Idiotprogrammer Blog

Category: Social Sciences

  • Dear Mr. Cornyn and Ms. Hutchinson (RE: Health care)

    (Here is a short complaint letter I sent to my US Senators. I have basically given up on writing these people because they seem to have ideological blinders on (especially Mr. Cornyn).

    Dear Mr. Cornyn and Ms. Hutchinson:

    I wanted to point out one fact: my Aetna individual health insurance rates skyrocketed 40% in 4 months. I am a perfectly healthy person and haven’t visited the doctor in 4 years. (The rates of other companies have gone up considerably).

    That is capitalism. I accept that. What I don’t accept is your failure to participate in any kind of meaningful discussion about health care reform (except in an obstructionist and  jeering way). Solving my particular problem isn’t rocket science: individual mandates coupled with some kind of subsidies for indigent people. Most observers say this is a fair and necessary policy change.

    When I see this 40% increase, I blame YOU  specifically for failing to endorse any comprehensive solution.

    Here are 4 articles I wrote about the subject of health reform.

    http://www.imaginaryplanet.net/weblogs/idiotprogrammer/2010/02/health-insurance-rate-hikes/
    My recent thinking about death spirals and health insurance.

    http://www.imaginaryplanet.net/weblogs/idiotprogrammer/2009/09/health-care-reform-and-medical-bankruptcy-answering-the-libertarian-argument/
    (I know your position papers and mass mailouts are full of the usual libertarian claptrap; I address these concerns in a general way)

    http://www.imaginaryplanet.net/weblogs/idiotprogrammer/2010/02/the-free-market-can-be-a-time-sink/
    How the notion of a free market in health insurance assumes an infinite amount of time and knowledge to make decisions. Some people have this luxury; most do not.

    http://www.imaginaryplanet.net/weblogs/idiotprogrammer/2008/12/how-to-buy-an-individual-health-insurance-policy-in-texas/
    In 2008 I wrote an article for Texans about how to buy individual health insurance.Suffice to say I have looked into  Texas consumer issues in depth.

    I have been tempted to write detailed responses to any one of your misguided missives, but frankly, your arguments are replete with misinformation and industry talking points; why bother? But I’ll throw out random remarks.

    http://cornyn.senate.gov/public/index.cfm?p=NewsReleases&ContentRecord_id=8b8955bf-ac40-4bf8-b54b-edd2ca6197e3
    (RESPONSE: Entitlements is a problem, but not THE problem, which is adverse selection and  death spirals. You are diverting attention away from the REAL problem).

    http://cornyn.enews.senate.gov/common/mailings/?id=314
    I reject the premise of your  article. The Mass Senate victory was fueled by Massachusetts people’s antipathy towards helping states with stingy Medicaid coverage.

    http://cornyn.enews.senate.gov/common/mailings/?id=303
    this article is frankly nonsense. Earmarks are not THE problem here (but they are A problem). This horse-trading is being done because of Republican obstructionism. If you supported  a comprehensive solution, this kind of horsetrading would not need to be done.

    http://cornyn.enews.senate.gov/common/mailings/?id=301
    I’ve seen different numbers than the ones you quote. Also, you haven’t really distinguished your bugaboo from the status quo (which is already swallowing us in health care increases). Also, your complaints would seem to be an argument for single payer.

    http://hutchison.senate.gov/cc010810HealthCare.html
    (I just wanted to say this is one of the vaguest articles I have seen. Transparency is important and a debatable issue with respect to health care reform. but it is a minor side issue).

    http://hutchison.senate.gov/pr122109a.html
    You say the bill was rammed in the middle of the night. This is grandstanding and you know it. You guys had an entire year to debate many provisions of this bill (and I watched hours of it on CSPAN). You can’t on the one hand be obstructionist and at the same time blame Democrats for having to do last minute negotiations as a result of your intransigence.   You can’t pretend ignorance about what was in the bill. Legislation is always a moving target, but to claim that the Democrats are hiding their activity from public scrutiny is dishonest and unfair. (By the way, I sure wish I could have been able to witness the discussions of  Aetna execs when they decided to raise my rates. Oh well, I  guess I won’t be hearing you express any pseudo-outrage about that!)

    http://hutchison.senate.gov/cc121809Healthcare.html
    (At least this gets into specifics! ) My basic response is: so what! You shouldn’t accuse Obama of saying falsehoods without stating the context of each remark (which is that Republican intransigence forced the bill to be reshaped several times).  You talk about more taxes. So what! From my perspective it’s either paying  increased costs to insurance companies or the government. You talk about tax credits. (which I’m semi-neutral about). But so what! You are focusing on the viability of insurance markets when you should be focusing on  health outcomes. Is it a matter of indifference to you that insurance coverage in Texas is one of the nation’s highest and that our Medicaid is one of the stingiest?

