Disruptive technology

What is disruptive technology?  It is technology that brings in a change to our understanding of what is fundamental to a system.  Computers changed how businesses processed information which meant that whole categories of workers were put out of jobs.  Rooms that used to be filled with accountants were downsized.  Similarly rooms full of draftsmen and architects got pared down, as did rooms of engineers to design everything from squeeze bottles to jet aircraft.  Computers disrupted business in ways large and small, and that intruded on our lives and our lives slowly began to change, as well.  Connecting computers to a network and having them internetworked was meant, way back when, to be a way to have computers split processes amongst them as they were few and expensive and idle time was money lost.  Instead the internetworked systems allowed people to contact each other across all the networks in a way that enabled human intelligence to be shared and increased.  E-mail was the first real disruptive technology of networks, and then, later, would come the ability to browse from site to site with information put up in a flat network system with agreed-upon means to display information.  The Internet with World Wide Web came into being and the compelling way it changed lives was through interaction of people to do many things that they could have never done before.  People who would never dream of publishing anything soon had blogs and realized that there was readership available with people desperate for something interesting to read.  Videos also were shared when bandwidth increased, and that also changed our view of each other and the world.  And commerce moved onto a global stage accessible by anyone with a computer connected to a network, and competition became global at a retail level.

Our world changed.

Yet the seasons still come and go, the Earth orbits the sun and the Moon orbits the Earth.  That world did not change as it is Nature and beyond our reach to change, as its laws are required to allow us to be here.

Today we see the last gasp of governments trying to regain control of people in ways large and small, from the Transnational Left and Right we see the disruption of societies as governments and companies try to liquidate what it means to be a citizen of a Nation.  Across much of Europe the attempt to socialize health care has resulted in the horrors of the British system and people left to die of thirst, to the lax attitude of physicians all taking their holiday on the hottest days of the year so that hospitals cannot treat those with heat stroke, to the much admired German system that can't seem to ask its own people if they actually like having to wander from doctor to doctor to get seen on a timely basis and never have continuity of care from a physician that knows them.  These systems have tremendous overhead and lacks big, small and always at the cost of actual health provisioning in a way people prefer.  Bureaucrats run these systems and they are run for the interest of the governments involved, not the people.  Control over personal health is one of the fastest ways a tyrannical system can find and eliminate opposition as it finds out just who has what, and then figure out how to deny opponents actual health services.  With such a whip the political class finds ways to dole out a bit here and there to get re-elected, all in the knowledge that the people are afraid of government as it has taken over the health care system.

This is an antiquated way of doing things, with large lab systems taking lots of time running costly tests at high overhead with may companies and levels of bureaucracy which now must be sustained by the individuals actually using the system.  Put in a few levels of bureaucracy and the actual cost of provisioning health care goes up, timeliness and quality of care goes down.  Computers have not made inroads to anything but forms processing so that forms get ignored on a more timely basis by bureaucrats playing solitaire on their systems instead of just hanging out at the water cooler instead of doing their jobs.  They do that, too.  Computers increase inefficiency as well as efficiency and provide many ways to goof off that could not have been conceived of just 30 years ago.  Health care has resisted disruption from the inside as the insiders have a vested interest in keeping a high overhead, high cost system going: it provides control and makes money for them, and grants those running it much power over others.

Yet automation and miniaturization are coming to the health care system, but this isn't coming from the decaying inside-out.  No this is coming from the outside, from people who don't much care for the inefficient, high overhead and centralized control realms that are the tyrannical features of government controlled health care.  Disruptive technology threatens the apple cart by putting power back in the hands of individuals who are able to walk away from aspects of the system to save money and empower those doing the liberation.  The place to start isn't with the 3D printing of organs... well, that is a pretty good place, actually, but to disrupt the entire system requires hitting at its underpinnings and that is with blood tests.  The things you have to get done to yield some information about what is going on with your body.  I've had so many of them it isn't funny, and if you have ever seen a nurse walk into a room with a full rack of vials to test your blood then you have some understanding of just how important the tests are.  Due to my health I've had up to 35 taken at a single draw, and there are people who have many more than that taken just to try and identify what is going on in their bodies.

From Instapundit I read, today, about a woman who, at age 19, started a company after dropping out of Stanford University and used her tuition money to put into the company (Article at Wired).  She is afraid of needles and thought that there must be a better way to do blood testing.  Now at 30, Elizabeth Holmes' company, Theranos, is featuring a 30 test service at Walgreens in Palo Alto, CA.  The blood sample is a miniscule amount that fits into a half inch collection vial.  Results for their tests are in 4 hours.  The company posts the costs of its tests on its website and they are a fraction of the cost of going to a traditional lab.  Their goal is to run thousands of tests via a single sample, and to have that sample available so that if a doctor wants secondary tests done on it they can be performed without the need for a re-draw.

Do they test for bacteria and viruses? Yes.  Instead of culturing blood, and risking contamination, they do a DNA screening to see if known viruses or bacteria are present and at what levels.  That is days of specialized culturing thrown out the door and the most definitive way to find a pathogen, via its DNA, put in its place. At some point my guess is that they will be able to give you your entire genome so that physicians can quickly see what medical conditions you might be susceptible to via your genetic profile.  The cost of a full genomic work up has been dropping drastically, and making it an everyday test done in hours, not days, would begin to change the course of medicine as diseases can be cross-referenced with genetic background and statistical results derived from it.

Even with Moore's Law slowing due to the fact that physics at the atomic level limits the size of processors, the ability to multiply what a processor does increases computing power per die for production.  Once some of this technology goes off patent, or once competition with alternative and faster ways gets into play, the cost of the tests will go down, the rate to get results will speed up and the size of the sample will decrease.  Give it two cycles of Moore's Law and the microengineering to get a 'lab on a chip' and you will begin to see the first generation of full spectrum blood sampling devices as something that becomes available in nearly every store.  Put in a few more cycles of Moore's Law and that then becomes a device you buy to add to your cellphone.  Cross that with the X-Prize for a non-invasive tricorder and you have Dr. McCoy's minimal test tricorder.

Time for something like this to get off the drawing board?  Less than a decade.

What is the basis for Larry Niven's device in the Known Space stories called an Autodoc (a capsule you rest in that does full medical procedures from a simple blood test and manicure to setting bones and treating cancer, or replacing organs or limbs)?  A full spectrum blood test.  As results are processed faster and cross-indexed with diseases, pathogens, and genetic background plus having a 360 degree body scan to see what is wrong with you, then the basis for the Autodoc appears.  The blood test is key as it is the basis of so much of modern medicine that it isn't funny.  As of today the first piece of the Autodoc is being worked on, although not as an Autodoc but as a way to get small blood samples to yield up information that used to take racks of vials to get.

This sort of technology is no longer a question of 'if' but of 'when' and 'how soon will it get here'.

Our health care system is on the verge of disappearing as we know it, with its high overhead bureaucracy, within 20 years.  Possibly within 10.

What will you do when you are given the freedom of having all of that medical knowledge on the cheap about yourself and then able to have a doctor step you through the beginning of understanding just what is in your body and how you can deal with it effectively?  Why would you want 'insurance' when you are in control of your medical life in an absolute way that is at once low cost and easy to do?  The power to control you begins to evaporate with low cost, effective blood testing that breaks the old system at its foundations.  How long will it take to do simple genomic cross-indexing of inherited conditions?  I'm guessing less than a decade, but certainly in that 20 year time horizon.

And what happens when governments try to take this away from stores, doctors and you?

That is an obvious power grab directly against you, the individual, to put a bureaucrat in control of your life and death.  Yet it will be cheap and easy to snub these control monsters.  Will you dare to be free of them?

This is just one disruptive technology.  Others are here and just being perfected.  Still more are coming from the horizon at a high rate of speed.  If you want to know why those wishing to dissolve your personality, your bonds to your country and your fellow citizens, are so desperate it is this: the future is arriving far faster than it can ever be controlled.  Governments are ill suited to coping and understanding what this means.  Individuals, however, are very able to do so as they do not have the burdens of collective stupidity and bureaucracy to hamper them.  And those who will benefit most are the poor, who do not need this controlled for them to get a good price as it already comes with a low price tag.  What happens when the poor are set free of the clutches of those wishing to control them?  Will they quake in fear of freedom or just shake their head at those who seek control and let them know that their day is over?

Change is here, but it isn't the one that the controllers hoped for.  Quite the opposite as this kind of change is their deadly enemy.

Welcome to the future.

I embrace it with open arms while those who seek control yell in fear of it.

Oh, happy day.

Recovery

A personal retrospective on my physical well-being.

I hope to get some more normal posts up, but such is life.

Late in 2004 I began a trip into a land of darkness where my mind was slowly losing track of work and I was beginning to feel exhausted beyond anything I had experienced in my life before that.  With that also came a lack of awareness of these things and the simple and all too human attempt to rationalize these sensations.  Being made senseless and having one's mind dimmed when aided and abetted by rationalization meant that things that should have alerted me to my dire straights were passed off... until my body forced the issue by giving me a cataleptic attack while driving.  No accident resulted, but that warned me that something truly serious was going on, even through the mists of my befuddled state of mind and being, which was turning into a strange place where being awake and being asleep meant little difference at all.

By 2005 I just wanted to know what was causing these attacks and if they could be dealt with, and the list of tests I went through was long and deep.  The only change had been in a standard medication, one of the statins, and when my endocrinologist heard the symptoms he took me off them, but the damage had been done and worse was to come after that until the full extent of it was finally reached.  My brain had the normal attributes of someone a good 20 years older than my physical age, and yet that was not a natural thing.  Narcoleptic conditions run in the male side of my family and I had thought I had escaped them as they have two general periods of onset: up to teenage years and then again in one's 60's.  Well, my brain had reached that magic age, I guess, just decades ahead of schedule.

