Do you trust the certificate authorities who tell your browser which servers to trust? How come this is the one super special time when it is absolutely unacceptable for you to trust anyone else? Why is this one thing inevitably doomed, while all those others have some magic aura protecting them from the same inevitability? Nevertheless, we still let judges issue search warrants for houses, and we have since approximately ever. Some people sometimes choose to use insecure services, but they have the choice to use secure ones.
A better analogy is the government having keys to all homes and the ability to invisibly sneak around inside them. But literally no one has proposed such a thing. I really important feature of all serious proposals is that it would be a process which necessarily runs through courts and companies. No government agency would have any key to anything.
The example concept starts from the point that Apple is good at doing security. Search warrants already come with a receipt requirement. Encryption is winning the arms race against cryptanalysis, so it's feasible to encrypt something in a way that can't be broken.
So there is a binary of "can be read by powerful adversary" vs "can't be read", and there is very little reason to choose the former unless you don't care about someone reading your messages. But if you'd prefer, imagine I said "drastically less secure" rather than "insecure". I think what Amber Rudd UK home secretary is proposing is unclear. It seems likely that she doesn't know anything about any technical details, and is just telling WhatsApp to find a way of giving her terrorists' messages, with no regard to how practical that is.
And in practice, often much smaller organisations of ordinary criminals can. In comparison, if they get a warrant to search your house, they either find some evidence of illegal activity or they don't. This is the standard accusation leveled at the Burr-Feinstein draft, too.
No government agency has access to it. Distinguish this from the current ability of the government to acquire a Title III wiretap warrant. There is good reason to require notification for LE. There is good reason to not require notification for FCI. You try to mitigate the damage or exploit your knowledge of this operation in some other fashion. You certainly try to tap all of his communications. There are some arguments for this… and some arguments against it.
Sure, they did a lot to encourage more information sharing across the wall, but there are still lots of really important distinctions between the two domains. Namely, in one of them, we have strong notification requirements for search warrants. That division likely has the international terrorism hook into products of FISA.
We were talking about what the law actually says, and what future law is likely to say… not whether someone thinks one particular portion of the government has broken the law at some time. Even if one particular portion of the government has broken the law by performing parallel construction for law enforcement, that has absolutely nothing to do with whether or not future search warrants that compel decryption through a company will come with a notification requirement. EDIT: For both of you, I should note that various portions of FISA still allow for sharing of information and use in prosecutions if there is an indication of a threat of death or serious bodily harm.
The various details are complicated, and I encourage you to spend more time reading the actual law and comprehensive reviews from groups like PCLOB rather than breathless reporting and anonymous sources. Which means the DEA has access to intelligence data.
I know you are. As I pointed out explicitly, a component of DEA has access to intelligence data. That component is the one with the international narcoterrorism mission. Either the wall between intelligence and law enforcement has to be rebuilt, or intelligence activities have to be evaluated as if they will be used for law enforcement purposes as well. Because they will. If the intelligence activities are so essential, then the wall needs rebuilding.
Still, that has approximately nothing to do with whether search warrants will come with a notification requirement. A law requiring decryption as a result of a warrant is a problem only if it by analogy with CALEA requires making that decryption possible; that is, it forbids communications which cannot be decrypted by the provider. Because in practice, anything which can be decrypted by the provider may be decrypted also by the NSA and WILL be so decrypted if the NSA has anything to say about it , which is likely to pass anything juicy onto law enforcement, which will concoct a reason to get a search warrant, completely vitiating the whole warrant requirement.
My bad. I was under the impression that search warrants issued by an ostensibly independent judiciary were a meaningful check on government investigative powers and is the core of the Fourth Amendment. I suppose I could be hallucinating various cases where this resulted in suppression of evidence. Good news! No one thinks this is possible.
For example, under Burr-Feinstein, you could still download PGP and encrypt your communication before sending it through a channel. It targets widely-used and easy-to-use systems. Do you think that it has completely vitiated the whole Title III wiretap warrant requirement? Of course, he had actual talent, which makes up for a lot. On Tumblr, Scotty did some self-confessed wild speculation on foreign policy, to the effect that we should ally with Iran and Assad.
The other side can always choose to not play along. The Middle East is a mess. Always has been and always will be. I found this article interesting. Has the Middle East had much more historical tension than, say, Western Europe? But the history of Europe before seems to be mostly alternating tension and war. ASEAN allowed sharing of wealth and prestige between small prosperous states and larger poorer ones.
So the large ones were less tempted to invade and loot the smaller ones. No-one found it worthwhile to fund insurgencies in their neighbors ahead of developing their own economy. In theory, the Arab Union could have done the same across most of the Middle East. Real shocker that a body named after its favored ethnicity did not bring stability to a multi-ethnic region. ASEAN largely ignores authoritarianism in the region in favor of stability and the maintenance of good relations.
Still worth emphasizing. Hezbollah needs to stay armed via Syria to defend Lebanon from invasion. Your other Sunni ally Pakistan loves killing Shiites too, ideally Shiite girls going to English and informatics classes. You should stop spoiling the barrel of your otherwise correct view on the region with poisonous bigotries. Is that being ironic, too? The history of Israel vis a vis Palestinians is not all that similar to the U. In the Israeli case, large numbers of Jews immigrated peacefully to Israel and bought land there.
