Mr. Shiney’s Blog of Goodness

First let’s define out criteria: “successful” means a program which 1) covers all american citizens (and permanent residents), 2) has a sufficiently large risk pool to be sustainable, 3) provides a reasonable level of care without being ridiculously expensive to the taxpayer or citizen who pays the premiums, 4) provides premium assistance to low income citizens, 5) encourages a high standard of care without excessive waste, and 6) lets providers make a profit.

COVERAGE AND PREMIUM COST

All american citizens (and permanent residents) would be covered by the program as long as their premiums are paid. Premium cost would be determined by factors such as age, sex, and occupation. Cost would not be determined by health condition. Premium cost would be increased for non-citizens.
RISK POOL

The risk pool is defined as the people who pay into the program (with premiums) and who may cost the program money (with claims). The risk pool would be all american taxpayers. (People who have a TIN.)

Americans and permanent residents can buy their own insurance, but they pay for the universal insurance regardless. Employers do not get a tax break for providing insurance to their employees. If they do provide it, employees may take it, but they still have to pay their national insurance premiums. That way we have everyone in the risk pool to keep the insurance profitable for the groups funding it.

Permanent residents help lower risk because they pay into the pool from day 1 — to offset potential drain, there would be restrictions on when they can make claims — say, they have to establish continuous residency for 8 quarters (two years) or intermittant residency of a total of four years over a five year period.

All eligible americans (and permanent residents) are auto-enrolled in the default plan. By auto-enrolled, I mean, put onto the rolls of the plan. Any premiums due that they fail to pay are automatically deducted from any government benefits they would receive (such as reimbursements under the plan, tax refunds, social security benefits, etc.). People who become seriously in arrears get a discussion with IRS.

PLAN CHOICE

Plan choice is an important feature of the national plan.  First of all, the government sets minimum standards, and then any entity can become accredited to offer a plan that meets those standards. They can also offer bonus plans that exceed the standards (offer additional care over and above) for an increased premium. But each accredited insurer must insure a certain percentage of lives where premium cost is based solely on age, gender, occupation, and citizenship status — say 60%. As a result their are able to receive a percentage of premiums paid into the entire risk pool.  Result: private plans, large public risk pool.

If an american wants better insurance he is free to buy a supplemental plan, but he still pays the base plan premium.

PLAN STANDARDS

The plans would basically be a high-deductible health savings plan hybrid. The network would be anyone medicare pays. Meaning, medicare would not pay a provider unless they agreed to accept the usual and customary assignments from the universal plan. The plan would have incentives to encourage providers to practice less, higher efficiency medicine, and would reward providers who eliminate wasteful costs (like unnecssary tests).

The HSA component could be administered by any bank that typically does that. The government would cap the fees they can charge, and would ensure that decent interest is paid (and/or investment options). Individuals fund their HSA through a tax credit they receive — say $2500 per family per year — and their own tax free contributions. There would be additional credits for certain individuals, such as low income, child credits, and so on.

HSA funds would automatically roll over from year to year, growing tax free, and uncle sam would offer incentives to individuals who leave money in their accounts. Withdrawals would also be allowed tax free to: 1) pay eligible medical expenses under the plan, 2) pay plan premiums, 3) pay supplemental plan premiums, 4) transfer to an IRA (at age 59 1/2), and in limited circumstances transfer to a 529 (probably a yearly cap). Uncle Sam would look at the overall risk pool and provide premium credits (deposited to individual HSAs) in years when the plan is making money. Premiums would increase in years when it doesn’t.

REDUCING COSTS

Costs overall are reduced because the plan design is such that it does not encourage over-utilization. Also, the incentives for keeping money in the HSAs means there is disincentive to spend them on unneccesary care. Providers will be tracked in terms of their efficacy of care (cost + effectiveness) and the better providers will earn better payouts from the plan. A standardized system of usual and customary care costs (managed by medicare) will simplify medical coding, reduce administrative costs, and provide both a level playing field among providers — as well as provide increased transparency to the patients.

RX COSTS

The RX benefit will be more like a discount card. The discount will be very good for frequently prescribed, low-cost generics. It will encourage importation of drugs at lower cost. For more expensive drugs, costs will be contained by requiring drug companies to offer a rebate to the plan equal to the largest rebate they offer (Medicare currently gets this deal, so its already trackable). A P&T commitee made up of doctors will regularly look for the best generics and lower priced alternatives to expensive medications. Generics can be fast tracked to approval on the basis of this committee’s recommendation –> meaning a company that offers an expensive brand for which their is no alternative may cause, by action of the commitee, a competitor to more easily have their generic alternative approved by the FDA.

