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http://www.technologyreview.com/featuredstory/520441/a-tale-of-two-drugs/ says that Vertex offers a cystic fibrosis drug for $307,000 per year to insurance companies and Medicaid/Medicare. The article also notes that Vertex offers the drug for free to patients who are uninsured. Doesn’t that give an incentive to an insurance company to cooperate with the patient? Instead of paying for 20 years of this drug ($6 million), the insurance company could give the patient $2 million to drop his or her policy. With that $2 million, the patient could buy health care as needed and get the $307,000/year drug for free.

What stops an insurance company from offering this incentive?

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The news media has been reporting on polls showing diminished public support for Barack Obama following the squandering of $5 billion on a bunch of semi-functional health insurance web sites (see this analysis of $4.5 billion in federal spending on state-operated exchanges, plus another $500+ million on the federal one).

At Thanksgiving gatherings with friends and family, however, I found that people who had previously supported Obama were no less enthusiastic about him than in previous years.

None of the Obama enthusiasts had any idea what web development typically cost or any knowledge about what healthcare.gov cost or what it was supposed to do. Therefore they didn’t have a strong opinion about the reported problems with the site.

To the extent that there were any problems with America’s healthcare system, Obama supporters blamed insurance companies and their inefficiency and greed. They didn’t see any contradiction between this opinion and the idea that the federal government should force people to do business with these inefficient and greedy companies.

Generally Obama supporters accepted that “health insurance” and “health care” were equivalent and therefore a person without health insurance would not be able to get health care. The Obama supporters believed that health care was a universal right and that, without insurance an American would not be able to obtain any care, so they were very happy that Obamacare was going to result in universal coverage [i.e., none were aware that Obamacare will leave approximately 30 million Americans uninsured (see this Washington Post article)].

The minority of Obama supporters who were were aware that the U.S. currently spends a much higher percentage of GDP on health care than other countries believed that with appropriate direction from Washington, D.C., our costs could be brought in line with the rest of the world’s, if only the central planners were given more power. [Health care spending in the U.S. was 4 percent of GDP in 1950 and is 18 percent today; Singapore spends about 4.6 percent of its GDP on health care, according to the World Bank, while most European countries are in the 9 percent range.]

Obama supporters believed that the only possible way for poor people to get health care was if the federal government paid for it through Medicaid. They believed that between 1776 and 1965, Americans who were poor and sick could not get any treatment at all. Obama voters who lived within walking distance of Boston City Hospital (founded 1864) were unaware that local or state governments had ever played any role in delivering health care to the poor. Obama supporters who lived within a short drive of one of America’s hundreds of Catholic hospitals were unaware that health care for the poor had ever been delivered through private/religious charity. If the federal government had not started paying in 1965, Americans who lacked funds would simply drop dead in the streets for want of a straightforward procedure (hence Obama supporters were very grateful for the continued existence of Medicaid).

Obama supporters felt much better about our continued wars in Iraq and Afghanistan than they had during the George W. Bush years. While Bush was president the same folks had argued for withdrawing our troops but since Obama was elected they no longer actively opposed foreign military intervention (they could have starred in this video). I asked if they wouldn’t have been happier if Obama had withdrawn our troops from Iraq and Afghanistan on January 20, 2009, using his authority as Commander in Chief. The answer was two-fold: (1) it might have made sense for Obama, in 2009, to continue the wars, even at the cost of thousands of American lives and tens of thousands of civilians’ lives, through his 2012 election campaign in order to improve his chances of being elected, (2) “Obama couldn’t do anything about the wars because of the military-industrial complex.” [i.e., Point 2 boiled down to them being passionate about Obama’s election and the election of similarly-minded successors, but at the same time believing that the president for whom they were actively campaigning didn’t have any power when it came to starting or stopping wars.]

Generally Obama supporters among my friends and family were happy with the way things were going, except that they wished that taxes were higher (ideally collected from people who earned more than they did). To the extent that they wished the U.S. economy would grow faster, they blamed Republicans in Congress for obstructing Obama’s proposed spending, regulations, and taxes. Generally there was no erosion in support for a centrally planned economy (see this poster that I made just before the 2012 election, after listening to the various promises made by Obama and Romney).

My poll was admittedly unscientific, but I did not find any erosion of support for Obama, centrally planned health care, shifting responsibilities from local/state to the federal government, or a larger percentage of the economy being given over to government. What are the readers seeing? Are friends and family who’d voted for Obama in 2012 now disillusioned because they read that healthcare.gov doesn’t work? If so, would they be motivated to vote differently in the future?

[Related: My 2009 health care reform article]

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I just noticed that 23andMe was shut down by the Federales. http://en.wikipedia.org/wiki/23andMe says that over $100 million was invested in the company ($52.6 million plus an additional $50 million in 2012). The New York Times reports that the FDA has made it illegal for them to sell their only product (story). This is a great example of regulatory risk that ordinary investors might not have budgeted for.

