tag:blogger.com,1999:blog-582368152716771238.post2349432604474893421..comments2024-03-28T14:41:03.793-05:00Comments on The Grumpy Economist: NoahLogicJohn H. Cochranehttp://www.blogger.com/profile/04842601651429471525noreply@blogger.comBlogger42125tag:blogger.com,1999:blog-582368152716771238.post-80543381701678220092017-07-23T14:20:13.965-05:002017-07-23T14:20:13.965-05:00You forgot to mention mattresses. Have you shopped...You forgot to mention mattresses. Have you shopped for one online before? The amount of free information, reviews, and comparisons available on the internet is remarkable. Markets are wonderful at providing information and education in all forms, especially as the choices increase. My local coffee shop, where I'm currently writing this comment, provides all sorts of mini-courses on coffee. If you don't want to pay the very small fee, the barristas will be happy to chat with you as long as you want to learn more about their process for roasting, the differences in beans, etc. <br /><br />As consumers, individuals are far better educated than they are as voters. To fear that they aren't belies the daily experiences of literally billions of people. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-53893744826321843092017-06-27T09:08:54.935-05:002017-06-27T09:08:54.935-05:00Food stamps shouldn't ignore its effects on he...Food stamps shouldn't ignore its effects on health economics.That was a great content but too lengthy so i read it upto 80% only.Anonymoushttps://www.blogger.com/profile/05406605686956263621noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-36212579260058772982017-06-22T14:00:15.820-05:002017-06-22T14:00:15.820-05:00I'm skeptical about the ability of consumers t...I'm skeptical about the ability of consumers to be educated shoppers for cars, contractors, car repair, financial advice, banking, home remodeling, food, restaurants, taxis, TVs, air conditioners, computers, software, houses and just about everything else. It's a complex world out there. I'm less skeptical about the ability of intensely competitive industries to help consumers to buy quality products. Look out the window -- the more supply competition, the better all of these information problems are resolved. I'm deeply skeptical about government bureaucracies to do a better job of finding a highly varied, personalized service, with great quality variation. Would you trust the Affordable Kitchen Rehab Act bureaucracy to get you a good deal? John H. Cochranehttps://www.blogger.com/profile/04842601651429471525noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-10176328442973951042017-06-22T13:21:38.688-05:002017-06-22T13:21:38.688-05:00John,
I generally find you to be a very clear-ey...John, <br /><br />I generally find you to be a very clear-eyed and logical writer on the health insurance topic. However, I'm a bit skeptical about the ability of consumers to be educated shoppers in the healthcare market. Do you really believe that in a less-regulated market there would be full price transparency? Do you imagine hospitals and doctors moving to standardized price schedules that one could peruse online? Moreover, how is one supposed to judge the quality of those services (or prescription drugs for that matter)? I'm skeptical that there would be a "consumer reports" for hospitals and drugs with thorough cost-benefit data available. There is always an advantage for the seller to keep pricing opaque and insist that each instance is 'bespoke' - I would be surprised if hospitals/drug manufacturers surrender that advantage readily. Anonymoushttps://www.blogger.com/profile/00724280544364726437noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-58283437383993379722017-06-12T09:39:11.476-05:002017-06-12T09:39:11.476-05:00Fabrizio, see below what the BBC reports for Engla...Fabrizio, see below what the BBC reports for England. Similar studies show similar results for Canada. And the numbers are probably lower because those who can afford to do so, come to the US. Now, given that the population of England during that period was about 52 mil, the percentage is indeed very small, 0.03% over a five-year period. But the report certainly dispels the idea that a national healthcare system gives poorer people equal access to health care. The question is whether we can do better than that.<br /><br />"There were 15,396 more deaths than expected at the trusts in the period between 2011 and 2016. Blackpool Teaching Hospitals Foundation Trust had the highest number of excess deaths - 1,878 over the five years. The analysis reveals a strong link between high mortality rates in England and lower than average doctor numbers. High levels of hospital bed occupancy also appear to be an increasingly important factor in high mortality rates."