On the other hand . . .

Something the WSJ hasn’t taken up yet, and really, really needs to be addressed in this whole health-care-reform debate:  The way our current insurance system supresses entrepreneurship.

What works well right now is the company-sponsored health insurance plan.   Go to work for a large organization with good benefits, and you’re in pretty good shape, healthcare-wise.  Thus it goes against the grain, when thinking about improving access to health care, to do anything to fiddle with the one part of our system that is actually providing decent care.

–> But because it is the *only* method that is working well, people who need good insurance at an affordable rate are essentially barred from entrepreneurship.

It needn’t be this way.  There is nothing special about insurance pools formed by grouping co-workers.  Individuals could be be grouped by location, by industry, by favorite color — however you like, the principle of pooling risk works the same, as long as you have a large number of buyers over whom to spread the risk.

–>  A reform of the insurance industry could open up affordable insurance options to individual buyers, regardless of their employer.  Transparent pricing policies would further enable individuals to make confident health care purchases without relying on an insurance company to do all the negotiating for reasonable rates.

But as the system stands now, large companies are able to suck in a disproportionate amount of talent because they hold the key to reliable, affordable health care.  And specifically, they are able to suck in over-qualified talent because of the cost/price differential between health care costs in the corporate versus the individual markets.

***

People work around it.  You start your own business on the evenings and weekends, and hold onto the corporate job until you finally have enough income to go on your own.  Or your spouse works the corporate job, any job, just to get the benefits, so you can be covered while you get the business up and running.   As you grow your little company, at first you try to hire employees who already have insurance through a parent or spouse or a 2nd job.  There are ways to work the system.

But I think economically it is a drain.  We would be better off– and better able to whether economic downturns — if our structures for providing health care were more favorable towards entrepreneurship and small businesses.

 

health-care: private versus public rationing

One of the arguments in favor of Obama’s health care program is something like this:

“Insurance companies effectively ration care, too — deciding what treatments the insurance will and will not cover.  Therefore, going to a government-run program will make no difference.  Those who complain about possible ‘rationing’ are throwing out a red herring.”

I disagree, for all the reasons Darwin Catholic lists here.

***

[Review: I am not a person who is opposed to health care reform.  Indeed, I am a person who has written on this very blog about what kinds of health care reform I think are needed.  I have specifically given examples of why charitable assistance is needed for those who can't afford adequate health care.  I just happen to think that going to a single-payer, government-run system might not be the best of our available options.]

***

I would add that in my opinion, effective health care reform would free up our insurance system so that consumers have *more choice* and *more information* in order to choose an insurance progam that best meets their preferences.  For example, someone has proposed making insurance portable from job to job.

–> I think the idea is that insurance pools would not be formed by companies on behalf of their employees, but rather by individuals.  The role of the employer would be to provide the means to pay for the insurance.

***

And of course for all this to work, yeah, you’d need pricing transparency.  You’ve got to know what your costs are, if you mean to control them.  You just have to.

 

Good ideas on health care reform

Glad to see the Journal has finally started running op-eds with proposals for solutions to the health care situation, rather than just storming against the Obamacare thing.

What I’ve seen that I really like:  Reforming and expanding Healthcare Savings Accounts, combined with high-deductible insurance policies.  And then providing health care stamps, analagous to food stamps, with which people who have legitimate financial need can fill their HSA.

This seems to me like a relatively efficient, manageable solution that offers a real possibility of helping the poor without undermining the many things that actually work in American healthcare.

I also, of course, am firmly convinced that we need pricing transparency.  Just no way you can run an efficient market when nobody even knows the product prices.

***

One thing I’d like to argue about:  Saw a comment a week or so ago about how Americans, compared to other nations, spend the most on healthcare, but do not have the best health outcomes.  To which I’d observe:  If you are in poor health, you will spend more money on healthcare.

I believe our obesity rates alone probably explain a significant portion of the gap.  We as a nation choose to be in poorer health than we must, and then we choose to treat the health problems we give ourselves (understandably!).  No surprise the figures run as they do.

[There is also a significant amount of money spent on elective procedures such as cosmetic surgery that are may be bundled into our 'healthcare expenses', but have nothing to do with making people healthier.]

None of which is to deny that our health care situation has its problems.  Just that the raw statistics do not tell you what the problem really is.

 

Book Review Finally Up

For those of you who have been desperately awaiting my review of The Angels and Their Mission, now your summer can be complete.  Enjoy.

 

Home Again

Back from the achingly beautiful desert . . . enjoying the riotous delight of a place so wet the trees grow like weeds.  Excellent trip.  During which I, unusually for me when I visit the place, got almost no news and no internet time.  And was really quite happy that way.

Attempted to goof off one day and ended up doing my planning for the coming homeschool year.  Determined that there really just isn’t that much free time running around my life.   So I’m guessing the summer vocation will tranform into a full-time gig.

Encyclical remains just partly read.  The part I read was, as expected, entirely fabulous.

