Friday, May 5, 2017

"Medicare for all" or Public Option

Medicare for all has been a popular refrain, but there are a couple of points that need to be mentioned.

First, most other countries have a system that is a combination of "government" services plus private-pay providers, with the system knit together by some form of private insurance. I don't know the details, but the main difference between Canada and the UK, for example, is that Canadian Medicare is virtually all-encompassing (administered at the provincial level, not nationally) with no private insurance -- though I have read that some private insurance and providers do exist. Britain's NHS, on the other hand, is a universal provider for everyone, but the services (and wait times) are replicated privately, augmented by a robust private insurance alternative for those who can afford them. A series of reports at The Health Care Blog several years ago offered a first-person report by an American physician who went to Britain to see for himself. His reports were fascinating, and I was left with the impression that NHS is more comparable to our own Medicaid than Medicare -- and he specifically said many Brits never darken the door of a NHS facility. However he underscored the fact that in the case of any emergency or for some complicated cases NHS was preferable to any private providers.

That said, I decided some time ago that a public option is a better alternative -- using the exchanges already in place -- than displacing everything with Medicare for all. That would truly satisfy those cries about choices. And if you like your doctor (and insurance) and want to keep it -- and can afford to do so -- good for you.

A word about American Medicare

Most people don't realize that Original Medicare has been slowly losing beneficiaries for the last few years with the advent of the misleadingly named Medicare Advantage private alternatives. MA is basically the cleaned up version of PPO and/or HMO "health maintenance" systems -- all privately organized and knit together by a private insurance company. About a third of all Medicare eligible people are no longer beneficiaries of Medicare, having been kidnapped by the MA private sector alternative.

I am familiar with both Original Medicare and Medicare Advantage because my wife and I have been with both. When we first qualified for Medicare a MA plan was available in our area and we both decided for that -- not knowing all the details, but attracted by the bizarre fact that not only did we not need supplemental insurance, but that the "premium" for MA was ZERO!
I was mystified, but that was the case and the attraction was irresistible.

At the end of that year, that particular MA plan was discontinued for our county, and we then faced two options: either return to original Medicare (plus a supplement) or enroll in a different MA plan from a different insurance company. By then we had learned that original Medicare is a better option for someone with a complicated medical picture (read "expensive") but for someone in pretty good health, MA is less expensive.

MA vs original Medicare is the senior version of what the insurance people call "adverse selection" with MA being the senior analogue to young people who don't expect to have expensive health care, but who hit the wall should they get hit with a catastrophic medical problem (or combination of issues).

So here is the dirty little secret not widely known about PPACA: once someone has been enrolled in Medicare Advantage, the price of returning to original Medicare can be steep -- in the form of "medical underwriting" which is essentially the equivalent of having a preexisting condition. It's like life insurance. The older and/or sicker you are, the more the insurance will cost. (That "community rating" system the GOP wants to retroactively make optional for the states never left for the Medicare set. Think "preexisting conditions" writ large.)

Which brings us back to the "Medicare for all" discussion. Most people don't realize that Medicare does NOT cover 100% of medical costs. Thanks to a lifetime of payroll taxes only 80% of charges are covered. The other 20% of medical bills is the responsibility of the beneficiary. The beneficiary then faces two choices -- pay out of pocket, OR pay for supplemental insurance covering the other 20% -- and even then, there will be co-pays, deductibles and limitations that come with private insurance.

It becomes a damned if you do, damned if you don't choice. And in the end, American health care remains a rationing system -- rationed by affordability.
And anyone who wants to pay privately is welcome to do so -- hence a thriving field of cosmetic and other options, including medical tourism. But when the money runs out, and "spending down" depletes enough assets, the safety net finally becomes Medicaid.

And that is a completely different conversation...

Friday, March 3, 2017

Notes on Education & Science

I'm reblogging this post from 2005 for safe-keeping. 
"Students face consequences if they choose to accept evolution in a family or a church or a community that patently rejects evolution ... It might affect whether you get a date to the prom, or whether you get that summer job or not," McCoy said. "You may even anger close family members. Conversations about evolution can make family reunions very tense. "
It is bound to happen.
The same thing that happens to the children of divorced parents is now happening to students as the debate over teaching evolution rages on.

