The Health Care Swamp

View 707 Thursday, December 29, 2011

Mark Steyn, substituting for Rush Limbaugh this morning, says that Newt Gingrich is wrong on first principles: it is simply wrong in a free society for the government to require you to have health insurance, and anyone who believes that is beyond the pale, a liberal or socialist, not a conservative.

In fact Gingrich hasn’t been quite so clear in his “endorsement”, but leave that. Is it true that any consideration of mandated insurance is simply anathema?

Well, we can postulate that a free country ought not dictate what its citizens should buy, and that is perhaps a fundamental principle. Yet while there is certainly a sense in which that is true, it neglects other principles and facts, none of them particularly obscure.

To begin with, it is certainly no less conservative to insist that someone pay for his own health insurance than it is to insist that someone else pay for it. If you aren’t obliged to provide your own insurance, should someone else be so obliged?

And that is the essence of the health care debate.

One answer is that no one is obligated to pay for anyone’s health care insurance. It’s a free country and you’re free to have insurance or not, as you determine by your needs and income. That was the case for most of the history of this Republic: you’re on your own. If you get sick, pay your own bills. If you must, seek charity, or else be sick, languish, suffer, and if your illness is sufficiently severe, die. This is a free country. You are free to pay your own way, but you are not free to demand that others pay your medical bills.

Of course if you have had the forethought to buy health insurance, you are in good shape. If you have not, then pay your bills. Whatever you do, this is no business of the government.

The problem is that this doesn’t really seem acceptable. People are born with defects that prevent them from getting medical insurance. Others develop problems. These people encounter the problem of “pre existing condition.” They plead they would have bought health care insurance but the pre existing conditions make the premiums too high. Others say they once were insured, but when their conditions developed, the insurance company dropped them. It is barbaric simply to ignore all these people. In order for a man to love his country, his country ought to be lovely. Look at these innocent victims. Surely we must do something?

And over time, particularly in boom times when the nation was getting richer, in many parts of the country and perhaps nationally, a new consensus was developed: first, that there ought to be a safety net, then that people have a right to health care insurance, and their birth defects, or health problems developed over time, should not prevent them from obtaining it. Nor is it fair for the insurance companies to charge premiums consistent with the risks the company is assuming.

Thus came the demand for health care insurance available to all at the same price. Of course that’s not insurance at all except in the sense that we are all insuring each other: we all pay and we all benefit. But that requires that we all pay, without exception, and that requires mandated insurance, and we’re back to where we started, except that now we find it is the will of the people that there be this universal insurance policy. Can’t we just accept that and get on with it? And thus Obama Care, modeled in some ways on the Massachusetts system implemented by the Democratic legislature of Massachusetts and the Republican Governor, then Mitt Romney.

And there we are. Meanwhile, the costs skyrocket, in large part because those who receive the benefits are not those who pay for them, and those who pay for them have no control over what benefits are paid. Everyone wants the system to deliver more but cost less. This squeezes some health care providers while opening up the gates to fraud for others. If a system were designed to insure runaway costs while infuriating dedicated health professionals it could not work better to accomplish those nefarious purposes than the system we have now. It doesn’t work, we can’t afford it, and it tramples what we once thought were liberties; yet how is it conservative to overlook people dying in waiting rooms? Or –

That discussion can go on for a long time, and involve any number of well meaning people.

It hardly matters whom we shall elect as President so long as these fundamental questions continue unresolved, and castigating one or another of the candidates as not sufficiently conservative does nothing until we establish just what is a conservative position. No one wants things to go on as they do. No one wants to bite the bullet and come out for “Death Panels” — health care committees that allocate the available health care resources. There doesn’t seem to be much desire for simply nationalizing the health care system and having done with it. And every year, we spend more money and get less for it.

There aren’t many ways out of this swamp, and none that will not infuriate some people. And it’s never going to be addressed if it becomes a third rail, a subject discussable only at peril.

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It does seem to me that there is a constitutional solution: make it clear that the federal government has neither the obligation nor the power to solve it. National health care perhaps ought to be a national concern, but it is not mentioned in the constitution, and thus is not a power granted to the Federal government. If this be any government’s concern it is the business of the states. One may argue that all government ought to get out of the health care business, but that, surely, is a matter of politics; but I argue vigorously that as concerns the Federal Government, it is not politics but law. The Constitution didn’t give the Federal Government that power, just as it did not give the Federal Government the power to provide, interfere with, or regulate education.

