Minor Thoughts from me to you

Are We Headed Towards an Ice Age?

Are We Headed Towards an Ice Age? →

This is the type of thing that worries me.

Holdren does do us a favor by raising a subject which doesn’t get nearly as much air time when this topic is debated in the media. No matter what you think about the viability of various climate models predicting the effects of various atmospheric agents on the biosphere, there has always been a long term question about what mankind will do when (not if) the next ice age comes. Rather than looking at hockey sticks for global temperature trends in the 20th century, a more alarming picture comes into focus when you look at our track record for the last half million years.

Temperature graph for the last 400,000 years.

The relatively pleasant weather we’ve enjoyed throughout mankind’s rise across the globe is, traditionally, a fleeting thing. Eventually the glaciers come back and that’s something which our biggest brains have no clue how to stop once they start their southward march. Once the process starts, it happens pretty fast, too. (At least “fast” in geological time frames.) It might not spell the actual extinction of the species, but there wouldn’t be room for many people in the habitable areas. There are also theories out there which suggest that a sustained rise in temperatures can actually trigger a faster onset of glaciation. So when you’re done arguing about what to do when the ocean levels rise and swallow Miami, you can figure out how to grow corn on an ice sheet.

The Milwaukee Public Museum has an exhibit on the ice ages. It's a sobering thing to stand next to a scale replica of a glacier, looking up, and imagine everything that you know being kilometers underneath your feet.

This entry was tagged. Global Warming

Communist Medical Care

Communist Medical Care →

David Henderson shares this story, from LCDR Ilia K. Ermoshkin, an officer in the U.S. Navy.

I grew up in the USSR and became familiar with the healthcare system both from the beneficiary point of view and from that of a provider, as my grandmother was a dentist. The government owned and ran all health care, and it was free to the people. However, the quality and the "care" in the health care system were dismal: long waits for specialists and advanced procedures, etc. But, as anywhere, people have developed ways to get around and get what they want. Here are some examples of wonderful free health care in the USSR.

Birth was to take place only at birth clinics, of which there were about half a dozen in a city of five million people. Husbands or any other family are not permitted to even enter, under the premise of keeping the place free of germs, etc. My delivery was very difficult for my mother, she was in labor for three days, and it was deemed unnecessary to give her any pain medication or do a Cesarean. So she roamed the hallways of this clinic/hospital howling with pain. Nobody was permitted to use the phone (there were only a few in the administrative offices), so she could see my father and her parents only through a window once a day. When I was finally born, I was taken away from my mother immediately to be placed in a post-birth unit (this was done to all newborns), and my mother did not see me until about 24 hours later. We were released from the hospital after 7 days, and that was the first time my father saw me. This is a story that was a fairly normal routine for the Soviet women, and no other options were available as it would be then nearly impossible to get a birth certificate for the newborn. When my mother told this to my wife, who is American, she was horrified and had nightmares about it. [DRH note: for similar stories about the birth process, see Red Plenty. I reviewed it here.]

When I was two, I got severe pneumonia. I was at home with fever of 42C [DRH note: this is over 107 degrees Fahrenheit] and the doctor decided that this was a lost case and would not even prescribe penicillin to try to fight the disease. It took my parents and grandparents pulling all their connections and bribing to get penicillin that fairly promptly took effect and saved me.

This entry was tagged. Healthcare Policy

The war on rape: the logic of the lynch mob returns

The war on rape: the logic of the lynch mob returns →

Brendan O'Neill offers some historical context about whether or not we should immediately believe all rape accusations.

Automatic belief of rape accusations was a central principle of the KKK’s war on rape, too. This was one of the things that most shocked Ida B Wells, the early twentieth-century African-American journalist and civil-rights activist. ‘The word of the accuser is held to be true’, she said, which means that ‘the rule of law [is] reversed, and instead of proving the accused to be guilty, the [accused] must prove himself innocent’. Wells and others were startled by the level of belief in the accusers of black men, and by the damning of anyone who dared to question such accusations, which was taken as an attack on the accuser’s ‘virtue’. The great nineteenth-century African-American reformer Frederick Douglass was disturbed by the mob’s instant acceptance of accusations of rape against black men, where ‘the charge once fairly stated, no matter by whom or in what manner, whether well or ill-founded’, was automatically believed. Wells said she was praying that ‘the time may speedily come when no human being shall be condemned without due process of law’. No, rape suspects aren’t lynched today. But, as we can see in everything from the destruction of Bill Cosby’s career to the demand to banish from campus students accused of but not charged with rape, they are often condemned on ‘the word of the accuser’ and ‘without due process of law’. Now, as then, ‘I believe’ is the rallying cry of crusaders against rape, and now, as then, such ‘automatic belief’ reverses the rule of law.

