Coyote Blog

Government health care initiatives are not about cheaper or better care.  They are about control, and increased power for government officials.

First, via Carpe Diem:

The state is trying to shut down a New York City doctor's ambitious plan to treat uninsured patients for around $1,000 a year. Dr. John Muney (pictured above) offers his patients everything from mammograms to mole removal at his AMG Medical Group clinics, which operate in all five boroughs. His patients agree to pay $79 a month for a year in return for unlimited office visits with a $10 co-pay.

"I'm trying to help uninsured people here," he said.But his plan landed him in the crosshairs of the state Insurance Department, which ordered him to drop his fixed-rate plan - which it claims is equivalent to an insurance policy. Muney insists it is not insurance because it doesn't cover anything that he can't do in his offices, like complicated surgery. He points out his offices do not operate 24/7 so they can't function like emergency rooms. The state believes his plan runs afoul of the law because it promises to cover unplanned procedures - like treating a sudden ear infection - under a fixed rate. That's something only a licensed insurance company can do.

"I'm not doing an insurance business," he said. "I'm just providing my services at my place during certain hours." "If they leave me alone, I can serve thousands of patients," he said.

Expect similar efforts by Wal-Mart and CVS to run afoul of the government soon, under some pretext.   Massachusetts debated for over a year before allowing just two licenses for this type of clinic.   I have already observed lefty bloggers turning their nose up at this trend, and sense they are scrounging around for some kind of meme or message to consolidate around to oppose this kind of care.  Because having people find private solutions to their problems is the last thing they want to see.  (Seriously - is this the goofiest indictment of the US medical system you have ever seen? How deep are we reaching here?)
Anyway, should you think I am exaggerating, I will leave you with this story I saw on Radley Balko's site:

The five plaintiffs, who now include former House Majority leader Dick Armey, are challenging a policy of the Department of Health and Human Services (DHHS) that denies Social Security benefits to anybody who refuses to enroll in Medicare.

Read that again: As the policy now stands, if you want to pay for your own health care rather than let taxpayers finance it through Medicare, government will not let you receive the Social Security benefits for which you have spent a lifetime paying taxes.
Note that nobody is trying to avoid contributing to Medicare. The plaintiffs merely want to decline the tax-funded benefits for which they already have paid. None of them want the bureaucracy, the governmental intrusions into their privacy, and the rationing of care they believe Medicare entails - so they volunteer to let taxpayers off the hook by providing their own health care coverage.

But DHHS won't let them. Or at least not if they want to receive Social Security benefits. Forfeit Medicare, says DHHS, and you must also forfeit Social Security even if you've paid for it for half a century.

Kevin Drum is glad the Democrats are ready to body-slam the health insurance companies, and is rooting them on:

It means the health insurance industry is scared that we might actually do something in 2009 and they want to be seen as something other than completely obstructionist. That means only one thing: they've shown fear, and now it's time to bore in for the kill and gut them like trouts. Let's get to it.

Because everyone knows that most of the costs of healthcare reform can be paid for by ripping the excess profits out of the health insurance business like a liver from a fish.  Just to remind everyone, these are net profit margins reported by Google Finance for 3Q2008 of the largest health care providers and insurers:

Cigna: 3.50%
United Health Group: 4.56%
Aetna: 3.64%
WellCare:  4.08%
Amerigroup: 3.51%
Humana 2.56%
WellPoint: 5.49%

I am having a blast at the Change.gov transition site for Obama, now that I have satisfied myself it is not a fake.  Those who doubt that Obama has super-human powers should read this, from the Obama site:

The Obama-Biden plan provides affordable, accessible health care for all Americans, builds on the existing health care system, and uses existing providers, doctors and plans to implement the plan. Under the Obama-Biden plan, patients will be able to make health care decisions with their doctors, instead of being blocked by insurance company bureaucrats.

Under the plan, if you like your current health insurance, nothing changes, except your costs will go down by as much as $2,500 per year.

If you don't have health insurance, you will have a choice of new, affordable health insurance options.

Wow - so now you can go out purchase any care you want - any tests, any procedures, whatever - and no one is going to tell you no.  Everything is paid for.  You have a blank check to go spend.  And, by granting you an infinite supply of care, your cost is going to go down.  Obama is really superman, because no one else in history has figured out how to invert the supply curve or make 2x cost less than x.

You see, it's all about insurers' margins.  If we can just cut down on those fat margins, everyone can have full health care and a pony for less money.  You doctors who are worried about health care, you will have it better too:

Prevent insurers from overcharging doctors for their malpractice insurance and invest in proven strategies to reduce preventable medical errors.

All these years you thought malpractice insurance costs were high because of huge malpractice court settlements that usually bore little relationship to true malpractice, well, you were wrong.  Its because of the insurers and their margins.  We don't have to reform malpractice tort law (which is just as well since tort lawyers were so generous with donations to our campaign), we just have to get insurers to stop overcharging doctors.

To give you an idea of the absolutely huge amount of savings that can be extracted by just pounding on the insurers to give more coverage for less money, let's take a look at those outsized margins they are making.  These are net profit margins reported by Google Finance for 3Q2008 of the largest health care providers and insurers:

Cigna: 3.50%
United Health Group: 4.56%
Aetna: 3.64%
WellCare:  4.08%
Amerigroup: 3.51%
Humana 2.56%
WellPoint: 5.49%

Freaking robber barons!  Look at those outsized margins.  No wonder we have a health care crisis.  By cutting these guys margins in half, Obama expects to reduce the price of health care by 1-2%, which should be more than enough to pay for large increases in services and 30-50% price cuts.

Update: Oh, its magic.  That explains it.

