I’m not as enthralled with the Halo games as a lot of gamers are. They’re perfectly fine games, but not so much so that they deserve the accolades that they seem to get from a lot of people. So, I had planned to pass on Halo 3: ODST. I’ve played plenty of Halo, and didn’t really see the need for more Halo 3. I know you’re playing as a different character and that’s supposed to mean different dynamics, but when I’m hiding behind a car waiting for my stamina to come back, I can’t help having a sense of déjà vu. I mean, is it really that different from hiding behind a rock waiting for my shields to come back?

So, I hadn’t planned to buy Halo 3: ODST. Until I heard that Nathan Fillion, Alan Tudyk, and Adam Baldwin had done voices for the show. Since I’m highly unlikely to ever actually get a Firefly game, this might be as good as it gets. Until Bungie wants to make a prequel game about the war of Independence game, anyway. (Sure, we’d already know the outcome, but that’s the point of Halo: Reach, too, isn’t it?)

…that Mac should fall under “user friendly.”

In my experience, the Mac OS was relatively easy to use for extremely basic stuff. There was also some graphic and video editing software that seemed pretty cool, but that’s not the same as the OS. If I wanted to do anything beyond internet and e-mail, I found myself cursing at the computer more often than not, because it simply wouldn’t let me do what I wanted to do. Of course, that probably stretches under the “customizable” banner from which Mac OS is excluded.

The utter contempt with which Apple treats its customers (to the point of making it nearly impossible for my sister to get a replacement power cord after she lost it in a move) makes it absolutely perfect for the demographic that uses it more than any other – liberals who’d rather have their lives dictated to them by a higher power (as long as it’s the government and not God) and who don’t want to ever make any decisions or take responsibility for defending themselves.

I was out of town for the wedding of one of my wife’s college friends, and missed the post when it first went up, but Eric (of the oft-linked Classical Values) had an interesting post over the weekend contrasting veterinary care and (human) health care:

The instruments, the drugs, the surgical techniques, sterile hygiene, intravenous lines, and post-operative support, all of these things are basically the same. True, the boy would not be placed in a four by six cage during his stay in the hospital, but a bed in a room is not all that complicated.

What accounts for the huge difference in price? A lot of people say it’s the liability insurance, but is that all there is to it? It’s not as if there’s much difference in the degree of education between an MD and a DVM. (And it’s actually harder to get into vet school than it is to get into med school, so if there’s an issue involving brains, the vets might win.)

It strikes me that there is a giant, overarching difference between veterinary care and regular medical care, and that is that the former is barely regulated by the government, while the latter is so regulated that even now — without socialized health care — many doctors feel as if they spent most of their time being bureaucrats. Is that it? I’m sure my vet kept records for Puff, but I’d be willing to bet they consisted of little more than a couple of paragraphs summarizing the diagnosis, the procedure, and his recovery. And I’d also be willing to bet that for the same procedure on a boy, if all of the records were all printed out they’d be a stack of documents inches thick.

The commenters (and there are a lot of them, thanks to a link from Instapundit) seem to mention three things that they believe contribute to the difference in prices:

• Medical insurance breaking the economic link between supply and demand,
• Willingness to let veterinary patients die if their lives would be substantially worse (or if there’s no ability to pay),
• A much subdued willingness to sue when compared to people’s propensity to sue doctors, and
• No subsidizing of patients who can’t pay (see: “letting patients die”).

Some of these things could be addressed in the (human) medical system, but some of them are politically or ethically distasteful (see: “Death Panels” and “Refusing Treatment To Those Who Can’t Pay”). The post is thought-provoking, I think, and is definitely worth a read.

What if they only did it to pay for college?

Getting ready for work this morning, my wife turned on our combination TV/DVD player to remove the Netflix movie so it could be returned (The movie was I Love You, Man, which is much more her kind of humor than mine, but it wasn’t a bad movie). While the television was on, we saw a brief news story about ongoing FBI investigations into former home”owners”^[a] who stripped everything from their homes when they went into foreclosure.

First, I just want to say that these homeowners are clearly in the wrong. Nothing I’m about to say should be read as me defending them. What they’re doing is selfish, childish and clearly immoral. I’m just not sure what the basis is for making it illegal. This article has the only real justification I’ve found, and it’s pretty questionable, I think:

FBI Special Agent Julie Halferty is part of a FBI mortgage fraud task force now investigating foreclosure homes that have been stripped.

