Ronin of the Spirit

Because reality is beautiful.

Health-care debate VII

Do we want to fix health care? Health care is a cross roads where health-care providers, health-care consumers, health-care insurers and government all meet up. I can not talk about reforming those things without getting into pretty serious conversation what government’s role in society is, and here is my “simple” answer…

Government has a legitimate monopoly on force. If the mafia says “Give us 30% of your paycheck, every paycheck, to spend on protecting you and if you don’t we will take your stuff and/or lock you up in a small room with highly abusive people,” we would call that a protection racket, a form of organized crime. The reason the government is allowed to do this, and other groups are not, is because the government has a legitimate monopoly on force.

Under normal circumstances, a person exposes themselves to force by contract. Your collectors have the right to take your stuff if you don’t pay because you signed a contract saying it was OK. The fact that you have many contractors to choose from and that you enter the contract of your free will, makes this type of force self regulating and legitimate.

Government, on the other hand has this right regardless of contract, and there is no competition. So, in the absence of voluntary contracts serving as a control to the force, freewill is expressed through democracy.

However, democracy requires a system in order to function well. The simple will of the majority for every government tasking would be disastrous, even it it were logistically feasible. Fifty-one percent could (and would) use their power over the government to use the government’s monopoly of force to seize the money and resources of the remaining 49%.

Also, the fact that the government has monopoly on force doesn’t mean the government is the best instrument to accomplish every job. Socialism basically means the rich pay more taxes and the money taken from the rich provides for the poor. In a totally socialist state, the government would make all economic decisions for the people. Historically, this works very poorly.

Americans, justifiably proud of their economy, often complain about socialist economic control. However, if people take the time to think, few people really want a totally capitalist society, in which the supply of anything is controlled only by market demand, and not by the government’s monopoly of force.

Prescriptions are a good example. In a totally capitalist society, people could buy whatever drugs they wanted. The supply of drugs would be controlled completely by the demand for them. However, we impose non-market control over drugs, denying people access to drugs regardless of their demand because, in this case, capitalism harms rather then helps society.

Why? Because capitalism is a means to an end and not an end to itself. Capitalism is great at providing a variety of products, and using competition to drive the price of those products down, but capitalism, like many tools, is without morals. It is neither good, nor bad; it just is. Sometimes we stop capitalism from working on moral grounds.

The military is another good example. Bill Gates pays about 15 million times more taxes than the average American. Yet, he receives exactly the same level of military protection as the homeless who live nearby. That is socialism at its most basic. Yet few Americans clamor to have the US military dismantled and replaced with competing mercenary bands. We turn capitalism off and utilize the government’s monopoly of force when it seems that taking unequally from all to provide equally to all is more moral than not. In a totally capitalist economy, the rich would have the best police, the best roads, the safest airplanes, just as in our current economy they have the best cars, the best houses, and the safest neighborhoods.

Morality is the test. The poor people in a police district get the exact same protection as the rich in the same district, flying first class is just as safe as flying other classes, and the military protects us all to the same degree regardless of income, because we have decided to tax those with money, to pay for a service for all.

The government has a responsibility to protect its citizens, thus everybody pays what the government thinks they are able, to receive the exact same level of military protection. This does not mean there is a universal right to military protection, for there is no such thing as a right to a service when no contract has been made; it simply means the government has a responsibility to provide the best military the people will fund.

Health-care is no different. The government has a responsibility to protect the lives of its citizens. If 50,000 people a year die in attacks, the government acts through the military. If 50,000 a year die in traffic accidents, the government acts through the Department of Transportation. If 50,000 a year die from inaccessible health-care…well then let’s not do a fucking thing because that would be socialism?

My. God. Obviously, morality calls for the limited suspension of capitalism in this case. France has the the highest value health-care on Earth. In a few other countries, people pay less but get far less (Chad for instance). In most other countries people pay far more and get a bit less. There are three keys: (1) There is a single payer (the government) for everything; (2) The book keeping is state of the art; (3) The doctors strike regularly.

It’s that simple. In response to the will of the people, the government sets price caps as low as possible. In response to the health care providers, the government raises price caps. Between the two, the providers get the incentive they need to stay in the market, and the people get what they need to be able to afford health care.

