Tuesday, March 14, 2017

There Can Be Only One (Healthcare edition)

The nation appears to have reached a consensus that healthcare should be affordable and portable.  Our pols are now left with the impossible task of putting this square peg into the circular hole called "insurance."

Insurance is not a label; it's a concept.  Insurance covers risks that have not matured.  But we want to provide coverage for risks of illnesses that have already been contracted when the insurance policy is issued.  Unfortunately, the existence of the condition removes the risk that it will arise later, leaving only the risk that treatment will cost an unknown amount.  That risk can be insured, but the risk that the illness will occur cannot, because that insurable event has already happened.

Yet, we have decided we want to cover the costs of illnesses that have already been contracted when the insurance is taken out.  How do we do that?

One solution - the one used in Obamacare - is to require everyone to buy "insurance," all paying the same price (perhaps age-adjusted), whether they are sick or healthy.  All we have to do is add up the total expected costs of treating all illnesses, divide by the number of people paying insurance premiums, and provide assistance to those who can't afford that amount.  Problem solved.

Except for one thing.  The logic behind this solution demands that all of the premiums collected be available to pay all the claims presented.  But that cannot happen with multiple insurers in the same market.  The better a company is at servicing claims, the more likely it is to attract those who need claims serviced. Meanwhile, a company with poor service would make more money, as its premium payers leave when they get sick.  The companies would, in effect, be competing for the right to go broke.  Companies don't do that, and, mirabile dictu, many Obamacare insurance markets are finding only one player in the game.  How else could it be?  Nothing else works.

Portability is basic stuff to insurance people. A carrier can take on a matured risk if (i) it is paid the estimated cost associated with that risk, or (ii) it is reimbursed for paying actual claims associated with that risk, or (iii) some combination of both.  In the property/casualty business, so-called "loss portfolio transfers" are a common practice.  Claims incurred under one carrier's policy are transferred to another carrier in exchange for a lump sum or other negotiated payment.

A more pertinent model involves reinsurance.  Many primary insurance carriers have reinsurance agreements in place that survive a loss portfolio transfer.  Thus, when the transfer occurs, the amount the original carrier will have to pay to the acquiring carrier may be fully known and fairly small, because the real cost of the loss is borne by the reinsurer.

An Obamacare fix could adopt this reinsurance model.  Each insurance company could take the risk that a healthy insured will get sick while under its coverage, collecting a premium for that eventuality. When an insured gets sick, the company would be required to buy "reinsurance" with respect to that illness by paying an actuarially determined amount into a common Already Sick Pool (ASP),  Then, if an insured changes insurance companies, the company acquiring the risk could tap the ASP for payment.

To assure adequate financing for the reinsurance pool, some combination of three things must occur: (i) healthy people must buy insurance, or (ii) healthy people must pay a tax in lieu of the portion of the premiums they would have paid in excess of the actuarial cost of insuring them, or (iii) coverage by insurance would be automatic and free, with a tax imposed to pay for it on some basis that people find fair.  (See "Medicare.")

Note, though, that a single ASP is central to any of these approaches.  It is not a "detail to be worked out in conference."  It is essential to portability, which is essential to covering pre-existing conditions.  Unless the insurer on the risk when the illness is contracted, or someone else, pays for the cost of that illness, there cannot be portability between competing insurers. Since that is not happening now, competing insurers are withdrawing from the market, and they won't come back no matter how easy it is to enter the market, because the market itself cannot support competition without a single-payer already-sick pool.

The ramifications of a single ASP are enormous.  Insurance companies are essentially investment banks that make their money lending out their insurance reserves. Underwriting activities are just a way of collecting money to lend.  Insurers can even compete on the extent to which their investment results reduce the premiums they need to collect. So, unless an insurance company gets some money to manage, it's not really doing what its shareholders set it up to do.  It becomes a buying service for insureds rather than an investment bank for its owners.  Those are different businesses.

