You're Doing it Wrong: The US Healthcare "Market"

Not too long ago we reviewed a study that showed that when given a cost choice vs. a quality of care choice in healthcare, people overwhelmingly chose quality of care over any cost factor.  97% of the time.  So people said 'yeah, make my kid healthy and take what you need from the vault in order to do it.' 

To put that in perspective, you couldn't get 97% of Americans to agree not to stick a needle in their eye.  There are always 2-5% of the population who will mess with your survey just to mess with it.  Stoner sarcasm is often lost on survey-takers.  And there are another 2-5% who will genuinely refuse to cure themselves or their loved ones based on the cost of that care.  $50 is too much for whatever them pills are, and prayer is nearly always free, depending on the size of the mega-church you belong to and the number of engines on the Pastor's personal jet. 

As we've discussed, patients who need medicine are not "Consumers."  Health care for humans has no financial correlation.  If you are drowning or suffocating, air has no price.  We cannot negotiate price with parents who are watching their kids bubble under the waves.  They will literally pay for a rescue with anything up to and (usually) including their own lives. 

But Upton Sinclair was right:  " "It is difficult to get a man to understand something, when his salary depends upon his not understanding it." 

So, to those with a salary at risk, the survey actually means people can and want to shop for their health care.  It means that you will seek the bottom dollar to get that life preserver while your wife is drowning.  Wait - what?

No.  And the newer story in this series shows that when you give people an app which shows them prices and deductibles for health services, they still don't care what the price is. Even when they end up paying more out of pocket.  So...  You tell people clearly what their health care costs are (shockingly a new idea for Americans but whatever) and they react - not at all. 

Sadly, there are Americans who are still drawing a salary which is dependant on their seeing this as a market issue. 

No less an authority than Harvard Medical School is lamenting:  '"Our findings temper the enthusiasm around the idea that price transparency is some sort of panacea… That price transparency alone, coupled with high deductible health plans, are going to lead to reduced spending," said Sunita Desai, a health economist in the department of health care policy at Harvard Medical School, who led the study."

This is the part where salaries block really basic fundamental understanding of what words mean.  Those who need to see health care as economics and not basic humanity need to see the market in action.  But they don't.  Why don't people react to market stimulus when purchasing or 'consuming' health care? 

It's like this mystery to them.  It's like watching a drunk high school kid trying to start his dad's car with his house key.  Why doesn't this work? 

It's important to those who are making huge money from the health care "industry" to keep costs down and maximize profits.  And that's why profit has no place in health care.  As long as corporations and fat cats are making big bucks from the suffering of Americans, they're going to push for lower costs.

To them, a financial incentive should influence people to 'use' less health care.  Why wouldn't it?  It works with breakfast cereal and beer, right? 

In the real world where we don't make our living like vampires sucking the life from actual people, there is no cost incentive to use less health care, because we use what we need.  We won't turn down health care that our doctor says we have to take.  And we're not looking to add anything unnecessary. 

American Health executives (including that sad bunch at Harvard) seem to think people with good health benefits are walking into their doctors offices asking "whatta you got?"  Like we're looking to suck up some health care when we don't actually need it. 

"Hey Doc, how about prescribing me some heart meds to go with the cholesterol pills you hooked me up with?"  Or "how about fixing me up with a hernia operation?  I haven't had a good operation in ages." 

When the rich and corporate executives need to get some work done on their personages, to them that's a good spend, no matter what.  But somehow when other people who make a lot less money than they do need health care, it's a Market.  The Poors should be bartering services or selling blood or entering into indentured servitude or - best yet - just not getting the treatment. 

For crying out loud, if you take someone's mother hostage and point a gun at her head and ask what they'll give to save her, that's not actually a "negotiation."  It's not a Market that's set on Momma's Life.  There is no price point at which pulling the trigger is really the best option because the costs have risen over the deductible. 

It would be kidnapping and extortion, and would hopefully end up in a healthy living mother and a life sentence for the kidnapper. 

I think that would be the best way to address those whose salaries require them to imagine a market, or worse - make a market out of health care.  Anybody who treats medical care as a market commodity should be sent to jail as an extortionist. 

See how fast the system changes then.

You're Doing it Wrong: Counterterrorism

I recently got lectured to at a professional event - which I admittedly attended of my own free will -  about how frightened I should be about terrorists.  Again.  It's at the point where the message is just implicit:  ISIS exists, therefore we need to be on our toes to monitor our 80-year-old neighbor and that kid that always dresses funny and listens to that music.

They're on my radar, for sure. 

