Not robust

I've mentioned before why a "robust" option (one that sets reimbursement rates to health care providers the same way Medicare does) saves money and is desirable in a health care reform bill. H.R. 3200 had a robust public option and the Congressional Budget Office estimated its premiums would be about 10% cheaper than those of its competitors.

The new (final) House bill, H.R. 3962, has a weak public option, meaning it negotiates rates (proponents call it the "level playing field" public option). What does the CBO say the effect of having negotiated reimbursement rates will be?

That estimate of enrollment reflects CBO’s assessment that a public plan paying negotiated rates would attract a broad network of providers but would typically have premiums that are somewhat higher than the average premiums for the private plans in the exchanges. The rates the public plan pays to providers would, on average, probably be comparable to the rates paid by private insurers participating in the exchanges.

So...too bad. This could've been better.

Out with the old, in with the new

For a while we've focused on H.R. 3200, the House health care reform bill that went through the three committees, yadda yadda yadda.

But now the final House superbill has emerged. Super indeed, as it picked up another 900+ pages from the original version (H.R. 3200). But this is the bill that the House is going to vote on, probably as early as next week: H.R.3962 - Affordable Health Care for America Act. I've updated the bill-tracker widget on the sidebar accordingly.

Oh, expletive deleted!

Apparently Governor Schwarzenegger was recently heckled by some Democratic members of the California General Assembly during a public event. He later sent a veto to a bill that reads:



Some observant soul noticed that if you read down the left margin it says "F-U-C-K Y-O-U." Says Schwarzenegger's office:

"My goodness. What a coincidence," said Schwarzenegger spokesman Aaron McLear. "I suppose when you do so many vetoes, something like this is bound to happen."

Coincidence or not, politics is pretty hilarious.

Best Part of Tonight's Game

I really don't like Rajon Rondo.

Who needs pitchers?

The World Series is starting tomorrow. And as you might have guessed when first you heard that the Phillies would face the Yankees:

In the latter scenario the series could feature three matchups between [Cliff] Lee and CC Sabathia, which would probably make Indians general manager Mark Shapiro's head explode.

And many other heads in the city, I would guess.

But in other news: Go Cavs! First game of the season coming up in a few minutes. And now an abridged word from the Presidents of the United States:

You Don't Say...

Two weeks ago (Anti-Trust Me) I mentioned that the Democrats are moving some legislation to remove the exemption from anti-trust laws enjoyed by the health insurance industry. I mentioned that this is primarily a bit of political theater; as a policy matter, it's more like a band-aid that wouldn't address the big issues facing our health care system:

This [the McCarran-Ferguson Act] is the law that essentially says the regulation of insurance companies is up to the individual states. McCarran-Ferguson also exempts insurance companies from federal anti-trust laws. This is the provision the Democrats are zeroing in on.

But it seems a little narrow to me. The root problem is that we want to have our socialist cake and eat it, too. This is evident in Schumer's declaration that what we really need to do is "bring true competition to the health insurance industry." And to some extent that's true; that is, after all, the rationale behind the public option. But it's a band-aid designed to keep a malfunctioning system on its feet a bit longer. No, the key to the whole thing revolves around a dirty little secret: the whole idea of health insurance is, at its core, socialist.

Still, the Democrats introduced H.R. 3596 ("The Health Insurance Industry Antitrust Enforcement Act of 2009"), described by the Congressional Budget Office in this way: "H.R. 3596 would prohibit such [health insurance] companies from price fixing, bid rigging, or allocating markets while providing coverage for health insurance or medical malpractice claims."

But as Donny Shaw over at OpenCongress reported today, the CBO looked at this proposal over the weekend and projected that it wouldn't make much of a splash:

H.R. 3596 could affect the costs of and premiums charged by private health insurance companies; whether premiums would increase or decrease as a result is difficult to determine, but in either case the magnitude of the effects is likely to be quite small.

To the extent that insurers would otherwise engage in the prohibited practices and be prevented from doing so by enactment of this bill, premiums might be lower. (That effect is likely to be small because state laws already bar the activities that would be prohibited under federal law if this bill was enacted.) To the extent that insurers would become subject to additional litigation, their costs and thus their premiums might increase. Based on information from the Justice Department, the Federal Trade Commission, the National Association of Insurance Commissioners, consumer groups, and private attorneys, CBO estimates that both of those effects would be very small, and thus that enacting the legislation would have no significant effect on the premiums that private insurers would charge for health insurance.

The Elite

Posner, on how smart those financial wizards on Wall Street are:

Banks had traditionally been conservative organizations emphasizing risk avoidance, modest compensation, gradual promotion, and secure tenure. When in the deregulation era they were permitted to expand into riskier and (therefore) more lucrative forms of financial intermediation, they attracted a different kind of employee--smarter, more willing to take career as well as financial risks, more independent, and demanding higher pay. Because they were generating more profits for the bank, their influence grew and placed pressure on the traditional bankers to take more risks in order to hold their own in the struggle to control the organization. So one proposal for preventing a recurrence of the financial crisis, since the crisis was due in part to highly risky lending by banks, is to restore the separation codified in the Glass-Steagall Act of conventional banking from high-risk forms of financial intermediation.

Becker, on why actions should have no consequences:

I have not seen convincing evidence that either the level or structure of the pay of top financial executives were important causes of this worldwide financial crash. These executives bought large quantities of mortgage-backed securities and other securitized assets because they expected this to increase the average return on their assets without taking on much additional risk through the better risk management offered by derivatives, credit default swaps, and other newer types of securities. They turned out to be badly wrong, but so too were the many financial economists who had no sizable financial stake in these assets, but supported this approach to risk management.

There you have it. Those business school geniuses who pushed us to the brink of ruin through reckless behavior deserve every penny of their pay, despite having been colossally and disastrously bad at their jobs. After all, even financial economists couldn't see the possible harm of their actions. And if we do cut their pay we'll give them an incentive to move on to other companies, which will then give those companies a competitive advantage over the government-supported companies. Ha! That's a bit like suggesting we'd all better be extra nice to ex-President G. W. Bush because he might head off to give a competitive advantage to another country by lending them his superior governing skills.

So if you've lost your job in the ensuing economic meltdown that these goons helped to trigger and you think they ought to at least take a paycut while their companies help themselves to the public treasury, remember: they make more than you because they're smarter than you and they're better than you. Consequences are for the little people.

Missing Link?

I recently stumbled upon this while perusing through MSNBC the other day. This fossil, known as Ida, was discovered and highly heralded initially as the famed "missing link" that links us, humans, to the other apes. There was a huge media storm, a Discovery feature, a book deal, things that generally follow a find of such a perceived magnitude, as recently witness following the discovery of Ardi. Media blitzes like these are not rare, and people love to jump on the "missing link" bandwagon whenever something like this is found. That's all and good, I am glad that people are embracing the fossil record as something to be studied and be interested in. The problem that I have is with the fascination of this missing link. These missing links, also known as transitional fossils, don't really exist in great numbers. This has nothing to do with flaws in the theory of evolution, and the lack of their existence does not disprove anything, as some might have you believe. It's just that the problem with these media storms and the constant hammering of the misnomer "missing link" tend to insinuate that the only way we can prove the theory of evolution as accurate is to find these links between species that are so long sought after. Darwin himself commented on the lack of transitional forms in the record (a point creationist are always willing to bring up, but as the good scientist that Darwin was, he was not blind to his own inconsistencies):

"The number of intermediate varieties, which have formerly existed on the earth, (must) be truly enormous. Why then is not every geological formation and every stratum full of such intermediate links? Geology assuredly does not reveal any such finely graduated organic chain; and this, perhaps, is the most obvious and gravest objection which can be urged against my theory."

