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: Books The Last Well Person: How to Stay Well Despite the Health-Care System: Nortin M. Hadler: 9780773532540: 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:
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.