Not too many people like math, I think. It can be opaque sometimes, very hard to understand even for somebody who is "good at math," quotes read aloud, would you kindly. Even harder than the abstract concept of math as something you do in a class, from a textbook, sometimes while drinking, is the application of mathematics to real life.
Economics is a strange intersection of mathematics and human psychology, or perhaps macro-scale sociology. If politics is America's favorite sport, then economics is America's favorite part of America's favorite sport. On the internet, it's not a rare thing to hear a call of, "read an economics textbook," to indicate that somebody thinks their opponent doesn't know anything about it. (I rank this right up there with "most Americans think" as a way to disguise the phrase "I think"). The truth is, very few people know anything about economics, economists included. If it's the intersection of social science and mathematical science, it's definitely near the social science border. It is, to say the least, inexact, and anytime anybody tells you, "I read an economist who was positive that xxxxxx," that economist is lying. Being positive of anything in economics is a good indicator of overconfidence and little else.
That is what baffles me about the new rallying call, which states that the only way to fix the deficit is to cut taxes. The argument is that if taxes are lower, people spend more, the economy grows, and we collect more in revenue. There is some precedent for this: In southern Ireland, in 1997, a reduction from 40% to 20% of the capital gains tax resulted in a huge increase in revenue, almost 300%. Of course, those of us with analytical minds may seek to ask, "what else was happening around that time," and indeed, there was a credit bubble present in the country at the time, but even so, the dramatic impact of this move cannot be denied, and it seems clear that to some greater or lesser degree, the tax rate does impact revenues collected, and it is possible to lower the tax rate and increase revenue.
However, here is where math enters. You cannot simply say, "lower taxes result in increased revenues," because this language implies that this is always the case, and that there is therefore a linear relationship between taxation and revenue. This is absurd. Were this the case, the government would achieve the highest revenues at a 0% tax rate, which mathematically simply does not work. (Any amount of money multiplied by 0% is 0.) Similarly, it cannot be argued that higher taxes result in higher revenues, because this implies another linear relationship, in which a 100% tax rate produces the highest possible government revenues. This is also absurd. (If all money leaves the economy due to taxes, then there is no economy, which means there is no flow of money, which means there are no taxes collected.)
Clearly there must be a more complicated relationship between taxation rates and government revenues, which means that any such relationship must be modeled using a polynomial equation whose degree is AT LEAST two. (For those of you who don't know math: a 2nd-degree polynomial is a quadratic equation, wherein the highest exponent to which the variable is raised is 2, for example x^2+2x+1). This, in fact, represents an economic concept known as a laffer curve. While the specifics of the laffer curve are frequently debated, the idea that there is a point of taxation which will minimize burden and maximize revenues should not be surprising. The curve is not as simple as a 2nd-degree polynomial, and finding the "sweet spot," the very top of the curve, where dr/dt = 0, will more than likely never occur, (we would need an extended period of economic stability, and we would have to play with the tax rate every year, adjusting everything just so) but it is for this that we should strive. Saying that "more taxes increases/decreases revenue collected," is a drastic oversimplification of the matter, and is not at all how we can or should effectively pursue this debate. An in-depth discussion of historical precedent, into which is incorporated notes about the current levels of saving versus spending, and how increased or decreased taxation is likely to affect them, as well as a discussion about who would be least and most impacted by any adjustment in taxes, and how this would impact the economy as a whole, is necessary. Saying that you know exactly what will happen if you increase or decrease the tax rate, just as saying you know exactly what will happen in any economic situation, is simply wrong.
Politics for Engineers
It's amazing what can be accomplished if nobody cares who gets the credit.
Saturday, November 20, 2010
Saturday, October 30, 2010
On compromise, and "winning"
Americans are very focused on the idea of being a "winner." In many ways, our dog-eat-dog business climate benefits from this attitude -- we are willing to shelve our pride, to embrace new ideas, to take an honest look at what the other guy is doing better than us, if we have reason to believe it will benefit us. There are negative aspects to this culture as well -- there is such a thing as a good idea which makes no money for anybody, but you'd be hard-pressed to convince many people of this. If an idea is good, it will make money, right? It will make you a winner.
