Archive for the ‘Cato Publications’ Category
As the Supply Curve Shifts…
Today’s New York Times runs an oped on the supply of physicians by David C. Goodman, an investigator with the Dartmouth Atlas of Health Care. The Dartmouth Atlas does invaluable work documenting the waste that exists in Medicare and other parts of the U.S. health care sector. Goodman critiques a recommendation by the Association of American Medical Colleges that the United States increase its output of doctors by 30 percent to meet the needs of the growing number of elderly Americans. That critique is excellent as far as it goes, but it seems to miss half the picture.
Goodman argues that increasing the number of physicians will do nothing to improve the quality of health care. He cites the sort of data for which the Dartmouth Atlas is famous:
Many studies have demonstrated that quality of care does not rise along with the number of doctors. Compare Miami and Minneapolis, for example. Miami has 40 percent more doctors per capita than Minneapolis has, and 50 percent more specialists…
The elderly in Miami are subjected to more medical interventions — more echocardiograms and mechanical ventilation in their last six months of life, for example — than elderly patients in Minneapolis are. This also means more hospitalizations, more days in intensive care units, more visits to specialists and more diagnostic tests for the elderly in Miami. It certainly leads to many more doctors employed in Florida. But does this expensive additional medical activity benefit patients?
Apparently not. The elderly in places like Miami do not live longer than those in cities like Minneapolis. According to the Medicare Current Beneficiary Survey, which polls some 12,000 elderly Americans about their health care three times a year, residents of regions with relatively large numbers of doctors are no more satisfied with their care than the elderly who live in places with fewer doctors. And various studies have demonstrated that the essential quality of care in places like Miami — whether you are talking about the treatment of colon cancer, heart attacks or any other specific ailment — is no higher than in cities like Minneapolis.
In other words, doctors in some areas of the country order up a lot of health care that seems to benefit no one but the doctors themselves. All that apparently value-less health care costs workers and taxpayers tens of billions of dollars per year.
UK National ID in Collapse – U.S. National ID to Follow?
The Sunday Times (U.K.) reports that “Tony Blair’s flagship identity cards scheme is set to fail and may not be introduced for a generation.” The Times cites leaked e-mails reflecting senior officials’ belief that the plan to subject the U.K. population to the regimentation of a national ID system is falling apart. Even a backup, scaled-down national ID card isn’t “remotely feasible,” according to the e-mails cited by the report. Ministers who are pressing ahead with the plan are “ignoring reality.”
Similar e-mails may well be floating around the U.S. Department of Homeland Security, which will be issuing regulations to flesh out the REAL ID Act this summer this fall after November 7th. (No bureaucrat with an ounce of political acumen would drop a $9-billion-dollar unfunded surveillance-mandate before the mid-term election.)
This is not bad news. A national ID system is useful for controlling a law-abiding population, but not useful for securing against law-breakers, particularly committed threats like terrorists – unless it is part of a total surveillance system.
The failure to implement a national ID system in the U.S. would represent little loss to the nation in terms of security, and a substantial gain in terms of preserved freedom and autonomy. All this is discussed in my new book, Identity Crisis: How Identification is Overused and Misunderstood.
Unlike the U.K., where a national ID is apparently a project identified with Tony Blair, the Bush Administration does not have to look for a face-saving alternative. The U.S. national ID was not a Bush Administration project, but something it accepted in a political bargain. The Administration can now (rightly) declare it impossible to implement and inconsistent with American values, then work with Congress to repeal the REAL ID Act.
New at Cato Unbound: What to Do about Iran?
In this month’s Cato Unbound, “What to Do about Iran,” Reuel Marc Gerecht, resident fellow of the American Enterprise Institute and author of The Islamic Paradox, argues in a provocative new essay that diplomatic attempts keep Iran’s clerical regime from getting nuclear weapons will fail, so the U.S. must choose between preemptively bombing Iran’s nuclear facilities or allowing the mullahs to have the bomb. Arguing that the latter option “would empower its worst enemies in Tehran and spiritually invigorate all Muslim radicals who live on American weakness,” Gerecht advises the former: a policy of preemptively bombing Iran’s nuclear sites.
