(via voluntary Xchange)

One of these things does not belong:

Found here. (Via Future of Capitalism)

The principal reason why we’re dealing with this portion of the plan so early, and yes, there’s much more to come, is that our President has insisted on pushing this issue to the forefront of his policy agenda. Regardless, in the Grand Plan we tackled issues that are prerequisites to taking on health care reform before tackling the issue itself. In fact, much of the Rob Sama Grand Plan for health care has already been implemented in earlier planks. Didn’t notice that happening? That’s ok, I’ll walk you through it.

But before we begin, we need to state clearly what it is we’re setting out to accomplish. If we act without delineating our goals, we’re not likely to achieve much good. So here goes:

• Stop the runaway cost inflation: Any and every other problem relating to health care is related to the spiraling cost of delivery. Take care of this and most other problems become easy to fix.
• Encourage the development of new medical technologies: Medical advances don’t just happen, and they don’t just happen anywhere. Yet we all benefit from them. Any changes to our medical care systems cannot discourage the development of new medical technologies, whether they be devices, drugs or techniques.
• Address concerns about portability and pre-existing conditions: People are upset about losing health insurance coverage in between jobs, and about insurance companies using the notion of a condition being pre-existing so as to not have to make payments. These are two sides of the same coin and are addressable concerns.
• Stop the looming catastrophe that is Medicare bankruptcy: Medicare cannot continue as is, or it will bankrupt the country. At root a new system needs to be devised for seniors so that their medical care costs do not become an undue burden on the rest of society.
• Retain patient autonomy in decision making: patients and their loved ones ought to be able to make decisions regarding their health without interference from the government.

One thing that it’s important to note that is not a goal is universal or free coverage. Universal, free national health care is not possible or compatible with our earlier stated goals. People’s appetites are unlimited, and where their appetites are limited their tastes are not. As a result, if you make something free, people will consume as much of the highest quality stuff as they possibly can. Unfortunately, while their appetites and tastes are unlimited, our means are not. Therefore, granting free health care to people is a surefire way to go broke. Alternatively, the government can get intimately involved in every healthcare consumption decision, which destroys our earlier goal of patient/doctor autonomy. In short, free health care provided for by the government is simply not affordable and not compatible with freedom.

What’s more, utopias don’t exist. Humans are imperfect creatures and they form imperfect societies. But when utopian promises are made by a society and those promises aren’t kept, invariably a scapegoat is sought, and then the ugliness begins. Putting the entirety of health care under the government’s umbrella puts enormous power in the hands of government. A government that controls whether or not you can receive medical care is a government that can dictate anything to you, whether or not you ostensibly have freedom. For that most fundamental reason, government health care is incompatible with freedom, and thus not a part of the Grand Plan.

If you don’t value your freedom than you’re fundamentally on a different page than I am, and the Grand Plan is probably not for you. For the rest of you who do value your freedom, let us continue.

So why is it we’re not currently achieving our objectives except for new medical innovations? The short and simple answer is that there is a disconnect between he who pays for medical coverage and he who is receiving the service. Virtually never does the patient pay his own bill. Rather, today, the patient has his insurance company pay the bill, and the insurance premium is paid for by a combination of his employer and a deduction taken from his paycheck. Alternatively, it’s paid for by the government if you’re on Medicare. But the point is, it’s never paid for by YOU.

This is a crucial point to grasp. If a good is not paid for by a consumer, then two things occur: the consumer makes no effort to limit his consumption of that good, and he makes no effort to price shop, he only shops for quality. Because human appetites are unlimited, they can literally gorge at the medical trough without even knowing that they’re doing so. Medical bills need to be reconnected to the person paying for the service, and insurance needs to return to its original purpose – to insure against the unexpected.

You will note if you remember in the Taxation plank of the Grand Plan, we eliminated the corporate income tax. This means that corporations no longer benefit from offering health plans to employees. They can if they wish to, of course, but it’s all income to the employee. Over time, most companies will stop offering insurance, and will instead opt to just pay employees in dollars, which makes more sense. This leaves employees to procure insurance on their own dime, in a non-tax subsidized way.

