Thursday, August 16, 2018

Options on health insurance

Alex M. Azar, U.S. secretary of health and human services, published an interesting OpEd in the Washington Post, describing a clever health insurance innovation. HHS will allow "temporary" health insurance, including a guaranteed renewability provision. The HHS announcement is here and the official rule on the Federal Register here.
Americans will once again be able to buy what is known as short-term, limited-duration insurance for up to a year, assuming their state allows it. These plans are free from most Obamacare regulations, allowing them to cost between 50 and 80 percent less.
Insurers will also be able to sell renewable plans, allowing consumers to stay on their affordable coverage for up to 36 months. Consumers can also buy separate renewability protection, which will allow them to lock in low rates in their renewable plans even if they get sick.
The big news to me is guaranteed renewability. You sign up now, and you are guaranteed rates don't go up if you get sick.

The last sentence is the most intriguing. Long ago, before the ACA made all of this sort of innovation illegal, United Health started offering the option to buy health insurance. Pay money now, and any time you get sick you can still get health insurance, at the pre-stated rate. (Under the ACA that option is now called a cell phone, but the insurance is a lot more expensive and many doctors and hospitals don't take it.)

It sounds like HHS is allowing this again. But I couldn't figure out from a quick read whether the guarantee only lasts 36 months, or if they can sell that option for a longer date. It sounds like the plain guaranteed renewability is only 36 months, the length of the contract.

For newcomers to this blog, guaranteed renewability and the option to buy health insurance is the key to escaping the preexisting conditions problem in a free market for health insurance. I'm delighted to see the idea take hold, if at the edges. Great trees grow from saplings.

The trouble is, that most of the things you worry about happen in a time frame more than 36 months. I want guaranteed renewability for life! If I get cancer in 22 months, knowing I can keep health insurance for another 14 is not that helpful. (Much more here, especially "health status insurance.")

You may ask, then, why only 36 months? As I piece it together, the ACA, which is still law, has a little carve out for temporary insurance, defined as a contract that last 12 months. Anything longer must meet the list of mandates. It sounds like HHS was pretty clever within the constraints of the law, allowing them to be renewed, so 12 months can turn in to 36. I presume you can sign up with another company after 36 months? But you lose the guaranteed renewability so the new company may charge you a lot.

Unless, perhaps, they really are letting insurance companies offer the right to buy health insurance as a separate product, and that can have as long a horizon as you want? If they haven't done that, I suggest they do so! I don't think the ACA forbids the selling of options on health insurance of arbitrary duration.

Monday, August 13, 2018

Trade uncertainty and investment

My colleague Steve Davis has a nice post quantifying economic uncertainty due to the trade war, and its emerging impact on investment.

Steve (and Nick Bloom) have done a great job quantifying policy uncertainty over time. To be clear, policies can have two effects -- there is the certainty of damaging policy, but there is also the damaging uncertainty of what policy will be. If a trade war seems to be looming, and you don't know if you will get tariff protection (raw steel) or be hurt by the tariff (steel users, competing with tariff-free steel products from abroad), that's uncertainty. Businesses hold off investing when they know things will be bad. But they also hold off when they're not sure what will happen. That's uncertainty.

Our little (so far) trade war is full of uncertainty
Trade policy under the Trump administration also has a capricious, back-and-forth character... Less than three months after withdrawing from the TPP, the President said he would consider rejoining for a substantially better deal, only to throw cold water on the idea a few days later. Initially, the administration justified steel tariffs on the laughable grounds that Canada, for example, presents a national security threat. Later, President Trump tweeted that tariffs on Canadian steel were a response to its tariffs on dairy products. Some countries get tariff exemptions, some don’t. Exemptions vary in duration, and they come and go in a head-spinning manner. Two days ago (August 10), the President tweeted that he “just authorized a doubling of Tariffs on Steel and Aluminum with respect to Turkey” for reasons unclear. For a fuller account of tariff to-ing and fro-ing under the Trump administration, see the Peterson Institute’s “Trump Trade War Timeline.”
The arbitrariness, including the waivers, means
Crony capitalism, political favoritism, and extra sand in the gears of commerce – here we come!
But to the point, what's the Davis-Bloom quantitative measure of uncertainty doing? Answer: it is higher than even around the election -- whose outcome, and the nature of the Trump presidency certainly led to a vast amount of uncertainty.

As of July, this uncertainty is only having a small effect on investment, and the economy is still booming -- in my view from the corporate tax rate cuts and deregulation efforts. It is true that the US is so big that most of the economy does not live on exports or directly compete with imports.
Let’s sum up the U.S. survey evidence: About one-fifth of firms in the July 2018 SBU say they are reassessing capital expenditure plans in light of tariff worries. Among this one-fifth, firms have reassessed an average 60 percent of capital expenditures previously planned for 2018–19. ..Only 6 percent of the firms in our full sample report cutting or deferring previously planned capital expenditures in reaction to tariff worries. These findings suggest that tariff worries have had only a small negative effect on U.S. business investment to date.
But it could get worse. Steve closes with a nice list of recent trade outbursts from our part of the economics blog world:
In closing, I should note that the harmful consequences of tariff hikes and trade policy uncertainty extend well beyond short-term investment effects. For other critiques of the Trumpian approach to trade policy, see the worthy commentaries by Robert BarroAlan BlinderJohn CochraneDoug IrwinMary Lovely and Yang LiangGreg Mankiw and Adam Posen, among others.

Intellectual property and China

Let's transfer more technology to China, writes Scott Sumner, with approving comments from Don Boudreaux. They're exactly right, skewering one of the common backstop defenses of protectionists on both left and right.

The question is whether China can buy US technology, or require technology transfer to Chinese partners as a condition of the US firm entering China. Scott and Don have sophisticated versions of my reaction: If Chinese access isn't worth it to you, don't do the deal.

It stands to reason that stealing technology and IP is bad, and should be stopped. Whether imposing tariffs is the smart way to do that, we will discuss another day. But on an economic basis, even that is questionable!

A key point: Selling technology is not like selling a car. If you sell a car, you can't use it. If someone steals your car, you can't use it. But everyone can use knowledge. Scott:
The beauty of information is that use by one person does not preclude use by others
If I know how to wax my car in half the time it takes you, and you sneak in to my house to learn my secret, you wax your car in half the time too. But so do I.

Sunday, August 12, 2018

Lira Crash

No, a currency board won't save the Lira, contra Steve Hanke's oped in the Wall Street Journal. Steve:
Turkey should adopt a currency board. A currency board issues notes and coins convertible on demand into a foreign anchor currency at a fixed rate of exchange. It is required to hold anchor-currency reserves equal to 100% of its monetary liabilities,...
Well, that sounds reasonable no? If 100% of the country's currency and bank reserves are backed by US dollars, and the currency is pegged to the dollar, what could go wrong? Don't want Lira? The central bank promises to exchange 1 Lira for 1 dollar and always has enough dollars to make good on the promise. It sounds like an ironclad peg.

Government debt is the problem. Turkey may still have the resources to back its currency 100% with dollar assets. But what about the looming debt? Turkey does not have the resources to back all its government debt with dollar assets! If it did, it would not have borrowed in the first place.

So what happens when the debt comes due? If the government cannot raise enough in taxes to pay it off, or convince investors it can raise future taxes enough to borrow new money to roll it over, it must either default on the debt or print unbacked Lira.

I.e. a currency board run by an insolvent government will fail. The government will eventually grab the foreign reserves.

The Argentinian currency board did fail, and this is basically why.