Update #2: OK, the page has come down, as have most all the pages that had any kind of policy detail or promises in them.  I wish I had screen shots, but I can say everything above was cut and pasted directly form the web site.  Could I make that stuff up?  Too bad, there probably were another 10 blog posts in there somewhere.

Jack Tapper of ABC list all of the goodies promised by Obama in just one stump speech.  The list is really staggering, even more so than the usual political BS.  It is way to long to excerpt here.  There are so many outrageous ones, its hard for me to even pick a favorite.  But here are a few good ones:

"eliminate the oil we import from the Middle East in 10 years"

Uh, right.  We are going to completely eliminate half the fuel coming into the economy in 10 years.

"lower premiums" for those who already have health insurance;... "end discrimination by insurance companies to the sick and those who need care the most";

Perfect.  We are going to prevent insurance companies from dong any risk management, we are going to pile on even more "must cover" rules for all kinds of crap from acupuncture to mental health, and by doing so we are going to lower premiums.

This may be my favorite, though:

"reopen old factories, old plants, to build solar panels, and wind turbines"

LOL.  Barack is going to open some of those old GM plants in Flint, Michigan and build solar panels.  Seriously, is this a rhetorical flourish or does he really believe that factories are generic production facilities that can make anything, kind of like those little buildings you make in an RTS?

Update: And if you think that voters just discount all this stuff, don't miss this video of Obama supporters talking about the free gas and house she is going to get.

By the way, none of this will push me to vote for McCain.  McCain promises all kinds of crazy stuff too, its just less compelling stuff to voters.   He is not losing because he is promising less -- I think he is losing because Obama has a better grasp of what expensive shit people want to be promised than does McCain.

Yesterday I posted on the irony that in the name of "change" and "dynamism," the Democrats are pushing for what basically is an inherently more conservative (little-c), less dynamic economic system that mirrors that of many continental European countries.

Daniel, an American reader who does quite a bit of work in Europe, wrote me:

1) The static nature of the Euro mentality assigns a high cost to ... people ... who try to break the mold. Cost of failure is relatively high. In Italy if your small business declares bankruptcy, you forfeit the right to vote.

2) In Germany, workers are sorted at an early age into "blue collar schools" and "professional schools". I know from my youth, if I had grown up in Germany instead of America, I probably would not be a consultant but more like a janitor (not that there is anything wrong with janitors...).

3) Social services in Europe are hit and miss. In Germany, many people carry private insurance despite the availability of public insurance because of the lack of quality.

4) (this may be a good thing) Italian school children go through a less harsh puberty than American kids. Society has drilled into them that it's not cool to be different, so there are less cliques. When I share my experiences in school with most Europeans they usually make some snide remark about how growing up in a battle zone (primary school) has caused the Iraq war.

5) Highly skilled workers are in many cases no better paid than unskilled staff. In the south of Italy a senior programmer may make 2K euros per month. A secretary might make 1.5K a month. If it weren't for most Europeans fear of moving to new cities, there would be no programmers to hire.

6) Speaking of being afraid to move, many Europeans find the thought of moving to a different city complete alien concept.

7) Life in Euro is a much more comfortable than in America *if* you are European. If you are an immigrant, forget it. After two years of pitching companies in the South of Italy, I have never seen a black person be more than a street side vendor of trinkets. In Italy, there is an unsaid rule that you must be an Italian to ever be a professional.

8) Don't get me started on France.

9) It is illegal for a business to stay open more than it's quota in most European countries. It is illegal to operate a barber shop on Mondays.

I haven't posted at all on the brouhaha about mark-to-market accounting of derivatives and whether it was a contributor to the recent financial mess.  If I had to summarize the issue, I would describe it thus:  Investors want something more trustworthy than just management estimates of the value of complex securities -- so they would like an outside market-based reference point -- but the very complexity that makes these contracts hard to value as an outsider also tends to make their markets illiquid and volatile, making it difficult to get a good market value. 

Tom Selling addresses the problem of accounting for the value of credit default swaps here.  He makes what seems to me to be a common sense suggestion:

Requiring the asset and liability sides of derivatives to be separately
measured and reported seems like an amazingly simple fix that could
simplify regulation of the financial and insurance industries, reduce
the need for the disclosures in financial statements written so as to
discourage one from reading them, and help investors more easily assess
risk.

This certainly seems reasonable to me.  When one buys a revenue producing asset with debt financing, the two are listed separately as an asset and a liability, rather than as one "net" asset, even though they may be inextricably linked (say if the asset is collateral for the loan and the loan has high pre-payment penalties).  Any thoughts?  Does this make sense, or is it naive?

OK, I know burn-out is setting in.  I certainly think that explains, in part, why the House voted for a demonstrably worse bill than they voted against the week before.  But John Moore has a number links to an interesting set of charts from the Milken Institute on the financial meltdown.

They hit on many of the things I discussed earlier, but put a greater emphasis on 1) securitization, and the effect it had on good underwriting standards and 2) on interest rates as a driver of the housing bubble.

Update:  And an interesting post on the link between credit default swaps and short-selling.  My personal view is that credit default swaps will someday be looked at like earthquake insurance -- nice premiums today, but too much systematic risk, too much certainty that in 10 or 20 years there will be an event that forces nearly every policy to pay simultaneously, wiping out the insurer.  You can't get earthquake insurance, and you nearly can't get hurricane insurance, and I think the default insurance market may go the same way.  Or, as a minimum, the price is going so high few people will buy it.  This is not a market failure, it is a market lesson learned and adjustment to reality.

Update #2:  Even more from economists on the rush to bailout.

Here are some of the provisions in the bailout that converted "no" votes to "yes." Unbelievable.

