Friday assorted links

by on May 12, 2017 at 10:16 am in Uncategorized | Permalink

1 Ted Craig May 12, 2017 at 10:23 am

1. Wrong link.

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2 Anonymous May 12, 2017 at 10:48 am

But Justin Fox should be linked more often. He’s a sensible guy with an informed trust/distrust in markets.

The Noah Smith productivity link:

https://www.bloomberg.com/view/articles/2017-05-10/goofing-off-at-work-masks-rising-productivity

Read it on your own time

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3 Daniel Weber May 12, 2017 at 10:58 am

Noah Smith now identifies as a fox.

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4 Todd Kreider May 12, 2017 at 12:09 pm

Notice when discussing “The Complacency Class,” Noah Smith uses labor productivity for “productivity” when Tyler told me in the comments section here that he was using Total Factor Productivity for “productivity” and that his narrative makes sense then. Unfortunately, it doesn’t match what he has been saying on podcasts either. For example, he mentioned a “burst of productivity” in the mid 90s, but that never happened as TPF growth was about the same in the 80s and the 90s and completely stalled from 1966 to 1973, the era Cowen says was “high productivity.”

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5 FE May 12, 2017 at 1:34 pm

I think Smith is on to something, but what about all the ways technology forces us to work when we’re not at the office? I take more breaks at the office than I used to, but I also do more work from home, while commuting, and while vacationing. I wonder how it nets out.

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6 Todd Kreider May 12, 2017 at 1:49 pm

This idea is not at all new. I started to wonder about misreporting work hours when I saw a guy playing Minesweeper at his 40 hour a week job during the 90s and thought the internet would magnify this distorted reporting especially afterFacebook became popular.

Economists have been speculating about this for years, but I don’t think they have solid evidence.

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7 ChrisA May 12, 2017 at 3:58 pm

Not sure if this goofing off has really increased, maybe just a switch between chatting by the water cooler vs using social media. I personally have substituted lunch with my co-workers for more internet time, but overall I think my goofing off factor is about the same.

Regardless I think the point is that productivity measurements are not getting at either quality of the output or the quality of the workplace properly. The example I always use is extra staff at a restaurant to improve service. This is a productivity reduction unless somehow the quality of the improvement in service is taken into account, which is very difficult. With the revolution in online ranking now, like Trip-Advisor , service industries are improving services like never before, but this simply translates to productivity reducing when measured by the statisticians. An example, last week I rented an apartment for a holiday. The service by the company renting the apartment was great, like a good hotel, their rep even refunded the taxi from the airport as she had given us the wrong estimate of the cost . As the rep left she told us, “don’t forget to rank us on Trip-Advisor”. And of course we had selected this same apartment simply because of their great rankings. I couldn’t imagine this kind of service for a low cost apartment rental happening 10 years ago.

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8 Kevin Burke May 12, 2017 at 10:23 am

#3 contains a *ton* of factual inaccuracies; it describes a world that just isn’t true. I am a white tech worker advocating for more housing in SF, and not a single pro-housing person I know, or any person named in the article or associated with their organizations, thinks rent control should be abolished or modified, or that we should build _only_ market-rate housing and no BMR.

The pretty consistent line is “any housing, below market or at market, as long as it gets shovels in the ground.”

This Twitter thread outlines a number of other inaccuracies found in the article https://twitter.com/rolandlisf/status/862798080223006720

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9 MMK May 12, 2017 at 11:08 am

Also Reddit and TechCrunch are libertarian strongholds!

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10 Really? May 12, 2017 at 1:53 pm

Reddit is a progressive stronghold, you must not frequent it.

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11 MMK May 12, 2017 at 6:14 pm

Duh, that was the joke.

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12 DC May 12, 2017 at 11:13 am

I’ll give you one. I’m a white tech worker advocating for more housing in SF who thinks rent control should be modified, in that it was nuts that I was recently paying probably 30% under market rate for housing despite being in the 1% (nationally; regionally probably in the 10%?) Or the alternative interpretation, equally nuts, that market rate was 50% higher than it would have been without rent control, because landlords demand more up front knowing they can’t raise rent later, and tenants are willing to pay it in order to lock in rent control.

I don’t think it should be abolished, unless it was for a more direct and rational wealth-transfer system. The modifications I can think of (means testing, etc) are also flawed, but maybe less so.

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13 TMC May 12, 2017 at 12:09 pm

“not a single pro-housing person I know, or any person named in the article or associated with their organizations, thinks rent control should be abolished or modified”

That’s too bad. Rent control causes more problems than it solves. Maybe poorer folks should move to an area more within their means.

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14 Kevin Burke May 12, 2017 at 5:29 pm

The politics of it are awful and there are plenty of empty or underdeveloped lots in the city. The problems SF has with underbuilding are more due to a long pipeline and uncertainty in the planning process than rent control

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15 Larry Siegel May 13, 2017 at 1:09 am

It’s not a bad article, it’s a *terrible* article. And I refuse to take seriously any writer who uses the anti-word “Latinx.”

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16 Andrew M May 12, 2017 at 10:25 am

#2: Dilbert did it over a decade ago:
http://dilbert.com/strip/2006-05-13

Seriously, matching people on what they actually search for in private (revealed preferences) will be far better than matching people on what they tweet in public (stated preferences).

