Be Here Now

Posted on October 24, 2011 by Sci Fi Engineer

How did we get here? Why is this happening now?

The Here and Now is a phonograph needle tracking the wobbles in the groove that all our yesterdays laid down.

Is there a way out?

There is only foreward there is no going back.

There is a Destiny which has the control of our actions, not to be resisted by the strongest efforts of Human Nature. (From)

GEORGE WASHINGTON, letter to Mrs. George William Fairfax, Sep. 12, 1758

Not sure I agree at an individual level all the time, but on the aggregate in the immediate time frame I would. Perhaps its like this: Science tells me that most of my actions are planned a significant fraction of a second ahead of my consciousness recognizing what is going on. It is impossible to change what you do not know is coming but if you plan ahead you can control what happens at a future point in time and space.

And what we do individually and locally does matter nationally and globally, at least a little and if not now then sometime in the future.

Does that mean I demand “Word Gov’t Now!” how stupid do you think I am?

We need more self-control, personal control, local control and less regional control, national control and global control. We do need norms and some way of enforcing them for such things as : life, liberty and the pursuit of happiness, and such easily debased things as contract enforcement, property rights, ecological cost accounting, financial cost accounting…a few others…maybe

But….the old bureaucratic model, relying on a plethora of relatively well paid trustworthy functionaries to enforce norms is becoming unaffordable.

Laissez-Faire – let it be – management doesn’t work, it doesn’t work in regulation either.

Why has the US Constitution remained important for more than 200 years? Because its simple, basic, lays out fundamentals and leaves the rest for interpretation but by being fairly simple, constrained and pragmatic it is actually possible to interpret it to cover very large sets of cases.

We have to get over the belief that you can make life perfect if you can just tune your laws/regulations/rules just right and get the humans out-of-the-way. We used to know better, I think that most scholars know better. But somehow many folks have come to believe that if not all, then the one specific law they care about can be perfected, and since they care about it passionately they push it forward, usually through a system that has no time to really understand the consequences of this law when combined with that law and this social reality, etc. And with each law becoming more complex because of fiddling to tune it to perfection, the way they interact becomes utterly unknowable. And the law becomes harder to obey and easier for smart lawyers to subvert.

So….

So where do we go from here?

Start to build down the complexity we have built up at every level, what about:

For every new rule, two old ones have to be eliminated and no double dipping?
Limit the length of any law/rule/regulation to two double-sided 8 1/2 by 11 sheets one inch margins typed in 11 point Times New Roman with the option of an extra sheet of readable graphics?
Eliminate mandatory this, no tolerance that, rules that have become a pox on our society?
Make Judges accountable to other Judges and the Bar with impeachment by the people an option?

You can think of more, I know you can!

Cheers

Move along, nothing original to see here…. but maybe some interesting links..

Posted on October 20, 2011 by Sci Fi Engineer

As Russel Mead at Via Meadia writes to great effect the Great Loon, the Duck of Death is dead.

And here is Russel Mead’s interesting take on protests etc. A very insightful piece that hit home once more regarding something that puzzled me… ” There was a time long ago when political protest really mattered. The Vietnam protests didn’t end the war (and didn’t keep Nixon from carrying 49 states against George McGovern in 1972), but they helped end the draft. The civil rights movement led to some of the most profound social changes this country has ever seen. Before that, there were labor and suffragette marches…” ” But these days the old style protests remind me of political conventions: empty and pointless (though noisy and publicized) rituals. “ And he draws a comparison to the conventions. Once the conventions were important, before mass media and instant communications, but now they are just rituals the politic druidic class still hold. In the old days a mass rally meant something, life for the working class was twice todays and wages closer to subsistence, and brutality was expected of the police, going to a rally meant something. Today it’s not much more than a smelly holiday. Not to say that there aren’t some grievances and suffering…but OWS is more theater than struggle. And then Amity Shales had this to say about what these folks want, vs what they need.

I am never going to be the blog-media-news miner that Instapundit is. Here is the latest on the SLS fiasco from Rand Simberg, the Space Launch System is a works program, yes well paid and aerospace is effective economic multiplier but the money could be spent to so much better effect!

(edits, still not getting all of this right the first time)

“Here’s the problem: there are no grownups. “

Posted on October 18, 2011 by Sci Fi Engineer

I have a new hero! I love this line, maybe it was just a matter of right words at the right time on the right topic but it is perfect. Bob Krum was discussing the euro debt crisis among other things (like stupid questions on ‘presidential debates’) in Stop Waiting for Superman.

