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Megan McArdle

Megan McArdle

Megan McArdle is a senior editor for The Atlantic who writes about business and economics. She has worked at three start-ups, a consulting firm, an investment bank, a disaster recovery firm at Ground Zero, and The Economist. More

Megan was born and raised on the Upper West Side of Manhattan, and yes, she does enjoy her lattes, as well as the occasional extra-dry skim-milk cappuccino. Her checkered work history includes three start-ups, four years as a technology project manager for a boutique consulting firm, a summer as an associate at an investment bank, and a year spent as sort of an executive copy girl for one of the disaster-recovery firms at Ground Zero … all before the age of 30.

While working at Ground Zero, Megan started Live From the WTC, a blog focused on economics, business, and cooking. She may or may not have been the first major economics blogger, depending on whether we are allowed to throw outlying variables such as Brad Delong out of the set. From there it was but a few steps down the slippery slope to freelance journalism. She has worked in various capacities for The Economist, where she wrote about economics and oversaw the founding of Free Exchange, the magazine's economics blog. She has also maintained her own blog, Asymmetrical Information, which moved to The Atlantic, along with its owner, in August 2007.

Megan holds a bachelor's degree in English literature from the University of Pennsylvania and an M.B.A. from the University of Chicago. After a lifetime as a New Yorker, she now resides in northwest Washington, D.C., where she is still trying to figure out what one does with an apartment larger than 400 square feet.

Europe on the Brink

I haven't been blogging much about Europe because I felt like I was mostly repeating myself.  Europe is not an optimal currency zone.  It opted for monetary union without the fiscal or labor market integration that make America's sprawling  currency zone work. So far, the various governments have failed to mount a really credible coordinated response.  I don't see how the thing can hold together, except that Jesus, it will be hell if it all falls apart.

But it's probably worth interrupting your regularly scheduled unemployment-and-kitchen-blogging to point out that it all really seems to be coming to a head:  

In an interview with IMF advisor Robert Shapiro, the bailout expert has pretty much said what, once again, is on everyone's mind: "If they can not address [the financial crisis] in a credible way I believe within perhaps 2 to 3 weeks we will have a meltdown in sovereign debt which will produce a meltdown across the European banking system. We are not just talking about a relatively small Belgian bank, we are talking about the largest banks in the world, the largest banks in Germany, the largest banks in France, that will spread to the United Kingdom, it will spread everywhere because the global financial system is so interconnected. All those banks are counterparties to every significant bank in the United States, and in Britain, and in Japan, and around the world. This would be a crisis that would be in my view more serrious than the crisis in 2008.... What we don't know the state of credit default swaps held by banks against sovereign debt and against European banks, nor do we know the state of CDS held by British banks, nor are we certain of how certain the exposure of British banks is to the Ireland sovereign debt problems."
One of my twitter followers asks: "on scale of 1 to 10 (10=buy ammo, stockpile water; 1=go buy a Birkin Bag on credit),how serious is Greek default situation?"

Well, it's never a good idea to buy expensive consumer goods on credit, unless you have terminal cancer and no scruples about stiffing your creditors.  And even then, the waiting list is going to erode most of your utility.

Quibbling aside, it's hard to know how big a deal this is.  Deutsche Bank CEO Josef Ackermann famously said that "It is an open secret that numerous European banks would not survive having to revalue sovereign debt held on the banking book at market levels."  Which is pretty freaky.  But how numerous?  What's the exposure of American banks?  I'm not sure anyone knows--and if they do, they're government regulators who aren't saying.  Which is in and of itself pretty scary, because if the news were good, you can be pretty sure that they'd share it.

Don't get me wrong: at best, it's a big deal.  But is it a "0.2% knocked off US GDP" kind of big deal, or a "Credit Anstalt and the second American banking crisis" sort of event?

The Great Depression was composed of two separate panics.  As you can see from contemporary accounts--and I highly recommend that anyone who is interested in the Great Depression read the archives of that blog along with Benjamin Roth's diary of the Great Depression--in 1930 people thought they'd seen the worst of things. 

Unfortunately, the economic conditions created by the first panic were now eating away at the foundations of financial institutions and governments, notably the failure of Creditanstalt in Austria.  The Austrian government, mired in its own problems, couldn't forestall bankruptcy; though the bank was ultimately bought by a Norwegian bank, the contagion had already spread.  To Germany.  Which was one of the reasons that the Nazis came to power.  It's also, ultimately, one of the reasons that we had our second banking crisis, which pushed America to the bottom of the Great Depression, and brought FDR to power here.
To paraphrase Oscar Levant, there is always a fine line between a banking panic, and a sovereign debt crisis--and Europe has erased that line.  Which is ultimately what happened with Creditanstalt.  Austria's inability to backstop the bank's losses turned into a continent-wide problem for both banks and sovereigns, particularly in Germany, which was of course laboring under ludicrously unpayable debts from WWI.

On the other hand, parallels are rarely perfect.  There is still the possibility that Europe will somehow pull this one out--or that the contagion will not be as bad as when we were on the gold standard.  Gold is an excellent conductor of both electricity, and financial panic.

So while I wouldn't invest in canned goods and ammunition, I wouldn't invest in Greek bonds, either.  The only way we're going to find out how bad this will get is to live through it.

Follow Your Bliss—Sort Of

Since Steve Jobs died, his famous 2005 commencement speech has been tweeted, blogged, and written about extensively.  It is, to be sure, a very inspiring speech.  But Robin Hanson points out that the most prominently featured advice isn't actually very practical:

Now try to imagine a world where everyone actually tried to follow this advice. And notice that we have an awful lot of things that need doing which are unlikely to be anyone's dream job. So a few folks would be really happy, but most everyone else wouldn't stay long on any job, and most stuff would get done pretty badly. Not a pretty scenario.

OK, now imagine that only graduates from colleges like Stanford or better followed this advice. Since such folks have more fulfilling job options, a larger fraction of them would end up really happy. But we'd still have too much job turnover among our elites, with too much stuff done badly.

Now notice: doing what you love, and never settling until you find it, is a costly signal of your career prospects. Since following this advice tends to go better for really capable people, they pay a smaller price for following it. So endorsing this strategy in a way that makes you more likely to follow it is a way to signal your status.
I'm not sure that this captures what I found unsettling about the speech--and I did find it unsettling.  I'm not sure that Jobs was trying to signal anything as much as he was offering very good advice . . . for Steve Jobs. Steve Jobs', um, job, is to tell graduates how they could be Steve Jobs. And if they are to have any chance, they do indeed need to follow their bliss and take risks rather than settling down to a degree in accounting.

