Universal Health Care Myths

Universal Health Care Myth #1: Paying For The Other Guy

The most common complaint I hear about any proposed system of universal health care is, essentially, "I don't want to pay for some guy's medical bills who has lung cancer because he smoked for 20 years. *I* don't smoke, so why should I pay for *HIM*?"

This argument sounds compelling, and might be in a zero sum two player game, but in the scope and context of a nationwide health care program with 300M+ participants, it becomes nonsensical.

When we look at a population of that many individuals, we see a normal distribution in health - and more specifically, health costs. There are a few individuals out on both ends; the people who are both lucky *and* careful, and have extremely low health costs for their entire lives, and those that are unlucky or extremely careless, and have HUGE health care costs over their lifetimes. It's worth noting that mostly the truly expensive ones are unlucky, not careless. People with chronic illnesses ( such as my sister with epilepsy ) cost the system far more than most drug addicts or alcoholics, because the cost is both high and ongoing. She didn't make bad choices that put her there - she was born that way.

Now, the rest of society falls in the bell curve. The vast majority of people have very similar lifestyles and lifetime health costs, and the vast majority of people will be contributing the vast majority of the money.

Now, to further muddy the water. The vast majority of people who live careless, unhealthy lives will live shorter lives, in general; the majority of people who live careful, healthy lives will live longer. The older people get, in general, the higher their lifetime health costs. Thus, it's not entirely clear that people who live healthy lifestyles have a lower lifetime health cost. You just can't make those kinds of assumptions without long term studies.

Finally, when we research the issue, we discover that *most* people don't live as healthy a life as they think they do.

So, in the end, we discover that, while there are necessarily variances in lifetime health costs, the shared risk reduces costs for everyone - that's the foundation of insurance to begin with. In the final analysis, most people will pay for most people. The rest is just like property, road, and school taxes. Sure, there are outliers, but they're not particularly relevant in this context - that's why they're called outliers.

Universal Healthcare Myth #2: The High Cost of "Socialized Medicine"

I can't count the number of times I've hear people bandy around mind boggling numbers concerning the costs of "socialized medicine". The subtext - and sometimes the actual statements - indicate that this cost, this massive amount of dollars, is somehow a 'new cost', that it's an additional burden on the public. Fortunately, this simply isn't the case.

Every claim of the costs of universal health care is based on estimates derived from current costs plus expected increases in costs. The people of the United States of America *WILL PAY THAT BILL* no matter what action Congress takes, either to insurance companies or to the government in the form of taxes.

There are complexities, to be sure. The extension of coverage to people who do not now have it will increase costs, but the fact that those people will no longer have to go to the emergency room for things like the flu (where they cannot be denied treatment) will reduce costs. Extending preventive care to those people will probably reduce longer-term costs, as well.

The way our system works today is the reason we pay more per-person for health care than any other western nation, both as a percentage of GDP and in actual monetary value. Our system does have some shiny spots - particularly in cardiac outcomes and certain cancers - but several other western countries that finance medical research have similar segments where cutting edge treatments are available there. The wealthy frequently cross national borders for various treatments, in both directions. Overall, however, most other western countries have better overall healthcare outcomes, and pay much less than we do for them. In addition, most European countries have longer life expectancies and lower all-cause death rates.

The benefits of universal health care, in all probability, extend far beyond simply controlling costs and improving overall health care. For example, the American Journal of Medicine says that more than 3 of 5 personal bankruptcies in the US are directly attributable to medical debt. The reduction of the stress of dealing with medical bills and worrying about how to pay them will undoubtedly improve healthcare and healthcare outcomes.

There are two things that everyone needs to understand about health care costs and predictions. First: We're debating about HOW we'll pay those bills, not *whether* they will be paid. That money *will be spent*, and it will be spent by the US taxpayer, period. Second: The only way to get our health care costs under control is through government intervention. All of our peers in the western world realized this long ago. 'Competition' among health insurance providers has brought us to this place - the highest per-capita health care cost in the world, and sub-par care for much of our population. The Insurance companies are making their profits (ranging from 2 to 40% of company revenues!!) while hospitals are cutting raises, reducing staff, and jumping through hoops to cut costs because half of their patients can't pay. Insurance companies apply massive downward price pressure to medical providers while adopting 'first-pass deny' policies and jacking up premiums.