<br /><br />Source: http://www.bbc.com/news/health-39204681<br />Constantine Alexandrakishttps://www.blogger.com/profile/03148709241309623293noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-18173584318967952982017-06-11T06:17:56.727-05:002017-06-11T06:17:56.727-05:00John, it happens very rarely in Italy that the Nat...John, it happens very rarely in Italy that the National Health System says "This very useful cancer drug is too expensive and we don't pay for it". Nothing of this kind never happened to anyone I know of, for any kind of serious illness. Whenever it happens, you can still buy that very expensive drug by your own money. This is up to you. Let me repeat, very rare cases: not perfect, but acceptable. Anyway, it will take a few years and even that drug will be available through the National Health System -- of course, if you are rich you will have to pay some percentage of its cost. In Italy many things work very badly in the public sector. But the public health system works rather well, and is not expensive -- as you certainly know better than I do.Anonymoushttps://www.blogger.com/profile/13283043307876111192noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-14564353688517140542017-06-10T17:04:33.668-05:002017-06-10T17:04:33.668-05:00Why does it follow that they have to take over hea...Why does it follow that they have to take over healthcare for you and me? Because government has essentially taken over nearly 50% of healthcare in most of America, or defaulted to no healthcare and ER stability and discharge policies.<br /><br />In the mid 2000s, Arizona started experiencing a shortage of OB/GYN docs, why? Because AHCCCS (Arizona's public poverty level healthcare insurance) had a policy of paying the lowest rates in the nation, and guess what- more than 50% of the births in Arizona were being paid for by AHCCCS- so OB/GYNs began leaving the practice in the state. <br /><br />Meanwhile, as you can see the largest success of Obamacare was in expanding AHCCCS in Arizona, but the large percentage of uninsured continues to put the healthcare system on life support- https://crh.arizona.edu/sites/default/files/022616_Healthcare_safety_net_report.pdf<br /><br />But to raise taxes to even begin to pay for these huge losses is impossible in America.<br /><br />So, you can have a constantly failing system that requires more and more money, or you can just give up and have it totally fail. In short, fix the medicaid problem with enough money and coverage or just accept that so many are still going to be uninsured, and forcing your costs up for insurance to cover all of those ER visits, and underpayment by Medicaid. LoL.<br /><br />In short, we can socialize medicine for the poor entirely through government, or through the insurance industry with far greater overhead. <br /><br />I would even suggest we just copy the Swiss system and be done with it, but so many people have gotten rich off the inefficiencies in our system that it would prove politically impossible.<br /><br />But raise taxes and just provide healthcare to the poor, and all of the kludges providing subsidies to healthcare could disappear, and actual help might be cheaper than the eternal cycle of ER visits.... Citizen AllenMhttp://calculatedrisk.comnoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-8061882979213740262017-06-10T16:32:59.017-05:002017-06-10T16:32:59.017-05:00Interesting. When I or a family member have a seri...Interesting. When I or a family member have a serious illness, and the doctor says "the national health insurance board has decided that x cancer drug is too expensive so we don't pay for it, " or "x medication works better but is too expensive so we don't pay for it," I very much want to be involved with that decision. John H. Cochranehttps://www.blogger.com/profile/04842601651429471525noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-15819091870904589032017-06-10T15:51:32.637-05:002017-06-10T15:51:32.637-05:00This comment has been removed by the author.Anonymoushttps://www.blogger.com/profile/13283043307876111192noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-23124639409157335082017-06-10T15:50:13.259-05:002017-06-10T15:50:13.259-05:00Because, dear John, though I almost always agree w...Because, dear John, though I almost always agree with you, I don't want to have to decide how much to pay to cure my old dad's cancer. Neither would my dad like to take such a decision for himself. We prefer to pay taxes in advance and have to decide only about which hospital and doctor to choose. I write from Italy where this generally happens, the poor is cured as much well as the rich, and the health system seems to be much less expensive than US health system. Indeed, I prefer to avoid not only those major decisions, but even minor ones, for instance whether to pay for my blood pressure pills. I pay a bit for them, about fifteen euros every month, as I have a high income (lower income pay less or even nothing), but it is an easy decision. Of course a lot of improvements are possible here as well as in the US, but I hold my point. Taxes in Italy are very high, this is true, but mainly not because of our public health system. Sorry if I misunderstood your point. fabrizio.bercelli@unibo.itAnonymoushttps://www.blogger.com/profile/13283043307876111192noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-26862220345558850232017-06-08T22:33:18.460-05:002017-06-08T22:33:18.460-05:00Good point. The post was