Most people know the U.S. GDP is about $15 trillion. GDP represents aggregate income. But how large is total aggregate wealth. Here is one UN study across nations. Not only do they include physical wealth, but they also try to estimate human capital wealth -- the wealth we have due to our skills and education. Below is from the Economist blog Free Exchange. The UN estimates aggregate wealth in the U.S. is about $120 trillion, but three quarters of that is in human capital. Human capital is hard to measure accurately, but it's plausibly quantitatively quite important. Most asset pricing models in finance start with a notion of aggregate wealth and the return on aggregate wealth. In the end, we end up assuming the return on aggregate wealth is the return on the stock market, but that may end up being a bad proxy for the return on wealth if wealth is so concentrated in human capital. Of course, figuring out what to use instead is no simple matter.
Saturday, December 8, 2012
Wednesday, December 5, 2012
Arnold King is Basically Solomon
Arnold King is the fairest blogger on the internet, and smarter than me. So I feel bad criticizing him, but I think he missed the boat here. In a recent post, he argued that liberals have an exaggerated willingness to see issues in terms of oppression; conservatives have an exaggerated willingness to see issues in terms of barbarism encroaching on civilized life; and, as for libertarians:
A libertarian will exaggerate the extent to which a practice represents coercion. They are fond of saying, “If you don’t comply with xyz policy, men with guns will come and take you to prison.” I understand this argument and I generally take it as valid. However, I can also understand how someone with a different point of view might argue that when they pay taxes what they get in return is a fair deal.
That's characteristically open minded of him, since I think he mostly identifies with the libertarian position. But sadly, I think it rings false to anyone who has argued with libertarians. Maybe it's just me, but I most see libertarians exaggerating the extent to which human behavior is dominated by rational economic forces, both in terms of morality (what's really important here is material goods) and human behavior (people default to engaging in a series of mostly rational economic transactions). So take selling yourself into slavery: most people immediately dismiss the idea that that should be legal. But to a lot of libertarians, this just looks like an economic transaction -- a long term employment contract, of sorts. So the libertarian community has big arguments about whether this sort of thing should be allowed.
The point isn't that all libertarians endorse indentured servitude (most don't, I think, including King) or even that the ones who do endorse it are wrong. It's just that libertarians tend to see the world in terms of fair, rational, arms-length bargaining, to a super exaggerated extent when compared to other people. To pick a hyperbolic example, if, in the state of nature, a big man with a club meets a little man with a prosperous farm, in the libertarian world the little man is about to hire the big man as a body guard.
Errata (I am not good at short blog posts, but maybe I can get good at separating the stray observations from the main point. Feel free to stop reading here):
1. Of course, it isn't a bad thing for people to see the world in different ways, as King makes clear. Sometimes people do act like rational economic actors and libertarians figure it out before the rest of us and make good policy proposals, so go them.
2. Just for the record, I oppose letting people sell themselves into slavery, for a variety of reasons. If anyone cares I can make a blog post about it.
3. This makes libertarians sort of the anti-liberal/conservatives. If conservatives are constantly fearing barbarism and liberals constantly fearing oppression, libertarians are constantly pretty confident that everything will work out fine if we just give people the right incentives. This is even true of their big bugaboo, government. You hear the "men with guns will rob you" argument, yes, but in the main libertarians are surprisingly willing to ascribe what they see as bad government conduct to public choice problems. They very rarely think the government is a bad actor simply because it is full of oppressive barbarians, though historically some governments are.
4. Seeing the world mostly in terms of rational economic forces also explains King's argument about susan rice:
If you look at the biography of UN Ambassador Susan Rice, she apparently both inherited and married into wealth, received an elite education, worked for McKinsey, and now has a net worth of over $20 million. Yet people on the left describe her as oppressed, because she is African-American and female. I want to say, “Really?”
I don't know if Susan Rice is oppressed, but I know, "Went to a good school and is rich" does not equal "not oppressed," since society has important, non-economic/educational dimensions along which someone can be flexed with. You can imagine an American Jew in the 30's who went to Harvard, was born into money, and has a good job, but who is still dealing with very real oppression thanks to antisemitism (IE, can't join the clubs he wants, make the friends he wants, loses out on some business opportunities, etc. More importantly, all those real slights add up to living in a society that constantly reminds you you are an outsider, which has a real psychological cost). I'd add that you should not count a person un-opressed until they are dead: that same jew, were he Polish rather than American, would, in ten years, face clear and brutal oppression. Just so, Susan Rice may yet pay some sort of real consequence for her gender and race (lose her job?). Or not. Again, my criticism is more with the argument than with the underlying point.
