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June 29, 2009

Economist's View - 6 new articles

An "Ethical Dilemma" in End of Life Care

This looks at the costs of extending the end of life by a short period of time and tries to draw a boundary between those cases when treatment should be applied, and those when it is not worth it to do so (the conclusion is that "studies powered to detect a survival advantage of two months or less should test only interventions that can be marketed at a cost of less than $20,000 for a course of treatment").

How do we draw this line (and if you don't think we should, how do we avoid drawing it)? Usually, I would give the standard answer that we should employ these life-extending procedures up until the point where the marginal cost of the treatment equals the marginal benefit, and let someone else worry about how to actually measure the costs and benefits. But in this case the measurement of the benefits - life itself - seems particularly hard to quantify, and trying to account for quality of life complicates it further, and it is not clear to me that a market test is even appropriate when there may not be a tomorrow and standard opportunity cost tradeoffs are missing from the evaluation (update: thinking more, I suppose this is just "cap-T" in our models, which isn't too hard to handle in the deterministic case, i.e. where T is known in advance with certainty, but the evaluation still seems problematic due to the other reasons that are cited). So I don't think there is a good answer to this question, at least not one that standard economic models can deliver:

How much is life worth? The $440 billion question, EurekAlert: The decision to use expensive cancer therapies that typically produce only a relatively short extension of survival is a serious ethical dilemma in the U.S. that needs to be addressed by the oncology community, according to a commentary published online June 29 in the Journal of the National Cancer Institute.

Tito Fojo, M.D., Ph.D., of the Medical Oncology Branch, Center of Cancer Research at the National Cancer Institute, in Bethesda, Md., and Christine Grady, Ph.D., of the Department of Bioethics, the Clinical Center at the National Institutes of Health, ... illustrate cost-benefit relationships for several cancer drugs, including cetuximab for treatment of non-small cell lung cancer, touted as "practice changing" and new standards of care by professional societies, including the American Society of Clinical Oncology. ...

According to Fojo and Grady,... 18 weeks of cetuximab treatment for non-small cell lung cancer, which was found to extend life by 1.2 months, costs an average of $80,000, which translates into an expenditure of $800,000 to prolong the life of one patient by 1 year. At this rate, it would cost $440 billion annually ... to extend the lives of 550,000 Americans who die of cancer annually by 1 year.

To address the issue, the commentators recommend that studies powered to detect a survival advantage of two months or less should test only interventions that can be marketed at a cost of less than $20,000 for a course of treatment.

Every life is of infinite value, the authors say, but spiraling costs of cancer care makes this dilemma inescapable.

"The current situation cannot continue. We cannot ignore the cumulative costs of the tests and treatments we recommend and prescribe. As the agents of change, professional societies, including their academic and practicing oncologist members, must lead the way," the authors write. "The time to start is now."


DeLong: Sympathy for Greenspan

Brad DeLong can't decide whether or not Greenspan made a mistake when he kept interest rates low after the collapse of the dot.com bubble:

Sympathy for Greenspan, by J. Bradford DeLong, Commentary, Project Syndicate: In the circles in which I travel, there is near-universal consensus that America's monetary authorities made three serious mistakes that contributed to and exacerbated the financial crisis. ... US policymakers erred when:

-the decision was made to eschew principles-based regulation and allow the shadow banking sector to grow with respect to its leverage and its compensation schemes, in the belief that the government's guarantee of the commercial banking system was enough to keep us out of trouble;

-the Fed and the Treasury decided, once we were in trouble, to nationalise AIG and pay its bills rather than to support its counterparties, which allowed financiers to pretend that their strategies were fundamentally sound;

-the Fed and the Treasury decided to let Lehman Brothers go into uncontrolled bankruptcy in order to try to teach financiers that having an ill-capitalised counterparty was not without risk, and that people should not expect the government to come to their rescue automatically.

