Monthly Archives: October 2013

View 796 Thursday, October 31, 2013

All Hallows Eve

“Transparency and the rule of law will be the touchstones of this presidency.”

President Barack Obama, January 31, 2009

Christians to Beirut. Alawites to the grave.

Syrian Freedom Fighters

What we have now is all we will ever have.

Conservationist motto

If you like your health plan, you can keep your health plan.

Barrack Obama, famously.

One reason I try not to be involved in breaking news is that much of the information needed to understand what is happening simply is not available. This was the case with the statement that 160,000 Kaiser members had got letters of cancellation of their plans. There were no other details, including who and why.

This probably comes closest to an explanation:

Kaiser Plans

From BuyKP.org

Click through: 2013 -> get a quote

Has this disclaimer:

The plans offered on this site are available for coverage starting in 2013 and are effective through December 2013. Please note that all 2013 Kaiser Permanente plans will be discontinued on December 31, 2013, so that we can renew coverage on January 1, 2014, onto a new plan that includes all the benefits of the Affordable Care Act.

So all their plans are canceled, to be replaced by ACA plans

David LeFevre

I have not received any such notice from Kaiser, and apparently there are exceptions. At least I hope so. When we were first married we had the usual young people’s health care insurance through the aerospace industry: basically, we pay for anything normal and were insured for anything major. That lasted until the 70’s by which time we had four boys, and I was setting out on a career as a free lance writer, which meant that my income was, uh, variable. Roberta worked in education and got medical insurance through that. We determined that what we really wanted was Kaiser health maintenance, which essentially was, pay your membership dues, pay a reasonable co-payment per visit, pay your dental and eyeglasses bills, and Kaiser took care of everything. It wasn’t easy to get into Kaiser except through a group, and free lance writers were not in any recognizable group. We managed to get into Kaiser through Roberta’s employer, and that pretty well chained her to that job, and a long freeway trip every day. Eventually she needed to retire. By then I was making a decent income, and there was this thing called COBRA under which you got to keep your health care plan for several years by paying a not small but not unreasonable monthly fee, and when that ran out the choice was to continue with Kaiser and pay it myself, or go find something else. We chose to stay with Kaiser, and they took care of all of us as a health maintenance organization, and over the years I realized just what a good deal we had compared to most of my friends including many in the movie industry.

That lasted until I turned 65, when I was told my rates would go up by a factor of four, but I had another choice: I could let Medicare pay my Kaiser dues, and things would essentially go on as they always had. By then all the kids were out on their own and not covered under the Kaiser plan anyway. As far as I was concerned those were the only choices – I never even considered going anywhere but Kaiser where we had been happy for decades. So we chose the Medicare Advantage option and I took out some kind of supplementary insurance plan for a nominal monthly payment. It all went smoothly and when Roberta turned 65 some years later her Medicare payments went to Kaiser as well (in the intermediate years she had been covered at Kaiser under my account so far as I can tell – the payments I had been making to Kaiser had covered a family membership although by that time she and I were the only family members. In any event that was my status and when in 2008 I developed brain cancer and needed a long and expensive series of radiation treatments involving about ten specialists everything was covered including the parking fees for getting to the treatment center.

And all was well and all has been well. Our copayments are reasonable, high enough to discourage frivolous visits but not so high as to make us reconsider going to the emergency room when it seemed reasonable to do so. I don’t think Kaiser can be cloned into a universal health care system, but if it could be I’d be in favor of that. The people there don’t seem to be spending their time wishing they were somewhere else. Everyone is cheerful and friendly, from the orderlies to the medical specialists. It all works, and I have found that true at five local Kaiser establishments and one in Texas.

So when I heard that Kaiser was cancelling its memberships I was concerned. I wanted details. I have yet to find many. I do not know why.

Source of Kaiser Health News quote Re:Kaiser Permanente cancellations

Jerry,

Here is an email exchange I had today with Julie Appleby, one of the co-authors of the Kaiser Health News article about Kaiser Permanente’s cancellations …..

——————————————————————————-

Hi, thanks for your note. We interviewed Kaiser directly.

You can also find more information about enrollment in group and non group coverage in California in this report http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/C/PDF%20CAHealthPlansInsurersAlmanac2013.pdf

Best,

Julie

From: Steven Cooley [mailto:swcooley@me.com]

Sent: Wednesday, October 30, 2013 9:23 AM

To: Julie Appleby

Subject: Source for Kaiser Permanente cancellation number in Kaiser Health News article

Ms. Appleby,

In a recent article you co-authored in Kaiser Health News there is the following quote ….