But not everyone has the potential to be Steve Jobs.  Not just because most people are rather more ordinary, but because there are a limited number of jobs that are really fun, greatly admired, and fairly well remunerated, which is what most people want.

The problem is, the people who give these sorts of speeches are the outliers: the folks who have made a name for themselves in some very challenging, competitive, and high-status field.  No one ever brings in the regional sales manager for a medical supplies firm to say, "Yeah, I didn't get to be CEO.  But I wake up happy most mornings, my kids are great, and my golf game gets better every year."

That's most people.  But what does Steve Jobs have to tell them?  I doubt he can imagine what that's like, much less empathize, or come up with solid advice on finding a great hobby. So he tells them how to be Steve Jobs.  Which sounds great, and is of very limited practical value, even to Stanford grads.

I struggle with this problem when I speak to aspiring young journalists.  I have an extremely awesome job, one that is just about as close as one can get to a dream job in this vale of tears. (For me, anyway--I realize that "I write about economics for a living" sounds to many people like their own personal version of hell.)  While it's certainly not compensated at Steve Jobs level, and I wouldn't exactly object if my salary were doubled, we have a very solid income that allows us to do anything we have a right to want.

And I have this job because in 2002 I did something that was objectively rather stupid; I decided to use my MBA to pursue a job in journalism.  I decided to do this in part because the MBA job market was kind of thin, and in part because I really, really loved writing about economics.  But it was incredibly risky, as my parents pointed out . . . over and over and over.  Even when I landed a job at The Economist, my crushing loan burden made this a very long and difficult financial haul for many years.

Still, I was lucky--unbelievably, unrepeatably lucky.  To be sure, some other new grads will luck out too.  But most won't.  

So what do I tell them?  

I try to be pretty frank with them about careers in journalism: there are a lot of people who want to be journalists, and a shrinking number of well-paid steady jobs.  Usually, what I tell them next is that it's not a tragedy if they don't do what they thought they wanted to do at 22; that they have more time than they think to figure out "what they want to do with the rest of their lives"; and that the world outside of school and words is more interesting than they probably suspect.  That they should be prepared to take the risks involved in pursuing this career, but also to cut their losses.

This goes over surprisingly well--I think a lot of grads are so frightened right now that they're reassured just to have an adult telling them that no matter what happens, their life will not be over at 24.  But I doubt it would ever get much play on YouTube.

Debt Jubilee? Start With Student Loans

There is one concrete answer being offered to the anguish of the "99%":  a debt jubilee, where some or all of the outstanding debt is forgiven.  It's in the bible and it helps overburdened debtors, say supporters; shouldn't conservatives and liberals both be ready to jump on board?

The attractions are obvious.  But so are many of the downsides (which is why, as I understand it, orthodox communities that still follow the tradition have mostly come up with elaborate ways to get around it.)  In an op-ed for the New York Times, Martin Hutchinson and Robert Cyran run through some of the issues:

To start, writing off debts would not necessarily increase economic growth. Every liability is also an asset, so while a dollar that is no longer required for debt repayment might add some cents to consumer spending, it is also a dollar cut out of a bank's capital or of an investor's net worth -- subtracting from resources and confidence.

And write-offs big enough to change consumer behavior would probably be big enough to destabilize banks. The Federal Reserve or the government would need to help, presumably by injecting newly printed money as capital. Such government control is usually inefficient, and abundant printing of money increases the risk of uncontrolled inflation, which has its own way of making people feel poorer.

The issue of moral hazard also cannot be ignored. Much of the excess debt was incurred through irresponsible mortgage refinancing, which peaked in 2006 at $322 billion, representing 2.4 percent of G.D.P. The reckless use of houses as A.T.M.'s was a major factor in decapitalizing and destabilizing the American economy. Forgiving such debts will teach the wrong lesson: borrow in haste, repent never.

Finally, investors would rightly see a jubilee as an attack on property rights. That runs the risk of throwing markets into disarray and discouraging foreign investors from buying assets in the United States. Risk premiums on both debt and equity capital would increase.
With that in mind, let me propose a modification that might at least alleviate some of the problems experienced by the 99%: allow students to discharge their student loans in bankruptcy (at least the ones guaranteed by the government, and private loans made before the rules were changed to make private loans un-bankruptable).  There is really very little excuse for completely exempting student loan debt from bankruptcy.  Bankruptcy is supposed to be the recognition that a person does not and will not have the resources to pay their debts--so why shouldn't the government have to stand in line along with all the other creditors?  

I am fully aware of what this would mean: government lending costs would go up, the program might well become unaffordable, and if private loans were included (as they should be, at least for new loans), the private loan market might well disappear altogether for all but the most lucrative specialties.  The reason that the bankruptcy exception was written in the first place was that the loans used to have an extraordinarily high default rate.

But I'm not sure this would be a bad thing.  By allowing students to shift forward the additional income that their degree will earn them, student loans have allowed universities to capture a huge portion of that future income stream--which really hurts those for whom that stream doesn't materialize.  Moreover, it allows students to make the sort of stupid choices that most 19-year-olds will make if they're allowed.  I don't have a lot of patience for university administrators claiming that they just can't possibly charge less than $25,000 for 15 hours a week worth of classes, but they do have one point:  they build expensive new facilities and load on the services because students demand them, and threaten to go elsewhere if they can't get them.  Colleges look ever-more like four year resorts with a sideline in academic research.

If students actually had to earn the money to pay for that world-class fitness center, the 2,000 different clubs, and the off-campus apartment with the pizza parties, there would be a lot less of those things.  And while I like both world class fitness centers, and apartments, they're not the sort of thing that should be funded with borrowed money.  If the degree caused pain now rather than pain later, they might also think harder about whether what they were studying was likely to deliver a solid return on that investment.  I'm not faulting the students--the future is a pretty hazy concept when you're eighteen.  I'm just arguing that it's not necessarily helping to enable them.

But wouldn't that cut people off from the priceless gift of college? 

I don't think so.  When my parents were in college, it was possible to work your way through. At most colleges, for most students, that's no longer a realistic possibility.  College costs have inflated much faster than the costs of everything else, and if it weren't for student loans, I'm skeptical that this would have happened.

