American Mobacracy


http://www.commentarymagazine.com/2014/12/04/american-mobacracy/

By: Abe Greenwald. Editor  Commentary Daily
“The future belongs to crowds,” wrote Don DeLillo in his 1991 novel Mao II. Boy, was he right. Today it’s protests in response to a baffling grand jury decision, but the phenomenon has been building for years. Tea Party rallies, the Rally for Sanity, Occupy Wall Street, minimum-wage protests, hoodie rallies, anti-Israel protests, climate rallies, Ferguson “die-ins,” World AIDS Day, World This Day, World That Day. The mass-grievance spectacle has come to saturate our culture and politics, and shape our national life.
In between demonstrations mob-rule holds firm by other means. Foremost online. The armchair lynch mobs of social media drive news cycles and end careers. A vigorous digital witch-hunt can wreck a life. In China, online vigilantism by an otherwise enfeebled citizenry goes by the term “human-flesh searches.” We’re not they’re yet, but we’re close.
Television too is coming under the sway of mobacracy. During the first round of Ferguson protests, news reporters joined the ranks of the enraged so they too could rail against police. On hipper talk shows, the political applause line has replaced the joke as the fundamental unit of communication. The new definition of comedian is a demagogue who gets a pass on vulgarity and inaccuracy. His goal is no longer to leave them in stitches; it’s to affirm the pooled self-righteousness of the audience with a zinger aimed at a common enemy. The Daily Show, Real Time, Last Week Tonightit’s the news with cheering.
Why is this happening? It’s not because worsening conditions are driving people to justified rage. Life in today’s lowest American income bracket is no picnic, but all relevant data show it’s a material paradise compared to the poverty of less turbulent eras. Prejudice exists, naturally, but on a dramatically smaller scale than at any point in our history. And (if we must), global temperatures, as even NASA now acknowledges, haven’t changed significantly for 15 years.
Perhaps, then, the righteous mob satisfies a new non-material crisis in American life—namely, the need for meaning and connection. People are now less likely to affiliate with larger entities and institutions that once gave their lives shape and value: family, community, church, nation. Sharp declines in religious belief, marriage, and childbearing are stripping us of enduring notions of virtue and purpose and we’re striving to replace them.
Some quick facts: According to Pew, the number of Americans who claim no religious affiliation has doubled since 1990 alone. Another Pew poll tells us: “After decades of declining marriage rates and changes in family structure, the share of American adults who have never been married is at an historic high.” In 1960, only 9 percent of Americans over 25 hadn’t ever married. In 2012, the number was 20 percent. And in 2013, a federal government study concluded that the U.S. birthrate had fallen to a record low of 1.86 births per woman.
Here are the questions we face as a result: For whom or what do we sacrifice? What constitutes community? And how, ultimately, do we find transcendence? The old institutions furnished answers. We sacrificed for faith and family because that’s what our shared values dictated. Out of those shared values we found community. And through connections to God and each other, we transcended ourselves.
The galvanized mob picks up the slack both for lost meaning and lost human contact. Activism was once reserved for a small segment of the mostly young and self-righteous. Today, it’s just another dimension of cosmopolitan life. You subscribe to a cause—be it anti-fracking or organic food—and stick with it. As it occupies the space of religion, you tend to preach your cause hypocritically. But your cause asks so little of you (perhaps to post a meme on your Facebook profile), that you’re not really invested. It doesn’t ultimately satisfy the need for transcendence because you sacrificed so little.
The weak in conviction seek strength in numbers. They connect online and meet up to block a bridge or lie down in a train station. As community, this ultimately fails too. Participants don’t share values; they share a need for values. When it comes down to it, they’re no more sincere about one cause than they are about another.
Without strength (which comes from sacrifice), without ideas (which come from engaging tradition, not running from it), all that’s left is emotion. So emotion becomes the content of our politics. The irony of the recent anti-police outrage is that it’s arisen from a culture of constant policing: the identity police, the Islamophobia police, the language police, the food police, the bully police, the trigger-warning squads—they’re all out to catch and punish offenders. No grand jury convened.
These mob events look like action, but they ensure stasis. Nothing fruitful comes from channeling religious and family needs into politics. It’s worth recalling that the Russian word Bolshevik literally meant one of the majority.

Sent from my yacht

How much does your Healthcare cost?


It's a simple idea, but a radical one. Let people know in advance how much health care will cost them—and whether they can find a better deal somewhere else.