There is, however, a lively debate about whether there was a fourth big mistake: Alan Greenspan's decision in 2001-2004 to push and keep nominal interest rates on US Treasury securities very low in order to try to keep the economy near full employment. In other words, should Greenspan have kept interest rates higher and triggered a recession in order to avert the growth of a housing bubble? ...

Full employment is better than high unemployment if it can be accomplished without inflation, Greenspan thought. If a bubble develops, and if the bubble ... collapses, threatening to cause a depression, the Fed would have the policy tools to short-circuit that chain. In hindsight, Greenspan was wrong. But the question is: was the bet that Greenspan made a favourable one? ...

I am genuinely unsure as to which side I come down on in this debate. ... What I do know is that the way the issue is usually posed is wrong. People claim that Greenspan's Fed "aggressively pushed interest rates below a natural level." But what is the natural level? In the 1920's, Swedish economist Knut Wicksell defined it as the interest rate at which, economy-wide, desired investment equals desired savings, implying no upward pressure on consumer prices, resource prices, or wages as aggregate demand outruns supply, and no downward pressure on these prices as supply exceeds demand.

On Wicksell's definition — the best, and, in fact, the only definition I know of — the market interest rate was, if anything, above the natural interest rate in the early 2000's: the threat was deflation, not accelerating inflation. The natural interest rate was low because, as the Fed's current chairman Ben Bernanke explained at the time, the world had a global savings glut (or, rather, a global investment deficiency). ...

Greenspan's mistake — if it was a mistake — was his failure to overrule the market and aggressively push the interest rate up above its natural rate, which would have deepened and prolonged the recession that started in 2001.

But today is one of those days when I don't think that Greenspan's failure to raise interest rates above the natural rate to generate high unemployment and avert the growth of a mortgage-finance bubble was a mistake. There were plenty of other mistakes that generated the catastrophe that faces us today.

I have argued the Fed's decision to keep interest rates low contributed to the bubble, but was not itself the sole cause of it. As to whether the Fed made a mistake, I'll just note that the tradeoff wasn't quite as stark as Brad implies, i.e. there were other policy instruments that Fed could have used to limit the housing bubble. Regulation is certainly one means the Fed had to that end, but Fed communication could have helped too. If Greenspan had, for example, told people to stay away from mortgages because they were toxic rather than implicitly encouraging them to invest in housing, things might have been different.

Would limiting the bubble through regulation, communication, or other means have limited the employment response, the primary worry? I don't think so, at least not enough to matter. The money would have been invested somewhere, housing had an opportunity cost after all, so the next best alternatives would have been pursued to the extent that they were profitable (and many would have been, just not as profitable - apparently anyway - as investing in housing and mortgages). So people still would have been employed somewhere as the money was invested, just not in housing, and that would have helped to insulate us from the housing crash. (And a lot of them might still have those jobs, unlike the people who depended upon the housing markets for employment.)

So narrowly, keeping interest rates low and employment high was the right thing to do. The mistake was letting all of the action brought about by those low rates, or most of it anyway, occur in a single sector, housing, rather than using regulation and other means to limit the flow of resources into the housing market in pursuit of profits based upon the misperception of risk. Those resources could have been redirected into other sectors and put to productive use rather than wasted building houses nobody wants, and achieving this result did not require the Fed to aggressively raise the target rate, it only needed to use the other tools it already had available.

Unfortunately, however, those tools were not used, and the ideology Greenspan brought to the Fed played a large role in this outcome.


Paul Krugman: Betraying the Planet

Are the arguments against the need to act to prevent climate change based upon a morally defensible position grounded in science, or, given the predicted consequences of inaction, a morally indefensible position based upon ideology and political interests?:

Betraying the Planet, by Paul Krugman, Commentary, NY Times: So the House passed the Waxman-Markey climate-change bill. In political terms, it was a remarkable achievement.

But 212 representatives voted no. A handful of these no votes came from representatives who considered the bill too weak, but most rejected the bill because they rejected the whole notion that we have to do something about greenhouse gases.

