More Plinking

I know that I've just been taking a lot of pot shots lately, but you'll forgive my flagging enthusiasm for sweeping back the ocean. The stupid has always been with us and there's nothing we can do but sit back and smirk, trying hard to forget the misery that our selfish and idiotic tendencies bestow upon the less fortunate.

Anyway, in another post whose end I have no inclination of reaching, Megan starts out strong with the stupid, self-defeating debating tactics of which she's so fond.

Step 1) Decry the rhetoric of your opponents without citing any of them:

For some reason, everyone I've seen who has so far responded to my piece on mortality and the lack of insurance has pulled exactly the same debater's trick: they restate my argument in maximalist form, and then proceed to really kick the hell out of the strawman they've created.

Step 2) Spew a bunch of nonsense and evocative language meant to depict your opponents as absurd, wailing harpies who've lost all reason:

I mean, there's hay and shreds of fabric on the ceiling of offices three floors above them. Button eyes flying off so fast that several have achieved escape velocity. Crows shrieking in terror as far away as Fresno and Marseilles. It's a stunning display of . . . something.

And thus concludes another opening paragraph to another post I won't read.

I suppose you could accuse me of some form of argumentative fallacy here, but that's just something you'd do because you're a fucking asshole.

Tu Quoque!

Bundles of Stupid

Making a Bundle Out of iTunes:

Well, she's got the capitalization down. Now only if she could make some sense.

I suspected that this was some sort of an elaborate troll, but no, this chap at PC inciter actually wants to break up Apple's monopoly over the iTunes store, the iPhone, and the iPod.

What monopoly, you may ask, and indeed, I did. Apple has a monopoly over these things only in the trivial sense that P&G has a monopoly over Charmin, and I have a monopoly over the chocolate cake I baked last night.

Megan is right, although the concept of her harping on someone else for misusing a word is pretty much the best Allaanniiss Mmoorriisseettee song, ever.

Well, I'd like to get takeout from Ray's Pizza and enjoy it in the stunning ambience of Cafe des Artistes. If the waiter refuses to let me do so, is that a monopoly?

No, that's what we call "bundling". Most people hate bundling. That's because most people are under the impression that they would pay less if things were unbundled. Sometimes this is true. But if you forced Cafe des Artistes to "unbundle" the location from the food, that doesn't mean I'd be able to enjoy a cut rate meal in a beautiful location. They'd just charge me $100 for the seat.

Well, yes, because they don't currently charge you for the seat, only the food. The seat is implied with the purchase. Totally like iTunes, which gives its phones and mp3 players away for free and then charges you only for the music. What an awesome analogy. It only fails almost entirely.

Similarly, people who want their cable unbundled because they only want to pay for a few channels are under the delusion that they could save huge bucks by cutting off the Golf Channel. But cable companies don't save any money when you drop the Golf Channel, because they stream all the channels down the coax at once.

Through a series of pipes and tubes..... O_o ???? ¿que?

I hate it when she gets technical.

Indeed, it may cost them money; the Golf Channel now has fewer potential viewers, and hence falling ad revenues, and they have to hassle around with custom packages for every customer, which is labor intensive, and thus extremely expensive (and also more likely to break).

Potential viewers, the dream of every advertising man. I love that she calls cajoling people into buying shit they don't need "labor."

Like cable, iTunes is mostly fixed cost, which means that unbundling would make their profit fall much faster than their revenue.

This is such utter horseshit and completely contrary to Apple's entire business model, which is to make things user stupid friendly and force brand loyalty down people's throats. Then, when they're scared to even look at a PC, the consumers are fed iLife. Give all your money to Apple. We'll be you for you!

Megan is too stupid to know about the plethora of other mp3 players, online music libraries and internet phones that are much cheaper and don't force you to buy your fucking groceries through the iMart. iPhone will make plenty of fucking money on its own, and iTunes will still be profitable if you can play that song about rain on your wedding day that bought from it on a fucking "Chocolate" (or whatever's the rage these days). See, selling things makes money even if people don't buy other things. iTunes is mostly in business because people like the iPod and it was the first one on the scene with a presence. That doesn't make getting rid of iTunes a catastrophe for Apple and it sure as fuck doesn't make Apple products the fucking pinnacle of consumer satisfaction anymore than Morton's salt really is the fucking salt of earth. It doesn't "just work." It's just fucking there and people don't think that they really have a choice.

