pktechgirlbackup: (pktechgirl)
I have had many criticisms of Obamacare. I thought it was a sop to insurance companies and could only control costs by destroying innovation. But even I was not so cynical as to realize it was in fact another attempt to force the poor to subsidize the middle class.

The Obamacare plans, even the gold plans, have very high deductibles. I should be in favor of this, because low deductible plans are just prepaid health care, not insurance. But there's a wide range of health care that's...discretionary. There's my long health slog, of course, but you'd be surprised what becomes discretionary when you can't afford it. Urgent care for a heavily burned finger that will probably heal on its own. An ER visit when you're almost certainly not having another heart attack. A tooth ache.

Obamacare plans make some preventative care free. But otherwise it doesn't cover anything until you reach your deductible, and is pretty expensive until you reach your out of pocket maximum. The insurance doesn't really pay off unless you spend a lot. Who has the money to do that? By definition, the richer you are, the more money you have, the more likely you're going to reach your out of pocket maximum.

I think the poor are still covered in the event of true catastrophe, because you don't have to spend your out of pocket maximum, you just have to incur it, and hopefully the hospital will extend you credit on that after you've been hit by a bus. But the people this law was supposedly trying to help? They can't afford the premiums on the plans where they can afford the out of pocket maximums, even with the subsidies. Which means the subsidies are not going so much to them as to the people in their risk pool with the resources to meet their deductible (whose premiums are being artificially lowered by community rating and the premium ratio cap). Saying they have equal coverage is insulting and a break from reality.

But adults with wealthy parents can stay on their insurance until age 26, which is nice.
pktechgirlbackup: (pktechgirl)
I found one that addressed every single one of my issues with 3rd-world-poverty focused charities: GiveDirectly. To a first approximation, their model is to wander around Africa looking for poor people and give them money. The end.

It's a little more complicated than that, of course. They have better ways of finding poor people, for one, and they only work in Kenya and Uganda, because they recognize that there are differences between African countries and expertise developed in one does not automatically translate to another. They also do a fair amount of follow up: not in directing how the recipients should spend their money, but in measuring its impact on the families in question and their communities as a whole. One objection to cash transfers is that recipients will blow all their money on booze. GiveDirectly can tell you exactly how much spending on alcohol changes after the transfer (answer: it goes up a little, but not much). Another is that it will create resentment within the community outweighing the financial benefits. GiveDirectly measured that and found that it not only didn't happen, but communities with transfer recipients ended up slightly better off than control communities, indicating a spillover effect.

Even if the research results were not so favorable to them, the mere fact that they're doing the research makes them a good form of charity. This is a very new form of organized charity and they're not going to get it perfect right away, but they clearly recognize that and are doing everything they can to hone themselves. Moreover, they seem to have a very good sense of their own limitations. Their goal is not to replace every form of charitable giving, but to be the measuring stick for other forms. "Are you more effective than just giving money? Let's find out."

That worked so well I'm going to announce another kind of charity I'm looking for. As I've mentioned before, I'm fairly privileged, and sometimes when that privilege manifests I like to mark it with a charitable donation. I funded someone's dental care after my gum infection was removed, and a move for a job after I got my shiny new job. I'm feeling that urge again, this time because I paid $35 for antibiotics that cost four figures retail, for a relatively minor problem. I don't know if minor is the right word: it's another gastrointestinal ecosystem issue, so fixing it will have huge cumulative effects on me... but no where near the effect $1100 worth of penicillin could have for people who can't afford it. I don't know how to mark this one. No one goes to Modest Needs for antibiotics alone, and funding other health care, while obviously a very good thing, doesn't feel right in this particular case. Many years ago I read about a charity that pushed/facilitated hospitals to follow some very simple checklists that led to huge improvements in patient outcome. That felt right, but I can't find it now.

Hell, last week my boyfriend spilled bacon grease on his hand, and would have really liked to have gone to the hospital, but had neither the money nor the insurance. $1100 to enable that would have meant more to him psychologically than these antibiotics do to me, even though our home care worked fine. This time. I want to give someone else the gift of not worrying about it. That is why the checklist charity felt right: it's emphasis is on reducing the executive function needed to get the best outcome. But I just spent 10 minutes googling and found the initiative I was thinking of, but not the charity.

Taking another tact: Those antibiotics are supposed to help me digest food slightly better. Let's phrase the goal as "maximize number of nutrients digested." In that case, just giving people food is helpful. There are lots of charities to give people food. I will find a good one of those and donate.
pktechgirlbackup: (pktechgirl)
There are a lot of policy proposals, mostly but not exclusively progression, that I find troubling. I agree that the thing they are aimed at is negative, and that if their policy works as proposed it will weaken the effect, but I don't trust it. I either end up criticizing the proposals on libertarian grounds or just expressing a vague sense of unease, neither of which has the slightest effect on proponents.

Affirmative action used to fall into this category, but I now have some more articulate objections. Affirmative action is premised on the idea that the solution to black poverty is for white people to give them things. Not that the jobs are charity, but they're still given at the whim of white people, and ensure that the most rewards go to minorities who are best at assimilating into white middle class protestant culture. I would much rather have funded black entrepreneurs so they could be successful on their own terms. Or maybe just extended the protection of law so that white people didn't burn down their businesses *quite* so often. Or not used eminent domain to tear down black businesses to build housing projects, nominally aimed at helping the poor, and structured bidding so only white firms had a chance.*

Now I can move "fighting inequality" out of the inarticulate-unease/libertarian-sputtering category and into the real reasons category, thanks to Ezra Klein. He suggests that while inequality is bad, unemployment is worse, and we change priorities accordingly. I agree, but that's not impressive because I don't think inequality is bad. I also think most government efforts to increase employment are counterproductive and harmful. But Klein brings up the excellent point that there's at least one thing the government does that actively raises unemployment, and all they would have to do to lower unemployment is stop doing it.

