Showing posts with label Markets. Show all posts
Showing posts with label Markets. Show all posts

10 February 2010

Of Wal-Mart, Health Care, & American History

Sometimes I get so burned out from reading talking about nothing but slavery and the poor treatment of Native Americans and women in the American History seminar I teach (I have to stick to the syllabus) that finally reach my limit and lash out.

Mind you, America is not perfect. The aforementioned Big Three sins were real. But they aren't all there is to American History. And it doesn't help that we are teaching practically nothing more than those three plus the British hobby horse (class warfare) to British freshers who hardly even know who George Washington was.

Just in case the supervising professor on my course (or anyone else from my university, for that matter) read this post let me say up front: I don't blame them; this is the state of academia.

Anyway, where was I? Oh yes, sometimes I reach my limit and go on an I-love-America-liberty-markets-free-trading-are-awesome rant.

Like yesterday. We reviewed a bunch of reading that characterized the increased interdependence, division of labor and specialization of the American economy in post-Reconstruction America as horrible because it made the rich richer and the poor poorer and so on and so forth. One article we read trumpeted "economic independence" as an ideal that was somehow lost or never was or some other such nonsense.

That is, in the New South, capitalists from the North built factories to process raw cotton and tobacco and mine and coal and extract and refine iron (later steel) because it was closer to the source (reducing transportation costs) and laborers in the South were much less likely to unionize, thus resulting in lower labor costs.

And all of this was bad, bad, bad.

Missing is the fact that all of these developments brought jobs to the South (where there had been, prior to the Civil War, a lack of industry) and a higher standard of living. The fact that there were now stores near every railroad depot (another feature of post-Reconstruction America) selling goods people hadn't even imagined before was not a good thing, it was bad because people went into debt to the bad Northern capitalists who produced these goods and duped the stupid poor Southerners into buying them.

The post-Reconstruction period in America is widely considered by economists to be a Golden Age of commerce. Standards of living increased significantly. But the historical narrative is one of worker exploitation, etc. etc.

So I took a moment and tried to teach something about the power of competition and how it both reduces prices and improves quality.

Now the Wal-Mart & Health Care part of the blog post title: Stephen Spruiell made the point last Friday at The Corner that the mere presence of Wal-Mart in the health care industry would improve quality and drive down costs--even for those who never went to Wal-Mart for their open-heart surgery. He's right. This, my friends, is the power of markets in health care.

Because other people would have to compete with Wal-Mart in supplying health services to individuals, the quality would go up (just as there is Nordstrom) and the price would go down (think of the many different price-comparison websites on the internet).

Unlike Europe, we ought not care about the difference in income between the richest and the poorest so long as the poorest can become richer and the richest aren't ensconced, by some government diktat, as the ruling class. Indeed, though the spread between richest and poorest may increase, America remains the country where the most people are able to move between the five infamous quintiles on the income scale. By and large, the poorest do not remain the poorest and the richest die like everyone else.

In Europe, regulation, law, and other preferential treatments have resulted in fairly static class organization. The middle class remain the middle class and the upper class remain in the upper class and this continues on, ad infinitum, generation after generation. The modern European welfare state has created, as I point out to my friends who will listen (or at least act as though they are listening) a permanent underclass. In France, for instance, this underclass is populated mostly by Muslim immigrants who, despite the ever-increasing benefits being thrown their way by the French liberal elite, continue to burn cars.

They burn cars not because they want another 10 Euros a week to pay their mobile phone bill, but because the barriers to getting a job and generally breaking into civilized French society (for instance) are for all intents and purposes, impenetrable.

The same is basically true, to a greater or lesser extent, in every other modern welfare Western European state.

This is essentially what liberal utopia (aka social democracy) looks like. The Great Society largely reversed several generations of gains by African Americans (from the Emancipation Proclamation through the Civil Rights movement). Thomas Sowell has shown how African Americans income, education, standard of living, etc., increased right up until liberal good intentions destroyed the African American family and made them America's permanent under class.

African Americans now vote, practically en masse, for liberal Democrats who, in turn, promise them an expansion of welfare programs which do nothing more than make them, as a people, more dependent on the state and the "good will" of liberal elites.

