Minor Thoughts from me to you

SPM’s consideration of taxes will help Obama’s reelection campaign if (and I believe it’s more like when) the Census Bureau surprises everyone and releases its related report in October of next year instead of November, as it did this year, and attempts with media help to give it greater credibility than the official measurement. By far the largest tax low-income families pay is the payroll tax. In 2011, that tax was reduced by two percentage points. As a result, when next year’s SPM report comes out, millions of Americans will no longer be “low income” under its framework. I can imagine the campaign verbiage already: “Who first broached the idea of eliminating part of the payroll tax? Why, it was Barack Obama, who singlehandedly moved millions into the middle class in one bold move, undoing much of the damage of the past decade’s misguided policies.”

Cynical and paranoid? Perhaps. But hasn't the past 50 or 60 years taught us that it's hard to be too cynical when it comes to our government?

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Take-aways: Ron Paul is not racist, an anti-semite, or anti-gay. He is however, from a much older generation and is personally uncomfortable around gays, clueless about Hispanic and Black culture, and opposed to the nation of Israel. Also, he very nearly voted against the Afghanistan War.

This is worth a read, to get a better read on Ron Paul.

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In 1986, Congress passed EMTALA, making it a federal crime to transfer a patient from one hospital/emergency room to another for financial reasons. It compels hospitals to render care, even without any compensation.

... But EMTALA did more. It killed the voluntary nature of the Medicaid system.

... Today, if Arizona decided to leave Medicaid and resume its pre-Medicaid system, it couldn’t do so. EMTALA would prevent it from functioning. EMTALA specifically bans any hospital from transferring patients for financial reasons. Arizona’s pre-Medicaid system depended upon the transfer of indigent patients from private centers into its indigent health system, thus relieving private hospitals and providers from the burden of constantly providing uncompensated care.

States should be free to design their own systems and innovate, instead of all being forced into the same rigid mold.

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John Goodman, making sense on health insurance and third-party payment.

The fact is that health insurance is complicated because health care is complicated. Congress may think it can wave a magic wand and declare that it should be simple, but that is like passing a law that declares ice should not be so damned cold.

...

The biggest complicating factor is third-party payment. It is incredibly complicated to pay someone else’s bills — for anything. How would you like to be responsible for paying my grocery bills? Or my clothing bills? Or my transportation bills? How would you write the contract for any of that?

It is far easier to make a sum of money available to me and let me go get my own services and pay the bills myself. Now that would be an easy-to-understand contract! It would be one sentence — “Here’s $XXX. Go get your own services.”

If Congress wants health care financing to be “easy to understand,” it should remove the third-party from the mix.

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How insane is this?

If you defend your family and property from a knife-wielding druggie in Massachusetts, you’d better be prepared to also defend yourself from the justice system, too.

McKay is the young father who, seeing a local druggie breaking into his truck and stealing the tools he uses to pay the bills, confronted him, subdued him and held him for the police. When the police arrived, they found the bad guy had a knife, a billy club and — thanks to the unarmed McKay — a broken jaw.

Instead of thanking McKay for helping get an armed criminal off the streets, Swampscott officials charged him with a felony. As a Swampscott police spokesman said at the time, “We don’t urge anybody to fight back. We want them to call us.”

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Over the last few months, in consultation with sports economists, antitrust lawyers and reformers, I put together the outlines of what I believe to be a realistic plan to pay those who play football and men’s basketball in college. Although the approach may appear radical at first glance, that’s mainly because we’ve been brainwashed into believing that there’s something fundamentally wrong with rewarding college athletes with cold, hard cash. There isn’t. Paying football and basketball players will not ruin college sports or cause them to become “subcontractors.” Indeed, given the way big-time college sports are going, paying the players may be the only way to save them.

I'm in.

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Book publishers are starting to see the light.

“If we believe that convenience reading is moving at light speed over to e,” Mr. Schnittman said, using the industry shorthand for e-books, “then we need to think about what the physical qualities of a book might be that makes someone stop and say, ‘well there’s convenience reading, and then there’s book owning and reading.’ We realized what we wanted to create was a value package that would last.”

