Should health insurance be like fire insurance?

Steven Pearlstein has another of his level-headed pieces on health care today in the Washington Post Sept. 30, “Why health plans should be more like fire insurance,” link here.

The market place really should rule when people deal with things that their choices can control, including routine screenings. Health insurance should be just that: insurance for things we can’t control, such as catastrophes (cancer), and for routine “pre-existing” disease that cannot be avoided by choice (juvenile diabetes). It’s less clear what happens in his world with behavior-linked disease, whether that behavior is cigarette smoking or sexual promiscuity. Pearlstein wants a world in which individuals don't have to subsidize the faulty behavioral choices of others. George Will has made similar comments in the past. It sounds as like we can wind up with a world with individualized morality-based finger-pointing.

NBC Nightly News on Sept. 30 quoted Democrats as characterising Republican health care plans as "don't get sick, and check out qiickly if you do."

Our health care system grew piecemeal; so it benefits the likes of Clark Kent

Brad Reed of AlterNet has a good analysis of our health care system: “Americans pay more to die earlier: why is our health care system so screwed up?” on AlterNet. This seems to be an original article for that “left-leaning” site, link here.

His short answer as to why we’re the only major industrialized country without major single payor support (and we do with Medicare, for over 65), is that our system was pieced together by happenstance, starting during WWII when companies offered health insurance to get workers for the war effort. The system started to break when the economy became less stable and more “entrepreneurial”, with more job changes, and a philosophical shift among the young (whether religious or not) toward individualism, especially during the Reagan years. Over time, locally understandable but systemically perverse incentives developed in the health insurance industry, where normal modes of competition don’t work. Even so, many conservatives and libertarians want to turn all the responsibility for health care over to the individual with savings accounts, portable to be sure and maybe subsidized for the poor, but in general the sick would have to pay for their own illnesses. If you’re Clark Kent, all you have to do is stay away from green (and maybe red) kryptonite and you’ll get to cherry pick your way out of paying for the care of others (even in Kansas, where bills are a bit lower; If you’re Sam Winchester, it’s only a little more complicated.)

So now we’re left to answer why we do this to ourselves. And we have to think about when we have to take care of one another.

Washington Post Magazine does feature story on Michelle Rhee (DC School systems controverisal chief)

On Sunday Sept. 27, the Washington Post Magazine will feature a story by Marc Fisher about Washington DC’s controversial school system chancellor, Michelle Rhee. The story is titled “In Search of The Real Michelle Rhee: Arrogant or dynamic? Harsh or honest? Inside the mind of D.C.'s controversial schools chief”, link here.

The story starts out by recounting a teenage incident in Toledo Ohio where Michelle’s mother Inza Rhee, raising her in a somewhat insular Korean-American community, challenged her with “"What is wrong with you? You just don't care what people think of you!"

Rhee has certainly implemented her ideas a chancellor, demanding that teachers look to their own performance and not to a tenure system. But older African-American teachers apparently believe that the tenure system was necessary to protect them from legacy racial discrimination.

The story also depicts her hitch with “Teach for America” in Baltimore and shows that she does live and share with others socially even if she is very determined to enforce her own ideas (like I am!)

Should teacher licensure be made shorter and cheaper so that stronger academicians will want to enter teaching?

Jay Matthews has a readers column (called “Extra Credit”) today on teachers and education, with a letter on the effectiveness of IB (International Baccalaureate) programs, and a particularly challenging letter from Frederick, Maryland suggesting that the teacher licensure system discourages stronger academic people from going into teaching. The column, on p 3 of “Alexandria-Arlington” is “Open classroom doors to better teachers” with link here.

The reader mentions the American Board for Certification of Teacher Excellence (link) as offering a shorter and cheaper process online, but the nearest state to use the method is Pennsylvania.

Matthews says that Frederick County offers several “career switching” programs and that it felt that the internship program with ABCTE was too short.

The Washington Times had written in the summer of 2008 that the expense and time of education courses and teacher licensure was an impediment to recruiting good teachers. School districts, even in times of tight budgets, have gone overseas, especially the Philippines, to recruit special education teachers. On the other hand, there is a question as to how much course pedagogy is needed to replace real world time with kids in a world where people have fewer children – the same Phillip Longman argument again.


First picture: Dover PA high school; second, Arlington VA Career Center. I'll pass along the court opinion regarding the teaching of evolution at the Dover school, here.

