A Reader's Response to Healthcare

A reader responded to my Four Components of Healthcare Spending by advocating for a baseline level of government-sponsored health insurance, where people can purchase additional coverages if they want to. A tiered healthcare system, in the jargon of the day. Or similar to how MediCare has a "MediCare Part B" from private insurers.

It is important to note that the American Administration has specifically rejected such a tiered system in its current proposal, due to equality concerns.

Personally, I think we will end up with a tiered system. My analysis of the four components supports that conclusion. So actually, Anonymous, I somewhat agree with you. Where we differ, is on what the base healthcare plan should provide.

In your basic healthcare plan, it looks to me like you are covering all health problems/diseases, but only paying for standardized, concensus treatments for each of them. The coverage appears to be similar to private group plans today.

I disagree. I think the base plan should omit a couple categories. For example, there are many people who believes vaccines are bad. We should allow these people to opt out of the vaccine component of our base health plan. In return, however, we should either tax them, or charge higher insurance premiums, for their risky behavior, and for the greater disease transmission resulting from their actions.

Another example: Some people engage in risky behaviors such as drunk driving or speeding. Their actions increase demands for expensive trauma care. We should charge these people dramatically higher premiums for their risk to society.

Another example: Obesity is positively correlated to a whole host of health problems, and is also the probable cause for many of these problems. Treating Type II diabetes is expensive. So we should charge such individuals for the present value of these treatments. [ie, if they're young (20-ish) and obese, we should charge them enough money to cover their later treatments.] At the same time, we should reward people who lead a healthy lifestyle by lowering their premiums.

On the subject of healthy lifestyles, some people exercise too hard and sustain sports injuries. These injuries, such as hurt knees, ironically make these people more prone to become obese later in life. We should charge them for exercising too hard.

On the OB/GYN example you cited: Many people don't want kids, and some of them actually hate(!) kids. Should we make them share the cost of a child birth? Or is a newborn baby an inherent public good, which deserves taxpayer subsidy? Should we subsidize the families that bear more than 4 children?

The theory of mandatory healthcare coverage is that, by having a bigger client pool, we reduce the average expense for everyone. The assumption here is that, most of the uninsured Americans are of the young, healthy variety. However, that is not necessarily the case. By having mandatory coverage, we may in fact raise the per capita expense. Massachusetts's experience should hopefully have dispelled some of that assumption.

Another reason I broke out the four healthcare components is to show that, many individuals are willfully negligent, or in some cases, reckless, in managing their healthcare. As I commented elsewhere, we should not subsidize people's bad judgement. The moral hazard is too great. As a democracy, we expect voters to take responsibility for their political decisions. How can we then abrogate their responsibilities for their own personal health decisions?

Clarifications on Russia and Western Europe

An anonymous commenter responded to my thoughts on the Mistral order. He objected to my analysis because

I think Russia's present security preoccupations are NATO expansion towards
Russia's Near Abroad. Islam is a very minor threat to Russia, and entire
point of the SCO is to manage Sino-Russian interests without butting heads.

I responded:

Yes, Russians are pre-occupied with NATO expansion. However, as Defense
Secretary Gates has said, there's the war you're preparing for, and there's the
war that you're actually fighting.Yes, NATO is expanding. However, that does not
pose a security threat, per se, to Russia. Rather, it is more over spheres of
influence, prestige, and control.

In addition, NATO expansion is driven, in large part, by former Warsaw
countries such as Poland and Czech. If you think about intentions, these Central
European countries are more hostile toward Russia than, say, England and France
are. England and France may object to Russian internal politics on humanitarian
grounds, but that could change if Russia becomes more Westernized. Poles and
Czechs, on the other hand, will forever hold Russians in suspicion.

So geostrategically, England and France may be rekindling their strategic
relationship with Russia. Here I am thinking on historical timescales of
decades. Historians in the 22nd Century may well mark this Mistral order as the
start of the trend.

Ref SCO and China: For all the pomp and circumstance surrounding the SCO,
Russia is deeply worried about China due to the demographics. With the sporadic
anti-Chinese riots and actions in Moscow, and the de-facto Chinese colonization
of Russian Far East, China is Russia's biggest security risk at this moment.

