Science By Petition

March 11th, 2010

By Bradley J. Fikes

(Crossposted)

Global warming activists have had enough of being pummeled on blogs and in the press for errors in the 2007 IPCC report and bad scientific practices revealed in the Climategate emails. They’re frightened of the declining public belief that man-caused global warming is a serious threat.

So the climate change cheerleaders are doing what any self-respecting political group would do: circulate a letter and petition.

The letter, released Thursday, comes from the Union of Concerned Scientists, a left-wing pressure group. It calls for deep cuts in greenhouse gas emissions, and bears the signatures of about 2,000 scientists and economists. It’s available on the Web site of the Union of Concerned Scientists.. (Indicative of this group’s role with the letter, two of its eight references are to UCS advocacy reports).

The letter is notable for what it doesn’t mention, namely, any other potential human causes to climate change, such as the increasingly well-known role of soot and dust deposits in melting glaciers, especially in the Himalayas and the Arctic.

For example, the letter, published in a slick PDF, contains this highlighted quote from Lonnie G . Thompson of The Ohio State University:

Over the last 30 years I’ve watched many glaciers shrink in South America. It’s also happening in Europe, North America, China, and the Himalayas. More than 90 percent of the world’s glaciers are receding—they have no
political agenda. Science is about what is, not about what any of us believe.

But scientific research reveals that blaming glacial melting solely on carbon dioxide — even assuming that human- released CO2 is causing global warming — is flatly inaccurate.

A study by a team led by Surabi Menon of Lawrence Berkeley National Laboratory estimated that the vast majority of unusual melting in the Himalayas is caused by soot and dust

According to the study’s press release:
“Our simulations showed greenhouse gases alone are not nearly enough to be responsible for the snow melt,” says Menon, a physicist and staff scientist in Berkeley Lab’s Environmental Energy Technologies Division. “Most of the change in snow and ice cover—about 90 percent—is from aerosols. Black carbon alone contributes at least 30 percent of this sum.”

The findings are significant because they point to a simple way to make a swift impact on the snow melt. “Carbon dioxide stays in the atmosphere for 100 years, but black carbon doesn’t stay in the atmosphere for more than a few weeks, so the effects of controlling black carbon are much faster,” Menon says. “If you control black carbon now, you’re going to see an immediate effect.”

The point bears repeating: Aerosols, fine particles suspended in air, are not greenhouse gases. And if 90 percent of unusual melting is caused by aerosols, and the effects of controlling them are much faster than reducing greenhouse gases, it makes no sense to obsess over the latter and ignore the former — unless the motive is political,not scientific.

A 2005 NASA study also found that soot could be hastening melting of Arctic ice. The study, by Dorothy Koch of Columbia University, New York; and James Hansen of NASA GISS appeared in the Journal of Geophysical Research.

No reference to this and other scientific research on aerosols appears in the letter. It contradicts the political crusade of global warming activists against greenhouse gases. And they’re counting on politicians just skimming the letter and looking at the names, and not analyzing the logic of its content.

In fact, the letter and petition is just another one in a series from the busy PR types at the Union of Concerned Scientists. For example, UCS released another such letter/petition in May of 2008, dutifilly reported by the media stenographers.

One of the quoted scientists in the letter, Benjamin Santer, also figures in the Climategate emails. Enraged at researcher Pat Michaels, Santer wrote to Phil Jones of the University of East Anglia:

“Next time I see Pat Michaels at a scientific meeting, I’ll be tempted to beat the crap out of him. Very tempted.”

You can read a context-less blog post on the petition at USA Today.

Posted in politics, science | 4 Comments »

The pleasures of medicine; or not.

March 7th, 2010

UPDATE: Nearly half of all physicians plan to quit if Obamacare passes. Many will phase out but it will be a disaster. I’m sure Obama has plans to fix it.

I have been a physician for almost 44 years. I graduated from medical school in 1966 and finished my residency training as a surgeon in 1972. Since I began medical school in 1962 (For the second time but that’s another story), I spent ten years learning to do what I did until I retired from surgery in 1994 after back surgery. I have gone on doing medical things since then but I had to give up surgery. The 27 years I spent as a surgeon (including my training) were the best years of my life. Had I not injured my back in college, I would still be practicing, even at 72. The early years of my career as a surgeon were the golden age of medicine in this country. We still could not cure some diseases and we especially were limited in our ability to deal with infection in some cases but the life of a physician or a surgeon was the best it would ever be.