In Japan, there is a man named Yoshiro Nakamatsu. (Affectionately dubbed Dr. NakaMats.) He is a massively prolific inventor. There are some reports that he is responsible for inventing the floppy disk and the CD, and though these are contested, in particular by IBM, he is massively rich for it. (His bathroom, where he does his thinking, is made of solid gold.) Not all of his ideas are "winners," and he knows it. My personal favorite is a combination bicycle/moped. It is powered by water -- I don't know the details, but the basic mechanism uses the rotational motion generated by the pedalling action of the bicycle to generate electricity, which causes electrolysis; the pressure from the gasses produced power the engine. My friend, who is a mechanical engineer, explained more of the specifics of the engine to me, but I'm afraid a fair bit of it went over my head. The device moves faster than a bicycle, with considerably less work, but probably slower than a moped. There isn't any particular niche for this device, and so it is not a "winner," but I like it quite a bit, and if Dr. NakaMats can make the cycle of water/hydrogen/oxygen into a closed system (that is, where only work enters and only work exits, and therefore all of the hydrogen and oxygen can be reconstituted into water) he will have created the basic system for a sustainable water-powered vehicle. No business on the planet would buy this design from him, or indeed, even use the idea as a base-point -- what use does it have? It's not a winner. And yet, contained in it are the seeds for something incredible. The point I am trying to make is that our "winner" society creates motivation with amazing efficiency, but is not long-sighted.
Writing this on the night of the election, I can say with relative confidence that Republicans are going to retake the house, and by a wide margin. Depending on who you are, this prospect will either enthrall or mortify you (or perhaps you'll look at it with careful neutrality). They now have the monumental task of living up to not only their campaign promises, but being better than the people they defeated. They have railed for nearly two years about how the Democratic party has failed America in its hour of need, and how they know how to fix it. That they have been excluded from the process. It is now time for them to put their money where their collective mouths are; however, (probably now) Speaker of the House John Boehner has stated openly that now is not the time for compromise. That they will not work with a Democratic Senate, with a Democratic White House. The last time this happened, Speaker Newt Gingrich shut down the government in essentially a glorified temper tantrum, before Bill Clinton, who, it must be acknowledged, is one of our greatest living statesmen (whether or not you agreed with what he had to say, you must admit that he was masterful at handling those who disagreed with him) eventually stonewalled him into compromise.
Republicans have "won," as I said, but that is different from doing the right thing, by an inch and a mile. To John Boehner, all I can say is that now that he has "won," by which I mean he has emerged at the head of a race, he had better be ready to compromise. Working with people with whom you disagree towards a common goal is a process of give and take, not only take. I frequently disagree with my superiors, and always tell them when I do; what follows is not stonewalling. They do not call me a socialist or a fascist or a Nazi or the next Pol Pot and refuse to listen to me. Engineers, who above all else must do a job and build a working device, not so unlike politicians, must learn to listen, because they must understand that they are not always right, even when they are convinced they are. It is not a matter of winning and losing. When I disagree with my superiors, it is with the full understanding that I may or may not be right, and that there's a relatively equal chance that what I say will be heeded or discarded, entirely on the basis of its merits. This merit-based judgment is separate from compromise, but the ability to do one implies the ability to do the other.
Barrack Obama is willing to compromise with Republicans, and whether or not this is politically the right move, it is necessary to continue to run the government. I will rarely say this on this blog, but John Boehner and Mitch McConnell are quite frankly in the wrong on this. They are now responsible for doing more than talking. They are now the managers of the massive, eternal project that is America, and they had better learn to compromise, and do it pretty fast. One does not become a winner when one makes short-term gains. One becomes a winner when one completes a project, and does so successfully, and there have been very few engineers in this world who could complete a project with only one point of view working on it.
So, I will say again: John Boehner had better learn to compromise, and learn to do it fast.
