Tag Archives: health care

Why America’s health care is so bad

Images Money, Creative Commons

TOM REGAN: SUMMONING ORENDA
May 5, 2017

First, a personal observation. I lived under the Canadian healthcare system for my first 38 years, and in the American healthcare system for the past 22. Based on extensive experience in both, I say that, hands down, Canada’s system provides care every bit as good as in America, has far fewer hassles, and just plain works better.

Oh, I know, I remember the complaints I used to make when I lived in Canada. Sometimes you had to wait longer than you wanted for an appointment. Elective surgery might take a few months to get. In my experience, a lot of that depended upon where you lived. When I lived in rural Nova Scotia, near a hospital, I never had any waiting time. When I lived in the Halifax and Dartmouth urban area, there were occasional delays, but never anything outrageous. My mother said once, when I asked if she minded waiting two months for a procedure she needed, “Having to wait a while is better than not having it at all.”

Under the health care bill passed this week by the Republican Party in the House of Representatives – a bill which they did not read, did not have the Congressional Budget Office score, and obviously did not consider in light of the future consequences for their own political careers –  many people will “not have it at all.”

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But rather than go through this piece of legislation, that is a dead letter already, I want to talk about why the American system is so bad.

America is the only advanced nation in the world without a universal healthcare system. There are two reasons for this: 1) the companies that provide healthcare, and make billions and billions doing so, spend lots of money every year making sure politicians don’t mess with their golden goose; 2) the American notion of individuality.

Many Americans would tell you they see no reason why they should be responsible for the care of anybody else but themselves and their own families. They say they’d rather have the freedom to die than to have the government provide them with healthcare and live longer.

This is no joke. Conservative and far-right Americans have somehow convinced themselves that a single-payer system is “evil.” And the politicians who rake in the money from the healthcare companies that want to maintain this myth are more than happy to paint universal healthcare as a boogie man.

A variation on this attitude was illustrated this week by Republican Representative Mo Brooks, who told CNN’s Jake Tapper in an interview that “people who live good lives” don’t have pre-existing conditions.

Aside from the hint of religious bigotry implied in his comment (God-fearing folks don’t have to worry about getting sick), Brooks’ comments leave little doubt that far-right Republicans like him see no reason why they should help other sick people.

His comment made me think of a Canadian friend with a defective kidney. A single mother, she was able to get a kidney transplant without being shamed by people like representative Brooks for apparently not “living a good life.” She probably would not be able be able to afford such an operation in the United States in the first place.

There are other factors. The American system is clunky, riddled with inconsistencies, overwhelmed with paperwork, anti- rather than pro-healthcare, and so bad for business that it amazes me that American entrepreneurs and business people aren’t marching in the streets of Washington for a single-payer system.

Businesses in the United States, both large and small, are often forced to lay off much-needed employees so they can offer healthcare to remaining employees. (I know of cases where people have been laid off because the company considered them a financial burden because their healthcare costs were so high.) In other cases, they will charge employees outrageous amounts in order to purchase employer subsidized healthcare.

In Canada, Australia, England, France —  or just about any other first-world and many others as well,  businesses do not need to worry about healthcare, because it is provided by a single-payer system. In some cases, but not all, taxes can be higher to provide this benefit.

One would think that for the reduced paperwork, lower costs, and ability to help retain good people, more American businesses would be 100% behind the idea of universal healthcare.

Even Donald Trump spoke favorably about universal healthcare before he decided he would lie his way to the Republican nomination and later to the presidency. This week he also praised the Australian healthcare system as better than America’s. Australia has a two-tiered system that provides basic universal healthcare to all Australians, but they must purchase private insurance for some specialty medical services.

The flaws all come down to the never-ending American desire for profit: there is just too much money to be made providing Americans with an inferior healthcare system.

It’s the same reason why some argue for a different kind of system in Canada. There’s money to be made, and they have dollar signs in their eyes. All the other reasons they give you are just so much malarkey.

It’s hard to say where this healthcare fight in Congress will lead. It’s obvious that Americans are waking up to the reality that the Affordable Care Act, also known as Obamacare, is a pretty damn good thing. Republican representatives, especially from moderate or more liberal districts, who vote to replace it are putting their political futures on the line.

We can only hope that the Senate produces a better, fairer bill until the day comes when Americans wake up to the reality that what they need is a universal healthcare system and nothing else will do.

Copyright Tom Regan 2017

Contact Tom Regan:  motnager@gmail.com

 

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Tom Regan Tom Regan is a journalist in the Washington, D.C., area. He worked for the Canadian Broadcasting Corporation and with the National Film Board in Canada, and in the United States for the Christian Science Monitor, Boston Globe, and National Public Radio. A former executive director of the Online News Association in the U.S., he was a Nieman fellow at Harvard in 1991-92, and is a member of the advisory board of the Nieman Foundation for journalism at Harvard.

Return to Tom Regan’s page 

 

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Americans turn Canadian about health care

After six years with Obamacare, public opinion forces Republicans to think “expansion,” not “repeal.” 

PENNEY KOME: OVER EASY
April, 2017

American attitudes towards universal healthcare insurance have long baffled the rest of the world. Only in the US is serious illness a ticket to bankruptcy and the food bank.  How is this conducive to healing?

The Republican party has always insisted that Americans would rather die free than depend on socialist medical care. One result is that the American infant mortality rate is a “national disgrace,” according to the Washington Post. And Americans seemed okay with that – until lately (1).

