Curiosity Over Pride (FYI: To comment, send an e-mail to scifidink@gmail.com)

Friday, May 21, 2010

Why the fractal nature of health care will doom health reform

Health care spending is fractal; I won't belabor this point further.

I didn't always think this way, but as I spent more time in "the numbers" of health care and health care finance, this "fact" has became pretty obvious.

My group staffs 5 different emergency departments within a 125 mile radius which means the two furthest facilities are about 250 miles apart.

250 miles may not seem all that far but it in the world of medicine, it is worlds apart. So while a casual observer might think "they're just emergency departments", e.g. plain vanilla, let me add there is actually a world of difference between various vanillas. Or as a friend of mine who runs two emergency departments in Waco Texas likes to often say "all medicine is local".

Each of our department is unique. Not only are the communities and therefore the patients very different, so too are the facilities' staff, the facilities' capabilities,etc... I mean unique.

And as a medical bean counter for my group, where even my own natural tendency is to make everything "process, process, process", this uniqueness poses particular challenges to policy wonks. I can attest.

With that background in mind, reading Maggie Mahar today will make you smile.

Looks like the policy wonks are catching on to the fact that there are a few more levels to the fractal after all. Not only is the doctor the problem, now it's the region's doctors and how they cooperate with each other. Now its the patients.

... I wonder what they would find if they lumped clusters of regions together as well? Would these differ? You know my own view. ;-)

-"We have met the enemy and he is us."

All I can repeat is "all medicine is local" and we docs have know this for a very long time. Changing one person's behavior (like your own when you want to loose a few pounds) is hard enough. Changing entire communities' behavior is something entirely different. Having personally been down this very road many times (and I am only talking about 5 hospitals 250 miles apart where I know all the providers by first name), I can verify that it is really really really hard changing groups of people.

Here is an example: if people would stop shooting each other, this would save a boat load of money. So why not change this behavior?

Yet somehow they wonks think they can change the health provider behavior of entire regions of the country?

Will they use money to change behavior?

Oooohhhh, money! In our evil "money driven medicine" culture? (Sorry, I had to get that dig in, Maggie can be... I'll let it go) Now we will use the root of all evil to solve "their" problem?

PhD policy wonks are so good at seeing the interchangeable nature of people within their own models. I only wish they would cooperate with a few MBAs so they could see that people are not always as interchangeable as they often would like them to be.

Perhaps the military term that comes to mind to best predict what will happen is "fragging".

... And by saying this I most certainly do not want to imply in any way that I will personally "frag" policy wonks in their attempts to change collective behavior. Indeed far from it, I actually really do support their general goals and will try my darnedest to help them out.

But do I think it will work?

Do I think they will change enough people on a regional basis to change regional differences?

I might again ask if we are still shooting each other? Do we still use plenty of drugs as a society?

Are there regional differences in these behaviors? ;-)


I will be very interested to see if the people of New York or Miami will truly be willing to change their own collective attitudes towards uncertainty. Will they become as comfortable as someone from Minnesota with statement from their doctors like: "yes, you might have heart disease but what are we really going to do about it anyway so don't go looking for something that isn't a problem. If you do, you'll save someone else money."

... Indeed in a kind of twisted version of this logic, why not get rid of screening all together? ;-)

All I can say is that Gallipoli comes to mind. (start at 5:35)

I do not think policy wonks see how providers will frag them on this issue which is a shame. Providers are not their enemies.

Think about your own family, what you would be willing to hear a physician tell you and then tell me what you think?

... Or maybe if the physician tells you a different way. After all, physicians do not really serve you, physicians serve the collective. We all know this. ;-)

49 comments:

Thai said...

For comments

Dink said...

I remember in some psy or sociology class a prof asked us why we thought there was a correlation between schizophrenia and poverty. It just seemed ridiculous, but I kept my mouth shut. Did the prof think that making employment and financial decisions somehow wasn't effected by the disease? And that when the trust fund kid became poor and then had kids the gene wouldn't be transmitted?


Well, it seems the same argument with "medicine being local". An area of town has cheaper rent. The population is poorer. The same brain they are using to make financial decisions is making health decisions. How you do anything is how you do everything (isn't that paraphrasing your Marcus Aurelius, DJ?).

Dr John said...

