Thursday, October 20, 2016

Big Business and State Lines

For years I've wondered why conservatives have been so insistent on allowing companies to sell insurance across state lines.

Prior to Obamacare, Insurance was regulated by the states. State by state regulations would determine the behavior of health pools. A health pool in Utah behaves dramatically different from one in California. To be able to sell insurance across state lines, insurance would need to be regulated at the Federal Level.

Perhaps this is the reason:

In our present system health care is socialized at the employer level. In this bizarre system, employers place the health care resources of their work force into a single pool. Employers can then leverages the health care of their employees for political and economic gain.

Wall Street and big business see the United States as a single market. Big businesses like to have entities in multiple states to grab as large a share of this market as possible. When big business seeks to expand nationwide they have to set up separate health care pools in each state. This reduce their ability to leverage health care.

Regulating health care at the Federal level (so that insurers could sell insurance across state lines) would allow Wall Streets and Big Business to consolidate the health care of their employees into a single pool that would have greater leverage.

Unlike conservatives, I prefer small business and local control. I have so thoroughly broken with The Tories conservatives that I even question the wisdom of socializing health care at the employer level. Giving employers control over the health care resources of their employers creates a situation where employers can act like the feudal lords of old.

Speaking of Feudal Lords. Did you know that the grand ideology of Conservatism was created by King Williamn IV in the 1830s as an effort to rebrand the Tory Party in the wake of electoral reform.

The goal of Conservatism (The New Tories) was to preserve the social structure of the feudal system.

The Tories (also known as Conservatives) favor socializing health care at the employer level because it creates a class society with a distinct employer class that owns the resources of the nation and a working class that lives from hand to mouth dependent on the benefits given by the employers.

In the old world conservatives still proudly bear the name "Tory." In the United States, Conservatives are whimpering cowards who simply deflect conversations and refuse to engage in open debate about health care policy like the slimy little worms that conservatives are.

The issue of "buying insurance across state lines" is a perfect example of the way that Tories engage in conversation. Insurance is a regulatory product. Health care pools behave according to the state regulations. The great conservative cause of "buying insurance across state lines" means transferring control of insurance from the state to the federal government.

Conservatives will speak about state's rights in one sentence then demand the ability to buy insurance across state lines in the next (failing to mention that the sentences are are contradictions). Conservatism today is as flawed and corrupt an ideology as it was in 1830s when the Tory Party changed its name to "The Conservative Party."

The conservative cause of buying insurance across state lines means the creation of a single health care market controlled by central bankers on Wall Street with even less local control than we have today. Trump and his conservative followers are marching in the wrong direction.

Tuesday, February 9, 2016

Health Empowerment Accounts

For the last eight years I've held that, if a group of people engaged in a serious conversation about free market health care reform, that group of people could have a decisive effect on the heatlh care debate.

I've been been perplexed by the unwillingness of Conservatives to discuss free market reforms and had given up on the GOP.

However, I was delighted to hear Doctor Ben Carson mention the words "Health Empowerment Account" before the moderator cut him offer and diverted to less pressing concerns.

I was astounded. A word about free market health care reform was spoken in public and, just maybe, some people somewhere started thinking about the issue.

Maybe some people asked themselves: "What is a Health Empowerment Account"?

  1. How can an account empower people?
  2. How is a "health empowerment account" different than a "health savings account"?
  3. Why did the moderator cut Ben Carson off?
  4. Why haven't any other conservatives discussed free market health care reforms in the last eight years?

I actually do have answers to the questions above. Let's answer the easy questions first. Going in reverse order:

4) The moderator cut off Ben Carson because conservatives (and members of the GOP Establishment) do not want the American people to discuss free marketh health care reform.

3) Conservatives don't want Americans to discuss free market health care reform because true free market reforms would hurt the insurance industry.

Conservative opposition to free market reform is itself a very interesting story. For this paragraph I will simply state that Conservative think tanks are often funded by insurance and the goals of Conservatism and Big Insurance companies are closely aligned.