In Japan, there is a man named Yoshiro Nakamatsu. (Affectionately dubbed Dr. NakaMats.) He is a massively prolific inventor. There are some reports that he is responsible for inventing the floppy disk and the CD, and though these are contested, in particular by IBM, he is massively rich for it. (His bathroom, where he does his thinking, is made of solid gold.) Not all of his ideas are "winners," and he knows it. My personal favorite is a combination bicycle/moped. It is powered by water -- I don't know the details, but the basic mechanism uses the rotational motion generated by the pedalling action of the bicycle to generate electricity, which causes electrolysis; the pressure from the gasses produced power the engine. My friend, who is a mechanical engineer, explained more of the specifics of the engine to me, but I'm afraid a fair bit of it went over my head. The device moves faster than a bicycle, with considerably less work, but probably slower than a moped. There isn't any particular niche for this device, and so it is not a "winner," but I like it quite a bit, and if Dr. NakaMats can make the cycle of water/hydrogen/oxygen into a closed system (that is, where only work enters and only work exits, and therefore all of the hydrogen and oxygen can be reconstituted into water) he will have created the basic system for a sustainable water-powered vehicle. No business on the planet would buy this design from him, or indeed, even use the idea as a base-point -- what use does it have? It's not a winner. And yet, contained in it are the seeds for something incredible. The point I am trying to make is that our "winner" society creates motivation with amazing efficiency, but is not long-sighted.
Writing this on the night of the election, I can say with relative confidence that Republicans are going to retake the house, and by a wide margin. Depending on who you are, this prospect will either enthrall or mortify you (or perhaps you'll look at it with careful neutrality). They now have the monumental task of living up to not only their campaign promises, but being better than the people they defeated. They have railed for nearly two years about how the Democratic party has failed America in its hour of need, and how they know how to fix it. That they have been excluded from the process. It is now time for them to put their money where their collective mouths are; however, (probably now) Speaker of the House John Boehner has stated openly that now is not the time for compromise. That they will not work with a Democratic Senate, with a Democratic White House. The last time this happened, Speaker Newt Gingrich shut down the government in essentially a glorified temper tantrum, before Bill Clinton, who, it must be acknowledged, is one of our greatest living statesmen (whether or not you agreed with what he had to say, you must admit that he was masterful at handling those who disagreed with him) eventually stonewalled him into compromise.
Republicans have "won," as I said, but that is different from doing the right thing, by an inch and a mile. To John Boehner, all I can say is that now that he has "won," by which I mean he has emerged at the head of a race, he had better be ready to compromise. Working with people with whom you disagree towards a common goal is a process of give and take, not only take. I frequently disagree with my superiors, and always tell them when I do; what follows is not stonewalling. They do not call me a socialist or a fascist or a Nazi or the next Pol Pot and refuse to listen to me. Engineers, who above all else must do a job and build a working device, not so unlike politicians, must learn to listen, because they must understand that they are not always right, even when they are convinced they are. It is not a matter of winning and losing. When I disagree with my superiors, it is with the full understanding that I may or may not be right, and that there's a relatively equal chance that what I say will be heeded or discarded, entirely on the basis of its merits. This merit-based judgment is separate from compromise, but the ability to do one implies the ability to do the other.
Barrack Obama is willing to compromise with Republicans, and whether or not this is politically the right move, it is necessary to continue to run the government. I will rarely say this on this blog, but John Boehner and Mitch McConnell are quite frankly in the wrong on this. They are now responsible for doing more than talking. They are now the managers of the massive, eternal project that is America, and they had better learn to compromise, and do it pretty fast. One does not become a winner when one makes short-term gains. One becomes a winner when one completes a project, and does so successfully, and there have been very few engineers in this world who could complete a project with only one point of view working on it.
So, I will say again: John Boehner had better learn to compromise, and learn to do it fast.
Sunday, March 28, 2010
On criticism
`Criticism is the most important skill an engineer can learn. This is something they don't teach you in school, because how can they? You mostly work on your own things. Sometimes you work with a group of one of two other students, all of whom are mostly interested in finishing whatever they're doing. This is the nature of academia, and it's unavoidable.
