it's fair to say it won't be a picnic.

And in two weeks, I'll be in Boston, speechifying (look for some long, fancy words, yo) and rallying shoulder to shoulder with, among other people, my dad, who somehow lived through both the '88 strike and my adolescence. Word. (Long fancy.)

Yes, another political post. Tomorrow is the Super Tuesday to end all Super Tuesdays, so I don't feel too bad about it. For a political junkie, this has been the most fascinating 6 weeks I've ever seen. Results wildly out of line with the polls, huge lead changes, the death of "momentum" as a meaningful gauge of a candidate's chances, debates more wonkish than I've ever seen, and two candidates I'm super enthusiastic about...

And that's just on the Democratic side. With the Republicans we've got Giuliani's 50 million dollar delegate, Huckabee's shock win in Iowa and all-too-predictable collapse, Romney remembering too late that he had a far better case as a smart business guy than he ever did as the cultural warrior, and the resurgence of McCain (which I'm not enthusiastic about in a strategic sense, but which does make me feel smart for predicting that he would win the nomination way back in November when he looked DOA).

Anyways, I got an e-mail today from a friend in California leaning toward Hillary asking me to make the case for Obama. I ended up with a fairly lengthy response and figured it wouldn't hurt to post it here. Yesterday I made the emotional case. This is the strategic one:

You know better. You don't have to go to Africa to find people living with HIV who have trouble feeding themselves. Dr. Sheri Weiser reports that about half of homeless people living with HIV in San Francisco report chronic food insecurity, and that, no surprise, they are sicker and more likely to die than people who don't. That doesn't mean they are starving in quite the same way Africans do. They can come up with the calories, usually, but they either have to do it in socially unacceptable ways or they have to eat stuff they'd really rather not. Think dumpster, for example.

Now your friendly neighborhood Republican will tell you that homeless hungry people with HIV are that way because they failed to take personal responsibility, so the Christian thing to do is to let the Free Market™ sort them out. I'm telling you that they got that way because they have a serious mental illness, or are suffering from the effects of serious trauma or abuse.

In the last episode of our Hinges of History Review, I discussed the magical cloak of invisibility over the U.S. nuclear arsenal. Meanwhile, I've been nibbling at the edges of another Great Denial, known as peak oil. This is the most important geopolitical fact of our age, far more important in the context of international power struggles, war and peace, than global warming, infectious disease, water supplies, deforestation, mass extinction, human rights, you name it. Yes, you may care more about some of those other little problems, but governments, especially the ones that wield powerful militaries, do not.

Readers are begging for more about the Massachusetts health care reform legislation. Okay, not begging, but they have expressed mild interest. You can get a one page overview here, and the authority responsible for administering the law, called (weirdly) The Connector, provides links to the actual legislation and associated regulations here.

Unfortunately, in my view, this legislation has become the model for the leading Democratic national proposals. To answer Kathy A.'s question, the law provides sliding scale subsidies for low and moderate income people to purchase insurance. To answer Roger's question, it provides for fairly stiff fines for individuals who don't get insurance, although less than the cost of actually buying it.

Apologies for not posting yesterday. I wasn't feeling well (which is permitted of bloggers, you know) but more than that, I was just so knocked out by the idiotic state of political discourse in this country that words seemed inadequate. They still do but I'm typing anyway.

The Emperor of Mespotamia is about to go on TV and tell us about his new, strong and resolute plan to win the long-promised Glorious Victory. While there has been concern among the courtiers in both the Pentagon and the corporate media over such problems as the state of military readiness and whether the current policy is Making Us Safer™, they are all pleased to note that the level of violence in Iraq has been dramatically reduced. It is fortunate that when American helicopters and fighter jets fire missiles into residential neighborhoods and kill dozens of people, it is not an example of violence, otherwise that statement might be untrue. Come to think of it, it isn't necessarily true anyway, but it is virtually true by virtue of incessant repetition.

Tom Engelhardt is, but even he seems to stop one step short of the abyss.