Join the Conversation

What's the best way to find health-care deals? Don't miss this video chat with three health-care cost experts on Monday, Feb. 24 at 3 p.m. Eastern.
With outrage growing over incomprehensible medical bills and patients facing a higher share of the costs, momentum is building for efforts to do just that. Price transparency, as it is known, is common in most industries but rare in health care, where "charges," "prices," "rates" and "payments" all have different meanings and bear little relation to actual costs.
Unlike other industries, prices for health care can vary dramatically depending on who's paying. The list prices for hospital stays and doctor visits are often just opening bids that insurers negotiate down. The deals insurers and providers strike are often proprietary, making comparisons difficult. Even doctors are generally clueless about what the tests, drugs and specialists they recommend will cost patients.
Princeton economist Uwe Reinhardt likens using the U.S. health-care system to shopping in a department store blindfolded and months later being handed a statement that says, "Pay this amount."
The price-transparency movement aims to lift that veil of secrecy and empower patients and other payers to be smarter health-care consumers. Federal and state agencies are gathering reams of price information from doctors and hospitals and posting them for the public. Health plans are offering online tools that let members calculate their out-of-pocket costs. Startup companies are ferreting out and publishing the long-secret rates that providers negotiate with insurers.
When consumers can compare prices for doctor visits, hospital stays and other services, the theory goes, market competition will help keep them down.
An Incentive to Change
This is new territory for health care. Doctors and hospitals have rarely competed on cost. Third-party payers still foot the bulk of the bills, and many players in the health-care industry benefit from keeping their costs and profit margins murky.
"The time for transparency has clearly arrived—but is everybody ready to have real pricing power brought to bear in a way that could destabilize the health-care sector?" asks Susan Dentzer, a senior policy adviser at the Robert Wood Johnson Foundation. "It means upsetting a lot of apple carts."
The pressure to change is rising, however. Experts expect consumers to be much more price-sensitive as they shoulder a growing proportion of health costs themselves. Last year, 38% of Americans with employer-sponsored insurance had a deductible of $1,000 or more—up from 10% in 2006, according to the Kaiser Family Foundation.
Silver and bronze plans created by the Affordable Care Act carry average family deductibles of $6,000 and $10,386, respectively. More than half of bronze plans also require patients to pay 30% of doctors' fees, according to health-information siteHealthPocket.com. "Most of us still don't have much financial incentive to shop around for cheaper care," says Suzanne Delbanco, executive director of Catalyst for Payment Reform, a nonprofit that works on behalf of employers. "That's changing rapidly."
Efforts to raise transparency are coming from a number of corners, including the Obama administration. But some have mainly shown how confusing health-care pricing is.
Hoping to shine a light on the variations in hospital charges, the Centers for Medicare and Medicaid Services, or CMS, grabbed headlines last May when it released a list of the average prices 3,300 U.S. hospitals charged Medicare for the 100 most common inpatient services during 2011.
Huge Differences
The variations were stunning. The average charge for joint-replacement surgery, for example, ranged from $5,300 in Ada, Okla., to $223,000 in Monterey Park, Calif. Even in the same city, there were huge swings. The charge for treating an episode of heart failure was $9,000 in one hospital in Jackson, Miss., and $51,000 in another.
A month later, CMS released a second database comparing average hospital charges for 30 common outpatient procedures, and the variations were just as great. A hospital in Pennington, N.J., charged $3,036 for a diagnostic and screening ultrasound, while one in Bronx, N.Y., billed just $88.
Many hospital executives dismiss those list prices—also known as chargemaster prices—as meaningless and misleading, since few patients ever pay them. Commercial insurers often use them as a starting point for negotiating big discounts. Medicare itself pays hospitals predetermined rates based on diagnoses, regardless of what they charge.
Industry experts say list prices vary so much in part because hospitals use different accounting methods and have different patient populations. List prices also reflect all the costs of running a hospital, including keeping ERs, burn units and other costly services running 24 hours a day. What's more, many hospital executives say they have to mark up charges for privately insured patients because Medicare and Medicaid reimbursements don't cover those patients' cost—a shortfall the American Hospital Association puts at $46 billion nationwide last year.
Hospitals "are absolutely in favor of price transparency," says AHA president Rich Umbdenstock, and they support a bill in Congress that would let individual states determine price-disclosure rules. He also says hospitals would like to end the confusing chargemaster and cost-shifting practices, but they can't do it without big changes in payment practices by both the government and the insurance industry.
"If this were in our power to solve, we would have done it a long time ago," Mr. Umbdenstock says. "But it's not something we can do on our own."
Shining a Light
Jonathan Blum, deputy administrator of the CMS, counters that chargemaster prices do matter, particularly to uninsured patients who sometimes get stuck with those inflated bills. He says the administration's goal was to spark discussion about price variations, and that "a tremendous number" of visitors had downloaded the data.