Saturday, August 11, 2018

Links: trade, housing, taxes

Three interesting links caught my attention today:

1) Prefab housing in Berkeley and Alex Tabarrok Commentary on Marginal Revolution.
Imagine a four-story apartment building going up in four days, and from steel. It happened in Berkeley, a city known for its glacial progress in building housing. 
Four days? Well, not really
The modules were stacked on a conventional foundation. Electricity, plumbing, the roof, landscaping and other infrastructure were added.
That didn't take 4 days. And
The project, initially approved by the city in 2010 as a hotel, then re-approved in 2015 as studio apartments, 
So, really, 10+ years! (In my personal one data point, getting permits can take as long as building.)

Housing should be manufactured. As Tabarrok points out, it is one place where productivity has not improved much. I gather Ikea is now moving in to manufacture housing (I lost the link). Economies of scale should make a big difference. Once Ikea does to housing what they did to the Poang chair, steadily refining it, they can bringing the price down a lot.

But, manufactured houses have to obey local building codes too, and planning review and design review, and inspections, and all the other little local obstacles. Getting a uniform code will be a big fight, but strikes me as necessary to reap those economies of scale.

The prefab houses are made in China, using steel. A bunch of obvious meditations follow.

As I understand it, we now have import taxes (tariffs) on raw steel from China, but not taxes on products made out of steel. Why does the Trump administration so obviously provide an incentive for manufacturing to move to China? I've read a lot of stories about keg manufacturers, steel locker manufacturers, and so on going out of business over this difference. Is there some part of trade law that I don't know about that forces this outcome, and forbids them to also tax steel content of imports?

It nicely illustrates the point, that if you don't let people come to the US, the capital can go there. Even homebuilding.

2) Greg Mankiw makes an excellent point about marginal tax rates.

Phil Gramm and Robert B. Eklund wrote a great WSJ oped pointing out that inequality in the US really is not as large as it seems, because most measures left out government transfers, even cash transfers. (They cite the CATO study by John F. Early.) Once you add transfers back in again, the US has a much flatter income distribution. We have a more progressive tax system than Europe, with no VAT and lower payroll tax rates, and we do a lot of income transfers.

Greg points out a clever implication of this fact. From the pre- and post-tax and transfer income distribution, we can measure the average marginal tax rate, including the loss of benefits due to program phase out with income:
The bottom quintile earned 2.2% of all earned income in 2013, but after adjusting for taxes and transfer payments, its share of spendable income rose to 12.9%... The second quintile’s share more than doubled, rising from 7% of earned income to 13.9% of spendable income. For the third quintile, middle-income Americans, the increase was much smaller, from 12.6% to 15.4%.
.. the effective marginal tax rate when a person moves from the bottom to the middle quintile is 1 - (15.4-12.9)/(12.6-2.2), or 76 percent.
76 percent! The average person in the lowest quintile of the income distribution who earns an extra dollar, gets to keep only 24 cents. Can you spot the disincentive to work, or get an education?

Greg says something about heterogeneity that I did not understand, but it strikes me that heterogeneity makes matters worse. Hetereogeneity means people are different. Some people are at a cliff: make one more dollar, lose medicaid or another service. Some people are not.

But if 76 percent on average means half the people face a 100% marginal tax rate and half face a 50% marginal tax rate, I think this means the overall disincentive effects are worse than if everyone faces 75% tax rate. In that circumstance half the people will not work at all. Sometimes in economics heterogeneity makes things worse, sometimes better. I think this is a case of worse, but I would be curious to know if there is a standard answer.

While we're on income transfers and disincentives, back to Berkeley
In lieu of providing affordable units on site, Kennedy will pay a fee to the city of Berkeley’s Affordable Housing Trust Fund, as required under the city’s affordable housing laws. The amount is around $500,000, he said. 
Someone needs to write an expose of "affordable housing" programs. Who gets them and how? And once in, disincentives to earn more money, or take a better job in another city must be immense.  It's also another hidden cross-subsidy driving up prices.

3) Back to trade, Tim Taylor the conversable economist has an excellent post on the Jones act. The Jones act is the law that requires all shipping between US ports to be on US made ships staffed by US merchant marines. (Tim builds on another Cato report by Colin Grabow, Inu Manak, and Daniel Ikenson.)

If you want evidence on whether protection makes an industry thrive, this is it
If susttained protection from foreign competition was a useful path to the highest levels of efficiency and cost-effectiveness, then US ship-building and shipping should be elite industries. But in fact, US ship-building and shipping--safely protected from competition-- have fallen far behind foreign competition, with negative costs and consequences that echo through the rest of the US economy--and probably diminish US national security, too. 
...After nearly a century of protection from foreign competition, costs of ship-building in the US are far above the international competition. 
"American-built coastal and feeder ships cost between $190 and $250 million, whereas the cost to build a similar vessel in a foreign shipyard is about $30 million. 
High shipping costs induce substitution
This shift away from water-based transportation to overland road and rail has a variety of costs, like greater congestion and wear-and-tear on the roads. It also has environmental costs like higher carbon emissions: 
Unsurprisingly, the high cost of shipping by water means that in the US, freight is instead shipped overland. Consider, for example, all the trucks and trains that run up and down the east coast or the west coast.  
A long time ago when I was a CEA junior staffer, I got to see a bright idea die. The idea: Let's allow the US to export oil from Alaska to Japan. (There was an oil export ban, part of the legacy of 1970s energy policies.) Then use the money to buy oil from Saudi Arabia to send to the east coast. It's the same thing as sending Alaskan oil to the east coast but much cheaper.  Everyone said great idea until the congressional liason said those ships from Alaska to the east coast are Jones act ships, and here is their list of threats if you do it. End of idea.

I hear even from formerly sensible correspondents now mad for tariffs that we need steel tariffs for national security, so we can fight WWII again, I guess. Well, the Jones act is a nice test case since much of its rationale is to keep a merchant marine going to staff all those liberty ships. Tim (and, really, Colin, Inu and Daniel) demolishes even the national security argument.
if that [national defense] is the goal, the Jones Act is sorely failing to accomplish it. Instead, the Navy can't afford the extra ships it wants, the number of available US civilian ships and the knowledgeable workers to run them is shrinking, and military operations have had to find ways to make use of foreign ships. Some anecdotes drive home the point: 
"When U.S. forces were deployed to Saudi Arabia during Operations Desert Shield and Desert Storm, a much larger share of their equipment and supplies was carried by foreign-flagged vessels (26.6 percent) than U.S.-flagged commercial vessels (12.7 percent). Only one U.S.-flagged ship was Jones Act compliant. In fact, the shipping situation was so desperate that on two occasions the United States requested transport ships from the Soviet Union and was rejected both times. ... At the time, Vice Admiral Paul Butcher, who was then deputy commander of the U.S. Transportation Command, remarked that without the availability of foreign-flag sealift, `It would have taken us three more months to complete the sealift ourselves.' ... 
As with steel, if the goal is national defense, let the defense department ask for appropriations to staff a mothball merchant marine, don't force a hidden cross subsidy into the price of everything else.

Wednesday, August 8, 2018

Free Trade or Managed Mercantilism

Mary Anastasia O'Grady's WSJ coverage of Nafta talks included the following tidbit
auto-sector “rules of origin,” which dictate how much of a vehicle must be made in North America to qualify as duty-free when it crosses continental borders. 
In May, Team Trump proposed a new North American content requirement of 75%, up from the current 62.5%. It also wanted a new requirement that 70% of the steel and aluminum in Nafta vehicles be North American and new wage regulations that would require 40% of the value of North American cars and sport-utility vehicles—and 45% of Nafta trucks—be produced by workers making between $16 and $19 an hour. 
Mexico countered with 70% North American content, a 30% regional steel requirement and 20% regional aluminum. Market-based labor rates are important for Mexican competitiveness, but Mexico showed flexibility by proposing $16 an hour for 20% of the value of vehicles it makes. The U.S. rejected that offer. Now the two sides are trying to find middle ground.
Nafta and the like are often called "free trade agreements." Economists like me wonder, why does that take tens of thousands of pages? "We do not charge border taxes (tariffs), nor restrict quantities, nor will government purchases favor American companies." "We do the same." Done. That's free trade. This little snippet reminds us what trade pacts really are.