"Kaiser Permanente in California has sent notices to 160,000 people – about half of its individual business in the state."

What is your source for this quote?

Thank you for your time and consideration.

Steven W. Cooley, M.D

The pdf referenced above doesn’t enlighten me very much, but it does present an enormous amount of information about health care financing in California. Indeed it tells me more than I really wanted to know.

What is clear is this: The Affordable Health Care Act, otherwise known as ObamaCare, will end a very great number of medical care plans. It is not true that “If you like your health care plan you will be able to keep it” or that “If you like your doctor you will be able to keep him.” Moreover, it was known at the time that President Obama famously made those promises many times. What it really meant is “If you like your health care plan and I think it’s good enough for you, you will get to keep it,” which is not quite the same thing. The purpose of the ACA was to end “inadequate” health insurance.

The new plans have all kinds of minimum coverage mandated by law: I am unable to confirm that the new plans require women older than 45 to have maternity care insurance, but that has been reported by many sources. There are a number of items mandated for the minimum plan acceptable to the ACA regulators; there is also the mandate that all plans must accept anyone applying without regard to pre-existing conditions. If you are in third stage pancreatic cancer, they still have to take you at the same premium that someone ten years younger and not afflicted will pay. That sounds wonderful, but what it means is that the younger healthy person must pay the same premium as the middle aged overweight person already suffering from pancreatic cancer; and that premium is going to be considerably higher than what the younger person was paying.

There are a hundred variations on that story, but that is the essence of it. And this is the source of the widening opposition to the Affordable Care Act: it turns out to be affordable for the old and sick, but not affordable to the young and well, whose best economic option is to have no health care at all, pay the fines (which are fairly nominal), and go take out a health care policy only when they are sick and need one. That is the best economic course, and it’s hard to show that it is not a moral choice. The alternative is for young people just starting a family to pay a substantial part of their income to support the medical care of older sick strangers; and it is not at all clear why they have a moral obligation to do that.

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/10/29/this-is-why-obamacare-is-cancelling-some-peoples-insurance-plans/ 

The President’s Broken Health-Care Promises

It was well known, even in 2009, that millions would lose their health plans under ObamaCare.

By

Karl Rove

For nearly four years, President Obama has frequently offered some variation of this promise about the Affordable Care Act: "If you like your health-care plan," as he said in a speech to the American Medical Association in June 2009, "you’ll be able to keep your health-care plan, period. No one will take it away, no matter what."

NBC News caused a kerfuffle on Monday when it reported the Obama administration knew for years that millions would be forced off their preferred insurance plan. This hardly amounts to a revelation: the president and his people, along with Democratic Party leaders, had to know that this would happen.

http://online.wsj.com/news/articles/SB10001424052702303618904579167611885025296

I call your attention to another article in today’s Wall Street Journal:

One Quick Fix to Ease the Coming Doctor Shortage

The White House proposes to cut on-the-job training for new M.D.s just when we need more physicians.

By

Atul Nakhasi

Ryan Scully wanted to be a doctor from the moment he began volunteering as a paramedic and firefighter during his freshman year of college. In medical school at George Washington University, he passed all of his preclinical and clinical requirements, as well as two national licensing exams required of all medical students. Just before graduation in 2012, though, he learned that he had not been accepted into a residency training program necessary for gaining his certification as a practicing physician. He would receive his M.D. degree in May with the rest of his class—but without a hospital training spot, he could not practice medicine.

Last year 1,761 M.D.s shared the same fate. And now the White House wants to set aside even less money for doctor training while reorganizing the nation’s insurance market. At a time when the new health-care law is expected to create a demand for more physicians, a proposed $11 billion budget cut over the next 10 years guarantees there will be fewer doctors. This could have a serious effect on the health of the nation.

http://online.wsj.com/news/articles/SB10001424052702303680404579139563450701076

I have before commented that the real bottle neck to entering the medical profession is the lack of teaching hospital residencies.

I suggest we consider setting up some at VA centers in major cities. This would have the advantage of insuring better treatment for veterans while meeting some of the looming doctor shortage. I can think of other places for teaching hospitals. Yes, they are expensive, but it’s amazing how much a billion dollars will buy even in these days.

We already borrow money to pay Bunny Inspectors. May I suggest we would be better off paying that money to finance internships and residencies for recent MD graduates?

