Author Archives: rdmyers75@hotmail.com

An American Sickness

The New York Times has a review of a new book called An American Sickness: How Healthcare Became Big Business and How You Can Take It Back. Here’s an excerpt from the review:

Rosenthal thinks the health care market is different, and she sums up these differences as the “economic rules of the dysfunctional medical market.” There are 10 — some obvious (No. 9: “There’s money to be made in billing for anything and everything”); some humorous (No. 2: “A lifetime of treatment is preferable to a cure”) — but No. 10 is the big one: “Prices will rise to whatever the market will bear.” To Rosenthal, that’s the answer to Scalia’s question. The health care market doesn’t work like other markets because “what the market will bear” is vastly greater than what a well-functioning market should bear. As Rosenthal describes American health care, it’s not really a market; it’s more like a protection racket — tolerated only because so many different institutions are chipping in to cover the extortionary bill and because, ultimately, it’s our lives that are on the line…

The difference between the United States and other countries isn’t the role of insurance; it’s the role of government. More specifically, it’s the way in which those who benefit from America’s dysfunctional market have mobilized to use government to protect their earnings and profits. In every country where people have access to sophisticated medical care, they must rely heavily on the clinical expertise of providers and the financial protections of insurance, which, in turn, creates the opportunity for runaway costs. But in every other rich country, the government not only provides coverage to all citizens; it also provides strong counterpressure to those who seek to use their inherent market power to raise prices or deliver lucrative but unnecessary services — typically in the form of hard limits on how much health care providers can charge.

In the United States, such counterpressure has been headed off again and again. The industry and its elected allies have happily supported giveaways to the medical sector. But anything more, they insist, will kill the market. Although this claim is in conflict with the evidence, it is consistent with the goal of maximum rewards to (and donations from) the industry. As a result, Medicare beneficiaries have prescription drug coverage (passed by Republicans in 2003), but Medicare administrators have no ability to do what every other rich country does: negotiate lower drug prices. In January, President Trump said drug companies were “getting away with murder” because they had “a lot of lobbyists and a lot of power,” insisting he would get Medicare to bargain. Should we really be surprised that the dealmaker in chief dropped the subject after meeting with pharma executives earlier this year?

At the individual level, there are really only two things I can think of to do. One is to attempt to shop around for health care. If you call your doctors office or hospital and ask for the price they charge for a particular service you are considering buying, which is how every other market works, they are likely to laugh at you. Your insurance company might actually help though. I have tried this with Blue Cross Blue Shield with limited success, but it definitely takes time and effort. The second option is to go abroad for checkups, lab work, and elective procedures. It’s not that hard to combine a vacation with a doctor or dentist visit. Insurance companies will generally cover it, because it will almost always save them money, but you definitely have to talk to them in advance. Foreign hospitals (I have experience in Singapore and Thailand) will sometimes bill U.S. insurance companies provided you have a letter form the insurance company up front. Otherwise you might have to front the cash and do the paperwork for reimbursement when you get back.

Like I said, all this takes time and effort, but there are significant savings to be had. So why aren’t third parties stepping into the vacuum to make comparison shopping and medical tourism easier for the masses?

the middle seat

I like this idea for making the middle seat on airplanes just a bit more spacious and comfortable than the others, so people wouldn’t mind it so much and might even prefer it.

But if Molon Labe Designs gets its way, that panic could give way to placidity. The upstart Colorado aviation design firm wants to kill the middle seat’s middle child reputation. Its “stagger seat” concept sits slightly below and behind its neighbors, so it can be three inches wider than its window- and aisle-adjacent companions. It has its own armrests.

“Flying sucks, and design makes it suck less,” says Hank Scott, the CEO of Molon Labe, who’s currently in Germany to show off the prototype at the Aircraft Interiors Expo in Hamburg. (BMW Groups’ Designworks and Panasonic Avionics also had a hand in the design.) By extending curved armrest back, the designers ensure the middle seater has access to at least half of its length. (“If you’re in the aisle or window seat, you couldn’t possibly steal the entire armrest—your elbows would be behind your back at a weird angle,” Scott says.) That also gives the middle seat’s in-flight entertainment system room to grow to a whopping 18 inches, compared to the puny 15-inch screens on other seat backs. For all this design prowess, however, this thing gets you nothing in extra legroom.

Climate of Concern

It wasn’t just Exxon that knew about climate change decades ago. But unlike Exxon, which not only denied it but used the foulest of propaganda tactics to confuse the public and delay progress, Shell made an accurate movie about it in 1991 to inform the public, called “Climate of Concern”.

Perhaps there is a parallel universe where Shell developed a sustainable business model, put Exxon out of business, and saved the Earth. Of course that is not the universe you and I are in right now.