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17 GoneWithTheWind May 12, 2017 at 10:31 am

“No government health care fundiing for people who won’t make lifestyle changes”

What a slippery slope that would be. The health/diet agenda is full of opposing belief systems and much misinformation. So which of these many different belief systems must we all adhere to and how long before we discover it was the wrong myth and now we must adhere to the next favored myth about healthy eating/lifestyles. Ask 100 people what is a healthy diet/lifestyle and you will get 100 different answers and likely they will all be wrong. Don’t eat meat! Don’t eat fats! don’t eat carbohydrates! What’s left???

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18 JK Brown May 12, 2017 at 10:45 am

Yeah, seems he picked the easy target in those potato-chip eating redstater type II diabetics. I wonder the outcry if it was applied to those who engaged in promiscuous casual sex, thus acquiring a lot of future “pre-exisiting conditions”, such as herpes, HIV, etc. Or applying it to those who join a gang thus precipitously raising their chances of traumatic gunshot or other violent wounds.

It is the fundamental problem with government-provided healthcare, the government, meaning the dominant political class in society, now has a means to control almost every aspect of the individuals life according to their morality and culture.

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19 Anonymous May 12, 2017 at 10:54 am

“Nudgers” were ahead on this one. Government should encourage good diet and safe sex without coercion. That really isn’t a bad thing. So yummy healthy recipes, yes. Denying insurance, no.

Crime is a bit different. The threat is large enough that we think coercion is appropriate.

(I wonder how many who opposed the not-a-ban on soda as mommy state are on board to cut benefits to soda drinkers?(

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20 TMC May 12, 2017 at 11:09 am

Nudgers are just as bad, or almost at least. How long has the govt been nudging out eating habits in exactly the wrong direction?

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21 Anonymous May 12, 2017 at 11:18 am

Depends on which part. The NIH got straight quite a long time ago. The Department of Agriculture lagged.

Still, it is true that in controlled environments the old low fat diets work fine. In “lock down” tests most diets that limit calories work fine.

What the scientists did not expect was that people would be drinking 44 ounce sodas as a part of a low fat diet.

In the wild, people behave differently.

22 TMC May 12, 2017 at 12:11 pm

I’m not sure who was responsible for the food pyramid, but that’s who got it wrong and seemed to be the official voice of the government.

23 Hazel Meade May 12, 2017 at 12:33 pm

Yeah, the food pyramid – EAT MOSTLY GRAINS! They got it completely wrong.

24 Anonymous May 12, 2017 at 12:50 pm

Whole grains are still fine, and you probably won’t find many obese who just eat too much shredded wheat.

What humans did in the wild was substitute high fructose corn syrup for those “grains.”

25 Anonymous May 12, 2017 at 12:53 pm
26 Hazel Meade May 12, 2017 at 2:44 pm

HFCS has only slightly more fructose than refined white sugar.
The problem is simple carbs.

Whole grains are better, but if you live off diet composed largely of grains that’s still going to make you fat.
There are lots of obese vegetarians.

27 Mark Thorson May 12, 2017 at 4:20 pm

The problem is relying on the government to do it. Under Thorsoncare, geographically close consumers of health insurance would be assigned to groups of 100. Every member of the group would get the name, photo, and contact of every other member, as well as a list of their health risks (smoking, obesity, alcoholism, etc.). Group members would encourage the laggards to mitigate their health risks, and success would be rewarded with lower prices.

I didn’t see you at the gym today, Tyler. Are you going to be there tomorrow? I wouldn’t want to have to report you to the group.

28 Anonymous May 12, 2017 at 4:37 pm

“HFCS has only slightly more fructose than refined white sugar. The problem is simple carbs.”

Sugars are simple carbs, yes. Fructose is a sugar, yes.

The problem is making them a big part of the daily diet. Culture, and government farm subsidies, did that. Not the health nudgers though, they did not tell anyone to run out and eat Lucky Charms as the base of their food pyramid.

A pdf of the 1980 recommendations is at the link below. Avoid saturated fat, don’t eat too much sugar.

http://www.health.gov/dietaryguidelines/1980thin.pdf

29 Thomas May 12, 2017 at 11:17 am

“Government should encourage good diet and safe sex without coercion”

“So yummy healthy recipes, yes. Denying insurance, no.”

“(I wonder how many who opposed the not-a-ban on soda as mommy state are on board to cut benefits to soda drinkers?(”

These quotes together seem to demonstrate a fundamental misunderstanding of coercion, likely rooted in a belief in positive rights. Positive rights are internally contradicting and thus false.

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30 Anonymous May 12, 2017 at 11:23 am

It’s true. I don’t feel a lot of coercion. I am confident in my decisions.

31 P Burgos May 12, 2017 at 10:58 am

I agree that he picked the easy target in focusing on type II diabetics. However, it is astounding that just this one group of people eats up about half a trillion dollars in healthcare spending, if Kling is to be believed. Just one or two more chronic conditions like type II diabetes that can be improved with relatively uncontroversial lifestyle changes, such as more physical activity and a diet richer in fruits and vegetables and less reliant on highly processed food, and you have reduced US healthcare spending by a trillion dollars.

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32 Thomas May 12, 2017 at 11:23 am

One policy that would reduce the rate of Type II diabetes is delimiting EBT qualified purchases to exclude sugared-soda, sugared and heavily fatty snacks like chips.

These proposals face opposition on the basis of racism (because minorities disproportionately make poor food choices) and vile classism, because Republicans hate the poor or something. If Democrats proposed these sort of limits, they would pass. The question is whether Democrats care about the health of their constituents or votes, and the answer is clear. Perhaps we could nudge Democrats in to EBT limitations via elimination of the carry interest loophole?