    Finally Ms. Hutchinson  you have failed to take responsibility for the increased mortality rates as a result of noninsurance. I would think that in Texas this would be the number one issue. For you, that seems to be hardly worth mentioning. You seem more concerned with preserving a market free of regulation even if it means worse outcomes and  rapidly increasing individual rates.

    That is sad.

    Robert nagle

    Update: This screencapture about summarizes the kind of games Cornyn plays.

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  • Health Insurance Rate Hikes

    Ironic Postscript: Hours after I wrote this, I received a note from Aetna informing me of another price increase for health insurance.  Until January 2010 my total price for a $5000 deductible health insurance + dental plan  was $148. Starting January 2010, it bumped up to $184. Starting April 2010, the price is $207.  This seems certainly to be a death spiral.

    What happens if you delay passing individual mandates on health insurance?

    The prices go up, up up! In a Noam N. Levey piece on health care, he notes:

    1. Profits for health insurance co. went up 56% in 2008.
    2. The major insurers covered 2.7 million FEWER people than the previous year.
    3. Health spending as % of GDP went up to 19.3% (it was 13.7%) in 1993.

    The individual health insurance market has gone haywire. My own individual health insurance went up 25%, and in California Anthem’s individual policies had increases up to 39% increases.  When I posted an article about it on Facebook, two people chimed in rate increases of 23% and 50%. Robert Reich notes:

    WellPoint’s profits rose to $2.7 billion last quarter. Even if you subtract one-time-only financial maneuvers, WellPoint is still fat and happy, which makes Anthem fat and happy. Everyone is fat and happy except Anthem’s policy holders, who are being skewered.

    Anthem’s argument is even more questionable when you consider that Anthem has been among the most aggressive opponents of the health-care bills passed by the House and Senate. If Anthem were sincere about why it’s raising its rates, it would be embracing the legislation. The Senate and House bills would add tens of millions of Americans to insurance pools – thereby spreading the costs over more people and avoiding the very problem Anthem says is now forcing it to raise its rates so much.

    Even more troubling is the fact that Anthem obviously believes it can raise its rates by as much as 39 percent without losing every one of its remaining customers with average or even somewhat above-average medical needs. The only way it could possibly raise its rates so high and expect to keep its customers would be if Anthem’s customers have no other choice. In other words, Anthem’s strategy makes sense only if Anthem faces little or no competition from other health insurers.

    I wouldn’t be surprised if this were the case. Insurers, remember, are exempt from the federal antitrust laws. And WellPoint, Anthem’s parent, is the largest insurer in America.

    Caveats are in order. A health insurance spokesman says that the comparisons with when companies were in the middle of recession are not quite fair. Also, average profit margins for the insurance industry are historically low (3% on average).  Rick Newman provides more numbers.

    The problem I have with health insurers is not that they make money, but they that they claim the right to refuse customers while at the same time benefitting from tax subsidies for employer plans. A private insurer can reject a person without answering to the public. Health insurers don’t need 100% coverage; their goal is simply to maximize profits (even if their business plan to cover only athletic 22 year old billionaires). What happens when there’s too much cherry picking and the public has to pay the tab? "Privatize the profits, socialize the losses" seems to be the strategy for the health care industry. And it gets worse:

    Insurance companies last year continued to try to purge their most costly customers, which are often small businesses with older workers, said Richard Kirsch, national campaign manager for Health Care for America Now.

    Another reason for the robust profits, Mr. Kirsch said, is that the companies reduced the percentage of their premiums that they spent on actual medical care and devoted more to administrative costs and profits.

    A third factor, he said, is that the insurers continued to attract more customers to public programs like Medicare Advantage, in which the federal government pays private insurers 14 percent more than it pays Medicare to cover the same people.

