Saturday, November 30, 2013

WSJ on the Inferiority of ObamaCare

Article Link

from the artcile:

Liberals justify these coercive cross-subsidies as necessary to finance coverage for the uninsured and those with pre-existing conditions. But government usually helps the less fortunate honestly by raising taxes to fund programs. In summer 2009, Senate Democrats put out such a bill, and the $1.6 trillion sticker shock led them to hide the transfers by forcing people to buy overpriced products.


This political mugging is especially unfair to the people whose plans on the current individual market are being taken away. The majority of these consumers are self-employed or small-business owners. They're middle class, rarely affluent. They took responsibility for their care without government aid, and unlike people in the job-based system, they paid with after-tax dollars.


Now they're being punished for the crime of not subsidizing ObamaCare, even though the individual market was never as dysfunctional or high cost as liberals claim. In 2012, average U.S. individual premiums were $190, ranging from a low of $123 in North Dakota to a high of $385 in Massachusetts. Average premiums for family plans fell that year by 0.5% to $412.


Those numbers come from the 13,000 different policies from 180 insurers sold on eHealthInsurance.com, the online shopping brokerage that works. (Technological wonders never cease.) Individuals can make the trade-offs between costs and benefits for themselves. This wide variety is proof that humans don't all want or need the same thing. If they did, there would be no need for a market and government could satisfy everybody.


Source: WSJ Editorial, "ObamaCare's Plans Are Worse," The Wall Street Journal, November 29, 2013

Wednesday, November 27, 2013

Boudreaux on Henry Ford and 5 Dollars a Day

Article Link

from the article:

Turnover was significant. In 1913, Ford Motor Co. hired 963 workers for every 100 jobs it filled during that year. In other words, the typical worker quit after only six weeks on the job. The costs of training all those new workers who would soon quit raised Ford’s costs unnecessarily. By more than doubling employee pay — and by reducing the amount of time workers had to work to earn this handsome income — Ford reduced turnover and lowered even further the cost of producing the Model T.

While workers whose annual incomes doubled were, of course, better able to afford to buy new Fords, they were also better able to afford to buy nearly everything. No doubt some Ford workers did buy new Model Ts because of their doubled incomes. It’s also undoubtedly true, however, that many Ford workers spent their higher incomes not on newly produced cars but, instead, on better housing, better home furnishings and better and more education for their children.

Source: Don Boudreaux, "Ford's Pay Hike: It Wasn't About Profit," The Pittsburgh Tribune-Review, November 26, 2013


William Galston on President Obama: The Executive Without Energy

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from the article:

Over the past century, we have come to see the presidency as the principal source of the legislative agenda that Congress considers, and we tend to regard the enactment of the president's program as the key test of his efficacy. In the process, we have played down the importance of presidential management. The travails of the Affordable Care Act have reminded us that this understanding of the presidency is distorted—and reflects a neglectful reading of the Constitution.


Alexander Hamilton, in defending the presidency that the proposed Constitution would establish, remarked that "the true test of a good government is its aptitude and tendency to produce a good administration." The Federalist's co-author famously saw "energy in the executive" as a leading characteristic of good government, in large part because such energy is "essential to the steady administration of the laws." Section 3 of Article II of the Constitution states: The president "shall take care that the Laws be faithfully executed." The occupant of the office is rightly (and revealingly) called the chief executive.


In the early days of the Republic and for much of its history, executing and administering the law mostly involved enforcement. With the rise of the administrative state, a step prior to enforcement became essential. This involved translating Congress's will into terms specific enough to be workable and providing the means of administration. The chief executive's role expanded correspondingly to include ultimate responsibility for regulations and for the administrative activities of an increasingly complex executive branch beyond the White House.

Source: William Galston, "An Executive Without Energy," The Wall Street Journal, November 27, 2013

Tuesday, November 26, 2013

McArdle on What Experts Don't Know

Article Link

from the atticle:

I trekked wearily back to the office, where Mr. Senior Executive gestured at his computer. “It still doesn’t work right,” he said, and started to leave the office again.

“Hold on, please,” I said. “Can you show me exactly what’s not working?”

“It’s not doing what I want,” he said.

“What do you want?” I asked.

“I want it to be,” he replied, “like the computer on `Star Trek: The Next Generation.'”

“Sir, that’s an actor,” I replied evenly, despite being on the sleepless verge of hysteria. With even more heroic self-restraint, I did not add “We can get you an actor to sit under your desk. But we’d have to pay SAG rates.”

Now, when I used to tell this story to tech people, the moral was that executives are idiots. No, make that “users are idiots.” Tech people tend to regard their end-users as a sort of intermediate form of life between chimps and information-technology staffers: They’ve stopped throwing around their feces, but they can’t really be said to know how to use tools.