Enough for the moment. I will wait for comments before going on. It’s lunch time anyway.

Subject: The VA and teaching

Jerry, you said in today’s column that the VA should set up teaching residencies in some of its hospitals in major cities. I think you should know that there’s no need for them to do this, as they already have. As you probably know (but your readers won’t) I’m under the care of several different specialists at either the VA clinic in Sepulveda or at the VA medical center in West LA. (It’s that big building just to the west of the 405 at Wilshire.) Except for my ophthalmologist and audiologist, all of my appointments are with residents, although their attendings also see me after the resident is finished. And, the first time I was hospitalized for my low platelet condition, I was asked if I’d mind being examined by several students. Naturally, I gave my consent and was examined, one by one, by about half a dozen aspiring doctors. I know that the Wilshire VA is a teaching hospital, and unless I’m badly wrong, most if not all of their major facilities are.

Oh I knew that many already exist: my point was that more would be a better use resources than many of the federal government projects we fund.  Expand what we have and open some more; and of course the VA need not be the only places.

View 796 Tuesday, October 29, 2013

“Transparency and the rule of law will be the touchstones of this presidency.”

President Barack Obama, January 31, 2009

Christians to Beirut. Alawites to the grave.

Syrian Freedom Fighters

What we have now is all we will ever have.

Conservationist motto

Regarding the source of the news that Kaiser cancelled 160,000 memberships in Northern California, all of those statements including the one in Forbes Magazine come from a single line :

“Florida Blue, for example, is terminating about 300,000 policies, about 80 percent of its individual policies in the state. Kaiser Permanente in California has sent notices to 160,000 people – about half of its individual business in the state.” http://www.kaiserhealthnews.org/Stories/2013/October/21/cancellation-notices-health-insurance.aspx

In a publication called Kaiser Health News. It was quoted in an NBC Health News story that ended:

Jay Hancock contributed to this story. Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. http://www.nbcnews.com/health/thousands-get-health-insurance-cancellation-notices-8C11417913

I have been unable to find any story from a northern California source listing anyone who had received this cancellation, nor have I heard from anyone who says his/her membership was cancelled.

I have this:

Kaiser Cancelations

Jerry

The low cost plans are being canceled. One gets a new plan in 2014.

Going to the Kaiser web site and getting quotes for my birthday [1957].

The new plans have new free services, that show up in your monthly bill.

For reference the plan prices:

Prices December 2013

Copay: $602, $555, $490

Deductible plans: $584, $487, $459, $415 HSA Deductible Plans: $448, $390, $318, $336, $258

Prices January 2014

Copay: $782, $727

Deductible plans: $715, $598, $596

HSA Deductible Plans: $571, $480, $446, $439

David LeFevre

But it has no source listed. I would have thought a story of 160,000 cancellations in Northern California would have caused at least news in that area, but I have been unable to find any. Our local Kaiser office was unaware of any of this when I called the PR department, and friends on staff locally have not heard of it. It is not astonishing – the ACA is going to cause restructure of many health plans – but the details are lacking.

One possible speculation is that a number of employers which offered Kaiser as one of the alternatives to the employee health care plan have withdrawn that option recently, but the bare statement that 160,000 memberships were cancelled does not seem to have any other source or support than the Kaiser Health News report that has been repeated by other publications including Forbes and NBC. I would be glad of any other information on this.

Added at 1530:

" Kaiser cancelled the memberships of 160,000 members in California"

Dr. Pournelle,

Don’t know about the numbers, but here is a decent explanation of why insurance would be cancelled:

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/10/29/this-is-why-obamacare-is-cancelling-some-peoples-insurance-plans/

Kit Case

All of which is true enough, and probably explains the mysterious “Kaiser cancelled 160,000” report. Apparently ACA has so many exceptions to the “you can keep your policy if you like it” section in the bill that it there are more exceptions than guarantees.  This is another reason for the sticker shock, and it is still happening. The Republicans offered to let Obama have a year off to fix ACA, but he turned that down in a huff.  He may regret doing that.

Obama admin. knew millions could not keep their health insurance – Investigations

http://investigations.nbcnews.com/_news/2013/10/28/21213547-obama-admin-knew-millions-could-not-keep-their-health-insurance?lite

From the article:

President Obama repeatedly assured Americans that after the Affordable Care Act became law, people who liked their health insurance would be able to keep it. But millions of Americans are getting or are about to get cancellation letters for their health insurance under Obamacare, say experts, and the Obama administration has known that for at least three years.

