Ezra Klein writes this today about Paul Ryan's budget roadmap:

I don't think Paul Ryan intended to write a budget that concentrated its cuts on the poorest Americans. Similarly, I don't think Mitt Romney intended to write a budget that concentrated its cuts on the poorest Americans. But there's a reason their budgets turned out so similar…

Really, let's just stop right there. Ryan's budget didn't spring forth immaculately from the forehead of Zeus. It's pretty much the same as his 2011 budget. Which in turn is pretty much the same as his 2010 budget. Which in turn is just a nicely formatted version of everything he's been saying for the past decade.

I'm so tired of Paul Ryan I could scream. Every year we get a slightly different version of the same old thing, and every year we have to waste entire man-years of analysis in order to make the same exact points about it. And the biggest point is that his budget would force enormous, swinging cuts in virtually every domestic program, especially those for the poor. If this bothers Ryan, he's had plenty of time to revise his budget roadmap to address it.

But he hasn't. He knows perfectly well that his budget concentrates its cuts on the poorest Americans. It's been pointed out hundreds of times, after all. If he found that troublesome he'd change it. Since he hasn't, the only reasonable conclusion is that this is exactly what he intends. Let's stop pretending otherwise.

Austin Frakt posts a chart today showing that productivity growth in the healthcare sector sucks. In the durable goods sector, for example, productivity doubled between 1995-2005. In the healthcare sector, it went down by a few percent. In the middle of an economic boom, healthcare actually got less productive.

But wait. What does this mean? If I run a widget factory, measuring productivity is straightforward. If I make twice as many widgets with the same amount of labor and capital, my productivity has doubled. Hooray! But what does healthcare produce? What precisely needs to double to say that healthcare productivity has doubled?

Austin links to a paper by David Cutler, who admits that "Productivity growth is notoriously difficult to measure in health care." Why? Because "Accurate productivity assessment requires a good output measure." Official figures put productivity growth in the healthcare sector at -0.2% per year, but:

Other studies have looked more closely at health care costs and output, and can be used to assess the productivity of medical care over time. Figure 2 shows the cost per additional year of life attributable to medical care between 1960 and 2000.

The value of a year of life is generally taken to be about $100,000 (Cutler, 2004). Thus, costs per year of life below this amount are generally considered to be good value, while costs above this amount are considered to be poor value. Most of the estimates of cost per year of life are below $100,000. Thus, medical care on average is giving good value for the dollar. But the trend is adverse. Cost per year of additional life was lower in the 1960s and 1970s than in the 1980s and 1990s.

I just flatly don't get this. For one thing, it makes sense that people will value their lives more highly as they get richer. America is a much richer country than it was in the 60s, and it's hardly surprising that we're willing to spend a lot more to extend our lives by a year than we were then. This is more a reflection of spending priorities than it is of productivity.

More importantly, though, this just seems like a terrible measure. Even though everyone acknowledges that lifespan isn't a very good way of measuring the quality of healthcare, we keep on using it anyway. But that's like looking for your keys under the streetlight just because the light is better there. You end up missing enormous strides that have nothing to with lifespan. Lasik surgery doesn't extend your life, but a lot of people sure get a lot of benefit from it. When I tore a meniscus in my knee, I recovered fully and quickly thanks to arthroscopic surgery. I thought that was great, but it didn't extend my lifespan by a single day. Asthma inhalers save lives, but they also dramatically improve quality of life above and beyond that. The list of advances like this is endless.

I don't know how you measure that. Maybe it's impossible. But I halfway wonder if we should just admit that we have no good measure of healthcare productivity and give up on pretending otherwise. Just treat it like a gigantic productivity black hole, and concentrate our attention instead on simple efficiency, where we do at least have decent comparative measures. Some regions, and some practices, really do produce similar outcomes with less spending than other areas and practices, and that's worth looking at. But I'm not sure how you translate that into a traditional productivity measure.

We spend a lot of useless money on medicine. No argument there. But that's as much a value statement as it is an objective measure of productivity. I might think it's a waste to spend $100,000 keeping an 80-year-old man barely alive in a hospital bed for an extra six months, but if the man is your grandfather, you might disagree. And if that happens more today than it used to, it's just because we all have a lot more money to spend on this stuff, not because medicine has gotten less productive.

However, I'll be curious to see further posts on this subject from Austin and the gang. Are there better measures of healthcare productivity out there? I'd be interested in hearing about them.

