1000 Word Rebuttal

by on January 25, 2007 at 7:25 am in Economics, Medicine | Permalink

Paul Krugman:

The tax code, [Bush] said, “unwisely encourages workers
to choose overly expensive, gold-plated plans. The result is that insurance
premiums rise, and many Americans cannot afford the coverage they need.”

Again, wow. No economic analysis I’m aware of says that when Peter chooses a
good health plan, he raises Paul’s premiums.

Rebuttal:

Subsidy

1 Aaron January 25, 2007 at 8:49 am

BUUURRRRN!

Tou-frickin-che’

2 Student January 25, 2007 at 9:29 am

I don’t think this counts as a burn. Krugman already clarified that he was assuming that the long-run supply curve would be flat (therefore, no externality). In fact, Krugman’s clarification is included on THE EXACT SAME blog that Alex is quoting (economist’s view).

http://economistsview.typepad.com/economistsview/2007/01/what_pecuniary_.html

I seriously hope Alex had just over looked this post and isn’t just looking for a new way to burn Krugman for holding slightly less libertarian views than him.

3 Taggert J. Brooks January 25, 2007 at 9:34 am

I’m glad I wasn’t the only one who caught this glaring misrepresentation. Unfortunately Krugman continues down the path towards disingenuous political hack.

4 DK January 25, 2007 at 9:39 am

I just can’t get past the fact that a government official is deciding that some plans are “overly expensive”. Especially when state and federal governments mandate minimum requirements for plans including generous mental health benefits, chiropractors, etc., and the requirement to practice defensive medicine that the courts effectively impose. Do the tax incentives make a bigger difference than government mandates?

5 Jason January 25, 2007 at 10:15 am

Krugman clarifies: “Aha – I was wondering if anyone would raise that. I was taking it as true to a pretty good approximation that the long-run supply curve for medical services is horizontal. Unless you think that there’s permanently limited supply of medical education, or something, why should we think otherwise?” < http://economistsview.typepad.com/economistsview/2007/01/what_pecuniary_.html>

Hmm. I thought the usual assumption was that supply curves slope up somewhat. I’m probably just confused.

Krugman is saying that in the long run, there’s no scarcity of doctors, nurses, hospital rooms, etc. That’s counterintuitive to me. I thought potential doctors were rare.

6 Keith January 25, 2007 at 10:28 am

I was thinking a bit more about this. If Krugman belies the long-run supply of health care is perfectly elastic, then isn’t he therefore predicting a pretty steep decline (or at least leveling off) of health care costs in the medium term, given the steep recent rise in health care costs we’ve seen recently?

After all, if the long-run supply curve is perfectly elastic, then prices shouldn’t rise over the long run…

7 Boonton January 25, 2007 at 10:40 am

I think ‘gold plated’ here simply means expensive as in more than $15,000 a year. But how do you know how expensive your plan is unless your employer shares with you his cost as well as yours or if you’re buying it yourself?

Anyway, here’s a point for Krugman…. If insurance companies have two products…gold plated and standard why wouldn’t the subsidy for ‘gold plated’ simply serve to push up the price of gold plated plans? If the gov’t subsidizes Paul’s shopping at Nordstrom I’m not sure why that would cause Wal-Mart’s prices to go up….they may in fact go down!

8 John Thacker January 25, 2007 at 11:09 am

Boonton says:
If the gov’t subsidizes Paul’s shopping at Nordstrom I’m not sure why that would cause Wal-Mart’s prices to go up….they may in fact go down!

Ah, but don’t many of the people who believe in a crisis in health care think that it’s much more difficult for consumers to know the difference in price and quality among different health care choices than it is to know the difference between Nordstrom and Wal-Mart?

Sure it’s possible that hospitals will somehow charge higher prices to only people with good insurance plans. I think, however, that in reality we actually see the opposite– insurers seem to use their market power to negotiate lower prices than those charged for people without insurance, by using the threat of diverting the patients’ business elsewhere.

There are more complicated arguments that overconsumption of expensive experimental medicine will lead to greater research and in the long run benefit. I’m not sure why we necessarily want to subsidize the wealthy in doing that, though.

I’m always a little surprised when people seem to argue that subsidies cause higher prices and overconsumption in one area, say Medicare prescription drug benefits, and deny it that it’s even possible in another, such as health insurance or college tuition costs. I can understand arguments that the long term supply curve is flat and all, though that would seem to argue against a long term crisis.

9 Josh January 25, 2007 at 11:37 am

People who have insurance through their employer pay smaller premiums due to the nature of underwriting a policy that spreads the risk over more people. Also, health insurance premiums paid through an employer, regardless of the cost, are paid prior to any payroll or income taxes. People with private policies can only deduct insurance premiums in extreme circumstances on their taxes at the end of the year.