Of course, they are far better than the alternative, in which everything is tariffed, protected, managed, and individually negotiated.

Monday, August 6, 2018

Who will pay unfunded state pensions?

Homeowners. So says a nice WSJ op-ed by Rob Arnott and Lisa Meulbroek, and a proposal by Chicago Fed Economists Thomas Haasl, Rick Matton, and Thomas Walstrum.

The latter was a modest proposal, in the Jonathan Swift tradition. Despite Crain's Chicago Business instantly labeling it "foolish," "inhumane," and "the dumbest solution yet, the first article points out its inevitability. If indeed courts will insist that benefits may not be cut, then state governments must raise taxes, and this is the only one that can do the trick.

States can try to raise income taxes. And people will move. States can try to raise business taxes. And  businesses will move. What can states tax that can't move? Only real estate. If the state drastically raises the property tax, there is no choice but to pay it. You can sell, but the new buyer will be willing to pay much less. Pay the tax slowly over time, or lose the value of the property right away in a lower price.  Either way, the owner of the property on the day the tax is announced bears the burden of paying off the pensions.

There is a an economic principle here, the "capital levy." A government in trouble has an incentive to grab existing capital, once, and promise never to do it again. The promise is important, because if people know that a capital levy is coming they won't invest (build houses). If the government can pull it off, it is a tax that does not distort decisions going forward. Of course, getting people to believe the promise and invest again after the capital levy is... well, let's say a tricky business. Governments that do it once have a tendency to do it again.

In sum, a property tax is essentially the same thing as the government grabbing half the houses and selling them off to make pension obligations. And unless a miracle happens, it is the only way out.

Update: We're there already, say Orphe Divounguy, Bryce Hill, and Joe Tabor at Illinois Policy. The bulk of recent increases in property taxes have gone to pay for pensions, not more teachers, police, etc.

Update 2: I should clarify, that I found this an interesting piece of economics more than anything else. I do not think this is the right solution, nor is it the only one. Most other countries around the world, having made unsustainable pension promises, find some way around them and reduce pensions. It happens. Some sort of federal bailout is not unthinkable either. Moreover, the suddenly announced surprise once and for all property tax increase is unlikely, see update 1. So the states are likely to reap many disincentive effects of expected increases in property and other taxes.

Finally, most importantly property tax payers vote! They are unlikely to sit still for such a mass expropriation of their wealth.

Friday, August 3, 2018

Saving rate doubles

The BEA just revised the personal saving rate, and doubled it.

Source: Wall Street Journal

To commenters bemoaning the low and declining personal saving rate

I found the graph in Greg Ip's column in the Wall Street Journal, but updates seem not to show it. Greg ties it to the business cycle:
Previously, it looked like much of last year’s acceleration in consumer spending came by dipping deeper into savings, a sign of an expansion in its later stages. The Bureau of Economic Analysis has since found wages and self-employed income were much higher than it first estimated, so the saving rate, instead of sliding to around 3%, stands at 6.8%—in line with its average since 2012. The expansion now looks middle-aged (albeit late middle-age) rather than old.
Personal saving is one of the less well defined and measured concepts in economics. Is housing equity included? Is the value of employer pension plans included? (What if those pensions are massively underfunded?) If you own stock, but the company invests out of retained earnings, giving you a capital gain, is that included?  (Economically it's the same as paying profits as income, then issuing new stock to finance investment, which would show up as your saving. But we'd pay a lot of taxes, which is why most corporate investment is financed out of retained earnings.)  

The definition should conform to the question. If you want to know whether Americans are prepared for retirement, then the average saving rate doesn't really matter, and you should include social security and medicare. If you're worried about debt buildup, then you're worried about some households saving too little and others saving too much, not the average. If you want to think about the trade balance and capital formation, then you want the national saving rate and don't include social security. And so forth. 

Economic policy is also schizophrenic about saving. Half of the time hands are wrung that Americans don't save enough. The other half -- or really all the time -- policy pundits want Americans to consume more in the name of stimulus, meaning save less, or worry about "savings gluts" driving asset price "bubbles" or "secular stagnation."  

I couldn't find the BEA's explanation of what changed. It's something to do with finding more income among self-employed people, and I guess more income - the same consumption = more saving. But where was that income before? If blog readers know where the BEA explains the change in methodology or can comment directly, send a comment or an email.


A correspondent sends this, which I have not had a chance to check out

Here are some links that might interest you, one by Seeking Alpha and one by Barron’s:

The upshot is this (from the Seeking Alpha article):
“Last week, in tandem with benchmark GDP revisions, the Bureau of Economic Analysis (BEA) forewarned us of another wholesale recomputing of the savings rate. Based on new data made available by the IRS' National Research Program, the BEA has raised its income estimates to "correct for the effects of taxpayer underreporting." How the IRS has decided taxpayers are "underreporting" isn't clear (audits?), regardless there is more income than previously believed and reported in the national accounts.”

Thus, the saving rate changed because the IRS made an adjustment, and thus the BEA made an adjustment.

Wednesday, August 1, 2018

The conversation

A few pieces I read over the last few days juxtapose nicely on the state of America today.

On Saturday, Orrin Hatch, writing in the Wall Street Journal,
"America’s culture war has reached a tipping point. While our politics have always been divisive, an underlying commitment to civility has usually held citizens on both sides together... 
To be clear, I am not calling for an end to the culture war. Indeed, it can and must be fought. Intense disputes over social issues are a feature, not a flaw, of a functioning democracy. 

Tuesday, July 31, 2018

Trade War 1914

The analogy between our looming trade war and August 1914, when events quickly spun out of control, led to this opinion essay at It brings together some themes from recent blog posts, so faithful readers may find some repetition. For reasons of space, a desire not to personalize things too much, and not to strain real history vs. the the superficial stories we retell,  I didn't overdo the 1914 analogy. But it's easy enough to do if you want to. An impulsive leader, sensitive to personal sleights, started something that spiraled out of control. The idea that opponents will quickly surrender, rather than stiffen their resolve, has proved wrong over and over again in history.

The trade war to end trade wars will end badly

104 years ago this August, the war to end wars broke out. It was a war that nobody wanted. The world stumbled in to it almost by accident, and then could not get out. “Wars are easy to win,” leaders thought. “We’ll be in Paris (or Berlin) by fall.”  They were equally wrong, and equally befuddled once the trenches filled with bodies.

This August, the trade war to end tariffs looms, and the world seems to be stumbling towards an economic calamity that nobody wants, propelled by similar entanglements.

Sunday, July 29, 2018

Single payer sympathy?

A July 30 2018 Op-Ed in the Wall Street Journal, titled "The tax and spend health care solution"
Why is paying for health care such a mess in America? Why is it so hard to fix? Cross-subsidies are the original sin. The government wants to subsidize health care for poor people, chronically sick people, and people who have money but choose to spend less of it on health care than officials find sufficient. These are worthy goals, easily achieved in a completely free-market system by raising taxes and then subsidizing health care or insurance, at market prices, for people the government wishes to help. 
But lawmakers do not want to be seen taxing and spending, so they hide transfers in cross-subsidies. They require emergency rooms to treat everyone who comes along, and then hospitals must overcharge everybody else. Medicare and Medicaid do not pay the full amount their services cost. Hospitals then overcharge private insurance and the few remaining cash customers. 
Overcharging paying customers and providing free care in an emergency room is economically equivalent to a tax on emergency-room services that funds subsidies for others. But the effective tax and expenditure of a forced cross-subsidy do not show up on the federal budget. 
Over the long term, cross-subsidies are far more inefficient than forthright taxing and spending. If the hospital is going to overcharge private insurance and paying customers to cross-subsidize the poor, the uninsured, Medicare, Medicaid and, increasingly, victims of limited exchange policies, then the hospital must be protected from competition. If competitors can come in and offer services to the paying customers, the scheme unravels. 
No competition means no pressure to innovate for better service and lower costs. .....

