Wednesday, September 16, 2009
The health care issue in the U.S. is so difficult for four reasons.
The first reason is economic, and really a no brainer: The real costs of health care are hidden. People wrongly think (because it seems that way day-to-day) that they are getting something for nothing. Because the costs are hidden, the system generates services that are constrained by normal cost considerations. This was driven home to me two Sundays ago when I picked up a prescription for my son, who has bad acne. The clerk at the pharmacy handed me the prescription and said, "That'll be twelve hundred dollars...." before realizing he had been reading the "actual cost" information rather than the co-pay information. Incredible but true -- the actual cost of a one-month supply of this stuff was $1,217. My co-pay was $10. I rather think, as much as I love my son, that if I had to pay the actual cost, he would be using over-the-counter acne medicine, or some cheaper medical treatment. But if, God forbid, the insurance company refused to pay, I'd go off cursing the evil, profit-mongering health care companies. Demand will always go up for services seemingly priced so very much below actual cost. Hence the reason health-care premiums have skyrocketed over the past 15 years. Even when employers off-load more of the cost to workers (thus making the impact of health costs more directly felt), without some day-to-day, service-to-service price signals, people will just want, and take, more and more health care, even if, like my son's acne medicine, some of it can probably be done without.
The second reason has to do with the unique nature of what's being "consumed" by "customers" of health care. Being badly sick or wounded is horribly frightening. Death petrifies most people. Next to money, our physical well-being is so critical to our overall sense of happiness that it overwhelms most rationality. The power of modern medicine seems closed to magical or mystical, and how much would we pay for magic? I was going to die, and now I'm going to live -- how much is that worth, anyway. The intensely emotional nature of decisions about our health care would skew our rational economic behavior even if the system itself could send accurate price signals.
The third reason is political, the subject, really, of a full week of lectures when I teach my intro Political Science class. By virtue of the weak party system; the fact that legislators are elected on a local, not national, basis; increasingly "safe" districts and thus increasing powerful incumbents; the primacy of the committee and sub-committee system in Congress; and the increased importance of special-interest funding in Congressional elections, those same special-interests are able to exert an oversized influence on legislative outcomes. Since there's big, big money to be made in the health care industry, and many existing parties with an interest on seeing the present system continue, the odds of Congress ever enacting a truly effective health care reform bill is practically non-existent.
The fourth reason is sort-of political, but really beyond that: The massive distrust of government that has engulfed the right wing and, less obviously, subtly infiltrated the center and left as well. The federal government is inexorably involved in the health care system today, and any effective reform requires the federal government (or the state governments under a program of federal design) taking on a larger role. But because a solid minority of citizens believes the government is a dishonest, corrupt, self-serving, power-mad meddler that wants nothing more than to stomp out all individual freedoms, any "government" program for health care starts at a huge disadvantage. The reason we're at that point deserves another post, which hopefully I'll get to some day, but for now let's leave it there.
So there you have it -- it's a big, ugly, multifaceted mess. The economics are screwed up, people's emotions get involved, huge moneyed interests want to keep their piece of the pie, and many are distrustful of the government's competence and motives.
Could Obama have done anything differently that might have made things go better? Some have suggested that he should not have been so willing to work with Congress, or so willing to compromise with the Republicans. But these criticisms ignore the respective flip sides: Obama can't pass legislation alone, only Congress can, so working with Congress was a necessary evil. And Obama came to office believing that he should try to change the nasty, vitriolic awfulness that passes for discourse in Washington, D.C. He wasn't wrong, in my opinion, for trying to compromise, for even though he's reaped the wrath of Republicans on this issue (and may ultimately have to assemble his party and push something through), he has managed to stay above the nastiness fray in a way that's refreshing.
My one criticism would be that his plan is not bold enough. If you are going to address this issue, and have such a huge prolonged fight about it, do something big. From what I can tell, the current plan just nibbles around the edges. It doesn't really do much to contain costs (and, disappointingly, does almost nothing to further medical malpractice reform which, I believe, could have swayed moderate Republicans to support the bill). In fairness, Obama had a tough, tough road, and his pragmatism may, in the end, have been the best path. But we won't have a real solution until, unfortunately, the system starts to collapse around the heads of the middle class. The current plan, in my view, just puts that day off a few years.
