kottke.org posts about economics
Economics professor Daniel Johnson makes accurate Olympic medal predictions using a handful of indicators that are unrelated to sports.
His forecast model predicts a country’s Olympic performance using per-capita income (the economic output per person), the nation’s population, its political structure, its climate and the home-field advantage for hosting the Games or living nearby. “It’s just pure economics,” Johnson says. “I know nothing about the athletes. And even if I did, I didn’t include it.”
For the upcoming 2010 games in Vancouver, Johnson predicts that Canada, the US, Norway, Austria, and Sweden will end up with the most medals. (thx, brandon)
Update: Johnson’s predictions were a bit off.
There’s not a whole lot to do at work this week, right? So how about tucking into all ten hours of a PBS documentary featuring economist Milton Friedman called Free to Choose. Here’s part one:
Here’s part two and part three…all the rest are available on Google Video (aside from part six for some reason). From Wikipedia, a brief description of the series:
PBS telecast the series, beginning in January 1980; the general format was that of Dr. Friedman visiting and narrating a number of success and failure stories in history, which Dr. Friedman attributes to capitalism or the lack thereof (e.g. Hong Kong is commended for its free markets, while India is excoriated for relying on centralized planning especially for its protection of its traditional textile industry). Following the primary show, Dr. Friedman would engage in discussion with a number of selected persons, such as Donald Rumsfeld (then of G.D. Searle & Company).
There are at least 2 crazy passages in this article about the amount of inflation in Zimbabwe over the past 30 years.
Hyperinflation in Zimbabwe, the former Rhodesia, was a quadrillion times worse than it was in Weimar Germany.
In grade school, quadrillion was always an exaggeration but not here:
The cumulative devaluation of the Zimbabwe dollar was such that a stack of 100,000,000,000,000,000,000,000,000 (26 zeros) two dollar bills (if they were printed) in the peak hyperinflation would have be needed to equal in value what a single original Zimbabwe two-dollar bill of 1978 had been worth. Such a pile of bills literally would be light years high, stretching from the Earth to the Andromeda Galaxy.
Andromeda Galaxy! It’s our nearest galactic neighbor but still 2,500,000 light-years away. (via daveg)
This fun little post talks about how the economics of pinball changed as it became more and then less popular.
In 1986, Williams High Speed changed the economics of pinball forever. Pinball developers began to see how they could take advantage of programmable software to monitor, incentivize, and ultimately exploit the players. They had two instruments at their disposal: the score required for a free game, and the match probability. All pinball machines offer a replay to a player who beats some specified score. Pre-1986, the replay score was hard wired into the game unless the operator manually re-programmed the software. High Speed changed all that. It was pre-loaded with an algorithm that adjusted the replay score according to the distribution of scores on the specified machine over a specific time interval.
In the US, when you make under $20,000, there are government subsidies available to help you out. Between $20-40,000 per year, those subsidies are less available, which makes it difficult for people to cross the gap between one and the other.
In fact, until you get past $40,000 a year, any raise or higher paying job you get might actually sink you deeper into poverty.
(via migurski)
In a New Yorker book review this week, Elizabeth Kolbert tears Levitt and Dubner a new one over the geoengineering chapter of SuperFreakonomics, calling the pair’s thinking on the issue “horseshit”.
Given their emphasis on cold, hard numbers, it’s noteworthy that Levitt and Dubner ignore what are, by now, whole libraries’ worth of data on global warming. Indeed, just about everything they have to say on the topic is, factually speaking, wrong. Among the many matters they misrepresent are: the significance of carbon emissions as a climate-forcing agent, the mechanics of climate modelling, the temperature record of the past decade, and the climate history of the past several hundred thousand years.
The airlines that added the most fees (for food, to check bags) in the past few months saw their revenues decline the most.
I thought about his rant this week as the nation’s largest carriers reported first-quarter earnings. Or, more accurately, first-quarter losses. Except for AirTran and JetBlue, they all lost money. The legacy airlines — Delta/Northwest, American, United, Continental and US Airways — lost a lot of money. Collectively about $1.9 billion, in fact. Their revenue plummeted, too.
And do you know what most of them wanted to talk about? You guessed it. The baskets of ancillary revenue they’re harvesting by charging us fees for checking bags, choosing coach seats or whatever. Forget that their houses are burning down. They found a tap in the bathtub with some water leaking out, so they’re thrilled.
(via @kyleridolfo)
In Kashiwa, Japan, there was briefly an unusual cafe where you recieve whatever the person in front of you ordered…and you’re ordering for the person behind you.