A libertarian will exaggerate the extent to which a practice represents coercion. They are fond of saying, “If you don’t comply with xyz policy, men with guns will come and take you to prison.” I understand this argument and I generally take it as valid. However, I can also understand how someone with a different point of view might argue that when they pay taxes what they get in return is a fair deal.
That's characteristically open minded of him, since I think he mostly identifies with the libertarian position. But sadly, I think it rings false to anyone who has argued with libertarians. Maybe it's just me, but I most see libertarians exaggerating the extent to which human behavior is dominated by rational economic forces, both in terms of morality (what's really important here is material goods) and human behavior (people default to engaging in a series of mostly rational economic transactions). So take selling yourself into slavery: most people immediately dismiss the idea that that should be legal. But to a lot of libertarians, this just looks like an economic transaction -- a long term employment contract, of sorts. So the libertarian community has big arguments about whether this sort of thing should be allowed.
The point isn't that all libertarians endorse indentured servitude (most don't, I think, including King) or even that the ones who do endorse it are wrong. It's just that libertarians tend to see the world in terms of fair, rational, arms-length bargaining, to a super exaggerated extent when compared to other people. To pick a hyperbolic example, if, in the state of nature, a big man with a club meets a little man with a prosperous farm, in the libertarian world the little man is about to hire the big man as a body guard.
Errata (I am not good at short blog posts, but maybe I can get good at separating the stray observations from the main point. Feel free to stop reading here):
1. Of course, it isn't a bad thing for people to see the world in different ways, as King makes clear. Sometimes people do act like rational economic actors and libertarians figure it out before the rest of us and make good policy proposals, so go them.
2. Just for the record, I oppose letting people sell themselves into slavery, for a variety of reasons. If anyone cares I can make a blog post about it.
3. This makes libertarians sort of the anti-liberal/conservatives. If conservatives are constantly fearing barbarism and liberals constantly fearing oppression, libertarians are constantly pretty confident that everything will work out fine if we just give people the right incentives. This is even true of their big bugaboo, government. You hear the "men with guns will rob you" argument, yes, but in the main libertarians are surprisingly willing to ascribe what they see as bad government conduct to public choice problems. They very rarely think the government is a bad actor simply because it is full of oppressive barbarians, though historically some governments are.
4. Seeing the world mostly in terms of rational economic forces also explains King's argument about susan rice:
If you look at the biography of UN Ambassador Susan Rice, she apparently both inherited and married into wealth, received an elite education, worked for McKinsey, and now has a net worth of over $20 million. Yet people on the left describe her as oppressed, because she is African-American and female. I want to say, “Really?”
I don't know if Susan Rice is oppressed, but I know, "Went to a good school and is rich" does not equal "not oppressed," since society has important, non-economic/educational dimensions along which someone can be flexed with. You can imagine an American Jew in the 30's who went to Harvard, was born into money, and has a good job, but who is still dealing with very real oppression thanks to antisemitism (IE, can't join the clubs he wants, make the friends he wants, loses out on some business opportunities, etc. More importantly, all those real slights add up to living in a society that constantly reminds you you are an outsider, which has a real psychological cost). I'd add that you should not count a person un-opressed until they are dead: that same jew, were he Polish rather than American, would, in ten years, face clear and brutal oppression. Just so, Susan Rice may yet pay some sort of real consequence for her gender and race (lose her job?). Or not. Again, my criticism is more with the argument than with the underlying point.
Tuesday, December 4, 2012
Facts about Polling
From Paul Krugman:
First, Public Policy Polling found that 39 percent of voters have a view, pro or con, about Simpson-Bowles. Not bad, you might think. But a quarter of voters also had views on Panetta-Burns, a plan that as it happens doesn’t exist.
Meanwhile, another poll – internet-based, but by a firm with a good record — finds that, by a margin of almost four to one, people think that going over the fiscal cliff will cause the deficit to increase.
Don't Feed the Trolls?
