A Capitalist's Explanation for the USA's High Healthcare Costs?

First post in over two years, yeah! Get out your "politically incorrect" folder for this one, or perhaps your "American Elitist" folder...

I was thinking about the conventional wisdom that health care costs in the USA are higher than in any other developed country. I think a lot of theories have been put forth as to why this is. Off the top of my head, the commonly cited reasons are: greed, corruption, inefficiencies, antiquated systems, too much/too little regulation, focus on treatment rather than prevention, liability insurance, malpractice lawsuits, diet issues, and increasingly sedentary population... have I missed anything?

I'm sure there's varying degrees of truth to all those reasons (even the seemingly mutually exclusive ones like too much/too little regulation). But here I put forth yet another theory. Maybe someone else already thought of this, but if so, I haven't read that person's writing!

Assume that, as a whole, across the entire planet, healthcare is a market economy. That is, it is governed by the rules of capitalism. Yes, many countries have socialized medicine: but at the global level, those countries are just another consumer of healthcare.

So, what does a market economy do? It puts a value, or perhaps more specifically, a price on whatever product is being traded. What is the value, then, of healthcare? The ultimate value is keeping someone alive.

What price are you willing to pay to keep someone alive?

Most people would have a hard time putting a price on the life of a loved one. For example, most people would do whatever it took to save the life of their children, including paying "the ultimate price" (i.e. giving up their own life). But as you move out of your circle of loved ones, past the next tier of close friends, and exclude colleagues and casual acquaintances, you're left with an overwhelming number of people that you don't even know. The number of people you know and care deeply about is---for all practical purposes---infinitely greater than the number of people you don't know. You'd pay the ultimate price to save a loved one, but what would you pay to save a random person you know absolutely nothing about on the other side of the world?

In a pure capital market, the participants' relationships to each other is that of your relationship to a random person in another country: nothing. In fact, the relationship actually hinges to some degree on adversarial, and is yet further removed from a loving, caring relationship. Perhaps you don't wish the other market participants harm, but at the end of the day, you are competing for fixed resources.

In short, my market view of healthcare is that of a proxy for the value of human life. In an efficient capital market, those things with the highest value also have the highest price.

So perhaps the global economy puts a higher value on the lives of Americans in aggregate. Health care in the USA costs more because the value of American life is higher.

From a general capital market perspective (i.e., not just health care), the USA has clearly been the leader in value creation for the last century or so. I don't think anyone will argue against the notion that the USA has been the dominant global power since WWII. America's prosperity has certainly increased the overall prosperity of the world. Yes, not everyone has uniformly benefited from the rise of the USA (in fact many have been burned), but, my layperson's gut feel says that, overall, the "rising tide" of the USA has---more often than not---"raised all boats".

Device already mounted or mountpoint busy

First post in too long. The muse hasn't really grabbed me strongly enough to warrant additional entertainment for my tiny readership. Still, I won't give it up!

So here's a quickie technical post. I powered on my Ubuntu 9.10-powered computer the other day. When I logged in, I found that my home directory didn't exist, and was dropped into the root directory.

I mounted it manually, and everything looked okay. Assuming it was just some fluke, I rebooted the machine to make sure it would auto-mount correctly. It failed again. This time, manual mounting didn't work.

My home directory actually lives on /dev/md0, which is a Linux software RAID1 (mirror) device. I checked, and the device existed, and the array state was good:

Personalities : [raid1] [linear] [multipath] [raid0] [raid6] [raid5] [raid4] [raid10]
md0 : active raid1 sda1[1] sdb1[0]
      976759936 blocks [2/2] [UU]

      unused devices: 

Still, the manual mount failed:

# mount /dev/md0 /mnt/share
mount: /dev/md0 already mounted or /mnt/share busy

Huh? I ran the mount command with no options: neither /dev/md0 nor /mnt/share was listed anywhere. I ran lsof: neither of those files were listed as open.

I even tried mounting in a new directory:

# mkdir /mnt/tmp
# mount /dev/md0 /mnt/tmp
mount: /dev/md0 already mounted or /mnt/tmp busy

Well, clearly /mnt/tmp isn't busy, as it was just created! So what was wrong with md0?

At this point, I started to get a little worried, so did the sanity test to make sure my data was still there:

# mount -t ext3 /dev/sda1 /mnt/share
mount: /dev/sda1 already mounted or /mnt/share busy

I tried the same thing with /dev/sdb1, the mirror of sda1 in the RAID1. Same result. At this point, I was more than worried, but not yet panicked.

