Efficiency in the health care market

A friend of a friend runs a small HMO for a university (students, faculty, staff). Part of his job is negotiating with vendors for procedures and hospital care. “[A local academic-affiliated hospital] charges $2800 for a colonoscopy. I got a deal with a colonoscopy center, though, for $900. Same doctors. Same procedure. Same anesthesia.” Was there anything else that affects the price? “On top of these charges, the centers encourage patients to ask for Propofol as an anesthetic. That’s the Michael Jackson drug. It doesn’t work any better, but it has to be administered by an anesthesiologist and the centers and hospitals are able to tack on another $1000 in charges. Insurance companies will pay for it so the providers try to convince patients that it is better so they will ask for it. We tell them that we won’t pay for it!”

Full post, including comments

Health Insurance Mandate is not the same as Health Care Mandate

The Supreme Court has ruled that the federal government can try to coerce Americans into buying health insurance. What I haven’t seen in the news articles covering this event is a comparison to other things that the government tries to get Americans to do. The government tries to get teenagers to graduate from high school, but about 20 percent fail to do so. The government tries to get Americans to stop smoking marijuana, but about 20 percent light up periodically, despite the criminal penalties that attach to this activity. The government tries to get Americans to drive more fuel-efficient cars, and has various tax penalties associated with gas guzzlers, but SUVs and pickups clog our highways (I parked next to a monster one yesterday that had an “Eco Boost” badge on the side!).

The penalty for those who don’t buy health insurance is an extra tax, but http://www.slate.com/articles/news_and_politics/explainer/2009/04/taxes_schmaxes.html notes that roughly 7 million Americans (out of about 150 million civilians in the labor force) don’t bother to file tax returns.

Was it really worth two years of drama to turn America from a country in which millions of people lack health insurance into a country in which millions of people lack health insurance?

I’m still a fan of my own health care reform plan, which provides universal coverage, not just a nagging scolding nanny state that has proven itself to be incapable in the past of nagging and scolding with sufficient effect.

What will happen in 5-10 years when we discover that America still has a huge population of uninsured folks? The currently approved law does not seem to be a great stepping stone to universal coverage.

[Separately, if I were not a taxpayer, I would have been amused to see that each state got $8 million to do planning, but not actual programming, for a Web site to serve as a health insurance exchange. In other words, the federal government spent $400 million (50 states times $8 million) to do planning for the kind of Web service that a private start-up would build with five young people sharing an apartment and coding for three months.]

Full post, including comments

How does one remove photos from an iPhone 4S?

Folks:

How does one remove photos from an iPhone 4S? My “camera roll” folder is full of photos and videos (about 1500). Apple is saying that I need to buy more iCloud storage, which I don’t want to do. I plugged the device into a Windows 7 computer and the phone shows up as a drive. I was able to copy all of the photos onto a local disk for backup, but not able to delete any (an easy operation on an Android phone, which functions like a legitimate USB drive when plugged in).

I’ve Googled around a bit and there does not seem to be a straightforward way to delete all of the photos on the phone without selecting each one (1500!) with a touch. There was a hint that someone who purchased a Macintosh ($1000+?) would be able to delete photos by regarding the phone as a disk drive, but I can’t find anything for the Windows crowd.

Thanks in advance.

Full post, including comments

Interesting point-of-view video of helicopter lesson

One of the instructors at our flight school found an interesting way to mount a GoPro camera and make a video of a helicopter flying lesson. Comments would be appreciated because we could edit it. And yes I know that there is no sound! It would be nice to pipe in the radio transmissions at least but they’d have to be recorded with a separate device. The drone of the engines and blades would not be interesting. We don’t have a license for any inspiring music.

Full post, including comments

You can’t engineer around tax rates

The theme of this year’s Technology Day at MIT was advanced manufacturing in the U.S. Kresge Auditorium was close to capacity with alumni from all reunion years (I’m celebrating my 100th!). Marcie Black, founder of Bandgap Engineering, and Nathan Ball, founder of Atlas Devices, gave inspiring talks about advanced solar cells and an innovative climbing machine. Learned MIT faculty weighed in on the importance of proximity between engineers and factories. The Atlas Device story was initially an inspiring tale of can-do New England spirit, with engineers in Somerville and a machine shop in Woburn working together to make improvements on a weekly basis. But then we found out that the main customer was the U.S. military and they really didn’t care how much it cost or how efficiently it was produced. Similarly, the solar cell talk was great until we learned that there are about 12 good reasons why solar cells must be manufactured in Asia.