Scott Sumner has been an amazingly successful blogger. How successful? He blogged his way on to Foreign Policy's top 100 global thinkers list. Besides writing insightful posts on a timely topic (post financial crisis monetary/fiscal policy), one of the amazing things about his blog is that he responds to an amazingly large number of comments. For quite awhile, he responded to virtually every comment.
While this was amazingly successful at propelling his blog in popularity, it had a side effect. These extra bits of engagement and insight also turn out to be tasty morsels of troll food. So much so that to some extent has become a bit of a troll underworld. I swear several trolls think his comments section is their blog. Lately, it seems Scott has become a bit exasperated with this situation with some choice quotes:
Greg, The “principle of charity” suggests you might want to read what I actually said:i.e. “I’m not quite sure why”, before setting off on one of your typical mindless rants. It seems that you are agreeing with me, i.e. I was not quite sure why, if what you say is correct. BTW, If you and your fellow Austrians want to go through life with your own private language that no one else understands, you’ll have about as much success as language purists who insist on calling happy people “gay.” Good luck.
And
Greg Ransom, I really can’t figure out if it’s all an act on your part, a big joke, or if you are just completely delusional. Sincerity? Charitable reading? I don’t think I’ve ever come across a less charitable commenter in my life, except for MF of course. I’m just going to assume you are joking and leave it at that. The alternative is too depressing.
This is from someone so patient he answers virtually all his thousands and thousand of commenters! I imagine the only counter-tactic is ignoring the troll, which I noticed seems to be the strategy of this latest post. Yet, there seem trolls he's already ignoring, and they are still trolling strong. Sometimes the trolls troll each other. I am no expert on troll behavior or troll avoidance, but I'd bet my co-blogger has more insight into troll dynamics.
PS. - Scott's comments are still an excellent source of information. I find an excellent way to skim them is just looking for his (ssumner) responses. If he says something interesting, you can go back and check the original comment.
PPS - At least 50% of our commenters so far are top economists.
PPPS. - This PPPS. and the previous PPS. and PS. are homages to Scott.
Sunday, December 2, 2012
Laughing Matters
This is a video of a naked wizard with a micro-penis being repeatedly tased by policemen. More on that later.
So the common law makes a lot of use of a concept called "reasonableness." I think lawyers like to pretend that this is a very precise term of art with different, clear meanings in different situations, but the fact is that is crap. There's been manful work in trying to convert "reasonable" into a more objective standard -- several federal appellate judges have tried to make "reasonable," in the context of the tort of negligence, mean something like "cognizant of the cost-justified level of risk," for example -- but the fact of the matter is we frequently throw jury instructions to people that basically say, "Do you think the defendant acted reasonably? Reasonable means acting in a manner that is..." followed by vague bullshit.
And that's all fine. The law is never going to produce outcomes with mechanical certainty, there is plenty of room for vague concepts. But why this vague concept? Is it unique? What are the outlines of this "reasonableness?" Well, we can all agree that there is behavior the bulk of people think is reasonable, there is behavior a majority of people think is reasonable, there is behavior people disagree about, and there is behavior a large or small majority of people think is unreasonable. For most actions (most things that are done, I mean, not most kinds of actions), there is probably majority agreement about whether the action is reasonable (in a single society, anyway). And there are probably a lot of cultural, factual, random, and very human factors going into that judgment. So great.
The problem is, that seems very similar to a lot of human concepts: compare thinking about whether stuff is "reasonable" to thinking about whether it is disgusting, funny, sexy, etc. But the law is really loathe to use those concepts.
Take funny. Funny comes up in the law. Whether something is satire matters for copyright purposes. Whether someone is joking could matter for contract purposes (IE, did he make an offer to contract or was it just a joke). But the law normally avoids engaging the question of humor directly: it just asks whether a reasonable person would have interpreted it as a joke or contract offer, it defines satire without reference to whether it is *successful* satire, etc.
More interestingly, we could use "funny" as a concept by which to judge actions, like we do "reasonable." We don't actually care if someone saw a tortfeasor commit an act of negligence and thought it was reasonable. We only care whether his actions were, in some objective sense, reasonable. It's an "objective" standard.
