Paying an Arm and a Leg

So many charts, so little blog. Which chart should I show you from yesterday's release of the latest global comparison of healthcare prices? How about the cost of hip replacements? Here it is:

The "average" number is a little hard to see, so here it is: $34,454. That's 2x what it costs in Germany, 3x what it costs in France, and 6x what it costs in Switzerland. WTF?

This goes a long way toward explaining why hip replacements are so popular in the United States: they're a huge profit center for doctors and hospitals. Keep this in mind the next time someone starts going on about how you never have to wait in line for a hip replacement in America. It's not because our healthcare system is super efficient, it's because doctors are super eager to perform them.

The full set of cost charts is here, and they're pretty instructive. You can, if you want, try to make the case that we perform better hip replacements or do better angioplasties than other countries. But appendectomies? CT scans? Normal deliveries? As Aaron Carroll says about the astonishing numbers for routine CT scans and MRIs:

Why does it cost so much more in the US? Does the radiation work better here? Are the scanners different? If you’re wondering, the CT scanner was invented in the UK, so it’s not like there’s some reason to believe our machines are better....Let’s be clear. I have no problem with things costing more when they are demonstrably better. Or, if you’re getting more of them for your money. But a scan is a scan is a scan. There had better be a good reason for it costing more here, and I can’t think of a good one.

This is one of the reasons healthcare costs so much in America. We aren't getting more for our money, we're just paying a lot more for the same stuff as everyone else.

POSTSCRIPT: One caveat: the report doesn't mention how they convert foreign prices into dollars, and it probably makes a difference whether they apply purchasing power parity adjustments. Not a huge difference, but it's possible that different methodologies would produce modestly different results.

Obama in 2012, Revisited

On Sunday I noted that Ray Fair had released a projection of Obama's odds of winning reelection in 2012. His conclusion: Obama should win in a landslide. However, this depends not just on Fair's model being accurate, but on his rosy forecast of economic recovery being accurate too. Brendan Nyhan isn't quite so optimistic:

The Philadelphia Fed survey of professional forecasters revised its forecast of 2012 growth downward last week from 3.6% to 2.9% (somewhat lower than the Blue Chip 3.2% figure or CBO's 3.4%). If we plug that value into Alan Abramowitz's simple linear fit of second-quarter GDP in election years and presidential election performance, we find Obama right around where President Bush was in 2004.

The regression on the right is not the entire Abramowitz model and doesn't take into account the advantage of being an incumbent running for reelection. That's dealt with in his full model and adds a couple of points to the forecast for a four-year incumbent. For that reason, this chart almost certainly underestimates Obama's odds of winning in 2012. However, as Brendan points out, there's also a lot of uncertainty around that growth forecast of 2.9%. If the economy ends up at the low end of projections in early 2012, Obama will be in a precarious position. Still likely to win, I think, unless we slip back into a full-blown recession, but it might be a close run thing.

Taxing the Rich

Jim Puzzanghera of the LA Times writes today about whether small businesses are likely to reduce hiring if tax rates are raised on people making more than $250,000 a year. As he points out, big companies normally pay taxes at the corporate level:

But companies can also file as S corporations or partnerships. The business income flows to the owners or partners and is reported on their individual returns, so profits are taxed only once.

....[Rick] Poore, whose DesignWear Inc. takes in about $2.25 million a year [...] supports the expiration of the top-level tax cuts, pointing out that the costs of employees and equipment, such as a new automatic garment press he is purchasing, reduce his taxable income...."That's how small business works. We reinvest in our businesses. We try to minimize the amount of taxable income we have," he said.

Some small-business groups, such as the Main Street Alliance, a national network of state-based small-business coalitions, also support letting the top-level tax cuts expire. "Its disingenuous for people to say this is going to have such a horrible affect on small business if they let these expire," Poore said. "Either they're honestly ignorant of how this really works or they're being intellectually dishonest."

There are unquestionably small businesses who would be affected by the tax increase. But aside from the fact that only a tiny number of small businesses would have to pay the higher rates — perhaps 1-2% — it's important to understand how this works. As Poore says, in an S corporation, business income is passed through to the owner. So a tax increase doesn't affect the revenue of the business at all, and doesn't affect its incentives to invest in equipment or additional workers. What it does affect is the amount of income passed through. In other words, it modestly affects personal income, just as you'd expect.

If you think that would be a disastrous thing, fine. I disagree. But it has a very limited impact on the incentive of the business qua business to expand its operations. Those incentives are driven almost entirely by whether there's likely to be higher demand for their products in the future. Right now, financial uncertainty is high, and that's why business expansion is low. It has very little to do with new healthcare regulations or higher personal tax rates.

