Assorted links

1. Response from Aaron Carroll.

2. Via Chris F. Masse, Eric Schmidt debates Peter Thiel.

3. Tibet’s golden worm.

4. A short video about either Chinese civil society, or Austro-Chinese business cycle theory, or both, depending on your point of view.

5. Massive on-line learning and the unbundling of undergraduate education, a short thought piece by Benjamin Lima.


#1 "Doctor shortages and an underfunded systems lead to wait times. We always point to Canada, but their wait times (overblown) are because they keep the budget down. You can have a single payer system and no wait time problem (see Medicare). "

Awesome... So the unsustainable Medicare system, which is a major source of increases in private health insurance costs since hospitals lose on Medicare and make up for it with private plans, is the model for a single payer without wait lines. It sounds like Carroll wants to have his cake (single payer=lower costs with wait time) and eat it, too (single payer=no wait time with higher costs).

I don't see the problem, As far as GDP goes the US spends more on health care than any other comparable country (

So switching to single payer, will probably cut costs significantly and not hinder the waiting time by much, or with current spending, without the private sector's overhead, will probably cause negative waiting times.

And I am not going into all of the other benefits from a single payer system.

The myth of high private sector overhead is simply the result of govt keeping indirect costs off the programs books. Account for the costs of IRS, Justice dept, Treasury, etc. that are left off of Medicare's direct costs, not to mention fraud, and the overhead argument flops the other way.

Be careful drawing too simplistic of conclusions from our high GDP consumption. Between higher quality of care, and other countries free riding off of our innovation. Then, our current system is hardly "free market", and suffers from plenty of distortions of its own.

I find it very interesting how quickly proponents of ACA devolve their arguments into defending single payer, both you and Carroll. It's almost as if Obamacare is difficult to defend on its merits.

"So the unsustainable Medicare system, which is a major source of increases in private health insurance costs since hospitals lose on Medicare and make up for it with private plans"

This is a myth that is not supported by the empirical evidence. There is a difference between cost shifting and price discrimination due to market power.

In addition I think you are misinterpreting Carroll's point which is that wait times are not a function of single payer vs. private insurance, but rather health care costs and the number of doctors. His argument is that Canada has longer wait times because they keep costs down and uses Medicare as an example of single payer that doesn't have Canadian wait times precisely because it doesn't control costs as well.

At least the dialogue back and forth between Aaron and Tyler is somewhat substantive. Its the monkey wrench of the "zombie" comments, put forth by the blogger bully, that generally derails the progress of exchange between folks with different normative viewpoints.

Anyway, Aaron sings a mantra to other systems being "Cheaper, Universal, Just as Good". When i consider each of these claims, there are so many other cross factors that complicate the story.

Cheaper - to what extent do the higher wages in general in the United States contribute to this? To attract the highly skilled into medicine to become doctors requires a wage competitive with other wages that a highly skilled person on the US can make, which is often a lot higher than in other countries. So, controlling for factors such as this (and others), i would imagine that other systems aren't quite as "cheap".

Just as Good - to what extent do other systems utilize both medicines and techniques that have been developed in the United States in large part due to the financial incentives in place for them to do so? Would other systems be "Just as Good" if this is controlled for?

and as a side note - if someone who wants to engage in policy discussion utilizes the word "Zombie" in their argument, my vote is that people ignore the entire comment. Let those people engage in the partisanship and get out the vote efforts for the fall election. There is still an important place for those, just not here.

2. What an epic fail from Eric Schmidt.
We need more young people in the US to go to college so that they will be as well compensated as Googlers are today.
There has been great technological progress - for example, Chrome is #1 web browser today.

By the way, I don't think he actually believes these things, he's a smart (and very political) guy. Sad.

Just wanted to applaud Tyler and Aaron for about as civil a disagreement / misunderstanding you are ever likely to see on the political web.

It's also interesting to note that one Red state has done an exhaustive study of the Medicaid expansion and concluded it WILL save money: I wonder if all the other Southern states have even taken the time to do this type of analysis or if they are just rejecting the Republican-derived ACA because Obama got it through Congress. I doubt it.

From the linked article:

"Those are the costs. But there are also $131.5 million in savings that comes from three sources. There would be a reduction in uncompensated care — the medical bills that don’t get paid — as more Arkansas residents gained coverage."

So the care is no longer uncompensated. Who benefits from these savings? Hospitals that now get compensated? Other uses of health care services who get charged less? The state?

Who pays the compensation? Surely it isn't out of the pockets of the formerly uninsured. Sorry for the perhaps naive questions but the cash for the compensation has to come from somewhere and it also goes somewhere. It looks like the report comes from someone who doesn't understand TANSTAAFL.

Plus the article mentions the the savings turn negative in 7 years (2021). Is the whole project expected to end in 7 years (if so what's the point of a 7 year reduction in expenses), or what is is the terminal value in year 7? There's not enough information here to say whether or not it is a positive NPV project.

Finally in the linked article: "Arkansas ends up spending $3.4 million more on Medicaid in 2021 than it would by not participating in the expansion. Most spending goes toward its 10 percent share in covering the newly enrolled, which comes in at $112.7 million. At the same time, though, savings from the reductions in uncompensated care keep rising, partially offsetting those costs." But the savings don't offset the entire cost, it is still an expected negative cash flow.

On the Thiel / Schmidt debate, Thiel posits the problem with innovation is restrictions / gov't meddling, which is the standard libertarian party line. The question that I haven't seen addressed is what if technology makes people obsolete rather than improving lives for the less fortunate. The liberal answer is to address with education. The libertarian answer is to avoid government meddling. I asked Rod Long on BHL and he says it's hard to say. Tyler has mentioned on more than one occasion that the employment problem is structural. What if it turns out that it's structural and likely to get worse with additional innovation (more people become obsolete and for longer periods of time)? Retraining/ education are options but this becomes more difficult if the pace of innovation outpaces society's ability to deal with structural employment problems.

The problem with Carroll’s argument is that virtually every other country gets worse, less universal health care than Americans do.

Is it less efficient care? Absolutely, health care is marginal and in the end we all die regardless. Is it more expensive care? Definitely, and the price structure is largely broken because consumers almost never see price decisions. But on average you’re much more likely to be treated here — even if you’re poor (the exception is if you’re poor and live in a very red state, due to Medicaid).

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