What happens if, three months from now, or even a year from now, the people in metropolitan Atlanta - almost 5 million of them - open their faucets and nothing comes out but air? Engelhardt seems unwilling to follow through on the thought experiment, apparently because he's afraid he might be missing something, but I'm willing to be educated if what seems obvious to me really is not.

With no water in the pipes, people cannot flush toilets, bathe, do laundry, wash dishes, clean kitchens, bathrooms, hospitals -- not that there would be much point because all of those facilities would be useless. Obviously every restaurant would have to close, but so would all of the factories and offices, regardless of whether they use water in their operations, because the workers would be unable to perform the bodily functions of excretion.

Jeffrey K. Tulis

Whether Senator Obama has a well worked out domestic policy agenda and a detailed understanding of foreign policy is a lingering concern of democrats who find his inspirational rhetoric short on specific analyses, proposals, and plans. This concern has provided occasion for Senator Clinton and others to revive Walter Mondale’s famous question to Gary Hart, taken from a then popular TV commercial for a hamburger, “where’s the beef?” Obama may be tempted respond to the question by offering detailed counter-proposals to Senator Clinton’s plans for health care, immigration, the economy, campaign finance and any other issue she chooses to highlight. This would be a mistake both as tactical choice in the primaries, and in light of his impressive understanding of the place of the presidency in the constitutional order.

The frog boiling thing turns out to be a myth. As the temperature rises, the frog feels it and pretty quickly tries to escape. But apparently it's possible to slowly raise the temperature on the Murkan People and it takes them a long time to recognize that they are getting poached.

They're going to figure it out pretty soon. Jean Dixon is never accountable for her predictions but I will be. We'll check back this time next year and see how I did.

This morning we heard from Dr. Kelly Kelleher about how it's a great idea for primary care doctors to screen for alcohol and other drug abuse problems. There are, however, some difficulties.

Every disease advocacy organization in the world wants primary care doctors to be screening -- for asthma, diabetes risk, cancer, depression, domestic violence, you name it. In fact there are something like 700 questions that primary care docs are supposed to be asking their patients. However, they generally see 4 or 5 patients an hour. Since the patients are presumably there for some reason other than to be asked the first 30 or so of 700 questions, it's unlikely we're going to get very far with that.

I'm sure you don't need me to tell you that it is extremely crappy. Unfortunately, if you depend on resources such as the Washington Post, you do need me to tell you that.

For years, President Bush and his advisers expressed frustration that the White House received little credit for the nation's strong economic performance because of public discontent about the Iraq war. Today, the president is getting little credit for improved security in Iraq, as the public increasingly focuses on a struggling U.S. economy.

I notice that the NY Times has now caught on to the meme that the Obama candidacy has been accused of creating a cult of personality, a term redolent with overtones of Stalinism. (The "cult of personality" was the central theme of Nikita Krushchev's famous 1956 secret speech criticizing Stalinism.).

Okay, since the NYT decided to hire Bill Kristol over me, I'll have to restrict my punditication to this space.

You may have noticed that I've had basically squat to say about the presidential campaign. I did point out that of the three Dem contenders, Edwards has the best health care plan, and Obama has the worst, but who cares, really? It's not as if an Edwards presidency -- which seems unlikely at this point anyway -- will result in the legislation he has posted on his web site becoming reality. In the best case, a Democratic president and a somewhat more Democratic congress in 2009 will result in some marginal changes around the edges. Big Pharma and Big Insurance aren't going to get rolled no matter who is elected.

This week history was made with Obama winning the Democratic party's nomination!

I love this video of Chris Rock's views on the 2008 Election: Chris Rock's 2008 Election Analysis

Hilary's speech was very interesting. Click here

As the nation gears up to see what N.H. has in store for us, I couldn't help but try to pull some attention back to Iowa. Although I gave you a taste of what the caucus was like from my relatively juvenile point of view, I thought my parents would provide an interesting take on the caucus that often isn’t available in the blogosphere (my parents are decidedly not bloggers). Since they are semi-retired, I was able to rope them in. Their thoughts are below:

Thoughts from my dad:
"I’ve always been an independent—although most often voting Republican rather than Democrat—so spent a lot of time reading about and listening to the candidates from both parties. With growing concern about Iraq and Pakistan and many foreign/energy relations issues, I joined my wife and daughters in supporting the Democrats—making that decision in the last 1-2 weeks.