    The report said that the insurance industry’s long-term strategy was to shift responsibility for the care of millions of older, sicker and lower-income customers to taxpayer-supported programs, like Medicaid and the state Children’s Health Insurance Program. Those programs in turn are increasingly hiring the big insurance companies — and paying them — to manage the coverage.

    (The full PDF report is worth reading; full of good analysis of facts).

    In addition there is a power imbalance here. Multibillion dollar companies can refuse coverage secure in the knowledge they have a huge legal department and generally sympathetic regulators to prevent the individual from complaining or suing them.

    The justification for the privatized system was that private insurers will step in and provide private insurance for the public. Over the years, this coverage has been declining and becoming massively more expensive. Therefore, the justification for relying on the private system to fulfill a public concern is becoming more suspect.

    My preferred solution (if you take the privatized system as a fait accompli) is individual mandates. Generally people on both political sides agree with that, but disagreed with implementation details (subsidies, tax breaks, etc). Also, libertarian obstructionists have used the failures of the private system as a reason to justify even further use of it. (I’ve written about that here).

    That private strategy is also costing taxpayers a lot of money. We as taxpayers have a right to demand oversight for an industry that is increasing costs 5-10% per year (or 25% increases in the individual market). It’s easy to say, let the market offer better services. I’m sorry, but that hasn’t been happening; not only are costs increasing, but the number of companies offering services is decreasing.

    Update: Kevin Sack reports on the outrage in California.

    Medical costs have typically risen by 5 percent to 10 percent during each of the last five years. Mr. Poizner said he was starting to see significant increases for individual policies sold by some of Anthem’s competitors, and double-digit increases have been reported in other states.

    Several insurance analysts said it was possible, but not necessarily likely, that such increases would become common, at least while the economic downturn persists. Insurance brokers in Los Angeles said they had never seen jumps of such magnitude.

    “It’s more astonishment than irritation,” a Pasadena broker, John W. Barrett, said of the reaction from his customers. “Irritation was last year and the year before. Now they’re astonished.”

  • Health insurance and mortality

    A few months ago I brought up the question of amenable mortality as it relates to health care and insurance.  While the topic seemed interesting to me, I had to admit that the evidence looked questionable. When talking about public policy, it’s nice and convenient to have a way to quantify the number of corpses on the table,  but ultimately that kind of analysis fails to address the big questions for the sake of chasing after the “merely measurable.”

    Matt Yglesias summarizes some of the latest data.

    Ezra Klein covers the subject in more depth after first responding to a point by Megan McArdle:

    What we’re left with is three classes of evidence. The first are the major observational studies attempting to model something difficult to model, which is the causal effect of insurance on mortality. They do their best to control for the confounding factors and find an effect anywhere from 18,000 and 45,000 unnecessary deaths a year. The second are the natural experiment studies. The only one that measures people who are actually facing death in the near-term — and these studies are only really useful in the near-term — finds a 20 percent reduction in death rates. Then there are the many, many studies assessing the effect of insurance on conditions that kill you, like high blood pressure and cancer. And they show a large protective effect from insurance.

    “Policy can’t wait for perfect evidence,” (Harvard health care economist Katherine) Baicker says. “The evidence we have is strong enough that insurance is important for people’s health that one oughtn’t use the excuse of the absence of perfect information for not doing something about it.”

    There are 2 other effects to consider.

    First, delaying medical exams. I have a 5000$ deductible for my individual policy. I have coverage for a physical (up to maximum of $200 including lab work). Practically speaking though, a physical would be expensive. (The last time I went, the doctor ordered a routine test — an EEG — which cost me $700). This is money which comes straight from my pocket, and a strong disincentive for me to get a physical. Do  mortality estimates take into account the reduced number of office visits by people who have insurance policies but delay or avoid visits out of fear of the costs (and yet my individual premiums increased 25% from last year).

    Second, medical bankruptcies. Even if amenable mortality figures are later found to be fishy, we still have the economic toll of cost overruns. The sick individual (who is least able to earn income) is expected to pay maximum out-of-pocket costs which can run to $10,000 or $20,000 (if insured) or unlimited if uninsured.

    To the future anthropologists reading this blog entry: yes, these are the crazy things 21st century Americans used to worry about!

