Limiting health insurance companies

For some time now I have been complaining that one of the biggest issues in health care is that insurers need to be required to take any patient that wants in. Recently insurance companies have taken to refusing to cover people with pre-existing conditions, as well as trying to kick out those who are very sick. Allowing them to do so ruins the entire reason for insurance companies to exist. The healthy must pay for the sick in any reasonable insurance plan.

Luckily Congress seems to agree with me:

The House bill, for example, would require that all new policies sold on or off the exchanges must offer yet-to-be-determined “essential benefits.” It would prohibit those policies from excluding or charging higher rates to people with pre-existing conditions and would bar the companies from rescinding policies after people come down with a serious illness. It would also prohibit insurers from setting annual or lifetime limits on what a policy would pay. All this would kick in immediately for all new policies. These rules would start in 2013 for policies purchased on the exchange, and, after a grace period, would apply to employer-provided plans as well.

This one policy alone makes me support the Democrats plan. I am still a bit skeptical though for the plan as a whole. Any reasonable plan needs to ensure that the total costs of healthcare are kept down. So far I haven't seen any sign that the bills in congress take this seriously.

Obama has it made

There are few things better for a President than a recession at the start of his term. The reason is that whenever there is a recession everyone starts yelling about how the sky is falling. Then, usually, things get better fairly quickly. Judging by today's GDP numbers the recession will be over by the end of the year. After that much of a drop in GDP, the odds that GDP will be rising at the next election are really high. That gives Obama two years to look important, than walk into the next election able to talk about how he held off the second great depression.

Congress on the other hand.... Well there are reason's the democratic congress had approval ratings nearly as low as Bush. They seem entirely unable to craft anything without ridiculous amounts of silly pork. For example only about 10% of the stimulus money is being spent this year. Since the recession will probably be over by the end of the year that means that the stimulus bill did almost nothing to help. To be fair the republicans were no better, but Obama better start vetoing bills soon or he is going to get walked over by congress.

The only thing that this administration has done that is really impressive was the credit card bill. Even that will need a second round since there were a lot of loopholes.

Credit Reports for Hiring

I hope this bill goes through. The idea that employers can use credit reports for making hiring decisions is silly. It leaves too much risk that people get caught in a cycle where they can't get their credit to improve because they don't have a job, but can't get a job because they have bad credit. The idea that companies have to do this to protect themselves from fraud is silly. That is what they have criminal background checks for.

Paul Krugman on health care

Paul Krugman has really been quite impressive this past year. His recent articles on why the free market can't work for health care are really first class...

There are two strongly distinctive aspects of health care. One is that you don’t know when or whether you’ll need care — but if you do, the care can be extremely expensive. The big bucks are in triple coronary bypass surgery, not routine visits to the doctor’s office; and very, very few people can afford to pay major medical costs out of pocket...The second thing about health care is that it’s complicated, and you can’t rely on experience or comparison shopping. (“I hear they’ve got a real deal on stents over at St. Mary’s!”) That’s why doctors are supposed to follow an ethical code, why we expect more from them than from bakers or grocery store owners.

Health Care Realities

Why markets can’t cure healthcare

Biology, not the next big thing

When I tell people I have a biomedical engineering degree, one of the most common responses is "that is going to be the next big thing." They then either get shrugged off, or a long philosophical ramble depending on my mood. Far from being the next big thing, a lot of the biomedical world is set up for a pretty bad crash.

Biomedical Engineering faces one strong issue. Many of its best inventions, while quite impressive, don't actually provide much benefit to most patients. A great example is the poster child of the field, MRI. Doctors make a fortune off of sending patients to get MRIs. They have large fixed costs, and fairly low variable costs, so when a hospital has one it is in their best interest to keep it running all the time. To do that they often pay doctors well if they send doctors to get a scan. Patients are easily talked into getting them, and often pressure doctors into using them since they sound like the sort of thing that would help convince the doctor that the pain in their back is really some horrible condition that needs immediate surgery. This adds up to a lot of MRIs being done, and a lot of money being sent back to Biomedical Engineers and Medical Physicists. There is only one problem. For most conditions the patients who get MRIs do not do any better than those who don't. This means that whenever hospitals get serious about cutting inflation of medical costs medical imaging will be one of the hardest hit fields. You can save significant money without hurting patients.