They're not doing it for no reason, of course. They do it in the name of fighting inflation, which is generally considered to be good. But why? And have we ever measured how good low inflation is, relative to the costs of high unemployment? Unemployment makes people really fucking miserable. Moreover, inflation hurts net savers (i.e. wealthy people) and helps net debtors (i.e. poor people). And the closer we run to full employment, the less employers can get away with the soul crushing shit they pull on McJob holders (i.e. poor people). So prioritizing low inflation over high employment benefits the rich at the expense of the poor in every possible way.**

My conspiracy theory? The proposed solution to inequality is usually taxes. Taxes will always be worst for the people with the least flexibility. Flexibility increases with wealth. So in general, taxes will be worse for the rich than the truly wealthy. But there is no dodging inflation. That will hit the wealthy and there is very little they can do about it.***

Inflation also incentives people to invest in high-risk/high-reward ventures (which have a higher likelihood of creating jobs, although also a higher risk of royally fucking up the economy. Tto be fair, that risk will hit the rich harder than the wealthy) as opposed to letting it sit in bonds. It fights entrenched wealth by reducing the value of it, without the nasty side effects of an estate tax. It pushes everyone to keep creating rather than rest on accumulated wealth.

Let me note that as a net saver, I'm advocating against my own interests here. But however bad inflation may be, I think the moral thing right now is to tolerate a bit more of it in exchange for higher employment.

*Source: The Pruit-Igoe Complex

**Note: I'm assuming the alternative to low inflation is higher but *steady* inflation. Hyperinflation and unexpected spikes are still really bad for the economy as a whole.

***I'm not an accountant, I think that overseas investing might be an option, and that would have consequences for the US.
pktechgirlbackup: (pktechgirl)
Having taken a stand disparaging charitable gifts of goods over gifts of money, I feel obliged to report that I just donated a physical good. My employers gave me a piece of expensive electronics, and I passed it on to Treehouse For Kids, who will offer it in their !store for foster kids. Here is why I think it was okay:

  • The ratio of dollar value to physical mass and volume is quite high.
  • I already have the device and I'm not allowed to sell it, so giving them money isn't an option.
  • Even if I did give them the money, they don't buy this item in bulk, and while they may sometimes get opportunistic discounts, they do not have a regular supply.
  • I checked, and this is a type of item they have great demand for.
  • The fact that they are getting one unique item is not a problem, because one of their core competencies is accepting material donations and distributing them. They have chosen to prioritize variety over economies of scale.
  • I get a warm fuzzy feeling from being able to give something really cool and brand new to a kid who gets too litle of both.

So all in all: if I had $600 cash I wanted to donate, I should give them the cash, not buy and donate electronics. But given that I have a $600 toy I don't want and no way to turn it into cash, donating it to them is still a net good.

I suppose I should also note I donate to thrift stores all the time. I don't turn down the tax deduction for it, but I don't put that in the same category of giving as donating money or even this toy. That is a way to get rid of my stuff that gives someone else an opportunity to get some use out of it, and lessen the landfill load.
pktechgirlbackup: (pktechgirl)
[reminder: I've been against Obamacare since it was proposed]

I always knew Obama's promise that no one who liked their health insurance would have to change it, that everyone could keep their doctor, was bullshit. It would have been bullshit even if the law didn't expressly forbid some existing forms of insurance, because even if everything was technically legal, Obamacare changed the incentives and people respond to incentives. I knew that what he meant was "we're not instituting the NHS, your choice of doctor will still be between you and your insurance company." Nothing in the law *demanded* providers shrink their networks, but it would be criminally negligent if no one crafting the bill thought of that as a possible thing insurers would do when faced with a demand to provide more care for less money. So yes, Obama either lied or is so profoundly stupid it's amazing we're not giving farm subsidies to water crops with Gatorade.

That said, I think the insistence that Obamacare be a Pareto improvement over the status quo led to a lot of the worst parts of the bill. They reinforced the link between employment and insurance. Let me repeat that: THEY REINFORCED THE LINK BETWEEN INSURANCE AND EMPLOYMENT.

I have just about the shiniest, most employer provided insurance you could have. And I use it. I would definitely suffer financially if the link between employment and insurance was weakened. And I still think it's a travesty they didn't. I can't even use words to describe this, just more My Little Pony gifs

If they had been willing to let some people suffer temporarily, they could have ended up with a much better bill. One that, say, taxed insurance as regular income and thus removed the incentive to pay people in the form of health care, which they then overconsume. Or at least didn't reinforce the link between insurance and employment.

Speaking of employment and insurance and taxes, let's talk about the Cadillac Tax. Rather than, say, tax the cost of the insurance as income, thus weakening the link between employment and insurance, they have this weird excise tax that is higher than the top marginal rate for income tax (although to be fair, not quite the top marginal income tax rate + payroll tax), based on some weird moralism that person A having really amazing insurance is prima facia hurting person B. I had naively assumed that a plan was considered Cadillac because it had a low deductible or co-pay. This turns out to be wrong. It is considered a Cadillac plan if it costs more than a certain amount. Since premiums vary based on demographics, health status, and risk factors like smoking, this is essentially a tax on being high-risk.