But when you work for a living, the time you spend actually working on a project goes down significantly. The odds of you being the only engineer on your project are low. The odds of you creating everything from scratch are lower. Engineering is a group effort, and a big part of any group effort is reviewing what others do, and indeed, what you yourself do.
That's one of the reasons that I have become so incensed with the political climate -- and I should qualify this by saying that this feeling is not recent. Criticism of George W. Bush during his years was sometimes fair, but sometimes utterly unfair, and criticism of Barack Obama has been largely unfair. There have been some valid criticisms, but unfortunately, they have come primarily from his own party. He has not stuck to his schedule for closing Guantanamo Bay; he has involved us in more, instead of less, foreign conflict; he has done a very poor job at reining in spending. This last accusation has been repeatedly leveled from the right, and it is perfectly justified. His projected deficits for the next 5 years are unacceptable.(1) This is in stark contrast to one of his goals as President, which was to rein in spending. I will discuss these criticisms in some detail a bit later, but for now I want to address why I'm very disenfranchised with the overall style of criticism of Obama, and to a lesser degree, of Bush before him.
It's easy to criticize a president. He is in the news 24/7/365. He is probably the most public figure in the world. He's going to make decisions every day, and people are going to disagree with him. Those people should lay out broadly why they disagree with him, specifically on what points they disagree with him, and propose their own solutions. As to the former two, "everything," is not an acceptable set of points, nor is it acceptable to say "the vast majority of things," even if it is true, and use that to revert back to "everything." There is rarely a "right" or a "wrong" answer, and beyond everything else, it's important to acknowledge that. Before you disagree with something you must understand its merits - how can you criticize something you don't understand? You must lay out both the costs and the benefits to your proposed solution, as well as highlighting the differences and similarities with the solution presented by your opponent.
That's not what's happening right now. That's not even close to what's happening right now. What's happening right now is an ideological shit-flinging contest. Ideology helps keep us focused and directed, so there is merit to it, but if it puts in a double shift as your logic center as well, you're in trouble. For Republicans, this is what is happening, or at least the face they're presenting to the public. I don't doubt for a second that every Republican in Washington is capable of being a reasonable, intelligent lawmaker. Contrary to public belief, you have to be very smart to make it in Washington. But it seems GOP policy is preventing them from doing so.
The health care debate is, of course, a marvelous way to frame this discussion. Republicans have been railing against the bill from day one, but strangely, have produced very few specifics that they disagree with. This is, of course, a clever strategy. They haven't really campaigned against the provisions in the bill, nor against the idea of universal health care. They have campaigned against The Bill. The Bill is a socialist menace. The Bill is a government takeover. They will fight to repeal The Bill. From what I understand (and take this with a grain of salt, as it's one of those things that I Heard On The News but have not been able to validate) most people tend to support the provisions of the health care bill when presented to them individually, but those same people will turn to rabid opposition when asked about The Bill. People frequently say "we need health care reform, but not This Bill." I don't understand what that means, because that presents no criticisms of the President's proposal. They call it a Deficit Increaser and a Jobs Killer without understanding what those things mean. Vague ideas are presented -- 'This bill will force small businesses to stop hiring' but with little to no substantiation. In what way will it do this? It will run up costs for small businesses. What is the mechanism by which costs will be run up? Money. For which businesses will costs be run up? Small ones. What kind of small businesses? The small ones. Which provisions in the bill will run up these costs? The ones that target small businesses.
But none of these demonstrate any understanding of the workings of the system. No proposals were brought forth during the process to amend portions of the bill that Republicans believed would harm small businesses. During the health care summit, complaints were brought forth about various things -- the process by which the bill was created, the philosophy contained in the bill, and even a few of the specifics in the bill -- but no solutions were proposed. It is not a criticism until you finish that process. "This provision will unfairly harm this type of business in this manner, and here is an alternative." Until that is done, you're just complaining. And "scrapping the project" is not an acceptable suggestion.
Let's talk specifics for a moment, as a specific criticism of this nature demands specific examples.
