Archive for the ‘economics’ Category

Fixing healthcare

Sunday, March 26th, 2017

Obamacare is in a death spiral.

Trump promised to repeal and replace Obamacare, but then ran dead on it, allowing Ryancare to fail and washing his hands of it.

Trump then announces he has to compromise with the Democrats on medicine.

Single payer for everyone, as in Britain and Canada, is a horrible disaster, but despite being a disaster, once in place it seems impossible to remove. If we get single payer, we are screwed.

The key problem of US healthcare is absurdly high and completely unpredictable health costs – you stroll into hospital for something trivial, and if you are white and male, get hit for three hundred thousand dollars for no apparent reason. Routine and standard health care procedures like a colonoscopy typically cost twenty times what they cost in the rest of the world, and even though they are absolutely routine and standard no one will tell you what they are going to cost.

So, America has to copy from countries that have attained low and predictable health costs, and most importantly, up front health costs, where you know what you are going to be charged: These are Singapore, India, and Thailand, which have single payer for poor people. Which means that when some bum shows up at the rich people’s hospital, they send him over to the poor people’s hospital.

The reason America has no market in healthcare is cross subsidies – white males pay for everyone, and this requires opaque prices. The government decrees that hospitals will take care of the poor and female, that insurance companies will take care of the poor and female, which in practice winds up as cross subsidies, white males taking care of the poor and female, which results in a system with no prices and no markets.

To get health costs down you need a market and prices. Singapore and similar countries have a market and prices, and they can get away with this politically because there is a safety net for the poor, the feckless, and the unlucky.

If you have clear up front prices, someone has to pay for the poor people. If explicit up front prices then you need an explicit overt handout in place of the hidden handout paid for through hidden prices.

The trouble with single payer for poor people is that it is apt to grow into single payer for everyone, as has more or less happened in France and is happening in Germany. But Singapore has kept single payer under control, and single payer has not swallowed up the entire medical industry in Australia.

What I would really like is a system where you can just turn the poor and the sick away, but we cannot have that when we pretend to democracy, so some kind of single payer for poor people it has to be.

The trouble is, of course, the Democrats are going to demand single payer for everyone. But as the Obamacare crisis ripens, and the mid term elections approach …

Congressman Steve King’s solution to healthcare

Monday, March 13th, 2017

Instead of having a plan developed behind closed doors and then you have to vote for it to find out what is in it, you legislate the old fashioned way, congressional vote by vote. “A return to regular order“.

The great advantage of this is its great disadvantage. Congress cannot centrally plan the economy, or any significant part of the economy. No one central plan can receive a majority vote, or even a large plurality. Your are only going to get two or three percent to vote for one central plan, and four or five percent for another, and three or four percent for yet another, because there is a near infinity of possible central plans, any one of which is going to step on lots of people’s toes, each plan stepping on a different set of toes. You can never socialize medicine, or anything else, by congressional vote, except they vote for a closed box and discover to their big surprise what is in it when it gets implemented.

Before Obamacare, American medicine was unreasonably expensive by a factor of about ten or twenty.

After Obamacare, American medicine was unreasonably expensive by a factor of about ten or twenty, but bums, drug addicts, and vagrants were getting a lot more of this very expensive medicine, paid for mostly by white middle class males, and very shortly thereafter, white middle class males were getting a whole lot less of this very expensive medicine. Obamacare wanted more care for the poor, but it sought to prevent the total consumption of care from rising, for fear that would accelerate the already excessive price pressures, so a reduction in access to care by white middle class males was planned and intended from the beginning, though I don’t think anyone wanted to admit just how drastic and radical a reduction they had in mind.

The way to substantially reduce the cost of medical care is to have a free market in medical care with well known, well defined, and advertised prices, as in Singapore. At present, no one knows how much care is going to cost, and prices are frequently absurd by world standards. There is no good reason why a treatment in America should cost ten or twenty times what unsubsidized, for-profit, care, paid for out of pocket, costs in Taiwan and Singapore.

Genuine advances in medical care make medicine more expensive, as things can now be (expensively) treated that formerly could not be treated. But this fails to explain the enormous discrepancy in healthcare prices between America, and prices charged by private enterprise, for profit, healthcare businesses in Taiwan, Thailand, Singapore, and India.

