Thursday, June 28, 2012

Health care Court decision

http://www.npr.org/blogs/health/2012/06/18/155269171/supreme-court-upholds-care-health-law-rules-mandate-is-a-tax
http://www.kqed.org/a/forum/R201206280900

I think the health care economics effects of this legislation are still too opaque to comment on (plus I am fairly ignorant), but in terms of effects on the campaign, it should get interesting. Obviously it's a win for the Dems, but it may become a rallying cry for the GOP. Though if you look at things logically, I don't think this legislation should be the prominent conservative issue that it is (and why is it so unpopular and getting more so? misinformation?). I guess the right doesn't really have much else to work with besides the economy, though. The candidate the GOP chose is obviously not in a great strategic position to advocate Obamacare repeal. But really, I don't think true conservatives should so dislike this health care reform. It's far from perfect (and we all had plenty of debates together 2 years ago), but look at the underlying principles:

- Conservatives don't like "free riders" right? Insurance only works by spreading out risk, especially if they are now not legally able to price discriminate (or reject) based on customer traits (which most of us feel is ethical - shouldn't pregnant women be the first to be covered and not blacklisted?). It won't work if the healthy and young skip out on health insurance premiums, leaving only the older and sicker (and gov't) to pay - another manifestation of the generational conflict? And then when the uninsured need care, they often burden the system by using emergency services and may not pay full cost. The sick don't get off Scot free either, since they will still pay more into the system in the form of copays.

- Conservatives feel that the Constitution is their 2nd Bible, right? The conservative-leaning High Court ruled that most of the Affordable Care Act is constitutional, with the Chief Justice siding with liberals and writing the majority opinion (so it's not like the liberal justices hijacked the ruling - they can't anyway). They keep accusing the Dems of trampling on the Constitution, but what about now? And no one questions Roberts' conservative chops. He said that the Court's job is to decide whether Congress acted within its powers, not judge the merits of what the bill would do. So if the GOP don't like it, write a better reform. But now if they want to repeal Obamacare 100%, they're going to piss off people who think it's not right that the current insurance market excludes pregnant women and unemployed adult students.

- This Act doesn't force anyone or "take away" any freedoms (the "mandate" was kind of a misnomer). Americans still have a choice whether to buy coverage or not. They just have to fork over a small (~$300/year) fine/tax to pay for the social cost of their decision. Those funds will be used to make health care more affordable to the needy, which benefits everyone. The young and healthy may take that choice anyway, since the cheapest individual health plans they could get would run $1-2K/year, until the health exchanges maybe become efficient some day. Employer health care will be preserved, and customers may even get rebates. This is no different than other laws: I can have a non-neutered dog if I want, but I just have to pay a higher registration fee due to the risk I am imposing on my community.

But the problem is the anti-Obama crowd doesn't care about these facts. Everything he does is automatically evil and un-American, so he has to be stopped. They want to go back to 2008 (minus the recession I hope). So how to convince them that this really won't be as bad as they fear (and were taught to fear by the right wing media)? But by all means, if they have better ideas on how to reduce our health care expenditures (which is the highest % of GDP in the world, and in terms of raw dollars, and growing much faster than inflation) and make it more available, we're all ears.

PS - I think it's funny that Romney and Obama probably both had 2 versions of speeches (or more) prepared for today

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http://www.cbsnews.com/8301-3460_162-57464549/roberts-switched-views-to-uphold-health-care-law/?tag=contentMain;contentBody
http://news.yahoo.com/roberts-switch-health-care-signals-leaky-supreme-court-195755275.html

There's quite a bit of chatter on the possibly clerk-leaked revelation that Roberts changed his mind mid-course on the health care reform decision. If true, this would be an unprecedented breach of confidentiality and a major betrayal in Court history (especially considering that the leak came just 4 days after the Court revealed its decision). I guess some conservative circles (and maybe even Roberts' right-leaning peers) viewed his act as betrayal as well, but does that justify this significant breach of decorum? Like the Wikileaks fiasco with the State Dept, I think this leak will only serve to erode trust and collaboration on the Court, and ultimately hurt our ability to govern. I think people are allowed to change their mind sometime, especially when confronted with new evidence and arguments. People don't have to vote along party lines all the time, otherwise why not just have the parties rule the nation? And even within each party, there is quite a diversity of opinions (maybe begging the question: why not have more parties like the rest of the developed world?).