John

No one is astonished to learn that many cannot keep their old insurance policies because the policies will be cancelled: after all, the insurance company calculated the premium on the basis of no existing medical conditions – pre-conditions – and now if the policy is continued they must accept those with pre-conditions or acute maladies at the same premium cost as they used to charge for those without pre-conditions. That is a formula for bankruptcy; so the policies must be cancelled, and the coverage offered to the previous holders at the new premium rate which will have to be considerably higher than what they used to charge, or they can’t stay in business. You can’t pay out more than you take in and continue to exist.

http://www.sciencedaily.com/releases/2001/02/010212075309.htm# implies that Einstein’s Special Theory is falsified. It also invites revival of an ether theory (a medium in which light waves can wave). Michelson, whose experiment was the main impetus for the Special Theory that abolished ether, never accepted the Special Theory, but Relativity both Special and General are accepted by nearly all physicists (if not understood well by very many of them; the math is brutal). Petr Beckmann in Einstein Plus Two (alas, long out of print and never reissued, but popularized by Tom Bethell in Questioning Einstein http://www.amazon.com/Questioning-Einstein-Is-Relativity-Necessary/dp/0971484597) presents an ether theory to wit, that the ether is gravitational fields, which he says is consistent with all the observations including GPS and the clocks east and west phenomenon**, but with much simpler math. That theory would be consistent with these observations as well.

Obviously science fiction writers would be pleased to do away with the Special Theory and its absolute limit to the speed of light, but most, including me, have written around it one way or another.

** Note: On October, 1971, J. C. Hafele of Washington in St. Louis and Richard Keating of the US Naval Observatory in Washington, borrowed two cesium clocks from the Naval Observatory and bought each a first class found trip seat on commercial flights, one headed east, the other west.  The clocks were strapped into the seats and never moved again until they returned, nor were they observed in transit.  “The experiment may be the cheapest ever conducted” to test relativity, Scientific American explained. When the clocks were returned to Washington, the west bound clock had speeded up by 273 nanoseconds compared to an identical clock that remained at the Observatory, and the east bound clock had lost 59 nanoseconds. The previous position of Einstein was that “Moving clocks run slow”, but there had been no prediction of a time difference depending on the direction of travel. The explanation by the relativity theorists involved a new frame of reference and a long defense as to what that reference frame was needed. Beckmann’s theory predicted the time differences due to the travel of the clocks through Earth’s gravitational field.

Yesterday’s View had this:

Some numbers to contemplate:

                                 Expenditures in 2011 (Billions of Dollars):

New Homes                     $337 Billion

Automobiles                     $328 Billion

Computers                       $375 Billion

Comply with Tax Code     $392 Billion

Which generated this letter

Dr. Pournelle,

[I delete the Patron Subscription renewal notice with thanks]

In a recent post, you included this information:

Expenditures in 2011 (Billions of Dollars):

New Homes $337 Billion

Automobiles $328 Billion

Computers $375 Billion

Comply with Tax Code $392 Billion

Would you mind sharing your source? I would love to share this with some friends, but I hate to quote unsourced numbers.

Thank you,

Beth

The source of that is The Growth Experiment Revisited: Why Lower Simpler Taxes Really Are America’s Best Hope for Recovery, by Lawrence B. Lindsay. http://www.amazon.com/The-Growth-Experiment-Revisited-Americas/dp/0465050700

Lindsay, one time Harvard Professor of Economics, was a close advisor in economics to Ronald Reagan, and later was the principal economic advisor to Bush I, an economic period that produced budget surpluses. His Reagan years were reported in The Growth Experiment; in this new book he reports on what has happened since 1990 when The Growth Experiment was published.

I heartily recommend this book to your attention. It is all essential to understanding a way out of the train wreck we find ourselves in.

I am working on a report on what has happened to science, and how “Science has lost its way” as Michael Hiltzik put it in Sunday’s LA Times. http://www.latimes.com/business/la-fi-hiltzik-20131027,0,1228881.column#axzz2j8pM1NRd

Very few science experiments are every confirmed; when they are the error rates in the original reports, though peer reviewed and published in leading journals like Science and Nature, are astoundingly high. It is a matter of very great concern.

And it’s lunch time.

