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Health Care Costs (1)

I was listening to the Diane Rehm show this morning.  She had a panel discussion on Health Care, Obama Care and Health Care Costs.  They touched on a couple of issues that I find rather under discussed and it struck me as odd after a while that no one really dug in on the topics.

Here is Topic 1…

Why is it that the cost of a procedure or a piece of gear etc, varies according to who is paying?  If you’re lucky enough to be covered by a relatively old fashioned policy like I am you will see on your explanation of benefits that the Doctor, Hospital, Clinic, Dentist…(the provider) charged one price but the insurance agreed to pay another, the provider agreed to that and wrote off some or all of the rest and you paid your deductible plus some additional cost sometimes for one arcane reason or another. 

The Provider and the Insurer have some pre agreed price sheet that you never get to see.  (You never get to see any price sheet that I know of.)  Blue Cross Blue Shield apparently has one price sheet, UHC another, Medicare and Medicaid another, and the uninsured are hammered with the top line rate.  An uninsured person who cannot prove he/she can pay up front is charged a higher rate again, (at least that appears to be the game) and then the hospital hounds the near-victim for some ‘pittance fraction’ that in the end is still probably more than an insurer would have paid.

If there were an industry agreed to list of procedures etc (which has to be effectively in place.) You, a consultant, a doctor w/should be able to tell what services you require and you should be able to look up what those services cost on the web comparing various providers.  There should be various providers offering various prices and various deals, that you can work through and figure out what is the best value solution for you and your family quite quickly.

This way the insurance companies could reduce costs because they no longer have to individually negotiate prices, rebates, write-offs with each set of providers, the providers likewise can reduce costs for the reciprocal reason.

Administration costs are a huge part of the Health Care Expenses these days and to me this seems to be one of the myriad reasons why.

Health Care Costs are rising almost uncontrollably and the lack of a price comparison mechanism seems to me to be a significant issue.

 

The Senatorial Launch System Revealed

Artist concept of SLS on launchpad

Image from NASA of SLS on launch pad

For only $18Billion….and I’m not kidding about the ‘only.’  This is a big budget program on a pitiful credit line.  All the technology development is to happen in the first couple of years of development, before inflation robs the fixed and thus effectively decreasing NASA budget, of its buying power.  The choice of technologies was based on reusing the shuttle solid booster technology, shuttle main engine derivatives and the canceled Constellation’s upper stage engine because they are hydrogen fueled and thus use shuttle Infrastructure.  It will launch either cargo or cargo and the Orion exploration capsule/system into low orbit. 

It’s an impressive beast, it will start with the ability to loft 70 tons into orbit and end with something like 130 tons, significantly more than the Saturn V of Apollo fame.  But the plan is to launch maybe 1 a year, and that will make it terrifically uneconomical.  The intent is to have a booster capable of lifting exploratory craft for Luna and Lagrange Point exploration, with multiple launches it could do a Mars mission. 

In the meantime we are supposedly going to fund the Entrepreneurial Space companies to compete for ISS supply including crew launch and recovery…..

But if we have the ESpace why do we need SLS.  If SLS is going to need to do multi craft build to go further than Luna or the Lpoints why not focus on building up our space infrastructure and refueling capability to support a common set of commercially viable launchers lofting the parts for assembly of the earlier and simpler systems in orbit.  It may seem more expensive at first but in the long run it will become cheaper because the launchers are cheap on a per use basis. 

OK I’m sure they’re promising that SLS will be real cheap per lb to launch because it uses proven technology and it has the advantage of being bigger (bigger is generally more efficient in this game.) But its a Gov’t program w/infrequent launches, using technology that has been chosen to save money up front.  Not a promising Start. 

And it’s quite possible that one of the driving factors in choosing solid booster over pure liquids was to keep the manufacturer in business (I believe there is only one US supplier at this point) Solid fuel rockets are brute simple, on the surface, but brutally complex in detail, and the only other significant market for the stuff is weapons.  With the wind down of the cold war and the use of solids for various boosters the solid rocket industry has hovered on the brink of bankruptcy.  That means the supplier will have the ability to hold NASA over the barrel for providing the boosters. 