Climbing out of that pit meant trying to get my thought structure back together as it had been shattered and eroded by this condition.  I had become a creature of willpower alone, determined not to let this be the end of my life.  The hardest work in my life would not be physical, would not be trying to write great pieces of fiction or histories to last the ages, but to merely scrape back a formulation of my thoughts out of a land between waking and dreaming and back, fully, into the land of the waking and living.  We take the fact that we think for granted, at least most people do, but somewhere within my psycho-dynamic toolkit there is a repair kit that allowed me to begin the hard work of reconstructing my mental capabilities to get some thinking capacity up and running again.

Those dark days are dealt with in my early blogging, which take place after the internal collapse of my mental structure, diagnosis and the first medications to deal with the actual phenomena.  There is no magic pill to rejuvenate the mind, as yet, to repair damage and to regain lost capacity.  Maybe we shall have that in some future, but until that point one is stuck with the old fashioned way of hard work.  I set myself some tasks to exercise my mind: learn some rudiments of Javascript, find out just what terrorism is (not the talking around it to attempt to call it something else, but its actual being as an activity) and then to learn connectivity structures based on Person-to-Person systems which are the basis for so much of human life that it pervades the far reaches of the horrific and the criminal realms.  For, as my Uncle Joe used to say disparagingly of so many corporate and government affairs, 'it isn't what you know, its who you know'.

Thus diagnosis was done by others, but I was willing to go through just about any test they cared to put me through, and I would hazard a good couple of hundred of vials of blood were taken to that end.  I have a long, long, long list of things I don't have and for that I am very thankful, indeed!  I will give the Sherlock Holmes method of scratching off stuff from a list and whatever you are left with is what it is a hat tip: it works.  Unfortunately it is the brute force method of logic, and I prefer inductive reasoning of 'this is the only thing that fits to make the entire thing work' sort of approach to the list scratching business.  As I have learned, that is a bent of mind that one must have by some means other than education as no one can teach you how to take a look at a whole thing and then see where something is missing and say what it is.

Countering the effects of the problem, although not the problem itself, came next.  I was a Type 1 diabetic before this happened and can tell you that dealing with a problem is not the same as curing it.  For all the advances in genetics, biology, biochemistry, and 3D structural analysis of molecules and how they interact, plus the human genome, a simple auto-immune disease dating back into the far reaches of human ancestry is still beyond modern medicine to cure.  Somehow every promising approach is thwarted by it.  Yet one gains a toolkit of mental requirements to deal with such a problem on a daily basis and that means I had one available for yet another problem that has no cure.  We know that there are cases of spontaneous remission of Type 1 diabetes after about 20 years of having it: the poor immune system just gets tired of fighting that part of the body and natural regeneration takes place for islet cells.  That I still have the condition points to an immune system that is still misdoing its job!  Now I also get to take medications that modern medical science can say what its structure is, but has no real idea of how it works.

There are times when I suspect the strain of being known as Witch Doctor is still with us to this day. 'What is it, what does it do?' you ask and the response is 'Dunno, it just works, take it.'

I am not nor ever have been impressed by degrees sitting up on a wall.

Doctors are still practicing medicine.  They need more practice, less overhead, please, as the practice still is not perfected.

Now all of this research, fiddling with code, playing with stuff got me to firearms as there was a warning bell going off in my head circa 2007.  A good year before the elections, hell before there were candidates, some part of me was saying: Prepare For No Good Shall Come Of This.  I took NRA training to ensure that I properly understood function and safety of firearms, plus only rudimentary cleaning... there needs to be a real course on that, not just gunsmithing but just 'how the hell do you clean this piece of Swiss watchmaking called a gun?' sort of course.  And I like older firearms, so drift punches, springs, and scouring around for parts became a ready past-time.  All of this is DIY in the firearms community, and the modern arms are much, much simpler to work with than much of the older stuff until you get back to the bolt action rifle: those are, at least, pretty simple to understand.

My goal was to next find out what sort of useful skills I had or could gain, and I'm still on that path today.  Firearms leads to stocks made of wood and that means wood finishing.  In my family lineage is woodworking going back at least a couple of generations, and I had not only shop class but a father who did cabinetry in his spare time.  That means I had some of the old 'young shop assistant' sort of deal going on, although not a lot of it, enough to get me familiar with the tools of the trade.

Building back stamina became the major goal as of 2009-10 and woodworking, well once you start using the manual tools you now have a major way to utilize physical capacity and measure endurance, now, don't you?  Even on the power tool side, the lifting and toting of boards, planks, and other less savory bits of trees can get you all sorts of exercise, especially if you have a small shop and need to set up and break down the power tools so that you can have access to the rest of the shop when you aren't using them.

Up until the past few weeks here has been the deal: 1 day of a few hours of work, 2 days of recovery.  Doesn't matter if the day is woodworking, shopping, or whatever, either.  On rare times I could string a couple of days together and then need additional down time to recover.  That was getting me to an even keel, but the boat still had water up to the gunwales and I was bailing as fast as I could.  Stamina was not returning but I at least could keep what I had.

About a month ago I talked with my neurologist who told me that there are some preliminary longitudinal studies that indicate that for diabetics in Japan and Germany (two populations with a major concern over the disorder by genetic causation) that the use of a CPAP helps to lower the HbA1c (a basal blood glucose reading that you strive to get to 7% as a diabetic) by a full 1%.  That is an eye-opener, to be sure.  A real eye-opener as a CPAP improves flow of air to the lungs while sleeping.  I had tried a CPAP before as there were indications of some marginal sleep problems, and they continue to be marginal and the neurologist doesn't know what to make of the actual readings as they aren't showing a disorder but something else going on... but that a CPAP might help that and the the cause to actually get one.

Done!

The prior CPAP device made my sleep worse, not better.

There have been improvements over the last 6-7 years, not grand ones but gradual ones, to the point where I can actually tolerate the device, more or less.

It will take some months of use to see what it does for that long term basal blood glucose reading.

A more immediate effect is to get lots of oxygen into my system at night and well distributed through my body.  I do wake up logy, no two ways about it: it is the sleep of someone who has worked themselves to exhaustion.  I knew what that felt like, back before 2004.  It is the sleep that when you wake up you just had no idea of how tired you actually were.  Apparently I need that sort of sleep.

From that sleep I now have better and larger amounts of physical energy and mental awareness longer into the day and even into the evening.  I can accomplish a lot more with the energy once I get the logy feeling out of the system.  Learning to hand plane maple that has just been skip planed is really hard work, let me tell you.  Yet I haven't been tempted to power tools (although I have a planing jig for a router) because it just feels good to be able to put some actual physical capacity into the work.  For a few hours at a stretch.  So now I can have sore muscles when I wake up!  This is a good thing.

The next step of the recovery is actually reversing not just the effects of one of my major conditions, but the thing, itself.  Those require an actual, functioning medical system in which trying to redistribute wealth and making everyone sicker in the name of 'health insurance' is not the goal.  That is an enemy to actual scientific advancement.  Strange that the most backward looking people are now on the political Left: they are starting to sound like the old fogies who just want to do things the same, tired old way that doesn't work well because that is all they know and will tell you about how righteous it is to do things the broken, tired, old way.  Yet the 21st century isn't going to wait for them to catch up, and no matter how much kicking, screaming, and theft under the guise of 'doing good' goes on, this century is set to steamroller the prior 3,000 years of advancement with changes that seemed impossible just a decade ago.  Be it the first formulation for a warp drive or getting to the bounds of computer capacity and then leapfrogging that with quantum computing or finding out that the ways to deal with disorders and diseases isn't to just ameliorate the effects but treat the damned things with some skill ('what does this drug actually do?' 'I dunno, it just works') and get the idea of practice out of the way or education that is self-performed via online systems of study that can't be categorized but can be tested as to skill, knowledge and capacity to utilize it... everything, and I do mean everything, that has been the foundation for the modern world is about to undergo a sea change that will make the Industrial Revolution seem like something for children.

Thus my goal is to survive the current bout of MegaStupidity via Centralized Insanity of Government and get to this new age of Individual Freedom and Liberty writ large.

As has been my threat: the more I recover, the less I will be posting.

I hate repeating myself and that is mostly what I would be doing to no good effect.

I need to recover so I can join this up and coming age of wonder.

The age of Back to Basics, DIY and reaching for the stars and getting off this damned starter home of a planet.

And I hope you will join me.

For we are better than the old 20th century has led us to think.

And governing is the problem, and government is not the solution.

What you don't know, and neither does your Congresscritter

Yes the vim, vigor and vituperation surrounding the Health Care Bill has been astounding!  Well, mostly on the against side of things, on the for side it has been the usual platitudes of 'how much this needs to be done' and 'how good it is' and 'you will find out what is in it after it is passed'.  Unfortunately that latter is paraphrased from the Speaker of the House of Representatives, and if that had been spoken by, say, some Fifth Earl West San Francisco it would sound like an aristocrat explaining that the workings of government are just too complex for the 'little people' to understand.

Companies are pretty fast off the mark in 'understanding' things as their bottom line is something they care about, so they adjust the fastest to try and absorb the hits from changes in the tax code so as to properly structure their companies as to make a profit.  Any profit.  Thus the following are now taking charges to their bottom line this year to try and stay ahead of the curve:

1) Caterpillar Inc. - $100 million (Source: WSJ 25 MAR 2010)

2) Deere (of John Deere) - $150 million (Source: CNBC 25 MAR 2010)

3) AT&T - $1 billion (Source: Yahoo News 26 MAR 2010 article by Barbara Ortutay)

4) AK Steel (mentioned in the Yahoo News article above)

5) Valero Energy (ibid.)

6) 3M Co. - $85 - $90 million (ibid.)

That Yahoo News article is just full of fun stuff like this passage:

Under the 2003 Medicare prescription drug program, companies that provide prescription drug benefits for retirees have been able to receive subsidies covering 28 percent of eligible costs. But they could deduct the entire amount they spent on these drug benefits — including the subsidies — from their taxable income.

