JayB

What specific evidence are you referring to here? Please share. I'm happy to continue whatever conversation that we were having on global warming if you'd like to resume that debate instead of mischaracterizing my role in to.

BTW - where exactly is it illegal to turn a profit selling medical services (is this even true in practice in Canada any more since that court ruling a couple of years ago?)? Also - does changing "market based" to "according to their own particular values subjective assessments of costs and benefits" change things at all for you? I also have to wonder how folks who want to make it illegal for people to get their medical treatment from someone who may or may not make money on the deal reconcile that with (apparently sincere) concerns for preserving individual liberties elsewhere. Having a hard time understanding the folks who feel a deep resonance with "Keep the Government Out of My Uterus" signs while simultaneously idealizing a system that grants the state a kind of veto-power over medical choices involving everything from your urethra to your amygdala.

Keep in mind that includes inefficiencies and redundancies in each of the thousands of insurance companies which are themselves incredibly redundant in every respect, but especially so in claims processing. I'm guessing administrative and systems redundancies actually run more like 75-85% over a single payer clearing house. Sounds to me like that's all included in the 18% figure, but if you have the time, consult the original study and let me know. It would definitely be helpful to know precisely how they define and quantify inefficiencies.

I have to wonder if you read the article to the end, or very closely, since the author did actually propose a single payer plan underwritten by the government as part of his solution. He also discusses a mechanism for dealing with cases where the stakes are high, the potential costs are higher, and the best choice is far from clear. People general retain an attorney to represent them in complex legal matters that satisfy these criteria, and the author arrives at the reasonable conclusion that people would probably retain someone with the expertise necessary to help them make the right choices and coordinate their care in especially daunting medical situations. Anyhow -I don't imagine it will surprise you if I respond by saying that consumers already have to contend with a daunting array of information assymetries in that permeate pretty much every exchange that they participate in - yet somehow we manage. I don't know that kind of margin that Safeway is making on a particular head of lettuce, I know next to nothing about auto repairs, most people have no frame of reference with which to evaluate the RMI guide that they're counting on to lead them up and down Rainier safely, and if I need legal representation I'm even further out at sea. Do my injectors really need cleaning? Is a $5,000 fee really necessary, standard, or fair for divorce cases? Does my heli-skiing guide really understand the snowpack? Etc, etc, etc, etc, etc, etc. When you need to retain the services of an expert in an area that's far outside your expertise - are you really helpless or are there mechanisms and resources that you have recourse to? How are costs and outcomes linked everywhere else in the economy? As someone who gets more or less daily reports about what transpires in emergency rooms, and as someone who doesn't carry comprehensive insurance - I can tell you that people who are spending their own money on medical care can and do engage in a dialogue with physicians about costs, benefits, and risks associated with a particular course of action. To take but one example, people that come in to the ER with minor facial lacerations and insist that a plastic surgeon be called in to close the wound will often reconsider when the costs and benefits of doing so are explained to them - if they're bearing a meaningful portion of the cost. There's lots of reasons why it might make sense for someone to pay quite a bit more to avoid a facial scar, and lots of reasons why any number of other things might seem like a better use of the money. Once they start paying with other people's money - the cost/benefit calculus changes dramatically. Amplify that by a factor of a few billion interactions and you start to get a sense of the scale at which third-party payment mechanisms currently distort total spending on medical care. In the end - it's going to have to be insurance companies, government bureaucracies, or individuals that evaluate the costs and benefits and weigh all of the infinite number of subjective and contextual tradeoffs that drive medical spending. I don't think a HSA driven system will be perfect, but it certainly sounds more appealing than the alternative. I suspect that we'll wind up with that kind of system eventually, but only after insolvency and third-party rationing drive us to it.

Fix here: http://www.theatlantic.com/doc/200909/health-care/1 Unfortunately, what we'll actually get is reform that merely adds more people to the current system, a development which will hasten it's demise and bring about single-payer, the costs of which will eventually result in a debt-burden and rationing mechanisms so severe that people might actually start to consider implementing this guy's ideas.

