Thursday, May 30, 2013

Who Among Us Would Not Say The Same

Cross-posted from my outdoors and trail-running blog.

An interesting short piece at Reason about Gary Johnson:
One of the worst things you can say about Johnson is that he's a little too honest sometimes. Another is that he always seemed to want to be doing something other than campaigning. On Jan. 29, 2012, for instance, Johnson, Newt Gingrich, and Mitt Romney were all working crowds in Florida. On Jan. 28, Gingrich and Romney were working crowds in Florida, and Johnson was hiking in Taos, New Mexico. Can't say as I blame him, but the act of running for president does require a delusional belief in one's own significance that Johnson doesn't seem to hold.

...he does [say] that reaching election day last year "was kind of like being let out of prison."
It's sobering to think that Teddy Roosevelt was able to go camping in Yosemite with John Muir, while he was in office - but if someone is that much of a normal, whole human being today, their chances of getting elected are probably close to zero.

Tuesday, May 28, 2013

Emperors and Constitutions: Illusions of Continuity?

A quirk of Japanese history is the survival of the Emperor, for over two thousand years. This, despite multiple violently-ascendant governments in that interval, most of which relegated the Emperor to a figurehead who spent his days in a pleasant court in Kyoto writing poetry while the military rulers ran the country. This seems strange to just about everybody outside of Japan. If you take over a country, the first thing you do is stamp out all vestiges of the old order, right? Especially the figureheads of the old authority!

There may have been a method to their madness. Once the institution of the Emperor had survived one or two of these changes of the guard, keeping the Emperor around - with no power or ability to muster forces of his own - might make sense. It gives a false sense of stability by presenting a continuous succession of figureheads, giving the new government immediate legitimacy.

A cynical view of the longevity of the United States Constitution might stir similar thoughts. The democracies of the world frequently throw out their previous constitutions and write new ones even without violence, often multiple times per century. In fact, imagine for a moment that there is a European country that has kept the same document, unchanged, since the eighteenth century. Certainly this would seem curious; and the government in question, dishonest about how they're executing this ancient parchment, or (more charitably) maybe they're just a rural backwater where nothing much has changed. Certainly this latter situation does not obtain in the U.S. It might be the case then that the true function of the Supreme Court is to interpret challenges to the U.S. Constitution in whatever ways create the fewest ripples with respect to modern sensibilities. Activist judges or not, it would seem that "living documents" guarantee a certain amount of non-elected legislating.

A related question would be the relationship of currency stability (say, month-to-month fluctuations) over time relative to constitutional turnover. Do countries that explode their parliaments or set up new governments have less predictable currency values over time?

Sunday, May 19, 2013

Why You Should Avoid News

Great piece, available here. One of the points is that it makes us passive, a conclusion which this argument also converges upon. "News" here is not just the constant novelty, which is a source of many of the problems, but the way that what we call news is assembled, the motivations of the distributors, and the reinforcement of our own biases with this form of information. My favorite non-obvious point is that new "sunders the relationship between reputation and achievement".

Thursday, May 9, 2013

Chargemasters and Used Cars

Recently there's been a lot of discussion about the use of chargemasters in hospitals. It's an often baseless fiction used for bargaining, and the growth in healthcare costs has been attributed to it. This bothers people, not without reason.

Other industries use price shrouding, but this is something altogether different. The situation is most similar to car salesmanship. Opaque pricing, line items that no one can explain, made-up additional charges, and initial prices that everyone knows are not the final prices. This results in consumers generally not being happy at the end of the car-buying process, and a poor reputation for car salespeople. Why is this? Is it just totally path-dependent cultural inertia that has made the pricing in these industries so bizarre and (some would say) unethical? Or is there something inherent to each that encourages it? There are similarities and differences.

In both, people are making large infrequent purchases. They're spending a lot of money without experience in this specific domain. Furthermore they may not know what they should be paying in the first place; this problem is worse for healthcare consumers. When you buy a car you can get some idea what this Toyota model is going for in this area by doing research online, although the salesman hopes you haven't, and you'll have some ballpark idea even without that research - whereas in the hospital, you certainly have no idea what a paracentesis should cost in your city. What probably makes things worse is that most hospital admissions are not planned. If you're in the hospital, it probably wasn't on your calendar ahead of time (unless you were getting an elective surgery, but that's still a small minority of patients.)

Another problem comes from a collision of values, between trade and the value of human life. We see this every time trade - a dispassionate, utility-calculating way of thinking - collides with a highly limbic behavior, involving immediate pleasure or pain, family, tribal identity, or human life. You can see this best illustrated by the goods and services that are most likely across polities to be banned on moral grounds, or those which are socialized. Healthcare is one of those. (If this collision is still not clear: can I pay you $20 to hop on one foot for 1 minute? Sure, I would take that deal. Okay, now what's the price to sell your child? Disgusting and we shouldn't even be discussing it, right? There's the collision.) To begin with, even when they have time, people don't look up hospital quality ahead of time (let alone cost) as with other businesses - we spend more time on ratings sites for restaurants. For one thing, if your kid needs an operation, do you ask yourself "Is the extra $12,000 at the slightly more highly rated hospital across town really worth it?" If you do, you might feel guilty - anyone who has ever negotiated wedding or funeral costs has had a similar experience. But the other side of the coin is that healthcare providers are not trained as profit maximizers, but as life maximizers and pain minimizers. The ED physicians and nurses have no idea what's on that chargemaster, and they don't care. The system would be a lot worse if this were not the case - that is, if hospital physicians were compensated like car salesmen - because they could take much more horrible advantage of patients if they were incentivized. That said, there should be no surprise that healthcare costs go up, because the service providers are ignorant of the cost and there's no feedback loop.

Thursday, May 2, 2013

Business Using Government to Stifle Competition

A smartphone app in New York that would let people find and hail cabs is being profoundly retarded by the city. No doubt such an app would be of great benefit to people hailing cabs and to individual cab drivers, but a disaster for cab companies (and dispatchers). Is there anything more to this story than cab companies protecting their interest at the expense of citizens, and the the city eagerly using regulation to do this for them?

The established businesses are very good at having to avoid defending their behavior; no matter what they say their motivation is, it's pretty obvious that they're acting exactly the same as they would be acting if they were just defending their interests at all costs. The state liquor control board in Pennsylvania has been doing much the same thing.

Regulation is often the friend of big business.