Conflicts between them, the Muslim inhabitants and the British rulers arose, violent on both sides. A civil war developed into an invasion by adjacent Arab states in support of the Palestinians, the Israelis eventually won the war. Arabs who did not choose to leave during the fighting remained in Israel and continued to own whatever land they had owned before.
When dealing with head-in-the-sand types I find the echoes somewhat amusing. But I agree. To reiterate what Winter Shaker said above. The onus is on you to explain why it matters in the first place. Other than as whatever the opposite of a shibboleth is, the one that gets you killed. Get him! If we could trust that Iran was completely done with nukes I would agree that we could be friends but until then….
My foreign policy would basically be stop nuclear proliferation and stop terrorists. Those are the most important issues right now. To the extent that Iran is seeking nukes, though, it is an at least moderately rational reaction to the incessant threats from the West.
In , the U. Can you really blame the third one for learning the obvious lesson? Ok but at least two of those countries were run by tyrannical maniacs. The lesson is, if you are a tyrannical maniac, you must acquire nuclear weapons or die. If you are not a tyrannical maniac but your hands are dirty enough that you might be mistaken for one, you must acquire nuclear weapons or die.
If you imagine it is possible to shed your tyrannical past and your nuclear weapons, you will die. We used to be more flexible in dealing with tyrannical maniacs. We may look back at those as the Good Old Days.
Ever wonder why Assad has hung onto his power so relentlessly? I did not know that Putin acted in Syria because of Libya. Makes me even more skeptical of regime change. Even ones that are relatively cheap can have political fallout. You gotta kinda feel bad for Gaddafi, playing the frog to our scorpion. I shed no tears for Gadaffi. Given his much improved behavior from , doing him in like that was a poor geo-political move, but the man was a socialist dictator and terrorist.
His behavior from earned what he eventually got. True, but it also earned the Syrian people what they are currently getting, and the North Korean people what they are perhaps going to get. I agree completely, but I reserve my concern for the Libyan and Syrian people, not Qaddafi himself. Which isn't to say nothing more happened. Nor is it "okay" to shoot dozens of protesters.
But it was definitely no Rwanda. Even if you believe in R2P, applying it to Libya was a stretch. I honestly thank God I am not in a position to make such decisions because of the difficulty of even knowing what is really going on.
I would love to see a detailed analysis by knowlegable people of the options for a foreign policy in which we do not pretend to like the Saudis, including the ramifications for other foreign relationships once the dust has settled. But perhaps some think tank or some university team has done such an analysis and published it. Has anyone here heard of such a thing?
The claimed role is to allow them to conduct at least a token retaliation to ballistic missile attacks against Saudi Arabia. The reasonably suspected role is to enable Saudi Arabia to roll out a nuclear deterrent as quickly as possible if they feel the need, with only the warheads to be procured from Pakistan. If the U. This trend which allows the US to trade interests in high yield foreign businesses for low yield treasuries , is a key result of the petrodollar system , for which Saudi Arabia is the lynchpin though the large holdings are by large oil importers.
In short, Saudi Arabia keeps its position because their the financial enforcer of the agreement that lets the US run a global empire, while pretending not to be running a global empire. The concrete things we might do are 1 stop selling them arms and 2 stop helping them bomb Yemen. We get money by doing the first, and the second is justified by anti-Iran hysteria.
So our concrete actions towards Iran seem not to be about influencing the Saudis anyway. We told them to start bombing Yemen. What makes you say that? I had figured it was more genuinely homegrown on the part of the Saudis, about them not wanting a hostile neighbor or anything to inspire their own Shia minority.
We certainly benefit from have operations in the area insofar as it makes it easier to carry out the raids against the Yemeni Al Qaeda, but do we have a non-Saudi-supporting reason to be against the Houthis? Sounds good to me. I think bean misrepresents the situation between the U. But that is perhaps incompatible with domestic political realities in the U. For those unaware, Chevron deference is a legal principle, established by the Supreme Court in Chevron U.
National Resources Defense Council, Inc. This principle says that:. The basic idea of Chevron deference was that an agency is a subject matter expert and would probably know better how a law they are administering should be read when ambiguity arose. The opposition, generally, is that this is a delegation of judicial power to the executive and gives administrative agencies too much power to decide what laws are.
Gorsuch is against Chevron, where Scalia was generally in favor of it. It represents an abdication of judicial review, leaving the power of the administrative agencies unchecked. The problem with deferring to regulations that are ambiguous is that it can create an incentive to write ambiguous regulations and hold interpretation over the heads of the regulated.
I think that interpretation should always hew close to the written text of statutes, with ambiguity held against the Government. Your first paragraph is about regulation, rather than law. You could support Chevron and oppose Auer. It would be easier for courts to to convince agencies to rewrite rules than to convince congress to rewrite laws. Your second paragraph seems to be a complaint about courts, rather than agencies.
Chevron directly addresses this problem: it is easier to look up what the centralized agency said than to study the decentralized courts. Added: Using regulation to resolve ambiguity allows it to be resolved ahead of time, while courts generally only get involved late, increasing risk. But it may be difficult for the court to force the agency to use regulation for the purpose of clarity. In any event, I think the two situations are quite divergent.
