Today, Matt Yglesias informs me that "The president has successfully reignited the conversation over whether in the digital age everyone should learn to code." Seriously? The president thinks everyone should know how to program a computer?

But wait. The link leads me to a fairly routine presidential video in honor of Computer Science Education Week, in which President Obama encourages kids to take computer science classes. "It's important for our country's future," he says. But I imagine he's cut dozen of videos for every other conceivable skill that could be taught in our nation's schools. "Nursing is important for our country's future." "Agriculture is important for our country's future." Etc.

So did this really lead to a conversation about whether everyone should know how to write code? How tiresome.1 I can probably list on one hand the number of significant skills that everyone should know. The rest are optional. Some of us know how to fix cars and some just hire mechanics to do it for us. Some of us know the law and some just hire lawyers to help us out. Some of us know how to drive trucks and some choose other careers.

In any case, I don't think computer programming would even make my top 20 of broadly useful skills.2 It's a great thing to learn if you plan a STEM career or if you just feel like learning it. But useful? For the vast, vast majority of us it's of no use whatsoever. Reading and writing are useful in nearly all careers, and are useful personally even if your job doesn't require them. But coding? Unless it's part of your job, the odds are vanishingly small that it will ever be of much use to you. Nor is it something that's useful in its own right because it promotes clear thinking. Nor is it a steppingstone to other, more broadly useful skills.

Coding is a specific skill needed for certain specific jobs. That's it. There's no need to put it on a higher pedestal.

1Tiresome because this comes up so often. Why do so many people insist that whatever skill they happen to know is one that everyone should know? There are lots of skills in the world. All of us know only a tiny fraction of them, and that's the way it should be.

2As a time-wasting skill, however, computer programming is hard to beat. I can no longer count the number of hours I've spent coding (or scripting) little utilities that did me no real good at all. But it was fun!

A couple of days ago I read a weird story about allegations against David Wildstein, an official at the Port Authority of New York and New Jersey who's an old friend and close ally of New Jersey governor Chris Christie. According to this story, Wildstein closed two of the three lanes on the New Jersey end of the bridge last September, causing traffic tie-ups in Fort Lee. This was supposedly done in retaliation against Fort Lee's mayor, who had declined to endorse Christie for reelection.

The whole thing seemed a little too outré to be true, and Wildstein claimed the closings were part of a "traffic study." I figured that was the end of it. Wildstein would eventually produce some Port Authority engineers who would explain what the study was all about, and that would be that.

Except no. On Friday Wildstein announced that he would resign his position at the end of the year. And that traffic study? It turns out that folks in New Jersey have been asking for evidence of its existence for weeks and gotten nothing. Via Steve Benen, here's the Star-Ledger editorial board:

Why have the agency’s own traffic engineers said they knew nothing of the phantom “study”?

New Jersey lawmakers have asked questions — and gotten nothing but excuses and tap-dancing in return. So now it’s time to pull out the big guns and subpoena Port Authority honchos to testify, under threat of perjury, about the shutdown, the study and their connection to Gov. Chris Christie’s re-election.

....How do you study traffic and block lanes without notifying police, ambulance drivers or even your own bridge employees? The official “traffic study” excuse strains believability. Assemblyman John Wisniewski (D-Middlesex), who chairs the transportation committee, ordered Foye subpoenaed. More subpoenas should follow. At a minimum, Baroni and David Wildstein, the underling who ordered the Fort Lee blockade, should be ordered to Trenton, too — and told to bring documents proving the study exists.

Today, the general manager of the Port Authority testified that "he'd never been ordered to conduct unannounced lane closures in his 35-year career." And there's still no documentation for this study.

This is just strange as hell. I think it's vanishingly unlikely that Christie himself had anything to do with this, so maybe it all just gets chalked up to the rough-and-tumble of Jersey politics. If so, it's certainly one of the strangest and stupidest acts of petty political retaliation in recent memory.

The Wall Street Journal reports today that big traders—mutual funds, pension funds, sovereign wealth funds, etc.—are increasingly avoiding public markets to execute their stock trades:

Investors say such measures are increasingly necessary because the proliferation of algorithmic trading and other structural issues, including the fragmentation of the market, are hurting their ability to get the best prices and execute large trades quickly.

A trade has the possibility of wending its way through 13 exchanges and more than 40 "dark pools," off-exchange trading venues that don't publicly display stock trades. A trade could also be executed inside a large broker-dealer that matches buyers and sellers from its own holdings.

....Institutional investors long have complained that market complexity can make trading more difficult and that high-frequency traders were driving up prices by jumping microseconds ahead of big orders. But big investors say the cat-and-mouse games are growing more elaborate—and counterproductive—by the day.

