22 October 2009
The Invigorating Sight Of New Non-Green Shoots Of Unhope
Poll: US belief in global warming is cooling (Dina Cappiello, AP, 10/21/09)
Americans seem to be cooling toward global warming.I could get all wigged out about the AP's ignorance of the scientific consensus that "pollution" causes global cooling and part of whatever warming happened in the latter half of the 20th century was due to cleaning up the air. But why spoil this moment.
Just 57 percent think there is solid evidence the world is getting warmer, down 20 points in just three years, a new poll says. And the share of people who believe pollution caused by humans is causing temperatures to rise has also taken a dip, even as the U.S. and world forums gear up for possible action against climate change.
Dr. Duess
(WARNING: The following is not in any way nuanced, satirical or sophisticated. It is not an allegory for our times. There is no hidden meaning or moral, and those searching for one will be shot. The Proprietor)
Giants come,
Witches come,
Rumbling, bumbling giants come.
Slithering, dithering witches come.
How they run!
How they come!
They come to the house of Johnny Rum.
Johnny Rum is home in bed.
Johnny Rum with a cold in his head.
Laying in bed, cold in his head,
Johnny hears the giants run.
Mom is gone.
Dad is gone.
Billy and Jilly and Tilly are gone.
Johnny Rum grabs the phone,
Johnny Rum, home alone.
Johnny Rum calls 911.
"Witches, you say?"
"Giants, you say?"
"Please check your number and dial again,"
The Queen of the witches comes to the door,
The Queen of the witches chills to the core.
The biggest giant comes to the door,
The biggest giant, with the head of a boar.
Knock, goes the door,
Knock, goes the door.
"Who's there?," goes Johnny Rum.
A giant rumble comes to Johnny,
A witchy shrill grabs for Johnny,
"We've come for you," rumble the giants.
"We've come for you," shrill the witches.
"Abandon hope, Johnny Rum."
Johnny Rum knows the score.
Johnny Rum has learned the lore.
Johnny Rum opens the door.
A bucket of water pelts the Queen.
A bucket of water melts the Queen.
Melt, Queen.
The largest giant snorts and steams.
Johnny runs.
Johnny dashes.
The largest giant bends and bashes.
Johnny grabs his big shoe laces.
Johnny ties and knots and splices.
Johnny joins and knits the laces.
Johnny runs, the giant follows,
Down he goes into a hollow.
The earth shakes.
The ground quakes.
Bones break.
Mountains flake.
Thunder wakes.
In the mountains, a dam breaks, a lake quakes, a flood wakes.
All the witches scream in horror,
All the giants run in fright.
The ground shakes; the ground quakes.
A flood comes.
A rushing, gushing, shaking, quaking, moaning, groaning, frowning, drowning flood comes.
In the swirling waters, all the witches start to melt.
In the twirling waters, all the giants start to fall.
Giants run,
Witches run,
Rumbling, bumbling giants run.
Slithering, dithering witches run.
They run from the house of Johnny Rum.
Mom is home.
Dad is home.
Billy and Jilly and Tilly are home.
Johnny Rum is in his bed.
Johnny Rum, with a cold in the head.
Giants come,
Witches come,
Rumbling, bumbling giants come.
Slithering, dithering witches come.
How they run!
How they come!
They come to the house of Johnny Rum.
Johnny Rum is home in bed.
Johnny Rum with a cold in his head.
Laying in bed, cold in his head,
Johnny hears the giants run.
Mom is gone.
Dad is gone.
Billy and Jilly and Tilly are gone.
Johnny Rum grabs the phone,
Johnny Rum, home alone.
Johnny Rum calls 911.
"Witches, you say?"
"Giants, you say?"
"Please check your number and dial again,"
The Queen of the witches comes to the door,
The Queen of the witches chills to the core.
The biggest giant comes to the door,
The biggest giant, with the head of a boar.
Knock, goes the door,
Knock, goes the door.
"Who's there?," goes Johnny Rum.
A giant rumble comes to Johnny,
A witchy shrill grabs for Johnny,
"We've come for you," rumble the giants.
"We've come for you," shrill the witches.
"Abandon hope, Johnny Rum."
Johnny Rum knows the score.
Johnny Rum has learned the lore.
Johnny Rum opens the door.
A bucket of water pelts the Queen.
A bucket of water melts the Queen.
Melt, Queen.
The largest giant snorts and steams.
Johnny runs.
Johnny dashes.
The largest giant bends and bashes.
Johnny grabs his big shoe laces.
Johnny ties and knots and splices.
Johnny joins and knits the laces.
Johnny runs, the giant follows,
Down he goes into a hollow.
The earth shakes.
The ground quakes.
Bones break.
Mountains flake.
Thunder wakes.
In the mountains, a dam breaks, a lake quakes, a flood wakes.
All the witches scream in horror,
All the giants run in fright.
The ground shakes; the ground quakes.
A flood comes.
A rushing, gushing, shaking, quaking, moaning, groaning, frowning, drowning flood comes.
In the swirling waters, all the witches start to melt.
In the twirling waters, all the giants start to fall.
Giants run,
Witches run,
Rumbling, bumbling giants run.
Slithering, dithering witches run.
They run from the house of Johnny Rum.
Mom is home.
Dad is home.
Billy and Jilly and Tilly are home.
Johnny Rum is in his bed.
