Month: May 2008

Categories
culture National politics

Establish Criteria, Not Quotas

My wife was politically low-key when I first met her. I have enjoyed the fact that she has started to become more interested in political issues and principles of good government. This morning at breakfast, without any warning, she asked me about my thoughts on the issue of immigration. The conversation that followed led to some interesting insights (and must have been incomprehensible to our children).

First, as I have stated before, we need to make an informed decision on where we stand on the issue of immigration. Knee-jerk reactions (whether it’s “close the border” or “grant some legal status”) don’t fix the fundamental problem that we have created immigration laws that we are unwilling or unable to enforce.

One of the things that came out of the conversation was the idea that quotas are an arbitrary, and hence therefore poor, method for determining who can legally enter the country. In fact, quotas are a bad way to make any public policy. No matter where you set the numbers they are essentially arbitrary. There is no reason why person X+1 has greater potential to burden the nation than person X.

If we think that we should not have completely open borders then we should set criteria for who is allowed to come and then allow all people who meet the criteria to enter. Prior to 1924 when we started using quotas the criteria were essentially that we allowed anyone without major criminal backgrounds or communicable diseases to enter the country. I think those are good criteria to keep and there is no reason that we cannot develop other criteria to keep immigration at sustainable levels and make sure that we are getting the people that we want. For example, if we are looking for people to do menial jobs for us then we should allow people in who have arranged to take those jobs. If we only want people who will work to become citizens then we set criteria that they must achieve citizenship within a set amount of time or be deported.

I’m not saying what criteria we should use – I think that’s a national debate that we need to undertake – but I am saying that the land of the free should not be free only to the first 10000 people in line each year.

Categories
National politics

Delving Into “Six Steps”

Joe Jarvis is a doctor and a candidate for the Utah legislature. I was very interested in exploring the six steps to bring about true health-care reform in Utah that he outlined in the Salt Lake Tribune. He has been kind enough to answer some of my questions and I want to share what I have learned from him and from digging into his sources.

Health underwriting

Every critically ill or injured person will be treated in our health system whether they have health insurance or not.

The realization that doctors and hospitals are obligated under the law to treat people in need should really change the way we look at the issue of universal coverage and the underwriting process. It deserves to be one of the areas we look at to make fundamental change to improve our health care system.

Unsafe hospital practices

Another cause of inefficiency in the system. Dr. Jarvis pointed me to studies by the Institute of Medicine demonstrating the statistical results of accidents and poor industry practices. (I say statistical to make it clear that the above link does not lead to grotesque images of hospital injuries.)

Inappropriate care

Inappropriate care seems to be the symbol of all that is wrong with our system. It appears to be a direct result of a medical industry that is being controlled by the insurance industry which is more interested in avoiding legal repercussions than in keeping people healthy

Perverse incentives

Dr. Jarvis quoted an article from the Wall Street Journal on April 5. I was unable to find that article to confirm the numbers he quoted (“if everyone in America went to the Mayo Clinic, our annual health-care bill would be 25 percent lower (more than $500 billion) and the average quality of care would improve.”) I did find an article from April 7th in the Wall Street Journal, More Choices Drive Cost of Health Care, that appeared to be the same except that it had different numbers ($50 billion saved over 5 years). (Follow the link here to see more than the free preview.) While I could not verify the numbers he quoted, the concept that we must eliminate the perverse incentives that drive the health care system is sound.

Market-based health policy

Dr. Jarvis argues that “health care is not subject to market forces, such as a lowered price increasing demand. No one ever had an appendectomy because the price was right. The occurrence of illness and injury primarily determine demand for health services.” While I would agree with him in the case of an appendectomy there are services (lasik, orthodontics, or well child checkups for example) where demand will rise as prices fall. Besides that, the WSJ article cited above indicates that many people, fueled by a “more is better” attitude, will indulge in available health services that are unnecessary. This would probably not be the case if they had to pay more than a token amount for those extra procedures. Also, at times when the patient is not the driving force behind extra procedures the findings are that

More office visits, hospital stays and diagnostic procedures likely indicate poor coordination among doctors and facilities that can lead to worse care and outcomes.

So far I am not convinced that real market forces do not have a significant role to play in radically improving our health care system.

Benefit denial

I had never previously considered the cost associated with claim denials, but Dr. Jarvis provided some eye opening data. In his article he stated that “Claims costs are at least 10 percent higher in Utah than would be optimally efficient.” He was gracious enough to allow me to look through the data he used to arrive at that figure and answer my questions to help me understand what I was seeing.