The right chastised Obama for supposedly deliberately leaking details of his anti-terrorism decisions to shore up his defense chops, but where is the outrage over this SCOTUS leak? But getting back to the Roberts court, this leak is another public example of the right's disrespect and intolerance (Barton yelling "You lie!", ludicrous birther/Muslim accusations, etc.). I know the right feels that "gov. is the problem", but I thought they also believed in the sanctity of the Constitution, respect for American traditions, US exceptionalism, etc.? Begging your pardon, but they're acting more like trailer trash Republicans than Lincoln or TR Republicans. Though I wonder where Roberts goes from here. Will his future decisions be more conservative in order to get out of Scalia's doghouse? Or will he be so offended by this act that it will push him more centrist or liberal? I am not sure what cases await them in the next Court session, but it should be interesting. Though I think the SCOTUS is one of those institutions that does a good job if it seems "boring" and stays out of the headlines. It would be a real tragedy if this controversy becomes new precedent, and the already over-politicized Court becomes more so in the future. 

Wednesday, June 27, 2012

Generational warfare during the recession

http://www.thedailybeast.com/newsweek/2012/06/24/david-frum-on-how-we-need-to-learn-to-say-no-to-the-elderly.html

The long slump has revealed the preferences of the aging polities of the Western world. [Economics blogger Steve Randy Waldman:] “Their overwhelming priority is to protect the purchasing power of incumbent creditors. That’s it. That’s everything. All other considerations are secondary”—-including economic recovery.

We could jump-start the economy with a massive jolt of monetary and fiscal stimulus, but such a policy would risk inflation and pose a threat to retirement savings. So we don’t do it. We could borrow money to finance infrastructure programs that would set people to work now and enrich society over the long haul—but that borrowing would have to be serviced by taxes to which older Americans fiercely object. So we don’t do that either. - D Frum

Modern politics are so insane that now I'm quoting David Frum! Well, at least guys like Frum, Brooks, and other sane conservatives from the "Buckley school" (http://www.kqed.org/a/forum/R201206131000) are trying to pull the GOP back from the brink. In this article, Frum describes how the 1-vs-99 percent conflict is also a generational conflict, since older folks tend to have more assets per capita, and tend to vote more often than the young.

It's humorous that some deficit hawk conservative politicians claim that we need to balance the budget now so we don't saddle future generations with terrible debt. Well if they cared so much about the kids, then why are they cutting gov. spending that would directly benefit kids now and in the future (infrastructure, education, etc.). And in the meantime, they're cutting taxes to the rich (who are mostly old people + the nerds in Si Valley) and expanding or maintaining unsustainable Medicare spending (the Bush Era Rx drug expansion, with its lack of price bargaining, has cost America more than all the wars on terror combined). Old fogies are now more libertarian-leaning and opposed to an activist gov. compared to when they were younger hippies. Well that's understandable - they made their dough and now they want to be left alone to enjoy it, unless the activist policies benefit them of course.

The Fed was created to have a dual mandate: keep inflation AND unemployment at reasonably low levels. Now it's just concerned with inflation and protecting the value of capital (and who controls the capital?). Most non-ideologues with half a brain realize that we can't "cut our way to prosperity". Even with major budgetary restructuring, spending cuts during a recession will hurt a lot more now vs. what they may help in the future. You have to spend, and gradually throttle back and pay it down when you're enjoying more robust growth. So for the conservatives to focus on debt without addressing lack of growth is like the doctor working on your acne but ignoring your tumor. When their "cut the debt AND give rich tax breaks" argument fails, then the GOP turn to the "roll back job-killing regulations" line. There is some truth that inconsistent and irrationally complex US regs can be a business hurdle, but I think smarter regs are the answer vs. no regs. Plenty of thinking conservatives support that view.

