advice from a fake consultant

out-of-the-box thinking about economics, politics, and more... 

Friday, September 25, 2009

On Life In The Modern World, Or, What If Jesus Was An HMO?

Those among us who are familiar with the Bible will recall that Jesus Christ himself was an active member of the health care community as he travelled about the Holy Land.

It is reported that he practiced within multiple medical specialties, and his works as both an ophthalmologist and a neurologist are recounted within the verses of the Gospels.

But what if Jesus had been practicing medicine in the therapeutic environment we’re familiar with today?

In today’s conversation we’ll be tagging along with Jesus as he takes a few calls at his HMO’s Customer Care Center—and by the time we get done you should be able to bring a whole new take to those discussions you‘ve been having about why reform matters.

“…a blind man, Bartimaeus…was sitting by the roadside begging. When he heard that it was Jesus of Nazareth, he began to shout, “Jesus, Son of David, have mercy on me!”

…Jesus stopped and said, “Call him.”

So they called to the blind man, “Cheer up! On your feet! He’s calling you.”

Throwing his cloak aside, he jumped to his feet and came to Jesus. “What do you want me to do for you?” Jesus asked him. The blind man said, “Rabbi, I want to see.”

“Go,” said Jesus, “your faith has healed you.” Immediately he received his sight…”

--Mark 10:45-52

“Thank you for calling Customer Care. This is Jesus. How may I help you?”

“Hi, I was recently treated by you in Jericho for blindness—“

“Can I get your account number, sir?”


“Oh, yes. Is this Bartimaeus?”

“Yes it is.”

“So what can I do for you today?”

“Well, I went to check my mail, and I found a bill from you for 42,554 shekels for the eye treatment, and I don’t understand why you want me to pay this bill.”

“Well, give me a second while I look that up…ahhh, OK, I understand what happened. You see, I did perform the eye treatment, but your policy requires you to be referred by your Primary Care Physician for any specialist treatment and pre-approved by someone here at Customer Care before we can be liable for any costs of care, and the computer says that you didn’t do any of that first…so, I apologize, but we won’t be able to make any adjustments to this account.

Is there anything else I can do for you today, Bartimaeus?”

“Well, how am I supposed to pay this bill? I don’t have this kind of money. Can’t you perform a miracle or something to help me out here?”

“Well, sir, I can’t do that, but what I can do is transfer you to our Collections Department, who can help you make payment arrangements…”

Needless to say, the call went downhill from there.

“Here a great number of disabled people used to lie—the blind, the lame, the paralyzed…

One who was there had been an invalid for thirty-eight years.

When Jesus saw him lying there and learned that he had been in this condition for a long time, he asked him, "Do you want to get well?"

"Sir," the invalid replied, "I have no one to help me into the pool when the water is stirred. While I am trying to get in, someone else goes down ahead of me."

Then Jesus said to him, "Get up! Pick up your mat and walk." At once the man was cured; he picked up his mat and walked…”

--John 5:3-8

“…so you say you were lame and I made you walk, and now you’re getting calls from a collections agency that wants to garnish your ass?”

“Yes, Jesus, that’s correct.”

“Well, it says here that that back in Tishri of 12 AD you had severe boils and lesions, which is a preexisting condition. Now when I asked you if you wanted to get well you never disclosed any of this, and I don’t see it anywhere in your application packet, either.

Your policy requires you to inform us of any medical treatments you received before you became a policyholder, and because you failed to make a true and complete statement in your application we have to reject this claim.

I really do apologize, but we won’t be able to make any adjustments to this account.”

“To the elders among you, I appeal as a fellow elder, a witness of Christ's sufferings and one who also will share in the glory to be revealed:

Be shepherds of God's flock that is under your care, serving as overseers—not because you must, but because you are willing, as God wants you to be; not greedy for money, but eager to serve; not lording it over those entrusted to you, but being examples to the flock.

And when the Chief Shepherd appears, you will receive the crown of glory that will never fade away.”

--1 Peter 5:1-4

“We didn’t know what to expect when he came here, but in just a few months Jesus has shown us what can happen when the Son of God is a Customer Care Representative.

His average call volumes are more than double those of any other rep, and when you listen to him take calls…well, when you hear him tell someone that they won’t be getting their benefits…it’s almost like he has some divine power over the customers or something, and that’s why today I’ve gathered you together to announce that Jesus is going to be transferred from the call center to the Executive Training Program.