Or at least, it should be. Another problem with Obamacare is that it limits the spread between what young people and old people pay, to a ratio far lower than the expected cost for each group. And it bans considering health status entirely. The explicit goal is to have the young and healthy subsidize the old and sick. Government action making one class of people give money to help another is called a tax, except it's going through a private company and is obfuscated by semi-enforcable demands to purchase a product. I hate taxes as much as the next puppy-kicking neocon, but given that we're going to pay them, I would at least like to pay them to the government. Involving a theoretically unlimited number of private companies to collect the tax and distribute the benefits is a gross violation of every reasonable set of principles I can think of.

It's like someone looked around the country and realized that we pay farmersing conglomerates a lot of money to not grow crops, and the return we do get is less and less like real food every year, and trying to fix it by giving the farming conglomerates more money and forcing everyone to pay a portion of their income to their choice of McDonalds, Wendys, or Burger King. And then claiming all the problems are solved because Consumer Choice.

pktechgirlbackup: (pktechgirl)
When the Mother Jones article on worker condition inside an Amazon warehouse came out, I was not sympathetic. Yes, the company wants you to work fast. I don't consider it damning that a writer on an assignment was unable to meet quota for a highly physical job. Okay, it sounds mean that they will fire you for saying "This is the best I can do" but again, they have the right to retain the fastest workers. It is weird that they will fire you for missing a day your first week, no matter what the excuse, but then hire you back. That's expensive to them and could be fixed with some discretion. And not giving employees lockers is a total dick move. They can't even keep their keys or phones on them in the warehouse, so they have to hide them and pray. Making all the employees break at once is pretty cruel too, given the bottlenecks of metal detector and bathroom.

Debt talks a lot about how slavery, debt, and ripping people from their contexts are intimately linked. Slaves don't get to have social networks like owners, or even poor free people. Slavery often originates as a way of paying off debts/response to debts unable to be paid. Debt itself is about removal of context- people will do things to get out of debt they never would have for the the same amount of money outright. People will accept treatment of debtors for being debt that they would never accept as conditions for getting out of whatever caused the debt in the first place. Somehow the gap between original conditions (sick child) and when the payment comes due changes the moral calculus. And since money's entire purpose is to reduce the context necessary for economic exchange, it does the same thing.

I've had shitty jobs, but I never had a McJob, and I am beginning to recognize the importance of that distinction. I have never felt interchangeable. My shittiest job was summer school tutor. The teachers didn't even want me, my position was funded by a federal grant meant mostly to help the tutors themselves, finding people qualified to take the position would have been trivial... and yet, once I was in the classroom and working with kids, I was an individual with an individual position. I was not irreplaceable, but replacing me had a cost. If I had screwed up, the school would have had reason to pause before letting me go. The thing about McJobs is that no matter how good you are at them, you're replaceable. Even the fastest warehouse picker can be replaced by a finite number of other pickers. It's not until you get late 90s level unemployment levels that unskilled labor any leverage over your employers.

Which explains the unmeetable picker quotas. But why can't they get some g-ddamned lockers? I know the employees are replaceable and the margins low, but I can't imagine there wouldn't be some productivity benefit to employees not spending their entire workday wondering if their car will be there when they get back, and that that benefit exceeds the cost of the lockers. I'm having trouble typing this because I feel like a dirty commie*, but I believe my friends' explanations that it's a deliberate attempt to keep the workers down. That if you consistently tell them they're not even worth lockers, they won't be able to ask for more. I've talked about government and sick systems in poverty, and those are at least nominally designed to help people. Corporations will proudly state they're not allowed to have morals.

Yesterday I talked about the gaslighting involved in subtle racism: why wouldn't the same thing apply here? Once you've accepted that employers want you to fear losing your phone every day, it's not crazy to wonder if they're deliberately setting your quota beyond what a mortal is capable of so they can yell at you. Especially when they will fire you for not promising to try harder, regardless of what your numbers do. Maybe the McWorkers aren't in a position to judge exactly where economic rationality ends and arbitrary cruelty begins and letting that devalue their point is choosing to let the toxin win.

*And then I swing around to "only an unfeeling neocon would be feeling that"
pktechgirlbackup: (pktechgirl)
A while ago I read Farewell To Alms, whose basic thesis was that Europe industrialized before Asia because Europe had worse hygiene. More specifically, Europe had both a higher birth rate and a higher death rate (in part because their atrocious sanitary conditions encouraged disease), and that led to more selection pressure, making Europeans smarter and more industrious than Asians. At the time I thought the book had some serious holes but also some interesting ideas. After reading more history, I increasingly want to withdrawal what praise I gave it. If disease led to economic prosperity, Africa would look like Dubai.

Learning history in school, I vaguely knew that at one point China had been pretty advanced, but then regressed somehow. And it's true, they did suppress a few technologies, like gun powder. But China was the world's superpower for much longer than I appreciated- probably right up until the industrial revolution. Europe went off to other lands in search of precious medals because China would give them spices for them*. And a lot of the civilizations they conquered were pretty advanced themselves, but were crippled by European diseases (so I guess the poor hygiene thing did work out for them after all).

The industrial revolution happened in England because coal was cheap and labor was expensive (why the difference in the cost of labor? I don't know, but I'll bet it's interesting). But more generally: the rules of the game had changed, and the winners under the old rules are never the winners under the new rules. It's true of people, it's true of companies, and it's true of countries. That is because a lot of what looks like genius is actually happening to have your gifts be the right thing for the moment, and happening to bet on the right horse **. Not that success is randomly attaching itself regardless of your skills, but that different skills have radically different values in different contexts. Big tech companies are obsessed with acting like start ups because start ups have the most growth, but that's because we're only looking at the successful ones. Thinking you can predict the next big thing is like thinking you can predict lottery numbers by studying the characteristics of the winners.