Question: would it be illegal for 23andme to relocate to Singapore, for example, and have people mail DNA samples to Singapore and then email them the results? The company’s web site indicates that customers in Singapore (and a bunch of other countries) can send their DNA to have it tested. Would the FDA have jurisdiction to prevent a Singapore-based company from accepting packages from consumers in the U.S.?

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I just finished Empty Mansions: The Mysterious Life of Huguette Clark and the Spending of a Great American Fortune, the New York Times bestseller by investigative reporter Bill Dedman and a relative of the rich old lady who died and left a legal mess.

Huguette Clark was the youngest daughter of a 19th century western mining and banking magnate. She died in 2011 at the age of 104 with a fortune worth more than $310 million.

If you were considering becoming old and rich in New York City, this book will serve as a cautionary tale. Clark was reclusive and spent the last two decades of her life in Beth Israel Hospital, which extracted about $400,000 per year from her but did not put her in one of their VIP rooms. As Clark was in pretty good health and should not have been there, the hospital hid her from inspectors while simultaneously trying to extract a massive donation from her (over $100 million was the goal).

One of her doctors tapped her for more than $1 million in loans that he would never repay. Her longtime nurse managed to collect $31 million in gifts during Clark’s lifetime and was on track to collect an additional $15 million in her Will.

Clark had jewelry in safe deposit boxes at Citibank. The bank lost some of it in the 1980s and took advantage of Clark’s fear of publicity by saying that they couldn’t pay her the fair value discreetly. Then due to incompetence and miscommunication between two departments within Citibank, in the 1990s the bank decided that the rest of her jewelry was abandoned and they sold it “to a liquidator at rock-bottom prices.”

Her accountant had a felony conviction for trying to meet up with 13-year-old and 15-year-old girls in AOL chatrooms (apparently the only people in AOL chatrooms these days are affiliated with the police). The account and lawyer had previously collected for themselves nearly the entire estate (about $2 million) of the lawyer’s former partner. Perhaps because it was so easy to get money from estates, these guys barely did their jobs while Clark was alive. Because they didn’t file gift tax returns (despite being paid over $200,000 per year in fees), the estate owed the IRS $82 million in gift taxes, penalties, and interest.

Apparently in the world of New York State estate law, even the judges need not be above suspicion: “The [dispute over Clark’s will] was assigned in 2013 to a judge, Surrogate Nora S. Anderson, who the previous year had been censured for failing to report $250,000 in campaign contributions. She was acquitted by a criminal jury of two felony charges of filing false campaign reports, then was censured by the state judicial conduct commission.”

New York apparently allows a pretty fair amount of stealing from rich dead people without anyone having to break the law. The accountant and lawyer were set up to be executors of Clark’s estate as well as trustees of a foundation to handle some of the charitable bequest. It seems that New York has a standard “executor commission” of about 2 percent on large estates. So even if the bequest had been as simple as “give everything to Princeton” and the work required be nothing more than writing one check, the accountant and lawyer would have paid themselves over $6 million. As foundation trustees they then would have been able to pay themselves additional fees for many years to come.

The book is a little sad because Dedman was able to dig up so few honest or selfless New Yorkers. It seems that virtually anyone who got near this woman or earned her trust could not resist the temptation to take advantage of her generosity.

There are some happy parts of the book. Clark uses her fabulous wealth to indulge a taste for the world’s best dollhouses and model Japanese castles, built by craftsmen in Germany and Japan. She pays an assistant to write down transcripts of Flintstone episodes. When she wants to make a little music, she takes a Stradivarius violin out of the closet (first she needs to choose which of her Stradivariuses to play). Back in the middle of the 20th century, Clark bought all of the stuff that rich New Yorkers like and consequently seemingly everything that she bought appreciated beautifully, ranging from her Impressionist paintings to the violins to the big apartment (47X increase in value, adjusted for inflation, from 1955 to 2012).

The book reminds us that even if we aren’t rich enough to own a Renoir or play a Stradivarius, there are some advantages to living in the modern age. Ultimately the saddest part of the book concerns the death of Clark’s beloved older sister at age 17, from an infection that would easily be cured today with antibiotics. Clark’s life might have been very different if her only sibling had survived.

More: buy the book.

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Objective testing oftentimes reveals that a fancy brand name and high price is no guarantee of performance superior to work-a-day Canon and Nikon optics. the Zeiss 55/1.4 Otus, however, seems to be an exception. It is 10 times the price and 4 times the weight of a standard 50/1.4, but the test results for this $4000 2 lb. lens are impressive. See lensrentals.com and dxomark.com.

It should be a great lens for documenting Thanksgiving turkey carving, so head over to Adorama.com now!