I remember reading studies by the RAND corporation years ago making it clear that those who received less healthcare overall had no worse outcomes on general measures all things being equal.

The system promotes this. I work with a DR who has spent months and thousands of dollars learning how to do nothing but maximize his billing codes. Part of this is making multiple dx. If he does he gets paid more. He also may be compelled to provide Tx he otherwise would not. This is what happens when you have a 3rd party paying for things.Many of my pts are self pay. You can bet I am not ordering any damn tests unless I think its life or death. With universal coverage I don't need to give a shit about what tests I order. Someone else pays.

You will never come up with a system that involves 3 parties that someone cannot figure out how to dupe. Make Drs responsible to pts and not the collective. That would fix this but that is also a not gonna happen.

Thai said...

I would love to see that study if you have a link since from what I have read, this issue is complicated.

As but one example, as I understand it, if you take two patients with an identically severe chronic illness (say Crohn's disease) and follow them over the course of their life, you find:
1. The patient with insurance will spend twice as much as the patient without insurance over their entire life.
2. The patient with insurance will live longer, though the difference is small.

And while this does not prove insurance was the deciding factor in the slightly improved mortality (one can imagine Dink's example a where a patient without insurance does not engage in the same behaviors as one with insurance), still it suggests insurance may play a role.

Of course the mortality difference we are talking about is not very large and again we spent twice as much money to get it. So it still begs the issue of how much money should "we" as a collective spend on an individual to increase their longevity. And when is an individual allowed to spend more than this of their own money to seek better results.

Or would we outlaw the private purchasing of care as they do in Canada in some instances?

And of course, if we do spend money to help someone live longer, we are still left with the question as to whether the spending should be in health care or whether it should be used in other ways- like safer roads- which might give more life extended for each dollar spent, etc...

In which case we shouldn't spend it on health care at all if we are to take a purely utilitarian approach.

So it is hard to take a truly moral position even on this issue since there might still be superior ways to spend money from the same moral viewpoint that leads to spending less of the person you were trying to get more health care resources for.

Dr John said...

This is a wiki reduction Thai. The paper is very long. As I remember the essence was if people are asked to share costs the average person in the study used less care with no change in outcomes. There were some groups of poor with certain illnesses where this was not the case. The point you make is a good one. How much are we willing to spend and for what.

I think this is a great summary of the fallacy of providing more health insurance as a means of solving this problem.

The "moral" choice to me is to allow individuals both the risks and benefits of living in a free society. We will never get it right for everyone and someone will always be able to say someone else is not acting "morally". Almost always what this means to me is "they are not acting how I want them to". Roads are moral too.

Dink said...

"And when is an individual allowed to spend more than this of their own money to seek better results."

It reeks of the Social Security problem. Because so many voters (not just citizens, actual voters) benefit from the system, it becomes sacrosanct and no one dare speak of altering it.

And many feel fully justified because "they paid into it". To which I would argue that they did indeed put some money into it, but the never did the math. And they didn't demand their elected officials be fiscally prudent with the funds. Had they put any effort into reviewing the system they would have known it wouldn't work. Its disingenuous of them to act surprised that there is a problem.

Okay, that was a weird tangent. Back to medicine. If the majority of people assume that they'll be getting more out of the system than they'll be putting in, they'll vote for it. And the majority of the citzenship knows (@%^&^&!!!)they're making bad health decisions daily and will therefore be very expensive in the (near) future.

Moral hazards everywhere!!!

"Or would we outlaw the private purchasing of care as they do in Canada in some instances?"

This is outrageous! How do they justify this?

Dink said...

(The previous comment was my tinfoil hat comment. It needed to be isolated from this comment ;) )

I watched the Myhrvold TED. I love it I love it I love it. Surreal in its scope. Shoot them out of the sky with lasers. Exactly. Perfect.

Large numbers of very small things are a bitch. But dammit, we have the technology now to deal with it.

Dink said...

(The previous comment was my tinfoil hat comment. It needed to be isolated from this comment ;) )

I watched the Myhrvold TED. I love it I love it I love it. Surreal in its scope. Shoot them out of the sky with lasers. Exactly. Perfect.

Large numbers of very small things are a bitch. But dammit, we have the technology now to deal with it.

Thai said...

"This is outrageous! How do they justify this?"

