Friday, August 28, 2009

I can't bend my arms

If you're not allergic to poison ivy, you just haven't been exposed enough.

I never did believe that old saying, because I never was allergic to poison ivy. When I was a kid, I could walk through the stuff, and not even get a blister. Even recently, I might get one or two blisters while Milady would break out in full-body rashes.

It seems that now, I've been exposed enough. My left forearm is a constant and solid rash, and my right arm is a third of the way there. I am alternating calamine lotion, hydrocortisone cream, and antihistamines. Generic Zyrtec was definitely the best antihistamine, but the 24 hour dose only lasted 12 hours...

Excuse me while I work on taping on oven mitts.

Tuesday, August 18, 2009

A comment over on Roger Ebert's Journal

I'm not done on this, but this is too good a post to just leave as a comment somewhere else.

Ebert: The government woudn't run the health care system. It would make insurance more affordable.

The dirty little secret of "health care reform" is that there are only three ways to decrease costs (Adam Smith 101): increase supply, decrease demand, and remove overhead. Let's take on each one individually.

Milady and I have talked to doctors about overhead. For the birth of Number 1 Son, her ob/gyn was barely clearing enough to order a pizza after the delivery. He ended up retiring to take care of his ailing father. Why? Insurance paperwork and liability insurance. I would like to see a pseudo-criminal system completely replace the current tort liability system. If a doctor commits malpractice, he is criminally liable to losing his license for X number of years. Allow private prosecution (as England does some still), but institute loser pays for them. Make the doctor liable for consequences without opening up unending financial liabilities onto the entire system. The Democratic plans make no tort reform, and do nothing to lower Medicare overhead (which are running doctors out of the system).

We are also making no steps to increase the number of doctors out there. There are less medical schools now than in 1900, and less doctors per capita than in 1900. Most medical schools are turning away 4 or 5 equally-qualified students for every 1 admitted. Allow doctors a path through to where they aren't crushed by debt, and make a bunch more of them.

As an aside, make doctors publish price lists, and make insurance companies publish their payment lists. One price for everyone. I shouldn't pay $200 for what Humana pays $40. Instead, the doctor charges $50, and Humana pays up to $60, so I'm happy. Or maybe Humana pays $40, but the doctor charges $50, and I have to cough up $10. Most other people would face jail time for what is called business as usual in the insurance field.

The third step is lowering demand, aka rationing. No one wants to say "you can't have it", but we need to say so. We want to tell the lazy poor "get out of the ER, go to the free clinic in the morning". 90% of the people who get cholesterol medicine don't really need it; it's just that the 10% who do need it need it desperately. We just can't tell right now who the 10% are. Most areas of the country don't have enough need of a medical helicopter to justify it. They also don't need a trauma center enough to justify it either.

The British and the Canadians have made those choices, and most of the time they work. If you have something simple, you get a treatment, and it works. But the edges are where the cost savings hit the road. If Natasha Richardson had been in the US, she would have been in range of a medical helicopter and a Grade 1 trauma center. Only God knows if she'd have lived, but because she was stuck with ground transportation and multiple hours from any trauma center, she didn't have a chance. Canada works because the US back-stops it. The really bad cases (troubled pregnancies, denied claims, etc.) can cross the border.

The real question: who pays for the really expensive stuff? I've heard some claims that 80% of Medicare costs are for caring for the last year of life. Number 1 Son cost our insurance $100k from pneumonia that destroyed half a lung, and then another 100K or so with pericarditis. That chopper, that trauma unit, that second MRI, that extra doctor in the ER, all those things cost a lot of money. The British and Canadians are saying no to the "extras", and it's starting to show.

Our health care providers currently have to compete on service, and it shows. They can do the 20% chance of success treatments enough times to convert them to 50% or 75%. They can drive the $50000 MRIs to $500. But, all that costs money.
There won't be "death panels" deciding individuals. That will be too gaudy. There may be appeal panels, but not often. Most of the time, there will be faceless groups making actuary tables, deciding that the chance of you living doesn't pay off, so you won't get the knee replacement, or the speech restoration surgery, or that quad bypass.

As a libertarian, I want a real market. Most people don't pay for car care insurance; it costs more than the actual work. Most health insurance is really health care plans. We pay the insurance X+Y dollars to spend X dollars on our behalf, when X is usually a well-defined minimum amount each year. 80% of the people in the US (under 65) would be better off having a plan that had a $4000 out of pocket minimum and paid 100% of everything else, and be able to put that $4000 back pre-tax. If you can't afford that plan or can't afford the $4000, then provide that money as charity or welfare, not by hiding the costs as health care overhead.

Push the spending decisions back onto the consumer. If it's important to do, then you spend the money, and pay for it.

Thursday, August 13, 2009

Insomniac notes

Milady and Little Miss are camping with American Heritage Girls up in the Cincinnati metro area. When I'm away from Milady or Milady is away from me, I don't sleep well. That's why I'm up at 1:49AM local time.

  • Mr. Obama needs to quit campaigning. Even Number 1 Son is starting to notice that everything is a campaign issue.
  • I am teaching a computer science class to the little darlings at homeschool co-op. At the teacher's meeting this week, they asked us to tell one thing that few people might know. I thought about mentioning that I was becoming quite good at Omaha and was winning at Texas Hold-Em. I knew that wouldn't go over well. Instead, I mentioned that I am right-handed but left eye dominant.

Since I'm finally sleepy, it's time to go to bed. Fortunately, Milady will be back tomorrow.

Thursday, August 6, 2009

Scraping the inside of your skull

Yesterday was the first day of a well-deserved vacation. Instead of shopping and playing with Milady and the kids, I was laying on my sister-in-law's bed. Why? My first awful migraine in almost two years. I took some aspirin before I left the house, and I thought that had it under control. Nope. By the time we were done shopping at Big Lots, I was in a full-blown migraine. We stopped by my sister-in-law's house, and I made it up into her yard before I threw up the peanuts I'd had as a 2PM snack. Boy do peanuts hurt coming back up...

Instead of a nice trip to Sam's Club, I ended up sleeping on her day bed. Vomiting always eases the worst of my migraine symptoms, but I want to sleep afterwards.

Fortunately, I'm better now. I just feel like I want to crack open my skull and scratch the insides of my head. This should pass a day or two.