Tag Archives: Health care

Notecard of Knowledge: Logorrhea

1. pathologically incoherent, repetitious speech  2. incessant or compulsive talkativeness; wearisome volubility

His [Jacques Derrida] logorrhea, which has done him harm, is the more regrettable for coming from someone who has also campaigned as a pedagogue to defend and if possible extend the teaching of philosophy in French schools and universities. (Sturrock 1998, 72)

His logorrhea is regrettable because he has campaigned to defend and extend teaching philosophy in French schools. 37 words reduced to 17. Paring out the redundancy, pure and simple.

Here we have another example of the old lie sold to us, particularly here in the US: there are some activities that are inherently the provence of business and people who think only in terms of profitability. The emphasis is mine.

Particularly, NASA needs reforms on the distribution of funds and budgetary approach for effective governance and operation in this post-cold-war and globalized modern era, in which there is no strategic need for engaging in any type of Apollo-like space-race programs. Although an efficient and functioning NASA is critical to conduct the nation’s space exploration programs successfully, NASA and its space exploration (manned or robotic planetary science) effort can represent only part of the large picture of America’s needed human activities in space. In other words, there is a much broader category of human space activities (referred in this chapter as the VSD, or Space Development category) that cannot be handled or managed effectively or successfully by such a government agency as NASA.

In our view, even with adequate reform in its governance model, NASA is not a rightful institution to lead or manage the nation’s business in Space Development projects. This is because human space development activities, such as development of affordable launch vehicles, RLVs, space-based solar power, space touring capabilities, communication satellites, and trans-earth or trans-lunar space transportation infrastructure systems, are primarily human economic and commercial development endeavors that are not only cost-benefit-sensitive in project management, but are in the nature of business activities and are thus subject to fundamental business principles related to profitability, sustainability, and market development, etc. Whereas, in space exploration, by its nature and definition, there are basic human scientific research and development (R&D) activities that require exploring the unknowns, pushing the envelope of new frontiers or taking higher risks with full government and public support, and these need to be invested in solely by taxpayer contributions. (Hsu and Cox 2009)

But I have to ask a question. Why is profitability the domain only of the business? It is not, if only because profitability is not the end all be all. Profitability is merely a tool to achieve efficiencies. Sometimes it achieves efficiencies in the face of other (more) important goals (many businesses could afford quality health care coverage for all employees and still turn a profit, but instead they focus on maximizing profits and scrimp on the coverage and cherry pick who qualifies).

Another reason it is not solely the domain of profitability is because there are government programs run by people with goals that are not (just) profitability that have also been efficiently run organizations. There is mounting evidence that Medicare delivers health care to people that would be left outside the profitability calculus. The data is also suggesting that it not only delivers goods to people that would be locked out but it does so more efficiently than for profit insurance companies would have.

Speaking of insurance companies as supposedly delivering health care efficiently, take a look at the attached photo. It is of the Mutual of Omaha headquarters. Note the statue of the swimmer in front. Sure the company supports the Olympic swim team, but how was its commission a profit maximizing move?

 

Hsu, Feng and Ken Cox. (2009). Sustainable space exploration and space development: A unified strategic vision. www.spaceref.com

Sturrock, John. (1998). The word from Paris. London: Verso Books.

Distractions: July 4

Yea yea, fireworks are distraction enough. And yes, I do have work to be distracted from on this day.

It’s a little late, but still interesting. This is a 10 question quiz about the Affordable Care Act. I answered all 10 correctly, but I have bene following it closely for a long time now. It will not take you but a minute to complete and see how you did.

This guy has a whole series of funny lip syncs. I wonder how much money he is making through YouTube. “I wish my eyebrows could play saxophone.”

[tube]0exXGfzivJ8[/tube]

They’ve found the Higgs particle. So what? Most of the world asks. Here is a well done little cartoon that helps to explain it somewhat. There’s more “what” instead of “so what” than I would prefer, but still…

Single Payer System

There is new evidence for universal health care coverage. A new study (link here) measuring the effects in Oregon of its health care policy which is the most progressive in the US has some interesting data. Here is a portion of a summary Slate did of this study. I found this to be terribly interesting and supportive of the argument that health insurance (not necessarily of the private kind) carries over into other aspects of a person’s life and ought to be considered a social good:

