Robert Bork named Chairman of Romney's Justice Advisory Committee

There is now another entry in the "Republicans have Jumped the Shark" contest.  Romney has named Robert Bork the Chairman of his Justice Advisory Committee.  After citing a number of Bork's controversial views, the New York Times called him "a polemicist for ultra conservative ideas,"

Why I love Obamacare

I am an independent conservative.  I believe in American ingenuity, and in free market capitalism.  When I think of problems our country faces, sometimes I dream up free market solutions that no one ever thought of.  I understand the perverse consequences of high marginal tax rates, and can explain the Laffer curve.  I’ve voted for lots of Republicans.

All of this suggests, you would think, that I oppose Obamacare, which Republicans have labeled socialism.  You would be wrong.  I’ll vote for the guy who wants to keep it and against the guy who wants to “Repeal it on Day 1.”  This is the story of why I love Obamacare. 

Of course you’re now thinking I suffer from a terrible cancer.  You are wrong again.  I am healthy, thank God.  My wife, son and daughter, thank God, are all healthy too.  I can afford insurance.  All four of us have been continuously insured since the day we were born.

Imagine someone starting off on his own as a consultant after years of employment.  There are millions of people like this, including me.  We need to move from my group insurance policy at Blue Shield to an individual insurance policy at Blue Shield.  We have been with Blue Shield for years.  This will be easy, because this is America, and America is exceptional.  Whatever faults the health insurance market may have, and some argue it has many, I know it has no problems at all dealing with healthy families that have been continuously covered and can afford insurance. We are the perfect health insurance customers.  It may not be fair, but financial services companies of all kinds fawn all over me in their attempts to win my business. 

In another, less exceptional country, this trivial change from “group” to “individual” insurance could be a bureaucratic nightmare.  But in America, staying with the same insurance company, a paragon of private enterprise efficiency, it’s a single, two-minute phone call.  Three minutes, tops.

Wrong.  After about 6 hours filling out the world’s most humiliating medical underwriting form, plus another three hours in follow-up phone calls, Blue Shield decides to issue an insurance policy for me and my son, while refusing to cover my wife and daughter at any price.  At.  Any.  Price.

Did I mention my wife and daughter had been insured by Blue Shield for years?  Did I mention my wife and daughter are healthy, and that they have been continuously covered since the day they were born? 

What does it say when a free market can’t even address the needs of its ideal customer? 

I don’t blame this fiasco on Blue Shield, and you shouldn’t either.  Blame it on an individual insurance market that’s unable to function properly due to a problem called adverse selection, where the people who buy insurance tend to be those the insurance company will lose money on.  This is a market failure.  Every free market capitalist knows that markets can fail.  This is, however, where American ingenuity shines.  We’re exceptionally good at structuring free markets such that they can function properly and work their Adam Smith magic.

And we know exactly how to make the individual health insurance market function properly.  Although it gets technical, a properly functioning health insurance market requires four critical characteristics:

(1) Guaranteed issue – an insurance company can’t cherry pick the best customers, and neither can its competitors.

(2) A ban on exclusion of preexisting conditions.

(3) Community rating – everyone in a given age group pays the same premium.

(4) The widest possible risk pools – virtually everyone is covered, as is the case in the group insurance market and with seniors, solving the adverse selection problem.

That is exactly what Obamacare delivers on January 1^st, 2014, a date that cannot come soon enough.  A humiliating, bureaucratic, expensive, nine-hour medical underwriting process?  Gone.  A decision to decline coverage, or charge more?  Illegal.  You should be able to go to a web page, supply your name, address, birth date, social security number, credit card and expiration date, and, paraphrasing an iconic Silicon Valley entrepreneur, boom, you’re covered.  As fast as an Amazon book order, except for the two additional pieces of information (birth date and social security number).  It would be impossible for Blue Shield to make these improvements unilaterally, because if they did, it would put them in an adverse selection death spiral.

As you probably know, there are other narratives about Obamacare.  There’s the Supreme Court decision; the death panel conspiracy theory; the Blunt amendment which, had it succeeded, would have allowed any employer to exclude any medical service from coverage for any reason, and which caused Olympia Snowe to retire from politics.  There are the people with cancer who can’t get coverage; the businesses of all kinds stiffed by medical bankruptcies; the poor.  There are the Republicans incensed by “socialist” Democrats, and the Democrats incensed by “heartless” Republicans.  There is the “Medicare-for-all” crowd.

I empathize with all those narratives and the emotions behind them.  And I believe a country without universal health insurance can’t call itself a first-world nation.

But these narratives don’t reflect my story.  I neither expect nor deserve your sympathy.  There is trouble in paradise, however, when a market can’t even address the needs of its perfect customers, and, by the grace of God, I am a perfect customer.  I love Obamacare because it represents American ingenuity at its finest.  I revel in the audacity of a classical American question: Can we make the individual health insurance application process not twenty percent faster, not twenty times faster, but two hundred times faster?