Moreover, I take seriously the arguments that no everyone who currently goes to college should be there.  Calm down--I'm not arguing for some society of morlocks and eloi where many are born to labor in the dark without end.  I do think that there's a lot of fairly ridiculous credentialism out there--employers require college degrees because they can, not because it actually helps you do your job better.  If fewer people went to college, those jobs would still be available; they just wouldn't require college degrees.

There are also a lot of people who go to college because they don't know what else to do, find out they hate it, and drop out.  Those people end up burdened with loan repayments for value they didn't receive.  Whenever I suggest that not everyone should go to college, I am met with cries of classism and snobbery.  But here's the thing: I love studying in a way that most people just don't.  That's not a moral judgement: it doesn't mean that I am better than people who do not particularly care for classrooms.  Which is why I see no reason to insist that everyone should be avid . . . indeed, practically forced . . . to spend another four years in classrooms.

My grandparents had maybe ten books in their house, and I never saw either of them read one.  They were wonderful people (my grandmother still is).  They had rich, full lives that were exactly as valuable as the lives of a Harvard physicist.   My grandfather was an extremely successful businessman and a pillar of the community who was deeply respected by everyone who ever met him. I don't think we need to create a world in which everyone like my grandparents "gets" to spend four years seeking a degree in history; I want a world in which you can skip college and still be a successful businessman and a pillar of your community.  It's still possible, but it's a lot harder than it used to be.

On net, I'm sure some people would be worse off if student loans were harder to get--but I'd guess that many more people would be better off if their government, and private creditors, and universities, had not enabled them to make some very, very expensive bad decisions.  The answer to this problem is not to further socialize the college-industrial complex; it's to demand that it justify its worth to its customers up front, for cash on the barrelhead.

Plus if we stopped the broad general subsidy for student loans, we could put that money into merit scholarships or scholarships for the neediest students, rather than yet another plan for the middle class to get rich by picking its own pockets.

Meanwhile, making student loans bankruptable would offer immediate relief to those who are trapped under crushing debt burdens from which they now can't escape.  It might not give a huge immediate boost to the economy.  But at least it would give some of those people some hope that they might one day get ahead.

The 99%

I spent quite a lot of time on the "We are the 99%" website last night and this morning.  There's been a considerable amount of carping about it from the conservative side, and to be sure, some of the stories strain plausibility (the percentage of people in the sample who have either taken up prostitution, or claim to have seriously considered doing so, seems rather high, for instance, and as far as I could tell, not a single person on the site had been fired for cause).  Many of the people complaining made all sorts of bad decisions about having children, getting very expensive "fun" degrees, and so forth.

But quibbling rather misses the point.  These are people who are terrified, and their terror is easy to understand.  Jobs are hard to come by, and while you might well argue that any of these individuals could find a job if they did something different, in aggregate, there are not enough job openings to absorb our legion of unemployed.
Employment Gap.png
When the gap between the number of job openings and the number of people who are out of work is so large, there are going to be a hefty number of unemployed people.  Maybe these people individually could have done more to get themselves out of their situation, but at the macro level, that would just have meant that someone else was out of work and suffering.

I think it's hard to read through this list of woes without feeling both sympathy, and a healthy dose of fear.  Take all the pot shots you want at people who thought that a $100,000 BFA was supposed to guarantee them a great job--beneath the occasionally grating entitlement is the visceral terror of someone in a bad place who doesn't know what to do.  Having found myself in the same place ten years ago, I can't bring myself to sneer.  No matter how inflated your expectations may have been, it is no joke to have your confidence that you can support yourself ripped away, and replaced with the horrifying realization that you don't really understand what the rules are.  Yes, even if you have a nose ring.

I'm not sure that this constitutes the seeds of a political movement, however.   For all the admiring talk about bravery and perseverance, it's not really al that difficult to get young, unemployed people to spend a couple of weeks camping out somewhere.  They have a low cost of time, they're in no danger, and yes, I have to say it, demonstrating is fun.  No, don't tut-tut me.  I was at the ACT-UP die-ins, the pro-choice marches, the "Sleep Out for the Homeless" events and the "Take Back the Night" vigils.  It's fun, especially when you can see yourself on television.  This is not the Montgomery bus boycott we're talking about here.

So my question is, how does this coalesce into a broader platform?  Does someone have a coherent, plausible answer for someone whose pricey liberal arts degree has not equipped them for a tough job market?  And is it a coherent, plausible answer that they will believe?  I don't think those kids in Zucotti park are waiting to hear about QE3 and the American Jobs Act.

HPV: It's Not Just For Ladies Anymore

By 2020, cases of throat cancer caused by the human papillomavirus may outnumber those of HPV-caused cervical cancer

Bad news on HPV:  it now seems to be the leading cause of throat cancer in men. Worse news: it may be spread by kissing.

Researchers examined 271 throat-tumor samples collected over 20 years ending in 2004 and found that the percentage of oral cancer linked to the human papillomavirus, or HPV, surged to 72 percent from about 16 percent, according to a report released yesterday in the Journal of Clinical Oncology. By 2020, the virus-linked throat tumors -- which mostly affected men -- will become more common than HPV-caused cervical cancer, the report found.

. . . Until recently, head and neck cancer mainly occurred in older patients and was associated with tobacco and alcohol use. The HPV-linked head and neck cancers, usually of the tonsils, palate or tongue, hit men their 30s, 40s, and 50s, Gillison said. It is unclear why women are affected much less often than men, she said.

. . . In a 2007 epidemiology study published in the New England Journal of Medicine, Gillison and her colleagues found that having a high number of oral or vaginal sex partners are risk factors for HPV-associated throat cancer. The cancer may also be spread by open-mouth kissing, Gillison said in the interview. "Nobody paid attention to oral HPV infections until 2007," she said. "We are about 15 years behind in the research" compared with the data on cervical cancer and HPV, she said.
The most troubling thing for me is that I imagine that this is going to be harder to detect than cervical cancer. (ENTs and cancer docs, please feel free to correct me).  As an OB-GYN said to me, "HPV just loves the cervix", which means that as long as you're getting regular pap smears, the doctor is very, very likely to catch a genital infection before it turns into terminal cancer.  (I don't mean to imply that the treatments are no big deal, because they aren't--they range from uncomfortable to excruciating and can mean infertility.  But they're still preferable to being dead.)

But the throat's got a lot of stuff in there, a lot of nooks and crannies where HPV could hide--can we catch potentially cancerous oral infections the way we do when they're in the reproductive tract?

The other question I have is whether this is going to change the terms of the debate around HPV vaccines.  Me, I figure if we can possibly wipe out a virus that gives people cancer, we should do our very damndest.  Regardless of how the cancer is contracted.  But from the extremely emotional response I got when I blogged about Gardasil a few weeks ago, this is obviously not the universal view.

