This is an article which is a long time coming. Unless you've had your head in the ground, you can't have missed the discussion on health care going on lately. I've had plenty of chance to muse over the issues myself, both on my own, with my wife and with a number of my friends. I've heard a lot of good ideas, but also some misunderstandings and I'd like a chance to lay things out as I see them.

Background

In my time as a working adult I've had the opportunity to experience pretty much the whole range of health care options. I started at the top, working for a large company who had quite a few options. We picked the one that matched our coverage needs the best, based on the fact that we were planning to start a family. When that momentous occasion came, we ended up payed very little out of pocket. It was quite nice, in fact. And for all that, the cost was very reasonable, my share of the cost, anyway.

Many Americans are in this boat and I think for them, their perspective is clouded. They see a decent system, payed for by the economy of scale of a large company, which gives them good options at decent rates. But such is not the case for everyone.

Jump forward just a few months. The tech bubble burst and I ended up out of a job. For over a year we squeaked by without any insurance. It was rather scary actually. Our new son needed shots, of course, but they were $70 a pop at the doctor. He recommended we go to the county health department instead where the shots where subsidized down to about $10. We had a few things come up. Our son had some breathing trouble early on, something that delightfully has disappeared, and every time he'd have trouble we'd be stuck with a hefty doctor's bill. We would panic if he started having trouble on a weekend and generally we'd (well, he would) suffer through until Monday morning when a doctor's office visit was much cheaper.

I would not wish that experience on anyone, but it's something 40 million Americans experience every day.

After suffering for a while I finally landed a decent job at a small company. The drawback was they didn't offer any benefits, but compared to slogging extended warranties or worse, it was a huge step up. Once we'd saved up a small amount, managed to move out of the in-laws' house, we looked to our options for health care. We came away somewhat depressed. In the end we found a plan on the open market which gave us basically what we needed for basically what we could afford.

Since we were coming in without a current health plan they were very emphatic about not covering preexisting conditions, especially pregnancy. In fact, to cover pregnancy at all required a separate rider, a separate waiting period, and a separate deductible. That was the time of our lives so we shelled out the extra cash and put our family on hold for a bit. Things worked out OK, but I would rate that experience somewhat lower than our first insurance scenario.

Eventually we moved on to a new company, where I'm still working in fact, and they had some pretty good plans. The deductible was higher than we would have liked, and it didn't quite cover as much as we wanted, but it worked and it wasn't outrageously expensive either. But nothing stays the same, and this was no different. Every year our premium went up by $40 a month. Every month some small aspect of the plan was reduced or dropped. Vision care, gone. Dental care, optional. Coverage amounts were lowered but somehow we kept paying more.

The current situation is that we're now on a high deductible health plan coupled with a health savings account. There are some benefits and some drawbacks, the primary one being that every expense is now out-of-pocket making for a strong disincentive to seek necessary care. I'm not yet certain how I feel about this plan but so far (it's been just 3 months) I'm not convinced.

My Options

So hypothetically speaking, if I'm dissatisfied with my situation, what can I do? Well, I do have a few options.

1. Drop my health care. Obviously that's not a reasonable solution, not with the costs of health care in this country. Just about anything is preferable to that.
2. Seek out a health care on the open market. For all the people working for small companies, or who own their own business, that's their only choice. The costs are high, the benefits not all that great, and the selection is limited. Consider the amount of leverage a single customer has and you can see it's not really in the company's interests to be competitive.
3. Get a new job. In this economy that's often easier said than done, and the simple fact is I like my job. I like where I work and what I do. And even more importantly, why should that have anything to do with my health insurance? Does my employer choose my car insurance? My home insurance? My grocery store? The simple fact is that it's rather ludicrous for a health care plan to be tied to employment at all. It's merely a historical happenstance that it occurred that way at all and now we're stuck with it. Life would be much simpler, for both me and my employer, if the two were separated completely.
4. Or just stick with the one plan that's offered me.