getting long so I didn...Good point. The post was getting long so I didn't reiterate the main question -- OK, so the government is going to provide health care for the poor, indigent, unfortunate, etc. Why does it follow they have to take over health care for you and me? Why must we be dragooned into the system? Just tax me to pay for it and leave me alone! John H. Cochranehttps://www.blogger.com/profile/04842601651429471525noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-31142133016727282242017-06-08T20:45:49.900-05:002017-06-08T20:45:49.900-05:00To address Prof. Cochrane's final puzzlement: ...To address Prof. Cochrane's final puzzlement: the same bad arguments against market-based healthcare have been trotted out again and again, for the past four decades to my certain knowledge, because what the writers actually want is not healthcare for all, including the poor, but the same healthcare for everyone. They find it morally offensive that some people get more or better healthcare than others just because they are better off financially. That's the underlying case for government-provided (not just financed) healthcare: it promises to provide the same healthcare for all (notoriously it doesn't in practice, but that's another story). Once you have the conclusion that healthcare should be government-provided, all that's left is to get people to vote for it, and any means you choose are acceptable, because, as everyone knows, the end justifies any means, especially when the end is justice (in healthcare). So plausible-seeming arguments that are ready to hand get recycled endlessly.<br /><br />Andrew Mnoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-52038799145456145312017-06-06T21:04:54.512-05:002017-06-06T21:04:54.512-05:00God on you, Dr Cochran. This is typical of Noah Sm...God on you, Dr Cochran. This is typical of Noah Smith. He's among those giving economists a bad name by explicitly playing the partisan and popecon bit. He publicly and subjectively attacks those he doesn't agree with (you, Milton Friedman) and exalts those he's fond of (see recent piece on Keynes) to an extent that is embarrsing to the field of economists. In my eyes, he has turned into a less-respected and less-credentialed version of Krugman... the economist turned oped columnist. rtdnoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-56269868715873244752017-06-06T18:35:16.864-05:002017-06-06T18:35:16.864-05:00While I understand health care spending is higher ...While I understand health care spending is higher in the U.S., I couldn't help but laugh reading a Nat'l Geographic during a visit to the dentist. The article showed a graph of health care spending around the world and then had three other articles, one on a runner with an artificial limb, and two other articles about advances in healthcare. I think of robotic surgery, stents and IUD's and wonder where these technologies were invented?<br /><br />Also, in my state, MA, doctors are networked with insurances and have to accept the fee structures proposed by the insurance firm for the most part so the line about "the fellow on the way to the ER has no time to negotiate" seems off base unless he has no insurance, because his insurance company has already negotiated the fee reimbursement with the network of doctors that are most probably near him. And those fees are usually a function of the Medicare allowable. If negotiation is key, I would rather negotiate the fees I pay to Fidelity for my 401(k)but that is a different kind of market power.<br /><br />I used to read Noah regularly but it always seemed he was promoting an agenda. Promoting an agenda is not necessarily bad but hurts those of us non-economists who are looking for a more objective analysis. My remedy is to read a lot. <br /><br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-6957253862090173012017-06-06T09:40:09.664-05:002017-06-06T09:40:09.664-05:00Noah has written what he has written. I have writt...Noah has written what he has written. I have written what I have written. The facts are plain for the reader to decide, and whether the issue amounts to "wording" of "the" sentence (?), or to the rather larger violations of standard journalistic and ethical norms that I perceive. I do not see a back and forth as particularly productive.<br /><br />I hope that the substantive response -- yes, us "free market purists" have thought about all of these issues, thank you, we have articulated responses that you can debate, we don't just "ignore" them, if you only care to actually read what we have to say -- is more interesting than who said what when anyway. John H. Cochranehttps://www.blogger.com/profile/04842601651429471525noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-27155840796999956292017-06-06T08:41:53.024-05:002017-06-06T08:41:53.024-05:00I reached out to Bloomberg and this was the reply ...I reached out to Bloomberg and this was the reply from Noah Smith (I'm happy to validate by forwarding the email but I don't know where to):<br /><br />Hi, James! My editor pointed me to your criticism of my inference regarding John Cochran's health care argument. It seemed obvious to both me and the editor that Cochrane was referencing health care. However, I have reached out to Cochrane and asked him if he would like us to alter the wording of the sentence in question. So far he has not responded. Anyway, I appreciate your concern for the facts!