I Vaguely Implied To You So!

Megan wants to know if there's a doctor in the house. She hints (but does not link) to an NYT article (presumably this) about a shortage of doctors. She then modestly states "Gee, where have I heard this before?" Luckily, she didn't forget to link to herself.

The link is to a post "Is there a better way?" which attempts to address this comment:

You're a long way from establishing your critical point, focusing only on the downsides of unionism to productivity. What about the downsides of focusing only on the next quarter's return? Any individual corporation would be best served by a return to servitude (company towns, anyone?). The system as a whole may well be better served by having a systematic counterweight to maximizing short-term profits.

Just curious. Are you paid on a piece-work basis or do you draw a salary? Given what you do here, shouldn't you be paid on a piecework basis?

As you think about that, remember that there are other values in this world than maximizing short-term productivity, like treating people with dignity. Who knows, maybe the people who get paid a little more can actually afford to buy the products that the economy generates.

Strangely, it doesn't mention health care at all.

I think she's patting herself on the back for saying this in reply (amongst a host of other "points."):

On the fourth point, this is a silly canard. On an economy level, we cannot produce more by paying workers more, any more than you can increase the height of your house by calling the basement the first floor. The amount of stuff everyone has is determined (more or less) by the productive capacity of the economy. You can redistribute that stuff between people, and you can change the mix of stuff that gets made. But you cannot make more of it by changing the nominal price of labor. The only way to get more stuff as a society is to improve our productive capacity, mostly by research and capital investment.

Which is, of course, total fucking bullshit. If we pay people who do useless shit like being lawyers a shit-ton and our productive members nothing, then we will produce less. Also, she isn't talking about fucking health care. She's stating a simplistic Econ 101 principle that applies TO THE ENTIRE ECONOMY and not A SPECIFIC PROFESSION. Naturally, it bears only a passing relation to the real world like all simplistic Econ 101 principles.

So, this is Megan's life these days. She finds a current topic vaguely relevant to some bullshit econo-crap she has recited previously in an entirely unrelated context and we're all supposed to be like "ZOMG, how does she predict these things?!?!?!??!"

Gather round all and listen to the great Nutstradamus. When you pay CEOs a shit ton of money to account for only stock holder considerations, then they will do things that may cause great harm to non-stock holders. Next time a large corporation cuts a corner and causes significant harm to random people, be sure to check back here to see me saying "Gee, where have I heard that before?"

On to Megan's "points" about health care.

The core problem is that we don't actually have a ton more doctors and nurses. (...) But when I look at the numbers, I don't see all that much room to believe that getting rid of the AMA would let a thousand flowers bloom. In 2008, 42,000 people applied to medical school, and 18,000 enrolled.

Hm, well, I see about 24,000 people's worth of wiggle room, myself. I also see that the focus of the NYT article is a lack of primary care doctors, not total doctors. It briefly mentions a lack of specialists but only cites examples of people having trouble getting access to them in rural areas -- an entirely different story.

Another problem is that a teaching hospital is a hard thing to construct--given how much training doctors need, we won't do that overnight. Teaching hospitals are very expensive, and receive heavy government subsidies. Obviously, we could increase the number of doctors by some amount, but it wouldn't take care of the supply problem.

No! What will we do?! Not "very" expensive and "heavy" government subsidies! That sounds "really" hard! We can only increase doctors by "some" amount! That clearly won't be enough!

It's more reasonable to note that reimbursement structures are creating an undersupply of primary care physicians, compared to the number of specialists.

Right, which is why the article focuses on that. I like how she destroys a strawbaby and then takes her "opponent's" actual argument as her own.

We reimburse for procedures, not wellness, so surgeons are well paid and GPs aren't.

For someone who is an "economist" you'd think she would understand that we always reimburse for "things" rather than "intangible bullshit."

First of all, thanks to previous generations of these reimbursement policies, the AMA is dominated by specialists. It's a democratic organization, and there are more specialists than GPs, so guess who wins? They will launch an all-out war against any politician who changes the reimbursement policy, and the politician will lose, because they can't fight ads featuring sad, sick, telegenic grannies.

Don't you love how when it comes to things like health care she's so pragmatic, always addressing the political reality rather than any flaws in that reality? I love it almost as much as I love how thoroughly she ignores those same realities when talking about things like invading countries, destroying medicare/social security etc.

