Results for “from the comments” 1938 found
From the comments, more on health care
Again this comment is from Sure:
From the comments, on single payer
Single payer’s magic has historically worked via just a few channels:
1. Some amount of monopsony allows the government to bid down medical services below market rates.
2. Political imperatives lead to lower training burdens, lower staffing ratios, and lower certainty in diagnosis and treatment.
3. Obfuscation of possible alternatives diminishes demand for costlier care.Option 1 means that you pay health professionals worse. There is some utility in this even. But it has some long run consequences that are only now being discovered. First, you see the exit of the most skilled people from medical careers. Second, the physicians unionize (or equivalent) and become political actors. Third, with everyone trying this and some semblance of open borders, it becomes ever harder to keep people in the places you need them (which rarely match the places where the sort of folks who can become Western physicians want to live). At some point you can no longer suppress wages below their natural clearing rate and it becomes ever harder to import foreign talent when other places (e.g. the US) offer a more lucrative immigration option.
US physicians are overtrained. But it also means that as things need ever more understanding to manage, we can deal better with things like CAR-T therapy and the like. And it is not like foreign docs are unaware of these things. As status is the important thing for most educated professionals, there will be continuous pressure towards increasing the prestige of the job at that comes with more training. As much as the government wants to have the minimally trained folks doing as much as possible, single payer countries are starting to see ever more pressure for their physicians, nurses, and the rest to match educational qualifications of the rest of the world.
Tying into all of this is the fact that the alternatives are quite visible. Everyone in the US these days can see an alternative where the masses do not have to pay out of pocket and theoretically fund health care by taxing someone else. But the flip side is also true. Wealthy Britons know that their American friends need not live with chronic pain for years for surgeries the NHS eventually will perform. They know that their American friends get screened more frequently and actually get treatment that cures diseases which are merely managed in Britain. They may still support the tradeoffs that come from single payer, but the days when these sorts of comparisons are no longer discussed are long gone.
Frankly I am always amazed at how much gets attributed to single payer. We know that, at most, only 25% of life expectancy outcomes are due to healthcare. We know that all of the correlates of single payer (e.g. percent of health expenditures paid by government) and health correlates (e.g. life expectancy) get vastly less favorable when you drop the US from the analysis as an outlier. We know that the UK has habitually adopted US practices a decade or so later, once the cost falls into the range where the UK can afford it.
But going forward, I think the old metrics that showed large advantages for single payer are going to continue to slide. Unions (formal or otherwise) are going to militate for higher pay. Governments are going to have to deal with one side of the political spectrum going into hoc to the health employees and the other polarizing to the folks in the disfavored region(s) who are lower priority for healthcare and pay more in taxes for the “giveaways”. And all of it is going to run into the trouble that the developing world is going to have fewer kids and hence fewer physicians while the relative advantage of immigrating is going to continue to fall.
Single payer was overwhelmingly built on the post-World Wars consensus and environment. It operates as a monopsony. What on earth would make us think that it would be stable into the future?
That is from “Sure.”
TC again: There is a natural tendency on the internet to think that all universal coverage systems are single payer, but they are not. There is also a natural tendency to contrast single payer systems with freer market alternatives, but that is also an option not a necessity. You also can contrast single payer systems with mixed systems where both the government and the private sector have a major role, such as in Switzerland.
I’ll say it again: single payer systems just don’t have the resources or the capitalization to do well in the future, or for that matter the present. Populations are aging, Covid-related costs (including burdens on labor supply) have been a problem, income inequality pulls away medical personnel from government jobs, and health care costs have been rising around the world. Citizens will tolerate only so much taxation, plus mobility issues may bite. So the single payer systems just don’t have enough money to get the job done. That stance is conceptually distinct from thinking health care should be put on a much bigger market footing. But at the very least it will require a larger private sector role for the financing.
From the comments, from Susan Dynarski on debt forgiveness
Zimmerman’s article does not make the case you claim. This RD captures the effect of going to a 4-year instead of a community college. The counterfactual is college attendance. This article is one of our key pieces of evidence that the quality of colleges matter. Put an student at a 4-year instead of a community college and you get the estimates discussed in the abstract.