America was the winner under the last system. It was never going to be the winner under the next system. I don't know if the system has changed yet, but it seems highly plausible. So many of America's advantages are due to inertia, or network effects, or the tallest pygmy effect, rather than things we do right now. If we lose those, they are not coming back, even if we fix everything.

Breaching the debt ceiling may very well be the thing that catalyzes that loss. And then things will get much, much tougher for us. I'm consoling myself with the idea that this was going to happen eventually, and postponing the inevitable will only make it worse. The best case scenario is we pull at IBM/England, and that involves a much more intimate relationship with reality than the country has had recently.

*source: Debt: the first 5000 years.

**Queen of Versailles is a documentary about a family that made billions of dollars on time share properties, who are spending a small portion of the proceeds on the biggest/most expensive house ever. The business was built on the worst of the pre-crisis banking practices, and is decimated when the banks curtailed that. There were good businesses that went under because the credit markets froze or demand temporarily dropped, but this is not one of those: this corporation's very existence depended on toxic banking. The money dries up, and you watch them make stupider and stupider choices- to keep going with the $100 million house, to refuse to downsize or sell the business. I couldn't get over how someone smart enough to make that much could money be that dumb. The answer is probably that he would have had the same money making model whenever he went into business, and it just happened to be the right model for the moment.
pktechgirlbackup: (pktechgirl)
I have finally found a convincing counterargument to my belief that cash aid is better than in-kind and restricted aid (e.g. public housing and housing vouchers). My belief was based on the following:

  1. Data showing that cash transfers are better at lifting people out of poverty than specific aid.
  2. Intuition that people are generally better at knowing what they need than the government
  3. Intuition that if they don't, they need to learn, and this is how to do it.
  4. A willingness to let mentally competent adults starve for their own bad decisions.
  5. Belief that the government claiming to best know how people should spend their money was inherently paternalistic and poisonous to a healthy citizenry even when it's government provided money.

My goal in anti-poverty intervention is not to eliminate poverty or suffering, but to make sure that an individual's suffering is mostly a result of their own, recent choices, and not bad luck, environmental factors outside their control, other humans, or shitty choices they made when they were 15. Or even mildly poor choices they made a month ago, depending on the cost to do so.

Here are two things I have thought of recently. One, decision fatigue is a thing. There is space to recognize and accommodate that without creating a cycle of dependency. Of course, our current programs often manage to be condescending and induce decision fatigue, so this is no defense of them, but the theory is there.

The second specifically applies to housing, and other consumables requiring extended contracts. Low, and especially high variance, income can easily lead to a poor credit rating. Poor credit makes housing harder to find, lower quality, and more expensive- and justifiably so, since tenants with low credit ratings are more likely to miss payments. You can compensate with a higher deposit, but that doesn't help the poor. A dedicated housing allowance that is paid to the landlord in a timely manner (which the current housing voucher system demonstrably does not do) credibly commits you to paying for housing. That insulates people not only from their own past poor decisions, but from the decisions of other poor people who have created the statistical association between poverty and irregular payment. Stable housing is almost fundamental in establishing a stable life and pulling out of poverty.

I am more and more seeing poverty not as a problem of too-low income, but of unpredictable income. And some sort of minimum income guarantee makes a really credible solution.
pktechgirlbackup: (pktechgirl)
The health care debate has gotten very, very muddled. Most of my reading on the subject is by progressives (writing either for other progressives or for a general audience as an attempt at conversion), or by libertarians for libertarians. There is a pattern I have noticed that I think is worth addressing: progressives tend to see either One Big Healthcare Issue, or lots of issues with the same solution. Libertarians (as personified by me) tend to see hundreds of small issues that are going to need individual solutions. Which is interesting, because it's the reverse of the usual pattern, in which I think everything could be solved by introducing competition and progressives think we need an expert to tailor a solution to the specific problem.

So here are some of the individual problems I see, and short versions of my preferred solutions.

Problem: People can't afford health insurance/health care.

Give them money. To be fair, this is my solution for all problems relating to poverty. It sounds glib, but I'm being sincere. If we want to place a floor on the consumption of adults, we should just do that. If people are not using the money on the things we want them to, we should reevaluate our wishes or their ability to take care of themselves. Alas, this gets considerably more complicated if children are involved.

Problem: Health insurance is too expensive/increasingly expensive.

Insurance profits are reasonable and have not been rising in recent years. What you are seeing is a rise in the price of health care itself.

Problem: Health care is too expensive/increasingly expensive.

This is sometimes called "health care inflation", which is misleading, because much of the increase comes from the introduction of new things to buy. It's like saying we've had smart phone inflation since 2000. You could make the problem go away by not buying new things.

Some of it is that we're consuming more things. I am maybe the only person who liked Obamacare more after she heard about the death panels, because the alternative was everyone deciding for themselves how much of other people's money they wanted to spend on their own health care. Also, it's still not inflation in the technical sense of the word, any more than we experience produce inflation when I double my banana consumption.