And, of course, users can do some idiotic things. But this particular executive was not an idiot. He was, in fact, a very smart man who had led financial institutions on two continents. None of the IT staffers laughing at his elementary mistake would have lasted for a week in his job.

Call it “the illusion of omnicompetence.” When you know a lot about one thing, you spend a lot of time watching the less knowledgeable make elementary errors. You can easily infer from this that you are very smart, and they are very stupid. Presumably, our bank executive knew that the phasers and replicators on "Star Trek" are fake; why did he think that the talking computer would be any more real?

But why should he have known that voice-recognition software, circa 1998, was sort of slow and ponderous? He was getting paid to think about financial issues, not the limits of computer learning. To be sure, he probably should have asked more questions before he bought that software. But as any journalist will tell you, the greatest danger of going into a new domain is the questions that you don’t know enough to ask.


Source: Megan McArdle, "Obamacare Is No Starship Enterprise," bloomberg.com, November 25, 2013

Saturday, November 23, 2013

Ridley on Economic Freedom and Political Authoritarianism

Article Link

from the article:

Yet this is precisely the wrong lesson to draw from China (and Singapore). It’s not because it’s unfree at the top that China is growing fast, but because, at least in some respects, it is very free at the bottom. The extraordinary fact is that — economically — the average Chinese person is more free from government interference than the average Westerner. As Niall Ferguson has documented, general government total expenditure is twice as high in the United States and Europe as it is in China as a per cent of GDP. China ranks higher than America on the ethics of politicians. It takes far less time and trouble to build a house or a nuclear power station in China than it does in Britain.

So long as you don’t cross the Communist Party, China is laissez-faire on a scale that would make Hayek blush. That’s what happens when you liberalise a totalitarian regime: if the party was previously taking all the decisions, then once it steps back there’s very little else in the way of state bureaucracy.

Source: Matt Ridley, "When Political Tyranny Allows Economic Freedom," therationaloptimist.com, November 13, 2013

Friday, November 22, 2013

John Grantham on Markets and Medical Innovation

Article Link

from the article:

This good news comes in a fascinating article by a venture capitalist published at VentureBeat just last month. The author, who invests in health technology ventures, sketches out the economics of the hearing-aid industry. It has been high margin and low volume. Traditionally, the manufacturer would sell a pair of hearing aids to an audiologist for $1,000, earning a gross margin of 43 percent. At a retail price of $3,000, after buying the device and incurring sales and other costs, the audiologist’s gross margin has been 55 percent. On the other hand, the average audiologist only sells 16 pairs a month.

But that is all changing. Not only are online vendors and innovating hearing-aid manufacturers cutting costs and improving quality and service times, but digital developers are offering online hearing apps via iTunes and other virtual stores for as little as $3.99. (Yes: There is a decimal after that 3.)

It has taken a long time, but the price of hearing aids is in the process of falling dramatically. How has this happened? Technological innovation, of course, but there is more. There’s no shortage of technological innovation in U.S. health care. However, because third-party payers, that is, health insurers and governments, determine prices, there is no mechanism for customers to signal value to providers.

This is not the case for hearing aids: Although some states have mandated insurance coverage for hearing aids, this is usually limited to disabled children. The big market for hearing aids is seniors, and Medicare does not cover hearing aids.

This good news comes in a fascinating article by a venture capitalist published at VentureBeat just last month. The author, who invests in health technology ventures, sketches out the economics of the hearing-aid industry. It has been high margin and low volume. Traditionally, the manufacturer would sell a pair of hearing aids to an audiologist for $1,000, earning a gross margin of 43 percent. At a retail price of $3,000, after buying the device and incurring sales and other costs, the audiologist’s gross margin has been 55 percent. On the other hand, the average audiologist only sells 16 pairs a month.
But that is all changing. Not only are online vendors and innovating hearing-aid manufacturers cutting costs and improving quality and service times, but digital developers are offering online hearing apps via iTunes and other virtual stores for as little as $3.99. (Yes: There is a decimal after that 3.)
It has taken a long time, but the price of hearing aids is in the process of falling dramatically. How has this happened? Technological innovation, of course, but there is more. There’s no shortage of technological innovation in U.S. health care. However, because third-party payers, that is, health insurers and governments, determine prices, there is no mechanism for customers to signal value to providers.
This is not the case for hearing aids: Although some states have mandated insurance coverage for hearing aids, this is usually limited to disabled children. The big market for hearing aids is seniors, and Medicare does not cover hearing aids.
- See more at: http://healthblog.ncpa.org/can-you-hear-me-now-another-health-market-that-really-works/#sthash.q9ONWsvB.dpuf
Source: John Grantham, "Can You Hear Me Now? Another Health Market the Really Works, John Goodman's Health Policy Blog, Nobember, 20, 2013

Another HeCan You Hear Me Now? Another Health Market that Really Works

- See more at: http://healthblog.ncpa.org/can-you-hear-me-now-another-health-market-that-really-works/#sthash.q9ONWsvB.dpuf