As Russia is fighting its Muslim minorities right now, Islamic insurgency is
Russia's biggest security task. The war you're fighting today, like I said.

Quick Thought on Russian Mistral Order

DefenseTech and InformationDissemination have thoroughly covered the Russian order of France's Mistral Landingship, Helicopter/Deck, or Landingship, Platform/Dock, depending on your classification tastes. Just a quick thought here:

Historically, Russia had allied with France and England to balance against Germany. So this Mistral perchase is interesting in this historical sense. It could be the re-start of Russia's affinity with France and England. Germany is no longer Russia's enemy number one; China and Islamic insurgents are Russia's present security preoccupations. So in this context, it will be interesting to note how other EU countries will react to this. How this new strategic relationship affects the global dynamics of balancing will also be interesting to observe.

LMG, Assault Rifles, & Infantry Squads

Alter has some questions about LMG magazines. Sorry about the delay in my reply here. I will also talk about how assault rifles has changed the infantry squad, and squad operations in general.

1.) Drum magazines: Yes, reloading drums can be slow. However, in a fire fight session, soldiers rarely have time to reload their magazines, so the loading time is not an issue.

For the US Army, the basic load for a SAW gunner is 600 rounds. A 200 round belt and box is 6.92 lbs, whereas 200 rounds in BetaCo drum magazines is 8.8 lbs, and in 30 round magazines 7.5 lbs. The belt-feed mechanism (top cover) on an M-249 is about 0.75 pounds [from memory], so given the basic load, belt-feed would be lighter. 30-round magazine feed is a close second, though.

2.) Top-loading vs optics: you can angle either the feed or the optics. Angling the magazine well would also help with changing the magazines and reduce the exposed profile of the gun crew during reloading.

3.) Configurable components: ARES's Shrike is a great example of a modular weapon system, with various barrell lengths and belt feed vs magazine feed. However, soldiers generally will leave all of the components behind in the barracks and will deploy with a single configuration.

With the invention of the fully automatic Assault Rifle in World War II, the Light Machine Gun has become much less critical in squad operations. A fire team of 4 full-auto assault rifles can keep up a fire volume similar to that of a fire team with 1 LMG and 3 semi-auto rifles. Therefore, today, infantry squad armament is more a reflection of philosophy than fire volume arithmatics.

There are two schools of thought in infantry squad armament: Generalists vs Specialists. The Specialist school is exemplified by WW2 Stormtroopers and modern American squads: you have riflemen/marksmen, machine gunners, grenadiers, and submachine-gunners in a squad. Each man specializes in a weapon system. In a squad attack, he has a designated role based on his weapon system. He may cross-train on the other weapons, but he is supposed to be an expert of his weapon.

The Generalist school is exemplified by the French All-FAMAS squad. Everyone uses a full-auto-capable, high rate-of-fire, assault rifle. In the Generalist squad attack, the focus is more on the tasks than the weapons: Suppression, indirect fire (rifle grenades), marksmen, and close-in/breach/demolitions. Over time, the squad members end up specializing anyway, but at least their assault rifles help them do everything when necessary.

In an attack, squad/platoon fire (as opposed to maneuver) has two main tasks: suppressing a bunker and cutting off enemy reinforcement/maneuver. A machine gun suppresses the bunker by firing at it as a target. A rifle does so by aiming and firing at the bunker's firing ports/holes. Similarly, the machine gun cuts off maneuver by firing at the group, while the rifle fires at the individual maneuvering. So in the attack, the Specialists and the Generalists engage the same targets; they just go about it differently.

In the defense, the Specialist squad acts different from the Generalist squad. The Specialist squad defense is organized around its LMGs. The LMGs focus on the enemy attack axis, and the rest of the squad focuses on protecting the LMGs. At the same time, the squad needs to site the LMGs away from the other fighting positions, because the LMGs draw fire from the enemy. So the defensive line tend to be a series of one- and two-men foxholes.

The Generalist squad defense also orients on the enemy attack axis. However, it relies on 3- and 4-men fire teams to generate the fire volume (to approximate LMGs). So the defensive line tend to be section trenches (short trenches for the team) or fire team strong points. A fire team strong point can be either one large foxhole or two smaller foxholes right next to each other.