The steady state of evolution was long popular, both before and after the inception if the field of genetics. This gradualism, as it became to be known, has its detractors, most notably the late Stephen Gould. Gould was a huge proponent of the newer, much more radical idea of punctuated equilibrium. It is this idea that has gained the most steam recently, and is starting to be backed up by genetics research. The evidence that is being found states that genetic mutation does not advance at a uniform speed. Conversely, species experience periods of stagnated evolution followed by a period of expedited mutation, leading to a greater rate of change of the species than would be normally observed. That being true, it would mean that a species tenure on this Earth would being fairly consistent. Throughout the fossil record we would see a species exist for a few million years and then see it exist no longer, which is exactly what we do see:

"The extreme rarity of transitional forms in the fossil record persists as the trade secret of paleontology. The history of most fossil species includes two features inconsistent with gradualism: 1. Stasis. Most species exhibit no directional change during their tenure on earth. They appear in the fossil record looking much the same as when they disappear… 2. Sudden Appearance. In any local area, a species does not arise gradually by the steady transformation of its ancestors; it appears all at once and 'fully formed'. The evolutionary trees that adorn our textbooks have data only at the tips and nodes of their branches; the rest is inference, however reasonable, not the evidence of fossils."

It is these trees that Gould is referencing:



That beautiful sinuous pattern on the left, the one that so amazingly looks like a stream system, in fact, does not exist. We do not have evidence for a tree to look like such, instead we have the evidence for the tree on the right. This step-wise pattern of evolution is looking to be more and more accurate as the fossil record is probed.

And I suppose that brings me to my last point... the fossil record itself. If you want to keep something for posterity, fossilization is not the way to do it. It is horribly inconsistent, as one would expect of a process that more or less requires a body to stay intact long enough for all of the calcium in the bones to be replaced silicate minerals. Not an easy feat to say the least. Then the layer that the specimen is fossilized within needs to be preserved til the present, i.e. no erosion of the layer, thereby losing the layer altogether. Finally, the specimen needs to be at the surface and visible so someone can stumble upon it. Honestly, not the easiest thing in the world. I don't know the numbers, unfortunately, and I can't seem to find them, but the percentage of species that have ever lived that are actually fossilized in the record somewhere is horribly low.

Alright, it seems that I have deviated from my point somewhere along the line, whatever it was to begin with, I may never know. These transitional species truly are astonishing when they are found, we have the fossil evidence for the reptile to bird transition in archaeopteryx, from water dweller to amphibian in tiktaalik, and from land dweller to whale in ambulocetus, amongst many others. It is these creatures that we should be fascinated with. They are the ones that made the giant leaps in evolutionary history, and our planet would look much different if these species never advanced towards the land, or air, or back to the sea again. Humans, or something like them, have roamed this Earth for about 300,000 years, a drop in the bucket of the history of this planet.

I suppose what really has been grinding my gears lately is just our constant pursuit of what lead to us, why are we what we are, what came before. So much time is spent on finding our direct ancestor, the species just before. There are 550 million years of macrobiologic history on this planet, why are we so fascinated my the last half a million years when there is so much more out there to be explored?

Form Letters and Chat Responses

Ezra Klein over at The Washington Post answered one of my questions today in his weekly lunchtime chat:

Cleveland, Ohio: You've mentioned before that state-level public options would lack the bargaining power of a national public option. But why is this true? When dealing with hospitals or other providers, wouldn't only the number of potential customers (i.e. enrollees within the state) the public option could offer be relevant? Why would it matter that the public option also has millions of customers in other states who will likely never use the particular facility the public option is negotiating with?

Ezra Klein: There are a few reasons. The first is simple administration efficiencies, and national purchasing. Drug companies, for instance, aren't state-based in the way hospitals are, so that would change things. The other is that eventually, a big enough public option could do what Medicare does and set payment rates for services rather than negotiating with each provider individually. That could bring huge savings, but you have to be big enough to do it credibly. There are no examples I know of it happening on the state level.

It makes sense that a national public option would have more leverage when it comes to national purchasing--and drugs are a great example of something you buy from national organizations, pharmaceutical companies--but it still seems to me that most of what gets paid for in the health care industry (e.g. services offered by doctors and hospitals) is fundamentally state-based or regionally-based. So if weak versions of the public option that rely on negotiation to set reimbursement rates, instead of strong versions mentioned by Ezra that reimburse like Medicare, are implemented I'm still not sold on the idea that they can't work on the state-level, though I'm sure there are reasons it would be at least marginally better to have a national public option.

But, speaking of the difference between the weak and strong public options (which I've mentioned before), I recently sent a quick email to Sherrod Brown on this issue. Senator Brown reportedly played a big role in writing the public option section of the Senate HELP Committee health bill and he's been a huge proponent of including a public option in the final bill. He recently circulated a letter among Senators urging Harry Reid to include a public option in the final (merged) Senate health care bill; the letter picked up 30 signatures.

But the HELP Committee bill's public option is the weak version: it relies on negotiated reimbursement rates instead of pegging rates to those of Medicare, as the House's public option does. So I sent an email expressing my gratitude that he's been fighting so hard for a public option but I also asked why he's pushing for the weaker version instead of the robust version, particularly when the latter could reportedly save $85 billion more over the next decade than the former. Here's what his staff sent back:

Dear Mr. Stanek:

Thank you for sharing your concerns regarding health care.

Since first coming to Congress in 1993, I have refused to enroll in the coverage offered to members of Congress until every American has access to high-quality, affordable health insurance. Should a health care reform bill pass that offers a public insurance option, I would be pleased to enroll.

I strongly believe that our health care system is in need of reform. First and foremost, we must reduce the long-term growth of health care costs for patients, taxpayers, and businesses; protect families from bankruptcy or debt because of health expenditures; guarantee a choice of doctors and health plans; invest in prevention and wellness; improve patient safety and quality of care; assure affordable, quality health coverage for all Americans; and end barriers to coverage for people with pre-existing conditions.

One promising solution to the problems of cost, quality, and access that plague our health care system is to increase competition in the health insurance market. If the private insurance industry was truly competitive, then there would be strong incentives to provide coverage to as many Americans as possible and to build customer loyalty through cost savings and quality improvements. Unfortunately, insurers do not truly compete against one another; instead, they make use of the same basic strategies to earn significant profits. These tactics include selectively insuring the lowest risk enrollees, slow-walking claims payments so they can earn interest on every premium dollar, and denying as many claims as possible.

What the insurance industry needs is some healthy competition from a public insurance option. This option would not replace employer-sponsored coverage and no one would be forced into it; the public option would simply give uninsured or underinsured Americans the choice of enrolling in an insurance plan that does not engage in the same cost-avoidance tactics as private insurance plans do. The public health insurance option would also be a vehicle for improvements in quality, coverage, and provider-access that sets the bar higher for private insurance plans. This option would be available to all Americans: both private and government employees, including members of Congress and their staffs.

Since Congress began debating health reform, an overwhelming number of people in Ohio have contacted me. I appreciate this input and am carefully considering the thoughts, questions, and concerns that you and other Ohioans have shared with me.

In particular, some individuals and small businesses have cited proposals to tax employer-sponsored health benefits or tax the top 1% of income earners in order to help pay for health reform. Others have mentioned proposals that would help pay the insurance subsidies of low-income, uninsured Americans by collecting fees from medium and large employers that do not offer employer-sponsored insurance. Finally, many seniors and retirees have shared concerns about the continued availability of quality health care coverage for older Americans.

The House and Senate are still in the process of drafting this health care legislation and a final bill has not yet been released. The Health, Education, Labor, and Pension (HELP) Committee spent several weeks working to pass a health reform bill that includes 161 provisions promoted by Republican senators. That bill is available online at www.help.senate.gov. Individuals interested in the progress of the Finance Committee’s health reform bill can visit www.finance.senate.gov to review the plan, its proposed amendments, and budget estimates.

I support giving every member of Congress, and every member of the public, time to review the bill. I also strongly agree that health insurance reform must not ignore seniors and must benefit Ohio's small businesses and manufacturers. Please be assured that I am considering all the options carefully. As Congress moves forward on health insurance reform, I will certainly work to address the issues contained in your letter.

If you wish to learn more about my work on health reform as well as the most Frequently Asked Questions (FAQs) that Ohioans have posed to my office, please visit my website at:

http://brown.senate.gov/issues_and_agenda/stories/share/?issue_id=f565635b-e37a-45d3-b15f-edf6b930bd1a.

