Letter to Krugman

In response to this column, another beauty:

Dear Dr. Krugman,

Splendid column as always.

Part of the reason for the failure to consider the “Iceland strategy” is that, despite its evident failures, we still subscribe to the view that “capital” is a quantity or figure possessed by banks, rather than recognizing that our productive capacity, whatever its nominal value in dollars or any other currency, is comprised of knowledge, social infrastructure, and physical infrastructure. In a crisis, the goal of a government should be to balance risks
of short-term disaster against threats to long term health, i.e., against threats to capital at different time horizons. It is possible that these threats are best addressed by saving banks, but this would be only a special case. In particular, this would occur if and only if banks were seen as having crucial knowledge about risk — whom could be trusted and whom could not — that would be lost if banks themselves were allowed to fail.

Clearly that was not the case here. In fact, bank disbandment might actually improve capital in this case insofar as many banks seem to have institutionalized bad decision-making.

Consider a simple trade-off. Spend $40k to allow one college senior to complete a year of school studying finance at a university or spend $40k to induce a banker who neglects what they learned in finance class 20 years ago and imitates industry trends to stay in their job. Not only is the former spent, rather than placed on a balance sheet, giving it a multiplier effect, it would appear to improve productive capital in the nation’s medium term. This student could conceivably replace the banker-counterpart in 5 years.

I am confident that any number of similar analyses would show that bank bailouts are not only unfair, they are capital depleting.

Best Regards,

Drew Margolin


Back after a long hiatus.

Years ago I worked with an individual who alerted me to the difference between what he called “value creating” and “value claiming.”  I think he may have learned these concepts at Harvard Business School, but I am not sure.  Anyway, I think they are very apropos to many of the issues and debates raised by the Occupy Wall Street movement.

Value creation is the creation of knowledge or wealth.  Value creation includes scientific discoveries and technical inventions, but also the creation of new social relationships.  A salesperson can be a value creator when they help a customer and a company build a satisfactory relationship.  A manager can be a value creator when they help their organization function more smoothly.  There is no domain restriction on value creation.

Value claiming is claiming credit for the creation of knowledge or wealth.  Value claiming includes financial compensation — such as wages, salaries, commissions and bonuses — as well as gains in reputation and authority.  A manager can be a value claimer when they convince others that a useful idea was theirs.  There is no domain restriction on value claiming.

In some circumstances, the value that is created is easy to assign or attribute to those that created it.  In baseball, for example, it is relatively easy to assign credit.  Batters that get hits and pitchers that get outs create more value than those that don’t.  So they should be played more.  Better pitchers are used as starters, better batters play every day and hit higher in the order.   To the extent to which winning generates revenue for the team, they should also be paid more.  In other circumstances, it is much more difficult to assign credit.  In football, for example, it is very difficult to tell whether line players or skill players are responsible for a successful play.  Was it the running back or the blockers that created a 12 yard gain?  Is the quarterback good or is he just getting time to throw and make good decisions?  Often in these team oriented sports there is no meaningful answer.  That is, the contributions are based on the interaction of both, not the creation of an individual.  Tom Brady throws good passes because he gets protection from his line, but he gets protection from his line partly because he inspires them and gives them confidence, audibles to plays where they have a better chance of stopping the pass rush etc.

Because value creation cannot always be accurately or precisely attributed, there is an opportunity for value claiming.  In particular, to the extent to which there is a system by which credit is assigned for value creation, but this system is imperfect, individuals can obtain credit by investing their skills and efforts in meeting the criteria for credit assignment rather than in creating value itself.  For example, in football, pass rushers are rewarded for recording sacks.  This encourages them to pursue sacks even when this means giving up other defensive responsibilities.  In particular, the pass rusher is inclined to give up responsibilities that can be compensated for by others, such as other defensive linemen or linebackers.  So the pass rusher gets more sacks, but another player is burdened with extra responsibilities.  This weakens the team.

