Unleashing the power of markets in health care

Regular readers of this blog know of my skepticism that the costs attributable to America’s reliance on third party payors in its health care finance system are commensurate with the benefits of paying for medical service in that fashion.
Following up on that thought, Alex Tabarrok over at Marginal Revolution notes in this post that one of the most popular types of medical procedure has declined in cost recently precisely because it is not generally covered under America’s third party payor system:

Everywhere we look it seems that health care is more expensive: prescription drug prices are increasing, costs to visit the doctor are up, the price of health insurance is rising. But look closer, even closer, closer still. Don’t see it yet? Perhaps you should have your eyes corrected at a Lasik vision center.
Laser eye surgery has the highest patient satisfaction ratings of any surgery, it has been performed more than 3 million times in the past decade, it is new, it is high-tech, it has gotten better over time and… laser eye surgery has fallen in price. In 1998 the average price of laser eye surgery was about $2200 per eye. Today the average price is $1350, that’s a decline of 38 percent in nominal terms and slightly more than that after taking into account inflation.
Why the price decline in this market and not others? Could it have something to do with the fact that laser eye surgery is not covered by insurance, not covered by Medicaid or Medicare, and not heavily regulated? Laser eye surgery is one of the few health procedures sold in a free market with price advertising, competition and consumer driven purchases. I’m seeing things more clearly already.

Touche!

A new form of business regulation

Don’t miss George Mason University law and economics whiz Henry G. Manne‘s brilliant Wall Street Journal ($) op-ed from yesterday in which he criticizes Eliot Spitzer’s latest assault on business. Dean Manne cuts through the fog of Spitzer’s public relations blitz to bear in on the true nature of Spitzer’s campaign against the big insurers:

In an era of general acceptance of deregulation and privatization, Mr. Spitzer has introduced the world to yet a new form of regulation, the use of the criminal law as an in terrorem weapon to force acceptance of industry-wide regulations. These rules are not vetted through normal authoritative channels, are not reviewable by any administrative process, and are not subject to even the minimal due-process requirements our courts require for normal administrative rule making. The whole process bears no resemblance to a rule of law; it is a reign of force. And to make matters worse, the regulatory remedies are usually vastly more costly to the public than the alleged evils.

Professor Manne goes on to point out that Marsh’s contingent commissions were as innocent as payola, which is widely misunderstood with regard to its market effect:

Nobel Laureate Ronald Coase once famously showed (Journal of Law and Economics 1979) how kickbacks in the so-called radio DJ payola scandal were really a legitimate, albeit superficially confusing, competitive device. Payola was essential, Coase explained, to preserving competition between record companies, and its demise was only sought by competitors who were injured by the practice — not by consumers. There are eerie similarities between the two situations.
If the Coasian analysis is correct — and no serious rebuttal has ever appeared — we may witness the demise of specialized insurance-brokerage firms like Marsh & McLennan in favor of more integrated insurance companies who will do their own marketing. This is already rumored to have begun. Or we may see insurance brokerage firms beginning to acquire and operate insurance companies. In either case we would be witnessing a decrease in market specialization with a commensurate loss of economic efficiency. Mr. Spitzer would have succeeded in making the industry less competitive and less efficient, and insurance buyers will eventually pay higher not lower premiums.

With his usual insight, Professor Ribstein succiently points out in this post that governmental regulation of payola is misguided because of the valuable market benefits that it provides:

The problem is that, whenever government interferes with the market, it can create more problems than it solves. When government banned payola . . , it blocked a practice that was, after all, getting more air time for new kinds of music. (In general, regulation hurts the newcomers more than it hurts the established players.) But it didn’t stop payola. . . .“[N]ew payola” (spot buys) arose in response to the banning of the old payola. The new payola, . . . creates a less informed market than the old payola.

Payola’s effect in making the music market less transparent is analogous to the effect of insider trading regulation. Insider trading, like payola, helps disseminate information. Regulation forces the trading underground, making markets less informed.

The criminalization of business practices exemplified by Spitzer’s tactics and most of the Enron-type prosecutions combines the worst elements of business regulation with overt miscarriages of justice. Although the prosecutions play well as superficial morality plays in the mainstream media, I fear that the damage being done to America’s business and justice systems will ultimately exceed even the tragic destruction of individual lives that has, and will continue, to occur.

The theological dilemma of moderate Islam

In this Asia Times op-ed from the Asia Times, Spengler explores the the theological challege that moderate Muslims face in siding with the West in its war against the radical Islamic fascists. The entire piece is a must read, but this excerpt gives you a taste of the dilemma that moderate Muslims face:

Smugness oozes from European politicians who demand that Muslims repudiate violence as a precondition for residence in the West. To repudiate the death sentence for blasphemy would be the same as abandoning the Islamic order in traditional society in favor of a Western-style religion of personal conscience. The West spent centuries of time and rivers of blood to make such a transition, and carried it off badly. Whether Islam can do so at all remains doubtful.

Read the entire piece.