The Ogori cafe was an unforgettable travel moment, and an idea that has stuck with me: It was a complete surprise in our day. It encouraged communication between total strangers or, in this case, members of the Kashiwa community and a couple of weird guys from Oregon. It forced one to “let go”, just for a brief moment, of the total control we’re so used to exerting through commerce. It led you to taste something new, that you might not normally have ordered. It was a delight.
(via mr)
An article in Forbes postulates which countries billionaires could purchase, factoring in their estimated worth and the countries’ GDPs. On the list: Bill Gates, Warren Buffet, George Lucas, Zambia, Haiti, and Belize.
Update: A valid point to make here is that a billionaire’s income isn’t an accurate measure of their ability to “purchase” a country based on their GDP, especially if you think of the GDP as the equivalent of rental income. For instance, if a person’s net worth is $9 billion, which is equivalent to the Bahamas’ GDP, that doesn’t mean the billionaire could buy the islands. He or she could only rent it for a year, theoretically. Then again, the idea of countries being up for sale, and individuals purchasing (or renting) them, is a somewhat silly premise. (thx, ian)
Update: Perhaps purchasing countries isn’t such a silly premise after all. In 2003, the entire principality of Liechtenstein was up for rent. The tiny country, which borders Switzerland and Austria, attempted a “rent-a-state” program sponsored by Xnet. The idea was to draw attention to the tourist-friendly charms of Liechtenstein by essentially “renting” the country’s hotels, restaurants, and sports stadiums en masse. (thx, colin)
Tom Chiarella took a stack of $20 bills with him to New York City just to see what he could get by offering them to the right people at the right time. Turns out, quite a bit. I probably linked to this a few years ago (it’s from 2003), but it’s worth another look. I just love this kind of thing…probably because I’m too much of a candy ass to ever attempt something similar.
A twenty should not be a ticket so much as a solution. You have a problem, you need something from the back room, you don’t want to wait, you whip out the twenty.
I could have stood in line at the airport cabstand for fifteen minutes like every other mook in the world, freezing my balls off, but such is not the way of the twenty-dollar millionaire. I walked straight to the front of the line and offered a woman twenty bucks for her spot. She took it with a shrug. Behind her, people crackled. “Hey! Ho!” they shouted. I knew exactly what that meant. It wasn’t good. I needed to get in a cab soon. One of the guys flagging cabs pointed me to the back of the line. That’s when I grabbed him by the elbow, pulled him close, and shook his hand, passing the next twenty. I was now down forty dollars for a twenty-dollar cab ride. He tilted his head and nodded to his partner. I peeled another twenty and they let me climb in. As we pulled away, someone in the line threw a half-empty cup of coffee against my window.
A few months later, Chiarella tried the same technique in Salt Lake City, Vegas, and LA.
I pushed around; the ballsier I became, the more success I experienced. I got tablecloths, a personal garlic press, a dozen extra forks in one meal, chopsticks in a steak house. I bought primo parking spaces from people who had just parallel-parked.
Aha, turns out I linked to a similar article by Chiarella in which he haggles on items like hot dogs, TiVos, and gasoline. (via big contrarian)
Update: Ah, I’ve also previously linked to this one, from Gourmet in 2000.
It’s just after 8 P.M. on a balmy summer Saturday and I’m heading toward one of New York’s most overbooked restaurants, Balthazar, where celebrities regularly go to be celebrated and where lay diners like me call a month in advance to try and secure a reservation. I don’t have a reservation. I don’t have a connection. I don’t have a secret phone number. The only things I have are a $20, a $50, and a $100 bill, neatly folded in my pocket.
(thx, david)
A bunch of odd economic indicators that I have read about recently. The use of the 2nd Street Tunnel in Los Angeles in car commercials:
According to FilmL.A., the nonprofit organization that coordinates on-location shooting in the city, no permits have been issued in 2009 for car commercials. Although commercial production in the city is flagging anyway — down 34% in the first quarter — the 100% drop in tunnel permits suggests “very tough times in the car business,” FilmL.A. spokesman Todd Lindgren said.
The reinstatement of the £90 lingerie-and-blouse allowance at London law firm Clifford Chance:
Inevitably dubbed the “90 nicker knicker allowance”, this may or may not be the most reliable indicator yet that the credit crunch is over. (Business is apparently so hectic that the firm has also installed sleeping pods.)