Johnny Rum, with a cold in the head.
12 October 2009
Coase Gets His Second Nobel
Donna this morning mentioned that she heard on NPR that some American had been awarded the Nobel for his work on the boundaries of the firm. After making the mandatory Barrack Obama joke, I said that it must be Oliver Williamson, and I was right.
As it happens, I just spent a measurable portion of my summer reading Williamson and about Williamson. (I've pulled three of his books from the shelf, The Mechanisms of Goverance, The Economic Institutions of Capitalism, and The Nature of the Firm, and I highly recommend them. Williamson is an accessible writer and if you're interested in why some functions necessary to produce a product are in the firm and others aren't (and who isn't), Williamson makes for a good read.) The old saw is that an economist is anyone who calls himself an economist, but I think of Williamson as an organizational theorist. Org theory is a name more than a discipline -- psychologists, sociologists, anthropologists and economists all write org theory -- and the line between org theory and strategy (my field) is whisper-thin. If you look at organizing, you're an org theorist, unless you look at whether different ways of organizing effect performance, in which case you're in strategy.
As Prof. Williamson would be the first to admit, his work owes much to Ronald Coase. Coase first asked why organizational boundaries exist where they do? This is a more subtle question, and a more fundamental question, that first appears. The question really is why, if the market is so great at delivering the right product at the right price, does so much economic activity take place within the firm, where decisions are made bureaucratically by a hierarchy. Why have an HR department when the market could deliver the right worker for the right price? Why did Ford try to control the entire supply chain from mining the iron ore through selling the completed car, but buy it's tires from Firestone?
Coase's answer was that it must cost less to do it that way, at least in the long run. As Williamson says, "What is one to do with a 'gift' that is patently right, eludes analysis, and upsets foundations?" Essentially what org theory (and economics) did was ignore it for 50 years until Williamson based his career on building on Coase's analysis. His first book, and in some ways his best book, is Markets and Hierarchies (1975) which does a great job of combining work on information theory, organizational innovation, transaction costs and the behavioral theory of the firm.
Overall, Williamson's work allows us to make predictions about broad trends in org theory. Recent advances in information management and the collapsing costs of communicating across distances led to a predictable (and predicted) increase in outsourcing and vertical dis-integration. In other words, we're now in a period in which we should expect to see market mechanisms substituting for hierarchical/bureaucratic command and control mechanisms. Which is just another reason that the move to nationalize healthcare is a bad idea.
In fact, the work of both of this year's economic laureates suggests that nationalizing healthcare is a bad idea. (Elinor Ostrom's work suggests that the revealed preferences of local consumers does a better job of allocating scarce resources than diktats from national hierarchies.) Predictably this will be ignored by the very people who expect us to defer to the wisdom of the Peace Prize committee.
As it happens, I just spent a measurable portion of my summer reading Williamson and about Williamson. (I've pulled three of his books from the shelf, The Mechanisms of Goverance, The Economic Institutions of Capitalism, and The Nature of the Firm, and I highly recommend them. Williamson is an accessible writer and if you're interested in why some functions necessary to produce a product are in the firm and others aren't (and who isn't), Williamson makes for a good read.) The old saw is that an economist is anyone who calls himself an economist, but I think of Williamson as an organizational theorist. Org theory is a name more than a discipline -- psychologists, sociologists, anthropologists and economists all write org theory -- and the line between org theory and strategy (my field) is whisper-thin. If you look at organizing, you're an org theorist, unless you look at whether different ways of organizing effect performance, in which case you're in strategy.
As Prof. Williamson would be the first to admit, his work owes much to Ronald Coase. Coase first asked why organizational boundaries exist where they do? This is a more subtle question, and a more fundamental question, that first appears. The question really is why, if the market is so great at delivering the right product at the right price, does so much economic activity take place within the firm, where decisions are made bureaucratically by a hierarchy. Why have an HR department when the market could deliver the right worker for the right price? Why did Ford try to control the entire supply chain from mining the iron ore through selling the completed car, but buy it's tires from Firestone?
Coase's answer was that it must cost less to do it that way, at least in the long run. As Williamson says, "What is one to do with a 'gift' that is patently right, eludes analysis, and upsets foundations?" Essentially what org theory (and economics) did was ignore it for 50 years until Williamson based his career on building on Coase's analysis. His first book, and in some ways his best book, is Markets and Hierarchies (1975) which does a great job of combining work on information theory, organizational innovation, transaction costs and the behavioral theory of the firm.
Overall, Williamson's work allows us to make predictions about broad trends in org theory. Recent advances in information management and the collapsing costs of communicating across distances led to a predictable (and predicted) increase in outsourcing and vertical dis-integration. In other words, we're now in a period in which we should expect to see market mechanisms substituting for hierarchical/bureaucratic command and control mechanisms. Which is just another reason that the move to nationalize healthcare is a bad idea.
In fact, the work of both of this year's economic laureates suggests that nationalizing healthcare is a bad idea. (Elinor Ostrom's work suggests that the revealed preferences of local consumers does a better job of allocating scarce resources than diktats from national hierarchies.) Predictably this will be ignored by the very people who expect us to defer to the wisdom of the Peace Prize committee.
09 October 2009
Next To The Nobel Committee Wearing Sashes Announcing "We're Racist Dupes And Hypocrits"
This news couldn't be any better.