So take the video of the naked wizard with a micro-penis prancing around a music festival until cops tase him. Was that reasonable force? I don't know! But let's propose another standard: police are justified in using as much force as is reasonable or hilarious. I think reasonable minds could disagree about whether the cops acted in a way that was reasonable, but they clearly acted in a way that was hilarious. If you don't think a naked wizard with a micropenis being tased is funny then you, sir or madame, are a stick in the mud. And maybe we can throw on another check, and get a law like: "force is justified when it is reasonable. If it isn't clear whether it is reasonable, it is justified if it is hilarious. If it still isn't clear, it is not justified if it is horrifying." etc. Rather than trying to parse close cases of reasonableness, we can set up a hierarchy of vague notions our society cares about and go down the list until it isn't a close case anymore. I care more about living in a society where cops can't do things that are horrifying than I do living in a society where cops do things that are marginally reasonable to a random collection of jurors.
This may be a really dumb idea.
So the common law makes a lot of use of a concept called "reasonableness." I think lawyers like to pretend that this is a very precise term of art with different, clear meanings in different situations, but the fact is that is crap. There's been manful work in trying to convert "reasonable" into a more objective standard -- several federal appellate judges have tried to make "reasonable," in the context of the tort of negligence, mean something like "cognizant of the cost-justified level of risk," for example -- but the fact of the matter is we frequently throw jury instructions to people that basically say, "Do you think the defendant acted reasonably? Reasonable means acting in a manner that is..." followed by vague bullshit.
And that's all fine. The law is never going to produce outcomes with mechanical certainty, there is plenty of room for vague concepts. But why this vague concept? Is it unique? What are the outlines of this "reasonableness?" Well, we can all agree that there is behavior the bulk of people think is reasonable, there is behavior a majority of people think is reasonable, there is behavior people disagree about, and there is behavior a large or small majority of people think is unreasonable. For most actions (most things that are done, I mean, not most kinds of actions), there is probably majority agreement about whether the action is reasonable (in a single society, anyway). And there are probably a lot of cultural, factual, random, and very human factors going into that judgment. So great.
The problem is, that seems very similar to a lot of human concepts: compare thinking about whether stuff is "reasonable" to thinking about whether it is disgusting, funny, sexy, etc. But the law is really loathe to use those concepts.
Take funny. Funny comes up in the law. Whether something is satire matters for copyright purposes. Whether someone is joking could matter for contract purposes (IE, did he make an offer to contract or was it just a joke). But the law normally avoids engaging the question of humor directly: it just asks whether a reasonable person would have interpreted it as a joke or contract offer, it defines satire without reference to whether it is *successful* satire, etc.
More interestingly, we could use "funny" as a concept by which to judge actions, like we do "reasonable." We don't actually care if someone saw a tortfeasor commit an act of negligence and thought it was reasonable. We only care whether his actions were, in some objective sense, reasonable. It's an "objective" standard.
So take the video of the naked wizard with a micro-penis prancing around a music festival until cops tase him. Was that reasonable force? I don't know! But let's propose another standard: police are justified in using as much force as is reasonable or hilarious. I think reasonable minds could disagree about whether the cops acted in a way that was reasonable, but they clearly acted in a way that was hilarious. If you don't think a naked wizard with a micropenis being tased is funny then you, sir or madame, are a stick in the mud. And maybe we can throw on another check, and get a law like: "force is justified when it is reasonable. If it isn't clear whether it is reasonable, it is justified if it is hilarious. If it still isn't clear, it is not justified if it is horrifying." etc. Rather than trying to parse close cases of reasonableness, we can set up a hierarchy of vague notions our society cares about and go down the list until it isn't a close case anymore. I care more about living in a society where cops can't do things that are horrifying than I do living in a society where cops do things that are marginally reasonable to a random collection of jurors.
This may be a really dumb idea.
Bartlett on Obama
This line in Bruce Bartlett's recent article has me thinking:
The final line for me to cross in complete alienation from the right was my recognition that Obama is not a leftist. In fact, he’s barely a liberal—and only because the political spectrum has moved so far to the right that moderate Republicans from the past are now considered hardcore leftists by right-wing standards today. Viewed in historical context, I see Obama as actually being on the center-right.Tell most Republicans this and there evidence against will be a health care plan that was first floated by Heritage.
