Governor Bradford recorded in his diary that everybody was happy to claim their equal share of production, but production only shrank. Slackers showed up late for work in the fields, and the hard workers resented it. It’s called “human nature.”
“More importantly, if you care about improving the quality of life and living standards over time, the essential question is always about creating broad-based, sustainable economic growth. What are the conditions that are most likely to help the economy get bigger, stronger, and more resilient? At the top of the list is a government which promulgates simple, predictable, and widely enforced rules; spends within its limits and doesn’t pursue arbitrary trade wars and military interventions; and doesn’t bog down the future with an ever-increasing mountain of debt that tamps down growth and freezes out investment. Near the bottom of the list is something that is part of Sanders’ policy repertoire: Announcing bold new plans (Medicare for All! Free College for All!) without even pretending to know how to pay for them.“
The Political Dogma:
Government social “reinvestment” programs benefit the poor at the expense of the wealthy.
The Political Reality, as instantiated by Director’s Law:
Public program expenditures primarily benefit the upward rising middle classs at the expense of the wealthy AND the poor.
Observe that while fulfilling the role of the medium of savings, money is not savings. An increase in money will not result in more savings. An increase in savings requires the increase in the production of consumer goods all other things being equal. Through money, people channel real savings, which provide support to economic activity.
Once real savings are exchanged for money it is of no consequence what the holder of money does with the money. Whether he uses it immediately in exchange for other goods or puts it under the mattress, it will not alter the fact that his real savings are already employed towards the expansion of real wealth.
In a free unhampered market economy there will be a harmonious and sustained change in the pattern of consumption with a rise in consumers’ real wealth. With an increase in real wealth, individuals are likely to strive to acquire various less essential goods and more goods that are luxurious. This harmony however, tends to be disrupted whenever the central bank pumps money.
- FP/GP = 1,041 patients per doc
- IM/IM-Peds = 464 patients per doc
- Pediatrics = 552 patients per doc
- Ob-Gyn = 642 patients per doc
- Geriatrics = 1,237 patients per doc (this was tough to estimate, maybe way off)
Take a close look at the patient panel sizes. Yes, they are derived from raw data and don’t represent actual practices, but they do represent every single individual via census data that were represented in the categories that I used. Why are they so much lower than the “average” U.S. primary care doctor patient panel numbers we see quoted so often? The panel sizes would be larger if we count those with more than one doctor, but that would be a wild guess. But, that effect is dwarfed by the fact that I assumed every single American in the age/gender categories that I used has a personal physician, which we know is not the case. There is the issue of uneven distribution of doctors, with more in urban/suburban area compared to rural areas, tending to skew sampling surveys to higher panel sizes. The other sampling bias of surveys may be web presence of the practice. Again, these practices are easier to locate and contact; which might also account for why they have larger patient populations.
So it the physician shortage real? I don’t know. I do know access to supply is out of balance and we can do much better with some efficiency enhancers.
A recent Congressional Budget Office report shows that when you measure federal taxes paid minus federal transfers received welfare, food stamps, Social Security, etc., the top 20 percent of earners pay an average of $46,500. The next 20 percent pay an average of $700. The bottom three-fifths get back more than they pay. Plus, the U.S. already relies more heavily on the income tax for revenues than any other advanced economy nation.
In other words, America already has lots of economic redistribution. American voters evidently sense that more redistribution would sap economic growth. They’re willing to throw a little to minimum wage earners, but they don’t want to kill the geese laying the golden eggs.
Americans are not alone in feeling that way. You don’t see much demand for Piketty policies in other countries either.
What is important to remember about Medicaid and similar programs is that you can sign up when you need care. People with private insurance can only sign up during open-enrollment periods.
Sure, the people who sign up for Medicaid will consume a lot of medical care and then drop off. But they will also drop out of Medicaid until they need it again. Meanwhile, eligible people who become sick will sign up next month. It never stops.
And it certainly does not address the problem that Medicaid provides poor access to physicians. If it did, the newly covered would not have had to flood hospitals’ emergency departments.