The new law allows companies to only deduct the 72 percent they spent.

AT&T also said Friday that it is looking into changing the health care benefits it offers because of the new law. Analysts say retirees could lose the prescription drug coverage provided by their former employers as a result of the overhaul.

Changes to benefits are unlikely to take effect immediately. Rather, the issue would most likely come up as part of contract negotiations between the company and unions representing its employees and retirees. AT&T is the largest private employer of union workers in the U.S.

Hey!  I thought the 2003 Medicare Bill was too big for a Nation at war, that we couldn't afford it, and that the shift to private plans, being something the government could allow also means the government could fool with it in the future.

Which it has done.

And if you like your health care plan and are getting it from an employer?  Its either changing, benefits are being reduced or just going away... so forget about keeping it.  That promise was a lie as anyone who looks at the system could tell you when you start doing wholesale changes to mandates and such.

Now a bit more for the above on folks losing benefits due to this bill from AP via Google 26 MAR 2010 in an article by John Funk:

The health care law signed by President Barack Obama on Tuesday prohibits companies from writing off the subsidies starting in 2011, meaning they will no longer be able to deduct them from their taxable income.

For example, if a company spent $100 on benefits, including a $28 government subsidy, it could write off the full $100 on its taxes under the old rules. The new rules would allow the same company to write off only $72.

The follow-up health care bill to reshape parts of the overhaul would delay the changes until 2013.

As many as 1.5 million to 2 million retirees could lose the drug benefits provided by their former employer because of the tax changes, according to a study by the Moran Company, a health care consulting firm.

James Klein, president of the American Benefits Council, said between 6 million and 7 million retirees currently get the benefits. But the number of companies offering them has been dwindling for years.

Generally, retirees would prefer to stay with prescription drug coverage provided by their companies as opposed to enrolling in a Medicare Part D plan, said Marilyn Moon, a health care economist with the nonpartisan American Institutes for Research.

She said most of the company-sponsored plans are more generous and almost none have the coverage gap that comes with Part D plans.

Private plans more generous than what the government can do?  And they keep the retired better cared for without having to spend US taxpayers money?  And the benefits are more generous than what the US government can do under Medicare?

Say, why is Medicare such a great system for retirees if it is stingy, can't fully reimburse medications, costly and, oh, going broke with the approaching retirement of the 'Baby Boom' generation? Because it is what people will be falling back to, once the bite of this stuff fully takes place.  Notice that most of that starts to disappear just before an election year and then fully in place after it?

But the kicker is what those companies that DON'T change their benefits will do, and its a real kicker:

Consumers Energy, a Michigan gas and electric company with 2.9 million customers, said it will not take a big first-quarter charge because, like most utility companies, it can try to recover the added costs from its customers through rate hikes.

It has got to suck to be in MI with such bad tax codes and businesses fleeing Detroit that the city wants to turn some of the abandoned lots back into farmland (Source: AP via Washington Times 09 MAR 2010) .  Costs too much to turn the Motor City into the Farm City, however, so get used to vacant lots and abandoned buildings in Detroit for the foreseeable future.  Just watch RoboCop and you will get the idea, there.  So if you live in Detroit you will pay for the unsubsidized health benefits of Consumers Energy via rate hikes in gas and electric bills.  And through increased federal taxes, too.

Ed Morrisey at Hot Air (25 MAR 2010) hosted a video clip of Bill O'Reilly trying to get a straight answer on who collects the penalties if you don't enroll in Obamacare and he also put up the bill so you could search it yourself.  He came up with the IRS on p. 345 of the bill under its Section 5000A powers given to it by Congress in 1986.  Dutifully I looked that up:

From Title 26 (26 USC 5000) which is under Subtitle D – Miscellaneous Excise Taxes – Chapter 47 Certain group health plans, which has this as its taxing provision:

Sec. 5000. Certain group health plans

(a) Imposition of tax

There is hereby imposed on any employer (including a self-employed person) or employee organization that contributes to a nonconforming group health plan a tax equal to 25 percent of the employer’s or employee organization’s expenses incurred during the calendar year for each group health plan to which the employer or employee organization contributes.

There you go, Section 5000A of Title 26!  So if you get income that isn't employment income, say you get unemployment benefits or are rich and live on the earnings of off-shore accounts, you don't have to comply.  You have just gotta love how the very poor and very rich are BOTH able to get away from this junk, but the middle class gets screwed.  But don't worry, we Daniel Foster on 26 MAR 2010 at NRO (h/t: Morgen Richmond at BigGovernment)has found out that whatever the bill may say in one place, it might just contradict in another as found in the Joint Committee on Taxation on 21 MAR 2010 on p. 33 :

The penalty applies to any period the individual does not maintain minimum essential coverage and is determined monthly. The penalty is assessed through the Code and accounted for as an additional amount of Federal tax owed. However, it is not subject to the enforcement provisions of subtitle F of the Code.68 The use of liens and seizures otherwise authorized for collection of taxes does not apply to the collection of this penalty. Non-compliance with the personal responsibility requirement to have health coverage is not subject to criminal or civil penalties under the Code and interest does not accrue for failure to pay such assessments in a timely manner.

Yes, that's right, there is no penalty for not getting a health care plan that can be assessed against you.  Basically its 'pretty please sign up or if you want to pay a fine you can but if you don't that is a-ok, too'.  Thus we will get 16,500 brandy-new IRS agents to... send you imploring letters to please, please, pretty please get health care and, if you could, send some cash to the IRS for your trouble, would ya?

Oh, joy!

Oh, rapture!

Then at the CampaignSpot at NRO on 24 MAR 2010 Jim Geraghty found the tampon tax:

b) TAXABLE MEDICAL DEVICE.—For purposes of this section— (1) IN GENERAL.—The term "taxable medical device" means any device (as defined in section 201(h) of the Federal Food, Drug, and Cosmetic Act) intended for humans. (2) EXEMPTIONS.—Such term shall not include— (A) eyeglasses, (B) contact lenses, (C) hearing aids, and (D) any other medical device determined by the Secretary to be of a type which is generally purchased by the general public at retail for individual use.

Yes and in that latter category is: tampons.  That sort of thing was brought up months ago... last year around this time if memory serves, but Harry Reid decided to keep such language in the bill.  Say, you can get a pacemaker, but if you need special lenses to see your way around the house, you gotta shell out for those through the nose. PLUS 2.3%  Good job!

From AP via Hot Air on 24 MAR 2010:

Hours after President Barack Obama signed historic health care legislation, a potential problem emerged. Administration officials are now scrambling to fix a gap in highly touted benefits for children.

Obama made better coverage for children a centerpiece of his health care remake, but it turns out the letter of the law provided a less-than-complete guarantee that kids with health problems would not be shut out of coverage.

Under the new law, insurance companies still would be able to refuse new coverage to children because of a pre-existing medical problem, said Karen Lightfoot, spokeswoman for the House Energy and Commerce Committee, one of the main congressional panels that wrote the bill Obama signed into law Tuesday.

Yes the 'For The Children' folks who pushed this from Congress were lying.  Young adults are under that too, so sorry.

It was such an important thing to do, they forgot to do it.

I am sure, very, very sure, that the Harry Reid Bill to bring us Obamacare will be chock-a-block with goodies like this because this landmark legislation was so important, so damned necessary, and had to do so very much that no one in Congress could bother to read it.

Just like the 'stimulus' which hasn't stimulated a damn thing save the pocketbooks of Congressional cronies.

I really do think that such behemoth bills should be read out on both floors of the Chambers of Congress.

So that it goes completely on record as having been read out so there are no excuses, no blathering, NOTHING that can be used to defend the passage of such bills.

It is one thing to have a bleeding heart.

It is quite another to slit one's wrists to prove just how much you care.

Health Assurance, not Health Insurance

This is a dovetail piece to Culture of Ineptitude.

We have, as a Nation, favored big business and large unions via restricting Nation-wide coverage to those businesses that have facilities and workers in all 50 States.  Rep. Paul Ryan went over this and described how professional and industry associations with National membership (things like the American Restaurant Association or National Association of Barber Boards of America) could offer industry level pricing due to the membership being National in scope.  This would allow small businesses to band together or use pre-existing industry organs to supply members with business health insurance that is standardized and accepts all entrants, just like Big Business.

The government mandate is stepping in-between small businesses getting treatment for their associations at a National level, and removing that mandate is a repeal of it by Congress to allow this to happen.

With that mandate gone the second set of groups with Nation-wide membership will also have the opportunity to do the same thing.  Who are these groups?

In the blather we hear for reasons on Nationalizing or National control over health insurance the term 'pre-existing conditions' arises very, very often as a bugaboo.  'Denied coverage because of pre-existing conditions!' is how the howls go.  Yet pre-existing conditions are defined risk pools with known ailments that have expected and normal courses throughout one's life.  Here 'insurance' doesn't do so well, but a coordinated treatment plan system so that those WITH pre-existing conditions and KNOWN requirements for medications and procedures should be able to get price BREAKS because they can negotiate at a National level.

How would they do that?

Through the current voluntary patient advocacy organizations.

You know those: American Heart Association, American Lung Association, American Cancer Society, American Diabetes Association, Lupus Foundation...

Heard of those?

Their voluntary membership is:

1) Nation-wide,

2) Targets pre-existing conditions,

3) Covers the demographic risk pool of an entire disease.

Health 'insurance' doesn't really cover this, but known treatment types combined with risk analysis then garners known and expected outcomes and needs for future goods and services.  These organizations have the power of their pre-existing conditions behind them and can negotiate the lowest possible cost for medications used by their members for their diseases and even give a good idea of how the overall course of medications is going, over time.  This becomes not only a patient treatment system (where the patient cost for the coverage may be higher than normal, but the cost for medication and treatments far lower due to the shared, known risk pool) but an industrial feedback system to let the industry know how its work in new medications, devices and treatments is actually doing.  Statistical demographic data is a gold mine that can be held by the PATIENTS to get the best PRICING from industry so as to get a lower COST due to KNOWN NEEDS.