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33 P Burgos May 12, 2017 at 12:07 pm

I’ve often wondered how much of the junk food purchased on EBT cards is actually consumed by the beneficiaries? I remember reading that there is a large market for buying and selling soda, with people using EBT cards to buy soda and then selling it at a discount to cash buyers.

34 GoneWithTheWind May 12, 2017 at 2:15 pm

“diabetes… can be improved with relatively uncontroversial lifestyle changes”

There is a real problem with this issue. Diabetes is a genetic disease not caused by diet. However it can be fairly effectively treated by diet and exercise. Understand that what the author is really suggesting is that everyone adopt what he believes is the “right” lifestyle/diet because he believes diabetes is caused by eating too much sugar/carbs. Make no mistake they want to tell everyone what they can eat and their belief of what the “right” diet is, is based on superstition, bias and bad science.

But also understand that even healthy diabetics who eat a proper diabetic diet will still incur much higher health care costs over their lifetime because they are much more prone to other serious illnesses AND the inevitable problems that accompany diabetes. So there wouldn’t be much of a savings in health care costs. Even a diabetic who makes the required lifestyle changes is 2-4 times more likely to have a heart attack and other health related problems. It is a really bad disease. Ironically and sadly the cheapest solution would be to allow/encourage them to eat whatever they want because they would most likely die younger and avoid years of being seriously ill. So I don’t think there is much if any major savings to be had from these so-called life style changes.

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35 Art Deco May 12, 2017 at 2:29 pm

If I’m not mistaken, there’s been a 7-fold increase in the prevalence of adult-onset diabetes in the last 60 years. Is that what you expect of a ‘genetic disease’?

36 P Burgos May 12, 2017 at 3:26 pm

I haven’t looked in depth into studies on lifetime medical costs, but I have seen the claim that improving people’s health now will cost the government (and society) more resources in the long run. Even without looking into the studies in depth, I am a bit skeptical, because I have not yet seen mentioned how, if at all, the studies handle the time value of money, nor have I seen an estimate of how much additional economic value is created when people are healthier due to fewer sick days, fewer people on disability, etc. The principal economic resource in the U.S. is labor, and it seems to me that improving the health of the population right now will increase the value and amount of labor done right now and in the near future by a greater amount than the resources that would need to be devoted to having more elderly people sometime far into the future.

37 GoneWithTheWind May 12, 2017 at 3:47 pm

Not a 7 fold increase. The data on diabetes is both complicated and misused. About half of the people who have type II diabetes do not know it. This is for a couple of reasons but primarily because what we all think of as diabetes is the symptoms of diabetes. For young people these symptoms often don’t show until they get into their 20’s. Their go-go lifestyle and high metabolism delays the onset of symptoms. With marriage and a steady job they begin to notice “something”. They go to a doctor who runs some tests and by gosh they “caught” diabetes. Since they probably just gained some weight AND the doctor has told them to lose some weight and eat a special diet they conclude I must have “caught diabetes from my crappy lifestyle/diet. But they had it all along and didn’t know it.
A second but related factor is that to their credit the diabetes assc. has recommended that more people get tested earlier because diabetes responds better to early treatment. To their discredit the diabetes assc. then used these newly discovered cases of diabetes to scare people into to thinking diabetes is on the rise. It isn’t, the rates are the same we are just finding more of the here-to-fore undiscovered cases.

Third and somewhat complicated is different races have different rates of diabetes. Indians for example have rates 4-8 times greater than whites of Northern European descent. Most people native to Central and South America have rates similar to the Indians. People of African heritage have rates 2-4 times that or Northern Europeans. And the U.S. has seen an increase in the percentage of these particular ethnic groups while the percentage of whites from Northern Europe has decreased. This increases the average overall rate of diabetes in the U.S. while at the same time the actual rates by ethnicity hasn’t changed at all.

38 prior_test2 May 12, 2017 at 4:04 pm

‘ Is that what you expect of a ‘genetic disease’?’

Sure, if the disease is related to life span, which it is reasonable to assume ‘adult diabetes’ just might be.

To give a more concrete example – an increase in Alzheimers would say little about its genetic basis, pro or con, but an awful lot about a notable increase in life span in the past two generations.

39 Floccina May 12, 2017 at 5:34 pm
40 derek May 12, 2017 at 5:38 pm

>there’s been a 7-fold increase in the prevalence of adult-onset diabetes in the last 60 years. Is that what you expect of a ‘genetic disease’?

Depends if the cure permits sufferers to reproduce more.

41 Amigo May 12, 2017 at 6:41 pm

You really don’t want to eat fruits if you’re type II. Most will spike sugar levels.

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42 Daniel Weber May 12, 2017 at 10:59 am

Honest question: in countries with government-provided healthcare, how much does the government meddle in your health decisions?

I expect there is a range of responses.

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43 prior_test2 May 12, 2017 at 11:07 am

Basically, the only industrial country with government provided health care is the UK.

Why people keep thinking that a for profit system like Germany’s or France’s is equivalent to ‘government provided health care’ remains one of several mysteries when Americans discuss such topics.

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44 Milo Minderbinder May 12, 2017 at 11:45 am

Canada is not an industrial country?

