tag:blogger.com,1999:blog-2499715909956774229.post8503686063584404535..comments2024-03-22T22:37:02.639-07:00Comments on Stephen Williamson: New Monetarist Economics: Fiscal PolicyStephen Williamsonhttp://www.blogger.com/profile/01434465858419028592noreply@blogger.comBlogger53125tag:blogger.com,1999:blog-2499715909956774229.post-76700421931944537742011-05-20T09:11:26.713-07:002011-05-20T09:11:26.713-07:00http://www.guardian.co.uk/society/2011/may/19/nhs-...http://www.guardian.co.uk/society/2011/may/19/nhs-hospital-waiting-times-longer<br /><br />"NHS budget squeeze to blame for longer waiting times, say doctors<br /><br />Latest performance data reveal number of English patients waiting more than 18 weeks has risen by 26% in last year"<br /><br />that's the British experience.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2499715909956774229.post-31287451828697673102011-04-21T21:35:53.980-07:002011-04-21T21:35:53.980-07:00Chris: I'll see what I can do about that tone....Chris: I'll see what I can do about that tone.Phil Rothmanhttp://personal.ecu.edu/rothmanp/rothman.htmnoreply@blogger.comtag:blogger.com,1999:blog-2499715909956774229.post-90461218292137851742011-04-21T19:54:25.864-07:002011-04-21T19:54:25.864-07:00Phil,
Sorry, I didn't see your response to St...Phil,<br /><br />Sorry, I didn't see your response to Steve before I wrote my own similar comment. <br /><br />BTW, Phil, I agree with almost everything that you have written but I object to the measured, reasoned tone. I prefer a more fevered, wild-eyed approach.Chris-the-regression-runnerhttp://nowhere.comnoreply@blogger.comtag:blogger.com,1999:blog-2499715909956774229.post-89621208386176295312011-04-21T19:51:43.649-07:002011-04-21T19:51:43.649-07:00"The key point is that, when your life is on ..."The key point is that, when your life is on the line, any individual is going to want to spend infinite amounts to stay alive,..."<br /><br />Certainly an exageration if the money is yours and you have a bequest motive. <br /><br />"...but for society the cost of keeping you alive may just be too large."<br /><br />Which is exactly why people should be spending their own money and making their own decisions. I include privately contracted insurance payments in "their own money."<br /><br />Let govt pay for basic services for the poor and mandate high-deductible, catastropic policies for everyone else.Chris-the-regression-runnerhttp://nowhere.comnoreply@blogger.comtag:blogger.com,1999:blog-2499715909956774229.post-81371222416106972962011-04-21T19:46:48.726-07:002011-04-21T19:46:48.726-07:00"That's the story in the NYT."
I ha..."That's the story in the NYT."<br /><br />I have to meet you halfway on that one. The Times is not known for veracity. On the other hand, their politics would tend to push the story the other way, if anything. <br /><br />"...the resources didn't come out of thin air."<br /><br />Steve, if you buy a fancy BMW next week, does it make me any poorer?Chris-the-regression-runnerhttp://nothere.comnoreply@blogger.comtag:blogger.com,1999:blog-2499715909956774229.post-76852236581016649572011-04-21T16:14:02.402-07:002011-04-21T16:14:02.402-07:00Stephen:
Perhaps it's simply a stylistic choi...Stephen:<br /><br />Perhaps it's simply a stylistic choice in writing, but I think it's an exaggeration to say that, "when your life is on the line, any individual is going to want to spend infinite amounts to stay alive," since millions gracefully acknowledge and accept their highly likely path to a soon-to-arrive death each year. Indeed, that's part of the foundation of the hospice movement.<br /><br />Still, there are lots of very tough choices to make. Economists can help out in the discussion by clearly characterizing the opportunity costs.Phil Rothmanhttp://personal.ecu.edu/rothmanp/rothman.htmnoreply@blogger.comtag:blogger.com,1999:blog-2499715909956774229.post-79858609535124934392011-04-21T15:33:36.964-07:002011-04-21T15:33:36.964-07:00Chris,
