I suspect, but don't know for sure, that private insurance can have no long term role in health care. The only role they seem to serve is to be a middleman who takes a substantial cut in return for work that is really pretty trivial, and insulates providers from consumers in a way that prevents the free market from working.
Whether medical care should be completely nationalized or can be implemented by a mix of public and private hospitals and other providers isn't clear to me, but what is clear is that the present system is rife with gouging and prevents a sizable part of the population from getting health care.
Here's my strategy:
1: Fix the PPACA. The mandate is critical. The regulatory constraints on what counts as acceptable insurance are critical. There are lots of details that need to be polished. The price of drugs needs to be brought under control. The numerous areas where there is huge gouging need to be regulated. (e.g. MRI) The medicaid expansion needs to be mandatory for all states and everybody needs to be eligible. If you have a contagious disease, you need to seek treatment, whether you're legally here or not. If you're afraid to go to the hospital because you might get deported, and you're sick, you are spreading disease.
2: A public option. The insurance companis exist to make a profit, and in far too many cases, they're making the bulk of their money by gouging. In addition, they are a major insulator between the provider and consumer, totally preventing any semblance of an effective free market. A public option would be an insurance company with the resources of the government behind it. When this has been tried before, it has been vastly more efficient than private companies. I am pretty sure that the insurance companies will not be able to compete with a public option, but I'd be more than happy to be wrong about this. In that case, the public option would simply be another option, which could help out in places where insurance doesn't reach for some reason. But I'm pretty sure that won't happen, and the insurance companies will fight hard and dirty, by lobbying, bribery and outright cheating, to keep their perquisite.
3: After a few years of a public option, most of the insurance companies will be gone. At this point, there will be three systems: 1: the various existing government systems, such as the VA and medicare. 2: the various existing employer based systems. Most of the insurance based ones will have already been turned into versions of the public option by this point, but the self-insurance ones may still exist. 3: public option. The employers and many employees will be seeking a way to rationalize this. I suspect the best way to do it is Medicare for All: Simply pay medical costs like any other government service. This is by far the cheapest way to do it.
None of this would ban private insurance. If you want private insurance over and above medicare for some reason, you can do that. More realistically, there are plenty of things the government shouldn't be paying for, such as optional cosmetic surgery, that will be paid for out of pocket, and that's fine. Other concierge services would also be perfectly ok.
I'm ok with a nominal cost per visit. One of the things that happens in government systems sometimes is that hypochondriacs and bored people often spend a lot of time with the doctor just to have someone to talk to. To some degree, this is ok--hypochondria is sometimes a cover for some more serious underlying condition. So charge a few dollars per visit, just to keep abuse to a minimum. The provider may waive this fee at the behest of the doctor.
01 August 2019
14 May 2019
Unresolved Questions in Game of Thrones
With one last episode to go, Game of Thrones has left a bunch of big questions hanging. A lot of this is spoiler, so if you haven't caught up to season 8 episode 5 yet and plan to, read no further.
Mass Extinctions.
Are the Children of the Forest gone? Did the last one die saving Bran and Meera? Or are there some more out there?
Giants? Mance Rayder had apparently worked out an alliance between the Giants and the Free Folk. Are there Giants who were not part of that and are still alive or were the last of them killed in the first battle of Winterfell, AKA the Battle of the Bastards? We are led to think that WunWun was the last.
Wights, White Walkers and Night Kings? Was there only one night king, and when he died, did all his descendants die too?
Now that The Wall has been breached, does that mean it will collapse away entirely? Or is it still there? If there are no magical enemies left, it seems like there's not much purpose to it. Historically, Nights Watchers have done raids against the Free Folk and some Free Folk have done raids against northern villages and occasionally the back side of the wall itself. As anyone knows, walls don't really keep anybody out, they just impede progress enough to make an active defense more practical.
The seasons have been screwed up for long enough that Westerosi don't know anything else--winters that last years, etc. Is the magic that created the Night King and The Wall part of that? In the end of episode 3, as Melisandre was walking off, day is dawning and the clouds that dominated the last few episodes are parting.
Dragons. How do dragons reproduce? Now that there's only one left, is it possible for Drogon to reproduce? Did Dany's dragons produce any eggs? (random theory: Dragons lay eggs. To fertilize those eggs, you need fire and the sacrifice of a human life per egg, and you may need a special "dragon" human such as Danerys or Aegon to participate.) I think we've all assumed that Drogon was male but we don't actually know. Perhaps he is, or perhaps one of the others laid eggs before their untimely demise.
