Some quick health care policy and cost links

From Walter Russell Mead, “Why America is Going Broke.”  It is not simply the cost of health care itself, but the efficiency in administering it.

A study of which hospital services contributed the most to growth in 2001-2006; hint, it’s not more radiology and diagnostic testing. Those services, however, will be the first to be rationed or cut during ObamaCare, and radiologists will be making substantially less money.

ObamaCare, by the way, will make life even harder on underpaid university adjuncts.  As anyone who works over thirty hours per week will be entitled to “free” health care, paid for by the employer (perhaps with a modest co-pay by the employee), universities will cut the hours of their adjuncts.  (Yes, these are non-profit, accredited universities.)  The predictable result: instead of being an adjunct at one school, you’ll be an adjunct at two, which will increase your commuting costs and the time spent away from home.  Alternatively, you’ll merely see your hours get cut, which means even less take-home pay.

As a health-related item, cities are declaring war on food trucks.  The usual over-regulation is the culprit, which will either drive food trucks out of business, or will drive up prices (no pun intended).  I’m not a food truck aficionado, but I do appreciate the variety of consumables that are on them, as well as the general healthiness – you can get hummus, veggies, stir-fry, and tofu at McDonald’s prices, but not at McDonald’s quality (or lack thereof).

I don’t like being right…

…well, I don’t like being right when it’s my cynical self doing the talking.

Back in the fall, a lot of very libertarian-minded people refused to support or vote for Mitt Romney under the “He will be just as bad as Obama” theory.  To which I said, “Do you want Obama nominating Antonin Scalia’s replacement?”  (We’ll assume, arguendo, that the two people would be the same, a premise with which I strongly disagree.)  “Oh, Scott Brown is too liberal.”  Hey, guys, he said that his favourite Supreme Court Justice is Scalia, and he voted to filibuster Elena Kagan. 

So, my friends, what do you want to happen if and when the constitutionality of Obama’s twenty-three gun-related executive orders* is challenged?  The orders can be challenged both on the merits, and on the constitutionality of regulating that area via executive order.  Do you want a 5-4 ruling that the President has the right to overrule certain sections of HIPAA, violate state privacy laws, and require states to actively share information on a federal database?  I mean, if you’re cool with that, and if you stayed home in November like eight million other 2008 voters did, then rock on. 

There is also some abject foolishness in the way that doctors are treated by this Administration.  (Yes, this is a health care policy blog; here’s some health care policy for my wonks out there.)  A potential doctor goes to college, takes at least two semesters each of chemistry, physics, biology, and organic chemistry, then applies to medical school.  Most of those students do not get into any medical school.  The ones who get in spend four more years and over a quarter-million dollars learning about immunology, cancer, anatomy, each system of the body, etc.  Then it’s another four to six years in residency, by which time they are all at least thirty years old, in debt up to their eyeballs, and members of a profession that is somewhat understaffed.

In what screwed-up world are we going to have these people talk about seatbelts, guns in the home**, and other issues?  I’m sorry, if you think that doctors should be spending their precious (and, to us, scarce) time talking about crap that a social worker can handle, you’re delusional.  Nothing against social workers, but if we want every American to spend time talking to a professional about seatbelts, we can do that by having them all talk to a social worker, straight of college, before their doctor’s appointments.  Or before they renew their driver’s licenses.  Requiring doctors to talk about these things is like requiring a Nobel prize-winning physicist to spend half his day scrubbing toilets in the bathroom. 

A cornucopia of higher education bubble commentary and links

A few days ago, Michael Graham, the Boston Globe, and Paul Caron (of the TaxProf blog) reported that the dean of New Engalnd School of Law is paid $867,000 per year.  Only about a third of graduates of the institution find jobs that require or suggest a Juris Doctor degree, but both tuition and enrollment have skyrocketed over the past few years. 