The plan will also recoup costs by controlling the prescribing data for its members, and selling it back to companies like IMS or the drug companies. Plan pharmacies will not be allowed to track prescribing data for plan patients without paying the plan a cut.

CAPS, CAPS, CAPS

Sorry to say it, but we’ll have to have lifetime maximum (caps on plan payouts) for the basic universal plan. Say that the cap is $2M. There will also be caps set on certain expensive procedures (like limits on PT, mental care, etc.). Individuals are free to pay for additional procedures or unconvered items out of pocket — or pay into a plan that has more generous options.

BIG GOVERNMENT AT WORK

Yes, yes it is. But whatever freedoms we give up in the form of national insurance will be done so to benefit everyone equally — to standardize care and insurance practices - and more importantly to create a sufficiently large risk pool that all Americans can be insured while offering a decent standard of care, such that one medical mishap won’t send you to the poorhouse.

CONCLUSION

Really, the blueprint I’ve outlined is the only universal healthcare plan that will work. None of the plans I’ve seen from the current candidates are really workable (that includes McCain, Clinton, and Obama). I did cherry pick their ideas, however. Anyone who thinks other plans are workable, particularly those that don’t mandate a universal risk pool, are stupid or lying.

When I read about the Fed’s move today (and saw the resulting bounce in the market) my first impulse was “Oh noes…” That is because the Fed is essentially handing out cash at negative interest rates to anyone who wants it. As collateral, the banks can offer up the same junk paper (mortgage backed securities) that is responsible and central to the financial mess we’re in.

The Big Picture blog today puts things very clearly.

[The Fed] created a new credit facility, the Term Securities Lending Facility (TSLF). Then, they empowered the TSLF to accept a broad range of private collateral — “AAA” private mortgages in addition to those that are agency paper….If I read the Fed release correctly, this is the junky paper the Fed will be accepting as collateral.
….[This] will help brokers and banks; the bad news is it will do nothing to help the Housing market, or stop the decline in House prices. Nor will it help resolve the inverted pyramid of derivatives that sits atop Housing. And, one has to believe it will only add to inflationary pressures.

From The Big Picture

Since they are unwilling to properly grade the paper they are accepting as collateral, we are just adding onto the house of cards. Not to mention the increased access to capital seems to be fueling commodities speculation. Hang on kids, it is going to be a bumpy ride!

There are a number of authors that have had a big influence on me, but the EGG man created something new. I played Dungeons and Dragons for the first time when I was 7. I had no idea what was going on. I was immediately killed by a goblin. I was hooked.

On my first intercontinental plane ride I brought a borrowed copy of the “Advanced Dungeons and Dragons” rules’ Dungeon Master’s Guide. Hoo boy, what a volume. Despite the 6+ hour flight, I found it very difficult to get much past the first couple of pages. The dense chart and discussion of the mathematics behind the selection of the various dice, followed by a very detailed (and seeminly out of place) chart for mystical effects associated with various gemstones. But it was good, oh yes it was good. I played D&D (and other games) throughout Jr. High and Highschool. When packing my things for college, I carefully selected the gaming books that would make the trip with me. And sadly I have most of them still.

One thing I loved about Gygax was that he didn’t apologize. He was curmudgeonly. He loved his dense rules and he hated the no-nothing fancypants that thought it was fine to play fast and loose with the cannon of rules he had assembled. He had an excellent point. Rules helped give fantasy a form; a bad rule, seemingly, was better than no rules. He was big believer in the power of the Dungeonmaster. This is a position I supported, since I often DM’ed.I was never much of a wargamer, but I didn’t mind the touches of his wargamer heritage that put their indelible stamp on D&D.

Now that he’s gone on to the Gamer’s Parents’ Basement in the sky, I just had to take a sec and reflect on what th’ man wrought. I’m just glad he did.

No. No it won’t. Not to pick on Snapple here, who makes decent tea despite the stupid commercials for the new product — which imagine the protection of the antioxidant additives to be like coating everything in bubble-wrap. But this whole “antioxidant drinks are better” thing has got to stop.