Why Ryancare will not work

Wednesday, March 8th, 2017

Ryancare, like Obamacare, involves cross subsidies. Some people wind up subsidizing other people. The resulting landslide of rules and regulations will shut down competition, with the result that everyone plus the government winds up paying unreasonable prices.

Ryancare requires that insurance cover people with pre-existing conditions. That is not insurance, that is a handout. If the government is going to give people handouts, should be done openly through government funded hospitals and the like. If you rope private enterprise into giving handouts, you will find that this turns out to be a stupendously expensive way of providing handouts, not a cheap way.

You order private enterprise to give handouts, you wind up giving them monopolies so that they can fund these handouts, and they wind up abusing these monopolies. Further, people receiving handouts tend to be problem people. Some of them are unlucky, but most of them are no good. You don’t want no good people showing up to hospital in front of the good people who are actually paying for the hospital, or you get the Canadian situation, where no Canadian who can avoid it goes to a Canadian hospital but rather nips across the nearby border to an American hospital, because the Canadian hospital is full of homeless and drug addicts. And when I say full, I mean very full indeed, with beds in the corridors and urine soaked sheets, and not a normal middle class person in sight.

If the government is going to give handouts to people with pre-existing conditions, or handouts to anyone, it needs to keep the insurance companies and private sector hospitals out of it. Handouts need to be done openly and need to appear on the books as handouts. Hidden handouts inadvertently shut down the free market system, resulting in at best socialist levels of service, at worst socialist levels of service with staggeringly high costs.

Ryancare is the continuing ratchet leftwards, Ryancare is Republicans doing their jobs as tax collectors for the welfare state, where Democrats create unfunded entitlements, and Republicans proceed to make white middle class males pay for them.

Ryancare means that Republicans get to take the blame for Obamacare. If you are not going to repeal Obamacare, at least hang it on the Democrats.

The cost disease part 2

Sunday, February 19th, 2017

Costs of many important things, in particular education, housing, and healthcare are rising in ways that create artificial first world poverty, the inability to afford a wife and children.

Scott Alexander wrote a superficially thoughtful and well informed examination of these problems, which analysis was made stupid by crimestop.

A lot of high intelligent well informed people responded with explanations of the problem which accurately described parts and details of the problem, but crimestop prevented them from seeing, or at least prevented them from mentioning, the big picture formed by the details they quite accurately describe. Scott has collected these intelligent and detailed responses.

Among the commenters, LukHamilton observes that increased education is likely of negative value to society, and fc123 observes we are spending an awful lot of money educating stupid people in things that are unlikely to be of use to them, but then fail to put two and two together, or if they did put two and two together, they refrain from mentioning it.

The things raising costs are described correctly enough, but are treated as an assemblage of random unrelated facts. Things just supposedly happen to be this way supposedly for no apparent reason, and the fact that we cannot seem to do anything about these things also supposedly has no apparent reason.

The cost disease

Saturday, February 11th, 2017

Some leftists and a PC libertarian have noticed that progress is not progressing: Education, healthcare, and infrastructure is getting much more expensive without improving in quality, and in many respects declining in quality. Doctors no longer make house calls. Education teaches ignorance and stupidity. Infrastructure has brutalist architecture. Naturally they are completely mystified about what is causing it because crimestop makes them stupid.

First world poverty – the inability to afford a wife and children – is as artificial as the Ukraine famine. It is not a natural result of technology. Rather it is a manifestation of ever escalating left wing repression. Parents are forced to pay ever higher prices to send ever fewer children to ever lengthier periods in institutions of left wing propaganda. Used to be that getting a school leaving degree at the age of twelve showed you were a smart hard working kid. Now getting a PhD in intersectional feminist basketweaving at the age of thirty shows you are an idiot.

The ever escalating suppression of jobs forces people to live ever closer to the revolving door between regulators and regulated. Anarcho tyranny destroys housing and prevents the creation of new housing. Credentialism intended to force people to attend ever lengthening lectures on leftism forces people to waste their youth.