Many presidents have attempted to introduce a universal state-run healthcare system similar to Canada’s or Europe’s.  Bill Clinton won the 1992 election after campaigning heavily on health care, HRC, Hillary Rodham Clinton, introduced a national health care plan in 1993, when she was very popular First Lady. Her policy ran into trouble immediately.

 

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US conservatives, libertarians, health insurance and pharmaceutical industries furiously rejected anything that smacked of universal health care, saying patients would be stigmatized by having public rather than private insurance. They also launched vicious personal attacks on HRC that destroyed the proposal and permanently damaged her reputation.(2)

President Barack Obama campaigned on health care reform in the 2008 campaign and managed to pass the Affordable Care Act (ACA) during the two-year window (2008-2010) when the Democrats held the White House, a majority in the House of Representatives, and a Supermajority in the Senate. The ACA expanded Medicare and expecially Medicaid, the existing public health insurance programs. (3.)

Since the president signed the ACA into law in August 2010, House Republicans have voted more than 60 times to repeal it, knowing the president would veto the Bill, even if the Senate passed it.  (4.)

Part of President #45’s 2016 election triumph was the GOP’s opportunity to introduce yet another Bill to repeal the ACA (“Obamacare”), in full expectation that the majority Republican Congress would whisk the Bill through promptly.  Wrong! How mortified they must feel that the Speaker of the House had to withdraw the (empty) repeal-and-replace motion for lack of supporting votes!

Remember the old bumper sticker, “My karma ran over my dogma”? Between 2010 and 2016, US public opinion on healthcare changed dramatically. As with affirmative action programs, once people actually had to live and work with an “other,” they found the situation more congenial and less threatening than they ever expected.

While the greatly expanded Medicaid included 20 million more people, the catch is that each state has to sign on to the program and design its own system. Thirty-two states joined Medicaid, each with its own version and requirements.

As the New York Times editorialized, “….Medicaid now provides medical care to four out of 10 American children. It covers the costs of nearly half of all births in the United States. It pays for the care for two-thirds of people in nursing homes. And it provides for 10 million children and adults with physical or mental disabilities…

“The program is so woven into the nation’s fabric that in 2015, almost two thirds of Americans in a poll by the Kaiser Family Foundation said they were either covered by Medicaid or had a family member or friend who was….” (5)

Those people, and their loved ones, resisted the Bill. They contacted their Republican Congressional reps to protest this was not why they voted them in. Their vocal opposition forced their  representatives to back away from #45’s ill-conceived plan.

More than resistance, what the Republicans encountered is a parade marching in the other direction. Pew Research found that by February 2017, a majority of Americans (54%) supported Obamacare. In 2010, only 40% approved of the Act, and 44% disapproved of it. Ten percentage points is a lot of growth in seven years. (6.)

Medicaid has won over participating state governments, several of which moved quickly to expand their Medicaid programs just as soon as it was clear Trumpcare had failed.  Kansas and Missouri moved to expand; recalcitrant Governors in Virginia, North Carolina, and Georgia have indicated interest in joining Medicaid to get health coverage for their poor people.

The NYT notes that, “The A.C.A. offered a tempting deal to states that agreed to expand Medicaid eligibility to everyone with incomes up to 138 percent of the poverty level — $16,400 for a single person — mostly low-wage workers like cooks, hairdressers and cashiers.

“The federal government would initially pay 100 percent of the costs of covering their medical care, and never less than 90 percent under the terms of the law. Over the past three years, 31 states and the District of Columbia took the deal….”

Remember, many states are facing the twin opioid and suicide epidemics now wracking the US. Disability rates are at an all-time high, although people may turn to disability when faced with lifetime limits on welfare eligibility.  There’s evidence that cash-short state governments are encouraging welfare recipients to apply for federal disability funds instead.

States that sign Medicaid agreements for convenience or out of desperation, soon find they are saving money and producing goodwill among voters.  Patients bring home healthy babies; they take their children to the doctor. They visit family members in long-term care.  People with disabilities rely on Medicaid for adaptive equipment and physiotherapy. And oddly enough, they don’t seem to worry about any social stigma at all.

In short, just as Canadians have come to love our Charter of Rights as much as Americans love their Bill of Rights, now it seems that Americans have come to embrace health care for all the way that Canadians do (and most of the rest of the world.) As Joni Mitchell sang, “You don’t know what you’ve got” until somebody tries to take it away.

Copyright Penney Kome 2017

Contact:  komeca AT yahoo.com

Notes:

  1. https://www.washingtonpost.com/news/wonk/wp/2014/09/29/our-infant-mortality-rate-is-a-national-embarrassment/
  2. https://en.wikipedia.org/wiki/Clinton_health_care_plan_of_1993
  3. https://www.reference.com/history/did-obamacare-pass-congress-8fb44b73f7bcdcb6
  4. http://www.reuters.com/article/us-usa-obamacare-idUSKBN14X1SK
  5. https://www.nytimes.com/2017/03/27/health/medicaid-obamacare.html
  6. http://www.pewresearch.org/fact-tank/2017/02/23/support-for-2010-health-care-law-reaches-new-high/

Read more F&O columns by Penney Kome here

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Penney KomePenney Kome is co-editor of Peace: A Dream Unfolding (Sierra Club Books 1986), with a foreward by the Nobel-winning presidents of International Physicians for Prevention of Nuclear War.

Read her bio on Facts and Opinions.