This thing we call ObamaCare (PPACA) is a network of state run health exchanges. The structure for the health exchanges was created by a Conservative group called "The Heritage Foundation." The basic idea is that the industry could improve coverage if the state were to combine insurance mandates with regulations that forced insurance companies to provide coverage for pre-existing conditions.

The Heritage Foundation believed that insurance mandates might help it achieve a variety of conservative social goals. After all, the group that controls access to health care can control the people.

2) Conservative have a long history of passing legislation that benefits insurance companies. The system of Health Savings Accounts is a prime example.

The HSA program gives a tax credit for money put aside in a "Health Savings Account." My first observation is that only people with large incomes benefit from the tax credit.

An HSA is usually given in conjunction with high deductible insurance policy. The high deductible frees insurance companies from having to process small claims for day to day care.

The pernicious effect of the HSA is that only upper income employees benefit from the tax credits. Lower income workers simply receive health coverage with high deductibles which they cannot afford to pay. While it is true that low income workers with no children and no health expenses can benefit from an HSA, the HSA model artificially decreases the income of low income with children and those with health expenses.

The HSA model was created by the insurance industry as an add on to insurance to benefit insurance and people in upper management. The fact that one model built around savings benefits the rich does not mean that all models will benefit the rich.

1) This is why I was excited to hear Ben Carson mention the words "Health Empowerment Accounts" during a public debate.

I believe strongly that, if one built the health care system around a health account that one could create a system that empowered people to take control of their health.

I am not an expert on the Ben Carson plan. Okay, the only thing I know about the Carson plan is that it starts by giving each person an account that is used to track their personal health savings and expenses.

I know that this statement will sound weird at first. But this simple step of giving people an account to track their savings and expenses would fundamentally change health care in America.

The current health care system is built on a collectivist model. In the current system, health care is provided at a group level through insurance companies. Insurance companies collect premiums for care to build a health care pool. The insurance company tracks the expenses of the pools and the wealthy investors speculate on the pool. Claims adjusters within the pool determine who receives care and when.

For more information on the philosophical model behind insurance. I suggest reading a rather dense tome titled "Das Kapital" by a nineteenth century thinker named Karl Marx. (I never really understood insurance before I read this work by Marx who could rightfully be considered the founder of modern insurance).

And yes, I did just state that employer based healthc are is socialization of health care at the corporate level. From a mathematical point of view, there is little difference between health care collectivized at the employer level and health care collectivized at the state level.

The most direct path to breaking apart a collectivized system is simply to start tracking expenses at the individual level.

The money for health care could still be in a pool. The simple fact that the system is tracking the health of individual people and not collective health would fundamentally change the system.

The simple fact that individual accounts would allow individuals to start seeing their health as their concern would dramatically change the health care system and health in this nation.

I admit, I am part of that radical fringe who wants America to take the anti-social step of removing some of the money from insurance pools and giving individuals greater direct control over their health care dollars.

Like other free marketeers, I have a tendency to jump of ahead of myself and start talking about how our society would appear if there was a more equitable distribution of capital. (Hint there would be more small businesses, less big businesses, a more equitable distribution of income, and healthier people.

People are so cowed by big insurance that, at this point in time, people are in capable of imagining health care without huge pools.

But, if they had direct access to information about their personal health, people would start to realize that they would be better off with direct control of their health care dollars.

Anyway, I was really excited to hear Ben Carson say the word "Health Empower Account" on the TV set before being cut off by the moderator.

My head has been spinning with all of the possibilities that could take place if there were people brave enough to talk about free market health care reform.

Now, both Ben Carson and Rand Paul seem to be out of the running for this presidential race. None of the other GOP candidates seem to have any interest in free market health care reform.

I can't imagine a debate about free market health care reform taking place in this political cycle; So, I admit I am somewhat at a loss as to where we should take this debate.