Speaking of reading and weighty topics, focus for this school year is going to be on Just War, legitimate self-defence & waging peace.  Maybe a little will trickle out onto the blog.  Probably very little will trickle out — I’m scrambling to get the house ready for the school year, and hope to hit the ground running August 17th (our legal school year opens the 15th, a Saturday) so we don’t run into the gotta-work-through-the-end-of-June thing that hit us this past year.

All that to say, do recommend your favorite titles on Just War and related topics.  And if you know of any such titles aimed specically at school-age *boys*, please oh please oh please speak up.

Have a good August,

Jen.

 

A new encyclical!

Woohoo!  Wildly excited to see that news, as I tried desperately to catch up on my goofing-off today.   [Dear Lord Jesus, thank you for giving us a Pope who writes things I am just barely smart enough to read.] Printed it out, will drag to Las Vegas next week with the rest of my overdue reading pile, and maybe write about it one day.   Meanwhile, the summer vocation goes very well in massively busy kind of way.  Hope you are having a good summer yourself.

 

Excuse of the month, I suppose

Crazy busyness ’round here.  Mostly the good kind, but it sucks up writing time.  You know I want to talk more about health care, and about 6,000 other timely economic and political topics.  Just not happening right now.   Goofing off is in short supply, and goofing off with brain engaged even more so.  One of these centuries I’ll get back into the swing of things.  Meanwhile I’ll note that the Darwins are doing plenty o’ posting these days, and I’m sure you can find others.

 

May the Best Budgeter Win

A few months ago (yeah, I know), I picked up a copy of The Medieval Military Revolution (Barnes & Noble 1998 – originally written in 1995 — Edited by Andrew Ayton & J.L. Price).  Been sitting on my shelf, inherited from TR, yet unread.  I was looking for something I didn’t find there, but I came across this thought in the editor’s introduction:

Those that live by the sword shall die by the sword, and this can be applied in a sense to governments and even states as well.  States went bankrupt, at least technically, through the cost of war, and the fiscal strain of long-term involvement in warfare was perhaps the single most important threat to political stability even in this most turbulent of periods.

In this case, the editor is writing about the mid-16th to mid-17th century.  But every century has its nations, and the realities of economics and defense don’t disappear over time.

When I was in high school economics, I can remember people trying to argue that somehow the US’s national debt just didn’t matter.  We were too big to fail, or by some bit of magic we could borrow as much as we wanted and nothing would really happen . . . it was bizarre. Didn’t make sense then, and still doesn’t.  I suppose we could always stiff our creditors in the end, but even that has its consequences.

The US is a mighty wealthy nation.  Wealthy people can waste a lot of resources and not feel the consequences the way poorer neighbors would.  But there are limits to our wealth.  We can’t just magically spend on anything we decide we want — even we must pick and choose.

***

And anytime we borrow? We have to pay it back out of future wealth.  The only time borrowing fuels growth is when the money borrowed is invested in something that makes us more productive. The hallmark of a chronic debtor, of course, is the conviction that every debt really was necessary, really did make the debtor ‘better off’.

But reality isn’t so.

In the current economic quagmire, households, businesses, and governments that had previously acted prudently and with fiscal restraint are managing fairly well.  A neighbor was laid off, but fortunately he had savings, was living beneath his means — he has a little cushion to get by while he looks for a new job.  The greatest crises today are coming among those who were massively in debt a year ago or more, and don’t know how to get by without yet more debt.  (Or, of course, stiffing their creditors.)

–>  Not talking here about those families and businesses that did everything ‘right’ during the flush times (which were not, for them, all that flush), but still struggle today.  Not talking about those whose reverses have been far greater than anyone could plan against.  Prudence today won’t withstand every possible storm tomorrow. But it sure improves your odds.

***

So I’m a bit alarmed by the current rush to spend, spend, spend.  Oh and it isn’t a democrat’s problem — I had a pit in my stomach prior to the presidential election, knowing that I could count on either party to be just as irresponsible.  I’m alarmed by things like trying to create new government-sponsored insurance programs *for people who already have health insurance*, when we haven’t sucessfully put together a program for those who don’t.

–> Frankly I’m really dissappointed in the democrats, because they aren’t actually coming through on helping people who actually need help.  Tons and tons of spending on vague programs to ’stimulate’.  Er, how about we just get everyone who needs food fed?  Houses for *actual homeless people*?

A more personal example: I’ve a friend who has an undiagnosed breathing problem. She *stops breathing*.  She can’t afford a doctor’s visit to diagnose the problem.  Mmn . . . how ’bout we stimulate the economy by making it possible to get in for a doctor’s appointment if you’re a person who can’t work because you can’t, uh, breathe reliably??  That cash would trickle into the pockets of a receptionist, a maintenance guy, a lab worker, an MD — *and* we’d have a person who might be able to breathe all the time? And thus be able to go get a job? Hmmn?

***

End of the rant.  Have a good week.  Soon as I find my lost book, I’ll have a review up on the other blog.  Meanwhile am trying, as always, to clean the house, educate the children, exercise the ol’ mind, body & spirit, and all that other vocation-y stuff.  Hope y’all are doing well.  Oh, and hey, to keep you busy during my slackerlyness, here’s another cornucopia of social-issues rants: http://www.frontporchrepublic.com/ . Thanks to Bethune Catholic for the link.

