Health care law, economics, and related musings

Not musings, exactly, but the things that I would blog about in more detail if I had more time to blog.

Crony capitalism is an oxymoron.  It’s cronyism, and it’s not just for conservatives.  An Obama ally got $340 million to set up health care co-ops, despite a “chronic record of consumer and regulatory complaints.”  Now, I have nothing against the consumer protection that is often championed by the Left.  What I do have a problem with is the selective enforcement and targeting thereof, which gives the impression that for many liberals, it’s not about the actual principle; it’s about winning.  I will also point out that a capitalist system does not reward those with a “chronic record of consumer and regulatory complaints”; those people go out of business or mend their ways.  Government largesse, however, allows them to continue without having to worry about pesky do-gooding competitors stealing their customers.

“Like Clint Eastwood Talking to a Chair” – an essay on the Obamacare ruling.

Another day, another blog post about doctors leaving medical care en masse.  Look, these people didn’t get straight As in high school and college, then go to medical school, then spend six years in residency, and get half-million dollar educations in order to do anything but save people’s lives.  They certainly didn’t do it to become paper-pushing bureaucrats.

ObamaCare adds $62 trillion to the long-term budget deficit.  But, you know, it’s

Note to the geniuses on Beacon Hill

Okay, fine, several notes to those geniuses. First, obesity is a problem with children in teens, but so are anorexia and bulimia.  (It is a problem for young men, too.)  While a letter home to parents stating that a child is obese may or may not make that child healthy, these letters and this screening could very well trigger eating disorders in young women and men.  Functionally, you are turning these fragile teens into guinea pigs in a social engineering experiment, attempting to find out whether or not quantifying a student’s ‘obesity’ is going to do more good than harm.

Second, BMI is a miserably terrible way to measure obesity.  It’s epically flawed.  A muscular person can be ‘obese’ and have nary an extra ounce of fat; an unhealthy couch potato can be a ‘normal’ weight, due to having a small frame but lots of extra weight.  Muscle weighs more than fat, which is why people (especially teenagers) can gain weight when they get in shape, although they may drop a dress size.  (Back when I was 19 or 20, a nurse at my doctor’s office weighed me; I was just under 130 lbs, and I’m 5’8.  She then told me that I should try to maintain that weight for the rest of my life.  Yeah, that’s a healthy, realistic goal for a middle-aged woman – try to maintain her college athlete weight.)

In fact, BMI is so absurd that it makes no distinction between men and women – it assumes that a healthy weight for a man is a healthy weight for a woman, and vice versa.

Finally, let us remember that this entire exercise is predicated on the notion that a parent cannot tell when his or her own child is not a healthy weight.  These parents have nurtured their children since birth, fed them every day, buy their clothes, see them every day, talk to them, know what sports they are playing (or not), and know how much time they spend in front of the TV.  Yet our government thinks that they need to tell parents when their children are not a healthy weight?  Japan and China are kicking our collective scholastic arses, and school systems are now spending their limited resources telling parents that their kids are fat?  Rather, no wonder why Japan and China are kicking our academic arses: we’re spending our time telling athletes that they are fat, couch potatoes that they are skinny, and getting everyone into sex ed, and they are teaching calculus.

Things that make me happy on Friday morning

Dark chocolate caramel bars from Trader Joe’s.  A slow day at work.  Not much traffic going to work.  Hearing that W2 forms will now show the cost of health insurance plans.

Okay, I’m a nerd.

As workers open their W-2 forms, many will see a new box with information on the total cost of employer-sponsored health insurance coverage. To some, it will be a surprise, perhaps even a shock.

Workers often have little idea how much they and their employers are paying for coverage. In many cases, economists say, workers give up cash compensation to get and keep health benefits.

The disclosures, required by the 2010 health care law, are meant to make workers more cost-conscious. Health benefits are still tax-free. But labor unions and employer groups say it could be easier to tax them in the future, now that employers must report their value to the government.

This is probably the only thing about ObamaCare that I like.  Most people have no idea how much their health insurance costs, and cannot fathom how much less money their families have because of these gold-plated plans.  Let’s consider a very average American family: household of four, income of $50,000 annually, and a $15,000 employer-provided health insurance plan.

Now, that family probably hates the idea of medical plans that have been proven to reduce costs: high deductibles, catastrophic coverage, and a lot of copayments (or payments that aren’t provided by the insurer at all).  That family is clipping coupons, budgeting like crazy, and trying to save up for college for the kids – how on earth, they rightly think, can they afford an extra $500 a year for physician’s visits, deductibles of up to $10,000 in a year, or 20% of radiology costs?

Except those costs would be very easy for that family to cover if $15,000 of their yearly compensation weren’t already being funneled into gold-plated health insurance.  High deductible plans and HSAs save money for both employers and patients; that can mean a higher salary, and a HSA paired with a high-deductible health care plan.  (See here and here.)  Ultimately, until people understand what money they are not receiving in salary due to the push for super-comprehensive health care coverage, or even how much money could be available for different types of health care coverage, we’re not going to be able to bring costs down.