"We've discovered that oftentimes, even health-care providers don't fully realize the extent of those variations," he says. "Our hypothesis is that a lot of the variations aren't warranted."
The prices insurers negotiate with hospitals and doctors are more important to consumers, experts say. Traditionally, those rates have been proprietary. Neither insurers nor providers want competitors and other business partners to know what they're willing to settle for. Some contracts include gag clauses barring disclosure.
But states are increasingly requiring payers and providers to reveal that information. A few states specifically outlaw gag clauses in health-care contracts. Sixteen states have "all-payer claims databases" designed to collect insurance claims data and use it to monitor trends and identify high- and low-price providers. And some 38 states now require hospitals to report at least some pricing information, although only two—Massachusetts and New Hampshire—rated an "A" in Catalyst for Payment Reform's annual report card for making the information accessible and usable by patients.
Meanwhile, entrepreneurs are sleuthing out negotiated rates from claims data and making them available to consumers and employers in various forms. Healthcare Bluebook aims to do for health care what the Kelley Blue Book does for used cars: It analyzes negotiated rates paid for thousands of medical services in every ZIP Code—supplied by employers and other clients—and posts what it considers a "fair" price for each so consumers can evaluate what they're being charged.
Bluebook's founder and CEO, Jeffrey Rice, says the rates insurers pay for, say, an MRI or knee surgery can vary as much as chargemaster prices do, particularly if a local hospital is dominant or prestigious.
"The difference may not be much between Nashville and Chicago—the big difference may be just down the block," he says.
Mr. Rice says the employers Healthcare Bluebook works with have saved as much as 12% on their health-care costs by making price information available to their employees, with most savings coming on imaging studies, endoscopies, cardiac testing and other outpatient procedures.
Another service, PricingHealthcare.com, asks users to anonymously supply information from their own medical bills to help it amass the list prices, cash prices and negotiated rates for common procedures. It currently shows rates for some 500 procedures in 11 states. Founder Randy Cox says some providers are furious when asked what their rates are, while others are eager to have their entire price list posted. "I get calls from hospital CEOs who know people are concerned about price and think this is an opportunity for their business," he says.
A Hand From Insurers
One of the most widespread initiatives comes from insurers themselves—who say they are eager to help plan members and employers cut their health-care bills. Some 98% of health plans now offer their members some online tool that lets them calculate their out-of-pocket costs, according to a survey by Catalyst for Payment Reform. A few let users compare different providers in the same network.
UnitedHealth Group Inc. has one of the most extensive tools. More than 21 million members can log into myHealthcare Cost Estimator and compare the negotiated rates for more than 500 individual services at in-network providers across the country, as well as their individual out-of-pocket costs for each one. Hundreds of thousands of plan members have used the tool since it launched in 2012, the company says.
Nationwide, only about 2% of health-plan members who have access to such tools have used them, according to Catalyst for Payment Reform. But Ms. Delbanco expects that number to rise as more patients become aware of the tools and see their out-of-pocket costs growing.
Proponents say it is too early to tell how much impact transparency efforts will have on costs overall. California has required hospitals to make their chargemaster prices public since 2003, with little effect on prices.
But one approach called "reference pricing" has yielded some savings. Where local prices differ substantially for a service like a colonoscopy, an insurer publishes a list of providers' rates and agrees to pay a set amount. If patients choose a provider that charges more, they must pay the difference themselves.
In one pilot project, the California Public Employees' Retirement System, found prices for hip and knee replacements ranging from $15,000 to $110,000 in the San Francisco area. It agreed to pay up to $30,000, and some 40 hospitals cut their prices to match. Such initiatives have helped Calpers save nearly $3 million in the past two years, one study found.
What Comes Next?
Experts say that as consumers increasingly compare prices, it's critical to provide them with information about quality of care as well—otherwise, they might assume high cost equates with high quality.
A growing body of research has found that there is no clear connection between price and outcomes such as mortality rates, blood clots, bed sores and hospital readmission. "Until you break that connection in peoples' minds, there is a perverse incentive for hospitals and health systems to continue to raise prices," Ms. Dentzer says.
Indeed, critics fear that some price-transparency efforts could backfire and spur higher prices: If providers see that insurers are paying competitors more, they might hold out for higher rates, and insurers might be less inclined to give some providers favorable deals.
Some skeptics think that without fundamental changes in how health care is priced and paid for, transparency may confuse consumers more than it empowers them.
But there's a growing consensus that while price transparency alone cannot transform the health-care system, it is necessary to help reveal which costs are excessive and let consumers make better-informed choices.
"At the end of the day, it's our money," Ms. Delbanco says. "We have a right to know what our health care is going to cost."
Ms. Beck covers health care and writes The Wall Street Journal's Health Journal column. She can be reached at melinda.beck@wsj.com.