Martha K. Levin, the executive vice president and publisher of Free Press, the imprint of Simon & Schuster that published “The Iliad,” said the presentation sent “the message that even if you’re buying 90 percent of your books on your e-reader, this is the one that you want to have on your bookshelf.”

Exactly. There are books that I just want to read---and then there are books that I want to treasure and display.

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Eric S. Raymond gives his explanation for why he loves the unlovable: Walmart.

I do not love the ambience of Walmarts; by my standards they’re loud, cheerless, and tacky – and that describes a lot of their merchandise and their shoppers, too.

But my esthetic and aspirational standards are those of a comparatively wealthy person even in U.S. terms, let alone world terms. To the people who use Walmart and belong there, Walmart is a tremendous boon that stretches their purchasing power, enabling them to have things that don’t suck.

That’s why I love the idea of Walmart, and will defend it against its enemies.

This is my reason too. Even though I rarely shop at Walmart, I'm glad that it exists.

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Dune by Frank Herbert

My rating: 6 of 5 stars

Brian Herbert, on Dune.

Dune is a modern-day conglomeration of familiar myths, a tale in which great sandworms guard a precious treasure of melange, the geriatric spice that represents, among other things, the finite resource of oil. The planet Arrakis features immense, ferocious worms that are like dragons of lore, with “great teeth” and a “bellows breath of cinnamon.”

It’s hard to find something to say about Dune that hasn’t already been said. It raised for the bar for the entire genre of science fiction. It won both the Hugo and Nebula awards. It combined elements of ecology, politics, philosophy, history, evolution, religion, psychology, adventure, revenge, and more. It’s fantastically layered, lending itself to many different interpretations and explanations. It gave us a world complex enough, with a history rich enough to support 15 sequels, a movie, and 2 TV mini-series.

It can be a slow read at times, demanding close attention from the reader. Herbert introduces a dizzying array of characters, concepts, terms, languages, histories, and peoples. You are, in essence, dropped into a story already in progress and trusted to keep up as events unfold. But, in spite of its occasional flaws, it’s a worthwhile read. From start to finish, the book rewards the reader with an all-engaging universe.

If you have already read Dune, you know what I’m talking about. If you haven’t, you should probably give it a try. It’s a true classic of the genre for many very good reasons.

Glory Season by David Brin

My rating: 5 of 5 stars
Personal Enthusiasm: Loads of Fun

The best science fiction is, at its heart, speculative fiction. These books start with a single big idea—a single question—and develop it. The great books take that idea and develop it superbly. Glory Season is a great book. It starts with a single idea: what if humans could clone themselves when times are good and revert to sexual reproduction when times are bad and genetic diversity is at a premium?

David Brin explains how his idea developed, from that single root.

The idea of cloning has been explored widely in fiction, but always in terms of medical technology involving complex machinery, a dilettante obsession for the very rich. This may serve a pampered, self-obsessed class for a while, but it’s hardly a process any species could rely on over the long haul, through bad times as well as good. Not a way of life, machine-assisted cloning is the biosocial counterpart of a hobby.

What if, instead, self-cloning were just another of the many startling capabilities of the human womb? An interesting premise. But then, only female humans have wombs, so a contemplation of cloning became a novel about drastically altered relations between the sexes. Most aspects to the society of planet Stratos arose out of this one idea.

David Brin relentlessly develops this big idea, to see exactly where it takes him. He follows it through the sciences, to see where it takes him: biology, sociology, psychology, and more. By pursuing this idea so relentlessly, he constructs a society that is very alien to our own (uncomfortably so, in cases) but yet is still very recognizable.

Glory Season is a tale of a largely static society, where women hold the upper hand. Men are kept around primarily for their ability to "spark" clone births. It's a society largely dominated by extended clans of female clones. It's a society where being unique is very uncomfortable and where "var" is a derisive slur.

But David Brin didn't allow these big, well developed ideas to get in the way of telling a story. Glory Season is an adventure tale, a coming of age tale, and a tale of radicals seeking to remake society. It was both thought provoking and thoroughly entertaining. I highly recommend it.

