Over at Free Exchange, we've got a presidential advisor scoop of our own.
Via Futurepundit comes a study backing up what I already knew . . . leaning back is more comfortable for your back then sitting up straight. In fact, sitting up straight is the worst thing you can do; even slouching forward is better.
I work prone whenever possible; the most comfortable work seat I've ever had is a curved chaise lounge bought on deep discount from Maurice Villency. (Not by me). I can work for ten hours and get up without a trace of stiffness.
| What American accent do you have? Your Result: The Northeast Judging by how you talk you are probably from north Jersey, New York City, Connecticut or Rhode Island. Chances are, if you are from New York City (and not those other places) people would probably be able to tell if they actually heard you speak. | |
| Philadelphia | |
| The Inland North | |
| The Midland | |
| Boston | |
| The South | |
| The West | |
| North Central | |
| What American accent do you have? Take More Quizzes | |
What are the secrets to really good coffee?
1) A gold filter or a coffee press, so you get the oils. Yes, your coffee will have an oil slick on top. That's where all the flavour (and much of the stuff that's good for you) is.
2) Filtered water. A lot of high end machines now come with filters; I don't bother with it. They're outrageously expensive to replace, and also, a pain in the [expletive deleted]. I use a regular Brita pitcher, which has the added benefit of giving me nice, cold water whenever I want; also great for pasta, tea, and so forth. I bought one of the high end Brita models because (I blush to admit it) it was cobalt blue; otherwise, I wouldn't bother. The digital counter to tell you when to change your filter strikes me as much ado about very, very little. Buy a cheap model and change your filter on the first of every odd numbered month. There! Wasn't that easy?
3) Fresh coffee. Anything that you found on your grocery store shelves has gone stale, no matter how well vacuum packed it is. Buy the beans and grind them yourself, or at the store . . . but do not buy more than two week's worth at a time, as it quickly starts to lose flavour. On no account put your coffee in the freezer, which destroys something or other that holds the flavour. (Thanks to reader HB Christ for educating me on this point).
Unfortunately, you cannot grind coffee in your food processor. I know it looks like you can, but you'll damage the motor. Trust me.
4) A decent machine, unless you press your coffee. Showerhead design works best. Most machines are fine provided you drink the coffee quickly; if you like to consume it over the course of hours, a thermal carafe or internal brewer works better.
5) Do not, on any account, buy one of those single pod brewers. The coffee has been sitting around in those little bags since god knows when; also, they almost always brew too weak for my taste.
As long time readers know, now is the time of year when I engage in an absolutely shameless attempt to encourage you to earn me money from my Amazon.com associates account, under the thin pretense of suggesting things you can buy your loved ones for Christmas. I am poor, and my student loan officer is hungry, and the people at the workhouse will only give me one serving of gruel a day. . . this brazen commercialization of The Birth of Our Lord is the only way that I can afford to buy myself the books with which I enrich my mind so that I can offer you keen insight and witty commentary on a quasi-daily basis.
If you're going to do your Christmas shopping on Amazon this year, just click the handy links provided by me or another of your favourite bloggers (mine's over there at the right, if you scroll down a little!), and at absolutely not cost to yourself, you can send a little commission our way. We get the commission even if you buy something other than the product we linked
However, even if you don't order through Amazon, all the stuff I'll suggest here is stuff that I genuinely love, so do consider purchasing for yourself or your loved ones at the local outlet mall or discount centre. And if you do buy something I recommend, please, please, please email me to let me know how it went over.
And if you don't like anything you see here, please feel free to peruse last year's selections, though there is some overlap. And if you want to browse all the items in once place, try my AStore.