Socialism

Let me switch topics just a bit and address a point which I think is entirely overblown by far too many people: the term "socialism". In some circles even mentioning the word is like preaching vi usage to an emacs mailing list. Too geeky for you? How about wearing a Yankees jersey to Fenway Park? You get the idea I hope. Many people have made "socialism" a religious issue when it needn't be so.

I put the word in quotes above because it's a very mis-understood word and used completely out of context. Consider for a moment a few very socialist institutions: your local police force, the school system and the Forest Service. If we were to take a strictly capitalist approach to those organizations we would have private armies, private schools and private forests. Well, we do. We have both, so don't let anybody convince you that one cannot exist in the presence of the other.

But just looking at the police for a minute, I think we can see that a capitalist police force would be much less efficient. Those with money to hire guards would be able to protect themselves. Those without, well they'd have to fend for themselves. That in turn would encourage more crime by those more destitute which would lead to a pretty miserable feedback loop I fear. So it's in everybody's self-interest to provide for a common police force. And in this country I would argue we've done a good job of it. There's the occasional account of corruption or pandering, but far and away most cops are good folks doing a good job.

We've established that some scenarios just play out better with a socialist scheme, and I would also argue that many scenarios work better with capitalist setups. And many more are a mix because dogmas rarely work perfectly in the real world. The task we face is to select the one that is the best fit. We shouldn't let ourselves be driven by blind ideology or clever witticisms about liberty or freedom. Never let yourself be so vain to think that your ideals are without fault.

Possibilities

Well then, where does that leave us? First and foremost, before you make any choices you need to go watch Frontline: Sick Around The World from PBS. It's the most honest, unbiased collection of the facts of health care around the world that I've ever seen. I reserve the right not to debate anyone who has not watched it. Yes, it's that good.

Next, take a glance at two good Washington Post articles about our current system and the proposed changes.

Now that you've done that (I'm very patient, aren't I?) I can suggest to you what I would prefer. I would like health care to be divorced from employment. I would like minimum health insurance standards to be enforced on insurance providers and required of citizens, with subsidies for low income levels. I would like the option to buy up to better insurance if I felt it would benefit me.

Speaking to a few specific points, I would like to have the public option merely for the fact that it fills a needed gap and provides a certain incentive for private companies to stay competitive. I'm not convinced yet that co-ops would fill that role, but I'm not opposed to those either.

I'm also not against a single payer system (aka the Canada system) in principle. The devil is always in the details but I don't believe we should exclude it just because it's "socialist" or because the moose people do it.

The biggest stumbling block I see to coming to consensus on health care, to bringing affordable insurance to all Americans, to reducing the nightmare that is our heath system, is that people aren't willing to listen to each other any more. I see too much hate. Too many ideologues. Far too much 24 hours cable news. We have to forget our biases and start acting civilly again. If we do, I think we all stand to benefit from the results.

Lately I've put a bit of thought into the state of drug policy in our nation. It's really not in dispute that illegal drugs are a major problem which doesn't seem to be on the road to solution. It's been over 20 years since Reagan declared a War on Drugs. The war has been rather successful in much the same way the War on Terror has, it's built up our police force and ruined the lives of countless people but really hasn't reduced the amount of drug usage.

Now before we get all into this, I guess I should lay down my stance on drug usage. Generally speaking I'm against usage of mind altering substances. There are exceptions of course, such as doctor prescribed or over the counter medicines (although I do try to avoid those whenever possible). I generally steer clear from even caffeine because a) it has never affected me much, b) I don't care much for the typical caffeine conveyances (soda) and c) I would prefer to not get addicted.

I did find it rather interesting in Michael Pollan's book, Botany of Desire, that nearly every (or maybe he did say every) culture on Earth has some sort of mind altering substance which it condones. So in once sense it's rather hypocritical of us to deny one person his drugs just because his choice differs from our own. But of course the details do matter and meth is different from pot is different from caffeine, so we can't simply lump them together.

It's only natural that we would choose to legislate something with such potentially harmful side effects, and it's human nature to want to punish those who can't follow the rules. But we have to be realistic about the results. While it may feel good to put those no-good pot smoking hippies in jail, what we really have to judge in our approach is whether we're decreasing the amount of crime and violence associated with drug abuse and whether those hippies are actually any better off. That's really the direction I'm coming at this from.

