Assorted links

1. Why do aphorisms and cynicism go together?

2. When did bank executives cash out?

3. In defense of managed care, with a pointer on median wage stagnation.

4. Chinese vs. Russian reforms.

5. Monkey language has syntax.

6. The final paragraph of the article: "But the big winner is the rabbi, a recent arrival from Brooklyn who is
working hard (against tough odds) to bring his Lubavitch movement to
Montana. He has been scouring the state for anyone who can speak
Hebrew, and is elated to have found a German shepherd he can talk to."

7. The encyclopedia of counterintuitive thought.


7. Some of those are great and some are just crazy, which, is of course the problem with contrarianism (and of course, on the other hand the very same problem with conventional wisdom).

When an aphorism isn't cynical, it's called a cliche.

1,2&7 Bank runners ran banks?


While the insurers called it "managed care" trying to convince people they were doing something useful to promote good care with good health as a result, but what they were really doing is paying for services with the doctor getting rewarded for doing more, and punished if he spent time with a patient to figure out how to care for them without expensive treatment. Then when the doctor needed to use some treatment, he had to waste time fighting with a clerk who told him the patient didn't need the treatment he called for because she worked for the insurance company. Numerous terrible cases of denial of care that was reasonable and necessary convinced insurers to end their denial care and just hike premiums.

By the mid 90s, the for profit insurers had driven the true managed care providers who combined the management, care, and the risk sharing into one package. The Blues that were community based, with the community and the providers involved in supervision, were cherry picked to bankruptcy, or into operating as insurers. The HMOs were forced to effectively switch to a near fee for service as they were forced into more of an insurance model. As both the Blues and the HMOs didn't do underwriting, they got stuck with the sick people the for-profit insurers didn't want, and that's what forced them to switch to the insurance model in order for them to compete for employers.

The idea that health care today should be delivered under the small business single proprietor model is absurd. You will have a GP or internist or family practitioner who might specialize in some areas like mothers and her kids, or diabetics, but that need quick and easy access to specialists in other areas.

When I had a real HMO, a question about a mole resulted in the doctor saying "doesn't look like a problem, but hold on..." and a minute later the skin guy came in, pulled out his ready at hand magnifying glass to take a close look, at which point he stood up declared it a something or another that wasn't cancer. My doctor was the lung guy, focused on smoking, so I imagine he got called in for those questions.

For the HMO, this was something the HMO wanted to promote by giving the doctors time to know each other and putting them together and promoting the quick informal consultations by making the appointments long enough. But for an insurer, that overhead is waste, they seek to cut payment for the standard checkup, but then they make it more expensive to get a mole checked for cancer. So, by cutting the payment for the visit from $100 to $75, they then create the two minute specialist visit that costs $400.

In 30 years of computer systems engineering, we worked as a team, calling or walking to someone's office all the time for a consultation with never a billing or record made. I can just imagine the cost of computers if our compensation were based on fee for service principles like heath care.

a German shepherd he can talk to.

I'd be really impressed if he found a German Shepherd who could talk back. Mostly they just growl.

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