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 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 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

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

Environmentalism and Overpopulation: The Solution, Part V

This is the part where I describe my perfect utopian vision of a global society.  Except I don’t believe in utopia.  I have a lot of ideas, brilliant if I do say so myself, about the proper way to run government, which I will not say here.  If I just spout off what I think is perfect, and everyone else does to we still have no solution, which was the whole point of this post.  Further, I think one of the problems with existing governments is that they try to codify what they believe to be utopian, creating to a lesser degree what might be called the Soviet Paradox.  The logistics required to achieve the Soviet utopia require a bureaucracy which is totally incapable of achieving said utopia.  Though creators of an infinitely better system, the framers of the Constitution did a similar thing.  They took what they understood to be the most perfect solution and codified it.  We now fight that codification everyday.  The public demands socialism, in the form of Social Security and Welfare.  But the Constitution is purposefully written against socialism.  Thus, we end up with a really bass akwards version of socialism with a very high cost to benefit ratio.

Besides, I believe in the holiness of the perfect market: a place where all men can trade not only products, but ideas, and the person with the best ideas wins the most influence.  Who am I to say one system of government is best for every person in every place?

I offer instead a simple idea:  any geopolitical region of 5 million people or more (the size of Denmark) can chose to be an independent nation.  As an independent nation it choose to belong to any union it wishes.  Further, with a vote of it’s people and the people of any other nation, it can chose to become a state of another nation.  The unions will be modeled after the EU. 

In this way, countries with inefficient social services will be abandoned, and countries with efficient social services will be joined, all without emigration.  It creates a highly competitive market place for which country will get the most people, forces governments to compete to be the safest, freest, and lowest tax collecting.

The global government would take whatever democratic shape works best.

December 18, 2008 Posted by | Government, Politics, Religion, Self discovery, skepticism, Uncategorized | , , , , , , , , | 1 Comment

Obama’s red hoard

The following is the ten planks of the communist party as stated in the Communist manifesto:

 

  1. Abolition of property in land and application of all rents of land to public purposes.
  2. A heavy progressive or graduated income tax.
  3. Abolition of all rights of inheritance.
  4. Confiscation of the property of all emigrants and rebels.
  5. Centralization of credit in the banks of the state, by means of a national bank with state capital and an exclusive monopoly.
  6. Centralization of the means of communication and transport in the hands of the state.
  7. Extension of factories and instruments of production owned by the state; the bringing into cultivation of waste lands, and the improvement of the soil generally in accordance with a common plan.
  8. Equal obligation of all to work. Establishment of industrial armies, especially for agriculture.
  9. Combination of agriculture with manufacturing industries; gradual abolition of all the distinction between town and country by a more equable distribution of the populace over the country.
  10. Free education for all children in public schools. Abolition of children’s factory labor in its present form. Combination of education with industrial production, etc.

 

Ok,  let’s start from the the top.  (1.) “…property in land…”  They want to take away all the land! Actually no. This refers specifically to the form of parasitic land ownership practiced in Europe between about 1600 and 1916.   The modern use of money to make money is in factories, which requires active management.  So, despite a lack of laws abolishing it, it’s extremely rare in developed nations.

“…progressive or graduated income tax…” Got it.

“…abollition of all rights of inheritance tax…” Why abolish it when you can tax it as unearned income, at 60%

“…confiscation of the property of all emigrants and rebels..”  ie, illegal immigrants.  Glad to see Doctor Dobson and Engles/Marx agree on this.

“…national bank…with exclusive monopoly…” Aw, we can’t do that: not constitutional.  Let’s just make a US Treasury with all the same powers. Got it.

“…centralization of the means of communication and transport in the hands of the state.”  Like the FCC and the F DOT?

We seem to have only partially dodged (7.) and (8.)

“Combination of agriculture with manufacturing industries…”  Like the fact that the single largest receiver of US Dept of Agricultural subsidies is multinational super firm Monsanto?   (Who spent 3.6 million of their 8.5 billion on lobbying, by the way.)

“…Free education for all children in public school…”

So in order for Obama to not be seen as a socialist/communist he would need to (1.) Establish manorial farm management, (2.) Give tax breaks to the rich, (3.) Remove inheritance laws, (4.) Rob and imprison rather than ship out illegals (5.) Eliminate the Federal Treasury (6.) Eliminate the FCC and DOT, (7.)  Destroy the federally funded dams and canals in the Southwest which make agriculture possible there (8.) Refuse to let those on welfare work (9.) Eliminate the Department of Agriculture, and (10.) Make a constitutional amendment forbidding public schools.

So since, all of those programs have bipartisan support, doesn’t that mean the Republican party is also Communist? MY GOD, THE RED HOARDS! 

…Or, maybe, just maybe, we could admit that the US is a socialist democracy which uses a mixed economy which is predominately free market and includes many elements of command economy?

I’m not trying to be mean here, but how stupid are these people?  Yes, Obama is a socialist.  So is McCain.  “But socialist want to rob from the hard working and give to people who didn’t earn it!”  So what exactly did you do to earn the “EARNED INCOME CREDIT”?  The government is paying you to have HAVE PROCREATIVE SEX!  The government takes money from hardworking rich people without kids to pay it to you.   The government is paying for your kids to go to school.  The government is paying for your retirement.  The government is paying your workman’s comp.   The government is paying the interest on your college loans. This is a socialist society.  Freakin’ deal.

November 10, 2008 Posted by | Government, Politics, Religion, skepticism, Transportation, Uncategorized | , , , , , , | Leave a comment