The bigger trend for the biomedical field is that the United States spends twice as much on health care as a percentage of GDP than any other country in the world. For this extra money we buy essentially nothing. Most of the money is wasted. Some of this goes to the fact we pay doctors more than any other country. Some of this goes to our over-treating of many conditions like back pain or cancer that we really aren't able to do much for. But whatever the cause of the extra expense it is clear that this country could choose to spend a lot less money on health care and get the same or better outcomes. Whenever the government takes this fact seriously expect a lot less money to be flowing into that part of the economy. When that happens we will find that, actually we need a lot less biomedical engineers and laboratory scientists. It may even go as far as hurting nurses and other professions that interact with patients, but I suspect they are more insulated.

On the research side of the world there are two issues that will cause an increasing squeeze. First, we are producing less and less new drugs. For quite some time now the number of new drugs approved by the FDA has been decreasing. This means that in the long run all those jobs at pharmaceutical companies are unstable. There will still be blockbuster drugs, but as patents run out companies just won't be able to afford as much research and development as they had in the past.

At the same time NIH budgets are huge. Medicine takes up the highest percentage of government research dollars it ever has. Regression to the mean says that it is a pretty good guess that in the long-run this value will drop. Eventually the military, or NASA, or energy research, or some other field will pass up medicine in importance for those in congress. If that happens it won't be pretty for those with professor jobs that require grant money to get any real chance at tenure. To be honest with how things looked before the stimulus plan, I am not sure we haven't hit that point already.


Even if biomedical sciences was the next big thing, that doesn't make it a good field to enter. A lot of demand for a skill set can still result in poor job prospects if supply is greater than demand. In 2008 there were 75,151 bachelors degrees granted in the life sciences. To that number add another 101,810 in "health sciences and related clinical sciences" and another 90,039 in Psychology. That is a lot of competition in this part of the economy. Compare this to the 67,092 in all engineering degrees combined!

Of course doctors will always do just fine, worst case scenario they start taking jobs from nurses. But being in a non-patient oriented part of the biomedical world is a pretty scary prospect right now.

Why California Utilities Love Renewables

I just had my new employee orientation training today. Most of it was pretty dumb. What idiot turned the perfectly reasonable policies of not allowing bosses to make employees to sleep with them or lose their job, into don't tell a joke involving sex or the PC police will come and yell at you? The same applies to racial jokes. The whole over-reaction to minor issues makes a farce of the real issues and invites a huge backlash.

Anyways I did learn something interesting though, how Utilities make money in California. They are allowed a guaranteed return on capital investments. What does this mean? Well if they build a ten thousand dollar piece of equipment they get something like an eight percent return on the investment or 800 a year. So, how do utilities make more money? By talking the regulatory committee into letting them build more capital of course. So if we build relatively cheap power lines to a few central plants we make less money than if we build a ton of power lines to little solar plants...

That explains all the pro-renewable energy propaganda i have been hearing here. It is the best way the utilities have to grow. They will make billions off the state requirements.

Allergy hypochondria

I always suspected a lot of people I know just made up there allergies. Given how long I thought I was allergic to milk with from what I can remember no evidence whatsoever this seems pretty plausible...

This LA times article from today supports this thesis.

KD6HMN

I have interesting luck with license plates. My last one seemed to mark me as the devil(DRD 6667). My current one starts with 6HMN. This would not be an unusual license plate if given to anyone else. However when I had an Amateur Radio license my call sign was KD6HMN. I can see no reason to believe this was more than random.

There is no important science in space

There is no important science in space.

Ok, there is Hubble and a few other space telescopes which are actually important. But the general theme stays true. All those probes we send to other planets, they are sightseeing. They take a lot of pretty pictures, and collect data about other objects in the solar system, but that data is essentially useless. All those microgravity experiments on the space station, they also don't matter. I don't think I have ever heard of a result with real impact coming from it.