As a recent report from the CATO Institute found, when Portugal decriminalized (which is not the same as legalized) all drugs they actually saw a very positive outcome. John Tierney recently wrote on that topic as well. And Freakonomics a few months ago had a very enlightening debate about legalization.

To sum up, I'm not encouraging drug usage but I don't believe our current prohibitionist laws are doing anybody any good, from the law abiding citizen spending tax money to house criminals to the addict himself who might very much like to get sober. It's the ethical and economical thing to do.

My son is just finishing up first grade, so now is a particularly apropos time to reflect on how it went. Of course this year was his first year eating lunch at school. Long before last September we decided we would be sending him with a sack lunch and it's articles like this that make me glad we did.

We sat down and did the math before we started. For the $1.80 the school wants we can make a sandwich, buy a juice box and some snacks and still have a good $1.00 left over. So monetarily it makes sense. After reading the menus, nutritionally it makes sense too. We do let him eat hot lunch once a month, just for the experience of it (and sometimes when we run out of bread or wake up late). Without fail he chooses pizza day, and who can blame him? Pizza is delicious. We make pizza at home and he eats far more than his small demeanor would imply.

So while pizza is a fine food and is certainly OK to eat occasionally, what do we really expect from our kids? I have great faith in mine and they're smart, sure, but this is the same kid who stuck a BB in his ear requiring a trip to the doctor to remove it. They just don't have all the decision making skills of an adult and we shouldn't expect or require them to. It's our job to provide them with the right choices and show them why they're the right choices so they can make their own good ones in the future.

Getting junk food out of the school is an easy, no-brainer first step. Getting the USDA out, well that's a good next step.

It looks like the latest credit reform bill is going to become law. I've read through the law and it really sounds fair to me. What always surprises me is when people make comments similar to those contained in this BBC News article, "the industry has warned that the measure could backfire, leading banks to issue fewer credit cards thus making it harder to get credit". I'm failing to see the problem. Many people do have too much credit.

Now I'm not against credit. It's certainly a useful financial tool, without which I likely would not own my own home. But it needs to be done wisely, and that's a challenge when credit companies get to write all the rules such as when you can go bankrupt. This bill will equalize the system and hopefully stem some of the nonsense going on.

Stephen Dubner, the famed economist behind Freakonomics (an excellent book, btw), posed the question, is it time to rename 'Digital Piracy'?" The answer is an unequivocal "yes". Despite what Shakespeare said, sometimes a name can mean everything. I refuse to accept the word "piracy" as anything other than high-seas pillaging. I suppose one positive outcome of the recent surge in Somali piracy is that people are realizing that copyright infringement hardly warrants such a strong word, especially when we have a perfectly adequate one. Let's not let the geniouses at the RIAA, who've had a wonderfully successful program of suing their customers, dictate our terminology on the matter.

Congress is considering a new bill which would modify the Food, Drug, and Cosmetic Act with requirements for labeling of food in restaurants. I know that there are some requirements now, but I've only ever seen nutrition information at fast food places so I believe the laws only affect them. As I read this bill, it would apply to any business which makes and sells food at least 90 days of the year and which operates at least 20 locations under the same name. That eliminates one of my beefs with proposals like this, that they will unfairly burden small purveyors who can't as easily afford the nutritional testing or calculations required.

I'm still opposed to it however. If this bill became law, it would do nothing to stem the tide of obesity in this country. Nutrition information hasn't stopped Americans from eating far too often at fast food restaurants. Nor has it stopped people from buying pre-packaged meals at the supermarket. It won't do anything in sit-down restaurants either. It's a premise that's well worth some research, but is far from proven effective enough to be cast into law. My gut tells me that it isn't going to discourage anybody from ordering the "unhealthy" items, and as we know from Brian Wansink, "healthy" foods tend to be over eaten because we feel less guilt.

No, the real solution doesn't involve a food priesthood, as Michael Pollan calls it. We don't need nutritionists to tell us what to eat. Stressing about fat calories and daily allowances just causes stress, which won't help anything. Deep down we all know more or less what we ought to be eating, but we've lost it somewhere in our industrialized food economy. Just eat real food and don't eat too much of it. It's really just that simple.