But going back to the generational war and inflation... one side-effect of Keynsian spending is that inflation will rise. It's an economic maxim. That means that savings and other assets will lose a little value. And rich old savers don't like that (aww, their $100M net worth is now worth $99M, shucks). They'd rather force the young to suffer in order to protect their coin. And it's not like we're talking about pre-Nazi Germany or Zimbabwe here. Inflation in the US is at historic lows and very stable vs. most of the world. Everyone is flocking to buy dollars and US Treasuries. A few points rise won't kill us in order to stimulate growth, and in fact may have a few side benefits: makes our debts cheaper to pay off and our exports more attractive, for example. Like most of economics, a rise in a certain metric always has both pros and cons.

The Millennials could be the first US generation with a bleaker future (on average) than their predecessors, with the "American Dream" out of reach to more of them. Their parents and grandparents (Boomers and Gen X) should be ashamed of themselves for putting their progeny in such a situation. I've already posted about the pains that unemployment causes on a recent graduate's psyche and lifetime earning potential (http://www.blogger.com/blogger.g?blogID=795070259362236467#editor/target=post;postID=5441080136358967453), and with rising student debt (this is a great interview that I'll discuss soon: http://www.npr.org/2012/06/26/155766786/whats-driving-college-costs-higher) and leaner workforces, it's even worse now. Of course the fogies would say that it's their own damn fault (lazy, spoiled punks!). Well as J previous wrote, if it's even true, who raised them to act like that? I tend to dislike kids for other reasons, but some stats suggest that Millennials are more eco-conscious, law-abiding, and volunteer more often than any other generation. So they're not just a bunch of pot-heads waiting for their inheritance (well, maybe some are). They want to work and contribute, but the fogies are making that really hard, and all the while expecting the young to support them (despite having less wealth).

As political scientists Theda Skocpol and Vanessa Williamson found in their study The Tea Party and the Remaking of Republican Conservatism, the general anti-government attitude of today’s retirees is heavily seasoned with mistrust and dislike of today’s youth. “[Y]oung people feature prominently in stories Tea Partiers tell about undeserving freeloaders.” They don’t exempt their own children—in fact, it is often their own children and grandchildren toward whom they direct their angriest scorn. As one elderly activist quoted by Skocpol and Williamson puts his generational irritation: “My grandson, he’s fourteen, and he asked me: ‘Why should I work, why can’t I just get free money?’” (A comedian’s riposte: “The Tea Party is God’s judgment on us for teaching our parents how to use the Internet.”) - D Frum

Important tenets of conservatism is self-responsibility and earning what you get. I guess that's why many of them are so against welfare and other "handouts". They see success in a context vacuum; everyone can be a self-made man, and if you fall short it's your own fault so don't cry for help. Well if that's true, then why are the most successful Westerners today more often the children of powerful, educated, and rich people? Why do guys like Donald Trump get to keep failing and get more chances (and handouts)? I can spare you the rhetoric, you know it's not an even playing field out there. It's like the Yankees mocking the A's for not winning enough. But I can see where some of them are coming from. The fogies worked their asses off and now want to enjoy their retirements, as their predecessors and their values said they deserved to. But at what cost? It's not the 1950's anymore. Will they protect their twilight years at the expense of millions of future Americans - not just the Millennials but many generations after them? Because I assure you that our mistakes from this botched recovery will burden America for at least the next half-century. And it's not like every fogie is rich. My wife and I often comment about the haggard elderly people in SF rummaging through trash cans to find recyclables. Those folks deserve a social safety net, but why should George Bush Sr. get gov. benefits? Even if he is an ex-president, that doesn't mean he deserves to be a burden on the nation when he's already self-sufficient.

