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.
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.
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.
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.
The purpose of market is to provide a place for the producer and consumer to form voluntary contracts. The market has no intrinsic morals and only one rule: the best deal. The producer makes supply, the consumer makes demand. Between them, and the competition of various producers to provide for various consumers, this constant desire for the best deal drives price ever downward. It rewards the most efficient producer and the most efficient consumer alike. It’s almost a kind of magic.
Market failure doesn’t refer to a total break down of the buying and selling but a break down of the magic, of the automatic best deal for everyone. It’s not discrete point, but direction the market can go. The opposite direction leads to the perfect market. It too is not a destination but a direction, the ideal by which markets are judged.
A perfect market consists of a few key principals, describing the market as a game it looks like this: (1.) Rationality of all players in the game. (2.) No hidden costs to any move. (3.) Enough players that no single one can steer the game by their behavior. (4.) something all the players want to play with [demand] (5.) Freedom to play or not play at any point (6.) No barriers to entering or leaving the game (7.) No barriers to any player about information on any other player.
How does the medical industry fail these criteria?
Rationality of all players in the game
(1.)Well, first of all, the medical consumers are highly irrational. Short term fun at the expense of long term health is not rational, yet 80% of heat disease alone is preventable. Throw in smoking, obesity, diabetes, etc, and the single greatest killer is short sightedness. In a perfect world, doctors would serve as check on this irrationality, but the fact is, doctors are over-treating (which gets people killed) because of their fear of litigation. The consumer is crazy and so is the producer.
No hidden costs to any move
(2.)The whole field is full of hidden costs. From regulations you never heard of to taxes you can’t imagine, the medical field is a minefield of hidden costs.
Enough players that no single one can steer the game by their behavior
(3.) Well, about half of the cost is payed for by one player (gov-care), and up to 70% of the remaining half is payed for by one company per area. Normally, this would be called oligopoly, but honestly, its worse than that. Because the first half is the government, its more like a oligopoly on the second half and monopoly on the first. Under normal circumstances, even if a player owns 50% of the total market, that player can rarely take away your organization’s legal right to exist, or place members of your organization under arrest. The government has what is known as a monopoly on force. Monopoly represents a market distortion. Force, on the other hand, represents the nonexistence of market. The foundation of market is people forming contracts of their free will, ie, without threat of force.
Something all the players want to play with [demand]
(4.) Demand, we’ve got. Sort of. The fact is, while doctors may not be the paragons of reason we hope, the producer side (as is typical in other industries) is better at being rational then the consumer side. If nothing else, it’s better organized. The consumer demand is health, not care. But doctors have no economic incentive to pursue health. They have need to produce care. So there is break down between the needs of the consumer and the ability of the producer to meet that need. Note, I am not saying there is a conspiracy by doctors to keep people sick. Doctors are like most people: there’s a few true saints, a few evil bastards, and lot of pretty ethical folk. But the fact is, we must relay on doctors’ moral incentive and not their economic incentive to provide us with health. Systems work better when the two incentives are the same.
Freedom to play or not play at any point
(5.) This one absolutely does not apply. Playing in this case means the freedom to form or not form voluntary contracts. If the consumer doesn’t enter the market he suffers or dies. At the same time, if the producers do not enter the market many suffer or die. Further, hospitals must provide emergency care to everyone, regardless of ability to pay. On the insurance side, insurers must provide insurance to at a loss to certain high risk people. They must by law.
No barriers to entering or leaving the game
(6.) Well, the barriers to entering the game are enormous. Lets say we want to start a tiny private practice, with very limited services. First, the price of becoming a MD is between $175K and $200K. Then, the first year cost for 1600 square foot commercial space, a receptionist and tech who makes no benefits is about $250K. So, minimum startup cost is right around half a million dollars. Nor can hospitals simply exit the market, they provide a community service and without them people will suffer and die. Insurance is the most heavily regulated industry in the US, so even if cash on hand was not a problem the regulations would be, but in any case, and insurance company must have the cash on hand to pay out all claims if they were all called at once. The startup costs for an insurance company are in the tens of millions.
No barriers to any player about information on any other player
(7.) This is the worst. Insurance companies use hundred page contracts written legalese on purpose, to hide the information the consumer needs to know. At the same time, insurance fraud is a huge expense, because people aren’t honest with the companies either. If people are totally honest with doctors, their premium could go up. Conversely, if doctors are honest about risks with patients, the patients will simply go to another doctor who paints a rosier picture. Again, the moral incentive is diametrically opposed to the economic one.
All in all, it’s a wonder health care is as cheap as it is. Again, I’ve hit over 1000 words, so I will post my solution(?) later. Thanks for reading all, feel free to weigh in on any of this.