In a panel discussion afterwards, the speakers were asked what it would take to make the U.S. more competitive for manufacturing. The answer was that it was pretty much hopeless at current tax rates. Big companies make a lot of money in foreign countries, but if they bring the profits back home they get hit with the world’s highest corporate tax rate. So they leave the money in China, for example, and then invest it there in research and development or a new factory. I.e., our own multinational companies are financing the new facilities around the world that are rendering the U.S. uncompetitive. A new enterprise, meanwhile, would be facing a choice between China, with a 15 percent corporate tax rate, proximity to all kinds of suppliers, and low costs, and the U.S., with a 35 percent tax rate (plus any state corporate income tax) and an ocean separating it from most component vendors.

Other than for defense contracting, nobody seemed optimistic about the U.S. becoming comparatively more attractive. (Can we still call it “defense” when we keep starting the wars?)

[I was a bit skeptical of the message that high costs and taxes explain the U.S. decline. After all, Germany has high costs for everything and Europeans are famous for high tax rates. Yet Germany is wonderfully successful in manufacturing. Then I looked up the corporate tax rate in Germany and it turns out to be 15%, the same as China’s.]

Full post, including comments

Boomerang, by Michael Lewis

I’m halfway through Boomerang: Travels in the New Third World as a book on tape. It is far more entertaining and enlightening than I’d thought and it sheds a clear light on a lot of supposedly complex and confusing current events.

For example, the Greek/Euro crisis has always confused me. A 65-year-old California private sector worker does not mind paying high taxes so that a 50-year-old former fire chief can enjoy a $241,000/year public employee pension. Why then do working Germans get so angry that they have to work harder and pay more taxes so that 50-year-old Greeks can enjoy retirement? Is it simply because Germans and Greeks have less in common than the American taxpayer and the American public employee pension collector? News articles have not been helpful in answering this question.

Lewis explains that Greece wanted to join the Eurozone so that it could cut its borrowing costs, borrow a lot of money, and then distribute it among government workers and other citizens. It wouldn’t have been possible to join the Eurozone without meeting some requirements for budget deficit as a percentage of GDP and inflation, so the Greek government falsified its numbers and thereby gained entry into the Eurozone. Once in, the Greeks, sometimes aided by Goldman Sachs, continued to put out absurdly fraudulent numbers, e.g., that their budget deficit was 3% of GDP when in fact it was 15%. The fraud was sort of obvious in that the new debt being issued by the Greek government was at least double the stated budget deficit, but hardly anybody bothered to add up the numbers until 2008 and 2009. Greek banks were relatively conservative. It was the citizens who brought down the banks, not vice versa as in other nations.

So it is not a simple matter of some Europeans working until they drop while others retire comfortably at 50 but rather that there was fraud in how the Greeks presented what they were doing.

Full post, including comments

HP laptop with preinstalled software

I purchased an HP 17″ laptop with some software preinstalled in order to save myself some time. Normally I would prefer to buy from Dell, but this was the only 17″ machine that I could find with the latest generation (3rd; “Ivy Bridge”) of Intel CPUs.

The computer arrived in good shape, but once opened the purchased software was nowhere to be found, except for Microsoft Office, which was on the hard drive but demanding a product key. HP has invested heavily in a support application that enables their technicians to see everything on the hard drive. I opened a chat session and authorized HP to look at everything on the hard drive. Unfortunately the folks on the other end of this have no way to look up orders, apparently, and the hapless fellow had no clue as to whether or not purchased software should be preinstalled or not. He gave me a phone number to call.

I called the 888 number and waited for my turn. The woman who answered said that the purchased software should be on the hard drive. In fact, it was on the hard drive, she asserted (though she did not have access to the fancy support app that would have enabled her to see the hard drive). I pointed out that was nothing in the Adobe folder under “Program Files” other than Reader. If Photoshop Elements was on here, where was it hiding on the disk? She continued to assert that all of the software paid for was there and when I asked to be transferred to someone more familiar with Microsoft Windows she dumped me into HP’s tech support queue.

