Miscellaneous

Obviously, I dropped the ball on this blog. I anticipate preparing
five or six more "Thoughtful Thursdays" over the next year. And sending out
more of these miscellaneous postings.
I have been focusing my
writing energies this semester on the complete Requirements Document for the
Constitutional Construction Kit
The next Thoughtful Thursday is from that effort.

Hack for Egypt

The Hack For Egypt , as part of Cloud Camp 2011, has proposed
a "crowdsourcing" project for the new Egyptian Constitution.
They are looking in the future at a crowdsourcing for the Bill of Rights in
that Constitution.
This is a much less ambitious proposal than the one I am working on. one needs
a simulation component where the Egyptians.
The Egyptian unemployment
is concentrated among the young, as it is in
many other countries including the Arab world.
And 50 percent of educated of
men
and ninety percent of young female
college graduates are unemployed.
So there is a resource of time to work on the Constitution.

Climate Change

I talked about using sortition-based consumption taxes to address
climate change. The Wall Street Journal
had a special issue on Energy and the first article, which frankly
is an editorial, on Climate Change. They say that emissions cuts,
raising energy costs with taxes, cuts economic
activity. Countries do not want
to do this. By putting the tax at the consumption side, this attacks
imports, and tends to get people to consume in ways
that are not energy-intensive.
They may not buy a computer-they may use an internet cafe.
Imports get taxed based on the embodied energy.
They may buy a smaller and more energy efficient house, use public transportation instead of a car.
The article suggest that governments should push for innovations that produce
less costly energy.
Wall Street Journal, November 29th 2010, Page R1

United States Health Insurance Mandate

As I assume all readers of this blog know, the United States has
mandated that all people purchase health insurance. However, there
is some question whether that is constitutional. The famous "necessary
and proper" clause of the United States Constitution gives the
United States Congress the power to make laws "necessary and proper" to
exercising its enumerated powers.
Does mandating that everyone buy health insurance fall within the
"necessary and proper" clause? One District Court has said no!
And it appears that a Florida judge will rule the same way.
However two lower courts said yes, they did.
I made a proposal that would resolve this. Make individuals tax rate
dependent upon their financial responsibility. We already have deductions
for contributing to IRA and for some education items. Individuals who are
purchasing disability insurance, health insurance, education should pay
lower taxes than those who are not.
There are people who cannot be expected
to have money for
health insurance, the single mom putting
herself through Nursing School. However, those who have money
for a flat panel TV or internet, should spend or invest
it some other way such as health insurance.
The New England Journal of Medicine article,
"Can Congress Make you Buy Broccoli? and Why
That's a Hard Question" by Wendy K. Mariner J.D. M.P.H.,
George J. Annas, J.D. M. P. H. and Leonard H. Glantz J.D.
said that Congress had two goals in passing the health reform
it did:

1. 
   provide a way for all Americans to gain health care
2. 
   preserve the private, commercial health industry

Obviously, it is not reasonable to require the health insurance companies to insure anyone regardless of sick they are and let people wait until they are in the proverbial ambulance to buy health insurance.
When a person wants insurance and has a "preexisting condition," we need to distinguish between those who simply waited until they got sick and those that had good reasons for not purchasing health insurance. A bureaucracy cannot. A sortition jury can.
Judge Vinson asked "If the government decides that everyone needs to eat broccoli, can Congress require everyone to buy Brocolli." If Congress chose to expand Medicare or Medicaid to cover everyone, they could have. Congress could then raise everyone's taxes to do so.
I believe at tax time, everyone should compete to show how responsible they are, buying and eating their broccolli, and saving, whether for retirement or their health needs.

Bronte Capital Management Blog

I met Mr. Hammond on the plane to New York City, and then by luck as I walking near 42nd Street in Manhattan. The first article I turned to, was the one on the Australian financial system. There is concern about one of the strategic funds in Australia. More importantly, he discusses the risks with privatized social security of fraud.
There are many other articles there, often very insightfully showing the numbers in investments and securities, from Chinese bus adverts and alcohol sales to Australian Real Estate near the iron ore mining boon.

