Health Insurance

Why doctors are bailing out:

As the open enrollment period for 2014 approaches, premiums on individual plans in the Obamacare exchanges for California will double, and will increase 80 percent or more in Ohio. At the end of its first decade in force, the ACA will leave more than 30 million Americans without insurance – the driving issue behind health-care reform for at least the last twenty years.

The problem with all of the health-care industry reforms has been that precise goal: expanding insurance. The widespread use of comprehensive insurance policies insulates end users in the system from price signals, especially on routine care. That eliminates competition on price as insurers use their economic weight to pre-negotiate pricing on every kind of service and product under their coverage, from blood tests to setting broken bones. Providers locked into a specific schedule of reimbursements have no reason to innovate to either lower costs or increase value, and end up having to spend money and time dealing with insurance companies for delayed payments rather than focusing on the patients seeking treatment in their clinics.

Ironically, the multiplication of mandates and other regulations in the ACA on both private insurers and government-run programs like Medicare and Medicaid have more doctors opting out of the third-party-payer system altogether. Earlier this week, CNN Money reported on the migration to cash-only services among health-care providers, driven by poor reimbursements, increasing regulation, and high overhead.

ObamaCare has taken a terrible system and made it much worse.

Lois Lerner

Should be doing a long stint in Club Fed:

Lerner, it is prudent to assume, is one among thousands like her who infest the regulatory state. She is not just a bureaucratic bully and a slithering partisan; she also is a national security problem, because she is contributing to a comprehensive distrust of government.

The case for the National Security Agency’s gathering of metadata is: America is threatened not by a nation but by a network, dispersed and largely invisible until made visible by connecting dots. The network cannot help but leave, as we all do daily, a digital trail of cellphone, credit card and Internet uses. The dots are in such data; algorithms connect them. The technological gathering of 300 billion bits of data is less menacing than the gathering of 300 by bureaucrats. Mass gatherings by the executive branch twice receive judicial scrutiny, once concerning phone and Internet usages, another concerning the content of messages.

The case against the NSA is: Lois Lerner and others of her ilk.

This is the danger of a too-powerful government.

Space Safety Regulation

Too much or too little? Clark Lindsey has a post linking to the two extremes. I’d say that Carolynne Campbell-Knight’s piece isn’t just overwraught, but hysterical:

Make no mistake, if a few very wealthy people get killed, the waivers they signed won’t mean a thing if they didn’t know the risks. It may make no difference whether they knew the risks or not. There will be a massive outcry, huge negative publicity and a demand for regulation and accountability. That would be the end of passenger space travel for decades and the damage to the industry would be immense. A wise industry would regulate itself, set published standards, and be open about the risks involved. It would do this before the disaster happens.

When the West was wild, it was a different era. A Wild West in space won’t be acceptable in the day of 24 hour news and the litigious society.

Right now, the risks are not being properly declared. The impression is being given that riding rockets can be as safe as a ride in a light aircraft. That simply isn’t true. Rockets are dangerous and even the most careful engineering can only make them ‘as safe as possible’. They can’t make them ‘safe’.

I’m unaware of anyone “giving the impression” that these vehicles will be as safe as light aircraft. I think that she’s just unjustifiably inferring that. Here’s what I wrote in the book:

Some will argue that part of promoting the industry is to ensure that it doesn’t kill its customers, but the industry already has ample incentive to not do that, and the FAA isn’t any smarter on that subject than the individual companies within it — everyone is still learning.

There is a popular view in the space community that the first time someone dies in private spaceflight it will somehow doom the industry. Bluntly, I believe that is nonsense, because it is based on absolutely no evidence. In fact, there is an abundance of counterevidence with examples being the early aviation industry, various extreme sports including free diving and mountaineering, and even the recent cruise-ship disaster of the Costa Concordia, in which at least thirty passengers died.

In fact, it may take just such a death, a sanguineous christening, to normalize this business, and end the mystical thinking about it.