Regardless of the squad armament, both schools have medium machine guns (or general purpose machine guns) at the platoon level. The machine gun may not be critical in the platoon attack, but its value shines through in the platoon defense. Much as its historical role since World War I, the machine gun is a force-economy tool in the defense: A platoon can cover its sector with just the machine guns. It can keep the rest of the soldiers resting and/or under protective cover. At the moment of attack, the machine guns give time for the defenders to get on the firing line.

The reason the Generalist squad can get away without an LMG is because a squad is always part of a platoon defense. A ten-men squad cannot defend a location on its own for long. It can barely keep up an LP/OP while staying on 50% security. Because the platoon MMGs are always available in the defense, the Generalist squad does not need an LMG.

Hope you find it useful in understanding squad operations and machine guns.

Edited to add links and labels.

Polyethylene Combat Helmets

Army Times this week reported that the US Army and Marine Corps are buying new helmets made of polyethylene, instead of Kevlar. Polyethylene is significantly lighter than Kevlar, so it can provide the same level of protection at a lower weight. That will be nice, in reducing soldiers' load weight.

Polyethylene is used in many applications. As Dyneema and Spectra, it is used in bulletproof vests. Manufacturers have also used polyethylene to make rifle protection plates, as an alternative to steel and ceramic. So it has a proven track record in protection. The French Army currently uses a helmet made with Dyneema.

However, polyethylene is very sensitive to temperature. BulletProofMe.com, for example, advises against exposure to temperatures less than 15 degree Fahrenheit nor more than 175 degrees Fahrenheit. Ultraviolet exposure will also degrade its performance.

So it remains to be seen if the vendors have fixed the temperature problem. The US Military definitely will have to replace their helmets much more often to avoid performance degradation.

Further Thoughts on US Field Artillery

After my earlier article on the US artillery gap, I thought a bit more on this subject. The artillery gap is not uniform throughout the field artillery branch.

Field artillery has two sub-fields: howitzer cannons and rockets. In OIF and OEF, the cannoneers are often working as ad hoc dragoons, as I described earlier. However, the rocketeers are staying on their wartime mission of fire support. So the cannoneers are losing their skills, but the rocket artillery are still very proficient with their Table VIII tasks.

So in our next war, at least the rocketeers will be there to save our bacons.

College Admissions and the Female Applicant Pool

Interesting article at Volokh and discussions.  Basically, the admission office of selective schools are looking for female applicants who stand out from other female applicants.  One way to stand out, is to be good at math and science, want to major in science/engineering, and be athletic.

It is interesting to note that, 40+ years after the general civil rights movement, America still faces a demographic disparity in the undergraduate physics and engineering population.

It is also interesting to note, for example, the majority female undergrad math population in Portugal, and the majority female undergrad engineering population in UAE colleges.

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REOs Priced to Move

Another interesting real estate story on Real Estate Owned (REO) properties, which are the ones banks have foreclosed on.

Good News: Banks are pricing the REOs to sell.  They price them low so they can get their money more quickly.  They'd rather bid up the sale price from multiple offers, than price higher with no offers at all.

Bad News: They all are predicting the next wave of residential foreclosures in the fall.  This prediction is largely in agreement with my earlier analysis on this blog.

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Swine Flu, Cellular Quarantine, and Education

Swine flu is on the news in America, as the school systems around the country try to convince parents that they are on top of the potential crisis, at the start of our new school year.  Most take the form of disinfecting the schools during the summer break, and educating the school staff on swine flu and precautions.

However, one refrain I've heard from the school systems is, "We will not close the schools during a Swine Flu outbreak," to accommodate the working parents who cannot find alternative childcare arrangements.  That is suicidal.

I will not discuss the potential virulence, or the absence of, of swine flu for this fall/winter flu season, because it is mostly an unknown factor at this time.  Instead, I will focus on the general quarantine procedure policy here.

When swine flu, or a general flu outbreak, hits a school (probably defined as 5+ patients at the same time), we have to quarantine the student population.  Parents know that the schools in America serve as the disease incubator and transmission vector for the community; students get sick first, most of the time, before passing it onto the rest of the households.  So schools have to take the lead in minimizing disease transmissions.