Benefits Schemes

A gentleman who won two million dollars from the lottery is still collecting food stamps. The food stamp program uses income and lottery winnings is not considered income. State of Michigan is talking about getting a special waiver from the Federal government. (Ron French, Detroit News)
This is why all benefit recipients should go before a sortition jury to eliminate those who don't deserve them, even though they may qualify under the rules.

State Income Taxes

Wall Street Journal, Volume CCLVII Number 70, Page C1 and C2, March 26th to 27th, "The Price of Taxing the Rich" Robert Frank
Million dollar a year incomes pay 45 percent of California's Income Tax receipts. Similarly percentages for Connecticut and New Jersey. The problem with this is that these individuals incomes are erratic. Of course, when the market is up, these people "take their profits." And they have to pay their taxes on the capital gains, and tax revenue goes up. (We saw that when the federal government was briefly in surplus around the turn of this century. But some of this was due to "hundreds of millions in unanticipated tax revenues from taxes on capital gains.") In one year, the top one percent of the taxpayer's income dropped sixteen percent. In 2006, California anticipated a six billion change, either direction, from year to year on a regular basis. In the dot com bust, revenue from capital gains changed from seventeen billion to five billion.
Of course, states can protect themselves with "rainy day" funds. But state governments, like people in general, do not have the discipline to do this.
This blog has long called for salaries and other expenses to be a share of their revenue. Thus States would make goverment salaries and pensions a percentage of revenue. (Note that under the full share economy, government workers and retirees would set their mortgage, rent, etc. as a percentage of this amount. Thus, if this varied fifteen percent a year, they would not be between this decrease and an expense that does not change. Their discretionary income for day-to-day purchases would go up or down by the same percentage as the state's revenues.) And their "borrowing" would be the same way. Thus, rather than selling a three percent bond due in thirty years, they would sell a perpetual bond that paid out nnn percent of the revenue. I earlier called for a "clawback" tax to deal with, among other things, those earning high pensions.
A consumption-based sortition "badness tax" could have firms competing to avoid the taxes necessary to fund the state government.
And with individuals having a share of the income of the companies in which
they invest, there would be less variability of income. Individuals
earn money as the company does, not by selling the shares.

The Congressional Budgeting Office said they were off by one hundred billion dollars on the cost of the Health Reform Some companies apparently will drop their health coverage for their employees since there was something already available-- Walmart was accused of relying on medicaid for its employees, but it shows that it has a greater percentage of full time workers on medical coverage than other retail firms and large firms and net it is removing people from the Medicaid rolls.

This shows the importance of two things:

1. Firms should compete on the way they treat their workers to avoid taxation and that it is difficult to evaluate the numbers fairly.
2. The only way to fix the costs is to fix the expenditures and let the providers compete to earn them on the basis of their accomplishments.

Australia Incentive Program to improve Diabetics care

One of the problems with incentivizing anything is that the description of what one has to do to earn an incentive will not accurately match the mental image of what should be incentivized. Australia will have a new program for improving Diabetes care, where they give money to the doctors when the patients avoid the complications from diabetes (32% of the health care costs there).

Not only is the article excellent, the link excellent, the comments are very well informaed.

Health Care Reform Lobyists

The Chicago Tribune had an excellent article on the role of lobbyists in the health care reform bill. This parallels the article I found on bribing senators with special benefits for their state. By the way, thanks to Ariela Huffington .com for pointing me at this article.

Health Care Cost Control

Health Care Reform has now become Health Insurance Reform, putting "the squeeze on insurance companies." But it does nothing about lowering health care costs and the incentives on physicians and others to do more and more procedures, and to salami slice the health care activity and bill to make more money.