The case for deference in interpreting their own regulations is much stronger than for interpreting legislation. For the interpreting legislation part, I disagree with Chevron. It seems an abdication of responsibility. I guess I should note for context that, for someone on my general side of the aisle, I am unusually sympathetic to a broad and robust non-delegation doctrine.
I tend to lump those together, even though the argument for Auer deference is stronger. Actually I sort of like Auer deference less than general Chevron cases. Where Congress writes an unclear provision, the agency is just trying to implement things as best they can. Yeah, I could see that, or other reasons, so I guess I should have asked a different question. Has there always been such polarization?
I feel like it has suddenly appeared, without any explanation. I wonder if it actually a consequence of Gorsuch and most people, both left and right, are assuming that if he opposes it, it must be left-wing, even though he is relevant because he disagrees with Scalia. I think this article gives a reasonable guess at how it started. Since we just came from a split presidency under Obama, we should expect liberals to like Chevron right now. Rolling back Chevron would mean that a court would decide, de novo , what the correct interpretation of an ambiguous statute looks like.
Capato —. The Third Circuit, on appeal, reversed, finding that the undisputed biological children of a widow and father are his children. If there were no Chevron deference, would the case have changed at all? Maybe not. But you would probably have more courts holding contrary to agency decisions, because people disagree about ambiguity in the law all the time. The Department of Administrative Affairs adopts an official policy of interpreting a statute as meaning X.
You would much rather it was interpreted as meaning Y perhaps because you own a business that becomes much less profitable if it says Y instead of X , so you sue for an injunction to change the official interpretation. A judge who opposes Chevron will rule in your favor merely if he believes Y is a better interpretation than X.
This seems to come up a lot in tariff laws, where the Treasury agency administering the tariffs disagrees with importers over what category and thus what tariff rate a particular thing falls into. For example, Snuggies are taxed at 8.
With Chevron, the Treasury wins unless its classification is unambiguously wrong. Without Chevron, the court would decide based on the statute which classification was a better fit, regardless of what the Treasury thinks it should be. More cases would probably wind up in court under any given interpretation regime, but the agencies would be incentivized to stick closer to the most plausible interpretations of the statutes.
This is controversial? Read that sentence again. If you were to try to map these out to a traditional political matrix there would be no discernible pattern. Granted, statistics and economics, two highly represented groups, are not necessarily political to begin with. But SSC readers really do seem to be coming from multiple different directions. Speaking of match day, just matched at Henry Ford in Detroit.
I have a wife and a newborn, no connections in the city. Any advice on where I should live? When my brother and his wife matched to Henry Ford a few years ago, they got a place in Ferndale. Or one of the other locations in the Henry Ford Health System? Though, come to think of it, housing in Ferndale would be good for most of those, except possibly for the Wyandotte hospital.
Yeah the one on Grand Boulrvard. Thank you both for the replies. Any recommendations for learning resources on GIS? Ideally platform-agnostic ones. Do we ever talk about our favourite commenters? Talking about individual commenters introduces a new incentive and maybe disincentive to some into commenting. Some might feel the desire to increase quantity possibly lowering quality , others, quality.
Net result? Maybe a stroll down the reddit popularity lane…. I finally figured out how to get a list of most frequent commenters, so if anyone else was wondering:. Who are all these people with actual names? I only have one 1 email account where I use my real name and that is only for Official Business. Everything else online is under a nom de plume. Must learn to resist the siren call of someone being wrong on the internet. There are, of course, a great many more commenters here I enjoy for shorter form posts, valuable insights, good faith participation, and entertaining writing.
Spookykou is amazingly patient and polite. Deiseach is always hilarious. David friedman is great all round. I am very much one of those who finds this place unusual in being a place to receive polite, intelligent, non-echo-chamber feedback on controversial ideas. You never know the difference between something that is possibly controversial and something that will make you a pariah for defending.
Among the commenters I disagree with, I like lvllin sp? Among the commenters who I sometimes disagree with, I like Douglas Knight and Deiseach for very different reasons , as well as Larry Kestenbaum. Someone should combine the comments on who people like with data on who is where on the political spectrum, and see to what extent people are liking those who agree with them, to what extent not. And about once every six months, I ask about German idealism and someone always answers — so that person.
Maybe Urstoff? In no particular order and surely missing some of higher cardinality: FacelessCraven — We disagree on so much and yet can easily reach agreement on matters where we do onyomi — I find his preferred system completely unworkable, but the conversations about it are interesting and in search of truth. Also easy to come to agreement with. HOF nominee — Vox I. Special shoutout — James? Sorry, failing on the name for being willing to spend exhaustive time debunking various AGW denial and minimization arguments.
Not sure if I am willing to venture out onto tumblr. That comment interface makes me twitch. I consistently find your contributions interesting and cogent. Please try harder in the future not to misnumber other commenters. Though if I follow the Youtube link to the edited interview, I get this impartial and balanced production:. Have a Nice Day! Colette Dowell. That being said — what the what? So this kind of talk is very weird. Question: what should an actual good health care bill look like?
Obamacare has some issues; not having it is worse. The problem with the health care system is that neither the doctor nor the patient cares very much about the cost. Pass a law that health care providers have to tell you the price ahead of time. Let people bargain hunt.