And from this article, several others, including:
The baked bean index — my colleague Anthony Reuben noted in the spring how the value of sales of baked beans — a classic recession food — had risen 21.6% in April compared with the same month last year. Could a reverse signal the start of a recovery?
The number of people signing up to dating agencies offering extra-marital affairs, on the basis that demand goes up either in times of excessive confidence — “I won’t get caught”; or depression — “I don’t care”. (Sex had to figure somewhere.)
(via schott’s vocab log)
Update: But wait, there’s more! Sex dolls, vendor gifts, and the Puma Index.
Update: The 90-pound knicker allowance is bollocks. (thx, cheryl)
Update: How about the closing speed of car salesmen around a prospective buyer?
Here’s an indicator economists should study as they study GDP: speed with which, upon entering a store, you are surrounded by salesmen. (I would record both gather-rate-in fractions of a second-and density.) I was approached by the first salesman as I came in the door, picked up another as I went by the reception desk, picked up a third as I skirted a Buick Enclave. I looked back when I reached the Corvettes. There must have been ten salesmen back there and more coming, spilling out of offices and break rooms like police cruisers appearing from side streets to chase Burt Reynolds in Smokey and the Bandit. We moved in a buzzing cloud around the Corvette. From a distance, we would have made a fine subject for a painting in the National Gallery: Salesmen and Commission; or, Depression and Its Discontents. When I stood and stared and pretended to think, they stood back and stared and pretended to think. “You know, it’s not so expensive if you realize you’re buying it over the course of three years.”
Update: And a bunch more from Time’s Cheapskate blog.
Update: And still more! Hair dye (more is sold in down times) and complimentary kids crayons at restaurants (50% fewer crayons per package).
Paul Krugman writes in How Did Economists Get it So Wrong? (where the “it” is the 2008 recession):
As I see it, the economics profession went astray because economists, as a group, mistook beauty, clad in impressive-looking mathematics, for truth. Until the Great Depression, most economists clung to a vision of capitalism as a perfect or nearly perfect system. That vision wasn’t sustainable in the face of mass unemployment, but as memories of the Depression faded, economists fell back in love with the old, idealized vision of an economy in which rational individuals interact in perfect markets, this time gussied up with fancy equations. The renewed romance with the idealized market was, to be sure, partly a response to shifting political winds, partly a response to financial incentives. But while sabbaticals at the Hoover Institution and job opportunities on Wall Street are nothing to sneeze at, the central cause of the profession’s failure was the desire for an all-encompassing, intellectually elegant approach that also gave economists a chance to show off their mathematical prowess.
Unfortunately, this romanticized and sanitized vision of the economy led most economists to ignore all the things that can go wrong. They turned a blind eye to the limitations of human rationality that often lead to bubbles and busts; to the problems of institutions that run amok; to the imperfections of markets - especially financial markets - that can cause the economy’s operating system to undergo sudden, unpredictable crashes; and to the dangers created when regulators don’t believe in regulation.
He goes on to describe the history of macroeconomics (in brief) and how the current theories are flawed. Very interesting long read.
If you can figure out what words are gonna trend on Twitter, you can use the pretweeting site to buy and sell words to make fake money.
Make a (virtual) profit by buying and selling words on twitter. Predict what’s going to be hot and buy it up before it hits twitter, and you’ll make a killing once people start talking about it.
This is like Google Adwords except with play money. (via waxy)
Unsurprisingly, the MLB teams currently drawing the most benefit from the lessons of Moneyball are those with lots of money operating in big markets.
Well, of course, the big-market teams figured it out. They hired their own Ivy League consultants. They bought even better computers. Walks is only one tiny aspect in it … but who leads the American League in walks this year? The New York Yankees. Last year? The Boston Red Sox. The year before that? The Boston Red Sox. And so it goes. Now, six years later, it seems to me that the small-market teams are really grasping and trying to find some loophole, some opening that will allow them to win in this tough financial environment.
Parking is heavily subsidized in the US; spaces in cities can cost between $10,000 and $50,000, a high price to pay to house hunks of metal that don’t do anything for 95% of the day.
Who pays for this? Everyone. The cost of building all that parking is reflected in higher rents, more expensive shopping and dining, and higher costs of home-ownership. Those who don’t drive or own cars thus subsidize those who do.
The argument comes from a book called The High Cost of Free Parking.
To the ever growing list of odd economic indicators (sushi, lipstick, Coca-Cola), we can now add the hotness of your waitress.