Dr. Carson's system of "Health Empowerment Accounts" would go a long way to restoring freedom in America. I think what we have to do is discuss why recording health information on an individual basis would change health care and work to differentiate this idea from Health Savings Accounts. Above all, those seeking to advance free market reforms have to counter this fiction that Conservatives support free market reforms, when the truth is that conservatives actively silence discussion of such reforms at every step. Just hearing a person mention a word in a debate before being silenced should be enough. But I can't figure out where to proceed with that.

Monday, November 9, 2015

The Difficulties of Discussing Mathematics

Truthfully, I stopped following Utah politics. While watching national news, I discovered that Utah's Health Coop was one of the dozen of health coops which have failed. Apparently, the coop officially failed on October 27th and the Utah insurance industry is ripping at the dead carcass of this beast as I write.

I was really upset when the Utah political machine shoved the Utah health coop down our throat with very little debate. Had Utahans engaged in a conversation about insurance, I am sure the state could have pieced together a much better deal.

I read several of the reports on the failure of the coop and wondered if the failure of this entity might lead to an open discussion about alternative approaches to health care reform.

I feel like a broken record here. For the last seven years, I've contended that if a group of people got together to discuss the mathematics of free market health care reform, that group could create an alternative to group health insurance that would get our nation out of the mess created by the insurance companies.

The discussion involves mathematics (Junior High level mathematics) but math is still math and people are scared of math.

As you see, a discussion about health care simply must start by creating a mathematical model that describes individual income and individual health care expenses.

There is no way to discuss health care reform that does not involve discussing the mathematics of health care.

Unfortunately, it is impossible to talk about mathematics of health care online because people browsing the internet simply lack the attention span to discuss mathematics.

Let's take a very simple equation A = B, where A is a complex express and B is a complex expression.

To discuss "A = B," I might start by creating a post about "A."

The post is likely to lead into a huge flame war about "A."

After the flame war settles a bit, I will try to talk about "B" and another flame war will ensue with trolls accusing me of hypocrisy because B is different from A.

The way people behave on the Internet, I will never get to the sentence that "A = B."

The battle is lost from the get go.

One does not find a large number of web sites discussing mathematics on the internet, because people on the Internet lack the attention span to discuss complex ideas in depth.

The "Medical Savings and Loan" is a conversation about health care that starts by creating a mathematical model of income and health care expenses. The model has several components: Every member of the plan has a health savings account. Members buy into a loan reserve. The system includes a generously funded grant program. The plan is administered by independent agents call Health Care Advocates.

These components work together to create a mathematical model of health care.

I put together a presentation in which I talk about each of the components of this plan. I talk for almost 15 minutes about each component. This is about an hour.

After creating this model, I create a mathematical model of group health insurance. (Employer health insurance and socialism are essentially the same thing. Socialism is group insurance at the state level. Employer based care is socialism at a corporate level). From a mathematically point of view there is little difference between group insurance and socialism. The only real difference is political.

An hour and twenty minutes into my presentation, I get to the point where I can compare the Medical Savings and Loan to Group Care.

At this point in the presentation, I start to compare the models of group care to individual care. I contend that if people started having this conversation, they would not only opt for individual health care, they would use the mathematics I discussed to create viable alternatives to Obamacare.

I live in Utah. Utah is a closed and intolerant society.

Anyway, I see that exchanges have failed in Arizona and Nevada. It is possible that people in neighboring states might be interested in discussing health care reform.

I am still convinced that if people studied the mathematics of funding health care and discussed free market health care reform, that the group could have a positive impact.

Of course, a person who is locked out of society can't do much ... which is why I had stopped blogging.

Monday, July 27, 2015

Dehumanized Care

The "Center for Medical Progress" is making a stir by showing videos of people from Planned Parenthood negotiating the sale of body parts from aborted babies.

