Over-Utilization Isn’t the Problem

There’s a simple lesson that I learned in one of my econ courses, now more than 50 years ago. In the absence of increases in productivity wage increases require an increase in prices. I do not believe that physician Marty Makary has ever taken an economics course. In his post at RealClearHealth he calls for a reduction in excessive treatment in favor of a more “patient-centered” approach and in the interests of reducing spending:

The trend to recognize over-treatment led my Johns Hopkins colleagues and I to conduct a study of approximately 2,000 physicians nationwide asking them how often is medical care unnecessary (excluding the respondent’s own practice)? The result—doctors say that 15-30 percent of everything done in medicine is unnecessary, a finding consistent with that of a 2012 Institute of Medicine report that stated that 30 percent of health care spending ($750 billion) is spent on things that do not make us healthier.

His suggestions are benign but, unless providers can be persuaded that they should not expect their pay to rise, it won’t reduce costs. Health care is notoriously lacking in increases in productivity and Baumol’s cost disease will inevitably lead to higher costs whether treatment is necessary or not.

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Still Too Big to Fail

At RealClearMarkets finance prof Sanjai Bhagat, noting that despite Dodd-Frank many large banks are still simultaneously vulnerable and too big to be allowed to fail, advises:

Our bank capital proposal has two components. First, bank capital should be calibrated to the ratio of tangible common equity to total assets (i.e., to total assets independent of risk) not the risk-weighted capital approach that is at the core of Basel. Second, bank capital should be at least 20% of total assets. Also, total assets should include both on-balance sheet and off-balance sheet items; this would mitigate concerns regarding business lending spilling over to the shadow banking sector.

Greater equity financing of banks coupled with the aforementioned compensation structure for bank managers and directors will drastically diminish the likelihood of a bank falling into financial distress; this will effectively address the too-big-to-fail problem. Our market-based solution (greater bank equity, and reforming bank executive and director incentive compensation) will accomplish Dodd-Frank’s worthy objectives without the need for much of the pursuant regulations. Our bank capital reform is also consistent with the essence of the CHOICE Act regarding bank equity capital.

Back in the early days of the financial crisis, I suggested that our problem was that everyone was pursuing the incentives they had. As long as you keep the incentives in place, you’ve changed nothing. All of the same incentives are still in place.

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How Not to Win Votes

At Washington Monthly Martin Longman gives advice very much along the lines I’ve been giving. After taking note of an article advising Democrats to offer white working people “palliative care” rather than the opportunity to thrive, he writes:

But it’s not actually a misinterpretation of political self-interest that appalls me in this case. It’s the idea that the modern left can self-define itself in a way that leaves out any hard-pressed community. I believe Anti-Monopoly policy can bring economic vitality back to these communities and that it is simply irresponsible to tell them that their communities are doomed without having made a real effort to save them. If I lived in a culturally working class county, it would be as clear as day to me that the left, as currently comprised, has no plan for me. I completely understand why the Democrats have cratered in county after county after county in this country. We like to tell them that they’re voting against their self-interest, but how is it in their self-interest to latch onto a party that thinks they’re beyond help?

I’m not saying the whole Democratic Party feels this way, but the default position among a lot of progressives since the election has been that to even talk about these folks is to pander to their racism and dilute the party’s commitment to civil rights, women’s rights, gay rights, and the environment. If we want to draw up our battle lines like that, then they sure as shit are going to take the hint.

It is a question of priorities. As long as searching for heretics maintains a higher priority than looking for allies, you are more likely to find the former than the latter. Structural considerations and simple mathematics dictates that getting out the base isn’t enough.

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Older Than You Think

Homo sapiens fossils found in Morocco demonstrate that our species is older than had been thought, reports the New York Times:

Dating back roughly 300,000 years, the bones indicate that mankind evolved earlier than had been known, experts say, and open a new window on our origins.

The fossils also show that early Homo sapiens had faces much like our own, although their brains differed in fundamental ways.

Until now, the oldest fossils of our species, found in Ethiopia, dated back just 195,000 years. The new fossils suggest our species evolved across Africa.