Ever since Congress passed the Dietary Supplement and Health Education Act (DSHEA) in 1994, advertisers have been able to say whatever they wanted about their products without having any proof whatsoever. Since they aren’t too concerned about proof, we have to be. so let’s look at the facts. eDocAmerica has the straight dope in this excerpt, summarizing some Harvard Medical School Men’s Health Watch (HMHW) research findings

Careful research shows that taking anti-oxidant supplements do not protect against heart disease or cancer, and may increase the risk. For example, supplementation with Vitamin E may increase blood clotting and increase the risk of a heart attack or stroke. Almost all of those cardiologists have stopped taking Vitamin E. Beta carotene supplements increase the risk of lung cancer in male smokers, excess Vitamin A increases the risk of bone fractures and people who take anti-oxidant supplements may have a higher death rate per year than those who don't (HMHW, November 2007).

Even folic acid does not escape the cold hard light of scientific scrutiny — there is evidence to suggest that megadosing on the super-supplement (more than 1000mcg/day) may be associated with an increase risk of colon polyps, which are a pre-cursor to colon cancer. 1000mcg sounds like a lot, but folic acid is increasingly being added to everyday foods, and has been pushed as a prenatal and circulatory problem panacea. A typical multivitamin will have 400mcg of folic acid, so if someone takes a seperate folic acid supplement they could easily exceed the safe limit.

The discussion of the problem of supplementation of dubiously beneficial antioxidants and other substances returns back to good ol’ Snapple. According to their product page, the drinks contain “165 mg of protective antioxidants (as EGCG tea polyphenols, vitamins A and E to help protect your body’s cells from free radical damage)”. Shall we imagine for a moment that EGCG tea polyphenols were definitately beneficial — they appear to be in rats, but not so much in humans. So what? Does that mean you should drink Snapple? Or should you go right to the source and DRINK SOME GREEN TEA. Of course, if the goal is to really get those EGCG polyphenols going in your body, you’d need to actually inject the tea. And even then, the effect would mainly go to your intestines and your kidneys. Another study seems to suggest you’d need massive doses of that tea, like 150mg per kg of body weight (per day!) — in other words, a 150lb angst-ridden teen would need 10,200mg of those delicious tea polyphenols — or the equivalent of up to 62 bottles of Snapple per day. I hope you are thirsty!

So let’s summarize. The stuff in the new Snapple drink isn’t likely to do you any good. You’d have to drink a whole lot of it to have a benefit, if there’s a benefit — and that isn’t to say that there isn’t the very real possibility of it causing harm. You’re probably better off drinking the green tea (from whence the “antioxidants” come) and eating a healthy diet.

I’ve gone to the Kelley Blue Book to get trade in values or to sanity check used car prices, but it seems there’s another source that’s closer to what the dealer’s actually use: the black book. You can get a black book value for your car from CarQuotes. Visit their site and click on Used Cars at the top. Then on the right look for the Black Book banner and click the Used Car Valuation link. While you’re at CarQuotes, be sure to checkout their quotes service for searching their network of dealers local to your area.

For the blackbook valuation, they ask for your financial institution’s name and contact information. It may take a little while, but eventually you’ll get a PDF emailed to your with your valuation. An example is shown below.

In the linked article from US News, the author Amanda Gardner presents what is on the face appears to be a cogent argument against spanking. The subtitle, “Review found physical punishment of kids linked to unprotected, masochistic sex as adults”. Before you hand up your paddles, hang on a sec and dig a little deeper into the issue.

Sure, according to the article the ratio of kids who later are involved in partner abuse is 5-to-1 (25% of spanked kids compared to 5% of unspanked kids) which sounds bad. But 90% of Americans spank. So if you have 50 million kids, that means 45 million of them were spanked and 5 million were not. One sample size is ten times as big as the other. I would argue that you can’t compare the numbers for that reason and the studies are so flawed as to be useless.

This Murray Straus character, the so-called “spanking expert” is in fact an anti-spanking crusader. Yes that’s his website, nospank.net. I wonder what their mission is? If you go to some of his sites you find articles that look at the issue in a clearly unbiased, and balanced view — articles like “CHILDREN SHOULD NEVER, EVER, BE SPANKED NO MATTER WHAT THE CIRCUMSTANCES” and others in which he claims spanking should be banned outright, made a crime, claim that spanking is equivalent to child abuse, and other such nonsense.

Back to the article. Let’s put under a microscope exactly what they mean by the so-called “risky sexual behavior” they claim spanking leads to:

They found that spanking and other corporal punishment is associated with an increased probability of verbally and physically coercing a dating partner to have sex; risky sex such as premarital sex without using a condom; and masochistic sex such as spanking during sex.

So “verbally coercing” a partner to have sex is risky behavior? Clearly the author of the study has never been married.