There is a moral position that justifies this, much like the selective service, etc...

The problem of course is it does not address the personal responsibility component of needing health care in the first place.

... Why is it we seem incapable of seeing both sides of the coin as a collective.

I understand in the end we have to choose one side or another but to pretend one is better than the other...

Oh well.

Thai said...

Funny you should mention Social Security. Right after I read you comment and responded, I noticed a colleague of mine sent me the following emails which I'll copy and paste here:

Why did Bernie Madoff go to prison? To make it simple, he talked people into investing with him. Trouble was, he didn't invest their money. As time rolled on he simply took the money from the new investors to pay off the old investors. Finally there were too many old investors and not enough money from new investors coming in to keep the payments going. Next thing you know Madoff is one of the most hated men in America and he is off to jail.

Some of you know this... But not enough of you. Madoff did to his investors what the government has been doing to us for over 60 years with Social Security. There is no meaningful difference between the two schemes... Except that one was operated by a private individual who is now in jail, and the other is operated by politicians who enjoy perks, privileges and status in spite of their actions.

Do you need a side-by-side comparison? Well here's a nifty little chart.

BERNIE MADOFF
SOCIAL SECURITY
Takes money from investors with the promise that the money will be invested and made available to them later
Takes money from wage earners with the promise that the money will be invested in a "Trust Fund" and made available later.
Instead of investing the money Madoff spends it on nice homes in the Hamptons and yachts.
Instead of depositing money in a Trust Fund the politicians use it for general spending and vote buying.
When the time comes to pay the investors back Madoff simply uses some of the new funds from newer investors to pay back the older investors.
When benefits for older investors become due the politicians pay them with money taken from younger and newer wage earners to pay the ones 62 and older.
When Madoff's scheme is discovered all hell breaks loose. New investors won't give him any more cash.
When Social Security runs out of money they simply force the taxpayers to send them some more.
Bernie Madoff is in jail.
Politicians remain in Washington.

Dr John said...

Dink, your comments are not a tangent. The are dead center on the problem. I would gladly give up every dime of what I put in SS if they fixed the problem. Hardly anyone has this attitude including idiots like these. The bubbles are all going to burst. People expect not only theirs but yours too.

Thai, thanks for the BM/SS comparison. Dead on accurate. Can't wait to use that.

Dink said...

"Thai, thanks for the BM/SS comparison. Dead on accurate"

Agreed, its very apt.

"And the majority of the citzenship knows (@%^&^&!!!)"

(Belaboring my previous rant)

This faux naivite that "victims" adopt will make me insane. Why are some people so opposed to any kind of skepticism? I'm not talking full blown 224/7 paranoia, just a balanced assessment of "what could go wrong". Do they feel its a betrayal? That if they question the belief that they want to believe in that they are "bad"? Guilt? Fear?

This stubborn, sometimes belligerent, defensiveness against asking questions is everywhere. "But he told me my money was safe". "But they wouldn't put ingredients that are bad for you in their product". "But he must know what he's doing because he's on TV/rich/has been in Congress for years/has a PhD".

I caught such hell from Californians during the housing bubble for being skeptical. The eye rolls, the paternalistic "pats on the head" for being so blind, teasing that I was just jealous because I moved out of state and missed the big easy cash. Surely this skepticism on a belief they loved dearly couldn't be based on reason or even unbaised curiosity; it had to be sinister or ignorant.

Again, I'm not saying skepticism 24/7. Just enough to be balanced. It would save the collective so much effort in the end.

Well, I'm heading to the mountains later today. Have a great weekend y'all!

JP said...

Ah money, the incomplete motivator.

And I wish everyone would understand this about Social Security.

It is a tax.

You aren't "paying into" the Social Security system.

You are paying a tax. Period.


In the future, benefits will go down and taxes will go up.

JP said...

Dink says:

"I caught such hell from Californians during the housing bubble for being skeptical. The eye rolls, the paternalistic "pats on the head" for being so blind, teasing that I was just jealous because I moved out of state and missed the big easy cash. Surely this skepticism on a belief they loved dearly couldn't be based on reason or even unbaised curiosity; it had to be sinister or ignorant."

You think the housing bubble gets you funny looks?

Just try to to explain to people that the stock market is probably going to go nowhere for the next 10years, just like it went nowhere for the last 10 years.

