Abandon Text! - Politics

True Story: Consumer-driven healthcare costs less

nospam@example.com (Georg Buehler) — Sun, 21 Mar 2010 11:31:42 -0700

Once again, my life has conspired to give me a real-world example of how consumer-driven healthcare saves money.

At five o'clock on a sunny spring Friday afternoon, my six-year-old begged me to go outside and ride Razor scooters. We went to the top of our enormous hill (wearing helmets and biking gloves, or course) and came speeding down again. Right at the end of the ride, as I was stepping on the brakes to come to a stop, I found the scooter wasn't slowing down. I pressed down harder, and suddenly the whole scooter kicked out from under me to the side. I flopped sidewise and landed smack on the pavement. I sat up, feeling a little stunned but not too bad. "Am I hurt?" I ask Malcolm. "You're bleeding!" he shouts. I looked down and saw quarter-size drops of blood on my jeans and gloves. I walked about twenty yards into the house and look in the bathroom mirror. My left cheek is covered with blood. After gently wiping it away, though, I find I have only one injury: a cut under my left eye, about an inch long. Later on I figured out that the cut had come from the edge of my rimless glasses.

I wrapped ice in a wet washcloth and held it on my face while I contemplated what to do. My wife Janet, juggling an infant and two other sons, called a neighbor to drive me into the emergency room. I briefly considered going to an urgent care clinic, but at that point I wasn't quite sure what I was going to need. I figured I'd be better off going to the emergency room, in case the cut called for a plastic surgeon.

I sat for three hours in various waiting rooms at UNC Hospital, ice clutched to my face. After the first two hours I decided that I wasn't concussed and hadn't broken anything, and I started to wonder if I'd made the right decision to come here. After a few text messages to my wife, I found out I didn't have any other option; all the urgent care clinics closed at 8 pm. I paged my regular physician, who advised me to stay put; "Since it's your face, you're probably in the best possible place." Ok. Fine.

After another hour in the examining room, the doctor finally arrived: a young, calm, conscientious resident. I had had lots of time to prepare my speech. "Hi!" I said. "I'm really, really glad to see you. Before we get started, though, I have one small request. I have a high-deductible insurance plan. That means everything you do for me tonight, I will be paying for entirely out-of-pocket. So, as you do your work, I would appreciate it if you tell me what services I can expect to be billed for, and what they might cost, if you know." The doctor was very sympathetic: "To be honest, I know absolutely nothing about what you will be charged. I just write down what I do, and someone else figures out the charges. But I will keep that in mind as we discuss your options for treatment."

I was very glad we started with that conversation, because here's what the doctor said next after examining me: "Because you have a laceration on your face, ordinarily we would call in the 'face team,' which would include a plastic surgeon as well as an experienced EMD. However, looking at that cut, I can tell it's really clean and would come together with just two or three sutures. I could do that for you right now."

"In your professional opinion," I asked, "How much difference would there be between you doing the stitching, and what the 'face team' would do?"

The doctor shrugged. "Not much . . . none, really."

"Ok, then! Stitch me up!" It only took about 20 minutes for him to do the job. There was no mirror in the examining room, but he led me to a bathroom around the corner so I could look at his work. As promised, the wound was closed completely, with three sutures. A nurse gave me a tentanus shot and I walked out, a satisfied customer.

What are the morals of this story?

Always wear a helmet when you're on wheels. I wasn't going fast, I wasn't doing anything daring. I just fell, and that was enough to seriously mess me up if I wasn't wearing the right safety equipment.
Healthcare costs go down when consumers have an incentive to spend wisely. Were I covered by Obamacare-mandated insurance, I would have said, "Sure! Bring in the face team? Why not? I've already paid my deductible." But because I was spending my own money, I asked more questions about treatment options and probably saved $1,000. (I paid $190 for my treatment that night.)
Conversely, healthcare costs will continue to rise as long as patients and doctors have no incentives to contain costs. My ER doctor had no idea what his actions were costing . . . is it any wonder that costs are high? Nor would he make any effort to economize, unless I (the patient) ask him. This is why healthcare costs are rising – it's not the uninsured, not technology, not evil pharmaceutical or insurance companies. This is why I oppose the Democrats' healthcare bill: the one proven means of controlling healthcare costs (consumer-driven HSAs) will be rendered illegal under the new legislation, while the greatest cause of rising costs (disconnecting patients and doctors from the financial consequences of their decisions) will be mandated for all.

Freakonomics, Incentives and ObamaCare

nospam@example.com (Georg Buehler) — Tue, 02 Mar 2010 06:34:40 -0700

Now that the health care reform debate has gone into overtime, I feel like I need to make one more last-ditch argument. Fortunately, at least one person has made all my arguments for me: David Goldhill's cover story in the September 2009 issue of The Atlantic ("How American Healthcare Killed My Father") says practically everything that needs to be said.