Additionally, because Jesus did not adjust a single claim in favor of a customer for the last three months we’re also giving him the “Employee of the Quarter” award, which means he gets three days off with pay that he can take anytime he wants, a check for $500, and, of course, Jesus gets to use the parking space right by the front door for his Hummer.

We expect really great things from Jesus in the future, and while we will miss Him here at Customer Care I think we can safely say that with Jesus running the show this company is going to remain profitable for decades to come.”

Tuesday, September 22, 2009

On Improbable Realities, Part One, Or, “I Want A Jet Car With Frickin’ Lasers…”

When it comes to getting around, Americans love to consider the question of “what if…?”

As a result, our cars have evolved into “land yachts”, our trucks have become “monster trucks”, and the desire to drag our living spaces around with us has morphed into converted busses with rooms that pop out of the side, a Mini-Cooper hidden under the master bedroom floor, and self-tracking satellite dishes that fight for space on the roof with air conditioning equipment.

And for more than a few of us, “what if…?” has even extended to “what if my car…was a jet car?”

In today’s improbable reality I’m here to tell you that Chrysler engineers asked that exact same question, for roughly a quarter of a century, and as a result they actually designed and deployed seven generations of cars with jet engines—and they came darn close to putting the eighth-generation design on sale to the general public.

It’s a story of pocket protectors and slide rules and offices full of guys who look a bit like Drew Carey…but as we’ll see in Part Two, it may also be a story of technology that couldn’t be perfected “back then”, but could be reborn in our own times.

As so often happens, a bit of “setting up” is needed, and to get this story going we need to discuss exactly how jets—particularly gas turbines—work.

In the case of an automotive engine, the idea is that air is drawn into the engine, that air is compressed, fuel is added, and the air/fuel mixture is then set on fire with a spark plug. This rapidly heats the mixture, it expands, and the energy created by that expansion is used to turn a turbine (a variation on a fan) which is connected to the driveshaft that eventually turns the wheels.

Some aircraft and helicopter engines also use this design to turn propellers, but the majority of aircraft jet engines force the expanding air/fuel mixture out the back of the engine in the form of “thrust” that, to put it as simply as possible, “make airplane go fast”.

From an engineering point of view, there are a lot of advantages to a turbine engine.

In contrast to a design that requires pistons and valves and a crankshaft and a cooling system and a system for oil distribution, turbine engines have very few moving parts, are cheaper to manufacture, and require a relatively small amount of maintenance. They also have very long service lives compared to piston engines.

Beyond that, turbines start right up on very cold days. Because jets output lots of heat you never have to wait for the jet car’s heater to “warm up”, and they can burn virtually any combustible liquid or volatile gas as fuel.

Vibration is very low, and you get 100% of available torque at 0 rpm, which means you don’t have to “rev up” the engine to get the wheels to start turning (something that is also true of vehicles powered by electric motors).

“Eagles may soar, but weasels don't get sucked into jet engines”

--John Benfield

So that’s the why…now how about the “who did what when?”

1954, 1955, and 1956 saw Chrysler rolling out the first-generation CR-1 turbine engine. One vehicle was produced in each of those years; the ’55 version was designated the Plymouth Belvedere Sportone CR-1 Turbine Special. (The 1956 version of the same vehicle was rated at 100 horsepower and 13 MPG.)

By 1959 the CR-2 engine was in service, again only in “testbed” vehicles, and it had achieved ratings of 200 horsepower and, after a 1,200 mile demonstration run from Detroit to Princeton, New Jersey, a far more respectable 18 MPG.

Operating these vehicles had taught Chrysler a few things about the disadvantages of turbine designs:

--the gases that come out the back of the car are really, really hot (temperatures can climb above 1000 degrees F.).

--after you put your foot on the gas, there is an annoying delay before the turbines (and the wheels) start spinning faster.

--because you’re basically dumping fuel into the combustion chamber, fuel economy sucks.

--the CR-1 and CR-2 engines did not offer “engine braking”, which means there would be extra wear and tear on the brakes at the wheels, and, because the driver would be constantly “riding” the brakes, increased potential for a heat-related braking system failure.

An engine was coming along that would address these problems, and in 1961 it was dropped into the visually stunning TurboFlite, which looked like a cross between two famous automotive avians: an early 1960s T-Bird and a late 1960s Plymouth Superbird. This Chrysler-designed and Ghia-built car even featured a clear “bubble” canopy that lifted up to allow passengers to get in and out.

