Health care is expensive. It is arguably much to expensive. Here's a true story showing some of the foolish reasons it to expensive.
Day 1 - Call pharmacy to get prescription refilled. CVS has a generally good prescription refill automated system. Unfortunately, after asking for a refill I pressed 2 instead of 1 and got an IVR script to refill another prescription. No way out of IVR script except 3, talk to a pharmacist. Choose 3, talk to pharmacist who gladly helps. Dear CVS Common Sense thinks it's DUMB not to have a go back option on your IVR menus. Extra cost of prescription refill, one pharmacist conversation.
Day 1, later - Go to CVS to pick up prescription. Not there. Talk to pharmacist again. Pharmacist says insurance won't cover until tomorrow. Prescription has 1 refill every 30 days. Prescription dated 24th of last month. It's now 24th of this month. That's actually 31 days since November has 31 days. Pharmacist agrees but it seems that prescription wasn't picked up until 25th of November, never mind that it's still been 30 days, insurance says no. Pharmacist says phone it in on the 25th. Dear insurance company, Blue Cross Blue Shield Ma, days are days not dates. BTW, what does the pickup date have to do with the prescription date. Dumb to reduce your cost at the expense of system cost. Extra cost of prescription refill, another pharmacist conversation.
Day 2 - Phone CVS and order prescription again. Manage to hit 2 not 1. Extra cost of prescription refill, additional IVR interaction.
Day 2 later - Pick up prescription interacting again with pharmacist.
So the insurance company optimized their cost by screwing me, happily I don't take the med every day so days vs date not an issue. Along the way, the insurance companies inflexible policy, we're talking 24 hours here folks, actually since it was 4PM when I went to pick up the prescription we're really talking 12 hours, lead to 1 additional lengthy human interaction, 1 additional IVR interaction, and 1 short human interaction.
This is NOT efficient. It's a case study in how one parties optimization actually increases cost. Dumb, just plain dumb. So thinks Common Sense.
With a nod to Thomas Paine, Baron d'Holbach, and "Captain Obvious" perspectives on what should be, but remarkably often isn't, obvious common sense.
Saturday, December 25, 2010
Wednesday, December 22, 2010
On net neutrality
Net neutrality is again in the news. For those non-geek the notion is that internet bandwidth providers can not tie the bandwidth to specific devices and can not block specific services. This is sometimes characterized as the four freedoms:
On the face of it, these notions appear reasonable and fair. But are they?
One important consideration is bandwidth. For those non-geek, bandwidth is the ability of the internet to carry data. We've all seen bandwidth issues when using the internet. "The internet is slow today" is a frequently heard complaint. In fact sometimes the internet IS SLOW. It's slow because there are more users than typically; or those users are using network intensive applications like video; or part of the internet infrastructure is currently unavailable because of maintenance or outage; or sun spot activity is high and radio communications are effected; or any number of other reasons. The central point is that internet bandwidth is NOT LIMITLESS. That's true of both wired and wireless internet. Bandwidth is also NOT CONSTANT. Bandwidth varies with time, the number of users, user applications, etc. These are simply technical facts of life, technical realities that CAN NOT BE IGNORED.
Another consideration is that there are some fundamental differences between wire and wireless internet. Generally, wire internet has much more bandwidth than wireless. While 4G wireless brings much more bandwidth to the individual wireless cell and users in that cell, the available bandwidth remains much lower than that available to wire users in a wired internet head end distribution point (a similar technical constraint). Try as one might, it's much easier technically to get bandwidth down a hard link like a cable or fiber optic line than it is over an RF channel. Hard connects simply have more inherent non-conflicting bandwidth.
A final consideration is that increasingly we are moving more and more communications based activities to the internet. The applications we run on the internet today are far different than those we ran 30 years ago. The ones we run tomorrow will be more different still. Today we have video communications, telephony, and medical monitoring. Who knows what we tomorrow's applications will be.
What then of the "four freedoms?"