Mixed signals is the worst of all shortcomings in management, in parenting, in education, in politics, in every human endeavor that requires the transmission of information. And mixed signals is what students are getting in this debate. The odd part is, it makes no difference if a well-meaning parent is home-schooling or sending the student to a private school with a curriculum that has the Good Faith-keeping Seal of Approval. The finished product, the student, will still have to live and work a world that is, according to their training and instruction, deeply flawed to a dangerous point. Lacking the adult interpersonal skills that allow us to sit together in the same place with publicans and sinners, and others of ignorant, illicit and misguided creeds, adolescents and young adults are still trapped in that idealistic place where everyone who can't agree with them is simply ill-informed. All they need to do is persuade others of the truth, and in time ignorant people will see the truth and the truth shall set them free.

We are witnessing the indoctrination, polarization and intellectual vaccination of a generation of young people prepared to engage in another civil war over principles, if necessary to defend and protect what they know to be "right." We are already teaching them the skills of actual combat in the proving grounds of the Middle East. After all, it's not about land, or oil, or international politics. It's about principles, you know. When the seeds of mixed signals are sewn, a lifetime of irresolvable conflict is the harvest. Social workers, pastoral counselors and others who work with children can attest to the fact that children will love and often try to protect a parent or parents who are abusive or negligent.

The bonds of affection in healthy families are stronger than dysfunctional ones, to the point that children from that family can express the family identity even more than that of society around them according to how well the family has succeeded in passing on its values and beliefs. But in the long run, society carries the heavier weight. How else to account for the changes in first-generation immigrants whose children don't speak the mother tongue as well as their new language? Whose grandchildren engage in habits or wear fashions their grandparents find unacceptable?

How else to explain the desegregation of public schools and accommodations, followed by private schools, clubs and churches? I remember widespread creation of "private schools" in the South, meaning "white schools." An avalanche of social opinion eventually prevailed, as in the case of smoking. Prejudice survives along with the use of tobacco, but the voice is sotto voce, just as more and more buildings are designated non-smoking. For me the question is not about faith versus science. It is about how faith approaches the world, not only its science, but its whole being. How can we teach our children to be IN the world, but not necessarily OF the world? Not how can the world teach our children, but how can we teach our children...


I am a supporter of both public and private education. There is a place for both in society. I know people whose private school education was far superior to what I received in public schools. Thank God, I say, that those people are well-prepared to make excellent, achievement-oriented contributions to the world. I had enough experience with Applesoft Basic to appreciate that there are programmers who have a passion for writing tight programs so that I don't have to write my own (even though many of those people tend to be at the margins of education...geeks, you know...which is why I don't worry about the flaws of education, public or private).

I hear voices calling for the abandonment of public schools. At its most benign, the message is to get your kids out of the public classroom at any cost, as though there were no important differences among the spectrum of public schools. Quickly, for their sakes, get your children into a private setting (never mind what agenda, curriculum or quality it may have) because private is by definition better than public. As we worship more and more at the altar of market economics we conclude that the marketplace holds the best possible remedy for just about every problem. No one seems to notice the self-fulfilling prophetic nature of such advice: the students taken away will be the very ones whose faith, values and family support will most likely ameliorate the problems they purport solve by quitting.

Try to picture a society that does not support public education at all, which is where I sense a lot of people wish to go. When I was in Korea I spent my off-duty hours teaching English conversation to high school students, as well as young professionals who planned to study in America and wanted to be conversationally prepared. Korea in 1966 could not afford to provide public education for all its children, so beginning at about year six, students had to pass tests to continue receiving free public education. By the time a student got to college he or she had already been tested three times by the system so that only the brightest students could take advantage of post-secondary education.

There were private schools in Korea at that time, as well as private tutors. But private education was the resource of financially able families whose children, for whatever reason -- sloth, indifference, dullness, or other problem -- failed to pass the tests to remain in public school. Korea was desperately poor, so without free public schools the future of the country would have been bleak. Private education was a safety net for underachievers, not the repository for the best and brightest as in America. Knowing that some of my students were better at speaking English than others, I asked the Korean English teacher how to speak to them as a group. Should I use simple words and make a conscious effort to speak slower so that more of them could understand what I was talking about. He told me not to worry about those in the middle or at the bottom, but to speak with the best students at whatever level they could understand. "The rest will follow," he said. And there was no hesitation in his answer. As an educator, he knew that his role was to set the standard and let others strive to reach it. Anything less would be cheating those who were near the top. The rest, as he said, would follow.

