Some "What's Next" ideas for GOP healthcare reform

Democrats are scrambling to avoid a well deserved pasting in the 2014 fall elections and have come up with a strategy to ask "what's next" and put the GOP on the defensive. But that's only going to work if the GOP doesn't have a ready answer to the question. Here are a few candidates:

1. Big bang reform didn't work so now it's time to do small, incremental reforms where if it works, we've made things better and if it doesn't, we can quickly pull back before we wreck the whole system. 
2. The AMA invented the CPT in 1966 and charges royalties. The US Congress adopted CPT as a standard but didn't buy it to make it a copyright free government document. You still have to pay a license fee, for digital copies that's a per user fee and the fee is high. We need to liberate the CPT so that we harness the spirit of price comparison and getting the best deal that exists in most of our commercial lives. Finding out that your $3k MRI can be gotten for $500 down the street can be the difference between limping along in pain and getting the treatment you need. By using Congress' power to set weights and measures we can make that happen and it doesn't have to be that expensive. 
3. We are two years away from a legally mandated 20+% cut in disability insurance payments. In part this is because of the unprecedented wave of convenient disability cases flooding the system. The fiscal crisis was tough. I think we should have compassion for people who panicked and made a wrong move. We need to pass legislation giving people amnesty and a pathway back into the workforce so that the truly disabled do not have to pay the price for a bad economy. 

Simple Question

With the rise of military policing, I've noticed something missing in the discussion, a comparison of law enforcement models. Nobody seems to be answering the question, for every particular jurisdiction, which of the three models available is best for fighting crime in that jurisdiction. The three models, in order of their invention, are hue and cry, peace officers, and military style policing. If you think the model list is too short, feel free to add to it in comments.

It's such a simple question, but nobody's asking it, nobody's answering it, and nobody's making adjustments to policing models in a systematic, scientific way. This is not rocket science. You don't need above average intelligence to do this task but people talk about the future where we'll have nothing to do and no way to earn our daily bread.

We won!

I participated in the first ever NW Indiana Startup Weekend this past weekend. My team won. We now have a year of free office space and a lunch with a VC to pitch the idea to fund it.

Multiplying fishes

We got 4.5 times the expected Pacific salmon run this year due to one weird trick. We (and by we I mean an eco entrepreneur named Russ George and a BC indian tribe, the Haida) strategically distributed 120 tons of iron sulfate in the Pacific and created an ocean paradise for the salmon to feed on. 12 men and one boat worked in 2012 to set up that feeding ground to reduce the traditional levels of starvation among migratory fish going out into the resource poor Pacific Ocean. Open-sea mariculture has been hemmed in by unfortunate treaty language that fails to distinguish between pollution and setting out fish food. The 2012 experiment results are in.

The SE Alaska Pink catch in the fall of 2013 was a stunning 226.3 million fish. This when a high number of 50 million fish were expected. Those extra ocean pasture fed fish came back because their pasture was enjoying the richest plankton blooms ever, thanks to me a[nd] 11 shipmates and our work in the summer of 2012. IT JUST WORKS.

As a side effect of the process, a great deal of carbon dioxide was sequestered as the diatoms that did not get eaten by the fish died a natural death and sank to the bottom.

Environmentalists are beside themselves with fury. They're more interested in establishing a precautionary principle regulatory framework that would have led to many tons fewer fish to feed families across North America this year if not banning the process altogether. Their global campaign made the Haida blink and Mr. George has been fired.

We can't have fish multiplying beyond all reason and solving our global food problems while knocking down CO2 levels. That might reduce the need for environmental NGOs to study the problem.

Posted Social Security report alpha 6

I mentioned that I would be putting up a report. This is one of a long backlog of reports that have been waiting on me finding technical talent to program. I've decided to shift strategy and put up report alphas and just manually update. This usually has massive scaling problems as the number of pages goes up which is why I've been avoiding this approach.

In any case, here's the first Citizen Intelligence report.

Will you get all promised Social Security Benefits? Here's a hint, for most americans, the answer is no under current law. Males born in 1955 or later and females born in 1952 or later have a pretty hefty Social Security cut written into the present law.

This is a manual report at present. I need to work out a scalable way to take e-mails so that I can send out the yearly updates for this report when the new trustees report means updated data. Ultimately, this report will be a module to be plugged into the yet-to-be-created Citizen Intelligence oversight dashboard.

Insurance does not mean health care

Four decades ago, the US fell into a trap. We essentially adopted government pricing healthcare. It had become clear that the Treasury couldn't handle traditional fee for service medicine. With the government paying, too few made the effort to drive a good bargain. So the government took on the huge job of putting out a fee schedule. Private insurance followed the government's lead because, frankly, it was a big cost saver not to have to do the work themselves.