Goldhill is extremely forthright with his motivations, which I especially like – he lets you know right away that his study of healthcare is the result of seeing his father die of a preventable hospital-borne infection. But despite the personal tragedy, his article is remarkably free of emotional charge. He doesn't attack anyone, or blame anyone, but rather lets his critique rush unerringly to the glaring absurdities of the business structure of American medicine:

Paying for all healthcare with insurance is patently absurd. The whole nature of insurance is to spread out the risk for unusual disasters, not to provide for day-to-day, predictable expenses. He writes: "Imagine sending your weekly grocery bill to an insurance clerk for review, and having the grocer reimbursed by the insurer to whom you've paid your share. An expensive and wasteful absurdity, no?" By making someone other than the consumer responsible for healthcare costs, we systematically create a "moral hazard" in which neither doctors nor patients have an incentive to limit costs, as well as using an extremely expensive, inefficient system for payment.
America got its current system of employer-provided health insurance by accident. It was the result of a wage freeze during World War II that encouraged companies to offer non-wage benefits. But having someone else pay for all your healthcare was not a conscious goal of American policy . . . at least, not until people got used to the idea that "someone else" should pay for their health care.
The consumer is the ultimate protector of quality and value. Is it any wonder that we get poor customer service, poor quality, and astronomical cost when we have removed ourselves as the primary purchasers of health care? Doctors, hospitals and drug companies all serve their customers as well as they can – it's just that we, the patients, stopped being their customers long ago. Now the insurance companies and the government are their customers.
Competition is the most natural, responsive way to lower costs. In a competitive environment, technology tends to make things cheaper; in a non-competitive environment like our current healthcare system, it only makes things more expensive.
The cure for American healthcare: mandate cheap high-deductible health insurance to cover medical emergencies, and then use Health Savings Accounts to cover day-to-day medical care. Make the patient the primary payer of medical costs again, and they will naturally seek the best balance of quality, value, and cost. Fund the care of the poor directly. Use government power to mandate visibility into the cost and outcome of care.

Goldhill's entire analysis would fit nicely into one of the Freakonomics books, since he is merely pointing out what Levitt and Dubner took as the central thesis of their pop-econ books: "People respond to incentives." Everything that has happened to American healthcare is clearly the consequence of distorted economic incentives. From this perspective, it should be clear that ObamaCare will only give us more of the same distorted incentives, cementing in place the illusion that "someone else" is paying for our healthcare, while letting the healthcare beast continue to devour our national economy.

Goldhill's article is refreshingly full of common sense, especially when you compare it to other popular studies of American healthcare, like Atul Gawande's high-profile article in the New Yorker ("The Cost Conundrum", June 1, 2009) which Obama publically praised. Gawande confronted overwhelming evidence that high costs of health care were driven by doctors' and hospitals' financial incentives to overtreat and overcharge . . . and still he is utterly dismissive of the power of competition. "Any plan that relies on the sheep to negotiate with the wolves is doomed to failure," he quotes one doctor. I see it as a sign of doctors' arrogance that they find it impossible to think of themselves as a commodity that can be shopped. Consumers might not "haggle over the price as if he were selling a rug in a souk," as Gawande puts it . . . but if a hospital down the road offers the same surgery for $20,000 less, don't you think that's going to influence the patient's choice? Especially if it's $20,000 of the patient's own money?

Gawande had another New Yorker article ("Testing, Testing", December 14, 2009) that compared the healthcare industry to agriculture, and suggested that healthcare might undergo a revolutionary change similar to the "green revolution" through government sponsored experimentation similar to what the USDA did for farms. The article was a lengthy apology for the Democratic health reform proposal, which did not have a clear plan for cutting costs but did have lots of pilot programs that would hopefully find new ways to cut costs. I find it utterly disingenuous to suggest ObamaCare is a set of experiments, when the core elements of the plan – guaranteed issue, mandated levels of coverage, wimpy personal mandates – have already been tried in several states, and were colossal failures in every instance, driving up costs and exhausting state budgets, while hardly making a dent in the number of uninsured. You can't position yourself as an experimenter when you ignore the results of the experiments.

Speaking of experiments, I have run the high-deductible insurance and Health Savings Account experiment for myself and my family . . . and it works. I protect myself from debilitating debt from medical emergencies, but I also function as a smart consumer. I spend half of what I used to on insurance, and lower overall medical costs by at least 20% by questioning bills, tests, and procedures. And all of it – insurance and medical costs – could be entirely covered by my FICA taxes, if the government only let me keep that money.

Speak moderately, and carry a big Government Program

nospam@example.com (Georg Buehler) — Sat, 04 Jul 2009 10:17:37 -0700

In response to my rant about government-run health insurance being positioned as a "competitor" to private health plans, Kenny writes:

Obama was asked in Virginia yesterday by a liberal audience if he would consider a real single-payer system. "We're talking about 1/6 of the economy here," he shot back, emphatically rejecting total nationalization. It is very important to him to introduce a government alternative without gutting the existing private system.

I suppose I should be comforted by the fact that Obama's rhetoric is rigorously moderate. But actually the opposite is happening; it is only making me more cynical. Obama made some very moderate statements about the auto industry, as well. Here was his position on March 30:

We cannot make the survival of our auto industry dependent on an unending flow of taxpayer dollars. These companies — and this industry — must ultimately stand on their own, not as wards of the state . . . Let me be clear: The United States government has no interest in running GM. We have no intention of running GM.

Ah, good. Sounds very moderate and responsible. But, a few months later, the government winds up acquiring a 60% stake in General Motors. I guess the United States government was interested in running GM.

When Obama was running for president, he was widely lauded as the sign of a "post-racial America." His "more perfect union" speech on race was an eloquent statement of how we can move past identity politics and embrace a common good. But then his first Supreme Court nominee is Sonya Sotomayor, who, no matter what you think of her relative merits, is not winning any prizes for being a "post-racial" icon. Were she not a Latina woman, would she have gotten that nomination? The best that people can say of her is that she is merely competent.