Pro-life groups are using these shocking tapes to target the abortion industry. The sad truth is that this type of behavior is likely to become common throughout our entire health care system.

Planned Parent receives a substantial amount of federal and state funding. It is the model of the highly regulated medical industry envisioned by the progressive movement.

The path that the health care industry is following is dehumanizing. Socialism is dehumanizing. Socialism sees the community as having greater value than the individual humans in the community. And when the system stops seeing people as living inviolate beings, the system is likely to start seeing the harvest of body parts as a legitimate form of income.

In a true free market system, health care is a service provided by doctors directly to patients. This direct contract forces the system as a whole to align with the needs of individuals.

In socialized care, insurance is a form of socialized care, throws a third party into the mix.

As the system aligns to the desires of the third party, the system become dehumanized.

Planned Parenthood is the poster child of this industrialized form of health care. According to CNSNews Planned Parenthood performed 333,964 abortions in fiscal 2011.

Reports say that the Holocaust took six million lives. So, every 18 years, Planned Parenthood commits a Holocaust.

Our industrial style approach to health care reduces people to statistics. When the "health care system" simply sees people as parts processed through a machine, the harvesting of body parts in the system is soon to follow.

Please note, I don't see this problem as unique to government funded care. The Health Insurance industry is as bad as government. The insurance industry attempts to fund care by putting us in groups and providing care to people on a group basis. The actuaries and underwriters who determine the scope and quality of our care see us as statistics. This dehumanized approach to health care has no moral compunction against harvesting body parts from the people who flow through the system.

I am delighted that prolifers are outraged at Planned Parenthood. I only wish that people on the right realized that their precious little insurance companies, the fertility industry, as other aspects or our industrial approach to health care (including insurance companies) are as dehumanizing as Planned Parenthood.

The abortion machine in the Planned Parenthood corporation is just one of the more flagrant examples of an entire health care system which is off track.

Sunday, February 15, 2015

The Best of Care and the Worst of Care

My father is 87 and is finally at the part of his life where he has huge health expenses and has spent the last several months trapped in the American health system. In the last two years he has had a heart attack, two major strokes (many minor strokes) along two broken hips. The health experiences involved three stays in rehabilitation.

My family members are active and aware of nutrition; so we have had very few health issues until now. The last prolonged illness we experienced was that of my Grandmother who moved in with my parents for three years back in the early 1980s while I was away in college.

My father's experience seems to be the same as many Americans. Our experience with doctors, nurses and physical therapists have been wonderful. Our experience with the health care bureaucracy has been horrible. Our experience with insurance, social workers and fuzzy left wing type therapy has been negative.

While the real medical care has been top notch, the political side health care system kept forcing us into making costly decisions that did not enhance the care.

I should say that it forced bad decisions with one major exception. The insurance forced my father into rehab. If he was paying for his own care he would have insisted on coming directly home after each operation which would have turned my mother's life into a living hell.

The hip surgery involved pinning a fracture in the femur that was just below the hip. The problem with this surgery is that the patient's hip needs to immobile for six weeks after the surgery. But if a person is inactive for six weeks, he will pretty much turn static and die. Hip patients need a trained physical therapist who knows how to keep a patient with an immobile hip active.

Because of insurance, the doctors were able to pull the trick of requiring the physical therapy. Refusal of physical therapy would be against doctor's orders, in which case the insurance company would deny the claim for the surgery. The insurance put my father in a bind that forced him to do what was best and follow doctor's orders.

There is a strong temptation to say that the health care system must be structured in ways that doctors can force patients into making the decisions that are best for the patient.

This was my first direct experience with hip surgery. The orthopedic surgeon, of course, had experience with hundreds of operations and access to literature based on millions of operations.

So while my family were neophytes in the hip surgery arena, the professionals know the choice intimately. One must keep the hip immobile and patient active. Without a trained therapist in the mix, the patient either becomes sedentary and dies or moves in a way that causes extreme pain and requires another expensive surgery.