Just a quick, throw away post about current events. (Health Care IV will come soon.) Ok, I don’t follow celebrity news, if fact I don’t follow celebrities at all. I’m a big believer in Cintra Wilson’s theory “Celebrity reexamined as a grotesque, crippling disease” . But I feel a need to weigh in on this one.
Miley Cyrus does not disturb me. What deeply, deeply disturbs me is what the world has done to her. She is a goddess of sexless purity. Parents make her hero to their daughters because she is pure, and clean, and good. We know that she is pure, and clean, and good because she is unsullied by any sexuality whatsoever. She has no sexual identity. Her gender exists completely in following social convention. She is the plastic, sexless ken doll of the age, to be dressed and positioned however the narrative of her sexless perfection demands.
The problem of course, is that I am describing a fictional character. This is not the flesh and blood Miley Cyrus, but the highly successful Miley Cyrus brand. Let me steal from Wikipedia here…
Careful brand management, supported by a cleverly crafted advertising campaign, can be highly successful in convincing consumers to pay remarkably high prices for products which are inherently extremely cheap to make. This concept, known as creating value, essentially consists of manipulating the projected image of the product so that the consumer sees the product as being worth the amount that the advertiser wants him/her to see, rather than a more logical valuation that comprises an aggregate of the cost of raw materials, plus the cost of manufacture, plus the cost of distribution. Modern value-creation branding-and-advertising campaigns are highly successful at inducing consumers to pay, for example, 50 dollars for a T-shirt that cost a mere 50 cents to make, or 5 dollars for a box of breakfast cereal that contains a few cents’ worth of wheat.
Ford doesn’t really have a personality. Diseny doesn’t have a personality. These are massive, multinational conglomerates. But people treat brands like people: they have personalities, values, wishes, etc. And the key to the $3.5 million per annum Miley Cyrus brand is the perverts’ idealization of childhood: A perpetual thirteen, one foot poised on childhood, one foot poised on sexuality. Perhaps Britney Spears said it best with the song “I’m not girl, not yet a woman”. Unfortunately for the Britney Spears brand, a perpetual gum chewing, curl twirling 13 year old did not appeal as much to the brand’s name sake as growing up. Britney Spears first real controversy? Her development of full breasts. She went, as most young women will, from a B cup to a C cup.
The spokes person of the brand shattered the sick fantasies of nation by having hormones. The response? Unchecked rage, which only grew worse as she committed such horrible sins having sex drive, or having adult relationships.
Back to Miley Cyrus. Her first controversy was a “topless” photo in Vanity Fair. The words “child pornography” were thrown around. Pornography has a fascinating entomology, being Greek for “Writings about whores”.
If this image is pornographic to you, you need to talk to a therapist. There is nothing sexual about this image at all. (See comment). Unless you’re a pervert. But by doing this photo, she make clear that she had intentions of becoming a woman. That at some point in the future there would a person who was experiencing sexuality instead being totally oblivious to it. And for that, all the perverts were up in arms. They wanted her to stand between girl and woman so they could desire her, but tells themselves it was a pure healthy desire. The image forced them to admit they were sexually attracted to her. And for causing that revelation, she had to become “bad”.
But the point here is Miley Cyrus’s most recent flub. SHE WAS POLE DANCING…SEE
Words like “pole dancing” “leather clad”, “provocative” “dressed like a hooker” were bandied about. Of course, the less popular version of this photo is this…
Yeah, see she wasn’t “pole dancing” she was hanging onto a pole on top of a moving cart so she wouldn’t fall off. It’s called a “stage show”. Her ability to do that, while lip syncing, dancing, smiling, and not smudging her make-up, is one of the reasons she makes a couple million a year and most of us don’t.
But the public has to do this. When ever Miley Cyrus the person (who actaully exists and has needs and desires) conflicts with Miley Cyrus the brand (which is pure fabrication to sell shitty merchandise) society at large must lose it’s pathetic little mind. Because if Miley Cyrus isn’t child anymore, she forces people to admit they are getting old and their attraction to her is a bit perverse. Thinking she is “dirty”, “slutty”, or “bad” is much easier then admitting they have problem. Miley Cyrus’s (TM) owners however, make a lot more money if this pathology is encouraged. Tellingly, the first person called in when she was accused of making child porn was not a lawyer specializing in anti-liable cases, or even a PR rep, but Disney brand consultant.
Oh, and my original thought, before this turned into a multimedia, decently researched post? Just because someone is famous, doesn’t mean they are a role model. In fact, it might just mean they’re not.