Then there's the banking bailout. On February 20 White House press secretary Robert Gibbs, when asked if the Obama administration would seek to nationalize CitiGroup and Bank of America, he responded that the administration continues to "strongly believe that a privately held banking system is the correct way to go." But in the following months, the administration proceeded to put the banks in a headlock, forcing them to take aid that is worth more than double the banks' own capitalization, whether they want it or not, regulating their compensation, secretly pressuring executives to make certain acquisitions and not complain about it, either. Now most pundits seem to agree that CitiGroup and BofA are essentially nationalized in effect if not in name.

Do you see the pattern here? Moderate rhetoric, followed by extremely liberal action. Some people on the left see this as merely masterful politics -- after all, the winning strategy has always been to make your own position appear to be the middle of the road. But how much longer can you say one thing, and do another, before it stops being politics and starts being hypocrisy?

You can't play against the Umpire

nospam@example.com (Georg Buehler) — Wed, 01 Jul 2009 04:27:33 -0700

On the big call-out quotes page in Newsweek this week, I saw the following quote :

"Why is it that the government, which they say can't run anything, suddenly is going to drive them out of business?"
-- Barack Obama, responding to private insurers' criticism of a "public option"

Normally, I can stay calm about politics. But this sort of flagrant attack on common sense makes me angry. The president is insulting my intelligence.

Here's an analogy for you:

Let's say all the umpires in Major League Baseball got together and decided that they would form their own baseball team, and compete against the other Major League teams. They are going to play -- AND officiate -- all the games. Who do you think is going to win in a match-up between the Yankees and the Umpires? The Umpires can't hit 90 mph fastballs . . . but they don't have to. They just call them balls, and every single player up gets a walk to first. The Umpires can't pitch a ball over the plate to save their life . . . but that won't stop them from calling them strikes anyway. Every game is no-hitter, and the Umpires cruise to a World Series victory.

Does anyone have the audacity to call this a "competition?" If the Yankees give up in disgust, does that mean the Umpires are a better baseball team?

The federal "public option" for health care does not have to worry about making a profit . . . unlike every other insurance provider. It's easy to win market share on price, when you can give the product away. The government does not have to persuade people to pay for its products -- they compel payment, through taxes. Or just print more money. The government does not have to persuade doctors to participate in their insurance plan -- they can mandate that they do, or not practice medicine at all. The government does not have to negotiate with pharmaceutical companies -- they mandate drug prices, regardless of market value. Oh, yeah, and they can't get sued.

Let's get this straight. The Obama administration does not intend to fix healthcare by "competing" with private companies, in any meaningful sense of the world. They are doing just the opposite: using monopolist power to kill all competition. If they want to nationalize the healthcare industry, fine, I can understand why they might want to do that. But don't try to dress it up as a "competitor" in a free marketplace.

Physician, Heal Thy Motive

nospam@example.com (Georg Buehler) — Tue, 26 May 2009 08:49:24 -0700

I just read a great New Yorker article on factors that influence medical system costs ("The Cost Conundrum," by Atul Gawande, June 1, 2009") I have written about health care finance in the past, largely because I'm a participant and enthusiastic fan of one of the alternatives currently available, Health Savings Accounts.

In the article, Gawande examines a particular small town in Texas in which Medicare costs are nearly twice the national average, to see if it gives any indications of what causes health care costs to grow. He systematically rules out various popular explanations – people are sicker, care is better, malpractice suits are driving up costs, etc. – and hones in on the motives of the doctors themselves. Hospitals that have the highest level of care (and, surprisingly, the lowest costs) are those which make improving patient care the number one priority, and deliberately structure the financial and social incentives for doctors to stay focused on patient care. The costliest hospitals (which, ironically, often have the lowest quality of care) are those in which doctors focus on maximizing their profits rather than making people well.

I'm glad that someone has named the elephant in the parlor. You would think that it would be obvious that health care providers have every incentive to inflate costs, at least until someone puts on the brakes and refuses to pay. I was disappointed, though, in how quickly the author dismisses the notion that changing who pays for the system (private insurers, the government, or the individual) would change the dynamic in spiraling costs. He quotes a doctor who contemptuously dismisses the thought that an individual could control the costs of their health care: "They discuss the blockages in her heart, the operation, the risks. And now they're supposed to haggle over price as if he were selling a rug in souk?"

Well, no, they probably won't haggle. But don't you think that if hospitals had to publish their price lists, and a well-rated hospital offered to do the same procedure at half the price, that an individual might decide to go to another provider? The internet has empowered patients more than ever to be informed about their conditions, their options, and (if the health-care system allowed it) the costs.

I have lots of first-hand experience of this sort of thing. When I was a young man, unemployed and uninsured and doing my Walden thing in West Virginia, I found a suspicious lump on my testicle. I saw a GP, who said it was 95% not cancerous, but referred me to a urologist to check it out. The urologist did an ultrasound, and confirmed it was a spermatocoel, a mostly-harmless blockage, which wouldn't be a problem unless it caused me pain. So far, so good. But then the urologist tried to schedule me for another ultrasound a month later. "Why do you need to do that?" I asked. "Well, it's good if we can keep an eye on these things," he said. "What do you expect might be different in a month's time? And why do we need an ultrasound to know if it's a problem?" The urologist, blustering, just kept repeating himself. "It's good to keep an eye on these things." I did not make another appointment. I didn't feel like spending $250 just to "keep an eye on things." I also noticed that I the bill had a charge for a urinalysis lab work-up, which I knew had not been done because I never gave them a urine sample. I paid my bill, minus the bogus lab fee.