Second of all, it's actually really, really hard to pay GPs well, at least in the context of cutting overall costs. Note that private insurers, who are presumably not attempting to ingratiate themselves with the AMA, also reimburse procedures, not wellness.

I must be atypically smart because I can think of a million and one things that might be easy to do and involve paying GPs more money. One of them involves handing them some money. The rest are even more complicated. Also, procedures are given more money because they cost more. Specialists take as profit a certain percentage of that higher cost. Naturally they are paid more. This has fuck all to do with "wellness" or "paying for procedures" or whatever. It's a fucking consequence of everything in capitalism. There is more money to be made per capita in high cost goods. Whoops! I'm getting into advanced economics here which is over our poor woman's head.

Pay for office visits, and you will get a lot of unnecessary office visits. As David Cutler once told me, it's no coincidence that health care and education are the two fields where outcomes are hardest to monitor, and where costs are growing uncontrollably.

No, the first is only true if the doctor's are struggling to fill their schedules. If they can already fill them with legitimate office visits, they won't prescribe extraneous ones.

The second is, again, completely irrelevant to the topic at hand. GPs don't provide "more wellness" than other doctors. They just provide different services which aren't be funded as highly.

Nor can you simply slash specialty reimbursements as a way of herding people into general practice, because med school applications are already declining; they're down 3.5% since 2001. Doctors are not, by and large, altruists who dream of living on a GS-13 wage. Nor can I blame them.

But we're only enrolling 40% of applicants, and there are major opportunities for overhauls such as increasing care from less trained workers such as LPNs. As for wages, my father is a psychiatrist; one of the lowest paid branches of medicine. He probably doesn't know what the fuck GS-13 is, but I'm sure he's making more than it. He's not complaining about his pay. Frankly, I'd rather not have doctors around who are in it for the money. If you only care about money, then you will do what is profitable rather than what produces "wellness." Naturally, Megan doesn't blame them for that.

Fun with Hypotheticals

Megan is too lazy to construct her own straw people these days, so she's outsourced to Arnold King:

Next, imagine that the best hope is a treatment that costs $100,000 and offers a chance of success of 1 in 200. Would I want her to get that treatment? Absolutely.

But look at the issue from a rational, bureaucratic perspective. You have to treat 200 patients at a cost of $100,000 each in order to save one life, for a cost per life saved of $20 million. Is that what a rational bureaucracy would do?

Yeah, that must happen all the time. Just recently drug trials showed that a new controversial treatment, which involves the killing of 100 kittens and has a one in a million chance to spontaneously reverse Earth's gravitational field, cures athletes foot for 1 in 12,354 people. They had a REALLY large sample size.

Of course, most of us would unhesitatingly take this risky treatment to cure athlete's foot. Sure the chances are slim, but wouldn't you do ANYTHING to alleviate the uncomfortable itching and burning sensation. Now, a one in a million chance of killing all life might not seem like a lot, but let's imagine a hypothetical. Imagine that every person on earth has athletes foot. Now imagine that Earth has 1000 times more people than it does. That would mean that 6 trillion people would need this treatment. Not only would we be forced to farm kittens (at the expensive of world saving tobacco peanuts wheat!) but the chance of catastrophic gravity reversal becomes almost certain. Clearly, if we had universal health care, gravity would reverse itself.

Megan realizes the direness of the situation and asks the tough questions:

Unless we're willing to let health care expenses grow unchecked, someone is going to have to think about costs. But so far in America, I see no means to develop a culture which will allow bureaucrats to deny potentially life-saving treatments simply because they're costly--either in the free market or in a single payer system. Thus, I predict, costs will continue to grow.

OK, there are no actual questions. I forgot she's an expert and hence all questions have been answered. It's true, though. I mean now, we don't worry at all about cost effectiveness. I went to the doctor for an ulcer the other day and he said that it was stress induced. When I told him that the stress in my life was due to work, family issues, girlfriends, friendships and the weather, he quickly wrote me a prescription for 50 actors/actresses to take over the roles of my personal network. He also got me on full disability and paid for a house in a small Caribbean island. It was a bit costly but since we never worry about the price of treatments, my HMO immediately authorized the procedure. Now my life is totally stress free and my ulcer is cured. I'd hate for socialized medicine to come in and start performing some kind of ridiculous "cost analysis" and ruin this all for me.