The CR-2A engine featured fancy new engineering that dramatically reduced the acceleration delay and provided engine braking, and in 1962 one of the two Dodge Darts that was fitted with this engine was taken on a 3,000 mile national tour (New York City to Los Angeles) to introduce the concept to the public. (Two other cars, both Plymouth Furies, were also fitted with turbine engines that year.)

At this point we need to talk about the most unusual characteristic of this type of car: its singularly unique sound.

If you can imagine the sound of a Learjet taxiing several hundred feet away you might have a pretty good idea of—well, actually, you don’t have to imagine it if you don’t want to. You can hear it for yourself by watching the film produced by Chrysler to document that 1962 cross-country trip.

By 1963, a fourth-generation engine had deployed new technology that recycled heat from the exhaust to “preheat” the intake air. This dramatically reduced the exhaust temperature while making it easier to set the intake air on fire, which significantly increased both fuel economy and horsepower.

Other improvements further reduced “acceleration lag” and provided better engine performance while idling.

There is just too much story for one day, so we will stop right here and pick up the rest next time. Before we finish, a quick recap of where we’ve been, and a preview of where we’re going:

Chrysler, among other manufacturers, was experimenting with using jet engines to turn turbines; the idea being to replace the piston engines used in virtually every car built from that day until this with something better.

Four generations of engine had already been produced, many of the problems that were associated with the original design had been either partially remediated or fully resolved, and a significant effort was underway to introduce the idea of “jet cars” to the motoring public.

In Part Two, Chrysler puts a turbine car in the hands of 200 lucky families, we continue a history that may not be over yet—and in a most unexpected development, we’ll discover the common heritage that links the 1956 Ford Thunderbird, the 1961 Lincoln Continental, the 1964 Chrysler Corporation Turbine Car, and the 2009 Dodge Challenger.

So how about that? A decade-long story of history, engineering geekery, and conceptualism…and all of it presented in the form of useful objets d’art.

And in Part Two: lots more to come.

What’s not to love?

Sunday, September 20, 2009

On Pulling A Prank, Or, Climate Change Conference Changed By…You

It’s time, once again, to bring you the news that is not yet news.

For those not yet aware, there will be a climate change conference in New York City next week, conducted under the auspices of the United Nations.

The 100 world leaders who will be participating in the conference will be arriving on Monday, and if you’re in New York City the same day, you have a chance to participate in a not-to-be-forgotten “welcome event” and pranking opportunity.

Follow along and I’ll tell you how to get involved—and if you do, they’ll even send you home with a lovely parting gift.

To really understand this story you need to know a little bit about some of the best “merry pranksters” out there, The Yes Men, so before we go any farther, let’s cover that base.

Imagine if there was a group of people who specialized in impersonating capitalism as a means of exposing the reality of “profit before all else”, and that their impersonations occur in ways that even the capitalists don’t see coming—and sometimes don’t even recognize while it’s happening.

Imagine no more, because The Yes Men, not unlike Mighty Mouse, have “come to save the day.”

My favorite example of what they do is what I think of as the “Bhopal Prank”.

Union Carbide was the majority owner of a company that owned a manufacturing facility in Bhopal, India; a leak of methyl isocyanate gas from that facility immediately killed 3,800 people in the early morning hours of December 3, 1984. It is now estimated that as many as 25,000 people may have died over the years as a result of the leak. More than 500,000 have received some form of compensation for injuries related to the events of that day.

The Indian Government assumed legal control of the liability issues arising from the incident, which turned out to be pretty good for Union Carbide, as the average settlement to the families of the deceased has been about $2,200 (for a total of about $470 million), a number that’s probably quite a bit lower than if the liability question had been adjudicated in a US venue. Settlements notwithstanding, litigation continues to this day in the Indian Court system.

Union Carbide denied that they were operating the facility at the time, a position with which other observers strongly disagree (at one point, the company also asserted that sabotage from Sikh separatists was responsible for the leak). The disagreement has been so strong that on July 31 of this year a court in India issued an arrest warrant for Warren Anderson, Union Carbide’s former CEO.

As of this date no environmental cleanup has been undertaken at the Bhopal site, and technical information relating to this gas and the dispersal event remain unavailable to the local medical and scientific community.