Can You Hear Me Now? Another Health Market that Really Works

- See more at: http://healthblog.ncpa.org/can-you-hear-me-now-another-health-market-that-really-works/#sthash.q9ONWsvB.dpuf

Can You Hear Me Now? Another Health Market that Really Works

- See more at: http://healthblog.ncpa.org/can-you-hear-me-now-another-health-market-that-really-works/#sthash.Go7oya3W.dpuf

Can You Hear Me Now? Another Health Market that Really Works

- See more at: http://healthblog.ncpa.org/can-you-hear-me-now-another-health-market-that-really-works/#sthash.Go7oya3W.dpuf

Perry on the Falling Cost of Things Over Time

Article Link

from the article:






appliance

Source: Mark Perry, "When It Comes To The Affordability Of Common Household Goods, The Rich And The Poor Are Both Getting Richer," AEI/Ideas, October 3, 2013

Wednesday, November 20, 2013

Caplin on the Economic illiteracy of Historians

Article Link

from the article:

So what should history textbooks say about these matters?  This: Working conditions during the early Industrial Revolution were bad by modern standards, but a major improvement by the standards of the time.  Factory work looked good to people raised on backbreaking farm labor - and it looked great to the many immigrants who flocked to the rising centers of industry from all over the world.  This alliance of entrepreneurs, inventors, and workers peacefully kickstarted the modern world that we enjoy today. 

And what of the "workers' movement"?  A halfway decent textbook would emphasize that it wasn't quantitatively important.  Few workers belonged, and they didn't get much for their efforts.  Indeed, "workers' movement" is a misnomer; labor unions didn't speak for most workers, and were often dominated by leftist intellectuals.  A fully decent textbook would discuss the many possible negative side effects of labor market regulation and unionization - so students realize that the critics of economic populism were neither knaves nor fools. 

The Big Picture: Industrialization was the greatest event in human history.  Critics then and now were foolishly looking a gift horse in the mouth.  Until every student knows these truths by heart, history teachers have not done their job.

Source: Brian Caplin,"The Economic Illiteracy of High School History," econlog.com, November 20, 2013

Tuesday, November 19, 2013

Roberts on Inequality

Article Link

from the article:

No matter how you look at it, the growth rate in family income (as measured by these data at least) changed dramatically around 1973.

. . . What people often forget, especially economists, is that there were huge changes in family structure in the 1960′s and 1970′s. There was a big increase in the divorce rate and a big increase in the number of households headed by women. The increase in the divorce rate was much larger among poor families than it was in rich families. It also grew more dramatically. So as a result, family composition changed dramatically.

. . . Starting around 1971 or 1972, the increase in the proportion of families with children that were headed by women rose draatically. Female-headed households became more numerous generally compared to other types of families. In 1970, about 5% of all families were families with children headed by a woman. By 1991, the proportion had doubled to about 10%. Female-headed households with children tend to have lower income for lots of reasons. That demographic change is going to slow the average measured rate of growth, especially when those families are disproportionately created out of married families that are poorer than the average to begin with.

Source: Russ Roberts, "Inequality in Two Graphs," cafehayek.com, November 19, 2013

Monday, November 18, 2013

Kling on Entry/Exit

Article Link

from the article:

Start by asking why it is that Healthcare.gov is not as good as Amazon.com or Kayak.com. One answer is that the government is not good enough at deploying information technology. However, I think that is only a shallow answer.

The deeper answer is that when we look at Kayak and Amazon, we are seeing the survivors that emerged from an intense tournament. In this tournament, thousands of competing firms fell by the wayside. Competitors tried many different business models, web site designs, business cultures, and so on.

Healthcare.gov did not emerge from this sort of competition. It came about because Congress passed a law.

Central to my approach to economics, and that of other economists who are variously called Austrians or market-oriented economists or Smith-Hayek economists or what have you, is the respect that we have for the evolutionary process by which markets produce innovation and excellence. My sense is that what divides us from pundits like Brooks and Shields, and even from most economists, is the credit that we assign to market evolution rather than elite expertise as a process for solving problems.

Source: Arnold Kling, "David Brooks and Mark Shields on ObamaCare," askblog.com, November 17, 2013

Times Interview with Lars Hansen

Article Link

From the article:

The thing to remember about models is they’re always approximations and they will always turn out to be wrong at some point. When someone says all the models that economists use are wrong, well, in a sense that’s true. But you need to ask, are the models wrong in ways that are central to the questions, or are they wrong in ways that aren’t so central?

And so part of the task of statistical analysis is to look at models and try to figure out what the gaps are so that people will build better models in the future.


