Thursday, September 21, 2017

Cassidy Graham

The Cassidy-Graham healthcare bill would give some of the money that is spent on the PPACA to the states. 

The bill seems bad on the details (to be expected from congress even PPACA was bad on details) but since the big problem with healthcare in the USA is cost, driven BTW by growing bureaucracy part of which is due to state regulation, I think would be a good idea to give all the money that the Federal Government normally spends on healthcare to the states. how much money each state got would based on age adjusted population. The states would be required to at least cover the old (Medicare), the poor (Medicaid) and Federal Government employees.

Cost looks to me like a state problem because health care spending per capta in Utah is lower than in stingy Canada and only slight higher in Arizona which has an old population.  States like Utah and Arizona and maybe even Texas might be able to cover everyone with what they get from the Feds. High spending states woudl have an incentive to regulate with more attention toward costs.

Alternatively the Fed Gov. could take over all health care regulations from the states. As it is now the fed Gov subsidizes demand and the states restrict supply which is what you would expect considering he incentives.

Friday, September 15, 2017

Angus Deaton Deaths of Despair

New Hampshire was the highest earning state in 2016 and number 2 in opiod OD deaths.

Dear Angus Deaton with all due respect you might consider reassessing your deaths of despair theory. It never made much sense to me, there is in fact some evidence that people drink and drug more when they have more income and therefore access to booze and drugs, which is BTW a problem for my advocacy of legalization but I thin the positives would out weigh the negatives.

Related: Healh Insurance Might not be Good for Everyone

Added 2018-01-08  see here
In the preferred estimates, changes in economic conditions account for less than one-tenth of the rise in drug and opioid-involved mortality rates. The contribution of economic factors is even less when accounting for plausible selection on unobservables, with even a small amount of remaining confounding factors being sufficient to entirely eliminate the relationship. 

Friday, August 25, 2017

On Healthcarre are the Feds Focusing on the Wrong Thing?

Healthcare spending per capita is lower in Utah than in Canada. Healthcare in the USA is much too expensive due to corruption in state government,so before looking at paying for healthcare thorough taxes, the federal government should be looking at taking over healthcare regulation from the states. Heathcare for the poor is already paid for by Gov taxes, they are focusing on the wrong thing. The more the feds pay for it through fed taxes the less incentive the states have to address the problem of high cost.

Short of taking over regulation a way to push the states would be to give all the money that the feds now spend on healthcare to the states on a per capita age adjusted basis to the states and tell the states you must cover the old and the poor.

Friday, June 30, 2017

Health Insurance Might not be Good for Everyone

Steve Randy Waldman‏ of interfluidity called this thread: Thread, counterintuitive and disheartening. (Here is Aaron Carroll saying that Medicaid access may not have increase opioid deaths and of course that Medicaid expansion may still net out positive.)

It could for a number of reasons be that the current western healthcare (beyond the basics that you do not need insurance to get) is not good for those at the low end of diligence, IQ, conscientiousness scales.

Here are some possible reasons why:
  • MD’s often do not explain enough and nobody follows up.
  • Protocols are sometimes too complicated and require too much attention. 
  • Opiates are too tempting.
  • etc. 

If true it could explain:
U.S. Age-Adjusted Mortality Rates per 100,000 (Annual, 2002–2015)

And BTW  on the opioid epidemic being deaths of despair:

New Hampshire has the second highest opiate death rate in the US.  Very good economy in NH. These epidemics come and go look more like viruses than anything caused by despair. 
So why would West Virginia be the leader in overdose deaths, because it has been loosing its best and brightest for a long time leaving a higher percent on the lower end of diligence, IQ, conscientiousness scales, the most susceptible.

Related links:
The Amish and the marginal value of health care
The Amish and the marginal value of health care

Ironic Health Links 
Hanson on Health
Wealth and retirement might not be good for everyone!
Has Medicaid Made the Opioid Epidemic Worse?  
Exploring the Paradox of U.S. Hispanics' Longer Life Expectancy
This is related in that it's one reason that free Government health insurance might be bad for some people. Some people might be working longer because they want to maintain health insurance: Early Retirement May Be The Kiss Of Death, Study Finds


Wednesday, June 28, 2017

Why I am Against the Minimum Wage

2 recent minimum wage studies here and here.