Our participatory democracy plan is to make the insurance companies and other large payers spend a certain amount of money. The health care providers would provide the best care they possibly can, and on the basis of same, after the fact, the participatory democracy juries in collaboration with experts and computer software provided by the insurance companies decide how to allocate the fixed pot. For group plans, the sortition juries are selected from the premium payers, the group covered. For those plans subsidized or completely paid for government, the sortition juries are chosen from the general population.

In other words, fix the costs, but leave the autonomy to the doctors on how to practice!

Health Care Poll

The Associated Press polled Americans on health care. Eighty-two percent are in favor of a ban on insurance companies discriminating against those in poor health. However, when told that this ban would cause most to pay more for health insurance, 31 per cent of Americans are now against it and only 43 percent support it.

The questions should have been Would you support a ban on insurance companies not insuring those with pre-existing conditions who had an opportunity to buy health insurance, could afford same, but chose not to do so?

Would you support an insurance company not insuring someone with a pre-existing condition who lost their insurance through no fault of their own (e. g. got laid off)?

A bureaucracy might not be able to distinguish between the two but a sortition jury could have. It is also the premise of my alternative to a public insurance plan, a sortition plan. That is, there is no public "insurance" but there is a public "pool" of money to which both the person covered and the public (as part of general taxes) would pay for. When an individual got sick, they would petition for approval to have the public pool pay for this. A sortition jury would look at both the illness and treatment involved. It would also look at how much the person contributed to the public pool and their income in comparison to the contributions made. Thus, the eighty dollars that the proverbial washer-women contributed might have more weight than the eight hundred dollars that the YUPPIE contributed.

Sixty-seven percent agreed that everyone should have "at least some health insurance" with only 27 percent opposition. However, sixty-four percent are opposed to a tax penalty for not having insurance. And even half of Democrats oppose fines to enforce the requirement to get insurance.

I proposed a broader requirement of financial responsibility and this, obviously ambiguous one, be interpreted by sortition juries.

Medical Cooperatives

This idea has come up in the health care debates recently. Many people poo-poo it; I heard a legislator saying that coops can work well for grain elevators and the like but not for health care. There are two successes, Health Partners in the Twin Cities of Minneapolis and the Group Health Cooperative of Seattle. There have been failures. My mother was a member of HIP which merged into Group Health Insurance which apparently is oging to health. They claim that one needs 600,000 members in the same location. This enables the coop to have its own physicians and buildings.

NPR had a presentation on this, in response to the Senate Finance Committee having approved this Unfortunately, the difference between medical cooperative and a non-profit insurance company like Blue Cross Blue Shield is that in a medical cooperative, one has the opportunity to vote for a board of directors. In the Seattle one, only one percent of the members vote. Minnesota does do better at one third. I belong to several professional societies; we get to vote for directors, the president and maybe a few other officers. Although, the members do have their "say" through a yearly vote, and the organizations seem to do a fine job, their costs do seem high and we really don't have a meaningful voice in the day-to-day running of our organization. Similarly, the Cooperatives have less complaints than regular insurance companies but costs are at best comparable.

In China, 726 million people in rural areas are members of a "rural cooperative insurance system," but where the government pays eighty percent of the costs. article does not discuss other people who might be living in rural areas such as hte medical providers), are coverd by a rural cooperative system. Yet, there are problems with theft, $100,000.00 out of about five billion in one county alone.

The real challenge is to make them particpatively run, where each decision is made by a randomly chosen subset of the members, from how much each person is paid and whether they are going to get. Also the amount of premiums or membership fees should be voted on by the group and should be a median of the amount selected.

Wall Street Journal Health Care Article Response

The Wall Street Journal just had an opinion piece on health care. It has some good facts:

1. 400,000 people engaged in medical tourism here
2. Our five-year survival rate for all cancers beat those for Canada, Europe and England
3. The HR 3200 is long and has too many new taxes and penalties and mandates.