No, I am not mad. The Kitchenaid mixer is worth every penny, which is why I keep telling you to buy one. It's not the nine fashion colours, or the sleek retro styling; I wouldn't urge you to spend $3 on such frivolities, much less $300. The reason you ought to buy a Kitchenaid mixer is that it has the power to turn you into the cook you never knew you could be. You can make acres of cookies, three layer cakes, or fresh homemade bread with practically no effort. Just throw the ingredients in and come back ten minutes later to find them perfectly mixed, no bowl scraping or supervision required. That's right, you--all thumbs, "never baked a thing in my life" you--can have fresh homemade bread with only the effort it takes to stuff the dough into a loaf pan. Just turn on the mixer and add the ingredients--the dough hook (which comes standard with every mixer) does all the mixing and kneading for you. Let it rise in the same bowl, then pull it out and put it in the oven when it's finished rising. Then there's the ice cream making attachment (better than an ice cream machine), the meat grinder, a grain mill for the vegans . . . and if you're actually a good cook already (or related to one), this mixer will carry you to previously undreamt of heights. Its' the one piece of kitchen equiptment I should refuse to do without, if I had to choose. I recommend the professional level, and the 6-quart, because I've never seen anyone sigh and say "I really wish my mixer were less powerful". If you're cooking for a small number, you might want to get the five quart pro, since some readers report difficulties with very small batches in the six quart. And if that's too pricey, even the cheaper models, such as the 4.5-quart Artisan model, are far superior to anything but industrial models; however, I don't recommend getting them just because you like a tilt-head. The reason the more powerful Kitchenaid mixers are bowl-lift is that the motor is very strong and heavy, which would be major drawbacks in a tilt-head . . . IMHO, taking off the paddle before you remove the bowl is a pretty small price to pay for mixer power. And the attachments fit every mixer, including ones made in the 1920s.
Cleanup looks hard, but is actually easy; everything goes in the dishwasher except the plates, and those you clean just by letting the stuff dry in the plate (perfect for those of us who tend to get vegetative after dinner) and poking it out with a fork or skewer. Super impressive for guests; if you hide the machine before they get there, you can pretend you've been slaving for hours. Not that I'm encouraging you to lie to your guests, or anything.
Plus, it holds a lot of coffee. And if you're like me, you need a lot of coffee.
Incidentally, when knife shopping, the temptation is to buy one of those big, cheap sets. This is all wrong. You really need only three knives: a chef's knife, a serrated knife, and a paring knife. It is better to get three good knives then ten bad ones that will lose their edge ten minutes after you get them home. That doesn't mean you have to get this knife; there are cheaper, very good knives out there. But don't waste money on the pretty, colour coordinated sets--unless you're trying to decorate the kitchen with knives you'll never use.
Where to buy You can buy on Amazon, obviously; it's convenient, and you'll get a good price. That's where I shop when I know exactly what I want, and will accept no substitute. Costco has a limited selection, but it's generally good stuff; you can get a decent set of entry level cookware, some very okay Henckels knives, and all the mixing bowls and tupperware you'll ever need. Silicone oven mitts are dirt cheap, as are sundries like corkscrews. The appliances are very good, though you don't get much choice. I also highly recommend checking out QVC from time to time; they often have great prices on select brands like Kitchenaid, and every day they have a loss leader called their "Today's Special Value" that is sold well below market price. Of course, your local outlet mall will probably be cheapest of all; who cares if your pan is "slightly irregular", so long as the irregularity is cosmetic? (They almost always are). I got my Calphalon One ten-inch skillet for $20 at a place in upstate New York, courtesy of a microscopic dent in the rim. The problem with all of these, of course, is that you get whatever they have, not exactly what you want. But if you're a woman, you've probably got more than a little of that gathering instinct in the blood. And if you're a man . . . try to think of kitchen gear as a sort of shinier, more portable woolly mammoth. Avoid Wal-Mart and Target; the former gets low prices by cutting out the better models, and the latter favours style over substance. Beyond that, it doesn't really matter where you shop; Kitchenaid, Cuisinart, Panasonic and so forth are excercising increasing price discipline over their categories, so if you're looking for the latest model, you're unlikely to see much difference in prices between, say, Macy's, Nordstrom's, and Bed, Bath & Beyond.
Okay, so I don't actually have a potato gun, an omission for which I plead the exigencies of a 450 square foot flat in a metro area rather too densely populated for spud cannons. But if I did have one, the authorities could have it when they pried it from my cold, dead hands. Stay strong, Dr. Helen.
Emily Oster, an economist, has written a widely quoted article on AIDS in Africa suggesting that it's the wrong disease to attck; instead we should be focusing on the other sexually transmitted diseases that facilitate its spread.