About 1987, things really began to change for the worse. Some of it was the fault of the profession, some the fault of politics and some the fault of human nature. In 1978, the first political reaction to the rapid growth in the cost of medicine appeared. It was called PSRO, or Professional Standards Review Organization. Of course, it had little relationship to professional standards and everything to do with cost. We all had to participate like some Red Guards self examination in Mao’s China. We learned how to analyze care for what were purportedly quality issues but we all immediately recognized as cost. All the doctors of the hospital staff had to attend these classes and learn how to do this. Then we had to “volunteer” for committees to review cases to see if they met the standards. The standards always seemed to focus on cost issues, such as length of stay. Length of stay is an American obsession. A few years after this first experience with self examination, we began to have demands from Medicare and insurance companies for AM admissions before surgery.

AM admission is one of the examples of the lunatic aspect of government intervention in medicine. People who were to have major operations were expected to get up at 4 AM the day of surgery and come to the hospital at 5:00 for a 7:30 surgery. They were given instructions about not eating or drinking after midnight or whatever. Why not just have them come in at 6 PM the night before and be prepared then. ? They would sleep better with a sleeping pill, we would know for sure that they hadn’t had a late snack in spite of instructions and the hospital staff would know they were there, ready for surgery.

When this began, I asked what I thought was a logical question. Why are we doing this ? Cost, I was told. Why charge for the admission day before surgery? We could just make that a free day since the patients came in after 3 PM anyway. Nobody ever answered. The hospital had to add staff for the early morning shift. Sometimes a patient would not show up or arrive too late for their 7:30 case. Then we would scramble around to see if the next patient could come in early instead of the 10 o’clock they had been told. The schedule would be shifted around and the charge nurse would call the next surgeon to see if he could come in early, only to find he was doing surgery in another hospital at that time. I was sure, and still am, that the costs were no different and the aggravation and even the danger was increased for no good reason. It’s a bit like the Army. “Why are we doing this sir?” “Because I said so !” “Thank you sir.” A stint in the Army is helpful in understanding how government works.

That was the beginning. Next came calling the insurance company for permission to do surgery. In 1987 came the new way of being paid for care. It was called Resource Based Relative Value Scale, or RBRVS. A Harvard professor came up with a new way to pay for care. The methodology was supposed to account for the value of inputs in determining what Medicare (and quickly all insurance companies followed suit) would pay. It is related to the “Labor Theory of Value.” If you follow the link, you will see who thought this up. The original Relative Value System was developed by the California Medical Association in the 1930s. It was constructed by doctors to rate services, relative to each other, on what the price should be. I have previously covered some of this in a post on “How we got here.” Now, we have arrived at a system that is so onerous and counterintuitive that doctors have lost a lot of the pleasure of private practice. As usual, Thomas Sowell has something to say about it that concisely summarizes the foolishness of the present situation. If that is not enough, there are numerous examples of what government medicine eventually looks like. If you remove the pleasure, pretty soon everyone turns into the DMV or the Post Office employee. I mean no insult to those people but psychology has rules about behavior. Read the Thomas Sowell article. He always has something worth while to say. This is even better than most.

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Posted in economics, health reform, medical history | 4 Comments »

Sayonara Senator Bunning

March 4th, 2010

UPDATE: This takedown of Paul Krugman is hilarious. He attacks Bunning and is show to be an incredible phony.

Krugman:

Today, Democrats and Republicans live in different universes, both intellectually and morally.
“What Democrats believe,” he says “is what textbook economics says” But that’s not how Republicans see it. Here’s what Senator Jon Kyl of Arizona, the second-ranking Republican in the Senate, had to say when defending Mr. Bunning’s position (although not joining his blockade): “unemployment relief “doesn’t create new jobs. In fact, if anything, continuing to pay people unemployment compensation is a disincentive for them to seek new work.”

Krugman scoffs: “To me, that’s a bizarre point of view–but then, I don’t live in Mr. Kyl’s universe.”