He views the best route to resolving this discrepancy as subsidizing everyone with a standard deduction from our taxable income.

Is this the advantage that he wants to level between the those who pay for insurance through an employer and those who buy private policies?

Thanks for the clarification.

10 eriks January 25, 2007 at 12:28 pm

Perhaps Krugman believes that rising health costs are due to an upward shift of the horizontal supply curve rather than a movement along the curve. Keith, would this explain Krugman’s reasoning better? I’m pretty new to the economics of health-care and to this particular argument but the curve shift makes sense to me.

11 Keith January 25, 2007 at 12:54 pm

“Perhaps Krugman believes that rising health costs are due to an upward shift of the horizontal supply curve rather than a movement along the curve. Keith, would this explain Krugman’s reasoning better? I’m pretty new to the economics of health-care and to this particular argument but the curve shift makes sense to me.”

And these upward shifts (a decrease in health care supply) would be from…? You actually need an event that decreases the overall supply of health care to actually shift the supply curve like that…does Krugman believe that a sudden illness will disproprtionately kill doctors, that computer viruses or electrical failures will destroy medical equipment?

Nope, it looks like Krugman has either predicted a future drop (or at least leveling off) of future health care costs thanks to shifting short-run supply curves along the horizontal long-run supply curve, or he made an erroneous argument in order to defend a flaw in his initial reasoning.

Krugman’s only argument left: He really believe health care outsourcing will take off and that we will pass legislation that will allow health insurance companies and organizations to do business across state lines, which will then lower (level off) heal;th care costs. In this model, short-term political pressures are endogenous, so that when health care costs get high enough, politicians then undo restrictions that made the supply curve inelastic.

12 Tom January 25, 2007 at 1:16 pm

Many problems with Alex’s post. First, the graph goes too far in assuming that the supply of medical care is perfectly inelastic (though i think it’s also a stretch to assume that it’s perfectly elastic over time). It’s way over-simplistic to represent either the supply or the demand of ‘medical services’ as a unitary thing – so from a functional standpoint of representing something about the real world, it’s meaningless.

It’s also missing the point to depict a tax subsidy to the purchase of group insurance as if its a subsidy to the purchase of medical care per se. Insurance ‘subsidizes’ the purchase of medical care in two fundamental ways: by annuitizing or amortizing the cost of medical care that the insured population will consume over their lifetimes; and by making it possible for insurers, representing groups of consumers, to negotiate for lower prices. Both of those advantages are subject to very strong economies of scale and scope, with the result that for any given population, group insurance is always more efficient (lower total cost per person) than individual insurance, and is always more efficient for larger groups than for smaller groups. (There are also, in theory, some economies of scale in payment processing and so forth; and managed care advocates would say that insurance can improve the quality of information and care to boot. But I think those are speculative and marginal benefits, so ignoring them for this purpose.) So before we join Alex in laughing off Krugman’s argument, let’s remember what it is that the President has suggested, that Krugman is rightly critiquing: reducing the tax subsidy for employer-provided group insurance, and using the proceeds to provide a new subsidy to individual insurance. Right off the top, that implies using our tax system to subsidize a less efficient type of health insurance, at the expense of a more efficient type. That’s a deadweight loss, one that Alex might want to consider representing somewhere on his tidy little graph.

But i understand Alex is making a theoretical point, not a quantitative one, so let’s look at it that way. If we subsidize one person’s consumption of a scarce good, we can end up driving up the price of that good for everyone else – fair enough. If nobody had comprehensive insurance – i.e. if everyone had to pay for medical care out of pocket – then we could expect the prices of a lot of medical services to come down. The mechanism by which that would happen would be a reduction in consumption – probably a pretty drastic one. Over time, medical care in general being a high-fixed-cost type of good, the supply curve would most likely shift to the left, which would depress consumption even further, up to the point that some new equilibrium would be achieved. In the meantime, we as a society would have to deal with all of the externalities to a fall-off in the use of medical care that don’t make it into Alex’s graph: more undiagnosed chronic conditions that spiral into acute health crises, more people courting bankruptcy based on medical bills, more people foregoing even necessary care because they don’t have the money, fewer medical providers and fewer choices of treatment (because there won’t be sufficient buying power out there to support very many specialists), fewer medical advances (because why invest in a market where demand is drying up) … all of the things that were characteristic of health care in the US before the dawn of group health care in the 40s – 50s & Medicare/medicaid in the 60s-70s.

Alex seems to be a smart guy, but this is a dumb, cheap-shot post. It’s the kind of argument that somebody would make if they dropped Econ 101 halfway through the semester: taking the most rudimentary of economic analysis tools and treating it like it holds the answers to everything.