The story of heterosexual AIDS transmission in Africa--that it's a matter of promiscuity--has never made any sense to me. It's very, very, very hard for women to give AIDS to men in the United States; so hard that the number of men who get it from their female partners in studies is too low to derive statistically significant results. So low that they seem to have stopped studying it in America, funnelling research dollars to matters with higher health and political priorities. The "AIDS affects everyone" meme is a flat lie, at least in America; AIDS is a disease of sex workers, homosexual and bisexual men, intravenous drug users, and women who have sex with people in the above three categories.
On the other hand, if you have other uncontrolled sexually transmitted diseases . . . ones that don't require bodily fluids to come into contact with uninfected blood in order to spread . . . they can produce open sores that make AIDS transmission much easier. Ms Oster's prescription is to treat those diseases, rather than the AIDS:
So what do we learn from this? First, the fact that Africa is so heavily affected by HIV has very little to do with differences in sexual behavior and very much to do with differences in circumstances. Second, and perhaps more important, there is potential for significant reductions in HIV transmission in Africa through the treatment of other sexually transmitted diseases.Such an approach would cost around $3.50 per year per life saved. Treating AIDS itself costs around $300 per year. There are reasons to provide AIDS treatment in Africa, but cost-effectiveness is not one of them.
And as a bonus, you not only prevent AIDS; you cure another presumably extremely unpleasant disease. Two for one sale in the public health aisle!
We pay police to protect us. We do not pay people to sit in their homes. Thus, one would expect that we would expect rather better behaviour from the police we are paying, than the citizens they interact with. Yet as Radley Balko points out, even when the people are innocent of any crime prior to their interaction with the police, the expectation all runs the other way:
When people like Kathryn Johnston or Cory Maye understandably mistake raiding police officers for criminal intruders, police and prosecutors are rather unforgiving, particularly if the warrant was "legal." People like Maye and Johnston are supposed to show remarkable poise and judgment, despite the fact that armed men are breaking into their homes..When police make mistakes, however, they're nearly always forgiven. Because we're supposed to understand how an officer in such a volatile situation might misjudge an everyday object for a gun, or shoot a completely innocent, unarmed man -- all perfectly understandable, given the volatile, confrontational circumstances surrounding SWAT raids. Such deaths -- while tragic -- are mere collateral damage. We have to keep fighting the war on drugs. And we have to protect our police officers by allowing them to break down doors while people are sleeping. The deaths of a few innocent people are the price we pay for the privilege of having the government tell us what we are and aren't allowed to put into our bodies.
It's an abhorrent double standard.
For a libertarian, I'm pretty sympathetic to the police; I have no idea what I'd be like if my job routinely involved confronting people (often intoxicated) with a clear desire to hurt or kill me. But the idea that they would be held to a lower standard than the innocent folks they accidentally burst in on is lunatic. Hello, police state.
Incidentally, as far as I'm concerned, Radley Balko's work on Cory Maye is indisputably the best thing the blogosphere has ever done. That's citizen journalism. Emphasis on the "citizen".
Julian Sanchez meditates on emerging evidence that child-rearing explains most of the lag in women's success in high-level academic positions.
Obviously there is a difference, since the study is finding parenthood to be a disadvantage only for women. Whether and to what extent this is an unfair difference will depend on the reasons for the difference. For instance, if university departments were just assuming that women who have kids will be bearing the primary responsibility for childrearing, while men will not, and making tenure decisions accordingly, that would be pretty clearly unfair, even if it happens to be statistically true. I'm inclined to say the same—though here join Matt in resting the blame with "society" rather than the university—if women disproportionately "choose" to stay home because of intense social pressure, or because sexism has granted their partners access to more lucrative jobs, biasing the economics of division of household labor.But there are a range of other reason we can imagine where it's less clear. What if one factor is just the physical incapacity associated with being the one to bear the child (and recover from bearing it)? In cases where the woman is choosing to be the one to spend more time home taking care of the child, does it matter to what extent her desire to do so is a function of systematic biological differences in parent-child bonding, of early socialization and internalization of stereotypes, or of plain old personal idiosyncrasies? Obviously the "internalized stereotype" account points to an element of potential unfairness in the early socialization of boys and girls, but once the preferences are there, I'm not sure to what extent we should regard outcome differences flowing from them down the line as cases of additional unfairness. Or, more to the point, I don't know what the remedy could be, given that they are nevertheless now genuine preferences, beyond trying to change our educational policies for the next generation. (Raising the further thorny question what kinds of differences in socialization should be seen as inherently pernicious.) Least ambiguous seems to be the case where average levels of interest in hands-on childrearing just differ biologically across genders—here "fairness" doesn't seem to enter into it at all, unless we want to consider "maternal instincts" as a kind of unlucky genetic disability for which society should compensate people.