Kyle B. Smith tells about his experiences, while visiting North Korea.

I took my camera out and started snapping some photos. “No pictures!” I was politely, but firmly, admonished by a pretty young flight attendant. Though still sitting on the tarmac in Beijing, I figured it would be best to follow DPRK rules as being inside the Air Koryo plane already made me feel like I was under the watchful eye of the Dear Leader.\

You could easily tell who the North Korean citizens were. Each had a pin on his or her shirt, right over the heart, featuring either the beaming smile of Kim Il Sung, the Great Leader and Eternal President of Korea—the only official head of state who is dead—or a more innocuous pin with the North Korean flag on it.

Interesting. I'm looking forward to part 2.

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This is absolutely wrong and is a very good example of why the current hysteria over illegal immigration is a bad thing. We are a nation of immigrants. We shouldn't be so paranoid about immigrants that we're willing to treat citizens like crooks.

In a spate of recent cases across the country, American citizens have been confined in local jails after federal immigration agents, acting on flawed information from Department of Homeland Security databases, instructed the police to hold them for investigation and possible deportation.

Americans said their vehement protests that they were citizens went unheard by local police and jailers for days, with no communication with federal immigration agents to clarify the situation.

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I loved Daniel Craig's first Bond movie, Casino Royale. Consequently, I had high hopes for Quantum of Solace and was bitterly disappointed with what I saw in theaters.

There was a reason for that. Daniel Craig talked about it, in a recent interview.

It seems that the script is sometimes an after-thought on huge productions.

‘Yes and you swear that you’ll never get involved with shit like that, and it happens. On “Quantum”, we were fucked. We had the bare bones of a script and then there was a writers’ strike and there was nothing we could do. We couldn’t employ a writer to finish it. I say to myself, “Never again”, but who knows? There was me trying to rewrite scenes – and a writer I am not.’

It seems that Craig's next Bond movie, Skyfall, has a proper script. Perhaps I'll allow myself to hope that it's good.

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David M. Primo talks about how campaign finance laws work to restrict free speech.

This past election when Dina Galassini emailed some friends urging them to join her in opposing a ballot initiative proposing $30 million in bonds for the town of Fountain Hills, Ariz., she thought she was doing what Americans have done throughout our nation’s history—speaking out on matters of public concern. Instead, she received a letter from a town clerk strongly urging her to “cease any campaign related activities.” It turns out she failed to fill out the paperwork required by Arizona’s campaign finance laws and therefore didn’t have the government’s permission to speak.

Under Arizona law, as in most states, anytime two or more people work together to support or oppose a ballot issue, they become a “political committee.” Even before they speak, they must register with the state, and then they must track every penny they spend, and if spending more than a small amount, fill out complicated reports detailing every move.

Worse yet, these laws do nothing to help educate voters. They're worthless, they're unconstitutional, and they're keeping citizens from becoming involved in politics.

I honestly don't understand why "progressives" think that these laws are such a great idea. Why is it okay for me to be involved in politics by myself but not okay for me and 10 or 100 or 1,000 or even 10,000 people to pool our time, resources, energy, and money together, to promote or oppose an idea?

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A. Barton Hinkle examines the Virginia state budget and determines that increased Medicaid spending is the big reason that the state government has had to cut the budget in recent years.

To hear some folks tell it, budget cuts in Virginia over the past three to four years have been so savage it’s a miracle there’s any state government left. We long ago cut out all the fat and hacked through the muscle; now we’re sawing deep into bone. Localities are scared stiff that the state will stiff them come January. And it’s only going to get worse. Gov. Bob McDonnell has had state agencies prepare plans cutting 2 percent, 4 percent, and 6 percent from their budgets. The stories have grown numbingly familiar.

Still: The general fund has grown roughly $1 billion from last fiscal year to this one. That represents about a 6 percent hike. So why is the governor asking agencies to plan for cuts?

… For example: From fiscal 2008 to fiscal 2012, general-fund outlays for the Department of Medical Assistance Services (that’s the one responsible for administering Medicaid and the state’s Children’s Health Insurance Program) have grown 35 percent. General-fund revenue hasn’t grown anything like that, so the difference has to come from the pockets of other programs.

