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Rob Salkowitz

Pedro - Sorry for the delay. I just saw this and I appreciate your views here. A few quick clarifications:
1. I'm not necessarily imputing evil motives to my opponents on this. A lot of people, possibly even yourself, proudly and unapologetically advocate privatization of practically everything on the theory that the market always provides better outcomes than government. I think that's sometimes true, but not always, and in the case of programs like Social Security and Medicare, the benefits of spreading risk around via government management exceed the advantages of a market-based system. It's generally libertarians and the right who consider any form of government ownership to be "socialism" (a dirty word if ever there was one). In my view, there are important differences to socializing unavoidable risks (aging and illness), as opposed to socializing variable risks (e.g., employment and prosperity). People who insist on dogma without distinction can do a lot of harm. This is one case where a lot of folks could suffer needlessly to demonstrate some "point" about the superiority of markets, and I don't take a kind view of that.

2. The example of exporting the elderly (with their consent, of course) was simply an attempt to consider all the possibilities. You know we are outsourcing a lot of medical procedures these days by sending patients to India, Brazil or Mexico where the costs of surgery are much less. Insurance companies sometimes insist on it. So it's not a huge stretch.

3. "Collect more at the front end" means raise the FICA tax (as was done in 1983) or lift the cap, both of which are being considered. I don't care for this approach myself, but it's hard to argue that it would impact the financial projections.

4. Technology in medicine - I'm not talking about the technology used for treatment. I'm talking about the technology that supports the business. Did you know that something like 90% of medical records are still kept on paper? That medical office workers spend 25-28 hours per week looking for information in files? That it can take three phone calls and 20 minutes to fill a prescription? A recent study showed that fully half of the $2 trillion America spends annually on healthcare is lost to waste and inefficiency, mostly of office processes. To say nothing of the impact on quality of care.

Medicine is behind even government and education in terms of adoption of basic information technology for business processes. Way behind. That's partly because all the budget goes to MRI machines and such, instead of on things that can really squeeze out costs. Even a little investment here would go a long way.

5. Sadly, I'm not that young.

Sorry for the long rebuttal, but what do you expect?

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November 2008

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Seen at low tide

  • American White Pelican
    Saw 30 in one flock on a weptember evening while fishing
  • Hummingbird
    Finally, my first hummingbirds. Saw them on a fire bush in Crystal Beach, FL. My rental's neighbor's yard is all xeriscaped, which is ugly to me but just fine with the little hummers. At first, I thought they were the biggest hornets I'd ever seen.
  • Flamingo!
    One of these dudes flew right over my house. I couldn't believe it. And please don't tell me it was a roseated spoonbill because it was a frickin' flamingo, dude! Huge and pink and right there above me. I was like so freaking out, you know?
  • Falcon!
    Don't see these guys too often. Wish we did. Bet the morning doves don't.
  • Black Skimmer
    These beauties are getting scarce, but one flew by yesterday at low tide on the hunt for minnows.
  • Dead sea turtle
    cool, but smelly
  • Reddish Egret
    These have been hanging out around the pool quite a bit lately. Must be a new group of adolesent birds -- the youngsters like to hunt where the water is clear, and it takes them a day to figure out there are not now and never will be fish in the swimming pool no matter how clear the water.
  • Sand Piper
  • Brown Pelican
    I saw a flock of about 200 of these at Disappearing Island yesterday, just south of Anclote Island on the west coast of FL. Good to see such a large flock.
  • Wood Pecker
    They've developed a sudden interest in the orange tree, which just went into bloom.
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