So here is why I'm against the minimum wage:
  1. Idle hand are the devils workshop. Young men not working get into more trouble than those with jobs. I would rather not take the chance of even putting a very small number of people out of work.
  2. Anyone working full time in the developed world is really not living in poverty. See: How I Live on $7,000 per year.
  3. Unemployment is depressing. The Grave Evil of Unemployment
  4. People often learn skills on the job and BTW you would have to make internships pay minimum wage to be fair.
  5. Jobs integrate younger and older people and older people's life styles are generally better.
  6. If you consider the difference in pay between the market rate and the minimum wage rate a tax, fair in my mind, the tax falls on employers of low wage labor in the short run and consumers of products produced by low wage labor in the longer run, why tax them more than others? BTW Dear Republicans even if you do not call it a tax it's still a tax, so  you might want to support a higher taxes to fund an hourly wage subsidy or a UBI.
  7. Many people are already working for less than minimum wage.  WHy Drug Dealers Live with there Mom's
  8. Black youth unemployment is already much to high. 
  9. An hourly wage subsidy would be so much better. 
And yes, I would get rid of it all together and leave it to individuals, unions to work out wages.

BTW statistics and be tricky and when you read economic studies, you need to think about what could have gone wrong on the study and how they could be biased, but statistics are much better than stories (anecdotes). Statistics and theory are the best we have. The old saw "There are three kinds of lies: lies, damned lies, and statistics." has truth to it but again statistics are better than the alternatives.

Wednesday, June 21, 2017

My Playing off Arnold Kling's Clarifying his Null Hypotheses on Schooling

Here is Arnold answering: The null hypothesis: do I really believe it?

My null hypothesis says that spending more inflation adjusted on schooling than was spent in 1960 has no positive effect on education. (that's about 1/3 of what is spent today.)

Also that only a tiny fraction (perhaps .1%) of schools are good or bad schools. The rest are judged good or bad have good and bad students. And so parents should relax should only try to avoid the worst .1% of schools and not pay more for a home in a “good” school district.

Also my mother has told me that her parents went to school for just 1 year, yet they where educated. They were not superstitious as many where in their era. They could read and write and do arithmetic. They read books. They owned and ran a barber shop. they speculated in real-estate (but lost most but not all of it in the great depression) and sent their son to Brown University.

School is not only place people learn.

Perhaps 3 years of formal schooling would be enough for most people. Never the less in the modern world we would need something for them to do so maybe keeping most in school to 16 is a good idea, not so much for education but to keep them out of trouble.

The Amish drop out early and do OK.

For a modern example, the guy who invented this car claims to have dropped out of school at 14 years old.

Also, if we cannot teach children more and it looks like we cannot, we should focus on teaching the most valuable stuff.

Friday, June 9, 2017

What are the Best Things We Could Do for the Poor Through Government

  • End the War on Drugs, give amnesty for non-violent drug prisoners, and criminal justice reform with the aim of reducing incarceration rates. What has done more economic harm to the poor than having their working-age men locked away
  • Hire more and better police. See here. Poor people are too often victims of crime and fraud. It is better to live on a corner of the roof than share a house/neighbourhood with crime, violence or biting insects.
  • Allow any subdividing and residential building that increased overall density and some that does not. 
  • Wipe out the mosquito. seems like it cold not be done but heard about it on NPR see here.

Thursday, June 1, 2017

Plan from the Niskanen Center: Universal Catastrophic Coverage

This plan from the Niskanen center: Universal Catastrophic Coverage — Or How the Senate Can Fix the AHCA

Is similar to my compromise proposal.
 
A Healthcare Compromise

I think that they are a little to people with above average income but I like it otherwise. They say it would be cheaper than the ACA. So why are we stuck with the ACA and AHCA?

Wednesday, May 24, 2017

USA Healthcare Facts

In 2003, of the roughly 3,900 nonfederal, short-term, acute care general hospitals in the United States, the majority—about 62 percent—were nonprofit. The rest included government hospitals (20 percent) and for-profit hospitals (18 percent). In exchange for tax-exemptions, estimated to total $12.6 billion in 2002, nonprofit hospitals are expected to provide community benefits.



Percent of national health expenditures for prescription drugs: 9.8% (2014)

Many health insurance companies are nonprofits including some of the state Blue Cross organizations. see: Google search for percent non profit health insurance.