Danerys' descent into madness.
It seemed very quick and propelled by loss. Veserion was killed by the Night King--what's more he was revived and used to bring down the wall, and fight effectively at Winterfell. Not very long later--a ship ride from Eastwatch to Kings Landing and then back to Winterfell--a few weeks?--she loses Jorah, and Jon, having learned she's been his Aunt all along, withdraws from their relationship. She tries very hard to make friends with Sansa, and is rebuffed. The knife is twisted when Tormund and others praise Jon loudly, while Danerys did a lot of the same things and got no special love. The last blows come when Missandei is killed right in front of her (and Grey Worm) and she learns that not only had Jon told his "sisters" (cousins, actually) and Sansa had told Tyrion, who immediately told Varys.
After Drogon, Varys was probably Danerys' most valuable ally, although the Unsullied and Dothraki surely deserve honorable mention. Upon learning that Varys had spoken to Jon about his worries over her state of mind, she had him executed. The right thing to have done would have been to offer more visible support. The hardest to take was probably Jon, who while remaining completely loyal, had withdrawn from their personal relationship, which she made clear over and over was extremely important to her.
There was a moment when she'd destroyed Euron's fleet, the Golden Company, and all the new "scorpions" on the walls (and a section of the wall itself), when she could have attacked the tower of the Red Keep and had a great victory with almost no civilian casualties. The Goldcloaks had surrendered to Jon when they realized that the dragon was on his side, but he'd played a minimal role in the battle.
Perhaps this was all part of a great urban renewal plan she had for Kings Landing, but it looked more like she'd caught the same disease her father had and was taking Misandei's final wish (Dracarys--Burn it!) to heart.
My prediction is that instead of killing Cersei as she'd planned, Arya, from whose POV we saw most of the destruction, will wind up killing Mad Queen Danerys instead.
What is it with battle plans?
In JRR Martin's 5 books of this series so far, he wrote a number of stories about large battles, and although a lot of the action was described by a POV character, most of it occurred off camera. The battle of Highgarden was entirely off camera and Casterly Rock was shown in a highly condensed manner. The first real dragon battle, where the slavers brought their ships to Mereen thinking they had all the marbles and not understanding what dragons could doo, was also mostly abstract.
The first big battle from "After" the books is Hardholm, where Jon takes Stannis' navy to pick up a bunch of freefolk, where they are trapped on a narrow beach. The Night King makes a surprise attack and most of the freefolk are lost. Although Jon (and all of us) saw the real power of the Night King for the first time (it still makes my skin crawl when I think of it). This was a surprise attack, so I can't really fault the writers.
Stannis' arrogance led to him losing his beloved daughter and his entire army, by attacking when he wasn't ready and improperly defending from the Guerilla attacks from his opponents, and most importantly, thinking mumbo jumbo would help him. Melisandre had powers, but any time she tried to use them to see beyond what was obvious to most of us, she got it wrong.
Next came the battle of the bastards. By not telling Jon that the Knights of the Vale were on the way, Sansa killed thousands of Stark bannermen and freefolk, possibly including her little brother. She may not have known how far out the Knights were, but she did know they could swing the battle, and a little stalling could have saved thousands of lives. By the same token, Ramsey had Winterfell. Why was he so desperate to have a battle in a field? His archers could have picked off opponents for days with almost no losses--at least until the Knighs of the Vale showed up.
The most outrageous was the night battle of winterfell. the right strategy would have been to fill the entire field with fire trenches and not light it until the undead were among them. The Dothraki should have been kept to the sides to act as pincers should any undead try to make a flanking move. The unsullied and other northmen should have stayed inside the castle, pelting the enemy with flaming or dragonglass arrows. the dragons should have harried the undead from above, careful to stay out of range of the Night King and his magic ice spears. Instead, the Dothraki did a bold frontal attack, which had little effect and killed lots of them. (We were led to think most of them but apparently not). The flaming trebuchet balls should have started long before the dothraki charged.
The vaunted "Golden Company" did the same thing at Kings Landing, but Danerys had a much better strategic attack than the Night King's army.
Accuracy of Scorpions
The first shot we saw from a ship-mounted Scorpion/balista hit it's mark, and two more quickly did too. Yet Danerys was able to fly straight in at a fleet of these things and destroy them at the start of the battle. My theory?