Among the assets Dow Chemical acquired from Union Carbide as part of their 2001 takeover of the company was an incredible amount of bad will related to the leak and the continuing denial of responsibility…which brings us back to The Yes Men.

“If you were wise you would learn life only by inexperience. That is what makes it always unexpected and delightful. Never to realize—that is the true ideal.”

--Laurence Housman, Echo de Paris; a study from life.

On the 20th anniversary of the leak, Dow spokesman Jude Finisterra made worldwide headlines by announcing on the BBC that Dow would now accept full responsibility for the deaths, injuries, and environmental damage caused by the Union Carbide operation, and that they would dedicate $12 billion to the remediation effort.

Roughly two hours later, an actual Dow spokesman announced that they were not, in fact, doing any such thing; and Andy Bichlbaum of The Yes Men (who, as you might have guessed, was also “Jude Finisterra”) appeared on the BBC for a second time that day to explain their highly successful prank. The video of that appearance suggests that the BBC was not amused. (Neither was Dow, who saw their stock go down 3% during that hour or so.)

It’s not their only prank (see: The Halliburton SurvivaBall)—and tomorrow, if you’re in New York City, you can help pull off another.

Here’s what you do to join in the fun:

Go right now to and sign up. You will either be notified by “TwitterPhone” or standard text that you’ve signed up, and between now and tomorrow morning you will receive instructions by text on that same phone.

Show up for the event—even for a few minutes, if that’s all the time you have—and a statement will be made, fun will be had, and an international climate change conference will get the kind of kickoff it really deserves.

Not to mention, you’ll be leaving with a cool gift.

Today’s story is a short one, so let’s wrap it all up:

In an effort to help people see corporate criminals for who they really are, The Yes Men create dark and beautiful pranks, and they pull them on people who truly deserve it.

Tomorrow, in an effort to “set the right tone” for the international climate change conference taking place in New York City, another one of these pranks will occur—and you can be a part of it all, in front of an audience of millions and more or less 100 arriving heads of state.

So get over there (again,, get signed up…and tomorrow, get involved in doing something you won’t soon forget.

The entire Planet Earth, with the exception of Senator James Inhofe, will thank you.

Wednesday, September 9, 2009

On Understanding Your Market, Or, Mr. Obama, We Need To Talk

So it’s the day of the big speech, Mr. President, and we got trouble with a capital “T” right here in Health Care City.

What are you gonna do? Do we follow the traditional Democratic Party legislative process of any cost, assuming the entire time that the Left and the Netroots will “go along with the program”, or is there a risk that the calculus doesn’t work as well today as it did in 1994 and 1996?

Well, lucky for you, I’m a fake consultant, and I know a few things about your “target market”, so before you answer that question...we need to talk.

So the common sense approach to handling this situation is to make any deal required to get a bill passed, because otherwise your entire Presidency will be tagged as “strong on oratory but unable to govern”. Since the Far Left supports Democrats today and won’t be supporting the Republican Party under any circumstances, they’ll have no choice but to follow the “centrist” (read: “bluedog”) Democratic lead.

What you don’t want to do, common sense tells us, is demand that reform contain elements that simply are too tough to get through Congress. Insisting on a public option is absolutely out of the question, the new “preexisting conditions” requirements would be too onerous on the insurance companies—and requiring everyone to purchase insurance, with no public option competition at all to moderate the prices private insurers charge, and, for that matter, no guarantee of universal coverage, somehow makes perfect sense.

To mollify those who will object, we can hold out “triggers” as a compromise: in other words, Government says “hey, let’s wait a few years, and if the insurance companies still haven’t changed their ways...then we’ll do something.”

If you decide upon this approach, then the speech you want to give is to remind the Far Left and those pesky bloggers that political progress is incremental, you take what you can get, and that we can always come back later and make this whole stew of compromise better than what we propose to cook today.

While that’s a pretty good approach...most of the won’t be this time.

There are two major reasons why, and, ironically, they’re both derived from your success in 2008.

Right off the bat, this strategy assumes the millions of new voters—and even more importantly, donors—that you attracted in 2008 are Democrats, and that, no matter what, they will continue to support Democrats. The problem is, they’re not....and they won’t.

Why? Because the vast majority of those new voters weren’t “redirected” from another Democratic candidate. Instead, they were “political non-participants” who had previously held no political affiliation whatsoever—and other than supporting you personally, the vast majority of those new voters have no long-term political affiliation now, other than, perhaps, “Progressive”.