This is not an isolated incident. I have had things like this come up with nearly every single health-care provider I've ever used . . . even the ones who I loved dearly and thought were the best doctors in the world. I've been asked to make an extra appointment, just to have the doctor read lab results to me, and give me the same diet advice he gave me the first time. (He could have done the same thing over the phone, or even just put it in the mail with a pre-printed explanation of the results, but then he wouldn't have been able to charge $80 for an appointment.) I have had emergency rooms and doctors try to charge me for the exactly the same service. In most instances, I have challenged the unnecessary or bogus costs and paid less . . . all because I'm the one paying for them.

If we want to control health care costs, somebody has to have a stake in controlling costs. We have a magic way of doing that. It's called a market economy. I'm perfectly happy to let the physicians have a profit motive . . . as long as I get to exercise my profit motive, too.

Rand and Evolution

nospam@example.com (Georg Buehler) — Wed, 25 Mar 2009 03:34:31 -0700

I have continued chipping away at Atlas Shrugged while on the elliptical machine. It has made for timely reading, since during the period I was reading it the financial system melted down. Lots of Ayn Rand fans have commented on the fact that current events somewhat parallel the events of Atlas Shrugged – government efforts to serve the needs of the unproductive leads to economic failure, which leads to more government interventions, which leads to more failure, etc. I must admit, Congress' platitudes about helping out the little guy by pushing Fannie and Freddie into ludicrous loans, and then the Wall Street rush to exploit this unsustainable generosity, looks an awful lot like the "looters" of Ayn Rand's magnus opus.

If current events made Rand's philosophy look more plausible, though, it was counteracted by the fact that I was also reading Steven Pinker's How the Mind Works at the same time. Evolutionary psychology blows a lot of big holes in Rand's philosophy, and it looks like the critics of Objectivism have noticed. It was screamingly obvious to me that Rand's view on sexuality – that people are sexually attracted to those who manifest their highest ideals – was perfectly consistent with what evolutionary psychology would predict for a woman. Females' genetic interests are best served by mating with the most fit male, i.e. the wealthiest, most productive one, and since they have such a high investment in having a baby, they will tend to be very selective of their mates. That same formula doesn't quite work for the males, though – males get much more genetic, ahem, bang for the buck by being promiscuous, since the have to invest much less than the female in generating offspring. Rand concocts a contorted theory that only men who hate themselves could be promiscuous, and that promiscuity is antithetical to their true nature. I didn't buy it. Even men who are profoundly committed to monogamy (such as yours truly) will admit that it is not the natural state of affairs – if commitment was natural, why would we have to make vows to stick to it? Evolutionary psychology presented a cleaner explanation than Rand, in this case.

The gaps were even more noticeable in Rand's notion of the virtue of selfishness, and the sin of altruism. Evolutionary biology points out that people are self-interested, but not exclusively self-interested. We are also predisposed to helping our relatives, since they share our genes, and helping our mates, since their genetic interests are mostly identical to ours. Rand would have us believe that altruism is nothing but an illusion and a sham, but in fact our inmost nature tells us otherwise. There are no children in Rand's books, because love for one's children blows apart most of her ideas. Nearly all parents do believe in sacrificing their own interests for the sake of their children's interests – and no amount of arguing will make us think otherwise. Again, evolutionary biology perfectly explains what Objectivism strains to cover.

If she was so wrong about human nature, then, why does her philosophy appeal so strongly to so many? The world-view in Atlas Shrugged is not implausible – I often find myself seeing life as a war between the competent producers and the incompetent freeloaders. There still may be some truth to be mined from it.

Stimulating Reading

nospam@example.com (Georg Buehler) — Thu, 29 Jan 2009 07:35:55 -0700

Since the House passed the nearly $900 billion stimulus package yesterday, I've been trying to figure out what constitutes an "economic stimulus." Here's what I've learned so far:

Spending money (like buying an iPod) stimulates the economy and is good. Saving your money, like, say, putting aside some money to weather an economic downturn, is bad.
Spending money on green projects (like an electric car) stimulates the economy more than spending on non-green projects (like repairing roads and bridges).
Spending money on things that drive conservative Republicans nuts (like the National Endowment of the Arts) stimulates the economy.
Giving money to unemployed people is supposed to create jobs for them.
Passing money through a government program stimulates the economy more than just letting tax-payers keep more of their money.
With sufficient lobbying, absolutely anything and everything stimulates the economy.
No matter how much you spend to stimulate the economy, if it fails, you can always say we didn't do enough.

Equal pay for equal . . . what?

nospam@example.com (Georg Buehler) — Sat, 24 Jan 2009 04:04:00 -0700

Gender pay equity has been back in the news lately, as the Senate passed the Lilly Ledbetter Fair Pay Act, which starts the clock on the statute of limitations on inequitable treatment at the time of the last paycheck. I include the link to original text, because it does turn out that the Wall Street Journal's warnings of a trial-lawyer bonanza are somewhat exaggerated – under the law, someone could recover for back pay for up to two years, instead of twenty or more. But the Paycheck Fairness Act, which supposedly seeks to revive the notion of "comparable worth" and set wage guidelines on abstract notions instead of market demand, does seem to me to be a little more disturbing.