Taranto:

What does textbook economics have to say about this question? Here is a passage from a textbook called “Macroeconomics”:

“Public policy designed to help workers who lose their jobs can lead to structural unemployment as an unintended side effect. . . . In other countries, particularly in Europe, benefits are more generous and last longer. The drawback to this generosity is that it reduces a worker’s incentive to quickly find a new job. Generous unemployment benefits in some European countries are widely believed to be one of the main causes of “Eurosclerosis,” …

So it turns out that what Krugman calls Sen. Kyl’s “bizarre point of view” is, in fact, textbook economics. The authors of that textbook are Paul Krugman and Robin Wells. Miss Wells is also known as Mrs. Paul Krugman.

Unbelievable.

Jim Bunning was a famous major league pitcher who was elected to the US Senate in 1986 from his home state of Kentucky. He has had a reputation as being a bit quirky, especially in recent years and he announced last year that he would not seek re-election. He is 79 years old and would be 80 at the start of his next term. He has been in the news lately for a one man objection to extension of unemployment benefits. Naturally, his position has been demagogued all over the world and he finally gave in in return for a symbolic vote, which will be meaningless since his fellow Republicans left him to face the world alone. The story was that he is “an angry Senator” who does these quirky things for no good reason. For example, he attacked the Treasury Secretary for his responsibility in the financial crisis. Bunning has been saying inconvenient things about the current fiscal crisis. For another example, his objection to the unemployment extension was the failure to pay for it by deleting other spending.

Andy McCarthy explains what happened and why it matters.

The Kentucky Republican finally caved in Tuesday after relentless pressure from other senators — including Republicans — to drop what the Politico called his “one man” filibuster of a bill to extend expiring unemployment benefits. Technically, it was not a filibuster. It was an objection to a procedure, called “unanimous consent,” used to speed along uncontroversial legislation.

He was right to do so. These extensions happen continually. The stimulus — which is a redistribution of wealth from the private to the public sector, and from people who work to people who don’t — extended unemployment benefits for 53 weeks. Another extension in November added 20 more weeks. Cato’s Alan Reynolds reports that this brings the total to 99 weeks of benefits in high-unemployment states. The measure on which Bunning has relented adds another month. And having browbeaten him into withdrawing his objection, Democrats will now seek an extension through the end of this year, i.e., another 36 weeks or so.

The Democrats gave him a small concession for withdrawing his objection. His amendment to pay for the extension by canceling one of the many “green initiatives” that are throwing billions down that rat hole, will be allowed a vote. The vote, of course, will be lost because he was not supported by his fellow Republicans. His lonely stand for fiscal sanity was a tiny drop in an ocean of recklessness. He explains himself today in an op-ed.

None of this is paid for. Instead, the government borrows ever more money, incurring ever more debt and ever more interest on that debt. The price tag on the relatively modest, stopgap measure Bunning was blocking is put at $10 billion, but that does not count the interest that will be paid on the money borrowed to fund the bill. To count the interest would be to highlight the fact that we are filching the money from our children and their children rather than paying for spending today by cutting something else. Bunning wasn’t even against spending the money; he just wanted the something else identified and cut.

That proved unacceptable, and not only to Democrats. Maine’s Susan Collins took to the Senate floor to assure Americans that Bunning’s radical views about Congress’s not spending yet more billions it doesn’t have “do not represent a majority of the Republican caucus.” And sure enough, they didn’t. Once Bunning backed down, the measure passed by a whopping 78-19.

In this case, there ought to have been raging controversy: Bunning was objecting to yet another monthly extension of unemployment payments absent an explanation of how it would be paid for.

This why we should be suspicious of Republican assurances that they will prove fiscally conservative once elected into the majority. They are also the party of government; just a little more slowly.

Think about that. We are talking about $10 billion in a year when Leviathan is slated to spend a total of $3.6 trillion. The majority of Senate Republicans joined Democrats in concluding that the allocation of every one of these 3.6 thousand billion dollars is so vital that not one of them could be sacrificed in favor of unemployment insurance. So another $10 billion just gets heaped on the already unfathomable trillion-dollar deficits stacking year upon year.
The pols call these mounting months (now years) of unemployment benefits “temporary,” even though the real unemployment rate remains in the double digits and no relief is in sight. The “temporary” label is a budgetary trick. It enables lawmakers to sidestep “PAYGO” — Pay As You Go — restrictions that require the federal government to pay for current obligations out of current revenues. Democrats recently made a big show of reinstituting PAYGO — but not until after they’d blown deficit spending through the stratosphere.