Access to any internet site: Seems like a reasonable idea but is it? How about child pornography sites, or how to make a bomb? Should these sites be accessible? Common Sense says no. There is content and there are applications that are simply unacceptable within a given society. The argument can be made that it is the content, not access to the content that should be controlled. That's certainly true but the internet is a transnational network. The content may well originate from a rogue state or a state where the content is acceptable and thus not subject to control within the receiving state. When the content can not be controlled then the remaining remedy is to control access. That being the case the "access" freedom requires that we consider the question of how and who decides to block access. In a free society this is a very thorny issue. Should the bandwidth provider decide? Common sense says no as the bandwidth provider has no particular legal or social more standing. How about the government? Common Sense is troubled by the notion of direct government control as there is a history of highly inappropriate and frequently illegal government blocking and control by classification. Fundamentally Common Sense sees this as a free speech issue with all the attendant complexities.
Use of any application: Again, it seems like a reasonable idea but is it? What is the relative value of my nieces tweet compared say to the data stream from a heart patient? Or how about a tweet compared to a fire alarm? Or how about a call to 911 compared to a conversation with my brother? NOT ALL DATA IS EQUALLY IMPORTANT! NOT ALL APPLICATIONS ARE EQUALLY VITAL! Bandwidth is limited and Common Sense says that some data and some applications deserve priority. The question then becomes who decides? Should the bandwidth provider decide? Common sense says no since there are many examples of providers acting not in the interest of society at large but in their own financial interest. How about a government agency? Common Sense says perhaps as the FCC has been marginally effective at regulating similar issues, at least recently, though Common Sense is concerned about political (read corporate money) influence. How about an independent entity like the IANA, internet assigned numbers authority. Common Sense likes this notion since by and large the IANA has worked reasonably well.
Ability to hook up any device: This freedom seems entirely reasonable to Common Sense. One can go back to before telephone deregulation when there was a similar issue with regard to telephone handsets, answering machines, and other telephony equipment. Initially AT&T did not allow such devices to be connected to the phone system. History tells us that the reasons were not technical but business, an attempt by AT&T to maintain an iron grip on telephony. But deregulation happened and today we have many choices of telephony equipment and the telephone network was not destroyed in the process. Of course there had to be rules that insured compatibility between equipment and the network. Common Sense thinks this is entirely reasonable.
Transparency: Common Sense thinks transparency is important. But what kind of transparency? When the other internet freedoms are constrained as Common Sense thinks is reasonable it is essential that those constraints be public and clearly stated. But is this enough? Common Sense thinks not! Common Sense believes that when an internet freedom is constrained there must be a clear mechanism for challenging the constraint. While Common Sense thinks that it is OK to block sites, Common Sense doesn't think that the NY Times should be blocked because it republished some Wikileaks material. So if the Federal Government decided to block the NY Times or for that matter Wikileaks there must be a remedy that allows society as a whole to challenge. Common Sense believes that constraints on freedoms must be transparent and that the transparency freedom must include a mechanism to challenge those constraints.
I was just starting my technical career when the internet was created. I had a hand in some of the earliest internet development. I've seen it grow from a private network between a handful of research labs with a limited number of applications to a ubiquitous communications environment with applications that were never imagined 40 plus years ago. Common Sense thinks that regulation is both inevitable and necessary. That said, the kind of regulation and the details of regulation are critical. Common Sense believes that the internet has the potential to change not only the US society but the world society profoundly for the better. Common Sense believes that inappropriate regulation can damage or perhaps destroy that potential.
- Access to any internet site
- Use of any application
- Ability to hook up any device
- Transparency
On the face of it, these notions appear reasonable and fair. But are they?
One important consideration is bandwidth. For those non-geek, bandwidth is the ability of the internet to carry data. We've all seen bandwidth issues when using the internet. "The internet is slow today" is a frequently heard complaint. In fact sometimes the internet IS SLOW. It's slow because there are more users than typically; or those users are using network intensive applications like video; or part of the internet infrastructure is currently unavailable because of maintenance or outage; or sun spot activity is high and radio communications are effected; or any number of other reasons. The central point is that internet bandwidth is NOT LIMITLESS. That's true of both wired and wireless internet. Bandwidth is also NOT CONSTANT. Bandwidth varies with time, the number of users, user applications, etc. These are simply technical facts of life, technical realities that CAN NOT BE IGNORED.