And as I watched the deniers make their arguments, I couldn't help thinking that I was watching a form of treason — treason against the planet.

To fully appreciate the irresponsibility and immorality of climate-change denial, you need to know about the grim turn taken by the latest climate research.

The ... planet is changing faster than even pessimists expected: ice caps are shrinking, arid zones spreading, at a terrifying rate. And according to a number of recent studies, catastrophe — a rise in temperature so large as to be almost unthinkable — can no longer be considered a mere possibility. It is, instead, the most likely outcome if we continue along our present course.

Thus researchers at M.I.T., who were previously predicting a temperature rise of a little more than 4 degrees by the end of this century, are now predicting a rise of more than 9 degrees. ...

Temperature increases on the scale predicted by ... researchers ... would create huge disruptions in our lives and our economy. As a recent authoritative U.S. government report points out, by the end of this century..., Illinois may have the climate of East Texas, and ... deadly heat waves ... may become annual or biannual events.

In other words, we're facing a clear and present danger to our way of life, perhaps even to civilization itself. How can anyone justify failing to act?

Well, sometimes even the most authoritative analyses get things wrong. And if dissenting opinion-makers and politicians ... had carefully studied the issue, consulted with experts and concluded that the overwhelming scientific consensus was misguided — they could at least claim to be acting responsibly.

But if you watched the debate..., you didn't see people who've thought hard about a crucial issue, and are trying to do the right thing. What you saw, instead, were people who ... don't like the political and policy implications of climate change, so they've decided not to believe in it — and they'll grab any argument, no matter how disreputable, that feeds their denial.

Indeed, if there was a defining moment in Friday's debate, it was the declaration by Representative Paul Broun of Georgia that climate change is nothing but a "hoax" ... "perpetrated out of the scientific community." ... Mr. Broun's declaration was met with a round of applause from his Republican colleagues.

Given this contempt for hard science, I'm almost reluctant to mention the deniers' dishonesty on matters economic. But in addition to rejecting climate science, the opponents of the climate bill made a point of misrepresenting ... studies of the bill's economic impact, which all suggest that the cost will be relatively low.

Still, is it fair to call climate denial a form of treason? Isn't it politics as usual?

Yes, it is — and that's why it's unforgivable.

Do you remember ... when Bush administration officials claimed that terrorism posed an "existential threat" to America,... [so] normal rules no longer applied? That was hyperbole — but the existential threat from climate change is all too real.

Yet the deniers are choosing, willfully, to ignore that threat, placing future generations of Americans in grave danger, simply because it's in their political interest to pretend that there's nothing to worry about. If that's not betrayal, I don't know what is.


Fed Watch: A Tangled Policy Web

Tim Duy:

A Tangled Policy Web, by Tim Duy: Incoming data continues to confirm an emerging period of relative economic tranquility following the financial storm of 2008. Importantly, the bleeding in consumer spending has been staunched, despite ongoing job losses that look likely to remain a feature of the American economic landscape for months to come. But incoming data also point to America's sustained and perplexing dependence on foreign capital inflows - a dependence that suggests an underlying economic vulnerability that has yet to be addressed. Whether it needs to be addressed next month, next year, or next decade is still a question that continues to haunt the followers of global macro trends.

The most recent Personal Income and Outlays report, for May 2009, highlights many of the trends currently impacting the evolution of economic activity. The headline jump in incomes, like that of the previous month, was driven by federal stimulus. Declining private wage and salary disbursements are a more telling indicator of the health of household finances, and are consistent with ongoing labor market weakness. The best bet is the that private wage gains remain subdued, even as conditions stabilize. Although the apparent peak of initial claims is in the rearview mirror, persistent high levels of claims points to a jobless recovery.

