JayB

Didn't the study you cite for the 45K figure compare mortality amongst the two completely different demographic cohorts, and exclude everyone who made enough money to buy insurance from the "uninsured" pool? Thank goodness they didn't compare the folks with Medicaid coverage to the pool of folks that make enough money to buy insurance but don't carry it - since the statistical associations would "prove" that getting covered by Medicaid causes a dramatic increase in illness and mortality. The key take away is that there's quite a bit more than an insurance card that differentiates the folks that are consistently too poor to purchase insurance from the folks who consistently carry coverage. Education, lifestyle, etc, etc, etc. If your study proves anything, it's that long-term structural poverty is the problem.

I shop there because sometimes I have to. I stay because Walmart's so enlightening as the Reaganite equivalent of a Hogarth engraving. Looks like downtown Detroit circa 2010. Look for the union label! BTW - "sometimes you have to?" Please explain....

"Controlling political outcomes to enhance one's economic activity" covers quite a bit more than plain ole corporate welfare, kemosabe. Unless you add a few caveats that make allowances for ag subsides, protectionism in all of its guises, the aptly named "Davis-Bacon" Act, etc, etc, etc, Except in right wingers' very vivid imagination, trade unions and other citizens' associations do not buy political influence in any appreciable way. The influence yielded by non-corporate associations pales in comparison to the influence of corporate money in politics. I am not against subsidies per se. A mixed economy is the only sensible way to address the challenges of the future. Fair trade, which also accounts for social and environmental costs, isn't protectionism but the way to make sure local economies aren't destroyed by pillagers. No political influence in any appreciable way? Tell that to GM bondholders! Davis-Bacon, prevailing wage contracts, longshoremen controlling ports, public sector compensation packages, mandatory carve-outs for unions on public works projects, etc, etc, etc, etc constitute quite a laundry list of accomplishments for folks with no influence on policy.... Why not leave it to consumers to determine who is and who isn't a pillager, and make their purchases accordingly, instead of having the government make that decision for them and thereby leave the door open to the abuses that you cite above. There's plenty of folks out there that voluntarily pay more for their coffee, produce, clothing, meat, etc, etc, etc, precisely because of the manner in which it was produced. They did so without the alternatives being banned, outlawed, or being subject to punitive taxation intended to tip their hand. As a matter of fact - they did so despite massive ag subsidies, etc designed to tip their hands in the opposite direction.

Interesting that you use mom and pop groceries as an example here. Can't wait to see their Super Bowl commercials next year! Sweet! One more reason to shop at Wallmart. Come for the bargains, stay for the schadenfreude...

84%- where the fuck did you get this number? fox news? and how many out of your 84 have only so-called catastrophic coverage, which btw don't really cover anything. and since you are such a fucking duche-nozzle expert on healthcare when did you have to pay any medical bills. by the way you spew your bullshit not in the last decade. Bob: That figure comes from the US Census Bureau. Specifically, page 27 of this publication: http://www.census.gov/prod/2009pubs/p60-236.pdf You'll find the text below on the top left of the said page: "The percentage of people without health insurance in 2008 was not statistically different from 2007 at 15.4 percent." This figure includes people who are only uninsured for part of the year, those who make enough to purchase coverage but decline to do so, non-citizens, etc, etc, etc, etc and as such dramatically *overstates* the number of people who cannot get coverage because they're too poor or too sick. It's strange for someone who's concerned about the price of coverage complain about high-deductible plans, when they're one of the few good mechanisms available to limit wasteful spending, keep premiums affordable, limit the capacity of insurance companies to meddle in routine medical decisions, while simultaneously protecting against getting wiped out in a medical catastrophe. If you're upset about anything, it should be the first dollar plans that encourage waste and state mandates that foist the cost of fertility treatments, massages, Retin-A scripts, etc, etc, etc, etc, on people who just want something to cover them when they get a serious injury or illness.

I agree that medical spending tends to be concentrated near the end of one's life - the only place where we'd disagree a bit is on the conclusions that can safely be drawn from that fact. Lots of folks go from the above to "...and is therefore both futile and wasteful" and I'm not convinced that that's a defensible logical correlate t the preceding statement. Seems like the folks compiling the Dartmouth Atlas fell into that trap - but the discussion is incomplete IMO unless you look into percent survival, duration of survival, etc. The fact that patient A and B are equally dead after having tons of money spent trying to keep them alive doesn't tell you much unless you factor in how many patients like A and B survive out of a given population when X-dollars are spent on their care. And that's supposing that you limit the conversation to a technical input-vs-output discussion, and don't get into the political implications of granting cash-strapped states the right to pull the plug on Granny, particularly when there's lots of other hands grasping for the same pile of money. I don't know about you, but when it comes to arm-wrestling in the legislative sausage factory I think the odds favor public sector unions plying for the right to retire a year earlier over grannies vying to live a year longer...