Who, then would manage the ASP?  In what would it be invested?  One can imagine a mechanism whereby each carrier gets to manage a chunk of the pool based on its contributions to the pool.  That might be cumbersome.  The obvious alternative would be transferring the ASP money to the Medicare Trust fund, where is would fund the national debt.  That's not a terrible idea in economic terms, as it would lower interest rates for everyone, thereby benefiting savers and borrowers. But it would deprive the capital markets of the money they now get in the form of health insurance company reserves, so that's pretty much a wash.

And, if there's going to be one pool, it might make sense to put it in a place where administering medical claims is already being done.  That means putting everyone in Medicare.  In short, if we want to insure pre-existing conditions, the only viable solution is a single payer, and the best choice for single payer is Medicare.

The rabbit is already in the hat. All that remains is for some political magician to extract it. Unfortunately, the rabbit looks like a poisonous snake. Maybe "ASP" isn't so good a name for it...

Sunday, February 12, 2017

About Judge Gorsuch

When it comes to Constitutional law, I'm an originalist.  That's with a small "o," like the small "r" in the republican that I also am.  I won't bore you with the difference between my kind of originalist and the kind the Right wants on the Court.  I'm just saying that I take the words in the document seriously.

So, when the Constitution says, in Article II, Section 2, that the President "shall nominate, and by and with the Advice and Consent of the Senate, shall appoint ... Judges of the supreme Court...", I believe that an originalist must regard as a dereliction of Constitutional duty the failure of any Senator to perform with respect to any nominee for "judge of the supreme Court" the actions that the founders intended be performed with respect to such a nominee.  And it is, therefore, the obligation of any such originalist, should he be offered the chance, to decline to take a seat for which a prior President made a nomination that the Senate has refused, with clearly partisan political motives, to consider.

Judge Gorsuch said in his remarks on being nominated that any judge who likes every decision he has to make is not a good judge.  Well, here's his chance to put his money where his mouth is.  If he takes the Constitution as seriously as those supporting his nomination say, without irony, that they want him to take it, he should decline the nomination until the Senate has dealt with the nomination of Merrick Garland.

I wonder what would have happened if President Obama had sued the Senate, claiming that its stonewalling his nomination of Judge Garland violated the Constitution.  Ignoring the procedural hurdles, how would Justice Scalia would have voted on that one?  How would Justice Gorsuch? Happily, President Obama did not bring that case, and I don't hear any suggestion that such a case is in the offing.  As a result, Judge Gorsuch may legitimately be asked about his reading of the Senate's responsibilities under Article II, Section 2, without the questioner having to worry that the issue might arise before the Court.

I would urge the Democrats on the Judiciary Committee to press Judge Gorsuch for his views, as an originalist, on the Constitutionality of the Senate's treatment of Judge Garland's nomination.  And then, whatever he says, I would urge the Democrats on the Senate to vote "nay" on Judge Gorsuch on the grounds that his very standing for the office is inconsistent with his claimed devotion to the Constitution and with the oath to uphold it that he will take as he usurps Justice Garland's seat.

Saturday, December 31, 2016

Welcome to the Zero-Sum World, where Winning Trumps Sharing

I first came across game theory when I was in High School.  I liked math, and I liked games.  So when I found a book on game theory lying on a table in the school library, I picked it up and got hooked.  Not that I am anything of an expert.  We reductionists don't much go in for uncompensated expertise.  I just want the kernels, especially the idea of coordinated plus-sum games, i.e., games where everybody can win if the players cooperate.

Plus-sum games are distinguished from "zero-sum" games, in which the pay-offs to winners must be matched by the losses of losers.  The Prisoners' Dilemma is the quintessential coordinated plus-sum game.  It quantifies a simple notion that has been around for as long as there has been civilization, a notion captured by the golden rule, and explicated in grand style by Thomas Hobbes in Chapter XIII of Leviathan.
There Is Alwayes Warre Of Every One Against Every One Hereby it is manifest, that during the time men live without a common Power to keep them all in awe, they are in that condition which is called Warre; and such a warre, as is of every man, against every man. ...

