Opinions change

Source:David Brady and Mo Fiorina

My Hoover colleagues David Brady and Mo Fiorina gave a recent talk updating some of their work on polling American political opinions. I found this one particularly interesting. Notice how after President Obama's first win in 2008, the fraction of Democrats reporting that the economy is getting better jumped from 10% to 50%. The Republican fraction declined, though not as much. When Trump was elected in 2016, the Republican opinion jumped from 15% to 80%, and Democrats fell from 60% to 25%.

Financial reform video

Capital, more capital. I did a video interview for the Chicago Booth Review, summarizing a few talks I'm giving this fall. At some point I'll put the talks together in useful form for the blog. In the meantime, the Booth team did a nice job of cutting and splicing to make me sound coherent. 

ASU forecast luncheon

On Wed Nov 28 I will be giving a talk at the ASU Forecast Luncheon in Phoenix. Blog readers will likely be bored, as I'm going to unapologetically recycle blog material, emphasizing strategies for long run growth. But you may find it amusing, and do say hi if you're one of my dozens of readers.

Imagine what we could cure

A WSJ oped with J J Plecs, formerly of Roam Analytics, which does a lot of health related data work.

The discovery that cigarettes cause cancer greatly improved human health. But that discovery didn’t happen in a lab or spring from clinical trials. It came from careful analysis of mounds of data.

Imagine what we could learn today from big-data analysis of everyone’s health records: our conditions, treatments and outcomes. Then throw in genetic data, information on local environmental conditions, exercise and lifestyle habits and even the treasure troves accumulated by Google and Facebook...

So why isn’t it already happening?..., the full potential of health-care data analysis is blocked by regulation... medical-data regulations go far beyond what’s needed to prevent concrete harm to consumers, and underestimate the data’s enormous value.... 

I'll post whole thing in 30 days. In addition to  Roam, Tafi and Datavant are two other companies I'm aware of working on this issue.

Update: 

Bob Borek, Head of Marketing, Datavant wrote to describe their effort to keep lots of data while protecting privacy:

We connect de-identified patient data. In short, as part of the process of de-identification, we create encrypted tokens that are built from the underlying PHI. The encrypted tokens allow patient records to be joined across data sets on a de-identified basis, without ever revealing the underlying PHI. In contrast to the Safe Harbor method, which - as you correctly point out - removes much of the information that would make data analytically valuable, our approach can be certified under HIPAA's Expert Determination method, allowing our clients to both join data for analysis and respect patient privacy. We're already seeing exciting new use cases, from rare disease patient finding to designing real-world evidence trials; from payers and providers building targeted intervention programs to life sciences companies forming go-to-market strategies around intelligent physician targeting.   

Update 2 the FDA sentinel initiative implements one approach to these issues. The data stays secure, but you're allowed to make queries, i.e. basically to run regressions on the FDA server.  

Regulatory cost disease

A post on Marginal Revolution is so good, I have to quote in its entirety before commenting.

From my time in both the military and healthcare I can say that the biggest problem are the compliance costs.

For example, I have a phone app that allows me to send texts. We pay very good money to have said app. It does nothing that my phone cannot innately do – except be HIPAA compliant. EMR software is clunky, an active time suck, and adds little or no value … but we are required by law to use it. In each case there are scads of less specific programs out there which are insanely cheaper and more functional, but those programs cannot justify the costs of becoming compliant for a small niche of their business.

In the military we had similar difficulties. If you want systems to be secure, you need to pay extra as the marketplace does not do real security for consumer goods. Likewise, if you worry about logistical tails, building in assured access drastically increases costs.

And I fully suspect that prices will continue to diverge. As ever more of the internet ends up in a giant interconnected mess there will be fewer people able to code in a secure fashion. There will be fewer parts of the ecosystem that can be used by security conscious actors.