Let's take the conservative response to the recent oil spill disaster. (2). Rush Limbaugh recently called the oil spill "Obama's Katrina," and conservatives are having a grand old time comparing Obama's long reaction time (8 days before he was on site) with the long reaction time (4 days before he was on site) of the Bush administration to Hurricane Katrina.
Now, I'd like to take a moment, if I could, to discuss some of the criticisms leveled at the Bush administration about hurricane Katrina. A lot of mud was slung his way for the subpar response of FEMA to the crisis. And let's be clear, FEMA's reaction was mediocre at best; it left a lot of people and as president at the time, it was George W. Bush's responsibility to accept responsibility for that, which he did. That being said, Michael Brown was directly in charge of the enormous fuck-up that was the Katrina response. To provide an example of valid criticism, Brown allocated inadequate resources for evacuation, failed to even consider the possibility of civic unrest, and his information network was poorly deployed--he learned of the starving refugees in the Convention Center only via media coverage. His coordination was overall lacking, and on these points in particular, and on more salient points -- late-in-the-game search-and-rescue operations, subcontracted corpse retrieval work, perceived preferential treatment of non lower-class citizens--he could have improved his response by requesting additional support from the national guard and giving commanders the authority to engage in immediate and constant search-and-rescue operations, and by coordinating information gathering by placing agents on the ground at sites of interest. These are valid criticisms of the response to Hurricane Katrina. "George Bush hates black people," is not. "George Bush was an incompetent fuck-up" is not.
Similarly, criticisms of Obama's response to the oil spill have ranged from the unfair ("This is Obama's Katrina" -- no populations were at risk during Obama's time of inaction, and he has, in fact, taken many tangible steps to ensure that BP fixes the mess it made at no expense to the taxpayer, and is taking steps to ensure that if BP can't do it, the government will, at no expense to the taxpayer.) to the absurd ("Obama waited for the spill to worsen to push public opinion against offshore drilling" --Former FEMA director Michael Brown, the man in charge of the botched Katrina response (3)). None are actual criticisms. Just ideological nonsense. A valid criticism would be, "Obama could have arrived in the areas affected by the oil spill sooner to make a public announcement and reassure the public." This is not the criticism that was made.
Another easy example is the Republican response to the recent efforts towards Wall Street reform, which mirrors their response towards the health care reform package. ("We want to do something, but Not This Bill.") Their responses are vague and ideological -- "Regulation will stifle wall street, and it will Kill Jobs and Cost the Taxpayers Money," with no specifics, and with no intent to improve the ideas presented, only to shoot them down.
If I were to take umbrage with a specific of one of my projects, and suggest to the team I work with that it be scrapped and started over, I'd be laughed out. If I were to limit my criticisms of their work to saying what socialist nincompoops they all were, I'd be fired.
Why would we hold politicians to any lower of a standard?
Monday, January 4, 2010
"Public Option" C/B Overview
Contents
- Introduction
- Cost/Benefit overview
- Cost-Benefit analysis
- Case study: Germany and Japan
- Conclusion
1. Introduction
Health care in this country is a topic that is close to my heart. I have a couple of very sick family members, so we need to be very careful about making sure we keep our health care.
Be that as it may, we need to strive to make policy decisions that will benefit the most people over the longest term. It's a hard thing to gauge, and requires us to measure cost and benefit, as one must when building just about anything.
2. Cost/Benefit overview
Benefits
The primary benefit to a public option is, as we have heard a great deal about, covering the uninsured. More than that, it's about making sure that those who can't buy into a group insurance program have the ability to do so.
This ties into the second benefit to a public option -- driving down overall costs. There are two reasons that being employed with a larger company allows employees to afford health care--the whole company purchases premiums at a group rate, lowering the per-capita cost, and the employer pays a certain percentage of the premiums. In the United States, an average employee pays just over $3,300 per year in fees(1), but his employer can expect to pay three to four times that amount. This drives up costs to businesses and to individuals.
The third benefit to a public option, and, indeed, a logical goal of any health insurance reform, is making health insurance stable. It is rare, in most other industrialized nations, to see a family lose their savings and perhaps their home over medical bills. Not all of these nations have a public health insurance plan, but those who do not have a fairly high level of government regulation(2).