I've been thinking over why I find this news so amusing and so gratifying. It comes down to a line from Deep Space Nine: "A true victory is to make your enemy see they were wrong to oppose you in the first place. To force them to acknowledge your greatness."
What we really want is for our intellectual opponents to come to us one day and admit that we were right all along to believe that they couldn't really believe the bilge that they were speaking. We were right; they were wrong; and they knew it at the time.
Of course, in real life that never happens, making this the next best thing.
08 October 2009
I'm Sure I'm Against It ...
It is university policy to provide equal employment opportunity to all employees and applicants for employment regardless of their race, religion, color, national origin, ancestry, age, sex, sexual orientation, gender identity and expression, disability, atypical hereditary cellular or blood trait, marital status, civil union status, domestic partnership status, military service, veteran status, or any other category protected by lawRutgers University web site
But what the heck does it mean?
02 October 2009
Should'a Put A Ring On It
Does Single Ladies even have any competition yet for best pop song of the century?
01 October 2009
Step Away From The Google
Not to hijack the, "There's too much internet" meme, but this thread is the poster child for "too much internet."
Being intelligent and yet socially awkward =/= Asperger's Syndrome.
Being intelligent and yet socially awkward =/= Asperger's Syndrome.
Why Did GM Fail?
There's a bit of a discussion in the comments to the next post down about why GM failed. Since that's what I'm studying (except not GM, I'm just studying generally why some firms outperform other firms), I probably ought to have an opinion. And I do.
It was management's fault. It's always management's fault. It's in the job description. But that's not a particularly satisfying or interesting answer.
I'm not sure why GM died, but there's one explanation (or rather one set of explanations) that's worth looking at. I think that it's fair to say that most strategic management scholars (and I) think that strategy matters. That organizations can effect their own performance by choosing strategies that fit their environment. The sub-field I'm working in, strategy process, is the study of how organizations monitor their environment, move information to the places in the organization best able to act upon it, and then develop strategies to fit the current environment. This side of strategy assumes strategic choice.
But there is a another side of strategy called, not entirely appropriately, determinism. These theories basically assume that strategy doesn't make a difference; that individual organizations don't really have much control over their own performance. Michael Porter, who some of you have probably heard of, started strategy by more or less teaching that what industry a business is in makes all the difference -- all companies can do to help performance is choose the right industry and then work with their competitors to shape the industry by, for example, getting the government to restrict entry. Other scholars think that organizations are subject to the laws of population ecology; or that corporate routines are like genes, immutable in the organization but mutable as new organizations are created. Other scholars think that young organizations can be entrepreneurial, but then bounded rationality, risk and loss aversion, satisficing, etc., embed the existing strategy which cannot thereafter by changed. My off-the-cuff reaction is that this last description fits GM.
Miles and Snow (1978) -- a great book I recommend to lay business people and Harry -- divides up corporate functions between the entrepreneurial, the engineering and the administrative. Different companies emphasize different functions, and the result is four types of companies: prospectors, analyzers, defenders and reactors. Any of the first three can be fine, depending on the environment. Being a reactor is fatal. GM was founded to concentrate on the administrative function. Toyota and Honda focus on the engineering function, with some attention paid to the entrepreneurial function. GM never could shake its focus on the administrative function; they always thought that they could manage themselves out of the predicament. Over time, they slid from analyzer to defender to reactor, and then they died. This makes it sound as if GM could have saved itself if it had become entrepreneurial, or if its unions had allowed it some engineering slack. But GM was what it was. There's no sense telling the lobster that it could save itself from the pot if it would only sprout wings.
Of course, that suggests that the government bailout was exactly the wrong thing to do.
It was management's fault. It's always management's fault. It's in the job description. But that's not a particularly satisfying or interesting answer.
I'm not sure why GM died, but there's one explanation (or rather one set of explanations) that's worth looking at. I think that it's fair to say that most strategic management scholars (and I) think that strategy matters. That organizations can effect their own performance by choosing strategies that fit their environment. The sub-field I'm working in, strategy process, is the study of how organizations monitor their environment, move information to the places in the organization best able to act upon it, and then develop strategies to fit the current environment. This side of strategy assumes strategic choice.
But there is a another side of strategy called, not entirely appropriately, determinism. These theories basically assume that strategy doesn't make a difference; that individual organizations don't really have much control over their own performance. Michael Porter, who some of you have probably heard of, started strategy by more or less teaching that what industry a business is in makes all the difference -- all companies can do to help performance is choose the right industry and then work with their competitors to shape the industry by, for example, getting the government to restrict entry. Other scholars think that organizations are subject to the laws of population ecology; or that corporate routines are like genes, immutable in the organization but mutable as new organizations are created. Other scholars think that young organizations can be entrepreneurial, but then bounded rationality, risk and loss aversion, satisficing, etc., embed the existing strategy which cannot thereafter by changed. My off-the-cuff reaction is that this last description fits GM.
Miles and Snow (1978) -- a great book I recommend to lay business people and Harry -- divides up corporate functions between the entrepreneurial, the engineering and the administrative. Different companies emphasize different functions, and the result is four types of companies: prospectors, analyzers, defenders and reactors. Any of the first three can be fine, depending on the environment. Being a reactor is fatal. GM was founded to concentrate on the administrative function. Toyota and Honda focus on the engineering function, with some attention paid to the entrepreneurial function. GM never could shake its focus on the administrative function; they always thought that they could manage themselves out of the predicament. Over time, they slid from analyzer to defender to reactor, and then they died. This makes it sound as if GM could have saved itself if it had become entrepreneurial, or if its unions had allowed it some engineering slack. But GM was what it was. There's no sense telling the lobster that it could save itself from the pot if it would only sprout wings.
