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In today’s (January 20, 2007) Boston Globe there is an article entitled Sticker shock for state care plan talking about the new Massachusetts state-mandated health plan…

State-mandated, to be clear, means that all citizens are going to be required to have state-approved health coverage. If you cannot show that you have state-approved coverage then you will be penalized on your state taxes (there was even talk of having your drivers license revoked).

This plan is supposed to eliminate the state’s population of uninsured people by forcing them to sign up for insurance. Unfortunately, nothing in the plan does anything to make the insurance offered affordable. The underlying agenda is to use the state’s enforcement capability to provide an additional revenue stream to politically well-connected insurance companies.

There is this strange notion that the majority of the uninsured just cannot be bothered buying insurance. In actual fact, the vast majority of folks without insurance simply cannot afford it.

According to the Globe article, the average individual’s monthly cost under the state-mandated plan will be $380 per month. That is about the same monthly cost as I pay for the health insurance I get through my local Chamber of Commerce… And I get the strong impression that the state-mandated coverage will actually cover less than my current coverage.

Of course, what will and will not be covered is rather hard to figure out. The details of the coverage being proposed by the insurers are “secret.” Even State Legislators have been unable to get any details on what is and is not included in the coverage.

It seems from the Globe article that the state panel responsible for setting up the plan was hoping to establish coverage that would cost about 50% of the current norm for commercial coverage (i.e. the mandated insurance would cost about $200 per month for an individual). And the insurance companies were OK with that until they found out they were actually expected to provide at least a minimum level of coverage.

As one of the members of the State panel, MIT Economics Professor Jonathan Gruber, stated, “If we’re going to mandate this, people need to see that they’re getting some value.”

This gets back to a fundamental issue with healthcare policy. Free market capitalism and private enterprise are not the way to go with healthcare. Free market capitalism leads to enormous efficiencies in some areas. Computers and consumer electronics get better and better and cheaper and cheaper each year. But that is because the right market conditions exist.

There are a number of conditions that need to exist to create efficient markets. You need real competition between vendors or providers (which doesn’t exist in the healthcare market), you need the purchasing decisionmaker to be the same individual as the final consumer (which doesn’t exist in the healthcare market), and you need the purchases to be fully knowledgeable about the products or services being provided (which is not the case in the healthcare market), and you need elasticity of demand (which doesn’t exist in the healthcare market).

Competition

In most states there are only 3 or 4 health insurance companies operating. And for the most part they offer similar coverage for similar prices. One of the reasons that healthcare costs keep rising is that no one is trying to keep them under control. The insurance companies are basically skimming a percentage of the revenue that passes through their hands on the way to doctors, hospitals, medical testing companies, and the pharmaceutical industry. The more money flowing through, the higher their profits.

Individuals do not decide who provides their coverage

The vast majority of individuals get their healthcare through their employer. The individuals do not decide which insurance company to use… Their employer’s HR department decides. And the HR department is deciding based on the cost of the plan to the employer, how easy or difficult it is for the HR department to deal with that insurer, etc. Very few individuals decide to accept or reject a job offer based on what health plan the company offers and even fewer would leave a job for that reason. In the end, companies will happily sacrifice individuals coverage in order to save themselves money… Or they will follow the Walmart sweatshop approach and provide lavish coverage for their management personnel and no coverage at all for their rank and file employees.

Lack of transparency

Even the HR departments are largely flying blind when it comes to what is and is not included in a given plan’s coverage (I know, having asked the HR folks at a number of my previous employers). And, as we have seen in today’s Globe article, the people managing this State effort are similarly baffled by the obfuscation tactics and fine print used by the insurance companies.

Elasticity of Demand

In order for a healthy (so-to-speak) free market to exist, buyers need to be able to not buy a product or service if they think it is too expensive. The classic example used in college economics class is “water in the desert.” If you must have something to survive, you will pay any price to get it. The healthcare market is a bit more complicated but, if you have a medical condition that is life threatening or makes you horribly uncomfortable then you are not going to be able to walk away from buying a cure or treatment. In contrast, if that new wide-screen TV is too pricey, you can wait until next year.

Eat your own dogfood

Probably the only way we can make sure that this Mass State mandated plan is providing people with adequate coverage is by mandating that the State Legislators, State Officials, and their families use the plan too. Otherwise, we will be creating a state-mandated 2nd-class-citizen health plan.

And the only way we will reduce costs is when there is complete transparency about what is covered and how it is paid for. With that sort of transparency we have a better chance of streamlining the system and removing waste.