"Controlling political outcomes to enhance one's economic activity" covers quite a bit more than plain ole corporate welfare, kemosabe. Unless you add a few caveats that make allowances for ag subsides, protectionism in all of its guises, the aptly named "Davis-Bacon" Act, etc, etc, etc,

"Economic activity isn't evil. Controlling political outcomes to enhance one's economic activity to the detriment of the great unwashed masses is however evil." Glad to hear that you've finally come around. Looking forward to seeing your posts against tariffs, subsidies, and all of the other impediments to competition that Congress has erected on behalf of politically well connected interest groups.

You have vastly more faith in a physician's capacity to influence how their patients behave once they leave their offices than any physician I've ever met. A person's weight is the government's responsibility? Really? How does one simultaneously believe this and insist that the government has neither the capacity nor the right to dictate or determine what constitutes "safe" climbing?

Is there anywhere that this doesn't happen - outside of a ghetto anywhere in the world including the U.S.? Do you think our elder care system (languishing in nursing homes) is particularly humane for the individual involved or their families or one in which someone isn't making such decisions now? This is probably the most disingenuous, specious argument put out there by the Right; the assumption that old people in the US enjoy unlimited access to health care while their counterparts in other civilized countries are selected for life or death by the state. First, all systems ration, one way or the other. Ours does by a) refusing coverage b) not covering certain conditions c) capping coverage and d) not providing affordable health care at all. It does not, like most other countries, provide EQUAL ACCESS to health care for all. Here, if you can afford it, you live. If not, bye now. It is absolutely the cruelest system in the civilized world. JayB's obviously insulated from the reality of our system. He's married to a doc living in NZ. I'm surrounded by people who can't afford coverage or who are inadequately covered. My own father, a 30 year military veteran who fought in 3 wars for this country, was one of the latter. There was no system available to him to cover his required home health care, which had to be paid out of pocket. He was considerate enough to die before the family savings were exhausted. Fuck you, JayB. You're completely out to lunch here, and I think a large part of you knows it. Frankly, you remind me of the good little Nazi family man who pets the dog, kisses the wife and kids, and dutifully goes off to work gassing Jews. How an asshole like you can sit back and support what's going on when you, of all people, should know better, is completely beyond my moral understanding. Hey - I like to do my part to inspire empirical verifications of Godwin's law from time to time. Much to your probable dismay - I've been back in Seattle since May - and since we've been back we've had two grandparents die off - one in hospice, one in a long-term care facility, an uncle in the ICU for eight weeks, my Dad hospitalized with an ongoing cardiac issue, etc, etc, etc. Before that I spent three years getting daily decompression updates from the safety-net hospital in Boston that all of the folks with no coverage got funneled into. I have a different opinion than you do with regards to the best way to reform the payment and delivery of healthcare, but I am not quite as oblivious to the realities of healthcare as you claim. BTW - don't you live in Phinney in a house that'd go for $400-600K? Are you invoking your neighbors when discussing people who are too poor to pay for their own coverage - or other people that you are surrounded by in a less literal sense? It's true that all systems ration one way or another, but I find it hard to square your civil libertarian impulses and healthy distrust of the state when it comes to speech, and your awareness of all of the unintended consequences of state actions, etc, etc, etc - with a desire to hand responsibility for both payment *and* delivery of care over to the state. I could understand if someone with your background was in favor of something like a voucher system, but it's difficult for me to understand how a guy who doesn't want the likes of Tom Tancredo to have any role in determining who gets to say what has no problem with a system where...Tom Tancredo has a role in determining who gets what treatment when they're sick. With regards to rationing, it would be interesting to take a look at exactly what treatment guidelines are in force that determine what kind of care the elderly get around the world and who makes those decisions. So if you are privy to the algorithms that they use to determine who gets chemo in say Canada, England, and NZ vs the US - I hope you'll share it. And finally, as a guy who seems to like to challenge conventional wisdom from time to time, I'm surprised to see you tethering your argument to the "50 million" number. I've also looked into the "50 million" stat a bit, and even a brief look at the evidence was sufficient to establish that it includes large numbers of people who qualify for Medicaid but haven't enrolled for some reason, people who make enough money to buy insurance but choose not to for some reason, people who are only temporarily without insurance in a given year, non-citizens, etc. Not sure what the final number you get is, but it's considerably lower in quantifiable terms, and qualitatively, is something very different than a static pool of people who can never get insurance. Having no insurance is also something very different from having no access to any health care at all under any circumstances. Pay a visit to an urban ER and see for yourself.