Being the contrarian that I am, I'm wondering . . . upper middle class professional woman that I am . . . whether we should even try to eradicate all the differences in the socialisation of girls and boys.
Some things I believe:
1. For most people, the most rewarding jobs have the highest degree of autonomy and cognitive content.
2. Those jobs cannot be successfully divided. A very smart expert working 80 hours a week will be more productive than two equally smart people working forty hours a week. Because their jobs involve facts and ideas linking up in new and unpredictable ways, the more time they spend accumulating facts and ideas, the better they will be at their jobs. And the higher the informational component of the jobs, the trickier the handoff between two people. Increasing worker autonomy increases coordination problems exponentially.
3. Whether or not you think they are overpaid, most people with these jobs are making a very valuable contribution to society.
4. Whether you assign it by gender or not, the "Mommy" role is a real thing, and it is not divisible. The gay couples I know with children have found themselves falling into traditional "Mommy" and "Daddy" roles, and not because they're uncommitted to overturning traditional gender norms. Becoming a parent means taking charge of another person's entire life, and this is a difficult job to split between two people: imagine having two personal assistants, with neither one in charge, running your life. The co-ordination costs are large for the parents, and made larger by the fact that highly standardized routine is the best way to inculcate good habits in a child. Splitting the labour between two people does not mean that each of them spends half as much time on childcare.
5. Professional organisations cannot produce the same level of output with a significant number of people working half time. Such arrangements are easily incorporated when they are a few exceptions, but when half the team is unavailable at any given time, the coordination problems mount rapidly. Anyone who's worked for both European and American firms can vouch for the fact that all that glorious European vacation makes everything take a lot longer in Europe than it does in America, because at any given time someone who has a critical piece of information, or decision-making ability, is missing.
This leads to the following conclusions:
1. Even for parents who outsource most of their childcare, having children will make at least one parent less valuable to their employer.
2. The idea of (in essence) splitting one high-powered job between a couple who then spends the other half of their time on childcare, as a substitute for having one high-powered career and one stay-home spouse, is probably not going to work.
3. Ceteris paribus, couples composed of two professionals will see at least one career suffer from the decision to have children.
Of course, you could outsource your childcare. But there's a weird tension between environmentalists and biological determinists here. If you believe that intelligence, and the other personal traits are highly heritable, then you can stick the kids in day care 14 hours a day. If you think environment matters, then probably you don't want your kids raised by the low-skilled workers who gravitate towards childcare. Yet people who are ideologically committed to the latter are more likely to use daycare, while those who believe the former are less likely to do so.
That's on an individual level, though. The real question is, how should we socialise our kids?
Postulating that we allow people to socialise their kids to do all sorts of weird things--eschew cheeseburgers, spend the first thirty years of their lives in school, join major political parties in the mistaken belief that this makes the world a better place--there's a decently high bar of social need that we have to clear before we can start telling people what they ought to tell their children.
Society has a number of vested interests here:
1) Future generations: if we don't have any, what are we striving to create a perfect society for?
2) Justice: a healthy society can't rest on the wholesale oppression of large swathes of society
3) Production: not merely of money, but also of knowledge, of culture, of solutions to the world's problems.
4) Happiness and meaning: society should aim to maximise these for its members.
Assuming there isn't any biological predisposition towards childrearing whatsoever, is the current mildly pro-childrearing socialisation we give girls a good or a bad thing?
I'm not sure. If childrearing is a) necessary and b) as tedious as everyone assures me, then it strikes me that whatever feminine thrill women get out of doing it probably increases the happiness associated with the activity. And, based only on my own previous relationship experience, I'd imagine that socialisation which reduces the number of areas that have to be negotiated probably, on net, makes marriages happier.
Moreover, while it almost certainly makes ambitious professional women less happy, there's probably a net increase of happiness for all the women who don't have to go to tedious jobs. Most jobs suck at least as badly as taking care of (your own) home and children. There are a lot more bookkeepers and factory workers in the world than there are economics correspondents for international newspapers. It seems to me that, among my friends who have chosen to stay home, the decision is highly correlated with how interesting their previous job was. All the former corporate lawyers I know are happily home; none of the journalists I know are.