That's the story in the NYT. We don...Chris,<br /><br />That's the story in the NYT. We don't know all the details. The hospital of course is going to say it was a good idea, and the resources didn't come out of thin air. The key point is that, when your life is on the line, any individual is going to want to spend infinite amounts to stay alive, but for society the cost of keeping you alive may just be too large. It's a tough thing, but that's reality.Stephen Williamsonhttps://www.blogger.com/profile/01434465858419028592noreply@blogger.comtag:blogger.com,1999:blog-2499715909956774229.post-36059169991783156262011-04-21T14:36:34.625-07:002011-04-21T14:36:34.625-07:00Steve,
Easy call: The government should not gene...Steve, <br /><br />Easy call: The government should not generally decide what kind of treatment that you get. <br /><br />With respect to "wrongheaded", perhaps you missed this part: "St. Louis doctors said the procedure provides Joseph with increased mobility and comfort while providing a more stable airway. It protects his lungs from inhaled saliva or other material that could cause aspiration pneumonia."<br /><br />As far as "costly" goes, it isn't my money. I applaud Cardinal Glennon if it wants to give away care.Chris-the-regression-runnerhttp://greatmidwest.usa.comnoreply@blogger.comtag:blogger.com,1999:blog-2499715909956774229.post-76041916932047088812011-04-21T13:24:22.053-07:002011-04-21T13:24:22.053-07:00On the NYT story: Is that some horror story about ...On the NYT story: Is that some horror story about Canadian health care, or is it a story that tells you that if you want some kind of treatment in the United States, wrongheaded or not, extremely costly or not, you can get it?Stephen Williamsonhttps://www.blogger.com/profile/01434465858419028592noreply@blogger.comtag:blogger.com,1999:blog-2499715909956774229.post-16403434385667067602011-04-21T10:05:08.799-07:002011-04-21T10:05:08.799-07:00Stephen:
Paul Starr's "The Social Transf...Stephen:<br /><br />Paul Starr's "The Social Transformation of American Medicine" gives a good account of how path dependence played out in the US health care market; the roles of WWII price controls and the 1954 IRS decision to treat employer-paid health insurance premiums as tax-free income were non-trivial.<br /><br />Pieces like this, from today's issue of the US's newspaper of record, would not help Obama's hypothetical case in referring to the provision of health care in Canada:<br /><br /> http://www.nytimes.com/aponline/2011/04/21/us/AP-US-Canadian-Boy-End-of-Life-Dispute.html?ref=usPhil Rothmanhttp://personal.ecu.edu/rothmanp/rothman.htmnoreply@blogger.comtag:blogger.com,1999:blog-2499715909956774229.post-62030843844244760052011-04-21T06:38:38.560-07:002011-04-21T06:38:38.560-07:00Yes, the Swiss system is an alternative model that...Yes, the Swiss system is an alternative model that seems to work well. Some people think there is path-dependence in how these different countries adopted these things, with a good degree of randomness along the way. Why did the US adopt government-provided health insurance only for old people and veterans, and not make it universal? Why did the Swiss go with private insurers instead of a single-payer system?<br /><br />As you say, no one is going to go wild if told the truth about what it takes to control the monster. As you say, it seems impossible politically to take the US to a Swiss, French, or Canadian system, for example. Wealthy people with good insurance will at least think they are losing a lot, though my perception is that the loss is actually marginal, and that they would more than make up for it indirectly with the freeing-up of resources. It's like free trade, where you never see the benefits directly.Stephen Williamsonhttps://www.blogger.com/profile/01434465858419028592noreply@blogger.comtag:blogger.com,1999:blog-2499715909956774229.post-1729614513948702952011-04-20T23:25:25.469-07:002011-04-20T23:25:25.469-07:00Steve:
Perhaps your proposed speech for Obama sho...Steve:<br /><br />Perhaps your proposed speech for Obama should be amended to include: "Yes, you'll have to wait, say, 6 months before seeing the specialist you can now see within 1 or 2 days. But you won't die!" It's hard to picture the crowds going wild with that last line.<br /><br />The connection between health insurance and employment in the US is both a serious source of inefficiency and morally suspect. I think the Swiss health insurance system is the way to go (though they also free-ride off of US medical research). Politically, an 'impossibility theorem' preventing the US from ever getting there is probably operative.Phil Rothmanhttp://personal.ecu.edu/rothmanp/rothman.htmnoreply@blogger.comtag:blogger.com,1999:blog-2499715909956774229.post-58896412065177184812011-04-20T14:21:21.654-07:002011-04-20T14:21:21.654-07:00Steve,