There are options to pinning a fractured femur. For example a costly complete hip replacement could be done on more of an outpatient basis, or the surgeon could have amputated the entire leg which can be done on an outpatient basis. Although I am applauding the insurance for forcing a good decision, I can see other ways to force the right decision of attending physical therapy after a surgery.

For example, the doctor knew before the surgery that the procedure he was undergoing would require physical therapy. He could have informed us of options before the surgery. In the way it happened, the doctor did the surgery then gave us the ultimatum of attending therapy or paying the full cost of the surgery out of pocket. If my father had the choice between a hip surgery and six weeks of rehab or an amputation; I am pretty sure he would have chosen the surgery with rehab.

Although I am glad that the bind placed on my father by the insurance company forced him into physical therapy, I cannot say that such binds are the best course of action.

Anyway, I thought about blogging about this decision a few months ago. But I have been stuck on a problem. I realized that conservatives are as much a part of the problem as progressives, and I have to come up with an approach to discussing health care to show that the Conservative approach to the subject is as bad as the progressive approach.

The real science based medical care delivered by doctors is part of the classical liberal tradition. Both conservatives and progressives are guilty of piling political garbage on the health care industry. No matter how one goes about it, the politics involved in care generally diminishes the care.

Anyway, I held off on writing any blog posts until I found a good way of showing that both Conservatism and Progressivism hurt care.

The primary problem in American health care is politics. Paul Ryan and Mitt Romney are as bad for our collective health as Barrack Obama and Harry Reid. I fear that my blogging about health issues is feeding the false narrative that conservatives have solutions to health care when conservatism and progressivism are both parasites feeding off the system.

Monday, December 1, 2014

Economies of Scale

It is possible for a manufacturer to achieve economies of scale by building a huge factory that buys everything in bulk and processes the material through an assembly line.

This idea applies to the supply side of manufacturing. It does not apply to the demand side.

Buying in bulk is not the ideal approach for the demand side.

For example, lets say you are thirsty for a soda: Are you doing yourself a favor by ordering a Big Gulp?

Attempts to apply supply side thought on the demand side actually leads to waste.

We see this clearly in diet.

A healthy diet should include a steady stream of fresh fruits and vegetables. The best way to eat a healthy diet is to establish a steady stream of seasonal fresh vegetables.

On the consumption side of the equation, people maximize their resources through moderation.

It is possible for the food industry to supply a steady stream of such vegetables by growing a huge winter crop in Arizona and then shipping it around the county. But, there is an asymmetry in this equation.

One can achieve economies of scale on the demand side, but the consumption side should be ruled by moderation.

It is possible for a physician to set up an assembly line for select procedures. This happened in laser eye surgery. A doctor might streamline the procedure for cataract surgery by carefully analyzing and optimizing each step of the process. The doctor can then efficiently treat this problem by having a steady stream of eyeballs rolled through the operating room.

This procedure is great when there is a large population needing the surgery, but doing cataract surgery on a population that does not need it is harmful.

There appears to be a correlation between cloudiness of vision and diet. AllAboutVision cites studies claiming that people eating a diet high in anti-oxidants and certain vitamins have a reduced need for such surgery and people with a diet high in carbohydrates seem to have an increased need for surgery.

While I applaud ophthalmologists for developing industrial treatment for laser eye surgery. I believe that individuals are best served by learning about the effects of diet and health on the eyes to postpone cataract surgery for as long as possible.

The secret to developing a good diet is information.

The world is in the process of transitioning from the industrial age to the information age.

Seeking "Economies of Scale" was a mantra of the industrial age.

The direction of the information age should be learning how to employ all the wonderful information we receive from scientific discoveries to improve the quality of life.

In the industrial age, people were seeking the benefits of economies of scale.

The goal of the information age is to use information to maximize the benefit of our consumption of resources.

