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Friends have been asking lately what I think of the health care bill, now that it has passed (and bears no resemblance to my own health care reform plan). Of course, like the legislators who voted it into law, I have not read the 1000 pages and truly have no idea what the intended and unintended implications might be. But I do get the main point: as a society we will be spending an extra $1 trillion on health care that we wouldn’t have spent previously. This is the part that strikes me as a non sequitur to the debate.

For the past few years we’ve been hearing about how inefficient and ineffective the American health care industry is. We spend ten times as much per capita as Mexico, for example, and achieve a similar life expectancy. We spend two or three times as much per capita as a lot of industrialized nations, are less healthy, and are tortured by paperwork and bureaucracy. If you heard about an industry that was this uncompetitive internationally, the next thing that you’d expect to hear would be “and this is how it is moving offshore” or “and that is why people are choosing to spend less money on this service.”

The logical punchline to the health care discussion should have been “The U.S. health care industry has not been able to deliver most services in an affordable way, so it is going to concentrate on emergency care and simple checkups and screening tests. Ambulatory patients who require surgery will walk into their local airport instead of their local hospital. A Boeing 747 [a product that we are pretty good at making] will take them to a country where they’ve figured out how to take care of people without bankrupting them.”

It is odd that Americans seem intent on believing that we can somehow “fix” our health care industry through clever command-and-control bureaucracy sitting at desks in Washington, D.C., and that this question is worthy of national debate. Imagine if we were buying flat-screen televisions, PCs, and mobile phones made in the U.S. by government and insurance company contractors. An average family’s consumer electronics budget would now be $100,000. Would it be worth debating why these companies needed to charge $100,000 for something that could be purchased from overseas for $2,000? Or would it be more productive simply to import those goods and concentrate on doing other things in the U.S.?

So… for those who have asked. My reaction to the health care bill is bewilderment. We heard all about how much money the U.S. health care industry was wasting. Then our political leaders decided to give the industry an extra $1 trillion. The money is coming from tax increases, so presumably it is being diverted from products and services that American consumers would willingly purchase from efficient and competitive suppliers.

[There does seem to be precedent for this. We heard about how Wall Street and Fannie Mae executives exposed their shareholders to enormous risks so that they could have a chance at earning billions of dollars in bonuses. The industry was fully exposed as a means of transferring shareholder wealth into employee pockets. Plainly shareholders would have been better off investing in German and Chinese financial services firms. The seemingly logical response to the situation would have been to let the insolvent Wall Street banks disappear and be replaced by prudently managed American and foreign banks (this would have required no government intervention). What did Congress and the Federal Reserve Bank do instead? Toss trillions of tax dollars onto the Wall Street bonfire (see my review of It Takes a Pillage).]

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Living on a hillside, with a lot of hydraulic pressure from the uphill slope against the concrete foundation, I am feeling very grateful to the engineers and concrete workers who built the walls and the slab of our 1968 classic Deck House. A flooded basement is truly bad news in a house like ours, where half of the living space is in what most folks would regard as the basement. We have a lot of new materials and knowledge, but it seems as though hard work and intelligence forty years ago counted for something.

So far, despite the heaviest rains in approximately 100 years, I can’t find a drop of water up against the foundation. The 1968 septic system has not overflowed either.

So… to those unknown concrete technicians: thank you.

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Today was the first ground school for the 2600 introductory helicopter lessons that we sold through Groupon. Fifteen students showed up somewhat bleary-eyed at 9 am. Contrary to dire predictions at the instructors’ meeting last night, nobody fell asleep and in fact people seemed enthusiastic about learning all of the new material. A young motorcycle-riding kid was overheard to say “It was pretty technical, but I found the explanations very interesting, even the physics.”

Our 25-question graduation exam turned out to be a good screening tool. Three students got more than 7 questions wrong and we sat down with them for an additional 45 minutes to address their points of confusion (two of them were non-native English speakers). After that everyone was signed off and all but two were able to fly this afternoon (the weather happens to be perfect today).

The instructors in the helicopters report that these are among the best-briefed intro students that they’ve flown with. The customers, debriefed after the flight said it was “awesome” or they were “addicted” or they wanted to continue all the way to a career as a helicopter pilot (admittedly that guy came in with the idea in the back of his head).

We are, of course, right now seeing the eager beavers who did the reading and immediately registered for ground school. But so far I am encouraged.

Videos:

• http://www.youtube.com/watch?v=c0cKHXxm9vM
• http://www.youtube.com/watch?v=_O9KnncjdCY
• http://www.youtube.com/watch?v=P0UVdsMvmBI

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It seems as though the 1000-page health care bill is soon to become law. A friend of mine suggested the following strategy:

Consider a family in Massachusetts that earns $100,000 per year. They decide not to pay $20,000 per year for health insurance in 2013 when the bill takes effect (we already have the highest rates in the U.S. (source)). They get fined 2 percent of their income by the IRS, which costs $2,000 per year, plus pay a bit out of pocket for routine checkups. When a family member is diagnosed with cancer and needs treatment, they sign up for health insurance at $20,000 per year. The insurance company cannot deny them coverage based on the preexisting condition that was diagnosed a week before. After the cancer has been treated, they drop the insurance.

What’s the flaw in this strategy?

[Update: An April 4, 2010 article in the Boston Globe, “Short-term customers boosting health costs”, indicates that precisely this strategy was being used here in Massachusetts during 2009 (we implemented the proposed federal system here on a statewide level). Additional rules and bureaucracy are being layered onto the system to discourage people going forward.]

