June 6th, 2011

Predictions and Transitions

When I was in college, or very shortly after graduating, a friend of mine predicted that Real Soon Now, as in months, people would mostly be reading ebooks, rather than pbooks. No, I am _not_ kidding. This was around 1991.

Another friend of mine and I had a bet going about how long it was going to take to transition to DVDs, if I recall correctly. I won that one, too. I had this little notebook that I kept, and pretty much all of my bets were the same: it's going to take a lot longer to happen than you think it will. This says a lot about the group of people I was hanging out with at the time (young, male and geeky) and only a little about predictions in general.

One of the things I got interested in when I was older and trying to assess the validity of predictions in a very different context (that is, when an investment decision was involved), I started taking predictions for the future and trying to "work back" to the present. The process was by analogy to how I set goals and devise a method for attaining them. If I can't come up with a path, I don't set the goal. If I can't figure out a path from the present to the predicted future, I don't believe in the prediction.

When people predict that various social programs such as Social Security and/or Medicare will not be around at some particular point in the future ("when I am eligible to benefit from them") I want to know what path they are envisioning for getting from here to there.

(1) A zombie apocalypse, or a similar, nationwide/world wide breakdown in social order and governance, ending the meaningful existence of the federal government, etc. Of course, this would be so bad that not having Medicare might be quite low on your priority list.
(2) A replacement social program which would render what Social Security and/or Medicare currently supply, but meaningfully different. Examples would include: guaranteed minimum income for everyone replacing Social Security; national, single payer health care for everyone replacing Medicare. In this scenario, no one is going to miss Social Security and/or Medicare.
(3) Congress signs legislation ending Social Security and/or Medicare for everyone on a specific, near term date (before the next mid-term election can reverse the decision). The President signs it. End of Social Security and/or Medicare. I find this unimaginably ballsy, with an emphasis on the "unimaginably" part.

Probably more people would sign onto something like this:

(4) Social Security and/or Medicare is phased out explicitly (what the Republican Party just tried), or
(5) Social Security and/or Medicare is phased out implicitly via (a) raising the age of eligibility to a point where I might personally expect to die before becoming eligible, or (b) making benefits needs based to a point where I might personally expect to be ineligible due to being-too-rich.

The next election will tell us whether anyone will _ever_ attempt (4) again. (Answer: NO. And it's quite shocking they tried it at all.) Which will leave us contemplating (5).

I have certainly been guilty of saying that I don't expect to benefit from Social Security and/or Medicare. I made a lot of decisions when I was younger based on this set of beliefs, and the net effect of those decisions and a whole lot of luck is that I probably _will_ be right under some variation of (5)(b). I sure hope we have the sense to write age limits in such a way that, say, everyone in construction trades doesn't get screwed under (5)(a). That would be wrong.

My sister posted a comment on the fb mirror describing a pessimistic scenario involving age clashes and some very drastic reductions of medical expenditures on the very old. It's always a little tricky to know how serious she is when she's being colorful; my sense is that we're much more likely to increase taxes than we are to resort to what she is describing on a large scale.

But I do wonder: if you believe that Social Security and/or Medicare will not be around in 2040, give or take, do you think it will be through one of the five transitions listed above or do you envision something different? If you envision something different, I'd really be interested in details -- even tongue-in-cheek ones. Here are a couple more to get us started:

(6) The transhumanists turn out to be right, and we upload our personalities into machines and upgrade ourselves, thus being able to maintain health and the capacity to work productively for compensation forever.

(7) Some variation on Varley happens, and we can transplant our memories into a younger clone, thus living healthfully and productively for as long as we can afford a replacement and do not meet with traumatic accident.

Healthcare Costs

I had a nice, long conversation with my sister (a nurse) about health care. She's pessimistic about the probable utility of Medicare in her future. She doesn't not think it will be legislated away, just that reimbursement rates will become so pitiful that anyone using that to access health care will be completely screwed. I'll save my thoughts on that for a later post.

She would like to see us save money by not doing treatments that do extend life, but at massive cost to quality of life. I think that's way too controversial for me to want to take on. I mostly want to do a bunch of studies to decide which really expensive things _don't_ extend life, so we can quit doing them and improve outcomes (no benefit from doing it plus risk means stopping makes it all better).

Long before we get to that point, however, I would like to point something out about infection control. Hospital-acquired infections are nasty, expensive and sometimes lethal. That we know. What may be less obvious is how a hospital-acquired infection can become a person-on-a-heart-transplant-list. I, personally, have seen that happen. Resolving the infection and a slow recovery process means that person came back off the heart transplant list (yay, happy), and a better mix of blood pressure and other meds means they're mostly okay now. But it could have gone another direction that would have been fantastically more expensive.

Putting a stop to hospital-acquired infections is a really high priority right now, for a lot of reasons. But one of the less expected side effects might be massive savings on really big other interventions that are a knock-on effect of the infection but that we don't _realize_ are knock-on effects.

Weiner News Conference Coverage

I don't have anything in particular to say about this; I didn't read a ton of coverage. I picked this article because it includes the truly surreal bit about supporting Arnold's love child.

http://www.theatlantic.com/politics/archive/2011/06/anthony-weiners-surreal-press-conference/240026/

I was obviously _very_ wrong when I said the conservative bloggers responsible for this were going to regret it. They _weren't_ responsible for this. Altho I guess it's still possible they'll wind up regretting it; politics can be funny like that.

TRMS did a "consequence-o-meter" bit on this, but in surreal terms, this is definitely beaten by the Jenrette incident which led to the name of the comedy troupe "Capitol Steps" (Jenrette's involvement in Abscam being less surreal, obviously).