Will Work for Beer?

This is an idea just crazy enough to work in a city like Amsterdam. According to The New York Times, the city is now paying unemployed alcoholics to clean the city–and the payment is in the form of beer. They get five or six cans of beer, interspersed throughout the day, as well as tobacco, lunch and about 10 euros a day.

I had to share this because it is totally zany, but if you think about it, it’s not that bad of an idea. Obviously paying people with a substance addiction in beer is not ideal, but neither is letting them waste away through a substance addiction. Reading the article, I was really struck by the pride that these men took in their work:

“I’m not proud of being an alcoholic, but I am proud to have a job again,” said Mr. Schiphorst, the grateful beneficiary of an unusual government-funded program to lure alcoholics off the streets by paying them in beer to pick up trash.

Another man said the program raised his self-esteem and helped him decrease his daily alcohol intake:

“It keeps me away from trouble, and I’m doing something useful,” he said. “I help myself, and I help my community.”

In a way, it’s sort of like a rehabilitation program, helping them find a place in society, which I fully support. (Just the other day I was thinking about how our society should have some kind of equivalent of a Brotherhood of the Night’s Watch, which would serve to simultaneously oblige prisoners to serve and give back to society, while also giving them a respectable, redemptive path that they can be proud of.  I admit that I have no idea how that would work in practice, but it’s nice in theory.)

I can certainly understand why people might be skeptical about using government funds to sponsor an alcoholic’s booze, but do those same skeptics support additional funding for addicts? And if not, what alternatives do they suggest on how to deal with these societal outcasts?

We’ve got them right where we want them; now we can let them slip away

What the hell was the point of garnering hard-earned international support for sanctions against Iran? I thought it was to put so much economic pressure on the country that we could get them to end their nuclear enrichment, diminish their ability to threaten the U.S. and their sworn enemy, Israel. 

But apparently I was wrong. It would seem that all that pressure was applied so that we could get Iran to promise not to enrich their uranium by more than 5% over the next six months. That’s it. John Hinderaker at Power Line summarizes the results of the agreement best: 

What is striking about the agreement, on its face, is how little Iran gave up to obtain this badly-needed relief. In essence, it promised not to enrich uranium past 5% during the next six months. Of its existing stock of 20% enriched uranium, Iran will keep one-half and dilute the other half to 5%. But Iran’s enrichment program will continue, its research will go on, its nuclear facilities will not be dismantled. The agreement doesn’t mention Iran’s missile research and development, so that will continue.

In short, this agreement barely hinders their nuclear ambition while completely destroying any leverage that we gained from sanctions. (Which will be nearly impossible to replicate, considering how long it takes to make the consequences of sanctions felt, and how difficult it was to get the cooperation of other countries in the first place.) 

Luckily, Israel does not consider itself constrained by the United States’ stupidity; they seem prepared to fight back unilaterally against Iran. They may be bluffing, but considering how adept Israel has proven at self-defense over the course of its short existence, I highly doubt it. It’s a good thing Israel isn’t counting on the support of its allies; since they obviously can’t be trusted. The United States may have the luxury of indulging in naivete to the point of stupidity, but Israel doesn’t. Iran has made it abundantly clear that once it is capable of doing so, it intends to wipe the “rabid dog” of Israel off the map.  If I didn’t know any better, I might think Obama doesn’t care that Israel’s entire existence is in danger. 

Meanwhile, faced with another problem, Obama has turned to his most popular solution of late: kicking problems down the road. Can’t solve the budget problem? Push back the default date until the holidays! Can’t get people on board with his healthcare law? Push back the implementation of new policy standards! Can’t get Iran to disarm? Get them to agree to a tiny reduction in their nuclear growth–but just for the next six months. Maybe he can just push all our problems back until 2016, so they’ll be the next guy’s problem, not his. Ladies and gentlemen, the essence of leadership.

Filibuster, Begone!

At least for Presidential picks, anyway. I think it’s a smart decision–they can still vote unqualified people down, obviously, but they can’t waste everyone’s time infinitely to do so. It’s sort of encouraging that there’s enough bipartisanship to pass something (even if it was only passed 52-48). 