Pay equity is one of the most vexing social issues ever to plague a policy wonk. It's thornier than even healthcare. Everyone agrees they want a level playing field and equal opportunity for all. But knowing whether particular outcomes are fair challenges every other principle that supports a free economy. In the real world, wages are not set by bureaucrats but by a labor market – that is, negotiations between buyer and seller. Research suggests that the wage gap may not be due to sinister employers trying to keep women down, but rather the fact that men are more aggressive than women when it comes to negotiating pay. The U.S. General Accounting Office research demonstrates that the majority of pay discrepancies between men and women are due to what they cautiously refer to as "work patterns" – namely, women are more likely than men to place their family obligations ahead of their career ambitions, which inevitably leads them to make decisions that diminish their earnings. As a general rule, the people who care more about money get more of it . . . and those who care about other things, get less. That might be frustrating, but is it unfair?

Ok, time out for mandatory PC disclaimers. Yes, bona fide cases of unfair gender discrimination in pay exist. Yes, women should have legal protections against such abuses. I do think, however, it is flat-out wrong to assume that differences in pay are automatically a moral offense. A difference in outcome does not necessarily mean a difference in opportunity.

Rick Warren’s Prayer

nospam@example.com (Georg Buehler) — Tue, 20 Jan 2009 06:14:00 -0700

I had commented on the selection of Pastor Rick Warren to do the invocation at President Obama's inauguration, so it seemed only right to also comment on how it turned out. It turned out just fine. (You can see it here, or read the full text here.)

Many media outlets (U.S News & World Report and Newsweek, among others) had commented on the obvious gestures of inclusion: opening with the Jewish Shema ("Hear, O Israel, the Lord is our God, the Lord is One.") and echoing the Koran ("compassionate and merciful"). I say "obvious," but actually it was subtle enough that the average rank-and-file Christian probably wouldn't even have noticed. (Heck, the average American Christian can't even list the Ten Commandments, much less recognize key phrases of other faiths.)

And most commentators congratulated Warren for navigating the trickiest bit of his prayer: invoking the name of Jesus, but in the most inclusive way possible. "I humbly ask this in the name of the one who changed my life: Yeshua, Essa (ph), Jesus, Jesus, who taught us to pray, "Our Father …" His invocation is clearly given as a personal testimony, rather than speaking for all present, and he names Jesus in the languages of the major religions, which all recognize him to some degree. Warren knew clearly that not to mention Jesus would be wussing out, and would lose the respect of his evangelical followers. But since Obama had set the tone of inclusion by inviting him in the first place, Warren was wise enough to keep the love-fest going.

Also notice that he invoked Jesus, not as the object of the prayer, but as the one "who taught us to pray, 'Our Father . . .'" This emphasizes Jesus' role as a teacher, rather than a divine being; a prophet rather than a Messiah. Most religious people are willing to acknowledge Jesus' status as a teacher of peace and humility. Thus, Warren stays true to his evangelical roots while staying within the bounds of the most universal aspects of his faith.

I was a little surprised to hear Warren roll into the Lord's Prayer at the end. The Lord's Prayer is pretty universal among all kinds of Christians, but it is also absolutely, undeniably Christian. No universalism here. Or is there? Stop and think about the text of that prayer. Maybe you said it in Sunday school a bazillion times, and you've come to think of it as uniquely Christian, but the actual text is about as inclusive as they come. It acknowledges the authority of a supreme being, asks for his blessing and guidance, and humbly acknowledges our sins and limitations. That's the essence of nearly every prayer. All the rest of Warren's prayer is just a gloss. So, again, Warren manages to be solidly Christian, not by subduing his Christianity, but by highlighting the inclusiveness of his faith.

Coming soon . . . Airport 2: the Rematch

nospam@example.com (Georg Buehler) — Wed, 14 Jan 2009 11:43:28 -0700

Well, it looks like my cheers of victory are a little premature. While UNC Chancellor Thorp issued a statement saying the university would not pursue an airport in rural Orange County, he didn't close the door to eventually starting the process again. He said he would not support the repeal of the legislation that gave the university the power to form an airport authority. Everyone is saying that the "process" was flawed, but nobody has backed down from the assertion that the university still needs an airport.

Ok, let me get this straight. The legislation that started this mess explicitly states that in order to create an airport authority, the Board of Governors must "'find that the authority is essential to support the missions of The University of North Carolina" and that "the sole purpose of the authority is to resite Horace Williams Airport." And Chancellor Thorp has already stated what's going to happen to Horace Williams: "While we will keep Horace Williams Airport as long as we can, to realize the full potential of Carolina North, we must close the airport. When that happens, we will still need an airport. It's essential to our AHEC program. But we have an acceptable option – RDU."

That sounds like a pretty tight case. Thorp has said RDU is an "acceptable" replacement for Horace Williams. If there is an "acceptable" replacement for Horace Williams, how could the BOG consider building a new airport "essential"? At ten times the cost, I might add?

I have a few questions I wish local journalists would extract from the University:

Exactly how many doctors are going on how many flights with the AHEC program? I'd like to know just how many poor, struggling doctors we are so rudely inconveniencing by refusing to build an airport for them.
Exactly why is a new airport supposed to be so critical for the AHEC doctors? The only thing I've heard, so far, is that we don't want to increase their travel time. If you plot out the driving time from UNC Hospital on Manning Drive to RDU, it's 27 minutes. The nearest of the top picks for an airport site (say, the intersection of Dodson's Crossroads and NC-54) is 16 minutes from the hospital. So we would be spending $50 million to save 11 minutes on the drive . . . for how many people, again? If you assume a doctor is paid $250,000 a year, that comes down to about $23 per 11-minutes extra travel time, or $46 round trip. You would have to have about 1,087,000 doctor trips to the airport before you would break even on that airport. Even if you flew 200 doctors around every day, that still means it will take nearly 15 years before you've broken even on the savings in doctors' time. If someone from the University can correct me on these numbers, please do. I'd like to know what the real numbers are.
Chancellor Thorp said it was so hard for him to disappoint all those AHEC doctors . . . I would like to have one of those AHEC doctors come forward, identify himself to the press, and tell the community he lives in why it is essential to the mission of the university that his drive time is cut by eleven minutes. I'd really like to see someone do that with the straight face.