My view of the UK system (based on experi...Steve, <br /><br />My view of the UK system (based on experience there) is similar to your view of Canada. I'd add that in the UK, it seemed very hard to see a specialist, i.e. there seemed to be some deliberate rationing of care by family doctors. In the US, by contrast, seeing a specialist involves nothing more than asking the doctor, and appointments are available very quickly. <br /><br />Anon @ 518Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2499715909956774229.post-12202953142500936532011-04-20T07:15:21.182-07:002011-04-20T07:15:21.182-07:00Phil, Chris,
I have plenty of personal experience...Phil, Chris,<br /><br />I have plenty of personal experience with both the Canadian and American health systems, as I have lived in both places. Though I am generally healthy, I have had close and extended family who have made intense use of health care in both countries.<br /><br />Canada: (i) up side: dealing with the bureaucracy is easy. Routine treatment gets done quickly and efficiently, and you never have to deal with some bureaucrat to settle a claim. Everyone has access to a minimum level of care. It burns up far fewer resources. There's less physical capital, but as far as I can tell the human capital is as high-quality as in the US system. (ii) Down side: You may have to wait for non-life-threatening care. Your buddy's back was killing him for 8 months, but he did not actually die, and eventually he got treated. My brother had to wait 6 months to get his knee fixed, but he didn't die, and it got fixed well.<br /><br />US system: (i) Up side: If you are in a good pool, like mine, it's not that expensive, and the level of care is excellent. (ii) Down side: Health insurance is tied to employment, which reduces labor mobility. Suppose you are self-employed, and say you have something like bipolar disorder. Now you are uninsurable. We also have a shortage of doctors. When I came to St. Louis, I would not be able to see a family doctor on demand until I had an initial appointment, but I could not set up my initial appointment for less than 4 months in the future. I have spent hours on the phone with insurers settling claims. What a pain in the butt. Another thing: too much testing, too much treatment.Stephen Williamsonhttps://www.blogger.com/profile/01434465858419028592noreply@blogger.comtag:blogger.com,1999:blog-2499715909956774229.post-40072133888192396182011-04-20T06:26:49.628-07:002011-04-20T06:26:49.628-07:00Chris,
Other people have had this problem. If it&...Chris,<br /><br />Other people have had this problem. If it's too long, in fact the blog will eat it. It's what the Google software does. I'll look and see if I have some control, but I may not.Stephen Williamsonhttps://www.blogger.com/profile/01434465858419028592noreply@blogger.comtag:blogger.com,1999:blog-2499715909956774229.post-30747648041613627142011-04-19T20:37:41.086-07:002011-04-19T20:37:41.086-07:00"On the issue of "access to medical spec..."On the issue of "access to medical specialists" in Canada, that's certainly true, but that's how you gain control of costs. There has to be serious gatekeeping, with someone saying "no" at various stages in the process."<br /><br />I think that this argument ignores the significant costs of non-price rationing. How about introducing some serious market-based rationing measures, like actual price competition and letting people internalize the marginal cost of their care?Chris-the-regression-runnerhttp://hospital.comnoreply@blogger.comtag:blogger.com,1999:blog-2499715909956774229.post-33640815778754808972011-04-19T20:34:41.990-07:002011-04-19T20:34:41.990-07:00" it's not clear how much of what is spen..." it's not clear how much of what is spent in the United States on so-called innovation, is actually socially useful."