Of course, that suggests that the government bailout was exactly the wrong thing to do.
15 September 2009
What Is To Be Done?
Even knowing that I sometimes work with long lead times, I'm somewhat embarrassed to admit that I'm still toying with a thought I first had about fifteen years ago. When Hillary Clinton was pushing for national health insurance -- and how times change -- she was asked about the effect compulsory health insurance for employees would have on employers. Her response was something to the effect of "Why should I worry about the fate of undercapitalized businesses."
I was struck then, and have been struck repeatedly since then, by the relationship (I would even say co-dependence) of big government and big business. Big government needs big business, because big businesses are a nice pot of assets that can be coopted for the purposes of big government without having to use the "t" word. Big business likes big government because (a) in a world where only big businesses can afford the cost of regulation only big businesses survive and (b) big government will be a big client.
Mix in some Olsen (Theory of Collective Action) and some Stigler (Regulatory Capture) and, hey presto, you've got the corporatist state not through right-wing fascism but as the most likely path from where we are (or were 20 years ago) to lefty nirvana.
It strikes me that there is some meaning to all this, and something should be done about it, but after 15 years, I'm just not sure what.
I was struck then, and have been struck repeatedly since then, by the relationship (I would even say co-dependence) of big government and big business. Big government needs big business, because big businesses are a nice pot of assets that can be coopted for the purposes of big government without having to use the "t" word. Big business likes big government because (a) in a world where only big businesses can afford the cost of regulation only big businesses survive and (b) big government will be a big client.
Mix in some Olsen (Theory of Collective Action) and some Stigler (Regulatory Capture) and, hey presto, you've got the corporatist state not through right-wing fascism but as the most likely path from where we are (or were 20 years ago) to lefty nirvana.
It strikes me that there is some meaning to all this, and something should be done about it, but after 15 years, I'm just not sure what.
A Nice Illustration Of An Odd Rule Of Evidence
From a comment at Firedoglake:
But the fact that they decide that the witness is lying about a particular point is not evidence of the opposite. The usual example given is a trial in which whether it was raining at a particular time is important. If one party testifies that it was not raining, the jury can disbelieve him. But that is not evidence that it was raining; the other side still needs to enter its own evidence on that point, which the jury -- again -- can believe or disbelieve.
I think, though, that the comment illustrates a better example. We are free to disbelieve Joe Wilson's statement that his outburst was spontaneous. But that disbelief is not evidence of a plan to embarrass the president.
How about when Wilson was asked about the outburst one of the first things out of his miserable pie hole was, “It was totally spontaneous.” He was never asked if it was planned or spontaneous; he volunteered that information right off the bat. That’s what made me first believe it was all planned. And who better to do it than a piece of work like Wilson?One of the important rolls played by a jury at trial is to disbelieve evidence. The jury is supposed to watch the witnesses and, using their common sense and everyday experience, decide whether or not the witness is telling the truth. If they decide that the witness is lying, they can disregard that testimony.
But the fact that they decide that the witness is lying about a particular point is not evidence of the opposite. The usual example given is a trial in which whether it was raining at a particular time is important. If one party testifies that it was not raining, the jury can disbelieve him. But that is not evidence that it was raining; the other side still needs to enter its own evidence on that point, which the jury -- again -- can believe or disbelieve.
I think, though, that the comment illustrates a better example. We are free to disbelieve Joe Wilson's statement that his outburst was spontaneous. But that disbelief is not evidence of a plan to embarrass the president.
10 September 2009
Doh! Spoke Too Soon.
Apparently, I wasn't quite correct to concede, below, that the uninsured exist. After all, Barack Obama wiped 15 million uninsured off the map last night.
04 September 2009
US Health Insurance Myths
As we go along debating health insurance reform, I am constantly amazed by the myths people believe about US health insurance. As I run across these myths, I'll try to note them here.
1. Preexisting conditions: People seem to think that this limitation is some sort of trick. Instead, it is a fundamental part of insurance. You can't insure your car after the accident or your life after you die. But so long as you have insurance, a preexisting condition does not stop you from changing your insurance. You cannot get trapped in a job and you can't lose your insurance because your employer changes plans; so long as you have insurance, you can't be excluded from a new group plan. Under federal law (lots of states have more generous laws), preexisting condition exclusions only apply if you have been uninsured for at least 63 days, apply only to conditions for which you have sought treatment and only allow a look-back of one year. A nice primer on preexisting conditions and federal law is here.
2. What we have is "insurance": As implied above, insurance policies are basically bets we make against catastrophe. I bet that my house will burn down, the insurance company bets that it won't. I bet that I'm going to die in the next year, the insurance company bets that I won't. I bet that my car is going to get stolen, the insurance company bets that it won't. If I lose the bet, there I am with my life, my house and my car. If my car explodes when I plow into my house, my wife and kids have a big pot of money to sit up at family dinners and call "Daddy."
