## 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.

Economics

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!

Regulations

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.

## Thursday, July 12, 2018

### Loss Aversion

A frequent email correspondent asked "I’d love to hear your take on “loss aversion.” I just finished listening to Kahneman’s book." My response seems worth sharing with blog readers.

Expected Utility

Let’s review expected utility first. The utility you get from consumption or wealth is a concave function of consumption or wealth. An extra dollar makes you more happy than it makes Bill Gates. So, compare either getting C for sure, or a 50/50 bet of getting C+Delta or C-Delta, i.e. having C or betting 50/50 on a coin flip. The expected utility of C for sure is just U(C). The expected utility of the bet is

EU = prob(loss) * U(consumption if loss) + prob(gain) * U(consumption if gain)

EU = 1/2 * U(C - Delta) + 1/2 * U(C + Delta).

As the graph shows, this is less than the expected utility of C for sure. So, people should decline fair value bets. They are “risk averse”.

Comments. Behavioral fans (New York times has done this often in its economics coverage) criticize “classical economics” by saying it ignores the fact that people fear losses more than they value gains. That’s absolutely false. Look at the utility function. People fear losses more than they value gains. That’s the whole point of expected utility. (You’ll see the confusion in a second).

A common mistake: EU( C) is not the same as U [ E(C )]. You do not find the utility of expected consumption, you find the expected utility of consumption. In my graph, C is equal to the expected value of C-Delta and C+Delta, and the whole point is that the utility of C is bigger than the expected utility of (C-Delta) or (C+Delta). You can take E inside a linear function, but you cannot take E inside a nonlinear function.

Loss aversion

OK, on to loss aversion. In the usual sort of experiments Kahneman found that people seem reluctant to lose money. They have a “reference point” and work  hard to avoid bets that might put them below that reference point. He models that as expected utility with a kink in it, as in the second drawing.

I was careful to draw the reference point as different than C. People do not necessarily place the reference point at the expected value of the bet. In fact, usually they don’t. If betting on stocks, the expected value of the bet is to gain 7% per year. The “don’t lose money” point would be do not go below 0, not do not go below the mean. Here people are especially afraid only of the very left part of the distribution.

Now, really, how are these models different? Expected utility can be any function, and nobody said it doesn’t have a kink in it. The key distinguishing feature of loss aversion – and its Achilles heel – is that the reference point shifts around. If you make some money, and play again, then your kink shifts up to the new amount of money you made. Expected utility is supposed to stay the same function of consumption or wealth. People might change behavior – most likely the utility curve is flatter at high levels of consumption, so rich people are less risk averse. But the curve itself does not shift. The key assumption that distinguishes loss aversion from expected utility is that the kink point shifts around as you gain and lose money.

That’s also the Achilles heel.  The first problem is how do you handle sequential bets. If I go to the casino, and know I will play twice, how do I think about my strategy? With expected utility this is easy, because the expected utility works backwards. Suppose you win the first bet, then figure out what you do in the second bet. For each of win or loss in the first bet, then, you have an expected utility from taking the second bet. The expected utility of the first bet is then the expected vaule of the expected utilities you would have if you won or lost.

## Thursday, June 14, 2018

### Different Planets

A friend, who reads an unusually diverse set of sources, passed on some interesting pictures suggesting that our media live on different planets.

On the Trump-Kim summit

On the investigations:

## Tuesday, June 12, 2018

### Cross-subsidies

Cross-subsidies are an under-appreciated original sin of economic stagnation. To transfer money from A to B, it would usually be better to raise taxes on A and to provide vouchers or otherwise pay competitive suppliers on behalf of B. But our political system doesn't like to admit the size of government-induced transfers, so instead we force businesses to undercharge B. Since they have to cover cost, they must overcharge A. It starts as the same thing as a tax on A to subsidize B. But a cross-subsidy cannot withstand competition. Someone else can give A a better price. So our government protects A from that competition. That ruins the underlying markets, and next thing you know everyone is paying more for less.

This was the story of airlines and telephones: The government wanted to subsidize airline service to small cities, and residential landlines, especially rural. It forced companies to provide those at a loss and to cross-subsidize those losses from other customers, big city connections and long distance. But then the government had to stop competitors from undercutting the overpriced services. And as those deregulations showed, the result was inefficiency and high prices for everyone.

Health care and insurance are the screaming example today. The government wants to provide health care to poor, old, and other groups. It does not want to forthrightly raise taxes and pay for their health care in competitive markets. So it forces providers to pay less to those groups, and make it up by overcharging the rest of us. But overcharging cannot stand competition, so gradually the whole system became bloated and inefficient.