I have a good deal of mail reflecting the following views:

Mass Cancellations Jerry,

More corroboration for the Kaiser Health News story: The Director of "Covered California" (which I gather is the official California state Obamacare implementation organization) says 800,000 to 900,000 Californians overall will lose individual coverage this January 1st due to Obamacare not grandfathering their plans.

http://blog.sfgate.com/djsaunders/2013/10/29/coveredca-chief-up-to-900000-will-lose-health-plans-on-1231/

Given that Kaiser Permanente has 40% of the overall California health insurance market, 6.6 million customers overall, 1.1 million of these non-group (http://articles.latimes.com/2013/jan/29/business/la-fi-mo-health-insure-market-20130129),

160,000 losing their individual Kaiser coverage at the end of this year seems highly plausible and in rough proportion to the national numbers being reported.

Note also that this implies hundreds of thousand more Californians losing their Kaiser individual coverage at the end of next year, and millions more Californians overall losing their individual coverage then

– see my previous letter.

Kaiser Health News, for what it’s worth, has been one of the more reliable and factual Obamacare news sources I’ve found during the last couple years I’ve been following this. They are in fact associated with the Kaiser Foundation; they’re not some fly-by-night outfit.

And 900,000 Californians losing coverage this year makes the 2 million nationwide estimate I quoted earlier look distinctly conservative.

I’m not surprised that you had a hard time finding others reporting this story a day ago, by the way. This story is just in the last 24 hours hitting mainstream media consciousness, after being ignored for years.

I suspect we’ll see a lot more data emerge in coming days.

Porkypine

I have never doubted that a very large number of healthcare insurance policies would be cancelled as a result of the Affordable Care Act, nor have I any doubt that some of them will be at Kaiser; thus when I heard the 160,000 at Kaiser story I was merely looking for some details.  The surprise came when I did not find them, nor have I yet a week later., I found a number of citations of NBC news and Forbes but they all traced back to a single sentence in the Kaiser Health News issue – a simple assertion without details or cause.  And I do note that Kaiser Health News although founded at the same time as Kaiser Permanente is not the same group and does not have so far as I can see any sharing of Directors or staff.  I don’t actually question that 160,000 memberships have been cancelled – but I have yet to find any details, or hear from anyone it happened to.  This seems very odd to me, because Kaiser Health News is not a source of news about Kaiser policy: it reports but it does not make or govern or debate Kaiser policy. If it is reporting inside knowledge it certainly doesn’t have much detail to report.  That seems odd.

Normally when 160,000 people lose their health insurance there will be a flood of local stories featuring people who have just lost their insurance, with much weeping and sorrow.  I haven’t found those. Perhaps the news media have a reason for neglecting the stories: indeed my suspicion was that this was a direct result of ACA and reporting the details would have been seen as harmful to Mr. Obama and ACA. 

And I first saw it about a week ago, and thought that by now it would have sunk in. Perhaps it has.

We have not seen the last of the consequences of ACA. I am still concerned how it will affect me: although I paid my Kaiser membership fees or premiums for years, when I reached 65 I was told that I could either allow Medicare to pay them for me, or I could pay about 4 times as much as I had been paying the day I turned 65.  On reflection I decided to allow you to pay it for me, since clearly the 4 times as much was not insurance premium cost: I wasn’t any more likely to be critically ill at the end of my birthday month as I was when it began.  My payments increased because the law said they would, and for no other reason. 

I will be interested in how this all turns out. I am one of those who is pleased with the health care plan I had before the Affordable Care Act, but then I was happy enough with what I had been paying before I turned 65. I wasn’t given any choice in that matter; I do not know what choices I will have this time. Everyone I talk to at Kaiser says I should not worry about it.  We’ll see.  I am of an age to frighten MBA administrators of health care plans…

And this from the Washington Post

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/10/29/this-is-why-obamacare-is-cancelling-some-peoples-insurance-plans/

View 796 Monday, October 28, 2013

“Transparency and the rule of law will be the touchstones of this presidency.”

President Barack Obama, January 31, 2009

Christians to Beirut. Alawites to the grave.

Syrian Freedom Fighters

What we have now is all we will ever have.

Conservationist motto

I have more or less recovered from the Flu, the horrid stuff is off my face, and I look a bit as if I’d joined one of the Studeneinkorps in Heidelberg, but I am recovering well. Again my thanks to all who subscribed during the Pledge Week, and apologies for bugging out for about a week immediately thereafter. I simply haven’t had much in the way of energy for a while. That too is changing.