Reverse degree inflation, children become profitable once more. Cut regulation, price of housing falls because people can get jobs without having to live next to the regulatory revolving door. Restore marriage 1.0. Marriage then gives you the security to produce children and invest in them.

In a previous post Fixing Housing Healthcare and Education, I address those fixes.

In this post I will also address the  problem of overpriced infrastructure spending.

The rise in education costs is runaway rule by priests. Most education is useless, and gets more useless at the higher levels. If you ask why we are giving more stupid people more useless education even though it costs much more than it used to, then you also have the answer to why it costs more. If you have priests in charge, they will make everyone go to church all the time. Our education system is the state church making everyone go to church and attend religious festivals. It is time for the Dissolution of the Monasteries. We need degree deflation.

Our education system is state church making everyone go to church and attend religious festivals. In other words, degree inflation To deal with this, needs a full on attack on priestly power. We need a revolutionary transfer of power analogous to the dissolution of the monasteries.

After crushing the priestly class, then we can deflate credentials.

The priests need to be subjected to the Bishop, the Bishops to the Archbishop, and the Archbishop to the King. The Dean of a university should be appointed by the board, the Dean should have the power to hire and fire professors, and all academic funding should go through university, which is to say through the dean. If the Pentagon wants a professor at MIT to research something, it should pay MIT, not the professor. I discuss disempowering the priesthood and dissolving the monasteries in Draining the Swamp and in The Cathedral Defined.

The problem with Healthcare is that a system of cross subsidies and transfers results in a non price system, where there is no competition on price and quality. They abolished the free market in order to provide hidden subsidies from men to women, from whites to blacks, and from the rich to the poor, resulting in socialist levels of efficiency. Compare and contrast with Singapore, India, and Thailand that have free market sectors in medicine.

When you regulate healthcare so that the husband of a woman with complications of pregnancy winds up subsidizing the services provided to half a dozen women getting abortions, the result is that both the facility providing pregnancy care, and the facility providing abortions are given regulatory immunity from price competition, resulting in socialist levels of efficiency.

For healthcare to be efficient, you cannot allow people for whom healthcare is free to go in by the same door and face the same triage nurse as people who pay for their healthcare. If you want people to pay for their healthcare, they had better not see a pile of drug addicts looking for free drugs and vagrants looking for free room and board in the queue ahead of them. And you will only get efficient reasonably priced healthcare if people do in fact pay for it themselves.

Infrastructure is inefficient to the extent that it is provided by socialist means.

If I hire some people to fix my privately owned road, they come in, fix it, are done in no time. Council workers fixing council roads take a little longer. If, however, a road is being done on a federal tourist development grant, being paid for by people far away, well, when the cat is away the mice will play. That road takes a couple of years to do. Socialism is bad for infrastructure costs, especially when Democratic Party Politicians start importing vote banks, and federal socialism is worse for infrastructure costs, even if Republicans are in charge.

Infrastructure costs reflect in varying degrees, socialism, Parkinson’s law, and Democratic Party vote banks: The subway systems tend to become welfare programs for blacks, employing large numbers of blacks for their votes without any real expectation of any useful work. The most egregious examples of outrageous infrastructure costs are Democratic party vote banks, where ever more people with a Democratic Party voter profile are employed to do ever less work.

Educational inflation, (degrees are inflated in the sense that even stupid lazy people get the degree these days, and they are also inflated in that they cost a hell of a lot more) is a reflection of priestly power. Priests need to be disempowered.

Medical inflation is a result of the non market economy, that medical facilities (doctors are mere cogs within a “facility”) do not compete on price and quality.

Housing inflation is a result of regulation, zoning, and ethnic cleansing.

Infrastructure inflation is Parkinsons law: Socialist production always gets more expensive over time – and Democrat politicians hiring Democratic Party voting blocks worsens this natural tendency.

Vox, observing gigantic bureaucracies flailing incompetently, says

By the same token, while we know now that it’s certainly possible to set up a Healthcare.gov website that works as intended, we also know that on the launch date the Obama administration had not, in fact, built such a website. That embarrassing governance failure undermined the president’s signature policy initiative in serious ways, with crucial long-term repercussions.

But Vox was disinclined to wonder why the Healthcare.gov website failed.

