" 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.
It will never happen all at once, but we should keep it in our back pocket to implement pieces of it as political winds allow. Fabian Neo-Liberalism! :)
Beyond that, if you want a system of health coverage that isn't first dollar you need a citizenry with the savings necessary to handle multiple thousand dollar healthcare bills without assistance and generally a decent level of personal health.
If you don't have that then something like catastrophic health insurance still leaves you with a bunch of sad sack cases that run to the government.
Finally, as a society we are unwilling to "get tough" on self imposed health problems. Randomly getting cancer is health insurance. Getting your Type 2 diabetes treatment covered because you are fat isn't really insurance, it's a subsidy to your lifestyle. But to end that we would have to get "judgmental" about peoples lifestyles (if you think it's OK to hate fats, wait till you want to charge gays for their anti-retrovirals).
>> 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.
People mostly aren't trapped by falling home prices. In most cases the drop only is the last couple years of increase. They are trapped because they have low interest mortgages and low payments that would increase drastically if they moved and got a new mortgage.
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 a good think you don't read over at Slow Boring. They get to hear me about taxation of net CO2 emission, lower deficits, land use reform, and merit-based recruiting of immigrants almost daily!
I am old, somewhat cranky, and somewhat libertarian. I plead guilty to the first two "downsides" and regret how China has turned out (yes, I believed they would become more like us, rather than us becoming more like them).
But I very much did not support 5. Quite the opposite. I believe that people should be pretty free to do what they want with their lives, but that means taking responsibility for their choices, and realizing that some choices are better than others, often a lot better. Like Charles Murray, I am bothered that successful people nowadays don't "preach what they practice." They make sure their kids do what is necessary to succeed: work on what will help them, don't get pregnant, don't overdo psychoactive chemicals, and get whatever educational credentials they need. One of the ways of forcing people to take responsibility is to have consequences for behavior that hurts others, for crimes.
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.
To varying degrees, all of that explains limits on implementing 50 year old medical treatment. As you hinted it probably explains very little of our cost increases.
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%.
I have maxed my free WP articles and can't read it unless you gift it but multiple sites say our current electric use requires 20,000 square miles or about 0.5% of contiguous US. Not Texas size. Maybe the article was for total energy use?
Doubling electric demand to change to EVs sounds in the ballpark. Since about 2000, our electric consumption has barely budged so increasing with GDP is not a reasonable assumption. Still not close to TX size and some can go on roofs, over parking areas, and other "wasted" space.
Note: I'm not arguing for or against solar/wind. Just trying to get the facts straight. Solar panels are scheduled to go on my roof next month but that's only because govt is paying for more than half the installation cost.
Debt accumulates one dollar spend one dollar of tax cut at a time. And the way it is passsed on the future generations is by consuming today rather than investing today.
My point is that "debt" is good, bad, problem, no problem, only to the extent that the taxing and spending decisions that went into it are good, bad, etc. It seems silly to me for Congress to pass tax and spending laws, whether wise or not, and then have to pass another law to permit borrowing if that is what the net result of the taxing and spending comes to.
If you were familiar with my comments elsewhere -- on Matt Yglesias and Noa Smith's sites, you would know I am quite the _deficit_ "hawk." I think that deficits generally have the effect of shifting resources from private investment to private consumption (and that investment not made reduces future income and that reduced income is the way "future generations" are forced to "bear the burden" of today's accumulation of debt).
To reduce the deficit in ways that promote future growth is by increasing progressive taxes with low dead-weight loss and reducing expenditures with NPV<0. To me this means higher collections from personal and estate taxes on higher income people (many more than the top 1%) and a few sacred cow expenditures like farm and ethanol subsidies and subsidized disaster insurance that have bad incentive effects.
Of course this has noting to do with the political issue of what to do about the "debt ceiling." My preference on that is the mint the coin to make the limit go away permanently.
" 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.
It will never happen all at once, but we should keep it in our back pocket to implement pieces of it as political winds allow. Fabian Neo-Liberalism! :)
+1
Beyond that, if you want a system of health coverage that isn't first dollar you need a citizenry with the savings necessary to handle multiple thousand dollar healthcare bills without assistance and generally a decent level of personal health.