Democrats Propose Another Surtax on Millionaires

According to the Wall Street Journal, Democrats are attempting to revive the president's jobs bill by proposing a 5% surtax on all income earned above $1 million--capital gains, dividends, whatever.  I'm not seeing how this revives the bill, since the GOP is probably going to filibuster it anyway.  But it's certainly an interesting proposal.

If we add in the Medicare surtaxes which start in 2013, then for a person earning a million dollars a year (we really need a better word for this than "millionaire", which already has a meaning), the marginal tax rate on long-term investment income for this group jumps to 24% in 2013, from 15% now, while the marginal tax rate on earned income will be (assuming the Bush tax cuts expire like they're supposed to) 48.5%.  This of course does not include any state income taxes, or property taxes.  The tax penalty on earned income seems likely to rise well over 50% for the typical high earner under Democratic plans.  Most left-leaning pundits and wonks do not seem to believe that millionaires pay attention to decreasing returns to effort.  I confess, I'm a bit more skeptical.

The real question, however is this: what do you do for an encore?  They're hiking taxes on this lucky group 5% to pay for one temporary jobs measure.  What happens the next time Democrats need some money to pay for something?  Surely we need to leave millionaires a little something for themselves on their marginal dollar, say 10%--a sort of tip for good service.  And the state and local tax people will want their bite too, so you'll need to leave another 10-15% so that those high-tax jurisdictions where sound Democratic politicians like Senator Schumer campaign can enjoy their full bite.

Since the current trend is a 4-5% hike on high-earners every time new spending is required, that seems to indicate that Democrats have only about five bites left at the apple.  Then they'll be out of money for new programs.  That's assuming, as they seem to, that rich people don't care about money, and will not change their behavior in response to higher tax rates.  If that assumption is wrong, then they reach the end of this particular rope much sooner.

Presumably the next step is people who make over $250,000 (which is, indeed, the group already targeted by the Medicare surtaxes).  But this group contains a lot of solid Democrats who do not, in my experience, think that the socially just marginal tax rate on such incomes is 80%.

Should We Tax Financial Transactions?

The idea of a sort of extra-broad Tobin Tax on all financial transactions has been quite popular with the left half of the punditocracy for some time now.  Myself, I don't really see the charms.  Tiny taxes on high-volume transactions raise a lot of money, but they also cost money to record, collect, and audit, which is why few jurisdictions have 0.25% sales taxes.  And I'm not clear on what problem taxing financial transactions is supposed to solve.  It's not as if our woes were caused by legions of high-frequency traders wrecking the markets with their tiny, tiny spreads.  Nor do I think that penalizing sales would have prevented the run on the money markets, or any of the other problems of the acute phase of the crisis.  The charm seems to be entirely that it might raise some money, and it pisses off bankers.  

Of course, we have to raise money somewhere, and how better than by pissing off bankers?  It seems like this might be that most magical of policy possibilities--the tax with no downside.

Ah, but is that really so?  Ken Rogoff, who spent quite a lot of time thinking about these issues as chief economist of the IMF, points out that financial transaction taxes aren't actually pain free:

True, great thinkers like John Maynard Keynes and the late Nobel laureate James Tobin floated various ideas for taxing financial transactions as a way to reduce economic volatility. (Tobin's tax applied specifically to foreign-exchange trading.) But, since then, the idea has received close attention from many economic researchers, and, frankly, it is hard to find their research results supportive.

Such taxes surely reduce liquidity in financial markets. With fewer trades, the information content of prices is arguably reduced. But both theoretical and simulation results suggest no obvious decline in volatility. And, while raising so much revenue with so low a tax rate sounds grand, the declining volume of trades would shrink the tax base precipitously. As a result, the ultimate revenue gains are likely to prove disappointing, as Sweden discovered when it attempted to tax financial transactions two decades ago.

Worse still, over the long run, the tax burden would shift. Higher transactions taxes increase the cost of capital, ultimately lowering investment. With a lower capital stock, output would trend downward, reducing government revenues and substantially offsetting the direct gain from the tax. In the long run, wages would fall, and ordinary workers would end up bearing a significant share of the cost. More broadly, FTTs violate the general public-finance principle that it is inefficient to tax intermediate factors of production, particularly ones that are highly mobile and fluid in their response.

All of this is well known, even if prominent opinion leaders, politicians, and philanthropists prefer to ignore it. The European Commission has surely been strongly cautioned by the Fiscal Affairs Department at the International Monetary Fund, whose economists have thoroughly catalogued the pros and cons of FTTs.

So why did the Commission go forward with the idea?The most generous interpretation is that the Commission simply does not believe economists' estimates and analysis, and views an FTT as more workable than is commonly realized (a scenario that calls to mind the debate surrounding the creation of the euro). It is true that Latin American governments, particularly the Brazilian authorities, succeeded in raising more revenue from taxes on bank withdrawals (a crude version of an FTT) than most policy analysts thought possible. On the other hand, Latin America's long-term growth record is hardly an advertisement for the approach, and accounting for lost tax revenues due to lower GDP would surely yield a less impressive fiscal outcome.
Perhaps there are excellent answers to these concerns.  But I haven't seen the people supporting an FTT offering any.  I'd like to see that gap addressed before I jump on board.

Stainless Steel and Granite: The Harvest Gold of the Future?

I'll have a post up on Europe soon.  For now, however, let's focus on something less weighty than health care costs, energy subsidies, or the future of the euro:  how long can a housing trend last?

I ask because I recently discovered HGTV, a channel I watched devotedly for about three weeks before all the renovations began to look the same to me.  Every young couple looking for a house wants stainless steel and granite countertops, and wants them RIGHT NOW.  Everyone redoing a kitchen wants the same, ASAP.  Which makes me think that these things must be on their way out.

My mother was an early adopter of the stainless steel appliances, largely through happenstance.  We had a huge used Sub-Zero fridge that she bought cheap off of someone who was leaving the building, and didn't want to pay to move it.  And a Viking range that I seem to recall was acquired under similar circumstances (the benefits of growing up in Manhattan).  I still think wistfully of those appliances--enormous workhorses that performed far better than my own ersatz versions.

Though I'm sure that there were even earlier adopters of the quasi-professional appliance, we were certainly on the early edge, because, well, Manhattan.  The early versions were made to look like restaurant appliances because it signaled that they were actually almost as large and powerful as restaurant appliances (minus the need for costly fireproofing of your walls).  And the professional versions were stainless because it's cheap and sanitary.