Then we get to actual procurement itself. People worry that arcane institutions will somehow make off with lots of money and spend it either poorly or nefariously. Absent easily observed price and cost data in both sectors we began developing rules. These rules drive firms out of the market (e.g. we needed some light interior remodeling to comply with a regulation that specified inches between things, the contractor who has been most affordable and highest quality refused to bid because the hassle on his side was too great). Eventually the rules become too complicated and you start needing specialists to interpret them. Costs skyrocket and firms abuse rules to pad profits. Then the lawyers get involved and things get more expensive. Again, medical and military consumers become a captive market facing greater monopoly as fewer firms can navigate the thicket of rules to even try to make money.

Then we have the problem that people look at these sectors and say that it is public money. All public money should help with goal X (e.g. going “green”, affirmative action, boycotting South Africa/Israel, patriotism, “America first”) and then we become even more overly constrained. Find vendors who meet one hurdle is hard, finding ones that meet 30 is nigh unto impossible unless the vendor is engineering the firm to market solely to this niche – and charging monopoly rates as his reward.

Any single thing would not be too bad for prices, but the marketplace in general is diverging from military and healthcare. Even education is diverging with mandates in FERPA and political business constraints. We have pretty effectively restricted supply, why exactly would we not expect an increase in cost?

This story seems much broader than just healthcare and military procurement. The story also clarifies a bit why it's going to be hard to fix. The thicket of regulations often have a purpose -- security, to protect patent privacy, or more importantly, for military applications. But we do not often ask properly what the cost of extra regulations is. Even well done cost benefit analyses tend to take the supplier network as given, and ask what it will cost them to add just one more step. That the network will shrink and the number of potential entrants shrink more -- the best protection against monopoly power -- is really not part of any cost benefit analysis. The note also points slightly to the public choice problem. The few companies who become specialists at meeting regulations become advocates for the regulations, which puts them in fine position with the army of bureaucrats who promulgate and enforce regulations.  Yes, military text messages probably need high security. Does every doctor's text message to a patient need the same?

It doesn't take long to see in this post a reading of many contemporary economic ills. The perception of increasing monopoly power fits well. The decrease of small business formation and increasing size of businesses fits. And we can think of a number of industries that have the same problem. Banking is obvious.

General aviation is a tiny, but clear example.  Go to your local airport, and contrast the ramp (where planes park) to the parking lot. The ramp is typically an excellent example of a Cuban used car lot. Lovingly maintained aircraft either from the 1950s or designed in the 1950s predominate.  Beautiful, yes, to nostalgic eyes, but not exactly practical. Small aircraft engines are much less reliable than automobile engines. Why? Well, they all must be FAA certified, and it's not worth the cost to certify, say, a new model of spark plug. The parking lot is full of Teslas. Well, in Palo Alto. BMWs elsewhere. But stuffed with the latest technology. Planes are not inherently more durable than cars. They're just regulated differently.

The HIPAA regulations, making electronic medical records every doctor's nightmare, and adding billions to costs, are actually an improvement. We can all remember the not too distant past, and sometimes still present, that doctors needed us to fax things around, because of the same regulations.

The central point of the story is the interplay of new technology and regulation. Our technology has huge fixed costs.  Commercial off the shelf technology, usually "pretty darn good" is amazingly cheap and effective. Specialized technology written to constantly evolving regulation is nightmarishly expensive, and usually not very good. And leads to cronyism and monopoly. The cost of regulation is higher than you think. Make sure the benefits are appropriate.

Carbon Tax

Source: Seattle Times

"The carbon tax is dead; long live the carbon tax" is the headline of Tyler Cowen's Bloomberg column on the failed (again) Washington State carbon tax.  And rather decisively, per the picture on the left.

"Maybe its failure on the ballot in Washington state will inspire economists to come up with better arguments" challenges the subhead. I can't resist.

The key question for a carbon tax is, what do you get in return? What do you do with the money? Washington's carbon tax would have, according to the Seattle Times,

It would have taken effect in 2020, rising year after year to finance a multibillion-dollar spending surge intended to cut Washington greenhouse-gas emissions. The initiative reflected proponents’ faith that an activist government can play a key role in speeding up a transition to cleaner fuels.