If a corporation raised costs, decreased the quality of goods, and paid its CEOs more money than anyone else in the industry, that corporation would either go out of business or be the subject of an Occupy Wall Street protest.  A for-profit corporation, operating in a free market, could not behave this way.  However, a “non-profit”, funded by a well-intentioned federal government intent on sending kids to school, can do frightening amounts of damage to young people’s lives without incurring the wrath of politicians, bureaucrats, or OWS.  Any debts incurred to for-profit corporations (credit card companies, mortgage companies, on your cell phone bill) are dischargeable in bankruptcy; student loans are not.  Those schools get their money no matter what, and the lenders get it from you, no matter what, with no risk of loss.  (That risk of loss is what keeps companies in check in the free market.)

The prospects for young lawyers are beyond dismal.  One ad is for an attorney with up to three years of experience, who will primarily work as a paralegal, will segue into an attorney position, is expected to work long hours, and pays thirty grand a year.  Yeah, those are the loss-leader years, of sorts, wherein one is paid badly, gains experience, and leverages it into better pay years from now.  But if you’ve spent seven years and three hundred grand in higher education, you should be making more than a receptionist.

Twenty-first century relationships aren’t actual relationships, apparently

In this NY Times article about the dating woes of twenty-somethings in Manhattan, singles describe being asked out on dates via text message, for what aren’t actual dates.  While this isn’t the main reason that I blocked texting to my phone years ago, it’s a great unintentional benefit: if he can’t text me, he can’t ask me out by text. 

Chicas, do not go out with a man who texts you for a date. This may mean you’ll go on fewer dates, but they will be actual dates, not pseudo-dates, and you shall not be wasting your emotional energy.  You are not being high-maintenance by asking that he at least g-chat you for a date.

The notion that it’s either “hanging out” or an expensive, unaffordable, princess date is also absurd.  If you have student loans for a liberal arts degree, you’ve learned what a false dichotomy is.  Surely, he can take you out for coffee and a muffin.  Or he can stick coffee in a Thermos and take you to Central Park for cuddling on a blanket and watching the swans (wait, those are in Boston) dirty city pigeons.

Now, my twenty-four year old self did not know these things.  My twenty-five year old self figured it out when interning in D.C., where I met other think-tank interns who kept taking me out on actual dates that involved the Smithsonian and silly excuses to buy my macchiatos.  I’m here to pass that wisdom onto the next generation.

Between Scylla and Charybdis

You know, sometimes I get bored of writing about the whole debacle that is ObamaCare, so I write about UFOs.  But then I can’t help but point out, over and over, how the news that comes out every day shows us what a disaster this thing will be.  The latest, via Instapundit:  Democrats are thinking of taxing expensive health care plans (valued at more than $14,000).

“Okay,” you think, “What’s wrong with taxing Cadillac health care plans?  If you want to have health care that pays for acupuncture, aromatherapy, and such, you should be paying taxes on that, not getting it tax-free.”  To which I say: yeah, except the feds are now mandating that everyone buy Cadillac health care, and the average family plan under ObamaCare will be $15,000. 

Well, that’s diabolically brilliant, Congress: mandate that everyone buy expensive ‘insurance’, tax people who don’t buy it (by accusing them of being free riders), and tax people who do buy it (by accusing them of having luxury health plans).  Evil, but effective.

A blast from the past, courtesy of Patterico

Peter Schiff, getting laughed at in 2006 for his belief that the housing market would crash in spectacular fashion.  My only additional commentary is to point out that there’s nothing really to help America when she falls – Greece has the rest of the Eurozone, Europe has America, smaller countries have larger countries; states have the U.S. government.  There’s no country out there with a big military who is friendly to us, who can cover for us as we spend less on R&D and more on servicing our debt.  There’s no big capitalist country out there to produce new drugs, new technologies, new anything to help keep the global economy chugging along.

UFO seen in Amherst, Massachusetts

Last night, residents of Amherst, MA reported seeing a diamond-shaped UFO, roughly the size of two or three cars, that flew more slowly than do planes.  It was illuminated by dim white lights. (Story.) 

What are our options here?  Alien invasion (which would explain John Kerry)?  Secret military plane, singular?  Hoverboards? Small group of planes that appeared to be a single object? 