It still isn't widely appreciated how many of the best ideas from the right (and in particular from neoliberalism and neoclassical economics) have bee co-opted by the left. Every wonk's preferred climate solution is Cap and Trade or gas taxes, not regulation. When Obama attacked Hillary Clinton on trade, he had his chief economic adviser call Canada to reassure them that we don't really believe this stuff. Remember Romney's plan to limit tax deductions, that was Obama's idea first.
Listening to Free to Choose debates, Milton Friedman sounds like Matt Yglesias: stop restrictive zoning, fight poverty with the earned income tax credit, increase immigration...
In a better world, the political parties would be separating Bruce Bartlett and Matt Yglesias. In many ways, the wonk spectrum is divided that way. Unfortunately, the public is not.
Saturday, December 1, 2012
John Cochrane on Health Care
John Cochrane (famous Chicago economist) gives an interesting podcast on health care with host Russ Roberts. You can find more thorough remarks in this paper. I find myself amenable to both free market critiques and lefty critiques of our health care system, because I think the U.S. is at a local minima. Moving a long distance toward more market oriented Singaporean health care or a single-payer Canadian health care would both be improvements.
I was hoping Russ would press him on one point I can't comprehend, which is central to Cochrane's argument. First, we agree that insurance should be long-lived and guaranteed renewable. Meaning, if a person gets sick, the insurance company can't drop them or raise their premiums. This makes perfect sense to me. The reason we buy insurance is to insure ourselves from risk. In this case, the risk of getting really sick in a way that will cost a ton of money for care. If I buy insurance that only lasts one year and I get cancer, I'll get the benefit for one year, but the next year when I try to renew my premiums will go sky high. What good is that? The answer is obvious. I need to buy "insurance insurance." I need insurance against the risk that my premiums rise. Of course, if insurance insurance isn't long lived, I'll need to insure the risk my insurance insurance premiums rise and this rabbit hole goes on and on. It's turtles all the way down. This logic leads to the idea that insurance should be long lived. Rather than buying an infinite number of insurance contracts, I can buy on contract that never expires.
What I can't figure out is this statement?
Suppose that two parents have a kid that is covered on their insurance, until he's twenty-five. Then he has to go to the market and buy his own insurance. Now suppose when he's twenty-four, he gets cancer. In John's world his premiums should skyrocket. I think he would argue that the parents should buy "insurance insurance" for the kid. The parents need to buy insurance against the kid's future high premiums, before he gets sick. Obviously, they can't do that after he's diagnosed. The "insurance insurance" would be too expensive. They need to do it earlier. Perhaps, when he is born. Though what if we find he has complications? Perhaps, when he's conceived? But what if the parents have genetic predispositions to certain diseases? The kid is more likely to become sick, thus the insurance on his future premiums must be higher. Maybe they'd be high enough that the two parents wouldn't get married, because of the possible complications. Oh no, two people who love each other can't get married. What if the grandparents stepped in and helped out? They could buy "insurance insurance insurance," they could hedge the risk that their son or daughter grew up wanting to marry someone who wasn't as genetically compatible.
Maybe this sounds convoluted, but I'm trying to get to the notion of complete markets. Complete markets means that all risk that can be insured is insured. Since we are risk averse, complete markets make us all better off. If one of our houses burns down, we'll all chip in $100 bucks to get us back on your feet. The Amish did it literally, but nowadays we do it through insurance companies. The premium on home insurance is just the $100 bucks that goes to some unlucky person that just watched their home go up in flames.
But in a truly complete market, ALL risk is insurable. I could insure against a risk, before I was ever born, before I ever had a medical history. In a truly complete market, we insure all risks at "time zero," before we even exist. I picture a random soul in heaven, just like all other souls. One of the risks those souls want to insure against is sickness. Maybe being born sick. Maybe being sick later in life. Basically, they don't know when it will or if it will happen, but there's some risk they'll get sick. So they get with all the other souls and agree, we'll all put money aside, and whoever gets sick gets the money. That's insurance. My question is how much would each put in. Well, it's obvious they'd all pay the same. They are exactly alike in every way. It's only fair.
The point I'm trying to make is that in John's system, no matter how you slice it, there will be some choke point along the way. What if we switched from our system to John's tomorrow? A lot of healthy people would buy guaranteed renewable insurance, but a lot of sick people would be out of luck and face exorbitant premiums. If we are in a system where everyone is paying a different price for insurance, then we can't possibly be at the complete markets case. If we aren't at the complete markets case, either John's policy is suboptimal or there is some friction that prevents us from getting to the complete markets case. So what is it?