It's always tempting to go with what we "know" to be true, without worrying about pesky things like standards of evidence, due process, and the right to confront your accuser. But throwing those things out doesn't increase justice. It just opens minorities up to abuse from the majority.

This entry was tagged. History Rape

Crunchy Granola Nature Lovers Can Cause As Many Problems as the ATV Nature Lovers

Crunchy Granola Nature Lovers Can Cause As Many Problems as the ATV Nature Lovers →

It’s tempting for the muscle-powered recreation crowd (of which I’m a proud member) to argue that we’re lighter on the ground than those who roar into nature astraddle their growling snowmobiles and churning all-terrain vehicles. Surely motorheads are to blame for any problems in the forest.

The uncomfortable fact is, we’re all complicit. In a not-yet-published review of 218 studies about recreation’s impacts on wildlife, researchers found more evidence of impacts by hikers, backcountry skiers and their like than by the gas-powered contingent.

Cross-country skiers on the Kenai Peninsula in Alaska, for instance, can be more disturbing to moose than noisy snowmobiles, one recent study found. Grant Harris, a biologist for the Fish and Wildlife Service and the main author of the study, explained that snowmobiles, while a noisy intrusion, announced their presence and then quickly departed. But cross-country skiers can sneak up on an animal without warning and then linger. Worse, animals “don’t know where the skiers are going to pop up next,” leaving them on edge.

This reminds me of my favorite quote about limited knowledge and unintended consequences.

"The curious task of economics is to demonstrate to men how little they really know about what they imagine they can design." — F.A. Hayek, The Fatal Conceit

This entry was tagged. Environmentalism

An Experimental Wireless Network from Artemis

An Experimental Wireless Network from Artemis →

Artemis Networks, a start-up that says it has created a technology for increasing the speed and reliability of wireless networks, is getting closer to bringing that service to the public.

The start-up, which first announced its technology a year ago, said it planned to lease wireless spectrum from Dish Network, the satellite television provider, for up to two years. It will use the spectrum to introduce a wireless Internet service in San Francisco.

… San Francisco, like many big cities, is already served by all the major wireless carriers, but Artemis has developed a technology that it promises will increase wireless Internet speeds through an innovative method of dealing with the congestion that dogs cellular networks.

When too many users get onto the Internet in one area from wireless devices, speeds typically slow, like a freeway jammed with too many cars. Carriers try to mitigate the problem by putting up more antennas in busy places like stadiums, but there are limits to how much of that can be done without creating interference between the antennas.

Artemis, in contrast, has an antenna technology called pCell that it says embraces, rather than avoids, avoids wireless interference. The antennas on an Artemis network are connected to data centers that perform nearly instantaneous mathematical calculations to fashion a unique wireless signal for every person on the network, giving them access to wireless data speeds that are not degraded as other people use the Internet from their devices.

This is the type of innovation that makes me skeptical about the need for net neutrality. The entire push for net neutrality is predicated on the idea that internet access lacks the competition needed to keep internet providers honest.

New technologies can quickly provide competition where none previously existed. My iPhone's LTE connection is already as fast as my home internet connection. If it weren't for data transfer caps, I could use my LTE access as my only internet access, bypassing Charter.

This pCell technology could enable wireless providers to offer much higher data caps, providing competition for cable in every city in America. With that kind of competitive pressure, who'd need network neutrality to keep providers honest? Big cable would be falling all over itself to offer "true unlimited" internet access, at prices below that offered by Big Cellular. We should be looking for every opportunity to increase competition, rather than looking to increase regulation.

This entry was tagged. Innovation Regulation

What Is "Health Insurance"?