Leave these matters to the states. Meanwhile, if the Congress wants to show how well it can provide health care and education, it has the undoubted right to take over the health care and education systems in the District of Columbia. Let it show how well it can do there. If what it does works well, it may be tried by the states. If it turns into a bureaucratic mess, the states can avoid the Federal methods.

Leave these matters to the States. Get the Federal government out of the health care and education business.

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December 29, 2011 1100 AM

I’m writing this at the kitchen table on Khaos, my Mac Book Air. One set of workmen have left. They finally found the cracked and leaking six inch of gas pipe. This was the third attempt. Each previous time ended with supposed success, but turned out to be This Time For Sure. All would be well for a couple of hours and then we would smell gas. The first time was at ten PM. The Gas Company technician, a very pleasant man who turned out to have kids who read science fiction so I gave him a copy of Starswarm, was able to show us how to turn off the section where the leak was while leaving the water heaters, but because it was after ten PM he was alone and they don’t crawl under the house unless they have a partner. Yesterday the contractors came out twice, and each time thought they had found it, but last night there was once again the smell of gas. This time they actually found a pipe with an actual crack in it, and replaced it. They’ve been gone for an hour, all the relevant valves are open, there’s heat in Roberta’s bathroom which was the whole point of the operation, and there is no smell of gas in the hallway. I believe we can at last rejoice.

The moral of the story is that Roberta’s persistence in finding a reliable firm to do the work fixing her bathroom heater has paid off in spades and big casino.

Now she’s out taking Sable for a walk, and I’m sitting at the kitchen table while the plasterer fixes our ornate dining room cornice which was damaged by leaks from my upstairs bathroom, which had to be repaired and – but you get the idea. Chaos Manor has been sufficiently chaotic for the month. With luck it will all be over by Saturday. Meanwhile one of us has to be downstairs while there are workmen in the house, which is why I am working with my wonderful Mac Book Air at the kitchen table.

I’d forgotten how nice the Air is for working. My normal work position involves a Henry Miller chair and a keyboard at precisely the height I want, and big monitor screens. I don’t have any of that at the kitchen table. It takes a bit of getting used to. First I set the Air far enough back on the table so that I can rest my arms on the table and my fingers properly on the keyboard. Strange at first, but after a few minutes it turns out to be very natural.

Of course the Air saved my sanity back when I was getting my brain burned out – 50,000 rads of high energy X-rays to eliminate the inoperable lump in my head – and I was daily in the Kaiser Sunset radiology facility waiting room. I was able to work there, and that’s about the only thing that kept me sane. Clearly the treatment worked since I am still here and they can’t find any traces of cancer left.

Of course the Air saved my sanity back when I was getting my brain burned out – 50,000 rads of high energy X-rays to eliminate the inoperable lump in my head – and I was daily in the Kaiser Sunset radiology facility waiting room. I was able to work there, and that’s about the only thing that kept me sane. Clearly the treatment worked since I am still here and they can’t find any traces of cancer left.

The Mac Book Air – mine is named Kaos for the Goddess of Air – is a remarkably useful device. I don’t think it’s quite enough computer to be one’s only system, and my main machine remains Bette, a quad core Windows 7 machine and a 23” screen. If I am going somewhere for days and I need a system to set up in the hotel room and leave it in place, I tend to carry a ThinkPad; but for just knocking about writing wherever I happen to be, cruising the Internet at need, and just generally having a computer to use, the Air is wonderful. Lightweight, good battery life, gorgeous to look at, and easily carried in a small brief case or messenger bag. She’s not fast but she’s fast enough, and she’s easy to use in awkward places.

And, suddenly, all is well. The gas lines are fixed, the plasterer is done, Roberta is back from her walk, and I can go back up to the office. I can say I enjoyed resuming my affair with Khaos. She really is gorgeous.

For some of my early impressions of the Mac Book Air, see http://www.jerrypournelle.com/view/2008/Q2/view512.html

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At work at the breakfast table with Khaos, the Mac Book Air.