On the one hand, I sort of agree with Senator McConnell

“You think this is in the best interest of the United States Senate and the American people?  I say to my friends on the other side of the aisle, you’ll regret this. And you may regret it a lot sooner than you think.”

On the other hand, what does he expect the Senate to accomplish instead of this, repealing Obamacare? (It’s still not time yet for that–if the legislation continues to grow more and more unpopular, it could still happen. But they need to wait for the right moment.) Anyway, if Congress just waited until the most pressing issues of the day had been addressed to pass other, less critical legislation, then nothing at all would get done, since the big stuff never gets passed at all. (Obamacare being the massive exception that proves the rule.) 

So congratulations, Senators. You actually accomplished something today. And it’s a day that ends in Y! I think I just lost a bet.

Obamacare, Subjected to the King Solomon’s Baby Treatment

Please don't cut me in half!!

Please don’t cut me in half!!

The big political news of the last 36 hours, of course, is that President Obama has created a loophole in his own law. In order to live up to the oft-quoted “if you like your insurance, you can keep your insurance,” he has now announced that people will be able to keep their old plans through the 2014 calendar year.

I know what President Obama is hoping to accomplish with this temporary fix. He’s hoping that it will temporarily satisfy voters, appeasing them and renewing their goodwill with the Democratic party through the 2014 midterm election.  His approval ratings have reached record lows, so the running Senators cannot hope to ride his coattails.  In addition, since this piece of legislation is the Democratic Party’s defining act of the last couple of years, it is really important that it not be perceived as a failure.

But between the disastrous website roll-out, the abysmal enrollment numbers thus far, and the millions of cancellation notices that have been sent to people who were apparently happy with their “substandard” policies, well, let’s just say it hasn’t been a rousing success.  You can tell by the fact that Democratic politicians with something to lose have been jumping off the bandwagon as fast as humanly possible. First, it was Senator Mary Landrieu, who introduced the “Keeping the Affordable Care Act Promise Act.” (Just the name itself is a bit of a slap in the face of her ostensible ally, the President.) Then the party’s elder statesman, playing the long game with his wife’s future Presidential candidacy, tried to give himself plausible deniability against the least-popular aspect of the new law.

Of course, Senator Landrieu’s bill poses a serious threat to the foundation of Obamacare. As I’ve discussed previously, the bill hinges on a sort of redistribution of wealth—the middle-class and wealthy pay more (even the people who don’t need more), in order to ensure that the poor can be covered. If the middle-class and wealthy aren’t paying more, who is going to cover the cost of the poor?

The President’s bill was in jeopardy on the left from Senators like Landrieu and Feinstein who would make the Affordable Care Act unsustainable. It was also in danger from the right, thanks to the continuing threat of repeal from Senators like Cruz—a threat that might carry more weight as the law became increasingly unpopular. So, to appease both threats, the President split the difference and came up with his compromise.

That’s why he did it. How he is going to do it is another question. As Paul Mirengoff explains, the President does not have the authority to bypass his own law.

Even if he did, however, this so-called “fix” strikes me as the equivalent of King Solomon cutting the baby in half. (For the sake of this analogy, President Obama is both the King, doing the cutting, and the mother, since the bill is his offspring.)  He’s trying to quiet his opponents on both sides, but he’s going to end up with a dead baby on his hands, without solving either of his problems. For the people who get to keep their plans through 2014—great! Until 2015. Then what? (Doesn’t it seem like President Obama has a habit of kicking problems down the road? Federal debt crisis, anyone?) He’s just postponing, not solving, the problem. That may alleviate pressure for the 2014 midterm, but then again, if people start getting cancellation notices again right around election day, it may not.

It also puts the viability of the program in danger, for the same reason that Senator Landrieu’s bill would have done.  Granted, it’s only for a year, but we still don’t know whether it will cause a so-called “death spiral.” So this solution isn’t avoiding that potential pitfall either; at best, it’s lessening the blow by making it temporary.

Look, I’m not one of these people who is hoping that Obama will fail in his mission. (My political affiliations just aren’t strong enough for me to favor my party’s success over the nation’s.) Healthcare is a mess and I genuinely admire that he has waded into the muck to try to make the situation better for the majority of Americans.  But as the expression goes, the road to hell is paved with good intentions. Rhetoric and idealism are not sufficient when you’re overhauling a multi-billion dollar industry that deals with life and death. I sincerely hope he is able to pull this off. But right now, I am not counting on it.