What Is "Health Insurance"? →

Thanks to government policy, the word insurance has been fatally corrupted in the health care industry. Insurance arose as a way for groups of individuals to protect themselves against insolvency by pooling their risk of unlikely but highly costly happenings. Today, private and government health insurance is merely a scheme to have others—the taxpayers or other policyholders—pay one’s bills not only for rare but catastrophic events, but also for predictable and likely, that is, uninsurable, events—and even for goods and services used in freely chosen activities.

The system is so camouflaged that the privately insured are often simply prepaying for future consumption, but the prepayment includes a hefty administrative overhead charge, which means the policy would be a bad deal if customers were paying the full price with eyes open.

What makes private medical insurance look like a good deal today is that employers seem to provide it for "free" (or at low cost) as noncash compensation, or a fringe benefit, which is treated more favorably by the tax system than cash compensation. If an employer pays workers in part with a $5,000 policy, they get a policy that costs $5,000. But if the employer pays workers $5,000 in cash, they’ll have something less than $5,000 with which to buy insurance (or anything else) after the government finishes with them. That gives employer-provided insurance an appeal it would never have in a free society, where taxation would not distort decision-making. Moreover, the system creates an incentive to extend "insurance" to include noninsurable events simply to take advantage of the tax preference for noncash compensation. Today pseudo-insurance covers screening services and contraception, which of course are elective. (This does not mean they are trivial, only that they are chosen and are not happenings.)

Extract Child Support From Poor Men Who Aren't Fathers

Extract Child Support From Poor Men Who Aren't Fathers →

How is it possible in the Land of the Free that men can face huge fines, revocation of professional licenses, forfeiture of the right to international travel, and sometimes (as in Alexander's case until this week) even jail time, from owing child support to kids that aren't theirs? I wrote a feature about that 11 years ago, entitled "Injustice by Default." Short version:

Governments (and sometimes even hospitals) are financially incentivized to attach paternity to the children of single mothers, particularly those seeking welfare benefits. Departments of Child Support Services will sometimes go on information as flimsy as "Dude with this name living in Southern California"; if a records search turns up only one dude, he will likely be mailed a court summons. That court summons will often be very confusingly written, so that the men don't realize that they are just 30 days away from being declared the father via default judgment. Once you have been named the father, you owe all back child support (sometimes with interest), said support will be garnished from your wages, and it is devilishly hard to get your paternity undeclared, even with DNA proof and sworn affidavits from the mother.

So why don't we hear about this outrage more? Because nobody likes to defend "deadbeat dads," and the people hardest hit are typically poor men who have even less political and media clout than they do access to good lawyers.

Sometimes the modern version of women's rights seems more like making someone—anyone—else pay the bills than it does true equality.

When Tribes Have Different Moral Standards

When Tribes Have Different Moral Standards →

Earlier this year, Russ Roberts interviewed Joshua Greene, on the topic of how to solve dilemmas arising from people having different moral standards. Greene led off with a morality tale about differing tribes, with different moral standards.

[I]magine that there's this large forest. And all around this large forest are many different tribes. And these different tribes are all cooperative, but they are cooperative on different terms.

So, on the one side you might have your communist herders who say, "Not only are we going to have a common pasture; we're just going to have a common herd, and that's how everything gets aligned. Everything is about us".

And on the other side of the forest you might have the individualist herders who say, "Not only are we not going to have common herds; we are not going to have a common pasture. We are going to privatize the pasture, divide it up; and everybody's responsible for their own piece of land. And our cooperation will consist in everybody's respecting each other's property rights. As opposed to sharing a common pasture".

And you can imagine any number of arrangements in between. And there are other dimensions along which tribes can vary. So, they vary in what I call their proper nouns, so that is: Which leaders or religious texts or traditions have authority to govern daily life in the tribe? And tribes may respond differently to threats and outsiders. Some may be relatively laissez faire about people who break the rules. Other people may be incredibly harsh. Some tribes will be very hostile to outsiders; others may be more welcoming. All different ways the tribes can achieve cooperation on different terms. They are all dotted around this large forest.

And then the parable continues: One hot, dry summer, lightning strikes and there's a forest fire and the forest burns to the ground. And then the rains come and suddenly there is this lovely green pasture in the middle. And all the tribes look at that pasture and say, 'Hmmm, nice pasture.' And they all move in.