Tesla vs. Ford

BBC says Tesla’s market value is now greater than Ford’s.

At the close of trading Tesla had a market value of $49bn (£38bn), compared with Ford’s value of $46bn…

The firm delivered more than 25,000 cars in the first quarter, up 70% on the same quarter last year.

While Tesla’s sales are growing fast they are still a fraction of Ford’s, which sold almost 6.7 million vehicles in 2016.

Tesla delivered 76,000 electric cars last year.

The legacy Detroit car companies could be embracing the new technologies, but instead they are allowing themselves to be creatively destroyed. Their business model, I believe, is to keep cramming pickup trucks into developing countries until they burst at the seams. Meanwhile, Tesla and Google and Uber will pass them by and become the new face of the U.S. auto industry. Then next time Ford, GM, and Chrysler tell us they need a taxpayer bailout or the U.S. auto industry will disappear, we may not have to listen.

skyscraper hanging from an asteroid

Here’s an idea for a skyscraper hanging from an asteroid. It’s a twist on the old space elevator idea because it doesn’t actually touch the ground. First, you have to go out, catch the asteroid, and put it in the right position in orbit. Then, you build the thing. Then, once you’re in the thing it takes you on a wild ride all over the world every 24 hours.

David Fleming

Today is the first time I heard of the late David Fleming, but he appears to have been a sort of new age steady state economy theorist. His seminal work is Lean Logic: A Dictionary for the Future and How to Survive It, which is notable for being written in a sort of encyclopedia format that can be read in any order. Here’s the Amazon description:

Lean Logic is David Fleming’s masterpiece, the product of more than thirty years’ work and a testament to the creative brilliance of one of Britain’s most important intellectuals.

A dictionary unlike any other, it leads readers through Fleming’s stimulating exploration of fields as diverse as culture, history, science, art, logic, ethics, myth, economics, and anthropology, being made up of four hundred and four engaging essay-entries covering topics such as Boredom, Community, Debt, Growth, Harmless Lunatics, Land, Lean Thinking, Nanotechnology, Play, Religion, Spirit, Trust, and Utopia.

The threads running through every entry are Fleming’s deft and original analysis of how our present market-based economy is destroying the very foundations―ecological, economic, and cultural― on which it depends, and his core focus: a compelling, grounded vision for a cohesive society that might weather the consequences. A society that provides a satisfying, culturally-rich context for lives well lived, in an economy not reliant on the impossible promise of eternal economic growth. A society worth living in. Worth fighting for. Worth contributing to.

The beauty of the dictionary format is that it allows Fleming to draw connections without detracting from his in-depth exploration of each topic. Each entry carries intriguing links to other entries, inviting the enchanted reader to break free of the imposed order of a conventional book, starting where she will and following the links in the order of her choosing. In combination with Fleming’s refreshing writing style and good-natured humor, it also creates a book perfectly suited to dipping in and out.

The decades Fleming spent honing his life’s work are evident in the lightness and mastery with which Lean Logic draws on an incredible wealth of cultural and historical learning―from Whitman to Whitefield, Dickens to Daly, Kropotkin to Kafka, Keats to Kuhn, Oakeshott to Ostrom, Jung to Jensen, Machiavelli to Mumford, Mauss to Mandelbrot, Leopold to Lakatos, Polanyi to Putnam, Nietzsche to Næss, Keynes to Kumar, Scruton to Shiva, Thoreau to Toynbee, Rabelais to Rogers, Shakespeare to Schumacher, Locke to Lovelock, Homer to Homer-Dixon―in demonstrating that many of the principles it commends have a track-record of success long pre-dating our current society.

Fleming acknowledges, with honesty, the challenges ahead, but rather than inducing despair, Lean Logic is rare in its ability to inspire optimism in the creativity and intelligence of humans to nurse our ecology back to health; to rediscover the importance of place and play, of reciprocity and resilience, and of community and culture.

globe buying guide

I’m thinking of getting my son a globe for his fourth birthday. I’ve done a little research, which I’m going to share here.

Replogle appears to be the largest manufacturer of globes. But dig into some reviews, and they appear to be not all that well made, yet not priced any lower than other brands.

There are all kinds of globes with electronic bells and whistles out there, like this one from Oregon Scientific. In the end I decided to keep it simple and not go for one of these.

Some globes have “raised relief” for mountains, like this Advantus globe, which is cool.

Ultimately I picked this Waypoint model. Even though it doesn’t have topographic relief, I like the colors and topographic detail.

 

 

the Black-Scholes equation

This 2012 article from the Guardian goes into some detail on the Black-Scholes equation for pricing options, which bears some responsibility for the 2007-2008 financial crisis. It was cooked up by geniuses to spread risk, but misapplied by idiots to actually create risk. What are the geniuses cooking up now for the idiots to misapply next?