This week and next, a panel of defense strategy and foreign policy experts will challenge Gerecht’s argument, starting with Ted Galen Carpenter, vice president of defense and foreign policy studies at the Cato Institute, and followed by Edward N. Luttwak, senior fellow of the Center for Strategic and International Studies and author of widely discussed recent article in Commentary, “Three Reasons Not to Bomb Iran — Yet,” and Anthony H. Cordesman, Arleigh A. Burke Chair in Strategy at the Center for Strategic and International Studies and author of Iran’s Developing Military Capabilities.
Is Gerecht right? Are all non-military approaches to the Iranian nuke bound to fail? If so, should the U.S. resign itself to a nuclear Iran and rely on deterrence as it did during the Cold War? Or is deterrence ill-suited to a regime run by religious extremists?
Stay tuned for incisive commentary and criticism by some of America’s leading defense policy thinkers.
Identity Crisis Reviewed
Over at Tech Liberation Front, Tim Lee of the Show-Me Institute has reviewed my book Identity Crisis: How Identification is Overused and Misunderstood. It’s a good summary if you want a sense of what the book is about. In my opinion, Tim concludes well: ”You should buy the book.”
Competitive Federalism Can Reform Health Insurance, Med Mal
In a previous post, I suggested that my brother and his family could save thousands on their health insurance if they moved in with his former college roommate’s family in Pennsylvania, rather than settle and buy coverage in New Jersey.
I thought that former roommate’s wife (Kristin, another college friend) would shoot me virtual daggers. Instead, she wrote:
Wow — guess we’re pretty lucky! Although, we can’t seem to keep our doctors here in PA due to high malpractice insurance costs. So maybe the best deal for everyone would be to buy their insurance in PA, then drive to NJ for their doctor’s appointments.
That’s one way to get around unwanted costs imposed by a state’s medical malpractice laws. In our book Healthy Competition, Mike Tanner and I suggest another: Let patients, doctors, hospitals, and insurers agree up front on the level of malpractice protection that patients receive.
Medicare Part D: Who Is the Main Constituency?
Watson Wyatt Worldwide has just released a survey showing — again — that Medicare Part D’s employer subsidies and the availability of the new stand-alone drug plans are bailing out employers who can no longer deliver on their promises to retirees:
Despite widespread use of the Medicare federal subsidy, a vast majority of employers are planning to curtail their retiree medical plans for current and future retirees in the next five years…
Fourteen percent of employers plan to eliminate the benefit entirely for future post-65 retirees and 6 percent plan to eliminate it for their current post-65 retirees…
The lesson from the Pension Benefits Guarantee Corporation and other corporate bailouts could not be more clear: if government lets corporations escape the costs of making promises they can’t keep, we’ll get more corporations making promises they can’t keep.
Health Care Provider Finds No Tragedy in This Commons
An article from the Minneapolis Star-Tribune on competition between physicians and nurse practitioners includes this endearing quote, which encapsulates how some providers see the U.S. health care sector:
The American Medical Association is against giving full autonomy to nurse practitioners, stating as its official policy position that a physician should be supervising nurse practitioners at all times and in all settings…
“There is an element within the physician community that gets a little antsy. … They think it’s going to take away revenue and business from them,” said Dr. Jan Towers, director of health policy for the American Academy of Nurse Practitioners. “Really, there’s more than enough for everybody.”
Cue “We’re in the Money”….
For more, be sure to check out Medicare Meets Mephistopheles, to be released by the Cato Institute in September.
“Crisis of Abundance” Makes Executives’ Reading List
The leadership of the National Chamber Foundation (the educational arm of the U.S. Chamber of Commerce) recently recommended to its board of directors a list of 10 “Books that Drive the Debate.” Among the recommended titles was Crisis of Abundance, a Cato Institute book by adjunct scholar Arnold Kling and the only health policy book to make the list.
The foundation’s board is a bipartisan group of influential figures from the business, political, and policy spheres. The NCF also plans to recommend the 10 titles to all Chamber of Commerce members.
The complete list is pasted below. NCF chairman Bill Little told me today that Crisis of Abundance will be the first book they send out to their board members.
