In response to my math question from yesterday, some of you wisely pointed out that medical insurance costs have to plateau at the point where they become literally unaffordable.

This made me wonder about the trajectory of medical expenses. On one hand, you can imagine that technology will lower the cost of routine medical treatment. The cost of existing drugs will drop as they go off patent protection. And maybe gene therapy will, in time, end up being inexpensive relative to traditional medicine. One can hope.

On the other hand, scientists keep coming up with new and expensive medical procedures, and new and better drugs. For example, the surgery that gave me back my ability to speak is relatively new. So you can imagine a world where POTENTIAL medical costs rise indefinitely because science keeps coming up with ways to fix medical problems that might have otherwise gone untreated.

My prediction is that medical insurance will cover more and more procedures, but if you consider all of the things that can be covered, it will be a smaller percentage. In other words, if insurance currently covers 90% of what you might need, someday it will only cover 70%, because that's all the public can afford. But that might represent far more medical procedures than your insurance covers today, so it might not seem so bad.

As some of you pointed out, a person's health insurance should start out cheap when you are young, and increase every year as you age. So if you want to take a crack at yesterday's question by altering the cost/year assumption, I'd be interested in that result.

Here's a little math problem. Let's see who can solve it first. The question is this: How much money would you need to give to a 21-year old today, in a lump sum, so he can invest it and pay for his lifetime of healthcare?

Your assumptions are as follows:

-        Life expectancy: 85

-        Health insurance currently costs $6,000 per year

-        Healthcare costs rise 10% per year

-        Investment income averages 4% per year after taxes

-        You can spend your principle too, so you have zero left at death

Feel free to add any assumptions I left out, except for assuming a higher investment return. You would invest your healthcare money in something safe, such as municipal bonds.

Over the past 20 years or so, most of China's leaders have been engineers. I'm embarrassed to say that I was not aware of this until recently. Suddenly, everything makes sense.

For years I have marveled at the fact that the Chinese government could be so practical. They didn't seem bogged down by the superstitions and sideshow passions that you so often see in other governments. China's leaders make decisions like engineers. For example, every time I hear someone yapping about how China harvests organs from executed criminals, all I'm thinking is That's a practical way to get spare parts.

China's leadership isn't big on religion. And apparently they don't see any upside in war. They handle their money wisely. They put a lot of energy into building infrastructure. And they care more about stability than human rights. In other words, they value efficiency over feelings. It's exactly the way you'd expect a bunch of engineers to run a country. Obviously this approach has served China well.

The bad news for China is that their up-and-coming leaders have backgrounds in law, economics, and history. In time, the lawyers will start passing lots of laws that individually make sense while collectively strangling the business sector in red tape. The economists will all disagree with each other, and the historians will be planning for the past. So China is pretty much doomed. But they had a good run.


Before you complain that I'm a socialist who wants to take away your freedoms and your money, what follows is just a thought experiment. I start with the premise that the government of the United States, against all odds, declares universal healthcare a basic right.

Obviously no one has figured out how to pay for universal healthcare in a way that society can swallow. So today's thought experiment imagines that ALL options are on the table except raising taxes, just to make this interesting.

As President Obama has pointed out, there might be some savings involved with covering everyone. At the moment, two-thirds of all bankruptcies are caused by medical bills. If that problem goes away, society saves a bundle.

If we assume a so-called single payer option goes into effect, which means the government offers an insurance program in competition with private insurers, we could eventually see some drops in prices. If you prefer keeping your private insurance company, the only change you would see is a lower bill.

A big benefit of universal healthcare insurance is job mobility. At the moment, lots of people stay at suboptimal jobs because switching jobs would mean losing healthcare for themselves or their families. That's a huge drag on economic efficiency. I suppose wages might creep up if people feel more freedom to job hop, and there would be some extra training involved for all the fresh meat, but on balance I'm guessing job mobility is a boost to the economy, and potentially a big one.

Another economic benefit from universal healthcare coverage is that doctors can catch problems early, before they become more expensive to treat. That's a winner all around.

A big downside of insuring everyone is that in the short run there wouldn't be enough doctors to go around. One solution is to recruit qualified doctors from overseas. If they can pass the same tests as American doctors, they're in. I have to think we'd have plenty of doctors in that case. Then the shortage becomes the problem of other countries.

Next, we legalize doctor-assisted euthanasia, under strict medical guidelines. A disproportionate amount of healthcare costs go toward the last few months of life, when the patient is getting very little bang for the buck. I don't know anyone who wouldn't want the option for himself.

