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Thursday, April 9, 2009

Come to my Rave! Rant and Rave that is

I've written 24 fairly wonky health care posts, 8 posts about the MBA admissions process that are fairly enjoyable reading and I actually might share some useful information, and 13 posts about articles related to MBA's. The most popular post was about the not very sweet and surprisingly inept story of the love lives of MBA students. I've been fairly disciplined with very few posts about the mundanities of my daily life around traffic, lines at the company cafeteria, or corporate decision-making process. I definitely could be accused of having too many analogies with colons and yak herding but that's not going to change. What is going to change is I am going to indulge myself with some good old fashioned complaining. Welcome to my Rant (and Rave).

It's not the economy, you're just being stupid: In general, we read a lot of more about business and finance these days. This could be driven by the fact that we are now mostly responsible for managing our retirement accounts. One result is more people, especially bloggers, try to build an economic rationale for their social or political opinion when it really isn't there. For example, if taxes were an economic issue, than economists would have figured out the ideal tax structure and every country would use it. Taxes are a political and social issue and a values question. High taxes to fund services for the all or the low income, low taxes with no services and you eat what you kill, or a very progressive tax structure that has the rich pay for the low income are all societal or political issues. It's about fitting an economic structure into a set of values and not the other way around.

I've seen some posts that try to discuss unions or cigarette taxes as purely economic decisions. The economic results are mixed and cases could be made for either. Value are picked first.

Vblogging: I attended an Edward Tufte presentation where he described how we can read twice as fast as someone can talk. Therefore, why are bloggers videotaping their posts? There is no interesting video being done, the blogger just talks. Thus, a reader has to spend twice as much time on that post. Videos on blogs are being misused like power point as they mainly slow down the delivery of information.

My favorite part of the Edward Tufte presentation is when I approached him with an example of a data display were were working on. We were trying to show patient visits in a combination of our hospital, health plan, and physicians and came up with a peacock. Before, I could even open my mouth to describe, Tufte said, "No. Set it up like a distance table between cities like they have on maps." I nodded and walked away without saying a word.

Obama, Medicare Advantage is not the health plan that doesn't work: It has been amazing to watch what competent or even good politicians can do. Obama already has done more for health care than any president in a long time with the COBRA subsidies, expanding SCHIP, and framing health care as an economic issue (and really an economic issue as opposed to a values issue). However, his statements that Medicare Advantage "doesn't work" because they cost the government 12% more than original Medicare does not look at why they cost more. Rather than private plan profits, the extra 12% comes from more benefits for beneficiary and paying providers enough that they will actually accept the insurance. Original Medicare does not do anything to promote good health care usage other than paying below market rates. It's like complaining that a car with 4 wheels is more expensive than a car with 3 wheels.

The health plan that really does not work is the individual insurance market for those who aren't 65 yet. Health plans have steadily gotten stricter and stricter about who they will accept to the point where it's really difficult to get individual insurance if you actually need it. Prices typically increase 10% year making it one of the faster rising products in health care. Rather than tinker with a segment of the population that has many insurance options, the Obama administration should focus on the most dysfunctional insurance market.

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