Friday, February 28, 2020

Will it be Orange Clown vs. Pink Clown

I'm with Bernie on the war in Iraq (though he did authorize Bush to go into Afghanistan with a pretty open ended bill and that was bad see 1 below), but he seems to have some Marxists ideas that I do not like. 

He talks about jailing bankers, compares drug co. executives to murders, calls for criminally prosecuting fossil fuel co. executives etc. which is #MoreLikeTheUSSRThanDenmark. And national rent control which is #MoreLikeVenezulaThanDenmark.  

Also he talks about rights to healthcare rather than providing healthcare being the charitable thing to do. Rights that require the labor of others are not really rights. The danger of such rhetoric is, rights are defended with violence.  On top of that, what level of healthcare (more than half or the expensive stuff doesn't work)? (See: herehere and here: ). In his mind, do I have any right at all to the money I acquired if I earned it honesty through free exchange?
He also heaped praise on the USSR and Venezuela, which indicates a level naivete.  

I'm afraid that the election will be between the Orange Clown (Trump) and the Pink clown (Bernie).

(1) Sanders supported Bill Clinton’s war on Serbia, voted for the 2001 Authorization Unilateral Military Force Against Terrorists (AUMF), which pretty much allowed Bush to wage war wherever he wanted, backed Obama’s Libyan debacle and supports an expanded US role in the Syrian Civil War.

Tuesday, February 18, 2020

Healthcare Compromise Updated Again

This is my new compromise between advocates of government provided health insurance and those against. My earlier version may have had a flaw incentive wise so I am changing it. This version moves close to that put out by the Niskanen Center see here.

The state would provide insurance to all Americans but the annual deductible would be equal to 60% of each family’s trailing year adjusted income minus the poverty line income (say $25,000 for a family of 4) + $300. 
Why 60%? Because some research by the Democrats has shown tax revenues are maximized at 70%, meaning most people will not hugely cut back at working at up to a 70% marginal tax and the current top rate in some states is about 50% already. I took the mid point between the two at 60%.
So a family of 4 with a trailing year adjusted income of $30,000 would have a deductible of $5,300 * .6 or $3,180. 
A family of 4 with a trailing year adjusted income of $80,000 would have a deductible of $33,180. 
Middle class and rich people could fill the gap with private supplemental insurance but this should be full taxed. This would encourage the middle class and rich, who are generally capable people, to demand prices from medical providers and might force down costs. They could opt to pay for most health-care out of pocket while the poor often less capable would be protected. 
It is not a perfect plan but it might help. Some deregulation of health-care would also help the poor gain access. The gauntlet that Doctors have to run these days to get to practice seems like an anachronism in today’s world. Let smart people get to practice medicine after on the job training. Let the medical businesses decide who is qualified to practice medicine. 12 years of training to tell if my child has an ear infection is overkill and reduces access to health-care for the poor. It appears that medical care could much cheaper than it is, see here.

Another benefit of my plan is that it would encourage capable Americans (the rich and middle class) to be a counter weight politically against the providers.
Also it seems worthwhile to me to maintain flexibility in the system. Our slightly more freedom oriented medical  systen looks not so great right now because we spend more than the other developed countries but things are still changing and our more flexibility may start to pay off at some point. 
Here are some possible avenues for that flexibility to pay off:
One, all or none of these things might workout and others not mentioned but it is worth maintaining some level flexibility and freedom.   

Here is an article that makes a strong case for a system similar to the one that I propose.  His plan suggests a  insurance for catastrophic events that cost more than, $50,000 combined with a large health savings account.

In addition since Government provided health insurance is paternalism it should provide insurance that experts would recommend and that means among other things insurance that only pays for care that shows a significant margin of cost benefit. So it should not cover procedures that the UK's NHS does not cover. There would be huge savings there.

Friday, September 27, 2019

Before We have Government do More to Help the Poor We Need to examine what Government is Doing to the Poor.

I just read the following on Marginal Revolution and it reinforced my thinking that
before we get government to do more to help the poor we need to examine what Government is doing to the poor and stop some of it.

This is only one data point, but it supports hypotheses that higher levels of New World violence stem from relatively recent population shifts, drug trafficking, and arms trafficking. When Old World cities have that blend, they too become quite violent.
 It played into my priors:

The effect of requiring consumers to obtain prescriptions for pharmaceuticals on mortality is examined for a sample of middle‐income countries. In countries enforcing the requirement, infectious disease mortality is no lower and poisoning mortality is higher than in those not enforcing the requirement. A broader measure of government intervention—public expenditures on health relative to GDP—is shown to have moderately adverse effects on overall life expectancy.