Redefining Capitalism


Article|McKinsey Quarterly

Redefining capitalism

Despite its ability to generate prosperity, capitalism is under attack. By shaking up our long-held assumptions about how and why the system works, we can improve it.

September 2014 | byEric Beinhocker and Nick Hanauer
art
Capitalism is under attack. The financial crisis of 2008, the stagnation of the middle class in many developed countries, and rising income inequality are challenging some of our most deeply held beliefs about how a fair and well-functioning society should be organized.
Many business leaders are of two minds about the situation. They note that market capitalism has yielded massive increases in human prosperity, particularly in the West in the 19th and 20th centuries. More recently, it has lifted hundreds of millions from poverty in emerging economies. Yet despite these historic accomplishments, it’s also easy to worry that something is wrong with how the system is performing today.
This article will argue that while we have been correct to believe that capitalism has been the major source of historical growth and prosperity, we have been mostly incorrect in identifying how and why it worked so well. By analogy, our ancestors did know that the stars and planets moved in the sky and had various theories to explain their observations. But it wasn’t until the Copernican model replaced the Earth with the sun at the center of the solar system and Newton articulated his laws of gravitation that people understood how and why they move.
Likewise, the conventional economic theories we have relied upon for the past century have misled us about the workings of capitalism. Only by replacing our old theories with better and more modern ones will we build the deeper understanding necessary to improve our capitalist system.

Rocking-horse versus wild-horse economics

For the past century, the dominant economic paradigm—neoclassical economics—has painted a narrow and mechanistic view of how capitalism works, focusing on the role of markets and prices in the efficient allocation of society’s resources. The story is familiar: rational, self-interested firms maximize profits; rational, self-interested consumers maximize their “utility”; the decisions of these actors drive supply to equal demand; prices are set; the market clears; and resources are allocated in a socially optimal way.
Over the past several decades, though, some of the bedrock assumptions of neoclassical theory have begun to unravel. Behavioral economists have accumulated a mountain of evidence showing that real humans don’t behave as a rational homo economicus would. Experimental economists have raised awkward questions about the very existence of utility; and that is problematic because it has long been the device economists use to show that markets maximize social welfare. Empirical economists have identified anomalies suggesting that financial markets aren’t always efficient. And the macroeconomic models built on neoclassical ideas performed very poorly during the financial crisis.
Andy Haldane, the chief economist of the Bank of England, notes that the conventional theory views the economy as a rocking horse that, when perturbed by an outside force, sways for a while before predictably settling back down to a static equilibrium. But, as Haldane has pointed out, what we saw during the crisis was more like a herd of wild horses—something spooks one of them, it kicks another horse, and pretty soon the whole herd is running wildly in a pattern of complex, dynamic behavior.1
In the years before the crisis, a new view of economics began to stir. Since the crisis, it has begun to blossom.2 This view holds that the economy is a constantly evolving, interacting network of highly diverse households, firms, banks, regulators, and other agents, more like Haldane’s wild herd than a rocking horse. The economy—a complex, dynamic, open, and nonlinear system—has more in common with an ecosystem than with the mechanistic systems the neoclassicists modeled their theory on. The implications of this emerging view are only just beginning to be explored. But the two of us believe it has fundamental implications for how people think about the nature of capitalism and prosperity.
Significantly, this view shifts our perspective on how and why markets work from their allocative efficiency to their effectiveness in promoting creativity. It suggests that markets are evolutionary systems that each day carry out millions of simultaneous experiments on ways to make our lives better. In other words, the essential role of capitalism is not allocation—it is creation. Life isn’t drastically better for billions of people today than it was in 1800 because we are allocating the resources of the 19th-century economy more efficiently. Rather, it is better because we have life-saving antibiotics, indoor plumbing, motorized transport, access to vast amounts of information, and an enormous number of technical and social innovations that have become available to much (if not yet all) of the world’s population. The genius of capitalism is that it both creates incentives for solving human problems and makes those solutions widely available. And it is solutions to human problems that define prosperity, not money.

Prosperity redefined

Most of us intuitively believe that the more money people have, the more prosperous a society must be. America’s average household disposable income in 2013 was $38,001, versus $28,194 for Canada3 ; therefore, people believe, America is more prosperous than Canada.
But the idea that prosperity is simply about having money can be disproved with a simple thought experiment. Imagine you had the $38,001 income of a typical American but lived among the Yanomami people, an isolated hunter-gatherer tribe deep in the Brazilian rainforest. You’d easily be the richest of the Yanomami (they don’t use money, but anthropologists estimate their standard of living at something around $90 a year). But you’d still feel a lot poorer than the average American. Even after you’d fixed up your hut, bought the best baskets in the village, and eaten the finest Yanomami cuisine, all of your riches still wouldn’t get you antibiotics, air conditioning, or a comfy bed. Yet even the poorest Americans typically have access to these important elements of well-being.
This is why prosperity in human societies can’t be properly understood by looking just at monetary measures, such as income or wealth. Prosperity in a society is the accumulation of solutions to human problems.
These solutions run from the prosaic (crunchier potato chips) to the profound (cures for deadly diseases). Ultimately, the measure of the wealth of a society is the range of human problems it has solved and how available it has made those solutions to its people. Every item in a modern retail store can be thought of as a solution to a different kind of problem—how to eat, dress, entertain, make homes more comfortable, and so on. The more and better the solutions available to us, the more prosperity we have.