13 Keith January 25, 2007 at 1:39 pm

“First, the graph goes too far in assuming that the supply of medical care is perfectly inelastic”

No it doesn’t. Perfectly inelastic would be if the curve is vertical. Since the curve is linear, I’d need to know the price and quantity to tell you if that’s the elastic or inelastic part of the curve, but even a rudimentary familiarity with Econ 101 would tell you that the curve is not perfectly inelastic.

And Krugman did not make the defensible claim that Econ 101 may not be a complete paradigm for health care economics. Krugman made the indefensible claim that no such analysis of subsidy increasing price existed. In addition, by arguing that he believes the long-run supply curve is horizontal, Krugman himself used Econ 101 tools to defend his argument.

Let me say, I believe, contra Econ 101, that subsidies COULD decrease long-run prices, if we subsidized certain preventive care. I believe that because I believe people get disutility from visiting the doctor, and so don’t visit until something’s a bigger problem, which causes negative pecuniary externalities. But we do not subsidize preventive care now; we subsidize other types of care.

14 eriks January 25, 2007 at 1:47 pm

Keith, I am aware that something must cause a curve shift. However, I don’t think that it has to be “an event”; instead I believe it could be the introduction of new technology (rather than destroying technology) and drugs that could cause the upward shift. From what I’ve read MRI machines are costly upfront and to maintain and this is a relatively common machine known by most of the population. Most esoteric machinery is surely out there and more will come with similar costs.

15 Nathan January 25, 2007 at 1:50 pm

So Paul Krugman is talking about the long term equilibrium and you throw up a diagram that’s valid for the short term. Not to say Krugman’s right, but you haven’t shown he’s wrong.

16 Steve Miller January 25, 2007 at 2:12 pm

Andrew Samwick said:

“One could point out that if he was ‘wondering whether anyone would raise this point,’ then he seems to realize that he was going a bit overboard in claiming that ‘no economic analysis I’m aware of says that when Peter chooses a good health plan, he raises Paul’s premiums.'”

That’s a generous understatement. Krugman took a running jump overboard. We have the unusal case where long-run supply of a product is perfectly elastic, which is a strange assumption since medical care comes from relatively scarce human talents and capital goods, and has high barriers to entry to boot. Yet any analysis that does not accept this strange assumption of horizontal supply falls under “no economic analysis [Krugman is] aware of.”

Sorry, but Krugman’s explanation doesn’t make his original claim any less preposterous, and it’s a rather weak explanation anyway. Alex’s post wasn’t dumb, and it wasn’t a cheap shot. It was just an amazingly easy shot, because Krugman said something so plainly stupid in the first place.

17 BillWallace January 25, 2007 at 2:27 pm

Who thinks their health plan is gold-plated? I do. I’d buy catastrophic insurance only if it weren’t for the fact that my employer is picking up almost all of the cost. I do know what my employer is paying for it, and it’s ridiculous. I would be ecstatic to take half of it as extra salary.

18 Ragerz January 25, 2007 at 3:50 pm

Alex is just trying score points, rather than actually address what Krugman is saying. It hurts your credibility, not his.

Krugman did not say: “No economic theory I am aware of…”

He did say: “No economic analysis I am aware of…”

That is, no economic analysis, that Krugman is aware of, shows the long-run supply curve in this context is other than flat or mostly flat.

Theory versus analysis. Pie in the sky, versus real world. Assumption versus empirical analysis. Guess what, Krugman is more interested in the real world than theory laden with false assumptions when discussing health care. Shouldn’t you be?

19 Ragerz January 25, 2007 at 4:09 pm

We should also, for the sake of avoiding more ridiculousness from those looking to bash rather than engage with Krugman, modify Krugman’s words with a few modifiers that he surely implicitly meant.

He wrote: “No economic analysis I am aware of [demonstrates that supply-curve in this context is other than flat or mostly flat]”

He meant: “No serious and reliable economic analysis I am aware of [demonstrates that supply curve in this context is other than flat or mostly flat].”

So, if Alex or any of your commentators want to produce some serious and reliable economic analysis that demonstrates (not merely assumes) that the supply curve in this context is other than flat or mostly flat, that would be great. Then Paul Krugman could become aware of such analysis.

If you don’t do that, then you lose. And Alex loses no matter what, because he cannot demonstrate that Paul Krugman was aware of any solid economic analysis that demonstrates (not merely assumes) that the supply curve if other than flat or mostly flat.

Alex writes:

“Krugman is surely aware of this analysis!”

You say analysis. I say theory. But anyway, since you are so confident that Krugman is aware of this so-called “analysis”, don’t you think it is best to consider alternative interpretations of what Krugman is saying, before adopting the most absurd interpretation? Or, are you just going to go straight for the interpretation that implies that Krugman is a liar, that he is aware of this so-called “analysis”, but intentionally deceives his readers, even when other perfectly reasonable interpretations are available? (Being aware of economic analysis that demonstrates X, but saying you aren’t aware of such analysis = lying.)