Contact:  komeca AT yahoo.com

 

 

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Romania shows the dire results of a healthcare “brain drain”

Lacrima Dambu, a Romanian doctor who has been working in Germany for five years, holds her nephew in Cluj-Napoca, Romania January 19, 2017. REUTERS/Andreea Campeanu     SEARCH "CAMPEANU HEALTH" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES.

Lacrima Dambu, a Romanian doctor who has been working in Germany for five years, holds her nephew in Cluj-Napoca, Romania January 19, 2017. REUTERS/Andreea Campeanu.

Photos by Andreea Campeanu
March, 2017

Sonia Papiu started her first year of residency as a psychiatrist in the Romanian city of Cluj in January, but she plans to move abroad within the year, seeking better learning opportunities and hospital conditions.

She will not be alone.

“I don’t think any of my colleagues are planning to stay,” she said. “I think I could learn more abroad. You have higher responsibilities as a resident there.”

Students study at the Medicine and Pharmacy University in Cluj-Napoca, Romania, December 8, 2016. There are currently over 6600 students at the Medicine and Pharmacy University in Cluj-Napoca, of which around 2260 are foreign. REUTERS/Andreea Campeanu     SEARCH "CAMPEANU HEALTH" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES.

Students study at the Medicine and Pharmacy University in Cluj-Napoca, Romania, December 8, 2016. There are currently over 6600 students at the Medicine and Pharmacy University in Cluj-Napoca, of which around 2260 are foreign. REUTERS/Andreea Campeanu .

 

In the Romanian system, doctors go through six years of medical school and then three to five years as a hospital resident, treating patients while working under the supervision of senior staff.

Finding a job abroad will be easy. Cluj, one of Romania’s largest cities and a university and business hub, hosts several agencies recruiting for western European hospitals.

Romania has bled out tens of thousands of doctors, nurses, dentists and pharmacists since joining the European Union a decade ago, lured abroad by what the country lacks: significantly higher pay, modern infrastructure and functional healthcare systems. France, Germany and Britain are among the most popular destinations.

The consequences are dire. Romania is one of the EU states with the fewest doctors. Nearly a third of hospital positions are vacant and the health ministry estimates one in four Romanians has insufficient access to essential healthcare.

A mother holds her baby during a home visit from doctor Robert Ganea (not in the picture) in the village of Sacel in Romania, January 4, 2017. REUTERS/Andreea Campeanu

A mother holds her baby during a home visit from doctor Robert Ganea (not in the picture) in the village of Sacel in Romania, January 4, 2017. REUTERS/Andreea Campeanu

“Medical staff leaving Romania at an almost massive pace deepens the problems of the healthcare system,” former health minister Vlad Voiculescu has said. “Entire hospitals are facing a major personnel deficit and entire towns don’t have a family physician.”

This despite the fact that Romania is a leading EU state when it comes to the number of medical graduates. But the system – ridden with corruption, inefficiencies and politicized management – has been unable to motivate them to stay.

The shortages are even starker in rural areas.

Snow lies on roofs in the village Salistea de Sus, Romania, January 4, 2017.  REUTERS/Andreea Campeanu

Snow lies on roofs in the village Salistea de Sus, Romania, January 4, 2017. REUTERS/Andreea Campeanu

“Because we have one doctor per section for most specialties, when a doctor goes on holiday we need to close down the section,” said Cristian Vlad, the hospital manager in Viseul de Sus, a small town near the Ukrainian border.

Vlad said three hospitals in the region shared one anesthetist until last year, when his hospital brought in another from neighboring Moldova.

“I live in hope that our resident doctors will change their mind and stay in smaller hospitals, too,” Vlad said.

Medical staff work in the emergency ward (UPU) in Cluj-Napoca, Romania, December 10, 2016. REUTERS/Andreea Campeanu

Medical staff work in the emergency ward (UPU) in Cluj-Napoca, Romania, December 10, 2016. REUTERS/Andreea Campeanu

Romania is taking steps to address the issues. Pay has risen significantly, although it still does not measure up to western standards. The net average monthly wage for the healthcare system stood at 2,609 lei ($606) at the end of 2016, nearly double what it was three years ago.

In 2016, the health ministry created a multi-year plan for the medical profession, including a simpler recruitment process, education reform, better promotion opportunities, and subsidies for physicians willing to move to remote villages.

The strategy has yet to be approved by the two-month-old cabinet of Social Democrat Prime Minister Sorin Grindeanu.

Doctor Gabriela Dromereschi does an ultrasound on a patient at her practice in Salistea de Sus, Romania January 4, 2017. REUTERS/Andreea Campeanu

Doctor Gabriela Dromereschi does an ultrasound on a patient at her practice in Salistea de Sus, Romania January 4, 2017. REUTERS/Andreea Campeanu

“Measures to improve healthcare are in place, but the system suffers from inefficiencies, limited accessibility and corruption,” the European Commission said last month.

Yet not all doctors shy away from remote areas. From the village of Tureni, Andreea Kis has been serving as a family doctor for five villages for nearly five years.

“I chose to be a family doctor because this is compatible with family life,” said Kis, a mother of two. “People in the villages preserve their humanity better.”