The wrench that I haven't thrown in yet is incentives. If I have guaranteed insurance before I am born, I'm much less incentivized to put effort into maintaining my health. I may drink like a fish or eat too much. I may smoke or do drugs. Maybe I just won't sleep enough. We make decisions that affect our health. This is a "friction." This is a reason that the complete markets case may not work (as if the having to buy insurance before your born wasn't enough). Maybe this is the sort of important friction John has in mind, because for conditioning on pre-existing conditons he gives these examples in the podcast, "Fat people don't pay more than thin people; smokers don't pay more than non-smokers. All sorts of things they don't condition on." Russ corrects him that they can condition on smoking, which in my understanding isn't that big of a bump in premium. I don't have a problem with insurance companies conditioning on smoking or charging a higher premium on people like me that eat and drink too much. It's the all sorts of other things I don't want. What about something simple like being female? Women have to pay higher insurance premiums, because women have babies. In a complete market, women would pay the same premium as everyone else. They'd buy their insurance before they had a gender (or even parents) and pay the same price as everyone else.
Conditioning on effort is fine to the extent that an insurance company can do it. But what they really want to do is condition on how sick we are. People with cancer pay more, and I don't see John distancing from that. I can't imagine by pre-existing condition he really means "big sweet tooth."
I thought I found a lot to like in the essay. I think there are lots of regulations that make health care more expensive and that the health care market should be more competitive. But I was really jarred by this statement, "Romney was pushed on what he was going to do, he said: Well, but of course we can't let insurance companies discriminate on pre-existing conditions. Well, once you've done that, you've swallowed the fly--the old lady that swallowed the fly...And once you do that, you've got most of the ACA." He's really arguing that my disagreement is irreconcilable with his preferred health care solution. Which makes sense, if my story is correct then charging everyone the same price and mandating everyone buy insurance sounds pretty close to the preferred solution. Since in a truly compete market, we'd all pay the same health care premiums. His preferred solution must be a market frictions story, but its a story I can't understand and he spends a good deal of the podcast and paper dismissing frictions in the health care market. If there is a well-formed second best model there, I'd love to know it.
I was hoping Russ would press him on one point I can't comprehend, which is central to Cochrane's argument. First, we agree that insurance should be long-lived and guaranteed renewable. Meaning, if a person gets sick, the insurance company can't drop them or raise their premiums. This makes perfect sense to me. The reason we buy insurance is to insure ourselves from risk. In this case, the risk of getting really sick in a way that will cost a ton of money for care. If I buy insurance that only lasts one year and I get cancer, I'll get the benefit for one year, but the next year when I try to renew my premiums will go sky high. What good is that? The answer is obvious. I need to buy "insurance insurance." I need insurance against the risk that my premiums rise. Of course, if insurance insurance isn't long lived, I'll need to insure the risk my insurance insurance premiums rise and this rabbit hole goes on and on. It's turtles all the way down. This logic leads to the idea that insurance should be long lived. Rather than buying an infinite number of insurance contracts, I can buy on contract that never expires.
What I can't figure out is this statement?
Now, the “adverse selection” phenomenon, that sick people are more likely to buy insurance, and healthy people forego it, is a big problem. But the insurance company charges the same rate, not because it can’t tell who is sick – a fundamental, technological, and intractable information asymmetry. The insurance company charges the same rate because law and regulation force it not to use all the information it has. If anything, we have the opposite information problem: insurers know too much.As best I can tell by following his links, health status insurance is the insurance insurance I just discussed. So John's big idea is the asymmetric information isn't a big deal, the real problem is that insurance companies can't charge sick people higher premiums.
This source of adverse selection is a legal and regulatory problem, not an information problem, and easily solved. If insurance were freely rated, nobody would be denied. Sick people would pay more, but “Health status” insurance shows how to solve that.