“We did not evolve from a single cradle of mankind somewhere in East Africa,” said Phillipp Gunz, a paleoanthropologist at the Max Planck Institute for Evolutionary Anthropology in Leipzig, Germany, and a co-author of two new studies on the fossils, published in the journal Nature.

My hypothesis about the development of our species looks better with each of these new discoveries.

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The Brave New World of Virtual Communities

In a piece at The Federalist the writer tells a sad, lonely story:

Let me tell you about my Southern California neighborhood. I have lived in this one for 22 years. I don’t know anyone, but it’s not for lack of trying. Each time a new neighbor moves in I bake a loaf of bread and take it to them. They thank me at the door and then close it. That is the last I see of them other than when they go to their cars.

One neighbor was pregnant and her husband was employed, so I gave her my phone number just in case she needed anything. She thanked me and didn’t give me her number. We spoke over the fence occasionally, but not in any way that would turn us into buddies or even casual friends. They moved.

Our newest neighbors dropped a card on our front porch before their bread was baked to tell us their names and gave us their phone number. I still have it four years later. I baked the bread and the mister thanked me at the door. I have never met the Mrs. in person.

I hosted a coffee klatch and made up fliers and put them on the 12 nearest homes. I got donuts, cut up fruit, and made coffee and tea. Six people came, drank the tea, and no one touched the donuts or fruit. They chatted about who all used to live here in this neighborhood over the years, said thank you and left. No one asked a single question of me. I have never been to their homes or had a conversation with any of them since.

By way of comparison let me tell you about my Chicago neighborhood. In my neighborhood we know each other, know each other’s children’s names, and care about each other. We exchange Christmas cookies. We hold block parties. On occasion we exchange the keys to each other’s homes. We watch each other’s homes when someone goes out of town. We shovel each other’s walks when it snows. We share the produce from our gardens. We talk with each other over our backyard fences or sitting on the stoops in front of our houses or when walking our dogs.

Maybe what the author of that article has experienced is the well-documented collapse of community in the United States chronicled in Bowling Alone. But I think there may be something else at work as well.

We’re choosing our communities differently than we used to. It’s far less common that we’ll have a geographically-based community like a neighborhood or the things that go along with that like block clubs. We’re also less likely to form communities around our work. There are fewer company bowling leagues or baseball teams than there used to be. Bowling leagues and baseball teams aren’t being replaced by company videogame groups or cosplay clubs or something else more 21st century.

Our communities are much more likely to be virtual ones—our Facebook friends or people on Pinterest or what have you—or based on other affinities, e.g. shared interests like canine agility or collecting stamps or some other interest. It will be different than the communities of the past and I don’t know what the implications will be. It may be cold and lonely as the author of the piece believes. I don’t think it is reversible.

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In Common With Iran

As of today as reported in the Washington Post France and the United Kingdom have something quite significant in common with Iran—all are being attacked by Sunni Islamist terrorists:

Gunmen stormed two major sites in Iran’s capital Wednesday, killing at least 12 people in gunfire and suicide blasts in parliament and at the revered tomb of the nation’s Islamic revolutionary leader. The Islamic State claimed responsibility for the Tehran attacks, which would mark the group’s first major strikes in Iran.

The twin attacks — coming in the middle of the Islamic holy month of Ramadan — also appeared calculated for maximum shock among Iranians.

Parliament is widely respected as a voice on domestic policies even as the supreme leader, Ayatollah Ali Khamenei, has the final word on most international and security issues. The vast shrine complex of Khamenei’s predecessor, Ayatollah Ruhollah Khomeini, is a centerpiece of homage to the 1979 Islamic revolution that overthrew Iran’s Western-allied monarchy.

The timing, meanwhile, could have been designed as an attempt to boost the Islamic State’s stature among backers as it faces a two-pronged assault against its key urban strongholds: Mosul in northern Iraq and the Islamic State’s de facto capital, Raqqa, in Syria. An expanded offensive by U.S.-backed forces against Raqqa began Tuesday.

It will be interesting to see how the Iranian government responds to this challenge and whether it resembles or is in contrast to the reactions in France and the United Kingdom.