So the SLS remains the Senatorial Launch System and a yoke around the neck of our future in space…..Its a pity we didn’t build this system twenty years ago, when it would have had a positive impact….

Laptops and the PC model

The earlier link leads to an interesting article on the PC industry.  The WinTel mass market suppliers have carried the Desktop market model into the Laptop arena and are now reaping the downside.    [This is what the US Car manufacturers did as well, developing too many me-to platforms and then forcing folks to option up singularly unattractive base models of which there were too many as well. ]

The solution is similar to the car industry as well: in the long run there needs to be  an emphasis on base quality and fewer options. (Is it not strange that this is what Apple is doing?)

BUT why not take a step back as well.  Components have gotten smaller and a Laptops frame can only get so small without losing functionality.  All these companies have developed custom interfaces so they can plug in modules for this and that but also standardized the chassis frames so that they can ‘plug in the modules for this and that.’ In other words they should have a platform to move to the Home Build market and let people build their own.  Companies could compete with plastic, aluminum, titanium or bamboo chassis with various levels of cooling sophistication in 17″, 15.6″, 15″, 14″ and tubby 13″.  Keyboard manufacturers could offer various keyboard modules.  You could buy motherboards with a variety of chip solutions .  Graphics solutions.  Phone net solutions.  LCD Panel solutions. Battery solutions.

Now all of this would require the establishment of an interface standard.  IBM did this for the Desktop market almost by accident, but there is no reason that companies like Dell, Asus, Acer, etc could not come together, they build only marginally differentiated systems now, the differentiation mostly based on a ‘keep those rascals out of my hardware’ business model and design history. 

What would this do?  1) Make it cheaper to build ma, pa and baby laptops to be sold in the big box stores. 2) Create a market for high-end technology in moderately tight form factors for a range of suppliers 3) Allow those with the tennies to move into building mainline power user, mainline business and high-end units which I believe will owe more to the MacAir than the ThinkPad or Inspiron of yore.

Link

This is a really neat article on Intel’s Ultrabook initiative.  In other words get other companies to compete against Apples MacAir 11″ and 13″ models.    And he likes the ‘IBM’ keyboard and pointing stick to!

Lethal Fantasy

I happened on this article through a hyperlink chain from Glenn Reynolds, it blew my mind that an article from that timeframe could clearly explain why 9/11 never made any sense to me, at least not after it became clear that it was not part of some greater campaign.

But read it for more that the explanation of why 9/11 was never about war in the normal sense and that treating it as such may have been a mistake. 

Almost more stunning is the explanatory concept it lays out, a concept that provides a powerful too for examine the social dynamics in the world of today. 

Perhaps I am taking it too far but if I start holding it up against a lot of major movements today as an explanatory meme…I get worried.

 Read the article, take the basic concept it explains to view various ‘movements’ , and do it for ones you are for as well as against with intellectual honesty and clear-eyed understanding of your own biases .  

It makes one wonder if we aren’t all living in a matrix of interlocking Fantasies?   Is our civilization driven by something close to magical thinking?  Is this unavoidable?

The Barbarians are at the Gate, but which side?

Aside

Every civilization carries the seeds of its own destruction, and the same cycle shows in them all. The Republic is born, flourishes, decays into plutocracy, and is captured by the shoemaker whom the mercenaries and millionaires make into a king. The people invent their oppressors, and the oppressors serve the function for which they are invented.
– Mark Twain in Eruption
www.twainquotes.com/Civilization.html

OK I’ll Agree its not NASA’s fault they serve Congress…

As always Glenn Reynolds keeps his finger on the pulse, this great article by Rick Tumlinson provides much of the reason for my concern with the current path NASA is on.  While pointing out that it’s not really NASA’s fault.  He also puts forth a much stronger case and view of, the near term piece of my vision.  He touches in more concrete terms the technological items that make a L point observatory and exploratory complex an important stepping stone.   