I do believe that's one of the nicest things you've ever said to me, you old charmer! I'm still waiting for the pendulum to swing back towards the original philosophy from whence the modern variant derives its name, but I see waaay more of it in your thinking (this is meant to be a compliment) than most of the folks who apply that label to themselves.

When I get a moment I'll post the chart that shows the OECD figures adjusted for stuff that doctors and hospitals can't prevent - murders, suicides, drownings, motorcycle-building collisions, etc. That might not address the major unstated premise of your argument and that chart, which is that longevity stats are an accurate proxy for the quality of healthcare. I think the literature shows pretty well that once a country is wealthy enough to get nutritition, sanitation, and vaccination online the way people live is every bit as important as the standard of say - cardiothoracic surgery - where they live. There's another dimension to quality that also never seems to make it into these discussions, which is alleviation of pain, suffering, inconvenience, etc. You can live to a ripe old age with a harelip, vaginal fistula, gimpy knee, mortifying acne, urinary incontinence, etc. The folks in the NZ health district that I lived in that were using long courses of medication to treat their gall bladders while they were waiting years for surgery are/were probably going to live as long as they would otherwise, but I suspect that they'd concede that it had an adverse affect on their quality of life. The other thing that surprises me coming from a liberal of the highest order is what seems to be an implicit concession that the state - while having no legitimate role in determining what happens to a first or second trimester fetus - should have the authority to say whether or not, when, and how an octogenarian well past his 240th trimester gets treated or not.

Worth noting that the combined annual profits of all insurance companies would pay for approximately two days worth of medical expenses in the US. Then there's also the fact that there's already a ton of non-profit insurers competing in the marketplace, and it's not clear that this has had an affect on premiums, prices, etc. The best equation for evaluating the cost-efficiency of care is: magnitude of medical benefit for a given treatment/cost of delivering said treatment. Break the denominator down, look at the price of the actual delivery and give me your best estimate as to what percent of it is composed of "insurance company profits."

It's not so bad, Off. The WHO themselves state quite clearly that the rankings have much more to do with fairness than clinical efficacy. Better yet, when you account for mortality that no doctor or hospital could prevent, the US longevity stats rank us right up there at the top of the OECD. The picture would be even brighter if you did away with the ridiculous distortions in infant mortality stats that arise from the wild divergences in what various countries count as a "live birth." We count an awful lot of very small, very light babies as live births that would pass away unrecorded in other countries. Ditto for those that die shortly after being born. Kids that don't eat, drink, or smoke themselves to death and stay away from occupations like "crack dealer" have every reason to look forward to a longer run than their parents. If we ever get anything remotely resembling price transparency and competition going they might even spend a smaller percentage of their total earnings on health care than their parents did.

As long as government has no role in deciding which voices, interests, etc are legitimate and are allowed to express an opinion about particular politicians using whatever means are available to them - I'm happy to let the chips fall where they may. If George Soros wants to blow his wad telling the world that George Bush is a Douche the day before an election - fine with me. I agree with you about the ideal role of the Fourth Estate, but the reality is that "The press" is every bit as much a for-profit entity as, say, Amway. There's nothing magical about the beings that write editorials that elevates them above the rest of the mortals frittering away their time in other occupations that entitles them to voice their opinions about a candidate immediately before an election while The Fraternal Order of Sanitation Workers or GE have to remain silent. The other bit I find odd is the conviction that economic activity immediately becomes suspect and evil when organized in a corporation, as opposed to a sole proprietorship, partnership, etc. The trial lawyers manage to exert a fair amount of influence over legislation and other aspect of government without being incorporated. It's also worth asking whether all corporations will perceive themselves as having common interests that they'll act upon. Particularly when the primary end of their lobbying is to get Congress to rig the game in their favor with tariffs, subsidies, tax-breaks, win contracts, or some other intervention in the market that will hobble their competition and extract excess returns from consumers. If a politician gives GE a sweetheart deal via an earmark XYZ corp might be the only interest with the motivation and resources to squeal about it in a way that gets heard.

