How much will that cost, doctor?

Of all the expensive services and products I can think of, only one denies to the consumer the leveling effect of competition and market pricing, and that is health care. The way it works here in the most developed country in the world is non sensical. If, like 85% of everybody now, you have some form of health insurance, either through your employer or a federal agency like Medicare or Medicaid, you don’t even ask what things cost. When you get sick or hurt, you just enter the system and place yourself at its mercy. If you are one of the 15% uninsured you are probably either too poor to afford insurance or don’t have good sense. Or a “young invincible”. Or too rich for it to matter.

If you do have healthcare insurance, your insurer is supposed to negotiate pricing, and they do as best they can. But the negotiations are hamstrung by a paucity of data. Even the federal government has problems with it. Why? Well, healthcare is complicated and subjective. A half century ago there was no standard pricing at all, but then Medicare got into the act and, just for the elderly, they set up pricing for everything from bunions to bypasses. That was both good and bad. Doctors and hospitals were aghast at first, but they soon came to love it because for the first time they could charge for all they did instead of bundling everything into what they thought people could pay.

But Medicare still negotiates and the result is pricing that has started to become standard. But, what is the basis of even those prices? The medical industry and the AMA have been fighting attempts at data collection and analysis and transparency of pricing at least since the 1970’s. In 1979 a federal court in Florida granted the AMA an injunction barring release of doctor-specific Medicare information, and that is pretty much where it stood until now. Pricing varies wildly and has no rational basis.

The situation is finally changing. Based on a court order the injunction has just been lifted and the Centers for Medicare and Medicaid Services (CMS) have released data on more than 880,000 doctors and other medical providers who collectively received $77 billion from Medicare in 2012. The medical industry is crying foul and appealing on the basis of privacy, both of doctors and patients, but that is a thin argument. Consumers are being skinned. One ophthalmologist alone took in more than $20 million from Medicare in 2012. The USA Today newspaper was prevented from contacting him under the legal provisions that lifted the 1979 injunction and permitted the release of the pricing data.

The veil is starting to drop. If pricing does become transparent, then both insurers and the high-deductable insured can better shop and the market will begin to matter, not just for the elderly but for all, and that includes all the newly-insured under the Affordable Care Act.

This development could be a game-changer, but it is only happening under a Democratic administration. What I fear is that under the GOP it would be reversed under the pretense that healthcare pricing is not the unique thing that it is.

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Monopoly, Anyone?

My friend and blogging colleague The Erstwhile Conservative just wrote an interesting post on multi-billionaire Sheldon Adelson, a man who was listed by Forbes as the 8th richest person in the world this month with a net worth estimated at $40.8 billion dollars. I was prompted to look up his biography and found that when he was in his 30’s he had “ . . . built and lost a fortune twice” already. But, he had a flair for wielding money and that led to his current status as a “casino magnate”. The post was occasioned by GOP presidential hopefuls seeking his financial support at Adelson’s invitation.

credit:  politico.com

credit: politico.com

magnate n. A wealthy and influential person, esp. in business

Mr. Adelson is similar to another billionaire magnate, Donald Trump. Like Adelson, Trump has also gained and lost fortunes – he has been in bankruptcy at least three times. Both men have a disdain for the poor and speak often of socialism and deplore any government schemes for “redistribution of wealth”. This is not new rhetoric – the same was heard during the Gilded Age of the late 19th century. They like to push the notion of charity, noting that conservatives give more than liberals. Of course they do. Wealthy liberals are rare.

How did these guys get to be so rich? As the EC mentions, Adelson “earns” about $32 million each and every day from his Las Vegas operations, but that verb is marvelously flexible and hardly means the same thing for them as it does for, say, the guy who fixes your leaky roof. I think they do have a flair for the work ethic, or at least did, but I also think they have a flair for risk-taking and have benefitted from bankruptcy laws that favor such risk.

It’s kind of like the board game of Monopoly. If you’ve ever played that you know that whoever first gets ownership of the bulk of hotels and houses then becomes unbeatable. And, like in Monopoly, the laws give you a good chance of starting over. Heck, if you get big enough you can get consideration as “too big to fail”.

