Friday, October 9, 2015

Mandatory Insurance for Gun Owners

The mass murder committed at Umpqua Community College is a terrible reminder of the risk we accept by allowing widespread ownership of the means to easily and speedily commit mass murder.  We need a better way to manage that risk.

A rough toll of costs at UCC includes lost earnings, ongoing medical, disability, loss of companionship, and loss of use.  Those damages likely add up to tens of millions of dollars.  Some of that will be paid by insurance coverages such as workers comp or medical, some of it will be paid by charity, and some of it will be left for victims and their families to eat.  Virtually none of it will be paid by those most responsible, the shooter and those who gave him access to firearms.  Why should that be?  Why should the public bear the cost of private, risky decisions that inflict catastrophe on us?

There is an alternative, one that balances respect for gun rights with a recognition of the costs they impose on society.  Require anyone possessing a gun to also hold high-limit liability insurance.  Require anyone transferring a firearm or ammunition to verify the recipient's insurance coverage, with failure to perform that duty constituting negligence should the recipient use them to harm people.

Such insurance would not be a simple flat tax on gun owners.  Insurers are good at classifying risks and determining what factors are connected with high costs.  An older rural hunter who uses a gun safe probably wouldn't pay much, an unemployed young male who collects pistols when he isn't smoking pot might have to pay a lot.  Why shouldn't he?  Why wouldn’t we want him to?

A benefit of using private insurance to manage gun ownership is that it takes the task away from the government.  Insurers would compete for business using whatever plans and assumptions they wanted.  Neither the state nor any single insurer would decide who could or couldn’t own a gun, instead the market would determine the cost of ownership based on an individual’s risk.  For those who believe that private gun ownership constitutes a check on government, insurance creates a kind of regulatory buffer.  The state’s only role would be to ensure that those who had guns could make good on the damages that result.

Mandatory insurance provides a central means of recovery for victims of gun violence, funded by those most responsible for the violence.  It provides market pricing, recognizing that gun owners are a diverse group posing diverse risks.  It minimizes the role of the state, respecting the intent of the second amendment.  And it sends a much needed message to gun owners every time they buy a gun or a bullet: that their private decisions have public consequences, and they will be made to pay for them.

Gun rights advocates routinely dismiss the risk that widespread ownership of firearms poses to the public.  We should demand they put their money where their mouth is.

Tuesday, September 29, 2015

The difference between health care and housing policy, and why I'm inflexible on the latter

This was written in response to a friend's comment on facebook.  Published here because I hate reading long comments on facebook.

I think there are two big differences between our discourse on housing policy and that with health care.

First, the external context for the latter was much more objectively defined.  Health care had been the topic of extended national debate.  There was tremendous literature on health care reform, from academics to journalists and everyone in between.  Many of those people were self-consciously working to inform public debate, people like Aaron Carroll and Uwe Reinhardt put a lot of work into translating research results and policy discussion into layman's terms.  You and I could draw on that, it wasn't just "I think…".  Finally, when we began discussions the ACA was law, we never dealt with mutually exclusive choices where doing one thing necessarily implied not doing something else.  We also never confronted value choices like universal coverage vs. affordable care for the very sick, the ACA set the table.

None of that is the case with housing policy.  I find the literature sparse and of limited scope, and the only people promoting it in public discourse are advocates of one policy or another.  There's nothing objective to connect with.  And with that material we confront a vaster problem, the gulf between "what is" and "what should be" is bigger with housing.  For example, even before health care reform we had  backstops, anyone could walk into an ER and receive life sustaining care.  We didn't have bodies in the street.  That's clearly not the case with housing.  A bigger problem means bigger solutions, and more variability in preferred courses of action.

The second difference is that with health care, I thought both the state and the country were going in the right direction.  Political debate was focused on how best to expand access to care, there was no voice of significance arguing that we needed less access to care, or that some people should get care and others should not.  I'd liken health care discourse to a river that, while it had rocks and other hidden dangers that could turn over the unwary, would sooner or later get everyone to the right place.  In contrast, I think the housing discourse in Portland is headed to a terrible place. 

Two groups have dominated that discourse in recent years.  One is a large chunk of people interested in nothing other than preserving the economic exclusivity of their neighborhoods.  The other is a smaller chunk of people who think the problem isn't that there's not enough housing, but that the wrong people get it.  They want to take housing away from some people and give it to others.  Those two groups define political discourse in Portland, every code or policy proposal related to housing since Sam Adams left office served one group or the other.  Needless to say, I think both groups are wrong.  To go with the flow, to not contest the bogus assumptions (less housing means lower prices!  people can't live without cars!) and questionable values (I should be able to dictate the economic class of my neighbors!) they rely on, is to accept a more racially and economically exclusive Portland.  I don't want that.

