Month: May 2013
The most expensive hospital in America is not set amid the swaying palm trees of Beverly Hills or the luxury townhouses of New York’s Upper East Side.
It is in a faded blue-collar town 11 miles from Midtown Manhattan.
Based on the bills it submits to Medicare, the Bayonne Medical Center charged the highest amounts in the country for nearly one-quarter of the most common hospital treatments, according to a New York Times analysis of 2011 data, the most recent available. No other hospital was at the top of the price list more often.
Bayonne Medical typically charged $99,689 for treating each case of chronic lung disease, five times as much as other hospitals and 17 times as much as Medicare paid in reimbursement. The hospital also charged on average of $120,040 to treat transient ischemia, a type of small stroke that has no lasting effect. That was six times the national average and 24 times what Medicare paid.
For those prices, the quality of care at Bayonne Medical is no better — or worse — than that at most other New Jersey hospitals.
The back story is this:
Bayonne Medical, which was founded in 1888, was losing nearly $1.5 million a month before it filed for bankruptcy in 2007. By 2011, under new ownership and a new financial model [sic], its patient revenue had nearly tripled and its operating income had reached $9.3 million, according to the American Hospital Directory, a publication that compiles data from Medicare and other sources about health care facilities.
Here is one commentary:
“Their model is to charge exorbitant rates, particularly for emergency room services, and if the insurance companies don’t pay them, they threaten to go after the member for the balance of billing,” said Carl King, head of national networks for Aetna, whose in-network contract was also ended by Bayonne in 2008.
You can read more here, interesting throughout.
2. Ezra Klein interviews Bill Gates about public health and development. Excellent piece. Gates, by the way, is now the world’s richest man once again.
One sometimes hears arguments for busing or against private schools that say we need to prevent the best kids from leaving in order to benefit their less advantaged peers. I find such arguments distasteful. People should not be treated as means. I must confess, therefore, that I took some pleasure at the findings of a recent paper by Carrell, Sacerdote, and West:
We take cohorts of entering freshmen at the United States Air Force Academy and assign half
to peer groups designed to maximize the academic performance of the lowest ability students.
Our assignment algorithm uses nonlinear peer effects estimates from the historical pre-treatment
data, in which students were randomly assigned to peer groups. We find a negative and significant treatment effect for the students we intended to help. We provide evidence that within our
“optimally” designed peer groups, students avoided the peers with whom we intended them to
interact and instead formed more homogeneous sub-groups. These results illustrate how policies
that manipulate peer groups for a desired social outcome can be confounded by changes in the
endogenous patterns of social interactions within the group.
The man of system, on the contrary, is apt to be very wise in his own conceit; and is often so enamoured with the supposed beauty of his own ideal plan of government, that he cannot suffer the smallest deviation from any part of it. He goes on to establish it completely and in all its parts, without any regard either to the great interests, or to the strong prejudices which may oppose it. He seems to imagine that he can arrange the different members of a great society with as much ease as the hand arranges the different pieces upon a chess-board. He does not consider that the pieces upon the chess-board have no other principle of motion besides that which the hand impresses upon them; but that, in the great chess-board of human society, every single piece has a principle of motion of its own, altogether different from that which the legislature might chuse to impress upon it. If those two principles coincide and act in the same direction, the game of human society will go on easily and harmoniously, and is very likely to be happy and successful. If they are opposite or different, the game will go on miserably, and the society must be at all times in the highest degree of disorder.
Do note that this discussion is not a critique of the paper which is very well done.
What would happen if the ECB immediately and directly ran a helicopter drop of money to the periphery? I don’t find that an easy question to answer. Here is one recent report:
But the indicator [interest rate spreads] has since risen again and reached a record of 3.7 percentage points in January, indicating companies in southern Europe were paying significantly higher interest rates than northern rivals.
“Market segmentation remains, divergence in bank lending rates persists and, as a result, immediate growth prospects in the periphery are bleak,” said Huw Pill, European economist at Goldman Sachs, who was previously a senior monetary policy official at the ECB in Frankfurt.
