It's all about healthcare. Well, and signaling.

This afternoon I was sitting in the third row, right behind the woman who placed the winning bid -- $13,000 -- on the auction of Harry Potter's bow tie. Well, of J. Pierpont Finch's bow tie, Finch being the lead character of How to Succeed in Business Without Really Trying; Finch is played by Daniel Radcliffe, a talented young actor/singer/dancer (well, a bit weaker as a dancer, I thought, but I'm no judge) who will probably be plagued for the rest of his life by people who can't help but think of him as Harry Potter. And he and his co-star were trying to raise money for a Good Cause, namely healthcare, after the performance. (Okay, a specific healthcare cause, but I'm still fussing about healthcare in general.) So....

So I would call the winning bid rather impressive; I think most people would. Radcliffe commented that we were "well over the record", some time before the auction closed---I presume he does this with a fresh bow tie for each performance. But I couldn't help but be reminded of the cost of my own appendectomy, not quite a year ago: it was in fact a little over the bow tie's price. Consider what that audience pays for healthcare each year...the auction was a Good Thing to Do, an Exercise in Nobility, a demonstration of the Brotherhood of Man (that being the last song&dance) but as a contribution to healthcare it was a teaspoonful in a lake.

Yes, I understand that's not the point. It's not really about healthcare, even healthcare is not really about healthcare. Robin Hanson put it rather well, some time ago, in his argument that it's about Showing That You Care:

I can explain these puzzles moderately well by assuming that humans evolved deep medical habits long ago in an environment where people gained higher status by having more allies, honestly cared about those who remained allies, were unsure ... These ancient habits would induce modern humans to treat medical care as a way to show that you care. Medical care provided by our allies would reassure us of their concern, and allies would want you and other allies to see that they had pay enough to distinguish themselves from posers who didn’t care as much as they.

That makes sense to me as the beginning of a model, and it certainly isn't a criticism of the woman who paid so much for the bow tie. She evidently does care, and presumably cares that it's evident that she cares, and that's a good thing.

Nonetheless, if you want to use healthcare provision to show you care, I think it would be a good idea to spend some time looking for actual ways to provide actual healthcare; a few more teaspoons of water in the lake won't do it. So I'd like to go back over my proposal of a bit more than a year ago. I'd organize it a bit differently now, but I don't seem to have moved all that far.

If I were (heaven forfend) In Charge, I would crowd-source as much as possible of the decision-making by pushing it into a market, with participants being given as much data for decision-making as possible, and being simultaneously milked for as much data as possible. I want incentives for innovation, to reduce the death-rate for billions yet unborn; I also want incentives for good performance now, not for the sort of regulatory capture our current system maximizes. Specifically I would:

1. Allow unlicensed health care, wherever it's clearly labeled as such; it won't get public support but people can choose to spend their money on it. The argument against this is apparently that people will make bad choices. Yeah, some will, probably including me and you. So? I've never understood the way some people believe that they (or those they select) can make good choices for others; in fact I'm moderately cynical about licensure requirements as they are now structured, whether for medics or morticians or cosmetologists.
2. Require transparent pricing, uniform no-bargaining pricing, from all providers of licensed health care. (The services producing my appendectomy really don't do this.)
3. Require that "licensing" be independent of geography; if the best/cheapest supplier of a particular treatment is two states over or on another continent, that's fine. As I've said before, I believe that telepresence medicine can enable the specialization and trade that has made markets work in other contexts since before Adam Smith wrote about it, so I expect this as the usual case, not an exception.
4. Take away the employer-based tax exemption; health care shouldn't be an employment issue.
5. Add a universal tax-funded "insurance" policy (insulation, actually): if your expenditures for "proven procedures" from licensed health care providers exceed the overall 16% (of GDP) average, then the taxpayers contribute some. Maybe if your cost is 30% of your income, then the taxpayers kick in (30-16)/2=7%, half of the overage, and the maximum you can pay is 50% of your income whether that's $0/year or $10M/year. Is that too generous? Not enough? I dunno. The point is to combine protection from catastrophe (but not from serious pain) with making sure that market prices are set by people or groups who are actually bargaining in that market, i.e. the better-off people for whom procedure X will not be covered. I want to do that combination with some simple, less-than-perfect-but-better-than-nothing rule with which I can trust a government. (Democrats and Republicans trust government on different things; just figure you want a better-than-nothing rule with which you'd trust a politician of the party you despise.)
6. If you want "unproven procedures" and you can pay for them, that's fine too; the licensed health care providers should have a strong motive to come up with new stuff and document/publish that it works. The FDA should not be able to keep you from paying for these likely-to-fail treatments, but it should keep you from charging it to the rest of us. If procedure X has no accepted studies supporting it, then it's up to you to pay for it.
7. Whatever additional insurance/insulation you want to buy for proven or unproven procedures is just fine, and can be bought across state lines. It's your problem. You want to save your money in a special bank account? Feel free.
8. Any care that has been paid or partly paid by public funds goes into an anonymized public database, so that we learn more about which treatments have what effects on which conditions. Organizations promoting not-yet-approved treatments will be encouraged to contribute data.