Any set of laws that prevents American Citizens from banding together via voluntary medical organizations from getting tailor-made coverage for their conditions is nuts.  Yet that is exactly what we have.

Even better is that these organizations can work with their patient community via donations or special fees so as to EXPAND this coverage to the poor.  Make that a tax-deductible donation and you will see the sufferers of conditions helping the poor to get good treatment because they know exactly, and particularly, what it means to have that disease.

Further than that is these groups could easily cooperate between themselves to offer co-coverage for people with multiple pre-existing conditions so that they get the best coverage, treatment plans and price breaks possible for their multiple conditions.

No one can be excluded from pre-existing condition pools for having a pre-existing condition.  They are set up to address those, in particular, and may even do things like offer price break incentives to those secondary complications that can be put off by living healthier lives and managing your condition better than you have.  That is because these organizations are currently health information and teaching organizations who have a purpose in letting their members know of the best way to treat conditions, what you get by doing so and who to contact to GET such help in forming a healthier set of living conditions for your condition.

At this point the piecemeal removal of regulations that restrict competition gains far, far more rewards than does new regulations further restricting competition.  Even if only a few million, say 3 or 4 get covered by small businesses, that is 3-4 million FEWER of the 'uninsured' to worry about.  And if those who band together on a Nation-wide basis with pre-existing conditions can start to pick up those generally able to afford any insurance but have been refused general health insurance, then that is more millions to stop worrying about and a charitable system can help to address the poor with those conditions via known organizations designed to offer the best medical coverage and help for that condition.

The final thing the patient run associations can get, and it is the one place where there is absolute interest that cannot be gotten with today's system or any future government run system:  spontaneous remissions of diseases for known pre-existing conditions.

These are the rarest of the rare, and hard to find in the general population for health care but extremely easy for those with such conditions as they are the ones who will have signed up for those plans.  An agreement whereby if you have a spontaneous remission you get health care coverage FOR FREE so that you can be studied to find out HOW your body did this would begin to offer keys to unlock the most persistent and difficult to understand conditions on the planet.  After 20 years there is a small chance of actual remission for Type I diabetes, as an example, and there have been reported cases of AIDS not only going into remission but individuals having no evidence of it after suffering from it for many years.  How the immune system can stop attacking the body (as is the case with Type I diabetes and possibly MS and Lupus) or suddenly find the way to get rid of one of the most pernicious and adaptable of viruses (AIDS) may hold valuable keys to the entire understanding of our immune systems as a whole.  Yet we currently scatter those keys and cover them up, because there is no concerted effort by PATIENTS to have these people agree to step forward in case their body contains the lottery winner of genetics for that disease.

Any government that could do that, on that basis, I would not want to live under as it would be so omnipresent as to stifle liberty and it would be controlling my life.

I would gladly do it for my fellow sufferers if my body pulled up the lucky winner.  I've been through a medical trial for one of my conditions and came out far worse for wear, though not because of the test medications, strangely enough.  I am far more interested in assuring the long-term health of my fellow citizens than in 'insuring' it.

Insurance means that, sooner or later, you come up with snake eyes.

Assurance means you get the best fighting chance to lead a healthy, long lasting life that is full of capability and attempts to put the secondary problems of a condition further and further into the future via better care and treatment.

And don't forget price breaks for good personal care of your disease!

Seeing long term test results that demonstrate good personal management and understanding of your own pre-existing conditions should be rewarded.

Culture of ineptitude

Watching a couple hours of the 'Health Care Summit' yesterday was extremely instructive! Indeed it was difficult to not see that President Obama as 'moderator' had a cat in the fight and was a vocal supporter and partisan of it... which meant that he talked more than the House and Senate members from both parties.

Combined.

Ok, that may be an exaggeration it was only 1/3 of the time, but when anything over 10% of any meeting is taken up by the 'moderator' then you are not having a 'Summit' but an attempted partisan ambush with a fervent supporter of one set of ideas unwilling to let half the meeting actually finish up their points... points that the 'moderator' had ASKED FOR. And when Rep. Cantor, I believe it was, actually had the bill in question on his table for demonstration and reference, the 'moderator' chastised that as a 'prop' and then took up the man's time in talking.

Remember, bringing a copy of the bill in question is a 'prop'.

But even with the non-moderation a number of the Republican points were clear, succinct and easy to present. I heard one, in particular, from Rep. Ryan that left me utterly floored. I could not believe it was the case until I checked up on it. It is a damned simple point, and being unable to get it into a one-page bill for quick passage to get the potential for millions of individuals health care coverage from small businesses points the arthritic and arteriosclerotic nature of our elected representatives in both Houses of being unable to leave the support for Big Business and actually help those businesses that employ the overwhelming majority of Americans, which is small businesses. A deal passed decades ago put forward a federal MANDATE that a company had to be in all 50 States to get waivers for a Nation-wide health care plan. Which means that Big Businesses can get it and small businesses can't.

Now here is the deal: if you were a small business with a professional association, and the American Restaurant Association was used as an example, and IT has members in all 50 States and IT would be willing to work a deal for its members, then why are we PREVENTING that via a MANDATE?

I hear great and lovely pontificating from Republicans on a 'National Market' but here is a clear and direct instance where a 'National Market' is being PREVENTED by government MANDATE.

Here is the Dogbert clue for the clueless: if you want small businesses to be able to get affordable insurance through self-organizing of professional organizations, then GET RID OF THE DAMNED MANDATE that stops that, and you will GET results from a self-made 'National Market' requiring no federal MANDATES.

Get out of the freaking way you numb-nuts!

And the Left should adore this: millions of individuals and families picked up under health care insurance thus reducing the pool of the uninsured, offering coverage for pre-existing conditions through Nation-wide plans and not costing one single red cent of the taxpayer's money or adding one single federal bureaucrat to the payroll.

What? Did I say something bad?

If you really mean what you say about wanting the uninsured covered at the lowest possible cost then support the ending of MANDATES that are corporate charity from government to Big Businesses. I hear pontificating against Big Businesses so why not let the small businesses figure out how to compete in this and get some competition to the Big Businesses? Competition will lower cost, improve service and rejuvenate the field, plus flatten the damned 'cost curve'.

On the Right: what the hell is up with you folks? I hear great pontificating and gesticulating and adoration for Ronald Reagan that verges on necrophilia. But actually carrying through with his view of REMOVING government from problems it is CAUSING? Well, damn, you can't do that, now, can you? Instead we hear about a 'National Market' via government fiat so that it can get 'federal oversight' which means an expanded federal presence, more bureaucrats and the wedge necessary to drive any damn thing into the system if such legislation gets put in place. So instead of compounding the PROBLEM why not simplify it, follow what Ronald Reagan prescribed, and let the People and their small businesses figure out how to cover more people at NO COST to the federal government?

Be nice. Spare us the bureaucrats so we can figure out how to live a good life outside the Beltway and not get it dictated to us by our elected numb-nuts Upon the Hill who are gelatinous, wool covered, bleating masses that look more like amoeba and have the appetites of same in the way of taxes.

Stop trying to run our lives so you can protect the damned Nation as a whole.

We the People can figure out how to live a good life if you just stopped 'helping' us.

And give us our money back for, with only a few exceptions, they all want bigger government at higher cost, endlessly. Yet it is out here where the skills, ability and knowledge of how to lead good lives resides, not in elitist, Ivy League fools elected to High Office. That is a D and R criticism across the board, with very, very few exceptions and none in the leadership roles. When you can help most at the lowest cost by getting out of the way, then get out of the damned way.

Otherwise you are just power-hungry, seeking ever more power concentrated into the least able, least flexible and least capable area of government: National Government. And looking at the millions dead due to that dream, I can say that no good ever, not once, comes of that end no matter how 'nice' you intend it to be.

The terms are the thing for defining what you want

In the 'health insurance' debacle that is playing itself out around the Nation, I have heard many, many, many terms thrown out but the question of 'covering the poor' and the 'uninsured' come out the most with the partisans in favor of large expansions of government.  Yet the first, the poor, are supposed to be covered by Medicare and Medicaid.  The 'uninsured' are not numerous particularly when you remove those who don't want insurance or refuse to buy it.  The number of those seeking insurance who can't get it is small.  Then the reasons of 'pre-existing conditions' is bandied about for why the 'insurance' system needs 'reform', which is to be expanded to cover everyone, everywhere with unlimited liability to do so.

That is a mess of terms and ideas floating around that need some rigor to them before you can even ask the question: what should we do?

You might first ask: are we doing the right thing to begin with?

Pre-existing conditions are those you get when relatively healthy or are born with that then limit your ability to get medical 'insurance'.  But are you truly looking for 'medical insurance'?  Hold that thought as we go along.

Insurance is the idea that you bet something will happen to you, like you will die in the case of life insurance, and the insurer bets that you won't.  You pay into a plan so that if you die unexpectedly or younger than would normally be the case, then a larger payout than anything you have put into the plan is then paid to those you designate.  Catastrophic care health insurance is your bet that you will come down with one (or more) catastrophic problems health-wise and the insurer covers you on the bet that you won't get them.

Health Insurance does not follow that formula.  I has you paying into it to get price breaks on seeing a doctor, getting tests run or getting medications or procedures done.  Your expectation is that you will use a certain number of visits and procedures as part of your annual needs (physicals, colds, injuries, etc.) and have a catastrophic component of a plan that will cover you in case something bad happens to you.  It is not just catastrophic insurance but has a large maintenance and minor to intermediate levels of care thrown in, plus things like reduced costs on medications.