I went long gold (bad idea) and short the market (very good idea) this month.

Moral of the story? I made a little money, but not much. :)

JP said...

Oh, and the partnership I was practicing with has dissolved, leaving me with no work.

And no unemployment to draw.

Am I particularly worried about this?

Nope.

Although I should try find some employment sometime in the near future to reduce the stress on my wife.

I may, once again, become a patent attorney.

Law is such a fun and exciting profession. :)

Thai said...

Oh that's terrible, sorry to hear it.

I hear a lot of patent work is moving in house. Would you agree?

JP said...

It's not particualy terrible. Ultimately, it means that I will have to take a pay raise and work longer hours.

For GE, patent work was moving inhouse a few years ago. I got recruited for the work that I was already doing for their aircraft engines division. I told them that I preferred to do the work I was doing right were I was, rather than moving to Ohio. ;)

Dr John said...

Hey, I think someone just insulted me and Ohio...

I am no money expert but I admit I find the arguments against anything but a stock market downturn and more long term malaise(another lost decade) not very compelling. I mostly liquidated last week and will stay out and keep my cash.

JP. Tell me what you mean you went "long gold" and it was bad.

I once was out of work for a month. It was the best month of my life. I have lots of pts who have been on unemployment for 12 months and have zero desire to look as long as it is coming. You do not have to be BF Skinner to understand-cause effect in this process.

Thai said...

I've been doing that for years, it wears on you.

I agree SS is a tax. Indeed all government monies are really one giant collective pool but is hard hard to not occasionally artificially compartmentalize the monies.


PS- Okie was saying that student loans could be garnished from SS.

Is there a way that say criminal punishments, etc... can similarly be garnished from either SS or Medicare?

It seems odd that student debt would be the issue the government goes after considering there is so many things people do that are so much more offensive to so many other people.

Thai said...

when I say "the government goes after" I mean the voters of course

So many things I wish people would pay back and not do again before I went after someone making a bad college major decision, etc...

Thai said...

Ohio seems like such a wonderful state to be from ;-)

By brother went to med school at Ohio State which was the first time I ever spent any time in Ohio.

I'm normally one of those people who says everywhere he goes "I could live here". And while I liked Columbus, I don;t think I could live there. Way too overcast way too often.

By comparison it makes Seattle downright sunny.

Don't you ever miss the sun?

JP said...

Penn State - Good (my undergrad). Ohio State - Bad. ;)

I actually bought the "Permanent Portfolio", which has about 20% gold/5% silver and stocks/bond. I figured that a gold spike would enable that fund to continue to make gains through the correction. I was wrong.

I hate buying and selling funds because it's a giant pain, but I've learned that you have to sell or you will take severe losses. I much prefer to buy and hold funds because it's easier. The exception are short funds, which you have to sell or you will lose money.

I thought gold would continue to spike as the market tanked, keeping that fund up. When it was clear that gold was at a short term top and going down along with the market, I sold after losing a couple of percent.

My current investospeculation vehicles are:

HSGFX (Hussman Strategic Growth Fund)
HSTRX (Hussman Total Return Fund)
PRPFX (Permanent Portfolio)(which I have sold)
GRZZX (Grizzly Short Fund)(short term trading only)(which I have sold)

JP said...

My goal with investing is to make small gains and not have any signficant draw downs as we work through this secular bear market.

So far, I've succeeded. I think my largest draw down was 2% of assets. I'm quick to sell anything that declines.

I should just put my money in long term CD's and take the 3% annual returns that my investing is providing without any of the market risk.

But it's an entertaining hobby for me.

JP said...

When you take out Federal Student loans, you are essentially "borrowing" from any future Social Security benefits to which you become "entitled".

But they don't tell you that.

If you want to get your Social Security benefits now instead of at retirmenet, just take out student loans and don't pay them back. But watch out for the accrued interest. :)

JP said...

Dr. John says:

"JP. Tell me what you mean you went "long gold" and it was bad."

If you were asking what it means to take a "long" position, it means that I bought gold (in my case, near it's peak), as opposed to a "short" position, which would mean that I was betting on the price of gold declining.

Dr John said...