Spending per pupil at four-years is about 75% higher than community colleges (historically it’s been even higher). https://hechingerreport.org/proof-points-states-and-localities-pump-more-money-into-community-colleges-than-four-year-campuses/
Here is the link, to my post on the educational returns to the marginal student. Please go back and read that for the context on Dynarski’s statement.
And from an email from David J. Deming, Harvard researcher in the area:
Sue is right that community college attendance is more common for students below the threshold in the Zimmerman paper. But many of them also attend no college at all. Table 4 shows that making the GPA cutoff increases years of 4 year college attendance by 0.46 and decreases years of community college attendance by 0.17. This implies that there is an increase in total college attendance – so the counterfactual is a mix of 2-year college and no college.
On the substance of the comment “do these people need debt forgiveness”? I’d say that ex ante they do not, but maybe some should receive it ex post. The Zimmerman estimate captures ex ante returns. Debt forgiveness is ex post. FIU’s grad rate was around 50% at that time, so the average return of 22% includes graduates and dropouts together. Ex post returns could be 44% for graduates and zero for dropouts.
Your idea of limiting debt forgiveness to dropouts was great. I wish that had been on the table. We’d worry about moral hazard if it became a forward-looking policy, but the Biden policy was probably not foreseeable in advance.
I would have also liked to see debt forgiveness focused on institutions rather than students. Forgive debt obtained at low-quality for-profit colleges. I would actually guess that college quality is a better predictor of lifetime wealth than current income. A person making $50k as a working adult 2 years after dropping out of University of Phoenix surely has lower expected lifetime wealth than a person who graduated from Harvard a few years ago and is making $50k in a public sector job.
My view is that decent returns to the marginal student still create problems for the Dynarski debt forgiveness argument. Overall the private returns to education are good. You can pack some of the problems into specific subgroups, but to the extent you do that the case for more debt relief targeting — much more targeting — rises rather steeply and rapidly.
From the comments, on corporate tax
How about the corporate minimum tax provisions?
Different rules apply for the determination of income for US tax purposes and for financial reporting purposes. Both are artificial constructs. Who is to say that one is a more accurate indication of “income” than the other? Congress is largely responsible for the difference by creating incentives through the tax code by offering accelerated depreciation, etc. for taxable income for pet projects such as climate related investment.
The AMT provisions of this tax bill create enormous additional complexity. The fact that they are designed to apply to only about 150 large corporations isn’t a way to create an rationale and equitable corporate tax system. Rather, it is designed to punish, in a Robin Hood like manner, the most successful US corporations and to *temporarily* fund spending provisions in the bill. Its complexity will create additional complexity and costs which consumers and investors ultimately bear.
I say *temporary* funding because the corporate AMT is generally an acceleration of regular tax liability. If a corporation pays the AMT, a credit against future corporate regular tax is carried forward. Congress likes to complain about corporations artificially carrying forward financial book income and postponing taxable income. Here, Congress is engaging in the same sort of shenanigan by accelerating current tax revenues at the cost of future revenue. The JCT only estimates additional revenue over a 10-year period. What they don’t report is that the AMT revenue during the first 10 years will reduce tax revenues in the years thereafter. It’s not completely zero sum, but mostly zero sum over a longer period of time.
The extent of public accounting games played by our political *leaders* is shameful.
That is all from Vivian Darkbloom.
From the comments, on Covid
We are just now evaluating vaccines based on the initial Omicron variant, which emerged seven months ago. They are only a moderate improvement on the status quo, in part because we have gone through several iterations of the variant since then. Because they are probably better but might not be that much better, Offit’s advice is even more delay while we study even more.
We have basically enshrined a process that guarantees vaccine development will be far behind the progress of the virus, the bad process itself being its own self fulfilling prophecy because the lag ensures the results will be worse.
The capability of mRNA vaccines to be quickly adapted to the disease is not being leveraged.
That is from Dan1111. And this is from Naveen K:
The Left in the last two weeks has said they’re for imposing mask mandates (coming soon in LA county) and Fauci restated his support for masks last week. All this while Biden WH saying Biden getting COVID isn’t a big deal.
