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September 27, 2004

The Inconvenience of Medical Insurance

The topic of health insurance generates a lot of heated emotion. That makes it a good campaign issue. A month ago, the Census Bureau reported that there are approximately 45 million people without health insurance in the United States. It turns out that only 8.2 million of those are truly hard cases, the rest either able to afford it or not without it for very long.

I know one of those hard cases, and I'd like to share some first-hand knowledge. Of course it's anecdotal and therefore you shouldn't generalize, but I do think it holds some explanatory power. (And I can get away with this because I don't think she reads my blog…)

With apologies to Homer Simpson, let's call her Jane D'oh. No, that's really mean and I didn't just write that. I don't have to use every pun I think of. Let's just call her J.

J fits the stereotype — a young single mother working several low-wage jobs and unable to make ends meet. She has no health insurance, among other things, although inexplicably she has a cell phone. She has a few relatively minor health problems she can't afford to get treated, but treatment would substantially improve her quailty of life. Sorry, I'm not going to go into much detail.

Last year, I blogged my shocked reaction to news that more than one-third of people in the Oregon Health Plan were dropped for failing to make premium payments as low as $6 a month. (The premium schedule is available online.) Those are the kind of people who will only have health insurance if they're not inconvenienced by any responsibility for it at all.

I don't know if J was among the dropped; she may never have been in the program, or even eligible for it. But recent experience makes me believe she's the kind of person to whom a $20 monthly premium would be a significant obstacle. And that it's a bigger psychological hurdle than financial.

A few months ago I was in possession of a coupon for a very cheap initial visit with a chiropractor. I thought it could help with J's headaches, and gave her the coupon and some extra money that would make it completely free to her. (I had also told the chiropractor I would pay for a few followup visits, which J never knew.) All she had to do was schedule the appointment. She never did, even after my reminding her and her being apologetic for forgetting.

She turned down free health care for a problem that had been bothering her for a long time.

Now J has a small piece of glass in her foot and doesn't want to see a doctor to have it removed. It's not indifference, she positively does not want to see one. I think she tragically undervalues her own health and don't see a way to get her to the doctor short of kidnapping. Which I shouldn't even be thinking about, for the temptation of doing it. It's hard for me to resist a crazy plan!

I'm feeling dramatic. It should go something like this:

How may I help you?
J has a piece of glass in her foot. We need to see a podiatrist right away.
Do you have a referral? Who is the insurance?
I'm her referral, and her insurance. <place a small stack of $50s on the desk.>
Yes, sir! I'll page a doctor immediately.
Oh, my hero! <swoon>

Urm, except for that last part, it sounds pretty good, right?

I suspect J's refusal to seek health care is a self-esteem problem. She doesn't value herself, so she doesn't value her health. She complains about it but resists action to impove it — even when encouraged, and when it's free.

This is the kind of article well-suited to an ending of "I don't know what to do." But I do. I need to talk to her for a few minutes to learn the specific reasons she doesn't take care of herself.

And if that fails, try the kidnapping.

September 23, 2004

A Walk Around the Blogosphere

As you've no doubt already noticed, I haven't felt like writing very much lately. It's been a unusually stressful period at work and I've come home wanting to relax, not wanting to write. Practicing piano has also stolen a considerable amount of my time.

Instead of writing something substantial, I'll just take you for a little stroll around the blogosphere.

From The Commons Blog, news that the NOAA may be exempted from federal information quality guidelines. This is an open door to basing policy on junk science. (Even more than it already is.)

Mr. Micha Ghertner takes on Hans-Hermann Hoppe's anti-immigration argument. Eric W., I told you he'd read it, didn't I? ;)

The comment by qwest is right — HHH sounds like a Republican, not a libertarian.

Also at Catallarchy, Don Lloyd looks at Social Security solvency, lifting the monetary veil of funding and appropriately focusing on production and consumption.

I've argued that the real problem with Social Security is that it fixes a retirement age. With increasing lifespans, people who could be productive will live off the dole instead.