Would you have others interpret you as a liar when other reasonable interpretations are available?

(Finally, it should be noted that Krugman is under heavy space constraints in writing his column. He doesn’t have time to go on about theory versus empirical analysis in his column.)

20 Ragerz January 25, 2007 at 4:20 pm

Steve Miller writes:

That’s a generous understatement. Krugman took a running jump overboard. We have the unusal case where long-run supply of a product is perfectly elastic, which is a strange assumption since medical care comes from relatively scarce human talents and capital goods, and has high barriers to entry to boot. Yet any analysis that does not accept this strange assumption of horizontal supply falls under “no economic analysis [Krugman is] aware of.”

Actually, I think that you are fundamentally confused. Krugman isn’t looking for analysis that assumes one thing or another. You assume it is sloping. I assume it is flat. But there is no serious and reliable economic analysis out there, that Paul Krugman is aware of, that demonstrates rather than merely assumes that long-run supply curve is other than flat or mostly flat.

Guess what your so-called “analysis” here does. It assumes that the supply curve is not flat. As such, Krugman would rightly not consider your analysis to be “serious and reliable economic analysis” on the question of whether the long-run supply curve if flat (or mostly flat) or not.

You are the one that just took a running jump overboard, by demonstrating your inability to come up with alternative interpretations rather than assuming an economist that is a serious candidate for a Nobel Prize in the future is a total moron.

So yes, Alex took a cheap shot. And so have you.

21 josh January 25, 2007 at 4:30 pm

Ragerz,

Alex applies an economic theory, hence Alex perfoms an analysis. It may not be your favorite analysis, but Alex is right in assuming Krugman would be aware of such an elementary analysis. He should have acknowledged that. Then he could claim that he’s convinced by analyses that lead him to believe long-run supply for medical care is flat.

22 Ragerz January 25, 2007 at 4:41 pm

It may not be your favorite analysis, but Alex is right in assuming Krugman would be aware of such an elementary analysis.

Whether it is my favorite analysis or not, it is entirely irrelevant to the real world unless the assumption behind it, that is, a long-run supply curve that is other than flat or mostly flat is correct.

You and Alex are absolutely right that Krugman is aware of this simplistic economic model that you put forth. What Krugman was getting at, is that he is aware of no serious and reliable economic analysis that demonstrates that this simplistic economic model is applicable in this particular context.

By the way, theoretical “analysis” that contains false assumptions and is thus inapplicable to the real world would not meet the “serious and reliable” test.

And no, if you are writing a NY Times column, you don’t go into “serious and reliable” or theory versus empirical analysis demonstrating the applicability of a theory to a particular context. Before you all willfully decide to misinterpret Krugman, maybe you should remember the limitations of the medium in which he is communicating, including severe word limitations and an audience of mainly non-economists.

23 eriks January 25, 2007 at 5:08 pm

Keith, I’m not sure what unit of health care you’re referring to. Perhaps you could explain.

24 Ragerz January 25, 2007 at 6:13 pm

Sebastian Holsclaw,

There are reasons to think that long-run supply in this context may be flat and that this industry may be partially what Brad DeLong calls a “constant-returns-to-scale industry.” Interesting, even if superficial, commentary on that issue can be found here. Whether the long-run supply curve is flat or or not is an empirical question. One thing is for sure. Paul Krugman knows of no serious and reliable economic analysis demonstrating that long-run supply is other than flat or near flat.

When it comes to the real world, proceeding by unreliable assumptions, like the one you are making here, is unacceptable. So, your gut feeling tells you that that constant-returns-to-scale industries just don’t exist? My gut feeling says the opposite.

Maybe, just maybe, we should try to resolve this issue with reference to the particulars of the industry in question and with reference to the real world rather than through conflicting “feelings” about what assumptions to make.

If you have any serious and reliable economic analysis to put forth, that discusses the long-run supply curve issue with less feelings about correct assumptions and more factual and industry specific analysis, I am very interested.

In the meantime, don’t insult Krugman, who is merely saying that he knows of no dispositive evidence resolving this issue. And perhaps implying that the burden should be on those who want to, in effect, reduce peoples’ healthcare to correct for pecuniar externalities. It is up to advocates that want to correct this particular pecuniar externality to prove that it exists before we change the status quo in a way that reduces people’s health coverage to correct for it.

So, bring on the industry specific analysis. Your assumptions just aren’t good enough.

25 ChristianCB January 25, 2007 at 6:47 pm

I’m new to all of this, but thinking back to what little I remember from math classes….