I am taking steps to cope with another Depression. The Republicans don’t seem to be concerned. Read the rest of McCarthy’s article.

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Posted in economics, politics | 6 Comments »

Clueless experts on health reform

March 3rd, 2010

Today Gail Wilensky, who was Medicare administrator under Bush I, tries to explain where we are in a New England Journal article. Since the NEJM is firmly socialist on health care, the article holds no surprises.

The third option is to create a new, more limited bill, which essentially means starting over. This strategy seems unlikely to be acceptable to Democrats, and it’s hard to know whether Republicans really want a new bill, either, though they say they do. In reality, there seems to be little inclination on either side to change the positions already staked out. Republican support has coalesced around two different bills: the Common Sense Health Care Reform and Affordability Act developed by the Republican House leadership last July and the Coburn–Burr Patient Choice Act of 2009 sponsored by Senators Tom Coburn (R-OK) and Richard Burr (R-NC) and Congressmen Paul Ryan (R-WI) and Devin Nunes (R-CA). However, as happens too often with Republicans and health care, neither proposal was pursued with the single-mindedness and passion that characterizes the Democratic pursuit of health care reform.1

That might have something to do do with the fact that nothing is better than any of the Democratic proposals. Will none of these people ever recognize that command economies don’t work ? Health care is an economic system that has been wrecked by perverse incentives and moral hazard for 60 years. There is no reason why employer provided health insurance should be tax exempt. It goes back to World War II and wage and price controls.

Most of these people are bureaucrats who have spent their lives managing other people’s lives, usually poorly. Gail Wilensky was no great shakes as Medicare administrator. The academics who write about this have no experience and are using their own theories of management based on a life on salary with clinic patients arranged for their convenience. They know nothing of paying a staff or rent or running a private practice.

My own preference for some time has been the French system, which uses fee-for-service to control utilization and which requires patients to pay first and be reimbursed later.

The Obama system has no market mechanism to control utilization and is a disaster requiring an intricate command and control system that would make the Soviet Union envious.

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Posted in health reform | 1 Comment »

Common sense

February 28th, 2010

There is a basic amount of shared experience that most people in this country have that is often referred to as common sense. People know how to go to the store and buy food, how to put gas in your car and how to get dressed in the morning to go to school or work. Then, there are people who seem to have missed out on some of these shared experiences. One of them is learning what car insurance does. When I was young and poor and a college student, I had an old car and did not have insurance. I probably drove a little more carefully but there was no law that said I had to have it and I was making a choice between insurance and eating.

Our president was presiding over a summit meeting on health insurance this week, but began with a story from his early experience with auto insurance. There is video at the link.

When I was young, just got out of college, I had to buy auto insurance. I had a beat-up old car. And I won’t name the name of the insurance company, but there was a company — let’s call it Acme Insurance in Illinois. And I was paying my premiums every month. After about six months I got rear-ended and I called up Acme and said, I’d like to see if I can get my car repaired, and they laughed at me over the phone because really this was set up not to actually provide insurance; what it was set up was to meet the legal requirements. But it really wasn’t serious insurance.

Now, it’s one thing if you’ve got an old beat-up car that you can’t get fixed. It’s another thing if your kid is sick, or you’ve got breast cancer.

It’s one thing to tell a story and another thing to know what the hell you are talking about !

When you are “rear ended,” the other driver is responsible for fixing your car ! You don’t call your own insurance company; you call the other driver’s insurance company !

OK, so let’s say the other driver doesn’t have insurance. Did he pay the premium for uninsured driver coverage ? Or did he just pay the minimum for liability coverage ? If he didn’t pay for uninsured driver coverage, why is that the insurance company’s fault ?

Some of us choose to buy high deductible health insurance because it is cheaper, we are healthy and we choose to pay for routine care out of pocket. Obama is planning to take away that choice. We will all have to buy Cadillac coverage and, if we can’t afford it, the government will subsidize it. Why is that better ?

How would he know if he doesn’t even know how car insurance works ?

I still wonder who was guiding this guy through life when he was young. It sounds to me like he would starve to death if left to his own devices.

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Posted in Uncategorized | 4 Comments »

San Diego Tea Party Photos

February 28th, 2010

By Bradley J. Fikes

I attended the Tea Party rally in downtown San Diego Saturday and took photos and videos. You can read a more detailed account by local Tea Party leader Dawn Wildman, who spoke at the rally.