Commercial aircraft usually move at several hundred miles per hour.  Cessnas and other light aircraft can get airborne around 55 knots (63 mph); commercial aircraft take off around 150 mph.  You can definitely get a plane to be airborne when it travels at the speed of a car on a highway; it’s just not the planes that people fly on to get to California, nor the speed that those planes move in order to get people to their destinations in a timely manner.

If the thing is visible because of its own lights, it could have lights that are in an odd pattern but do not necessarily illuminate the entire aircraft.  Likewise, it could be a group of Cessnas or Pipers, each of which had illumination, grouped together; in such a configuration, they may look like a single, oddly-shaped plane.

Other possibility: test flight of advanced military aircraft.  Sorry, conspiracy theorists, alien loves, and Holocaust-deniers, but the military likes having American pilots in highly-advanced aircraft, and likes Americans to be protected with the most advanced technology around.  It also likes people to not know that they are being protected with this stuff, because then our enemies don’t know about it.  If you think it’s aliens, you aren’t going to spill to the Chinese, Russians, North Koreans, or whomever about our fancy new toys that can kick the butts of their not-so-fancy toys.

Yeah, I’m a killjoy.  There’s aircraft out there – called Cessnas or Pipers – that can fly close to the ground at a relatively slow rate of speed.  Planes flying together can give the illusion of one big plane.  Unless E.T. drops out of the cockpit, it’s nothing special.

The obligatory “yes, your health care premiums are going up” post

Look, we all told you that this would happen: ObamaCare, with all of its mandates, will make health care premiums go up.  Health insurance does not cost a lot of money in this country because insurance companies make too much money; they are high because we’ve set up a situation in which every darn thing is “covered” by insurance, which leads to (a) skyrocketing administrative costs from the doctor’s and the insurance company’s perspectives, and (b) over-utilisation of health care.  Third-party payer systems really only work efficiently when catastrophic and rare events are covered (e.g., auto accidents, a tree falling on your house, an ocean vessel sinking when hit by a meteor). 

Forcing people to buy more health insurance is about as likely to drive down the cost as it would be to eliminate obesity by forcing every restaurant to offer an All You Can Eat buffet in place of a la carte items, then demand that Americans eat every meal at a restaurant. 

So yes, your costs are going up.  They are going up the most for individual and small business plans, which is exactly what you would expect from this type of law.  Big employers can spread risk over a large population and have less of an adverse selection problem: few people get new jobs because they might have a heart attack next week, or have a nasty looking mole that has bred other nasty-looking moles.  But the same cannot be said of the individual insurance market, which is the most affected by the law that insurance companies can’t discriminate against people who are already sick.

  AAA does not do towing within a week of purchasing a policy; they charge a same-day fee if you buy a policy and need a jump start or a tire change; and they don’t let people get their gold membership (with free 100 mile towing) if they have old, broken-down cars.  Guess what?  AAA is a very reasonably-priced insurance package.  Homeowner’s insurance, which requires an inspection before issuance, is also priced reasonably.  You’re not allowed to buy insurance as a hurricane approaches; insurers shut down issuance of new policies.  No one says, “Crud, my house just burned down, I’m going to buy homeowner’s insurance!”   If that happened, if if Allstate were mandated to issue such policies, the cost would move from what it is now to something approaching replacement cost of a house.

Want to see health care be like AAA, homeowner’s insurance, or car insurance?  Then let it abide by the same set of rules.  Let people get insurance for catastrophic conditions only, permit insurers to deny gold-plated benefits to people who are already sick, and have some sort of non-accident grace period between the time you buy a policy and when you’re covered.

 

Hey, I thought were were rid of Barney Frank

So he lives only a couple of miles away from me, but I do feel well rid of the guy, even as I remain unimpressed with his replacement.  But Barney couldn’t long stay out of the Beltway; he has made it known that he would like to be appointed to the U.S. Senate.  If John Kerry becomes Secretary of State, then Gov. Deval Patrick will appoint a replacement Senator until the Commonwealth holds a special election.  Frank has this to say:

Frank said that while he could see how the request might seem “a little arrogant,” he felt that his experience in Congress could benefit his home state during crucial negotiations. Under the “fiscal cliff” deal struck earlier this week, no resolution was reached on an extension of the debt ceiling, set to expire early this year, while deep sequestration cuts were only delayed two months.