Then we require junk food to be labeled like cigarettes, and make it a national priority to decrease our exposure to unhealthy food. People still have to eat, so perhaps the fast food outlets could make the same profit from offering convenient food that is healthy, even if it isn't as tasty and addicting. The government could bully or legislate unhealthy foods out of our diets if it needed to.

Next, the government could start to push the benefits of exercise. And I don't mean the hand-waving they do now. I mean a serious push, until couch potatoes start feeling like flag burners. Exercise could become a matter of national pride.

The government could tax cigarettes into the realm of novelty. Remember, this is the imaginary world of the thought experiment. If universal healthcare is mandated, and you don't want to wait ten months to see a doctor like you do in Canada (allegedly), then society has to make some hard choices.

The government could also require your doctor to treat patients by e-mail, as my HMO already does. That probably saves 10% on patient visits right off the top. Once hi def cameras are more ubiquitous, you should be able to e-mail photos of your bruises and suspicious moles to your doctor too. And I have read that there is a lot of progress in various types of home medical monitors that can send info to your doctor. That should help.

Imagine also that employers who offer health insurance have to treat cohabitation just like marriage. If you're shacking up with someone, you have the option of being on their insurance plan, no further questions asked. Employers currently don't discriminate against married employees even though their families cost extra to insure. This simply extends that benefit to non-traditional familes.

I can also imagine a loosening of the rules for what a Nurse Practitioner can do without a doctor's direct supervision. Between the Internet and a Nurse Practitioner, patients can eliminate a lot of doctor visits.

Most of what I mentioned here is thoroughly impractical because of lobbyists, morons, bad leadership, superstition, and our addictions to unhealthy behavior. It's just interesting to imagine what universal healthcare would look like if it were a constitutional right and raising taxes was off the table.

I saw an article recently about states that have favorable taxation for retired people. I wonder if buying first-floor condos in those states would be a good investment, since demand will be rising.

And I wonder what other types of investments make sense as the baby boomers retire in numbers. Let's ignore the obvious ones, such as the companies who make rest homes, funeral homes, pharmaceuticals, canes, walkers, and Depend undergarments. I'm looking for the next level of cleverness. That's what I expect from my readers.

For example, I can imagine artificial grass becoming a boom business, both because of water shortages and because it takes mowing out of the equation. The fake grass these days looks convincing, and the prices are coming down. Replacing your lawn when you're about 60 might be a good investment, making it easier to retire in your current home.

Lately I have been hearing a lot of buzz about the game of bocce. The game has been around forever, but suddenly it's hot. I think that has a lot to do with the fact that you can do it at any age, and at any level of sobriety. And it's generally cheap. If there's a pure play in bocce, I'd take that bet. It's like catnip for the over-50 crowd. And the grandkids can play too.

Cruise lines seem like a good gamble. They make it easy to vacation on a budget, especially if you're not too active. And retirees are the ones who can most easily take a 3-week cruise.

Do you have any other non-obvious ways to make money from the boomer retirement bulge?

I'm fascinated by the debate over fixing/expanding the healthcare system in the United States. The issue is so complex that people understandably fall back on basic philosophies of the free market system to reach an opinion. For example, if you think the government tends to screw up everything it touches, and the free market does a good job, you might come down on the side of less government involvement in the healthcare system. But that view ignores the confusopoly effect.

A confusopoly - a term I concocted several years ago - is any industry that intentionally makes its products and services too complicated for comparison shopping. The best examples of confusopolies are cell phone carriers and insurance companies. And health insurance companies might be the most confusing confusopoly of all. I suspect that no individual has the knowledge, time, and information necessary to effectively compare two health insurance plans. And in that environment the free market doesn't operate efficiently.

Some people support the so-called Public Option for healthcare, where the government would offer health care in competition with the free market. The idea is that private companies would eventually lower prices to compete with the government's low cost option. That sounds good on paper, but the reality is that the private industry folks would use the uncertainty of the confusopoly to convince people that the government option would somehow end up killing its subscribers, e.g. "Sure, it looks inexpensive until your kidney starts hurting."

I think a better role for government would be shining a light on the existing private healthcare plans in a way that would help consumers choose the most economical option. The government did this successfully with the bank loan industry when it required all loans to have an APR, which is a single number that allows consumers to compare one loan to another. Healthcare can't be boiled down to a single number, but I suspect you could come up with a report card and some sort of average cost per subscriber. That way, consumers could shop wisely, and the free market might work the way it is meant to work.

Here's a concrete example. I have a health care plan that allows me to e-mail my doctor through the plan's website, and I usually get an answer in an hour or two. For 90% of the minor issues that would otherwise require a visit to the doctor, my doctor handles them in about half a minute by e-mail, including sending an electronic prescription to the pharmacy if needed. It is a HUGE time saver for me, and a big money saver for them, which I hope gets translated into keeping my premiums low. So here's my question to you: Which health care insurance do I use?

