Monica

In the comments here we were talking about health care in the US. The current system is broken in many ways, but the "nuke it and start over with some nationalized program" proposals are scary too. What incremental improvements are possible? I have to believe that there are some.

One idea I'm interested in is what would happen if we separated paying for routine care from paying for catastrophic care. What would happen if people could be on their own for the former but could buy a policy to cover hospitalizations, major illnesses, and the like? How effective would that be and what would it tend to cost? What would having that in play do to the over-the-counter (uninsured) price of routine care? (Yes, I know that not everyone can afford to pay for routine care out of pocket. I'm exploring a suite of options, not choosing a single one.)

On the flip side, would medical practices or insurance companies be willing to sell affordable plans that cover all your routine care (only), if they were not on the hook for catastrophic losses? Could that get things down to the point where the average family could afford regular checkups, preventative care, and routine tests (which helps prevent some catastrophic issues)? Such plans exist now in niches (vision and dental, most commonly in my experience), but I haven't heard of one for general medical care. Why not? (Am I totally misunderstanding where the profit centers are in the insurance business?)

Both angles are important. What I'm labelling catastrophic incidents are (as the label implies) financially devastating if you don't have sufficient coverage. Outside of elder-care issues I'm not sure how common they are, but it's the sort of thing I wouldn't want to take a chance on. I insure my car and house, after all -- how much the moreso should I insure my health?

What I suspect has a bigger impact on the poor, though, is the routine care. If you don't have insurance, you're looking at a three-digit number to walk into your doctor's office. Throw in some kids and you're in trouble. (This is why I asked what would happen to those costs if catastrophic care were a separate factor.) Could plans that just cover routine care be made affordable enough for most people? This doesn't solve the other problem, but neither does the current system -- we rely on hospitals' obligations to treat (which is a legitimate public demand while they pay no taxes), or medicaid/medicare/SSI in some cases, to get through those. Remember, incremental improvement.

I'd also like to explore the effects of reducing drug regulation, letting people buy from anywhere that's selling and reducing barriers to getting things onto the market. I know the standard argument against this (those high prices pay for R&D), but I'm not sure how much I believe that. What are the other considerations?

Where else could we look for incremental improvements?

(In case you haven't figured it out, I am not a medical professional, an economist, nor part of the insurance industry.)

I bought a new calendar today and, to my surprise, among the candle-lighting times on each page it lists Pittsburgh. (Usually we don't make the cut.) While looking at this I noticed that sunset in September is moving by about 12 minutes per week, but that in March it only moves by about 8 minutes a week. Shouldn't it be symmetrical? (The delta for sunrise and sunset changes over the course of the year, with the widest swings being at equnoxes and the smallest ones at solstices. I grok that; I don't grok that they don't match.)

Friday night I saw something unusual at services: a man lit candles and a woman made kiddush and there was no special occasion dictating that. For all that egalitarianism is a core principle in my movement, I don't think I have ever seen a woman make kiddush in our sanctuary before, unless there were special circumstances (sisterhood service, a bat mitzvah, etc). Gee, maybe there's hope that someday I will be offered that honor after all. (There's still another barrier: there is a strong meme of giving that pair of honors to a couple. This was violated this week, too.)

Yesterday morning after services our newest rabbi (hmm, I need a shorthand notation for him -- the others are "senior rabbi" and "associate rabbi") talked with the group about adult education. He wanted to know what we want to learn, when we want to learn it, and how we want to learn it. It was a good discussion; I wish im luck in distilling down feedback that, in aggregate, meant "all of it". :-) He seemed a little surprised by the idea that, actually, we'd love to learn on Shabbat -- ideally right after services, but late afternoon leading into havdalah would be acceptable to some. I hope that idea bears fruit. (Of course, he was asking the group of people who self-selected to stay around after services for the discussion... but every option doesn't need to appeal to every congregant, only to a critical mass. And we also discussed the idea of giving the same class multiple times, in different kinds of timeslots -- a teacher's dream, but for some reason we don't tend to do it.)

At the end of the discussion he said something interesting, so after it broke up I asked him "did you just imply that you're available for individual study?" and he said yes. Heh. I'll be in touch.

Short takes:

I assume that everyone has by now seen Jon Stewart on election hypocrisy. You might not have seen Language Log's discourse analysis on Karl Rove.

(I have not posted about the election; it's not because I don't care, but because there's so much as to overwhelm and lots of other people are already posting good, thoughtful pieces.)

