Published in The Tennessean, Sunday, March 31, 2013 and the full version at FORBES with archives.
Richard J. Grant
A reader writes, “The Center for Economic Policy and Research found
that the minimum wage would be $21.72 an hour if it kept pace with
increases in worker productivity.” Touting data from the same study, in a
U.S. Senate committee hearing last week Sen. Elizabeth Warren
(D., Mass.) noted that the current federal minimum wage of $7.25 falls
short of the productivity indexed estimate of “about $22 an hour.” She
asked, “What happened to the other $14.75? It sure didn’t go to the
worker.”
Sen. Warren’s question is absurd for the same reason that it would be
wrong to assume that all senators share her economic illiteracy. Just
as not all senators are equal, not all workers are equal. Each worker’s
productivity level differs from others depending on attitudes, skill
levels, and the types of tools available to the worker. Productivity is
generally higher in jurisdictions with greater economic freedom, which
means less government interference.
Labor productivity estimates are statistical averages; but minimum-wage
workers are not average. The $21.72 estimate is itself above average
because it applies only to non-farm productivity. The CEPR’s
productivity estimate for the broader population is $16.54, which is
still an average and is well above the marginal productivity of
minimum-wage workers.
People often confuse a statistical average for an actual event or entity. While we all laugh when we hear ...
Richard J. Grant is a Professor of
Finance and Economics at Lipscomb University and a Senior Fellow at the Beacon Center of
Tennessee. His column appears fortnightly on Sundays. E-mail messages
received at: rjg@richardjgrant.com
Follow on Twitter
@richardjgrant1
Sunday, March 31, 2013
Sunday, March 17, 2013
Medicaid benefits politicians more than it benefits citizens
Published in The Tennessean, Sunday, March 17, 2013 and the full version at FORBES with archives.
Richard J. Grant
Richard J. Grant is a Professor of Finance and Economics at Lipscomb University and a Senior Fellow at the Beacon Center of Tennessee. His column appears fortnightly on Sundays. E-mail messages received at: rjg@richardjgrant.com
Follow on Twitter @richardjgrant1
Richard J. Grant
In how many
states have the governors or legislators claimed that their state would be a
net beneficiary of federal spending for Medicaid expansion? There are
supporters of Medicaid expansion in all 50 states who do make such claims. But not
everyone can be a net beneficiary of subsidization.
When
redistribution is the game, someone must be a net contributor. What becomes important
here is that the burdens borne by such contributors are not necessarily
relevant to the decision process. The question of whether Medicaid expansion
brings net benefits to a state is a less-useful predictor of a state
politician’s actions than is the expected effect of that expansion on the politician’s
reelection chances. ...
Richard J. Grant is a Professor of Finance and Economics at Lipscomb University and a Senior Fellow at the Beacon Center of Tennessee. His column appears fortnightly on Sundays. E-mail messages received at: rjg@richardjgrant.com
Follow on Twitter @richardjgrant1
Sunday, March 03, 2013
What does Medicaid mean to governors?
Published in The Tennessean, Sunday, March 3, 2013
and the full version at
FORBES with archives.
In the coming weeks, several state governors will attempt to increase low-income citizens’ access to medical services by expanding a state-federal program that, on average, pays doctors 40 percent less than private insurers pay. How wise is this?
When you pay less, eventually you’ll discover that you are getting less. In the case of Medicaid programs, we found that out pretty quickly. Medicaid has created a class of medical consumers that do not have either the incentive or ability to consider the cost of the services they consume. As with any third-party payment system, which gives the illusion of someone else paying, patients tend to demand far more medical services than they would if they believed they could spend any savings on something else.
In this regard, Medicaid works less well than food stamps. Whatever the flaws of the food stamp program, at least it does not require grocers to accept 40 percent less for food-stamp payments than they would from other customers. But that is exactly what Medicaid does to doctors and, as a result, many doctors are limiting their acceptance of Medicaid patients. Some doctors refuse to see Medicaid patients at all.
The current drive to expand Medicaid is really just an attempt to correct the problems created by the existing Medicaid and all the other government programs and regulations that have similar effects. During the 2010 health care reform debate that resulted in the utopian Affordable Care Act, opponents often claimed that this would result in the nationalization of 16 percent of the economy. But the difference from the status quo was not really that great.