He didn't say it, but there will always be followers. Followers always outnumber leaders. My instinct is that as Christians we should be producing good leaders for the public good, not trying to transform the public into a Kingdom of God on earth. Anything else strikes me as another attempt to build a Tower of Babel. Christians have a duty, alright. But it is not what is being advertised. Their duty is to be good Christians in the world around them, and teach their children to be the same. And since followers will always outnumber leaders, it would be wise to teach their children to be good Christian followers. St. Paul didn't attack the institution of slavery when he sent Philemon back to his master. Elsewhere he even advised slaves to set a good example for their masters. I have managed a lot of people and know from experience that leadership in a peer group is more important than leadership at the top. There is a lesson here, but there is too much noise in the public debate for it to be taught.


Two weeks ago when we turned on the air conditioner for summer, we found, much to our frustration, that the compressor was not coming on. (Why do we wait until the weather is uncomfortably hot? Why not try it out in early spring to avoid frustration in case it stopped working over the winter? It's like using the stapler. We only run out when we are attempting to staple something...anyway...)

So we called for service. We called the best and most reputable heating and air company in the county, a business now in it's second-generation of private management, still owned and operated by the man who started it years ago. We learned to our surprise and delight that the owner of this business, who had personally come to make arrangements for the installation of a heat pump when we were finishing the basement, a prosperous man who owns rental property and has a street named for him... this man cannot read and write. He flies his own airplane, but has no license because he cannot pass a written test.
The moment I met him, I knew that he was a man of good character. You can tell from how a person carries himself, shakes hands, or things that he says. Sometimes you just know. The moment you meet someone. I have met millions of the public myself and I can tell when I have met someone like him. You aren't gonna tell him anything that he hasn't already heard. Just know that you have met one of the good guys.

Finding out that he couldn't read only underscored my good feelings about him. I already liked him, but I like him better now than I did before.

Go on. Tell me about education.

Saturday, February 25, 2017

Some thoughts on the "Deep State"

I am enshrining this excellent post here as a backup copy for future reference. Experience has taught me how quickly content can vanish from the web. Ansel Sigmar is the screen name for an American living in Thailand. 

Considered without partisan hysteria, the existence of a "Deep State" is natural to any enterprise as complicated as a modern superpower. At present, the United States is the largest and most powerful state in the world, and likely contains the most advanced Deep State on the planet. I've watched US politics evolve for nearly sixty years. Claiming only that qualification, I'd like to make some personal observations about this hot "new" concept making its way through both left and right-wing media, but with the caveat that neither I nor anyone else knows enough to claim a comprehensive understanding. We're all tempted by the charms of reductionism, which accounts for our never-ending fascination with conspiracy theories, but it's clear to me that, in spite of my fondness for a good story, simplification isn't an appropriate way to describe complexity.

The idea that some sort of continuing institutional management exists beyond the political arena is hardly new, and those now loudly decrying the Deep State aren't exactly original thinkers, but it's easy to understand their confusion. The only way to begin understand the apparent contradictions that govern American life is to accept that there is no such thing as an omniscient and omnipotent Other that runs things behind the scenes. We also must understand that there is no secret set of agreements among the people and institutions that are the alleged Deep State. There are always a variety of goals and ambitions among the participants in any game with stakes this high, but the goal of farsighted players has always been stability above all else. Breaking the state means breaking everything, and the cost to a society is beyond calculation. Only vultures profit from mass destruction, as we saw in the case of post-Soviet Russia.

The sometimes chaotic arena of electoral politics has the highest visibility in public discourse, but it's not the only place political decisions are made, and not without reason. As I first understood the Deep State, it was simply a collective noun referring to the entrenched bureaucracy that gave long-term continuity to government. As partisan parties won and lost control through elections, they could temporarily dominate the public conversation about policy, but could not interrupt the necessary functions that make it possible to have a coherent state delivering services and executing laws, without regard
to the prevailing political ideology.

