Wednesday, September 23, 2009

john cochrane on the fiscal stimulus

with the recession being declared "nearly over" it would be good to take a look back at what economists said before. john cochrane write a great article on the aftermath of the fiscal stimulus. he notes that as the economy improves banks with stop sitting on their reserves which will shoot up the money supply even more than the $1 trillion stimulus package. we'll have to to wait and see what happens when that occurs.

Tuesday, September 15, 2009

the real cost of healthcare

Lawmakers are currently attempting to pass legislation that will lower costs. A simple lesson in economics will show how their reform will actually increase costs. There are three main reasons why healthcare costs are increasing: the care is getting better, we are getting richer, and the patients are getting unhealthier. The reform, rather than fixing each of these, actually exaggerates these reasons.

If you compare the miracle of modern medicine to its grandfather of decades ago you will notice the drastic improvement due to technology and innovation. Better coverage comes at higher costs; to think that hospitals should be able to operate at the same cost today as they did even ten years ago, with all the technological advances and high-tech equipment they have access to now, is madness. Better care comes at a higher cost. Cutting costs would stifle innovation in the field of medicine. It inherently implies lowering the rate of return on investment of pharmaceuticals and machinery, meaning that people would not get much back for medical breakthroughs. This lack of incentive is enough kill innovation, decreasing the quality of our healthcare for all. The same goes for not just capital but also those in the profession, as salaries are slashed in an attempt to cut costs. Attempting to cut costs through this reform can only lead to decreased quality.

Healthcare has an income elasticity of 1.6, classifying it as a luxury good. This means that as people’s incomes increase they will spend a higher percentage of their income on healthcare. As I’m sure you have noticed America is continuing to get richer with GDP, and thus income, increasing about 3.3 percent a year. Thus, as our incomes grow over time the demand for quality healthcare is going to increase as well, driving up the price. This is not the fault of greedy insurance companies, but merely the work of the invisible hand. The reform would force every American to have insurance. Mandating that all citizens buy insurance would drive up the price of private insurance because of increased demand, crowding out those who could have afforded it but no longer can. This squeezes more people out of private insurance into the public option. There is no “choice” or “competition” in that.

We as Americans do not live healthy lifestyles. Obesity alone accounts for ten percent of healthcare costs directly, and a much larger portion of it indirectly. We fail to eat our fruits and vegetables that contain the nutrition we need to prevent cancer and other diseases. Poor lifestyle choices equates to a higher demand for healthcare, and once again higher costs. The Wall Street Journal wrote, “The prevalence of obesity rose 37% between 1998 and 2006....Obese people spent 42% more than people of normal weight on medical costs in 2006.” In encouraging people to choose healthier lifestyles we must provide the right incentives. Insurance companies can do this by offering discounts to those who exercise and eat their fruits and vegetables. On the other hand, by the government establishing a public option in which one can receive coverage at minimal cost to himself would incentivize continued unhealthy living, which only increases the cost.

Healthcare must be reformed, but we must do it the correct way. If cutting costs and providing healthcare for all is the goal then we must look at ending employer-based insurance. This would allow employees to have an open market and choose their own insurance, establishing real choice and competition. Creating Health Savings Accounts in which people could roll a percent of their paycheck into a fund used only for healthcare would provide portability and security that we desperately need, without the $1 trillion expense of a public option. Tort reform will decrease costs significantly. None of these are in the current bills.