    Update: J. Michael McWilliams provides more documentary evidence.

  • Various things smart people should know

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    Business reporters Alex Nussbaum and Meg Tirrell estimate the impact of no health care reform on the US.

    One in five working-age Americans lacked health coverage during the first half of 2009, the highest in six years, the U.S. Centers for Disease Control and Prevention said in a Dec. 16 report. Health-care spending last year reached an estimated $2.5 trillion, rising 6 percent from 2008, analysts with the U.S. Centers for Medicare and Medicaid Services said in another paper, released Feb. 4 in the journal “Health Affairs.”

    I was shocked to learn that my super-high deductible Aetna plan went up 25% in one year – and I haven’t visited a doctor in three years!

    Here is an incredibly informative 90 minute lecture about the science of climate change.  I found that I watched the whole thing. (I recommend the slides on the same page too). Joe Romm interviewed each of the two scientists afterwards as well.

    Here’s an outstanding video by Peter Sinclair about plugin hybrids.  Apparently, having cars recharge their batteries is very compatible with our current power grid. Why? It’s done offpeak at night, and this electric reserve from the car could theoretically be shifted to the household during peak times (when the local power company usually needs to resort to their dirtiest power generator). Fascinating stuff!

    Garry Kasparov on chess.  Apparently the new thing is team matches (each consisting of 1 person and 1 computer).

    A while back I blogged about the hilarious Charles Brooker media criticism TV show.  I didn’t realize that this came from a longer TV series on BBC (See here and here and here).

  • You do not have the right to waste my time: Ignorance Removal Service

    (If a person has redirected you to this page, that is because the person sending you here thinks that you have used one or more tactics described below and should seriously consider either reexamining your argument or   purchasing the Robert Nagle Ignorance Removal Services. My prices are very reasonable: $300 per hour with a required minimum of 1 hour).

    image

    A few years ago a family member forwarded an email about the spurious claim that underarm deodorant causes breast cancer. That email infuriated me for various reasons. First, the email exhibited many of the classic characteristics of a bogus email.  Second, the truth of the email could easily be fact checked. Typing “breast cancer” and “underarm deodorant” in a search engine easily disproved this idea in less than one minute. When I mentioned this fact to the person who sent the email, he/she replied, “I was wondering if it were true.”

    You were wondering about it!?!? You didn’t know whether a fishy story was true; therefore, you forward it to two dozen of your closest friends to circulate the half-truth more widely! How is that an example of commitment to truth? But this person did not preface the email by saying, “I’m guessing this is false; can anyone confirm this?” He/she simply passed it along unthinkingly.

    When you do that, you are in fact using your reputation to promote this alleged  “truth.” You are tying people’s opinion of you to this piece of crap. So you better take the time to make sure you are  willing to stand behind it.

    More importantly, you are wasting my time. And if you forwarded it to 100 people, you are wasting 100 people’s time.  I’ve noticed that people have different opinions about what constitutes a worthwhile email. Some  think an email of 100 jokes is justified by entertainment value. I don’t share that opinion, but at least I understand the motivation behind this impulse. (That is why good labeling in the subject line is important).

    I have noticed (not only in email but on comment sections as well) that climate denialists will respond to solid science with URLs that purport to disprove some point or point to some counter-hypothesis, but in fact rely on some old tired argument long since discredited. When a person recently commented on a global warming thread by linking to a discredited petition, I immediately dug up the links about this petition. Then I realized, this commenter has already beaten me up  by wasting my time. Rescuing people from ignorance is a thankless and time-consuming job, but a blogger should not have to spend more than 3% of his time doing it. In a way, this person is like a troll because he/she is aware that dropping a URL into a comment requires less than 10 seconds  while responding to it is hard.  I try to be tolerant of political differences, but a blogger has a responsibility to prevent ignorance; he can’t just allow misinformation like that to stand on a blog without a response.  A few months ago, somebody I would describe as a crank left an incoherent economic rant on my blog in response to a short link I gave about TARP funding. The person left a long comment. It was not spam, but it was complete poppycock, dredging up some wacko conspiracy theory about currencies and gold and I don’t know what. After googling around, I found that the person did indeed have a blog, and was a ranter, so this rant was not exactly out of character.

