Ronin of the Spirit

Because reality is beautiful.

Health-care Debate IX

So, I was asked on the last post, what DO I support…

I believe in freedom, as defined by the Wiccan Rede: “If it harm none, do what you will.”

One of the freedoms we have is to buy and sell and start and stop business.  That’s a free market and it works like this: if there is demand, then the market supplies it.  The higher the demand the higher the price.  This makes sure the supply is never exhausted, because the higher the demand is the more the supply is rationed by price.  Its self regulating, efficient, and simple.  The only problem is amorality: the free market only follows the back half of the rede “…do what you will.” and completely ignores the the first part.  It’s self regulating nature does not include moral regulation. The free market is just a tool; it can be used for constructive or destructive purposes or for just sort of plodding along.

If all free markets were perfect markets, the market would need little moral guidance.  Simple things like: “You can’t buy or sell people” or “Only certain parties can buy and sell substance X” would be all the morality the market would need.  Perfect markets mean all actors are rational, there are no hidden costs, and the buyer and the seller both have all the information they need to make a rational decision.  The problem is, “free market” means free to be a perfect market, or a highly imperfect market.

Remember that a perfect market requires rationality of all actors?  What about when the market actors are highly irrational? In a disaster the price of staples tends to skyrocket in a free market.  Now, in a perfect market this would be a good thing.  Raising the price would ration access to the supply, ensuring that vital commodities only go those who really need them and preventing the exhaustion of supply.  Unfortunately, the first thing to run out at ground zero is rationality.  The people who can afford the goods at any cost by all of them (far more then they need).  They sit on top of their horde, and no one else gets any.  (This is why the government often controls prices and access to goods in an emergency.).

In fact, I think I can make the case that irrationality is the cornerstone of the free market.  There is no real, functional difference between a Chevy and a Pontiac, but people pay more for the Pontiac because they are irrational.  People pay hundreds of dollars for Nike shoes that cost the Nike corporation a few dollars to produce because they are irrational.  Brands, in general, are irrational.  People will tell you “I like this brand because it stands for X,Y, and Z.”  Actually it doesn’t.  Every brand stands for the exact same thing: money for the owners.  That’s it, nothing more nothing less.  Various CEO’s have actually been taken to court for trying to say they had a responsibility besides money for the owners.  The stock holders always won.

Because of irrationality, the free market fails to do what the perfect market does: lower the price to the lowest level the producer can sustain.  Instead, the free market produces a ladder of products with the cheapest and lowest quality going to the poorest and the most expensive and highest quality going to the rich.  In most of what we do, this is perfectly fine.   Jim Beam bourbon is about $15 a 3/4 liter.  Jack Daniels about $20, and thats just fine.  I absolutely support a free market for booze, because it’s not something anyone actually needs anyway.  I support a free market most of the time.  When it evolves to a perfect market thats even better, but often people are too bloody irrational for that.  That’s fine too. Freedom means the freedom to be irrational.

I think, however, that health-care is good case for government involvement.  This is because the ladder will apply to health-care.  The rich will get the very best doctors, and the poor when they can afford them at all, will get the very poorest.  I think that such a situation is immoral.  It’s fine and dandy for the rich to get the best houses, cars, TV’s and booze, and the poor to get the worst.  It’s not so fine for the poor to get the worst health-care.  I think it is immoral for people to have to die or suffer just because they are poor.  I also think, in general, it is immoral to take people’s money even if you are doing it to help others.  In the end, I think it is more wrong to let the poor suffer and die then to let the rich keep what they worked for.

Thus, I support a national health care plan.  Research shows the single payer model to be the most cost effective, so that is the model I support.  So, would I vote for the Obama plan were I allowed to?  Absolutely not.

Any program which requires a large, strong, national government must be in violation of the constitution, if not in letter, then in spirit.  As a result, it will be a bass-ackward band-aid whose form is characterized by what is necessary to pass through the constitution and not what is best for the American people. I cannot support any national plan, or any national goal, in the absence of 4 things: a new constitution, Condorcet voting, proportional representation, and a national assembly.