A Different World credit:  www.nytimes.com

A Different World
credit: http://www.nytimes.com

What’s depressing about these guys to me is that they use their wealth to deprecate those who are down on their luck, implying there must be something fundamentally wrong with you if you haven’t succeeded financially. This is a pervasive theme among conservatives and it’s a convenient dodge. Even George Will, a man whose intellect I used to respect, endorsed in his column recently the opinion that “a large part of the jobs problem for American men today is that of not wanting one”.  Try telling that to the long-term unemployed.  There is plenty of evidence that because of the great recession brought on by the profligate spending after 9/11, they are permanently stigmatized.

They say the first million is the hardest. What does one do after the first billion? Not to mention 40 billion. Messrs. Trump and Adelson have apparently decided to take up politics as a hobby. This is redolent of the lyrics in Fiddler on the roof:

If I were a rich man,
Yubby dibby dibby dibby dibby dibby dibby dum.
All day long I’d biddy biddy bum.
If I were a wealthy man.
I wouldn’t have to work hard.
Yubby dibby dibby dibby dibby dibby dibby dum.
If I were a biddy biddy rich,
Idle-diddle-daidle-daidle man.

The most important men in town would come to fawn on me!
They would ask me to advise them,
Like a Solomon the Wise.
“If you please, Reb Tevye…”
“Pardon me, Reb Tevye…”
Posing problems that would cross a rabbi’s eyes!

And it won’t make one bit of difference if I answer right or wrong.
When you’re rich, they think you really know!

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A Matter of Perspective

Fellow blogger, A Frank Angle recently treated us to a review of Carl Sagan’s famous video clip on “the blue marble”. It is one I never tire of.  Thanks, Frank.

credit:  timebinders.wordpress.com

credit: timebinders.wordpress.com

I too greatly admire Carl Sagan. He was not only an able astronomer but a philosopher and poet as well. The scientific knowledge gained since his death only confirms his conclusion that this pale blue dot is the only home mankind is likely to have. The reality of galaxies, the age of the universe, the existence of other planets, all this has been revealed by science, but the utility of this knowledge is likely to be small, except for one thing – that if nothing else it may provide the motivation for mankind to collectively cooperate in keeping the Earth a good place to live. As Sagan says, this is it, our only home.

As I watched the clip I couldn’t help but reflect on how far human-kind has to go to reach that level of cooperation. We are still morally and ethically primitive. The Syrian civil war, the Palestinian situation, North Korea, global warming, the pollution of the ocean (there’s really only one), and the Russian invasion of Crimea, are but a few examples. Cooperation is lacking on a smaller scale as well. The cover story in the USA Today newspaper shows that even here in what we think of as the most advanced country, murderers, rapists and other felons are easily escaping justice simply by fleeing to other states. It turns out that states are unwilling to spend the money required for the manpower and transportation that extradition entail. If the crook is out of the state, then he’s someone else’s problem, it’s that simple.

I submit that the greatest and most wondrous development in the history of the universe, so far as we know, is the evolution of a brain capable of abstract though and self-awareness. This is something that has occurred in only the past 2.5 million years or so (human predecessors). That is 1,440 times less than the time since the first simple cells formed, 3.6 billion years ago. Mankind has only had writing, as we know it, for less than 10,000 years. That is 250 times less than the time abstract thought has been around. We have had science and machines for only about 1,000 years, which is 10 times less than writing. Now consider the internet and weapons of mass destruction, existing for only a half century. This increase of physical ability and technical knowledge is occurring on an exponential scale, but human instincts and cultures have progressed not much at all. We are tribal still. In this context, Sagan’s exhortation to cooperate is more cogent than ever. But how many are listening?

In looking up the numbers I found a Wikipedia site on the timeline of evolutionary history that I hadn’t seen before. For those interested in the subject, I recommend it. It’s quite well done.

credit:  en.wikipedia.org

credit: en.wikipedia.org

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Gaming the SAT

Headlines from several sources the other day announced that the folks who run the college SAT testing for high-schoolers were not only revising the tests significantly but even making the essay part optional. Well, I thought, this sounds like just one more step in dumbing-down the education system. I was wrong, and things aren’t always what they seem (he said tritely). There was much more to the story than the superficial treatment given by most sources. Most of those implies that public complaints as being the primary cause of the changes.