 

Copyright Reuters 2017

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A one-armed robot will look after me until I die

As old age approaches, Geoff Watts confronts an inevitable future in the care of robots. But that doesn’t mean he likes it.
The Sunflower Robot is a prototype that can carry objects and provide reminders and notifications to assist people in their daily lives. It uses biologically inspired visual signals and a touch screen, located in front of its chest, to communicate and interact with users. Photo by Thomas Farnetti for Wellcome/Mosaic, Creative Commons

The Sunflower Robot is a prototype that can carry objects and provide reminders and notifications to assist people in their daily lives. It uses biologically inspired visual signals and a touch screen, located in front of its chest, to communicate and interact with users. Photo by Thomas Farnetti for Wellcome/Mosaic, Creative Commons

By Geoff Watts
April, 2016

The game is simple, designed for a child and intended to teach users about diet and diabetes. I sit opposite Charlie, my diminutive fellow player. Between us is a touch screen. Our task is to identify which of a dozen various foodstuffs are high or low in carbohydrate. By dragging their images we can sort them into the appropriate groups.

Charlie is polite, rising to greet me when I join him at the table. We proceed, taking turns, congratulating each other when we make a right choice, and murmuring conciliatory comments when we don’t. It goes well. I’m beginning to take to Charlie.

But Charlie is a robot, a two-foot-tall electromechanical machine, a glorified computer. It may move, it may speak, but it is what it is: a machine that happens to look humanoid. How can I ‘take’ to it?

Charlie’s intended playmates aren’t sixty-something Englishmen, they’re children. Children naturally interact with dolls, imagining them to be sentient beings. It’s a part of childhood. But I’m an adult, for God’s sake. I should have put away such responses to dolls… shouldn’t I?

In truth my reaction to Charlie, far from being odd or childish, is pretty typical. Robots, of course, are hardly new. Over the last few decades we’ve had industrial devices that assemble cars, vacuum our floors and shunt stuff around warehouses. But the 2010s have seen a rise in the attention paid to robots of the kind that most of us still think of as robots: autonomous machines that can sense their surroundings, respond, move, do things and, above all, interact with us humans. We all recognise R2-D2, WALL-E and scores of their lesser-known kin. The unnerving thing is that their nonfictional counterparts are extremely close at hand. Some press stories are exotic – those about ‘sexbots’ being among the more sensational – but many have featured robots at the less hedonic end of social need: disability and old age.