However, some of it is genuine inflation , brought on by Baumol's cost disease (short version: if you have two sectors, and one gets more labor efficient, the other one experiences inflation). There are three solutions: pay workers less for the same job (which every politician ever has promised not to do, because health care professionals are sympathetic, have money, and vote), shift work to lower-wage workers (which we are trying, via things like nurse practitioners and physician's assistants. I am in favor of this but think it bears monitoring before we declare it a total success), or invent labor saving devices (which we have actually done some good at, but since in many cases the replacements are themselves expensive, we won't see returns until they go off patent). I am totally in favor of investment, both public and private, in labor saving devices. But we can't do that by wishing really hard, we have to work with the market we have and adjust if it improves later.

Problem: Wait a minute, you skipped over a possible solution. We could just pay less for the new things.

Okay, technically that's true, but it's a one time savings. Profits are what motivate pharmaceutical companies to make new things that let me live longer. I think our patent system actually does an excellent job here, providing some time to make money and then providing the drugs nearly at cost for all eternity (I have no opinion on the proper length of that first period).

Problem: why don't we just cut out the middle man and do it ourselves?

That is a good idea. There are definitely inefficiencies in the current model. But how do we do that? University research isn't directly translatable into usable drugs. There are many possible improvements to this model, and I am fully in favor of government funding for them as pilot projects, but I would like to see them work before we shoot the old model in the back of the head.

Problem: Even if the increase in insurance costs are due to care costs, couldn't we get a one time boost by removing their inefficiencies?

Yeah, maybe. There certainly are inefficiencies introduced by having 40 different billing systems. But considering that the government's systems are the most complicated and time consuming of all, I don't see them fixing it.

Problem: Health insurance is linked to employment.

Yes, this is deeply stupid. There are two causes: one is that the government subsidizes employer-provided insurance by not taxing it as income. This is stupid and they need to stop doing it.

The second is that employment is a way to get around adverse selection and the resulting insurance death spiral. This one is harder to solve. We probably can't fix the information asymmetry, which leaves mandating everyone purchase insurance. There are two problems with this: done by the federal government, it is either unconstitutional or stretches the commerce clause to the point that it can do anything. State governments can do it constitutionally, but still risk what happened in Massachusetts: originally advertised as mandating only catastrophic (i.e. true) insurance, the bill bloated until it mandated all kinds of care (because lobbyists bought the clauses), raising the premiums considerably. (My impression is that the conclusion progressives draw from this is lobbyists and/or money has too much power over politicians. The conclusion I draw is that we should minimize the number of things government can mandate so that there's no point in bribing politicians).

Note that Obamacare introduced mandatory issue (insurers must insure everyone that asks) and community rating (insurers may not charge more for riskier people) years before mandating purchase (everyone *must* purchase insurance). This is the worst possible thing.

So it's a stupid system, but it will be very hard to transition to something else.

Problem: what was that snarking about "true" insurance?

Insurance means insulating you from rare, extremely costly, unpredictable events, like car accidents and cancer. What gets called insurance today is often just 3rd parties paying for routine care, like vaccines and annual check ups.

Kathleen Sbelius, United States Secretary of Health and Human Services, got this exactly backwards .

Problem: but preventative care lowers the costs for the insurance company, so it still makes sense for them to pay for it.

This is just not true. Very little preventative care lowers the total cost of care over someone's life, because we just keep treating you until you die. Everyone dies of something, and the causes get more interesting and expensive the older you get. Even if the cost was exactly the same, you've been alive for longer and sucked up more money for annual care. The only things proven to actually lower costs are vaccines, dental care, and pre-natal care. You can argue about preventative care being a more cost effective way to raise life span or Quality Adjusted Life Years, but that is a different issue. To the extent that it is true, the gains don't accrue to the insurance company. This doesn't mean preventative care isn't an excellent thing, but excellence and money saving are not synonymous

Problem: The same care costs a lot more when you pay out of pocket than when insurance covers it, and with a lot more uncertainty and anxiety too.

This is a big problem. I don't know how to solve it and am interested in hearing ideas.

This is all very hard to argue at cocktail parties. The other side has some very good visuals and easy to explain solutions. I have a lot of graphs and arguments about highly distributed long term consequences.
pktechgirlbackup: (pktechgirl)
My municipality has public (government funded) assistance programs to help people make the balloon payment required to rent an apartment (security deposit/first + last month's rent, etc). As assistance programs go, I'm pretty okay with this one: it's a one time investment that helps people get into long term better, more stable, cheaper living arrangements. It increases mobility and threat of exist from bad situations. I like all those things.

But why is it necessary? At least part of the reason is the insane tenants' rights laws. If it takes three months from missed payment to eviction, landlords will demand three months rent up front. A friend of my is being evicted because he missed a payment. The landlord isn't out any money yet because my friend paid last month's rent when he moved in, but he doesn't want to risk a repeat next month. If they could evict on two day's notice, the economically optimal thing would be to take a more wait and see attitude.

Except those rules didn't come about for no reason. I couldn't move on two days notice, and allowing my landlord to force me to do so would give him an extraordinary amount of power. It becomes trivial to extort people, and it's most effective against the most vulnerable, which is the opposite of how I like my extortion to go.

Full disclosure: I already dislike laws that give tenants substantial lead time before eviction, because 1. they're unfair and 2. they push us towards more professional landlords and fewer individuals renting out spaces, and thus hurt both small time capitalists and renters, to the benefit of large capitalists.

This is a thing I've been thinking about a lot since I read Debt. It makes the point that medieval European peasants tended to be heavily involved on both sides of the free market. A household was extended credit by the miller, but they were themselves extending credit to the cobbler. It kept the system from spiralling into wage slavery* or debt peonage, while still giving useful signals about what things were and weren't wanted. It bears a striking resemblance to the ghetto economics described by Sudhir Venkatesh in Off the Books. I'm hoping that things like lyft and airbnb will move more of us back to that, but as they grow they're running into tax and regulatory obstacles.