On Nebraska (from the comments)
Seven-year Nebraskan here: Nebraksa is a well-governed semi-socialist polity effectively managed by competent antihero big businesses). This is all largely based out of business-Mecca Omaha. Business/govt relations are rather close. Governor Ricketts is brother to TDAmeritrade founder Joe Ricketts, Warren Buffet weighs in on the Omaha mayoral elections [1], real-estate taxes go to schools, [2] etc. There’s a tremendous amount of business/professional culture to match, and also a hometown/togetherness ensuring academia and healthcare are well-provisioned. CWT guest Ben Sasse best demonstrates these qualities. This comes at a cost of stopping taxation arbitrage -> eventual taxing of the burbs (Omaha annexing the wealthy Elkhorn suburb was the most notable political fight), the gradual Omaha-ization of Nebraska. Smaller counties struggle, and indeed some younger friends tell stories of their county struggling to keep the lights on when Bass Pro Shop dropped the store there. But one thing is certain – Omaha marches on.
Omaha has an effective moat (a business-only, low-arts town w/ awful weather) against a more radical political activist crowd that might ruin the flow of Omaha. Other companies are taking note – Google is building a new data center here, for instance.
This is all deliberate. Put yourself in enough fancy enough Nebraskan rooms and you will hear about how this is done – scholarships, targeting double-income-no-kids (DINKs) with things like dog parks, regular hosting of brief entertainment to draw crowds (CWS and Olympic trials) but not enough to draw the worst types of audience (drunk NFL fans). Omahans accordingly have an eagle eye for their city – ask them about Conagra’s HQ move and they will spend half an hour explaining to you how they were wronged.
Alas, the signs of Omaha experiencing larger business-town problems are sort-of on the way. For one thing, Omaha businesses were notably less woke when Trump was elected, and far more woke now, reflecting a greater influence of federal politics/topics, although it is hard to tell whether our businesses influence politics or our politicians influence our businesses. For another, the typical issues of more prominent cities are here – WestO, NorthO and SouthO are three different entirely towns divided by race/income pretty clearly. First National Bank of Omaha holds the original copy of the Louisiana Purchase, which ought to be visible to the public at a museum if you could ensure that BLM rioters wouldn’t destroy it. (Un)fortunately, the LP is hidden at the top of the building in a high-security office…
The real problem that Omaha faces is that while SF’s top guns are in their early thirties-fifties, Omaha’s leaders are in their early seventies to late nineties, and there is no guarantee that the next generation is up to the task. Culture changes when new people come in with new ideas, and there is no guarantee that Omaha’s next generation doesn’t ruin it for everyone.
I do find it odd, and perhaps a little too prescient, that some Omaha employers fitted their employees with emergency preparedness plans/WFH gear shortly before the pandemic, but this isn’t the point. The point is that Nebraska is an extremely intriguing place. The fact that there are only this many comments suggests MR audience does not take Nebraska seriously enough.
[1] https://jeanstothert.com/warren-buffett-endorses-mayor-stothert/
[2] https://omaha.com/news/state-and-regional/govt-and-politics/effort-to-revamp-nebraska-school-aid-ease-property-taxes-ends-for-now/article_98379cde-8b68-11ec-be12-affd05439f05.html
https://en.wikipedia.org/wiki/Elkhorn,_Omaha,_Nebraska
That is from Harvey Bungus.
From the comments (on war)
One of the really interesting contrasts that is widely known but highlighted by this war is just how well-provisioned and competent the USA is when it comes to manufacturing the needs of their armed forces as well as getting them where they are needed compared to their competitors.
The Afghanistan occupation may have been a failure but it was an unbelievable exercise in logistical execution. And even when the US had to leave in a hurry and left behind all that equipment, the controversy was all about “how could we let the Taliban get all that stuff?”. The cost of the equipment never really arose which indicates that the attitude to that was basically “there’s always more where that came from”.
Logistics wins wars…
That is from SpeculativeDiction.
From the comments, on Putin and Russia
I shall continue with my bad news from my Russian source. Apparently media in Russia are continuing to spout the brazen lie that US troops are in Ukraine (a few advisers are). I have also heard that apparently he is also ticked at Xi Jinping, apparently having not been met by any Chinese when he landed in Beijing, only the Russian ambassador. David Ignatius reports that Xi is “skeptical of Putin’s overbearing manner and disdain for rules” may be a two-way street.
What worries me is his isolation and egomania. While Xi is rational, Ignatius reports that Putin seems to have some delusions. The worst apparently is the one W. Bush had about iraq before going in, that he will be welcomed as a liberator, at least by the native Russian-speaking minority. it is now pretty clear that even in relatively pro-Russia places like Kharkiv, they do not want him coming in at all. He also has gotten the idea that taking Ukraine is a “sacred” cause, ugh.