Rhaegal was still recovering from injuries received at Winterfell (he did a rather spectacular faceplant) and may have been stiff. They were almost home after their foray into the icy north and their attention wasn't where it should have been. Once Rhaegal was hit, he was even less maneuverable and took too more arrows. Drogon was healthy and probably stronger to start with, and was better able to dodge. I think the ships got a lucky shot, and at the next contact, Drogon was all in...and succeeded. That was really the only time the dragon had to do a frontal assault on a balista--when attacking the wall, they came from the back.
Valerian Steel Blades
I think there were five Valerian steel blades that were used in the Battle of Winterfell
The famous dagger, now owned by Arya. It was visible in the last scene, along with her castle steel sword, Needle.
Heartsbane, which is the Tarly family sword. Sam, the only living male Tarly, had little use for it so he let Jorah Mormont use it during the battle. Jorah used it well and had it in hand when he was killed, so I imagine it went back to Sam.
Oathkeeper, which was reforged from the Stark family sword "Ice", was with Brienne of Tarth in Winterfell.
Widows Wail, the other part of Ice, was captured with Jamie when he tried to sneak across Targarian lines and was captured. I imagine it's still with whoever took it from him. (Jamie grabbed a random sword that he passed by as he rushed through burning King's Landing, looking for a way into the red keep, and this was the sword that he used to fight Euron). Now that Jamie is presumed crushed to death under the collapsed keep, I imagine Danerys or Jon will give it to someone who has served them well. (we don't actually know whether Jamie, Cersei or Euron are dead, or for that matter Sandor or Gregor or Qyburn, but probably.)
The Mormont family sword, Longclaw, was given to Jon Snow by Lord Commander Jeor Mormont. Jon offered to give it back to Jorah Mormont but he refused. Jon used it well in both the battle of Winterfell and in Kings Landing, and it was in his hand when we last saw him.
Mass Extinctions.
Are the Children of the Forest gone? Did the last one die saving Bran and Meera? Or are there some more out there?
Giants? Mance Rayder had apparently worked out an alliance between the Giants and the Free Folk. Are there Giants who were not part of that and are still alive or were the last of them killed in the first battle of Winterfell, AKA the Battle of the Bastards? We are led to think that WunWun was the last.
Wights, White Walkers and Night Kings? Was there only one night king, and when he died, did all his descendants die too?
Now that The Wall has been breached, does that mean it will collapse away entirely? Or is it still there? If there are no magical enemies left, it seems like there's not much purpose to it. Historically, Nights Watchers have done raids against the Free Folk and some Free Folk have done raids against northern villages and occasionally the back side of the wall itself. As anyone knows, walls don't really keep anybody out, they just impede progress enough to make an active defense more practical.
The seasons have been screwed up for long enough that Westerosi don't know anything else--winters that last years, etc. Is the magic that created the Night King and The Wall part of that? In the end of episode 3, as Melisandre was walking off, day is dawning and the clouds that dominated the last few episodes are parting.
Dragons. How do dragons reproduce? Now that there's only one left, is it possible for Drogon to reproduce? Did Dany's dragons produce any eggs? (random theory: Dragons lay eggs. To fertilize those eggs, you need fire and the sacrifice of a human life per egg, and you may need a special "dragon" human such as Danerys or Aegon to participate.) I think we've all assumed that Drogon was male but we don't actually know. Perhaps he is, or perhaps one of the others laid eggs before their untimely demise.
Danerys' descent into madness.
It seemed very quick and propelled by loss. Veserion was killed by the Night King--what's more he was revived and used to bring down the wall, and fight effectively at Winterfell. Not very long later--a ship ride from Eastwatch to Kings Landing and then back to Winterfell--a few weeks?--she loses Jorah, and Jon, having learned she's been his Aunt all along, withdraws from their relationship. She tries very hard to make friends with Sansa, and is rebuffed. The knife is twisted when Tormund and others praise Jon loudly, while Danerys did a lot of the same things and got no special love. The last blows come when Missandei is killed right in front of her (and Grey Worm) and she learns that not only had Jon told his "sisters" (cousins, actually) and Sansa had told Tyrion, who immediately told Varys.