Governments have long accounted for more than half of all medical expenditures, and health care is one of the most heavily regulated industries in America. The supply and qualification of doctors is restricted by governmentally enforced licensing requirements, not by a free market. Rather than seeing health and medical care as a profit center – a center of value creation, characterized by innovation and free competition to provide the best service – our governments have tended to treat medical services as a cost center.
Do our governors really believe that they can reduce the cost of medical care by decreeing lower prices? They have never succeeded in doing so and never will. Whatever advances we have experienced in medical care have been despite the misallocations caused by government interference. Had we regulated the electronics industry as tightly as the medical industry, then much of the diagnostic and informatic equipment that we now take for granted would not have been invented here. Even government-directed medical research money is redirected from some other research or productive use.
When we recognize these alternatives, we perceive a much bigger cost. The government might pay Medicaid doctors a lower price, but Medicaid patients have trouble finding doctors, wait longer for appointments, and have poorer medical outcomes than they would in a system that is more respectful of social realities.
Few people would begrudge giving assistance to the poor through charity or an efficient government program. But Medicaid is neither of these. We can do better.
Just as Medicaid creates counterproductive incentives for doctors and even for hospital administrators, the existence of the program and the possibility of its expansion create perverse incentives for many state governors.
For a state governor, the ultimate third-party payer is the federal government. As long as a significant number of voters believe that the federal government will always benevolently subsidize their state, they will be unhappy with a governor that turns down what they naively believe to be free money.
The decision rests on the governor’s integrity.
FORBES with archives.
In the coming weeks, several state governors will attempt to increase low-income citizens’ access to medical services by expanding a state-federal program that, on average, pays doctors 40 percent less than private insurers pay. How wise is this?
When you pay less, eventually you’ll discover that you are getting less. In the case of Medicaid programs, we found that out pretty quickly. Medicaid has created a class of medical consumers that do not have either the incentive or ability to consider the cost of the services they consume. As with any third-party payment system, which gives the illusion of someone else paying, patients tend to demand far more medical services than they would if they believed they could spend any savings on something else.
In this regard, Medicaid works less well than food stamps. Whatever the flaws of the food stamp program, at least it does not require grocers to accept 40 percent less for food-stamp payments than they would from other customers. But that is exactly what Medicaid does to doctors and, as a result, many doctors are limiting their acceptance of Medicaid patients. Some doctors refuse to see Medicaid patients at all.
The current drive to expand Medicaid is really just an attempt to correct the problems created by the existing Medicaid and all the other government programs and regulations that have similar effects. During the 2010 health care reform debate that resulted in the utopian Affordable Care Act, opponents often claimed that this would result in the nationalization of 16 percent of the economy. But the difference from the status quo was not really that great.
Governments have long accounted for more than half of all medical expenditures, and health care is one of the most heavily regulated industries in America. The supply and qualification of doctors is restricted by governmentally enforced licensing requirements, not by a free market. Rather than seeing health and medical care as a profit center – a center of value creation, characterized by innovation and free competition to provide the best service – our governments have tended to treat medical services as a cost center.
Do our governors really believe that they can reduce the cost of medical care by decreeing lower prices? They have never succeeded in doing so and never will. Whatever advances we have experienced in medical care have been despite the misallocations caused by government interference. Had we regulated the electronics industry as tightly as the medical industry, then much of the diagnostic and informatic equipment that we now take for granted would not have been invented here. Even government-directed medical research money is redirected from some other research or productive use.
When we recognize these alternatives, we perceive a much bigger cost. The government might pay Medicaid doctors a lower price, but Medicaid patients have trouble finding doctors, wait longer for appointments, and have poorer medical outcomes than they would in a system that is more respectful of social realities.
Few people would begrudge giving assistance to the poor through charity or an efficient government program. But Medicaid is neither of these. We can do better.
Just as Medicaid creates counterproductive incentives for doctors and even for hospital administrators, the existence of the program and the possibility of its expansion create perverse incentives for many state governors.
For a state governor, the ultimate third-party payer is the federal government. As long as a significant number of voters believe that the federal government will always benevolently subsidize their state, they will be unhappy with a governor that turns down what they naively believe to be free money.
The decision rests on the governor’s integrity.
Richard J. Grant is a Professor of Finance and Economics at Lipscomb University
and a Senior Fellow at the Beacon Center of Tennessee. His column appears fortnightly
on Sundays. E-mail messages received at: rjg@richardjgrant.com
Follow on Twitter
@richardjgrant1
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