If you don't have that then something like catastrophic health insurance still leaves you with a bunch of sad sack cases that run to the government.
Finally, as a society we are unwilling to "get tough" on self imposed health problems. Randomly getting cancer is health insurance. Getting your Type 2 diabetes treatment covered because you are fat isn't really insurance, it's a subsidy to your lifestyle. But to end that we would have to get "judgmental" about peoples lifestyles (if you think it's OK to hate fats, wait till you want to charge gays for their anti-retrovirals).
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.
People mostly aren't trapped by falling home prices. In most cases the drop only is the last couple years of increase. They are trapped because they have low interest mortgages and low payments that would increase drastically if they moved and got a new mortgage.
"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.”
That’s terribly depressing.
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.
That is your insight? :)
It's a good think you don't read over at Slow Boring. They get to hear me about taxation of net CO2 emission, lower deficits, land use reform, and merit-based recruiting of immigrants almost daily!
Older? Yes you are. Libertarian? Probably. Crank? Absolutely not!
I am old, somewhat cranky, and somewhat libertarian. I plead guilty to the first two "downsides" and regret how China has turned out (yes, I believed they would become more like us, rather than us becoming more like them).
But I very much did not support 5. Quite the opposite. I believe that people should be pretty free to do what they want with their lives, but that means taking responsibility for their choices, and realizing that some choices are better than others, often a lot better. Like Charles Murray, I am bothered that successful people nowadays don't "preach what they practice." They make sure their kids do what is necessary to succeed: work on what will help them, don't get pregnant, don't overdo psychoactive chemicals, and get whatever educational credentials they need. One of the ways of forcing people to take responsibility is to have consequences for behavior that hurts others, for crimes.
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.
To varying degrees, all of that explains limits on implementing 50 year old medical treatment. As you hinted it probably explains very little of our cost increases.
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%.
In my experience the answer is "whatever number paints the best picture for the speaker."
That's an interesting mix of things to consider and things that seem absurd. Be that as it may, there's one correction.
"there is no better way to achieve that than by carrying out the plans to cover 1/3/ to half the country with solar panels and wind turbines"
Solar panels on an area of high solar gain (sw US) about the size of 1/3 Illinois is enough energy for current demand (ignoring storage issue)
I have maxed my free WP articles and can't read it unless you gift it but multiple sites say our current electric use requires 20,000 square miles or about 0.5% of contiguous US. Not Texas size. Maybe the article was for total energy use?
Doubling electric demand to change to EVs sounds in the ballpark. Since about 2000, our electric consumption has barely budged so increasing with GDP is not a reasonable assumption. Still not close to TX size and some can go on roofs, over parking areas, and other "wasted" space.
Note: I'm not arguing for or against solar/wind. Just trying to get the facts straight. Solar panels are scheduled to go on my roof next month but that's only because govt is paying for more than half the installation cost.
Debt accumulates one dollar spend one dollar of tax cut at a time. And the way it is passsed on the future generations is by consuming today rather than investing today.
My point is that "debt" is good, bad, problem, no problem, only to the extent that the taxing and spending decisions that went into it are good, bad, etc. It seems silly to me for Congress to pass tax and spending laws, whether wise or not, and then have to pass another law to permit borrowing if that is what the net result of the taxing and spending comes to.
If you were familiar with my comments elsewhere -- on Matt Yglesias and Noa Smith's sites, you would know I am quite the _deficit_ "hawk." I think that deficits generally have the effect of shifting resources from private investment to private consumption (and that investment not made reduces future income and that reduced income is the way "future generations" are forced to "bear the burden" of today's accumulation of debt).
To reduce the deficit in ways that promote future growth is by increasing progressive taxes with low dead-weight loss and reducing expenditures with NPV<0. To me this means higher collections from personal and estate taxes on higher income people (many more than the top 1%) and a few sacred cow expenditures like farm and ethanol subsidies and subsidized disaster insurance that have bad incentive effects.
Of course this has noting to do with the political issue of what to do about the "debt ceiling." My preference on that is the mint the coin to make the limit go away permanently.