Coyote Blog

Kevin Drum thinks he has found the smoking health care gun - US doctors are paid more than everyone else.  That is why we have too-expensive medical care!  A few quick thoughts

• I am the last one to argue that doctors salaries are set anywhere like at a market clearing price.  Our certification system, crazy third-party payer systems, lack of price transparency, and absurd arguments over the "doc fix" and Medicare reimbursement rates all convince me that doctor salaries must be "wrong"
• The charts he shows have absolutely no correction for productivity, at least as I read the methodology.  Per the text, they don't even have correction for hours worked.  A McKinsey report several years ago found that US doctors made more, but also saw a lot more patients in a day.  GP care cost more than expected vs. other country's experience, but is due mostly to number of visits, not cost per visit.
• There is no correction for doctor expenses.  Malpractice insurance, anyone?  We have the most costly malpractice insurance in the world because we have the most broken system.  Doctors pay that out of their salary
• US GP salaries in Drum's linked report are actually falling, unlike all the other countries studied.  Seem to have fallen 6% in 10 years (page 18), whereas France, for example, has increased more than 10%.

To the last point, I have a hypothesis.  When you first overlay a government health care / price control regime, you get an initial savings.  Doctors are forced to work for less and they still, out of habit and momentum, abide by past productivity standards.  But over time, productivity, like any government-captured function falls.  And over time, doctors, like other civil service groups, become better at organizing and lobbying and begin to get increasing pay packages.  After all, if teachers and fire-fighters can scare Californians into absurd pay and benefit packages, what do you think doctors will be able to do once they learn the game?

One of the charities my family supports is Teach for America.  Among other things, we sponsor a local teacher in the program.  A bunch of our friends were kind enough to chip in with gifts for the kids in her class and my wife and I delivered them last week at the Phoenix Collegiate Academy, a charter school in South Phoenix for 5-8 graders.

The fun of delivering the presents was reduced later on finding out that at almost that same moment, another group of kids was being killed in Connecticut.  But through a strange series of articles that seemed to have used the Sandy Hook massacre as an argument for teacher unionization and against charter schools (yeah, I don't get the connection either), I found out that teachers unions hate Teach for America.  Which means that I will likely double my contribution next year.

Postscript:  Teach for America began as a senior thesis at Princeton.  Its key idea is to make teaching a viable job option, as least for a few years, for top college grads.  The program is quite selective, and combines talented highly motivated young people with a proven teaching approach.  They then drop these teachers into the public school system, often in classrooms with a high percentage of kids who qualify for school lunch programs (ie low income).

It's clear from the article that teachers union and education establishment types hate these teachers.  Since they make a contrast by calling themselves "professionals", the presumed implication is that these young people are unprofessional.  Its amazing to me that anyone who has spent even ten minutes in a room with a group of TFA teachers could be so hostile to them.  I have met many of them, and they are a consistently amazing bunch who are both smart and genuinely love their kids.

I was skeptical, and still am a bit, of the notion of throwing great teachers into a failing public school system.  They clearly help individual kids, which is why I am still behind it, but they do nothing to help the overall system.  It's like sending great engineers into Solyndra  -- at some level, it seems like a waste (though I am impressed with this particular charter school, which seems to be doing a good job with the limited resources it has -- it gets far less money per pupil than the average public school in Phoenix but does a better job given the demographic of its students).

OK, there are lots of reasons to get Obama out of office.  The problem is, that for most of them, I have no reasonable hope that Romney will be any better.  Corporatism?  CEO as Venture-Capitalist-in-Chief?  Indefinite detentions?  Lack of Transparency?  The Drug War?   Obamacare, which was modeled on Romneycare?  What are the odds that any of these improve under Romney, and at least under Obama they are not being done by someone who wraps himself in the mantle of small government and free markets, helping to corrupt the public understanding of those terms.

But here is one issue Obama is almost certainly going to be worse:  Bail outs of states.  States will start seeking Federal bailouts, probably initially in the form of Federal guarantees of their pension obligations, in the next 4 years.  I had thought that Obama would be particularly susceptible if California is the first to come begging.  But imagine how fast he will whip out our money if it is Illinois at the trough first?

Now that Chicago's children have returned to not learning in school, we can all move on to the next crisis in Illinois public finance: unfunded public pensions. Readers who live in the other 49 states will be pleased to learn that Governor Pat Quinn's 2012 budget proposal already floated the idea of a federal guarantee of its pension debt. Think Germany and eurobonds for Greece, Italy and Spain.