Source: Jeff Sommer, "A Talk With Lars Peter Hansen, Nobel Laureate, " The New York Times, November 16, 2013

Richman on Libertarian Morality

Article Link

From the article:

Libertarians believe that the initiation of force is wrong. So do the overwhelming majority of nonlibertarians. They, too, think it is wrong to commit offenses against person and property. I don’t believe they abstain merely because they fear the consequences (retaliation, prosecution, fines, jail, lack of economic growth). They abstain because they sense deep down that it is wrong, unjust, improper. In other words, even if they never articulate it, they believe that other individuals are ends in themselves and not merely means to other people’s the ends. They believe in the dignity of individuals. As a result, they perceive and respect the moral space around others. (This doesn’t mean they are consistent, but when they are not, at least they feel compelled to rationalize.)

That’s the starting point of the libertarian philosophy, at least as I see it. (I am not a calculating consequentialist, or utilitarian, but neither am I a rule-worshiping deontologist. Rather, I am comfortable with the Greek approach to morality, eudaimonism, which, as Roderick Long writes, “means that virtues like prudence and benevolence play a role in determining the content of justice, but also — via a process of mutual adjustment — that justice plays a role in determining the content of virtues like prudence and benevolence.” In this view, justice, or respect for rights, like the other virtues, is a constitutive, or internal, means (rather than an instrumental means) to the ultimate end of all action, flourishing, or the good life.)

Source: Sheldon Richman."One Moral Standard for All," Explore Freedom from the Future of Freedom Foundation,

Sunday, November 17, 2013

The German Economy Compared to the French

Article Link

from the article:

But the issue for Mr. Sarkozy is job creation. Unemployment in France is at a 12-year high and rising. Germany’s unemployment rate, at 7.4 percent, is at its lowest point since reunification in 1991.

and

French salaries have increased in real terms while German salaries have fallen, making French workers more expensive and thus less productive and competitive. French social protections for the unemployed are also much more lavish, especially after the Germans pushed through the so-called Hartz reforms, which largely limited unemployment benefits to 12 months. In France, the duration is 23 months for those under 50 and three years for those over 50, many of whom never work again. 

In part to pay for those benefits, the cost to business of an hour’s labor is 11 percent higher in France. But there is less job security in Germany, and more Germans do part-time work. The Germans do not have a centrally fixed minimum wage, as the French do.

The practical results of these trends are visible in these border towns, where the shape of industry — largely small- to medium-size metal-working companies or factories — is similar. For example, there are 10 times as many job offers a month on the German side as on the French one, said Norbert Mattusch, who works on cross-border cooperation for the German Federal Employment Agency in Freiburg.


Source: Steven Erlanger, "French-German Border Shapes More Than Territory," The New York Times, March 3, 2012

Kieffer Pear

Article Link

Friday, November 15, 2013

Fouad Ajami on the Obama Charisma

Article Link

from the article:

The current troubles of the Obama presidency can be read back into its beginnings. Rule by personal charisma has met its proper fate. The spell has been broken, and the magician stands exposed. We need no pollsters to tell us of the loss of faith in Mr. Obama's policies—and, more significantly, in the man himself. Charisma is like that. Crowds come together and they project their needs onto an imagined redeemer. The redeemer leaves the crowd to its imagination: For as long as the charismatic moment lasts—a year, an era—the redeemer is above and beyond judgment. He glides through crises, he knits together groups of varied, often clashing, interests. Always there is that magical moment, and its beauty, as a reference point.

Source: Fouad Ajami,"When the Obama Magic Died," The Wall Street Journal, November 14, 2013

Thursday, November 14, 2013

Conor Friedersdorf on Our Modern Road to Serfdom

Article Link

from the article:

I certainly don't have all the answers, but I have some advice.

Number one, behave as if your goal is actually persuasion. So many times, people engaged in political speech, broadly construed, aren't really trying to change anyone's mind. They're more interested in a rant that makes them feel self-righteous, or getting in digs that feel satisfying to deliver. Don't confuse scoring debating points with persuading people. Listen to them. Understand them. Respect their insights. And explain why you differ in a way that permits them to agree without seeming to have lost, or looking foolish.

Number two, look for allies, not heretics. Someone who agrees with you 80 percent of the time is an ally, not an enemy to denounce for not being a true libertarian. Someone who agrees with you 1 percent of the time, on just a single issue, is someone you can work with in good faith on that issue. And if you do, odds are they'll listen more closely to your other ideas.

Number three is the most important. A friend taught me this.

He's an orthodox Catholic. I am not. I went to 14 years of Catholic school and decided that it wasn't for me. As you can imagine, I've heard all the arguments for Catholicism. So when my friend, Nick, argues with me about Catholic doctrine, he is very unlikely to persuade me of anything. But Nick happens to be one of the best people I know. Even though I don't have faith in the same things that he does, I see how his faith makes him a better person. I see how he makes the world a better place, and how his belief system drives him to do it. And whenever I think about Nick, I think to myself, you know, I disagree with the Catholic faith on a lot of particulars, but there must be nuggets of truth within it if it inspires people like Nick to be this good. It makes me so much more open to the notion that I can learn something from the Catholic faith—just as the molestation scandal took a lot of people and closed them off to the idea that Catholics had anything to teach them.