How to wrap this up? Eric Foner, of all people, wrote about Frederick Douglass's concerns regarding liberal paternalism in his article, "Rights and Black Life in War and Reconstruction."
Frederick Douglass himself had concluded in 1865 that the persistent question "What shall we do with the Negro?" had only one answer: "Do nothing.... Give him a chance to stand on his own legs! Let him alone!" Douglass realized that the other face of benevolence is often paternalism and that in a society resting, if only rhetorically, on the principle of equality, "special efforts" on the freedmen's behalf might "serve to keep up the very prejudices, which it is so desirable to banish."
America need not make the same mistake as our friends in Europe. Liberty and responsibility are inextricably tied together and our government laws and policies--whether health care or welfare or whatever--ought to reflect that relationship.


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01 December 2009

The Power Of Markets In Healthcare: I Have Seen A Vision Of The Future And This Is It


Division of labor and specialization.

The approach has transformed health care in India through a simple premise that works in other industries: economies of scale. By driving huge volumes, even of procedures as sophisticated, delicate and dangerous as heart surgery, Dr. Shetty has managed to drive down the cost of health care in his nation of one billion.

His model offers insights for countries worldwide that are struggling with soaring medical costs, including the U.S. as it debates major health-care overhaul.

"Japanese companies reinvented the process of making cars. That's what we're doing in health care," Dr. Shetty says. "What health care needs is process innovation, not product innovation."

At his flagship, 1,000-bed Narayana Hrudayalaya Hospital, surgeons operate at a capacity virtually unheard of in the U.S., where the average hospital has 160 beds, according to the American Hospital Association.

Narayana's 42 cardiac surgeons performed 3,174 cardiac bypass surgeries in 2008, more than double the 1,367 the Cleveland Clinic, a U.S. leader, did in the same year. His surgeons operated on 2,777 pediatric patients, more than double the 1,026 surgeries performed at Children's Hospital Boston.
[...]

But Jack Lewin, chief executive of the American College of Cardiology, who visited Dr. Shetty's hospital earlier this year as a guest lecturer, says Dr. Shetty has done just the opposite -- used high volumes to improve quality. For one thing, some studies show quality rises at hospitals that perform more surgeries for the simple reason that doctors are getting more experience. And at Narayana, says Dr. Lewin, the large number of patients allows individual doctors to focus on one or two specific types of cardiac surgeries.

In smaller U.S. and Indian hospitals, he says, there aren't enough patients for one surgeon to focus exclusively on one type of heart procedure.

Narayana surgeon Colin John, for example, has performed nearly 4,000 complex pediatric procedures known as Tetralogy of Fallot in his 30-year career. The procedure repairs four different heart abnormalities at once. Many surgeons in other countries would never reach that number of any type of cardiac surgery in their lifetimes.

Dr. Shetty's success rates appear to be as good as those of many hospitals abroad. Narayana Hrudayalaya reports a 1.4% mortality rate within 30 days of coronary artery bypass graft surgery, one of the most common procedures, compared with an average of 1.9% in the U.S. in 2008, according to data gathered by the Chicago-based Society of Thoracic Surgeons.

It isn't possible truly to compare the mortality rates, says Dr. Shetty, because he doesn't adjust his mortality rate to reflect patients' ages and other illnesses, in what is known as a risk-adjusted mortality rate. India's National Accreditation Board for Hospitals & Healthcare Providers asks hospitals to provide their mortality rates for surgery, without risk adjustment.

Dr. Lewin believes Dr. Shetty's success rates would look even better if he adjusted for risk, because his patients often lack access to even basic health care and suffer from more advanced cardiac disease when they finally come in for surgery.
In addition to keeping costs low so the people of his country can afford life-saving heart surgery, Dr. Shetty also turns a profit--about 7.7% after taxes and more than the 6.9% average in the United States.

This is the sort of thing I'm talking about when I refer to market reform of healthcare. Neither I, nor anyone else has to come up with all the answers, indeed, we couldn't possibly do so. That is for a market, full of enterprising, profit-seeking individuals to figure out.