It failed because women and minorities were in charge of setting it up. They threw ever more enormous amounts of money at it. Nothing worked until they brought in an emergency team that just happened to consist entirely of white males and east Asian males. This closely parallels the fact that Democratic Party administrations whose infrastructure building teams are full of people who profile as Democratic Party voters tend to produce Democratic Party majorities but not to produce very much infrastructure.

The psychological benefits of protectionism

Sunday, January 29th, 2017

Free trade is good on average, but:

1. Protectionism declares production, which is at present condemned as fascist nazi sin against Gaia, to be righteous and good.  Protectionism strikes at the moral superiority of progs, who think that shutting down factories, mines, and sawmills is inherently virtuous.

2 .  International agreements like the Transpacific Partnership are not free trade, and impair people’s ability to form families and have children, which harms the kind of people that voted for Trump.

3.  Even genuine free trade, even though beneficial on average, hurts some people.  In particular free trade between China and the US tends to equalize worker’s wages between China and the US, which harms the kind of people that voted for Trump.  On the other hand, free trade between Britain and the US is fine for the kind of people who voted for Trump.

When Trump permitted two pipelines, conditional on them using US made steel in US made pipes, the delicious liberal tears flowed – for not only did they consider the pipelines sinful, but they considered US made steel and US made pipes sinful as well.  When Trump added those protectionist conditions to the pipelines, he used the bully pulpit to tell liberals that they were not holy, that producing stuff is right and good.  No matter what the detrimental effects of protectionism on efficiency, the effects of a moral climate that condemns work and production as sinful and illegitimate is a thousand times worse.  When Trump explained his permits to the American people, Trump told the people that a steel mill belching out carbon dioxide is a good thing.

Obviously free trade is good on average.  But international trade agreements that consist of thousands of pages of legalese like the Transpacific Partnership are not free trade.  Rather, they are arrangements to replace local regulation with regulation by “The International Community”.  But distant regulation is necessarily more rigid, inflexible, and out of contact with reality, than local regulation.

Local regulation is corrupt in that you have a beer with a friend, who has a beer with his friend, who arranges that the regulation will be overlooked for you.  Or one of your employees seduces the bureaucrat.  Distant regulation, international regulation, is corrupt in that you hire a team of Harvard lawyers and team of lobbyists, who occupy several towers in Washington and New York City and get to write the regulations that bugger your competitors more severely than they bugger you.  Thus distant regulation, the Transpacific Partnership, inevitably favors giant corporations in major cities, and crushes small businesses in small towns – favors the people who voted against Trump, and crushes the people who voted for Trump.  When Trump dumped the Transpacific Partnership, he took a boot off the throats of the people who voted for him.

Inevitably, international trade agreements like the Transpacific Partnership favor people in the big cities, and hurt people in flyover country, hurt the people who voted for Trump, benefit the people who voted against Trump. So people move from flyover country to the big cities.  And it is hard to marry in big cities, and there is nowhere for the kids.  Women in big cities, like women on international trips, are free from the watchful eyes of friends and family, and tend to fuck around, rendering them unmarriageable.  If you repeatedly reuse stickytape, it stops sticking, and women that fuck too many men become emotionally incapable of bonding to husband and children.  Also, in the big city, hard to know what your wife or girlfriend is doing.  In a small town, your wife will not misbehave, because she knows news will get back to her husband.  Because the big city makes it easier to cheat on your wife or husband, the big city makes it harder for men and women to cooperate to form families.  Notice that most of those women screaming in outrage about Trump grabbing women by the pussy are big city women who are old enough that they are quite safe from the likelihood that Trump might grab them by the pussy, are single, are too old to marry and have children, and are facing what they thoroughly deserve, a lonely and unloved old age.  Again, Trump benefits those who voted for him, and to hell with those who voted against him, to hell with those who are now screaming at him and weeping tasty tears.

Trump’s healthcare plan

Saturday, January 28th, 2017

Trump has explained the free market part of his healthcare plan in detail. It is heavily influenced by the free market part of Singapore’s tremendously successful free market healthcare system. I have no doubt that if implemented as described, it is going to work and work well.

Trumps plan for the free market healthcare system is great.