Here’s what I learned; the claims cost is the percentage of the insurance company’s revenue that is spent in evaluating and denying claims – it does not count the cost of claims paid, just the cost of processing the claims. The 10% figure is a bit misleading. Let me try to clarify the numbers. The most efficient insurance provider in Utah is apparently the Public Employees Health Plan (PEHP) which spends nearly 4% of revenue in processing claims. The data from the other major health insurance providers (IHC, Blue Cross, Altius, and UHC) shows that they spend between 12% and 19% of revenue on the processing of claims. To put that in perspective, PEHP spends 1 of every 25 dollars in claims processing while the other providers spend between 1 in 8 and 1 in 5 dollars. That is 3 to 5 times higher than optimal. It is a difference of 10% of their revenue but it is not evidence that they spend 1.1 times the optimal amount on claims processing.

Conclusion

Even where I do not fully agree with the details of Dr. Jarvis’ claims about these six steps I do agree that all six of these steps are important issues to address if we are to come up with a decent approach to improving health care in our state. I also agree wholeheartedly with Dr. Jarvis that the system requires a major overhaul, not just some tinkering if we are to avoid the looming crisis in the health care system.

Categories
National politics

A Good Summary of the FLDS Situation in Texas

I really liked the content of the well titled San Angelo Witch Hunts. The author does a good job of outlining the case and demonstrating that so far we have ample evidence that the authorities are and were violating the Constitutional rights of the FLDS people (even if they were breaking the law) and that we have zero solid evidence that the FLDS people were actually violating the laws. Either there is a lot of evidence that is not being made public (which would still not excuse the illegal actions of the authorities) or else this is an example of authorities who have zero respect for the most fundamental laws of the nation.

I don’t think anyone could read that post and still excuse the actions of the Texas authorities.

Categories
technology

I Finally Dig Digg

When Digg arrived on the web I wrote it off as another Slashdot – nothing wrong with it, but no reason for yet another account to remember. I change my tune today because of the fact that there are no editors deciding what submissions get posted. By itself that’s no big deal, but I was trying to get access to a story in the Wall Street Journal without paying $80 a year. I learned that you can access full stories when coming from sites like Google News or Digg.

When I couldn’t find the month-old story on Google News I registered with Digg and submitted the story myself (I had already found the link that leads to an article stub when coming from the sites of mere mortals like myself) – through Digg the link produced instant access to a valuable story.

Categories
National politics

Hillary Clinton: Babysitter in Chief

Here is another gem from Laura. She came in to my office this afternoon and told me that she had just seen a bit of a speech by Senator Clinton. She thought it very important that I be aware that Hillary Clinton had just told her audience that they wanted a President who would solve their problems, take care of their families and watch out for their children. (I don’t claim that to be verbatim.)

Of course my first thought is that I would prefer a president who would enforce the laws of the land, defend the Constitution, and tell the truth to the American people. I don’t need someone to keep pushing the lies that there are painless, if complex, solutions to the problems we have been busy creating for ourselves.

Upon reflection I realized that maybe Senator Clinton is really making a good offer – free babysitting of my kids. I’ll bet she’s a lot more dependable than many a teenage babysitter. Of course by the time I finished writing this I realized that she never said she would babysit for free – or even for cheap.

Categories
life technology

Strengthening Families, One Cell Phone at a Time

Laura made an interesting observation today. She suggested that cell phones might actually make for stronger extended families with nearly ubiquitous features such as free nights and weekends and free long distance as well as not quite universal features like free calls within the network or plans such as T-Mobile’s MyFaves. Of course that would depend on whether people use those features to connect with family members, but the potential is certainly there. I know I have talked with my not-local family members much more since getting my cell phone with many of those family-friendly features.

Categories
National politics

Willing Suspension of Disbelief

Reports from the CBO that a Universal Health Coverage Bill would be budget neutral are obviously based on the third kind of lie (namely statistics). Commonhealth sums up the effects of the bill like so:

The legislation:

  1. gets rid of employer based insurance (employers that contribute to coverage would give employees that money at first, and eventually shift to a federal health coverage tax)
  2. requires all Americans to have health insurance
  3. offers subsidized coverage up to 400% FPL (Mass is up to 300%)
  4. sets up purchasing pools (like the Connector)

Could someone please point out to me where this plan gives health care providers an incentive to provide efficient, high-quality care? It seems to me that insuring all our uninsured citizens will never pay for itself in a system that thrives on inefficiency – as the current system does. Adding inefficiency couldn’t possibly pay for itself.