Thai, I live about 20 min from a huge old army munitions ground called the Ravenna Arsenal. I understand it was built around WW 2 and was placed there for the specific reason that it was inland and in one of the most overcast areas in the entire country. Even at that time they were worried about the potential of enemy bombing raids inland at some point. Seattle is overcast but beautiful. Columbus is like living in Miami compared to the sun we get in NE Ohio. I remind myself there are no poisonous snakes, natural disasters nor is it a likely to be the target of terrorism. That's something I guess.

JP, thanks for the explanation.

Thai said...

When you hold an S&P Index fund for a long time expecting it to go up over the long term, you are "long" (i.e. buy low and sell high).

Short is the opposite as JP says; e.g. you purchase something expecting the price to actually drop (sell high then buy low).

... So in "shorts" you don't actually purchase what you are selling, instead you actually "rent" for a small fee another person's stock or bond and you promise to return what you rent as you tell the person you borrow it from that you will buy back some more shares of what they own in the future and give them back their shares then.

There are a number of issues around shorting which I won't mention unless you ever think of doing it (be careful as you can be wiped out).

... I have never actually truly shorted anything though my investment advisor has purchased for me a version of shorts known as inverse ETFs.

Typical examples might be include the following

If you think something is going to crash, they are a great way to bet on your beliefs.

FWIW this is also why they are more expensive than simple long only funds as not only do you pay the transaction costs involved, you also have to pay the fee to borrow the shares from someone else.

And just in case you were also unaware, a "naked short" means you sell something you do not own nor have you even borrowed it. Think of it as the ultimate bluff if you will.

If you have been following this crisis closely, you might have noticed that the German ban on naked short selling of CDS was at least partially responsible for at least the timing of the recent upheaval with the Euro and Greece, etc...

Governments will typically ban various forms of short selling/naked shorts during government defaults, etc...

Recent historical examples might include Greece, Vietnam, Germany, etc...

Its all a bunch of silly nonsense but if you have the balls to bet on yourself and against the crowd, you can make a fortune.

Indeed the largest fortune ever made in the shortest period of time was made by John Paulson as his hedge fund made something like $20 billion (with a personal take home of something like $4 billion from this) as he shorted CDS on home mortgages betting against the housing bubble. I think he did this all in just a few months.

Thai said...

And hence you can see my potential interest in a fund shorting the health care bubble

... Though I think we are a ways off

Thai said...

By the way, I really want to thanks you John and JP for the recommendation of The Last Psychiatrist blog.

He is a national treasure if ever there was one.

... I wonder if they would make him head of HHS? ;-)

Dr John said...

Thanks for the explanation Thai. I am mystified as to how these vehicles of economic exchange were developed. I also can see why the average Joe would be very distrustful of a market that involves these types of transactions. Nothing at all appears to be created of value but rather money appears to change hands based on the same kind of speculation that goes into betting on the Browns to have another sub .500 year.

I don't think most people who buy into an index fund or hand there money over to a money manager expect they are getting anything but some stock of of a company that manufactures widgets. If that fails they get it. When this other stuff goes bad they are confused and pissed. It does not seem right someone should make 20 billion dollars off shorting the housing market. It is not the 20 billion that bothers me at all. It is just the inability for me to see what at all of any value such a transaction creates?

Thai said...

Oh, think that through a little more. I simply have to strongly disagree with you here.

Is someone who always tells you what you want to hear your friend?

Is someone who says "don't do it!" you're enemy.

Short buyer/sellers are every bit as important as long buyers/sellers.

Having only one is like living in a world of only optimists, or living in a world brought to you by Kool-Aid. ;-)

Like all the greats of any field, Paulson saw a systemic error and bet big on it. My hat is off to him.

... Trying to repeat it on the other hand is something entirely different.

Thai said...

Think of it this way

A bunch of economic idiots had the money to invest before.

So Paulson came along and took their money from them all the while saying "if you can't invest responsibly with this money, then someone who can needs to take it away from you so the capital can be invested wiser."

We'll see if he does. ;-)

Dr John said...

I am not talking about long term or short term. I am talking about what you are paying for. Maybe I need to re-read and study a bit more.

It appears to be nothing more than gambling. What is produced? I certainly recognize their is "gambling" in all economic investment but this gambling does not seem to occur with any attempt to produce anything but just rather flat out betting on if something will succeed or fail and in fact often betting and wishing for failure.