<br /><br />This argument is not consistent with the dominance of US-based researchers in winning Nobel prizes in medicine. After the 1950s, the US has a grossly disproportionate number of Nobels in medicine. <br /><br />http://www.u-s-history.com/pages/h2007.htmlChris-the-regression-runnerhttp://hospital.comnoreply@blogger.comtag:blogger.com,1999:blog-2499715909956774229.post-56866436433168554392011-04-19T19:52:46.144-07:002011-04-19T19:52:46.144-07:00Some studies which provide analysis of the economi...Some studies which provide analysis of the economic benefits of medical/pharmaceutical research: <br /><br /> http://www.nber.org/papers/w11405<br /><br /> http://www.maxwell.syr.edu/uploadedFiles/cpr/publications/pb27.pdf<br /><br /> http://content.healthaffairs.org/content/26/1/97.abstract<br /><br />But however high these benefits are, satisfying the US intertemporal government budget constraint in a sane and smooth manner is unlikely to be an easy political act.<br /><br />On outcomes in the Canadian health care system, there are plenty of anecdotes from which we can draw with lots of sample selection bias. A personal one includes a friend in Calgary who waited 8 months to be treated by a specialist for very nasty back pain. In the backwaters of Greenville, NC (where I live), he would have been seen by an orthopedist within a couple days (conditional on having health insurance of the sort that roughly 90% of people in the US legally have).Phil Rothmanhttp://personal.ecu.edu/rothmanp/rothman.htmnoreply@blogger.comtag:blogger.com,1999:blog-2499715909956774229.post-78662800725125536222011-04-19T19:39:30.885-07:002011-04-19T19:39:30.885-07:00Steve, tell me that you didn't zap my comment....Steve, tell me that you didn't zap my comment. <br /><br />Tell me that the blog ate it.Chris-the-regression-runnerhttp://hospital.comnoreply@blogger.comtag:blogger.com,1999:blog-2499715909956774229.post-9362815468984020512011-04-19T15:13:31.211-07:002011-04-19T15:13:31.211-07:00Yes, all good points. There is an issue in general...Yes, all good points. There is an issue in general of free riding, by the Canadians in particular. You could argue that they get away with low defense spending and low expenditures on private R and D in general by free riding on the United States. However, on the medical "innovations," it's not clear how much of what is spent in the United States on so-called innovation, is actually socially useful. How much progress has been made on curing cancer, given the resources put into it? Some of the innovation in terms of introduction of "new" drugs is just tweaking the molecular structure slightly to get an extension of patent protection. There certainly is a brain drain of medical professionals from Canada to the US, particularly in the specialties. Being an anesthesiologist is much more lucrative in the US. You could say, though, that this is in part driven by some of the inflated prices I was talking about. On the issue of "access to medical specialists" in Canada, that's certainly true, but that's how you gain control of costs. There has to be serious gatekeeping, with someone saying "no" at various stages in the process. Actually my relatives have no problem with this. My brothers have had their bad knees fixed, and fixed well, with no problems, for example.Stephen Williamsonhttps://www.blogger.com/profile/01434465858419028592noreply@blogger.comtag:blogger.com,1999:blog-2499715909956774229.post-89750570615166709112011-04-19T14:57:54.468-07:002011-04-19T14:57:54.468-07:00This comment from Phil Rothman:
We're also fa...This comment from Phil Rothman:<br /><br />We're also far away from my area of expertise. But some stylized facts about the economic welfare of Mexican Americans, a quantitatively important component of the Hispanic demographic group in the US, can be found at:<br /><br /> http://www.ppic.org/content/pubs/rb/RB_502JGRB.pdf <br /><br />But returning to the "juxtaposition" you mentioned, I was wondering: aren't those who are surprised by it familiar with, e.g., the level of safety and security found in some of the banlieues east of Paris (e.g., Clichy-sous-Bois) and various council estates in the UK? <br /><br />Also, in your main blog post you wrote, "Obama could have said: 'You wusses! Canadians have universal health care, insure their unfortunate generously, and they are fiscally responsible to boot! Do you hear them whining about it?'" It's possible he chose not to because, if he had, some reasonable (non-rabid non-Fox