New Mileage Labels!

Me, in 2008, offering a bright idea for getting people to pay more attention to auto mileage:

Require stickers to list the estimated cost of fuel consumption over a five year period. The estimate doesn't have to be perfect, just close enough to make it clear to consumers how much more one car costs than another over its life. Upside: it's free. Downsides: none that I can think of.

From the Los Angeles Times today:

Federal regulators unveiled new fuel economy labels that could make it easier for new-car buyers to compare fuel-efficient vehicles and gas-guzzlers. In addition to the miles per gallon, the labels will show [...] the expected cost of fuel over the next five years compared with the average new vehicle.

Clearly the federal government stole this idea from me and now refuses to give me credit. Bastards.

Oh wait. They actually did this back in 2006. But that label redesign only showed the expected cost of fuel over one year. Clearly the idea to extend this to five years was mine. I think they should name the new sticker after me.

(See update below.)

Mitt Romney is getting a lot grief today over his flip-flopping on the Detroit bailout. Talking about the Obama plan to rescue GM and Chrysler, his spokesman said, "Mitt Romney had the idea first. You have to acknowledge that. He was advocating for a course of action that eventually the Obama administration adopted." The only problem? A 2008 New York Times op-ed titled "Let Detroit Go Bankrupt."

But as much as it pains me to say this, I'm not really sure Romney is all that wrong here. After dismissing the original bailout requests from GM and Chrysler as too charitable, here are the relevant recommendations from Romney's op-ed:

First, [GM and Chrysler's] huge disadvantage in costs relative to foreign brands must be eliminated. That means new labor agreements to align pay and benefits to match those of workers at competitors like BMW, Honda, Nissan and Toyota. Furthermore, retiree benefits must be reduced so that the total burden per auto for domestic makers is not higher than that of foreign producers.

....Second, management as is must go.

....Investments must be made for the future. No more focus on quarterly earnings or the kind of short-term stock appreciation that means quick riches for executives with options. Manage with an eye on cash flow, balance sheets and long-term appreciation. 

....Don’t ask Washington to give shareholders and bondholders a free pass — they bet on management and they lost....A managed bankruptcy may be the only path to the fundamental restructuring the industry needs....The federal government should provide guarantees for post-bankruptcy financing and assure car buyers that their warranties are not at risk.

So what happened? Taking Romney's points in order: First, Obama rejected the automakers' original bailout requests as too charitable and sent them back to the table. Second, his auto task force forced the UAW to accept reductions in both worker compensation and retiree health care. Third, they fired GM CEO Rick Wagoner and handed management of Chrysler to Fiat. Fourth, they fundamentally restructured GM's finances, killed off a bunch of brands, and shut down a thousand dealerships. Fifth, they put both companies through a prepackaged brankruptcy that wiped out shareholders, forced bondholders to take a substantial haircut, and provided guarantees for post-bankruptcy financing. Sixth, Obama put a government guarantee behind GM and Chrysler warranties.

None of this is precisely what Romney called for. He criticized Obama's plan for not being done earlier. He undoubtedly would have preferred more concessions from the UAW. He wanted the government's stake in GM to be immediately distributed to taxpayers instead of being held for later sale. He said the Detroit bailout had "not been well-played" by either Bush or Obama.

Still, his op-ed really isn't all that far off from what eventually happened. As for the two gotcha quotes currently being distributed around the intertubes, "Let Detroit Go Bankrupt" was the headline the Times put on Romney's op-ed, not something he wrote himself. His piece makes it clear that he favors a managed bankruptcy, which is what eventually happened. And Romney didn't say that Obama’s plans for rescuing the auto industry were “tragic” and “a very sad circumstance for this country.” He said, "This is a very sad circumstance for this country, and it represents bad decisions by management, overreaching by the UAW. It's really tragic in a lot of ways." He was obviously referring to Detroit's troubles in general here, not specifically talking about Obama's plan.

Is Romney trying to take more credit than he deserves here? Sure. But it strikes me as being garden variety political puffery, not third-degree hypocrisy. Unless someone can turn up some other quotes, that is.

UPDATE: Hmmm. On April 29, 2009, after the outlines of the Obama plan were fairly clear and GM produced a proposal meant to address its requirements, Romney trashed it in pretty strong terms. "What is proposed is even worse than bankruptcy," he said. "It would make GM the living dead." And a correspondent says that Romney consistently opposed the infusion of any government money into the bankruptcy process, which is pretty far afield from the "course of action that eventually the Obama administration adopted." If this is true, it makes the flip-flopping case stronger. Still not a killer case, maybe, but a little stronger.