Tuesday, August 18, 2009
Je le crois aussi.
Rough translation: To be a conservative leftist is to possess a bad chromosome, unusual in political DNA; it's believing that the public interest exists outside the market, but that the State is not the natural and exclusive expression of that public interest.
Monday, August 10, 2009
Thursday, July 09, 2009
Je ne voudrais pas penser à ce que peut être se passera demain!
Sunday, July 05, 2009
I needed surgery immediately, and ended up with a steel plate and 9 screws in my arm. Yesterday all the pain medicine made me sick; today all the other non-arm bruised and battered parts of my body are aching.
The staff at Kaiser were fantastic, and some very funny things happened during the experience, which I will post later, but all in all it was not at all fun.
Monday, June 29, 2009
Ironic, given that technology has opened up a huge pipeline of information, that our writing has reverted to the days of the telegram: "Arrived London. Deal on. Return tomorrow."
So today, something a bit longer, a whole 20 minutes, perhaps, on Albania.
When I was younger, Albania -- a small country on the Adriatic Sea lying between Greece and Macedonia -- was in the grip of a dictatorship that originally was aligned with the former USSR but later formed strong ties with China. As a result, I always thought of it as a sinister and threatening place, a nest of oppressive communist evildoers, even though, in fact, I really knew nothing about it.
My view of Albania changed last year when met and became friends with a young woman from Albania at the Alliance Francaise in Paris. To the extent I had a mental image of Albanians, she was the antithesis of it: smart, funny, informed, interesting, engaging, open, friendly, pretty (perhaps even beautiful), and sweet, with a big, generous heart. She was studying French because she wanted more than anything to be an architect, and that path wasn't open to her in Albania, so she came to Paris, 18 years old (though she seems much more mature than that) to study French and enroll in a university.
On the face of it, we were unlikely friends, this bright young Albanian woman and me, an older fairly stodgy American, but we became friends, and we'd sometimes we'd sit in the cafeteria and she'd tell me stories of her family in Albania. Times were hard sometimes; political changes would impact them in a way that wouldn't happen in the U.S. But it became clear that Albania, like many other Eastern European countries, was now on its way to becoming more free, more open, more a part of the rest of Europe. And although she didn't perhaps recognize it, my friend -- and the rest of her Albanian friends in Paris -- were part of the vanguard of that change.
Sunday Albanians voted in parlementary elections, an election that seems to have been conducted peacefully, openly, and fairly. My friend's Facebook posts were election-related; I wished her country courage and good luck.
Albania joined NATO last year and is hoping to join the European Union soon. I hope it succeeds. Amidst all the crises we are facing, there is good news out there. My young Albanian friend has given me a peculiar interest in that country. I know it continues to have problems (the countryside, I think, remains backwards and very poor), but if it has many young people in it like my friend, its future is bright.
Wednesday, June 17, 2009
Even the world’s best pros are so consumed with avoiding bogeys that they make putts for birdie discernibly less often than identical-length putts for par, according to a coming paper by two professors at the University of Pennsylvania’s Wharton School. After analyzing laser-precise data on more than 1.6 million Tour putts, they estimated that this preference for avoiding a negative (bogey) more than gaining an equal positive (birdie) — known in economics as loss aversion — costs the average pro about one stroke per 72-hole tournament, and the top 20 golfers about $1.2 million in prize money a year.
A fascinating study in the New York Times this week (which should have been somewhere other than the sports section) on the cost of fear. We think by being cautious we hold on to our gains, but in fact fear costs us long-term. I confess I'm like this; a loss seems bigger to me than the same-sized gain. Or more precisely, perhaps, the pain of a loss is considerably more than the sense of joy or satisfaction at the same-sized gain. This is why politicians run negative ads, and why people hold on to stocks they've taken a loss on. We know this intuitively, but it is remarkable to see it demonstrated so clearly.