So now we have in this common space all of these different tribes that are cooperative in different ways, cooperative on different terms, with different leaders, with different ideals, with different histories, all trying to exist in the same space. And this is the modern tragedy. This is the modern moral problem. That is, it's not a problem of turning a bunch of 'me-s' into an 'us.' That's the basic problem of the tragedy of the commons. It's about having a bunch of different us-es all existing in the same place, all moral in their own way, but with different conceptions of what it means to be moral.

I thought it was a good illustration of why I think that there should be a small, central government with very few areas of responsibility and many local governments, with much greater areas of responsibility. People will disagree about what forms of behavior are moral and just. They should be free to live in communities that reflect their values, without being forced to live according to the beliefs of whichever groups outnumber them.

Free Speech in America is Pretty Absolute

Free Speech in America is Pretty Absolute →

Charles C. W. Cooke offers a quick primer on America's expansive free speech tradition. When I think of American exceptionalism, this is one of the areas that comes to mind.

As the Supreme Court has repeatedly ruled, under American constitutional law there is simply no such thing as “hate speech.” In Texas v. Johnson, the Court confirmed that “the government may not prohibit the verbal or nonverbal expression of an idea merely because society finds the idea offensive or disagreeable,” thereby echoing the insistence of a lower court that “the First Amendment does not recognize exceptions for bigotry, racism, and religious intolerance or ideas or matters some may deem trivial, vulgar or profane.” Indeed, as FIRE’s Sean Clark noted in 2006, the government may not prohibit much at all:

The First Amendment allows you to wear a jacket that says “Fuck the Draft” in a public building (see Cohen v. California, 403 U.S. 15), yell “We’ll take the fucking street later!” during a protest (see Hess v. Indiana, 414 U.S. 105), burn the American flag in protest (Texas v. Johnson, 491 U.S. 397 and United States v. Eichman, 496 U.S. 310), and even give a racially charged speech to a restless crowd (see Terminello v. Chicago, 337 U.S. 1). You can even, consistent with the First Amendment, call for the overthrow of the United States government (see Brandenburg v. Ohio, 395 U.S. 444). This is not a recent development in constitutional law—these cases date back to 1949.

It is worth remembering that Madison did not believe that his Bill of Rights was necessary to protect speech at all. Because the Constitution is a charter of enumerated powers, he argued in Federalist No. 10, Congress enjoys no capacity to censor the press in the first instance and does not therefore need to be prevented from doing so:

Why for instance, should it be said, that the liberty of the press shall not be restrained, when no power is given by which restrictions may be imposed? I will not contend that such a provision would confer a regulating power; but it is evident that it would furnish, to men disposed to usurp, a plausible pretence for claiming that power.

This entry was tagged. America Free Speech

The Sydney Gunman's Failed Message

The Sydney Gunman's Failed Message →

When Michael Totten talks about the Middle East, I listen.

When the Australian gunman forced his hostages to hold that flag up to the glass, he was identifying himself as a Salafist. But no one in media seemed to know what that flag is. Reporters just described it as “a flag with some Arabic writing on it,” as if it’s just some random flag from anywhere that could have meant anything.

The guman sent a message, but it wasn’t received. And we know he was monitoring the news in real time. He was directly across the street from an Australian news channel. He wanted attention, but he was not getting the attention he wanted. Reporters couldn’t even figure out who he was when he clearly identified himself and his ideology.

Hours into the standoff, he demanded an ISIS flag in return for the release of one of the hostages. CNN anchors wondered aloud why, if he wanted an ISIS flag, he didn’t just bring one with him in the first place. But he did bring a Salafist flag. He must assumed that at least somebody would recognize it and explain it to the audience. I recognize it because I’ve been working in the Middle East for ten years, but news anchors are generally not experts in anything in particular except presenting information on television. They’re generalists.

Would the standoff have ended better if the man had more quickly succeeded in delivering his initial message without all the mounting frustration of being misunderstood? Probably not. Obviously, since he took hostages at gunpoint, he was not from the non-violent wing of the Salafist movement. Nevertheless, it’s time for Westerners who aren’t Middle East experts to know who the Salafists are and what they’re insignia looks like. They’ve been at war with us now for a long time.

The important thing for me, is that certain groups in the Middle East consider themselves to be at war with the West. It does no good for us to pretend that it's just random violence from some kind of a lost generation. That will only make us feel better until the time that they show up in our cities, bringing the war to us. As happened in Sydney.

