| Sunday,
February 25, 2001 Working on AAAS report. Answers will be
BRIEF.
Begin with two from Steve Stirling:
Dear Jerry:
With respect to the debate on insurance and genetic
screening:
The social function of insurance is to spread risk.
Very few people can save enough to avoid pauperization in the event of
catastrophic illness, when care can easily cost tens of thousands of
dollars a _day_. The only way to make such sums available to an ordinary
individual is to take a little from all the people who _aren't_ sick just
then.
Our current problems with health insurance stem from
two causes, basically:
a) Medicine can now do much more than it could in
the recent past.
There's an old folk-song that has a refrain:
"If life were a thing that money could buy/Then the rich would live,
and the poor would die."
Note the fatalistic assumption behind the song;
until recently, it was broadly true.
It's only since about 1890-1900 that going to a
doctor increased your chances of survival in a serious illness, apart from
the placebo effect. Before then, apart from bone-setting and such, the
doctor was more likely to kill you out of well-meaning ignorance.
As recently as the time of my birth in the early
1950's, if you got what we would consider a serious illness that wasn't an
infectious disease, you usually either recovered or died. Hospitals and
doctors could only give you nursing and pallative care. Really long
illnesses where medical inputs made a difference existed, but they were
rare. Most people died around their Biblical three-score-and-ten.
This is no longer so. Money -- resources, machinery,
drugs, doctors -- can now mean the difference between life and death for
yourself or your loved ones. As medical knowledge increases, and it's
doing so with exponential speed as genomics starts to yield results, this
becomes more and more the case.
People will accept fatalistically that there's not
much you can do about sickness and death. However, when there _is_
something that can be done, and someone else is escaping death and you
aren't... well, then "social envy" takes on a whole new meaning.
b) There's a basic conflict of interest between
health insurers and their customers.
In most lines of business, in a market economy, the
provider makes their money out of giving the customer something, whether a
good or a service. Cheating is usually self-punishing, provided enough
information is available.
A HMO, on the other hand, makes their money out of
_not_ giving you anything, since you're paying them long before actually
getting anything back.
Their profits come from people who pay the premiums
and then don't get sick; in fact, from a strictly business viewpoint, the
best type of customer is one who remains healthy as long as possible, and
then dies instantly.
The minute they actually have to start delivering
their promised service, it comes right out of their profit margin. It's
pure loss, rather than being analagous to a cost of doing business.
Hence their eagerness to screen out high-risk
clients, and to dump people as soon as possible once they start demanding
the service they've been paying for, and their general approach to demands
for payment -- that the sick client is some sort of parasitic thief.
Within broad limits, a health-insurance company has
no interest in actually doing what it ostensibly says it's doing --
providing coverage for you when you get ill. Quite the contrary. And even
the usual incentives not to alienate the customer don't really apply in
this instance.
Because at any given time more people will be
healthy than sick; and the short-term interest of the healthy in this
transaction is to keep their premiums down as low as possible.
Therefore the policy most likely to fatten the
bottom line of an HMO is to _pretend and falsely promise_ to provide
prompt payment when customers fall ill; to actually do their damndest to
deny such payment; and to vigorously deny that this is so, while pointing
out that making it more difficult for them to deny payment will put up
premiums.
It's a perverse mutation of the usual free-market
incentives; a Ptomekin-village imitation of a system for providing against
the risk of illness.
-- and now, of course, with genetic screening, we
have a new means for insurance providers to lower their risk.
But every step to lower the insurer's risk makes it
more difficult to spread risk generally, which is why the general public
wants insurance in the first place.
Yours, Steve Stirling
Alas I fear you are right in describing both the
motives and the reality. there has to be a better way.
And of course you are correct that prior to about
1900 doctors routinely did far more harm than good. The classic case is
Byron who tried to keep the physicians away from him but eventually lost
consciousness and they literally bled him to death. Old Doc on Gunsmoke
was clearly a magician, not a physician...
Dear Jerry:
Greg says:
"Mr. Stirling is dreaming. Dreaming that the US
Government would decide to go to war against the computer industry."
-- actually, in this case a lot of the computer
industry would be on the same side. There are powerful interests who would
very much like to control unauthorized copying. Microsoft, for one; not to
mention the publishing industry, which is not without political clout.
Have you noticed how many politicians finance their lifestyles by
"writing" a "book"?
Them just for starters, not to mention important US
trading partners.
As the saying goes, money talks.
>dreaming that the US Gov't would win if they did
start the war (remember HilaryCare?
-- in this instance, the equivalents of the
insurance industry would be on the same side as the Government.
>Think the techies would be any less effective
than the doctors?
-- it was the insurance companies, not the doctors.
Individuals are weak; consolidated interests, strong. Because they have a
lot more money to offer legislators, among other things.
Isolated techies have very little political clout,
and politics trumps technology.
Looking at things in historic perspective, vested
interests don't always win... but it's the way to bet.
Yours, S.M. Stirling
Techies have more power than you think, and
places like this help keep them informed. The value of www.byte.com
is that it comes out often, it's current, it is backed by a big enough
outfit that it is not easily shut down (as I would be) and it pretty
darned well has to keep the good will of most of the technoweenies. Which
is all to the good.
Techie Power!