Quote of the Day: Paul Ryan's Big Mistake

From Paul Ryan, talking backstage to Bill Clinton at the 2011 Fiscal Summit about his Medicare plan:

You know the math. It's just, I mean, we knew we were putting ourselves out there. You gotta start this. You gotta get out there. You gotta get this thing moving.

No. You don't just "gotta get this thing moving." You need to get the policy right. You need to actually care about controlling healthcare costs. You need to actually care about delivery systems. You need to actually care about what works and what doesn't. You need to actually care about the details.

Paul Ryan doesn't. He's a right-wing ideologue with a single right-wing solution for everything. But he's sociable and friendly, not a fire breather, so everyone figures he's not one of the tea party nutjobs. This is a serious mistake.

Why Not Let the Dead Pay for Medicare?

So here's an idea: why not reform Medicare by means testing it? Conservatives should love this idea.

Here's how it works. Basically, we leave Medicare alone. Oh, we can still go ahead with some of the obvious reforms. Comparative effectiveness research is a no-brainer for anyone who's not part of the Republican leadership. Ditto for some of the delivery reforms on the table. Or allowing Medicare to negotiate for lower prices. It would be great if that stuff works. But if it doesn't, then people will need to pay more for their care. So why not have dead people pay? They don't need the money any more, after all.

So Medicare stays roughly the same, but every time you receive medical care you also get a bill. You don't have to pay it, though. It's just there for accounting purposes. When you die, the bill gets paid out of your estate. If your estate is small or nonexistent, you've gotten lots of free medical care. If it's large, you'll pay for it all. If you're somewhere in between, you'll end up paying for part of the care you've received.

Obviously this gives people incentives to spend all their money before they die. That's fine. I suspect they wouldn't end up spending as much as you'd think. What it does mean, though, is that Medicare has first claim on their estate, not their kids. But that seems fair, doesn't it?

Do you want to make sure to credit estates with all the Medicare taxes that have been paid over the years? Fine. Do you want to exempt a certain smallish amount to account for genuine family heirlooms? Fine. Do you want to pass laws making sure that estates can't be transferred to other people or trusts in order to evade this rule? Or regulate the use of reverse mortgages? Or make special rules for heirs who are minors? Fine, fine, and fine. Whatever.

But I'll bet this would raise a fair amount of money. What's more, that Medicare bill, with its continuously increasing grand total, would give people a pretty good sense of just how much medical care they're really getting. And it wouldn't impoverish the elderly with means testing while they were living. It would come solely from dead people, who have taken advantage of Medicare while they were alive and have no use for their money after they're dead. So what's not to like?

The Problem With Medical Testing

Ezra Klein responds to a Robin Hanson post suggesting that a lot of cancer screening is basically useless:

I think Hanson goes a bit far in the conclusions he draws, for reasons that some of his readers articulate in the comments. But “a bit far” isn’t the same as “wrong.” So if you’re anything like me, take a moment to think about how much you don’t want to believe that lung-cancer screenings or breast-cancer screenings may not actually work. And then think about trying to convince yourself they don’t work when your doctor is strongly urging you to get screened.

Actually, it's even worse than that. A couple of months ago I got examined by a urologist and he recommended that I get a prostate biopsy to check out a lump he felt. So I made the appointment, and a few weeks ago I went in. But my second appointment was with a different doctor who wanted to check things out for himself. He proceeded to do an extremely thorough DRE1 and concluded that most likely my lump was just a bit of calcification. But he was ready to do the biopsy if I wanted it. Did I?

Well, here's the thing. Even though my PSA test had been negative and I have no family history of cancer whatsoever; even though a prostate biopsy is a fairly unpleasant experience; even though prostate biopsies also have unpleasant lingering side effects; even though I'm philosophically opposed to overuse of medical tests; and even though I had a doctor standing right there telling me I probably didn't need the test

Even still, I almost went ahead and had him do it anyway. I mean, I was right there. It would only take ten minutes. Better safe than sorry, right?

Basically, everything you can think of was in place to turn down this test. But I almost didn't. If even one little thing had suggested I should do it — maybe because the test was quick and painless, or perhaps because I had an uncle who had once had prostate cancer — I would have done it. And if that second doctor had told me to do it, regardless of whether it was in strong terms or not? Then I wouldn't even have hesitated for a moment.