Costs
There are several costs associated with health care reform and the public option.
The first cost is, for lack of a better word, the cost. The CBO projects that the House bill (which includes a public option) will cost just under $900 billion. (Only $29 billion less, pocket change, right?) It also projects that the bill will lower the Federal deficit overall. A less robust public option proposed by moderate Democrats will not reduce the deficit as significantly. So far the option has been projected to be paid for by premiums and additional taxes on medical equipment, as well as a tax on the wealthiest Americans. (3) The cost of the cost is a worry--new taxes are not always the way to go, and there is only so much we can squeeze out of the wealthiest Americans. In addition, a tax on medical equipment may (or may not) increase hospital costs.
The second cost is the cost of implementing such a program. Federal programs are often awkwardly implemented in their infancy. Older programs (such as the V.A. and medicare) are actually quite robust, but are still routinely victim to fraud and error. The potential scale of a public option leaves little room for such error. Put another way, they'll need to get it right from the outset.
The third potential cost is a worry of many, the cost to the quality of patient care, and more broadly, to insurance companies. Many worry that insurance companies will be unable to compete with the public option and will be forced to either A. Reduce coverage, B. Increase premiums, C. Decrease quality of care, or D. Fold entirely.
3. Cost/Benefit analysis
There a lot of variables affecting how broadly this bill will reduce the number of uninsured. With a public mandate to purchase insurance, it has been speculated that about 94-96% of Americans will end up with coverage. The bill includes exemptions and subsidies for those who can't afford it. It is hard to tell if anything but a purely single-payer system would eliminate these remaining 4-6%. We can assume that many of the country's most destitute will continue to remain uninsured, and broaden this to say that those in this country who simply live "off the grid" will be included in this number. The success or failure of this goal will depend on the specific implementation of the hardship subsidies included in the bill--if they are such that families near the poverty line are assisted in obtaining insurance, the bill should succeed. Otherwise, it will fail.
When it comes to driving down health care costs, the existence of a public option is not so critical as the rest of health care reform. It is easy to speculate that the existence of a not-for-profit entity will provoke insurers to drive down premiums, and indeed, if the public option is successful in keeping its own costs and premiums low, insurance companies will be forced to emulate this behavior or risk having to decrease quality of care, client roll, or fold entirely. (One of the previously-stated costs). Wellpoint, Inc, a very typical insurance company, had a profit margin of about 3 billion dollars in 2008.(4). This is about 4.19% of its total revenue. This is a very typical margin, and leaves some wiggle room to decrease premiums. However, the rest of the reform package is what will decide the future of private premiums--they aim to drive down administrative costs, which accounted for about 12% of Wellpoint's expenses. (Benefit expenses were about 7 times greater.) This decrease could be potentially significant, and would offset many concerns about the failure of insurance industries as a whole.
Finally, it is clear that a non-profit public option would be a stable option, and it is likely that the additional reforms found in this bill would force insurance industries to go the same route.
The actual cost of the bill, and whether it would add to or subtract from our deficit in the long term depends, once again, more on the rest of the bill than on the public option. If we assume that the CBO's estimates are close to accurate, then we can assume that overall the bill will be roughly deficit-neutral. The real savings in the long term comes from the adjustments to medicare. According to the CBO, the bill could reduce the growth of medicare costs from 4% / year (adjusted for inflation) to 2% / year. This will primarily depend on whether or not future congresses stick to the provisions of the bill. (5) In the best case, (the CBO's estimate is spot-on) the bill as a whole could reduce annual deficits by ~1% of the nation's GDP each year. (5). In the not-best case, the whole thing would likely wind up deficit-neutral.