But as the mania for huge kitchens grew unabated, everyone started thinking of stainless steel as generically upscale.  And so it became a moderately pricey option on otherwise downscale appliances.  (I have to assume that it does not actually cost more to put a steel sheath on your appliance, since steel is presumably what the appliances are made of).  Now everyone but the very cheapest landlords has stainless steel, and laminate and various composites and synthetics do a very passable imitation of granite.  

My understanding of the luxury cycle is that as soon as everyone can afford a decent replica of high-priced items, the replicated qualities become passe.  By that metric, stainless steel and granite have to be on their way out; the only thing more ubiquitous in the American kitchen is the George Foreman grill.

On the other hand, maybe in 1948 I'd have been saying that wall-mounted cabinets were a passing fad.  So I throw it open to the moderate slice of my readership that is interested in these questions:  is stainless steel the new Harvest Gold?  And if so, what will replace it?

Confronting the Cost of Health Care

One of the major factors contributing to the general feeling that people aren't as well off as they used to be is that they are consuming more and more of their income as health benefits.  Though there's obviously controversy over how much of this represents real gains, there's no question that a lot of it is an actual material improvement in peoples' lives.  As Steven Paulson notes, "In 1965, a typical patient entering the hospital with a heart attack received care similar to the care given to then-President Eisenhower when he had his heart attack in 1954. Six weeks of bed rest, oxygen, and intravenous narcotics, with cardiac monitoring to manage arrhythmias, were followed by another six weeks of limited activity."  The patient was usually never the same again.  We have made major strides in both the quality and quantity of life given to post-heart-attack patients.

The problem is that people don't feel richer.  In part that's because the costs are hidden--employers rarely tell you how much health care you're being "paid" with--and in part it's because almost all of our health care compensation consists of embedded options, rather than direct consumption.  When we develop a new way to treat very premature babies which costs $1 million and shepherds 10% more babies to viability, we all have to pay for it.  And probably we'd all like to know that if we had a very premature baby, it would have a better shot at living.  But most of us don't have very premature babies, and those who do, don't really connect that event with a 1% increase in their insurance premiums 10 years ago.

Austin Frakt wonders what would happen if people realized how much of their wages were diverted into health care spending:

I think many people will be furious at how much of their paychecks are, effectively, being piped into the pockets of health insurers, health care providers, drug manufacturers, health IT gizmo creators, massive radiology machine developers, other device makers, and government programs. Some will think the return is worth the price. Many will not, particularly those who think insurers are wringing them dry.

What then? I can't help but think that's when people turn to government. After the market has adjusted, provided new products with higher deductibles and more managed care (or whatever the latest private-side cost control mechanisms are), people will still not be happy. More of them may then look to political leaders and say, "Do something about this. NOW!!!"

Transparency is the right way to go. But there's no telling what market and extra-market fury it might unleash. I'm not making any firm predictions here. My feet are securely planted in the zone of speculation. (I'm entitled to three seconds, right?) I'm just saying we don't know what passion can do. Be careful what you wish for. (And, for all that, I'm wishing it too.)
A couple of thoughts:

1.  People--particularly high consumers of health care--are not quite as ignorant about costs as you might think.  I am frequently struck by the way that high-utilization folks such as the parents of special-needs children, those with expensive chronic conditions, and people going through high-risk pregnancies voice the following thoughts in sequence:

a)  Health insurance is an overpriced rip-off administered by greedy insurers
b)  The prices are going up far too quickly
c)  They need health insurance because it's horrifyingly expensive to pay for the cutting edge treatments and supplementary therapy that gives them (or a family member) the best shot at living a quasi-normal life.

The delivery usually implies a total disconnect between items a & b, and item c.

You could maybe square this circle by saying well, the providers are gouging, and insurers ought to push the prices down instead of catering to them.  But none of these people, at least in my experience, think that their speech therapist, neonatologist, home health care aides, or immunologist should have their incomes cut by more than half; on the contrary, they usually regard these providers as dedicated professionals who are justly rewarded (maybe even somewhat underpaid) for the help they provide. The ire focuses on the insurance company, or maybe some faceless provider of drugs or medical equipment.

While there are obviously exceptions to this--I also know people whose deep experience with the health care system has made them appreciate all the complexities that reform would entail--in general, making people conscious of how much it costs to, say, spend an hour with the pulmonologist does not seem to make them eager to have either the government or an insurer bargain down pay or set hard treatment guidelines.  It just creates a vague sense that someone should somehow come in and make everything better.

That's not a policy program.  Policy programs require specifics.  And given that the specifics will specifically hurt beloved providers upon whom the high-utilization patients depend (as well as restricting their freedom to select a treatment with their doctor), I'm skeptical that they will "Turn to the government" in any way that would make Austin Frakt happy.  Special needs parents are a very powerful constituency in favor of more spending on special needs kids.  They are not a very powerful constituency in favor of cost-control or evidence-based treatment.

2.  There are entitites in the private sector like unions who do, in fact, directly confront the tradeoff between benefits and pay.  Many unions run their own health plans; most of them negotiate a pay package in which the tradeoff between more pay or more benefits is extremely specific.  What these entities seem to show is that even people who are very well aware of how much things cost, choose bundling and price insulation over transparency and efficiency.  As far as I know, they rarely choose cost control in any way that significantly inhibits participant autonomy, or increases price exposure.  

This is an important challenge for health care reformers on both left and right: even when given a direct choice, people seem to want a system that closely resembles the expensive and inefficient one we have; their main policy goal is simply to shift the bill onto someone else.  Obviously, this is not a feasible solution at the national level.

The Downside of Washington's Leverage Game

Commenter No_Rush makes an important point about using loan guarantees as a way to make your government spending go further by "leveraging" private sector investment.  Which is that loan guarantees are, in fact, increasing the leverage of your program.  As with all leveraged investments, your upside increases--but so does your potential downside.
Suppose that the DOE has $1bn that it's happy to risk in order to subsidize alternative energy. It could simply grant that $1bn in $50m pieces to twenty companies. Using loan guarantees, however, it can leverage that $1bn to much greater effect. Assuming that the DOE thinks that 10% of these businesses will fail, it can guarantee $10bn worth of loans to the same 20 companies, so that each gets $500m. Assuming that it's right about the 9-to-1 repayment to default ratio, it will still be out $1bn once the loans are satisfied (or defaulted upon). (I've used round numbers for simplicity, these aren't even close to real ratios.)