There are things I can do to adjust my odds in these bets. I can get an alarm for my car and garage it in Northampton Massachusetts rather than the Bronx. I can get an alarm for my house. I can stop smoking and flying airplanes. For each of these, my premiums go down. But note that I the insurance company doesn't take my higher premium and then pay for alarms. Because that would be nuts.
But my health insurance pays for costs that are entirely predictable. It pays towards my annual physical. It pays towards medicine for chronic conditions that are very common among men my age. There's no sense betting on my having an annual physical, so why am I insured against it? I'm sure that all of you know the answer, but note that, when it comes to paying for relatively small, foreseeable expenses, all of the carping about wasteful spending is entirely correct. It makes no sense for me to pay my employer (think about it) to pay the health insurer to pay my doctor for an annual physical. I should just pay for it directly.
3. People are dying because they don't have health insurance: OK, that's not exactly a myth, but the general conception of how people are dying from lack of insurance is wrong. People with acute conditions -- heart attacks, trauma, etc. -- don't die from lack of insurance. They get treatment regardless of insurance. Someone falls down clutching their chest, you call the ambulance, the paramedics start treatment and get him to an emergency room and they get to a hospital bed before anyone even starts to try to figure out if they have insurance. Outcomes from acute treatment are pretty much invariant by income status.
People die -- more exactly, their life-span is shortened -- because of chronic conditions. High blood pressure isn't treated, cancers aren't caught as early, high cholesterol isn't treated, diabetes isn't caught as early, etc. This is what people mean when they say that we substitute treatment for prevention.
The problem here is that "prevention" is of questionable value and is incredibly expensive. For every heart attack delayed (and delay is basically all that can be accomplished) by blood pressure or cholesterol drugs, a large number of potential victims have to be treated. It is that "unnecessary" but unavoidable treatment that will make reform incredibly costly -- and the costliness of reform will lead, in turn, to government guidelines that avoid new expensive drugs. But can the government really prohibit people with government insurance from getting access to the newest and best drugs available to people with private insurance? Isn't avoiding that the whole point of reform? So, in the end we either end up with incredibly expensive government insurance (the most likely result) or no new drugs (an even worse result).
4. Reform is meant to benefit the uninsured. For reasons we've discussed, the uninsured tend to be middle-class and young. Forty percent are between 18 and 34, as opposed to 23% of the population. Generally, the uninsured young are making a good bet; the average health insurance premium for an individual in the states is $4000 and the young -- barring acute need, for which they'll get care and then have to worry about paying -- never spend that much. Far from giving health insurance to these people, which seems to be what they assume is going to happen, the reform plans on offer now mandate that they buy insurance or pay a penalty for non-insurance. These premiums or penalties will be at "community rate," which is (more or less, we don't know the details yet) the average cost of health insurance in their county/state/region/nation. In other words, the purpose of reform isn't to provide free health care to the young uninsured as it is to force the young uninsured to subsidize health insurance for those who already get government funded health insurance.
1. Preexisting conditions: People seem to think that this limitation is some sort of trick. Instead, it is a fundamental part of insurance. You can't insure your car after the accident or your life after you die. But so long as you have insurance, a preexisting condition does not stop you from changing your insurance. You cannot get trapped in a job and you can't lose your insurance because your employer changes plans; so long as you have insurance, you can't be excluded from a new group plan. Under federal law (lots of states have more generous laws), preexisting condition exclusions only apply if you have been uninsured for at least 63 days, apply only to conditions for which you have sought treatment and only allow a look-back of one year. A nice primer on preexisting conditions and federal law is here.
2. What we have is "insurance": As implied above, insurance policies are basically bets we make against catastrophe. I bet that my house will burn down, the insurance company bets that it won't. I bet that I'm going to die in the next year, the insurance company bets that I won't. I bet that my car is going to get stolen, the insurance company bets that it won't. If I lose the bet, there I am with my life, my house and my car. If my car explodes when I plow into my house, my wife and kids have a big pot of money to sit up at family dinners and call "Daddy."
There are things I can do to adjust my odds in these bets. I can get an alarm for my car and garage it in Northampton Massachusetts rather than the Bronx. I can get an alarm for my house. I can stop smoking and flying airplanes. For each of these, my premiums go down. But note that I the insurance company doesn't take my higher premium and then pay for alarms. Because that would be nuts.
But my health insurance pays for costs that are entirely predictable. It pays towards my annual physical. It pays towards medicine for chronic conditions that are very common among men my age. There's no sense betting on my having an annual physical, so why am I insured against it? I'm sure that all of you know the answer, but note that, when it comes to paying for relatively small, foreseeable expenses, all of the carping about wasteful spending is entirely correct. It makes no sense for me to pay my employer (think about it) to pay the health insurer to pay my doctor for an annual physical. I should just pay for it directly.
3. People are dying because they don't have health insurance: OK, that's not exactly a myth, but the general conception of how people are dying from lack of insurance is wrong. People with acute conditions -- heart attacks, trauma, etc. -- don't die from lack of insurance. They get treatment regardless of insurance. Someone falls down clutching their chest, you call the ambulance, the paramedics start treatment and get him to an emergency room and they get to a hospital bed before anyone even starts to try to figure out if they have insurance. Outcomes from acute treatment are pretty much invariant by income status.
