Thursday, July 30, 2009

Tuesday, July 28, 2009

Health Care -- an analogy

So there's a massive debate in Washington about how to remake American health care. Our health care "system" -- well, it isn't a system at all, because that would imply some sort of design -- but our health care approach is nothing short of madness. It is a system without price tags, competition or any of the other hallmarks of a free market. And yet this bastardized model is being defended by the right in this country as the "best health care system in the world." Which it demonstrably isn't.

The chief shortcomings of our approach are these: 1) It does not produce acceptable health outcomes; 2) It is obscenely expensive; 3) It is grossly unfair; and 4) It is mind-bogglingly complex. There is a simple reason for this: Health care institutions in the United States, from hospitals to pharmaceutical companies to medical-device suppliers are all constructed around the premise of profitability, not health outcomes. Thus, our health care system fails at producing healthy people, but succeeds wildly in producing profits. This is not mysterious.

Look, I took economics in college, and I get the concept of free markets. I embrace the concept of free markets. I love free markets. They can work wonders. But the idea that we have a "free market" health care system is a fallacy, a lie, a deception. We have a semi-free market in health insurance, which is not at all the same thing.

To illustrate my meaning, I want to give you an analogy. We all need food to live, so imagine that you are going to the supermarket. In reality, supermarkets are vigorously competitive, free-market businesses, which compete ferociously over pennies and nickels. There are numerous competitors, many sellers and buyers, and very transparent information about pricing. Every item has a price tag. You can compare items side-by-side. Good products and brands engender loyalty. People make rational choices on the basis of taste, quality, price, and preference. It works.

Now imagine the supermarket worked like our health care system... How would it be different? You arrive and are issued a cart. Before you are allowed to shop, a stern official-looking person checks your credit. You then must wait your turn to enter the store to fill your cart. About an hour later, you are issued a wrist band and permitted to enter, attended by a highly-educated foodsycian employed by the supermarket. He talks with you sympathetically, and steers you down certain aisles, recommending certaing foods.

Nothing has a price tag on it; it would be difficult to mark each item anyhow, because the price could vary by a factor of 10 depending on which shelf you took it from. A can of mushrooms from the end cap could run you $7, while one from the back of the regular shelf of canned mushrooms might be $.70. Or vice-versa. But you won't know until later... Anyhow, you proceed up one aisle and down the next, with your foodsycian urging certain foods and forbidding others. What he says seems to make sense, but you're not really certain, and he's really not answering your questions about pasta. He won't even let you look at the Mexican foods. You bite your tongue, in part to quell your rising hunger.

At the end of one aisle, he stops you. "Wait here for your frozen-food specialist." You wait here for three months, starting to feel a bit faint. Finally, your specialist arrives, and leads you through the freezer section, adding numerous unlabled products of significant weight to your cart. You don't know what they are, but are told they're very important. You sigh.

Finally, it is time to check out. This part is a breeze: You just put everything in bags and put it in your car and go home. They have been keeping track of your selections the whole time. They're very conscientious about keeping track of what went into the cart. A few weeks later, a bill arrives. This is the first time you get to see the price of any of the items in your cart, most of which you have already consumed. The charge is $10,503. Separate bills arrive a week later for the services of the foodsycian and frozen-food specialist, adding another $2,372 to the tab.

That's pretty hard to take, but things are looking up. You've been offered a job with a new company. You go in to meet the H.R. guy, and he makes his offer: A good salary, and they offer food insurance. They will cover about 3/4 of your food bill, but there are quite a few rules you'll have to follow, and lots of forms to fill out. Anything, you tell him, would be better than the shock of opening another bill for 10 grand! He smiles -- he knows that you'll soon be like the rest of his employees: Kept in the fold through a carrot-and-stick system -- happy to have the job, and terrified of losing that food insurance.

This is our health care system, America. Would you vote for it?

Thursday, July 23, 2009

Sunday, July 19, 2009

It can be a tough sport all right

Panamanian player Gabriel Gomez "misses the ball" and gets American Robbie Rogers instead in a typically rough game in the Gold Cup series. Ever been kicked by someone with those legs wearing cleats?

The U.S. won the game 2-1 on a goal scored after another Panamanian star kicked an American player in the gut. The U.S. plays in the semi-final game on Thursday.

Wednesday, July 08, 2009

I thought this was cool

One of the things about the Internet that I continue to find fascinating is its ability to de-mystify things that have long been mysterious. I know: The Web's been around a while now. But in the pre-Web world I cut my teeth in, lots of specialized information was almost completely inaccessible to the non-expert. Now, it's at your fingertips, and at times I still get a thrill of wonder about that.

For example, the radio spectrum. As a regular person, your interaction with the upper reaches of the electromagnetic spectrum was "Channel 12" or "WSGW, AM 790." If you were a curious type, you might associate these "stations" with the idea of a continuum of electromagnetic waves. But did you give thought to where they shoe-horn in the police radio? What else uses those waves?

Now you can see how it's all sliced and diced in exquisite detail. Take a look at this. It's a wall chart from the federal government. Turns out there is an extraordinary amount of stuff going on between Channel 6 and Channel 7 on your teevee. It actually boggles the mind.

Like I said, pretty cool to be able to see this stuff without having to dig around the more arcane corners of your public library.

Tuesday, July 07, 2009



The Democratic governor of New York frequents hookers and resigns. This too, I believe I understand.

But the Republican Senator from Louisiana frequents hookers and doesn't. No comprende.

And the Republican governor of South Carolina freely and annoyingly proclaims his forbidden love for an Argentinian woman, and for the purposes of a final fornication with her, he fled the state under false pretenses without notifying anyone. He does not resign. I guess he didn't break any laws, technically, but I'm somewhat surprised that this did not destroy him.

And the Republican governor of Alaska suddenly decides it's in the best interests of her state if she resigns. While I'm inclined to agree with her, I'm nevertheless surprised by this, too.

I used to understand how these things worked, generally, but I freely confess that I can no longer make any sense of the way Republicans handle these things.