Thank you again for getting in touch with me on this important matter.

Sincerely,

Sherrod Brown
United States Senator

All good stuff, just not an answer to my question. But he's still my favorite Senator.

I'm Just Five Bills

The legislative process can be tricky. Particularly with hugely important (and just all around huge) pieces of legislation. I want to look a little closer at what's going on with the issue du jour, health care reform. I'm not convinced the media has been particularly clear on explaining what's happening or why so many ideas--some of which are mutually contradictory--are floating around. Is health care reform going to be paid for with a small surcharge on high income individuals or is it paid for through an excise tax on the most expensive health insurance plans? Does it require employers to provide health insurance to employees or not? Is there a public option or not? All of these possibilities exist right now because multiple health care reform bills exist now.

Congress has been burning the candle at both ends on this one and I don't just mean they've been working hard: they lit wicks in both chambers of Congress and are letting the flames in the north and south wings of the Capitol building slowly burn toward a common point. Take a look on my crudely drawn (and slightly mal-proportioned) representation of the health reform policymaking process:



The House introduced its reform bill, H.R. 3200, in July. The text of that original proposal then went to the three different House committees that have jurisdiction over the issues covered by the bill. In each committee, H.R. 3200 went through a markup; this is the process in which members of the committee get to offer amendments to change things they don't like or correct weaknesses in the bill. Amendments garnering majority support in the committee get tacked onto the bill and once all is said and done the committee votes to report the bill out of committee and to the House floor. All three House committees finished their markups in July and we were left with three independent permutations of H.R. 3200. For the most part, the changes made in each committee weren't particularly large. The exception, I think, is the Blue Dog amendment in the Energy and Commerce Committee we talked about before that would change the way the public option works and reduce the amount of subsidies available to people.

Regardless, three slightly modified versions of H.R. 3200 came out of committee and the task now falls to the Democratic House leadership to merge them into one final House bill (i.e. figure out which changes to retain and which to ignore). So when you see a headline declaring that Speaker Pelosi is leaning towards including a robust public option in the final House bill that means she might just ignore that Blue Dog amendment. But soon there won't be three slightly different versions of H.R. 3200, there will be only one--the final House bill. This will then face a floor debate and its own amendment process but once it gets 218 votes the House will have passed a health care reform bill.

The Senate handled things a bit differently than the House. Instead of one bill heading to face trials by fire in the two relevant Senate committees (the Health, Education, Labor, and Pensions Committee and the Finance Committee), the HELP Committee and the Finance Committee each drafted their own bill. The HELP Committee finished its markup and passed its bill out of committee months ago and the Finance Committee made headlines last week when it (finally) passed its bill out of committee, picking up one Republican vote in the process. Just as the House is now merging its three versions of H.R. 3200, the Senate is working to merge the HELP and Finance bills right now. This is a much bigger task because the differences between these two Senate bills are much larger than those between the three House bills, which don't have much breathing room between them. Reportedly this merger is happening through negotiations between three principal Senators: Chris Dodd, who shepherded the HELP bill through committee when the chairman, Ted Kennedy, fell ill; Max Baucus, the chairman of the Finance Committee; and Harry Reid, the Senate Majority Leader.

Ultimately these bills will fuse into some Frankensteinian piece of legislation and the Senate will have a final bill to debate and then vote on. Assuming Democrats can secure 60 votes to defeat any Republican filibusters and can find 50 votes for final passage, the Senate will have passed its own bill.

Once all this happens, the House and Senate bills go to a conference committee of handpicked negotiators from each chamber. Out of this committee comes a final health care bill that goes back to each chamber to be voted on. If it's agreeable to both chambers, it goes to the Big Man's desk for a signature. And health care reform will be a reality.

So where are things now? The committee process is over and the merger of bills marked up in committee is happening in both chambers. Within a few weeks (maybe much sooner), both the House and Senate will be considering final bills and, hopefully, each will pass a bill. But at the moment it's impossible to say exactly what health care reform consists of because we haven't reached the point where one final (conference) bill exists. But that day isn't far off. Of course, the general form of all of these bills is the same, it's merely the details (some of which are pretty big) that differ.

Here, have some nostalgia:

Star Trek Did It

Someone over at Forbes recently fretted about the potential of fMRI:

Neuroscience has, for the first time, demonstrated that there may be ways to directly access human thought--even, perhaps, without the thinker's consent. While the research is still preliminary, the science is advancing at an astonishing rate. While many obstacles need to be overcome and the technology is not yet practicable, the implications for our current state of knowledge are profound. [. . .]

While our abilities in these areas are still quite limited, and while there is always the possibility that the technology will never progress to the point where it can extract truly useful information from anyone, the time to think about the implications of this endeavor is now, before the technology is upon us. The appeal of the technology to the state is obvious. So we need to ask ourselves: What are the limits of the use of this technology? Should we ever allow the courts, or the state, to demand access to the recesses of our minds?

Reminds me of the time Scotty was accused of murder on Star Trek and they tried to retrieve his memories with a techno-thingamajig. I love their gadgets:

The psychotricorder was a Starfleet tricorder specifically programmed for a psychologist's use in analyzing a patient. This version of the tricorder scanned specific brainwave patterns during questioning of the patient, and was helpful in diagnosis and treatment of mental ailments and disorders. It may have possessed a hypnosis-assist subroutine, as well as subroutines for lie-detection and amnesia analysis. The device was normally operated by an assistant technician while the attending psychologist directed the patient.

A psychotricorder and medical technician were once requisitioned by Kirk and McCoy to help analyze the apparently amnesic Scotty when he became a suspect in several murders on Argelius II.

When Corruption Becomes Liberating

There was a time not too long ago when the Senator whose name was most closely associated with corruption was the junior Senator from Illinois, Roland Burris (no small feat in a body composed mostly of plutocrats). And if that time has now passed, that's likely due in no small part to the fact that no one remembers who Roland Burris is. Appointed by disgraced former governor Rod "B-Rod" Blagojevich (a man who had this thing--and it was fucking golden--and just had to share it with Burris), Senator Burris clawed his way into office against a strong headwind. Turned away at the door of the Senate when he showed up in January and given the cold shoulder by the Democratic leadership, Burris was only sworn in as a U.S. Senator following the issuance of a state Supreme Court decision favorable to his cause.

Today he's in the news with a headline that's nothing short of hilarious: Shunned senator suddenly relevant.

"I would not support a bill that does not have a public option," Burris, 72, said in a recent interview with The Associated Press. "That position will not change."

Those words caught the attention of the very Democratic leaders who tried to keep Burris out of the Senate, suggested he resign and have shunned him in unprecedented fashion. Burris is not the only Democrat to insist on creation of a government-run health plan. But he is the one who has the least to lose by defying President Barack Obama and the Democrats who once turned him out in the cold rain.

We have now, by the way, entered into the part of the health care debate where anyone not publicly moored to a particular legislative stance tries to jockey for a tiny sliver of relevance. Following the extended media and legislative courtship--culminating in a coveted committee "aye" vote--enjoyed by malleable Maine Senator Olympia Snowe, her fellow Pine Tree Stater Susan Collins started making noises about her own newfound openness to voting for a health care reform bill. Not to be outdone, Joe Lieberman tried to garner some attention by declaring that he doesn't support the bill that Snowe helped vote out of the Finance Committee (though, soon after, he--somewhat sheepishly, one imagines--admitted he wouldn't support a filibuster of a reform bill). Even members of the other chamber are getting into the act, with a leading conservative Blue Dog Democrat, Mike Ross (he of the Ross amendment), recently signaling a (token?) openness to allowing the uninsured to buy into Medicare.

And now we have Roland Burris. This isn't a new position for him, to be sure. He has indicated before that his vote for a reform bill is contingent on the inclusion of a public option. The fact that this storyline is emerging now indicates one of two things: 1) the media is going to push the narratives that it wants to and 2) as the Eleventh Hour for Senate health care negotiation finally appears on the horizon, Burris actually has caught the attention of the leadership as they start thinking about whipping votes. I imagine it's a little of Column A and a little of Column B.