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Consider a boring training video, such as this one on how to brief an instrument approach. At various times in this video, an FAA approach plate appears on screen. It would be nice if, during those periods, parts of the player became active for mouse clicks. Clicking near a fix would bring up the airnav.com page about that fix in a separate window, for example. So there might be three or four buttons hidden in the frame and those buttons would be active only as long as the plate remained on the screen (i.e., 5 or 10 seconds out of the total video).

I’m assuming that the best way to do this is in Flash, since that is the main way that people seem to be embedding videos these days and I believe that there are some open-source Flash video players. But I would be open to other ideas that will still work in a standard browser.

How tough would this be for someone who actually knew how to program in Flash?

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The latest New Yorker magazine has a fun article on marriage therapy and one of its early promoters, who also was an advocate of eugenics. Jill Lepore, one of my favorite New Yorker writers, picks out some choice quotes from Paul Popenoe:

“Many a college girl of the finest innate qualities, who sincerely desires to enter matrimony, is unable to find a husband of her own class, simply because she has been rendered so cold and unattractive, so overstuffed intellectually and starved emotionally, that a typical man does not desire to spend the rest of his life in her company.” (Popenoe was, at the time, unmarried. Two years later, at the age of thirty-two, he married a nineteen-year-old dancer.)

Marriage therapy does seem to be premised on the questionable assumption that it is possible to live with another human being, seven days a week, 52 weeks a year, decade after decade, without them getting on one’s nerves.

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We’re expecting up to 2600 Groupon customers to come into East Coast Aero Club for ground school over the next calendar year. We’d like to avoid darkening the room and boring people to death with PowerPoint-style slides (illustration). That means a hand-out of about 10 pages, at least 70 percent color, that could be printed double-sided. So… now we’re talking about printing 2000+ copies (students should be able to take these course notes home with them). If done at Fedex/Kinko’s, this costs more than $5000. The latest generations of color laser printers don’t cost that much per page (Xerox claims down around 3 cents for some of theirs). So where to find a service bureau, ideally in the Boston area, that can take a PDF file and make us some stapled handouts at lower price than Kinko’s?

[I guess an alternative would be to have a traditional printer print this on a standard press, but we don’t want to print all 2600 copies at once because we may refine our ground school outline.]

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This is a follow-up to my posting about our attempt to get some Yelp reviews. The reason that we wanted to look good on Yelp is that we were planning to market some helicopter intro lessons via Groupon. We took our standard $225 helicopter into lesson and had Groupon sell it for $69. The fraction that they share with us will cover some of the cost of spinning the helicopter; we instructors will have to volunteer our time in order to try to convert some of these folks into long-term customers. We expected to sell 200 and hoped for 500. We figured that maybe 1-3 percent of these people would sign up as regular students, so we’d put in a few weekends of sweat and come out with 2-10 new students.

Starting just after 6 am, Groupon sent out emails to its roughly 200,000 Boston subscribers. I knew that there might be a problem when I checked a few minutes after receiving my email (I am a subscriber). They’d already sold 30. By 11:00 am, they’d sold more than 2000. We finally had to beg them to shut it down at 2600 (we could have set a limit initially but didn’t think to).

I think what this shows is that we were much worse at marketing than even we could have believed. East Coast Aero Club has been training pilots since 1985 and the owner reports that people almost invariably say “I didn’t know that I could learn to fly here; I thought that Hanscom was only an Air Force base.” Because the phone very seldom rings with new customer inquiries we figured that there was almost no market for helicopter lessons in Boston and not too much for airplanes either (though ECAC is one of the nation’s larger flight schools, with about 30 airplanes). One lesson that I’ve learned from Groupon, though, is that there were probably a lot more potential customers out there than we imagined but they didn’t know we existed.

On the other hand, we probably priced this deal too low. A huge number of customers telephoned the office to ask if they could buy the $69 intro lesson deal directly from us. We tried gently to explain that we weren’t quite sure how we were going to serve 2600 customers and that adding a 2601st would not help. We then offered them the $225 standard intro lesson price, which is already discounted to some extent. Nobody was interested at that price. So unless we can figure out how to sell them 2nd, 3rd, and 4th lessons at $69, perhaps this will be the first and last flight for nearly all of these folks.

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A friend looked at my posting about the proposed sales tax on airplanes in Massachusetts, likely to send airplanes and associated jobs across the border into tax-free New Hampshire, and asked “Why should there be a sales tax on cars and not on airplanes?” My first answer was “Because it is a lot quicker to fly a $50 million Gulfstream over the border than drive a $20,000 Toyota” (though perhaps this is wrong given recent reports of sprightly performance, albeit unintended, in Toyotas). But the deeper answer was “There shouldn’t be a sales tax on cars. It doesn’t make sense to discourage people from buying new fuel-efficient low-emissions cars. If the government wants to collect money from drivers it should do it by taxing gasoline, thus discouraging people from driving inefficient and high pollution cars.”

It seemed an obvious idea, but as far as I know there aren’t any states that have dropped a car sales tax and substituted a higher gas tax. How come?

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Folks: I’d like to create a file system archive of an email account. Suppose that I have 100 messages in an email account (for concreteness sake, let’s assume they are in gmail). I can configure the email account as a POP or IMAP server. From a Windows, Mac, or Linux machine, I would like to fetch all 100 of the email messages and write each one out to a file. I would like it if the file were sensibly named, but that isn’t critical. How to do this?

I think that I’ve tried the obvious solution, which is to pull the messages down into Microsoft Outlook and then “export” a folder. The result is a .csv file containing all the messages from the folder.

A friend suggested using Thunderbird and the following extension: http://www.nic-nac-project.de/~kaosmos/mboximport-en.html

Better ideas?

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