The only reason they voted for you in the first place was because you were out promoting that whole “change you can believe in” thing. They saw you on TV telling people that universal access to care “ a moral responsibility and a right for our country...”, and saying you would:

“...set up a government plan that would allow people who otherwise don't have health insurance because of a preexisting condition, like my mother had, or at least what the insurance said was a preexisting condition, let them get health insurance”.

At that same evening’s event (the Democratic Presidential Debate of January 31, 2008), they also saw you say this:

“...because my view is that the reason people don't have health care... [w]hat they're struggling with is they can't afford the health care. And so I emphasize reducing costs. My belief is that if we make it affordable, if we provide subsidies to those who can't afford it, they will buy it.

Senator Clinton...believes that we have to force people who don't have health insurance to buy it. Otherwise, there will be a lot of people who don't get it.

...I think that it is important for us to recognize that if, in fact, you are going to mandate the purchase of insurance and it's not affordable, then there's going to have to be some enforcement mechanism that the government uses. And they may charge people who already don't have health care fines, or have to take it out of their paychecks. And that, I don't think, is helping those without health insurance.”

The fact that you said all those things brings us to problem number two: if you don’t live up to your...exceptionally public...campaign promises, you’re gonna get YouTubed.

Forget about the Republicans. The Netroots will dig these quotes up in about two seconds—in multi-part harmony, I suspect—and all of a sudden, all those “new voters” who helped put you over the top last time, instead of seeing change they can believe in, are going to start seeing you as the “same old same old”...and if that happens, they won’t be voting Democratic again (or for anyone else, for that matter) for years to come.

And if they won’t vote for you...they most assuredly won’t be giving money to Democratic causes and candidates...including you in 2012.

You have to understand, it’s a question of trust. We want to believe that you’ll do the right thing, but we have been lied to for eight years straight...and we now fundamentally mistrust our elected representatives...including you.

Not all the news here, however, is bad news.

There is a way to turn all this to your advantage, and it basically involves “leapfrogging” the opposition.

Here’s what you do:

In the speech tonight, you look America in the eye and you tell us that you said all along that we must have a public option if we hope to control costs, you tell us that insurers can’t continue to “exclude” us out of insurance, and that universal coverage is, indeed, a moral obligation for our Nation—and a smart investment to boot.

Tell America that you will fight for them and against the special interests that are trying to hustle us once again. Most importantly—and this will be The Tough Part—tell us that a bad bill is a bill you won’t sign.

You have to tell America that if we don’t get it this year, we’ll have to come back next year and try again. And if we have to, the year after that, and the next, and the next.

You also get to remind America exactly what kind of methods Republicans were wiling to use to advance their position over this past month, and whose interests they’re representing when they do it.

To put it another way, you gave ‘em enough rope, and now it’s time for some noose-tightenin’.

The best part: not only does this approach lay to waste Republican opposition, it reels in the wavering Democrats—and it allows them to go home and tell their constituents that “Barack Obama and I are fighting for people and businesses and jobs while Republicans fight for fat cat insurance companies”.

If it's done correctly, the 2010 midterms will be y’all’s to lose—but as I said earlier, if you are seen as selling a political product everyone’s seen far too many times before, the cost could be brutal...maybe even “President Palin” brutal.

We all have a busy day today, especially you, Mr. President, so let’s wrap it all up:

You made a lot of campaign promises about public options and universal coverage and ending exclusion abuses, and now it’s come time to make good.

A lot of the people who supported you didn’t do it because you’re a Democrat—and not because they are, either. If you don’t make good, you got a problem, and so do the Democrats, possibly for years to come.

YouTube was a fantastic tool for you and the seed of trouble for many Republicans in ’06 and ’08—but if you’re not careful, the tables will turn, and a lot of the people doing the turning will be to your left.

Do it right and you and the Democrats have a superb opportunity to pivot on the opposition and imprint the Democratic “brand” for a new generation of voters—and donors—and an aggressive approach tonight could be the opening salvo of a message barrage that either forces Republicans to become more moderate, or turns them into a crazier political movement that loses seats and Governors in 2010 and carries even fewer states in the 2012 Presidential than they did in 2008.

Screw it up, and even Tina Fey might not be able to save us from the wrath of “Palin/Gingrich 2012”.