Source: Conor Friedersdorf, "How to Safeguard Liberty Through Discourse: What I told a group of college libertarians," theatlantic.com, November 12, 2013

Peter Schweizer on Rent Seeking and Obama Care

Article Link


from the article:

As CNBC recently put it:"Thanks to ObamaCare, the health-care industry is going to get a big makeover during the coming years and venture capitalists have wasted no time looking for ways to cash in.” Put simply, ObamaCare’s complexity and catastrophic rollout create rivers of cash for Obama’s cronies.

Source: Peter Schweizer, "At Least One Group of Americans Loves ObamaCare," FoxNews.com, November 12, 2013

Dina Cappiello on Ethanol's Damage to the Environment

Article Link

From the article:

But the ethanol era has proven far more damaging to the environment than politicians promised and much worse than the government admits today.

Source: Dina Cappiello, "The Secret, Dirty Cost of Obama's Green Power Push," wtpo.com, November 12, 2013

Tuesday, November 12, 2013

Cochrane on Old vs. New Keynesianism

Article Link

 from the article:

Most of Washington policy analysis uses Keynesian models or Keynesian thinking. This is really curious. Our whole policy establishment uses a model that cannot be published in a peer-reviewed journal. Imagine if the climate scientists were telling us to spend a trillion dollars on carbon dioxide mitigation -- but they had not been able to publish any of their models in peer-reviewed journals for 35 years.

Source: John Cochrane, "New vs. Old Keynesian Stimulus," thegrumpyeconomist.com, November 8, 2013



Ridley Says the Earth is Getting Greener


Bart Wilson on Prices and Words

Article Link

from the article:

If prices are like words, then good policy is listening to what the words say is the real problem, using the context of the entire sentence and language. Bad policy is reacting to one symbol. Forcing the meaning of a word to mean what you want it to mean, though it doesn't quite mean that, doesn't work. Ask my students who insert words from the thesaurus into their papers to sound more scholarly. A word like "pyretic" sounds good by itself and feels good to use, but it doesn't fit in any sentence we can imagine. The general use of language determines each word's fit, so leave the word alone and work on the meaning of the sentence.

Likewise, leave the price alone. Forcing a price by law to mean what you want it to mean fits even more poorly within the entire web of exchange. It invisibly prevents some people from improving their personal circumstances, their lives, with a voluntary exchange. Raising the minimum wage or capping rents sounds good and feels like we're doing good, but the mandated prices don't fit just because we can imagine they fit. Prices are to good economics as words are to good literature.


Source: Bart Wilson, "Prices are Like Words," econlog.com, November 12, 2013

Monday, November 11, 2013

Obama's Political Naiveté

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from the article:

Vulnerable Democrats in Congress are starting to panic because they are seeing the consequences of violating the law of diffuse and concentrated interests.  Those insurance cancellation letters and the higher prices faced by a portion of those shopping on the exchange are a small portion of the population (probably less than one percent), but they are highly concentrated, not to mention vocal.

Source: Steve Wilson, "Even Obama Can’t Violate Fundamental  Laws of Politics," pileusblog.wordpress.com, November 8, 2013

Obama Admits to Government Incompetence

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from the article:
This should have made him sympathetic to the way government burdens private enterprise, but he's focused on liberating government to take over more of what has been done privately. And yet there's no plan, no idea about what would suddenly enable government to displace private businesses competing to offer a product people want to buy.

Source: Ann Althouse, Obama Admits that Government -- as Opposed to the Private Sector -- Is Far Less Capable of Accomplishing Anything With Computers, althouse.blogspot.com, November 8, 2013

Thursday, November 7, 2013

Kling on the Cutler Memo

Article Link

from the article:
Yet the problems go even deeper, and the late Kenneth Minogue had the correct diagnosis when he said that the political process encourages people to become fantasy despots. Cutler, President Obama, and others who want to use government to reform the health care system suffer from “Fantasy Despot Syndrome.” They want to introduce reform through government dictate because they lack the patience and pluck to reform health care the market way, through entrepreneurial trial and error.

Source: Arnold Kling,"Fantasy Despot Syndrome and Healthcare.gov," The American,  November 6, 2013

Whittaker Chambers vs. Ayn Rand

Article Link

from the article:

In his review of “Atlas Shrugged,” in “Witness,” . . . Chambers’ work is closely connected with an important and enduring strand in conservative thought -- one that distrusts social engineering and top-down theories, emphasizes the limits of human knowledge, engages with particulars, and tends to favor incremental change. This is the conservatism of Edmund Burke, Michael Oakeshott and Friedrich Hayek. 