I’m guessing about 300 people showed up at the rally, which had intermittent rain.

As usual, what I post here does not necessarily reflect the opinion of my employer, the North County Times.

Here are some videos, followed by photos:

Tea Party Leader Dawn Wildman speaks

Richard Rider speaks, part 1

Richard Rider speaks, part two

Richard Rider speaks, part 3

Roger Hedgecock speaks

Don't Tread On Me flags were prominent at the event.

Don't Tread On Me flags were prominent at the event.

Ouch!

Ouch!

COUNTERDEMONSTRATION: All the Tea Party talk of "socialism" was of course complete nonsense.

COUNTERDEMONSTRATION: All the Tea Party talk of "socialism" was of course complete nonsense.

Peasant with a pitchfork!

Peasant with a pitchfork!

Not a likely member of Greenpeace

Not a likely member of Greenpeace

Richard Rider, the grand old man of local Libertarians and tax-reduction advocates.

Richard Rider, the grand old man of local Libertarians and tax-reduction advocates.

"Clean House And The Senate in 2010", reads the bumper sticker, held by talk show host Roger Hedgecock, a keynote speaker.

"Clean House And The Senate in 2010", reads the bumper sticker, held by talk show host Roger Hedgecock, a keynote speaker.

More to come ….

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Posted in politics | 4 Comments »

Lies about malpractice reform

February 26th, 2010

I looked at Washington Monthly today, as I usually do to see what the far left is thinking. They were, as usual, obsessing about the health “reform” legislation and yesterday’s summit. I noticed a link to another article about malpractice reform.

First, from Wash Monthly,

John McCain recommended malpractice reform modeled on California and Texas.

There’s two examples right now of medical malpractice reform that is working. One is called California and the other is called Texas. I won’t talk about California because we Arizonians hate California because they’ve stolen our water.

“But the fact is that Texas has established a $750,000 cap for non-economic damages; caps doctors at $250,000; hospitals at $250,000; and any additional institution, $250,000; and patients harm to a finding of medical malpractice are not subject to any limitations on recoveries for economic losses. And I hope you’ll examine it.”

Wash Monthly comes back with a response that is based on lies.

I hope policymakers will examine it, too, because the results of the experiments in California and Texas offer some important lessons.

McCain preferred to ignore California’s experience, not because of water rights, but because the caps haven’t worked the way conservatives would have liked.

This is a lie. The “source” he links to is Jamie Court who is a really far left anti-insurance zealot and part of the phony Prop 103 auto insurance “rollback” that passed a decade ago and screwed up California’s auto insurance for a while. Here is what Court says:

Data from the National Assn. of Insurance Commissioners show that doctors’ malpractice premiums nearly tripled in the first dozen years after the 1975 California law. Premiums fell sharply and stabilized only after Californians passed insurance reform Proposition 103 in 1988.

Under 103, $135 million was refunded by malpractice insurers. The insurance measure also created an elected insurance commissioner who imposed a rate freeze for his entire first term, implemented stringent regulation and ended price fixing.

This is just a lie. I was practicing surgery in California the entire time he refers to. I began my private practice in 1972. My malpractice premium was $3500 per year. In 1974, following the stock market decline which devastated insurance company investments, my malpractice carrier raised my (and my partner’s) premium to $35,000 per year, but we learned that the company was insolvent. For a while, there was no insurance available except at stratospheric rates we could not afford. Thousands of California doctors practiced without insurance for several years. In 1974, there was a statewide doctor’s strike. Many doctors refused to treat any but emergency cases until the state did something about medical malpractice. Governor Jerry Brown called an emergency special session of the state legislature in January 1975. They passed a very good law called AB1XX, named for the special session. Since that time, it has been called MICRA, The Medical Injury Compensation Reform Act.

It has been attacked many times by the trial lawyers, with whom Court is affiliated. Eventually, the State Supreme Court upheld the reform act, in spite of furious attacks by the medical malpractice bar. It has resisted further attacks every few years for the past 25 years.

Court claims that premiums tripled and that Prop 103 affected the rates. Both are lies. My partner and I practiced without insurance for three years. In 1978, when we added another surgeon to our practice, we decided to start buying insurance again and we joined a company called CAP/MPT. That stands for Cooperative of American Physicians/ Medical Protection Trust. It is a non-profit cooperative of doctors who are self insuring. We each deposited $20,000 into a trust fund. We were than assessed an amount each year according to our specialty. Surgery is higher risk than General Practice, for example. My assessment remained at about $6,000 per year for the next 20 years.