Andrew Leonard goes digging in the Senate's bailout package and finds a bunch of "sweeteners" added to lure in votes.  Among them:

* Sec. 105. Energy credit for geothermal heat pump systems. * Sec. 111. Expansion and modification of advanced coal project investment credit. * Sec. 113. Temporary increase in coal excise tax; funding of Black Lung Disability Trust Fund. * Sec. 115. Tax credit for carbon dioxide sequestration. * Sec. 205. Credit for new qualified plug-in electric drive motor vehicles. * Sec. 405. Increase and extension of Oil Spill Liability Trust Fund tax. * Sec. 309. Extension of economic development credit for American Samoa. * Sec. 317. Seven-year cost recovery period for motorsports racing track facility. * Sec. 501. $8,500 income threshold used to calculate refundable portion of child tax credit. * Sec. 503 Exemption from excise tax for certain wooden arrows designed for use by children.

There
are also tax credits for solar and wind power, and a very expensive
requirement that health insurance companies cover mental health the
same way they cover physical health.

I know this may be pointing out the obvious, but I think it needs to be said:  Lenders have to lend, just as much as borrowers have to borrow.  I know most people understand the "borrower" part of this phrase, but they seem to act as if lenders are somehow only putting their money on the street as some sort of charitable activity, and if we don't sufficiently kow-tow to all their needs, they will run away and never help us all again.

The fact is that people with large pools of money -- banks, pension funds, insurance companies -- HAVE to lend.  And in a time where stocks are dicey, they probably have more, not less, cash than normal they want to lend, much of it short-term.  Now, they may be temporarily scared off from doing so for a few days or weeks as they try to assess what is safe and what is not, but they can't stick their money in a mattress or buy tons of gold or invest in ammunition and run for the hills.  Banks have to pay off depositors; insurance companies often aim to break
even on premiums and payouts and make their money on investing the cash
in between; pension funds can't make their long-term obligations
without making steady returns.Their very survival, in many cases, depends on making continuous returns off their free cash. 

Wisdom from Schoolhouse Rock:

You got a couple hundred bucks saved up in your birthday stash.Why not deposit them dollars in the bank instead?
Then at the end of the year you'll come out way ahead,
Because the bank'll pay you money in exchange for the use of your cash!
And that's called interest; you're makin' money that way,
And you can buy that gear about a year from today.

      

Several people I know have argued with my "do nothing" approach to the current mortgage and liquidity mess.  Their argument is that the current crisis has frozen the short term money market, with banks refusing to lend to each other, and only doing so via central banks.  The problem, they claim, is that this could lead to an extended drying up of business to business credit.  For example, two people both used the fuel retailing example, arguing that inventory purchases are made on credit, and paid off as the inventory is sold.  The logic, I assume, is that businesses have all reduced their working capital, and so a drying up of short term business credit will cause the economy to lock up, with producers and retailers unable to buy components and inventory.  One such argument here.

I guess the questions are 1) for how long and 2) how best to fix it.  To the first question, this is by no means the first time in my lifetime that short-term credit has dried up.  Liquidity eventually returns, mainly because lenders need to lend as much as borrowers need to borrow.  As to the second question, central banks are currently handling this by increasing the amount of money they will lend short term.  Rather than lend to each other directly, bank A deposits with the Fed and then the Fed lends to bank B.  The cycle ends NOT when every bank is healthy but when banks and other institutions are confident they know which banks are healthy.  All the bailout is doing is delaying this reckoning.  I don't think it matters that banks and certain financial institutions survive, I think it matters that the ones who are not going to survive are identified quickly so the rest can start lending again to each other.

Given these concerns, I reiterate my position that if the government is going to inject liquidity and create new financial asset insurance programs, it makes more sense to me to do it at the point of concern, i.e. in the credit market to main street businesses, rather than dumping the money into the toxic sludge of credit default swaps. 

Much has been made of the bailout legislation provision that the administration would be immune to any scrutiny of any sort for any decision made vis a vis the $700 billion in bailout funds and the resulting spending decisions.  But I thought this was equally telling of the over-broad power grab that is going on at Treasury:

The SHR [senior House Republican] calls this an insurance program and the original Paulson plan a
purchase program. He says Treasury Department people have told him that
they considered an insurance program but decided that a purchase
program would be better. But he also added that in the draft
legislation Paulson has advanced, the Treasury would have the authority
to set up such an insurance plan without congressional authorization.
From what he said, it struck me that both courses could be followed.
After all, neither purchases nor insurance is contemplated to take
place unless and until a financial institution comes forward and
requests one or the other.

Jeez, how much latitude are they asking for?  Is the bill really so broad that the secretary of the treasury could set up an entirely new government insurance program for financial assets without further Congressional approval?

While I think Cantor is being overly-optimistic about the near-term cash flow of his insurance proposal, it does seem to be at least an incremental improvement over Paulson's plan.

I know that most non-financial folks, including myself, have their head spinning after this past few weeks' doings on Wall Street.  Doug Diamond and Anil Kashyap have a pretty good layman's roundup on Fannie/Freddie, Lehman, and AIG.  My sense is that their Lehman explanation also applies to Bear Stearns as well.  Here is just one small piece of a much longer article:

The Fannie and Freddie situation was a result of their unique roles
in the economy. They had been set up to support the housing market.
They helped guarantee mortgages (provided they met certain standards),
and were able to fund these guarantees by issuing their own debt, which
was in turn tacitly backed by the government. The government guarantees
allowed Fannie and Freddie to take on far more debt than a normal
company. In principle, they were also supposed to use the government
guarantee to reduce the mortgage cost to the homeowners, but the Fed
and others have argued that this hardly occurred. Instead, they appear to have used the funding advantage to rack up huge profits
and squeeze the private sector out of the "conforming" mortgage market.
Regardless, many firms and foreign governments considered the debt of
Fannie and Freddie as a substitute for U.S. Treasury securities and snapped it up eagerly. 