As usual, I have to wait 30 days to post the whole thing.  It synthesizes some of my earlier blog posts (here here here)  on how cross subsidies are worse than straightforward, on budget, taxing and spending.

Let me here admit to one of the implications of this view. Single payer might not be so bad -- it might not be as bad as the current Medicare, Medicaid, Obamacare, VA, etc. mess.

But before you quote that, let's be careful to define what we mean by "single payer," which has become a mantra and litmus test on the left. There is a huge difference between "there is a single payer that everyone can use," and "there is a single payer that everyone must use."

Most on the left promise the former and mean the latter. Not only is there some sort of single easy to access health care and insurance scheme for poor or unfortunate people, but you and I are forbidden to escape it, to have private doctors, private hospitals, or private insurance outside the scheme.   Doctors are forbidden to have private cash paying customers. That truly is a nightmare, and it will mean the allocation of good medical care by connections and bribes.

But a single provider or payer than anyone in trouble can use, supported by taxes, not cross-subsidized by restrictions on your and my health care -- not underpaying in a private system and forcing that system to overcharge others -- while allowing a vibrant completely competitive free market in private health care on top of that, is not such a terrible idea, and follows from my Op-Ed. A single bureaucracy that hands out vouchers, pays full market costs, or pays partially but allows doctors to charge whatever they want on top of that would work. A VA like system of public hospitals and clinics would work too.  Like public schools, or public restrooms, you can use them, but you don't have to; you're free to spend your money on better options if you like, and people are free to start businesses to serve you. And no cross-subisides.

Whether we restrict provision with income and other tests, and thus introduce another marginal disincentive to work, or give everyone access and count on most working people to choose a better product, I leave for another day. It would always be an inefficient bureaucratic problem, but it might not be the nightmare of anti-competitive inefficiency of the current system.

The free market describes well how your and my health care and insurance should work. It does not offer nearly so clear advice on how the government should manage the finances and bureaucracy that provide subsidies (if we want to provide them).  There are always tradeoffs, generosity vs. moral hazard and disincentives. Economics is crucial to understanding those tradeoffs, of course, but the answer will always be a muddy middle of tradeoffs. I have offered that taxing and spending -- on budget and appropriated -- to provide those subsidies may be better than the current mandated cross subsidies. We already have a "single payer" -- the federal government. The argument that a  single point of entry, a single payer, or a single provider, may be more rational and cost effective than the current system  for the purpose of providing subsidized care is not as crazy as it sounds -- if it allows a free the market for the majority of Americans who own cars, houses, TVs and cell phones and can pay for better services in that free market.

"Single payer" also usually means "single price-setter." It means a gargantuan Federal bureaucracy that will somehow produce health care cost savings by simply decreeing that doctors and hospitals be paid less. Good luck with that.

Both left and right forget that "negotiation" means only you pay less and somebody else pays more. We can't all pay less by negotiation. Price controls mean rationing. Period. This is the heart of current "single payer" proposals, and they are doomed.

My "single payer" is just that, a "payer," operating in a completely free market.

Still, when a politician endorses "single payer," ask "does that mean we all can use a single payer? Or does that mean we all must use a single payer?"

Friday, July 27, 2018

Trade war off?

Events move quickly in the Trump era. Since my last post, President Trump met with European Commission President Jean-Claude Juncker and announced a cease-fire with Europe.  A correspondent sends this link to Marc Thiessen at Fox news on the subject
it appears Trump is being proved right. On Wednesday, he and European Commission President Jean-Claude Juncker announced a cease-fire in their trade war and promised to seek the complete elimination of most trade barriers between the United States and the European Union. "We agreed today ... to work together toward zero tariffs, zero non-tariff barriers, and zero subsidies on non-auto industrial goods," declared the two leaders in a joint statement.   
.... contrary to what his critics allege, Trump is not a protectionist; rather, he is using tariffs as a tool to advance a radical free-trade agenda.
... during the G-7 summit he made a sweeping proposal. "I said, 'I have an idea, everybody. I'll guarantee you we'll do it immediately. Nobody pay any more tax, everybody take down your barriers. No barriers, no tax. Everybody, are you all set?' ...
Now Trump's hard-line trade strategy is being vindicated. Not only is the E.U. negotiating zero tariffs, but also it agreed to immediately buy more American soybeans -- which helps Trump in his trade battle with China.
If Trump succeeds in using trade wars to bring down European and Chinese trade barriers, he may end up being one of the greatest free-trade presidents in history.
The question always remains with our President's dramatic moves. Crazy like a fox or just plain crazy?  To his credit, it helps if your opponents think the latter.

Could this trade war really be in the service of a completely free trade agenda -- either very well hidden, or newly discovered? There is nothing I would like to see more than a pure free trade world, and it is heartening to see this president or any president come close to endorsing such.

"Non-auto industrial goods" is already a big qualifier. US' 25% import tax on pickup trucks remains, and Europe's auto protection as well. Europe's big barriers against agricultural goods remain, along with the US' too. (Sugar quotas on and off since the 1790s, lots of Mexican produce barred even under Nafata.) Services, more important in the modern world than industrial goods,  are off the table. So pure free trade this is not.

"it [europe] agreed to immediately buy more American soybeans -- which helps Trump in his trade battle with China." Free trade this is not. In a free trade world, European governments do not stop private European people and companies from buying US soybeans. In a free trade world, government ministers do not agree to buy more American soybeans! That's government run trade 101. Especially to gang up on a third party.

Valentina Pop and Vivian Salama at the Wall Street Journal add some reporting
Mr. Juncker stuck closely to the negotiating mandate handed to him by leaders of big EU countries including Germany, France and the Netherlands. Germany, which is heavily dependent on exports, was from the onset open to a trade arrangement, including abolishing EU tariffs on U.S. car imports. France, meanwhile, was vehemently opposed to opening EU agricultural markets.
Mr. Juncker told Mr. Trump and Mr. Lighthizer that any talk of including agriculture would kill prospects of a deal. He countered with a threat to drag public procurement into negotiations, which would question the Buy American Act, a nonstarter for the U.S. side.
Well so much for unfettered free trade. Plus, as widely reported, this was a cease fire. There is no schedule for talks or any other implementation of the free trade niravna.

"We can do stupid too" said Mr. Junckers, and he is right. This is stupid. We can shoot holes in the bottom of the boat to try to get you to stop shooting holes in the bottom of the boat. But if this is going to work, it had better work darn fast before the boat sinks.

Does President Trump really believe in a free trade world? Is this where it is all heading? In my last post I questioned the lack of a public goal to all this. Only two days ago -- yes, an eternity in Trump time, but fairly recent for the rest of us, the President tweeted

$817 seems to represent the overall trade "deficit" (I hate that word!) and Mr. Trump has consistently labeled trade deficits a "loss" for the US. (No, just as your trade deficit with the grocery store is not a loss -- you get the food!) If his hope is that the point and success of completely free trade is to eliminate trade "deficits," Mr. Trump will be sorely disappointed, as will any of his supporters who view this as a goal.

Completely free trade will open up many slowly dying industries to quick death from international competition. It will open up many new industries to tremendous growth. But is Mr. Trump really prepared to accept the former? In his tour through steel country, he did not say, "In six months I hope to see you all unemployed and this mill shut down again. But the opportunities for the country in software development, banking services, and intellectual property are so huge, I want you to support it."