[1-16-09 Update: I found in another article on the Thorp's announcement that some AHEC doctors had testified before the legislature that the closing of Horace Williams would "cost them valuable clinic time." So someone did step forward . . . which I suppose is good, though I would still want to grill them if the airport question is reopened. I was told by a well-informed faculty member at UNC that it was most unlikely that an airport would be pursued again during Thorp's tenure as Chancellor, so that probably buys us at least five or ten years.]

Airport goes down in flames

nospam@example.com (Georg Buehler) — Fri, 09 Jan 2009 15:25:58 -0700

As some of you probably know, the University of North Carolina was in the process of trying to establish an airport in rural Orange County . . . and the most likely sites were within two miles of my house. The airport was ostensibly to serve the university's AHEC program for flying doctors to underserved rural areas, but was actually a stealthy attempt of wealthy owners of private planes to have their own convenient airport for coming to Carolina sports events.

I am so happy to say, "was in the process," in the past tense. Today UNC Chancellor Holden Thorp held a press conference to announce that UNC would call off the creation of an airport authority, and instead relocate its AHEC program from Horace Williams Airport to RDU instead.

Phew. That was close.

So what made Thorp change his mind? His official statements were fairly opaque, referencing "a great deal of distrust . . . of the process by which [the airport authority] came to be" and that "it's in the best interest of the University and our community not to form the authority." But I can guess to some other factors:

Well-organized opposition. Two separate grassroots organizations, Protect Rural Orange (PRO) and Orange County Voice, quickly sprang up to oppose the airport plans. I went to one of the first public meetings of PRO, which drew hundreds of locals and TV news crew. The organizations petitioned every level of government and won strong support from the local press, who put out increasingly frequent editorials opposing the airport. Most importantly, the organizations incorporated and started raising money to put up a fight;
they weren't going away any time soon.
Preliminary skirmishes. PRO put up a spirited fight against the County's placement of a waste transfer station in the same area in which the airport was most likely to be sited. When the county commissioners went forward with the plan anyway, the group filed a lawsuit to get an injunction to stop the transfer station. While PRO didn't win that particular fight, it may have shown the University how tough the opposition to an airport would be.
Powerful images. It's probably only coincidence, but it's interesting that Thorp made the announcement the same day that local photographer Jesse Kalisher opened an exhibit of photographs documenting the rural land and lifestyle that would be displaced by the proposed airport. I remember reading the story of one of the first politicians ever to be mocked by political cartoons, and he told his staff, "Get those pictures out of the papers! My constituents don't read – but they can look at pictures." I think Thorp started to realize just how bad the airport authority was going to look, once people see images of the land to be razed, and fourth-generation farmers losing their homes and livelihoods.
Bad economy. With the markets tanking and unemployment up, even the savviest politician will have a hard time explaining why we should spend $30 million to build a new airport instead of spending $2 million to build a new hanger at RDU, just so some doctors can shorten their drive to the airport by ten minutes. The fiction that building an airport would "stimulate economic growth" becomes harder to sustain when companies everywhere are pulling back instead of building.
Moral conviction. Maybe, just maybe, Thorp pulled the plug on the airport just because it was the right thing to do.

Whatever the reason, Chancellor Thorp, my family and I extend our heartfelt thanks to you.

Why Politics Sucks, and How

nospam@example.com (Georg Buehler) — Sat, 13 Dec 2008 08:59:00 -0700

(continued from yesterday)

So, the Board of Orange County Commissioners, using a supposedly fair process, decides to haul the county's trash eleven miles back and forth across two-lane roads just to get it packed up and hauled off. And they're packing it up next to Chapel Hill's drinking water supply. How did we arrive at such a bad decision?

Well, the commissioners were pretty candid about it, when pressed. "Everyone agrees that, were technical considerations the only factor, the Eubanks Road dump site would be the best place to put the waste transfer station," said Commissioner Mike Nelson towards the end of the meeting. "But we also agreed, as a community, that we didn't want to go in that direction." What he was referring to, cautiously, was the fact that community organizers in the Rogers neighborhood adjoining the Eubanks Road dump had pilloried the commissioners for years with accusations of "environmental racism," as the predominantly black neighborhood dealt with the consequences of having to live next to trash. Rather than endure the political pressure of being the oppressive bad guys, the commissioners decided to look for another site.

"Where a site like this belongs is near the interstates," said Commissioner Barry Jacobs. "But Hillsborough immediately threatened to annex anything we tried to put close to them. And believe me, that's not an idle threat."

Ah. Now I see. I started out thinking that this was a fair, objective process that just happened to have landed a trash site near my home. Here I was thinking about what's fair, and what's right. But then I find out that the objectively best possible options were taken off the table from the start – either by individual interests who made the loudest noise, or the brute application of political power, public interest be damned. I'm starting to feel like a schmuck for even thinking about fairness. "Ok, if that's the way this game is played, fine: not in my backyard, dammit." Time to scream and yell, time to call in the lawyers. Did I say democracy was people talking out their issues? Democracy is the art of defending your selfish interests while appearing to serve the good of the whole.