Steve Bannon, our revolutionary du jour, understands this very well, and is leading a blitzkrieg insurgency whose first targets are fundamental to what he calls the "administrative government." As long as there are independent institutions carrying forward the long term objectives of the state, there can be no revolution that will effect structural change in the US. Unfortunately, Mr. Bannon and company have arrived on the scene at the moment in history when political parties are in tatters, when there is no coherent debate emerging from anywhere on the political spectrum, and when disinformation has become as easily transmitted as fact. He has a great thirst for deconstruction, a fondness for violent conflict, and a very great secret. He's never told us exactly what he wants beyond the "deconstruction of the administrative state."

In this environment, some interest group is going to take charge. That's inevitable. Whether it's the so-called Deep State or the nihilist oligarchs running the show around Bannon, we're going to be living with the result for a long time to come. When you next hear someone fretting over the Deep State posing a threat to an elected president, consider the option. There's only one, and it's exactly what the US has been carefully structured to avoid for more than 200 years. As far too many citizens appear to have forgotten the long-term commitments made from the Declaration of Independence to the present, the most powerful memory we can rely upon to preserve the rule of law, and to ensure the orderly dispatch of governmental duties, is institutional. I might not have said this forty years ago, but I've decided it's much better to opt for institutional stability than to jump off the cliff we're being led toward.

Wednesday, February 8, 2017

Public & Private Education -- a Facebook Colloquy

This exchange is lifted verbatim from my Facebook post and comments February 6, 2017.

DeVos will likely get confirmed, unfortunately, but my concerns have not changed. I'm a firm supporter of public schools. Federal, state, local, whatever -- pubic education is as much a tax-supported project as fire protection and safe roads. However when private sector PROFITS derive from education it's a diversion of tax dollars.

America has a long tradition of private academies, both parochial and endowed by foundations, where tax money sometimes benefits students but with marginal institutional benefit. Even now there is a rising crop of private-sector schools -- call them charter, private, target, magnet or whatever -- many of which do a good job at educating their respective student bodies. Outfits are now getting in the game that are organized, clean, with cutting-edge resources, even well-compensated faculty and/or operating as non-profits. What could be more attractive?

The problem is two-fold:

1) By further enabling "in loco parentis" they are collectively eroding the importance of family (even community) input to the growth and development of upcoming generations, and

2) most of them are cherry-picking the most promising students from the "public" population, thereby giving their respective institutions a differential advantage in the education goal, while leaving the public sector teachers the task of educating a more challenging population -- not to mention removing from that group the very peers who would otherwise have become role models for others as well as surrogate teaching assistants ("teacher's pets" at whom we have been taught to sneer).

(Also, damn few, if any of these private school alternatives accept kids with mental or behavior problems or those who don't speak English as their mother tongue.)

I'm sorry, but I still regard this government-can't-do-anything-right attitude and doctrinaire libertarian-privatization-free-market worship to be lies from the pit of Hell.

Philip Eismann  But what to do,if in your neighborhood,the school aren't functioning,your child can't wait till we fix the public school system,ideals and all. At the moment we test schools and students,to determine who gets funds,who goes on to higher education. A student who needs to work,in order to feed his siblings,isn't going to have his homework done but in truth works harder then most but is lucky to get a C or D plus,but no higher education . Those struggling students,with broken homes,those are the teachers pets ,both teacher and student are lost in our current system.

John Ballard You make excellent points. Sadly the circumstances you describe are widespread across the country in many public education systems, and I have no problem with private options in those cases. I'm very impressed, for example, with KIPP Academies and any number of similar alternative systems. I'm not painting all private alternatives with a broad brush. But I am keenly aware of a proliferation of doctrinaire efforts often driven by politics, ROIs and/or religious motives more than the admittedly more challenging task of improving schools in the public sector.

Atlanta's Westminster and Lovett schools are truly excellent, and one of my children went to Howard School for two years because the public school teacher she encountered "didn't believe in" LD -- said she was "just lazy and needs to study harder." We knew better thanks to a private opinion by a clinical psychologists advised otherwise. I was fortunate to have a friend in public education to guide us, but all that was decades ago and since then much has changed.