If the supply curve is flat, then demand could increase at an infinite rate and the price would never go up. How is that possible? Anyone?

26 Ragerz January 25, 2007 at 7:01 pm

Christian CB,

You have to distinguish between short-run supply and long-run supply.

In the long-run, increased entry, changes in technology and other dynamic effects can result in a flat long-run supply curve.

27 Steve Miller January 25, 2007 at 7:09 pm

Ragerz is doing a great job of making a fool of himself. It’s possible to defend the position that under certain circumstances a subsidy doesn’t lead to higher prices. But there’s no defense for pretending that Krugman believes the standard supply-and-demand tools have no relevance or are an unsuitable form of economic analysis. Krugman is not a denier of economics, and in fact his response used standard economic reasoning to explain his position. He simply said something silly and wrong, and he got called on it. It’s not the first time, and it won’t be the last.

28 Ragerz January 25, 2007 at 7:18 pm

CB Christian,

The supply of computers, in the long-run, might be flat.

Say there was a large increase in demand. This would increase the price of computers. This, in turn would lead to at least two effects. Existing computer makers would have more incentive to increase efficiency (i.e. technological changes) thus increasing supply. New entrants would an incentive to enter the industry. Also increasing supply.

If the increases in supply (shift in the supply curve) matched the increase in demand (shift in the demand curve) in the long-run, you would have a flat long-term supply curve.

29 ChristianCB January 25, 2007 at 7:27 pm

Thanks for answering again! Good stuff. So then, to get back on topic:

Nothing needs to be done to deal with the increasing costs of health care because in the long run the supply curve is flat? Should I not bother myself with issues dealing with flat supply curves, as the curve just moves with demand over time?

And if anything I just wrote is correct, why so much debate about what needs to be done if it will naturally be done?

Thanks again!

30 ChristianCB January 25, 2007 at 7:46 pm

I’m not trying to fool you with my little questions Ragerz, I’m just trying to get some basics down. 🙂 No harm from me, as I doubt I could hold my own yet with anyone on this blog. I’m willing to write what I think, and accept that I could be very wrong; in that case, I would hopefully get a pointer into the right direction towards what is right.

From what I’m seeing, from my very basic and simple eyes, is that supply, in the short run, isn’t very flat…No matter how much incentives suppliers have to increase the supply, it just can’t be done that fast, while on the other hand, the demand can shift wildly when buyers are subsidized. But, over the long run, the supply will catch up as the incentives are still there.

31 Keith January 25, 2007 at 7:49 pm

“There are reasons to think that long-run supply in this context may be flat and that this industry may be partially what Brad DeLong calls a “constant-returns-to-scale industry.””

If that’s the case, then there is no problem over the long run with rising health care costs. Any health care costs increases we’ve seen will be undone as the short-run supply curves shifts along the horizontal price path defined by the long-run supply curve.

Now, if Krugman is prepared to state that he believes health care costs will now fall, then he can credibly argue that he really believes that long run supply curves. But Krugman has given every indication that he believes health care costs will rise and will continue to rise. This is at odds with any belief that the LRS curve for health care is horizontal.

Krugman made a dumb statement. He tried to cover for it with a statement that relies on a conjecture (horizontal long run supply curves) that he himself clearly does not even believe. He’s done on this.

32 Ragerz January 25, 2007 at 8:10 pm

Keith writes:

If that’s the case, then there is no problem over the long run with rising health care costs. Any health care costs increases we’ve seen will be undone as the short-run supply curves shifts along the horizontal price path defined by the long-run supply curve.

This is a good point, if you never move away from your model and into the real world.

What this fails to take into consideration is the creation of new markets via innovation within the medical field. The long-run supply curve for existing treatments, after patent protection runs out, could be flat, but then overall prices are rising as innovators are awarded patents for new innovations that create new markets.

Let us say that you curtail Peter’s “gold-plated healthcare” plan by denying access to existing treatment where the long-run supply curve is flat. You don’t help Paul, for the reasons discussed.

Let us say that instead you curtail Peter’s “gold-plated healthcare” by denying him access to innovations. The intermediate supply curve here is not flat (the very long-run might be), but does this help Paul? Not if by depriving Peter of these things drug companies and other innovators do not have the funds to invent these innovative new drugs and treatments in the first place.

Basically, your mistake, Keith, is by characterizing healthcare markets in a unitary manner. When an industry specific analysis calls for looking at the multiple markets and supply curves that constitute healthcare. You can have rising prices, and flat supply curves in some areas at the same time.

33 Keith January 25, 2007 at 8:25 pm

Certainly, subsidizing gold-plated health plans can lead to misallocations of investment dollars, as drug companies overinvest in certain types of innovations and engage in all sorts of marketing to get people to spend many more of their gold-plated insurer’s dollars to get only marginally better drugs and treatments. Worse yet, doctors also get into the act with extremely cost-ineffective treatments. And certainly this welfare cost lands on the non-gold-plated insured. So Alex’s analysis is actually supported by your example.