Fannie and Freddie were weakly supervised and strayed from the core
mission. They began using their subsidized financing to buy
mortgage-backed securities which were backed by pools of mortgages that
did not meet their usual standards. Over the last year, it became clear
that their thin capital was not enough to cover the losses on these subprime
mortgages. The massive amount of diffusely held debt would have caused
collapses everywhere if it was defaulted upon; so the Treasury
announced that it would explicitly guarantee the debt.

But once the debt was guaranteed to be secure (and the government
would wipe out shareholders if it carried through with the guarantee),
no self-interested investor was willing to supply more equity to help
buffer the losses. Hence, the Treasury ended up taking them over.

Lehman's demise came when it could not even keep borrowing. Lehman
was rolling over at least $100 billion a month to finance its
investments in real estate, bonds, stocks, and financial assets. When
it is hard for lenders to monitor their investments and borrowers can
rapidly change the risk on their balance sheets, lenders opt for short-term lending. Compared to legal or other channels, their threat to refuse to roll over funding is the most effective option to keep the borrower in line.

This was especially relevant for Lehman, because as an investment
bank, it could transform its risk characteristics very easily by using
derivatives and by churning its trading portfolio. So for Lehman (and
all investment banks), the short-term financing is not an accident; it
is inevitable.

Why did the financing dry up? For months, short-sellers were
convinced that Lehman's real-estate losses were bigger than it had
acknowledged. As more bad news about the real estate market emerged,
including the losses at Freddie Mac and Fannie Mae, this view spread.

Lehman's costs of borrowing rose and its share price fell. With an
impending downgrade to its credit rating looming, legal restrictions
were going to prevent certain firms from continuing to lend to Lehman.
Other counterparties
that might have been able to lend, even if Lehman's credit rating was
impaired, simply decided that the chance of default in the near future
was too high, partly because they feared that future credit conditions
would get even tighter and force Lehman and others to default at that
time.

A.I.G. had to raise money because it had written $57 billion of insurance contracts whose payouts depended on the losses incurred on subprime real-estate related investments.
While its core insurance businesses and other subsidiaries (such as its
large aircraft-leasing operation) were doing fine, these contracts,
called credit default swaps (C.D.S.'s), were hemorrhaging.   

Furthermore, the possibility of further losses loomed if the housing
market continued to deteriorate. The credit-rating agencies looking at
the potential losses downgraded A.I.G.'s debt on Monday. With its lower
credit ratings, A.I.G.'s insurance contracts required A.I.G. to
demonstrate that it had collateral to service the contracts; estimates
suggested that it needed roughly $15 billion in immediate collateral.

A second problem A.I.G. faced is that if it failed to post the
collateral, it would be considered to have defaulted on the C.D.S.'s.
Were A.I.G. to default on C.D.S.'s, some other A.I.G. contracts (tied
to losses on other financial securities) contain clauses saying that
its other contractual partners could insist on prepayment of their
claims. These cross-default clauses are present so that resources from
one part of the business do not get diverted to plug a hole in another
part. A.I.G. had another $380 billion of these other insurance
contracts outstanding. No private investors were willing to step into
this situation and loan A.I.G. the money it needed to post the
collateral.

In the scramble to make good on the C.D.S.'s, A.I.G.'s ability to
service its own debt would come into question. A.I.G. had $160 billion
in bonds that were held all over the world: nowhere near as widely as
the Fannie and Freddie bonds, but still dispersed widely.

In addition, other large financial firms "” including Pacific
Investment Management Company (Pimco), the largest bond-investment fund
in the world "” had guaranteed A.I.G.'s bonds by writing C.D.S.
contracts.

Given the huge size of the contracts and the number of parties
intertwined, the Federal Reserve decided that a default by A.I.G. would
wreak havoc on the financial system and cause contagious failures.
There was an immediate need to get A.I.G. the collateral to honor its
contracts, so the Fed loaned A.I.G. $85 billion.

Update:  Travis has an awesome post with his own FAQ about what is going on.  Here is a taste:

Lots of financially naive folks think that we can remove all risk,
inflation, etc. by only ever trading apples for chickens on the barrel
head, and doing away with paper money (so that all money is gold) and
doing away fractional reserve banking, so that when I deposit one gold
coin in the bank, the bank can then take that actual physical gold coin
and loan it to someone else. It turns out that the friction involved in
doing things this way is so huge that the effect would make The Road
Warrior look like a children's bedtime story. You want to borrow money
to buy a car? The bank can't just loan money that's been deposited in
someone else's checking account - the bank has to get that person to
sign a note saying "yes, I understand that this money is on deposit
until that dude buying the card pays the bank back IN FULL". And the
lender, if he wants his money out ahead of time, is SOL. And even then,
there can be a flood, and your car gets totaled, and you get
Legionaire's disease, and you can't make the payments.

or this:

Now, for the next complication, let's also imagine that there are
300 million other people watching all of this, thinking "How bad is
this? Should I go down to the gun store, stock up on .223 and 12 gauge
shells, then stop by the veterinarians to see how much antibiotics I
can cadge before heading to the hills" ?

And the Feds really don't want 300 million armed folks heading
for the national forests, so they first try to tell everyone who owns a
bicycle "Hey, the value of your bike didn't really drop! It's still
worth $9!".

But no one wants to believe that.

So then they go to the guy who's writing insurance policies on
the value of bikes and they say "if you got $100 million, would that
calm things down a bit?".

