Leaving aside the actual merits of the argument about the woman with bladder cancer who’s in danger of losing her oncologist due to the consequences of the PPACA, there’s something about the discussion I’m curious about. Why is the woman’s insurance company being accused of profiteering while her oncologist and other healthcare providers aren’t?

Is the reason due to some preference for labor over capital? I think that’s a particularly weak argument. Without the insurance company the woman would have been forced to bear the entire cost of her treatment herself which means, presumably, she would have gone without and, possibly, died. The insurance company is performing a service and the service deserves to be compensated. Judging by the estimates of the cost of her treatment, it’s a pretty darned valuable service.

The median hourly wage of an oncologist is about $100 per hour. Frankly, I’m skeptical that any hourly wage over about $30 per hour earned by anybody for anything is actually the cost of labor. I think it’s some combination of the actual cost of labor, a premium for capital investment, and the result of restrictions on the distribution of medication, barriers to entry, and other anti-competitive measures.

So, why are the insurance companies the bad guys?

I agree with this observation from Jonathan Bernstein, from his most recent column in the Washington Post:

If the law works — if the website is repaired, if people sign up through the exchanges in sufficient numbers, if competition on the exchanges really does bring costs down without undermining the kind of care consumers want, if Medicaid expansion goes smoothly where Republican opposition allows — then there’s no chance that it’s going to be repealed, or delayed.

but I’m not so sure about this:

If it really does collapse, then it’s certain that it will be delayed or even replaced, although again that would mean building on what’s been done.

I suppose it depends on what the operative definition of “collapse” is. I strongly suspect that regardless of what happens supporters of the PPACA will be proclaiming its success while its opponents will be declaring its failure. Once again, they each have their own facts.

Mr. Bernstein has some signficant omissions in his list of “ifs”. The anecdotal reports suggest that most of those who’ve signed through Healthcare.gov are enrolling in Medicaid and that some of those qualified under the old eligibility rules. The states will not receive 100% reimbursement for them as they will for those who qualify under the new eligibility rules. If a very large proportion of those enrolling for Medicaid via Healthcare.gov would have been eligible for Medicaid anyway, I’d say the system will have collapsed then and there. The states are already unable to keep up with their share of Medicaid and thousands or millions of new participants will already aggravate a bad situation. Providers are already waiting many months for reimbursement under Medicaid in some states, notably Illinois. And that 100% reimbursement will be phased out after three years. That has been one of the things I’ve been most skeptical about in the plan. What happens after three years? Here in Illinois the cupboard is already bare.

I also wonder what proportion of those who actually enroll for insurance under the exchanges will be older people with pre-existing conditions as opposed to people who are young and healthy. If the young and healthy just don’t participate the entire plan will be ineffective from the outset but the shoe won’t really fall until next year when new and presumably higher premiums will be charged.

IMO we’re probably stuck with the PPACA as-is for the foreseeable future and as to what its impact will be we can only say “we’ll see”.

Of course economics is a science. It’s a descriptive science like anthropology or sociology not a predictive science like physics. Gussying it up with numbers to support your political preferences doesn’t change that.

Alex Tabarrok is concerned that all of that information the NSA is gathering will be used for political purposes:

The Nixon administration plumbers broke into the offices of Daniel Ellsberg’s psychiatrist in order to gather information to discredit him. They busted into a single file cabinet (pictured). What a bunch of amateurs.

The NSA has broken into millions of file cabinets around the world.

Nixon resigned in disgrace. Who will pay for the NSA break-ins?

I think that this is actually a more serious issue than his title or mine might lead you to believe.

My preference would be that the NSA not cast so broad a net. Indeed, I think that nearly every response of American politicians to the attacks on September 11, 2001 has been wrong-headed. I think they’re understandable but indefensible. At this point the only way the scope of the security state will be reduced will be through the democratic process and, since the incentives of both major political parties favor excess and neither major political party opposes it, such a reversal of course is far, far away.

I also think that if any U. S. administration exploits the vast amount of information we’re gathering for domestic political purposes the president whose administration it is should be removed from office whether he or she knew about it or not. To encourage the others.

However, in the absence of any real evidence that such a thing has actually transpired, I think that Dr. Tabarrok’s fears are overblown.

You might want to take a gander at this very interesting post at The Crime Report on big city policing in the post-Bloomberg era. Of course, here in Chicago we avoid all of this hugger mugger by ceding large portions of the city to street gangs.