And it will not work in the U.S. for just as simple a reason – we lack the sort of democracy that allows it. In the U.S.’s single-member-district plurality representation, it’s all or nothing; 100% or 0%. That simply will not work for government price fixing. Let us suppose the Republicans side with the doctors, and the Democrats with the “more-for-less” voice of the people.

When the regime is Republican, the doctors will do well. When the regime is Democrat, the doctors will do poorly. In a society like France’s, the doctors will always win something, but never as much as they ask for…every year. The people will always win something but never as much as they ask for..every year. In the U.S., doctors will spend 4-8 years going broke followed by 4-8 years of getting paid. Though this averages out to the same thing, the fact is after 8 lean years, doctors will be leaving the field in droves. The profession of medicine cannot survive the zero sum game (0% or 100%) method of democracy; it needs proportional representation.

If we really want health-care reform, we need to partially socialize medicine. If we want that, and we want crops of new doctors to replace the retiring ones every year, we must have proportional democracy.

Proportional democracy, however, only works for large bodies of many representatives, like the House. For things like the Senate, or the Presidency, we still need to vote for one person. No matter how democratic the House, unless the Senate and the President are elected differently, we will have made huge change with no positive effects. The two-party system would still rule the executive branch and the Senate.

For these, we need a Condorcet vote. In this system, the voter rank candidates, and the overall winner gets the seat. This breaks the back of the two-party system and puts the President and the Senate in the same democratic boat as the House.

Without these, any attempt at health-care reform is so much verbal masturbation.

September 27, 2009 Posted by | atheism, Christianity, Government, Politics, Religion, Science, skepticism, Uncategorized | , , , , , , , , | Leave a comment

Health Care Debate VI

So, one of the things I thought about as I was siting in my car seat, either watching barriers shoot (by far to close) or stuck in traffic, was the American health care system.

In post five, I said health care is a real problem in the US and needs a solution. A gave a solution, but it was so cursory as to be nearly comic. (Like a three step process to getting the moon: 1. Build rocket, 2. Load up and launch. 3. Land on moon.) I wanted to go into detail, but I simply don’t have the time it would take to write a book about it. Here is my less summarized than before, but still highly summarized problem. (The solution in the next blog.)

I’ve come to think, after much reflection, that problem is not health care. The problem is Americans. We have the 2nd most expensive socialized health-care per capita GDP on earth, yet it covers only a 1/3 of our citizens. We have the 1st most expensive private care per capita GDP on earth, yet have the lowest age of mortality and highest infant mortality in the western world. We have highest medical costs, bar none, on earth, yet the leading cause of death cancer caused by tobacco and heart disease due to diet and inactivity. We have all of this…and yet at least half of Americans don’t think there isn’t a problem.

Most Americans are stupid. We have only two possible causes for any undesirable behavior: internal and external. I find the idea that Americans are genetically inferior to people of other nations ridiculous, so that just leaves external. What could be acting from the outside in of whole nation to make Americans so politically stupid?

Let me pause for a moment, to say that I love my country. It’s not a perfect place, but I love it worts and all. I’m not so naive to believe that the election of single black man to the highest office in the land eliminates racism. I see private, quietly expressed racism nearly everyday I am work. The fact remains however, only three generations from one of the most homicidal racial slave systems on earth, a black man as president is a good step. It doesn’t solve inner city poverty. It doesn’t change the fact that schools with mostly black kids get a fraction the funding as schools with mostly white kids, but you will not see an outcast on the Diet of Japan, or Jew as the president of Egypt in three generations. America, ultimately, does many thing better then any other nation on earth.

But in the American democracy, there is a corrosive element that eats away at the will of the people constantly. It’s called the two party system.. In turn, the two party system is what causes this uniquely American stupidity.

I could go on about how two party systems prevent any real change (which they do), or why the left and right of the Communist party in China represent more choice of ideals then the Democrat and Republican party (which they do) but thats not the important part. No matter how bad the collusion between our politically parties, or between those in power and those with money is, democracy has an amazing power to right such wrongs, and in a way the people support. While the US does have systemic problems, the existing system has the capacity for self correction…but it’s only as good as the people voting.

