One Reason Why American Health Care is Expensive

tl/dr; Canadian woman is diagnosed with cancer, told she has  2 years to live at most, that she is not a candidate for surgery but would she like medical help committing suicide? She declines, comes to the United States, spends a lot of money, and is treated within weeks. Her health insurance is refusing to pay.

Global News: Ducluzeau said her family doctor told her that with this type of cancer, they usually do a procedure called HIPEC, which involves delivering high doses of chemotherapy into the abdomen to kill the cancer cells. But when she saw the consulting surgeon at the BC Cancer Agency in January, she said she was told she was not a candidate for surgery.

“Chemotherapy is not very effective with this type of cancer,” Ducluzeau said the surgeon told her. “It only works in about 50 per cent of the cases to slow it down. And you have a life span of what looks like to be two months to two years. And I suggest you talk to your family, get your affairs in order, talk to them about your wishes, which was indicating, you know, whether you want to have medically assisted dying or not.”

…Her brother contacted his mother-in-law who lives in Taiwan and she was able to get some advice from an oncologist there, after only waiting an hour. That oncologist confirmed that HIPEC was the treatment for Ducluzeau’s cancer. She set up a Zoom call with that oncologist later that week but then she found out about Dr. Armando Sardi at the Mercy Medical Center in Baltimore, Maryland.

“I had an appointment to speak with him via Zoom as well within a week and then also in Washington State,” she explained. “So there were two hospitals in Taiwan, one in Washington State and one in Baltimore that were able to take me as a patient.”

Ducluzeau decided to get treatment with Sardi in Baltimore.

…“I had to fly to California to get one of my diagnostic scans done there, a PET scan, because I wasn’t getting in here and I had to pay to have another CT scan done when I got to Baltimore because they couldn’t get it in time before I left,” she said.

Before she left, Ducluzeau said she called BC Cancer to ask how long it might be to see the oncologist was told it could be weeks, months, or longer, they had no idea.

“And I said, ‘Well, will it help if my doctor phones on my behalf?’ And they said, ‘no’. And my doctor submitted my referral again and still no word. No word at all from (BC Cancer) until after I flew to Baltimore, had my surgery and got home.”

With the help of a surgeon in Vancouver, Ducluzeau finally got a telephone appointment with an oncologist at BC Cancer for the middle of March – two-and-a-half months after receiving her diagnosis and the news that she may only have two months to two years to live.

…The BC Cancer Agency is refusing to provide documentation that would allow Ducluzeau to be reimbursed for the cost of out-of-country care, citing she did not proceed with additional investigations, such as a colonoscopy and laparoscopy.

“Universal healthcare really doesn’t exist,” Ducluzeau said. “My experience is it’s ‘do it yourself’ health care and GoFundMe health care.

Best movies of 2023

As usual, they are in the order I saw them (more or less), not ranked ordinally.  And sometimes there are reviews behind the link, sometimes by me:

Knock at the Cabin, theology all over this one.

Return to Seoul (NYT review).

John Wick 4, yup.

Polite Society

Are You There, God? It’s Me, Margaret

Spider-Man: Across the Spider-Verse

You Hurt My Feelings

Incredible But True

Landscape with Invisible Hand

Bottoms, lesbian best friends in high school, not what you think.

The Creator

Joan Baez: I am a Noise, you don’t have to like her music to like the movie.

Holy Spider

Dream Scenario

May December, drenched in Bergman’s Persona.  And that is my pick for the best movie of the year.

The Killer (Netflix)


Godzilla Minus Zero.  I haven’t even seen this one yet, but I am confident in my judgment.

Updates will be made as is appropriate.  Overall, after some big dry spells, it was a pretty amazing year for movies.  Maybe not for Hollywood, but for movies.  Moviemakers are adapting well to the new circumstances and the new economics.  There are many more recommended selections I haven’t had the chance to sample yet, and maybe after I wake up I will put my list of those in the comments section.

What did you all like?


You can’t treat it as a normal movie with anything contextualized or explained.  Nope.  Rather think of it as a crazed male fantasy (the director’s?  Certainly not mine) about one particular way of living, presented large and vivid on the screen, with sex scenes too.  The fantasy doesn’t even have Napoleon as an especially smart guy, which of course he was.  The battles scenes for Austerlitz and Waterloo are some of the best ever filmed.  I can’t bring myself to call it “a good movie,” but it was better than expected and I was never tempted to leave.

Saturday assorted links

1. Tiny robots made from human cells heal damaged tissue.

2. Is the gender confidence gap contagious to evaluators?

3. What Tom Whitwell learned this year, always good stuff.

4. Should you offer to tip your GPT?

5. Claims from Jonah Goldberg.

6. Women fare better than men on the economics job market when they specialized in “high-male” fields.

p.s. they are doxxing anons using voice samples matched against text.  Just fyi.