The fee would have raised more than $1 billion annually by 2023, with spending decisions to be made by a governor-appointed board as well as the state’s utilities

Well, perhaps the voters of Washington State were not so much against a carbon tax per se, but had less than full faith that a large increase in green boondoggle spending by Washington State government was a good idea. They need only to look south at California's high speed train to see cost-benefit analysis at work in dollars per ton of carbon saved.

And in fact it violates the whole idea of a carbon tax. The point of a carbon tax is to give people and businesses an incentive to figure out their own ways to cut carbon emissions. The whole point is not to fund big government projects. If you want to fund big government projects, you do it out of the broadest based and fairest tax you can find.

As Tyler suggested,

But maybe it’s time for a change in tactics. These new approaches might start with the notion that we can address climate change without transferring more money from voters to politicians.

Here are three ideas:

Idea 1: One answer is obvious: a revenue-neutral carbon tax. Use the carbon tax to offset other taxes. Tyler anticipates this with

The economist can respond, correctly, that a carbon tax will ease the path to greener outcomes, and that other taxes can be cut as recompense if necessary. But it seems right now there is not enough trust for such a grand bargain to be struck. 

Perhaps. But if the carbon tax were coupled with an explicit reduction in other taxes, it might help to convince people. If carbon taxes were coupled with elimination of other taxes, it would help more. Taxes are like zombies. If you just lower the rates they tend to come back. If you eliminate them entirely, perhaps requiring referendum for their reinstatement, there can be more trust. Couple the carbon tax with elimination of, say, state property taxes, income taxes, or sales taxes.

And in the end we all know taxes must equal spending. You can convince voters there won't be more taxes if there isn't more spending. Advertising the carbon tax as a substitute for carbon spending; simultaneously eliminating green boondoggles, would help to seal the deal.

Idea 2: The Baker-Shultz plan, or Americans for Carbon Dividends, (previous blog post here) has another bright idea: Send the proceeds back to the voters. Write everyone a nice check. This ensures that the money doesn't go to boondoggles, and gives every voter a stake in keeping the scheme going. It is highly progressive, which Democrats should like.

I had a similar idea a while ago: Rather than a tax, give each American a right to, say x tons of carbon emissions that they can sell on a carbon market. That also gives everyone an incentive to vote for the system. And it states the issue squarely. You, a voter, are having your air polluted. You have a right to collect on that damage. It makes it clear that carbon is a fee, a penalty, not a "tax." The point is to disincentivize the use of carbon, not to raise revenue for the government to spend. "Tax" is a loaded word in American culture and politics. Carbon rights takes the whole discussion away from "tax."

Idea 3: Lastly, one could pair the carbon tax and fee with a trade: A hefty fee, in return for elimination of all the other carbon subsidies and regulations. To those who don't believe in climate change: ok, but our government is going to do all sorts of crazy stuff. Let's cut out the rot and just pay a simple fee instead. No more electric car subsidies -- $15 k from taxpayers to each Tesla owner in Palo Alto -- HOV lanes, windmill subsidies, rooftop solar mandates, washing machines that don't wash clothes anymore (hint: do NOT buy any washing machine built since Jan 1 2018), and so on and so forth.

I think on the left the strategy has been to ramp up climate hysteria: if we just yell louder and demonize opponents more, the voters will buy it. No matter how much of a problem you think climate is, let's admit that's not working. In part the claims are now so over the top that everyone can tell it's gone too far. No, the way to put out fires in California is not to build a high speed train.

When, in the name of science the IPCC writes things like this -- right up front in the executive summary --

D3.2. ...For example, if poorly designed or implemented, adaptation projects in a range of sectors can increase... increase gender and social inequality... adaptations that include attention to poverty and sustainable development (high confidence).  