The big question is, when does this stop? If it stops when we have global free trade, great. If we are going to keep plowing forward with tariffs, managed trade, countervailing subsidies, and so on until the trade "deficit" is eliminated, not so good.

OK, skepticism aside, yes he has twice said that the goal is totally free trade. I suggest the rest of the world call the bluff, if it is one, or give him what he wants, if not, immediately!

Tariffs, quotas, managed trade, arbitrary waivers, will damage the economy and our political system quickly. If this is going to work, it had better work fast.

Wednesday, July 25, 2018

Trade War

I am encouraged by the reported Senate reaction (Politico) to the latest salvo in the trade war, the agriculture department's announcement to ramp up Roosevelt-era farm subsidies to offset the Administration's tariffs.
“Taxpayers are going to be asked to initial checks to farmers in lieu of having a trade policy that actually opens and expands more markets. There isn’t anything about this that anybody should like,” said Sen. John Thune of South Dakota, the No. 3 GOP leader....
You put people in the poorhouse and provide them aid. What you need to do is not put them in the poorhouse,” Corker said 
These views are good, but not really in my mind the largest danger. The closest is Sen. Ron Johnson:
“This is becoming more and more like a Soviet type of economy here: Commissars deciding who’s going to be granted waivers, commissars in the administration figuring out how they’re going to sprinkle around benefits,” said Sen. Ron Johnson (R-Wis.). ...”
It's not really Soviet, which was more do what you're told or go to Siberia. It's a darker system, which leads to crony capitalism. 

Everyone depends on the whim of the Administration. Who gets tariff protection? On whim. But then you can apply for a waiver. Who gets those, on what basis? Now you can get subsidies. Who gets the subsidies? There is no law, no rule, no basis for any of this. If you think you deserve a waiver, on what basis do you sue to get one? 

Well, it sure can't hurt not to be an outspoken critic of the administration when the tariffs, waivers, and subsidies are being handed out on whim. 

This is a bipartisan danger. I was critical of the ACA (Obamacare) since so many businesses were asking for and getting waivers. I was critical of the Dodd Frank act since so much regulation and enforcement is discretionary. Keep your mouth shut and support the administration is good advice in both cases. And to my mind, our drift to an economy in which every successful business needs a special waiver or dispensation from the government, granted at the government's pleasure or displeasure,  is our greatest danger. 

I'm even more delighted to see signs of Congress waking up
... a number of senators have been itching to tie the president’s hands from making unilateral tariff policy with legislation that would require Congress to approve of unilateral tariffs that are imposed with the justification of national security.
Yes, but that's only the beginning. Tariffs are a tax. Why does the President have unilateral power to impose a tax? The president can't change the income tax code (except for some interpretation issues. Index capital gains for inflation now!)

The answer is, because the Congress handed him that power. Congress likes to pass laws that make it look protectionist, and then count on the fact that no sane Administration would ever enforce them.

The regular trade law basically says that the Administration should impose tariffs if any industry is hurt. That's basically any industry that has any imports, i.e. all of them. We have counted for decades on no administration being nutty enough to actually do that.

The national security provisions under which the Trump administration is acting are even vaguer.

By now, both parties ought to be sick of the imperial presidency. Take back the power to impose tariffs. Or at least write a reasonable statute: that tariffs and quotas may only be imposed if consumers are harmed.

If national security is an issue, then write that the defense department must ask for it and pay for it. Do we need steel mills so we can re-fight WWII? If so, put subsidized steel mills on the defense budget. If defense prefers to use the money for a new aircraft carrier rather than a steel mill, well, that's their choice.

We are told that the trade war is all a game on the way to freer trade. I am dubious. From WSJ coverage,
What’s the strategy, what’s the end game here? At what point do we start seeing things move out of the chaotic state they are in now and to where we actually see new trade agreements?” asked Sen. Mike Rounds (R., S.D.).
Mr. Trump, addressing a gathering of veterans groups on Tuesday, urged patience on trade, despite concerns raised by critics: “Just stick with us,” he said. “It’s all working out.”
Well, what is the end game? If it is a world of zero tariffs -- a suggestion the G7 should have taken and run with -- fine, but say so. If it is for China to reform intellectual property treatment, fine, say so. You cannot expect a negotiating adversary to move unless that adversary understands that if you do X, the problem really will be solved. If the goal posts always shift, they have no reason to budge.

I fear the goal is a bilateral trade surplus with every nation. That cannot happen without a massive change in our saving rate and federal deficit. In the meantime, if you impose a lot of tariffs on a country, its exchange rate depreciates so that the overall amount of trade is exactly the same. As is already happening with China, and now currency manipulation charges are back in vogue.*

Wars are hard to win, and they are only won if you have a clear objective, and know to stop when you reach the objective.


* Update: A blog reader asked for an explanation.

You run a trade deficit with the grocery store. They sell you more food than you sell them. You run a surplus with your employer. You sell him or her more services than they sell you. Bilateral deficits are not a bad thing! If your garden is anything like mine, growing your own is a bad idea.

If you earn more from your employer than you spend at the store, then you are saving money. You run a net trade surplus with the world, and save it. You are accumulating financial assets. If you run a net trade deficit with the world, you are dissaving or borrowing.

So, we have the ironclad law. Savings - Investment = Net Exports. If you want to sell everything to the world, you have to save more than you are investing at home, and use the money you get from selling stuff to the world to buy foreign assets.

If your saving and investment do not change, your export position cannot change.

Now, what happens if the Administration puts a 100% tariff on everything imported, but we do not change savings and investment? Well, the total volume of imports - exports can't change. So the dollar has to go up relative to foreign currencies so that the after tax price of exports has not changed.

I hope that is not too simplified -- Im holding a lot of general equilibrium effects constant. Trade experts feel free to chime in in the comment if I am not clear or screwed that up somehow.


Update 2: The Washington Examiner does a much better and more detailed job on economic policy by fiat and waiver, though still missing, I think, the greatest danger:
Similarly [as with current tariffs and subsidies], President Barack Obama was able to help companies with taxes and regulations that protected them, with bailouts that rescued them, with a stimulus that subsidized them, and with massive federal programs that padded their profits. 
General Electric, Chrysler, Goldman Sachs, Netflix, Boeing, H&R Block, Solyndra, and many other companies benefited, if fleetingly, from Obama’s big-government policies. Conservatives and Republicans generally didn’t applaud these “pro-business” policies even though they created jobs at these favored companies. 
Instead, Republicans rightly charged Obama with “picking winners and losers.” ...
GE CEO Jeff Immelt heralded the Obama era with a shareholder letter declaring the “reset” of capitalism. “The interaction between government and business will change forever. In a reset economy, the government will be a regulator; and also an industry policy champion, a financier, and a key partner.” 
Tax them, regulate them, subsidize them, bail them out. 
This was the clear and deliberate structure of Obamanomics. Fewer profits were to be earned separate of government. More profits were to be earned in partnership with government. 
That’s where Trumponomics is headed. Trump’s tariffs on China have spurred Chinese tariffs on American soybeans. "No problem," Trump declares, "we’ll just use a New Deal law to subsidized soy bean farmers."
Also, forcing business to run the government gauntlet tilts the playing field toward the big guys who can afford the lawyers and lobbyists.
The one thing missing is in that last sentence. It's not just about affording lawyers and lobbyists. It's about showing support for the Administration.  Both left and right wing autocracies dispense economic favors in return for political support, or at least acquiescence. People worried about authoritarianism, this is your worry. This is how China and Russia work. And don't mistake this as Trump hysteria. This was my complaint about the Obama administration, and it seems pretty clear that  Democrats have no interest in reining in the regulation, waiver, executive order state, they just want to capture it back for themselves.