I checked dmesg, to see if there were any obvious problems. Nope. So then I went into /var/log, and started looking at those files for clues. I finally found something:

EXT3-fs warning: mounting fs with errors, running e2fsck is recommended

Ah-hah! So I ran e2fsck on /dev/md0, and corrected the errors. I was then able to manually mount my home directory. I rebooted, again to make sure it came up, and it did.

I don't know if this is considered a mount bug or not, but the error message is extremely misleading.

DHS = Paranoia

Yesterday, I was trying to take some artsy photos of the rail road tracks near my home, as well as some general autumn/changing leaves/nature shots. A local cop pulled up next to me and asked me about the pictures I was taking, in particular: "What are you taking pictures of?"

I answered, plainly, "Nature photos, the changing leaves, the railroad."

He then told me I looked suspicious. He went on to say that, with the Department of Homeland Security, taking pictures of railroads looks suspicious. He repeatedly used the word "suspicious".

He then asked if he could see the pictures I took. As I started thinking of a polite way to say "not without a warrant", he got paged on his CB radio. He chatted on the CB for a minute or so, then turned to me and gave another quick "it looks suspicious" speech, then drove away.

Overall, it wasn't a big deal. It only took up a few minutes of my time. The cop wasn't a jerk, simply matter-of-fact. I didn't have to give him my information (likewise, he didn't identify himself).

I have nothing against the police officer; he was just doing his job. What bothers me is that, a guy walking around with a camera in broad daylight is now considered "suspicious". Have we become so paranoid that hobbyist photographers are now included in the group of potential enemies?

The Most Annoying Office Mate Ever

I have a close friend who described to me, at length, the annoying habits of the person who sits closest to him at work. He went on in such detail that I felt like I was there...

The first and most notable annoying habit is the "violent nasal exhalation". Basically, we all have an opening that connects our nasal cavity to our mouth. Apparently, the annoying guy closes that off, builds up pressure in his mouth, then opens the nasal passage. The result is similar to the sound he would make if he was blowing his nose, but immediately preceded by a kind of "thunk" from the explosive opening of the mouth-to-nose cavity.

I've never heard a whale expel air through its blowhole, but I can only imagine it's very similar to what this guy does.

Of course, such a habit could easily be ignored if it occurred infrequently. My friend---who is never prone to exaggeration---says the guy makes the noise at least once every minute. Every minute!

The guy's next habit is less frequent, but louder and much more prominent: the "mouth vacuum". This involves opening the corner of his mouth and forcefully sucking in air. I've heard people (and probably done it myself) do this when their mouth is full of saliva. Of course, the silent alternative is just to close your mouth and swallow.

That he does it out of the corner of his mouth is important: the side he does this with is the same side on which my friend sits. It's as though the sound is directed squarely at him. It's quite loud too: loud enough that it can be heard in the whole office. But of course, my friend is at ground zero, where it's loudest and impossible to ignore. Frequency is lower than the nose thing, but still at least every five minutes.

Hacking and spitting. One to four times an hour, he'll hack up what ever drainage or phlegm he has in his sinuses, and spit it into his garbage can. As an added bonus, sometimes he'll skip the garbage can and use the sink in the office's kitchenette. My friend said that the other day, he heard the annoying guy hack and spit into the sink. That in and of itself was unremarkable, nothing new. But then my friend went over to the sink to rinse out a mug... and there it was, in all its phlegmy glory: a giant, yellowish ball of mucous, sitting innocently in the sink, half-way between the drain and the edge. He hadn't even bothered to rinse it down the drain! A public office sink turned spittoon.

He occasionally gets into throat-clearing fits, which becomes the culmination of all his foul habits. He'll sit there and continuously clear his throat for a solid minute or two, punctuating his clearings with violent nasal exhalations. Often a mouth vacuum or two is thrown in for good measure, and the spectacle's grand finale is hacking a big loogie into his garbage can. Fortunately, this only happens, on average, a couple times per day.

On days when my friend is really lucky (sarcasm), the guy will accompany every violent nasal exhalation with a throat-clearing. Like a lone barking dog, the sounds are too frequent to ignore, but not frequent enough to fade into the background.