Would the new helicopter drop money be kept in periphery banks and lent out to stimulate business investment? Or does the new money flee say Portugal because Portuguese banks are not safe enough, Portuguese loans are not lucrative and safe enough, and Portuguese mattresses are too cumbersome?
The former scenario implies that monetary policy should be potent. The latter scenario implies that the helicopter drop will be for naught and the fiscal policy multiplier also will be low, on the upside at the very least (fiscal cuts still might cause a lot of damage on the downside). I call this the liquidity leak, rather than the liquidity trap.
So which scenario is it?
Does it matter who gets the helicopter drop? Perhaps a granny gets the money first and sticks it in the local bank. Alternatively, a financial manager in Lisbon would transfer that same euro rather seamlessly to his second account in Frankfurt. Under this differential scenario, changes in the distribution of wealth also have nominal and eventually real effects.
Is the flow of marginal deposits the problem or the flow of marginal loans? Or both?
Ryan Avent suggests allowing banks to swap their risky commercial loans for safer assets. Other ideas propose running QE on packages of small to mid-sized loans or accepting those loans as collateral at the ECB. Of course these assets are difficult to price and also moral hazard problems would loom. If the ECB is not “overpaying” for the small loans, they won’t be encouraged. If the ECB is overpaying, there are plenty of Sicilian businessmen who have friends at the local bank. The mere lending isn’t enough, the projects also need to be good ones, because in these cases we are talking about tackling issues in the real economy. Can a long-distance ECB collateral support operation spur good, growth-inducing projects? It is easy to see why the Germans might be skeptical.
In some regards these problems will look like liquidity traps, because monetary policy will not always work. But in the periphery lending rates are high (albeit with restricted credit), and standard liquidity trap models will not in general apply. Again, I call it the liquidity leak.
Liquidity trap approaches will encourage you to think in terms of raising expectations of inflation (which is indeed the correct question in many settings), but here the geographic distribution of credit and economic activity is instead the crux of the matter. Our current macroeconomic tools are not well-suited for integration with spatial economics, I am sorry to say.
Addendum: On some related issues, read Scott Sumner.
We examine causes and consequences of relative income within households. We establish that gender identity – in particular, an aversion to the wife earning more than the husband – impacts marriage formation, the wife’s labor force participation, the wife’s income conditional on working, marriage satisfaction, likelihood of divorce, and the division of home production. The distribution of the share of household income earned by the wife exhibits a sharp cliff at 0.5, which suggests that a couple is less willing to match if her income exceeds his. Within marriage markets, when a randomly chosen woman becomes more likely to earn more than a randomly chosen man, marriage rates decline. Within couples, if the wife’s potential income (based on her demographics) is likely to exceed the husband’s, the wife is less likely to be in the labor force and earns less than her potential if she does work. Couples where the wife earns more than the husband are less satisfied with their marriage and are more likely to divorce. Finally, based on time use surveys, the gender gap in non-market work is larger if the wife earns more than the husband.
Their title is “Gender Identity and Relative Income within Households.” There is a non-gated copy here.
1. Actual weekly number of hours worked in the UK, the data series. Not your grandfather’s AD problem.
7. In the world of theater, is this vigilante justice or not?
From Brad Plumer:
Nearly all U.S. clothing chains, citing the fear of litigation, declined to sign an international pact ahead of a Wednesday deadline, potentially weakening what had been hailed as the best hope for bringing about major reforms in low-wage factories in Bangladesh.
Companies including Wal-Mart, Gap, Target and J.C. Penney had been pressed by labor groups to sign the document in the wake of last month’s factory collapse in Bangladesh that killed at least 1,127 people. More than a dozen European retailers did so. But U.S. companies feared the agreement would give labor groups and others the basis to sue them in court.
…Wal-Mart reiterated Wednesday that it would not sign the accord at this time, because it “introduces requirements, including governance and dispute resolution mechanisms, on supply chain matters that are appropriately left to retailers, suppliers and government, and are unnecessary to achieve fire and safety goals.”
