SSSBlog

One of my four readers asked if I’d considered writing a post on health care reform in the U.S.  I don’t know that I will say anything that hasn’t been said elsewhere, but here we go …  et voilà:

The health care issue in the U.S. is so difficult for four reasons.

The first reason is economic, and really a no brainer:  The real costs of health care are hidden.  People wrongly think (because it seems that way day-to-day) that they are getting something for nothing.  Because the costs are hidden, the system generates services that are constrained by normal cost considerations.  This was driven home to me two Sundays ago when I picked up a prescription for my son, who has bad acne.  The clerk at the pharmacy handed me the prescription and said, “That’ll be twelve hundred dollars….” before realizing he had been reading the “actual cost” information rather than the co-pay information.  Incredible but true — the actual cost of a one-month supply of this stuff was $1,217.  My co-pay was $10.  I rather think, as much as I love my son, that if I had to pay the actual cost, he would be using over-the-counter acne medicine, or some cheaper medical treatment.  But if, God forbid, the insurance company refused to pay, I’d go off cursing the evil, profit-mongering health care companies.  Demand will always go up for services seemingly priced so very much below actual cost.  Hence the reason health-care premiums have skyrocketed over the past 15 years.  Even when employers off-load more of the cost to workers (thus making the impact of health costs more directly felt), without some day-to-day, service-to-service price signals, people will just want, and take, more and more health care, even if, like my son’s acne medicine, some of it can probably be done without.

The second reason has to do with the unique nature of what’s being “consumed” by “customers” of health care.  Being badly sick or wounded is horribly frightening.  Death petrifies most people.  Next to money, our physical well-being is so critical to our overall sense of happiness that it overwhelms most rationality.  The power of modern medicine seems closed to magical or mystical, and how much would we pay for magic?  I was going to die, and now I’m going to live — how much is that worth, anyway.  The intensely emotional nature of decisions about our health care would skew our rational economic behavior even if the system itself could send accurate price signals.

The third reason is political, the subject, really, of a full week of lectures when I teach my intro Political Science class.  By virtue of the weak party system; the fact that legislators are elected on a local, not national, basis; increasingly “safe” districts and thus increasing powerful incumbents; the primacy of the committee and sub-committee system in Congress; and the increased importance of special-interest funding in Congressional elections, those same special-interests are able to exert an oversized influence on legislative outcomes.  Since there’s big, big money to be made in the health care industry, and many existing parties with an interest on seeing the present system continue, the odds of Congress ever enacting a truly effective health care reform bill is practically non-existent.

The fourth reason is sort-of political, but really beyond that:  The massive distrust of government that has engulfed the right wing and, less obviously, subtly infiltrated the center and left as well.  The federal government is inexorably involved in the health care system today, and any effective reform requires the federal government (or the state governments under a program of federal design) taking on a larger role.  But because a solid minority of citizens believes the government is a dishonest, corrupt, self-serving, power-mad meddler that wants nothing more than to stomp out all individual freedoms, any “government” program for health care starts at a huge disadvantage.  The reason we’re at that point deserves another post, which hopefully I’ll get to some day, but for now let’s leave it there.

So there you have it — it’s a big, ugly, multifaceted mess.  The economics are screwed up, people’s emotions get involved, huge moneyed interests want to keep their piece of the pie, and many are distrustful of the government’s competence and motives.

Could Obama have done anything differently that might have made things go better?  Some have suggested that he should not have been so willing to work with Congress, or so willing to compromise with the Republicans.  But these criticisms ignore the respective flip sides:  Obama can’t pass legislation alone, only Congress can, so working with Congress was a necessary evil.  And Obama came to office believing that he should try to change the nasty, vitriolic awfulness that passes for discourse in Washington, D.C.  He wasn’t wrong, in my opinion, for trying to compromise, for even though he’s reaped the wrath of Republicans on this issue (and may ultimately have to assemble his party and push something through), he has managed to stay above the nastiness fray in a way that’s refreshing.

My one criticism would be that his plan is not bold enough.  If you are going to address this issue, and have such a huge prolonged fight about it, do something big.  From what I can tell, the current plan just nibbles around the edges.  It doesn’t really do much to contain costs (and, disappointingly, does almost nothing to further medical malpractice reform which, I believe, could have swayed moderate Republicans to support the bill).  In fairness, Obama had a tough, tough road, and his pragmatism may, in the end, have been the best path.  But we won’t have a real solution until, unfortunately, the system starts to collapse around the heads of the middle class.  The current plan, in my view, just puts that day off a few years.

C’est à Alain Minc, dans Le Point le 6 aout:  “Etre un libéral de gauche, c’est posseder un mauvaise chromosome, atypique dans l’ADN politique; c’est croire que l’intérêt général existe en dehors le marché, mais que l’Etat n’est pas l’expression naturelle et exclusive de cet intérêt général.”

Je le crois aussi.

Rough translation:  To be a conservative leftist is to possess a bad chromosome, unusual in political DNA; it’s believing that the public interest exists outside the market, but that the State is not the natural and exclusive expression of that public interest.

Bien dit.