It's Surprising How Few Countries Have National, Single Payer, Health Care Systems


It is surprising how little, expensive healthcare contributes to health. See here. (buy expensive I mean beyond vaccinations and antibiotics).

Wednesday, May 3, 2017

Trust and Cost Disease

I have been wondering if loss of trust is a significant driver of our rapidly increasing spend for schooling and medical care. Spending is increasing rapidly and yet the teachers and MD's are less happy with their jobs and the patients are not happier with the service. See here.

We do not trust the teachers as much as we used to and so we test more and regiment them more. We don't trust MD's and so we build rules and bureaucracy to regiment them. Part of that is inevitable in a 3rd party payer system but it might be increased by this international competition. All the stories that tell us how poorly the USA does on PISA and life expectancy as compared to the other developed countries when there are many non schooling non health care things that effect PISA scores and life expectancy.

BTW As far as schooling goes, does PISA really test anything important? On PPP GDP per capita USA Ranked 6th, 44% more than Finland, maybe the Finns should change their schools to look more like ours? Maybe the PISA tests are too close to an IQ test tell us much about the quality of our schools.

Monday, April 24, 2017

On Paul Romer's Idea of Charter Cities


We should lead by example and make Brownsville or Detroit charter cities. The current residents would keep their US citizenship but newcomers would need a passport and VISA to get into the rest of the USA.
 
A lot of capital is going to waste in Detroit. we would people to fill Detroit, but most voters don't want more immigrants and they know that you cann't keep people in the area that you want. I have heard that programs that bring in immigrant MD's to places like Iowa have a problem with them moving. 

But I don't see anyone taking this up, such is nationalism. So Paul Romer should understand that it is unlikely to be accepted elsewhere. Argentina might be the best bet because they seem to have an open boarders policy now. 

Friday, April 14, 2017

How much would single-payer healthcare cost in the USA?

Someone asked me: How much would single-payer healthcare cost in the USA?

My answer:

It could be very cheap, but political realty makes me think it would cost about what is spend now.
There is a lot of evidence that we are overtreated (Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer: Shannon Brownlee: 9781582345796: Amazon.com: Books The Last Well Person: How to Stay Well Despite the Health-Care System: Nortin M. Hadler: 9780773532540: Amazon.com: Books Cut Medicine in Half Hanson on Health | EconTalk | Library of Economics and Liberty) but since the people over 65 are already covered and are politically active I think they will prevent us from doing what the NHS in the UL does and what they do the Netherlands.
To illustrate the point that absent politics you could implement single payer for cheap” Since probably 90% of the benefit of heath care comes from vaccination you could just cover them and say you have single payer. Further much of the rest of the benefit comes from trauma care, infant care and drugs (about 20% of health care by cost.)
Another thing that could be done to limit costs would be to squeeze providers like they do in Japan and Canada but with healthcare being up to 18 of the US economy the providers here are pretty powerful politically.
Another problem in the US is that states do most medical regulation so the Fed. Gov. paying for more creates a bad incentive: Before the Federal Government Starts to Pay for Even More Healthcare (expanded)
Here is an interesting article about the rise in medical costs: https://slatestarcodex.com/2017/02/09/considerations-on-cost-disease/
One additional thing to keep in mind is that health insurance premiums are motivation to work more in the taxed economy (rather than for in family consumption) but taxes are an incentive to not work in the taxed economy, mostly wives of good earners way the 2 alternatives and act on them.
BTW most countries do not have single payer but something like the PPACA but with a public option, Canada does though.
Very tough to tax another 9% of GDP (the Gov. already spends about half of medical care spending).

Tuesday, April 11, 2017

Considerations On Cost Disease


Maybe it is because, we used to trust teachers and MD’s, now we want Government to watch them closely, and maybe that is caused by this international competition in PISA test and in life expectancy. Even though schooling above some low quality base does little to drive up PISA test scores and health care does little to drive up life expectancy.

My Perception of US Schools

Russ Roberts, who I agree with on most subjects, often contends that we are greatly disadvantaging poor children because the schools that they go to are awful. 
 
