Healthcare and the KISS Principle

One of the maxims I strive to live by is the KISS Principle: Keep It Simple, Stupid! It is based on this that I can accepted as fact that society doesn't scale well, nor do its institutions and bureaucracies. Case in point, the federal online healthcare marketplace stood up at www.healthcare.gov. I point to the following excerpt from the non-partisan Starts and Stripes as case in point:

The HealthCare.gov website is a disaster — symbolic to Obamacare opponents, disheartening to supporters, and incredibly frustrating to people who just need to buy insurance. Some computer experts are saying the only way to save the system is to scrap the current bloated code and start over.

Looking back, it seems crazy that neither the Obama administration nor the public was prepared for the startup difficulties. There’s no shortage of database experts willing to opine on the complexities of the problem. Plenty of companies have nightmarish stories to tell about much simpler software projects. And reporting by The New York Times finds that the people involved with the system knew months ago that it was in serious trouble. “We foresee a train wreck,” one said back in February. (Virginia Postrel, 28 Oct 2013, Obamacare was fooled by high-tech glamour)

While I am on my luddite soapbox, I want to be clear that I do not oppose the excellent advances in medical technology in the past century. Had they not occurred, I would have lost my trigger finger due to a table saw accident (NB: Never attempt to cut out a pinewood derby car with a 14" circular table saw... and never reach across the blade... with the guard off... to turn off the power) when I was eighteen. A very skilled doctor was able to reconnect nerves and tendons and keep me from what I fear might have ended my military career in its first year.

What I do oppose is the unnecessary administrivia associated with modern healthcare a la the insurance cabal. The best definition I have found for this evil institution was written by the sage Ambrose Bierce in his Devil's Dictionary in 1906:

INSURANCE, n. An ingenious modern game of chance in which the player is permitted to enjoy the comfortable conviction that he is beating the man who keeps the table.

INSURANCE AGENT: My dear sir, that is a fine house – pray let me insure it.

HOUSE OWNER: With pleasure. Please make the annual premium so low that by the time when, according to the tables of your actuary, it will probably be destroyed by fire I will have paid you considerably less than the face of the policy.

INSURANCE AGENT: O dear, no – we could not afford to do that. We must fix the premium so that you will have paid more.

HOUSE OWNER: How, then, can I afford that?

INSURANCE AGENT: Why, your house may burn down at any time. There was Smith's house, for example, which –

HOUSE OWNER: Spare me – there were Brown's house, on the contrary, and Jones's house, and Robinson's house, which –

INSURANCE AGENT: Spare me!

HOUSE OWNER: Let us understand each other. You want me to pay you money on the supposition that something will occur previously to the time set by yourself for its occurrence. In other words, you expect me to bet that my house will not last so long as you say that it will probably last.

INSURANCE AGENT: But if your house burns without insurance it will be a total loss.

HOUSE OWNER: Beg your pardon – by your own actuary's tables I shall probably have saved, when it burns, all the premiums I would otherwise have paid to you – amounting to more than the face of the policy they would have bought. But suppose it to burn, uninsured, before the time upon which your figures are based. If I could not afford that, how could you if it were insured?

INSURANCE AGENT: O, we should make ourselves whole from our luckier ventures with other clients. Virtually, they pay your loss.

HOUSE OWNER: And virtually, then, don't I help to pay their losses? Are not their houses as likely as mine to burn before they have paid you as much as you must pay them? The case stands this way: you expect to take more money from your clients than you pay to them, do you not?

INSURANCE AGENT: Certainly; if we did not –

HOUSE OWNER: I would not trust you with my money. Very well then. If it is certain, with reference to the whole body of your clients, that they lose money on you it is probable, with reference to any one of them, that he will. It is these individual probabilities that make the aggregate certainty.

INSURANCE AGENT: I will not deny it – but look at the figures in this pamph –

HOUSE OWNER: Heaven forbid!

INSURANCE AGENT: You spoke of saving the premiums which you would otherwise pay to me. Will you not be more likely to squander them? We offer you an incentive to thrift.

