" a basic bundle of valuable services that is publicly financed for all, while allowing individuals to “top up” by purchasing additional coverage, "
This describes basically every attempt to reform our health care financing system that has occured in my lifetime. It was what Obamacare/Romneycare was supposed to be. It pretty well describes what Medicare is today. Almost every expert who looks at the problem comes up with the solution but nobody wants to implement it. It is vigorously opposed by the 'equity'/Medic(aid) for all crowd who think all healthcare should be 'free'. It is opposed by more doctrinaire conservatives who don't like 'socialized medicine'. It is opposed by big healthcare organizations because they don't want to be tied exclusively to government fee schedules. It is opposed by health insurers because it wrecks the current group insurance market. It's opposed by most groups that have negotiated first-dollar insurance coverage instead of salary increases.
It's the obvious solution and it's never going to happen.
>> latest attempt is to posit some cognitive dissonance between two recently popular claims that “we have a banking crisis” and “we have a shortage of homes.” ...
both of these statements cannot be true:
if only we’d invested less in real estate, then things wouldn’t be so bad
if only we’d invested more in real estate, then things wouldn’t be so bad ...
another way of saying that “individual homeowners are ‘trapped’ by their cheap mortgages” is that they can’t find anyone who can afford their home at now-prevailing rates. If they had to sell, it would be at a loss (and so they prefer not to sell). Individual homeowners are, in other words, sitting on piles of unrealized losses.5 Remember, banks are people too, y'know.
<<
Just like SVB 2% T-Bills lost huge market value when the current market rate is 4%, higher interest rates mean lower sale prices.
>>My affordability, is your deflation ...
building more would make housing more affordable . . . in the same way that new 4% Treasuries made SVB's assets more affordable.
<<
SVB's assets went DOWN in sale price value (more affordable to buyers!)
Nobody who owns a home wants the value of THEIR home investment asset to go down.
MOSES STERNSTEIN said it very well and in more detail.
great excerpts today. The premium medical idea reminds me of a story I heard from a friend who was an senate appropriations staffer in the 1990s. When they were earmarking a bill, my friend suggested a list of the best projects to fund. His boss said, “See what you are doing there is talking about the best policy. What I’m talking about is the best politics and I don’t ever want to hear that s#!% out of your mouth again.”
The statement: "In general, economic publications have a very strong bias in favor of papers that show what government can do to solve problems." is what would be expected. With the reality of the increasing complexity in the world that results from "specialization and trade" having progressed to the point where no individual or internally communicating institutions or group of institutions has the band-width to understand all the relevant details of modern problems, honest economic publications would have to admit the government doesn't understand what they are doing. Neither do businesses, but they try more things and junk failures faster.
Recent (and past) research on nutrition and mental health focuses on metabolic health. Finally RCT studies are being carried out, funded by Baszucki Group (billionaire Roblox founder). Bret Scher and Julie Milder run Metabolic Mind, providing education). Chris Palmer is leading research (author of Brain Energy). Georgia Ede articles and talk "Our Dietary Descent into Madness" suggest mental health epidemic in colleges is consequence of diet. I have posts and links on Normal Nutrition substack page. Also, reforming federal dietary guidelines is proposed as national high school debate topic.
Arnold, I can't speak to whether you are a libertarian or a crank, but you are old, at least in the sense of having experience. And experience teaches, at least to those who are open to learning from experience, that government programs don't always work like their proponents say they will work.
It's not clear how "use 1975 medicine" could be implemented?
I use modern insulin. My Dad used a very primitive form of insulin. Would 1975 medicine mean I'd have to use primitive insulin? What about insulin pumps and continuous blood sugar monitors?
My Dad went to the hospital a lot due to low blood sugars, and to avoid that he often ran high blood sugars (which damages your body).
By contrast all this modern insulin and technology has allowed me to control my blood sugars and I've never gone to the hospital for low blood sugar. I can't see giving up this technology as reducing healthcare costs, even putting aside the massive benefit to quality of life.
When we talk about healthcare for diabetics, it's not improving technology to help Type 1 diabetes like me and my father that drives it. The massive increase in Type 2 diabetics (90% of diabetics) caused by people getting fatter is the driver. And that modern insulin isn't even expensive. It's just that the drug rebate system drives up list prices even as net prices stay the same.
We could expand this to other items. What doctor would do a 1975 procedure when a 2023 procedure would be much better? They would get disbarred. Many people might not even know how to do the 1975 procedure anymore.
Bureaucracy, over utilization, deteriorating public health, and more desperate end of life care seem like they could drive up costs all on their own no matter the year of technology used. In most cases when a new medical drug or device is introduced people at least make a pitch as to how it will reduce overall health costs (say Hep C drugs curing Hep C so people don't need organ transplants).
Ironically, the #1 way using worse medicine might drive down healthcare costs is if people just died sooner.
What is the cost of health care? Recent experience: hospital charges $719 for a procedure, insurance company gets a discount of $527, and the remaining charge paid is $192. Is the cost discussed by policy makers $719 or $192?
Analysts and headlines always seem to take the $719 as the "cost of healthcare"--it's the amount billed to those 12% without insurance. But $192 is more representative of the charge to the insured 88%.
