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by on October 17, 2010 at 8:16 am in Web/Tech | Permalink

1 joe October 17, 2010 at 5:37 am

I love this paragraph from Diamond's op-ed:
"Government-created groups as a way to manage risk aren't novel. Consider the market for residential mortgages. Any mortgage poses a risk of default. But a large bundle of mortgages poses a more predictable risk, with little threat of default. The Federal National Mortgage Association (Fannie Mae) groups individual mortgages together into securities that are sold to private investors."

Government-assigned coverage groups would be as safe and risk-free as mortgage-backed securities! Perfect! Now let's party like it's 1991!

Diamond's proposal would also deprive families and employers of their choice of health care plan. It'd be like playing the lottery. The price and quality of different health care plans can vary drastically. How awful if the government forced us to take the lowest bidder!

People have somehow conflated health care providers (e.g. hospitals, doctors) with health insurance companies. Health insurance companies are in the business of covering *risk*. They aren't in charge of the health care industry itself. A person with a pre-existing medical condition doesn't pose a risk of medical bills but a certainty. Insurance is not the right path for that person to take. If a driver without auto insurance wrecks his car, he goes straight to the auto shop and pays out of pocket; he doesn't demand that a car insurance company cover him retroactively and pay for repairs. And yet, people still find a way to blame health insurance companies when a patient cannot afford to pay his medical bills, rather than wondering why those bills are so large to begin with.

2 Andrew October 17, 2010 at 7:06 am

1. I never did.

3 londenio October 17, 2010 at 8:21 am

Re #5. I am not a particularly fast reader. But one day I had to kill 2 hours in a foreign city (NYC) and went to Borders. I realize I could read pretty fast. It was partly the time pressure of finding out the most about some books I was not planning to buy. But I was surprised at the "Cowenesque" speed I could take in information. When I went back home I tried reading standing up and I realized I could read faster. I still do not understand what kind of weird mechanism is behind this change in performance. Maybe I get distracted more easily when I am sitting down. From then on, I do my quick reads (i.e. when I do not need to take notes, for instance) standing up or just walking around in my office. Perhaps my next step is to buy a "standing" desk.

4 Millian October 17, 2010 at 10:33 am

1. Freezing an embryo is not like freezing a human. One may as well say that our ability to freeze DNA sequences, or whatever, means that cryo-obsessives are right.

This is such an obvious point that I feel embarrassed writing it.

5 Andrew October 17, 2010 at 11:50 am

Of course it is Millian. And freezing and reviving a mouse will be way different. So will a monkey. So will a chimp.

6 Andrew October 17, 2010 at 11:57 am

And why do you think "we" are obsessed? More than high-speed rail people? Noone even said cryonics until you brought it up. The simple fact is it's going to work. It's a pretty easy technical problem. I don't know what other cryonics obsessives think, but to me obsessive cryonics denialists are in some sort of denial. I think a hint to why this might be is in the article where it says something about "opening up a whole slew of ethical questions." My reaction to that is "and?" But I suspect ethical questions might be something other people try to avoid.

7 DK October 17, 2010 at 1:10 pm

#1. Laugh all you want. There are very simple and very real barriers to cryopreserving large tissues. As long as water can make ice and the rate of heat transfer is governed by conduction, the prospects of freezing humans are not realistic.

The title of the article is absolutely stupid. "On ice" should read "cold without ice", for cryopreservation of cells entails freezing under conditions that prevent ice formation.

8 mulp October 17, 2010 at 1:24 pm

Health insurance companies are in the business of covering *risk*. They aren't in charge of the health care industry itself.

Oddly, the fire insurers see themselves as in the business of reducing risk be changing the behavior of its customers. And the fire insurers see the government as an important tool for forcing their customers do change their behavior in compliance with insurer prescribed behavior.

Fire insurers have reached into every aspect of American life to dictate the behavior of individuals and industry and government, using a combination of carrots and sticks, and relying on big government to dictate the behavior of individuals and corporations.

Examples of carrots:
– if your community has a fire department capable of fast response, rates are lowered
– if your community has fire hydrants within a maximum distances from structures, rates are lowered further

Examples of sticks:
– government enforced electrical, plumbing, and construction building codes
– refusal to cover losses from non-UL approved products
– zoning regulations that separate fire hazards from the majority of insurable property, and with setbacks

With government dictating the way insurable property is built and protected from greater loss from fire, insurers write standard policies inexpensively and with relatively low risk of unexpected loss.

This system of government and insurer loss prevention was shaped in America at the time of the founding on the nation by businessmen like Ben Franklin, so this business-government policy of dictating behavior is as old as the nation.