The Army Officer Who Committed Murder

The Army Officer Who Committed Murder →

Conservative commentators want the President to pardon Lt. Lorance.

A few minutes into that morning patrol, while walking through a field of grapes, a private named James Skelton spotted a motorcycle in the distance carrying three men and called it out to Lieutenant Lorance.

News media reports based on interviews with Mr. Lorance’s family and lawyers have described the motorcycle “speeding toward the platoon,” giving the lieutenant only seconds to act. But soldiers testified that the bike was about 200 yards away and could not have reached the platoon’s position in the grape fields.

Without asking for more information, Lieutenant Lorance, standing in a low spot where he could not see the motorcycle, told the soldiers to “engage,” soldiers testified.

“Nobody fired initially,” Todd Fitzgerald, a specialist in the platoon who was standing near the lieutenant, said in an interview. “There was no reason to. Then Lorance said, ‘Why isn’t anyone firing yet?’”

Private Skelton fired two shots that missed.

The men on the motorcycle stopped, got off and looked around, soldiers testified, trying to figure out what had happened. Lieutenant Lorance radioed a nearby truck that had a machine gun with an order to fire. Sergeant Williams, who watched through a high-powered camera at the outpost, saw two bursts from the gun truck take down the motorcycle driver, then, after a pause, a man with a wispy white beard. A third man fled into the village.

“I got on the radio and was, like, what the hell just happened?” Sergeant Williams said in an interview. “There was no threat from those guys whatsoever.”

Lieutenant Lorance then told the machine-gunner to fire at the motorcycle, but a boy had come to retrieve it, so the gunner refused.

“I wasn’t going to shoot a 12-year-old boy,” the gunner, Private David Shilo, testified.

Soldiers searching the dead men found only a pair of scissors, an identification card, some pens and three cucumbers.

Women and children came out of the village, screaming and crying, soldiers said. Mr. Fitzgerald said in an interview that the lieutenant turned to him and said, “If anyone tries to touch the bodies, shoot them.” Then, as the villagers confronted the platoon members, Mr. Fitzgerald said, Lieutenant Lorance swore at them and said, “Shut up or I’ll kill you, too.”

I think Lt. Lorance is fine right where he is—serving a 19-year prison sentence.

This entry was tagged. Military

You'll Never See It In Galaxy

Horace L. Gold, the first editor of Galaxy, published this ad in Galaxy 1 (October 1950).

Galaxy Ad

(Image taken from Battered, Tattered, Yellowed, & Creased.)

First Story

Jet's blasting, Bat Durston came screeching down through the atmosphere of Bbllzznaj, a tiny planet seven billion light years from Sol. He cut out his super-hyper-drive for the landing…and at that point, a tall, lean spaceman stepped out of the tail assembly, proton gun-blaster in a space-tanned hand.

"Get back from those controls, Bat Durston," the tall stranger lipped thinly. "You don't know it, but this is your last space trip."

Second Story

Hoofs drumming, Bat Durston came galloping down through the narrow pass at Eagle Gulch, a tiny gold colony 400 miles north of Tombstone. He spurred hard for a low overhang of rimrock…and at that point a tall, lean wranger stepped out from behind a high boulder, six-shooter in a sun-tanned hand.

"Rear back and dismount, Bat Durston," the tall stranger lipped thinly. "You don't know it, but this is your last saddle-jaunt through these here parts."

Sting

Sound alike? They should—one is merely a western transplanted to some alien and impossible planet. If this is your idea of science fiction, you're welcome to it! YOU'LL NEVER FIND IT IN GALAXY!

What you will find in GALAXY is the finest science fiction…authentic, plausible, thoughtful…written by authors who do not automatically switch over from crime waves to Earth invasions; by people who know and love science fiction…for people who also know and love it.

Transferring College Students Mess Up Graduation Statistics

Transferring College Students Mess Up Graduation Statistics →

A new report released Tuesday by the National Student Clearinghouse Research Center, a nonprofit higher-education research organization, shows that 13% of students who enroll at one school end up graduating from another. With a six-year overall completion rate of 55.1% for the class that started in fall 2008, that means nearly one in four students who graduated were transfers, according to the study.

