Thursday, February 28, 2013

Health care as a Car

Health care is a lot like a car. Here is what I mean.

There are two ways Americans think about cars. For most Americans, people over 25 who work every day and don't live in a city, you just have to have a car. You need it to drive to work, to drive your kids to the park, to pick up the groceries. Yeah, cars are expensive, insurance adds to that cost, and most of all (even though its not the biggest cost) gas is expensive.

But you have to have a car so you bitch and moan . . . and then pay for the gas.

Most people think of health insurance like they think of their car and gas. It is expensive, it keeps getting more expensive, they whine about how expensive it is . . . but they have to have it so they pay for it.

But cars look very different when you are 14. When you're 14 you can't drive, but you know in 2 years you can get a license. You're eligible to work. You're too dumb to figure out that you'll make a lot more money in the future if you spend your time learning to program or do something useful, but you're smart enough to know you can get a job at McDonalds and slave away for two years saving up so that, when you turn 16, you can buy some wheels.

From the eyes of a 14 year old, a car isn't a hassle to bitch about, a car is just fucking awesome. It's so fucking awesome that you are willing to sacrifice your time and effort mopping floors and cooking burgers so one day you can take your girlfriend to a movie and then nail her in the backseat.

This is, I think, how people should look at Medicare and maybe health insurance in general. Medicare is fucking awesome. Medical care keeps getting better and better. When today's old people were young doctors couldn't treat depression or do much about high blood pressure, heart attacks, or cancer. Today they still can't do that much about heart disease or most forms of cancer, but they can do enough to keep you alive for several years longer than you would probably otherwise live. And when today's workers are old--when I'm old--they probably will be able to treat my skin cancer (I'm a red head) and save my life. That is awesome. In fact, it's a lot more awesome than banging your girlfriend in the backseat in a deserted parking lot.

Like a 14 year old slaving away at the drive-thru window hoping to save up enough for his first car, I should be happy to make some sacrifices today so I can reap the rewards in 45 years when doctors pump me full of chemicals and my tumors shrink like Jared's waistline. In other words, I should just accept the fact that to get what I want (life-saving medical care), it's going to cost me, probably with a Medicaid tax of more like 5% than 2.9% of my income, including the employer's contribution.

Thursday, February 21, 2013

Should Technology make Health Care Cheaper?

There is a big cover story for Time this week on health care prices. I only got through the first page before I stumbled onto this question:
And what is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?
People often talk about technology reducing costs but . . . I just don't see it in any industry except computers.

CPUs, hard drives, memory chips, and the like have gotten both better and cheaper over time, but everything else gets better but more expensive. (All of this discussion is adjusting for inflation.)

Cars get better gas milage than they did in the 1970s and you are a hell of a lot less likely to die driving thanks to better construction, airbags, seatbelts and the like. And they break down less often to boot. But car prices have increased dramatically over time due to the addition of those features and other technological innovations like cameras to guide backing up, power windows, power locks, etc.

Movie studios have increasingly relied on computer technology to help bring stories to life. Digital imagery has allowed movie studios to blow audiences away since Jurassic Park came out in 1993. But Jurassic Park cost $63 million to make, more than double the inflation-adjusted cost of Star Wars at $25 million. Digital imagery helps movies come to life, but the cost of developing the software, hiring animators, and buying the technology to render scenes has raised the cost of making movies (and ticket prices) the same way safety features have raised the price of cars.

There has been enormous advances in TelCom over the past few decades. Butter's Law says that network capacity doubles roughly every year and wireless networks have become increasingly reliable. In the 1990s no one had a cellphone and you connected to the Internet using dial-up, but now you can get a high-speed Internet connection over your cellphone. Of course, the price of FiOS and a data plan from Verizon is at least 5x what you paid for Compuserve in 1999, even adjusting for inflation.

Health care similarly uses diagnostics technologies  to detect diseases earlier, new pills to cute formerly untreatable disease such as HIV, and new surgical procedures to save people's lives. But the cost of developing, building, and testing these technologies is enormous so they have, just like digital imagery for movies, safety features in cars, and fast, reliable wireless for the Internet, raised the cost of the product.

So everywhere you look except for semiconductors new technology has made things better and more expensive, not cheaper. Yet whenever I hear people talk about technology and health care they act like the increasing speed and decline prices for computers is the rule and health care is the exception.

Wednesday, February 13, 2013

Is Rubio a closet liberal?

I've never seen Poland Spring in Florida. The local branded water where I grew up was called Zephyrhills.

But I do see Poland Spring in Massachusetts.

Where did this guy film his response?

And why doesn't he buy store brand?

The only answer I can come up with is "Elizabeth Warren's house" and "because he's too good to shop at Wal-Mart."

Wednesday, February 6, 2013

Good example

I hate to link to a good example of how not to write (and, by extension, think) but this blog is too good to pass up.

Lots of examples:

Mood affiliation: "Tough echoes the arguments of the corporate education reform movement. . . . He gives the elite and powerful the ultimate excuse to do nothing about structural problems of poverty."
(The author thinks we should instead give teachers an excuse to do nothing because the only way to  help poor/minority students is solving "structural problems.")

Vague buzzwords: "KIPP’s curriculum is not based in social justice, in teaching students about oppression, racism, or class structures."
(All of these words sound like they mean something, class and structures have clear meaning but what is a class structure? Racism has meaning in everyday language, but here it is either jargon or gibberish.)

Blame Game: "At KIPP, if you do not exhibit the correct “character” it is YOUR fault, and YOUR fault alone."
The blame game can be fun, David Jones has a fun article that reinvents the history of Amerindian-European interaction because he thinks traditional history doesn't blame white people enough. But the blog is a commentary on a man who wants to fix problems not find someone to blame for them.

Stupidity: "There is no conversation about WHY the children (often rightfully so) are feeling the way they are.  There is no talk about historical oppression or institutional racism. . . . Why not create curriculum that is so engaging and relevant that children discover a joy in learning?"
This one is far and away the most important. The author wants to tell kids to blame history, white oppressors, institutions, etc. for their problems. Yet at the same time she wants kids to enjoy learning and be happy. She is ignorant of all the research on happiness and depression. People who are taught to have an external locus of control feel powerless, not empowered, and people who complain all day are miserable, not happy. KIPP teaches children that they can succeed if they work hard to empower them. It teaches them to give thanks, not whine, because that gratitude is a key to happiness.

Monday, February 4, 2013

You cannot be SERIOUS!!!

Someone at Slate wrote a blog on the political implications of Hillary Clinton's choice of font in her resignation letter.
Clinton made other questionable choices in her resignation letter as well: the old-fashioned indents, what appear to be two spaces after each period. What does this say about the presumptive front runner for the Democratic presidential nomination in 2016?
OK, probably nothing. . . . Nevertheless, branding has become a key part of any presidential campaign . . .

I still can't tell if this is serious.

Sunday, February 3, 2013

BREAKING: Harbaugh bribed refs

In a breaking story, Jack Harbaugh bribed referee Jerome Bogger. A large wire transfer was made from his savings account into Bogger's checking account last night as confirmed by Bank of America.

In a statement issued to the media Jack said "[he] just wanted both of [his] sons to feel like they won. Letting the game end on a blown call lets both boys believe they were the real winner."

When asked who won the game Jack reflected that "we will never know what would have happened."