A Bloomberg article "Air Ambulances Are Flying More Patients Than Ever, and Leaving Massive Bills Behind" by  John Tozzi offers a striking illustration of the phenomenon, and much of the mindset that keeps our country from fixing it.

The story starts with the usual human-interest tale, a $45,930 bill for a 70 mile flight for a kid with a 107 degree fever. At the heart of the dispute is a gap between what insurance will pay for the flight and what Air Methods says it must charge to keep flying. Michael Cox ... had health coverage through a plan for public employees. It paid$6,704—the amount, it says, Medicare would have paid for the trip.
The air-ambulance industry says reimbursements from U.S. government health programs, including Medicare and Medicaid, don’t cover their expenses. Operators say they thus must ask others to pay more—and when health plans balk, patients get stuck with the tab.
Seth Myers, president of Air Evac, said that his company loses money on patients covered by Medicaid and Medicare, as well as those with no insurance. That's about 75 percent of the people it flies.

 Source: Bloomberg.com

## Tuesday, May 15, 2018

### Meditation on a trip to the DMV

I arrived at the DMV yesterday at 9 AM. My number came up at 5:45 -- you have to wait anxiously all day as you have 10 seconds to respond to your number. At 6:05, 10 hours after arrival. I was informed it was too late to take my written test so I would have to come back. As usual the place was packed, no food, no drink, two filthy restrooms.

(California has an appointment system but it takes two months to get an appointment, so if you need something now or can't book a free day two months ahead of time, you wait. 10 hours. Then you still get an appointment to return two weeks later as they won't get to you.)

Despite 13.2% top income tax rate, 7.5-9.5% sales tax, gas taxed to $3.80 a gallon, California cannot operate a functional DMV. Even Illinois, good old corrupt, bankrupt, Illinois, can operate a vaguely functional DMV. (Direct election of the secretary of state may have something to do with that.) Estonia, this is not. Piles of paper flow around. Technology is about 1992 -- there is a number system, so you don't stand in line for 10 hours. But no indication where you are in the queue or when they might get to you. Rebellion was in the air. Most people do not have my time flexibility. The very nice lady next to me had taken the day off work and had to arrange child care, which was going to end at a finite time. This was her second day of waiting. She was ready to start the revolution. This is not unusual. It's just a completely normal day down at the DMV. The joke has been around a long time: Do you really want the people who run the DMV to operate your health care and insurance system? But it is a good joke. The DMV is the main interface most people have with the functioning or lack thereof of a bureaucracy. The irony is that the democratic candidates in California are falling all over themselves to be stronger on "single-payer" health -- which does not just mean one fallback, but that all others are banned. The amazing thing is that citizens of this noble state are all for it, though they must, like me, each take their turn in the 10 hour line at the DMV. (I suspect many high income progressives do not realize that "single payer" means them too. No concierge medicine.) Republicans: I suggest you set up tables outside the DMV. After all, there is motor voter registration and this might get people in a good frame of mind for your message. Second thought: Things could be worse. The DMV is good proxy for the quality of government institutions. In many countries in the world you must pay a bribe to get a driver's license. In many other countries you can pay a bribe to cut through swaths of paperwork. At least in the US you can't do that. But there are countries where government actually works. When our friends on the left dream of Scandinavian health care, perhaps they should visit a Scandinavian DMV first, and agree that let's see if our government can run a DMV before it tackles health care. And don't go after me with taxes -- the cost of a functional DMV is not that high. This one just needs to expand to match the growth in its population and the complexity of the various laws it has passed. ## Friday, May 11, 2018 ### Argentina update and IMF From Alejandro Rodriguez, my correspondent from the last post We are ***! People are withdrawing funds from fixed income mututal funds (which hold ARS 300 billion of CB short term debt). Yestedary alone people withdrew 4% from those funds and ran to the dollar today. Peso falls 5% to$24.00 ARS/USD. Next step is a ran against term deposits in banks. Next tuesday the CB has to roll over ARS 680 billion of short term debt. A conservative estimate is that ARS 150 billion will not be rolled over and will ran immediatelly to the dollar. No IMF bailout will stop the crisis but it will definitively help us in the aftermath.