This has set me wondering how I might cope with the experience – not for an hour or a day, but for months, years. Not tomorrow, but very soon, I will have to get used to the idea of living with robots, most likely when I’m elderly and/or infirm. Contemplating this, my line of thought has surprised and disturbed me.

~~~

Modern medicine and increasing longevity have conspired to boost the need for social care, whether in the home or in institutions. “There’s a pressing requirement for robots in the social care of the elderly, partly because we have fewer people of working age,” says Tony Belpaeme, Professor in Intelligent and Autonomous Control Systems at Plymouth University. Traditionally among the poorest paid of the workforce, carers are an ever more scarce resource. Policy makers have begun to cast their eyes towards robots as a possible source of compliant and cheaper help.

The robots already in production, Belpaeme tells me, are principally geared to monitoring the elderly and infirm, or providing companionship while, as yet, performing only the most straightforward of physical tasks. Wait… companionship? “Yes,” says Belpaeme, deadpan, “Of course it would be better to have companionship from people…” He points out that for all sorts of reasons this can’t always be achieved. “Studies have shown that people don’t mind having robots in the house to talk to. Ask the elderly subjects who take part in these studies if they’d like to have the robot left in the house for a bit longer, and the answer is nearly always yes.”

Consider our relationship with nonhuman entities of a different type: animals. The ancient bonds between us have changed, of course: hunting, transport, protection and other such necessities have slipped to a secondary role. The predominant function of domestic animals in advanced industrial societies is companionship.

When medical researchers started to take an interest in the health effects of pet ownership, they began to find all sorts of beneficial consequences, physical as well as mental. Though somewhat debated, these include reductions in distress, anxiety, loneliness and depression, as well as a predictable increase in exercise. Pets seem to reduce cardiovascular risk factors such as serum triglyceride and high blood pressure.

The pleasures of animals as companions – and the real distress that may follow their loss or death – are self-evident. Research in Japan has revealed a biological and evolutionary basis to the relationship, at least in so far as it applies to one group of pets. Japanese scientists measured the blood levels of oxytocin in dogs and their owners, had them gaze at one another for an extended period, then repeated the measurements.

If you already know that oxytocin is the hormone associated with building a bond between mothers and their babies, you’ll guess where this is going. Dogs have enjoyed a long period of domestication, during which their psychology as well as their physical attributes have been subject to intense selection. What the Japanese researchers found was that periods of mutual eye contact raised the oxytocin levels in both parties. In short, they uncovered the physiological basis of loving your dog.

Whether on account of chemistry or for other reasons, there is evidence that the majority of pet owners see their animals as part of the family. “This doesn’t mean they regard them as humans,” says Professor Nickie Charles, a University of Warwick sociologist with a particular interest in animal–human relationships. Close links with animals are often in addition to rather than instead of relationships with family and friends. “But pets are easier and more straightforward, some owners say.”

The suggestion that nonliving things, including robots, might be able to evoke human responses that are quantitatively and even qualitatively comparable to our feelings about animals is contentious. Yet the evidence of common experience suggests that this is the case, even if we might not admit it or feel faintly uncomfortable if we do.

Who hasn’t shouted at a failing machine? The first vehicle I owned was a decrepit van that struggled even on modest inclines. More than once when driving the wreck I found myself putting an arm out through the window and using the flat of my hand to beat the door panel – like a rider on a horse’s flank. “Come on, come on,” I shouted at the dashboard. Only later did I contemplate the absurdity of this action.

Some such behaviour is simply the relief of pent-up tension or anger – but not all. Think back to the mid-1990s and the advent of small egg-shaped electronic devices with a screen and a few buttons. They were called Tamagotchis. Bandai, the original Japanese manufacturer, described a Tamagotchi as “an interactive virtual pet that will evolve differently depending on how well you take care of it. Play games with it, feed it food and cure it when it is sick and it will develop into a good companion.” Conversely, if you neglected your Tamagotchi, it died. For a time, millions of children and even adults became willing slaves to the demands of these computerised keychain taskmasters.

Also from Japan is PARO. Modelled on a baby harp seal and weighing a couple of kilos, it’s slightly larger than a human infant. PARO made its debut more than a decade ago, and although the majority of the 4,000 sold remain in Japan, PAROs can now be found in more than 30 other countries.

Covered in soft white fur, PARO responds to touch, light, temperature and speech sounds – as I discover when I try stroking and even talking to the creature sitting on the table in front of me. It turns its head to me when I speak; it emits seal-like squeaks when I stroke it; and when ‘content’, it slowly lowers its head and closes its big appealing eyes, each kitted out with seductively long thick lashes. This blatant emotional manipulation is accentuated when I pick PARO up; cradled in my arms, it begins to wriggle as I go through my talking and stroking routine.

When PARO met Geoff from Mosaic Science on Vimeo.

I encounter PARO at the London offices of the Japan Foundation, where it has accompanied its inventor, Takanori Shibata, an engineer at the Japanese National Institute of Advanced Industrial Science and Technology. Shibata categorises PARO’s benefits under three headings: psychological (it relieves depression, anxiety and loneliness), physiological (it reduces stress and helps to motivate people undergoing rehabilitation) and social. In this last category, he says, “PARO encourages communication between people, and helps them to [interact with] others” – social mediation, to use the technical term. As Shibata points out, “PARO has many of the same effects as animal therapy. But some hospitals do not allow animals because of a lack of facilities or the difficulties of managing pets.” Not to mention worries over hygiene and disease.

Much of the evidence of the benefit from PARO is based on informal observation (though there have also been more controlled trials). In one pilot study, three New Zealand researchers investigated a small group of residents in a care home for the elderly. Each resident spent a short period handling, stroking and talking to a PARO. This activity triggered a fall in blood pressure comparable to that following similar behaviour with a living pet.

In my brief period handling PARO, I can’t say I felt anything more than mild amusement – and certainly not companionship. Dogs and cats can do their own thing; they can ignore you, bite you or leave the room. Simply by staying with you they’re saying something. PARO’s continuing presence says nothing.

But then I’m not frail, isolated, lonely or living in a care home. If I were, my response might be different, especially if I was becoming demented, one of the conditions for which PARO therapy has generated particular interest. Shibata reports that his robots can reduce anxiety and aggression in people with dementia, improve their sleep and limit their need for medication. The robots also lessen the patients’ hazardous tendency to go wandering and boost their capacity to communicate.

This value as a social mediator interests Amanda Sharkey and colleagues at the University of Sheffield. “With dementia in particular it can become difficult to have a conversation, and PARO can be useful for that,” she says. “There is some experimental evidence, but it’s not as strong as it might be.” She and her colleagues are setting up more rigorous experiments. But the calculated use of a PARO for companionship she actually finds worrying. “You might begin to imagine that your old person is taken care of because they’ve got a robot companion. It could be misused in a care home by thinking, ‘Oh well, don’t bother to talk to her, she’s got the PARO, that’ll keep her occupied.’” I raise this with Shibata. He insists it isn’t a risk but, despite my pressing the point, is unable to say why it couldn’t happen.

Reid Simmons of the Robotics Institute at Carnegie Mellon University tells me that it doesn’t make sense to pretend you can create a robot that serves our physical needs without evoking some sense of companionship. “They’re inextricably linked. Any robot that is going to be able to provide physical help for people is going to have to interact with them on a social level.” Belpaeme agrees. “Our brains are hard-wired to be social. We’re aware of anything that is animate, that moves, that has agency or that looks lifelike. We can’t stop doing it, even if it’s clearly a piece of technology.”

~~~

Hatfield, Hertfordshire. An apparently normal house in a residential part of town. Once through the front door I’m confronted by a chunky greeter, standing at just below my shoulder height. Its black-and-white colour scheme is faintly penguin-like, but overall it reminds me of an eccentrically designed petrol pump. It’s called a Care-O-bot. It doesn’t speak, but welcomes me with a message displayed on a touch screen projecting forward of its belly region.

Care-O-bot asks me to accompany it to the kitchen to choose a drink, then invites me to take a seat in the living room, following along with a bottle of water carried on its touch screen, now flipped over to serve as a tray. My mechanical servant glides silently forwards on invisible wheels, pausing to perform a slow and oddly graceful pirouette as it confirms the location of other people or moveable objects within its domain. Parking itself beside my table, Care-O-bot unfurls its single arm to grasp the water bottle and place it in front of me. Well, almost – it actually puts it down at the far end of the table, beyond my reach. Five minutes in Care-O-bot’s company and already I’m thinking of complaining about the service.

The building I’m in – they call it the robot house – is owned by the University of Hertfordshire. It was bought a few years ago because a university campus laboratory is not an ideal setting in which to assess how experimental subjects might find life with a robot in an everyday domestic environment. A three-bedroom house set among others in ordinary use provides a more realistic context.