Finding it humorous that none of the "realists" weighing in against this decision seem to be the least bit concerned about political implications of allowing the humans that occupy key positions in the government at any particular time to determine precisely who gets to criticize them, how, and when. Funnier still that somehow the NYT is presumed to be composed of disinterested observers with no skin in the game who are dedicated only to advancing the public interest, while the guy who runs an appliance factory and wants to criticize a congressman or administration who supported a steel tariff is a grubby partisan with no business airing his grievances in the public. The most humorous assertion of all is that it'd even be possible for Congress to make politically neutral rules governing the rights of between the NRA, Amway, and move-on.org. You really want Michelle Bachman to have any role whatsoever in making that call?

Interest rates below equilibrium might inspire some “malinvestment” but also some investment that will be fruitful with an expected future rise in interest rates. Many other investors will not make interest sensitive investments expecting a future rise in rates. (Read Lucas a Washingtonian!)) It is hard to see that absent implicit government guarantees and incentives and regulatory inexperience in actually closing huge financial institutions. (ie large bank holding companies) that the current crisis would have unfolded as it did. Agree with the last sentence 100%. Seems like the magnitude of the malinvestment was sufficient to sink the ship this time around, but I'll read the guy you cite if you tell me his full name and/or the publication you're referring to.

Wrong - deregulation doesn't just mean the repel of existing laws. Under the Bushies they systematically ignored their power to regulate under existing laws. One of the best examples is when the CFTC tried to regulate default swaps under their jursidiction - they got hammered big time by Greenspan and his Ayn Rand groupies. Also under the Bushies, the amount of capitalization that financial institutions were required to keep was significantly reduced - allowing them to take larger bets with less backup. The "let the markets regulate themselves" was the rule and Greenspan just kept shovelling low interest rates into not one, but two bubbles, which turned out to be nothing more than a international Ponzi scheme. Credit default swaps definitely exacerbated the problem, particularly by giving folks the illusion that by buying them they were effectively covering the risk that the Alt-A, neg-am, no-doc pay-option paper that they were leveraging 33:1. Having said that - the basic problem was and is too much debt backed up by too little collateral and income. It's difficult to tell how much worse the factors you cite made things, but the SNL crisis of the 80's and all of the other implosions going back to the South Sea Bubble indicate that you can have a world class financial crisis with nothing more than excessive optimism and/or poor lending standards. IMO Greenspan's single biggest contribution to the disaster wasn't his failure to deploy the regulatory apparatus with sufficient vigor - it was keeping real interest rates at or near zero for far too long. Having said that - the bigger problem is a financial system that relies upon a single man/institution to pick the "right" interest rate. That's an impossible job. Ditto for determining the "right" capital ratio for all banks. When you couple a system with that kind of structural weakness with the likes of FNMA/GNMA, the CRA, the mortgage interest deduction, public deposit insurance, etc, etc, etc, etc, it's a wonder that we don't have financial crises more often. Speaking of which - taken a look at the books for, say - the FHA loans originated *after* the nature and extend of the financial crisis began? How about the projected losses for FNMA/GNMA? Neither inspired much confidence in the inherent superiority of using bureaucratic mechanisms that are subject to massive political distortions/incentives to allocate credit/resources/capital.

Not only is everyone expected to work but fixed expenses like transportation, child care, health care, local nickel and dime regressive taxes, etc .. have increased much faster than family income (even more so when considering that inflation is systematically understated thanks to creative cooking of books). These findings aren't equivocal despite refusal by clowns to even acknowledge they exist. [video:youtube]akVL7QY0S8A Just watch JayB not even address Warren's work and later on keep pretending there are no data pointing to the demise of the middle class. The burden of proof is on you, amigo. Define middle class and post-up some unambiguous proof that folks in that arbitrary statistical category are disappearing because their total income - wages, benefits, tax-credits, transfers-in-kind, etc are actually decreasing in real terms.

probably why the first graph is put in terms of 2007 dollars? Just an addendum to note that the term "real" (lower plot) = inflation adjusted whether the subject is dollars, interest rates, etc.