I recently found myself in a discussion about internet discussions and used the phrase on the internet nobody knows you're a dog. I later went looking for the cartoon; it shouldn't surprise me that it has a Wikipedia entry, but it did surprise me a little that Google suggested the phrase after I'd typed only "on the internet". That real-time search-guessing thing is good sometimes. (I also went looking for a recipe for a dish I ate last night at Ali Baba's, and when I'd typed only "mujdara" it offered two completions, "recipe" and "calories".)

Speaking (sort of) of internet discoveries, this article from Real Live Preacher taught me about the Caganer, a figure we don't often see in nativity scenes these days but apparently quite normal in times past.

This article on using the internet for identity theft (link from Raven) didn't have anything new for me, but it's a good summary to give to people just getting started. It did remind me how annoying I find the canned security questions used by most banks -- things like "mother's maiden name" and "city of your birth" were way too easy to crack even before the net was ubiquitious. (And the ones that aren't tend to be non-deterministic, like "favorite color".) Fortunately, in most cases your bank doesn't really care about the answer; it's just a password. So lying adds security at little cost, assuming you can remember the lie. (What do you mean my first pet wasn't named "as375m~@z"? :-) )

No surprises here -- with 99.3% counted Clinton won PA by 8.6% (54.3 - 45.7) (full results here), enough to continue an increasingly-ugly fight but not the clear win she needed in order to be viable. Obama isn't much affected; a win would have helped him but everyone expected him to lose, so a loss doesn't seem to hurt. Apparently she got the older rural white vote and he got the younger urban black vote, as everyone expected. I wonder if months of arguing about demographics will be better or worse than months of mud-slinging? Though I guess after the people are done voting, with no winner, things might change. I do wish that, in the absence of news in one area, the online media were more inclined to report actual news in other areas. (I'm glad my dead-tree newspaper still does a reasonable job of that.)

Some folks have been claiming that the media are biased against Clinton. I don't see it, really; there's plenty of bias against Obama too. Who actually believes that "the media" speak with one voice? It's important to use multiple news sources precisely because they don't. But for those who claim an anti-Clinton bias, what's with reporting this as a win by 10%? At best you can round (legitimately) to 9. (While I was writing this the site updated, now reporting 54.6 to 45.4. That's still not 10% unless you do your math by rounding one number and then substracting from 100 to get the other. I could see some sloppy reporters doing that, but those weren't the published numbers this morning when I saw 10% headlines.)

In unrelated news... friends in Boston, is this report accurate? (Link from Metahacker on LJ.) Legislation is pending to restrict public movement of people suspected of being gang members -- sponsored by Democrats? WTF? That seems really out of character for most Democrats at all, let alone New England Democrats. Or is this some sort of trick where you introduce a bill you know can't pass to get some of your constituents off your back, while hoping other people see what you're doing and don't hold it against you?

PSA: tomorrow is the deadline for registering to vote in the PA primary.

I'm curious about the numbers of new and party-change registrations. Apparently there have been 111,000 new Democratic registrations since the fall election and the number of registered Republicans has gone down by 13,000 in the same time period. But, of the remaining 98,000, how many are brand-new registrations and how many are changes from third-party or independent voters? I'm curious.

According to this article linked by byronhaverford, they're a few thousand shy of 4 million Dem registrations. That says to me that, while 111,000 new (nominal or actual) Democrats is impressive, it's not nearly the number of cross-registrations I would have expected. Of course, this number will change in the next few days, but even so, I guess I was expecting a lot more non-Dems to temporarily switch, like I did.

So for those of you who kept your Republican registrations, I have a thought. Your primary is sealed up already, but instead of staying home or wasting votes on McCain (who doesn't need them), how about casting votes for whichever Republican candidate you feel best represents what the GOP should be and was before the far-righteous got into power? You're not voting for a person (that's already over with), but you could vote for an idea or a direction. Were I registered Republican I would be voting for Ron Paul because he's the only Republican who's against the Iraq war and he seems to actually be for smaller government. (That latter used to be definitive for Republicans, but it hasn't been true for a while.) Could he win? Of course not. If he did, could he implement his agenda? Not very much. But if he showed up with a primary win, that just might get people to start talking about those ideas.

Or not. Up to you. I'm just suggesting that you make your votes count in this late state.