Source: Cass Sundstein, "Whittaker Chambers Versus Ayn Rand," bloomberg.com, November 5, 2013

Monday, November 4, 2013

W_Post Explains the Disasterous Health Care Rollout

Article Link

Source: Amy Goldstein and Juliet Eilperin, "HealthCare.gov: How Political Fear Was Pitted Against Technical Needs," The Washington Post, November 2, 2013

David Cutler Memo (from link in article)


May 11, 2010

To: Larry Summers

From: David Cutler

Subject: Urgent Need for Changes in Health Reform Implementation

I am writing to relay my concern about the way the Administration is implementing the new health reform legislation. I am concerned that the personnel and processes you have in  place are not up to the task, and that health reform will be unsuccessful as a result.
Let me start by reminding you that I have been a very active supporter of reform. In addition to being the senior health care advisor to the President’s campaign, I worked closely with the Administration, helped Congress draft the legislation, met with countless Members of Congress and interest groups to explain the reform effort, conducted numerous radio and television interviews, walked hundreds of reporters through health care, and wrote a number of op-eds and issue briefs supporting reform. I am told that the President and senior members of the Administration valued my input, though I was never offered a position in the Administration. I say this to illustrate that I have thought about the issues a good deal and have discussed them with many people.

You should also note that while this memo is my own, the views are widely shared, including by many members of your administration (whose names I will omit but who are sufficiently nervous to urge me to write), as well as by knowledgeable outsiders such as Mark McClellan (former CMS administrator) and Henry Aaron (Brookings). Indeed, I have been at a conference on health reform the past two days, and have found not a single person who disagrees with the urgent need for action.

My general view is that the early implementation efforts are far short of what it will take to implement reform successfully. For health reform to be successful, the relevant people need a vision about health system transformation and the managerial ability to carry out that vision. The President has sketched out such a vision. However, I do not believe the relevant members of the Administration understand the President’s vision or have the capability to carry it out.   Let me illustrate the problem you face and offer some solutions.

Problem Areas

A central concern is the Department of Health and Human Services, the main implementation agency for reform. The Department is making a good start on the immediate deliverables of reform: high risk pools and coverage for young adults. But it is far behind the curve on the key long-term reform efforts, most notably reforming the delivery system to support higher quality, lower cost care. Let me give you a few examples.

1. A good deal of reform implementation needs to occur at the Centers for Medicare and Medicaid Services (CMS). You were dealt a bad hand here. The agency is demoralized, the  best people have left, IT services are antiquated, and there are fewer employees than in 1981, despite a much larger burden. Nevertheless, you have not improved the situation. The nominee to head that agency, Don Berwick has never run a provider organization or insurance company, or dealt with Medicare or Medicaid reimbursement. On basic issues such as the transition from fee-for-service payment to value-based payment, Don knows relatively little. Further, he has  been ordered not to be involved in anything at the agency until he is confirmed, which will likely  be in the fall. Don has a wonderful vision, but there is no way he can carry it out in any reasonable time without substantial help.

Unfortunately, the senior staff at CMS, which has been appointed, is not up to the task. For example, I recently met with the senior CMS staff about how all the new demonstration and  pilot programs envisioned in the legislation might work. This is a crucial issue because the current demonstration process takes about 7 to 10 years, and thus following this path would lead to no serious cost containment for the next decade. When engaged about the speed of reform, the staff expressed the view that: (a) their fear was going too fast instead of going too slow; (b) we ought to add a layer of university review to the existing process, to be sure we are doing the right thing; and (c) the natural place to start demonstrations is in end-of-life care (Death Panels notwithstanding).

As a result, you have an agency where the philosophy of health system reform is not widely shared, where there is no experience running a health care organization, and where the desire to move rapidly is lacking. The result is that I have very little confidence that the Administration will make the right decisions about the direction and pace of delivery system reform.

2. The second major task of reform is to set up and run insurance exchanges. I am not encouraged by what is occurring there either. Running exchanges is a collaborative process. As just one example, the person who ran the Commonwealth Connector in Massachusetts estimates that he had 500 town meetings to discuss reform, the equivalent of 17,000 meetings nationally – and this was in a state where two-thirds of people, along with insurance companies, supported reform. The person newly appointed to head the insurance oversight office has a reputation as an insurance bulldog, not a skilled facilitator. Remember that most people will get their information about reform from their doctor and their insurance agent. If you cannot find a way to work with hesitant states and insurers, reform will blow up. I have seen no indication that HHS even realizes this, let alone is acting on it.

3. A fundamental issue in making reform work is explaining reform to providers and showing them how to respond to it. The Department has done nothing along these lines. Most  providers know very little about reform, and they are universally surprised to hear a positive  philosophy about how they can benefit from health system transformation. Their most common comment is ‘why hasn’t anyone explained this to us?’ As Atul Gawande’s famous
 New Yorker  article put it, you need the equivalent of an agricultural extension worker in every community to make reform work. This does not appear to be on HHS’s radar screen, however.