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Khaos at work. The Mac Book Air (mine is an old one, of course) is my favorite carryable if I need to get some real work done.

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Did the real Cheetah die in 1938? A chimp named Cheetah died at 80 this week, but the conspiracy theorists claim that the real Cheetah died, and this one is a fake.

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There was apparently a major problem with the site today. It has been hacked up and fixed, although there’s now contemplation of some internal structure changes (which you won’t see).  I believe all is well there now. Thanks.

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Fiction Time; nasal pumps; dragons to slay

View 707 Wednesday, December 28, 2011

The house has been filled with workmen again, and Niven came over with some contracts for the Chinese translation rights to MOTE and HAMMER. Fairly decent payments for five years worth of translation rights to old books. Print is still worth something.

Once Niven was here the dog made certain that workmen or not, we were going to take a hike. She likes Larry. She’s also insistent. We set out with a goal of going about halfway up, but we got to talking, and there were lots of gophers, and it was a very pleasant day. The upshot was that we went all the way up to the summit, 2 miles and 700 feet elevation, and by the time we got there we had a new character, a better story line, and a pretty complete reshaping of the book. It’s going to be a humdinger. Maybe it will be around and worth something forty years from now.

We continued the discussion and notes over lunch, and I pretty well exhausted myself physically and mentally. I have a lot of fiction work to do. Things may be a bit thinner here for a while as I work on this. I know where we have to go, and it’s time to get us there.

I have chosen some mail comments which I include here because I haven’t time to write my own essays on the subjects, and I think they are important topics that need consideration.

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For amusement you may want to look at http://www.theregister.co.uk/2011/12/15/climategate_police_action/ . In particular, play the video; it’s both amusing and chilling.

Thanks to Tracy.

Subject: The green police are taking it to a new level:

http://www.theregister.co.uk/2011/12/15/climategate_police_action/

Tracy

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Brain-Eating Amoeba Fatalities Linked to Neti Pots

http://www.foxnews.com/health/2011/12/19/brain-eating-amoeba-fatalities-linked-to-common-cold-remedy/

I seem to recall you recommending a high-tech version of this device.

Tim of Angle

I do use a nasal pump, and I have always used Los Angeles tap water out of the hot water tap, along with the powder that comes with the pump. The brand I use is Grossan, and at one time I had a link to their site, but they seem to have changed hands or something. It’s easy to find if you’re looking. I always clean the system before and after use, but I have taken no other precautions. Those who live in water districts that might allow amoeba to infest the tap water, or those who draw their own water from wells or cisterns, should be more cautious and probably boil hell out of the water before using it, or use some other source of water. Injecting amoeba into ones sinuses is not likely to have a good outcome.

On the other hand, I have been using the Grossan nasal pump and their powder for more than a decade, and they have proved to be the best way I know to deal with pollens, allergies, and other sinus problems. My experiences have been entirely positive, and I’d hate to be deprived of the system. Prior to getting the Grossan pump I tried a number of things in desperation, including “Fresh Snake Biles” in a rather evil smelling concoction I would not recommend to anyone else. The “Snake Biles” actually worked, but nowhere near as well as the Grossan, and I haven’t been tempted to try to find any more Snake Biles.

Clearly I won’t be responsible for anything that happens to a reader who tries a nasal pump. I’m not a physician. I can only say that my experiences, using Los Angeles tap water from the hot water tap have been positive and pleasant with what I consider a good outcome and this has been the case for a decade.

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Spengler > Civil War as the Second-Best Option

Jerry

Spengler is at it again. He takes Voltaire’s saying that the best is the enemy of the good and examines the current Middle East with an eye to what is good for the U.S. He says civil war is the second-best option, and is therefore better than some other outcomes:

http://pjmedia.com/spengler/2011/12/23/civil-war-as-the-second-best-option/?singlepage=true

“The best has been the enemy of the good throughout. Pursuing the fantasy of a “best” option — stable and democratic Muslim states — has cost us too much blood and treasure, and above all, far too much in terms of the morale of the American public. . . . I warned in April 2008 that: “it was illusory to believe that the US was capable of creating a stable to regime to replace [Saddam]. To prevail in the regime meant an unending series of small interventions and unending chaos in the region, with hideous humanitarian consequences. Cardinal Richelieu had the stomach to pursue such a policy towards the German empire during the Thirty Years’ War of 1618-1648, but not Bush. Yet a Richelovian policy towards the Middle East, horrible as it would be, is the inevitable consequence of American interventionism.” [end of embedded quote]