Then there is the concept of 'managed care', in which you are trying to manage your medical expenses via pooling your risks with that of others in a given plan.  We often call this 'health insurance', especially when it has a catastrophic portion to it, but is it, really, that?  This dovetails with 'pre-existing conditions', above, as those conditions have set courses and routines to them that are generally well known.  If you are a Type I diabetic, say, there is an expectation that you will need more frequent eye exams and almost a certain course of laser work to stop degeneration of your eyesight.  Similarly people who have had any cancer in their lives need certain treatments based on the cancer type they had.  Individual with HIV/AIDS have a generally known set of problems and conditions, along with medications and treatments for that suite of conditions.  In many of these conditions if you take better care of yourself you may forestall the need to have certain procedures performed or get certain medications, thus by taking good care of yourself you move within the overall set of statistics for all patients: those who do take good personal care of themselves and those who do not.

Our current system of 'insurance' only has a negative reward built in: you don't have to pay out for a treatment you don't need in a given year.  But forestalling a need is not the same as not needing a procedure at an unknown future time.  Thus you are trying to use 'insurance' as a model for something that pays out on a continual basis for 'managing' your care and gives no incentive for you to take better care of yourself so that you follow closer to the average risk rather than shifting your risk and costs to a future time.  Without encouragement, beyond the nice talks you have with your doctors on the subject, you have no incentive to actually take care of yourself as future problems are 'in the future' and as individuals we tend to place lower value on future problems and concentrate on current costs.  It is a given that not all conditions can let you shift the need for procedures and medications and such by you maintaining your health in a better way on a personal level, but many can and do have that potential.

Thus with 'pre-existing conditions' you would like to have a system that allows for some pooling of risk, some price breaks, and some actual rewards for better health care that you do so that you do not utilize the system at an average or above average rate for your condition(s).  As we acknowledge that tangible rewards beat the absence of cost and give assurance that we have actually done a good job and should continue to do so, this means that a good 'managed care' system would then give you a return for a future procedure that comes up statistically for your condition, age and length of time that you have had it, but through your good work at maintaining or even improving your health you do not get at the average time.  For that you get a certificate that you can have a full course of work done, at any future time, within 'the plan' or its associated plans or through similar cross-accepting plans, this procedure or treatment for FREE.

This concept is called: investing.  You are investing via payments to 'the plan' and you can get 'payback' from it for full cost treatment of conditions by taking good care of yourself now.

Any individual 'plan' is not insurance, then, but investment management via managing your pre-existing conditions in a better fashion in the short term, so as to stave off secondary or consequential impacts of not doing so at a later date.  And as such treatments usually require follow-ups, re-testing and such, if you continue to keep up your good health then as those come on their normal and expected times from when you would, on average, have required such follow-ups, then you continue to garner free benefits for an entire course of normal treatment for you condition(s).  Even if you leave the plan or go to another one or get laid off, the certificates remain valid and have a definite value to them in the form of the cost of a procedure that is vested in the certificate.  Mind you it may not be a paper certificate, but an electronic one keyed to a banking or financial institution, insurance company, or medical management group.

At this point the concept can now be broadened to the general population in which individuals have a set of risks associated with their genetic background, current lifestyle and health, as well as other factors.  This concept of paying an up-front set of costs for guaranteed treatment with defined parameters is something that will go beyond those with 'pre-existing conditions' and extend to those who have 'pre-existing tendencies' towards a condition or set of conditions, often due to family heritage, but they have not manifest at that point in time.  Individuals could start pre-investing in treatment plans for those conditions, get certificates for the typical types of work done and necessary courses for a given condition years or even decades in advance of possibly getting such problems and pay a substantially lower cost, up-front, than when the actual on-set happens.  Thus if you are prudent with your health, invest a minimal amount in your future health when younger, you can then have assurances that major problems that often happen in your family are covered by those early investments.  And if you get another condition or problem, you can then either trade or cash-out those pre-paid investments for treatment courses you need, now, via utilizing your investments.

This, too, is 'managed care' but done by individuals willing to pay into treatment risk pools due to their background, jobs, or other conditions that indicate a future risk of certain conditions.  Competition for this comes from groups able to offer better sets of treatments, wider arrays of affiliates beyond the immediate plan or such things as paying for research into the specific condition(s) 'the plan' covers.  The latter would be investment plans into better future treatment or even ameliorating and removing the condition completely.  At which point you can cash out your investments for their last face value cost before the cure was found, or trade them for other treatment plans.

Like stock you can pass these on to your children if you die before utilizing the treatments.  It can be argued that cash may be a better investment, but that has become taxable so many times through current investment systems that it isn't funny.  As these certificates have real value attached to them, that is an actual set of treatments, tests and procedures, which can vary across a set of affiliates, there is no set cost to a given certificate, only a 'high-low' range.  Further, when you utilize the certificate for that treatment, it cannot be taxed as it is a deferred service being rendered, not an actual good or cash payment.

This can be applied to medications, as well, as conditions often need medicines or durable equipment.  A given plan may associate with pharmaceutical and durable equipment companies to include certain name brand medications and durable equipment, or their future successors in improved medication or equipment, so that the level of treatment for a given procedure gets better over time.  Purchase a treatment plan that relies on generics, now, and in the future you get the generic equivalent of what is standard for the treatment at that future time.

Covering those with 'pre-existing conditions' no longer centers on the current cost, but on the future need for treatment.  Joining a plan that covers a condition or set of conditions then allows you to move into a known risk category and have some minor pricing breaks immediately and then rewards you for keeping yourself healthy once you join such a plan (perhaps after a given vestment period in it, say 3 years).  Once you are vested in a plan that works for you and that allows you to demonstrate that you can have a positive control over the course of your disease, the rewards are lowered future costs and even getting the ability to know that necessary future treatments will not take a bit out of your budget because you have practiced a healthy lifestyle to avoid complications.  This changes our systemic viewpoint from paying and 'let the insurance company handle it' to having some price breaks because you are in a pool with known risks and then getting rewards for shifting the actualizing of those risks further into the future.  The plan you join is centered on managing your care and treatment, not on your 'health' save to help you lead a good life so you need less care and treatment in the immediate future.

At that point only the critically and terminally ill are left to deal with, and for that we do have charity.  Of course if you had spare treatments available to you, and spare medication guarantees that you aren't likely to use, you could donate those directly to a charity that cares for the ill so that they could match up those people with good care givers at no cost.  And you could invest money to replace a treatment if you needed to do so, also.

I am less than impressed with 'health insurance' as it does not center on critical factors of coverage, health maintenance and rewarding good health in a positive fashion that is tangible.  If we were serious with verbiage that makes our health an 'investment' and started treating as something we can invest in, then we might just find out that we had the wrong idea about our own health in the first place.  And that the individual is the best person to judge risk, cost and expectations.  And you could still purchase catastrophic care insurance if you really needed a backstop, too, for the unexpected future.  But you can take care of the expected and probably future on your own far better than 'insurance' will ever lead you to do.

The detritus of past concepts

The past decade has been one of our changing idea of how we, personally, as individuals, relate to institutions and deal with them.  This conceptual change was getting into swing in 1999 and the Dot Com Bubble economy introduced us to it via the ill-conceived, ill-timed and poorly run companies that sprouted up to offer goods and services via the Internet.  That first wave left the Dot Com Bust of 2000-2001 and the outflow of those poorly funded, poorly conceived, poorly run companies that burned through their Venture Capital and vanished in a puff of business projections.  The reality of what was happening was spoken of widely during the years leading up to 1999, but by 1999 it had become an established concept that was being touted as the 'wave of the future'.  It started in commercial areas then slowly leaked over to more staid venues of governments and institutions that soon found a growing call for them to start doing something very different than they had in the past: provide goods, services, information and feedback directly to individuals and NOT go through a subsidiary institution.

A name was attached to this and describes it to this day:  disintermediation.

That term had a use previous to the Dot Com era, which was to move funds from low yield accounts to high yield ones, but that did not even begin to describe what was happening in that era.  For the Dot Com era disintermediation had one meaning, and one meaning only: getting rid of the middle-man.  Doom forecasters predicted the end of shopping malls, strip malls and even the local market, thus forgetting that there are some items which individuals will insist on seeing, having or otherwise obtaining immediately, not just purchase today and wait for it to be shipped.  With the end of the sock puppet era of advertising, came the concept of 'bricks and clicks' that would see a melding of online transactions with brick and mortar establishments (local retailers) so that customers would have options to purchase and have things shipped, have them made available locally or just shop locally.

Other institutions didn't have that option.

Newspapers had been going through a downturn since the late 1970's with the consolidation of local newspapers with many places becoming 'one newspaper' towns.  That downturn continued with the introduction of cable television and then accelerated in the 1990's as the idea of information delivery, which is something newspapers should have been good at, started to eat away at the print revenue base of newspapers.  For newspapers revenue is derived from circulation and that determines advertising rates.  Thus newspapers are advertising delivery systems, not news delivery systems, and subscriptions make up only a tiny portion of revenue for newspapers.  Those delivery substrates became disintermediated from the news they were containing and trying to get ad revenue from digital delivery has proven to be difficult, at best, as end-users can use proxies, blocking software and other means to stop ads from arriving and get directly to the wanted content.

One phenomena would arrive that had started before the Dot Com era, but became a force after it was unheralded and yet common place.  The ability to have one's credit or bank account automatically charged for monthly billing, which would start to remove the paper bill mailed to individuals.  Furthering that was the concept also started pre-Dot Com which was charging things to a credit card, which had been around for a couple of decades in the catalog sales market, but positively boomed in the Dot Com era and afterwards.  Thus the marriage of any business being able to offer sales online with easy charge systems meant that paper catalogs, while still available, would no longer be the timely way to offer or order goods and services.  Over time this has meant that much of the transactions that take place between individuals and companies for many venues have an online counter-part that is usually far faster and as reliable as the paper based system.