Immigration Backlash

In a new paper Ernesto Tiburcio (on the job market) and Kara Ross Camarena study the effect of illegal immigration from Mexico on economic, political and cultural change in the United States. Studying illegal immigration can be difficult because the US doesn’t have great ways of tracking illegal immigrants. Tiburcio and Camerena, however, make excellent use of a high-quality dataset of “consular IDs” from the Mexican government. Consular IDs are identification cards issued by the Mexican government to its citizens living in the United States, regardless of US immigration status. Consular IDs are used especially, however, by illegal immigrants because they can’t easily get US IDs whereas legal migrants have passports, visas, work authorizations and so forth. Tiburcio and Camarena are able to track nearly 8 million migrants over more than a decade.

Our main results point to a conservative response in voting and policy. Recent inflows of unauthorized migrants increase the vote share for the Republican Party in federal elections, reduce local public spending, and shift it away from education towards law-and-order. A mean inflow of migrants (0.4 percent of the county population) boosts the Republican party vote share in midterm House elections by 3.9 percentage points. Our results are larger but qualitatively similar to other scholars’ findings of political reactions to migration inflows in other settings (Dinas et al., 2019; Dustmann et al., 2019; Harmon, 2018; Mayda et al., 2022a). The impacts on public spending are consistent with the Republican agenda. A smaller government and a focus on law-and-order are two of the key tenets of conservatism in the US. A mean inflow of migrants reduces total direct spending (per capita) by 2% and education spending (per child), the largest budget item at the local level, by 3%. The same flow increases relative spending on police and on the administration of justice by 0.23 and 0.15 percentage points, respectively. These impacts on relative spending suggest that the decrease in total expenditure does not simply reflect a reduction in tax revenues but also a conservative change in spending priorities.

The main reason for this, however, appears not to be economic losses such as job losses or wages declines–these are mostly zero or small with some exceptions for highly specific industries such as construction. Rather it’s more about the salience of in and out groups:

We study individuals’ universalist values to capture preferences for redistribution and openness to the out-group. Universalist values imply that one is concerned equally with the welfare of all individuals, whether they are known or not. By contrast, people with more communal values assign a greater weight to the welfare of ingroup members relative to out-group members. We find that counties become less universalist in response to the arrival of new unauthorized migrants. A mean flow of unauthorized migrants shifts counties 0.06 standardized units toward less universalist, i.e., more communal (Panel B, Column 5, std coeff: -0.16). This result is the most direct indication that some of the shift to the political right occurs because migrants trigger anti-out-group bias and preferences for less redistribution. Although this evidence is based on a smaller subset of counties, the impact is large. The change toward more communal values is consistent with theories that hinge on out-group bias. Ethnic heterogeneity breaks down trust, makes coordination more difficult, and reduces people’s interest in universal redistribution (Alesina et al., 1999).

These results are consistent with the larger literature that finds “Across the developed world today, support for welfareredistribution, and government provision of public goods is inversely correlated with the share of the population that is foreign-born and diverse.” (Nowrasteh and Forreseter 2020). Similarly, one explanation for the smaller US welfare state is that white-black salience reduces people’s interest in universal redistribution.

Contra Milton Friedman, it is possible to have open borders and a significant welfare state but it may be true that the demand for a welfare state declines with immigration, especially when the immigrants are saliently different.

Do start-ups formed during recessions fare better?

We combine novel micro data with the quasi-random timing of patent decisions over the business cycle to estimate the effects of being born in the Great Recession on innovative startups. After purging ubiquitous selection biases and sorting effects, we find that recession startups experience better long-term outcomes in terms of employment and sales growth (both driven by lower mortality) and future inventiveness. While funding conditions cannot explain differences in outcomes, a labor market channel can: recession startups are better able to retain their founding inventors and build productive R&D teams around them.

Here is the full research paper by Daniel Bias and Alexander Ljungqvist.

The realities of socialism

The Realities of Socialism is a multimedia project—a collaboration between organizations in Canada, Australia, the United States and United Kingdom—to educate people about the experiences of socialism that was imposed on tens of millions of people across the world throughout the 20th century. Here you will find data-driven videos, infographics, short videos and informative studies about socialism’s history in Poland and Estonia, Sweden and Denmark’s short experiment with socialism, and Singapore’s unique approach.

Here is the link, my colleague Peter Boettke is closely involved in this work.

YIMBY for commercial real estate

That is the topic of my latest Bloomberg column, here are some bottom line results:

What would “Yes in My Backyard” even mean in the context of commercial real estate?

A new economic research paper offers a hint of an answer: Most likely, there would be taller buildings, more mixed-use neighborhoods and considerably more wealth.