The two might be related in this case but insisting that drug-use and promiscuity/sexual-misconduct only manifest themselves in morally permissive environments requires a level of innocence that few people can persist in maintaining over the age of about nine. Just saying the words "Army Barracks," or "Catholic Church" should be enough to put that argument to rest. Most people who favor the free market readily acknowledge that people are inherently fallible in ways that manifest in every conceivable fashion, which is why they tend to favor mechanisms that minimize the centralized concentrations of power so that the amount of damage that any single coke-addled, power-hungry fuck-up can do is minimized. I'll take the kind of disasters that the likes of a Bernie Madoff & Co can conjure in an exchange economy over what the likes of Stalin, Mao, Pol-Pot, and Hitler can conjure up any day. Hell, it's not even necessary to go that far - add up 3-4 years of medicare fraud and the cost will outstrip the tab for the entire bailout. They also argue that even if humans weren't beset by the urges to lie, cheat, steal, and snort lines of coke off of their secretary's ass from time to time - the knowledge required to keep the economic basis of civilization going is so massively dispersed and contextual that it could never be centralized and administered by any single person, committee, or institution. This is an insight that seems to escape people who spend their time trying to precisely actuate the price of corn or computing a dollar figure that represents the "right" amount of gross national spending on health-care. Ditto for the notion that something magical happens to people when they start working for the government that nullifies all of the faults and foibles that characterize human behavior in the private sector. Bernie Madoff running a single financial companies is a disaster. Constructing a system where the next Bernie Madoff is in a position to effectively run all financial companies is a sure way to bring about a catastrophe that'd make the recent implosion look mild by comparison.

Unfortunately, this is the kind of non-sequiter that typically accompanies these statistical analyses: "All this could help explain why Americans spend more per capita and the highest percentage of GDP on healthcare than any other OECD country, yet has an unhealthier population with more diabetes, obesity and heart disease and higher rates of neonatal deaths than other developed nations." Hospitals and doctors have zero control over how people conduct themselves when they're not physically in hospitals or clinics. The fact that we spend so much on medical care is one of the primary reasons that the mortality rates from diabetes, obesity, and heart disease aren't significantly higher. Good luck getting that gastric bypass before you eat yourself to death in other countries.

I'm always suspicious of studies that use high-level abstractions and statistical aggregates to define "waste," particularly those that make broad retrospective claims about what tests were warranted for a particular individual, etc....but let's assume that these figures are accurate for the sake of argument: * Unnecessary care such as the overuse of antibiotics and lab tests to protect against malpractice exposure makes up 37 percent of healthcare waste or $200 to $300 billion a year. * Fraud makes up 22 percent of healthcare waste, or up to $200 billion a year in fraudulent Medicare claims, kickbacks for referrals for unnecessary services and other scams. * Administrative inefficiency and redundant paperwork account for 18 percent of healthcare waste. * Medical mistakes account for $50 billion to $100 billion in unnecessary spending each year, or 11 percent of the total. * Preventable conditions such as uncontrolled diabetes cost $30 billion to $50 billion a year." If these numbers are accurate, you'd think that people who are ostensibly concerned with making healthcare more accessible and keeping costs down would have spent twice as much time and energy on efforts to reform the medical malpractice system as they have parsing the administrative-efficiency stats.

No, it's entirely appropriate and quite instructive that the suffering and destruction caused by these people and those like them is driven by the basest, most pathetic motivations possible. These "captains of industry", the "best and the brightest" that are driving the planet off a cliff (whether they're doing it legally or not) are simply infants playing in each others dirty diapers or strung-out adolescents. It's a simple truism but it is an obscenity and makes the suffering they're creating actually seem worse. No wonder we need to create myths of shadowy, omnicient conspiracies to understand the exercise of power. The reality is far more depressing. Cue the "human nature", "it's always been this way", biodeterminist horseshit whenever... Clearly, sex and drug-use amongst consenting adults are only permissible when undertaken to promote social justice.