Benihana killer shrimp

This New York Law Journal article reports on the wrongful death case against Benihana that grew out of a customer’s reaction to a chef’s playful toss of a shrimp:

A piece of grilled shrimp flung playfully by a Japanese hibachi chef toward a tableside diner is being blamed for causing the man’s death.
Making a proximate-cause argument, the lawyer for the deceased man’s estate has alleged that the man’s reflexive response — to duck away from the flying food — caused a neck injury that required surgery.
Complications from that first operation necessitated a second procedure. Five months later, [the customer] was dead of an illness that his family claims was proximately caused by the injury.

What a way to go.

The Heisman Trophy winning faith healer

This Austin American-Stateman article reports on the latest undertakings of former University of Texas Heisman Trophy and NFL running back Ricky Williams. The quixotic Mr. Williams — who retired from the NFL earlier this year at the relatively young age of 27 — is now training to be a faith healer:

Williams has turned up about as far from professional football as you can get, as a student of the ancient Indian medical system known as Ayurveda. In the Sierra foothills, no less.
“I realized a while back that I have an innate ability to be compassionate,” he said, “and I saw that the strength of compassion is something that healers have and healers use.”

Williams is now a month into a 17-month course at the California College of Ayurveda (pronounced I-yur-vay-da) in Grass Valley, a city of 12,000 about 45 miles northeast of Sacramento. He’s renting a one-bedroom cottage in nearby Nevada City.

Reluctant at first to talk, [Williams] soon started describing his old life in football and his new life in holistic healing.
“Ayurveda deals with using your environment to put yourself in balance,” he said. “I’ve realized, both on a psychological and physical level, that the things we do in football don’t bring more harmony to your life. They just bring more disharmony.”

Is he happier now that he’s removed from the game?
“I’m closer to being happy. I’m doing things that make me happy,” Williams said. “In football I loved to practice and I loved to play, but I hated to be in meetings, hated to talk to the media, hated to have cameras in my face, hated to sign autographs. I hated to do all those things.”

But then Ricky — how do you explain this?
Earth to Ricky, over and out.

Political hack alert

This earlier post noted that the brewing controversy in Dallas over the Wright Amendment provides a ripe field for politicians to reap financial windfalls so long as they are willing to make bad policy decisions that favor certain private business interests.
It appears that their is an inexhaustible supply of issues in which politicians can parley the sale of their political soul into a nice financial return for their campaign war chests. This Wall Street Journal ($) article reports that telecom companies are lobbying elected officials around the country to rationalize support for legislation that restricts free or inexpensive WiFi service for their constituents:

Dozens of cities and towns across the country are rushing to provide low- or no-cost wireless Internet access to their residents, but the large phone and cable companies, fearful of losing a lucrative market, are fighting back by pushing states to pass legislation that could make it illegal for municipalities to offer the service.

Philadelphia announced during the summer that it would hook up the entire city with Wi-Fi. Its current Wi-Fi service is free, but it hasn’t decided whether that would continue with wider deployment; it may charge a small fee. “There are some very specific goals that the city has that are not met by the private sector: affordable, universal access and the digital divide,” says Dianah Neff, the city’s chief information officer. She says that less than 60% of the city’s neighborhoods have broadband access.
However, last week, after intensive lobbying by Verizon Communications Inc., the Pennsylvania General Assembly passed a bill with a deeply buried provision that would make it illegal for any “political subdivision” to provide to the public “for any compensation any telecommunications services, including advanced and broadband services within the service territory of a local exchange telecommunications company operating under a network-modernization plan.” Verizon is the local exchange telecommunications company for most of Pennsylvania, and it is planning to modernize the region using high-speed fiber-optic cable. The bill has 10 days for the governor to sign it or veto it.
The Pennsylvania bill follows similar legislative efforts earlier this year by telephone companies in Utah, Louisiana and Florida to prevent municipalities from offering telecommunications services, which could include fiber and Wi-Fi.

Rather than encouraging municipalities to provide free or inexpensive broadband internet access for its citizens, telecom companies argue that legislators should be more concerned with protecting the telecom companies from competing with local governments to provide WiFi service. Even such palpably superficial reasoning is resonating with Pennsylvania legislators, who apparently need to replenish their campaign war chests:

The Pennsylvania bill, first introduced in 2003, was passed by the state Senate late Thursday night and then passed for a second time by the state House of Representatives late Friday night by wide margins. Senate supporters agreed with Verizon’s view of the legislation. Don Houser, a spokesman for Senator Jake Corman, the Senate sponsor of the bill, said “the thinking was the telephone companies didn’t want to have local municipalities using tax dollars to compete with private dollars.”

Well, citizens are perfectly capable of replacing their elected officials if they do not want their local municipalities competing with private business in providing WiFi service. Pennsylvania Gov. Edward G. Rendell has until November 30 to act on this legislation and has not yet declared which route he will choose. It’s not a close cal that he should reject the legislation, but money talks in politics and the telecome companies are willing to throw it around. Keep an eye on this one.
By the way, have you noticed that elected officials do not seem to mind having government compete with private financiers in connection with providing governmental financing for a new stadium?