Summary of T. R. Reid at Commonwealth Club

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T. R. Reid is a journalist and author of The Healing of America; here's a summary of his prepared remarks at Commonwealth Club of California (mp3):

Reid went and visited a bunch of countries and looked at how they fund health care.

1. Not every modern country uses a socialist scheme: private health care works in other rich democracies.
2. Not every modern country is single-payer; e.g. Japan has 3000 payers, Germany 220, Switzerland has 70.
3. Not all developed countries do the same things.

Of 190 countries there are four basic models; they can be broken down by asking who is the provider and who is the payer:

1. The Beverage model (UK): taxes are high, but they pay half of the what the U.S. does; government owns hospitals, pays doctors, and pays bills. This is real socialized medicine.
2. The Bismarck model (Germany): premiums are split between employers and employees; private insurance purchased through employer. Private doctors/hospitals/insurance.
3. National Health Insurance model (Canada): private providers; government pays. Premiums are paid to provincial governments (Reid did not deal with the question of whether people opt out). Model for Johnson/Medicare plan. Popular in newly-rich countries. Reid singled this approach out for criticism because Canada has limited numbers of specialists and advanced equipment; "lots of waiting" for non-emergency care. A gatekeeper system.
4. Out of pocket model (much of the world). Patient pays at point of service; for some reason Reid spent a lot of time talking about people paying with potatoes.

All four models are in effect in the United States: the military has the Beverage model, the elderly have the NHI model, many employed people have the Bismarck model, and about forty-million Americans pay out of pocket. This differs from much of the rest of the world: most countries have just one model.

Why do most countries have one model? Reid chose to examine Switzerland:

1. It's simpler and cheaper to administer; Reid says in the U.S. we spend 18-25% of our health care dollars on administrative costs.
2. They have a strong incentive for preventive health care; cited many anecdotes from the UK.
3. It is "fairer" to have everyone have the same access to the same health care at the same cost. Reid ended his remarks here by admitting this is a subjective assessment of a moral question and fundamentally reflects a moral value.

During the Q&A Reid said he expects the US to move to a Canadian model.

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Ken Fisher's Five Signs of Financial Fraud

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Ken Fisher is pushing a book, and put in an appearance at the Commonwealth Club of California recently. His book is about Ponzi schemes generally, and the traits they typically share. Here's his list as best I can summarize it from listening to his appearance at the Commonwealth Club:

1. Combines custody with decision-making; this means that your shares are held in-house and not with an independent third party.
2. Numbers too good to be true/fees to low to pay manager/manager making money by "just trading."
3. Investment strategy opaque, not understandable by laymen, or a trade secret.
4. Markets things that don't matter but contribute prestige; has flashy hobbies; makes a big deal of associations with politicians or celebrities. Makes a big deal of impressive family history or impressive resume. Implies that he's offering you a special person or specially connected.
   
5. Does not answer questions; resistant to due diligence; shuts down/out people who ask questions.

Also, Fisher basically says that there's no difference between a politician and a crook, so beware anyone to takes politicians seriously.

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This Little Light

I've been on unintentional hiatus for more than two months now, but I wanted to do the prairie dog thing for just a moment to mention Christa Brown's new book on abusive ministers:

1. Eileen Flynn comments on her weblog
2. Eileen Flynn's column at the Austin American-Statesman about Brown's book

This is Flynn's coverage of Christa Brown's book This Little Light: Beyond a Baptist Preacher Predator and His Gang.

I haven't read this book, but I will probably pick it up when I can find it at a good price and have the time to read it. There really is no dispassionate discussion about abusive preachers, but I'm hoping that Brown takes a more measured tone in her book than she does at her weblog.

See also the promise of a review here and points beyond.

things we think are brilliant

Thornburg Mortgage RIP

Our condolences to employees of local mortgage securitization company Thornburg Mortgage, which announced plans to cease operations a couple of weeks ago.

• Thornburg Mortgage Announces Additional Forbearance Agreements, Sale of Its Remaining Assets and Discontinuance of Operations
• Thornburg Mortgage Drops Other Shoe (Updated)
• The House Thornburg Lost

No analysis. I just plumbed the third article to find out what went wrong: according to the article they were borrowing over the short term, secured by packages of AAA-rated mortgages; when their lenders lost faith in the ratings of the mortgages (that's the discussion of "Alt-A," etc.) the fact that they were moderately leveraged (12.5:1) caused their funding formula to suddenly not make sense.

All the other stuff, about taxes, etc. is just sound and fury as far as I can tell; if Thornburg were still in business nobody would be talking about whether they're paying enough taxes.

on the cusp of a post-literate society

Here on the cusp of a post-literate society, pictures used to compliment text.

• From the Telegraph, the world's best passenger complaint letter.
• From Yahoo UK, the same letter, with a followup.

Look at this Richard. Just look at it.

back in the USA

I am finally back sleeping in my own bed after three weeks away: two weeks in Singapore and most of one in Tokyo. I'm on a tight, somewhat difficult schedule for a project at work, so I will be gophering only occasionally over the next few weeks.

This was a fascinating trip and months from now I will probably still be trying to understand what I saw. Singapore is run by a dictator, but the people seem happy. Tokyo, on the other hand, is in principle a democracy but seems moribund at best, and people spend their entire lives at work but a lot of them just seem to be going through the motions.

I didn't realize it, but Alex Kerr (of Lost Japan fame) resurfaced in 2001 with a book called Dogs and Demons: The Fall of Modern Japan in which he says essentially that Japan is a mess and getting worse and for deeply-embedded reasons: because their culture is so inward-looking and so much dependent on reaching consensus it's very difficult for them to change course. This manifests in two ways: when they have a good idea they tend to run it into the ground, and when they have a bad idea there's no shifting it.

I really have no idea if he's right or wrong: I read the book somewhat skeptically, suspecting that if he were talking about a culture I am part of I would have been inclined to marginalize a lot of the particulars he cites as being symptoms of a sick society: e.g. some nuclear plant had contamination because it was poorly run, not because Japan has a cover-up culture. And as a foreigner who doesn't speak Japanese I really have no access to information.

Regardless, Dogs and Demons is a fascinating book, and one of the strangest I've ever read. I highly recommend it if you can read it at the right price. Some of what he says hasn't stood the test of time: the economy here in the States is no longer the model of health it was (relative to Japan anyway) in 2001, so some of his comparisons don't have the force they had then. Nevertheless it's still an interesting read.

I also got to change planes in Kuala Lumpur on this trip. I had been somewhat concerned flying a Malaysian airline, and I have to admit the leg from Kuala Lumpur to Tokyo was long and not especially pleasant, but on balance it was probably better than flying Delta.

I think Kuala Lumpur is the furthest I've been going west; I'm looking forward to finding an excuse to get back there again, and this time to visit the city itself. Patience patience.