SAT'S

credit: online.wsj.com

Educational testing is a big deal. Really big. It’s grown into a $4.5 Billion dollar industry that seeks to satisfy the demand to capture the academic potential of students and to sum that up in just a few numbers. It works poorly, so poorly in fact that a few colleges are already abandoning testing and relying only on school records and testimonials. Studies seeking to find correlation between test scores and success in college have been consistent in finding almost none. But, what about the essay? Surely a student’s native ability for self-expression is an essential element in any formula for success, so how can they abandon that? (Students who want to continue that tradition will still be able to, and colleges who want it can specify that they need it.)

A New York Times reporter investigated and reported on how the changes came about. It was enlightening. The new president of the College Board, one David Coleman, is a major force behind the changes. This is a guy who thinks outside the box and who has been a long-time critic of the testing system. In talking to an MIT professor, one Dr. Perelman, he found that the essay part of the test can be gamed. Here, from the NYT article, is how:

Since 2005, when the College Board added an essay to the SAT (raising the total possible score from 1,600 to 2,400), Perelman had been conducting research that highlighted what he believed were the inherent absurdities in how the essay questions were formulated and scored. His earliest findings showed that length, more than any other factor, correlated with a high score on the essay. More recently, Perelman coached 16 students who were retaking the test after having received mediocre scores on the essay section. He told them that details mattered but factual accuracy didn’t. “You can tell them the War of 1812 began in 1945,” he said. He encouraged them to sprinkle in little-used but fancy words like “plethora” or “myriad” and to use two or three preselected quotes from prominent figures like Franklin Delano Roosevelt, regardless of whether they were relevant to the question asked. Fifteen of his pupils scored higher than the 90th percentile on the essay when they retook the exam, he said.

And this:

Over the course of their two-hour conversation, Perelman told Coleman that he wasn’t opposed to an essay portion of the test, per se; he thought it was a good idea, if done well. But “when is there a situation in either college or life when you’re asked to write on demand about something you’ve never once thought about?” he asked. “I’ve never gotten an email from a boss saying: ‘Is failure necessary for success? Get back to me in 25 minutes?’ But that’s what the SAT does.” Perelman said that tutors commonly taught their students to create and memorize an all-purpose essay that contained the necessary elements for a top score — “a personal anecdote, a few historical references; Florence Nightingale seems a strangely popular reference.” When test day comes, they regurgitate what they’ve committed to memory, slightly reshaping depending on the question asked. But no one is actually learning anything about writing.

What the article does not say, explicitly anyway, is what flows naturally from this. The SAT people are using software to grade essays. It makes sense. Just consider the problem if they tried to hire English majors to do the job. They would have to give them something like these instructions.

We would like to hire you part-time for six months to do nothing but grade essays by high-school students. Since we have hundreds of thousands of these, through-put is important, so you will need to do this fairly and to be consistent with the output of the other 500 English majors we’ve hired of course. We expect you to complete at least 200 papers per week. Your results will of course be sampled by peer-review for quality.

Would you take that job? I wouldn’t, not unless I was starving and desperate. No, they’ve got to be doing it with software, hence Perleman’s analysis for tricking the system.

Self expression is vital, but I see no better way to gauge it than by lessening the testing burden on schools and freeing teachers to teach the way they should and not just “teach to the test”.

New York time reporter Todd Balf did a fine job with “The Story Behind the SAT Overhaul”. Those interested in education will, I think, find more to like at the link.

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Is Ukraine Another Austria?

In thinking about the situation in Ukraine I can’t help but to compare it to pre-WW II when Adolph Hitler began the takeover of Europe:

Similar:

  • Invasion of one country by another country, by force for hegemony and economic gain.
  • Invading country is led by an egocentric strongman inclined to force and supported by patriotic fervor.
  • Part of Ukraine is ethnically similar to Russia and approves the take over, like Hitler’s takeover of Austria.
  • Invading country is militarily powerful.
  • American sentiment is anti-war.
  • Immediate economic impact for America is negligible.
1938_0315_cartoon

credit: latimesblogs.latimes.com

Different:

  • WMD’s exist and are held by both Russia and the US.
  • Ukraine is ethnically different from most Americans.
  • America is militarily powerful, and Europe’s forces are significant as well.
  • The nature of war has changed and is less reliant on cannon fodder, conscription unnecessary.
  • Russia evidences no ambitions to extend their takeover beyond this one country, and the takeover may be limited to the Crimea.
  • The UN, NATO and the IMF exist now.
  • All countries are now committed to a global economy.
  • In the internet age, world opinion is more immediate and more of a factor for both participants and observers.
  • This time there is no attack on our homeland (Pearl Harbor).