I called the same 888 number again and got someone different on the phone. He also had no access to my hard drive, but believed me when I said that the software was not there and that Office was demanding an activation key. He said that this case was being escalated to the highest priority available and that I would be called back by someone from HP within two business days (i.e., on Wednesday of next week, given that Monday is a holiday). I said “Given that I need an activation key, wouldn’t it be simpler for you to have someone email it to me?” That, apparently, is not an option.

My attempt to save myself some time delayed my usage of the software by at least a week (I could have purchased all of these things for download and activated immediately) and will cost me at least two hours of phone and online chat with HP.

More interestingly, I think this shows one reason why economic growth isn’t hugely accelerated by clever technology such as the latest Intel chips or HP’s fancy “look at the customer’s hard disk” support application. The fancy technology is eventually put into the hands of the same workers who made a mess of the old stuff.

Full post, including comments

Avengers 3D movie

I spent a couple of the longest hours of my life this evening at the Avengers 3D movie. A companion pronounced herself thoroughly bored and complained about the thin dialog. It does not seem as though it would have killed the screenwriters to have explained how Loki survived his death plunge from the Thor movie or who was behind his effort to take over the Earth and/or what he planned to do once he became supreme dictator (Loki was compared to Hitler in the movie, but Hitler at least had a published plan prior to taking power).

It occurred to me that if this is the creative energy that supposedly renders the U.S. immune to foreign competition we might be in some trouble. Chinese actors could certainly learn to speak a handful of lines in English while stuff blows up around them. Chinese screenwriters could presumably come up with a plot pretty similar to the Avengers movie. It is not the idiosyncratically creative stuff that Americans do that makes money, apparently, but the formulaic. So can we really have a sustainable competitive advantage in this area?

Full post, including comments

Book review: All the Devils are Here

I’ve just finished All the Devils Are Here: The Hidden History of the Financial Crisis and it shows that just when you think you know everything sleazy that happened up to and during the 2008 financial collapse you still have a lot to learn.

One of the authors is Bethany McLean, a journalist famous for helping to expose Enron’s accounting fraud. Her partner is Joe Nocera, a New York Times reporter. They concentrate on telling the story rather than offering suggestions for cleaning up the system.

Much of the reporting on Fannie Mae’s lobbying efforts was new to me. Up to the point of collapse, Fannie Mae earned most of its profits by holding onto consumer mortgages that paid, say, 6 percent, and borrowing short-term funds at lower interest rates thanks to its presumed status as an arm of the U.S. government whose debt would be federally guaranteed (as in fact it was). This was a way to make almost unlimited profits that a lot of high school graduates could have managed, yet managers helped themselves to billions of dollars in compensation for running this scheme that was guaranteed to blow up and wipe out shareholders if ever interest rates rose or homeowners began to default.

How did Fannie Mae protect its special status? They would open “partnership offices” in the districts of important House committee members. Those offices would be run by children of senators and other important politicians and would hold ribbon-cutting ceremonies, studded with politicians, to celebrate Fannie Mae putting money into a senior citizen center or whatever. Fannie gave high-paying jobs to former top officials in the Clinton administrations. By paying an above-market salary to the child of a senator or a former Democratic appointee, Fannie Mae was able to stave off Bush administration hospitality and enrich its managers permanently and its shareholders temporarily (until they were all wiped out when the government took over).

This was not the only example of the spectacular returns on investment from lobbying. One of the biggest and sleaziest subprime companies, Ameriquest, hired Deval Patrick, currently governor of Massachusetts, to serve as a board member of the parent company (ACC). Patrick was paid $360,000 per year and in exchange lobbied politicians such as Barack Obama so effectively that Ameriquest’s founder was eventually confirmed by the Senate as America’s ambassador to the Netherlands.