Now, say that one of the companies--we'll call it Hypolyndra--fails and defaults on its loan relatively early. There are two ways of looking at this: first, that only 5% of the DOE's total exposure to the market has defaulted. This is the way that it appears, from your comments above, that you're looking at it: there's only been one default, and everything else is doing "okay for now." The other way of looking at it is that 50% of the expected losses have now occurred, and two more defaults will make the program considerably bigger than anticipated. While six defaults would only represent a total of 15% of the DOE's total market exposure, that wouldn't be a phenomenal success, it would be a program that's 300% of its forecast budget.

Solyndra and the Dubious Benefits of Loan Guarantees

I do apologize for the all Solyndra, all the time tenor of the blog recently.  But I wanted to expand upon Friday's post a bit, because I had a blog conversation with the excellent Tom at Manifest Density which bears on the subject.

Tom argues that leaving aside the question of whether Solyndra, in particular, was a good idea, loan guarantees may represent a good way to leverage government funds in risky situations.  

All of this is a separate question from whether the government should be intervening in the economy in this manner. I think that's a conversation worth having. But it should be a conversation about programs, not transactions. To focus on one failed loan is a bit like pointing to a lottery winner and saying, "That's how they think we're going to pay for our schools -- by handing out checks? What a bunch of dopes!" But of course this ignores the bigger picture. Perhaps there is a problem with that lotto payout, but that's a different and frankly less important issue than whether it's wise for the government to run a lottery. This is why the intense focus on Solyndra strikes me and many others as a transparently partisan feeding frenzy rather than a considered discussion of energy policy.
I almost precisely disagree with this.  The question of whether or not we should subsidize solar panels should be held separate from the questions about how we should subsidize solar panels, and whether the decision making process for allocating the subsidies worked.  But as it happens, I think the questions about how we should subsidize things is important, and that one of the answers to those important questions is "not with loan guarantees".

Full disclosure: I have something of a bias against cosigning or guaranteeing loans; I think it only ever looks like a good idea because of the peculiarities of government accounting.  So Tom points out that by guaranteeing loans for four dynamite factories, each of which has a 1-in-4 chance of blowing up, you can mobilize four times as much spending as you would if you just built a dynamite factory--and that you've got a diversified portfolio of factories, to boot, instead of one factory with a 1-in-4 chance of suddenly not existing.

But as I argued last week, the capital markets have ways of dealing with risk: you spread it out over multiple people (with a loan syndicate, say) or you raise the price.  That doesn't necessarily mean charging a higher interest rate; you can also offer various sweeteners such as stock warrants, or issue equity (which is very expensive, from the point of view of existing shareholders, because it represents a permanent claim on future earnings, rather than the temporary and limited claims of a loan.)

The reason that markets won't invest is not that they think a project is risky, but that they think it is not likely to pay back its investment.  Neither private investors, nor the government, can build a winning portfolio out of a large group of investments with negative expected value.

Loan guarantees look good if you start by assuming that the government is going to spend a certain amount of money building solar panel plants, and then ask yourself how to make that money go furthest.  But let's question that assumption: why should the government build solar panel plants?  The reason that the private market will not build them is not that the individual firm has too high a risk of failure, but that the returns on the investment will not compensate for the risk:  either too few solar panels will be sold, or they cannot be sold very profitably. Neither of these problems are problems that loan guarantees fix.

However, they are problems that the government might be able to fix, by subsidizing the purchase of solar panels.  If the profits are right, lots of capital will mobilize to build plants to exploit them.  We get the same sort of "multiplier" that we got from a loan guarantee.

This has a number of attractive features, compared to loan guarantees: it doesn't require the government to pick a winning company, and more importantly, it only costs you money when the solar panels are actually installed.  By contrast, with Solyndra we have an enormous new factory that consumed resources and carbon in the building, and a warehouse full of unused solar panels.

But from the point of view of a bureaucrat, I suspect this is not as good.  With a loan guarantee program, you can point to a shiny new factory, and a hard figure of how many billions went out in loans from the private sector, which can be happily contrasted with the administration's tastefully understated spend.  With direct subsidies, you get a lot of solar panels, but you can't name the jobs that were created or point to hard figures on how much additional investment in "Green Jobs" occurred as a result of your program.

However, most of us are not bureaucrats, and we should be skeptical.
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Why the Solyndra Loan Wasn't Like a VC Investment

Despite all my Solyndra-blogging earlier in the week, I missed making one point that I really wanted to  about the various facile comparisons between the DOE loan guarantee programs, and venture capital firms.

A number of people have claimed that the government had to make these loans because they're "too risky" or "too big" for the private sector, forcing the government to act as a VC firm.  That riskiness means that yes, a non-insubstantial number of the loans will fail.

But this doesn't really make any sense.  The private sector doesn't have any trouble dealing with risky ventures; it simply prices the capital accordingly, demanding high interest rates, or a larger equity chunk, in exchange for money.

Nor is the private sector unable to provide large sums of money--indeed, you may have noticed that it is doing so this very year, to the government.  It may not be able to provide the capital through one bank, or one firm, but it can certainly syndicate a loan or do a large securities offering in order to aggregate many providers into one giant pile of cash.

Now, maybe you think that there is some unpriced social return of these investments.  But then this has nothing to do with VCs, portfolios, or risk; it's a subsidy.  And loan guarantees are not a very good way to structure that subsidy.

Here's why: at the company level, there's no difference between an optimal market outcome, and an optimal social outcome (from the DOE's point of view); both investors and society benefit if more solar cells are sold.  If the solar cells are unlikely to be sold to many people, than the loan guarantee is not a good idea--it will not foster much environmental benefit.  If the solar cells are likely to be sold to many people, than the loan guarantee should not be needed; private investors should be easily found to back the manufacturing.  

The loan guarantees may help make the product slightly cheaper, of course.  But again, if the product is sufficiently likely to be popular, capital should be available in the marketplace at a fairly decent price; the difference in interest rates should not be the difference between success and failure unless the loan itself represents an unsustainably large portion of the company's assets and income.

At any rate, it does not make sense to issue a massive loan guarantee in order to make a company's solar panels slightly cheaper; that's maybe a case for subsidizing solar panel installations, but it's not a case for guaranteeing the loans of a particular solar panel manufacturer.

So no, this isn't much like a VC.  Or anything else that makes financial sense in the private sector.  It's like . . . the government giving money to companies that sound whizzy.