We should at least take a sober and serious look at legalizing all drugs but antibiotics without a prescription

Friday, August 23, 2019

The Green New Deal

A funny thing about the green new deal. It includes:
1. “a job with family-sustaining wages, family and medical leave, vacations, and retirement security”
2. “high-quality education, including higher education and trade schools”
3. “high-quality health care”
4. “safe, affordable, adequate housing”
5. “economic security to all who are unable or unwilling to work”

I read those and I say they are technically easy to do with less Government spending than today (Of course they are politically impossible until and if the t-bond market goes south dramatically.)

To do it:

  • Replace Social Security, minimum wage SNAP and TANF with a negative income tax
  • Force state and local gov to allow any residential building increases density.
  • Replace medicare and medicaid with a plan with a very high deducible based on income that only cover care that has strong evidence of dollar efficacy.
  • Cut defense spending in half.
  • Quality education can be done for 30% (at least) less than is spent now and many go to school longer than they should. And USA schooling is already good. We could make it even better by using some existing money to pay for low cost tutors.
  • Cut enrollment at state schools in half and we'll be fine
  • Cut university spending per student in half and we'll be fine. We spend a lot.
  • People can live well on less than many think see.

The Democrats and AARP will not lat any of that happen except defense spending cut and the republicans will not let that happen.

So do they really think AGW in an existential danger. I think not. Nor do they think much of the above are really important.

My Problem with Bernie Sanders

My problem with Bernie Sanders.

Judging from the communists that I spoke to back in the 1970's, Bernie's language seems to me to be colored by his communist past.
He doesn't say not we should be more charitable to our poor people, which I can buy, rather he sounds like the old communists who liked to say, you made it you deserve it, the capitalists stole what was yours.

He doesn't say that Healthcare is not something we should provide for everyone, he says it's should be a right.

He likes to talk about Millionaires and billionaires rigging the system against you and me. He talks like millionaires and billionaires getting a cut in taxes is stealing form you.

High Deductible and Delays in Getting Care

I've been confronted about my very high deductible healthcare plan with a challenge that people with high deductibles delay care after diagnosis costing more for the insurer, be it Government or Insurance companies.

Here is the research:
And once diagnosed, women in high-deductible plans waited longer to start chemotherapy: an average of almost nine months among lower-income women, and nearly six months among higher-income women.
Diagnosis of breast cancer at early stages is associated with better clinical and survival outcomes. How the costs of care vary depending on the stage at which breast cancer was diagnosed has not been thoroughly examined.
Here is some research that goes the other way on screening and preventive care:
Sweeping statements about the cost-saving potential of prevention, however, are overreaching. Studies have concluded that preventing illness can in some cases save money but in other cases can add to health care costs
But the question is, can and will people learn if we were to implement a plan with very high deductibles? 

One data point that I go to is the Peltzman effect, how does the Peltzman effect work with safer cars? It may be by people hearing about someone being in an accident. Another is to consider the that the salience of terrorism has caused a huge overreaction in the USA. 
These lead me to believe that people can and will learn such things and that may tend move toward about or above the optimal reaction to a diagnosis healthcare regardless of the higher deductibles.

On a personal note I have paid a deductible of $10,000 in one case and of $30,000 in another and in neither case did we delay treatment. 

Also if the problem does persist, one way to combat delays might be to have health saving accounts. And there are many other potential ways to address the problem at low cost.

The USA Needs a More Positive Message on Immigration

The USA Needs a More Message on Immigration here is my attempt:

Americans descended from a bunch of rejects. Religious rejects including the puritans, baptists, Quakers, Anabaptist, English Catholics, Russian and Polish etc. Jews. The bottom of Irish society from during the potato famine, a little latter economic migrants from the bottom of Italian society and blacks from the bottom of African society, mostly war captives which tend to skew low stats, brought here in chains. More lately Mexicans and Central Americans .

They have all given us great things and made the USA great.

The religious rejects gave us our moral and governmental foundations.

Blacks brought here in chains, gave us and the whole world great music; gospel, jazz, blues, rock and roll. The world would be a poorer place without such and they added great grace, skill and style to athletics.

Italians and Mexicans improved our food. (Food in the UK is bland and bad.)

The Jews have excelled in science giving the world great things.

The Irish built up our police and fire forces.

Even those who just work blue collar increase the division of labor and help us cover our national defense.