Assorted links

by on January 14, 2014 at 12:05 pm in Uncategorized | Permalink

1. Zerocoin, a new Bitcoin competitor with anonymity.

2. Are immigrants really so anti-libertarian?

3. What do liberals get wrong about single payer?

4. The custom of the public deathbed.

5. William Chislett on where Spain stands now.

6. What scientific idea is ready for retirement?  (Hint: most of the criticisms are wrong, even the attack on the law of excluded middle from Alan Alda.)

Alex Godofsky January 14, 2014 at 12:13 pm

#6: Contra the first writer, string theory.

Finch January 14, 2014 at 1:36 pm

Yeah, that’s the obvious, though probably premature, candidate.

Steve Reilly January 14, 2014 at 12:15 pm

Do you mean most of the ideas are wrong, or most of the attacks on those ideas are wrong?

Yancey Ward January 14, 2014 at 12:23 pm

In regards to #1:

That is the primary danger to Bitcoin- a future competitor with a better product. However, I still assert that anonymity ends the moment you take receipt of a good or service.

john personna January 14, 2014 at 12:41 pm

Saying capitalism chooses “better” products is a bit like saying evolution chooses “better” genes. Then along comes influenza, beanie babies, whatever. Thus bitcoin’s downfall need only be a more popular alternative, be that alternative be real or some degree of virtual.

Finch January 14, 2014 at 1:48 pm

> However, I still assert that anonymity ends the moment you take receipt of a good or service.

Yeah, I don’t think people get this yet. PRISM is the tip of the iceberg. It won’t be long before it’s trivial for Sears Roebuck or some similar two-bit organization, in proximity to their store, to recognize your face, understand everything you say, read the text on your smartphone over your shoulder noting your contact list, inventory and feel out whatever electronics you have on your person, and connect all that to any digital footprint you have.

dead serious January 14, 2014 at 1:50 pm

That’s what iBeacon was made for.

john personna January 14, 2014 at 4:34 pm

So, I wanted some new running shoes. I found some at a department store, and set out to pay with my VISA card. Did I have a store card? I don’t know, it’s been years. So they have me punch in my SSN, show a driver’s license, and I walk out of the store with my shoes and an extra 20% off. It all felt very strange. I guess they (think they) know where I live.

I guess the SciFi, not that far off, would be that the store has my biometrics? “Enjoy your shoes, john. Come again.”

Tim January 15, 2014 at 11:25 am

*Go* to a store? What’s a store? I’ll just say “Ok Google I need some new running shoes” and something appropriate will be dropped off on my porch in an hour or less.

anonymous January 15, 2014 at 12:28 am

Zerocoin is not a Bitcoin competitor. It works within the Bitcoin protocol and anonymizes Bitcoin transactions. You should correct your link.

http://www.zerocoin.org

J January 14, 2014 at 12:49 pm

#6: To accept most of those proposals would greatly impoverish human thought. Ian McEwan’s entry rejecting the whole idea is the best one. Steven Pinker’s is one of the few “eliminative” proposals I completely agree with. Treating only protein-coding genes as genes is highly misleading, and it’s clear that a lot of what are thought of as “environmental influences” on phenotypes are in fact best seen as noise.

Marie January 14, 2014 at 1:13 pm

#3 I read until:

“A birth by cesarean section costs $3,676 in the United States ” –

Um, thirteen years ago the bills for my C-Section totaled about $10,000.

But he does have a point about price setting.

Just took my kids to the doctor, got the stink eye from the receptionist since we have now changed to Medicaid from private insurance.

Private insurance would have paid about $90 for the visit (actually we would have, high deductible). As self-pay, we’d have had to pay about $120 for the visit. Medicaid probably paid about $50.

So sad for the doctors, right? Except the waiting room and offices were entirely empty and the appointment lasted about ten minutes, only five of which were with a doctor. And I’ll throw in that we were only there because the government has criminalized buying antibiotics without a doctor’s permission, so the feds require that I pay this guy in order to get the drugs my kid obviously needed.