“Books that Drive the Debate”
NCF’s Top 10 Reading Selections
- Illicit: How Smugglers, Traffickers and Copycats are Hijacking the Global Economy by Moises Naim
- Three Billion New Capitalists: The Great Shift of Wealth and Power to the East by Clyde Prestowitz
- The Bottomless Well: The Twilight of Fuel, the Virtue of Waste, and Why We Will Never Run Out of Energy by Peter Huber and Mark Mills
- In Our Hands: A Plan to Replace the Welfare State by Charles Murray
- Our Brave New World by Charles Gave, Anatole Kaletsky, and Louis-Vincent Gave
- The Sarbanes-Oxley Debacle: What We’ve Learned; How to Fix It by Henry N. Butler
- An Army of Davids: How Markets and Technology Empower Ordinary People to Beat Big Media, Big Government, and Other Goliaths by Glenn Reynolds
- The Innovator’s Solution by Clayton Christensen and Michael Raynor
- Crisis of Abundance: Rethinking How We Pay for Health Care by Arnold Kling
- Education Myths What Special-Interest Groups Want You To Believe About Our Schools – And Why It Isn’t So by Jay P. Greene
(Another Cato connection: in March, the Cato Institute held a book forum for Glenn Reynolds’ An Army of Davids: How Markets and Technology Empower Ordinary People to Beat Big Media, Big Government, and Other Goliaths.)
The leadership of the NCF evidently agreed with Marginal Revolution publisher Tyler Cowen that Crisis of Abundance “is one of the most important books written on health care.”
Why Do We Spend So Much on Defense?
Reuters alerts us to the new report from the Stockholm International Peace Research Institute, which includes a workup on global military expenditures. A few key findings:
World military expenditure in 2005 presents a real terms increase of 3.4 per cent since 2004, and of 34 per cent over the 10-year period 1996–2005. The USA, responsible for about 80 per cent of the increase in 2005, is the principal determinant of the current world trend, and its military expenditure now accounts for almost half of the world total.
[...]
The USA is responsible for 48 per cent of the world total, distantly followed by the UK, France, Japan and China with 4–5 per cent each.(emphasis mine)
The USA is today unchallenged in our hemisphere, and we enjoy friendly relations with almost all great powers in the world, depending on one’s perspective on where the US-China situation is headed. Fighting terrorism the right way–with bolstered intelligence cooperation, small-scale special forces activities and cooperation with our allies–is actually quite cheap.
But we still spend nearly as much on defense as the rest of the world combined. Why? If the threat of terrorism doesn’t justify such massive expenditures, what on Earth are we so afraid of?
There isn’t a good answer. Moreover, even this enormous level of expenditure doesn’t seem to be turning the Bush administration’s ambitious foreign policy aspirations into reality, and the unfortunate mismatch between means and ends is on display daily in Iraq. The thing to do, of course, would be to acknowledge the limits of military power, quickly pull our foreign policy goals into line with our national interests, and stop trying to reshape the culture and politics of faraway peoples that we don’t understand, and who don’t threaten us. Unfortunately, such a correction doesn’t seem to be in the offing.
For a useful and thoughtful critique of US defense spending, see this PA by my former colleague Chuck Pena.
New at Cato Unbound: Frank Levy on Education and Inequality in the Creative Age
In today’s reply to Richard Florida’s lead essay on “The Future of the American Workforce in the Global Creative Economy,” Frank Levy, Daniel Rose Professor of Urban Economics in the MIT Department of Urban Studies and Planning, agrees that creativity is more important than ever in a world where computers and foreign workers can do routine work less expensively than domestic workers. This shift, Levy says, requires better education in problem-solving. But better education can only do so much. The gains from rising labor productivity are going largely to the wealthy, Levy argues. Unless policies and norms are reinstated that spread those gains more widely, “all of the nation’s institutions will be at risk.”
Holt & HSAs: Perhaps Fruitful after All
Matthew Holt writes:
The argument I want to have is a theoretical one about what would happen if we had essentially a completely personalized account-based system, as he advocates in his Large HSA proposal.
Holt raises important questions about what would happen under a system of large HSAs, where workers would get a large but limited tax break for cash that they (and/or their employer) deposit in an HSA — tax-free cash that workers could use for health savings, spending, or insurance as they wish.
Filed under: Cato Publications; General; Health Care; Tax and Budget Policy
New at Cato Unbound: Robin Hanson on Creativity and Smart Machines
In his reply to Rise of the Creative Class author Richard Florida’s lead essay, George Mason economist Robin Hanson argues that creativity matters less for economic growth and the future of work than Florida thinks. According to Hanson, Florida’s emphasis on creativity distracts us from the prospect of a truly revolutionary change just over the horizon: rapidly exponential growth driven by smart machines. “An economy with intelligent machines could grow very rapidly indeed,” Hanson argues, “and induce rapidly falling human wages.” Will we be prepared if we’re busy making the Creative Class comfortable?
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