Would healthcare costs in the United States be controlled better if people had more "skin in the game"? That is, if instead of insurance picking up the tab for everything, we had to pay more for medical services ourselves, making us a little more selective about what medical care we need and what medical care we don't? There's some evidence that says the answer is yes, and if it's implemented in a smart way (as in France, for example, where copay amounts vary depending on the value of the treatment) there might be a place for this. The problem, as Aaron Carroll pointed out a few days ago, is that Americans already pay more for medical services than residents of most other countries, but our healthcare costs are going up faster anyway.

But why do Americans pay so much? Part of the reason is that published averages include the uninsured, who have high out-of-pocket expenses. But that's not all. Even the insured, it turns out, have pretty high out-of-pocket expenses. Via Catherine Rampell, here's a chart from the Labor Department that shows coverage of various conditions by private sector health plans. It includes everything that's even partly covered, and as you can see, it leaves a lot to be desired. Sure, office visits and basic hospital costs are covered. But if you need an organ transplant or kidney dialysis or diabetes care? You're probably out of luck. Hell, even maternity care and physical therapy are a crapshoot. But just remember: America has the best healthcare in the world, baby. Don't let anyone ever tell you otherwise.

Everybody agrees we need to restrain the growth of Medicare. Unless, of course, someone proposes an actual way to restrain the growth of Medicare.

We are ruled by idiots. Bipartisanly, of course.

Is it rude to be constantly checking messages while you're socializing with someone else? That's a matter of opinion. But a professor friend emails to remind me that rudeness is actually the least of the problems with the perpetual multitasking of the smartphone generation:

This is the way kids these days think. My administration calls it "the millennial student" and apparently we are supposed to cater to their habits. Fully half of my 60 person general physics class this semester sits in the back of the room on either phone or laptop. They're not taking notes. The good ones are working on assignments for other classes (as if being present in mine causes the information to enter their pores). The bad are giggling at Facebook comments.

....But here's the thing: there is convincing evidence that this inveterate multitasking has a serious, measurable and long lasting negative effect on cognitive function. Look up Stanford psychologist Clifford Nass sometime. There's a lovely episode of Frontline from a year or so ago featuring him. He has shown that multitaskers are not only bad at multitasking, but they are also worse than nonmultitaskers on every individual one of the tasks.

That's the millennial student and it isn't something to be catered to. Put the damn iPhone down before you make yourself stupid.

I should have remembered that! Nass has been studying "high multitasking" for years, and his results are pretty unequivocal. Here's the Frontline interview:

What did you expect when you started these experiments?

Each of the three researchers on this project thought that ... high multitaskers [would be] great at something, although each of us bet on a different thing.

I bet on filtering. I thought, those guys are going to be experts at getting rid of irrelevancy. My second colleague, Eyal Ophir, thought it was going to be the ability to switch from one task to another. And the third of us looked at a third task that we're not running today, which has to do with keeping memory neatly organized. So we each had our own bets, but we all bet high multitaskers were going to be stars at something.

And what did you find out?

We were absolutely shocked. We all lost our bets. It turns out multitaskers are terrible at every aspect of multitasking. They're terrible at ignoring irrelevant information; they're terrible at keeping information in their head nicely and neatly organized; and they're terrible at switching from one task to another.

....We were at MIT, and we were interviewing students and professors. And the professors, by and large, were complaining that their students were losing focus because they were on their laptops during class, and the kids just all insisted that they were really able to manage all that media and still pay attention to what was important in class -- pick and choose, as they put it. Does that sound familiar to you?

It's extremely familiar.... And the truth is, virtually all multitaskers think they are brilliant at multitasking. And one of the big new items here, and one of the big discoveries is, you know what? You're really lousy at it. And even though I'm at the university and tell my students this, they say: "Oh, yeah, yeah. But not me! I can handle it. I can manage all these," which is, of course, a normal human impulse. So it's actually very scary....

....You're confident of that?

Yes. There's lots and lots of evidence. And that's just not our work. The demonstration that when you ask people to do two things at once they're less efficient has been demonstrated over and over and over. No one talks about it — I don't know why — but in fact there's no contradictory evidence to this for about the last 15, 20 years. Everything [as] simple as the little feed at the bottom of a news show, the little text, studies have shown that that distracts people. They remember both less. Studies on asking people to read something and at the same time listen to something show those effects. So there's really, in some sense, no surprise there. There's denial, but there's no surprise.

