well looks like i’ve found the birge that was competing with me for all the birge.something domains. I noticed you grabbed .us just before i went for it and then stumbled over here for my uncle but you got here first .

Currently the proud owner of .me!! Looks like .com has been squatted by a domain name dealership. Commercial squatting a**holes – ICANN will sort it out eventually. Value of our virtual real estate is really becoming a serious thing. Fortunately the birge name seems to be relatively rare (apparently only three registered to vote in the UK, where we are).

Nice blog…

Choreographer

Having said that, I stick by my assertion that insurance is one of the few things that actually is best handled by government. Note that I said insurance, not health care. I think the government should just handle a single payer insurance scheme, not run the hospitals like they do in Britain. We can still have a layer of consumer choice, and I support the idea that things like routine visits and less than catastrophic things should be out of pocket. This would help contain a lot of expenses.

Here’s why I think the rest should be single payer: health care is about as unique a situation as you can get, and many of the good things about competition either don’t work well in health care, or come at a cost that I can’t abide. Healthcare is something you need rarely, and when you need it, you don’t have time to “shop around”. Unlike car insurance, health insurance is unavoidable. You can choose to not drive a car, but I hope you can agree that a civilized society just isn’t going to let people writh around on the street when they break their leg. So, given that we’re going to help them, we have a social need to make sure this is done in an orderly and fair manner. However, the truth is many people are bad risks, and no private insurance company should be expected to cover them as a rational decision. Like drunk drivers or the blind who can’t get car insurance, lots of people are essentially insane risks to cover with health insurance. This is the fundamental problem, the way I see it.

The insurance model assumes pooled risk of a random probability event. Health care is not that, by any stretch. Some people are so clearly at risk that no sane insurance company would willingly cover them at a rate they could afford. So, either we let these people die painful deaths, or we strong arm the insurance companies, completely violating any notion of private health care and causing no end of unintended consequence. Do you really like either solution? I don’t. It’s Lord of the Flies in the first case, and the shitty Public/Private nightmare we have now in the second. So, I think the only solution, which also sucks, but sucks less, is single payer.

Basically, the bottom line is that we, for better or worse, have opened Pandora’s box by developing so much medical technology that we can easily spend millions of dollars fixing a single person. Now we’re in the position where everybody needs insurance to have a shot at the best healthcare, and yet a large percentage of us are obviously going to require that at some point. I’m sorry, but that situation is pretty clear cut to me the more I think about it: either you have the government handle the wealth transfer to pay for it or you have lots of suffering. But at the end of the day, somebody is going to get forced to pay something.

The reason I think single payer is better than micromanaged private insurance is that I think the micromanagement required is so high that all the private industry can do at this point is get in the way, creating inefficiency and acting as essentially a middle man. That is to say, we really already have single payer in some sense, you just don’t know it because a large portion of your insurance rates go into creating a huge infrastructure dedicated to creating the illusion of a private industry.

It seems to me that in the – I hesitate to call what happened in the run up to the passage of Obamacare a debate but it’ll do for shorthand – debate over healthcare reform there were some reforms that were never really discussed. Or at least not very seriously. Perhaps they are too much of the rearranging the deck chairs on the Titanic sort, but I’d like to know what you think.

First, purchasing insurance across state lines. If I live in a state like New York or California or Maryland, that require a bloated bag of coverage requirements, why shouldn’t I be able to buy a plan from a company in Wyoming that will offer me more of what I need? If I don’t want a plan that covers viagra or birth control, why shouldn’t I be allowed to buy it?

Second, and this is intertwined with point one, why don’t we have more choice in the types of plans we can buy? Why shouldn’t I be able to buy a high-deductible plan that covers catastrophic accidents or disease? One of the most ludicrous concepts is the idea of a co-pay on a routine physical examination. Do you have a co-pay with your car insurance provider for oil changes (i.e. preventive maintenance)? Of course not.

Third, health insurance should be divorced from employment. I am sure I probably don’t need to tell you what happened here. Congress gave companies a tax break on what they spend on employees’ health insurance. True to form when you subsidize a behavior, we got more of it in the form of co-pays. I think we should be more aware of the cost of insurance, not less. Right now I don’t care how much a test costs that my doctor ordered, or what a prescription costs since I am only going to be shouldering a very small portion of it. I would like to see my employer pay me more in salary and then – combined with reforms mentioned in points one and two – let me go out and buy a plan that makes sense for me.

I think we need more choice and hence competition. We have more choice in cell phone providers than we do with insurers.

I write software for a living so I should be willing to pay for software. Oh wait, I do pay for software. Sometimes. Some categories though I just refuse to pay for. Pretty interfaces to free systems is one of them. Perhaps because 95% of the awesome of SVN is SVN itself as opposed to any fancy interface – I am not willing to pay for a SVN client regardless of how great it is.