In nature, organisms exist purely to produce the next generation, and protect them until they are strong enough to flourish on their own. In fact, after some species procreate, they die. They have fulfilled their biological purpose, and return their matter to the earth for others to use. Of course I am not advocating elderly euthanasia here, but there is some logic into the old helping the young. Because ultimately there is more to gain from that. Think of Shell Silverstein's famous "The Giving Tree". That story still makes me cry. What if the tree complained all day and nagged the boy/man to keep giving it better fertilizer? It's not right. Maybe in our modern economy it's a bit different, with old people running gov. and industry. So their brains are still needed for society. But the innovation and energy are coming from the young, and I don't think old people are the only ones qualified to lead. So kids should be given the majority of resources, because the future of our civilization depends on their success. And they will do the same for their kids when they age. There should be no higher duty and privilege for a parent to sacrifice for his or her young (within reason of course, and I don't mean buying them a Mustang for their 16th birthday). But unfortunately, our culture places a higher premium on personal legacy, hedonism, and the good-and-bad tradition of filial piety in some cultures. So the old would rather have the young serve them, maximize their imprint on the world, and enjoy life rather than sacrificing for the progeny, which should be hard-wired in our DNA.

Look at Fukushima (http://www.bbc.co.uk/news/world-asia-pacific-13598607). Some old people volunteered to face the radiation to help fix the reactor leak. They didn't force young people to do it, which is the exact opposite of what Americans would do (the old rich assholes send the young to die in their pointless wars), but then again Japan is a lot more of a communal culture. In Japan there are problems with elderly neglect and uprising too, but that is a different matter (http://www.blogger.com/blogger.g?blogID=795070259362236467#editor/target=post;postID=2222532001653943345).

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A couple minor quibbles:

 - The top 1% isn't old people and Silicon Valley.  It's predominantly corporate executives and non-executive finance workers, plus a smattering of lawyers, doctors etc.  Silicon Valley engineers are well-paid, but it's 100-200k, not the 400k+ it takes to make the top 1%.  Moreover, they're not socially connected to the corporate and financial elite that we're generally talking about when we discuss "the 1%."

 - It's not an economic maxim that a side effect of government spending is that inflation will rise.  That's true outside of a liquidity trap, because the additional g't spending will compete for resources that are in use, driving up the price.  But in a liquidity trap (where the real interest rate at which the market clears would require a nominal interest rate below 0%), many of those resources are idle.  Government spending that uses those otherwise-idle resources doesn't necessarily create inflation.  This is a deeply non-intuitive but important result.  It's also the reason that the tripling of the monetary base over the last few years has occurred without creating inflation (to the deep surprise and disappointment of the commentators on the right who've been predicting hyperinflation for the last couple years).


More broadly, I don't think old-vs-young is the right division along which to analyze America's current set of problems.  There is a fault line there, where there are differing interests and opinions, but it's not the main one anymore than the everybody-vs-public-sector-unions division, or even the left-vs-right division.  The right division is insider-vs-outsider - roughly approximated by the 99-vs-1-percent division, though obviously there are folks in the 1% by income who are not what we'd consider policy-influencing elites contributing to our current situation (LeBron James makes a ton of money, and is responsible for a lot of shit, but he's not responsible for our economic policy).  It's that elite, insular group of policy-makers, lobbyists, financial and corporate executives, the high social circles in DC and NYC, the incumbents, vs the rest of us.

These other divisions are certainly real.  And they're made worse by our economic situation.  Human psychology is such that losses count for more than equally-sized gains, so people are much less acrimonious when dividing up the new parts of an increasing pie than they are in apportioning losses from a shrinking pie.  The result is that when we have economic pain to apportion, those divisions of old-vs-young and left-vs-right and so on become a lot more acrimonious.

But they're not the cause of our current problems.  The cause is best understood along that insider-vs-outsider division.
 