Whatsoever therefore is consequent to a time of Warre, where every man is Enemy to every man; the same is consequent to the time, wherein men live without other security, than what their own strength, and their own invention shall furnish them withall. In such condition, there is no place for Industry; because the fruit thereof is uncertain; and consequently no Culture of the Earth; no Navigation, nor use of the commodities that may be imported by Sea; no commodious Building; no Instruments of moving, and removing such things as require much force; no Knowledge of the face of the Earth; no account of Time; no Arts; no Letters; no Society; and which is worst of all, continuall feare, and danger of violent death; And the life of man, solitary, poore, nasty, brutish, and short.
Hobbes reads as a Utopian monarchist.  He argues, in effect, that with "a common Power to keep them all in awe," people would prosper, enjoying those things denied them by the war of all against all.  He understood the prisoner's dilemma.  But there is another way to view the war of all against all.  Any given man can decide simply to win it.  It's a bad choice for most, and it is hard on those who don't win, but the choice is available.  Just ask Vladimir Putin.  Or Donald Trump.

Trump and Putin see the world in zero-sum terms.  They are obsessed with winning, because they have doped out that they cannot do as well by sharing a growing pie as they can do by drinking everybody else's milkshakes.  But that's what the Prisoners' Dilemma is all about: it is always better to steal, if one will not be punished for it by a common Power, than not to steal.  It's not enough to argue that, if everybody steals, we are back in a Hobbesian war.  That argument only works if enough people believe it.  The good behavior must be "coordinated."  Otherwise, the honest man simply becomes the one stolen from.

Hobbes's "common Power" comes in many forms.  One is morality, the shared value system whereby self-esteem derives from not making war against those it would be best not to make war against.  If enough people in a community believe it is wrong to steal, then they won't steal.  Whether that belief is supported by the fear of God, the fear of legal sanction, the fear of ostracism, or the bootstraps we call virtue, the good behavior effectively enjoys a "common Power" sufficient to end the war of all against all.

Morality is the most important driver of good behavior, far more so than the external sanctions.  The sanctions are there to catch the moral weaklings: if you don't see the damage your behavior would do if everyone else mimicked it, we will provide a disincentive for our mutual benefit.  But morality is underlain by material conditions.  Unless cooperation - obedience to law, etc. - yields a better result than defection, people will lose the sense that cooperation is worth the restrictions it imposes.  To put this in game theoretical terms, unless the coordinated game is a plus-sum game, in which the pay-offs exceed the losses such that enough players are enticed to join in, people will revert to a zero-sum view of the world, in which the only way to win is to make somebody else lose.

That view changes everything, and I think it explains the gulf that exists between the Trump voters and their antagonists, not to mention successful states and their kleptocratic enemies.  Trump is about winning a zero-sum game; his opponents are about working together to create a bigger pie and sharing that pie in a politically acceptable way.  In a plus-sum society, a politically stable number of people must be getting more pie soon enough to keep them from thinking it's ok to take someone else's pie.  One can see how losing a war to an unforgiving victor (Germany at Versailles), or losing jobs to an emerging economy of low-wage workers, or seeing all of the gains from trade inure to the benefit of 1% of the population, might lead the common man to believe that morality ain't really all it's cracked up to be.  Maybe we need to be winning rather than sharing.

My internal reductionist sees the "plus-sumness" of one's worldview as a key determinant of behavior.  He also sees self-esteem as the prime motivator of behavior.  If I feel good about inflicting losses, because I see the world as a place where my success depends on those losses being inflicted, then I become or support a Trump.  If, on the other hand, I feel bad about inflicting losses, because they are counterproductive to my sharing in a bigger pie, I become or support a Bush or a Clinton.  Note, this is not a right-left thing; plus-summers can disagree wildly about how to grow or share the pie.  No, it's more of a zeitgeist thing: can the pie be grown and shared, or can't it?