Such high mobility among students points out potential challenges in the Obama administration’s proposal to rate school performance, as well as state-level funding efforts tied to school success.

Figures currently reported by the U.S. Department of Education include as success stories only students who initially enroll on a full-time basis and those who graduate from the same school where they started. The college ratings plan largely has been put on hold amid pushback by schools.

“We’ve got to make sure that we don’t let students fall through the cracks in the transfer process,” said Jamie Merisotis, president of the Lumina Foundation, a nonprofit that works to increase the number of college graduates and provided financial backing for the report.

He said historical assumptions about how students progress through school, including that they remain in the same institution, “run against the reality of the lives that today’s college students are living.”

According to the new National Student Clearinghouse data, one in four students who first enrolled at four-year, public schools in Minnesota graduated from a different school, as did 24% of those in Missouri. Forty-seven and 39% of students who started at such schools in those states, respectively, graduated from their original institutions.

In 22 states, more than 5% of students who started at public, four-year colleges in fall 2008 completed their programs in another state. For example, 8.4% of students who enrolled in public universities in Maine ultimately graduated from schools in other states.

"The curious task of economics is to demonstrate to men how little they really know about what they imagine they can design." — F.A. Hayek, The Fatal Conceit

This entry was tagged. Education Policy

Review: Lock In [★★☆☆☆]

Lock In

Lock In
by John Scalzi

My rating: ★★☆☆☆
Read From: 20 February 2015 - 23 February 2015
Goal: Awards

Warning: This review contains spoilers. If you don't want to be spoiled, don't read it.

Haden's Syndrome is a flu-like virus with a nasty side effect: one percent of its victims experience "lock in". They're fully awake and aware but they're completely cut off from control of their own bodies. They can no longer speak or move. It is, essentially, a conscious coma.

A whole panoply of technologies were created in reaction to the disease. The locked in are able to interact with the physical world through the use of cybernetic bodies called "threeps". (In homage to C-3PO.) They're also able to control the bodies of volunteer Integrators, through neural links.

Lock In is the story of FBI agent Chris Shane's first week on the job. It's a nasty first week, as his first case involves the murders of multiple "Hadens" and the suicides of multiple Integrators. As he investigates, he begins to see a common thread weaving everything together.

That grand tapestry is what ruined the book for me. (This is where I spoil the mystery.) The criminal mastermind is that most likely, most stereotypical, of suspects: the corporate billionaire. One man, seeing harsh times ahead as his government subsidies come to an end, decides to keep the profits flowing by any means necessary.

The billionaire's plan involves committing multiple murders, blowing up a competitor's research facility, manipulating stock prices to crash multiple competitors, and then buying everyone up to create a near-monopoly. Because, greed. Everyone knows the rich are greedy and will doing anything to keep the wealth coming. Murder and stock market manipulation are common tools of the wealthy elite. One frequently sees it in the news headlines.

I like the set up Scalzi created for this novel. I though Haden's Syndrome was creative and the various tech created to help the Hadens offered a lot of storytelling potential. But Scalzi decided to waste all of that on a murder mystery with an unintelligent plot.

This is a plot that I expect from the worst of the mass-market action thrillers. This story is science fiction only in that the hero has a robo-body and the villain controls people through neural links rather than blackmail. Without those elements, it's just another by the numbers murder thriller. Boring.

This entry was tagged. Book Review Review

The Spontaneous Gingerbread House Tradition

The Spontaneous Gingerbread House Tradition →

Way back in December, Sarah Skwire shared a story about how one family tradition came to be.

When I was growing up, we made gingerbread houses every year. They grew increasingly ornate over time–crenelations and portcullises were standard, and melted crushed lifesavers made exceptionally good stained glass–and they were always a highlight of holiday pictures. We kept the house around for weeks.

One year either my sister or I knocked the house off the dining room table. Lower lips began to quiver. Howls of despair and recrimination were JUST about to begin.

Mom stepped in.

“Oh good! You smashed the house on New Year’s Eve. That seems just right. Now we can eat it.”

So we did.

And now, Skwire family gingerbread houses are ritually smashed (with a meat tenderizing mallet) and eaten on New Year’s Eve.

Because it’s tradition.

May your holidays be filled with delightful and delicious emergent orders of all kinds.

This is a holiday tradition that I can support wholeheartedly.