At the bottom, I suspect we have fundamentally different ideas on what a community should do to define itself. I'd call one way a negative approach, to exclude those who don't conform.  How do you maintain a neighborhood of Amish people?  You refuse to allow residency to anyone who isn't Amish.  That negative approach is conservative and reactive, at best it preserves what is.  It relies on authority rather than consent.  It is sterile, incapable of building anew.

As you might guess, I think the negative approach is intensely undesirable, I'd go so far as to say it's a recipe for community self-destruction.  Such a community lasts only so long as it attracts sufficient members, and as soon as its authority or self-definition is violated it becomes meaningless.  White city neighborhoods that spilled blood resisting integration only to crumble away into suburban flight are an example.

The alternative is a positive approach, to promote public community institutions and traditions that are open to all.  Things like parks, schools, and community groups can include residents regardless of demographics.  They can demonstrate to residents what they can do, and why they should care.  That approach creates a two-way conversation, it continually challenges groups to show their relevancy and adapt as necessary.  It doesn't just maintain but increases the public good by bringing an interest to people who wouldn't otherwise be exposed to it, and in turn by being exposed to new ideas and challenges that exclusion wouldn't allow.

I think the positive approach, building more good, is what Portland desperately needs.  I think that's how Portland should respond to growth.  Not by putting up walls, but by embracing people and showing them who we are.

Monday, September 7, 2015

Aristocracy of Everyone

I finished reading Benjamin Barber's An Aristocracy of Everyone.  It was published in 1992, the same year I headed to college.  The context in which it was written- the emergence of multiculturalism, and reactionary criticism of "political correctness", brings back memories.

Barber tries to carve out a middle ground between radical and reactionary, and he does it in an interesting way.  He starts from the equation that Liberty = Education, and that a primary purpose of getting educated is to understand liberty and support it.  Barber is worried that we've lost our sense of "positive" liberty, the obligations we must accept to make self-government possible.  We're too infatuated with "negative" liberty, the right to do as we please without interference.  The latter without the former is impossible because we interact with each other too much, generally speaking we aren't hermits.

To the left Barber says that majority rule by itself isn't enough for good governance, that uneducated voters are no more than a mob waiting for their demagogue.  To the right Barber says that liberty for the masses is both possible and desirable, and implicitly they are flim-flam artists for wanting otherwise.

It's heady stuff and there's a lot of quotable material.  But it comes up short in in its prescription:  How do we educate people in liberty?  Barber's suggestion is to add a service component to undergraduate degree requirements.  This is inadequate on multiple levels.

First, as Barber ably demonstrates the problem of uneducated citizens isn't primarily a problem of youth.  The dominant systems students interact with- education, economy, culture- are largely controlled by elders.  The world outside of college is much, much bigger than the world inside of college.  Adding a service requirement won't change those systems or the incentives they create.

Second, what work does Barber envision students doing?  He means for work to be a component of education in democracy and its obligations, something more than charity.  What would he have students do?  Invert the question and ask how much does your company need a bunch of pre-interns who explicitly aren't actually working for you, but are instead guided by a goal of understanding democracy and its obligations?  Who, outside of non-profits, would even let them in the door?  I think the service requirement runs into a hard reality that most of our economy is private, it has nothing to do with democracy.

The answer to Barber's challenge has to focus on people who aren't students, on civic organizations that bring people together to pursue common interests.  Those interests might be political, such as with a political party, they might be local, as with a neighborhood association or PTA, or they might be issue oriented such as with advocating a cause.  What they have in common is
    • people coming together, working in concert and learning that the whole is greater than the sum of its parts,
    • coming together on a public matter, not limited by class or education, and
    • doing it in their free time, as in not subject to anyone's direction but their own.  When people are at work they aren't free, they're guided by bosses or business requirements.  Liberty exists when we aren't a Teacher or a Welder or an Accountant, but when we act on our own as citizens. 

Learning about liberty means learning that what we do "on our own" in public matters, those actions define what is public. 

Friday, September 4, 2015

Unsolicited Advice for Portland Mayoral Candidates

I took a poll the other day which asked a number of questions about Portland and the mayoral race.  My assumption is those questions are on behalf of a potential candidate, and they're testing the waters.

The poll focused on economic matters:  how is the economy doing, how important are jobs, should Portland try to entice businesses from out of state to move here or focus on growing our own, etc.  They're all good questions on their own, but if that's the focus of a mayoral candidate I think they're all wrong.  In my view Portland's economy is doing pretty well, and when the economy does well people take it for granted.  It won't get votes.