I'm no expert in intelligent design, but isn't this the gist of their argument? So this is an argument they would use in support of intelligent design. Yes, you are correct. In any case, 'precisely calibrated' systems are prone to failure. Evolution tends to disfavor them, producing instead more robust 'good enough' systems, which are usually supplemented by a patchwork of back up systems, and crowded with legacy spare parts in the process of evolving into something else or nothing at all. Tvash: Always certain, sometimes right.

I'm no expert in intelligent design, but isn't this the gist of their argument? So this is an argument they would use in support of intelligent design. Having said that, neither "minutely calibrated" nor "precisely choreographed" necessarily entails or assumes design. You are definitely correct that they would seize on the sort of language I used in order to make an argument to the contrary. Unfortunately the words that we have available to us to describe particular physical features or interactions that occur in the natural world evolved long before we developed a scientific understanding of the physical and chemical processes associated with life. If most of the words that you have to work with came into being at a time when some kind of intentional human or supernatural agency was deemed necessary to create or maintain a particular order or relationship, it can be difficult to find words that describe either without inadvertently suggesting that there's something other than the operation of physical law at work. Ergo sometimes its next to impossible to translate the said concepts into words without leaving the semantic door open for the creationists to crawl through. IMO there's a similar problem any time that you have to translate concepts that relate to dynamic, self-ordering processes that are governed by broadly distributed mechanisms and local equilibria into words. Economics in particular suffers from words that suggest control and agency by some kind of intentional and centralized ordering mechanism where none actually exists. Which is probably part of the reason why creationism's economic cousin, protectionism, has such an intuitive resonance. ""The curious task of economics is to demonstrate to men how little they really know about what they imagine they can design." — Friedrich von Hayek

"Democrats for a Flat Tax? By Joe Mathews, New America Foundation The Wall Street Journal | July 11, 2009 If that happens, California's tired budget debate -- which usually pits Democrats against Republicans -- will take on a new twist. This time the debate to watch will be among Democrats as they hash out whether taxes are too progressive to accomplish progressive political goals. If that happens, California's tired budget debate -- which usually pits Democrats against Republicans -- will take on a new twist. This time the debate to watch will be among Democrats as they hash out whether taxes are too progressive to accomplish progressive political goals. Karen Bass is an unlikely tax cutter. She's the Democratic speaker of the California State Assembly, a fierce defender of the labor movement, and an advocate for repealing a constitutional provision that requires that tax increases pass the state legislature with a two-thirds majority. But as California faces a budget crisis that defies efforts to resolve it, there is a woman-bites-dog story developing with Ms. Bass at its center. By the end of the month, a commission she pushed to create is expected to recommend that the state adopt a flat (or at least flatter) personal income tax and cut or repeal corporate and sales taxes. Normally, such proposals would be dead on arrival in Sacramento. But now many Democrats, including the speaker, are realizing that what they need is a tax base that will provide steady funding for their programs. In other words, they need a tax base that doesn't count on a large slice of revenue from taxes on a relatively small number of wealthy residents who can flee the state or who are themselves vulnerable to losing a substantial portion of income in a recession."

Please take a look at the "Who's here" thread and chime in with your thoughts. If you want to participate in this effort and don't have access to the forum, get in touch with Jon/Porter.

37?

Its the Circle of Life, fool. Any 4 years old who has watched The Lion King knows this I suppose it's worth stressing that I don't find this sort of thing the least bit shocking or distressing, but then again I'm not a proponent of creationism/intelligent-design, or of the idea that there's a supernatural being out there with any particular attributes that we should either praise or scorn. There's a gazillion viral mechanisms operating at the molecular level that enable viruses to pull essentially the same maneuver that the jewel uses to hijack cockroaches for reproduction, ditto for cancers, etc. I just find it amusing that proponents of a theism that posits something like the cosmological equivalent of Mr. Rogers is running the show selectively omit the vast preponderance of evidence to the contrary - whether that's the holocaust, plagues, purges, pogroms, earthquakes, or the infinite number minutely calibrated and precisely choreographed parasitic mechanisms that predominate in each of the five kingdom's o' life.