Il y a une expression en Anglais — “to be snakebitten” — qui veut dire mot à mot “être mordu par un serpent,” mais veut dire figurativement “avoir de malchance.”  Moi, je suis “snakebitten” cette semaine.  Ca commence par mon accident à velo. Puis hier soir, notre chienne Elsie, la plus mignon chienne du monde (regardez), a été mordue par un serpent à sonnette, qui est très dangereux à cause de son venim, qui peut tuer des animaux et des hommes.  Elsie a été mordue à sa bouche, qui a commencé à saigner.  J’ai dû la emmener à la clinique vétérinaire à vingt-deux heures; nous avons eu peur qu’elle puisse mourir.  Elle est restée à la clinique vétérinaire jusqu’à ce soir.  Sa bouche est très enflée, mais la vétérinaire m’a dit qu’elle serait meilleure après deux ou trois jours.  Mais le traitement a couté plus de mille dollars, parce que le “anti-venim” est très cher.

Je ne voudrais pas penser à ce que peut être se passera demain!

Friday was a beautiful day for a ride.  I rode into Santa Rosa, stopped downtown for a soda, then started home.  I was riding up Old Redwood Highway, wanting to get to my son’s Geometry class (the last of his difficult summer school session) before it ended, so I could surprise him.  I started to make a right-hand turn onto Angela Drive, but realized at the last second that I was going too fast.  I tried to brake and turn to avoid a decorative rock pillar on the left side of the road, but was unable to, and crashed directly into it, leading with my left forearm: a hard, sickening crash that threw me onto the pavement and left me stunned.  A very kind couple took me to Kaiser.  These pictures are not for the squeemish; I was probably going 25 mph and stopped all of my momentum with my forearm:

I needed surgery immediately, and ended up with a steel plate and 9 screws in my arm.  Yesterday all the pain medicine made me sick; today all the other non-arm bruised and battered parts of my body are aching.

The staff at Kaiser were fantastic, and some very funny things happened during the experience, which I will post later, but all in all it was not at all fun.

Deux versions — le premier en français, le deuxième (le même chose) en anglais.

Enjoy!

  
Download now or listen on posterous

Podcast Francais 06-0602009.mp3 (5031 KB)

  
Download now or listen on posterous

Podcast in English 06-06-2009.mp3 (4479 KB)

In 1997, I almost went to work for this man and his company. Some of my colleagues did go to work there. Now the company's gone under, and he's charged with fraud by the SEC. After my visit to his operation, I can't say that I'm surprised. It was a testosterone-infused money-money-money operation that left me feeling ill at ease. One time in my life when my gut instincts steered me in the right direction….

http://www.economist.com/finance/displaystory.cfm?story_id=13805607

Well, yes, laugh on, laugh on, but the fact is that tomorrow we start our French classes, and have to be at the school at 8:15, which means no more sleeping in, and using our brains, and doing homework.  One of the most wonderful part of this trip has been getting all the sleep I want almost every day.  I’ve been contemplating the effect on my body of the fact that needs about 9 hours a night (that’s what I sleep on average if given no constraints) but gets about 7 hours a night during “real life.”  I can tell you that I am a lot more relaxed, even though we’ve been through a series of fairly stressful events the last three-plus weeks.  Sleep is good.  Not enough sleep is bad.

Today we decided to divide up the boys.  I was going to take them to a science museum in northeast Paris (the Cite des Sciences in the Parc de la Villette) in the afternoon and then Suzie was going to take them in the evening.  So the boys and I set off about noon, taking the Metro from one end of the city to the other (even so, it took less than 40 minutes to get there).  We didn’t get to see the grounds (we ran out of time), but one highlight was the view of the Geode (which, on the inside, is a 180 degree movie theater):

The museum was very interesting, situated in a large, spacious, modern building infused with a lot of natural light.  There were exhibits on the evolution of the Citroen (yes, the car), on genetics, an exhibit on the “Story of the Universe” (which was a bit disappointing), and an excellent exhibit on sound and language.  There were also a couple of things that were flat out fun:  An electronically-controlled image of the Mona Lisa that you could cause to lip-synch to words you said into a microphone (it sounds stupid but it was laugh-out-loud funny to see it; an interactive on-line version is here), and a large covered cylinder that held about 15 people, and spun around like a merry-go-round; it was filled with soft rubber balls that curved to the right when you threw them (because of the motion of the cylinder), and when you exited, your body ‘naturally’ wanted to walk to the left, which was what it had to do inside the rotating cylinder in order to travel “straight ahead.”  By the time we got back at 5, we were tired from the go-go-go, and we had a quick dinner, watched some TV (yes, it appears that Suzie was successful in her battle with the Orange Livebox and decoder), then the boys went down the street to skateboard (those cell phones come in handy).  Here are some pictures.

A DRAGON ON OUR CEILING (as mentioned, this apartment has incredible old, detailed ornamental plaster all over and around it; spookier than the dragon are a couple of odd faces, which peer straight down at the corners of the rooms).

SUZIE IN THE KITCHEN:

THE VIEW OUT OUR LIVING ROOM WINDOW, the other direction from the one in this post:

THE VIEW SOUTH DOWN AV. DU GENERAL LECLERC:

And finally, the calls have gone out for pictures of my new Paris haircut, so as much as I loathe pictures of myself, I am closing my eyes and posting this one.

I am going to force Suzie to blog this evening, so stay tuned.

I’m trying out a new blog style today. It seems cleaner and more readable. Reader input is appreciated. An entry about our interesting day at the Northern Ireland Assembly is forthcoming.