But another major problem is the studies described by the article lump spanking together with “other corporal punishment”. I wonder what they mean by “other” corporal punishment? Could it be beating the kid with a belt, or punching them, or throwing them downstairs? In fact, on one of Straus’ personal sites he includes just such a broad definition.
Of course they lump it all together, it allows them to inflate the imagined harm of spanking: let’s suppose that children who are physically abused tend to become abusers. Let’s include those children in the group of “children who experience corporal punishement”. Is it any wonder the number of abusers found in the group increases?

Interestingly, Elizabeth Gershoff, the another researcher they mention in the article had this to say about spanking in one of her research articles (my emphasis):

When [spanking] is restricted to several slaps on a young child’s behind with an open hand for the intended purposes of behavior modification (what is defined as spanking in the consensus statements of the pediatrics conference attended by Baumrind and Larzelere; Friedman & Schonberg, 1996), it is considered normative corporal punishment and a part of appropriate parenting.
REFERENCE: Elizabeth Gershoff. “Corporal Punishment, Physical Abuse, and the Burden of Proof: Reply to Baumrind, Larzelere, and Cowan (2002), Holden (2002), and Parke (2002)” in Psychological Bulletin Copyright 2002 by the American Psychological Association, Inc. 2002, Vol. 128, No. 4, 602–611

I think that the bolded words are pretty key. Spanking is normative corporal punishment and a part of appropriate parenting. Certainly there is “good” spanking and “bad” spanking — and certainly, like anything else, it can be abused. But I think any blanket statement is not very useful. Personally, I try to experiment with alternatives but I think that a spank (both as a threat and as a punishment) is an effective means of rearing a well-adjusted child. And I sincerely hope the dope who wrote this article has children so she can find out for herself the sort of undisciplined brat that is sure to develop when parents refuse to consider spanking them no matter what.

If you ever wondering how interesting your IP address is, what it looks like as a bitmap, unix date, or other silliness — check out ipspotting.com. They have the answers you crave.

And in case you wondered how froppy.com fares.

Wikiscanner is an interesting service that can ferret out who really edited a particular wiki page. Should be required for researchers. Then again, if it is on the Interweb it MUST be real, right?

A friend recently chided me about needing a new post here, so there you go.

Anyway, been subscribed to DirecTV for a coupla months now. I got in on a pretty decent promotion that offered $20/month off their standard programming and free premium channels for three months. I also managed to snag another $50 credit via AAA for locking in a 12mo contract, but I digress. The point is, with the $20 off I can get their premium tier for much less than I would pay for “basic cable” through the local cableco. Even when you figure in the $5 per extra receiver.

But I recently got an email letting me know DTV is going to be upping prices towards the end of February. On the good side, my 12 mo. contract means I can pay the old price till the end of the contract. On the bad side, I was planning to save another $10/mo by dropping my programming package down a notch (since I really don’t need all the “Choice Xtra Plus” channels).

I will grant you, the cost increase is not stupendous — about $3-5/mo depending on the package you chose, but I think the point is that the satellite providers have been trumpeting about how the cost isn’t supposed to increase (unlike cable, which seems to go up 6% or so every year).  $3 on a $29.99/mo. package IS a significant increase, percentage wise though.

I wonder if you can get out of your commitment on this basis.  Hmm.

I’m a buy and hold investor. I like to spend a little on a regular basis to buy stock over time. As dividends come in, they compound more stock. In short, I’m a DSP-DRiPper … DRiP as in, “dividend reinvestment program”, DSP as in, “direct stock purchase”.

You generally need one share of stock to start out with. Buy it from your broker or brokerage account. Then call up your broker and have them issue the certificate. It will cost between $30-70 for that service. Once you have the certificate, you can start buying more stock from the company using their DSP program, and sign up for DRiP.

To find a nice list of such programs, go to Computershare’s site. COmputershare is one of the larger bank transfer agents, which means it adminsters the DSP/DRiP programs for a lot of companies. The link let’s you search for companies based on various criteria.

Some DSP programs are better than others. For one thing, I look for a company that is likely to be around for a while — e.g., Coca-Cola. For another, I look at the plan fees. Coke’s plan charges only a dollar for regular automatic investments (as little as $25 a month from your checking account). You can also buy additional shares at the same commission level.

In some cases you may be able to buy the initial share and sign up from the link above, but I have always just bought the initial share through a discount broker and had them issue the certificate.

Shareowner Online is another site (poss. affiliated with Wells Fargo) that offers a similar service to Computershare. Check it out, but I have no experience with it.

Also, I recommend signing up for electronic statement delivery if you plan offers it. Otherwise you will get bombarded with statements.  But keep your statements!  If you ever want to sell shares, you’ll need ‘em to calculate your cost basis.