One way to approach this question is to look at less regulated cities. According to one widely used index, the least regulated metro area in the US is Midland, Texas. Midland isn’t particularly large or well-known, with a population of about 132,000, yet one of its nicknames is the “Tall City” because of its downtown skyline. When there is freedom to build, going vertical often is most cost-effective…

The research paper estimates the total social gains if every US city deregulated to the level of Midland, including the evening out of regulations within each city. The gains are strikingly large (though with some caveats): National output would rise by between 3% and 6%, and the gains in well-being would be in the range of 3% to 9% of lifetime consumption. Think of it as Americans getting a lifetime raise of at least 3%.


Another caveat is that the data behind these estimates is based on 2018 numbers, when a little more than 5% of the work force worked from home. Under one more recent estimate, 12.7% of all full-time employees work fully from home. (Hybrid work is more common yet, but that typically still requires office space.)

So the researchers ran their model again, this time assuming that 40% of workers were at home full-time. They still found a 1.5% output gain. Of course, given that the US is not currently close to 40% work from home, the actual gains from commercial real estate deregulation, circa 2023, lie somewhere between 1.5% and the larger numbers — the 3% to 6% output boost — I cited earlier. The researchers suggest that the gains from deregulation are almost linear in the share of workers who need offices, so the larger measured gains should be closer to the truth.

Here is the underlying research by Fil Babalievsky, Kyle F. Herkenhoff, Lee E. Ohanian, and Edward C. Prescott.

Who is responsible for grade inflation at Yale? (economists are meanies?)

If you click on the tweet you can see the full lists, as it gets much worse than what makes it on the screen here.  Via T. Greer.

Friday assorted links

1. Rasheed Griffith on reparations for the Caribbean.

2. Millions of new materials discovered by deep learning.

3. You can now pre-order Henry Oliver’s excellent Second Act: What Late Bloomers Can Tell You About Success and Reinventing Your Life.

4. Chinese semi-clone of a GPT model.  It’s not bad.

5. Remote collaboration fuses fewer breakthrough ideas.

6. You can pre-order Coleman Hughes, The End of Race Politics.

7. “Paraguay official resigns after signing agreement with fictional country.

Constructing Influence

VoxDev: A pervasive politician-developer nexus exists in Indian cities, where politicians receive illicit financial support from real estate developers in exchange for favourable building policies and accelerated approvals. This “quid pro quo” facilitates the flow of “black money” — income hidden from tax authorities — into campaign coffers. The nexus is difficult to discern in detail due to the opacity of the system, but we uncover what is plausibly a natural consequence: when politicians turnover, building construction slows down.

From a summary in VoxDev of my Journal of Development Economics piece (with Tandel and Gandhi) on the politics of development in Mumbai.

Addendum: See also my Journal of Urban Economics piece on the dangers of public interest litigation in slowing development and also my videos Skyscrapers and Slums and Rent Control in Mumbai for more on these issues.

South American economic growth

While there are varying sources, I did check a few of the numbers and they were confirmed. At first they seemed a little high to me.

Addendum: Note there is some kind of data problem with the 1980 numbers, but the latter-day numbers seem fine.

World War II R&D and the Takeoff of the US Innovation System

That is the article subtitle, the title is “America, Jump-Started:,” and the authors of this new AER piece are Daniel P. Gross and Bhaven N. Sampat.  Here is the abstract:

During World War II, the US government’s Office of Scientific Research and Development (OSRD) supported one of the largest public investments in applied R&D in US history. Using data on all OSRD-funded invention, we show this shock had a formative impact on the US innovation system, catalyzing technology clusters across the country, with accompanying increases in high-tech entrepreneurship and employment. These effects persist until at least the 1970s and appear to be driven by agglomerative forces and endogenous growth. In addition to creating technology clusters, wartime R&D permanently changed the trajectory of overall US innovation in the direction of OSRD-funded technologies.

This is very important work, and among other things it may help explain the productivity slowdown starting in the early 1970s (that is my speculation, not from the authors).  Recommended, for all those who follow these topics.

Here are earlier, less gated copies.

Nathaniel Hendren emails me

Saw your recent post on Intergenerational Mobility being constant over time. Just wanted to flag the importance of defining the relevant notion of Intergenerational Mobility. Much of the “mobility is falling” discussion has been about absolute mobility (kids earning more than their parents) not relative mobility. I think the evidence is now reasonably well-aligned in suggesting that various measures of relative mobility are reasonably stable over time (as we found in our work). But, absolute mobility has fallen in the last 50 years.

Thursday assorted links

1. Alexandria, Virginia ends single family only residential zoning.

2. Predictions about Seoul yikes.

3. Profile of Tamara Winter.

4. Background on the pending Guyana conflict.

5. Camera obscura, AI, and art.

6. Is AI easy to control? Speculative, but a good example of how the discourse runs, this time from the optimist side. And claims about Chinese open source AI, speculative too but important if true.  And more.