[Separately, on the other end of the optical quality spectrum, here’s a recent photo taken with my phone…

]

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I ran into something interesting this evening. I am trying to finish an Amazon Kindle book on my Samsung Note 3 that I started on an iPad Kindle app. I couldn’t download the book due to “license limit exceeded”and that the book could be on a maximum of 6 devices. So I deleted the book from the iPad and a couple of Android devices, thus freeing up three licenses. Trying to download the book still failed. I looked in the “Manage Your Kindle” interface on Amazon. It is possible to find the books that I’ve bought but there is no way to see which devices Amazon thinks the books are on. So I called Amazon customer service. They helpfully explained that the number of available licenses was 0, which is why the downloading was failing. “Well… I deleted the book from three Kindles so shouldn’t I have at least three licenses available?” They just kept repeating that the number of licenses was 0, as though from a script. I asked if they had any way to tell what devices the book might be on. They said “no” and that their preferred method of debugging was simply to deregister entire Kindle apps at random and see if the problem went away.

The whole Kindle system seemed well thought-out at first when an owner could have just one Kindle but I wonder if the left out something critical…

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Thanks to the installation of a couple of Schlage keypad locks, I am enjoying a mostly keyless lifestyle. On those days when the female portion of the household permits me to use the family car (2007 Infiniti M35x), however, I must add an RFID tag to my pocket. Given that I always carry my phone, which has both Near Field Communications and Bluetooth, why can’t I use the phone to authenticate myself to the car? The car already has Bluetooth. Newer cars certainly could incorporate NFC at a pretty low cost. The security on Bluetooth is good enough for payments (see this article on PayPal using it).

Hyundai is supposedly working on this (source) but why is this seemingly obvious idea not already implemented in at least any car that has Bluetooth networking? Is it a battery drain issue? A car battery is pretty huge.

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Folks:

Some friends have a long-established physical goods company in Manhattan. They have a market-leading niche Web-based business that sells digital goods via a site built with the Magento toolkit. They’ve outsourced development of this site with mixed results (though better than healthcare.gov!). I suggested that they might be better off hiring their own programmers who will be dedicated to the site and the customers.

I’m thinking that they would need a product manager who does some coding and database development and two programmers (one fresh out of school and one with a few years of MySQL/ecommerce experience?).

First, do readers think it is positive or negative that they have a Manhattan location? Obviously there are talented people in Kansas who can work at a lower salary and still enjoy a very comfortable standard of living. On the other than there are a lot of young people who want to live in Manhattan.

So… if they are to hire some full-time people are they better off establishing a satellite office somewhere else? And, if not, what are the going rates for competent full-time PHP/ecommerce developers in Manhattan?

Thanks.

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As a complement to seeing Hollywood’s All is Lost (previous post), I watched Wild Eyes streaming from Netflix. This is a made-by-the-proud-father documentary about Abby Sunderland‘s attempt to be the youngest person to sail non-stop solo around the world. If your impression of 16-year-olds is that they spend most of their time texting friends, this is an inspiring story of a teenager who learned all of the systems of a 40’ oceangoing yacht and pushed it through (most of) the Southern Ocean.

Even if you don’t like sailing, the documentary is well worth it for a single scene in which the 7 existing siblings of the Sunderland family learn that their mother will soon be giving birth (at home, of course) to an 8th child. The lack of enthusiasm is all too real!

[Separately, the Wikipedia story is interesting for the story of how the Australian government, instead of using a military plane, charters an airliner from Qantas to go looking for Sunderland. (TIME reports that the cost of a USAF Boeing 757 (C-32A) is about $43,000 per hour to the taxpayers; Conklin & De Decker says that $12,000 per hour is about what an airline would spend to fly one extra hour; a source of mine at a U.S. company that charters out 757s says that the cost is about $4500 per hour not including fuel (roughly another 1000 gallons per hour times about $3/gallon at the refinery (source)).]

Related:

• my June 2009 review of the book Black Wave, a multi-person trip that goes a lot worse than Sunderland’s solo voyage

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Having switched from an iPhone 4S to a Samsung Note 3, one of the things that is most confusing is the contacts interface. My iOS contacts were simply set to sync with Google as though Google were a Microsoft Exchange server. The phone knew only about contacts with a phone number. My Android phone, however, similarly set to “show only contacts with phone numbers” responds to a search query with, for example, three separate contacts for my friend Jannis (one is the real contact with a phone number; the other two are orphan contacts that have an email address only). Thrown in for good measure are all of the people that I’ve ever exchanged email with whose name or email address contains a subset of the search query.

This makes it very cumbersome to find contacts with a text search.

How about by browsing the list? That’s cumbersome too because I haven’t found any way in Google Contacts to archive an old contact. I can move stuff into an “Obsolete Contacts” group but I haven’t found a way to tell Android not to sync such contacts.

Back in November 2009 I wrote that “Contacts is the weakest part of Gmail and especially a year ago, could best be considered a work in progress.”

Are there obvious features of either Android or Google Contacts that I am missing?

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