Am I more cynical now? No, not really. I still believe our system is the best, in spite of really sucking. After all the acrimony and impassioned pleas in the public hearing, it's important to remember that everybody went home. There were no fights, no arrests. In other parts of the world, the county office would probably be on fire by now, and people like me would be in jail, or shot by police, or disappeared in the night. Power politics sucks . . . but the alternatives are tyranny, or anarchy, or usually both.

A Political Process

nospam@example.com (Georg Buehler) — Fri, 12 Dec 2008 08:58:00 -0700

(continued from yesterday)

The county staff were invited to make a brief statement ("please, brief," said the acting chair) about the site that they were voting on tonight. (Uh-oh, I thought. They're going through the motions here. They've already made up their minds.) The staff ran through their talking points for the site: a willing seller, not near any schools or churches, access to Highway 54, no current agriculture, heavily wooded, yada yada.

Then the public (who had been waiting around for three hours to speak) had their say. Many made appeals to preserving a beautiful rural area, which had emotional appeal but didn't seem to carry the weight people hoped they would. The better arguments (I thought) were on the technical merits: how could you possibly decide the best way to deal with trash is to truck it eleven miles down two-lane roads away from the interstates, and put it right next to our drinking water supply? Why put an industrial facility in a place with no infrastructure?

The commissioners were extremely reluctant to talk about the issue. And who can blame them, when a hostile room is facing them? (I have no doubt they had put the waste transfer station at the end of long agenda to try to blunt the edge of the opposition; if you have to face an angry crowd, at least let it be an exhausted one.) One commissioner (Pam Hemminger) was swayed by the public arguments and thought the proposed site was a bad one. The others, however, appealed to the necessity of having a fair and transparent process, and that this site was the best that their fair process could generate, and now they were slam out of time to find a better site, or even a better process to find a better site. The general sentiment of the commissioners was, "Yes, I know, this sucks, but we have no other realistic choice at this point."

Most of the public crowd had no patience with talk of 'process'. "That's the way heartless bureaucrats talk – 'sorry, gotta follow the process.' It's a bad decision, dammit!" But I listened very carefully, because I think I actually understood what the commissioners meant, and it's not an easy point to grasp.

Normally, when a group of people are trying to make a decision that affects everyone -- like, "Where shall we go out to eat?"-- they follow a process of ad-hoc suggestions, followed by counter-suggestions, followed by a call for consensus:

"How about the steak house?"

"Joey's vegetarian. Maybe the Panda Palace?"

(Pause . . . no one's seconded the motion . . . Chinese isn't going over well.)

"Winston's?"

"Yeah! Winston's!"

"Winston's? Yes? Everyone? Ok then, Winston's it is."

That decision-making process works really well . . . when everyone affected is in the room. Everyone has a chance to speak up, raise objections, make suggestions, and ultimately converge on a solution. It's very easy for anyone to propose an alternative at any time in the process . . . and the stakes of the decision are relatively low. But what about when everyone isn't in the room, and can never all be in the room? And the outcome will inevitably be unacceptable to someone? Like, when choosing where to put the county's trash?

Big decisions like that face a logistical problem, and a fairness problem, when it comes to proposing alternatives. Logistical, because there are a huge number of potential solutions that could be considered, and if you argued each one individually you would never finish. Fairness, because just suggesting one alternative ("how about putting the trash over there?") immediately puts people affected by that suggestion at a disadvantage that other equivalent sites do not have to face, just by the accident of it being considered. Another fairness question involved is usually called "the tyranny of the majority" – since everyone has an interest in not having trash located near them, and votes in their self-interest, the site ultimately falls on those with the least political power.

To get around these logistical and fairness issues, the county commissioners (and politicians around the world) have to resort to a process where the criteria for selecting a site are established before any particular site is considered. This is as close as we can get to John Rawls' "veil of ignorance" – we try to figure out what's fair before we find out whose ox is getting gored. Then, those criteria get applied to every possible site: not just one or two or ten or a hundred, but every possible site in the county, because it would be unfair to include some for consideration and not include others.

So, we have a collision of decision-making models. Most of the public standing by is saying, "That's a lousy choice for a site – let's find another one. What about that one over there?" The model they are using is not that different from the one used to decide which restaurant to go to; they assume they can keep generating alternatives until something fits. They assume that the limiting factor is that not enough options have been considered; if they keep making suggestions, a better option will eventually become apparent.

The commissioners, however, use a different model. They know that they can't just pull another site out of a hat at the last minute, without completely compromising the fairness of the whole process. They would have to start over from the beginning, this time with a new set of criteria, and spend another year applying those criteria to every possible site. And, no matter what criteria they use, they know they will inevitably wind up at the same conclusion: a room full of angry citizens, telling them to find another site.

So . . . assuming the process used by the commissioners is the most fair one, how did we wind up with a lousy decision? (to be continued)

First-hand local politics

nospam@example.com (Georg Buehler) — Thu, 11 Dec 2008 11:56:00 -0700

Tonight I went to a meeting of the Board of Orange County Commissioners (BOCC), since one of my neighbors urged me to attend since they were voting on the waste transfer station. If you've never experienced local politics like this, I would encourage you to do so; it will open your eyes to the nature of politics.