So that's what we're up against.

UPDATE: Aaron Carroll says I'm still underestimating the problem. His take here.

1DRE = digital rectal examination, and yes, this is exactly what you think it is.

The Republican Message

David Frum, after surveying the wreckage of the decisive Republican loss in New York's conservative 26th congressional district:

What does the GOP have to say to hard-pressed voters? Thus far the answer is: we offer Medicare cuts, Medicaid cuts, and tighter money aimed at raising the external value of the dollar. No candidate, not even if he or she is born in a log cabin, would be able to sell that message to America’s working class.

Actually, it might be worse than that. Let me rephrase:

What does the GOP have to say to hard-pressed voters? Thus far the answer is: we offer Medicare cuts for you and your children, Medicaid cuts for you and your family, reduced taxes for CEOs and other fat cats, and tighter money aimed at wrecking American industry by making our goods too expensive for anyone overseas to afford. Plus lots of wars and unquestioning support for the Israeli right! Don't forget that.

That is indeed a tough one. Ronald Reagan himself would have a difficult time winning with that message hanging around his neck. But then, Ronald Reagan wouldn't be able to win the Republican nomination these days in the first place. Too liberal by far. So I guess it's a moot point.

Open Wide!

The American trend toward forced arbitration is bad for consumers. Basically, most commercial transactions you go through today — buying a house, buying a car, seeing a doctor, etc. — include contracts that demand resolution of all disputes not in a court of law, but via arbitration. And, unsurprisingly, the arbitrator is chosen by the business person, not the consumer. You can, of course, refuse to sign a contract with anyone who insists on arbitration, but there are whole industries where this has become so pervasive that you hardly have a choice. If you refuse to sign, you just don't get your teeth cleaned. See Stephanie Mencimer for chapter and verse on this.

Now, via Matt Yglesias, I see that things are going even further. Here's Tim Lee writing at Ars Technica:

When I walked into the offices of Dr. Ken Cirka, I was looking for cleaner teeth, not material for an Ars Technica story. I needed a new dentist, and Yelp says Dr. Cirka is one of the best in the Philadelphia area. The receptionist handed me a clipboard with forms to fill out. After the usual patient information form, there was a "mutual privacy agreement" that asked me to transfer ownership of any public commentary I might write in the future to Dr. Cirka. Surprised and a little outraged by this, I got into a lengthy discussion with Dr. Cirka's office manager that ended in me refusing to sign and her showing me the door.

....The growing use of censorious copyright assignments recently caught the attention of law professors Jason Schultz and Eric Goldman, who created a site called Doctored Reviews to educate doctors and patients about the phenomenon.

When Ars asked Schultz about medical professionals who ask their patients to sign these agreements, he was scathing. "It's completely unethical for doctors to force their patients to sign away their rights in order to get medical care," he said. He pointed out that patients seeking treatment can be particularly vulnerable to coercion. Patients might be in acute pain or facing a life-threatening illness. Such patients are in no position to haggle over the minutia of copyright law.

We bought a new car this weekend, and the sales contract included the usual arbitration clause. We signed it. What choice did we have? But if the car is a lemon or the dealership screws us over, at least I can write about it without worrying over whether I'm violating some kind of gag clause. The experts Lee interviewed said these clauses are probably unenforceable, but how many ordinary citizens are willing to bet on that if they get a threatening letter on legal letterhead threatening to ruin them? Not too many, probably.

As near as I can tell, businesses in the United States increasingly think that basic constitutional rights are mere annoyances to be swatted away. Before long they're going to demand the right to search your house without your permission anytime they think you've done something they don't like. And why not? The United States government increasingly seems to view the constitution the same way.

Paul Ryan's Healthcare Boondoggle

Peter Orszag may be an ex-Obama aide, but his cost control bona fides are pretty widely acknowledged. And he says that last month's CBO is right: Paul Ryan's plan to voucherize Medicare wouldn't reduce healthcare spending, it would raise it:

On the critical metric of whether the Ryan plan would reduce total health-care costs [] the CBO conclusion is shocking: The plan would not only fail to decrease health-care costs per beneficiary, it would increase them — by an astonishingly large amount that grows over time. By 2030, health spending on the typical beneficiary would be more than 40 percent higher under the Ryan plan than under existing Medicare, according to the CBO report.