HOUSE OWNER: The willingness of A to take care of B's money is not peculiar to insurance, but as a charitable institution you command esteem. Deign to accept its expression from a Deserving Object.

As evidenced by the definition above, insurance violates the KISS principle. However, due to the Affordable Care Act (i.e. Obamacare), one cannot not participate in the scheme without paying a particular fine. There is much debate about the virtues of just paying the fine vice paying for insurance (and in fitting with the dialog in the definition), however, there is one major wrinkle in non-compliance in our modern world: technology. By our playing God in the realm of virulent and bacterial realms, we have intentionally or unintentionally uncorked many nasty little genies over the past century. And the pyramid scheme of insurance (augmented by frivolous lawsuits) has put us in a fine kettle of fish whereby insurance is required to offset the outrageous costs of healthcare.

Unlike many of my fine conservative friends, I do not see Obamacare nor this exchange nonsense as the problem. It is a symptom of the greater problem of the institution of insurance. It has made the means of paying for healthcare unnecessarily burdensome to the point of being unsupportable. It is a welfare state mentality whereby the collective is supposed to support the weight of the system. The problem therein lies in the fact that unless there are healthy people (with little service utilization) supporting the unhealthy (with greater utilization), the system shall collapse. It is inevitable, and expected, thus the mandate that everyone be insured.

That then begs the question, what to do after the system collapses?

Here is where I go off the reservation, or more realistically, back to it. In communities across America there are practitioners of traditional medicine, Native American, Far Eastern, African. Some of their methods have stood the test of centuries, possibly even millennia. We disregard these medicine men or shamans, or whatever term fits, as frauds, snake oil salesmen. Why, how can their primitive tribal practices even compare to our modern medicine? Tell me this: how many diseases has "Big Pharma" cured in the past fifty years with all our advances? Why does it take 95% of a commercial to speed read a pill's side effects?

The reason we eschew traditional/ folk/tribal treatments is because we have been slowly indoctrinated into the fallacy that Western medicine has all the answers. That the FDA knows best. That 200 years of science trumps 5000 years of practice.

Maybe I am naive, but history tells me that complex, "civilized" systems collapse, and basic, tribal approaches have a way of surviving. They may not be the most advanced, but they may just be enough.

So here is where I propose another healthcare exchange. An alternative healthcare exchange where practitioners pushed off into the shadows are able to offer their treatments and services, outside the confines of the insurance quagmire. It's called Word-of-Mouth. Reputation. Trust. And a website might not be that bad, either.

In deference to true heraldic artists

I recently stumbled upon A Message from Andrew Stewart Jamieson in which he contrasts true "heraldic artists" with "fraudsters, amateurs, and con artists who, calling themselves heraldic artists, offer substandard, commercial services to unsuspecting clients and patrons". On the same site was a post titled Heraldic Art and Copyright Infringement, both of which are written on the premise of the existence of amateur hacks attempting to exploit the desire for heraldic designs.

Mr. Jamieson is the Scribe and Illuminator of HM Queen Elizabeth II, and has a well-documented career in heraldic arts. Given his reputation, I give much credence to what he has said in the aforementioned article. In it he stated he "began to notice a pattern emerging and to me it was a danger signal which warned of the very demise of the art form I love." This was related to individuals on web forums offering services as heraldic artists, but without a background and portfolio of works commensurate with the services they were looking to charge others for. In Mr. Jamieson's words:

Many of these amateurs have little or no idea of the craft of heraldic art or of its long tradition and development from the techniques of medieval manuscript illumination. They have no sense of design and, most importantly, they cannot draw. 

This statement, to me, sums up much of modern art, but I suppose in that realm I am just not cultured enough to appreciate it. Many an artist has splashed paint against a canvas and sold for profit what would earn my children a severe scolding, were I to find it on my own wall. Alas, beauty is in the eye of the beholder. Mr. Jamieson's heraldic works, though, truly are objets d'art.