I have to disagree with Russ on that subject. There are only an insignificant number of truly bad schools in the US (or good Government run schools for that matter.) What is fooling people is that there are some schools with a very good set of students and other schools with a very bad set of students. The former schools look good and latter look bad. I went for one year to one of the top rated Government high schools in the USA (Classical High school in Providence RI) and the teachers there were not very good. I also went to a school with a very bad reputation for 3 years and if anything the teachers there were a little better. My theory for that is because any teacher could survive with Classical's students the teachers were worse. My brothers who went to classical 4 years joked that it was the school for the mentally ill (pause) teachers.

On funding I think we have gone beyond what is  a good level of funding and that most students go to school for longer than optimal. It would be nice if teachers eared more but most of the addition money spend by school departments in the last 40 years has gone to administration and that has served to make teachers lives more miserable (see: Considerations On Cost Disease More bosses?).  BTW it is hard to pay people more than the market rate (see: Giving Away Money Costs More Than You Think) and some people are willing to teach for free (see: Arnold Kling, Steve Wozniak).

I think per student funding of schools should approximate what the median income family would spend on schooling if there were no Government schools.

I think you could theoretically achieve that by charging above median income families the full cost for each child that they send to the Government schools. Since that is a political non starter, I think that the way to go is to try to reduce school spend whenever possible.

Thursday, April 6, 2017

More Thoughts on the PPACA (Obamacare)


PPACA (better known as Obamacare) seemed very Republican to me from the start. To me it looks like an attempt to get people seen as irresponsible to buy Health insurance by fining those who don't.

The people that I know who are most upset about PPACA had no insurance before the PPACA. They are forced to buy something that do not see sufficient value in to be worth the cost. One complained to me that he had to buy insurance that would not even cover him if he got sick due to the deductible. (He evidently sees no value in insurance.)

People like him think it is not worth the price, and the thing no one admits, is that they may be right. Many of them are single and if you look at the research healthcare, beyond the really cheap stuff like vaccinations and antibiotics, contribute very little to health. (Infant care and trauma care also seem to effective enough to be worth while for more people.)

But the responsible people would counter with "but we will end up picking up your bills rather than letting you die at home" but that is more a benefit to the responcible.

We may have to get used to the idea of covering everyone with a minimal plan and letting people die without treatment if they get an expensive disease. 

I have heard the Dutch public plan is kind of stingy and most people get additional coverage on top of it, but I have not researched it.

Monday, February 20, 2017

Comments on the Article: Our Miserable 21st Century

Some comments on an article by Nicholas N. Eberstadt that is getting a lot of attention on economics blogs.

Our Miserable 21st Century by NICHOLAS N. EBERSTADT

1. Although I do not buy the negativity, I do feel like better measure of a person's wealth net-worth would include the flow of income that it produces along with the market value. It is not a good thing if the same house now costs more. It is not a good a thing that the stocks that yield 2% now cost what stocks that yielded 4% used to cost (unless their yields are rising faster).

2. One thing few people mention is that cleaner air and waterways cost and are worth something. If you like the PPACA it to is worth something.

3. From the article: Hispanic white men and women 45–54 years of age—but they rose sharply for those with high-school degrees or less, and for this less-educated grouping most of the rise in death rates was accounted for by suicides, chronic liver cirrhosis, and poisonings (including drug overdoses).

A lower percent of the population today are without a high-school degrees (especially among white women) and that messes up that data. One reason to not graduate high school these days on bad health (another is drug use and wildness) as the group becomes small that becomes more significant.

3. b. Wouldn't it be ironic if this turned out to be true and due the passage of the PPACA, maybe by it leading to more opiate addiction. More likely though it is an epidemic due changes and MD's prescribing and social factors.

4. Proverbs 12:24 Diligent hands will rule, but laziness ends in forced labor..

This may be truer than we knew and set of the population may need to be forced to work, therefore maybe making it harder to get SSDI would help the very people denied the benefit.

5. Our system of law enforcement and punishment seems so very far from optimal to me that it should be easy to reform. More detection and prevention and much less severe punishment for many crimes.Prison should be a last resort.

Wednesday, January 25, 2017

Before the Federal Government Starts to Pay for Even More Healthcare (expanded)

Before the Federal Government starts to pay for even more healthcare shouldn't they attempt to remove incentives for state Governments to make healthcare less affordable?
Here is quote from Cato:
, further removing incentives for the states to make medical licensing and regulation more modern and rational shouldn't they remove some of the barriers to practice?