And we have those regulations on hotels, and taxis, and restaurants for reasons too. Food poisoning, bed bugs, and kidnappings are real things that I think the government should work against. Regulatory capture makes it worse, but that's a distraction from the fact that every safety regulation disproportionately discourages new and small entrepreneurs.

Third, initially unrelated thing: I've been thinking a lot about parenting lately, and how we tend to emphasize protecting children from dangerous things, or teaching them to protect themselves. Avoiding dangerous situations costs them a lot, both in good things they miss out on, and bad things they would have learned from. If I have kids**, I want to emphasize resilience and recovery from trauma, not avoidance out of fear.

This is relevant because the government's current tact is a lot more like wrapping your kid in bubble wrap, and a lot less like teaching them to stand up and brush themselves off. Speculatively, what if we lessened food safety restrictions but provided free treatment for food poisoning? What if anyone could run a cab but everyone had a panic button that could summon the police immediately? I already think the government should spend infinite money in the War on Bed Bugs because fuck bed bugs it's a public safety issue. New reputation mechanisms are arising that could substitute for the closeness of a medieval village.

Once again I have no closing paragraph, just a bunch of thoughts.

*A phrase I still find ludicrous and diminishing to the horror of genuine slavery, but am now beginning to see what it's getting at.

**A thing I have been feeling more positive about since the hypochlorhydria was treated.
pktechgirlbackup: (pktechgirl)
I'm reading Debt: The First 5000 Years, and it has me seriously rethinking my thoughts on economics and even libertarianism. It's an extremely dense book, so I have a lot of thoughts, and I need to read more on them before I commit to any them, but here are things I am thinking right now:

  • I've treated the economics of capitalism/the market as physical laws, as inescapable as gravity. And they pretty much are, in this society, at this time. There are other societies where they are not, where humans orient themselves towards something else, and it's worth examining the costs and benefits of each.
  • Capitalism is based on an assumption of constant growth that can be very destructive. The author is an anthropologist, and I've never heard an economist say it, so I want to read more, but it feels true. This is tied in with Protestantism somehow but I don't know how.
  • Societies where more than a trivial percentage of the population can't support themselves collapse. This is true even though "support themselves in the manner to which they which to become accustomed" is a moving target. Today's peasants may live materially better than anyone on the planet 100 years ago, but they're scoring against something else.
  • A credit-based market among neighbors, where everyone is using credit from and extending it to everyone else (=medieval markets), is very different from a system where everyone goes to a few central organizations, otherwise removed from them, and gets money to use somewhere else (=modern banking).
  • Most of the things I like about capitalism are actually things I like about free markets, and maybe I can get the latter without the former.

Let's talk about the constant growth thing. I was recently faced with a series of decisions at work in which I chose the path with the higher required effort, higher growth potential over the easier ones. I did this in part because I'd had jobs where I coasted, and I found them unfulfilling and was unhappy. This decision path has worked out Poorly. It's cost me a lot, and I haven't accomplished anything I set out to. I am probably going to end up jumping to the safer path I was offered initially, which would seem to make the months of distress completely wasted, and thus the choice wrong. And yet, I don't feel it was. I am proud of myself for trying, and I couldn't have lived with myself if I'd taken the safe path.

Why not?

Some of it, which I figured out right this second, is that I would have been doing it out of fear, and facing down fears is a huge good. So good for me on that. But another driving factor was the belief that I need to grow, and I think that's tied in to capitalist/protestant notions of need to grow. I don't *need* more money. There are more toys to buy, but the additional happiness purchased would be low to non-existent. There are doctors appointments and personal trainers and specialty prepared foods to buy for my health, and those are expensive, but there's no point incurring the health costs of a more stressful job in order to pay for them. There's security, and knowing how long I could last without a job, but again there's no point being miserable now to buy myself out of misery later. So really what we're seeing is my inability to accept not being the best, or at least doing my best, at everything, ever. That's an exhausting way to live
pktechgirlbackup: (pktechgirl)
I am a software tester, but that's imprecise. "tester" can mean anything from someone with a 12 week training course certificate from a community college that plays xbox all day to someone with a computer science degree from a top university that writes software that tests other software, with a coding proficiency rivaling all but the best traditional developers. These are often called test automation engineers or "[company's internal term for software developers] + in Test".

Between the two, automated testing is far more prestigious and better paid. Although frequently not as well paid or prestigious as development, which is frustrating when companies insist TAEs should be able to code as well as developers.* People who do more things get paid more. Anyways, within reason, I agree that automated testing deserves to be the more prestigious. Automation scales and requires more planning. And because of that, the smarter people move into it, which means more of the interesting work goes to the automation side, and so on. But ego has begun to enter into it. A lot of software companies have a thing about only hiring the best and the brightest, and will either refuse to hire manual testers outright, or only hire them on contract.

There are very few products that even contemplate doing entirely automated testing, and zero consumer products. Whether or not you hire manual testers, you're going to be doing manual testing. In an attempt to grab a halo of "only hiring the best", this gets dumped on automated testers, support engineers, and maybe even developers, people who are both horribly overpaid for the task and likely not very good at it. A really good manual tester has an OCD or Aspergerish focus on things being exactly right, a trait heavily discriminated against in computer science programs, where the emphasis is on doing things in the absolute laziest way possible. If manual testing is dumped primarily on "automation" testers, you'll push the best ones into development** and start a vicious cycle of losing your best engineers. If it's spread equally, well then you're just not allocating resources very efficiently.