Thank you for sharing, Governor.

Sooner or later, we knew it would come to this since the Democrats who are running Illinois into the ground can't bring themselves to oppose union demands. Illinois now has some $8 billion in current debts outstanding and taxpayers are on the hook for more than $200 billion in unfunded retirement costs for government workers. By some estimates, the system could be the first in the nation to go broke, as early as 2018....

For years, states have engaged in elaborate accounting tricks to improve appearances, including using an unrealistically high 8% "discount" rate to account for future liabilities. To make that fairy tale come true, state pension funds would have to average returns of 8% a year, which even the toothless Government Accounting Standards Board and Moody's have said are unrealistic....

Look no further than the recent Chicago teachers strike. The city is already facing upwards of a $1 billion deficit next year with hundreds of millions of dollars in annual pension costs for retired teachers coming due. But despite the fiscal imperatives, the negotiation didn't even discuss pensions. The final deal gave unions a more than 17% raise over four years, while they keep benefits and pensions that workers in the wealth-creating private economy can only imagine.

As a political matter, public unions are pursuing a version of the GM strategy: Never make a concession at the state level, figuring that if things get really bad the federal government will have no political choice but to bail out the pensions if not the entire state. Mr. Quinn made that official by pointing out in his budget proposal that "significant long-term improvements" in the state pension debt will come from "seeking a federal guarantee of the debt."

I had not paid much attention to the Chicago teacher's strike, except to note that the City basically caved to the unions.  The average teacher salary in Chicago, even without benefits, will soon rise to nearly $100,000 a year for just 9 months work.  But I am amazed at the statement that no one even bothered to challenge the union on pensions despite the fact that the system is essentially bankrupt.  Illinois really seems to be banking on their favorite son bailing them out with our money.

New taxes are frequently sold as protecting police, fire, and education, though these together represent barely 25% of all US government spending.  Where does the rest go?  It's a giant bait and switch, made worse by the fact that even within these categories, new headcount is more likely to be added in administrative and overhead roles rather than in promised functions such as "teachers".  This is the subject of my Forbes column this week:

There is a way to reconcile this:   While increases in education spending are sold to the public as a way to improve results in the classroom, in reality most of the new money and headcount are going to anything but increasing the number of teachers.

Let’s start with an example from the city of Phoenix, New York.  Why this town?  Am I cherry-picking?  In fact, I was looking for data on my home town of Phoenix, Arizona.  But I have come to discover that while school districts are really good at getting tomorrow’s cafeteria menu on the web, they are a little less diligent in giving equal transparency to their budget and staffing data.  But it turns out that Phoenix, New York, which I discovered when I was looking for my home town data, publishes a lovely summary of its budget data, so I will use it as an example that helps make my point.

The city’s budget summary for 2012-2013 is here.  Overall, they are proposing a 0.4% increase in spending for next year, which initially seems lean until one understands that they are projecting a 4% decline in enrollment, such that this still represents an increase in spending per pupil faster than inflation.  But the interesting part is the mix.

What are the two things politicians are always claiming they need extra money for?  Classroom instruction and infrastructure.  As you can see in this budget, only two categories of spending go down:  classroom instruction and facility maintenance and cleaning.  Administrative expenses increase 4% (effectively 8% per pupil) and employee benefits expenses increase just under 1% despite a total decline in staffing.  Though I am not very familiar with the program, one irony here is that the fastest growing category is the 8.7% growth (nearly 13% per pupil) in spending with BOCES, a New York initiative that was supposed to reduce administrative costs in public schools.  In other words, spending increases are going to everything except the areas which politicians promise.

I don’t think these trends are isolated to this one admittedly random example.  The Arizona auditor-general recently did a study on trends in education spending in the state.  They found exactly the same tendency to reduce classroom spending to pay for increases in administrative headcounts.

Read it all, as they say.

Yes, yet another group of school kids and their parents are battling it out over whose little darling should be valedictorian.   I like the approach taken by my son's high school.  All the seniors, on dates scattered through the year, must make a 10-15 speech to the school.  On anything.  This year there were speeches on topics ranging from the Holocaust to the banking crisis to "why I love my dog" to "why the rumors of my crying at that formal dance Freshman year when my date abandoned me are greatly exaggerated."