The classic tension between value creation and value claiming in business is between sales and production.  Salespeople are evaluated on customer acquisition and satisfaction.  Production processes, and the people who work in and manage them, are evaluated on efficiency or yield.  Sales agreements are constructed around fixed prices.  Production processes are targeted toward fixed, or at least reliable, standards of quality.  Salespeople thus have an incentive give their customers superior quality at the fixed price, what we might call “special treatment.”  Production workers have an incentive to create products that are easy to make, even if they are not desirable, forcing the salespeople to “convince” customers that this product is what they really want.  In both cases, an individual can get “credit,” i.e. can successfully claim value, even when they are doing something bad, i.e., destroying rather than creating value.  The salesperson books a sale by promising a product that is more expensive to make but more satisfactory to the customer.  The production person insists that such a product ‘cannot be made,” and that an easier to produce substitute is the only alternative.

There is no formal, a priori system that can solve  this problem.  That is, the problem cannot be solved by creating a system of categories and incentives tied to these categories.  This is because the problem is based on a fundamental information asymmetry: the salesperson knows what the customer wants better than the production person does, and the production person knows what can be made better than the salesperson does.  This information asymmetry cannot be solved.  First, based on talents, interests, and raw processing capacity it is not possible for every individual to know every detail of every part of a business.  Think about the defensive lineman and the linebacker.  How are they going to know what each other “could” or “could not” achieve on a play?  The complexity of the chaos at the line of scrimmage is too great.  Second, since information asymmetry is a key to value claiming, there is no incentive for individuals to be entirely forthright.  If one individual shares all of their information and another does not, the former will be assigned less value and the latter more.  If production people admit that they actually can make the “special product” for the salesperson, but the salesperson hides their customer’s true preferences, the salesperson can say “yes, that is the only thing they will accept,” when in truth, it is the easiest thing to get the customer to accept.

From these points it should be fairly clear that one can specialize in value claiming and, depending on the circumstances, succeed at receiving credit and resources even without creating much or any value.  For example, a pass rusher who learns when and how to shift responsibilities to other players in order to rush the passer has an advantage over one that does not.  With the same set of skills, he will get more sacks.  Of course, coaches and teammates will monitor this.  But their monitoring will not be perfect.  To the extent to which it is imperfect, their gap may be exploitable.  Furthermore, the opinions of coaches and teammates do not always matter for value assignment.  If a player leads the league in sacks but is disliked by teammates and coaches for being “not a team player,” he may still get signed to another team for a big contract.  The key question is not whether the player was in fact ‘shirking” to get those sacks but the standard by which the player is judged by the other potential employers.  For example, the other team may believe that the player’s “bad reputation” is because he is a shirker who pads his own sack numbers at the expense of team success.  But they may also believe that they player’s “bad reputation” is because of his personality.  This suggests a strategy for value claiming players:  if they mouth off to the media or otherwise look like they have problematic personalities, they may be able to enhance their value.   This is because, even though they may lose some credit because they are seen as “difficult,” this “difficulty” validates their statistical record.  Other teams believe that the player “gets a lot of sacks but is a loudmouth,” and rules out the explanation “the player gets sacks at the expense of his teammates.”  If the salary for high sack, problem personality players is greater than for low sack, shirking players, then there is a value claiming incentive for a shirking player to cultivate the image that he has a problematic personality.  This image will then serve as an explanation for the shirking based complaints.

People specialize in these sort of strategies in business all of the time.  The clearest example was the use of the handle “.com” during the 90’s bubble.  Many CEO’s figured out that, for the purposes of valuing their company, it was more worthwhile to invest resources in convincing other people that they were a  dot-com than in producing a product that had value.  The information asymmetry — the fact that investors did not know exactly what constituted a viable dot-com — invited this value claiming exploitation.  That is, the strategies were too easily available and the value that could be claimed too great.  People invested effort and resources in searching for these strategies, found them, and were rewarded for it.