The reason this bugs me is that I occasionally hear people argue we should cancel our manned space program because we could do everything more efficiently with robots. If all we ever send to space is robots though we may as well stay on earth. All we would gain by this route is a couple books full of meaningless data, and a few picture books of our solar system. The only reason to bother with space is to ultimately colonize it. The only real way this happens is if we make orbital travel cheap. Space travel is just too expensive. This is not an inherent problem, if you look at the kinetic energy of an object at escape velocity, that calculate how much that amount of energy costs on the electrical grid you find it costs just a few cents. Clearly if we build a new space shuttle design every five years we can build on our failures until costs are a fraction of what they are today.

Unfortunately it does not appear that Obama agrees with me here. As far as I can tell they are asking NASA to scale down the successor to the space shuttle. That gives me little hope that they will redirect money away from almost everything else NASA does into new engines and shuttle designs.

Cucumbers

I ran into this on the wikipedia article about cucumbers the other day:

In the later 1600s, a prejudice developed against uncooked vegetables and fruits. A number of articles in contemporary health publications state that uncooked plants brought on summer diseases and should be forbidden to children. The cucumber kept this vile reputation for an inordinate period of time: “fit only for consumption by cows”, which some believe is why it gained the name, “cowcumber”.

That makes me realize just how long we have been demonizing food types without anything resembling solid evidence. It makes it easier to laugh at the biases we have in our own society.

Just charge me a fee already and stop wasting my time!

Having just moved, there are no Citizen's Banks near me. I hadn't imagined this to be a real issue, with direct depost and autopay on bills I don't really need to actually go to a bank. That plan would have worked just fine if I didn't sign up for direct deposit one day too late. That resulted in me getting sent a check. Oh well I thought I will just go to an ATM and deposit it. Sure they might charge me a fee since I am not from their bank, but I would rather pay some silly fee than go through the trouble of getting a new bank.

So off I went to an ATM I put my card in, and what the heck, no deposit option. Oh well, this was a little bank. So I went to a Wells Fargo. Sure enough once again no option. So I went ahead and called my bank and asked if there was any way for me to deposit this check while I am in LA. There answer was to just go to an ATM and deposit it, they will charge a few dollars in fees but it will work.

So off I went to another ATM, and another, and another. As far as I can tell she was clueless. None would let me deposit the check. This strikes me as absolutely moronic. If one of these banks had just said to pay a twenty dollar fee to deposit the check I would have done it. It would have been worth it to be done with this silly ordeal. If direct deposit can go to a NY bank there is no good reason why any ATM in the country can't deposit checks for every bank in the country. Why would banks turn down such an obvious opportunity to charge more fees to us poor customers?

Cost of Living

The first cost you see when moving to a new area is rent. So seeing that rent in LA was significantly more expensive than in Ithaca I assumed the total cost of living would go up by a similar amount. So far as I can tell the opposite is true. Costs of most things here seem cheaper. For example when buying tires for my car I managed to get them for half what they were in Ithaca. Plane tickets are substantially cheaper. At a store of similar quality food is around the same price. There are however more low end stores that cater mostly to immigrants. These seem to be a lot cheaper and really aren't of that poor quality. Restaurants generally seem the same price, gas is more expensive but not by a stunning amount. Since my rent trippled I imagine I will spend more here, but it really isn't by a huge amount.

Spanish Radio

My iphone stubbornly refuses to play Audiobooks, and I really have trouble stomaching most radio stations. So I started listening to a Spanish music station. I don't speak Spanish, two years of high school Spanish taught me a few words but even a conversation using only those few words is too much for me to handle. I just can't think as fast as they can talk. I also can not understand much of what is said well enough to know whether or not i know the word.

After a few weeks of this a few interesting things have happened. First, it is a lot less annoying. Now the station I listen to plays an absurd amount of Shakira, so it isn't quite polka, but it still started out being really hard to listen to. Now I seem to constantly having Spanish songs stuck in my head and it is starting to make sense how people willingly listen to this stuff

My brain is also starting to put in gaps between words. People hear gaps between words not because they objectively exist, on an oscilloscope they can't be seen, but entirely because our brain adds them. So when I first started listening it was a jumbled mess. Now it is turning into distinct words. This means it at least is theoretically possible for me to google words until I understand what they are talking about.

401k

I finally am signed up for a retirement plan for the first time in my life. I put 6% of my income into it and SCE puts in another 6%. I will likely up that to 9% at some point but by far the best investment I can make is to pay off my credit card debt. After that I will worry about whether my retirement savings should be higher.