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Well what I meant about the 1% is that those financial execs and other professionals tend to be over 50. I don't have data on it, but I would guess that their voting behavior is closer to that of the non-poor elderly than that of the young. For the Si Valley comment, it was mostly a joke aimed at the founding execs like Brin and Zuck (and the VC, PE moguls of the Valley). Connections to big finance are not really necessary - their net worth puts them at the 1% (maybe not their base salary but their total net worth) because big finance wanted a piece of their businesses. Come on, I wouldn't hate on the noble, lowly, public-good-serving engineer with his stock options and Porsche. :)

Good point about inflation; sorry I didn't expand on that point that there needs to be crowding out and scarcity for prices to rise from G spending. As you said, when resources are idle (as they are during the recession), it's almost a no-brainer to spend to utilize those resources (and laborers), even if there isn't market demand for their output. At least they won't be languishing in the unemployment line depressed and frustrated.

I agree about the insiders vs. outsiders distinction as the most critical one. I just thought Frum's piece was interesting, and describes an angle of the situation that we don't often discuss (especially coming from the right). The old-vs.-young thing may not directly apply to policy and power, but more like social-cultural roles and priorities. 

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Ah, ok.  I've long considered the old-vs-young issue to be a fairly standard trope of the right - my mother's pretty far right, and I've been hearing about it from her for most of two decades.

My suggestion on reframing it as insiders-vs-outsiders is to suggest that as the richest country humanity has ever known, we have the ability to support both old and young.  What we don't have the ability to do, apparently, is to support both old and young while also supporting fraud, looting and widespread criminality among the elite.  "Old-vs-young fighting over a shrinking pie" is only a reasonable way to look at it if you ignore the big chunk of pie the elite has stuffed under their shirt and is pretending doesn't exist.
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It seems to me that alot of these divisions (young v. old, black v. white, left v. right, labor v. business) are creations to keep us divided mentally  to keep us from thinking past the current paradigm.
I like your insiders v. outsider comparison.  That's the closest I've seen.  Unfortunately, so many outsiders think they'er insiders and therefore will demonize or denigrate the outisiders as 'others'.
the young v. old prevents alot of people from seeing that the 'young ones' in the streets are there fighting for them, too.  they're not fighting against them, but the framework established keeps those older, disgruntled ones from joining ranks (like they are in greece). 
I think the issue is that many of us out here don't understand the issues.  These divisions are tools used to prevent the general population from understanding those issues. They are angry, sick of being ripped off and tired from overwork, just as the ones who've taken to the streets.  But, they're told over and over again that the ones on the street are whiners and complainers, young lazy blah de blahs... 'not you's'.  Therefore they become the target of your disdain and not the ones who are working you to death, robbing you blind, etc. etc.
Until the 99 in this country sees that we are truly 99 to 1, the 1 will continue to utilize the media techno fog machine to keep us blaming each other while they pick our pockets clean.
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Thanks for the comments you two. I agree - why do the old see the young as a threat? The old made the young, and the young are Americans, so it's not like we are foreign invaders. Unless there is some weird psych-stuff going on regarding self-resentment and whatnot (Frum's comment that the old hate their own grandkids even more than stranger kids), I don't get it. Those without large savings literally depend on the young for survival. They don't have to be all humble and grateful, but at least don't talk so much shit. We're not going to send them to the death panels, and it's the Tea Party that wants to cut or privatize the Social Security "Ponzi scheme". I guess it's part of that conservative suburban paranoia, "bowling alone" syndrome? Especially in America, inter-generational communities are not as common (though they are getting more so due to the recession). The young keep to themselves unless they need grandma to babysit, and the old keep to themselves at FL and Palm Springs golf communities. I guess it's like the GOP and Dems in DC not socializing after work anymore, and now cooperating less on the job.

As L said, we don't make the effort to get to know the other side, we don't empathize, and it's easy to just feel hostility for the unknown, even if they share our last name. Humans are susceptible to groupthink and mob mentality, but don't draw the lines as young-vs-old, black-vs-white cliches, but instead fair, sharing people vs. greedy assholes, or sensible open-minded folks vs. ignorant, intolerant zealots? At least then it's not on demographic lines (too tribal and crude), but on behavioral and personal choice lines. In the sensible group, you will get young, old, rich, poor, black, and white together. They will interact, exchange ideas, and get stronger. Maybe then the old will see that the young have a lot in common and are fighting for them too, as L said. And the real enemy are those who have everything, want more, and pit the rest of us against each other to fight for the scraps.

