Matthew Yglesias's Blog, page 2398

Price Transparency in Health Care

(cc photo by donielle)

BA writes in to say I should write more about transparent pricing in medical services:

I think you should do some posts on the lack of transparent pricing of medical services. My girlfriend just injured her knee. Her primary care physician referred her to a sports medicine doctor who said, it doesn't appear to be major, but I think you should get an MRI. When she makes an appointment for an MRI she learns that it may cost at least $900 out of pocket because her health insurance has a $2,500 deductible. I tried to look online to see if there were any websites that provided comparative pricing for MRI services and could find nothing. She called her insurance company and they said they were unable to provide her with pricing information for the various providers in the area. When you call the providers themselves and ask, they say Ask your insurance company. I think one way we could improve health care in the US is to require providers to post the prices of their services so that you can compare. There are at least 15 providers in the immediate area (Chicago) so it is not for a lack of competition that prices are out of whack, it a result of opaque pricing that leaves the consumer of medical services powerless.

I'm not really sure how much good increased price transparency would do, since in many situations there really isn't much provider competition, but it certainly seems like it would be a step in the right direction. According to the Heritage Foundation the need to increase price transparency is one of the main reasons it would be a good idea to repeal the Affordable Care Act. Unfortunately, as often happens when you hear conservatives making constructive proposals to improve health care policy in the United States it turns out that this is already in the bill and in fact constitutes a reason conservatives should shy away from root-and-branch repeal. You might say to yourself "as a free marketer, I don't want to mandate price transparency." What you should say to yourself is "between Medicare, Medicaid, public sector workers, and tax subsidies the vast majority of health care spending is publicly financed and the client ought to demand some accountability."

China Clamping Down on Foreign Journalists

Sometimes all you really need to read is the denial:

"At the same time we hope that the foreign journalists will abide by the Chinese laws and regulations," [Foreign Minister] Yang [Jiechi] said Monday at a news conference on the sidelines of the annual meeting of the country's largely rubber stamp parliament. "There is no such issue as Chinese police officers beating foreign journalists."

The underlying issue, beatings aside, is that around the time of the 2008 Olympics, China loosened restrictions on foreign journalists' ability to operate. This spirit of openness was controversial inside the governing elite, with some viewing it as dangerous and others (more accurately, I think) seeing it as beneficial for China. The current wave of protests in the Arab world seems to have strengthened the hands of the skeptics. Along with a general belief in free speech, I really do think openness is the right strategy for the PRC's leadership. Obviously probing journalism will result in some stories that some officials don't like. But at the end of the day, what the Chinese government and Chinese people are accomplishing is genuinely extraordinary and getting more information out about it predominantly reflects well on them.

Watch Scott Brown Ask David Koch For Money

My colleague Brad Johnson snagged some footage of a rarely seen occurrence, a politician asking a rich guy for money:

That's Senator Scott Brown and David Koch.

The Partisan Mind and NYC Politics

Dana Goldstein bemoans the reactionary attitudes taken by many NYC Democrats toward the Bloomberg administration's forward-looking transportation policies and his visionary DOT director Jeanette Sadik-Kahn.

It's worth saying that this is, in part, personal. JSK's predecessor under the Giuliani administration was Iris Weinshall who happens to be married to Senator Chuck Schumer. Meanwhile, Rep Anthony Weiner got his start in politics as a staffer for Schumer and Schumer helped mentor him into political office.

But I think it also reflects the perverse logic of partisan municipal elections. Bloomberg is for bike lanes. The bike lanes are controversial. And Bloomberg's not a Democrat. So someone has to take the anti-Bloomberg side on bike lanes, and those "someones" wind up being the Democrats. So even though at the margin the decision to mildly reduce the massive pro-automobile bias of status quo allocation of streetspace is good for poor people and good for the environment, you have prominent Democrats taking the anti-bike stance. This upends the logic of the national Democratic Party's ideological commitments, but it makes sense within the context of a New York City politics that pits a "change a bunch of stuff" Bloomberg administration against sundry small-c conservative interests.

I think partisanship is a very useful device of governance and democratic accountability. But large American cities are so lopsidedly Democratic and deal with issues that are so different from the national ones, that I think most cities would be better served by a different system. The ideal thing, I think, for places like NYC and DC would be to actually have freestanding separate municipal level political parties.