The ordinariness of the house is, of course, an illusion. Sensors and cameras throughout it track people’s positions and movements and relay them to the robots, and it’s this, rather than my box-shaped companion, that I find more perturbing. Also monitored are the activity of kitchen and all other domestic appliances, whether doors and cupboards are open or closed, whether taps are running – everything, in short, that features in our activities of daily living.

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Joe Saunders, a research fellow in the university’s Adaptive Systems Research Group, likens Care-O-bot to a butler. Decidedly unbutlerish is the powerful articulated arm that it kept tucked discretely behind its back until it needed to serve my water. An arm “powerful enough to rip plaster off the walls,” says Saunders cheerfully. “This robot’s a research version,” he adds. “We’d expect the real versions to be much smaller.” But even this brute, carefully tamed, has proved acceptable to some 200 elderly people who’ve interacted with it during trials in France and Germany as well as at Hatfield.

As Tony Belpaeme pointed out to me, the robots we have right now don’t have the skills that are most needed: the ability to tidy houses, help people get dressed and the like. These things, simple for us, are tough for machines. Newer Care-O-bot models can at least respond to spoken commands and speak themselves. That’s a relief because, to be honest, it’s Care-O-bot’s silence I find most disconcerting. I don’t want idle chatter, but a simple declaration of what it’s doing or about to do would be reassuring.

I soon realise that until the novelty of this experience wears off, it’s hard for me to judge what it might feel like to share my living space with a mobile but inanimate being. Would I find an advanced version of Care-O-bot – one that really could fetch breakfast, do the washing up and make the beds – difficult to live with? I don’t think so. But what of more intimate tasks – if, for example, I became incontinent? Would I cope with Care-O-bot wiping me? If I had confidence in it, yes, I think so. It would be less embarrassing than having the same service performed by another human.

After much reflection, I think adjusting to the physical presence of a robot is the easy bit. It’s the feelings we develop about them that are more problematic. Kerstin Dautenhahn, of the Hatfield robot house, is Professor of Artificial Intelligence in the School of Computer Science at the University of Hertfordshire. “We are interested in helping people who are still living in their own homes to stay there independently for as long as possible,” she says. Her robots are not built to be companions, but she recognises that they will, to a degree, become companions to the people they serve.

“If a robot has been programmed to recognise human facial expressions and it sees you are sad, it can approach you, and if it has an arm it might try to comfort you and ask why you’re sad.” But, she says, it’s a simulation of compassion, not the real thing. I point out that many humans readily accept affection, if not compassion, from their pets. She counters that a dog’s responses have not been programmed. True. But future advances in artificial intelligence could blur the distinction, particularly if a robot had been programmed to programme itself by choosing at random from a wide array of possible goals, purposes and character traits. Such an approach might lead to machines with distinct and individual personalities.

“Behaving socially towards reactive or interactive systems is within us, it’s part of our evolutionary history,” she tells me. She’s content to see her robots providing supplementary companionship, but she is aware that care providers with tightly stretched budgets may have little incentive to become overconcerned if a robot does seem to be substituting for human contact.

As I leave the robot house this worries me too. But it also puzzles me. If dogs, cats, robot seals and egg-shaped keyrings can so easily evoke feelings of companionship, why should I be exercised about it?

~~~

Charlie, the robot I played the sorting game with, is designed to entertain children while helping them learn about their own illnesses (Charlie is also used in a therapy for children with autism). When children are introduced to Charlie, they’re told that it too has to learn about their illness, so they’ll do it together. They’re told the robot knows a bit about diabetes, but makes mistakes. “This is comforting for children,” says Belpaeme. “If Charlie makes a mistake they can correct it. The glee with which they do this works well.” Children bond with the robot. “Some bring little presents, like drawings they’ve made for it. Hospital visits that had been daunting or unpleasant can become something to look forward to.” The children begin to enjoy their learning, and take in more than they would from the medical staff. “In our study the robot was not a second-best alternative, but a better one.”

Charlie is a cartoon likeness of a human. A view widely held by researchers, and much of the public, is that robots should look either convincingly human or obviously not human. The more a machine looks like us the more we’ll relate to it – though only up to a point. A very close but imperfect similarity tends to be unsettling or even downright disturbing. Robotics professionals refer to what they call the ‘uncanny valley’; in short, if you can’t achieve total perfection in a robot’s human-like appearance, back off. Leave it looking robot-like. This is rather convenient – a version of Charlie indistinguishable from you and me could price itself out of the market. That doesn’t mean it shouldn’t simulate our actions, however. A robot that doesn’t move its hands, for example, looks unnatural. “If you look at people when they’re talking, they don’t stay still,” says Belpaeme, pointing at Charlie and a child engrossed in conversation. “Besides their lips and tongues, their hands are moving.”

The angst we generate over adults forming relationships with robots seems not to be applied to children. Consider the role of dolls, imaginary friends and such like in normal childhood development. To start worrying about kids enjoying friendships with robots seems, to me, perverse. Why then am I so anxious about it in adult life?

“I don’t see why having a relationship with a robot would be impossible,” says Belpaeme. “There’s nothing I can see to preclude that from happening.” The machine would need to be well-informed about the details of your life, interests and activities, and it would have to show an explicit interest in you as against other people. Current robots are nowhere near this, he says, but he can envisage a time when they might be.

Dautenhahn hopes that robots never become a substitute for humans. “I am completely against it,” she says, but concedes that if that’s the way technology progresses, there will be little that she or her successors can do about it. “We are not the people who will produce or market these systems.” Belpaeme’s ethical sticking point – and others usually say something similar – would be the stage at which robot contact becomes preferred to human contact. But in truth, that’s not a very high bar. Many children already trade many hours of playing with their peers for an equivalent number online with their computers.