“Americans are not cold enough to initiate a Richelovian campaign of destabilization. But whether we like it or not, a general destabilization has overwhelmed North Africa, the Middle East, and parts of Central Asia. We did not seek it. We did our best to prevent it. Our hands are clean. Unlike the Reagan administration, which did its best to prolong the Iran-Iraq War with its million casualties, the Bush administration tried to avoid such conflicts. Now that we are stuck with humanitarian catastrophes of biblical proportions, we had better make the best use of them. Never let a crisis go to waste, as somebody said during his 15 minutes of fame.”

<snip> “The analogies to be drawn between America’s strategic situation today and the Peloponnesian War are few; those with the Thirty Years War, much closer to our own times, are strong. It is dreary stuff; there is no-one to root for, no white hats or black hats, just a mass of misdeeds that killed off about two-fifths of the people of Central Europe between 1618 and 1648.”

He finishes with: “Like it or not, circumstances will force us to think this way. Might as well get a head start.”

Ed

The question is, what are our international obligations? Are we to be involved in territorial disputes in the Middle East (or in Eastern Europe? Caucuses? How did the American people get saddled with such obligations.

The only acceptable answer, at least to me, would be that the American interest is best served by our interventions; an international rescure, it would seem to me, should be subject to a Congressional resolution. But then I have been against all our interventions since the Cold War ended. I think both the United States and the world would be far better off had we invested the $Trillions our wars have cost in the development of American energy sources and energy independence. Had we declared war on energy shortages we would long ago have won that war, and we would not be in such crushing debt. But then I said that prior to our interventions.

I have great admiration and regard for our military, who have performed well and efficiently while suffering from a lack of mission definition; but had they been put to work drilling oil wells and building Space Solar Power Satellites we’d be a lot better off, and while such developments always cost lives, I expect there would not have been thousands.

We are the friends of Liberty everywhere. We are the guardians only of our own. I see no need for a policy different from that, but I am willing to have it debated. Perhaps we ought to intervene to prevent genocides, but our record in that regard is not so great. We stopped the slaughter of Albanians in Serbia by giving part of Serbia to the Albanians; the result has been the genocide of the Serbs in that area. It is not clear that this was in the US national interest. Perhaps it was a moral triumph although neither the Serbs nor the Russians believe so, and the people of the Lower Danube have not really recovered from the economic damages we inflicted on the area. As to Iraq, the story there is not over: I hear little from the Kurdish region of Iraq. I think that silence will not continue. We have withdrawn from Iraq; we are not loved there; and we have left behind auxiliaries who helped us and to whom we have an unfulfilled moral obligation. Civil War between the Sunni and the Shiites in Iraq is not improbable. Iranian intervention is not unlikely.

We did go abroad seeking dragons to slay. There have been consequences. There will be more.

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The below is from a friend of mine and contains information I believe of importance to you and our country. You can find out more about Dr. Kupper at his website: http://chinaresourcesgroup.com/about.html

Cheap energy = prosperity!

Drill here, DRILL NOW!

David Couvillon

Colonel, U.S. Marine Corps Reserve, Retired.; Former Governor of Wasit Province, Iraq; Righter of Wrongs; Wrong most of the time; Distinguished Expert, TV remote control; Chef de Hot Dog Excellance; Avoider of Yard Work

Subject: Harbinger of the Near Future

For anyone watching the events unfold in the world economic arena for the past two years, it is has been obvious that China has become extremely concerned regarding the devaluation of the U.S. dollar under the policies of the Obama administration. This includes, most notably, not only our massive foreign debt, but the policies of the Fed and Treasury in just printing increased amounts of paper money to put into circulation. It is a classic case of the debasement of the U.S. currency. Consequently, China has increasingly lost faith in the value of the U.S. dollar, both short term and long term, to serve as the defacto currency for world trade. When China suggested, last year, that a new currency be created for world trade, preferably through the IMF, this idea was quickly shot down by the U.S. and Europe.