Read bits of Deuter after listening to a Hitchens debate. What's in Leviticus?

Que? (For Ponderosa). Short summary: -Wasp injects cockroach's abdomen with venom A, paralyzing its forelimbs. -Wasp injects paralyzed cockroach's brain with venom B, reversing the original paralysis but turning it into a zombie. -Wasp bites off cockroache's antenna, drinks a bit of cockroach's blood to revive itself. -Wasp bites antenna, and pulls on it to lead cockroach back to its den. -Wasp lays eggs on 'roach, then seals roach in den. -Wasp larvae eat their way into the living zombie roach, then selectively feast on its organs to keep the zombie roach alive while they grow. -Larvae hatch, roach dies. -Repeat.

I suppose, but you never go broke by saving too much.

No, no - lots of people have. I'd argue that the majority of people that believe in an omniscient/omnipotent deity have considered them, and I'm sure there are folks that have spent years or decades either composing treatises that parse these questions in minute detail, studying them, or both. It's just that when there was an occasion for folks to toss around these questions in public, like the Tsunami, I was just surprised at the sheer number of folks who evidently hadn't done so.

Combine the high-pressure meat sales with Scientology and you'll have yourself a cash-machine that'll make Amway look like a lemonade stand...

The omniscient/omnipotent makes even the stuff humans do to each other problematic, but seems much more difficult to overlook earthquakes, genetic disorders, plagues, tsunamis, etc. Hell, even the prevalence of the peanut-allergy should raise some troubling questions. "Ooooh - dang! Er, sorry about that one Jimmy. I was busy tweaking the binding kinetics of this highly-specific neurotoxin in this one species of parasitoid wasp and forgot to get rid of that epitope on the peanut protein. My bad." After the Tsunami I was amazed to learn that there were actually (lots of) adults that had seemingly never grappled with some of the more basic implications of the creeds that they'd ostensibly dedicated their lives to abiding by and spreading.

Tried when I was a kid but never got beyond the infinite regress of begats. Might explain the sense of befuddlement I experienced when encountering Deuteronomy, the book of revelations, Job, Lot, Jonah, and various other highlights. For some reason that reminds me of a lab-mate of mine from India that had only vaguely heard of Jesus and knew nothing of the scriptures when he arrived in the US, and encountered Jehovah's witnesses at his door. Listening him recreate the interaction, where he (sincerely) played the earnest straight-man while they shared their message with him was priceless. "So - I am sorry? You are here at my home knocking on my door to tell me about this Mr. Jesus fellow?" "Yes." "Why is it important that I should know about this Mr. Jesus." "Because he died for your sins" "But this Mr. Jesus is has been dead for an extremely long time. Yes?" "Yes - he died on the cross over two thousand years ago." "If that is the case, then this statement of yours about this Mr. Jesus is making no sense to me. If this fellow died over two thousand years ago, there is clearly no manner in which he could have even the slightest notion that I would ever exist, much less that I would commit engage in any shameful acts..." From what I can recall they touched on the Garden of Eden and a couple of other highlights before moving on.

Gotta wonder how one would account for this in a sermon concerning the nature of an omniscient, omnipotent being that designed life on this planet. [video:youtube]

For realtors, it's always a good time to cash a commission check. Cynic.

Still might. We're renting a place on the North end of Capitol Hill now that'll probably do for the next 2-3 years. Don't see the rent/own math changing anytime soon, even if our circumstances do, so no rush. All things being equal, having a large garage, a yard, driveway, and being way closer to the pass sounds quite a bit more appealing but it probably isn't in the cards unless teleportation replaces the standard commute.