Saturday, September 5, 2009

On Fighting The Madness, Or, Send This To A Deather

We are coming down to the home stretch on healthcare, and we have seen the results of the first couple of rounds of crazy that have been sent forth in an effort to stop the process.

In addition to the Town Halls, opponents are flooding the email inboxes of America’s “low information” voters with no end of lies. Those emails are getting passed around and around and around, and by now some of them have probably appeared in your inbox.

But it’s summer...and who has time to respond to this stuff?

Well, guess what, Gentle Reader: I’ve already done the hard work for you.

Today’s story is an email response that you can send right back to your “inbox friends”. It’s a reminder of some of the frustrations that we all share in this country and some explanations of what’s being proposed...and a few words about socialism, to boot.

So get out there and copy and paste and forward and reply, and let’s see if we can’t fight the madness, one email at a time.

There is a whole lot of talk about health care reform these days, and a lot of it is designed to be confusing, instead of helpful.

To cut through some of that confusion, let me ask you a simple question: is your health insurance stressing you out more than it should?

If you worry about paying for drugs you might not be able to afford, if you don’t go to the doctor as much as you should because you recently pawned your last gold bar to cover a margin call on your AIG stock...or if the odds of getting your insurer to take care of what you thought they’d cover are lower than hitting 13 on a double-zero roulette wheel...we need to talk.

This conversation won’t be about death panels or secret camps or black helicopters or any of that silly stuff. Instead, let’s talk about a few things that we’re probably all worried about, and then let’s talk about some ideas that might make things better.

So first off, why do we even need reform?

How about because we pay about twice what the rest of the word pays for health care—and we don't get good value for the money.

The US spends almost three times as much as the UK, and twice as much as Canada, per person, for health care—and of the top 50 countries in life expectancy...we come in 45th.

Canada, the UK, Cuba...and 40 other countries...also have lower infant mortality rates than the US.

That is not good; and over the long term it's killing businesses and, by extension, the larger economy. Not to mention, as consumers, we deserve better.

We also want to provide for the nearly 50 million Americans that have no coverage at all, for a couple of reasons:

First, it's extraordinarily expensive to have uninsured people showing up at the emergency room. For a good example, consider the cost of treating a relatively simple cholesterol problem with drugs instead of a paramedic response, an ambulance ride, and heart surgery followed by a stay in the hospital.

The average family with health insurance is today paying about $1000 a year in extra premiums that they wouldn't be paying if we could find a way to cover those 50 million people—and if my guess is correct, there are a lot of families that could use the extra $1000.

And for what it's worth, not having insurance is already killing about 18,000 Americans every year.

So that's the uninsured...but what about the insured?

Right off the bat, here's something you should think about: we can expect the cost of the average family's health insurance premium to double by 2020 to roughly $23,000 a year...which is almost $2,000 a month.

If we can't slow that rate of growth, there's going to be a whole lot fewer people getting health care through work—and for several years now employers have been trying to get workers to bear a larger portion of their health care costs.

Plus, insurance companies are increasing profits by looking for more and more ways to cut off policyholders, or by refusing to renew insurance for those clients who do file claims.

And once you get cut off, no one else is likely to allow you to purchase insurance...which means the number of uninsured is growing all the time.

We have also seen the cost of deductibles go up (with $5000 to $10,000 deductibles looking like the wave of the future)—and all of this means that insurance companies are doing great, while the customers are getting the short end of the stick.

Did you know that more than 60% of the Americans who filed for bankruptcy in 2007 did so because of medical bills? That's not all: more than ¾ of those 900,000 or so newly bankrupt families had health insurance when they went broke.

What about this whole "putting bureaucrats between me and my doctor" thing?

How many people have health insurance that requires pre-approval for procedures or pre-approval to see specialists, or drug formularies that charge different prices for generic and brand-name drugs?

All of those things exist because of insurance company bureaucrats that at this very moment sit between you and your doctor.

So those are some of the problems.
Here are some ideas about how to make things better:

—We could tell health insurers that they can't use "preexisting conditions" to deny people coverage, and that they can't just cut people off for the crime of needing care. This allows more people to have access to health care, and it also reduces bankruptcies, since insurers wouldn't be allowed to simply deny coverage when claims come in, leaving families to pay both the health insurance premiums and, later, the medical bills.

This is the least controversial part of the reform plans before Congress today.