This entry was tagged. Christmas

Equalize Medicare Payments

Equalize Medicare Payments →

Imagine that there are two providers of the same service. Their quality and timeliness are comparable. However, one provider charges significantly more than the other. In a normally functioning market, you would expect that the more expensive provider would have to significantly change its cost structure to stay in business.

What if the more expensive provider argued that it had higher overhead, and therefore needed and deserved to be paid more? He would be laughed out of the marketplace. Yet, this is exactly what happens in Medicare. Because of different fee schedules, doctors in independent practice are paid less for the same procedure than hospital-based outpatient facilities. Unsurprisingly, this has resulted in hospitals buying up physician practices, in order to profit from this arbitrage:

For example, Medicare pays more than twice as much for a level II echocardiogram in an outpatient facility ($453) as it does in a freestanding physician office ($189). This payment difference creates a financial incentive for hospitals to purchase freestanding physicians’ offices and convert them to HOPDs without changing their location or patient mix. For example, from 2010 to 2012, echocardiograms provided in HOPDs increased 33 percent, while those in physician offices declined 10 percent. (Medicare Payment Advisory Commission, March 2014, p. 53)

The Medicare Payment Advisory Commission (MedPAC) has argued that the fees should be “site neutral” for many procedures. President Obama’s budget proposes to phase this in starting in 2017, and estimates savings of $29.5 billion over ten years (p. 65).

This is something I've seen a lot. A hospital buys a clinic. The clinic keeps the same doctors, seeing the same patients. Nothing about the building changes. But the cost of the medical care increases significantly just because the ownership changed. That's wrong and needs to stop. I support this piece of President Obama's budget.

Understanding Geographic Variations in Medical Procedure Rates

Understanding Geographic Variations in Medical Procedure Rates →

For example, this 2010 Dartmouth Atlas Surgery Report from the Dartmouth Institute made much of the national variation in Medicare hip replacement rates in 2000-01. Noting that the rate ranged from 1.2 per 1,000 in the hospital referral area of Alexandria, Louisiana, to 6.7 per 1,000 in the hospital referral area of Boulder, Colorado, it concluded that

[b]ased on the data presented here, it appears that patients in some regions and among some populations may not be getting adequate access to the procedures, while patients in other regions and among other populations may be undergoing the procedures at higher rates than necessary.

Reaching such a conclusion from local hip replacement rates requires assuming that the U.S. population is composed of identical people identically distributed over a featureless geographic plain that is everywhere the same.

Unfortunately, the Dartmouth report failed to inform readers that the most common reason for hip replacement is osteoarthritis and that it is well known that the prevalence of primary osteoarthritis of the hip occurs at much higher rates in Caucasians than in other population groups. In 2010, the proportion of blacks or African Americans in Alexandria, Louisiana, was 57.3 percent. In Boulder, Colorado, it was less than one percent. Hip replacement rates also vary with age, comorbidities, socio-economic group, and employment history.

I did not know this. It does seem relevant to know this, before concluding that one region is doing "too many" hip replacements.

This entry was tagged. Healthcare Policy

Practicing Self-Defense in School

Practicing Self-Defense in School →

A nurse in Surrey, England was called into her daughter's school and informed that her daughter had punched a male classmate—twice. The mother was confronted by the teacher, the head of the students' year, and the school's head (fka headmaster). Then her daughter explained what had happened.

Daughter: “He kept pinging my bra. I asked him to stop but he didn’t, so I told Mr. [Teacher]. He told me to ‘ignore it.’ [Boy] did it again and undid my bra so I hit him. Then he stopped.”

(I turn to the teacher.)

Me: “You let him do this? Why didn’t you stop him? Come over here and let me touch the front of your trousers.”

Teacher: “What?! No!”

Me: “Does that seem inappropriate to you? Why don’t you go and pull on Mrs. [Head Of Year]’s bra right now. See how fun it is for her. Or on that boy’s mum’s bra. Or mine. You think just because they’re kids it’s fun?”

Head: “Mrs. [My Name]. With all due respect, [Daughter] still beat another child.”

Me: “No. She defended herself against a sexual attack from another pupil. Look at them; he’s nearly 6 feet and 11 or 12 stone. She’s 5 feet and 6 stone. He’s a foot taller than her and twice as heavy. How many times should she have let him touch her? If the person who was supposed to help and protect her in a classroom couldn’t be bothered what should she have done? He pulled her bra so hard it came undone.”

