Vote for Katz! When the election comes, you may as well vote for Katz!

So the dominos are falling…

My mom is a staunch conservative and the discussion after tonight's speech was my usual argument of common sense versus pre-conceived notions. She also brought up some good points, though, so let's examine them. Mainly, she's concerned that the country cannot afford this radical idea and that her Medicare benefits will be affected. She also pays for additional insurance, an additional Medicare supplemental insurance police as well as a long-term care policy.

So from tonight's speech:

That is why not a dollar of the Medicare trust fund will be used to pay for this plan. &
The only thing this plan would eliminate is the hundreds of billions of dollars in waste and fraud, as well as unwarranted subsidies in Medicare that go to insurance companies – subsidies that do everything to pad their profits and nothing to improve your care. & Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan. & I will protect Medicare.

So in that language there is an obvious direct cut to Medicare, but not the amount (number) or quality of benefits paid out. I assume the President is referring to overhauling the Medicare prescription drug program, the one that pays full-retail prices for drugs and is administered not really by Medicare, but by the individual insurance companies on behalf of Medicare. Does this extend to anything more or anything else?

Medicare payment processors run on a fairly thin budget, and the reimbursement rates for tests and procedures are pretty low. So I'm trying to figure out where $80B annualized dollars of waste and graft are. The plan is supposed to cost $900B over 10 years, and a majority of that money is supposed to come from savings in Medicare and Medicaid. So I'm rounding down to $80B/yr.

One concept I've come up with is that Obama is proposing taking the payment and processing in-house for the government, and getting rid of the regional MACs. Alternately cutting the number of MACs from 15 to a much lower number, potentially to match the number of Jurisdictions that handle DMERC and Hospice claims would reduce overhead and increase standardization (therefore reducing the number of appeals.)

Logically, this is the continuation of steps that were put in place with the George W. Bush's Medicare Modernization Act (MMA) of 2003 which cut the number of Medicare processing centers in half, ridding the process of the associated waste that comes with 15-20 centers.

I could see $1-$2B per year coming from changing the MACs to match the larger Jurisdictions, but even the overhead in administering the modifications could eat through the initial savings.

I think another small battle for savings would come from taking 1-800-MEDICARE from a 24/7 call center to one that was 8-8 7 days per week. Given that they may only receive 6 phone calls between 7PM Sunday and 8AM Monday it is fairly wasteful to have all that infrastructure in place (including 20 call center reps at $8/hr), but that is savings in the thousands, not billions.

So we're down to $78B/yr in savings we need to "find." Can that simply come from overhauls in the prescription drug program? It's quite possible.

The prescription drug program for Medicare costs about $120B/yr ($1.2T 10 year cost as estimated in 2005.) Say that 25% of that 120B is eaten in administrative costs (that's a REALLY high number. It is likely closer to 5%.) So we're paying $90B/yr for drugs. If the gov't was able to negotiate a lower cost for those drugs, say a 30% savings, 30% of the annual $90B cost is $51B.

Now we're at a $51B/yr annual cost. Comparatively we pay $200M/day to clean-up Iraq. That's 255 days in Iraq, less than what we pay per year for the war to take care of our own.

I haven't even touched Medicaid yet, and that's a subject I know very little about. We can randomly say that reforms in Medicare can yield a 20% "chip" against the $51B/yr cost, taking it to $41B/yr.

If there are additional overhauls in tort reform and less "defensive medicine" is practice, medical costs could stabilize or go even go down (look at IN and TX for examples of tort reform. IN has had it since the 1970s.) So that remaining $41B could come in savings from the fact medicine (not just drugs, but doctors visits, procedures, etc.) won't cost more and continue to outpace inflation. Using fancy math, the $41B annually could be carved from the perceived savings if costs really go down.

So the math almost adds up. Any other clues where this cash will come from? Other than "raising taxes."

On healthcare and government.

One of the complaints about any proposed healthcare legislation is that it invites the scary "expansion of government" flag. True conservatives; ones who have stood more to the libertarian side and rejected the government spending on the Iraq war have a different philosophical explanation for government and society than do many mainstream Republicans who claim to be conservatives, as well as those who define themselves as moderate or liberal. This leads to a lot of consternation about how to evolve our society beyond the questions of healthcare and in turn, government at large.

Editors note, a lot of my ideas that I'm expressing here have been brewing in my head for several years. As my friends and I discuss healthcare reform and I have some time to set aside I'm only now able to put it all together.

I wrote elsewhere that for those who have a conservative mindset, the healthcare debate "is philosophically painful to watch, especially because of the beauty of the utilitarian nature of conservatism (pay for the tiniest amount, only what you need, keep gov't small, etc.)" The concept of government even acting in the tiniest of Keynesian matters with respect to basic marketplace regulation causes heartburn in even the most mild of Glenn Beck fans.