This seems contrary to the goals of standard types of business investment where you want to create a product of some nature that has value that other people want in the end.Your investment success is based on the success of that creation.

Thai said...

Re: "This seems contrary to the goals of standard types of business investment where you want to create a product of some nature that has value that other people want in the end."

I think I understand what you mean and at some level we agree, though I think the statement is a little "school boy".

Think of this subject as fractal, and the notion of whether shorting is a waste of resources depends on what level of the fractal you are referring to as well as what perspective on the fractal you have.

Are you are referring to an individual's viewpoint on this issue or are you referring to the collective's viewpoint on the issue?

From the collective's viewpoint, it is absolutely fair to criticize any and all monies that go into financial products and services which are not absolutely necessary for the finance of "real businesses" as a complete waste.

But this is also like saying anyone who buys home security systems or spends public dollars on police protection is wasting money as society would be much better off if people stopped wasting their money on such non-productive enterprises.

... Unless you think you should take one for the team on these particular issues.

Thai said...

If you look at the issue from the perspective that money already in the financial sector is a zero-sum game as it gets shuffled around, shorting has very valuable functions.

You could take it out of the financial sector (and indeed I hope we all do as Americans) but you better hope it moves to more productive places.

...My own opinion is that a lot more societal resources should be placed into basic hard sciences but that does not seem very popular right now.

Thai said...

Oh, and investing is gambling

Dr John said...

No all investing is not "gambling". It can be but not all of it is. It is risk taking all the time but it is not "gambling" all the time. We are getting into a disagreement about the meaning of words but you know there is a difference between me betting my money the market will tank and using it to create a self contained electric generator to sell to people so we can end the use of grid power as we know it. Both involve the risk of capital in an attempt to create it but for very different ends. I would not describe the latter as "gambling" despite the element of risk involved. Putting money on a horse to finish is gambling and a lot closer to putting money on the housing market to crash than it is to putting money into creating something.

As far as my viewpoint in regards to the individual or collective I would say maybe both. I cannot see the negative externality created by an individual getting a hoe security system so easy as I can as the crash of derivatives.

What valuable functions are served by the money shuffle?

Thai said...

Agreed that this can be one of these endless loop discussions depending on the meaning of words, though I tend to think of it as endless loops because of the infinite perspective you can look at the issue from.

First, not all investing is as you suggest. Indeed, only a very small percentage of investing actually improves productivity, etc... as your example suggests.

If the US government wants to pay welfare/disability to people and borrows to do so and your mother and father, looking for "security and stability" decide to fund America by purchasing US Treasury bonds with their savings, are they really "adding value" as you suggest with your first example?

Yet is this not also a form of investing?

I would certainly agree with you if you are saying you wish we would invest more resources in examples like you allude to with your self contained power generator company example.

... Though this kind of investing can be done by either public or private entities... The Internet came as a result of defense spending and the public dollars spent on CERN in Switzerland).

But even assuming the investment example you gave, e.g. your "power generator" where people are taking significant risk in order to improve the productivity of something, my response is still a kind of "yes and no"

As it is again one of these perspective issues.

For there are some perspectives on your hypothetical power generator example where things are zero sum and some perspectives where they are not.

If you successfully invest to build a self contained generator, you have greatly improved the productivity of energy distribution in society and in this regard energy is freed up for other purposes.

E.g. This is non-zero sum from the collective's viewpoint and is non-zero sum from the viewpoint of the person who made the successful bet.

But (there is always a but)...

1. You have to invest wisely (which is a lot harder than many people admit). If you do not and or something else happens, you loose your investment.

2. You may want to invest money to do this, but if the skills, or technology, or people, or ability to execute, or market, etc... are not there, throw all the money in the world you want at the problem, you will not be successful.

3. Even assuming success, all the people whose jobs were dependent on the old power distribution system will now loose their old jobs and have to be gainfully redeployed in other areas of the economy.

And the areas of the economy they move into are largely dependent on the tastes of the people who make the correct bets in the first place. For as new profits are created by the company that sells the new self contained power generators, these profits are either consumed by their new owners (say they purchase a new boat or a bigger home) or they will be saved and therefore reinvest/spent in still other areas of the economy.

And this capital attracts people from elsewhere in the economy (or the one's who lost their jobs).