The two party system putrefies the minds of the people. It reduces every discussion of shade and color of meaning into single binary choice of black or white. It turns every attempt at discussion into a cosmic battle of good and evil, characterized by a double false dichotomy. “False dichotomy” in argument refers to painting a bleak picture of you opponent’s viewpoint to make yours look better by comparison. In the two party system, both the viewpoints provided are absurd. One side is the bastion of all freedom, happiness, and light, the other a hotbed of evil, conspiratorial lies, and ill will. One side is God, the other side is Satan. 100% or 0%, with no in betweens.

In that environment, there can be no discussion, no debate, only people screaming slogans. The two party system is often defended with the statement “Well, it’s a good system, because it tells both sides of the story.” That single statement shows the mental atrophy that a two party system exacerbates: the idea that all meaningful thoughts on a subject can reduced to two viewpoints. Obviously it’s better then a single party system, but thats damning with faint praise. (Two steps removed from anarchy! Go team!)

Such simplicity is seductive. You don’t need to worry about how or why. You don’t need to think. You just need to know which of a pathetic two options you choose. This brain rot affects other things besides politics. Auto accident policy is the same. Pretend you are going down a road and the person in front of you slams on the breaks to turn right. You hit their car. It is 100% your fault. Why? Yes you were following to close, but couldn’t it be even a few per cent the other drivers fault breaking irresponsibly? (Which is how most traffic law is set up in Europe.)

The first step in my little “How to fix health-care” post was “Tort reform”. The 0%/100% fault system rears it’s ugly head hear as well. If you have a pool in your back yard, it must have fence of certain opacity and height, because it is an “attractive nuisance”. You must do this, because if someone gets into your pool without it, you are 100% at fault and they are 0%. That’s stupid. At the same time, the law was put into place to right the wrong of people putting things very dangerous to children in their yards with no protection whatsoever, an environment where the pool owner had 0% fault and small child was 100% at fault.

The real answer to tort reform is a society that recognizes partial fault. I think a two party system trains peoples minds to be incapable of functioning in the gray areas that make up real life. The real cause of the American health-care failure, is Americans incapacity for rational thought, followed by an inability to turn rational thought into rational policy.

September 27, 2009 Posted by | atheism, Christianity, Government, Politics, Religion, skepticism, Uncategorized | , , , , , , | 2 Comments

My European Vacation I

So, I drove through Germany, Austria, France, and Italy. I spent several days in Verona and Rome each, and a day in Venice and day in Paris. I can’t speak for all of Europe, or even all of Germany. I don’t fell I can speak with any real authority on any of these places, because I haven’t been there long enough. Even my statements about things like the roads can’t be take in whole of the network, but merely the roads I drove on, in the late summer of 2009.

The very first thing I learned is that “European” is not the east of the Atlantic version of “American”. In the States we tend to think of Europe as a lot more ideologically cohesive then it really is. People say things like “This is how they do it in Europe”, or “European style”, or “Already for sale in Europe”. When we say “American Way” we aren’t talking about the way Canadians, Mexicans, El Salvadorians, or Argentinians do things. Though those countries are, in fact, part of the American continent, thats not what we mean by American.

We are talking about the US of A way of looking at things. Because we are a nation of immigrants, more than any other nation, the adjective “American” means consistent with a certain ideology, a certain world view. For other nations, “German” or “French” means a racial type, a religion, or ancestry. There is no “European” view point, at least not yet. Maybe after another 250 years of the Union, but right now I would say a small town in Mexico and and small town in Minnesota have more cultural similarity then a small town and Germany and small town in Italy. There is no such thing as a European outlook.

Americans too, are convinced that Europe has far higher taxes then the US. It’s a stupid thought for a lot of reasons. First of all, there is no such thing as European taxes anymore then there is State social security taxes in the US. Each nation has its own way of doing things. Second, inflation is a form of taxation on future tax payers. You have to include inflation, the national debt, etc, when you figure taxes. Also, the US uses lower Federal level taxes, but our local taxes are much higher, making up almost 50% of total government income. If you really run the numbers, Germans pay only about 5 to 10% more total taxes then Americans.