News) commentators might have respectfully pointed out that: (1) Canadians and the rest of our wealthy allies whose societies provide relatively high levels of social insurance serially free-ride off US taxpayers/consumers by way of funding for medical research; (2) access to medical specialists, past the general practitioner gateway, is considerably restricted (perhaps optimally so, but nonetheless far more restricted) in Canada versus the US; and (3) concerning "whining," evidence suggests that a good number of Canadian health professionals have expressed their views by voting with their feet: <br /><br /> http://www.statcan.gc.ca/pub/11-008-x/2010002/article/11287-eng.htm <br /><br />Raising points such as these in response to the statement you proposed Obama make would not imply the absence of serious problems in the overall US health care system.Stephen Williamsonhttps://www.blogger.com/profile/01434465858419028592noreply@blogger.comtag:blogger.com,1999:blog-2499715909956774229.post-38412048700683971652011-04-19T09:56:06.325-07:002011-04-19T09:56:06.325-07:00Second last anonymous,
Yes, don't forget abou...Second last anonymous,<br /><br />Yes, don't forget about the interest payments. We are doing nicely with that right now, but I think we'll be out of the low-interest-rate period soon.<br /><br />Wonks anonymous,<br /><br />Yes, those other countries could certainly have got it wrong. There is more migration out of Canada to the US than going the other way, though maybe that's not the case recently. However, take an example. If you were allowed to create a universal health care system from the ground up in the United States, and did not have to worry about all the political obstacles to getting it put together, I think you could have a system with excellent incentives that would be highly-efficient and would free up an enormous quantity of resources that would make us all richer. What was passed is essentially just redistribution. It does little to increase efficiency and will provide health care for the poor at the expense of the rich, which I guess is what the rich are complaining about.Stephen Williamsonhttps://www.blogger.com/profile/01434465858419028592noreply@blogger.comtag:blogger.com,1999:blog-2499715909956774229.post-20015922957970700572011-04-19T08:20:09.294-07:002011-04-19T08:20:09.294-07:00Why does the U.S have to be like all those other c...Why does the U.S have to be like all those other countries? Someone who wants a system like Canada's can always threaten to move to Canada (as was the case in the Bush years). Where do those who don't want it have to go if the U.S adopts that kind of system?<br /><br />"Anyone have evidence on this?"<br />There's a book, "Generations of Exclusion", written by a pair of (gasp!) sociologistsWonks Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2499715909956774229.post-39330634431225007622011-04-19T07:06:12.049-07:002011-04-19T07:06:12.049-07:00"Over many decades health care inflation will..."Over many decades health care inflation will have to be slowed to no more than wage growth"<br /><br />Richard, the US does not have "many decades". It does not even have a single decade. Using CBO figures, by 2025, tax revenue will be entirely consumed by entitlements and interest payments alone.<br /><br />[from Anon @ 518]Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2499715909956774229.post-15052698965414576902011-04-19T06:55:50.858-07:002011-04-19T06:55:50.858-07:00Phil,
We're getting far outside the area of m...Phil,<br /><br />We're getting far outside the area of my expertise, but casual empiricism suggests that the Hispanic population in the US and the African American population behave in observably different ways, and that the former tend to be more upwardly mobile. Anyone have evidence on this?<br /><br />David,<br /><br />There is always friction associated with immigration. Some of these things eventually calm down (more or less), as with the Irish and Jewish immigrants to the US. Problems arise when some people are seen as having no right to be here, or when they were brought here against their will, or when some immigrants are treated differently in a legal sense (as in Europe).Stephen Williamsonhttps://www.blogger.com/profile/01434465858419028592noreply@blogger.com