" a basic bundle of valuable services that is publicly financed for all, while allowing individuals to “top up” by purchasing additional coverage, "
This describes basically every attempt to reform our health care financing system that has occured in my lifetime. It was what Obamacare/Romneycare was supposed to be. It pretty well describes what Medicare is today. Almost every expert who looks at the problem comes up with the solution but nobody wants to implement it. It is vigorously opposed by the 'equity'/Medic(aid) for all crowd who think all healthcare should be 'free'. It is opposed by more doctrinaire conservatives who don't like 'socialized medicine'. It is opposed by big healthcare organizations because they don't want to be tied exclusively to government fee schedules. It is opposed by health insurers because it wrecks the current group insurance market. It's opposed by most groups that have negotiated first-dollar insurance coverage instead of salary increases.
It's the obvious solution and it's never going to happen.
The https://www.therandomwalk.co/p/consider-the-everything-bubble is great, especially on housing, with his:
>> latest attempt is to posit some cognitive dissonance between two recently popular claims that “we have a banking crisis” and “we have a shortage of homes.” ...
both of these statements cannot be true:
if only we’d invested less in real estate, then things wouldn’t be so bad
if only we’d invested more in real estate, then things wouldn’t be so bad ...
another way of saying that “individual homeowners are ‘trapped’ by their cheap mortgages” is that they can’t find anyone who can afford their home at now-prevailing rates. If they had to sell, it would be at a loss (and so they prefer not to sell). Individual homeowners are, in other words, sitting on piles of unrealized losses.5 Remember, banks are people too, y'know.
<<
Just like SVB 2% T-Bills lost huge market value when the current market rate is 4%, higher interest rates mean lower sale prices.
>>My affordability, is your deflation ...
building more would make housing more affordable . . . in the same way that new 4% Treasuries made SVB's assets more affordable.
<<
SVB's assets went DOWN in sale price value (more affordable to buyers!)
Nobody who owns a home wants the value of THEIR home investment asset to go down.
MOSES STERNSTEIN said it very well and in more detail.
"Just listen to the music of the traffic in the city
Linger on the sidewalk where the neon signs are pretty
How can you lose?"
great excerpts today. The premium medical idea reminds me of a story I heard from a friend who was an senate appropriations staffer in the 1990s. When they were earmarking a bill, my friend suggested a list of the best projects to fund. His boss said, “See what you are doing there is talking about the best policy. What I’m talking about is the best politics and I don’t ever want to hear that s#!% out of your mouth again.”
The statement: "In general, economic publications have a very strong bias in favor of papers that show what government can do to solve problems." is what would be expected. With the reality of the increasing complexity in the world that results from "specialization and trade" having progressed to the point where no individual or internally communicating institutions or group of institutions has the band-width to understand all the relevant details of modern problems, honest economic publications would have to admit the government doesn't understand what they are doing. Neither do businesses, but they try more things and junk failures faster.
Recent (and past) research on nutrition and mental health focuses on metabolic health. Finally RCT studies are being carried out, funded by Baszucki Group (billionaire Roblox founder). Bret Scher and Julie Milder run Metabolic Mind, providing education). Chris Palmer is leading research (author of Brain Energy). Georgia Ede articles and talk "Our Dietary Descent into Madness" suggest mental health epidemic in colleges is consequence of diet. I have posts and links on Normal Nutrition substack page. Also, reforming federal dietary guidelines is proposed as national high school debate topic.
Arnold, I can't speak to whether you are a libertarian or a crank, but you are old, at least in the sense of having experience. And experience teaches, at least to those who are open to learning from experience, that government programs don't always work like their proponents say they will work.
Older? Yes you are. Libertarian? Probably. Crank? Absolutely not!
It's not clear how "use 1975 medicine" could be implemented?
I use modern insulin. My Dad used a very primitive form of insulin. Would 1975 medicine mean I'd have to use primitive insulin? What about insulin pumps and continuous blood sugar monitors?
My Dad went to the hospital a lot due to low blood sugars, and to avoid that he often ran high blood sugars (which damages your body).
By contrast all this modern insulin and technology has allowed me to control my blood sugars and I've never gone to the hospital for low blood sugar. I can't see giving up this technology as reducing healthcare costs, even putting aside the massive benefit to quality of life.
When we talk about healthcare for diabetics, it's not improving technology to help Type 1 diabetes like me and my father that drives it. The massive increase in Type 2 diabetics (90% of diabetics) caused by people getting fatter is the driver. And that modern insulin isn't even expensive. It's just that the drug rebate system drives up list prices even as net prices stay the same.
We could expand this to other items. What doctor would do a 1975 procedure when a 2023 procedure would be much better? They would get disbarred. Many people might not even know how to do the 1975 procedure anymore.
Bureaucracy, over utilization, deteriorating public health, and more desperate end of life care seem like they could drive up costs all on their own no matter the year of technology used. In most cases when a new medical drug or device is introduced people at least make a pitch as to how it will reduce overall health costs (say Hep C drugs curing Hep C so people don't need organ transplants).
Ironically, the #1 way using worse medicine might drive down healthcare costs is if people just died sooner.
What is the cost of health care? Recent experience: hospital charges $719 for a procedure, insurance company gets a discount of $527, and the remaining charge paid is $192. Is the cost discussed by policy makers $719 or $192?
Analysts and headlines always seem to take the $719 as the "cost of healthcare"--it's the amount billed to those 12% without insurance. But $192 is more representative of the charge to the insured 88%.