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    Maxine's Essays

    • 21st Century Regress
      Sometimes it seems like the world is going to hell and there's absolutely nothing a girl economist can do about it.
    • What Exactly Are We Crowding Out?
      The current economic downturn isn't a random draw of a black ball from an urn containing white balls and black balls. There's no sampling distribution. Very specific policies and actions landed us here. Now we must decide not only what policies need to be put in place to prevent it happening again, but also what policies would best drive us out of the ditch faster and sustainably.
    • I Wish It Were Only Butter
      We should be giving up some butter if we must. We should not give up education or health investment (or infrastructure or the environment (hello, BP). They may be the only legacies of any value that we pass on to our children and grandchildren.
    • Rational Health Investment?
      The obvious "market solution" is to improve the long run return on investments in health among the disadvantaged through meaningful and effective publicly funded education. The obvious short run "market solution" is to reduce the costs of investment and the shadow price of health for the disadvantaged by providing health insurance cover and reduced out-of-pocket costs.
    • The Socrates Parameter
      To the extent that our limbic systems respond to such engineering by over-riding the judgment of our frontal lobe and to the extent that our frontal lobe is deprived of the information it requires to make a rationally self-interested judgment, we are not only pigs and fools, we are slaves.
    • The Economic Rewards of Virtue
      If individual virtue tempers our "piggy" desires and conditions our choices to something that is both individually and socially better, then the economic rewards of virtue as embodied in and promoted by societal norms and institutions are far greater than we have ever suspected. As economists, we would do well to recognize this when we teach U max.
    • The Market for Morals
      Markets then are places where more is exchanged than goods and services, labor and product, credit, and interest. They are places where we also develop the personal virtues of temperance and prudence and the social virtues of benevolence and justice. When they function well, they produce trust, loyalty, and sympathy among those who trade there.
    • Post-Modern Applied Economics: It’s the Error Term, Stupid
      Maxine believes it’s time to refocus attention and discussion on the error term. It is often where much of the action is in our models. It is where unexpectedly catastrophic events dwell resulting in fat tails. It is where our animal spirits manifest and cause us to do the right thing or the wrong thing or the thing everyone else is doing rather than the self-interested, fully-informed rational thing. It is where God and miracles and chance dwell.
    • Intergenerational Win-Win: Health Insurance, Education, Environment, Infrastructure
      So when we’re talking about fiscal stimulus packages and we’re borrowing from our grandchildren to finance them, we should be thinking about how to use stimulus monies to create value for those grandchildren AND stimulate our economy.
    • Short-term Private Payoffs, Long-term Social Costs
      The real health reform discussion, the one we should be having, is “What must we do to create a health system that is both efficient and fair?” The answer will almost certainly include relegating the private sector to markets where market forces or regulation are effective at aligning short-term private incentives and goals with long-term societal interests. If such markets are scarce or non-existent in health, then the private health sector will be of limited value.
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    07/29/2010

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    looks like people are being squeezed, maxine...

    Americans Cut Back on Visits to Doctor - Insured Americans are using fewer medical services, raising questions about whether patients are consuming less health care as they pick up a greater share of the costs. The drop in usage is showing up as health-care companies report financial results. Insurers, lab-testing companies, hospitals and doctor-billing concerns say that patient visits, drug prescriptions and procedures were down in the second quarter from year-ago levels. "People just aren't using health-care like they have," "Utilization is lower than we expected, and it's unusual." Continued weak demand could eventually put downward pressure on spiralling health-care costs, a long-sought goal of policy makers. It could also force insurers to lower premiums. The new trend comes amid a broader drop in health-care use as more Americans lose their jobs and their health insurance. Such cutbacks have happened before in recessions, but the drop seems to be more pronounced this time, industry analysts say.

    http://online.wsj.com/article/SB10001424052748703940904575395603432726626.html?mod=djemITP_h

    here's something else curious:

    In Haiti, a Lesson for U.S. Health Care

    http://www.nytimes.com/2010/07/29/opinion/29wilentz.html?_r=1&hp

    I hear the same from my fellow docs. Then I hear them complain about government spending and the debt. I think it is partly an entitlement issue. I think it is also frustration with lack of non-financial rewards. I do find it interesting that as I read right of center health care blogs, most seem to think that part of the problem is that Medicare and Medicaid do not pay enough. Not sure how they plan to cut medical spending or if they have conjured a reverse Laffer curve where increased spending on medical care will somehow reduce total spending.

    Steve

    Maybe the doctors I go to are different. I have never had a doctor refuse to take me because I am on Medicare, but I've had to change most of my doctors because they don't want to deal with Medicare Advantage, run through a private insurer. It is apparently the hassle rather than the payments they object to. And I think it is mainly Medicare Advantage payments that are set to be cut.

    Doctors leave Medicare all the time. They get outraged when someone swats their entitlement with a rolled-up newspaper...

    It's hard for me, as a CPA who deals with a lot of doctors, to be sorry for a bunch of people making $350K, or more, a year. Much of which is deliberate over-medicalizing problems.

    It never fails, someone gets a new machine, next thing you know... It's a cash-cow...

    The comments to this entry are closed.

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