But what about Singapore’s socialist healthcare system for the poor and unfortunate?

Trump gets vague. Hospitals, he tells us, are going to get paid to take care of people “who really cannot take care of themselves”.

The trouble with this is that as I said earlier if bums, vagrants, and drug addicts go through the same intake, queue in the same line, and get the same treatment as you and me, there are going to be so many drug addicts looking for free drugs, and so many vagrants looking for free room and board, in line ahead of you and me that you and I are not going to get treated.

The way Obamacare deals with this problem is that you and I cannot afford to get treated because we are paying so much to look after drug addicts and vagrants.

Obamacare has provided insurance for everyone, by making everyone equally uninsured, provided equal access to everyone by equally denying everyone access. Obamacare has, predictably, collapsed. Ann Coulter cannot get insurance that covers broken bones and cancer. If you cannot get insurance that covers broken bones and cancer, not much point in having insurance at all. (Ah, but she is guaranteed free abortions, which get priority above broken legs.) If she suffers anything expensive, she will wind up with the same treatment options as the homeless bum who heads to hospital for free room and board. Which is to say, really crappy room and board, which is what you got in place of treatment in Cuban hospitals. Universal healthcare for the poor has become universal lack of healthcare for the well off.

The healthcare system has, predictably, collapsed, because it is being swarmed by bums, vagrants, and drug addicts.

When you fly, there is business class and cattle class. For Trump’s plan to work, hospitals are going to have to have separate intakes for those who are insured and paying deductible, and those who are getting free handouts. And those who are getting free handouts have to be made to really wish they were getting the kind of treatment that those who are insured and paying deductible get.

The big, big, problem, the problem he is being very quiet about, is preventing his plan for “Insurance for everyone” from devouring free market insurance the way Obamacare did. To prevent it from devouring the free market, you have to be mighty harsh on people who are getting medical care free.

You cannot adequately take care of bums, because bums will always demand more care than can be supplied. Thus a genuine universal scheme always winds up not providing care for anyone. If Ann Coulter breaks a leg or gets cancer, probably will wind up flying to Singapore, Thailand, or India.

For Trump’s scheme for “those who cannot take care of themselves” to work without destroying healthcare for paying customers, hospitals are going to have to have a separate door for “those who cannot take care of themselves”. And behind that door there needs to be someone with a taser, a stun gun, and a baton, plus doctors with a very simple and effective treatment for drug addition and obesity. They give the druggie no drugs till he completes withdrawal, and the obese person with no food at all till he is slim. Doctors have a hundred too clever by half rationales for not giving unpopular treatments. For non paying customers, however, need to give the most unpopular effective treatment possible.

The perils of government intervention in health care.

Monday, January 16th, 2017

It is mighty embarrassing if a sick person is turned away from hospital to die in the street because he has no money. So the kindly government insists that sick poor people be treated for free.

But if the hospital is going to treat poor people for free, then the hospital is going to besieged by people with carefully memorized symptoms for vague and difficult to treat diseases who show up looking for a bed, some food, and some human contact.

So, the next thing the government should do is empower to the hospital to turn away unwanted patients with a jab from a stun gun. But they don’t, because that looks kind of bad. But they do kind of sort of give the hospital some kind of monopoly power, and some power to hurry up patients who are taking too damned long to die. And then to the government’s surprise they find the hospital is mistreating and murdering affluent middle class patients. The government also finds that it still running up gigantic medical bills on bums, who are supposedly getting all sorts of extremely expensive medical treatment, though in fact they are getting this super expensive treatment only in the most superficial manner or not at all.

The hospital is rushing middle class patients out the door or into the morgue, while every corridor is piled high with incredibly expensive (and profitable) bums piled three to a urine soaked bed. (Yes, Canada, I am looking at you.)

When the government empowered the hospital to be quietly and furtively brutal and murderous, the intent was that the hospital only be brutal and murderous to the horde of bums besieging it – but they could not actually say that out loud, and if they had said it out loud would still find it difficult to get compliance.

So now the hospital is massively over treating bums, massively undertreating people who are genuinely ill with genuine diseases, and murdering any of its customers who are too sick and weak to protest. And medical costs are soaring.

So what should the government do?