So you might think even with overhead and malpractice insurance and billing costs that $300 an hour might not be something to complain too much about. Especially as contrasted with the zero per hour if they hadn’t taken us as Medicaid patients (which is, of course, why they took us — no Christian love in that receptionist’s face!).

But if you contrast the real $300 an hour they got with the dream potential $720 an hour they think they “deserve” — well, no wonder they’re bitter. We’re clearly the “takers” in society.

Meanwhile, my husband who works much harder than those guys did at a skilled labor job with a useful product being produced for the market makes $14 an hour. And doesn’t complain about it.

Z January 14, 2014 at 1:21 pm

It certain sounds like the rest of us are footing the bills for your choices so yeah, you are a taker.

Marie January 14, 2014 at 1:33 pm

Yeah, I figured that was coming.
So, does the doctor get to be a “taker” too, at least? Because, you know, he’s the one who takes the cash for a service I’m federally required to go to a doctor to get.

Z January 14, 2014 at 1:51 pm

The doctor’s business is none of your business. It’s bad enough that you’re a loafer. Do you have to be a busy body too?

uffs January 14, 2014 at 3:59 pm

This response makes no sense. Answer the question or at least remain silent.

Z January 14, 2014 at 4:32 pm

It makes perfect sense. Don’t blame your defects on others. Take them head on and maybe you will overcome some of them.

The business owner runs his business as he sees fit. If the loafer does not like it, too bad. It is none of her business. If you still don’t get the point, then give up and move onto something else.

Rahul January 15, 2014 at 2:30 am

The only way this “business owner” (an American doctor) is able to make the obnoxious amount of money he does is by utilizing the coercive power of the state to restrict competition and throttle supply by erecting artificial barriers to entry.

So disabuse yourself of this fantasy notion that US-doctors are enjoying the fruits of their self-earned, legitimate prosperity.

libert January 15, 2014 at 10:49 pm

Yes and lobbyists and government contractors are legit too. It doesn’t matter when their clients are rent-seekers or financed by tax-dollars–they work hard, dammit!

Marie January 14, 2014 at 2:04 pm

Hey, this doesn’t have to become a referendum on my parasitic life choices (although I have to confess I anticipated the attack and not the defense — we could just go with a scare that winds up being nothing, eh?)

My point is about the role of expectation in medical pricing.

Rahul January 14, 2014 at 1:37 pm

I have this sadistic itch to see you develop an expensive malignancy. I’d be really curious to see how well you’ve planned your bill payment strategy so that you won’t eventually be a “taker” like her.

dead serious January 14, 2014 at 1:48 pm

Don’t dare suggest such a thing or take the chance that Marian Kechlibar, internet cop, will suggest you be banned for life.

Z January 14, 2014 at 1:53 pm

Been there done that chief. Planning for life’s difficulties is what responsible people do. But let me return the favor and wish you a nasty paper cut that gets infected.

Marie January 14, 2014 at 2:12 pm

Oh, baby, I hope you figure out early that’s not the way life works. Figuring it out late hurts more.

But I’ll stipulate to my loaferdom so we can head back to the topic — legally forcing patients to pay (by proxy, themselves, or with government welfare bucks) for services when pricing is set in a manner they have little control over has definitely set us up with a system where certain health care entities overvalue their contribution to the market.

zzzzz January 14, 2014 at 6:02 pm

Get a life Z. You did not deserve her first reasonable response. No one asked for and/or expects your seal of approval on their life choice, but this should be a forum for everyone to share their experiences and views WITHOUT personal reproach. It’s not about you, really.

Mark Thorson January 14, 2014 at 2:24 pm

You can get those antibiotics without going through a doctor by using eBay. Search on “ampicillin” or “amoxicillin”. Sure, it’ll come from Thailand and be for putative veterinary (aquarist, actually) purposes, but that’s how you break the monopoly.

You could also make usnic acid from lichens, but that’s an advanced topic for people who know what they’re doing, like me.