Bear with me as I jump around. In the prior administration, as the roots of neo-conservatism took hold, Alberto Gonzales was roasted because he declared the Geneva Convention as quaint. A 75-year-old landmark document that defines the rules of war and limits of torture was declared nearly obsolete. His view, and the Bush administration view, is that in the past 75 years war as a notion of nations struggling for land or a resource has evolved to be fights against militant groups and terrorists who do not have a nation and who are not battling for borders, but instead battling to shape ideologies. And they weren't wrong. They weren't right, either. Personally I think we as a nation need to take the higher road and play by the rules, and let those who want to cause harm or terror fester how they choose, but others did not think that way.

The message from this exercise is that the model use to define war and terror and punishment is complex and evolving. Documents that we live by today were created many years ago, and will occasionally need to be re-examined as society evolves, as well as aspects of our immediate government.

The concepts around a democratic government are evolving, too. Let's think about this for a moment. In the 20th century many extremely successful democracies were created with the help of the USA. Generally this nation building occurred after the Second World War. Many of the governments that were built were not based on the US constitution or a federal/republic model, but instead were designed after various parliamentary systems widely found in Europe. Even in the latest US approaches to nation building in Afghanistan and Iraq parliamentary systems have been put in place.

As the USA has evolved so has the methods in which we divide our land. Typically in the US the smallest units of government are towns or townships or cities or incorporations. The next layer up is a county, the next layer up is a state, and the next layer up is the federal government. Compare the typical size of a county in an older state, like a New Jersey or Maryland or Maine or Florida. Compare that with the size of a county in Texas, Kansas or even California. The further west we move, the later that portion of the country was settled, the larger the land-mass is that is. The more recently the portion of the country was settled, the more technology we had to "conquer" the situation. Initially there may have been stone bridges and people walking or riding horseback. Later we had railroads and bridges were more quickly constructed of steel. Just with this example, we can see that government, especially in some parts of the east, is established around the limitations of the 17th century, and further west puts us in the 19th century.

Our constitution was solidified in 1789, 220 years ago. It has evolved quite a bit over time, including provisions for ending slavery, ending alcohol consumption, resuming alcohol consumption, and even allowing women to vote. Many people cling to the constitution, and other items like the Federalist Papers as if they're a gospel, not to be strayed from. Our constitution and government was created of two problems. One was rejecting the rule of a monarchy. The other was an effort to solidify relations among different, disparate and geographically diverse colonies. There was no internet, no phone, no hopping in the car and driving six or eight hours to spread a message. Instead the founding fathers developed a lowest-common-denominator to string together thousands of miles of coastline.

These same notions brought us concepts like the "circuit court" which was really a circuit that judges and state prosecutors rode on a horse to administer justice to different areas. These units of measurement and units of government were developed for horseback and not the innovations of the past 200 years.

From this sprung what we have today. But in the process we developed conventions and methods of government and units of government that don't need to apply anymore. Think of this in terms as "government per square inch."

Over the past 5 years in Indiana, one idea to help curb property taxes, reduce government waste, and provide "one throat to choke" was the concept of limiting and reducing township government. Typically townships are sub-parcels of counties. There are usually six or nine townships in a single county. Sometimes more, sometimes less. They were created to handle things that people didn't want to handle at the county level. Typically fire departments, distributing aid to the local poor, and assessing properties for taxation. Sometimes they also managed building permits and local zoning when there was not a city to manage such things. There is also some graft associated with this. Local officials can be appointed instead of elected, or if they are elected they then hire family members to fill out office positions.

But for the most part, in rural areas this makes sense. However, a large city like Indianapolis does not need nine townships with nine different fire departments and nine decentralized offices for small claims courts, each with their own constables.

In various heroic attempts both Democrats and Republicans have tried to curb this excess government. And they've failed miserably for the most part. We're down to six or seven different fire departments in Indianapolis.

Take a look at this from a bigger picture that applies in many places. How many police jurisdictions do you live in? Until recently, I could be serviced by the city police, county sheriff, state police and the state excise police. (Indianapolis recently consolidated the count sheriff and city police.) How many policing agencies do we need working in the City of Indianapolis? Each have their own set of regulations, their own command structures, their own motor pools, individual weapons requirements and individual garages.

There is obvious waste in this, both in headcount as well as operational expense.