If the original worker who lost his job was once a power distributor (before they lost their job) and they have to become leather workers as the new owners want nicer leather shoes, is this really a positive change from either societies perspective or from the perspective of the worker who lost his job?

And if a new industry is set up to re-train people to become leather workers, is this really a positive development from the new power system?

It is true their is new energy freed into the system as the new energy generator improves the efficiency of energy utilization, but it is not necessarily true that the worker who lost his job will see much of this (though they may).

Thai said...

You can think of shorting as similar to these scenarios I allude to.

People buy Treasury bonds to fund welfare/disability, are these "better" ways of investing money than shorting companies or markets?

I'm not so sure.

Further many short investors see bad investment decisions being made- e.g. they see the "excess"- and in effect by rewarding them as they make money off shorting the system, you are funding the very people who force efficiency on the system in the first place.

It is true that you could have a system without shorting but I do not see how it would be any different than one with in the end.

And "yes" shorting is a less than zero-sum game. But from some perspectives, so is life.

Thai said...

And when you purchase a home security system, societal resources are still being spent on security, hardly a great use of resources I think we would agree- except they are as they are needed to protect someone (that is the catch-22).

It is just as true that society does not grow all that much from home security (though providing the same level of security for less resources allows resources to be freed up for other purposes, etc...).

If you think there is excess and you short and you make a profit, you win big. If you get this wrong, you loose.

But how is this any different than trying to figure out whether to bet on a bond issued from someone who wants to provide home security services because you think the bond is undervalued? Yet this is exactly what bank loan officers do all the time.

... And yet shorting and the bond are different. This is the paradox.

I'm not saying shorting is the same, though I am saying it is similar, and I am saying it is not more wasteful than many other ways we use resources. Further there is little difference between investing because you see something as undervalued (say a piece of property in your neighborhood you think is selling at a good price) vs. investing because you think something is over-valued.

To the extent you are correct, you are rewarded for bringing prices/value back into "balance". To the extent you are wrong, you take a bath. And either way, from the collective's perspective, the two are equivalent.

Dr John said...

Ok. I see there are lots of layers to this onion Thai.There is no perfect system.

JP said...

Thai says:

"People buy Treasury bonds to fund welfare/disability, are these "better" ways of investing money than shorting companies or markets?

I'm not so sure."

Don't worry. I own treasury bond funds, too.

So I both short the market and fund disability/welfare.

Yes!

:)

JP said...

And, if you think about it, I use revenue that was provided to disabled people for attorney representation to short the market.

Although, at the moment, I'm no longer being funded by disability payments.

Thai said...

Re: "So I both short the market and fund disability/welfare"

LOL!!!

The irony is sooo perfect! :-)

LOL!!!!



PS- I want to be clear, there is disability and then there is disability.

I really don't mean to seem stronger in my views than I intend. My main point was only to let John know that the ethics of "social good" in investing is very complicated, that there is often no clear answer, and that even his best example represents on a very small % of global investment activities.

I'm really not trying to pick on the disabled.

As for using their proceeds to short the market...

All I can say if there was ever a more perfect example of how everything in economics is connected to everything else, I know not how.

It is also a wonderful example of why the rich get richer

Be well my friend

Thai said...

John, have you ever read any books along this thread?

Dr John said...

No I have not. It looks challenging. Should I read it?

Thai said...

Not necessarily.

Nor am I even saying you should read these classes of books

I only suggest it to give you a different sense of the economic debate around this issue of zero sum/non-sero sum.

For at some level, at least to me, an understanding of it is critical to understanding the different views of economics and the different world philosophies that are out there and I suspect it will help you come up with a better framework around things like "shorting the market is nonsense".

I don't think there is an absolute right answer to these issues as I'm not religious (though I sympathize with many of their views), I do think there are equally valid perspectives on these issues and I thought this book (or books like it and there are a great many) might help.

But I really don't recommend it for most people. I only suggested as since you said you delved into economic philosophy like Hayek, etc... and I though this another view that does not necessarily disagree with Hayek

Dr John said...

I will just assume I should.

Dr John said...

I am not at all religious either but completely buy into your pitch for "cooperation". On some level I see some economic vehicles so contrary to this philosophy as to be immoral. That does not mean I am naive enough to buy into the idea that we can regulate them through central planning. This is where I am a great lover of Hayek.

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