“When you sign the deed to the home, you agree not to devalue the home. Stripping it is devaluing the home and that’s illegal,” said Halferty.

Okay, I’m not a homeowner, but the deed says you can’t devalue the property? How does that work? Is it illegal to remodel your home (which would devalue the property briefly while preparing to increase the value later)? My guess would be that these people purchased homes in developments with Home Owners Associations, or that Special Agent Halferty misspoke, and the rules about not devaluing the homes is in the terms of the bank loan rather than the deed^[b].

Either way, I accept that the FBI’s involvement probably means there’s some facet of the law that actually does make this sort of behavior illegal^[c]. But… should it be illegal?

I can understand it if it’s in the bank’s loan contract; these are secured loans, and they need some reassurance that the people living in the home won’t deliberately devalue it. The Home Owner’s Association’s interest is understandable as well (though I abhor HOAs and absolutely will not, ever purchase a home that falls under the rule of the petty tyranny of HOA busybodies). Still, I can’t help but think that this sort of “law” is questionable.

What if a homeowner was in the middle of remodelling, lost his job, and was then foreclosed on? He wasn’t intentionally stripping the house, but he’s broken the law. What if a homeowner discovered that the cabinets that were installed contained a nasty chemical that could potentially leach out of the cabinet material and poison his family, and the unexpected cost of clearing out the cabinets pushed him into foreclosure? These hypothetical men have done the exact same thing as our lawbreakers, and I can’t argue that they’ve done anything wrong. What if the cabinets were removed and sold to try to make the payments?

In this case, where the exact same behavior is treated differently only because of what’s going on in the individual’s mind, it seems like there’s no real way for us to prove whether a crime has been committed or not. I can’t come up with any other situation where that would be the case (murder vs. a killing in self defense isn’t the same thing, as there’s more going on than just what’s running through one’s mind).

One last comment that’s not really related to the main point of this post – the second article I linked also mentioned that only people who have the cash can buy these homes, because they’re not eligible for traditional financing… but aren’t the homes owned by a bank at this point? Can’t the bank make some sort of special deal?

1. I’m going to leave those quotes out from here on out, but you don’t own anything that has a lien against it, and the fact that foreclosures are even possible prove that. Of course, I’d make the same argument about ongoing government rent property taxes, though, so what do I know? [↩]
2. There’s an interesting side point here, I think; what if one of the homeowners’ neighbors was a bank loan officer, and it could be proven that he helped these people get the loan for a house they really couldn’t afford (Alternate scenario – he’s a politician who voted for requiring banks to make riskier loans in the interest of helping the “underprivileged,” which helped him win votes from the aforementioned “underprivileged”). Is he then responsible for devaluing his own house (as the article mentions, the devaluing of a neighbor’s house hurts the value of one’s own home)? [↩]
3. I’m really curious about what makes it an FBI case, though. Either a contract or a local deed was violated; neither of which seems like it should involve the Federal Bureau of Investigation. Maybe some kind of Commerce Clause invokement based on large banks that also have offices out of state? It seems like a stretch, but that’s the best I can come up with. [↩]

No Straw Men Here

I acknowledge there’s a problem: health care costs too much. I explained yesterday one of the major reasons I don’t like the idea of the government becoming too involved in health care (there are others, but I’m not going to get into those right now). President Obama likes to have television appearances where he says his critics “want to do nothing,” when the only statement he could legitimately make in most cases is that his critics just don’t want to do what he’s proposing.

Still, I don’t want to play the role of one of The President’s (Straw) Men, so here’s my four-part proposal for reforming the health care system.

Part 1: Malpractice Tort Reform

One reason for high prices for the consumer is high prices for the provider. Therefore, one of the reasons our health care costs so much today is the cost of malpractice insurance. The reason malpractice insurance costs so much is that we, as a society, will sue over anything, and we treat these lawsuits as though we’ve won the lottery. Uncle Joe died because the doctor screwed up? Great! Let’s get a lawyer.

Look, unless you were personally dependent on Uncle Joe, then there’s no reason you should get money because of his death. Even if you were, the argument could be made that Uncle Joe should’ve had his dependents in mind during his life and made arrangements (e.g., life insurance) for them in the event of his death.