My friend's office is small and generally quiet---whisper quiet, in fact, with an open seating plan (i.e. no cubes or anything dividing up one person's workspace from the next). This means that even the slightest of sounds can be heard.

The annoying guy uses this library-like silence to achieve his full annoyance potential: lip-smacking. Generally, such behavior is reserved for animals and sloppy-eating cartoon characters. But during, and for several minutes following any eating, the annoying guy manages to continuously slurp and smack his lips. If he only ate once or twice a day, perhaps these noises could be ignored. But most days, he eats at least six times: breakfast, lunch, two to four yogurt snacks, two to four nut snacks. And then there's the cookies: between all the other meals and snacks, he'll toss a whole cookie in his mouth, and just suck on it, presumably until it disintegrates. The sucking is of course open-mouthed, and practically at broadcast volume for my friend.

Also rising above the silence are random whisperings are finger snaps. Throughout the day, the annoying guy randomly whispers and snickers to himself. My friend doesn't know what causes the guy to talk to himself; presumably, he's thinking through something. But the giggling comes about when he's reading online forums and/or email. Once, the guy was so moved to laughter, that in an attempt to muffle the outburst, he actually produced the most awkward, hyena-like noise my friend has ever heard a human make. And if the random whisperings weren't distracting enough, they are often peppered by finger snaps. Yes, the guy snaps his fingers off and on throughout the day. It's not a constant snapping, just two or three snaps---as though he is trying to get someone's attention.

The solution to my friend's problems? McMaster-Carr part number 6207T53: taper end foam earplugs with a noise reduction rating (NRR) of 33 dB.

Gentoo to Ubuntu Migration Part 3: Conclusion

And now for the long-overdue and gripping conclusion of my Linux distribution journey. Over the last few posts, you've witnessed my curious initial dabblings with Slackware, my coming of age with Debian, and finally being all grown-up with Gentoo. I suppose that makes the Gentoo-to-Ubuntu switch my midlife crisis.

Cheesy metaphors aside, I should probably start out with a disclaimer that this isn't an anti-Gentoo post in anyway. My position on Linux distributions has always been that the best one is the one that works for you. In other words, it's a matter of personal preference. So this series is really a journey of how my preferences have evolved over time.

In a word, the biggest motivator for me was time. Gentoo is great but time consuming, both in terms of man-hours required to manage it, and the CPU time required for constant compiling. That may be a bit misleading to those who don't know Gentoo: once you have a stable setup, you really don't need to compile any additional packages (except security updates). However, I'm an obsessive tinkerer and upgrader, so I can't help but do an "emerge -vuD world" (i.e. update all packages on the system) every week or so.

The upside to having all packages built on your local machine is immense flexibility. This is supported via Gentoo's portage system, in particular, "USE" flags. USE flags typically correspond to build options passed to a source package's configure script. For anyone who's ever done a "./configure --help", you've probably noticed that most non-trivial packages have compile-time options. Typical examples include whether or not to build support for such things as: graphics, sound, internationalization/multi-lingual, different video and sound codecs, ssl, etc. An obvious example: if you have a server that has no connected monitor ("headless"), it's reasonable to build all your packages without X11 (Linux's core graphics API) or sound support.

As with many things that offer such flexibility, "with great power comes great responsibility". For myself, I took advantage of Gentoo's system, and had very specific configurations for each of my multiple machines. Sometimes I'd even do things like globally removing support for a feature, except for one or two packages. What this ultimately led to was tricky system updates: since so much open source software is "in-flight" (i.e. undergoing continuous development), package upgrades often introduced incompatibilities.

So, at least in my experience, at best half the time, I could get by with "emerge -vuD world", wait a few hours for all the new packages to recompile, and come back to a functioning, upgraded system. Unfortunately, the other half the time, I was tracking down "blocking" packages, playing version-specific games, tweaking config files, changing USE flags, etc. Consider, when there are dozens, sometimes hundreds of packages to be updated, all compiled from source, any one could break the build process---you can't really "set it and forget it". It requires some baby-sitting, or at least periodical checkups to make sure the upgrade is still progressing.

When I had more free time, I enjoyed this process. But my commute and job are leading to attention-starvation of all my hobbies, one of which is maintaining my Linux systems. (Which means, hopefully, someday I'll have the time to switch back to Gentoo.)