People die -- more exactly, their life-span is shortened -- because of chronic conditions. High blood pressure isn't treated, cancers aren't caught as early, high cholesterol isn't treated, diabetes isn't caught as early, etc. This is what people mean when they say that we substitute treatment for prevention.
The problem here is that "prevention" is of questionable value and is incredibly expensive. For every heart attack delayed (and delay is basically all that can be accomplished) by blood pressure or cholesterol drugs, a large number of potential victims have to be treated. It is that "unnecessary" but unavoidable treatment that will make reform incredibly costly -- and the costliness of reform will lead, in turn, to government guidelines that avoid new expensive drugs. But can the government really prohibit people with government insurance from getting access to the newest and best drugs available to people with private insurance? Isn't avoiding that the whole point of reform? So, in the end we either end up with incredibly expensive government insurance (the most likely result) or no new drugs (an even worse result).
4. Reform is meant to benefit the uninsured. For reasons we've discussed, the uninsured tend to be middle-class and young. Forty percent are between 18 and 34, as opposed to 23% of the population. Generally, the uninsured young are making a good bet; the average health insurance premium for an individual in the states is $4000 and the young -- barring acute need, for which they'll get care and then have to worry about paying -- never spend that much. Far from giving health insurance to these people, which seems to be what they assume is going to happen, the reform plans on offer now mandate that they buy insurance or pay a penalty for non-insurance. These premiums or penalties will be at "community rate," which is (more or less, we don't know the details yet) the average cost of health insurance in their county/state/region/nation. In other words, the purpose of reform isn't to provide free health care to the young uninsured as it is to force the young uninsured to subsidize health insurance for those who already get government funded health insurance.
24 August 2009
Can't Even Make Fun Of Ireland Anymore
Massachusetts General Laws Chapter 272: Section 36. Blasphemy
Whoever wilfully blasphemes the holy name of God by denying, cursing or contumeliously reproaching God, his creation, government or final judging of the world, or by cursing or contumeliously reproaching Jesus Christ or the Holy Ghost, or by cursing or contumeliously reproaching or exposing to contempt and ridicule, the holy word of God contained in the holy scriptures shall be punished by imprisonment in jail for not more than one year or by a fine of not more than three hundred dollars, and may also be bound to good behavior.
22 August 2009
In Which We Try To Be Informative And Constructive
If you manage to find a supporter of nationalized health care to debate, and you manage to move them past "fascist dupe," they often point out that we have rationing, of a sort, now. Health insurance companies won't pay for certain procedures on the basis that they're not cost effective, or are experimental, or some such. "Wouldn't you rather," they say, "have these decisions made by government."
"No, I bloody well wouldn't," you respond. Correctly. But why wouldn't you? In addition to our well-founded suspicions of government, which the left share in most other situations, there are several tangible reasons not to want to fight with the government.
Now, if you and your health insurer disagree about a treatment, you go through a relatively simple internal appeal, they deny you coverage, and then you sue them in federal court. (You get to go to federal court because most people get their health care through their employer and employee benefits are regulated by ERISA, a federal law. If you buy your insurance directly and get to go to state court, that's even better for you and yet another advantage lost to nationalized health care.)
If the government denies you coverage, you get to appeal, in the first instance, to an Administrative Law Judge. Despite his title, an ALJ is not a judge. He is an executive branch bureaucrat, answerable to the same agency hierarchy that made the decision to deny coverage in the first place. Now, so far this isn't too much different than the private sector internal appeal. But there are differences. First, ALJ proceedings, in my experience, take longer than internal appeals. Second, health insurer appeal panels tend to include practicing doctors, so there's some chance of a favorable verdict. ALJs will be lawyers, not doctors, beholden to the agency for reappointment (they serve for a fixed term (6 years, usually) and not for life). So there's somewhat less chance of a favorable result.
But the real difference comes when you go to court. Now, we don't know what the final statute is going to look like, so I'm going to assume that you will be able to appeal the ALJ's decision to the district court for determination de novo, that is, without the court deferring to the decisions of the ALJ. If you have to appeal to a federal appeals court, or if the court has to defer to the findings of fact of the ALJ unless they are clearly erroneous, then you are sunk. If you sue a private insurer, you just have to prove that your version of the facts is more likely than not.
If you sue your private health insurer, you'll go in front of a federal judge who, probably, doesn't particularly like insurers. In other words, a lawyer. Even if he doesn't hate insurers, he is the judge; he won't want to defer to the company. (Does ERISA suggest that the judge should defer to the company's denial? Arguably, but I've done a lot of ERISA work and, believe me, they don't.)
If you sue the federal health provider, on the other hand, the judge -- a federal employee -- is now meant to second-guess the workings of other federal employees. Is he going to treat them the same way he treats insurers? No way. In fact, he shouldn't. Even if the judge doesn't have to defer to the factual findings of the ALJ, he must defer to the expertise of the agency within the scope of its mandate and to its legal interpretation of its own regulations and establishing statute. So if the agency says that, as a matter of law, grandma doesn't get her hip replacement, then the judge must accept that decision unless it is arbitrary. Which it never is.
If you sue a private insurer, you can argue that they are estopped from denying coverage. That is, that they told you there was coverage in this situation, you relied on the statement to your detriment, and now they're not allowed to change their mind even if the first statement was wrong. You can never estop the government. (There is an argument under ERISA that you can't estop insurers, but I don't think that's the prevailing law. In fact, this is a nice example of how judges give private insurers less latitude than they'd be forced to give to a public insurer.)