 

Still Alive and All That

Didn’t realize it had been so long since my last post. Have written for you many times in my head, but apparently the whole ‘typing’ thing never materialized.  The free time has pretty much dried up lately, not really sure where it’s gone, though there are rumors it is in my garden.   Will get back here with some health care topics and other exciting stuff just as soon as I can.  Meanwhile, it’s spring!  Back away from the computer . . . Go play outside.

 

When Even the Buildings Are In Denial

For a cornucopia of social-issues posts, check out the Blogging Against Disablism Day blogfest.   I’m running behind on my own contributions, but I wanted to talk for a minute here about dumb architecture.  Not merely bad in the sense of ‘ugly’, for I must grudgingly admit that ugliness is in the eye of the beholder.  But dumb as in ‘doesn’t work’.  Buildings that don’t meet the needs of the people who use them.  Or would use them, if only they were useful.

What stuns me is not that there was a time when buildings were not made to be wheelchair-accessible.  There was, after all, a time when wheelchairs, like indoor plumbing, just weren’t a significant part of most people’s lives.  Would have been nice to have such conveniences, but you didn’t.  Too bad.  The architecture of those eras reflect that, and retro-fits to modernize can be a bit clumsy.  (But worth it!  In both cases!)

But I am continually amazed that we don’t, as a society, seem to have caught on to the bit about how people — all people — ought to be able to get in and out of a building, and even move around in it.  I’m reminded of when I lived in a little ground-floor room in Paris and that had a window that let out onto a courtyard.  I hosted a party at the end of the school year, and fully expected that my guests, if they wanted to relax on the grass outside, would simply climb through the window.  I was stunned to discover that not everyone includes climbing through windows as part of their traveling repertoire.

But I was young then.  I was not an architect, not even a builder.  My assumption that anyone (among my guests, who were all walking-around kinds of people) could and would climb through windows was naive and a bit self-centered.  I assumed that if I could do something, everyone else could, too.   Somehow you would think that building professionals would have grown passed that point.

I am fortunate to live in a home that was designed to be moderately wheelchair accessible.  Not perfectly so, but better than average.  One of the previous owners did a few renovations to make it even better.  And the sordid truth?  It isn’t that big of a deal.  Any grown-up who has, say, studied architecture, ought to be able to whip out fairly accessible homes without too much difficulty.  There’s nothing really magical about it.

[Tuning a building to the precise needs of a particular individual or family?  Yes.  That takes some doing.  But being able to get far enough into the ballpark that the residents can easily take it the rest of the way?  Not nearly so hard. ]

And curiously, I think that defaulting to accessible architecture would bring down construction costs.  Here’s why: in order to make a home wheelchair-friendly, you can’t crowd it up with a bunch of built-ins.   And built-ins — cabinets, counters, shelves, drawers, even closets and extraneous doors — these are things that drive up cost.

So why aren’t modern American homes built to a default level of accessibility?  It isn’t a lack of space — our homes are larger now, on average, than they were fifty years ago, and have fewer residents.  It isn’t that everything goes to two stories, and it’s just so hard to make a two-story home accessible.  If that were the case, a) single-story homes *would* default to accessible design, and b) two-story homes would still have an accessible first floor.  (After all, even if I don’t have a ground-floor bedroom for my wheelchair-using visitor, it sure is nice for that person to at least be able to *get in front the door*.)

So I’ve got to assume a sort of perpetual adolescence on the part of our building industry.  Not surprising in a culture that worships youth and beauty and vigor — I’ve known people with gray hair and grandchildren to openly deny they were ‘old’.   So I suppose if you are going to great lengths to fight any appearance of mortality or even maturity, intentionally purchasing a wheelchair-accessible home isn’t going to help you keep up the facade.  And for a builder, suggesting someone might actually want such a building some day is going to about as popular as my letting slip to my gray-haired companion that no, she was not actually all that young anymore.

It’s a sad kind of denial.  As I rode through the countryside yesterday on the way home from a family reunion, I was myself a little surprised at how many homes had a ramp tacked on to the front.   More informative than riding through the city, because in the country you aren’t likely to move when your house doesn’t fit your needs anymore, you just try to adjust your house as best you can.

Not the end of the world — a slapped-together plywood monstrosity of a ramp isn’t particularly attractive, but as I said, this post isn’t about beauty.   Look inside our family farmhouse, and the bathroom — converted from a bedroom, I think — betrays that same problem of The Home That Had To Be Brought Into the Present.

But there reaches a point when you’ve got to lose patience with builders and architects who are still building for Some Other Era.  Be a grown-up, builders. What you build, people *will* buy — most of us haven’t got a choice but to purchase what is on the market.  It falls to you to lead.  Recognize that humans are frail, mortal.  That not everyone can climb through the window.   And it just isn’t a good building if people can’t use it.