There are no grownups; there are just folks (blokes in Brit speak) like us, imperfect humans who are lucky to make a right decision (on issues more complex than whether to turn into the path of that oncoming Mack truck or not) much more than 50% of the time (and we don’t always make the right one regarding the Mack truck.)

What does that mean? Many things but one of them is that overly complex political, financial, social, technical…etc constructs are asking for problems. Stable systems are ones that are essentially self organizing, a pile of sand will settle into the same conical shape every time because its stable in its environment. Small c capitalist, old meaning liberal economies, are self organizing and stable. The euro zone is a complex web of overly constrained systems that like some cartoon Rube Goldberg steam plant is constantly threatening to blow a gasket and it requires a genius just to know where to apply the next tourniquet.

In the last few decades we have made vast strides in understanding ourselves and our world (in a thousand different dimensions.) Then we have often reacted to this increased understanding by thinking we can control more things and implementing more and more rules. The effects of those rules are often individually complex and unintended but the interactions between them is (IMHO) utterly outside of our ability to cope with. Among other things I rather suspect that every one of us (barring a newborn baby maybe) is technically a criminal, having violated at one time or another various laws, rules or regulations most of which we had no idea existed or had no way to follow.

Somehow we have become inured to the regulated world, see it as natural, but it’s probably reached its practical limits and is now in the process of imploding. We have the tools to creat a more self organized – de-bureaucratized world but have not yet quite figured out what it really looks like and how to transition from where we are to where we need to be.

Maybe that’s just wishful thinking….fueld by a frustration at the idiocy that seems to have become institutionalized in so many places. But change ‘is in the air,’ though it may still be some years away. I just hope that the transition can be made relatively peacefully, there are far too many people on this orbiting rock (7Billion!?) for a major disruption to be anything other than catastrophic for far too many.

There is no utopia waiting over the brow of the next hill, and there was never a golden age that we have somehow lost (one man’s golden age was someone elses hell.) We can’t go back to a past that never existed, and refusing to live and work today because the day after tomorrow will be better is foolish and self-destructive. Tomorrow never gets here, let alone the day after, and your vision of the world will never occupy a future today unless you work for it in the today you find yourself in. Live in the now with a vision of where you want to end up.

Why I miss coughing

Posted on October 10, 2011 by Sci Fi Engineer

Flying was something you did very infrequently when I was young. By the time I joined the workforce as a junior civil servant it had become quite common for the engineering set. By the time I left deregulation had made it cheap enough for folks to go places several times a year, even fly to Vegas for the weekend.
Those too young to remember should be assured that flying in ‘the good ole days’ really was a different experience, you have to deal with it in a metal tube at 30,000 ft know how horrid cigarette smoke really is, and I even smoked at the time! But they did really feed you and they gave you the whole damn can unless you didn’t want it. People where polite and seemed happy enough. You didn’t often have a full flight. The xray machine was a formality and you didn’t have to undergo the equivalent of a strip search every other flight just to appease the god of a little more security.
These days the only joy I get are the occasional extra special views out the window. A few months ago flying out of Cleveland between storms, looking into the side of a thunder cell at eyeball level and seeing the strokes of lightning lashing down. Flying out over the hot coal orange symmetry of Chicago at night and seeing it end in the moon silvered black of lake Michigan.
But other than that I might as well be on a inter prison subway train with a politer than average set of inmates.

Sometimes I miss that wheezy after flight cough!

Written from an undisclosed location far from the bosom of my family on my trusty iPad.

Health Care Costs (3)

Posted on October 2, 2011 by Sci Fi Engineer

So to continue: The way I see Health Care has seen a bubble in the US that has grown huge over a very extended period. Most have called this ‘bubble’ Health Care Cost inflation. But a bubble over any period between inception and bursting can be seen as (mistaken for) inflation. Is the HCC “Bubble” going to burst or do we have to just accept this as inflation. I think that too many people want this to be Inflation, not a bubble. And I do not want a ‘bust’ but I do think we need to get on the off ramp, to a price plateau at the very least.

