Thursday, March 25, 2010

Libertarians and health care

I've been having an email discussion with a libertarian friend of mine about the recent passage of the health care reform bill. While the exchange is already too long to post in its entirety, I did want to put up some excerpts. It started when I received an email blast saying that the bill is an inappropriate use of funds to interfere with the functions of private enterprise.

The first thing I mentioned is that I have a personal interest in the bill's provision that patients cannot be denied coverage for pre-existing conditions, as I have already gone through the experience of being denied coverage due to a mild case of high blood pressure that requires me to take some low dosage pills. Luckily, I got a new job later that covered me, and I can now extend the same plan under COBRA if I switch jobs. But it was a tense few months for me.

Later, I wrote:

Libertarianism has always struck me as a severe case of having only a hammer in your toolbox and perpetually seeking nails. Is the economy doing well? Then it's time to lock in those gains by eliminating regulations. Is the economy doing poorly? There are too many regulations. Is the economy still doing poorly after regulations have been gutted or deliberately unenforced in a particular area? The measures didn't go far enough; the solution is to roll back more of them. When I say that I am results based, what I mean is that you should be willing to actually compare economic conditions during different times or across different countries that have more or less regulation in these areas.

Libertarian "experiments" don't appear to confirm their hypotheses, because countries with varying degrees of regulation don't appear to reflect the claim that an unencumbered economy is a healthy economy. Let me demonstrate with a little on-the-spot research. The United States ranks 38th in a list of countries by life expectancy. Quick spot check. Among the top three countries:

All three of these countries I just looked up have stronger government involvement in health care than the bill that just passed. By contrast, let's take a look at the bottom three.

This is the kind of elementary research that I mean when I say that I would prefer evaluation to be driven by outcomes and evidence. Now, granted, health care isn't the only factor in life expectancy. However, there is a clear correlation that seems to belie the assumption that "more public involvement => worse results." Obviously I haven't done an exhaustive survey of all 195 countries on the list. But I'm willing to bet that a completed graph would retain the overall pattern that countries which spend more public dollars on health tend towards higher life expectancies, and vice versa.

Of course people are healthier when there is more access to healthcare. The question is, who is better at providing the health care. Governments make the claim to cover everybody. But that's all it is, is a claim. We hear a lot about private insurance companies rejecting individual people's claims. But that's nothing to the number of people rejected by government plans. Just look at Massachusetts.

I think I've covered this question pretty well by my back-of-the-envelope survey of other countries. But all right -- I took you up on your request and looked. First thing I found was that Massachusetts has the lowest rate of uninsured residents in the country, at 5.5%. It was 8.7% in 2006, before the bill was enacted, so it has dropped significantly. The highest uninsured rate? That would be Texas, illustrious home of no state tax, clocking in at 26.9%.

I also looked for something to corroborate your implication that more claims are denied in Massachusetts than in most other states, but have so far come up empty handed. If you have evidence that Mass's system has enough negatives to offset the very excellent coverage rate, I'm sure you'll let me know. In the meantime, I'll continue my previous theme and take a look at life expectancy by state.

Huh... what do you know? Liberal Massachusetts with their public health program is fifth highest on the list. Texas, with the highest number of uninsured, comes in at 34.

Now, you might fairly regard this as a little bit of sleight of hand, since Mass only enacted their health plan a few years ago, and the results on life expectancy could hardly be expected to be measured thoroughly by now. However, Mass has always been demonized by economic conservatives as being an example of rampant "socialist" liberalism at its worst. So I'm content to have past results of this horror be reflected by the life expectancy now.

In a followup letter, this exchange occurred:

The best analysis I've seen of [a nation's economic strength] is the Economic Freedom Index. The way I found out about this web site was a few years back when it made headlines (at least in Europe) that the US was no longer in the top 10...

That's interesting, but it is begging the question. The Heritage Foundation is a well known conservative economics think tank. Any standard they use for measuring "Economic Freedom" is bound to involve qualities which are in line with the goals of the Heritage Foundation. Such a concept is inherently subjective, and assumes that the things that you want out of a government (i.e., lack of public funding for health care) are for the best. You can probably see why I'm hesitant to accept this as a neutral measure of how good those countries are.