I think what I did with my contributions might make some financial planner lecture me, but I am willing to take the bet that I know enough I won't get burned. Pretty much I am trying to be as diversified as possible while paying as low of fees as possible.

The bulk of the money, 70%, went to an index fund. Philosophically these are my favorite investment. On average after fees they are something like the 65th percentile of mutual funds. They however will never be the best mutual fund because they only track the market, while other mutual funds are roughly normally distributed just below the market average meaning a random few significantly beat the market in any given year while most match the market only before fees are taken out. My index fund only wastes 0.05% of its money in fees, where as some of the other funds were paying over 1%. Which means i lose a lot less money to wall street. Even though 1% doesn't sound like much after compounding forty years it is huge!

Diversification makes a lot of sense to me. Let the good investments balance the bad. For that reason my next 20% of contributions went to international mutual funds. It was split between one primarily investing in European stocks and one primarily in Asian stocks. To pick the funds I wanted I again simply found the international options I had with the lowest fees, 0.6% and 0.75%

The last 10% went to bonds. I know nothing about bonds. I simply looked at the graphs to find the three that seemed to fluctuate the least and split the 10% between them. Really I don't like the idea of investing in bonds at my age. But if the stock market chaos continues I would like to know I at least have some retirement savings that beat inflation. I imagine in a decade or so I will retreat from putting as much new money into stocks and buy bonds. Stocks are great if you have forty years to wait but over a twenty year period I don't feel so safe. Over a ten year period stocks terrify me.

Space Elevator on the Moon

While camping I was discussing the idea of a space Elevator on the Moon. Justus quite rationally pointed out that unlike the earth there is no way to put something in geosynchronous orbit around the moon. This is because it is tidally locked with the earth and doesn't spin. This means there is nowhere to put a space elevator on the moon. Now, i was sure i had heard plans about putting a space elevator on the moon, so it took me a while to believe him, but the more I thought about it the more obvious it was he was correct.

So i went to wikipedia's page on a lunar space elevator. Sure enough, Justus was correct, it can't be in Geosynchronous orbit. However I was right that it is feasible. It just has to have its center of mass at L1 or L2. At these points on either side of the moon the gravity from the Earth and moon, as well as centrifugal forces add up to zero. What makes this idea most exciting is that it could be made from Kevlar! Many existing materials are strong enough to build it.

Cancer Grants

The cancer grant system is a bit funny. The other day the New York Times had an interesting article on the subject. Some of it I found rather absurd while at Cornell:

Some experienced scientists have found a way to offset the problem somewhat. They do chancy experiments by siphoning money from their grants.

“In a way, the system is encrypted,” Dr. Yamamoto said, allowing those in the know to wink and do their own thing on the side.

Great discoveries have been made with N.I.H. financing without manipulating the system, Dr. Klausner said.

“But,” he added, “I actually believe that by and large it is despite, rather than because of, the review system.”

This was really my experience. You can't get a grant without preliminary data. You can't get preliminary data without a grant. That chicken and egg problem often gets solved by using your last grant to fund your next research. Usually this means just a little siphoning on the side, but sometimes it gets more absurd. I have even known of professors who would complete research before even submitting the grant request. Then they would use their new grant to fund a new set of completely different research. This way they develop a track record of doing exactly what they say they will. They also don't get bogged down in doing only research that they can get grants for. Really though, that is the state the system encourages. Until they make grants entirely for "preliminary data" easier to get things stay that way.


The bigger issue with cancer specifically is that they waste too many resources on research that is too theoretical. The research I was doing for example wasn't going to matter for decades if ever. Instead they need to be throwing as many patients as possible into clinical trials to test every minor thing that can be done to improve care.

Evolutionary Psychology didn't go Anywhere.