Forty Years Later: 26 Stories

In case you missed it, you should check out this feature in New York Magazine. Roe vs. Wade was passed forty years ago (yes, that number surprised me too), but as we all know, abortion remains a contentious issue in this country. If we get a couple more conservative justices on the Supreme Court, it is not at all clear that the status quo will remain.

What I like about this piece, which includes blurbs from 26 women who’ve had abortions all over the country, is that it doesn’t seem to have an agenda. Some of the women seem to have no regrets–one women concludes her story by saying, “In the waiting room, my husband said, “Where do you want to go on vacation?” We booked a trip to Spain.”–which strikes me as pretty ice cold. But some women do regret it. Most of the women are deeply ambivalent, juggling concerns about whether they could afford a baby, whether they wanted to be tethered to the man who impregnated them, whether the pregnancy was “God’s will,” and even grappling with issues relating to the health of their fetuses. Some of the most interesting stories were the older ones–one woman had an abortion in the 1960s, when it was still illegal, and the doctor told her she’d never have another child and that she shouldn’t call the doctor’s office after she left (even though she was bleeding profusely). Pretty harrowing stuff.

Abortion was an issue I grappled with for a long time, and it’s stories like that which have rendered me pro-choice. The knowledge that it will happen anyway, and the dangerous means which women would have to endure for the procedure if it was de-legalized, is one argument which carries a lot of weight with me.

There’s also this, as one woman put it about the people who dissuaded her from having an abortion: “I went ahead and had my son. Those people weren’t there after I lost my job and couldn’t afford my COBRA, utilities, rent, food.”

That being said, it is repugnant when there are women who have had lots of abortions–who have no interest in having a baby and yet aren’t using any birth control.  Thoughtful people can universally agree that an abortion shouldn’t be your primary form of birth control. On the other hand, I think that one of the things this story does well is show why that’s the case–why it’s not a decision to be undertaken lightly.

Ending Whack-a-Mole: A Concept for Lowering Healthcare Costs

Whacking symptoms or problems reactively is not the most efficient healthcare system.

Whacking symptoms or problems reactively is not the most efficient healthcare system.

One of the reasons healthcare remains such a contentious and intractable issue is because of how expensive everything is. Scans, procedures, appointments—they’re vastly more expensive than in other well-off countries, such as Canada and the Western European nations. When I was living in Paris, I once had a lengthy doctor’s appointment—a full half hour, with an examination—and at the end, the doctor just asked me for 32 euros. She took the money and stuck it directly in her wallet. No insurance, no paperwork, no bills in the mail for an extra $65 on an appointment that happened two months ago (an occurrence that happens regularly with my doctors here in Miami). It was a revelation.

But why is everything so expensive in the States? This has been discussed at length by other healthcare specialists, but the main reason is that our entire system is reactive instead of proactive. Instead of making a concerted effort to teach people about nutrition, diet and exercise—in schools, for example—we let them get obese and then have to treat them with expensive medicines and surgeries.

Another example is that way that perpetual 911 callers are dealt with. This isn’t the first article that I’ve read about this problem, but it clearly depicts the situation.  This DC area woman calls 911 literally hundreds of times a year. The paramedics have memorized her social security number and birthdate, because of the frequency with which she calls them. For the first time, the authorities are talking about what should be done for her—because the status quo has been continuing for years and obviously it’s doing nothing, other than wasting taxpayer dollars. She’s not getting any better, and it’s using up a ton of time, money and manpower every time she calls them and they have to respond.

In order to be proactive, instead of reactive, our healthcare providers would have to stop focusing on the quashing of individual symptoms or flare-up incidents, and concentrate on treating the root cause of the symptoms. It would benefit both the patients, because they’d feel better for longer, and our healthcare system, because it ineffectually treating the same problem over and over, they’d stop the problem at its source. I see it as the equivalent of whack-a-mole—instead of whacking each mole as it pops up, they should go to the back of the game and unplug the whole system. You might have to get your hands dirty, it might take longer and cost more in the short term, but in the end, it’s a much more efficient way to prevent damn moles from popping up all over the place.