Good places to find out more about this issue are:

www.masscare.org

healthcareformass.org

When I look at the array of likely 2008 presidential candidates, from both parties, I feel a bit queasy. I am an independent, I have voted for both Republican and Democratic candidates in the past. I do certainly pay attention to a candidates policy stands but I am would prefer to vote for candidates that have shown some leadership and integrity.

I have not seen much of either in the last few years…

So who do we have in the running?

• John McCain – I voted for him in the past but I don’t think he has shown much leadership or integrity of late. He must despise GW, look at the tactics that GW’s campaign used against him during the primary. Yet he has repeatedly allowed the Bush campaign to use him to shore up GW’s rather deficient military credentials. And he must have known from day one what a disaster Iraq would be. So, forget McCain.
• John Kerry – God I hope he doesn’t run. To my mind John Kerry is the Democratic equivalent of GW. Hyper-privileged, went to all the best schools, had everything handed to him on a plate, achieved nothing, and then went into politics. He’s been the senator from my state for as long as I can remember and yet I cannot think of single bill he initiated, or principled stand he took. And he did flip-flop. Like McCain, he must have known that the Iraq invasion was stupid but he was scared of the polls and voted to invade like all the other gutless wonders in Congress… So no to John Kerry.
• Mitt Romney – It’s sort of funny. I actually helped vote Mitt in as Governor. I doubt many people outside of Massachusetts understand the peculiar political dynamics that got Mitt elected as a Republican Governor in an overwhelmingly Democratic state. The Massachusetts legislature has been dominated for decades by a corrupt bunch of South Boston Irish-American politicians and they have totally dominated the State’s Democratic machine. The voters have repeatedly voted in Republican Governors… Essentially, as a protest. Mitt got voted in because a majority of voters figured voting for Mitt was the equivalent of a write-in vote for “Mickey Mouse.” He’s a Republican version of John Kerry. Born with a silver spoon in his mouth, floated through life thanks to lots of money and political connections. Never really accomplished anything. Oh, I forgot, he ran the Salt Lake Olympics… Right. With that on his resume, sorting out Iraq will be duck soup.
• Hillary Clinton – Hillary is intelligent, seems to work very hard, and is about as tough a character as I have ever observed in US politics. But I also think she is unscrupulous and self-serving. Her constant support for unacceptable Israeli policies and blatant pandering to the NY Jewish vote is quite unattractive.And she seems to be taking a page out of the G.W. Bush playbook… Never admit a mistake. When challenged on her voting to support the Iraq invasion she says she was misled by the Bush administration erroneous information about WMDs and connections between Iraq and Al Qaeda. Yeah right. Whatever else one can say about Hilary, she’s nobody’s fool, she knew the administration justification was bullshit. But she was reading the polls and decided to do what was politically expedient at the time. It has come back to haunt her and I suspect it will thwart her presidential ambitions.
• Rudolf Giuliani – I thought Giuliani handled himself well after 9/11 and he was also able to maintain at least some distance between himself and GW… Against what I imagine was immense pressure. So.. Rudi’s a possibility.
• John Edwards – I always preferred him to Kerry. I have a bias towards self-made types as opposed to wasted scions of our imitation aristocracy. I am not crazy about lawyers but I prefer a good one to a bad one. And I like his policies. I might vote for John if he survives the primary season.
• Barak Obama – I am getting serious doubts about this guy. Does he have any kind of track record? What has he done apart from getting elected to Congress? He speaks very well but it seems to be largely platitudes. He is getting tons of media attention but for what?

Update 31JAN09: What a difference a year makes. Not only is Obama our new President but I actually voted for him. It took about 6 months but by the time the Democratic Convention was looming, Obama had convinced me that he was, if not “The One”, then at least the best choice available… And we have Hillary as Secretary of State. Oh well, at least she’s not incompetent and, one hopes, Obama has folks keeping an eye on Bill.

I really feel that American politics is devolving… We are getting more Third World. We vote in George Bush, Senior and then eight years later we vote in GW. What’s that remind you of, eh? Papa Doc and Baby Doc.

And now people are seriously talking about Hillary. What’s that remind you of? Juan and Eva Peron, maybe? Maybe we’ll have Madonna sing “Don’t Cry for Me, Argentina” at the convention.

Remember Gerald Ford and Jimmy Carter. I cannot say I was all that impressed with them back when they were in office but, boy, do they look good compared to the current bunch.

I think it is high time for our friends at the highest reaches of government to “share in the sacrifice.”

George, Dick, Don, and Condaleeza got us into this mess.