Another consideration is that there are some fundamental differences between wire and wireless internet. Generally, wire internet has much more bandwidth than wireless. While 4G wireless brings much more bandwidth to the individual wireless cell and users in that cell, the available bandwidth remains much lower than that available to wire users in a wired internet head end distribution point (a similar technical constraint). Try as one might, it's much easier technically to get bandwidth down a hard link like a cable or fiber optic line than it is over an RF channel. Hard connects simply have more inherent non-conflicting bandwidth.
A final consideration is that increasingly we are moving more and more communications based activities to the internet. The applications we run on the internet today are far different than those we ran 30 years ago. The ones we run tomorrow will be more different still. Today we have video communications, telephony, and medical monitoring. Who knows what we tomorrow's applications will be.
What then of the "four freedoms?"
Access to any internet site: Seems like a reasonable idea but is it? How about child pornography sites, or how to make a bomb? Should these sites be accessible? Common Sense says no. There is content and there are applications that are simply unacceptable within a given society. The argument can be made that it is the content, not access to the content that should be controlled. That's certainly true but the internet is a transnational network. The content may well originate from a rogue state or a state where the content is acceptable and thus not subject to control within the receiving state. When the content can not be controlled then the remaining remedy is to control access. That being the case the "access" freedom requires that we consider the question of how and who decides to block access. In a free society this is a very thorny issue. Should the bandwidth provider decide? Common sense says no as the bandwidth provider has no particular legal or social more standing. How about the government? Common Sense is troubled by the notion of direct government control as there is a history of highly inappropriate and frequently illegal government blocking and control by classification. Fundamentally Common Sense sees this as a free speech issue with all the attendant complexities.
Use of any application: Again, it seems like a reasonable idea but is it? What is the relative value of my nieces tweet compared say to the data stream from a heart patient? Or how about a tweet compared to a fire alarm? Or how about a call to 911 compared to a conversation with my brother? NOT ALL DATA IS EQUALLY IMPORTANT! NOT ALL APPLICATIONS ARE EQUALLY VITAL! Bandwidth is limited and Common Sense says that some data and some applications deserve priority. The question then becomes who decides? Should the bandwidth provider decide? Common sense says no since there are many examples of providers acting not in the interest of society at large but in their own financial interest. How about a government agency? Common Sense says perhaps as the FCC has been marginally effective at regulating similar issues, at least recently, though Common Sense is concerned about political (read corporate money) influence. How about an independent entity like the IANA, internet assigned numbers authority. Common Sense likes this notion since by and large the IANA has worked reasonably well.
Ability to hook up any device: This freedom seems entirely reasonable to Common Sense. One can go back to before telephone deregulation when there was a similar issue with regard to telephone handsets, answering machines, and other telephony equipment. Initially AT&T did not allow such devices to be connected to the phone system. History tells us that the reasons were not technical but business, an attempt by AT&T to maintain an iron grip on telephony. But deregulation happened and today we have many choices of telephony equipment and the telephone network was not destroyed in the process. Of course there had to be rules that insured compatibility between equipment and the network. Common Sense thinks this is entirely reasonable.
Transparency: Common Sense thinks transparency is important. But what kind of transparency? When the other internet freedoms are constrained as Common Sense thinks is reasonable it is essential that those constraints be public and clearly stated. But is this enough? Common Sense thinks not! Common Sense believes that when an internet freedom is constrained there must be a clear mechanism for challenging the constraint. While Common Sense thinks that it is OK to block sites, Common Sense doesn't think that the NY Times should be blocked because it republished some Wikileaks material. So if the Federal Government decided to block the NY Times or for that matter Wikileaks there must be a remedy that allows society as a whole to challenge. Common Sense believes that constraints on freedoms must be transparent and that the transparency freedom must include a mechanism to challenge those constraints.
I was just starting my technical career when the internet was created. I had a hand in some of the earliest internet development. I've seen it grow from a private network between a handful of research labs with a limited number of applications to a ubiquitous communications environment with applications that were never imagined 40 plus years ago. Common Sense thinks that regulation is both inevitable and necessary. That said, the kind of regulation and the details of regulation are critical. Common Sense believes that the internet has the potential to change not only the US society but the world society profoundly for the better. Common Sense believes that inappropriate regulation can damage or perhaps destroy that potential.