Being a citizen of a "great" country is a  source of self-esteem, "big league."  We want to make America great.  If we believe from looking around us that greatness can come only from "winning," because we tried sharing, and it just isn't working out for enough of us, then we will elect a zero-sum leader.  It's a mistake, because there are plus-sum solutions to our problems, but we need to understand that those solutions are counter-intuitive and not likely to be tried until simpler things have been tried..  (For one thing, sharing the benefits of outsourcing labor require a denigration of work, itself a crucial source of self-esteem in a plus-sum or zero-sum world.)  With any luck, we will find that a non-violent war - a trade war, say - merely impoverishes both sides, i.e., that trade really is a plus-sum activity and that the problem in the US has been the not the paucity but the maldistribution of its benefits.  If that happens, we may move one step closer to solving our problems.  On the other hand, there may be blood.

Thursday, November 17, 2016

For the Electoral College

One good way to lose the Presidential race is to piss off the Jewish vote in Florida.  That alone should be enough for any Jew with a sense of history to care about the Electoral College.  But we're not all Jewish, so here are some less parochial thoughts.

Losers too often blame the rules.  In recent history, liberal voters have outnumbered conservative voters.  In some instances, the Democrat candidate for President has received more popular votes than the Republican but lost the election.  Liberals like Barbara Boxer are now claiming that this is a bad thing per se.  But the Electoral College is meant to produce just that result from time to time.  Why else have it?  Consequently, when the losing candidate receives more votes than the winner, the Electoral College is serving its purpose, not thwarting some "democratic" ideal.

Is a popular vote margin of 1 vote in 200 really worth all this fuss?  Even that margin is suspect.  The idea that someone "won" a contest that was not held is rhetorical hooey.  There is no popular vote.  No candidate campaigns for it, so no one can "win" it.  No one knows how the popular vote would have turned out if the candidates had actually campaigned for it.  Does anyone doubt that Mr. Trump could have picked up more votes in New York or California if those votes would have counted?  Until one maps out a strategy (and calculates the budget) to win a race for the popular vote, one cannot begin to form an opinion about whether the country would be better off holding such a race.

The Electoral College exists precisely because the founders believed that numbers aren't everything.  How many bills get through the House but fail in the Senate?  Should we abolish the Senate, too?  The Electoral College simply does for the executive branch what the Senate does for the legislative: it makes it less small-d democratic, which is to say more small-r republican.  That's why it's there.  (For Democrats who think raw democracy is such a great idea, I have two words: George McGovern,)

Anyway, Hillary's problem was not the Electoral College.  Hillary would have won her election if she had carried various permutations of Ohio, Pennsylvania, Michigan, and Wisconsin, all of which would have been within her grasp if she had appealed to the economic interests of farmers and working-class breadwinners.  She failed to do that, but she still got more votes nationwide.  If the popular vote were all that mattered, maybe a person could get elected President while (by?) telling important constituencies that they don't matter.  Is that really the kind of country we want to live in?

As the software guys say, the Electoral Collage is a feature, not a bug.  It did its job this time, and we may each be glad at some time or another when it does it again.  The rules were fine.  The losing player just failed to win by them.

Monday, October 17, 2016

I'm with her, sort-of


I am not a fan of Hillary Clinton.  She seems to me a good if misguided person.  She's a tad messianic for my taste, and she seems to worry more about victims than anyone else.  Compassion is good, but it's a luxury, and it ought not to be the organizing principle of our politics.  Also, like her husband, she is content to be accurate when truthful would be more to the point.  For example, one can be for a bill (with some minor amendments) or against that same bill (as it currently stands).  Leave out the parenthetical, and you are always telling "the truth" by Clintonian standards.  And so we have Hillary on TPP.  But, hey, that's politics, right?

The "trustworthiness" thing doesn't much bother me.  One of the great ironies of this election is that the people who oppose Hillary claim not to believe a word she says, but oppose her because they know she will do what she says she will do.  Do they doubt she will, as promised, appoint Justices to the Supreme Court who they think will shred the Constitution?  Hell, no.  They are sure she will do exactly that.  But they don't trust her in some unspecified respect, and that's the argument they want to make.  Only in America.

This election boils down to one simple question, first asked by Harry Callahan: Do you feel lucky, punk? Well, do you?  Because, if we elect Trump President, we will have to get very lucky.  I expect that I would like his Supreme Court more than hers.  I might like his tax plan more than hers, too.  His focus on jobs and defense appeals to me more than her obsession with weeding out every last vestige of unfairness in this worst of all possible worlds.

