Thursday, April 9, 2015
Saturday, February 28, 2015
The basic reason we have a cost problem, as far as I can see, is insurance companies, which are financial companies whose whole business is maximizing profit, make a profit from providing care. There are therefore enormous incentives to overtreat and treat in the most expensive ways. This spreads through the whole system. All the health care providers: the doctors, the hospitals, the pharmaceutical companies, come to expect high returns from their work, and expensive practices drive out frugal.
I am haunted by this article: Why I Had to Close My Preventive Healthcare Clinic. There was a lot that went wrong for Dr. Charlap, but this concluding remark stands out: "It takes a very long time to get a thorough history and do a good exam and almost no time to prescribe a medication for a presumed illness. I chose the former. Insurance pays for the latter." And makes more money from it. Keeping people healthy does not pay as much as keeping them chronically ill.
All the cost control efforts I am aware of focus on getting doctors to accept less for treatment, and do nothing to resolve the perverse incentives in the rest of the system and, especially, the conflict between insurance company profits and cost-effective health care.
- Massive tax evasion by its rich.
- Government spending without regard to debt.
- Losing control of its currency.
- Punitive economic policies by the coalition of the European Committee, the European Central Bank, and the International Monetary Fund—the infamous troika.
So there's the story: the right wing of the Republican Party wants to turn the USA, or at least as many states it can control, into Greece.
Tuesday, February 24, 2015
“It is better to be a live jackal than a dead lion, for while there is life there is hope.” And so there is still hope here. The big news here, I think, is that both sides seem want to reach some sort of not-disastrous deal.
Personalities and realpolitik, I think, are the questions here. I don’t believe that the IMF has suddenly turned wholeheartedly Keynesian, personally; my impression is that it’s more a matter of it being easier to vote for things one knows is not going to pass. It is also hard for me to believe that someone as authoritarian as Schäuble has in fact turned over a new leaf. Still, with luck, the members of the troika will end up pointing at each other, providing the plausible deniability for an easing of austerity.
(Originally posted in comments at Crooked Timber.)
Monday, February 16, 2015
Thursday, February 5, 2015
Tuesday, February 3, 2015
She may be more associated with its horrors than any other politician in Europe, but Angela Merkel hates austerity. The word, that is. The crisis gave German the ugly term Austerität. When the German chancellor pronounces it, she wrinkles her nose in distaste, affects incomprehension, seeks distance from it. Sparsamkeit, or thrift, is more her thing. Merkel sees that as an old-fashioned household virtue, which she has elevated into national and European policy. But when it comes to the formula that Europe needs most of all, Merkel’s magic word is “competitiveness”. The belt-tightening, in Greece as almost everywhere else, is but a means to that end…
The results in Greece are a society traumatised, elites untouched and taking their money out of the country, no jobs for the young, national output shrunk by a quarter, national debt soaring to levels where it can only be serviced by sacrificing any prospect of recovery. Five years into what in Brussels is dubbed “the programme”, Greece is not competitive. It has the EU’s first government of hard-left rebels and rightwing antisemitic nationalists…
“I never discuss economic policy with Germans,” jokes a senior eurozone official in Brussels, “because for them it’s not about economics, it’s religion.”—The Guardian
By this account, it appears that Germany is the leader in European austerity; they are persuaded by Lutheranism and the prophets of the profits. But, also, the German position is not a bluff and it is popular in Germany. They might be willing to destroy the European Union, rather than give Greece a bailout.