I am now down to a couple of tasks that have to take some precedence. First is getting the last of the introductory material together for the Sixth Grade Reader. This is the official California Sixth Grade Reader for 1914, meaning that nearly all the work in it was public domain at the time it was written; it is important for several reason. First you can gauge for yourself the caliber of instruction in the schools for then and now: the sheer “difficulty” of the material that sixth grade students were expected to read, complete with poems that they were to memorize and recite, should be informative. Remember that in California of that time nearly everyone was expected to get through sixth grade. They might not all go to High School, but Sixth Grade? It will also be useful to home schoolers. The poems in the book will be thought difficult by today’s students and many will simply not go through them, but for those who take the trouble the reward is great: one of the great intellectual pleasures of life is good poetry, but it is an acquired taste. We used to make everyone expose themselves to it on the theory that some would like it. It is also a good way to learn to speak the English language well.

We have also decided to reissue the 1981 Anthology Survival of Freedom, which has 375 pages of stories and essays on the title theme. It sold well when it was first published, and lasted a while: and I think there is a place for it again. It contains stories and essays by me, Harlan Ellison, Larry Niven, Poul Anderson, Ursula Le Guin, Norman Spinrad, Robert Heinlein, and others, all still quite relevant to today’s world despite all the technological changes and the end of the Cold War.

I’ve also been absorbed in a certain amount of time wasting, but my study is nearly cleaned up, and I’m planning a tea party. Not political, just some writer friends over for tea. I haven’t been able to do that for years because my place began to look like one of those hoarder’s mazes where the police find the owner ten years after he died behind a stack of useless junk. That’s mostly thanks to my friend Peter with some help from Eric. There’s still work to be done, but it is not possible to visualize an ending,.

So I haven’t vanished from the Earth, and I am catching up. I know I keep saying Real Soon Now, but I really have made progress. And I look all right except for the dueling scars…

Some numbers to contemplate:

                                 Expenditures in 2011 (Billions of Dollars):

New Homes                    $337 Billion

Automobiles                    $328 Billion

Computers                      $375 Billion

Comply with Tax Code     $392 Billion

These are interesting numbers, and show something of the structure of our national economy. Now contemplate that in 2011 we spent $392 Billion complying with the U.S. Tax Code. That’s not what was paid in taxes. It’s what it cost to pay the taxes and prove they had been properly paid: record keeping, bookkeeping, compliance officers and consultants, legal fees, tax consultants, tax accountants – all the myriad ways that it costs money to fill out and check all the forms that have to be filed with the IRS.

Where your treasure is, there will your heart be also; is this where the nation’s heart truly ought to be? I will have more on this subject another time when I have a bit more energy.

We have considerable mail, and more to say about the health care situation: I invite you ton continue to consider why anyone ought to pay for someone else’s health care. I don’t mean pubic health and sanitation, which are local matters anyway, or communicable diseases. We have seen in the past weeks a ton of stories about people unable to get health insurance because they had pre-existing conditions – which is to say, they were already sick, so no sane insurance company would undertake to pay for their medical care without charging a premium equal to or greater than the expected cost of their care. The remedy in the Affordable Care Act is to require the companies to issue the sick person an insurance policy and charge no more for it than the company charges a well person. This means that the well person must pay a great deal more for his insurance since the policy must also cover some sick people as well. The Affordable Care Act solves that problem by requiring everyone to buy an insurance policy at the new price that covers everyone. This means a enormous increase in the cost of insurance for the young and healthy, who aren’t going to want to pay that much so that someone else’s grandma can have a year in the Intensive Care ward, or the child born with a defective heart can get a heart transplant. That’s a wonderful boon for the parents of the child, but a large burden on the parents of the child not born with a heart defect.

But all that assumes that they young and healthy may grumble, but can be coerced into buying the insurance because the IRS will see to it that they buy it; and that assumes that the economy is vigorous enough to allow all the young people – not just those who manage to grow up and get an education and acquire job skills and find a job, but all of them – will have, inherit, or somehow acquire the money to buy that insurance policy. This does not seem as likely as perhaps it did in boom times.

There are other such matters to consider, and they are not trivial questions. They will have to be answered, once the Federal Exchanges begin working properly.

News items

I remember when the Sony reader was preferable to the Kindle. Now:

http://blog.the-ebook-reader.com/2013/10/26/sony-withdrawing-from-ebook-reader-market-entirely-in-us/

Then we have:

http://www.publisher…e-the-norm.html

First the electronic rights become worth something.  We noted that back in the BYTE days when computers were rare, and that sparked the debates about information wants to be free, and perhaps electronic rights should not be worth anything to the writers because that exploits the readers, and those who long for information but can’t afford it.  Before that was settled, electronic rights grew in value to the authors, and grew and grew, and some of us observed that electronic rights were now worth as much — yea, verily more — than print rights.