Burris is interesting because he isn't beholden to the Democratic establishment that resisted his entrance into the Senate. That goes as much for the Madigan machine in Illinois as it does for the Reid-Durbin hegemony in the Senate. His association with Round-the-Bend Rod poisoned his relationships with respectable Democrats before he ever directly fell under their wary gazes. Moreover, it's virtually certain that Burris won't be returning to the Senate in January of 2011. The reason Mr. Smiths are so rare in Washington is that most politicians are caught in the gravitational pull of institutions larger than themselves. They are beholden in part to their political party, which assists them in their electoral battles (retaining a Senate seat is almost always easier with the financial and political artillery of the DSCC behind you) and helps to put their policy priorities on the legislative agenda. Politicians are also influenced in part by interest groups. Not only do these outside actors pipe in money for re-election bids, they provide retiring politicians with VIP passage through the "revolving door" that places former government officials into private sector positions that utilize their insider knowledge and connections. Access is power, as well as a currency in which former politicians are well-equipped to deal.

His short tenure in the Senate limits Burris's useful institutional knowledge and his apparent lack of a cordial professional relationship with his colleagues reduces his post-Senate career access almost to nil. He is very nearly a man without a party and a man who can offer organized interests next to nothing. This alone ought to put him in a position as close to purity as it gets in politics: a man who answers only to his own conscience and to his perceptions of his constituents' needs. And, depending on the individual, to pure pettiness. Maybe he's worried about rehabilitating his tarnished legacy or maybe he's looking for headlines, however (unintentionally?) derogatory. But the fact remains that Roland Burris seems to be in a very special position right now.

Ironically, the stench of corruption surrounding Burris may in the end make him the most incorruptible man in the Senate.

Quantum Russian Roulette...in France

There's something freeing about ridiculously speculative ideas. In sifting through the shards of crackpottery you get to let your mind wander to the furthest recesses of Meinong's Jungle. So let's have some fun.

A while back I mentioned that quantum mechanics is beset by questions of interpretation: the mathematical relations in it correspond well to experiments. Better than any other area of physics, in fact, but that doesn't mean we know what they're telling us. They seem to suggest that systems are in multiple states ("superposition") until a mysterious event ("measurement") forces them to choose just one. As Wikipedia can attest, there's no shortage of suggestions for what's really going on there. The so-called Copenhagen interpretation has historically had the most weight, so much so that its philosophical precepts are often seamlessly integrated into the introductory QM curriculum to the extent that undergrads don't even know their "objective" physics is coming with a helping of philosophy (hint, kids: it always does). The squares of coefficients in expansions of a wave function (the piece of math that's taken to be a complete description of a physical system) are to be taken as the probability of the system collapsing into a given possible state during measurement. Thus the notion of a collapse is built right into that interpretation.

The interpretation I want to focus on here is called the many worlds interpretation (MWI). This one rejects the notion of a collapse from many states to one. In the MWI, there's nothing magical about measuring something, no (meta)physical difference between that state before and after. Instead of things being in a superposition of every possible state and then dropping out of it, states always remain in superpositions. Sometimes this is stated as the universe "splitting" whenever a measurement occurs but this is sloppy language that implies the existence of multiple universes. The split is merely the smooth evolution of wave functions simultaneously down different streams of possibility. MWI only involves one universe but there are many stories playing out concurrently (many superposed worlds) in that universe. Schrödinger's cat is dead and alive, both before and after we peek at it. In peeking, our state (I see it alive vs. I see it dead) gets mixed up with the state of the cat and we ourselves are in a superposition. We exist in many different worlds but since these worlds or branches of our existence can't interact we're only aware of one of the possibilities.

Now that we've got that background down, we're ready for the good stuff. There's a thought experiment, perhaps most closely associated with physicist Max Tegmark, called quantum suicide. It posits that if the MWI is correct suicide is pretty much impossible. Tegmark envisions a (pretty sick) experimental apparatus in which a machine gun is aimed at an experimenter and hooked up to a tool that measures the spin of a certain particle along a certain axis when the gun's trigger is pulled. If the spin of the particle is found to be up, the gun fires a single bullet. If the spin is down, nothing happens. The experimenter lives in one possible outcome, he dies in the other. So what happens when we try it out? Tegmark argues that we have a superposition of the two possibilities: 1) spin-up, experimenter dead and 2) spin-down, experimenter alive. However, since presumably conscious experience ceases in the first possibility, one's conscious experience can't travel down that road. That doesn't mean that this possibility doesn't occur (both possibilities play out), it means that you can't experience it. This is intimately related to that continuity of consciousness notion I've mentioned before.

In practice, this would imply that you--the experimenter--can pull the trigger as many times as you want, the gun will never seem to fire and kill you. Your lack of dying will get exceedingly improbable after a while, effectively proving the MWI to be the correct interpretation of quantum mechanics. However, someone watching you do the experiment can see you die (their conscious experience is free to flow down that branch). So while you can't experience a world in which you're dead, others can. Which intuitively makes sense. I should note that not everyone agrees with Tegmark's conclusions but let's ignore those buzzkills for a bit.

For a moment, let's accept the (admittedly absurd) conceit that the new Large Hadron Collider in France could destroy the world. What might we expect to see if MWI is correct? I assume this would be a bit like a massive quantum suicide experiment--or rather, more like a worldwide cult suicide attempt. If operating the LHC inevitably leads to the destruction of the planet and the death of everyone on earth, none of our conscious experiences could ever travel down a branch of existence in which the machine works. In other words, the only observation we could ever have is the machine breaking. Every single time we try to use it. Is this what we've observed every time we try to use it?

Well, it's hard to be sure because the first time they tried taking it out for a real spin last year they broke it.

On 19 September, just nine days after protons were circulated in both directions of the €3bn LHC, an electrical connection between a dipole magnet (one of 1232 that bend the protons around the ring) and a neighbouring quadrupole magnet (one of 392 that focus the proton beam) failed during circuit tests in the last of the LHC’s eight sectors. At the time, a current of 8.7 kA was being pushed through superconducting cables the width of a stick of chewing gum to generate the enormous magnetic fields required to bend protons at high energies.

But they're going to start it up again next month. So we'll see. If it breaks again and again maybe we'll have some slim evidence that 1) the LHC is destroying us all in another branch of reality and 2) MWI is correct, in the same way that an endless series of clicks from Tegmark's quantum gun would indicate that MWI is correct and he can never lose a game of quantum Russian roulette. Or it could mean that the LHC is a multi-billion dollar piece of shit.

Of course, most of this is utter nonsense. But everyone's allowed to be a crackpot once in a while.

Responsibility in the Marketplace of Ideas

Some time ago Salom and I discussed the social responsibilities borne by artists. As I did my daily survey of my favorite corners of the blogoweb the other day, I noticed some withering assaults on a forthcoming book from Steven Levitt, the UChicago economist who came out with the bestselling book Freakonomics a few years ago. If these critics are to be believed, Levitt (and co-author Stephen Dubner) has abdicated the responsibility one might expect comes with being a respectable (i.e. somebody with letters after his name) intellectual with a megaphone that allows him to reach some broad swath of the public. So what's all the hubbub about? Apparently there's a not-so-good chapter about climate change in the book:

So now Levitt and his co-author Stephen Dubner have a sequel, Superfreakonomics, which includes a chapter on climate change. Do they deploy Levitt's trademark economic techniques to shed new light on old questions? Because that might be useful! Alas, no, there's nothing of the sort. Levitt and Dubner just parachute into the field of climate science and offer some lazy punditry on the subject dressed up as "contrarianism." There's no original research. There's nothing bold or explosive. It's just garden-variety ignorance. . .

In just a few dozen pages, Dubner and Levitt manage to repeat the myth that the scientific consensus in the 1970s predicted global cooling (quite untrue), imply that climatologists are unaware of the existence of water vapor (no, they're quite aware), and traffic in the elementary misconception that CO2 hasn't historically driven temperature increases (RealClimate has a good article to help with their confusion). The sad thing is that Dubner and Levitt aren't even engaging in sophisticated climate-skepticism here—there's just a basic unwillingness to gain even a passing acquaintance with the topic. You hardly need to be an award-winning economist to do that.