No Mandate for Republicans

You could hardly expect me not to post about this, could you?

A majority of Americans want the Congress to keep the new health care law or actually expand it, despite Republican claims that they have a mandate from the people to kill it, according to a new McClatchy-Marist poll.

....The results signal a more complicated and challenging political landscape for Republicans in Congress than their sweeping midterm wins suggested. Party leaders call the election a mandate, and vow votes to repeal the health care law and to block an extension of middle-class tax cuts unless tax cuts for the wealthy also are extended.

"The political give and take is very different than public opinion," said Lee M. Miringoff, the director of the Marist Institute for Public Opinion at Marist College in Poughkeepsie, N.Y., which conducted the poll. "On health care, there is a wide gap between public opinion and the political community."

Unsurprisingly, the poll finds that most provisions of the healthcare reform bill are quite popular. The main exception is the individual mandate, but as we've discussed a million times, you can't keep all the popular stuff unless you have the mandate too.

In less good news, the public is evenly split on repealing Don't Ask Don't Tell. I've seen plenty of other polls showing broad support, so this might be an outlier. Alternatively, it might be that support for repeal drops once it become an immediate issue getting a lot of attention. We'll see.

Quote of the Day: Persian Hospitality

From Keith Humphreys, quoting a friend on Persian cultural norms of hospitality:

Iran is a place where if you walk up to a street demonstrator who is holding up a sign reading “death to the west” and ask for directions to a particular restaurant, you may well get the response “Oh, that place isn’t very good. And anyway, I want you to meet my family and have a proper Iranian dinner. I’ll be done here in a sec, as soon as the cameras leave — do you mind if we walk, it’s only a few blocks, but I can get us a ride, if you are tired.... 

This introduces a post that questions whether high levels of personal hospitality are in fundamental conflict with high levels of customer service in the commercial sector. He thinks they probably are.

My TSA Anti-Rant

I am so going to regret writing this post. For those of you who used to respect me, please just chalk it up to food poisoning or early onset Alzheimer's or whatever. But here goes.

I hate the TSA screening process. Everyone hates the TSA screening process. You'd be crazy not to. It's intrusive, annoying, and time-wasting. It treats us all like common criminals even though most of us are just ordinary schlubs trying to get on a plane and go somewhere.

But guess what? The fact that you personally are annoyed — you! an educated white-collar professional! — doesn't mean that the process is idiotic. I've heard it called "security theater" so many times I'd be rich if I had a nickel for each time it popped up in my browser, but although the anti-TSA rants are often cathartic and amusing, they've never made much sense to me. All the crap that TSA goes through actually seems pretty clearly directed at improving the security of air travel. So here we go, a brief Q&A session about TSA procedures:

Q: Why do we have to take our shoes off?
A: To prevent terrorists from packing explosives into their shoes and bringing down an airplane.

Q: Why do we have to go through those new body scanners?
A: To prevent terrorists from packing explosives around their bodies and bringing down an airplane.

Q: Why the 3-ounce limit on liquids?
A: To prevent terrorists from bringing liquid explosive precursors through the gate, mixing them together in the onboard lav, and bringing down an airplane.

Q: Nobody's ever brought down an airplane this way. Why worry about it?
A: Nobody thought a bank could bring down the entire global economy before 2008, but guess what? Banks kept trying and eventually they figured out how to do it. Ditto for terrorists, who learn from their mistakes. Maybe next time they'll try a slightly bigger shoe. Or a better explosive. Or a more efficient trigger. And then the plane comes down. Do you really want to risk your life on the proposition that terrorists will never figure out how to make this stuff work even if we give them enough chances?

Q: But other countries don't do all this stuff.
A: That's because Islamic terrorists mostly target American planes. It's fine for Switzerland to be a little less cautious, not so fine for us.

Q: The Israelis don't do all this stuff either. Why not adopt their methods?
A: Because even experts don't think we could scale up the Israeli system for use in the United States. What's more, the Israeli system is only convenient for Israeli Jews. It's a huge pain in the ass for everyone else.

Q: Shouldn't we focus more on intelligence and less on physical security?
A: Sure. But I'd guess that our intelligence just isn't good enough to rely on it exclusively.

I'm not trying to defend everything TSA has put in place. Some of the stuff they do, like the penknife and nail clipper bans, really is stupid. And maybe backscatter scanners don't work. I'm certainly open to the idea. But honestly, most of what they do is pretty easy to understand: they're trying to make it so hard to get weapons and explosives on board airplanes that no one bothers trying — and the few who do can't pack a big enough punch to do any damage. For the most part, it seems to be working. The price we pay for this is plenty of annoyance, but again: do you really want to get rid of the annoyance and bet your life that terrorists will never figure out how to make a better shoe/underwear/liquid bomb? I'm not so sure I do.