I was sued several times although most were nuisance suits. For example, when we did apply to CAP/MPT, I learned that I had eight wrongful death suits filed against me. When we investigated, we found that these were ER patients, mostly trauma cases, that had died. Some, I had not even been involved with their care. I wrote letters to each law firm asking them to dismiss the suits or be subject to a suit by me for malicious prosecution. All were quickly dismissed. I was threatened with suits a couple of times by disgruntled patients. One woman kept coming back complaining because she had a tiny scar from a varicose vein injection. I couldn’t see it from ten feet away. I finally (a mistake) asked her why she was so obsessed with this scar that no one else could see. She had been warned that these injections can cause scars. I even asked her if she was having personal problems, with her husband, for example. That was a big mistake. She threatened to sue me but she could never find a lawyer to take her case.

Ironically, she had originally come to me because I had saved her mother’s life. Her mother, a smoker, had been in California to help her daughter with a new baby. While here, she had a catastrophic vascular accident that resulted in her entire small intestine dying. I put together her duodenum and colon but did not expect her to live. She had no remaining bowel that could absorb nutrients. Also, the connection of the bowel was tenuous because of the poor blood flow. Amazingly, it healed but she had no way to absorb food. We put her on total parental nutrition and she did well but there was no known way to keep the catheter from getting infected. They had never been used for a chronic IV nutrition situation.

I had been to the American College of Surgeons meeting a couple of months before and had seen a new catheter that was intended for long term IV use. It was still experimental. I called Belding Scribner, who had invented the first shunt that allowed chronic dialysis for renal failure. He was the one at the meeting who was showing the new catheter. He told me the name of the small company that was making them and they agreed to send me one. They are now commonly used for chemotherapy but this was probably the first use for a patient who lost her entire small bowel. It worked and she went home to Bethesda, Maryland after we taught her husband how to care for it. I called the National Institutes of Health to find someone who could help the husband with the care and she did well for several years, finally dying of a heart attack. Ten years later, her daughter sued me for a 2 mm scar.

I had a couple of other suits, one of which went to trial and I was exonerated, including being awarded the court costs. In 1994, after a major back operation for an old injury, I retired. A couple of years later, my $20,000 trust fund contribution was refunded. Court is lying about the malpractice situation in California and trying to puff up the role of his anti-insurance Prop 103. There was no refund until I retired and that had nothing to do with Court and his Naderite pals.

The fact that the left has to lie to support their position is excellent evidence that they have nothing else on their side.

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Posted in health reform, medicine, politics | 8 Comments »

Now, about that insurance premium spike…

February 23rd, 2010

One of my favorite health blogs is written by a retired cardiologist who calls himself Dr Rich. Cardiologists have a thing about that. One of the cardiologists in Irvine, a few years ago as stent and angioplasty technology took off, said his life’s ambition was to drive a Mercedes and to see cardiac surgeons driving Chevys. Anyway, Dr Rich has many excellent insights into health care reform, although he expresses them in a facetious way many times. Here is what he has to say about the current state of health reform.

DrRich is pleased to note that events have so quickly confirmed the explanation he gave, in his last post, regarding what the health insurance companies are up to by choosing to massively increase insurance premiums at this critical juncture. The insurance companies, to repeat, are willfully embracing their assigned role as “villain,” in order to get apparently stalled healthcare reforms back on track.

A mere few hours after DrRich had posted, Kathleen Sibelius issued a press release angrily documenting several additional requests for large rate increases by health insurance companies all across the land, and pointedly reminding us regular folks that healthcare reform would prevent these greedy companies from committing such abusive and harmful acts. And thus has the administration now officially established runaway health insurance premiums as the crisis of the moment.

The health insurance companies are firmly behind the Obama “reform” bill as the mandate and the administration’s plan to make them public utilities, is their own ambition.

So, dear readers, once again the health insurance industry has handed reformers a fine new crisis, just when they needed it, in order to get faltering healthcare reform back on track.

He doesn’t think much of Republicans but then I have my doubts, as well.