The current constitution is made for a weak, small federal government.  If we need national health-care, and I think we do, we need a new constitution which produces a cohesive, rational, strong, large, federal government.

Condorcet voting: a strong, national government and the constitution which allows it can be a great assistance to the people, or an unholy terror of the Soviet type.  The only way to keep the government, by, for, and of the people is democracy, and Condorcet voting is, frankly, more democratic.

Proportional representation is the same.  It gives more voice to more people, and helps keep multiple parties.  Condorcet voting is pretty useless if there are only two contenders for every election.

Finally, a national assembly.  National programs need to be overseen by leaders elected nationally, not a national collection of leaders elected locally.  All legislators need to be elected by Condorcet voting, and the Senate needs to be elected in a coast-to-coast popular election.  Baring these changes, placing the national health-care in the hands of the existing system would be a cure fare worse then the disease.

Remember the bridge-to-nowhere? Get ready for the hospitals for no one.

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October 12, 2009 Posted by | atheism, Government, Pharmacology, Politics, Religion, skepticism, Uncategorized | , , , , , , , , | 1 Comment

Health-Care and Socialized Medicine (Health-Care IIX)

I am a member of the US military. It’s not something I talk about on my blog a lot because there is not a lot I can say about it.  I can’t say anything that would reflect poorly upon my branch, the Air Force, and it is important that in any political or religious thing I say that I make very clear what I am saying is my opinion alone, and does not in anyway constitute an Air Force or DoD agreement or disagreement with my point of view.  Further, I cannot reveal any information that about what I am doing at work that you wouldn’t get from the base website, because I could inadvertently reveal sensitive information.  (My job isn’t that cool; I put gas on planes, but that’s the policy.)

The above paragraph is over 100 words.  It’s a pain in the rear to throw that boilerplate on any blog I do that mentions work, but this subject is important to me so I believe it is worth the hassle today.  So is it clear to everyone this is my view and in no way reflects the views of the Air Force? Good. I want (surprise!) to talk about health-care.  You see, when I get sick….

I go to a medical clinic which belongs to the government, whose every operational bill is paid by the government, and I see a doctor or nurse in a government uniform, whose every paycheck is signed by the government.  He or she writes me a prescription which I take to the government owned pharmacy, and the pharmacist, wearing a government uniform, who is paid by the government takes the pills the government paid for, and gives them to me.  And I never, ever, see a bill.

Now, there is a name for the sort of medicine where the government owns the hospital and everything in it, pays all the employees, pays for all the drugs, and never charges the patients anything, regardless of income.  It’s called SOCIALIZED MEDICINE.  So, if socialized medicine is so bad, why does the military have it?

The number one answer I get is that we in the military deserve our benefits. (Implying, I guess, that the unwashed, unpatriotic masses at home don’t, but that’s not my point.)  My somewhat biased opinion is that the US military deserves the best health-care available. And the statistics say we have it…and oddly enough that we are very happy with it, and don’t want to have to pay our own way, or have to find which of hundreds of competing hospitals has the most affordable rates, or read hundreds of pages of insurance documents.   The service members I know, don’t want more competition, or a system in which the service members who make the most, get the best care.

How un-American of us.

October 9, 2009 Posted by | Government, Pharmacology, Politics | , , , , , , | 2 Comments

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

Health Care Debate IV

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.

August 30, 2009 Posted by | atheism, Government, Pharmacology, Politics, Religion, Science, Self discovery, skepticism, Uncategorized | , , , , , , , , | Leave a comment

Miley Cyrus is not a pole dancer.

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”.

cusl02w-miley

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

miley-cyrus-pole-dancing-teen-choice-awards-03

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…

Miley-Cyrus-pole-dancing-20090810212121

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.

August 29, 2009 Posted by | atheism, Christianity, feminism, Politics, Religion, Self discovery, skepticism, Slice of life, Uncategorized | , , , , , , , , , , | 8 Comments

Health Care Debate III

I thought this was going to be an easy post.  I thought, hey, the insurance companies are a bunch a bastards, but it turns out insurance companies, while not blameless, are not quite the devils I’d thought.