Growth redefined

We typically talk about growth in terms of GDP, though it has been much criticized recently as a measure of progress. There have been a variety of attempts to make GDP account for things such as environmental damage, unpaid work, the progress of technology, or the development of human capital.
In our view, the biggest problem with GDP is that it doesn’t necessarily reflect how growth changes the real, lived experience of most people. In the United States, for example, GDP has more than tripled over the last three decades. Although those increases have been concentrated at the top of the income spectrum, people across the board have benefited from improvements in technology (say, safer cars, new medical treatments, and smartphones). Other changes, though, have been accompanied by unintended consequences (such as the stress many knowledge workers feel from 24/7 connectivity). Is life actually better or worse for most people? How are the gains of growth shared? GDP cannot answer these questions.
If the concept of growth is to have significance, it should represent improvements in lived experience. If the real measure of a society’s prosperity is the availability of solutions to human problems, growth cannot simply be measured by changes in GDP. Rather, it must be a measure of the rate at which new solutions to human problems become available.
Going from fearing death by sinus infection one day to having access to life-saving antibiotics the next, for example, is growth. Going from sweltering in the heat one day to living with air conditioning the next is growth. Going from walking long distances to driving is growth. Going from needing to look up basic information in a library to having all the world’s information instantly available on your phone is growth.
Growth is best thought of as an increase in the quality and availability of solutions to human problems. Problems differ in importance, and a new view of growth must take this into account: finding a cure for cancer would trump many other product innovations. But in general, economic growth is the actual experience of having our lives improved.
This is different from other alternative measures of growth. For example, research shows that happiness does not necessarily correlate with GDP growth—Bhutan has even famously developed a Gross National Happiness (GNH) Index. Likewise, the United Nations created a Human Development Index (HDI) based on Amartya Sen’s theory of human capabilities and freedom. What the two of us are proposing sits somewhere between GDP and these measures. Like GDP, it is intended to be a definition of material prosperity. But it is also a more meaningful way of thinking about material standards of living than GDP.
Can the rate at which solutions appear and their availability be measured? While such a measure has not been tried yet, we believe it is possible. Inflation is measured by looking at changes in the prices of goods and services in a “basket” typically consumed by households. Similarly, it’s possible to look at how the actual contents of such a basket are changing across time or how they differ across countries or levels of income. What kind of food, housing, clothing, transport, healthcare, education, leisure, and entertainment do people have access to?

Capitalism redefined

If prosperity is created by solving human problems, a key question for society is what kind of economic system will solve the most problems for the most people most quickly. This is the genius of capitalism: it is an unmatched evolutionary system for finding solutions.
Finding new solutions to human problems is rarely easy or obvious—if it was, they would have already been found. For example, what is the optimal way to solve the problem of human-powered transportation? There are a multitude of options: bicycles, tricycles, unicycles, scooters, and so on. Human creativity develops a variety of ways to solve such problems, but some inevitably work better than others, and we need a process for sorting the wheat from the chaff. We also need a process for making good solutions widely available.
Capitalism is the mechanism by which these processes occur. It provides incentives for millions of problem-solving experiments to occur every day, provides competition to select the best solutions, and provides incentives and mechanisms for scaling up and making the best solutions available. Meanwhile, it scales down or eliminates less successful ones. The great economist Joseph Schumpeter called this evolutionary process “creative destruction.”
The orthodox economic view holds that capitalism works because it is efficient. But in reality, capitalism’s great strength is its problem-solving creativity and effectiveness. It is this creative effectiveness that by necessity makes it hugely inefficient and, like all evolutionary processes, inherently wasteful. Proof of this can be found in the large numbers of product lines, investments, and business ventures that fail every year. Successful capitalism requires what venture capitalist William Janeway calls “Schumpeterian waste.”4

The role of business

Every business is based on an idea about how to solve a problem. The process of converting great ideas into products and services that effectively fulfill fast-changing human needs is what defines most businesses. Thus, the crucial contribution business makes to society is transforming ideas into products and services that solve problems.
This sounds simple and obvious, and many executives would say, “Of course that is what we do.” But again, that is not what standard theory says businesses should do. In the 1970s and 1980s, academic work based on neoclassical theory argued that maximizing shareholder value should be the sole objective of business. If corporations just did this, said these professors, they would maximize overall economic efficiency and social welfare. This focus did correct some deficiencies in the previous system, most notably by empowering shareholders to push back against CEOs who maximized the size of their empires rather than economic returns.
But some argue that elevating the creation of shareholder value to the status of primary objective is based on a faulty assumption—that capital is the scarcest resource in an economy, when in reality it’s knowledge that’s the scarce, critical ingredient in solving problems.5 It has also led to a myopic focus on quarterly earnings and short-term share-price swings, to say nothing of a decline in long-term investment.6 This is in startling contrast to the attitudes of even the recent past. If you asked a CEO in the 1950s, an era of tremendous prosperity growth, what his job was, his first reply would probably have been “to make great products and services for customers.” After that, the CEO might have said something about looking after his company’s employees, making profits to invest in future growth—and then, finally, giving the shareholders a decent, competitive return.
We believe that a reorientation toward seeing businesses as society’s problem solvers rather than simply as vehicles for creating shareholder returns would provide a better description of what businesses actually do. It could help executives better balance the interests of the multiple stakeholders they need to manage. It could also help shift incentives back toward long-term investment—after all, few complex human problems can be solved in one quarter.
This is not to say that shareholders or other owners are unimportant. But providing them with a return that is competitive compared with the alternatives is a boundary condition for a successful business; it is not the purpose of a business. After all, having enough food is a boundary condition for life—but the purpose of life is more than just eating.
Some companies already think in these terms. Google, for example, defines its mission as “to organize the world’s information and make it universally accessible and useful”—a statement about solving a problem for people. And it famously refuses to provide quarterly financial forecasts.