Fuel (diesel in our case) is expensive everywhere we went, about 6 USD per gallon, making it twice what we normally pay. I’m not sure why though…Petrofuel is about the most fungible commodity on earth and traded very aggressively. Economy of scale being what it is in such an industry, the real cost of fuel varies by a few percent worldwide. The huge difference in cost is caused by the level of subsidy or tax placed on the fuel. The countries with the cheapest fuel have the greatest subsidy, and the countries with the most expensive fuel have the highest tax. Where is all that tax going?

Not the roads, near as I can tell. Germany, at least, doesn’t do gravel roads. If a road is government sponsored, its paved. The cost of paving and maintaining paved roads being what it is, they save money on the secondary roads by making them 4 to 8 feet wide, and contour following, which means they are pretty much just poured where ever without grading or cut and fill. The speed limit on them is often around 30 mph, and you have to slow to a crawl and pull of into the brush to let someone coming the other way by.

The roads (outside of Germany) are heavily tolled. I’d say I spent at least 100 USD going 1200 miles on tolls alone. And most bathrooms cost about .75 USD a person. The publicly supported ones were atrocious. Never in a America have a seen anything bathroom as disgusting as tax funded ones in Germany and Italy.

The interstates here (Autobahn in German speaking countries, Autostrade in Italy, Autoroute in France) are not that great. I’m sure in the US, you’ve been driving down the interstate looking at the ¼ mile of cleared right away on each side of the interstate as well as the 100′ wide median and thought, “What a waste of space! What do they need all that extra land for?” Well, growth. No, not every 4 lane interstate is going to grow into a 16 lane (at least we hope not. Yuck.) but lets say gravel road is paved making for a convenient new place to exit. With all that clearance, it’s east to put in a big, gentle, off ramp. Not here.

You usually have about 500 feet to go from full speed to about 18 – 40 mph to hit the turn. Often as not, the turn is banked…the wrong way (For minimum footprint, I guess.) Exits for both traffic flows go to the same side of the interstate, making for long, slow ramps. Since they can’t just lay the road where ever, those dual exits sometimes turn into a mile of highway making odd, sharp turns every could hundred feet (To fit on the existing rightaway between farmers’ fields) before you get the road you were exiting to.

The worst issue with the lack of right-away is construction. In the US, when you have long term repair to make, you just grade the shoulder or median, pour some blacktop and make a new lane while you work on the old one. Not an option here. When they need to close a lane, the have just put the road down to one lane. The individual lanes are so narrow they can’t use F-barriers. (http://en.wikipedia.org/wiki/F-shape_barrier), so they use pre-fabbed aluminum barriers that about 12” accros and 18” high. This makes your narrow lane even narrower, and is the only thing separating you from oncoming traffic. Also, they just slow thing way down. My average speed on the Autobahn/Autostrade from Trier to Verona was 75 KPH, about 46 mph. Bleh.

But the very, and truly worst road experience is reserved for the interstates into big cities. You see, they don’t have emanate domain over here. (In may come to a surprise to many Americans, but the US Federal government has significantly stronger property rights over it’s citizens then any nation I am aware of over here.) So the interstates go right into the center of town, and just sort of die…There you sit. Your interstate died, you are in the middle of a mideval tangle of alleyways, and don’t know how to get out.

Or you could take the train. Rail travel is subsidized here So you would think it is super cheap. Actually, flying is cheaper. The trains are great when you want to go a certain distance, to far to be close, and to close to be far, and where parking is very expensive. Berlin is about 8 hours from here, and the train is perfect for that. It’s about 150 dollars round trip, and you don’t have to worry about paying for parking for a week. But the trains are surprisingly slow. Since passenger rail service is provided as a public utility, the train must stop in every one horse town along the way, even if no one is there to get on board. Since this is Germany, it is rare that you find a spot more then 5 miles long without a stop for ramshackle old train station in some back holler.