    Here was the problem with this ranter. I was not prepared to argue this point with him. To be more precise:  Just because this person wrote nonsense doesn’t imply that I needed to spend the time showing why he was  wrong. Maybe I should also be compelled to write a scientific explanation defending  the “theory” that  the earth is round!?  I am not an economist and although I could probably do some research to defend myself, it would be hard to win this argument without spending a lot of time.  I had not intended to make an argument, just to provide a well-chosen link to an insightful article.

    Here were my options for responding:

    1. I could choose not to approve the article (that would be very easy).
    2. I could approve the article but would attempt a brief retort (with the knowledge that the commenter might try to engage me more)
    3. I could approve it, ignore it and hope another reader takes the time to write a counterreponse.

    I ended up approving the response conditionally and emailing the person to ask him to post URLs to his post rather than write long comments on my blog. As it happens, yet another person responded to the crazy person’s response with an even crazier  response  (This second person was a well-known troller).

    Regular readers will know that I have been blogging a lot about climate change over the past year. I certainly do not understand the issues as deeply as a scientist would, but I am familiar with most of the common counterarguments and tactics used by  denialists. Also, I have a pretty good sense of which kind of evidence is more authoritative, so  I think I would be capable of having a productive debate on the subject … for a while at least.  But why should I want to  – especially when the same denialist counterarguments are offered over and over?

    When a debate is as big and important as climate change, you can expect a lot of “debunking articles”  and a lot of “Scientist X doesn’t know what he is talking about” articles to pop up everywhere. Many are by paid industrial scientists which though reputable may have an inability to see the big picture.   So here are my blog  rules about having a civilized discourse or dropping a link:

    1. Does it pass the smell test? is the person who wrote the article a qualified scientist or just an opinionator?  Does the headline actually reflect the actual evidence presented?
    2. Has the argument been addressed before? Skepticalscience answers most of the common counterarguments, and you need to check there first to see if has been answered already.  I also recommend searching at realclimate.org and climateprogress to see if the actual article has already been discussed.
    3. Is the article or research breaking news or is it simply old news repackaged as new? I have been emailed a link to an article or video by John Coleman several times about the so-called global warming scam.  On Realclimate or climateprogress they rarely take seriously critics like Ian Plimer or John Coleman or Lord Monckton. Yet they are commonly found on many denialist blogs as though it were new research.
    4. Has the source cited shown a tendency over time not to provide useful or accurate information? First check here, then check here. Let me explain myself. All science sites will have inaccuracies or opinion pieces with controversial statements. That is normal. It does not  not bother me unless the site  seems to prefer  scare pieces to reasoned analysis. Wattsupwiththat is one of the most notorious sites like that. So is climateaudit or climatedepot.  But in fact, it is rare that either site presents original research or analysis. More likely than not, they are citing arguments presented more exhaustively elsewhere. Similarly Marc Morano is not considered a reliable source, and even Fox News is not reliable in my book.   I will almost never take seriously anything from these sources.  In truth, these sites are perfectly capable of digging up and promoting legitimate skeptical arguments, so it would be folly to say that everything on these sites is wrong. The Internet makes it possible to bypass these sites and link to the original analysis. If the argument has intellectual heft, chances are that it has been discussed on a more legitimate site.
    5. Does the article you cite show an obsession with certain themes? Such as Al Gore, hockey stick, Climategate, weather stations, the IPCC conspiracies, water vapor, sunspots  or “people are just trying to make a buck off cap and trade”? (See more in this Global Warming Skeptic Bingo).   These are sure signals that the arguer is not engaging seriously with the issues – and is probably not even knowledgeable. Ad hominem attacks on Gore are not only wrong, they are irrelevant. The hockey stick was hotly debated but is now widely accepted after some data issues were resolved. Now the National Academy of Science vindicated it.  Climategate was a red herring and even if you accept all the accusations at face value, all you’ve accomplished is undermine one kind of proxy evidence; scientists have several other kinds of proxy evidence to prove their same points. IPCC may not be infallible,but it’s as close as you’re going to get in science (especially if you limit yourself only to the well-vetted scientific recommendations in the Working Group 1 portion, not the less reliable Working Group 2).  Water vapor and sunspots has been posited  multiple times as alternative causes, but the research hasn’t borne it out. Water vapor amplifies warming rather than forcing it.  The influence of sunspots is a well-known phenomena that scientists have learned to factor out when assessing trends.  This is basic climatology 101.
    6. Does the article accuse a prominent figure or group from reaping  personal or financial benefit from climate change research or green investments? Most of these types of articles exaggerate the importance of self-interest when making intellectual arguments. Does anyone seriously think that Al Gore is going to get rich from issue advocacy? (In fact, he gives a healthy amount to charity and his job as communicator involves highlighting ideas which he thinks are most workable – that is precisely what he is good at and what people want him to do). Do scientists get tenured jobs for promoting climate change? Of course. But they have to do it well;  if a skeptic also did it well, he would ultimately be able to find acceptance in academia provided his scientific papers are sound.  In fact 5 of the 10 companies listed at the top of the Fortune 500 list are fossil fuel industries (7 if you include 2 car companies – who arguably are vested in fossil fuels as well).  The amount of money that fossil-fuel industries have to throw around to cast “commercial doubt” on climate change science dwarfs the paltry sums available to academics and government researchers. Yes, researchers benefit from an academic career, but they are often dedicated people who make enormous sacrifices to conduct their research. I would never castigate an academic (skeptic or otherwise) simply for being an academic.  Cap and trade has its flaws – though they are often exaggerated. But the best counterargument to the self-interest argument is: how is an  accusation that  greens are motivated by self-interest any more pernicious than the fact that fossil fuel people are already motivated by self-interest today?
    7. Is the article tossing out too many arguments at once without trying to defend any one  of them? (That is known as the Gish gallop or —  in the words of my high school debate coach — the “shitspread”).  Lord Monckton is the prototypical person to do this.