I had long been thinking he would not invade, partly following the views of my friends in Kyiv on this, where even now they are probably more complacent than many others. But this latest stuff from Putin has me more seriously worried. I think Xi has him so he will not go while the Winter Olympics are on, but around Feb. 20 looks like a dangerous moment, the end of those and also the supposed end of the war games in Belarus. Officially his troops there are supposed to go home. But they could easily decide to do otherwise about then.
It is a combination of his delusions, isolation, and clearly mounting egomania on the part of Putin that have me the most worried now, and I am.
That is from J. Barkley Rosser, who has longstanding connections with Russia and the USSR.
From the comments
If it is indeed the case (very plausible) that the current crypto prices are highly overvalued but web3/crypto adoption becomes very mainstream and the gains do not accrue significantly to holders of many crypto assets that would redirect the investor energy towards Bitcoin aka “digital gold” by these investors and push the price of Bitcoin very high.
This would be a funny way how the Bitcoin maximalists win.
That is from Naveen K.
“What is wrong with physicians?” (from the comments)
My top candidates:
1. Loss of locus of control. People go into medicine to save lives. They believe that they will use their demonstrated intelligence and skills to make a difference. Unfortunately, modern medicine is ever more about turning physicians into box checkers. CPT codes, checklists, facility mandates, perpetual boards … a physician quickly loses control of their working day unless they are weird freaks who do extensively more work to retain control. And beyond that the average physician becomes enculturated to this much earlier. Which medical school you get into is largely a function of where you grew up, went to undergrad, and exactly how well you did on a test that everyone aces with a side of barely legal implicit racial quotas. Your residency is determined by where you went to medical school, where you went to medical school, where/what the top candidates want, and how well you did on a test that everyone aces with a side of barely legal implicit racial quotas. You spend a decade where your locus of control in life is minimal. Then you hit the real world and rather than being set free, you get hit by unending paperwork and yet a thousandth petty demand on your time. If you do research it is not uncommon to spend multiplicatively more time on compliance paperwork. If you head out to make money, you will find that your charge capture is more relevant than the quality of care you provide by an order of magnitude. All of this is a textbook case of loss of locus of control that we know is highly correlated with drug use and depression.
2. There is a wild disconnect between “being a physician” as understood by the public and what you actually live. The public thinks this is still the 1980s when you could pay for medical school working a summer job, residency was three years, and salaries were higher in real terms than they are today. Instead, physicians spend much closer to fifteen years going through training as the needed resume padding has grown at every step along the way. This means that they live longer at resident salaries which are close to US median, but typically are located in high population areas with expensive housing costs. And being a resident physician is not cheap. You have high commuting costs because the regs allow your boss to work you 24 out of 28 days. You can, and will, have weeks with over 100 hours of actual patient care. And again, remember that something like half of residencies are in violation of these rules. And all of this is while nursing a second mortage in undischargable medical school debt. Everyone will think you are rich and that you take fine vacations to Europe and the you will drive a flashy care. And maybe you will, but it will not be until after you are 40 and often 45 that the full physician lifestyle of the movies really comes into play.
3. And then we have the stakes. At every step in a physicians formative adult years you face massive ultra-high stakes events that we know are bad for mental health. College admissions (where you will hit a ceiling for medical schools if you get in too low), MCAT and medical school admissions (which will drastically lower your access to certain specialties if you end up having to go DO), Step and the Match (where you will spend five figures to beg for interviews, the folks on the other side will be unable to differentiate you from the thousands of other applicants, and when you get the interview the only thing of meaning that will come forth is if they like you and if you grew up nearby). Then you have boards and your first job. All of these are massively high stakes and they all require performing quite well relative to your peers. This sort of setup is known in experimental animals and people to lead to depression, anxiety disorders, and drug use.
3. Then we have the punctuated nature of the physician’s life. Going back to medical school, you routinely have long weeks with minimal time to enjoy because studying is rampant. Your entire career can theoretically hang on if you memorized which ultra-rare cancer is caused by which mutation in which gene – even if you want to be a psychiatrist. When you have time “off” this may be the only time you get and there is a very strong tendency toward binges and bacchanals. This will continue to residency where you might have one free weekend in a month (the others being taken up with working and studying), which again lends itself toward binging. And it may continue from there with horrid call schedules and long weeks punctuated by long vacations.