The indicator I prefer is the Hot Waitress Index: The hotter the waitresses, the weaker the economy. In flush times, there is a robust market for hotness. Selling everything from condos to premium vodka is enhanced by proximity to pretty young people (of both sexes) who get paid for providing this service. That leaves more-punishing work, like waiting tables, to those with less striking genetic gifts. But not anymore.
The same article also mentions the Overeducated Cabbie Index, the Squeegee Man Apparition Index, and the Speed at Which Contractors Return Calls Index.
Update: A possible related metric: the quality of street musicians.
Update: Yet another economic indicator: men’s underwear.
“It’s a prolonged purchase,” said Marshal Cohen, senior analyst with the consumer research firm NPD Group. “It’s like trying to drive your car an extra 10,000 miles.”
Cameron Lester, a partner at a VC firm, on A Golden Age for Venture Capital:
For 14 months, we at Azure Capital tried to invest in companies but could not reach an agreement with entrepreneurs and existing investors on valuation and terms — the gap was too great. Despite meeting with hundreds of companies and reaching the point of discussing terms with a few, we did not make a single new investment.
That gap no longer exists. We recently invested in a company called BlogHer in May. It is an exciting company, whose team and investors were wise enough to realize that taking money now would give them a competitive advantage. And last week we invested in SlideRocket, our second new investment in less than two months.
It is as if the venture-funding environment has finally hit the reset button.
Translation: Now that money is tight, venture capital firms are able to fully dictate the terms of their investments. Entrepreneurs, prepare to part with more of your companies than you wanted to and receive less for the pleasure. Lester goes on to hand-wavingly assert that this is a good thing for entrepreneurs.
Daniel Suelo, who lives in a cave near Moab, Utah, has gone without using money since 2000.
“When I lived with money, I was always lacking,” he writes. “Money represents lack. Money represents things in the past (debt) and things in the future (credit), but money never represents what is present.”
The idea started to take shape when Suelo was on a Peace Corps mission to Ecuador. As he monitored the health of the population of the village he was staying in, he noticed that their health declined as they made more money — “It looked like money was impoverishing them.” You can find out more about Suelo’s philosophy on his web site and follow his adventures on his blog, both of which he updates at the public library.
Malcolm Gladwell’s piece in this week’s New Yorker about the psychology of overconfidence is pretty much a transcript of the speech he gave at the New Yorker Summit a couple of months ago. Gladwell’s thesis is that the overconfidence of experts caused the current financial crisis.
“I’m good at that. I must be good at this, too,” we tell ourselves, forgetting that in wars and on Wall Street there is no such thing as absolute expertise, that every step taken toward mastery brings with it an increased risk of mastery’s curse.
Eight Michigan credit unions are offering an unusual way to save: putting $25+ into a one-year CD comes with an entry to a raffle with a monthly prize of $400 and a yearly grand prize of $100,000.
This unusual CD is federally guaranteed by the National Credit Union Administration and pays between 1% and 1.5% annual interest, a bit lower than conventional rates. In 25 weeks, the program has attracted about $3.1 million in new deposits, often from people who have never been able to set money aside.
This reminds me of a recent observation by Sam Arbesman:
An intriguing coincidence: The repayment rate of individual loans in Kiva (a broker for individual loans around the world) is 98.50%, which is quite similar to the payback percentage of Las Vegas slot machines.
Why not put the lottery effect to work with Kiva? Instead of straight-up loans, enter lenders in a raffle and slightly decrease the return rate to account for the prize money. I bet (ha!) the lending rate would increase accordingly. (via waxy)
Update: Several people pointed out that British Premium Bonds have worked this way for decades. (thx, christopher)
How do you follow up a kooky-titled bestseller like Freakonomics? With a book called SuperFreakonomics. It’s due out on October 20 and has a subtitle of “Tales of Altruism, Terrorism, and Poorly Paid Prostitutes”.
As an avid player of Flash games (when I’ve got time), I found Dan Cook’s post on the economics of the Flash game platform really interesting and applicable to anyone who is offering content online and wants to get paid for it.
Flash games are currently the ghetto of the game development industry. Compared to the number of players it serves, the Flash game ecosystem makes little money, launches few careers, and sustains few developer owned businesses. Despite the vast potential of the ecosystem, Flash games contribute surprisingly little to the advancement of game design as an art or a craft.
This is just the first installment…two or three more are yet to come. (via @anildash)
I, Pencil is a 1958 ode to mass production, industrial specialization, commodity economics, and the invisible hand using the manufacture of a simple graphite pencil as an example.