Maybe you are Uncle Joe, and instead of being killed, you were injured in a way that makes you unable to work at the job you’ve spent your whole life doing. Okay, yeah, if the doctor was really guilty of malpractice, this situation would probably involve some kind of compensation, but not extravagantly so. Enough money to pay for medical services (physical or mental; I’m not arguing that this sort of thing doesn’t take a mental and emotional toll, too.) that you’ll need as a result of the malpractice, and enough money to get you by while you train for a new job that you are able to handle. Nothing more.

If the doctor is grossly negligent, he should have his license revoked and, if criminally negligent, maybe he pay a fine or even go to jail, but those things are to be decided by the appropriate authorities. It is not the place of the civil court system to punish these sorts of things by simply giving more money to the victim.

Reducing these malpractice costs would enable doctors to lower their own prices (and would possibly bring back that dying breed, the family doctor, which is the reason why I gave this post the title I did.)

Part 2: Get More Doctors^[a]

Another reason for high prices can be a confluence of high demand and low supply. Everyone needs health care, at least at some point in their lives. That generates a lot of demand. We keep the number of doctors artificially low, though. How many medical schools in the nation can’t get enough students? How many turn perfectly qualified students away every single year because they just don’t have enough room for them? My understanding is that the former number is much lower than the latter.

I’m not advocating reducing the standards; if these students are all being turned away because they really couldn’t cut it, that’s fine. If they’re being turned away because there aren’t enough slots for them, then we need to increase the size of our medical schools or build more medical schools. There’s some argument that the reason the number of doctors is so low is that the costs of becoming a doctor are so high (which, in turn, adds to the high costs of health care). More medical schools competing for student dollars equals lower costs for students, therefore lower debts for new doctors, and lower costs for patients.

I also don’t really have much of a problem with subsidizing the costs of new doctors, especially if we require them to work in more rural areas for a few years (I know there are, or at least were, some programs to do something like this) or see a certain number of pro bono patients per week. You subsidize things you want more of, and more doctors is a good thing (assuming they’re qualified – see the first sentence of the last paragraph).

That might lead to some doctors who care more about the money to leave the profession, but I don’t think being a doctor is something that people stick with if they’re only interested in money.

Part 3: Insurance Reforms

If we can suceed in lowering some medical costs, that would help with the cost of medical insurance, but maybe there’s something else we can do there, as well. Two major problems with the cost of insurance are, I think, moral hazards (individuals take more risks because they have insurance than they would take otherwise, not necessarily consciously) and adverse selection (individuals who know they’re likely to have higher medical costs are more likely to buy insurance than individuals whose only medical costs, barring accidents, are likely to be routine check-ups).

Better minds than mine have tried to tackle these things, but I suspect that the lack of a solution is not because there’s no feasible way to do it, but that theres no politically feasible way to pull it off. I’m fortunately not a politician, so I don’t really have to worry much about political feasibility. Still, I think there are ways to do this that aren’t impossible.

The best way of combatting a moral hazard that I can think of is to offer deductions for safe behavior. This is actually similar to what I fear the government would do if it takes over healthcare (making behaviors illegal, generating fines, simply because the behaviors are unhealthy), but the difference is that one could simply choose not to have insurance, or at least not with this particular company. Possibly a track record of not having unexpected issues could lower premiums over time? ^[b] Automobile insurance companies already do this sort of thing; I don’t see any reason why health insurance companies couldn’t.

The key, though, is not to allow people to be come too isolated from the costs of health care. Behaviors which increase costs will then increase premiums. Isolation from the costs of our health care is one of the reasons why the market doesn’t seem to work well in health care (the fact that it’s a need rather than a want, and the fact that the market is heavily skewed by government influence are also contributing factors).

As for adverse selection, part of me wants to suggest requiring at least some kind of medical insurance for everyone. Maybe we could require at least an “emergency” policy, one that doesn’t cover routine check-ups or minor illnesses, but does pay out in case of serious illness or injury? I’m thinking of the car insurance model again there, too.