I would like to mention the concerns about quality of care ("rationing") overall, and also discuss how critical the public option really is. In truth, the public option is not as crucial as the goal of the bill -- universal health care that is stable, as opposed to entirely based on your job. The truth is that virtually all industrialized nations have a system of universal health care. None have fallen victim to communism. It is true that many of these nations utilize a public option, but not all. We have all heard horror stories about their health care systems, but the truth is that these stories exist in every system. This is what an engineer would call "operator error," (see also: rtfm, read the manual. I couldn't possibly know what the f stands for.) in which it is less the system than those responsible for running it have failed, or else small, noncritical errors in the system have been found. A VLSI circuit such as an Intel i7 processor can have as many as 730 million transistors in it. All of these transistors have to be placed, and sized for speed and space efficiency, but also routed for operational correctness. In a 730 million transistor circuit, not all paths actually pertain to the normal use of the device. There may be a broken functionality that is not exposed in normal operation until well after the circuit's release. This does not mean the circuit is broken, but that there is a broken element to the circuit. It is highly unlikely that in fixing this error Intel would scrap the layout and start over. In addition to the enormous cost of such an endeavor, it is a waste of effort. This applies to both the stories we have heard about health care abroad ("The socialist doctor thought that a giant cartoon mallet made the tumor in my brain!") and to our own system. ("Insurance companies are massive, evil entities run by creatures who bathe in the blood of newborns.")
Our system can be fixed. It will take reform, and in the end, we will need to choose between two things that fiscal conservatives will abhor: A new Government entity or extremely tight regulation.
Therefore, to return to the intent of this section, the criticality of the public option, it's not. There are alternatives, but none have been proposed. An insurance co-operative is not the answer, because it only fixes part of the problem--access to insurance. It does not necessarily increase stability, nor ensure universality, because in the end, there needs to be a nonprofit entity which exists somewhere in the system of health care. In the public option plan, it's the public option. In other systems, it is the regulatory body of the government.
4. Case study: Germany and Japan
It is not necessary to reinvent the wheel to implement a universal system of health care, so to conclude and illustrate this point, I would like to contrast two systems of health care which are both relatively effective: Germany and Japan.
In Germany, health insurance is provided entirely by private industry whom the government regulates tightly to ensure legitimate business practices whose goal is first and foremost to maintain an adequate level of coverage to all Germans. (Market gains and profit come second.) Ironically, the German system is essentially a "single-payer" system, in which individuals pay premiums out of their paycheck (a payroll tax) whose funds are redistributed based on market share to the companies that provide insurance. The companies have no ties to government (i.e. they are private corporations) and compete with one another. Since the companies are still private businesses and their income depends on their market share, competition still exists, driving down prices. Since the government handles dissemination of funds, premiums are regulated and it is up to the companies to keep their costs down. In addition, companies are more tightly pressed to adhere to regulation, since the government can cut their funding for any infractions they may commit. (It is perfectly possible to implement this system in America, or a system similar to this, speaking purely in financial terms--up to 45 percent of premiums for many health insurance companies could be spent on "marketing, broker commissions, administration, other expenses, and profits".*(6))
The Japanese system of health care is very similar to a proposed American system with a public option, however, it is stricter. It, too, relies on heavy regulation of the industry (overall profits are banned and must be spent on improving quality of care and payouts to stockholders.) It also has a public option which is reserved for the unemployed, the poor, and the self-employed. It costs about half of what the U.S. system costs, due to the universality of insurance, as well as the strict way in which the system is regulated, but suffers from some problems, such as a frequent shortage of hospital beds. The reason for this, however, is based primarily on the implementation of the system--patients are treated "too" equally, with low-priority cases being given beds with equal preference to high-priority cases. Presumably an American system, which already does an excellent job of regulating who goes where for how long, could do better. American doctors tend to be better-trained, and more specialized, and the Japanese system suffers from a lack of specialized doctors and primary caregivers in public hospitals. This is because their pay is lower and they are overworked. Most of these issues, as previously stated, stem from the lack of "gatekeepers" in the system--that is, people who can filter out those who are truly sick from those who are simply coming in from worry. In addition, Japanese medical training does a poor job of training doctors to have this filter, and any system which is universal in nature must emphasize this filtering. (1).