Consider the millwork in San Leandro. The cedar logs are cut into small, pencil-length slats less than one-fourth of an inch in thickness. These are kiln dried and then tinted for the same reason women put rouge on their faces. People prefer that I look pretty, not a pallid white. The slats are waxed and kiln dried again. How many skills went into the making of the tint and the kilns, into supplying the heat, the light and power, the belts, motors, and all the other things a mill requires? Sweepers in the mill among my ancestors? Yes, and included are the men who poured the concrete for the dam of a Pacific Gas & Electric Company hydroplant which supplies the mill’s power!
Really great. A nice illustration of embodied energy to boot.
Update: A old Cardigan article by Dean Allen shares a certain kinship with I,Pencil.
First, you need some water. Fuse two hydrogen with one oxygen and repeat until you have enough. While the water is heating, raise some cattle. Pay a man with grim eyes to do the slaughtering, preferably while you are away. Roast the bones, then add to the water.
Update: From Transparent Things by Vladimir Nabokov:
Now let us not lose our precious bit of lead while we prepare the wood. Here’s the tree! This particular pine! It Is cut down. Only the trunk is used, stripped of its bark. We hear the whine of a newly invented power saw, we see logs being dried and planed. Here’s the board that will yield the integument of the pencil in the shallow drawer (still not closed). We recognize its presence in the log as we recognized the log in the tree and the tree in the forest and the forest in the world that Jack built. We recognize that presence by something that is perfectly clear to us but nameless, and as impossible to describe as a smile to somebody who has never seen smiling eyes.
Thus the entire little drama, from crystallized carbon and felled pine to this humble implement, to this transparent thing, unfolds in a twinkle. Alas, the solid pencil itself as fingered briefly by Hugh Person still somehow eludes us! But he won’t, oh no.
(thx, matthew)
David Galbraith calculates that if buildings by famous architects were priced like paintings, a Le Corbusier building would be worth more than the entire US GDP.
The top floor of Corbusier’s Villa Stein (one of perhaps the top 500 most important houses of the late 19th/early 20th centuries - i.e. a Van Gogh of houses) is for sale for the same price per sq.ft. (approx $1400) as buildings in the same area of suburban Paris, designed by nobody in particular. Meanwhile, Van Gogh’s Portrait of Dr. Gachet sold for an inflation adjusted price of $136 million yet a poster of similar square footage and style costs around $10.
In terms of signaling, it’s difficult to hang a house on one’s parlor wall…buying a Corbusier means living in it wherever it happens to be located, at least part of the year.
Tyler Cowen previews a portion of his upcoming book, Create Your Own Economy, for Fast Company.
More and more, “production” — that word my fellow economists have worked over for generations — has become interior to the human mind rather than set on a factory floor. A tweet may not look like much, but its value lies in the mental dimension. You use Twitter, Facebook, MySpace, and other Web services to construct a complex meld of stories, images, and feelings in your mind. No single bit seems weighty on its own, but the resulting blend is rich in joy, emotion, and suspense. This is a new form of drama, and it plays out inside us — with technological assistance — rather than on a public stage.
I’ve got two follow-ups to share with you regarding Atul Gawande’s New Yorker piece about healthcare costs in the US (kottke.org post). In the Wall Street Journal, Abraham Verghese argues that in order for a healthcare reform plan to be successful, it has to include cost cutting.
I recently came on a phrase in an article in the journal “Annals of Internal Medicine” about an axiom of medical economics: a dollar spent on medical care is a dollar of income for someone. I have been reciting this as a mantra ever since. It may be the single most important fact about health care in America that you or I need to know. It means that all of us — doctors, hospitals, pharmacists, drug companies, nurses, home health agencies, and so many others — are drinking at the same trough which happens to hold $2.1 trillion, or 16% of our GDP. Every group who feeds at this trough has its lobbyists and has made contributions to Congressional campaigns to try to keep their spot and their share of the grub. Why not? — it’s hog heaven. But reform cannot happen without cutting costs, without turning people away from the trough and having them eat less. If you do that, you have to be prepared for the buzz saw of protest that dissuaded Roosevelt, defeated Truman’s plan and scuttled Hillary Clinton’s proposal.
In Gawande’s example, what Verghese is saying is that you can’t just make McAllen’s healthcare system adopt an El Paso type of system without a whole lot of pain.