45 prior_test2 May 12, 2017 at 2:29 pm

It is an industrial country, but it does not have government provided health care in the sense of the NHS in the UK – ‘Health care in Canada is delivered through a publicly funded health care system, informally called Medicare, which is mostly free at the point of use and has most services provided by private entities. It is guided by the provisions of the Canada Health Act of 1984.’ https://en.wikipedia.org/wiki/Healthcare_in_Canada

Do note that ‘private entities’ part. Government payment of health care, when it is provided by private entities, is not ‘government provided’ – this is a real confusion among Americans discussing the entire subject, almost as if this confusion was somehow desirable to major American interest groups. Doctors, nurses, etc. in the UK (in the main) are employed by the NHS as government employees. Medicare in Canada does not employ doctors as government employees, as noted in that linked article – ‘With rare exceptions, medical doctors are small for-profit independent businesses. Historically, they have practiced in small solo or group practices and billed the government Canadian Health Care system on a fee for service basis. Unlike the practice in fully socialized countries, hospital-based physicians are not all hospital employees, and some directly bill the provincial insurance plans on a fee-for-service basis. Since 2000, physicians have been allowed to incorporate for tax reasons (dates of authorization vary province to province).’

Government funded health care is distinct from government provided health care – there are good reasons that essentially no other health care system in the industrial world uses the British model. The U.S. has plenty of government funded health care, but no one calls it ‘government provided’ (the VA and general military health care excluded, as that is government provided health care, by employees of the federal government).

46 P Burgos May 12, 2017 at 3:43 pm

@Prior_test2
I don’t know if you are Canadian or not, but it seems pedantic to comment on a blog by a US academician that people are not using language the way that people outside the US use language. Perhaps it is helpful to clarify for non-US readers that Daniel Weber uses the phrase “government-provided healthcare” to signify healthcare that is provided and paid for using government funds. But given your comment’s reference to countries in which governments provide the vast majority of funding for healthcare, you knew perfectly well what Daniel Weber meant, and your response was not at all germane to the question, but merely took the question as an opportunity to b1tch without adding anything of value to the discussion.

Does it matter that the UK is unique in answering Daniel Webber’s question? I would suspect that at least some people think that it is (i.e. the political economy of having NHS workers vs. private physicians may have a large impact on the politics and politicking of things like soda taxes, or it may not). A comment that examined the differences between the political economy accompanying different kinds of healthcare systems in which a distinction is made between the UK and other countries would be helpful. Your comment is not.

47 prior_test2 May 12, 2017 at 4:27 pm

‘but it seems pedantic to comment on a blog by a US academician’

I’m American.

‘are not using language the way that people outside the US use language’

It is not the language, it is the actual factual distinction between a system, like in the UK, where the doctors are government employees, and in Canada where the doctors do their job for their own profit. As is the case in pretty much all industrial countries apart from the UK.

‘Perhaps it is helpful to clarify for non-US readers that Daniel Weber uses the phrase “government-provided healthcare” to signify healthcare that is provided and paid for using government funds.’

Except then, in most cases, that is government funded health care, and not government provided health care – again, note the distinction between the NHS and Canada’s Medicare and who is actually providing the health care. It is not a trivial distinction.

‘But given your comment’s reference to countries in which governments provide the vast majority of funding for healthcare’

Except in most industrial countries, that is simply not the case. It is most definitely not the case in either France nor in Germany, to name two systems where the health care is at least comparable to that in the U.S., for at least a third less. In Germany, most people pay a percentage of their income for health insurance/health care, for example. And though one could call the AOK something like Medicare/Medicaid (very, very roughly, it must be noted), no one would suggest that the American government provides the vast majority of funding for healthcare because of Medicare/Medicaid.

‘you knew perfectly well what Daniel Weber meant’

No, I think he is, at best, not well informed. Like many other American commenters on this subject.

‘opportunity to b1tch without adding anything of value to the discussion’

Yes, I recognize telling people here that they don’t know what they are talking about, and many times providing information and links to show why that is so, is valueless. We all have our little unexplainable hobbies.

‘Does it matter that the UK is unique in answering Daniel Webber’s question?’

Actually, yes, because the NHS is a fairly poor health care system in the eyes of comparable European countries, and always talking about socialized medicine tends to cause people to think that is how health care is provided in all the other European health care systems. It isn’t, because countries like France or Germany have no interest in reducing the quality of their health care systems by using both exclusively government funded and exclusively government provided health care.

‘A comment that examined the differences between the political economy accompanying different kinds of healthcare systems in which a distinction is made between the UK and other countries would be helpful.’

First, people would actually have to grasp there are different kinds of health care systems, most of them neither exclusively government funded and exclusively government provided.

48 Floccina May 12, 2017 at 5:40 pm

@Prior_test it seems obvious that Daniel Weber meant to ask: Honest question: in countries with government-paid for healthcare, how much does the government meddle in your health decisions?
How precise to expect commenters here to be?

49 DOC May 13, 2017 at 5:09 am

Doctors as government employees in the UK? According to Wikipedia:

Although the NHS routinely outsources the equipment and products that it uses and dentistry, eye care, pharmacy and most GP practices have always been provided by the private sector, the outsourcing of hospital health care has always been controversial. https://en.wikipedia.org/wiki/National_Health_Service

Or:

. . . in the new NHS market the NHS must manage on a daily basis more than 53,000 contracts for the provision of services by private providers, ranging from GP services, dental care and pharmacy services, to community health services and secondary care.
http://blogs.lse.ac.uk/politicsandpolicy/the-private-provision-of-nhs-clinical-services-how-is-the-nhs-handling-the-contracts/

50 Don Reba May 12, 2017 at 11:48 am

Canada:
– Influencing what children eat for lunch, such as discouraging fruit juice.
– Strong anti-smoking campaign.
– Tax breaks for buying sports equipment.