The book helps answer the question “Why does everyone hate Goldman Sachs?” An example is on page 338, in which Goldman Sachs put together a $1.5 billion CDO in 2004 called “Davis Square III”. This was stuffed full of mortgages from early in the decade of mortgage madness, before credit standards fell and fraud by loan officers became the general rule. The credit ratings agencies gave the CDO a triple A rating. AIG agreed to insure this CDO against default for a minimal percentage. Goldman meanwhile directed the manager of the CDO to swap out some of the better quality mortgages with 2006 and 2007 subprime loans, which were virtually guaranteed to default. There was some fine print in the CDO structure that enabled the manager to do this. Goldman then bought insurance on this crippled CDO from AIG. The ratings agencies finally woke up and downgraded the CDO in May 2008, “costing AIG $616 million in additional collateral calls–which came, of course, from Goldman Sachs.”

Stan O’Neal, the former CEO of Merrill Lynch, is featured in a chapter called “The Dumb Guys”. He took on $55 billion in exposure to subprime loans and didn’t even realize it, wiping out the shareholders who’d paid him hundreds of millions of dollars in salary. His top executives, also paid a fortune by the shareholders, were equally clueless. In July 2007, they estimated that Merrill’s total subprime losses would be no more than $82 million (about half of O’Neal’s golden parachute payment after he was fired). By October the losses were figured as at least $7.9 billion. O’Neal and his cronies at Merrill are featured as truly, adjusted for income and position, the dumbest people in the Collapse of 2008. Of course, sitting in your fully paid-for $50 million Greenwich, Connecticut mansion, a couple of journalists accusing you of being dumb might not sting too badly…

Alan Greenspan takes a beating in a chapter chronicling his refusal to look at any of the facts on the ground, i.e., that mortgage brokers were issuing loans to people who would never pay them back, then having Wall Street banks securitize those loans and sell them to unsuspecting pension funds. Greenspan was convinced that if these loans were truly so bad then Wall Street wouldn’t be buying and selling them. The Fed had the authority to deflate the subprime bubble but it did not exercise that authority. By contrast, Hank Paulson, who left Goldman Sachs to become Bush’s Treasury Secretary, is lauded for his practical approach and attempts to improve regulation (all blocked by Congress, basically). If you’re kicking yourself for not having figured out that inflated house prices would eventually wipe out years of growth in the U.S. economy, take heart. Paulson, according to the authors, had a similar blind spot: “Paulson didn’t suspect that housing or mortgages could be the catalyst for a crisis. … he thought the way others on Wall Street did and the way economists did: Housing prices hadn’t declined on a nationwide basis since the Great Depression! … for all of Paulson’s worries about derivatives, he didn’t understand the dangerous potential of credit default swaps on mortgages.”

Are there any fundamental problems identified in All the Devils Are Here: The Hidden History of the Financial Crisis? One them cutting through the book is that consumer-facing finance companies, if given the chance, will always try to cheat consumers with complex contracts filled with fine print. The basis of the subprime industry’s profit was that they gulled consumers who would have qualified for a reasonably priced standard loan into signing up for a subprime loan with vastly higher fees, sometimes more than 20 percent of the value of the house. These fees were rolled into the loan along with the principal, so the consumer didn’t pay the fee all at once. With low teaser interest rates, the monthly payment might be lower than on a standard mortgage even as the consumer was handing over his life savings to the subprime lender and its Wall Street investment bankers. The authors don’t quite come out and say it, but they imply that this is why it is necessary to regulate consumer lending much more tightly than it had been during the 1990s and 2000s.

Another theme is that Wall Street investment banks will, if given the opportunity, cheat “real money” investors with fine print and complexity, supplemented by optimistic ratings purchased from corrupt ratings agencies such as Moody’s, Standard and Poors, and Fitch. Sometimes the complexity gets too much even for a bank’s own employees who, despite their stratospheric salaries, aren’t very good at understanding risk. When this happens, the investment bank fails and shareholders and taxpayers are left to pay for the managers’ mistakes. Again, the authors don’t come out and say it, but they imply that this is why the government needs to regulate investment banks.

Overall the picture painted by All the Devils Are Here is of a nation whose population is nowhere near smart enough to use or operate the financial services industry that we have. Once things get to a certain level of complexity, fraud and confusion dominate.

Full post, including comments