If you know the answer from something I wrote in the past, don't give it away in the comments. The point is that you can Google all day long and never find a way to compare health insurance plans on price or features. That's a problem that I think the government could fix.

Sep 18, 2009 | General Nonsense | Permalink
As regular readers know, I wonder if the economy is being manipulated by a small group of people who make vast fortunes by investing ahead of the swings. And if there isn't any major manipulation happening, the economy certainly acts that way.

You might have noticed that there are times, such as now, when the stock market is marching straight up and there is a suspicious lack of bad news. Oh, don't get me wrong - there is plenty of bad news out there if the media wants to focus on it. But for some reason (conspiracy) there is more emphasis on the good. That means something big and bad is in the pipeline to create the next unnecessary panic. The conspirators are tamping down on the smaller bad news stories to get the biggest bang out of the panic they intend to create. That's what my spider sense is telling me is happening now.

Perhaps the Dow will continue to 10,000, but the next big shock will be in the downward direction. I predict stories about some sort of financial crisis that you never even heard of, before the end of the year. And I predict it will drive the market down 20%.

And then Special Forces will find and kill Bin Laden, driving the market back up to new highs. You and I will find ways to lose money during these swings, by panicking and selling at the wrong times. The manipulators will double their money.

Disclaimer: Don't take investment advice from cartoonists, especially if it includes a reference to spider senses.

Sep 17, 2009 | General Nonsense | Permalink
In the old days you married whoever was nearby and willing. Today you have a greater chance of marrying someone who shares common traits. I wonder how this selective breeding will shape humans of the future.

We're already seeing this to some degree. Athletes often have parents who are both athletes. And geniuses generally have two parents that were inclined in that direction. IQ and athleticism are two obvious categories, but I wonder what other, less heralded traits will get exaggerated in the generations to come.

For example, religious people will continue mating with religious people, and atheists will seek out other atheists. By default, that leaves the agnostics to mate with each other. Will this group create babies who have an unusually hard time making decisions? Or on the positive side, will that group be unusually open-minded?

People who enjoy wine tasting are finding each other, and often mating, in numbers that never would have happened a hundred years ago. I assume this group has a more refined sense of taste and smell than the average person. Will they create babies with super senses?

I started thinking about this after reading an article about one researcher's hypothesis about the increase in autism rates. I stress that I don't think his hypothesis will pan out, but his line of thinking is fascinating. He noted that children of engineers are somewhat more likely to be autistic, and then observed that because there are more women in high tech jobs, you have more kids spawned from techie couples. Again, I don't think this link to autism will hold up to testing, but the line of thinking is interesting.

What other traits do you think will become exaggerated in the future?

I had planned to read the reports of inappropriate witticisms that many of you submitted yesterday and put the best one in today's post. It turns out that there is a problem with that plan: I really don't want anyone to know which one of those stories made me laugh hardest.

Somewhere in the darkest part of my mind there's a little dark room. And inside that room is a closet. And inside the closet is a little box, covered with a wool blanket. That's the place I plan to keep some of your stories, so I can laugh about them later without anyone knowing what a sick bastard I am.

The second problem is that picking a winner would be impossible. There are so many side-splitters in the group that I declare you all winners in your own way.

I have a theory that people who enjoy the darkest forms of humor don't subscribe to superstition, or to conformity unless it has a purpose. That probably describes Dilbert Blog readers pretty well.

When I was in my mid-twenties I attended a singles mixer in San Francisco, held outdoors on a pier. It was a frightening place for a shy person. One very Dilbert-looking fellow (literally), in a brown leisure suit, went straight to the outdoor bar and started ordering stiff drinks. I watched in awe as he chugged one after another, trying to find some social courage. Unfortunately he reached the blackout point before he reached the witty and charming sweet spot. I happened to be looking in his direction when he started to topple, like a diseased redwood tree. He was probably unconscious before he hit the pavement because he never used his hands to break the fall. It was a full-on face plant in cement. I didn't see him move again, even after the emergency crews arrived, although I assume he recovered.

Anyway, as the emergency crews worked on him, right in front of the outdoor bar, while the assembled crowd watched in horror, I walked up to the bar and said in an overloud voice, "I'll have what he had."

This witticism did not go over as well as I hoped. The bartender went into full legal defense mode, explaining that the fallen gentleman must have had many drinks before he even showed up. And none of the single women came up to me later and said anything like "That was very witty. I must have you." It was one of my more inappropriate moments.

Tell us your most inappropriate witticism. What's the worst thing you ever said out loud?

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