As we previewed last week, the IRS came out with its numbers on 2006 taxes, and it turns out that the top 1% richest taxpayers earned 22% of the taxable income and paid 40% of the income taxes.  According to candidate Obama, this represents an unfair free ride for the rich.  These numbers increased from 21% and 37% in the last year of the Clinton administration.

I guess my question is, what's enough?  Already, half the country only pays less than 3% of the income taxes.  Do we really want a country where 50.1% of the people vote to live off the other 49.9%?

Postscript:  Yes, I know payroll taxes work differently and hit lower income folks pretty hard.  But then again, the Social Security program is supposed to be an insurance and retirement plan, not a transfer program. The left goes bananas when you suggest Social Security is welfare and not an honorable paid participation program.  So, like any other insurance, the premiums are flat rather than progressive.  You can't have it both way.

If I had to name the one single biggest problem in US healthcare, it would be this:

"Twenty years ago, when I was in training, nobody really dealt with
economics," says Stephen Hufford, an oncologist in San Francisco. The
prevailing thinking, he says, was: "Cost should never be an issue in
someone's care."

In a survey of 167 cancer doctors reported last year in the Journal of
Clinical Oncology, 42% said they regularly raised the issue of costs
when discussing treatment options with patients.

Which means that even today, 58% of oncologists did not raise cost or price issues with various treatment options, despite practicing in perhaps the most costly of medical fields.  What planet are we living on, here?  Can you imagine a survey in which 58% of car dealers refused to raise the issue of cost in a new car sale?   Or 58% of real estate brokers saying they never mentioned the prices of houses when discussing them with clients? 

This represents a process failure in the health care system on two levels.  First, not having any single person in the decision-making process making cost-benefit trade-offs is a recipe for disaster.   Insured customers will consume as much as they can when price is off the table.  Many folks in the health care debate recognize this.

But there is a second problem.  Even when there is a single entity making these trade-offs, it is almost never the patient.  Most "reformers" on both the left and the right want to place this decision-making authority in government bureaucrats, in insurance companies, in Congress, in doctors -- any place but in the individual patient herself.   This particular article discusses the role of doctors in this process:

Many health-policy experts say it's high time for American doctors to
start considering costs when assessing treatment options. In 2007, the
cost of cancer care alone reached an estimated $89 billion in the U.S.,
up from $72 billion in 2004, according to the American Cancer Society
using data from the National Institutes of Health....

The study, conducted
by Deborah Schrag, an oncologist at the Dana Farber Cancer Institute in
Boston, found that 23% of oncologists said costs influence their
treatment decisions, and 16% said they omit discussion of very
expensive treatments when they know the cost will place great strain on
patients' resources.

This misses the mark.  Doctors should be ready to inform patients of their options, but at the end of the day we need a system where the patient is making these tradeoffs.  Note the absolute, nearly criminal arrogance of doctors who don't suggest the best treatment regime because the cost might stress out the patients.  How does the doctor know what financial resources the person might be able to bring to bear?

Postscript:  In an adjoining article, the WSJ has an article on the wacky way the French government makes these cost-benefit trade offs in health care:

Since 1860, when Napoleon III appropriated this
ancient Roman spa at the foot of the Alps for his empire, the National
Baths of Aix-les-Bains have been a symbol of France's cushy health-care
system.

On a recent morning, Jacqueline Surmont and her
husband, Guy, a 77-year-old retired construction worker, headed for
their daily mud wrap. The spa's rheumatism cures, thermal baths and
13-minute deep-tissue massage all are covered by France's national
health-insurance system. Transportation and lodging are, too....

"For many people, it's like a free holiday," says Ms. Surmont, who says
all her mud wraps and massages were properly prescribed by a doctor to
soothe her ailing back. "Some patients go shopping in the afternoon.
They're hardly in pain."

Wonderful.  This kind of BS is virtually inevitable in state-run systems.  I think one can already imagine a US health care system where taxpayers foot the fill for groovy treatments loved by the dippy left, from acupuncture to aromatherapy to homeopathy, while cancer patients are denied drugs and people have to wait months or years for elective surgery.

By the way, we get this in the "goes without saying" file from a state-run spa employee facing cutbacks:

"Of course we went on strike," said Martine Claret, a 52-year-old
physiotherapist who has worked at the spa since 1979 and doubles as a
union representative.

Via Michael Tanner:

• Slightly less than half of Massachusetts' uninsured population
  actually complied with the mandate. True, the number of people without
  health insurance was reduced from 13% of the state's population to 7%,
  but when the bill was passed, advocates promised that "all Massachusetts citizens will have health insurance."  Perhaps it depends on your definition of "all."
• Most of those who are signing up are low-income individuals, whose
  coverage is fully or partially subsidized, proving once again that if
  you give something away for free people will take it. It certainly
  appears that it is the expensive and generous Massachusetts subsidies
  (up to 300% of the poverty level), not the unprecedented individual
  mandate that is responsible for much of the increased coverage.
• Adverse selection remains a big problem, with the young and healthy
  failing to comply with the mandate. The state refused to change its
  community rating laws which drive up the cost of insurance for young,
  healthy individuals. Not surprisingly, they don't find this a good deal.
• The program is far exceeding its projected costs, with at least a 33% budget overrun in its first year.
• The program has increased demand for health care services without
  increasing the supply of providers. As a result, patients are having
  trouble finding providers and waiting lists (Canada here we come) are
  beginning to develop.

It is difficult to imagine that we would have the extensive, absurd subsidies of corn ethanol that we have today if it were not for the fact that Iowa is the first stop on the presidential campaign trail.  Every four years, here-to-fore fiscally sober and rational candidates stand up on Iowa TV and pledge to support ethanol subsidies.