I recently attended an A-list panel on “Distributive Justice” at a philosophy conference, with papers by Harvard philosophy professors Michael Sandel and Thomas Scanlon, and University of Pennsylvania President Amy Gutmann.

There was a lot of serious philosophical analysis of the adverse consequences of today’s huge wealth disparity, sprinkled with enthusiastic bashing of mammon-obsessed CEOs and hedge fund managers, and lamentations about what this means for our country, from the corruption of politics to the growth of gated communities. President Gutmann, especially, launched a heartfelt barrage against the manifold forms of social injustice that now plague our society.

I’m down with all that. CEOs and hedge fund managers are engaged in an obscene money grab. Many bad consequences follow from the wealth disparity. No question.

I couldn’t help but think, however, that if we are going to allocate blame for social injustices then higher education should be a prime target of critical scrutiny as well.

The Randomized Controlled Trial (RCT) is the so-called gold standard for determining what is and is not evidenced based therapy. When we talk about the clinical trials submitted to the FDA in new drug applications, that's what we're talking about. When people call for Evidence Based Medicine, they mostly want doctors to use interventions that have been "proven" through RCTs.

So it was refreshing to day to hear Malcolm Gordon, who is an official of the Center for Mental Health Services, tell us about many of the reasons why RCTs don't necessarily tell us what does and does not work when it comes to mental health services. For example, they are very expensive to do, so they seldom go on long enough or have large enough sample sizes to support adequate subgroup analysis. An intervention that works for some people might not work for others, but we just don't get the information we need from RCTs to understand that. Attrition is a big problem in trials, particularly of mental health treatments, and it can seriously mess up the statistics. A truly major problem is that interventions are developed, implemented and tested in highly specialized settings and circumstances that just don't correspond to anything that is likely to happen in the real world of the mental health system.

One would think from the recent excitement over the possibility of a bipartisan political movement that Hillary Clinton was running on a platform calling for confiscation of corporate property, reestablishment of the moderately progressive tax structure of the 1970s, the return of all American troops from abroad, the abolition of capital punishment, and (heaven forbid), gay marriage. With the exception of a stray remark by John Edwards, Democrats polling more than 10% continue to run to the right of Richard Nixon. Indeed, judging by their legislative activity this year, the Democrats as a whole have almost no ambition to push any program that is substantially to the left of center. The real issue ought to be why some journalists are so excited about the possibility of a third party that might take a middle position between the party clearly to right of the electorate and the party that on its best day sometimes lurches very slightly to the left.

Paul Finkelman

A year ago everyone assumed that by the early winter of 2008 Hillary Clinton would have locked up the Democratic nomination for president. She had money, name recognition, and a seemingly well-oiled machine. Now she is on the ropes, fighting to stay in the race. What happened?

Senator Clinton lacked one ingredient in the mix to make her a winner: the ability to project a sense of hope and optimism. I write this before the Ohio, Texas, and Pennsylvania primaries, so she may be able to turn this around. But, even if she wins the nomination, Senator Clinton needs to learn how to project a sense of hope and of a greater future for America if she is to win the general election. With the possible exception of Richard Nixon in 1968, every successful presidential aspirant since 1932 has been the more optimistic, hopeful candidate. Hope and a sense of a better future have been the key to electoral success. Senator Clinton should remember that in the depths of the Depression, with one third of Americans (more or less) out of work and hungry, Franklin D. Roosevelt campaign to the song “Happy Days Are Here Again.” It was little misleading – or at least a poor prediction. But it worked well.

Many things we might want in a president have not always been found in the winner.