After Drogon, Varys was probably Danerys' most valuable ally, although the Unsullied and Dothraki surely deserve honorable mention. Upon learning that Varys had spoken to Jon about his worries over her state of mind, she had him executed. The right thing to have done would have been to offer more visible support. The hardest to take was probably Jon, who while remaining completely loyal, had withdrawn from their personal relationship, which she made clear over and over was extremely important to her.
There was a moment when she'd destroyed Euron's fleet, the Golden Company, and all the new "scorpions" on the walls (and a section of the wall itself), when she could have attacked the tower of the Red Keep and had a great victory with almost no civilian casualties. The Goldcloaks had surrendered to Jon when they realized that the dragon was on his side, but he'd played a minimal role in the battle.
Perhaps this was all part of a great urban renewal plan she had for Kings Landing, but it looked more like she'd caught the same disease her father had and was taking Misandei's final wish (Dracarys--Burn it!) to heart.
My prediction is that instead of killing Cersei as she'd planned, Arya, from whose POV we saw most of the destruction, will wind up killing Mad Queen Danerys instead.
What is it with battle plans?
In JRR Martin's 5 books of this series so far, he wrote a number of stories about large battles, and although a lot of the action was described by a POV character, most of it occurred off camera. The battle of Highgarden was entirely off camera and Casterly Rock was shown in a highly condensed manner. The first real dragon battle, where the slavers brought their ships to Mereen thinking they had all the marbles and not understanding what dragons could doo, was also mostly abstract.
The first big battle from "After" the books is Hardholm, where Jon takes Stannis' navy to pick up a bunch of freefolk, where they are trapped on a narrow beach. The Night King makes a surprise attack and most of the freefolk are lost. Although Jon (and all of us) saw the real power of the Night King for the first time (it still makes my skin crawl when I think of it). This was a surprise attack, so I can't really fault the writers.
Stannis' arrogance led to him losing his beloved daughter and his entire army, by attacking when he wasn't ready and improperly defending from the Guerilla attacks from his opponents, and most importantly, thinking mumbo jumbo would help him. Melisandre had powers, but any time she tried to use them to see beyond what was obvious to most of us, she got it wrong.
Next came the battle of the bastards. By not telling Jon that the Knights of the Vale were on the way, Sansa killed thousands of Stark bannermen and freefolk, possibly including her little brother. She may not have known how far out the Knights were, but she did know they could swing the battle, and a little stalling could have saved thousands of lives. By the same token, Ramsey had Winterfell. Why was he so desperate to have a battle in a field? His archers could have picked off opponents for days with almost no losses--at least until the Knighs of the Vale showed up.
The most outrageous was the night battle of winterfell. the right strategy would have been to fill the entire field with fire trenches and not light it until the undead were among them. The Dothraki should have been kept to the sides to act as pincers should any undead try to make a flanking move. The unsullied and other northmen should have stayed inside the castle, pelting the enemy with flaming or dragonglass arrows. the dragons should have harried the undead from above, careful to stay out of range of the Night King and his magic ice spears. Instead, the Dothraki did a bold frontal attack, which had little effect and killed lots of them. (We were led to think most of them but apparently not). The flaming trebuchet balls should have started long before the dothraki charged.
The vaunted "Golden Company" did the same thing at Kings Landing, but Danerys had a much better strategic attack than the Night King's army.
Accuracy of Scorpions
The first shot we saw from a ship-mounted Scorpion/balista hit it's mark, and two more quickly did too. Yet Danerys was able to fly straight in at a fleet of these things and destroy them at the start of the battle. My theory?
Rhaegal was still recovering from injuries received at Winterfell (he did a rather spectacular faceplant) and may have been stiff. They were almost home after their foray into the icy north and their attention wasn't where it should have been. Once Rhaegal was hit, he was even less maneuverable and took too more arrows. Drogon was healthy and probably stronger to start with, and was better able to dodge. I think the ships got a lucky shot, and at the next contact, Drogon was all in...and succeeded. That was really the only time the dragon had to do a frontal assault on a balista--when attacking the wall, they came from the back.
Valerian Steel Blades
I think there were five Valerian steel blades that were used in the Battle of Winterfell
The famous dagger, now owned by Arya. It was visible in the last scene, along with her castle steel sword, Needle.
Heartsbane, which is the Tarly family sword. Sam, the only living male Tarly, had little use for it so he let Jorah Mormont use it during the battle. Jorah used it well and had it in hand when he was killed, so I imagine it went back to Sam.