PS: If you want to know what interest rates are now (like if anyone cares about them anmore)

maturity APR 5 days 81% 41 days 45%

Why do share prices sometimes go up when companies announce buybacks? Well, as before, suppose that management had some zany idea of what to do with the cash that would turn the $100 cash into$80 of value. ("Let's invest in a fleet of corporate Ferraris"). Then the stock would only be worth $180 total, or$90 per share. Buying one share back, even overpaying at $100, raises the other share value from$90 to $100. That was the big point. Share buybacks are a good way to get money out of firms with no ideas, into firms with good ideas. We want firms to invest, but we don't necessarily want every individual firm to invest. That's the classic fallacy that I think it turning Washington on its head. Best of all we want money going from cash rich old companies to cash starved new companies. Buybacks do that. 1) Management getting rich on buybacks is good. OK, on to management. Management, buyback critics point out, often has compensation linked to the stock price. They might own stock or own stock options. So when the buyback boosts the stock price, then management gets rich too. Aha! The evil (or so they are portrayed) managers are just doing financial shenanigans to enrich themselves! The fallacy here, is not stopping to think why the buyback raises the share price in the first place. If it is the main reason given in the finance literature, that this rescues cash that was otherwise going to be mal-invested, then you see the great wisdom of giving management stock options and encouraging them to get rich with buybacks. ## Friday, April 13, 2018 ### Fiscal theory of monetary policy Teaching a PhD class and preparing a few talks led me to a very simple example of an idea, which I'm calling the "fiscal theory of monetary policy." The project is to marry new-Keynesian models, i.e. DSGE models with price stickiness, with the fiscal theory of the price level. The example is simpler than the full analysis with price stickiness in the paper by that title. It turns out that the FTPL can neatly solve the problems of standard new Keynesian models, and often make very little difference to the actual predictions for time series. This is great news. A new-Keynesian modeler wanting to match some impulse response functions, nervous at the less and less credible underpinnings of new-Keynesian models, can, it appears, just change footnotes about equilibrium selection and get back to work. He or she does not have to throw out a lifetime of work, and start afresh to look at inflation armed with debts and deficits. The interpretation of the model may, however, change a lot. This is also an extremely conservative (in the non-political sense) approach to curing new-Keynesian model problems. You can keep the entire model, just change some parameter values and solution method, and problems vanish (forward guidance puzzle, frictionless limit puzzle, multiple equilibria at the zero bound, unbelievable off-equilibrium threats etc.) The current NK literature is instead embarked on deep surgery to cure these problems: removing rational expectations, adding constrained or heterogeneous agents, etc. I did not think I would find myself in the strange position trying to save the standard new-Keynesian model, while its developers are eviscerating it! But here we are. The FTMP model (From here on in, the post uses Mathjax. It looks great under Chrome, but Safari is iffy. I think I hacked it to work, but if it's mangled, try a different browser. If anyone knows why Safari mangles mathjax and how to fix it let me know.) Here is the example. The model consists of the usual Fisher equation, $i_{t} = r+E_{t}\pi_{t+1}$ and a Taylor-type interest rate rule $i_{t} = r + \phi \pi_{t}+v_{t}$ $v_{t} =\rho v_{t-1}+\varepsilon_{t}^{i}$ Now we add the government debt valuation equation $\frac{B_{t-1}}{P_{t-1}}\left( E_{t}-E_{t-1}\right) \left( \frac{P_{t-1}% }{P_{t}}\right) =\left( E_{t}-E_{t-1}\right) \sum_{j=0}^{\infty}\frac {1}{R^{j}}s_{t+j}$ Linearizing $$\pi_{t+1}-E_{t}\pi_{t+1}=-\left( E_{t}-E_{t+1}\right) \sum_{j=0}^{\infty }\frac{1}{R^{j}}\frac{s_{t+j}}{b_{t}}=-\varepsilon_{t+1}^{s} \label{unexpi}$$ with $$b=B/P$$. Eliminating the interest rate $$i_{t}$$, the equilibrium of this model is now $$E_{t}\pi_{t+1} =\phi\pi_{t}+v_{t} \label{epi}$$ $\pi_{t+1}-E_{t}\pi_{t+1} =-\varepsilon_{t+1}^{s}$ or, most simply, just $$\pi_{t+1}=\phi\pi_{t}+v_{t}-\varepsilon_{t+1}^{s}. \label{equil_ftmp}$$ Here is a plot of the impulse response function: ## Thursday, April 12, 2018 ### Intellectual property The China trade argument has boiled down to intellectual property and trade. Roughly it has gone like this: "We need to stop China from selling us all this stuff. Bring the jobs home!" "Uh, right now the jobs problem is that employers can't find workers. Cheap stuff from China is a boon to American consumers. Tariffs like that on steel cost more steel-using jobs than they save." "Hm. Ok, but we have to threaten with tariffs to get China to stop requiring our companies to share intellectual property!" I'm still skeptical about the intellectual property and trade argument. OK, suppose China says that in order for a US company to produce there, it must share intellectual property with a Chinese partner. Just how terrible is this? Just how terrible for the US economy, and society as a whole, justifying a robust policy response -- obviously the company would rather make more profits, but that's not a basis for economic policy. Intellectual property is different from real property, in that it is nonrival. If you live in my house, I can't live in it. But if you use my equation, my blueprints, my recipe for nanoscale lubricants, or my designs for specialty oilfield equipment, that does not hamper my use of the same ideas. Because of this feature, intellectual property is quite different in law, and in economics, than other kinds of property. Ideally, once an idea is produced, it should be distributed freely to everybody. The marginal cost is zero, it is nonrival, so society is best off if everyone gets to use new ideas immediately. Economic growth is the spread of better ideas, and the faster the better. Period. ## Wednesday, April 11, 2018 ### Why not taxes? Reaction to the Washington Post oped (blog post, pdf) on debt has been sure