There seems to have been a few articles trying to bash evolutionary psychology recently. They make it sound like the field has died and is being replaced by something else. In reality no such thing is happening. Simply scientists are testing evolutionary psychology and figuring out what is actually in our evolutionary interest. Here is an example using rape:

But how to test the claim that rape increased a man's fitness? From its inception, evolutionary psychology had warned that behaviors that were evolutionarily advantageous 100,000 years ago (a sweet tooth, say) might be bad for survival today (causing obesity and thence infertility), so there was no point in measuring whether that trait makes people more evolutionarily fit today. Even if it doesn't, evolutionary psychologists argue, the trait might have been adaptive long ago and therefore still be our genetic legacy. An unfortunate one, perhaps, but still our legacy. Short of a time machine, the hypothesis was impossible to disprove. Game, set and match to evo psych.

Or so it seemed. But Hill had something almost as good as a time machine. He had the Ache, who live much as humans did 100,000 years ago. He and two colleagues therefore calculated how rape would affect the evolutionary prospects of a 25-year-old Ache. (They didn't observe any rapes, but did a what-if calculation based on measurements of, for instance, the odds that a woman is able to conceive on any given day.) The scientists were generous to the rape-as-adaptation claim, assuming that rapists target only women of reproductive age, for instance, even though in reality girls younger than 10 and women over 60 are often victims. Then they calculated rape's fitness costs and benefits. Rape costs a man fitness points if the victim's husband or other relatives kill him, for instance. He loses fitness points, too, if the mother refuses to raise a child of rape, and if being a known rapist (in a small hunter-gatherer tribe, rape and rapists are public knowledge) makes others less likely to help him find food. Rape increases a man's evolutionary fitness based on the chance that a rape victim is fertile (15 percent), that she will conceive (a 7 percent chance), that she will not miscarry (90 percent) and that she will not let the baby die even though it is the child of rape (90 percent). Hill then ran the numbers on the reproductive costs and benefits of rape. It wasn't even close: the cost exceeds the benefit by a factor of 10. "That makes the likelihood that rape is an evolved adaptation extremely low," says Hill. "It just wouldn't have made sense for men in the Pleistocene to use rape as a reproductive strategy, so the argument that it's preprogrammed into us doesn't hold up."

First thing to note is that what they did is figure out what was evolutionary the best thing for members of that society to do. This is exactly what evolutionary psychology tries to do, meaning that if this study is to be taken seriously evolutionary psychology is doing just fine. All that is happening is we are fine tuning our understanding about what selective pressures are within our history.

The results are otherwise blindingly obvious. They found a society with no rapes, and found that rape wasn't an evolutionary advantage for those people. Sounds to me like the people are exactly following what you would expect based on evolutionary psychology. The rapists were bred out of that particular culture. To then say that rape is never an evolutionary advantage based on that example is quite silly though. To have any interest at all you would have to look at a situation where there were actual rapes, preferably lots of them. For example: did the Russian soldiers who raped something like a million Germans during their invasion of world war two gain an evolutionary advantage over those who abstained? Almost certainly, there were no significant costs as they would never face retribution from these women, and many of them ended up with children they never would have had otherwise. This has been true in times of war for as long as history has been recorded. Another great example would be slave masters in the south. They faced no costs, and significant evolutionary gain by being rapists.

All this study shows is that people are pretty good at evaluating costs and benefits from behavior. In a civilation like the one they studied, or ours for that matter, rape is rarely going to get you anywhere. So the vast majority of men are quite predictably not rapists.

The evolutionary psychology does have a great deal of predictive power: It explains why the vast majority of rapists are male, and vast majority of victims female. It explains why the median age of a rape victim is 23 which not coincidently happens to be right about at peak fertility (for comparison the median age of a murder victim is 29). It explains why women over 50 are only 3% of rape victims despite being a third of the population. It also happens to explain why most men are not rapists, just as it explains why some are. Sure the predictions of evolutionary psychology will change as further experimental evidence comes along. But the field as a whole will still exist, and explain a great deal.

Still Getting Fatter

For some reason I was under the impression that obesity rates had stabilized. Apparently I was wrong:

Adult obesity rates increased in 23 U.S. states last year and did not fall in a single state, an annual survey released on July 1 found. Adult obesity rates now exceed 25% in 31 states, up from 28 states last year and 19 the year before that.

Adult obesity rates now exceed 20% in 49 states plus the District of Columbia. Only Colorado, where 18.9% of the population is obese, falls below the 20% mark. Still, in 1991, no state had an obesity rate above 20%.