The problem is that the government got the prices wrong. Specifically the payment ratio of primary care codes to specialist care codes has been off. Primary care codes have been too low to attract enough primary care doctors. This has distorted US medical care. Both right and left know that these ratios are not correct. It's not a matter of partisan difference. We just don't know where to get the money to pay the primary care doctors enough to attract enough doctors to make the system work right.

The US is too poor to do everything else we've committed to and to do this right as well. As a consequence we just have lived with too few primary care doctors. Enter Obamacare.

A number of California uninsured have been assisted by their free clinics to get on the exchanges but after a few months are right back at the free clinics. Doctors who are supposed to be in their networks are either not taking new patients or deny that they even accept their insurance. But the free clinic isn't allowed to take them either. They now have insurance and free clinics are for the uninsured.

For now, human compassion has led them to be accepted. But the bureaucratic rules won't be flouted forever as budgets get stretched and the theory that health insurance equals access to health care is exposed as the fraud it always was. The free clinics will be threatened with a loss of money if they keep allowing insured patients to use their services.

Not every Obamacare story is a horror show. But we simply don't have the data to exclude the horrifying possibility that after a half century of pushing for something like Obamacare, liberals have, on net, made things worse on the health care front. That's a travesty.

Christ is Risen

For the Easter season, romanians say to each other in greeting "Christ is risen" and respond "Truly He is risen". It's an eastern tradition that runs across many churches. 

So to all of you, friends, and future friends, acquaintances, and enemies I hope to make peace with, to everybody reading I say to you Christ is risen and wish you all the good things that are promised with that statement. 

How not to improve government

"Proof The Feds Are Stalling On Oil And Gas" is a boring article that isn't going to change anything about how the US Federal government handles drilling permits on federal land. It won't change anything because the approach used skips right past the foundations and prerequisites and goes straight to the charges.

To have effective, durable change, we would need to map out the entire process for drilling on federal land as a part of a larger project identifying what government does from soup to nuts. We need to insist on commitments for performance for each of them and normalize an expectation that the least efficient and effective things that government does will be heavily scrutinized for alternate arrangements.

Slow rolling permits is not something the bureaucracy is going to be happy to do when they know that to delay legitimate requests puts them at risk for unemployment. But that's not the world we live in. The world we live in has articles decrying oil drilling delays in an oil drillers website while the public blissfully goes about its business, in general rationally ignorant of the whole issue.

There needs to be a better way.

Don't skip looking up the law

The Pennsylvania special ed student who recording a bullying episode and was threatened with a wiretapping felony charge has been making the rounds. What nobody seems to be mentioning is that what he did was perfectly legal. The school officials, the police, the judge, and even all the hyperventilating commenters all seem to have skipped looking up the law.

Title 18 Section 5704 Subsection 17

Any victim, witness or private detective licensed under the act of August 21, 1953 (P.L.1273, No.361), known as The Private Detective Act of 1953, to intercept the contents of any wire, electronic or oral communication, if that person is under a reasonable suspicion that the intercepted party is committing, about to commit or has committed a crime of violence and there is reason to believe that evidence of the crime of violence may be obtained from the interception.

I'm not a lawyer. I just know how to use Google fairly decently. Bullying is a crime of violence.

The law seems pretty clear. So why did the school officials, the cop, and the judge all fail to do their basic duty? Why aren't we calling them on not enforcing the law?

The only silver lining in this whole mess is that the judge is elected and could get booted for this.

Catholic Death Penalty

The argument in the Catholic Church regarding the death penalty has always proceeded on terms that are not that clear to many outsiders. The essence of the argument for invalidating the traditional permission for the death penalty is that something fundamental has changed about modern penal systems, that for the first time ever we can prevent crime and that it is safe to keep heinous criminals alive and thus the death penalty should be abolished.

The counter in Catholic circles has always been that it is simply not true, that nothing fundamental has changed. It has always bothered me that neither side seems eager to tear the covers off what modern prisons are really like and honestly, openly monitor matters. Here's a data point on the pro-death penalty side. Murder spree conducted by sex offenders wearing GPS ankle bracelets.

Can we trust the state to actually keep us safe? That's an open question.

The known unknowns of taxation

Donald Rumsfeld is at it again. Like many of us, Rumsfeld has no idea whether he's actually paid his taxes accurately.

Sell Nevada

Michael Munger comes up with a very nice snapshot of the problem of too much federal land, especially out west.

Essentially the entire state of Nevada is owned by the federal government. And it seems like they're managing federal lands poorly all over the US. Utah has gone so far as to issue an ultimatum that the federal government has until the end of 2014 to hand over control to the state or else. Several other states are considering similar legislation.