The preceding has been provided to show that, logically, the value that an individual or company has acquired or been assigned is not indicative of the value it has created.  It is indicative of the value it has created plus the value it has learned how to claim.  In biology, we know this problem as the problem of parasitism.  A parasite is a master value-claimer.  For example, a parasite learns how to look like and act like something that is helpful so that it can gain access to the host.  The host admits the parasite and gives it access to its resources because it is indistinguishable from a value creator.  But it is not a value creator, it is a value claimer.  It sucks resources from the host.

It is important to note that the problem is uncertainty, i.e. information asymmetry.  Distinguishing a parasite from a value creating, symbiotic helper is difficult for the host.  That an organism is in the host and drawing resources does not mean it is a parasite.  It might be a vital organ.  Cancer cells and vital cells look the same to the body.  Indiscriminately eliminating those suspected of being parasites if just as dangerous, if not more so, than allowing parasites to flourish.

Nonetheless, it is important to remember that value assignment is not necessarily indicative of value creation.  To get closer to the topic at had: Some rich capitalists are vital job creators; and some rich capitalists are parasites.  The amount of capital or wealth they have accumulated is insufficient information to tell the difference.  Some people made a lot of money by creating products that people need.  Other people made a lot of money by convincing others they wanted products that are easy to create.  Some people made a lot of money by showing people the value of products they did not understand.  Other people made a lot of money by making junk products that were easy to explain and then invested resources in making further understanding confusing, painful, or expensive.

But the fact that wealth is an insufficient discriminator between value creators and value claimers does not mean that there is no way to distinguish between them, or, more properly, that there is no way to set of a system of incentives that increases the ratio of creators to claimers.  This will be the subject of my next post.


Letter to Krugman: Interest Rates

In reference to his column today:

Dear Dr. Krugman,

This may be a naive point of view.  It seems to me that, in the long run, the economy is a function of the knowledge accumulated and distributed within the society.  Growth occurs because new techniques are learned and disseminated.  The economy suffers when bad techniques are learned and dissseminated.

Of course, we don’t know which techniques are good or bad until we’ve experimented with them a bit.  It seems to me that interest rates are a rough marker of our tolerance for experimentation.  When interest rates are high, we trust few new ideas, i.e. we don’t give them very long to prove themselves.  When interest rates are low, we trust many new ideas and give them a lot of leeway.

From this perspective, there is a set of superior (though not necessarily uniquely optimal) interest rates.  These rates match the distribution of ideas currently in the economy by locally maximizing the discriminatory power of lenders.  That is, they minimize the # of false positives (bad ideas that get funded) and false negatives (good ideas that don’t).

Appropriate monetary policy in this perspective would be evaluated in terms of deviation, short term and long term, from these maxima rather than strictly in terms of the risks of inflation/deflation in the consumer sphere.

For example, rates have been low for at least a decade.  This means it’s very likely that the market is flooded with bad ideas, because we’ve been favoring false positives over false negatives.  To correct this imbalance, we need to raise interest rates, not to curb inflation for businesses and consumers, but to re-direct capital to well thought out projects.


Drew Margolin

Accounting Tricks

Here is another example of an accounting trick whereby:

1) Corporations get taxpayer money for no good reason

2) It turns out that health care was already paid for by the government but just funneled through corporations.

Here’s the main point…

To encourage corporations to continue the provision of prescription drugs to retirees under their retiree health plans, rather than dumping the outlay into the lap of the new Part D Medicare program, the [Medicare Modernization Act of 2003] granted corporations a federal subsidy equal to 28 percent of their outlays on prescription drugs for retirees….

Suppose a firm in, say, 2009 spent $1 billion on prescription drugs for retirees and received from the government a $280 million subsidy toward that outlay.

Should the firm be allowed to deduct from its taxable income only its net outlay of $720 million on prescription drugs for retirees (Option A), or should it be allowed to deduct the full $1 billion (Option B)?

The Bush administration and the lawmakers in 2003 chose Option B ($1 billion in our illustration), in effect allowing corporations to deduct from their taxable income an expenditure actually made by the general taxpayer.