D6. Sustainable development supports, and often enables, the fundamental societal and systems transitions and transformations that help limit global warming to 1.5°C. ... in conjunction with poverty eradication and efforts to reduce inequalities (high confidence).... 

D6.1. Social justice and equity are core aspects of climate-resilient development pathways that aim to limit global warming to 1.5°C... 

D7.2. Cooperation on strengthened accountable multilevel governance that includes non-state actors such as industry, civil society and scientific institutions, coordinated sectoral and cross-sectoral policies at various governance levels, gender-sensitive policies.... (high confidence). 

D7.4. Collective efforts at all levels, ... taking into account equity as well as effectiveness, can facilitate strengthening the global response to climate change, achieving sustainable development and eradicating poverty (high confidence)

You can't blame the suspicious Washington State voter from wondering if perhaps a larger agenda isn't being financed here.

There is a sensible middle. Voters who want to do something about carbon, but not finance massive boondoggles or a collectivist progressive agenda. Environmentalists who want to do something about carbon that actually will work. Skeptics who understand, as long as we're going to so something, let's do it efficiently via a carbon fee rather than at massive cost as we are doing now.

Europe's Banks

My visit to Europe resulted in many interesting conversations. There was a stark contrast between the complex regulatory vision of formal presentations and papers, and the lunch and coffee discussion reflecting experience of people involved in actually regulating banks. They seemed to be quite frustrated by the state of things. Disclaimer: this is all completely unverified gossip, and remembered through a fog of jet lag. If commenters have better facts, I'm hungry to hear them.

Risk weights are ungodly complex, and not many people actually understand them, or the layers of buffers and how they are applied.

Risk weights are suspiciously low. Big banks are allowed to use their own models, calibrated on 10 years of data. That means the data have, now, 10 years of stable growth and very low default. Look, say the banks, our investments are nearly risk free.

"Micro" regulators who look at the specifics of an individual bank are prone to offset the "systemic" and "macro-prudential" efforts. Look, say the banks, we have to fulfill all these macro-prudential rules, give us a break. Regulators do.

The financial regulatory community has been preoccupied with writing reports about one thing after another. Meanwhile, the elephant remains in the room:  Italy may default or leave the euro.

Italian banks remain stuffed with Italian government bonds. I learned some new words for this: a "doom loop." If the government defaults, the banks go with it.  Some smaller foreign banks still have large investments in Italian bonds. Another new word: "Moral suasion," governments encouraging banks to buy a lot of their bonds.  I imagine the Godfather had more colorful words for it. On the other hand, Italian banks are reportedly happy for the moment, since as long as Italy doesn't actually default, they make a bundle from high interest rates. Government debt is still treated with low or no risk weights.

State of thought on financial regulation

I'm at a conference on "Financial cycles and regulation" at the Deutsche Bundesbank. Beyond the individual papers, I find the conversation interesting.

Groups of researchers develop a common language and a common set of assumptions. This is productive -- to push a research frontier we have to agree on a few basic ideas, rather than argue about basics all the time. I, as an outsider, parachute in, and learn as much what the shared assumptions are, as I do about particular points in elaboration of the program.

Here,  it is pretty much taken for granted that there is such a thing as a "financial cycle." It's in the conference title, after all! That means a "cycle" of credit expansion, usually "unwarranted," "excessive," or an "imbalanced," followed by a bust. It is also agreed that it is the job of financial regulators to manage this "cycle."

Kotlikoff on the Big Con

In preparing some talks on the financial crisis, 10 years later, I ran across a very nice article, The Big Con -- Reassessing the "Great" Recession and its "Fix" by Larry Kotlikoff. (Here, if the first link doesn't work.) 

Larry is also the author of Jimmy Stewart is Dead – Ending the World's Ongoing Financial Plague with Limited Purpose Banking, from 2010, which along with Anat Admati and Martin Hellwig's The Bankers' New Clothes is one of the central works outlining the possibility of equity-financed banking and narrow deposit-taking, and how it could end financial crises forever at essentially no cost.