Really, get this Krugman albatross off your neck.

34 Ragerz January 25, 2007 at 8:56 pm

Keith,

I don’t get how curtailing Peter’s ability to use medical innovation, such that it is not even invented, helps Paul.

If a market for a product does not even exist, Paul’s consumption is zero. I don’t see where your pecuniary externality comes into play. This is not Alex’s cute drawing. This is erasing all supply and demand curves because the market does not even exist.

35 ChristianCB January 25, 2007 at 9:20 pm

Sounds like nothing is going to help Paul, but I don’t think it’s about helping Paul, I think it’s more about what could be hurting Paul (the distortion caused by the tax code).

If by increasing the amount of people that use the high end insurance increases the ability to produce newer and better advancements through higher investments, Paul would still be where he is anyways; not using the latest and greatest stuff, just as he was before.

The incentives to innovate are there as long as there is a profit to be made.

I also think that by creating the incentive that pushes the employers to only offer the best plans, the employees that don’t need them are now out of a few extra bucks that they could spend on other things.

Maybe the benefits just don’t outway the costs… ?

36 Ragerz January 25, 2007 at 9:47 pm

Rob C writes:

“I buy the reasoning. There is a subsidy in place, so people buy more than the optimal quantity at no greater cost to themselves, but to society.”

This doesn’t really make sense. For those health products where long-run supply is flat or near flat, their are no pecuniary externalities to harm Paul. Instead we are talking of only a benefit to Peter.

If you are talking about the idea that subsidizing innovation leads to more than an optimal quantity of innovation, I don’t think this makes sense divorced from a very specific analysis of innovation.

Patent protection is a form of tax/subsidy. It can be increased or decreased. Should we abolish all patent protection, on the theory that all subsidies prevent the “optimal” amount of innovation? What is your definition of “optimal” in the context of innovation anyway?

37 Ragerz January 25, 2007 at 10:06 pm

Keith writes:

“Certainly, subsidizing gold-plated health plans can lead to misallocations of investment dollars, as drug companies overinvest in certain types of innovations and engage in all sorts of marketing.”

Patent protection is a form of tax/subsidy for innovation. Patent protection attracts investment dollars from industries where patents aren’t available, to industries where patent protection is available. Would you characterize that as a “misallocation of investement dollars”?? Companies that are eligible for IP protection also engage in marketing. Think iPod. Is all marketing socially wasteful? Surely, there would be less marketing of the iPod if we lessened IP protection for it.

When it comes to innovation, the question is not whether we should subsidize it. Because we always subsidized it with an implicit tax on consumers in the form of higher prices as long as we have granted patent protection. The question is how much should be subsidize it.

Everyone agrees with subsidizing innovation to some degree. Unless you think that people will innovate enough when they have no financial incentive to do so, which I don’t think any serious person thinks.

In any case, if you want to argue that innovation is oversubsidized (perhaps we should decrease patent protection??) that is fine. But you aren’t going to be able to make this argument without an industry specific analysis.

So sorry. Krugman was right all along. There is no serious and reliable economic analysis that shows that robbing Peter will benefit Paul. (1) For existing treatments, you would have to show the long-run supply curve is not flat or almost flat. (2) For innovative treatments, you would have to show that the benefits of the treatments outweigh the costs of the subsidy. This would obviously require an in-depth industry specific analysis AND would always be subject to debate. You may value a new cancer treatment different than the people who have the cancer. Not only that, you would have to show that this subsidy to innovation (in the form of gold-plated insurance plans) is the best one to eliminate, instead of say, making changes to patent law. And even if you show that this subsidy is not the most efficient, the reason isn’t because it primarily benefits Peter at Paul’s expense. So Krugman stands and is no albatross.

38 Ragerz January 25, 2007 at 10:34 pm

Having commented a little much on this particular thread, I have decided that this will be my last comment.

For a very interesting summary as he sees it of the views of right-wing versus left-wing economists on health care by Brad DeLong, check out this post here.

39 ChristianCB January 26, 2007 at 12:51 am

Interesting link Ragerz…I’m glad I’m not pushing either viewpoint. I got this thing about telling other people how to live; I guess I’m just another nice guy. 🙂

40 Stefan January 26, 2007 at 4:50 am

I would like to raise a point with regard to the graphical rebuttal which I haven’t read so far in the comments (though it simply might have escaped me). The price for Paul can only go up if the excess demand of Peter exerts some market power. So you have to assume away the atomistic competition on the demand side in order to let that happen. Just my 2 cents, I am not so much into US health care policy, it’s only Micro 1.