Of course, in the absence of federal stimulus, the underlying weak income growth indicates sustained pressures on consumer spending power. Indeed, the numbers tell a clear story of stabilization, but little to suggest that a V shaped recovery for consumer spending is at hand:

FED063009

In addition, the report adds further credence to the claims that American's long affair with spending has ended in a bitter divorce, with the saving rate climbing to its highest level in 15 years. To be sure, some of the increase is likely not sustainable in the short run, as it partly reflects a time lag between federal stimulus and the spending it was meant to encourage. That said, the underlying saving increase is tempering the impact of stimulus spending, as households sock some of it away for the next rainy day and/or pay down crippling debt loads, effectively turning private debt into public debt. And note that large shifts in consumer behavior are not required to have significant macroeconomic implications. Small changes across households - a little less, percentage wise, spending here and there adds up. From Bloomberg:

Saks Fifth Avenue is cutting orders 20 percent after posting losses in the last four quarters. Kia Harris says some customers at the Washington shoe store where she works are buying one pair rather than three.

In the recession following a borrowing binge that sent consumer debt to the highest level ever, Americans are shutting their wallets and building their nest eggs at the fastest pace in 15 years.

While the trend will put the country's finances in better balance and reduce its dependence on Chinese investment, it may also restrain economic growth in 2010 and beyond, said Lyle Gramley, a senior economic adviser with New York-based Soleil Securities Corp. and a former Federal Reserve governor.

The interesting line here is the implication that increased savings will jointly improve national finances and lessen dependence on foreign capital inflows. To be sure, the increase in household saving or, equivalently, the decrease in household borrowing serves as the offset for increase federal borrowing. Indeed, the data is supportive of those who argue the importance and necessity of deficit spending to support economic activity. Given that low interest rates are insufficient to spur spending and, instead, households rapidly increase the pool of available saving, the federal government is best positioned to step up as the economic engine, and can do so without significantly impacting interest rates and crowding out private investment. Case closed.

Or is it? In a closed economy, this story works. In an open economy, the tangled webs of international finance are spun into a more complex tale. Why, if rising households saving justifies deficit spending, are foreign central banks increasingly important again in financing a US capital shortfall? From Brad Setser:

Over the last 13 weeks of data, central banks added $160 billion to their custodial accounts, with Treasuries accounting for all the increase.

$160 billion a quarter is $640 billion annualized — a pace that if sustained would be a record. Of course, $640 billion in central bank purchases of Treasuries would still fall well short of meeting the US Treasuries financing need. The math only works if Americans also buy a lot of Treasuries. That is a change.

The annualized inflow of $640 billion is nothing to sneeze at; at that rate, foreign central banks are supporting US spending to the tune of 4.5% of GDP. Without those inflows, I find it difficult to think that US interest rate would have anywhere to go but up - an increase that would be necessary to resolve what remains a persistent element of the American economic landscape - a smaller but still significant current account deficit. A deficit that could perhaps be dismissed if it was being financed by individual investors in Shanghai looking to be shares in Apple to capture the profit potential of the US economic engine. A deficit that is difficult to dismiss if it requires foreign central banks to continually compensate for the absence of interest from private investors.

The ongoing US dependence on foreign central banks, long chronicled by Brad Setser, has another implication. If foreign CBs only provided temporary financing, we could rightly view their actions as addressing a temporary liquidity crisis in the US. No harm done, good stabilization policy. The persistence of those flows, however, suggests something much darker…the US does not face a liquidity challenge. It faces a solvency challenge. From the Washington Post:

The nation's long-term budget outlook has darkened considerably over the past six months, and President Obama's plan to extend an array of tax cuts and other policies adopted during the Bush administration has the potential to "create an explosive fiscal situation," congressional budget analysts reported yesterday.

In a new report, the Congressional Budget Office found that extending the Bush administration tax cuts, reining in the alternative minimum tax and canceling a scheduled reduction in payments to Medicare doctors would dramatically slash tax collections at a time when federal spending would be "sharply rising." The resulting budget gap would drive the nation's debt over 100 percent of gross domestic product by 2023, the report says, and past 200 percent of GDP by the late 2030s.