The federal government subsidizes demand for healthcare and the state governments restrict supply, which you would think would lead to higher prices.

Coincidentally as long as the federal Government is subsidizing demand, restricting supply is what you would expect state politicians to do if they were amoral ruthless maximizers for there states. (hmmm I do not think that they really are amoral ruthless maximizers but things tend to evolve is a biased direction). That the state politicians have an incentive to protect their Hospitals, Doctors and Nurses (maybe even insurers) from competition.

Here is an example of the AMA trying to keep completion from increasing.



As a case study, consider Utah is arguably the least corrupt state in the USA and healthcare sending in Utah is not that different from in the European countries that you mentioned (for schools also which USA spend more on). Washington DC on the other hand is off the charts. 



It is a state problem and should be addresses at the state level.
My solution to get the states to act is here.

Tuesday, January 17, 2017

Denmark Should Try to Get More Like the USA.

The USA is a great place for people to live Denmark should try to get more like the USA.

American Indians and Alaska Natives born today have a life expectancy that is 4.4 years less than the U.S. all races population (73.7 years to 78.1 years, respectively).

Greenland is part of Denmark. Greenland life expectancy 71 years, Homicide rate 19/100,000.

In Canada Life expectancy for Inuit in Nunavut for 1999 was 67.7 years for males and 70.2 years for females.

Almost a quarter (23%) of those 516 homicide victims were reported by police as Aboriginal, a group that accounted for just 5% of the Canadian population.

Teaching

From an article about training teachers:

Eric Hanushek, an economist at Stanford University, has estimated that during an academic year pupils taught by teachers at the 90th percentile for effectiveness learn 1.5 years’ worth of material. Those taught by teachers at the 10th percentile learn half a year’s worth. Similar results have been found in countries from Britain to Ecuador. “No other attribute of schools comes close to having this much influence on student achievement,” he says.
Rich families find it easier to compensate for bad teachers, so good teaching helps poor kids the most.

It is hard for me to imagine why that would be true.  He adds that if the average American teacher were as good as those at the top quartile the gap in test scores between America and Asian countries would be closed within four years. The above is also hard to believe does he assume a cumulative effect without diminishing returns?  

I had some bad teachers but I doubt that better teachers back then would make me smarter or significantly more knowledgeable now. I think that the low hanging fruit in schooling is to focus on what is taught, teaching the most important stuff, rather than trying to get students to learn more. Most of what is taught currently is only a signal for further schooling. Case in point the article seems to imply that in 4 years of college teachers are not taught how to teach! And that Ed majors are not flunked out if they do not show good ability to teach before graduation! That is alarming!

The article is self refuting. If schooling is signalling then the raising the quality of all teachers will have little/no impact, but if schooling is about human capital formation, how is it that after 4 years of college focused on teaching, teachers have not taught bee adequately taught how to teach! That Ed majors are not flunked out if they do not show good ability to teach before graduation would be considered alarming if college were about human capital formation! It would seem that that fact would be devastating to the human capital formation theory of schooling.

Student Loan Debt

An article on how to bring down college costs:

What’s really behind ‘free college’ and America’s student debt problem? A higher-ed Q&A with Jason Delisle


My additional idea:
One way to cut the cost of sending a child to University is to put the state funded Universities where the families live.
Tuition is already subsidized and financial aid has made it quite far up the income ladder so much of the debt is finance living expenses. University students being able to live with parents reduces that cost greatly.

Favelas are not so Bad

Favelas are not so bad.

Chuck Martel wrote:
There have been favelas in the US. See this in Park Bugle.

