Never-Ending Health Care Crisis, Part 2: Struggling to Pay for Stuff That’s Worth It—and a Possible Reprieve

Ross Douthat predicted that we are in for a never-ending health care crisis. He’s right, partly because health care is paid for by health insurance, which means spending other people’s money, as I said in Part 1.

But another factor drives the endless health care cost crisis even more: ever new and better medical technology—and the ever-increasing amounts we must find to pay for it. Those who follow health care policy (like Douthat) understand this. But to help inoculate the public against health care policy snake oil salesmen, everyone needs to understand it. To make things more complicated, but possibly a bit better, the US might, just might, get reprieve from the endless cost-growth.

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Are 90% of academic papers really never cited? Searching citations about academic citations reveals the good, the bad and the ugly

“90% of papers published in academic journals are never cited.” This damning statistic from a 2007 overview of citation analysis recently darted about cyberspace. A similar statistic had made the rounds in 2010 but that time it was about 60% of social and natural science articles that were said to be uncited. Neither statistic came with a link to supporting academic research papers.

That lack of support was a problem for me. I did not doubt the basic truth that many academic papers are uncited. But to be sure 90% was not urban legend and to learn the context and caveats, I needed to find the original research paper. I was not the only one who wanted the supporting evidence.  So, I dove into Google scholar, searching the disparaged academic literature for articles on academic citation rates.

What’s the truth? Continue reading

Douthat is Right, Health Care Debate Will Never End, But He Misdiagnoses Some Underlying Causes, Part 1: Other People’s Money

Ross Douthat predicts that despite Obamacare’s comeback from’s disastrous rollout, its failure to unravel and the failure of Republicans to repeal it, health care debate will never end: “What we should expect for years, decades, a generation: a grinding, exhausting argument over how to pay for healthcare.“ Health care policy experts tweeted their agreement.

Douthat is totally right that this debate will never end. And all his facts and analyses are correct too. But he mistakes “a society that’s growing older, consuming more care, and (especially if current secularizing trends persist) becoming more and more invested in postponing death,” a relatively small effect, for a big one. It’s not aging that is the big driver of health care spending growth but new and improved health care technologies driving up costs per person.

More importantly, Douthat fails to identify the underlying, inescapable reasons that, like the proverbial poor, a health care crisis will always be with us. Thus he fails to distinguish problems we can (eventually) avoid from those we can’t. And he conflates causes that affect all rich countries with those specific to the US. To avoid over-reacting to Obamacare’s problems and rushing into the arms of a snake-oil salesman promising the unobtainable…. to spot the Obamacare reforms which will help, we need to understand the reasons and distinguish the cases.

To help you do that, I offer, over four blog posts, a guide to why no rich country can avoid permanent health care crisis and why it is so hard to fix the US-only problems. Continue reading

Ted Cruz got Obamacare right—massive transfers from the healthy; His contempt shows Republicans’ health care bind

Last week’s CPAC conference’s discussion of health care was dominated by (yet more) calls for Obamacare’s repeal, along with preeminent mocker, Sarah Palin’s memorable I do not like this Uncle Sam. I do not like his health care scam.” More measured Republicans worried that CPAC offered no constructive health care suggestions and ignored the new Republican alternative to Obamacare.

No one seems to have noticed that Ted Cruz fairly accurately characterized Obamacare as “a massive wealth transfer from young healthy people to everyone else.”  That’s a pity. That sentence and Cruz’s contempt for such transfers are revealing. They show that Republican rhetoric conflicts with the economics of health insurance, in particular with the fact that only government interfering in the market can solve our health insurance problems. Republicans can only produce good health care policy when they build it on a base of reality.

Here is the economic reality that Cruz misses: health insurance consists of transfers from the healthy to the sick. It’s just like fire insurance. Everyone pays premiums. Those who have fires get massive transfers of wealth, paid for by those who don’t have fires. All insurance is about transfers from the lucky to the unlucky.

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Journalists Need More Than Free Access to Best-Selling Academic Papers

Ezra Klein thinks he understands the real reasons Nicholas Kristof is frustrated with academics. It’s not that we write badly. That’s actually good, at least for journalists’ livelihoods: Since academics “write in jargon but speak in English,” journalists can “arbitrage,” translating academics’ work for the public. So, Klein is not focused on helping academics reach the public themselves, as I was in my reaction to Kristof.

Klein believes journalists’ real problems with academics are that academic journals are “wildly expensive” and there is no “academic equivalent of a best-seller’s list,” making it hard to find interesting papers.

I am skeptical. I think Klein vastly under-estimates the distance that most academic writing and most academics would have to travel to be relevant and understandable to journalists. His suggestions, while laudable, won’t bridge much of that gap.

My skepticism comes from my own experiences in academia, particularly too many hours scrutinizing endless equations or convoluted writing trying to tell if an academic paper in my own field was convincing or useful. And I fear that many academics cannot extract from our work what matters to the public and explain it clearly. In fairness, much of what we academics do is intrinsically complex.

I suspect that Klein is optimistic about journalists and academics’ papers because he unconsciously envisions many academics like the ones he hangs out with.  They explain well and have their pulse on what matters for the public. And there is another problem with Klein’s optimism: quite frankly, most journalists are not going to “get” complex analytical material as well as he does. Continue reading

The Ferocious Winds Blowing Us Towards Inequality For All: Four Ways to Stop Over-promising about Higher Education

During the closing credits of Robert Reich’s documentary, Inequality for All, some of those profiled describe how, now inspired, they plan to take action against inequality. Erika Vaclav—Costco worker, mother, former owner of a foreclosed Condo and wife of laid-off Circuit City manager—plans to follow her husband into higher education. With the song 9-to-5 playing in the background, she says proudly, “I want to become a lawyer.”

My heart sinks. Erika doesn’t know that law school graduates now struggle to get jobs or that lawyers’ earnings and job security have plummeted. Erika envisions a law degree taking her permanently into the middle class. I envision it leaving her with much debt and few job prospects.

The jobs of the highly educated are not immune to the information revolution or globalization. Lawyers are hurting in part because software can do discovery (searching documents for relevant information) more cheaply than live lawyers. Other educated workers are also likely to be hit by the ferocious winds of the Information Revolution blowing towards inequality.

Professors, policy wonks and politicians—not just Reich but many of us—need to incorporate these forces into our policy pontifications. Let’s stop over-simplifying and stop over-promising what higher education can do. If we don’t, we’ll misdirect and mislead people like Erika. Continue reading

What Kristof and His Critics Missed: Journalism’s Obsession with Newness Helps Keep Academics Obscure—Or Why Ezra Klein is Even More Right

Nicholas Kristof ignited fierce protests—and enthusiastic support—by saying that most academics “don’t matter in today’s great debates,” because they (we!) write dreadfully and in obscure journals, rather than for broad audiences. Both Kristof and his critics got a lot right. But they focused on what academics and academia do wrong and right, missing what journalism does to make the problem worse.

Coincidentally, only weeks earlier Ezra Klein, a fantastic wonky journalist, articulated journalism’s problem, explaining why it drove him to start a new journalistic enterprise:

New information is not always — and perhaps not even usually — the most important information for understanding a topic… Today, we are better than ever at telling people what’s happening, but not nearly good enough at giving them the crucial contextual information necessary to understand what’s happened. We treat the emphasis on the newness of information as an important virtue rather than a painful compromise.

Journalistic outlets today provide news, not what Jay Rosen describes as helping “us grasp the stories we care deeply about.” Why does journalism’s obsession with newness hinder academics trying to reach broad audiences? Continue reading