Quite honestly, I find the implementation of temporary fiscal spending to fill an economic hole something of a no brainer at the current time; the likely persistence of deficit spending long into the future is cause for concern. It is cause for concern because it is a problem that likely just builds so long as there is no market mechanism to signal a need for meaningful change. The obvious signal would be rising interest rates. But so long as foreign central banks are willing to be the buyers of last resort for US Treasuries, interest rates will remain in check; external policymakers will ensure that the US continues to receive the financial support to keep the dynamic in play.

When will this dynamic be brought to an end? That's still the multi-billion dollar question. Chinese policymakers see the writing on the wall, as they played no small part in sustaining US spending prolificacy:

The dollar declined the most against the euro in a month and dropped versus the yen after China repeated its call for a new global currency.

The Swiss franc declined against the euro and dollar this week as foreign-exchange analysts said the central bank sold its currency three times to support the economy. The greenback fell against most of its major counterparts after the People's Bank of China said yesterday the International Monetary Fund should manage more of members' foreign-exchange reserves.

"The dollar's status as a reserve currency is being questioned," said Benedikt Germanier, a foreign-exchange strategist in Stamford, Connecticut at UBS AG, the second- largest currency trader. "There are reasons to sell the dollar."

This, however, does not appear to be a realistic stab at the bringing about greater balance to the global economy. China wants to sustain large current account surpluses while avoiding any portfolio risk on the offsetting rise in official reserves. Ironically, the US wants the opposite - steady inflow of cheap goods without the risks associated with a large build up of external assets. All players want upside without risk. We are all well versed at this point with the wisdom of pretending that everyone can shed risk. It doesn't disappear in those situations; it becomes concentrated. Think AIG.

In any event, for now Chinese angst appears to be meaningful saber-rattling, as each threat to change behavior is quickly retreated from. Bloomberg this morning:

People's Bank of China Governor Zhou Xiaochuan said the nation won't change its currency reserve policy suddenly, helping the dollar to snap a two-day decline.

"Our foreign-exchange reserve policy is always quite stable," Zhou told reporters at a central bankers' meeting yesterday in Basel, Switzerland. "There are not any sudden changes."

Sudden changes in the Dollar's status as a reserve currency serve no purpose. Best instead to use a pattern of outright threats and changes in patterns in bond purchases to keep American policymakers aware of the ultimate cost of Dollar hegemony. Given that as of yet, there is no realistic alternative to holding Dollars, policymakers globally slavishly heed to past behaviors that have entrenched global imbalances, hoping the problem spontaneously disappears. But instead, it only grows, looming like a dark shadow over the global macroeconomy.

What are the policy options? Short of imposing capital controls, open capital markets implies we can't stop foreign central banks from accumulating US assets. Long needed has been an international agreement that brings sanity to the seemingly insane equilibrium in which poor nations finance the spending of rich nations. Such a voluntary, multilateral withdrawal from the current regime, however, remains little more than a bedtime story.

Domestically, the optimal path is to meaningfully address the long term budget challenge. Does this mean cutting programs and boosting taxes now? No, quite frankly, at this juncture that would be an almost insane policy response, one that would not be appropriate for either the US or our trading partners. In the short run, such as policy response would be needlessly disruptive (indeed, that potential disruption is what keeps foreign central banks in the game of buying US Treasuries). Instead, you need to examine the policy space to find an obvious candidate for controlling the growth of aggregate spending in the US. And that exercise always leads you back to health care, and the realization that we spend an extra $1 trillion more than other industrialized nations, and we don't get much if anything for it. A trillion dollars is a lot of money; more in fact, than the recent pace of foreign central bank Treasury purchases. If you can meaningfully "bend the curve" on health care spending, you can see a light at the end of the tunnel. If you can't or are not willing to bend the curve, I fear waning global patience in sustaining US spending will result in a rude awakening that the tunnel of US fiscal policy ends at a hard wall.


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