Evidently the Obama administration and its allies in Congress disagree with that decision, for included in the recently passed health-reform bill is a provision allowing business firms to deduct only their net outlay on prescription drugs for retirees (Option A above — $720 million in our illustration).

In other words, the taxpayer subsidizes these health care expenditures by more than 28% of the cost.  If the top corporate tax rate is 35%, a company with $1 billion in prescription drug outlays would pay $350 million less in taxes.  If it were only able to deduct $720 milion, its taxes would be $252 million.  So this provision is worth $98 million or 9.8 % (35% of 28%).  In other words, the subsidy is not 28% but in fact 37.8%.

Thus, taxpayers are already paying 38% of prescription drug benefits for retirees with corporate pensions.

It might be argued that the fact that this subsidy is executed via this apparent loophole is inconsequential.  The real question, it might be argued, is whether  28% or 38% is the right level of subsidy.  That is, what matters is the effective degree of subsidy, the net dollars, rather than the means.

This position is wrong for two reasons.  First, this particular means is not neutral in its impact.  In particular, it favors corporations that pay higher tax rates.  If, for example, a corporation only pays a 15% tax rate, the extra subsidy is worth only 4.2% rather than 9.8%.  And how is the tax rate assigned?  Based on the total size of a company’s profits.  Company’s with bigger profits pay a higher rate.  In other words,  this subsidy favors large companies over small companies.  While it is true that, in this case, larger companies are more likely to have qualifying pension plans, the point is still that the means of the subsidy has an impact over and above its level.  If we accept the “only effective rates” matter logic, then we should assume it is used in many other circumstances in which the effects are more significant.

More broadly, this means is problematic because it is overly complex.  As the complaints over the reversal of this policy under the new health care bill show, every time you effect a policy through an extra step or trick, you make the impact of additional changes more far-reaching and thus more objectionable.  More things have to change to get things working the way you intend, which means change is more difficult, which means it is less likely, which means your system is on the path to being outdated and under-performing.  If you want to subsidize 38% of retiree prescription drug benefits, write a check for 38% of the cost.  Don’t mix and match a thousand rules that each contribute .038%.

But of course, finding, mixing and matching thousands of .038% rules is exactly what politicians tend to do.  It’s easier for them because it’s harder for people to figure out that this is what’s really happening.

The Knowledge Power of Lobbyists

Why are lobbyists so powerful?

The conventional wisdom suggests that lobbyists are powerful because of the money they can spend on campaign contributions and advertising.  Wealthy lobbies get their legislative way by coaxing congresspeople with contributions and threatening them with the mass distribution of attack ads.  The underlying rationale is that lobbyists have power because they use their money to sway or manipulate voters.

I propose an alternative, complementary thesis.  In addition to the promise/threat of influencing voters,  lobbyists use their resources to acquire and disseminate knowledge amongst elites.  In particular, I suggest that effective lobbyists deploy their resources to do (at least) the following:

1. Deeply research the potential impacts of policy to construct maximally plausible and persuasive arguments for policies that favor the interests of their clients

2.Embed themselves in networks of conversation that contain sources of knowledge that policy makers, including but not limited to elected officials, trust.

3. Coordinate a strategic dissemination of these arguments, including the rapid, iterative researching of contingent arguments in the face of challenge.

In other words, lobbyists are successful because their money gives them knowledge making power. That is, they have the power to form the beliefs of policy makers.  Equipped with such knowledge making power, they may not even need to coax or threaten elected officials in regard to their specific elections.  In fact, the contributions and advertising strategy is a rather low efficiency use of their resources.  It tends to be expensive and to work only on an issue by issue basis.  Lobbyists would much prefer for things not to get to that stage.  If everyone in Congress believes that, say, cutting taxes stimulates the economy, no expensive ads need to be run or relationships threatened.  The “right” policy will just follow as a matter of course.