4. Above the operational level, the process is also broken. The overall head of implementation inside HHS, Jeanne Lambrew, is known for her knowledge of Congress, her commitment to the poor, and her mistrust of insurance companies. She is not known for operational ability, knowledge of delivery systems, or facilitating widespread change. Thus, it is not surprising that delivery system reform, provider outreach, and exchange administration are receiving little attention. Further, the fact that Jeanne and people like her cannot get along with other people in the Administration means that the opportunities for collaborative engagement are limited, areas of great importance are not addressed, and valuable problem solving time is wasted on internal fights.

All in all, the administration has immense decisions to make about transforming health care delivery and coverage. But no one I interact with has confidence that your current  personnel and configuration is up to the task.

Some Ideas

When a corporation needs to move in a new direction, it sets up a new structure to focus on where it needs to go. You can’t change the culture by piling new responsibilities onto a  broken system. I believe you need to follow this model. You need to bring in people who share the President’s vision and who know how to manage health care or other complex operations. These people then need to interact with existing agency personnel to make reform happen.

You need to start with a strong team at the White House. That team needs to lay out the milestone goals for the next 5 to 10 years, coordinate across various agencies, and communicate with the public. To avoid the perception of secrecy, I would recommend an outside Board of Overseers that would monitor progress and report regularly on whether health reform is meeting its goals.

You also need a major change at HHS, which I envision as a revamped and enhanced implementation group. That group needs to share the President’s vision and have expertise in several areas:


  • Managing large and complex enterprises
  • Payment reform, including people who can work with existing employees to design and implement the necessary programs;
  • Information technology systems, including how to update the IT structure in CMS and link that to the effort to computerize medical records;
  • Outreach, including people who can lead an education campaign for medical care  providers, insurers, and insurance brokers; and
  • State coordinators, who can empower and work with state-specific groups to set up and manage insurance exchanges.


In each of these areas, you need to take advantage of external experts as well as people inside the Administration.
 
I show below one way to organize this. There may be better ways to organize things than what I have laid out. But it is clear to me that these functions are vital and are not being met. I strongly encourage you to make changes now, before you are too late to get the outcomes we need. 

(Couldn't copy the Cutler's organization chart)


The Robbers Cave Experiment

Article Link http://lesswrong.com/lw/lt/the_robbers_cave_experiment/

Source: Eliezer Yudkowsky, "The Cave Robber's Experiment," lesswrong.com, December 10, 2007

Context of the reference:Alex Tabarrok , The Sad Losers of Politics, marginalrevolution.com, November 4, 2013  Link


Pierce, Rogers and Snyder find that political partisans are more upset about an election loss than a random sample of parents were upset by the Newtown shootings.
Partisan identity shapes social, mental, economic, and physical life. Using a novel dataset, we study the well-being consequences of partisan identity by examining the immediate hedonic impact of electoral loss and victory. We employ a quasi-experimental regression discontinuity model that minimizes many of the inferential biases associated with surveys. First, we find that elections strongly affect the well-being of partisan losers (for about a week), but minimally impact partisan winners. This is consistent with research on the goodbad hedonic asymmetry. Second, the well-being consequences to partisan losers are intense. To illustrate, we show that partisans are affected two times more intensely by their party losing the U.S. Presidential Election than both respondents with children were to the Newtown Shootings and respondents living in Boston were to the Boston Marathon Bombings. We discuss implications regarding the centrality of partisan identity to the self and its well-being, and the methodological contribution.

The authors suggest that the happiness effects of political losses are surprisingly large but they would have done better to compare elections with something people really care about, sports (and here). Sports and politics share the same irrational attachment to a team, the only difference being that the rivalries and hatreds of the former rarely lead to as much death and destruction as the latter.

I feel fortunate to have never been emotionally invested in the winner of any election. It’s all a carnival of buncombe to me–a giant robbers cave experiment for the amusement of those in the know.