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51 Anonymous May 12, 2017 at 11:52 am

Really expensive beer.

52 P Burgos May 12, 2017 at 12:09 pm

What’s the historical reason that alcohol in Canada is so expensive? It strikes me as good government policy (the cheapest way to fight crime is to reduce the number of men who regularly get intoxicated).

53 Ricardo May 12, 2017 at 4:00 pm

One reason is that it is difficult to sell alcohol across provincial lines. I lived in Alberta and would only see Moosehead when I travelled to the States.

54 Daniel Weber May 15, 2017 at 12:57 pm

All that sounds pretty innocuous, and what I’d expect from a government interested in public health even if it were paying none of the bills.

55 derek May 12, 2017 at 5:42 pm

They don’t dare because they cherish their head attached to their bodies.

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56 Floccina May 12, 2017 at 5:13 pm

Or, my favorite, ride motorcycles.

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57 Harun May 12, 2017 at 5:29 pm

Careful assuming its “red staters” who are diabetic.

A lot of hispanics and african-americans are diabetic, too.

He chose this disease because its the 20/80 rule…its the biggest line item. And yes, diet can really, really help.

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58 Hazel Meade May 12, 2017 at 12:37 pm

This is why I’m saying just let health insurers price based on these sorts of risks. the insurer can invent all sorts of programs to encourage consumers to eat healthier, work out, etc. Frequent monitoring to see if you get your blood sugar under control, wth a rate reduction if you do.

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59 carlospln May 13, 2017 at 2:28 am

Fuck health insurers

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60 Floccina May 12, 2017 at 5:26 pm

People with diagnosed diabetes incur average medical expenditures of about $13,700 per year, of which about $7,900 is attributed to diabetes. People with diagnosed diabetes, on average, have medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of diabetes.

Seems affordable for most US citizens. Here is guy who lives on $7,000/year. In fact it seems to me that one of the causes of type II diabetes is being able to afford enough food to get fat. Thus the disease was until recently more common in rich countries.

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61 Anon7 May 12, 2017 at 7:04 pm

The simpler answer is no government health care funding, which means no more Nanny Bloombergs (and perhaps some of them will stop stuffing their faces because it’s expensive to treat the bad health effects).

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62 Milo Fan May 12, 2017 at 10:38 am

3. It is a really bad article. Typical Leftist zero sum mentality. It’s also true that there aren’t many actual YIMBYs, that alt right is after all about keeping non White immigrants out of the country rather than merely out of the neighborhood. But in this debate, one side IS clearly more hypocritical than the other.

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63 Jason B May 12, 2017 at 10:45 am
64 MMK May 12, 2017 at 11:10 am

I have been making the argument for 5 for years and people look at me like I’m crazy. I am for single payer healthcare if everyone goes to the gym and squats heavy three times a week and avoids processed carbs.

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65 Moo cow May 12, 2017 at 1:38 pm

Squats? What??

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66 Ricardo May 12, 2017 at 4:01 pm

No ACL surgery for you, knee-abuser!

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67 MMK May 12, 2017 at 6:19 pm

ACL injuries are from sudden changes in direction. I doubt there has been a single ACL injury in the history of mankind from performing a proper squat.

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68 The Anti-Gnostic May 12, 2017 at 4:23 pm

Always do full squats.

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69 prior_test2 May 12, 2017 at 2:31 pm

An excellent idea for toddlers, pregnant women, and 64 year olds, right?

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70 Alex May 12, 2017 at 3:14 pm

Mini me.

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71 MMK May 12, 2017 at 6:17 pm

Toddlers, no because they have not hit puberty so it’s useless for them to train. Pregnant women, maybe. 64 year olds, definitely should be squatting to avoid bone density loss.

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72 rayward May 12, 2017 at 11:13 am

5. Of course, the proposal that Kling is sort of endorsing is just another example of the rather common believe that sick people are to blame for being sick. As for surgeons being required to publish their complications and outcomes, wouldn’t that discourage surgeons from taking the more difficult cases? If the publication requirement were extended to other specialties like oncology, would someone with pancreatic cancer be able to find an oncologist to take his case? I work with physicians, and when asked what specialty I would choose if I were to be a physician, my response is cardiology. Why? Because heart patients require regular treatment and remain alive years, decades, which allows the cardiologist to build an enormous book of business. Oncology, not so much.

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73 adam May 12, 2017 at 11:25 am

Some sick people are to blame for being sick.

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74 Jeff R May 12, 2017 at 12:16 pm

Yeah, but a lot of those people are smokers, and I say we cut them a break because we’ve really only known about the dangers of smoking for 40 years.

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75 Art Deco May 12, 2017 at 2:31 pm

About 50 years. The warnings went on the packs in 1966.

A lifelong smoker of my acquaintance (b. 1908, d. 2001) was poleaxed by the Cippolone case in 1990. She said throughout her life it had been assumed to be an unhealthy habit. (“We used to call ’em coffin nails”).

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76 The Anti-Gnostic May 12, 2017 at 11:50 am

Sincere question: what is the percentage of medical treatments for conditions attributable to obesity/diet, smoking, lack of exercise, or just being old?

I’m going to say 60%. Happy to be proved wrong.

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77 P Burgos May 12, 2017 at 12:13 pm

Why tack on being old to the end of that list. I guess that people could commit suicide to avoid being burdens on younger generations when they get older, but it seems weird to include old age in the same category as obesity/diet, smoking and lack of exercise. Maybe the common thread is that the cost per additional QALY is high for people who are either old or engage in unhealthy lifestyles?

