Obamacare #3

Jane O'Brien, one of BBC America's new anchors, expressed some puzzlement as to why Americans think there is something wrong with socialized medicine; like me, she grew up in a country in which the government pays for peoples' health care from the taxes it raises.

I can vouch for the fact that while it may not be bleeding edge, the National Health Service does a fine job. It is also free from the fraud and abuse that plagues the American health care industry and contributes significantly to its quite disproportionate cost. At the same time, anecdotal evidence suggests that the American healthcare is far from perfect; start a discussion about medicine and you're far more likely to hear a horror story than a glowing endorsement.

It's hard to see why people who have never had any experience with 'socialized medicine', who complain about high cost and poor treatment from the system they have, are so opposed to something of which they know nothing, which statistics suggests does at least as good, if not better, a job.

Obamacare #2

According to much of the media, polls have consistently shown that Amreican's dislike the Affordable Care Act (aka. Obamacare) while liking many of not most of its provisions.

This should not be in the least bit surprising. The parts people like are the provisions that deliver benefits like no limits on insurance payouts, guaranteed coverage for those with preexisting conditions, and the outlawing of cancellation of coverage when you get sick. The part of the act people don't like is 'the mandate' i.e. the way that all of these benefits are paid for.

Clearly people would like a law that overall delivered those benefits but didn't ask people to pay for them; a 'free lunch' is something everyone would support.

It's also worth bearing in mind that in all likelihood, more people are healthy than are sick, so there are more people who'd prefer not to be paying for insurance they don't think they'll ever need than there are people who think what they'd already paid in premiums was a wise investment.  

Obamacare

Rather than a tax on those who fail to buy insurance, why not think of it as a tax deduction or a tax rebate? A reward for those who do, rather than a penalty for those who don't.

And while we're on the subject, the devil in the Republicans' proposal (such as it is) will be in the detail; when it comes to coverage for pre-existing conditions, look for the phrase "maintained continuous coverage". Think about what that means for someone who is laid off and can't afford private insurance until they find work again.  

Two ways to close the deficit

1. Raise taxes - everyone who is doing OK has to chip in a bit;
   
   Those who aren't (a smaller number) don't (since they aren't paying taxes).
   
   
2. Cut spending - those who are doing OK continue blissfully unaffected;
   
   Those who aren't (a smaller number) bear the brunt
• through public sector job loss,
• private sector redundancies that accompany economic contraction (see a) and
• in cuts in essential support and services to the less advantaged (those in a and b).

Should 100 million quite well off people pay $x or 10 million people who are struggling pay $10x? Take your pick...

Giving Back?

Dr. Cesar Sabates (practising dentist and President of the Florida Dental Association) on Frontline (@ 8 min 08 secs): "I looked into becoming a Medicaid provider because I do believe in giving back, and I noticed that the reimbursement schedule was dismal to be quite honest with you; it was maybe 20% of what we would normally charge, so I thought to myself; this doesn’t make any sense."

So if I understand this right, "giving back" only "makes sense" when it doesn't involve a reduction in profits (i.e., giving)?

Watch Dollars and Dentists on PBS. See more from FRONTLINE.

The last mile becomes the last 72 inches

Fifteen years ago, when I was collecting data for my thesis from a European telco, the threat all the company's employees, particularly the senior managers, were worrying about was VOIP. I confess I had only a vague idea they were talking about; I knew what it meant but somehow it didn't really grab my imagination. Yesterday, after installing my own analog telephone adaptor (ATA), I now realize in an oddly viscerally way what they meant. More colloquially, now I get it.   

In the 90s, the trunk network, the backbone that links local exchanges together, was transforming from analog to digital. I talk about this in class when we look at Alcatel in Spain. Huge rotary telephone switches in the locals exchanges were being replaced by small(ish) computers. But for residential customers, the last mile has remained stubbornly analog. Until now - at least for me. After setting up my ATA, my analog portion is now down to about 6 feet; and if I had a shorter cable it would be 3.        

What Money Can't Buy

I should probably read "What Money Can't Buy: The Moral Limits of Markets" by Michael J. Sandel before writing this but I have a backlog of books and this thought came to me when he was being interviewed on The PBS Newshour this evening.
 

Watch 'What Money Can't Buy' and What it Shouldn't Buy on PBS.

Sandel was talking about "line standers" people who lobbyists pay to stand in line to get in front of members of congress, so that the lobbyists don't have to waste their valuable (literally - the opportunity costs is huge) time waiting in line.

So if lobbyists buy all the people in the line, then potentially regular citizens are crowded out. Extend this further (and it's not beyond the realms of the possible) and they might pay ordinary folk with a beef wanting to talk to their congress person to given up their place in the line for a sum of money (to be negotiated).  After all, everything and everyone has their price, don't they?

Then I realized why the trends Sandel talks about have been troubling me. When groups and individual with great wealth have a disproportionate voice (some would say the only voice) in a system of  representative democracy, we have a system reminiscent of Britain in the 1700s; if I have remembered correctly what little history I learned, only those with land (i.e., wealth) could vote.

Moreover, there were some electoral districts (or boroughs) which had so few (land owning) residents, that these voters could be readily bribed by candidates. [As it happens, I was born only a few miles from one such "rotten borough", Bramber in West Sussex]. When the outcome of an election depends on the size (in dollars) of the coffers and war chests, government is no longer truly representative, a point being made much more forcefully and eloquently by Lawrence Lessig.

A quarter of a millennium of struggle for universal suffrage seems to have been de facto reversed, or at least some significant ground lost, in the last 30 odd years.