The response of China would naturally be to either replace the U.S. Dollar with the Chinese Yuan or to make the Chinese Yuan a currency equal to the Dollar as the vehicle for foreign trade. About two years ago, China began, on a limited basis, to utilize the Yuan as the basis for trade with selected countries in Southeast Asia. Following the typical and rational Chinese approach, they experimented with this for the past couple of years and found that using the Yuan as the basis settlement of trade between China and these select countries was working quite well. Now, in what I consider to be a major step forward, and one which seems not understood or appreciated for its significance, the Chinese have expanded this to the their trade relationships with Japan. In this morning’s report on CNN, in the discussion of the meeting between the Japanese Prime Minister and President Hu Jintao of China, the following sentence appeared, buried in the overall story of discussing Japan’s desire for China to control North Korea.

“Both sides also signed energy conservation and environmental protection agreements, along with an announcement that the two sides will use their own currencies in bilateral trade rather than U.S. dollars in an effort to encourage economic cooperation”

This now means that trade between the world’s second and third largest economies will now occur using the Chinese Yuan and the Japanese Yen, and not the U.S. Dollar. The Chinese Yuan is becoming the currency for trade in Asia. Probably in another 2-3 years, the Chinese Yuan will become a freely convertible international currency and come to dominate trade not only with Asia, but with Europe. The age of the U.S. Dollar as being the predominant world currency has now begun to become a memory. True, it will take several more years for the figures to be revealed and reported in world currency markets, etc., but with this announcement between the second and third largest economies in the world, the roadmap is quite clear for the future.

And with all of the occurring, we proceed in our own ignorance to have Presidential primaries where the debates remain centered around religious values, abortion rights, divorces, and a host of extraneous issues. In our own ignorance, we continue down the failed road of European socialism and have become a nation of entitlements and cheap currency. There is a dearth of leadership in our nation, and the fault lies with both political parties.

= = = = =

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School Lunches in Los Angeles

Jerry:

In light of recent items you posted regarding the new lunch program put together by the LAUSD, here’s a link to Megan McArdle’s comments on why, despite a very successful pilot program, the lunch program is a miserable failure.

http://www.theatlantic.com/business/archive/2011/12/why-pilot-projects-fail/250364/

Among her remarks:

* This is one more installment in a continuing series, brought to you by the universe, entitled "promising pilot projects often don’t scale <http://www.theatlantic.com/business/archive/2011/01/the-value-of-health-care-experiments/70106/> ".

* Sometims the "success" of the earlier project was simply a result of random chance, or what researchers call the Hawthorne Effect.

* Sometimes the success was due to what you might call a "hidden parameter", something that researchers don’t realize is affecting their test.

* Sometimes the success was due to the high quality, fully committed staff.

* Sometimes the program becomes unmanageable as it gets larger.

* Sometimes the results are survivor bias.

"So consider the LAUSD test. In the testing phase, when the program was small, they were probably working with a small group of schools which had been specially chosen to participate. They did not have a sprawling supply chain to manage. The kids and the workers knew they were being studied. And they were asking the kids which food they liked–a question which, social science researchers will tell you, is highly likely to elicit the answer that they liked something.

That is very different from choosing to eat it in a cafeteria when no one’s looking. And producing the food is also very different. Cooking palatable food in large amounts is hard, particularly when you don’t have an enormous budget–and the things that make us fat are, by and large, also the things that are palatable when mass-produced. Bleached grains and processed fats have a much longer shelf life than fresh produce, and can take a hell of a lot more handling. Salt and sugar are delicious, but they are also preservatives that, among other things, disguise the flavor of stale food.

I think one anecdote in the article is particularly telling. People complained that salads dated October 7th were served on the 17th–and the district responded by first, pointing out that that was the "best served by" date, not the date when the food actually went bad; and second, removing the labels because they were "confusing". Now, as anyone who has forgotten to eat a bag of lettuce knows, while it may not actually be rotten after 10 days, it probably doesn’t look much like something you’d eat voluntarily. This is not something that you can change by stamping a different "sell by" date on the container. If that were my choice, I too would come to school with a backup bag of Cheetos."

It’s worth reading the whole thing. And maybe follow it up with some readings on systemantics. http://en.wikipedia.org/wiki/Systemantics

………….Karl

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