Wednesday, December 9, 2009

Things I Was Against Before I Was For

Is it time to geoengineer the Earth?
"I actually did vote for the $87 billion before I voted against it."
I keep this John Kerry quote handy to remind myself how convoluted our explanations can become when trying to explain our flip-flops. It's timely because I might be in the process of making some major flip-flops myself and I don't want my own thinking to become convoluted. After the jump, four things I was against that I now just might be for.

Things I was against before I was for:

  • Nuclear power: Nuclear waste from our own age is a problem that will still exist long after we're all dead, to be passed down to our descendents for thousands of years. Because I've generally believed in the Boy Scout notion that one ought to leave a campsite better than one found it, I've long thought that it's better if we don't generate toxic waste in the first place. Except that our chosen alternative, burning fossil fuels, is spoiling the planet in a way that is going to have its own long term negative consequences. We might not be leaving behind a cavern full of rusting barrels of radioactive sludge in a corner of Nevada, but instead we're leaving behind a planetwide atmosphere full of smog and greenhouse gases. Maybe sacrificing that cave in Nevada is the lesser of two evils after all. Sorry, future Nevadans for this flip flop.

  • Geoengineering: I've long thought it folly to believe that we have enough knowledge and wisdom to positively affect climate change by tampering with the atmosphere. The law of unintended consequences suggests we'll end up messing things up even worse than we started with. But, given the political power of the vested interests to keep our carbon economy rolling towards disaster; given the ability of conspiracy theorists to sow fear, uncertainty and doubt about the science; and given our innate human nature to resist change of any kind, I'm coming around to believe that any attempt to reverse global warming by reducing our greenhouse gas emissions will be a case of too little, too late. Our only recourse is to attempt geoengineering, however perilous that course is. It's not like geoengineering can't be done. We've been geoengineering inadvertently for decades now, only in a negative direction. It's time to try doing it in a positive direction. Who knows, if we're successful, we won't need that cave in Nevada after all.

    Read Superfreakonomics for the case for geoengineering in easily understood layman's language.

  • Tort reform: Capping the size of monetary malpractice awards is supposed to prevent the need for doctors to pay exorbitant insurance premiums to protect themselves from greedy lawyers and their even more exorbitant malpractice lawsuits. In this battle between the doctors and the lawyers, if the tort reformers win, it's the little guy, the victim of real malpractice, who ends up the biggest loser. Because I generally tend to pull for the little guy, I've opposed tort reform. Except that we've reached the point where patients' last two months of life are costing Medicare $50 billion a year, with much of the care having no meaningful impact and much of it even against the patients' own expressed will to die with dignity. Why does this happen? Some of it can be explained by the practice of defensive medicine. Expensive, invasive, uncomfortable, unwanted, defensive medicine. Maybe, just maybe, one unintended consequence of tort reform may be that doctors will be more willing to listen to patients who ask to die with dignity without fearing the family will change its mind later and sue the doctor and hospital because they didn't go to extraordinary lengths to keep that dying heart beating in the ICU for a few days longer.

    Or maybe not. Unless the business model for health care changes from paying health care providers for how much treatment they provide to a model paying for how well the treatment works, our country will continue to spend $50 billion a year on too often ineffective medical care. I realize tort reform does nothing directly to change the payment model. That's why my flip-flop on this issue is far from certain. The logic needed to get me to flip flop is still too convoluted to be convincing. But stay tuned. I'm open to new ways of thinking about this.

    Watch 60 Minutes for the case of reforming end-of-life care.

    And one last thing I was against before I was for...

  • Creationism: Just kidding. I might be open to flip-flopping on public policy issues, but abandon basic science for mythology? No way. That's just nuts.

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