Maybe you support Obamacare for one or more of its other provisions: the ban on lifetime caps; the filling of the Medicare drug benefit donut hole; the refunds when premiums are too high; the ‘no one left behind’ expansion of Medicaid; the subsidies for those who can’t afford insurance; the incentives for small businesses; the provisions related to accountable care organizations; the ban on co-pays for certain preventive services.

Maybe you oppose Obamacare, or maybe you don’t love Obamacare as much as I do, because, like many, you are covered by group health insurance or Medicare, and the fact that the individual health insurance market can’t function properly is irrelevant to you, at least for now.  Or you’re a medical underwriter, and the humiliating, time-consuming process we experienced represents good money.  Whether you support it or oppose it, however, Obamacare represents an ingenious free market solution.  Anyone who calls it socialism doesn’t understand free market capitalism. 

To those of you who have to apply for individual health insurance prior to 2014, you have my deepest sympathies.  It will not be like ordering a book from Amazon, although it should be.  If you’re 26 or younger, Obamacare provisions that have already taken effect might spare you from the horror I experienced.  If not, and if you are any less perfect a health insurance customer than I am, I shudder when imagining what your experience could look like.  I pray you survive until January 1^st, 2014, when you can join me in celebrating American ingenuity.

(Postscript: after enduring a second humiliating medical underwriting process, my wife and daughter are now insured by Aetna.  Having two insurance companies means our family deductible is essentially twice what it should be.)

An outstanding article from an outstanding author

Warning - if you're like me, once you start reading this article, you will not be able to stop.

Michael Lewis: Obama's Way

Famous words from the moon

Neil Armstrong's death over the weekend brought back memories of the lunar landing as well as the time I met Gene Kranz, Apollo 11's launch director, when I arranged for him to speak at a user group meeting.

Neil is best known for the "... one giant leap for mankind" quote, but after reading Gene's book Failure is Not an Option, some other words spoken by Neil, what many consider to be the best test pilot ever, and his lunar module colleague, Buzz Aldrin, are equally memorable for me.

"Forty feet, picking up some dust, thirty feet, seeing a shadow ... contact light ... engine stop ... ACA out of detent."

What's memorable about these words aren't the words themselves, but the equanimity with which they were spoken by Buzz, at Neil's side in the lunar module, during a nerve-wracking landing, with a descent engine running on fumes, as if they had performed hundreds of lunar landings before, which of course they had, in practice. Buzz transitions to the descent engine shutdown checklist without a trace of emotion, during an event Gene Kranz compares to Columbus wading ashore in the new world. (Checklists would continue in the lunar module as well as at mission control, making tough "stay/no-stay" decisions at two minutes after touchdown, eight minutes, and two hours.)

"Houston, Tranquility Base here.  The Eagle has landed."

There's a little more emotion here. Tranquility is a reference to the area of the Moon where they landed, the Sea of Tranquility. What's remarkable is that in all the preparations for Apollo 11, no one had ever uttered "Tranquility Base," a term conveying a confidence that did not naturally arise from the circumstances. I don't remember where I heard this back story, or whether Neil ever said how he came up with it.

A table saw that cuts wood but can't cut fingers

This is pretty impressive technology: http://www.sawstop.com/.  It detects the electrical characteristics of blood, and stops the sawblade in 3-5 milliseconds.  Making some reasonable assumptions, about 90% of that time is spent in detection, making the stop decision, moving the brake into position, etc.  Once the brake finally comes into contact with the sawblade at the end of that process, it takes roughly 500 microseconds to bring the sawteeth from 120mph down to zero, the equivalent of roughly 12,000G's.  The general contractor who showed me the saw says you hear a loud BANG!, the sawblade has vanished (the effects of angular momentum cause the blade to retract into the table faster than you can see), and all you have is a small nick on your finger that barely warrants a band-aid.  Replacing the blade and the brake will set you back about $100, but that is cheap compared to the alternative.  One flaw I noticed is the brake system requires power, so if there's a power failure, there's no finger protection until the sawblade comes to a stop.

Patients Would Pay More if Romney Restores Medicare Savings, Analysts Say

Current law includes $716 billion in Medicare savings, endorsed by the AARP. This article in the New York times points out that Romney's promise to revoke those savings means seniors would pay more for healthcare:

Marilyn Moon, vice president and director of the health program at the American Institutes for Research, calculated that restoring the $716 billion in Medicare savings would increase premiums and co-payments for beneficiaries by $342 a year on average over the next decade; in 2022, the average increase would be $577.

Beneficiaries, through their premiums and co-payments, share the cost of Medicare with the government. If Medicare’s costs increase — for instance, by raising payments to health care providers — so, too, do beneficiaries’ contributions.

Ryan's budget uses those same savings to pay for tax cuts for the wealthy, and only balances by including artificial spending caps that would push even more costs onto the elderly.  By contrast, Obamacare uses those savings to pay for healthcare.

A Tale of 2 Plans

The essay A Tale of 2 Plans in the Journal of the American Medical Association points out a political irony: on the political spectrum, Obamacare is to the right of Ryan's Medicare plan in key (but not all) respects.  Yet Republicans oppose the former and support the latter, while Democrats support the former and oppose the latter.

Update: Over the weekend the New York Times had a great article on Medicare Advantage.