What will get votes is articulating a response to Portland's population growth and housing shortage.  Portland desperately needs not just a direction or a set of actions that will happen ("we'll build more housing, we'll stop demolitions") but a reconciliation with our commitment to sustainability and livable neighborhoods that have long defined the city.  To paraphrase a wise person who's name escapes me, out of
  • affordable housing, 
  • a tight UGB, and
  • our current neighborhood densities,
we can only have two out of three.  One way or another we have to compromise on one of those, and we ought to explicitly decide which.  If we don't, we'll lose affordable housing by default.  That's a shitty thing to do to people with lower income.  If we're pushing them out, the least we can do is tell them so and tell them why.  And if we're embarrassed to say such things out loud then maybe we should look at a different compromise.

I think (I hope) the next mayor will be someone who presents that call, who can answer it out loud, and convince us that they are right.

Thursday, August 27, 2015

Equity without Measurement is Impossible

This is a popular image demonstrating the difference between equality and equity (with equity implicitly the more desirable outcome).  Think about something though.  What does equity mean without measurement?  It's easy in the picture because we can see it, height is easily gauged by visual inspection.  But what happens if we don't know anything about height, either of the kids or the fence they all want to see over?  

To get a sense of the problem, imagine if we could only see the kids from above:

Without height, all we see are the tops of three heads and the fence in front of them.  How do we know who needs more resources and who needs less?  How do we know who can see over the fence?  Without the ability to measure height we can't answer any of those questions.  We could make some kind of guess and move resources based on that, but we wouldn't know if we were improving equity or diminishing it.  In the absence of measurement equity is impossible, even if we got lucky and lined up everything perfectly no one would know it.

I bring this up because measurement in at least one area, education, is a highly contentious issue.  Opposition to testing is a mainstream movement in Portland, even promoted by School Board members.  Not infrequently, those people also claim to be concerned with equity.

Any test can be improved, and any process informed by tests can be improved.  But categorically rejecting testing, which seems to me the heart of the anti-testing movement, simply isn't compatible with a commitment to equity.  Without testing policy is necessarily blind, and equity nothing more than a good but meaningless intention.

Saturday, June 20, 2015

A letter to my state legislators on Clean Fuels Standards

I'm writing to urge you to reject pressure to repeal Oregon's Clean Fuels law, particularly as part of some larger package involving transportation and land use.  Oregon is already feeling the impact of climate change with widespread drought and ocean warming, those impacts will only accelerate.  Clean Fuels is a small step towards a practical and inevitable response, shifting away from fossil fuels.  As compelling as Clean Fuels is, so are reasons to oppose the proposed repeal package.

The repeal package is at every level an abuse of process and an insult to democracy.  Where in the state constitution is there a "Gang of 8"?  Where does it say that Republican and Democratic interests must be given equal weight regardless of election results?  This isn't the first time we've seen a "Grand Bargain" that sacrificed process in the name of political expediency.  The result speaks for itself.

Please, look to the future.  Don't repeat mistakes of the past.

Thanks for your consideration,

Sunday, June 7, 2015

California Network Regulation Musings

Good doings in California on network regulation.  Two quotes jumped out at me. 
The problem this leaves is who's going to eat the excess charge? That's the core of the medical association's problem with the bill. It's asking that the measure be amended to "require an efficient, equitable dispute resolution mechanism that guides parties towards a reasonable rate for services," in the words of an Assembly staff analysis. The California Medical Assn. says it favors the approach of a 2014 New York law, which requires arbitration between providers and insurers, leaving the patient out of it. 
Arbitration in this context sounds like a polite word for "crappy rate setting process with limited input, limited consistency and limited accountability."  Why would anyone want that?  If we know physicians will do these services for these patients why not deal with it upfront by establishing what they will be paid?  That allows the possibility of opening the process and incorporating more of the interests involved.  Someone could argue, "why make a big deal about this when there's essentially no process around in network contracting?" but the difference is control.  If an insurance plan has a too-expensive or too-cheap network one can switch plans.  There's no equivalent remedy with out of network providers, whatever process the state comes up with is what everyone in the state lives with.  It ought to be held to a higher standard.
Here's the background. in the good old days, doctors in those three key specialties[radiology, pathology, and anesthesiology] were employees of hospitals, so if your hospital was in your insurer's network, they were too. Over time, many hospitals have outsourced these specialties to independent doctor groups, which may or may not be in the same network as the hospitals themselves. If they're not in yours, you could suddenly get a bill with an astronomical number at the bottom line.
Organizational structure matters.  Shock bills are stemming in part from hospitals arbitrarily and without any public discussion deciding that radiology, pathology, and anesthesiology are no longer their problem, instead it's the patient's responsibility.  That's a huge change that I don't think we'd accept uncritically in any other industry.  Airlines are getting pushback about baggage fees, imagine the outcry if one day they decided that ticket prices no longer paid for pilots and passengers had to pay that on their own.  Part of the solution here might well be stricter controls on what hospitals are allowed to outsource and what they're required to bundle within their own services.

Food for thought as I look forward to Oregon jumping into network regulation.