But some other facts are just plain wrong:

1. "Anyone can walk into an emergency room and receive care regardless of their ability to pay.
   That is not true. They can be treated for the emergency, but if they have cancer, a gall bladder that needs to come out, it probably is not an emergency.
   As I have argued here, we need to replace this with a plan that says that those who do not have insurance must go before a sortition jury (Unless it is truly something current like a heart attack or a car wreck) and they will decide whether the person could reasonably be expected to have health insurance or be putting money away into a health savings plan. The person making $20,000 with a family probably will be excused for not having helath insurance. Ditto for the person who was layed off. Ditto for the person who went to the health insurance companies but was turned down. The yuppie making $70,000 who went bare would not. And we would like at the amount in the health care savings care plan as compared to one's income. The proverbial washer-women who saved a few thousand dollars over her life in her health care plan would be given much more credit than the young urban professional.
   We would all serve on these committes. I know I would probably push people to go to the premier medical facilities such as John Hopkins, Hospital for Special Surgery and Memorial Sloan Kettering, just as I do for my students and family. They would all use Pubmed the wonderful free resource provided by the United States Government that indexes the medical journal literature, to research diseases, treatments and outcomes.
2. They blame "runaway lawsuits," "malpractice"premiums for the problem. Malpractice costs are only two cents of every health care dollar. They blame defensive medicine. But the CBO found many studies that show this is not a problem.

Doctors and hospitals that do provide charity care should be rewarded at tax time by sortition juries. The Wall Street Journal advocates vouchers! But I would argue that those who receive public funds for their health care should have to answer to the public for what is done with it. As mentioned above, this would be done on a one-on-one basic through sortion juries. Of course, I am not including here programs that represent earned dollars like Medicare.

I also have advocated that businesses that do provide health insurance for their workers be rewarded at tax time. This is better than mandates.

Media

An important issue is how are people informed. Paul Krugman writes eloquently about horse race reporting. Media spend more time reporting on which policy proposal is up and which policy proposal is down than what is in them.

I believe the problem is partially a symptom that we don't vote on the proposals; thus, we are sheep who just have to know how we are to be done to. If we were to vote, there would be more information on what it was on which we were to vote.

Richard Serling in a comment asked for a solution--what about my proposal

Hierarchies are bad for health

Hierarchies are bad for health.

Marmot studied British workers in the government. The clerical workers had 11.67 mortality while senior administrators had 4.73, less than half as much. Profssional were in the middle at eight. All had white collar jobs--so they weren't subject to occupational hazards such as chemicals. They all had the same National Health Service Health Care and as civil service employees were not subject to the stress of job insecurity. (Medical Sociology by William C. Cockerham citing:

1. Marmot, Michael, M. J. Shipley and Geoffrey Rose, 1984, "Inequalities in death--Specific explanations of a general pattern." Lancet 83, 1003 to 1006.
2. Marmot M. G. George Davey Smith, Stephen Stansfeld, Chandra Patel, Fiona North, Jenny Head, Ian White, Eric Brunner and Amanda Feeney 1991, "Health inequalities among British Civil Servants: The WhiteHall II Study" Lancet 337 1387.

Participatory democracy eliminates hierarchies in two ways. People report to randomly selected sets of jurors, rather than Everyone serves as jurors. They will serve as jurors for decisions made by the government. So everyone has an opportunity to be in charge. Some of these jurors would be for the companies in which they invest or have a share.

But the biggest change will be eliminating rules in making decisions. For example, a clerk in the welfare office distributes benefits as per a very precise set of rules. A juror would hear the story of many potential beneficiaries. They would then vote how a limited fund would be distributed among them. A health insurance company determines the precise rules for how much to pay medical claims. This is to attempt to ensure that the money going out to the doctors does not exceed their revenue. A claims handler in this insurance company, thus obeys precise rules, and is at the bottom of the hierarchy.

In my proposals for participatory democracy, the individuals vote on how much to spend on health care, or each type of health care. Then each juror gets a set of claims and a budget and decides the most just way to distribute the money. The jurors decide how to organize the work and what to look at and the order in which to look at it. Marmot reports that low control negatively impacts health and recognizes "workplace democracy." The jurors discuss this and hopefully arrive at a consensus.