 

Some frivolous blogging

A new study shows that women prefer men who are eight inches taller than they are, but men prefer women who are three inches shorter.  Is that good news for tall women like me, and, if so, why did all the dorkheads of my youth complain about my height?

Aside from the obvious mismatch interpretation – women prefer a larger height difference than men do – there is the possible interpretation that women prefer tall men, whereas men are fairly flexible about how tall a woman is, so long as she is shorter.  For example, most women, regardless of their own height, could prefer a man who is at least six feet tall.  Coupling that with the average height of women (approximately 5’4), you arrive at the researchers’ conclusion, but it could simply be that a woman, no matter how short, wants a tall man.

Men, on the other hand, seem to like tall women if they themselves are also tall, but shorter men still prefer women who are shorter than they are.  Men might be giving an ideal height difference, whereas women were responding with an idea height.

Correlation does not equal causation

The indomitable John McDonough asks who is right – does ObamaCare cost money or does it bend the cost curve down?  One thing I would like to highlight is this, from a NY Times article (internal citations omitted):

“One sign that the slowdown might be lasting is that it seems to have started before the recession took hold and is continuing even as the economy picks up. ‘The more we look at the data, the more it seems to me that the cost curve did bend before the recession,’ said Charles Roehrig of the Altarum Institute, a health care research organization. Additionally, health spending did not seem to decline or slow down more in states that were hit harder by the economic downturn, and it has flattened for Medicare patients, even though they tend to be sheltered from the effects of economic fluctuations.”

(Emphasis mine.) The recession started in 2007.  ObamaCare was passed in mid-2010 and does not take full effect until 2014.  It is entirely possible that ObamaCare could be driving up costs amid a slowdown in health care spending – i.e. the reduced spending (from other causes) is balanced out by increased spending for ObamaCare.

This is related to the way that you can cut permitting for drilling on federal lands but have gas prices drop: increased gas production in other areas temporarily offsets decreases in that particular area, although those decreases in production will increase costs over what they would otherwise be.  To analogise to one’s personal finances, you could save money by clipping coupons for groceries, but go to Starbucks for your morning lattes instead of making them at home.  Obviously, buying your lattes will cost you more money than making coffee at home, and obviously, you are saving money every week by clipping coupons to buy detergent, corn chips, and frozen meals.  But you wouldn’t say that buying Starbucks saves you money over making lattes at home – but this is exactly what Obama does.

Jake Tapper at St. Anslem College

Note: about 2/3ds of this was deleted (I blame either WordPress, iPad, or myself).  Will try to reconstruct the talk below.  Also, there are minor edits.

I’m in NH at St. Anslem College, listening to Jake Tapper speak about his career as a war correspondent.

He describes “The Outpost” as the most intense professional project of his life, a way to help Americans understand the military and why the war in Afghanistan is so difficult. He wants readers to understand counter-insurgency: how Americans fight insurgents by driving them out of their villages, work with the villagers to help, and work with the families who may have insurgents in their families or as friends.

Tapper wants readers to understand this “Not just intellectually, but emotionally”; the fear, difficulties, and struggles of American soldiers.

“It is not for me to judge” the policies of the war, Tapper says. He believes that between three and seven thousand troops will remain in Afghanistan after 2014.

The two small arguments made are that we need to equip our troops if we send them into harm’s way; the outpost did not have enough a equipment, including helicopters. Strategically, there were problems with sending provisions to the troops.

Tapper also said that there is an “inertia of Army thinking.”. Outpost Keating was too vulnerable and not accomplishing anything; due to some stubbornness (my words, not Mr. Tapper’s), the outpost remained in operation.

The Value of the Socratic Method

Professor Bainbridge asks “How big is too big?” for a law school class.  The professor concludes that two hundred students in a class is acceptable (while minimising the questions of cost, i.e. why law schools should charge eighty thousand dollars a year when two hundred students are in a class).

Now, I only had a few classes that had fifty or more students; none of my sections ever had more than seventy.  (My alma mater doesn’t even have a classroom that holds that many people.)  Many of my classes were with twenty or so other students; some had less than a dozen.  In some of the smaller classes, we knew that we would be grilled on a weekly basis; that’s just how the math works when three or four students are on the spot every day in a class of ten people.  It forced us all to be prepared each and every day in a way that we did not have to be prepared in larger sections. That training is part of the value of law school – and probably the only part that resembles the real world.

Students who are in a classroom of two hundred know that they may never be called on all year, and, if they are, it will be for a few minutes at a time, not for a half-hour of roasting.  This isn’t just a hazing ritual; it’s a means to train students to meet daily deadlines and to be prepared.  One can only imagine the disaster of arriving for court not having read the other side’s briefs, or sitting down with a client and being unaware of the relevant law, the client’s situation, or similar.

The problem with ‘positive rights’

It is tempting to say that there is a right to health care (or food, shelter, clothing, love, etc.), but the reality is that we merely have rights to try to obtain something without undue interference.  We have the right to seek out a physician’s services, to have that physician treat us to the best of his ability, without the government throwing barriers in the way, or without another person restraining us.  What we do not have is a right to actually succeed.