If bad science from non-scientists isn't bad enough, Paul Krugman suggests that they unintentionally (one hopes) misrepresented the work of another economist who tackled the question of the discount rate of tackling the climate change issue now (that is, figuring out what the value of possible future benefits is to us right now):

Yikes. I read Weitzman’s paper, and have corresponded with him on the subject — and it’s making exactly the opposite of the point they’re implying it makes. Weitzman’s argument is that uncertainty about the extent of global warming makes the case for drastic action stronger, not weaker.

That's a pretty serious breach, something you'd expect more from the makers of tripe like that "What the Bleep Do We Know?" movie about quantum mechanics than from a respected economist and journalist. It seems the irresponsibility in the book may not be limited to the chapter on climate. Ezra Klein took issue with a chapter that apparently attempts to show that driving drunk may be safer than walking home drunk:

It's terrifically shoddy statistical work. You'd get dinged for this in a college class. But it's in a book written by a celebrated economist and a leading journalist. Moreover, the topic isn't whether people prefer chocolate or vanilla, but whether people should drive drunk. It is shoddy statistical work, in other words, that allows people to conclude that respected authorities believe it is safer for them to drive home drunk than walk home drunk. It's shoddy statistical work that could literally kill somebody. That makes it more than bad statistics. It makes it irresponsible.

The sentiment is echoed by Krugman in another blog post considering the climate change chapter:

And that’s not acceptable. This is a serious issue. We’re not talking about the ethics of sumo wrestling here; we’re talking, quite possibly, about the fate of civilization. It’s not a place to play snarky, contrarian games.

I, of course, haven't read any of this yet-to-be-released book (Levitt himself insists it's not that bad) but that won't stop me from speculating as to why someone would engage in these kinds of games. There really is a marketplace of ideas out there: in this case it takes the form of the bestseller list. Competitive pressures in such a marketplace aren't necessarily for correct ideas but rather for interesting ideas. Book sales determine whether ideas sink or swim. That's why the Dan Brown school of lousy fiction is so successful and why Briane Greene can make money off "non-fiction" books about fantasy physics with little in the way of experimental support. That's interesting, imaginative stuff. Who cares if it's well-written or supported empirically?

Of course, that leads one to wonder whether it's okay for a public intellectual to lend his credentials to a questionable idea in pursuit of royalty money. For undergrads, being contrarian can give a competitive edge in the market for attention because it can lend one the appearance of intellectual depth. For full-blown professors with book deals, contrarianism can generate a competitive boost because it sells books. But just as regular markets can be dysfunctional in the absence of regulations, the market for ideas can also produce perverse outcomes in the absence of self-restraint (self-regulation). That's where the responsibility lies.

We can zoom out a bit and consider a slightly larger issue: namely, the insulation of academics from responsibility more generally. Academics have a hugely important role to play in the public discourse, in that they produce much of the research that decision-makers look to for guidance on the most pressing issues of the day. But responsibility for the consequences of a public policy decision doesn't fall on an academic who suggests it, it falls on the decision-maker who implements it. To be sure, some academics do find themselves at the actual policymaking table. Federal Reserve Chairman Ben Bernanke, regarded by many as an expert on the causes of the Great Depression when he has his professor's hat on, found himself in the unexpected position of having the public responsibility of preventing a second one. Policy advisers at all levels of government have often (or will later) spent time in the academic world.

But many prisoners in the Ivory Tower haven't spent much time in the world of consequences. I enjoy reading the Becker-Posner blog for intellectual reasons but there's something strange about reading two tenured professors (one of whom also holds a federal judgeship for life) poo-pooing the job- and benefits security that workers with less cushy jobs seek to attain through the bargaining power of unions. They draw paychecks from one of the most perverse systems around (the American higher education system) and dictate how others should be happy to abide by the vaunted rules of the free market.

So what can we take away from such examples of academics not buying what they're selling (neither in the marketplace of ideas nor of books)? Simply that academics are not the sole arbiters of truth in the modern world. They have great value but can still be blinded by their own accolades or book sales just like everyone else. It isn't anti-intellectual to suggest that extended real-world experience--residence in the world of real consequences and responsibilities--is an extremely important supplement to one's time behind the ivy-covered walls. It at least serves as a reminder that policy is more than a mathematical exercise or a rhetorical game useful for boosting book sales: it impacts real lives and has enormously significant repercussions for the segment of the population that doesn't enjoy tenure.

Update: I'm angry at myself for not including a Rick James joke somewhere in the above.

Bounded in an Inflatable Nutshell

Thirty years ago, big bang cosmology faced a problem. Actually, it faced a trinity of problems. It couldn't account for the uniformity of the observable universe, the near-perfect flatness of the universe, and the absence of certain particles that theoretically ought to exist. These three birds were taken down with one big stone when Alan Guth realized that a brief period of superluminal expansion early in the universe's history could account for all of these observations. The notebook pages on which he scribbled his historic calculations--with "Spectacular Realization!" written triumphantly at the top--are on display at Chicago's Adler Planetarium.

But inflation--now a cornerstone of modern cosmology and supported by additional observation evidence--comes with some heavy ontological baggage. It implies that what we know as the universe, a vast expanse bordered by distant quasars and gamma-ray bursts, is not the totality of existence. Instead, this observable universe is a merely a pocket of a much larger Universe, a bubble in an endlessly larger cosmic sea. And there are other bubbles in that sea, pockets of the Universe that have inflated or are inflating. Each one is a universe in its own right, some subject to different physical laws than our own observable universe. The bigger Universe (with a capital U) containing all the bubbles is likely infinite but one question worth exploring is how many types of other bubble universes exist beyond the horizons of our own. The arXiv blog has a post up detailing a new paper from one of the pioneers of inflationary cosmology, Andrei Linde, where he explores the question and comes up with an answer: 10¹⁰¹⁰⁷:

How many of these could we actually see? What's interesting here is that the properties of the observer become an important factor because of a limit to the amount of information that can be contained within any given volume of space, a number known as the Bekenstein limit, and by the limits of the human brain.

Linde and Vanchurin say that total amount of information that can be absorbed by one individual during a lifetime is about 10¹⁶ bits. So a typical human brain can have 10¹⁰¹⁶ configurations and so could never disintguish more than that number of different universes.

10¹⁰¹⁶ is a big number but it is dwarfed by the "humungous" 10¹⁰¹⁰⁷.

"We have found that the strongest limit on the number of different locally distinguishable geometries is determined mostly by our abilities to distinguish between different universes and to remember our results," say Linde and Vanchurin

This is a bit like the human eye distinguishing shades of a given color--how many shades are "really" there is less relevant than the number of shades the human eye/brain can distinguish. Two bubble universes might be slightly different in some physical sense but if you plop a human in first one then the other and he can't find a way to distinguish between them, then it doesn't really matter how different they are. That's why the number of possible types of universe they calculate is reduced to the vastly smaller (but still enormous) 10¹⁰¹⁶ number.

This reminder of the vastness of the inflationary Universe makes me think of an argument I once read that inserts anthropic reasoning into an inflationary universe and finds that something's got to give:

Anthropic reasoning often begins with the premise that we should expect to find ourselves typical among all intelligent observers. However, in the infinite universe predicted by inflation, there are some civilizations which have spread across their galaxies and contain huge numbers of individuals. Unless the proportion of such large civilizations is unreasonably tiny, most observers belong to them. Thus anthropic reasoning predicts that we should find ourselves in such a large civilization, while in fact we do not. There must be an important flaw in our understanding of the structure of the universe and the range of development of civilizations, or in the process of anthropic reasoning.