I’ve discussed:

The pernicious effect of opaque pricing
A spike in Cost/Value in capital investment (buildings and equipment.)
The Gov’t affected floor to pricing
The profit motive effect of increasing costs in the system

Now I’ll add some more:

Direct sales…more and more selling of this that or the other service, drug, wonder cure, to the general populace who have no real way of parsing the useful from the useless or even harmful. And then the sales guys got to congress and punditry and started demonizing those who tried to point out that the common man was not really in a position to make medical decisions. (Not that the god-doctors should be put in charge, much as many of them believe that they should be because they are smarter than anyone else.)
Litigation, because medical outcomes are impossible to ensure, and there has been a Lawyer bubble going on for many decades, doctors got sued more and more frequently, malpractice insurance costs went up and so another cost was added into the equation (and for a long time absorbed because the system hid the costs)
Specialization, again 9% of 10,000 is a lot more money than 10% of 5,000, but 15% of 10,000 is even more. Specialist charge at a higher rate because they are specialists and have special skills, that are needed by special cases…..they don’t have to see as many patients, get to go to conferences and consult with other wizards and look down their noses at the rest of the world, even at other doctors. What’s not to like? Just one more cost adsorbed in the system.
Administrative fief building, its a fact of nature, or rather an emergent property of human society: administrations grows more complex and adsorbs more resources as time moves on, as the top level administrators increase the number of ‘direct reports’ then create hierarchies so they don’t have to talk to as many people so they can be ‘more efficient.’ Administrators (Bureaucrats) are extremely good at capturing the system and turning it to serve them versus the customer the system is supposed to serve.

So what is the solution. Well I think you can see the one I would focus on first but that will be a discussion for another day.

Health Care Cost (2)

Posted on September 30, 2011 by Sci Fi Engineer

When I was a kid and even as a younger adult I went to the dentist’s office and other ‘providers’ and the amenities were clean and neat but often I was treated in a ‘ward’ environment. And this was way after I’d left Jolly Olde England and the NHS (National Health Service.) Today most providers I go to the office/clinic space is custom designed often with soothing art, music, video etc. Now don’t get me wrong, Video/Music does help when you’re under the drill (having something probed etc,} and the video screens used for modern digital x-rays or other data reproduction are a boon as well. But why is every ‘provider’ the same. Why did hospitals move away from wards to private or semi private rooms with the concomitant increase in capital and operating costs. Why does my local hospital s soaring almost churchlike multi story lobby floored in granite with overlooking balconies and a Yamaha robo grand piano, and this is not the top end hospital in the region.

It seems to me that what we have seen is a health care bubble, much like the higher eduction bubble (or the overall education system foam,) we’ve seen in the last thirty years….but I digress.

As providers realized that they could attract more lucrative patients by setting up nice offices in nice parts of town the general price of HC (excuse the acronym) went up, in general the expectation in all for pay HC went up while the free clinics crashed.
It’s mathematically obvious that 10% of 5,000 is a lot less than 9% of 10,000 and the cost of consumables etc are usually fully reimbursed by the payee because their price is a published known. So providers made more and more use of high cost consumables of one sort or another, and were not incentivized to keep the costs down even if their ‘profit’ was squeezed a bit.
Medicaid and Medicare have managed to subsidize the lower end of the patient rainbow and pushed up the overall cost by pushing the higher end patients and providers into a different ‘market space.’
Because the actual cost of HC is essentially invisible to the patient the steady spiralling cost was not noted by the high-end clients because they perceived (I think rightly) that they were receiving value for money. BUT as the high-end pulled away the middle dependent ons insurance etc was stretched and the low-end fell away, the old-fashioned cheap equipment / methods / services they had used were rendered obsolete and replaced by the new much higher cost versions.

Add this and other mechanisms together and you have a bubble. One that grew and grew, while people griped, tried to do something about it but failed. For some reason we seem unwilling to change the basic underlying dynamics. Is that because they are so complex and interlaced that people can’t be bothered to go beyond the simplistic. Or do a lot of the bad things have attractive sides that would be lost if we made major changes?

In the current system its impossible to figure out the trade-off between a private room and a ward. Once that wasn’t true or as true. We have the technology to make this problem go away. I believe that with transparent pricing and costs wouldn’t we make different decisions. Maybe not all the time, but maybe enough to break the back of the ridiculous inflation rate we see in health care.

Health Care Costs (1)

Posted on September 29, 2011 by Sci Fi Engineer

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.