My daughters' principal and teachers keep indoctrinating them with the idea that violence at school is never justified. As this event illustrates, it's sometimes very justified. If school staff are unwilling to protect students, my daughters will have my full support when they defend themselves.

Spread the (Local) Wealth Around

Twitter friend @joeld linked to an article about The Miracle of Minneapolis. The article was asking (and answering) the question of how "the city stayed so affordable despite its wealth and success".

In the 1960s, local districts and towns in the Twin Cities region offered competing tax breaks to lure in new businesses, diminishing their revenues and depleting their social services in an effort to steal jobs from elsewhere within the area. In 1971, the region came up with an ingenious plan that would help halt this race to the bottom, and also address widening inequality. The Minnesota state legislature passed a law requiring all of the region’s local governments—in Minneapolis and St. Paul and throughout their ring of suburbs—to contribute almost half of the growth in their commercial tax revenues to a regional pool, from which the money would be distributed to tax-poor areas. Today, business taxes are used to enrich some of the region’s poorest communities.

Never before had such a plan—known as “fiscal equalization”—been tried at the metropolitan level. “In a typical U.S. metro, the disparities between the poor and rich areas are dramatic, because well-off suburbs don’t share the wealth they build,” says Bruce Katz, the director of the Metropolitan Policy Program at the Brookings Institution. But for generations now, the Twin Cities’ downtown area, inner-ring neighborhoods, and tony suburbs have shared in the metro’s commercial success. By spreading the wealth to its poorest neighborhoods, the metro area provides more-equal services in low-income places, and keeps quality of life high just about everywhere.

... The Twin Cities’ housing and tax-sharing policies have resulted in lots of good neighborhoods with good schools that are affordable for young graduates and remain nice to live in even as their paychecks rise. This, in turn, has nurtured a deep bench of 30- and 40-something managers, who support the growth of large companies, and whose taxes flow to poorer neighborhoods, where families have relatively good odds of moving into the middle class.

My immediate reaction to this plan was negative. "I'm a libertarian! I don't believe in making people share the results of their hard work and effort!" Then I stopped to actually think about it. Local governments are, obviously, different from people.

A metropolitan area is more than the sum of its constituent parts. Good suburbs reinforce each other and the city's urban core. Businesses can be located in one suburb, but draw employees from all over the metropolitan area. In a very real sense, the success of each suburb—or city—depends both on its own decisions and on the decisions, and general health, of the surrounding suburbs.

I think it makes a lot of sense to have the city and its suburbs sharing tax revenue with each other. They each contribute to the local pool of welfare, with businesses and employees constantly crisscrossing boundaries as they live, work, and play each day. It seems to make good sense to make sure that the entire metropolitan area is economically healthy, rather than having some areas that are wealthy just because a business is headquartered there instead of five miles away, inside a different municipal boundary.

I'm now interested in having Wisconsin apply a local version of this Minnesotan law.

The Unintended Consequences of Bike Lanes

The Unintended Consequences of Bike Lanes →

It won’t surprise you to learn that these lanes, like many technocratic schemes, come with unintended consequences. When it snows — and it does, from time to time, always catching the city completely by surprise — the plows can’t remove the snow from the streets because the plows can’t fit in the bike lanes. So the plows dump all the snow into the bike lanes themselves. This causes a problem for the two or three people who actually ride bicycles in the bike lanes. It also causes problems for motorists because the city, employing its micromanagerial genius, often uses the portion of the bike lanes near intersections as left-turn lanes for cars. Safety first.

Another consequence — unintended? — is that already congested streets lose an entire lane. I remember once it took me nearly thirty minutes to travel five blocks down L Street, NW. The road was down to one lane, effectively.

And today’s observation: Delivery trucks can’t fit in the bike lanes. So they load and unload not at the curb, but in the street. Safety first. Bottlenecks form. Commuters lose productive time at work or time home with their children. Welfare decreases because rage, or at least irritation, increases.

"The curious task of economics is to demonstrate to men how little they really know about what they imagine they can design." — F.A. Hayek, The Fatal Conceit

This entry was tagged. Incentives