But today it appears the primaries are finally over (it appears that Ms. Clinton will bow out tonight) and so attention now focuses on the general election.  And though I am not really an expert, I would presume the election will again turn on a few states including Ohio, Pennsylvania and, of course, Florida.

It appears that Florida Democrats have a plan to parlay their swing state status into pork, in the same way that Iowa has done for years.  The only difference is the issue is not ethanol, it's subsidizing beach-front homes:

As hurricane season begins, Democrats in Congress want to nationalize a
chunk of the insurance business that covers major storm-damage claims.

The proposal -- backed by giant insurers Allstate Corp. and State Farm
Mutual Automobile Insurance Co., as well as Florida lawmakers --
focuses on "reinsurance," the policies bought by insurers themselves to
protect against catastrophic losses. The proposal envisions a
taxpayer-financed reinsurance program covering all 50 states, which
would essentially backstop the giant insurers in case of disaster.

The program could save homeowners roughly $500 apiece in annual
premiums in Florida, according to an advocacy group backed by Allstate
and State Farm, the largest writers of property insurance in the U.S.

But environmentalists and other critics -- including the American
Insurance Association, a major trade group -- say lower premiums would
more likely spur irresponsible coastal development, already a big
factor in insurance costs. The program could also shift costs to
taxpayers in states with fewer natural-disaster risks....

The legislation passed the House with bipartisan support, 258-155, late
last year, despite a presidential veto threat. Although a Senate vote
is unlikely this year, proponents are trying to make it a litmus-test
issue in the presidential race. The two Democratic contenders, Sen.
Hillary Clinton of New York and Sen. Barack Obama of Illinois, in their
recent visits to Florida -- a key swing state -- have both voiced
support for the plan.

Big winners would be coastal states, particularly Florida, where more
than half of the nation's hurricane risk is centered. Currently,
property-insurance rates in Florida are among the highest in the
nation. Florida also has a struggling state reinsurance fund that would
be helped by a federal program....

Florida's status as a presidential swing state has helped the plan win
support from Sens. Clinton and Obama. Sen, Clinton is one of the bill's
co-authors, along with Democratic Sen. Bill Nelson of Florida.

Florida Democrats' effort to make a federal disaster fund a big issue
in this year's presidential race was one reason the state moved up its
primary election to January from March, defying party rules. (That move
is partly what's behind the current, heated battle between the
Democratic candidates over how to count Florida's delegates in the
nominating race.)

The Arizona Republic the other day had this headline which certainly caught me attention:

Report: 35% of Arizona jobs  'bad'

I can sympathize.  I have had jobs that were boring and unrewarding.  My last couple of Fortune 50 corporate jobs, while nominally cool on paper, were hugely frustrating.  But it seems this particular "report" had different criteria for "bad" jobs:

The new report calls 35 percent of jobs "bad" because they pay less
than $17 an hour, or $34,000 a year, and offer no insurance or
retirement plans. In a typical state, only 30 percent of the jobs are
considered "bad."

Here is the heart of these studies:  A bunch of middle class people sit around and try to decide what jobs they would be willing to accept and which ones they would not.  Any job that they would not accept is a "bad" job, despite the fact that $12 or $14 an hour might be very good pay for someone with no skills, despite the fact that it makes no consideration of a person's circumstances (e.g. single, married, 2nd job, teenager, etc), and despite the fact that $34,000 would probably put a person in the top 20th  percentile of global wages.  I made a similar point vis a vis jobs in the third world.

Just so I can't be accused of cherry-picking, I will use my own company as an example.  We have a about 80 employees in Arizona, about 70 of which are paid less than $10 an hour and none of whom have a retirement plan or insurance.  All of my jobs in Arizona are included in their count of "bad jobs."  And you know what?  We have a waiting list of over 200 names of people who would take another of these jobs tomorrow if I had one to offer.  That's because my employees are not middle-class academics.   Most are older people who already have a health plan, who don't need a retirement plan (because they have already retired) and who just want a fun job in a nice location where they can live in their RV. 

This has to be one of the most utterly pointless studies of all time.  Sure, $14 an hour would probably suck as a 45-year-old college grad with 2 kids.  But it would be a windfall to a 16-year-old new immigrant with few skills and no English.  The only thing that would be more pointless would be to try to compare states - which they also do:

About 22 percent of Arizona jobs are considered "good" because they pay
at least $17 and offer benefits. That is less than the typical state,
which has 25 percent "good" jobs. The rest of the jobs are in between
because they offer some benefits.

Since cost of living is totally comparable between Phoenix and Manhattan, then using a fixed wage rate to compare states makes complete sense.  By the way, by the study's definition, my job, which is usually awesome, is not "good" because I have no health plan.  In fact, in this study, a $40,000 job with a health plan is ranked as good while a $400,000 job with no health plan is not good.  Yeah, that makes sense.

WSJ, via Libertarian Leanings:

One of the worst places, in
term of frivolous lawsuits, was Jefferson County. It became renowned as
the lawsuit capital of the country, with more plaintiffs than
residents. This is the infamous county where one pharmacist was named
in more than 1,000 lawsuits. In one legendary case against a
pharmaceutical company that sold the diet pill Pondimin (part of the
weight-loss combination known as fen-phen, which was later banned), a
Jefferson County jury awarded $1 billion to the family of a woman who
had taken the drug.

But four years ago, Mississippi transformed itself
from judicial hell hole to job magnet, a story that is instructive for
other states trying to attract jobs in turbulent economic times. The
lessons here are especially timely, because the pro-growth tort reform
trend that was once spreading across the country may soon reverse
course....