J: curious to hear what some of your mom's thoughts are about the generational divide. I figure I could guess some of them. Don't worry, believe it or not I was partially raised by a grumpy Tea Party old white lady (whom I love very much - the only ultra-rightie I will ever love haha), so I've heard it all. Maybe the old also blame the young (and the illegals, and the Muslims, and the liberals, etc...) for what they feel is the decline of America and its values? I guess there was always some of that with the Swing Kids, hippies, and punks of the past, but now it seems like nastier scapegoating. Before they just hated our music, now they hate everything about us. They blame the young (even though we have no power or money) because it's easier than looking in the mirror. But do the old really think that their demographic is best suited to right the ship now, in 2012?  To me, it's just depressing that the old prefer to idolize and trust a Romney or Palin rather than try to empathize and help our a poor single mother trying to raise her kids and get an education, who never did anyone any harm.

Also, isn't insider vs. outsider a fairly traditional paradigm as well? Monarchies, Catholic Church, Guilded Age, etc. were all manifestations of basically the same struggle. I guess modern plutocratic America is the first time in a democracy where insider power is so concentrated and has so thoroughly bought the political process without using force. America's income inequality metrics are bad and about the same as China's, yet our political and economic systems are vastly different. 

Tuesday, June 5, 2012

Stanford and Silicon Valley

http://www.newyorker.com/reporting/2012/04/30/120430fa_fact_auletta?currentPage=all

"...so many [Stf students] will take the exhortation to occupy Wall Street quite literally after graduation. So before making any decision, we ask one, very simple question: What will I get out of it?”- Stf senior in the Daily

Despite the title, this article is more of a guided tour of Stf rather than criticism of Stf's ties to business (apart from the obvious C.O.I. implications and threat to the "pure learning and personal growth" objective of a college education, but these are not unique to Stf). I do think that there is legit concern that Stf is becoming too monolithic and engineering-heavy, but that's where the $ and headline-grabbing innovation is happening.

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http://www.kqed.org/a/forum/R201206051000

The guest did mention that for East Coast schools, people would cry foul if a president/chancellor had such overt ties to companies as Hennessey does (if only he had ties to Hennessey Cognac and LVMH group!). Not sure what he bases that on, but at Stf I guess it's no biggie. Every big shot there who isn't a Spanish prof has some connections to some company.

The guest also compared how Cal's endowment is miniscule compared to Stf's, and Stf on paper is actually more racially diverse than Cal. But that doesn't take economic class into account. I am sure that you fellow alum would agree that while Stf had many people of color and foreigners, they (we) often came from upper-middle-class to rich backgrounds. So they (we) probably have more in common culturally with wealthy whites than with rural and/or poor minorities (who may have trouble adjusting to the Stf scene?). A good % of students at Cal are the first in their families to enroll in a top school, or even college in general. UC is more of a way to move up in society, whereas Stf is for the kids of people who have already made it (stereotype I know). 

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When the host (Dave Iverson, also a Stanford graduate) stated that Stanford is more diverse than Cal my thought was the same (that the measure of diversity being relied upon to make the claim is not multi-dimensional); nevertheless, it's not the type of claim I would expect to hear on NPR!


I think your email brings up an interesting point... but that point might be transient.  At present Stanford might actually be more affordable for low-income families; given the ties to industry and the alumni network it might also be more likely to afford a given individual a "leg-up" in the world.  Of course, if the "Middle Class Scholarship Act" is passed the reality would be closer to the historical truth.
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Reflecting on the classmates I met at Stf, my family was probably in the bottom quartile of wealth there, and you know that I had a fairly comfortable childhood. But privileged upbringings don't necessarily lead to social and self awareness. College is a good time to develop that as part of the maturation process, so spending 4 years in the "Stf-Paly bubble" may actually be a handicap for the rest of the student's life. But since Stf alum usually have financial means, they often can afford to engage in supplemental self-discovery activities like traveling the world, volunteering, and/or attending grad-professional schools - while public school students may need to rush into the rat race (if they're lucky enough to land a job) to support their families and pay back loans.