Roughly speaking, there are two concerns here. The first is that high-frequency trading is distorting the market. The second is that large trades done in dark pools get leaked before the trades are finished, allowing other traders to sneak in and game the price. This is happening during an era in which stock markets are shrinking—there are now fewer publicly traded companies on American exchanges than at any time since 1990—which probably exacerbates the problem.

Somehow I have a feeling that Felix Salmon is going to come along and tell me why this is a smaller issue than I think it is, but I'm getting less and less open to such arguments over time. Big, transparent equity markets are public goods that build trust in the financial system, and the more transparent they are the better. Opacity mostly just contributes to growing financial rents among the very rich, and there's simply no reason to think that this is a positive development.

There's no turning back technology, so maybe this is one of those things that we just have to deal with somehow. But if we don't deal with it, it won't stop here. There are too many smart people and too much improving technology for that. Better to do it now than later.

Under Obamacare, if your income is less than 100 percent of the poverty line, you don't qualify to buy subsidized insurance on the exchanges. However, if you miss the subsidy threshold you might still qualify for Medicaid depending on your state's eligibility rules. Unless, that is, your state has refused to participate in Obamacare's Medicaid expansion. In that case you might not qualify for anything.

Dylan Scott has a piece at TPM about health care navigators who have to break this news to people. Here's the saddest passage:

In some cases, those being left out seem to understand, having been left out of the health insurance complex for a while, said Cynthia Rahming, who is heading the Houston, Texas, navigator program. She did agree, though, that her team is "often" coming across people who are part of the Medicaid gap in that state.

"They were excited. They were trying to see what's available to them," she said. "But they're still okay. They know it's just a chance."

These are poor people. They mostly represent families making less than $20,000 per year. And yet in many cases, they greet the news that they're completely excluded from access to health care with weary acceptance. They probably never really believed that anything good might come their way in the first place. In the meantime, multi-millionaires can virtually bring the government of the United States to a screeching halt over the prospect of a 2 percent increase in the marginal rate they pay in income taxes.

The refusal of Republican states to accept Obamacare's Medicaid expansion surely ranks as one of the most sordid acts in recent American history. The cost to the states is tiny, and the help it would bring to the poor is immense. It's paid for by taxes that residents of these states are going to pay regardless of whether they receive any of the benefits. And yet, merely because it has Obama's name attached to it, they've decided that immiserating millions of poor people is worth it. It's hard to imagine a decision more depraved.

Conservatives hate it when you accuse them of simply not caring about the poor. Sometimes they have a point. This is not one of those times.

UPDATE: Apologies. I originally wrote that this was a problem for people between 100 percent and 138 percent of the poverty line. It's not. Those people qualify for exchange subsidies. It's people above the Medicaid eligibility line (which varies from state to state) but below the poverty line who are getting screwed. If your state sets the eligibility line at, say, 80 percent of the poverty level, then residents between 80 percent and 100 percent of the poverty level are too rich to qualify for Medicaid and too poor to qualify for exchange subsidies. In states that have accepted the Medicaid expansion, everyone under 100 percent of the poverty level qualifies for Medicaid.

I've corrected the text.

Silicon Valley Takes On the NSA

The titans of Silicon Valley have finally banded together to tell Washington they're tired of the NSA ruining public trust in the internet by hoovering up every gigabit of data ever created. It's all very polite, and naturally they've made their views public via a website that promotes the following five principles:

  1. Governments should codify sensible limitations on their ability to compel service providers to disclose user data that balance their need for the data in limited circumstances, users’ reasonable privacy interests, and the impact on trust in the Internet. In addition, governments should limit surveillance to specific, known users for lawful purposes, and should not undertake bulk data collection of Internet communications.
  2. Intelligence agencies seeking to collect or compel the production of information should do so under a clear legal framework in which executive powers are subject to strong checks and balances. Reviewing courts should be independent and include an adversarial process, and governments should allow important rulings of law to be made public in a timely manner so that the courts are accountable to an informed citizenry.
  3. Transparency is essential to a debate over governments’ surveillance powers and the scope of programs that are administered under those powers. Governments should allow companies to publish the number and nature of government demands for user information. In addition, governments should also promptly disclose this data publicly.
  4. The ability of data to flow or be accessed across borders is essential to a robust 21st century global economy. Governments should permit the transfer of data and should not inhibit access by companies or individuals to lawfully available information that is stored outside of the country. Governments should not require service providers to locate infrastructure within a country’s borders or operate locally.
  5. In order to avoid conflicting laws, there should be a robust, principled, and transparent framework to govern lawful requests for data across jurisdictions, such as improved mutual legal assistance treaty — or “MLAT” — processes. Where the laws of one jurisdiction conflict with the laws of another, it is incumbent upon governments to work together to resolve the conflict.

This is a good start. Next up: whether these guys are really serious, or whether they're going to call it a day after creating a website and not really try very hard to harness public opinion to fight for these principles. Stay tuned.