From the point of view of the lobbyist, these two strategies are complementary.  But from the point of view of the counter-lobbyist, a champion for the common good rather than the special interest, the implications are distinct and in many cases opposite.

The best way to fight the coaxing and threatening strategy is to counter-coax and counter-threaten — to raise just as much money and spend it in opposition to the lobbyists threats and ads etc.  But if the knowledge strategy is in operation, this counter-strategy will be quite wasteful.  Ordinary people are unlikely to be able to match corporate lobbyists for wealth.  More importantly, this counter-strategy spends the money in the lowest yield manner — issue-by-issue.

If the knowledge strategy is in operation, the best counter-strategy is to develop an alternative knowledge strategy.  Of course,  those in support of the common good are unlikely to have achieve the organizational focus necessary to target inside access to a particular network of policy makers.  But this is not the only tactic by which the knowledge strategy can be executed.  The knowledge strategy can also be executed by promoting a rigorous, well supported, and consistent ideology that has broad scope of application.  Working within such an ideology, the natural conclusions drawn by individuals will be the desired conclusions.  The greater the rigor and consistency, the greater the likelihood that the conclusions promote the intended goals.  The greater the support, the more likely they are to adopt the ideology.  The greater its scope, the greater number of policies for which it can do this work — the greater its yield.

If this analysis is correct, it suggests that progressives ought to be spending more money on research and less money on campaign contributions.

It’s ok, I’m sure Lehman Brothers is the exception

The NYT reports that Lehman used accounting tricks to appear solvent while their bad mortgage holding ate away at their balance sheets.  Specifically, they used repurchase agreements to temporarily move bad loans off their balance sheet just in time for quarterly reports.  After the quarter was over and the numbers on which the report is based are set, Lehman would accept the bad loans back:

Repos, short for repurchase agreements, are a standard practice on Wall Street, representing short-term loans that provide sometimes crucial financing. In them, firms essentially lend assets to other firms in exchange for money for short periods of time, sometimes overnight.

But Lehman used aggressive accounting in its Repo 105 transactions: it appears to have structured transactions such that they sold securities at the end of the quarter, but planned to buy them back again days later. These assets were mostly illiquid real estate holdings, meaning that they were hard to sell in normal transactions.

The effect of the accounting was to artificially and temporarily lower the firm’s debt levels to hit certain targets, making the firm look healthier than it really was.

The revelation of Lehman’s Repo strategy now makes at least 3 firms in the last decade that have experienced sudden collapses following financial chicanery (Lehman, Enron, Tyco).  Is this a coincidence?  No.  It is exactly what theory predicts should happen.

Theory predicts that managers can and will exploit information asymmetries to fool shareholders into allocating more capital to them than they deserve (See work by Oliver Williamson).  But since there are limits to this information exploitation, there comes a point at which it is no longer sustainable.  Mis-allocations are not sustainable in the long run, only the short run. By extension, if the short run price is biased high and the long run price is accurate, corrections will come in the form of steep drops (which are collectively bad for the market).

The underlying logic of this process is fairly simple.  By manipulating their books, these firms  allocate their “bad news” into the future.  They take advantage of the fact that most news is somewhat indeterminate.  Sometimes, news that looks bad is actually meaningless because other factors intervene.  So when they get bad news, such as “our loans are performing poorly,” they invent concepts or categories that neutrtal-ize the news contingent on as yet unknown information.

For example, the loans may be under-performing because they are bad loans, or they may be under-performing because some random factor, such as unusual weather, has biased the defaults to come early.  In other words, these are a regular set of loans, but because of the weather, the bad ones reported default early.  If this is true, these bad ones won’t report default later, so in the end it will be a wash.  So the firm can create a category called “March-June timing losses” and book the loans as performing regularly and book the under-performance as a “timing loss.”  Then they can argue that the “timing losses” average zero over time because they are due to seasonal factors.  The trick works because of the information asymmetry regarding what comprises “timing losses.”  If shareholders knew that timing losses are simply regular loan losses, put in another category and assumed to average zero, the fraud would be obvious.  But by giving the category a separate name, the firm suggests that “timing losses” have an independent history, an independent ontology as it were, and so statements about the performance of this category are subject to an independent debate. So it becomes plausible that “timing losses” average out over time even though it is implausible that bad loan losses average out over time.