In short, I don't have the time for source-based distributions. Well, that's easy enough, as most distributions are binary-based anyway. But which one? I basically defaulted to Ubuntu: it's one of the more popular distributions, which should count for something. It's also based on Debian, with which I had previous experience, so, hopefully, I would find it semi-familiar. It also has role-specific flavors, i.e. Ubuntu Server (for servers), and MythBuntu (for MythTV)---in theory, I could have one operating system for all my computers, and quickly and consistently manage them.

So, given all that backstory and rationale, here I am today, running Ubuntu on my main workstation. I run Ubuntu Server on my file server/NAS box, as well as my backup server. But I still haven't completely switched: my firewall/gateway/NAT box runs OpenBSD, although I don't intend to ever change that. My parents' and my MythTV still run Gentoo. Since these systems are used by other people (my parents and wife, respectively), I didn't want to disrupt anything until I was sure I had a viable solution (plus my parents are 150 miles away!).

Overall, I feel I'm generally saving time using Ubuntu over Gentoo. But I won't go so far as to say it's been perfect. Even though I had experience with Debian (Ubuntu's baseline), there's still a learning curve. And as I've learned more about Ubuntu, I've developed a little collection of gripes (those will be the topic of some future blog post).

The Irony of my Blog Name

It recently occurred to me that, recently, my blog's title is kind of ironic. I originally wrote it from my perspective, as a bit of cliche, self-deprecating humor: I'm the stand-up comedian getting no response from the crowd. And that's because I had low expectations for the size of this blog's audience.

So I went well over a month without any posts, the one or two readers I might have were asking the same thing: is this thing on?

Passion in Jobs

Roughly a year ago, I started an essay called Passion vs. Engagement. The piece is unfinished, but so are my thoughts on the matter; I'm still thinking about this stuff, and how I want to present it... at least, how to present it in a formal, professional tone. But this blog is neither formal nor professional; it is a playground for thinking out-loud.

Anyway.

As my line of work is software development (aka "programming" aka "coding"), I find myself reading Joel Spolsky's blog from time to time. Though I have no desire to move to New York, the work environment for his programmers is envious: individual offices, comfortable/ergonomic work spaces, modern tools and equipment, etc. He's also hinted to the fact that pay at his company is very competitive (although, personally, I'd take a cut in pay to actually have a quiet, distraction-free environment).

However, he eludes to passion for programming as effectively being a hiring criterion. I don't think Joel is any different from virtually every recruiter, HR staffer, or hiring manager (in any field) when he says he wants passionate employees. Who doesn't?

But my question is, what exactly is passion? Joel gives some hints to what he means by passion: evidence of programming-related pursuits outside of work. Although I genuinely love programming, I have to admit: after 11 hours of it, each and every day, I have no desire to write any code outside of work. I have too many other hobbies that are already on the brink of attention starvation. Does that mean I'm not passionate?

I can think of a few examples where I've witnessed true passion:

1. My friend and boss where I'm currently employed. Relentless 11--12 hour days, with practically no break in focus. While I'm in the same boat, after three years, I already know this isn't something I can sustain for the long haul. But my boss has been working like this for well over a decade; my friend is approaching a decade of the same. It's neither an exaggeration nor an unfair statement to say that both would work even more hours if it weren't for the wife and kids.
2. My wife used to work for a non-profit organization. Due to matters very close to her heart, this was a cause for which she was definitely passionate. When she worked for this company, she worked as many or more hours than I do; and they were erratic hours at that (nights, weekends, etc). Being a non-profit, her pay was substantially below her effort.
3. There are at least a couple open-source developers whose lives I've researched a bit. These people develop software for their employer by day, and write just as much open-source code by night.

In all cases, the common trait is a singular pursuit in a given field.

But for me, I simply have too many interests to devote myself entirely to one.

I think (or at least I'd like to think) that most people are more like me---we willingly fall into the "work-to-live" camp (as opposed to the "live-to-work" one). That is, I'd wager that the majority of people, even the ones who love their jobs, want to have time to do other things besides work.

In other words, if my guess is correct, most people aren't passionate about their work.

And maybe that's just it: the majority of employers aren't looking for "most people"; they want the best (who are, by definition, a minority). But the main idea behind my essay (and this blog post) is that I believe there exists a happy medium between passionate and mediocre. I call it being engaged; it's Passionate, Jr., but still mutually beneficial to employer and employee. Engagement has most of the attributes of passion, but stops short of being a singular life focus.