Also, Daniel Gilbert has argued persuasively that we're actually happier when are choices are irrevocable, rather than negotiated; a woman who has stayed home because that's what women do may be (probably is) happier than one who is constantly deciding between staying home longer or returning to work.
And there are large network effects. Working women can force other women to work by using their salaries to bid up the cost of homes in good school districts; stay home moms are happier when there are more women around to socialise with; both groups would rather have schools and services geared to their schedules.
So it is entirely possible that society might be better off with pro-childcare socialisation for women.
But then a little voice whispers . . . I'm one of those happy professional women. What about me, dammit?!
Humiliation doesn't entertain me. I don't like any form of entertainment that uses gullible people as props. And the self-congratulation of much of the commentary I've read (those people need to be exposed for the bigots they are) hasn'texactly endeared it to me. Plus, like many of the critics, I suspect that in most cases, all Mr Baron Cohen is exposing is that there is a tension between politeness and responding to outrageously wrong sentiments. This would be interesting . . . if Mr Baron Cohen seemed to have any inkling that this is the source of his comedy.
It does make me wonder though: how bad would something have to be before I would challenge it? I have, on occasion taken stands against bigotry that were potentially dangerous to myself--telling my project manager, for example, that his racist remarks were wrong, and that I wouldn't stand for hearing them. (When I thought about what I'd done, afterwards, I required several stiff scotches. But the PM, a welshman, took it well, and was actually quite nice to me until he quit 9 months later). But I've also let things slide, particularly with old people, or people I was never planning to meet again, or people who were themselves members of a minority--from the things my black nationalist college roommate used to say about the Irish, I swear to God she could have authored those cartoons you see from the 1950's. She once, upon observing me drinking a beer, said "Should you be drinking that?"
(I was, to be fair, not 21 . . . but I was in a private room, I was not drunk, and the owner of the beer had purchased it legally.) I stared at her in disbelief, whereupon she said, "I thought all Irish people were alchoholics."
I let a lot of misogyny slide, because, hey, it's not worth it, I won't change any minds, and besides, I'm frankly too arrogant to feel like it affects me.
At some point, like "I think we should herd all the Jews into camps and then kill them", you have to speak up. But what about the fellow who makes disparaging, abut only mildly culture-specific, remarks about people you know? What about the people who are not members of an ethnic group, but refer, in a not particularly opprobrious way, to cultural traits that are, on average, true? How about the guy who says he can't stand his Mexican neighbours because they play their music until all hours? Where do you get the courage to correct someone? Should Cohen's victims have been rude and expressed horror that had no chance of affecting his beliefs? Am I a wimp, or a person with manners?
So it looks like I'm going to be rotating through our Washington office this winter, which is exciting . . . DC will be only the fifth city I've ever lived in . . . but raises a new difficulty: I don't have a car. Nor do I wish to acquire one for the long term, since I'll be moving back to New York sometime in the spring. This raises a problem, since even short-term lease assumptions are longer than I want to have a car for.
I'm therefore looking for someone who:
a) wants to rent, for the short term, their car to someone who drives like a grandmother and has never been in an accident. Seriously. Ask anyone who's ever driven with me; they will tell you long tales of my maddening caution
or
b) (more likely) sell me a piece of crap that will run for six months. I don't care what it looks like as long as it is reliable, gets more than four miles a gallon, and fits my legs. It has to cost less than $3500, that being the cost of a long term rental from Avis. If you know someone with a very short term lease that ythey would like me to make the payments on, that is another option. I'm planning to commute via metro; the car is only for social outings, shopping, and occasionally returning to New York.
If anyone has a line on such a vehicle, please let me know.
Update I'm moving in with my sister, who lives in the burbs 10 miles from the nearest metro stop; while car sharing is a lovely notion, it won't work for me. I have to be able to get to and from shopping, the train, etc.
Ezra Klein's obit of Milton Friedman makes a major classification error:
One thing to note on the death of Milton Friedman: It means that, in the same year, both he and John Kenneth Galbraith have died. They were -- easily -- the two most influential, publicly-accessible, politically-oriented economists of the 20th century. Who takes their place?