and swift. We suspected we might get criticized by Republicans for complaining about deficits are a problem. Instead, the attack came from the left. Justin Fox hit first, followed by a joint oped by Martin Baily, Jason Furman, Alan Krueger, Laura Tyson and Janet Yellen. It's almost an official response from the Democratic economic establishment. Their bottom line, really, is that entitlements and deficits are not a problem. They put the blame pretty much entirely on the recently enacted corporate tax cut. (I'm simplifying a bit. As did they, a lot.) By contrast, we focused on entitlement spending -- Social Security, Medicare, Medicaid, VA, pensions, and social programs -- as the central budget problem, and entitlement reform (not "cut") together with a strong focus on economic growth as the best answer. Our warning was that interest costs could rise sharply and unexpectedly and really bring down the party. Well, deficit equals spending minus tax revenue, so why not just raise taxes to solve the budget problem? First, let's get a handle on the size and source of the problem. I. Roughly speaking the long term deficit gap is 5 rising to 10 percentage points of GDP. And the big change is entitlements -- social security, medicare, medicaid, pensions. For example, even Fox's graph shows social security spending rising from 11% of payroll in 2006 and asymptoting at 18%. The most recent 2017 CBO long-term budget outlook is quite clear. Long before the tax cut that so upsets our critics was even a glimmer in the President's eye, they were warning of budget problems ahead: If current laws generally remained unchanged, the Congressional Budget Office projects, ..debt...would reach 150 percent of GDP in 2047. The prospect of such large and growing debt poses substantial risks for the nation.... Why Are Projected Deficits Rising? In CBO’s projections, deficits rise over the next three decades—from 2.9 percent of GDP in 2017 to 9.8 percent in 2047—because spending growth is projected to outpace growth in revenues (see figure below). In particular, spending as a share of GDP increases for Social Security, the major health care programs (primarily Medicare), and interest on the government’s debt. The CBO gives us this nice graphs to make the point: Another CBO's graph follows. Top graph -- where is the spending increase? Social security, health, and interest. Not "other noninterest spending." (In the bottom graph you see a rosy forecast that individual income taxes will rise a few percent of GDP to help pay for this. Don't be so sure. This comes from inflation pushing us into higher tax brackets and assuming congress won't do anything about it. Notice also how small corporate taxes are in the first place.) The more recent CBO budget and economic outlook is equally clear: The near term problem is 5 percentage points of GDP: CBO estimates that the 2018 deficit will total$804 billion....[GDP is $20 Trillion, so that's 4% of GDP] ... In CBO’s projections, budget deficits continue increasing after 2018, rising from 4.2 percent of GDP this year to 5.1 percent in 2022... Deficits remain at 5.1 percent between 2022 and 2025 ... Over the 2021–2028 period, projected deficits average 4.9 percent of GDP.. Then, things get worse, In CBO’s projections, outlays for the next three years remain near 21 percent of GDP, which is higher than their average of 20.3 percent over the past 50 years. After that, outlays grow more quickly than the economy does, reaching 23.3 percent of GDP ... by 2028. That increase reflects significant growth in mandatory spending—mainly because the aging of the population and rising health care costs per beneficiary are projected to increase spending for Social Security and Medicare, among other programs. It also reflects significant growth in interest costs, which are projected to grow more quickly than any other major component of the budget, the result of rising interest rates and mounting debt. ... And that's only 2028. You see the problem in our critic's complaint: "The primary reason the deficit in coming years will now be higher than had been expected is the reduction in tax revenue from last year’s tax cuts, not an increase in spending. This year, revenue is expected to fall below 17 percent of gross domestic product." Let us take the estimate that the recent tax cut cost$1.5 trillion over 10 years, i.e. $150 billion per year or 0.75% of GDP. Compared to the$800 billion current deficit it's small potatoes. Compared to the 5 percent to 10 percent of GDP we need to find in the sock drawer, it's peanuts.   (Compared to the $10 trillion or more racked up in the last 10 years it's not huge either!) [Update: Thanks to commenters, I now notice the "had been expected." OK, we expected 4% of GDP deficits, and then they passed a tax cut and now it's 5% of GDP. Sure. On the day that the tax cut was passed, the entire increase in the deficit was due to the tax cut. But our article, and the economy, is about the overall level of the deficit. The problem is what had been expected, not the recent minor change!] Here is what the CBO has to say about it: For the next few years, revenues hover near their 2018 level of 16.6 percent of GDP in CBO’s projections. Then they rise steadily, reaching 17.5 percent of GDP by 2025. At the end of that year, many provisions of the 2017 tax act expire, causing receipts to rise sharply—to 18.1 percent of GDP in 2026 and 18.5 percent in 2027 and 2028. They have averaged 17.4 percent of GDP over the past 50 years. 