Republicans (who are certifiably clueless) must be wondering why their stalwart allies in the health insurance industry are once again stabbing them in the back. Of course, Republicans have not understood the health insurance industry for several years now. They certainly don’t understand that the insurance industry absolutely relies on healthcare reform to bail them out of their failed business model.

In fact, DrRich suspects that (despite this latest evidence) these unfortunate Republicans are heading into President Obama’s Health Care Summit on Thursday with the very same plan they’ve had all along – to set things up so that health insurance companies can compete with each other more robustly (across state lines, &c.), since, don’t you know, such competition will create the efficiencies we need to bring down the cost of healthcare.

This is truly a crazy idea.

Competition is the last thing health insurance companies want. Now comes a story that I had not heard before.

Consider, for those who have forgotten, the sad experience of Mr. Jim Clark, one of the founders of WebMD. Clark, widely acknowledged in the 1990s as one of the first Internet visionaries (having started – and sold – both Silicon Graphics and Netscape), originally envisioned WebMD as an electronic clearing house that would streamline various complex transactions within the healthcare system. Companies would sign up for WebMD’s transactional processing services and save millions; WebMD would take their cut; everybody would be happy.

The first big target for WebMD was to be health insurance claims processing.

Clark’s proposition to the health insurance companies seemed solid. In fact, it was obviously too good to pass up. Whereas processing a typical claim costs an insurance company $7.00, WebMD offered to do it for only $0.70 – a savings of 90%. Since the big insurers process multiple millions of claims each month, their potential savings would be colossal. This business model seemed compelling, and indeed, it was this very proposition that attracted most of the original investment capital that got WebMD started in the late 1990s.

But by early 2000, it became obvious that the insurance companies simply refused to play with WebMD, despite the astounding savings they stood to gain. WebMD – which for a long time refused to believe that actual businesspersons would act in a way so obviously counterproductive to their own interests – was eventually compelled to move on to different (far less lucrative) pastures. And to this day, the handling of insurance claims transactions remains, well, inefficient.

I have known for a long time that health insurance companies prefer the role of “administrative service organizations.” That means they process claims for self funding employers. They would be happy to play that role for a government funded health plan. The insurance model for health care, meaning collecting premiums and paying claims out of premium investment earnings, has not worked for years. What we have evolved in this country is a prepaid model for health care, not an insurance model. The only way the insurance model can work is to go back to insurable events, like heart attacks and strokes and cancer, as the basis of claims and pay routine care costs out of pocket. That is the HSA model. It suffers right now from the inflation of fees that are then discounted by insurance companies and Medicare. The cash purchaser of health care is at a tremendous disadvantage and doctors and hospitals can be punished, or even prosecuted, for giving cash discounts.

Read the rest of Dr Rich’s essay. I don’t know that I agree with him on delay in paying claims as a major part of the business model but he is correct about much of the story.

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Posted in economics, health reform | 2 Comments »

George Will’s speech at CPAC

February 22nd, 2010

George Will is an eloquent spokesman for the conservative cause and has never been more riveting than he was in this speech. I recommend everyone watch it.

He is diplomatic when he points out how much Bush anticipated the policies of Obama and the Democrats.

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Posted in politics | 5 Comments »

More steps to a UAV air force

February 21st, 2010

I have previously posted about the development of unmanned aircraft in the US, Now Israel has unveiled a huge (the size of a 737 airliner) UAV that is a potential bomber with a very long range and loiter time over a target zone.

Israel’s air force has introduced a fleet of large unmanned planes that it says can fly as far as Iran. Air force officials say the Heron TP drones have a wingspan of 86 feet (26 meters), making them the size of passenger jets, which can fly 20 consecutive hours, and are primarily used for surveillance and carrying payloads. (AP Photo/Ariel Schalit)

It looks something like the US Global Hawk.

Although the Global Hawk looks a bit huskier and may have a larger payload. The Predator, however, is quite similar although not as large as the Israeli UAV. The Predator is prop driven with the Global Hawk is a jet.

The future of warplanes is going in this direction more and more. If I were an Iranian military man concerned with air defense, I would be very concerned. These aircraft can fly very high, maybe higher than disclosed, and for very long periods, Global Hawks have been aloft without refueling for over 24 hours. The pilot is sitting in a chair at Davis Monthan AFB in Tucson, perhaps, or back in Israel. No pilot fatigue on these aircraft. The US Navy has a big UAV that will be making carrier takeoffs and landings next year.

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