Government redefined

Traditional economic theory holds that markets are efficient, inherently maximize welfare, and work best when managed least. But such perfect markets don’t seem to exist in the real world. Furthermore, this view fails to recognize that the great genius of capitalism—solving people’s problems—has, by necessity, a dark side: the solution to one person’s problem can create problems for someone else.
This is the age-old puzzle of political economy: how does an economic system resolve conflicts and distribute benefits? A fancy derivative product may help corporate treasurers solve their problem of managing corporate risk, and it might make bankers rich, but it might also create greater systemic risk for the financial system as a whole. Likewise, eating fatty food may solve someone’s problem of satisfying unconscious desires programmed by millennia of evolution. But it might also create new problems of clogged arteries and burden society with that person’s future health costs.
It can be challenging to distinguish between problem-solving and problem-creating economic activity. And who has the moral right to decide? Democracy is the best mechanism humans have come up with for navigating the trade-offs and weaknesses inherent in capitalism. Democracies allow its inevitable conflicts to be resolved in a way that maximizes fairness and legitimacy and that broadly reflects society’s views.
Seeing prosperity as solutions helps explain why democracy is so highly correlated with prosperity. Democracies actually help create prosperity because they do several things better than other systems of government. They tend to build economies that are more inclusive, enabling more citizens to be both creators of solutions and customers for other people’s solutions. And they offer the best way to resolve conflicts over whether economic activity is generating solutions or problems. Many (though not all) government regulations are created to do just that—to encourage economic activity that solves problems and to discourage economic activity that creates them—thus fostering trust and cooperation in society.
Businesspeople often complain about regulation—and indeed many regulations are poorly designed or unnecessary—but the reality is that solving capitalism’s problems requires the trust and cooperation that good regulation fosters. It is notable that the most prosperous economies in the world all mix regulation with free markets, while unregulated and anarchic economies are universally poor.

What problems do you solve?

Once we understand that the solutions capitalism produces are what creates real prosperity in people’s lives, and that the rate at which we create solutions is true economic growth, then it becomes obvious that entrepreneurs and business leaders bear a major part of both the credit and the responsibility for creating societal prosperity. But standard measures of business’s contribution—profits, growth rates, and shareholder value—are poor proxies. Businesses contribute to society by creating and making available products and services that improve people’s lives in tangible ways, while simultaneously providing employment that enables people to afford the products and services of other businesses. It sounds basic, and it is, but our economic theories and metrics don’t frame things this way.
Today our culture celebrates money and wealth as the benchmarks of success. This has been reinforced by the prevailing theory. Suppose that instead we celebrated innovative solutions to human problems. Imagine being at a party and rather than being asked, “What do you do?”—code for how much money do you make and what status do you have—you were asked, “What problems do you solve?” Both capitalism and our society would be the better for it.
About the authors
Eric Beinhocker, an alumnus of McKinsey’s Washington, DC, and London offices, is the executive director of the Institute for New Economic Thinking at the Oxford Martin School, University of Oxford.Nick Hanauer is an entrepreneur, venture capitalist, and author. This article is adapted from “Capitalism Redefined,” Democracy: A Journal of Ideas, Issue 31, Winter 2014, democracyjournal.org.

