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Would Doctors Benefit from Globalization that Lowered Their Pay and the Cost of Health Care?

Better yet, would economists say they had benefited? The reason for the question is that this is essentially the question that the University of Chicago's Initiative on Global Markets (IGM) asked its group of elite economists about trade with China. It asked:

"Trade with China makes most Americans better off because, among other advantages, they can buy goods that are made or assembled more cheaply in China."

This question could be taken to be saying that most Americans are better off because they can get cheaper goods from China. It's a bit difficult to imagine how that could not be true, taken in isolation. In other words, are we better off because we have the opportunity to buy some goods at lower prices?

Other things equal, we certainly would be better off. Hence the question about having the country flooded with foreign educated doctors so that their pay is cut in half. With around 900,000 doctors in the country averaging paychecks of well over $200k a year, this would save the country more than $90 billion a year on health care costs (@ $700 per household per year -- how does that compare to your tax cut?). If we asked our elite economists whether doctors were benefited by lower cost health care, how would they answer? Aren't doctors benefited by paying less rather than more for their health care?

If this seems like a strange question it would not be the first time that IGM stumped the experts. It previously posed a question on whether Piketty's views on growing inequality were correct. The overwhelming majority answered "no," so did Thomas Piketty.

Dean Baker / February 25, 2015

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The Patent Theory of Knowledge

For thousands of years we have seen people develop knowledge and skills, make discoveries, and advance science. The overwhelming majority of this work was not motivated by the hope of getting a patent monopoly. Yet somehow, the ostensibly serious people at the Association of University Technology Managers think that patent monopolies are the only way to support the development of new drugs, or so it would seem from a speech to them by Joseph Allen.

Mr. Allen took issue with my suggestion that if the government funds research that the findings and any associated patents should be placed in the public domain. He pointed to the period before the Bayh-Dole Act when there were:

"28,000 inventions wasting away on the shelves in Washington because there was no patent incentive for anyone to develop them."

Okay, let's try to get this straight. Suppose that the government made its funding partly contingent on developing a usable product approved by the Food and Drug Administration (FDA). Would all the inventions still sit on the shelf because people are too dumb to make a usable product without the motivation of a patent monopoly?

Suppose that the funding even went to private companies who would see their payments increase 50 percent, 100 percent, or even 200 percent if they get a usable product approved by the FDA. Even in that case the inventions would just sit on the shelf because there are no patent monopolies?

One has to wonder what it is about developing drugs that require patent monopolies when people in so many other areas can be motivated simply by money. It's a great mystery.

Dean Baker / February 24, 2015

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Robert Samuelson on History, Inequality, and Productivity

Robert Samuelson was inspired by a graph in the new Economic Report of the President to tell readers that the real problem for the middle class is not inequality but rather productivity growth. His point is that if we had kept up the Golden Age (1943-1973) rates of productivity growth it would have mattered much more to middle income families living standards than the rise in inequality since 1980.

This is true in the sense of if I were six feet five inches, I would be taller than I am, but it's not clear what we should make of the point. We don't know how to have more rapid productivity growth (at least not Golden Age rates), so saying that we should want more rapid productivity growth is sort of like hoping for the second coming. As Samuelson notes, we do have policies that would likely improve growth, more spending on infrastructure, education, and research and development, but no one seriously thinks such policies would get us back to the golden age growth rates of 3.0 percent a year. (Samuelson includes tax reform on his list. While a cleaner tax code probably would boost growth, it's worth noting that tax rates were much higher and the tax code contained more loopholes in the golden age.)

As a practical matter we may not be able to boost productivity growth, but we can change the policies driving inequality. At the top of this list, if we maintain low levels of unemployment as we did in the late 1990s, then middle income and lower income wages will rise in step with productivity growth. This would require generating demand through fiscal policy and lower trade deficits from a lower valued dollar. It also means not having the Fed cut off growth with higher interest rates.

If we also structured labor laws so that it was possible for workers to organize unions, had a minimum wage that kept pace with productivity growth (as it did in the golden age), and didn't protect high-end professionals (e.g. doctors, dentists, and lawyers) from domestic and international competition, then it would be reasonable to expect middle class incomes to keep pace with the economy's productivity growth. If we can only sustain the 1.5 percent annual productivity growth of the slowdown years (1973-1995) this would still imply income gains of almost 60 percent over three decades. While it would of course be better to have golden age productivity growth, since we don't know how to get back such rapid growth, why not pursue the policies that we know will be effective in restoring middle class income growth?

Dean Baker / February 23, 2015

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On a Technicality, World Bank Rejects Complaint on Support for New Mining Law

A complaint from Haitian communities and supported by New York University’s Global Justice Clinic and Accountability Counsel has been rejected by the World Bank on technical grounds. The groups had asked for the Bank’s Inspection Panel to review whether assistance the Bank is providing to the Haitian government follows Bank guidelines relating to transparency and environmental safety.

Since 2013, the World Bank has provided technical assistance to the Haitian government in rewriting its mining laws, leading to a new mining law being drafted in 2014. Though Haiti has not seen large-scale commercial mining for decades, the government awarded multiple concessions in 2012 over opposition protests. In 2013, following a forum on mining sponsored by the World Bank, then Prime Minister Laurent Lamothe declared that to advance Haiti’s development, “we are counting heavily on the contribution of the mining sector.”

The Haitian communities’ complaint [PDF] states:

Complainants fear that, due to the government’s weak capacity and the law’s inadequacies, this increased investment in the mining sector will result in serious social and environmental harms, including contamination of vital waterways, impacts on the agriculture sector, and involuntary displacement of communities. Complainants are also concerned about the exclusion of Haitian people from the law reform process, particularly when contrasted with the reported regular participation of the private sector in drafting the new law. Further, Complainants fear that the government of Haiti lacks the capacity to regulate and monitor mining company activity.

In its response, the World Bank’s Inspection Panel says that it “has decided not to register the case.” The Panel acknowledged that the issues raised were “serious and legitimate,” and agreed that the new mining law could “have significant and considerable adverse environmental and social consequences.” However, because the World Bank support was provided through a technical assistance mechanism, “policies and procedures applicable to design, appraisal and implementation of a project, including the safeguard policies, were not applied to the Haiti Mining Dialogue.” The mechanism is not subject to the World Bank’s safeguard policies and therefore the Inspection Panel refused to hear the complaint.

Jake Johnston / February 18, 2015

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Disunited States of America
I have a chapter on state-level labor-market regulations in a new ILR Press book edited by David Jacobs (Morgan State University) and Peggy Kahn (University of Michigan, Flint). The book is called Disunited States of America: Employment Relations Systems

John Schmitt / February 18, 2015