Once again, the principal question as I see it is the one of American exceptionalism and involvement. I feel sorry for the Western Ukrainians, but if the wars in Korea, Vietnam, Iraq and Afghanistan haven’t taught us that we can’t be the world’s policeman, then nothing can. But, that won’t stop the hawks from howling.  War can be quite a rush for those who aren’t themselves at peril in it.

When the rich wage war, it’s the poor who die. — Jean-Paul Sartre

The basic problems facing the world today are not susceptible to a military solution.  –  John F. Kennedy

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Splice the Main Brace!

My online friend and co-blogger, Pied Type, ran an interesting post a few days ago regarding the author Tom Clancy’s inspiration for music and singing in the movie, Red October. It got me to thinking about the role of music in my own military training. As I told her in a comment:

The use of music to build military cohesion and camaraderie has a long and well-deserved tradition in all cultures that I know of. When I entered USNA in the hot summer of 1955 one of the items on our agenda was a series of assemblies in which all thousand of us learned and sang songs from our “Book of Navy Songs”. I just looked in the book shelf and I still have it. In addition to the obvious, like Navy Blue and Gold, the Marine’s Hymn, and Anchors Aweigh, the selections included:

Abdul Abulbul Amir
The Navy Drinking Song (says something about the culture, eh?)
Blow the Man Down
The Navy Hymn
The Goat is Old and Gnarly
Army Blue (helps to know the enemy)

During the time I was there one of the favorite records my roommates and I had was one from the Red Army Chorus. They were famous even then, when the Cold War was hot.

The Navy Drinking Song may have been inspired by something that happened in 1914 when our WW I Secretary of the Navy, the racist and blue-nosed Josephus Daniels unilaterally banned drinking alcohol on all Navy ships, and it has been so ever since. I’m not sure that it was a good thing or a bad one because the argument can be made that it may have made conduct ashore less controlled.

MI0002537732

 

The action, a General Order, inspired a song titled, “Farewell to Grog” (Note:  for you land-lubbers, the phrase, “splice the main brace” means to have an alcoholic drink):

Come mess-mates, pass the bottle ‘round
Our time is short, remember,
For our grog must stop, and our spirits drop,
On the first day of September.

Chorus:
For tonight we’ll merry, merry be,
For tonight we’ll merry, merry be,
For tonight we’ll merry, merry be,
Tomorrow we’ll be sober.

Farewell old rye, ’tis a sad, sad, world
But alas, it must be spoken.
The ruby cup must be given up,
and the demijohn be broken.

Jack’s happy days will soon be gone,
To return again, oh never!
For they’ve raised his pay five cents a day,
But stopped his grog forever.

Yet memory oft’ will backward turn,
And dwell with fondness partial,
On the days when gin was not a sin,
Nor cocktails brought courts-martial.

All hands to splice the main brace, call,
But splice it now in sorrow,
For the spirit-room key will be laid away
Forever, on tomorrow.

 

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A Choice: Skepticism or Dogma?

A news item today presents a useful example of the difference between science and religion, something that continues to confuse many people. The announcement, confirming that the oldest fragment of the early Earth is 4.4 billion years old, is based on a new study in the journal Nature Geoscience, appeared in various media including NPR, Sky News, and even Fox News. (Yes, really.)

The study is based on new techniques for measuring the radioactive decay of uranium isotopes in zircon minerals and in accounting for the various geological processes affecting the samples in that vast time span. But what may be most interesting in the account is not the age itself but rather the process of the investigation as it seeks to answer past criticisms of techniques. What comes through clearly is that science is a self-correcting process in which data are openly discussed in a skeptical forum of educated specialists. This is much different from religion because that is based on dogma, something that is meant to be defended and for which skepticism is heresy.

This example is, I submit, a particularly worthy one because it just happens to have as its subject something that many fundamentalists dispute: the age of the Earth. I have to wonder how Fox News viewers/readers avoid cognitive dissonance on this one? I found it interesting too, even amusing, to compare the news accounts on NPR with that on Fox News. If you read them, you’ll see what I mean. They are aware of their readerships.

Posted in Religion, Science / Engineering | Tagged , , , , , , , , , | 7 Comments