~~~

In the end, of course, the question becomes not ‘Do I want a robot companion to care for me?’ but ‘Would I accept being cared for by a robot?’ If the time comes when I am still compos mentis but physically infirm, would I be prepared for the one-armed Care-O-bot to take me to the toilet, or PARO to be my couch companion during movies?

There are cultural considerations here. The Japanese, for example, treat robots matter-of-factly and appear more at ease with them. There are two theories about this, according to Belpaeme. One attributes it to the Shinto religion, and the belief that inanimate objects have a spirit. He himself favours a more mundane explanation: popular culture. There are lots of films and TV series in Japan that feature benevolent robots that come to your rescue. When we in the West see robots on television they are more likely to be malevolent. Either way, though, I’m not Japanese.

On a simple level of practicality there’s a way to go before Mr Care-O-bot or any of its kind have the communication skills, dexterity and versatility of even the most cack-handed human carer. But assuming the engineers overcome this hurdle – and I’ve every reason to believe they will, very soon – I’m back to the question of companionship. Life devoid of it is sterile. So the fact that we tend naturally to form bonds, even with robots, I find, in principle, encouraging.

~~~

But companionship, to my mind, incorporates three key ingredients: physical presence, intellectual engagement and emotional attachment. The first of these is not an issue. There’s my Care-O-bot, ambling about the house, responsive to my call, ready to do my bidding. A bit of company for me. Nice.

The second ingredient has yet to be cracked. Intellectual companionship requires more than conversations about the time of day, the weather, or whether I want to drink orange juice or water. Artificial intelligence is moving rapidly: in 2014 a chatbot masquerading as a 13-year-old boy was claimed to be the first to pass the Turing test, the famous challenge – devised by Alan Turing – in which a machine must fool humans into thinking that it, too, is human.

That said, the bar is fooling just 30 per cent of the judging panel – Eugene, as the chatbot was called, convinced 33 per cent, and even that is still disputed. The biggest hurdle to a satisfying conversation with a machine is its lack of a point of view. This requires more than a capacity to formulate smart answers to tricksy questions, or to randomly generate the opinions with which even the most fact-laden of human conversations are shot through. A point of view is something subtle and consistent that becomes apparent not in a few hours, but during many exchanges on many unrelated topics over a long period.

Which brings me to the third and most fraught ingredient: emotional attachment. I don’t question this on feasibility counts because actually I think it will happen anyway. In the film Her, a man falls in love with the operating system of his computer. Samantha, as he calls her, is not even embodied as a robot; her physical presence is no more than a computer interface. Yet their affair achieves a surprising degree of plausibility.

~~~

In the real world there is – so far – no attested case of the formation of any such relationship. But some psychologists are, inadvertently, doing the groundwork through their attempts to develop computerised psychotherapy. These date back to the mid-1960s when the late Joseph Weizenbaum, a computer scientist at the Massachusetts Institute of Technology, devised a program called ELIZA to hold psychotherapeutic conversations of a kind. Others have since followed his lead. Their relevance in this context is less their success (or lack of it) than the phenomenon of transference: the tendency of clients to fall in love with their therapists. If the therapist just happens to be a robot… well, so what?

The quality and the meaning of such attachments are the key issues. The relationships I value in life – with my wife, my friends, my editor – are emergent products of interacting with other people, other living systems comprising, principally, carbon-based molecules such as proteins and nucleic acids. As an ardent materialist I am not aware of evidence to support the vitalist view that living things incorporate some ingredient which prevents them being explained in purely physical and chemical terms. So if silicon, metal and complex circuitry were to generate an emotional repertoire equal to that of humans, why should I make distinctions?

To put it baldly, I’m saying that in my closing years I would willingly accept care by a machine, provided I could relate to it, empathise with it and believe that it had my best interests at heart. But that’s the reasoning part of my brain at work. Another bit of it is screaming: What’s the matter with you? What kind of alienated misfit could even contemplate the prospect?

So, I’m uncomfortable with the outcome of my investigation. Though I am persuaded by the rational argument for why machine care should be acceptable to me, I just find the prospect distasteful – for reasons I cannot, rationally, account for. But that’s humanity in a nutshell: irrational. And who will care for the irrational human when they’re old? Care-O-bot, for one; it probably doesn’t discriminate.

Creative Commons

This article first appeared on Mosaic and is republished here under a Creative Commons licence.

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“Cause marketing” not clear as a bell

DEBORAH JONES: FREE RANGE
February 6, 2016

I just donated a few dollars to my local schizophrenia support charity. I should do so more often, knowing that we’re all, directly or indirectly, affected by mental illnesses. I don’t, though. It’s one of too many issues clamouring for scarce attention and funds.

Kudos for the reminder, then, to #bellletstalk, an annual “cause marketing” campaign by Canada’s largest communications company, BCE Inc.  Bell, as it’s known, reminded me of the cause  — but instead of joining its campaign, I gave independently. Why? Because behind its cool hash tag, #bellletstalk is a leading example of a trend we really do need to talk about.

Today is Bell Let’s Talk Day! Every time this post is shared, we’ll donate an additional 5¢ to mental health initiatives in Canada.

#bellletstalk is a leading example of a trend we really do need to talk about. Photo from Bell’s Facebook campaign page, which said, “Every time this post is shared, we’ll donate an additional 5¢ to mental health initiatives in Canada. Photo: Facebook

To give due credit, Bell, and the millions of people who participated, did good, raising money and awareness for a cause.

