It is the damn price, stupid!

For a couple of years, my primary care physician has talked to me about colonoscopy.  A well-accepted preventive care routine, he has assured me.  And, yes, when doing that, they will also check the state of my prostate.  And, yes, the insurance will pay for most of the expenses too.

"Let me think about it," is my typical response to him.  I have been putting this off for a while now.

If I were to pay out of my pocket, I would not undergo this. 

Given my dietary habits, the type-4 "regularity," if you get my drift, and a near-maniacal approach to a healthy living means that it is an ultra-low probability of something wrong in the colon.

In addition to the discomfort with the process, it is also insanely expensive--if I were to pay for it.  The cost of colonoscopies is typical of the most important problem in healthcare in the US: The astronomical prices:

Colonoscopies offer a compelling case study. They are the most expensive screening test that healthy Americans routinely undergo — and often cost more than childbirth or an appendectomy in most other developed countries. Their numbers have increased manyfold over the last 15 years, with data from the Centers for Disease Control and Prevention suggesting that more than 10 million people get them each year, adding up to more than $10 billion in annual costs.
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While several cheaper and less invasive tests to screen for colon cancer are recommended as equally effective by the federal government’s expert panel on preventive care — and are commonly used in other countries — colonoscopy has become the go-to procedure in the United States. “We’ve defaulted to by far the most expensive option, without much if any data to support it,” said Dr. H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice. 

If I were to pay for the colonoscopy, I would think about the benefit from such an expense.  For now, it is clear--way expensive and not worth it, irrespective of the fact that the insurance company picks up the tab.

Colonoscopy is merely an example of the pricing aspect of the healthcare crisis.  All Obamacare, which trump and the Republicans failed to repeal-and-replace, does is to make that healthcare affordable; there is nothing being done- to bring down the prices.

The Affordable Care Act did many things. It extended coverage to millions of Americans and created a more equitable health insurance market that treated healthy and sick patients equally.
But that law did not tackle the unit price of health care in the United States.
“The ACA didn’t change the trajectory at all,” Hopkins’ Anderson put it bluntly.
The ACA made health care more affordable in the sense that more Americans have someone else (Medicaid or a private insurance company) paying the majority of those medical bills.
But the medical bills themselves didn’t actually shrink — and that will vex any effort at reducing the cost of American health care going forward.

Ah, but do not ever reflexively think this is the market at work:

“In the U.S., we like to consider health care a free market,” said Dr. David Blumenthal, president of the Commonwealth Fund and a former adviser to President Obama. ”But it is a very weird market, riddled with market failures.”                                         

We are screwed!

What's the price of retail jobs?

The pussygrabber ranted on and on about jobs in the coal mines, as if he knew anything about the industry or the people who work.  But, 63 million suckers voted for him anyway!

If only his voters had paid attention to the real world, they would have been worried about an entirely different industry: "The retailing industry employs 15.9m people, accounting for one in nine American jobs."

The retail industry is shedding jobs, and closing stores, are frightening speeds:

 Since January the industry has shed 50,000 jobs, with more lay-offs sure to come. Mr Mathrani reckons that, for shopping centres to match demand, 30% of space should close permanently. In one particularly gloomy scenario, all retail property would shrink by as much. If staff dropped by the same proportion, 4.8m would be at risk of the sack—around half the number of American jobs lost during the financial crisis. Eventually, even more may be laid off, as remaining stores cut costs through automation.

Did you notice that "a" word?  Automation!

The result is that America’s rich landscape of shops now looks like a dangerous glut. Since the start of 2016 Macy’s has announced that it is closing 140 shops. J.C. Penney said in March that it would shut 138. More closures are sure to come. Department stores’ floor space has contracted by 11.5% since 2006, but sales have shrunk more than twice as fast, according to Green Street Advisors, a real-estate research firm (see chart 2). To reach the inflation-adjusted sales productivity of 2006, at least another 800 department stores would need to close, reckons D.J. Busch at Green Street.

In the world of politics, it is coal that translates to diamond when it comes to votes:

This slow melt has so far attracted little attention from politicians, despite jobs in retailing outnumbering those in coal mining, which has caught the political eye, by a factor of 300.

Meanwhile, automation in retailing is taking on another fundamental aspect of the transaction: price.