Gawande addressed some of the criticisms of his article on the New Yorker site. One of the major criticisms was that McAllen’s higher costs were associated with higher levels of poverty and unhealthiness:
As I noted in the piece, McAllen is indeed in the poorest county in the country, with a relatively unhealthy population and the problems of being a border city. They have a very low physician supply. The struggles the people and medical community face there are huge. But they are just as huge in El Paso — its residents are barely less poor or unhealthy or under-supplied with physicians than McAllen, and certainly not enough so to account for the enormous cost differences. The population in McAllen also has more hospital beds than four out of five American cities.
In an analysis of the global financial system, Duncan Watts says that we should limit the complexity of these sorts of systems because “once everything is connected, problems can spread as easily as solutions”.
Traditionally, banks and other financial institutions have succeeded by managing risk, not avoiding it. But as the world has become increasingly connected, their task has become exponentially more difficult. To see why, it’s helpful to think about power grids again: engineers can reliably assess the risk that any single power line or generator will fail under some given set of conditions; but once a cascade starts, it’s difficult to know what those conditions will be - because they can change suddenly and dramatically depending on what else happens in the system. Correspondingly, in financial systems, risk managers are able to assess their own institutions’ exposure, but only on the assumption that the rest of the world obeys certain conditions. In a crisis it is precisely these conditions that change in unpredictable ways.
No one, for example, anticipated that an investment bank as old and prestigious as Lehman Brothers could collapse as suddenly as it did, so nobody had that contingency built into their risk models. And once it did fail, then just as the failure of a single power line increases the stress on other parts of the system, leading to further “knock on” failures, so too did Lehman’s unlikely collapse render other previously unlikely failures suddenly much more likely.
This is essentially the same point that Nassim Taleb makes in The Black Swan re: Extremistan and Mediocristan.
On the Freakonomics blog, Dmitri Leybman tells us about the three main ways that the President’s political party can have an impact on the economy.
This tendency of Republican presidents to preside over growth that occurs so close to re-election has been cited by Bartels as the main reason why Republican presidents have been so successful in achieving two-term presidencies in the post-World War II era. Voters, Bartels believes, are economic myopists, paying attention only to the most recent economic outcomes and not the overall outcomes experienced under a president’s rule.
Altruism in business and behaviorial economics is a topic that comes up quite often on kottke.org, even when it’s not explicit. (For instance, the central issue in the Atul Gawande article I pointed to yesterday pits the individual financial desires of doctors vs. the health of their patients.) This article from Ode Magazine takes a look at the research done in this area so far and how the idea of altruism in economics is currently on the rise.
The theory is based on the premise that humans evolved in small groups with strong social contracts and plenty of contact with strangers. Cooperation within the tribe was advantageous so long as free riders were punished. It was also the best gambit on encountering strangers. Cooperation, particularly in times of famine, was the only means of survival, so altruism became a favored evolutionary trait.
One of my favorite books on altruism and economics is Robert Wright’s Nonzero.
Atul Gawande discovered that McAllen, Texas spends more per person on healthcare than El Paso (which is demographically similar to McAllen) and set out to find out why. Along the way, he encounters a curious relationship between the amount spent on healthcare and the quality of that care: higher spending does not correlate with better care.
When you look across the spectrum from Grand Junction to McAllen — and the almost threefold difference in the costs of care — you come to realize that we are witnessing a battle for the soul of American medicine. Somewhere in the United States at this moment, a patient with chest pain, or a tumor, or a cough is seeing a doctor. And the damning question we have to ask is whether the doctor is set up to meet the needs of the patient, first and foremost, or to maximize revenue.
There is no insurance system that will make the two aims match perfectly. But having a system that does so much to misalign them has proved disastrous. As economists have often pointed out, we pay doctors for quantity, not quality. As they point out less often, we also pay them as individuals, rather than as members of a team working together for their patients. Both practices have made for serious problems.
Obama, you’re reading this guy’s stuff, yes? Get him on the team.
Update: Dr. Peter Orszag is the Director of the Office of Management and Budget for the White House and is working on some of the problems that Gawande talks about in this article. Here’s a 40-minute video of Orszag speaking on “Health Care - Capturing the Opportunity in the Nation’s Core Fiscal Challenge”. (thx, todd)
I changed the bit in the first paragraph about El Paso and McAllen being “nearby”. Funny, I thought 800 miles in Texas *was* nearby. (thx, stephen)
I also changed “lower spending correlates with better care” to “higher spending does not correlate with better care”…those two statements are not the same. I misread the results of one of the studies that Gawande mentions. (thx, patrick)
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