5. Conclusion
Overall, the case for the public option is not as strong as the more general case for some form of universal, stable health care, but I think it is clear that a purely private system of insurance cannot stand. The costs that I have mentioned here can, to some degree, be offset by a proper implementation of what comes of the health care bill. You will notice that I have not discussed the ethics of implementing such extensive regulation of an industry, nor the moral arguments for or against universal health care as a human right. So long as the public option is not dangerous (and I hope my C/B analysis has indicated that it is not) such questions are not for an engineer to discuss.
* This number comes from a lobbying group, the Council of Affordable Health Insurance, who protested a regulation demanding that insurance companies spend at least 70% of their premiums on benefits. The group stated that unless a non-group insurance company spends around this much, they cannot be successful in the non-group market.
References
Many of my facts came from the marvelous New York Times economist Uwe Reinhardt. He has professed no opinion for or against the public option, and as such has done an excellent job of analyzing the state of health care in this country. I suggest you look him up if you have some free time.
(1). Health Care in Japan: Low-cost, for now. Harden, Blaine. Web. 07 Sept. 2009.
(2). Health Reform Without a Public Plan: The German Model. Reinhardt, Uwe. Web. 17 Apr. 2009.
(3). CBO Finds Dem Bill with Public Option Reduces Deficit. Walsh, Deirdre. Web. 21 Oct. 2009.
(4). Budget sheet for Wellpoint, Inc. Web.
(5). Will the Senate Health Bill Tame Costs? Sahadi, Jeanne. Web. 24 December 2009.
(6). What Portion of Premiums Should Insurers Pay Out in Benefits? Reinhardt, Uwe. Web. 09 Oct. 2009.
Welcome to politics for engineers
The internet is a bad place to find your political opinions. You search for people who agree with you, and then you agree with them. You click the little red "x" at the top-right corner of your screen (or maybe the little red dot at the top-left if you're of the Macintosh persuasion) if somebody doesn't agree with them but you don't feel you can argue with them. Even if you do argue with them, you don't have to look them in the face, so you don't have to take them seriously so you don't. There's a turn of phrase that relates internet arguments to the Special Olympics.
I won't be able to change this.
These are the first few lines of the Engineering code of ethics:
(Taken from http://www.nspe.org/Ethics/CodeofEthics/index.html)
Preamble
Engineering is an important and learned profession. As members of this profession, engineers are expected to exhibit the highest standards of honesty and integrity. Engineering has a direct and vital impact on the quality of life for all people. Accordingly, the services provided by engineers require honesty, impartiality, fairness, and equity, and must be dedicated to the protection of the public health, safety, and welfare. Engineers must perform under a standard of professional behavior that requires adherence to the highest principles of ethical conduct.
I. Fundamental Canons
Engineers, in the fulfillment of their professional duties, shall:
- Hold paramount the safety, health, and welfare of the public.
- Perform services only in areas of their competence.
- Issue public statements only in an objective and truthful manner.
- Act for each employer or client as faithful agents or trustees.
- Avoid deceptive acts.
- Conduct themselves honorably, responsibly, ethically, and lawfully so as to enhance the honor, reputation, and usefulness of the profession.
I will do my best to follow these tenets in this blog, which I hope will be composed of political ramblings, musings on my craft, and dry humor in equal measure. I am not an expert in any political or economic field, so I will have to call that one a draw. I hope that you, intrepid reader, will call me on it when I don't. Nobody is unbiased, and even the smartest people have holes in their reasoning. That's why engineers work in groups. Einstein came up with some of the mathematical and theoretical physics behind nuclear weapons (and nuclear energy) but it took many engineers several years to complete the Manhattan Project. Edsger Dijkstra solved many problems that made modern operating systems possible, but Windows (which, contrary to popular belief, is a fabulous operating system) was made possible through the labors of thousands of software engineers. Hence, I would like this blog to be a group effort. I will formulate my entries and responses as carefully as possible in the hope that you, dear intrepid reader, will afford me the same courtesy, but the internet is a place for loldongs as well. Nonetheless, I look forward to discussing my ideas and yours.
It's amazing what can be accomplished if nobody cares who gets the credit.
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