If you sue a private insurer, then the court will construe any ambiguity in the policy -- and there is always ambiguity in an insurance policy -- against the insurer. If you sue the government, the court will defer to the government on how any ambiguity should be construed.
Judges have no hesitation to order insurers to spend money. Although they will do it, judges are supposed to be reluctant to order the government to do anything.
Basically, this comes down to the question, would you rather sue a private company or would you rather sue the government. You'd much rather sue a private company.
"No, I bloody well wouldn't," you respond. Correctly. But why wouldn't you? In addition to our well-founded suspicions of government, which the left share in most other situations, there are several tangible reasons not to want to fight with the government.
Now, if you and your health insurer disagree about a treatment, you go through a relatively simple internal appeal, they deny you coverage, and then you sue them in federal court. (You get to go to federal court because most people get their health care through their employer and employee benefits are regulated by ERISA, a federal law. If you buy your insurance directly and get to go to state court, that's even better for you and yet another advantage lost to nationalized health care.)
If the government denies you coverage, you get to appeal, in the first instance, to an Administrative Law Judge. Despite his title, an ALJ is not a judge. He is an executive branch bureaucrat, answerable to the same agency hierarchy that made the decision to deny coverage in the first place. Now, so far this isn't too much different than the private sector internal appeal. But there are differences. First, ALJ proceedings, in my experience, take longer than internal appeals. Second, health insurer appeal panels tend to include practicing doctors, so there's some chance of a favorable verdict. ALJs will be lawyers, not doctors, beholden to the agency for reappointment (they serve for a fixed term (6 years, usually) and not for life). So there's somewhat less chance of a favorable result.
But the real difference comes when you go to court. Now, we don't know what the final statute is going to look like, so I'm going to assume that you will be able to appeal the ALJ's decision to the district court for determination de novo, that is, without the court deferring to the decisions of the ALJ. If you have to appeal to a federal appeals court, or if the court has to defer to the findings of fact of the ALJ unless they are clearly erroneous, then you are sunk. If you sue a private insurer, you just have to prove that your version of the facts is more likely than not.
If you sue your private health insurer, you'll go in front of a federal judge who, probably, doesn't particularly like insurers. In other words, a lawyer. Even if he doesn't hate insurers, he is the judge; he won't want to defer to the company. (Does ERISA suggest that the judge should defer to the company's denial? Arguably, but I've done a lot of ERISA work and, believe me, they don't.)
If you sue the federal health provider, on the other hand, the judge -- a federal employee -- is now meant to second-guess the workings of other federal employees. Is he going to treat them the same way he treats insurers? No way. In fact, he shouldn't. Even if the judge doesn't have to defer to the factual findings of the ALJ, he must defer to the expertise of the agency within the scope of its mandate and to its legal interpretation of its own regulations and establishing statute. So if the agency says that, as a matter of law, grandma doesn't get her hip replacement, then the judge must accept that decision unless it is arbitrary. Which it never is.
If you sue a private insurer, you can argue that they are estopped from denying coverage. That is, that they told you there was coverage in this situation, you relied on the statement to your detriment, and now they're not allowed to change their mind even if the first statement was wrong. You can never estop the government. (There is an argument under ERISA that you can't estop insurers, but I don't think that's the prevailing law. In fact, this is a nice example of how judges give private insurers less latitude than they'd be forced to give to a public insurer.)
If you sue a private insurer, then the court will construe any ambiguity in the policy -- and there is always ambiguity in an insurance policy -- against the insurer. If you sue the government, the court will defer to the government on how any ambiguity should be construed.
Judges have no hesitation to order insurers to spend money. Although they will do it, judges are supposed to be reluctant to order the government to do anything.
Basically, this comes down to the question, would you rather sue a private company or would you rather sue the government. You'd much rather sue a private company.
19 August 2009
Why Don't People Disbelieve Obama Now?
One thing that's always struck me as strange about President Obama's supporters is the extent to which they support him because they think that he's lying about key policy positions. The best example of this is gay marriage: Obama announced that, as a Christian, he believes that G-d has mandated that marriage be the union of one man and one woman. The people who vociferously support gay marriage (Andrew Sullivan leaps to mind) shrug and tell each other, "he has to say that, but we know that he's lying." Robert Wright has said much the same thing about Obama's professed belief in Jesus. Wright can just tell that, in private, Obama is an atheist. I don't remember a candidate for whom perceived lying has been such an important selling point.
So why, I wonder, are people starting to believe him now. His real problem with the public on this lunatic idea of nationalizing health care (or the 2/3's of health care not already nationalized) is not that it's lunatic, but that he promises to cut spending. Since seniors have realized that cutting spending translates to not giving them hip replacements on demand -- the single most common surgery under Medicare -- they're up in arms. But isn't this just a completely transparent lie?
I don't know if Obama is really a Christian. I don't know if his religion forces him to oppose same-sex marriage. Pretty much, I'm with the courts. All we can know is what people say and do, so I have to give Obama the benefit of the doubt here. But one thing I'm sure of is that there is no way nationalized medicine is going to cut costs. The evidence from every other government welfare program, as well as common sense, is clear: the government is going to spend, spend, spend. Obama knows this perfectly well. He's clearly lying when he says that we're going to drive down the cost curve. No matter where the line is drawn on spending, some cute little kid or gray-haired Nana is going to fall just outside. The papers will have a field day, politicians will pontificate and bureaucrats will soon learn that the only downside is denying care. Pretty soon, we'll be looking back wondering how the 10-year cost appraisal could have been so wrong.