The survey also asked whether respondents were “happy, pretty happy, or not too happy.” The insured were 32 percent more likely to answer “happy” or “pretty happy.” This is an enormous effect. To get a sense of how large, it’s helpful to use estimates from studies that link income to happiness as a benchmark. You’d have to double a participant’s income to see an effect like this, making Medicaid ridiculously good value for money. Better health is surely part of the reason for the more upbeat view of life. But insurance also relieves the financial anxieties that come with being uninsured in America—the fear that, quite literally, one wrong step could spell financial calamity. The study found that Medicaid recipients were 40 percent less likely to skimp on other financial obligations as a result of medical bills, and presumably even those that never had health problems worried less about such possibilities. [emphasis mine]

What are we left with? Not only are people healthier but they also pursue cheaper (to society) health care options. Being insured also allows people peace of mind which makes them happier. That is a goal worth some government interventions. The insurance also means there is less credit card default, and mortgage default and more consumer confidence. These are all good Republican talking points.

Mitt Romney, Romneycare and 2012

Ryan Lizza’s new story about Romney is all about the health care plan Romney signed into law in as Massachusetts’ governor. It is nearly identical to Obamacare, a name that I will now change to Romneycare. What’s interesting is that this is not a law passed by a Democratically controlled legislature and begrudgingly signed by a Republican governor.

The most noxious part of Romneycare is the individual mandate, noxious because that is the part of Obamacare claimed to be unconstitutional. What I did not know and found really interesting is that the individual mandate was put into the law precisely because of Romney. His advisors cautioned against it and he was in the back of the room arguing for why it was a necessity. Which it is/was. It wasn’t just Romney’s endorsement of the individual mandate I loved reading about. The Heritage Foundation endorsed it in 1990. President Bush endorsed the law. The law was seen as such a hallmark of conservative values — ending the free riding ER visits and instead require citizens to own up to their civic responsibility — that it would surely put Romney on the map allowing him to make a Presidential run. And here we are. Except Romney is trying to walk back from the policy which made it possible for him to be here.

Not only is Romneycare responsible for allowing Romney to be the GOP 2012 nominee, but it also will have caused the primary issue at issue with the 2012 election.

“If it were not fro Mitt Romney, with assistance from the Heritage Foundation and George W. Bush, it is extremely unlikely that Obama would have passed his universal health-care law last year.” (42)

Here’e the math Obama faced. Without the mandate the law would have saved $270b over 10 years and left 28 million uninsured. $2.7b a year is chump change for the deficit. But having uninsured guts those savings. Even with a mandate there will be uninsured persons, and Medicare will still be paying those bills. Hence the mandate, some people are bound to break the law. But, without the mandate those numbers will swell and probably swamp the $2.7b per year savings.

This leads to two questions. First, will Romneycare sink Romney’s 2012 bid? If not, then how does Romneycare v Obamacare shake down in a general election? The first answer is that it probably will not. Romneycare is too wonky to be at issue. If the GOP voters want a wonk as their candidate then Romney is it regardless of Romneycare. If they don’t want a wonk, then it is not Romney regardless of Romneycare.

The second question, about the general election is more interesting. Romney has already given his answer. He claims the difference is a question about federalism. Romneycare was about Massachusetts. Obamacare is about seizing federal power. This is Romney’s rhetorical gift: to make the insincere sound sincere. First, Romneycare was financed entirely by Medicare. In fact, Romney, with the help of The Heritage Foundation, went to President Bush and asked for permission to do this with federal dollars. Second, and here’s the nuts, Obamacare would end what many states consider to be the biggest infringement of state rights. States are given Medicare money only if they match some of the funds and states are then given little control over how to use those funds. The status quo pushes states around and Obamacare ends that. Yet another conservative value in favor of Obamacare, a federally scaled Romneycare.

Lizza, Ryan. (2011, June 6). Romney’s dilemma: How his greatest achievement has become his biggest liability. The New Yorker, 38-47.

 

Health Care Reform Again

Second Term - Room 2
Image by cliff1066 via Flickr

Jeffrey Flier, the dean of the Harvard Medical School, agrees that one of the problems needing to be fixed is the employment based system (the easiest implementation of health care as a negative right).

there is our inefficient and inequitable system of tax-advantaged, employer-based health insurance. While the federal tax code promotes overspending by making the majority unaware of the true cost of their insurance and care, the code is grossly unfair to the self-employed, small businesses, workers who stick with a bad job because they need the coverage, and workers who lose their jobs after getting sick.