And that's really it, for me. I'm even less confident of this than I was when I wrote the first version, but I still don't see anything else I like as well. I think that the market I'm describing would probably evolve rather quickly into a market in which people choose and buy packaged health plans from "insurance" agents, and web sites build up crowd-sourced ratings of those health plans; there would be quite a bit of overlap with the better parts of what we have now. I hope. And I care, and I suppose I'd like to signal that I care.

Or then again, maybe not.

update:I never actually mentioned that this post was prompted by thinking about Mark Thoma's Economist's View: Discussion Question: How Can We Reduce the Growth of Health Care Costs?

there is far too much discussion of cutting services, and not enough about how to control costs without affecting services (e.g., using the government's purchasing power to reduce the amount the government pays for drugs, reducing the cost of insurance companies fighting over who pays bills, etc.)

You see, I doubt the premise: if you use government power as I believe Thoma wants, you are increasing the incentives for regulatory capture, crony capitalism, rent-seeking... you are putting yourself on a path where you have signaled your concern but healthcare is not what you're rewarding. Of course government power needs to be used -- to collect the money for treatments which research results say are crucial and which markets say are expensive. And government power needs to be used to maintain a context for innovation (rather than squelch it, as I believe our recent trends in "intellectual property" law tend to do.) But if bargaining-on-prices-with-the-government is the multi-billion$ activity you focus on, then that's what companies will have to invest in. That's a bad bad bad bad thing. I commented here.

Well, it's Easter morning. Maybe we're all saved?

Or then again, maybe not.

Colgate v. Consolidation -- maybe. For now.

At last night's budget meeting, Superintendent Bowers had very good news to announce. As Radio Free Hamilton put it, Colgate Contributes $300,000 More to HCS

HCS is able to restore the equivalent of 3.5 teaching positions scheduled to be cut from the 2011-2012 budget thanks to a $300,000 contribution from Colgate.

The state had planned to cut $486K; a last-minute cut reduction had restored $94K of this; now we're back within $92K of last year's situation, except that various expenses have risen. But the immediate layoffs of teachers are deferred. Yay!

RFH continues

Colgate's donation, which will be followed by a similar one next year, was announced at the HCS Board of Education budget presentation Tuesday night. Superintendent Dr. Diana Bowers said Colgate is willing to make two more similar donations in the future depending on need and the outcome of a potential merger with Morrisville-Eaton Central School.

Actually I'm not sure she mentioned M-E by name, but the point was clear; Colgate's extra support is not forever, but might continue for two more years, unless the Hamilton district had become part of a larger district "funded in a different way." Colgate has an interest in supporting HCS as the kind of school it now is.

This doesn't take consolidation off the table, even in the short run; it does provide a substantial incentive counter-balancing the state pro-consolidation incentive, at least for now. For me as a parent whose youngest child is an 8th grader, whose grandchildren will almost certainly grow up elsewhere -- gee, I can reasonably hope that takes care of it. Probably. We'll probably muddle through for several years.