Tuesday, July 24, 2018

Shorter Papers

Ben Leubsdorf at the WSJ does a great job of covering the discussion within economics over too-long papers, picky editing and refereeing, and other issues.

Defensive writing is certainly part of the issue
“If you want to publish a paper in a top journal, even if you think you have one key insight that can be conveyed succinctly, the referees are not going to take it,” Ms. Finkelstein said.
I think Amy would want to clarify this means referees at other journals. Editors are also to blame. We must remember, referees do not take or reject papers, referees advise editors, and it is always the editor's job to make publication decisions.
From an early stage of an academic career, “it becomes pretty clear that you need to check off a pretty long list of items to really convince people that the way you’re interpreting your results is indeed the right way to do it,” Mr. Bazzi said.
..... When you’re trying to anticipate possible criticisms on a controversial topic like the minimum wage, and situate your research in the deep existing literature on the subject, it “quickly adds up to a long paper,” said University of Massachusetts-Amherst economist Arindrajit Dube,....
Mr. Dube said that paper is now in the process of being revised ahead of publication—including acting on a request to make it shorter.
However, journals don't encourage length, and there is some sense to the current equilibrium.  You write a paper with lots of defensive "what if this what if that." You send it to journals. My typical paper is rejected at 2-3 journals, so by the time it's published I have 6 to 12 reports.  My referees are typically thoughtful and diligent, and the paper grows in addressing all of their what-abouts too. Since I haven't been doing detailed empirical work lately, the requests are not nearly as extensive as those authors receive. Then we finally arrive at publication, and the editor says "now cut it down to 40 pages. You can stuff all that into an internet appendix if you like." Which nobody reads.

This isn't necessarily a bad equilibrium.

Friday, July 20, 2018

Nobel Symposium on Money and Banking Day 2

Day 2 of the Nobel Symposium on Money and Banking focused on monetary policy. (My last post covered Day 1 on banking.)


Sadly Ben Bernanke's video and slides are not up on the website. Ben showed some very interesting evidence that the crisis was an unpredictable run, rather than the usual story about predictable defaults resulting from too much credit. Things really did get suddenly a lot worse in September and October 2008. Yes, it's easy to say this is defense against the charge that he should have done more ahead of time. But evidence is evidence, and I find it quite plausible that the relatively small losses in subprime need not have caused such a massive crisis and recession absent a run. Ben says the material is part of a paper he will release soon, so look for it. One can understand that Bernanke is careful about releasing less than perfect drafts of papers and videos.


Barry Eichengreen gave a scholarly account of why history matters, especially the great depression, and we should pay more attention to it. (Paper, video.) He aimed squarely at typical economists whose knowledge stopped at Friedman and Schwartz, or perhaps Ben Bernanke's famous non-monetary channels paper, in which bank failures propagated the depression. He emphasized the role of the gold standard and international cooperation or non-cooperation, and warned against facile comparisons of the gold standard experience to today's events and the euro in particular.

Randy Kroszner has a great set of slides and an engaging presentation. He also started on parallels with the great depression, and told well the story of the US default on gold clauses. He closed with a warning about fighting the last war -- particularly apt given the exclusive focus of most of this conference on the events of 2008 -- and on how to start a crisis. In his view when Bank of England Gov Mervyn King said: “We will support Northern Rock." People hear "Northern Rock's in trouble? Run!" Likewise, in my view, speeches by President Bush and Treasury Secretary Paulson did a lot to spark the run in the US.


A highlight for me, was the session on DSGE models.

Marty Eichenbaum (video, slides, subsequent paper) gave a nice review of the current status of new Keynesian DSGE models, and how they are developing in reaction to the financial crisis and recession, and the zero bound episode.

Harald Uhlig

Critiques, or more precisely lists of outstanding puzzles and challenges, are often more memorable and novel than positive summaries, and Harald Uhlig delivered a clear and memorable one. (Video, Slides)

Asset prices are a longstanding problem in DSGE models. In typical linearized form, the quantity dynamics are governed by intertemporal substitution, and the asset prices by risk aversion, and neither has much influence on the other. (I learned this from Tom Tallarini.) Rather obviously, our recent recession was all about risk aversion -- people stopped consuming and investing, and tried to move from private to government bonds because they were scared to death, not a sudden attack of thriftiness. There is a lot of current work going on to try to repair this deficiency, but it still lives in the land of extensions of the model rather than the mainstream. Harald also points out a frequently ignored implication of Epstein-Zin utility, the utility index reflects all consumption and anything that enters utility

Financial frictions are blossoming in DSGE models, in two forms: First, HANK or "heterogenous agent" models, which add things like borrowing constraints and uninsurable risks so that the distribution of income matters, and in an eternal quest to make the models work more like static ISLM. Second, in response to the financial crisis (see first day!) stylized models of banking and intermediary finance are showing up. I'm still a little puzzled that the more standard time-varying risk aversion part of macro-finance got ignored, (a plea here) but that is indeed what's going on.

The conundrum, here as elsewhere in DSGE, is that the more people play with the models, the further they get from their founding philosophy: macro models that do talk about monetary policy, (now) financial crises, but that obey the Lucas rules: Optimization, budget constraints, markets, or, more deeply, structures that have some hope of being policy invariant and therefore predictions that will survive the Lucas critique. Already, many ingredients such as Calvo pricing are convenient parables, but questionably realistic as policy-invariant.

Harald points out that since most of the frictions are imposed in a rather ad-hoc manner, neither will they be policy-invariant. This is a deeper and more realistic point than commonly realized. Every time market participants hit a "friction," they tend to innovate a way around that friction so it doesn't hurt them next time. Regulation Q on interest rates was once a "friction," and then the money market fund was invented. The result is too often "chicken papers:"

The understandable trouble is, if you try to microfound every single friction from Deep Theory -- just why it is that credit card companies put a limit on how much you can borrow, in terms of asymmetric information, moral hazard, and so forth -- the audience will be asleep long before you get to the data. Also, as we saw in day 1, there is (to put it charitably) a lot of uncertainty in just how contract or banking theory maps to actual frictions. I think we're stuck with ad-hoc frictions, if you want to go that route.

Harald's next point is, I think, his most devastating, as it describes a huge hole in current models that is not (unlike the last two) a point of immense current research effort. The Phillips curve and inflation are the central point of the New Keynesian DSGE model -- and a disaster. 

The Phillips curve is central. The point of the model is for monetary policy to have output effects. Money itself has (rightly) disappeared in the model, so the only channel for monetary policy to work is via the Phillips curve. Interest rates change inflation, and inflation causes output changes. No surprise, it is very hard for that model to produce anything like the last recession out of small changes in inflation. (I have to agree here with the premise of the financial frictions view -- if you want your model to produce the last recession, other than by one huge shock, the model needs something like a financial crisis.)

The Phillips curve in the data is well known

Less well known, but worth lots of attention, is how the now standard DSGE models completely fail to capture inflation. Harald's slide:

The point of the slide, in simpler form: The standard Phillips curve is

inflation today = beta x expected inflation next year + kappa x output gap  + shock

Essentially all inflation is accounted for by the shock. The model is basically silent about the source of inflation. Looking at the model as a whole, not just one equation, Neither monetary policy shocks nor changes in rules accounts for any significant amount of inflation. 

I made a similar graph recently. Use the standard three equation model
Now, use actual data on output y, inflation pi, and interest rate i, to back out the shocks v. Turn off the monetary policy shock vi = 0. Solve the model and plot the data -- what would have happened if the Fed had exactly followed the Taylor rule? 

