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August 25, 2009

What Is The Price?

Tim says,

Sen. Edward M. Kennedy, 1932-2009:

His first words are "How much time do I have?"

Comments (0) | Permasnark | Posted: 11:35 PM

August 13, 2009

The Health Care Meltdown

Matt says,

screenshot.jpg

I've been an independent contractor for the past year, and my boyfriend's been unemployed. So I've been getting acquainted with the intricacies of the US health care system outside of employer-provided care, the universe affectionately known as the Wild West. Firsthand familiarity led me to seek a bit more policy familiarity - reading some books and think tank reports, following the health reform battle as it wends its way through Congress. And I've been itching for a while to create something that I hadn't been able to find - a stark, straightforward overview of why health reform is happening and where it's heading.

This week, when the hysteria seemed to reach a fever pitch, seemed like the right time to get this project done. So starting Tuesday night, I put together a quick little site, on the order of The Money Meltdown: DeathPanels.org.

Hope you enjoy it. Please send it to your crazy grandpa.

Comments (2) | Permasnark | Posted: 4:59 PM

August 5, 2009

Beyond Starbucks: Physical APIs

Tim says,

Some great ideas are sparking here, helped along by Robin's notion of a "Starbucks API." Noah Brier calls it a "physical API" (see also the smart comments) and Kit Eaton at Fast Company extends the concept (tongue-in-cheek) to Microsoft, Apple, and Twitter. But I like Drew Weilage's proposal at Our Own System the best:

The idea: create a "physical API"... of the Mayo Clinic or Cleveland Clinic. Copy their entire way of doing business and paste it into hospitals around the country. In a nicely wrapped package deliver their systems for decision-making, integration, coordination, and expertise. Include their human resources practices, innovation efforts, and technology. Import their employment model, their bargaining power, and of course brand recognition. This is a beta release so if anything is left out, it can be included in a later version.

Mix with water. Implement. Poof! Great health care!

Just think about it, Local County Hospital, powered by the Mayo Clinic or Our Lady Health Care System, supported by the Cleveland Clinic; it's a definite brand extender.

Seriously -- this has, potentially, amazing public policy implications. My dad, who's worked in the government for-practically-ever in Wayne County/Detroit (first at the jail, then in public health, then in lots of places), always used to stun his bosses, co-workers, everybody, because whenever they ran into a persistent problem or one they couldn't solve, he would get on the phone to people he knew in Oakland County, or Chicago, or Denver, to see how they handled it, who would in turn refer him to other people, etc.

You can get these information bottlenecks even when there's no competing interests, and nothing proprietary -- it's just hard (without an API) for people to know where or how to look.

Comments (6) | Permasnark | Posted: 7:46 PM

July 15, 2009

Two Different Ways of Looking At "Simple"

Two different blog entries about health care ended up in my RSS reader at the same time. They argue for diametrically opposite positions based on what appear to be identical principles.

One is by Conor Friedersdorf, who's filling in for Andrew Sullivan. It's essentially a follow-up to his earlier post about requiring Congress to read the laws they pass, which I commented on here.

The worst thing about "comprehensive reform" efforts are that they shut the average citizen out of the legislative process by making bills so complicated that it is nearly impossible for the average citizen to properly evaluate whether on balance it is a wise or unwise measure. Who can predict all the effects of a 3,000 page bill spanning all manner of issues? Often times not even the legislature itself. Certainly not the press, which often focuses on bits of the legislation that won't actually have the most impact, sometimes because legislators themselves are deliberately obscuring what's actually at stake.

It's a conservative lesson: we should make "small, piecemeal improvements to public policy, rather than the kind of sweeping efforts that flatter vanities but fail citizens."

And here Ezra Klein presents an argument from a reader named Lensch, who compares the current reform bill being considered to the old Ptolemaic epicycles in astronomy:

We want a "uniquely American solution." So we have weak plans, strong plans, coops, exchanges, individual coverage, community ratings, etc., etc., etc. I still haven't seen we are going to handle the problem of people with pre-existing conditions. If we cover them, people will take out minimal insurance until they get sick and then switch. We need some more epicycles.

If Copernicus were alive today, I am sure he would say, "If you simply give everyone Medicare, you wouldn't need all this complication, and I'll bet it would be cheaper, too."

The practically radical answer turns out to be intellectually conservative; it's a back-of-the-envelope solution.

I don't think one answer trumps or refutes the other. I think there's another meaning of "simple" here, which both arguments ignore. The health care proposal floated in the House, is intellectually complex not only because it's designed to please different legislators and constituencies, but because it's designed to have a minimal impact on most people, particularly those who already have some kind of health care. If by a stroke of law, we switched everyone from private insurance to Medicare tomorrow, it would be chaos. That's why you get epicycles - because it turns out that asking the earth to move in this case might actually make it change its orbit.

And really, the same thing could be said about the plan to make Congress read their bills out loud and then take a day to deliberate about them. It would actually introduce a great number of brand-new complications into the legislative process, not just for them, but for us, particularly if we actually cared enough to pay attention. You mean, my politicians actually want me to pay attention to what they do and weigh in on complex issues and hold them accountable? Wouldn't it be easier just to complain that they're all crooks who don't represent my interests?

Tim-sig.gif
Posted July 15, 2009 at 1:24 | Comments (0) | Permasnark
File under: Snarkpolicy, Snarkpolitik

July 13, 2009

Ferguson/Fallows on China

Robin says,

This 75-minute dialogue between Niall Ferguson and James Fallows, about China and its relationship with the U.S., is nuanced, detailed, and thought-provoking.

(My view here is colored by the facts that a) James Fallows has been my favorite journalist since I started reading his Atlantic articles back in college and b) I want to somehow, somehow, learn to speak like Niall Ferguson. Scottish accent and all? I think so.)

Anyway, Ferguson and Fallows really argue here—in the way two smart people argue over dinner, not in the way that people argue ("argue") on cable news. It's always surprisingly thrilling to see people actually think on camera.

To set it up, the point they don't dispute is that, right now, the world's most important entity is "Chimerica"—the blended economies of China and America. At this point, even after the economic shocks of 2008 and 2009, they are still inseperable, and incoherent without each other.

Ferguson and Fallows disagree on what happens next. Ferguson says Chimerica is doomed, and get ready for a painful disruption. Fallows, fresh off of three years living in China, is more optimistic—he thinks the relationship is flexible, durable, and many-faceted.

I saw Niall Ferguson debate Peter Schwartz here in San Francisco, and all I gotta say is: I wouldn't want to face off with this guy across a stage. He is erudite, to be sure; but he also carries and deploys his erudition in a particularly cutting way—like an Oxford don James Bond.

Anyway, I emerged from the 75 minutes mostly on the side of Fallows—but I always appreciate Ferguson's gloomy, ultra-realist point of view. Also, Fallows follows up here.

Comments (11) | Permasnark | Posted: 11:10 PM

Ordinary Everyday Crisis vs. Cartoonish Super-Crisis

Tim says,

California, strapped by an insane budget crisis, is issuing IOUs to its employees and creditors, and will soon likely be willing to accept these IOUs as payment for taxes and other state obligations. Nothing like a little extra-constitutional currency creation to spice up the economic picture of the U.S.A!

The Economist's Free Exchange offers this take on the consequences:

The highly uncertain long-term value of the IOUs may make anyone reluctant to accept them, preventing them from rising to de facto currency status. On the other hand, if enough people and institutions begin accepting them, Gresham's law may apply. Consumers may be anxious to hold on to dollars and spend their funny money wherever they can, until circulation is dominated by the IOUs.

But then, of course, economies that do business with California would have a demand for the IOUs, and other states