If you think about it, this is no different that the way your car insurance works today. You shop around for a policy that will cover you in case of catastrophe, and you carry that policy with you no matter who you’re employed with. Your policy is priced in part on your driving record, but also on what type of coverage you want. And in most cases, barring some sort of disaster with one’s insurance company, you hold your policy throughout your life. That’s how insurance ought to work.

Because consumers will be paying the bill themselves, they can make an informed economic trade-off as to how much they’re willing to self-insure before insurance benefits kick in. They can choose to pay high premiums for something more all-inclusive, or a lower premium for something with a higher deductible. I strongly suspect that most people will choose a higher deductible. When the consumer puts money away to self insure, there is no need for any special health-savings account or other such paperwork generating nonsense. Simply put the money in an interest bearing account, and it’s assumed to be invested under the Grand Plan tax setup. And when consumers spend their money, they’ll be encouraged to shop on price, as they shop for everything else in their lives. This simple change will encourage health care provides to drive costs down, and provide better service to their consumers, who will now be paying their own bills.

So the changes we’ve already made to the tax code alone, will go an enormous way toward reducing costs in health care. Moreover, these changes will also eliminate problems regarding portability and alleviate problems regarding preexisting conditions. Because you own your own health care plan, you’ll take it with you wherever you go. And consumers will be motivated to keep some form of catastrophic insurance with them throughout their lives. Costs will be lessened, and the price for not doing so may be getting caught without should a medical emergency arise. Yes, some people will wind up getting stuck or take undue risks, not hold insurance, and then get sick. But we’re not seeking an utopia here. The best solution is for people to maintain catastrophic insurance, maybe coupled with unemployment insurance, so that the premium gets financed for the consumer is they’re unemployed for a period of time.

The other thing we’ve done to reduce costs is enact tort reform. Any serious proposal to bring medical costs down must include tort reform, if not begin with it. Though we’re discussing the Grand Plan here, it should be noted that the plan passed by congress and signed by the president does not include any meaningful version of tort reform. It is, in my opinion, an unserious bill.

We should also discuss life insurance here. You may not be aware of this, but currently, the biggest lobby in favor of the death tax, also called the inheritance tax, is the life insurance industry. The reason for this is that when a person wants to pass down a non-liquid asset to his descendants, an asset such a business or a piece of land, he must find a means of paying off the inheritance tax in order to avoid liquidating the asset. In order to accommodate this need, life insurance was born.

However, in a world without an inheritance tax, the need for life insurance diminishes substantially. So let’s repurpose it. Instead of life insurance, let’s call it “End Of Life Insurance”. After all, we all know that somewhere at the end of our lives, we may encounter large, end of life medical expenses. These are not the type of expenses that should be covered by catastrophic medical insurance, because death is inevitable. But the expenses are not necessarily inevitable. So here’s how it would work: you buy end of life insurance, which is available to be cashed in on any time after you’ve reached the average of death, 75 years or so. It’s up to you if you want to spend it on keeping yourself alive, or if you’d rather let your descendants get the money. But the point is, it’s up to you. And like life insurance now, it could even expire after a point, say 95 years of age, if you think you’ve lived a full enough life. The great part about this is that the infrastructure for this already exists. All that needs to happen is for existing policies to be repurposed from being life insurance to being end of life insurance.

There are a few things that do need to be changed to further lower costs beyond what we’ve already discussed in the Grand Plan however. Let’s talk about them now:

Allow Insurance To be Purchased Across State Lines:

As it currently stands, citizens are forced to buy health insurance within their state borders. This is patently absurd. You can get your mortgage from anywhere, hold your retirement accounts across state lines, get credit cards across the country, incorporate in any state regardless of where you reside. So why should ou be restricted to buying insurance from within your state borders?