Felix Salmon writes something peculiar today. He's not too keen on the JOBS Act, a bill designed to loosen securities regulations on small businesses, and yet it's gotten wide bipartisan support anyway:

I don’t fully understand the political dynamics here. A bill which was essentially drafted by a small group of bankers and financiers has managed to get itself widespread bipartisan support, even as it rolls back decades of investor protections. That wouldn’t have been possible a couple of years ago, and I’m unclear what has changed.

Felix! What's unclear here? Dodd-Frank is the exception, not the rule, and even Dodd-Frank's very modest rules are currently in the process of being eviscerated by human waves of Wall Street attorneys. Besides, a bill like the JOBS Act would have been eminently possible two years ago. In fact, in April 2009, a mere few months after the Great Meltdown, big banks successfully gutted a "cramdown" bill that would have allowed bankruptcy judges to reduce the principal owed on mortgages. And not only did they gut it, but they even got Congress to hand over billions in new bailout money at the same time. I guess they figured they were owed something for all the time and money they'd spent lobbying.

Long story short, nothing has changed. And that's the problem.

I've noted on several occasions that Fox News spent pretty much the entire summer of 2010 fanning the flames of xenophobia and racial resentment, and a few days ago I wondered if the ridiculous Derrick Bell incident foreshadowed a reprise during this year's election summer. We'll have to wait for summer to find out, but ThinkProgress reminds us today that there are two sides to this kind of thing: there's the wildly overwrought coverage of stories that keep the frenzy alive, but there's also the wildly understated coverage of stories that contradict the favored narrative of white culture under assault.

The Trayvon Martin story is just that. Adam Weinstein has a quick explainer here if you need to get up to speed on the story of a black kid in Florida who got shot by a white neighborhood watch patrolman for no apparent reason. The neighborhood watch guy was barely even questioned after the incident, which was apparently written off by the local police force as just one of those things. It's been a big story. And how has the news channel of conservative white folks covered it? ThinkProgress has the answer below. Apparently Trayvon Martin just doesn't fit into the Fox agenda.

Via Julian Sanchez.

Last month I noticed that Mitt Romney seemed to be changing his economic message. Instead of the economy sucks and it's Obama's fault, it had morphed into the economy's recovering but it would be recovering even faster if not for Obama. Today, Mark Barabak and Paul West of the LA Times suggest that this is a pivot that's here to stay:

Mitt Romney entered the presidential contest as Mr. Fix-It, saying his business know-how was precisely what could rescue the struggling economy from its deep and devastating slump....But after months of steady job growth, improved consumer confidence and big gains on Wall Street, the economy seems in less dire need of fixing, and Romney has been forced to alter his message or risk seeming out of touch.

"I believe the economy's coming back," Romney said at a breakfast stop Monday in Springfield....But he gave absolutely no credit to President Obama — "the economy always comes back after recession" — and insisted the administration's policies had made matters worse and the recovery slower than it should have been.

....If the slow but steady improvement continues and Romney hangs on to become the GOP nominee, the choice presented to voters in the fall could rest on a pair of abstract arguments: one candidate saying he would have done better and the other insisting things could have been worse.

Maybe Romney doesn't have a choice, but this is a tough message. The true believers will truly believe, as always, but will anyone else? If the economy really is improving, it's not very convincing to say "Yeah, but I could have done even better." It bodes ill for Romney that he's apparently decided this is his best shot.

Earlier this morning I said that since Paul Ryan's latest budget proposal caps revenues and cuts Medicare and Social Security only modestly, this means that "everything non-elderly gets whacked hard."

But what does that mean? Well, it turns out that the Congressional Budget Office has put a concrete number to "whacked hard" here. Medicaid and CHIP (children's healthcare) would decline from 2% of GDP today to 1% of GDP in 2050, and everything else — that is, everything other than Social Security and Medicare — would decline from 12.5% of GDP today to about 4% of GDP in 2050.

This is, to put it mildly, nuts. Defense spending alone amounts to 4% of GDP, and it's vanishingly unlikely that this will ever fall much below 2-3% of GDP. This means that all domestic spending will decline from about 8% of GDP to 1-2% of GDP by 2050. That's prisons, border control, education, the FBI, courts, embassies, the IRS, FEMA, housing, student loans, roads, unemployment insurance, etc. etc. It's everything. Whacked by about 80% or so.

This is not a serious plan. I don't care how serious Paul Ryan sounds, or how many numbers he spouts, or how many charts he buries us under. It's not serious.

As I recall, last year's version of the Paul Ryan voucher plan for Medicare basically amounted to mailing seniors a check each year to pay for health insurance. The value of the check went up at the rate of general inflation, which is much lower than the rate of medical inflation. Within a few decades, this means that the checks would cover no more than half or two-thirds of the cost of insurance, and seniors would be forced to pay huge sums out of pocket. Democrats were unamused.