…Most U.S. companies, however, balked at the language in the accord. Some said it would would expose them to excessive legal liability — particularly in America’s litigious courts. Written by labor groups, the agreement would require retailers who source clothing from Bangladesh to commit to pay for inspections, building upgrades and training — all enforced by binding arbitration.
Here is more. Most likely, the damage done to Bangladesh will continue. Note that the prospect of successful litigation was not what drove FDI into the 19th century United States, or twentieth century Singapore, to the point where wages rose significantly.
Which raises a delicate question: Having already eclipsed Paris in Michelin stars, could Tokyo chefs one day eclipse the French at their own cuisine?
I put the question to pastry chef Sugino, who trained in France and is one of only four Japanese members of the prestigious Relais Desserts, an association of the world’s top pastry makers who meet regularly to exchange ideas.
Choosing his words carefully, he notes that pastry shops in France are having difficulty finding young people willing to put in the time and effort required to learn the craft. He also says that even top French patisseries are now taking shortcuts — by using stabilizers in their desserts, for instance.
“They are losing the basics,” Sugino says. “It is possible that, 10 or 20 years from now, the French will have lost the art of pastry but that it will live on in Tokyo, in Japan.”
Here is more.
Everyone has been talking about the revised CBO deficit forecast, which suggests the short-term U.S. fiscal picture is more favorable than had been realized. It can be said that in the short- to medium-term, the deficit is no longer an issue (in my view that was the case anyway, but that is a different story.)
But I am puzzled as to how the whole story is supposed to fit together, at least from an Old Keynesian perspective.
For instance, we have been told that the United States has been engaged in a good deal of fiscal austerity in the last few years.
We also were told that fiscal self-austerity was quite possibly self-defeating (or here, pdf) or at the very least fairly close to self-defeating. That is, it would make budget balance harder rather than easier.
The amount of attention, and the fervor of the rhetoric, also suggest that this was seen as a major issue, not one minor to moderate factor with seven other significant confounding factors operating on top of it. Admittedly this latter point is more of a subjective impression, but I believe many people have shared it.
OK, now here goes the potential story. We did fiscal austerity, it was self-defeating, that was a major factor, and we ended up in…a better budget situation than we had been expecting?
It is fine to say “our budget situation could have been better yet,” but then the fiscal austerity story then seems to collapse into one factor among many confounding factors. Which is fine by me, but it is not the story we seem to have been receiving.
I am myself comfortable arguing something like “when underlying fundamentals are sound, and/or there is monetary accommodation, an economy can withstand fiscal consolidation just fine.” That is simply a more specific variant of the above.
Another “way out” is to question whether “austerity” is always to easy to measure, given the associated modalities and baselines involved in its current definitions, and given the multiple dimensions of fiscal policy, and so perhaps the degree of austerity has not been nearly as high as we were told. I can buy that too, but still it would be news to the Old Keynesian accounts we have been reading.
So what’s up?
You will find his essay here, and I have many points of agreement with him, but I think he undervalues the first series. Characters and script were excellent in about sixty percent of the original episodes. It is also noteworthy that the original characters have entered popular culture for an enduring period of time and we are still making movies about them forty-five years later. It’s not absurd to think of someone saying “Beam me up, Scotty” fifty years from now. I don’t see Data or any other later character receiving the same treatment, nor do I think that any of the later installments would have, on their own, generated an entire franchise of installments, spin-offs, sequels, and the like, where Matt can tweet something like “Animated series is non-canon, people. Get with the program.” If you’d like a treat, watch some of the D.C. Fontana-scripted Star Trek episodes, noting that “Tomorrow is Yesterday” is one of the funniest and most profound takes on “the great stagnation” to be found in popular culture or anywhere else for that matter. And it was written before the great stagnation even started, and by Roddenberry’s office assistant at that. Magic was in the air. As for “Spock’s Brain,” well, that is another matter.