You may have noticed them here and there in the northwest Como area, small houses situated much farther back from the street than their neighbors. Some of these probably were the “garage homes” of a century ago, the idea being that their owners would build and live in them until they could afford a main house on their property. For one reason or another, some never got around to building the big house. Following World War I, St. Paul had an estimated 100 garage homes with one of the largest groups of them clustered around the Hoyt Avenue and Chelsea Street intersection. Technically, the homes were in violation of the city’s building code—a garage wasn’t supposed to be a long-term domicile—but times were hard and officials such as J.M. Clancy, commissioner of parks, playgrounds and buildings, tried to be understanding.“We have had unusual conditions during the war and after it,” he told the St. Paul Daily News in July 1921. “Regulations that might have been highly proper at other times might work injury to some people if enforced too strictly. “Most [of these people] are thrifty,” Clancy said. “Indeed, the very fact that they have the courage to take a small place like they do, is evidence of their desire to improve themselves. If some other people lived within their means, they would be better off.” C.A. Hausler, city architect, was in charge of building inspections at the time. He told the newspaper that he was trying to discourage the construction of garage homes, but acknowledged that there was only so much he could do “once a family has taken up its abode in one of the miniature homes.”To obtain a building permit, he noted, sewer and water connections were required. In that summer of 1921, a garage home had just been completed at Huron Street and Hoyt at a cost of $90 and two others were planned. And another home was under construction in a hayfield across Hoyt, even as the harvest went on around it.Albert Larson, a carpenter, owned one of the garage homes and his wife told the newspaper reporter that she liked it just fine. “We lived in a flat and paid $47.50 rent,” she said. “The landlord wouldn’t fix the place at all. It didn’t even have a cupboard. We moved out here and we like it much better. “We have one room, 20 x 20 [feet], and another 10 x10 [feet]. So we have lots of room. The material cost $400 and my husband did all the work,” she noted. “So, you see, our little home didn’t cost a great deal. And then it is all ours. That is something.”

If State Universities End Their Persuit of Presige

From over at Marginal Revolution

: Four tough things universities should do to rein in costs

Cap administrative costs
Operate year-round, five days a week
More teaching, less (mediocre) research
Cheaper, better general education
I think that the why of this is that University management is to intererested in raising the prestige of the University.  

In most fields there is not a shortage of PHD's and little of the Universities' prestige comes from its professors. So if they quit you replace them, if they go to other Universities you could get the experienced professors that they replace. 

I think that the state schools being subsidized already should ignore loss of prestige to some fairly low level and educate more students at lower cost. To be concrete target 20% increase in enrolment and 50% of the current per student cost. I think if you forgo prestige it could be done.

Maybe Germany Economic Policy Wise Should try to be more like the USA

Germany PPP GDP Per capita = $38,700.00 Ranked 17th. 
USA PPP GDP Per capita = $51,700.00 Ranked 6th. 
USA PPP GDP Per capita is 34% more than Germany. 

Maybe Germany economic policy wise should try to be more like the USA.

Friday, January 13, 2017

Before the Federal Government Starts to Pay for Even More Healthcare

Before the Federal Government starts to pay for even more healthcare shouldn't they attempt to remove incentives for state Governments to make healthcare less affordable?
Here is quote from Cato:


, further removing incentives for the states to make medical licensing and regulation more modern and rational shouldn't they remove some of the barriers to practice?

The federal government subsidizes demand for healthcare and the state governments restrict supply which you would think would lead to higher prices.

Coincidentally as long as the federal Government is subsidizing demand, restricting supply is what you would expect state politicians to do if they were amoral ruthless maximizers for there states. (hmmm I do not think that they really are amoral ruthless maximizers but things tend to evolve is a biased direction).

Utah is arguably the least corrupt state in the USA and healthcare sending in Utah is not that different from in the European countries that you mentioned (for schools also which USA spend more on). Washington DC on the other hand is off the charts.

It is a state problem and should be addresses at the state level.
My solution to get the states to act is here.

Wednesday, January 4, 2017

What Should Republicans do About PPACA

What Should Republicans do About PPACA

Because of loss aversion and because people (me for example) have changed coverage based on the law, they should take it slow and one step at a time and do the following:

  • Remove the 3 to 1 rule. See here because with income subsidies I see no reason to force a subsidy of older people by younger people.
  • Slowly each year raise the allowable deductibles until they get very high, like $30k per year or $250k lifetime. 
  • Either fix or eliminate the employer mandates, by fix I mean, do not completely exempt part-time workers (maybe make employers pay a percent based on hours worked), and do not exempt employers based on the number of employees they have. 
  • Allow insurers to create plans that only cover care with strong evidence of proven net benefits.
  • Finally raise the penalty to where you are forcing most everybody to get health insurance.

Then think about how to get the states to eliminate regulations that drive up cost without providing proven net benefits.