The role of government is not to provide healthcare for everyone through some sort of trojan horse-like public option that morphs into British- or Canadian-style socialized medicine. It is to get the hell out of the way of a free market that would lower costs and improve quality.


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13 August 2009

President Obama's Ringing Endorsement Of The 'Public Option'




'What, are all you free-marketers afraid of a little competition!?!!'


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26 June 2009

11 December 2008

Oil: It's Not Black & White (UPDATED)

As a general rule, I look to the efficiency and amorality of the market to solve economic issues. I guess that makes me libertarian. However, my libertarian-ness has limits. I won't get into those here.

From that general rule, I find myself hesitant of any plan that seeks to manipulate the market to attain some desired, utopian end. One example of this would be "an end to oil dependency." You see, I used to just accept, like everyone else, that dependence on oil for our energy use was an unmitigated bad--the blackest of black.

(nor should this be interpreted as a call for laissez faire, whatever)

My opinion is shifting. Like any other traded good, and especially one so vital to the operation of a country, I think oil forces the United States to make compromises and care about parts of the world which would otherwise receive no attention. And I don't buy the "blood for oil" arguments of the most ardent anti-Bush people. Sorry, folks, President Bush doesn't/didn't just take his marching orders from Exxon & Haliburton.

And I'm worried about the unintended consequences of "going green" or even of imposing some sort of pigovian tax. Sure, I'm sympathetic to a plan that trades cuts in income taxes for a carbon tax, but I'm worried that under such a scenario, the poor will pay--and not just the poor of this country. I'm reminded of the failure of the massive ethanol subsidy which contributed to worldwide food shortages and famine.

I bring all of this up because of an article in the Wall Street Journal which argues, essentially, that oil dependency and the moderation in foreign policy it forces is good. It's a persuasive essay written by someone, Roger Howard, who has done his homework.
While there are, of course, circumstances in which oil can exacerbate tensions and be a source of conflict, it can also act as a peacemaker and source of stability. So to identify America's "foreign oil dependency" as a source of vulnerability and weakness is just too neat and easy.
It's at least worth considering because, like so many other things, the question of oil is not black & white.

12 December 12:50am BST: RD at Pendulum Politics responds.


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08 October 2008

Brit Humor



Finally, after watching this, I understand the complex movement and machination of the markets.

(from Ace)


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03 October 2008

John McCain Is A Free Trader

Courtesy, Mary Kissel, WSJ Political Diary:
HONG KONG -- One of the two guys now running in the U.S. will be president, so the rest of the world is hungry for signs about what the election means for them. Quietly, the McCain campaign has set out an Asia policy that's worth paying attention to.

In an op-ed piece for The Australian newspaper last week, Mr. McCain put heavy emphasis on building traditional alliances with Asian democracies. The 100-year-old U.S.-Australian alliance "sets the standard," he says. Mr. McCain also laid down a strong call for "American leadership" on trade, noting that free trade agreements with Australia and Singapore "are critical building blocks for an open and inclusive economic order in the Asia-Pacific region." In a statement voters back home might like to hear, he added: "America has never won respect or created jobs by hiding behind protectionist walls and I will continue making the case for free trade, regardless of political expediency."

Right-thinking Australians loved the op-ed. The Lowy Institute's Andrew Shearer lauded Mr. McCain's "deeply personal engagement in the alliance and our shared history," and recalled that Mr. McCain's grandfather and father had served "side by side with the Royal Australian Navy" in the Pacific during World War II.

Mr. McCain is the only presidential candidate so far who has put forth a coherent foreign policy vision for engagement with Asia, one of the world's most volatile regions. His strong endorsement of free trade was especially welcome to Asians who frequently understand better than Americans how much it has contributed to the world's prosperity.

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23 September 2008

On The Bailout

Reader Victor S. writes:
The news today said the price-tag is going to be $700 billion. (That would be about $2333 per American, and on tv today one commentator suggested the price tag might go over $1 trillion. That price of $2333 is including everybody, including children, retired, and others who do not actively contribute to the tax base. That means that for those of us who do it will be much higher.)

This bailout appears to have approval of both parties.