Maritan Headsets (from Joel on Software) is a long but worthwhile article on software standards -- both not having them early enough, and having them and trying to enforce them. Parts of it made me laugh out loud, like the paragraph containing this passage: "[...] but of course when you plug the headphones into FireQx 3.0 lo and behold they explode in your hands because of a slight misunderstanding about some obscure thing in the spec which nobody really understands called hasLayout, and everybody understands that when it's raining the hasLayout property is true and the voltage is supposed to increase to support the windshield-wiper feature, but there seems to be some debate over whether hail and snow are rain for the purposes of hasLayout..."

Rescue me: a fed bailout crosses a line seems (to this non-expert) like a good analysis of what just happened to the market and the dollar. (Need a login ID? Try BugMeNot.) I am more scared, and more angry, about our government's economic policies than I've been in a while. As someone on my subscription list said (I forget who), the people who actually took personal responsibility and saved rather than spending recklessly are the ones who are going to get hammered by this, while the idiots who bought houses (or corporate holdings) they couldn't afford and racked up tons of debt will be bailed out because we can't stand to say "too bad you were an idiot".

As long as I'm saying "too bad"... too bad, Michigan and Florida. Agreed.

On a lighter note: Garfield Minus Garfield is surreal. And since seeing it a week or so ago, I haven't been able to read Garfield "straight".

I'm kind of sad that John Edwards dropped out of the Democratic race. He wasn't going to win (on first ballot at the convention), I don't think, but he has enough of a following that it seems like he could have influenced the front-runners had he stayed in. On the other hand, he was probably drawing more votes from Obama than from Hillary ("sleaze as usual"), so if it helps Obama win the nomination it won't be all bad. He hasn't made a formal endorsement, but this might count. Still, if the Dems don't slap Hillary down hard and soon, they risk blowing the election, either by nominating a slick divisive candidate or by doing too much dirty campaigning before rejecting her.

(I'm not for Obama, but I'm against Hillary. I really wish we didn't have institutionalized two-party rule in this country; it discourages innovation.)

Did anyone else catch the complaint from the NH chapter of NOW? (It was in the news yesterday or the day before.) They complained that Kennedy "betrayed women" by not endorsing Hillary. Earth to NOW: you are doing harm to your candidate if your entire platform is "she's a she". Not that I mind, but I'm just sayin'.

This isn't a gripe about the electronic voting machines with no audit trail and annoying user interfaces; that's a separate rant. This is a gripe about a feature also shared by the old machines: the "vote party line" lever/button.

I am offended by the presence of this option. It wasn't as glaring on the old machines, where the entire option space was in front of you and you watched the affected levers go ka-chink, but it was still wrong. My ballot this morning consisted of six screens, so I could have pressed that button without even looking at the effects. (Yes, there's a confirmation phase, but it's easy to just hit the big red "vote" button at that point.)

I don't want it to be that easy for people to vote for people whose names they won't recognize two minutes later. If you want to vote a straight Democrat or Republican or Pastafarian ticket, you should have to touch every lever, button, or check-box. Voting is a responsibility in which you should invest more than a few seconds' worth of thought. There were ballot items I skipped this morning because I did not feel well-enough informed; that should be more common, and the party-line button makes it less likely.

If we want a parliamentary government where you vote for parties instead of people, we should make one explicitly. I've heard the argument that taking away this option would disenfranchise some voters. Well, yeah -- if you don't want to look at each ballot item on which you're voting, you should be disenfranchised. If you've gone to the polls at all, the incremental cost of facing the candidate's names (and parties -- you get that information) does not seem at all burdensome. If even a few voters look at a name and say "hey, wasn't he the one who was indicted?" (or whatever), it will have served its purpose.

My state's government has partially shut down over a budget spat. "Non-essential" employees have been given the temporary boot, but the legislators and governor at the center of the problem are still getting paid. Instead, they should keep the workers and stop paying the politicians until it's fixed. Fast Eddie and the more-numerous-than-necessary-anyway legislators should suffer the consequences of their brinksmanship, but, sadly, it never works out that way.

Aside: LJ has been really crawling for me for the last several days. Is this happening to other people too, or do I have a local problem? (LJ is blocked at work, so I can't collect that data point.)

I've got a lot of stuff accumulating in browser tabs on a wide variety of topics, so...

The (spam)bot wars heat up, by jducoeur.

I'm a little behind in my tech news. siderea posted a helpful summary of the news about cracking the DRM code on DVDs and the subsequent firestorm on Digg.

merle_ on the true reasons behind the bee population problem.

Why programmers should never become ministers, link from aliza250. Satan is a MIS director who takes credit for more powers than he actually possesses, so people who aren't programmers are scared of him. God thinks of him as irritating but irrelevant.

insomnia on the new military rules that significantly limit participation in blogs, mailing lists, and so on. I saw an article that quoted an anonymous military source saying "we didn't mean that; use common sense". I don't know enough yet to have a handle on what's really going on, but it bears watching.

