Carl Lumma | Google Plus archive
- Letter to fiscalcommission.gov
Thanks to all the commission members, who've worked in a bipartisan manner and come up with perfectly sensible recommendations for solving our projected fiscal problem.
Being sensible, it's no surprise that Congress has so far rejected them.
I'm writing today with a suggestion I haven't heard elsewhere, that may at least be feasible.
Our biggest projected challenge is the rise in health care spending. It's caused by several factors, including that people are living longer. Another major cause – as Warren Buffett puts it – is having no way to not pay for something. We routinely administer cancer treatments that cost $250,000 per QALY (quality-adjusted life year conferred by the treatment). That's five times GDP/capita. Anything marketed as a treatment, we more or less have to buy. It's how our society deals with death.
HMOs and PPOs as we know them are little more than protection rackets for doctors. They have no incentive to contain health care spending, and they hide costs from the only other party that does: consumers.
Therefore I suggest we take steps to restore patients as consumers of health care products and services. No, sick people aren't as good at comparative shopping as healthy people. But they are better than nothing, and they are on the ground with pertinent information.
President Bush II, in his infinite wisdom, created HSAs. They're like IRAs except you can only use the money for medical expenses. And you've got to have an HDHP (High-Deductible Health Plan) to get one. Great idea. Makes a lot of sense for a young family like mine, with high income, high tax burden, no assets, high housing costs, and little disease.
But we can't get one. Why? Neither of our employers offer them. Why? Because they have small HR departments, struggling to manage complicated benefits programs, and there is no sales team offering to hold their hand in getting an HSA program established. Aetna, Cigna, and Blue Cross are on call, but they aren't going to advertise their HDHPs (and they make it nearly impossible for consumers to buy them directly).
This is where I think government can help. Simply require that all companies currently offering health benefits offer HSAs too. Or even more simply: fund a program at the IRS to assist our nation's HR departments in setting up HSA programs. (If I had my way, the government would offer a universal HDHP, but unfortunately that's not what we got last year.)
The proposed intervention merely aims to make an existing federal program more widely available. But it could have a big impact. No one would be forced to participate. The cost for firms to offer the plans is negligible.
Male energy is shown to be fundamentally violent and destructive. Modern man is forever trying to cure himself of this fundamental nature, to no avail. Society cannot tolerate it, and punishes it severely. But it is ultimately shown to be a force for good, of comfort and protection from the cold. I am of course talking about the Incredible Hulk.
Adric's kindergarten computing teacher asked his class which is smarter: humans or computers. Adric answered computers, and when she tried to correct him, he insisted that computers are obviously smarter. I told him I thought he was right. While simulating a cortex worth of STDP oscillators might take 1 EFLOP, I suspect AGI is already mostly a robotics problem.
How to make a kajillion dollars #37: Selectively breed a romaine lettuce with leaves shaped like sandwich pockets. Sell them pre-washed and pre-cut from a mini fridge in the bread aisle.
- Invisible Waves
Adric: How come we can't look it up, dad?
Me: Because my phone isn't getting an internet connection.
Adric: Why not?
Me: Because wireless internet sucks in Berkeley.
Me: Because ignorant people won't let the phone company put up the needed radio towers. They think the towers will hurt them – hurt their bodies.
Adric: Why do they think that?
Me: They don't know.
Adric: I have an idea! Let's build a tower in our house!
Me: Well, we did. I put a small one in the basement. But it's not powerful enough to reach us here. For that we need a big tower, and they're very expensive. So everyone chips in and pays the phone company a little bit of money, and then the phone company has enough money to build a tower for everyone to share. But ignorant people in Berkeley won't allow it.
Adric: I've got it! We'll get our tools at night and go out and build our own big tower!
Me: Well, that might still be expensive, though I think some people did do it at burning man recently...
Adric: Great, let's move there!
Me: Unfortunately we can't live there. People only go there for one week of the year. It's because there's not enough water – it's a desert. People bring enough water for one week in jugs, and when the jugs are empty they go home.
Adric: Dad, I think I have an idea. We'll get a huge water canon that can also manage cold steam, and we'll spray that steam over the desert and make it rain! Then we can move there!
Me: That's a good idea. There are people who want to do that with deserts. They want to pump water from the ocean so that plants can grow.
Adric: Yes! We can swim out in the ocean and push the waves into a special pipe...