He explains what the SLS (Space launch System….or as he calls it the Senate Launch system)  is but not so much the FAR and does not address its nearly equally pernicious cousin ITAR.

The FAR is (are) the Federal Acquisition Regulations, an accretion of CYA (cover your ass) and make sure the Guilds and Unions get their cut, rules based on the accretion of laws and executive directives that one could swear must contain fossils from the Civil War, let alone WWII.  The FAR is often refered to in the singular as at the beginning of this sentence, like the monster it is.  Why is the FAR a problem:

  • Because it requires special accounting methods and tools the FAR makes it all but impossible for a company that sells products to the commercial sector also sell to the Gov’t unless it is strictly off the shelf (toilet paper comes to mind for some reason.)  You will notice that many companies, Motorola, Texas Instruments, GE, and many, many others who used to do a lot of Gov’t work no longer do so, they sold off the units that did mostly Gov’t work long ago to companies like Raytheon, L3, DRS even those giants who do both, Boeing is the one example that comes readily to mind, are very special cases.
  • The FAR requires that contracts have things like Small Business Set aside plans (a targeted $ amount that goes to small, women owned, disadvantaged, Indian….etc companies.)
  • The FAR requires that even for a Fixed Price contract you have to open your books to Gov’t auditors and show that you in fact gave the gov’t the lowest possible price and appropriately sent out bids to three vendors for major sub assemblies….this is after you have been chosen as the lowest cost technically compliant supplier and promised on the bankruptcy code that you will deliver the program at the agreed upon cost.
  • The FAR requires that you identify where you get your materials from, heaven help you if you buy certain grades of stainless steel from a vendor who got it from China or any one of a long list of other Congressionally frowned upon countries.
  • If you are working on a Gov’t contract you have to make sure that you pay a living wage and that your suppliers do as well and follow all union rules.  You have to pay overtime, you have to account for hours accurately. 
  • Almost worst of all the FAR makes evolving technology and relationships and dealing with risk and changing circumstances extremely difficult.  All of these things do happen, between Gov’t units that have existed and had a strong mission for decades and large industrial companies with the lawyers and deep pockets to ride through a bad spot, (the Navy Aircraft Carrier and Submarine programs for example.) But its a disaster for small lean companies trying to drive forward a program that  needs to move forward in months not decades or even years and is subject to the caprices of a few Senators and Congresspersons who see NASA as their personal fief.

Individually most of the rules can be explained to a reasonable person (though I am sceptical that they all can be)  the problem is that there are too many with too many special exceptions and special restrictions.  You need specialists who know the FAR, special processes to do the work and special groups to deal with the paperwork, making it extremely expensive to do gov’t work.  So expensive that you almost cannot do commercial work, generally you’re overheads are going to be 30% to 200% more than a pure commercial house, and in some cases more than that upper bound.

Many will argue that FAR just codifies Laws and Ethical Business Practices, the problem is that the R in FAR is regulations, and there are auditors who check on this stuff and they have the full faith and fury of the US Gov’t behind them.   Look at Gibson Guitars problems and this is because of fricking slivers of wood!

There are many excuses for why the FAR is the way it is but to be honest its like it is for the same reason the tax code is like it is, because of special interests and too many attempts to create rules that deal with peculiar and special circumstances that should instead be left to the discretion of a human agent with integrity and oversight. (My daughter tells me that no such creature exists…but note I used the word oversight, that is a process of oversight that can’t be too easily and quickly co-opted.)

Small lean aggressive entrepreneurial shops move forward thinking that their predecessors just weren’t that smart and run into the FARs bureaucratic buzz saw.  The reason that the entrepreneurs have made as much progress as they have is that they have avoided the Gov’t but at some point that is or at least seems impossible, but the new $’s comes from a poisoned chalice and it’s not clear to me that the majority of the inflowing new $’s won’t go to rapidly increasing staff of administrators instead of into bent metal and blazing rocket trails.