Marie January 14, 2014 at 2:27 pm

At the risk of sounding very adolescent — cool.

Locke January 14, 2014 at 5:06 pm

Over the counter antibiotics would be a terrible idea. They are already overprescribed by doctors trying to streamline patients or just get a nagging patient out the door, even if the ailmemt isn’t bacterial in nature. Marie, can you tell the difference between a viral infection and a bacterial infection?

Every use pf antibiotics contributes to the future diminishment of their effectivness. This is especially true with a misdiagnosis.

Mark Thorson January 14, 2014 at 5:26 pm

I agree that they’re a terrible idea for everybody else. When I need it, I’ll figure out how to get it. When I kept bees, the beekeeping catalogs offered cans of sulfanilamide and oxytetracycline. That’s another source.

I’ve heard that you can buy them over-the-counter in Mexican pharmacias. If that’s true, it hardly matters what we do north of the border.

Matt January 15, 2014 at 8:48 am

They’re overprescribed, yes. That doesn’t imply that people would just up and take them without a doctor telling them to. If the money chain wasn’t there and antibiotics were OTC then their use might actually go down.

Marie January 15, 2014 at 11:02 am

Locke,

No, generally I cannot tell the difference between a viral and a bacterial infection without a culture.

Generally, neither can a doctor.

Doctors are not the gatekeepers because they have magical powers, but because they can be pressured and are therefore expected to use more restraint. As is pointed out below, that assumption may or may not be well founded.

Floccina January 15, 2014 at 3:35 pm

I agree that antibiotics are the one medicine that should not be freely available but I think that one should be able to get them by taking a test that shows one thoroughly understands why they are not freely available, which are appropriate for what and the dangers of misuse and overuse.

The way it is today it seems many MD’s do not understand the things listed above and yet can subscribe antibiotics.

PD Shaw January 14, 2014 at 3:12 pm

I think the writer might mean $3,676 more than for a vaginal delivery? We had our first child almost 13 yrs ago, and at the first doctor’s visit we were given a quote on how much it would cost, about $7k for the one, and $10k for the other. It was the only time I’ve been to a doctor and been given a quote in advance.

Marie January 14, 2014 at 3:26 pm

That sounds right, I bet that’s it. Or maybe that’s the charge from the hospital, which my memory tells me was about half the bill (doctors’ bills the other half).

mulp January 14, 2014 at 5:25 pm

“…C-Section totaled about $10,000…”

The hotel and room service obviously cost about $7000 – the cost of delivering normally.

Z January 14, 2014 at 1:13 pm

#3: What I learned from that is Ezra Klein needs a better headline writer. The body of his post is just a bunch of cherry picked items that feel like they are related. That and he does not understand the difference between cost and price. if I have to wait two years for the MRI priced at $300 is costs more than the one I can get in a day priced at $1800.

Sigivald January 14, 2014 at 3:50 pm

What I had confirmed for me by #3 was mostly that “Michael Moore is still a complete idiot*”.

(* Or someone very good at pretending to be for attention.)

Marie January 14, 2014 at 1:16 pm

Which relates to the #3 article in that expectations for compensation among health care service providers is probably pretty out of whack, not because they are greedy jerks, but because they have no real idea of what the value of a dollar is, having worked with this tortured health cost payment system probably all of their working lives.

Luis Pedro Coelho January 14, 2014 at 2:13 pm

What American liberals get wrong about government negotiation (in price of hospitals or drugs) is that your negotiating position is only as strong as your ability to walk away. The British government can get amazing deals on drugs because it has shown that it is willing to walk away even if it costs British lives. No way the American government will ever do that. It can do it for Medicaid because the poor have no political pull, but for people who could reach out to the media?

Neither single-payer nor government price negotiations in the US would look anything like they do in countries where citizens just accept that sometimes you cannot have the high-priced drug because of an ongoing negotiation (and, yes, sometimes, you die; it’s a costly signal to the pharmaceutical company, if you want to call that way).