Fat Politics

Jonathan Chait and I don't agree on much.  But we do agree on this:  the argument that Chris Christie is somehow unqualified to be president because he is fat is absolutely ridiculous:

Robinson edges toward what I suspect is the deeper belief at work, urging Christie to follow the example of others who have lost weight. The premise here is that weight is a marker of personal discipline, and anybody who's fat must simply be too lazy to take care of themselves. This conveniently fulfills the desire to categorize obesity as a character flaw, but ignores the extreme difficulty of sustained weight loss. Robinson cites, as an example of somebody who has "lost weight and kept it off for extended periods," Mike Huckabee. Has he seen Huckabee lately? . . . .

Kinsley more explicitly casts Christie's weight as a moral failing, arguing, "a presidential candidate should be judged on behavior and character, not just on policies." It's pretty jarring to see somebody openly make the case that being fat is a sign of poor character. It certainly helps make Campos's case that there's a moral panic afoot.
Kinsley is certainly quite slender.  So it's not surprising that his piece had all the hallmarks of the weigh snob: the folks who believe that their committment to keeping off that last ten pounds by eating less dessert and cheese than they'd really like, is somehow akin to what Chris Christie would have to do to get his weight to "normal".  Naturally, they think this makes them qualified to judge Chris Christie's weight.

As Chait notes, there's no evidence that being thin makes you a better leader.  The only seeming bit of evidence--the tendency of thin people to be richer and more successful--is as easily explained by the fact that America discriminates against heavy people.

How does the idea that weight is somehow a reliable proxy for discipline and self control survive contact with the existence of people like Michael Huckabee, Oprah Winfrey, and yes, Chris Christie?  Do we think that Oprah became the most successful television personality of all time by being lazy and out of control?  She's lost loads of weight what, a half dozen times?  Yet despite her personal trainers, her private chef, and what is by all accounts a work ethic that would be the envy of an entire busload of Puritan slave-drivers all hopped up on IV Adderall, the weight always comes back.

Gina Kolata's Rethinking Thin makes a pretty compelling case that almost everyone's weight fluctuates within a band of 20-30 pounds.  Some peoples' band is higher than others, (and perhaps, slowly increasing over time). When you get nearer to the bottom of your body's weight tolerance, your hunger increases; drop below it, and your body reacts as if you're starving, slowing your metabolism and focusing more and more of your mental attention on food.  I'm near the top of my weight band right now, and am nearly revolted by the idea of eating much besides vegetables and clear liquids.  If Chris Christie was at a similar BMI, he'd probably be continually, distractingly ravenous.

Almost no one manages to stay outside of that band for very long, and those who do need to devote almost their entire energy to doing so, because the hunger is a biological signal on par with pain or the urge to drink.  As Paul Campos notes in his excellent book, the idea that we can permanently reduce our weight through diet and/or exercise is one that has been experimentally tested about 500 million times over the last several decades, and fairly resoundingly refuted.

The band that your body wants to occupy is no more a sign of virtue than the color of your eyes.  Yet people who would be ashamed to argue that Barack Obama should be excluded from the presidency because of the amount of melanin his skin contains, feel no compunction at all in declaring that your genetic predisposition towards adiposity is an intolerable fault.

China's Sometimes Scary Infrastructure

After last week's subway accident, Adam Miniter pens some pretty scathing words about the Shanghai subway system:

Shanghai's subway riders (I am one) are all-too-familiar with bungling conductors who often ignore signals and don't line up train cars with platform doors. Shanghai Subway Line 10, along which the Sept. 27 accident took place, has only existed for 18 months but had already become notorious. One day, a train car's glass doors  spontaneously shattered. Another day, a conductor led a train down the wrong track, only to then make the dangerous decision to back the train up.

Subway commuters across China have been plagued by similar operational problems and the subway lines' overall sub-standard construction. In 2008, for example, 10 people were killed in eastern China when a subway tunnel collapsed.

After the Sept. 27 accident, Yu Shunshun, a well-known blogger, went to Sina Weibo, China's leading Twitter-like microblog, to give some advice to Shanghai's subway-wary citizens:

... Take the middle carriage whenever you are on a metro line or a high-speed train ... if the vehicle is overloaded, please send a message describing your position so as to make it easy for your relatives and friends to locate you. Make sure your cell phone has power before you step on any vehicle and be sure to pray for yourself.
In many cases, that's the best Shanghai's commuters can do to protect themselves.

As Shanghai's housing prices rise, residents have little choice but to move further and further away from the city center. They rely on the subway lines to get to work, but the lines were built quickly and shoddily. A common feeling among Shanghai's commuters is that the subway was not designed to serve them, but to enhance the status of Shanghai's Communist Party leaders.
I'm not sure it's possible to build so much infrastructure so quickly without cutting corners on quality.  But whether or not it's possible, it doesn't look as if China has managed.

On the other hand, as Miniter notes, what are you going to do?  The alternative is sleeping in a park.  Or staying home.

Why Immigration Won't Fix Social Security

Periodically in some debate over social security and entitlements, someone will suggest that we simply throw open the immigration doors and let young, fresh immigrants come in and rebuild the bottom of the Ponzi scheme pyramid.  I used to think this was a good idea, but (while I remain in favor of more open immigration), I'm not sure it will work, for the reasons outlined below:

1.  The places that send us immigrants aren't having so many kids.  Phillip Longman has a piece in the new issue of Foreign Policy which points out how dramatic a demographic transition the world is undergoing:

Indeed, the U.N. projects that by 2025, the population of children under 5, already in steep decline in most developed countries, will be falling globally -- and that's even after assuming a substantial rebound in birth rates in the developing world. A gray tsunami will be sweeping the planet.

. . . Because of the phenomenon of hyper-aging in the developing world, another great variable is already changing as well: migration. In Mexico, for example, the population of children age 4 and under was 434,000 less in 2010 than it was in 1996. The result? The demographic momentum that fueled huge flows of Mexican migration to the United States has waned, and will wane much more in the future. Already, the net flow of illegal Mexican immigration northward has slowed to a trickle. With fewer children to support and not yet burdened by a huge surge of elders, the Mexican economy is doing much better than in the past, giving people less reason to leave. By 2025, young people on both sides of the border may struggle to understand why their parents' generation built this huge fence.
Even if we wanted to go this route, it would probably be at best a stopgap.