Maybe the most surprising thing about this whole trip, (and I feel stupid for needing this shown to me) is that to the people who live there, its just somewhere to live. Some parts of Venice are very nice. Many parts are not. Public bathrooms have poop on the wall in Paris, just like in Washington DC. Over all I had a great trip, but Europe is (over all) much shabbier then spy movies taking place in Europe had led me to believe. Europe is just a place to live. As continents go, it’s pretty nice: pleasant temperature and a lack of anarchy or poisonous fuana make it far more attractive then say, Africa. But it’s not magical.

Rome was great, and probably my favorite part, but it lead to my other big realization. It’s a funny place, because everything you’ve seen your whole life that was supposed to make an area look expensive is in Rome, not looking expensive. Rome doesn’t have 17th century fountains to show off it’s wealth. It has 17th century fountains because in the 17th century, they thought the place could use some fountains. It has Renaissance sculpture because during the Renaissance, people in Rome made sculpture.

In short, Rome doesn’t have all of those icons of “expensive European city parts” to be an expensive European city. That’s why US cities have them. Rome has those things because it must. There are gorgeous fountains in Rome for the same reason there are curbs, stop lights, and fire hydrants in DeKalb Illinois: because when they were put in, it was the best thing to do at the time. Old European cities don’t have quaint winding streets and fascinating back alleys to be quaint and fascinating. They have them because that was the best way to do those things at the time they were done. US cities don’t for the exact same reason. Europeans  haven’t preserved them because of a morally superior relationship to their own history, but because of a tax and income climate that favors preservation rather then replacement.

Prarie Skyscraper, Alton, Iowa

Prairie Skyscraper, Alton, Iowa

In short, specialness is where you choose to find it. The bubbling fountains of Rome are beautiful, and though you can find copies of them all over the world, no city wears them as well. But, then again, the huge, grain elevators of Iowa, white and tall against the endless sky, are beautiful as well. I’ve seem nothing like them in Europe.

September 21, 2009 Posted by | Uncategorized | , , , | Leave a comment

Health Care Debate V

Health Care Debate V.

Well, lets go over the facts, as I can find them.

  1. Health care in the USA is troubled. 60% of all bankruptcies are due to medical debt. America pays more per capita GDP for it’s gov-care (which covers 1/3 the population and ½ the cost of all medical bills) then countries with universal gov-care for 100% of the population. By the same measure, the US also has the highest private health care expenses. Between the two, US citizens, on average pay over two times more than citizens of other nations with comparable qualities of life. Worse still, by almost any measure, the US health care system is at best, only competitive and at worst, behind other nations in over all citizen health.

  2. Despite the objectively verifiable low value of health care in the US (That is to say, the price adjusted for exchange rate and local GDP is far higher then the same effectivity of care in other nations.) The producer’s price isn’t high enough to change consumer behavior. This is proven by the fact 33% of all mortality is preventable through life style change. (18% and 15% to tobacco and obesity/inactivity respectively). Preventable care expenses are over half the total cost of health care.

  3. Health care is a system or network. Consisting of four major actors. The health care provider, the health care consumer, the health care insurer, and the government that regulates them. Change must be network-wide to improve the situation. Single actor change would only displace expenses onto the other actor/s.

  4. Health insurance premiums are expensive primarily because health care is expensive. In order of dominance, the costs of health care seem to be…

    (A) Over-care. All actions have risk, including inaction. The increase is procedures does not increase in expense proportionally, but exponentially, because with each action the provider takes, the person is exposed to new risks, which will require new corrective action, which will create more risk, in a cycle. The number one cause of over-care is fear of litigation.

    (B.)Health care provider labor cost, primarily nurses.

    (C.)Government payments cover only 85% of the cost of care. (Resulting in private costumers subsidizing the hospitals costs of gov-care patients in addition to the payroll income tax payments which paid the first 85% of the expenses.)

    (D.)Administration

    (E.)The requirement for all hospitals to provide free emergency room care to anyone who needs it.

  5. Regarding insurance, in other industries, insurance, by organizational ability and economy of scale is a powerful force towards efficiency. This is not happening in the health care field. Health insurance have several points of note:

    (A.)Other then the cost of claims, the primary cause of high premiums is deductibles which are proportionally low in comparison to the claim cost.

    (B.)Insurance companies are not allowed to price premiums based on risk but must instead at least in part, price premiums based on government mandate.