Oathkeeper, which was reforged from the Stark family sword "Ice", was with Brienne of Tarth in Winterfell.
Widows Wail, the other part of Ice, was captured with Jamie when he tried to sneak across Targarian lines and was captured. I imagine it's still with whoever took it from him. (Jamie grabbed a random sword that he passed by as he rushed through burning King's Landing, looking for a way into the red keep, and this was the sword that he used to fight Euron). Now that Jamie is presumed crushed to death under the collapsed keep, I imagine Danerys or Jon will give it to someone who has served them well. (we don't actually know whether Jamie, Cersei or Euron are dead, or for that matter Sandor or Gregor or Qyburn, but probably.)
The Mormont family sword, Longclaw, was given to Jon Snow by Lord Commander Jeor Mormont. Jon offered to give it back to Jorah Mormont but he refused. Jon used it well in both the battle of Winterfell and in Kings Landing, and it was in his hand when we last saw him.
18 February 2019
Breakthroughs vs Debugging
When considering an engineering project, there are three potential barriers to succeeding:
Political/Economic. These are things like funding and NIMBYism. A store that wouldn't mind having your train station across the street may be upset if it's so close it requires them to find another location. Such considerations need either to be bought off or taken by eminent domain. Enough such problems may make it impossible to implement your project with the funding you have, but are solvable problems, at least in theory.
Debugging. It's rare that the first design of anything very complicated succeeds. Some debugging or redesign is nearly always necessary. Oversights, mistakes, shortcomings, misunderstandings, etc., always occur. The engineering or construction time to fix it costs money and if there's not enough available, the project may fail, but if the problem is one of debugging, it is a solvable problem.
Breakthrough required. Some ideas are simply contradictions of the laws of physics. For example, a nineteenth century scientist likely thought that traveling to the stars was just a matter of going faster and applying more energy. But in the early 20th century it was discovered that the speed of light is an absolute limit and that the energy required to get even close to it was impractical. To get to the nearest star will take more than a human lifetime. Unless some breakthrough, like Star Trek's "Space Warp" technology is discovered. It's conceivable but nobody has even the first idea of how to do it.
So, for example, Hyperloop (transit in an evacuated tube near the speed of sound) does not require any breakthroughs to succeed, although there may be some. All the technology required is fully understood, in at least a general way. There may be some friction from politics and engineering, but with enough determination, they are all solvable.
A space elevator (a cable anchored to a geosynchronous satellite) is mostly straightforward engineering, except for one thing: the cable needs to be strong and light enough that it doesn't break under 22,000 miles of its own weight. No fiber presently known can do this. There are some breakthroughs on the horizon that might succeed (e.g. carbon nanotubes), but this is impossible until there is an actual breakthrough.
Political/Economic. These are things like funding and NIMBYism. A store that wouldn't mind having your train station across the street may be upset if it's so close it requires them to find another location. Such considerations need either to be bought off or taken by eminent domain. Enough such problems may make it impossible to implement your project with the funding you have, but are solvable problems, at least in theory.
Debugging. It's rare that the first design of anything very complicated succeeds. Some debugging or redesign is nearly always necessary. Oversights, mistakes, shortcomings, misunderstandings, etc., always occur. The engineering or construction time to fix it costs money and if there's not enough available, the project may fail, but if the problem is one of debugging, it is a solvable problem.
Breakthrough required. Some ideas are simply contradictions of the laws of physics. For example, a nineteenth century scientist likely thought that traveling to the stars was just a matter of going faster and applying more energy. But in the early 20th century it was discovered that the speed of light is an absolute limit and that the energy required to get even close to it was impractical. To get to the nearest star will take more than a human lifetime. Unless some breakthrough, like Star Trek's "Space Warp" technology is discovered. It's conceivable but nobody has even the first idea of how to do it.
So, for example, Hyperloop (transit in an evacuated tube near the speed of sound) does not require any breakthroughs to succeed, although there may be some. All the technology required is fully understood, in at least a general way. There may be some friction from politics and engineering, but with enough determination, they are all solvable.
A space elevator (a cable anchored to a geosynchronous satellite) is mostly straightforward engineering, except for one thing: the cable needs to be strong and light enough that it doesn't break under 22,000 miles of its own weight. No fiber presently known can do this. There are some breakthroughs on the horizon that might succeed (e.g. carbon nanotubes), but this is impossible until there is an actual breakthrough.
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