I think this would sort of work for non-urgent care. For emergency services it would fail horribly. I think these problems are solved by different things. For 1 the solution is to not cover that with health insurance — just give people a basic income or let their employers pay them more money, or whatever and let them bargain hunt. Case 3 is a redistribution-of-wealth problem, and I think we actually have to get the government to do that, with all the inefficiencies that brings.
How much of our health care spending falls into each of the three categories above? One is the ban on interstate insurance sales. The other is the problem of pre-existing conditions. Pre-existing conditions should only be a problem if you have them when you first come on the insurance market. Their problem is what happens if something goes wrong and you then have to negotiate a new insurance contract. Why would that happen? The point of insurance, after all, is that you make the bet before the dice are rolled.
You should be able to buy a policy when you are twenty that guarantees its terms for the rest of your life, priced to allow for the risk that you might turn out to need a lot of medical care. Another factor with similar effects is the link between employment and insurance, which is at least partly due to the fact that employer provided insurance is bought with pre-tax dollars, privately purchased with after-tax dollars.
If your insurance is through your employer, shifting jobs means getting a new policy, which is a problem if in the meanwhile you have developed an expensive medical problem. What happens if they come up with new medicinal advances during the life of the insured person?
Does the insured person get that care? Does the cost of the policy then go up to cover this? Can insurers then drop medical care that they no longer consider effective enough to compensate or that has been replaced by better care options? If not and if you keep adding medicinal advances, you guarantee cost disease. If so, your lifetime policy guarantees nothing and the insurers can just drop a lot of care from their locked in customers and thus make huge profits. Reinsurance is totally a thing, and can be used to insure against a primary insurer going bankrupt.
And if you are going to have the government meddling in your health care industry, having them act as the ultimate guarantor for health insurance just as they do for pensions is probably one of the better things for them to do. At this point it would take more than just an interstate market to provide guaranteed health insurance continuity and portability, but for the reasons Dr.
Friedman cites it is a necessary step towards that ultimate goal. And sometimes they can, but you need to think about who exactly should be tasked with fixing them. Insurance companies may not be the right tool for this job, any more than EHarmony and OKCupid can be expected to solve the problems of everyone who screwed up their love life in their 20s.
Legitimate questions. I think you want the contract structured in a way that lets the company raise or lower prices on everyone but not on specific people. Otherwise an increase in the cost of what they are providing could push many of them into bankruptcy. Their ability to raise prices is limited by the need to sell new policies and the ability of policyholders who are in good health to switch companies. The last thing an insurance company wants is to have all the healthy customers leave.
Accept that policies will be life-time for people with discovered pre-existing conditions, and assume the insurance companies will stay healthy over the period. Healthy people just switch plans, the pool bleeds those patients, and those who are left will pay higher and higher rates.
I think you are allowing a misleading to name to, well, mislead you. Health insurance in the U. The main issue is provider networks. Much of the value of a health insurer is in the discounted rates they negotiate with hospitals and medical practices, so to expand to a new state you need to have enough bargaining power to get competitive rates from local providers.
And for it to be profitable, you need to do enough business in the new state to cover the overhead costs of the expansion. Note that this applies intrastate too. The insurance company in the linked example is owned by a Pittsburgh-area hospital chain. And of course United Health has subsidiaries in states other than Minnesota, likewise Cigna outside Connecticut, etc. All healthcare systems and non-systems are facing the problems of demographics and other rising costs.
Universal systems manifest the problem more acutely because they can;t take up the slack by just leaving some percentage of the population uncovered. In the UK almost all hospitals are actually operated by the government. The situation with primary care is a bit more complicated, but it is not too far wrong to think of that as being provided directly by the government as well.
I think most developed countries have private hospitals where the government funds a high proportion of treatment. The UK and Canada are exceptions in having publicly run hospitals, the US is the exception in other ways. Austria for example has mostly public-run hospitals too, but even in Germany about a third of all hospitals are run by the government mostly by states and not on the federal level though.
My impression is that most developed countries have their hospitals divided between locally-government-run, private for-profit, and private non-profit in widely varying proportions. The way the UK handles it is that the NHS covers everyone, whether you have a billion in the bank or a a pocket full of moths.
Neither will get a bill in the post no matter what treatment they need. For the same price british citizens got universal cover. My theory is that the 2 parties in the US work so hard at sabotaging everything and injecting poison pills into anything the other tries to do that everything ends up costing far far more than it should. The americans would fuck it with the other party constantly doing stupid things like injecting requirements that every hospital have years of pension costs in liquid assets at all times or something equally stupid purely to fuck it up and destroy it.
Is that number set legislatively, or what? It seems to imply potentially unlimited total spending. Roughly, the QALY figures are used to decide what treatment capabilities to have, and then those are operated from a fixed budget. No-one secretly builds a cancer ward without budget authorization, so the main way to go over-budget is to pay overtime, which is inherently limited.
Going a few percentage points over budget happens a lot, but more than that is a career-limiting move for the management team. The ultimate failure mode is waiting lists for facilities become long enough that the budget is only maintained by people dying before receiving treatment.
Obviously, for something like an epidemic, there presumably would be an emergency budget change to acquire needed treatment facilities immediately. Medicare and Medicaid together cover a number of people roughly equal to twice the total population of the U. And enrollees to these programs are obviously skewed toward the old, the poor, and the disabled — not exactly cheap populations to cover for any system. Meanwhile a majority of the nonelderly get covered by employer-provided plans that are by and large pretty good.