Larry points out that the crisis was, centrally a run. He calls it a "multiple equilibrium."  Financial institutions have promised people they can have their money back in full, at any time, but they have invested that money in illiquid and risky assets. When people all do that at the same time, the system fails. Such a run is inherently unpredictable. If you know it's happening tomorrow, you run to get your money out and it happens today.

This is a common view echoed by many others, including Ben Bernanke. What's distinctive about Larry's essay is that he pursues the logical conclusion of this view. If the crisis was, centrally, a run, all the other things that are alluded to as causes of the crisis are not really central.  Short-term debt, run-prone liabilities are gas in the basement. Just what causes the spark, how big the firehouse is, are not central, as without gas in the basement the spark would not cause a fire.

Larry puts it all together nicely by starting with the 2011 Financial Crisis Inquiry Commission report:

"There was an explosion in risky subprime lending and securitization, an unsustainable rise in housing prices, widespread reports of egregious and predatory lending practices, dramatic increases in household mortgage debt, and exponential growth in financial firms’ trading activities, unregulated derivatives, and short-term “repo” lending markets, among many other red flags. Yet there was pervasive permissiveness; little meaningful action was taken to quell the threats in a timely manner. "

Larry then takes apart each of these non-culprits, as below.

Cross subsidies and monopolization, explained

I found a beautiful, clear, detailed, fact-based, and devastating explanation of how forced cross-subsidies, monopolized markets, and lack of competition conspire to strangle the American health care system.

No, this was not on some goofy libertarian website. It was in the official Voter Information Guide, for the ultra-progressive state of California, authored by "the legislative analyst." Whether the analyst is a secret libertarian struggling to get the word out, or simply that this is so much the way of doing things in California that nobody notices the scandal of it all, I do not know.

Starting on p. 62, with my emphasis

911 EMERGENCY MEDICAL TRANSPORTATION

Ambulances Provide Emergency Medical Care and Transportation. When a 911 call is made for medical help, an ambulance crew is sent to the location. ... (Ambulances also provide nonemergency rides to hospitals or doctors’ offices when a patient needs treatment or testing.)

Private Companies Operate Most Ambulances. ...  State law requires ambulances to transport all patients, even patients who have no health insurance and cannot pay. ... 

Commercial Insurance Pays More for Ambulance Trips Than Government Insurance Pays. The average cost of an ambulance trip in California is about $750. Medicare and Medi-Cal pay ambulance companies a fixed amount for each trip. Medicare pays about $450 per trip and Medi-Cal pays about $100 per trip. As a result, ambulance companies lose money transporting Medicare and Medi-Cal patients. Ambulance companies also lose money when they transport patients with no insurance. This is because these patients typically cannot pay for these trips. To make up for these losses, ambulance companies bill patients with commercial insurance more than the average cost of an ambulance trip. On average, commercial insurers pay $1,800 per trip, more than double the cost of a typical ambulance ride.

Not stated, just why do commercial insurers put up with this? The answer is, that you need government approval to run an insurance company in California, and an insurer who said "we're not paying for that" won't be allowed to do business in California.

Also not stated, just what happens to you if you don't have health insurance but actually are the type who pays your bills? Good luck.

THE EMERGENCY AMBULANCE INDUSTRY

Counties Select Main Ambulance Providers. County agencies divide the county into several zones. The ambulance company that is chosen to serve each zone has the exclusive right to respond to all emergency calls in that area.

If you want to know why there is no competition in the 911 ambulance industry, now you know. I don't know about private, non-911 ambulances. Is this all just exploiting the convenience of 911? Can you get a competitively priced ambulance ride if you know who to call?

The company generates revenue by collecting payments from patients’ insurers. In exchange, the ambulance company pays the county for the right to provide ambulance trips in that area. The county typically chooses the ambulance company through a competitive bidding process....

So cash strapped counties are in on the business of fleecing insurance companies, and through them, people and businesses who pay premiums.