Genoa is one of the best food venues in Italy, as is Liguria more generally. It is also one of the best places in Europe for vegetarian dining. Maximize the number of tarts and vegetable tarts you eat, skip hotel breakfast and look for small places with morning snacks, preferably baked goods, and treat them as the equal of cooked dishes. Forget about meat altogether.
1. Antica Sciamadda, 14-16 Via San Giorgio, arrive at the 11:30 opening and keep on buying the tarts and farinata as they are freshly baked and put out on the counter. There is a vaguely Arabic feel to the dishes, and there is an excellent video of the place here. There are many excellent “sciamadda” in Genoa and they lie somewhere between a food stall and a very small restaurant, so do not count on them being open for dinner.
2. Trattoria alle Due Torri, Salita del Prione 53, near the Columbus house. Order pasta and focaccia, this is some of the best spaghetti I’ve had, and the pansotti (ravioli in walnut sauce) is notable.
3. La Rina, superb seafood restaurant, don’t focus on the main courses.
There are relatively few tourists in town, although the most common group — by far — is Russians. From Bologna, here is a post about flunking out of Gelato University.
…almost nobody is willing to break out the champagne on these estimates. The Keynesians think our shrinking deficit is a sign of the White House’s foolish surrender to austerity at a time when the economy still needs more government spending, not less, to achieve real lift-off. The deficit hawks think a dropping deficit will only encourage Washington’s fatal short-term thinking, by persuading policymakers to ignore the still-yawning gap between our long-term commitments and our revenues. Conservatives don’t like the extent to which we’re taxing our way to temporary fiscal stability (some of the unexpected deficit reduction reflected high-income tax filers paying extra for 2012 to avoid higher rates for 2013), while liberals have reason to fret that the White House’s “fiscal cliff” strategy squandered an important opportunity to raise upper-income taxes even more. And anyone who worries about the American political system’s ability to do structural reform can’t be that encouraged by the path we’ve taken to this point – the crude cuts to discretionary spending that leave entitlements untouched, the higher marginal tax rates rather than a rate-lowering, deduction-capping tax reform, and of course the general inability to compromise in the absence of artificial deadlines and self-created crises.
I don’t drink champagne but I’ll break out the dark chocolate instead. One way to put it is that “yapping” — on all sides of the political spectrum — is overrated, most of all by the yappers themselves.
A slightly different take would be this. Voters are getting more or less what they want, which is some spending restraint, mostly holding the line on taxes, not too much trust in government as a way of moving forward, and a love of entitlements. One can find that objectionable, and indeed I do across a number of fronts, but there you go. We are not going to elect a new people anytime soon, and in this odd sense you can see all the recent political gridlock as reasonably democratic, more so than its critics would like to admit (I know I’ll generate a bunch of criticisms citing poll data about how Americans really want this, that, or the other but I’ll hold my ground on this one). Relative to the quality of the preference inputs, we are getting a better outcome than one might otherwise have expected. After all, isn’t that what this country is really all about? We may not have the world’s best farinata, but let’s raise a toast to America once again.
7. D.H. Lawrence on Edgar Allen Poe (excellent short essay).
The Georgia Institute of Technology plans to offer a $7,000 online master’s degree to 10,000 new students over the next three years without hiring much more than a handful of new instructors.
Georgia Tech will work with AT&T and Udacity, the 15-month-old Silicon Valley-based company, to offer a new online master’s degree in computer science to students across the world at a sixth of the price of its current degree. The deal, announced Tuesday, is portrayed as a revolutionary attempt by a respected university, an education technology startup and a major corporate employer to drive down costs and expand higher education capacity.
Georgia Tech expects to hire only eight or so new instructors even as it takes its master’s program from 300 students to as many as 10,000 within three years, said Zvi Galil, the dean of computing at Georgia Tech.
…The deal started to come together eight months ago in a meeting between Galil and Udacity CEO Sebastian Thrun.
“Sebastian suggested to do a master’s degree for $1,000 and I immediately told him it’s not possible,” Galil said.
Eventually, the program came together for about $6,600 per degree. In a blog post, Thrun compared the day of the announcement to the day he proposed to his wife.
There is more here. Hi future.