Huh. Maybe we really should talk about reforming Medicaid.

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Education used to make up a bigger share of state spending. When the association first began compiling the report in 1987, elementary and secondary education made up the biggest share of state spending, and higher education the second-biggest share. Medicaid surpassed higher education as the second-biggest state program in 1990, and in 2003 it became largest state program for the first time. Since then it has vied with schools for the biggest share of state spending, but for the past three years it has been in the lead, with an increasing margin.

Maybe it's time to consider reforming Medicaid? Before it eats up state budgets completely? And maybe we could do it without demonizing the one party that's willing to talk about it? (Hello, Congressman Paul Ryan.)

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Some health plans require you to fill your prescriptions through mail order pharmacies. Some patients don't like that requirement. In New York State, that requirement will soon be a thing of the past.

The bill barred insurers or employers from forcing patients to use mail-order plans for prescription drugs, except for plans negotiated by unions. Instead, consumers would be guaranteed the choice of having their prescriptions filled either through mail-order or at the local drugstore, without any added copayments or fees.

So, at a time when health plans are under tremendous pressure to cut premiums (or at least to raise them as little as possible), the Governor is going to raise health plans' costs? Not exactly.

But the governor signed both bills late Monday on the condition that the Legislature would retroactively amend them to require retail pharmacies to accept the same reimbursement rates for drugs as mail-order pharmacies.

Oh, okay. The Governor is going to force small mom-and-pop stores to lose money on every prescription that they fill. Yeah, that's going to work out well.

There's absolutely no good way to fulfill this requirement without raising somebody's costs. The patient's preference for locally filled prescriptions is more expensive. By rights, patients should pay for that preference. Instead, the Governor is looking to make someone else pay instead. That's always a bad idea and this is going to end up back-firing.

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I just discovered this 2007 article from Paul Graham. He said something that I've vaguely thought of before but I've never even come close to articulating it this well.

We all have lots and lots of stuff. We like to think that it's valuable because we'll use it one day. It's not. It's worthless.

What I didn't understand was that the value of some new acquisition wasn't the difference between its retail price and what I paid for it. It was the value I derived from it. Stuff is an extremely illiquid asset. Unless you have some plan for selling that valuable thing you got so cheaply, what difference does it make what it's "worth?" The only way you're ever going to extract any value from it is to use it. And if you don't have any immediate use for it, you probably never will.

Companies that sell stuff have spent huge sums training us to think stuff is still valuable. But it would be closer to the truth to treat stuff as worthless.

After reading this, I'm ready to go through the house and to start tossing "stuff".

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John Goodman finishes his analysis of complex systems. This time, he considers the policy implications of the fact that healthcare is a complex system.

• Complex Systems Cannot Be Managed from the Top, Down
• The Core Components of Complex Systems Cannot Be Copied
• Choosing Public Policies for Complex Systems
• Public Policy Lessons

Most people in health policy do not understand complex systems. They really don’t understand social science models either. As a result, when they advocate or enact public policies, they are almost always oblivious to the inevitability of unintended consequences. The idea that a policy based on good intentions could actually make things worse is beyond their comprehension.

Speaking as someone who works in healthcare: yup. Every time healthcare people get together in large numbers, I see the belief that they can figure out a master plan, using the power of good intentions to make everything better. (Usually, of course, without using any evil profits either.)

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John Goodman explores some of the characteristics of complex systems and applies them to healthcare.

• Complex systems can never be accurately modeled
• There is no reliable model of the health care sector
• Complex systems have unintended consequences
• Implications of unintended consequences.

The key take away is that it's impossible to centrally plan a complex system and that trying to do so is generally counterproductive.

Why are unintended consequences so important? Because in trying to solve one problem we can create other problems. Also in trying to solve problems, we can end up making them worse. ObamaCare has three principal goals: control costs, raise quality and increase access to care. Yet there is no model which allows us to predict that any of the three objectives will be even partially achieved. In fact, readers of this blog know that we expect all three problems to get worse.

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