2. The workers who most want to come aren't the same as the workers who are already here. Social Security does not just depend on the existing pool of workers; it depends on their output.  You cannot keep the pyramid going by replacing each retiring public accountant with 1.5 cleaning ladies and carpenters.  While there are certainly lots of highly skilled immigrants who want to come here, it's far from clear that the math works for social security.  To be clear, that's not a brief against letting lower-skilled workers come in; they are a valuable complement to higher-skilled workers. But they cannot en masse shore up social security's finances, especially since they too will eventually collect it--and social security's benefit structure is progressive.

3.  America's capital is cultural as much as financial and physical.  We cannot bring in so many immigrants that we swamp the institutional structures: trust, rule of law, common norms about commercial behavior--that make us wealthy.  I think that America can absorb more immigrants than it does--and should.  But I am skeptical that it can absorb enough to keep the pyramid going.

4.  An aging America is one that is going to be politically resistant to change.  Immigrants change things.  Therefore, politically this solution is going to be very tricky.  Which probably makes my other three points irrelevant.

New Post Office Ad Backfires in at Least One Case

Apparently, the Post Office has come up with a solution to its intractable budget woes: advertising!

Americans watching college football games and news broadcasts in the next week may notice new ads from the agency -- long known for its campy messages promoting Priority Mail shipping services. Now, the "If it fits, it ships" campaign will share airtime with two 30-second spots designed to remind customers that paper mail, unlike e-mail, can't be hacked, and that letter carriers are still providing reliable and safe deliveries to doorsteps.

"A refrigerator has never been hacked," an announcer says in the first message as an actress pins a paper bill to her fridge.

In the other ad, a smiling letter carrier is seen walking her route while an announcer reminds viewers that hand-delivered messages ensure that "important letters and information don't get lost in thin air, or disappear with a click."
Who knows, maybe this will work in rural areas where the mail carriers are beloved and reliable.  In DC, however, all it does is remind me about the months worth of freelance checks that used to go missing at my old house, and the cavalier way that my current mail carrier dumps packages on my (in plain view of the street) stoop, rings the doorbell, and darts away without waiting to see that I am home.  Though I often work on the couch right next to the front door, I have never made it to the door in time to catch him.

On the other hand, I've never missed an e-pay reminder or a direct deposit.  So what this commercial reminds me to do is check to see if there are any more bills I can automate.

Paying for Performance is Hard

An important observation by Arnold Kling:

When a remote authority sets incentives, people respond by manipulating the system. This fact is poorly understood by education reformers who are fond of pay-for-performance and national standards, by health care reformers who are fond of paying for quality, and by financial regulators. In fact, the quoted paragraph provides an excellent description of the financial regulatory process under risk-based capital. The banks spent much energy and time trying to manipulate the risk-based capital regulations in their favor. They got what they wanted, in terms of risky portfolios backed by little capital.
Also poorly understood by many corporate managers, in my experience.

There are periodic vogues for "scientific management" into which category fall such diverse phenomena as time-and-motion studies, extremely complicated statistics-based compensation schemes, and powerful committees that promise to eliminate wasteful and unnecessary treatment on a nationwide basis.  Then it turns out that rules-based systems are inherently weak, and they tend to be replaced by a vogue for autonomy and accountability.  Unfortunately, the change is rarely manifested within organizations--once you're encrusted with a nice, thick layer of red tape and rules, it's hard for the pendulum to swing back.  Rather, dysfunctional organizations fail and are bought or liquidated by nimbler competitors.

The government is different: it can't be replaced (really), and it's hard to generate accountability in an organization as big as the federal government.  With obvious implications.

Poster Kids for New Health-Care Model Won't Participate in Model Program

The administration has been pushing very hard on the Accountable Care Organization (ACO) model, which is a somewhat nebulous concept, but which is broadly supposed to save money by streamlining services and coordinating care.  It's one of the centerpieces that pro-Obamacare wonks point to as a real source of cost savings and improved services.  Exhibits A and B are usually Mayo and the Cleveland Clinic, with a few others occasionally thrown in.

However, when the administration rolled out its new ACO program last March, the poster children declined to participate, and an organization that represents large provider groups sent a letter to the Center for Medicare and Medicaid Services indicating that most of their members would not participate.  The reporting requirements, and the financial penalties for ACOs that didn't achieve savings, were simply too onerous.

In response, in May the administration created a new ACO program called Pioneer for "mature ACOs".  Unfortunately, it looks like the poster children have again refused to become a part of the demonstration project:

During the health care debate, the Mayo Clinic, the Cleveland Clinic, Geisinger Health System and Intermountain Healthcare were repeatedly touted as models for a new health care delivery system.

Now, they have something else in common: All four have declined to apply for the "Pioneer" program tailor-made by the Obama administration to reward such organizations.

"When the poster boys ask that the posters be taken down, you have a problem," says Michael Millenson, president of Health Quality Advisors LLC. The lack of participation, he says, suggests that "somebody messed up": either the government didn't make the rules appealing enough, or "when push came to shove, the big players didn't want to play by the rules."

The four health systems are considered the most promising models for "accountable care organizations," a new approach to delivering health care services that rewards doctors and hospitals for providing high-quality care to Medicare beneficiaries while keeping costs down. The ACO provision became one of the most highly anticipated elements of the health care overhaul, and providers embarked on a frenzied race to join in as quickly as possible.
ACOs--or at least some of the features that the administration envisions--may well be the future of Medicare, for all I know.  But it was always folly to point to places like the Mayo Clinic as an example of what was possible for national health care reform.

Mayo is the best in the world at what it does.  This allows it to give all sorts of rewards to doctors that compensate for not being richly remunerated gunslingers: the status of working at Mayo, the excitement of being near the cutting edge, the reward of working with other tip-top physicians.  You can no more replicate that nationwide than you could turn every college in America into Harvard.  Hell, you could build a scale replica of Harvard, put every last one of its rules and policies into effect at your new school, and hire Harvard-trained anthropologists to observe how people at Harvard act, and teach people at the new school to behave the same way.  You could put into place an elaborate system of incentives designed to reward people who act like Harvard people, and punish those that don't.  And at the end of the day, it still wouldn't be Harvard.  It probably wouldn't even be a second-tier state school.  It would be expensive performance art.

There's a clue to this in the fact that the top models for ACOs don't want to join the program.  Doing so would kill the autonomy and flexibility that makes the institution great--and that standardization would rob the institution of the status that lets it attract top talent.  It's also possible that they don't think that threats would make their doctors better at their jobs.

I've written before about the difficulty of replicating successful small-scale programs into large-scale transformation of the health care system.  It continues to be very difficult.
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