But I'm still puzzled: why do so many people suddenly believe the President the one time he is clearly lying?
So why, I wonder, are people starting to believe him now. His real problem with the public on this lunatic idea of nationalizing health care (or the 2/3's of health care not already nationalized) is not that it's lunatic, but that he promises to cut spending. Since seniors have realized that cutting spending translates to not giving them hip replacements on demand -- the single most common surgery under Medicare -- they're up in arms. But isn't this just a completely transparent lie?
I don't know if Obama is really a Christian. I don't know if his religion forces him to oppose same-sex marriage. Pretty much, I'm with the courts. All we can know is what people say and do, so I have to give Obama the benefit of the doubt here. But one thing I'm sure of is that there is no way nationalized medicine is going to cut costs. The evidence from every other government welfare program, as well as common sense, is clear: the government is going to spend, spend, spend. Obama knows this perfectly well. He's clearly lying when he says that we're going to drive down the cost curve. No matter where the line is drawn on spending, some cute little kid or gray-haired Nana is going to fall just outside. The papers will have a field day, politicians will pontificate and bureaucrats will soon learn that the only downside is denying care. Pretty soon, we'll be looking back wondering how the 10-year cost appraisal could have been so wrong.
But I'm still puzzled: why do so many people suddenly believe the President the one time he is clearly lying?
12 August 2009
"That's What Gods Do"
Again with the idea that finding a biological explanation for belief would make it less likely that G-d exists. The truth, of course, is that such a biological foundation for belief would be weak evidence in favor of G-d's existence. It is more likely that G-d would create us with the biological ability to believe in Him than that such an ability would develop randomly. Thus, the existence of such an biological ability is somewhat more consistence with G-d's existence than not.
Health Care And Trust
I just saw this passage, quoted from a supporter of nationalized health care, over at Just One Minute:
There are Americans who don't trust the government at all. But I think the main stream American attitude towards the government -- which is to say, towards our fellow citizens -- is to trust the government to do what it is legally bound to do, and no more. It is inconceivable to me that many Americans could have strong-form trust in the government; that many Americans believe that, in situations in which it can act opportunistically, that shifting set of coalitions we call a government will act in their own best interest. Of course, that I believe that strong-form trust in the government is inconceivable is likely tied to my preference for limited government.
Given my semi-strong form trust in government, nationalized health care seems like a bad joke. There are two many situations that will occur that we haven't, and can't, tie the government's hands. There are too many ways that the government, or the controlling coalition of the day, can act opportunistically and little chance that it won't. We need only look at the public schools -- where opportunistic choices are routinely made for the benefit of the teachers and administrators -- to understand my worry about a decision to (strong-form) trust the government with my family's health care and 14% of the economy.
What we're seeing here is not merely distrust in the House health-care reform bill. It's distrust in the political system. A healthy relationship does not require an explicit detailing of the "institutional checks" that will prevent one partner from beating or killing the other. In a healthy relationship, such madness is simply unthinkable. If it was not unthinkable, then no number of institutional checks could repair that relationship. Similarly, the relationship between the protesters and the government is not healthy. The protesters believe the government capable of madness. There is no evidence for that claim, which means that there is no answer for it, either.In my field, we divide trust into three different types (Barney & Hansen, 1994). The first, called weak form trust, results from two parties in a relationship not being vulnerable to each other. This is really more indifference than trust. The second, semi-strong form trust, is where two parties to a relationship trust the other party to do what they have agreed to do; this is the trust of contract law, enforced by formal governance and law. Strong form trust, the third form, is where the parties have the power to act opportunistically, but trust each other not to. We see this mostly in very good friendships and strong marriages. Arguably, just having a joint checking account is strong-form trust.
There are Americans who don't trust the government at all. But I think the main stream American attitude towards the government -- which is to say, towards our fellow citizens -- is to trust the government to do what it is legally bound to do, and no more. It is inconceivable to me that many Americans could have strong-form trust in the government; that many Americans believe that, in situations in which it can act opportunistically, that shifting set of coalitions we call a government will act in their own best interest. Of course, that I believe that strong-form trust in the government is inconceivable is likely tied to my preference for limited government.
Given my semi-strong form trust in government, nationalized health care seems like a bad joke. There are two many situations that will occur that we haven't, and can't, tie the government's hands. There are too many ways that the government, or the controlling coalition of the day, can act opportunistically and little chance that it won't. We need only look at the public schools -- where opportunistic choices are routinely made for the benefit of the teachers and administrators -- to understand my worry about a decision to (strong-form) trust the government with my family's health care and 14% of the economy.
08 August 2009
The Point Of Statistics
It strikes me as worth saying, because I don't see it out there very often, that the only point of statistics is to try to determine whether an apparent difference between two sets of data is a real difference rather than simply an artifact of error and randomness.
Also, that statistics is a fairly blunt instrument and no one study "proves" anything. All generalizations from studies are a leap of faith, albeit some more than others.
Also, that statistics is a fairly blunt instrument and no one study "proves" anything. All generalizations from studies are a leap of faith, albeit some more than others.
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