    Please ask yourself these questions when dropping a URL on my blog or sending me a random URL. You do not have the right to waste my time – especially if you have not bothered to do your homework. Believe it or not, I enjoy genuine skepticism – but only if you have taken the minimal  time necessary to make sure that the article you cited  is not  making some easily debunked claim.  I’ll be the first to admit that some articles can sound  incredibly persuasive — and turn out to be inadequate at closer inspection. Naturally I don’t claim to be an expert on everything; heavens, I would hate to be held accountable for articles I blogged about 4 years ago  (even though I probably did think it was insightful and reliable at the time I blogged about it).

    Lots of controversial topics remain  in climate change science. Now is not the time to be distracted by well-worn and shallow arguments from the past.

    I don’t enjoy trying to suppress arguments I disagree with. But if I feel you haven’t taken the time to vet your argument, then instead of responding, I will simply recommend a new  professional service I am offering:

    The Robert Nagle Ignorance Removal Service

    At the reasonable rate of $300 per hour, I will be more than happy to compile a dossier explaining in detail what I feel to be a reasonable evidence-based position on the issue and the essential fallacies in your  argument.

    Keep in mind that I am not a trained scientist, but I will try to cite only sources from reputable journals or scientific bodies. I do not have subscription access to the most prestigious science journals, but I can use the city library or general science magazines or moderated websites like Realclimate to gather good information.

    In order to request service, you will need to pay a $300 advance before I will even look at your issue. Otherwise,  stop wasting my time.

    Jan 30 Update: A commenter correctly points out that I should not have used the phrase “obviously false” when describing the breast cancer-deodorant claim. I agree. Instead I should have said,  “probably untrue.”

    March 10 2010 Update. See this incredible 70 minute analysis of the rhetorical problem of countering  climate denier  logic by science historian Naomi Oreskes. It is positively brilliant! See also Juan Cole’s piece about how to respond to irrational climate change arguments

    August 28, 2010. For people who can’t afford my service, let me recommend these books:

    (I’m sure there are countless others worth recommending, but these 3 stand out among the pack for me). Finally,  I’ll extend an offer which I make to all my denier friends. I would be willing to bet you up to $1000 that the 10 year average global mean surface temperatures between the decade 2000-9 will be less than the average of the global mean temperatures between the decade 2010-9. (Using NASA GISS Surface Temperature Data, with the important stipulation that the bet doesn’t apply if 2010-9 has 1 or more  VEI 6 volcano or  more than 2 VEI 5 volcano  during that time period. I’ll give you 2 to 1 odds on it. If you agree, we will have to talk about signing a promissory note that is legally binding in the state you are in.