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78 The Anti-Gnostic May 12, 2017 at 12:23 pm

I’m not arguing the merits or demerits of providing socialized medical treatment to every warm body in the US for every thing under the sun. Hell, I figure out of $3.5T in tax revenue we can come up with something besides Departments of Commerce, Labor, and Education and scrambling soldiers all over the planet. Idiot.

I’m asking, what percentage of total medical care is attributable to those conditions, including being old. Because there’s no real “cure” for any of those conditions, and they are effectively uninsurable. This has implications for how, as we apparently must, intervene in this sector of the economy.

Grow up.

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79 Art Deco May 12, 2017 at 2:39 pm

I’d be very skeptical of his contention that 1/4 of Medicaid and Medicare spending was attributable to adult-onset diabetes.

The most hideously expensive sort of treatment is kidney dialysis. I think that problem can pretty much hit at any age and is something of a random strike. Long-term care is also hideously expensive, but it accounts for only about 10% of ‘health care and social assistance’ expenditures. The sticker price on cancer treatments can be steep (close to $300,000 for my family’s last experience with it, luckily handled by insurance). Again, except for lung cancer (which is usually lethal and commonly terminal from diagnosis), personal habits do not have much of a predictable relationship with cancer strikes. Auto-immune disorders are also expenditure. What do you have to do to avoid getting lupus?

80 P Burgos May 12, 2017 at 4:01 pm

@Anti-Gnostic
Thanks for the explanation of what those things have in common now. I didn’t realize at first that the thing that old age, obesity/diet, smoking, and lack of exercise are all things that cannot be cured via medical interventions. Certainly people can change their diet, get more physical activity, quit smoking, quit doing drugs and drinking too much, etc., but it is the case that those things aren’t the result of taking a pill or the actions of a medical care provider, just like there is nothing medical providers can do to stop someone from aging. What are the implication for how we must intervene in healthcare? Also I just found a Kaiser foundation webpage that claims that Medicare spent roughly $600 billion in 2014 and I think that I saw somewhere that total US healthcare spending was in the $3-3.5 trillion range for 2014. Using some simplifying assumptions, Medicare is only spending money for care on the elderly and disabled, so all of that $600 billion is going to pay for conditions that are effectively untreatable or uncurable.

81 Harun May 12, 2017 at 5:31 pm

Diabetes often ends in….dialysis for kidney diseases due to….diabetes.

You’d be surprised how much is related to diabetes, and that its related to weight.

Lose weight, lose diabetes.

82 Hopaulius May 12, 2017 at 12:24 pm

My 92-year-old father-in-law stopped going to the gym while his wife was dying. This was in part because the hospice people didn’t believe he would actually go to the gym, so they didn’t respond to his requests for respite care. After his wife passed, he was using a walker to get around the house. He resumed going to the gym, his strength returned, and now his walker is a coat rack. He does not take any prescription medication.

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83 Art Deco May 12, 2017 at 2:41 pm

That’s a strange story. The median quantum of time people are in hosipice is about 12 days.

84 Hopaulius May 12, 2017 at 6:02 pm

It was a few weeks, but he stopped going to the gym before hospice became involved. Not entirely hospice’s fault.

85 rayward May 12, 2017 at 1:19 pm

Sure, bad habits might increase health care spending, but they reduce social security and Medicare spending; encourage these folks to smoke, eat french fries, etc. so they don’t make it to old age, adding to the insolvency of social security and Medicare. The alternative is that we round em up and gas them early on so we don’t have to subsidize their health care before they reach old age. A win, win, I suppose. It’s like the many often overlooked benefits of war: war takes car of overpopulation and excessive inequality (by destroying capital that’s owned by wealthy folks) while encouraging investment in technology. War, it’s win, win, win.

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86 The Anti-Gnostic May 12, 2017 at 4:25 pm

War is dysgenic. So is welfare, but in a different way.

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87 David Condon May 12, 2017 at 11:34 am

3. I didn’t click because you didn’t give a description of the content. I suspect the topic of the article governs my intrigue a lot more than its quality, but that’s adjusting for the average quality of articles you link to, which is very high. Calling it a bad article may slightly increase my willingness to click.

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88 Don Reba May 12, 2017 at 11:42 am

> language scientists Receptiviti AI

I wouldn’t put much trust in language scientists who can’t spell.

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89 Justin May 12, 2017 at 11:49 am

#5 has many problems. Although I personally am on a low-carb kick, it’s not the consensus treatment for diabetics. It’s going to further politicize nutrition. And publishing complication rates for doctors will just make it so that doctors refuse to take on the sickest payments for fear of hurting their rate. We’ve already seen that phenomenon well-document with surgeons who work in hospitals that incentivize low mortality rates.

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90 Daniel Weber May 12, 2017 at 12:06 pm

It’s hard to measure professionals by numbers.

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91 Harun May 12, 2017 at 5:32 pm

HFLC lost me 30 lbs and got my blood sugar to normal range.

It will be consensus soon enough.

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92 Hazel Meade May 12, 2017 at 12:28 pm

5. Why don’t we simply allow health insurers to charge these people according to their (measurable) compliance with lifestyle changes.

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93 The Other Jim May 12, 2017 at 1:38 pm

Yeah right. If they don’t move out of Chicago, to reduce their risk of getting shot, double their premiums? I don’t think that will fly, Hazel.