Basically, health insurance is expensive because (1.) Continual, long term expenses are a really stupid thing to pay with insurance. (2.) Hospital bills are really high and require high premiums.  Could insurance be improved? Certainly, but it is not the real cause of high medical bills.

So, then I went into why hospital bills are so high.  Basically hospital bills are high for a few reasons. (1.) Fear of litigation, rather than litigation itself, causes a lot of unnecessary stuff to be done.  (2.) Hospitals are a skilled labor intensive industry, and skilled labor is very costly. (3.) The existing socialized care costs the hospital about 15% loss off of net, or about a 40% loss off of gross.  Could hospitals improve administration and information management?  Certainly, but those are marginal gains compared to over-treatment and labor costs.

So, can hospitals be run cheaper?  Yes.  Should they be?  Should is a surprising long word. Every war in history has been fought between the S and the D of should. Should implies is an ideological question, not an economic one.

So lets talk about ideology.  First off, do you have a right to health care?  Absolutely!  You have a right to life, liberty and the pursuit of happiness.  Rights are tricky things though. The First Amendment says you have right to freedom of press.  Does this mean the government has to assist you in setting up your own news network? Or merely that the government is forbidden from preventing you from doing such?

You do have a right to life. You have right to not have the government forbid you from seeking health care. You categorically, do not have the right to have them provide it for you.  If you believe that health care is a right and the government must provide it, you must logically believe that government must provide printing presses to those to poor to afford them,  protests marches to those to poor to organize them, and guns to those to poor to buy them. (Your first and second amendment rights, respectively.)

Clearly, your right to life means the government cannot prevent you from seeking health care, not that it must provide it. So, accepting that fairly obvious fact, what is the health care problem? The fact the health care consumer is complaining health care costs too much really doesn’t amount to a hill of beans.  Consumer think everything cost too much.  Producers think everything goes too cheap. Demand drives prices up, supply drives them down. So, what’s the problem?

Two possible ones: false expectations and market failure.

First false expectation?  You are entitled to long life.  Actually you’re not. No one is. Long life is combination of four things, genetics, choices, luck, and health care.  You know what the leading cause of death is in the United States? Heart disease. You know why that is pathetic? BECAUSE 80% OF IT IS PREVENTABLE THROUGH LIFE STYLE CHANGE!  That’s right, 80% (Harvard School of Public Health, Department of Nutrition)  Over 600K people died in 2006 from heart disease,  480,000 at the end of a series of stupid ideas.  Even if the US had the best health care in the world, even if by some economic miracle it was free, 20.8% of all fatalities would have happened anyway because people found health care more attractive than responsible living.

Second false expectation? The Law of Diminishing returns  doesn’t apply to health.  Actually it does.  Moving the age of mortality from 45 to 55 takes pennies.  From 55 to 65, took much more.  Surgery is a risk. We choose the risk of surgery when it is lower then the risk of not having it.  Unnecessary surgery means risk for no reason, and that means expense and injury.  Which leads me nicely into the…

Third false expectation: Doctors will make decisions dispassionately, and never expose patients to extra risk just to cover their legal rear.  Actually, doctors are people too.  And the fear of litigation hangs over them like anvil on string.  They order to many tests, and treat too agressively for fear of malpractice suits.  Which leads finally, to the…

Forth false expectation: people are entitled to a risk free life, and are entitled to compensation when risk has consequences.   No.  Just plain no.  Life is risk.  Hospitals, treatments, etc, all have risk, and if a person is made aware of the risks and choose the course anyway, they aren’t entitled to any form of compensation.

That just leaves market failure.  I try to keep my blogs under 1000 words, so I will have to write that one later.

August 27, 2009 Posted by | atheism, Pharmacology, Politics, Science, Self discovery, skepticism, Slice of life, Uncategorized | , , , , , , | Leave a comment