17, maybe 18. We're waddling around in the 1% range, when the problem is in the 10 percent range. The long run budget problem has essentially nothing to do with the Trump tax cut. It has been brewing under Bush, Obama, and Trump. It fundamentally comes from growth in entitlements an order of magnitude larger. It is simply not true that "The primary reason the deficit in coming years will now be higher than had been expected is the reduction in tax revenue from last year’s tax cuts, not an increase in spending." To call us "dishonest" -- to call George Shultz "dishonest," in the printed pages of the Washington Post -- for merely repeating what's been in every CBO long term budget forecast for the last two decades really is a new low for economists of this stature. Is Krugmanism infectious? Put another way, US government debt is about$20 trillion. Various estimates of the entitlement "debt," how much the government has promised more than its revenues, start at $70 trillion and go up in to the hundreds. To be clear, I agree with the critic's complaint about the tax cut. "The right way to do reform was to follow the model of the bipartisan tax reform of 1986, when rates were lowered while deductions were eliminated." Yes! As in many previous blog posts, I am very sad that the chance to do a big 1986 seems to have passed. A large, revenue neutral, distribution neutral, savage cleaning and simplification of the tax code would have been great. There are some elements in the current one -- the lower marginal corporate rate is nice, and there is some capping of deductions, which is why it was a "good first step." But it fell short of my dreams too in many ways. If only these immensely influential authors had been clamoring for their friends in the Resistance to join forces and pass such a law, rather than (Larry and Jason in particular) spend the whole time arguing that corporate tax cuts just help the rich, perhaps it might have happened. Having to do the whole thing under reconciliation put a lot of limits on what the Republicans could accomplish. All that aside though, we're still talking about 0.75% of GDP cut compared to a 5%-10% of GDP problem. The long run deficit problem does not come from this tax cut. II OK, so why not just tax the rich to pay for entitlements? I hope I have sufficiently dismissed the main line of this particular criticism -- that deficits are all due to the Trump tax cut and all we have to do is put corporate rates back to 35% and all will be well. On to the larger question, echoed by many commenters on our piece. OK, social security and health are expensive. Let's just tax the rich to pay for it. Like Europe does, so many say. I do think that roughly speaking we could pay for American social programs with European taxes. That is, 40% payroll taxes rather than our less than 20%; 50% income taxes, starting at very low levels; 20% VAT; various additional taxes like 100% vehicle taxes and gas that costs 3 times ours. I don't think we can pay for European social programs with European taxes, because Europe can't do it. Their debt/GDP ratios are similar to ours. And their lower growth rates both are the result of this system and compound the problem. Many European countries are responding exactly as we suggest, with deep reforms to their social programs -- less state-paid health insurance, more stringent eligibility requirements and so on. But that's the option: heavy middle class taxes for middle class benefits, at the cost of substantially lower growth, which itself then drives the needed tax rates up further. America in fact already has a more progressive tax system than pretty much any other country. Making it more progressive would increase economic distortions dramatically. A key principle here is that the overall marginal tax rate matters. There is a tendency, especially on the left, to quote only the top Federal marginal rate of about 40%, and to say therefore that high income Americans pays less taxes than most of Europe. But that argument forgets we also pay state and sometimes local taxes. The top federal rate is about 40%. In California, we add 13% state income tax, and with no deductibility we're up to 53% right there. But what matters is every wedge between what you produce for your employer and the value of what you get to consume. So we have to add the 7.5% sales tax, so we're up to 60.5% already. But we're not done. The Federal corporate tax is now 21%, and California adds 8.84%, so roughly 29% combined. Someone is paying that. If, like sales tax it comes out of higher prices, then add it to the sales tax. Those on the left say no, corporate taxes are all paid by rich people, which is why they were against lowering them. OK, then they contribute fully to the high-income marginal rate. What about property tax? The main thing people do with a raise in California is to buy a bigger house. Then they pay 1% property tax. As a rough idea, suppose you pay 30% of your income on housing and the price is 20 times the annual cost (typical price/rent ratio). Then you are paying 6% of your income in property taxes. Add 6 percentage points. I'm not done. All distortions matter. In much of Europe they charge taxes and then provide people health insurance. We have a cross subsidy scheme, in which you overpay to subsidize others. It's the same as a tax, except much less efficient. In terms of economic damage, and the overall marginal rate, it should be included. If you live in a condo, whose developer was forced to provide "affordable housing" units, you overpaid just like a tax and a transfer. And so on. I won't try to add these in, but all distortions count. In sum, we're at a pretty high marginal tax rate already. The notion that we can just blithely raise another 10% of GDP from "the rich" alone without large economic damage does not work. This isn't a new observation. Just about every study of how to pay for entitlements comes to the same conclusion. Again, my argument is not about sympathy for the rich. It is a simple cause and effect argument. Marginal tax rates a lot above 70% are going to really damage the economy and not bring in the huge revenue we need. Bottom line: Paying for the current entitlements entirely by taxes would involve a big tax hike on middle income Americans. III Answers The most important answer is economic growth. 30 years of 3% growth rather than 2% growth gives you 35% more GDP, and thus 35% more tax revenue. If federal revenues are 20% of GDP, that's 7% of the previous GDP right there. Deregulation and tax reform -- get on with the lower marginal rates and simplification that we agree on -- are important. (The CBO also writes, In CBO’s projections, the effects of the 2017 tax act on incentives to work, save, and invest raise real potential GDP throughout the 2018–2028 period.... The largest effects on GDP over the decade stem from the tax act. In CBO’s projections, it boosts the level of real GDP by an average of 0.7 percent and nonfarm payroll employment by an average of 1.1 million jobs over the 2018–2028 period. During those years, the act also raises the level of real gross national product (GNP) by an annual average of about$470 per person in 2018 dollars.
This is not a terrible result!)