The Right, The Unions, and Campaign Finance

Ezra Klein wonders why conservatives upset about the disproportionate political influence of labor unions don't support the kind of measures that might reduce the influence of labor and business alike:

The income of many corporations — Boeing is a good example — depend on government contracts. Tax policy is also important when it comes to setting take-home pay. Then there are rules, regulations, bailouts, backstops, and all the other ways that the government helps structure and shape the economy. And "through gigantic campaign contributions and overall clout," corporations "have enormous influence over who gets to bargain with them." And in the aggregate, of course, the business community spends much more than the unions — in 2010, business groups spent $1.3 billion, while unions spent $93 million.

Given that disparity, it's not at all clear to me why I should worry more about the money unions spend on elections than the money corporations spend on elections. But more to the point, I'd like to reduce both: The AFL-CIO and the Chamber of Commerce and the Republican Party joined forces against the DISCLOSE Act. But the DISCLOSE Act was a good bill! And the Fair Elections Now Act is a better one. It's curious that the alarm conservatives feel when they look at the nexus of moneyed interests and government power doesn't translate into support for the sort of laws that might weaken that link.

One could speculate on the motives, but to me this seems like a sub-set of one of my big grievances with conservatives and libertarians. I find that right-of-center people are very good at noting ways in which the political process is at times pathological. The technical term for noting the existence of problems in the political system while also having absolutely nothing constructive to say about how to improve things. There's even entire divergent disciplines such that complaining that the political process is unfair while also having right-of-center political opinions is called "public choice economics." The usual response to these complaints is something like liberals are upset at how the rich and powerful have disproportionate political influence, but that's why some of us think the government should be as small as possible. The problem here is that you need to apply a "public choice" analysis analysis to that idea. If there's a state, and if the rich and powerful have massively disproportionate influence over what the state does, then the state will tend to advance the interests of the rich and the powerful. There's no substitute for a well-functioning political system.

The Yoga Instructor Economy

Paul Krugman on the jobs of the future:

And here's the thing: Most of the manual labor still being done in our economy seems to be of the kind that's hard to automate. Notably, with production workers in manufacturing down to about 6 percent of U.S. employment, there aren't many assembly-line jobs left to lose. Meanwhile, quite a lot of white-collar work currently carried out by well-educated, relatively well-paid workers may soon be computerized. Roombas are cute, but robot janitors are a long way off; computerized legal research and computer-aided medical diagnosis are already here.

And then there's globalization. Once, only manufacturing workers needed to worry about competition from overseas, but the combination of computers and telecommunications has made it possible to provide many services at long range. And research by my Princeton colleagues Alan Blinder and Alan Krueger suggests that high-wage jobs performed by highly educated workers are, if anything, more "offshorable" than jobs done by low-paid, less-educated workers. If they're right, growing international trade in services will further hollow out the U.S. job market.

I completely agree with this analysis and also with Krugman's view that "We need to restore the bargaining power that labor has lost over the last 30 years, so that ordinary workers as well as superstars have the power to bargain for good wages. We need to guarantee the essentials, above all health care, to every citizen."

That said, this is why I've been saying that yoga instructors have the job of the future. Nothing in these trends suggests that the actual quantity of janitors is going to increase in the future. If anything, falling demand for office workers implies that the future can have fewer. So is the future a smallish number of wealthy office workers served by an "aristocracy of labor" of unionized janitors awash in a pool of unemployed people enjoying free health care? Presumably not. The people of the future will be richer than the people of today, and therefore will more closely resemble annoying yuppies. Nicer restaurants are more labor-intensive than cheap ones, and the further up the scale you go the more specialized skills (think sommelier) come into play. Annoying yuppies take yoga classes, or even hire personal trainers. Artisanal cheese is more labor-intensive to produce than industrial cheese. More people will hire interior designers and people will get their kitchens redone more often. There will be more personal shoppers and more policemen. People will get fancier haircuts.

This is where I think education does get back into the picture. Most of these are jobs that require some skills. Personal services generally exist on a spectrum between "things a person might hire someone else to do because it's a pain in the ass" and "things a person might hire someone else to do because it's difficult to do it well." You hire a maid because you don't want to clean the toilet. You go to Komi because you can't cook as well as Johnny Monis. There's more money and prestige to be had as you move up the maid-Monis spectrum and there's a need for some kind of mechanism to help people move up it. That sounds like "education" to me, though not necessarily the kind of education we're handing out.

Florida Conservatives Standing Up For Liberty With New Law to Ban Farm Photo

(cc photo by macieklew)

Once again, right-wing politics smells like freedom:

Taking photographs from the roadside of a sunrise over hay bales near the Suwannee River, horses grazing near Ocala or sunset over citrus groves along the Indian River could land you in jail under a Senate bill filed Monday.