LEDs in the Camper

So I'm replacing the incandescent lamps in my Airstream with an LED based lighting system. The main illumination in the cabin is supplied by clusters of four 1156 bulbs per fixture in 7 fixtures. Measured current draw on several bulbs was ~1.4A@12VDC, for ~17 watts, even though GE says the 1156 is a 27 watt bulb, for 2A+ draw. No matter. GE says at 2A, the 1156 should produce 400 lumens; I know it's not linear, but linear calculations should be sufficient for this kind of back-of-the-napkin engineering; I'm saying that if an 1156 produces 400 lumens at 27 watts, it probably produces around 250 lumens at 20W (400/27=15lumens/watt*17W=255lumens). This makes for ~1000 lumens per fixture, at 6A. ( Yes, I know luminous output is determined by filament temperature; I'm not building the space shuttle )

I ordered several kinds of LEDs for experimentation, but one of the more promising is the Luxeon 1W LED, that produces ~100 lumens for 300ma@3-4VDC. So 3 of them in series should draw ~300ma@12VDC for 300 lumens; if I replace each 1156 with three of these 1W Luxeons, I get ~1200 lumens for ~1.2A@12VDC! For roughly the juice used by ONE fixture, I can run all seven!

This assumes I use the standard fixtures. I'm thinking of some other solutions - for instance, I've found some 5 lumen 5mm LEDs with the same 3-4v voltage, 20ma draw. I'm thinking about taking a piece of flat white plexiglass and gluing, say, 100 of those (well, 99, as I need 'em in 3-deep series/parallel for 12V w/o limiting resistors) to it, then replacing the fixture with this new, 1/2" thick low profile light panel @ ~500 lumens. Less light, true, but I'm thinking about supplementing with some indirect light from white CCFTs around the edge of the cabin. This would make for a soft, easy-on-the-eyes light, while cutting the power consumption to extremely low levels. The CCFTs just aren't bright enough to replace the current lamps by themselves, though.

Anyway, I'll post back here with further developments as I experiment. :D

Verisign VIP for iPhone

I've been using the PayPal "football" for some time now to secure my ebay and PayPal accounts. Two factor authentication is fairly natural for me as my various jobs have required them since ~1997, so it doesn't seem like too onerous a burden. Verisign offers back end authentication as well to many websites, and you can use the dual-factor model with your OpenID.

Recently a friend pointed out to me that Verisign had put an application into the iPhone App Store that provides a virtual "token". I went and downloaded it immediately. My main problem with the football is that I just don't want to carry that much crap on my keys all the time. I like to have a car key and a house key and the remote-lock dongle, and nothing else; the 'football' tends to ride in the computer bag. This means if I'm not near the computer bag, and I want to bid on ebay, I get to go and GET the computer bag.

Since I always have my iPhone with me, I no longer have to worry about it. The App is free, and works flawlessly so far. Its functionality is so simple as to be obvious - touch the icon, it opens the app with the serial number of the VIP token and the current six-digit code. I *highly* recommend it to anyone who wants to do personal dual-factor authentication.

Elgato Turbo.264 HD

Elgato makes a bunch of video-centric devices for the Macintosh. One of them is a USB dongle that provides hardware h264 compression assistance. The original was the Turbo.264, and just recently they released and updated version called the Turbo.264 HD.

Some time ago I purchased the Elgato turbo.264. At the time I had a 17" Macbook Pro, 2.3Ghz Core2 Duo. I was underwhelmed, to be honest. My laptop was just as fast as the USB dongle at encoding virtually anything. There was a significant drop in the processor power required to encode the video, but I was looking for a time advantage, and it just wasn't there, so I returned it. At the time, I thought it would be a great addition to, say, a PPC based Mac Mini or a PPC based Powerbook - it made both of those machines encode h.264 at almost the speed of my Macbook Pro.

A week ago, I bought the Turbo.264 HD. This is a much different experience! I have one of the newer unibody Macbook Pros - noticeably faster than the old 17 - and the Turbo.264 HD kicks ass. It does SD - such as ripping an unencrypted DVD to my iPod for treadmill viewing - at ridiculous speeds. At full DVD resolution I frequently see 80 to 130 frames per second, and average well over 3X realtime. At 720p HD it encodes at a rate faster than realtime in nearly every instance. I haven't timed it at 1080, but it does 1080, and I have no reason to believe it won't be much faster than my unassisted laptop.

The software that comes with it supports drag-and-drop encoding of nearly anything from avi to mkv. For some reason, the software has a long, complex authorization key; I'm not sure why, as it won't work without the Turbo.264 HD plugged in. But hey, whatever. Regardless, it works very much like other user-friendly Mac-based video encoders. Drag and drop a movie, select the format for the output, and click start. It gives you a fps count and a time remaining counter. A little red light lights up on the USB dongle to let you know it's processing data.

Processor utilization is high, as well; I suspect that the dongle handles a few of the encoding tasks very rapidly, and the rest is left to the software. However, testing on a much slower device shows a very, very significant increase in encoding speed, even with the slower processor.

You have considerable control over the output, but that's hidden if you're not interested. The default settings should work for most people.