The problem with this limitation is twofold. Firstly, people who live in small states have a limited number of insurers to choose from. Limited choice will always drive up costs. Secondly, state laws differ as to what insurance plans are required to cover. Some states cover quackery like chiropractic and acupuncture. But if you don’t want those services, why should you be forced to pay for those who do? The easiest way to drive those inefficiencies out of the system is to make the states compete with their laws, the same way that they do with incorporation statutes and lending statutes. That way, you can buy a plan in Delaware regardless of where you live, so long as you like the plan, just as you can incorporate there today.

Roll Back The FDA

The FDA imposes enormous costs on the development of new drugs and devices in the medical field. Approval of a new drug or device can take years. Because patents only last 20 years, this process significantly diminishes the ability of companies to adequately recover sunk R&D costs when selling new products. So the approval process need to be seriously scaled back.

Currently, the FDA tasks itself with two things: ensuring safety and efficacy. But why should the FDA concern itself with efficacy? Does denying a drug to a sick patient because the FDA is uncertain of its effectiveness a smart idea, so long as it has been deemed safe? Does anybody want to spend money on drugs that aren’t effective? Clearly not. Yet the FDA delays letting drugs come to market, using up valuable patent time attempting to do what the market is better able to do more quickly and more effectively. And in the meantime, they’re denying treatments to patients who need it, while they satisfy themselves as to whether or not those treatments are effective. Let patients and their doctors make that determination. There is no need for government intervention there.

Moreover there’s no need even for the FDA to be in the safety certifying business either. Certifying safety is something private licensed agencies can do perfectly well. SImply make the agencies post a large enough bond in case of failure, and let them compete with each other on price and time spent testing. Competition in the safety certification market will reduce costs and time to market, which ought to lower costs across the board, all the while ensuring that new technological advances make it to market in a timely manner. Should a certification company screw up, it can lose its posted bond, or even its license to certify.

Unwind Medicare:

It should be apparent by now that there is little need for government sponsored health insurance for the middle class under the Grand Plan. In old age, most people should still have their own insurance policies, and they should have end of life insurance policies that would cover them with end of life medical expenses, should they choose to incur such medical expenses.

However, in the current time frame, too many people are dependent on Medicare to simply shut it down. But entry into the program ought to be limited, pending implementation of the remaining portions of the Grand Plan. I would support a cutoff of something like 35 or 40 years of age, under which Medicare would no longer be offered. Furthermore, any new entry into Medicare ought to be strictly means tested for those over the cutoff age. In this way, we limit the public exposure to future medical costs. We will likely incur debt to pay off the reminder of Medicare participants, but at least it is capped, and with a growing economy we ought to be able to handle the load.

Government Oversight:

It ought to be acknowledged here that any insurance provider, private or government run, has an incentive to collect premiums and simply to not provide payment when it is required. While it is difficult if not impossible to get the government to police itself, it is part of the normal functions of a proper government to police private industry. To that end, having a specialized agency, either at the state or federal level, enforce insurance contracts and payouts is a proper and desirable function of government. I would also be supportive of a fund established to aid plan participants transition over to other providers should an insurance company go under. However I should also state that I believe that insurance is best handled in a cooperative fashion, where the participants are also the shareholders. It’s how I buy my home and car insurance, and how I would choose to buy my health insurance, were that option available to me.

Recap:

So let’s just recap what life looks like for a consumer under the Rob Sama Grand Plan from a health insurance perspective:

As a consumer, you buy health insurance in much the same way you buy car insurance. You likely buy a high deductible plan, which is competitively priced because it’s competing for your business on a national basis. You self insure for the remainder, and pay ordinary medical costs out of pocket, price shopping in the process, thus further driving down costs. This policy will cover any catastrophe but perhaps have limits for normal, end of life medical costs, For those costs, you carry an “end of life” insurance policy, which will cover a fixed dollar amount, and which can be drawn on after the age of 75 for medical costs should you so choose. Current Medicare subscribers would continue unchanged, but a cutoff ill be instituted after a certain age, with younger people and people of means prevented from entering the system. Medicare is finally wound down some 30-40 years from now.