The argument is pretty simple. Start with the assumption that of all the sentient observers in all the multiverse (the collection of bubble universes in the sea-Universe), you're not particularly special. The majority of civilizations in the multiverse will be relatively small but imagine that a handful of "supercivilizations" exist that spread across a galaxy in their universe (and perhaps on to other galaxies) and pack individual star systems a billion times more densely than we do. Then there's a very good chance that the majority of sentient beings exist in such a supercivilization. To take a real-world example that might make this a little clearer: in the United States, only 0.4% of firms have more than 100 employees, yet employees of these big firms account for 63% of paid employees in U.S. firms. The reason, of course, is that even if there are lots and lots of little firms, the big firms are the ones that have lots of people. So if I picked a worker at random from the working population of the U.S., it would be a smart guess that he works for a big firm and not a small one (even though big firms are rarer than small ones).

The same logic applies here, except the numbers are significantly more exaggerated. Whereas all but about 2 in 5 U.S. private employees work for a large firm in our example, the authors in that paper calculate that "all but one individual in a hundred million belongs to a large civilization." So if you pick a sentient observer at random, it would be a very good bet that he belongs to one of those supercivilizations because that's where most of the sentient beings are. But we Earthicans are in the curious position of not finding ourselves in such a supercivilization. So is our starting assumption that we're not special (i.e. that if we pick someone at random out of the multiverse we're free to pick ourselves) wrong? Is inflation--with its untold numbers of other bubble universes--wrong? Is there some general principle that forbids or nearly rules out the development of supercivilizations?

Ultimately we don't know but the author does offer some suggestions. In addition to the ones I just mentioned, he suggests maybe we are part of a supercivilization but just don't know it (paging Agent Mulder!), maybe some sort of selection bias is going on here, or perhaps even "the idea of 'individual' will be different in the future. That last one is particularly interesting:

Perhaps civilizations more advanced than ours consist of only a single individual, or only a single individual per planet, in whatever sense of individual is necessary for anthropic reasoning. In that case, even though the civilization is very widespread, the number of individuals is small. A similar idea is that individuals of those advanced civilizations are so different from us that they cannot be considered part of the same reference class, and we should not reason as though we could have been one of them.

Does this remind anybody else of the Kurzweil predictions we talked about in What Lies Ahead? Particularly the bits like:

● Individual beings merge and separate constantly, making it impossible to determine how many “people” there are on Earth.
● This new plasticity of consciousness and ability for beings to join minds seriously alters the nature of self-identity.

Something to mull over.

The problem is choice

Please, as I was saying she stumbled upon a solution whereby nearly 99 percent of all test subjects accepted the program as long as they were given a choice, even if they were only aware of the choice at an unconscious level. . . As you adequately put, the problem is choice. -- The Architect, The Matrix Reloaded

I got a "Vote Yes on Issue 3" mailer today. This comes on the heels of a barrage of vaguely-worded commercials featuring some FOP guy who assures me I can trust him. I can see why the Yes on 3 issue ad campaign is supposed to be one of the most expensive in state history.

I can't say I really lean either way. But Issue 3 serves as a reminder that when it comes to money-making schemes, nobody does it quite like a cash-strapped state or locality. Cities will lease their parking meters, states will lease their toll roads to foreign companies, set up state lotteries, sell government buildings, or, as with Issue 3, roll out the red carpet for casinos to set up shop. Many of these schemes can end up being highly regressive, with the costs falling on people lower down the economic ladder (rich people don't play the lotto quite as much as the less well-off).

I suppose this is palatable to some people, in part, because of the emphasis we as a culture put not on fatalism but on free will and personal responsibility. Some of our schemes might take money away from those who can least afford to part with it but it's their fault for making that choice. This is far less tyrannical than, for example, a tax that falls more heavily on the upper economic strata.

The same sort of logic is often applied to the health reform debate. I've seen people outraged that the government will mandate them to get something that they already have. I've heard people argue that poverty alleviation and the provision of health care is the duty of good Christians but it must be done freely through acts of personal charity: government involvement through progressive taxation isn't appropriate (despite the fact, apparently, that these are social problems). For some people, the key is their ability to choose--willingly submit--to help.

We can raise money on the backs of folks who have little, as long as they are given a choice--even if they are only aware of the choice at an unconscious level--to spend their money on cigarettes, lotto tickets, casinos, whatever. But we can't coerce money from those who can afford to part with it. The problem is choice.

Sagan Song

When I was much younger I came across a battered edition of Carl Sagan's 1980 book Cosmos in the public library. I didn't know at the time that it was a companion to a television series and I wouldn't see an episode of the series for many years. And even though I don't remember much of the book now, I credit it with sparking my interest in science, particularly astronomy and cosmology. Sagan had a marvelous way of getting across the wonder of it all without getting too sappy.

I came across an autotuned song version of some of Sagan's lines from the Cosmos TV series on Cosmic Variance the other day. It's tight and I think that somehow, oddly enough, it captures the spirit of Sagan's efforts to make science not only accessible but wonderful. Also, it's got some Hawking action.

(Anti-)Trust Me

Something strange is going on. Some of the Senate Democrats are showing a willingness to attack the health insurance industry. But to attack a product of the system, they're attacking a feature of the system that happens to be at the center of that (flawed) system which, by the way, they're simultaneously trying to defend. Confused? Take a look:

Sen. Chuck Schumer (D-N.Y.) on Wednesday called for an amendment to the health care reform bill that would remove the long-standing antitrust exemption for insurers, echoing a push by other Democrats to crack down on the industry.

“The health insurance’s antitrust exemption is one of the worst accidents of American history," Schumer said. "It deserves a lot of the blame for the huge rise in premiums that has made health insurance so unaffordable. It is time to end this special status and bring true competition to the health insurance industry."

Sen. Patrick Leahy, chairman of the Judiciary Committee, introduced a bill last month to remove the anti-trust exemption and convened a hearing Wednesday, where Schumer called for eliminating the exemption as part of the health bill working its way through Congress.

At issue here is the 1945 McCarran-Ferguson Act which came up in my long-winded explanation of why selling insurance across state lines in the absence of federal regulations is bad. This is the law that essentially says the regulation of insurance companies is up to the individual states. McCarran-Ferguson also exempts insurance companies from federal anti-trust laws. This is the provision the Democrats are zeroing in on.

But it seems a little narrow to me. The root problem is that we want to have our socialist cake and eat it, too. This is evident in Schumer's declaration that what we really need to do is "bring true competition to the health insurance industry." And to some extent that's true; that is, after all, the rationale behind the public option. But it's a band-aid designed to keep a malfunctioning system on its feet a bit longer. No, the key to the whole thing revolves around a dirty little secret: the whole idea of health insurance is, at its core, socialist.

I'm not a socialist, I'm just an American. We're pragmatists who know the value of capitalism and the value of socialism. We're just not allowed to talk about the latter, though we accept it in practice with a wink and a nudge. Health insurance brings together a group of people who voluntarily pay premiums every month into a communal pool of resources from which others can draw when they're sick or require some medical service. The younger and healthier members of the insurance pool subsidize the health-related expenses of the older or sicker members of the pool. A health insurance pool necessarily entails an intra-pool transfer of resources just as surely as Medicare entails an intergenerational transfer of resources.

In accordance with their prerogative under McCarran-Ferguson, states make decisions on what consumer protections they will afford their residents. The state-by-state variation in these laws (along with state licensing requirements) fragments the industry and compartmentalizes it into 50 state variations. As this is done to protect consumers, this is largely a good thing. But it puts an upper limit on the size of the population from which an insurance company attracts its insurance pool. Here we run into a problem: in general, a bigger insurance pool is a better insurance pool. This is the reason all of the health care reform bills mandate that everyone enter an insurance pool: we need young and healthy people to enter the pools so that they can subsidize the people with pre-existing conditions that will also get to enter the insurance pools. There's also the matter of negotiating with providers, something every insurance pool must do: a larger insurance pool theoretically has more bargaining power to levy against doctors and hospitals. It just isn't feasible to have Mom and Pop insurance companies because big insurance pools are needed to make an effective pool.