Thousands of soldiers and marines are on their third or fourth tour of duty in Iraq, more than three thousand have made the ultimate sacrifice, around twenty thousand have been maimed, and the US taxpayer is pouring billions of dollars down a rathole.

I am getting a little tired of listening to this smug, complacent bunch of fools driving around in armored limousines surrounded by Secret Service agents talking about how they “feel the pain” of our injured troops, widows and orphans, and the public in general.

Let’s see some real sacrifice… Collectively the Gang of Four is worth tens, if not hundreds, of millions of dollars. I think its time to pony up. I’d like to see the Bush, Cheney, Rumsfeld, and Rice fortunes donated to US Treasury. Let ‘em keep a million dollars a piece to supplement their lavish government and corporate pensions but let’s use the rest to pay for this debacle they’ve jointly created. Even with all their millions it will just be a drop in the bucket… But, hey, it’s the thought that counts.

I got this from page A13 of today’s New York Times (January 12, 2007).

In February 2003, prior to the US invasion of Iraq, General Shinseki (the then US Army Chief of Staff) said the following in testimony before Congress:

“Something on the order of several hundred thousand soldiers are probably, you know, a figure that would be required to stabilize Iraq after an invasion.

We are talking about post-hostilities control over a piece of geography that’s fairly significant, with the kinds of ethnic tensions that could lead to other problems…

And so it takes a significant ground force presence to maintain a safe and secure environment, to ensure that people are fed, that water is distributed, all the normal responsibilities that go along with a situation like this.”

After these remarks before Congress, the Bush administration led by Donald Rumsfeld first vilified and then marginalized General Shinseki who then faded away into retirement.

Three years and three thousand combat deaths later, General Abizaid, the departing commander of US forces in the Middle East told Congress:

“General Shinseki was right that a greater international force contribution, U.S. force contribution and Iraqi force contribution should have been immediately available after major combat operations.”

General Shinseki has not made any public statements since retirement and certainly isn’t telling anyone “I told you so…” He doesn’t need to.

Years later, with Iraq’s infrastructure still in a shambles, and outright civil war going on between Shia and Sunni, the Bush administration wants to send another 20,000 troops and commit additional $ billions to Iraq reconstruction… Way Too little, way too late.

I read an interesting column in the February 2007 issue of Dr. Dobb’s (a software development journal). The column is by Ed Nisley and he is discussing a report on the problems with electronic voting machines in Cuyahoga County, Ohio during the recent Federal election. The column is entitled Root the Vote: Wetware… It doesn’t seem to be on the Dr. Dobbs website (www.ddj.com) yet but it may show up next month.

I don’t think I have ever talked to someone who is professionally involved with computers or software who isn’t anything but appalled by the idea of purely electronic voting.

As Ed Nisley comments in the column, the current issue is how difficult it is to implement a new voting technology with a temporary once-a-year or once-every-couple-of-years organization largely staffed by volunteers. This years problems were due to poorly designed machines, poor organization, and a lack of training. The issue in the future will be deliberate, subtle, difficult-or-impossible to detect, vote tampering.

In my electoral district we use the “fill in the oval” paper ballots which are then scanned electronically. In my opinion, that is the way to go. Most people are able to figure out how to fill in the ovals, there is a permanent ballot that can be recounted. The thousands of paper ballots would be difficult to alter without its being noticed.

Given the tendency towards dirty tricks in US politics and the generally corrupt relationship between government officials and government contractors, I think purely electronic voting is a recipe for disaster for our democracy…. Just imagine the closed room conversations… “Not only can we guarantee a smoothly run election… For only a few million more we can make sure your guys win!”

If we end up with a significant fraction of the votes being counted in a purely electronic manner then we will also get deliberate biasing in the outcomes. And it will be, essentially, undetectable. You can at least argue about a “hanging chad.”

In fact, the first we will know that there is anything wrong is when some techie gets sufficiently disgusted (or decides he wasn’t paid enough) and we wake up to find we’ve just elected Mickey Mouse president.

Ed Nisley called attention to a recent New York Times article (U.S. Investigates Voting Machines’ Venezuela Ties – October 29, 2006) about the Venezuelan government buying a US company that makes electronic voting machines… That were purchased for use in Venezuela’s elections. Apparently this is being investigated by the Bush administration… One is being asked to believe that a Republican administration is suddenly interested in free and fair elections in South America?

If you want to find out more, check the following links:

Cuyahoga Election Review Panel – Final Report

Election Science Institute – DRE Analysis for May 2006 Primary

Avi Rubin’s blog

VerifiedVoting.org