After these venues those of charities, not for profit and information based institutions (notably think tanks) also migrated to have online counter-parts and new opportunities for getting donations, input and other interactions with a public that could only have been considered near unreachable just before 1999.  Today everything from religious teachings to managing your finances to planning your vacation can all be done online with little to no interference from a middle man.  The only place where this lags is the one institution that is one of the most conservative and retrograde on the planet.  That is NOT the US Army which adopted to online games and building an entire electronic system of input and recruiting nearly overnight... no it is the institution far above it: the US Government.

As a whole, not by parts as there are one or two shining examples, the US Government has proven the least adaptable, least capable and least able to move into the disintermediation era.  In an era where one can find information about any medication in mere minutes, we depend on a Government that still takes weeks to months to process simple forms.  Fighting this strong tide of putting more power into the hands of the people, the US Government and many State and Local governments, have demonstrated an inability to adapt, a trenchant attitude against being disintermediated and even trying to build NEW intermediation structures that don't exist.  Just in pure sales alone Ebay can be considered the third largest retailer in the US, coming from nowhere a decade ago.  That ability for person-to-person interaction for goods is NOT being mirrored by any government.  A number do offer some activities online, of course, and if your DMV has any online functions that can AVOID the brick and mortar buildings of it, then people are willing and able to do that and avoid the 'personal' interaction of the institution itself.  The IRS is finding extreme difficulties in moving to a modern processing platform, can't give the same answer to the same question twice, mis-returns forms to thousands of businesses, and only with the leanest, sparsest and least complex returns is it able to offer any swiftness at all.  Data leaks from the IRS, however, demonstrate that your local financial institution is more trustworthy for your personal data than is the IRS.

Lackluster is the best description you can give the IRS and the worst ranges down to abysmal, draconian and authoritarian, what with it having separate courts from the rest of the civil court system.  Yet that is the institution that Congress wants to run some form of National oversight on Health Care.

To put it more succinctly:  Congress wishes to create a huge bureaucratic intermediation institution that isolates you further from your health care practitioner than you currently are and then decide what sort of payments for your health are appropriate.  After a decade of the erosion of institutions to becoming leaner, more responsive and more open, the US Congress wishes to make Health Care more opaque, harder to get and costlier than it currently is by inserting the IRS, of all parts of government, to oversee your health.

Of course your local Congresscritter Representative has a staff of over 20 people to help intermediate between their Noble personages and you the peon.  So if they are unfamiliar with 'disintermediation' it is because they have an entire set of intermediaries to shield them from it, which then distorts their views of how the common man lives their life.  These flacks, flunkies, secretaries and so on run the offices of the Congresscritters to the point where they also write the bills that go on to the floor.  Thus the House of Representatives would be, itself, a prime target for disintermediation by upping the proportion of representation and removing all the staff: you would have the same number of people working but they would all be directly accountable to small and compact districts.

Which, in itself, would remove the power of lobbyists, labor unions, and other organizations trying to sway Congress as 9,000 or so Representatives becomes a very, very, very hard target to sway and the cost to bribe even a small proportion of them is huge.  Unlike the current Congress.

The US Government is entrenched in the late 19th to early 20th century Progressive mold of command and control systems, which means an elite class ruling over the common man who is intermediated by government so as to lose liberty and freedom to make decisions on their own.  Anyone seriously wanting a responsive government and having it disintermediated then must look towards the entrenched old line of thought towards government that was formulated in the horse and buggy era of Marxism.  The Industrial, Space, Post-Industrial, Manufacturing, Information and now Disintermediated eras have all eroded the philosophical core of Marxism and its centralized planning systems.  Even Anarcho-Syndicalists fall into this as the concept of 'workers councils' having any concept of what other people want outside of a supply and demand system is one rife with old-line thought of limited goods, limited distribution, and intermediation of the 'workers council' between the common man and his daily living requirements.  No council, no government, no single institution, no matter how wise can accurately predict or run an important facet of the lives of individuals.  The Roman Catholic Church failed with religion, the USSR failed in an entire economy and goods supply, and the US Government fails in ensuring that individual liberty is not encroached on as those elected to run it feel they have every right to tell the common man what is or is not safe, what is or is not good, what is or is not healthy and then tell the common man to pay up for such divine wisdom as is bestowed by the bureaucracy created by the Aristocracy in Congress.

If the Federal Reserve can't figure out that pushing banks to accept government rated 'safe' securities built on loans to those who can't repay them is a BAD IDEA then just what sort of trust should we have with the IRS and your HEALTH?

The tide of disintermediation is leaving a lot of dead fish on the beach, most of them from government although a number from tiny organizations that should never have been started in the first place and are now long gone.  But Congress is trying to land Moby Dick on the beach to flop around and entertain the beach goers... and then rot in the hot sun for all to enjoy providing you with lovely health care benefits while the system decays and collapses entirely.  Right next to Social Security and Medicare which both have a very unhealthy stench to them, and the newly flopping carcass of the mortgage securities landed by Fannie, Freddie and Ginnie.  Soon the entire beach will be rotting whale flesh, and we will be told how good it is as the maggots infest these dying bodies.

Only a Congress unconnected to the actual, real world that the common man lives in could have devised something like this.

And soon we will all pay for the rotten flesh dropping on us from these rotting beasts.

Because bureaucrats know how to run your life better than YOU DO.

And yet you were born free.

Medical care and Federalism

The concept of the United States is that we live with a federal system, a system of multiple governments each addressing the areas that they are given to address and conforming to the representative system that provides citizen input into that level of government.  To find out where medical care should be addressed, the outlay of powers is given in the US Constitution in broad context, to reserve a very few areas for the National level so that there is continuity as a Nation on these few items.

Those who have been pushing 'the public option' or 'single payer plan' run into the problem of monopsony where there is but a single payer in a given market. When one purchaser has an overwhelming or sole presence in the market for any good or service, it has untoward market power to demand pricing acceptable to it by varying how much of those things it is willing to buy so as to establish an acceptable price point to the monopsonist.  Such markets can be static or dynamic, and can include such things as: the labor market, welfare causing a change in the rate of exploitation as compared to a competitive market, minimum wage, and other areas where competition drives costs down so as to gain more market share.  Any National government does have, within its power, to create a monopoly position by granting such a monopoly to a private concern, although this was discouraged as far back as Adam Smith who pointed out that only in those areas of National need (such as defense of the Nation, protection of critical labor skills, etc.) should that be done.

On economic ground I, too, had examined a monopsony use for medications, not medical practice, but have been dissuaded from that by the cogent analysis of other writers.  Indeed I was unaware of the term  monopsony until it was explained, then the problems of it became self-evident in that it restricts market efficiencies to provide the greatest number of goods and services from multiple competing agents seeking multiple competing buyers so as to properly value a given good or service until such time as innovation changes the price point for that within the market.  The elimination of the multiple purchasers is just as, if not to some degree far worse, than having monopoly or oligopoly in which sellers fixing prices seek to maximize their profit in uneconomic ways.

Beyond that, however, is the much abused 'commerce clause' of the US Constitution along with the 'general welfare' clause in Article I, Section 8, in parts which are separate listings:

The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States;

[..]

To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes;

[..]

The 'general Welfare' clause is in regards to taxes, duties, imposts and excises that go into the general treasury to pay for our common defense and the federal government's other activities.  It is not a separate power in and of itself to the general welfare but a reason why these fund sources are to be used and what they are to be used for: paying for the other items in the federal government, not for some vague generalization of 'general Welfare'.  All the other things in the federal government are part of the 'general Welfare' but are a discreet subset of the entire general Welfare of the People, as written in the Preamble.  That clause is about taxes, duties, etc., things that we call 'revenue', not about the provisioning of goods and services.

In the 'Commerce clause' we get three distinct areas that the federal government is to play a role: in commerce with foreign Nations, amongst the States and with the Indian Tribes.  The 'regulate' is to regularize, not dictate to others what to do and how to do it.  If these three items (foreign Nations, the States and the Indian Tribes) must have logical connection to each other and the power described.  That power is one that seeks to work with autonomous and independent, indeed Sovereign, units so as to create agreement amongst those in negotiations to regularize the way commerce is conducted.  As a Sovereign power cannot dictate terms of a civil treaty with an equal, the federal government cannot do so with the States and the Indian Tribes.  If these things did not act in a similar manner they would be called out separately in the Constitution and provided for with their own clauses as was done with taxation and other revenues.

This power has been abused by the federal government to reach into individual States, individual markets and exercise power and influence in those markets without consent of the State Legislatures and Governors who are at the level of office of Sovereignty for their States as that of the head of foreign Nations and Indian Tribes.  The Raich decision is one in a long series of expansions of federal power into areas it is not given to work in and attempting to tell the States how they must comply with federal regulations in a venue where the federal government has no given power to it.

That we know by two Amendments to the US Constitution that tell exactly what those things not specifically handed to the federal government are:

Amendment IX

The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.

Amendment X

The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.

If it is not handed to the federal government, then the rights and power are retained by the people and may be exercised by the States or the people as they choose amongst their States. Thus the federal government retains no monopoly or monopsony power over medical care.  What the federal government CAN do is encourage the States to work with each other to set up their own methods of providing these things, but the States are on the hook for that and there is no compelling any State to do what it does not wish to do in that realm.

No matter how 'good' it might be for the federal government to do anything outside of its given powers, it is powerless to do so: it is not handed those powers and can only be given them by Amendment.

Thus I can see no place for even such things as Medicair or Medicaid save as voluntary acceptance, at best, of government largesse.  Already that market presence distorts the market, causes problems with the subsidies provided to citizens on the cost of treatment for them by creating uneconomical price points that are not market driven but cost driven.  When a good or service is subsidized, either by setting abnormally low prices and paying producers directly (such as in State owned ventures seen in other Nations) or via subsidy to purchasers, we find imbalance in the system that tries to adjust to these non-market based drivers that then inflate the cost or artificially hold the cost low with detriment to infrastructure and encouraging new market competition.  Other treatment venues that are held by the federal government, namely the VA system and Indian health services system, provide medical care that is not high quality, not in enough supply and treats patients in a sub-optimal manner as there is no incentive to treat them better.