9 George October 17, 2010 at 2:48 pm

Stamding vs sitting: to me this goes under the evolutionary medicine category. How did humans spend their time before the last 10,000 years, i.e. for over 95% of our existence? Clearly not sitting, nor standing. My guess is that we were either moving (mostly walking, some estimates are 12 hours a day) or squatting. What is the anthropological evidence for primitive societies?

10 David N October 17, 2010 at 5:05 pm

Yancey Ward,

I think there are many things you can do to address shortfall or the risk of shortfall before you have to consider denying care. I also think that insurance of every kind carries with it the risk of shortfall; it wouldn't be a problem unique to LHI. My hope would be that a portion of the enormous float LHI would involve could be used to invest in ways to permanently reduce medical costs.

11 Andrew October 18, 2010 at 3:20 am


Of course there are technical barriers to success. Technical barriers don't bother people (except it seems in the case of cryonics). Are these barriers more difficult than curing cancer, which basically requires a complete understanding of development, toxicology, genetics AND the immune system? I don't think so. And there are reasons to believe they will be solved pretty quick. And just imagine if cryonics research got 1/1000th the money that goes to just breast cancer awareness.

Also, of course freezing cells is different from freezing tissues. You have to deliver the anti-freeze and then deliver the cold. There's good news. There is something we can use for this. It's called the circulatory system. It's actually pretty good at delivering things to the individual cells. In fact, it's like, kind of the whole reason for it. It's pretty good at it.

We are already trying to create blood substitutes. Not for cryonics but just for standard medical needs. Some of these are going to be synthetic. It's not a stretch to think that cryopreservatives can be developed that are compatible with blood for the short times that it will be exposed to the tissues at physiological temperatures, during cooling and re-warming.

Note here how I'm not advocating for cryonics. I am an advocate for it. But here I'm just letting you know that it's going to happen.

12 Andrew October 18, 2010 at 4:00 am

Another anecdote. For 10 years I've wanted a projector. That's 10 years of convincing and cajoling. Saturday my wife watched her favorite football team on-line for the first time. She said "let's get a projector."

13 Andrew October 18, 2010 at 4:22 am

If we all got standing desks then we could double up by putting desks for little people underneath.

14 Careless October 18, 2010 at 7:11 am

Some people said Tebow wouldn't work out in the NFL

A lot of teams wouldn't touch him.

Well, the Jets didn't touch him.

What? 0 passes, 6 rushes, 23 yards. Those are not impressive numbers.

15 Dan Weber October 18, 2010 at 9:01 am

I think we could get some cost containment if families were assigned to the same pool, of a size not so great that one's individual actions were noticeable in the pool. I would be more hesitant about, say, radical chemotherapy if I knew it meant my children would have a less robust pool to finance their health care in the future.

That said, I'm sure some family of jerks would see it as their goal to bleed the plan dry.

16 Yancey Ward October 18, 2010 at 2:16 pm

Exactly, David, there are no plans that don't have these bad parts, but they also don't don't have unlimited liability either. With medical care, the government attempts to be the ultimate reinsurer, but reinsurers also fail, and they also have caps on payouts. You seem to be trying to deny reality that lifetime caps have to be included.

17 Yancey Ward October 18, 2010 at 3:59 pm

Yes, David, and what is the major complaint about health insurance in the US?

18 Yancey Ward October 19, 2010 at 6:48 am


You are citing your health insurance policy as support for your LHI plan without caps, but your policy is one of the reasons the present system is slowly but surely pricing itself out of the reach of more Americans. Think about term life insurance since this is essentially the type of insurance you were describing, but for health care. Term life policies give you a capped payout on your death, and the younger you are, the lower your payments. Now imagine a term life policy that has no cap on your benefit- what do you think this means for the payments of the customer- it means higher payments that might well have no cap themselves, and if the payouts keep increasing, the customer may well have to abandon his policy before he dies, and this, in turn raises the payments for those still in the plan, and so on.

I am guessing that one of the "many things you can do to address shortfall or the risk of shortfall" was to raise the premiums on every paying customer- I was just trying to get you to state that yourself. Was it or wasn't it?

19 Yancey Ward October 19, 2010 at 11:09 am

Pricing them into future contracts is exactly the problem I am trying to point out to you. If there is a shortfall (and we see the shortfall every single year in the rising cost of health insurance) , you are proposing to make it up by passing the cost onto future beneficiaries of lifetime health insurance contracts, not those holding the present contracts. Such a system is bound to fail without limiting liability because eventually you start pricing out the young at some point, just like today. All I can see is that your proposal buys a little time enticing low cost enrollees to buy in with the promise that future enrollees with cover some of the costs. Without a cap, I call this a Ponzi Scheme.

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