4. The stakes never get lower. You go through with your career riding on high stakes tests and your studying time never being accounted for in your official duties. Boards are now never ending and you face ever more theoretically threatening liability for your decisions.
5. And then there is the obvious stuff. Day in, day out you meet people at their worst. And all your coworkers are doing the same. People cry, threaten, swear, and otherwise abuse you. And nobody wants to get mad at somebody who was just paralyzed from the waist down. Likewise, you can only become so inured to death and dying, we are a social species with extremely large portions of our brains dedicated to feeling empathy for others, physicians see the 5% of humanity who is most obviously suffering as their modal patient.
6. Lastly, whatever you think about physician renumeration, it becomes painfully evident that the golden days were decades ago and there is a small army looking for ways to reduce your renumeration. It will fall disproportionately on you even when the major growth in medical expenses has been nursing, administration, and other warm bodies. Whatever you got paid for a highly taxing job last year, there will be a thousand signs that people think you should do it again for less. People who believe wholeheartedly in the stickiness of wages for reasons of morale and who hold that pay cuts are sufficiently difficult that we need to order international finance around inflation and obviating the need for explicit wage reductions will turn around and concoct wild schemes that explicitly reduce your income in real and nominal terms and question your character should your professional organization (to which you don’t belong) object. All, of course, while the administrators who are generally incompetent at understanding medical practice rake in an ever larger share of the money.
Some of this is US specific, but we have set up medicine to be highly backloaded with its rewards for physicians. We have risen the profession to a vocation and made it a truly arduous task to get through. And at every step along the way physicians have not had access to healthy coping mechanisms and repeated psychic injuries of the sort known to cause or exacerbate these conditions. Major life protective events (e.g. marriage, children, home ownership) are routinely delayed and disrupted by the demands of the training. Why again are we surprised that physicians come out bruised, batter, and willing to take the short term fix for some relief?
That is all from Sure.
From the comments, on nuclear waste storage
“Nuclear has a waste storage problem that remains largely unaddressed .”
Not so. The first, and easiest way to address it is to reprocess spent fuel as France does. The next is to use modern reactor designs that actually clean up old fuel from light water reactors. For example, Canada’s CANDU reactor, a proven common design, can burn the fuel from U.S. LWR reactors, and its own spent fuel is only dangerous for on the order of a thousand years (600-1200), instead of the 30,000 from current US designs. Maintaining waste for hundreds of years is feasible, and on a whole different scale than a 30,000 year storage plan.
Another plan for the waste problem os small modular reactors, which are never refueled onsite. You bring in the fueled reactor, run it for 10 years, then exchange it for a new one and take the old one back to the factory to be refueled. That centralizes waste and prevents all the problems with on-site storage. With waste reprocessing, 90% of it goes back into the reactor for the next decade.
There are known, robust solutions to these problems. Anti-nuke types just ignore them.
That is from Dan Hanson from the comments section.
From the comments, on boosters and Covid policy
My first reaction upon hearing that boosters were rejected was to ask the same thing: would these same “experts” say that, because the vaccines are still effective without boosters, vaccinated persons don’t need to wear masks and can resume normal life? Of course not. They use the criterion “prevents hospitalization” for evaluating boosters (2a) but switch back to “prevents infection” when the question is masks and other restrictions. What about those that are willing to accept the tiny risk of side effects to prevent infection so that they can get back to fully normal life? The Science (TM) tells us that one can’t transmit the virus if one is never infected to begin with.
Also, one of the No votes on boosters said that he feared approval would effectively turn boosters into a mandate and change the definition of fully vaccinated. So, it appears that the overzealousness to demand vaccine mandates has actually contributed to fewer people getting access to (booster) vaccines, thus paradoxically contributing to spread. A vivid illustration of the problem with, “That which is not mandatory should be prohibited.”
The biggest problem with public health professionals continues to be (1) elevation of their own normative value judgements — namely that NPIs are no big deal no matter how long they last — which have nothing to do with scientific expertise, (2) leading them to “shade” their interpretation of data to promote their preferred behavioral outcome rather than answering positive (non-normative) questions with positive scientific statements, (3) thus undermining the credibility of public health institutions (FDA, CDC) and leading to things like vaccine hesitancy.