At the same time, working parents have a legitimate concern over childcare during a school close.  Schools serve a secondary function as general daycare for working parents, who need to make ends meet.  So we need to provide an alternative childcare function during the quarantine as well.

The answer, logically then, is a cellular quarantine.  Essentially, the school teachers and students disperse away from the school during such a quarantine, but keep up the school days. 
1. The students in a subdivision or a neighborhood meet up at a location, either a teacher's house or that of a parent volunteer. 
2. The student group is made up of all students in that local area, regardless of grade, age, school, or other groupings. 
3. We keep the groups small, at 5 to 20 per group, depending on staff availability.
4. We assign a teacher or a school employee to supervise the student group.  The adult preferably lives close to the student group.
5. The students work on their assigned homework under adult supervision, a local Study Hall for an American equivalent.  The adult, or other students, provide homework assistance when necessary.
6. The local study hall can operate during the regular school day, or go on until 5pm, depending on the school policy.
7. In the litigation-prone America, the school district takes on all legal liabilities of the study hall, to encourage the house volunteering from parents.  The students then can walk to study hall.
8. Parents have the right to keep their children home, away from even the study hall, if they choose.  It is treated as equivalent to school absence.
9. Private schools are on their own, but they can work out memos of agreement with the public school systems, if they want to participate in the cellular quarantine.

We keep the students and staff dispersed into local cells.  These cells minimize interaction with each other, so there is no disease transmission across cells.  Any outbreak is immediately contained.  Parents will continue to have their day care.  The school staff continue to receive their working salary during the school close.  We keep the students occupied during the day.

This policy of a cellular quarantine provides a spectrum of policy responses for the public health officials and the school systems.  Instead of choosing between a business-as-usual versus a total system lock down (school closing), now we have a third choice of a cellular quarantine.  If the school system has a Geographical Information System, then it can even calibrate the size of the cells based on a risk assessment.  In other words, it can set the group size, 5 vs 10 vs 20, depending on the speed of disease transmission.

For the school systems in Northern America, who frequently have to contend with Snow Days during the winter time, this cellular quarantine provides an alternative as well.  Students can walk to their local rendezvous point during the snow days.  Parents have a daycare available, and we keep the kids occupied.  The school system gets a workout of its cellular quarantine procedures as well.

I hope some school districts will pick up on this idea and thus become less afraid of the political costs of a school closing.

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More Somalia and Nation-State Paradigm News

Another report supporting my previous piece on Nation-State paradigm and Somalia. Any good scientist knows to chuck the model when it no longer fits the reality. Perhaps Obama and Hillary Clinton should have studied science (or engineering) back in college.

Field Artillery: Critical US Army Capability Shortfall

Anonymous, sorry I hadn't replied to your comment. An airborne tank would be in the same class as the M8 Buford or an M-113 ACAV. It has been the shortfall of the airborne/light units in the US Army.

However, on further reflection, the true Army capability shortfall is in field artillery. There are two components to this short fall: human and materiel.

[SHORAD has been drastically cut back as well, but there wasn't much to start with in the first place. If the USAF cannot come through on the air superiority piece, we'll be in for a tough, long fight.]

Human: The wars in Iraq and Afghanistan has depended heavily on artillerymen serving as Dragoons (mounted infantry). In the process artillery collective training has fallen by the wayside. In the chaotic dwell time back at home, there is too much turnover to get any benefit out of collective training. Much of the training focus is on the war time mission of convoy security and dismounted operations. A few of the batteries get lucky and draw an artillery fire support mission during deployment. These lucky batteries get to train on the artillery collective tasks, but there is little institutional memory instilled, because of the personnel turnover later on and because they probably won't do artillery fire support the next deployment.

So it is a real question if anyone will remember how to shoot a Table VIII to the standard by the time we get out of OIF/OEF. [Table VIII is the 8th table in the 12 gunnery tables of the collective training pyramid, 12 being a fully proficient battery. 8 means proficiency at the section level: gun lines, FDCs. During the Cold War, few units got past Table VIII, and never in a repeatable, year to year, manner.]