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94 Lord Action May 12, 2017 at 1:43 pm

Because the difference between lifestyle and “preexisting condition” is fuzzy and much of Congress doesn’t want to appear so hard-nosed.

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95 Hazel Meade May 12, 2017 at 2:42 pm

They were happy to allow a tobacco surcharge.
What difference is there, really between being addicted to nicotine, and being unable to quit eating carbs?

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96 jonfraz May 12, 2017 at 3:22 pm

It’s impossible to not eat carbs) they are the basis of the food chain and are present in some form in all food. If you mean “excessive carbs”, yes, eating too much of anything can be bad for you. But then we get into an argument as to how much is too much.

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97 Hazel Meade May 12, 2017 at 5:25 pm

Well, yes. I don’t literally mean no carbs, I’m talking about the sort of low-carb diet you need if you’re diabetic.

98 Anonymous May 12, 2017 at 2:44 pm

They should be concerned, especially as genetic tests start showing evidence of “appetites” of one sort or another.

Of course there was this report:

http://www.cnbc.com/2017/03/10/employers-could-demand-genetic-testing-under-congressional-bill.html

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99 Hazel Meade May 12, 2017 at 2:47 pm

Yet another reason to get employers out of the business of providing health insurance.

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100 John Hall May 12, 2017 at 12:37 pm

I’m not so sure that the yimbys in this case are just another kind of nimby, but I am sure that calling yimbys alt-right is an ad hominem. So what that they’re mostly rich white guys?

I think that the yimbys have a point, but unless they figure out a way to appease the minority groups that might get squeezed out as a result of their policies, they’re going to have an uphill battle.

One approach could be pairing the yimby policies with a rent price increase sharing agreement. For current low income residents, the city could agree to pay 50% of any real increase in rent over the next 10 years and then cap it at that amount. For instance, suppose that rent increases 2% for the next 10 years, then 0.5% thereafter with 1% inflation. That means that after 10 years, the real rent price would have increased ~10% over the first ten years, then fall to about a ~5% increase thereafter. The city would agree to pay half the amount the real rent is greater than the original (only for current residents). After thirty years, the city’s payment would fall to 0. However, if the nominal rent increase does not slow down, then it would be fixed at about 5 in real terms.

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101 Frans De Waal May 12, 2017 at 2:05 pm

if haute-magnon (cro) > haute culture, then middlebrow wins out, the hoi polloi and the apes and winos, riffraff and other whitewashed whatnot

Why did UBS and Medley capital pull back. Are they correlated?

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102 Cooper May 12, 2017 at 2:14 pm

If you don’t build more housing, the next generation of San Franciscans will have nowhere to live except their childhood bedrooms. I know dozens of people in that situation.

They have college degrees and full time jobs but they can’t afford to spend $1800 to split a three bedroom apartment with three other roommates.

You can’t stop gentrification. As soon as the little old lady in her rent controlled unit dies, the market rate rent returns and some yuppie will take the spot.

What are the anti-YIMBYs advocating for? A right to inherit rent controlled units at 1980s prices?

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103 Hazel Meade May 12, 2017 at 2:39 pm

The no-building/rent-control effort to stop gentrification is ultimately self-defeating. You can control supply, but you can’t control demand. The market rate is what it is and there’s nothing anyone can do about it – other than increase supply to meet it.

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104 Massimo Heitor May 12, 2017 at 2:49 pm

Sure, you can stop or at least slow gentrification. Have local government take enough properties off of the market, convert them to low income housing units, and stop the rich from building new properties.

BTW, I think it’s absolutely absurd to see these wealthy neighborhoods that have the very rich who can afford the price, and the very poor who get government housing. Middle class families are pressured to move away, but some completely unemployed underclass families get to move in? I see this in Texas neighborhoods, btw, with underclass adults who generally don’t work and don’t try to work, living in the priciest areas in government housing. so, it’s not just California.

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105 Hazel Meade May 12, 2017 at 5:17 pm

Sure, you can stop or at least slow gentrification. Have local government take enough properties off of the market, convert them to low income housing units, and stop the rich from building new properties.

So, basically convert the neighborhood into a housing project. We’ve tried this before, you know.

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106 Hazel Meade May 12, 2017 at 5:23 pm

Beside, the hate for gentrification is ridiculous. Would you rather live in a low-rent slum where noone wants to live except welfare cases and criminals, or a gentrifying neighborhood where it’s safe to walk down the street and there are thriving businesses?

The anti-gentrification mindset manages to outdo the hatred for Walmart for progressive retardation. The economy is good and people want to move to your neighborhood. THAT’s BAD!

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107 Massimo Heitor May 12, 2017 at 10:04 pm

I wasn’t implying that stopping gentrification or converting neighborhoods into government housing was a good idea. It’s quite the opposite. I’m just saying it can be done or something close to it. That’s not a good thing.

Generally, a bad neighborhood turning into a desirable one is an overwhelmingly good thing, although I’m sure there are edge cases of people who lose out that I can sympathize with.

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108 Rafael R May 12, 2017 at 2:23 pm

1st- US tax revenues are only 26.5% of GDP? How does if the US government spent 6.66 trillion in 2016, which is about 35-36% of GDP and states is had a deficit of 2% of GDP?

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109 Massimo Heitor May 12, 2017 at 2:39 pm

#3: That is an *awesome* article. Calling relatively wealthy tech incomers “immigrants” and those opposing their entry as “anti-immigrant nativists” is a brilliant and true maneuver. It’s very “alt-right” to challenge the dominant narrative like that.