Answer: Inflation and output would have been virtually the same. The inflation of the 1970s and its conquest in the 1980s had nothing to do with monetary policy mistakes. It is entirely the fault, and then fortunate consequence, of "marginal cost" shocks that come from out of the model. This is a pretty uncomfortable prediction of a model designed to be about monetary policy! Or, as Harald put it

  • Data: no Phillips-Curve tradeoff.
  • QDSGE: don’t account for inflation with monetary policy shocks.
  • The NK / Phillips-Curve-based NK QDSGE models may thus provide a poor guide for monetary policy.

Wait, you ask, what about Marty Eichenbaum's pretty graphs, such as this one, showing the effects of a monetary policy shock?
The answer: After a lot of work, the effects of a monetary policy shock look (at last) about like what Milton Friedman said they should look like in 1968. But monetary policy shocks don't account for any but a tiny part of output and inflation variation, quite contra Friedman (and Taylor, and many others') view.

Last, standard new Keyensian DSGE models have strong "Fisherian" properties. In response to long lasting or expected interest rate rises, inflation goes up. More on this later.

Ellen McGrattan

Ellen stole the show. (Slides.) Take a break, and watch the video. She manages to be hilarious and incisive. And unlike the rest of us, she didn't try to sheohorn a two hour lecture into her 15 minutes.

Her central points. First, like Harald, she points out that the models are driven by large shocks with less and less plausible structural interpretation, and thus further from the Lucas critique solution than once appeared to be the case. The shocks are really "wedges," deviations from equilibrium conditions of the model with unknown sources

What to do? Focus on rules and institutions. This is a deep point. Even DSGE modelers, in the desire to speak to policy makers, often adopt the static ISLM presumption that policy is about actions, about decisions, whether to raise or lower the funds rate. The other big Lucas point is that we should think about policy in terms of rules and institutions, not just actions.

Monetary policy and ELB

Stephanie Schmitt-Grohé (slidesvideo)  talked about the Fisherian possibility -- that raising interest rates raises inflation. New-Keynesian DSGE models, with rational expectations, have this property, especially for permanent or preannounced interest rate increases, and when at zero interest rates or otherwise in a passive regime where interest rates do not react more than one for one with inflation. She and Martin Uribe have been advocating this possibility as a serious proposal for Europe and Japan that want to raise inflation.

She presented some nice evidence that permanent increases in interest rates do increase inflation -- and right away, not just in the long run.

Mike Woodford. (slides, video)  gave a dense talk (37 slides, 20 minutes) on policy at the lower bound. During the ELB, central banks moved from interest rates to asset purchases and forward guidance. Mike asks,
To what extent does this mean that the entire conceptual framework of monetary stabilization policy needs to be reconsidered, for a world in which ELB might well continue periodically to bind? 
In classic form, Mike sets the question up as a Ramsey problem. Given a DSGE model, what is the optimal policy, given that interest rates are occasionally constrained? He derives from that problem a price level target. The price level target works, intuitively, by committing the central bank to a period of extra inflation after the zero bound ends. It is a popular form of forward guidance. The innovation here is to derive that formally as an optimal policy problem.

Mike's price level target is stochastic, changing optimally over time to respond to shocks. I'm a little skeptical that the central bank can observe and understand such shocks, especially given the above Uhlig-McGrattan discussion about the nature of shocks. Also, as I emphasize in comments, I'm dubious about the great power of promises of what the central bank will do in the far future to stimulate output today. I'm a fan of price level targets, but on both sides, not just as stimulus, but for utterly different reasons.

Mike takes on rather skeptically the common alternative -- quantitative easing, asset purchases during the time of the bound. He points out that to work, people have to believe that the increase in money is permanent, and won't be quickly withdrawn when the zero bound is over. As evidence, he points to Japan:

Similarly, he likes the price level target over forward guidance -- speeches in place of action -- as it is a more credible commitment to do things ex-post that the bank may not wish to do ex-post.

Finally, he addresses the puzzles of new Keynesian models at the zero bound -- forward guidance has stronger effects the further in the future is the promise; effects get larger as prices get less sticky, and so on. He argues that models should replace rational expectations with a complex k-step iterated expectations rule.


Video, slides from Swedenslides from my webpagewritten version. I covered this in a previous blog post, so won't repeat it all. I put a lot of effort in to it, and it summarizes a lot of what I've been doing in 15 minutes flat, so I recommend it (of course). It also offers more perspective on above points by Mike and Stephanie. My favorite line, referring to Mike's push for irrational expectations is something close to
"I never thought we would come to Sweden, that I would be defending the basic new-Keynesian program, and that Mike Woodford would be trying to tear it down. Yet here we are. Promote the fiscal equation from the footnotes and you can save the rest." 
Emi Nakamura

Poor Emi had to go last in an exhausting conference of jet-lagged participants. She did a great job (video, slides) covering a century of monetary history and monetary ideas clearly and transparently. These are great slides to use for an undergraduate or MBA class on monetary policy, as well. An abbreviated list:

  • Gold standard
  • Seasonal variation in interest rates under the gold standard; money demand shocks
  • Money demand shocks in the 1980s -- how the supposedly "stable" V in MV=PY fell apart when the Fed pushed on M.

  • Theoretical instability / indeterminacy of interest rate targets
  • The switch to interest rate targets and corridors in operating procedures
  • The (near-miraculous) success of inflation targets
  • Taylor rules and other theory of determinate inflation under interest rate targets
  • How is it "monetary economics" without money?
  • Why did immense QE not cause inflation? 
The overarching theme is the grand story of a move, intellectual and practical, from money supply targets (of which gold is one) to interest rate targets.


Monday featured two panels, Macroeconomic research and the financial crisis: A critical assessment, with Annette Vissing-Jørgensen, Luigi Zingales, Nancy Stokey, and  Robert Barro ; and Banking and finance research and the financial crisis: A critical assessment with Kristin Forbes, Ricardo Reis, Amir Sufi, and Antoinette Schoar.

Perhaps it's in the nature of panels, but I found these a disappointment, especially compared to the stellar presentations in the main conference. Also I think it would have been better to allow more (any, really) audience questions; the whole conference was a bit disappointing for lack of general discussion, especially with such a stellar group.

In particular, Luigi led by excoriating the profession for not paying attention to housing problems and financial crises. I thought this a bit unfair and simultaneously short-sighted. He singled out monetary economics textbooks, including Mike Woodford's, for omitting financial crises. Well, Mike omitted asteroid impacts too. It isn't a book about financial crises. And, after lamabasting all of us, he said not one word about events since 2009. What are we missing now? I had to stand up and ask that rude question, again suggesting that perhaps we are all not listening to Ken Rogoff this time. Annette went on to ask something like "don't you Chicago people believe in any regulation at all," and the respondents were too polite to say what an unproductive question that is and just move on.

Again, I offer apologies to authors and discussants I didn't get to. The whole thing was memorable, but there is only so much I can blog! Do go to the site and look at the other sessions, according to your interests.

Thursday, July 19, 2018

Nobel Symposium on Money and Banking Day 1

I attended the Nobel Symposium on Money and Banking in May, hosted by the Swedish House of Finance and Stockholm School of Economics.   It was a very interesting event. Follow the link for all the presentations and videos. (Click on "program." )

This review is  idiosyncratic, focusing on presentations that blog readers might find interesting. My apologies to authors I leave out or treat briefly -- all the presentations were action-packed and even my verbose blogging style can't cover everything.

"Nobel" in the title has a great convening power! The list of famous economists attending is impressive. And each presenter put great effort into explaining what they were doing, in part on wise invitation from the organizers to keep it accessible.  As a result I  understood far more than I do from usual 20 minute conference presentations and 15 minute discussions.

The first day was really "banking day," giving a whirlwind tour of the financial economics of banking.

