Wonk Stuff

I’ve got a couple of small pieces in the current issues of California and San Francisco magazines. One is on climate change, the other on health care. Wonky? Sure. But contentiously wonky.

The first, a short profile (.pdf) of former SF environment department director Jared Blumenfeld (who decamped to the EPA last month), is about climate change policy:

While most leaders who confront the climate crisis choose to accentuate the positive aspects of global warming–the “win-win” business opportunities, all the new green jobs and game-changing technologies on the horizon–Blumenfeld spikes the cheerleading with straight talk. He called carbon offsets a “con” when many environmentalists were hyping them as an environmental cure-all, and he is equally dismissive of the magical thinking at the heart of many green-jobs programs. And despite the strides we’ve made in greening our lives, he says, there’s almost no way we’ll be able to change course before the cataclysm hits.

(I went biking with Blumenfeld last year, too. That piece is here.)

The second is a review of Thomas Goetz’ new book, The Decision Tree, which posits a brighter future for our health care–not through legislative reform but through technology. Color me unconvinced.

Given the circuslike debate on Capitol Hill, you might have abandoned all hope of seeing our dysfunctional healthcare system improved. Thomas Goetz hasn’t. The executive editor of Wired (he also has a master’s in public health from UC Berke­ley) posits a hopeful future, one that combines “the lessons of technology and the rigor of public health” to person­alize and improve our health­care: Online tracking software and social networking will help us take advantage of an ever expanding stream of health data, DNA testing will offer snapshots of our genetic pre­dis­positions, and doctors will be able to detect disease before it strikes–or at least manage it better once it does. Goetz lays out the benefits of this more engaged approach in clear, commonsensical prose. But many of his fixes depend on Herculean efforts by tech-savvy patients, and it’s hard to see how they translate to the unwired bulk of our citizenry. Moreover, he barely mentions the pernicious “fee for service” model that rewards doctors not for fostering good health but for ordering expensive tests and procedures–a widespread practice that stands in the way of many of his preventive-care prescriptions. “Change is hard,” Goetz notes. That’s an understatement. While laudable, the sol­­utions he offers here feel less like revolutions than like workarounds.