A little background:

Orange County's landfill on Eubanks Road is running out of room. By 2011, the landfill will be out of space and the county's daily 170 tons of trash will have to go someplace else. County officials eventually settled on building a waste transfer station: a place where garbage is packed up, put on to big trucks, and hauled off to someplace else with more land than money. A waste transfer station is not as bad as a dump, but it still means an awful lot of garbage is going to be sitting around nearby (and potentially contaminating ground water), and lots of trucks will be coming and going.

So, the county has been going through a long, drawn-out process of figuring out where to put this waste transfer station. After a number of false starts (something I'll talk about later) the final site the commissions were set to approve was about three miles from where I live. So, I had a personal interest in this particular meeting.

What it was like:

There's a room -- not a very big room, maybe large enough to seat 80 people -- where the commissioners conduct their meetings. The six commissioners (one was absent) sat in an elevated panel, with microphones and name plates in front of them. Not that different from the sort of C-SPAN segments you see for Senate hearings. To either side of the commissioners were a couple broad tables, where the county management staff sat: a clerk who recorded the proceedings, a county manager who seemed to be running the docket, and a lawyer who provided counsel when needed. Some big computer projection screens were up front as well, so staff or visiting parties could present information. A gallery of chairs was set out for the public, and a podium sat in the middle of the chairs from which individuals could address the commissioners.

You could pretty much tell who was who by the way they dressed. The commissioners, being local politicians, had a mostly business-casual look to them: shirts and khakis, some with ties and some without, maybe a tweedy jacket here and there. The staff, being professional bureaucrats, wore the uniform of government: suits that were anything but casual but still managed to look cheap. The lawyers (and no matter what the commissioners were discussing, there was always a lawyer or two involved) wore dark silk suits, which did look expensive and seemed to gleam menacingly. The public -- well, they looked like you and me, mostly: people in jeans, loafers, raincoats, workboots. Everyone in the public gallery looked unhappy and bored -- because, I soon learned, nobody comes to a county commissioners meeting without cause to be unhappy, and anyone who sit through such a meeting is doomed to be bored out their skulls.

The proceedings went something like this:

The chair would announce the next item on the agenda. "Next . . . 6-A, Efland Sewer Rate Schedule Change . . ." The names were just obscure enough unless you knew what they were talking about, you didn't know what they talking about.
The county staff would make some sort of presentation on the matter at hand. Sometimes it was as simple as just reminding them what the matter was about, and why they needed to vote on it. Other times a bureaucrat of some stripe would wiz through a PowerPoint presentation, explaining numbers, charts, time tables, and plots of land. It seemed like the staff had a lot of power in determining what defined the option that was presented to the Board for review.
The commissioners would ask a few questions of the staff, some of which seemed genuinely pertinent and others which seemed like political posturing. Rarely did a measure, no matter how picayune, go through without someone having to say something about it, even though nearly every measure brought up was met with unanimous approval.
The public was invited to comment. Someone would step up to the podium in the middle of the floor, and begin a speaking. A timer would chirp in the background as the clerk set the clock -- individuals only had three minutes apiece to speak. Occasionally the speaker would hand a written copy of their statement to the clerk, which was the best indication of whether they had ever done this sort of thing before. Nearly all the speakers were reasonably succinct, eloquent, and persuasive. (Maybe I just had low expectations; I expected the sort of lunkheaded sentiments I hear on talk radio. Instead I heard people speak in complete sentences and appeal to reason. Wow! People talking through problems! Democracy! Wow!) No matter what the issue was, the speakers from the public were always against it. (Like I said, nobody comes to these things unless they have a problem.)
The commissions would put a motion on the table, almost unfailingly to approve what had been proposed by staff, but always with a few modifications. A voice vote was taken, the commissioners would vote unanimously in favor, and then on to the next agenda item.

It went like that from 7:00 pm . . . to 8:00 pm . . . to 9:00 pm . . . to 10:00 pm. Finally, at about a quarter past 10 pm, the waste transfer station issue was brought to the floor.

Local politics, evidently, is an endurance game. I'm glad I came early and got a seat. Half the people there couldn't even sit down the whole time. (to be continued)

Congress considers $80 billion bailout for UAW

nospam@example.com (Georg Buehler) — Thu, 13 Nov 2008 20:29:28 -0700

Facing declines in membership and influence, the United Auto Workers union approached the U.S. Congress with an appeal for a fresh infusion of cash to avoid immanent extinction.

"I would not call it a bailout," said UAW president Ron Gettelfinger. "It's an investment in greener, more efficient union technology. Companies like GM and Chrysler are fossils, and their available cash reserves and shareholder value are a finite resource. Unions cannot continue to tap those limited resources forever, if we want to pass on to our children a world of cushy $70 per hour semi-skilled jobs. We need to reduce our dependence on the American consumer, and develop alternative, renewable sources of graft like government largess at taxpayer expense, and redistribution of wealth from economic enterprises that actually make money."

"The Europeans are way ahead of us on this front," Gettelfinger added.

The sought-for aid would funnel $80 billion dollars directly into the pockets of UAW bosses, which are expected to flow over into aiding the 1 million union "workers" in the form of wages and benefits they couldn't dream of getting anywhere else. The cash will also go a long way towards making the UAW competitive against rapidly encroaching foreign concepts like fair-market value and quality manufacturing.

Without the aid, UAW officials predicted an extremely dire future for Big Labor. "We cannot afford to have our domestic unions perish. The U.S. might never recover its sense of unrealistic entitlement again without the unions."