If people don't know how to shoot a Table VIII, then we will start shooting our own people by mistake. Of course, the situation is fixable if we bring back all the retired red legs as contract consultants and rebuild our field artillery branch. But it will take a long time, and during that time the US Army will have a gap in its conventional capabilities.

Materiel: On the materiel side, we have a gap in fire delivery. The acqusition trend is going toward precision munitions and away from dumb weapons like regular shells and DPICM rockets. So we will be short on stock for sustained volume fire, should we ever need it again. In addition, the Assault Breaker project was essentially abandoned. So the US Army is short in the Deep Fight arena. Granted, we will have plenty of smart weapons to take out the high valued targets, and Apaches will still swarm with their Hellfire volleys. But the OMG over the Fulda Gap? Not so much anymore.

Mortgage: A Still Ticking Time Bomb

This story yesterday from CNN is very interesting and confirms my suspicions and observations on our current economy. Basically, it says that the regulatory uncertainty surrounding the whole "Mortgage Bailout" has frozen the mortgage industry in its tracks.

Last year, people were predicting left and right that the coming wave of foreclosures will devastate the housing market and push the US into the Second Great Depression. Today, there have been some foreclosures, but definitely not the tsunami waves predicted by the Cassandras. What happened to all those ARMs?

Bush and Obama launched the "Mortgage Bailout" to rescue all those ARM homeowners. The Bailout was supposed to help these homeowners to stay in their homes. By converting the ARMs into fixed rate mortgages, the Bailout aimed to arrive at the unhappy median where both the bank and the "homeowner" lose some money, but still stay in the house and pay the bills.

The Bailout failed to rescue all ARMs. Banks and homeowners do not like to realize their paper losses. Both the banks and the homeowners are expecting the government to give them a better deal later on, so they do not have to write down their losses. So in that respect, the Bailout failed in conclusively resolving the ARM problem, and thus allowing the US economy to "Move On" toward full recovery.

On the other hand, the Bailout accomplished its political purpose, which is to hold off that tsunami of foreclosures for now. In that respect, it is "Mission Accomplished". Banks are reluctant to foreclose all those houses, because they will definitely have to write off those profits from the 10% ARM mortgage rates. Homeowners are reluctant to move in general. The Bailout gives them the expectation of a better deal in the future, so they wait the best they can.

However, the mortgage time bomb is still ticking. The hope behind the Bailout was that, by delaying the foreclosures, the economy will improve, lifting the housing markets, and thus make the ARM problem go away. "Hope and Change", in a sense.

So now we are in a race against time, as I mentioned in the agriculture and economy in general articles. The ARMs from the crazy home real estate 2006 year are resetting right now, so the full scope of the problem is coming to the surface. The commercial real estate time bomb is still ticking away. The economy is improving. The Whales now have some money to spend in Las Vegas, but not the rest of the gambling market. The other real estate hot spots are suffering similarly.

So the question now facing the economy is: Can the US multi-nationals make enough money from the Chinese and Indian economic stimulii to save us from the mortgage time bomb? Will the Chinese and Indians buy enough American wheat, industrial machinery, airplanes, and financial consulting man-hours? Or, will they and the oil sheiks be crazy enough and start playing the American stock market again, that other great "export" of our economy?

[Note: That crazy Wall Street market is our invisible export. Its promise of riches lures in investors around the world. Their active stock trades generate tons of trading fees for the traders in New York, et al, who in turn spread the wealth to the rest of the US. We will have to place our faith in the hope that foreign investors do not wise up to the wisdom of Passive Management.]

Capt Speicher: Closure for the Family

DoD confirmed that they found Capt Speicher's remains. At least his family now know what happened to him.

Recession vs Recovery: A Race of Time

This is an interesting story on the post-recession America. What it tells us, is that we are now in a race against time. If we do not have a recovery in demand, somehow, agriculture and manufacturing will start falling again. Agriculture, and to a lesser extent, manufacturing, remain important drivers of the US economy. Agriculture, in particular, is vital in propping up the trade balance of the US, making it not as bad as it could be.

So we may yet have that "W" shaped recession, after all.