Friday, March 27, 2015

The sick health care market

Here's a great reminder that the health care market is not very comparable to traditional markets:

The charge for a lipid panel ranged from $10 to $10,169. Hospital prices for a basic metabolic panel (which doctors use to measure the body's metabolism) were $35 at one facility — and $7,303 at another ... Hsia's previous research looked at the cost of an appendectomy in California and found similarly gigantic variation. For an appendectomy with no complications, she found that hospitals in the state would charge anywhere between $1,529 and $186,955.

Different grocery stores tend to charge different prices for my favorite Haagen Dazs ice cream (chocolate chocolate chip). But the price varies from about $4 a pint to $5 a pint, not $4 to $4000. And if there was such a difference, I would be able to easily tell because the price would be indicated on the product before I bought it. And unlike an appendectomy, I could choose not to purchase it and still go about my day not dying, despite what my stomach is telling me.

Wednesday, March 25, 2015

Nashville's traffic problem

If there's a hell it will probably feature me sitting in traffic for eternity. It's personally soul-crushing, economically annoying, and environmentally unhealthy. Nashville isn't the worst city for traffic, but it's bad. And expecting population growth to continue, the problem seems to be destined to get worse in the coming years. The city's mayoral candidates at least acknowledge there's a problem, but offer few potential solutions. Here's a few could help a bit:

Mayoral candidate Linda Eskind Rebrovick, a former business executive, has discussed practical measures like the installation of real-time adaptive sensors on traffic lights that respond to sensors on roadways to trigger them to green or red. She suggested the city could also offer new cell phone apps to direct drivers to available parking downtown and elsewhere.

You might have noticed that app idea from somewhere:

Knew I should have trademarked that. the traffic light sensors aren't already a thing is beyond me. Sitting at a light while there is no one coming the other way is a waste. So that could help a bit with congestion. The parking meters should help with that too, though I'm not sure there's enough supply to meet demand. Either that or it's just price gouging.

The rest of that article is light on actual proposals. Here's David Fox:

"Just think how awesome it would be to have a light-rail system where you could come in from Williamson County or Rutherford County and go to downtown on existing right-of-ways that are already there?" Fox said. "You don't have to fight these legal battles to get the property."

Sounds nice, but expensive. And good luck with getting the funds and the political support need to do it (see Amp's failure). Even if you could fund something like that I'm not sure how far it would go in solving the problem. There would still be the massive number of people who live in Davidson who drive on the ridiculous interstates, which seem inherently inefficient. Everything merges into everything else with very few lanes devoted to the merges. It's not like you can just add lanes or tear it up and start over again, at least not on the cheap. Assuming light-rail isn't very realistic, the main arteries flowing into the heart seem mostly clogged without relief.

So without a clear way to relieve congestion with the current number of cars on the road, it seems the only way to make improvements is to cut down on the number of cars on the road. Increasing the routes and efficiency of the existing public transit seem like very minor improvements. Busses can only hold so many people. And I doubt they could reach the suburbs cost efficiently, even if people wanted to abandon the cars they're paying loans on.

Where bus improvements could matter is in the downtown area and it's immediate surroundings. Being more densely populated, it's easier to get around without a car and more efficient for busses to have to travel over shorter distances. The problem is that it's really expensive to live in these areas. The difference in expense could be mitigated by not having a car note and the gas bills that go with it. But renting/purchasing an apartment or house in this area imposes huge up front costs that many people can't afford. So while in the long run it might be a wash or cheaper to pay $1200 a month to live downtown without a car compared to $800 a month in the suburbs, it the short run it's more expensive to pay first and last month's rent and a security deposit. It's just really difficult to save up enough to afford those up front costs (That's why people opt for the iPhone plans that are more expensive in the long run but have less up front cost).

As with many cities, the rent is too damn high. Building bigger complexes instead of these smaller luxury ones that only trust funders can afford would help keep prices down and encourage more people to move out of the suburbs and use their cars less. If there's a better way to solve the traffic problem than getting more people to live closer to the city I'd love to hear it. In fact, it's one of the main issues I'll be considering when it comes time to vote for Nashville mayor.