 “That deal now means Feburary, March, and April are going to be among the most important months in American financial history,” Frank said.

I will have to gently disagree with the lovely Michelle Malkin; it’s annoying, but not really narcisstic, to think that as a former Congressman of three decades, you could manage an interim Senate appointment.

My bigger problem is that Barney Frank was largely responsible for the housing bubble and subsequent collapse; despite being warned about the dangers to the economy and to homeowners, he wanted to “roll the dice”, even as the market exploded.

When your signature financial achievement goes down in flames, don’t talk to us about what a wizard you are.

Are you too sexy for work?

From Instapundit, we get an article claiming that a Ms. Melissa Nelson was terminated from her work as a dental assistant for being “too sexy“.  The opinion from the Iowa Supreme Court tells a different story – one of a spouse who asked her husband to terminate the employment relationship because it was destroying their marriage.  Justice Mansfield reasoned that Nelson’s “but for” argument was insufficient to raise a claim under the Iowa Civil Rights Act; Nelson had not filed a sexual harassment charge, but merely said that if she had been a male, she would have kept her job, ergo, discrimination.   Part of the rationale was that Nelson’s employer, Dr. Knight, promptly hired another woman in the same position.  (I have to wonder how one can argue but-for causation when the same requirement, applied to the subsequent hire, obliterates the sex discrimination argument.  Apparently, the Iowa Supreme Court agrees.)

First, some practical advice on avoiding expensive litigation: if you are a male employer and a young, sexually attractive female employee is dressing provocatively, do not tell her this yourself.  You have other women on staff, correct?  A matronly type who can say, “Susie, would you please be more cautious about what you wear to the office?”  When you comment on the young woman’s clothing, and in doing so, say that it causes a bulge in your pants (slip opinion, pg. 3), you are setting yourself up for a lawsuit.

Why Melissa Nelson did not choose to file a sexual harassment claim is not something I understand – her attorneys are more familiar with employment law and have facts not mentioned in the sixteen-page opinion – but such a lawsuit might have made it past summary judgement (unlike the sex discrimination suit that was filed).

With that, my non-legal advice to women in Melissa Nelson’s position (especially if the wife is part of the office, as is Mrs. Knight): if your sketchy, sleazy employer starts texting you about your orgasms, tight shirts, and sex life, tell his wife to tell the old lech to knock it off.  She’s less likely to think that you’re having a covert affair if it’s, you know, not covert and the lady in question is really grossed out by the affair-ish parts of it.

Ultimately, the Iowa Supreme Court did not rule that you can terminate an employee for being sexy; it did not necessarily rule that you can terminate an employee for looking really hot in a low-cut blouse.  (The latter would have been a finding of fact, not appropriate for the summary judgement claim.)  It functionally ruled that you can fire an employee whose presence infringes upon your marriage and threatens to destroy said marriage, and, in doing so, relied on precedent wherein the women had been having affairs with their married male bosses.  Apparently, something in the mind of Justice Mansfield, and the Justices who agreed with him, honed in on the idea that the plaintiff would text her boss to complain that her husband wasn’t sleeping with her, and found those behaviours to be much more in line with affairs and homewrecking than with merely being a young, lovely women with the misfortune to have a lech for a boss.

Update: Jessica Valenti misreads the article (or rather, fails to delve into the details) and offers a profanity-laced tumblr about the incident.  My only criticism of the decision is that it was decided on summary judgement, not after trial – it seems like a fact-finder could logically disagree about the application of certain precedents to this situation, or logically disagree as to whether or not Ms. Nelson was fired for being attractive, or fired for being a picometer away from having an affair with her boss.  Valenti, like all other women critiquing this decision, also fails to acknowledge the role that Mrs. Knight, the defendant’s wife, played in the case – she asked him to do the firing.