I don’t want it to sound like I’m blaming doctors and nurses for this reactivity problem, though—at least not entirely. Because of the way our healthcare system is designed, doctors see way too many patients, are rewarded for each procedure they perform, and are often so specialized that they can’t see the full picture. A single patient may see four or five experts for the same problem, and because their schedules are so hectic, doctors don’t have time to really sit and talk together about any one patient at length. Instead of getting paid for each procedure they perform or appointment they have, maybe they should get paid for good results—how healthy their patients are.  Perhaps the next healthcare law should be focused on addressing these kinds of issues?

The Failures of Technocracy and Socialism

Or, put in another way, the problems with Obamacare. Now that the law has been enacted for about a month, some of the fundamental problems with the Affordable Care Act have become apparent. The two main problems with the law so far appear to be accessibility and affordability. 

Accessibility:

The difficulties that people have encountered in accessing insurance quotes through the Healthcare.gov website have been well-documented. Not only does the website appear to be full of bugs, but in order to see what sorts of plans are available, people have to create an account and input their personal information, which has proven to create a severe bottleneck on the website. So far, the specific issues with the website are the following:

1)     People haven’t been able to purchase insurance because the website is dysfunctional or buggy.

2)     Their information isn’t secure.

3)     It continues to crash, even though the technicians are supposed to be working on it day and night.

The website’s problems have gotten to be so severe that even Senator Feinstein (D-Calif.) says that it should be closed until they have been fixed.

These problems, however, merely reflect a faulty website. One assumes that once these “glitches” have been repaired, the accessibility issues would disappear. However, because of the intricacies of healthcare in this country, it is likely that even without technical issues, website users could feel overwhelmed and uncertain about which plan to choose. The state of Kentucky has actually become a model in this regard, offering website users “navigators” who help them figure out how to use the site and can clarify their options for them. (Anyone who has ever been told to “go to the website,” when faced with a complicated question, and then found an uninformative or confusing website with no answer in sight, can appreciate how valuable the human touch must be for people using Healthcare.gov.)

Is it likely, though, that the other 49 states will follow Kentucky’s example and offer the resources necessary for website users? Maybe it’s the cynic in me, but I doubt most will. That’s the problem with technocracy: it assumes not only flawless technology but also a flawless product (in this case health insurance, which is almost always confusing and flawed) and highly adept technology users (which not everyone is).  Even once the website is fully functional, then, users will probably still have difficulties.

Affordability:

Considering that this is right in the name of the law, the absence of affordability in the new, government-compliant plans is severely problematic. Many website users are experiencing so-called “sticker shock” at the plan prices. Stories about single men having to pay hundreds of dollars a month more than their old plans for maternity coverage (required by the new law) abound.  The problem is that we want everyone to be able to have healthcare in theory, but in practice, that requires a major redistribution of funds.

After all, the poorest members of our society can’t afford health insurance, so we’ve created these subsidies that will make it affordable for them. But the money to cover those expenses doesn’t grow on trees, so the rest of society covers the costs of their care, by making people get more expensive plans and pay for treatments that they won’t need (see again: single men paying for maternity coverage).  If we decide that’s what we want to do as a society—redistribute middle-class money to pay for the insurance of the poor—fine. But call a spade a spade (or in this case, call socialism socialism). Don’t tell the American public that their options will be “affordable,” or that “if you like your plan, you can keep your plan.”

Why did Obama lie about what the healthcare act would do? Probably because Americans have never really been very fond of socialism, especially when it means they have to pay a lot more in healthcare costs. Let’s be honest: a lot of people think that the poor should have access to healthcare when some abstract government entity is covering it, but feel a lot less magnanimous when they realize that coverage is coming directly from their pockets. (Jonathan Chait in the NYMag makes basically the same argument, but from a different slant–he essentially says that if we’re going to be a moral society, people should be willing to make the sacrifice and pay extra on behalf of those who can’t afford it. I’m not saying he’s wrong, necessarily, but I don’t think people usually vote based on theoretical morals; they vote from their pocketbooks.)  

Will these realizations spell doom for the Affordable Healthcare Act? Only time will tell.