Even that is slowly eroding as patients become more informed with the internet and start demanding the drugs whose existence they would previously not be aware of (doctors do not tell their patients that there is a drug available in the US which would give them a 50/50 shot, but it was deemed too expensive for the UK, but with the internet patients are starting to find out about these things).

Seriously, how do you think it will go when a President announces that all high-priced hospitals must now cut their prices by force and they threaten to close in response? A few media specials on skimping on care. A TV special with infant care nurses who might be fired. The AMA quietly threatens to support whoever is the other party. Who is going to win that media battle? Do you expect that the President will then say “Look, if you don’t support me, I’ll nationalize all of you!” and the doctors will cower in fear or do you expect that that President will soon find themselves with very few political allies?

[It doesn't matter that most of the staff in a hospital are admins, the TVs will show the nurses and the doctors, not the 100s of people who check your forms. It doesn't matter whether the AMA would be doing the "moral" thing, they'd fight and they'd win like they win the doc-fix every year]

Marie January 14, 2014 at 2:25 pm

Walking away — it’s very true.

If everyone paid for their health care out of pocket, we’d see different choices at every level. People talk a lot about end of life, but I’d love to see pharmacy studies on people with high copays or high deductible insurance. I’m betting many folks leave some prescriptions unfilled if they judge the need is not great (comfort or cosmetic, rather than health and safety) and the cost too high. Same for many services, surgeries, etc. I can’t tell you the number of women I know who have had tubals — I’m betting if they had to pay for those themselves, they’d have just relied on the drug store aisle instead.

It’s absolutely accurate that the distance between the payer and the paid distorts the market, seems like that was a pretty obvious problem that we should have solved, in the rear view. If we had solved it, maybe the nightmare of ACA would never have happened.

mulp January 14, 2014 at 5:39 pm

A “50/50 shot” at what?

A cure? Or six weeks or maybe six months if paying $3000 a week for 25 weeks?

Studies of programs that get people into hospice care sooner shows they typically live longer than those being aggressively treated. Those treated aggressively suffer more and experience more complications than those who are treated for pain, symptoms, and standard care (oxygen, antibiotics, nutrition, etc).

Other that blaming Americans for being violent gun shooting drunks and meth users who engage in road rage or poor streetwalkers getting DR STDs or choosing to be homeless to get DR TB, what is your basis for Britain’s dying sooner than Americans given the LE data showing under the NHS British LE increased from about 8 years less than the US to about a year longer than the US, and all along the way the costs were significantly less than in the US which had a younger population.

Luis Pedro Coelho January 14, 2014 at 6:11 pm

My point was normative, not positive. I don’t think Americans will accept cost controls. You instead argued that they should. Maybe they should, but I don’t think they won’t. The political system won’t bear it.

Luis Pedro Coelho January 15, 2014 at 11:35 am

I meant positive, not normative; of course.

Jacob January 14, 2014 at 2:37 pm

#1 – why is this news? What about dogecoin, a bitcoin competitor with doge?

Sigivald January 14, 2014 at 3:55 pm

Such coin. So algorithmic.

anon January 15, 2014 at 12:18 am

wow

D January 14, 2014 at 3:02 pm

#6: Alan Alda is attacking bivalence, not excluded middle. Anyway, there are actually a bunch of good reasons to reject excluded middle, even if they’re not the ones Alda mentions. (Mostly they have to do with the semantic paradoxes, e.g. the liar paradox).

theCoach January 15, 2014 at 8:51 pm

HoTT unifies.

AD January 14, 2014 at 3:22 pm

#3. I like his defense of insurers, but I just can’t get on board with the solution of government price setting. Can someone please explain to me how this will work out for health care? Perhaps it will lower nominal costs, but will it respond to supply and demand properly? What about health innovation? Do we just depend on government funded research to resolve those issues, too? I can sort of see the argument that it’s better than the current system, but how is government price setting the ideal? If it came with an all knowing bureaucracy then I guess I could support this ideal, too, but how does it work in reality?