Suppose that two parents have a kid that is covered on their insurance, until he's twenty-five. Then he has to go to the market and buy his own insurance. Now suppose when he's twenty-four, he gets cancer. In John's world his premiums should skyrocket. I think he would argue that the parents should buy "insurance insurance" for the kid. The parents need to buy insurance against the kid's future high premiums, before he gets sick. Obviously, they can't do that after he's diagnosed. The "insurance insurance" would be too expensive. They need to do it earlier. Perhaps, when he is born. Though what if we find he has complications? Perhaps, when he's conceived? But what if the parents have genetic predispositions to certain diseases? The kid is more likely to become sick, thus the insurance on his future premiums must be higher. Maybe they'd be high enough that the two parents wouldn't get married, because of the possible complications. Oh no, two people who love each other can't get married. What if the grandparents stepped in and helped out? They could buy "insurance insurance insurance," they could hedge the risk that their son or daughter grew up wanting to marry someone who wasn't as genetically compatible.
Maybe this sounds convoluted, but I'm trying to get to the notion of complete markets. Complete markets means that all risk that can be insured is insured. Since we are risk averse, complete markets make us all better off. If one of our houses burns down, we'll all chip in $100 bucks to get us back on your feet. The Amish did it literally, but nowadays we do it through insurance companies. The premium on home insurance is just the $100 bucks that goes to some unlucky person that just watched their home go up in flames.
But in a truly complete market, ALL risk is insurable. I could insure against a risk, before I was ever born, before I ever had a medical history. In a truly complete market, we insure all risks at "time zero," before we even exist. I picture a random soul in heaven, just like all other souls. One of the risks those souls want to insure against is sickness. Maybe being born sick. Maybe being sick later in life. Basically, they don't know when it will or if it will happen, but there's some risk they'll get sick. So they get with all the other souls and agree, we'll all put money aside, and whoever gets sick gets the money. That's insurance. My question is how much would each put in. Well, it's obvious they'd all pay the same. They are exactly alike in every way. It's only fair.
The point I'm trying to make is that in John's system, no matter how you slice it, there will be some choke point along the way. What if we switched from our system to John's tomorrow? A lot of healthy people would buy guaranteed renewable insurance, but a lot of sick people would be out of luck and face exorbitant premiums. If we are in a system where everyone is paying a different price for insurance, then we can't possibly be at the complete markets case. If we aren't at the complete markets case, either John's policy is suboptimal or there is some friction that prevents us from getting to the complete markets case. So what is it?
The wrench that I haven't thrown in yet is incentives. If I have guaranteed insurance before I am born, I'm much less incentivized to put effort into maintaining my health. I may drink like a fish or eat too much. I may smoke or do drugs. Maybe I just won't sleep enough. We make decisions that affect our health. This is a "friction." This is a reason that the complete markets case may not work (as if the having to buy insurance before your born wasn't enough). Maybe this is the sort of important friction John has in mind, because for conditioning on pre-existing conditons he gives these examples in the podcast, "Fat people don't pay more than thin people; smokers don't pay more than non-smokers. All sorts of things they don't condition on." Russ corrects him that they can condition on smoking, which in my understanding isn't that big of a bump in premium. I don't have a problem with insurance companies conditioning on smoking or charging a higher premium on people like me that eat and drink too much. It's the all sorts of other things I don't want. What about something simple like being female? Women have to pay higher insurance premiums, because women have babies. In a complete market, women would pay the same premium as everyone else. They'd buy their insurance before they had a gender (or even parents) and pay the same price as everyone else.
Conditioning on effort is fine to the extent that an insurance company can do it. But what they really want to do is condition on how sick we are. People with cancer pay more, and I don't see John distancing from that. I can't imagine by pre-existing condition he really means "big sweet tooth."
I thought I found a lot to like in the essay. I think there are lots of regulations that make health care more expensive and that the health care market should be more competitive. But I was really jarred by this statement, "Romney was pushed on what he was going to do, he said: Well, but of course we can't let insurance companies discriminate on pre-existing conditions. Well, once you've done that, you've swallowed the fly--the old lady that swallowed the fly...And once you do that, you've got most of the ACA." He's really arguing that my disagreement is irreconcilable with his preferred health care solution. Which makes sense, if my story is correct then charging everyone the same price and mandating everyone buy insurance sounds pretty close to the preferred solution. Since in a truly compete market, we'd all pay the same health care premiums. His preferred solution must be a market frictions story, but its a story I can't understand and he spends a good deal of the podcast and paper dismissing frictions in the health care market. If there is a well-formed second best model there, I'd love to know it.
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