The idea that some of the very poorest people have some basic human right to afford real estate in the priciest neighborhoods on the planet is ridiculous. Normal Americans can’t afford to live in downtown San Francisco or much of neighboring Oakland.

The determination of the anti-gentrification types to make this about race is ridiculous. Rich people can expensive real estate, poor people can’t, that really isn’t tied to race. Advocacy of building market rate housing that is in-demand is “white supremacy”? Really? Or consider this quote:

“The reality is that a low-income family of color who has lived in an area for years does not have the economic or cultural capital of the tech-moneyed arrivals”

This basically says that poor people are poorer than rich people. That is a tautology. Then adds in a irrelevant racial component to the argument to amplify outrage or maybe just to distract from the core ridiculousness of their argument.

Tyler is right, this is just competing NIMBYs. The broader immigration debate is also about competing NIMBYs. Recent non-US-immigrants are furiously defending physical real estate in California from other resident Americans who can outbid them. Mexicans are livid and hysterical at the idea of US actually imposing any kind of immigration limits on Mexicans, but Mexico themselves are ruthless about blocking immigration on their southern border. Canada loudly welcomes a tiny number of refugees and makes big PR about how welcoming they are, but in reality, they are very selective about choosing the most desirable people to be offered the privilege of living in Canada and they exclude the more genuinely desperate and needy who are generally less desirable populations.

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110 Anon7 May 12, 2017 at 7:20 pm

But intersectionality…yada yada…zzz.

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111 Edgar May 12, 2017 at 3:37 pm

#1 – the Justin Fox link – OECD does not include the health insurance mandate as a tax. Obama sock-puppet Chief Justice Roberts explicitly found the mandate constitutional because it is a tax. The OECD comparisons are therefore half-baked and meaningless and Fox too much of a half-witted twit to recognize Trump as his intellectual superior in every respect. If Fox is so frikking smart, why isn’t he rich?

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112 Todd May 12, 2017 at 4:27 pm

Another good link about productive people, how to treat successful people, mentoring, and more:

“He’s funny, let’s never discount that. It’s just, like most successful people, the thing they do is like third or fourth on the reasons why they’re successful.”

http://www.vulture.com/2017/05/chris-rock-aziz-ansari-mentor.html

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113 Floccina May 12, 2017 at 5:10 pm

#5 To harsh for most people to go along with, but maybe you could make some cheap insurance that does not cover medical care that can be self treated by, say losing weight or in the case he gave changing your diet.

Lots of interesting stuff but mostly politically impossible at this point.

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114 prior_test2 May 13, 2017 at 4:57 am

Yet, strangely, in Germany, where health care is thoroughly comparable (most people seem to have a real problem when saying better, even when linking to the Commonwealth Fund) to that found in the U.S. and costs a third less, such ideas would also be politically impossible. But then, in Germany, your doctor is also allowed to prescribe a Kur (not to be confused with ‘cure’). For example, an overweight person would spend say 6 weeks – salary paid, of course – at a place where they are expected to learn and follow the necessary recommendations concerning their weight. Kur is not vacation, at least not according to the people I know who have had one (for different reasons, none for weight loss). And it is pretty uniquely German, with a well connected lobby as it is quite profitable – a famous Kurort (town) can make quite a lot of money based on that designation.

Sounds utterly impossible to have such a system in America, particularly as it would likely to be considered the sort of thing that would drive health care costs sky high. Except that health care costs are a third less in Germany, yet again showing that there seems to be something uniquely American concerning these debates. Whether it is that famous American puritan streak, or just a lack of precision in thinking about health care compared to anywhere else (at least reference to the Kling’s reference – German doctors also bill through a generally non-government third party, and the patient never sees a bill) when talking about why America is different.

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115 steve May 14, 2017 at 11:12 am

Noah Smith may not be old enough to know how much time pre social media was wasted at work via 2 hr lunches by many in 1970’s as well as plain old visiting with work colleagues as part of at times not very short breaks in following decades.

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116 Troll Me May 14, 2017 at 11:27 am

A more reasonable number would be to compare (taxes + health expenditures).

But then the several percent higher spent on GDP (about a trillion dollars potential wastage a year) would be more apparent.

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117 Byomtov May 14, 2017 at 11:46 am

#5.

So when you show up at the ER with a heart attack is someone going to study your diet and exercise history before the bypass gets paid for? And if it’s a car wreck, how fast were you going? And didn’t you know motorcycles are dangerous?

If you are going to do it, and I prefer that you don’t, do it right. Diabetes is too easy an example.

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118 Byomtov May 14, 2017 at 11:54 am

All surgical providers of any sort must publish de-identified procedure counts and account for all complications and outcomes, updated no less often than monthly. Consumers must be able to shop not only on price, but also on outcomes.

More silliness. Cases vary. Do we want surgeons avoiding difficult ones to keep their batting averages up? Are consumers going to be able to make meaningful quality-based decisions?

And are “outcomes” and “complications” well-defined terms?

Oh, and in case anyone doesn’t know it, consumers don’t “shop on price,” as a rule, on serious medical treatment, even if it made sense to quote prices.

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119 Byomtov May 14, 2017 at 11:56 am

Americans, and especially health care providers, do not want to think of health care as a commodity. The providers want to be paid, but they do not want to think of themselves as selling their services, so the payment comes from third parties and the price is hidden to consumers.

How is this unique to Americans, as Kling seems to claim? If it’s not unique to Americans, and it isn’t, then it does nothing to explain uniquely American issues.

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