Obviously, by following a set of rules, one achieves an efficiency, in terms of less time per case. In a sortition-based system, each decision is made from first principles each time. Each decision requires a large number of people, say twenty people per decision. In a system where rules are specified, one person can apply them. It is an empirical question, is the unpleasantness of having individuals apply rules greater than the unpleasantnwss of individuals discussing things from first principles.

The Wikipedia article for the study and one by Marmot himself. He provides his full paper on how to prevent job related disorders, none of which look at the issues herein.

Obama said No Meddling by government or insurance company executives

Obama said, Quote: "I don't think government bureaucrats should be meddling. But I also don't think insurance company bureaucrats should be meddling,"

I agree. That is why we should have sortition juries determining health care reimbursements, not government rules or insurance company bureaucracy. This is the last two steps of my four step plan for participatory democracy.

Public Plan, Heatlh Care option

Our goal is to provide a public option such that individuals who deserve it can get health care and to encourage people to pay as much as they can reasonably afford to do so. We want to avoid rationing and we don't want a government bureacrat determining who gets care and not. We want the private plans to be able to compete so as not to destroy the current system. We also don't want to mandate that individuals get health insurance. Individuals should be able to pay what they feel they can afford into the public option. Individuals would also have the option to save money and use that fund to pay part of the expenses. And they should be encouraged to do these good things.

These goals can be achieved simultaneously! The answer is that those who choose the public option, which is anyone who feels they need it, regardless of what other health insurance they may or may not have, regardless of their income, to get approval from a randomly selected jury for each health care procedure. That jury would have the full power to vote that the heart attack victim be left to die on the side of the gutter. They have full power to say the motocycle rider without a helmet does not get care and full power to deny care to those who drive drunk. That jury would have the full power to say go ahead and have that care and the government will pay for it. But we will have full control over your income until it is paid off. And if there is a controlled study running that is relevant to their condition, the jury would have power to say to the person they must enroll to get their care. The jury would have full power to make the person's medical records avaialable or even public, or keep them fully private if that is just. And the jury would have full power to mandate a specific care option, e. g. prostate removal when the person might prefer some other treatment choice. And the jury would have access to the person's financial and income history so they could decide whether the person presenting for case could have saved/contributed to the public option/bought private care and chose not to for foolish reasons, or they truly could not afford to do so. I made a more general post on a four part plan on how to apply participatory democracy to health care. However, now the main question is public plan, to be or not to be, so on that I blog now.

A government could not, it is simply not politically feasible to let a person die. The juries won't often vote to exercise this power, nor should they! But the power would be there--

(Victor Broadcasting versus Federal Communications Commission. WABZ was the incumbent broadcasting system and Victor Broadcasting wanted the frequency. They claimed that WABZ was simply not contributing to the community and frequently duplicated care. The case itself, of course, is not relevant to health care. But I remembered one dissenter's comment in the opinion for decades, when they observed that from 1961 to 1983, the FCC always let the incumbent license holder keep their license with one exeption. and he said the following.

One is reminded of the remark attributed to Theodore Roosevelt: "If the President of the United STates were obligated, irrespective of cause and at his own free choice, to put to death one man every year, the powers of the Presidency would be vastly enhanced." "If the Commmission would screw up its courage to a height never before reached by that agency, and firmly resolve to deny just one incumbent out of thousands of license renewals each year, the quality of television and radio programming ni America would be remarkably enhanced." Victor Broadcasting inc. versus Federal Communications Commission, 722 F.2d 756, 779, (1983, United States Court of Appeals for the District of Columbia Circuit)

Everyone would get the opportunity to serve on such juries. Everyone would have the power to say, "you screwed up; you shall be left to die." Maybe once per year, this option will get a majority vote of a health care jury. But with that option, the public option and the private plans would be immeasurably enhanced.

(I searched for this quote. It appears to be apocryphal.)