If you dump the testing on contractors, you lose any expertise they develop in the product every 12 months. Companies like to pretend there's no value in that expertise because it's harder to measure than code, but there are some exceptionally good manual testers out there who would provide a lot of value if people let them do what they were good at. And they're cheap relative to the people who would be doing the work otherwise, because it's low prestige and has a much lower barrier to entry.

But honestly, I think "hiring the only the best" is kind of a bad strategy even for automated testers and developers. There is not a direct correlation between "requires intelligence" and "valuable". Smart people can get themselves involved in any number of hilarious low pay off adventures, and average people can maintain google reader. This drive to hire only the best is being driven by something other than value.

*I once got a haircut from a woman who was doing a one-course-at-a-time programming degree at a community college. There was a detectable dismissive sniff when I told her I did software testing, because she was aiming for much bigger things. I didn't play the "I went to school in Boston" card, but I was thinking about it.

And it was a shitty haircut

**Because they like coding, or because of the increasing pay gap, or because of the prestige. Nobody likes being thought of as settling for second.
pktechgirlbackup: (pktechgirl)
First, a review: I liked it. Some of that is because it required exactly the amount of attention I wanted to give it, but it's also well acted, well directed, and a pretty good plot. It rewards thought. Totally worth your time, but no The Shield or Mad Men. Yet.

Spoilers for both British and American version )

I was going to give the US version credit for having more female agency, but I think it's really a shift from a show focused around a single individual to an ensemble show. At the same time, the show widened its discussion of power tremendously. The only man who consistently understands power is Underwood. Other men are either his victims or his unquestioning helpers. There is a single act of male rebellion in the very last episode, and the perpetrator is black*. Meanwhile, the women are shown to be playing the game, and to either be good at it or getting better. Underwood's wife is as skilled as he is. Each of them try to manipulate a young woman to serve their own ends, and each is facing serious consequences for it by the end of the series.

*Underwood dismisses this man as trading power for money and not understanding the difference in an early episode. He was wrong.
Read more... )
pktechgirlbackup: (pktechgirl)
I'm currently neglecting normal savings in favor of squeezing the last penny into my 401k. I can do this because I can be really sure I will not need that money until I am 65. I have a large cushion, and if anything truly catastrophic happened, my parents would help. I assure you I am extremely motivated not to let this happen, but I can't escape the fact that in case of expensive cancer, I can break that glass. I have friends who make more money than me who cannot do this. They need a larger cushion because not only can their parents not rescue them, they might have to rescue their parents. Or siblings. Or in laws. And come 65 (under current tax codes), even if my friends never actually gave money to their parents and I never actually accepted any from mine, I will have more money than them, because I had the flexibility to put more in my retirement account. And these are people high paying, highly secure jobs.

This strikes me as a flaw in programs like 401ks and Flexible Spending Accounts: they're more useful the more flexible your money, and flexibility is directly tied to wealth. Not even income, but wealth.
pktechgirlbackup: (pktechgirl)
Capitalist is a weird word, because it can mean "pro-capitalism" or "an owner of capital". Neither communism nor feudalism have this problem, and I think it muddies up the waters quite a bit. I have no particular affinity for the owners of capital. I don't think it makes them* morally better than non-owners. Policies designed to give people with more money because they have money seem prima facia stupid to me.

What I do have an affinity for is markets. Markets are clearly neither feudalism nor communism, so we'll call them capitalist, but one of the things I like about them is their disregard for who has the capital. Centrally designed systems tend to pick a winner and stick with them, and this helps the rich get richer. Markets, in which ideas compete freely, are much more open to the latest good idea. IBM had a good idea, but it stopped, so it withered away. Markets do end up creating owners-of-capital, but I see that as a side effect of their actual point, which is to give people choices. Note that once people acquire capital, they often favor anti-market practices, like tariffs and overly restrictive licensing.

Side note: This is why privatizing government functions while retaining the monopoly is the stupidest possible plan. There's nothing magic about a private company, what I want is *competition* that lets people choose between multiple options, leading the lesser options to die or improve.

This is tangentially related to my latest book Hungry Ghosts, which is about the famine caused by China's Great Leap Forward. Without knowing much about the subject, I had assumed that the famine was caused by Communism's edict of "to each according to their needs" creating a tragedy of the commons, in which no one had an incentive to work. This is incorrect. The famine was primarily caused by the government taking all off the food. Initially people in the cities ate fine because they were given grain rations, but the government insisted that the peasants were hiding grain and thus took everything they could find. In later years the famine did spread to the city, not because the farmers were freeriding, but because many of them were dead of starvation or torture. The communists' belief that their ideological purity allowed them to improve agriculture in ways those bourgeois scientists and farmers could not did lower the crop yield, but if the crop had been good, they would have just stolen it and sold it overseas. Also, I have trouble taking seriously the idea of "according to their needs" when the government mandated abandoned children be left to starve, because it would only encourage people to abandon their children.

So ideological Communists? I'm officially allowing the argument that the Chinese were not practicing real Communism and thus don't count as a failure disproving Communism. I still think Communism is a terrible plan, but it's not the terrible plan the Chinese were following.

*As a net saver, technically I'm an owner-of-capital, although like many rich people, I don't feel rich.
pktechgirlbackup: (pktechgirl)
I recently developed quite the jigsaw puzzle habit. I can go through a 500 piece puzzle in a day or two, although it scales up exponentially from there. I have funny rules for the purchase of puzzles. I will spend $70 in a go on a bunch of $12 puzzles, even though I already have more puzzles than I am likely to get to before I get bored of this. But one $17 puzzle? That is Too High for a puzzle and I will not stand for it, no matter how perfect and amazing it is.