And now the print rights aren’t even being exercised….   Turn the page.  Oops. We don’t do that any more.

Saturday Morning we managed to get up, breakfast, and make our way to a local movie house where we saw a live performance of the Metropolitan Opera production of Shostakovich’s The Nose, an opera based on the absurd short story of the same name by Nicolai Gogol. I remember reading this as an undergraduate and finding it amusing, and it is amusing as an opera: indeed it is quit faithful to Gogol’s story. As with most modern opera there are no tunes to whistle or hum after you leave the theater, but some of the imagery will stick with you for – well in my case, a day or so. You may be more fortunate. I am not sorry to have gone;. The Los Angeles Opera has hit a doldrums period I fear. The Met will broadcast live Dvorak’s Rusalka in a couple of weeks, with Rene Fleming, and I intend to go see that. If it sounds as if I am still unhappy about the LA Opera spending everything it had on a surreal production of the Ring with staging so bad that one soprano suggested they simply use her CD since no one would hear her in the mask with her face turned away anyway – well, yes. Wagner was not trying for an opera of the absurd and his source was not Gogol.

Query: I keep hearing and seeing news to the effect that Kaiser cancelled the memberships of 160,000 members in California, but I cannot find an actual source to that story, nor anything about who they were, or why the cancellation.  Does anyone know, or is this a rumor?

View 795 Monday, October 21, 2013

“Transparency and the rule of law will be the touchstones of this presidency.”

President Barack Obama, January 31, 2009

Christians to Beirut. Alawites to the grave.

Syrian Freedom Fighters

What we have now is all we will ever have.

Conservationist motto

I got the stitches taken out of my face today, and we managed to get in a better than half hour walk, with Sable, so we can count it a good day and I am recovering. I am still in a situation to say that you really don’t want to fall out of bed and tear holes in your face.

The stories continue to pour in of government officials – particularly for some reason Parks Department employees including Rangers – taking care to make life miserable for citizens as a matter of policy. Precisely where this policy originated is not known, but considerable money was spent on the operation. The World War II, Viet Nam War, and Korean War monuments on the Mall are not attended and are open for anyone to stroll through, and they are meaningful to the veterans of those wars. The nearest barricades would be in some Park Department storage place a good way from the Mall. Had the government shut down simply removed the park people from the site, it would have cost nothing to ask the American Legion, WFW, and other such outfits to provide monitors; but it was very costly to bring out the barricades and post park police around those monuments to keep the veterans away from them. Yet that was done.

The same with the access off-ramp to the privately owned parking lot at the privately owned and operated Mount Vernon: it costs nothing to operate and no one parks on government property; but at considerable expense barricades were put up to block the off ramp, and federal employees were sent to enforce the shutdown of the turnoff. Same story for the off highway viewpoints for Mount Rushmore; at considerable expense they were closed. And tourists on a tour bus that stopped to look were forbidden to “recreate” by taking photographs of Old Faithful; it took people on duty to do that. This wasn’t saving money, this was intended to be hard on people, presumably so they would blame the Republicans for shutting down the government.

Now you might argue that these acts originated in low level management, but after the first couple of days the President and every senior officer in government had to be aware of them, but nothing was done. Apparently it was decided that this was a reasonable policy. It would seem to be a good subject for investigation with possible firing of government employees under the Hatch Act, but I suppose all the teeth were taken out of that a long time ago. Civil Servants are supposed to be officially politically neutral in exchange for job security when administrations change; clearly that is not working today, and something ought to be done about it. The theory of civil service is that it beats the spoils system by keeping experienced and efficient officials on the job when administrations change. It has a cost: under the “spoils system” it is much easier to hold elected officials responsible for the actions of government. We seem to be working out a system that has all the disadvantages of both.

Rights, etc.

The cardiologist quoted by Mark makes a number of important points. One of them in particular got my attention.

"Why do many Americans think that healthcare is not a right for its own taxpaying citizens?"

What made the author think that it isn’t a right? Please define "right". It is a word that is bandied about a lot, too often by people who manifestly have no notion of its actual meaning. Simply put, a right is something that you can do without requiring the permission of another. Therefore, a right is an action, not an entitlement.