Doctors Refusing to Participate in Obamacare


Exchange Plans a Bad Deal for Doctors

October 30, 2014
A number of doctors are choosing not to participate in Obamacare exchange health plans in the upcoming year. According to the medical practice trade group Medical Group Management Association, 214,524 physicians will not be participating in any Affordable Care Act Exchange.
Why are doctors unwilling to participate? According to Brittany La Couture of the American Action Forum, many doctors are worried that patients may stop paying premiums, which is problematic for providers:
  • According to HHS regulations, individuals who stop paying their premiums are granted a 90-day grace period (unlike in the private insurance market, where an individual would lose his coverage altogether in the event of nonpayment).
  • Insurers must continue coverage for the first 30 days of that period.
  • For the next 60 days, insurers will cover any services that are provided to nonpaying patients only if the patient actually pays his overdue premium by the end of the three-month grace period.
  • If he does not, the health care provider is stuck with the losses and must try to recover payment from the patient directly. (Blogger's Comment: Who thought this was a good idea? Can we get a name, title and picture so we can ask what the thought process was? I'll bet Admin wanted 90 days and insurance companies pushed back and settled for 30 and since AMA was bought off and not representing the providers interests, this is the result. And like most things in the ACA no one considered the law of unintended consequences.)
La Couture writes that this is the main reason doctors are not participating in the exchange plans. Data indicates that 1 million Americans enrolled in exchange plans but did not pay their premiums. If those individuals obtained care during the grace period, their doctors may go uncompensated.
Additionally, the exchanges have narrow networks and low reimbursement rates which are unattractive to doctors:
  • To make their health plans cheap and thus attractive to potential enrollees, insurance companies created narrow networks which featured relatively few health care providers per insurance plan. Insurers offered doctors low reimbursement rates, with the idea that health care providers could make up the difference due to the high patient volume that would come from the narrow networks.
  • However, the reimbursement rates are so low -- and doctors are already burdened with patients -- that the increased patient volume does nothing to make it more profitable. Insurers are offering incredibly low reimbursement rates; what the private sector would pay $1.00 for, Medicare pays $0.80 for and exchange plans pay around $0.60 for. (This is the first I have seen the claim that the exchanges will only pay 60%. Is this number correct? Is it part of the ACA? Did HHS regulate it? Market forces? Other?)
  • Many doctors are worried that those on exchange plans are sicker than the average patient, because many on exchange plans were uninsured prior to the Affordable Care Act.                                     
According to La Couture, 70 percent of California doctors were not participating in the state's exchange in January 2014.
Source: Brittany La Couture, "Health Care Providers are Opting-Out of Obamacare Exchange Plans," American Action Forum, October 27, 2014.
Sourced from NCPA.ORG


Social Security Finances Fixed – Forever


Pre-funding at birth: A Senior Entitlement Reform Plan that will work for all Americans:

Imagine that after months of intense debate the following article appeared in the New York Times.

Social Security Finances Fixed – Forever 

Washington DC 9/1/2016: Today, President Smart signed the American Birth Contribution Act into law. The ABC law, as it is commonly called, mandates that the Social Security Administration shall deposit $1000 into a new ABC-Social Security account for every US citizen born after midnight January 1, 2017. By investing in a total market equity index, the ABC fund is predicted to mirror the historic US average annual rate of return of 10.4%. At that growth rate, a beneficiary can expect her account value to double nine times by age 63 and ten times by age 70. A ten fold doubling would place the account balance at over $1 million and would be sufficient to pay 30% more in inflation adjusted benefits for the life of the beneficiary.

Furthermore, the law guarantees through the full faith and credit of the United States that benefit purchasing power will be at least equal to the average purchasing power of Social Security benefits forecasted under current law. The guarantee helps ensure that ABC beneficiaries will no longer have to fear the security of their Social Security benefits because of political gamesmanship, economic slowdowns, stock market fluctuations, changes in inflation computations, underfunding of accounts or government shutdowns. 

The ABC plan not only protects Social Security for the next and all subsequent generations but goes a long way to resolving the current Social Security system’s financial shortfall. As ABC beneficiaries die over time, the ABC Plan will amass sizable surpluses. These surpluses will be used to sure up today’s Social Security shortages and are projected to eventually eliminate the $20 plus trillion in Social Security’s unfunded liability. 

The annual cost to fund the ABC plan for the expected 4 million US citizens born each year is approximately $4 billion and shall be funded by reducing the amount Congress may borrow each year from the Social Security surplus fund. 

During the signing ceremony President Smart said that the ABC-Social Security law was the keystone of her platform’s Win-Win solutions for America. She added that she was looking forward to Congress sending her the ABC-Medicare bill next month so that she could sign that bill into law and that this government could finally start eliminating our nation’s $60 trillion in unfunded liabilities. 

You can learn more about the American Birth Contribution plans at

The Minimum Wage Debate - A New Way Forward



March 18, 2014:  Jim Schneider

The minimum wage debate has raged on for decades. Like most of the perennial battles between the political left and right, the two parties invariably fail to consider policies that would benefit all Americans. Instead, they have divided the nation into various factions and only promote policies that support their factions at the expense of their rivals. A political system that is based on compromise, like ours, fails under these tactics and leaves our economy to languish in the uncertainly and neglect wrought from political gridlock. We need a new approach. We need a strategy that is designed to unite us, not divide us. ---- But how could we possibly do that in this political climate?

For starters, we need leaders that recognize the critical importance of unifying our nation. We need leaders that are able to convince the American people and both parties that our Federal Government should adopt a single, overarching economic objective that would guide the development of our nation’s economic policies. But could the hodgepodge of America’s diverse interests ever agree to a common economic objective? Yes, if that objective spoke to every American like this one.