I'd still say the overall package is reasonable. That said - there has been an increased tax burden over the past 25 years on the individual vs. the corporate entity. Combine this with the restrictions placed on state and local governments regarding Tim Eyman's wako-ness and there is little wiggle room. The idea that there is some bloated bureaucracy living off the public dole is baseless. Spend any time with federal, state, or local employees these days and you will quickly understand what they are up against. They are stuck in a difficult place - and floating bond measures, as unpalatable as it is during a recession, seems to be the only choice. Unless of course you don't mind 50 kids per classroom, parks closed, and services curtailed. It's a big hole and one that has been dug over a couple decades. Foreign adventures, unprescedented flow of capital to the upper class, and reducing of corporate taxes - that's were our money has gone. Have you looked at the trends for public sector vs private sector job-growth for the past 40 years (e.g the ratio of goverment employees to private sector employees)? Do you really think that the stats will bear out the claim that we spend fewer inflation-adjusted dollars per capita on government services than we used to, or that the ratio of government employees to private sector employees has decreased over the long run? Once again, the first thing that happens in a budget crisis is talk of socking it to the most vulnerable parts of society, and no mention of making any structural adjustments to compensation schemes for public sector employees.

IMO "airless utopian calculus of the cocktail napkin" is much a much more apt description of the mainstream, highly formal Kenneth Arrow, Paul Saumuelson crew than folks in the Menger-Mises-Hayek camp, but I wouldn't expect you to know that. That's not intended to be a slight - it's just not something you'd know or appreciate unless it happened to be a hobby of yours. Just google "Samuelson - Revealed Preference Model" if your actually harboring any doubts about which camp is more enamored of utopian calculi. The Chicago school sits somewhere between the two. I think we've covered the deregulation bit before and I don't think you can make a credible claim that any of the deregulation that transpired under Ford-Carter-Reagan had a material effect on the present crisis, unless you think that allowing truckers, airlines, and oil companies to set their own prices, or the changes in the telecom market had a material effect on the present crisis. The only bit of de-regulation that you could reasonably implicate in the crisis is the repeal of Glass-Steagal, and the decision not to have credit-default swaps traded on an exchange. If you take a look at the rent/mortgage, mortgage/income, etc, etc stats all over the world you see even greater price inflation in countries that didn't make major regulatory changes between 1998 and 2005 so it'd be hard to make a case that the repeal of Glass-Steagal in the US is sufficient to explain the global property bubble and subsequent collapse. I also think that we've covered the said crisis before. My conclusion is that the Austrian explanation - interest rate distortions by a central bank leading to an unsustainable credit expansion leading to colossal malinvestment in credit sensitive sectors which eventually implode - is way closer to the mark than anything that the Keynsians have to offer. All of the other political distortions that generated a massive overallocation of capital into housing - FNMA/GNMA, CLA, mortgage interest deduction, capital gains exemption, property tax exemption - etc just got us where we were going faster. I'm not terribly concerned about the long-term trajectory of "neoliberalism," since the alternatives will inevitably fare worse.

Debatable. I'd say the impact on political discourse has been far more profound than it's impact on policy, which has remained a mercantilist-keynsian ghoulash. Just take a look at the latest farm-bill, or better yet - the federal budget for a concrete demonstration of that fact. Not terribly surprising when you consider the political economy of the two systems. Any system that gives its blessing to dispensing vast amounts of debt and inflation fueled patronage is going to enjoy certain structural advantages in Washington. In academic econ circles the highly formal Arrow-Samuelson approach has been dominant for the past 60 years, and folks in the Austrian school have very much been outsiders. Since the characters are attending an econ conference, this portrayal is both accurate and fair IMO. When you ponder what the likes of Samuelson had to say about events that transpired outside the boundaries of his "general equilibrium" models - such as this gem from his 1989 econ textbook "The Soviet economy is proof that, contrary to what many skeptics had earlier believed, a socialist command economy can function and thrive." - that's truly remarkable.

Ahh - stimulus spending. Time for the Keynes vs Hayek Rap Battle... [video:youtube]whGlF-hjCaI

How do you define middle-class, and what data set confirms that it's disappearing? Most of the data that I've seen tells a different story depending on the statistical categories that the analyst chooses. "Households" seem to be a favorite despite the fact that the composition of the average household has changed significantly over the interval being considered, a household for demographic group A isn't the same as an average household for group B, the quintiles being compared don't contain the same number of people, the composition of the average income (money-wages vs benefits vs subsidies vs tax credits etc) differs between groups and quintiles, etc, etc, etc, etc, etc, etc. Below for example, you've got the same data, parsed with different statistical categories. Agree with your sentiments about the current national hardships vs the depression though.