South Park Mac vs. PC, link from bkdelong.

Unconventional greeting cards, like "your painful breakup has made me feel less alone" and "your cell phone ringtone is damaging your career". Link from thatcrazycajun.

In light of my recent post about kippot in synagogues and elsewhere, I found this post on hair-covering by katanah interesting.

Cached for later reading: Clay Shirky: A group is its own worst enemy. (He's talking about online fora.) Link from Geek Etiquette.

And, for those in the SCA, what looks like a thoughtful and fascinating conversation about staying in-period at events versus talking about your computer, and why people go to events anyway, and what changes we might want to make. This post by msmemory has an overview and links to several other posts I would have mentioned here but now don't have to.

Freedom to, freedom from, an interesting discussion of what it means to fight "for freedom" from opposite sides of the same conflict (by rjlippincott).

An open letter to the president and congress by metahacker. Excerpt: Mr. President, you make me scared. That may be your intent; but it is something you have no moral right to do. Friend citizen, it is your duty as our leader to make us brave -- to make us strong, morally, strong enough to stand against enemies within and without.

On the lighter side... Fantasy Congress, for those who aren't into fantasy football. (Link from metahacker and others.)

I haven't made a big post about what's going on in Israel. I have the feeling that those of you who know me know how I feel, and those of you who don't know me don't really care. And it's so depressing and draining. So maybe later, but not now.

That said, though, I want to pass on a couple of links. First and most importantly, it seems likely that as with Jenin, Qana is not what it seems. The world sometimes seems to have a hair-trigger-condemn reaction to Israel when it looks like they've done something bad, but that doesn't always make it so. Jenin was a fabrication that most media never followed up on. Look for information on Qana after it ceases to be fashionable. I will. Thanks to psu_jedi for the link. (I haven't personally seen some of the video cited in that link, like the dusty child with clean pacifier. I have seen the video showing the outbound missiles. Likely, not yet certain.)

These photos show a side to the military not often seen. Thanks to kmelion for the link.

The Washington Post reported yesterday that new federal guidelines ask all females capable of conceiving a baby to treat themselves -- and to be treated by the health care system -- as pre-pregnant, regardless of whether they plan to get pregnant anytime soon. amergina posted a link to the 30-page report from the CDC, which I haven't gotten to load yet but I'm caching the link for future reference.

Recognizing that this is (currently) a limited recommendation, I am still fearful of where this could go. It's a small step from "recommend" to "require"; even if the government doesn't formally require, will doctors follow the recommendation to stay on the right side of malpractice claims and future federal action? Will many (or most) pharmacists refuse to fill prescriptions for drugs to treat actual ailments for fear of harming a hypothetical fetus (even if the woman says "if impregnated I will not carry to term")? Will restaurants and bars start refusing to serve alcohol to women? Will employers keep women out of jobs with environmental hazards? No, not immediately, but we shouldn't ignore it any more than we should ignore other dangerous trends oozing from Washington (and Washington's handlers).

Women are not incubators. It is hubris for anyone not directly involved to expect women to restrict ourselves for the sake of children we're not necessarily even planning to have. If, heaven forbid, I come down with some serious illness, I want the best treatment available -- regardless of what it could do were I to become pregnant. [1] I will listen to my doctor's advice about things like alcohol, diet, and exercise for my own sake (that's part of what I pay him for), but acting on it is my decision alone, morally speaking, and it's insulting to say "think of the baby!" rather than "think of your own health!". ('Cause, I suppose, we aren't smart enough to want to take care of ourselves, but we're programmed to love babies. Bzzt.)

By all means -- make patients aware of the effects of their choices and treatment options on hypothetical future children if they care about this. That's being a good doctor. So long as we stay in the space of recommendations from doctors to patients, we're fine. But I fear the slope before us -- that it will not stay between doctors and patients, and that it will not stay as mere recommendations. And I don't know what the best way to prevent a slide down that slope is.

[1] Ok, I am not personally capable of becoming pregnant, but that is irrelevant to my point.

The President of the Oglala Sioux Tribe on the Pine Ridge Reservation, Cecilia Fire Thunder, has said "I will personally establish a Planned Parenthood clinic on my own land which is within the boundaries of the Pine Ridge Reservation where the State of South Dakota has absolutely no jurisdiction."

More information here and here.