The surprise here is that what happens when you chronically multitask, you're multitasking all the time, and then you don't multitask, what we're finding is people are not turning off the multitasking switch in their [brain] — we think there's a switch in the brain; we don't know for sure — that says: "Stop using the things I do with multitasking. Focus. Be organized. Don't switch. Don't waste energy switching." And that doesn't seem to be turned off in people who multitask all the time.

Italics mine. So here's the thing: whether it's rude or not, multitasking is probably ruining your brain. You should stop. But if you can't do that, you should at least take frequent breaks where you're fully engaged in a single task and exercising your normal analytic abilities. So why not do that while you're socializing? It's as good a time as any.

So about those ground troops in Libya:

A rebel official in Libya's besieged city of Misrata pleaded desperately on Tuesday for Britain and France to send troops to help fight strongman Moamer Kadhafi's forces, saying "if they don't, we will die." In the first request by any insurgents for boots on the ground, a senior member of Misrata's governing council, Nuri Abdullah Abdullati, said they were asking for the troops on the basis of "humanitarian" principles.

The French foreign minister is said to be "entirely hostile" to the idea of sending in ground troops, but perhaps that phrase doesn't translate quite the way you'd think:

The EU has drawn up a "concept of operations" for the deployment of military forces in Libya, but needs UN approval for what would be the riskiest and most controversial mission undertaken by Brussels.

The armed forces, numbering no more than 1,000, would be deployed to secure the delivery of aid supplies, would not be engaged in a combat role but would be authorised to fight if they or their humanitarian wards were threatened. "It would be to secure sea and land corridors inside the country," said an EU official.

....The planning has taken place inside the office of Catherine Ashton, the EU's foreign and security policy chief....Diplomats say Ashton is pushing for a UN consent under strong pressure from the French, which is generally keen to promote projects supporting European defence and security policy.

This would be an EU force, not a NATO force, and would be tasked only with protecting humanitarian aid, not fighting for the rebels. So, just like all the other non-boots on the non-ground in Libya, this also wouldn't count as boots on the ground. Comprendre?

A couple of weeks ago I linked to a paper predicting that China's growth would start to slow down in about five years, when its per capita income reaches $17,000. The authors based this on a comparison to a set of other countries that had also experienced high growth rates but eventually slowed down.

This week the Economist gathered a host of economists to comment, and for the most part they all agreed with the gist of the paper. However, they didn't invite Stuart Staniford, who thinks the $17,000 number is all wet. Roughly speaking, he thinks the authors chose the wrong set of countries for comparison, so he set out to get a more apt sample set:

To try to get a better grip on the situation, I did two things. Firstly, to formalize the instinct that the US has been at/near the productivity frontier at most times, I expressed every country's GDP/capita as a fraction of the US value in the same year. Then I started kicking countries out of the sample, unless they met the following criteria: they started out the sample clearly less productive than the US (I took less than 60% as my threshold), and ended up significantly more productive, relative to the US, than they had started out. Ie, we want countries where it's somewhat plausible that there's a story of underdevelopment, period of rapid catchup, followed by slowing growth once the country is a fully developed country with modern capital infrastructure and levels of productivity.

Long story short, Stuart produced the chart below, which suggests China can keep growing at a fast pace until its per capita income is somewhere in the $25,000 range, which is probably still 15-20 years away. I don't have the chops to adjudicate this, but I thought it was worth highlighting a contrarian opinion anyway. China might very well slow down in the next five or ten years anyway, since it faces multiple constraints (resource scarcity, productivity limits, demographics), but the $17,000 limit is just a guess, and you should probably put some fairly large mental error bars around it.

It's not like Paul Krugman needs my help in spreading his opinions, but people really ought to be paying a little more attention to the fact that right after S&P's warning yesterday morning about U.S. debt, interest rates on U.S. debt.....fell. Why? Because demand for U.S. securities rose and their price went up, as the chart below of a typical treasury index fund shows.

In other words, actual bond traders not only ignored S&P, they decided that U.S. debt was even safer than they thought before. And if S&P's warning didn't have any impact on trading in actual treasuries, it almost certainly didn't have any impact on anything else, including the stock market. As Krugman says, "People, this was a non-event."