[I don't] value life expectancy if it interferes with quality of life. I had the privilege of sitting in on a health panel at Renaissance Weekend last year. There were many doctors and hospital administrators from Massachusetts. They were talking about a patient they refer to as the "Six Million Dollar Man" because there is no limit to what they are obligated to pay to keep this particular patient alive. To continue end of life treatment to this extreme will break the budget if everyone recieved such care.

You are, again, begging the question. I chose life expectancy because it is a relatively easy to obtain quantification of the overall health of the nation, one which is objective enough that it can't be easily fudged. If all else is equal, I assume you and I would agree that we'd rather live a longer life than a shorter one. (Or as Dave Barry once eloquently put it: "Son, it is better to be rich and healthy than poor and sick.")

But you've introduced a red herring, in saying "if it interferes with quality of life." Without providing any supporting data to show that quality of life suffers a lot from living in Japan, Hong Kong, or Iceland, this has nothing to do with what I said. If you'd like to pick another neutral measurement of quality of life, make a suggestion. But I'm not taking "The Heritage Foundation likes them" as an answer.

Here's an example of another standard you might pick for "quality of life." There is an organization that takes a snapshot of self-reported happiness by country.

DEFINITION: This statistic is compiled from responses to the survey question: "Taking all things together, would you say you are: very happy, quite happy, not very happy, or not at all happy?". The "Happiness (net)" statistic was obtained via the following formula: the percentage of people who rated themselves as either "quite happy" or "very happy" minus the percentage of people who rated themselves as either "not very happy" or "not at all happy".

In a similar vein to my previous message, I note that the top three countries -- Iceland, Sweden, and Denmark, all have universal health care.

Thursday, March 11, 2010

Bob Corker challenges Chris Dodd to single combat

I was struggling to remember what this reminds me of:

March 11 (Bloomberg) -- Senate Banking Committee Chairman Christopher Dodd said he will release his version of legislation to overhaul financial rules, signaling that talks on a compromise with Republican Bob Corker have collapsed.


“I have been fortunate to have a strong partner in Senator Corker and my new proposal will reflect his input and the good work done by many of our colleagues,” Dodd said. “Our talks will continue and it is still our hope to come to agreement on a strong bill all of the Senate can be proud to support.”

...and I finally put my finger on it.

The Democrats have a lead in the House of Representatives of 253 to 178. To put it another way, there are nearly three Democrats for every two Republicans. By historical standards it is a fairly large numerical lead, greater than any advantage Republicans ever had while Clinton and Bush were presidents. And yet to Dems like Dodd, being "bipartisan" means one Democrat negotiating with one Republican.

What it reminds me of: In George R. R. Martin's Song of Ice and Fire book series (coming soon as an adaptation on HBO!!) many characters frequently challenge one another to single combat. This actually has a historical basis: sometimes during a war, the outcome would be determined by each side selecting a champion and letting them fight one other to the death. In some cases, the armies would agree to abide by the resolution of the fight, and the side with the losing champion would simply forfeit the battle.

There is a scene I love early in the third book, A Storm of Swords. Jaime Lannister, a prominent sometimes-villain of the series, is being pursued in a boat by agents of the enemy Tully family, who intend to catch him and bring him to justice. With capture imminent by a small squad of Tully warriors, Jaime taunts the captain, asking if he is brave enough to face him in single combat. Unsurprisingly, the captain shouts back words to the effect that he isn't that gullible, and he elects to keep his forty or so soldiers in the fight against three people.

Chris Dodd is that gullible.

Friday, March 05, 2010

Presidential video... cute but not that funny

So this video has been making the rounds on the internet. Am I the only one who doesn't find it particularly funny?

Ron Howard managed to pull together all the living past presidential impersonators from Saturday Night Live into one all-star sketch. That's an accomplishment in itself. And they apparently shot it in fifteen hours. Also impressive, or so I'm told.