It's pretty unclear whether state transfer laws are constitutional or just crazy talk. But we're likely to hear a great deal more about later this year.

We don't deserve better than Sebellius

Kathleen Sibellius' term as HHS Secretary has been a disaster according to Newt Gingrich. But I have to disagree with Nick Gillespie that we deserved better than Sibellius' incompetence. We don't deserve better. This is what we've chosen, Democrats and Republicans, over the course of decades.

Inefficiency and incompetence can strike everywhere. In a large, bureaucratized environment, humans are particularly vulnerable to these problems. Exceeding our government oversight capacity by growing government to its present size increases our vulnerability even more because fundamentally the fear of bankruptcy and ruin makes private oversight about 2% better, project after project, year after year.

Every little two bit program that is solving a problem publicly that could have been solved privately sucks up oversight time that should have been focused on the roll out of the ACA. This sort of oversight failure of a big government project is guaranteed to happen again. That's the nature of humanity. But it doesn't have to happen so often. We've grown our government so large that I would say it's guaranteed to be happening right now. It just hasn't been discovered yet.

Virtuous Capitalists

Are entrepreneurs virtuous? Here's an excellent (if long) video that lays out the issues.

The short version is that yes, entrepreneurs are virtuous when they profit from creating value, new products, services, as well as converging prices through arbitrage. Entrepreneurs are not virtuous when they rent seek, creating a legal system that forces people to give them money (or more money) based on a political decision influenced by lobbyists.

The weakness is that you can make good money by rent seeking in a debased political system that permits it. Any firm focused on creating value can add to its accounting profits by adding lobbyists to rent seek on behalf of the firm. This means that they are vulnerable to hostile takeover. The vulnerability to vicious rent seekers is only repaired by healing the political system so the rent seeking is denied in the political process.

Klavan's Revolting Truth: Obamacare Edition

With Kathleen Sebelius resignation becoming public today, now's a good time for an Obamacare analysis. Andrew Klavan is happy to oblige. 

Tech Crassness

At the time Dr. Kermit Gosnell was caught, prosecuted, and convicted for removing live children from women and then killing them, the line went out that Gosnell's moral confusion was an outlier, that the pro-choice side stood as one with the pro-life side in condemning Gosnell and that there would be nobody trying to whitewash or minimize Gosnell's crimes.

Kickstarter has demonstrated that this was aspirational at best and that the pro-choice side has a problem. Slate's not exactly a right wing news source but they see the problem of a discriminatory review process just fine. For those who are unfamiliar with Kickstarter, a successful fundraising project might have dozens of short videos talking about details of the project. Kickstarter pretty clearly laid down the line that talking details about Kermit Gosnell could get the entire project pulled, or at least pulled from the internal search engine. In a time limited process like Kickstarter, getting pulled from the search engine can mean the difference between getting funded and getting nothing. The filmmakers were right to seek a different platform where they would not have to pull their punches in their crucial communications during the fundraising campaign out of fear that a reviewer with the same sort of moral confusion that led to Gosnell's life sentence would pull their project.

Update: The film was successfully funded via Indiegogo

Social Security bust

Is the US government going to keep its word to you, personally, regarding your old age pension and health care? Actuarial Study 120 plus the yearly Trustees Report from the Social Security/Medicare trustees are your keys to finding out.

Once you spend an hour or two figuring it out the first time, sorting out the yearly changes isn't too hard. But who spends those research hours? Virtually nobody, that's who. This is why I'm working on a report so you just sign up and every year get the answer based on the official numbers you've already paid to have compiled but aren't going to go out. If you'd like to sign up, say so in comments.

The basic information needed is pretty simple. What year were you born and what sex are you? Table 6 yields life expectancy figures based on sex and the summary in the Trustees Report for the latest year gives you the best guess on what year the funds run out of money and your payouts get reduced and by how much. Plug in your birth year and look it up in the right table and you're done.

According to the latest (2013) report Social Security goes belly up in 2033, 19 years from now. If you have a life expectancy of 19 or greater, you're going to have to save extra money to make up for the shortfall.

The government doesn't give up to date mortality tables for every year. They just give them for every 10 years and then projected mortality tables in the future. So you can look up the 2010 tables and the 2020 tables and blend them to get a slightly better figure. Excel is very good at this. It does occasionally make a difference.

Back from vacation

I went to Disney World with my family last week. We really needed the vacation. I'm back and rested and will be resuming regular blogging. 

I'm actually happy I missed the past week. Catching up led to several face palm moments at the crassness and stupidity.