The Indy Conundrum

Greg Sargent notes a contradiction:

The poll finds that 63 percent of independents support dealing with the deficit by raising taxes on those over $250,000. It also finds that only 23 percent of independents support cuts to Medicare and Medicaid, versus 75 percent who oppose such cuts. Indys are far more in agreement with Obama than with Republicans on the two core questions at the heart of the fiscal debate right now.

Yet the poll also finds that only 28 percent approve of Obama’s handling of the deficit, versus 68 percent who disapprove.

How can this be? What explains such odd behavior?

This will probably satisfy no one, but I think the answer is pretty simple. First: the vast, vast majority of independents don't really have any idea what Obama's plan to handle the deficit is. They just know that (a) the deficit is high and (b) Obama is president. Beyond that, there are kids to get to school, laundry to be done, bosses to be pleased, and leaky faucets to be fixed. The details of the deficit debate are just a bit of partisan background noise that they haven't really parsed yet.

Second: the economy still sucks. Unemployment is high, wages are stagnant, housing prices are dropping, friends and neighbors are having trouble making ends meet, and taxes are due. So approval of everything Obama related is down.

I realize that these two things are sort of an all-purpose explanation for everything. Nonetheless, that's my explanation.

The LA Times reports on how things are going in Libya:

"We rushed into this without a plan," said David Barno, a retired Army general who once commanded U.S. and NATO forces in Afghanistan. "Now we're out in the middle, going in circles."

The failure of the international air campaign to force Kadafi's ouster, or even to stop his military from shelling civilians and recapturing rebel-held towns, poses a growing quandary for President Obama and other NATO leaders: What now?

Well, this, apparently:

A joint British-French military team of advisers is to be sent to Benghazi in a move that is likely to lead to accusations of mission creep....The UK-French team will advise the rebels on intelligence-gathering, logistics, and communications. In an indication of the serious nature of the move, the team will be run by a joint force headquarters, the Guardian has learned.

....William Hague, the foreign secretary, said in a statement that the team "will enable the UK to build on the work already being undertaken to support and advise the NTC [National Transitional Council] on how to better protect civilians". He added: "In particular they will advise the NTC on how to improve their military organisational structures, communications and logistics, including how best to distribute humanitarian aid and deliver medical assistance."

Hague said the British section of the team will consist of "experienced British military officers".

Bud these are advisors, not trainers, no rebels are being armed, no boots are on the ground, etc. etc. Move on, nothing to see here, folks.

Wall Street Watch

So how's the banking industry doing in the wake of the Great Collapse? Here are a few bellwethers:

  • Goldman Sachs crushed analysts' expectations. They're doing great!
  • Citigroup is successfully gaming those pesky new capital requirement. Nice job, Citi!
  • America's top bank regulator is cutting yet more sweetheart deals with America's top banks. Good job, OCC!

Being on Wall Street means never having to say you're sorry. It's a grand life.

Why We Deny

I've always known that facts and evidence don't generally affect people's opinions much. But possibly the worst aspect of blogging for the past nine years is that now I really, really know it. I have my face rubbed in it every day. That's a different, and far more discouraging thing, than simply knowing it in an abstract, intellectual sort of way. But Chris Mooney comes to the rescue today, putting this all back into the realm of the abstract and using science to explain why science persuades so few people:

The theory of motivated reasoning builds on a key insight of modern neuroscience: Reasoning is actually suffused with emotion (or what researchers often call "affect"). Not only are the two inseparable, but our positive or negative feelings about people, things, and ideas arise much more rapidly than our conscious thoughts, in a matter of milliseconds—fast enough to detect with an EEG device, but long before we're aware of it. That shouldn't be surprising: Evolution required us to react very quickly to stimuli in our environment. It's a "basic human survival skill," explains political scientist Arthur Lupia of the University of Michigan. We push threatening information away; we pull friendly information close. We apply fight-or-flight reflexes not only to predators, but to data itself.

We're not driven only by emotions, of course—we also reason, deliberate. But reasoning comes later, works slower—and even then, it doesn't take place in an emotional vacuum. Rather, our quick-fire emotions can set us on a course of thinking that's highly biased, especially on topics we care a great deal about.

Read the rest for the whole story. But be prepared to be annoyed when Chris wrenches his spine out of shape bending over backward to find an example of liberals denying science as much as conservatives. It might be true that you can find vaccine deniers in the aisles of Whole Foods, but if there's any rigorous evidence that belief in the vaccine-autism link is especially pronounced or widespread among liberals, I haven't seen it. Surely there's a better, more substantive example than that floating around somewhere?