I am a fan of old SNL and like every one of the performers -- yes, including Jim Carrey (the only non-SNL guy on set) as Reagan. Each guy goes through the motions of all the quirks they used to give these characters. Dana Carvey says silly disjointed things, Will Ferrell acts clueless, Chevy Chase falls down, etc. But it just seemed like they forgot to add any jokes. Also, the inspirational message didn't inspire me all that much.

As a nostalgia trip, thumbs up. As a comedy routine, not so much. Also, it goes without saying that I miss the late Phil Hartman an awful lot. His portrayals of both Reagan and Clinton could run circles around most of those guys.

Wednesday, March 03, 2010

Social media resembles magically multiplying broomsticks

For a few weeks I've been a member of Google Buzz. Because of my ever expanding list of automatically updated sites, here's how posting stuff works:

  1. I write a new blog post.
  2. The link gets forwarded to Twitter.
  3. My Twitter feed in turn gets forwarded to Facebook and Buzz.
  4. At that point, I am equally likely to receive comments on Buzz, FB, or in the comments of the post itself.

The additional exposure for said posts is quite nice, because there are people on each site who don't pay attention to some of the other three feeds. However, it is tough to converse about a topic when the discussion is split three ways. Also, the blog posts themselves look a lot lonelier with the shorter comment threads.

Monday, March 01, 2010

A comic genius has died

John Reed Dies at 94

I won't be surprised if most of you never heard of the guy.

Here's a semi-obscure fact about me: I love Gilbert and Sullivan plays. Love em. I can rattle off the plot lines and characters of ten of their major plays, and have at one time or another memorized at least one song from each of these, and in many cases a significant chunk of the score. (But I'm not gay! Not that there's anything wrong with that.)

A large part of the credit goes to my father, who took my sister and me to see HMS Pinafore when I was eleven. The production was so good that he hired the director to handle a family-only production of The Mikado for my bar mitzvah, in which I played the role of Koko, the comic lead.

Dad was also an early adopter of the brand new audio technology known as Compact Discs, in the early 1980's. Some of the first CD audio recordings he bought for his extensive classical music library were soundtracks from the D'Oyly Carte Opera Company, and I think every single one of them featured John Reed in a major role.

See, G&S operettas are almost universally comedies, and I love comedy, but the major plot is usually some quasi-serious topic involving a love story with some significant and frequently bizarre obstacles. So there are a lot of famous songs that are essentially love ballads, and I tend to skip past those. The part that I like is where the funny guy shows up, who is either a walking satire of some trope of Victorian England, or makes wry and sarcastic observations about such tropes. This guy's signature song tends to be very rapid paced and difficult to say. Not only does he have to provide spot-on comic timing and delivery, but he has to flawlessly spit out tongue twisters, on pitch and at as fast a tempo as possible. These are called "patter songs."

That was John Reed's gig. If you know any of his material, it will probably be "I am the very model of a modern major general" from The Pirates of Penzance. He also played my role, Koko in The Mikado, and I'm sure that at 13 years old I shamelessly ripped off his performance as much as I was able to. His other roles included a prancing, self-absorbed poet who represented Oscar Wilde, a self-deprecating impoverished nobleman, and a lecherous old judge... among many others.

When I was a teenager I went to a summer camp in Colorado, and each year after the month of camp ended, we always went to the University of Colorado in Boulder where John Reed had taken over the theatrical organization and cranked out a new Gilbert and Sullivan production every year. He was about 70 years old at this point, but he kept on stealing the show when he managed to show up in his traditional parts, or wrung a similarly excellent performance out of whatever younger actor was available to replace him when he couldn't go on. A highlight of these shows was that the funniest songs would get a series of encores, each one more over the top and wackier than the last.

John Reed made to 94, and it seems to me like he had an unusually long, enjoyable, and hilarious career. So as a sign-off for one of my favorite performers of all time, I'll toss off a verse from Jack Point, his character in Yeoman of the Guard, for comedians and Fools of all generations:

I can set a braggart quailing with a quip,
The upstart I can wither with a whim;
He may wear a merry laugh upon his lip,
But his laughter has an echo that is grim!
When they're offered to the world in merry guise,
Unpleasant truths are swallowed with a will -
For he who'd make his fellow creatures wise
Should always gild the philosophic pill!