What's the effect of this? There naturally tends to be concentration in the health insurance markets, particularly in states that have small populations because those states can support fewer insurance companies. To borrow a graphic from Speaker Pelosi's blog:


Compare that with this map of state populations where yellow states have the biggest populations, purple-blue states have the smallest, and shades of green are somewhere in between:



You can see that, in general, less populated states have a greater concentration in their insurance markets while the states with the largest populations have the least concentration. Certainly the insurers' exemption from federal anti-trust laws helps this to happen but this result is also a logical imperative, given the rule of thumb that bigger pools are better pools.* This is why tiny Rhode Island passed a bill last year to examine the feasibility of fusing its health insurance market with those of Connecticut and Massachusetts. Schumer's desire to try to inject capitalism into socialism in this case won't necessarily work because insurance pools by their very nature are strongest (i.e. spread out risk enough and have enough healthy people to keep the communal resource pool stable) when they're large; you simply can't have a multitude of tiny insurance pools competing for customers. In order to remain competitive (not to mention solvent), those pools would have to cherrypick customers to such an extent that no one who actually needs health insurance would ever get it. Thus there is an inherent contradiction contained in the idea that socialist resource pools should act in a more capitalistic manner.

Part of the problem is the mere existence of for-profit insurers. Here we see the same contradiction. The profit motive forces these quasi-socialist institutions to "compete" but being very odd birds by nature, they don't necessarily do it the way most businesses compete with each other. Instead of lowering prices for everyone and increasing access to care (things one might naively assume are the point of having a health care sector), a health insurance company often can compete by shedding risk--read "sick people"--or shifting costs to less insurable customers who might have difficulty shopping around for something else. There's no reward for doing the decent thing, the thing an insurance company ostensibly exists to do: insure people. A socialist institution subject to capitalistic forces is a wretched creature more at home on the Island of Doctor Moreau than in the Land of Liberty. Thus insurance companies twist themselves into knots pursuing profits over people. And if there should be one guiding principle in health care in the United States, it should be "people over profits." The skeptic might suggest that this requires bankrupting the nation in paying for every conceivable health expense; it most certainly does not and that would be a somewhat ironic accusation, given the fact that the current system is bankrupting the nation.

A slightly smarter system could retain private insurers if it made insurance companies (at least partly) into not-for-profit organizations that enjoyed a risk-adjustment mechanism, in which the government redistributes revenues in accordance with the level of risk associated with a given insurance pool. That way the market doesn't punish a given insurance company for ending up with a slightly sicker insurance pool than another insurer. Radical thoughts! This, by the way, is how Switzerland does it: private insurance companies exist but they cannot make profits on basic health insurance plans (they can, however, make profits on supplemental insurance policies). But this requires letting a socialist system--health insurance--behave in accordance with its socialist tendencies instead of making it pretend to be your average free market business enterprise. And that's politically dangerous.

So the health reform proposals preserve the profit-driven, employer-based system we have now. Sure, they rein insurance companies in a bit with new federal regulations (e.g. with guaranteed issue provisions that prevent insurers from turning people away and with community rating rules that limit the ability of insurers to charge different premiums to different members of their insurance pool). They strengthen existing insurance pools by pumping in hundreds of billions of dollars--filtered through lower-and-middle-income people who get to vote for an insurance pool with their government affordability credits--over the next decade. They even potentially have a strong public option that competes with private insurers not just by merely existing but by reimbursing providers at Medicare (+ 5%) rates. There are lots of good (read "better than the status quo") things in these bills. But at their heart they preserve and strengthen the existing system, sanding over some of its rougher edges but not necessarily eradicating them. So the attempt by Senator Schumer to attack the anti-trust exemptions in McCarran-Ferguson seems weak. What he ought to be examining is the inherent friction between the competition he values and the socialistic leanings of the very concept of health insurance which, by its very nature, is often a matter of scale and thus not necessarily the best target for strict anti-trust regulation (it might be a better idea to think of insurers in the same way we think of regulated monopolies: as sons of bitches but our sons of bitches).

So why are the Democrats bothering to take this shot at the insurance companies now? Probably because heretofore the insurance companies had been allies (attracted, no doubt, by the infusions of government-subsidized customers that would flood their pools under these reforms) but they've now gone off the reservation, launching their opening volley the other day with a bogus "study" that suggested premium spikes would result from the Senate Finance health reform bill that passed out of committee the other day. One wonders why, if in the end the final forms of the reform bills will engender the opposition of the insurance industry, the Democrats didn't just go for broke in writing these bills: force insurers to operate at least part of their pools in a not-for-profit capacity in some sort of Swiss-American cheese hybrid. Hindsight may be 20/20 but this stuff has to stop someday.



*One might think that this logically points to a need for greater competition, not within states but nationwide. As I explained in another post, allowing insurers to sell policies in different states can have negative consequences in the absence of federal rules. However, it should be noted that the Senate Finance health reform bill (the Baucus bill) allows for the creation of national health plans that would be subject to federal standards and could be sold across state lines. This is likely much more workable than the Republican version of this idea. To be clear, I'm well aware that competition can have positive effects; my concern is simply that competition alone doesn't correct for the issues that accompany a profit-driven system of private insurance.

Does God Play Chess?

There is a peculiar fact about the effect scientific progress has on perceptions of the relevance of religiosity: namely, that progress eliminates god at the same time that it validates it.

The God of the Abyss

In the beginning there was nothing. The beginning of human knowledge about the universe, that is. Things happened without any particular rhyme or reason. As long as the universe was an orderless Abyss that didn't appear to be playing by a set of consistent rules, a person could conclude either that 1) the world is fundamentally random and devoid of reason or 2) events can be explained by the caprices of a deity. The latter notion at least provides the universe with an organizing principle, an indication that there's some intelligence behind events. This is a comforting thought to the organized mind of a human being, even if knowing that offers no predictive power. This deity--that which separates us from an orderless, incomprehensible universe--is what I'll call the God of the Abyss.

The God of the Gaps

With the benefit of hindsight, we now identify the God of the Abyss as the God of the Gaps. Today we know that recurring patterns--underling laws--are responsible for natural events. Thus the God of the Gaps argument posits that religion has always served as a placeholder whose utility disappears as the body of scientific knowledge grows. Religion's God of the Gaps offers explanations in the absence of genuine understanding; but the order it brings to an otherwise orderless universe is only temporary. It is supplanted by scientific knowledge as the gap--which we recognize to be a gap in that scientific body of knowledge--shrinks. The God of the Abyss, dating from a time when it was not known that there were laws governing the universe, did not, strictly speaking, fill gaps because it was not recognized at the time that there was another side to the chasm.

Thus, the argument goes, just as science has shown us that the God of the Abyss was actually the more limited God of the Gaps, it has also indicated that in the limit that those gaps shrink to zero there is no need for god. Science slays god.

Chess

But there is another way to view this progression. Physicist Richard Feynman once described our quest to understand the underlying laws of the universe by using the analogy of a chess game:

One way, that's kind of a fun analogy in trying to get some idea of what we're doing in trying to understand nature, is to imagine that the gods are playing some great game like chess, let's say, and you don't know the rules of the game, but you're allowed to look at the board, at least from time to time, in a little corner, perhaps, and from these observations you try to figure out what the rules of the game are, what the rules of the pieces moving are.

The God of the Abyss arises from the assumption that there are no rules that the pieces on the chess board obey, merely an intelligent hand moving them around as it sees fit. Once we recognize that the pieces do obey laws, the mysterious intelligent hand is invoked only to explain chess moves that do not yet conform to our understanding of the rules (e.g. we might be absolutely befuddled the first time we observe castling). The recognition of underlying rules reduces the God of the Abyss to the God of the Gaps, as long as we regard god as a fundamentally pragmatic tool. But ultimately we will understand all of the rules and we won't need to assume that any sentient hand is guiding any of the pieces.

However, one might also look at the chessboard and muse on how extraordinary it is that the pieces follow any rules at all. If they moved randomly it might be psychologically comforting to "explain" their motions as occurring due to the actions of an intelligent player with designs of his own that remain mysterious to us. But the simplest explanation under those circumstances would simply be that the pieces are drifting around without any organizing principle accounting for their movements. The very lack of apparent purpose behind their movements could easily be taken to indicate the lack of an intelligence behind the game. Thus a rule-less chess game lends itself to both arguments: 1) that it must indicate that an intelligence with independent will (some cosmic rebel without a cause) is moving the pieces or 2) that the pieces move the way they do precisely because the chess game lacks any intelligent force driving it. This is the issue faced by a person living in the Abyss.