The speeches are a fun event.  The speaker's friends leave an offering of food and balloons on the stage.  When they are done, much of the school comes up on stage and congratulates them.  It is great experience, and (within the context of public speaking, which is stressful for many) the school works to lower the pressure on the kids -- in fact, there are no grades for the speeches that hit any transcript.

The only grading is simple -- whoever is judged to have given the best speech, both in subject matter and in presentation, gives the speech at graduation.

Of course, this could only work at a private school, where the school and teachers can actually exercise judgement without having to defend their decision in court.

PS-  My son's speech included, among other topics, one of the four subjects listed above.  If you really must know which, see the 23-minute mark here.

I could not resist commenting on the brouhaha around the stolen Heartland Institute documents in my column at Forbes.  The key one that is the "smoking gun" now appears to be fake.  I wrote in part:

One reason I am fairly certain the document is fake is this line from the supposed skeptic strategy document:

His effort will focus on providing curriculum that shows that the topic of climate change is controversial and uncertain – two key points that are effective at dissuading teachers from teaching science.

For those of us at least somewhat inside the tent of the skeptic community, particularly the science-based ones Heartland has supported in the past, the goal of "dissuading teachers from teaching science" is a total disconnect.  I have never had any skeptic in even the most private of conversations even hint at such a goal.  The skeptic view is that science education vis a vis climate and other environmental matters tends to be shallow, or one-sided, or politicized -- in other words broken in some way and needing repair.  In this way, most every prominent skeptic that works even a bit in the science/data end of things believes him or herself to be supporting, helping, and fixing science.  In fact, many skeptics believe that the continued positive reception of catastrophic global warming theory is a function of the general scientific illiteracy of Americans and points to a need for more and better science education (see here for an overview of the climate debate that does not once use the ad hominem words "myth", "scam" or "lie").

The only people who believe skeptics are anti-science per se, and therefore might believe skeptics would scheme to dissuade teachers from teaching science, are the more political alarmists (a good example was posted today right here at Forbes, which you might want to contrast withthis).  For years, I presume partially in an effort to avoid debate, certain alarmists have taken the ad hominem position that skeptics are anti-science.  And many probably well-meaning alarmists believe this about skeptics (since they may have not actually met any skeptics to know differently).  The person who wrote this fake memo almost had to be an alarmist, and probably was of the middling, more junior sort, the type of person who does not craft the talking points but is a recipient of them and true believer.

At the end I make a sort of bet

 If the strategy memo turns out to be fake as I believe it to be, I am starting the countdown now for the Dan-Rather-esque "fake but accurate" defense of the memo -- ie, "Well, sure, the actual document was faked but we all know it represents what these deniers are really thinking."  This has become a mainstay of post-modern debate, where facts matter less than having the politically correct position.

But in the first update I note the winner may already be delcared

Is Revkin himself seeking to win my fake-but-accurate race?   When presented with the fact that he may have published a fake memo, Revkin wrote:

looking back, it could well be something that was created as a way to assemble the core points in the batch of related docs.

It sounds like he is saying that while the memo is faked, it may have been someones attempt to summarize real Heartland documents.  Fake but accurate!  By the way, I don't think he has any basis for this supposition, as no other documents have come to light with stuff like "we need to stop teachers from teaching science."

My new column in Forbes addresses a topic I wrote about over 6 years ago, and got a ton of feedback on.

The problem with salaries for government workers like teachers is that, in a monopoly (particularly one enforced by law), the usual checks and balances on compensation simply don’t exist.  Let’s say a private school gives its teachers a big raise, and has to raise its tuitions to pay for those higher salaries.  Parents are then left with a choice as to whether to accept the higher tuitions, or to look elsewhere.  If they accept the higher fees, then great — the teachers make more money which is justified by the fact that their customers percieve them to be offering higher value.  If they do not accept the higher tuition, the school withers and either changes its practices or goes out of business.

But what happens when the state overpays for teachers (or any government employee)?  Generally, the govenrment simply demands more taxes.  Sure, voters can push back, but seldom do they win in a game dominated by concentrated benefits but dispersed costs.  On a per capita basis, teachers always have more to fight for than taxpayers, and are so well-organized they often are one of the dominant powers in electing officials in states like California.  This leads to the financially unhealthy situation of a teachers’ union negotiating across the table from officials who owe their office to the teachers’ union.

We might expect this actually to lead to inflated rather than parsimonious wages.  To see if this is true, we have a couple of different sources of data within the Bureau of Labor Statistics (BLS) to help us.

Click through to see the numbers, which tell the story pretty clearly