 

The Sad Losers of Politics

by on November 4, 2013 at 7:21 am in Political Science, Religion | Permalink
Pierce, Rogers and Snyder find that political partisans are more upset about an election loss than a random sample of parents were upset by the Newtown shootings.
Partisan identity shapes social, mental, economic, and physical life. Using a novel dataset, we study the well-being consequences of partisan identity by examining the immediate hedonic impact of electoral loss and victory. We employ a quasi-experimental regression discontinuity model that minimizes many of the inferential biases associated with surveys. First, we find that elections strongly affect the well-being of partisan losers (for about a week), but minimally impact partisan winners. This is consistent with research on the goodbad hedonic asymmetry. Second, the well-being consequences to partisan losers are intense. To illustrate, we show that partisans are affected two times more intensely by their party losing the U.S. Presidential Election than both respondents with children were to the Newtown Shootings and respondents living in Boston were to the Boston Marathon Bombings. We discuss implications regarding the centrality of partisan identity to the self and its well-being, and the methodological contribution.
The authors suggest that the happiness effects of political losses are surprisingly large but they would have done better to compare elections with something people really care about, sports (and here). Sports and politics share the same irrational attachment to a team, the only difference being that the rivalries and hatreds of the former rarely lead to as much death and destruction as the latter.
I feel fortunate to have never been emotionally invested in the winner of any election. It’s all a carnival of buncombe to me–a giant robbers cave experiment for the amusement of those in the know.
- See more at: http://marginalrevolution.com/#sthash.ycQ5XJRC.dpuf

The Sad Losers of Politics

by on November 4, 2013 at 7:21 am in Political Science, Religion | Permalink
Pierce, Rogers and Snyder find that political partisans are more upset about an election loss than a random sample of parents were upset by the Newtown shootings.
Partisan identity shapes social, mental, economic, and physical life. Using a novel dataset, we study the well-being consequences of partisan identity by examining the immediate hedonic impact of electoral loss and victory. We employ a quasi-experimental regression discontinuity model that minimizes many of the inferential biases associated with surveys. First, we find that elections strongly affect the well-being of partisan losers (for about a week), but minimally impact partisan winners. This is consistent with research on the goodbad hedonic asymmetry. Second, the well-being consequences to partisan losers are intense. To illustrate, we show that partisans are affected two times more intensely by their party losing the U.S. Presidential Election than both respondents with children were to the Newtown Shootings and respondents living in Boston were to the Boston Marathon Bombings. We discuss implications regarding the centrality of partisan identity to the self and its well-being, and the methodological contribution.
The authors suggest that the happiness effects of political losses are surprisingly large but they would have done better to compare elections with something people really care about, sports (and here). Sports and politics share the same irrational attachment to a team, the only difference being that the rivalries and hatreds of the former rarely lead to as much death and destruction as the latter.
I feel fortunate to have never been emotionally invested in the winner of any election. It’s all a carnival of buncombe to me–a giant robbers cave experiment for the amusement of those in the know.
- See more at: http://marginalrevolution.com/#sthash.ycQ5XJRC.dpuf

The Sad Losers of Politics

by on November 4, 2013 at 7:21 am in Political Science, Religion | Permalink
Pierce, Rogers and Snyder find that political partisans are more upset about an election loss than a random sample of parents were upset by the Newtown shootings.
Partisan identity shapes social, mental, economic, and physical life. Using a novel dataset, we study the well-being consequences of partisan identity by examining the immediate hedonic impact of electoral loss and victory. We employ a quasi-experimental regression discontinuity model that minimizes many of the inferential biases associated with surveys. First, we find that elections strongly affect the well-being of partisan losers (for about a week), but minimally impact partisan winners. This is consistent with research on the goodbad hedonic asymmetry. Second, the well-being consequences to partisan losers are intense. To illustrate, we show that partisans are affected two times more intensely by their party losing the U.S. Presidential Election than both respondents with children were to the Newtown Shootings and respondents living in Boston were to the Boston Marathon Bombings. We discuss implications regarding the centrality of partisan identity to the self and its well-being, and the methodological contribution.
The authors suggest that the happiness effects of political losses are surprisingly large but they would have done better to compare elections with something people really care about, sports (and here). Sports and politics share the same irrational attachment to a team, the only difference being that the rivalries and hatreds of the former rarely lead to as much death and destruction as the latter.
I feel fortunate to have never been emotionally invested in the winner of any election. It’s all a carnival of buncombe to me–a giant robbers cave experiment for the amusement of those in the know.
- See more at: http://marginalrevolution.com/#sthash.ycQ5XJRC.dpuf

Postrel on Selfridge

Article Link

Source: Virginia Postrel, "How Mr. Selfridge Created the Modern Economy," bloomberg.com, April 5, 2013

Sunday, November 3, 2013

Paglia on Capitalism and Art

Article Link

from the article:
Capitalism has its weaknesses. But it is capitalism that ended the stranglehold of the hereditary aristocracies, raised the standard of living for most of the world and enabled the emancipation of women. The routine defamation of capitalism by armchair leftists in academe and the mainstream media has cut young artists and thinkers off from the authentic cultural energies of our time. . . .

We live in a strange and contradictory culture, where the most talented college students are deologically indoctrinated with contempt for the economic system that made their freedom, comforts and privileges possible. Thus young artists have been betrayed and stunted by their elders before their careers have even begun. Is it any wonder that our fine arts have become a wasteland?

Source: Camille Paglia, "How Capitalism Can Save Art," The Wall Street Journal, October 5, 2012