I finally found a way out of this dilemma through trickery. My friend Ashley and I are stretching buddies, and she has agreed to buy me the puzzle if I meet my goal this month. So 1. the puzzle is a reward for something unpleasant, but that I will retroactively take pride in. 2. I'm getting a nice dose of
pktechgirlbackup: (Default)
Just watched Orgasm, Inc, a documentary on the creation of the diagnosis Female Sexual Dysfunction and the search for treatment (verdict: decent, but not spectacular). My short thoughts:

  • If 80-something percent of people who can have the diagnosis do have the diagnosis at some point in their lives, it is probably worth reevaluating the concept of what merits the dysfunction label.
  • There was a woman who had new wires put into her spine in order to correct the deficiency of being unable to orgasm from penetration. Goddamnit doctors, you should not be so bad at this.

My longer thought involves the (long term) use of testosterone to treat FSD. Testosterone is a critical chemical in many biological pathways. Using it to treat one very localized problem seems like using a sledgehammer on a fly. On the other hand, testosterone seems like an excellent treatment for low testosterone levels, for which low libido is definitely a symptom. Because of the way medical patents work, there's no financial incentive for a drug company to investigate what a normal testosterone range is, and what symptoms indicate a person would benefit from more testosterone even if their numbers look normal. This seems like an excellent thing for the government to invest in.
pktechgirlbackup: (Default)
One of the accusations frequently lobbied against organizations like the Pink Ribbon Foundation is that their corporate ties lead them to focus on cure over prevention- in the worst case, partnering with companies and even specific products that contain carcinogens. I kind of feel the same way about government and public health. I've talked before about how ridiculous it is to cover organ transplants for 80 year olds but not dental care for children, but I think it goes even deeper than that. The US government not only allows but subsidizes meat raised on a diet of grain and antibiotics, to the detriment of our health.

I don't think medical companies (or farmers) are evil for wanting to make money. It's what they do, and a lot of good comes out of it. And I don't think people who fight for cures for the specific disease they have, as opposed to general prevention, are evil either. It's human nature to overweight things that affect you.* But left unchecked, these things lead to a highly reactionary approach. Preventing the tragedy of the commons is an excellent use of governmental authority and I'd like to see us get good at that before we start trying to do stuff like decide exactly how much tamoxifen we're willing to buy for an individual 75 year old.

You know, I started this trying to explain that I wanted something else in place of what we're doing, but the more I think about it, the more I realize that this misallocation of energy really is what keeps me from getting behind Obamacare in particular and socialized medicine in general. It's like putting a crown on a tooth needs a root canal: technically some helpful in the short term, but it will need to be torn out before you can fix the real problem. I need to devote more thought to this, but it's entirely possible that if we mastered the fundamentals of not poisoning ourselves, I would not only be okay with socialized medicine, but championing it.

*See: me and dental care.
pktechgirlbackup: (pktechgirl)
Headline: Merck halts shipments of key cancer drug to Greece

Me: You mean Greece is no longer buying the drug because it can't afford it?

Source article: " German pharmaceuticals firm Merck KGaA is no longer delivering cancer drug Erbitux to Greek hospitals, a spokesman said on Saturday, the latest sign of how an economic and budget crisis is hurting frontline public services."

Me: ... so is Greece in debt to Merck KGaA and they're refusing to ship more until the account is settled? Are they willing to sell for cash but not credit? Is that a change? Has Greece declared it won't pay more than $x and Merck judged that to be insufficient? If they'll ship to pharmacies but not hospitals, what's the difference between them? Is there a supply shortage? If no, what are they doing with the excess pills and/or capacity?

So clearly, my first reaction is to assume that Merck KGaA, and drug companies in general, do things for reasons. And to implicitly assign blame for the people who will die for lack of the drug to the Greek government, not the corporation who manufacturers it. This is not the universal reaction. The nicest suggestion in the BoingBoing comments was patent infringement. The worst was throat slitting for the board of directors.

We don't have the drug without the research to produce it. Merck did the research (or bought whoever did). Merck did the research in anticipation of profits. We could temporarily boost everyone's utility by selling all drugs at cost, but as the system stands now, there would be no new drugs, because there would be no incentive to make them. This system has flaws, and those flaws kill people, and there are quite possibly better systems out there. But until we actually have such a system in place, dismantling the current one will cause more death than leaving it alone.
pktechgirlbackup: (Default)
Publicly traded corporations are legally obligated to be sociopathic: doing something moral at the cost of profits is a violation of shareholder rights. This isn't as terrible an idea as it sounds. The actual point of the law is to prevent executives or large share holders from ripping off small shareholders by funneling money from the large corporation to their personal holdings (by, e.g., giving to a charity but earmarking the money to buy products produced by a family member). I support that idea. Letting individuals with little money and no connections invest with minimal friction is important to class mobility. But it did have this rather nasty side effect.

Someone finally fixed this with a Benefit Corporation. B Corporations specify their altruistic mission in their articles of incorporation, and are required to report their progress using established third party standards in their annual reports. I'm freaking out a little bit at the ambiguity implied by "established third party standards", but I'm not sure there was a better solution. And there's even a non-profit dedicated to certifying with companies that meet (their vision of) acceptable levels of accountability and performance. We gave people more freedom and private organizations popped up to help people use it wisely. It's a libertarian wet dream.


pktechgirlbackup: (Default)

May 2014

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