    (C.)Insurance companies have restrictions placed on their business model that other similar industries don’t have.

    (D.)Insurance companies are not allowed to enter area markets based on market forces, but on government mandate.

So, whats the solution? 4A: Tort reform. 4B: Replace the universal state boards with industry designed tests based on specialization. 4C: Creation of single gov-care agency instead multiple competing ones. 4D The Canadian gov-care system has about half the administrative cost of the US system. Utilization of “best practice” is in order. 4E: Congressional moratorium of this unconstitutional unfunded mandate. 5A. Creation of tax sheltered savings accounts for funds earmarked for deductibles. 5B, 5C, 5D: The deregulation of prices and charges within the insurance industry. The new price-controlled-by-market insurance companies will be able to charge cost effectively rates for self inflicted illness, solving 2.

This is the last word on health care reform. Anything less then this isn’t reform.  Anything more is government reform with a focus on health care.

September 6, 2009 Posted by | Uncategorized | , , , , , , , | 2 Comments

The coming blue funk

Ok, so I am almost done with my Health Care V post.  It’s a honking 2k words and I need to edit the crap out of it.  I’ve actually found some false conclusions and mis-facts that I hadn’t caught the first time, but I will probably leave those in because the concepts are right, and the type of polishing I need to do will probably be part of larger project where I rewrite the whole US system. It probably doesn’t have a chance of getting published but I would like to do the kind of editing that published work gets, so you all get the 2nd draft instead, in a couple more days.

Being a full time student has changed the way I view the passage of time. My life is broken down into 8 week blocks, and I can keep alot better track of when I feel good and when I feel like crap.  I am nearing the end of pretty pleasant 3 weeks.  This Monday I just couldn’t get excited about going to work.  The day drags on, I seem to get head aches easier, and I am tired all day, but then can’t sleep when I get to bed.  The petty irritations of social interaction with strangers weighs on me.

Times like this…

are when porn seems like a great idea. Porn is a substitute but not a very good one.  The way I feel after hitting up porn because I am sad is the same I way I feel when I haven’t eaten all day and late in the night eat a bag of Dorittos.   Satiated, but still empty.

are when I wish I could go home.  I’m not sure why, but I checked out when I was around 15.  My parents did their best to make a home, but from about 15 all I could think about was leaving.  I’ve been on the run from myself every since.  It’s only been very recently I decided that when my enlistment is up I am going back to Iowa and I am going to build a real life there.

are when I wish I could still pour my soul into a six string the way I used to.

are when I wish I could be as broken on the outside as I feel on the inside and be taken home by a well meaning woman to sleep pathetically beside her. Me feeling blessed by her presence, and her by my tears.  It’s a primal feeling that I can never entirely shake.  It’s not about sex, just acceptance.  (The strength of that feeling is why I don’t get drunk, and why I don’t frequent bars, btw.)

are when I wish I could still go the community art class I took in highschool, and turn out delightful abstract nonsense on the potters wheel.

are when I wish the claims of religion had evidence, so I could believe them.

Some of these things have consequences I will not risk.  Once upon a time, these feelings made it hard for me to hold down a job, but I’ve learned to live with them.  It is rare, this early in my blue swing that I will wake up tomorrow and feel better.  Once this starts it takes about two weeks to work out.  But, it will get better.  There will be moments of dark clarity, moments of where melancholy poetry is possible, moments where, because of frailness a single kind word will carry me up to the sky.

It’s not bad to be me.  Sometimes it’s just harder than others.  I will not say there is something wrong with me because this happens to me.  I’m not damaged, just different.   Sometimes I look at sunrise and I see the glory of a new day.  Sometimes I look at sunrise and I try and find those happy hopeful thoughts, but all I can feel is the pressing blackness of another day of struggle.   Regardless of whether I see darkness or light, I’d rather be the me I am then try to be someone else.

Maybe that someone else, that perfect Christian self who didn’t feel those ways was the person I was running away from for all those years, and “home” was wherever I didn’t think I had to keep up the masquerade.

September 1, 2009 Posted by | atheism, Christianity, Religion, Self discovery, skepticism, Slice of life, Uncategorized | , , , , , , , , | 3 Comments