In the past, an artist would master his craft by mimicking the works of those whom he admired, and spend many years working toward his own style, but as was stated in the articles referenced, modern technology has short circuited the process. One now only has to obtain a digital copy of an image to begin manipulating it to his own designs. With a little practice, one could become proficient in taking a cookie cutter approach to emblazonment, and output decent quality (digital) work. It is my uneducated opinion that a vast majority of heraldic consumers would never know the difference. With the anonymity afforded by the Internet, one could easily build a pseudo-reputation as an heraldic artist. And as stated by Mr. Jamieson:

These fraudsters are often retired or are employed and have careers and receive a regular wage; to them heraldry is just a sideline. I have seen young professionals for whom heraldry is their only career, fall by the wayside no longer able to support their families. This is morally wrong and it is delivering a death blow to this field.

The problem here seems to be whether a patron is willing to pay for true art put down on canvas by a steady hand in quality inks, or is the patron satisfied with a digital work? As an anachronist, I do not even consider the two to be on the same level. The physical artist makes an heirloom to be passed down for generations, the digital artist creates a work that lasts so long as it is electronically available^[1]. One cannot be duplicated without retaining the hand of the master, the other can be duplicated en masse with the click of a button. Anyone can own a "Renoir", but only one can possess the original^[2].

So what of the aspiring heraldic artist, the rank amateur, or (in my case) the novice? Those of us who want to dabble in heraldic design and entertain ourselves with our handiwork? Mr. Jamieson has words for us as well:

There is, of course, no problem with amateurs and hobbyists doing heraldic scribbles for their own amusement. I positively welcome this

As illustrated by my assumed arms as emblazoned, I am amongst the ranks of heraldic scribblers. I think in putting my illustrations together I violated nearly everything spoken against in the two articles. First, I pulled down SVGs of heraldic examples from Wikipedia. I cut and pasted elements to suit my needs. I traced over jpegs of lower quality so that I could make scalable vector images. I did my best not to use copyrighted images, so as not to violate anyone's copyright. I bought several books on heraldry and heraldic art so that I would have examples to follow, but I have not developed my own style, nor likely will I. I simply reached a point with my "work" that I was not ashamed to post it to my own website. I sat back, satisfied (but not content) with the "quality" of what I had created. Would I do the same for someone else? Sure. Would I charge them for it? Absolutely not. One should not pay someone else for amateur quality work. Would I ever endeavor to become a professional heraldic artist. Never. This is not my forte, and as quoted above from Mr. Jamieson, it cuts into the livelihood of true artists.

All this hearkens back to the notion that technology undercuts talent. We can call this luddism if we like, but the fact remains that skills are lost when the means of creation are taken out of human hands. This is especially true in the arts. Where once a musician was required to perform great melodies, nowadays, anyone with Garage Band and a sufficient supply of instrumental samples can put together a song. That song can then be replayed in its digital "perfection" as many times as the listener desires. Likewise, the Renoir referenced above can be reprinted to exact tolerances as many times as it can be sold, always "perfect". And this perfection can be obtained in anything reproduced digitally, but the element lacking is "soul": that imperfect and one-offness that can only be imparted at the moment of creation by a human hand. The fingers strumming a string or grasping a brush. The pressure applied by human hand to create that which is truly unique.

So back to the premise of supply and demand. Are we who desire objects willing to pay for the quality of masters, or are we satisfied with a third-rate knock-off? I fear I know the answer. Will we see the demise that Mr. Jamieson fears? Let those of us interested in heraldic arts hope not.

~~~

[1] I am purposely ignoring arguments for the loss or destruction of the physical work and I realize a digital copy may be archived, replicated, recreated, &etc.

[2] What if the artist created two originals? They are still going to be two unique works, and not identical.

[UPDATE: 22 July 2013]
Here is another example of a truly talented heraldic artist:
http://www.rochdaleonline.co.uk/news-features/2/news-headlines/81516/rochdale-man-carves-oldham-coat-of-arms

Artisan Resurgence

From Der Spiegel:

Backlash against Consumerism: Handicraft Sites Turn Hobbies into Big Business: Internet companies like Etsy and Germany's DaWanda are helping to promote a renaissance in handicrafts in Europe and around the world. The firms provide platforms that enable individual artisans to sell their wares on the web in a growing market niche. And business is booming, as both companies expand internationally and venture capitalists make new investments.