Jerry, on the moonbow picture, Francis Kupo wrote:
"The chap on his site does describe how he took the photo and why it
looks like a daylit shot .." Evidently Matt BenDaniel, who took the
picture, reads your website, also, as now the sidebar to the picture
clearly explains the effect: This picture was taken at night, well after
the end of twilight. There had just been a brief rain shower at our
location that moved off to the Southwest. The full moon, in the Northeast,
reflected off the raindrops and created a moonbow. To my eye the moonbow
appeared faintly in color. Why does this shot look like it was exposed
during the day? The moon is a neutral color and reflects the same spectrum
as the sun. This exposure was 400,000 times longer than would be used
during the day, and the sun is 400,000 times as bright as the full moon.
Human eyes do not see color well at low light levels, but the camera does.
You can see the blurring of the anchored sailboats from their motions
during the time exposure. You can also see stars at center left. The
apparent lower end of the rainbow is exactly at a reef where we snorkled
the next day.
http://people.ne.mediaone.net/mbendaniel/gallery/astro/moonbow.html
Tracy Walters
Suppose as you say that Moore's first law has 50
years to run; I calculated some months ago that the number of switchable
states would equal that of the human brain in 42 years time...
Regards, Terry Cole
Dear Dr Pournelle, You think legal developments on
copy deprotection are frightening? Have you considered that the geeks are
actually helping the cartels by promoting the revised IP protocol known as
IPv6? Read the following.
I'm in the second year of a law degree trying to get
my head around this stuff. At this rate I won't be finished till sometime
in 2004. Hope it's not too late. But if you're interested I'll start
trying to tie the main threads together for your readers. They could start
with the EFF's take on the issues - see for starters http://www.toad.com/gnu/whatswrong.html
, and http://freenetproject.org/
.
October 04, 1999, Issue: 783 Section: Gray
Matter
Where's All The Outrage About The IPv6
Privacy Threat? Bill Frezza
What happens when companies such as Intel or
Microsoft are found to have embedded unique identifiers in their hardware
or software that pose potential privacy problems for Internet users? As we
know from experience with both the Pentium III Serial Number flap and the
Microsoft Win98 Registration Wizard brouhaha, professional privacy
advocates so...
Terry Cole
d
Dr. Pournelle,
Now that I have subscribed to your web site (please
see my separate email), I feel comfortable sending in my $0.02 on the
whole MS vs. Linux issue.
Linux makes a lot of sense in the managed services
arena. E.g., I work for a pretty large provider of cable Internet access
to small and medium sized businesses in PA. Some of our customers purchase
a service whereby in addition to Internet access, they get an on-site NT4
server providing POP3 &; SMTP mail, and a caching proxy server. We're
using MS Commercial Internet Server (MCIS) and Proxy Server 2.0. Remote
admin is handled using pcAnywhere, from Symantec.
MCIS is a subscription-based product, and our
license expires later this year. Further, the upgrade path is Exchange
2000, since MCIS development has been ended by MS. Exchange 2K can only
run on Windows 2000 Server. So, our continuing use of MS products would
become _quite_ expensive. Also, reliability is often less than stellar.
Servers need to be rebooted and since we're running SP5, we sometimes
encounter file corruption once we get about 4 gigs worth of files on the
hard disk. (The fix for this problem is to upgrade to SP6, btw.)
As a result, we are moving to an open source
solution. We're going to customized Cobalt Qube server appliances. The
Cobalt OS is a derivative of Red Hat Linux. Essentially, for the cost of
the hardware, we'll be able to provide our customers with POP3, IMAP4, and
SMTP mail services. The Cobalt boxes will also provide web caching using
Squid, and Windows file sharing, using Samba. We'll be doing remote admin
with Secure Shell.
Anticipated savings will come from:
* No OS license fees, * No application license fees,
* No remote admin tool license fees, and * Increased reliability of Linux
cf. NT4, thus contributing to lower support costs.
On an unrelated note, I've read many of your SF
works over the last 15+ years. The "War World" series was among
my favorite SF series, and I've read each volume more than once. Do you
have any plans for more installments?
-- Dave Markowitz
And the quest for competition continues. There
will be more. And now this:
Jerry, I thought you might be interested to know
that I set up currentview.html and currentmail.html to download into my
Palm IIIxe via AvantGo and it is wonderfully formatted -- even the links
work which are handy for jumping to the current day's notes. Now I'm sure
you didn't format www.jerrypournelle.com
with the Palm in mind, but I may have just found the second "killer
app" for my 3-day-old Palm (the first killer is Pocket Quicken).
Andrew Cohen
Love it!
My recollection is that a whole lot of folks in this
country have tried for years to pass a Constitutional amendment to outlaw
flag desecration in this country.
It reminds me of the story of the discussion between
the Chinese and U.S. diplomats. The U.S. diplomat tells his Chinese
counterpart that the great thing about the United States is that he could
stand in front of the White House and should "down with the United
States of America" and nothing would happen to him. The Chinese
diplomat responds, "Big, deal. I could stand in the middle of
Tienamin square and shout 'down with the United States of America' and
nothing would happen to me, either."
With our drift towards empire, the possibility of a
flag desecration amendment and stories like the one you quoted, the joke
isn't as funny as it used to be.
Rick Samuels in Portland
Yeah.
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