But a person living in an ordered universe with gaps--areas of incomplete knowledge of the laws that we trust can and will disappear as we learn more--faces the same problem. On the one hand, one can argue that things happen because they're obeying the laws. A chess game on autopilot doesn't require a chess player. But the mere existence of underlying rules can also be taken to indicate the existence of an intelligence somewhere in the process. If we take this interpretation, then the steady march of scientific progress merely vindicates faith because it demonstrates that something ("the laws of physics") is governing the universe. And that's a very curious fact. Why should a godless universe be governed by mathematically elegant rules?

Which way do we lean on this one? Sadly, the question is unresolvable. Is there an intelligence at work somewhere, is there not--the answer you prefer depends on your world view. The facts don't favor either one because what's at stake here is merely an interpretation of the facts. We know that the chessboard has rules. The question is whether that relieves us of the burden of having to worry about a deity or whether the chessboard is gesturing frantically in the direction of some chess-playing deity watching--or perhaps not watching--its game play out according to the rules it devised.

And therein lies the intellectual honesty of the agnostic position: fuck if I know.

Addendum

On the back of yesterday's revelation that "46% of people aged 16-24 had jobs in September, the lowest since the government began counting in 1948," I should also add that the Lost Generation knows who is hiring :

WASHINGTON (AP) — The Pentagon says it has just finished the best recruiting year since the all-volunteer military was established in 1973.

Defense Department head of personnel Bill Carr says all services met their goals for active duty and reserve recruiting and that the quality of recruits improved during the budget year that ended Sept. 30.

He told a Pentagon press conference that it's because the department continued to spend strongly on finding recruits as fewer jobs were available in the civilian world due to the nation's economic problems.

Carr says an example of the higher quality of recruits is that nearly 95% of those coming into the Army were high school graduates, an 11% improvement over the previous year.

The Lost Generation

Life still sucks:

For people just starting their careers, the damage may be deep and long-lasting, potentially creating a kind of "lost generation." Studies suggest that an extended period of youthful joblessness can significantly depress lifetime income as people get stuck in jobs that are beneath their capabilities, or come to be seen by employers as damaged goods. [. . .]

Only 46% of people aged 16-24 had jobs in September, the lowest since the government began counting in 1948. The crisis is even hitting recent college graduates. "I've applied for a whole lot of restaurant jobs, but even those, nobody calls me back," says Dan Schmitz, 25, a University of Wisconsin graduate with a bachelor's degree in English who lives in Brooklyn, N.Y. "Every morning I wake up thinking today's going to be the day I get a job. I've not had a job for months, and it's getting really frustrating."

Nobel Prize

I like Obama. A lot. But you can't give a Peace Prize to a guy who's in the middle of conducting two wars just because he's a fan of diplomacy.

I'm unemployed

And they still want money from me. In my email:

Think about the time you spent at the University of Chicago.

Think of the all the classes and discussions, problem sets and papers, all the Thai food and stuffed pizza, the sun on the Point and the ice on the quads.

Then think of all the people you met at Chicago. Bet you’re glad to have gone to a college where you could be surrounded by smart, thoughtful, and, yes, occasionally geeky people.

Be one of every four young alumni—that’s 2,356 graduates of the College since 2000—who give back to the University of Chicago this year and tell the world how much you not only appreciate the rigorous education you received, but appreciate all things chicago. Make your gift today.

Fuck off.

A fistful of compromises

It seems the Senate is tripping all over itself to find a way to insert a kinda-sorta-not-really public option into the final health care bill. It's hard to even keep up with all the "compromise" ideas that have been proposed to ensure that there's no robust public option on the table. Before we do a quick survey of these ideas, let's take a detour and touch upon what the original public option is.

The public option in the original draft of the House bill is a government insurance option, national in scope like Medicare, and financed entirely by the premiums that enrollees pay into it. The key feature that makes it "robust" is the way it reimburses doctors and hospitals. The robust public option reimburses the same way Medicare does: according to a set fee schedule that lays out how much different procedures are worth, adjusted for certain variables. Here's a relevant slice of a fantastic overview of how Medicare works:

DRG is a prospective payment system that covers payment for all patient costs for each hospitalization except doctors’ fees, which are covered separately under [Medicare] Part B. For each patient and each admission, the hospital is paid a fixed amount that is meant to cover all hospital costs and charges for services that would be needed to treat a patient with a particular problem. About five hundred DRG categories have been created, each associated with a specific disease or injury. Modification for other co-existing or underlying health problems alters the payments, in effect creating thousands of categories. For example, there is a DRG for acute cholecystitis (gall bladder infection) that can be modified by other DRG’s for complications like co-existing infections, gallbladder rupture, and pancreatitis, or for underlying conditions like diabetes or heart disease, and so on.

The values of DRG’s are set empirically, based on actual data collected about costs of hospital services, and modified on a regular basis to reflect changes in costs and management approaches. There is one baseline DRG for each condition, but that baseline payment for hospitals is adjusted for other factors, including local labor costs, hospital location, teaching and training programs, large Medicaid and non-paying populations, and so on. The dollar value of the modifiers often exceeds the dollar value of the underlying DRG. It is these modifiers that account for the large region to region variation.

If you want a picture of that regional variation, take a gander at this handy map. One of the keys to the robust version of the public option is that Medicare reimbursement rates tend to be lower than what private insurers pay for the same services. Does this shortchange hospitals? Well, probably not, if they're operating efficiently:

The March 2009 MedPAC Report to Congress: Medicare Payment Policy (Chapter 2A). . .concludes that the dominant dynamic in the market is that hospitals with strong market power have abundant financial resources. In turn they have a high cost structure (perhaps due to provision of relatively higher quality care) that causes lower or negative Medicare margins. In contrast, hospitals that are forced to run efficiently are adequately funded by Medicare payments. That is, Medicare payments are sufficient to cover costs but some hospitals run inefficiently and make it appear otherwise. Therefore, MedPAC has concluded that increased Medicare payments to hospitals would not reduce rates charged to private insurers. The primary effect would be to induce lower cost operations.

This is where the true cost-saving potential of the robust public option comes from. It pays--on behalf of its customers--rates that are just a bit higher than Medicare rates but still less than what private insurers are paying. Hence the added competition and downward pressure on the rates and spending of private insurers.

So what are the compromises that have been suggested?

● The "weak" (negotiated rates) public option. A cousin of the robust--or "strong"--version of the public option, this weaker version was actually included in a bill that already passed out of one Senate Committee (the HELP Committee) a few months ago. Instead of relying on pre-set rates that are pegged to Medicare rates, this public option negotiates its rates (via the Health and Human Services Secretary) with providers. It isn't likely to save much money but it's more palatable to conservative Democrats who are skeptical of the robust public option.

● The trigger. We've talked about this idea before. Favored by Republican swing senator Olympia Snowe, the trigger would create state-level exchanges if two or more affordable health care options aren't available to more than 95% of a state's population. What's affordable? That's defined by a sliding scale, from a family paying "3 percent of [income] at 133 percent of the Federal Poverty Level, to 13 percent at 300 percent and above."

● The co-ops. The government provides some seed funding for non-profit health insurance collectives that would compete with profit-driven insurers. This idea is plagued by nagging doubts that co-ops will have the muscle to sustain themselves and make a dent in the health insurance market.

● The opt-in. Individual states can decide whether they want to set up a state-level (weak) public option. Actually, the proposal is a bit broader than that: "Carper suggests giving states the option of creating a competitor to private insurers, which could include a government plan, a network of co-ops, or a large purchasing pool modeled after the revered Federal Employees Health Benefits Plan."

● The opt-out. Here a national robust public option is created but individual states are free to opt out of it.

The trigger compromise that seemed to be gaining steam a few weeks ago seems to have largely fallen by the wayside. Which (if any) of these compromises will make it into the final bills? We'll have to wait and see.