Almost overnight, the flow
of lawsuits began to dry up and businesses started to trickle in.
Federal Express invested $1 billion in a new facility in the state.
Toyota chose Mississippi over about a dozen other states for a new $1.2
billion, 2,000-worker auto plant. The auto maker has stipulated that
the company would pull up stakes if the tort reforms were overturned by
the legislature or activist judges.

That hasn't happened. About 60,000 new jobs have
arrived in four years "“ not a small number in a workforce of about 1.3
million "“ and a sharp improvement from the 30,000 jobs lost in the four
years before Mr. Barbour took office. Since the law took effect, the
number of medical malpractice lawsuits has fallen by nearly 90%, which
in turn has cut malpractice insurance costs by 30% to 45%, depending on
the county.

Todd Zywicki has a nice post on the The Two-Income Trap: Why Middle Class Mothers and Fathers are Going Broke by Professor Elizabeth Warren and Amelia Warren Tyagi. 

In his writings on the tactics for engineering the communist state, Karl Marx talked a lot about the need to "proletarianize the middle class."  This has been a very popular tactic among leftish writers and politicians today, attempting to convince the middle class that they never had it so bad.

I won't repeat Zywicki's whole post, but the books author's argument revolve around examples which purport to show that as families go from one to two earners, their costs (health care, child care, cars, mortgage, etc.) go up by more than the additional income, making them poorer on a discretionary spending basis.

Zywicki first points out the same thing I immediately thought of when I read a summary of the book:

It is not clear what to make of all of this, except that it is hard to
see how this confirms the central hypothesis of "The Two-Income Trap"
that "necessary" expenses such as mortgage, car payments, and health
insurance are the primary draing on the modern family's budget. And
again, this unrealistically assumes that all increased spending on
houses and cars is exogenously determined, ignoring the possibility
that an increase in income leads to an endogenous decision by some
households to increase their expenditures on items such as houses and
cars.

While the assumption seems crazy, it makes sense in the context of leftish ideology, which holds that the middle class have only limited free will and tend to have their decision making corrupted by advertising and other corporate pressures.

But Zywicki goes further, and actually digs into the author's numbers.  He finds that the authors are surprisingly coy about addressing changes in taxation in their numbers.   Zywicki then uses the authors' own numbers, this time with taxes factored in using the authors' own assumptions, and gets these two charts:

As Zywicki summarizes:

As can readily be seen, expenses for health insurance, mortgage, and automobile, have actually declined
as a percentage of the household budget. Child care is a new expense.
But even this new expenditure is about a quarter less than the increase
in taxes. Moreover, unlike new taxes and the child care expenses
incurred to pay them, increases in the cost of housing and automobiles
are offset by increases in the value of real and personal property as
household assets that are acquired in exchange.

Overall, the typical family in the 2000s pays substantially
more in taxes than in their mortgage, automobile expenses, and health
insurance costs combined. And the growth in the tax obligation
between the two periods is substantially greater the growth in
mortgage, automobile expenses, and health insurance costs combined. And
note, this is using the data taken directly from Warren and Tiyagi's
book.

A reader pointed me to this article about a really amazing piece of government science:

A strong and deadly
earthquake is virtually certain to strike on one of California's major
seismic faults within the next 30 years, scientists said Monday in the
first official forecast of statewide earthquake probabilities.

They calculated the probability at more than 99 percent that one or
more of the major faults in the state will rupture and trigger a quake
with a magnitude of at least 6.7.

Uh, okay.  Next up:  California demonstrates more than a 99% chance that I will be dead in 100 years.  I would also give them the false precision award:

An even more damaging quake with
a magnitude of 7.5 or larger, the earthquake scientists said, is at
least 46 percent likely to hit on one of California's active fault
systems within the next three decades.

Are they really sure that its not 46.1%?

"The report's details should
prove invaluable for city planners, building code designers, and home
and business owners who can use the information to improve public
safety and mitigate damage before the next destructive earthquake
occurs," said geophysicist Ned Field of the Geological Survey, who
headed the Working Group on California Earthquake Probabilities, which
developed the forecasts.

Really?  How?  They should have given me the money and I would have written a two sentence report:  "You are going to have an earthquake in the future -- duh, its California.  Plan for it."

Update: A reader notes that this was funded by some insurance companies or trade group, and the whole point is the unspoken message "insurance rates are going up."  You guys are so cynical.

A reader pointed me to this article about a really amazing piece of government science:

A strong and deadly
earthquake is virtually certain to strike on one of California's major
seismic faults within the next 30 years, scientists said Monday in the
first official forecast of statewide earthquake probabilities.

They calculated the probability at more than 99 percent that one or
more of the major faults in the state will rupture and trigger a quake
with a magnitude of at least 6.7.

Uh, okay.  Next up:  California demonstrates more than a 99% chance that I will be dead in 100 years.  I would also give them the false precision award:

An even more damaging quake with
a magnitude of 7.5 or larger, the earthquake scientists said, is at
least 46 percent likely to hit on one of California's active fault
systems within the next three decades.

Are they really sure that its not 46.1%?

"The report's details should
prove invaluable for city planners, building code designers, and home
and business owners who can use the information to improve public
safety and mitigate damage before the next destructive earthquake
occurs," said geophysicist Ned Field of the Geological Survey, who
headed the Working Group on California Earthquake Probabilities, which
developed the forecasts.

Really?  How?  They should have given me the money and I would have written a two sentence report:  "You are going to have an earthquake in the future -- duh, its California.  Plan for it."

Update: A reader notes that this was funded by some insurance companies or trade group, and the whole point is the unspoken message "insurance rates are going up."  You guys are so cynical.