For me as a local citizen, one who wants things to go well even for current elementary school students and maybe even for those who haven't been born yet....hmm.... the upstate NY demographic prospects are still what they were. Things that can't go on forever, won't.

Is there an answer? Sure. This local school, like many similar local schools, will not go on as it is -- that's a given. But that doesn't mean that there will be no local school, just that there will be no local school based on the current model of school organization. Personally that thought doesn't bother me, because even without financial pressures I would expect the current model of schools to change. It's really not a great model; it's a 19th-century factory model, as stretched in various directions by good people trying to work inside that model.

If I were trying to get a community school model that would last for a while, I'd try to follow the people in this region and others that I talked about in Budgets, Consolidations, Charters. A charter school might work better against consolidation pressure; might be better able to adopt the sort of technology that would help it work at a smaller scale. I'd like to know what my neighbors would think about that. Of course most of the ones I know are parents of 8th-graders, or older -- maybe they'll settle for a solution that will last a few years. “Après moi, le déluge.”

Or then again, maybe not.

Exercise and Education

This morning I spent 45 minutes trying to pound a few modern Greek words and phrases into an aging memory; until a month ago, this would have required a major effort of willpower, but lately I've been doing it every day with no problem. Also this morning, I did almost 5 miles of gently uphill jogging against random resistance on an elliptical machine, a Life Fitness X5i; up until a month ago, this would have required a completely impractical effort of will. No problem, because I now do them together. As Seth Roberts put it a year ago, Boring + Boring = Pleasant!?:

Two boring activities, done together, became pleasant. Anki [flashcards] alone I can do maybe ten minutes. Treadmill alone I can do only a few minutes before I want to stop. In both cases I’d have to be pushed to do it at all. Yet the combination I want to do; 60 minutes feels like a good length of time.

I'm a lot slower at memorizing than I was forty years ago, but this is good. It's funny to think how close I was to finding this for myself; I have tried music while exercising, watching TED talks while exercising, even memorizing verse while exercising. I think the crucial missing factor was total focus-in-the-moment, as required by flashcards or the Dover Books Listen & Learn Modern Greek (CD Edition) which is basically a booklet of flashcard-style utterances, English+Greek+phonetic, to be read along with the audio. (I photocopied the booklet with 41% enlargement.)

I do wonder how many people this would help. I look at related discussions like What is the best and fastest way to memorize a lot of material for a test? and of course Seth Roberts' later posts at Walking and Learning Update and at Walking Creates A Thirst For Dry Knowledge and gee, I dunno. Learning is good; exercise is good; making both easier is a very good thing.

Self-experimentation, dental care, health-care policy

As I mentioned in a self-experimentation post, I've been following Seth Robert's recommendation of flaxseed oil for calorie management (because the diet was so strange, but explained so plausibly, that I wanted to try it despite not being actually overweight, and I did lose weight) and I was interested in his series of gum inflammation (and other omega-3 factors) posts. I don't have a major problem there either, but I have had a problem in the past -- a root canal thirty years ago which had to be redone, with gum surgery, fifteen years ago, leaving a plastic-on-gold-on-tungsten implant. It kept getting moderately inflamed, then less, then more; a common discussion topic after tooth-cleaning. Lately it hasn't been a problem; today I was very conscious that there just wasn't a problem. And my eldest son, who has had a problem, recently wrote that his "one gum, which was the only one that bled regularly with flossing, has almost completely stopped. i don't know if it's the flaxseed oil, but it sure could be. the big test will be the next dentist appt...".

Systematic self-experimentation does not appeal to me; I'm just not sufficiently obsessive about data collection. But I'm very glad there are people like Seth Roberts in the universe, and I'm hoping that improved technology will gradually increase their number and effectiveness. If I were In Charge, there would be basic health-care vouchers for everyone, and expanded vouchers for everyone willing to sign up for data-collection services, and big cash prizes for donations of patents (to an open-innovation patent protection fund) to make that collection easier. I would like to have lots of us live long enough to outlive the whole idea of "aging".