California illustrates that beautifully.  Now that health care is a ‘right’, there aren’t enough doctors to provide that ‘right’.  Giving people the ‘right’ to access medical care leaves precious few options: (1) make someone else pay the bill, and that bill is whatever the hell the doctor wants to charge, or (2) not pay the physician what the physician would like to be paid.  Note that the former almost always devolves into the latter as the populace gets tired of paying the bills.  When the second option kicks in, doctors leave the profession en masse – they have other things to do with their time that can be equally lucrative or a lot less frustrating.

Where does that leave our patient seeking out the ‘right’ to health care, but with no doctor to provide that right to him?  How much better for a patient to not have the right to a physician – he would have a better chance of obtaining health care.

The same thing is happening with the ‘right’ to the fanciest medical technology (paid for, of course, by the medical device tax):

Minnesota’s medical device makers say a new tax to help pay for the federal health care law could cause cutbacks, and even layoffs. The state is home to more than 700 medical device companies, and between 250,000 to 300,000 workers.

The nine employees left at Signus, a Chanhassen-based spinal implant company, took a 40 percent pay cut, and the owner isn’t getting paid at all. He blames the new medical device tax.

(From the above-cited article.)  So where does that leave people who squeal about how expensive medical devices are?  Without any medical devices, at any price, of course.

An interesting reversal

Dr. Helen Smith writes that boys perceive girls to be smarter, and thus, the boys try less hard in school.  Their teachers reinforce this by giving lower grades to the boys and punishing the boys more for behaviour infractions.  Dr. Helen speculates that the absence of ability to discipline boys in school has caused teachers to punish boys with bad grades, as well as to seek revenge on the next generation of men for what the previous generation of men did to them.

Miscellaneous thoughts:

It’s ironic that the same people who squealed about how girls couldn’t be as smart as boys, how the downtrodden Larry Summers was lynched for suggesting that innate abilities were at the heart of the male dominance in math and science, are the first to say that society is influencing how boys are succeeding.  My usual stance is that I frankly don’t care whether we think things are innate or social, but we should pick one and analyse all trends accordingly, not switch modes when we don’t like the group at the bottom.

It is further ironic that elementary school teachers are mad at discrimination in high-level jobs.  While all honest work is honest work, and a great teacher can change a generation of kids, let’s not pretend that we’re talking about a group of people who have faced any real job or career discrimination.  If a lady computer scientist or theologian wanted to sic it to men to get revenge for the treatment in her career, well, I wouldn’t agree, but I would understand.  But please explain to me what horrific career/academic-related sexism this group has suffered.

It does not benefit girls to be rewarded for following the rules and behaving properly – unless the goal is to turn them into bureaucrats, not business leaders, politicians, lawyers, scientists, artists, and writers.  The best people in any industry are the ones who know how to break the rules, refuse to conform, and have the confidence to implement their radical visions.  Even standardised testing, wherein men typically outperform their women counterparts, rewards a certain amount of rule-breaking.  The goal is not to show your work in a neat, organised fashion; it is to find the correct answer as quickly as possible, eliminate the four wrong answers, and know when to guess or when to give up.  Rules-followers get crushed by those tests.

Past performance is no indicator of future performance…

…but try telling that to my generation or the Gen Y generation.  Ann Althouse speculates that Baby Boomers have indoctrinated the young people to believe, deeply and emotionally, in the entitlement programmes that are crippling America.  David Brooks had asked why young people are going along with their own demise – sacrificing our own chances of building a stable future so that the Boomers may have everything.  (As I’ve often pointed out, ObamaCare transfers wealth from the elderly and the young to the wealthiest cohort of people – the Boomers. Thanks, guys!)

I’m not sure that it’s a deep and emotional connection that keeps young people voting for ever-larger entitlements: it’s the fact that, despite a $16 trillion national debt (of which Obama is responsible for $6 trillion), unfunded liabilities in the tens of trillions of dollars, and other horrifically scary economic statistics, America keeps chugging along.  How, they ask, could there really be a problem, when the Social Security checks are still being sent on time?  How is it a problem when Granny gets he second hip replacement?  Oh, we’re borrowing money to pay the interest on money we’ve borrowed – but that can’t mean a problem in the future, since it’s not having any discernible effects now.Psychological studies show that humans are really bad at thinking decades into the future, and young people are especially bad at it.  Whaddya mean, crisis?  You’ve been yammering about this crisis my entire life, which is like, totally long – do you know what high school is like? – and nothing has happened.  America is still rich, Bill Gates is rich, Warren Buffett is rich, and you think that there’s not enough money to go around?  This magical crisis will one day appear?  Yeah, right.  Where’s my Obama bumper sticker?Young people simply lack the perspective to see how slow decay, continued over many years, will cause a crisis.  They haven’t seen enough other “oh, that will never happen” crises turn into actual problems to understand how this will happen. They are good stooges for the Boomers.