That is from BC.
From the comments, on restaurant labor and UI
I own a restaurant and bar in a rural community in western Washington. Our state minimum wage is currently $13.69 per hour which is what we pay our tipped front of the house employees. After tips these employees are making $25 to $35 per hour. Not bad for a job that requires no formal training.
We start our back of the house cooks at $17 hour and up. For full time employees we also offer health insurance.
We are still having major problems finding employees. I have ads for employees that get zero responses. I am not alone in this. Everyone in our area from Costco, to Walmart, to all of the construction companies which pay very well can’t find help. In all my years I have never experienced a labor market like this.
My anecdotal experience from talking with local individuals is that they are enjoying the paid time off and have no plans to come back until the bennies run out.
For those of you who think you can just pay more and raise prices by a nickel, you are out of touch. As a point of reference, in 2020 the minimum wage increased from $12 hour to $13.50. The increase in costs to my business based on 2019 hours was over $65,000 which is most of my profit. Then covid hit.
Finally, keep in mind that most restaurant workers are not going to learn to code. I’ve have had recovering drug addicts, felons, and people with other social and mental disorders work for us. The restaurant business is an opportunity for many people at the margins of society to be productive and to get their lives together. We give them structure, training, and a paycheck. But the big question is how can you pay someone $15 hour who is only giving you $7 of value? In the long run you can’t.
The current policies of paying people not to work in the long run is going to hurt a lot of small businesses and more importantly, a lot of people in the margins of society.
And Slocum chimes in:
Everyone commenting here and every restaurant owner out there facing labor shortages is perfectly aware that if they raise wages high enough, they’ll get all the applicants they could ever want.
But some of the commenters here (and restaurant owners themselves) also know that restaurant profit margins are not large and that they have limited pricing power because restaurant meals are highly elastic, and that as restaurants raise prices, their customers will come less frequently and buy less when they do come. They also know that wages are sticky — that when the pandemic UI ends, they won’t be able to simply reduce wages back to previous levels without having a big impact on employee morale.
And as a business owner, just how big a bidding war would you want to get into just to be able to bribe the least ambitious prospects into getting off their couches?
Here is the link to the comments.
From the comments, Zaua on capital gains tax hikes
This is a big mistake even from a class equality perspective as it will cause rich people to invest more in things that are less liquid and accessible, and therefore harder to tax, from private businesses to real estate to crypto.
I believe that as much wealth as possible should be based on publicly traded corporations, because that is an avenue to build wealth that is accessible to all people with any amount of spare money and an avenue where regular people probably aren’t going to get screwed too badly by insiders because of the efficient markets hypothesis. However, the liquidity and accessibility of public markets also makes them easier to tax. So the higher capital gains tax rates are, the less attractive the public company form will be and the more attractive investment options will be put behind opaque structures that have tax advantages but also become too risky or even inaccessible to the general public.
If you must raise taxes on the rich, do it on their individual income rates, not their capital gains rates.
Here is the link.
From the comments, on FDA credibility
This maybe a violation of Cowen’s second law, but my cursory examination turns up no useful hits in PubMed about FDA credibility. We have the odd op-ed, some drivel about people thinking the FDA is more credible about cigarettes when they learn that FDA regulates cigarette manufacture, and precious little else of remote utility.
Almost as though senior FDA leadership have not bothered, after over a year of pandemic to even commission a rigorous survey of which action(s) the public would view as credible. Certainly what they are doing is not coherent with any of the effective medical communication techniques I was taught nor with any of my training for dealing with public responses to calamity.
But maybe I’m wrong. Maybe somewhere the FDA dumped a couple of grand into even a Mechanical Turk survey to justify actions that will have billions in cost implications and might lead to the death of thousands of folks (particularly overseas).
I mean, the civil servants at the FDA surely are not just LARPing as pop psychologists, somewhere I’ve missed they have actual peer reviewed literature guiding any of their moves regarding communication, credibility, and risk management, right?
That is from Sure. So what is the best piece on FDA credibility? (Yes, I know the work of Daniel Carpenter and have a CWT with him coming out and we do address this directly.) And what has the FDA itself done to study the issue of its own credibility?