Our oped was clear to say social program "reform" not just "cut." Little things like changing indexing and retirement ages make a big difference over 30 years. We argue for reducing the growth and expansion of entitlements, not "cut."  Removing some of the very high work disincentives would help people get off some programs. Europe is facing this too, and many countries are a good deal more stringent about qualification than we are.

Our critics say that to point out America cannot pay for the entitlements we have currently promised "dehumanizes the value of these programs to millions of Americans." No. Failing to reform entitlements now and gently will lead to chaotic cuts in the future, on programs that people depend on. If we're going to throw around accusations of heartlessness, denying the problem is the heartless approach.

## Friday, April 6, 2018

### Unraveling

Economists delight in unravelings -- behavioral responses that undo bright ideas. A subsidy for skunks produces cats with white stripes. Two good ones came up this week.

As hare-brained as they are, I have to opine that the actual economic consequences of US steel import tariffs and Chinese soybean tariffs are essentially zero.

(Political comment: tariffs are taxes on imports. It would do fans of the Administration's trade policies good to utter the correct "tax" word to describe tariffs. Or "self-inflicted sanctions." )

Why do I say that? Each country is assessing a tariff on goods produced only by the other country. Well then, why not park the ships overnight in Vancouver, or Tokyo, fill out some paperwork, and say steel is imported first from China to Canada, and then Canada to the U.S., and vice versa?

Trade bureaucrats are smart enough to catch that. But they cannot hope to stop essentially the same thing: China sells steel to Canadian steel users, who currently buy from Canadian firms. Canadian steel producers reorient their production to the US, and sell to US companies who formerly bought from China. The steel is genuinely Canadian.

## Thursday, April 5, 2018

Now that 30 days have passed I can post the full oped on buybacks at the Wall Street Journal.

As the Republican tax reform has gained popularity, the Democrats have had to update their messaging. To cast corporate tax cuts as a “scam” and redistribution to the wealthy, opponents have shifted their focus to the evils of stock buybacks and dividends.

“Corporations have been pouring billions of dollars into stock repurchasing programs, not significant wage increases or other meaningful investments,” declared Senate Minority Leader Chuck Schumer Feb. 14. Such buybacks, he claimed, “benefit primarily the people at the top” and come at the expense of “worker training, equipment, research, new hires, or higher salaries.” Other Democrats have echoed the theme, and their media friends are cheerfully passing it on.

Economic logic isn’t strong in Washington these days, but this effort stands out for its incoherence.

Share buybacks and dividends are great. They get cash out of companies that don’t have worthwhile ideas and into companies that do. An increase in buybacks is a sign the tax law and the economy are working.

## Thursday, March 29, 2018

### Debt Oped

An oped on debt in the Washington Post. Growing debt and deficits are a danger. If interest rates rise, debt service will rise, and can provoke a crisis. Really the only solution is greater long-run economic growth and to reform -- reform, not "cut" -- entitlements. And the sooner the better, as the size and pain of the adjustment is much less if we do it now.