41 Keith January 26, 2007 at 9:08 am

“Is not correct, since good analysis would seperate healthcare into multiple markets.”

Then Krugman himself performed poor analysis when he talked about health care costs rising, since he did not separate health care into multiple markets. In addition, Krugman himself claimed the long-run supply curve for health care was flat, meaning Krugman himself treated health care as a single market, and made a statement that he, in treating health care as a single market in the past, had flatly contradicted.

Since Krugman has discussed health care as one market, and you claim that some sub-markets in health care have rising long-run supply curves, then Krugman’s one-market approximation has an upward sloping supply curve. Or are you now going to claim that there are sub-markets with downward long-run supply curves which balance out those upward-sloping supply curve markets?

And I’ve heard and seen real health care economists use the Micro 101 analysis Alex discussed. Krugman made a dumb statement, and he’s basically been smartly backing off of it while using the flat long-run supply curve for health care as his fig leaf for his quick escape. But belief in a flat long-run supply curve clearly contradicts Krugman’s past concerns about rising health care costs.

Dude, really, your boy really whiffed this one. It’s okay. It happens to everyone. But don’t fight harder for somebody else’s mistake than the mistaken person themselves.

42 Rich Berger January 26, 2007 at 12:03 pm

RJR-

Good comment. I will give the big R credit for sheer persistence. He does have an answer for everything and it is harder to hit a constantly moving target. Alex – thanks for pointing out Krugman’s hidden assumptions. Nevertheless, he has been caught so many times that it’s no longer very sporting.

43 Sebastian Holsclaw January 26, 2007 at 1:54 pm

“Plus, we were able to introduce plenty of breakthrough medical advances in last 20 years for the country of our size (this is for a “but, but USA pays all the medical research and all other are free-loaders” crowd)”

This isn’t a good answer when a large portion of the research is funded in anticipation of sale on the US market in order to cover research costs. The argument is not that the US government or US companies pay for a majority of the research (though in fact it is very close to a majority) but that sales on the US market cover research costs.

44 Matt January 26, 2007 at 6:41 pm

There is also the fact when illegal alien Pedro is given health care at essentially no cost, that also increases demand AND raises healthcare costs as Paul’s premiums and/or taxes are raised to subsidize this added cost burden.

45 lrC January 26, 2007 at 7:31 pm

>Krugman’s original point stands, there is no serious and reliable economic analysis

It was one thing for you to reinterpret what Krugman must have meant (that’s quite a gift you have, the power to read minds) and leave it in scare quotes, and quite another to subsequently refer to it in clean text as if it were now established and conventional wisdom. Overpowering intellect indeed.

46 Brian January 26, 2007 at 9:17 pm

Keith,

How has Krugman contradicted himself with what he has said in the past? (I’m not recalling his specific comments.)

47 Birkel January 26, 2007 at 9:48 pm

If Krugman predicts that more potential doctors will enter the health care provision market, then the worst thing he could prescribe is a change to the cost structure of the market that would deter new entrants to the market.

Or am I missing something?

48 TallDave January 27, 2007 at 12:15 am

“If a higher price of healthcare pays for the development of new, fancy, expensive but effective treatments, then people will bid it up, because they want those new treatments. Especially when they’re older, with money to spend but plaque in the arteries.”

The problem is, there’s little incentive for new, fancy, cheaper but more effective treatments. Look at dicholoracetate; no major company will get behind it because it can’t be patented. You can bet if people paid for most of their own cancer treatment, companies would be breaking down the door to test the stuff.

Meanwhile they spend billions developing and promoting statin drugs, which can have serious sides and have not been shown to improve mortality, just because they change a number on a test. And why shouldn’t they? The market as currently built rewards that behavior.

49 Brian January 27, 2007 at 10:11 am

Ragerz:

The supply of computers, in the long-run, might be flat.

Say there was a large increase in demand. This would increase the price of computers. This, in turn would lead to at least two effects. Existing computer makers would have more incentive to increase efficiency (i.e. technological changes) thus increasing supply. New entrants would an incentive to enter the industry. Also increasing supply.

If the increases in supply (shift in the supply curve) matched the increase in demand (shift in the demand curve) in the long-run, you would have a flat long-term supply curve.

This one statement alone ought to bar you from ever being taken seriously as an economist.

Computers are made from limited resources (specifically copper). An increase in demand for computers may in fact drive moanufacturing costs down, but it won’t drive material costs down. Unless someone comes up with a replacement for copper in circuit boards (or a massive new copper mine), there’s enough competing demand for copper in other industries to ensure that its price will increase without bound.

Therefore, the supply of computers cannot be flat.