Trying to get rid of a part of a system that works to model it on failed systems is not a pathway to success, but to failure.

When people talk about the 'failure of the health system' in the US, it is due to the very federal interventions that were supposed to 'help' and 'fix' the system, and yet these initiatives have had just the opposite outcome in neither 'helping' nor 'fixing' the problems they set out to fix.  Worse, still, is that by concentrating administrative power in a sole or oligarchical arrangement, lobbying then can be concentrated at one or a very few points by companies seeking greater income and wealth in the system.  The very same people who decry the current influence of Big Pharma and Big Insurance on government legislation should want just the opposite of a 'single payer' or 'public option' as this then concentrates the ability of those organizations to lobby and further change the system to their benefit.  This is strangely not understood by those that advocate that sort of system and yet want less lobbying power and influence.

Now if you follow this line of reasoning, keeping 'good wishes' and 'nice things' out of the picture because they are not part of the described power structure of the Union granted to the federal government but reserved by the people to use as they wish in the States, we get a major point of departure from the Left but also on the Right.

How so?

This system, that keeps the federal government out of doing things actively, also describes the market arrangement for those things outside of the federal purview.

First it is market driven, with little to no interference from federal government.

Second it is of the concern of the people and the States.

Thus from the first and the second, there is no 'national market' in health care services or their provisioning, but a large number of State and local markets.

To understand the problem of this on the Right, I will turn to Grace-Marie Turner in an article on the 27 AUG 2008 at the Wall Street Journal on this topic of a 'National Market':

States should be giving residents more options to buy policies that suit their budgets, not the priorities of politicians. Rep. John Shadegg, a Republican from Arizona, has proposed federal legislation that would allow people to buy health insurance across state lines.

But Congress could do more than simply knocking down the barriers to interstate health insurance. For starters, it could make health insurance more portable. One way to do that would be to change the tax subsidies already going to those who get health insurance at work and turn them into refundable tax credits. This would make the subsidies available to everyone, and help millions of people buy coverage who can't afford it now. It would also help people keep their health insurance when they lose their jobs or move.

Freeing Americans to buy health insurance across state lines would give people more choices in health care. And giving individuals a direct tax break for purchasing coverage would put armies of consumers to work to find affordable policies. That would force states to lighten their regulations or lose out to other, less regulated states.

The complex problems in our health sector are best cured by a bigger dose of market competition, not more government intervention.

In that first cited paragraph my problem with the Progressive Right is in clear view: the government has NO ROLE in creating a 'National Market' unless the States agree to it and the federal government cannot 'allow' people to purchase services when their States have already had their say in things.  From that first intervention we now get the fine idea in the second paragraph that the federal government should over-rule the States to provide 'nice things' for individuals who are going from State to State with the express reason of taking up residence in a State more to their liking for either economic, social or other reasons.  And how will this be supported?

SUBSIDIES!

Free money to EVERYONE!

What could possibly go wrong here, right?

Yes, let us further inflate the system so that people cannot take advantage of their new position with the costs inherent in any such a move because they want to move and can weigh the risks and benefits on their own.  Yes, let us overburden the system yet still more, no?  Perhaps this will be Medirelocair?  Medimoveade?

What the hell is up with these people?

The reason that these are discrete markets under the control of the people and the States is that is the way the system is designed from the outset.

Believe it or not a Nation with far more people runs in this way without much in the way of intervention from the National end of things.  It is also the largest representative democracy on the planet: India.  Hey!  If we are supposed to look overseas for good practices, like the Left so often wants, then how about examining India's medical system and seeing just how and why it works with little government overhead?  We might be able to provide more care, at lower costs and with better quality... but then neither the Left nor the Right likes the idea that power should be in YOUR HANDS and not in THEIRS.

If you truly want a better health care system you must: remove the 'oversight' from government, remove the subsidies for insurance, end the current system for new entrants and allow those already in them to either receive a lump sum cash payout or continue the system in a declining state as it loses individuals in it, and take the huge hit to our economy that comes from doing something wrong-headed and driving a once working system to insolvency by 'helping' it from the federal end of things.

So, to the Left: why do you want to concentrate power and the power of lobbying over our government at the cost of the citizenry?

And to the Right: just why do you want to expand federal power, expand un-economic practices and refuse to look at market based and consumer driven alternatives that actually work in other places?

Just why are both 'sides' of the political spectrum so enamored of more National power?

And just why don't they trust the people, trust our States and stop messing up with a system after their 'fixes' make the problem deeper and worse?

But then I am neither on the Left nor the Right, but a free man looking to see that our liberty is not trampled by those willing to take away necessary liberty for ephemeral security of health care by National fiat.

Price vs value

The following is first presented at The Jacksonian Party.

"What is a cynic? A man who knows the price of everything and the value of nothing."
Oscar Wilde, Lady Windermere's Fan, 1892, Act III
Irish dramatist, novelist, & poet (1854 - 1900)

Visiting Megan McArdle's site (h/t Instapundit) where she writes about her writing about nationalized health care and how critics are trying to paint a very narrow window for criticism while the larger objective is to get nationalized health care is interesting.  What is more interesting is that a number of commentators speak about chronic diseases and their cost.

So, having a number of chronic conditions or conditions which can complicate chronic conditions or being treated with medication that treats chronic conditions that lead to further and worse fall out from chronic conditions... do you follow that?

One chronic condition can get complicating factors from other, possible, causes and medicating to lower the risk of those separate causes then lowers the risk of further complications to the main condition down the road.  Thus you treat the others at the first sign of problems or, due to the effects of medications for those conditions, you have the medication supplied BEFORE any of those other conditions show up as they help the main condition stave off further problems.

Got it now?

Good!

Now I've had type I diabetes (previously 'Juvenile Diabetes' but it now has been demonstrated to show up independent of age and other conditions, although may have some environmental factors associated with it as seen in the Scandinavian effect of more cases showing up in late fall and winter) since 1983.  Over 25 years with it and nearly 26.  As type I is not amenable to the medications for type II, and has different symptoms with it, and is the low percentage of all types of diabetes (~10%), it has some similar and some different risk factors with it although complications run about the same direction.

Starting in the early 80's and going to the early 90's I was on NPH insulin, one injection per day.  That had crept up with a resistance to it, but that (as it turns out) is not a permanent effect.  I was switched to Lantus (glargine) which lasts longer in the blood stream, but my use of it crept up, also.  Before all this I was and am prone to infections of the upper respiratory tract, and if you have ever experienced a dual ear infection, sinus infection, pleurisy and vomiting, I know EXACTLY what you have gone through.  All at the same time.  Without modern antibiotics of the 1970's I wouldn't be here, today.

Now this all changed when I volunteered for a trial study at NIH.

You know, National Institutes of Health?

I was, relatively, well at that point but a few of my cholesterol and other numbers needed to be 'baselined' so I was taken off of one statin that was causing me to gain weight and put on another.  That all squared away I was then put through a day or so of 'how to properly maintain your blood glucose level for this study' which turned out to be a primer on how to do this for your life.  It is not that complicated, and takes about a month to finally get all the proportions worked out right so you are balancing carbohydrate net intake per meal with the proper amount of insulin to counter it, per meal, and then do a test two hours later to ensure that your glucose levels are in the preferred range.

Thus my control of my condition went from 80's understanding relatively so-so to early 2004 understanding by the top researchers on the planet.

With poor control I was getting normal and expected complications due to how long I have had the disorder.  I had three bouts of laser surgery to cauterize areas at the back of my eyes that were seeping interstitial material.  I was getting some peripheral neuropathy, mostly in my feet, but still had and have decent sensation in them.  Basically, at 20 years onwards I was doing pretty well, all things considered.  And being a government employee and having chosen a health plan, all of the complication were picked up by the plan.

Now things changed in 2004-05 as one of the medications given to me to lower my cholesterol level had truly nasty and undesired side-effects that are not well publicized but horrific for anyone getting them.  Beyond memory loss I was having sudden lapses where I could not do anything with my body but was conscious.  Lethargy was omnipresent and my stamina plummeted to almost nothing.  Starting in DEC 2004 when these problems first started to appear, they were not correlated to the study medication and the best minds at NIH got a chance to try and figure out what was going on.  My personal physician also started work on it.  My endocrinologist identified the medication and the problem immediately... that was FEB 2005 and things were getting worse as the loss of body control was happening multiple times per day.  I was taken off the medication but the problems persisted and were not getting better.  By MAY 2005 I had my primary care physician fill out the paperwork to take me off the roads and I could no longer function at work.  From MAY-JUL 2005 I went to a neurologist who had a preliminary diagnosis in JUN 2005 (after an MRI) and final diagnosis after a PET scan (which I paid for out of pocket) as I wanted the condition nailed down.

From then, onwards, I have been dealing with a steadily improving condition via treatment with medications that we still don't know very much about even after they were invented in the mid-1970s.  Seems fitting as my genetic background has a predisposition to the condition that the prescription medication caused to become present.  That is no hard and firm diagnosis, but it does fit all the facts and will continue to be the best-fit explanation until a better one can come along.  Turns out my own endocrinologist was thinking of putting me on that medication, anyway, because of my underlying condition.

That period from DEC 2004 to JUL 2005 saw me taking more blood tests, getting imaged multiple ways, having my heart scanned in 3D (I was interested but my lack of energy and stamina kept that to a minimum), having pins inserted into my muscles to measure them and then have them artificially stimulated (it is not as unpleasant as it sounds, but isn't pleasant, either) and until I got a neurologist who could figure it out the next thing up was a spinal tap.

Mind you, this is with the VERY BEST researchers and clinicians I could get my hands on in the DC metro area...