If business and political forces didn't perpetrate a massive transfer of assets from public service institutions to private elites (exacerbated by the recession), then maybe schools like the UCs would have more $ to maintain a quality educational experience and financial accessibility to the average student. But instead, many public schools are privatizing to some degree in order to cope with financial realities, thereby losing some essence of what made them special and egalitarian. As you said, it's true that Stf financial aid will literally work things out with any student's family so they pay only what they can no matter their situation. It's very generous, but that's not the problem - the bigger challenge is getting accepted at Stf first (admission rates are one of the lowest in the US, much worse now than when we were students - I think it fell from 15% to 8%). And in order for that to happen, you need legacy, connections, and/or demonstrated student excellence. All those come easier with wealth. Stf has a new fin aid program for families with household incomes below $100K (Ivy League has similar). So that is basically the plan for the 99% (well 80% actually). I wonder what the median family income is at Stf. vs. Cal. It could be 2X, and it's not like Cal families are poor.

http://news.stanford.edu/news/2009/april1/stanford-admission-rate-2013-040109.html
http://blogs.wsj.com/economics/2011/10/19/what-percent-are-you/?mod=wsj_share_twitter

Stf enjoys more donations partly because of their business partnerships (firms give because they want access to student and professor talent) and the quality of their people generate more IP royalties and alum charity. But also Stf's prestigious and large endowment gets access to prime investment opportunities that smaller institutions and maybe even the UCs can't tap. So the rich get richer. Iverson and the guest seemed to suggest that this is partially due to Cal's liberal, populist "bias" and Stf's conservative, pro-business appeal - the giants of Wall St. and Si Valley are turned off by Cal. Both schools are good at most things, but Berkeley has a rep for excellence in physical sciences, humanities, etc., while Stf may be better known for engineering and professional education, which are more relevant to businesses today. So I don't blame the VCs for preferring to tap the Stf pool over Cal, but it's just too bad that equally good if not better students and faculty at the UCs get less access to partnerships, jobs, and other opportunities.

Those with privilege shouldn't work to amass more privilege, especially at the expense of others who are deserving - I think Leland Stanford would agree with that (the later-in-life philanthropist Mr. Stanford, not the robber-baron Mr. Stanford). Those who make it to the top should send the elevator back down for others. Buildings at Cal are literally crumbling, classes cancelled, and staff are getting furloughed, while Apple gave Stf $50M last year (investment, not charity LOL) and Phil Knight donated untold millions to his alma mater to build the nicest b-school in the world (http://www.gsb.stanford.edu/about/knightcenter/). Why give charity to the rich? It's part of the bigger national issue. So of course Stf has the luxury to look all generous and righteous, allowing students whose families make under $X to attend for free (but what % of students is that exactly?). They are only able to be so "generous" because they exploited huge advantages in the zero-sum game vs. other schools (esp. public schools who are burdened by much more bureaucracy and uncertain budgets). 

Monday, June 4, 2012

Comments on the pharma industry

I think the problem in pharma is similar to "Moneyball" - people are pursuing the wrong goals and measuring success incorrectly. Health care should be a holistic, systemic effort. It's about measuring quality of life enhancements, longevity, and other social goods vs. opportunity costs. I guess that is similar to the NHS but of course their system has flaws too. But if we really measured health care properly, and priced drugs and services based on that, the industry would look radically different. Now we just have fragmented players each pursuing their own narrow profit motives, and the invisible hand breaks down (well that theory was never meant to characterize our complex, computerized, global, accountability-lacking modern economy anyway). Academics just want to publish so they can get grants (that are getting harder to come by due to austerity). Drug and device makers just want to develop positive NPV projects and milk monopoly rents. Physicians just want to prescribe more high-margin treatments. Insurers just want to place the right bets. So of course we have inefficiencies. Though drugs are not the biggest culprit for our current healthcare mess, and it's probably more due to unnecessary diagnostics, procedures (esp. end-of-life), and implanted devices. We have a treatment-based, consumption system when it should be a prevention-based one.