Me: It is a very good idea. But it takes a lot of energy to do it. You need to pump the water, and you need to make a lot of heat. And unfortunately, ignorant people won't let us do that either.
Adric: Why not!
Me: Because they think the energy generators will hurt them – hurt their bodies.
Me: They don't know!
- Polly Wanna Help
In the future I want to go around with a couple of robots on my shoulders, like parrots. When I go to do a task, they crawl down my arms to assist.
- Ant Farm Insights
The biological pathway that women use to make gay men will be fully elucidated within 5 years
The amount of 'social leverage' in a species should determine the portion of non-viable offspring and, ultimately, parthenogenesis.
Increasing urbanization, therefore, ought to increase the portion of homosexual men.
Coincidence that gay men often work in industries that serve women (hair, clothing)? Coincidence about homophobia?
- Remote-controlled Beyblade!
The hot Christmas item for boys this year is a line of high-performance tops from Japan. Adric got a couple since the start of the school year, and for Christmas he asked for one that is remote-controlled (like, he said, one of his friends had). I went out and found a gun-shaped launcher for them, which has a level in it but of course doesn't control the top after it starts spinning. I gave it to him for Christmas.
They have a cartoon series for it, in which the characters do battle to see whose top can stay spinning longest. The tops have Shinto spirits inside and the characters talk to them and direct them to perform jumps etc during battle... every top has a unique finishing move, and so on.
So on Christmas, when Adric asked why the launcher gun didn't actually control the top, I explained, "That's only in the show" and that his friend must have a prop launcher too and had only been pretending.
Tonight I get home and find Denali had taken him to Target and gotten him a new top and launcher, which ticked me off at first because the kids just got so much stuff on Christmas. The new launcher had buttons on it, and I saw an LED on the front and realized it must have light effects, so I found the battery compartment and put batteries in for him. But he couldn't get the light to turn on, so I took it and said, "I bet you have to actually launch a top for that", launched one, and lo and behold found myself controlling the top remotely!!
The LED on the front was an infrared LED. This top, unlike his others, comes with 3 watch batteries inside from the factory (according to the instructions). And like, it can do cool tricks and fast directional movements by remote control! The tip it spins on is connected to a high-speed motor than can turn it in either direction relative to the top.
I was so completely blown away by this I started jumping around like an idiot. Denali's mouth was hanging open. And Adric was delighted. In retrospect it may not sound so incredible, but after weeks of telling your kid the difference between make-believe and reality only to see that difference being violated right in front of you is a nearly cathartic experience.
- We Are As Gods
All species exist in the environment and change it. Together they create the environment, each contributing according to its essential nature. Birds eat and poop, and build nests. We humans do these things too, but in our essential nature is also the unique ability to think. I can't fathom on what basis we could choose the 'proper' role for our civilization in the universe, but to discover it through the full use of our brains seems wholly in tune with the natural order.
The story of the garden of Eden is about the ego-destruction of paradise (specifically, I reckon, the advent of agriculture). With the transformative growth of wealth in the 17th century, this ancient story took a new form in the notion of the "noble savage". And again, in the 1960s, a new form in the environmental movement we know today. The stories offered by this movement are often confused or even insincere, but are indeed consistent as moral calls for restraint of the ego, of human judgement, and for certain doom to befall us otherwise.
The practice of meditation is often described as a means to undo the ego, by living in the moment and foregoing judgement. And like the story of the noble savage, these descriptions were embraced by the founders of the environmental movement. They may not accurately describe the purpose or effect of meditation, or at least I hope they do not.
I will offer an alternative story: Vigorous use of the ego will allow the stated goals of environmentalists, humanists, and capitalists to be satisfied simultaneously, while mistrust of the ego will be the only guarantee of doom. Despair comes not from too many judgements, but from poor ones. When the ego makes mistakes, it is from lack of exercise; in honing it, it is its own best master. The wealth which first suggested the nostalgia of the noble savage is ironically the thing that makes it possible, for the first time, to actually realize this nostalgic ideal (stationary and comfortable rural living).
Human judgement is flawed, but it is the only judgement we have. We must embrace it to be true to ourselves.
P.S. "We are as gods and might as well get good at it." – Stewart Brand, 1969
P.P.S. "We are as gods and HAVE to get good at it." – Stewart Brand, 2009
P.P.P.S. Start with the planned extinction of bedbugs by the most expedient means possible (likely site-specific selfish genes).