But here's an interesting thing. A few months ago I linked to a Yuval Levin proposal for Medicare reform that basically told his fellow conservatives to put their money where their mouths are. If conservatives really believe that competition is the key to holding down costs, he said, then let's make Medicare competitive. Levin proposed that each year Medicare would define a minimum benefit level, and then providers in each Medicare region would bid for business. The traditional fee-for-service Medicare plan would be among the bidders, and the second-lowest bid would become the value of a voucher sent to each senior. You could pay more for a more generous plan if you want to, but at all times "there would be at least one option that would cost less than the Medicare benefit, and seniors choosing that option would get the difference back as cash in their pockets; [and] there would be at least one plan that cost the same as the benefit, so that seniors could obtain it with only the same out-of-pocket costs they have today."

At the time, I suggested that liberals might very well be OK with this idea. After all, it's pretty much how Obamacare works. Within the insurance exchanges set up by PPACA, providers engage in competitive bidding based on a minimum coverage package defined by the government. The size of the federal subsidy for low-income families is set at the value of the second-lowest bid.

So here's what's interesting: this is basically what Paul Ryan is proposing this year. He's not quite willing to trust the free market completely, so his proposal also includes a cap on cost growth that's equal to GDP plus 0.5%. This is similar to the growth cap mandated in Obamacare. I have a problem with using this same number for Medicare, however, because it doesn't contain the word "per capita," and the retirement of the baby boom generation is going to increase the number of Medicare beneficiaries at a higher rate than the rest of the population.

Still, it's a start. The basic competitive framework is worth a look. The growth rate formula is negotiable. The regulatory apparatus is negotiable too. It's not prima facie ridiculous.

Now, given the slowdown in Medicare growth over the past couple of decades, along with the cost controls that are already part of Obamacare, I'm not really in favor of adopting a plan like this. I think we should give Obamacare a chance to work instead. Still, Ryan's plan is a step in the right direction. I'll give him that.

The Supreme Court ruled today against a Nestle patent on a test that helps doctors set drug dosages:

The high court, in a 9-0 ruling by Justice Stephen Breyer, said the patents were invalid because they made claims on laws of nature, which aren't patentable.

OK then. We've finally set an outside boundary: you can't patent God's inventions. That's a good start! Now how about if Congress eliminates all software and business process patents too? That would make the world a much better place.

Paul Ryan.

As a blogger, there are days you know you're doomed. Today, for example. Paul Ryan has released the latest Republican budget, and it's a blizzard of numbers, gimmicks, weird comparisons, and obfuscation. It's no more serious than any of Ryan's other budget proposals, no matter how many PowerPoint slides he includes, and yet, this is what everyone will be talking about. I'm pretty bored with Ryan, but I feel like I need to say something too anyway.

Other people with more fortitude than me will eventually pick through his numbers and deliver more precision about his proposals. As near as I can tell from a quick scan, though, it's not a lot different from his previous plans. He makes modest cuts in Medicare and Social Security over the next ten years, zeroes out Obamacare, keeps defense spending high, and then takes huge whacks at everything else.

The single most important number in Ryan's plan, as usual, is his top line limit on spending: 19% of GDP. He will, of course, justify this with a chart showing that this is about the average over the past 50 years, so it's perfectly reasonable that we should be able to stick with this for the next 50. But it's not. For starters, average expenditures over the past 30 years have been more like 20-21% of GDP, with the exception of a few years in the late 90s during the Clinton boom era. What's more, the country is aging. Nothing can stop that, and this means that spending on the elderly is going to go up no matter how good a job of reining in healthcare costs we do. This means that spending over the next 20-30 years is going to be in the range of 23-24%.

This is just pure demographics. There's really not much we can do about it. In fact, it's actually a best-case scenario.

So if we cut spending to 19%, it means that the entire budget outside of Social Security, Medicare, and Defense (which Ryan also doesn't want to cut much) has to be cut by half or more. Ryan will do his best to cover this up, but there's no way around the numbers. The country is aging. We're going to spend more on the elderly. If we cut spending levels at the same time, everything non-elderly gets whacked hard. That's the basic story. It's not a path to prosperity, it's a path to penury.

More later on some of the details of Ryan's plan.

UPDATE: So what does "whacked hard" really mean? It means hard. Details here.

The New York Times is tightening the noose:

There are enough back doors through the NYT paywall that this may not matter for a lot of people. But this move suggests that those back doors may start to disappear over time, just like the number of free articles is likely to decline. It looks like the Times is dead serious about making sure you pay them if you want to read their content.