Trading liquidity

Darrell Duffie gave (as always) a super presentation on the effects regulation is having on arbitrage in markets. (Slides, video)

Tuesday, July 17, 2018

Health care competition?

Continuing the health care series, there does come a time in which innovative disruptors can break open a protected market and bring some competition. Think Uber and taxis. In a very nice essay, John Goodman describes one such effort, MedBid, an online marketplace where hospitals (gasp) bid for your business:
[entrepreneur Ralph] Weber says MediBid got about 3,500 requests last year from patients; and providers made 12,000 bids on those requests. ...
The average knee replacement on MediBid costs around $15,000. The normal charge by U.S. hospitals is around $60,000 and the average insurance payment is about $36,500.  A similar range exists for hip replacements, with an average Medibid price of about $19,000.
Recall prices of $180,000 per hip in my last post. The most interesting feature of Goodman's essay is the nature of price discrimination hospitals practice. It turns out they will negotiate lower prices for cash customers... Sometimes:
...Canadians can come to the U.S. and pay about half as much as we Americans pay. By taking advantage of Medibid, you and I can do the same thing. So can employer health plans. 
So which hospitals are giving Canadians and MediBid patients 50% off? It could easily be a hospital right next door to you. Strange as it may seem, hospitals are willing to give traveling patients deals that they won’t give those of us who live nearby. 
The reasons? Hospitals believe that if you live in their neighborhood, they’re going to get your business, regardless. Also, after your operation, your insurance company might argue over whether the operation should have been done in the first place. They might argue that there was no pre-authorization. They may argue over price. They may argue over many other things. And when the hospital finally gets its money, it might be a year or two after the fact. 
The “medical tourism market,” as it’s sometimes called, has three requirements: (1) you have to be willing to travel and (2) you have to pay up front, and (3) there can be no insurance company interference after the fact. 
This last part is really interesting. You have to travel to get the discount.

We'll see how long the price discrimination lasts in the face of a market that organizes people around it. More and more people have high copayment policies, ACA policies that have such narrow networks they can't get the treatment they want, health savings accounts and so forth. Employers can steer you to Medbid as well.

Sunday, July 15, 2018

Cross subsidies again -- hip replacement edition

From the Wall Street Journal, a familiar story of medical pricing mischief:
Michael Frank...had his left hip replaced in 2015. The Manhattan hospital charged roughly $140,000. The insurance company paid a discounted rate of about $76,000, and his share—a 10% copay, plus a couple of uncovered expenses—was a bit more than $8,000. 
The author, Steve Cohen
I’d recently had two hips replaced, six months apart, at the same hospital that had treated him....the hospital had charged $175,000 for my right hip and $180,000 for the left. The insurance company had paid discounted rates of $75,000 and $77,000. 
The usual picture is a huge sticker price, an "insurance discount" and Medicare and Medicaid paying even less than that. I googled around a bit looking for the latter numbers, which I didn't find but I did find here a nice study of cost variation
The average typical cost for a total knee replacement procedure was $31,124 in 64 markets that were studied. However, it could cost as little as $11,317 in Montgomery, Alabama, and as high as $69,654 in New York, New York. Within a market, extreme cost variation also exists. In Dallas, Texas, a knee replacement could cost between $16,772 and $61,585 (267 percent cost variation) depending on the hospital. 
Similar trends also were seen for the average typical cost for a total hip replacement procedure, which averaged $30,124. However, it could cost as little as $11,327 in Birmingham, Alabama, and as much as $73,987 in Boston,5 Massachusetts, which had the greatest variance within a given market, with costs as low as $17,910 (313 percent cost variation). 
These are, I think, insurance costs not the above sticker prices. Also from the LA times,
New Medicare data show that Inglewood's Centinela Hospital Medical Center billed the federal program $237,063, on average, for joint replacement surgery in 2013. That was the highest charge nationwide. And it's six times what Kaiser Permanente billed Medicare eight miles away at its West L.A. hospital. Kaiser billed $39,059, on average, and Medicare paid $12,457. The federal program also paid a fraction of Centinela's bill -- an average of $17,609 for these procedures.
That does give some sense that Medicare is paying even less than private insurers.


What's going on here? Observations:

1) This market is grotesquely uncompetitive. In any competitive market, suppliers bombard you with price information to get you to shop, and prices are driven to something like cost. Airlines don't need a government run nonprofit to disclose how much they charge. There is not just massive price-based competition for flights, there is massive competition for price-shopping services -- google flights vs. orbitz vs. kayay vs. priceline vs. expedia and so on.

2) The insane list price, the insurance discount of about half, and medicare paying about half that is telling. You would expect a cash discount. There are people with $30k to spend, insurance that doesn't cover hip surgery, and hospitals should be jumping to serve them, cash and carry, no paperwork. There are plenty of people with that kind of money to spend on cosmetic surgery.

The clearest sign of pathology in US health care is that the cash market is dead. Even if you have the money, you must have an insurer to negotiate the "insurance discount."

I suspect that in fact if you go to the hospital and say you're paying cash and negotiate, you can get a much better deal. So long as you don't let anyone else know what you're paying. But even that is no defense. You don't have to go visit airline offices and negotiate one on one for a ticket to New York. Competitive businesses chase after their cash customers. And people with $30k to spend on hip replacements don't want to spend weeks negotiating.

Why don't they advertise? Hospitals cannot publicly say what the cash price is. If they did, insurance would demand that price too and the cross subsidies would vanish.

The quoted price is a fiction. It allows hospitals to declare lots of charity care when they treat uninsured people with no money at all. But more importantly, it gives them a great starting point for a one-on-one ex-post negotiation for the unwary.

As in "cross subsidies," we have an immense scheme of cross-subsidies going on, in which private insurance at $70k overpays compared to Medicare, and the hospital is left free to fleece the unwary with outrageous $140k bills. Cross subsidies cannot withstand competition.

3) The huge price variation gives some sense how wasteful the system is. In addition to the obvious variation across hospitals in a given town, variation across cities is telling.

Google flights shows $591 for a first class ticket from New York to Birmingham Alabama, and the most expensive hotel I can find there is $177 per night. Why not fly to Alabama? Well, of course, insured patients are insured. And insurance is, per law, state based, so Alabama is out of network!


The government needs to do something about this, right? Steve mentions one apparently failed effort,
In 2009, New York’s then-attorney general, Andrew Cuomo, announced the creation of a nonprofit organization called FAIR Health. Its mandate is to provide consumers accurate pricing information for all kinds of medical services. 
I found the FAIR Health website and queried its database. It reported that the out-of-network price for a hip replacement in Manhattan was $72,656, close to what Mr. Frank’s and my insurance companies had paid. The problem: We were both in-network, and FAIR Health estimated that cost as only $29,162. 
I never did figure out the reason for the difference in pricing—but somebody ought to.
The second natural response, which we hear over and over, is that the government needs to pass rules mandating price disclosure. But what happens when the government forces price disclosure and companies (evidently) don't want to tell customers what the price is? Well, there are rules mandating price disclosure for hotel rooms, which must be posted on the door of the hotel room.

Yet on the hotel's website,

Well, that regulation is working great isn't it.

It's easy to jump to the conclusion that people need more skin in the game, greater copays, greater incentive to shop. But the real problem is lack of supply competition. Incentive to shop is no good if you can't find out what things actually cost.

The problem is that hospitals don't want to tell you the price to attract your business. They don't want to because they don't have to, because they are protected from competition.

Hotels do want to tell you the real price. Until hospitals do too, they will find their way around disclosure regulations too. It's easy to post phony prices and wink that nobody actually pays that price.  Hospitals already do that when forced to disclose by stating huge prices and then offering insurers bundle discounts separated from the individual bill.