This is written with Mike Boskin, John Cogan, George Shultz, and John Taylor. George Shultz was the inspiration, and wrote the first draft. He radiates an ethic of government as responsible stewardship, and displeasure when he does not see such. It is a pleasure of my job at Hoover to work with such distinguished colleagues.

The Post gave it two headlines, in one "horizon" and in the other "doorstep," in different versions. The latter is a bit more alarmist than we care for.  Like living above an earthquake fault, living on a mountain of debt can be quiet for a long time. Until all of a sudden it isn't.  A pdf version

***
A Debt Crisis is on the Horizon

By Michael J. Boskin, John H. Cochrane, John F. Cogan, George P. Shultz and John B. Taylor

We live in a time of extraordinary promise. Breakthroughs in artificial intelligence, 3D manufacturing, medical science and other areas have the potential to dramatically raise living standards in coming decades. But a major obstacle stands squarely in the way of this promise: high and sharply rising government debt.

## Tuesday, March 27, 2018

### Friedman 1968 at 50

This month marks the 50th anniversary of Milton Friedman's The Role of Monetary Policy, one of the most influential essays in economics ever.  To this day, economics students are well advised to go read this classic article, and carefully. The Journal of Economic Perspectives hosted three excellent articles, by Greg Mankiw and Ricardo Reis, by Olivier Blanchard, and by Bob Hall and Tom Sargent.

Friedman might have subtitled it "neutrality and non-neutrality."  Monetary policy is neutral in the long run -- inflation becomes disconnected from anything real including output, employment, interest rates, and relative prices. But monetary policy is not neutral in the short run.

There are three big ingredients of the macroeconomic revolution of the 1960s and 1970s.  1) The remarkable neutrality theorems including the Modigliani Miller theorem (debt vs. equity does not alter the value of the firm), Ricardian equivalence (Barro, debt vs. taxes doesn't change stimulus), and the neutrality of money. 2) The economy operates intertemporally, not each moment in time on its own.  3) Basing macroeconomics in decisions by people, not abstract relationships among aggregates, such as the "consumption function" relating consumption to income. Efficient markets, rational expectations, real business cycles, etc. integrate these ingredients. You can see all three underlying this article.

As money is not neutral in the short run, the neutrality theorems are not true of the world in their raw form, but they form the supply and demand framework on which we must add frictions. Friedman's permanent income hypothesis really kicked off the latter, and The Role of Monetary Policy is a central part of the first.

I.  The Phillips curve

Friedman's view on the Phillips curve is the most durable and justly famous contribution. William Phillips had observed that inflation and unemployment were negatively correlated. (The observation is often stated in terms of wage inflation, or in terms of the gap between actual and potential output.)

For fun, I plotted the relationship between inflation and unemployment in data up until 1968, with emphasis in red on the then most recent data, 1960-1968.  This was the evidence available at the time.

The Keynesians of Friedman's day had integrated this idea into their thinking, and advocated that the US exploit the tradeoff to obtain lower unemployment by adopting slightly higher inflation.

Friedman said no. And, interestingly for an economist whose reputation is as a dedicated empiricist, his argument was largely theoretical. But it was brilliant, and simple.

## Friday, March 16, 2018

### Unintended consequences

Unintended consequences of well-intentioned policies, unexpected behavioral changes in response to ignored incentives, unusual supply (or demand) responses to demand (or supply) interventions, and clever new pathways for changes to happen are the sorts of mechanisms that make economics fun, and I hope useful to cause-and-effect understanding of human affairs.

A case in point is an Atlantic article from 2012 that a friend pointed me to last week, by Richard Sander and Stuart Taylor Jr.
... UCLA, an elite school that used large racial preferences until the Proposition 209 ban [on overt racial preferences] took effect in 1998... Many predicted that over time blacks and Hispanics would virtually disappear from the UCLA campus.
And there was indeed a post-209 drop in minority enrollment as preferences were phased out. Although it was smaller and more short-lived than anticipated, it was still quite substantial: a 50 percent drop in black freshman enrollment and a 25 percent drop for Hispanics...
[However,]
...The total number of black and Hispanic students receiving bachelor's degrees were the same for the five classes after Prop 209 as for the five classes before.
Indeed, I too would have guessed, if I didn't think hard about it, that eliminating racial preferences would have to have reduced the number of minorities who graduated, and that the affirmative action argument would have gone on to other pros and cons. But that's wrong.
First, the ban on preferences produced better-matched students at UCLA, students who were more likely to graduate. The black four-year graduation rate at UCLA doubled from the early 1990s to the years after Prop 209.
Second, strong black and Hispanic students accepted UCLA offers of admission at much higher rates after the preferences ban went into effect; their choices seem to suggest that they were eager to attend a school where the stigma of a preference could not be attached to them. This mitigated the drop in enrollment.
Third, many minority students who would have been admitted to UCLA with weak qualifications before Prop 209 were admitted to less elite schools instead; those who proved their academic mettle were able to transfer up to UCLA and graduate there.
Thus, Prop 209 changed the minority experience at UCLA from one of frequent failure to much more consistent success. The school granted as many bachelor degrees to minority students as it did before Prop 209 while admitting many fewer and thus dramatically reducing failure and drop-out rates.
To be absolutely clear, this post is about pathways. I do not wish to wade into a perilous pro or anti affirmative action debate, a basically radioactive topic for white male economists. (Though I am pleased to report a quick Google search that suggests both Sanders and Taylor still employed, something that might not happen if their book were published today.)