Sunday, December 19, 2010
Racism and xenophobia in Isreal
Israeli holy town sends message of exclusion to Arabs
Rabbis frown at rentals, warn of intermarriage
By Joel Greenberg Washington Post / December 19, 2010 SAFED, Israel — In the winding stone alleys of this Galilee hill town, a centuries-old center of Jewish mysticism, a campaign is underway.
It is being waged by the town rabbi, Shmuel Eliahu, who along with other area rabbis issued a religious ruling several months ago forbidding residents to rent apartments to Israeli Arab students from the local community college.
The rabbi has warned that the Jewish character of Safed, long revered as sacred, is at risk and that intermarriages could follow if the students mingle with the locals.
Last month, Eliahu called a public meeting to sound the alarm. On the agenda was “the quiet war,’’ a reference to the feared Arab influx, and “fighting assimilation in the holy city of Safed.’’
Several days later, a building that houses Arab students was attacked by a group of young Jews, and an elderly Holocaust survivor renting a room to students received threats.
To civil rights advocates and other critics, the unsettling developments in this normally quiet community of 32,000 are a window into ugly currents of racism in Israeli society. The events here, the critics say, reflect a general atmosphere of growing intolerance under a government and Parliament dominated by parties of the nationalist right.
Common Sense finds this very troubling on several grounds. Considering that Jews have been widely persecuted one would imagine that they, particularly a teacher, a rabbi, would understand better than any that racism and xenophobia are ugly and vial. Yet here we have a rabbi promoting just that. And we have a group of Israelis attacking an elderly Holocaust survivor for the offense of renting a room to an Arab. That is no different than the actions of the Nazis that created the Holocaust. That this was a crime of Jews on a Holocaust survivor is offensive and profoundly wrong. Common sense feels that we should all be better than this, particularly a people, an ethnic group, that has first hand experience of racism and xenophobia.
Tuesday, December 7, 2010
Is really OK for the Federal Government to order the killing of a US citizen without trial?
From the WSJ
U.S. District Judge John Bates said the father's suit seeking to block President Barack Obama from ordering the extrajudicial killing of his son "lacks standing." Also, said Judge Bates, "his claims are non-justiciable," or incapable of being settled by a court.
The ruling is a victory for the Justice Department. While not acknowledging plans to kill Mr. Awlaki, it argued that the cleric as a U.S. citizen could ensure his safety by turning himself in to U.S. authorities or seeking the protection of the court himself.
Mr. Awlaki's fiery Islamist sermons are popular among jihadists on the Internet, and he is a target of the U.S. program aiming to kill leaders of terror groups, U.S. officials say.
The U.S. says Mr. Awlaki is a leader of al Qaeda in the Arabian Peninsula, or AQAP, the group the U.S. says was behind the recent thwarted attempt to blow up U.S.-bound planes with package bombs as well as the botched attempt to bomb an airliner last Christmas Day. AQAP has claimed responsibility for the plots.
In court last month and in his order Tuesday, the judge called the lawsuit an extraordinary case. He said the suit was dismissed without having to consider the government's state-secrets argument, which held that the court couldn't hear the case because it would expose sensitive classified information.
Write to Evan Perez at evan.perez@wsj.com
Common Sense is troubled by this news item. It is certainly true that Mr. Awlaki is not a nice man. It is certainly true that his actions are reprehensible and, likely treasonous and perhaps illegal. It is also certainly true that this otherwise evil man is an American citizen and, as such, entitled to protection under the Constitution. It is true that he has fled the US and that there is a valid arrest warrant outstanding. But, does that mean that the Federal Government can order his murder/execution without a trial? Common Sense says no, otherwise we acknowledge that the Federal Government can arbitrarily execute a citizen, a proposition that clearly flies in the face of law, justice, and Common Sense.
More troubling is that Mr. Awlaki's presenting offense is speech! If the speech is illegal, let him be tried and sentenced for his actions. If he is guilty of other offenses, let him be tried and sentenced for those actions. That the Supreme Court argues standing is also troubling since it means that Mr. Awlaki, a US citizen, is denied constitutional redress. That the Court argues that the claim is "non-justiciable" is very troubling since we are to accept that the Supreme Court can not intervene is what is clearly an Executive Branch action. Common Sense is offended.