—There are proposals to create more competition among insurance providers, the idea being to use market forces to keep private insurance companies from drawing so much money out of the system as profit. This would be in the form of one or more insurance plans, operated by some new entity, for which members of the public would be able to "buy in" and get coverage that they can't get today.

The idea here is to create a large new pool of insured persons, which allows the insured group to negotiate for better prices on drugs and procedures and office visits and medical equipment—and if you allow anyone to sign up it can force private insurers to either match the price of the "public option" or lose customers.

Businesses would be required to either pay for coverage for their workers or a tax if they don't. Small businesses would be exempt, but we are not sure how small exactly "small" would be as of today.

This public option proposal is very controversial, and insurance companies are spending over a million dollars a day to shut the idea down before it gets out of Congress.

—The most controversial reform proposal is to create a "single-payer" system, which is what Canada has today. At the moment, this is not likely to be part of the program that comes out of Congress, if any program does.

In the Canadian system, people keep their own doctors and the Province where you live becomes the insurance company. You go to your doctor, who then bills the Province. Everyone is entitled to an insurance card, which means everyone has coverage. All of this is paid for with tax dollars.

That's also how Medicare works, and there are people who suggest the best way to do healthcare reform would be to simply enroll everyone in Medicare.

The catch would be how to control costs while providing care for all, and that's the last thing we'll talk about here.

Right now it looks like it would cost about $1 trillion, over ten years, to provide coverage for roughly 50 million people.

Remember the conversation we had about how treating high cholesterol problems with drugs is cheaper than treating heart attacks? It turns out it's so much cheaper that about $700 billion of that $1 trillion can be found with that change and other similar changes, like treating people before they have diabetes instead of dealing with the disease later.

That leaves us roughly $250 billion short. In 2003 we gave a substantial tax cut to people with especially high incomes, and Obama has proposed ending that tax cut. This would cause people making more than $1.2 million a year to return to the same tax rates they had from the 1990s until 2003.

If the public option is made widely available, the insurers tell us, private industry could never compete...but that's not as certain as insurers would want you to believe.

Consider the electricity market: in Washington State, Puget Sound Energy, a private company, operates side-by-side, literally, with "public options" like Seattle City Light and Snohomish PUD, and seems to be doing just fine—and they've been doing just fine for roughly a century.

A final point: there is a lot of talk about how government providing health care is "socialism".

Maybe it is.

But you know what? In America we also have socialized police and firefighting and EMS, and socialized streets and roads and libraries and sewers and airports and Post Offices...and socialized National Defense.

And if you really want to talk about the Founding Fathers and socialism, consider this: among the original 13 Colonies were the Commonwealths of Massachusetts, Pennsylvania, and Virginia.

Add in the Commonwealth of Kentucky, and four of the 50 stars on our flag today represent places that are known not as States, but instead as "Commonwealths"...which, oddly enough, is both about as American and as socialist as you can get.

How's that for a lot of stuff to digest?
To finish, let's summarize what we have.

There are a lot of reasons we want to do some sort of reform:

—we pay more than anyone else in the world for health care, but lots of other countries have longer life expectancies and lower infant mortality rates.

—we need to do something about the nearly 50,000,000 Americans who have no access to care outside of the emergency room, both for moral and for economic reasons.

—in 10 years the cost of health insurance will be somewhere around $2,000 a month for the average family. Businesses cannot afford this, so as time goes on more and more people who now have coverage through their jobs...won't.

—if nothing changes those who are able to keep their insurance at work should expect their employers to move to plans with $5,000 to $10,000 deductibles.

—every year, almost 900,000 American bankruptcies are related to health care costs. 3/4 of those people had insurance, but their insurers refused to cover their medical bills, and they went broke.

—if you have a significant claim, or you lose your job, you stand a good chance of losing your insurance, which means you are not very likely to be insurable again.

We talked about some reform ideas, with protections against "preexisting conditions" and cutting people off for having claims being the most likely reforms to be turned into law, a "public option" being less likely, and "single payer" being highly unlikely.

There is money available to pay for this. Roughly 2/3 would come from treating the uninsured in cheaper ways than we do today, and the other 1/3 could be raised by letting a tax cut for very wealthy people expire.

The good news here is that lots of other countries are doing better than we are, and spending half the money we are doing it; which means there are solutions available that do work and do save money.

If we can put some of those solutions to work here, it would probably help us, too.