I wish I had better answers. But from all I have read an avalanche of private schools has more to do with private sector mining of taxes for profits ahead of education. The trend has been more pronounced in the post-secondary sector than primary and high schools, but that segment also has a growing share of the problems from which my objections derive. It is a pernicious trend that over time will only make public education worse for the students you describe so well.

John Ballard My opinions derive in part from when I was a GI in Korea all of 1966 and half of 1967. Most of my off-duty time was learning about the country and teaching English conversation to advanced students at the local high school. Korea was so poor at that time that it could not afford universal free public education, so private alternatives in that case were available for those young people who couldn't pass the entrance exams to attend public school. It was exactly the opposite of what I knew from America where "private" meant "exclusive top-grade" settings. By the time one of those Korean high school kids got into my after-school, weekend classes they had already passed two entrance exams to remain in public schools. And those who were academically strong enough to go on would have to pass more tests to advance to college -- again, most of which was publicly funded. I did have a chance to tour Ewha University once, founded by Methodists in the nineteenth century, but as with today's American alternatives the places with truly good standards were few and far between.

Philip Eismann  Yes,I agree. Education has never been a one size fits all. Some children learn by route ,that may work for you as a teacher but others need something else. Here in Germany, the Rudolf Steiner,and Waldorf education, also known as anthroposophy, pay a big role. Its pedagogy emphasizes the role of imagination in learning, striving to integrate holistically the intellectual, practical, and artistic development . All of it ,pretty ideals,if you happen to believe.

I leaned about the ideals of a public education,I went to NYPS,PS32 and when I came up ,we were sure this was the best answer,with standardized teaching and testing,that was the ideal behind the Iowa tests. Now that public schools are rated by they're students test results and teachers worried about the schools ratings,only prep,for those tests,SAT's,college enrollment,those troubled neighborhoods ,zones,students are the big losers.
In a world where kids grow up wanting to be famous.

John Ballard  I forgot about rote learning. It's no longer highly regarded by most professionals, but I'm also a believer in memory discipline, having come from a time when memorizing the multiplication tables and committing poems and segments from literature was pushed hard in school. My Korean students often carried with them homemade strings of flash cards, about the size of postage stamps on a string, to help them memorize the many Chinese characters in widespread use all over Asia. Pronunciations change from country to country but the meanings of Chinese pictographs doesn't change. I learned the phonetic Korean alphabet quickly (it's phonetic, like the Western alphabet, so I could "read" without knowing what it meant -- rather like "reading" any Western foreign language -- but those characters remained a mystery to me).
And who can forget that the Scripps national spelling bee is always won by Indian kids who come from an education tradition heavily invested in rote learning?

Philip Eismann  If only one size fit all. I liked memorizing. I was no good at it but it taught me nonetheless.To do what,what was hard. That my material,took on many shadings,that a text wasn't a fixed thing, that words had colors, that an idea was only fascinating as long as it was in movement.( which is why I at times I write ,out to lunch posts,keep it moving,what did you say?)Like looking out over the same view but from a slightly different shift in position, that you can never enter the river in the same spot idea,(whether life is a river,that's an amusing discussion. Are we shipwrecked,for the moment, is there such a thing as progress? )Memorizing text may hold a key.

Memorizing poems,formed a national identity. Every child could recite,Paul Revers Night Ride, even the weekly hit parade,built a national memory,stuck in traffic on the way home from the beach,every car with its windows rolled down,played basically from the same hit list,in the dinner the jukebox played the same songs,now we have climate control. For some this was stifling,the constrictive Eisenhower's Years.( it's funny to find hippies,posting Eisenhower quotes)And we rebelled,rebellion is patricide. This urge for destruction,this instinct, to blame the system, this idea that out of a vacuum something new and better will emerge, is probably a terrible notion(my argument with Buddhism ).Trump as Cultural Revolution.
I like Chinese poems,simply cause ,you have to learn in read a different way,both vertical and horizontal.

Cicadas' voices gather in the old monastery
Birds' shadows fly over the cold pond

"cicadas' voices ,"echo the "birds shadows', ""cold "prolongs "old "and "monastery "is reflected in the "pond."
We just can't be exposed to enough trivial stuff that leads nowhere ,in a pragmatic world. Crime and Punishment,is reason with a sledgehammer,but it's no longer on the school curriculum.