I did find one odd bit. I was encoding an HD program that I captured from my cable box. The show was recorded in 1080p HD, and had an aspect ratio on the order of 2.35:1 or so. When I ripped it to 720p using the 720p Setting on the turbo.264 HD, I ended up with a video that was 1728x720, rather than the 1280x540 I was expecting. I'm not sure what's up with that; I re-encoded with a custom setting of 1280x540, and it encoded it faster than realtime.

You can also use the device in any program that supports Quicktime export properly. This means iMovie will take advantage of the turbo.264 HD - and that's a real win! I have a 720p video camera, and the Turbo.264 makes short work of encoding those videos to h.264.

All in all, if you do a lot of video encoding or converting, whether re-encoding content from others, or just making your own movies, the Turbo.264 is a must have.

Fair Use in Real Life

To say that there is a lot of discussion and debate about Fair Use in recent years would be a ridiculous understatement, yet I don't want to resort to the kind of hyperbole required to accurately describe the situation. No matter how you describe it, though, the debate usually boils down to two sides: "You can't interfere with my Fair Use rights!" and "You don't mean Fair Use, you mean PIRACY."

And for most of the 90s and some of the 2000s, the second assertion might have been fairly reasonable, as the vast majority of "DVD copying" or CD ripping had as its only purpose the sharing of the result via internet or sneakernet. Still, some idealists defended Fair Use - the right of the consumer to use purchased goods in a reasonable fashion - such as backing up or changing format - despite the fact that most of the "Establishment" dismissed them as piracy apologists. Some people intent on willful copyright infringement defended their actions thus, as well.

No one suspected that the "IP Industries" would some day insist that copying your DVD to videotape so you could play it in your daughter's TV-with-built-in-VCR would be a violation of the DMCA. Or that the RIAA would state that ripping a CD that you purchased legally so you could play it on your media player would be copyright infringement. Or that the consumer would be reduced to requesting an exemption from a ridiculously draconian and poorly-considered corporate instrument (the DMCA) so that consumers could legally encode a DVD for playback on their iPod or other portable media player - and being REFUSED the right to do so legally. We're not talking about asking for the right to rip your sister's DVD of "Gone With The Wind" for the long plane trip back to Frisco; we're talking encoding your own copy of The X Files Season Five onto your iPod so you can watch Mulder and Scully whilst pounding away on the Bicycle to Nowhere at the Gym. If you do this, you're in violation of the DMCA, and you can be arrested and fined. You are now a criminal.

Roll back the clocks 30 years or more - before the propaganda convinced America that "copyright infringement is theft" - and people would be astonished at this turn of events. Shocked that it would be illegal for them to copy their LPs to tape so they could play it in their cars. Because the propaganda had not yet had opportunity to take root and infect us with its insidious, disingenuous, deceptive nature.

You see, once upon a time, copyright infringement was, well, copyright infringement. If you copied your Kansas album and gave the copy to your cousin who couldn't afford to buy it, nobody gave a shit. Even the record labels didn't care all that much, as they didn't really lose any money; your cousin wouldn't have bought the album anyway. He'd have taped it off of the radio on one of those midnight album shows. If you copied your Kansas Album fifty times and started handing out copies on Broadway, you'd get a Cease and Desist order. If you copied it five hundred times and sold it out of the back of your Camaro - well, if you got caught, you could be stuck paying three to five times retail for every copy you sold in fines, plus court costs. And if you made five thousand copies and sold them as "The Real Thing", you would go to jail for fraud.

Then the digital age came along, followed by the age of lossy compression, and the cost of distribution dropped to, essentially, zero. The problem is that the media companies use "Cost of Distribution" as a major player in bilking the "talent" out of money that most reasonable people would have otherwise argued should be paid to the "talent". By the time a performer's work made it to the record store, most didn't make any money at all because of the multitude of costs piled onto the contract. The performers, if they were lucky, made money touring. It wasn't (and probably still isn't) uncommon for an act to make a fairly successful CD, a fairly successful tour, and finish without a dime in their pocket - in some cases, in the hole - while the record company actually made money along the way. So the low cost of production and distribution threaten the established business model - and make it easier for the average guy to "share" music.

So, like all once-incredibly-lucrative-but-now-failing-business-models, the industries turned to the Law. They decided to legislate themselves into continued - and, they hope, permanent - relevance by convincing the government to pass ridiculously draconian laws that can be used to keep the 'sharing' down to a dull roar. Rather like, say, buggy whip manufacturers lobbying Washington to require every new Ford to ship with a buggy whip in the trunk. Rather than revamp their business model to face the changes in reality, they decided to reject reality and substitute their own. That's where we got the DMCA, which makes it illegal to copy your own DVD to your own iPod if the company that produced your DVD made ANY attempt to encrypt or otherwise prevent you from doing so.