That the Justice Department argues that "as a U.S. citizen could ensure his safety by turning himself in to U.S. authorities or seeking the protection of the court himself" is both silly and outrageous since it would establish the proposition that a US citizen having fled the country can be coerced to return by the threat of murder/execution. Common Sense is greatly offended by this as well.
Al Qaeda is certainly evil. Mr. Awlaki as a vocal proponent likewise so. Al Qaeda and Mr. Awlaki would deny America its right to exist as a free society governed by law not religious zealotry. When we deny Mr. Awlaki, a US citizen, the protection of law we become in some way like Al Qaeda. America IS a country of law. As such we need to be sure that the principal of equal protection is extended to all US citizens, even the most reprehensible and evil.
Just some Constitutional Common Sense.
Court Dismisses Suit Over Targeted U.S. Killings
By EVAN PEREZ
WASHINGTON—A federal judge on Tuesday dismissed a lawsuit by the father of Yemeni-American radical cleric Anwar al-Awlaki challenging the Obama administration's targeted-killing program.U.S. District Judge John Bates said the father's suit seeking to block President Barack Obama from ordering the extrajudicial killing of his son "lacks standing." Also, said Judge Bates, "his claims are non-justiciable," or incapable of being settled by a court.
The ruling is a victory for the Justice Department. While not acknowledging plans to kill Mr. Awlaki, it argued that the cleric as a U.S. citizen could ensure his safety by turning himself in to U.S. authorities or seeking the protection of the court himself.
Mr. Awlaki's fiery Islamist sermons are popular among jihadists on the Internet, and he is a target of the U.S. program aiming to kill leaders of terror groups, U.S. officials say.
The U.S. says Mr. Awlaki is a leader of al Qaeda in the Arabian Peninsula, or AQAP, the group the U.S. says was behind the recent thwarted attempt to blow up U.S.-bound planes with package bombs as well as the botched attempt to bomb an airliner last Christmas Day. AQAP has claimed responsibility for the plots.
In court last month and in his order Tuesday, the judge called the lawsuit an extraordinary case. He said the suit was dismissed without having to consider the government's state-secrets argument, which held that the court couldn't hear the case because it would expose sensitive classified information.
Write to Evan Perez at evan.perez@wsj.com
Common Sense is troubled by this news item. It is certainly true that Mr. Awlaki is not a nice man. It is certainly true that his actions are reprehensible and, likely treasonous and perhaps illegal. It is also certainly true that this otherwise evil man is an American citizen and, as such, entitled to protection under the Constitution. It is true that he has fled the US and that there is a valid arrest warrant outstanding. But, does that mean that the Federal Government can order his murder/execution without a trial? Common Sense says no, otherwise we acknowledge that the Federal Government can arbitrarily execute a citizen, a proposition that clearly flies in the face of law, justice, and Common Sense.
More troubling is that Mr. Awlaki's presenting offense is speech! If the speech is illegal, let him be tried and sentenced for his actions. If he is guilty of other offenses, let him be tried and sentenced for those actions. That the Supreme Court argues standing is also troubling since it means that Mr. Awlaki, a US citizen, is denied constitutional redress. That the Court argues that the claim is "non-justiciable" is very troubling since we are to accept that the Supreme Court can not intervene is what is clearly an Executive Branch action. Common Sense is offended.
That the Justice Department argues that "as a U.S. citizen could ensure his safety by turning himself in to U.S. authorities or seeking the protection of the court himself" is both silly and outrageous since it would establish the proposition that a US citizen having fled the country can be coerced to return by the threat of murder/execution. Common Sense is greatly offended by this as well.
Al Qaeda is certainly evil. Mr. Awlaki as a vocal proponent likewise so. Al Qaeda and Mr. Awlaki would deny America its right to exist as a free society governed by law not religious zealotry. When we deny Mr. Awlaki, a US citizen, the protection of law we become in some way like Al Qaeda. America IS a country of law. As such we need to be sure that the principal of equal protection is extended to all US citizens, even the most reprehensible and evil.
Just some Constitutional Common Sense.