The larger part of me, though, screams that mandating medical insurance is a violation of an individual’s right to choose whether or not he carries insurance (and mandating insurance coverage that then puts into place discounts intended to influence behavior gets us back into sketchy Big Brother territory). Instead, maybe the government could use a lighter hand to encourage individuals to purchase insurance; instead of a tax deduction, maybe a tax credit, worth the same amount as a tax deduction at the highest marginal tax rate?

That is, if the highest marginal tax rate is 50%, then you have 50% of your health insurance premium credited to your taxes. If you’re already in that tax bracket, this has the same effect as a tax deduction (if I understand how the tax code works), but if you’re in a lower bracket, it’s a much better deal. Say you’re at the 25% marginal tax bracket. You pay $1200 a year for health insurance. A tax deduction for this amount would earn you $300, but the tax credit instead gives you $600.

Alternately, instead of giving it as a tax credit, put that much money into an account that the individual can access to pay for medical bills. Kind of like a persistent Flexible Spending account, except I’d remove the over-the-counter medications (since the major reason they were added, as I understand it, was to offset the issues with the FSA end-of-year expiration). I’d also want to allow part of that money to be invested (say, up to 50%). The money in this account and any growth it may have would be completely tax free.

The investment part of that would be especially appealing to younger individuals if they were well educated about it. They have time to allow compound interest to help them considerably by the time they’re likely to need large sums of cash for medical bills, after all.

Finally, the funds in these Medical Spending Accounts cannot be accessed for anything besides medical expenses and funeral costs at death, but they can be transferred. Say that an individual dies^[c] in a sudden accident after a long and healthy life. There is $185,000 in his MSA, which he designates in his will to be split evenly among his children. Or among his neighbor’s children, if he’s close to them and he wants to be generous. Or to some stranger he’s never met before. Perhaps the money could even be transferred into a charitable fund designed to pay for healthcare for individuals who can’t afford it…

I’m still not entirely comfortable with the tax credit or the Medical Spending Account, but either is a much lighter touch from the Government, and would certainly encourage those who can afford to get coverage (or better coverage than they have now) to do so.

Part 4: Ensure Payment

I’m not honestly sure how this one would work. Part of the additional cost we find is the number of people who receive medical treatment but never pay. I’d give hospitals a little more leverage in going after medical bills (maybe not letting medical bills be discharged by bankruptcy, possibly dependent on income and ability to pay?), and try to encourage private charities that help pay medical bills that are overwhelming for the debtor?

There definitely needs to be some way to discourage the amount of people who simply default on their medical bills, but I’m not completely certain on how to do that.

So, in summary, my plan is to:

1. Limit malpractice awards to actual damage and rehab (or re-education) costs. No vague “mental suffering” payouts. Severely limit malpractice payouts in case of death.
2. Train more doctors. Increasing supply should put a downward pressure on prices.
3. Reform Insurance. Offer more freedom for different types of plans for different needs. Encourage more people to become insured. Ideally, limit individuals’ isolation from the cost of their healthcare.
4. Ensure Payment. Getting medical treatment and not paying for it at all is known as stealing. Work with private charities to help those who really can’t pay, but keep those who can from simply ignoring the debt until they get overwhelmed and file for bankruptcy.

There’s my plan in a nutshell, and each step could be implemented separately and see some improvements on the current system (no irreducible complexity here). I’m sure that there are aspects of this I haven’t considered, and that there are huge flaws in this plan, but it is a plan, one that really should provide at least some relief without burdening American citizens with an even stronger governmental presence in our lives.

1. I say “Get More Doctors”, but this applies, to some extent, to all medical professionals. [↩]
2. Understandably, one can’t predict when one will get sick, but there are behaviors (e.g., washing hands after using the restroom and before eating) that would increase health and, therefore, lower premiums. Similarly, every accident can’t be avoided, but careful behaviors would help, at least. [↩]
3. I’m half tempted to say the money should be transferrable at any time to any one, but that raises some issues with the possibility of someone selling their MSA cash. I’m not entirely opposed to the idea, but I would think that’d get politically hairy, especially if the individual in question sold, say, $15,000 of MSA cash for $5,000 of “real” cash in order to pay off a debt or buy a pool or something frivolous of that nature. A medical emergency could then pop up and we’d have an Esau’s birthright sort of situation that’d be huge fodder for political opponents. Maybe such transfers should be restricted to immediate (or close circle) family members… It needs more thought. [↩]