The RIAA and the MPAA don't make any bones about what they want. They want you to have to pay for each and every access of your copyrighted media. They want you to have to purchase every format separately. They want you to have to account for every copy you have; meaning they want YOU to have to prove that you aren't a 'pirate', rather than them (or law enforcement) having to prove you are. They have lobbied for laws that made it illegal to release any media without DRM - which would have effectively destroyed the future of the fledgeling indie music scene. They have a lot of money, and they are fighting for their "lives", the way they see is.

If we don't fight the idea that copyright infringement is theft at every instance, enough people will hear it enough times in enough contexts that in twenty years we may find ourselves reading about people being sent to jail for nothing more than changing the format of a piece of media they purchased legally. If you think that's an exaggeration, go ask your dad or grandfather if he ever thought people would be breaking the law by an act roughly equivalent to "copying an LP to tape so they can play it in their car." And realize that it is ALREADY ILLEGAL for you to rip that DVD to your ipod for watching on the plane.

My (beta) hackintosh logo

Still working on it. It will be better when I'm done.

At What Cost Frugality?

Microsoft has been running advertisements that lead one to believe that Macintosh computers are overpriced, with the subtext that you're paying extra for "cool", not for any tangible benefit. This is not intended to be another salvo in the Mac vs. PC "war". If you feel that a PC does what you want it to, the way you want it to, then more power, my friend, more power. I'm not trying to convince you otherwise. No, this is merely a response to the dual claims that Macs are overpriced and offer no advantage over PCs but a brand name - both of which are largely a matter of opinion, but often supported by fallacious "facts".

For instance, I've heard many, many people describe the Mac Pro as a "[insert high dollar number here] machine that I could [buy/build] for [insert some ridiculously low number no larger than half of the first number here]". A little bit of research on the web shows this claim to be absolutely fallacious. The fact is that the entry level Mac Pro (at the time of this writing) is around $3300. That's an eight core Xeon with 6 GB of RAM. If you go to a random computer site - take, say, Dell.com - and spec out a comparable machine - say, the Precision Workstation - you find that with half the processors and a much lower quality case, you pay $3000. Now, Dell runs on a very slim profit margin. I've found in the past that I can only beat Dell's price by about 10-20% when I build my own PC from components, and that usually vanishes if I buy a legitimate copy of Windows. That means if you spec out the Precision workstation, you should come in somewhere between $2400 and $2700 for the Dell specs. I'm imagining you'll have to pay more to get dual quad cores instead of a single.

When people compare Apple laptops to "PC" laptops (Macs are actually PCs, too; they mean "Computers Designed to Run Windows" - which they are, even if you put Linux on them) they invariably compare them to the bottom of the line Dells and HPs that you can get for a song and a few bucks. This is an absolutely ridiculous comparison. The Apple machines are better built in ever aspect. Pick up any unibody Macbook and tell me it feels similar to picking up one of those cheap plastic "PCs". It doesn't. In fact, even when you compare it to machines that have the same kind of target demographic (the Vaios, Adamos, etc) it comes out rather well on price comparisons. Apple just doesn't compete in the cheap-as-you-can-make-it market.

None of these things take into account the "intangibles" of the Apple ecology. As a former PC user who spent YEARS building my own boxen, and was once one of those "Apple is overpriced" complainers, I can tell you that I was wrong. In a twist on a popular phrase, "PCs are cheaper than Macs only if your time is worthless." Since I've switched to Macs I spend much, much more time using my computer, and a lot less time getting it to work. I no longer have to deal with bus contention or incompatible upgrades or ... well, you get the idea. I buy stuff from Apple, and with very rare exceptions, it just works.

And OSX is a joy to use, by comparison. No, of course it wasn't when I first switched. I switched initially because Apple did what all of us Linux "zealots" had been trying to do for years - made Unix "Desktop Ready". I loved working in Linux, but the applications I wanted to use - audio recording and production, video editing, photo editing - just didn't "live up" to their Windows counterparts. Apple just did it, in one fell swoop, and that changed everything for me. I can pop up a terminal and I'm in bash! OSX ships with many useful scripting languages (not batch files) built in - you can write perl, bash, or phython on your Mac from the time you power it on. You can ssh to another *nix server without installing additional software. You can grep files, tr them, pipe them to sed or awk - the whole package. I no longer have to put Cygwin on my laptop just so I can have a functional command line.

And it runs Photoshop. And Lightroom. And Final Cut Express. And Ableton. And Tracktion. And Microsoft Office (ick). And ... the list goes on. Plus, it ships with iLife - iPhoto, Garage Band, iMovie - these are apps that just don't exist for Linux or Windows.

Maybe none of this is attractive to you, or you don't feel that it justifies the premium computer price. Great, I dig it. But be sure that your "facts" reflect reality; the price difference isn't between "PCs and Macs", it's between "Premium computers" and "cheap computers". And the Mac OS offers many very real benefits to many people.