I understand the argument that it will hurt the economy if these companies falter and fail. But look at the obvious. It will hurt the economy to ask every person fork over $2000+ (please, again, remember that those who are paying taxes will have to cover those who don't) just to save some companies who, apparently, made some bad choices.

What I cannot figure out is why they have to rush to get this approved.

A final thought; both parties seem to be supporting the President in this. Nobody can blame their political opponents for this one.
(emphasis added)

Republicans are starting to push back against the bailout because it seems to be the opposite of capitalism--anti-capitalism.

The conservative in me approaches this thing with caution. I think this problem was caused by bad Democrat-influenced policy through their campaign fundraisers, Fannie Mae & Freddy Mac. But just because the problem was caused by government intervention does not, of a necessity, mean that government is best suited to "solve" the problem.

In this instance, Democrat socialists will have significantly harmed the American economy only to accrue to themselves greater control of the economy as a result.

Any believer in free markets should be very skeptical of a government solution to this problem--especially when the problem was, at its core, caused by elements of the government. The tendency in crises like these is to want to do something. That is not always the best response.

The fiscal libertarian in me says, "let the banks fail and the market will pick up the pieces." That's my ideological response.

I'm prepared to be persuaded on practical and pragmatic grounds.


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07 September 2008

Fannie/Freddie Fail

The inevitable finally happened. The Federal government seized Fannie Mae and Freddy Mac. I'm not an expert on these sorts of things so I will make just one observation:

Despite what you may read elsewhere, this was not a failure of the free market.

The backing given these companies by the federal government guaranteed their debts thereby distorting the market. When an institution is not forced to account for risk, it makes very irresponsible decisions. In this instance, the risk-less decisions made by the two mortgage lenders distorted the whole market and set us up for the problems the market now faces.

The best solution would be for the government to take control of Fannie & Freddy and break them up and sell off the various parts. This may require putting them both into some sort of receivership.

As important as solving the problem is, it is also important that people keep their heads and not lose faith in the free market. This was another government failing, not a market failure.

UPDATE 2:17pm MDT: Greg Mankiw weighed in on the bailout and for the most part, reflects the perspective I gave above--though obviously, he writes it better:
The problem is far from over, as the future of these institutions and a large segment of the financial system is still to be determined. The worrisome part is that this future will be determined by a political system that both created the GSEs and failed to provide sufficient oversight, even when many economists suggested reform was needed. To believe that the Congress will do a good job of it would be the triumph of hope over experience.
This was a government problem, not a market problem.


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15 July 2007

Rosie O'Donnell & the Amoral Market

We read it in the aforementioned comments over at the Seattle PI about the fairness doctrine and we read it in a post our buddy made on cougarboard.com. We refer, of course, to the hokey notion that because media outlets are controlled by supposedly "conservative" business interests, that makes the media outlets they control ipso facto conservative.

Nevermind the fact that in the last several election cycles, most businesses donated almost equally to both the Republican and Democratic parties. Where they don't give equally, it is based on who they think has the best chance of winning, not ideology. They want to support whoever will eventually be sitting on the Ways and Means Committee--regardless of political party. Ignore also the fact that few businesses are controlled by some small cabal of middle aged white males who, along with trying to gain monopolistic control of their industry, work tirelessly towards their ultimate goal of playing puppetmaster with the US government. Come on. Aren't we too old for these crazy conspiracy theories?

Capitalism, markets, business--these things are neither Republican or Democrat, conservative or liberal. The market is neither moral nor immoral. It seeks only profit. This guiding principle applies equally to the media. If a corporate interest believes ratings will rise and with it their profits, they will keep Rosie O'Donnell on the air until the public tires of her. If Jon Stewart or Stephen Colbert or Keith Olbermann makes them money, they will continue to fund production of their shows. The same thing applies (obviously) to conservative media. These businesses didn't pull their advertising from Air America because of politics, they stopped buying airtime because Air America didn't have enough listeners.

Wake up. If there are dollars to be made, and one company will ignore the opportunity because of some ideological difference, you can bet your bottom dollar that their competitor will step in and take advantage of the opening. They don't care if Democrats, Republicans, Communists or Atheists buy their widgets, they just want to make a profit. That's business. That's capitalism. That's the amoral market.


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