We can look at education the same way. How many school boards do we need? How many administrators? To save money some counties combine their schoolboards, (not necessarily individual schools) to save money and raise standards and opportunity for local children. 20 years ago discussions of national standardized testing for students was heresy. Now, with NCLB we have such a system. In the past regional and local differences for the purposes of different school boards were a shield to prevent racial integration and the teaching of Darwinism in the classroom. As our society starts to embrace science and move past racial lines, why do we need these excess local divisions?

We can consolidate X to achieve Y. In another example, we have 50 different bureaus of motor vehicles in our country. 50 different regulatory agencies that do the same thing, each with their own command structures and infrastructure. Imagine the savings if these were consolidated, even just down from 50 to 25?

So we grow to overcome the "quaintness" of the conventions foisted upon us. It is how we evolve as a people, a society, and a nation. Our 220 year old notion of government could be considered just as quaint as the Geneva Convention in the right context.

The current Libertarian (and historically Republican/conservative) movement argues for a weak (or alternately minimalist) federal structure and strong state structures. I argue the opposite is far more logical. We don't require the notion of states anymore, as today's technology is sufficient to govern larger chunks of society than what existed 200 years ago.

I have some substantial posts coming. Honest!

Right now I'm doing a quick index of friend's stores at etsy.com. I did one before at an older blog, but wanted to do it here. If you're looking for quirky, cool, custom stuff, these are good places to go.

My cousin runs the following stores:

http://www.etsy.com/shop.php?user_id=5130103

http://www.etsy.com/shop.php?user_id=28719

Alice, our friend in the UK runs:

http://www.etsy.com/shop.php?user_id=5198007

Leigh runs:

http://www.etsy.com/shop.php?user_id=5283125

All about the TSA, and then some…

As a relatively frequent traveler I have learned how to get through airport security efficiently, despite the best efforts of both clueless fellow passengers and the bureaucracy of the TSA.

I learned a few things. Avoid secondary screenings...

I'm also irate at the whole Clear situation, as I was a Clear member and relied upon it so I could arrive at the airport about an hour before my flight and be able to walk straight from the car onto the airplane.

So those are my lame tips, but hopefully they'll help you.

Tonight’s Long Walk

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After dinner across the street from my hotel I walked across town to the Cuban Cigar Outlet to pick up some Cubanos for myself and my friends. I zig-zagged through town, seeing some great sights and sites.

I wanted to hot-link all the pictures in, but they're now up at picasa and my iPhone auto-located for most of the pics, so you can track them along the routes.

Like a lover in a abusive relationship, the B5 S4 that is parked outside the hotel on occasion (with the RS4 mirrors, no less) makes me pine for my Nogaro princess, which is long gone. The food is from Fourquette Fourchette which is across the street from my hotel. Lots of good gourmet stuff including rabbit, caribou, elk, buffalo, deer, veal, and seafood.

The building is the North American ICAO headquarters here in Montreal. Good for us aviation-types.

Further along is a view of the entrance to the Square Victoria metro station made to look like a Paris metro station.

Eventually, there is a nice view along Boulevard Rene-Levesque looking towards Mount Royal.

Finally, on the walk back I spotted the FX35 that someone had recently smash-n-grabbed. There was also a Z8 outside Centre Bell, which was packed tonight. I guess there was another Celine Dion show. The Habs were out of the NHL playoffs for a while, so I know it isn't them.

On my walk tonight I also saw an A5, two Maserati Gran Turismos, and a Quattroporte. When the weather gets nice, people bring out their toys.

This was the route back to the hotel. Not quite as exciting...
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…. And we’re back!

I had a hosting bill I didn't realize I needed to pay, since the hosting company had an expired credit card.

New flyclear clear discount code

Just for reference/fun, and to see how I do on search engines, my clear flyclear discount code for 2009 is DSCAM1136187

Good for one free month. Should be good through 4/2010.

One paperclip….

Remember the story of One Red Paperclip and how it led to a house? I'm wondering if I can do the same which will lead me to a 1950s Navion B model with tip tanks.

Things I have to trade...

Computer Junk:
Sun E3000 with 6x400Mhz CPUs
Sun A5000 FC-AL array with 6 146GB FC-AL drives
NIB Sun Exx00 system boards
HP DL580 with 1GB of RAM, 4x72G disks, and 4 x 2.3Mhz Xeon CPUs with HT.

Avionics:
Sigma Tek HSI
KNS-81 RNAV
King KMA-24 audio panel

Other stuff:
A set of wicker patio furniture that is painted white.
A four-year old female beagle named Annie who is UTD with shots and fixed.
An out-of-tune 1910s-era John Spencer and Co. upright piano made of a lighter wood.
A set of approximately 40 "piano-key" windows with leaded glass.
Assorted toys for small children.
A four-stroke-engine based 21" lawnmower.
A full-size car engine hoist capable of 5,000 lbs lift.