....How could this possibly be, when the point of reform is to reduce costs? The CBO points to two factors: Private plans have higher administrative costs than the federal Medicare program, and less negotiating leverage with providers.

Everything in life is relative. The CBO’s analysis of the health-reform act that was passed last year was, well, lukewarm on its potential to reduce costs. Compared with the Ryan plan, though, the health reform act comes across as an efficient cost- containment machine.

The main goal of Medicare reform isn't to reduce federal healthcare spending. That's only a side effect. The main goal is to reduce healthcare spending, full stop. If, instead, your plan increases the cost of healthcare but reduces the federal share of that spending, all you're doing is making things worse. The cost of healthcare goes up and more and more patients no longer have the means to pay for it. There's literally no upside to a plan that does this.

In other words, there's no upside to Paul Ryan's Medicare plan. It's bad news across the board. What we need isn't ideological nostrums, it's actual ideas for controlling costs. Paul Ryan is entirely silent on that.

On Tuesday, the CFTC accused a couple of obscure traders of trying to illegally manipulate the oil market in 2008. Here's the gist:

In a matter of a few weeks in January 2008, the defendants built up large positions in the oil futures market on exchanges in New York and London, according to the suit, filed in the Federal Court in the Southern District of New York.

At the same time, they bought millions of barrels of physical crude oil at Cushing, Okla., one of the main delivery sites for West Texas Intermediate, the benchmark for American oil, the suit says. They bought the oil even though they had no commercial need for it, giving the market the impression of a shortage, the complaint says.

At one point they had such a dominant position that they owned about 4.6 million barrels of crude oil, estimating that this represented two-thirds of the seven million barrels of excess oil then available at Cushing, according to lawsuits.

That's it? The excess capacity at Cushing is only 7 million barrels? So all you have to do to corner the market is use a bunch of subsidiaries to buy up about 5 million barrels of crude? That's nothing. It's $500 million or so. There must be thousands of hedge funds, investment banks, PE funds, or private investors who could pull off something like that. And the operation itself wasn't exactly rocket science. I had no idea that manipulation of something the size of the oil market was so easy.

Watching Benjamin Netanyahu

This is from Benjamin Netanyahu's speech before Congress today:

Two years ago I publicly committed to a solution of two states for two peoples: A Palestinian state alongside a Jewish state.

I am willing to make painful compromises to achieve this historic peace. As the leader of Israel, it's my responsibility to lead my people to peace. Now, this is not easy for me. It's not easy. Because I recognize that in a genuine peace, we'll be required to give up parts of the ancestral Jewish homeland. And you have to understand this, in Judea and Samaria, the Jewish people are not foreign occupiers.

So that's it? The "painful compromise" Netanyahu is willing to make is an agreement not to keep the entire West Bank forever? Wow.

(For those not in the know, to Likud politicians "Judea and Samaria" = Israel plus the entire West Bank, aka "Greater Israel.")

I really don't follow Middle East politics closely enough to say this with any confidence, but things feel very different to me today than they have in the past. The Israeli prime minister, for the first time ever, now feels free to publicly dress down an American president in the secure knowledge that Republicans consider him a firm partisan ally and Democrats will go along uncomplainingly. Then he goes in front of Congress and says he won't negotiate the right of return, he won't negotiate Jerusalem, he insists on a permanent military presence all the way to the Jordan River, and his only concession is that he won't annex the entire West Bank. And he gets 20 standing ovations for it. Netanyahu's visit has been practically a triumphal procession.

It's hard to know what to think of this. My instinctive reaction is revulsion over being treated this way, and that's despite the fact that I've always fundamentally blamed Arabs for the lack of a peace agreement. They've started and lost three wars against Israel, they've turned down every peace agreement offered to them, and they've adopted terrorist tactics against Israel that no country in the world would tolerate. Israel, obviously, bears a considerable share of blame for this state of affairs too, but it's a distinctly minority share.

At least, that's how I've always seen it. But now? After watching Netanyahu in action; after watching his orchestrated attack on an American president who quite plainly is on Israel's side and proposed nothing new in the way of negotiating parameters; after watching the almost fawning reception he got from Congress; after watching him make it belligerently clear that he will concede nothing for peace; and after watching his almost smug recognition that he can singlehandedly direct American foreign policy — after watching all that, I just don't know anymore. Rationally, I still think that Palestinians are the ones who need the bigger reality check, but in my gut it's now a much closer call than it's been in the past. The last few days have been pretty sobering ones.