But the least effective approach to the problem is to make people VERY AFRAID.  It's really the go-to method for the lower IQ crowd among national leadership.  Terrorism as an "ism" is complex to the point of being undefinable.  Politicians like Canada's Peter MacKay, who thought the movie "Dumb and Dumber" was autobiographical (despite not having written it), can only shake a fist to the heavens and promise vengeance against all beards when trying to understand the nuances. 

Those among his grey-matter-challenged voting constituents respond to the fist-shaking with a vaguely beer-slurred "fuck yeah..."  Pile on the national security apparatus of the western world as it exists today and the tattered remains of the Republican Party in the US and you have defined the problem of counterterrorism in our time. 

In short:  they're doing it wrong.

What lashes these people together is their inability understand the fundamental problem, and the resultant failure to cobble together any response that has a remote chance of solving it.  Let's start with what it is not.  The problem of Terrorism is not the problem that has most of the Middle East currently on fire.  The region is imploding loudly (with US-made munitions driving the kinetic energy on both - all - sides) because there is no longer any legitimate government holding together Iraq and Syria. 

Syria is a victim of it's own longstanding brutality and lack of freedom and fairness - it is a regime that has been begging to be overthrown for decades.  Iraq is a failed state that the US failed.  We lied about it and then broke it.  The "Dumberer and Dumbererer administration of W. Bush and Dick "The Gimp" Cheney used the proud US military to commit an illegal invasion and then shame all Americans in their conduct of the occupation.  So much for national military pride - maybe we'll earn some back in disaster relief or something. 

The problem of terrorism in the West is nothing the military can solve.  The problem is the use of the internet to radicalize young men (mostly) to do terrible harm to innocent people in order to further a radical religious and political cause.  The 'bad guys' are not sneaking into our communities wearing hijabs with bomb belts.  They are not breaking into The Gap before opening to kill us among racks of discount blue jeans. 

No, the person who will try to make a bomb (and only end up with a stale tuna casserole) will be the high school dropout who can't get a job because nobody will hire him and who is convinced by some cultist rapist sociopath on-line that his way to respect and happiness is to kill a bunch of people because god. 

How do you stop that kid?  The answer is not to drone-bomb his distant relatives in Sudan and Pakistan.  That just gives the on-line psychopath more stuff to use in recruitment (at home and abroad). 

The answer is not to power-vacuum all communication globally.  Not only does that make a mockery of the idea that we have 'rights' and 'freedom.'  It's a complete waste of time and energy.  It stops nothing.  The only thing it does is chill discussion and free expression.  People know they are being watched on-line and listened to on their phones.  Big Brother doesn't have to put a monitor with his face on the wall;  we know he's there. 

Authorities such as the FBI want to tell us that they've stopped any number of plots before they come to fruition using our lost privacy.  That's what I was told in the professional lecture Monday.  Literally:  "the FBI stops thousands of terrorists before they attack.  They don't talk about it - we'll never know how many times they kept us safe."  There is a word for this:

BULLSHIT.

We hear from the FBI every time they think they stopped a plot.  And it's always a plot that the FBI created by themselves out of civilian gullibility.  It's always the same story:  an informant tells them about a guy.  The informant is told to egg the guy on.  The FBI provides money, encouragement, and, in some cases, even fake hardware.  Invariably, the threat is only a threat because the FBI wanted another headline. 

Billions of dollars spent, possibly trillions over a decade or two  - why would they tell us how much?  It's only our money.  Money on eavesdropping, data collection, copying the entire internet, drones in the air over all parts of the world - including the US.  High resolution camera pictures of almost everyone, almost all the time.  And of course all your phone calls and email.  For what?

What does work - doing it right - is real police work.  That starts with getting various agencies to talk to one another.  Way way back in 9-11 days we figured out that the FBI and CIA (and others) had all sorts of information on the attackers, but hadn't spoken with one another nor explored obvious leads.  Well, 15 years later, that's been solved by us forgetting about it.  They still don't talk to each other.  They're busy reading our texts and looking at our dick-pics. 

Look:  doing real counterterrorism is getting the police work right.  If you don't do the basic stuff that you do to stop fake criminals on the dozens of "CSI" and "Law and Order" TV show variants, and every day and in every case in real life, why spend billions of advanced technology?  The basic human investigatory methodologies work.  Add a DNA lab and you have a counterterror strategy.

Look at the recent Brussels and Paris attacks.  The murdering scumbags who were radicalized by other scumbags in the Middle east and treated like scumbags by the Parisian and Belgian locals (who, let's face it, had a point in retrospect) were being watched because police knew - back in 2014 - that they were harmful assholes. 

When police officials know that someone has been radicalized to do harm others by anyone - from Charles Manson to a radical Imam to Oprah Winfrey (which is totally unfair to Oprah but go with me here) - the authorities are empowered to act.  Trying to figure out which radicalized young person is a wannabe "White Chocolate" or "Vanilla Ice" type, and which are really a danger to themselves and others is very, very difficult.