P.P.P.P.S. Maddox: Animals are people (that we can eat)
2.3e8 metric tons of municipal solid waste were generated in the US in 2010. At a density of 475kg/m^3 (about what it's at in a trash truck... most sources give about double this by the time it's put in a landfill, but let's be generous) that is 5e^8 m^3.
Piled 10 ft high, it would cover a plot of land about 8 miles on a side.
62% of it was paper, food scraps, yard trimmings, or wood... all of which biodegrade rapidly. About 12% was plastic.
In 2010 we recycled, composted or burned for energy 45% of it, meaning we actually sent no more to landfill than we did in 1980.
We recycled 20% of the aluminum and 30% of the steel. Steel is easier to separate because it's magnetic, but aluminum has six times the embodied energy, and it melts at a much lower temperature so it takes far less energy to recycle.
- Texas Tea
U.S. oil consumption by use case, rounded to the nearest 5%:
cars (gasoline) 45%
buildings (industrial/commercial/residential) 25%
trucks (diesel) 20%
airplanes (jet fuel) 5%
petrochemicals (plastic, etc.) 5%
Percent produced domestically... 50
Percent imported from Canada... 10
Percent imported from each of: Saudi Arabia, Venezuela, Nigeria... 5
Just got back from the dentist. Routine check-up. The dentist herself spent a solid 15 minutes performing a delicate procedure in my mouth, that is proven to prevent future illness. Her assistant spent another 15 minutes performing another such procedure. At the end I paid cash: $102.xx. And I got a free toothbrush, tube of toothpaste, and package of floss for my trouble. I'll never get another bill for this – $102 is what it cost. They were even nice to me the whole time.
I could have had X-rays for an additional $50. But that would have required two more visits. I'd have to go to another building to get the X-rays, then come back on a third day, to her office again, to discuss them with her.
Just kidding! She would have turned around, grabbed an X-ray machine, taken the images, and showed them to me on a monitor 30 seconds later.
If I'd needed an implant, well, my dentist has a CEREC machine in her office that can fabricate custom implants while you wait.
A few months ago I went to the doctor. He was scheduled to chat with me for 15 minutes. He spent half that, talking a clip. He wasn't prepared to do anything for me – just chat. The cost was approximately $300.
Now, MDs may like to make fun of dentistry degrees. But both professions require similar years of training. And in a typical week, a dentist will perform more surgeries than a typical clinician will in their entire career. A year ago, my dentist cut a salivary gland stone out of my salivary duct with a laser, on a drop-in basis. It cost $150. A trip to the ER would cost at least ten times as much.
So it's not expensive education. And it doesn't seem to be, as we hear from the right, malpractice risk. So why is the one experience so different than the other?
Because, for some reason, our society never decided that people are entitled to dentistry. So there are no elaborate "insurance" schemes for dental "care" (well, there are, but a much smaller portion of patients use them) and relatively little debate in Washington. No politician has ever called the procedures I had this morning "preventative dentistry". And so the market for dentists functions relatively well. There is no shortage of dentists. If I don't like my dentist I can go to a different one. My dentist knows her livelihood depends on my business. She is free to buy CEREC machines on a market relatively unencumbered by regulators (though ACA will soon begin taxing such machines to help pay for folks to chat with MDs).
ACA, by the way, only increases such forces on clinical medicine, and even adds price controls. It can only hurt the situation. Markets are a part of reality. They aren't something we can choose to accept or not.
The solution is just as obvious. The guild of clinical medicine must be disrupted. Concierge services like One Medical and Qliance are entities that could do it. But in the clasped and tightening regulatory environment, they can't. They need the freedom, for example, to hire PhDs to practice medicine. MDs would of course find that extremely threatening. PhDs aren't qualified! A fleet of vocational PAs from within the guild, however, are totally qualified to see patients.
DTC services like 23andMe are another bellwether. Predictably, MDs enlisted the FDA to attack this industry. And all DTC genomics firms but the deep-pocketed 23andMe have shuttered as a direct result. Such abuse of regulators must be stopped.
Most importantly, the federal subsidy that ties medical insurance to employment must be unwound. The politically-feasible first step is to extend the subsidy to individual consumers for purchases on the open market. HSAs do this, but are widely unavailable, since most employers rely on the insurance industry to guide them through the legal framework for offering benefits. I describe the trivial solution to this problem here
 At the outside, he would have given me permission to buy a drug. Nifty bit of regulatory capture, that.