Friday, December 3, 2010
Republicans message to America: It's our way or the highway
Republicans Slam Democratic Proposal as 'Political Exercise'
Dec. 3, 2010
Senate Majority Leader Harry Reid said he plans to hold two tax cut votes on Democratic proposals Saturday after a bipartisan deal to have four votes in the Senate collapsed.
The two Saturday votes will be on the House-passed bill to extend tax cuts for Americans earning under $250,000 a year and another from Sen. Chuck Schumer, D-N.Y., to raise the threshold to $1 million a year.
On Thursday, Reid, D-Nev., had been working with Republicans to gain the unanimous consent of all senators to bring four votes to the floor -- the two Democratic proposals as well as two Republican ones.
The GOP votes were to be on a proposal to permanently extend the tax cuts for all Americans, including the wealthy, and a proposal to temporarily extend all the tax cuts for five years. However, a Republican senator objected, so Reid instead filed cloture tonight on the two Democratic proposals.
"We think we can show the American people what the Democratic priorities are and we are free to talk about what the Republican priorities are because they showed us today," Reid told reporters after a night of closed-door meetings on the Hill.
"We are for tax cuts for the middle class and they will do everything they can to further their number-one goal: tax cuts for millionaires and billionaires," outlined Schumer.
No sooner had the upcoming flurry of Senate votes been announced by Democrats than Sen. Orrin Hatch, R-Utah, accused them of "pandering to their political base" with "pointless" votes that are "charades."
"With only 28 days until middle-class families, job creators and investors are hit with massive job-killing tax hikes, Senate Democrats are scheduling pointless tax votes that have no chance of becoming law," Hatch said. "Pandering to their political base with these votes isn't the responsible action the American people are demanding from their elected officials."
================================================
On Thursday, Reid, D-Nev., had been working with Republicans to gain the unanimous consent of all senators to bring four votes to the floor -- the two Democratic proposals as well as two Republican ones.
The GOP votes were to be on a proposal to permanently extend the tax cuts for all Americans, including the wealthy, and a proposal to temporarily extend all the tax cuts for five years. However, a Republican senator objected, so Reid instead filed cloture tonight on the two Democratic proposals.
"We think we can show the American people what the Democratic priorities are and we are free to talk about what the Republican priorities are because they showed us today," Reid told reporters after a night of closed-door meetings on the Hill.
"We are for tax cuts for the middle class and they will do everything they can to further their number-one goal: tax cuts for millionaires and billionaires," outlined Schumer.
No sooner had the upcoming flurry of Senate votes been announced by Democrats than Sen. Orrin Hatch, R-Utah, accused them of "pandering to their political base" with "pointless" votes that are "charades."
"With only 28 days until middle-class families, job creators and investors are hit with massive job-killing tax hikes, Senate Democrats are scheduling pointless tax votes that have no chance of becoming law," Hatch said. "Pandering to their political base with these votes isn't the responsible action the American people are demanding from their elected officials."
================================================
Where does common sense begin?
First the Republicans could have had their measures brought to a vote but they objected presumably knowing that those measures would not pass. Message to Americans, "If you want to vote on non Republican measures hit the rode. If we can't have our way go away." Common Sense says this is NOT governance, it's borderline totalitarian by a single party.
Second, Mr Hatch, R-Utah, accuses the Democrats of "pandering to their political base" with "pointless" votes." That makes so little sense as to be nonsense. All political parties pander to their base. That's what they are suppose to do. Beyond that, facts show that it is not the Democrats but rather Republicans that pandered by objecting to having their own measures voted on and allowing the Democratic measures to come to a vote. Common Sense says this is just another example of telling the lie often enough that someone believes it true.
Finally, Sen. Chuck Schumer, D-N.Y., to raise the threshold to $1 million a year! Common Sense says that $1 million a rear is NOT middle class. Come on lets get real people making $1 million a year are NOT suffering like people making $250 a year, and certainly not like people out of work.
As a nation we are just beginning to recover from the worst economic crisis since the Great Depression. That crisis occurred because our Congress passed laws that allowed it to occur; because government chose to be dogmatic and partisan, and not to govern for the common good. It's time that Congress grow a pair and deal with the real problems of real Americans.
Just a Common Sense point of view.
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