For the same reason, the apportionment of health-care services cannot be. You might want to argue that health care insurance has the potential for a flat supply curve, but what is insurance but a contract to sell someone else’s services? I can write contracts all day long. What happens to the cost of the services themselves when there are more contracts than there are medical personnel to fulfill them? One of two things (usually both) – my premiums go up by 18% a year, or my insurance company starts cutting benefits.

Unless, of course, everyone’s a doctor.

50 Ragerz January 27, 2007 at 10:15 pm

Brian,

Copper? You can’t be serious.

Such a scarce resource with absolutely no substitutes. I am sure that it makes the long-run supply curve practically vertical.

Your a moron.

51 PaulD January 28, 2007 at 6:18 am

“Actually, I think that you are fundamentally confused. Krugman isn’t looking for analysis that assumes one thing or another. You assume it is sloping. I assume it is flat. But there is no serious and reliable economic analysis out there, that Paul Krugman is aware of, that demonstrates rather than merely assumes that long-run supply curve is other than flat or mostly flat.”

Its been a long time since I was an undergraduate economics major, but it seems to me almost impossible to measure empirically a long-term supply curve. All data exists in a short-term time frame. Isn’t the long-term supply curve is a theoretical abstraction–in that markets in the real world move towards but for the most part never actually reach a long-term equalibrium. So it is hardly a “wow” type statement to say, “there is no serious and reliable economic analysis out there that demostrates that the long-term supply curve is other than flat or mostly flat”.

52 Ragerz January 28, 2007 at 6:33 am

Keith writes:

“you claim that some sub-markets in health care have rising long-run supply curves”

No, not exactly. My claim is that the shape of innovative medicial treatment while something it is protected by patent obviously is not flat while the patent protection lasts.

If you have a long-run long enough for the patent protection to expire, the curve probably would flatten out as well.

So, my claim is that there is an intermediate run period with a rising supply curve.

But, even so, I don’t think robbing Peter helps Paul with respect to these submarkets, if Peter’s consumption is necessary to give companies incentive to innovate in the first place.

53 brian January 28, 2007 at 11:58 am

Ragerz –

Name for me the substitutes for qualified medical personnel. You’re assuming a limitless supply of doctors, nurses, medicine, etc. But I’m the moron?

You admit that the supply curve for the most important input to a computer (copper) is vertical, but you still believe that the supply curve for computers is flat? And I’m the moron?

You claim that nobody can predict long-term economic trends, and then proceed in your next post to do precisely that? And I’m the moron?

Good sir, compared with you my intellect is a sun to your match.

54 stefan February 12, 2007 at 10:13 pm

Late but still relevant: Amy Finkelstein at MIT has exactly the paper Krugman syas doesn’t exist:

The Aggregate Effects of Health Insurance: Evidence from the Introduction of Medicare 2007, Quarterly Journal of Economics. February.

http://www.nber.org/~afinkels/papers/Finkelstein_Medicare_April06.pdf

Abstract: This paper investigates the effects of market-wide changes in health insurance by examining
the single largest change in health insurance coverage in American history: the introduction of Medicare
in 1965. I estimate that the impact of Medicare on hospital spending is over six times larger than what the
evidence from individual-level changes in health insurance would have predicted. This disproportionately
larger effect may arise if market-wide changes in demand alter the incentives of hospitals to incur the
fixed costs of entering the market or of adopting new practice styles. I present some evidence of these
types of effects. A back of the envelope calculation based on the estimated impact of Medicare suggests
that the overall spread of health insurance between 1950 and 1990 may be able to explain about half of
the increase in real per capita health spending over this time period.

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火狐浏览器
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Mac DVD Ripper
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Mac DVD Ripper
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Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器吴尊
阿穆隆
林志玲
尚雯婕
大人物
王睿
Mac DVD Ripper
火狐浏览器
Firefox浏览器

62 不動産投資 July 11, 2008 at 11:06 pm

資金を増やそうとするのに不動産投資をするのが手っ取り早い。日本で不動産で東京 賃貸をさがすのはきわめて難しくシステム開発は日本の会社が良い。

63 Anonymous October 22, 2008 at 10:00 pm
64 蜂王浆 December 16, 2008 at 7:16 am

i hate my life so much

65 芦荟 December 16, 2008 at 7:22 am

siter do not let me leave a message with http://www.hzygzs.com

66 adipex March 3, 2009 at 4:16 pm

Weight loss is easier than you think!

Adipex
Phentermine

67 r4 revolution February 10, 2010 at 12:34 am

This can also be applied to advocates of a single payer health care plan (which most Americans support). According to FAIR “the views of advocates of single payer have only been aired five times in the hundreds of major newspaper, broadcasts and cable stories about healthcare reform over the past week. No single-payer advocate has appeared on a major TV broadcast or cable network to talk about the policy during that period.†

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