Of course, this solves nothing, it only kicks the problem down the road.  The implicit commitment of this strategy is that timing losses will average out (to zero) over time.  But of course, if timing losses are simply allocations of bad loans, that is not going to happen.  So after 12 months of timing loss accumulation, shareholders will again become concerned.  But there is a way around this, too: keep changing the name — don’t call them timing losses every reporting period.  If they’re timing losses in Q1, call them “reprobate contingency” in Q2 and zero out the timing losses.  Claim that reprobate contingency is a general category that you only use rarely.  Then, in Q3, put the same losses back in timing losses.  Voila!  Timing losses oscillate around zero, just like you said they would, and you churn them through a variety of meaningless, but rarely used, categories so they don’t accumulate in any one place.

The key to this logic is that solid inferences require the accumulation of compatible data.  So the firm can obscure bad news by splintering and scattering bad news so that it is difficult for outsiders to re-assemble into a compatible set of information.  It is because of this logic that this trick works in the short term, and it is also because of this logic that this trick is not sustainable in the long term.

In the short term, any given piece of bad news can be splintered and scattered.  But in the long term, the splintered and scattered bad news accumulates.  It accumulates in the places where it is easiest to hide it.  Much like sweeping dust under the rug eventually leads to a rug with a weird, unsettling and obvious hump.  The news, like the dust, has not gone away, it’s just accumulating in a place that is difficult to see.  But every time news is put there, it becomes a bit easier to see.  At some point, the task of splintering and scattering the news such that it cannot be observed with compatible information is greater than the firm can undertake — it involves calculations that are too complex or aligning incentives that are too disparate or costly.  So the bad news accumulates and the shareholders notice.  But when they notice it, they don’t just notice the most recent bad news, they notice all of it.  It is the accumulation of all of it that makes any of it apparent.

I first observed such a process when I was a consultant to Campbell’s Soup in the mid/late nineties (mainly 1997).  Campbell’s knew that what Wall St. cared the most about was top line revenue growth.  Campbell’s was seen as a company with “flat growth” in a market that wasn’t expanding.  To get their share price up, they needed to both promise and deliver on growing sales.  So it was absolutely critical that Campbell’s met its quarterly sales volume targets.  But, sadly, the demand for soup was not growing very much.  So to make their quarter end sales numbers, Campbell’s used to call their customers (major supermarkets and big box stores) and ask them if they wouldn’t mind placing their orders for next month now, right before the end of this quarter.  They called it the “quarter end load,” because what they were doing was “loading up” their customers.

Of course the problem with this is fairly obvious.  If you “load” your customers at the end of this quarter, your sales will dip next quarter (in the first week or so), and so you’ll be playing catch up at the end of next quarter.  But this is, of course, the short term/long term trade-off at the heart of the scheme.  Today, your share price stays strong.  Tomorrow, it is likely to be weaker.  But tomorrow is a ways off (3 months in this case).  Lots of things can happen.  Maybe soup demand will finally take off!  Maybe (the individual salesman thinks) “I won’t be in this job in 3 months.”  Maybe (the CEO thinks) “I won’t be in this job in 3 months.”

And once they started thinking creatively about this, they didn’t need to be confined by a 3 month window.  At some point, somebody had the brilliant idea of using trucks as carriers of phantom orders.  Rather than try to convince Ralph’s to take extra soup before they wanted it, they placed orders for Ralph’s and put them on trucks.  Then, when the next quarter started, they let Ralph’s cancel the orders.  So the trucks just come back.  You just pay a little extra in freight.  Of course, freight costs go up, but that’s ok because freights costs are influenced by all kinds of factors, including energy prices and various complexities having to do with order sizes and what not.  In other words, even if freight costs consistently go up because of quarter end loading, it is going to take a shareholder a really long time to figure this out.