Really, America has excellent medical care, just with an inefficient hodge-podge of ways to pay for it. So one thing I have to give the NHS credit for is doing a bang-up job of demonizing the American health care system. Particularly for anything not immediately life threatening.
For example, I tore my ACL a few years ago. Within a span of 3 weeks, I decided I should see someone about it, got a consult from a surgeon of my choosing, with no need for a referral or even a visit with a GP , got an MRI again at a location of my choice , had my surgery, and enrolled in physical therapy. And I could have done it quicker if I wanted to. All for a very affordable deductible. In the NHS, my understanding is that this treatment would have involved several extra steps and approvals, with much less choice and much longer wait times.
If I got approved at all — my surgeon did say that a no surgery, PT only option was possible if I was willing to avoid certain high impact recreational activities. My point is just that, for a very big chunk of Americans, the medical care we get is at least as good and in some valuable ways better than the NHS. And your drugs are cheaper. As far as I can see, the relevant statistics are how much different treatments cost in different countries comparing health directly is confounded by differences in lifestyle.
I said per citizen. As in take how much the US spent on medicare and medicaid and divide by the total population of the USA. Fun side note: the NHS also has some of the duties covered by other US departments that do things like fund research. Changes in the exchange rate mess with the comparison a bit but it was only a little while pre-obamacare that I ran the numbers.
I have no illusion about the numbers. Add in the worry that even if I pay every premium the insurance company will refuse to pay out over some bullshit reason like having a health kick and losing some weight before starting the insurance or having a cold or something? Get this: I never have to worry about that. That has significant utility to me. My life is fundamentally better as a result. I never have to worry that I could end up tied up in court because an ambulance company and my insurance company are having a fight.
The NHS tends to perform best when the situation is most urgent and the care needed is most critical. And get this super amazing bonus: I can get by american standards super super cheap health insurance on top of that if I feel like it so I can go to a private hospital and get private care for things like torn ligaments and do everything you mention.
I already pay less as a taxpayer and if I want the fringe benefits of the american system I can get those for a fraction of the price as well. This is really rather remarkable. We could have universal healthcare using only money that we already pay in taxes. I really doubt you could. One party would propose something like it, probably with more pork for their friends, then the other would keep injecting exceptions and requirements into the bill designed to make it unpopular or impossible to run effectively in order to kill or neuter it.
The UK only managed to create the NHS during the post war years because the country was riding an ideological wave of people pulling together and making things work. If you tried it in the US it would probably be a disaster. I see a fairly constant stream of horror stories from americans. So, the US might have an easier time than the UK providing NHS-style public hospital coverage in, say, New England, but it would be considerably more expensive and difficult to get even remotely near the same level of care in the Midwest.
To rephrase things, a common argument in favor of public health care in the US is to compare US health costs per capita with those other countries that do have public care programs. We also have a significant issue with delivering medical care to rural populations. This is compounded by the fact that many of our rural populations are indigenous, and hence a federal responsibility, whereas health care is provincial.
Part of this is addressed by sometimes mandating medical professionals serve in rural areas in exchange for their education my second cousin spent years in Iqaluit as a dentist under this program. Other options are shipping rural patients to urban centres, which is expensive and has mixed results.
I grew up in a more rural part of Canada. There are notable differences. Once it arrived there were large number of hoops put in place in advance of being able to use it. My dad worked as a middle manager for a local mill. On occasion usually just before a major sporting event a worker would claim that they were sick and needed to go home early. The best way to prevent this from happening was to insist that the employee go to the ER by ambulance all costs paid for by the company to be evaluated before going home.
Getting to see a doctor with something like strep throat at the local clinic not ER would routinely involve me waiting for multiple hours. A non-typical example — note that the target ER waiting time was 8 hours. More recent data has resulted in the numbers getting down to hours. Rarely is there more than a few patients waiting. My PCP down here has never had me wait more than 2 weeks to get in, with additional options for urgent conditions.
It gets even worse when it comes to specialists. It was rather impressive. Requiring workers to go by ambulance! What is the system of family practitioners like in Canada? Although it seems that our more or less single payer system works better than that of Canada, since waiting times at a GP are a lot shorter, especially in rural communities. Probably a mix of a denser population and a somewhat high number of GPs, altough that is declining already.
A 10 km trip can take far more than half an hour. But it seems to be almost an order of magnitude more expensive. One fun thing about the NHS is how much they publish so for example you can look up NHS costings and somehow, even on simple things like pints of blood, american hospitals seem to manage to spend dramatically more. Again, not just a bit more but double or triple. If you choose to live on Fair Isle in the UK you make do with the medical center.
My impression is that a lot of the cost is tied up in phase 3 clinical trials, which drive up treatment costs for Americans while Europeans approve such treatments on the basis of those strong and expensive American safety rules. Another part of the cost is tied up in the comparative sizes of the nations. Countries in the EU have on the order of million people. The US has on the order million people.
If the network effect goes up with the square of the number of network nodes as is widely claimed, one would expect care costs in the US to be over times as high. My impression is that a lot of the cost is tied up in phase 3 clinical trials …while Europeans approve such treatments on the basis of those strong and expensive American safety rules.