To go through the disability paperwork I had to fill out a raft of forms from SSN.  That was necessary for my government disability, I expected nothing, zip, zilch from SSN because I was just debilitated to the point I couldn't drive, could walk around the block, and had problems staying awake most of the day.  My lady helped me and SHE was fine!  She had problems understanding the SSN paperwork which appears to be meant to defeat anyone who does not have their full cognitive abilities to their credit which was my case at the time.  Remember, this is FOR that exact, same sort of problem, so the paperwork is made in such a way as to stymie those needing help.

Gotta love that.

My diabetes, however, was in great control!

And I was put on two non-systemic medication to address cholesterol which runs relatively high in my family.

So, from that, and trying to avoid things like dialysis by keeping my blood vessels open NOW means a raft of medications, many that can have pretty nasty side effects and a tendency towards low blood pressure... I have had nurses at NIH look at me and ask if I was actually still conscious when they took my blood pressure.  Twice.  Two different machines.  Then come back in a half hour only to find that it hadn't increased.

So, what is my annual cost to keep going?  Well, I will round and ballpark some figures.

Insurance cost: $7,800 /year

Insulin - $120/year for one on co-pay, market price $370/year

$120/year for a second type co-pay, market price $480/year

$120/year for a third type co-pay, market price $480/year

$160/year for syringes co-pay, market price $160/year

$180/year for pen needles co-pay, market price $180/year

$200/year for test strips co-pay, market price $1,560/year (I kid you not)

$45/year for lancets co-pay, market price $75/year

Hypertension - $240/year co-pay, market price $240/year (now if I take the pet version my price plummets)

Cholesterol - $240/year co-pay for the first medication, market price $340/year

$240/year co-pay for the second medication, market price $2,700/year

Neurological condition - $240 year co-pay, $800/year

Cost of medical visits varies, but I have few of them per year at this point.  A hard guess is $60/year co-pay, $600/year market

Dental costs vary widely due to my conditions and my ability to actually be conscious in a dental chair.  If I was healthier I could give an estimate on that, but I can't... the price differential due to my plan only giving partial dental coverage is generally a wash.

When I add up the numbers I come to the total cost insured, with cost of insurance: $9,765/year

Total cost without insurance: $7,985/year

Why stick with insurance?

Since I get my lady covered under this plan her costs, added in, would tend to balance things a bit, making health insurance a bargain.  It would be even more of one if we could just get to single plans, but that is not to be in our lovely world.  Shocking, but true, we could knock nearly $2,000 off our total coverage costs if we had two single plans.  Yup, divorce and re-marry!  Hey what a way to 'preserve the family'!  Thank you to the two party system for making something simple so asinine.

Plus my conditions and possible complications.

I am NOT a relatively healthy individual.  And yet just about half my net income goes towards my health.

I really do love how people make the argument, to me, that 'this is for those who are very sick', not realizing that I am very sick.

If I had federal paperwork ON TOP of all the other paperwork INCLUDING the daft SSN paperwork, I would not be here.

What I did do was ascertain the shortened life expectancy of people with my condition, the cost of long term complications, and then started planning when I was younger to deal with these problems.  My personal precautions were about half-done when the second chronic disorder was visited upon me.  Yet planning, saving, and working out how to deal with these things with the ones I love meant that I would not be a burden on them, that I would not be in poverty and that I would not need charity.  I have looked into getting a price break on some of my medications, but I am just 'too rich' for that.  Yes, take what I pay out and multiply it by 2.  That is 'too rich' in the way of income.  I do have other sources of funds, yes, but the plans I made have served me well.  I have gotten unexpected support from others, but that is extra and I am damned and duly grateful for such gifts and am not too proud to accept them... because I know I am not in the best of shape.

My life plan had not included anyone else, and I had expected to live a life alone.  That plan was adapted with changed circumstances, but the basis of preparing early for one's future meant that I had to face the basics of my condition as it was, then, and not expect a damned insurance company to pick up the tab for my costs.  Plus I did not and do not expect a single penny from SSN as it is heading towards insolvent and draining cash out of the rest of the federal budget which will sink this government like a rock heading into the abyss.

 

What is my 'solution' for 'health care reform'?

 

If you read past this, don't complain.

 

First - tort reform - Any malpractice suits are limited to actual costs to fix what wasn't done right and, yes, pay for your upkeep if the problem is permanent.  NO 'pain and suffering' awards which have become an inflator and a lottery system for juries to hand out bundles of cash that insurers have to pay, that raise the cost of insurance.  And double damages on anyone bringing a frivolous suit in attempt to win a payout lottery.

Second - remove the subsidies - Remove all tax incentives for 'health insurance'.  Why?  Because subsidized goods and services get over-utilized in an uneconomic fashion, raising costs.  What do we see?  Raising costs of health insurance and health care?  Why?  It is subsidized.

Third - incentivize health care - What the hell is that?  Here is a two-fold deal: change 'health care' from an 'insurance' system to an 'investment' system.  Instead of paying for 'coverage' you pay for 'treatment' that you may or may not immediately use.  Your 'treatment' can then be cashed in at any future time at any set institution that you invested in.  The cost is set on purchase and can even be reduced if the group providing treatment doesn't expect you to need it any time soon.  What would a triple-bypass cost 20 years before you could reasonably expect to need it?  If you paid for it NOW via investing at an institution that will guarantee the procedure (backed up with proper insurance and bonding) then you have an ironclad guarantee of service for that treatment.  Going to move?  TRADE IT.  This is an investment, after all, but one for treatment.  So if you wanted to trade it for, say, similar coverage at a facility near where you are moving to and, maybe, 3 visits over 5 years for a top notch specialist in the area and can work that trade, then you have those in trade for your previous investment.  Like bonds, if an institution goes under you are first in line for the FULL COST of the treatment when the place goes under: you are a creditor.  That is part one of incentivizing health care so you pay, now, for procedures you may not need and can then trade for ones you DO need.

Fourth - health savings accounts redux - Allow a full roll-over of money in all HSAs just like IRAs.  Allow full investment in money earning vehicles in HSAs.  Do not tax money earned in HSAs so long as they are used for medical procedures, medications, office visits, durable equipment, etc.  Set no limit on how much can be put into such accounts.  Allow employers to put money into their employees accounts TAX FREE.  Thus the employee could manage these funds towards the good end of paying for their health care (be it with or without insurance).  When employers offer job packages they can offer HSA contributions in lieu of pay or in addition to health insurance but with a lower salary.  Good long term investments will yield larger accounts, over time, and will ease the worry of skyrocketing medical costs... particularly if people decide to invest IN those providing health care.  Are health care companies and pharmaceutical companies making gonzo bucks?  That is reflected in investment portfolios, is it not?  If you invest in a portfolio, then you gain the benefit of a growing industry that will help you pay for the costs of it due to it being the one you need services from.

Fifth - there is no such thing as a 'national market' for health care - This is why we have 50 States.  You see a better arrangement in another State?  MOVE THERE.  Or write to your State representatives to see if a State to State arrangement can be made to expand coverage.  Large companies providing coverage already do this, of course, but smaller ones need protection due to the fact they address more localized markets and are better adapted to them.  When localized health care companies go under to be taken over by larger ones, the market loses competition and that is a long term worry to the citizenry and should be to the Nation as only a dog-eat-dog system at the lowest level allows larger structures to be pulled apart by innovation.  As it is the larger companies gobble up the small, shut the small facilities and leave communities without the facilities or coverage that used to be available.  Small scale inefficiency that is adapted to the small scale may have other benefits outside of 'cost maintenance': like providing any care AT ALL to a small community or sub-community in a larger population center.  If we are supposed to have 'laboratories of liberty' in our 50 States then getting a 'national market' is the last thing anyone should want.  That concentrates too much power in the hands of too few groups and individuals.  This also removes the 'tragedy of the commons' in which no one really much cares about the larger market and it then starts to stagnate because no one has the power to actually make sure it is working well at the small scale.

Sixth - The grotesque thing about government run anything is the inefficiencies of government, itself.  The best run of government agencies at the federal level, and I worked at it, was 65% efficient at what it did.  Yes the government, via overhead, only wasted 35% of every dollar spent!  Private industry does a much better job at 20% inefficiency, on average.  Remember the average of industry is still better than the best of government.  But if you really want to drive costs DOWN and put COMPETITION into the market there is one area that can compete with industry.  That is charity.  There are organizations that rate the amount that charities spend on overhead, and it is typically in the 7-15% range.  That is the equivalent of waste for a charity.  There are some that try to get that down to 1% via volunteers and other organized form of help that doesn't need to be paid for.  Of these three groups, which is the most efficient at providing 'health care'?  Government, industry or charity?  If you answer 'charity' then why is not the full and absolute amount donated to charity given as a tax write-off?  This, too, is a marketplace incentive, but one geared towards actually HELPING the poor get treatment.  Pharmaceutical companies could be given write-offs based on donations of modern medicines, not those that have expired, but fresh production.  Ditto to other parts of industry making durable goods and consumables used in health care.  By allowing companies to donate goods directly to charity to be used for the poor or those that cannot pay, we ALL gain greatly without any further interference by government.  Indeed local governments can give incentives in the way of property tax and other tax breaks to charitable organizations that do this work.  What is garnered are committed individuals who have the best interest of patients and the community at heart.

 

I do, indeed, want a health care system that 'works' for everyone.

One where we invest in our future infrastructure, not worry about current payments.

One where individuals are allowed to invest in themselves and their families, not one that takes money from them in taxes.

One that rewards charity to build communities so that the poor and needy are looked after by those who want to and will do their level best to cut all costs so that the money is spent ON the poor and not for profits.

To do these things requires that we change our way of viewing 'health care' as a service and treat it as an investment for ourselves, our children, our neighbors and our Nation.  You can't get that with government oversight.

But you can do that by the common citizen willing to take part to donate money and time, precious time from their lives, to charity.  Why do we penalize that instead of rewarding it? 

We are missing out on the best value around when we argue about costs.