A member, and hoping to stay that way, of the reality-based community
06 April 2010
A letter to David Brooks
In your columns (like today's— 6 April) you often express unbridled optimism about the future of the United States. All too often, in thinking about what you've written as compared to the universe of data available on the subject, I find myself wondering why you dismiss the view that we have serious problems that we are ignoring because we can't imagine the answers.
I can't help but think that this blog post ("The Collapse of Complex Business Models") and more importantly the work that it references (Joseph Tainter's "The Collapse of Complex Societies") hint at the challenge the present state of Western society faces. We've built an edifice that works very well for the top 10-40% of Americans and Western Europeans. It even works OK for another 20-30%-- their lives are vastly better than their ancestors just three or four generations removed (with all but a few exceptions born of squandered gains).
As any investor knows, though, past performance is no guarantee of future gains. We are at a point where we must change so much about our society-- not least how we use and create the energy we need to support our (historically) lavish lifestyles-- but the systems we've put in place to support our societies have ossified. De-constructing them (and re-constructing their more flexible replacements) will require real sacrifice from the elites. Yet still the elites pretend otherwise.
I can't help but see works such as the one you wrote today as being a shining beacon of foolishness in a world filled with dark and murky truths-- it looks good and gives everyone a warm fuzzy, but it's a false lead and presages doom.
13 March 2010
12 July 2009
Predicting wetter than average fall for Boulder
30 June 2009
Health Insurance isn't
Congressional committees heard a lot this month about the devious schemes used by health insurance companies to drop or shortchange sick patients. It was a damning portrait — and one Americans know from painful personal experience — of an industry that all too often puts profits ahead of patients.As health care reform moves forward, Congress must impose tighter regulation of companies that clearly are not doing enough to regulate themselves. Creating a public plan could also help restrain the worst practices, by providing competition and an alternative.
A House oversight subcommittee took a close look at a particularly shameful practice known as “rescission,” in which insurance companies cancel coverage for some sick policyholders rather than pay an expensive claim. The companies contend that rescissions are rare. But Congressional investigators found that three big insurers canceled about 20,000 individual policies over a five-year period — allowing them to avoid paying more than $300 million in medical claims.
The companies typically argue that the policyholders withheld information about pre-existing conditions that would have disqualified them from coverage. But the subcommittee unearthed cases where the pre-existing conditions were trivial, or unrelated to the claim, or not known to the patient. When executives for the three companies were asked if they would be willing to limit rescissions to cases where the policyholder deliberately lied on an application form, all said they would not. This tactic will not be ended voluntarily.
If only I could believe it is not true. But of course it isn't. The insurance companies, doctors, pharmaceutical companies all have no financial interest in you being healthy. The insurance company wants only to take your premium, not to pay a claim on it. The doctor is rewarded financially only if you are one of the many people shuttled through his office (and only if your insurance— or you!— will pay). Pharma only makes money if you take the high-margin pill.
If we are to solve the problem of health care costs in the context of a market-based system, we have to change the profit incentive to one where your care-giver makes money when you don't need care.
Otherwise, we're probably better off with single-payer. Yeah, there will be rationing. We already have that today. We just have a different name for it. We call it poverty.
Just chew on that for a while.
14 June 2009
Padilla & Lebron v. Yoo
07 June 2009
Health care for all, please.
If you could structure the profit motive so that care-givers are rewarded for keeping people healthy (which is not the same as keeping them from seeking treatment, as many insurance companies seem to think), then a private system makes sense. Otherwise, single-payer seems the only sensible approach to the goal that I, at least, appear to share w/Scott: treat everyone regardless of ability to pay and don't bankrupt them while doing so.
If the insurance industry goes out of business in the process, that's too bad. At least while *they* are looking for work they won't get sick without being treated!