 Nobody's quite sure the exact amount, despite several invoices having been mailed between two billing offices and my house over a period of months.
 Despite the fact that dental interventions are known to be more effective at conferring quality-adjusted life years than outpatient medical interventions.
In the five years 2007-2012, the fastest buildout of "renewable" energy in history has taken place, in the form of wind power in the United States. During this period, we added 25 TWh of wind generation per year. This quantity is about equal to all of Germany's solar generation in 2012 (and Germany has more solar than anyone else, by far). Total wind generation in the U.S. in 2012 is likely to have been 158 TWh.
In the five years 1983-1988, the U.S. added 47 TWh per year of nuclear generation (not including naval reactors). The 2012 total generation was 790 TWh.
Total inflation-adjusted federal subsidies from 1950-2010 are about the same for nuclear as for wind, solar, and biomass combined. But we get much more energy from nuclear than from those sources, whether electrical or primary energy (even excluding naval reactors) are considered.
Sources: EIA, NREL, Bezdek 2012
- Nearest in Light Years...
star [red dwarf]: 4.2 (Proxima Centauri)
GV star: 4.4 (Alpha Centauri A)
planetary system: 10 (Epsilon Eridani)
multiplanetary system: 15 (Gliese 876)
exoplanet [directly imaged]: 25 (Fomalhaut b); 65 (Beta Pictoris b)
galaxy [Milky Way satellite]: 25,000 (Canis Major Dwarf Galaxy)
[diameter of Milky Way]: 100,000
spiral galaxy: 2.5M (Andromeda)
- Industrial Revolution
The GDP of nations is remarkably unconcerned with the number of people living in them or their geographic size. Using World Bank data for 130 countries in 2010, population, energy use, and various measures of GDP all vary by at least a factor of 3,200. Per-capita GDP varies by at least a factor of 242. Total primary energy per $ GDP at PPP varies by only a factor of 25.
Labor force participation rose dramatically in the U.S. starting around 1970. Yet GDP per capita rose no faster than it did in previous decades (actually it rose more slowly). Everybody knows, most middle class households are two-income now. But it all went to price inflation of positional goods like real estate and college – at least according to Elizabeth Warren.
In recessions, unemployment responds more sharply, and later in time, than GDP. There's actually quite a bit of economics literature on this phenomenon.
Peter Norvig's "economics simulation" suggests that rising income inequality may be inevitable in a zero-sum economy. The cause of rising inequality is more likely underwhelming growth than overwhelming innovation. But then, the "secular stagnation" crowd have hardly been persuasive suggesting that travel booking websites are reducing employment when mass production and electrification increased it.
- Bad Capitalism
Libertarians believe capitalism has never been practiced. I believe it's the only thing that has been practiced. E.g. North Korea doesn't have communism or some other system, just bad capitalism.
In a high-functioning society, government has little freedom (or ability) to specify property rights. In a dysfunctional one, it has a lot of freedom to do so. It doesn't follow that a particular specification, inferred from government activities in a particular dysfunctional era, was the cause of the dysfunction.
The best natural experiments we have here are postwar Germany and Korea. The above predicts that regions which became East Germany and North Korea – and neighborhoods which became East Berlin – were also poorer before the war.
Ibuprofen is a true miracle drug. The team that discovered it routinely tested candidates on themselves. This wasn't uncommon. My dad did it at Merck in the 1970s. In one case, he and his lab partner took a candidate appetite suppressant (serotonergic) and then went out for Chinese. They ate like kings and concluded it didn't work.
- Natural Stupidity
I always have a laugh when somebody says they're going to use deep learning or Watson or some kind of advanced technology to improve health care, or elementary schools. It's a joke because the major problems in health care and elementary schools have obvious solutions, which are blocked by politics. So what we really need is to turn over governance to AI. It's the opposite of what pundits and captains of industry are recommending – that we should put AIs to work on hard problems but somehow keep them from taking control of our lives. It's exactly the opposite of what we should do. But that's human governance for you.
Were I a billionaire, I'd have them trained to do chores for me
Were I a millionaire, I'd shoot them dead on my property
As I am, I caw back at the crows, to protest the invasion of privacy
It seems little has changed since biblical times, conditioned on the rate of change we know. Prior to 1800 much less had changed, but the observation wouldn't have been made.