Here is Lori Montgomery in the Washington Post on the congressional budget negotiations currently in progress:

The deal expected to be sealed this week on Capitol Hill would not significantly reduce the debt, now $17.3 trillion and rising....Republicans and Democrats are abandoning their debt-reduction goals, laying down arms and, for the moment, trying to avoid another economy-damaging standoff.

The campaign to control the debt is ending “with a whimper, not a bang,” said Robert Bixby, executive director of the bipartisan Concord Coalition, which advocates debt reduction. “That this can be declared a victory is an indicator of how low the process has sunk. They haven’t really done anything except avoid another crisis.”

There's nothing wrong with talking about the federal deficit in a story about the budget. But this entire story is framed around a sense of dismay that Congress has "abandoned" its debt-reduction goals. This is done with no mention of the fact that Congress has already slashed the 10-year deficit by nearly $4 trillion over the past couple of years. No mention that we've been engaged in this frenzy of deficit cutting despite the fact that the economy is still fragile, which means that reducing the deficit is almost certainly a terrible idea. No mention that deficit cutting of any size in the wake of recession is unprecedented in recent history. No mention of the fact that the deficit has been falling for years and will continue to decline in 2014 and 2015.

Wait. That's not true. There is a mention that the deficit will continue to fall over the next two years. It gets one sentence at the very tail end of the story:

Where would that leave the nation’s financial outlook? Not in a particularly good place, budget analysts say. The most recent Congressional Budget Office projections show the red ink receding over the next two years. But annual deficits would start growing again in 2016 as the baby-boom generation moves inexorably into retirement. And the debt would again soar.

This is crazy. A story that's supposed to be evenhanded shouldn't simply assume as its premise that any budget that fails to slash the deficit is a failure. That's what Robert Samuelson and Jennifer Rubin are for. If it's on the news pages, it should tell the whole story: plenty of people think that deficit cutting has already gone too far. But no reader of this piece would have any idea that this side of the story even existed.

When President Obama said that if you like your health insurance, you can keep it, he was clearly taking some liberties with the strict truth.1 But as Ezra Klein points out this weekend, the reason he pressed this point so hard is that Americans have an understandable fear of losing their health insurance. And why not? You can lose it if you lose your job. Or if you lose access to Medicaid. Or if your insurance company decides to effectively eliminate your plan by jacking up its price. And that's not even counting the millions of people who don't have health coverage in the first place.

So, yes, it's true that Obama was wrong when he guaranteed that every single person could keep their current plan if they wanted to:

What Obamacare comes pretty close to guaranteeing, though, is that everyone who needs health insurance, or who wants health insurance, can get it.

It guarantees that if you lose the plan you liked — perhaps because you were fired from your job, or because you left your job to start a new business, or because your income made you ineligible for Medicaid — you'll have a choice of new plans you can purchase, you'll know that no insurer can turn you away, and you'll be able to get financial help if you need it. In states that accept the Medicaid expansion, it guarantees that anyone who makes less than 133 percent of poverty can get fully subsidized insurance.

Health insurance isn't such a fraught topic in countries such as Canada and France because people don't live in constant fear of losing their ability to get routine medical care. A decade from now, that will be true in the U.S., too. But it's not true yet, and paradoxically, that's one reason health reform is so difficult. The status quo has left people rightly fearful, and when people are afraid, change is even scarier.

Yep. I want to add one more point to this that doesn't get as much attention as it deserves: Hospitals routinely charge uninsured patients rates that are 3-4x higher than those paid by insured patients. A heart attack that gets billed—profitably!—to Blue Cross at $50,000, can end up costing you $200,000 if you're unlucky enough to suffer that heart attack while you're uninsured. Think about that: for decades, the health care industry has deliberately taken ruthless advantage of the very people who are the weakest and most vulnerable—those who are poor or unemployed—and seems to think that this is a perfectly decent and moral way to conduct business.

It's not. It's shameless and obscene. It's like kicking a beggar and stealing his coat just because you know the cops will never do anything about it.

This is something that Obamacare goes a long way toward fixing. If you're covered by private insurance through an exchange, you're not just protected against catastrophic illness. You're also protected against being charged outrageous rates for non-catastrophic problems—broken legs, asthma attacks, etc.—just because hospitals have the brute power to do so.

Because of Obamacare, you no longer have to fear being shut out of the insurance market. But that's not all. You no longer have to fear being gouged and possibly bankrupted because you've been shut out of the insurance market. Access to reasonable rates2 is one of the key benefits that Obamacare delivers to millions, and it deserves more attention.

1Though, let's be honest, not that big a liberty. The vast, vast majority of people will see little or no change in their coverage thanks to Obamacare, and of the ones who will, most will be able to buy similar or better coverage at a lower price. The problem of rate shock isn't an invented one, but it is a much exaggerated one.