But that is exactly the hard thing that we need to do.   It's a hard job to put 10,000 armed drones in the air and drop expensive bombs on people - but that hard work is wrong and extremely counterproductive.  Just like reading a billion emails a day and saving everyone's phone calls on mainframe computer storage - hard and counterproductive. 

We're doing it wrong by working hard on the wrong things.  Hard work on the right projects is the only way we can win.  It's not as cool and Top-Gunny to go to immigrant neighborhoods and engage with people who are marginalized by our society.  That would be a shitty job and likely not a safe workplace.  But it's the only way to get to the would-be terrorists in our midst before they remove the "would-be" label. 

In America, toddlers kill more people than terrorists.  Sad but true.  But you can't run for office on an anti-toddler ticket.  The slope-brows need to fear a scapegoat - Muslim Arabs - so that their anger and racist derision can help Paul Ryan suck up to rich people and help the rest of the Republican Party sell out American troops and workers in their phoney-baloney jobs.  So fear gets votes, and therefore there is a fear industry which sends representatives to speak at conferences to make people more and more afraid.  The money and power are all in the fear. 

Don't use the fear.  Do the police work.  That will more than cover the tiny terrorist threat we live with in what is really a North American paradise (compared to the rest of the world).  That's the smart thing.  Spying on everyone, faking terror plots to stop (and arresting real humans in the process), and killing strangers in the Middle East is either more expensive than stupid or more stupid than expensive.

I can't decide.

The Obama Foreign Policy Legacy

President Obama is finishing his presidency with a mic-drop.  In some ways, it's historically well-deserved.  His domestic accomplishments are exceptional.  In some ways, though, this president has been a historic disappointment. 

Obama has proven to be LBJ Lite.  Johnson passed the Great Society in the face of implacable congressional opposition.  This included a Civil Rights Act, a Voting Rights Act, and a score of medical, educational, fiscal, and other 'public good' measures that nobody will ever touch.  Mainly because, thanks to Johnson, no America in the future will need as much as the America that Johnson faced when he became president in 1963. 

Obama was able to barely stave off the Bush Depression in 2008, with a minimal stimulus package to save the earth economy.  Unlike Johnson, he did too little - and the little he did helped mostly those who needed the least amount of help.  Wall Street was bailed out while millions of Americans were underwater.  But the lows of the 1930's were avoided, for which we're all grateful. 

And Obama passed a watered-down health care initiative.  It was nothing like what he'd campaigned on, but it was a mildly progressive bill that will end up saving millions of people from a slow grisly impoverished death.  So that's pretty good.

The rest of the economy rebounded.  Sustained growth isn't half of what Johnson brought, but it was a more-than-sold result based on what there was to work with.  The Republican party became a full-time obstruction from day one, which was a drag to be sure.  The difference between the scorched-earth Republicans of 2010 and those of 1964 has been that in the 1960's the opposition was focussed on maintaining segregation and burning Johnson - but still honored the traditions of the institution that they served. 

The Republican party since 2001 has been a more open joke than any political movement in history - certainly in American history.  And, in opposition since 2008, they've crossed every line and broken every rule in their racist - yes racist - assault on the prerogatives of a sitting president.  Their stated goal was to stop any Obama accomplishment.  Is that what Congress was supposed to do? 

So this president can be pleased with the advances he's made here at home.

The problem comes when we look at foreign policy.  Here, we get into trouble.  That's Legacy-threatening trouble. 

Not with the big-ticket items we used to worry about.  Russia is increasingly hostile, but for the past eight years our relationship has been cool enough that we haven't seriously considered firing nuclear weapons at them.  Hey - progress is where you find it. 

China has become hooked on the crack-cocaine of capitalism.  The money is a sweeeeet sugar.  First taste is free.  Their economy is threatening to come to a screeching halt pretty soon, but we can buy our rubber dog crap from India, so no worries.  They're trying to take over the South China Sea by creating artificial islands there - "possession is nine-tenths of the law" - which will be an issue for the next president- let's say Trump.  Fortunately the US has a lot more friends in the area than China does.  Hell, the North Koreans don't even like the Chinese (and the feeling is mutual). 

We're good with people on the continents of South America, Australia - hell even Antarctica. 

The Legacy dies with the 'war on terror.'  Obama chose to escalate rather than decommission it.  You can't, as they say, fight a war against a noun.  'Terror' (more properly 'terrorism') is a series of violent actions (and threats of actions) with a variety of purposes, but mostly intended to scare people into doing things they wouldn't otherwise do. 