Firstly, needs to hit who everyone lays down his head on a hospital bed with a high enough deductible that anyone who is not all that sick and who has to pay the deductible will not go near the hospital bed. It does not have to be all that high, does not need to be nearly as high as the Obamacare deductibles. Five hundred should do it. First thing that should happen on intake is a wallet inspection.

But suppose the patient does not have five hundred in his pocket, nor an acceptable credit card, and seems unlikely to pay. Then the nice friendly hospital for nice respectable middle class people sends him to the hospital for poor bums staffed by big ugly lesbian nurses with thick mustaches, where the first thing he meets is the death penal, with a big male guard holding stun gun, a baton, a taser, and a twelve gauge shotgun standing uncomfortably close beside him, and the death panel decides whether his treatment is likely to be cost effective.

Now at the nice friendly middle class hospital for nice middle class people we try to organize things so that the doctor and the hospital has to please the customer, if they are going to make some money, and the patient bears enough of the cost to scream bloody murder if overbilled or billed for nonexistent or barely provided services. Deductibles need to be high enough to hurt a bit, but not so high that they are, like Obamacare deductibles, frequently unpayable.

And at the hospital for poor bums, we provide all the wonders of socialist medicine so beloved by Bernie Sanders, modeled on the wonderful success of Cuban healthcare. </sarcasm>

If the hospital is in the business of handing out free beds and food, it is going to need to be able to whack undeserving customers with a baton, jab them with a stungun, and throw them into the street hard enough to bounce several times. On the other hand, you would probably prefer to send your elderly grandma to hospital that does not do that sort of thing. So we need to keep a good separation between the hospital that hands out freebies, and the hospital that does not hand out freebies.

Or, equivalently you need to have very different rules in place for treating the people who are getting free food and free beds, from treating the people who want to get out of hospital as soon as they can. You have to treat one lot pretty much the opposite of the other lot.

Replacing Obamacare

Thursday, January 5th, 2017

The major problem with the American healthcare system is that it has no prices, making it a completely non market system.  It also has a massive redistribution from whites to nonwhites, which wealth redistribution system disrupts the provision of healthcare.  What tends to happen is a hospital treats a hundred illegal immigrants for morbid obesity, and they do not pay their bills, and then it treats one white male, and he does pay his bill – which is set high enough so that the one person who pays covers the hundred people who do not pay.

The best system is Singapore, which has a socialist healthcare system for the poor, and the most Ayn Randian hard core capitalist healthcare system in the world for everyone else.  Which system provides healthcare at a fraction of the cost of everyone else’s system and for the most part healthcare of substantially better quality.

If you are poor and sick, or sufficiently healthy that the quality of your healthcare does not matter much to you, you go to a government owned hospital, consult with a government employed doctor, buy government owned medicines from a government owned pharmacy.  Otherwise, you just pay for it as if you were hiring a plumber to make modifications to your bathroom. The major government intervention in the private sector is making pricing information accurate and available.  Private healthcare practitioners are free to dump people who will not or cannot pay on the socialist sector, or just not let them through the front door if they fail a credit check.

So the explicitly socialist system takes care of the pity cases, and the explicitly capitalist system takes care of everyone else.  So everyone else gets the benefits of capitalism, and only the poor or the healthy suffer the consequences of socialism.

Nuclear Technological decline

Sunday, October 9th, 2016

The US no longer produces weapons grade plutonium. Supposedly this is a choice.

It has asked other countries to not produce weapons grade plutonium, and to get rid of the weapons grade plutonium they do have.

The economical way to destroy weapons grade plutonium is to burn it in nuclear reactors, to use it for power, which destroys some of it and irreversibly contaminates the rest with plutonium 240, making it unusable for weapons, though still usable for power.

Unfortunately, the US, in attempting to do so, ran into “massive cost overruns”, which is to say, technological decline. Putting it in breach of its agreements with Russia and Japan.

Under the US-Russian PMDA, originally signed in 2000, both parties agreed to dispose of at least 34 metric tons of weapons grade plutonium, enough to produce 17,000 nuclear bombs.

The US, however, has not disposed of any plutonium, despite spending a lot of money attempting to do so. If you cannot use it, probably cannot make it.