2Reasonable by American standards, anyway.

The Washington Post has a long piece today titled "An effective eye drug is available for $50. But many doctors choose a $2,000 alternative." It's the story of Avastin vs. Lucentis, and it's been making the rounds for years. Oddly, despite the length of the story, the writers never clearly explain precisely what's going on.

You may recall the name Avastin because it's been the subject of numerous unflattering news stories. It was introduced in 2004 as a cancer treatment, but it turns out to be mega-expensive even though it usually provides only a few months of extra life. For an average-size person, a single injection runs about 500 mg or so, and injections are required every two weeks. Genentech sells Avastin in vials of 100 and 400 mg priced at around $6 per mg, so a single dose costs around $3,000 and a full treatment can end up costing anywhere from $30,000 to $50,000 or more.

It turns out, however, that the Avastin molecule seemed like it might also be promising for treating Wet Age-Related Macular Degeneration (AMD), which can cause blindness in older patients. So Genentech created a modfied version of the drug and started testing it. While that was going on, however, a few opthalmologists got impatient and decided to just give Avastin a try. AMD treatment requires only slightly more than 1 mg of Avastin, so they'd buy a 100 mg vial and then have it reformulated into smaller doses. It seemed to work great, but the evidence of a few one-off treatments wasn't as convincing as a full round of FDA clinical testing. So when Genentech brought its modified drug to market under the name Lucentis, it quickly became the treatment of choice for AMD. And even though the required dosage was even smaller than the equivalent Avastin dose, Genentech priced it at about $2,000.

Genentech, for obvious reasons, was very aggressively not interested in testing Avastin for AMD. But others were, and over the next few years several clinical trials were run. The results were pretty clear: Avastin worked great. Genentech claimed that the clinical trials showed that it was less safe than Lucentis, but virtually nobody bought that. In some of the smaller trials, Avastin showed a slightly higher incidence of adverse effects, but they were things that seemed completely unrelated to the drugs themselves. It was most likely just a statistical artifact. The opinion of the medical community is almost unanimous that Avastin works just as well as Lucentis.

Last year, Medicare's inspector general released a report on this subject and concluded that the average physician cost for Lucentis ran to about $1,928 vs. $26 per dose of Avastin (including drug and compounding costs). Needless to say, since Medicare is prohibited from negotiating prices or turning down treatments, there was nothing much they could do about this. If Genentech wanted to sell Lucentis for $2,000, it could do it. If doctors wanted to prescribe it, they could. And even though Avastin worked just as well, Medicare couldn't insist that it be used instead.

You can draw your own conclusions from all this. In one sense, you can sympathize with Genentech: they spent a bunch of money on clinical trials for Lucentis, and they want to see a return on that investment. The fact that AMD requires only a tiny dose doesn't do anything to lower their research and testing costs. On the other hand, they could have done those trials a whole lot more cheaply using Avastin, but chose not to since that would make it clear that Avastin worked just fine—and Avastin, unfortunately, was already on the market at a price that was very low in the small doses needed for AMD. Likewise, doctors could have rebelled and refused to prescribe Lucentis, which would have benefited their patients since Medicare beneficiaries pay 20 percent of the cost of pharmaceuticals. But why would they? Lucentis is more convenient; doctors don't bear any of the higher cost themselves; and, in fact, since Medicare reimburses them at cost plus 6 percent, prescribing Lucentis earns them about $100 more per dose than prescribing Avastin.

Quite the pretty picture, isn't it? And here's the most ironic part: Avastin continues to be widely used for cancer treatment, where it's extraordinarily costly and of only modest benefit, but is less widely used for AMD, where it's quite cheap and works well. This is lovely for Genentech, but not so much for the rest of us. Isn't American health care great?

UPDATE: In the last paragraph, I said that Avastin "isn't" used for AMD. That's not right. In fact, it's used more often than Lucentis. But as the Post documents, even with a smaller market share, Lucentis accounts for 73 percent of the cost of treating AMD nationwide. I've corrected the text.

It looks like we have a new winner in creepy, non-self-aware surveillance logos. The previous all-time great, on the left, is the 2002 classic from London Transport, "Secure Beneath the Watchful Eyes." The new champion, on the right, is the 2013 mission patch for satellite launch NROL-39 from the National Reconnaissance Office, "Nothing Is Beyond Our Reach." The short-lived logo for Total Information Awareness has now been relegated to third place.

Do you feel safer now?

Friday Cat Blogging - 6 December 2013

Today we have a statesmanlike pose of Domino on the stairs. Why? Because that's where she was when I hauled out my camera, and that's where she stayed when I started clicking away. This dynamic explains about 90 percent of catblogging. Actually, it might explain about 90 percent of life.