This employer-based system arose not by thoughtful design but as an unforeseen result of price controls during World War II and subsequent tax policy. How this developed and persisted despite its unfairness and maladaptive consequences is a powerful illustration of the law of unintended consequences and the fact that government can take six decades or more to fix its obvious mistakes.

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The Health Care Debate

Hospital room (Denmark, 2005)
Image via Wikipedia

I find myself more and more coming to ObamaCare’s, as if there were such a thing at the moment, defense.  While not what I would prefer to see it is at least a step in the right direction.  I played with the idea that maybe the status quo’s unsustainability might be preferable as a way to hopefully make the ideal more likely in the future, but that would require a massive crisis which is one 1. capable of being stymied 2. blamed on a marginalized group and not the elites  and 3. would, at best, require massive pain.  So, the compromise it is.

Megan McArdle has a piece over at The Atlantic which is one of the better anti-reform pieces I have found.  It is also exemplifies the most persuasive arguments against reform.  Her main argument is the Government Theater, where the government tries to pay as little as possible and so it stymies research into more expensive and yet more effective treatments.  An interesting argument with a few problems.  First, this argument assumes the dissolution of a private health care system.  The public option would not replace private options.  The current incentives for research would still exist.  The current treatments would still exist.  Surely the public option might provide less quality than the private options but it would also retain the fidelity to the “personal responsibility” myth hailed by conservative thinking folks.

Even if the dissolution argument is correct, reform is still preferable: preventive care is more important than catastrophic care, it would bring more people into a system of preventive care, overseas options would still exist for the middle and upper classes, status quo treatments would remain available because people know about them (the Government Theater could only distort so much), there would only be a loss of some research (note that ‘some research’ is very different from ‘all future research’ as R&D incentives would still exist), and much research is funded by the NIH (those commitments would remain and would actually ramp up as the government would become a consumer of government funded science.)

McArdle then tries to answer the ‘people are without insurance now’ argument.  First, she says that she was uninsured for two years dealing with illnesses and still believed what she does now.  So what?  She has a credible stake in the debate.  So does everyone, that’s the issue.  Everyone is affected by this decision.  Her disclosure is also demonstrates false consciousness, a topic better explained by others that comment or linked to by this site.  She then tries to flip the argument, “why don’t you tell some person who has a terminal condition that sorry, we can’t afford to find a cure for their disease?”  That flip, at best, only cuts against the argument and does not overwhelm it.  First, there are many more un(der)insured than there are treatable terminally ill people.  Second, an un(der)insured person is terminal.  Studies show that these people die significantly sooner than the insured and their quality of life during their life is also significantly reduced.  McArdle’s argument is doing the very thing she claims ought to be avoided.  Third, this argument assumes the dissolution of private options, which is not accurate.  Fourth, see the argument above about how research may be advanced by the public option.  Fifth, as if the status quo option does not currently have rationing.  Only the agent of the rationing may change and I for one would rather have the government with a larger and more generous pocketbook making those decisions than a CEO at an insurance company who is beholden only to stockpayer dividends.

Her final argument is about the intervention of government into our lives.  What McArdle fails to realize is that this argument is about the importance of preventive care and to make this argument is to concede what is most persuasive about a public option: its ability to increase preventive care to those currently without.  Her fear is that the government will then crack down on poor nutrition and smoking and other such lifestyle choices in the name of cost reductions.  This argument is naive because the government is already involved in these problems.  A public option causing such a cost-cutting measure might then be forced to evaluate its support of dangerous agricultural subsidies, unhealthy school lunch programs, fossil fuel subsidies and other government interventions that have made the very free market, which is supposedly so grand, a myth.  It is a suspect claim to think this means the government will then intervene to ban Doritos.  Maybe an anti-Doritos ad campaign, possibly.  But why would that be bad?  Especially if it means the government stops pushing Doritos to school children, which is where the obesity pandemic begins.  Obviously the use of Doritos is a metonymy as there are more problems, not just nutritional, than Doritos and school lunches.

McArdle’s piece is the typical trope where larger connections are not made and their is an undergirding of free-market faith.  The debate about the value of the free-market, even if one assumes it actually exists, is a rich one worthy of being explored as well but is beyond my scope at the moment.

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