Large drug companies run their trials in tandem, running both the European and American phases at the same time. I had heard about the value of a network increasing with the number of nodes, and of the implications thereof on gains from scaling. Why do the costs also increase in that way? And if that is so, why do networks grow past the point where the efficiency gains are eaten up by the costs? That the value of a telephone network goes with the square of the number of connected users is pretty easy to explain, because each telephone user can call each other user.
Why would health care costs go with the square of the number of people in the country? Health care typically requires matching a patient up with the right treatment, which often means the right specialist. Health care in the large means matching N patients with M caregivers with varying specialties. This smacks of a strongly multiplicative problem, which likewise strengthens my suspicion that other countries get away with it largely because of their smaller population.
There is a lot of standardization there, though. You go to the nearest hospital, who does the standard thing X-ray and then another standard thing like apply plaster. Paul Brinkley But why would you be matching patients with doctors nationwide? The vast majority of the time people will go to nearby hospitals. I wish there were. I believe that in most cases, a broken limb could be treated the same way, using no more than a couple hundred dollars in training, meaning the procedure ought to cost even less.
A free market would actually suit this fine — even better than the current system. Patients would shop more assiduously for the price they can afford per care they want, meaning that their preference curves would be actually visible, rather than utterly obscured by a combination of insurance companies paying for non-insurancey things and regulations that obscure the signals that patient preference would otherwise reveal.
To me, that locality limitation is what keeps the price from being truly N-squared, and instead breaking down along various lines. Another cost I keep noticing involves drug research. Every drug has to be tested against huge numbers of patients before being approved for market. It might be more cost effective to target drugs at much smaller groups, or to let patients decide if they want to assume the risk of a certain drug in return for it costing much less.
Yeah, I agree that doctors tend to have habits that cause divergent outcomes and costs. Doctors who want to address a rare illness have to find as many patients with that illness as they can. Patients with a rare illness or who suspect they do have to find the doctor that treats that illness.
But I see that as one of the contributing factors to US health care being so costly. The rightmost health-wonk-preferred policy a bit to the left of ACA, and to the right of Medicaid-for-all is all-payer rate setting. In an insurer network, the insurer and providers negotiate mutually-acceptable charges for their library of procedures.
APRS is where a consortium of providers and one of insurers set mutually-acceptable rates that apply to everyone. Maryland has this for hospitals, it works well, and nobody gets stuck with a bill at charge-master rates the ones you see on EOBs before the insurer network discount kicks in. The American public will never allow a free-ish market to develop in healthcare. Price controls from APRS through single-payer to direct provision are it. Overall it would save a lot of money.
In the short term, a bill that repealed the ACA exchanges and associated legislation but kept the medicaid expansion would preserve the vast majority of the coverage expansion, repeal most of the cost, and get rid of the parts everyone hates. How do you mean this? They may not be able to reduce the cost hospitals pay their doctors or equipment suppliers, but they definitely, though bargaining, reduce the cost paid by and on behalf of their clients.
Some preferential treatment of HSA to encourage their use, tax employer provided coverage as regular income. Add some sort of death panel of experts who get to decide which ultra expensive treatments are denied under the emergency single payer. Add in some kind of subsidy for the poor. I completely agree that there is a porblem with the costs being divorced from their use, thus not allowing for a functioning market that would distribute resources. However, a functioning market needs rational participants.
By the time one is really sick, they are not a rational participant anymore. No one is going to shop around for their life saving cancer treatment, and there is going to be a substantial portion that is not going to have the mental capacity to make decisions. So, lets take care of the really and truly sick with single payer. There a market should work to better allocate resources, and encourage innovation.
The two things I would do is make it gradual and use our existing institutions. Ergo, my bill would be two sentences long:. Health Insurance is very hard for me to figure out. It seems to me that insurance companies are in a weird place where their profit maximizing strategy is to offer you the worst product they possibly can maybe this is true of all businesses?
But there are various special cases that can make this argument weaker; the worse your information is about your options, the more external constraints are placed on the service, and the closer the service provider is to having monopoly power, the more business incentives point away from customer satisfaction. You have weak and incomplete information about insurance.
And there are relatively few players in the market, with very high barriers to entry. As long as the monopoly is free to charge what it wants and the customer free to buy or not buy there is an incentive to aim at customer satisfaction, since a satisfied customer will be willing to pay a higher price.
One can be extremely dissatisfied with a service that provides something which is perceived to be essential, and still buy it. Regardless, these kinds of definitions of, say, satisfaction will be very different for economists than everyone else. I assume a monopoly is always charging the price that maximizes their profit. So if you really want something they are charging you a thousand dollars for it. Does that make the argument clearer? Neither a monopoly nor a firm in a competitive market will make it that good—or should.
Would it be clearer if I said that it pays the monopoly to make any improvement that is worth more to the customer than it costs them? And what is really going on is that there are some elements of the package I am satisfied with and some I am not, and overall I am not satisfied, but I would be even more dissatisfied if I cancelled the service altogether. DavidFriedman, your own math indicates that the customer will not benefit from the improvement in the service; the monopoly will charge enough that anything the customer gains from the improvement will be fully offset by the increased cost.