It goes without saying that nothing I’ve seen in the Obamacare proposal is compatible with the Grand Plan.

So Adam Shostack, over at Emergent Chaos, has written up the singularly most obnoxious thing I’ve seen written about the passage of Obamacare. You can go read it for yourself, and for what it’s worth, I’ve already thoroughly responded in the comments there. I’ll reprint here if he deletes it.

However in his noxious screed he makes the critical mistake of making a prediction, and a poor one at that. He writes:

I would not be surprised to see the Republican minority shrink in 2010 and 2012, and I think some (but not all) of the shrillness I hear is people who fear that outcome is now inevitable.

Well then. Let’s put some money on that prediction shall we? After all, it runs contrary to every political prediction and prognostication I’ve seen made on the matter. And it certainly runs contrary to how Obamacare is currently polling.

Adam believes that the Republican minority will shrink in 2010. I believe that is preposterous. Furthermore, as someone who attended the Boston Tea Party rally and thus, someone who Adam thinks fears a Republican minority shrinking further in 2010, I feel I need to prove otherwise. So, inspired by Coyote Blog, I propose a simple but substantial wager. $1000 for every net senate seat that changes in 2010, and $100 for every net house seat that changes. And just to sweeten the deal, I’ll offer you a handicap: one free senate seat plus five free house seats. That means Adam’s ahead $1500 even if no change whatsoever takes place! How could he lose?

So how about it Adam? I’m publicly calling you out on this. Accept my wager and stand by your convictions! Or at a minimum, explain your refusal to do so.

I eagerly await your response.

UPDATE: I just want to be clear that Adam and I are old friends and we go back a long ways, and that hasn’t changed nor will it. We had a good talk on the phone, and we’re going to work out the details of the bet, though it won’t take the form as outlined above.

(via voluntaryXchange)

The most glaring flaw if not outright contradiction about the iPad was the fact that it seemed to be designed as a device on which to consume content, but not one on which to create or upload much content, email excepted. To that end, iPhoto was reduced to a photo gallery, and Garageband was not ported to the iPad. What’s more, it only had a dock connector port as it only data port.

The contradiction, of course, was in the existence of iWork for the iPhone, which is obviously designed to generate content. So too for the paint program that was demonstrated at the iPad unveiling. But these were all add-ons, not included with the iPad out of the box. So Apple seemed to be saying that for most people, the iPad was a consumption device, though for some people, they could create using it should they so choose.

The problem with this is that the world is no longer divided between content creators and consumers and Apple of all companies should have realized that. Apple built the entire Mac OS around the idea that consumers should be creators. But with the iPad, they seemed to assume that most consumers would use the device solely for content consumption, outside of the occasional document creation need. But this was fallacious.

Almost immediately, among the most common complaints were that one could not hook a camera or SD card up to the iPad. The reason why someone would want to do this is obvious: who wants to blog about their vacation and not be able to upload their photos and/or video clips? The lack of a USB or SD card slot was a major omission on the iPad, and a primary reason why I was not considering buying one.

So I was rather pleased to note that Apple has recently put an iPad “camera connection kit” on their web page as a future product (it doesn’t seem that you can order one yet). The connection kit comes with two adaptors, one for an SD card and one for a USB slot. One can’t help but think that the existence of such a product amounts to a mea culpa on the part of Apple, a recognition that the iPad should have come with these slots integrated in the first place. I would think it’s very likely that future versions of the iPad will come with these slots integrated.

I would also think that the existence of this camera kit will mean that Apple will provide some sort of rudimentary editing software as well, at least enough to crop photos and remove redeye, and to truncate video clips and adjust sound levels. Perhaps they will be released when the camera kit actually goes on sale.