But here’s the caveat, why I refused to join the massively popular campaign despite the risk of being called curmudgeonly: a public issue should not be driven primarily by private interests. Mental illness is too complex, with causes and cures too embedded in our families, workplaces, communities and overall structures, to be fixed with a cause marketing program.

When I grumbled to this effect amid the torrent of posts about the campaign on social media, a friend pointed out that without #bellletstalk few would talk about, or donate, to mental health. He was right. Again, kudos to Bell.

But my friend also noted,  “that’s how the world works.” Ah — and that’s the rub.

I don’t think our world should work that way. I know we can do better.

Bell pledged five cents apiece for messages with the hash tag #bellletstalk. Canadians responded with 125,915,295 tweets, texts and shares on social media. The 24-hour fundraiser, Jan. 27, raised nearly $63 million* for mental health programs throughout Canada.

Mental illness costs Canada alone $51 billion* each year in health care costs, lost productivity, and reductions in health-related quality of life, estimates the Centre for Addiction and Mental Health in Ontario. Despite Canada’s universal health care, advocates say mental illness is neglected and underfunded compared to other diseases. Globally, the World Health Organization reports that one in 10 people have a mental health disorder, but just one in every 100 health care workers serve them.

Mental illness is a difficult subject, and a marketing campaign based on it could have backfired, even turned away customers. Instead, each January #bellletstalk gets an entire nation talking, enthusiastically — for weeks! — about mental health. Prime minister Justin Trudeau participated, noting his mother Margaret Trudeau’s famous struggles with bi-polar illness. Celebrities tweeted. Ordinary people poured their hearts onto Bell’s campaign Facebook page, like the man who wrote, “I suffer with depression, anxiety, social anxiety, panic attacks and ocd ….Thank you #Bellletstalk for helping raise awareness.”  The campaign received widespread news coverage, including in other countries.

Arguably, in just one day each year, Bell’s cause marketing campaign does more than any government or non-profit agency to raise awareness of an illness that lurks below our radar, or is swept under our rugs.

My criticism is not aimed at Bell, or the millions of people who shared the hash tag. But #bellletstalk is an example of how we confuse a public good with private interests, and of how — without thought —  we accept “that’s how the world works.”

I am an enthusiastic capitalist in the way I am an ardent democrat: both are the least bad of all the systems we’ve invented (with apologies to Winston Churchill). And, both require oversight. Healthy capitalism requires an awareness by citizens that the legal priority of corporations is to make profits for shareholders. Healthy democracy requires us to acknowledge that no marketing campaign can be equated with altruism, or substituted for public policy.

As generous as it is, the $63-million #bellletstalk campaign is no panacea for Canada’s $50 billion/year mental health burden. Mental illness is complicated, its social and medical roots deep – and they extend into Bell’s own workplace, and into most of our institutions. That point was sharply made by a former Bell Media employee, who wrote on Canadaland her job at Bell “gave me mental health issues and no benefits … I just wish they would send some of that funding and change towards their own people too.”

My criticism of #bellletstalk is in the context of private interests increasingly dominating in our societies. This is hardly news. It’s been thoroughly documented, from Thomas Piketty’s 2013 book Capital in the Twenty-First Century, to Oxfam’s report in January, An Economy for the 1%,” released at the World Economic Forum in Davos. Fewer and fewer people control more and more of our economy, and spend their vast wealth to influence our decisions, not merely on choices we make as consumers about, say, Bell mobile phones, but in our elections  — including for the legislators who regulate the communications and health care industries, in which #bellletstalk has become influential.

American philosopher Michael Sandel  warns that we’ve stumbled, without consciously thinking about it, from having a useful “market economy” to, dangerously, being a “market society,” in which anything and everything is for sale. And #bellletstalk, even as it does some good, exemplifies this market society, by  linking an essential public good with selling things to us as consumers.

Canada, and its #Bellletstalk campaign, are considered leaders in the “cause marketing” genre, noted the business publication Forbes. Cause marketing is useful to business, and it has a place in public discourse. But all marketing is aimed primarily at  “consumers.” Consuming is only part of what citizens do.

I think we citizens are capable of a great deal more than tweeting once a year about a vital area of health care. Citizens in healthy democracies have managed to develop public health and urban planning; invented vaccines and implemented public education; sent spaceships to Mars — and replaced, for a time anyway, the rule of man with the rule of law.

Citizens in a developed country like Canada, with its universal health care system, should support research, treatment and awareness of debilitating, socially-devastating mental illness the same way Canadians provide pre-natal health or vaccinations.

Bell raised nearly $63 million* in 24 hours for a neglected cause. It is a lot of money, even compared to the billions that mental illness costs Canadians. And, Bell’s campaign boosted awareness about mental health.

Bell deserves a pat on the back. At the same time, we should pause to question: Will the programs that rely on Bell continue if the company cancels its campaign in future, or the company is bought by a competitor? Will Bell’s popular marketing campaign affect government decisions on regulating the communications industry?

Even the most  enthusiastic capitalists need to ask if a market society is the model we want to serve public needs. It is now, as my friend said, the way the world works.  It doesn’t have to be so.

Copyright Deborah Jones 2016

Contact: djones AT factsandopinions.com (including for republishing.)

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Facts and Opinions is a boutique journal, of reporting and analysis in words and images, without borders. Independent, non-partisan and employee-owned, F&O is ad-free and spam-free, and we do not solicit donations from partisan organizations.

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