Older people might actually get good protection from H1N1 with regular seasonable flu vaccine

Older people do seem to be less susceptible to H1N1, and they may actually gain some protection from H1N1 with the seasonal flu vaccine already available, according to a CDC MMWR report, link here (May 22, 2009, title “Serum Cross-Reactive Antibody Response to a Novel Influenza A (H1N1) Virus After Vaccination with Seasonal Influenza Vaccine”).

The University of Missouri published an article Sept. 1, 2009, saying flatly that persons over 65 were not advised to have the H1N1 vaccine, and that studies show existing immunity, link here. Apparently, other viruses, maybe related to Spanish flu, were around six or more decades ago with surface proteins very similar to the supposedly novel Mexican H1N1 flu antigen. Then these viruses disappeared.

Current plans are for some people, youngest children, to receive two doses and others to receive one. It is likely that by Thanksgiving or so, however, there would be enough vaccine available for everyone who wants it. However otherwise healthy seniors who get the regular flu shot may get enough protection from H1N1 to avoid significant illness if exposed. It’s not clear whether they could “carry” the virus for a few days to others (like children in a household or school, for example, with older adults who work as teachers or mentors) while developing only minimal symptoms (“viral” sore throat or cough that resolves on its own in a couple of days).

There have been very few cases of serious H1N1 illness in older people without other major health problems. There are other H1N1 influenza-A viruses, and some of them have appeared in vaccines in the past. But probably repeated exposure to similar viruses has taught the immune systems of older adults to recognize the newer H1N1 virus even though some of its proteins are novel. Similarly, older people sometimes are less susceptible to GI upset (like Norovirus) than younger people because of past repeated infections.

Karen Kaplan has a story in the Los Angeles Times, Sept. 18, 2009, link here, title "Swine flu's tendency to strike the young is causing confusion".

Old cathode ray TV's are the latest E-waste problem

The latest wrinkle in electronic waste seems to be old cathode-ray TV’s, which are hard to dispose of responsibly. There is a site “Take Back My TV” with a “2009 TV Companies Report Card”, with link here. This is the second year this site has offered such a rating of services.

The Washington Post had reported on the problem Saturday in a short piece called “What To Do With That Clunker”, here.

I seem to remember our first TV set in 1950, complete with halo light. One day it was no longer on the living room floor. People had jobs in those days repairing TV sets. Until the late 1970s, color TV's would last about four years and then the picture tube would just go. Apartment buildings would have to help tenants dispose of them.

Old televisions would have become a bigger issue since the government forced all broadcasts to go digital in June 2009, as converter boxes wouldn't be a hassle for some people.

Waste-disposal companies have been accused to shipping waste to China, where some of it is dumped in riverbottoms in villages of poor people.

Covering everyone with health insurance doesn't really requre "sacrifice"

Yesterday, on Anderson Cooper’s 360 on CNN, there was a panel discussion about health care reform, and one of the panelists said that he had Type 1 diabetes and would never be able to buy affordable insurance in an unregulated private market in today’s world. “What’s supposed to happen to me?” he asked. Die, he is hinting.

The answer that came out was not put in Darwinian (or Spencerian) terms; it was discussed in your typical Michael Moore-like concern with profits of health insurance companies.

But the problem is that we even “go there.” If everyone had to get insurance, if insurance companies could not exclude for pre-existing conditions, if unnecessary care were eliminated (by malpractice tort reform) and if medical billing and record keeping were properly automated to save money, the “sacrifice” by healthy (or lucky) people would not be noticeable. That is the president’s pitch. In fact, since society would not have to deal with emergency room visits for the uninsured, the “healthy” might even come out ahead. The president does make sense on this one.

But today Mike Huckabee actually said that covering more people could lead to more bad health habits! Would you believe??

In Europe, it seems, this problem has been handled more or less collectively, we don’t “go there” and you don’t have to be Nick Jonas to be able to afford treatment for juvenile diabetes or for anything else beyond one’s control.

Joe Davidson has a column in the Federal Diary in the Washington Post today, “Health insurance not universal for federal workers,” link because some don’t make enough to afford it.

DC faces teacher, school staff layoffs; how to get people into teaching?

Six weeks after school started, Washington DC schools face administrative staff and some teacher layoffs, even during the school term. The Metro Washington Post story is here “D.C. Schools Face Bigger Classes, Layoffs Due to $40 Million Gap: Rhee Says Principals, Parent Groups Will Decide What to Cut at Each Site”, story by Bill Turque, link here.

Michelle Rhee says that decisions will be made locally by principals and parents’ groups, but the DC budget shortfall is certainly impacting her promises to turn DC education around, with all her strict oversight of teachers.

At the same time, the Post has been reporting more controversy about the need for many school districts to go overseas to recruit special education teachers, especially for the youngest children.