First, there’s the decline in his approval that’s been in progress over the period of the last year and newly substantiated by Gallup, which reports a 39% approval rating. Then there’s this. Writing at The Guardian, Jeffrey Bachman outlines the case that President Obama is a war criminal or, more precisely, that the basic strategy of the Obama Administration’s anti-terror policy is itself a war crime:

Outside of a defined conflict zone, international human rights law is the applicable law. This is important because human rights law demands significantly more stringent rules for the use of lethal force than does humanitarian law.

If the United States is only involved in an armed conflict in Afghanistan, international human rights law would be the regime that regulates the use of lethal force in Pakistan and Yemen.

[…]

If we accept the argument made by the Obama administration and the Bush administration before it – that the United States is involved in an armed conflict with al-Qaida and associated forces wherever they are engaged – international humanitarian law is the lex specialis in Pakistan and Yemen. Yet, even with less rigorous limitations on the use of lethal force under international humanitarian law, there is mounting evidence that the Obama administration’s use of drones constitute violations of international law in the form of war crimes.

I think that this needs to be taken with a grain of salt. IMO any U. S. president, so long as he or she pursues the highly interventionist and overwhelmingly military foreign policy we have been following for some time, will inevitably be guilty of war crimes. That may go some way to explaining why we’re not a participant in the International Criminal Court.

so goes New Jersey. I think that those who see in New Jersey Gov. Chris Christie’s re-election victory, like Michael Barone, anything other than a victory in New Jersey for Chris Christie are over-interpreting the results. I seriously doubt that Gov. Christie’s style, persona, and even content will play outside New Jersey as it does inside it.

I do find this result from Virginia interesting:

Northern Virginia was perhaps more impacted by the shutdown than any other part of the country. Yet when the exit poll asked who was more to blame, 47 percent of voters said Republicans in Congress and 46 percent said Obama. Considering that individuals almost always poll better than groups of people—particularly Republicans (or, for that matter, Democrats) in Congress, this is a devastating result for Obama.

The government shutdown has already faded from the news. The problems of the PPACA will be in the news and providing headwinds for Democrats for at least the next six months. It will be an interesting midterm election.

Yesterday there was no general repudiation of Republicans following Congressional Republicans’ failed (and outrageous) gambits over the budget and debt ceiling last month. In the three most followed races progressive Democrat Bill de Blasio was elected mayor of New York by a wide margin to nobody’s surprise and New Jersey’s Republican Gov. Chris Christie won re-election by a wide margin in the bright Blue Garden State.

The only surprise was in the widely-followed race for governor of increasingly Purple Virginia. Despite an extremely large pre-election polling advantage Clintonite Democrat Democrat Terry McAuliffe eked out a three percentage point victory over the strident Tea Party Republican Ken Cuccinelli. Winning is winning and it’s better than losing.

Politics continues to be local and personal.

Chicago restauranteur, chef, and innovator Charlie Trotter has died at the young age of 54:

In August last year, as he prepared to close his eponymous fine-dining bastion in Lincoln Park after 25 years of booming business and international plaudits, chef Charlie Trotter talked of taking an extended break to pursue other interests such as travel and a master’s degree.

Doing the same thing for too long wasn’t healthy, Mr. Trotter added, because “Life’s too short.”

Late Tuesday morning, those words rang hauntingly true.

After being rushed to Northwestern Memorial Hospital from his home on the North Side, Mr. Trotter died at 54. The cause was undetermined, but police said there appeared to be no signs of foul play. According to the Cook County medical examiner’s office, it appears he died of natural causes.

Clearly, those words took into full recognition his own precarious health. He accomplished more in a relatively short life span than most people do in lives decades longer. He was primarily self-taught. The vision that guided him was largely his own. After only a short apprenticeship and aided by his father he opened his own restaurant where he made culinary history. I believe that Mr. Trotter is most likely to be remembered as a mentor, innovator, and philanthropist.

Young chefs in many of Chicago’s finest restaurants and fine restaurants around the world are alumni of his organization.

I dined at Mr. Trotter’s restaurant only once. It was outside my price range and we went as the guests of more prosperous friends. It was a grand dining experience but our hosts were dissatisfied until I explained what we were experiencing to them. Mr. Trotter’s cuisine relied on the excellence and punctilious selection of his ingredients and the perfection of their preparation. Flavored essences were used in preference to classical sauces. Once they understood the character of the experience they became great fans, returning again and again.