One also can’t help but notice that by releasing a USB adaptor, Apple has in effect created the opportunity to hook all manner of devices into the iPad. It will remain to be seen what is done with this ability.

In any event, I still wish the iPad had an integrated camera. And frankly, I’m an IM addict, so some sort of multitasking for IM is still a must for me. But with the camera kit for the iPad, I can for the first time really see myself wanting one to take with me on vacation.

So now that Rush Limbaugh has moved to the new “Rush Radio 1200″ in Boston, they’re playing him on the morning drive in. Presumably, when Howie Carr leaves WRKO he’ll go there and take that morning slot. Anyhow, I was listening this morning and caught this bit on Net Neutrality:

What’s coming way beyond this, what’s coming in the fall is the deceptively named net neutrality. The easiest way to understand this is to think of a Fairness Doctrine for the Internet. Now, how would this work? Let’s say that you want to go Google or Bing, you want to search the mating habits of the Australian rabbit bat. Net neutrality would require that every search engine produce an equal number of results that satisfy every disagreement about the issue. Yep. And that’s going to happen. That pretty much is going to happen. And the White House is in bed with Google. The White House and Google are bedmates, Google, largest search engine. Already, if you do a search of me on Google and you look at the crap that comes up, it’s by design and on purpose. It’s literal crap, I mean the most obscure places you never knew existed with comments about what happened on this program every day. It took a long time, but we had to really work hard at getting our website to pop up in a search of Google, our own website.

So in the era of net neutrality — and this is where the Google-White House partnership comes into play — the results of any search, let’s say you want to search abortion, or you want to search the health care bill, they want to control what you see. They want to control what your options are. They can’t really control the content, it’s too massive and it’s too big. What they want to try to do is limit your access to it and have that access flavored toward whatever particular point of view the administration wants supported. Now, that is coming. That’s why they want all this new broadband. That’s why they want all this new speed. That’s why they want all this new access. It’s not to own it; it’s to control the content as best they can. Just think of it as Fairness Doctrine for the Internet. I’m not making this up. I guarantee you that’s what’s coming. I think this is a fait accompli. I think it practically has been voted on, done deal.

Rush evidently thought that this was so good that he decided to publish it on his website. For the record, this couldn’t be more wrong. All net neutrality says is that if you’re selling Internet service, that said service adhere to the published standards of Internet protocol (IP), and that providers cannot intentionally degrade service from particular websites or from the use of particular programs whom they don’t like or who refuse to pay a ransom to the ISP.

I’ve written extensively on Net Neutrality in the past. Click on the tag to see everything I’ve written on it. In short, my position is that I’m in favor of it so long most consumers continue to have no choice in broadband providers at their home. And I don’t subscribe to the FCC’s definition of broadband. My definition would be “If you can watch YouTube and Hulu at their highest definition without skipping, you have broadband.” DSL doesn’t cut it for that.

Brilliant movie, must watch:

Via gruber.

So Obama says that his healthcare package deserves an up or down vote. But no vote has been called. Mostly because they don’t have the votes in the house for the Senate bill.

So I say the Republicans should call their bluff. Why give them time to twist arms and dole out favors? Demand the vote NOW. And watch them lose.

Moreover, if you’re a Democrat in the House caught in the middle of this mess, you must be pissed at Pelosi for putting you there, and for not telling Obama that it’s time to move on. So why not give those House members the opportunity to tell Pelosi to move on? There are 255 Democrats in the House, with 216 needed to vote for passage. Why not say to the 40 or so members who are going to vote no on this or who are on the fence, “Look it, we’ll support you in an effort to replace Pelosi. Join with us and we’ll oust her tomorrow, and we’ll support your effort to make Steny Hoyer the new speaker!” From all I’ve read about how much of an autocrat she is as speaker, I suspect that rank and file Democrats would relish the opportunity to throw her out.

So I say make your move. Strike now, while they don’t have the votes.

last day