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The Worst? Not Nearly

If Jamie Fly thinks that what American presidents have done since 9/11 are “the worst impulses of the electorate”:

Americans look to their leaders, especially their presidents, to explain the challenges the United States faces on the world stage. Instead of providing this leadership, presidents of both parties have played to the worst impulses of the electorate, telling them that they were correct to believe that America needed to refocus on problems at home and dismissing the terrorist threat as minimal. When we did intervene militarily, Americans were told it would be quick, painless, and easy or they weren’t told at all because of the deniability of the military and intelligence tools used in an attempt to avoid public discussion of the fact that we were still at war.

as expressed in his Medium article, either he doesn’t get out much or his notions of good and evil are drastically different from mine. You don’t need to look too hard to find people who want to engage in an exterminatory, genocidal campaign against the people of the Middle East and North Africa. Overthrowing the government of Iraq or conniving at the overthrow of Qaddafi pale in comparison.

What has been done instead has been very bad but neither the worst nor the impulses of the electorate. I think the impulses of the electorate have been pulling to two contradictory directions. One has been in the direction of the use of overwhelming and largely indiscriminate force and the other has been in the direction of extricating ourselves from the Middle East and North Africa completely.

My explanation is different. Presidents have been responding to the median impulses of their donors and closest advisors. Those have resulted in ineffectual, futile, half-hearted feints in one direction or another but not an anti-terror strategy.

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The Hollowing of California

I don’t think that Francis Wilkinson is reading the statistics correctly in his Bloomberg piece on Californians moving to Texas:

According to a Sacramento Bee review of Census data, “Every year from 2000 through 2015, more people left California than moved in from other states.”

The departures are, in some broad sense, linked to a failure of liberalism. “The people leaving tend to be relatively poor, and many lack college degrees,” the Bee reported. “Move higher up the income spectrum, and slightly more people are coming than going.”

In other words, while California is a very nice place to be rich, and is attracting more affluent people as a result, it’s hard to get by there if you’re poor or working class, especially in California’s marquee cities.

What I think is happening is that those with from one standard deviation below median income to one standard deviation above median income, i.e. from family incomes of about $40,000 to family incomes of about $80,000, particularly the native born, are leaving California in large numbers and being replaced by immigrants from the extreme ends of the income distribution. If you think those leaving are the poor, you’ve been living in an affluent neighborhood too long.

When he was defeated in his bid for re-election to the U. S. Congress, the frontiersman (and general character) Davy Crockett famously declaimed “You can all go to hell. I’m going to Texas.” I think that’s pretty much what’s happening in California now.

The Golden State is in the midst of a great experiment to determine whether a state can build a viable economy based on the affluent, the poor, and public retirees. I wish them all the luck in the world but I don’t think it’s a model open to most other states and not to Illinois in particular.

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Anything But Basic

At Reason, mind you, Reason Jesse Walker traces the idea of a universal basic income not just back to Huey Long but all the way back 250 years to Tom Paine, claiming that a UBI may be the only policy on which Tom Paine, Huey Long, Milton Friedman, Timothy Leary, and Sam Altman could agree. In my view a UBI satisfies everything an income provides except the most basic: independence, a strengthening of non-state institutions, and providing meaning for one’s life.

If you think the mortality rate due to opioid abuse today is appalling, implement a UBI and you’ll learn what appalling is.

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Heed The Prince

At The American Conservative, mind you, The American Conservative Bert Peterson advocates a bizarre sort of universal medical benefit. I can’t excerpt it so you’ll need to read it in full. It hinges on medical debt and estates and is intended to replace all other forms of medical benefits including both Medicaid and Medicare.

I think the problems with his proposal are grave. Decades may pass between the point at which a medical debt is incurred and the death of the debtor. How will providers operate in the interval? Will they be forced to finance their expenditures, using debt as collateral?

These debts are likely to become confiscatory over time. I think he should heed Macchiavelli’s advice from The Prince:

But when it is necessary for him to proceed against the life of someone, he must do it on proper justification and for manifest cause, but above all things he must keep his hands off the property of others, because men more quickly forget the death of their father than the loss of their patrimony.

or, in other words, his calculations about harm are wrong.

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