Galbraith was a very, very good writer, but he was not a very good economist. His economic history is entertaining, but it is not theoretically sound, and his major theories, captured in The New Industrial State, were almost comically wrong. The book was being proven incorrect by history virtually as he wrote it. His tirades against advertising, much beloved by current critics of consumer culture, were backed by no research or empirical data, and still aren't. I love his books, and highly recommend them, but he was not a major economist.
Milton Friedman, on the other hand, was as successful inside the academy as outside it. His Monetary History of the United States, and associated work, revolutionised monetary policy, removing it from the clutches of the Keynesians. You can thank Milton Friedman for the fact that our central banks no longer hand us double-digit inflation in a fruitless quest for permanently higher output levels. While his work has since been refined, and his push for quantity targeting has largely been abandonned, he remains central to modern monetary policy. His permanent income hypothesis has made similar contributions to consumption theory. His students have also expanded the boundaries of human knowlege in significant ways, particularly Gary Becker, another Nobel-prize winner.
Unlike other popularisers, such as Paul Krugman, whose best popular work (such as Pop Internationalism) focused on his own field, what Mr Friedman is known for within the academy is completely different from what has made him famous outside it, which is possibly why liberals tend to classify him with Mr Galbraith. Mr Friedman has done more than possibly any other economist to advance the cause of free markets. But that is not his only contribution; perhaps it is not even his largest. Anyone who would compare the Nobel prize-winner to JKG as an economist can only have a gaping hole in their economic education.
. . . merely taking a photograph of yourself with a gun-or even something that just looks like a gun-makes you a potential mass murderer.
Apparently, the correct attitude towards students who allow such pictures to be taken is to report them to the police and their principal.
Is it just me, or has the counseling culture gotten completely out of control?
Democrats, however, claim labour market gains under Mr Clinton were largely the result of sound economic policies, including the elimination of the budget deficit, which encouraged business to hire.
The desire to attribute all wonderful things to Bill Clinton, combined with the fact that Mr Clinton just didn't do very much, economically speaking, during his time in office, is leading Democrats to make ever more bizarre claims for the benefits of closing the budget deficit. I've discussed Bob Rubin's more extravagent claims elsewhere, but here I will just point out how odd it feels to watch Democrats, who tend to be sceptical of efficient markets theory, talking about social security. Suddenly, the bonds we have issued to the SSA are a perfect proxy for the accruing unfunded liability, because bond markets are so efficient that traders are perfectly factoring in the risk of defaulting on retirees and/or bondholders 30 or 40 years hence. Even I, scion of the Chicago GSB, don't believe that. And now we have some unnamed Democrats alleging that business owners were holding back on hiring new employees, not because they didn't think they could profitably employ them. but because they were waiting for the government to raise their taxes in order to close the budget deficit.
I presume that there was at least some argument behind this marginally less stupid than "Business owners are, for some unexplained reason, prone to worry about government interest payments ten or twenty years hence", which was undoubtedly chopped for space. Still, I did spend a few minutes in silent wonder.
Now that the Democrats have won, talk has turned to how we can get a single payer system on the agenda. And critics inevitably say "I don't want a system like England or Canada's", to which the advocates reply "Neither do I--I want a system like [insert favourite country here]", except without the bad stuff, of course.
What I don't hear a lot of people addressing is what sort of system it is feasible for us to get, given the interest groups and institutions we already have. There are some serious constraints that I think would have to be considered by anyone trying to design a national health care package:
1) It cannot provide less, or less rapid, coverage than the typical American policy does now. Over three quarters of Americans are happy as clams with their health care now; to the extent that they support national health care, it is because they fear losing what they have. Nationalisers, therefore, cannot sell a programme by guaranteeing them that they will lose some of what they have now. Horror stories aside, most Americans, despite their copays, have much more lavish coverage than that available elsewhere, with unfettered access to their doctors, semiprivate hospital rooms, expensive machines around every corner, and so forth. In what other country would my eighty-eight year old grandmother have had her hip replaced two weeks after the doctor decided it was time? That two weeks being the period needed for my mother to arrange her schedule so she could take care of Mom. That is the baseline of care, not whatever is currently on offer in France, no matter how fond the French may be of their system. Countries with national systems set them up a long time ago, when the median voter had no insurance at all, so whatever crap the government gave you was an improvement.