The Democratic party, which so often accuses others of adopting superstition over science, are themselves pursuing Medieval economics:

The Democratic Party's protectionist make-over was completed yesterday,
when Nancy Pelosi decided to kill the Colombia free trade agreement.
Her objections had nothing to do with the evidence and everything to do
with politics, but this was an act of particular bad faith. It will
damage the economic and security interests of the U.S. while trashing
our best ally in Latin America.

The Colombia trade pact was signed in 2006 and renegotiated last year
to accommodate Democratic demands for tougher labor and environmental
standards. Even after more than 250 consultations with Democrats, and
further concessions, including promises to spend more on domestic
unemployment insurance, the deal remained stalled in Congress.
Apparently the problem was that Democrats kept getting their way.

I am sure the Columbians, who for years have been told by the US to export something other than cocaine, are scratching their heads at this rebuff when they actually try to do so.  My sense is that the Democrats are reacting to this ugly picture of US manufacturing output post NAFTA:

We can see that since the passage of NAFTA in the mid-1990s that US manufacturing output has, uh, has.... can that be right?

I got to thinking today about regulation and its enforcement in this imperfectly government-dominated world after reading this Jon Stewart quote as relayed by Kevin Drum:

With this administration, if a passenger blows up a plane, it's a
failure in the war on terror. But if the plane just blows up on its own
"” eh, it's the market self-regulating.

What struck me that I had not thought of before is the question of whether non-enforcement of a published regulatory regime was the same as letting a market self-regulate.  And my answer was:  No, at least not in the short to medium term.

The reason is that the government regulatory regime crowds out private mechanisms that might attempt to achieve the same goals.  What do I mean by crowding out?  For example, if the government published car reliability metrics and regulation for all cars, no matter how imperfect, would JD Power and Consumer Reports bother with the investment to do the same?  For decades, insurance companies wrote de facto building codes and performed fire inspections of their insured structures.  They no longer do so, because the government has taken on that role (arguably less well than the insurance companies, who had the reputation of being tigers on such inspections).  Would Moody's exist to rank bond risks if the government had regulations in place that theoretically forced all securities to (I don't know how) have the same risk?  My marina liability insurer conducts occasional inspections of my marinas.

As a result, insurers don't inspect airlines, nor do manufacturers enforce inspection and replacement regimes (as automobile companies do, to some extent, to protect their warranty).  Third parties rate airlines for customer service but not for safety.  The whole private evaluation regime for airlines exists on the assumption that the government has regulatory program X and Y in place that is enforced.  In the long term, if the government were to abandon enforcement, and this lasted long enough for that expectation to exist in the market, new private regulatory methods would arise [arguments would most certainly exist between libertarians and others whether these new regimes were as effective as the old regime, but almost undoubtedly something would emerge].  But in the near term, we don't have a self-regulating market or even the expectation of one. 

As a result, I come to the conclusion that while deregulation may be needed, the absolute wrong way to do it is via non-enforcement of existing regulations.  So there you have it, a libertarian calls for better enforcement.  Comments?  I am just starting to think about this and would appreciate feedback.

Despite seeing all kinds of major problems in tort law today, I have never been a huge proponent of many tort law reforms (though I support loser pays).  I don't see why my ability to pursue legitimate damages in court should be curtailed.  What all these tort law reforms never get at is this:

A Glendale jury on Friday cleared an emergency room doctor of
negligence and liability in John Ritter's death, holding he did
everything he could to save the comic actor. ... Jurors, who voted 9 to
3 against liability for Lee and Lotysch, said they were torn between
sympathy for Ritter's wife and children and their conviction that the
doctors were blameless.

The fact that the jury is at all conflicted on this point represents a huge miscarriage of justice, but this goes on every day in court.  In fact, if the doctors had worked for Exxon, you can bet Exxon would have been paying despite being blameless.

What patients (and juries) really seam to want is bad outcomes insurance rather than malpractice insurance.  This is in part born out by the fact that researchers can usually find little statistical relationship between truly bad doctors and the size of court malpractice payouts.  Maybe the answer to malpractice insurance is to convert it to a workers-comp-like no-fault insurance systems that pays off on bad/unexpected outcomes following a fixed schedule and keeps everything out of court.  The reduction in legal costs alone would be staggering.

Megan McArdle makes a great point that should be absolutely uncontroversial:

government is much better as a price taker than a price maker.
Government procurement is all kinds of tedious and cluttered with red
tape, but in the end there's no gigantic problem with the government
pencil supply. Defense procurement, on the other hand, is pretty well
agreed to be godawful-expensive for what we get, the only excuse being
that we can't think of another way to buy fighter planes.

That means that government procurement alongside a free market looks a lot
different from government procurement when the government is the only
buyer. Yes, the health care market is extremely screwed up, but the
prices in it do tell you something about demand for various services,
and provide some signals about cost/benefit. You may think that viagra
is a prime example of wasted pharmaceutical R&D spending (though if
you do, I am willing to bet that you are either under forty, or
female), but the fact that a lot of people are willing to pay a fair
amount of coin for it tells you that they probably feel it is improving
their lives in some significant way. Governments can estimate
cost-benefit when the benefit is limited to crude mortality
improvements, but they are pretty much at sea when it comes to
quality-of-life. America's price signals are wildly distorted by its
insurance markets--but they're almost certainly better than no signal
at all.

Europe's governments operate their health care systems in the
context of an existing US market that provides information about demand
for new treatments (and of course I would argue, also the new
treatments). They don't use that price information to set what they pay
for drugs, but it does filter through to their markets--for example,
more widespread use of Herceptin for breast cancer in the US is putting
pressure on the British government to provide it. I think an American
shift to single-payer would be more problematic than the European
example for a variety of reasons related to our government structure.
But one important reason is that if we did, we'd have no where left to
get prices from.