In some circumstances, manufacturers can reduce waste by manufacturing on a large scale, but the real benefits of the information in the information age arise by applying information in ways that properly size our consumption to our needs.

In many cases, economies of scale actually harm us by creating wasteful imbalances.

The insurance industry preaches that they can reduce health care costs by pooling local resources and buying health care on a massive scale.

The insurance industry has made this promise for over a century. The system has systematically failed to reduce the cost of care.

Pooling our resources seems to have the effect of concentrating wealth and power in the hands of a insiders in the insurance industry while creating wasteful imbalances in the application of care.

My presentation on health care shows why this happens. When one realizes that health care is a matter of many things taken in moderation, it is easy to prove that pooled health insurace (including socialism) is incapable of achieving the economies of scale that it promises.

I have to repeat. If there is a large market for a given product such as cataract surgery, doctors can achieve efficiencies by creating a streamlined surgical procedure that passes patients through assembly line medicine.

These efficiencies are achieved on the supply side. Physicians will create streamlined procedures with or without group health insurance.

Insurance salesmen lie to us with the claim that we can achieve economies of scale by putting our health care resources in a pool. They are taking a legitimate idea from the supply side of the equation and applying it to the demand side.

Proper health care is a matter of balance and moderate consumption of many different things. Yes, individuals can benefit by streamlined health processes. Our individual consumption of these resources still must be ruled by moderation.

The best way to achieve the right balance in health care in the information age is with the concept of mass customization.

Attempts to apply economies of scale from the consumption side, as is done with insurance and socialism, leads to a wasteful imbalance in the consumption of resources and eliminates the customization of care that would happen if health care were left to a free market.

Friday, November 7, 2014

The People v the Kleptocrats

The GOP won an election, but they seem to lack vision or direction. A political movement that lacks direction can be dangerous.

The vision from the political parties should come from the people. If the people fail to provide a vision, the lobbyist will step and sell their vision. The vision of lobbyists is best called "kleptocracy." (kleptocracy: rule by compulsive theives).

Than antidote for this lack of vision is simple: People need to start talking about solutions and a positive direction for the country.

I am interested in free market health care reform. My goal for the last six years has been to attend or host a meeting in which people spoke about free market reform. I admit what I am saying is radical. I believe that if people actually got together and spoke about the issue of health care reform they could help clarify and provide vision to health care reform.

I realize that my vision of people meeting and actually talking about free market health care reform is a radical step which conservatives are unwilling to even contemplate. But this is what has to be done to save our nation.

A little shameful self-promotion is in order here: To make a meeting productive, I put together a presentation.

I believe that funding health care is a business problem and not a political problem. We need business solutions and not political solutions.

This sentence alone puts us on a path to fighting the kleptocracy of Washington because is says we are not looking for the lobbyists to provide a solution, we want the lobbyists and government to get out of the way.

The statement: "leave us alone" is not enough to insure a good tomorrow. The next step is to talk about what we will do when left alone.

My presentation starts by creating a mathematical model of health care expenses. I then create a new business model to help people cover these expenses. I then discuss how an improved business model for funding health care would overcome the inequities of the insurance industry.

I have searched high and low to find meetings to attend and groups to support. If we want to repeal ObamaCare and restore free market principles in health care, people have to talk. This continued dead silence and intransigent unwillingness to discuss health care reform means that the GOP will surrender our health care to kleptocrats.

The presentation I put together is a nice starting point for a discussion of health care. The presentation has a role for individuals. It has a role for health care providers. It has a role for private charities and a greatly reduced role for government.

I keep trying to have meetings, but no-one has ever attended (PS: I live in Utah. I am not LDS). I am happy to attend meetings by others, but no-one is holding such meetings.

Anyway, I've been stuck in a rut for the last six years on the idea that the first step to restoring free market principles health care is for people to talk about the issue. But Conservatives are scared of mathematics; so no discussion will ever occur, and we are left to surrender our society to the kleptocrats in DC.