Skip Oliva, president of Citizens for Voluntary Trade, wrote an excellent introduction to the antitrust problems faced by doctors. CVT is the place to go for antitrust news.

Iraq the Model translates and publishes comments from Iraqis from a BBC forum. Good reading.

September 16, 2004

Check Your Premises

A while ago, I was involuntarily added to the mailing list of The Independent Institute, who now spams me every time they post a new article, asking me to "please post to or feature the following new article." Upon the first such e-mail I wrote back:

Just one question: When did I become your publicist?

Your request is extremely poor etiquette and likely irritated everyone you sent it to.

I got a personal reply, but he pretended to miss the point, and I'm still on their mailing list. I didn't press the matter, instead creating an e-mail filter — it's just another kind of spam.

I don't automatically delete that e-mail. Once in a while I go look at it. And the most recent article from TII is a fabulous example of embarrassingly sloppy reasoning:

The tragic milestone of 1,000 U.S. deaths in the Iraqi quagmire should cause introspection about why the United States really went to war and whether it has been worth it. While the Bush administration's public justifications never really added up, evidence exists that there was a hidden agenda behind the invasion of Iraq: securing oil. [source]

It's the standard blood-for-oil line, although the article spends a lot of time examining and dismissing — in unconvincingly brief fashion — other potential justifications for war. Eventually it gives some economic reasons why going to war to secure oil doesn't make sense. They're not great reasons (I have better ones) but the specific argument is beside the point, because this is the article's conflusion [sic - that was a typo, but I'll let it stand]:

So even oil, the most defensible of the potential unstated reasons for invading Iraq, doesn't turn out to be very defensible at all. Could 1,000 Americans have died in vain?

Let's make the train of thought more clear:

There were major nonpublic reasons for invading Iraq.
I agree.
It's oooooil!
I disagree, but will grant it arguendo.
…but war to secure oil doesn't make sense economically.
I agree.
Therefore, Americans died in vain.
Hold on a second there, professor.

He's cut down his own reason, and then declared that without it, there's no reason! Is this a reflection of the intellectual bankruptcy of the advocates of invasion, or a reflection of his own lack of imagination — or more pointedly, lack of research?

The pro-war argument is available. Dr. Eland doesn't show any signs of being familiar with it.

Dr. Eland's article is a transparent straw man. If he wanted to give it some sticking power, he should have quoted a policy-setter in the Bush Administration giving energy security as a justification for war. But of course he can't do that; the whole article is about the "hidden agenda". Dr. Eland ought to be embarrassed to publish such a sloppy article. (But I see we're both graduates of Iowa State University; that could explain it…)

Let me offer a suggestion. If you can't think of reasons that would explain someone's position, you should ask them their reasons instead of concluding they don't have any.

September 12, 2004

The Jumpers

By way of a Catallarchy article I read an Esquire story from last year about one of the most famous photographs from Sept. 11th 2001, the image of a man falling through the air with the World Trade Center towers in background.

The story makes the point that the images and videos of the jumpers were quickly scrubbed from the media. Some still talked about it, but very few continued to show it.

Near the 2002 anniversary I watched a program about the attacks. One video clip included a jumper. I wasn't expecting it, I wasn't prepared for it, and I remember gasping even before being consciously aware of what I was seeing. My shudder and recoil were a reflex, even a year later, having known that many people jumped and having seen the images before.

There is a good reason the media have kept these images in file rather than on the front page. They're powerful. They instantly evoke the anguish of that day in its rawest visceral form. Intellectually, we don't need the reminder, it adds nothing to our understanding of the facts — and emotionally, it has no outlet, but becomes a standing wave washing out everything else important to feel.

I want to remember. I don't need to see again. Once is enough. (That it happened at all, is too much.)

Reading the story I was struck by a daughter's reaction after her mother denies that the man in the image was from her family:

"They said my father was going to hell because he jumped," she says. "On the Internet. They said my father was taken to hell with the devil. I don't know what I would have done if it was him. I would have had a nervous breakdown, I guess. They would have found me in a mental ward somewhere. . . ."