<br /><br />Best,<br />Noah Smith<br />Bloomberg ViewAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-79727424018463635762017-06-05T23:19:21.546-05:002017-06-05T23:19:21.546-05:00I would appreciate you not putting words in my mou...I would appreciate you not putting words in my mouth.BradKhttps://www.blogger.com/profile/00311675925651145239noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-26680158996152079902017-06-05T23:07:46.732-05:002017-06-05T23:07:46.732-05:00I think healthcare would be better thought of as a...I think healthcare would be better thought of as a lifetime purchase instead of job to job or year to year. The reason being that it's most expensive when we can last afford it. I think you should pay when young to buy it down for when old.<br /><br />Society needs to decide if they want universal coverage or not. A free market solution likely won't provide universal coverage.<br /><br /><br />BradKhttps://www.blogger.com/profile/00311675925651145239noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-34052568294562326622017-06-05T22:11:57.149-05:002017-06-05T22:11:57.149-05:00Catastrophic health occurrences, the kind that can...Catastrophic health occurrences, the kind that can wipe almost anyone out could probably be handled by strictly private markets with minimal regulation. But that is not what we have. Like Thomas W says what we have is prepaid health care, a kind of service agreement. The policies pay for even small and sometimes routine events. Some may argue that this may make sense in that it encourages people to seek medical service for the small events that may help them more likely avoid the catastrophic costly event. With the ACA mandate and requirements of what policies must cover , health insurance becomes similar to social security. The young pay more into the system than they take out while they are young and healthy, but they get their turn to take out more when they become older and less healthy. After all everyone who is lucky gets to be old and eventually too sick to keep living.Joe H.https://www.blogger.com/profile/13242905344393452259noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-87365489904695802802017-06-05T21:04:35.786-05:002017-06-05T21:04:35.786-05:00You are no longer on faculty at the U of C but you...You are no longer on faculty at the U of C but you are still teaching. Excellent review of these economic principles, more importantly, advancing critical thinking. As for being in no position to negotiate the bill, What is one's life worth? What would one pay for water in the Sahara if they were dangerously dehydrated? Personal note. I served in Southeast Asia and Vietnam. In some of those firefights, death was imminent. Anyone of those nineteen year old combatants would have given anything to be home. I heard it a number of times. What would Noah pay? David Seltzernoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-89662724793711810362017-06-05T19:49:33.948-05:002017-06-05T19:49:33.948-05:00Quite true. "Health insurance" is better...Quite true. "Health insurance" is better compared to a service plan or extended warranty which pays for routine repeating expenses along with bets based on probabilities.Thomas Whttps://www.blogger.com/profile/05701283200252131890noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-11331615870152857042017-06-05T18:47:30.697-05:002017-06-05T18:47:30.697-05:00This comment has been removed by a blog administrator.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-82227951322647053102017-06-05T16:28:04.266-05:002017-06-05T16:28:04.266-05:00I usually like reading Noah, even if I disagree. H...I usually like reading Noah, even if I disagree. He can be pretty even handed. This last one is pretty disappointing and I lost a lot of respect for him. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-72581134085565542482017-06-05T16:18:32.097-05:002017-06-05T16:18:32.097-05:00What portion of health care dollars are spent in t...What portion of health care dollars are spent in the ER? <br />Numbers vary from 2-10% according to Politifact.<br /><br />http://www.politifact.com/truth-o-meter/statements/2013/oct/28/nick-gillespie/does-emergency-care-account-just-2-percent-all-hea/<br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-87018156105740129752017-06-05T16:15:48.356-05:002017-06-05T16:15:48.356-05:00Krugman was, I think, shamed in to start providing...Krugman was, I think, shamed in to start providing links to his ad-hominem attacks. He originally habitually left them out. DeLong continues the practice. The bottoms of these have some documentation. <br />http://johnhcochrane.blogspot.com/2012/01/stimulus-and-etiquette.html<br />http://johnhcochrane.blogspot.com/2011/12/krugman-on-stimulus.htmlJohn H. Cochranehttps://www.blogger.com/profile/04842601651429471525noreply@blogger.com