And a proponent of affirmative action could nonetheless make many arguments consistent with this work.  Perhaps dropping out of UCLA is good for people. Perhaps more minorities on campus is useful for white students' social perceptions, even if it harms its intended beneficiaries. Perhaps things were going on at other universities that drove minority upperclasspeople UCLA's way. UCLA is part of the California state system, which encourages transfers at year two, which is not the case everywhere. I also don't know how the numbers are holding up post 2012. Finally, racial preferences seem to have advantaged whites by keeping asians out, which is an interesting scandal by the silence surrounding it.

The Federal Reserve tried to limit the damage with extraordinary actions, first extending the firm credit before forcing it into a hasty weekend shotgun marriage to JPMorgan Chase with $29 billion in assistance. More specifically, Ten years ago, Bear’s crisis week began with rumors of liquidity problems following steep losses from mortgage bonds. Mr. Schwartz, the CEO, phoned JPMorgan Chief Executive James Dimon to ask for a simple overnight loan. By that Thursday, Bear’s lenders and clients had backed away, and the firm was running out of cash. Mr. Schwartz called Mr. Geithner for more help. Fearing a Bear-induced panic could spread throughout the banking system, the Fed arranged a$12.9 billion emergency loan routed through JPMorgan. It ultimately agreed to purchase $29.97 billion in toxic Bear assets. First, Bear lost a lot of money in mortgage backed securities. Second, like Lehman to follow, Bear was mostly financing that investment with borrowed money, and short-term borrowed money at that, not with its own money, i.e. equity capital. Small losses then made it more likely Bear would not be able to pay back its debtors. Third, there was a run. Short term creditors ran out the doors just like Jimmy Stewart's depositors in a Wonderful Life. More interestingly, Bear's broker-dealer clients started running too. Just how investment banks like Bear were using their broker-dealer clients to fund investments is a great lesson of the event. Darrell Duffie lays this out beautifully in The failure mechanics of dealer banks and later How big banks fail. ## Thursday, March 8, 2018 ### Fama Portfolio The Fama Portfolio, is a new book from the University of Chicago Press. This is a collection of Gene Fama's papers, edited by Toby Moskowitz and me. It includes introductory essays by a group of Gene's distinguished colleagues, Ken French, Bill Schwert, René Stulz, Cliff Asness, John Liew, Campbell Harvey, Jan Liu, Amit Seru, and Amir Sufi. The essays explain the ideas in modern terms, tell you why the papers are important, explain how the papers influenced subsequent thinking, update you on where our understanding on each point is today, and speculate about where new ideas may go. The continuing vitality of this work, even parts decades old, is impressive. The task was hard. Which Fama papers should one read? Well, all of them! but we nonetheless had to pick. We typically chose a famous one from early in one of Gene's many research programs, and then a less known later one that really sums it up clearly. Gene's ideas get clearer over time, just like the rest of ours do. The press lets us post our essays. Here are mine (most joint with Toby): Other authors may post their essays on their webpages. Otherwise, you'll just have to buy the book! The contents: ## Monday, March 5, 2018 ### Buybacks A short oped for the Wall Street Journal here on stock buybacks. As usual, they ask me not to post the whole thing for 30 days though you can find it ungated if you search. An excerpt: ... Buybacks do not automatically make shareholders wealthier. Suppose Company A has$100 cash and a factory worth $100. It has issued two shares, each worth$100. The company’s shareholders have $200 in wealth. Imagine the company uses its$100 in cash to buy back one share. Now its shareholders have one share worth $100, and$100 in cash. Their wealth remains the same.
Now suppose Company B has an idea for a profitable new venture that will cost $100 to get going. The most natural move for investors is to invest their$100 in Company B by buying its stock or bonds. With the infusion of cash, Company B can now fund its venture.