Daily Archives: 05/01/2011

Saving costs – low hanging fruit


Austin peaked my interest with his post on Deloitte’s analysis, The Hidden Costs of U.S. Health Care for Consumers. So I went and read it. Towards the end, there was one page that really jumped out at me.

A survey of 1,008 U.S. adults asked people, “Would you consider doing any of the following if it would save money for health care?” Here’s what they said:

Health Savings Accounts, in the middle there, get a lot of press.  So does destination medicine, down there at the bottom. Do you know what gets relatively little attention? Using generic drugs. I hear from lots of physicians who say that patients demand name brand drugs, but those are anecdotal reports. This tells a different story.

Look at that chart again. 80% of people say they would use generics to save money! Not only that, but look at this, which I made from the accompanying Deloitte table:

Are there any groups at all that don’t overwhelmingly support the use of generic drugs to save money?

With this kind of support, I don’t know why we aren’t trying harder to push for formulary reform in Medicare and Medicaid. I also don’t know why private insurance companies aren’t doing the same. This would actually, not just theoretically, save money; it would also do so immediately.

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Software picked, likely related articles at The Incidental Economist:

Saving costs – low hanging fruit
Aaron Carroll
Fri, 29 Apr 2011 13:38:44 GMT


U.S. forces kill Osama bin Laden

CNN.com – World

via U.S. forces kill Osama bin Laden.

Earth to Libertarians: Private Parties Have Coercive Power Too

naked capitalism

I’m sick of the free pass given the libertarian blather, “The state is the only source of coercive power.” I doubt that many non-libertarians buy that assetion, but they too often remain silent because most libertarians are rabid on that issue and arguing with them is like talking to a wall. But since that bogus assertion has been showing up increasingly in comments here as right-wing plants are becoming more common, I might as well do a quick shred, since it does not take much effort to show this claim is nonsense.

Let’s look at some simple empirical examples of why this pet argument just ain’t so. The first comes from Tom Ferguson:

American history is replete with examples of business groups and individual firms retaining vast armies of military and paramilitary forces for long periods of time. In the nineteenth century many railroads kept private armies. The Pennsylvania Coal and Iron Police ran their own Obrigkeitsstaat [authoritarian state] for decades. General Motors maintained the Black Legion; Ford sported a veritable Freikorps recruited by the notorious Henry Bennett; and any number of detective agencies, goon squads, “special consultants,” and wiretappers have also been active. . . . Force on such a scale potentially menaces competitors, buyers, and suppliers almost as much as it does workers.

Some modern versions of coercion don’t involve actual harm, but credible threats. For instance, I know three different lawyers who have been suing banks who have gotten ugly warnings (and some follow-up action, like break ins and messages specifying where children were on specific days; one is spending $20,000 a month on bodyguards)….

via Earth to Libertarians: Private Parties Have Coercive Power Too.

It seems reasonable that private coercion would be come more common in the absence of all or much of government.

Boise Homemaker Bows Toward Mecca Just To See What It’s Like

BOISE, ID—After reading an article about Muslim rituals, curious homemaker Frances Parker decided to give bowing toward Mecca a shot Tuesday. “I guess I just wanted to see what it’d feel like,” Parker said of the few minutes she set aside…

The Onion

via Boise Homemaker Bows Toward Mecca Just To See What It’s Like.

The Good Old Days???

I’ve read the opening to Paul Krugman’s Conscious of a liberal.  I’m definitely less enthusiastic about a larger state than he, but that introduction resonated with me.  I also have the feeling that the country has gotten much more fractious and less friendly.

Jim Manzi of about the same age seem to agree.

Megan McArdle had an interesting counterpoint.

Megan McArdle

via The Good Old Days.

Jim Manzi and Paul Krugman are both nostalgic for childhoods that seemed safer, more egalitarian, less consumption-driven than the world today:

The safety and freedom that Krugman describe are rare now even for the wealthiest Americans – by age 9, I would typically leave the house on a Saturday morning on my bike, tell my parents I was "going out to play," and not return until dinner; at age 10, would go down to the ocean to swim with friends without supervision all day; and at age 11 would play flashlight tag across dozens of yards for hours after dark. And the sense of equality was real, too. Some people definitely had bigger houses and more things than others, but our lives were remarkably similar. We all went to the same schools together, played on the same teams together, and watched the same TV shows. The idea of having, or being, "help" seemed like something from old movies about another time.Almost anybody who experienced it this way (and of course, not everybody did), intuitively wants something like it for his own children. The tragedy, in my view, is that, though we all thought of this as the baseline of normality, this really was an exceptional moment in our nation’s history.

My motivation in writing about political economy is, in some ways, much like Krugman’s. But rather than seeing that moment as primarily the product of policies like unionization, entitlements and high taxes, as is Krugman’s view, I believe that it was primarily the product of circumstance. We had just won a global war, and had limited competition; we had a huge wave of immigration, followed by a multi-decade pause; oil was incredibly cheap; a backlog of technical developments had yet to be exploited and scaled up, and so forth. We can’t go back there, at least not exactly.

Maybe it’s because I grew up later than either Manzi or Krugman; maybe it’s because I grew up in Manhattan; or maybe it’s because I’m a woman.  Whatever the reason, what I notice about their idyll is how dependent it was on women being home.  Home production looks very similar no matter who is doing it; one family may be having meatloaf, and another filet mignon, but the family meals still have the same basic rhythm of Mom in the kitchen for hours until the family comes to dinner.  Families only need one car because Mom, who doesn’t herself work, is available to drive Dad to work every morning before she heads to the grocery store.  And the kids can play unsupervised because, of course, in this neighborhood–in all neighborhoods–there is a network of constantly watching eyes.  Meanwhile, the poor people and minorities are somewhere comfortably distant, allowing young Paul and Jim to experience a world without want. I can tell you where all the inequality and fear and crime was; it was in the neighborhood where I grew up, and the neighborhoods elsewhere in the city that were much poorer and more dangerous.

I don’t mean to sneer; I’m sure it was idyllic.  And the income gains of the 1950s and 1960s were real.  But the suburbs of the era were not created simply by the rise of the middle class.  Their existence, in the way that Manzi and Krugman remember, was also completely dependent on other forms of inequality: of the ability to move away from social problems, which is harder now; of generations of women whose sole destiny was the kitchen.  This produced a world in which most homes were, from the point of view of kids, basically the same: all of them contained a mom who spent most of her time cleaning the place or feeding its occupants, and the size and contents were naturally limited to the amount of stuff that Mom was personally willing to care for.  It was a great world for kids.  But not everyone was so lucky.
I find my self wanting to add that I think its consumer choice expanding and maybe the other edge of that sword.  Clearly we generally have more choice on many products today than 40 years ago.  Much of this is because of the globilization of the economy.  The spread of the internet and better communications as well.  Note the comment about watching the same TV shows.  Today how could that be true when the number of choices of what your friends could be doing is vastly greater than 40 years ago.  Numerous cable channels, the internet, video games all atomize and customize our activity to be different than what others are doing.  Think how common it was to talk about what Carson had said or joked 35 years ago.  Today no one has that size of audience in general.