2) It cannot substantially lower the wages of medical workers. They all have powerful lobbies, and they vote on their interests. Doctors in Britain may be thrilled to make 60K a year in return for the shot at someday, if they're very lucky, exiting the system for a private hospital. You will not get American physicians to take the same deal; they've already got hefty mortgages and kids in private school. Between the right of exit and the lobbying power of the unions, it will be some time before we can even eat into doctor's pay with inflation; I would expect the pay of lower level medical employees to rise (New York's experience is instructive here).
3) It cannot ration end-of-life care. The AARP is the most powerful lobby in America. Anyone who thinks that a nationalised system will ration all those dollars poured down the drain in the last few months of life is engaging in fantasy--a particularly ludicrous and risible fantasy because we already have nationalised health care for end-of-life care RIGHT NOW and we're spending like eighty shrillion dollars on it.
4) It will not cover immigrants, at least not until they are citizens. That means at least 12 million people will remain uninsured. It also means that emergency room usage will remain high, since that is where illegal immigrants tend to get their health care. Not that this really matters. It doesn't seem to me that emergency room care for routine ailments is actually more expensive to provide than clinical care; it's just that hospitals price it to cover the cost of dead, uninsured trauma patients and so forth. I don't see how a triage nurse, a doctor, and a waiting room are more expensive to provide because they're on the first floor than they would be on the fifth. But perhaps I'm missing something there.
Your thoughts?
Mark Kleiman asks a question:
Since the Veterans Administration, since its reform under Bill Clinton, now has the best medical-records system going and produces high-quality health care at a reasonable cost, could we move a baby step toward national health insurance by allowing non-veterans to buy into the VA system at a price equal to whatever the VA figures is its marginal cost? The initial, emotional reaction from veterans' groups might be opposition, but surely having a bigger client base would strengthen the VA system politically, against the moment — coming soon — when we're no longer at war and when, accordingly, treating veterans well starts to lose political saliency saliency.
I can see several problems with the idea. The first is that I don't think the VA system is very scalable. My impression is that the VA system is deepy tied into the university hospital system; academic doctors who, for one reason or another, value a steady paycheck and/or the opportunity to do research over the financial rewards of private practice, often do double duty as VA doctors. This keeps the quality rather higher than it ordinarily would be at VA wages. Separate them from the teaching hospitals, and the quality of care might look at lot more like your average Medicaid clinic than the system that Paul Krugman is raving about; and I don't know how many more teaching hospitals could have a VA facility slapped on top of them, or how many more doctors would be willing to practice under those conditions.
VA hospitals are also able to manage demand to meet their supply through playing with eligibility standards. In effect, my impression is that they do not have enough supply to serve their entire target population (all veterans), so they are able to keep their facilities operating at or near full capacity all the time. This helps keep average cost low. However, it also means that there isn't much slack in the system; so the marginal cost of serving extra patients will be very high, requiring new facilities be built and new staff hired. The new staff, particularly the doctors, may be higher cost or lower quality than the old staff. Nor do I think that, politically, it would be possible to turn down someone with a 30% service-related disability for care while selling care to a lifelong smoker with lung cancer; in order to expand the VA at all, you would first have to open eligibility so that all veterans were served by the system. This would be very expensive.
Also, people who are paying for their care, unlike the veterans who get deeply discounted treatment, are substantially likely to excercise their right of exit; if they get a job that offers good insurance, they'll probably drop out of the system. This means that the much vaunted preventative care savings that the VA hospitals are supposed to realise would suffer in the same way that preventative care allegedly suffers in the private system: the VA will realise substantially fewer savings from good preventative care, making it much more expensive to offer. Its electronic records system also probably wouldn't work so well, since it wouldn't get to start collecting data at 18 or 20.
But there's one criticism made by his commenters that doesn't seem very apt: adverse selection. After all, if the VA is really so much better at taking care of sick people than the rest of private industry, and if the VA really is pricing at marginal cost, then they should be able to attract a very desireable pool. It's only if the savings are fairly trivial that adverse selection becomes a problem--and if the savings are trivial, then it is more likely that the VA is a statistical anomaly than a breakthrough model.