For eight years of the W. Bush administration, the terrorists won every round.  If there was a stupid violent racist inflammatory immoral act the US could do, they did it.  Illegal spying?  Where do we sign up?  Bombing, invasion, torture - bring it on!  Osama bin Laden had pinned his filthy 9-11 dreams on the Washington Dumb Guys acting in character.  He got his wish.  There has been no more venal ego-driven know-nothing delusional groupthinking nothinking lowest-common-denominator billionaire-funded earth-despoiling immoral presidential administration in US history. 

The W. Bush crew had the ethics of Satan's personal drug dealer. 

Obama campaigned and won twice on a 'hopey-changey' platform to make that shit stop.  He didn't.

The Guantanamo prison still operates, incarcerating humans forever without charging them and without any recognizable legal due process.  Up your Habeas Corpus.  Don't think that's in the constitution, either.  We claim to have stopped torturing and rendition (where we send the poor SOB off to be tortured by some of our buddies who don't mind doing that sort of thing).  But we never put that into law.  The next president - let's say Trump - can reverse that decision by, well, deciding to. 

Time was, before the W. Bush zombies (did you know "W" Bush stands for:  Walker!  Coincidence???), to eavesdrop on a person - read their mail, listen to their phone calls, etc. - you needed to convince a US Judge - hired (appointed, confirmed, elected, whatever) by the judicial system and empowered to dispense justice on the part of the United States of America - that you needed to do so for a good reason.  Unless you were Hoover.  But I digress. 

Now you don't need anything.  The NSA, CIA, FBI - whatever letters are on the go - can just read the stuff.  And if they don't like what they read, you're gone baby.  No court challenges - courts are for justice, and there's none of that going on here.  There are no more civil rights or right to privacy.  The feds get it, and the feds read it.  Walker Bush started it, Obama has grown it exponentially. 

But back when you needed a judge's order to kill people and read their mail, you also needed a reason to kill those people, because you weren't at war with them.  We used to be at war with Japan and we killed a lot of Japanese people.  Try killing a few nowadays - they'll lock you up! 

But no judge or jury is needed if you're a brown person in the Middle East.  No judge is looking out for you or your friends or family.  Drones don't know you or them.  Drones don't care.  The Obama Legacy is and will always be the drone program that has been a blight on the world.  Obama himself personally picks targets who are tracked by drones via satellites and signalled by a base in Germany, and when we find them (or someone who looks like them or is borrowing their cell phone) we kill them and anyone who is unfortunately close enough to not survive the detonation of large American explosives. 

We intercept communications without cause.  We target people we can barely identify - sometimes even US citizens.  We kill them and their neighborhoods.  We have a 'secret' drone base in Central Africa to kill people at or near Boko Haram locations.  We're moving more troops and assets back into the places Obama swore to leave - like Afghanistan and Iraq.  And then we wonder why people in Yemen and Libya and Syria and Iraq and all points in between want to join organizations dedicated to killing Americans. 

They hate us for our freedom! 

Obama never reconciled all this with us.  Why would a constitutional scholar step so far out of bounds?  Why would he ever think an American president was empowered to use the American military to murder at will?  Even with the convoluted legal opinions they've apparently produced to justify at least some of this activity, how could someone who claims to cherish the spirit of - and swore an oath to "preserve, protect, and defend" -  the constitution prosecute this offensive? 

In our name, Obama has takes thousands of lives all over the world.  And the more effort and time and money is put into the drone war, the worse we make it for the US.  Worse:  there is no endgame.  Obama will leave office having escalated a spy and assassination program globally that has no exit. 

What do we do?  Just stop? 

And we're not the only ones with drones anymore.  ISIS and other bad actors all over the place are developing and flying their own drone air forces. 

Look:  as long as people have lived they've developed weapons.  And as long as they've developed weapons, they've used them.  Couldn't we get past that once?  The US likes to think of themselves as an advanced civilization.  Could they - under the Obama administration - restrain themselves once?

When we developed the capability to listen to eneryone's phone calls and read the world's email, it was important not to immediately use that power to hunt and kill them.  Same with the drones.  That technology was bound to develop quickly - did we have to immediately use it to end the lives of other humans?

By using unmanned aircraft to kill people, we do worse than just murder.  We fight without risk.  We hit them without a chance of retaliation.  Hell - they don't even know who killed them.  Isn't that the height of cowardice?  Shouldn't we, at the minimum, have the guts to put our people close enough to the target to positively identify them?  How is it that the US president can now approve an execution based on blurry photos of someone whose identity he cannot prove and, even when we know their identity for certain, cannot prove guilt of any offense in a court of law?

That's Obama's Legacy.  The next president - let's say Trump - will either continue it, expand it, or cancel it.  In any case, Obama is sadly 'next in line' for the prosecution of American Presidential War Criminals.