Continuously improve the standard of living of all Americans.

That’s it. That’s as complicated as our national objective needs to be. A standard of living can be defined and measured. It can be compared over time and between groups and across locations. It would be easily understood, actively supported and would lead to broader participation in the political process. An objective would persuade policy makers to couch their proposals in terms of the objective and prioritize them accordingly. The voters would gain a gauge for comparing actual results against the plan and measuring the contributions of their elected leaders.

An objective would make it harder for the parties to demonize the motives of the other party. When voters no longer believe someone is the devil, they may be more likely to consider that person’s point of view. The political discussion might then switch from castigating opponents to how best to achieve objectives. Yes, the debates would certainly rage on; but instead of discussing the emotionally charged and economically less significant, we just might begin to delve into solutions that address our most pressing economic problems. So how would a national economic objective help our minimum wage debate?

Well, if the nation were to agree to a national objective then we could get about the business of debating the economic strategies that would best reach that objective. I contend that our government should first concentrate on two major policy arenas.

  1. Jobs
  2. Safety Net

Jobs:
The most effective way for individuals to improve their standard of living - as well as increase their sense of worth and well being is through a job. The most effective way for our economy to grow and generate jobs is through a vibrant private sector that offers goods and services that people want at prices they can afford with enough profit to warrant their continuation. The goal of our Federal Job Policy should therefore be: 

To enact policies that allow the private sector to maximize the quantity, quality and sustainability of U.S. based, profit funded, private sector jobs.

Repeated Keynesian approaches by the Republicans to reduce taxes or by the Democrats to increase spending have not and will not have the long-term desired effects to jump-start our economy. The theory behind a Keynesian stimulus is that a short-term cash/demand infusion will prime the private sector economic pump. But if the pump is broken, the infusion will have no more effect on stimulating our economy than would a jockey going to the whip in order to stimulate a race horse with a broken leg. The only remedy is to fix the leg first. Therefore, the best strategy for fixing our economic race horse is to:

Eliminate the obstacles that inhibit the hiring of US based private-sector employees.

The main obstacles inhibiting demand for US based jobs include:
  • The employer funded Safety Net Programs including healthcare and retirement
  • The business costs to comply with federal and state regulations
  • A perverse tax system that causes sub-optimized economic decisions
  • Uncertainty over future regulations is inhibiting business start-ups and expansions
  • An absence of a supply-increasing and price-stabilizing national energy policy
  • An absence of a commerce-facilitating infrastructure-improvement plan
  • An inconsistent supply of short-term debt for small businesses to finance operations
  • A mismatch between labor skills needed and labor skills available.

There are certainly other job expansion impediments but a concerted effort to minimize these obstacles would produce an immediate, dramatic and sustainable improvement in the US labor market.

Safety Net:
America needs a safety net for the simple reason that no one has yet devised a way for a regulated free-market capitalist system to adequately ensure a minimum standard of living for all her citizens all the time. But if we want to achieve our national objective we must stop forcing our employers to pay for our safety net because doing so makes US based jobs less competitive in a global economy. We therefore must adopt an alternative safety net funding mechanism. --- But what should that be?

First, we should categorize all federal expenditures into safety net costs and everything else. By so doing, minimum wage would clearly fall under the safety net category and by definition should NOT be paid for by our employers. --- That would really change the minimum wage debate - for the better.

To pay for our safety net, I suggest a national retail sales tax appropriately called the Safety Net Tax (SNT). The SNT would include a rebate to all US citizens for taxes paid up to the poverty level. The first programs transferred to the SNT would include Social Security and Medicare eliminating the need for the Payroll Tax. Advantages of the SNT over the Payroll Tax include:
  • US based labor costs would decline which would increase demand for US based labor
  • The SNT Rebate would make the SNT more progressive than the Payroll Tax and help the poor
  • Payroll Taxes are hidden in prices and passed along to customers. The SNT would reduce the prices of US goods and services and show the cost of government on every receipt.

Once the SNT was established, and the minimum wage was considered part of the safety net then minimum wage discussions would focus on how much the SNT would need to increase in order to pay for a particular minimum wage increase. Ethereal debates over price increases and job decreases would be replaced with Americans discussing their desire to pay a definitive SNT rate increases.

With $17.4 trillion in debt, $63 trillion in unfunded liabilities and over $2 trillion of job burden costs already foisted annually on our employers, the minimum wage is but a fly on an elephant’s back. But nonetheless the topic helps to illustrate the economic anchor we have chained to our collective neck. The $17.4 trillion national debt would be best solved by following through with our job policy goal and strategy. The $63 trillion in unfunded liabilities would be best resolved by replacing pay-as-you-go funding with prefunding at birth for the next and all subsequent senior entitlement generations. The $2 trillion in job burden costs would be resolved by implementing the Safety Net Tax.