As we’ve noted here before, it seems like one problem with teaching jobs as that they are getting comingled with substitute parenting.

The idea of teacher layoffs can interfere with the decisions of college students to go into teaching, for “career switcher” programs for licensure, and for participation in “Teach for America” service programs.

Update: October 3

Washington DC media report that teachers were escorted out of the classrooms, sometimes in front of students, when they were "laid off" Oct. 2. The total of teachers fired was about 220. This sounds humiliating. Who will spend the money on teacher licensure now?

Young people will pay for health insurance reform

Shailagh Murray has a story in the Wednesday Washington Post “Young adults like to pay big share of reform’s cost.” Various versions of health care reform imagine a large fine for not purchasing health insurance, but it still not be as much as premiums. And it would be vital that reform eliminate exclusion or surcharges or rescissions for pre-existing conditions once and for all.

This will be a problem for young adults, already struggling with credit card and student loan debt.

But the mandatory participation of younger, usually healthier people will make premiums cheaper for everyone, and continue a chain of transfer of wealth to older generations to provide social insurance.

Mandatory health insurance comes to be like mandatory auto insurance. When you think about the talk of eliminating “systemic risk”, you wonder what’s next: mandatory insurance for bloggers?

Update: Sept. 17, 2009

President Obama spoke at the University of Maryland today and pointed out that under his plan, college students could stay on their parents' policies until age 26 (ironically, that was the old age that eligibility for the draft ended).

Here is a CNN video on the Baucus Proposal.

VA town will allow citizens to operate speed camers to nab and warn motorists

ABC’s affiliate WJLA reports that the Leesburg VA police Dept (in Loudon County) is implementing a program anticipating Michael Moore’s “citizen’s arrest”. Not exactly. But citizen volunteers, working in pairs, will be able to operate speed cameras, which will result in notices being mailed to drivers.

Stationary speed cameras are in use in the District of Columbia and Montgomery County, MD and may return to northern VA.

This is not vigilantism, the police say.

The FDA announced approve of H1N1 vaccine today and it may be coming sooner than had been expected.

MSN delivers a smackdown, but not by Suze Orman (we're lazy, we don't sacrifice)

Rick Newman, of US News and World Report, gives the decadent American public a Suze Orman-style smackdown with a recent article reproduced today on Dell’s MSN site. It’s “4 Problems that Could Sink America”, here.

One of the things is that we don’t like to work hard. I can remember that problem in the workplace many times. In mainframe I.T., we had people who were dependable, and people who weren’t. I’ve seen this kind of thing for years. Companies were pretty good in the 80s and 90s about rewarding people appropriately who worked hard and got results.

His comment about sacrifice is touchier, and less conclusive. We generally talk about it in economic terms, particularly taxes, but also in things like mandatory health insurance: making the “invincible” pay for some of the care for the less fortunate, because the invincible can quickly be vanquished by someone else’s wrong (a drunk driver) or no wrong (cancer out of the blue). But the real place sacrifice happens is within families, supposedly under the control of parents; sacrifice goes in hand with attachment, but we hardly want to talk about that.

"Sacrifice" is an important concept in chess. Pawn sacrifices for initiative or for permanent structural advantage (like in the Benko Gambit).

Are we headed toward strong carrots for national service, if not a draft?

By the way, read the comments there, too. One reader says how he has avoided layoff for 17 years.

Picture: garter snakes are easy to find in suburban DC; foxes, crows, even cats like to eat them.

H1N1: one vaccination shot may be enough, and that may be a good thing; virus burrows into lungs

Multiple media reports point to an Australian study indicating that one moderate dose of new H1N1 vaccine will provide sufficient protection in about two weeks. If these results hold, by the end of October a much larger number of people, including older adults, can be vaccinated, hopefully ending the threat of a major outbreak and economic disruption in most workplaces, and the alleviating the idea of having to enforce social distancing, which could close some venues.

There are other studies that suggest that H1N1, even in milder cases, burrows deeper into lung tissue than does conventional influenza, which may help why it can be so deadly with young pregnant women in later term, and also which explains why there could be concerns over mutation.

It appears that the conventional seasonable flu vaccine is becoming available, at Giant Food and at CVS Minute Clinics. I’ll check in person soon.

Update: Oct. 6

A Reuters news story today also reports that some people seem to get some protection from H1N1 with the regular flu shot, link here.

Senate works on federal journalists' shield law

The Senate Judiciary Committee is working seriously on a journalist’s shield law, according to the Washington Times in a story today by Jennfier Harper, with link here.