Ending employer based insurance is potentially a good thing. Requiring everyone to buy insurance looks like an incentive for more inefficiency and even price gouging. And one of my senators is sponsoring this. I think he should have his head examined.

Categories
culture National politics

A Thin Red Line

I stumbled upon a great statement on the line that separates civilization from anarchy. Timothy Gatto writes this in response the the FLDS situation:

While you might not agree with what the FLDS is doing, it doesn’t warrant any civil authorities to act outside of Constitutional law. When civil authorities bypass or ignore the Constitution, we are all put in jeopardy, and we are that much closer to living under a totalitarian government that makes up its own laws as it goes along. Sometimes the issues are larger than the crimes. I think I can safely say that most Americans abhor the practice of using young girls as ‘breeders” and in the process satisfy the lust of old men, but that issue isn’t as important as civil authorities acting outside the law. We are supposed to be a nation that believes in the rule of law. That premise is behind the definition of a civilized state. The law is for everyone to obey, the governors as well as the governed. Once the line that separates civilization from lawlessness is crossed, the result is anarchy, no matter who crosses that line first. There were other ways of stopping what was happening to these young girls. The authorities didn’t have to violate anyone’s constitutional rights.

While he is speaking specifically to that one case, the line he draws – the respect for law by those who govern and those who are governed – is a universal line. It’s a line we really can’t afford to cross.

Categories
life

A Dose of Competition

Today was a work day for the kids because they have not had to do any of their regular work in the last week. Unfortunately (but unsurprisingly) we found that they seemed to have misplaced their ability to work. They spent 3 hours on a room that should have been done in 30 minutes. Savannah and Alyssa finally perked up and started working like they’re capable when I challenged them to a race. The race was to see if they could finish the family room they had been working on for nearly 3 hours before I could empty the sink and load the dishwasher.

It really should have been no competition but I managed to nearly finish by the time they passed their quality check. The really nice thing was that I didn’t have to remind them to get back to work. Even when they started dawdling a bit they kept working because I didn’t tell them at the beginning that there was basically no way I could win.

Even after the race was over they kept working on the other tasks that still had to be done. It’s nice to find some effective motivation – I hope I can use that technique in the future.

Categories
culture politics

Wired for Authoritarianism

Starting by referring to two posts I wrote back in January, Obi wan Liberali posts More Thoughts on Authoritarian Thinking. I have to say that, like Obi wan, I am deeply concerned about our shift towards a more authoritarian society. I also agree that the positions publicly identified as conservative are tending towards greater social authoritarianism although I’m not sure they are becoming more authoritarian economically. On the other hand, the positions publicly identified as liberal have always been likely to take an authoritarian stance economically while remaining libertarian in the social arena.

I believe that Obi wan is correct in identifying two classifications of authoritarians – most being authoritarian followers, and the minority being authoritarian leaders (he calls them dominators). Obi identifies religion as being naturally authoritarian in structure. While I agree that religion is generally authoritarian I don’t believe that this is peculiar to religion – I believe that authoritarianism is human nature.

People who strive for power are naturally going to be authoritarian leaders. Leadership based solely on logic and persuasion is not a dependable way to maintain authority. Those who rely on persuasion are not concerned about their personal authority. The reason that so many people qualify as authoritarian followers is a combination of short-sightedness and laziness. Some people are unwilling to do the work necessary to form their own opinions so they follow whatever authoritarian leader they are inclined to follow. Others are willing to do the work to form their own opinions, but they fail to foresee the dangers of supporting the authoritarian pursuits of those who are ideologically in line with the positions they have chosen.

The reason that authoritarian systems are so worrisome to me is that I view personal responsibility to be the foundation and the working definition of liberty. Authoritarianism is antithetical to personal liberty and personal responsibility. People who are unwilling to take the time to gather the information to form their own opinions will always be seeking for someone to follow politically, religiously, or in any other arena. People who will put forth that effort will enjoy the fruits of their personal liberty only to the extent that they are allowed to – meaning that they cannot enjoy the fruits of liberty in a situation where their opportunity to make choices is cut short by the system. This applies to equally economic, political, and religious systems.