That may sound pedantic, but it is really important. I have the right to be an astronaut, in that no one can forbid me outright. Does that mean I can demand that NASA send me up on the next available flight (whenever that will be)? Of course not. There are other considerations.

By the same token, everyone has the right to high-quality health care, a superior education, comfortable housing, etc. No one can be denied, "just because". If I can pay for it, it’s mine. If I can’t pay for it, I can certainly govern myself ("self-government", see?) so that I can accumulate whatever resources I need to have what I want. That is my right.

It is also my right to be a lazy, indigent, wastrel. No one can force me to be responsible. Can I then demand that others provide me with what I refuse to provide for myself?

That is the central question of economic policy in the modern age.

(I’m so proud I thought of that. I never spent even a nanosecond in an economics class.)

Richard White

Austin, Texas

The Constitution of the United States does not confer positive rights in the sense of welfare, pensions, and health care. The Bill of Rights was negative and prohibited the Federal government from certain actions — Congress shall make no law respecting an establishment of religion did not prohibit the seven states that had established churches in 1787 from maintaining them, and indeed the last state church was not disestablished until well into the 19^th Century.. The Civil War Amendments did prohibit the states from certain actions, but whether they, by sort of incorporating the Bill of Rights into prohibitions on the state government, forbade what amount to socialism was not settled until the Roosevelt Administration and then not by anything like unanimous consent. Child Labor Amendments were proposed and failed, as were Amendments allowing Congress to set minimum wages. Eventually the Warren court worked its revolution to the point that State Senates, modeled after the US Senate, were forced to change their districting by the Federal government, and mysteriously Child Labor Laws and minimum wages became constitutional without an amendment.

The point being that it is only recently than anyone could or would dream that anyone had a federal right to health care. It’s not in the Constitution. Neither is education.

And because these “rights” have been sort of decided to sort of apply, but that was done without the debates of a Constitutional Amendment, and there is nothing like agreement as to what rights one gets because your father lay with your mother: how that obligates someone not related to you at all; whether it is enough just to live here to get the right to be paid for being disabled (or being able to pretend to be disabled for that matter) – all of these are matters never really debated, and not really settled.

Your view of ‘right’ is about that of the Framers, and what used to be meant when we said “It’s a free country.” I can do that because there is no one with the authority to say I can’t. It’s my right to shout my opinions, although there are limits (I can’t yell Fire! in a crowded theater). But now we talk of a right to an education, which is odd because the word is not in the Constitution and no one in 1792 had any idea of a right to an education. And the right to a doctor who would be paid by someone else simply did not occur to anyone at all. That was what charities were for.

Now no one is surprised when we speak of a right to health care, but what it really means is that someone else has an obligation to pay your doctor and hospital bills. You need not worry about who that would be. Vaguely “the rich” I suppose, but in fact soaking the rich won’t solve that problem.

Enslaving the doctors and nurses might accomplish that goal, but no one is suggesting that.

And why a person who eats fats and sweets until he is morbidly obese while smoking cigarettes and drinking rum should have free “health care” has not been established by anyone I know. Of course this chap has a right to his fats and sweets and tobacco and rum in the sense that “it’s a free country”, but what entitles him to have his health care paid for by you and me is not clear. (Note that you are free to support him if you like, probably through a charity; that is your right because it’s a free country. Our discussion is where he acquired a right to your involuntary support, that right to be enforced by the tax collector and if you resist by armed police.)

Just as it is not clear why Social Security which at least attempts to look like savings/insurance –you enroll in it and pay into it so long as you can, in order for you, or your dependents to get something out of it – should make payments to someone who has never worked because he is disabled has never been established. Sure, a guy works for years and is disabled has some claim on Social Security as either insurance or savings, but someone who is simply emotionally unstable and cannot work and has never worked? Even if the permanently disabled have a “right” to be supported, why should it be from the forced savings of those who work? Shouldn’t that be from the general fund? Veterans have earned benefits, but not from Social Security. If we are going to fund the disabled it ought to be from a special appropriation, not something extracted from social security or veteran’s affairs.

As I said earlier, the question of health care cannot be separated from the obligation of the society to support the poor – and that brings us to the question of the ‘deserving’ and ‘undeserving’ poor; and does not settle just who is now obligated to pay, and at what level the payment should be. And until all these issues are debated we will not even understand the question, much less come to an agreement.

It’s late, and I am tired. This will have to do for the day. My thanks to all those who responded to last week’s Pledge Drive and subscribed or renewed.