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John Goodman on Reforming Medicare "What Medicare is trying to do is impossible," writes John C. Goodman in The Wall Street Journal. Medicare pays physicians for about 7,500 tasks, he writes, but it varies the prices according to factors including location so that it is actually setting about 6 billion prices. When Medicare inevitably fails to set appropriate prices for every transaction, it creates "perverse incentives" that, for instance, give doctors far more money to perform a cataract removal than provide primary care. "A more sensible approach is to quit asking for the impossible. Instead, let's begin the process of allowing medical fees to be determined the way prices are determined everywhere else in our economy--in the marketplace." All over the country, walk-in emergency care clinics post prices, determined outside the insurance industry based on experience. Medicare should authorize enrollees to go to these places and it should pay the posted prices. Second, Medicare should allow enrollees to use commercial telephone health care services, which often have much lower costs than a visit with a nurse. "Finally, Medicare should encourage physicians to repackage and reprice their services in ways that are good for the doctor, good for the patient, and good for Medicare."

Roscoe Bartlett on Apes and Testing  Representative Roscoe Bartlett of Maryland invented a respiratory device that helped the first chimpanzee survive a trip to space and back while he was a physiologist at the Navy's School of Aviation Medicine. He also notes that another ape on that flight died from an allergic reaction to anesthesia. He once believed those sacrifices were necessary, he writes in The New York Times, but now "I no longer believe such experiments make sense--scientifically, financially or ethically. That's why I have introduced bipartisan legislation to phase out invasive research on great apes in the United States." Methods such as computer modeling, testing in small doses on humans, and growing human tissues for biomedical studies now often prove "cheaper, faster and more effective," he says. This decline means about 500 federally-owned chimpanzees now sit idle in warehouses. Because chimpanzees are stronger than humans, simple tests often require extreme methods such as "knock-downs" with tranquilizers. "There is no question that chimpanzees experience pain, stress and social isolation in ways strikingly similar to the way humans do." He writes of studies that show chimps kept in captivity communicating dismay through sign language and displaying symptoms of post-traumatic stress disorder. He concludes: "Continuing innovations in alternatives to the use of invasive research on great apes is the civilized way forward in the 21st century."

Bill Gross on the Economy's Real Disease  "It is critical for politicians and investors alike to distinguish between cause and effect, disease and symptom," writes founder and co-CIO of the investment firm Pimco Bill Gross. "Washington has been operating the past few months under the assumption that the United States and our euro-zone economic trading partners are experiencing a debt crisis that must be resolved by exorcising excessive spending in the near term." Our budget deficit is a real problem, Gross notes, but it "is not the disease--it is a symptom. Lack of aggregate demand or, to put it simply, insufficient consumption and investment is the disease." This lack of demand, he writes, has been brewing for decades for several reasons. As baby boomers age, they approach retirement and spend much less than they once did. Globalization has shifted jobs to emerging markets and away from middle-aged, poorly-trained workers in developed countries. Technology has replaced some jobs with machines, "resulting in corporate profits but declining wages." Focusing on contracting the Keynesian spending that has propped up aggregate demand will not help. "Washington hassles over debt ceilings instead of job creation in the mistaken belief that a balanced budget will produce a balanced economy. It will not. The president and Congress must recognize that an AA-plus country, to remain AA-plus, must focus on growth, not debt reduction, in the short term." 

Zoe Williams on U.K. Vigilantism  Zoe Williams writes in The Guardian that the UK riots show British people--both looters and otherwise--pulling together. There are images of socially-responsible people taking cleanup and security into their own hands, and "that all feels extremely heartening and spirit of the blitz." But, Willliams writes, we should be on guard against vigilantism. The looters "ran a broad church, racially" she notes, but there are reports that those resisting the looters might see the opportunity to exercise their own desire for racial confrontation. "The Manchester shopkeepers, interviewed anonymously ... were more disturbing, talking not of protection but of revenge, assembling evidence for the execution of their own justice." Because these people gave up on the state's protection, they too, operate outside its control. "They may use this new community spirit to tidy up their streets, where previously they would have left it to the council, or they may use it to hunt down the people who smashed their windows where previously they would have left it to the police: either way, it would be a very blase politician who was reassured by this sight," she says. People might be engaging more than ever in their community, but only to fill a power vacuum, and that is not the stuff a stable society is made of, she says.

Edward Glaeser on the FAA  The Federal Aviation Administration should not be involved in union disputes or rural airport subsidies, writes Harvard professor Edward Glaeser in The Boston Globe. "If Americans want to keep flying safely, Congress must free the FAA from obligations unrelated to preventing accidents," he writes. The FAA was shut down for two weeks because of a dispute in Congress over subsidies. "As a policy matter, lawmakers should limit subsidies; anyone who worries about carbon emissions should be apoplectic that the government is bribing people over $1,000 each to take another flight." he says. "Yet neither issue is relevant to air traffic safety, and FAA reauthorization should never be tied to such matters." Air safety has made great strides in recent decades, but it risks stalling if the FAA is not allowed to focus on that part of its mission. "The FAA shutdown, like the near default of the United States, is a crisis that calls for institutional reforms to create a more professional, more effective government," he concludes. "One such reform is eliminating unnecessary distractions from the FAA, and giving it one focus--air safety--and a more stable, more sensible source of money."

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