The bill is S. 448, introduced by Senator Arlen Specter (D-PA), govtrack reference here. A related bill in the House is HR 985, introduced by Frederick Boucher (D-VA) and passed by the House.

Such laws are in effect in 49 states. The federal law appears to be pretty comprehensive and it might even cover “amateur” bloggers in some situations, particularly if done for significant compensation. However, the House version, according to the Congressional Research summary, “Defines "covered person" as a person who regularly gathers, photographs, records, writes, edits, reports, or publishes information concerning matters of public interest for dissemination to the public for a substantial portion of the person's livelihood or substantial financial gain, including a supervisor, employer, parent, subsidiary, or affiliate of such a person. Excludes from that definition foreign powers and their agents and certain terrorist organizations and individuals.” Typically, law enforcement will want or need information from private individuals who happen to discover a (previously undetected) crime in process when doing research for personal blogs or self-published books, so that kind of situation could present an interesting question.

Health insurance "rescissions" provoke controversy over anti-selection and "cherry picking"

Karl Vick has an important article Tuesday morning Sept. 8 in the Washington Post about the pre-existing condition problem with health insurance, “When your insurer says you’re no longer covered; firms defend ‘rescissions’ as fraud control”, link here.

Probably the most disturbing detail in this story is that some health insurers, including supposedly “not-for-profit” Blue Shield plans (whom I thought were supposed to take everybody) deny claims and cancel policies based on the idea that a patient didn’t voluntarily disclose some kind of minor problem. Is this legitimate prevention of anti-selection? Is it cherry picking? Reportedly, some of these insurers (for profit or not) reward employees for finding and denying such "anti-selected" claims, as pointed out in Michael Moore's Lionsgate film "Sicko".

Probably, the insurance industry will say, if no one else can cherry pick, we won’t. It’s about “level playing fields” and equal places in line.

Imagine how this paradigm would play out in other areas, including property (homweowner's, renter's and landlord's) insurance, and even media perils insurance

The Childlessness Debate

The childlessness debate (aka Philip Longman and his social contract and “empty cradle”) is imputed by a couple of columns in the Washington Times Sunday Read today (Sept. 6). The main entry appears on p 14, by Cheryl Wetzstein, “Generation X’s rough childhood”, link here

She talks about a trend that started perhaps in the late 60s, a “societywide hostility toward children”, with the “Stop at One” and “None Is Fun” slogans. There would follow the simple things like “adult living” garden apartments, and a gradual mentality that marrying and having kids was entirely an optional, private choice outside the prevue of others.

In the post 9/11 world, that has swung back, ironically, in some part, because of the Internet and social networking, and partly because the media has made the uncontrollable problems of some families so evident (as in the health care debate). Add to this the eldercare issue: as there are fewer children and elders living much longer, sometimes in disability, people will not get out of taking care of others.

On p. 17, Roland C. Warren has his column, “Interruptions part of being a father”. He says at one point “… what makes you a dad is that you have kids. Otherwise you’re just a guy.” He’s accidentally quote a critical line from the black-and-white indie film “In Search of a Midnight Kiss”. But that at least means that I’m just a guy, a gay guy. “Conservative writer” George Gilder, author of “Men and Marriage” in the 1980s, once said, “intercourse remorselessly sets the limits of androgyny.” The trouble with all this thinking is that once people have to be “numbered” or “measured”, by logic I now become a second class citizen.

I had an email exchange with Wetzstein a few months back, and she wrote to me "Reproduction rules, but what changes is the "rules of engagement"; the latter phrase would become a major label on my main blog.

Update: Tuesday, Sept. 8

Wetzstein has a similar column (title: "Better Ways to Boost Families") today on the Culture Page, A16, of The Washington Times, and starts out with a discussion of the "welfare cap", and moves to the broader "values" problem of hyper-individualism v. the family. She mentions the 2007 book "The Natural Family: A Manifesto", by Allan Carlson and Paul Mero, with website here -- and right now the free PDF download gets an Internal Server error. (You can read the summary, and you can order used from Amazon). I guess any book with the title "Manifesto" raises a red flag with some people. She also mentions the remarks of University of Tennessee history professor Wilfred McClay, who scorns "widespread elective childlessness" and writes "It is only within the family's deep web of duties and obligations that our achievements can matter and that our freedom can be authentic." Those duties don't necessarily wait for one's own sexual intercourse. The McClay "endorsement" review link is here. McClay is critical of "vocationalism" as if to say something like this: Maybe Works without faith is dead, but Works without a specific "family" to support is also a dead end (or comes from a "dead wire"). I'm not one of the conjugal, connected beings that the Manifesto talks about.