The right price—the one that will extract the most profit from consumers’ wallets—has become the fixation of a large and growing number of quantitative types, many of them economists who have left academia for Silicon Valley.

Yep, "the right price can change by the day or even by the hour" thanks to automation, which is killing the real world stores:

Guru Hariharan uncapped a dry-erase marker in a conference room at Boomerang’s headquarters in Mountain View, California. He was talking about what had led retailers to this desperate place where it’s necessary to change prices multiple times a day. On a whiteboard, he drew a series of lines representing the rising share of online sales for various kinds of products (books, DVDs, electronics) over time, then marked the years that major brick-and-mortar players (Borders, Blockbuster, Circuit City and RadioShack) went bankrupt. At first the years looked random. But the bankruptcies all clustered within a band where online sales hit between 20 and 25 percent. “In this range, there’s a crushing point,” Hariharan said, clapping his hands together for emphasis. “There’s a bloodbath happening.”
Beyond this crushing point, traditional retailers with both a brick-and-mortar and an online presence feel compelled to compete purely on price. Hariharan talked wistfully of the days when he’d walk into RadioShack and have a salesperson direct him to the exact connector cable he needed. But once retailers enter the crushing zone, expenses like staff, training, and customer support typically are slashed. Profit margins keep falling nonetheless—why go to the store at all if no one there can help you?—and a death spiral ensues. (RadioShack traced just this path before filing for bankruptcy in 2015.)

Yet, the pussygrabber always talks about those few thousand coal mining jobs?

The older I get, the more I hate college football

In the market economy, we certainly know how to put a price on anything and everything, irrespective of how much we value that item or the work that a person does.

Take for instance the snow that has been piling up in Boston.  Imagine if the workers whose job it is to clear the roads and streets did not show up for work. Or threatened to go on a strike.  We immediately see the value of the work they do, right?  These are real services they provide, without which quite of bit of life in Boston will come to a standstill.  One would think that they will be highly paid.

source

Or, take elementary school teachers as an example.  We trust them with what pretty much every parent would consider to be the most precious in life--their children.  Teachers who have immense opportunities to shape or ruin their children's futures.   One would think that they will be highly paid.

Instead, you and I and the other billions of humans collectively prefer to pay people for services that we could easily do without.

Take, for instance, the latest news about a college football coach. At the university in the town where I live.

The University of Oregon will pay at least $17.5 million to keep winning football coach Mark Helfrich on his home turf for another five years.

$17.5 million!  Other than this guy who is now spending some of his fortunes on a road trip, I doubt whether any reader of this blog really knows what $17.5 million mean.  I have no freaking clue how to understand that kind of a money.

$17.5 million for coaching a football team.

The market, my friend, knows how to put a price but has no fucking understanding of value!  This is the system that we are stuck with.  Especially when the people can't get enough entertainment in their lives.  To heck with the children in the second grade, but goddammit we shall have entertainment 24x7!

You want more references to understand the distorted and screwed up emphasis on entertainment?

Helfrich’s annual salary is now about six times the UO president’s compensation.

Let me recap.
The coach is for a football team, whose existence is made possible by the university whom the players represent.
Without the university, there will not be students.
Without students, no football team.
The university is there to educate students.
One would think that, therefore, the educator-in-chief, the university president, would be the highest paid officer, right?
But, the coach earns six times what the president is paid!

According to the USA Today coaches salaries database, Helfrich — whose previous annual salary of $2 million ranked 52nd nationally and 10th in the Pac-12 — is now fourth among his Pac-12 counterparts and tied for 22nd nationally with an immediate base-pay raise to $3.15 million.

That, my friend, is how "the market" works!  But, we are stuck with it because the great alternative was infinitely worse.

Keep this in mind the next time you try to convince me, or somebody else, or even yourself, on the glories of the market!

BTW, because a $17.5 million can barely cover the caviar bill:

Some of the fringe benefits in Helfrich’s contract include:
Two courtesy cars.
Membership to the Eugene Country Club and the Downtown Athletic Club.
Use of a skybox suite and 12 tickets to home football games; four tickets to home games of Oregon’s other varsity sports.
Travel for his spouse to regular-season road games and for his spouse and children to postseason games.

