The Devil's in the Details

On election day, a little boy approached my wife in the park and informed her that he had voted for Governor Romney to be president because he had learned that President Obama wanted all the boys to marry boys and the girls to marry girls. He regretted his vote however, having subsequently learned that Governor Romney wants us all to be slaves and pick cotton 24 hours a day and never sleep ever.

Truly, it was a contentious election. Not quite the photo finish everyone was predicting though, huh?

Well, not quite everyone. Nate Silver of fivethirtyeight had pegged the president's chances of winning at nearly 91% on election day, taking 313 electoral votes. That was up from 86% just a day before. He wasn't the only one to predict a big lead, but he's the lightning rod right now.

Turns out he was right again. As of this writing, the president has 303 electoral votes in the bag, and there's still counting to be done, but it's all over but the shoutin'.

The fawning and frothing surrounding Silver is worthy of more than an eyeroll, but then there's isnatesilverawitch.com, the best belly laugh I had of the entire campaign.

As of this writing, he is up to "probably" from "maybe" last night, but it's the struck-out first paragraph on that site that bears being tattooed on the forehead of every fifth American:

His unusually accurate predictions are, thus far, explained by his use of validated statistical methods. His disregard of momentum, gut feelings, and the interpretations of people paid to promote certain viewpoints is not the result of supernatural assistance.

Oversimplified? Sure. His models and methods are a matter of debate, and he has in fact been wrong, as he'll tell you himself. But — and I'm talking to you, right now, America — read that paragraph again. And again. And again. Because the rest of us need to get on board with that idea.

It's time to give up our proud tradition of ignorance. Please, in the name of Christ, I beseech you.

Much is being made right now about how Republican electoral strategies are going to change. Nixon's Southern strategy, which built decades of success on the backs of racists, misogynists, and homophobes has been declared dead. America appears to be admitting that it's not entirely white, straight, male, and evangelical.

And, you know, thank God for that, because it's long past time, but that victory is just a touch tarnished for me. It's tarnished by the certainty that educated voters across the nation will still tune in to the bespectacled pro-wrestling shartstorm that is cable news for the post-mortem. They will care what Joe Scarborough thinks. They will listen to men who base their predictions on nothing more than what they think sounds right, and they will call these men "analysts".

Pundits will continue to sell books. Politicians will continue to disparage scientific research and strangle its funding. They will continue to cut funds for education as well, a quite literal investment in our country's future, every time there's a budget problem. They will appoint people who call their grandkids for tech support to craft laws affecting the Internet. They will use terms like "Ivy League" and "intellectual" as insults. They will value their guts over their brains.

Meanwhile, Nate Silver studies the numbers and ignores the know-nothings and continues to shame them with his record of success. The know-nothings respond with claims of "bias", which is crybaby for "he said a thing I didn't like" or "she asked a hard question".

Charlie Pierce offers greetings from Idiot America. Seven years ago, by the way, and he's no less right today. Here's a chunk:

The rise of Idiot America is essentially a war on expertise. It's not so much antimodernism or the distrust of intellectual elites that Richard Hofstadter deftly teased out of the national DNA forty years ago. Both of those things are part of it. However, the rise of Idiot America today represents — for profit mainly, but also, and more cynically, for political advantage and in the pursuit of power — the breakdown of a consensus that the pursuit of knowledge is a good. It also represents the ascendancy of the notion that the people whom we should trust the least are the people who best know what they're talking about. In the new media age, everybody is a historian, or a preacher, or a scientist, or a sage. And if everyone is an expert, then nobody is, and the worst thing you can be in a society where everybody is an expert is, well, an actual expert.

I said above that education is a literal investment in our country's future, but of course it's not the only one. So is research. Research leads to discovery leads to advances leads to New Useful Things leads to...wait for it...new markets (and also helping people, but let's ignore that). That's how you continue to lead. That's how you embrace the future.

Considerable investments in CERN, for instance, have resulted in new technologies with a big return on investment. Why didn't that happen here, the alleged world leader? Why do we wait for China to invite us to join in an effort to ensure that our west coast isn't obliterated by an asteroid strike? Indeed, how is it a vice presidential candidate can call for more research of congenital diseases like Down's Syndrome and in the same speech disparage that research, with zippo effect on her credibility with her base?

At bottom, it's because we (including, ironically, those who claim to hew to an absolutist view of truth) have embraced consensus as fact and ignorance as plain sense. It's because we want reinforcement, not knowledge. Easy answers and clear enemies, not nuance or understanding. We want to participate in the drama.

We stopped dreaming, and we stopped exploring, and we started sneering at those who didn't stop. We replaced our thinkers with talkers and our rigor with rhetoric. If we don't turn that around soon, say hello to our decline.

Plato hated the concept of democracy. He said it was a terrible idea because you're putting people who don't value learning and wisdom in charge of choosing the wise ones who will lead. That, he said, will ultimately lead to a populace governed by lies and manipulation and engaged in a diarrhea sandwich of public discourse (I'm paraphrasing here) that caters to the lowest common denominator. Sound familiar?

Though I have my problems with the man, I'm glad we re-elected President Obama. If you care why, and I don't expect that you do, this essay by John Scalzi approximates my own view closely enough. But to me, who gets elected matters far less than how (and why) they are elected, just as what you think is far less important than how you think.

Yes, I'm grateful for last night's results. I'm happy for the 32 million people who get to see a doctor and the tens of millions of LGBT citizens being recognized as Americans. I'm certainly happy that I don't have to pick cotton and never sleep. But there is a worm at the heart of the tower, a deeply-rooted cultural rot, and until we address it, until we as a country venture out of the cuddly Slanket of willful ignorance, we prove the ancients right and make our neighbors nervous.

If nothing else, it'll prevent this from ever happening.

Stuff We Don't Suck At: Healthcare Edition

So the Affordable Care Act got upheld by the Supreme Court. I don't know what your opinion of that was. Mine, if you care, was some relief that we are at long last on our way (if still not quite there) to no longer being the only industrialized nation on the planet that denies some of its citizens access to care.

I am also stunned that it happened. As I bet you are too. Roberts?

My job involves supporting people who work in the healthcare field, people who are working hard to improve the quality of delivery and create healthier populations, which in turn keeps costs down.

Right now, by the way, is the part where I have to tell you that I'm speaking for myself and not my employer. This is an annoying thing (again, my opinion only!) that's partly PR and partly on the order of those DVD warnings in which the movie studios beg you not to sue them over the commentary tracks, because movie studios and I and my bosses live in an absurdly litigious country.

Point being, if I were to point out my belief that even Dick Cheney looks upon Antonin Scalia from his throne of deformed baby skulls and thinks there walks a man who might eat a kitten just to taste the mew, that's not reflective of anyone's opinion but mine. Also, I'm blogging pseudonymously. I'M A PHANTOM OOOOOOOOOOOOOOOOOOOOOO.

Now let's move on.

Anyway, I bring up my employment because part of what we do involves evangelizing about fancy terms like patient-centered medical home and the chronic care model and meaningful use of electronic health record systems. These are important words. These are words that just might help fix some of the problem.

And so, in the context of that mission, and in the wake of this history-changing decision, I'd like to share a video I watched recently that you might like. It's about an hour long but, regardless of your political leanings, it will almost certainly show you a few things you didn't know about healthcare systems that (mostly) work. I am on my way to becoming an expert in this field, and it showed me things I thought were about as likely to exist as sexy mer-lady underboobs. So, without further ado:

The Good News in American Medicine