This assumption only seems safe in a framework without regulation. In a framework with regulation the monopoly will charge either the price that maximizes their profit or the highest price that makes an anti-trust response unlikely, whichever is lower.
I was assuming a monopoly that did a perfect job of pricing—as I mentioned, I was leaving out some complications. If so, the marginal customer is getting the product for just what it is worth to him, the customers who value it more are getting it for less than it is worth to them, hence a net benefit. The hypothetical improvement might increase or decrease their total benefit consumer surplus , depending on the details. My point was that that was not in general correct.
But both the monopoly and the competitive firm want to improve the quality of their product, as judged by consumer value for it, so long as the improvement is worth more than it costs. The relevant choice for most Americans is not which insurance policy or provider to sign up with, but which doctor or hospital to go to. Americans who are not single young men have an ongoing relationship with a primary physician that they want to maintain even if the bureaucracy decides some other doctor would be more convenient, and most Americans believe that if they develop some serious chronic ailment like cancer they ought to be able to chose the doctor or hospital they feel is best suited to their case.
Traditionally, American health insurance policies allowed for this; you picked whatever doctor you want within fairly broad limits , sent the insurance company the bill and they paid it. I have a choice of 1 insurance plan.
All of our families providers are out-of-network. I should go see an oral surgeon and there is precisely one in network and he works one day a week. I will probably have to pay out of pocket for this. Narrow networks are often used as a club to beat down overall utilization.
As in your example, you can wait in line for this one guy, or go elsewhere and accept unlimited financial liability, so people tend to take the third option of giving up. I can see how I could be blind to this side of the choice question. I have no primary care physician that I have seen more than once, I tend to go to the doctor once a year with a few exceptions and just ask for the most convenient time slot without a thought to the name of the doctor I will be seeing.
The bottlenecks are political naturally , and arguably also public consensus. I struggle to think of any logistical obstacles otherwise, though to be fair, these are relatively broad, unspecified opinions. Reduce regulatory barriers, if any, to what caregiver can conduct what procedure. Reduce the requirements for accrediting new doctors. And if employer tax rates are equal for all benefits, employers will no longer have incentive to manage their own insurance plan unless the work is hazardous , which means employees can get their own plan and take it with them if they change jobs.
Since Quality Adjusted Life Years can theoretically adjust for basically any condition you can even account for how much it sucks to live in bankruptcy and poverty with them. The gist of the results were that healthcare usage went up among those receiving coverage shocker!
So my question is, how would these results compare with something like a basic income, and what QALY gains are we really getting here? I know that scrapping all government payments to health care and replacing with a targeted basic income to the groups previously getting the health subsidies is politically infeasible in the shot-, medium-, and probably pretty long-terms.
The idea that health benefits are a great benefit to have is heavily ingrained. But a lot of what makes a huge difference in health is lifestyle things that healthcare systems only have limited capacity to impact. Thus I reach out to this community! Does anyone know of any data on how much healthcare coverage tends to improve QALYs? Has any short of comparison been made with Give Directly type no-stings-attached checks to people? What research is out there on whether or not all our subsidies are actually helping people relative to other forms of support we could be doing?
Price transparency 2. Change compensation structure for doctors patients can pay per service, but doctors should be salaried 3. Some deregulation of doctor licensing, what services NPs and PAs can provide, etc. Scott: I just registered this account locally as opposed to on WordPress and had some trouble doing so. The security code presented to me had 5 characters in it, but the field in which I had to enter the code had a maximum length of 4.
What even are computers? Seriously, how do you programmers deal with them every day without going insane? At least computers do exactly what you tell them to, you can read the source code and make very targeted fixes, etc, etc. What even are humans? Seriously, how do you psychiatrists deal with them every day without going insane?
As an embedded systems engineer I find that sacrificing a goat on the full moon before a quarterly code review will keep your code clean and free of bugs. Smaller sacrifices or supplications to Finagle and his Prophet prior to calibration tests are also recommended as a way to encourage compliance from individual machine spirits.
Proper revision control of source code allows us to take even the most maddening and infuriating bugs, reduce them to the precise instructions which spawned them, and find out which programmer was responsible for writing those instructions, at which point the computer is quickly recognized to be the logical element of the system and not the blameworthy part of the problem.
There are four lights! Which political entity is more of a state: Palestine or Taiwan? Palestine is recognized by UN members out of and is officially recognized by the UN as an observer. However, it is under the control of Israel. Well, Taiwan in de facto independent, but not de jure. Palestine is in some ways a de jure independent state but not in practice. It could be interesting to compare to US laws on immigration and marijuana.
In both cases the federal laws are far stricter than the de facto implementation. This is a purely semantic question; all this question depends on is the definition of statehood, and not about any actual facts in the real world. My questions are:. The alliance had established the 2 percent guideline at its Riga summit in , yet did not include the goal in the official summit declaration endorsed by all member states. But it is a commitment to work towards it. Source goes on to state that the Wales summit was a bit more of a thing, if still non-binding.
Playing footsie with Russia right now is destabilizing, for many reasons, although I think the odds of Russia trying to push tanks into, say, Poland are very, very low. But break-up NATO? The odds rise. They need to increase theirs as well. Pretty good. Back in the cold war days, it was hard to get the Spanish to get too excited about defending Germany. Such is the nature of international coalitions.