I think the most compelling question about nationalising the VA system is probably scale: lots of things work well in smaller populations that do not gross up well to the national level, like town meetings and search parties. The VA seems to be enjoying some complementary benefits to location and government plant that cannot be replicated cheaply, or at all, nationwide. The American Legion is a powerful pressure group that checks the power of the bureaucracy; it's hard to imagine a nationwide group that could do the same thing, except possibly the AARP, and we all know what getting the AARP involved in entitlements does to cost control. And the right of exit currently functions as a substantial safety valve to the VA; if private hospitals stick around, it will undercut support for the system, and if they don't, the American middle class will mutiny at rationing, which will cause costs to further explode.
A lot of libertarians, including me, got what we wanted this morning: a Democratic Congress.
I've got a baaaaaaad feeling that we're going to be suffering buyer's remorse by spring . . .
Update: Already starting . . . .
What is the deal with the congresswoman helmet-head hair? Do they all get their do's done by the same woman who styled Margaret Thatcher? Just askin'.
Full disclosure: For family reasons, I have a strong incentive to want a Democratic senate. Plus, I voted for them. But I also voted for Al Gore, and I wanted him to concede, so take this for what it's worth:
The country doesn't need another damn recount. It is vanishingly unlikely that Mr Allen is going to pick up thousands of votes. Meanwhile, the sniping and lawsuits will add to the general air of political ill will that currently grips the country.
Republicans who complained about Al Gore's refusal to concede the election now have an opportunity to put their money where their mouth is. Yes, I know you wanted control of the Senate. I myself am disappointed in what is probably going to happen to the Supreme Court, though obviously not sufficiently disappointed to vote Spencer. But given how slim the chances are of picking up enough votes to matter, now is a good time to be big. Pressure Allen to concede. Show America that your party cares enough about the country not to put it through a gruelling and pointless legal battle. The comparison to Gore's 2000 campaign will serve you well in 2008.
And, as a plus, that means that in a few years, you get to offer a candidate in Virginia who doesn't put safe seats in play (in his own state and others) with his relentless foot-in-mouthery.
The saddest commentary on this election is how uncompetitive many of the races were. I'm not just talking about things like that Berkely district where the Republican got 6% of the vote. I'm talking about New York, where until I actually looked at their names on the ballot, I couldn't remember who was running against Hilary Clinton and Eliot Spitzer. And the reason that I couldn't remember the name of Hilary's opponent is that I had never heard it.
I felt bad about myself, momentarily, for being uninformed. Then I remembered what a colossal waste of time it would have been to memorize the name and campaign platform of a man doomed to obscurity and failure before he ever got the nomination. It is kinder, really, to forget any of this ever happened. And how better to forget than never to have remembered in the first place?
It does remind you, though, how much fame matters in our elections. Even before Jeanine Pirro's ethics problems surfaced, she had a herculean task running against Andrew Cuomo, whose father everyone remembers as governor. I often wonder how much those millionaire candidates actually get out of their spending--as opposed to the media coverage that puts their name in every household.
Of course, Republicans may take comfort in thinking that voters like fame more than, say, higher minimum wages.
Didja miss me??? Didja? Because I missed you.
So now, the great unveiling: why have I been neglecting you? Am I giving up blogging? (Or at least cutting back?)
Hell no. Cutting back may be fine for some people, but blogging is like cigarettes for me; it's whole hog or cold turkey. And I'm not quitting.
In fact, the reason I've been neglecting you is that I've been feeding my habit in another venue: The Economist's new economics blog. After 160+ years of superlative print journalism, we're bringing our mad skillz onto the web. I'll be spending a significant portion of my work time blogging there, which means more scintillating economic bloggery for you--plus all my super-smart, witty, and oh-so-very-British colleagues.
Meanwhile, I'll still be blogging all my non economic stuff here, so don't abandon me . . . think of me as having a split personality. In which you'd be ever so right. In fact, come back later for my exciting tale of being robbed for the first time in 33 years of urban living.
Also, while you're checking out snazzy new blogs from The Economist, we've also got a new American politics blog for the election, called Democracy in America.
And because we bloggers are all about feedback, please let me know what you think of the new blogs here.
I watch BBC America in the morning,because unlike American news, it acts like the world is actually, you know, round. This morning, however, I got an amusing shock during a segment on American evangelicals, in which the reporter asked some Republican something-or-other: "Can you be elected to higher office in America without being a Christian?"
I sure hope Senator Lieberman wasn't watching.