Congress passed a new law requiring the Department of Homeland Security to create a new terrorist watch list. This one is actually a list of people who are not terrorists, but have been mistakenly labeled as such. That would be thanks to the famous no-fly list that the TSA maintains which is riddled with inaccuracies but doesn't provide for any practical way to get yourself off of it, until now. So in a sense, this is a step forward. It addresses problems that the TSA has been burdening Americans with. Unfortunately, it's only a partial solution. The whole idea of a list of people so dangerous that they can't fly, but innocent enough that we can't arrest them is ludicrous. The fact that the list is poorly maintained and horribly inaccurate is just icing on the cake. The only sensible thing to do would be to dump it and spend our money (estimated at $100 million per year) on something much more effective.

Don't even get me started on the liquids ban.

According to this AP story, about 1/3 of Idaho voters this election cast their ballot absentee. I'm actually surprised that it's that high, but not because I think it's a bad idea. Quite the opposite, in fact. See, I grew up in Oregon and cast my first ballot there via mail, as all elections have been for at least 15 years I believe.

In Idaho it's a bit harder than in Oregon, since voting by mail isn't the default. To mark my ballot I had to use a toothpick to punch out a paper ballot. But it wasn't terrible either and I think most people could manage it, possibly even some Floridians.

But also mentioned in that article is that some state representatives think the high number of absentee voters is a bad thing. These are the people we like to call "misinformed" and "crazy". Why would it not be a good thing? Instead of spending an hour of my business day in a school gym, I can vote at my home. Instead of trying to pawn my kids off somewhere, I can leave them be in the house. Instead of standing in long lines, I can vote whenever I've got time. Instead of being rushed to pick between two people I've never heard of, I can sit down and read about them on the Internet. That makes it a win-win-win-win.

I just don't understand why everybody hasn't moved to voting by mail.

The BBC is reporting that the bluefin tuna fishery in the Mediterranean may soon be shut down. That would be a Good Thing™. For full details I recommend watching the Deep Crisis episode of Scientific American Frontiers with the adorable Alan Alda or listening to this episode of Science Friday. The gist of it is that Mediterranean fisherman are harvesting way too many tuna and unless we make a change, we're bound to do to tuna what we did to atlantic cod. You've heard of Cape Cod, right? Just try to find a cod there and you'll understand the consequences.

I've been mulling over an essay about wolves which fits in very nicely to this topic, but I think it's deserving of a much longer post so I'll hold my tongue until then. I will just say that to date we as humans have been very ignorant of our place in our ecosystem. Somehow we imagine that because we're intelligent, we're immune from changes we make to our environment. Sadly we've been grossly mistaken and unless we learn to treat our resources wisely and with respect, we may not have them much longer.

For a while now I've wanted to create a full list of all the political topics being debated and how the various candidates feel about them. See then I could rank them and come up with an algorithm to figure out who most aligns with my view. Luckily, I decided to google around first and I found somebody already did it: Vote Gopher.

Vote Gopher is a non-partisan site devoted to getting facts out, without any spin. I've only been browsing around for a few hours tonight but so far I'm impressed. I compared their candidate position statements with some I found at other places around the net and they appear to all agree, so from what I see their information is accurate. I've also been giving them a very critical eye regarding neutrality and thus far I see no reason to doubt them.

What I find most refreshing about the site is that it skips past all the mumbo jumbo and gets straight to the details. No more yammering about how old McCain is or whether Obama is wearing a US flag pin, as if those things really matter. The real questions are what will the next President do and they have extensive statements from each candidate on that.

So far I've found that I'm pretty split on both candidates. In fact, both candidates are surprisingly similar in many areas, such as stem cell research (both favor) or carbon cap-and-trade (both favor). What's nice is that generally the areas they agree on are the ones which align with my views (and I suspect most American's, hence the concensus).

Don't wait. Run over right now and sign up for an account. Start tallying up your issue votes and see who you really support.