SB 1246 by Sen. Jim Norman, R-Tampa, would make it a first-degree felony to photograph a farm without first obtaining written permission from the owner. A farm is defined as any land "cultivated for the purpose of agricultural production, the raising and breeding of domestic animals or the storage of a commodity."

The specific freedom-enhancing element of this particular initiative is that apparently freedom-hating animal rights activists have been known to secretly document farm activities in order to advance socialism. The article quotes Wilton Simpson, "a farmer who lives in Norman's district" who "said the bill is needed to protect the property rights of farmers and the 'intellectual property' involving farm operations." I sort of suspect he just threw in the spurious intellectual property claim to make me angry.

Land, Leisure, and Inequality

Chris Bertram argues sensibly that in the long run improvements in productivity should lead to increased leisure rather than increased unemployment:

Allow me to suggest a third possibility. Instead of mass unemployment or horrendous inequality, technological improvement could reduce the time people spend working to meet their needs and give them more free time. Free time that they could use for other purposes (such as their all-round human development) . The Jerry Cohen video that I posted the other week centres on this very point. For more discussion see ch.11 of Karl Marx's Theory of History , which, I now see, furnished much of the script for that talk. Of course, if you take "free markets", extensive private property and the domination of the political system by money (so that you can't do much about the first two) as givens, then the third possibility will appear impossible or utopian.

For those less familiar with Marx, let me suggest the Star Trek series as an illustrative example. The development of replicator technology seems to have created such a surfeit of goods that traditional capitalist modes of production are obsolete. Rather than accept a world of boundless economic inequality, the federation appears to have eliminated patents (hence there's no super-rich Bill Gates of the replicator) and provided for socialized ownership of dilithium reserves (so there's no super-rich David Koch of the warp core reactor) and then we all lived happily ever after. As Jean-Luc Picard explains "The acquisition of wealth is no longer the driving force in our lives. We work to better ourselves and the rest of humanity." Material resources flow from each according to his abilities to each according to his needs. It's happy, that is, as long as we're blessed to be citizens of the democratic United Federation of Planets. In the Klingon, Cardassian, and Romulan empires the collapse of capitalism and the end of economic inequality seems to have resulted in the creation of strict hierarchical societies in which political inequality is a major factor in life.

But to return us to reality, I think an important point in this utopian vision is that the development of practical tools of interstellar exploration seem to have radically reduced the significance of land in this vision of the future. Try to imagine a utopian version of earth in which everyone on the planet can obtain the material living standards of the average contemporary Dutch person without doing any paid labor. Well some people are going to be enjoying the life of leisure from a nice villa in the Tuscan countryside or from the stunning beaches of the Caribbean while others will be less-fortunately situated in Arkhangelsk or the suburbs of Houston.

The interesting thing, to me, is that since the marginal utility of money declines these basic problems are the ones that arise whether or not we formally make the switch to socialism. Inequality is a phenomenon of scarcity. As material goods become more plentiful, inequality in material living standards becomes less of a reality. But things like land and political power become scarcer, and inequality in their possession becomes more salient. But money begets political power. And even in "free market" America, control of the land is largely a matter of controlling the political process.

Protesters Urge New US Policy Toward Bahrain

Bahraini's living in the USA want to see some change they can believe in:

Hundreds of members of Bahrain's Shiite majority protested outside the U.S. Embassy on Monday in a call for Washington to support their campaign for greater political freedom. The opposition supporters claimed during Monday's protest that Washington is showing less support for the revolt in Bahrain than it did for the uprisings in Tunisia and Egypt that ousted the countries' presidents. The protesters are staging daily marches in an effort to end what they say are royal family's discriminatory policies and political persecution.

They have called for a constitutional monarchy and elected government in Bahrain – which hosts the U.S. Navy's 5th Fleet, the main American military counterweight to Iranian forces. The Sunni minority has ruled Bahrain's Shiite majority for 200 years and some of the protesters camped out in the capital's Pearl Square are demanding that the Al Khalifa royal family step down altogether.

The presence of the 5th Fleet would seem to give the Obama administration considerable leverage here. But beyond considerations of leverage, if I were President I would be telling the al-Khalifas to give the King of Spain a call. Realistically, they're not going to hold power forever. If they transition to a constitutional monarchy, then they have a good chance of continuing to reign for a very long time. If they insist on ruling, then opposition demands will necessarily escalate and history is on the side of the opposition.

How Terrible Is Glenn Beck?

This terrible:

Many on the news side of Fox have wondered whether his chronic outrageousness — he suggested that the president has "a deep-seated hatred for white people" — have made it difficult for Fox to hang onto its credibility as a news network.

Is that something they're seriously trying to hang on to? If so, I might suggest that Beck's not the only host with a credibility problem.