It should have been dismantled in the late 90s, or at the very least not expanded. NATO is, on the whole, a good organization. It seems to work adequately, it was necessary when first brought about, and having coordination between the major Western powers is important.
NATO needs a clearly-defined mission, and it needs a commitment from all of its members to perform that mission. Is Spain going to send men to die for Latvia, if Putin pulls that trigger? We also need to be clear on whether NATO is about sending an army to protect doe-eyed waifs from Evil Murderous Dictators in regions with only vague and tenuous connections to the NA, and if so, who gets to decide.
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How frequently you update your site? Smithe Thanks Nonetheless I am experiencing issue with ur rss. Dont know why Unable to subscribe to it. Is there anybody getting similar rss drawback? Anybody who is aware of kindly respond. Thnkx eafdadddgebedeke. Smithf39 CraigPhark Mohammed In developed countries, for example, consumers pay for unlimited data plans.
As a result, many frequently use apps that have little or no data usage optimization. By making apps more effective, the cost of social connectivity would be less of a financial burden to developing or undeveloped. Bradly That, she said, is when her son socked the young woman. Dante John Aubrey Spencer GSK has said some of its Chinese executives appear to havebroken the law. Luigi Pitfighter We think he has a pretty good future.
He has things to learn, especially with his secondary pitches, but he is a mature, serious, hard-working young man. Ashton An estimated 30 million to 32 million of these doses will be quadrivalent flu vaccine.
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Barclayssaid it was considering its options. Mariano Amid all of this, the gas kept comi. Mike Madeline It fizzled quickly, but regrouped during the weekend and becamea tropical storm again on Tuesday. Noble Sara Spears and Buhayar raise an important questionabout job creation.
Teddy Foreign CorruptPractices Act can vary widely, depending on, among otherfactors, the extent and duration of the violations, the level ofbenefit the company received, and the level of cooperation fromthe target of the probe. Often, alumni volunteers lead interviews. Lenard An ugly three-putt at No. Bradford He encourages them to integrate with German society but not to be totally absorbed by it. There are 1. Jordon Connor We expected to have him back at this point.
Dillon Bryan Sammy Furthermore, based upon the absence of carbon, it is likely that the body was an asteroid; comets contain large amounts of carbon, whereas asteroids do not. Jasper Erin There are so many cameras at grounds it would be impossible for the umpires to get away with being biased, so have the best officials even if they are English or Australian.
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He is doing the "Biden thing". Where is Joe Biden for an opinion? Shawn Peyton Basil Young Alphonse Johnnie Clarence Allen Indeed, the corporate changes outlined byBallmer have already occurred in these two companies. Cameron It attracted some attention from Korean Internet users before being removed. It recently reappeared on YouTube and was posted to Facebook. Multiple Korean news outlets reported on the footage.
Vance The company is evaluating allalternatives with regard to raising capital, the source said. Kimberly Here are five recommendations from experts on how to successfully sell yourself as an international candidate for a U. MBA program. Francis Christian It can then travel to the brain, causing primary amebic meningoencephalitis, or PAM.
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Freeman The Facebook Card was introduced early this year as a reusable gift card that can be redeemed at a number of real-world retailers including Jamba Juice, Olive Garden, Sephora and Target, just to name a few. Renato Randolph Chadwick But the vote revealed cracks in the center-right coalition with its failure to muster a majority that would give it legitimacy to pressure Zeman to appoint its own candidate as prime minister.
Claude The people also elected a Republican House, and I. Nolan Leigh Practically speaking, though, the majority decision gutted it, as the court struck down the formula for determining which states are covered by preclearance. Lloyd It proved no less than Mexico deserved on the night and no more than Panama warranted after another wonderful display against their Central American counterparts. Stewart Brendan Bessemer expects the number of clients to grow by 10 to 15 percent this year.
Scotty Eblanned Brooke But if Chris makes mayor, that could change. He was reinstated years later but he never played in the league again. Mauro Forrest Jerrold Those he signed included a measure to ban people from gun ownership for five years if they tell a licensed psychotherapist that they plan to shoot people. Another, by Republican Ted Gaines, would give mental health professionals 24 hours to report such threats.
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Christopher Jeep sales fell 5 percent as Chrysler struggled to get the all-new Cherokee to dealers. Fiat brand sales plunged 24 percent, the first year-to-year decline in 18 months. Quintin The reason the market is so excited is the pace at which profits could accelerate if this recovery sticks. Caleb At the time it was founded, evidence was piling up that the world was warming and a consensus was forming within the scientific community that.
Samual Rocco That would have been bad enough even without Thompson's must-be-guilty beard. But the seven couldn't get their stories straight either. Randall One would toughen income verification for those seeking health insurance subsidies under the law. Another could delay a reinsurance fee included in the law that otherwise would start in , according to a labor-union source. Napoleon Lawrence Hutchins served about half of an year sentence after he was found guilty of unpremeditated murder, larceny and other crimes.
Titus And thatdelay has cost them big in terms of having a successfulrollout," Upton said. Rogelio Abdul Felix General Joseph Dunford, said he had talked "at every level from district and province to members of parliament Ronald If that's the case, then why weren't a lot of people killing each other during the depression?
Keep opening doors for excuses and no one will ever have to account for anything. God help us. Russell
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