In other words, I wish there were a Republican running for the office.  Not any Republican - many of the guys Trump beat were mental and/or moral midgets.  But maybe if the GOP had run JEB or Kasich, we would have a choice.  But they didn't, and so we don't, and I, myself, don't feel lucky enough to put a narcissistic twelve-year-old in the White House.  The Trump Doctrine - "He started it" - lacks, shall we say, a certain nuance that our foreign policy needs.  "Yo' mama" is not a bargaining position on the world stage.

The sex-talk on the bus is bad, but it confirms things we already know about the man, most notably that his reason for seeking power is to abuse it.  Why go to all the trouble of becoming famous if it won't get you laid?  Listen to him tell Howard Stern what he "gets away with," or Billy Bush what "they let you do."  It's all of a piece: the opportunity to ignore the rules.  Another irony there, as the knock on the Clintons is that they don't think the rules apply to them.  The Clintons think so because they are better than us; Trump thinks so because he's "a star."  Different brands of American exceptionalism.

And then there's the Russian hacks.  These have the moral status of Dr. Mengele's experiments.  It is unethical to pay them any attention.  Our ethics-free "journalists" say the contents are newsworthy - an argument that could be made for Dr. M's findings, too - but reporters are hardly arbiters of what's in the best interests of the country.

The issue is not legality.  I understand that publishing stolen documents is an essential function of a watchful media.  But the Podesta hacks are not just "stolen."  They are stolen by our geopolitical enemy and are being dribbled out by that enemy (or its co-conspirators at the "apolitical" Wikileaks) in order to do us harm.  Anyone, including any journalist, who recklessly does anything to make the Russians glad they hacked Podesta's emails is a traitor to the United States.  There are good reasons why such treachery cannot be criminalized, but there is no reason why it cannot be condemned in the strongest terms.  Shame on them, every last fucking one of them.

The self-styled conservative patriots on the right should be the first to take this position.  Maybe next time, when it's their secrets being stolen.  Because make no mistakes about it: only Putin's personal animus toward HRC and anticipation of an amateur fan-boy in the White House makes the Dems' stuff attractive to him.  When and if sanity returns to the USA, the GOP will again be the party of hawks, and it will then become the target of hacks.  Then will the right wing rise up against "the media" for giving the Russians just what they want.  One can only imagine what the Democrats will do then, i.e., when they stop laughing.

Did I mention "Feh"?

Saturday, August 6, 2016

Friday, July 29, 2016

A Man without a Party

Having watched both conventions, I am in a foul mood.  The media pokes fun at the dearth of black faces at the RNC, but one can name the white men who made it to the DNC stage.  We have become the two Americas that the politicians decry.  One is angry, straight, and white, and the other is smug and not those things.  The damage is worse on the Right, but that's to be expected.  Dysfunction is the demagogue's stock in trade.  Hillary has the wrong priorities, but, except for the glee she showed in taxing the rich, she is for advancing the downtrodden, while Trump wants to "take back" the ground where the downtrodden no longer fear to tread.

Serious conservatives are feeling especially impotent, unable to support "their" party's nominee, and unwilling to be associated with the views of the other.  The fecklessness of conservative politicians is mind-boggling.  It's like Warren Buffett says about how low tide shows you who's swimming naked. The Trump tsunami has revealed which Republicans are thinkers and which are posturers.  Speakers Ryan and Gingrich have come off particularly badly.  They have claimed to be philosophical conservatives, whether or not also fierce partisans.  But one cannot be a serious conservative and not bend every fiber to defeat Herr Trump.  One cannot be a patriot and sit still for his ascendance.  His rise is, in every sense of the word but one, "Unamerican."  That one sense is the one invoked by H.L. Mencken's observation that no one ever went broke underestimating the intelligence of the American public.  Trump has lived that sad truth, and now he is running on it.