Willitts January 14, 2014 at 6:06 pm

3. I call BS.

Don’t try to tell me that in a modern developed country like Canada, that a surgeon, a nurse, an anesthetist, and all the supplies and equipment for a C-section costs only $600. This doesn’t even count the other overhead costs.

It cost me more to change the water pump on my car.

Caesar’s C-section probably cost more than $600.

Like all socialized programs, costs are deliberately hidden.

Rahul January 15, 2014 at 1:14 am

Yeah that sounds a tad too low. A friend got a C-section recently back in India (not in a stereotypical overcrowded public hospital. A private hospital, individual room, western trained docs., 4 days hospital stay etc. ) and the cost was roughly $1000.

It’d be hard to beat that in Canada.

JWatts January 15, 2014 at 11:18 am

“In Canada, a first-time C-section costs approximately $2,265 CAD more than a vaginal delivery.”

http://www.cfhi-fcass.ca/SearchResultsNews/2011/05/06/ab4a74cd-ffbc-427b-9995-7f7434a87a67.aspx

So no the $600 figure is complete malarkey.

derek January 14, 2014 at 9:18 pm

The largest single payer system in canada serves 13 million people. Single payer in the US would be a disaster of epic proportions. There have been outrageous mismanagement episodes in various provinces in Canada, but the damage for the most part has been limited by the size.

prior_approval January 15, 2014 at 1:41 am

Or have a multiple payer (say, around 200) system, with a single rate sheet – just like in Germany. Where the health care system is around 5 times bigger than 13 million, by the way.

Though it does have a waiting problem, as I heard on the news yesterday. 20% of all patients of the Krankenkassen (call them health insurers) have to wait more than three weeks to see a specialist. 1 out of 5! More than three weeks!

Of course, since the U.S. doesn’t actually keep such statistics, there is no way to compare. Except to note that everyone who is complaining about having to pay more to keep a catastrophic health insurance policy in the U.S. is not really in the group of people that make routine appointments with specialists.

And the other way of phrasing that German statistic is that 80% of all patients covered by the normal health insurers see a specialist in less than 3 weeks – such is the outrage of having a health care system which costs a third less than America’s.

TMC January 15, 2014 at 11:54 am

The in my city largest hospital system is advertising that, if you use their online services, you can get an appointment same day most of the time. Maybe not with a specialist, but who knows, we seem to have more specialists than GPs.

TMC January 15, 2014 at 11:55 am

Meant “The largest hospital system in my city” of course.

ww January 17, 2014 at 1:42 am

Derek,

Trotting off the hoary scale cliche. I’m a bit tire of dingbats like you and Z. Pull Fox and Friends cliches out of the air, and there you go, truthiness!

Please leave Marginal Revolution and go to Fox. You’re lost (Z, too).

leftistconservative January 15, 2014 at 7:49 am

What scientific idea is ready for retirement?

The idea that economics is science and the idea that economics is anything but the ideology of the upper class.

Anon. January 15, 2014 at 12:55 pm

“But economic growth cannot last forever. If the GDP per capita of the U.S. grew, in real terms, at a modest rate of 1% for the next millennia, the average American would be making a whopping 1.1 billion dollars a year by the year 3,014.”

I don’t see how this is so wildly unrealistic. 1000 years is a long time. Fusion + strong AI will lead to an essentially post-scarcity economy. Mass scale asteroid mining would be entirely trivial with those two technologies…a 1 billion GDP per capita doesn’t seem that hard to achieve.

Finch January 15, 2014 at 3:40 pm

We already have people whose annual productivity exceeds that _today_. It doesn’t seem unrealistic at all.

Finch January 15, 2014 at 4:36 pm

Was there anyone alive in the year 1000 whose annual productivity equaled that of a random guy with a backhoe today?

Jazi Zilber January 16, 2014 at 1:45 am

Most criticism are wrong. Very well said.

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