But such charades cannot continue forever.  Eventually, the phantom growth in soup sales is too great for all the trucks and all the stores that might discretely carry excess inventory.  So what to do?  I wasn’t at Campbell’s long enough to see how they handled it, but I know the general corporate strategy.  Find an event that permits you to “credibly” take losses and then write-down all of your bullcrap in one fell swoop.  If all of your dust is accumulating under the rug, you wait until the plumber has to come fix something, then you kick out all the dust and say “that plumber sure brought in a lot of dirt!”  For example, any shock to the market that legitimately reduced soup demand could be used to absorb the accumulated losses.  Rather than demand being down 5% they could claim it was down 15% and write-off all of the accumulated cancellations in one stroke.

This is just one example.  And, as it should be apparent, if these kind of tricks can be played with a product as simple and concrete as soup, one can imagine how it could be done with “financial services” products.

A Healthcare Solution

As I’ve written about in several posts, the current health care system is built on flawed premises.  It mis-applies market principles.  Technically speaking, it assumes that doctors and health insurance companies are “suppliers” and that patients are “demanders” who have an independent preference function.  This is wrong.  In healthcare, patients only demand what the suppliers tell them to demand.  Thus, the system gravitates toward whatever incentives the suppliers have, unchecked by patient “demand.”  The result is:

1. Doctors identify the most lucrative services and organize their practices around delivering those
2. Insurers identify ways to minimize the dollars they pay out.  They try to attract healthy people and dump sick people.

The only thing that holds this process in check, concealing its absurdity, is the fact that doctors have an ethical conscience and the larger scientific community provides some checks and balances on absurd care.  But these balancing factors have limited power.

There is no independent consumer demand, but we do know what consumers want — long term health.  They want to live as long as possible.  Thus, we don’t actually need consumer preferences to set up an incentive system.  A proper incentive system would simply reward suppliers for making people healthy.

This incentive naturally exists in a single-payer system.  By making people healthy when they are young, the single-payer has lower costs when they are old(er).  Another way to do this is to try to use centralized judgments about “best practices” and mandate that insurers follow these (the current Medicare system).  But this system, as we know, is open to gaming and runaway costs.  The current “private system” simply lacks this incentive.  Since people can switch their plans at any time, private insurers are not likely to recoup investments in young, healthy customers in the form of cheaper-to-care-for, longer living older customers.

A system of “health co-op shares” might be able to solve this problem.  The key would be that every insured person would not only have a policy with fees and coverage, their policy would have a “value,” similar to a life insurance policy.  The “value” is an estimate of the cost of caring for the individual in the long run relative to the fees they are likely to pay, based on some standard schedule that includes health metrics (age, weight, cholesterol etc.).

Every person is covered and is the responsibility of some co-op.  The co-op tries to make me healthy.  If I stay in my co-op, the co-op earns a return on my long term health.  Thus, it has an incentive to make me healthy when I am younger.  If, for some reason, I want to leave my co-op, the new co-op I go to has to “buy out” my shares from my old co-op.  The shares would be valued by a standard formula based on my medical history, age, weight etc.  The government, or an independent board, could be the clearinghouse.

The upshot is that my co-op gets a return on its investment for making me healthy regardless of whether I stick with them.  If I stick with them, they get the low costs in the future.  If I switch, they get a payment rewarding their efforts, as they have made me a “high value” client.

There are likely to be important weaknesses to this approach.  I am somewhat wary in the way that it tries to re-apply market principles just because this is what is popular, when a single-payer system is a less convoluted way to achieve a similar result.  That said, a workable co-op system would avoid the major disadvantage of a single-payer or otherwise centrally run system: the only incentive for innovation is in bureaucratic exploitation.  In a co-op system, shareholders could do better if their co-op found a way to make people healthier.