She saw jumping as a surrender and a betrayal, and would be hurt if a loved one jumped.

I do not see the matter in those terms. I view it as an example of the most sacred dignity. A man, surrounded by heat and smoke and destruction, knowing his death was at hand, did not yield to his fate passively and silently. He asserted his humanity in the few alternatives still open to him. To choose the manner of one's death, when it is possible, is a noble decision. In his final act on earth, he chose to draw his last breath from the clean air away from the fire.

From hell, into the sky.

September 08, 2004

Death and Cornell

Among my group at work, we've nicknamed the intersection of 17th Ave. and Cornell Rd. to be "Death and Cornell" because it feels so unsafe. 17th ends in a T-intersection with Cornell. There's just a stop sign on 17th — no light. It's bad enough turning right onto Cornell because visibility isn't great, but what's worse is that there's usually someone ahead of you trying to turn left onto Cornell, and that's such a busy street that you waste a lot of time waiting. People get impatient and do stupid things. (It's unfortunate, because there's a light just over at 21st, although its left-turn capacity is poor…)

At Death and Cornell, there's a danger below ground as well. There's a gas station at that corner (map) that evidently leaked many years ago. The Oregon DEQ has fined the owner, local gasoline mogul Dwight Estby (Argus, Oregonian), although it looks like fault for the leak lies with previous owners.

From Loren, this commentary:

The DEQ is getting $93K in fines (and possibly other demands) from this guy for a gas leak that might be 30 years old. How's he supposed to defend himself? Even if the leak isn't from his tanks, they can still require him to put in more test wells and pay for additional testing. They can run that station out of business, but then what?? Dig up and haul away that entire area? Build something else on top of that contaminated soil? Or maybe just hassle the next gas station owner there.

Now for the non-PC questions.

  1. What's the harm here anyhow?
  2. If there's no leakage today, how long will it take the gas to dissipate to acceptable levels? The dissipation is exponential - the radius of infiltration increases by 4' per year.
  3. Can I get free gas if I dig a well on the school playground?

We wonder how the money from the fine will be spent. Will it fund further aggression against the station owner?

In other local news, this gripping headline:

home damaged by bag of cremated human remains accidentally dropped from plane.

You have my attention.

Part of that story was reprinted in an advertising circular I normally throw away without reading. This time was different. It's hard to walk away from a headline like that. Copy editors, take note.

September 05, 2004

Yes, I'm Still Here

Hi everybody. I took a week off from blogging. You should feel fortunate.

With Hurricane Frances headed for the Florida coast all week, I was thinking about doing a "FranceIs Attacking Florida" story with a little animation of a shrunken map of France spinning toward Florida. It would have included predictions from meaty urologists, etc. You get the idea. Don't you feel glad?

My price gouging article generated a lot of comment at Catallarchy you may be interested to read.

It has been a very bad time for Russia recently, with two airline bombings, several smaller attacks, and over 300 dead after terrorists took schoolchildren hostage.

I don't have anything to say about it that hasn't been said better elsewhere. But I wanted to mention it as a reminder that the war isn't the United States against the Terrorists, it's Civilization against them.

In somewhat better news, diplomacy carried the day in Iraq when al-Sistani returned to the country and gave al-Sadr a deal he couldn't refuse. Al-Sadr had been, among other things, running a Sharia court near the Imam Ali shrine, torturing his victims.

Yeah, I know. I said "somewhat" better.

In my only piece of genuinely happy news, I've been spending a lot more time practicing piano, and I can now play roughly half of the 18th variation of Rachmaninoff's Rhapsody on a theme of Paganini. It's the first serious piece I've tried to learn, although I'm learning a simplified version. (I have the "real" version also; different key, more notes, looks very hard…)

It sounds great.

Good enough for someone who's had substantially more piano training than myself (which isn't saying much) to ask me to give them lessons. I rather think it'll be the other way around, but either is fine.

Tiny Island