She herself isn’t consistent on the issue:

While there are some treaties covering satellites and debris, there are no laws. There is no regulator. It’s the wild west in space. Who is going to license and oversee the new commercial ventures? Those involved in this commerce think regulation is a bad thing and that it will preclude innovation. That’s what the early railroads thought. But then the bodies started piling up. When is an aircraft a spaceship? What’s the difference? Regulators such as the FAA have no experience in spacecraft. Once you’re above the atmosphere there are no rules, certainly no laws. If the history of transportation teaches us anything, it teaches us that there will be a dangerous mess until a regulatory regime is established.

If FAA has no experience in spacecraft (actually, they do have some), then how can they, or anyone else, be expected to establish a regulatory regime, until we get some experience actually flying? Not to mention that we do in fact have definitions for aircraft and spaceships, in the Commercial Space Launch Amendments Act.

And as Clark notes:

The same regulations that help keep a vehicle from crashing onto third parties also help protect the second parties in the vehicle. The companies are highly motivated to provide safe space travel. While the industry will go on from an accident, it will be very difficult for the company involved to do so. There will be a long grounding and many customers will no doubt demand refunds. Some states have now limited liability exposure for space tourism operators and manufacturers, but there is no limit when gross negligence is found. An accident will also mean the end of the “learning period” in which the FAA is restricted from applying new regulations on personal spaceflight.

I’ve really got to get the book out.

Destroyer Of Words

Some thoughts on technology, trust and legitimacy:

Washington forgot the main lesson from the nuclear age: that the existence of such powerful weaponry can never be protected by secrecy or technology. Their only defense in possession lies in legitimacy.

Snowden’s torpedo, unleashed perhaps by himself or by some third party, struck at the government’s most vulnerable joint, the weld between Washington and the governed.

Snowden said what many were already prepared to believe — even Obama’s liberal supporters — that the administration is a lying, corrupt, power-mad collection of unscrupulous men. Like a jilted woman, people didn’t believe Snowden because they knew him; they believed in Snowden because they knew Obama. The sense of betrayal may have even been more acute on the Left. In Snowden’s words: “I believed in Obama’s promises.” And how many of those said to themselves, “So did I and chose poorly”?

The solution to the current crisis of privacy is not technical. It is political. It cannot be found in uninventing the computer; only in creating institutions the public can trust to control such power, in the same way it trusts certain governments to control nuclear weapons.

Once again, the wisdom of the Founders is revealed, even as we have turned our backs on it.

[Update a couple minutes later]

Related: The unmediated president.

I think that these are impeachable offenses. Whether or not he will be impeached is a function of whether or not a sufficient number of people in the general public come to agree.

It won’t happen in the current election cycle — the House won’t make the mistake of impeaching again without having the Senate on board (particularly given the inevitable race riots that might ensue). But if this becomes a major issue, perhaps the issue next fall, and results in either a huge Republican takeover of the Senate, or enough Democrats themselves calling for removal, it could happen after the next election. The big quandary would be whether or not we wanted to have a President Biden. If he’s found to have participated in the scandals, and there is a sufficiently strong Republican majority in the senate, then we may have a President Boehner. That doesn’t thrill me, but it would be a huge improvement over what we have today. And it will be a result of the people speaking, as ultimately, the Founders would have expected.

[Update a while later]

Is the US still the land of the free?

In a police state, to be sure, people like Drake and Swartz might simply disappear, and people like me wouldn’t be writing about them. So no, this isn’t the United Stasi of America. Nonetheless, one still ought to ask, how far can one trust the security and law-enforcement complexes to police themselves? My answer would be: You can’t.

Power often seems to infect the powerful with tyrannical instincts. Shroud their transactions in secrecy and the danger multiplies. The people involved aren’t necessarily bad. First and foremost, in fact, they are bureaucrats — as muddled and incompetent as everybody else, with banal bureaucratic interests to advance. The NSA disclosures should remind us of this by drawing attention to the sheer size of the interests involved. Are NSA contractors who specialize in data mining likely to highlight the ineffectiveness of that technique? Is America’s law-enforcement industry — with its professionalized, para-militarized and literally uncountable agencies — going to call a halt to its own growth or ask for its powers to be curbed?

No. We’re going to have to do it for them. And more importantly, for us.

Biting Commentary about Infinity…and Beyond!