Then you have ITAR

ITAR is the International Trade in Arms Regulations, and in many ways though often wrong-headed its at least reasonably logical and only long because it essentially deals with anything that could be used as a weapon….possibly even carving knives and lawn darts for all I know…

What most people I meet don’t understand is that commerce is not a protected right, particularly international commerce.  This has always been the case since the founders assumed that most of the USA’s gov’t revenues would be generated by taxes on imports and exports.  (They were men of their time.  Up to that point in history a large majority of cash gov’t receipts had come from excise duties…which is why smuggling [also called free trading in some times and places, and often associated with Piracy]  has been an issue ever since the first recognizable states evolved…but that’s a great topic for another day.) My point is that for US Citizens exporting is a privilege regulated by the Gov’t not a right…its in the constitution.  And the Gov’t regulates it more than most people realize, especially if one of their buddies in industry get’s a bit bloodied by a foreign competitor.

At one time the US restricted ballistic missile technology and some related technologies related to solid rockets (we had some level of leadership over the soviets in the early days (We should all take our hats of to the soviet submariners who went to sea with liquid fueled ballistic missiles aboard for decades!!) However basic launcher technology was unrestricted…we had Werner Von Braun and the Sov’s had a whole bunch of lower level engineers, and its over the years Russian Liquid Fueled Rocket engines have generally been better as well as cheaper than US ones.  Satellite technology was also seen as commercial and not restricted that much. 

That changed when an US rocket scientist of Chinese heritage was accused of supplying the Chinese with technology.  Then some years later it was found that several US space companies had shipped satellites with supposedly sensitive technology to China for launch on the Long March boosters (developed by the aforementioned rocket scientist, who’d decamped to China.)  The Chinese were beginning to frighten the launch companies in the US with their low price and initially good reliability.  There were too many & too expensive launcher companies in the US and the US (read certain executives and their cronies in congress) reacted by making space technology ITAR, thus making it very difficult for any US company to use cheaper launch services overseas, and for any overseas company to buy satellite technology in the US, they could buy the system here, but not technology or components. 

The result was obvious to anyone with an understanding of the most basic economics.  We propped up the profits of the US space industry for some years, while also providing stimulus for european and asian countries and companies to get into the business, not only for militar or dual-use (commercial products with military applications…such as Earth observation) technology but all technologies.  This also propped up marginally viable space programs in many countries who could now launch their own military platforms. 

All of this would have happened anyway eventually but we did not slow the proliferation by more than a few years and made it more broad-based, we also damaged our own industry

  • Helped price support competitors
  • Stimulated nationalistic me to programs
  • Propped up expensive industrial age companies
  • Continued to fly derivatives of launchers first flown in the fifties 
  • Strangled international coöperation between engineers and scientists

There are now currents to reign in ITAR, its done what it can to slow by a few years the outflow of technology to our enemies while slowing our own development of those same technologies by some amount, at a great cost to the US Taxpayer.

Gov’t and Industry arrogance and short-sightedness (fueled by ignorance of basic economics and history) has cost us a great deal over the last few years.   More stable and long viewed policies would have allowed NASA to do much more with less and would have long ago gotten NASA out of the launcher business, it should was obvious years ago that the ISS was the ideal stimulus for a commercial human and cargo launch industry but Congress just wouldn’t get it…they were to enamored of all those good paying gov’t subsidized jobs…without being able to see the long-term consequences. 

And so back to the article by Rick Tumlinson, maybe we just need to cancel the SLS and exmpt NASA from the FARs as an experiment (and just fire and or jail someone if they cheat, lie, steal, instead of trying to create a new rule)

Cheers

And Best Wishes NASA, you still provide our window on the stars.  I just hope that others will grow up to carry you forward.