Meanwhile, the road cleaning crew in Boston gets ready for another dump on Thursday.  The elementary school teachers spend their own money for supplies.  We pay bullshit jobs quite a bit, and make sure we would attack the real value adders if they asked for an Oliver Twist-more!

in our society, there seems a general rule that, the more obviously one’s work benefits other people, the less one is likely to be paid for it.  Again, an objective measure is hard to find, but one easy way to get a sense is to ask: what would happen were this entire class of people to simply disappear? Say what you like about nurses, garbage collectors, or mechanics, it’s obvious that were they to vanish in a puff of smoke, the results would be immediate and catastrophic. A world without teachers or dock-workers would soon be in trouble, and even one without science fiction writers or ska musicians would clearly be a lesser place. It’s not entirely clear how humanity would suffer were all private equity CEOs, lobbyists, PR researchers, actuaries, telemarketers, bailiffs or legal consultants to similarly vanish.

We are fucked up!

ps: I am sure there will be some who will claim that these are not representative of a free market.  But, hey, that claim is no different from die hard Marxists' claim that the USSR was not practicing true Communism.  So, no point talking about some Utopian version of anything that does not exist on this planet.

The market for boobs. The market is for boobs.

The first time I read about the Tulip mania, I simply could not believe that people could have bid up on Tulips. I mean, Tulips! A flower!

If people could have bid up on Tulip bulbs, well, I figured that people are capable of bidding on any damn thing.  As long as people feel that the price is right and that they are coming out ahead.  It is one heck of a strange economic system that I will never truly, emotionally understand, though I can pretend to intellectually grasp the idea.

It is one thing to put a price tag on goods in the market.  But, do we really want to find out what the best price is that will work as incentives for mothers of newborns to breastfeed?  The longer I live, the less I will understand anything, I fear!

New mothers are to be offered up to £200 in shopping vouchers to encourage them to breastfeed their babies.

Seriously?  British mothers don't understand that concept on their own?  I am willing to bet all the tulips that new mothers have a whole range of reasons, perfectly rational reasons, for why well-informed new mothers choose not to breastfeed even when they biologically can.

Btw, how did they arrive at 200 pounds?  Why not 100?  Or 2,000?  Aaaaah, I should stayed back in engineering and earned my millions and retired like how my super-wealthy friend is in retirement now!

How will this incentive scheme be implemented?

Midwives and health visitors will be asked to verify whether the women are breastfeeding.

Sounds like this is from the Onion, right?  If only it were a joke!

XX Factor's take appeals to me:

What is almost never discussed in these exhortations to breast-feed is how hard it can be on mothers, particularly without social support. At the beginning, you are waking up several times a night to feed, and you’re exhausted and drained. If you don’t have a lot of help with your children—perhaps you are a single mother—and you have to go back to work, you might want those extra hours of rest more than you want £200. You might be able to be a better parent to your other kids with that extra sleep and energy, or you know, just a happier person.
...
I just don’t see how breast-feeding is so important we should consider spending government money to bribe women to do it.

As if this is not enough to make me wonder about incentives and price, I am reminded of the news from a few days ago about breast milk bought online here in the US having salmonella and E.Coli.  Which raises a whole number of questions: buy and sell breast milk? And online at that?

Three quarters of the purchased human milk was contaminated with gram-negative bacteria that can pose serious health risks in babies, the researchers found. Three of the samples were contaminated with salmonella. E. Coli was also detected in some samples, an indicator of fecal contamination. 

I certainly would not have imagined "fecal contamination" and "breast milk" in the same sentence.  I tell ya, it is one heck of a brave new world!

As of now, the sale of human milk via the Internet is almost entirely unregulated. Based on the postings on the milk-sharing sites, the sellers are mostly mothers who have a freezer full of expressed milk and aren't sure what to do with it, Keim said. The buyers are mostly women who have had trouble producing enough milk -- or any milk -- and were determined to feed their babies breast milk.

So, will we develop regulations on this?  Will there develop a black-market for breast milk?  Dark alley transactions?

Source

Maybe I am simply getting old.  Maybe this is how my grandmothers felt when they faced the changes during their times.  As much as I wonder how all these are also part of "progress," I am sure the generations that went before us had their own pangs over "progress."

The intellectual me understands these developments. The emotional me, on the other hand, finds all these just bizarre.

The world was way simpler, and fun-filled, when I was a single-digit-aged kid in PK Master's maths class!