Of course, that puts people like me, who didn't compete very well with others of my gender for reproductive legacy, in a position of having one's commitments and duties assigned by others. Station in life ultimately matters.

By the way, I see also that Mr. Carlson is author of "Family Questions: Reflections on the American Social Crisis" New Brunswick, N.J./Oxford UK: Transactions Books, 1988. In that book, Carlson spoke of the "family wage" as an antidote to the "logical consequences of radical individualism."

Judge orders girl out of home schooling into public schools, apparently over parents' religious rigidity

Julia Dunn has a provocative story in the September 4, 2009 front page Washington Times, “Christian girl ordered to attend public school; home-schooling mom’s religious views ripped by N.H. judge,” link here.

A judge in New Hampshire found that the ten-year old had “not had the opportunity to seriously consider any other point of view”, according to district court Judge Lucinda V. Sadler.

There have been other recent cases where the courts intervened in situations where parents relied on prayer instead of medical intervention. An Oregon couple was acquitted for the death of a girl from pneumonia, but in Minnesota courts ordered chemotherapy for a teenage boy after a relapse of Hodgkin’s disease.

Obama's planned high school speech (in Arlington VA) creates a stir

President Barack Obama will speak at Wakefield High School Tuesday September 8, according to a WUSA story. According to the Arlington Public Schools website, that’s the first day of classes. Presumably it will be widely televised on cable, including the APS station (which actually shows some AP classes).

There was a lot of flack about "lesson plans" (a favorite teachers' buzzword) that make kids write a letter about what they can “do for the president”, a wording that sounds inappropriate. The White House changed it to something like, what can you do for your own education. The president’s blog entry (and video) announcing the event is here.

Melinda Hennenbereger has a Politics Daily ("Woman Up') article “Protecting Our Kids from Obama’s Subversive ‘Eat Your Peas’ Message”, link here. Maybe it’s more like “eat your vegetables” (including broccoli, which the first President Bush doesn’t like). A lot of pundits accuse the president of indoctrinating high school kids with a “socialist” ideology on policy issues like health insurance (and the “dp’s). Those Republicans have carried their rhetoric to silly extremes, but so was the initial choice of words silly.

This whole thing makes me wish I were still substitute teaching. I have subbed at Wakefield. This high school, in South Arlington, has not yet gotten the renovations that Waahington-Lee (completely rebuilt as new; I graduated from it in 1961!) and Yorktown (established 1960, with a recent new academic building) have.

Tax law may be more favorable to "accidental landlords" than it used to be

The CBS Early Show today (Thursday Sept. 3) featured an interview with financial planner Ray Martin on the arguments for renting out a house that you can’t sell in a depressed market if you have to move elsewhere to get a job.

Although rental income is taxable, you can deduct mortgage interest, property taxes, and some other expenses related to the property. Furthermore – and this sounds new – if your AGI is less than $150000 you can take up to $25000 of loss against other income.

You should also convert your property insurance from a conventional homeowner's policy to a landlord's policy.

I rented a property in Dallas from 1988-1991, and I don’t think the last rule was in effect then. I remember a lot of talk about “passive losses” that had been shut out by the Tax Reform Act of 1986, which conservatives called a “public policy blunder” (particularly in Texas, which took a rolling real estate recession in the late 1980s and early 1990s due to the savings and loan crisis and lower oil prices).

The URL for the CBS video is here (no embed code was offered).

Jury duty during a recession

John Schwartz has an interesting story on the front page of the September 2 New York Times, “Call to Jury Duty Is Striking a New Fear: Financial Ruin”, with this link.

With some examples from Florida, Schwartz gives examples of jurors burdened by the expense of going to the duty, and others by missed work opportunities. Less clear is the burden of potential childcare or even eldercare expenses being outsources.

States are hard pressed to raise the meager juror pay for the value of the work they do, which in some states or in federal cases can run for weeks or months.

Texas had a good system of “one day or one trial” that other states should emulate. I was called four times in nine years of living in Dallas, and picked for two juries, and a foreman of one, a weapons case. Curiously, I had gotten familiar with the Dallas courts by visiting some trials of gay men nabbed in “police harassment” raids of gay bars around 1979 or 1980 (they stopped after one man won acquittal, but in a bench trial).

An important issue is juror sequestration from media sources. Another would be whether it is OK to blog about a trial, at least after it’s over (since jurors are often interviewed by the legitimate media after important or sensational trials).

For some people, jury duty could be a short term opportunity. It is "a job" after all, of sorts.

Here are a couple examples of blog entries about the experience; s ahort one or try this one.