I am loathe to catalog my misgivings about Mrs. Clinton for fear they might be seen as reasons to vote against her this November.  I don't really care much about the "dishonesty."  Neither she nor her lying husband were thieves to any important extent, and both have sought to do in office what they said they would do.  Like oppose TPP, at least until it is called something else.  I don't doubt that Hillary will try to keep her campaign promises.  To the contrary, it's the promises I don't like.

She told the convention that she is not there to get rid of the Second Amendment.  Then she said that she is there to get rid of the First.  I can't wait to see how her proposed amendment to overturn Citizens United distinguishes between corporations that publish newspapers with editorials in them and corporations that merely purport to do that to get around some ridiculous distinction between them.  Citizens United was rightly decided, as Bernie Sanders and Donald Trump have proved.  Trump has been immune to PAC attacks, and Bernie raised tons of money at $27 a clip, without a PAC.  Big money couldn't get JEB out of the starting blocks.  Yet Democrats, as the party of the poor, pretend that there is a point and a hope of getting it out of politics.  Shame on her.

Hillary wants to pay for her job-creating infrastructure work.  Generally, paying for stimulus is oxymoronic, with an emphasis on the moronic.  How can you create jobs by taking spending money out of people's pockets?  All else equal, when we raise revenue to pay for increased spending, we penalize the private sector exactly as much as we benefit the public sector.  Where's the gain?  The answer, of course, is that the object of the tax is not to pay for anything; it is to get payback from those who have done so well.  It is redistribution masquerading as fiscal responsibility.  It probably will create jobs to the extent that it moves money out of financial assets and into infrastructure. But it's really just class warfare.

Here's what she said:
Wall Street, corporations, and the super-rich are going to start paying their fair share of taxes.
Not because we resent success. Because when more than 90% of the gains have gone to the top 1%, that's where the money is.
Yeah, right.  Are we to believe that one's "fair share" of taxes is determined by whether one is where the money is?  But that we don't resent success?  (Like I said, she lies.)  Still, if the result is a better infrastructure and less income inequality, we will probably be better off than with neither of those results.

My own preference would be to borrow and print money to pay for the infrastructure work and redistribute wealth via a guaranteed basic income, also funded by printed money.  That's not to say the carried interest rule is a good thing, or that a higher tax rate on very high incomes would be a bad thing.  But not to raise revenue to pay for an improved national capital base.  The users can pay for that over time by using it to make things for the owners of the dollars printed to build it.  Future generations never pay in money; they always pay in outputs.  That is what self-styled fiscal conservatives always miss.

And then there's equal pay for women.  We have Title VII, and we have the Equal Pay Act.  The only thing left is the bureaucrat's delight called "comparable worth."  Yucch.  Don't get me started.  There is nothing left to be done on that front that is worth doing.  Hillary's motto is this:  "Give a woman a sou, and she eats for a day.  Teach her to sue, and she'll eat for a lifetime."   Maybe learning to negotiate would be more to the point.  There's really no there there, but the opportunity to pander to someone who is not white, male, and straight should not go to waste.

I guess we can blame it all on Nixon's southern strategy.  The GOP became the party of white trash when there were enough rednecks to win an election.  It is still the party of white trash, but there aren't enough to win an election, one hopes.  So the Democrats have naturally become the party of everybody else, including some ridiculous people on the left.  But somehow, the Democrats have abandoned the working stiff in the midwest.  They pay lip service to him, and they send Joe Biden to Scranton to mollify him, but they did not feature him in Philadelphia.  Where was the head of any major union?  I say this with no particular pro-union sentiment, just an observer of our polarized politics.  The party of the left doesn't need no stinkin' white men, so it isn't going to do anything to get their vote.  That could be a problem come November.

In general, the Philly convention was an exercise in bad triage.  Most of the preaching was to the converted, with one night targeted to an audience that included the non-disadvantaged.  Too little too late by my lights.  I think there were more votes to be gained than lost by courting the middle.  But that's just me, wishing there were a party for patriots who aren't angry.

(I'm not going to say anything about Trump beyond that his ascendance scares me as much as the possibility of his being President.  To paraphrase Dr. Johnson on women preaching, the remarkable thing is not that he is running well but that he is running at all.  What kind of people vote for that kind of person?  Sadly, Americans.)