I know gov-sponsored enterprises don't have a great track record, but I would propose something like that - not that I know anything about health policy. But like how the gov mandates that vaccine and antiviral makers have a sufficient stock of affordable product in case of an outbreak, they could take it a bit further and manage their own drug development org. Otherwise the market doesn't price healthcare properly and you get shortages. It's kind of obscene for the US that spends so much on health to have to ration, and we're not talking about Viagra here: http://www.npr.org/blogs/health/2011/10/04/140958404/shortages-lead-doctors-to-ration-critical-drugs. So like how the FDIC backs up commercial banks, maybe a nonprofit federal drug org could back up the pharma industry by producing sufficient quantities of generics. I know Asian firms are doing that now, but might as well consolidate into a single point of sale and keep jobs here if it's affordable? It's also a national security issue. Then this org could reinvest its excess cash into research to compete with the big pharmas and put price pressure on them too. But of course the conservatives would never allow such a "threat to the free market."

I would also hold academics more accountable, as the "Inside Job" documentary implicated academic economists for pumping up optimism during the credit bubble. For academics and MDs who have relationships with pharmas, if their published research is used in drug dev't and the drug turns out to fail later (esp. during expensive clinical trials), then those researchers should have to surrender some of their grant $ or other compensation. I know this is also impractical and fraught with issues, the general idea I'm getting at is to hold the upstream guys accountable for downstream results. I know research on paper may look great but then fail in practice through no fault of their own. But there can't be this total detachment. That's why some universities are even building their own drug dev't infrastructure. They discover the IP, they know it the best, so why not keep the dev in-house? Plus it keeps the research team focused on practical issues. I am not sure how to do this best, but basically there has to be some way to punish researchers for "bad projects", otherwise the current incentive structure just encourages them to pump out all sorts of pie-in-the-sky, diarrhea-of-the-brain, quantity-over-quality findings. This is exacerbated by the glut of bioscience PhD's getting pumped out of schools (esp. from Asia) - and often they are uncreative and under-qualified, but the school just needs to get rid of them after 6 years (so many of them can't get PI jobs and end up taking the jobs of BS and MS level people, thereby blunting the career dev of people like me). They are permitted to publish crap, since there is also a glut of stupid journals out there who are happy to fill their pages with something and make some money (you probably have seen the same in your field?). Then they over-sell them as the next wonder drug, and we end up wasting billions on a stupid idea. It's better and cheaper to kill bad projects early, and punish bad researchers so they really have to stake their careers on only the best projects. Of course you can tell that I'm a little (or a lot) jaded from R&D, but I think I have a point. And I haven't even gotten into the data fraud issue...

http://wenchwisdom.blogspot.com/2011/12/this-just-in-scientists-elusive-goal-to.html 

I think the patent system needs to be reformed too. Monopolies are rarely ever in the public's best interest. Yeah pharma bitches that if they don't get exclusivity, it's not "cost effective" for them to research new drugs, you know the usual blackmail shit. Even if we threw out our generous IP laws tomorrow, I guarantee you that it would still be profitable for someone to develop a diabetes or Alzheimer's drug, because like we see in semiconductors and other products, there is still value in being first-to-market and leading the learning curve. I do agree though that the FDA clinical approval process can be reformed and probably simplified (though how can we do that when the GOP cuts funding to the agency? I think they just want to gut regulators and let the industry "self monitor"). But like other industries, there is a big established infrastructure of paper pushers who stand to lose from reforms, so they will fight for the status quo. It's not an easy fix by any stretch. I can identify some problems, but I am not sure how to fit all the pieces together to make a better solution. Well if I did know, I would be set for life. :)