And now for a political note: this is GOP catnip. For seven years, Republicans insisted that every security procedure ever conceived was absolutely essential to keeping the American public safe, and anyone who disagreed was practically rooting for an al-Qaeda victory. Now a Democrat is in office and suddenly they're outraged over some new scanners. Helluva coincidence, no? But this is no surprise: this issue works for them on every possible level. In the short term, it gives them something to pound Obama about. In the medium term, it gets the chattering classes chattering about something other than the fact that Republicans have no remotely plausible plan for improving the economy. And in the long term, if a plane does come down, they will absolutely crucify the Obama administration for its abysmal and cavalier approach to national security. (Remember the dry run that Drudge and Fox News conducted over the underwear bomber?) And if you think we can fight back by reminding them that security was reduced because of their outcry, you are sadly delusional. That argument won't get two seconds of air time.

But what about our civil liberties? Maybe you think that even if TSA's procedures are slightly useful, they aren't useful enough to justify all the intrusion. Instead, we should just accept the risk of an occasional plane falling out of the sky. Think again: if a plane comes down, you can just kiss your civil liberties goodbye. Today's TSA procedures will seem positively genial compared to what takes their place with the full and eager support of the American public. Given that reality, if you're really worried about civil liberties you should welcome nearly anything legal that protects air travel from explosives, even the things that are really annoying and only modestly useful.

So that's that. I know that pretty much everyone in the universe disagrees with me about this. And obviously I'm not averse to pruning away some of TSA's dumber policies, making the security lines quicker and more efficient, and trying to get better at the largely invisible policing stuff that everyone agrees is essential. At the same time, while TSA's security procedures might have plenty of problems, they really do seem quite sensibly oriented toward the quite sensible goal of keeping explosives off of airplanes. I'm really not sure why everyone thinks this is nothing more than security theater.

Obama in 2012

Josh Marshall on Obama's chances in 2012:

People simply don't appreciate how seldom elected presidents get denied reelection. By my count, it's only happened three times in the last century. Carter, the first President Bush and Herbert Hoover. (If you come up with someone I'm missing I'll be terribly embarrassed. But please let me know.)

Actually, Josh is understating things. In general, Americans don't turf out parties from the White House in less than eight years. Hoover and Bush Sr. were both voted out after their party had held the presidency for 12 years.

The only exception to this rule in the past century is Jimmy Carter. There have been a couple of other close calls (Wilson in 1916, Bush Jr. in 2004), but that's it. 1980 is the only year in which a party got thrown out of the White House after only four years.

If the economy is in decent shape, Obama will win reelection. If it sucks, he's vulnerable. That's pretty much the shape of things.


I've lost two blog posts today. The first one was because I did something stupid. The second was because MoJo's blog software ate it. I'm tired of this.

So this is a plea for help. Can anyone recommend a good, simple Windows key logger? I don't need anything fancy, and I don't need to monitor other people's computers. Just my own. All I want is something that logs keystrokes to a file so that if I do something dumb, or the power goes out, or Drupal goes crazy, all I have to do is retrieve what I wrote from the log file and reconstruct it.

Any recommendations?

UPDATE: OK, I guess we can skip this. I'm already aware that writing in a different window would solve most of my problems with lost posts. For various reasons I prefer not to do this, but obviously it's an option.

Tab Mania

Dave Roberts tweets:

My great accomplishment yesterday was reducing the number of open tabs in my browser from 168 to 92.

I've read a lot of tab complaints like this over the years, but I've never quite understood them. Once you open up more than 20 or 30 tabs, there's not enough screen space to identify them even with a tiny icon (see below). So they're completely blank. Do people keep opening up tabs anyway, even though they're just tiny slivers that are totally unidentifiable? Or do they use add-ins of some kind that allow you to open lots of tabs but still retain some kind of minimal ID?

Just curious. Somehow I always feel like I'm missing something obvious when I read someone blogging or tweeting about this.

Living in Matt Drudge's World

Ben Smith on the TSA backlash:

There's no doubt about who won on this issue: Matt Drudge chose it and drove it, illustrating both his continued power and his great sense of the public mood, and it now seems a matter of time until he gets results. But the moment is also, a smart Democrat notes, representative of how this administration (and to be fair, everyone in public life) continues to wrestle with "populism as narrated by the Drudge Report." There are some echoes of the Shirley Sherrod mess in the panicked, mixed reactions.

I know I'm totally off the reservation on this, which is a little weird since I'm usually a bit of a privacy crank. But I think liberals have been badly rolled on this. We're usually better about letting ourselves get sucked into the Drudge vortex.